How do I know if I'm having a stroke?

0:00 Hey, guys. Welcome to Sarah Has Questions. Today, we're gonna talk about stroke and there's an acronym you need to know. It's called BE FAST. Every letter counts and it will let you know when it's time to call 911. Let's talk about it. I'm Sarah King and I have a lot of questions. What exactly happens when you orgasm physically? Will popping a knuckle or a joint give us arthritis? What can we learn from our poop? The size of your body doesn't necessarily indicate your measure of health. Yes. And what are your thoughts on that? Cleansing. Do we need to do anything special to our nether regions? In this show, I get to ask all these questions to WakeMed doctors who happen to know everything about everything. Sarah has questions is a production of Capital Broadcasting Company and Mix 101.5. It's presented by WakeMed.

0:50 So today, we have doctor Kilaria who is a vascular neurologist and the medical stroke director at WakeMed here in Raleigh. Welcome. Thank you for having me. And today, we're gonna talk about women and stroke. I mean, strokes happen to men and to women. Mhmm. But it seems like they happen to women more. But before we get into that, let's just get to the very basics. What exactly is a stroke? I'm really glad you started with that question because I found that a lot of patients use the word stroke a lot. It's used a lot in in just common talk. Mhmm. But most people don't know what's happening to their body. So, there are pipes that carry blood throughout our body to our brain as well, of course, and these pipes or blood vessels, if they can't get the blood where it needs to go, that's what a stroke is. So either you'll have a blocked pipe, which is called an ischemic stroke Okay. Or the pipe bursts, and that's called a hemorrhagic stroke.

1:41 And that's a bleeding type stroke. And so that's what a stroke is, blood not reaching where it needs to go. So can I have a stroke to my hand? You can have a blood clot that goes to your hand. And and, I mean so but that's not gonna present itself the way one that happens to your brain is. That's right. And so you you as a vascular neurologist deal with all all types of strokes that way. How how is it different than a bruise? So you know what's interesting? I actually sometimes describe it as a bruise to the brain. Okay. But what really happens, more unfortunately, is that when that oxygen and nutrients are cut off from the brain, that part of the brain, those brain cells start dying quite quickly. Okay. And so then whatever that function of the brain was starts to deteriorate. So if it's moving your right hand, you won't be able to move your right hand as well. What you're saying.

2:27 Okay. Alright. So now we can get into the demographics. Why do women have strokes more often than men? Yeah. So, a lot of different risk factors, that are similar to men. But in general, women live longer, and stroke becomes, more increased prevalence as you get older. And so, about 55,000 more women than men in general will have a stroke in a year. Oh, wow. And so, it it does become more common in women, which is which is surprising for a lot of people. So does the type of stroke, like, the hem how did you say? The hemorrhoid? Hemorrhagic. Hemorrhagic. Is that more common as you get older because our walls of our veins and things get thinner, or do they both happen just as frequently? They both are similar in, how often they happen throughout a lifetime. Okay. And in general, about for for strokes, about 85% will be the ischemic stroke, so the blocked pipe. Okay. And then, the rest will be the burst pipe, the hemorrhagic stroke. So let's talk about the ischemic.

3:24 Yes. How does a pipe a pipe get blocked? What is it getting blocked with? Yeah. That's a great question. So, a lot of times, blood clots can form in the heart, for example, from a risk factor called atrial fibrillation. So atrial fibrillation is, a disease of the heart where it's not beating to a drummer that we understand. It is, beating irregularly. Mhmm. And when that happens, if blood sits in the heart for longer than it was meant to, it can form a clot. Oh, wow. Then when the heart pumps, that clot goes up Yeah. Goes until it stops. If it finds a pipe in the brain, it'll stop where it stops. Yeah. And then that's when the damage happens. So that's one way that you can have a stroke for a blocked pipe. I see. And then some of the other ways are, you know, as we get older and then depending on how healthy your lifestyle is Mhmm. You can have what's called atheromatous plaques. And so to break that down, that sounds word Greek. Like hero. It's not a hero. It is a villain. Yeah.

