>> From WXXI News.

This is Connections.

I'm Evan Dawson.

Our connection this hour was made at 1024 in the evening when a man in his 40s began having a stroke.

As a man in his 40s myself, I don't often think about stroke affecting people that age, but I'm 47 and my dad was 47 when he had a stroke.

And, you know, we all have to think about what we would do.

Well, Joshua Graves knew that something was wrong, and his daughter called 911.

15 minutes later, the u r Mobile Stroke Unit was at his door.

Today, Graves says those 15 minutes saved his life.

He offered to be part of a new video for social media, describing his experience and why he credits the mobile unit for not only his life, but for preventing devastating effects that can come with stroke.

URMC s Mobile Stroke Unit is equipped to deal with the effects of stroke on sight or in transit to a hospital.

So instead of waiting to get to a hospital for evaluation, teams can begin treating immediately.

This hour, a conversation about what to do in an emergency, and how this unit is designed to make a difference.

And our guests include the man we were just talking about.

Josh Graves is with us.

I'm so glad to say a stroke survivor.

It's nice to see you.

Thank you for being here, Josh.

Thanks, Evan.

With us in studio doctor Adam Kelly is professor of neurology at the University of Rochester Medicine Comprehensive Stroke Center, associate chair of tele neurology and regional programs and director of the University of Rochester Medicine Telestroke program.

Dr., welcome.

Thanks for being here.

Thank you.

And Dr.

Tarun Bhalla is professor of neurosurgery at the University of Rochester Medicine Comprehensive Stroke Center.

Dr., Welcome to you as well.

Thank you.

We're going to get Josh's story in just a moment.

But this is an important day.

In fact, going right across the street at 1:00.

Guys, for what's going on there.

I'll start with Dr.

Kelly.

What's happening today?

>> Well, we have a press event that is celebrating the launch of our second mobile stroke unit.

Our first unit started in 2018 and it's been very successful.

And we realized it was time for a second unit to upgrade and just make sure that we have better coverage with this unit.

Uh, as much of the time as possible.

>> Well, and Dr.

Bhalla, as a professor of neurosurgery, I, I presume that means part of your work is, is surgical intervention for people who are in emergency.

Is that fair?

That's correct.

Do you do it on in the unit or are you on site at the hospital?

>> No, no, not in the unit.

We're not quite there yet.

On site at the hospital?

>> Yeah, but how important is that unit to you, given the work that you may have to do in an emergency?

That seems by the by the minute, which we'll talk about to get worse as time passes.

>> Yeah.

It's priceless.

I think in a time sensitive disease process, um, in order to be able to get the patients to the right hospital at the right time, after even delivering immediate care at the scene, time is brain.

>> Uh, doctor Kelly, where is your work typically happening?

>> Well, I work at strong.

I work at Highland, but then I do have a big presence with our Telestroke program.

And basically the concept there is we bring the the physician, we bring the specialist to the location where the patient is.

And increasingly these days that is the mobile stroke unit.

So even earlier today I was covering the Mobile Stroke Unit and the team there.

If they bring on someone like Mr.

Graves and and he needs to be evaluated.

We connect by video.

>> Yeah.

I was going to ask you how often the mobile unit is needed.

Now.

>> It really varies.

Um, you know, we're called a lot by 911, we're dispatched by 911 to evaluate a potential patient.

We are sometimes called by an ambulance crew who arrives on scene for a patient that maybe wasn't initially dispatched as a stroke, but the team gets there and realizes they need the assistance of the mobile stroke unit.

So we're dispatched several times a day.

We probably bring, you know, maybe one patient a day onto the unit.

We're quite selective because it's a very limited resource and we want to make sure that we bring patients on, like Mr.

Graves, who are going to really benefit from the care that we can provide on that unit.

>> Later in the hour, we'll answer questions from the audience about stroke.

I'm going to ask the doctors coming up here to tell us about the differences between ischemic hemorrhagic and Tia, and how to recognize that.

I had a family member years ago who sort of glibly said at dinner one day, well, I think I have several tias a year.

As if, um, you know, she's sort of self-diagnosing.

And I thought maybe talk to a doctor first.

But it is remarkable.

I mean, I had a next door neighbor, as I mentioned, right at the top of the hour here, uh, that he was gone for a few days.

This is about five years ago.

He was gone for a few days, came back and he said, yeah, I woke up in the middle of the night and told my wife I thought I was having a stroke and I, and I was, but not everybody can self-diagnose in that moment, right?

I mean, to state the obvious.

>> Correct.

And so we part of our education really these days is educating patients about stroke warning signs, but really educating families.

One of the big things that we're trying to do is get out and educate in schools so that children like, like we're going to hear about here, you know, who recognize stroke symptoms in their parents, their grandparents, other people can can activate nine one, one.

>> And Dr.

Bhalla, my father had a stroke, collapsed playing padel one day when he was 47 years old.

And, you know, I was a kid at the time.

And to me, 47 was old.

Um, I had this image in my head of only older people get strokes.

Well, now that I am 47, that does not feel old.

And is there a typical age curve, especially when they get to you for operation?

Um, does it skew older or do you see a range of ages?

>> Yeah.

I mean, stroke is definitely a disease that tends to skew a little bit of the elderly.

Um, but it is a disease that doesn't discriminate.

It doesn't mean that that young people aren't afflicted.

The causes are different.

And that's where the important thing is in trying to manage some of the risk factors as we age.

>> So let's get Josh's story here.

