neither the el paso medical society its members nor pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor in order to prevent the spread of the virus we all need to do our part one of the easiest ways to prevent that is by wearing a mask in order for masks to do its job it needs to cover your nose your mouth and your chin first you should wash your hands with either sanitizer or soap and water before putting on a mask then pick up your mask by one of the ear loops to make sure that there's no tears or stains on the mask if it is dirty throw it away immediately if it's intact take both loops and put it over your ears like this and then press down on the bridge of the nose to make sure that it fits and there are no uh gaps once you're done with the mask please take it off the same way both ear loops pull it away and put it either in a ziploc bag or throw it away if it's a surgical mask if it's a cloth mask make sure to wash it with soap and water and keep it dry for the next use do not put your mask down at your chin or above on your forehead when you're starting to remove it as that just contaminates the mask thank you so much for doing your part to prevent the spread throughout the scene when someone is having a stroke it's all about how fast can you get to treatment the title of this program is called time is brain and the acronym be fast we'll talk about that in just a minute during this next hour we have experts talking about strokes and all kinds of people not just those who are at high risk there are strategies and treatments that can not only save lives but really improve the quality of life once you've had a stroke as you know this is a live show so think of some questions that you'd like to call in with this evening the number is 881-013 we are streaming live on youtube just search for pbs el paso and the elf hassle physician this evening's program is underwritten by tenant the hospitals of providence and we also want to thank texas tech pauliel foster school of medicine for providing the medical students to man our phones this evening we have madeleine morris with us and she's already been testing and making sure the questions are coming my way so thank you very much madeline for joining us we also want to thank the el paso county medical society for bringing the show to you each and every month good evening i'm catherine berg and you're watching the el paso physician [Music] strokes it's loaded because there are different kinds of strokes or also brain bleeds there's hypertension it's part of the cardiac system it's part of the neurology system and we've got a lot of information here for you this evening uh we have a veteran with us dr uh kenneth beruman and he is in emergency medicine and then we have sin which actually is cynthian and i love that sin little is with us and she is a neuro nurse practitioner and uh she is a neuro intervascular nurse practitioner i just like the way that's that's put together and it helps explain what we're talking about here this evening um it's something that that sounds simple but when we talk about emergency medicine because you think of strokes you think of heart attacks you think about all the stuff that you see as the emergency doc what is it that you'd like to explain to the audience that you do in the idea of the topic for this evening but also what you do all day every day so what i do every day is just see people that have unexpected illness and so that's what we as emergency medicine people do as far as stroke goes you know we really look at that time of onset is the big thing for us and getting you to diagnostics and then getting to the treatment as fast as possible because as you said time is brain and every minute you're losing a million neurons or glial cells the cells that help keep that structure together so uh literally time is brain okay so every now and again you guys say something i'm like i haven't heard of glio cells before so you said the glio cells are helping to are structural so so it's kind of like the frame to your house so it keeps that stuff intact okay so that's what's happening every minute those start dissipating and everything else the actual cells that actually do the brain work okay you're losing both those cells at a million a minute so that's a huge amount of tissue that's getting lost very quickly so again it's all about the time and if you just think you're having a stroke or if you see somebody who thinks having a stroke we'll talk about a lot of those symptoms and risk factors in a moment too sin i feel so groovy saying that because everybody's calling you that so am i allowed to call you that yes ma'am thank you um so you're a neuro nurse practitioner again intervascular specialty what does that mean to the people at home so basically i work with five physicians and so our job really is when patients are coming through the ed we're looking for large vessel occlusions so if say they're having a stroke we'll do the head ct and the cta and that kind of gives us more information what kind of stroke they're having ischemic versus a hemorrhagic basically work for the large vessel occlusions that's a large clot that's in one of the main like the mcas the carotids the acas and my physicians can take them to the neural lab and we endovascularly will remove that clot okay actually i usually would ping pong over to dr beruman but i'm going to stay with you for a second because i'd like to like right in the get-go from the show define the two major types of strokes so you mentioned there's a hemorrhagic stroke and an ischemic stroke what is the difference between the two and then you can go right into very different treatments of the both so ischemic strokes are um strokes that basically your blood vessels in your brain are occluded by either clot or plaque so then you have decreased circulation blood circulation through the brain so then you have that brain or the tissue damage right the hemorrhagic strokes are the ones where your blood vessels in your head somehow they're they rupture from an injury or from a aneurysm and so then it causes you to have a hem like a hemorrhagic stroke or blood in the brain okay and so here's that difference that i feel like in many of these shows you also hear about people that have brain bleeds but it's not necessarily a stroke is there a way that you can explain that to where because a stroke really is um like you can you can recover from a brain bleed that wouldn't be having to recover from a stroke and i don't know how else to ask that question um because i think of a hemorrhagic stroke but it's still a stroke but a brain bleed what is the difference between there or is it one in the same it's yeah it's just pretty much one in the same way there is a difference between different okay that usually happens in elderly people that fall and it causes some compression still that compression whether it's the hemorrhage or it be the subdural that compression also decreases the blood flow to that part of the brain i see okay can you cause damage okay anything that's causing the lack of blood flow to any part of the brain is really causing stroke okay so