Welcome to Straight Talk on Health, I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the world of health. Whether it’s research that makes the news, another miracle diet, or a new food fad, I look at the science behind them, and let you know whether it’s real or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
The day began normally. I work for a few hours. Paula, who sleeps much later than i do, gets up and we eat breakfast together while watching something that we recorded on the DVR. On this particular day, they were showing promos in the lower left hand corner of the screen for what is coming up next. It was sort of irrelevant because we were watching on the DVR but here's the thing: no matter what I did, I could not focus my eye to read what it said. It was blurry. I could read the right hand lower corner of the screen but for whatever reason, I just could not read the left. I even had Paula rewind it several times.
The show finished and I went back to work. I wanted to check on a local news story online. When I found the story, it was all a blur. Instead of letters, it looked like zeros and ones, like you something you might see at the beginning of a movie about computer espionage or something like that. This caught my attention and I decided to check out a few things. Looked in the mirror. No changes. Smiled. No drooping. Held my arms out to the side. Steady as a rock. So I decided to go back to work.
I was recording an audio that morning. I was reading from a script and it was all going along just fine. Until I got to the last sentence. No matter how many times I repeated it, it made absolutely no sense. I've been the health expert that has said for over 30 years “when in doubt, check it out”. So I told Paula what was going on and said I thought it was best that we go to the emergency room. I didn't feel dizzy, I didn't feel faint, I wasn't confused, but still that vision thing bothered me. I'll let you know what happened later.
This podcast is about stroke. It's also about a slightly newer approach as to how to self-check yourself if you feel you might be having a stroke or you believe someone else may be having a stroke. Let's start at the beginning: what is a stroke?
A functional definition of the stroke is a lack of blood flow to the brain. A Transient Ischemic Attack or TIA is a temporary obstruction of blood flow to the brain that often resolves itself without damage. My father-in-law had several TIAs that were checked out completely. After the first one, which came as a complete surprise, he had an endarterectomy on one of his carotid arteries. He recovered completely and went back to running for a few more years.
There are basically two types of strokes. An obstructive or ischemic stroke is the lack of blood flow to the brain caused by a blood clot or other form of blockage. A hemorrhagic stroke is one that's caused by the breaking of blood vessels. Whether the symptoms of a stroke are minor and temporary or severe with the possibility of being permanent, relies on how much of the brain is impacted by the lack of blood flow.
It is important, make that critical, that we do everything that we can to reduce the impact of a stroke. The way we do that is to recognize when strokes are occurring and getting medical attention as quickly as possible. That's how I knew what to look for when my vision became blurred, even though that was the only symptom that I appeared to have “when in doubt, check it out, remember?”
The signs and symptoms of a stroke have recently been updated. The Society of NeuroInterventional Surgery has recently added a couple of signs and symptoms to the four that have been promoted by the American Heart Association. Let’s begin with those.
The original acronym was FAST. The F stands for face drooping. Does one side seem lower than the other? You can also have the person smile, a really, really big smile to see if they are smiling equally on both sides of their face or does one side just not make it.
The A stands for arm weakness. Typically, you would have someone stand with their arms raised to 90 degrees away from their body and parallel to the ground. You can visually check to see if one arm does not quite make it to parallel with the ground. During my brief visit to the hospital, every person that I came in contact with tested my arm strength in some way.
The S stands for speech difficulty. You can think of a phrase and have someone repeat it as best they can. That's sort of what freaked me out a little bit when I tried to read the script and the sentence made no sense. I was going to tell you this later but I might as well tell you right now that no one could have made sense out of that sentence. It was so poorly written that no matter how you tried to say it, it made no sense. I wrote that well before the blurred vision showed up. What it meant was I should have read my script a little closer so that in fact, it did make sense.
The T in FAST stands for time to call 911. Do you call if you just have one sign or symptom? Yes! Do you still call if these symptoms seem to resolve themselves? Yes! So why did I have Paula take me to the emergency room? We had the time, the situation had resolved itself, and mostly, I didn't feel it was necessary to use healthcare resources under the conditions I was in. There may have been other people who actually were having strokes that might not have gotten care quite as quickly.
Just to review the original fast acronym. F stands for face drooping, a stands for arm weakness, stands for speech difficulty, and T stands for time to call 911. So what did the brain surgeons add to the mix?
They added the acronym BE which then makes the entire Acronym BE FAST. What do the new letters stand for? Ironically the B stands for loss of balance. I didn't see any details about how to test that. It may be self-evident that someone cannot stand upright without tilting to one side or the other. Or it may be the while holding their arms to test their arm strength, they can be moved side to side to see how they respond.
E stands for eyesight. Loss of eyesight or, pay attention, blurry eyesight. That's exactly what originally happened to me. I think adding balance and eyesight are a good idea for the lay public. A physician or other health care professional may be completely aware that they are looking for balance and eyesight symptoms but maybe not as obvious to you and I.
Finishing up the story about my trip to the emergency room, they tested everything that they could think of. They did it a cat scan. Didn't find any cats. Joking aside, there were no signs that there was any damage in my brain. They did echocardiograms of my carotid arteries as well as my heart. They didn't find any blockages. They did do a great deal of blood work. Nothing outstanding there either. Fortunately, with the health insurance that I had, I could be put under observation without being formally admitted to the hospital. So they continued to monitor me and evaluate me with every kind of physical, mental, vision and other tests with no evidence that I had a stroke. They did have me wear a heart rate/EKG monitor for a couple weeks but that's a story for another day.
The purpose of this podcast was to focus on the new acronym for stroke: BE FAST. B stands for loss of balance. E stands for loss of or blurry eyesight. F stands for face drooping. A stands for arm weakness. S stands for speech difficulty. And T stands for time to call 911. Commit those to memory and if you feel that you are having a stroke or someone you care about might be having a stroke, assess those symptoms and most importantly, take action if necessary. I can't stress that enough because the sooner treatment begins, the less function a person loses. Until next time, remember that health is a choice. Choose wisely to day and every day.