This is going back, what, 4 or 5 months now?

How long ago and get pulled that mic up right for me there brother.

There you go.

And January.

Mhm.

Um, so take me through the day if you could.

I'm going to let you kind of tell the story a bit.

Um, and then we'll kind of get into some of the specifics, but walk us through what happened the day that you had your stroke.

>> I was, uh, having a week, a weekend with my daughter.

Um, we were doing a little bit of side work and, um, it was a normal Saturday.

Uh, it was in the process of doing some of the window replacement that was for a friend and, um, my daughter noticed that, uh, I wasn't, wasn't speaking correctly.

Um, that my, uh, my motor function started to kind of fall off.

I, I, to be honest with you, I never noticed any of it.

Okay.

Um, it never even registered.

To be honest, I actually disputed with her that, that it was that way.

I'm fine.

You know.

>> She noticed and she actually said something to you.

>> Absolutely.

>> And you said, nah.

>> I tried to I tried to dismiss it.

Um, and then, uh, then basically just lay down dad, sit down, you know, and I did.

And as soon as I did, um, I immediately started losing sensation feeling and the ability to move the left side of my body.

My face started to droop on the left side.

Um, she jumped right into action.

She called 911 said, something's wrong.

My dad's probably having a stroke or something and you need to get here fast.

Um, Amr or, uh, the people at Penfield, um, ambulatory came right down the street.

They were there very quick.

They immediately identified it as what it was, which is a stroke.

Um, and, uh, and they called the, the Mobile Stroke Unit in from strong, um, they arrived not long after we were changed over at the Penfield ambulatory.

Um, and then, uh, they jumped into immediate action.

They called, uh, you guys will have to, um, please correct me t Caine is that.

TNKTNK?

Okay.

Um, that that was a necessary, uh, action to be done.

And from what I understand, it has to be called in.

It has to be verified.

Um.

>> What is TNKT.

>> And k is a clot breaking medicine that we can give within the first few hours after someone is experiencing stroke symptoms.

>> Okay.

>> Um and, and Evan, in a, I mean, without any hesitation, they, they did everything they could.

And if it hadn't have happened as quick as it did, I would not be in the condition I'm at now, which is pretty remarkable.

>> So you look good, right?

You sound good.

Um, let me we'll get back to that day.

But how do you feel today and how do you feel most days now?

>> I if I had to put a percentage on it, I'm, I'm 85, 90%.

Um, I don't have any physical or motor function, uh, you know, layover from what happened.

Uh, a lot of it's mental.

Um, my memory wasn't great to begin with.

It's a lot worse now.

Um, but any longer?

Me not getting some, some care, uh, would have, would have made the, the, the outcome a lot worse.

>> Can you say a word about your daughter and how remarkable she was?

>> Um, without getting emotional?

Absolutely.

Um, yeah.

When I wouldn't be here if it wasn't for her, you know, I couldn't be more proud.

Um, she's a great student.

She's an excellent athlete.

Uh, she's she's going to spencerport middle school, going to the high school next year.

Um, it's not something that she'd ever been privy to.

You know, we didn't we didn't prep her for these kind of things.

So that was all just her natural instinct.

>> And how old is she?

>> She's 13.

13 going on 30, you know what.

>> I mean?

Yeah.

That is the definition, man.

That's amazing.

>> Yeah.

Um.

>> What a kid.

>> Just, uh.

Yeah, she just last week received, uh, Do the Right Thing award from the county and, uh, absolutely.

Just just a proud parent.

Um, and she absolutely knows what she did.

She's very, uh.

>> I'm sorry.

This is one of those things that words, um, humble.

She's very humble.

So she, she doesn't like the spotlight either, but, um, she knows what she did for me.

>> How aware once things really got going, how aware were you of what was going on around you?

>> I, I was in the moment all the time.

Okay.

Um, I think it really hit me when I literally couldn't move my, my left leg or my left arm, you know, they were, I couldn't feel touch some, you know, the Zach and the guys that were in the unit, um, you know, were routinely asking questions, trying to, you know, get the information out of me that they needed.

Um, I was a cognizant, I was aware, but, um, felt helpless.

>> Okay.

So let's kind of check in with the doctors as we go throughout this story.

So first of all, his daughter notices guys that he's something is up with the speech, right?

Is your speech and is that aphasia?

I mean, is that the word?

Is that the wrong word?

Is that the right word?

>> Yeah.

Aphasia is really dependent on what side of the brain is having a stroke.

Um, you know, if there's something wrong with your speech, it could be the inability to actually form the words or the, or a weakness in the muscles that are trying to sound the words out.

So I suspect what you probably experienced was something called dysarthria rather than true aphasia.

>> Okay.

Um, and how common is some kind of speech interruption in stroke?

>> It's quite common.

It's one of the hallmark symptoms that we tell people to look out for.

Um, you know, we have a mnemonic called be fast, which, you know, B is balance, E is eyes, F is face, a is arms, S is speech.

So it is one of the, you know, the classic symptoms that we have people, you know, on the ready to look out for, you know, there are other things that can cause slurred speech.

So it's not saying that every situation with slurred speech is indicative of a stroke, but certainly slurred speech, plus a facial droop plus starting to have difficulty on the left side, that is, that is a stroke until proven otherwise.

>> Uh, years ago, when I was a reporter in local television news, there was a lot of emphasis when a reporter in Los Angeles had a bout of what I thought was aphasia on the air, and it was an I mean, it was like 30s long.

