Stroke

Stanton Shanedling: Hello, everyone. Welcome to health chatter, and our show today is on stroke.

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Stanton Shanedling: and hopefully not having one. That's the idea. That's, hopefully, the final takeaway of the show. We have a great guest with us today, a really great colleague of mine. We'll get into that in a second. I'd like to

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Stanton Shanedling: Highlight our great crew; frankly, without their expertise, Clarence and I would be lost. We've got a great research crew that does background research for us on every one of our shows. Maddy Levine-Wolf, Erin Collins, Sheridan Nygard, and Diondre Howard, thanks to all of you for helping us get some useful information that we can talk about.

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Stanton Shanedling: Matthew Campbell is our production manager, who does all the logistics of making sure, technically, that our shows are in tip-top shape for you, the listening audience.

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Stanton Shanedling: And then, of course.

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Stanton Shanedling: I couldn't do any of this without my great colleague, and I really have to underscore that. Clarence Jones, Clarence, and I have known each other a long, long time, and we still like each other for all the different things that we do.

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Stanton Shanedling: We do. We do disagree at times, but, you know, we still give each other a good hug at the end. So it's wonderful to have clearance as a colleague for our health chatter. And then, of course, there's the Hueman Partnership, which is a community organization that Clarence is really intimately involved with. That helps a lot of people in the African American community and around health. And they're our sponsor for health chatter. And many, many thanks to them; you can see everything they do.

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Stanton Shanedling: and get information about them at Human Partnership.

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Stanton Shanedling: Dotcom. So thank you to all that org.org, right human partnership.org, and say,

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Clarence Jones: Before you go on, I want to say hue-man partnership. It is not just for the African community; every man has a hue. All of us have hues. All of us are humans. HUEM, MAN. 

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Stanton Shanedling: things to say, and how we can all help each other around many, many issues related to health. So again, thank you for the human partnership. So, alright, today we're going to talk about

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Stanton Shanedling: A subject that's actually in my career was near and dear to my heart, although this has more to do with your brain. It's called a stroke. We're going to look at We're going to talk about prevention, acute treatment, disease management, community initiatives, etc. with a great

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Stanton Shanedling is a colleague of mine, and I have to really underscore this.

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Stanton Shanedling: Hitham Hussein, Dr. Hytham Hussein from the University of Minnesota.

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Stanton Shanedling: Boy, I don't. I don't even know where to start. We've been involved in it in a lot of ways,  and I really have to underscore your commitment to really providing insight and help.

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Stanton Shanedling: and perspective around. Around this subject It. It's second to none. I just found out from hyphen that he's presently the President of the American Health Association in Minnesota, and so thank you for that as well, but originally just for a listening audience. Dr. Sain was originally from Egypt, where he attended medical school.

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Stanton Shanedling: Is this your first Neurology residency? I'm shams. Am I correcting that right? Am I pronouncing that right? I'm Shams University in Cairo, and then I moved to the United States and did a residency here at the University of Minnesota.

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Stanton Shanedling: a second to non-clinicians, educators, and researchers. I can only imagine if I, if any of us got a bit. Had to have a start. Having Dr. Sene as our physician would be

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Stanton Shanedling: really, really, really good. Good. Yeah, I don't want to have it. None of us want to have it, but not a bad doctor has to treat you. He's co-authored over 70 peer-reviewed articles and is involved with contributing to textbooks, etc. He was actively, and I still am, actively involved in the Cardiovascular Health Alliance at the Minnesota

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Stanton Shanedling: Department of Health, so many, many thanks for being with us. We really appreciate it.

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Haitham Hussein: Thank you very much. Stan. And thank Clarence for having me.

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Haitham Hussein: I look up to you not because you're old, but because

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Haitham Hussein: And how nice you always make your hair. So I am. Yeah, yeah, if yeah, you know, for all the listening audience, we do this; we record these shows on Zoom. And if you could also, I'll see you. We have

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Stanton Shanedling: a little bit of a reflection off of Clarence's head, my head, and Hyphen's head. So we have something in common here. So thank you for that anyway. Okay, so let's talk about strum. Alright. We're going to do some, you know. I thought it might. What might be good is to provide the audience with some basic information, and then we can get kind of into the nitty-gritty. So

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Stanton Shanedling: First of all, what

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Stanton Shanedling: Is exactly what is

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Stanton Shanedling: a stroke. Most people, I guess, will respond to it when they have one or somebody close to them has one, but knowing ahead of time

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Stanton Shanedling: What it is and what you should be aware of, I think, is important. So let's start there. Hythal.

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Haitham Hussein: Yes, thank you for the question. Stan. This is

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Haitham Hussein: absolutely important.

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Haitham Hussein: A stroke happens when there is damage to the brain because of something wrong. With the blood supply to the brain.

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Haitham Hussein: There are different kinds of strokes.

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Haitham Hussein: Ischemic stroke is when there is a blockage of an artery that takes the blood to a part of the brain, so that part of the brain then loses blood supply and suffers the damage that we call ischemic stroke.

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Haitham Hussein: The other kind is when the arteries burst or rupture. If the rupture is within the brain tissue, that is called intracranial hemorrhage or hemorrhage within the brain.

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Haitham Hussein: And if the rupture happens outside the brain tissue, then the blood is on the surface of the brain or around the brain; that's called subarachnoid hemorrhage. These are the three different types of strokes. And then there's also tia, or transient ischemic attack.

