Recognizing and Treating a Stroke with Dr. Martin Radvany

Timely response is critical when someone has a stroke, which occurs when blood flow to the brain is stopped or interrupted. Every second that the brain does not receive blood flow kills 2 million brain cells. In this episode of Inside Scope, host Dr. Daniel Haight talks with interventional radiologist Dr. Martin Radvany about the importance of seeking medical attention quickly when you suspect someone is having a stroke. Dr. Radvany shares information about risk factors of stroke, how to recognize the signs, and the treatments available for stroke patients. 

Transcript

SPEAKER_02 0:02

Hello and welcome to the Inside Scope, a podcast from Lakeland Regional Health, where we share insights from experts providing award-winning care right here in our community. I'm Dr. Daniel Hay, Vice President of Community Health at LRH. And also I have the privilege of hosting this podcast. On this episode, we are discussing two numbers: the number two million, and what can happen over the time span of one second. With me today to discuss these startling numbers is Dr. Martin Rodani. Before we get to those staggering numbers, tell us a little bit about yourself.

SPEAKER_00 0:43

Well, thank you for having me on today.

SPEAKER_02 1:01

Excellent. Because we were talking about the damage stroke does, and quite startling, the brain is made up of microscopic cells that do our thinking, but they need blood supply. Tell me about those numbers. Two million in just a second.

SPEAKER_00 1:19

What is that referring to? That's how many brain cells die in a second when blood is not reaching the brain.

SPEAKER_02 1:26

And when blood doesn't reach the brain, that's basically the definition of a stroke. If you can't get blood to the brain, the brain starts to die. And two million at a time, that's just massive. I also think of our audience listening that how do they recognize a loved one, a coworker who might be having a stroke, and and what's what should they do?

SPEAKER_00 1:50

So as far as recognizing a stroke, the mnemonic BFAST is what has been kind of popularized as an easy way of remembering strokes. So B-E. B E F-A-S T F-A S T. So B for balance. Okay.

SPEAKER_02 2:04

Because you need you need a brain operating properly to be balanced.

SPEAKER_00 2:07

Trevor Burrus, Jr.: E for eyesight. Patient starts losing vision in one eye. Trevor Burrus, Jr.

SPEAKER_02 2:12

Okay. So if your family member says, I'm not seeing things very well on the right side or the left side, that's the same thing.

SPEAKER_00 2:19

Yeah, and so the the classic like a shade coming down, amerosis.

SPEAKER_02 2:24

Oh, coming down from the top.

SPEAKER_00 2:25

Yeah. Everything gets gray. Yeah. And then it may or may not get better on its own. And sometimes it does get better. And then we have the fast part of it, F-A-S-T. So facial droop. It stays crooked. And then the A is for arm weakness. So you ask a patient to raise their arm and they either can't move it or it's weak. They raise it up and it starts drifting down. And then finally, S for speech. Are they slurring their words? Or they can't even get the words out.

SPEAKER_02 3:00

Can't find the right word. Or they're talking sort of a salad of mixture. Yeah, just it doesn't make sense. It doesn't make sense.

SPEAKER_00 3:07

And then finally, T is for time. Time is. Time is of the essence. And that's one of the big things is calling 911. And a lot of patients don't want to do that. The family doesn't, for some reason, they don't. They feel there's for some reason. And the problem with that is that when patients come to the hospital and they're let's say they drive their family member to the hospital, they think they're saving time. Well, not really, because when EMS comes to get them, just like with a heart attack, the hospital knows a stroke or the heart attack is coming. And they can be prepared to receive the patient. Whereas stroke patients, when they show up at the hospital, they're not an extremist. They don't look you know, a heart attack patient is sweating, they look terrible. Yeah, clutching their chest. Yeah, the stroke patients just kind of just sitting there.

SPEAKER_02 3:53

And our Polk County EMS is really that savior at that at the beginning. You call 911, you get EMS, you think you think you're having a family member or yourself is having a stroke. EMS being on the scene is so much better than you just trying to drive to the hospital. When EMS gets there, they understand what a stroke is. Go back to that part about the the B fast, the FA, the face drooping, the arm drooping. Is that one arm? Why is it always one side and not both sides of the face or both arms?