She was trying to say words, and it was not words coming out of her mouth.

A lot of people called that station in LA asking if she was having a stroke on the air.

I don't I don't have all that in front of me, but I don't think that's necessarily a stroke, though, right?

I mean, the point being that there may be sort of some crossed up, um, indicators that could be different things.

Is that right?

With speech in a moment like that?

>> Sure.

There are stroke mimics, you know, things that in the moment can resemble a stroke.

Um, you know, things like migraines, seizures.

I think, I think the case that you're talking about, I think ultimately it was concluded that this was some sort of, um, atypical manifestation of migraine.

But those are things that would be considered diagnoses of exclusion.

We've got to rule out a stroke or some other brain problem causing that before we make a judgment that this is a not, you know, not a stroke related problem.

>> Um, I had I'm a pretty regular migraine sufferer.

I mean, I say sufferer, they used to be much worse in terms of their intensity, but you know, multiple times a year.

And there have been times where I have not been able to fully form words just for a brief amount of time when aura is really heavy and I feel pretty disassociative.

And my mother one time said to me, are migraines like mini strokes?

I don't think that's correct.

Is that can we clear that up here, guys?

Correct.

Okay, so a migraine is not a mini stroke.

That is correct.

Okay.

Um, but what was going on with Josh was indeed a stroke.

And as you were cognizant of what was going on, were you still unable to, to speak and communicate at that point?

>> There were specific questions asked that I was able to answer.

Okay.

Um, but anything I guess that was, uh.

Uh, trying to think of exactly how to word it, but, um.

>> Let me help you with the question.

Were you able to answer yes or no questions?

Correct.

Okay.

Were you able to speak at length about what was going on with you specifically?

No.

>> Not not the way that I can normally.

>> Right.

Okay.

So but you're you never lose consciousness throughout this.

Is that right?

>> Negative.

>> So so you're, you're kind of aware of everything that's going on here.

Um, what else were you aware of that was happening in the unit on the way to, um, you ended up going to the hospital, right?

>> Absolutely.

>> Yeah.

>> Yeah.

Immediately.

Um, I could definitely tell that we were in motion.

Um, I could definitely tell that, um, you know, IVs were put in.

Um, there was a conversations with the hospital staff going on with the people in the truck at the time.

Um, you know, it's, it's basically like a, a functioning emergency room in the back of a vehicle.

I mean, there's no other way to say it, but everything that happened in there made it possible for, uh, more information to be given when we were at the hospital.

Um, they were prepared.

They knew what was happening.

Um, it's not like I just showed up and there, you know, what do we do with them?

That kind of, um, it felt controlled.

It felt like I, I was in the right place 100%, you know, um, that the right people were there.

It wasn't just somebody who was an EMS tech.

It was somebody who was specialized in what was going on with me at that moment.

>> Amazing stuff.

So let's ask the doctors.

I mean, can you get a better review for what you're all doing there?

That is pretty amazing stuff, isn't it?

>> That is a pretty humbling, humbling experience to hear.

And you're absolutely right, the whole, the whole purpose of the entire staff on that Mobile Stroke Unit, I mean, they are the special forces of stroke in Rochester, New York.

Their only job is to treat stroke, and they are exceedingly good at it.

>> So let me ask an ignorant question then that's related to that.

But sort of before the Mobile Stroke Unit days, if someone is in is going through what someone like Josh or other patients are going through and they end up needing your services in surgery, um, how important or how valuable is it for them to arrive on the premises at the hospital?

And the team already is aware of a game plan versus how much time it would take to kind of go through a diagnosis or a determination of what to do.

>> Yeah, it's all about time, right?

Um, the quicker we know, the quicker we can get the operating room prepared, the quicker we can get the anesthesiologists prepared.

We have our teams coming in, we have everything we need open and ready to go.

And right now our, our workflow is such that if a patient comes in with a Mobile Stroke Unit and needs to go to the operating room, they're barely even stopping in the emergency room.

Wow.

They come right in, they get a wristband put on there, and they go straight down to the operating room.

Because all that communication has happened.

>> Yeah.

And then you want to add to that part there, doctor.

>> Yeah.

I think what we've really done is and Josh mentioned this.

We have essentially an extension of the emergency department in the Mobile Stroke Unit.

So in his case, it's not just getting information which we will then use when someone arrives in the hospital.

We are delivering this tnk this clot breaking medicine on the scene.

So we are, you know, in the concept of time is brain.

We are meeting the patient where they are.

We're not waiting to bring them in and then delivering care there.

We are delivering care.

You know, sometimes within a few minutes of arriving on the scene.

And so really, to give this clot breaking medicine, we need to understand whether the person is having symptoms that are worrisome for a stroke.

And then we need to do a CT scan to make sure that this is an ischemic and not a hemorrhagic stroke.

And then we are delivering that medicine as quickly as possible.

And the team that we have on the unit is outstanding.

Like I said earlier, one of my partners or myself, we will remote in by video so we can see everything that's going on.

We look at the CT scan as it's coming across, and we really have everything between the critical care nurse, the CT technician, the paramedic, the neurologist is joining by video.

Everyone has their role.

Everyone works together and we can deliver care extremely quickly and hopefully have outcomes like we have here.

>> Doctors.

Josh described his left your left side not being able to feel it and use it right?

Correct.

Okay.

Including your face.

>> I couldn't feel the face.

But trust me, everybody let me know that that was happening.

Okay?

>> Why the left side is that is it typically the left side?

