May is Stroke Awareness Month, a time to educate and raise awareness around the illness. Dr. Amber Stephens from Optum - Main St. discusses the most common risk factors and how to reduce the risk of serious injury.
May 22, 2024
Docs in a Pod focuses on health issues affecting adults. Providers and partners discuss stories, topics and tips to help you live healthier with hosts Ron Aaron, Dr. Audrey Baria and Dr. Tamika Perry.
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Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award-winning veteran broadcaster Ron Aaron will share information to improve your health and wellbeing. And now, here are Ron Aaron and Dr. Tamika Perry.
RON AARON
Thank you so much for joining us today on the award-winning Docs in a Pod, I'm Ron Aaron. Delighted to have you with us in celebration of Stroke Awareness Month. Celebration because we want to prevent those strokes. We're going to be talking with Dr. Amber Stephens. Dr. Tamika Perry is our co-host and we're delighted to have Tamika with us as we do every week on Docs in a Pod. Dr. Perry is an associate medical director at WellMed, a physician at the WellMed at Redbird Square clinic located in Dallas. Completed her master's degree at the University of North Texas Health Science Center in Fort Worth. Earned her medical degree at Philadelphia College of Osteopathic Medicine in Philadelphia. Also earned her master's in public health from the University of North Texas. Dr. Perry's undergraduate degree is from Prairie View A&M University. And Dr. Perry, we're delighted to have you with us.
DR. TAMIKA PERRY
Thank you. I am delighted about today's topic. I think a lot of patients are surprised to know that there's more than one type of what? Stroke. So, we'll see what Dr. Stephens has to say.
RON AARON
Well, we're delighted to welcome Dr. Amber Stephens, who we've had on before. She's a great guest. Dr. Stephens is board certified in family medicine. She received her medical degree from Drexel University College of Medicine in Philadelphia. Completed her residency at Bayfront Family Medicine in St. Petersburg, Florida. Dr. Stephens is affiliated with Optum - Main Clinic. She's married, has two boys, 11 and 6, a couple of dogs, a couple of cats, a bearded dragon, and 40 snakes, which we have talked with her about before. She loves being a baseball mom and does a lot of media education presentations for Optum. And she was featured in the 2024 WellMed calendar, as I recall, holding one of your little animals. Amber, great to have you on again.
DR. AMBER STEPHENS
Glad to be back.
RON AARON
How's the snake population?
DR. AMBER STEPHENS
Growing, actually.
RON AARON
More than 40 now?
DR. AMBER STEPHENS
Yeah, we actually just had a clutch break free of their hatch or whatever you call it from the eggs and that's 12 baby snakes and then we have 3 more clutches to go in probably the next month and a half.
RON AARON
Well do a whole show on Dr. Stephens and her menagerie at home. I want to focus on stroke awareness month because I know some folks who have lost a loved one because of a stroke didn't get the help. They didn't understand as you can explain to us, Dr. Stephens, that time is truly of the essence So let's begin with the 4-1-1 on strokes. What are they? How do they happen? What do you do about it?
DR. AMBER STEPHENS
So, stroke is a general term for when for whatever reason the brain isn't getting enough oxygen. We look at that from a couple of different directions, either it's not getting enough oxygen because the blood vessels, just like they're responsible for providing oxygen to every other organ and part of your body, they are responsible for providing oxygen and oxygen to the brain as well. Whether the vessel gets blocked, whether it breaks for whatever reason, all of a sudden, now the brain tissue is not getting the oxygen it's supposed to get. What it ends up resulting in is a direct relationship to where we have lost oxygen in the brain. So, depending on if it's in a motor function portion, maybe someone will have weakness. If it's a sensory portion, someone might have numbness and tingling. So, it can be very specific as to what we're seeing based on the location that's affected. But at the end of the day, it's because there's not enough oxygen getting to the brain.
RON AARON
Now, there are two different types of strokes, right?
