There are more than 800,000 strokes every year. Preventing a stroke requires a holistic approach to health and wellbeing. In this episode, Dr. Bjorn Mercer talks to APU Associate Dean and nurse Dr. Stacey Malinowski about the different types of strokes and the common signs of a stroke. She also shares action to take if you suspect someone is having a stroke as well as ways to prevent a stroke through healthy habits, blood pressure management, and medicine.
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Dr. Bjorn Mercer: Hello. My name is Dr. Bjorn Mercer, and today we’re talking to Dr. Stacey Malinowski, Associate Dean in the School of Health Sciences. Today, we’re talking about stroke awareness and prevention. Welcome, Stacey.
Dr. Stacey Malinowski: Hi, Bjorn, thanks for having me.
[Podcast: How to Improve Your Heart Health]
Dr. Bjorn Mercer: Excellent. This is a great topic and, stroke awareness and prevention, nobody thinks about it until it happens. This leads to the first question is, what exactly is a stroke and who can be affected by it?
Dr. Stacey Malinowski: Well, that’s a great question. I like to equate strokes—some people think of them as brain attacks. So, when you have a heart attack, you have something is blocking, the blood can’t get into your heart, and you have tissue die and then the muscles die. Well, a brain, it’s pretty similar.
So, there’s two different types of strokes. The most common one is something is blocking the flow of blood to your brain so when the blood can’t get there, the oxygen can’t get there, and your tissue starts to die. That’s the most common type.
There’s another type of stroke, too, called a hemorrhagic stroke, where people have a bleed in their brain, something bleeds, and that blood reeks the same havoc on your tissues. So, those are the two different types.
There are about 800,000 strokes that happen every year, and so we really don’t pay enough attention to them. Out of those 800,000, about 150,000 of those are actually fatal strokes, and they can happen to anybody. So, adults, children, you just don’t know, but the good news is that 80% of them are preventable.
Dr. Bjorn Mercer: Now strokes typically are rare, so stroke prevention and really to prevent a stroke it’s quite the holistic effort, isn’t it?
Dr. Stacey Malinowski: Well, it really is. We have to look at the whole picture, of course. When you think about stroke and stroke prevention, we have two levels of risk factors. You have modifiable, the things that we can control, and then we have non-modifiable, the things that we can’t control.
For example, women are actually more likely to have strokes than men and the strokes that women have are more deadly. This is thought to be because of hormones during pregnancy and just different female hormones that men don’t have.
Black adults are 45% more likely than men of other races to die from a stroke. And there’s some people that are born with genetic conditions in their brain that can lead to hemorrhagic strokes.
But then, if you look at the modifiable risk factors, that’s where we really need to focus our attention on, so the things we can change. That’s where your holistic lifestyle comes in, so that’s smoking, excessive alcohol use, drug use, those unhealthy food choices, obesity, sedentary lifestyle. And then other medical conditions, diabetes, high blood pressure, and those types of things, so we need to treat the whole person.
Dr. Bjorn Mercer: That was actually one of the questions, which was how can we prevent ourselves and our loved ones from experiencing a stroke? It really makes me think of what I first said, nobody thinks about it until it happens.
Typically, people will be in their 20s and 30s and their body just works for them, it’s great. Then in their 40s, I’ll say from my own experience, you start feeling stuff. You’re like, “Huh, I actually feel my body.”
Then, after that you really have to be careful. You should be careful your entire life, but things such as smoking or drinking or diet really, really start catching up to you as you get older. If you can lay the foundation for really good habits as early as possible, it not only helps you hopefully potentially prevent strokes but so many other things that happen to you.
Dr. Stacey Malinowski: Absolutely, it’s all cumulative effect over your lifetime. Now, we’re seeing higher rates of high cholesterol in kids. Well, built up over a lifetime, going to lead to strokes. It could lead to heart attacks and a host of other health conditions so, yes, it’s definitely something we need to start thinking about and laying those healthy habits now because unhealthy habits now can lead to diabetes. Diabetes can lead to stroke.
Dr. Bjorn Mercer: There’s so many wonderful medications out there, so if you have this wrong or that wrong we got a pill for you, we got something for you. But at the end of the day, a percentage of what “is wrong” could be fixed by exercise, diet, having a lower stress lifestyle or a lower stress job.
If you have a heart attack, the doctor will say take a vacation. That’s simplistic, but it’s one of those things where, again, going the holistic approach towards health is you really have to think about everything. It’s not to overwhelm people but it’s really, you have to take care of yourself and it’s not just what medications can I get. The medications are needed potentially but they should be the last thing you do because everything else should be really worked on.