>> No, it could be either.

It depends on on which blood vessel is blocked, on which side of the brain.

Okay.

Um, in in Joshua's case here it was a blood vessel on the right side of your brain that was affected, that was stopping blood flow from going to an area of the brain that brought about all your symptoms.

Mhm.

>> Okay.

And how common is that symptom during stroke, numbness or an inability to use part of the body?

>> Very common.

>> Is it every time?

>> Not every time there is variation, but that is one of the more common syndromes.

>> Okay.

Um, can you tell us about sort of the rest of the experience and put a bow on it?

>> Um, one of the things that I actually appreciated the most is, is you guys have all that information.

It goes directly into your MyChart.

So as a person with a cell phone in, in, you know, waiting for whatever in my room or in the emergency, I could also see those pictures.

And to, to answer your question, you asked earlier, Evan, the point where I felt I understood the gravity of what was happening.

Um, was being able to see the white spot, you know, that had been created from the lack of blood flow in my brain and understanding that if the actions hadn't happened the way they did, it would be much bigger.

>> Being able to see.

>> The, the, the, basically the way it comes up on a CT scan and you guys can answer this more than I can, but it's a white spot.

And that white spot is unusable brain for the rest of my life.

You know what I mean?

That's part of where some of my speech problems or some of my memory, um, recall comes from issues with that.

It would have only created a bigger spot on that scan.

You know, that's the thing I understand.

>> How's he doing with that doctor.

>> I think he's he's doing quite well.

I'll just fill in a few, a few simple details.

So what Josh is referencing is, um, certain pictures on his MRI scan, which specifically look at areas of the brain that have been recently affected by a stroke.

And so we could see that there were some small areas of the brain that were injured.

Again, on the right side of the brain, corresponding with the symptoms that he had.

But really much a much smaller territory of brain than we suspect would have been damaged had he not gotten that clot breaking medicine.

And to take things just one step further, when he first came to strong after getting the clot breaking medicine, we did a Cat scan of the blood vessels leading to the brain, and we could see that there was a branch on the right side that was still partially blocked off, and then by the following day, we repeated that Cat scan of the blood vessels.

And that blood clot was completely gone.

So that that medicine did really precisely what we expect.

I would love to say that we could give that medicine and all of that white spot that represents areas of the brain that was damaged would go away.

But realistically, the brain is so sensitive to lack of blood flow, even a few minutes of no blood flow can can result in some injury.

But again, we're confident that that that medicine did a remarkable job at at decreasing the effects.

>> If he had been a half an hour later, an hour later, is there a way to know how much worse it would be for him?

>> Yeah.

So, you know, generally speaking, um, we like to say in our field that during a stroke you lose about 2 million brain cells a minute, right?

>> So I don't know how many brain cells we got.

>> Yeah, yeah.

>> And is that a lot?

It sounds like a lot.

>> Well, I think some brain cells are more important than others.

Okay.

Yeah.

Right.

So it depends where you're losing them.

Um, but for any one of us, we can't afford to lose even one, I would say.

And and two, 2 million a minute, 30 minutes.

That's, that's a lot of brain real estate that's at risk.

And that's the thing about the brain is once it's damaged, we can't reverse that damage.

Um, nothing we can do will bring that function back.

So the best thing is to intervene early and to make a difference early.

And that's what the Mobile Stroke Unit is designed to do.

>> So a couple of questions from the audience here.

Michael.

And Fairport says what procedures can be done on the mobile unit that can't be done on a typical ambulance.

>> So the Mobile Stroke Unit is equipped with a Cat scan.

And if you think about other time sensitive diseases, so things like a heart attack, for example, you know, during a heart attack, it's painful.

Patients will clutch their chests.

We actually have something at most ambulances and most emergency rooms that can measure the electrical activity of a heart, an EKG, a very basic test that we can do that can tell us if somebody's having a heart attack, or is it just real chest pain during a stroke?

There's no pain.

I didn't hear Josh describe pain at all.

Um, and no pain.

>> Not at all.

>> Okay.

We really rely on the neurologic exam and the Cat scan to determine whether or not somebody qualifies for this clot busting medication.

So that Cat scan is a key piece of information for that patient and the neurologist to make that decision.

Now most ambulances don't have Cat scanners inside them.

>> Okay.

>> We can also do every lab that the emergency room can do for making those decisions.

So as we were putting in IVs, your blood was being drawn and there's all this equipment on the Mobile Stroke Unit that we can get all your blood work and stuff processed.

There are medications that are that we use in our intensive care units that are stocked on the mobile stroke unit, that can be used if needed.

So it really is an emergency room or what we refer to as a primary stroke center on wheels.

>> Michael, I hope that answers the question there.

Um, and let's get, uh, Tom says my wife is a two time stroke survivor.

Clots caused by a hole in her heart.

Uh, he says my EMT training saved her life.

And that both times I realized she was having a stroke, but she did not.

Sounds like Josh's daughter.

Uh, each stroke, he says, was caught quickly.

And she has suffered no severe after effects.

Uh, time.

It's how quickly you can recognize.

So Tom's story there and his wife.

Yeah, yeah.

>> I think, uh, you know, Josh, you know, giving his story.

>> Our listener giving his story, I think I hope people, if they take one thing away from today's session, is that you cannot wait to get help.

If you.

If you or someone else might be experiencing a stroke.

We.

We see way too many times where someone says, let me quote, unquote try to sleep this off or let me try to go to urgent care or let me, you know, go to my primary care doctor's office.

