Episode 7-Dr William Taylor

Send us a text

Episode Transcript

(00:00):
Welcome to Pulse Check,Wisconsin.

Chris (00:24):
What's up.
What's up.
What's up.
How's everybody doing?
Hope you all are doing well.
I hope you are.
Receiving this in good health.
My name is Chris Ford.
I'm an ER doctor here inMilwaukee, Wisconsin.
And I want to thank you for now.
Our seventh episode of PulseCheck Wisconsin.
I want to thank you guys forjoining us today, as well as in

(00:45):
our previous episodes.
Feel free to go back to checkout any of our episodes up until
this point we've had.
Multiple experts come on fromthe Community Medical Services
talking about opioid abuse.
And.
Resources in the community.
We've had our former healthcarecommissioner here in Milwaukee.

(01:07):
Had the governor of course comeout and talk to us.
We recently did an episode inhonor of Sade Robinson, With
some of our Sane nurse expertcolleagues so feel free to go
back to those episodes and checkall of those out.
Today is going to be nodifferent.
We have a great guest with us todiscuss another topic that is

(01:32):
prudent to your health here.
In Wisconsin, as well as in thecity of Milwaukee.
So would that being said nofurther ado let's get started
with our case.
Patient is a 45 year old femalewho was presenting as a level

(01:55):
two trauma after falling downthe stairs.
Report is that the patient wasat home and fell down a number
of stairs.
The patient arrives with familymembers that state that
technically, there are around 12steps at the patient's home.

(02:15):
The patient reports that shedoesn't know if she lost
consciousness She states thatcurrently she has neck and back
pain as well as headache.
The patient baseline is nottaking any anticoagulant
medications.
No history of any other medicalconditions with the exception of
high blood pressure.
No history of any bleeding orclotting disorder examination of

(02:39):
the patient from head to toereveals that she has a hematoma
or a large bruise.
Over the forehead, the patienthas.
some tenderness to palpationalong the cervical spine, which
is the top of the spine.
She has no significanttenderness to the chest wall or

(03:02):
to the abdomen.
The patient has no signs ofdeformity of the upper lower
extremities.
The patient has no significantbruising noted throughout, with
the exception of the forehead.
As such, The patient was takento CT scan.
We ended up getting what'scalled a non contrast CT scan,

(03:25):
which is a picture of the brain.
There's no signs of any bleedingidentified.
The patient also had a CT scanof the cervical spine, which was
performed as well.
The patient does not have anysigns of any broken bones to the
cervical spine at this time.
The patient had a collar inplace, which is what we'll

(03:49):
typically do when a patient hastenderness to palpation over the
bones of the cervical spine.
As such, she was able to haveher cervical spine cleared after
she had a negative CT of thecervical spine.
And so we removed this rigidcollar from her neck.
Patient has some labs performedas well.

(04:10):
During trauma, we usually willperform some labs just to make
sure there's no signs of anybleeding or any clotting
disorders.
Also to make sure there's nosigns of any anemia caused by
bleed or blood loss.
All of her labs were negative aswell.
I had a discussion with thepatient about her results.

(04:32):
I informed her that sheessentially bit a bullet and did
not have any signs of any longlasting trauma.
The patient was relieved as istypical, I asked our nursing
staff if they could ambulate thepatient or walk the patient to
ensure that she's able to do soat home and get around at home

(04:55):
safely as it was a busy day.
We had additional traumas thatwere coming in other patients to
be seen.
And so I asked the nurse toreport back to me if there were
any complications.
After about 15 to 20 minutes ofseeing other patients, the nurse
comes to me and tells me thatunfortunately the patient is

(05:18):
unable to walk.
Thinking along the lines of atrauma still, I asked if she was
having any pain to the hips orany pain to the lower back.
Also, if she had any pain to theextremities, which before did
not show any signs of anydeformity or any trauma, the

(05:39):
nurse reported that when thepatient attempted to get up, she
felt as though she wasincreasingly dizzy.
The patient Reported that shehad felt nauseated right before
this attempt.
And actually had an episode ofemesis or episode of vomiting
when she attempted to get up.

