hello I'm Jennifer Blomqvist.

>> Welcome to Help Line this Tuesday evening.

I'm so glad you joined us.

This is a great show.

Maybe you're one of our regulars which is always great but maybe you're new to the show and if that's the case, I want to just let you know that we are live here in the studio here at PBS .

Thirty nine and we have a phone number up at the bottom of the screen because we welcome your questions during the show.

You can get some free medical advice tonight and nothing in life is really free anymore except tonight's show if you call it there's a no it's (969) 27 two zero if you're outside of Fort Wayne it is still a free toll or toll free call.

Just put 866- in front of the number and we'll get you through and when you call in you have two options.

You'll talk to a very nice call screener and you can either ask your question during the show which is great because you can interact with a doctor and he can maybe ask you some questions and maybe give you a better sense of guidance, guidance or advice or if you prefer I can ask a question for you suggest that the call screener know what you want to do.

We'll get your question answered so there's a number we'll keep it up through the show.

I would advise to call sooner rather than later.

Sometimes we get backed up at the end of the show.

We hate to miss your call so let me go ahead and introduce you to tonight's guest, somebody who is new to our show tonight, Dr. Christopher Vachon who is a neurologist.

Thank you so much for coming on.

Thank you for having me.

And he he brought a prop.

>> He brought the brain.

So since he is a neurologist so this will be helpful some maybe of a particular question it would help to know what part of the brain we're talking about.

So let's go ahead and start the show.

But like I said, Dr. Foshan will have a conversation talk about May which is Stroke Awareness Month.

We're talking about strokes right now.

But if you have something else neurology related, please feel free to give us a call at any time.

I did not know that made with Stroke Awareness Month but it never never hurts even if you think that you're never going to have a stroke or you've never seen anyone have a stroke that it won't impact you.

It's a good thing to at least have some basic knowledge of what a stroke is, how to recognize it absolutely.

>> And do they still use an acronym fast for I remember the first tee was the cut of the guideline for if you suspect you are having a stroke or see somebody having a stroke.

>> Yes.

And so they certainly do still use the acronym fast.

They have expanded it a little bit to include be fast the B stands for balance O use for eyes F is for face any facial asymmetry and then a is for arm any weakness of one arm over the other as is for speech like slurring of speech or difficulty getting words out and then t is time and that really emphasizes how important it is to address this medical emergency in a timely fashion and so really each stroke can affect any bodily function when it comes to weakness or numbness on one side of the body it can affect the eyes, the vision, your ability to articulate words and so though it can encompass a wide variety of symptoms really the uniform underlying feature that really gives us concern for stroke is when it has a sudden onset or stroke like onset and that's when you should seek care.

>> What's interesting about a year ago I was interviewing a man who had a stroke.

He was just at work one day and just by himself which was unusual.

But that day he happened to be in the office by himself and he just kept telling me he did not realize what was happening.

He kept saying it was so weird it didn't hurt.

He kept emphasizing he wasn't feeling pain really.

It was just he kept describing it as a weird feeling.

Of course he felt he fell out of his chair and just it took him a while before he even realized what was going on and being by himself fortunately he was able to I forget what if you used like a sweatshirt or something to knock his cell phone stayed on the desk but he was able to knock it off and call nine one one.

But I mean he couldn't get up and answer the door.

They had to break the door down to get in there and so he you know, in retrospect he said I lost a lot of time and as a result he does have some permanent disability from it.

>> So that time factor even I've heard seconds can make a difference.

Yes.

And there's another saying that time is brain and it couldn't be more true and they've actually done some research on this and have looked at the billions of cells in the brain and even more connections that all of those make altogether and in one minute without blood flow it's estimated that approximately one point nine close to two million cells are affected every minute and so that that's a striking number and so that really emphasizes that if you have those symptoms or if a loved one does, it's very important to get checked out right away.

So what you talked about the an acronym Be Fast so all those symptoms which I think most people would yeah.

You think of the slurring of the speech and losing balance and so forth.

>> What what do you do if you're a bystander?

I mean just call nine one one.

Is there anything that you as a bystander can do that could help the person while you're waiting for help to arrive?

>> You're really the main thing is to get them medical care as soon as possible and so that really means dialing 911 one in and or getting them to the hospital as soon as possible.

The sooner they can get in front of a physician and get a scan of the brain, the sooner a neurologist and or an emergency room physician can work together to try and deliver the best care as soon as possible.

