Vital to call 911 at first symptoms of stroke
East Bay system aims at care in critical first 4 hours
If someone suddenly loses the ability to speak, move body parts or has trouble seeing, call 911.
These are the first symptoms of a stroke and it's imperative that a person receive immediate medical attention, said Sarah Kiyoi, Stroke Coordinator at San Ramon Regional Medical Center.
Every minute counts when someone is having a stroke, yet the average stroke patient waits more than 12 hours before going to an emergency room and many wait much longer, sometimes an entire day, she said.
An expanded Stroke System to reduce brain damage launched Jan. 9 in Contra Costa to join Alameda County to provide a coordinated 911 emergency response. It identifies stroke victims en route to stroke-certified hospitals to treat them within the critical four-hour window.
"It's really, really exciting because stroke has kind of ended up taking second fiddle to heart disease. People don't know there are things you can do to turn a stroke around," Kiyoi said. "The overwhelming majority of people, less than 5% of patients nationally, get to the hospital to be treated acutely. Stroke is the third leading cause of death in the United States."
The leading two causes are heart disease and all types of cancer combined.
"The other thing to know is strokes are one of the leading causes of long-term disability in the U.S. -- paralysis, blurred speech, they can't walk without assistance," Kiyoi added. "Twenty-six percent of patients end up in a nursing home.
"The story of the heart attack is if they can get to an ambulance or emergency room they're most likely going to live. They are not only going to live but they are going to walk away," she continued.
"With a stroke they're not necessarily going to walk away."
There are two types of stroke, she explained: dry or ischemic and hemorrhagic or bleeding stroke.
"The overwhelming majority, 87%, are dry or ischemic," she said. "This means there's a clot, usually the arteries become narrowed from plaque and cholesterol building up. The clot builds up or gets lodged in a blood vessel, and the area beyond that starts to die. The bigger the blood vessel, the bigger part of the brain affected.
"The scary part is, the brain is what controls everything else."
The good news, she said, is that usually only one side of the brain is affected, which controls just one side of the body, the opposite side.
Hemorrhagic or bleeding stroke is caused by a blood vessel in the brain breaking and bleeding into the brain.
"The symptoms are a severe, severe headache. It's a quick onset -- boom! 'My head is going to explode,'" Kiyoi said. "This is 13% of all strokes and 30% of all stroke deaths. There is nowhere for the brain to go -- it gets squished."
Rapid treatment is important for any kind of stroke, she emphasized.
A third type of "mini-stroke" gives people a sign that an ischemic stroke is on the way. These transient ischemic attacks -- called TIAs -- happen when blood flow to the brain is temporarily blocked. They may cause blurry vision or loss of vision, tingling or numbness of the mouth or the inability to speak clearly, and your body produces a drug to deal with it.
"Your body breaks the clot up," Kiyoi said. "They are usually mild and last for 15-20 minutes."
They should not be ignored because it is estimated that 15% of TIA sufferers have a stroke within a year.
When stroke victims arrive at San Ramon Regional, the stroke team reaffirms the diagnosis, then treats the patient with the same clot-busting drug.
"We treat when appropriate with a drug that works in the same way as your body does to break up a clot, and return blood flow to the brain," Kiyoi said. "There is only one FDA-approved drug, and it takes an hour to give it.
"It returns blood supply to that part of the brain, and it's pretty miraculous when we see it work," she continued. "The signs and symptoms will turn around in the first hour or so."
"We do very, very close monitoring for first 24 hours after medication. We do lots of follow up screening and testing," she said. "We have a stroke team and we treat a stroke with the same level of urgency as someone not breathing. We page throughout the hospital, just like a code blue. We have a whole team that pops into action, 24 hours a day."
San Ramon Regional is affiliated with the neurology department at California Pacific Medical Center in San Francisco.
"So we are basically able to get a stroke neurological consultation very quickly and at a super high level," Kiyoi said.
San Ramon Regional received its certification as a stroke center in December after a year of fine-tuning its procedures.
"We definitely have 'owned' being a stroke hospital," Kiyoi said. "It was a culture change to feel like it's something we do and we do well. It's multi-disciplinary, involving five different departments."
Radiology performs the CT head scan; the laboratory runs three tests to help determine the treatment plan; the pharmacy provides the drug; and critical care doctors and nurses are stroke specialists.
Stroke victims can be seen in the emergency room or they may have been admitted for other reasons then have a stroke while in hospital, Kiyoi noted.