SPEAKER_00 4:30

Typically it is one side of the body, and it's because the right side of the brain controls the left side of the body and the left side of the brain controls the right side of the body.

SPEAKER_02 4:37

So typically a stroke hits one side of the brain or the other side of the brain, not always, but usually. So if it hits one side of the brain, only one side of the body will have the facial droop, the arm, legs weak. And then I guess certain parts of our brain control our speech. So that's the S part, the speech. And then balance, you know, our brain is so important with balance and all that. Then that EMS gets there. So they're they know BFAST very well, they know the symptoms. What are some things that that EMS does that gets the hospital ready? Because Lakeland Regional is a nationally recognized stroke center. And you know, here we are providing the highest level of services, but it really starts with EMS. So what what are they doing?

SPEAKER_00 5:19

Well, they are really there are some stroke mimics potentially in patients with diabetes. It looks like a stroke.

SPEAKER_02 5:26

Bell's palsy is a person who told me today they they have weakness on one side of the face, but none of the other symptoms but weakness of the face, you got to think stroke, but it's Bell's palsy, which is a totally separate disease. Okay. Correct.

SPEAKER_00 5:38

And then patients with altered mental status, if they're diabetics, they can have a low blood sugar. Yeah. It may be something that you know can be.

SPEAKER_02 5:46

And they can't move because a stroke that's bad enough, you can't get the person to try to move, so you can't really tell if they're weak and it's a stroke, but it could be one of a hundred other things like low blood sugar, many other causes. Okay. So EMS gets there and they can check, check, check all these different things and realize this could be potentially a stroke.

SPEAKER_00 6:05

And the more important piece of it is they can alert the hospital. You know, that some that they're brain-cerning a patient who is a possible stroke patient. So they can the hospital is ready to receive this patient and expedite their care.

SPEAKER_02 6:18

Trevor Burrus, Jr.: And that ties right into every second two million brain cells are dying. I wouldn't want to be driving myself or a loved one knowing that every second parts of the brain are dying. It's the same with a heart heart attack, is the same thing. Part of the heart is dying. All right. So they're they're alerting the hospital because every second matters. Where are we trying to shave off the time? What is this time savings driving towards?

SPEAKER_00 6:40

We're trying to save time at every step of the every step of the way. In my world, time is brain.

SPEAKER_02 6:46

Time is brain.

SPEAKER_00 6:47

We try and you know decrease the amount of time from the onset of symptoms until the patient comes to the hospital and gets evaluated. When they get to the hospital, they they'll be screened initially, and then if they think it's a stroke, they're going to very quickly get a CT scan of the brain.

SPEAKER_02 7:04

So an x-ray of the brain, yeah.

SPEAKER_00 7:05

To determine, is there a stroke? Is there a large is there an occlusion of the vessel that can be opened up mechanically? Do we need to go in there and pull it out and pull the clot out? Or is it something that can be treated with a medication through an IV? Trevor Burrus, Jr.

SPEAKER_02 7:19

You know, stroke is such an emergency, but I think of the person at home and the family just notices that they're quieter than usual, or they're not talking as much, or they're a little bit off balance, literally that could be a stroke. And you had a phrase for that. This is a what kind of an emergency? It's a painless emergency. A painless emergency. And you could almost see why the time is you're losing time and function and brain.

SPEAKER_00 7:45

Trevor Burrus, Jr.: And the problem is even when a person sometimes recognizes it, well, you know, I I sat weird, my arm feels funny, it'll get better.

SPEAKER_02 7:53

Trevor Burrus, Jr.: yeah, the denial the part of it. Or it will it will get better on its own. I and I think there is the fear, is I I think folks in general, yes, folks are afraid of dying, but I think many folks also see what I'm afraid of having a stroke and being permanently paralyzed and disabled. And it's this fear of, well, I can't have a stroke if nobody tells me. That's a unfortunate way of thinking, but it's please get to the hospital. Call 911.

