Title: Healthy YOU Podcast, Episode 9: Stroke: Prevention, Signs, and Symptoms
Host: Frankye Myers, Chief Nursing Officer for Riverside Health System
Expert Guest: Dr. Wolfgang Leesch, Neurointerventional Specialist with Riverside Neurovascular Specialists
Frankye Myers: From Riverside Health System, this is the Healthy You Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health.
So let's dive into learn more about becoming a healthier you. .
I am really excited to have Dr. Leesch, a neuro interventional specialist with Riverside Neurovascular Specialist in the studio. Today we are gonna be talking about stroke prevention signs and symptoms, so I'm really excited to have you join us, Dr. Leesch, how are you?
Dr. Wolfgang Leesch: Thanks so much for the opportunity.
Glad to be here.
Frankye Myers: Good, good. Looks like you've gotten some nice sun. Yes, I'm glad the sun has come out and, uh, the weather's changing and weather
Dr. Wolfgang Leesch: weather's getting better. That is true, yes,
Frankye Myers: yes, yes. Dr. Leesch. Talk to me a little bit briefly about why you decided to pursue a career in neurology.
Dr. Wolfgang Leesch: Well, maybe we should start with, uh, talking about why I went into medicine.
Okay. That's because I, because I, I, I always, I'm, I'm very broad, broadly based, you know, I think medicine was always the subject that combined Right. All the. Uh, humanities with the science and all the different sciences. You know, physics, you have biology, chemistry obviously. And
Frankye Myers: I stayed away from a lot of those things.
Dr. Wolfgang Leesch: And, and, and then, and then in medical school, I think the brain, you know, epitomizes basically when you look at all the organs. Okay. Um, that trajectory. And you think what it, it has. Combine the mind and the matter in this, you know, basically defines us as a person, etc. So, uh, that's, that, that was from the beginning I think my motivation to go into, to go into neurology because I, I just thought the brain was the most interesting organ.
Absolutely. Combines the matter in the mind.
Frankye Myers: Yeah, absolutely.
Dr. Wolfgang Leesch: And then even when I did my neurology training and further sub-specialized in neurocritical care and in neurointerventional surgery, um, Again, the idea that you, you're a person of the mind, right? Right. You try to make a diagnosis, but also like to work with the hands, you know?
Absolutely. So that's how my career has pretty much gone from, from medical school to neurology to neuro interventional surgery. Absolutely.
Frankye Myers: Absolutely. Wow. All right. I wanna talk a little bit today around, unfortunately, strokes are very common. Right. I wanna talk a little bit about strokes. Every year in the United States, more than 800,000 people have a stroke, and it is the fifth leading cause of death.
Um, so would you talk a little bit about that? Um, and some of the stats that I just reviewed
for our listeners.
Dr. Wolfgang Leesch: Right, right. It's, it's, it's a very common problem and I wanna say during my own lifetime, we have seen such tremendous improvements and changes, right? In the way that we can deal with stroke and that we can these days reverse stroke really.
I remember, um, When I was in medical school or even, uh, when I started medical school, um, all you would do is somebody comes in with a stroke, is give, give aspirin, right? And uh, and then since 1995, um, a trial was done where tics, TPA, tissue, plasminogen activator was trialed and they, uh, basically a clot busting medicine was given.
Somebody comes in with a stroke, and that is now more than 20 years ago, obviously. But, um, That changed the way we looked at stroke and saying, Hey, we can actually do something about it. And then throughout my training, even when I started my, my residency and all that, there was not much more that could be done.
Right. Only since the early 2000 teens, you know, and then in 2015 the trials come out that we can actually go in inside the blood vessel and open my blood vessels and reverse stroke altogether. Right. Right. So this. Th this whole development is, has happened while I did my training and, and had my pro professional career.
Right? When you think about stroke, um, you have to think about what, what is a, what is a stroke? You know? Right. And, um, there are two types of stroke that we distinguish. Uh, generally speaking, you think about stroke. Most of the time, 80% of the time, we talk about a condition where a blood clot occludes a blood vessel in the brain.
