18: Stroke Awareness

May is Stroke Awareness Month. Knowing the signs of a stroke are vital in saving brain function when a stroke occurs. In this special two-segment episode, the Vedalas talk to Jennie Melendez, a Healer at Norman Regional who is also a stroke survivor. The brothers get a first-hand account from Jennie as she shares her story. The doctors then bring in Holly Costner, DO and Lane Tinsley, MD to give their professional advice on stroke and describe the lifesaving care they perform on stroke patients coming into the emergency department who then come into our in-patient care. 

Guest bios:
Jennie Melendez, MBA is a communications professional with experience in news, print, higher education and state level agency. In her latest role, Jennie is a marketing and communications specialist for Norman Regional Health System. Jennie received her Bachelor of Arts in Journalism/Broadcasting from Oklahoma State University and received her MBA in Integrated Marketing Communications from Oklahoma City University.
Jennie is a hemorrhagic stroke survivor, with her stroke happening on April 22, 2022 during a normal day at work. She tells us her story and what she has had to overcome in her recovery.

Holly Costner, DO is an Emergency Medicine Physician at Norman Regional Health System.  Dr. Costner is also the co-medical director of Norman Regional’s Stroke Committee with Dr. Tinsley. 
 
 Lane Tinsley, MD, is Norman Regional Health System’s first Neuro-Hospitalist, treating acute neurological issues for actively admitted patients in the hospital. Dr. Tinsley has 7 years of experience managing adult patients with strokes, seizures/epilepsy, headache disorders and dementia. She is the co-medical director of Norman Regional’s Stroke Committee, along with Dr. Costner.

Links:
Holly Costner, DO
Lane Tinsley, MD
Norman Regional Stroke Center of Excellence
Norman Regional Stroke Support Group

This podcast is for educational purposes only. The information in this show is not to be used as medical advice. If you are needing medical care, please consult with your physician.

Norman Regional is hiring! See all our open opportunities here: https://careers.normanregional.com/careers-home/

Transcript

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Welcome, friends.

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Dr. Veer Vedala here.

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And I'm Dr.

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Krishna Vedala, and.

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We are. The Vedala Bros.

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Welcome to season
two of our podcast, Vital Visions,

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where we delve into all things
vital, empowering our community.

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One health topic at a time. Absolutely.

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And to our returning listeners,
it's fantastic to have you back

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and to our new listeners.

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Buckle up, because in this podcast
we explore emerging medical research,

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the latest in technology

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and crucial health care topics
that resonate with our community here

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at Norman Regional.

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Plus, we also sprinkle in some health
and wellness tips for good measure.

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That's the spirit.

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And each episode,
we're also joined by incredible guests,

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from medical professionals
to local community leaders

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and even some of our friendly neighbors.

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Together, we tackle various issues
affecting our community.

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So whether you're a health enthusiast
or just looking to stay informed

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about healthy living trends,
consider this podcast

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to be your ultimate go to resource.

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So join us as we navigate the journey
to healthier lives

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and explore
the latest trends in wellbeing.

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Welcome to Vital Visions
Where Health meets Community.

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Welcome

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back, my friends,
to another episode of Vital Visions.

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I am Doctor Veer Vedala
joined by my co-host

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Doctor Krishna Vedala.
And we are the Vedala bros.

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Thank you guys for joining us for yet
another episode of Vital Visions

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where we discuss all things
vital, empowering a community, one topic

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at a time.

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Krishna, let's begin this episode
with a little exercise again.

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Is that okay with you? Yeah.
That's fine. Okay.

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We're going to put ourselves
in another person's shoes, if you will.

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Imagine you're normally going
about your daily routine.

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Let's say you're
at your favorite restaurant, for example,

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and you're asking your friend across
from you a question about the menu,

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and you're
trying to get an answer from him,

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but he keeps responding
you with your mumbling.

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Why are you mumbling?

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Let's try again.

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You've had a headache for about a week.

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Yeah, you get migraines.

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This isn't new, but one morning you're

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looking for your keys to head out to work,
but you can't find them.

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It's very frustrating
because of this nagging headache,

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but all of a sudden, it intensifies
so intense that you can't think.

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You can barely speak.

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And you turn around and your wife comes

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to check on you,
and all you can let out is help.

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Big help.

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Frightening, right?

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No. Definitely.

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Yeah.

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These are real accounts from patients
who have suffered a stroke.

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Strokes can happen without warning
and can lead to severe consequences

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including brain damage,
long term disability or even death.

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In the United States,
someone suffers from a stroke every 40 seconds

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and tragically, every 3.5 minutes
someone loses their life to the condition.

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With nearly

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800,000 Americans experiencing a stroke
each year.

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It's the leading cause of serious
long term disability.

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Today will delve into why

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recognizing the signs of a stroke
and acting quickly is so crucial.

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Highlighting the importance of awareness
and early intervention.

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We'll also hear
a compelling firsthand account

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from Ms. Jenny Melendez,
who will share her personal experience.

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Additionally,
joining us for this vital discussion are

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two of our amazing providers
here at Norman Regional.

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neurologist Doctor

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Tinsley and emergency emergency medicine
physician Doctor Costner.

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Ms. Melendez
thank you for joining us today.

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Yes. Thank you for having me this morning.

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Once again,
thank you so much for, coming by today

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and also, sharing, us about your story.

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This episode means a lot to us.

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our father also suffered a stroke
in 2017, so, it really is a very special.

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And, we can only put ourselves,
and, you know, in our shoes at the time

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and just how terrified we were.

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So, can you please start off

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with just kind of telling a little bit
about yourself?

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Sure.

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I was born in New York,
but I consider myself an Okie.

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we moved here for family reasons,
and because of oil.

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and I went to college.

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I got my bachelor's at Oklahoma State.

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in journalism.

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I thought I wanted to be a television
reporter.

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later on, I realized,

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that I enjoyed the communication
and the writing aspect of it

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and went back and got, 
my MBA in integrated marketing.

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So that is something that I always,
prided myself on and even enjoyed

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being like in Toastmasters

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and just being able to debate with people,
speak with people, and just

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that was something that I, thought
that I was always gifted with. And,

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comes, you know, down the road later
that I have issues with it.

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Now that,

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Can you tell us a little bit about,

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your story,
and when you had your stroke?

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Absolutely. April 22nd.

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so it'll be two.

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It was two years ago this past April.

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So somewhat recent.

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I was working at as, a reporter
at the time

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at the, 
Capitol, covering the state legislature.

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And we had just gotten back from lunch.

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I have struggled
with my weight for most of my life.

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and had previously been prescribed, 
a weight loss medication

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that, you know,
even with my high blood pressure,

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I was successful on it
and was able to lose weight on it.

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And I had just,

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seen my primary care provider
and had gotten, back on, the medication.

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And so I had taken it, with my lunch
that day and then got back to work

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and, just out of nowhere, like,

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right as, the Senate started, I got
it was just the worst,

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headache of my life.

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And I had previously suffered
with migraines,

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but this was something different.

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my body was telling me it was
something is wrong,

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and, I was close to a hospital.

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I was lucky that I was close to a hospital
and was able to get there very quickly.

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But I remember just telling my boss, like,
I've got to go.

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And he was looking at me like,
where are you going?

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But I just, I didn't understand other

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than, starting to get some blurry vision
and just this headache

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and almost a feeling of,
like there was liquid in my brain.

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that something was very wrong,
and I needed to get checked out. so.

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But by the time I got to the hospital

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and they gave me medication
to get my blood pressure down,

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they thought I was doing

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all right
and they were ready to release me.

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And I really had to advocate for myself.

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And I was told them, you know, like this
migraine, something is wrong.

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And they brought up my previous history
with migraines.

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And I said, well,

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I know that I've had them my whole life,
so I know that

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this isn't a normal migraine.

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And I kind of had to,
you know, argue with them for a while.

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But they finally did a CT
and about an hour later,

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two doctors came back and I was like,
oh, this isn't good.

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and I didn't get all the information
until later.

