Stan and Clarence chat with Dr. Haithum Hussein about strokes, stroke prevention, and stoke recovery. Dr. Hussein is originally from Egypt, where he attended medical school and neurology residency at Ain Shams University in Cairo. After moving to the United States, he worked as a research fellow prior to completing his second neurology residency and stoke fellowship at the University of Minnesota. Dr. Hussein now serves as an Associate Professor of Neurology at the University of Minnesota as clinician, educator, and clinical researcher. He also serves as an investigator for several clinical trials. Dr. Hussein has co-authored over 70 peer-reviewed articles, contributed to several textbooks, and is a reviewer for several journals. Lastly, Dr. Hussein is the president of the AHA Twin Cities Board and member of the Minnesota Department of Health Leadership Committee tasked with developing the states 10-year plan for cardiovascular disease, stroke, and diabetes. Listen along as Dr. Hussein shares his wealth of stroke knowledge. Join the conversation at healthchatterpodcast.comBrought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships. More about their work can be found at http://huemanpartnership.org/
Hello, everyone. Welcome to Health Shatter. And our show today is on stroke and hopefully not having one. That's the idea. That's hopefully the final takeaway of the show. We have a great guest with us today, a really great colleague of mine. We'll get into that in a second. I'd like to highlight our great crew. that, frankly, without their expertise, Clarence and I would be lost.
We've got a great research crew that does background research for us on every one of our shows, Mandy Levine-Wolf, Aaron Collins, Deandra Howard, and Sharon Nygaard. Thanks to all of you for helping us with getting some useful information that we can talk about. Matthew Campbell is our
production manager who does all the logistics of technically making sure that our shows are in tip-top shape for you, the listening audience. And then, of course, I couldn't do any of this without my great colleague, and I really have to underscore that, Clarence Jones. Clarence and I have known each other a long, long time. And We still like each other for all the different things that we do.
We do disagree at times, but we still give each other a good hug at the end. So it's wonderful having Clarence as a colleague for our health chatter. And then, of course, there's Human Partnership, which is a community organization that Clarence is really intimately involved with that helps a lot of people in the African-American community around health.
And they're our sponsor for Health Chatter and many, many thanks to them. You can see everything they do and get information about them at humanpartnership.org.
dot org point before you go on i want to let us know human is that just for the african-american community every man has hue all of us have all of us are human h-u-e-e-m-a-n right yes yes yes so we all have a lot to talk about we all have exactly
things to say and how we can all help each other around many, many issues related to health. So again, thank you. Thank you to Human Partnership. So, all right, today we're going to talk about a subject that's actually in my career was near and dear to my heart, although this has more to do with your brain. It's called stroke. We're going to look at, we're going to talk about
prevention, acute treatment, disease management, community initiatives, et cetera, with a great colleague of mine, and I have to really underscore this, Dr. Haitham Hussain from the University of Minnesota. Boy, I don't even know where to start. We've been involved in a lot of things, and I really have to underscore
your commitment to really providing insight and help and perspective around this subject. It's second to none. I just found out from Hytham that he's presently the president of the American Health Association in Minnesota here. And so thank you for that as well. But originally, just for our listening audience, Dr. Sane was originally from Egypt, where he attended medical school.
And his first neurology residency at Ein Shams. Am I correcting that right? Am I pronouncing that right? Ein Shams University in Cairo. And then moved to the United States and did a residency here at the University of Minnesota. He's a second to none doctor. clinician and educator and researcher.
I can only imagine if any of us, God forbid, had to have a stroke, having Dr. Saina as our physician would be really, really, really good. I don't want to have it. None of us want to have it, but not a bad doc to have to treat you. He's co-authored over 70 peer-reviewed articles and involved with contributing to textbooks, et cetera.
He was actively and still is actively involved in the Cardiovascular Health Alliance at the Minnesota Department of Health. So many, many thanks for being with us. We really appreciate it.
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.