4:14 And so, so that villain will, sometimes break apart from, for examples, arteries in our neck where where you can have that plaque build up, and that can go up and block a pipe as well. And is that from things like cholesterol? Yes. Cholesterol plays a big part in that. And then it also happens just with general aging that that we get these types of buildups in our in our body. Are there more because just like you're thinking on roads, there are more places on roads that that tend to bottleneck, and you get, like, a a pooling of traffic. Are there places in our body that you see strokes more often? Yeah. So, usually, strokes more often happen in what we call the front part of the brain, the anterior circulation. And so, the big two pipes in front of the neck here called the carotid arteries that take blood up to the neck. Mhmm. Throughout that piping system, you have more often blockages than in the back part of the brain. Oh. But in the back part of the brain, when those blockages happen, obviously, they're also catastrophic and and can be very dangerous. Oh, yeah. I'm surprised that these clots form in the heart with the effibration. I I mean, no.

5:11 I just slurred that a little bit, but you know what I'm trying to say. AFib, we can say. Oh, AFib. Yes. There we go. There we go. Yeah. I'm surprised that I mean, how long how how he regulates his heartbeat? I mean, it seems like these clots can form extremely quickly. They can. They can. It can form very quickly. And one of the challenging things is that atrial fibrillation, most people don't feel it. It is something that you have to think about and ask your doctor to potentially be screened for. For example, over the age of 75 Mhmm. There are more women than men who have atrial fibrillation. And so keeping that in mind, and if you do feel like I have some palpitations, asking your doctor about that, having your pulse checked, asking for an EKG, those kinds of things are very important. Because if you catch atrial fibrillation, there are medications, blood thinners that can help prevent a stroke, much better than aspirin, for example. And so knowing about it and asking about it is important. Oh, interesting. Okay. Let's talk about symptoms of stroke real quick, and we'll get back to the healthy lifestyle because I'm not letting you off the hook, though, on that one. What so I I've I've heard that, you know, slurred speech, confusion. What are the symptoms of a stroke? I'm I'm assuming there are more than this, those 2. Yes. Absolutely. So, when we educate on stroke, we like the, the people in the world to know about, some some key main systems. Okay. And so using the acronym BE FAST is helpful. And so the b stands for balance. If all of a sudden you're trying to walk and you can't walk, you're tilting to the left and you can't understand why. You're just just not able to

6:42 walk. That's that could be a a sign of stroke. Okay. If you all of a sudden are seeing double, your vision is gone. You can only see half of your world. That can be a sign of stroke. And so that's the e for eye. Mhmm. F is for face, and that's a common one people kinda think of is is your face drooping. And and so that's that's one of the other signs of stroke. A is for arm. Mhmm. And so if your arm, you try and lift it up and it's one arm is not going up as high as the other, something's wrong with your arm, that's a sign of stroke. Okay. And then s is for speech. And so if you're all of a sudden not able to talk well or not able to understand what people are telling you Yeah. That's a sign of stroke as well. Mhmm. And then the t, to to wrap up the t fast is time. And so calling 911 is incredibly important.

7:24 And one of the big take homes is, if you try and get to the hospital yourself, you will delay your care. Calling 911 helps because, EMS starts blood draws. They start a line, and they also let the ER know you're coming. And, ER will be set up with the doctors waiting for you when you arrive. But if you are confused, how are you supposed to call yourself? Like, I mean, I'm assuming that that's in that moment because how often have you perhaps, like, had low blood sugar? You know? And, like, you feel a little disoriented. Should I call in that moment and say I might be having a stroke? Or you know, like, thinking about it in my real life terms if I would have the cognizance to say this is probably a stroke, especially if you're confused in that moment. Yeah.

8:04 What's interesting is that confusion is one of the symptoms that women complain of more than men, and it makes it more challenging. It's because men are always confused. Yes. Yes. That's that's their baseline. Yes. Just kidding. No. It's okay. I don't think we're here to determine, who's better, men or women. No. Definitely not. If something comes out, then that's fine. But, with, with the confusion, that's very challenging. And so, if you live alone, it's it's more sis setting up systems of support so that, you know, do you check does someone check-in with you regularly? Those kinds of things are important. Right. But, otherwise, as as a family or if you live with other people, you're gonna be relying on them really to recognize these signs and symptoms of stroke in you. So if your loved one's confused, look at their face. See if it's drooping. Try and ask them to hold their arm up. Try and ask them to talk, and then call 911 if those things are not going well. And if you're and if you're able to and you feel confused, go look in a mirror and try those things.