(06:02):
I went back to see the patientas our clinical exam had changed
a bit.
The patient states that shestill feels dizzy.
We gave her some nauseamedication.
I do a reassessment of thepatient at this time.
And the patient is able toprovide a little bit more
history.

(06:22):
She's able to remember thatbefore.
This fall down the steps, sheremembered feeling very dizzy.
She stated that it felt asthough the room was spinning and
that no matter which way shelooked, she had worsening
dizziness.
Given this additionalinformation, I did an expanded

(06:43):
neurological exam for thepatient.
As mentioned before, our nursingstaff noted that the patient
could not get up out of the bed.
However, I did a finger to noseexamination of the patient where
you have the patient place onefinger on the nose.
and extend their hand until theyare able to touch your finger,

(07:04):
which is right in front of them.
This test.
Assesses.
Cerebellar function or theportion of your brain that
allows you to keep your balance.
Unfortunately, this patient wasunable to perform this activity
as well.
In fact, the patient states thatit's hard to keep her eyes open

(07:29):
at this time, given the amountof dizziness that she's
experiencing the decision wasmade to take the patient back to
the CT scanner.
The patient had what's called aCT angiogram performed, which is
a test that we perform to lookfor any signs of stroke patient
did not have any significantsigns of stroke at this time.

(07:51):
As such, we proceeded withadditional imaging after this
initial imaging modality wasnegative.
The patient had an MRI that wasperformed.
The MRI was, in fact, abnormalfor this patient.
In fact, the patient had what wefound out was the eventual

(08:12):
diagnosis, which was a posteriorstroke.
So this case was an interestingcase in that it was two
different presentations wrappedup in one.
It's not atypical that we seethis in emergency medicine, and
it's probably one of the thingsin emergency medicine that I

(08:35):
love the most in that ifsomething isn't fitting, or if
you feel like you need a littlebit more information, the
patients are still in theemergency department at any
point in time, you can go back arapid assessment of the patient
in the moment, as is typical inthe cases of trauma, usually,
especially trauma centers inwhich this case occurred, there

(08:58):
is a very precise way that we goabout trauma assessment in order
to avoid missing any injuriessystem that we utilize is called
ATLS.
Which stands for advanced traumalife support.
And in this, we use guidelinesthat are standardized throughout
the country again, in order toprevent missing any injury

(09:22):
modalities as well as tostandardize our care so that if
you go and receive a traumaassessment in Maine, your trauma
assessment will be the same asit is here in Wisconsin.
So, in this patient's case, shereceived a full trauma
assessment from head to toe.
We do what's called a primaryassessment.

(09:43):
That will determine if there'sany abnormalities in your
breathing or in your circulationor in your airway, all those
things that we call the ABCs ofmedicine.
So, initially, we start out withthe ABCs, which is included in
that primary assessment, and welook out for.

(10:05):
Any injury modalities to theairway to your breathing to make
sure the lungs are functioningadequately as well as to make
sure there's no deficits incirculation.
After that assessment.
We'll take a look at youroverall picture to ensure that
there's no signs of any traumathat we need to address before.

(10:26):
We do any additional workup orany additional imaging in this
case.
And because of that, because wewere focused in on the trauma,
which in this case waswarranted, a lot of times what
will happen is something won'tfit in the patient's general
picture that places you back atsquare one when you ruled out

(10:47):
any significant injuries or anysignificant deficits.
In this patient's case, she hada very insidious presentation of
a stroke, which is one of themore difficult stroke processes
to rule out.
The reason being is these typesof strokes or posterior

(11:09):
circulation ischemic stroke, thereason why that is so difficult
to pick up is because it doesn'tpresent as your typical stroke
that we call a large vesselocclusion stroke, meaning that
one arm or one leg is flaccid oris weak, or in some cases, such
as speech deficits or deficitsin terms of getting the speech

(11:34):
out or having your sentencesmake sense.
All those things are generallypicked up on in those larger
typical strokes that we see.
However, in these cases ofposterior infarcts, a lot of
times, the only deficit that ispicked up is that feeling of

(11:55):
dizziness or that feeling ofunsteadiness when the patient
goes to stand up.
In this case, the nurse reallywas the hero of the patient's
case, which is typically how itgoes as the nurses have a lot
more face time with thepatients.
than physicians.

