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Episode #2113
Stroke I: No Respecter of Persons
[INTRO MUSIC]
Bullock-Brown: Did you know that stroke is the third leading cause of death in North Carolina? That nearly 30% of all people who have strokes are younger than 65 years of age? And that African Americans are twice as likely to die from stroke as Caucasians? More and more, statistics are proving that stroke is no respecter of persons. Find out more on Stroke and How to Protect Yourself next on Black Issues Forum.
Voiceover: Funding for this program is made possible in part by UNC TV members.
[MUSIC]
Bullock-Brown: Hello, everyone, and welcome to Black Issues Forum. I am Natalie Bullock-Brown. More and more statistics are proving that if you are an African American living in the state of North Carolina you need to be on the lookout for the onset of stroke. Our state is seated in what is being called the Stroke Belt and reports from the nation's Centers for Disease Control have found that half of all African American women will die from stroke or heart disease. If you don't think this will affect you, keep watching. Today we will talk to guests who are working hard to make sure that more African Americans are aware of the dangers of stroke. Right now let's take a moment to meet one of them and find out more about stroke. Please note that information in the program is for informational purposes and is not intended for use as diagnosis or treatment of a health problem or as a substitute for consulting a licensed healthcare professional for medical advice, instruction, diagnosis or treatment. If you have specific questions or concerns, please consult your physician or appropriate licensed healthcare professional.
Chase: Good morning. How are you?
M: I am pretty good. I've been doing better.
M: Dr. Cheré Chase is the Director of Stroke and Critical Care at Forsyth Medial Center in Winston-Salem. She defines stroke as an abrupt change in a person's normal neurological capacity.
Chase: There are several ways that strokes occur and the first is that a clot can develop within an artery in the brain and that closes the blood vessel so that the nutrients and blood cannot go to the brain in order for the brain to stay healthy. Another way is that there is a clot that either comes from the heart or another vessel in the body and it breaks off and goes up to the brain causing the same decrease of nutrients and blood clot.
M: Chase profiles those who are vulnerable to stroke.
Chase: Patients most at risk for stroke are patients who are over the age of 60 years old and also there are racial groups that have an increased risk for stroke including African Americans. African Americans are at two times greater risk for stroke than patients of other racial groups.
M: But Chase warns that stroke does not discriminate by age.
Chase: We often see patients who present too late for us to give the therapeutic intervention because they believed they were too young to have a stroke or not at risk for having a stroke. Strokes can happen in the pediatric population. They are not as frequent but they often happen after the age of 30 and 40 years old as well.
M: Timing is also a factor in treating stroke. Chase says that the earlier a stroke is diagnosed, doctors can use what are called clot buster medications to open blood vessels and reduce damage.
Chase: We're actually able to see the before and after picture where we see the brain with very little blood vessels that are full of the nutrients and blood that they need. And then after with the therapy we see that the blood vessels are open and we often see patients respond very quickly right on the angiography sweep and they go from having dense, a weakness on one side of their body to being able to move their body completely again.
M: Beth Parks is Executive Director of the North Carolina Stroke Association. She says the organization was founded in 1999 to help place greater emphasis on stroke prevention.
Parks: Disease management has been the school of thought for many years in medicine. With the insurance skyrocketing premiums, extended hospital care with relation to stroke incidences, there was a shift in this new concept of disease prevention. Stroke is the leading cause of adult disability. It is the third leading cause of death that it is largely preventable.
M: Parks says the association has created a stroke risk identification program that is operated by healthcare systems throughout North Carolina.
Parks: What we do is provide community risk screenings to identify those risk factors: elevated cholesterol, glucose, high blood pressure, carotid artery disease. Those people who may have symptoms of stroke that are mini-strokes but have no clue as to what those symptoms are.
M: Dr. Chase says warning signs for stroke vary.
Chase: Patients can present with very different warning signs. They can have dizziness, visual changes, frequently patients will present with difficulty with speaking, difficulty with understanding what other people are saying to them, numbness and tingling in an arm or a leg or both as well as weakness.
M: The North Carolina Stroke Association also has a unique service for recovering stroke patients.
Parks: We've created the hospital visitation program whereby we provide educational , materials while a person is still in the hospital. We collect demographic information on that person and we provide three month follow up telephone calls to people once they have been discharged from the hospital.
Chase: Well, you are going to get your handwriting back after all.
M: I even cut my meat.
Chase: I am proud of you.
M: The following advice is offered to those who may be at risk for stroke.
