Most strokes are preventable – here’s how

0:00There's meaning in every treatment journey, through each challenge, important decision and moment of hope. Hearing from others on treatment may help inspire you. To hear from people on Infancy Treatment, visit infancystories.com. Infancy, Der Value Mab, is approved to be used with chemotherapy medicines, gem-cyte bean and cisplatin before surgery and alone after surgery to treat muscle invasive bladder cancer. Infancy can cause your immune system to attack normal organs at any time during or after treatment. This may be severe in lead to death. See your doctor right away if you have cough, shortness of breath, chest pain, diarrhea, severe stomach pain, severe nausea or vomiting, changes in appetite, thirst, urine or weight, constipation, dizziness or fainting, headaches, eye problems, confusion, memory problems, irregular heartbeat, extreme tiredness, muscle pain or weakness, fever, rash, chills, itching or flushing. There may be other side effects. Tell your doctor about all of your medical conditions, including immune or nervous system

1:04problems, such as Crohn's, ulcerative colitis, lupus or myosthenia grovis, orgyon baracin drum, an organ tissue or stem cell transplant, chest radiation or treatment for an infection. Infancy can harm your unborn baby. Please see full important safety information and full prescribing information, including patient information at mfancy.com or call 1-800-236-9933. This is Health Matters, a podcast for Mayo Clinic where we discuss the latest medical advice, news and research to help you live a happier and healthier life. My name is Kristen Meinser, I'm a writer and journalist, and this episode we're talking about how to prevent strokes. Strokes might seem like they happen suddenly, but the risk factors can actually build up over years. In fact, some sources estimate that 80% of strokes could be prevented.

2:09So what can you do today to lower your risk of having a stroke further down the line? From managing blood pressure to everyday lifestyle changes, there are small steps you can take now to support your brain and body. This episode we're joined by Dr. David Miller, a radiologist and stroke expert at Mayo Clinic in Jacksonville, Florida. He's going to walk us through all the how-tos of healthy habits and managing medical conditions to keep our brains healthy for years to come. Dr. David Miller, welcome to the show. Thanks for having me. We are so thrilled to have you here today to talk about stroke prevention. We love telling us how we can be more responsible and more empowered when it comes to our health

3:10and we know that you're just the person for this topic. So thank you for being here. Thanks for having me. Stroke is something that I am passionate about and as much as I get excited about treating strokes on much happier if we don't get to that point. We all are. So we've already talked about strokes on this show, but in case anyone needs a refresher, can you please explain what a stroke is and the difference between the two types? So stroke is basically a lack of blood flow or a disruption of blood flow in the brain. There are different thoughts about the origins of this, but people say the word came from the Middle Ages when people would suddenly keel over or suddenly become paralyzed on one side and people would speak of it as if they were struck by the hand of God. I think to take away from that is that stroke can happen anywhere and it can happen quite suddenly. So there are two main types of stroke. The majority of strokes involve a blockage of the blood flow as it's going to the brain

4:11and those blockages can come from different sources, but basically we call that an eschemic stroke or a stroke due to lack of blood flow. That counts for about 80 or 85% of strokes that we see. The other strokes are what we call hemorrhagic strokes and they come from bleeding in the brain or along the surface of the brain and those generally either involve aneurysms, which are weak spots in the arteries that can sometimes tear or trauma or abnormal blood vessels that suddenly give way and bleed in the brain. So 85% of strokes involve blockages of blood flow to the brain and the other 15% involve bleeding either in the brain or around the surface of the brain. So what factors contribute to stroke risk? Number one is smoking. Number two is probably high blood pressure. Number three is probably smoking and number four is probably high blood pressure. Those are two things that I think are by far the most important things to concentrate on. There are other important things that the blood sugar is another one and blood cholesterol.