You know, if you are having stroke symptoms, you know, this is, you know, do not pass go, do not collect $200.

Pick up your phone, call 911.

You know, because you know, if not, then you know, our options are going to be limited and the outcome may not be as good with any delays.

>> I get the point about primary care or waiting until the next day, but a lot of people, maybe me included, hear the words urgent care and think, well, that's where you should go.

You're indicating that in this case, that's a mistake.

>> I think if you go to urgent care, they're going to turn around and say, you have to go to emergency department.

Urgent cares do not have CT scanners.

And, you know, as we've kind of learned from Josh's story and we've we've talked about one of the first forks in the road for stroke care is we need to figure out if this is a hemorrhagic or bleeding stroke or a non-bleeding stroke.

And short of a Cat scan, there's really no way to do that effectively at the bedside.

>> Okay, so ischemic is a blockage, is that right?

Yeah.

And that's that's most strokes.

>> That is the majority of strokes, in fact, about 70% of strokes would probably fall under that category.

>> And that was Josh.

>> That was.

Josh.

>> Which is why you used the I forgot the letters TNKTNK.

The the and so hemorrhagic something is bleeding.

>> Yeah.

Hemorrhagic means that a blood vessel has ruptured and leaked blood into the substance of the brain.

And the brain has been damaged as a result of that blood being leaked.

>> Um, we'll talk about more about Tia, which is transient ischemic attack in our second half hour, because I already have emails about this from listeners that we'll get to.

Um, but just when it comes to ischemic and hemorrhagic is, is hemorrhagic typically more devastating or is that not correct?

>> I think both strokes can be devastating in their own ways.

Certainly, you know, we can we, we have the ability to treat ischemic strokes better than we do to treat hemorrhagic strokes, because the bleeding can happen in, in various places in the brain.

It can happen with with various sources and the degree of bleeding that goes into the brain can, can be quite devastating.

>> This is where, you know, all these years later, when my dad was 47, I don't remember what I remember as a kid in seventh grade was being told that he had a stroke.

I thought at the time I was told he had an aneurysm or something ruptured.

That sounds hemorrhagic to me.

>> That is hemorrhagic.

Yeah.

Okay.

Yeah.

It's a it's a it's a different kind of stroke, but it does fall under the hemorrhagic.

>> Okay.

I mean, they must have done a great job because, you know, he's 81 and doing fine.

Um, and didn't lose a whole lot of motor function or other things.

But that's why we're talking to the experts this hour, because time is quality of life with a stroke.

And after we take this only break, we're going to come back.

Um, Josh is doing a great job telling the story this hour.

Josh Graves doing better than I thought he would.

I joke because I know him a little bit outside this, and I actually think he looks better after his stroke.

You look great, man.

Thank you brother.

It's great to have Josh.

We are so proud by the way, of Josh's daughter, who I wish was here, but I'm sure she's listening or will listen.

And she should know that everyone is saluting her work and recognizing her dad's stroke.

When her dad did not, and making that call, getting that mobile unit, this mobile unit now, uh, is doing the kind of work of both saving lives and saving quality of life.

And Dr.

Adam Kelly and Dr.

Tarun Bhalla are here talking about what happens during stroke and what we should know.

So we'll take more of your questions.

I should mention, by the way, it's 844295 talk.

If you want to call the program toll free 8442958255263.

WXXI if you called from Rochester 2639994, you can join the chat.

If you're watching on WXXI News YouTube channel.

And if you want to email as always, Connections at wxxi.org.

Coming up in our second hour, it's the WXXI News Friday roundup, and we've got Brian Sharp talking about a battle over the development of the former Irondequoit.

We'll have Noelle Evans joining us to talk about school budget votes that are coming up, and a little bit of Rochester history.

We go back in time to tell you about the Rochester Subway.

That's next hour.

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>> This is Connections.

I'm Evan Dawson.

I want to just mention something that the doctors mentioned during our brief break here.

This is important and this is not me doing PR for medical systems.

This is reality.

I mentioned that my next door neighbor years ago had a stroke and was gone for a few days, came home doing, you know, doing really well now.

Um, woke up in the middle of the night, talked to his wife, said I think I'm having a stroke.

She took him to the emergency room.

He did not go in a mobile stroke unit.

And obviously what your medicine is doing with mobile, with a mobile stroke unit is remarkable.

And it can save lives.

But I think the doctors want to make a point here that whether you're in Monroe County or in a different place, or buy your medicine or wherever you are, if you can't get a mobile stroke unit to you, does not mean that you can't get quality care or that you should immediately despair.

Because I think about my neighbor, I think about my dad all those years ago.

They didn't have mobile stroke units, but the medical systems are doing incredible work.

And I'm just going to give the doctors a little bit of space, because I don't want people feeling discouraged in any ways if they can't get this unit.

Dr.

Kelly, you want to start?

>> Sure.

I think, you know, as you as you just mentioned, you know, we we want people to call 911.

You know, if they have stroke symptoms and, you know, you you may get evaluated on the mobile stroke unit, but we're very fortunate in Monroe County.

We have four hospitals, all of whom have designations as stroke centers, so they can take care of stroke patients.

You know, very quickly.

They're all prepared, um, to, to take care and deliver early stroke care, even as we get out into the Finger Lakes region, many of the hospitals there have have primary stroke center designations.

So the most important thing is just get to a hospital.

Maybe the mobile stroke unit will be the hospital that comes to you effectively.

