Med Center expert offers 'Stroke 101' to local seniors

By CONNIE JO DISCOE

Regional Editor

Lacing his medical advice with a little dose of humor -- "Your genes are just bad!" and, "I highly recommend the dark chocolate" -- a stroke specialist from Omaha told McCook seniors the grave facts regarding strokes, their prevention and treatment.

Pierre Fayad, M.D. -- a professor and chairman of the University of Nebraska Medical Center Department of Neurological Sciences in Omaha -- presented what he called, "Everything You Wanted to Know about Stroke, But were Afraid to Ask," or "Stroke 101," to McCook's 55Plus group of seniors gathered Thursday morning at Community Hospital of McCook.

Damage to the brain

Stroke -- the result of damage to the brain -- is the leading cause of disability among adults, and the third leading cause of death in adults behind heart disease and cancer.

Americans suffer 700,000 strokes a year -- 500,000 of those are first-timers. There is one stroke every 45 seconds, Dr. Fayad said, and 2.4 million stroke survivors.

Survival and recovery are dependent upon treatment within three hours of the onset of symptoms, Dr. Fayad said.

Symptoms

Symptoms are sudden, and most are painless, Dr. Fayad said -- sudden weakness and numbness, speech difficulties, loss of vision and/or balance and, with a hemorrhagic stroke, "the worst headache of your life." Dr. Fayad encouraged people to come quickly to the hospital if they suspect a stroke, although a woman in the audience told him, "I don't want to call 911 if I've just slept on my arm wrong."

Dr. Fayad told her, "It's more common to have a stroke than to sleep on your arm wrong."

Dr. Fayad explained that 85 percent of strokes are "ischemic strokes," caused by a blood clot(s) and a lack of blood flow to the brain. Fifteen percent of strokes are "hemorrhagic strokes," caused by blood rushing out of a broken blood vessel and bleeding inside the brain structure.

An excruciating headache is associated with a stroke in which an aneurysm (a weakened place in a blood vessel) has ruptured and is causing bleeding into the brain. "It's not mistakable. It's the worst headache of your life," Dr. Fayad said.

No pain

"Most strokes do not have headaches," Dr. Fayad said." Most strokes are not painful. And that's unfortunate, because, if it's not painful, you have a tendency to think, "Wait it out, and see'."

Ischemic stroke is caused by a lack of blood flow, Dr. Fayad said, in which a clot(s) plugs the flow of blood to the brain area. "An area of the brain dies off and loses its function. Some areas die within minutes of the blockage," he said.

Treatment

The brain area can be restored to functionality if treatment is administered quickly enough, Dr. Fayad said.

An MRI at the hospital will reveal the blocked blood vessel, damage and/or the damaged area and/or an area at risk of dying.

"The bottom line is, a stroke is an emergency," Dr. Fayad said. "The more time it takes to get to the emergency room, the less effective the treatment will be." The limit is three hours, he said. "That's a very demanding time limit, but it can be done."

Dr. Fayad said that blood flow can be restored if a clot is broken up with medication within three hours of an ischemic stroke.

A relatively-new clot retrieval procedure -- in which a clot is dragged out of a blood vessel in the brain by an instrument inserted in the groin -- is another option that can be performed, within eight hours, he said.

Quick response

"Now, this is obviously something you don't want to do at home," Dr. Fayad said, dryly, with a smile. "Time is of the essence. The more time it takes you to get to the hospital, the more brain is lost."

Dr. Fayad said he is very enthusiastic about all that can be done in the area of stroke treatment, rehabilitation and dealing with the deficits caused by stroke.

"But we can't reverse a lot of what's happened," he admitted. "The hopeful message here," he said, "is that the best treatment for stroke is prevention."

Risk factors

Stroke's main risk factors are:

* Hypertension. "Eighty percent of strokes are attributed to hypertension," Dr. Fayad said.

* Heart disease.

* Atrial fibrillation.

* High cholesterol.

* Diabetes.

* Carotid artery stenosis.

* A history of prior stroke or "mini" stroke.

A "mini" stroke is as dangerous as a full-blown stroke, according to Dr. Fayad. Characterized by weakness and/or loss of speech or vision that can last a few seconds, a few minutes or even a few hours, the symptoms of a mini stroke goes away. "That provides a false reassurance," Dr. Fayad said.

"The opposite is true."

A mini stroke is a warning, he said, to seek immediate help, to prevent a major stroke.

Behaviors, lifestyles

Certain behaviors can lead to stroke, Dr. Fayad said, and include smoking, excessive alcohol use and inactivity.

The good news is that stopping smoking reverses the risk of stroke, Dr. Fayad said.

Reducing alcohol consumption to one to two drinks a day lessens the risk of stroke, he said, actually to a level lower than those who do not drink at all.

Even modest activity daily reduces the risk of stroke, Dr. Fayad said.

Certain things "you can't do anything about," Dr. Fayad said, including age (after 55 the risk of stroke doubles with each decade), gender (women tend to get their stroke on average ten years later than men do, but more women die of stroke than men), race (African-Americans are at the greatest risk of stroke and dying from it than any other race) and heredity.

