This episode of What the Health podcast focuses on strokes, their causes, types and advancements in treatment and prevention. Strokes, largely influenced by diet, lifestyle and stress, pose a significant risk, leading to paralysis, speech and movement impairment or even death. Featuring Dr. William “B.J.” Hicks, Vice President of Neurosciences at Ohio Health and a volunteer expert with the American Stroke Association, the discussion explores the mechanics of strokes, the distinction between ischemic and hemorrhagic strokes, and the impact of lifestyle choices on stroke risk. Dr. Hicks highlights the critical role of public awareness, healthy behaviors, and timely medical intervention in reducing stroke risks and improving outcomes for stroke patients.

00:30 The Alarming Reality of Strokes in America

00:56 Advancements in Stroke Treatment and Recovery

01:51 Understanding Strokes: Causes, Types and Prevention

02:18 Expert Insights: Dr. William “B.J.” Hicks on Stroke Risks and Management

05:52 Lifestyle and Health: Key Factors in Stroke Prevention

06:52 Addressing Stroke Risks: Smoking and Blood Pressure

10:11 The Impact of Social Determinants on Stroke Risks

15:52 Exploring Stroke Symptoms, Treatment and Recovery

29:14 The Importance of Stroke Awareness and Research

39:24 Closing Thoughts and Resources on Stroke Prevention

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Fortunately, there is some good news. Advances in research and medical applications have cut down the number of stroke related deaths. There are now 80, Even a number of growing treatments that can lessen or eliminate various forms of paralysis, helping stroke victims lead normal lives and reconnect to loved ones.

Yet for all of these advances, strokes still present an enormous danger, particularly for at risk groups, which may suffer more because of limited access to treatment or because of lifestyle issues that make them susceptible to attacks. All this begs several questions, including What can be done to lessen the risks, and what should someone do if they're having a stroke or think they might be?

Thankfully, we've lined up an expert from the American Stroke Association to help answer these questions. Listen up.

So today we're gonna deal with a topic a lot of people have heard about, as we mentioned, but maybe we don't know enough about it and we should, and that's strokes.

And thankfully we have an expert in the field to help us pull out some of the things we don't know about and maybe what we can do about them. And that is. Dr. B. J. Hicks. Dr. B. J. is Vice President of Neurosciences at Ohio Health and a volunteer expert with the American Stroke Association. So, Dr. B. J., welcome to What the Health and thank you for joining us.

[00:02:26] John Salak: Okay, so let's start off with the idea that everybody's heard of strokes. We probably know someone who's had a stroke. Hopefully we haven't had to experience that directly, but exactly what happens when somebody has a stroke? What is a stroke?

Stroke is a sudden phenomenon where the blood flow to the part of the brain is suddenly disrupted. Now, classically, that's from a blood clot that gets lodged or stuck into a part of the a blood vessel in the brain, in that area of the brain that typically gives the marching orders of one particular part of the body or one particular task, like seeing the world in one area or speaking, it's suddenly disrupted.

Another type of a stroke is again, if a blood vessel is disrupted in a different way, which is if a blood vessel bursts. And that's a different type of stroke but it can cause those same types of problems. And often it's a bit more deleterious or worrisome if that blood vessel is bursts, but that's basically what a stroke is in a nutshell.

[00:04:09] BJ Hicks: That's exactly right. The end result can often be the same because again, that blood flow gives oxygen and nutrients to the brain cells. And without that those oxygen and those nutrients, the brain cells die.

[00:04:32] BJ Hicks: Annually it's in the range of about 800, 000 people every year suffer a stroke. And the good thing is, I don't like to say that I'm. an old gray beard. I've been in the stroke world for a certain amount of time. And what I've seen through my career is that we are preventing stroke mortality or we are keeping more patients alive from stroke.

When I first started in the neurological field, stroke was the third leading cause of death in this country. It's now the fifth. So that's an improvement in keeping stroke patients alive. And we're proud of that. But the number of people that suffer strokes in this country is still quite significant to the tune of about 800, We 000.

[00:05:31] BJ Hicks: We had started to work on lowering the number of those that suffer strokes. And especially, like I mentioned those that pass away from strokes, but it's been a bit of a fight recently because we've seen an uptick in the number of strokes that people are surviving from, but they're occurring at younger ages.