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Haitham Hussein: This happens when the artery going to the brain is blocked, but then the blockage is temporary and opens on its own, so that the blood supply is restored without leaving any damage to the brain, so that person would have stroke symptoms for 15 minutes, a half hour, or an hour, and then the symptoms would subside completely.

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Stanton Shanedling: So let me ask you some. Alright, so

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Stanton Shanedling: Of the types that you just talked about. Is there

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Stanton Shanedling: one that

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Stanton Shanedling: more serious?

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Haitham Hussein: Yes, the

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Haitham Hussein: The most common type is the ischemic stroke type, which is about 80% or even more so in Minnesota. Here, 85% of all strokes are ischemic stroke blockages inside an R.

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Haitham Hussein: But the more dangerous type is the subarachnoid hemorrhage type. When the bleeding is on the surface or around the brain.

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Haitham Hussein: the mortality rate is highest in that type.

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Stanton Shanedling: So.

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Stanton Shanedling: Clarence,  what do you think of? You know. You know, we've all known

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Stanton Shanedling: Someone who's had us had a stroke. You know. Unfortunately.

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Clarence Jones: So, Clarence, yeah. So for my kick in here. Yeah, yeah. So from my perspective, you know, I am one of those more seasoned people. Doctor, just so you know that. but in my.

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Clarence Jones: in my community. We talk about stroke as though it's normal.

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clarence jones: And you know, we know people who had strokes, and yeah,  they had a stroke, you know. And so what are the signs that people

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Clarence Jones: Receive that the body gives off before an impending stroke

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Clarence Jones: This is one of the things that I want to know. And then the other thing that I want to know is: what are the really basic things?

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that we should know about strokes and how to prevent them.

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Clarence Jones: Because, again, you know, when I talk about certain communities, you know, it's just like we accept it as just a fact of life without thinking that there's any way for us to avoid them

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Clarence Jones: Or so, anyway. So those are my kind of mishmash of questions.

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Haitham Hussein: Okay? So, starting with the stroke warning signs,

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Haitham Hussein: So when a stroke happens, First of all, we don't know. If it's the ischemic type, the blockage type, or the bleeding type,

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Haitham Hussein: The doctors can't know without getting a picture, a CT scan of the head. So you can apply these warning signs to all different types of stroke.

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Haitham Hussein: You know, we talk about the acronym. Be fast, BEFA, ST, and the other way to remember this is through coordinating signs. So weakness in one of the arms, one of the legs, or one side of the body

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Haitham Hussein: without pain.

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Haitham Hussein: numbness or loss of sensation. Again, one side of the body, or one of the arms and face on the same side, or a leg

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loss of the ability to speak

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Haitham Hussein: or loss of ability to understand when someone is talking to you

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Haitham Hussein: law slurring of the speech. People talk as if their tongue is heavy or they're drunk.

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Haitham Hussein: In the droopiness of the face.

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Haitham Hussein: loss of vision in one eye or painless blindness in one eye can be a stroke symptom.

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Haitham Hussein: Our eyes do not see one half of the visual field.

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Haitham Hussein: and loss of ability to walk, loss of balance. A severe headache is a common symptom when there is a rupture or a burst of an artery inside the head.

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Haitham Hussein: and the decreased level of consciousness. So people become suddenly sleepy or drowsy.

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Haitham Hussein: These are the common stroke warning signs.

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Haitham Hussein: And we want people to call 9-1-1 right away.

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Haitham Hussein: when they are experiencing, or they're seeing someone experiencing, stroke, warning signs, weakness, numbness, or facial droop.

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Haitham Hussein: speech, difficulty, loss of balance, vision change

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Haitham Hussein: a decreased level of consciousness or becoming sleepy and lethargic.

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Haitham Hussein: and calling 9-1-1 before you call your doctor's office, before you call your friend, or before you call your son to tell them that something is wrong. You call 9-1-1 first.

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Haitham Hussein: And the value of that isn't just because, you know, you get the paramedics right away, and they drive fast and bring it to the hospital. They also call us

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Haitham Hussein: when they are at the scene, or on the way, they call the hospital. and they tell us that we think there is a stroke person coming to your hospital.

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Haitham Hussein: So we run down to the door and wait for the potential stroke patient and take them from the ambulance directly to the emergency room. No triage, no delay. And so that gives a lot of benefit to the patient and the treating team. When we get that heads-up from the ambulance, you always

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Haitham Hussein: Combine talking about the warning signs with what to do.

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Haitham Hussein: That has to be set together. That's why we call it B fast B for balance, E for IF for face.

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Haitham Hussein: a for arm weakness, s for speech, and t means time to call 911.

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Haitham Hussein: Be fast.

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Stanton Shanedling: So let me ask you some. You know what it's like.

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Stanton Shanedling: Okay,

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Stanton Shanedling: First of all, a. But a person

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Stanton Shanedling: I wouldn't necessarily experience all those symptoms.

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Stanton Shanedling: Okay, so let me give. Let me play something out all of a sudden.

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Stanton Shanedling:  You lose half of your vision in an eye. Okay, so how do you know how? How would a person know if it's not like, Hey? I should be calling my ophthalmologist because, you know, I might be experiencing a detached retina.

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Stanton Shanedling: as opposed to in this case.

