Episode 7-Dr William Taylor

Transcript

0:00

Welcome to Pulse Check, Wisconsin.

Chris : 0:24

What's up. What's up. What's up. How's everybody doing? Hope you all are doing well. I hope you are. Receiving this in good health. My name is Chris Ford. I'm an ER doctor here in Milwaukee, Wisconsin. And I want to thank you for now. Our seventh episode of Pulse Check Wisconsin. I want to thank you guys for joining us today, as well as in our previous episodes. Feel free to go back to check out any of our episodes up until this point we've had. Multiple experts come on from the Community Medical Services talking about opioid abuse. And. Resources in the community. We've had our former healthcare commissioner here in Milwaukee. Had the governor of course come out and talk to us. We recently did an episode in honor of Sade Robinson, With some of our Sane nurse expert colleagues so feel free to go back to those episodes and check all of those out. Today is going to be no different. We have a great guest with us to discuss another topic that is prudent to your health here. In Wisconsin, as well as in the city of Milwaukee. So would that being said no further ado let's get started with our case.

1:49

Patient is a 45 year old female who was presenting as a level two trauma after falling down the stairs. Report is that the patient was at home and fell down a number of stairs. The patient arrives with family members that state that technically, there are around 12 steps at the patient's home. The patient reports that she doesn't know if she lost consciousness She states that currently she has neck and back pain as well as headache. The patient baseline is not taking any anticoagulant medications. No history of any other medical conditions with the exception of high blood pressure. No history of any bleeding or clotting disorder examination of the patient from head to toe reveals that she has a hematoma or a large bruise. Over the forehead, the patient has. some tenderness to palpation along the cervical spine, which is the top of the spine. She has no significant tenderness to the chest wall or to the abdomen. The patient has no signs of deformity of the upper lower extremities. The patient has no significant bruising noted throughout, with the exception of the forehead. As such, The patient was taken to CT scan. We ended up getting what's called a non contrast CT scan, which is a picture of the brain. There's no signs of any bleeding identified. The patient also had a CT scan of the cervical spine, which was performed as well. The patient does not have any signs of any broken bones to the cervical spine at this time. The patient had a collar in place, which is what we'll typically do when a patient has tenderness to palpation over the bones of the cervical spine. As such, she was able to have her cervical spine cleared after she had a negative CT of the cervical spine. And so we removed this rigid collar from her neck. Patient has some labs performed as well. During trauma, we usually will perform some labs just to make sure there's no signs of any bleeding or any clotting disorders. Also to make sure there's no signs of any anemia caused by bleed or blood loss. All of her labs were negative as well. I had a discussion with the patient about her results. I informed her that she essentially bit a bullet and did not have any signs of any long lasting trauma. The patient was relieved as is typical, I asked our nursing staff if they could ambulate the patient or walk the patient to ensure that she's able to do so at home and get around at home safely as it was a busy day. We had additional traumas that were coming in other patients to be seen. And so I asked the nurse to report back to me if there were any complications. After about 15 to 20 minutes of seeing other patients, the nurse comes to me and tells me that unfortunately the patient is unable to walk. Thinking along the lines of a trauma still, I asked if she was having any pain to the hips or any pain to the lower back. Also, if she had any pain to the extremities, which before did not show any signs of any deformity or any trauma, the nurse reported that when the patient attempted to get up, she felt as though she was increasingly dizzy. The patient Reported that she had felt nauseated right before this attempt. And actually had an episode of emesis or episode of vomiting when she attempted to get up. I went back to see the patient as our clinical exam had changed a bit. The patient states that she still feels dizzy. We gave her some nausea medication. I do a reassessment of the patient at this time. And the patient is able to provide a little bit more history. She's able to remember that before. This fall down the steps, she remembered feeling very dizzy. She stated that it felt as though the room was spinning and that no matter which way she looked, she had worsening dizziness. Given this additional information, I did an expanded neurological exam for the patient. As mentioned before, our nursing staff noted that the patient could not get up out of the bed. However, I did a finger to nose examination of the patient where you have the patient place one finger on the nose. and extend their hand until they are able to touch your finger, which is right in front of them.

Chris : 7:08

This test. Assesses. Cerebellar function or the portion of your brain that allows you to keep your balance.