But, but getting to a hospital and getting care is really the most fundamental issue.

>> Dr.

Bhalla.

>> I would echo that.

You know, I think obviously it depends on the severity of the stroke as to which hospital can treat, um, what kinds of things at any given time.

But if you're having a stroke, the most important thing is recognition of those symptoms.

Dr.

Kelly talked about.

And then getting to your local emergency room as quickly as possible.

>> Uh, Josh, are you surprised at your age that this happened?

I want to talk a little about what you think the cause was here, but are you surprised?

First of all, I mean, you are a young man.

You're my age, man.

That's young.

>> Uh, it certainly wasn't something that I thought I'd have to, you know, look out for.

Um.

I haven't always taken the best care of myself.

I, uh, probably didn't follow up with my primary as often as I should have.

Um, I guess, uh, and being a, you know, 20 year foreman, construction worker a lot of times if, if it's not bleeding, it's fine.

Yeah.

You know, um, and not to say that, uh, um, you know, that I was ignorant to taking care of myself, but I didn't have, I didn't have all the information I should have had.

Um, and also, I think a lot of times, you know, anytime that I was sick or I thought I had an injury, if it didn't get better, it will, you know, um, it wasn't a priority for me to run to the doctor and look for an excuse or look for an answer.

It was it'll get better.

Um, this was not one of those.

It was a perfect storm.

And I got very lucky that I had access to something like the Mobile Stroke Unit.

I was lucky that I was in town, I was lucky that I wasn't by myself, and if I had been out on the golf course and had been this time of year may have been lying there, somebody came up on me.

I mean, it's it's I'm very, very fortunate, very blessed.

You know.

>> What you're describing with if it's not bleeding, you know, we're not going.

That's the unfortunate condition of being a man.

And often men do take more, uh, to actually go see a doctor.

But also, I mean, the nature of your work is very physical and you get used to sort of, um, trying to downplay any bumps and bruises until probably something is really, really serious.

Right.

>> Well, yes.

And to be honest with you, a lot of the work that I specifically do, we're isolated.

We're up on the top of a building.

We're not, um, you know, we often don't have, uh, really immediate access to, to water or even a restroom, let alone medical care, you know what I mean?

To, to the, to the requirement that I would have needed.

I mean, obviously we, we can handle first aid things, but, um, you know, I've been on jobs where, where somebody had a medical emergency and it's, it's, you know, you're getting taken down with a crane or you're getting picked up with a, you know, a fire truck, you know, with a ladder, you know, it's, uh, um, yeah, I. I just feel very fortunate.

>> So, uh, yours was caused by a clot, guys.

That's right.

His was caused by clot.

But what do we know?

What caused the clot for him?

>> Um, it was, uh, just a kind of a irregularity with my heart.

Um, it would have slow moments.

And then I had a clot building up in a pocket of one of my artery.

Um, uh, parts of my heart.

Um, and that clot eventually made its way through up to my brain.

>> Is that related to genetics and the lottery of like, luck, or is that also lifestyle, diet, et cetera.?

Guys?

>> I mean, it can be both.

Okay.

And Josh you're comfortable, I think, you know.

>> Mine.

It was both.

>> Yeah.

I think, you know, what we found is that the there were portions of the heart muscle that weren't squeezing quite as effectively.

And blood is not being pushed through that chamber of the heart as efficiently as it should.

And if that happens, then blood is pooling there for too long.

It can form a blood clot, which can then break off and travel to any organ in the body.

But we're most concerned about it happening in the brain.

And the reasons for that, you know, I think depending on the situation, there are genetic conditions that can contribute to that.

There are lifestyle choices that that can contribute.

In many cases, it's some combination of both.

>> Have you made any changes in your life since the stroke?

>> Uh, absolutely.

Yes.

Um, the, uh, the, the medications I'm on definitely help with the, uh, the just natural problems that I had to maybe the hereditary things.

Um, I mean, my, my mom's father passed away when she was 19 of an aneurysm at the sink shaving, you know, so it, um, there's obviously there was medical history there that I wasn't maybe paying enough attention to and absolutely lifestyle.

I smoked, uh, you know, for a portion of my life.

I did, uh, um, you know, some of the improper things that, you know, drank a lot and, you know, certain other things.

And it just, it didn't help.

It definitely added up.

It caught up, let's put it that way.

So, um, yeah, the lifestyle changes are 100%.

They were immediate.

Um, I don't think you get a bigger reality check than that, you know.

>> Um, well, I, I appreciate the honesty there and, you know, it sounds again, you look great.

You sound great.

Thank you.

I'm glad you're feeling good.

I mean, this is a weird question, but do you wake up feeling like you had a stroke?

>> Um, not, uh, no.

Uh, I would say it happens more throughout my day.

Um, when I just can't be as articulate as I want.

>> So it's memory or articulation of words.

Yeah.

>> I definitely don't spend as much time on myself as I used to.

I have a lot of people helping me with that.

Um, and, uh, and also it's just, um, you know, staying on top of whatever is suggested by the physicians that I'm with, you know, um, not pacifying it anymore.

>> Uh, so just briefly before I get to some emails, doctors for people hearing not only Josh's story, but some of the definitions you're giving them about what's happening with stroke.

Is there a basic lifestyle set of recommendations?

Is it simply, you know, exercise, eat?

Well?

I mean, is that related or any more specific than that that you'd want people to have?

>> I mean, I think there is a lot of that, but there are things we can't control.

Despite doing all of those things.