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Stanton Shanedling: a stroke. So there could be some potential confusion.

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Haitham Hussein: symptoms I get that question a lot. And it's not your job, Stan, and it's not the patient's job to make the diagnosis.

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Haitham Hussein: It's it's it's that's something that we can only find out when you are in the emergency room, and if it is a stroke in the eye.

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Haitham Hussein: That means that a person is at very high risk of having a stroke of the brain in the next 24 hours. Okay.

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Haitham Hussein: Right? And there are ways to treat strokes in the eye. And so if we can help you preserve the vision,

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Haitham Hussein: Then. There's just no way to know if it's a stroke or not, and we do not expect anyone to know, and suspicion is good enough. Yes, you or someone you see in front of you is having a stroke.

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Haitham Hussein: You don't need to be sure; suspicion is good enough. Just come to us, and we will figure it out.

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clarence jones: That's for saying, Yeah, I want to thank you for your previous explanation. Because, as you were talking about that, you were listening to all those various things. I think so. And again, I'm coming from a community perspective. Many times people might be experiencing some of those things, and they're afraid of calling because of the ambulance and the costs that they might incur.

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clarence jones: Okay, so let's put that out there. That is some of the fear factors that we have. You just talked about the fact that

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clarence jones: You know it's not our job to analyze.

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Clarence Jones: Right? Our job is to just call and get those things done. So I just wanted to make that comment. Thank you, because I think the way that you explain that

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Clarence Jones is very, very helpful for me. But also, I think when people listen to this program and hear that, there will be less hesitancy.

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Clarence Jones: About thinking that you have a homemade remedy

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Haitham Hussein: That could address that issue. So that was my thought. Right? We say we We talk about it this way because of how hopeful we have become about reversing the effects of stroke.

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Haitham Hussein: You know, in the mid-90s.

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Haitham Hussein: I went to medical school in 1993. That's how long it was and back. Then there was no treatment for stroke.

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Haitham Hussein: And in 1995 came the first medication that we gave through the vein. Iv.

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Haitham Hussein: That can open up clogged blood. Vessels restore the blood flow to the brain before the damage of a stroke sits in, and so we can re-perfuse, re-supply that part of the brain with blood, and prevent or minimize the damage of a stroke.

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Haitham Hussein: And then in 2015.

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Haitham Hussein: So from 1995 on, only treatment Is that an injection? A. until 2,015, when we had evidence that doing a minimally invasive procedure

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Haitham Hussein: We go with thin wires, tubes, and catheters inside the arches of the brain to pull out blood clots from the big arches of the brain. That's a procedure called mechanical thrombosis. Back to me.

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Haitham Hussein: Now we have evidence that mechanical thrombectomy also improves the outcome of strokes or reverses the effects of strokes before they settle.

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Haitham Hussein: And because we have these two treatments,

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Haitham Hussein: We are so hopeful that we can help everyone with strokes before they get the maximum damage that they can get from their stroke.

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Haitham Hussein: So we always plead to everyone if you have through coordinating signs or if you see someone was through coordinating signs.

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Haitham Hussein: Don't hesitate. Don't question it. Of course, you don't know if it is a stroke or not. Even I won't know when I first see you; I have to get a CT scan of the head and do other things.

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Haitham Hussein: But because we know that we have these treatments and they are effective, So please come as soon as you can.

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Haitham Hussein: Every minute counts; for every minute, the treatment of stroke is delayed. 2 million brain cells die. Wow. yeah. So you know, yeah.

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clarence jones: So one of the things that I want to tell you why I think this is important is because, you know, we kind of make jokes about the fact that we're seasoned, but you just said it was only 1995 when people started. You know, the first preventative kind of thing. So a lot of us who were born in the 1,900 fifty

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Clarence Jones: and the forties. We have a long, long history of not thinking that there's anything that we could do about this. You know that there was no medical procedure that could happen. And then you just said 2015?

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Clarence Jones: I mean. So this is why this kind of conversation is so important.

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Clarence Jones: This is because many of us who are more seasoned We don't have this history of learning about the impact of stroke. And we just think that it's just normal.

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Haitham Hussein: And that's why I appreciate the podcast. Clarence, and that you're hosting me. And we're talking about this; we have to spread the word.

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Haitham Hussein: especially in our communities of racial minorities and ethnic minorities. We've talked and will talk about this. I'm sure you mentioned your community or the African American community. And it is true that it is disproportionately afflicted by stroke.

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Haitham Hussein: Compared to other communities, not only is the number of strokes that the African American community suffers from higher, but it also happens earlier in life.

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Haitham Hussein is more severe, tends to recur, and is a major source of disability and loss of function in the African American community.

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Haitham Hussein: And the studies that we and others did and are doing show more delay.

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Haitham Hussein: In the African American community and among racial minorities in general, there is more reluctance to come to the hospital.

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Haitham Hussein: There's more delay. So we have that part about community education, and we have to get you to come to us first before we start treatment. And if you're late, these treatments—I told you about these two different ways of treatment.

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Haitham Hussein: Each of them has a time window. Yeah, we cannot give that injection. After 4 and a half hours from the time the person was lost, Normal. We cannot do this.

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Haitham Hussein: procedures after a certain number of hours as well. And so, if you're coming late,

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Haitham Hussein: You are also limiting your own options for getting the treatment. So it isn't only identifying the symptoms. And I know that in the African American community, there's a lot of experience with stroke, and people probably recognize it easily.