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But I stayed there for about a month,
and I had had a hemorrhagic stroke

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and had three brain bleeds,
which, you know, leaves

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permanent damage
in the three areas where it happened.

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and really, that

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said, they said that
all they could think of was just my blood

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pressure just got so dangerously high
from that medication.

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And, it was one of those things where,
I definitely think

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my saving grace was how quickly
I responded and got medical care.

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you know, I know that sometimes
people just think that they're too busy

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or, you know, sometimes it's, you know,
the woman in a relationship or whatnot

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that might make the medical decisions,
but it's just so important that,

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everyone listens to their body
is, in my experience, I knew that

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it was an emergency, and it didn't matter
about my boss or my job.

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I knew I had to be seen immediately.

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So sorry for everything we went through.

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That must have been very frightening.

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Yeah.

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It was, I have, aphasia now,
which is basically just disorder

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or language, ability to, to sometimes
speak as well as understand.

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and so for
that was probably what scared me

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the most was about five days afterwards.

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I just couldn't speak.

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I thought I was speaking
and people were just looking at me

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like, oh, what are you saying?
And I couldn't write.

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I did, my, the,
the lasting injuries that I do have

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are some right arm paralysis because that
was one of the injury areas of my brain.

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It's gotten a lot better.

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But I can't write normally,
you know, with a pen or pencil.

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And it was, you know, my dominant hand.

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And I'm limited with, driving and,

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you know, it gets
where if I don't have a lot,

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a lot of circulation going,
it just gets numb and tingly.

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And so I have to, like,
get up and walk, which is good. Anyways.

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So it's a kind of a good thing.

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but, it's a lot of the, 
kind of the motor stuff

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that really just the day in, day out
that you don't think about as much

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where like, I can't put on jewelry
or zip stuff or tie stuff.

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And it'll sometimes, as much as I know
how lucky I am to, just really have

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the paralysis and the aphasia
as far as my lasting, consequences.

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You know, there's mornings

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where I'm just crying
because I can't dress myself, you know?

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And it's just, 
I know that that is something that, other

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stroke survivors
talk about is they want to try to regain

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as much independence
as they had before their stroke.

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And, did
you did you end up also undergoing

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any kind of physical therapy
and speech therapy and all that?

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And what was your journey like afterwards?

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Yeah,
I, I mostly did occupational therapy.

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I was recommended for all three.

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And then for whatever reason, the place
I was at said,

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oh, your your speech is fine.

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And I'm like, well,
I'm wanting to get back to work.

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So, I mean, I know it's fine, but,
you know,

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I always want to challenge myself to be,
you know, better than the day before.

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But they really felt,
since I did want to have that independence

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and be cleared for driving and whatnot,
that they thought the occupational,

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which is that stuff
where, you know, it helps with,

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you know, cooking and dressing yourself
and grooming

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and all that stuff that that would be
what I would get the most out of.

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and I had kind of, I think I had read
that like a up to 18 months after that

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incident is when you have like the most,
the most progress that you will have.

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And so I think I kind of set

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a limitation on myself of, well, it's
not going to get better after that.

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00:10:51,342 --> 00:10:56,242
But I, had recently started going to our,
stroke support group that we have,

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Norman Regional on Wednesdays
at 2:00 at Norman Regional nine.

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00:11:01,674 --> 00:11:05,107
And seeing, 
some of the folks who have, you know, are

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00:11:05,107 --> 00:11:09,206
in wheelchairs, have aphasia to the point
where they're pretty non-verbal.

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00:11:09,773 --> 00:11:13,206
and just seeing them
still trying years after,

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00:11:13,306 --> 00:11:17,172
it's really, really motivated me to,
you know, maybe I should

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look into some speech therapy
to see if there is

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anything that can be done with the aphasia
that I do have.

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as well as just continuing
with just getting, healthier

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00:11:27,304 --> 00:11:28,870
because I think, you know,

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there's, there's, there's like a self-pity
kind of waiting time afterwards.

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But I definitely am re-energized now
to, try to get, my health back in line.

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And that has definitely been,
a pivotal point, 

220
00:11:43,468 --> 00:11:46,435
Yeah. You know, when something

221
00:11:46,901 --> 00:11:49,767
affects us, it's just doesn't stop there,
right?

222
00:11:49,767 --> 00:11:52,500
It affects our family
and our surroundings.

223
00:11:52,500 --> 00:11:55,533
How did you guys,
if you wouldn't mind sharing how,

224
00:11:56,167 --> 00:11:59,200
you know, your family coped with it
and where things are now?

225
00:11:59,533 --> 00:12:02,099
Yeah, my my mom, bless their hearts.

226
00:12:02,099 --> 00:12:04,665
they're we're very Catholic.

227
00:12:04,665 --> 00:12:06,965
And so she had the priest up there

228
00:12:06,965 --> 00:12:11,031
to take my last confession,
and I was just like, no.

229
00:12:11,364 --> 00:12:13,098
Like, I think that's like.

230
00:12:13,098 --> 00:12:17,030
Jinxing it or something, but,
I'm very glad that she had,

231
00:12:17,130 --> 00:12:20,830
you know, the church to support her
as well as support me.

232
00:12:20,830 --> 00:12:23,329
And they just were absolutely wonderful.

233
00:12:23,329 --> 00:12:26,396
you know, my niece and nephew
kind of were a little scared,

234
00:12:26,396 --> 00:12:29,295
so my brother just came.
But for the most part.

235
00:12:29,295 --> 00:12:32,295
Yeah, but I could
you just with understanding, like,

236
00:12:32,328 --> 00:12:36,194
I mean, I had episodes that I just,
I don't remember stuff that happened.

237
00:12:36,528 --> 00:12:39,227
And, you know, later on, you know, my

238
00:12:39,227 --> 00:12:42,427
aunt said something like that
that was so scary when I was visiting you.

239
00:12:42,427 --> 00:12:43,127
And that happened.

240
00:12:43,127 --> 00:12:45,726
And I had no idea
what she was talking about.

241
00:12:45,726 --> 00:12:47,793
And when I asked my mom, she was
I was like,

242
00:12:47,793 --> 00:12:49,792
why didn't you tell me that this happened?

243
00:12:49,792 --> 00:12:51,526
And she was like,
I don't like talking about that.

244
00:12:51,526 --> 00:12:54,292
I didn't think, you know, 
I didn't want to worry you.

245
00:12:54,292 --> 00:12:57,025
So it is interesting, like how, you know,

246
00:12:57,025 --> 00:13:00,491
I might not ever know it all happened
just for her trying to protect me, but.
  
247
00:13:00,491 --> 00:13:01,591
Yeah, definitely,

248
00:13:01,591 --> 00:13:06,190
you know, scared them and made them
nervous and makes me nervous.

249
00:13:06,190 --> 00:13:08,523
You know,
when I drive to the city and back, they.

250
00:13:08,523 --> 00:13:10,990
You know, she wants to make sure
that I made it back home.

251
00:13:10,990 --> 00:13:15,789
And so it definitely, is something that,

252
00:13:15,789 --> 00:13:19,288
you know, we it definitely
took us all to, to get me.

253
00:13:19,288 --> 00:13:24,254
Well, and, even from just the driving me
to all my appointments and everything

254
00:13:24,254 --> 00:13:28,687
before I could drive and stuff, but,
it's definitely a labor of love,

255
00:13:28,687 --> 00:13:32,087
and you definitely need that, family
and that support when that happens.

256
00:13:33,686 --> 00:13:34,720
Yeah, that's that's

257
00:13:34,720 --> 00:13:37,486
it plays a big role
when it comes to social support,

258
00:13:37,486 --> 00:13:40,785
whether if it is, the stroke group or,
you know, our loved ones.

259
00:13:40,885 --> 00:13:44,418
you know, it's,
I think for my, my grandfather, it was,

260
00:13:44,752 --> 00:13:47,851
you know, we were there, continuously,
as much as we could be.

261
00:13:48,051 --> 00:13:49,384
And of course, in life still happens.

