Alan Helgeson (Host): Hello and welcome. You’re listening to the Health and Wellness podcast brought to you by Sanford Health. I’m your host, Alan Helgeson with Sanford Health News. Our conversation today is about stroke. According to the CDC, every year, more than 795,000 people in the US have a stroke. In terms of time, someone has a stroke, every 40 seconds and every four minutes, someone dies from a stroke. Today, we learn one person’s personal story of surviving a stroke, and also learn about signs and symptoms for a stroke, as well as those risk factors that can be helpful for you and your loved ones. Our guests today are Dr. Gautam Sachdeva, a Sanford health physician, specializing in interventional neurology at Sanford Neuroscience Clinic and Melba Wentin to tell us her story as a stroke survivor. Melba, let’s begin with you. Tell us your story of what you recall about having a stroke.
Melba Wentin (Guest): It was sometime between quarter to five and somewhere around there. I was in the kitchen and I just went down on the floor. I had no warnings. I hit my head against the fridge. I tried to move myself over, but it could not use any of my right side. It did not have any strength that I remember. I couldn’t see the room just went black and then this peaceful feeling just came over me. And then I passed out.
Host: Were you alone, Melba, when that happened?
Melba Wentin: I was downstairs, alone. My husband was upstairs in bed. He came down and found me and called the ambulance.
Host: How much time had passed between all of this when it had happened Melba?
Melba Wentin: It couldn’t have been a long time though otherwise, I don’t think I’d be here.
Host: So going up to that point, were there any signs or symptoms that you remember having that day?
Melba Wentin: No. None.
Host: Where were you at? What time of day was this when that this happened to you?
Melba Wentin: I’m going to guess it was maybe a quarter to five in the morning. I get up at four o’clock in the morning and I already had my coffee. I had to wash my face, brush my teeth, so, and I was walking out of the bathroom and that’s when I went down and hit my head on against the refrigerator.
Host: From that point, your husband called the ambulance. They came in and took you?
Melba Wentin: Well, my husband tells me we were, the ambulance was out in front for maybe 12 minutes or so. And my husband was getting pretty excited. He was kind of yelling at the police officer saying, “why didn’t they take her to the ER?” She calmed my husband down and said “they know what they’re doing”, and he wanted to ride with, they said, “no, you got to stay here” because they’ll need someone to call you to get approval for different things they might do to me.
Host: So really not knowing what to expect and what was going on, your husband was, and rightfully, so anxious about “get her to the hospital right away”.
Melba Wentin: I don’t know when they, they tried to give me a clot-busting medicine. It was in the emergency room and that did not work so Dr. Sachdeva went in through my groin and went up and sucked the blood clots out.
Host: What do you first remember about being at the hospital then?
Melba Wentin: I remember waking up just momentarily in the ER. That’s all I remember and then the next time I woke up, I was in my room.
Host: Were you hospitalized for a long time?
Melba Wentin: No, I was very fortunate. Four days. I was hospitalized. I think.
Host: Give me a little sense about your lifestyle.
Melba: I do a lot of walking. Four times a week, I walk five miles. I have a total gym at home that I work out on. I work on that six days a week. So I’m pretty active.
Host: Prior to this happening, Melba, what do you recall or what was your knowledge base? What do you remember or know of stroke? What comes to your mind prior to this?
Melba Wentin: I did not know anything about a stroke prior to this.
Host: Great story. Talking about and just out of the blue, it just really happened. You really weren’t expecting anything. And thankfully you had a family member there.
Melba Wentin: Yes and may I just say that I would not be here if Dr. Sachdeva had not saved my life and I’m very, very grateful to him. He was able to respond to my emergency with great skill and clarity of decision, and thankfully he knows a lot about what he does otherwise I would not be here.
Host: Dr. Sachdeva let’s turn to you and let’s go back to that day. Let’s talk about it from your side as a physician. What happened at Sanford to take care of her?