And stroke is one of those things that that can come out of left field.

Um, you know, it does have a penchant for the elderly.

But again, like, like we said earlier, um, we see young patients all the time and it's a combination of things we've inherited and combination of the choices we've made.

Sometimes you can do all the right things, but things are out of your hand.

>> Dr.. >> Yeah.

I think there's never it's never too early to start instituting healthy lifestyle habits.

You know, staying active, physically eating healthy.

Um, you know, those things, you know, done in our 20s.

30s will pay off, you know, with big dividends down the road.

I think a couple of concerns.

We are seeing strokes more commonly in younger people, even though it does skew towards an older population.

And, you know, there are theories that maybe the typical risk factors like high blood pressure and diabetes that we used to, you know, just attribute to older age we are seeing at younger ages.

Um, and I would say if there is one medical condition that people can work with their primary care doctor on earlier, it's high blood pressure, you know, that is something that is that is a can that is proverbially kicked down the road for a long time.

And I would say, you know, if that is developing in someone's 20s or 30s, it needs to be treated then.

>> Josh, did you have high blood pressure?

>> Absolutely.

>> Even before you knew.

Okay.

All right.

So, um, so that's very consistent there.

Mark emails to ask, is TIAA stroke?

So we talked about ischemic and hemorrhagic stroke TIA transient ischemic attack.

Mark wants to know is it a stroke.

>> It is.

It's it's a it's a transient meaning it's short lived ischemic in the sense that there's probably a blood clot involved that's at the center of it.

Attack means the brain, the brain is suffering.

And the key there is that it's temporary, but it could be heralding a larger stroke to come, which is why all tias should be taken very, very seriously.

>> Okay, so Mark, there's your answer.

Now, let me get a couple of other emails that are related to that.

Um, um, sorry about this guys.

Email just kicked out on me here.

There we go.

So I don't know if this is related.

Shawn and Fairport says I had a nasal MRI and the doctor said that there was evidence of micro ischemic damage.

Two doctors said this was not uncommon and nothing to worry about.

I'm 67.

Should I be concerned?

>> Well, I think this is a scenario we see quite a bit where someone gets a Cat scan or an MRI scan for another reason, and in doing that, we take some pictures of the brain itself and we, you know, find things that may or may not warrant attention.

Microvascular disease is a pretty common finding on an MRI scan.

It's often attributed to the effects of things like high blood pressure or diabetes, or smoking, things that preferentially affect these microscopic blood vessels in the brain.

You know, again, it's it can be common in people, but I think a lot of it would depend on the actual extent of it in this individual.

And so I think it's something that, you know, might warrant attention from a primary care doctor and at the very least, make sure that these things that we know are attributed to microvascular disease, like high blood pressure, smoking, et cetera., are being addressed.

>> I should have done my usual caveat.

When I have doctors here, it's really hard to diagnose patients over email, the phone, et cetera.

And you know, they're giving you general ideas that they would give to anybody in general circumstances.

So, Sean, I do appreciate the email and it's a very good question.

I mean, it's a very fair question to be concerned about, but, you know, talk to a it sounds like talk to a primary if you want more information and kind of go from there.

Correct.

Uh, al writes to say just over a year ago while on vacation, my wife suddenly had no idea where we were, how we got there, et cetera.

It was scary for both of us.

Fortunately, she did know still know who I was.

We went to a rural hospital and they did the tests that they were able to and pumped her with numerous numerous IV fluids.

After several hours, her mind cleared up, followed up with a PCP, and had more tests.

When we came home with no real diagnosis other than Tia.

My question is, going forward, what can we do to keep her healthy?

If this was in fact a stroke?

So before you get to Al's primary question, let me just ask up.

Listening to his story, can you see enough if when you go to your PCP, if you've gone through what they've gone through, can they see enough to say, that's definitely Tia or that's probably Tia?

How do you know it was Tia after the fact?

>> Yeah.

This is.

>> Uh, or do you know after the fact or can you only conjecture?

>> This is a tough one.

>> Yeah, this is a tough one.

So I think it it's hard, especially after the fact when when we're not seeing a patient in the midst of their symptoms.

Um, you know, it's, it's hard to go back even with really good history provided by a family member or someone else.

It's hard to recreate exactly what's going on.

By definition, as Dr.

Bhalla mentioned, a Tia is a transient event and will not leave any kind of mark on an MRI scan if it leaves some sort of mark or injury, it's no longer a Tia.

It's actually a bona fide stroke at this point, so it's hard to prove that something was or wasn't a Tia.

Sometimes, out of the proverbial abundance of caution, you know we will, especially if someone has risk factors or anything else that makes us more suspicious that someone's had had a Tia.

We may institute stroke prevention strategies.

We might ask them to take an aspirin.

We might have them focus on blood pressure, cholesterol, the types of things that we know, if left out of control, can contribute to more tias or strokes.

But again, I think it would really depend on the context and the situation for that patient.

>> I think the key with Tia's is if, let's say you are unfortunate enough to have one, the key is to get a complete workup that there isn't a larger stroke down the pike that's going to come and harm you.

I think what Dr.

Kelly said is very important.

Is that a Tia does not leave a mark on the brain, but it can potentially signal that there is something going on that in the next few days, you might have a larger event.

So that workup is very, very important.

>> Yeah, I think it's not a perfect analogy, but I think what will maybe resonate with people is this is sort of like the equivalent of angina before someone has a heart attack.