DR. AMBER STEPHENS
Yes. There's ischemic strokes and hemorrhagic strokes. Ischemic strokes are where we get a blockage. So, that's either you get plaque formation, like you people hear about plaque in the heart, and that causes heart disease. The same thing can happen in the brain. Or you can actually get what's called under that same category of an ischemic where it's just blocked off, or it could be from a clot that's blocking it off. There's some different health issues that can cause clots to go to the brain and cause those blockages. The other kind is hemorrhagic, and that's usually bleeding either in the brain itself is an intracranial hemorrhage, which could be an aneurysm that burst. It could also be a subarachnoid hemorrhage, which is another part of one of the layers around the brain, and that can cause a severe headache. But then once again, now because the blood's going to that section, it's no longer going to the brain tissues. As you mentioned in the beginning, time is of the essence. The faster we can correct the problem, the faster we get blood back to the brain, the more likely that you're going to have resolution and healing.
RON AARON
Let me come back to you in just a minute. For those who've just joined us, let me let you know you're listening to the award-winning Docs in a Pod. We're available on the radio as well as on podcasts. Wherever you get your podcasts, you can find the award-winning Docs in a Pod. I'm Ron Aaron along with our co-host, Dr. Tamika Perry, and we're talking with Dr. Amber Stephens. Dr. Stephens is a family medicine physician, and you find her at the Bayfront where you find her at the Optum - Main Clinic down in Florida. Dr. Stephens, you just noted time is of the essence. For example, you've got a blood clot causing a stroke, are there blood clot busting drugs that you can get that can just knock that problem out?
DR. AMBER STEPHENS
So, the easy answer is yes, there are medicines that we have that dissolve clots and can allow for the blood to flow freely. But some of it does matter with how fast you get into the emergency department, whether or not you will qualify to get those medicines, because after a certain period of time, the risk of getting the medication actually is higher than the risk of letting the stroke go. So, there's a very tight window that has to be approached. The other thing is that not every stroke is amenable to those medications and that conversation is probably not quite at this level, but the bottom line is, if you're having symptoms, you get to the ER as fast as you can so the ER doctor can do whatever they need to do in terms of imaging and work up and get you the evaluation you need to find out if you're a candidate for one of those medications.
RON AARON
Let's say Im having a stroke and I go to the ER and the person at the reception desk says, have a seat over here and we'll be with you in a while.
DR. AMBER STEPHENS
If you tell them you are having a stroke, that's one of those trigger words that you don't get to wait in the ER waiting room anymore. I don't tell patients, though, to ever drive themselves to the hospital if they think they're having a stroke. The best answer is to call 9-1-1. The ambulance will get you there as soon as possible, and you will go right back and get the treatment you need.
RON AARON
Dr. Perry, I guess you would give the same advice.
DR. TAMIKA PERRY
I would, and I think it's also important to know that the same risk factors for heart disease can be the same risk factors for that clot type stroke. So, high blood pressure, smoking, being overweight. Just like Dr. Stephens alluded to before, just like you can have a clot in your heart, you can have one in your brain. So, a healthy lifestyle, seeing your PCP, like Dr. Perry or Dr. Stephens on a regular basis. Taking medications, if indicated, regular diet and exercise are things to head away from a stroke, right, Dr. Stephens?
DR. AMBER STEPHENS
Absolutely. I tell my patients all the time, if it's good for your heart, it's good for your brain.
DR. TAMIKA PERRY
Exactly.
RON AARON
Oh, I like that.
DR. TAMIKA PERRY
I couldn't have said it better myself.
RON AARON
Let's back up a little bit because we've jumped ahead in some ways. How do you know if you're having a stroke? How do I know if my wife is having a stroke? What are the symptoms that we ought to be aware of?
DR. AMBER STEPHENS
The acronym that works really well is called BEFAST. It's B-E-F-A-S-T. They each stand for a certain component. The B is for balance. If you find that you're having trouble walking or standing. Or just in general, trying to mobilize through your home or wherever. The E is for eyes. If you all of a sudden start to have some vision issues, double vision, blurred vision. The F is for face. If you're noticing any weakness or drooping, numbness, tingling. The A is for the arm, and I would even say arm or leg, I would say limb. But arm, and that's the weakness, the numbness. And then S is for speech, and if you're having any slurred speech. Then T is for time, because once again, time is of the essence. Also, when did it start? Strokes usually have a very specific start point. People don't go, oh, yeah, I started getting a little weak and then it got a little worse over the course of a week or two. It's like, I got up and all of a sudden, I used to be able to walk to the bathroom without any trouble and I was having a really hard time getting there. It's a very specific point in time. If you can follow the acronym and keep track of those symptoms, those are really your trigger points to whether or not you need to call 9-1-1.