7:18

Unfortunately, this patient was unable to perform this activity as well. In fact, the patient states that it's hard to keep her eyes open at this time, given the amount of dizziness that she's experiencing the decision was made to take the patient back to the CT scanner. The patient had what's called a CT angiogram performed, which is a test that we perform to look for any signs of stroke patient did not have any significant signs of stroke at this time. As such, we proceeded with additional imaging after this initial imaging modality was negative. The patient had an MRI that was performed. The MRI was, in fact, abnormal for this patient. In fact, the patient had what we found out was the eventual diagnosis, which was a posterior stroke. So this case was an interesting case in that it was two different presentations wrapped up in one. It's not atypical that we see this in emergency medicine, and it's probably one of the things in emergency medicine that I love the most in that if something isn't fitting, or if you feel like you need a little bit more information, the patients are still in the emergency department at any point in time, you can go back a rapid assessment of the patient in the moment, as is typical in the cases of trauma, usually, especially trauma centers in which this case occurred, there is a very precise way that we go about trauma assessment in order to avoid missing any injuries system that we utilize is called ATLS. Which stands for advanced trauma life support. And in this, we use guidelines that are standardized throughout the country again, in order to prevent missing any injury modalities as well as to standardize our care so that if you go and receive a trauma assessment in Maine, your trauma assessment will be the same as it is here in Wisconsin. So, in this patient's case, she received a full trauma assessment from head to toe. We do what's called a primary assessment. That will determine if there's any abnormalities in your breathing or in your circulation or in your airway, all those things that we call the ABCs of medicine. So, initially, we start out with the ABCs, which is included in that primary assessment, and we look out for. Any injury modalities to the airway to your breathing to make sure the lungs are functioning adequately as well as to make sure there's no deficits in circulation. After that assessment. We'll take a look at your overall picture to ensure that there's no signs of any trauma that we need to address before. We do any additional workup or any additional imaging in this case. And because of that, because we were focused in on the trauma, which in this case was warranted, a lot of times what will happen is something won't fit in the patient's general picture that places you back at square one when you ruled out any significant injuries or any significant deficits. In this patient's case, she had a very insidious presentation of a stroke, which is one of the more difficult stroke processes to rule out. The reason being is these types of strokes or posterior circulation ischemic stroke, the reason why that is so difficult to pick up is because it doesn't present as your typical stroke that we call a large vessel occlusion stroke, meaning that one arm or one leg is flaccid or is weak, or in some cases, such as speech deficits or deficits in terms of getting the speech out or having your sentences make sense. All those things are generally picked up on in those larger typical strokes that we see. However, in these cases of posterior infarcts, a lot of times, the only deficit that is picked up is that feeling of dizziness or that feeling of unsteadiness when the patient goes to stand up. In this case, the nurse really was the hero of the patient's case, which is typically how it goes as the nurses have a lot more face time with the patients. than physicians. In this case, the patient did not manifest her symptoms until she went to stand up. Because of that, to this day, I usually will attempt to ambulate or attempt to walk a patient as this was a huge teaching point for myself as well as some other residents that I was working with at the time. Posterior strokes differ not only in the presentation, but more so the treatment It's difficult, to identify on a CT scan. A lot of times you have to do an MRI in order to pick this up, as it's a little bit better at picking up the posterior circulation or the blood flow to the back of the brain. In many parts of the country, unfortunately, these posterior strokes are hard to treat, and a lot of it has to do with the lack of technology in some parts of the country. That allows neuro interventionalists to go in and to retrieve this clot that is causing the symptoms or the deficits to the circulation of the posterior portion of the brain. However, in the state of Wisconsin. We're very fortunate to have multiple neuro interventionalists that are able to go in through a vessel. in lets say your forearm or your groin in order to go after these posterior circulatory infarcts. And because of that, we're very fortunate and very grateful for the work that is able to be. Performed here in the state in this patient's case. They were able to do this intervention and were able to retrieve a relatively large clot in the posterior portion of the brain. Following this procedure, the patient had a great outcome. She was able to ambulate. She no longer had that nausea and that ataxia, meaning kind of falling all over yourself. She was on, she was not experiencing any of that. It was able to return to a pre-stroke quality of life following. Usually in these cases, the patients will have follow up and will also have medications that they'll be placed on to avoid future strokes. In this patient's case, she was admitted to the hospital. Of course, after the stroke, an additional workup was done to determine if she had any dysrhythmias, meaning rhythms of the heart that could predispose her to a stroke over time, such as atrial fibrillation. She was able to have an echo or an ultrasound of the heart performed to determine if there are any valvular abnormalities or any anatomical abnormalities of the heart. And eventually the patient was placed on antiplatelet medications such as aspirin and plavix over time to again, prevent a risk for stroke in the future. With that being said. I wanted to introduce our next expert that we've invited out to interview today. His name is Dr. Will Taylor. Dr. Will Taylor is. a neuro hospitalist here in Milwaukee, Wisconsin. He is a tremendous colleague to work with. I can't say enough great things about him at any point in time. Whenever I have a stroke case or a neurological case, Will is always available to talk it over with you to come down and assess the patient and neurologist like himself, as well as neurologists such as Dr Borders and also Dr. George Morris here in Milwaukee are an invaluable portion of our interdisciplinary team. So with that being said, I'm very excited to introduce Dr. Will Taylor. I think we're going to get a lot of good advice from him and hope you enjoy.

