Dr. Haitham Hussein
Appearances
Health Chatter
Stroke
Right. We say, we talk about it this way because of how hopeful we have become about reversing the effects of stroke. In the mid-90s, I went to medical school in 1993. That's how long it was. And back then, there was no treatment for stroke.
Health Chatter
Stroke
And in 1995 came the first medication that we give through the vein, IV, that can open up clogged blood vessels, restore the blood flow to the brain before the damage of stroke sets in. And so we can re-perfuse, resupply that part of the brain with blood and prevent the damage or minimize the damage of stroke. And then in 2015,
Health Chatter
Stroke
So from 1995 was only treatment is that injection until 2015, when we had evidence that doing a minimally invasive procedure, we go with thin wires and tubes and catheters inside the arteries of the brain to pull out blood clots from the big arteries of the brain. That's a procedure called mechanical thrombectomy.
Health Chatter
Stroke
Now we have evidence that mechanical thrombectomy also improves the outcome of strokes or reverses the effects of stroke before they settle. And because we have these two treatments, we are so hopeful that we can help everyone with stroke before they get the maximum damage that they can get from their stroke.
Health Chatter
Stroke
So we always plead to everyone, if you have stroke warning signs, or if you see someone with stroke warning signs, don't hesitate, don't question it. Of course, you don't know if it is a stroke or not. Even I won't know when I first see you, I have to get a CT scan of the head and do other things. But because we know that we have these treatments and they are effective.
Health Chatter
Stroke
So please come as soon as you can. Every minute counts. For every one minute, the treatment of stroke is delayed. Two million brain cells die. Wow.
Health Chatter
Stroke
And that's why I hit the podcast, Clarence, and that you're hosting me. And we're talking about this. We have to spread the word, especially in our communities of racial minorities, ethnic minorities. And we will talk about this, I'm sure. You mentioned about your community, your African-American community. And it is true.
Health Chatter
Stroke
that it is disproportionately afflicted by stroke compared to other communities. And not only that the number of strokes that the African American community suffers from is higher, but it also happens earlier in life and more severe and tends to recur. and is a major source of disability and loss of function in the African-American community.
Health Chatter
Stroke
And the studies that we and others did and are doing shows more delay in the African-American community and in racial minorities in general. There is more reluctance to come to the hospital. There's more delay. So that part about community education and we have to get you to come to us first before we start treatment.
Health Chatter
Stroke
And if you're late, these treatments I told you about, these two different ways of treatment, each of them has a time window.
Health Chatter
Stroke
Yeah, we cannot give that injection after four and a half hours from the time the person was lost normal. We cannot do these procedures after a certain number of hours as well. And so if you're coming late, you are also limiting your own options of getting the treatment. So it isn't only identifying the symptoms.
Health Chatter
Stroke
And I know that in the African-American community, there's a lot of experience with stroke. You probably recognize it easy. But then what to do and how fast you got to react to it. is what we need to stress on over and over. And I agree that the financial burden of calling 911 is on everyone's mind. And it's a true barrier. But you have to think of the disability that the stroke can cause.
Health Chatter
Stroke
And then the impact of the disability on a person financially and psychologically and mentally. And so weighing the two together, I think there is no doubt that seeking immediate care when there is a way to go.
Health Chatter
Stroke
Yeah. So stroke prevention is, We talk about the stroke risk factors. What are the conditions that pave the way for having a stroke? There are modifiable and non-modifiable risk factors. So a person's age, for example, is a non-modifiable risk factor. Genetics. Yeah, increased risk of stroke with age.
Health Chatter
Stroke
Being a man or a woman, the biological differences can also be their family history is important. But these are a few. Most of the risk factors for stroke are modifiable, are under our control. And that's what we need to talk to people about. High blood pressure is the most important risk factor for stroke.
Health Chatter
Stroke
So knowing what your blood pressure is, having regular checkups with a primary doctor or a primary provider, and also knowing what is high blood pressure, what is normal blood pressure, what number when you get, you feel good, oh, my blood pressure is good, and what number when you get, you feel bad. But this knowledge is important.
Health Chatter
Stroke
We want people to know that good blood pressure is less than 120 over 80. And every time we check blood pressure, we get two numbers, a top number and the bottom number. The top number is called systolic blood pressure and the bottom diastolic blood pressure. You don't have to remember the names, but you have to know the numbers and what you're aiming for and what your blood pressure is.