Okay, so the brain is starving from oxygen. Like a plant needs water, right? The brain needs oxygen, needs blood flow. Absolutely. When the blood flow is interrupted in the brain, that's called a stroke,
Frankye Myers: Okay.
Dr. Wolfgang Leesch: For intents and purposes. But there's another pa, another type of stroke that's a bleeding stroke, and oftentimes the symptoms are indistinguishable.
The initial symptoms. Which we'll probably talk about, right? Um, such as paralysis, you know? Right. Um, and, uh, and, and 20% of patients you could have a bleeding on the brain that presents just like that. So 80% of the strokes. What general public thinks about when they talk about stroke is an ischemic stroke, meaning a blood clot occludes a blood vessel in the brain.
20% would be a ruptured blood vessel in the brain causing. Causing bleeding on the brain. I think what we are focusing on mainly today is the blood clots, because they're more common, right? And. It parallels what we see in the heart. People have heard the term heart attack. Heart attack, right? Yes. At Riverside we have come to U call stroke, sometimes brain attack, right?
Yes. You know, because it is very similar. I mean, with a heart attack, you have a, think about it this way. You have a blocked blood vessel in the heart, right? With a brain attack or stroke, you have a blocked blood vessel in the brain.
Frankye Myers: That's a great way of putting it. Absolutely.
Dr. Wolfgang Leesch: And and the idea is, the idea is that if you can unblock the blood vessel, be it by giving blood thinners, Or be it by going in with a catheter or certain devices that you can unblock the blood vessel, restore the blood flow, restore the oxygen delivery, and then reverse the symptoms of the stroke, or at least minimize the damage of the stroke.
Frankye Myers: Right, right. So for our viewers, you know, time is of the essence as you describe how you know the impact of the lack of lack of oxygen. When we talk about BEFAST, what does that mean and what does that stand for?
Dr. Wolfgang Leesch: We talked about heart attack and stroke, right? Right. For heart attack when a, when a blood vessel is blocked in the heart, as I mentioned, the symptoms are very severe, chest pain.
You know, these patients, they often, they often tell us, it, it feels like an elephant is sitting on their chest, right? They will call 9 1 1 right away. It's no re there's no education required, right? The pain is just so severe. They come to the hospital automatically. They will call 9 1 1 for a stroke. It's a little bit different.
Oftentimes these symptoms, stroke symptoms occur without pain, without having a headache. Plus, the brain is not functioning right, so the patient doesn't even know what's going on, right? If the left side of the brain is involved with the stroke, for example, the left side of the brain has a language, they might not be able to speak.
They might not be able to understand if the right side of the brain has lack of oxygen. They, uh, I have a symptoms called neglect. Okay. So that they're even unaware of what's going on, or also sometimes referred to as anno, nausea from, from Greek, not knowing that there is any disease, okay? That there was anything wrong with them.
I had a patient up in Boston during my training. I remember who was a cardiologist who, uh, highly trained, highly, uh, Harvard trained, highly intellectual person, completely paralyzed on the left side of his body. Okay. Was brought in by his family with symptoms of a severe stroke of the right side of the brain, which is a complete paralysis of the left side of the body.
And, uh, the language was not affected because that's in the left side of the brain and he was arguing with, uh, Emergency room staff that there was nothing wrong with him. Right. While he was obviously having a very severe stroke. And luckily we could reverse the symptoms.
Frankye Myers: That denial,
Dr. Wolfgang Leesch: he, he had a great outcome.
But even that's a, that's a level of denial. Denial, yes. Sometimes you can show the patient their own hand, right. The left hand, and say, whose hand is that? Right. And they'll say, It's your hand, right? And say, Hey, look, it's attached to your body. No, right? I was like, no, it's still, it's still your hand. And even this person that I just mentioned after he had a good outcome after he was back to normal, he even said, are you sure I had a stroke?
Is that really true? Wow.
Frankye Myers: Wow.