And I think we could all understand as to why, because we have unfortunately developed healthy behaviors as our society has evolved in certain ways. We're no longer getting the free exercise that occurs with manual labor and more kind of time outside and more healthy living activities. We live in a more sedentary lifestyle.

We're both in our offices, kind of in a sedentary lifestyle. So we have to do a lot more to keep our bodies and our minds active. And those are the healthy behaviors that we have to work a lot harder towards where historically, we were just able to do that through natural living. And of course, the other thing is diet and other sorts of lifestyle choices that are at our proverbial fingertips.

We're able to get things quick, we're able to do things quicker, and in that unfortunately leads to unhealthy behaviors often.

[00:06:52] BJ Hicks: There are two major things that Americans society writ large should be focused on to lower one's risk of stroke. Whenever I'm at an event and someone asked me, Hey, what can I do? Or what can my family do? What can my community do?

I really have them firmly understand two things. Some people grasp this quite well. Other people struggle with this. And the first thing is smoking. You've got to stop smoking. You should never pick up the habit. And if there is a habit, there should be a strong focus to try to rectify it. Far too often, I have patients that say, I thought it was a cancer thing. And I didn't know it was a stroke thing also. So, we did great work to let people understand the risks of smoking and they automatically tie it to cancer, but heart disease and especially stroke risk meteorically rises with the use of cigarettes. And our society has lowered that risk tremendously, which is great, but there are two areas that are still being hit hard with Smoking and smoking cessation really hasn't grasped as well as others in those two societies.

And again, this speaks to social determinants of health and health inequities is our rural communities and it is our underserved and under appreciated urban pockets

Often the most deleterious or the most harmful types of cigarettes, which are menthol cigarettes are really targeted to those, black and brown populations in urban centers.

And so, so that's the big modifiable risk factor is cutting out smoking. The second thing is blood pressure, knowing your numbers for blood pressure. We call it in the business of stroke and in cardiovascular disease and in cerebral vascular disease, we call blood pressure, the silent killer because you can walk the earth.

You can be living your best life thinking that everything is perfectly fine, but if you don't know your numbers, it's not going to hurt you until it hurts you with a stoke.

[00:09:04] BJ Hicks: And so elevated blood pressure, high blood pressure, a blood pressure greater than with your top number, the systolic blood pressure greater than 130, that's hypertension.

That's high blood pressure. Those numbers have lowered recently as far as our guidelines. But that's because we know that every time someone lives a year and lives several years with high blood pressure, that puts you at a major risk of the non bleeding or the ischemic strokes, like I mentioned with where a blood clot can occur, but also the bleeding strokes or the hemorrhagic strokes.

And people can walk the earth with blood pressures that top number in the 180s, 200s, 220s. And. And think everything is fine until it isn't. So, so those are the two major risk factors that we say are modifiable. And the beauty of that strong recommendation is it not only protects you from stroke, it protects you from other things. those two major issues that should really be kind of dealt with pinpoint precision.

I may be wrong. So it's sort of a question and a statement at the same time.

The same thing. If you don't have access to public transportation, if your environment isn't susceptible to a healthy lifestyles, or at least to even kind of get to your doctor, if it's several miles away and you're working three jobs just to make ends meet, it's hard to set aside time. to get basic medical care.

And these are things that really social determinants of health are all about because the end result is meeting me in the emergency room with a stroke,

Is it that it begins to block your blood vessels?

Muddies up the water, so to speak. It causes, it accelerates atherosclerotic disease. or the hardening of the arteries is another way to say it.

So folks, my age, sometimes younger end up with a blocked or a very narrowed carotid artery, which is a major thoroughfare or a major blood vessel that feeds blood flow to the majority of one side of the brain. So we start to see that and that vessels. And again, we have all sorts of blood vessels feeding blood flow into our brains.

And that carotid artery that I mentioned, there's surgical techniques, there's what's called endovascular or you know, you can put stents in, into that type of blood vessel, but guess what? The ones up here, we don't always have access to, and it is very difficult to stent open or to do a surgical procedure on narrow blood vessels up here.

It is lifestyle modifications because the medications can only do so much. It's up to us to make sure that doesn't happen in the first place.