Yeah, you know, for the listening audience, we do this, we record these shows on Zoom. And if you could all see us, we have a little bit of a reflection off of Clarence's head, my head, and Haitham's head. So we have something in common here. So thank you for that. Anyway, okay, so let's talk about Strump. All right.
We're gonna do some, I thought what might be good is to provide the audience with some basic information and then we can get kind of into the nitty gritty. So first of all, what is exactly, what is a stroke? Most people I guess will respond to it when they have one or somebody close to them has one, but knowing ahead of time what it is and what you should be aware of, I think is important.
So let's start there, Haitham.
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.
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.
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.
So that person would have stroke symptoms for 15 minutes or half hour or an hour, and then the symptoms would subside completely.
So let me, let me ask you something. All right. So, um, Of the types that you just talked about, is there one that's more serious?
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.
So Clarence, what do you think? You know, we've all known somebody that's had a stroke, you know, unfortunately. So Clarence.
Yeah.
Kick in here.
Yeah, yeah. So from my perspective, I am one of those more seasoned people, doctor, just so you know that. But in my community, we talk about stroke as though it's normal. And we know people that had strokes, and yeah, they had a stroke. And so are there signs that people received that the body gives off before a impending stroke is one of the things that I want to know.
And then the other thing that I want to know is what are the real basic things that we should know about strokes and how to prevent them. Because again, when I talk about certain communities, it's just like we accept it as just a fact of life without thinking that there's any way for us to avoid them. So anyway, so those are kind of my mishmash of questions.
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.
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.
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.
And decreased level of consciousness, so people become suddenly sleepy or drowsy. These are the common stroke warning signs.
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.
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.
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.
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.
Let me ask you something. It's like... Okay, first of all, a person wouldn't necessarily experience all those symptoms, okay? So let me play something out. All of a sudden, you lose vision or half of your vision in an eye, okay? So how do you know? How would...
How would a person know if it's not like, hey, I should be calling my ophthalmologist because, you know, I might be experiencing a detached retina as opposed to, in this case, a stroke. So there could be some potential confusion there.
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.
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.
Just come to us and we will figure it out.
That's what I'm saying.
That's a great point.
Yeah. I want to thank you for your previous explanation, because as you were talking about that, you were listing all those various things. I think that and again, I'm coming from a community perspective. Many times people might be experiencing some of those things and they're afraid of calling the 911 because of the ambulance and the cost that they might occur. Okay, so let's put that out there.
That is some of the fear factors that we have. You just talked about the fact that it's not our job to analyze, right? Our job is to just call and to get those things on.
I just wanted to make that comment, thank you, because I think the way that you explained that is very, very helpful for me, but also I think when people listen to this program and they hear that, there will be less hesitancy about thinking that you have a homemade remedy that could address that issue. So that was my thought.
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.
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,
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.
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.
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.
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.
Yeah.
So, you know, yeah.
Yeah. So one of the things that I want to tell you why I think that this is important is because, you know, we kind of make jokes about the fact that we're seasoned. But you just said it was only in 1995 when people started, you know, the first preventative kind of thing. So a lot of us who have were born in 1950s and 40s, we have a long, long history of
Of not thinking that there was anything that we could do about this, you know, that there was no medical procedure that could help it. And then you just said 2015. I mean, so this is why this kind of this kind of conversation is so important is because for many of us who are more seasoned, we don't have this history of learning about the the impact of stroke.
And we just think that it's just normal.
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.
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.
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.
And if you're late, these treatments I told you about, these two different ways of treatment, each of them has a time window.
Yeah, they're less effective if you lose time.
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.
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.
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.
Yeah, of course. So here's an interesting comment. A lot of people are reticent to call 911 or go in an ambulance or this type of thing. Some people even, you know, elderly people will often say things like, you know, an ambulance is really for a real, real bad emergency. Okay, a real bad emergency somewhere, you know, there's whatever.