Chris : 16:25

All right, well, thanks again for our listeners. I apologize. I got the kindergarten crudd I'm getting over right now. So apologies for my voice, but we're very excited to have our guest with us here today who is a colleague of mine, Dr. Will Taylor, before we get into it. Will can you give us your current title and what your role is?

Will: 16:46

Yeah, I'm Will Taylor. I'm a neurologist. I'm technically a neurohospitalist, which is an inpatient neurologist. I'm also the medical director of the neurosciences service line for Ascension Wisconsin.

Chris : 17:01

Awesome, my friend. Thank you so much. And so just to jump right into it. So today's case, We covered a rather insidious presentation in terms of the patient who had a posterior infarct, meaning that, you know, it's not your typical you know, BFAST stroke that you'll see. Can you explain what a typical presentation is and what folks should be looking out for to, when to seek care?

Will: 17:23

Yeah, that's a great question, Chris. So typically what you're going to look for is, um, the, the, the term we use in education is called FAST face, arm, and neck. And speech and then time. So typically you'll see facial droop, uh, you'll, you'll see some, some arm or leg weakness and speech changes. And that just tells you time, time to get to the hospital as soon as possible.

Chris : 17:51

Yeah. And so if someone is experiencing these symptoms or their family members are experiencing these symptoms would you recommend they call 9 1 1?

Will: 18:01

Yeah. Time is brain is the term that, that we talk about all the time in medicine and stroke. Every, uh, every minute that goes by during a stroke, it's estimated that around 2 million neurons die. So it's a priority to call 911, get your yourself, your loved one, your anyone around you into the hospital as soon as possible to get treatment.

Chris : 18:26

Yeah, and just kind of jumping off of that. So speaking of the treatment, so let's say the patient does call 911. They come to the hospital. Typically, that'll be going through the emergency department with those stroke symptoms. What typically will a patient experience and what typically will they see during that workup and during sort of that treatment course?

Will: 18:46

Well, at a comprehensive stroke center like ours at Columbia, St. Mary's, Milwaukee, The there's protocol set up so that as soon as the patient hits a triage or even before the patient comes in we have set up to where we call it a pre arrival stroke alert if a patient is called a stroke alert in the field and Because of safety studies and protocols we found that the fastest way to get treatment is take the patient directly from the the, uh, EMT teased to directly to the scanner, uh, and there they'll get some initial imaging to look to see if if a patient is having a stroke can we see any signs of it on initial CT scanning, uh, whether that be an ischemic or hemorrhagic stroke. And then we have a protocol where we add in images to look for clots and changes in blood flow.

Chris : 19:39

Yeah. Okay. And just to specify those clots that you're talking about, that differs from the typical blood clot that people are thinking about in the lungs or in the legs and things like that. Um, and that kind of gets into what a stroke is in general. And so can you talk about what that clot does and what that clot could potentially have lasting effects on the patient?