[00:13:26] BJ Hicks: Well, imagine myself watching my team and we didn't even get there. So, you know, so, so, so, so, so, so I completely agree that could cause a certain type of strain and heartache. And do know is that historically physicians would downplay that. But we're learning a little bit more about how a life of chronic stress. And that could be from, like you said, if we just internalize too much then what ends up happening is we're not getting good sleep. And if we are always in a stressful state, our cortisol level is up. If that's just how we perceive the world, or if the world is doing things to a particular individual or particular community where there are microaggressions left and right.

And someone always feels like they're on guard because the world is doing things to them that is unfair in the way you're perceiving every encounter. There's always just a natural bit stress involved. That heightened level of cortisol we're starting to notice causing Elevations in your blood pressure, elevations in your blood glucose level.

It's a lot. It's making your sleep get disrupted and be suboptimal. You are often self medicating with things, not only the cigarettes that we talked about, but other unsavory types of illicit drugs or alcohol in excess to try to medicate in other ways. We're not allowing ourselves to engage in healthy behaviors because you may not think you have time or you're ruminating over something else.

or there might be a fear level associated with that. We're not dealing with our underlying issues with depression, anxiety that might be from our social situation or might just be genetic or might be something that we have been carrying with us for far too long and we're not addressing that appropriately.

And all of these things in aggregation, that elevated blood pressure, elevated blood sugar, poor sleep habits using kind of, unsavory drugs and alcohol, all of these things in aggregation will increase your risk of stroke. So it's easy to just say stress, but it's all of these things in concert increase that risk.

[00:16:08] BJ Hicks: It is the number one cause of serious longterm disability in the United States. And so that, I think Is a point blank period sort of a statement. And so why is that? Well, when you think of what the brain does, there are parts of the brain that allow us to breathe and allow us to stay awake. And so if that's disrupted because of a stroke, then we know that life is not sustainable without use of artificial means.

So, so that is a crippling way to be disabled. Our language centers can be affected. So our ability to communicate what we're doing right now in this podcast, if there is a notable stroke that were to occur, we would not be able to do that. Either the language center that allows us to understand what's being said to us and answer appropriately, or the ability to get those words out in a way that would not you know, would be, permanently disabled.

That's what certain strokes can do. Your vision can be affected where one side of your world, you're unable to see the world very well. Your ability to move your arm or move your leg or both can be permanently affected your ability to sense or feel one side of your body can be permanently affected your coordination or your ability to handle the right side of your arm, your leg, and therefore your balance.

or your ability to kind of dress yourself, all of these things can be affected and several other things. And often some of those are all of those in combination is what a stroke could do to someone. So that's why it's really something serious. And there are things that are quite obvious that someone's impaired because of those things that I mentioned, but there are other things that cannot be noticed or cannot be seen by the naked eye, where, Small elements of what I just mentioned are occurring.

And so it's really making it hard for someone to function throughout the day. And it's a real struggle to do certain things that we take for granted. And yet someone's employer or someone's loved one may not get what the big deal is and say, I don't understand it. You should be able to do the job because a lot of it is a cognitive element.

The cognitive functioning could be a little bit impaired. Their ability to process the world is impaired. And so there's a lot of people in silence, especially with depression, anxiety that may come with this, the fear and the sense of entrapment after a stroke all of these things are often difficult for the naked eye to see.

And so a lot of people are suffering in silence even after somebody will say, wow, you made a great recovery from that. I've been guilty of this as a stroke neurologist. We all have. We, the doctor says, wow, you made a great recovery. You should have seen how you were three months ago. And yes, that might be true, but I'm not back to myself.

And in fact that last 10 percent to get back to my a hundred percent, okay. is a big gap. And it's a gap that could lead somebody you know, just far enough to where they can no longer be the productive member of society that they used to be. And that's something that people don't often understand from strokes.

[00:19:38] BJ Hicks: That's certainly the case. And we used to see that a lot in prior generations when we didn't really understand stroke, we didn't have optimal treatment options. We didn't allow and prime people to change their thinking around stroke and change their management and say, call 911. I've had patients where they said, Oh, when I was young and something happened to my mother, we called 911 and they said, well, maybe we'll come by in the morning, but there's really nothing to do.

