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115 - LiveWell Talk On...Stroke Signs, Symptoms and Treatment (Kelly Printy, RN & Rhapsody Kirkpatrick, RN)

episode 115

Ep. 115 - LiveWell Talk On...Stroke Signs, Symptoms and Treatment

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guests: Kelly Printy, RN, nurse supervisor, & Rhapsody Kirkpatrick, RN, patient care coordinator, St. Luke's Hospital

Dr. Arnold:
This is LiveWell Talk On...Stroke Signs, Symptoms and Treatment. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. When it comes to stroke, time is of the essence. Today, as we recognize national stroke awareness month, we'll discuss the warning signs, the treatment, and support offered at St. Luke's and much more. My guests today are Kelly Printy, a nursing supervisor and Rhapsody Kirkpatrick, a patient care coordinator at St. Luke's. Thank you both for joining me.

Kelly Printy:
Thank you.

Rhapsody Kirkpatrick:
Thank you for having us.

Dr. Arnold:
Let's just start out with some simple background. Can you describe each of your respective roles, as it applies to stroke care here at St. Luke's?

Kelly Printy:
Sure. I work on the five center, which is the neurology floor. We take care of the stroke patients. So we see patients that come in for stroke either directly from the emergency room or from the intensive care if they are first getting treatment. And then we take care of them on the inpatient unit until they're ready to go on for either more therapy or ready to go home.

Rhapsody Kirkpatrick:
And I'm the patient care coordinator for five center on the neuro floor. And my role there is to kind of assist with the discharge plan. So I work with therapy very closely to determine what the best discharge plan would be for a patient and kind of assist in getting that implemented.

Dr. Arnold:
You know, I think as a physician, I can confidently say that I think stroke is the diagnosis that patients fear the most, probably only second to cancer. And that is because the risk of it leaving you disabled and they don't want to be a burden on their families, and have that quality of life taken away. So let's start out, what exactly is a stroke?

Rhapsody Kirkpatrick:
So stroke is when there's a lack of blood supply to the brain, whether it's interrupted somehow or there's a complete blockage.

Dr. Arnold:
And then, hence that's why` time is of the essence, because if blood supply is cut off and tissue dies after a while if it doesn't have blood supply.

Rhapsody Kirkpatrick:
Correct.

Dr. Arnold:
Then what is a TIA? That term is thrown around, and I think patients would benefit from knowing what that is.

Kelly Printy:
So that is what we refer to as a mini-stroke, or a trans ischemic attack. So that's kind of like what we call a warning for a patient. So you will have stroke symptoms, but they will resolve. It can be quickly, within minutes. And within 24 hours is what we determined to be called a mini stroke or a TIA.

Dr. Arnold:
If they resolve within 24 hours.

Kelly Printy:
If they resolve within 24 hours. Yes.

Dr. Arnold:
What are some common signs and symptoms, specifically, when should a patient either call 911 or be transported to the emergency room? What symptoms should trigger them to seek medical attention?

Kelly Printy:
So when we talk about a stroke the symptoms are, we refer to them as anything that happens suddenly. So it would be, we use the acronym, BE FAST. So the B would be balance. If you've lost your balance or having trouble with your gait or walking. The E stands for eyes. So anything that would be different in your vision, blurred or double vision, or you're losing some of your visual field. Next would be F for face. If you have, it'd be like a droop or numbness or tingling in your face. Next would be, A would be for arms. So any weakness, sudden weakness on one side or the other. S is for speech. And that would be trouble getting out your words or slurred speech. And then T is the last thing, for time. And so we refer to, time is brain. So it's important to get to the hospital right away, so you can get that appropriate treatment.

Dr. Arnold:
And Kelly, when we talk about time, how much time? Can you give people a window of time that they should seek care?

Kelly Printy:
So what happens is when people get symptoms, you know, they don't always know for sure if it's real, or if it's not. So a lot of times people will get like a numbness or tingling or weakness, or they have a severe headache and they'll think, okay, I'm just going to lay down for a while and see if it goes away. Well, that's wrong. We need them to get there right away. So what people don't realize is that we're lucky now with stroke, that we have a treatment, a medication that they can give called TPA. And if you are eligible for that and you get that medication, a lot of times you can see complete reversal of your symptoms. So it's very important and there is a window of opportunity for that medication. So it's four and a half hours. And it's important that you get to the hospital within that time. As soon as you can, because once you get to the hospital, there's lots of things they need to do to be able to give you that medication. So we really want people to, if they have symptoms, to come immediately.