A man in the audience told Dr. Fayad that he was unable to reduce his cholesterol level lower than 200, regardless of improved eating habits, exercise and eliminating salt. "Sometimes you're not responsible for your condition," Dr. Fayad said. "Your genes are bad. Don't feel guilty."

He continued, "Thank God for medications," that complement diet and exercise.

High blood pressure

Eighty percent of all strokes are blamed on high blood pressure. Normal blood pressure is 120/80. "Hypertension" is characterized by any blood pressure reading above 130/85.

"Focus on the top number," Dr. Fayad said. "You do not want it above 120."

"Hypertension is poorly managed," the doctor said, and added that there is no excuse for it.

Good medications are available, he said, and changes/alterations can be made in risky lifestyles.

The levels of optimum cholesterol levels keep going down every year, Dr. Fayad said. Cholesterol levels should be below 200, he said; bad cholesterol below 100; and in people known to be at-risk, below 75.

Dr. Fayad said about smoking, another risk factor of stroke -- "There's is nothing better than to get rid of it."

There's little or no excuse for inactivity either, Dr. Fayad maintains.

"You need only moderate activity to prevent stroke," he said. "All that is required is brisk walking for one hour a day, six days a week."

Dr. Fayad said -- to the grins and giggles of several in the audience -- "A couple drinks a day is reasonable. A couple drinks a day should be good enough."

Dr. Fayad also said that dark chocolate -- although without added sugars -- can lower blood pressure. "Dark chocolate is helpful in preventing stroke," he said, grinned and added, "I highly recommend it, by the way."

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Dr. Fayad's stop in McCook was part of a series of talks in Western Nebraska, in Scottsbluff and North Platte. In McCook, he spoke to health professionals and then to 55 Plus members.

A press release from UNMC explains the center's stroke center:

OMAHA -- UNMC's hospital partner, The Nebraska Medical Center, has been recognized by the American Heart Association and the American Stroke Association for leading the nation in following evidence-based guidelines for treating patients with stroke.

The Nebraska Medical Center is the only hospital in the state to receive the Annual Performance Achievement award for stroke care -- a distinction given by the American Heart Association/American Stroke Association's Get With the Guidelines SM program.

The stroke center at The Nebraska Medical Center was the state's first and is Omaha's only, nationally certified stroke center dedicated to the prevention and management of stroke. The stroke center has received the "Gold Seal of Approval" from the Joint Commission on Accreditation of

Healthcare Organizations for the past three years.

Prior to coming to UNMC in 2001, Dr. Fayad served on the Yale

University faculty for 10 years. A native of Lebanon, Dr. Fayad can write

and speak fluently in four languages. He earned his medical degree from the

University of Rome in 1983, then completed his internship and neurology

residency training at the State University of New York at Buffalo.

Since joining UNMC, Dr. Fayad has built a new department and

recruited neurology specialists. He has built programs that greatly

enhanced the capabilities of UNMC and The Nebraska Medical Center to help

patients suffering from strokes, seizures, muscle and nerve disorders,

brain cancer and degenerative disorders of the brain such as Alzheimer's,

Parkinson's and dementia.

"The brain used to be a mystery," Dr. Fayad said. "However, over the

past two decades, there have been a tremendous number of advances made,

especially with respect to imaging techniques and treatments for brain

diseases. Nebraska is the fourth leading state in terms of the age of its

population. Since many neurological diseases are associated with older age,

it's important that we provide Omaha, Nebraska and the surrounding area

with state-of-the-art neurological care that is unsurpassed in the rest of

the country."

Stroke is the third leading cause of death behind heart disease and

cancer. "It can dramatically affect our existence," Dr. Fayad said. "With a

stroke, time lost is brain lost. Many people don't understand how bad a

stroke can be until it hits someone in their family. Strokes can be deadly

and disabling and have a major societal impact on those who suffer from

it."

An active researcher, Dr. Fayad has over the years participated in

more than 25 funded research projects, including some through the National

Institutes of Health. He brought to UNMC two major trials for stroke

prevention, including one that is the largest-ever international trial for

stroke prevention.

He has written more than 70 book chapters and articles, including

some in most highly respected peer-reviewed medical journals like the New

England Journal of Medicine and given numerous lectures, abstract and

research presentations at scientific meetings nationally and

internationally.

Among his extra mural appointments, Dr. Fayad is a fellow of the

American Heart Association and on the board of directors of the Heartland

Affiliate of the American Heart Association.

UNMC is the only public health science center in the state. Its

educational programs are responsible for training more health professionals

practicing in Nebraska than any other institution. Through their commitment

to education, research, patient care and outreach, UNMC and its hospital

partner, The Nebraska Medical Center, have established themselves as one of

the country's leading centers in cancer, transplantation biology,

bioterrorism preparedness, neurodegenerative diseases, cardiovascular

diseases, genetics, biomedical technology and ophthalmology. UNMC's

research funding from external sources now exceeds $80 million annually

and has resulted in the creation of more than 2,400 highly skilled jobs in

the state. UNMC's physician practice group, UNMC Physicians, includes 513

physicians in 50 specialties and subspecialties who practice primarily in

The Nebraska Medical Center. For more information, go to UNMC's Web site at www.unmc.edu.