Seeking Stroke Care In The Time of COVID-19

Intro:
This is the best health podcast brought to you by wake forest Baptist health in partnership with MedCost. Good day everyone. Welcome back to the latest episode of the best health

Host:
podcast from wake forest Baptist health, Justin Gomez. Here. Once again, joining you to talk about another, uh, very timely, uh, conversation piece and, uh, hopefully you'll find it informational and useful. Before we dive into the topic of this podcast, I do want to remind everyone as part of this series of podcast episodes we're doing, um, surrounding COVID-19 and Coronavirus, um, that anyone is more than welcome to visit our wake forest Baptist health Coronavirus, a resourcePage@wakehealth.edu slash virus wake health, that EDU slash Coronavirus or you can call the covert 19 hotline and that is manned 24 seven at three three six seven zero COVID. Now on, uh, that webpage you'll find all kinds of, um, information, resources, myths versus facts, FAQ, [inaudible] updates on clinic locations and um, services provided and um, symptom checkers assessments, uh, all that kind of good information. So invites you to visit that website. If you want to see more. Also on the website there is, um, all these podcasts that we've done, um, surrounding various topics around COVID-19. Um, so this is another one today. I'm excited to talk with Ray the Johnson. She is the stroke program manager for our comprehensive stroke center here at wake forest Baptist health. So welcome Ray. Etta, how are you?

Rayetta J:
Thank you Justin. I'm very well, uh, thank you for having me today on this great stroke broadcast.

Host:
Yeah, absolutely. So, um, Ryan is here to talk about an important topic and you know, as, as health systems across the country, um, have altered the way that they have done quote unquote normal operations and, um, scheduling is a bit different and, and staffing might be shifted around from place to place. Um, but one thing we want to get across to you all today listening, um, is that, um, for people who need, um, emergence or urgent services from wake forest Baptist health, um, that, uh, we stand ready to open 24, seven, three 65. So, um, to take care of those needs. And Ray ETO is going to talk about an important, um, need that, that we are still servicing, um, with full capabilities and that is helping people who might be suffering a stroke or having stroke like symptoms. So Ray ETA, I know this is a, an important topic, um, and you, um, have many years of experience around this as a stroke program manager. So to kick things off, just tell us a little about yourself, um, kind of what you do day to day and how long you've been with Lake forest Baptist.

Rayetta J:
Okay. Justin. Um, I'd be happy to do that. Uh, I've actually been at wake forest Baptist for 46 years now. I came to nursing school here to the Baptist hospital school of nursing in 1970 and I've been here ever since. And um, also have always, um, worked within the, uh, neurosurgery and neurology department. So I've taken care of, uh, patients with neurological emergencies and neurological disorders for 45 years. Um, for the past 11 years I've actually been completely focused on taking care of patients with strokes. Um, so that's, that's been a wonderful opportunity and privilege to be part of our comprehensive stroke center as well as our telestroke, um, program that we have, uh, 20 hospitals across the state that we provide emergency stroke consultations for, which is, which has also been, uh, a great, um, opportunity and a great, uh, service that we've been able to provide our entire state of North Carolina with a stroke expert care from wake forest Baptist health.

Host:
Okay. Well we're going to get into 'em a little bit more specific questions here shortly, but I guess just to start off at a good foundational level, um, remind everyone listening, um, about, uh, our comprehensive stroke center and the services, uh, that are provided here at wake forest Baptist health.

Rayetta J:
Okay. I'd be happy to do that. Um, we are a comprehensive stroke center, so that is a, the highest level of certification from the accrediting body of hospitals, the joint commission. So therefore we are able to provide, um, all levels of care, even even the highest, uh, neurosurgical, uh, type interventions. Uh, so for emergency stroke care, there's basically, um, two major treatments that we can provide as a comprehensive stroke center. There. First there is the, um, intravenous medication called TPA or activate that we can give immediately, um, to those patients that meet the criteria to give that medication. And, and we always say the sooner, the better, that time is brain. So as soon as we can deliver that medication and obviously the patient's outcome usually is greatly improved. So we're always trying to decrease the time from door, the time the patient enters our door in the emergency room, uh, where, where immediately, uh, getting a cat scan, which is one of the first diagnostic, uh, exams we have to do and then get that medicine ready to deliver to that patient quickly.