on that note as the emergency guy we have somebody coming in now and you can use case studies in the past or what have you but what are the most common types of strokes that you see coming into the er you know faster is probably stroke okay uh that's this primary one the diabetes and hypertension really seemed much more unbeatable shall we say well unlucky to get it so that's what i definitely see more you do see some hemorrhagic strokes but for the most part it sees phoenix okay so if you have an ischemic stroke somebody's coming in um and let's say luckily they're with someone they're they're with an hour let's say from the onset of the stroke and i'd like to maybe now with both of you kind of go through the time so maybe somebody's there within an hour within two hours within three hours and what the differences are with those time lapses when somebody does it when they're finally able to get to you so the first thing i would say is anytime you notice anybody having these symptoms is your darling 911 okay that's how important this is you're not waiting to see if it fits better you're not waiting to see you know are they going to get worse or come back because all that period of time is getting worse the longer you wait the more tissue you lose so what we do essentially oftentimes we're going to ask you come in via 9-1-1 that's what the service is there for they're going to get to us faster when we get them from 9-1-1 the 9-1-1 service causes those it's a suspected stroke so we activate the team we clear the cath lab i mean the ct scanner and we get ready to take this patient through the patient comes in as long as they're breathing they go straight to ct scan so we start doing the study there and in our facilities what we have the ability to do is go over and actually assess the patient within the cat scan and we also have what's called tele neurology so we have a neurologist it's going to be a specially trained uh neurologist to take a literally at the avidia screen right there in the room where you're getting scans nice so everything happens very quickly uh including we have pharmacy there in case we need to give you the plug right yeah and we have lab there to draw your blood and so everybody comes in it's pretty much as we would think of a trauma team when they bring in a trauma well this is a stroke team when you bring in a stroke so everyone jumps right on so i like what you said too call 9-1-1 um and this is where i think it's so important i'd love for you to both of you to kind of talk about how important that is because once you're in the ambulance ambulance can call in as they're driving you to the hospital and give a lot of this information ahead of time which is something you can't do when you're in a car or your partner's in the car driving because some people think oh i can just drive myself or i can get my husband to drive or whomever so 911 is so important and if there's anything else you want to sell there that's right i think that's the big thing is 9-1-1 you're not going to call your husband and say hey my face feels droopy or i can't move my right arm right but the key is you know something's wrong and the key is just call but the service is there plus they run what's called code 3 meaning they get to run through traffic lights they get to get you there faster your husband or spouse or your next-door neighbor is not going to be able to do this exactly and if you go bad on them and you can't breathe any longer that's what happens your neighbor's going to feel horrible 9-1-1 we know how to take care of that problem so you can help you all the way through the process i like how you said that guess what's going to happen you're not going to die your neighbor is going to feel bad i kind of like the way he said that there and dr baruman talked a little bit and said if i can have you talk about again sometimes you don't know somebody's having a stroke sometimes they themselves don't know they're having a stroke so symptoms you talk about drooping your slowing speech etc throw out as many things as you have seen happen with people that have come inside well i wasn't sure you know we could talk about some of those because that is sometimes well do i call my number one why not will this just go away talk about some of the other symptoms too well you know we use the acronym be fast right so b means for balance um sometimes patients or an individual has trouble walking they're dizzy right so e is for eyes so vision changes sometimes we've had patients lose vision in one eye and then within a minute or two it comes back they think it's nothing and that's kind of recurs to a stroke double vision blurred vision so any visual changes it's not normal something's going on right um the f is for facial droop so sometimes a family member says oh yeah i saw that they had a little drooping at the corner or they were kind of drooling it went away within 10 minutes so that's kind of a telltale sign you'll see the drooping um arm or leg so sometimes they'll have um some weakness or they totally go flaccid right they can't move or they're picking up their cup and then they can't they just drop so i've had patients before say well i was in the kitchen i picked up a cup it totally dropped i didn't think anything of it that happened the day before and then the next day it gets worse right so s is uh speed uh oh no i'm sorry slur speech right so sometimes they have sort of speech they have trouble speaking or they're trying to speak and nothing's coming out and then t is for time so immediate like he said dr baroman said call 9-1-1 because these are symptoms that can get worse sometimes they do get better um and that's interesting they said you know somebody dropped a cup and you know yeah the next day they're at that point and i guess this is where i'm coming to because i did i know we want to dedicate time to time tonight um if someone has let's talk about mini strokes like there's mini strokes many heart attacks i feel like nothing's a mini stroke but when you hear people say that what what is that physiologically compared to a major stroke and i know i'm not using the right words but you will hear that right and left mini stroke a major stroke how would one explain a mini stroke so we call those tias or transient ischemic strokes right so sometimes they're just precursors to a big stroke right so a lot of patients that i've seen in the hospital when i'm you know they've been admitted and i'm doing my history they'll say oh yeah like a week ago i kind of had the drooling or my spouse noticed that i seemed a little confused or i was a little numb i felt numb and tinglies on my left arm and now today i couldn't move it it kind of made me you know kind of upset i was dropping the cup so these are things that are kind of they're trans they usually last less than 24 hours okay and then once you get to the hospital is there a and dr broome wanna ask you this is there's some kind of a test you can see oh well there was a mini stroke what is it that does show up in tests if anything usually a stroke won't show up until weeks to a month later oh my gosh you won't see the