Chase: As soon as you recognize a symptom of stroke you immediately call 911 and go to the nearest hospital in order to be evaluated because there are therapies that we have available and many patients believe that stroke is what it was 10 years ago and that there is nothing available and so whether they come in the first 15 minutes or the next 15 hours, it won't make a difference and in fact that is just not true anymore
Bullock-Brown: I'd like to introduce our guests. Once again, Dr. Cheré Chase, the Director of Stroke Programs at Forsyth Medical Center in Winston-Salem. Dr. Chase is in charge of stroke prevention and neuro-critical care programs.
We also have Reverend Daryl Napper, pastor of New Calvary Missionary Baptist Church in Greensboro. Through a CITIES Stroke Grant Rev. Napper has involved his church in community outreach and education on stroke. Welcome to both of you. I want to start out with Dr. Chase again. Very interesting information there that you have presented. Tell me, though, what about stroke is it that caused you to pursue that specifically as sort of your specialty?
Chase: One of the reasons why I developed a passion for taking care of stroke patients is that it became very obvious that there were things that we could do to reverse the symptoms of stroke if they happen. But more importantly actually try to prevent the stroke from happening in the first place.
Bullock-Brown: And how do you do that?
Chase: Well, one of the things that we want to do is to get out into the community and talk to them about risk factors; high blood pressure, diabetes and the risk factors that we talked about are preventable risk factors and we are able to give people information about how to control those risk factors and decrease the likelihood that they will have to have disability from a stroke.
Bullock-Brown: Speaking of community outreach let me just go to Reverend Napper quickly because I know that you work very diligently with your community trying to make people aware of the risk factors for stroke, signs of it. But have you-why are you doing that sort of work?
Napper: Well, I think it is very important that we do that because our people perish from the lack of knowledge and if I can do anything to get the knowledge out and get the word out about our stroke risk, I think it is very important because we don't understand really how at risk we really are because we don't really know. And I think that in conjunction with Dr. Chase and everyone else I think it is very important that we get it out.
Bullock-Brown: well, let's talk about some of the warning signs and we have a graphic that we can show our viewers that gives warning signs for stroke. Some of those signs are sudden numbness or weakness of the face, arm or leg especially on one side of the body. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes. Sudden trouble walking dizziness. Loss of balance or coordination. Sudden severe headache with no known cause. And Dr. Chase, I mean, sometimes you have, I have experienced a little tingling in my arm or dizziness. But how do you-what should our viewers know that would help them to just say, "Something is not right. This is not the usual tingle in my arm or dizziness or whatever. Something really is not right and I need to pursue medical help."
Chase: Usually what we recommend is if it is a symptom that you have never had before or if it is a headache for instance that is different from the kind of headache that you are used to or if it makes you sick for the first time in your life, you should seek emergent hospital care. One of the things that people try to do at home is diagnose themselves and figure out whether or not they slept funny on their arm for instance or whether this is a stroke. It is numbness or things that I need to be worried about and I always tell people that a false alarm is a good thing. If you go to the hospital and it turns out that it is something very simple, that is more important than staying at home and finding out it was something very serious.
Bullock-Brown: So you would encourage people to go to the hospital no matter what. I mean, even if you think it is nothing? Go.
Chase: It is more important to find out that it is nothing because at the hospital there is medication what we can potentially give you that can reverse the symptoms for your stroke and you won't have to have a disability from your stroke. But there is a time limit to it. We have to be able to give that medication within three hours. So if you sit at home and try and diagnose yourself for the first five or six hours we may not be able to help you when you come into the hospital.
Bullock-Brown: Reverend Napper, what sort of message do you give especially to younger people because I remember that Dr. Chase said that in the piece that we saw that young people are really at risk as well and that we don't often think of ourselves as being at risk. So how do you get that across to your community and your constituents?
Napper: I basically tell them that we are at risk as well because number one we are black and so that is a downfall that we have even from the beginning because we are just born black and so we have to be careful about what we don't know and get as much information as we possibly can.
Bullock-Brown: So it is an automatic risk factor is that we are African Americans?
Napper: Yes.
Bullock-Brown: That is just automatic. So if you don't have any risk factors you still could have a stroke.
Chase: That is right. In fact studies show that even if you don't have high blood pressure or diabetes or high cholesterol, just being African American is a risk factor for sure.
Bullock-Brown: Let's review the additional risk factors for stroke that are out of our control and besides your race these include age, sex, family history, previous stroke history, any others what we didn't list, Dr. Chase?