But, you know, I'm just, you know, myself, you know, it's no, you know, I'll get to the hospital if I need to, et cetera. Our point, one of the major points so far in this discussion is that's not correct, okay? What's correct is, 911 is for any kind of an emergency, and this is an emergency. Get in, and you know what? Worry about all the expense stuff later.
You know, that could be all siphoned out, okay? Expenses aren't life-threatening. What are life-threatening are the symptoms that you're having at this particular point. All right, so we've kind of been focusing our conversation on identification and acute treatment let's go into the another theme here of stroke and namely Prevention. So, all right.
So nobody's, let's just say for a moment, whoever's listening, you're not, you don't have any symptoms and all this kind of good stuff, but how is it that we can truly prevent a 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
So here's, you know, just so everybody is clear, oftentimes, Mark, we talk about cardio vascular disease. Okay. And what basically what we're dealing with is heart disease. And in this case, brain disease, if you, if you want to look at it that way and most people, when they think of cardiovascular, they only think about heart, but the vascular part is really connected to heart disease.
and brain and the risk factors are complimentary for both both arenas. The thing is, is that as you age, and you mentioned this, there are certain things that are frankly inevitable, there are certain things that are going to catch up with you one way or, or the other in and in keeping having consistent trusted care is also a major component for prevention. And not to compromise on that.
You should have a yearly checkup as you get older. If you're on medications, you need to have medication management, um, and assessment. Um, yes, taking your, your blood pressure more often than you did perhaps when you were in your forties, um, et cetera. So here's one thing I want to really kind of focus on. Have things gotten better?
So let me give you a, for instance, um, you know, when I was heading up the cardiovascular unit for years and years, um, what was known as the stroke belt of the United States, okay? And so for everybody, it's kind of a swath that runs from approximately Georgia, the state of Georgia, swinging down southeast and going west, almost as far as Texas.
First question out of the gate, Haitham, has the stroke belt changed? If so, has it gotten better? Do we still have a stroke belt where the incidence of stroke, well, those years I was involved, was much higher, et cetera. Talk to us a little bit about the stroke belt.
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.
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.
So what's going on? What's going on in this stroke belt if nothing has really changed? What's going on down there?
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.
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.
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.
And that hasn't changed significantly in the stroke belt.
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.
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.
Correct.
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.
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.
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.
Yeah, yeah, yeah, yeah. I'm really glad that you said that, because I always think that people say, say that community is always complaining. You know what I mean? And it's like, you know, but I think now that the research is coming out, there are reasons why there is such a discrepancy. And there are reasons why we have such a monetary impact.
negatively monetary impact in terms as it relates to health. And so I'm glad for the conversation that we're having, because I think that number one, it's not accusing anybody of anything. It is about, it's about taking a look at statistically what's going on. And how we can make things better. Yeah.
And I like that whole idea about the adequate primary care is that it is so important for us to understand that many times people don't get that. What really came to my mind was this, as you were talking, doctor, was the fact that in my 30s, I went to a clinic and they gave me a checkup, of course. And they said, oh, you're pre-diabetic. That's all he said to me.
I had no idea. When you were in your 30s.
Yeah, I was about 30. And I didn't think about it like I think about it now. But I'm saying if that's your procedure or your protocol, there's something wrong with that, which is one of the reasons why we try so very hard to
say and ask these questions and say how do we make this conversation so that it's bi-directional so that people can really understand how they enter into this and so I really appreciate the fact of what you have said today and how you said it because I think that we will definitely use this particular for me I'm definitely going to use this particular uh a program as a way to further inform my community because you said a lot of great things so let me you know
um, Hytham Clarence and I did a, um, a health chatter show on trust. Uh-huh. You know, and, um, One of the major themes that came out of that is it's important to have a trusted provider of care that you connect with and have access to them in order for us to at least start addressing some of these things in as a team effort between you, the patient, and you, your physician.