damage show off on an mri for you know a couple weeks up to a month uh so usually what you're going to see on an initially is going to be bleeds okay so that's what we're looking for is that's essentially is people will have symptoms one time and then they'll blow it off and then the next day it's much more so if you have any neurologic symptoms even if it goes away that needs to be investigated so we will study you within 24 hours of any symptoms and saying we're going to treat you just like you have an achieved stroke so if you're coming in and you have an acute stroke and let's say this is an ischemic stroke um again you're going straight to the cat scan from there what are some of the most um common sources of treatment i mean the iv if i remember from last time you're trying to something like a de-clotting type thing yeah there's g-clouding medication that actually eats away the clot uh there's tpa and then with your outer place i believe and then connect the place is the newer one that's gonna be a one-shot drug that's just been approved and something decisive moving forward tell me what that is so it's another drug that we use to heat up clots uh it's a little easier in that it's a single dose and not a grip so that's great i think that's going to be really helpful in our rural areas and areas that don't have stroke centers like we have in our castle so we'll be able to get those kind of treatments out to more rural areas and is it an injection is it okay okay i like the way said that sorry i've got some questions here coming in from the audience i'll let that go for just a second um so here here's a question i don't know if anybody can really tell but the cause of a stroke so there are risk factors in fact let's start there let's talk about risk factors because we were talking about here we've got hypertension we've got diabetes um in general there's family hereditary uh issues but what are some risk factors for people to know you know what i'm one of those people that's prone to stroke a lot of the chronic illnesses right we see diabetes uncontrolled right hypertension high cholesterol heart disease uh kidney disease anything that kind of is vascular in nature can cause infections you know can cause any strokes and how about genetics when it comes to my dad had a stroke my cousin had a stroke my uncle had a stroke how much is that that runs in the family i know there's a lot of behavioral issues behavioral you know things that you can do but just genetics in general so it's not really hereditary it's more the risk factors the chronic illnesses that are uncontrolled that will cause you to be higher risk so this really is something that you can take on and try to prevent yourself if you can ask behavioral modifications okay [Music] because that's where again that gets confused with a brain bleed with a hemorrhagic stroke what is an aneurysm so on that note describe what an aneurysm like give the definition of an answer so the aneurysm is like a think about your garden hose and as your garden hose gets older it gets too much pressure you get this little blank on it and it pushes out and looks like a ball on it that's what an aneurysm is it's a blood on a vessel and it's a weakness in the wall so eventually that weakness can give way and erupt or your blood pressure gets so high that makes it erupt so now you have this weakness and your water pose it now bursts and now you're spilling blood into a vault with your skull it doesn't hold very much blood right because there's a brain in there so it doesn't take a lot of blood to really sleep them down within 10 cc's of blood you're going to do a lot of damage just and that just so cc's is how much if you're looking at this cup of water don't tell them that their brain strength what is wrong with you do you not know our demographic here we're sensitive to those kind of things no but that's a good point though so there will be a little bit more fluid than someone who's are there any screenings that you can do for this i mean we're talking about aneurysms that is something that can run in families and i know with coronary heart or artery disease there's type of screening that you can do is there any kind of screening for this this type of a situation and any strokes really you know um you don't routinely screen and the gold standard would be a cta right of the head but i know a lot of times when we're treating our patients with aneurysms we do ask them do you have family members and sometimes they'll say yes sometimes they'll say oh my father died my great grandfather so if there's you know two or more then sometimes we'll say you know what maybe you guys you know sometimes i think i'm trying to remember the the physicians i work with i think once or twice we've said you know what maybe the other siblings should get tests or should get a cta only because i think there were like seven siblings and three of them like two have passed away and then we had one as a patient so they had a high incident in their family but um it would be doing a cta or an mri you would see the aneurysm and there really wouldn't be a year when you do that so i always think about screenings and preventative stuff cycle age 50 is when you start doing everything yeah just go to the doctor and check off all the lists um but i think in a situation like this you just look at what's going on your family and again lifestyle which you already have is this mobility so to speak and all of that um we i'd like to talk to you you're part of this team you're talking about the doctors that i work with and you have a bunch of doctors you're working with so you are in the emergency department uh you're in the neurology vascular department but it takes a team when somebody comes in and again i'm thinking emergency i'm thinking time who is it that stands next to you your team as somebody is coming in and they have you're assuming there's a stroke or not assuming the ambulance has kind of said okay this is what we're looking at right now who else is on that team with you and what are they doing so when we're calling it's the physician there's a phlebotomy check there's the administrator there's a ct check so all these people kind of come into the room at the same time we all try to work at the same time and the key again is we're going to try and push you to that cash center as soon [Music] i'd rather have six or eight people there instead of one i i would kind of feel it so i'd like to um talk about relieving pressure i know that we're talking about ischemic but like hemorrhagic strokes um and there's there's bleeding in the brain whether it's an aneurysm there's just there's pressure in there how is that pressure relieved you have to go in there and release some of the pressure take part of the skull um i know i'm getting gory here but it's interesting to me it's fascinating typically you put what's called a ventriculostomy and it's a it's achieved it's a bolt it goes into an area of the brain that's called the ventricle that has fluid in it and you can extract some of the fluid that way uh if it's a subdural hematoma then you can wear a hole and let the