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Haitham Hussein: But then what to do and how fast you have to react to it is what we need to stress over and over. And I agree that the financial burden of calling 911 is on everyone's mind.

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Haitham Hussein: And it's a true barrier.

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Haitham Hussein: But you have to think of the disability that the stroke can cause, and then the impact of the disability on a person financially and psychologically.

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Haitham Hussein: and mentally.

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Haitham Hussein: and so weighing the two together. I think there's no doubt about seeking immediate care when there is a way to go. Yeah, of course. So here's the interesting comment.

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Stanton Shanedling: A lot of people are reticent to

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Stanton Shanedling: Call 911, go in an ambulance, or do this type of thing. Some people, even, you know.

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Stanton Shanedling: Elderly people will often say things like, you know, an ambulance is really for a real, real bad emergency. Okay, a real bad emergency somewhere; you know there's whatever.

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Stanton Shanedling: But you know, I'm just, you know, myself, you know. It's no, you know. I'll get to the hospital if I need to, etc.

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Stanton Shanedling: Our port. One of the major points So far, this discussion is not correct. Okay, what's correct is 9, and one is for any kind of emergency. And this could be an emergency. Get in. And you know what

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Stanton Shanedling: worry about all the expense stuff. Later, you know, that could be all siphoned out. Okay, expenses aren't life-threatening. What is life-threatening? The are, the are, the symptoms that you're having at this particular point. So let's be alright. So we've kind of been focusing our conversation on

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Stanton Shanedling: identification and queue treatment. Let's go into another theme here of stroke, namely

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Stanton Shanedling: prevention. So alright. So nobody's, let's just say, for a moment, whoever's listing, you're not. You don't have any symptoms, and all this kind of

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Stanton Shanedling: good stuff. But how is it that we

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Stanton Shanedling: Can you truly prevent a stroke?

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Haitham Hussein: So, stroke prevention

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Haitham Hussein: Can we talk about the stroke risk factors? What are the conditions that paved the way for a stroke?

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Haitham Hussein: There are

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Haitham Hussein: modifiable and non-modifiable risk factors So a person's age, for example, is a non-modifiable risk. Factor. There is, yeah, an increase in the risk of stroke with age.

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Haitham Hussein: Being a man or a woman, the biological differences can also be their family history, which is important.

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Haitham Hussein: But these are a few.

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Haitham Hussein: Most of the risk factors for stroke are modifiable and under our control.

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Haitham Hussein: And that's what we need to talk to people about.

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Haitham Hussein: High blood pressure is the most important risk factor for stroke.

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Haitham Hussein: So knowing what your blood pressure is means having regular checkups with a primary doctor or primary provider.

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Haitham Hussein: and also knowing what is

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Haitham Hussein: high blood pressure; what is normal blood pressure? What number? When do you feel good? Oh, my blood pressure is good, and what number do you get when you feel bad? But this knowledge is important.

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Haitham Hussein: We want people to know that good blood pressure is one less than 120 over 80.

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Haitham Hussein: And every time we check blood pressure, we get two numbers: a top number and the bottom number. The top number is called systolic blood pressure, and the bottom is called diastolic blood pressure.

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Haitham Hussein: You don't have to remember the names, but you have to know the numbers, what you are aiming for, and what your blood pressure is.

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Haitham Hussein: And the trick is that blood pressure is silent. People have had high blood pressure for years and years. Are they not aware of it? It does not cause symptoms.

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Haitham Hussein: occasionally. Sometimes people would get something like a headache or something, but for the most part, high blood pressure

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Haitham Hussein: and the things that are tied to high blood pressure, like smoking

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Haitham Hussein: huge deal, you know, smoking and

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Haitham Hussein: You know, in

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Haitham Hussein: in the Midwest, you know. Maybe we're a little fortunate. But smoking remains a major issue. because it's tied to blood pressure. Too much caffeine

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Haitham Hussein increases blood pressure. So you have to be careful. With how much caffeine you take, especially, you know, energy drinks and all that crazy stuff, you know the ton of caffeine and also sleep, because sleep is related to blood pressure, and it has emerged now as one of the important risk factors for stroke.

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Haitham Hussein: People will sleep. Apnea. It's a breathing issue that happens during sleep.

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Haitham Hussein: When people fall asleep, the airway

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Haitham Hussein: that allows the air to go to the lungs sometimes collapses; the muscles of the throat relax.

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Haitham Hussein: So the palette and the tongue can kind of collapse on each other, and people start snoring, and sometimes there's a person not breathing for a few seconds, and then

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Haitham Hussein: and another breath. So that's a period of apnea.

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Haitham Hussein: and the problem with sleep. Apnea means that it lowers the blood oxygen level while the person is sleeping.

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Haitham Hussein: And the person does not feel that. But their body perceives that low oxygen as a stressful situation. So then, stress hormones are released in their bodies, and they don't know it, and they don't feel it.

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Haitham Hussein: like adrenaline, and they in. Then their blood pressure increases while they're sleeping, and they don't know.

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Haitham Hussein: And normally we have a drop—a natural drop—in our blood pressure. When we fall asleep.

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Haitham Hussein: and people with sleep apnea lose that natural drop, and their blood pressure remains as their wakefulness, and then, as the condition progresses, They even have higher blood pressure when they're sleeping.