RON AARON
Give us that acronym again folks who are listening might write this down.
DR. AMBER STEPHENS
It's BEFAST. B-E-F-A-S-T. B is your balance. E is eyes. F is for your face. A is for arms, or I would say limbs. S is speech and T is time.
RON AARON
And if you're observing someone, what is it you see that might trigger concern about a stroke? Speech would be one, of course.
DR. AMBER STEPHENS
Speech is probably the most obvious. If someone's talking to you and all of a sudden, they start slurring their words or even if they're having trouble with word finding, some depending on the area of the brain, it may not just be clearness of speech, it may actually be difficulty finding the correct words or using the wrong words. People don't realize your brain is finely tuned for that kind of stuff. You could see even just like misuse of words. But once again, it's a specific point in time. You'd be talking to somebody and then all of a sudden something's going to change. It's not going to be the same conversation because the person is no longer going to be communicating in the way they just were. The other thing is, if you see someone that normally has good mobility, that doesn't have loss of function and all of a sudden, they're just out of nowhere having trouble walking or they feel like they're holding onto a wall because they're having trouble with balance. But once again, it's a discrete point in time, so it's really more noticeable probably from people who know the person very well. You're sitting down with your wife and you're eating dinner and halfway through dinner, the slurring starts, or all of a sudden you can't use the fork like you used to be able to use. There's usually a very specific change in time and things progress from there.
RON AARON
And if you see that, what do you recommend rather than, hey, things aren't right. Let's sit down, it'll get better. Let's take our time. That would be the wrong thing to do. Right?
DR. AMBER STEPHENS
Absolutely. The answer is you call 9-1-1.
DR. TAMIKA PERRY
Yes. Take immediate medical care.
RON AARON
Failure to do that can result in even more damage to the individual?
DR. AMBER STEPHENS
Absolutely. If you are a candidate for what we call those anti-thrombotic agents, clot buster medications, they do have to be given within a certain period of time. And then, if you're not meeting that guideline, you one, aren't eligible, but two, you end up in a situation where the stroke can now progress further and you end up with more damage than you would have had from the beginning.
RON AARON
Now, is every hospital, Dr. Perry and Dr. Stephens, equipped to deal with a stroke patient when they come in, or do you really need to go to a place that specializes in treating strokes?
DR. TAMIKA PERRY
I think immediately you need to get immediate medical care and if that hospital is not equipped, they will get you to a place that is equipped. So, the ambulance is going to take you to wherever we can get the care right then and right there.
DR. AMBER STEPHENS
And that goes back to dialing 9-1-1. You shouldn't be driving yourself if you think youre having a stroke and your significant other or family member or friend should not be driving you either, simply because you don't know where you're supposed to go.
RON AARON
Interesting. And so, don't wait for an Uber?
DR. AMBER STEPHENS
No.
DR. TAMIKA PERRY
Gosh, no.
RON AARON
Now, in a situation, and I've heard stories like this, where someone is living alone or they're home because their spouse or whomever is not there, and they begin to have these symptoms, speech included, they're unable to speak properly, would you have enough sense to at least call 9-1-1 and try to get the word out?
DR. TAMIKA PERRY
I had one patient say, I knew I was having the stroke in the parking lot of Walmart because the A from BEFAST, my arm started not to work. And then I couldn't think the way I used to. She had enough wherewithal at that point to yell, scream, throw her phone down where someone could hear her.
DR. AMBER STEPHENS
The other thing is, if you are able to call 9-1-1 and you can't get out what you need, a lot of times they're able to kind of pinpoint where you're at.