Dr. Wolfgang Leesch: So, so that's, that's why we are going out into the public and reeducating the public about the sign symptom stroke. Oftentimes the patients themselves, they don't even know there's anything wrong. So, or they can't, can't tell, and they don't have pain, right? So, uh, unfortunately if the family's not aware that these symptoms could theoretically be reversed, right?
They sometimes say, oh, let's wait. And, you know, maybe sleep it off. When is gonna get better tomorrow? But as you mentioned, time is brain. The brain without oxygen slowly dies, right? Um, sometimes I have the analogy like a, like a boxer, you know, it's like in a boxing match and gets knocked out, right? They can't function, but they're still sort of, Alive, you can bring them back if you're with water, with food, et cetera.
Same thing with the brain. So the talk clock is ticking. Right? And, and ultimately if, if the family doesn't bring the patient to the hospital, it may be too late. You know, so we're going out and we have these pneuomonics you mentioned be fast, right? That's a pneuomonic that we teach to the general public, to uh, to explain to them what are the sign symptom stroke.
Yes. So, The simple one is fast, you know, F A s T, right? Face, droopy arm is weak, speechless, alert, think T times brain come to the hospital right away. Right? Right. And then there's some more subtle stroke symptoms that not do not necessarily involve paralysis and they're covered by the BFAs. Be
Frankye Myers: Okay.
Dr. Wolfgang Leesch: Balance B or balance and E for Eyes if you have double vision. Okay. You know, your vision changes, right? Or B, if your balance is off, you could stumble around those. could also be. signs and symptoms of a stroke. So this is a monic that we teach. B fast. B for balance. E for eyes.. Okay. F face droopy. Okay, A is arm is weak S is speech is slurred or speech is absent or understanding is off.
And then think time is brain. Time is because come to the hospital right away. We can give you the clot buster within three hours, right? We can take out the clot from the brain if we identify there as a blockage, right up to 24 hours. Okay. You know, depending on the individual, obviously.
Frankye Myers: Okay. Great information and thank you for your commitment to increase awareness in joining us today.
Can a stroke happen at any age? There's some, sometimes misconceptions that you have to be older to have a stroke, but I've heard of younger individuals having strokes, so, um, can you talk a little bit about that?
Dr. Wolfgang Leesch: Obviously it's more common in the older popul, right, right, right. But, uh, but can happen many younger people too.
I mean, there are different, that brings us, maybe leads us towards the stroke mechanisms also, you know? Okay. Um, We mentioned that a stroke occurs when the blood clot occludes a blood vessel in the brain, or there is a blockage of a blood vessel in the brain. Okay, the next question for us then, in the workup comes where does the blood clot come from?
Okay. You know, so some of the conditions that, and also again, different from the heart attack, is that in a, in a, in a stroke, oftentimes the blood clot travels from a different part in the body, from the heart, or from pluck in the blood vessels in the neck piece breaks off. And get stuck in the brain, sort of like a clogged sink, you know?
Right, right. The clogged in the sink didn't exactly grow there, but it kind of came down the sink. Right, right. So same thing with the stroke. Um, uh, where we, um, uh, where we, uh, think about elderly people, they often have a condition, you know, plaque buildup in the blood vessels. They have an abnormal, a rhythm.
In younger people, what you're asking, the mechanism may be different. Okay. Some people have. Precondition, such as like a inborn condition where they tend to form blood clots. Right? And we can test for that or. with people working out these days, you know, having contact sports, you know, having extreme hobbies, like, you know, weightlifting, stuff like that.
Yes, yes. Bungee jumping. Like, I had a patient who was in the seventies and she, she asked, can I have a normal life? She's like, what? What are your hobbies? It's, uh, basically jumping our airplanes with a parachute. Wow. It's like, that's not exactly what I recommend. No. But with younger people sometimes you can have conditions, connective tissue disorders where the blood vessels tend to.
Have to form tears, you know? Okay. We call it a dissection and that we see more often than younger people.
Frankye Myers: Yes. Yes. Very good. Thank you. Thank you. Um, are there any genetic factors that increase your risk? Of stroke.