8:57 And and, you'd be surprised that even through that type of confusion, it's not an all or none. It's something's off. You don't you feel quiet. And, the the, good and bad thing about stroke is stroke doesn't tend to hurt. And so we find that most people will feel off and try and rest at home. Right. And that's dangerous. Yeah. Because it I've always heard time is a is of the essence. That's right. That's right. Time is brain. And so, resting at home is not something you wanna do. You want to try and look in the mirror, look at your face, raise your arm up. And and if you're worried at all, calling 911 is appropriate. Getting the help you need. It's better to be safe than sorry. Absolutely. Yeah. For sure. For women, are there any unusual symptoms that men don't tend to have? Yeah.

9:40 Nausea is one of them, fatigue. Mhmm. And so I say that with, a bit of caution in that if you're only nauseous or just fatigued, you know, I think you know your body, and you know when something's different. And I think using that internal radar is very important. Mhmm. But if you have any other of those signs of stroke also, then don't think that it's just the fatigue is something is something normal. Right. Don't think the nausea oh, I I must have just ate something bad. Yeah. Those can be signs of stroke. So coupled with the B. F. A. S. That we ask people to recognize Okay. As more clear signs of stroke, knowing that women may be a little more confused, a little more fatigued and nauseous, and that doesn't mean they're not having a stroke. Okay. So that's the only other extra one for women. I wonder if it's along the lines of heart attack in women, whereas the atypical are only called atypical because we never studied female bodies. That's right. And we know females have been underrepresented in research and literature, and are trying to be more recently. But They die. It's 2024. Yeah. We'll be right back because you know I have more questions. For women, the common traditional risk factors for stroke, similar to men, are gonna be most important throughout their lifetime. Okay. And we can talk about some of the other, unique risk factors for women Uh-huh. That do increase the risk of stroke. But if nothing else, you wanna focus on those traditional ones. So high blood pressure, high blood pressure, high blood pressure. I say that three times because if I was given a magic button to cure one ailment in

11:11 the world, it would be high blood pressure. Oh, interesting. Downstream has so many effects. Oh. So high blood pressure is, the number one risk for stroke. It's, you know, worldwide, that's the number one preventable risk. What is it about high blood pressure that causes stroke? So it's the the wear and tear on the on the pipes, on those vessels. And so if you can imagine a hose, this is sort of the analogy I like to use in my patients. If you're gonna run that hose at full force 247, eventually, it's gonna collapse on you. It's gonna potentially burst, you know, and it's it's not gonna work. And so, the the vessels take that strain of high blood pressure, and it can cause stroke in so many different ways. And so, high blood pressure is one of the main risk factors to think about. And if your doctor says you're he's they're worried about blood pressure in, in you as a patient, I would spend as as much energy as possible trying to to get rid of that. Get rid of that. Do what you gotta do. And then, of course, we have diabetes. Mhmm. High cholesterol, and smoking is a big risk factor as well. Okay.

12:09 And then atrial fibrillation, the AFib that we talked about, especially as you get older Mhmm. That's a that's one of the ones that can cause some of the most devastating strokes. Okay. And how about for women? What are the specific risk factors in women? Sure. So for women, what's interesting is that younger women, I think, need to be more aware of stroke than men. Are you seeing it more in younger women now? Yes. I in general, I feel like we're seeing stroke in younger patients more often than before. Does stress have any part to do with that? I think so. I think that, because stress doesn't help us take care of our other illnesses. That's true. And I think that's that's one of the main, one of the main reasons, but also, stress in and of itself. But for women, especially young women, pregnancy is is a unique time when they can be at risk for stroke. Okay. Using oral contraception is another, increased risk for stroke. You smoke. And especially if you smoke. Especially. Yes. If you're gonna be on an oral contraceptive, with estrogen, you really gotta quit smoking. You know? And your doctor has to think twice before putting you on that. What is it about? Does the smoke attach to the why do you I mean, I don't know if you don't know the answer to this, but, like, if you're taking a birth control pill that is estrogen, progesterone, what is it about smoking that makes it so dangerous? Yeah. That's a good question.