RON AARON
With GPS, they'll find you. That's interesting. I think we need to take a little break here, right? We'll come right back to you. If you have just joined us, you're listening to Docs in a Pod. I'm Ron Aaron, along with Dr. Tamika Perry and Dr. Amber Stephens. This is the award-winning Docs in a Pod.
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RON AARON
Well, we're so pleased you're sticking with us right here on the award-winning Docs in a Pod. We're available on podcast wherever you listen to your podcast, and you can hear us on the radio on a number of radio stations in Texas and Florida. I'm Ron Aaron and Dr. Tamika Perry co-host is with us along with Dr. Amber Stephens, our special guest. Dr. Stephens is a family doc, and you can find her down in St. Petersburg, Florida. Tamika, you were telling me off the air, you're in a committee meeting a bunch of people there and somebody apparently was having a stroke.
DR. TAMIKA PERRY
Yes, so I belong to a charitable organization and we had a zoom meeting just for monthly business and the president started to slur her speech and you can see one side of her visibly become different than the other side and at this point all of the people on the call are either calling 9-1-1 or calling her husband immediately and this was a subsequent stroke she was having. She'd already had one and she said this is likely my fault because I had not been taking my medications that I was prescribed to prevent the subsequent stroke. So, I think Dr. Stephens will tell you that a lot of times it's not the first one, but it's the second event that takes you out.
DR. AMBER STEPHENS
Absolutely, without a doubt.
RON AARON
Is the rule of thumb, if you have one stroke, you might have another?
DR. AMBER STEPHENS
Yeah, your biggest risk factor for having a stroke is having a previous stroke.
DR. TAMIKA PERRY
Yes.
RON AARON
Oh, wow. So why wouldn't she take her meds?
DR. TAMIKA PERRY
Well, a lot of people feel good. They say, I don't feel bad, I didn't have to take meds before. My patients will tell me well I've never had blood high blood pressure before, but you've never been 75 before. 20 years ago, I never had to dye my hair, now I feel like I have to do it on a daily basis.
RON AARON
So, Dr. Stephens, is age a factor as well? Because I just turned 82, although God knows if you look at me, I don't look a day over 80. Is age a factor?
DR. AMBER STEPHENS
So yes, it absolutely is a factor. Strokes in general are far more common in patients over 80. Men are more common in general, except for there's a specific population for women over 85 or between 35 to 44 where women are in that starting perimenopausal. There's some hormone shifts that can put them at a little higher risk. But definitely, patients over 80 have a substantially higher risk of stroke. And I think even to go along with the medication discussion, 46% of adults in this country have high blood pressure and 47% only are under control. High blood pressure tends to be completely asymptomatic. People don't often know that they have it. And then when you add it in with cholesterol issues where most people don't have any clue they have a cholesterol problem unless they've been checked. And maybe they have a little bit of prediabetes on top of that, and we've just created a very perfect environment for someone to develop heart disease as well as the vascular disease in the brain that puts them at risk for stroke.
DR. TAMIKA PERRY
A lot of times people say, I felt just fine, but when I take this beta blocker, I feel tired. When I take this ace inhibitor, I cough. When I take this diuretic, I used to go to the bathroom all the time, but I was just fine before. These are conversations that you really need to have with your PCP, because sometimes we can do something about that cough, right? We can give you another medicine that still protects your brain, your kidneys, your heart that may not make you cough. We may be able to change that beta blocker to a different one. Suggestions that we can make. But with medicines, Dr. Stephens and I always have to weigh, what is the risk-benefit ratio? What are the chances of you having another stroke? Can we tolerate the fatigue?
DR. AMBER STEPHENS
Yeah, absolutely. I mean, there's several medications, we use different classes of drugs that we use to treat blood pressure. There are several medicines that we use to manage cholesterol. Within those, they all have side effects, benefits, risks. I don't want to make someone feel less well than they were before. That's not my goal here at all. I want somebody to feel the best they possibly can and mitigate the potential risks for the future. So, finding that balance.
RON AARON
Now, one of the risks we haven't mentioned for stroke, and I happen to know this because it's me, and that is if you have Afib, arterial fibrillation. Once I was diagnosed, the first thing they did was put me on a blood thinner because of fear of stroke. Why is that Dr. Stephens?