SPEAKER_00 8:21

Trevor Burrus, Jr. And that's where it's also important for the family to be able to see this. Because when you in general, if you have a stroke, it's on the left side of your brain. Most people, that's where they have the ability to speak and understand. So they may not be able to tell anybody something's happening.

SPEAKER_02 8:37

Right. And if they're and then we're not always moving both arms, and if somebody just sees one arm moving, they may not realize the other one can't be moved, and the balance may not be occurring if you're not standing up.

SPEAKER_00 8:49

And also because of the and the other thing that can happen if it's a right-sided stroke, because of the way our brains work, patients just don't notice.

SPEAKER_02 8:57

Yeah. Trevor Burrus, Jr.: That part of our brain is what makes us care. And if it's been damaged by a stroke, we may show apathy on that side of the brain. Trevor Burrus, they don't even realize. And the other part was when the family recognizes that their loved one could be possibly having a stroke, there's one thing they should never ever do with a stroke. And you were telling me earlier, what should not be done that that you gotta be careful with.

SPEAKER_00 9:21

Trevor Burrus, Jr. One of the things that people think about in emergencies is aspirin. So we know that with a heart attack, aspirin is potentially good. It can help decrease the heart. Unfortunately, with a stroke, we don't know if it's because the blood vessel is blocked or because there was bleeding into the brain. And so you wouldn't want to give aspirin.

SPEAKER_02 9:42

See, that's not what happens in a heart attack. It's just blockage. But in the brain, it could be different things, and the treatment is very different. So never give aspirin if you think someone's having a stroke. Correct. Never give aspirin if a stroke is possible. Oh my goodness. And I think that kind of recognition, and when you think of the family, is also the awareness that we really want everyone to have a good primary care doctor. They know the risk factors, because if your person is doing fairly well, but you have some of the risk factors for stroke, and then some of these things happen, hopefully the family is thinking, My loved one has risk factors for stroke. What what are some of the risk factors we want to say, you know, they're not 100% going to cause a stroke. Well But people who get strokes tend to have these.

SPEAKER_00 10:33

Trevor Burrus, Jr.: They are the silent things that are often picked up with health screening hypertension.

SPEAKER_02 10:39

Which you may have high blood pressure and you don't know it. You don't even know. But you need to have your blood pressure checked.

SPEAKER_00 10:44

Because that is a risk factor. Uncontrolled diabetes is terrible. It it beats up the blood vessels. And so patients come in and they don't know they're diabetic. Or they don't realize how much having that uncontrolled diabetes, how much it actually increases their risk of not just stroke, but other things, other medical conditions.

SPEAKER_02 11:03

Trevor Burrus, Jr.: You know, when we we want to have an episode where we talk about sleep apnea, because sleep apnea leads into high blood pressure getting worse. And here, yeah, everyone knows their family member snores or they stop breathing or they have risk factors for sleep apnea, but they haven't gotten that addressed. No. And their blood pressure is worse. And that is is stroke just for uh older people? Can a stroke occur in a younger person?

SPEAKER_00 11:26

A stroke can occur in a younger person. Um as a matter of fact, Dr. Amin, who was supposed to be joining us today, is actually treating a teenager right now. He was, as I was leaving the hospital to come here and visit with you, he was starting a case on a teenager.

SPEAKER_02 11:40

And you can imagine, you know, why it's so important that Lakeland Regional have this national certification that we are recognized, that we can provide the highest level of service. And so when you think of that, it's it's not just for a particular population of high blood pressure with diabetes. It's it could be someone that might have other risk factors. For a young person to get a stroke, what might be going on that would have increased that chance?

SPEAKER_00 12:04

And this is again generically, we'd we're not- we're not talking about a specific patient, it's just generally sometimes younger patients um can have hypercoagulable states.

SPEAKER_02 12:14

Aaron Powell So the blood clots easier and strokes are caused often by blood clots in the blood swell.

SPEAKER_00 12:20

And they may have a, as an example, they may develop a clot in a leg. Yeah. And about 20% of us are walking around with essentially a hole in our heart. Yeah.