Dr. Gautam Sachdeva (Guest): Absolutely Alan. I clearly remember the day. It was July 7th and she was brought in by the local ambulance service directly as someone with stroke symptoms, which were recognized at the time EMS responded to the call. Melba was, like she mentioned, completely normal at 4:00 AM. I clearly remember talking to her husband that morning. She was normal at 4:00 AM. Like she said, she goes up, walks around and you know, does her routine. And at 6:00 AM, rightfully so, as she mentioned, somewhere between quarter to five and six, around 6:00 AM is when her husband found her down. She couldn’t talk, she couldn’t move her right arm or leg. One thing I want to point out here is that somebody who has had a stroke, like you heard her story, they don’t remember a lot of things because the left hemisphere is what makes us human. That is what affects our ability to understand and talk. Because she was having signs and symptoms of a big stroke, she could not recall any of that because her ability and her language was compromised. That’s when EMS arrived. Her husband called right away and she was brought into a Sanford emergency room. I remember her hitting the ER door was 6:35 AM. We know in the stroke world, everything is sudden. There’s no warning sign. Everything comes out at the time you least expect it to. A lot of strokes to happen at night. So everything came sudden in her case as well. The good thing, her husband called, found her and called ER right away. That’s the key for you to have a good, meaningful recovery if you present on time. So she came in when I saw her in the emergency room, I remember she had no motor function on the right arm and leg, mind you that’s the dominant arm. She couldn’t talk. She couldn’t understand. She wasn’t verbalizing anything. So that itself, Alan, is a sign of a big stroke right there. Even before I could do any scans, I could tell you that this is a big stroke. The next step to that is, like Melba mentioned, the standard of care in the country and all over the world is if you present within the first three to four and a half hours, you are a candidate for a clot-buster medication, which is called TPA. Tissue Plasminogen Activator. It’s like a Draino for blood vessels. That’s how I like to say it to my patients. The bigger factor is that it guarantees you, you know, not a hundred percent recovery, none of the things does in medicine, but it does guarantee you that a big clot is going to go away. And that’s what we found that we gave her the clot-buster. We usually give it some time to act. But the thing is when the clot is in a big vessel, you don’t expect it to completely go away. And we did a cat scan with a dye to look at the blood vessels and saw that there was a big clot which was blocking the blood supply to the whole left hemisphere. Now, let’s say if somebody couldn’t have presented on time, if the whole left hemisphere was compromised, there would be no motor function. There would be no sensory function. There would be no speech and one could even die from it if the stroke is that big. When I saw the clot, the first thought in my mind was I will have to take her to the cath lab. I didn’t waste any time. I spoke to her husband over the phone to make sure that, you know, we understand what’s going on and you know, he’s agreeable with me moving ahead, because Melba was not in a situation where I could talk or explain things to her. And so the way we work fast here is that we were able to take her right away. The teams were ready even before I could call it out. And then once I took her, I was able to get the clot right out completely. I can tell you that 6:35 AM was when she hit the door at our ER, by 7:43 AM, the clot was out and medication was also given late. So very, very fast time. Now, why do I mention that is because what we are seeing here today is because of that. Is because of the fact that her husband didn’t waste any time. He knew right away something wasn’t right. He called 9-1-1 and then she came to us on time. Once you come right away, the stroke symptoms are actually reversible and Melba is a living example of that. So we calculate all our stroke scales in terms of severity and her scale went from being 20 plus, which is like significant, significant, disability to the fact that she barely had any deficits even the next day and that was all the result of her coming on time, right away. Melba’s story is a reflection which is a message I want to send to the public is that if you’re having stroke like symptoms, do not ignore them. Act fast. Act right away. Come to the emergency room right away and stroke symptoms could actually be near completely reversible if acted on time.
Host: Many times here over the last few minutes, you’ve mentioned and reference time in various ways. And at some point, I had heard something in regarding to stroke that time is brain. Could you go into a little bit more of the damage that kind of snowballs, based on taking time to get in? Or are there any metrics or things that you can share that to give us some context and perspective?
Dr. Sachdeva: Absolutely. Absolutely. That’s a great question, Alan. So I’ll start by saying that 1.9 million neurons or brain cells are dying every minute when you’re having a stroke. Per minute, you can age by three days if you’re having a stroke. So that’s the kind of damage you’re looking at. That is why time is brain is such an important thing to remember. Why is that? The reason is, see, the brain, the brain vessels , the brain tissue, how stroke happens, is a clot goes up in one of the blood vessels and it blocks. This is the clotting stroke I’m talking about. It blocks the certain areas of the brain, which are responsible for some function. And that function is affected right away. Now, imagine if you don’t take that clot out, that is more time that the brain is not receiving blood supply, not receiving oxygen. And those brain cells are dying irreversibly. Now, if there’s a certain area of the brain, which is dying, the area around it becomes the tissue at risk. So our goal when somebody comes in is to see, is there a big amount of tissue at risk, which we could save, which is at risk of dying, but hasn’t died yet. So that’s what we look for in all these scans to see that if somebody comes on time and we still have the potential to save that salvageable brain tissue, which could definitely affect their life and functioning, that’s when we act on it fast. And that’s where time matters.