Dr. Wolfgang Leesch: Well, as, as I mentioned, you know, I mean, we, we ask, we ask people, especially in younger populations, we ask, uh, do you have a history of blood clots in the legs or a family history of blood clots?
Okay. In the legs or in the lungs, you know? Okay, deep vein thrombosis, pulmonary embolism, this kind of thing. Okay? There are certain genetic uh, conditions. A very common one would be prothrombin gene mutation, or another one factor five line that we can check for, okay? In younger populations. Okay?
Frankye Myers: What about high blood pressure?
Dr. Wolfgang Leesch: So those, those are the, those are the most common risk factors, right? In more elderly populations or middle-aged, I want to say, you know? Okay. Um, what are the big ones? Well, high blood pressure. You mentioned that, right? Right. High cholesterol, right. Diabetes, yes. And then, And then other, you know, other lifestyle choices that can be easily modified.
Okay. That are connected to these such as smoking. Right, right. Smoking is a very common one actually. Right. But also recreational drug use that raises your blood pressure, you know, unfortunately, lot of great cocaine, right? Yes. Um, But those, what does it come down to? All these risk factors, they damage the blood vessels ultimately, you know?
Okay. So you have then plaque build up in the blood vessels that then ultimately leads to stroke. So there are risk factors, not for vascular disease in general, not only for stroke, but heart attack, stroke, peripheral vascular disease. Okay. And we always try to, when somebody comes with a stroke, oftentimes a small stroke or a warning sign of a stroke, right?
Um, we try to stratify these risk factors, right? And get the blood pressure under control. Recommend them that they measure the blood pressure at home. Right. You know, and write down the numbers, morning, noon at afternoon or evening, and then show it to their. Show to the primary care physician that their blood pressure medication can be optimized.
Right.
Frankye Myers: That accountability. Right. And tracking.
Dr. Wolfgang Leesch: Absolutely. So often people are not aware that there's things that they can do at home, you know? Right. And then dietary choices. Obviously your Mediterranean diet, not too much salt or white, too much fatty foods, you know, fruits and vegetables, that kind of stuff.
Absolutely. And quit smoking. I mean, that's just honestly a big one. Yes. We really, really recommend that. And it's not always easy, but. Wow. Be giving advice.
Frankye Myers: Yes, yes, yes. Just, uh, that's great information. I know. Uh, for me and, and just family history and, and, and having friends who've had family members who have been impacted by stroke, medication compliance can be such a huge issue just because I've heard people say, I don't feel good when I'm taking my blood pressure medication.
I don't have the energy level. And then some of the unfortunate side effects, um, Can you talk a little bit about that? Or is, is that something that comes up? Compliance. Compliance,
Dr. Wolfgang Leesch: yeah. I mean, we can give advice as much as we want if, if it's not being followed. Right,
Frankye Myers: right, right. The impact is a stroke.
Right. If you don't, that's all we can, the things you need to do. Right.
Dr. Wolfgang Leesch: Oftentimes it's a wake up call, you know? Yes. We have. We have these patients who come in with small strokes or even warning signs of a stroke. We call it a trans end ischemic attack. T i a. Right. And obviously it's better when you have like a warning sign before the big one, right?
Because then you can take corrective action. Absolutely. And it's sort of like a wake up call. Yes. Both for the patients and the family, it's oftentimes a team effort. We always encourage the family also to kind of remind their loved ones. Sometimes pill boxes will do the trick. Right. You know? Right. Um, encourage them.
Encouragement is a big one. Right. Um, work out, eat healthy. Yes. Have your, you know, see your primary care physician frequently? Yes. Honestly, to have
Frankye Myers: And be forthcoming with your primary care. Be forthcoming if you're, if, if you're struggling. So that adjustments can be made as opposed to you just not taking your medication.
Dr. Wolfgang Leesch: And in terms of lifestyle choices, you know, when, when we have close family members or, um, spouse, right? Husband, you know, wife, um, oftentimes they share habits, bad habits too. You know? That's true. That's true. So, so we'll say, Hey, why don't you quit smoking together? Hey, why, why don't you, why don't you get a gym membership right together?