5:14So those are probably the four areas that you think about most when you think about controlling factors for a stroke. Just to clarify real quick, when it comes to smoking is it just because of the nicotine or is smoking itself harmful, smoking anything? It's not just nicotine. There's tar, there's particulate matter and that stuff is also present in almost anything that you put in in smoke. So there's toxic chemicals in the smoke itself that longs and harm the lining of arteries. So smoking anything is a problem even if it's something other than cigarettes. So I would say smoking is definitely in the category of modifiable. This is something we have control over. But the other things, maybe there's a little bit more of a blurry area when it comes to blood pressure or other aspects of our health which may be partly genetic or would you say we definitely have control over those things? You can't control everything, but there are lots of things that you can do. Smoking is when you can definitely control to some extent.

6:14Importantly, I think the biggest time when you can control that is before you start smoking. Nicotine is an tremendously addictive substance. There are studies that show that you can get lab rats to do things for nicotine that they won't do for opioids. But certainly smoking is probably the most controllable of these. I would say the blood sugar and the blood cholesterol are the least controllable. Not that they aren't controllable, but they do have something to do with genetics. Maybe the best way to approach that without making it what can I do? This is going to do that. There's a small thing that the American Heart Association puts out called Know Your Numbers. I think that's the perfect place to start. Because like any other problem, you really need to know what the problem is. Blood pressure is probably, for me, one of the more scary things because it's not something that you will notice. Many people go around for years with high blood pressure and never knowing that they have high blood pressure. But if you're from a family where you know people in your family have high blood pressure or if you are a heavy person or overweight, African-American people a little bit more commonly have high blood pressure.

7:15So at some point early on, you should tone in on your blood pressure, know what that number is. And that's important because as you just said, you might not even feel any symptoms of high blood pressure. Most people don't for a long period of time. Yeah. In your opinion, how preventable are strokes? In the younger population, strokes are extremely preventable. Because most of the time, they happen from these very controllable factors. Like smoking and diabetes, some of your diets, your exercise. These are all things that you can use to control the things that cause strokes at early age. When we get older, we have some things like abnormal heart rhythms and other things that make it a little bit harder. But the truth is, you can do a lot to control stroke at any age. That's very reassuring. How direct would you say the link is between lifestyle and an actual stroke? Is that something where 50% of strokes you would say have to do with a lifestyle link or is it lower or higher than that?

8:16I would say at least half, if not more, could be prevented with lifestyle. Oh, that's great. Are strokes predictable? Are they something that we can actually see coming or we can say because of these lifestyle factors, there's a certain chance that a person might have a stroke? Certainly, the lifestyle, and as I said, knowing your numbers, those kinds of things, can give you an idea of whether you are at increased risk for stroke. So that's why it's important to know. And at some point, to check in with the doctor, don't get me wrong. It'd be great if everybody could see a doctor every year for a regular checkup and all those other kinds of things. But the truth is, everyone does it. But going to your doctor on a regular basis, be it every year, be it every couple of years, to check those numbers and to check one of the conditions. The other thing is to not ignore the early signs. Those are very sudden things as we talked about. But oftentimes there are warning strokes, we call them TIAs or transgenous schemic attacks. And they often involve a temporary blockage of an artery. The signs can be very subtle.

9:17So sometimes when you get into a situation where you are at risk for stroke and you throw a little clot or something to block an artery, sometimes that's very temporary. You'll suddenly have a garbled speech, but it'll only last for a few seconds. Or for a classically, you'll lose the sight in one of your eyes. One eye, all of a sudden it'll be like a shade that comes down over your eye. Only lasts for a few seconds, sometimes the minute disappears. Those can be warning signs of stroke. So that time the clot went up, that artery got blocked, but it opened up. But the next time it may not. Okay, so that's definitely a time to get medical attention. And there are other things. Let's say you work on the second floor and you occasionally have to go up to an office on the third floor. But the last six months you've been having a little more trouble climbing the stairs. It's a chore to go from the second floor to the third floor. By the end of the day, you're exhausted when you get home. If you didn't sleep well the night before, that's one thing. But if you're noticing it on a regular basis, these are the kinds of changes that you look back six months later when you have a heart problem or a stroke.