>> Yeah.

Can you do anything before you have a brain scan or do you really need to see that before you can intervene with you know ,with different treatments?

>> Yeah.

So really what happens when a patient presents to the emergency room with stroke like symptoms?

>> We first want to get a C.T.

scan of the brain because we want to evaluate to see if there's any changes on the brain and there's an initial fork in the road where we want to look and see if there's any evidence bleeding on the brain which would indicate a hemorrhagic stroke or a bleeding stroke.

>> Now that's different than an ischemic stroke which is really a lack of blood flow stroke from a blood vessel that's clogged up or that has collapsed.

And when a stroke is early on, we actually hope that that CT scan is normal and doesn't show us any changes because that usually means we have some opportunity that we might be able to offer some acute stroke treatment and I know we're going to keep talking about strokes and awareness of it and so forth.

But we did have someone who called in and wanted me to ask the question.

John called in and said he has a friend who had a stroke and unfortunately now this person the speech is like that of a little baby and so John's wondering what part of the brain his friend his friend's stroke affected.

>> OK, yeah.

And so is that is that common that you would have permanent speech disability?

>> I've heard of it being slurred but not so much talking like a child or baby.

And so there's two different aspects to her language.

There's the aspect of how clear we can talk and then there's a second aspect which is really our ability to use the our language and the language center is usually on the left side of the brain right here and it's a very highly specialized region in the brain which means that when a highly specialized area in the brain is affected it can be more challenging sometimes to gain as large of an improvement over time and so you can certainly have different ASPE of communication that are affected.

One is really the slurring of one speech.

The other is the ability to use words or comprehend what others are saying, the ability to read and write can all be affected unfortunately and it's a lot of times is that just a permanent issue then for the person for the rest of their life ?

>> It really depends on the extent of the stroke and the location of the stroke and what I would say is any time I see somebody who's been affected by a stroke I anticipate that they will recover to some degree if it's a smaller area of stroke, I actually might expect them to gain near to full recovery to the point they might not notice any residual symptoms six months from that point.

Now it's unfortunately a larger area of the brain that's affected then I still expect them to show some gradual improvement especially with physical therapy, occupational therapy and speech therapy.

But their new baseline might not be quite to where they were before that stroke actually happened.

>> All right.

Well, John, thank you for that question.

I was a good question and we welcome your question.

Maybe you know someone who's had a stroke or concerned about it or want just some just get it an issue maybe resolved regarding that topic.

So give us a call.

It's (969) 27 two zero still toll free if you put in 866- in front of there and again Dr. Foshan is only with us until about eight o'clock so I would call sooner rather than later.

I want to get back to when we're were talking about when a person has a stroke and immediately get immediate medical attention once they assess something with the scan.

What kind of a stroke you're dealing with is it usually medication or is there a procedure that can be done at the hospital to help the patient?

>> Yes, certainly there are a few different things that we can consider depending on each scenario.

And so there's two treatments.

The first one is a clot busting medication that we can sometimes use so long as that patient has arrived soon enough within about four and a half hours of the symptom onset and also we have to be sure that it's safe to use in everybody and in some cases that individual might already be on a blood thinner that might not make them eligible but that really is one of the primary considerations when somebody comes in is if we can offer that clot busting medication in a timely fashion.

Now the second consideration is a procedural consideration and after we take that initial picture of the brain, we also take a picture of all the blood vessels starting from the bottom of the neck all the way up into the brain.

And if we see evidence of a clot that is low enough down in that blood vessel tree, then an interventional radiologist might consider a procedure where they put a catheter through a blood vessel in the groin and can actually go up into the brain inside the blood vessel and attempt to remove that clot or that that blockage and try to restore blood flow to that area of brain that's deprived that is amazing.

>> But again, you were saying this all has to be kind of done relatively soon after the incident.

What happened?

>> So yeah, what are some things that people can do to prevent strokes?

I don't know if there are if men are more at risk than women are certain age groups or preexisting conditions maybe make you more susceptible?

>> Yes.

And so men tend to be affected a little bit more than women but with with with age really there's just in general more wear and tear on those blood vessels in the brain.

>> But there are certainly specific medical conditions that are risk factors for stroke and the main four risk factors that we look at are high blood pressure, high cholesterol, diabetes and smoking.

And so really it's important to identify if those exist and then really nail those down in terms of treating them to an optimal level.