You know? Right. Both of you. That'll be good for both of you get healthy together
Frankye Myers: so you Correct. Have those foods at home. Yep. One person's trying and then the other person has all these foods that they're trying to resist. That's a good point. Do it together. It has to be a, a, a, a team sport, um, a family decision as it relates to those things.
I, I like the way you put that. Um, Are there ways to lower your risk factor? We've talked a little bit about that. You've mentioned exercise. We've talked about diet, so I, I think we've hit those in the conversations. Anything else you would like to add for our viewers, um, as it relates to that?
Dr. Wolfgang Leesch: Yeah, like, uh, you need a positive, you need a positive spirit, like a mindset.
You know, as I said, sometimes people need a little, little, uh, Reminder, you know, like a wake up call, such as when they have seen us, you know, and then, right. And that, and that oftentimes helps. But we always, I think, you know, encourage, encourage them, you know? Right. And also encourage family members to encourage our patients, so, right.
You do need the spirit, you know? Absolutely. And you need, and you need to, you need to know that what we recommend can really make a difference. You know, it's kind of, it can really make a difference in your life. Uh, these diseases. Stroke in particular, heart attack, vascular diseases and those that they can be treated these days.
Right. And with what we know about them, with what we learned about them, you can really add 20 years of to your life, you know? Absolutely. It's not like cancer, which unfortunately to this day, you know, and especially in my specialty, like brain cancer, with all the modern neurosurgery and everything that we do, you know, life expectancy has only increased few months.
Right. Um, in some of these brain cancers, Since the 1950, since we have looked at it, you know, since it started. But with stroke, as I said, 1995, nothing could be be done except given, you know, before 1995, aspirin, after 1995, we had the clot buster, which gives you a 30% chance of improvement. Now we have the intervention, which basically can reverse in certain.
If you come to the hospital right away, we go in with the catheter under x-ray from the blood vessel and the leg all the way up into the brain. Do a minimally invasive procedure. Take that blood clot out, you can. Come in, be completely paralyzed, droopy, face, slured speech, or not speaking at all and walk out the next day.
We have seen that. Absolutely. It's miraculous like a Lazarus effect and it's so gratifying, right? So obviously we don't want it to come to that, right? But wanna say this, what I wanted to touch points, like say the spirit, you know, the spirit that we have seen that led to these treatments. We have to kind of infect our patients with that spirit that you can make a difference in your life.
You can really do some changes. Motivation, you know? Absolutely. And, and, and add like 20 years of your life to your life if you, if you quit smoking now. Right. You know, studies have shown that within a year, um, of quit quitting smoking, you cut your stroke risk already in half. Wow. You know? Wow. If you, if you can quit like for five years, you have the same low strokes if you never smoked, you know, and that's not talking about.
Heart attack. Lung disease, lung cancer, emphysema. You know, these people walk around with oxygen tanks and stuff, you know? Right. But I was miserable after 40 years of smoking. Absolutely. Let's just talking about stroke. Absolutely. So that's a spirit we try to convey.
Frankye Myers: Yeah, that's a good point. You know, do something about it while you can.
Right, right, right. Um, and so this podcast and you, um, talk in the day and just helping to educate, uh, and increase awareness is gonna truly make a difference. Um, I like what you said, you know, um, it's almost like you have to have the intention, right? If you, if you're intentional about making the changes, you may not do it right all the time, but you just keep striving to do better.
That's right. And eventually it'll become a habit, right? Mm-hmm. Right? Absolutely. So, if someone is. Experiencing some of the symptoms we talked about or may have a family member or, or a loved one. Um, would you please, uh, tell them how they can contact you or someone within your group?
Dr. Wolfgang Leesch: Um, right. Well the first thing is if you have any of the symptoms that we mentioned, be fast.