262
00:13:49,384 --> 00:13:53,117
I still went to school, and,
and my mom still went to work, and.

263
00:13:53,417 --> 00:13:55,817
And so it wasn't, you know, wasn't easy.

264
00:13:55,817 --> 00:13:59,983
But it's a journey that I think, stroke
is not just an individual's journey,

265
00:13:59,983 --> 00:14:01,749
but a journey that a whole family takes.

266
00:14:01,749 --> 00:14:04,749
any words of advice for our audience?

267
00:14:06,249 --> 00:14:10,015
yeah, I just
I definitely would, you know, stress that,

268
00:14:10,015 --> 00:14:13,548
the, the time element to just,

269
00:14:13,548 --> 00:14:18,347
you know, to always, you know, of course,
you know, with blood pressure

270
00:14:18,347 --> 00:14:22,280
and everything and all, all the stuff
that, you know, we all should be doing.

271
00:14:22,280 --> 00:14:25,812
But, in any if you're ever

272
00:14:25,812 --> 00:14:28,812
in a situation, you know,
where your body doesn't feel right,

273
00:14:29,045 --> 00:14:32,145
it's never going to be something
that you will regret.

274
00:14:32,578 --> 00:14:34,345
going and getting checked out for.

275
00:14:34,345 --> 00:14:38,311
And I think another important role
was that I, I was almost turned away,

276
00:14:38,311 --> 00:14:40,644
you know, if this would have happened
later in my sleep,

277
00:14:40,644 --> 00:14:42,810
you know, I might very well not be here.

278
00:14:42,810 --> 00:14:45,776
So the fact that I really had to advocate
for myself

279
00:14:45,776 --> 00:14:48,676
and, and,
you know, and tell the, the doctors there

280
00:14:48,676 --> 00:14:51,709
that, you know, you need to listen to me,
something is wrong.

281
00:14:52,509 --> 00:14:56,908
so I definitely think those are definitely
my, my two takeaways and,

282
00:14:57,241 --> 00:15:01,008
and just for, you know, people,
it's been,

283
00:15:01,008 --> 00:15:04,774
I've been fortunate to be able
to, you know, be back at work.

284
00:15:04,774 --> 00:15:08,940
And it's been great being at Norman,
Regional just because it does have

285
00:15:08,940 --> 00:15:13,306
a special culture where, you know,
the coworkers really, you know, do care.

286
00:15:13,306 --> 00:15:17,505
And so that has been,
you know, very helpful and just,

287
00:15:18,872 --> 00:15:19,538
just for people

288
00:15:19,538 --> 00:15:23,438
when they have questions like, if,
you know, they don't understand,

289
00:15:23,471 --> 00:15:28,004
you know, why I'm saying something wrong
and to just correct me or,

290
00:15:28,270 --> 00:15:32,037
just to not have or be like,
embarrassed to ask questions.

291
00:15:32,037 --> 00:15:35,036
I like to be an open book
so people can be educated.

292
00:15:35,969 --> 00:15:37,936
I was say,
thank you so much for being here.

293
00:15:37,936 --> 00:15:39,902
We we really appreciate you.

294
00:15:39,902 --> 00:15:44,335
I think it speaks volumes to get
a patient's perspective for our listeners.

295
00:15:44,335 --> 00:15:49,401
So we know what these signs and stories
can, can be,

296
00:15:49,401 --> 00:15:51,667
and we can actually prevent things

297
00:15:51,667 --> 00:15:53,767
like you're saying
and being an advocate for yourself.

298
00:15:53,767 --> 00:15:57,600
and, we're glad you're doing better now.

299
00:15:58,033 --> 00:16:00,833
and we appreciate your time. Yes.
Thank you.

300
00:16:00,833 --> 00:16:04,132
listeners, we'll take a short break
and then we'll be joined by and doctors

301
00:16:04,132 --> 00:16:06,165
Tinsley and Costner
and get their expert opinion.

302
00:16:07,632 --> 00:16:10,631
Doctor Costner, Doctor Tinsley,
thank you so much for being here today.

303
00:16:10,665 --> 00:16:12,264
We really appreciate
you spending your afternoon

304
00:16:12,264 --> 00:16:14,231
with us and answering our questions.

305
00:16:14,231 --> 00:16:17,164
can you please tell us a little bit
about yourself?

306
00:16:17,164 --> 00:16:19,130
I am Lane Tinsley.

307
00:16:19,130 --> 00:16:25,363
I am a neurologist and specifically Norman
Regional's neuro hospitalist.

308
00:16:25,662 --> 00:16:30,695
which basically means I,
I am inpatient only

309
00:16:30,695 --> 00:16:34,461
treating all the acute
neuro neuro neurology issues.

310
00:16:35,194 --> 00:16:36,328
Yeah.

311
00:16:36,328 --> 00:16:37,594
And I'm Holly Costner.

312
00:16:37,594 --> 00:16:40,760
I'm one of the emergency medicine doctors
at Norman Regional Hospital.

313
00:16:40,760 --> 00:16:42,727
And then I also work with Doctor Tinsley

314
00:16:42,727 --> 00:16:45,726
as a co-medical director
for our stroke committee.

315
00:16:46,060 --> 00:16:48,359
Well,
thank you guys again for both being here.

316
00:16:48,359 --> 00:16:51,359
I think to start off Krishna,
I think a great question would be like,

317
00:16:51,959 --> 00:16:55,092
what are some of the most common
early signs and symptoms of a stroke?

318
00:16:55,092 --> 00:16:58,991
And for patients, how can they
differentiate from other medical issues?

319
00:16:58,991 --> 00:17:01,791
You know, we just had a very compelling
tale from Ms.

320
00:17:01,791 --> 00:17:04,557
Jennie and wanted to look into that further.

321
00:17:04,557 --> 00:17:06,323
I think that's a pretty hard question.

322
00:17:07,457 --> 00:17:08,257
Stroke

323
00:17:08,257 --> 00:17:13,256
symptoms can be a variety of symptoms
that are as easy as just weakness,

324
00:17:13,256 --> 00:17:16,322
which most people recognize
all the way to balance issues.

325
00:17:16,689 --> 00:17:20,422
one of the biggest things about stroke
symptoms is that they happen

326
00:17:20,422 --> 00:17:22,388
acutely like Jennie's did.

327
00:17:22,388 --> 00:17:24,488
it's not typically something
that's drug out.

328
00:17:24,488 --> 00:17:27,987
So something that acutely changes
in your functionality

329
00:17:28,187 --> 00:17:31,187
would be, a good way to describe it,
I think.

330
00:17:31,353 --> 00:17:35,186
But as far as the common person
trying to figure out

331
00:17:35,186 --> 00:17:37,886
if these symptoms are due
to stroke or not,

332
00:17:37,886 --> 00:17:41,819
I think the best thing,
if they're worried or have thought

333
00:17:41,819 --> 00:17:45,151
that something is abnormal,
it would be just to come into the hospital

334
00:17:45,151 --> 00:17:49,584
and let us as a physician determine
what's causing those symptoms for them.

335
00:17:49,817 --> 00:17:52,284
Yeah. Like she said, you know, I

336
00:17:53,450 --> 00:17:54,517
anything that the brain can

337
00:17:54,517 --> 00:17:57,616
do can do a stroke can manifest that.

338
00:17:57,650 --> 00:18:01,349
So it can be as simple as a headache
and no other symptoms.

339
00:18:01,349 --> 00:18:03,382
But, you know, it can be the aphasia.

340
00:18:03,382 --> 00:18:08,581
It can be difficulties speaking, word
finding or understanding, dizziness.

341
00:18:09,015 --> 00:18:10,648
this is a hard dizziness is a hard one

342
00:18:10,648 --> 00:18:14,481
because dizziness is such a common issue
with a lot of different things.

343
00:18:14,481 --> 00:18:18,280
And so, you know, that can be a, a stroke

344
00:18:18,280 --> 00:18:22,313
symptom, double vision, blurred vision,
like she said,

345
00:18:22,313 --> 00:18:27,046
weakness on one side of the body, 
numbness and tingling vision loss.