Health Chatter
Stroke
And the trick is that blood pressure is silent. People have high blood pressure for years and years. They're not aware of it. It does not give symptoms. Occasionally, sometimes people would get like a headache or something, but for the most part, high blood pressure is silent. And the things that are tied to high blood pressure, like smoking, A huge deal, you know, smoking.
Health Chatter
Stroke
And, you know, in the Midwest, you know, maybe we're a little fortunate, but smoking remains a major issue in terms of smoking, because it's tied to blood pressure. Too much caffeine. Increases blood pressure.
Health Chatter
Stroke
So you have to be careful with how much caffeine you take, especially, you know, energy drinks, all that crazy stuff, you know, a ton of caffeine and also sleep because sleep is related to blood pressure. And it has emerged now as one of the important risk factors for stroke. People with sleep apnea, it's a breathing issue that happens during sleep.
Health Chatter
Stroke
When people fall asleep, the airway that allows the air to go to the lungs sometimes collapses. The muscles of the throat relax. So the palate and the tongue can kind of collapse on each other and people start snoring. And sometimes there's a... And people not breathing for a few seconds and then... and another breath. So that's a period of apnea.
Health Chatter
Stroke
And the problem with sleep apnea is that it lowers the blood oxygen level while the person is sleeping. And the person does not feel that, but their body perceives that low oxygen as a stressful situation. So then stress hormones are released in their bodies and they don't know it and they don't feel it.
Health Chatter
Stroke
like adrenaline, and then their blood pressure is increased while they're sleeping and they don't know. Normally, we have a drop, a natural drop in our blood pressure when we fall asleep. And people with sleep apnea lose that natural drop and their blood pressure remains as their wakefulness. And then as the condition progresses, they even have higher blood pressure when they're sleeping.
Health Chatter
Stroke
And if you're checking your blood pressure, you check it when you first wake up. That's always I tell my patients. Check it first thing when you wake up in the morning before you take any pills and then some other time later in the day. And I always like to compare these two numbers. And people with sleep apnea will have higher blood pressure upon awakening in the morning.
Health Chatter
Stroke
And so all the things tied to blood pressure, we have to really focus on and talk about. And it's not easy. You know, the amount of salt or sodium that you take also impacts your blood pressure. So it has to do with what we eat, what we drink. You know, exercise impacts blood pressure. People who exercise regularly have better blood pressure.
Health Chatter
Stroke
And then, of course, high cholesterol is an important risk factor. And it isn't always related to body weight. A lot of people have high cholesterol without being obese or overweight. So without checking, we won't know. So we have to have a primary doctor and we have to do these regular checkups to look at these risk factors.
Health Chatter
Stroke
And they are the same risk factors for stroke are the same as those for heart attack. And now we know that there are also the same risk factors for dementia. You take care of your blood pressure, you protect your heart, you prevent stroke and you sustain your memory. And other things that are also modifiable risk factor we touched on is the diet and the exercise. And
Health Chatter
Stroke
And so to prevent stroke, it's a matter of how we live our lives, what we eat, what we drink, how much we exercise, how much we prioritize exercising and we stay consistent with it, avoiding excessive caffeine intake, avoid excessive alcohol intake. Alcohol increases blood pressure.
Health Chatter
Stroke
And also puts a strain on the heart, causing irregularity of the heart beating, which is another way people can have stroke. So be kind of moderate in the consumption. No smoking ever at all. Yeah, yeah.
Health Chatter
Stroke
Yeah. There is a belt. I think there is a buckle to the center of it. Yeah. And unfortunately, it hasn't changed. We talk about the successes in stroke and reducing stroke mortality over the last 50 or 60 years. Remarkable improvement in reducing stroke mortality. But there are some failures still. One failure is that kind of regional disparity difference.
Health Chatter
Stroke
And there are still parts of the country where the stroke mortality is higher. And this is the south and the southeast, like you said. And the other failure is that the gap between men and women And between white and non-white are still there. These gaps have not closed yet. There are some improvements, but still most gains were made by white men and least gains made by black women.
Health Chatter
Stroke
The overall outcomes improved in general for everybody. But there are these disparities that are still there. And I think part of it is the higher concentration of African-Americans in certain parts of the country. And we talked before about the higher incidence of stroke in the African-American community. And also related to that is the social determinants of health.