When suspecting a stroke, the team performs standard tests. One is to show a picture of a feather to see if the patient can find the word to identify it, which shows whether the person can take in an image, understand it, organize a response and deliver it.
"People think strokes are more of an 'elderly' thing," Kiyoi said, "but I'm seeing lots more people in their 40s, 50s and 60s."
"A lot has to do with same old, same old -- diet and exercise," she added. "Some is hereditary. I have seen some patients look very healthy on the outside and feel healthy but they still have a stroke.
"High blood pressure is big risk factor and it's silent. Until they have to, people don't pay attention to it. High cholesterol is also silent. It builds up on your artery walls and makes it easier for a clot to lodge."
High blood pressure is 140/90 or above; 120-139/80-89 is the pre-hypertension stage, or at risk. Normal is less than 120/80, according to guidelines of the National Institutes of Health.
Eighty percent of strokes are preventable with proper eating and exercise, Kiyoi said.
"The cool thing is it's a twofer -- you reduce the risk of stroke and you also reduce the risk of heart disease."
A danger is that a person won't recognize they are having a stroke, and they may lie down hoping they'll feel better.
"There's lots of denial," Kiyoi said, which is why it's important for spouses and friends to be aware of symptoms and insist on medical treatment. "If you let a stroke patient tell you they don't want to come in, well, their brain is broken, the thing making decisions is broken."
Of stroke victims, 60% are women while 40% are men.
"We don't know why. We're looking at hormones," Kiyoi said. "Heart disease is 50-50. We're trying to figure out why we're seeing those differences; there's a lot of research going on."
"Women handle so much and are really good at that denial thing," she added.
They may think they can handle the symptoms without stopping their other activities.
Women think of breast cancer as their biggest health threat although stroke kills twice as many woman than breast cancer a year, according to the National Stroke Association.
"A huge, huge part of whether they come in or not is that awareness," Kiyoi said.
Countywide stroke systems and hospital certification to treat strokes have been gaining momentum in the last five years, Kiyoi said.
"It definitely takes an institutional commitment, from the administration down," she said.
The standard is tough, she pointed out, and she's proud that the medical center is holding itself to it.
"It's really neat that part of the requirements is that you do community outreach," she said. "That's one of my favorite parts, talking with people at wellness events."
In 2011, Kiyoi educated almost 800 people through seminars, classes and community events and is on the speakers bureau for the American Heart/American Stroke Association. Contact her at 275-8886.
"I'm always shopping around for more opportunities," she said. "It's free, an hour-long lecture. I answer questions and give out literature."
Kiyoi said she emphasizes the importance of being engaged in your own health, which leads to knowing why you should live healthy.
People also need to understand their medications and keep them up to date.
"Sometimes your body becomes less responsive or you pack on 10 pounds and it is not working. Things change," Kiyoi said. "Also, are people taking their medications regularly? Do you know why you are taking them?"
Someone might stop taking the aspirin the doctor prescribed because it is over the counter, or they can't afford it.
"There are a lot of reasons. If you understand that aspirin makes blood not clot as easily then you're going to take it every day," she said.
The American Heart/American Stroke Association has a "Life's Simple 7" list to help reduce heart disease and strokes by 20% by the year 2020.
"If we all make small changes it comes out to a huge impact," Kiyoi said. "Looking at the entire population, if we can reduce overall blood pressure by 10 points then the death rate goes down dramatically."
The Stroke System in Alameda and Contra Costa counties also promotes the "Act in Time" campaign of the National Institute of Health. This means that everyone will recognize the signs of stroke and not wait to call 911.
"Those who do wait risk permanent brain damage or death," said Mia Fairbanks, Contra Costa Stroke Program Coordinator.
Signs of a stroke
* Sudden numbness or weakness of face, arm or leg, especially on one side of the body.
* Sudden confusion or trouble speaking or understanding speech.
* Sudden trouble walking, dizziness, or loss of balance or coordination.
* Sudden severe headache with no known cause.
* Blurred or double vision, drowsiness, and nausea or vomiting.
If you suspect someone is having a stroke, remember the following:
* Face -- does one side not move as well or droop?
* Arm -- have them put their arms out in front of them. Is there numbness on one side?
* Speech -- is it slurred? Is it appropriate? Can they answer simple questions?
* Time -- call 911. The faster medical help arrives, the more brain they can save.
'Life's Simple 7'
1. Get active
2. Eat better
3. Lose weight
4. Stop smoking
5. Control cholesterol
6. Manage blood pressure
7. Reduce blood sugar
--American Heart/American Stroke Association