13:21 I can't say I could answer that exactly, but I you know, we know smoking by itself increases risk of stroke. Uh-huh. And then we know that oral contraception, especially estrogen based contraception, increases risk of stroke. And when you combine risks, they really accelerate. I see. And so that's that's the something that that happens. I see. Okay. And how about hormonal changes in women? Yes. That's a good question. So the other, time in a woman's life where you're at increased risk of stroke would be potentially postmenopause, especially if you're using the hormone replacement therapies. Oh, great. Yes. Just one more thing to attack on to that postmenopausal time in life. Yes. I always think it's interesting that you could be at increased risk of stroke if you're using the birth control, but then also an increased risk of stroke if you're pregnant. Yeah. So Yeah. You're just still winning. You could be in one of those states at any any point.

14:04 How about alcohol? Does that do anything? Does that mean smoking causes an increase? How about alcohol? You know, directly, in and of itself, alcohol is not necessarily linked with stroke, but alcohol increase your blood pressure. You know? So, again, you know, so, a lot of times people find that if they are drinking, in excess and they cut back, their blood pressure, they may even get rid of 1 blood pressure pill. You know? So that's that's, one of the ways where we know that that consuming too much alcohol will increase your risk That makes sense. In in sort of by, causing high blood pressure. Well, you know, and you're talking about the one where the the blockages that cause the stroke. Ischemic. Is that right? Ischemic. Ischemic. I was close. Yeah. I was so down right there.

14:45 So I have low blood pressure from time to time. Is that at all a risk factor? It can be, because we know that it's all about getting the right amount of blood to the brain. Yeah. And so if you're low enough where you're passing out Yeah. That would be problematic. Okay. You know? Especially if we talked about having some of that plaque in your pipes. Yeah. You know? So now yes. And so I know this is a piping podcast now. We're just we're we're I sound like I'm talking to a plumber. Yeah. We're plumbers here. We are. And so with, if you have a extra plaque in your pipe and it's already tight, then you can imagine that if your blood pressure drops too low, that'll take away the the blood that the brain needs. Yes. I know. That makes sense. But in general, to blow blood pressure, if you're able to walk around and function, is great.

15:28 Okay. Well, that's good. Yep. So if you're walking and everything seems fine, I'm here. Yeah. I don't have it all the time, but every once in a while, I'll stand up and I'll feel real woozy. Right. And I have had doctors tell me numerous doctors tell me that I have low blood pressure. Okay. Just a fun fact about me. So let's talk about the healthy lifestyle. Sure. So and this is I'm assuming before you answer, that's probably got something to do with lowering your blood pressure. Mhmm. And so I'm assuming exercise is in there. That's right. That's right. So what else what other things can we do to lower our risk for stroke? Yes. So one word about the exercise is that I have so many patients say, you know, doc, I am on my feet all day at work. Oh, yeah. And I get that. And it's good. It's not you know, not being sedentary is important. Being up and active, walking around is very important. Okay. But you really got to have that time in your week where you change into exercise clothes and build up a sweat, you know, moderate exercise. And so you wanna do that at least 4 or 5 times a week for at least 30 minutes. Mhmm. And that's that's it because sometimes people think they're getting enough exercise because they're active at work, and it may not cut it. Yeah. You need to sweat. That's right. You need to just build up a sweat. Okay. And so that's one thing. Then also eating a healthy diet. Okay. And one thing that's been studied in stroke is something called the Mediterranean diet. Oh, yes. It's very popular. Yes. Yes. You know about all of that. Oh, yes. Yeah. And so that that's one thing to think about. And so I'll often ask I tell my patients when you're looking at your plate, half of it should be vegetables, Vegetables and fruits. You know? Really, a vegetable heavy, plant heavy diet is very good. But, you know, people like to eat meat as well. But when we look at our plates, it

16:59 really is only about a quarter. 25% of that plate that should be lean meats, seafoods is probably gonna be the best thing for you. I'm hearing all these vegetables and fruit talk to. Is that because it's got fiber? I think fiber has a good good, good role in it. Fiber is awesome for a lot of things. And, like, the more I hear about it, I'm like I don't know. It just it it it makes me wonder if this is gonna help in this case as well. It is. It is. You know, a a good fiber in there, good whole grains, all those things. I think it's the sort of synergistic effect of all these foods together. Yeah. And then really paying attention to those portions and and focusing a little more on vegetables as much as we can would be good. So we've we know that when you when you've you when you've done the b fast and you your arm isn't raising, your face is dripping, you think you're having a stroke Mhmm. You should definitely not drive to the hospital. Right. And, can you just reiterate why that is?