So someone is having symptoms that may be a precursor or, you know, a warning for an impending heart attack.

That's not to say everyone who has a Tia is going to go on to have a stroke.

Most people, in fact, are not going to, but they are certainly at higher risk and should be evaluated accordingly.

>> Okay, let me get a few more questions in.

If we've got time.

I think we do.

Jillian says that, uh, she says, I suffer from migraines.

I understand a migraine is not a stroke, but I've been told that migraine with aura can cause stroke in the future.

That's what Jillian is asking about.

Doctors.

>> Yeah.

Migraine with aura is considered a a risk factor for stroke.

It's probably not to the extent of some of the more traditional risk factors that we, you know, have been familiar with for a long time, smoking and high blood pressure.

And, um, you know, things of that sort.

But it is something that does seem to, to confer a risk.

That's not to say that, um, that again, that it's likely to happen.

The incremental risk is probably quite small.

And so I would say patients, you know, in that category, this is a situation where again, if you are at slightly higher risk, let's control the things that we know are associated with a higher risk.

So your blood pressure, you know your smoking, you know your lifestyle, those, you know, those are things that we would want to address and everyone.

But I would say someone with migraine who might have that slightly increased incremental risk, we want to be even more, you know, more intensive about controlling in those situations.

>> Okay.

Yeah, I think this comes back to the earlier point that you were making, is that what leads to a stroke is really a combination of genetics and acquired risk factors.

And there are things you can control and things you can't control.

We can't do anything about our genetics, but we can do things about the choices we make.

>> Jillian, I'll also just tell you, as a migraine sufferer, I used to get two migraines a year and they were big ones.

Aura, a lot of pain, dissociation.

Now I get a lot of smaller ones.

Always aura, often no pain.

I don't know why.

It's been a long time since we've talked migraine on this program, and maybe it's a good time to kind of call your colleagues over there and get an update on what we know about migraine, because still a lot of mysterious stuff with the brain.

The brain is an amazing thing.

Uh, let's get one more here.

This is Barb.

She says my husband and several members of extended family have had a stroke in the last 13 years.

The day my husband had his stroke, I was not home.

He called me and said, where are you?

I told him and he said, well, come home.

But his voice was off.

I asked, are you okay?

And he just kept repeating, come home, come home.

I immediately knew he was having a stroke.

I kept him on the phone and then on a separate phone.

I called an ambulance to go to the house.

They had him at the hospital within 25 minutes and a Cat scan was done.

Within 15 minutes he could say yes or no, but not too much else.

We pulled up at the same time he was sitting up on the gurney.

I understand that you should not have a potential victim lie down.

He was able to say yes or no to questions, but not much else.

And we spent three weeks in the hospital, followed up by six weeks of inpatient therapy, followed up by three months of extensive outpatient therapy.

And over the years, some continued therapy.

I would say he's come back at about 75%.

Therapy is very, very important.

But someone who has had a stroke generally does not have the same cognitive or physical aptitude to do therapy on their own as maybe an athlete.

Would they need guidance and help and an advocate?

Um, so that's from Barb a lot there.

She mentions one thing that stands out to me real briefly here is she said she understood patients should not lie down.

Is that correct?

>> Yeah.

So if.

>> You think you're having a stroke, don't lie down.

>> I don't think that is a that they should lie down in the field.

I think if we're going to have patients lie down and there there are benefits to patients lying down under controlled circumstances.

What we're worried about in patients who are having stroke is their ability is their ability to swallow.

You know, can they protect their airway?

What we don't want them to do is we don't want them to aspirate and then have pneumonias and all those kinds of things that can compound the stroke on top of there.

But I think that that journey that was just described by, by, by, by Barb is actually quite acute.

And it's, it's, it's quite telling.

And it tells you how long that journey for that stroke patient and their families really is, which is why I think it's so important that the earlier we can make a difference, we can likely shorten that journey for that patient to recovery.

>> I hope that as we've gone throughout this hour, it's clear to the audience that time really, really matters.

Josh has made that point.

You might see him in a starring in a social media campaign, making that point, um, very appropriately.

So I'll give you about 30s.

Anything else you want to leave with the audience here?

>> I 100% agree.

Um, with Dr.

Bhalla, I was out of the hospital for days and I've been, I was back to work in a month and a half.

So, um, you know, time is of the essence.

The other thing is don't take for granted that we have all of this, this great medical, um, coverage and that we have the people that know what they're doing.

You need to be proactive if you're going to live your life a certain way, then you need to stay on top of it even more so than somebody else.

But the telltale signs check in boxes.

It's there's no reason to, uh, to just be complacent about it.

You need to stay on top of it.

>> You've done a great job this hour.

It's been awesome having you because this story is so important.

Josh.

And I know it's not always easy to talk about, but here's to continued success for you and your family.

And I know your daughter's going to be great.

She's obviously already a very mature young person.

So cheers to her and good luck to you, man.

Thank you for being here.

Thank you.

Josh Graves, a stroke survivor.

And our thanks to doctors Adam Kelly and Tarun Bhalla talking to us not only about the U. R Mobile Stroke Unit, but also what we all should know about stroke and care prevention and treatment.

Doctors, thank you for your expertise.

Great having you.

Thank you very, very much.

>> Thanks for having us.

>> Thank you.

>> And from a well, I was going to say I was going to sign us off here, but Rob, we should do another hour, shouldn't we.

Yeah.

We're on from 1 to 2.

That's what we'll do.

We're going to come right back with a Friday news roundup next.

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