346
00:18:27,712 --> 00:18:31,945
so it really just about anything
can happen

347
00:18:31,945 --> 00:18:33,611
which makes it a little bit difficult.

348
00:18:33,611 --> 00:18:38,611
But I think what she just to reiterate
it is stroke is a sudden onset change.

349
00:18:38,611 --> 00:18:43,943
It's not a this, you know, progressive
over 2 or 3 weeks or a month problem.

350
00:18:43,943 --> 00:18:47,443
It's a I was fine
five minutes ago and now I'm not fine. So.

351
00:18:48,643 --> 00:18:49,542
Well thank you so much.

352
00:18:49,542 --> 00:18:52,375
I know it's,
it's a little bit difficult to delineate,

353
00:18:52,375 --> 00:18:55,375
but we really do appreciate
you giving us some examples

354
00:18:55,375 --> 00:18:58,841
that our listeners can,
utilize in the future.

355
00:18:59,141 --> 00:19:00,108
moving on.

356
00:19:00,108 --> 00:19:03,641
What is the importance of the golden hour
when it comes to the stroke protocol?

357
00:19:03,974 --> 00:19:04,507
Yeah.

358
00:19:04,507 --> 00:19:09,206
So, you know, the earlier

359
00:19:09,240 --> 00:19:12,273
you can get to a hospital and evaluated

360
00:19:13,572 --> 00:19:15,672
potentially a better long term outcome.

361
00:19:15,672 --> 00:19:19,072
there is a medication,

362
00:19:19,672 --> 00:19:22,271
kind of generally known
as the clot buster medicine.

363
00:19:22,271 --> 00:19:27,537
the the fancy name for it is TPA
or Tenecteplase or Alteplase.

364
00:19:27,537 --> 00:19:29,004
you know, several different names.

365
00:19:29,004 --> 00:19:31,370
It all kind of does the same thing.

366
00:19:31,370 --> 00:19:36,703
but it's a medicine that in the studies
researching that drug,

367
00:19:36,903 --> 00:19:41,202
there is a, a very clear time
window of when that can be given.

368
00:19:41,635 --> 00:19:46,101
And generally the,
the cutoff is about 4.5 hours.

369
00:19:46,101 --> 00:19:51,167
So if someone comes in outside of that,
you know, if it's been 6 or 7 hours

370
00:19:51,167 --> 00:19:54,267
or 24 hours, they're not going to be
a candidate for that medicine.

371
00:19:54,267 --> 00:19:58,033
But if we can even get you to the er,
have our er, physicians,

372
00:19:58,433 --> 00:20:01,499
evaluate quickly,
you know, the sooner the better.

373
00:20:01,499 --> 00:20:04,832
So they call it a golden hour,
or maybe it's a golden 4.5 hours, but,

374
00:20:05,099 --> 00:20:09,698
you know, the less than an hour
is, is always the goal. Yes.

375
00:20:09,898 --> 00:20:11,331
The sooner you get there, the more brain

376
00:20:11,331 --> 00:20:14,331
we can save in the less deficit overall
that you would have.

377
00:20:14,464 --> 00:20:15,264
Yeah.

378
00:20:15,264 --> 00:20:17,797
so, so basically, you know,

379
00:20:17,797 --> 00:20:20,830
let's say
patient has a sudden onset change

380
00:20:20,830 --> 00:20:23,829
or you've witnessed a family member
that's got the sudden onset change.

381
00:20:23,929 --> 00:20:28,129
the first thing we would
do is head to the ER right.

382
00:20:29,629 --> 00:20:30,462
you think that needs to

383
00:20:30,462 --> 00:20:33,595
be just to, like,
get a better glimpse of our patients?

384
00:20:34,295 --> 00:20:36,461
Should they drive there?
Should they call EMS?

385
00:20:36,461 --> 00:20:38,961
what was the thought process behind that?

386
00:20:38,961 --> 00:20:40,094
I mean, I think definitely

387
00:20:40,094 --> 00:20:43,993
if you're having a medical emergency,
you should probably call 911.

388
00:20:44,260 --> 00:20:45,626
That's going to be your fastest

389
00:20:45,626 --> 00:20:49,426
onset to care, because not only can
they get you to the ER faster,

390
00:20:49,426 --> 00:20:53,125
but they can start initiating care
and get you to the right er,

391
00:20:53,825 --> 00:20:56,825
the quickest
and get you the best potential outcome.

392
00:20:57,225 --> 00:21:00,824
So I always advise patients or loved ones

393
00:21:00,824 --> 00:21:05,457
that unless it is just impossible,
you know, never drive yourself.

394
00:21:05,457 --> 00:21:07,757
you never know what's going to happen.

395
00:21:07,757 --> 00:21:09,823
what's causing your symptoms?

396
00:21:09,823 --> 00:21:12,323
And the last thing you want to be
is behind the wheel,

397
00:21:12,323 --> 00:21:14,989
causing more danger to yourself
or potentially to someone else.

398
00:21:14,989 --> 00:21:16,422
So 911,

399
00:21:17,789 --> 00:21:18,222
you know,

400
00:21:18,222 --> 00:21:21,221
ambulance is going to get you
where you need to go fastest, right?

401
00:21:21,288 --> 00:21:24,288
And to Doctor Costner's point like not all
ERs are equipped.

402
00:21:24,654 --> 00:21:25,987
Yeah. Yeah. So is it.

403
00:21:25,987 --> 00:21:28,587
There's a whole triage process that the,

404
00:21:28,587 --> 00:21:32,020
the paramedics
know that we probably don't.

405
00:21:32,353 --> 00:21:33,586
Yeah.

406
00:21:33,586 --> 00:21:36,186
Know where to go. Places to go. Right.

407
00:21:36,186 --> 00:21:39,752
So you know Oklahoma is somewhat also

408
00:21:39,819 --> 00:21:44,085
you know, 70 of our counties
are designated as rural counties.

409
00:21:44,518 --> 00:21:48,651
And so, for any of our listeners
that live in the rural area,

410
00:21:48,918 --> 00:21:50,451
and sometimes the nearest E.R.

411
00:21:50,451 --> 00:21:52,284
might be a little bit farther away.

412
00:21:52,284 --> 00:21:56,317
do you have any like, recommendations
like in that, in that situation,

413
00:21:56,616 --> 00:21:59,349
should they try to go to the nearest E.R.

414
00:21:59,349 --> 00:22:02,782
or if they actually try to go to, 
like the nearest,

415
00:22:02,882 --> 00:22:07,048
I guess, a secondary facility
that may have more resources?

416
00:22:08,548 --> 00:22:11,614
I mean, I would say definitely
go to your nearest ER.

417
00:22:11,614 --> 00:22:17,080
Most ERs have that initial treatment
that you can start,

418
00:22:17,080 --> 00:22:21,313
the bigger ERs may have more treatments
that can offer down the line,

419
00:22:21,313 --> 00:22:24,013
but just getting that
first access is like,

420
00:22:24,013 --> 00:22:25,779
especially in the window
of those medications.

421
00:22:25,779 --> 00:22:28,779
Doctor Tinsley was talking
about the best medications.

422
00:22:28,812 --> 00:22:30,345
The majority, if not all the E.R.

423
00:22:30,345 --> 00:22:31,812
should have that. Okay.

424
00:22:31,812 --> 00:22:33,345
and so that will give you

425
00:22:33,345 --> 00:22:37,177
your best opportunity
to get treatment as fast as possible.

426
00:22:37,177 --> 00:22:40,410
I Doctor Costner,
I think, for the next few questions,

427
00:22:40,410 --> 00:22:41,877
we're going to talk to you specifically.

428
00:22:41,877 --> 00:22:43,477
What happens in the E.R..

429
00:22:43,477 --> 00:22:45,010
So when a person comes into the E.R.