Dr. Stacey Malinowski: Yeah, I agree with you 100% and you’re absolutely right. If you have healthy exercise habits, you’re less likely to have high blood pressure, less likely to have diabetes, less likely to be overweight, less likely to have a stroke in the long run. But you make up a good point about medications, so for some diseases where lifestyle changes can’t manage it. Let’s consider a Type I diabetic who is born with it, their bodies just do not produce insulin.
Or if we think about somebody who has a diagnosis of a heart dysrhythmia called atrial fibrillation, their heart doesn’t contract normally, they can throw blood clots that can travel to their brain. There’s nothing they can do to fix that except to take their medications, so being in touch with your physician and taking your medications as they’re directed is also a very important part of the healthy lifestyle.
Dr. Bjorn Mercer: Oh, completely, agreed. I know some people—sounds funny saying that—where they’ve got great diets, vegetarians, exercise all the times and they’re not diabetic but they’re kind of close to being pre-diabetic so their numbers are just not where “they should be.” At that point you’re like, “Well, you’re literally doing everything you can and so you might have to take some medication. At that point, it makes sense because, yeah, consulting with your doctor and with some people, obviously, medication is important and the miracles of medication are quite a miracle these days.
You go back 100 years, 150 years, and there were medicines, but not like they are today and how they’ve really created a medicine for everything, which is both amazing, but those medicines shouldn’t be used as a crutch to living and breathing a healthy lifestyle.
Dr. Stacey Malinowski: Yeah, I agree.
Dr. Bjorn Mercer: The next question is, what are some signs of a stroke that people should be aware of and what should they do if they suspect someone is having a stroke?
Dr. Stacey Malinowski: Very important. There are definitely some common signs of stroke that everyone should be aware of. If you’re speaking with somebody and all of a sudden they seem disoriented or maybe they complain of being dizzy, they lose their balance or they seem uncoordinated, sudden trouble seeing, a sudden severe headache, we’re talking like the worst headache somebody’s ever had in their life. Sudden loss of feeling in their face or in a part of their body or if they’re suddenly, can’t understand them, they’re talking and you can’t understand them.
The key word with all of these is sudden. This is going to be something you notice right away and, hey, something’s not quite right. Maybe you can’t even put your finger on it, but that person that you know, something’s going to be not quite right.
What’s really important when you’re with somebody, if you suspect a stroke, is the faster you can get them treatment, the less negative outcomes they will have because there are medications that can treat a stroke when it’s happening, but they’re time-limited.
If you’re talking to someone and you think they might be having a stroke, you might not think about it but see what time it is because it’s a very important piece of information to give to the emergency responders or to the doctor what time was the last time you knew them to be well. They might be in a window of opportunity where they can get medications to actually break those clots in their brain.
So we use the acronym FAST if you’re wondering if somebody’s having a stroke. The F stands for facial drooping. Their face might look funny. You can ask them to smile and see if their smile looks lopsided.
The A stands for arm weakness. Have them lift their arms up, both of them, and see if one of them tends to droop or will fall back down or they might not be able to lift it at all.
S stands for their speech, difficulty speaking. It might be garbled, it might be just a little slurred or they may not be able to speak at all, depending on the severity.
The T in FAST stands for it’s time to call 911. Note that last time well. Don’t try to transport the person to your hospital themselves because, again, the emergency response team, they can start oxygen. They can do other vital treatments and start transmitting information to the hospital instead of wasting that time to striving in the car.
Another thing that’s important, in addition to noting what time the symptoms start, is if you can gather up that person’s medications to take to the hospital with them because there’s certain medications, if they’re taking them, they might not be eligible for the stroke treatments.
Also, to know their medical history. Share that with the paramedics or the emergency room staff. If they’ve recently had surgery, they might also not be a candidate for certain stroke treatments. The more information we can provide, the better off we are at getting our loved one life-saving treatment.
Dr. Bjorn Mercer: Absolutely wonderful, and I love FAST, that is a really good way to remember it. I really like how, when you’re talking about FAST, you said that you really need to tell the medical professionals your medical history and also the medications. Now, why is that so critical if somebody is having a stroke?
Dr. Stacey Malinowski: Let’s start with medical history. There could be other reasons why somebody becomes confused so it can help them as they’re working through the diagnosis. Perhaps they’re a diabetic and they have low blood sugar. You might see some of the same signs and symptoms so it will help lead the providers in the right direction of where they should start looking.