Health Chatter
Stroke
So aside from the biology, if you correct for the blood pressure and the blood sugar and the cholesterol and all of that, and you look at social factors like income, or where a person lives or having a steady job or the food they eat and how secure the food is and how healthy the food is and the education, the years of education. And these are independent predictors of stroke.
Health Chatter
Stroke
So if you fix all the medical biological predictors, just being African-American increases your risk for stroke. Or just having that fused education years versus higher education increases your risk for stroke. Or having that yearly income increases your risk for stroke.
Health Chatter
Stroke
Well, that's everywhere, actually. Yeah, there are studies that gathered data from all over the country. Social determinants of health are very powerful. We just didn't know how to study them in the past. And now we're figuring out ways to identify them and study them. And we're shocked. by how impactful they are, how predictor they are in terms of predicting stroke.
Health Chatter
Stroke
And so, you know, they have to do with access to care. They have to do the quality even of the primary care provided is different. You know, when we compare our patients with stroke here in Minnesota who have diabetes, and we look at how well diabetes was controlled before stroke, which we can find out using a blood test called hemoglobin A1C.
Health Chatter
Stroke
So look at the hemoglobin A1C for stroke patients and compare white and non-white. White patients will have high A1C, not at target. So 7.5 or we always aim for less than 7.0%. But then you look at the non-white and you'll find that their A1C is 10. In the cases of the Hmong, we just published 13. And these are people who have known diabetes and have been on a diabetes medication.
Health Chatter
Stroke
But then their diabetes control wasn't good. And there is a big difference between having primary care and having adequate care. Good primary care, right? You can go in and out of the office in 10 minutes and get a prescription and done. And you just didn't learn anything. You didn't understand what you're supposed to do.
Health Chatter
Stroke
No one really engaged with you and your family and shared with you what they're worried about, what you can do to get to where you need to be. So that adequate primary care is also a factor. And it's also tied to the social determinants of health and our African-American community, our friends, I don't think they get as good primary care as whites.
Health Chatter
Stroke
Okay, well, before we talk about rehabilitation, can I just make a comment about trust?
Health Chatter
Stroke
I have a patient, a friend of mine, who our relationship started when he was a patient. And I'm sure he will listen to the podcast and smile happily. you know, remembering what happened between us. So is an African-American man, professional, well-to-do, came to one of our hospitals with stroke symptoms. Fortunately, the stroke symptoms subsided very quickly.
Health Chatter
Stroke
And he was admitted to the hospital and he had an MRI, which did show that there was a stroke, which is an important thing. Sometimes stroke symptoms would go away within a day, But when we get an MRI, we see evidence of damage to the brain, a small stroke. They were just lucky that they recovered quickly from it.
Health Chatter
Stroke
And that is actually of a higher risk of having another stroke than someone with transient symptoms and we get an MRI and we don't see a stroke. But we also saw that he has severe blockage of one of the big arteries inside the head. The blockage is caused by a condition called hardening of the arteries or atherosclerosis and 70% blocked artery.
Health Chatter
Stroke
And so this is a situation where the risk of stroke is even highest. People with this condition have something like 8 or 9% risk of recurrence in the first 30 days and 23% risk of recurrence in a year. That is just terribly high compared to other types of stroke. And so our stroke team wanted to meet with him and talk to him about this.
Health Chatter
Stroke
And because of a glitch, there are two teams that are in charge of the patient. There's a hospitalist, kind of the primary, and then there is a consulting team, neurology. And the patient was discharged before we went to see him. We'd given recommendations for the hospitalist over the phone.
Health Chatter
Stroke
And then when we realized that he left before we saw him, we felt so bad because we really wanted to show the pictures and explain the seriousness of the situation and all of that. So we called him. It was not me on call, on service, one of my colleagues. So he called that patient. And he got upset and he refused to come back.
Health Chatter
Stroke
And then he told me later that I was thinking in my mind, oh, they let me go because I'm black. They didn't care. I had a 70% blocked artery and they just let me go. And now they're calling me to tell me to come back. I'm not coming back. And I brought him to the clinic a day later or something. And we sat down and we talked.
Health Chatter
Stroke
And I think the fact that I'm brown and my last name is Hussein made him more receptive and explained the situation. And he and I became good friends. And now he and I want to go and give talks to the African-American community, to share his experience and explain, because he was doing everything right. He had a primary doctor, but the quality of that care wasn't good.