Rayetta J:
Then there's another, uh, and emergency treatment that we have available. Um, it's called a thrombectomy procedure. And that patient that, uh, is a candidate for that procedure is immediately taken to our radiology, to our x-ray, uh, department, uh, to have that procedure, uh, which our neuroradiologist, um, are able to, uh, actually go in, uh, and abstract or remove a blood clot from a blood vessel in the brain that's causing the stroke. So that, that's, that's pretty amazing cause because I've seen patients come into the workstream, possibly totally paralyzed on the right side for instance. And, uh, then we give them the clot busting medicine, start breaking up the clot, dissolving that blood clot in the brain vessel, and then we take them to this interventional radiology suite. And then we are able to abstract or remove a, uh, a large blood clot from a, a large vessel in the brain.

Rayetta J:
And so we've totally restored blood supply and oxygen to the brain. And, and the patient when they leave the radiology suite is totally back to normal after procedures. That's amazing. Is, it is totally amazing. It's, it's, um, just, um, you know, one of the most, um, gratifying things that you can do as a health care professional, uh, is able to, to see that patient totally, um, come back to normal. Basically, you know, before your very eyes. It's, it's pretty amazing. So, uh, but the caveat here is patients have to recognize the signs of, of a stroke and then call now on immediately and get to the emergency room. So we can do these things because these treatments are time sensitive. Now. I'm glad you said that. Remind us what the main signs and symptoms of a are so that,

Host:
um, if you know, God forbid we or someone that we're with one of our loved ones starts showing some of the signs we might be prepared to, to take action.

Rayetta J:
Okay. Absolutely. That's, and there's a little, um, there's a fast, if you will, a fascinating mind that's kind of easy, um, to remember if you will, if you remember,F is for face. So just ask them on to smile. And if you know, if they kind of have a sideways smile, if they're not able to, uh, bring both of their mouth up. So, um, they kind of have a Quicken smile if you will. That could be a sign that that one side of the face is weak so they can't smile normally. Um, and in the fast pneumonic is a, is for arms. So just ask someone to lift up their arms. If one of the, if they're not able to lift up one of their arms or one of their arms is weak and if they're able to lift it, but it drops down quickly, uh, that, that means that their arm is weak, uh, could be caused from a strike.

Rayetta J:
And then the, uh, third little tests you can do are for the S for speech in fast is just ask someone to say a simple sentence like it's a beautiful day in Winston Salem or wherever. And uh, if their speech is clear, easy to understand, um, that is good. Then their speech center, that means their speech center is not affected by the stroke. But if their speech is like very garbled and mumbled and difficult to understand, very slurred, uh, or maybe unable to speak at all, that's a big sign of stroke happening. Um, so, um, those are are what we call the main symptoms or I guess the most common symptoms of stroke. Um, but just to be, um, totally complete with, uh, all the signs of a stroke, there are two other symptoms that can happen, which are vision. All of a sudden you lose total vision or partial vision or part of your vision is blocked out.

Rayetta J:
Okay. Um, and then the, um, other symptom is balance. If all of a sudden you get really, really dizzy and kind of lose your balance and fall down, um, that's a big sign of stroke also. That's, that's more of a what we called a, uh, push to your circulation strength. Um, but so any of those signs and then the last sign is worst severe headache of your life. Like all of a sudden you had feels like it's going to blow off your shoulders. Headache. That can be a sign of a, what we call a bleeding kind of stroke. So there's basically two types of stroke. There's the blood clot kind of stroke. Okay. And there's the bleeding kind of stroke it just to, just to really simplify it. Um, so 85% of strokes are caused by blood clots, just blocking off the artery in the brain, not allowing blood supply to get to a part of the brain.