10:18And you say, geez, this has been coming on. So pay attention to your body. Not everything's a problem, but not everything's nothing. Does that mean strokes can actually be avoided if someone is paying close attention and taking proper measures to modify their risk? Absolutely. The warning sign that I mentioned with the loss of vision in your eye, that's a very common and very specific sign that suggests that you have blockages in the carotid artery, which is one of the arteries in the neck that brings blood up to the brain. So if you get a clot that forms in the carotid artery, it will lodge in that artery to your eye. Very often I will find patients who come in with strokes. And when we look to get history, they say, well, yeah, you know, I had that thing with my eye that you're talking about about a month ago by thinking about it. Wow. Didn't do anything about it. Because it only lasted a few seconds, you said. Because it only lasted a few seconds, didn't seem like much. Oh, okay. But you know, if you think that there's something that happened that's not right, you should go find out.

11:18Call your doctor, ask them. Because the truth is we see people all the time that come in with strokes that have had a history of a little thing that they thought about, but they didn't pay much attention to. And if they had, we could have stopped it. But it's easy enough for me to tell you, yeah, that's probably nothing. Or let's just check this out and then go on your way. And I'd much rather be wrong 90 times to not miss the one time that we were right and you were having a problem. Absolutely. How much would you say people tend to underestimate their risk for stroke? I think it depends on people, but I think a lot. Because as I said, the warning signs of stroke are often fairly subtle. People are busy and you don't really want to think that anything's wrong. And you have to make time to then go check that out. And the next thing you know, it's a week or two weeks and you haven't checked into the things that bothered you. So it's very easy to minimize what happens. The internet's not a bad place to check some of that thing. If you think there's something wrong, Google it. Not everything on the internet's right, but there's enough good information there that

12:19you could get an idea if you really don't want to talk to somebody, put in your symptom. Let's see what it says. The male clinic website is a great place to start. And that's a good point. If you're going to look on the internet, you probably should look American Heart Association, the Merit Stroke Association, one of the major medical centers. A lot of places that have a lot of research behind it have good websites that they can give you good advice. I imagine that some people underestimate their risk for stroke also because it might just seem like, oh, that's something that happens to people who are a hundred years old. And stroke doesn't just happen to people who are a hundred years old. And it seems to be happening a little bit younger and younger age. It's actually, yeah. No, I've treated people with stroke who are in their 90s and older, but I've also treated people with stroke who are in their 20s and people who are otherwise healthy leading otherwise healthy lives.

13:20The two biggest risk factors for stroke are smoking and high blood pressure. After that, blood sugar and blood cholesterol are also significant. Some of these we can control and some we can't, or at least not as much. Smoking is the easiest to control, but blood sugar and blood cholesterol are the hardest. That's why it's important to see your doctor regularly. They can help make sure you're managing these factors. Strokes can also have warning signs. Oftentimes they'll be preceded by a mini stroke called a transient ischemic attack. One of these might look like garbled speech or loss of vision in one eye that lasts only a few seconds. Another warning sign is finding physical activity more difficult than usual. Remember, it's much better to see your doctor and have them tell you it's nothing than to find out it was a problem after the fact. So we know we can control our stroke risk, but how exactly do we do it?

14:26Let's go deeper into specific actions we can all take. Well, let's get to the good part here. Let's talk about lifestyle prevention. What are, in your opinion, the top three lifestyle changes? People can adopt right now to decrease their stroke risk. Well, diet would be one. It's not as hard as it sounds. You can make a huge decrease in your risk of stroke with diet. There's lots of good foods out there that aren't high in the bad things that cause arteries to harden and stroke risk to increase. What kinds of good foods? I think some people out there might be like, are you saying everyone has to be a vegan? Do they need to adopt a macrobiotic diet? Should they be going gluten free? Some folks out there might be understandably confused about what actually is the right kind of diet when there are so many voices yelling. It's this one. It's this one. You're right. There are fad diets and they come and go.