Health Chatter
Stroke
His blood pressure was borderline high. It was not treated. He had pre-diabetes. He had, you know, all these things that, you know, Had he, who knows, but we really- He was lucky. He was lucky.
Health Chatter
Stroke
Yeah, yeah. But then he told me and he explained that issue of trust that I was aware of, but hearing it from the person, who is living that environment, that life, and hearing what he was thinking. And then we asked him to give us lectures here at the Department of Neurology at the University of Minnesota. So he came and he talked to us and our trainees. He told us,
Health Chatter
Stroke
There's this history that you cannot just ignore. You cannot ignore. And he advised us to just address the elephant in the room and just acknowledge that I know what happened to you and African-Americans. And the second thing you have to do is to commit yourself I am going to be your doctor and I will take care of you. Exactly. You are my responsibility. I'll take care of you.
Health Chatter
Stroke
And with these two things, you can build a trust, build a rapport. You have to acknowledge what happened because what happened is, you know, long history. It's real. It doesn't go away. And it's in the conversations between the family members, you know, from the time when he was a little kid, seeing, you know, how his aunts and uncles and family got sick and how they got treated and everything.
Health Chatter
Stroke
You know what he told me one time? Just tell me that you're going to give me the stuff that you give the white guy. I'll be happy with that.
Health Chatter
Stroke
He's an awesome orator, and he has the ability to shock the audience. Love it.
Health Chatter
Stroke
So the first thing we got to do is make sure that we have a stroke prevention plan.
Health Chatter
Stroke
And the stroke prevention plan depends on the reason why the stroke happened in the first place. Okay. So the stroke doctor always has to understand the stroke mechanism. And then the stroke prevention plan is dependent on that understanding. Okay. So that's one thing we don't want people as they recover to have. They have another one. Yeah. Yeah.
Health Chatter
Stroke
Thank you very much, Stan and Clarence, for having me. I look up to you. Not because you're old, but because of how nice you are. And how nice you always make your hair. So I am trying to.
Health Chatter
Stroke
And then rehab historically has been focused on the physical recovery. And the idea is that if you have weakness of the arm, then you do physical therapy and occupational therapy to restore the strength of the arm and the use of the hand and all of that. And speech therapy if need be. Right, right.
Health Chatter
Stroke
And then there's speech therapy for the difficulty with swallowing, which is commonly affected after stroke. as well as difficulty with communication. Speaking can, there is a slurring of the speech that happens often, and there is also the difficulty with expression. that symptom that we call aphasia.
Health Chatter
Stroke
If someone has an idea in his mind, how can it be translated into words or being able to understand or being able to read and write? And so that's for speech therapy to work on. But the other aspects of rehab that we are getting more and more aware of is the psychological aspect and the cognitive aspect. Okay.
Health Chatter
Stroke
And, and these, you know, unfortunately have not been attended to in the medical literature as much. So the tools to measure them and the ways to improve them after stroke are not as mature as in the physical rehabilitation side of things. But yeah, You know, people have different degrees of impairment after a stroke. Right. And, you know, we do an assessment and we see where the difficulties are.
Health Chatter
Stroke
And then we tailor a rehab program for each one. Some people need to do only occupational therapy if they have loss of dexterity of the hand, but they don't need speech therapy or they don't. And some people need only speech therapy if their only problem is language. Many times people will need two or all three of these types of therapy.
Health Chatter
Stroke
Most commonly patients are in the hospital and it's a requirement it's an expectation that any stroke person gets evaluated by rehab physical therapy speech therapy occupational therapy in the hospital yeah and each of them has to do an assessment if there is an impairment how how bad the impairment is and then a plan how many sessions, how many weeks or months.
Health Chatter
Stroke
Usually when there is a physical component, people tend to go to a rehab facility. There are two different levels of rehabilitation. There is acute and subacute. Acute rehab is for people who are able to do three hours of therapy a day. So it's kind of an intensive type of therapy. And then the subacute rehab or what we call transitional care unit, TCU, is for those who cannot do three hours.
Health Chatter
Stroke
Yeah. Or something like that. And then the people after stroke, after they discharge from the hospital, they go to a rehab facility for a few weeks until they kind of recover more. of their function. And then there is a discharge plan then to home. And then there is an assessment of the home environment, the home situation.