Will: 20:00

Yeah, that's, that's a, it's a difficult question to answer, but it's also a very good question, but part of it, that's why I think that's part of the reason why treatment and stroke has been so difficult and identifying the right patients for treatment has been difficult since we've started with these quote unquote acute therapies or therapies that we can give to, to change the, uh, the, the, the possible disability and recovery and stroke, um, back in the in the nineties we, and that was, it's a clot busting drug and so but kind of backtrack. I'm sorry, back to your question about the stroke, but, uh, the, the clot, it depends on the location. So certain blood vessels are sort of earlier on in the brain tissue. And those clots can come from You know, maybe another part of the blood vessel that can flick off and travel to the brain or areas of the heart And they can travel up and they clog one of those major Highways or blood vessels if you will you'll have dramatic changes in the patient. Those are typically the patients you see with really dramatic speech changes and weakness Or even unconsciousness and dizziness, but then it can be even as small as one of those tinier arteries closing off over time from changes that occur because of uncontrolled risk factors or, or toxins that we, we induce into the body that close off those small arteries that cause very minor symptoms. And so those those, those, those changes show up typically as like maybe some minor sensation changes or a tingling in the body and things like that.

Chris : 21:33

Yeah. And, you know, to, to, to kind of allude to what you were saying too. I was watching an episode. This was probably one of the reasons why I got into emergency medicine is because my mom and I used to watch ER full disclosure. And so I was watching one of the episodes, one of the early episodes, it's like 1991 first season. And in it, Dr Green was one of the main characters had a stroke patient that had just that, that, that large vessel occlusion. One side of the body completely flaccid. And at the time he was recommending to do this experimental therapy, right? This T. P. A. That you know, the chief was completely opposed to and said, this is experimental. Get out of here. You can't do this. And he did it. And the patient had this recovery. We have a lot more science behind it now. Can you explain kind of what those acute therapies are that T. P. A. TNK as well as alteplase.

Will: 22:24

Yeah. Oh man. O.G remember, some days back, uh, that that show is awesome. Yeah, I remember it did start in the 90s. Uh, and that's when we started to get acute therapies or treatments that could treat stroke in ways before we, we never had been able to before, before that, you know we, we admit patients to the hospital and it was all about, you know, rehab and, and trying to figure out what caused it, but sort of being very powerless. Then we started to get these quote unquote clot buster drugs, TPA thrombolytics. Alteplase was, was the big one in stroke that was used as a mainstay for gosh, until, until recently at most centers. So we can only give that in the first, four and a half hours, three to four and a half hours of symptom onset or a last known, well, last seen. Well, so that's why it like as you alluded to earlier on, it's so important to get patients to the hospital. Recently in the last decade, we've started to expand our treatments, not just the clot busting drug, but we've been able to reintroduce or we've been able to introduce clot retrieval. And so that, uh, Has come about if you, if you have are familiar with, with medicine at all, and you've seen kind of a similar pattern between cardiology and neurology, but cardiology was able to make changes and identify the right patients for intervention far earlier than we were in neurology. And so you know, I'd say around 2010, sometime around then there started to be some, some new clot retrieving or stent retrieving devices. The technology improvement occurred enough to help us. And then we started to develop algorithms and imaging that allows us to identify the right patients And, and in certain software that, that says, okay, this is the area that's getting less blood flow. So we see clot, then we see sort of what we call a number on a core infarctive at risk versus damaged tissue. And that mismatch we were able to look at that in the trials and see these are the appropriate patients for clot retrieval. So that can be done up to 24 hours, but only in certain patients. It can be done longer than that, but, but just in general, we look at it in the first 24 hours, at least in our sites. So those, those two treatments have been sort of the mainstay now recently artificial intelligence has sort of creeped in, especially with some of the imaging techniques with the software we use and identifying the right patients. So it's a very cool time to be in stroke treatment in the acute treatment world, but, but, uh, an exciting time for patients. I'd say,

Chris : 24:50

yeah, and a lot of times to well, you know, we work together personally, we will go in and we'll talk to patients who are experiencing stroke like symptoms with some considerable disability associated. And so, you know, some of those will fall in that pocket of patients who have the ability to have that therapy. We have that conversation with family members too, about the risks and benefits discussed. about, you know, using some of these medications and using some of these modalities specifically kind of with the clot busting medications. Are there any significant risk associated with it? And, you know, how, how frequently are we seeing those those risks?