And we really after a stroke has happened, the goal is figuring out why it happened so that we can put things in place to reduce the risk that it might happen down the road and that's called secondary prevention after unfortunately a stroke happens once we figure out what's going on and get that patient the right therapies and urgent treatments really our focus turns to how can we reduce the risk of this happening again.

>> So it sounds like maybe some lifestyle changes.

I mean if you've got you know, diabetes and high cholesterol and and the smoking I mean that's that can cause a host of other issues not to mention the stroke.

But it's my understanding has always been when talk to other doctors about strokes is it's it's it can be a long recovery and it can take a while before your lifestyle change, you know, dramatically has an impact on your health .

It doesn't you know, you don't start smoking and next week you're fine.

Right?

Well, the damage is already done so yeah.

>> Yeah.

Unfortunately when a stroke happens that injury to those nerve cells in the brain is is irreversible.

However, the brain is of course the most complex circuitry that has ever existed and so it's really like a complex circuit board.

And so if a few of those connections disrupted from a stroke for example, there's still a lot of healthy nerve cells in the brain that can sometimes pick up the slack so to speak and lead to some improvement over time with the right therapies.

>> But to your point of some lifestyle changes, yeah, those are things that that do take time to see the benefits but really it's important for the long term not only for stroke risk but for cardioverter vascular health and heart health in general as well.

>> Yeah, sad but true sometimes a scare like that know can really shake somebody up enough that they would be willing to make the change even if it's difficult to do so.

It's unfortunate that they had to go through that.

But yeah, we did have somebody else.

Dr. Ishant who called in and wanted to ask the question live so I'm going to pass it along to Tim.

>> Are you there, Tim?

Yes, I had a great question pardon me regarding the strokes and the covid-19 vaccine, I've seen news reports regarding even teenagers having blood clots in their brain three days after they had the cold vaccine and also a swelling of the heart.

Have you seen or is there any correlation between these Fizer vaccines and strokes?

>> Thank you.

Thanks to you.

Yeah.

Thank you for the question and I certainly have come across anecdotal reports of this phenomenon and I have not personally encountered this but I've heard of anecdotal cases and to your point I think that the most frequent occurrence post vaccination with the vaccination you specifically mentioned typically put individuals at risk for clots in the veins of the brain and not the arteries.

And so if you imagine when your heart pumps blood it goes up into the brain through all your arteries to give oxygen and nutrients to all your brain cells and then that blood has to drain out through all the veins and go back to the heart to be recirculated.

>> And in the cases that you're alluding to that there were some observed changes in the veins of the brain where a clot formed which can also cause stroke like changes on the brain because it can disrupt blood flow overall.

I don't even think about that.

You know that you could have a stroke in a vein and issue a vein instead of the artery and that impacting it.

Is it easier to recover if the issue is vein related as opposed to artery?

>> Not necessarily.

OK, yeah.

In a venous problem or a venous stroke it is far more rare admittedly but really just depends on how extensive it is and how quickly we can treat it.

>> All right.

Great question, Tim.

Thank you so much.

We had another gentleman call in and out with Ronnie and he wanted me to ask the question for him.

So Lenny says he has a friend who gets dizzy sometimes and he's wondering if this is a sign of a stroke and if not, how should he treat the dizziness?

>> OK, excellent question and this is a really challenging symptom because dizziness can be a sign of stroke.

>> You're absolutely right.

It can also be from a bunch of other things so people can get dizzy if their heart isn't pumping quite enough blood fast enough to their brain and they might feel faint or woozy.

>> It can be a problem with the there's little crystals inside your inner ear that if they get dislodged can cause pretty extreme dizziness, vertigo and unfortunately it can also be a sign or symptom of a stroke and the part of the brain I'll actually hold this up here.

>> I'm glad I brought this tonight the part of the brain that is typically involved in causing dizziness this is the front of the brain.

It's actually the back portions of the brain in the brainstem that when those are deprived of blood flow can lead to dizziness.

So that's a frequent conundrum when we see patients in the emergency room is sorting out is this dizziness from a stroke or is it from another cause now if somebody's been having dizzy spells or just feeling dizzy, can you get more information if you were to do a brain scan?

I mean because what are the chances that you would actually witness the dizzy spell, you know, if they're just kind of happening right at random?

>> So can what a brain scan give you any information about what's going on?

Yes, it most certainly would and a brain scan would tell us if any of those episodes and spells of dizziness may have led to an actual stroke on the brain.

