- The human brain is just like a computer that controls our bodies.

It controls our movements, stores our memories, and is the source of thoughts, emotions, and language.

The brain also controls many functions of the body.

So, imagine what could happen if the brain should suffer an attack.

According to the CDC, stroke is a leading cause of death in the United States and a major cause of disability in adults.

On this episode, we'll look closely at strokes, their victims, and the causes and treatments of this devastating brain event.

Welcome to A Su Salud - "Cheers to Good Health".

I'm your host, Genesis Ortega.

We're broadcasting from inside the PPL Public Media Center in Bethlehem, Pennsylvania.

My first guest is Dr. Evan Marlin, a neurosurgeon from St. Luke's University Health Network.

Thank you, Dr. Marlin, for joining us today.

- Thank you for having me.

- Let's start here, what's a stroke?

- So, in a broad definition, a stroke, at least a majority of strokes, are what we call ischemic, or a loss of blood flow to the brain.

And so, often you'll get a blood clot within an artery that blocks flow of blood from the heart to the brain.

And then, with that lack of oxygen, it causes the brain to die.

There are also hemorrhagic strokes, which are a smaller percentage of strokes that we take care of, which are usually spontaneous bleeding within the brain or the brain spaces.

- What's the prevalence of non-traumatic strokes?

So, a majority of stroke that we see is non-traumatic.

So, I would say greater than 90%.

Issues can happen after trauma in where you hurt your blood vessels, and those blood vessels can cause strokes either by clots forming and going more downstream to the brain.

But a majority of the strokes that we see are spontaneous diseases.

- So, when we're talking about the spontaneous form of a stroke, what are some of the warning signs?

- So, when we think about ischemic stroke especially, which is probably, like I said, 85% of the strokes that we take care of, the thing that we tend to remind patients and people is that pneumonic "Be FAST".

And "Be FAST" means that you're looking for symptoms regarding balance, your eyes.

So, double vision, blurry vision.

Face symptoms, so droopy face or inability to move your mouth, your arms, so weakness for arms, sorry, weakness or numbness in your arms, speech difficulty, and then, time.

Time is always of the essence.

- Let's talk about risk factors here.

Is there anything that puts people more at risk for getting a stroke?

- Definitely.

So, when it comes to ischemic stroke or diseases of the blood vessels, the biggest risk factors that we worry about are high blood pressure, hypertension, high cholesterol or hyperlipidemia, lack of exercise, diet, obesity.

Those are things that are always going to increase your risk for stroke.

- And then, I'll take it a step further.

I mean, can a stroke be hereditary?

- So, there are definitely predispositions that are probably hereditary.

So, you know, I think there is a predisposition or hereditary link to things like hyperlipidemia or hypertension, which we monitor and treat with medications.

When it comes to hemorrhagic stroke, there are certain groups of people that are at higher risk or genetic risk for hemorrhagic stroke, especially with aneurysms.

And we tend to worry more about that when there are multiple family members with that disease process.

- Now, I have friends, you know, and I know that recovering from a stroke is a long-term process.

But can someone fully recover from a stroke?

And how long does that typically take?

- So, there are different areas of the brain which affect different things.

And a lot of the ability to recover from a stroke is dependent on which part of the brain has been injured.

In general, when we think about the brain or the central nervous system, once that part of the brain has been injured or has died, that is irreversible.

That doesn't necessarily mean that the symptoms are irreversible, the brain is highly plastic and can sometimes navigate some of those injuries and help you compensate.

But the loss of the neurons or the brain cells is irreversible.

- What would be some treatments after someone receives a stroke?

- So, if you have a stroke, the first thing that you should do is, of course, call 911, come to the emergency room.

When you get to the emergency room, you get monitored very carefully and you get evaluated very closely.

The things that we immediately look for when patients come for a stroke is, is there bleeding in the brain?

So, they will get a CAT scan of the brain to rule out any sort of bleeding that is there.

After that, they evaluate you for I.V.

medication, so that I.V.

medication is a medication that we can give you most typically within four-and-a-half hours after your symptoms have started to help start the process of breaking that clot down.

In addition, the other thing we look at are the blood vessels.

So, we get a special CAT scan to look at the blood vessels and make sure that blood is flowing throughout the large vessels of the brain.

Sometimes there is a blood clot in a very large blood vessel, most commonly in the internal carotid artery or your middle cerebral artery, or your entire cerebral artery that's amenable to an endovascular procedure where we go through the arteries in the leg and go all the way up to remove the blood clot from the blood vessel.

By doing that, we restore blood flow to the brain and really decrease the amount of irreversibly-damaged brain and help to improve the symptoms.