15:26There are a couple of diets that seem to have stood the test of time. The Mediterranean diet seems to have been proven in different studies to be a good diet for most people to follow. It emphasizes fruits and vegetables. It emphasizes whole grains, which are grains that have the husk, whole wheat bread, brown rice instead of white rice kind of things. Fresh lean meats, less red meat, don't have to go zero red meat, but less red meat, more fish and more garden. You don't have to be totally vegan, but yes salads and non-meat should be a large part of the diet. The other diet that seems to have stood the test of time, especially in patients with high blood pressure, is the dash diet. It emphasizes low salts. It also emphasizes fruits and vegetables and more whole grains and more whole foods. The other thing, you can really get fairly simple. If you look at this and say, okay, if it comes in a bright colored bag and it sits on a shelf, it may not be the first thing that you can grab. Be that candy or a potato chips or whatever. You can get a pretty sweet snack from a grape or an orange or a banana.

16:31Most things have a lot more of the vitamins and nutrients that you need. While they do have sugars, they have a lot less of the processed sugars and fats that draws a lot of the problems. That is a great suggestion. If it's in a bright colored bag, probably not going to be the healthiest thing for stroke prevention. All right, so diet. That's your number one recommendation for decreasing stroke risk. What are two others? So number two would be exercise. Now do you need to run a marathon? God, I hope not. The answer is you certainly do not. You don't have to be a track star. You don't have to be in the gym every day to get the heart benefits and the stroke risk benefits of exercise. Walking will do the trick. Moderate walking. Don't have to race walking. You don't have to jog. You do have to keep moving. You don't have to move every day. The recommendations are for 150 minutes a week.

17:32That's two hours in a week of moderate walking or maybe half that time in sort of risk walking. But that too can seem daunting. When somebody starts telling me that the minutes I need to do are in the hundreds. Certainly at the beginning, that's hard for a lot of people to imagine. You don't have to. 15 minutes of walking. 15 minutes in the morning. 15 minutes in the afternoon. It's a great way to start. Walk with a friend. Walk with your spouse. Walk your dog. You don't have to walk fast. Get out and walk twice a day. At least three or four of the days of the week. If you can do that, you'll notice a huge difference. You'll also notice that you'll be able to increase your time as you do it more often. The way I do it sometimes, especially when I get home late and I don't really want to walk, I just concentrate on heading in one direction for 10 minutes. Once you get there, the other has taken care of it because you've got to come back. I love that. It reminds me of a recommendation I heard from somebody else at one point. If you're listening to music, walk over there for three songs.

18:35By the time those three songs are up, 10 minutes will pass and then turn around and go back after three songs. That sounds so manageable. We can all do that, right? Exactly. You don't have to be a professional athlete to get the benefits. You can walk. You can ride your bike. Any form of exercise that you like to do. If you're one of those people who can't leave their TV long enough to do that, fine. Walk around the room where your TV is. Whatever it takes to do to keep you moving for 15, 20 minutes a day will make a huge difference in your stroke risk. Now we've talked about diet. We've talked about exercise. What would be your third top recommendation for a lifestyle change that would decrease our stroke risk? Number three would probably be sleep. Oh, okay. Most of us have a bed. Most of us have a pillow. We can do this, right? That's right. But it is interesting. I think in the last five or 10 years, maybe we've come to recognize more and more the effect that the lack of sleep has on our health. There's tremendous regenerative powers of sleeping and getting good nights rest.