SPEAKER_02 12:29

And so I remember a long time. It's right after birth, right? And but it sometimes it stays open and folks do have a hole. Is that always repaired, or is it people don't know they have it?

SPEAKER_00 12:46

Or typically people don't know they have it until it's diagnosed from some other study, where they're doing where they do the ultrasound of the heart, an echocardiogram, and then they're not sure.

SPEAKER_02 12:55

They see the hole in the heart. Or something, this silent emergency. Yeah. Where they have a stroke. Yeah, and they have a stroke because a blood clot in the leg typically would just go to the lung, but here it actually gets to the other side of the heart, goes up to the brain. Wow. Um and and I think also there are there are other risk factors for that. But so stroke could occur at any time. What now EMS has has it's wonderfully done their job to safely and rapidly not only gotten the patient to a stroke center like Lakeland Regional, but has communicated, given the heads up, the team, which is wonderful at Lakeland Regional, they're ready. And the first steps, CAT scan of the brain to make sure there's not hemorrhaging in the blind brain. Right. Then there's the understanding who this patient is, what are the risk factors, what else is happening right in that early moments?

SPEAKER_00 13:44

The patient, the EMS team on the transport, they're stabilizing the patient, make sure they're stable if the patient's breathing problems too. Right. They may need to be intubated in the field to put on a breathing machine, yeah. Yep, to get them to the hospital safely. Then once they get to the hospital, it's really determining what kind of stroke they're having. Are they having a stroke from a blood cot that's blocking blood from getting to the brain? Or did they have a bleed into the brain that's you know what's called the hemorrhagic stroke, which those are much less common? Trevor Burrus, Jr.

SPEAKER_02 14:13

Less common, but scarier. Uh you know, to be bleeding in the brain brain because there's nowhere for the blood to go. And it's that's is that often painful, that kind of stroke? That's the rare kind of stroke.

SPEAKER_00 14:23

Those strokes tend to be more painful. There's bleeding around the brain typically is the described as the worst headache of a patient's life. Yeah. And patients who have a history of migraines, I've had the I've treated patients who have had a history of migraines and also a ruptured brain aneurysm. And basically the headache from the brain aneurysm rupturing made the migraine look like a piece of cake.

SPEAKER_02 14:45

Oh goodness. And and then it's associated with weakness like the BFAST. Their balance is off, their speech is off, their face is paralyzed on one side.

SPEAKER_00 14:54

They can have exactly the same symptoms as well.

SPEAKER_02 14:56

With the pain, so I would we worry a lot about that, and time is of the essence. Treatment's totally different. The team is involving, and this goes into your role and some of the other team members' role. Who's sort of descending upon and to help this patient during this time of discovery? What is actually going on?

SPEAKER_00 15:13

In the emergency department, the emergency physicians are stabilizing the patient if they if they need anything.

SPEAKER_02 15:18

Blood pressure to stabilize. You just want to get into the right blood pressure.

SPEAKER_00 15:26

And typically for either kind of stroke, you want to correct the pressure because we don't want it to be too high either way. Aaron Ross Powell, Jr. Too high or too low. And then after that, it's really as they go move through the rest of the evaluation, getting the imaging studies over in CT, and then then alerting the appropriate teams. If the depending on what kind of stroke the patient is having, sometimes uh we need to get our neurosurgical colleagues involved.

SPEAKER_02 15:50

Yeah, for bleeding, especially. So neurosurgeon is available. Okay.

SPEAKER_00 15:54

Yeah, we have that as as a comprehensive stroke center. Lakeland has neurosurgical uh availability 24-7.

SPEAKER_02 16:02

Perfect. And now the part about, and this sort of gets into what's changed over the last 10 years, because I remember giving lectures about everybody knows what chest pain could be. And if you grab your chest and it's going down your left arm, we called it a heart attack. And a number of years ago, we were trying to say the BFAST symptoms, that's a brain attack. Same process as what do you do for a heart attack? Call 911. Now there are some differences, but I think that's like it's a it's a brain attack. Let's get you to the hospital. And now, if it's clots, what are those new advantages we've had over the last 10 years that have really changed how we deal with stroke?