And sometimes, it works very well that the symptoms can resolve almost on the table, depending on, again, the location of the clot and how quickly we're able to get to it.

- And, that being said, I can't help but feel like time is of the essence when it comes to treating strokes after someone receives it.

So, let me ask you this, how has Covid really impacted that timeline of when people receive treatment?

- Of course.

So, time is brain.

So, any minute that passes by is really thousands, hundreds of thousands, millions of brain cells that are dying.

So, the sooner you get to the hospital, the sooner we can start treatment and try to help prevent some of that brain loss and cell loss.

Covid has been difficult, especially in the beginning of Covid due to a reluctance of coming to the hospital by patients.

And fortunately, that has largely improved.

But there should never be a hesitancy or a reluctance to come to the hospital, especially because of Covid.

We really take every precaution, both as inpatient and outpatients, and then, in the emergency room to really ensure that we keep everyone safe.

So, the patient, the staff, and the family members.

- How has that relationship with family members been since Covid?

- So, Covid has changed a lot of things about medicine.

And one of the main things that has changed is the interactions that we have with families.

You know, unfortunately, a lot of the times, I meet patients and family members in an emergency.

And so, you know, before Covid, a lot of times, that was a person-to-person conversation.

Unfortunately, at least at the beginning parts of this, that has become more and more something that is unfortunately had to be communicated through the phone.

But, as things have started to improve and we now have visiting hours, and often in times of emergency cases, we're able to talk to people directly more and more.

But there is nothing more important than the family and patient rapport that we form.

And I think that is very important.

And I think we all are trying to do our best to negate the impact that Covid has had on that.

- And earlier, you mentioned and detailed some of the risk factors for a stroke.

So, I'll ask you, can you take a minute here to just talk about what are some steps people can take to prevent a stroke?

- So, one of the major things I'll say is make sure that you're keeping up with routine medical care.

So, seeing your primary care physician, making sure your blood pressure is controlled, your cholesterol is controlled, trying to do exercise physical and aerobic exercise 3-4 times a week at the minimum.

And just general lifestyle care, I think, is very important.

If you have family members that have had a stroke, or family members that have those diseases, it is very important to discuss that with your primary care physician to do as much as you can before you have problems.

- When I think about the brain, I think about its complexitiess before we close out?

- I think one of the most important things I can say is if there was ever a concern or worry that you are having a stroke, you should immediately call 911.

Strokes happen in all ages.

So, whether that means child or adolescents, or adults, and even as you get older, any of the symptoms that are worrisome should be reason for you to reach out and get medical care so we could take care of you as soon as possible.

- Wonderful.

Dr. Marlin, thank you so much for being with us today and sharing your insight.

- Of course.

- My next guest is Abby Silfies, the executive director for the Lehigh Valley and Northeast PA chapter of the American Stroke Association.

Thank you, Abby, for joining us today.

- I'm so glad to be here, thank you for having me.

Abby, let's start here.

What would you say is the mission of the American Stroke Association?

- The mission of the American Stroke Association is to be a relentless force for a world of longer, healthier lives.

We're both the American Heart Association and the American Stroke Association under one umbrella.

And the Stroke Association is a division of the AHA that helps with our efforts to educate people about stroke prevention and treatment.

So, how are you helping patients and caregivers find local support groups?

- So, we actually offer a lot of resources through our organization, through stroke.org.

We also educate via our health systems here locally, and we do a lot of mission campaign work throughout the year where we are trying to highlight the risks and knowledge on stroke prevention.

- And do you have accommodations for Spanish-speaking families, too?

- Absolutely.

- What are those?

- So, through our website, we have everything in both Spanish and English so that it is easily accessible.

We also, through our health systems have bilingual educational materials.

- And you know what?

That's important.

I understand that you have some stats for us about strokes and Hispanic Americans, and the incidence of stroke.

Can you share that with us?

- Yeah, absolutely.

So, it was really interesting when I started to look into this a little more.

High blood pressure is a leading cause of stroke.

And what I was finding, as I was doing some research, is that half of Hispanic men suffer from high blood pressure.

And about 42% of Hispanic women also suffer from high blood pressure.

So, that being the leading cause of stroke, those strokes are incredibly common right now amongst the Hispanic-American population.

It does project that in the next decade, about 29% more stroke cases will be relevant.

- 29% is pretty significant, I would say.

Is there any research or anything in the works right now to mitigate that?

- So, yes, the American Stroke and American Heart Association is working on a campaign called Together to End Stroke.

And so nationally, we're doing a lot of fundraising that is targeting the research and the educational resources towards stroke prevention in that area.

- What about advocacy?

Is there anything that your organization is doing on the federal or state levels for legislation?