19:37And life gets busier and busier and it's fairly easy to cheat the sleep to catch up with those friends you haven't caught up with or make sure that the work thing is done in time. But if we cheat ourselves with sleep and has tremendous effects on our cardiovascular system memory and a lot of other systems, what would you say is the ideal amount of sleep? And should that also include afternoon naps? The experts are divided on all this. But there are many who say eight hours is sort of necessary in the minimum. I think that's difficult for a lot of people. I think at least six to seven hours of uninterrupted sleep, good sleep is probably where you need to shoot for. If you want to decrease your risk of heart disease and stroke. Naps are actually a great thing for a lot of people. Most people immediately say, okay, my work does not allow me to do that. And if it doesn't, it doesn't. And an afternoon nap shouldn't be used to say, okay, if I take the afternoon nap, I can then stay up till 2 a.m. Let's go back to blood pressure for a moment because earlier you were talking about knowing

20:38your numbers, you were talking about high blood pressure. How would you recommend people go about lowering their blood pressure as well as maybe lowering other numbers that might be concerning for stroke like cholesterol and so on? Diet becomes the number one arrow in the quiver there. Both cholesterol and blood pressure are very closely tied to diet. Blood pressure particularly with the amount of salt in your diet and with body mass. So if you're overweight and you're eating a lot of salt in your diet, your blood pressure is going to be higher. There are some things with genes that you can't do anything about. But the genetic redifosition for blood pressure is something that you can do something about because between diet and exercise, which will naturally lower your blood pressure, we have a lot of blood pressure medications. While I'm not a huge pill fan, the truth is that medications for blood pressure are not only prudent, they're life saving. And they should be used when necessary to keep your numbers in the range that you're looking for. Would you say that's also true when it comes to managing diabetes?

21:42You alluded to a link between diabetes and stroke earlier. Absolutely. And both of those things, if you can get the changes that you need with diet great, but don't spend a lot of time trying to chase that with just diet to stay away from medications. It's more important that the numbers get where they need to be and as quickly as possible. Now you already mentioned the fact that smoking can be a contributor to stroke. What about alcohol? The answer is yes it can. When I was younger, they always said that a glass of wine was good for your heart. I think more studies have shown over time that alcohol just isn't good for you or your heart. But again, that doesn't mean you shouldn't ever have a drink. If you enjoy a glass of wine, I think that's not unreasonable to go ahead and have one occasionally. What do you mean by occasionally? That varies a bit. I would say that's maybe one drink, maybe two drinks a week, no more than that. Godhead. Let's talk about mental health. How does mental health affect stroke risk? It also is, I think, underappreciated stress is a very negative influence on your heart

22:47health and on your vessels. We find more cholesterol deposition. We find higher blood pressure. We find a lack of sleep with anxiety and all that goes with the stress. On any front, your mental health is this strong pillar of decreasing your stroke risk. You don't have to be the happiest person in the world and you don't have to necessarily undergo psychoanalysis to get everything in order. I think that we would all benefit a little bit by just concentrating on the things that are positive in our lives and with our relationships. Those are the things we tend to take for granted. Many of us, myself sometimes included, I tend to concentrate more on the things that are problems and the things that are difficult, rather than the things that I can appreciate. In addition to gratitude mindset, have you found any other stress-reducing strategies that have helped your patients? There was an article that came out not too long ago that suggested that one of the significant predictors of longevity was dancing. The reason seemed to be that dancing provided two very important pillars.

23:50It gave you exercise and it also gave you a socialization, need a partner usually and you have a group and you have music, all of which are strong influencers of mental health. You move and you interact with people and you get your endorphins increased. Things seems to be perhaps one of those things that can be strongly associated with decreased stroke risk and longevity. A great stress-reducer and a great time and the social aspect, that's interesting. Can you speak a little bit more to that and how social isolation might be a contributing factor when it comes to stroke? There's a lot of evidence that suggests that people who do not have a lot of social contact, there's depression. Also, you basically don't use your brain as much. Those memory, things like reasoning, etc. suffer from this. But also, most people who do not have strong social connections seem to have more problems with cholesterol, black stroke. That's so interesting. I didn't really think about how social connections exercise our brains as far as conversation