Rayetta J:
And, and then there's the other kind of struct that's comp, uh, makes up about 15% of all stroke, which is the hemorrhagic stroke, the bleeding construct that when you have an aneurysm, uh, and one of your blood vessels in your brain that ruptures and bleeds into your brain, or sometimes there's something called hypertensive bleeds, uh, where just, uh, your blood pressure gets really, really high and cause may cause a blood vessel to rupture in the brain and cause a big, massive hemorrhaging or bleeding in the brain. So, I hope that's not too complicated, but, uh,

Host:
well going back to the fast, um, uh, acronym when you touched on FAS and the, what's the T

Rayetta J:
yeah, that's, that's a good question to use for time actually. So every, that means every minute counts. Uh, so it's seen as you have any of those symptoms call nine one one immediately and get to the nearest emergency room.

Host:
Okay. So, um, you know, that's a great segue time. Why, and maybe you touched on this briefly earlier, um, where you said time equals brain. That's, that's pretty straightforward. But why is it so important for people to get in to a medical facility and start getting treatment as soon as possible? What's happening there?

Rayetta J:
Oh, excellent question. Um, 1.9 million brain cells die every minute after a stroke happens though we're losing a lot of brain cells. Um, yeah, so that's almost 2 million brain cells dying every minute. So, so that pretty take, puts it in black and white for me, that, uh, you know, brain cells start dying immediately and we want to stop that because that can continue to occur, occur over many hours. Uh, so as soon as we can stop that, our brain cells from dying, uh, absolutely. You know, obviously that's, that's the best thing to do. So, um, so that's, that's kind of it in a nutshell. We just want to prevent the further death of brain cells after a stroke occurs because there's a, sir an area, it's called a core infarct. There's a core area in the brain that dies immediately when a stroke happens, but then there's continuation of brain cells dying, expanding and, and, uh, dying, uh, beyond that core. So what we're trying to do is prevent that from happening. Yeah. So I think one of the

Host:
main points, um, you all at the comprehensive stroke center we're trying to get across with today's podcast is, um, you know, it's the covert 19 Coronavirus is still, um, you know, in our media cycle almost 24 hours a day if you'll let yourself listen to it that long. Um, and, and there seems to be, you know, some pent up apprehension or, or even fear among some people of, you know, maybe not wanting to go to the, the

Rayetta J:
any emergency department or urgent care facility.

Host:
But you, you're here to tell us and one of the main points is to remind us that that's you, you need to come to the ed as soon as possible.

Rayetta J:
There are stroke signs and symptoms, correct? Correct. Absolutely. Yes, because white forest Baptist health has prepared a very well for these, uh, pendant for this pandemic and we, uh, actually have put a lot of, um, policies and procedures in place. So actually for just the emergency room patients that come in, we now have two separate entrances. We have one entrance for patients with COVID, 19 symptoms. And then we have a separate entrance for all other emergency. So of course stroke patients would go immediately. They would be fast tracked, uh, if you will straight into our emergency room and actually immediately taken to the cat scanner for treatment to start to start the process of, uh, diagnosing in deciding the best treatment for that patient.

Host:
Yeah. So people should not be weighing or contemplating, you know, Oh, maybe this is, I mean, we'll just kind of wait it out for a little while and see if, if this person, you know, gets better or their symptoms kind of go away after a little bit and then, you know, maybe we don't want to go to the ed right away. People should not be thinking that way. Correct?

