Health Topics

Prevention, Lowering Risk and Treatment

Andrew Schorr:

Stroke though is life threatening, and you don't want to go there. Dr. Robinson is it okay if we give people some tips on how not to be your patient?

Dr. Robinson:

Absolutely.

Andrew Schorr:

Okay, because you're busy enough. So what are some things you would tick off so people could lower their risk of ever having a stroke?

Dr. Robinson:

The current emphases, there are two things to consider. One is just the general population, and those are the common sense healthy lifestyle issues of eating right and getting exercise, but there is a big emphasis on identifying those patients who are at increased risk. So it's important for patients to know if they are in that category.

Those things that have been well identified as increasing your risk for having stroke are high blood pressure, hypertension; being diabetic; if you're a smoker that certainly is a risk factor and you should stop; if you already have heart disease or peripheral vascular disease as our previous caller did, then you've been identified as a patient that has this systemic vascular issue; if you have high cholesterol; being overweight, particularly around the middle is a risk factor, and then of course if you have family history where there has been lots of problems with these sorts of things then you probably have a genetic tendency to it, and there are some other rare inheritable things, but those things that I mentioned are things that should make you think that maybe you're at increased risk, particularly after 50. That would be a reason to get evaluated by your doctor, and see if there are some medical interventions that can be done and lifestyle changes to reduce your risk, and that is the most important thing we could do to reduce the stroke burden of our country.

Andrew Schorr:

Okay. And when we were talking to Anna Rose from Tacoma so she's had heart disease, she's diabetic which puts her at higher risk. I don't know what her family history is, and she's been aging. She's 82, and as you get older the risk can go up too.

Dr. Robinson:

That's right.

Andrew Schorr:

Okay. So what is the range of treatments to try to lower your risk if things are starting to show up? Lower your cholesterol and you may take a medication for that.

Dr. Robinson:

That's right.

Andrew Schorr:

Exercise to try get those HDLs going. Right?

Dr. Robinson:

That's right.

Andrew Schorr:

Maybe a blood pressure medicine. What are some other things that typically are done?

Dr. Robinson:

Well of those medical conditions that I described, just tight control of all of those. So get the blood pressure under control, with diabetes tight control of the blood glucose. Lose weight and exercise, and so it's managing those medical conditions that we know put you at higher risk. Get that cholesterol down with a statin plus cholesterol-lowering drug. Those are the most important things that you can do to reduce your risk.

Andrew Schorr:

Okay. If they get to you though, in a non-emergent way, and let's say there was an ultrasound exam or MRI, CT as you mentioned. There's some blockage, and if that broke off or cut off the oxygen in the blood to some part of the brain it could be catastrophic. You, we mentioned with Heidi, and I'm going to get Heidi back on; Heidi I'm going to put you on the air, Heidi had this coil, not a coil but you run a catheter up from the groin like the doctors do to the heart, right, to put a stent in there, but this time you're going up into the neck are you, or do you go all the way to the brain?

Dr. Robinson:

Well we can do both, but I'm delighted that Heidi could join us today because she's just an example of the patient that benefits most. Her situation, she had this surgery after having had symptoms. So this is not a situation where we have an asymptomatic patient. This is a patient with symptoms identified as having a very narrowed carotid artery, likely the cause of those symptoms, and a risk factor for a much more serious stroke. Had surgery for that and did well, but then was appropriately being monitored with ultrasound, and the ultrasound suggested this artery was progressively narrowing.

At this point it was much lower than you can easily access with surgery, and so she was referred to me for this image-guided, minimally invasive type of procedure from within the vessel, and I will tell you that that was a very appropriate case because that artery was severely narrowed, and the flow in the artery beyond the blockage was very slow. I have no doubt that that was causing her symptoms and that she was at high risk for having a major stroke, and with this procedure we were able to open up that artery, essentially as an outpatient procedure in what would have been a very difficult surgery. So you just couldn't get a better patient to talk about the benefits of this type of approach than Heidi. So I'm glad she's with us.

Andrew Schorr:

And Heidi McKenna you're on the air now. You're feeling better as you said. Right?

Heidi:

Yes. I feel great.

Andrew Schorr:

And the procedure, this sort of minimally invasive procedure, was not a big deal.

Heidi:

No. It was not at all.

Andrew Schorr:

I think what you're hearing from Dr. Robinson is that nobody has a crystal ball, but the kind of blockage that you could have had had you not corrected it could have been life threatening. Right Dr. Robinson?

Dr. Robinson:

Absolutely.

Andrew Schorr:

So Heidi you're living right there, and it's great that you got the care that you needed and deserved. So Heidi what would you say to other seniors who are listening if they have some of the symptoms? What would you say from your perspective?

Heidi:

Well go to the doctor right away. Find out and get all the tests done and whatever you can.

Andrew Schorr:

Right. And you were probably impressed with where medical science is now that they could sort of go up through your groin and get way up there and do what they needed to do.

Heidi:

Oh yes, and I also wanted to thank Dr. Robinson.

Dr. Robinson:

Well you're welcome. It's our pleasure.

Andrew Schorr:

Okay. Well Dr. Robinson let's go on for just a second. So we mentioned about the; and I'm going to put you back on hold Heidi, just relax there for a minute; you mentioned that you can go all the way up to the brain, and we had Norm Beauchamp who is head of radiology at the University of Washington on a couple of weeks ago, and he just mentioned this briefly that there are these coils that you can go all the way up to the brain. What are those for? Where do they come in?