430
00:22:45,010 --> 00:22:47,309
and we're worried about stroke,
what kind of protocols are arise

431
00:22:47,309 --> 00:22:50,476
and what what happens,
you know, upon arrival, immediately.

432
00:22:51,076 --> 00:22:53,542
When a patient walks in
or comes by ambulance

433
00:22:53,542 --> 00:22:56,575
through 911,
they'll get quickly evaluated.

434
00:22:56,575 --> 00:23:00,408
So if they walk in, the registration
would notify the triage nurse

435
00:23:00,408 --> 00:23:03,674
who would then evaluate the patient
and see if the stroke,

436
00:23:04,040 --> 00:23:07,107
if symptoms are present
with are concerning for stroke

437
00:23:07,107 --> 00:23:10,440
at that time,
the patient would be quickly brought back

438
00:23:10,440 --> 00:23:13,872
if they're in within the time
frame for our acute stroke assessment.

439
00:23:14,239 --> 00:23:15,805
And at that point, the E.R.

440
00:23:15,805 --> 00:23:20,338
would then get notified to the physician,
asked where we get imaging of the brain

441
00:23:20,471 --> 00:23:21,271
would be notified

442
00:23:21,271 --> 00:23:24,938
that we have an acute what we call a code
stroke is what we've labeled it.

443
00:23:25,437 --> 00:23:29,270
and then from there,
the team would come in and start

444
00:23:29,270 --> 00:23:33,103
going through their care
as far as IVs and assessments.

445
00:23:34,136 --> 00:23:34,803
Awesome.

446
00:23:34,803 --> 00:23:35,336
Yeah.

447
00:23:35,336 --> 00:23:35,803
So what are

448
00:23:35,803 --> 00:23:39,236
some of the challenges or the difficulties
that, that you face in the E.R.

449
00:23:39,236 --> 00:23:42,235
when it comes to code stroke?

450
00:23:42,735 --> 00:23:46,168
I think the biggest challenge
is just that the patient's not a textbook.

451
00:23:46,201 --> 00:23:50,501
You know, we go through a lot of
education, and it's continually education.

452
00:23:50,501 --> 00:23:53,567
regarding stroke
care and workup and treatment.

453
00:23:53,834 --> 00:23:56,800
But patients
present differently than what, a textbook.

454
00:23:56,800 --> 00:24:00,799
And they have multifaceted
medical problems.

455
00:24:00,799 --> 00:24:02,466
They're on different medications.

456
00:24:02,466 --> 00:24:06,732
And also when you bring a patient
in that's having an acute medical concern,

457
00:24:06,732 --> 00:24:08,165
there's a lot of emotion there.

458
00:24:08,165 --> 00:24:11,864
So just trying to get the most accurate
information from that patient

459
00:24:12,064 --> 00:24:14,864
in the shortest amount of time
to be able to get them

460
00:24:14,864 --> 00:24:17,863
quick
treatment can be a really big obstacle.

461
00:24:17,930 --> 00:24:18,430
Yeah.

462
00:24:18,430 --> 00:24:21,630
So it's always nice if a patient can have
somebody that knows them

463
00:24:21,630 --> 00:24:24,629
with them to help with those situations.

464
00:24:24,663 --> 00:24:28,962
Dr. Costner, once the code stroke is announced,
you know, coming in,

465
00:24:30,095 --> 00:24:30,762
getting set

466
00:24:30,762 --> 00:24:33,761
up for everything,
getting vitals, getting IV's in.

467
00:24:33,861 --> 00:24:36,561
How long does it take
to get that CT done? Do you think.

468
00:24:36,561 --> 00:24:40,060
We like to have the CT done
within, like, the first 10 to 20 minutes.

469
00:24:40,060 --> 00:24:44,127
So as quickly as possible, 
they also do a secondary CT typically

470
00:24:44,127 --> 00:24:47,793
which takes longer, with dye
that actually looks

471
00:24:47,793 --> 00:24:50,859
at the vessels in the head
to see if there is an acute clot

472
00:24:50,859 --> 00:24:52,059
that they can see on there.

473
00:24:52,059 --> 00:24:53,625
But it all happens fairly quickly.

474
00:24:53,625 --> 00:24:56,158
I like to have all of it
done within like the first 45 minutes.

475
00:24:56,158 --> 00:24:58,391
So yeah, it's pretty good.

476
00:24:58,391 --> 00:25:00,191
Pretty quick process. Yeah.

477
00:25:00,191 --> 00:25:03,357
So I think the question
that we really haven't been able to

478
00:25:03,357 --> 00:25:06,757
talk about so far is that you guys know,
what got you interested in going

479
00:25:06,757 --> 00:25:07,723
into emergency medicine?

480
00:25:09,056 --> 00:25:09,956
I think it's just

481
00:25:09,956 --> 00:25:13,956
the ability to focus solely
on the patient's medical problems

482
00:25:13,956 --> 00:25:17,255
and not worry about all the administrative
stuff that people

483
00:25:17,955 --> 00:25:20,455
with their own private practices have to.

484
00:25:20,455 --> 00:25:21,988
I mean, I don't have that burden.

485
00:25:21,988 --> 00:25:23,588
I have other burdens, of course.

486
00:25:23,588 --> 00:25:25,254
it can be very difficult

487
00:25:25,254 --> 00:25:29,220
in the ER and chaotic,
but I think it's a personality thing too,

488
00:25:29,320 --> 00:25:33,986
that each of us have, you know,
oncologists, neurologists, emergency

489
00:25:33,986 --> 00:25:38,919
medicine physicians, family doctors,
you just find your focus and you really

490
00:25:39,952 --> 00:25:42,018
hone in on that and enjoy it.

491
00:25:42,018 --> 00:25:44,385
Well, thank you for recognizing
the administrative burden.

492
00:25:44,385 --> 00:25:45,518
I really appreciate that.

493
00:25:45,518 --> 00:25:48,518
So. It never ends.

494
00:25:49,651 --> 00:25:53,117
And and we were never warned
I guess in school or residency.

495
00:25:53,217 --> 00:25:55,750
Yeah. The hits you.
They don't teach you about that.

496
00:25:55,750 --> 00:25:58,450
No, no I'll focus on the medicine
in the textbook.

497
00:25:58,450 --> 00:25:59,449
Yeah, yeah.

498
00:25:59,449 --> 00:26:02,049
Oh, thank you
for sharing all of your insights.

499
00:26:02,049 --> 00:26:06,115
But, for Dr. Tinsley, when do you come in
as a neuro hospitalist?

500
00:26:06,482 --> 00:26:08,015
Yeah. so.

501
00:26:10,515 --> 00:26:13,747
Typically, like,
if someone comes in as a code stroke.

502
00:26:13,747 --> 00:26:18,113
most a lot of the time they call me,
you know, after the patient's

503
00:26:18,113 --> 00:26:21,546
kind of triaged and the Cat scan's done.

504
00:26:23,413 --> 00:26:26,179
one of the er physicians will call up
and just say, hey,

505
00:26:26,179 --> 00:26:29,778
this is the case, this is the situation
we've got, and we'll discuss.

506
00:26:30,012 --> 00:26:33,611
Does this person meet criteria
for receiving that clot buster medicine?

507
00:26:34,178 --> 00:26:36,211
certainly
they are capable of making that decision.

508
00:26:36,211 --> 00:26:39,211
But a lot of times
we'll do a shared decision on well,

509
00:26:39,510 --> 00:26:41,644
you know,
this would be a good candidate or.

510
00:26:41,644 --> 00:26:44,176
No, they're not a good candidate
for this, this reason.

511
00:26:44,176 --> 00:26:49,442
And so, that's generally as neurology
when we get, involved.

512
00:26:49,676 --> 00:26:55,075
at the first point
and then after the patient gets admitted

513
00:26:55,075 --> 00:26:57,208
and things are kind of calmed down
and they're tucked

514
00:26:57,208 --> 00:27:00,408
in, you know,
we will come and evaluate the patient,

515
00:27:01,607 --> 00:27:02,707
you know, get their story

516
00:27:02,707 --> 00:27:06,040
and my job is to figure out
why the stroke happened

517
00:27:06,773 --> 00:27:09,506
and what are we going to do about it,
and how do we prevent it.