Health Chatter
Stroke
And if there isn't any adjustment need to be made, say, for example, someone cannot walk upstairs, maybe they can have the bedroom in the main floor or some changes like that. And making sure that there aren't anything to trip someone walking or, you know, this and stuff, this kind of assessment. And then they go home.
Health Chatter
Stroke
Some people don't have that much impairment after a stroke to require going to rehab facility. Then these do outpatient therapies. They go home and every other day they go to physical therapy sessions in the clinic or in the, in the rehab center.
Health Chatter
Stroke
Thank you very much, Stan and Clarence. And I want to leave with a message of hope that we have treatments for stroke. And they're getting better, better and better. And so we can take care. And if you end up with a stroke, the recovery is there and it happens. It takes time, but it happens to everyone. Everyone gets better. And there are ways that we can help you get even better.
Health Chatter
Stroke
And just stay hopeful and continue every day. The consistency and watching what you eat.
Health Chatter
Stroke
Yes, thank you for the question, Stan. This is absolutely important. Stroke happens when there is damage to the brain because of something wrong with the blood supply to the brain. There are different kinds of stroke. Ischemic stroke is when there is a blockage of an artery that takes the blood to a part of the brain.
Health Chatter
Stroke
So that part of the brain then loses blood supply and suffers the damage, which we call ischemic stroke. The other kind is when the arteries burst or rupture. If the rupture is within the brain tissue, that is called intracerebral hemorrhage or hemorrhage within the brain. And if the rupture happens outside the brain tissue, then the blood is on the surface of the brain or around the brain.
Health Chatter
Stroke
That's called subarachnoid hemorrhage. These are the three different types of stroke. And then there is also TIA or transient ischemic attack. This happens when the artery in going to the brain is blocked, but then the blockage is temporary and opens on its own so that the blood supply is restored without leaving any damage to the brain.
Health Chatter
Stroke
So that person would have stroke symptoms for 15 minutes or half hour or an hour, and then the symptoms would subside completely.
Health Chatter
Stroke
Yes. The most common type is the ischemic stroke type, which is about 80% or even more in Minnesota here. 85% of all stroke is ischemic stroke, blockage inside an artery. But the more dangerous type is the subarachnoid hemorrhage type, when the bleeding is on the surface or around the brain. the mortality rate is highest in that type.
Health Chatter
Stroke
Okay. So starting with the stroke warning science, So when a stroke happens, first of all, we don't know if it's the ischemic type, the blockage type or the bleeding type. The doctors can't know without getting a picture, a CT scan of the head. So you can apply these warning signs to all different types of stroke. You know, we talk about the acronym BEFAST, B-E-F-A-S-T.
Health Chatter
Stroke
um and they they kind of um a way to remember the stroke warning signs so weakness of uh one of the arms one of the legs or one side of the body without pain uh numbness or loss of sensation again one side of the body or one of the arm and face on the same side or Leg. Loss of ability to speak or loss of ability to understand when someone is talking to you. Slurring of the speech.
Health Chatter
Stroke
People talk as if their tongue is heavy or they're drunk. droopiness of the face, loss of vision in one eye, painless blindness in one eye can be a stroke symptom, or both eyes do not see one half of the visual field. and loss of ability to walk, loss of balance. Severe headache is a common symptom when there is rupture or a burst of an artery inside the head.
Health Chatter
Stroke
And decreased level of consciousness, so people become suddenly sleepy or drowsy. These are the common stroke warning signs.
Health Chatter
Stroke
And we want people to call 911 right away when they are experiencing or they're seeing someone experiencing stroke warning signs, weakness, numbness, facial droop, speech difficulty, loss of balance, vision change, or decreased level of consciousness or becoming sleepy and lethargic.
Health Chatter
Stroke
And calling 911 before you call your doctor's office and before you call your friend or before you call your son to tell them that something is wrong, you call 911 first. And the value of that isn't just because, you know, you get the paramedics right away and, you know, They drive fast and bring it to the hospital. They also call us when they are at the scene or on the way.
Health Chatter
Stroke
They call the hospital and they tell us that we think there is a stroke person coming to your hospital. So we run down to the door and wait for the stroke, potential stroke patient. and take them from the ambulance directly to the emergency room, no triage, no delay. And so that gives a lot of benefit to the patient and the treating team when we get that heads up from the ambulance.
Health Chatter
Stroke
So we always combine talking about the warning signs with what to do. They have to be set together. That's why we call it BFAST. B for balance, E for eye, F for face, A for arm, arm weakness, S for speech, and T means time to call 911. BFAST.