blood out that way so um but a lot of times it's a matter of just control not necessarily going in and taking out the blood because the blood often sometimes it's not a not a big so it's controlling that bleeding controlling your blood pressure so that baby gets controlled rather than going in and trying to stop it now there are ways of stopping it if it's an aneurysm those kind of things that we have that's what we call sin and perfume let's talk about the machinery and the catheters and all the toys that you get to uh work with but again i'd like to kind of stair step for the audience of what it is that that you're doing so in reference to the hemorrhaging yes yes so um if it's a subarachnoid hemorrhage a lot of times um we'll look at the cta so my dogs will look at all the films and kind of see sometimes they'll know where the aneurysm is because you can see it or sometimes we'll just have to take them to the neural angiosweed and we do a cerebral angiogram so a lot of times i'll explain what that is so so we'll either go through the one of the arteries in the wrist or in the groin and we take a catheter he access it and then goes up to the artery to kind of the subclavian or the subclavian and then we go through the carotids and the vertebrals in the back and they kind of shoot dye and it kind of we see the perfusion of the brain okay so then we can see where that area hemorrhages and he can get a better look of the ruptured blood vessel or the aneurysm there's two ways with depending on how large it is we'll either put coils in which are like little springs like if you know a ballpoint pen you pull that out but they're very very small and delicate or they use stent which is a flow diverter so again he uses the pipe or the hose you have that little rupture that so the stent goes in the main uh hose area so it blocks off that blob that has ruptured then over time it just kind of adheres to the area and so it stops that uh flow to that open area and then it coagulates and then it slowly so i'm trying to think of when so depending on how large it is we always if we're putting stents in um and coils sometimes we'll put them on aspen and plavix those are anti-platelets um just depending on how large the bleed is if we put a stent in we do have to use aspirin planets and sometimes it's depending on where it's at it's three to six months okay so that's a good amount of time okay so would that be something that would help preventing in the future for example if somebody has a hemorrhagic stroke is this something that they may get again i think with aneurysms you can see that because that watering hose if it's not doing too well i can see how there'd be another and another is that something to look out for again if you had one hemorrhagic stroke that you're probably prone to another one or is that not necessarily the case uh yes and no so sometimes there is depending on again the risk factors and we're always doing the behavioral modification and we'll tell them you know if they're diabetic this is you have to control your diabetes if you're a smoker you have to quit smoking if you have kidney disease you have to control that hypertension you have to control your hypertension any of the chronic illnesses exercise lifestyle like healthy diet so these are all things that we can control and the same with having a hemorrhagic versus ischemic if you've had one chances are you may have another one but you got to control those risk factors exactly and that's that's nicely put too uh doctor i'm gonna get this guy i know the audience can't see him but man there's a guy that's just doing this all over the place thank you guys for chuckling cause i know he's been bugging too when when we're looking at again the treatment as an emergency doctor we talked a lot about you know the risk factors diabetes hypertension but there's a world of neurology here too that i think a lot of times we just don't think about with strokes um and i'd love for you just to address that so neurologically when a stroke is happening in the brain that's what you're looking at you're talking about neurons getting just dying you know there's a point where brain is time time is brain talk about that and the damages because you think of people having a stroke then one side of their body doesn't work i remember that when i was a kid my mother's you know friend had a stroke and that's what i remember so in my head that's what i always think it's like it's a huge neurology thing but we don't talk about that in prevention and i don't know if that is a prevention question well i think it's lifestyle changes and just healthy healthy healthy things that you should go see your doctor every year you know get your blood pressure checked know what your risk factors are avoid smoking in the youth people that think they're useful and using cocaine that should keep your blood pressure up and then ruptures aneurysms i mean it's just a matter of being wise and thinking about your health overall um these ones where they don't move their arm forever that's often times a large vessel occlusion which is what the sims team comes in so oftentimes you you can tell this looks like a large vessel they're staying off the runway and their their bodies flashing another i can tell right away i'm going to call her because that's that looks like a log so after a while you get to recognize strokes as they come in so i'm again you're good at transitioning because now i'd like to talk about because i don't feel like at least the last several shows that we've had regarding strokes that the quality of life and the rehab after certain strokes has really changed and been dramatically better over the last decade or so what is it now that you are able to do to help regain uh some of this neurological damage is that is that even possible actually neurological damage but i know that there's rehab and trying to work things through so talk about what your team does afterwards i think again we go down to the basics uh you start having numbness tingling or any of these symptoms getting to the hospital quickly right calling and getting so that you can be treated the quicker the better and whether it's a small vessel or large vessel we're able to remove the um clot or help that it's multi-disciplinary so speech and occupational therapy and physical therapy are working if not later that same day at least the next day so we're getting them out of bed we're moving them and it's very aggressive and you know we don't know within 24 48 72 hours how much damage is because sometimes a stroke can still kind of expand and some of the tissue can still die but it's just that hurry up and training your brain to get moving especially you know communication is key so we're already you know even let's say we've done endovascular treatment um let's say they did it i had a patient they were doing it in the morning right so he did it like three a.m and i'm in a rounding at eight um speech is already there at nine and he's exhausted but they're still working with him trying to get him to speak um they get frustrated right away this is the day that they've come yes the