And so we don't really see the need to come by and pick somebody up. We'll drop her off in the morning and they'll get her to the nursing home. You know, this was kind of the way. So certainly there are people that may have had a slight change in their standard operating procedure.

They suddenly had numbness or off balance. They try to push through it or they, you know, maybe they went to the doctor or maybe they just, for a week or so they, stayed out of work and then symptoms went away and kept moving on and then they become my patient when they're later in life and we might have seen old strokes on their scan and the family's mortified when we say that yeah there's evidence that there's been prior strokes in the past.

So yes a lot of people can suffer very mild or silent strokes we like to say without knowing it and that's where the risk factor modification really becomes important. but also knowing the signs and symptoms of strokes and knowing that is not something that we walk off. That's not something that we go to sleep on.

It's not something that we just kind of wish away. And if it goes away, it's out of sight, out of mind. That is far from the case. If someone has stroke like symptoms, you hightail it to the emergency room by calling 9

[00:21:38] BJ Hicks: that's a great question. We went over some of them and we talked about how someone could be disabled from a stroke. So those are ones certainly to know. But would we really want the public to know cold? is the acronym FAST. And that really lets us know what are the telltale signs of stroke.

There are others, but these are ones that are, we should really know quickly. It should always be in our head whenever we're out in public or whenever we're with our loved ones, or even if we're having a self kind of assessment of what's going on with us. The FAST acronym F is for face. If you suddenly have a facial droop, or if you have facial weakness suddenly, That's one aspect of stroke like symptom that should warrant further investigation.

A is for arm. So the F A is for arm drift. If you suddenly have, your arm can't lift, if you're having to lift it yourself. Or if it's a little subtle, if there's a subtle drift versus the other side, if it doesn't feel as strong as before, the A is for arm drift. And the same goes for leg, by the way. S is for speech.

If your speech suddenly changes, if suddenly your speech sounds like it's slurred, like you've had three too many the bar, but you know, you haven't had a drink or you don't drink. If you suddenly have slurred speech, if your speech is suddenly incoherent, If no one can understand what you're saying and kind of, it's like a word salad.

Or if you really can't get the words out like you used to. If all of a sudden there's that sort of pause. If it's really a struggle to get the words out. That S for speech. If your speech suddenly changes, that's an emergency. And finally the T in fast. T is for time. It's time to dial 9 1 1.

It's not time to dial your doctor's office. It's not time to get on the phone and Google what's going on. It's not time to call a friend or a loved one and certainly not time to take a nap. It's time to dial 9 1 1, hightail it to the emergency room. Your primary doctor, your relatives, they'll find out after that because minutes matter when it comes to stroke.

Time is brain and every second we're not in the emergency room getting assessed. or being evaluated in a mobile stroke treatment unit, for instance, where we have ambulances that can come to the bedside in certain communities that have that service and provide a stroke like care in someone's driveway at their beck and call.

This sort of emergency care has been revolutionized over the past several because of the importance, early, rapid, and immediate treatment for stroke. And so that FAST acronym can really help someone understand that I need to dial 911 so I can get that type of cutting edge care as soon as humanly possible.

[00:24:43] BJ Hicks: There is a bit of a revolution that occurred in the mid 1990s with a thrombolytic medication or a clot busting drug. And that drug was called TPA. Since that time, we've also developed, there's also been a medication we use called TNK, but the gist is the same. And it is a clot busting drug that we can give through somebody's IV if they're having stroke like symptoms that are non bleeding stroke like symptoms.

[00:25:14] BJ Hicks: So this medication is extremely time dependent. We have a window of time when we can safely give the medicine, but the magic is getting it within 90 minutes, within 60 minutes. That's really where the magic happens, where we can have someone with severe stroke like symptoms, get this medication rapidly and their symptoms rapidly improve.

The likelihood of that is much higher, the quicker we get the medication. So while there is a timeframe and it's classically four and a half hours. It's three hours for some select individuals, but we love to really push the envelope and get it to somebody rapidly because the quicker we give it, the better chance we have a full recovery or at least an excellent outcome.

So that's one revolution that we've had a little bit later in, in the evolution of stroke care within the past 10 years, we've really noticed a meteoric rise. in treating large blood clots. We've been working on this for several years. And there's several centers, like one where I work, where we've been doing this for even longer.