Chase: That pretty much covers it. I think that one of the things that we often forget about is a family history of cardiovascular disease. People don't always make the connection between stroke and heart disease and their brother or sister or their parents. That winds up playing a very important role in whether or not someone will go on to have a stroke themselves.
Bullock-Brown: Reverend Napper, when you go out into the community and try to make people aware of the risk factors for strokes, the symptoms of stroke, what sort of resistance or receptiveness are you met with?
Napper: We get some resistance and it is because they really don't understand and you are talking about the older population. Now our younger generation, talking about 30 or 40, they are more receptive because I am on my feet myself and I am walking the community myself trying to encourage them. And we do something at my church on Wednesday, we call it Walk with the Pastor. That is a type of exercise that people just come out and talk with me and they really come out and begin to talk and I can kind of get information out that way.
Bullock-Brown: And do you often find that by people coming out to do the Walk with the Pastor, I love that, do you find out things that you wouldn't ordinarily find out about your congregation?
Napper: Oh, yes. They will tell you how their day went at work , what is really going on with their lives, they get an opportunity to talk about issues with their children or just how they felt throughout the day, sickness or tingling in the arm and once they do that, I can say, "Well, you probably need to go see your physician because that can lead to something greater." Or they will talk about their child and the issues that they are facing. And I will tell them, "Listen, you take them to the doctor because the Lord put physicians here for a reason and we need to utilize those physicians."
Bullock-Brown: Well, it seems like going to the doctor is one of the things that we can control to prevent stroke. There is another list, though. There is actually a long list of things that we have control over related to risk factors for stroke. And these include high blood pressure, heart disease. These are things that we can take medicine for, we can do things about tobacco use, we can quit smoking. Diabetes, high blood cholesterol, physical inactivity which we were talking about earlier and something that I need to deal with. Overweight. What would you say, Dr. Chase, to our viewers, people who may not be dealing with stroke right now but most likely have the potential to have a stroke given the risk factors? What do we need to do right now to change the potential for stroke?
Chase: I think that one of the things that we can also include on that list is a sort of a lack of awareness and particularly finding out more information. But I always recommend that people do, of all ages, even in their 20s and 30s is begin to ask their doctors about their own health particularly if they have a family history of diabetes or high blood pressure. Frequently we will see physicians work with patients and they will say, "Well, you have just a little bit of sugar but we will watch for that," or, "You have just a little bit of high blood pressure." What I am telling patients to do is say, "Well, because my mom also had blood pressure, I would like to start dealing with it right now instead of potentially watching to see if it becomes a problem later on." Because particularly for African American patients, when you start to have even the slightest rise in your blood pressure or your cholesterol or you r sugar levels, that is the potential time when we can do the most good for preventing stroke.
Bullock-Brown: Are there little things that can be done right now? Even if I don't go the doctor again for another year, is there something I can do about what I eat? Exercise? Anything that could really make a difference?
Chase: We always talk about lifestyle changes and one of the things that is very helpful for people is there is lots of free information out there either in text or online. Take a look at those things that would increase the likelihood that you will have high blood pressure and increase the likelihood that you will have high cholesterol in your diet, becoming more active. We often talk at work about the fact that we are so busy we can't necessarily get to structured exercise programs. But then we laugh about the fact that we circle around and try to find the closest parking space to the front door of the hospital. And so parking a little bit further away from the hospital and walking or taking the stairs. There is a program at Forsyth Medical Center that is now encouraging people to walk the stairs instead of take the elevator. So there are little things that we can do as part of our day-to-day routine even when we feel like we are too busy to do more structured things.
Bullock-Brown: Reverend Napper, and I am going to ask you this also, Dr. Chase, but what since you have become more educated about the risk factors for stroke, what have you done specifically in your own life and maybe with your children and your wife that has potentially made a difference.
Napper: We have changed out eating habits and we use a Monday called Family Day and we go out and we get some exercise or actually we go to the gym, shoot basketball, we don't eat many fried foods at all. As a matter of fact, she is cooking more now. But she is a country girl from Henderson, North Carolina so she can cook so we are excited about that. So we just changed the way that we eat.
Bullock-Brown: Were you going out to eat a lot?
Napper: We were spending quite a bit of money eating out.
Bullock-Brown: Is that, Dr. Chase, something that can actually contribute to the potential for having a stroke if you are eating out where you don't have control over what is being put in the food and you don't really know how it is being cooked?
Chase: Absolutely. I think as a society we are getting very, very busy and so it is much easier to drive through and pick up dinner than to sit down and prepare a meal. Frequently we can't control the quantity of the food or how it is prepared or how it is seasoned. So that is one of the things that usually puts us at significant risk for high blood pressure or diabetes.