518
00:27:09,506 --> 00:27:12,506
Yeah. So I'm seeing, seeing, them, you know,

519
00:27:12,839 --> 00:27:15,839
subsequent days,
while they're in the hospital.

520
00:27:16,072 --> 00:27:20,105
So, Doctor Tinsley,
you brought up a really good point.

521
00:27:20,638 --> 00:27:22,071
Why are they there?

522
00:27:22,071 --> 00:27:24,371
What's causing this? Drugs, and so on.

523
00:27:24,371 --> 00:27:26,971
Would you mind going over
some of the risk factors for stroke

524
00:27:26,971 --> 00:27:28,704
and some of the factors that could

525
00:27:28,704 --> 00:27:30,870
that could be addressed
to prevent further strokes?

526
00:27:30,870 --> 00:27:31,403
Absolutely.

527
00:27:31,403 --> 00:27:34,669
So, the biggest risk factors

528
00:27:34,669 --> 00:27:38,036
and maybe these are sort of common sense
things but high blood pressure,

529
00:27:39,036 --> 00:27:41,868
diabetes, smoking,

530
00:27:41,868 --> 00:27:45,335
sleep apnea, diet,

531
00:27:48,901 --> 00:27:49,567
those are,

532
00:27:49,567 --> 00:27:53,234
those are a lot of the,
I guess, modifiable risk factors.

533
00:27:53,234 --> 00:27:56,600
So things that that we can change
whether we choose to

534
00:27:56,600 --> 00:28:00,166
or not,
they're potential fixable, or treatable.

535
00:28:00,699 --> 00:28:05,032
and then there's non modifiable non
modifiable risk factors

536
00:28:05,032 --> 00:28:08,298
which are your women are at higher

537
00:28:08,298 --> 00:28:11,698
risk, age, things like atrial fibrillation,

538
00:28:11,931 --> 00:28:15,597
which is a lot of people develop
and nothing you really can do on that.

539
00:28:16,530 --> 00:28:19,297
genetics,
you know, we're born with what we got.

540
00:28:19,297 --> 00:28:23,296
So, so, yeah, I mean, but the big
the big three I think are high blood

541
00:28:23,296 --> 00:28:27,995
pressure, diabetes, smoking
are the three that I see the most.

542
00:28:28,062 --> 00:28:29,329
I think for

543
00:28:30,328 --> 00:28:31,228
risk factors here.

544
00:28:31,228 --> 00:28:31,628
Yeah.

545
00:28:31,628 --> 00:28:32,395
Yet again,

546
00:28:32,395 --> 00:28:36,728
we touched on the smoking factor
multiple episodes and it keeps coming up.

547
00:28:36,728 --> 00:28:40,627
So another another reason
to try to educate our patients about it.

548
00:28:40,627 --> 00:28:43,627
But can you talk to like, you know,

549
00:28:43,827 --> 00:28:46,060
we were discussing this earlier
outside of the podcast.

550
00:28:46,060 --> 00:28:48,726
We were mentioning different types
of different types of strokes

551
00:28:48,726 --> 00:28:52,292
and how they present and, and,
and imaging, differences.

552
00:28:52,292 --> 00:28:53,825
Can you talk to us
a little bit about that?

553
00:28:53,825 --> 00:28:55,892
Kind of like a summary.

554
00:28:55,892 --> 00:28:56,625
Yeah.

555
00:28:56,625 --> 00:29:01,891
So, there is something called
ischemic stroke,

556
00:29:02,124 --> 00:29:04,524
also known as a blood clot stroke.

557
00:29:04,524 --> 00:29:06,090
So those are the most common.

558
00:29:06,090 --> 00:29:09,090
That's about 80,
85% of strokes are ischemic.

559
00:29:09,256 --> 00:29:13,856
the other is what we call hemorrhagic
stroke or bleeding strokes, about 15

560
00:29:13,856 --> 00:29:15,189
to 20%.

561
00:29:15,189 --> 00:29:18,722
within that category, there's some
subcategories which I won't go into, but

562
00:29:19,022 --> 00:29:23,754
basically we got a blood clot,
or bleed and, and a blood clot stroke.

563
00:29:23,754 --> 00:29:24,388
What happens

564
00:29:24,388 --> 00:29:29,254
is a clot forms somewhere farther down,
whether it's in the heart or maybe a

565
00:29:29,620 --> 00:29:33,820
a little piece of plaque breaks off the, 
one of the arteries, like, in the neck.

566
00:29:34,186 --> 00:29:38,619
And that travels down into the brain
as far as it can go until it can't go

567
00:29:38,619 --> 00:29:41,319
any further. And it
it plugs up that vessel.

568
00:29:41,319 --> 00:29:45,051
And so the area of the brain
that is supplied

569
00:29:45,051 --> 00:29:48,051
by that,
that blood vessel essentially dies.

570
00:29:48,118 --> 00:29:51,250
And so if it's if it goes down
to the left side of the brain,

571
00:29:51,250 --> 00:29:55,117
it may affect the,
the function of what happens there.

572
00:29:55,117 --> 00:29:58,183
So maybe language,
maybe weakness on the right side.

573
00:30:01,082 --> 00:30:02,982
a bleeding stroke or hemorrhagic

574
00:30:02,982 --> 00:30:06,915
stroke is due to an acute rupture
of a vessel into the brain.

575
00:30:06,915 --> 00:30:08,915
So there is active bleeding.

576
00:30:08,915 --> 00:30:12,281
there are depending

577
00:30:12,281 --> 00:30:15,280
on the type of stroke, there's different
treatment protocols for that.

578
00:30:15,614 --> 00:30:17,547
The first thing we get is a Cat scan.

579
00:30:17,547 --> 00:30:20,613
So a hemorrhagic or bleeding stroke is

580
00:30:21,380 --> 00:30:24,213
very obvious on a Cat scan
or should be obvious.

581
00:30:24,213 --> 00:30:27,212
so that's the first step
is and part of why we get

582
00:30:27,445 --> 00:30:30,578
scans quickly is
because if there is any evidence of bleed

583
00:30:31,078 --> 00:30:34,978
on the brain automatically, we are not
going to do that clot buster medicine.

584
00:30:35,111 --> 00:30:37,811
You know that
that increases the risk of bleeding.

585
00:30:37,811 --> 00:30:40,777
if there's no bleed
and they're having stroke symptoms,

586
00:30:40,777 --> 00:30:43,743
then we're probably
in that ischemic category.

587
00:30:44,776 --> 00:30:45,476
So we're looking at

588
00:30:45,476 --> 00:30:48,476
ischemic stroke versus hemorrhagic stroke.

589
00:30:48,643 --> 00:30:51,042
one of the things that I think
we haven't touched about today,

590
00:30:51,042 --> 00:30:54,475
and that is, TIAs or transient
ischemic attacks,

591
00:30:54,908 --> 00:30:57,941
would you mind explaining to our audience
what TIAs are about?

592
00:30:57,941 --> 00:30:58,874
Absolutely.

593
00:30:58,874 --> 00:31:03,007
So, TIA, transient ischemic attack,
also known a lot of people call, say,

594
00:31:03,007 --> 00:31:06,007
mini strokes.

595
00:31:06,040 --> 00:31:08,306
a TIA is a stroke

596
00:31:08,306 --> 00:31:12,073
typically an ischemic
type stroke that starts to happen.

597
00:31:12,073 --> 00:31:15,372
So a blood clot has gotten somewhere
into the to the brain.

598
00:31:15,639 --> 00:31:17,772
That area of brain starts to die.

599
00:31:17,772 --> 00:31:19,938
You start to see those symptoms.

600
00:31:19,938 --> 00:31:23,738
But for whatever reason, that blood clot
dissolves or breaks apart.

601
00:31:23,738 --> 00:31:24,904
It moves along.