SPEAKER_00 16:41

So, really back in 2015 is when stroke care changed. Not that long ago. No, very, very recently, actually. And that year there were five trials published from international sites all around the world who were conducting these studies. And we realized that we now had a way of treating patients. Prior to that, we treated patients. You know, some of them got the IV medication, but we had, if it worked, it worked.

SPEAKER_02 17:07

We had really So the IV medication tries to dissolve the blood clot.

SPEAKER_00 17:12

Right.

SPEAKER_02 17:12

Which there are good blood clots in the body. Like if you had ulcers in your stomach, dissolving blood clots leads to a stomach hemorrhage, and that's that's bad. Uh but the blood clot to be in the brain, there was a medicine they used to give. It used to dissolve it.

SPEAKER_00 17:26

Right.

SPEAKER_02 17:26

So there was a medicine that given through the vein at the hospital, dissolved the blood clot, and the blood flow went back to the brain for the right kind of patient. It might help.

SPEAKER_00 17:36

If the clot was small enough. Small enough and recent enough. And recent enough, exactly. And so then there are those clots that are either too big or they're they are what we call mature clots, and so the medication doesn't dissolve them.

SPEAKER_02 17:49

It won't dissolve them. The blockage will still maintain. It will still be there.

SPEAKER_00 17:52

And so we have various devices that have been developed that allow us to literally go up there and pull the clot out of the blood.

SPEAKER_02 17:59

So you go through a blood vessel at a distance, which is the leg or you start in the leg or the wrist. Leg or the wrist, and then you go in a blood vessel.

SPEAKER_00 18:07

Under x-ray guidance, we advance the tube over a wall.

SPEAKER_02 18:10

And you can see it under X-ray safely going from the arm or the leg up to the brain.

SPEAKER_00 18:16

We have a neat technique that we call road mapping, which is so what it does, it allows us to do is we inject the X-ray dye, and then we literally on the computer screen we can see the map of the blood vessel.

SPEAKER_02 18:27

Yeah, the blood vessel goes everywhere. To the right one.

SPEAKER_00 18:31

Yeah. We have a little wire with an A and we just guide our catheter right there where it needs to go.

SPEAKER_02 18:35

Yeah. Now does this work for if the blood clot came from the heart? Because sometimes we have blood clots in the heart and they break off and they go up to the brain in multiple areas. That's where you could be weak on both sides. But if you have it in multiple areas, are you trying to remove the worst ones?

SPEAKER_00 18:53

We try to remove the ones what we call a large vessel occlusion. So the vessels, if you think of the blood vessels going up to the brain or any part of the body, it's like a tree. You have this main stalk and then the branches get smaller and smaller than the bigger.

SPEAKER_02 19:05

Right and left, and there's yeah.

SPEAKER_00 19:06

So those big trunks, if we can get those open and restore blood flow to the R.

SPEAKER_02 19:15

Yeah. And and now what if you've waited too long? I I think that's a little harder concept, is if the blockage has been there too long. Like the person went to bed, okay, but then eight hours later they didn't they weren't themselves. You don't know when the stroke occurred. It could have been and the CT scan might show that it was m actually, unfortunately, many hours ago. And they didn't get to the hospital soon enough.

SPEAKER_00 19:38

Well, and that's where we start that's where we start having what we call advanced imaging on the radiology side. So we are able to actually do us do part of that evaluation that patients have is we do a certain kind of CAT scan where we infuse the X-ray dye, and we can see how big the actual what we call the core infarct, the part of the brain that's dead, and we're not going to be able to do it.

SPEAKER_02 20:02

The most damaged part, they have it has not had blood flow too long. And that's not going to recover.

SPEAKER_00 20:07

But there's an area around it called the penumbra. And that is potentially salvageable. And so what we look at on this study called the CT perfusion study is what is the difference between that area that we is the core in part.

SPEAKER_02 20:21

The dead part that's not going to get better.

SPEAKER_00 20:23

Is there anything left around it that we can salvage?

SPEAKER_02 20:26

Yeah.