24:55when it comes to paying close attention and absorbing what's around you. Of course, our brains are going to be way more active when other people are there. You see this, particularly, as our population ages, more and more people are in retired. Actually, since the pandemic, lots of people don't go to work every day, especially with social media and things where you can connect by computer or through your phone. You don't actually have to interact with people nearly as much as you used to. My father lives in the small town and he's ended to stay in the house for many years. After my mother passed away, he was by himself. He seemed to be having more difficulty with memory, with naming, with these kinds of things. His exercise tolerance seemed to be a bit less. At about age 86 or 87, he went into an assisted living facility. It wasn't very happy about it. Within about six months, he was doing much better. His exercise routine was back in swing. His memory was sharper. It was all due to the fact that he had people to talk to every day. He had to go to breakfast to interact.

25:56He ran into old friends that he hadn't seen for 20 or 30 years. He did so much better just simply because of the social interaction. What a fantastic story. My dream is to someday live in a senior living facility where I can socialize every day, where I can challenge my brain either because I'm playing ma jong or because there's a dance class or whatnot. It's great to know that's not just great for lifting the spirits. It's genuinely good for our health. Diet can make a big difference in your stroke risk. There's no one diet that you need to follow for stroke prevention, but we have good research to support the Mediterranean diet and the dash diet. Some of the things these two diets have in common are lots of whole foods, whole grains,

26:57fruits and vegetables, and lean protein. Exercise also plays an important role. Even moderate walking 15 to 20 minutes a day is enough to decrease your stroke risk. But any exercise you enjoy should do the trick. Sleep is the number three factor to focus on. Eight hours is the standard recommendation, but if that's a challenge, try to get at least six to seven hours of quality sleep. These lifestyle factors can help with managing blood pressure, blood cholesterol and diabetes. But if lifestyle alone isn't cutting it, you can also look into medications to get your numbers where they need to be. You can also consider limiting your alcohol consumption, finding ways to reduce stress, and making space for regular social interaction in your life. Maybe it's time to sign up for that dance class. So that's lifestyle, but many of us have medical conditions that contribute to our stroke

27:59risk as well. Let's learn more about how to manage those. Now we talked a little bit about medication earlier in terms of diabetes, in terms of cholesterol. What other role can medication play in lowering or controlling stroke risk? Basically, so many of the things that are good for your heart are also good for decreasing your stroke risk. The major one is control of your cholesterol and your lipids. When you go and get your blood tested, you sort of get what's called a high density lipoprogenia and HDL, which is sort of the good cholesterol and an LDL, which is sort of the bad cholesterol. The difference there really is that the HDL tends to grab the cholesterol that's floating around in your blood and take it to your kidneys and get excreted. If your cholesterol hangs on to the low density, proteins tend to circulate around longer in your blood and has a higher chance to get deposited in your arteries. So you're trying to increase your HDL and decrease your LDL.

29:01Dying in exercise can do some of that. Statin medications have been the mainstay of cholesterol lowering medications. So statin medications are an important part of decreasing your stroke risk as well as your risk of heart attack. Now if someone is concerned about their stroke risk, how should they be measuring these numbers you've talked about, the cholesterol, the blood pressures, this is something they can just do at home or would you recommend they just make regular doctor's visits? Well, the blood pressure can be done at home. You can get your own blood pressure cuff. Truth is though, if you don't have a blood pressure cuff or you can't figure out how to use one of your local fire station as blood pressure cuff. You can stop by your local fire station and they'll tell you your blood pressure. So blood pressure I think can be measured at home and in their arranges. We used to say that when people got older, it was okay to have a blood pressure a little higher and that doesn't seem to be the case at actuality. It seems like for everybody, if you can keep the number at least under 130 and ideally under 120 in your top number, we'll call your systolic number and below 90 in your lower

30:04number or your diastolic number. If you find that your number is significantly higher than that, then something you should get sooner rather than later. Speak to a physician and get new other numbers checked and then do the things that you need to do to get that under control. Got it. Cholesterol requires blood tests. It'll need to be done all the time. But I really think once you get to be in your 50s and 60s, if they're normal, maybe I should be checked every couple of years. If they're abnormal at all, then they should be checked maybe every six months or so until you get them under control. Got it. What is atrial fibrillation? This is a term I've heard before. How does that play in distro grisk? Atrial fibrillation is a huge stroke risk. It's a common problem and it increases as you get older. Atrial fibrillation refers to a mismatch of the pumping of your heart. The heart is a lot like those old ramen ships you see in the old movies where there's a guy up there with a drum that's gone boom and the guys are rowing. Boom, boom.