Will: 25:30

Yeah, it's unfortunately these treatments aren't without risks, especially the clot clot busting drugs. So we have to be really careful about who we choose. It's about a 3 to 5 percent risk of side effects like bleeding, including bleeding in the brain that can be devastating. And so we have to weigh those risks versus benefits. And there's certain patients we don't give it the medication to some patients who have very low disability from their stroke. So, or, or, or even a mimic, we suggest it's something other than a stroke. We try to avoid giving that medication. And even the thrombectomy or the clot retrieval also has risks as well. Uh, that can cause tears in the artery that cause even worse symptoms and worse disability. So, so unfortunately you're not really safe in the acute world, but, but at least there are treatments that can give you the chance of the highest level of chance of recovery.

Chris : 26:24

Exactly. And, you know, like you said, a lot of this, too, is kind of weighing the risk and benefits and a lot of, you know, just for context for folks who aren't medical, as we said before, when it was first introduced in the early 90s, you know, this is almost 30 years plus of data and studies, trials that have been utilized in order to see what would be the risk benefit associated with patients and what patients fall into a bucket of patients are going to be a higher risk. And so this isn't anything kind of knee jerk. This isn't anything experimental. Uh, this is potentially you know debilitation saving therapy for some patients that we will definitely have discussions with the family as well as the patient to to decide, you know, if they want to take that risk. And and if they want to also take the chance of benefiting from those therapies. So one of the reasons for starting the show as we talked about a little bit on the onset is to kind of highlight some of the health care disparities that affect people disproportionately. There was a recent article that looked at all that data that we talked about before, you know, kind of these studies have been going on for years now, but particularly during the pandemic. There was a study that came out by the CDC that was a stroke mortality assessment that outlined increased mortality on African American populations as compared to Caucasian cohorts in terms of stroke. What are some of the factors that you believe are associated with, with, this glaring data that we have from that study?

Will: 27:50

That's a great question. So I think there's really some key pieces to that, you know, race and ethnicity, as you've alluded to, are key parts of that socioeconomic status, geography, uh, gender, uh, education, awareness, and even ties into that insurance status. So kind of looking at a patient's race and race and ethnicity, African Americans and Hispanic Americans have a higher incidence of stroke compared to white Americans. Um, African Americans in particular suffer higher mortality rates and worse outcomes after a stroke. Stroke severity tends to be more severe in current earlier stages in African Americans and Hispanics. And these groups are also unfortunately more likely to have recurrent stroke. And within the socioeconomics factor, you have access to care. So individuals from lower socioeconomic backgrounds often have less access to health care services, which can delay diagnosis and treatment of stroke. Uh, they have within that socioeconomic status, they have less preventive care. So economic hardships limit access to preventative care and management of risk factors such as hypertension, diabetes, uh, and dyslipidemia. And then you look at education awareness. Unfortunately, stroke signs, um, there's educational disparities that affect the awareness of stroke symptoms. We've seen it and you've seen it here, you know, within our center. Where unfortunately people don't recognize the stroke symptoms. They, they tell a family member to take a nap and maybe it'll go away. Um, so that lower awareness can lead to delays in seeking emergent care, which is crucial

Chris : 29:18

yeah, and you know, like you said, a lot of this too, throughout the pandemic for additional context, we not only saw it in stroke, but we saw it in presentations for, um, MIs or heart attacks, right? So folks are coming in days after the fact, you know, they had that initial pain response. And a lot of that, like you said, is due to, A, people didn't want to go to the emergency department because that's where all the sick COVID patients were. And then B, also, you know, it's some of those, um, pre existing confounders that play a role in your overall health. So things like diabetes hypertension, access to care access to your medications and primary care too. So all those things, you know, kind of play a role in the whole picture of of your health your community health as well.

Will: 30:03

And the other thing that breaks my heart on the inpatient side that you may not see as much as insurance status. You know, that, that impacts treatment and recovery. Patients without health insurance or with inadequate coverage, they, may not get optimal care for stroke risk factors on the outpatient side, but also on the acute side, when they have delays and getting discharged to a rehab center, because they don't have approval. And as we know in medicine, early rehab is one of the best things for stroke recovery.