But the research has strongly backed the fact that clot retrieval or thrombectomies. This is a approach where we can go through with a catheter based therapies and we can get to the blood clot through the blood vessel, find that area and remove or extract the blood clot that's causing the problem.

And we have seen a real revolution in the care that we're able to provide to reverse major stroke symptoms because large blood clots cause the major stroke symptoms. And we are able to now remove those clots, restore blood flow at a very high clip and with a very high percentage or a very high likelihood of an excellent outcome with these procedures.

And we're now, the more research we're doing on these procedures. We are starting to push that time window where treatment is an option further and further out. We can do it 24 hours in some symptoms. We can do it where even we start to see some stroke damage already on the brain scan, we can still safely provide this care provide a much better outcome than if we did not do that.

So that type of care for the non bleeding or ischemic strokes, we're really starting to push the envelope reach more lives with that type of treatment. Now, what about the bleeding strokes? Those we see about 10 to 15 percent of all strokes. They are often the most deleterious or the most ominous.

They're the types of strokes that often cause the most disability and even death. We don't have a magic bullet like we do with ischemic strokes, but we are working hard about different therapies that we can provide. recently found that there's a surgical approach for bleeds that happen at the outer edge of the brain.

and we're very excited about that treatment option that we have for those type of bleeds, the bleeds that are a little bit deeper into the brain that are often from high blood pressure. We are starting to see if there's other types of treatment options that we provide, but time for that is extremely critical.

And there's a study called the Fastest Trial that we're looking at factor vii. This is a way to try to reuse a blood clotting factor to re clot or stop the bleeding in someone having a stroke like this. And we're still in the investigational stages to see if early treatment of of this.

Factor seven within two hours of somebody's symptoms could be effective but timing again is mission critical for these hemorrhagic strokes.

guess it's a combination of both to reach some of these goals you're talking about.

That may not sound like a big drop, but there is not a lot of diseases where we've seen such movement. And so just imagine what we can do with even more movement that often comes with. major research changes and opportunities. So when you look at what we can do based off of the small amount of funding in comparison to some other disease States that I won't name it is night and day.

So yes, more research is needed. And I would add That we have been really good about front end treatment for stroke. We have yet to find viable options for what happens if someone has had a major stroke and what can we do to help their stroke recovery? That is what I am desperate to see and what I can't wait to be a part of the course of my career, because that's really where that leading cause of disability, we need.

treatment options. We need therapies. We need innovation to help rectify that issue. So someone that was disabled all of a sudden can return to work, can return to being a functional member of society, can return to being engaging with their friends and families. really that's what I can't wait to see.

And that's where the funding really needs to be here.

[00:31:40] BJ Hicks: We all need to be advocates. I think that anything that needs action requires a grassroots effort towards it. The American Heart Association has done great work to become advocates and to really cultivate collective action to help rectify this issue to help drive research and to help show what can be done with research dollars in spaces in and around stroke and heart and vascular disease.

So joining up and then joining forces with the American Heart Association would certainly go a long way. Government funding for research for healthcare is critical. always a struggle. And the collective. We, the community needs to hold our Congress, women and men accountable, hold those that have the power and hold the purse strings for research funding.

And that, that occurs at not only the state and local level, but especially within U. S. Congress to have major funding. for NIH and for within stroke, what's called the NINDS. which is a subset of the nIH, that sort of funding along with just kind of overall grant and funding for research dollars, because we are often at the whims of what is earmarked for this and with, without that, level of funding, we can't get there.

But, you know, , to what another longstanding public good in society, users like you, or, you know, volunteers like, like you and me and others can also help donate to causes such as stroke research.

[00:33:49] BJ Hicks: We have done Yeoman's work his, over the past 10, 15 years to get the word out. We are now hearing and seeing more people reach the emergency room. by saying I knew something was wrong because I did the fast or and I knew to call 9 1 1 because of stroke symptoms or hey I know that there's a clot busting drug that you can give.

I thought that my loved one would be a candidate so I called 9 1 1 or I told the medics to take my loved one to this hospital because we know that you guys do great care for strokes here. So it's Getting there. It's never enough. It is never enough. When it comes to Know how for something as critical as stroke.