faster the better because if they can tolerate it right um of course if they're more severe they're still intubated you know they're just very unstable um so we're looking at their blood pressure we're looking at their heart rate so if you're getting up and moving in their blood pressure shooting up and they're very tachycardic then we're going to let them rest but a lot of them can tolerate it that same day and i think that's important is you got to train your brain again to start moving so and it helps them and sometimes they get frustrated but um you know the more you're working at it it's almost like sometimes you have to learn like you're a toddler and i don't mean to you know offend anyone and kind of compare them to a bait but as an adult especially older we have to relearn some things we did have a patient who was he had a severe stroke he had right-sided hemiplegia so he wasn't able to move him and he wasn't able to speak after 24 hours we were able to go in and remove the clot and after 24 hours he started to be able to speak a little better speech was in there he was getting very frustrated he wasn't able to move his arm so they were telling him different ways to help right so if you don't move a limb and guess what it just gets flaccid it's not going to work right so they were you know doing passive range of motion they were making him move it with his other arm every time i go around he was doing it um he was there for about two weeks and he was able to be discharged home with home health but he was able to speak a little bit more clearer um and he got most of his movement back on his leg and his hand was he was actually able to move it a little bit so he was improving um sometimes it takes these patients six to nine to one year to recover so it's not a quick recovery and we just have to reiterate to them that yeah you're frustrated but these are things you need to do to get better um and just you know be there and support this charge um and i guess this is something that senator hospital's providence does is send people home are there people coming to his home to help him then do some rehab just and maybe you can explain some of the exercises some of the things that you are asking the patient to do like you were talking about if they can't move their arm then they would physically move the arm themselves what are some of the other things that you teach them to do re-teach i guess so case management is the one who really works on the discharge planning so from day one we're getting them there so that they can help them with district planning what are their needs and what other families needs if we feel that they can't safely be discharged home and the family can't care for them then we try to get them into inpatient rehab and they're doing three hours of inpatient rehab daily they're tired but it's really aggressive and it's good for them right um sometimes they're able to go home like this gentleman was and then they'll go pt ot and speech will go to their houses um it depends sometimes it's you know two to three to four times a week right or they'll go and drive there um and we basically uh some of the patients um you know it's the movement of the arm we're having them sit up in chairs um we're having them feed themselves with the affected arm as much as possible some of uh some patients i remember having a hard time speaking it's more slurred so we have them read out loud so they can hear themselves some of our patients that have trouble speaking or have trouble kind of expressing themselves we've had a young girl and i can't remember why she had a stroke uh it was when i first it was like four or five years ago um they actually her parents bought her a ipad and she was texting and it was kind of helping her brain so she was able to actually write and then i think a year year and a half later she came back and she was able to speak so we use everything that they can do i mean we have wonderful therapists there we have wonderful speech therapists that work up in a rehab we'll call them for um advice sometimes they can't express so then we'll get them white paper with a marker and we have them right right so just because they can't speak doesn't mean they don't understand this and they can't communicate they can still write sometimes it's pretty messy but after a while just training them that way that improves as well so we try to work every patient's individual we try to work as much as possible with them to see what works for them it's very interesting too because you also mentioned uh the word young in there and dr baruman um now that we've talked about the old people we got to talk about the young people right um we were talking a little bit prior to the show starting that there seems to be an uptick in people in the ages of 30s and 40s that are having strokes and it's not so much the ages you were talking about it's it's some of the conditions that that they're in or if you could talk a little bit about that so people don't just think oh now just younger people are getting strokes i think it's conditions it's lifestyle choices it's a you know hypertension that's not i mean young people don't go to the doctor for the most part they don't know what their blood pressure are and that kind of is and there can be a person walking around that's quite young with a blood pressure that's 200 over 110 and they don't know it you don't feel it right so i think the key is to do routine maintenance on yourself uh avoid stuff that's gonna make you get your blood pressure up cocaine i see a lot of cocaine so you said cocaine earlier this is let's talk about cocaine we i don't think we've ever talked about cocaine on the show so let's just throw that together so you're talking about young people yeah people have aneurysms right and now suddenly you're you're using cocaine it shoots your blood pressure straight up and it ruptures those aneurysms you know so stuff like that now the other thing that we started to see and there was talked about a little bit i just didn't see a lot of it was the worry about covet and hypercoagulopathy that was a concern that was put out you know we're going to see a lot more strokes with this and i just don't know the science enough to tell you is it really true did we see a lot more cases i personally didn't see too many cases like that but i don't know enough about the literature to tell you and that's going to be interesting because i talk about it a lot during this year 10 years from now it's going to be such an interesting book to read of what the study is from these will be two to three years and the long-term effects uh talk about long haulers but also in the very beginning of kova you heard a lot of the underlying conditions but blood clots blood clots blood clots um and then you heard about asthma too and it turned out that asthma that wasn't really a thing because if you're controlling your lungs already anyway people who are asthmatic usually have inhalers or whatever if it's already under control then you're pretty much going to be okay with strokes i'd love to expand a little bit on that because that is the automatic