Rayetta J:
Absolutely not. Yes. We want them to come immediately if they just, I mean, this should not, this pandemic should not really change the way that the, um, community thinks about stroke. Um, that it still stroke is an emergency. We only have a few hours that we can provide these, uh, emergency treatment. So as soon as symptoms start, a patient or person should still immediately come to the emergency room. Um, you know, strokes, don't wait for this pandemic to pass. We're close. People who are I'm afraid are still going to have strokes. And so, you know, we at Baptist have prepared for this. So we've, we've made all these, uh, plans and, uh, protocols and procedures to steel safely take care, uh, of all patients, whether, whether they do have Kobe, we still, uh, you know, are taking very good care of COBIT patients and also all the other patients that are having all the other things that have gone on before Cove. It happened. Uh, so like strokes and like heart attacks and like all these other emergencies.

Host:
Sure. That's a good point, Ray to, um, so great Johnson is talking to us today on this best health podcast about, um, just the reminding us that if, if stroke signs and symptoms are happening, people need to take action immediately. Um, that, you know, and I'm glad you brought that up with, with patient safety. Uh, you know, patient safety is top of mind and a top priority every day regardless of whether I paint and Nick is happening or not. But you know, you mentioned that there, there have been additional policies and procedures put in place to just, uh, make, uh, people who come onto our campus, um, as safe as, as, as humanly possible. Correct?

Rayetta J:
Yes, absolutely. We are, we have done everything to keep the Coronavirus contained and, and all of our patients safe. Um, yeah, so we, we are still as always, uh, we are still protecting and caring for our patients. Um, you know, to the very best of our knowledge. Sure.

Host:
And, um, that's an important point. And, and people, um, should, should listen to Ray at a about that. That's um, please, please do not delay seeking treatment if something emergent like stroke symptoms are happening. Um, Retta also wanted to ask you, you know, shifting back to kind of the, the treatment and, and you know, strokes, there's different severity levels of, of different strokes I'm sure. Um, and so you all are still prepared to care for patients as long as they need patients as long as they need patient care. And, and, um, if you just want to talk to us about just kind of the process of after those initial, um, procedures are administered, you know, if people need longer term care, you're there to help support them through that as well. Correct?

Rayetta J:
Yes, absolutely. Justin. Um, we, we do emphasize emergency care for of course, because stroke is an emergency, but also, uh, we provide care across the continuum of, of stroke. So we have a, uh, dedicated neuroscience intensive care unit. Our stroke patients go to after receiving those emergency treatments that we talked about earlier, then they will be cared for and our state of the art neuroscience intensive care unit. Um, then after their initial acute phase, we'll call it, uh, and there can be things stable and they're doing well, then they, then the patient will be transferred to our, uh, neurology and or neurosurgery, uh, units where nurses are specially trained to take care of stroke patients. Uh, then after moving from that phase, if the patient does need a further physical therapy, occupational therapy, speech therapies, uh, and are a candidate for, uh, inpatient rehabilitation, we do have the sticks in our rehab facility that we can move, uh, appropriate patients and to continue their rehabilitation from stroke.

Rayetta J:
We also have outpatient rehabilitation. So some patients, maybe they're doing very well and they really don't need that inpatient rehabilitation. Uh, they, so they can go home, but they may need some outpatient physical therapy, occupational therapy, speech therapy. Uh, so we do also provide outpatient therapies, um, as well. You know, we, we want the best for our patients. We want them to have the very best outcomes possible. So we tailor our care for each individual stroke patient to, to what will best serve them and will best help them get back to their normal, uh, wives and, and activities in their communities. Yeah, that's great information. That's a, I appreciate you kind of walking us through that, um, this good information for people to realize that, you know, you're still there every step of the way to, to get the patient. Um, um, the best care possible.

Rayetta J:
And actually I wanted to also add this, if you don't mind Justin, that we actually have post-stroke nurses that call patients after they did get home. So like in just a couple of days after the, if they are discharged straight to back home, then we do call them and check on them and see how they're doing, see if they, you know, if they need anything. Cause there's so much going on when a patient's in the hospital, it's just a lot. It's almost overload. Yeah. It was all the information that we give them. So, so now we're, um, actually have a special um, post stroke program that we were calling patients and checking on them and seeing, you know, if they, if they do identify, they do have further needs after they get high and when they have questions after they get home that we can help them with. And then we also of course have followup visits, um, at wake forest Baptist. And I will add this, um, with the COVID, uh, pandemic, we are now seeing more patient, more patients virtually, if you will. So, so patients, you know, may not need to actually come into our clinics for a, you know, person to person face to face visit. But so we can do, um, what we call tele-health or, um, do virtual visits with patients. So that's, that's kind of been a little change also, you know, that we're doing more virtual outpatient visits just to kind of add that to the, to the discussion.