(12:16):
In this case, the patient didnot manifest her symptoms until
she went to stand up.
Because of that, to this day, Iusually will attempt to ambulate
or attempt to walk a patient asthis was a huge teaching point
for myself as well as some otherresidents that I was working

(12:37):
with at the time.
Posterior strokes differ notonly in the presentation, but
more so the treatment It'sdifficult, to identify on a CT
scan.
A lot of times you have to do anMRI in order to pick this up, as
it's a little bit better atpicking up the posterior
circulation or the blood flow tothe back of the brain.

(12:58):
In many parts of the country,unfortunately, these posterior
strokes are hard to treat, and alot of it has to do with the
lack of technology in some partsof the country.
That allows neurointerventionalists to go in and
to retrieve this clot that iscausing the symptoms or the

(13:21):
deficits to the circulation ofthe posterior portion of the
brain.
However, in the state ofWisconsin.
We're very fortunate to havemultiple neuro
interventionalists that are ableto go in through a vessel.
in lets say your forearm or yourgroin in order to go after these

(13:44):
posterior circulatory infarcts.
And because of that, we're veryfortunate and very grateful for
the work that is able to be.
Performed here in the state inthis patient's case.
They were able to do thisintervention and were able to
retrieve a relatively large clotin the posterior portion of the
brain.
Following this procedure, thepatient had a great outcome.

(14:07):
She was able to ambulate.
She no longer had that nauseaand that ataxia, meaning kind of
falling all over yourself.
She was on, she was notexperiencing any of that.
It was able to return to apre-stroke quality of life
following.
Usually in these cases, thepatients will have follow up and

(14:30):
will also have medications thatthey'll be placed on to avoid
future strokes.
In this patient's case, she wasadmitted to the hospital.
Of course, after the stroke, anadditional workup was done to
determine if she had anydysrhythmias, meaning rhythms of
the heart that could predisposeher to a stroke over time, such

(14:51):
as atrial fibrillation.
She was able to have an echo oran ultrasound of the heart
performed to determine if thereare any valvular abnormalities
or any anatomical abnormalitiesof the heart.
And eventually the patient wasplaced on antiplatelet
medications such as aspirin andplavix over time to again,
prevent a risk for stroke in thefuture.

(15:16):
With that being said.
I wanted to introduce our nextexpert that we've invited out to
interview today.
His name is Dr.
Will Taylor.
Dr.
Will Taylor is.
a neuro hospitalist here inMilwaukee, Wisconsin.
He is a tremendous colleague towork with.

(15:41):
I can't say enough great thingsabout him at any point in time.
Whenever I have a stroke case ora neurological case, Will is
always available to talk it overwith you to come down and assess
the patient and neurologist likehimself, as well as neurologists
such as Dr Borders and also Dr.

(16:02):
George Morris here in Milwaukeeare an invaluable portion of our
interdisciplinary team.
So with that being said, I'mvery excited to introduce Dr.
Will Taylor.
I think we're going to get a lotof good advice from him and hope
you enjoy.

(16:25):
All right, well, thanks again for our listeners.
I apologize.
I got the kindergarten crudd I'mgetting over right now.
So apologies for my voice, butwe're very excited to have our
guest with us here today who isa colleague of mine, Dr.
Will Taylor, before we get intoit.
Will can you give us yourcurrent title and what your role
is?

Will (16:46):
Yeah, I'm Will Taylor.
I'm a neurologist.
I'm technically aneurohospitalist, which is an
inpatient neurologist.
I'm also the medical director ofthe neurosciences service line
for Ascension Wisconsin.

Chris (17:01):
Awesome, my friend.
Thank you so much.
And so just to jump right intoit.
So today's case, We covered arather insidious presentation in
terms of the patient who had aposterior infarct, meaning that,
you know, it's not your typicalyou know, BFAST stroke that
you'll see.
Can you explain what a typicalpresentation is and what folks
should be looking out for to,when to seek care?

Will (17:23):
Yeah, that's a great question, Chris.
So typically what you're goingto look for is, um, the, the,
the term we use in education iscalled FAST face, arm, and neck.
And speech and then time.
So typically you'll see facialdroop, uh, you'll, you'll see
some, some arm or leg weaknessand speech changes.