Chris : 30:33

Yeah. How, you know, and that gets to another point too. There was another article, I believe it was in NBC news where they talked about kind of that disparity that you're speaking of too, not only the initial stroke, but the aftercare. How much, you know, let's say if someone is not a candidate or is outside the window for you know tech to place or all to place and you know, they, they have these deficits that are now, the new normal, unfortunately, how important is that post stroke care that, that rehabilitation in terms of gaining or regaining some functioning and the quality of life and going forward.

Will: 31:08

Yeah, absolutely critical. Absolutely critical. They have to have good access to early rehab. That's kind of the key to to improvement and recovery. If you don't get that early rehab, there's delay and then there can be more side effects. And so getting good comprehensive care from, you know, preventing clots in your legs to physical therapy, occupational therapy, speech, speech therapy. Getting really good follow up, uh, and speech therapies to make sure you're not aspirating. All these are key parts of not just recovery from stroke, but prevention of, of some of the side effects that unfortunately occur because of the stroke. Yeah.

Chris : 31:44

In our practice here in Milwaukee, do you see kind of a similar disproportionate stroke presentations to the E. R. As well as kind of a post recovery. Do you see it in mass as is kind of alluded to in these studies?

Will: 32:00

I see it is an interesting area and and Columbia ST Mary's Milwaukee because you have this Change. You have this big shift between a very wealthy area on the east side and then the west, uh, a real change in socioeconomic status education, awareness insurance and coverage and race and race and ethnicity. I see Very much similar presentations, but there's a lot more. I'd say patients who who suffer from that disparity of care who are coming in later. Their, their, their strokes tend to be much younger than, than uh, the, the high income folks. I feel like I, in these patients, I'm seeing a lot more uncontrolled risk factors. I'm seeing a lot more, you know, uncontrolled diabetes, hypertension, dyslipidemia, and unfortunately also drug use. Some of the medications like cocaine can can cause strokes if used repeatedly over time. Yeah.

Chris : 32:54

And you know, that kind of brings us to our next point to how do those things play a role? So like blood pressure, for instance, diabetes and other chronic illnesses, how does that contribute to your risk over time? And does it exponentially put you in a cohort of patients that is going to be at higher risk with stroke?

Will: 33:11

Yeah, the education. This is such an important question because talking about these and talking about them until I'm blue in the face is something I like doing because as an inpatient as a neurohospitalist and you, Dr. Ford, we see the patient when the disease is already hit.

Chris : 33:29

Right.

Will: 33:30

And, you know, so much of it, I would love to be able to change before they get to us, because that's really when when the magic happens, if you will. So, uh, control blood pressure. They, they, uh, every time I talk to patients, I always talk about blood pressure. It's, it's high blood pressure is the leading cause of stroke. Regular monitoring and effective management of it through diet, exercise and medications can significantly reduce your stroke risk. Thank you. Cholesterol. So diet and medication high cholesterol can can lead up to fatty deposits in your arteries, increasing your stroke risk managing diabetes. So controlling your, your blood sugar keeping diabetes under control is crucial as high sugar damages the blood vessels over time, making clots more likely. So regular monitoring and treatment is essential. Maintaining a healthy weight. This kind of ties back into diet exercise, cholesterol, hypertension. So the, the, the, the, the diet I talk about with my patients is the Mediterranean diet. That, that's really critical. It's one of the diets that can, can reduce your risk of heart attack and stroke. But just being overweight contributes to other stroke risk factors such as high blood pressure and diabetes. So maintaining a healthy weight is important. Increasing physical activity. Regular physical activity can tie into those other risk factors. Quitting smoking is extremely important. Limiting your alcohol intake, especially in a city like Milwaukee. And then just treating atrial fibrillation, some heart rhythm management managing sleep apnea, things like that, and just getting regular medical checkups. So I, I talked to all my patients about establishing a relationship with a primary care physician that alone, I think, can, can mitigate a lot of these because then you'll tie back in and they'll talk about blood pressure and all the other key issues and preventing stroke.