thought process that blood clots you think about blood clots with strokes um i'm thinking here arrhythmias afib you know all these other when you watch tv and there's that commercial that says and if you have a stroke not associated with afib what does that mean um yeah i think the big thing with atrial fibrillation is it's what it is the upper chambers of your heart are not really beating so there's four chambers you hire the upper chambers and lower chambers the upper chambers in atrophy but kind of like a bag full of worms so if you can imagine there's bad circulation there you can form a platinum and suddenly that clot moves that's what that's why atrial fibrillation is such a risk factor for stroke because you can form clots in these atria and you can either go to your brain or go to your lung and give you a pulmonary embolism or a stroke and so um that's why atrial fib is such a worrisome thing so what causes atrial fib are so many different things that can cause atrial fib it's usually a conduction problem it's generally a an electrical conduction problem um if there's there's physio there's a electrophysiologist that just do those studies and they can map out your heart and find that irritable area and they with radio frequency just ablate that area so you never have that again i remember the first show we talked about ablation and i remember just being blown away that that's even something you could do i i'm an afib girl i have a heart valve issue so i you know my heart's beating all over the place sometimes it's a butterfly sometimes it's a freight train but it it's interesting to me because when you're talking about the two top chambers and when you're not really beating it well you know the heart's not beating well and then you also now have let's say covid there's some kind of a compromise to your lungs to just getting oxygen to your limbs um with you said you saw a couple of them during this year but not enough to where you thought oh we all really expected that strokes are going to be a thing with these clottings right i think that's what we expected and i just don't know that we have enough data i mean we may very well find that's true but i don't think the data is out there enough to really tell us that that was a big contributor i still think it's lifestyle changes choices young people also they over exert themselves they don't drink enough fluid their body gets the blood gets viscous you know sick and so uh that's the other thing i mean strokes can also be caused by lack of blood flow from a trauma and you don't have enough blood flow going to your brain anything that's causing a lack of blood for your brain will cause a stroke right okay i want to bring in and not that this is a heart attack show at all um but there are a lot of the same risk factors there's a lot of the same types of issues for you know we're talking about diabetes again hypertension just high blood pressure cholesterol etc um when you're looking at someone who is at high risk for a heart attack does that kind of automatically mean they're also at a high risk for stroke is that one in the same in my opinion yes okay okay so i'm asking right now to just advertise to the people out there when you're driving here today and you'll have a little chance to do this later too of lifestyle because we talk about lifestyle but what does that mean i mean even walking five minutes a day i mean be great if you can do 30 minutes a day but feel free to just throw out there what people can do just listening to the show right now it's about healthy eating uh you know getting sleep uh well that's so easy to say geez and uh and some form of exercise i mean we all know it's hard to exercise i have a very hard time exercising but whether it be a walk whether it be a bike ride with your kids whether it be something uh get you outdoors let your mind think and also get some physical exercise in it so you don't have to start off with running a half marathon walk around the block you know a simple start walk your dog go out with your kid whatever it's it's those simple steps that make the difference cut out that extra slice of bacon you know cut out the extra sugar in your coffee i mean simple changes over a long period of time will make a big change and getting a dog years ago i remember one of the doctors just said just get a dog you know and i'm like what do you mean because you have to go walk the dog you have no choice you know so i kind of understand that too um some questions here it's like some sample questions um for people that says here my mom had a stroke and they did a procedure through an iv instead of a normal surgery what does that mean what difference is it to do it through an iv instead so read into that anything you'd like to read into it i feel like your venus girl um and maybe maybe we can talk about the blood thinners i'm not i shouldn't call it that but right away when you get there let's actually dr broome let's take that to you so let's go back to it was intravenous but now it's a shot but it's a one-time shot not something it has to drip maybe we can talk about that so yeah i think there's two ways to think about that one is was did they actually do a procedure intravenously with like when go up with a coil or or a balloon and open up something or did they just give the blood the the blood eating medication the blood clot eating medications okay so i think that's the two ways of treating it now certainly uh if you can treat it with just by giving medication you're far better off than having to go in and manipulate within the brain but sometimes those procedures are absolutely necessary and that's why we have such a great team to be able to go up and do that so when you do give a blood clot eating medication i love the way you say that how long do you wait for that to or maybe not to take effect in order to decide okay well now we need to go in and do something a little bit more seriously are you like the cat scan do you take a cat scan every hour or how does that work you can see it in the patient themselves oh you can so describe that so i've seen it multiple times where the limb will start to get stronger they're able to speak to you so oftentimes before they're even leaving the emergency department after we've given the medication you start to see a difference so you're talking a matter of hours a matter of minutes a matter of minutes minutes yes oh my gosh you start to see the difference okay and again that's why it's so important because the faster we get this medication to you the more brain we save and the faster you're going to be back to normal so literally i've seen people that cannot speak at all and by the time they're leaving my department within 90 minutes of everything we've done they're starting to speak they can move their arm oftentimes even within minutes of giving the drug while the tele neurologist is on if it's a small issue they'll start to see improvement right away it's miraculous it really is miraculous and when you say the tele neurologist are you talking about neurologists who's on the phone watching yeah there's i think telemedicine exactly