DR. AMBER STEPHENS
So, this goes under that ischemic stroke category, but specifically what we call the embolic stroke. An embolism is a term for a clot that starts somewhere else in the body and then travels somewhere else. So, in this case, if someone has atrial fibrillation, because the heart's not beating in the fashion it's supposed to, the blood is allowed to kind of sit and anytime blood sits, it clots. So, now we've formed a clot in the heart, and it basically can get mainline straight from the heart up into the brain or the lungs. That is the reason as soon as we know someone has Afib, the very first thing we're doing is putting them on blood thinners so that atrial fibrillation doesn't cause a clot situation. We're actively preventing stroke when we do that.
RON AARON
Blood thinner does what it says, thins the blood. So, it tries to prevent strokes from forming?
DR. AMBER STEPHENS
Correct. There are different blood thinners out there and they do work on slightly different pathways for the clotting process. At its essence, they stop that clot process from occurring. So, we prevent problems related to stroke or embolism that can occur.
DR. TAMIKA PERRY
This is one of those situations where we weigh risk-benefit ratios, right? Because the clot prevents the embolic stroke, but if you had some type of trauma to your head, it could make you more susceptible to what's called a hemorrhagic stroke, that bleeding stroke. So, we have to say, what are the odds that he's going to suffer trauma to his head? Ron, by the way, never go roofing, don't get on top of your house, don't do any of that because we don't want you to fall, right? He's going to have trauma to his head to cause a hemorrhagic stroke versus what are the odds that his Afib is going to cause a clot in his heart? And that heart has direct highways to the brain and lungs, right? The carotids, the pulmonary arteries. These are direct highways or pulmonary veins, highways to these major organs. So, in this instance, Dr. Stephens and I have to weigh the risk-benefit ratio. And in most cases, a lot of cases, the blood thinner wins. It's in the best interest of the patient to take the blood thinner, because you could just have a thromboembolic stroke just sitting there versus saying, well, he might fall and hit his head.
DR. AMBER STEPHENS
If youre a frequent faller, someone who has a history of head trauma, someone that I don't trust them to be safe. That's going to be someone I would seriously consider holding off. That's a doctor patient discussion, that's not something that people should be making a decision on their own.
DR. TAMIKA PERRY
Absolutely.
RON AARON
And then the question of compliance taking the meds. If you stop a blood thinner, you are causing yourself a potential serious problems like death?
DR. AMBER STEPHENS
Absolutely.
RON AARON
Now, we've got about a minute and a half left, Dr. Stephens. I want to come back when we're talking about BEFAST. The acronym that may indicate that you're having a stroke and is that something that we're teaching? For example, kids really ought to know about that in case their parents or an aunt or an uncle is having a stroke. How well are we doing, this being stroke awareness month, of spreading the word?
DR. AMBER STEPHENS
I mean, there are some other acronyms that I've seen used as well, but unfortunately, I think a majority of the education that's done is either done in environments like this, where the patient population that's listening is usually the affected population or in the hospitals, I'll see signs up. In terms of are we educating the younger populations? Honestly, I don't think we really are. I think people pay attention to what affects them the most and they're not thinking that far in advance, so it's not something they're paying attention to.
RON AARON
We ought to work on it. We sure got kids to tell their parents to quit smoking.
DR. AMBER STEPHENS
Yeah, I know.
RON AARON
Interesting. Well, weve got to stop right here, and Dr. Stephens, it's just a delight to have you on, and when you get home tonight, hug some of those new snakes for us, newly hatched in Dr. Stephens' home. And that's a story for another day. Thank you for joining us, Dr. Amber Stephens, down in St. Petersburg, Tamika Perry, our co-host, I'm Ron Aaron. We'll talk with you soon on the award-winning Docs in a Pod.
OUTRO
Executive Producers for Docs in a Pod are Dan Calderon and Lia Medrano. Associate Producer is Cherese Pendleton. Thank you for listening to Docs in a Pod, presented by WellMed.
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This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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