Host: So many things with, with time being so important, but then also the expertise of you and the Sanford team in Melba’s care. Let’s go back to the beginning here for others, Melba, maybe didn’t see any signs or a specific symptoms at the time when this happened. Are there signs and symptoms of a stroke that people can look for?
Dr. Sachdeva: Absolutely. Couldn’t be a better way to explain it. The acronym is B-E-F-A-S-T so let’s go over the components of it. B is for balance. Any acute loss of balance, dizziness, vertigo in coordination. E stands for eyes. Any sudden loss of vision in one eye or one half of both eyes. F, face, any acute onset of facial asymmetry any droopy face. So A, a stands for any arm weakness. So what do you look for is any loss of power or strength, heaviness of one side, more than the other. S, S stands for speech. So any sudden or acute changes in speech, which could include difficulty in understanding, difficulty in talking and the last, but not the least is T. What does T stand for? It’s time, time to call 9-1-1. Now this is so critically important to focus on each and every component. And what is common among all of them is the word sudden. Acute. So if you reflect back to Melba’s story, everything is sudden or acute. It doesn’t give you a fair amount of warning sign. It just comes all of a sudden. And unfortunately, sometimes people are in the situation when they’re by their selves, or they are in the middle of the night somewhere. And, you know, you don’t expect somebody to check on you. So those are important things to remember that it could happen any time.
Host: Dr. Sachdeva, as we were talking with Melba and her telling her story, she’s active, she walks a lot. She exercises and feels she has a pretty healthy lifestyle, but are there risk factors that people should know about?
Dr. Sachdeva: Talking about risk factors, some common things to keep in mind are, the stroke risk factors are very similar to cardiovascular risk factors. So anybody who has poorly controlled blood pressure, diabetes, high cholesterol, anybody who has untreated sleep apnea, those are the big risk factors. Smoking. Those are the big risk factors to keep in mind when you go for your regular physician checkups. And that’s why we stress the importance of regular, annual physicals with your primary care physician to keep these factors under control, because they check you for all these things to make sure that you are on the right track. And the risk factors are controlled. Now, looking at it after the stroke. Now, when a stroke happens, you tease out the individual risk factors in those patients case, like which risk factors could have caused the stroke in a certain patients case. And then you try to address that accordingly. One of the other risk factors is atrial fibrillation or irregular heartbeat. That’s not uncommon to see. So those risk factors should be adequately addressed for somebody to prevent a stroke beforehand, but after a stroke happens, then you individualize to see what could have caused somebody’s stroke. And you try to address that because remember one stroke is one of the biggest risk factors for having another stroke.
Host: Dr. Sachdeva, you jumped right into my second question. I was going to ask you about that risk of having a second stroke. So by mitigating these risk factors, that’ll help cut that back?
Dr. Sachdeva: Good question. Giving you some perspective into it, Alan, anybody who has had a stroke has around 23 to 25% chances of having another stroke. The chances of having another stroke usually is coded as the highest in the first 90 days. So that factor is in itself alarming. You know, 800,000, close to 800,000 strokes happen in America like you mentioned, in a year. Around 23% of them are strokes, which are recurrent strokes. So that’s where the importance of addressing the risk factor comes in. So let’s say if somebody was diagnosed with irregular heartbeat or atrial fibrillation, having something like blood thinners on board, like, you know, anticoagulants like Coumadin or Eloquis or those kinds of meds definitely reduces the risk of having another stroke. So importance of the workup when somebody has a stroke is to tease out the exact cause, which we’re not, again, able to find out in every person’s case, Around 25% of the time, you don’t know the exact cause, but we still keep looking with multiple things, but that’s the important factor to find out the cause and address it to avoid recurrent strokes. In the meantime, you take your meds, you see your doctors regularly, you keep your risk factors under control, and that is the key to avoid the next stroke.
Host: Dr. Sachdeva we know the importance of time and so many different things with expertise. In your skillset as an interventional neurologist, does it matter where a person goes for stroke treatment?