And if you have trust, it really, really helps. Today's environment is a lot different. You know, it's like some, some people see a different doctor every time they go in for, for care. And so that, that level of trust is never really quite built up, which I think personally, I think is an important thing in a message that we all, we all can do.
So here's, here's the, the other aspect of trust or of, of, stroke that I want to address and that's rehabilitation. So, all right. So we talked about acute treatment. We talk about prevention. Now let's say somebody has had a stroke and they're fortunate enough to have lived through it, but they've been affected by it. Okay. One way or the other. Okay.
So let's talk a little bit about rehabilitation. Rehabilitation.
Okay, well, before we talk about rehabilitation, can I just make a comment about trust?
Absolutely.
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.
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.
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.
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.
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.
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.
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.
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.
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.
On one side of the equation, he was lucky.
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,
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.
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.
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.
Yeah. And you know, that's sad. That's very sad. And I thank you for saying that.
That's building trust.
Yeah, it's really honest. And it is the experience that many people, communities of color have. And it's like, it doesn't mean that the other person is necessarily bad. I think so many times about the fact that we're just conditioned sometimes to do certain things.
For example, we were talking about the fact that, you know, nurses and doctors are still taught that Black people don't experience pain the way that white people do. You know, I mean, like, that's crazy. But, but it is what we have to do. And that's one of the reasons why I like health chatter is that we can get into these non political areas and say what we need to say.
And hopefully people are hearing this and so You know, again, like I said before, I really appreciate what you have done today because it will be one of my highly recommended shows for people to come in and to listen. And we would love to have you and that gentleman come out to our communities and talk about that.
Or even be on Health Chatter.
Yeah, we've got lots of options.
He's an awesome orator, and he has the ability to shock the audience. Love it.
Talk a bit, just a minute. Let's just take a minute about rehabilitation, rehab.
So the first thing we got to do is make sure that we have a stroke prevention plan.
Okay.
You don't want another stroke to happen.
There you go. Yeah.
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.
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.
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.
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.
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.
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.
Who coordinates all of this? So let's just say, let's play it out. Let's say I've had a stroke and I've been affected one way or the other. Does it start with you? as my neurologist and then the team expands based on need or how is it coordinated so that it becomes relatively easy for the patient to move forward?
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.
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.
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.
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.
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.
Overall, I think what's important for our listening audience, everyone to know is this. There is good stroke care available to all of us. Okay. 911 is something that has to be in everybody's minds and don't be afraid to use it. There are good, prevention-oriented things, especially if you, by virtue of your family, are perhaps at higher risk.
But all of us can still exercise, eat right, watch our weight, watch our blood pressure, etc. And then, unfortunately, if you know of someone or yourself that has had a stroke, It's not the end of the world, okay? If you've lived through it, there are good rehabilitation facilities that can help you get back to a normal life. This show has been very, very, very good. Clarence, last comment?
I was just writing into the chat box, thank you. I think, as I said, maybe two or three times. This has really been a very interesting, thought-provoking program, and I just want to appreciate you and to thank you for your work, but also thank you for your offer of helping the communities to become healthier.
You're excellent at providing clear, and concise information about this subject. And that's what health chatter is all about. So Haitham, thank you. You're a great, great doc.
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.
And just stay hopeful and continue every day. The consistency and watching what you eat.
Exactly.
Everything.
That's the hard work. So everybody in our listening audience, thanks for listening in today. Like we tell all of our guests, we reserve the right to give you a call back. Or if you have other reasons to use Health Chatter as a venue to get some more messaging out, please, please contact us. So to everybody out in our listening audience, keep health on.
chatting away hi everyone it's matthew from behind the scenes and i wanted to let everyone know that we have a new website up and running helpchatterpodcast.com you can go on there you can interact with us you can communicate with us send us a message you can comment on each episode you can rate us and it's just another way for everyone to communicate with
Stan and Clarence and all of us at the Health Chatter team. So definitely check it out. Again, that's healthchatterpodcast.com.