Chris : 35:13

Yep. You know, I think exactly you hit the nail on the head, right? So, like I said, we see a lot of times that initial presentation where the stroke process is complete, you have you know, the extremists of the presentation or the disease process, but it's that old adage, right? That ounce of prevention. And so it can't express more and more how important it is to establish primary care to get those regular checkups. Because having a primary doctor really will tie you into all those things as Dr. Taylor alluded to, you know, kind of having, having that compliance with your medication, especially if you have disease processes, such as atrial fibrillation, being on anticoagulants, making sure that your heart rate is controlled, you know, those things, I believe it was Kareem Abdul Jabbar recently did a PSA on about atrial fibrillation. And he talked about, you know, how it increases your risk, you know, up to 15 fold for having things like stroke if it's uncontrolled. And so I think kind of driving that home for folks is something that can, can really be key because, you know, a lot of times atrial fibrillation can be, you know, kind of under the surface and you're not feeling it and you're just kind of hanging out and everything is fine until it's not.

Will: 36:24

Absolutely. Absolutely. Yeah. Atrial fibrillation is one of those conditions that it's really critical to get in plugged in with a cardiologist or an electrophysiologist because you get heart remodeling from that heart failure stroke another critical condition. Yeah.

Chris : 36:42

Yeah. And it kind of brings it back to the other point to, you know, as you said, to be with that glaring disparity. here in the city of Milwaukee, you kind of have a tale of two cities. So we, we got a lot of work to do on our end in terms of trying to even that plan field for, you know, the access to primary care, as well as the ability for folks to get to their primary doctors and also afford their medication and having insurance that will cover these, you know, it's all this we got alot of work to do.

Will: 37:11

It's, it's one of those, you know, Milwaukee, like many urban areas has significant health disparities that I feel like are just this complex interplay of all these factors racial and ethnic disparities access to health care, socioeconomic disparities, food deserts, you know, um, air quality and then COVID 19. You talked about that earlier. It just, I, I, I think we also just highlighted and intensified existing health disparities in Milwaukee. Yeah, it's really unfortunate.

Chris : 37:41

Yeah, I gave a lecture at the beginning of the pandemic to MPS and a lot of parents had the, you know, like, how is COVID causing this? How it's like COVID didn't cause all these problems. It's just highlighting it. It's putting it, you know, on the podium for everyone to see. And like you said, it's unfortunate and some folks are still experiencing both physical as well as mental. Effects from COVID as well as, you know, some of the glaring disparities that have been exacerbated because of it. So We're going to keep pressing on though. We're going to keep, you know efforts like this to kind of get the message out and see if we can, we can get the folks in power to, to make a move. So, one of the things I wanted to touch on was the difference between what, what folks commonly call a mini stroke. What is the difference between that mini stroke and sort of that fulminant stroke, the stroke when you're having that large vessel occlusion, one side of your body numb, unable to speak, et cetera. How do those two differ and are they related at all?

Will: 38:44

Yes, that is an excellent question. Uh, so when people talk about a mini stroke, they're typically talking about a transient ischemic attack or maybe just even just a minor stroke. So it's important. They all tie into each other. I think that's definitely critical in that once you have a stroke, your highest risk of another stroke is within the first couple of weeks from that stroke. That's another reason why, even if you had a mini stroke, he's still got to get treatment. And get the right medications. So let's just break down a couple of terms. So transient ischemic attack. What that means is that the patient has had symptoms, but less than 24 hours and there's no evidence of damage on on neuroimaging and the neuroimaging I'm talking about is, is, is MRI. So there's no so basically a patient will have some very brief, Beach changes or brief vision loss or brief you know weakness in their body and that'll go away completely, complete resolution. It's still extremely important to treat those. Like I said, because once you have a TIA transient ischemic attack, or even ischemic stroke, a full stroke, your highest risk of recurrent stroke is within those first couple of weeks. So then you've got your TIA or transiting ischemic attack. Then the more severe version of that is sort of maybe a mini stroke. And that can be sort of a very small stroke within the brain that occurs. It's in a small territory, uh, that affects just very isolated symptoms. Maybe just simply. Your facial weakness. And then all the way to you know larger stroke, those can be things that were, it blocks one of those major arteries as we talked about earlier on that controls a vast amount of brain territory. And the, those strokes can be absolutely debilitating. And even there's a danger of death with those, unfortunately. So those can. And cause patients to unfortunately require 24 hour care, feeding tube, things like that.