they're on a big television screen high definition they're able to examine pupils they're able to do everything with a very high definition camera so now is in not only the emergency physician i have a a neurologist on the television that's helping me decide is this a patient candidate for for this for outplays for or connect the place either one so it's very helpful to have two brands especially a neuroradiologist that can take a look at the films and say okay this is what i think needs to be done so if you don't mind expand a little bit more on that and how that developed to what it is today um when you're so obviously it it takes time to get in your car go to the hospital and you know there's only so many specialized doctors here and there is that something that's going to be more and more commonplace in our world yeah i think that's very true i think the ability to to seek out specialists at a distance where you are underserved so say i'm in alpine and i don't there's no way i'm going to have a neurologist there that's going to be able to do that stuff but he may be in el paso he may be in dallas and now i can control that care working together with that emergency room physician in alpine decide you know i need to give this medication rather than waiting three hours to get them flown to el paso and all that brain is dying so i think you're going to see more and more of that being used in certainly in big cities but in rural areas i think it's going to be makes a bigger difference so this is me being a technological nerd so the camera is in the room and the camera is high definition or whatever words we're looking at it and the doctor so who's who's operating the camera is that is a nurse operating the camera is the position on the other side oh he's operating he's able to zoom in he's able to you know look at the different parts of the body uh oftentimes the nurse is in there many times the physician is in there at the same time because like i said every everything almost happens at the same time so everybody's doing the same time i've started my nih stroke scale and uh the tele neurologist has seen everything so he doesn't have to repeat that scale that we used to measure this okay so often times it's like i said it's it's the entire team working at the same time but the tele neurologist is there and he's really the specialist to help us decide you know is this a good candidate for for tpa so how long has that been a thing are we talking five-ish years i think right now with covet all that's extra exaggerated and there's so many things that we we now do learn with covid and efficiency with telemedicine and just the ways of doing things but i can see that being something that's been going on for quite some time well tell me tell your neurology this is probably our second company that we've worked with so it's been around i would say eight to ten years when we started here in el paso that i recall it may be even longer than that but the technology is getting better the cameras are getting better the speed of wi-fi is getting better so as it as it grows the technology also improves and i think that just helps to shrink the time to treatment wow it's so interesting how all this works um i would like to talk about smoking a little bit because i feel like uh smoking is on such a decline which is fabulous and i think years ago too when we started doing shows about heart attacks and strokes that was such a big thing we talked about i think we're at less than i think we're at 17 16 smoking in el paso right now but um talk about what again i think about physiologically what is it that smoking does to the vascular system because i know we were talking about uh your specialty in the vascular system what is it doing to the vessels the arteries etc and why is that such a thing for strokes and heart attacks um wow um so i guess smoking it it's inflammatory right so it's gonna cause damage to the vessels thin an amount um it also increases your blood pressure um so these are all things that are kind of intertwined i always think to myself the the hardening or the the thickening it's like fiber dysplasia because it's fiber dysplasia that's the word little changes in the vessel yes and that and that's what i'm interested in hearing about is is the changes in the vessel so again physiologically what is happening to the vessels because smoking affects so many things um and that's why i'd like to somehow create a picture for the audience of what it is that that it's doing to the vessels i think the way to think about it is they get less elastic okay that's that's it's kind of a it's a it's kind of a naive way but it paints a good picture they get less elastic and they get tougher to work with so they don't have the ability to flex uh to different conditions i mean normally your blood pressure goes up the vessel gets a little wider goes down and gets compressed so think of it as losing flexibility i think that's an easy way to think of it maybe a little too naive but no but that that's exactly what we need to picture in our heads of what it is that's happening because if you're looking at blood flow especially if you're you know you're going up a flight of stairs and you've got the blood pumping you want to be able to have that elasticity there and while you say smoking's going down that's very true but vaping is going oh god bless you for breaking that up yeah sleeping isn't big yes it is yeah exactly so i think we've just replaced one evil with another and uh it's extremely addictive uh as nicotine is i mean so and so i'm glad that you brought that up so people would think you know it's the smoke but it's the nicotine and it's also the 10 000 other chemicals that are in there um so get on the high horse now because i'd like to get on it with you um we passed the smoking ordinance in el paso in 2001. so that's 11 years ago it seems like in that in that point so vaping now for a while it seemed to be that's what the younger ones were doing but now i'm seeing older and older people vaping and you know i think it was advertised for a while this is how you quit smoking and now that's a whole nother new addiction what are you seeing now since that's still relatively new but as an emergency room doctor just a doctor in general what you're reading what is it that you're seeing now with people in the vaping uh just all the consequences of vaping well i see predominantly still youthful people are mostly vaping the older people still like their cigarettes or they they're trying to vape and quit which doesn't work so the biggest changes we see is respiratory illnesses and then uh you know asthma those kind of things now there are pulmonary diseases that are being thought of being caused by vapes because they have a high level of vitamin e in it vitamin e acetate and they think maybe that does damage to the lungs so there are some actual physiologic changes that happen to the lungs due to the chemicals within the vaping material and that's just freaky to me um we have seven whole minutes i've got a question here from the audience and the audience member is taking eliquis for preventing