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Haitham Hussein: And if you're checking your blood pressure, you check it when you first wake up. That's always. I tell my patients to check it first thing when you wake up in the morning before you take any pills, and then some other time later in the day, and I always like to compare these 2 numbers, and people will sleep. Apnea will have higher blood pressure upon awakening in the morning.

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Haitham Hussein: And so

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Haitham Hussein: all the things tied to blood pressure we have to really focus on and talk about. And it's not easy. You know the amount of salt or sodium that you take, which also impacts your blood pressure. So it has to do with what we eat. What we drink You know, exercise impacts blood pressure. People who exercise regularly have better blood pressure.

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Haitham Hussein: And then, of course, the high callisty role is an important risk factor.

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Haitham Hussein: And you know, it isn't always related to body weight. A lot of people have high cholesterol without being obese or overweight, so without checking

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Haitham Hussein: We won't know.

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Haitham Hussein: So we have to have a primary doctor, and we have to do these regular checkups to look at these risk factors, and they are the same risk. Factors for stroke are the same as those for heart attack.

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Haitham Hussein: And now we know that there are also the same risk factors for dementia.

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Haitham Hussein: Yeah, yeah, you take care of your blood pressure. You protect your heart, you prevent strokes, and you sustain your memory.

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Haitham Hussein: and other things that are also modifiable. Risk factor we we touched on is the diet and the exercise and

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Haitham Hussein: And so, to prevent stroke, it's a matter of how

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Haitham Hussein: We live our lives. You know that what we eat, what we drink, how much we exercise, how much we prioritize exercising, and how we stay consistent with it Avoid excessive caffeine intake. Avoid excessive alcohol intake. Alcohol increases blood pressure and also puts a strain on the heart, causing irregularities in the heartbeat, which is another way people can have strokes.

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Haitham Hussein: So be kind of moderate in your consumption. No smoking at all. So here's

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Stanton Shanedling: You know, just so everybody is clear.

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Stanton Shanedling: oftentimes more. We talk about audio-vascular

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Stanton Shanedling: disease. Okay? And what? Basically, what we're dealing with is heart disease. And in this case, brain disease. If you want to look at it that way. And

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Stanton Shanedling: For most people, when they think of cardiovascular, they only think about

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Stanton Shanedling: art. But the vascular part is really connected to art.

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Stanton Shanedling: and brain, and the risk factors are complementary for both.

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Stanton Shanedling: arenas. The thing is, as you age,

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Stanton Shanedling: And you mentioned this. There are certain things that are frankly inevitable. There are certain things that are going to catch up with you.

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Stanton Shanedling: one way or or the other, and and keeping having consistent

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Stanton Shanedling: trusted care.

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Stanton Shanedling: is also a major component for for prevention.

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Stanton Shanedling: and and and not to compromise on that, you know, if you need it, you should have a yearly checkup as you as you get as you get older. If you're on medication, you need to have medication management. And assessment.

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Stanton Shanedling: Yes, taking your your blood pressure more often than you did, perhaps when you were in your forties. Etc.

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Stanton Shanedling: So here's one thing I wanna really kind of focus on, have things

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Stanton Shanedling: got better? So let me give you, for instance.

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Stanton Shanedling: you know, when I was

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Stanton Shanedling: cutting up the cardiovascular unit for years and years.

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Stanton Shanedling: what was known as the stroke belt

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Stanton Shanedling: of the United States. Okay. And so for everybody, it's kind of a swath that runs from

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Stanton Shanedling: approximately Georgia, the State of Georgia.

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Stanton Shanedling: swinging down south, east, and going west almost as far as Texas.

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Stanton Shanedling: First question out of the gate. Hythe has the stroke belt changed?

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Stanton Shanedling: If so, has it gotten better?

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Stanton Shanedling: Do we still have a stroke belt where the incidence of stroke, while those years I was involved.

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Stanton Shanedling: Was much higher, etc. Talk to us a little bit about the stroke belt.

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Haitham Hussein: Yeah. There is a built. I think there is a buckle to, for like that very center of it's where the yeah.

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Haitham Hussein: And unfortunately it hasn't changed. We talk about the successes in stroke

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Haitham Hussein: and reducing stroke mortality over the last 50 or 60 years. Remarkable improvement and reducing stroke mortality.

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Haitham Hussein: But there are some failures still.

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Haitham Hussein: one failure is that kind of regional disparity difference, and there are still parts of the country where the stroke mortality is higher.

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Haitham Hussein: And this is the South and the South East like you, said

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Haitham Hussein: and the the other failure is that the gap between men and women

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Haitham Hussein: and between white and non-white, are still there. These gaps have not closed yet. There are some improvements, but still most gains were made by white men, and least gains made by black women.

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Stanton Shanedling: So what's going on? What's going on in this stroke belt? If nothing has really changed.

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Haitham Hussein: what's going on? The overall outcomes improved in general for everybody. But there are these disparities that are still there?

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Haitham Hussein: And I think, part of it is the higher concentration of African Americans in certain parts of the country. And we talked before about the higher incidents of stroken African American community

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Haitham Hussein: and also related to that is the social determinants of health. So, aside from the biology.

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Haitham Hussein: if you correct for the blood pressure and the blood sugar and the cholesterol, and all of that. And you look at social factors like income.