SPEAKER_00 20:27

And so on patients with salvage by getting blood flow back to Right, by opening the vessel back up. And so we bring patients in, that's what we call, we used to call a wake-up stroke. Patient went to bed okay, they woke up in the morning, they weren't okay. Trevor Burrus, Jr.

SPEAKER_02 20:40

So you don't know if it happened ten minutes after going to bed, and then eight hours later, things have already died, and and but you've got this area around that's just irritated from not getting enough blood flow. Correct. Wow. And so you try to re-establish flow to those areas. Trevor Burrus, Jr.

SPEAKER_00 20:54

And we can do that. Um it's been shown that we can do that out to about 24 hours. So every patient's different.

SPEAKER_02 21:02

Yeah. I I've had folks that show up three days later. They said, well, the woke up and they were balanced as bad and they were having trouble speaking, and then Uncle John Doe uh three days later, he's just not eating well. So we brought him in now. Yeah. Three days later. Unfortunately, three days there's usually not much we can do. Yeah, and now it's more try to rehabilitation, but that is what we used to see with strokes 20, 30 years ago. Right. So now it's getting in every minute counts, but even up the 24 hours, but every second. Every s every second. Yep. Um and we think of why folks delay, but that's where the family comes in. I I think sometimes um with heart attack, there's a sense of ominous bad. And most heart attack folks like this is so bad, I'm coming in. Stroke is it's it's affecting your thinking process. Is that where you find something that's gotta have a big role? Is that if you're having a stroke, your judgment of making good decisions and now you got the family. maybe able to make a really good decision. How do you it's a it's a delicate, hey, we got to call 911. Yeah.

SPEAKER_00 22:07

Well it's even I mean I've even taken care of patients who a grandmother was watching her grandchild and he was knew the signs. It was, I think it was on the magnet on the door of the refrigerator. And he was like something's not right with grandma. And he actually called 911. And they came and yeah she was having a stroke and we were able to take everything.

SPEAKER_02 22:26

But her but is recognizing it for that's what I think that's what you and your team are doing is raising awareness so that folks connect with their primary care doctors, know they have risk factors that are silent, but then know the worst case scenarios that this could be a stroke. And it is relieving to think it's a stroke and then you get evaluated and it turns out it's not a stroke. It's something else, but it's real. We've got to take care of that. I also wanted to bring up this issue of mini strokes. I mean uh folks say that all the time and I what I find out is like actually they didn't have a mini stroke. They had an actual stroke. They're better but they're they're not a hundred percent better. That that's sort of the definition that's changed over the years. Tell me a little bit about these transient attacks, these short-term attacks that go away.

SPEAKER_00 23:12

Trevor Burrus Well they they they do possi they may possibly go away.

SPEAKER_02 23:16

So let's let's rewind here so transient ischemic attack what is TIA transient ischemic attack ischemic means not getting a blood flow transient it came and went and it's it's an attack I love there is that attack word again. So TIA people is that a bad term to call it a mini stroke?

SPEAKER_00 23:31

Trevor Burrus Well I I yeah I think it it's not a bad term but I think it kind of belittles it to a point where people like oh yeah I just had a mini stroke. Well yeah a mini stroke is not little in the classic definition we used to say that if it got better it was a TIA. Now with better imaging MRI specifically we can see these small strokes.

SPEAKER_02 23:50

So some you see the damage that was done they just may not feel it. Exactly that's not a TIA or a mini that is they had a they had a stroke they they just don't see the side effects of it or they've adapted and the important part there is that is a huge red flag.

SPEAKER_00 24:06

Yeah. That is you need to figure out why this happened why it happened so it doesn't happen again. Yeah what can we do or worse, it becomes a stroke.

SPEAKER_02 24:16

Trevor Burrus Yeah huge stroke. And and and it's like what can we do about it? So these TIAs do they have a different cause the same cause? Is it the same process?

SPEAKER_00 24:24

It's the same general process that we were talking about and the same risk factors.

SPEAKER_02 24:28

Trevor Burrus High blood pressure, out of control or just diabetes diabetes, hypercholesterolemia that's not you know high cholesterol levels.