Chris : 40:39

So even like, just to highlight, even though a lot of folks said, Oh, it's just a mini stroke. I had this, I can't tell you how many patients I've seen that said, I had a history of mini stroke. That's about it. It wasn't a full stroke. These, these things are really still pretty significant. It's not anything you should dismiss.

Will: 40:55

Oh, exactly. No, absolutely not. Well, and the thing that I think is important to highlight too, with these, you know, quote unquote, mini strokes. Is that by the time you're at that point, you've, your body has sustained a significant amount of damage from, from time, you know, hypertension remodeling of those tiny arteries or maybe you just threw, you had atrial fibrillation, you threw a clot, but it broke up. Well, you, you still got to seek treatment. You can't just ignore that. Um, and if you do, unfortunately, it could be disastrous the next, next time it

Chris : 41:25

occurs. Yeah. Yeah. So definitely take it seriously. Definitely make sure that if you don't feel right, we're always here for you. Dr. Taylor and I'll be happy to see our colleagues as well, but definitely come on in. Well, Dr. Taylor, I want to thank you again for your time here. You know, just to kind of wrap it up. Are there any, you know, tips, tricks, any, anything that you want to leave our listeners with to help reduce their risk for stroke, if they're experiencing strokes, anything you want them to know?

Will: 41:55

Absolutely. I, you know, I do want to talk again about high blood pressure and how important it is to find a primary care position that you trust. Somebody you connect with. So getting that blood pressure controlled, get your blood pressure measured. Blood pressure ties into everything. It increases high blood pressure, increases your risk of dementia. Even slight increases in your blood pressure increase your risk of heart attack and stroke, peripheral vascular disease, like I said, dementia. Um, take care of yourself. I think that's also the other part for me. I've noticed within within the world we live in COVID 19 income disparities, things like that, you really have to focus on taking care of yourself, um, you know, no matter what position you're in, if you can because no one else will and it allows you to take her. So control your blood pressure, find a primary care physician and take care of yourself.

Chris : 42:51

Absolutely. And, you know, even if you don't have insurance, there's a number of free clinics throughout the city of Milwaukee. I know MLK has some of our family medicine clinic through Ascension, Wisconsin also has one. There was a program I'll give, uh, G a quick shout out here. There was a program back when my wife and I were in medical school. We started a blood pressure. barbershop project that eventually evolved at Juice Clippers now. So Juice Clippers is off of Dr. Martin Luther King Jr. Avenue. There's an entire free clinic in the back of Juice Clippers. So as Dr. Taylor said, the first part is controlling your blood pressure, knowing where your numbers are. If you don't know, you can, you can go to these clinics and you can find out that's the first step to protecting yourself as well as making sure that you're, you're, you're preventing some of these. Bad outcomes down the road. Awesome. Well, Dr. Taylor, I want to thank you so much again. I'm sure I'll see you around the hospital pretty soon. So thanks again for coming out and I hope your day goes well.

Will: 43:50

Absolutely. Absolute pleasure. I think what you're doing is extremely important. Education is extremely important. I feel like it's good for the soul, especially as people who provide emergent care to get the education out there to prevent people from coming up to us. We want to reduce our business.

Chris : 44:05

Yeah, the goal is to be out of business. Yes, sir. All right, my friend. Thank you very much. Have a good one.

44:19

So that's it. So I want to thank Dr. Taylor for joining us today and giving us some really good information about stroke, stroke prevention, as well as what to do and what to expect when you're at the emergency department is very important. If you're demonstrating any signs of stroke, or if you have any concerns about a family member to proceed directly to an emergency department, or call 9 1 1, feel free to look at any of the information provided with this. episode on the show notes regarding strokes, as well as the importance of establishing primary care and how that prevents you from manifesting strokes in the long run. Again, I want to thank everyone for listening. As always, I truly appreciate everything that you're doing. You all have provided thus far please continue to give us feedback. Please continue to reach out. If you have any questions about this episode or any other episodes, we always are interested in your show ideas. Feel free to let us know, as always take care of yourselves, take care of each other. And if you need me, come and see me.