Right, right down size, right Face, arm speed. Think time has been called nine one one. Absolutely. Call 9 1 1 right away. Okay. Go to Riverside. Because we are the hospital, I mean, that has the comprehensive stroke center capabilities. Not all hospitals here in this region have it. Absolutely. And um, we can make a difference.
Absolutely. If you do have any of the symptoms. Yeah. And then call, call our office, you know? Okay. Call our office and we'll, and we'll, and we'll put you in if it's something chronic, if you have any confessions. Yes. Obviously we treat a lot of conditions. We mentioned hemorrhagic strokes. Yes. Just to briefly touch on it, you know.
Yes. So aneurysms, yes. You have been diagnosed with any, I was gonna ask about that. Yeah, yeah, yeah. If you have an aneurysm, obviously if it's ruptured, You're in dire straits. You come to the hospital, right. If you make it to the hospital. But, um, bleeding on the brain is obviously very serious. Yes. But sometimes aneurysms these days get discovered by coincidence because many people get brain scans for whatever reason.
Headache. Right. And an aneurysm is like a outpouching, a bubble on a blood vessel in the brain. Think about like a corroded pipe. And we can treat that also from inside. We don't have to cut the head open anymore. We go from inside. Yes. And we can treat it from inside. If you have any of those conditions being been diagnosed with it.
Um, or you want a second opinion? We are here for you and just call our office. Five three four fifty two hundred five three four
Frankye Myers: fifty two hundred fifty two hundred, area code 7 5 7 57 7 57. Um, as it relates to aneurysms. Mm-hmm. Um, what are some signs and symptoms? I, I have a dear friend who unfortunately lost his wife and, uh, she was exhibiting, uh, forgetfulness.
It, it was pretty sudden. Mm-hmm. Um, and they didn't associate that and had a history of, um, high blood pressure and non-compliance. So what are some symptoms as it relates to aneurysms that, um, our viewers, uh, need to be on the lookout for? Mm-hmm.
Dr. Wolfgang Leesch: Unfortunately, I'm gonna say the majority of aneurysms. In the brain, they are completely asymptomatic.
Okay? So they incidentally discovered, or if they start to leak or rupture, right? Then you get a sudden severe headache. Okay? We call it sometimes a thunderclap headache, okay? Or the worst headache of your life, okay? If that happens is a real medical emergency. These people are very sick and the third of the people die on the spot.
They don't even make it to the hospital. Um, another third is doing better if the aneurysm doesn't explode, you know, it's like a. Think about you have a pipe breaking in your house. Right? Right. I mean, it could be a total disaster. It could be just dripping. Right? Right. And, um, similar in the brain. So if, if the aneurysm ruptures altogether, the little blood vessel being the pipe and you have a massive bleed on the head, then you have, you have no chance.
But if, if it just leaks, you get it. Severe headache, you come to the hospital, we fix your aneurysm. Okay. But most of the time, these aneurysms, if they're undiscovered, if they haven't been scared, if you have somebody in the family with an aneurysm, Sometimes they're run in families and you can have other loved ones get a brain scan, discover them, but oftentimes they're incidentally discovered, okay.
Because of a scan that has been done for headache, which is unrelated. Right? Right. Or dizziness. Or forgetfulness, right. That you mentioned, you know? Right. Uh, in which case then, um, you should consider treatment and see us in the office and should consider treatment because the treatments these days for aneurysms are much better tolerated than they were just 20 years ago.
Right. You think about it. Having your head shaved and cut the skull open yes, is obviously very, very, very traumatic. And now we can treat them from inside. From inside the blood vessel, from the. Blood vessel in the leg from the groin area. Okay. Under X-ray. So it's more minimally invasive? Minimally.
Minimally invasive. Invasive. The future of medicine. Yes. Yes. Absolutely.
Frankye Myers: All right. Well, thank you so much for your time. You've been a delight. Um, I've learned myself and I know our viewers have gained from having you on today. So thank you for what you do each and every day and the difference you're making.
Dr. Wolfgang Leesch: You're welcome. Thank you so much for having me. Thank you.
Frankye Myers: Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