Health Chatter
Stroke
And the symptoms, right? And I get that question a lot. And it's not your job, Stan, and it's not the patient's job to make the diagnosis. That's something that we can only find out when you are in the emergency room. And if it is a stroke in the eye, that means that the person is at very high risk of having a stroke of the brain in the next 24 hours. Okay.
Health Chatter
Stroke
And there are ways to treat stroke in the eye. And so if we can help you preserve the vision, then it's just no way to know if it's a stroke or not. And we do not expect anyone to know. And suspicion is good enough. If you suspect, yes, if you suspect that you or someone you see in front of you is having a stroke, You don't need to be sure. Suspicion is good enough.
Health Chatter
Stroke - A Patient Story
So when someone comes with stroke symptoms that are ongoing, we activate something called a stroke code. And that means that the emergency doctor, the neurologist on service, the pharmacist, the radiologist, the interventional radiology lab, everybody becomes alert that there is a potential stroke case that might require emergency treatment.
Health Chatter
Stroke - A Patient Story
However, if someone comes with stroke symptoms that subsided, and we think that person might have had a transient ischemic attack or TIA, Many people feel that just getting an MRI will give us all the information we need beyond what a CT scan would do. I don't really remember if Tony went for CT first and did an MRI or went to MRI right away. I think we have both images.
Health Chatter
Stroke - A Patient Story
Right. Yeah, but there is, of course, a lot of work, Clarence and Stan, that we do to speed up the stroke code process. And we calculate the time from the patient coming to the hospital to the patient getting treatment in minutes. We call it the door-to-needle time. Yeah.
Health Chatter
Stroke - A Patient Story
And, you know, there is a lot of resources that are utilized to just shorten the door to needle time by five minutes or something. And that would people, you know, count as great success. So what we struggle with is when people are late coming to the hospital. And we really want to avoid that. And I just did an analysis of our data. looking at white versus non-white.
Health Chatter
Stroke - A Patient Story
And we have about six or seven hours difference in the median time from stroke symptom onset to arrival to the hospital. Seven hours difference between the two groups. So I can talk about this later, but I want Tony to tell us you spent the entire night in the hospital and then the next day you saw a doctor, a hospitalist, and you were discharged?
Health Chatter
Stroke - A Patient Story
No, we do the intervention when we go with microcatheters, thin tubes and wires, arteries to open them up when there is 100% blockage.
Health Chatter
Stroke - A Patient Story
But when there is less than complete blockage, 70% or something like that, with oral medications most of the time such as aspirin and clopidogrel combination which he got when he was in the emergency room but he was not seen by the stroke team he was seen by an internist And the stroke team has a very long list of patients.
Health Chatter
Stroke - A Patient Story
And because Tony's case was kind of special, they wanted to have enough time to sit down and talk to him. And they were not aware that he was being discharged. So he kind of freaked out and called him and asked him to come back. But at that point, I think in his mind, he was thinking, Oh, they just let me go because I'm black. And, um,
Health Chatter
Stroke - A Patient Story
he just was angry and didn't yeah we tried to rectify that by having him come to the my clinic within like a couple days or something i don't remember how many days difference um and we explained everything well let me back let me back up because i want to correct something yeah and what's what's your colleague's name again
Health Chatter
Stroke - A Patient Story
Thank you very much, Stan. And hello to everyone. Thank you, Clarence, for having us again here. I am a stroke neurologist at the University of Minnesota. And about a year ago, Excuse me. About a year ago, we had a stroke patient who was very upset with us because he was discharged from the hospital before we talked to him about what exactly caused his stroke and...
Health Chatter
Stroke - A Patient Story
Yeah. Can I use a word that he told me once? He actually was giving us a lecture at the university. And he said, just give me whatever you're going to give the white guy. Yeah. That was the... Yeah, yeah, yeah. So part of it... He believed that, or maybe that's in their mind. We don't. There's this mistrust.
Health Chatter
Stroke - A Patient Story
Yeah, yeah, I totally hear you. And I think it isn't like there is black medicine and white medicine. There is attention to details. There is being, you know, providing high quality care. There is spending, you know, enough time to really understand what the struggles are. And, you know, you can...
Health Chatter
Stroke - A Patient Story
You can imagine if Joe Biden's cousin or something goes to the hospital versus one of our cousins go to the hospital. There is more attention and there's more time that maybe because of power. But there is also this perceived, at least.