31:04It's always moving, which is what's really important. The problem with atrial fibrillation is that you have a little set of nerves that run down the middle of your heart. For whatever reason, sometimes those nerves get out of whack. When they do, you lose the rhythm. Now all of a sudden, when you're trying to pump blood, sometimes the blood doesn't go anywhere. It swirls around and stuck there. At all the time in there where there's lots of blood that's not going anywhere and clocks will form. The heart kicks back into regular rhythm at times. When it does that, all the clocks that are formed, they get pumped out. Who should be screened for atrial fibrillation? Is that something that everyone should be tested for or just certain populations? Mostly as you get older, probably 10 to 15% of people in their 80s have atrial fibrillation. A lot of times people in atrial fibrillation and they don't recognize it. You don't necessarily feel it. You know, and then people will feel your heart going pitter-patter. If you suddenly feel like your heart's racing and then you feel your wrist and it's going

32:08130 and then all of a sudden it's not, then you need to worry a little bit that you may have atrial fibrillation. Most people who are younger don't. But again, it's not a difficult thing for me to do at EKG and see that your heart is regular and not. But if you think that there might be an irregular heartbeat somewhere, the consequences of not finding that can be a stroke. Earlier you mentioned the importance of getting enough sleep, getting quality sleep. How does sleep apnea then affect stroke risk? Sleep apnea is also a significant risk for stroke. When you stop pulling an air, your heart gets stressed and your blood pressure increases because you're stressing it for air. You don't realize it because you're asleep, but your body realizes it and it doesn't like it and it doesn't react well. So it disturbs the quality of sleep and also puts stress on your heart all night long because you're not getting the oxygen that you need. And again, for many people, they don't recognize it. The symptoms are going to be snoring.

33:10Without snoring, they're going to be waking up in the morning saying you didn't get a satisfying night's sleep. So you end up waking up tired. Your wife says, I'm sleeping in the other room because it doesn't snoring anymore. And at that point you should think about talking to somebody about that. All right. Should people take aspirin a redade to prevent stroke? The astral question. You knew what was coming. Yeah. So aspirin is one of those things that people have divided opinions on. Certainly if you're a patient who has had heart problems or if you've had TIAs or strokes in the past, I'm a big fan of aspirin. How much aspirin nobody's really sure. A baby aspirin is probably enough for most people. But I like the idea of an aspirin in older patients over 50 or 60 if they have no other contrary indications for aspirin because I think it has a little bit of anti-inflammatory effect and it has a little bit of blood-thending effect. Now you have to be a little careful with that because patients who are on other medications

34:13to thin their blood or patients who have kidney problems, there are other things that increase the risk of taking aspirin. But I would caution anyone before starting on a regular aspirin every day to have a discussion with your physician and make sure there's no good reason for you not to hang one. Absolutely. That should be the case with all medications. That's a good time. Talk to the doctor first to see if there's any interaction issues if you actually need the drug or not. While we've been talking about preventing strokes today, it's also really important to get swift care during a suspected stroke. So to close, can you give us a brief rundown on how one might be able to identify a stroke, any symptoms that should prompt people to seek immediate care? How they can even know is this a stroke or is there something else that could be related to a stroke? Some things in medicine are difficult for people who aren't medically trained to recognize and to make a difference. That's not the case with stroke. Anyone can recognize a stroke. It's fairly easy. If you think about this, there are 800,000 strokes every year.