Host:
Yeah. Thanks. Uh, that's great information, Ray, that, um, you know, I did kind of want to wrap up, we're getting close to the end of our time with this episode today. No, maybe one of the best things that you can help us with and remind us is, um, the best way to, to say out of the emergency department with a stroke is to, you know, mitigate certain, um, things that can lead or contribute to a stroke. So if you want to just take a second as we're wrapping up here to talk about, you know, to help us reduce the risk of stroke in the first place. What are some, some tips that you want to give the listeners?

Rayetta J:
Okay, great. Thanks. Uh, yes, absolutely. That's exactly right. We would just love for strokes and strokes are preventable. Uh, almost 80% of strokes are preventable. So very quickly, the things that cause stroke or increase our risk for having a stroke or high blood pressure, high blood pressure is the number one cause of stroke. Uh, high cholesterol, diabetes, smoking, uh, alcohol use. Uh, actually the American heart association does say that, uh, one drink a day, uh, for women and two drinks a day for men, uh, is, is acceptable. Uh, um, elicit drug use. Of course, we see a lot of young, healthy men and women come in, uh, that have been using, um, street drugs and have these massive brain hemorrhages. So, uh, that's not good. And we always encourage, uh, physical activity. So, um, the cheapest activity is of course walking. So offering, you know, 20 minutes, five days a week is, is great, uh, exercise and actually in now, since many of us are, uh, staying at home more, uh, and it's beautiful weather outside, we can all get out and do that, you know, 20 minutes of walking a day.

Rayetta J:
That's great. And of course just eating a healthy diet, you know, trying to eat low fat, low cholesterol diet, uh, eating a lot of fruits and vegetables. Um, and limiting your proportion size is actually is actually a great thing. Like a serving a minute is the, uh, the size of the Palm of your hand. So I'm trying to limit red meats, you know, eating more efficient chicken, uh, this type of things. All of those, all of those things are great, uh, ways to try to improve our health and live a more healthy, if you will.

Host:
Uh, well that, that's great information as well. To wrap up, Ray, thank you so much for taking time and talking to us today about the importance of, of the need for people to still seek out, um, care treatment as soon as possible. If someone, if they or someone they know is, is experiencing stroke signs and symptoms is very, very pertinent and timely reminder. Um, even though we're going through this, this challenging time of COVID-19 and Coronavirus, that you all are, are still there and ready and capable to take care of us should we need it. So I really appreciate your time, Ray. I

Rayetta J:
yes, thank you very much Justin. I really do appreciate and I just hope that everyone listening today will take advantage of our stroke expertise at wake forest Baptist health. Uh, we are here for you and uh, as soon as, um, you call, you recognize those signs of stress that we talked about earlier and call nine one one and get turmeric hearing, we'll, we'll start providing the absolute best care available.

Host:
Yes. Yeah. Good reminder. Read. And if people want more information about the comprehensive stroke center, all they have to do is go to wake health.edu/stroke that's wake health.edu/stroke and um, there's lots of great information and resources available on their website. Um, so Ray, thanks again everyone listening to this episode. We appreciate you taking the time to listen today and,
um, share this information hopefully with your friends and family. And until we chat next time, I just want to encourage everyone to please be well, thanks for listening to this episode of the best health podcast brought to you by wake forest Baptist health. For more wellness info, check out wake health.edu/best health and follow us on social media, wake forest Baptist health care for life.

Please note that this is an automated transcription and we do not guarantee the accuracy of transcribed content.