We're never going to get there until every single person is able to say the stroke acronym fast with me with without me even finishing my sentence in my thought So we always have work to do there. There are always future generations that need to understand We are always bringing in new citizens within our society, those that speak different languages.

We have a new acronym for Spanish speaking individuals called Rapido. So we are working to not only kind of pigeonhole our messaging, we want to bring the message for stroke awareness and what to do in the case of someone's having strokes to all in an equitable format in the american Heart and American Stroke Association have done great work to help drive access to awareness.

[00:35:27] BJ Hicks: That is unfortunately correct,

[00:35:33] BJ Hicks: You name it. It is diet, it is sedentary lifestyle, it is lack of access to primary care. And not feeling that's something that's necessary until later in life. So then these unhealthy behaviors, unhealthy lifestyle , not understanding your blood pressure numbers, thinking that the blood pressure that you had as a teen football player is the same that it is when you're 37 years old.

And that's often not the case. And we just haven't created an environment where we continue. follow ups in the healthcare setting once you reach your 20s and then your 30s and then your 40s. It tends to be something that we have to do once we have discerned something like stroke in somebody as opposed to we have to have a preventative lens.

We have to make sure that people in their 20s and 30s develop the habit of routine checkups. So when blood pressure elevation is noted on the front end, then there's more checkups. There's more work to lower that naturally with healthy behaviors and also with medications that thankfully don't have many nefarious side effects.

[00:37:01] BJ Hicks: A lot of people have a defeatist attitude or kind of a just a belief that there's not much that can be done. That is the old way. Stroke is preventable. Stroke is treatable. The quicker we get somebody to a stroke center that can provide this level of care, the better off patients are and patients have a much higher chance and opportunity to walk out of the hospital or to be back to work in a timely fashion.

But the key is to know what is going on. So knowing that FAST acronym, face, arm, speech, time, and to act on that. So it doesn't do anyone any good if you can identify a stroke, but you're not going to call nine one one, or maybe you wait for a ride or you drive yourself. These things slow down the process.

So it's not only being able to know what to do, act fast, so to speak, but to dial nine one one to get the care that you deserve as quickly as humanly possible. And then again, there are ways to prevent strokes. It provides front end care that is much better than any of the things that a stroke neurologist has to do to work somebody up and to make sure that they can't have a second one.

It's much better to work hard and to naturally change someone's life to make sure that we're engaging in healthy behaviors and we're eating in a way where we can naturally precipitously drop the risk of stroke and heart disease.

[00:38:52] BJ Hicks: Great

information at those sites.

Dr. BJ, I know we could go on and talk about this a lot more ., but I wanted to thank you. I believe this is stroke month, stroke awareness month. Is that correct?

[00:39:20] John Salak: That's all good advice. Dr. BJ, thank you very much.

Before we move on, we wanted to again encourage listeners to take advantage of the hundreds of exclusive discounts WellWell offers on a range of health and wellness products and services. These cover everything from fitness and athletic equipment to dietary supplements, personal care products, organic foods and beverages, and more.

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So, for all the advances in the stroke related research and treatments, these attacks remain a serious threat to the health and well being of victims and their families. As a reminder, thankfully, there are several ways to increase your chances of preventing a stroke or at least lessening its impact.

Knowledge is key. It always is, particularly if you're a member of an at risk group. Two, speed is also essential. If you suffer a stroke, or even if you think you might have, call 911 and get to an emergency room. Don't wait. The faster the risk is assessed and treatments begin, the greater the chances of lessening the consequences.

Recognize the sign of strokes. Not every stroke comes with devastating, recognizable consequences. Fatigue, memory loss, even the inability to use certain words may all be a sign that someone suffered a mild stroke. Again, I Early detection and treatment are essential. Four, lower your risk of getting a stroke by maintaining a healthy weight and exercising regularly.

And five, finally, think fast as an F A S T in dealing with strokes. This means if you see a face drooping, arm weakness, or speech difficulty, it's time to call 911. That's it for this episode of What the Health. We'd like to thank Dr. William B. J. Hicks, a volunteer expert with the American Stroke Association and the Vice President of Ohio Health Neuroscience for joining us.

We'd also recommend everyone visit stroke. org. That's stroke. org to learn more. Again, thanks for listening in and we hope you'll join us again on What the Health.