Dr. Arnold:
And I guess the best treatment for a stroke would be not to have one.

Kelly Printy:
That's so true.

Dr. Arnold:
So, what are some risk factors that patients could possibly control that might reduce their chance of having a stroke?

Rhapsody Kirkpatrick:
Right. So the way you can help with those controllable risk factors, like high blood pressure is a controllable risk factor. If you go to your primary care doctor every year, like you're supposed to for your yearly visits and they're monitoring your blood pressures like they should be, they can get you put on medications to manage that. Having your lipids checked. So like your cholesterol levels, getting put on statins to help with that and monitoring your diet. Exercising will help kind of decrease your risk of having a stroke. And then just maintaining a healthy lifestyle overall.

Dr. Arnold:
And so, what's the role of aspirin?

Kelly Printy:
So aspirin is an anti-platelet. So what that does is it makes those cells in your blood that form clots and stick, like if you got a cut, they would be what would go to help clot that and make the bleeding stop. Well, an aspirin is considered an anti-platelet. So what it does is it makes those cells less sticky so that the blood flows more freely and can get everywhere it needs.

Dr. Arnold:
I think that aspirin is a powerful medication, really. You know, it was invented in 1880 in Germany. If it was invented today, it'd probably be about five bucks a pill.

Kelly Printy:
Isn't that true.

Dr. Arnold:
You talked about the TPA, or the clot-busting drug, that we want to get that within about four and a half hours upon presentation. What is a complication of that medication? The most worrisome complication?

Kelly Printy:
Well, the most worrisome complication is bleeding. And so when you come into the hospital, the first thing that will happen when you reach the emergency room is you will go to x-ray for a CT scan. And that's to determine whether or not you have any bleeding in your brain, because there are different types of stroke. There are hemorrhagic strokes, so that would be the bleeding ones. And then the ischemic strokes, which would be from a blockage, be it a blood clot or cholesterol, that type of thing. So they want to determine, first of all, to make sure that your brain doesn't have any bleeding, so that you would be eligible to get that medication.

Dr. Arnold:
Okay. And then you could get it. But then obviously, if you want to make sure they didn't have bleeding, then a complication of that medication is probably excessive bleeding.

Kelly Printy:
It would be, but the risks of the benefit of the medication really outweigh the bleeding. They've shown, you know, it's way more beneficial to get the medication. There are quite a few things they check when you come in the emergency room before they would ever give it to you. So if you were on any medications that would thin your blood, that would be a contraindication for that medication. If you had blood in your brain, of course. They check different labs, they're in contact with the neurologist, and they do a lot of consulting to decide if you're eligible for it, but they have really shown that it's way more of a benefit than a risk to give that medication.

Dr. Arnold:
Yeah. Yeah. Now, if I have a stroke and I have a leg that's not moving or an arm that's not moving, is it possible for that deficit, that paralysis if you will, to get better?

Rhapsody Kirkpatrick:
I think there's always a possibility. I think every patient is different though. So we have to do a good job of individualizing our care for every patient. We've had patients come in who have complete left-sided weakness and paralysis, and they end up walking out of here. We do have a really good rehab here that is exceptional with our stroke patients. And they do a great job of getting the therapies that they need and helping to make them get as independent and back to their baseline as possible. But then you do have some instances where, unfortunately the stroke is so severe, that you continue to have deficits afterwards. So it's important to have resources available to you. And that's what we do here at St. Luke's, is we provide those resources for you to be as successful as possible, regardless of what deficits you have or may not have after you leave.

Dr. Arnold:
And we have a dedicated stroke unit. We have rehab services, which are award-winning, and certified. But, I think you're being a little bit modest from the standpoint that from a joint commission or a regulatory agency, we do have certification for stroke, correct?

Kelly Printy:
We do. Yeah. We're really, we're really proud of that. There's a lot of effort that goes into that throughout the whole hospital with a lot of different departments that help, from radiology to lab, to the emergency room, to the rehab units, to therapies. And we do our best to provide the best state of the art stroke care that we can.