602
00:31:24,904 --> 00:31:27,037
It no longer plugs up that vessel.

603
00:31:27,037 --> 00:31:29,903
And so the symptoms actually reverse.

604
00:31:29,903 --> 00:31:34,036
They resolve so that blood flow
is restored to that area of the brain.

605
00:31:34,036 --> 00:31:37,036
And the symptoms are not permanent.

606
00:31:37,136 --> 00:31:40,135
Also later on down the road
when you do it, further

607
00:31:40,135 --> 00:31:43,402
scans such as an MRI,
there's no evidence of damage.

608
00:31:43,402 --> 00:31:44,401
So that's a big thing.

609
00:31:44,401 --> 00:31:48,867
You know, if there's if we have an MRI
that shows and a stroke, it's a stroke.

610
00:31:49,167 --> 00:31:52,467
Even if it resolved,
even if it's small, it's still a stroke.

611
00:31:52,767 --> 00:31:56,700
So by definition,
TIA means that it started to happen.

612
00:31:56,700 --> 00:31:58,599
But didn't complete.

613
00:31:58,599 --> 00:32:02,466
And just to a question
of our question on that, so is it

614
00:32:02,466 --> 00:32:05,732
resolution of symptoms within 24 hours
or could it just you know.

615
00:32:06,465 --> 00:32:09,298
That's by definition
it's usually within 24 hours.

616
00:32:09,298 --> 00:32:15,030
again, in conjunction
with looking at further head

617
00:32:15,030 --> 00:32:20,130
imaging such as an MRI, you know, if
if those symptoms do resolve in 24 hours.

618
00:32:20,130 --> 00:32:22,429
But there's an abnormality,
we're going to call it a stroke.

619
00:32:22,429 --> 00:32:24,629
what I tell my patients, though, is

620
00:32:26,029 --> 00:32:27,762
TIAs, mini strokes.

621
00:32:27,762 --> 00:32:32,261
They're equally as important
or significant as a stroke,

622
00:32:32,328 --> 00:32:35,328
like just because it went away
and it was a mini stroke

623
00:32:35,428 --> 00:32:37,927
does not mean
that we're going to ignore it or treat it.

624
00:32:37,927 --> 00:32:41,893
And when we treat them a stroke in my
book, you know, we're just going to treat.

625
00:32:42,227 --> 00:32:42,427
Yeah.

626
00:32:42,427 --> 00:32:43,860
And I think another thing
we haven't touched

627
00:32:43,860 --> 00:32:47,859
on, is like,
you know, we've identified a stroke.

628
00:32:48,126 --> 00:32:49,392
They're admitted.

629
00:32:49,392 --> 00:32:51,959
And then comes the process
of finding out what happened.

630
00:32:51,959 --> 00:32:54,925
And then the the prevention
of another stroke from happening.

631
00:32:54,925 --> 00:32:55,192
Right.

632
00:32:55,192 --> 00:32:57,291
So could you touch on secondary stroke
prevention.

633
00:32:57,291 --> 00:32:58,291
Absolutely.

634
00:32:58,291 --> 00:33:02,324
So in the hospital you go through
all the tests, you get scans.

635
00:33:02,324 --> 00:33:04,557
We look at the heart.
You do an ultrasound of the heart.

636
00:33:04,557 --> 00:33:07,423
We watch the heart rate on a monitor.

637
00:33:07,423 --> 00:33:09,656
so we're trying to figure out
what that causes.

638
00:33:09,656 --> 00:33:13,422
So a lot of people

639
00:33:13,422 --> 00:33:16,422
will get put on
something as simple as a baby aspirin.

640
00:33:17,588 --> 00:33:20,655
some we may add
a medicine called Plavix to that aspirin.

641
00:33:20,655 --> 00:33:23,021
So those are in the realm of blood
thinners.

642
00:33:23,021 --> 00:33:25,254
They're called antiplatelet medicines.

643
00:33:25,254 --> 00:33:29,254
that will help prevent further plaque
buildup of those vessels.

644
00:33:29,953 --> 00:33:34,653
another category of medicine
is what we call blood thinners.

645
00:33:34,653 --> 00:33:35,786
And there's

646
00:33:35,786 --> 00:33:39,019
the old one that most people have heard of
is called Coumadin or Warfarin.

647
00:33:39,685 --> 00:33:42,685
we've got newer ones called,

648
00:33:42,985 --> 00:33:45,085
the well,
I don't know what they're actually called,

649
00:33:45,085 --> 00:33:48,384
but Eliquis, Xarelto, Pradaxa.

650
00:33:48,784 --> 00:33:51,784
and I know there's probably
some in the works, but but those are

651
00:33:52,184 --> 00:33:53,650
a different type of blood thinner.

652
00:33:53,650 --> 00:33:57,150
And we typically will put people,
you know, if they have a funny heart

653
00:33:57,150 --> 00:33:58,083
rhythm called AFib.

654
00:33:58,083 --> 00:34:03,082
Those, those people usually get placed
on a medicine like, Eliquis.

655
00:34:04,915 --> 00:34:05,249
you know,

656
00:34:05,249 --> 00:34:08,481
and then cholesterol medicine,
we usually do a statin.

657
00:34:09,048 --> 00:34:12,314
and that helps
not only lower cholesterol,

658
00:34:12,314 --> 00:34:14,914
but it also helps protect the vessels.
You know, it's good.

659
00:34:14,914 --> 00:34:16,447
So I have a lot of people that say, well,

660
00:34:16,447 --> 00:34:19,647
my numbers are fine
and I don't have high cholesterol.

661
00:34:19,647 --> 00:34:23,779
And we still try to do that statin
because it the studies have shown that,

662
00:34:24,146 --> 00:34:28,245
that just it has some anti-inflammatory
properties of the vessels.

663
00:34:29,312 --> 00:34:31,045
and then, you know,

664
00:34:31,045 --> 00:34:34,045
there's medicines blood pressure,
treating blood pressure is important.

665
00:34:34,578 --> 00:34:36,777
But then the lifestyle education. Yeah.

666
00:34:36,777 --> 00:34:39,477
Smoking, smoking, smoking.

667
00:34:39,477 --> 00:34:42,043
Yep. diet.

668
00:34:42,043 --> 00:34:46,609
you know,
everyone likes red meat in Oklahoma.

669
00:34:46,909 --> 00:34:48,909
Avoiding red meat is important in stroke.

670
00:34:48,909 --> 00:34:52,775
Red meat unfortunately increases
the risk of stroke and heart disease.

671
00:34:52,775 --> 00:34:55,075
So something called
the Mediterranean diet.

672
00:34:55,075 --> 00:34:56,575
Or there's the heart healthy diet.

673
00:34:56,575 --> 00:34:58,374
You know,
there's lots of different options there.

674
00:34:58,374 --> 00:35:02,341
getting sleep apnea evaluated.

675
00:35:02,374 --> 00:35:03,507
Yeah, that's a big one.

676
00:35:03,507 --> 00:35:05,707
So a lot of people snore.

677
00:35:05,707 --> 00:35:09,106
usually you got to talk to their spouse
or their family.

678
00:35:09,673 --> 00:35:12,073
and they say, oh, yeah,
they snore like a freight train.

679
00:35:12,073 --> 00:35:13,272
Well, they probably have sleep apnea.

680
00:35:13,272 --> 00:35:16,939
So that can actually, getting that
evaluated can actually be very helpful

681
00:35:17,139 --> 00:35:20,671
in talking about weight loss,
you know, healthy BMI, that kind of thing.

682
00:35:20,805 --> 00:35:23,171
Yeah. Doctor Costner,
we had a question. A question for you.

683
00:35:23,171 --> 00:35:26,837
we heard,
you mentioning earlier about you

684
00:35:26,837 --> 00:35:28,870
and Doctor Tinsley
being on the stroke committee.

685
00:35:28,870 --> 00:35:29,670
would you be,

686
00:35:29,670 --> 00:35:32,370
please be able to elaborate a little bit
more about the Stroke Committee?