- So, we are, and there is a lot of information about that.

And we would need much longer than this interview to get into that.

However, at stroke.org, our website, there's always an advocacy link on there, and you can see all the works that are happening right here in Pennsylvania and Harrisburg, but also nationally.

- Can you give us some accomplishments or a highlight or two on what you guys have accomplished?

- Oh, absolutely.

And, you know, it's interesting because stroke is something coming right off of Stroke Month in May.

We've been talking a lot about stroke being the number-five killer in the United States, and the number-two killer globally.

And so, as we have been talking about that, we've been talking about the resources that we have available on stroke.org, but we're also talking a lot about accomplishments.

And I'm not sure if you're familiar with FAST?

And FAST is our "how to spot a stroke" campaign.

And this has been nationally recognized, and is something that we're really working on continuing to push this year.

FAST is, to give everybody a quick, brief overview, "Face drooping, arm weakness, slurred speech, "and time to call 911."

This has become something that we're working on in communities.

It's something that we're teaching in schools, and it's something that we're really proud of as an organization, that it's really provided a lot of resource.

- Can you tell us about the Stroke Family Warmline?

- Absolutely.

So, the Stroke Family Warmline connects stroke survivors and their families with the American Stroke Association for support and resources.

So, it's a really easy way for families to get connected with us.

- What about Stroke Heroes?

What's that about?

- So, Stroke Heroes is a really incredible program, as well.

It allows us to highlight people's stories and use them in both a mission and an awareness capacity.

We have been able to highlight some really incredible stories from both Lehigh and Berks counties over the last couple of years.

And Stroke Heroes is a way that we're able to do that.

- On the website, on the American Stroke Association website, people are encouraged to get involved.

Can you share with us some of the ways they can do that?

- Yeah, so we have multiple ways.

Our Heart Walk or Heart Challenge program that happens in the fall also has elements of stroke with it.

And I think that that's something that maybe people aren't aware, that the American Stroke Association and American Heart Association are one and the same.

And so, we always have some stroke activities, resources, advocacy work that is happening at our local heart walks.

And so, we strongly encourage people that want to get those materials, to be involved, to volunteer, that our heart walk in the fall is a great place to do it.

And we're also expanding our stroke awareness through our Go Red for Women campaign.

And this year, we're telling ten stories of care, which we're highlighting ten caregivers, and three of those caregivers are caregivers of stroke survivors.

And so we're talking with a daughter, a mother, and a wife of stroke victims.

And so, there's a lot of education and awareness that is being spread throughout that campaign.

And our luncheon this year on June 23 is virtual and free for all to attend.

And you can hear those stories.

- We have about a minute left, but Abby, I'll end with this.

What is the biggest point you want to hit home with people when it comes to the work that you do with the American Stroke Association?

- I want to say use us as a resource.

I think that so many people aren't aware of the information that is right at your fingertips by visiting stroke or heart.org.

We just have a plethora of educational resources there and connection points.

So, use us as that resource.

That's why we're here in our community.

- Wonderful.

Thank you so much, Abby, for joining us today.

I appreciate your time.

- Absolutely.

Thank you for having me.

- My next guests are Mike and Sue Racine.

Mike suffered two strokes during the summer of 2019.

They're here today to tell us about his remarkable journey towards recovery and regaining his independence.

Thank you both for joining us today.

- You're welcome.

- Let's jump right in.

Can you share a little bit of your story with us?

- Well, let's see, July 26, 2019, Mike suffered his first stroke.

And they were very concerned with why all his blood counts were low, everything was very low.

And just to jump forward a little bit, he suffered another stroke August 8th.

And what we did find out was that he has hairy cell leukemia, and he also has anti-phospholipid antibody syndrome.

That's a mouthful.

And what that is, is a clotting disorder.

And that, with the cancer, just was like this perfect storm that caused his strokes.

He was hospitalized for three months.

Well, hospitalized for a month until they got all that under control, he had some cancer treatments, then he went into acute rehab, and then, he went to Subacute.

And now, he's at Good Shepherd, getting therapy since November of 2019.

And so, we're still going.

He couldn't even sit up.

We couldn't talk, he couldn't walk, he didn't understand anything.

Now he's back fishing again with one special device that we found online.

He's tying flies again.

We have a place in Vermont.

We're going up there and spending time with our family.

So, we're doing a lot of things that we didn't think we would ever do again.

So, he's come quite a long way.

- That's so great to hear, that he's on the road to recovery and that he's doing well to this day.

You know, when he first suffered his strokes, what were some of the symptoms that you saw?

- Well, I would say about a week before, we were on our way to our place in Vermont, and he was telling me he was very tired and asked me to drive.