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Haitham Hussein: or where a person lives. or having a steady job

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Haitham Hussein: or is the you know, the food they eat, and the and how secure the food is, and how healthy the food is, and the education education.

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Haitham Hussein: and these are independent predictors of stroke.

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Haitham Hussein: And so if you fix all the medical biological predictors

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Haitham Hussein: just being African American increases your risk for stroke.

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Haitham Hussein: or just having that

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Haitham Hussein: few education years versus you know, higher education increases your risk for stroke, or having that yearly income increases your risk for stroke.

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Haitham Hussein: And so and that hasn't changed in the significantly in the strong belt. Well, that's everywhere. Actually.

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Haitham Hussein: yeah, yeah, there are studies that gathered data from all over the country. Social determinants of health are very powerful. We just didn't know how to study them in the past. And now we're figuring out ways to identify them and study them. And we're we're shocked

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Haitham Hussein: by how impactful they are, how predictor they are, you know, in terms of predicting stroke.

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Haitham Hussein: And so you know, they have to do with access to care. They have to do that quality, even with the primary care provided is different.

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Haitham Hussein: You know, when we compare our patients with stroke here in Minnesota

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who have diabetes.

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Haitham Hussein: and we look at how well diabetes was controlled before stroke.

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Haitham Hussein: which we can find out using a blood test called hemoglobin, a one C, correct. So look at the hemoglobin, a. One C for stroke patients and compared

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Haitham Hussein: white and non-white.

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Haitham Hussein: Okay, white patients will have high a one C. Not a target. So 7.5, or we always aim for less than 7.

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Haitham Hussein: But then you look at the none white, and you will find that their ill and C is 10.

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Haitham Hussein: What in the cases of the month we just published? 13.

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Haitham Hussein: Wow! And these are people who have known diabetes and have been on a diabetes medication.

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Haitham Hussein: But then their diabetes control wasn't good. and there is a big difference between having primary care and having adequate

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Haitham Hussein: good prime

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Haitham Hussein: correct. You can go in and out of the office and

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Haitham Hussein: in 10 min and get a prescription and then done. you know, and just didn't learn anything. You didn't understand what you're supposed to do. No one really engaged with you and your family and shared

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Haitham Hussein: with you what they're worried about, what what you can do to get to where you need to be.

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Haitham Hussein: So that adequate primary care is also a factor.

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Haitham Hussein: And it's it's also tied to the social determinants of health. And our

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Haitham Hussein: African, American

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Haitham Hussein: community. You know, our friends, I don't think they get as good

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clarence jones: primary care as white people say that community is always complaining.

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clarence jones: You know what I mean, and it's like, you know, but II think now that the research is coming up. There are reasons why there is such a discrepancy. And there are reasons why we have such a a a monetary impact negatively monetary impact in terms of health. And so I'm glad for the conversation that we're having.

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clarence jones: because I think that number one, it's not accusing anybody of anything it is about. It's about taking a look at statistically, what's going on? And yeah. And I like the whole idea about the adequate primary care is that it is so important for us to understand that many times people don't get that. I th. What what really came to my mind was this, as you were talking, doctor, what's the fact that in my thirties

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clarence jones: I went to a clinic

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clarence jones: and they gave give me a checkup, of course, and they said, Oh, you you you pre-diabetic.

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clarence jones: that's all he said to me.

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clarence jones: I had no idea. Yeah, I was about 30. Okay, so you know. And I didn't think about it like I think about it now.

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clarence jones: But I'm saying like, if that's that's your your, your, your procedure or your protocol. There's something wrong with that which is one of the reasons why we try so very hard to say and ask these questions and say, How do we make this conversation so that it's bi-directional, so that people can really understand how they enter into this. And so I really appreciate the fact of what you have said today, and how you said it, because

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clarence jones: I think that we will. You definitely use this particular for me. I'm definitely use this particular program as a way to further inform my community. That's a lot of great things.

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Stanton Shanedling: So let me, you know. Hyphen, Clarence and I did a health chatter show on trust.

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Haitham Hussein: You know, and

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Stanton Shanedling: what really one of the major themes that came out of that is, it's important to have a trusted

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Stanton Shanedling: provider of care that you connect with and have access to them

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Stanton Shanedling: in order for us to at least start addressing some of these things

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Stanton Shanedling: in as as a team effort between you, the patient and you, your physician. And if you have trust, it really really helps. Today's environment

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Stanton Shanedling: is a lot

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Stanton Shanedling: different. You know, it's like some some people see a different doctor every time they go in for for care, and so that that level of trust is never really quite

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Stanton Shanedling: built up, which I think personally, I think, is an important thing in a message that we all we all can do. So here's a here's the the other aspect of trust, of stroke that I want to address, and that's rehabilitation. So alright. So we talked about a queue treatment. We talked about prevention. Now let's say, somebody has had a stroke, and they're fortunate enough to have lived through it. But they've been affected.

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Stanton Shanedling: Buy it okay, one way or the other. Okay, so let's talk a little bit about

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Stanton Shanedling: Rehabilitation.

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Haitham Hussein: Okay? Well, before we talk about rehabilitation, can I just make a comment about trust?

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Stanton Shanedling: Absolutely.

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Haitham Hussein:  we

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Haitham Hussein: I have a patient, a friend of mine who

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Haitham Hussein: our relationship started when he was a patient

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Haitham Hussein: and I'm sure he.