Dr. Sachdeva: Alan, that’s a great question. So let me begin by saying that, you know, the standard of care is that if you’re having anything acute, stroke symptom wise, like if your arm or leg is weak. If you’re having trouble talking, if you are having the worst headache of your life, if you have any facial droop or loss of balance, like we discussed, these are all signs and symptoms of an acute stroke. Now the first thing which I’ll start from the basics is I tell this to families. I tell this to patients and their loved ones that do not drive yourself. Call 9-1-1. The importance of that is not just that you live two blocks from the hospital, you could have driven it, driven them yourself. It’s because of the fact that people could get worse in a matter of seconds and the EMS personnel, when they pick you up from your house, they have already informed the hospital that they could be coming with a possible stroke. So the teams are ready. So you’re saving a lot of time by doing that and making sure that even if they get worse, the teams can take care of you. So that’s my first response, that it’s important to call 9-1-1. Now where to go, like, is there an option? I think the first thing I would like to mention there is you got to go to the nearest emergency room to at least get a cat scan because there is a possibility that you could be having a bleeding stroke. Now bleeding strokes management is very, very different than a clotting strokes management. So that’s important to know and not waste time, because what if your blood pressure is super high and it’s a bleeding stroke, then we’ve got to bring it down. But in the clotting stroke, it’s the other way, you’ve got to preserve the brain tissue so you let your blood pressure go high. So that’s the importance of going to the nearest emergency room. Why? Because if you get a cat scan, it doesn’t show a bleed, you can still get the clot-buster medication at a smaller hospital who doesn’t have the capabilities of interventional neurology, but they’re still able to give the clot-buster medication, which might be the key to your stroke. So you can’t all know that beforehand, but the importance of the next step is the next step in the acute treatment is endovascular treatment of acute strokes, which is thrombectomy, like taking the clot out endovascularly. So those are usually done at bigger centers. And the importance is that even when the smaller centers are a critical access hospital is able to give the clot-buster medication, they are still able to connect with the bigger centers like us and others and transfer the patients right away to get them access to the thrombectomy part of it. So bottom line is, if you are thinking that this patient could still be a candidate for the clot-buster medication, or if they’re having acute stroke like symptoms, which could be a mimic for a bleeding stroke, they still need to go to the nearest emergency room to get immediate medical attention and a cat scan. Now, your airway, your breathing, your circulation, these are the critical things which can go worse in certain kinds of strokes and they need to be addressed. So they need to be at the medical center closest to them right away with the possibility of transfer to a bigger center, which has the capability of doing the thrombectomy,
Host: Is there a connectedness of Sanford, knowing that there are a lot of rural areas around the region of being connected to some smaller communities and connected to larger facilities? Does that exist with Sanford?
Dr. Sachdeva: Yes, we have connectivity with a lot of critical care hospitals around the area. Not only do we provide urgent medical care for them, take transfers from all those hospitals, whoever needs to come to a stroke center for higher level of care, but we also make sure we connect to them, Alan, on a regular basis, even in non-emergent settings and provide outreach and education to their staff regarding the knowledge about management of stroke, the updates about the new guidelines. So we are very well connected with all. We have our stroke team, our stroke coordinator is the key. And she basically connects with all the hospitals, the critical access hospitals to go over the needs, what they need from us, to go over what we could provide them with, protocols as to how to manage ischemic strokes, how to manage hemorrhagic strokes and the basic setting and then we also provide them with protocols for when is a patient required to be transferred and what can we do, which they cannot provide, for their patients, so that they can get the best level of care. So, yes, we have a very, very strong connectivity. In fact, a lot of our patients, which we see for stroke, are actually transfers from other hospitals. And that is part of the reason because we make sure that we provide them with all the knowledge they need, with all the education, on a regular basis they need, and for emergency care and transfer facilities.
Host: Melba. I want to go back to you. After your stroke, after your hospitalization and working on recovery, was a rehabilitation involved for you?
Melba Wentin: Yes, my sister came from Duluth and she helped care for me for two weeks, and after that, I started therapies. I went to physical therapy, occupational therapy and speech therapy. I walked with a cane for a while, but I don’t anymore.
Host: How are you feeling today?
Melba Wentin: Really good.
Host: As we come to the end of our program here, wondering Melba, Dr. Sachdeva, any final thoughts you want to share?
Melba Wentin: I’m very thankful to be here. Again, I’m very thankful how things happened for me and don’t waste any time anybody. Get to the hospital, as soon as you can.
Dr. Sachdeva: I want to thank Melba today for coming here and sharing her story. It means a lot to us. And I want to send a message, to the public who is listening to this in this upcoming stroke awareness month. I want to let them know that time is brain. Do not waste any time. If you’re having signs and symptoms of an acute stroke, B-E-F-A-S-T and get to us right away and we’ll take care of you. Thank you so much for having me.
Host: Dr. Sachdeva, Melba, thank you for taking time to join in this conversation about stroke. Such important information. This was another episode of the Health and Wellness series by Sanford Health. For Sanford Health News, I’m Alan Helgeson. Thank you for listening.