deep vein thrombosis and they want to know does this medication also help with preventing strokes and that's a great question um because again we're trying to think in our head of vascular systems etc and i know that we didn't say that there's a screening for strokes etc but is that just something that like the three aspirin a day or the two aspirin a day uh thrombosis strokes well certainly eliquis is indicated for people that have either a clot in their leg and have a risk of forming clots or have atrial fibrillation and have the risk of throwing these clots it's not a drug that we would put people on to prevent it but those people that are higher risk it's a great drug to prevent the uh to lower the risk of a stroke okay all right sin i'm gonna do this because i try to do it before we get off the air is there anything that we have not spoken about yet this evening that you would like to talk about get across the audience i'm going to come back to you and ask the exact same thing sometimes the show wraps up so quick and it's like oh i forgot a b and c no i think uh i think we've covered a lot i think just it's i think just to reiterate um you have any kind of symptoms even if it's just dizziness and it goes away you need to call 9-1-1 you need to be checked out you need to go to the hospital i mean what's the worst they can say you didn't have a stroke right it's better than waking up in the morning and you can't move your side and if it's possible and i say this because i know it's not always possible but if you have someone around that can kind of watch you and say hey am i am i drooping am i looking funny i'm feeling kind of weird could you notice that too um and what i've just heard from years and years of doing this program is often the person who's having the stroke is not the one that realizes they're having the stroke it's the person they're with um and strokes are and correct me if i'm wrong they're painless so you don't really feel any pain usually uh so the person that you're with is a person who would see what's going on most of the time is that correct a lot of times that's exactly what happens a family member notice a droop or notice their speech is a little bit off or they can't seem to focus on their they're holding their phone accounts so a lot of family members will notice right off the bat and again the key is is that 9-1-1 don't worry about driving them yourself don't worry about any of that stuff just implement the system get stuff started and again why is that because what what's like a little driving hospital that's how i always think of ambulance and some doctors said that years and years ago and it's a mini hospital granted there's not all the things that a hospital has but there's a lot of stuff in there that can be accessed and again the important part too is there is an emt someone who has been able to speak to the person at the hospital yes you have a paramedic you have an emt you have medications to control your blood pressure you have medications that they can be given oxygen that can give you more oxygen to your brain so they and they can drive really fast yes exactly they can go through the lights so i i think that's the the whole idea that's why the ms system was set up and that's why it works so beautifully it's just a lack of use or feeling like you're going to impose you're not imposing that's what the system is there for exactly exactly on that note what is it that we haven't spoken about or something else that you'd like to reiterate before the questions wrap up i think the the our biggest help has been teaching children how to notice that something's wrong with grandma or mom or dad and so we really need to teach our children about be fast because they'll often notice something's wrong with grandma or something wrong with my aunt and so i think we need to take advantage of teaching this we've taught it to adults we need to go out and teach it to the our children in our community yeah i feel like i'm giving you guys a quiz so b is balance e is eyes f is fifth face face drooping you're still getting made your face face i know we're like that's like we're going through now arm or legs and the s is for slurring or speech speech s learning and speech and then the t is time everything is all about the time time is brain i almost don't want to ask you another question because we're starting to run out of time but again just be fast um and i'd love for you to just if you guys go on websites and this is such a big thing if you go on a website see if you can find it ending in dot o r g versus a dot com that makes such a difference when you're looking at it medical stuff because dr google isn't really a thing dr google is a.com you need a doctor.org to help out with a lot of these symptoms and if you want to watch this show backs a lot of times we do speak so fast uh that's hard to catch up but there's two ways to do that uh actually three now you can go to youtube and do pbs el paso and look up something called the el paso position which would be this you can also go to ksustv.org it's also pbselpasso.org they're both tracking with each other right now but it's probably better to get used to pbselpaso.org and when you do that just go to watch programs and find the el paso position you can also do that through the el paso county medical society's website and that acronym is e-p-c-m-s just think of el paso medical society and that one however is a dot-com i have a quick question from the audience is bell's palsy uh and stroke uh what is that you know what we don't have time for that though but do you want to like two complete different things that that helps out quite a bit actually uh madeline i want to say thank you so much to you i know sometimes it gets really crazy over there and i'm looking at my text messages and that's really the questions that are coming our way and i want to really quick because you touched base on this we have like a whole minute left glio cells tell me again what that is so when you're talking about every minute you lose glio cells which is holding that together there's two major cells in the brain there's neurons which are doing all the electrical work and there's gliostrosis which are just construction work okay keeping the cells in place so so i mean both of those are neurologic cells that you're losing so whether it's structural or whether it's the conduction ones they're still both very important okay so that's something i'm going to look up for the next time we have a stroke show because to me there's so many questions just around that in the timing because when you're looking at the 10 cc's and you've got the you know every minute there's a loss there so we've got 30 seconds i'm going to wrap up again kcos tv.org or pbs el paso.org or epcms.com and that will get you to see this show again um and plus all the other shows i mean their shows if you want to know about knee replacements you'll find that on there as well but i appreciate you watching thank you for the el paso county medical society thank you to tenet i'm katharine berg and you've been watching the el paso physician [Music] [Music] you