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Haitham Hussein: will listen to the podcast and

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Haitham Hussein: and the smile, you know, remembering what happened between us. So is an African American man.

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Haitham Hussein: yeah, pro professional. Well, to do came to one of our hospitals with stroke symptoms. Fortunately the stroke symptoms subsided very quickly.

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Haitham Hussein: and he was admitted to the hospital. and he had an MRI which did show that there was a stroke which is an important thing. Sometimes stroke symptoms would go away within a day.

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Haitham Hussein: But when we get an MRI we see evidence of damage to the brain, a small stroke.

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Haitham Hussein: and they were just lucky that they recovered quickly from it. and that is actually of a higher risk of having another stroke than someone with trans and symptoms, and we get an MRI, and we don't see stroke

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Haitham Hussein: but

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Haitham Hussein: we also saw that he has severe blockage of one of the big arteries inside the head.

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Haitham Hussein: The blockage is caused by a condition called hardening of the arteries or atherosclerosis, and this 70% blocked artery. And so this is a situation where the risk of stroke is even highest.

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Haitham Hussein: People with this condition have something like 8 or 9% risk of recurrence in the first 30 days and

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Haitham Hussein: 23% risk of recurrence in a year.

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Haitham Hussein: That is just terribly high compared to other types of stroke.

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Haitham Hussein: And so our stroke team wanted to meet with him and talk to him about this. And for because of the glitch, the there are 2 teams that in charge of the patient is a hospitalist kind of the primary, and then there is a consulting team generology.

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Haitham Hussein: and the patient was discharged before we went to see him.

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Haitham Hussein: We had given recommendations for the for the hospitalist over the phone.

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Haitham Hussein: and then when we realized that he left before we saw him, we felt so bad because we really wanted to show the pictures and explain the seriousness of the situation. All of that so we called him. It was not me on call on service. One of my colleagues, so he called that patient.

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Haitham Hussein: and he got upset. and he refused to come back.

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Haitham Hussein: And then he told me later that I was thinking in my mind. Oh, they let me go because I'm black. They didn't care. I had the 70% block to arch, and they just let me go. And now they're calling me to tell me to come back. I'm not coming back.

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Haitham Hussein: and and I brought him to the clinic, you know, a day later or something, and he sat down and we talked, and I think the fact that I'm brown, and my last name is Hussein made it made him order

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receptive.

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Haitham Hussein: and I explained the situation, and he and I became good friends, and now he and I want to go and give talks to the African American to share his experience and explain cause. He was doing everything right.

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Haitham Hussein: He had a primary doctor.

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Haitham Hussein: But the quality of that care wasn't to go is blood pressure was borderline high. It was not treated. He had 3 diabetes. He had the, you know, all these things that you know. Had he? Who knows but

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Haitham Hussein: I was aware of, but hearing it from the person

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Haitham Hussein: who is living that environment, that life

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Haitham Hussein: and hearing what he was thinking.

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Haitham Hussein: And then he we asked him to give us lectures here at the Department of Neurology, at the University of Minnesota.

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Haitham Hussein: So he came and he talked to us and our trainees. He told us there, there's this history that you cannot just think, ignore, you cannot ignore.

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Haitham Hussein: And he advised us to just address the elephant in the room, and just acknowledge

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Haitham Hussein: that I know what happened to you and the African Americans. And the second thing you you have to do is to commit.

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Haitham Hussein: I am going to be your doctor, and I will take care of you. Exactly. You are my responsibility. I'll take care of you.

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Haitham Hussein: And with these 2 things you can build a trust, build the rapport. You have to acknowledge what happened, because the what happened is, you know, to

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Haitham Hussein: long history doesn't go away, and it's in the conversations, and you know, with between the family members, you know, from the time when he was a little kid, seeing you know how his aunts and uncles and family, and got sick, and how they got treated. And

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Haitham Hussein: you know what he told me one time. Just tell me that you gonna give me the stuff that you give the white guy.

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clarence jones: I think so many times about the fact that

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clarence jones: which is conditioned sometimes to do a certain things. Example. We were talking about the fact that you know, nurses and doctor still talk to black people don't experience paying the way white people do.

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clarence jones: you know, I mean, like, that's crazy. But but it is what we have to do, and that's one of the reasons why I held chatter is that we can get into these non political areas and say what we need to say. And hopefully, people are hearing this. And so you know, again, like I said before, I really appreciate what you have done today, because it will be a a it'd be one of my highly recommended shows for people to come in and to listen.

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clarence jones: And we would love to have you and and that gentleman come out to our communities.

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clarence jones: Talk about that, be on the show, or even be on health chat. Or

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Haitham Hussein: first thing we gotta do is make sure that we have a stroke prevention plan.

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Haitham Hussein: You don't want another stroke to happen.

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Haitham Hussein: There you go. Yeah. And the stroke prevention plan depends on the reason why the stroke happened. In the first place.

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Haitham Hussein: Okay, so the stroke doctor always has to understand the stroke mechanism and then the stroke prevention plan is dependent on that understanding.

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Haitham Hussein: Okay, so that's one thing we don't want people as they recover to have, and then, rehab historically, has been focused on the physical recovery.

