Preventing and Treating Stroke

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Hello, and everybody, welcome to the show. You're listening to Weekly Dose of Wellness, brought to you by MemorialCare Health System. I'm Deborah Howell. Today, our guest is Dr. Kiet Loc, a board-certified neurologist and neurohospitalist affiliated with Saddleback Memorial. Dr. Loc's interests include managing complex stroke patients along with general neurology. Welcome, Dr. Loc.

Kiet Loc, MD: Thank you. Thank you for having me here.

Deborah Howell (Host): Oh, it's our pleasure. Today let's talk about preventing and treating stroke. A couple of facts: stroke is the fourth leading cause of death in the US and the number one cause of disabilities. Without prompt diagnosis and treatment when stroke occurs, permanent damage and a corresponding loss of function can occur. So every minute really matters. We're here today to learn what you can do to reduce risk factors for stroke and know the warning signs so you can act quickly if you or a loved one are experiencing stroke symptoms. First of all, Doctor, what is a stroke?

Kiet Loc, MD: A stroke occurs when brain cells are deprived of oxygen. This can happen within a few minutes, that's why time is always brain. There are definitely two types of stroke. One is what we call ischemic stroke when the blood supply is actually interrupted by a blood clot in the artery. This is about 80% of the cases. And the other type is what we call hemorrhagic stroke, which is a bleeding type of stroke. So the blood clot just kind of push the nerve tissue away and cause symptoms.

Deborah Howell (Host): Excellent. That was very brief and to the point and right in a nutshell. What are some stroke symptoms?

Kiet Loc, MD: Some of the stroke symptoms, as you need to act promptly if you notice your loved one having them, include have them smile, if you notice a droopy face on one side or the other, then that would consider one of the symptoms. The mnemonic is what we call FAST. F is for face. A is for arm. So you have your loved one raise both their arms, and if one of the arm drifts, that means that arm is weak. Now, speech is S, that's the next one. And you would have them repeat a simple phrase or ask them what this is, and if their speech seems slurred or what we call nonsensical, then that's another symptom as well. The last one is call 911 right away as soon as you notice your loved one have any of these symptoms. Again, the mnemonic is FAST: F A S T, for face, arm, speech, and time.

Deborah Howell (Host): I've also heard, in rare cases, that, you know, if you're texting with someone and suddenly their texts are just complete nonsense, that might also be a sign.

Kiet Loc, MD: That's definitely correct. That kind of give you a view of what are they thinking. If their thinking is not clear, therefore they would type, be typing nonsensical as well too.

Deborah Howell (Host): Right. So what should individuals do if they're experiencing these symptoms themselves? How quickly should they react to these symptoms?

Kiet Loc, MD: They should definitely call 911 right away. Do not try to drive your loved one in itself, because when the paramedic arrive, that's when the evaluation begins. And they have, they will definitely alert the whole system that the patient's arriving, so the emergency department can rally up the team. So it is much better to call 911.

Deborah Howell (Host): And paramedics, they do have the skills to determine whether or not this is a stroke?

Kiet Loc, MD: All the paramedics are trained to notice symptoms of stroke, and once they notice a patient has symptoms of stroke, they activate what we call a stroke code and alert the emergency department that a patient's arriving so the emergency department can rally up the team.

Deborah Howell (Host): Okay, very good. What's the importance of the stroke program and what is the need?

Kiet Loc, MD: Saddleback Memorial is designated as an advanced primary stroke center by the Joint Commission. What that means is Saddleback provides 24/7 neuro-interventional stroke care, which includes, around-the-clock neurologist, neuro-interventionalist, radiologist to help take care of the patient. So again, this is very important because time is brain, so we want the patient to be evaluated and get the care without any delay.

Deborah Howell (Host): Excellent. Okay. Maybe you could walk us through the stroke treatment. So a patient will receive, you know, these following steps at Saddleback Memorial.

Kiet Loc, MD: Once a patient arrive at the emergency room, the emergency room doctor will evaluate the patient and then they will ask the neurologist to come see the patient right away and evaluate the patient. And once the neurologist see the patient, then, depending on the case, they'll determine if the patient qualify for what we call clot buster, also known as a tPA. It's a medication that can only be given if you arrive within three hours of when the symptoms started. So it's, what I call a draino for plumbing. So if you have a clotting type of stroke, this medication, it has been determined by a very large NIH-supported trial, that at three months you will have 30% less disability and mortality.

Deborah Howell (Host): 30% less.

Kiet Loc, MD: Yes. And any percent will count.

Deborah Howell (Host): That is significant.

Kiet Loc, MD: I agree. That's why time is brain.

Deborah Howell (Host): Yes. Okay. Describe your role, if you would, as the neurohospitalist.