17:46 Absolutely. If you call 911, the paramedics are going to recognize the symptoms. They're trained in it. Yeah. And they can also recognize mimics and say, actually, this might be different. Maybe you had a seizure. Maybe something different. Palsy or something. Yeah. And then when, they're when you're en route, they'll be placing an IV, drawing blood that's needed to go to the lab emergently. And as soon as you get to the hospital, there's a team of doctors waiting, a team of doctors and nurses waiting to to really act fast and get you the medication you might need. And how is a stroke diagnosed once you get to the hospital? So it's it's through that exam is a very big part of it. Okay. And so at WakeMed, for example, we have a whole team of doctors that'll meet you. We actually have a stopping place in the hallway because this is how important it is to go fast. Yeah. They they stop. They do their exam. They take a quick history to find out, you know, when did this start? When were you last normal? Yeah. When were you really feeling fine? Yeah.

18:35 And then they'll call, the the stroke doctors, talk about that, and the stroke doctor does their evaluation after you get out of the CAT scan. But they go straight from the hallway to the CAT scan. Uh-huh. Because, again, time is brain. Yeah. And if they have the opportunity to give you a clot busting medicine Mhmm. To break up that clot Yeah. That's that's something you're gonna want. So you keep saying time is brain. What happens when your brain doesn't get enough blood? So every minute, about 2,000,000 brain cells die without blood. And then lose speech? Mhmm. That kind of thing? Absolutely. Absolutely. Speech, movement, balance, all those things. And, you know, as another example of of, I think sometimes this example helps me a little bit more is that the ischemic brain ages about 3.6 years every hour that you don't get treatment. Oh, wow. So sitting at home for that hour trying to figure out, is this really a stroke, or am I gonna just be fine, it can be really detrimental to your future and your health. And you'll lose, like, all these abilities. How interesting. Yes. So how does a stroke in the brain differ?

19:36 Because you mentioned the bursting kind, the hemorrhoid Hemorrhagic. I'm the worst. No. You're probably I could get these words. These words today, you you're winning. How does it differ from an aneurysm? So that's that's a great question because a lot of people say I have an aneurysm, and they mean they may mean I had a stroke where I bled. Right. They actually may mean I had an ischemic stroke, a blocked pipe. So, again, these words get very confused in in the general public. But, what an aneurysm is is when the blood vessels are weak and they form a kind of bubble and that that outpouching. If you look at a picture of an aneurysm, you'll see, sort of a normal pipe, a little balloon like area, and another normal pipe. Okay. And so that's at risk of bleeding Uh-huh. And puts you at increased risk of a bleeding type stroke. Okay. Gotcha. Alright. I'm gonna do a little myth busting with you right now. Okay. Are there assumptions people make about strokes or stroke symptoms that are really dangerous? Assumptions. What are the people like, this myth you've heard that people say about stroke that just aren't true.

20:39 Oh, that's an interesting question. I think that the the biggest assumption is that things are gonna be fine, and so staying at home Yeah. And and You can sleep it off. And sleep it off is is one of the the biggest problems Yeah. That I think of. One of the other, I think, assumptions that keeps people from really worrying about stroke in a way that we we want them to recognize because just like heart attacks, which which have got gotten a lot more publicity and and education out there Mhmm. This is this is a life threatening illness. I think people assume that a stroke is going to to sort of end your life. But, actually, the disability is one of the more devastating parts of it as, you know, as well. Is it more common for that than death?

21:26 Getting the disability side, like, the Yes. The most severe of strokes leads to death, I would assume. That's right. But but, the vast majority of people can can survive the stroke, but then you're stuck with disability. And so, you know, that's that's another myth. And one of the other myths that I that sort of builds on that, is that I've had a stroke. I can't move my arm or leg, and that's gonna be permanent. I would say that's not true. Oh, that's good to know. Yes. There is healing. The brain tries to heal. It really does. Okay. And so you'll you'll with therapy, with aggressive therapy, and taking medications to prevent another stroke, you can get better. And so Okay. You know, you may not go back to a 100% depending on how severe your stroke is. Sure. But there's lots of people lots of survivors out there who've had a stroke and made a full recovery That's wonderful. As well. So to give give the you know, because depression is very common after stroke as well Of course. You know, just like with heart attack. Yeah. And so knowing that there's a lot of patients in in the bed when I see them in the hospital who say, oh, this is it. This is how I'm gonna be, and that's not true. Oh, that's that is great news. Is it true that neurons I've learned this a long time ago, and I don't know if it's true, so I'm gonna ask you, that neurons can't regenerate. That's correct. They do not regenerate. Okay. So when you lose neurons, which is what I assume when you mean time equals brain Right. You're not gonna be able to get those neurons back, but yet you still can. The brain can heal.