So we'd be able to see on a brain scan if there's been any spots of irreversible damage over time.

We can also look at again the blood vessels as they track up to the back part of the brain to see if there's any areas that are narrower than they should be which would prompt us then to decide why that is the case and then get that patient on appropriate treatment.

>> So absolutely a scan of the brain with an MRI and a blood vessel scan to look for the health of those blood vessels that go up to the brainstem would be a very helpful step in clarifying where that dizziness might be coming from.

>> Yeah, that's good to know.

I mean especially I would imagine if it's happening frequently irregular they would definitely be something to get checked out as what it sounds like.

>> Yeah, absolutely.

And I do think that the intermittent nature if it's happening really frequently it might actually make my suspicion for stroke a little bit lower because usually if a stroke happens in a stereotype, if symptoms happen in a stereotypical fashion repeatedly over a long period of time but then resolve completely, I would have a slightly higher suspicion for some of those other things.

I might look a little bit harder in those categories once I've excluded that there's been evidence of stroke.

>> Sure sounds like there's a lot to consider with each patient.

So yeah, we did have someone else who called in and wanted me to ask for them.

So Pat wants to know if someone who has a fib is more likely to have a stroke.

>> Yes.

So if it would be the heart yeah.

>> Irregular heartbeat is that right?

Yeah, it's often referred to as a fib.

The full name is atrial fibrillation and it's a heart rhythm problem that can lead the heart to instead of pumping perfect perfectly rhythmically it can actually kind of flutter in place and not make a coordinated pump and when blood doesn't flow constantly it tends to clot and we all know this if we get a paper cut, if that blood doesn't keep flowing it will make a scab and it'll clot up.

And so the same thing can unfortunately happen in the heart when atrial fibrillation is happening and if that clot then breaks loose it can travel up to the brain and clog up a blood vessel and cause symptoms of a stroke and so atrial fibrillation is is certainly a condition we look for and if somebody comes in with a stroke and we find no other obvious cause we actually tend to monitor their heart rhythm for an extended period of time even after they left the hospital typically for at least a month and sometimes longer than that to make sure that we haven't missed it because that rhythm problem can sometimes be there all the time.

It can also come and go which is called paroxysmal atrial fibrillation, which is really tricky because it can really come and go without the patient even knowing.

>> All right.

Great question.

Thank you, Pat.

You're very popular tonight out of fashion.

We have Leslie who's patiently waiting for her question to answer.

>> Go ahead, Leslie.

Hey there.

I have a question about something that happened to me.

This was a few years ago.

I woke up and I couldn't walk.

I couldn't get my perception spatially and so I went to the hospital.

They ran lots of tests on my heart, on my brain.

They found absolutely nothing.

The symptoms lasted for about 36 48 hours, which my understanding is beyond the window of what's considered TIAA but the kicker to this and I would accept that it was a TIA except that I would have intermittent spells for the next several weeks of how I couldn't orientate myself spatially.

I would just it was I just had a loss of proprio ception and I can't figure that out.

>> We only have about a minute to have left.

>> I'm sorry but go ahead Dr. Foshan.

Yeah and so you're exactly right that a or a transient ischemic attack really is a threatened stroke meaning that your brain might be almost having a stroke but then it gets over it or restores blood flow to the brain that's in distress.

So that usually is less than 24 hours in duration because beyond that time frame usually there are nerve cells in the brain that that are irreversibly damaged and we can see that on a scan.

Oh, that being said, sometimes symptoms fluctuate and there can be a stuttering tia where the onset to the a stroke or a TIA might come and go and ebb and flow over the course of twenty four hours all the way out to several days.

And so I agree with you that it's still in the realm of possibility that that could have been what's ailing you.

But I also think it would prompt me to look for anything else that might be contributing to that.

>> Oh Leslie thank you so much.

I'm sorry we were short on time but that was a great question and we certainly wish you all the best.

Thanks for calling in.

Many thanks to all of you who called in tonight.

Great questions and a huge thanks to Dr. Christopher Foshan.

>> Appreciate you coming on tonight.

Thank you for having me.

And of course the brain was very helpful too.

So I have to absolutely bring him back.

>> So absolutely.

Thank you so much for watching.

Have a great night and join us next week.

Tremblant, our hearing instrument specialist who's a regular on the show will be here.

Great guest next week as well.

So take care.

>> Have a good week.

Bye bye