687
00:35:32,370 --> 00:35:32,870
Yeah.

688
00:35:32,870 --> 00:35:36,502
So the Stroke Committee
is a group of people within the hospital.

689
00:35:36,502 --> 00:35:39,602
It's, nurses, physicians

690
00:35:39,602 --> 00:35:43,468
like us, other, staff,
and we come together, we monitor

691
00:35:43,468 --> 00:35:47,534
stroke cases and look through ways
that we can improve or do better.

692
00:35:47,834 --> 00:35:50,167
we work on education with staff.

693
00:35:50,167 --> 00:35:53,200
So that involves,
you know, when a patient shows up,

694
00:35:53,200 --> 00:35:56,066
what's going to happen
so that we are on our game

695
00:35:56,066 --> 00:35:59,666
and we can get them through those quick
steps to get them the treatment they need.

696
00:36:00,566 --> 00:36:02,832
there's some research
that goes in on that,

697
00:36:02,832 --> 00:36:06,298
through our facility
and everything with the Stroke Committee.

698
00:36:06,465 --> 00:36:10,398
And it's just kind of really education
and building communication

699
00:36:10,398 --> 00:36:13,397
through the facility
to treat people with stroke.

700
00:36:13,797 --> 00:36:15,430
And that's a collaborative effort.

701
00:36:15,430 --> 00:36:16,497
Yeah. Right.

702
00:36:16,497 --> 00:36:19,530
Well, in this last question,
I think is for both of you

703
00:36:19,530 --> 00:36:22,529
guys, it's like, you know, it's
such an important topic that we should be

704
00:36:22,529 --> 00:36:26,296
spreading awareness of, in your opinion,
rather than talking about it.

705
00:36:26,362 --> 00:36:30,795
Anything else we can do to spread
awareness of patients about stroke and

706
00:36:30,828 --> 00:36:31,561
risk factors?

707
00:36:33,061 --> 00:36:34,261
I think

708
00:36:34,261 --> 00:36:36,794
it's tough because I
think reaching everyone, you know, there's

709
00:36:36,794 --> 00:36:40,660
so many different platforms
that people are on.

710
00:36:40,660 --> 00:36:43,860
And, there's a,

711
00:36:45,560 --> 00:36:48,359
a mnemonic called Be Fast
and you might yeah,

712
00:36:48,359 --> 00:36:51,392
you see it like they'll make magnets
or advertisements.

713
00:36:51,392 --> 00:36:55,392
I actually, now,
of course I can't remember which coffee shop.

714
00:36:55,625 --> 00:36:58,624
actually, on their little coffee.

715
00:36:58,791 --> 00:37:00,557
Oh, that's a little sleeves.

716
00:37:00,557 --> 00:37:02,224
The sleeves. Yeah. Oh, it's.

717
00:37:02,224 --> 00:37:03,457
Yeah, it says be fast.

718
00:37:03,457 --> 00:37:05,723
That's a it's
an American Heart Association thing.

719
00:37:05,723 --> 00:37:07,823
so I just think

720
00:37:07,823 --> 00:37:10,623
educating people about what that means
and that just those

721
00:37:10,623 --> 00:37:12,556
are the signs looking for stroke.

722
00:37:12,556 --> 00:37:16,122
Balance, Eyes, Face.

723
00:37:16,555 --> 00:37:20,488
like face, droopy face.
Arms, Speech, Time.

724
00:37:20,955 --> 00:37:24,054
And so those are things that,
you know, if,

725
00:37:25,654 --> 00:37:28,587
if you can recognize that

726
00:37:28,587 --> 00:37:31,920
and even if you're not having
something happen, but if you recognize it

727
00:37:31,920 --> 00:37:35,419
out in the community,
say, okay, call 911 right. And

728
00:37:36,486 --> 00:37:36,986
I also

729
00:37:36,986 --> 00:37:41,085
think, if you're having the symptoms
just coming in, coming

730
00:37:41,085 --> 00:37:44,251
in, I think one of the saddest things
we see is people with fairly

731
00:37:44,785 --> 00:37:48,084
big strokes
that come in 3 or 4 days later,

732
00:37:48,084 --> 00:37:51,450
and at that point, there's nothing really
we can do to help recover that.

733
00:37:51,517 --> 00:37:55,616
so if you are having a symptom,
don't think it's going to go away.

734
00:37:55,616 --> 00:37:57,150
That's what you're like.
Why didn't you come in there?

735
00:37:57,150 --> 00:38:00,849
Like I thought I would just go away,
just come in and let us help you.

736
00:38:01,016 --> 00:38:02,116
Yeah.

737
00:38:02,116 --> 00:38:03,849
So, one of the other things
we were wondering

738
00:38:03,849 --> 00:38:06,882
you guys could talk about,
are the stroke centers of excellence.

739
00:38:07,182 --> 00:38:07,748
Would you mind

740
00:38:07,748 --> 00:38:11,214
just kind of, explaining to our audience
what the Stroke Center of Excellence is?

741
00:38:11,681 --> 00:38:15,480
Okay, so Centers of Excellence,
focuses on

742
00:38:16,047 --> 00:38:19,013
quality, education and accreditation.

743
00:38:19,013 --> 00:38:22,813
And so it's basically where, you know,
the standard we're held to,

744
00:38:22,913 --> 00:38:26,812
giving the most, 
the highest quality of care.

745
00:38:27,045 --> 00:38:29,212
we have been,

746
00:38:30,178 --> 00:38:33,944
accredited with The Joint Commission
for the last 18 years.

747
00:38:33,944 --> 00:38:36,544
We get lots of awards.

748
00:38:36,544 --> 00:38:39,210
and we are one of the only, I guess,

749
00:38:39,210 --> 00:38:42,510
hospitals south of the metro
that that meets those standards right now.

750
00:38:42,577 --> 00:38:46,176
So, it's just something that we are

751
00:38:46,176 --> 00:38:49,176
continuously working on as the stroke
committee, you know, it's a joint effort.

752
00:38:49,809 --> 00:38:53,075
So Norman Regional
is the only, accredited

753
00:38:53,542 --> 00:38:56,408
excellence, center center for stroke excellence,

754
00:38:56,408 --> 00:38:59,408
in south of the metro, basically. Yes.

755
00:38:59,808 --> 00:39:03,440
Well, thank you guys so much
for taking the time to talk to us today.

756
00:39:03,440 --> 00:39:04,474
We really appreciate it.

757
00:39:04,474 --> 00:39:08,340
I think it's, it's going to be a pretty
invaluable resource for our listeners.

758
00:39:08,340 --> 00:39:11,173
and we just appreciate both of you.

759
00:39:11,173 --> 00:39:14,672
And we also want to thank,
Ms. Melendez again for coming by and

760
00:39:14,672 --> 00:39:17,838
and sharing her story,
very inspirational.

761
00:39:18,138 --> 00:39:20,038
And, of course, Doctor Tinsley.
Doctor Costner,

762
00:39:20,038 --> 00:39:23,038
thank you so much for coming by
and answering all of our questions.

763
00:39:23,071 --> 00:39:26,071
And for our listeners, as always,
thank you for joining us today.

764
00:39:26,071 --> 00:39:29,203
This has been a great episode talking

765
00:39:29,203 --> 00:39:32,603
about stroke and stroke awareness and,

766
00:39:33,570 --> 00:39:34,503
takeaways

767
00:39:34,503 --> 00:39:37,502
is if you have any acute changes
or have a loved one,

768
00:39:37,669 --> 00:39:41,002
call 911, go to the E.R., get checked out.

769
00:39:41,168 --> 00:39:42,768
Remember, BE FAST.

770
00:39:42,768 --> 00:39:45,768
And, 
we appreciate you again for joining in.

771
00:39:46,001 --> 00:39:50,301
And as always, this has been Veer and Krishna Vedala,
Stay classy, my friends.

772
00:39:50,301 --> 00:39:51,300
And stay out of trouble.