SPEAKER_00 24:36

And these are all things that we with regular visits to physicians and appropriate medications we can prevent.

SPEAKER_02 24:44

Trevor Burrus I think a lot of folks and and and this is private information that you may not share with the family but the reason you're taking that blood pressure medicine is so you don't have a stroke. It's so you don't damage your kidneys, so you don't hurt your eyes. And often it's like my blood pressure is not a problem but the doctor's telling me I have to do this. I like to have that conversation. It's like well no you don't have to do it but you are doing it because you understand you don't want to damage your kidney, damage your brain.

SPEAKER_00 25:08

And I think that's the really the important part. When I have patients I see patients in clinic I sit down and spend a lot of time my job there is to educate them on what's going on, why we're doing the things we're doing. Why is it important to me? And why are the ri what are the risks of not doing this? I mean everybody has free will you can do you know you can take the medicine or not. I'm just telling you here's the risk of not doing it.

SPEAKER_02 25:32

Yeah and I think it's important that you and your team are getting at what's most important to you as the patient. And when they talk about I want to make it to my kids graduation or wedding you know not treating that silent high blood pressure could lead to a not so silent stroke you know that that uh could interfere with what you want. So I think what you're doing is you're really getting what matters most to the patient and the family in that. But that's that's a key um so getting these um these changes these mini strokes getting them addressed looking at well what caused it because it could be a different cause in one person compared to another. Yes absolutely we had a program here that's that's in our library that you could see on the inside scope and it was discussing atrial fibrillation which is when the heart is not beating nice and regular it's actually quivering and the blood in the heart you know we were telling our audience the blood in the heart can form clots inside the heart and those clots can leave the heart and go up to the brain. Tell me about atrial fibrillation and a bit of the stroke is is that where you're you're also able to go in and try to remove those clots?

SPEAKER_00 26:40

So we're able to remove the clots that go to the brain. The clots that are in the heart we we don't tend to chase those. Yeah.

SPEAKER_02 26:46

But the heart doctors are giving blood thinners and things like that. Yeah.

SPEAKER_00 26:51

Trevor Burrus They they will definitely that's one of the many causes and as we see the population getting older we are seeing more and more people developing atrial fibrillation which is a huge risk factor for stroke.

SPEAKER_02 27:04

Trevor Burrus Yes and I know with atrial fibrillation if you're given a blood thinner and you continue with other problems that you mentioned already like high blood pressure could that lead to the rare kind of stroke a a hemorrhaging or a bleeding in the It could.

SPEAKER_00 27:18

And if you're on a blood thinner and the vessel ruptures now the bleeding is even more harder to control.

SPEAKER_02 27:25

Trevor Burrus Yeah so that's a good thing to know because a well-informed patient or a family member or a health advocate for a patient could ask these questions and go through with that. Tell me a little bit more about your team after uh after the patient comes in, you see the blockages you're in this particular kind of stroke you're able to remove with devices these blockages restablish for what happens next after that?

SPEAKER_00 27:48

Well after the uh blockage is removed then the patients will go to the ICU and the ICU team that's a great team. They're a great team they're essential to for what we do and then they will work on getting the patient basically stabilizing the patient afterwards and monitoring that blood pressure you were telling me about it's got to be the blood pressure's got to be not too high, not too low. Monitoring the blood pressure after the procedure and then looking for the other medical conditions that may have caused this. So consulting the cardiologist, looking at the heart, looking at the rest of the vessels to see if we can determine why this stroke even happened because we don't want it to happen again.

SPEAKER_02 28:27

Trevor Burrus Yeah and and controlling the blood sugar and other things that happen. But so the intensive care and then a little bit about the role of rec how how do you see the recovery going?

SPEAKER_00 28:36

Well and then after that probably one of the more important not one of the many important things we've learned over time is the patients get evaluated by physical therapy, occupational therapy and speech therapy because that is the beginning of the recovery. And what we've learned is we used to just put patients off to the side and give them let them rest a little bit before we start working with them. And what we've discovered is that's absolutely the worst thing we could have done.

SPEAKER_02 28:59

Well yeah I I used to tell them that you needed to get that physical terrorist, I mean therapist, in there to say get up, let's go right away.