35:17So it's not that uncommon that someone around you or where you are may be having a stroke. So we use it and I'll write them what you call be fast. Be stands for balance. E stands for eyes. F stands for face. A stands for arm. S stands for speech. And T stands for time. The easy thing to remember is that people are fairly symmetric. If you look at someone's face, one half of the face looks pretty much the same as the other. People have two arms. Both arms sort of work the same. Both legs work the same. People who are having strokes are symmetric. Someone is sitting next to you at a restaurant and they stand up to walk away and suddenly they fall down and you realize that they fell down because they're not moving and they try to get up in the right side, it's not moving. That's not normal. You look at them and you look at their face and they try to talk to you and one side of the face moves up and the other does not. That's problem. With a few questions, you can pretty much decide whether or not this is worrisome enough

36:20that you should call for help. So ask them their name. Ask them where they are. Ask them to put both of their hands out in front of them. Ask them to smile for you. They should be able to do all of this easily and they should be able to do it symmetrically. If you ask them to smile and only one side comes up, that's a problem. If you ask them to stick out their tongue and they can't do it, that's a problem. If you ask them their name and they can't tell you, there's something wrong. If it's not a stroke, it's something else. You don't have to figure out what it is. All you need to recognize is that this is not right. If you can recognize that this is not right, then you need to call 911. If we do decide something is not right, is it better to call an ambulance or drive them to the hospital? Do you grab them into your throne in a car? The answer is no. Sometimes it seems like that might be better because you call and nobody comes and you call and nobody comes. But it doesn't take as long as you think for EMS people to get there. There's lots of things that we can do in the field right away to help patients.

37:25Even though you think you might be helping by throwing somebody in the back of a car and driving to the hospital more than likely, you'll lose time to getting things started than if you call the ambulance people to come see them there. Because they will recognize the stroke right away and they will call. Most of our stroke centers and most stroke centers have mechanisms in place to fix these things. But everything has to get moving. While that person is being evaluated in the field and put in the ambulance and brought in, we have people who are coming in from home or people who are setting up rooms or people who are clearing scanners so that everything is in place when the patient shows up in the emergency room. So that time is actually saved by doing that. So if you're not sure, call 911. And this all applies also when it's just me by myself if it's happening also. Absolutely. If you're reading the menu and suddenly you can't read half the menu. If you're using your fork and suddenly you're dropping the fork or you're unable to corral the noodles.

38:26And again, most of us will tell you that we're very happy to tell 10 people that no, you're not having a stroke rather than miss one person who doesn't come because it's probably nothing. That's so great. Dr. Miller, this has been such a great conversation today. Thank you so much for all of the advice for folks out there who want to prevent stroke. And I think it's going to empower a lot of listeners to feel like, oh, yeah, there are things I can do. And again, you don't have to do it all and it doesn't have to be perfect to make a difference. Well, Dr. Miller, we really appreciate it. Thank you. Thank you for having me. To manage your stroke risk, keep an eye on your blood pressure and blood cholesterol. And if these numbers aren't in range, your doctor can advise you on what combination of lifestyle changes and medication are best to get you back on track as soon as possible.

39:31Your doctor can also advise you on whether you should be screened for other medical conditions that contribute to stroke risk, such as atrial fibrillation or sleep apnea. And if you think someone may be having a stroke, remember the acronym B fast. Once eyes face, arm, speech and time. And it's usually best to call an ambulance rather than drive them to the hospital yourself. There's so much we can do now to treat strokes, but the best treatment is to not have a stroke in the first place. So start small, step by step. You might be amazed by where you end up. Okay, that's all for this episode. But if you've got a question, a topic suggestion, or a follow-up question about this episode, you can leave us a voice mail at 507-538-6272. We might even feature your voice on the show. For more health matters episodes and resources, head to mailclinic.org slash health matters.

40:37And if you found this show helpful, please subscribe and make sure to rate and review us in your podcast app. It really does help others find the show. Thanks for listening. And until next time, take care and stay healthy.