Kiet Loc, MD: My job is to evaluate patients who present with acute neurological problems, such as stroke or seizure. As soon as the emergency room physician think the patient need my care, I'll be there right away to evaluate the patient.

Deborah Howell (Host): Okay. So you evaluate and then what happens?

Kiet Loc, MD: I will facilitate the appropriate care for the patient. If they have a stroke, then determine whether a patient has, what we call tPA or need any more, extra care, what we call intervention by the neuro-interventionalist. If a patient's having a seizure, the main important thing again, time is also brain for seizure. We need to give medication for seizure medication right away. Because you don't want...

Deborah Howell (Host): So you-

Kiet Loc, MD: Go ahead, I'm sorry.

Deborah Howell (Host): No, no, please finish, I'm sorry.

Kiet Loc, MD: Oh, I'm, I'm fine.

Deborah Howell (Host): Okay. I wanted to say that it seems like you certainly aren't working alone to help treat a patient. You've got to have a lot of teams around you.

Kiet Loc, MD: Definitely. I will have a great nursing staff at Saddleback Memorial and have a great team of emergency room doctors to help me out as well.

Deborah Howell (Host): Okay. What's the difference between a neurohospitalist and a diagnostician?

Kiet Loc, MD: Diagnostician? A neurohospitalist, in the past, the traditional for a neurologist is only seeing patients in the outpatient setting. Yes. And now with the demand of patient, you know, with acute care, we want to not delay any care and have me, a neurologist, be right there right away to take care of the patient.

Deborah Howell (Host): Okay. Again, it's just, people really need to understand they can't mess around, they can't look for the right pair of shoes to put on, you need to get these folks who are experiencing these symptoms immediately in the care of at least a paramedic and, you know, if not straight right into the hospital. Lots of times patients have the strokes right there in the hospital.

Kiet Loc, MD: Correct.

Deborah Howell (Host): And so they, they need to be surrounded instantly by, you know, thank God there are things like call buttons, and call buttons have saved many a life in, in these situations.

Kiet Loc, MD: Yes.

Deborah Howell (Host): What are the ways to help prevent a stroke?

Kiet Loc, MD: To decrease your risk for stroke, what we call secondary prevention are very important. Main thing is to make sure your stroke risk factors are being under control. They are blood pressure. If you have high blood pressure, make sure your blood pressure is, controlled less than 130, the top number, and less than 80 for the bottom number. And obviously this would help with medication. Second is if you have high cholesterol, you got to make sure your bad cholesterol, what we call LDL, has to be less than 70. And your cholesterol should be checked every six months. If you have diabetes...

Deborah Howell (Host): Really?

Kiet Loc, MD: Yes.

Deborah Howell (Host): I hadn't heard that before.

Kiet Loc, MD: It should be checked every six months so if you are on medication, you can see whether you need to be adjusted or not.

Deborah Howell (Host): Well, that makes sense.

Kiet Loc, MD: Mm-hmm. And next very important is diabetes. Diabetes can pretty much accelerate the clogging of almost every arteries in your body, including the brain. So gotta make sure your diabetes is under control, to eat well, exercise. And now if you have something what we call atrial fibrillation, which is an irregular heart rhythm, you have to be on the appropriate medication, whether a blood thinner or depending on your other medical factors, the appropriate medication would help. Because atrial fibrillation actually increases your risk of stroke in comparison to the general population of somebody without atrial fibrillation to 5 to 20% a year.

Deborah Howell (Host): Why is that so?

Kiet Loc, MD: Because when your heart pumps regularly, it's okay. What we call irregular heart rhythm is when they do not pump regularly, so they do not pump the blood effectively. So when blood just sit there, it kind of pools and it will clot. And then if your heart goes back to a regular rhythm, it will start pumping those clots up into the brain.

Deborah Howell (Host): Ah. Boy, you are...

Kiet Loc, MD: And that can cause a stroke.

Deborah Howell (Host): That was so visual the way you described it, I can actually see that happening in the body. So we don't want that to, we do not want that to happen, do we?

Kiet Loc, MD: And other important factors is if you're smoking, smoking actually again cause inflammation to all the arteries, and it will accelerate any clogging in the arteries involved.

Deborah Howell (Host): So much information. You've been so informative, Dr. Loc. It's been wonderful to have you on the program today. We're going to help you get the word out about stroke prevention. So to listen to the podcast or for more information, please, please, by all means, visit memorialcare.org. That's memorialcare.org. Remember, time is brain. Thanks again, Dr. Loc.

Kiet Loc, MD: That's right. Thank you, have a good day.

Deborah Howell (Host): You too. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness. It could save your, or your friend, or your wonderful loved one's life. It's brought to you by MemorialCare Health System. You have yourself a fantastic and healthy day.