I refer to that there are certain medications that somebody can take if they are having a stroke, if they catch it at the right time. These medications are very, very powerful blood thinners and clot busters so if they’ve just had a recent major surgery, you don’t want to give somebody clot busters because their body has formed natural clots at the surgery site.
Medications are also important. If somebody’s already taking a bunch of blood thinners, they may not be a candidate to receive additional blood thinners or they may. Having those pill bottles so the providers can actually see what they’re taking is very, very important.
Dr. Bjorn Mercer: A risk that people can go to, is that if they do have surgery anybody could be at risk of a stroke, correct?
Dr. Stacey Malinowski: Well, when we have surgery it can definitely put us at an increased risk for developing blood clots in our larger veins, and absolutely, if those break free, those can travel to your brain and create a stroke.
Dr. Bjorn Mercer: Right. Then, if they are on blood thinners, that is a heightened risk with surgery.
Dr. Stacey Malinowski: Yes, absolutely, because you’re worried about patients bleeding too much. If they’re on a blood thinner and we know they’re on a blood thinner, let’s say they’re a patient with atrial fibrillation and let’s say it’s your father and you give them, “Well, here is my dad’s medications, he has something wrong with his heart, I don’t know what it’s called.” They’ll be able to look and be like, “Hmm, okay. He’s on this blood thinner, this heart medication, it’s probably atrial fibrillation.” It’ll help guide them in the right direction.
Or, they may say, “Hmm, this patient has been taking a lot of blood thinners, let’s worry about a hemorrhagic stroke versus a regular stroke.” Because if your patient is on blood thinners, if they fall and hit their head they can also develop a brain bleed from that as well.
Dr. Bjorn Mercer: That totally makes sense. It reminds me of a previous podcast where when you go to the doctor you need to take careful notes. For someone like me, I’m not a medical professional so it’s very hard for me to remember stuff.
And so, if you have a loved one who is, say, older or is on a blood thinner or anything like that, really write it down, so in case something happens you’re not just relying upon your memory. I’ll just say, as a non-medical professional myself, that memory does not always work.
Dr. Stacey Malinowski: Yes, I agree. I was going to say, especially if somebody who’s on multiple medications, keeping a current medication list and keeping that on your person. Keep it in your wallet or in your purse, so if you’re out and about and something does happen where maybe you don’t have all of your bottles of pills with you, but you have that list. If something should happen, you still can provide that information.
Dr. Bjorn Mercer: Especially with those who have elderly parents who typically are on some medications, it seems to be that’s the way, you might have to be a little intrusive and say, “Hey mom, hey dad, what are you on so I know?” Then, write it down because if you are going to help them you need to know how to help them.
Dr. Stacey Malinowski: Absolutely. What’s really great about healthcare organizations now that we’re moving to everything is electronic health records. A lot of healthcare organizations, especially if you’ve been there before, they can pull up what your medications are. But if you haven’t been to the doctor in two years to update it, then the information’s only as good as the last time you updated it with your healthcare provider.
Dr. Bjorn Mercer: Exactly, and even there, I think of my own self because I went to the doctor recently for the first time since COVID for a general check-up. In that time, for myself, I had COVID twice so that’s something that they would write down. We don’t know how that might affect us in the future and the various inflammation that does come with COVID. Any final words about stroke and National Stroke Awareness Month?
Dr. Stacey Malinowski: Just to really be aware. Remember the FAST acronym because the key with stroke is early recognition of the symptoms. I would say if there’s any one thing that you can do, as far as modifiable risk factors to prevent stroke, the single most important thing you do is keep your blood pressure under control. That’s your walking, your low-sodium diet, stress relief, following up with your physician to make sure that your blood pressure is in normal range. But the studies have shown that that is the single most important thing you can do to prevent a stroke, blood pressure management.
Dr. Bjorn Mercer: Can you state the FAST acronym one more time?
Dr. Stacey Malinowski: Sure. FAST stands for faces, making sure the face is not drooping. A stands for arm weakness, have them lift their arms up and see if one droops down. S stands for speech difficulty of any type, and T means it’s time to call 911.
Dr. Bjorn Mercer: Thank you for a great podcast about the need to really be careful with our own health. We’ve all got one life and try to make the best of it and hopefully it’ll be a long life.
Today, we’re speaking with Dr. Stacey Malinowski about stroke awareness and prevention. Of course, my name is Dr. Bjorn Mercer, and thank you for listening.