Dr. Arnold:
Is it after I have a stroke, is there a such a thing as it's too soon to do therapy? And also, I probably don't want to wait and put off therapy for an extended period of time either, correct?

Kelly Printy:
Yeah. Really the only thing that keeps people from starting therapy right away would be is if their blood pressure was still, you know, abnormally high. That would be one thing. If they do get the TPA, or that clot-buster, they spend a night in the intensive care unit and they wait 24 hours to start therapy after receiving that medication. So those are the two things that would hold you up, but most of the time therapy is initiated the same day that they come in.

Dr. Arnold:
Okay. So get right after it.

Kelly Printy:
Right. Right.

Dr. Arnold:
Now I think, I think one thing that we should probably cover, because I'm sure people are thinking about this is, you mentioned a CT scan in the emergency room, Kelly. But then I know patients and family members have had to wait around to get the MRI. Why does the neurologist order the MRI after you have a CT scan that might not show anything?

Kelly Printy:
So the CT scan is done just initially to find out if there's any bleeding and that's it. It will not show a stroke for up to 72 hours after the stroke has occurred. The MRI scan, which is usually done later that day or the next day, will show a stroke right away, an ischemic event right away. So that's why they go ahead and do that.

Dr. Arnold:
Kelly and Rhapsody, we talked about preventing that first stroke and getting recovery and therapy from the stroke. If I recover from that stroke, is there, do I have a risk factor to get another stroke on top of one that I've previously had?

Rhapsody Kirkpatrick:
Yes. You're actually at a higher risk of having another stroke because you have already had one.

Dr. Arnold:
Okay. So you live in that neighborhood, so to speak.

Rhapsody Kirkpatrick:
Yeah.

Kelly Printy:
So that's why it's so important to address those risk factors and follow up with those. One of the things we do at St. Luke's here, is when every stroke patient is discharged, we schedule them a follow up appointment. And what we have here is a stroke clinic. And what they do at that stroke clinic is go over those risk factors and make sure everything is covered from pressure, blood pressure, cholesterol. If they have any heart arrhythmias, they would follow up on those. A lot of times people are sent home with an event monitor to monitor their heart rate for 30 days. And they'll follow up with that at your visit. Also, another risk factor is sleep apnea, and we don't address that as an inpatient, that's done as an outpatient, but they would schedule the patient then for a sleep study to have as an outpatient to follow up with that risk factor. So they, they do a lot of educating at that appointment. And they also, you know, go through those risk factors again and make sure they've addressed all of them.

Dr. Arnold:
Let's good. Kind of make sure nothing fell through the cracks, so to speak.

Kelly Printy:
Yeah.

Dr. Arnold:
You mentioned heart problems, Kelly. I guess, we really didn't cover that you can have a clot that's in your heart, that travels to the brain and causes a stroke. Patients might not understand why they're getting an ultrasound of their heart when it's their brain that was affected. So that was a good point to mention. So the takeaways are: be suspicious, don't wait for symptoms to evolve any more severe than they are when they present, use 911.

Kelly Printy:
That's very important.

Rhapsody Kirkpatrick:
Do not drive if you are having symptoms of a stroke.

Kelly Printy:
The other thing people don't realize is when you do call 911, they alert the hospital that a stroke alert is coming in. And here at St. Luke's, the emergency physician will meet that patient in the ambulance bay, do a quick assessment, and they'll go right to CT scan. So if you walk in, you're greeted at the desk, you're triaged there. You might sit a little bit. Whereas if you come in 911, they have that stroke alert. They know you're coming and things get done a lot faster.

Dr. Arnold:
Okay, well, that's good to know. Hence time is of the essence.

Kelly Printy:
Yes, time is brain.

Dr. Arnold:
Time is brain. That's good advice. Well, Kelly, Rhapsody, thank you so much for taking time and discuss stroke with national stroke awareness month. Awesome information. Again, that was nursing supervisor, Kelly Printy and patient care coordinator, Rhapsody Kirkpatrick with St. Luke's Hospital. For more information, visit UnityPoint.org. Thank you for listening to LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcasts. We're available on Apple Podcast, Spotify, Pandora, or wherever you get your podcasts. Until next time, be well.