Dr. Robinson:

Well Andrew, what we've been talking about is the bigger share of stroke is the blockage of blood flow to the brain, or ischemic stroke, but there is also hemorrhagic stroke, which may be bleeding in the brain or around the brain, and the bleeding around the brain is frequently caused by aneurysms. An aneurysm is a bubble off of an artery that may pop essentially, and there is bleeding around the brain, and that can be fatal. It always, almost always, presents with a severe sudden onset of headache with a very characteristic rapid intensity within seconds, rapid maximum intensity of the worst headache of the patient's life, and so that is the feared complication of a ruptured aneurysm, and that has been treated with neurosurgery where they remove part of the skull and get into the aneurysm, which requires some retraction of the brain out of the way and getting a clip across the neck of the aneurysm, kind of like a clothespin across the neck of this bubble in the artery, and a newer less invasive approach is to go from the groin and go up into the aneurysm and basically fill the aneurysm with these little filaments of platinum wire, very soft wire almost like a light bulb filament that's made of platinum, and pack the aneurysm full either in the case of a ruptured aneurysm or to prevent rupture.

One point it would like to make about this, and particularly in the setting of aneurysms is that we are, as I mentioned, blessed with all this technology and all these devices, and it's just wonderful that we avoid this morbidity of surgery in the vast majority of cases that patients undergo these sorts of things, but you have to be aware that the term "minimally invasive" does not mean risk free. So it's very important to be aware of that, and if you are not having symptoms I would say caution is advised for any of these types of procedures, particularly where you are going up into the brain like that because there is certainly risk to that procedure too. So I think you need to learn from your doctor what are the risks if you don't do anything, what are the medical options, what are the risks of treatment, and be well informed about these therapies and not become too enamored of this minimally invasive kind of hype that certainly it's easy to fall into.

Andrew Schorr:

Good point, although when it comes to the neurologic signs of a stroke, that's when you're aggressive. Get in and be evaluated.

Dr. Robinson:

Absolutely.

Andrew Schorr:

Okay. We're going to take a break and come back with some final comments after this. We've been visiting with Dr. David Robinson on the stroke team at Virginia Mason with some great information. We'll be right back.

We're in the final couple of minutes of this week's Patient Power. Remember next week we've got Gina Tuttle, my dear friend. Yes she's the lady that does the traffic reports around town and was on KOMO for years. She'll have Dr. Sarah Stolz, Dr. Preetam Bandla from Swedish Medical Center who are sleep experts for you and a child if you are having problems there too.

Today we've been talking about stroke, and I want to wish all the best to Heidi. Heidi you are back on the air. Heidi McKenna had a procedure with Dr. David Robinson at Virginia Mason, and you are doing well. Heidi, you are an 11-year breast cancer survivor. Most women with that sort of treatment you got good care then do extremely well, and it sounds like now with your early signs of potential stroke you're doing well too. So I wish you all the best Heidi.

Heidi:

Thank you David.

Dr. Robinson:

Your welcome.

Andrew Schorr:

So thank you for being with us Heidi McKenna. Dr. Robinson what's the message you want to leave for people about stroke?

Dr. Robinson:

Well I think pay attention to those warning signs that we mentioned. Do not ignore weakness, numbness, vision problems. Those can be important warning signs. Be aware if you're in that category of high-risk patient so that you can seek aggressive medical therapy to reduce your risk, and those would be the important things that you can do to reduce your chance of having to come and see me, which would be a good thing.

Andrew Schorr:

But if you are at high risk know where the stroke centers are, and Virginia Mason Medical Center is one of them. I'm going to give Dr. Robinson's phone number one more time in case you want to get checked out there. It's 206-341-0420. That's the stroke center at Virginia Mason, and they have a whole team there to help you or rehabilitation should you have had a stroke trying to get you back to as high a quality of life as you can. Dr. Robinson thank you so much. I hope you have a good rest of your President's Day weekend.

What's up here? Well all the replays wind up on www.patientpower.info, so take a look at that. Also a couple of other notes, I am going to start doing a daily show on the Internet, and you'll be able to get that right off of the www.patientpower.info website. That starts March 5th. So I'll invite your suggestions. You can always send me an e-mail at andrew@patientpower.info. Also there is some other things that I'm doing on the Internet too that the replays are available to you on www.patientpower.info. For instance later today I'm interviewing Dr. Janet Gilsdorf who is a pediatric epidemiologist at the University of Michigan, and she was diagnosed with breast cancer and tells the story of when the doctor becomes the patient. I'm sure Dr. Robinson you'd agree it happens. You know doctors are vulnerable too. She wrote a book called "Inside Out," and so we're going to have Janet on and also a specialist from the University of Michigan. So that winds up on www.patientpower.info.

I want to wish you the best week. Gina will be here next week. Do that stroke prevention, and watch out for the early warning signs, and get care. Call 911 if you need it. All the best and remember, knowledge can be the best medicine of all. Bye bye everyone.

Please remember the opinions expressed on Patient Power are not necessarily the views of KVI, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you're your own doctor, that's how you'll get care that's most appropriate for you.