And here, when we got there, he had a fever and he wasn't feeling well.

So, I took him to an urgent care and hear he had pneumonia.

So some of the signs, I would say, were that he was exhausted, he was tired.

It was partly the cancer that we knew nothing about, hairy call leukemia, which they did tell us it was around for decades.

So, the biggest sign was that he just was not himself.

And there were other things going on in his body besides with the stroke, so... - Understandable.

Now, immediately following the stroke, how did your lives change?

- From being very, very independent, traveling, Mike was extremely active, he's active in Trout Unlimited, chapter in Bethlehem, vice president of that.

He fished all the time, traveled all over, went to New Mexico every year with our son and his friends for a week off the San Juan River.

He did everything around this house.

I have a beautiful home, beautiful yard, that he planted everything, even planted the grass, took care of everything that, you know, and when we would travel, he took care of all the arrangements, and we traveled over through Europe, and we were extremely busy.

He watched the grandkids.

And then, everything came to a screeching halt.

- Wow.

I can't imagine.

I mean, did you find yourself becoming his primary caregiver, or did you have to seek outside help?

- Well, initially, when he first came home, I didn't know what it was going to be like, because at that point, he was still in a wheelchair.

So, I had a hospital bed here at the home.

I had people coming in from some agencies to help me with showering.

He needed help in the bathroom.

He needed help with everything.

And also, he went to therapy five days a week at Good Shepherd, and they were just amazing.

So then, I realized I could do a lot of this on my own, and now it's just me taking care of him.

And now, he's come so far.

He uses the bathroom on his own.

He walks through the house with a walker now, he uses a cane, sometimes, he goes up and down stairs as long as I'm right behind him.

He showers on his own.

He does so much by himself now.

Yesterday, for the first time, he started cleaning up the kitchen for me and putting dishes in the dishwasher.

So, that was a first.

So, he's come to where he...

When he was in the hospital and he was getting the first, the acute rehab, he didn't know how to even push a button to get the nurse, or what a remote control was.

And now, he's talking in sentences.

It's just a very slow process.

And you just see little glimpses of improvement every day, like just a little bit more than he's doing or he's talking, or able to do.

So, it is pretty amazing how far he's come.

And it's not done yet.

- Right.

There's still a little bit of ways to go, but he's cleaning the kitchen.

So, yeah, that's a good step.

- Can't complain about that!

I'm happy about that.

- Now, having gone through this life-changing experience, has your perspective on day-to-day life changed at all?

- Absolutely.

Yeah, I don't take anything for granted.

I wanted to live our lives and I want to travel with him.

We're going to Disney this fall with our daughter and her family.

And we were just down at my mom's, she lives in South Jersey, and she we just celebrated her 90th.

So, I look at life, and I want to do everything we can to have a fulfilling life, and not waste time, and just go do fun things.

You know, the... - I guess that's it.

- Now, you and your husband have been through a long journey, what advice can you offer others going through a similar experience?

- I would say the number one thing, and I guess it would be really hard with Covid.

Well, now I think it's getting a little bit better with that, but to advocate for your loved one.

Because so many times, I think if I wasn't there every day, I was there every day 8-9 hours for three months that he was gone out of the house.

So, there were many times that I would get a doctor or ask a question.

So, you need to be there to advocate for them.

- How important also is it, from a caregiver perspective, how have you done faring through all of this?

- It's been very difficult.

There were times I thought I would just completely fall apart, and I actually did fall apart a few times.

But I got help, I got a counselor, and that helped me get through a lot of things, and a lot of my friends.

I had a friend who brought me meals every, let's see, two times a week for a year.

I can't tell you how wonderful that was.

So, friends and family, and getting counseling helped me tremendously.

Well, I appreciate you sharing your story with us, Sue and Mike Racine, is there anything else you'd like to tell us today?

- No, just live your life.

You can't take anything for granted, and enjoy your life.

And try to do as much as you can while you can.

- I appreciate your time.

Thank you so much both for joining us today.

- You're welcome.

- I want to thank all of our guests for joining us on today's episode.

And thank you for tuning in.

This is our very last episode of the season.

And we hope to come back with a fresh batch of medical topics and content for you in the fall.

In the meantime, if there is a medical subject you'd like for us to cover, send me a message on social media.

You can find me on Facebook, Instagram, and even LinkedIn.

I'd love to hear from you.

Plus, you can tune in to hear more of my reporting on 91.3 FM WLVR News, your local NPR news source, all day, every day.

I'm Genesis Ortega, and from all of us here at Lehigh Valley Public Media, stay safe, be healthy, have a great summer, and cheers to your health.