Health Chatter
Stroke - A Patient Story
feeling among the minority communities that they are not being given the same quality of care, the same attention, the same understanding of their struggles as white patients. There's no way that we can ignore that or run away from that.
Health Chatter
Stroke - A Patient Story
The beginning of the relationship was a little bit rough, but I saw him in the clinic after his discharge and kind of clarified the misunderstanding. And we became friends since then. And I like my friend slash patient because of... how eloquent he is, and being an African American man, he taught me and also my colleagues and trainees at the University of Minnesota a lot.
Health Chatter
Stroke - A Patient Story
He taught us a lot about how the African-American community view the healthcare system and how we can approach an African-American person who is sick in a way to build trust because trust is severely lacking. And I'm also the current board president of the American Heart Association. I brought my patient friend to the American Heart Association meeting and he shared his story with them.
Health Chatter
Stroke - A Patient Story
Well, if I may interject to explain to the listeners, the study that we're talking about is a stroke prevention study. The stroke that Tony had was caused by a disease called intracranial atherosclerosis, severe narrowing of the arteries inside the head. And we do not have a good treatment for this condition. The risk of recurrence is about 23% in the first year.
Health Chatter
Stroke - A Patient Story
So a quarter of our patients are going to have another stroke. And this condition is more prevalent in non-white races, Black, Hispanic, Middle Eastern, Asian populations. So we are very much interested in bringing into the, and this is a study funded by the National Institutes of Health, the NIH. It's not by like a drug company or anything.
Health Chatter
Stroke - A Patient Story
And we want to study our Black patients and our Asian patients. And so I think my colleague's enthusiasm about Tony coming back is that first, the study offers what we think is kind of cutting edge medicine in terms of stroke prevention. So there is a chance that he will be on a combination of drugs that will in the future be shown to be superior.
Health Chatter
Stroke - A Patient Story
And second, that he is part of the community that we are desperately want to understand. And so being a participant in the study really is a great service to the African-American community in general. And I acknowledge that it was just not the right moment to bring it up. And my colleague, as many other doctors really, are not very well versed with the psyche of the minority groups.
Health Chatter
Stroke - A Patient Story
And that's why I brought Tony to our meetings and he taught us A very important lesson, he said that you cannot ignore the elephant in the room. What happened to us over the decades and hundreds of years cannot be ignored. He cannot say I'm blind to color and I'm just going to treat everybody the same. No, you have to understand that there is this difference.
Health Chatter
Stroke - A Patient Story
trust gap and you have to acknowledge it and you have to work on fixing it and building that bridge i agree i can tell you that uh chris my friend and colleague used that technique after after tony gave that lecture and it worked and he was delighted and i i told you tony right yep yep yeah he shared that that's that it has to be we have to respect the history
Health Chatter
Stroke - A Patient Story
I'm always very pleased and happy to let him talk and tell his story because there is no way that any of us can really experience and explain as much as he can. So without further ado, I introduce Tony Moore, my good friend. And thank you, Tony, for being here and being generous with your time.
Health Chatter
Stroke - A Patient Story
And suspicion is good enough. Yeah. You have to be sure. Suspicion is good enough.
Health Chatter
Stroke - A Patient Story
And I know sometimes this is a little bit traumatic to go over the story of what happened to you, but I see great good come out from you sharing the experience.
Health Chatter
Stroke - A Patient Story
You say that you knew about the stroke warning signs, right? Did you then call 911 right away or there was a little bit of denial that, oh, this cannot be happening to me or was there a delay or you just called right away?
Health Chatter
Stroke - A Patient Story
Can we quickly review the stroke warning signs for the audience?
Health Chatter
Stroke - A Patient Story
Weakness of one of the arms, one of the legs, one side of the body. Droopiness of one side of the face. Numbness or loss of sensation in one side of the body or one of the extremities. Difficulty speaking, either the words are slurred or a person is unable to express themselves in words or having difficulty understanding.
Health Chatter
Stroke - A Patient Story
Difficulty with vision, either one eye goes blind without pain or both eyes cannot see one half of the visual field. Sudden loss of balance and coordination. And we call them, there is a mnemonic, BEFAST, B-E-F-A-S-T. B for balance, E for eye, F for face, A for arm, S for speech, and T is time to call 911.