Bullock-Brown: Reverend Napper, with the CITIES Grant that you have gained access to I guess, what sort of changes have you seen take place in your congregation and in your community?
Napper: Our community is becoming more aware. We have health fairs. They have what we call a mobile that will come out and they come out and check your cholesterol and check where you are. They are just being more active and more participant in what they are doing and what we are doing actually.
Bullock-Brown: When the mobile comes out, I am curious to know, because I know that one thing for African Americans that we often deal with is not wanting to go to the doctor, being very hesitant to go and maybe not going for years. So when things crop up it might be too late. So when the mobile comes, do you find that a lot of people are taking advantage of this free opportunity?
Napper: Yes. I want to tell you that we had an incident that happened. As a matter of fact she is my, she is the head of my missionary department. And the mobile that came out one weekend and she was feeling fine but her blood pressure was extremely high. And when she went in to get checked they sent her directly to the doctor which helped a lot and when that actually happened our people in the community found out about it real fast and so they are now rushing over to the mobile to get checked because most of our African Americans don't have that much insurance or if any. So now they are using that opportunity to really see where they are.
Bullock-Brown: That's awesome. Dr. Chase, tell me about private stroke centers. I am sorry, primary stroke centers and why they are important.
Chase: One of the things that makes the primary stroke center important is that it looks at not just acute care for strokes. But what we do about stroke education. When we looked at our vision for our program we wanted to be sure that patients who had strokes were given the information that they needed to try to prevent a stroke from happening in their future. And then we realized that part of our mission needed to be to try to prevent strokes from ever happening. And that is really one of the things that as a primary stroke center we try to do. We're there if a stroke should happen, we try to provide excellent care based on a national standard. But not only that we try to prevent strokes by getting more involved in the community. It is not a requirement necessarily to be a stroke center but in my mind it is really an obligation as a community health program within Forsyth County. We try to avail people to prevention and education in order to decrease the likelihood that they come to the hospital and need our services.
Bullock-Brown: Right. Now when you say that not every hospital has to be a primary stroke center, does that mean that some hospitals pursue the designation of being a primary stroke center and others don't? But if they don't, are you saying that you think that all should?
Chase: I think that it is important that in every community we have at least one primary stroke center. The goals that are set for primary stroke centers are quite high and the expectation is that you will be able to provide a certain level of care if someone comes in that you are able to provide emergency medications if someone comes in with a stroke. So I think that at least one primary stroke center in every community would be very important.
Bullock-Brown: Let's go back to something that I believe you said in the piece that we saw which is this crucial time between when a patient has a stroke and when disability can set in because they haven't been treated quickly enough. I think you said there is three hours window of time. Talk more about that.
Chase: There is a medication that is called TPA and most of the public understands it as a clot-busting medication. One of the types of strokes you can have comes when a blood vessel is filled with a clot and you can't get the blood flow. We have a medication to actually dissolve that clot. But id we give it to you after three hours it puts you at significant risk for a hemorrhage or bleeding into the brain. So the minute you see symptoms or you feel like you have symptoms or you are witnessing someone else with symptoms, you should call 911. Even though we have a three hour window that medication is much safer if we give it in the first 10 minutes than if we give it at three hours. And we always talk about time is brain. And so for the period of time that the brain is without oxygen and nutrition in that part where the blood vessel is actually directed to, you may have disability even after 10 minutes of symptoms so I don't want people to wait until two hours and 30 minutes and say, "Okay, well, I better go to the hospital because my three hours are running out." I think that it is important to come in as soon as possible.
Bullock-Brown: And Reverend Napper, I am going to give you the last word. Are there any people in your congregation who may have had a stroke prior to you beginning the dialogue that you have with your community that now wished that they had known more before.
Napper: Yes. I had one woman who had a stroke. She is fine now. She had a small stroke, I guess one of those mini-strokes and she said if she had known the information she knows now, she would have gone to the hospital earlier to prevent anything that has happened to her now.
Bullock-Brown: And how old is she?
Napper: She is about 42.
Bullock-Brown: Wow. Well, I want to thank both of your for your expertise and sharing all your wonderful information with us today. We are going to talk more about stroke and how to deal with life after a stroke in our next broadcast. But if you would like more information on today's show or a transcript, visit us online at unctv.org/bif or call the BIF line at 919-549-7167. As always thank you for joining us for Black Issues Forum. I am Natalie Bullock Brown reminding you to be encouraged no matter what. Have a good one.
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