22:46 Right. Right. So that recovery comes from, sort of neuroplasticity. So, really, the the surrounding neurons try and do their best to take over the task. It's kinda like every office after the pandemic. You lost all these employees, and everybody's trying to do else's job That's exactly right. For the same amount of money. That's exactly right. Okay. That's exactly right. So you can see where a complete recovery sometimes is hard. Yeah. I can see that. Yeah. Done. Okay. That's good to know. My mom had mini strokes a while back. Okay. What exactly is a mini stroke? Yes. So, mini stroke is usually synonymous with something called TIA or transient ischemic attack. Okay. And, another term people use for it is pre stroke. And so what I don't like the thought of that. Yeah. Go ahead. And that's really what it is. It's a warning sign. It's a She changed her lifestyle, and it's it was probably 10 years ago. So Oh, great. Hoping she's good. But so it's a it's like a tremor before an earthquake. That's right. And if you think about what's happening in the brain, it's that a pipe is going on to be blocked. It's it's it's it's almost there. It's it's struggling. And so people may say, all of a sudden, I couldn't move my arm my hand for 5 minutes, and then it went away. Because there was a pipe there that was about to be blocked, had it gone on to completely stay blocked, you would have then had a full stroke. Correct. So it's a warning sign. Oh, wow. Okay. What are the what's the overall thing you want people to remember when they see the signs of stroke? Call 911. Okay. Yep. That's that's that's, I think, the the main message for, for

24:17 how to get yourself the treatment. Because, one thing, that I that I wanna mention is that when you get to the hospital, if you get there in time, within 4 and a half hours of when the stroke would have started, there's a clot busting medicine that you can receive Oh, good. That that really improves outcomes. That's wonderful. Really important. But less than 10% of people reach less than 10% of people reach there in time to get that medicine. Wow. 4 and a half hours is a long time. Yep. But you can think about people to get it as minutes. I always thought I I'm sorry. I'm just shocked. I always thought that that you had mere minutes in order to, like, recognize it and be en route, But 4 hours and people still aren't making it. Correct. Wow. And and that and that's funny that you say that. I think 4 and a half hours is not enough. I wish we had a medicine that we could give even more. Yeah. Obviously. But, like But From what I had gleaned off of what I learned through media and elsewhere, I thought it was a much shorter time. Yes. And and but you're right. That every minute's important. We talked about how much you age every hour that you go without treatment, every minute. But that clopisting medicine can only be given to you if if we find that, time within 4 and a half hours of when it started.

25:24 And then there's another treatment that's a possibility. If you have one of your larger pipes blocked, one of the ones that can actually be reached by a tool, you can get that clot pulled out. Okay. And so that's the other important thing. And that's why I say call 911 is that you have these therapies, but there's a finite time. Yeah. At which point, you can't get them. Yeah. Better be safe than sorry. Yep. Like, call them if you're worried. Just call them. Yes. Just call them. It's fine. Alright. Well, thank you so much for your time today. This was super informative. And if you live by yourself, and I'm looking at you, mom, because I know you're listening sometimes, you think you're having a stroke, go look in the mirror. Go look in the mirror, try to raise your arm. And, if you have to hold on the wall to get there, it's time to call 911. Right. Remember, be fast. Balance, eyes, face, arms, speech, and time. Don't wait it out and try to sleep it off.

26:13 Call 911. My guest today was doctor Chandni Kallaria. To find out more about WakeMed's stroke program, go to wakemed.org and search stroke. If you have a question you'd like me to ask or an idea for a future episode, well, go to wralfm.com/sarahhasquestions. We would love to hear from you. Links to both sites are in the show notes. Okay. Remember, be fast. See you next time.