SPEAKER_00 29:06

And what I and what I tell my patients their families is after a stroke, they need to hit it hard with the with the physical therapy and the recovery. Because the most progress is going to be made during the first three to six months of getting patients back to their baseline.

SPEAKER_02 29:19

Trevor Burrus And there was it's not that sort of rest in in bed. If if if given permission by the team, physical therapy comes in, gets the person started and when they're not there, what can the family do you know in the evening hours or whatever that's safe that the nurse and the doctor and the therapist have said it's okay.

SPEAKER_00 29:39

Trevor Burrus Well I think really it's typically the physical therapy occupational therapy may give certain exercises that the family members can then do with their family member so they can keep doing the therapy at home when they've left the hospital or the or rehab.

SPEAKER_02 29:54

And I wanted to mention that I I can understand physical therapy because you might have been weak you know in the arm or the leg. Speech therapy it might be the facial but it's also the you said parts of the brain generate the words. So speech therapy but speech therapy does some they do the speech well they do the swallowing tests as well because a stroke can affect the ability to swallow which can lead to pneumonia if you things go down the wrong way. Exactly. Trevor Burrus So speech therapy and physical therapy I always want to mention occupational therapy because you know I want to make sure that that's a to me a broader term than what it sounds like. So what are some examples of occupational therapy?

SPEAKER_00 30:31

Trevor Burrus It's being able to really do the things in life that the patient wants to do it's a whether it's your job or it's your hobbies.

SPEAKER_02 30:40

Trevor Burrus Your hobby and so want to get back to do. And I love that part about physical therapy gets the parts of the body working it's the occupational therapy to say well how do you do this with your grandkids and getting into a car and and I think that's where the Banish Institute which is our rehabilitation do you see many patients that that sort of follow that path it's EMS, hospital trauma center with the the stroke center, then the procedures, intensive care, physical therapy then tell me about the Banish Institute you have patients that end up I've had I have had some patients there and I actually went up to see Banish uh when I got here because I wanted to I had heard about the Institute and I heard very good things about it.

SPEAKER_00 31:22

And so I went to see a couple of my patients who were up there afterwards to see what they were actually doing.

SPEAKER_02 31:27

Because it's in the hospital to have that. It's very unique to have it right there in the hospital.

SPEAKER_00 31:31

And I was very pleasantly surprised to see how much they had right there in the hospital. Typically in my experience you know the rehab institute is somewhere else and you know miles away the patient has to get brought there. Here it's right in the facility.

SPEAKER_02 31:44

Well it's good because if if if swallowing is more of a challenge and something comes up to be a little bit of bronchitis, you you know you the hospital's not 10 minutes away, it's right there. And the doctors are right there. So the the Banish Institute for rehabilitation that that sort of closes the loop and I think makes it why you know we're we're really part you know here in Lakeland providing the highest level of care with that.

SPEAKER_00 32:06

Yeah and we try uh I try and see my patients especially the stroke patients back in my clinic for follow up. That's a little more challenging sometimes because sometimes they're doing so well they just don't even want to come back and visit. Oh I know I know that where is your clinic located? Our clinic is literally right across the street from the hospital.

SPEAKER_02 32:24

So you work in the hospital with all the procedures you have the clinic across the street from Lakeland Regional's main hospital and you had your training at Johns Hopkins?

SPEAKER_00 32:33

I did both my fellowships. So I did my basic my initial training was in the U.S. Army and then I went to Johns Hopkins for both fellowships and uh after I got out of the U.S. military I stay I was faculty at Johns Hopkins for approximately six years. And then eventually I made my way here to Lakeland to really help uh Lakeland become a comprehensive stroke center along with the other people who make that possible.

SPEAKER_02 32:59

Yeah I mean the Comprehensive Stroke Center designation that to me is just a national recognition of of every bit of care that is taking advantage of all the new developments right here in Lakeland it's it's the highest level. Excellent well I appreciate your time I think this has been very helpful understanding everything that's been going on and you've got a wonderful team working with you. Well thank you for having me on the