Jun 10, 2015

Interviewer: Somebody you know or love is having a stroke, you need to call 9-1-1 immediately. We'll tell you exactly why, coming up next on The Scope.

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Interviewer: Dr. Jennifer Majersik is the director of the University of Utah Stroke Center and a stroke specialist. And this is the message that I hear you say all the time, "If you think you or somebody you know is having a stroke, call 9-1-1 immediately." Why is it so important that you call 9-1-1 so immediately?

Treating a Stroke

Dr. Majersik: Yes, this is the heart of what I do is to try to get patients to understand just how important it is. In this country, there are about 800,000 strokes a year. And about 650,000 of them are ischemic strokes, maybe a few more, and only maybe 5% of them get acute treatment for stroke. The other 95% do not. And the vast majority do not because they do not get to the hospital fast enough. So we have two major types of treatment now that we can give quickly. One is intravenous, so via an IV, as it's usually called, it's a medicine called TPA and we can give that out to about three hours, sometimes four and a half hours.

Interviewer: And it makes a huge difference in the person's life afterwards.

Dr. Majersik: Yeah, it reduces disability, it makes patients walk again, talk again, go back to their lives, work, play, etc., all the things that are important. Some of the patients who are having a really severe stroke, so the kind that will land you in a nursing home if it doesn't get better or perhaps hurt you to the point of not surviving, those strokes we now have very effective treatment for as well.

2014 and '15 were landmark years for new trials that came out showing the efficacy, so the ability to work, for large-artery strokes, so these are the big ones. Nowadays we have physicians who are known as neuro-interventionalists and they can take a catheter and go into your leg and go on up to the brain and be able to pull clot out and, again, give you back that function so that the stroke is no longer affecting you like it was.

Emergency Treatment for a Stroke

Interviewer: So it seems like a no-brainer, bad pun not intended but it just kind of came out. Why don't people call 9-1-1 after a stroke then?

Dr. Majersik: They are afraid. Some people think that the ambulance will come, will embarrass them. They don't want their neighbors knowing about it. To that fear, I usually say, "Call 9-1-1 anyway, it doesn't matter what the neighbors think, and if you're really that concerned, tell them to not run their sirens and nobody will know."

Interviewer: And this is stuff actual people have told you after they've come in for stroke that blows my mind.

Dr. Majersik: Absolutely people tell me that. Also, there's been studies on it, people-- we've asked, "Why didn't you call 9-1-1 or why wouldn't you call 9-1-1 in this situation?" And these are the kinds of things people tell us. So they're afraid of embarrassment. They're also afraid of being wrong, so what if I'm not actually having a stroke, I'm whatever, having a migraine or Bell's Palsy. And I think it's really hard as a layperson, and sometimes even as a physician, to sort those out. And so I don't think it's worth the risk. I think our lives are too important to be worrying about those kinds of fears. And I think we should do the best thing, which is to call 9-1-1 and get to the hospital and let the professionals sort it out.

Symptoms of a Stroke

And then the last thing. But it's just that people don't even recognize that they're having a stroke. Which we've talked about before, but again goes back to recognizing the signs and symptoms of a stroke.

Interviewer: And sometimes it's not like a heart attack where somebody grabs their head like, "Oh, I'm having a stroke," it's a very quiet thing with very subtle signs that I think all of us, as humans, should know because time is brain.

FAST Stroke

Dr. Majersik: Right. So the stroke patient doesn't call out, they don't say they're in pain, they just lose function. So the function that they lose could be vision, or it could be arm strength, or face strength, leg strength, sensory, or balance, or speech. I almost forgot speech, the most important one, perhaps.

Interviewer: And the acronym you use is FAST.

Dr. Majersik: Right, so we always use FAST. "F" for face, "A" for arm, "S" for speech. And so if the face is drooping, or the arm won't hold up when you ask someone to hold it up, or speech, if they can't make or understand speech. And all of these should start suddenly. These aren't signs or symptoms that come on slowly, they should come on over just a couple of minutes.

Interviewer: So of all the medical conditions, if you believe that you're having any sort of symptom of a stroke, don't go to the computer and Google and figure it out, don't waste any time whatsoever. The first, and only, thing you should do is dial 9-1-1. And what happens if the person's wrong?

Dr. Majersik: If the person's wrong, they'll come and find out they're having a migraine, perhaps, and hopefully they'll feel better and we'll send them home. Or maybe something else is going on, but I think it's still the most appropriate thing to do. We certainly, on the physician end or the nursing end, we're not upset that you came to the ER. We're not annoyed by extra patients. This is what we do every day and we really enjoy our job. And so whether someone's having a stroke, or if they're not having a stroke I have the joy of telling them, "You're going to be okay."

Interviewer: I guess, you know, we go to the ER for a broken arm, so the repercussions are a lot less worse than the potential repercussions of a stroke, so why would you hesitate?

Dr. Majersik: Right. Absolutely.

Interviewer: What's your takeaway? What's the final thought here?

Dr. Majersik: I think the final thought is that stroke used to be a field that we thought there were no treatments. And I think that still pervades in our communities, that if you're having a stroke just curl up and don't worry about it. But we actually have great treatments now. You just have to get to the hospital fast to receive them.

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