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Haitham Hussein: Yeah. And the idea is that if you have weakness of the arm, then you do physical therapy and occupational therapy to restore the strength of the arm and the use of the hand, and and all of that, and speech therapy, if need be, right right? And then there's speech therapy for the difficulty with swallowing, which is commonly affected after as well as difficulty with

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Haitham Hussein: communication speaking can. There's a slurring of the speech that happens often, and there's also the difficulty with expression.

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Haitham Hussein: that symptom that we call aphasia.

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Haitham Hussein: Someone has an idea in his mind. How can it be translated into words, or being able to understand, or being able to read and write? And so that's, you know, for speech therapy to work on

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Haitham Hussein: but the other aspects of rehab that we

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Haitham Hussein: are getting more and more aware of

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Haitham Hussein: is the psychological aspect and the cognitive aspect.

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Haitham Hussein: Okay? And and and these, you know, unfortunately, have not been attended to in the medical literature as much so the tools to measure them, and the ways to improve them after stroke are not as mature as in the physical rehabilitation side of things.

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Haitham Hussein: But you know people have different degrees of impairment after stroke. And you know, we we do an assessment, and we see where the difficulties are. And then we tailor a rehab program for each one. Some people need to do only occupational therapy if they have loss of dexterity of the hand.

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Haitham Hussein: but they don't need speech, therapy or data, and some people need only speech. Therapy is the only problem is language. Many times people will need 2 or all 3 of these types of who coordinates all of this. So so let's just say, let's play it out. Let's say I've had a stroke, and I've been affected one way or the other.

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Stanton Shanedling: Does it start with you as a as my neurologist? And then then the team expands, based on need, or how how is it coordinated so that it becomes relatively easy for the patient to move forward.

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Haitham Hussein: Most commonly patients are in the hospital, and it's a requirement. It's an expectation that any stroke person gets evaluated by rehab physical therapy speech, therapy occupation therapy. Yeah. And each of them has to do an assessment. If there is an impairment, how bad the impairment is, and then a plan.

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Haitham Hussein: how many sessions, how many weeks or months usually when there is a physical component people tend to go to a rehab facility.

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Haitham Hussein: There are 2 different levels of rehabilitation. There is acute and sub acute or acute rehab is for people who are able to do 3 h of therapy a day. So it's kind of an intensive type of therapy.

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Haitham Hussein: And then the sub I queued rehab, or what we call transitional care unit tcu is for those who cannot do 3 h elderly or something like that. And then the people, after stroke, after they discharge from the hospital they go to a half facility for a few weeks, until they kind of re recover more of their function, and then there is a discharge plan, then to home.

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Haitham Hussein: and then there is an assessment of the home environment, the home situation. And if there isn't any adjustment need to be made.

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Haitham Hussein: Say, for example, someone cannot walk upstairs. Maybe they can have the bedroom in the main floor, or some some changes like that, and making sure that there aren't anything to trip someone walking or stuff this kind of assessment, and then they go home. Some people don't have that much impairment after stroke to require going to rehab facility.

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Haitham Hussein: Then these do outpatient therapies. They go home, and every other day they go to physical therapy sessions in the clinic or in the in the rehab center.

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Haitham Hussein: So

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Stanton Shanedling: overall.

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Stanton Shanedling: I think what's important for our listening audience, everyone to know is this.

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Stanton Shanedling: there is good

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Stanton Shanedling: stroke care available

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Stanton Shanedling: to all of us. Okay.

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Stanton Shanedling: 9, 1. One is

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Stanton Shanedling: something that has to be in everybody's minds, and don't be afraid to use it. There are good prevention oriented things, as especially if you're if you, by virtue of your family, are perhaps at higher risk. But all of us can can still exercise, eat right, watch our weight, watch our blood pressure.

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Stanton Shanedling: etc.

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Stanton Shanedling: And then, unfortunately, if you, if you know if someone or yourself that has had a stroke. it's not the end of the world. Okay, if you've lived through it, there are good rehabilitation facilities that can help you

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Stanton Shanedling: get back to a normal

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Stanton Shanedling: life.

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Stanton Shanedling:  this. This show has been

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Stanton Shanedling: very, very, very good. Clarence, last last comment.

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clarence jones: I was just writing into the chat box. Thank you. I think, as I said 2, 2, 3 times. This has really been a very interesting thought, provoking program. And I just want to appreciate you and to thank you for your work, but also thank you for your offer of of helping the communities to become healthier.

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Stanton Shanedling: You are, you're and you're excellent at at providing clear

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Stanton Shanedling: and

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Stanton Shanedling: concise information about this subject, and that's what

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Stanton Shanedling: how chatter is all about. So hyphen. Thank you. You're you're a great, great back.

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Haitham Hussein: Thank you very much, Stan and Clarence, and I want to leave with a message of hope

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Haitham Hussein: that we have treatments for stroke, and and if you end up with a stroke, the recovery is there, and it happens it takes time. But it happens to everyone. Everyone gets better. And there are ways that we can help you get even better.

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Haitham Hussein: And just they stay hopeful, and they continue every day the the consistency and watching what to eat.

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Haitham Hussein: So everybody in our in our listening audience, thanks for listening in today.

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Stanton Shanedling: like we tell all of our guests. Hyphen, we reserve the the right to give you a call back, or if you have other reasons to use health chatter as a venue to get some more messaging up. Please please contact us so to everybody out there listening. Audience, keep health

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Stanton Shanedling: chatting away.