(17:46):
And that just tells you time,time to get to the hospital as
soon as possible.

Chris (17:51):
Yeah.
And so if someone isexperiencing these symptoms or
their family members areexperiencing these symptoms
would you recommend they call 91 1?

Will (18:01):
Yeah.
Time is brain is the term that,that we talk about all the time
in medicine and stroke.
Every, uh, every minute thatgoes by during a stroke, it's
estimated that around 2 millionneurons die.
So it's a priority to call 911,get your yourself, your loved
one, your anyone around you intothe hospital as soon as possible

(18:24):
to get treatment.

Chris (18:26):
Yeah, and just kind of jumping off of that.
So speaking of the treatment, solet's say the patient does call
911.
They come to the hospital.
Typically, that'll be goingthrough the emergency department
with those stroke symptoms.
What typically will a patientexperience and what typically
will they see during that workupand during sort of that
treatment course?

Will (18:46):
Well, at a comprehensive stroke center like ours at
Columbia, St.
Mary's, Milwaukee, The there'sprotocol set up so that as soon
as the patient hits a triage oreven before the patient comes in
we have set up to where we callit a pre arrival stroke alert if
a patient is called a strokealert in the field and Because
of safety studies and protocolswe found that the fastest way to

(19:10):
get treatment is take thepatient directly from the the,
uh, EMT teased to directly tothe scanner, uh, and there
they'll get some initial imagingto look to see if if a patient
is having a stroke can we seeany signs of it on initial CT
scanning, uh, whether that be anischemic or hemorrhagic stroke.

(19:31):
And then we have a protocolwhere we add in images to look
for clots and changes in bloodflow.

Chris (19:39):
Yeah.
Okay.
And just to specify those clotsthat you're talking about, that
differs from the typical bloodclot that people are thinking
about in the lungs or in thelegs and things like that.
Um, and that kind of gets intowhat a stroke is in general.
And so can you talk about whatthat clot does and what that
clot could potentially havelasting effects on the patient?

Will (20:00):
Yeah, that's, that's a, it's a difficult question to
answer, but it's also a verygood question, but part of it,
that's why I think that's partof the reason why treatment and
stroke has been so difficult andidentifying the right patients
for treatment has been difficultsince we've started with these
quote unquote acute therapies ortherapies that we can give to,
to change the, uh, the, the, thepossible disability and recovery

(20:22):
and stroke, um, back in the inthe nineties we, and that was,
it's a clot busting drug and sobut kind of backtrack.
I'm sorry, back to your questionabout the stroke, but, uh, the,
the clot, it depends on thelocation.
So certain blood vessels aresort of earlier on in the brain
tissue.
And those clots can come fromYou know, maybe another part of

(20:45):
the blood vessel that can flickoff and travel to the brain or
areas of the heart And they cantravel up and they clog one of
those major Highways or bloodvessels if you will you'll have
dramatic changes in the patient.
Those are typically the patientsyou see with really dramatic
speech changes and weakness Oreven unconsciousness and

(21:06):
dizziness, but then it can beeven as small as one of those
tinier arteries closing off overtime from changes that occur
because of uncontrolled riskfactors or, or toxins that we,
we induce into the body thatclose off those small arteries
that cause very minor symptoms.
And so those those, those, thosechanges show up typically as

(21:27):
like maybe some minor sensationchanges or a tingling in the
body and things like that.

Chris (21:33):
Yeah.
And, you know, to, to, to kindof allude to what you were
saying too.
I was watching an episode.
This was probably one of thereasons why I got into emergency
medicine is because my mom and Iused to watch ER full
disclosure.
And so I was watching one of theepisodes, one of the early
episodes, it's like 1991 firstseason.
And in it, Dr Green was one ofthe main characters had a stroke

(21:55):
patient that had just that,that, that large vessel
occlusion.
One side of the body completelyflaccid.
And at the time he wasrecommending to do this
experimental therapy, right?
This T.
P.
A.
That you know, the chief wascompletely opposed to and said,
this is experimental.
Get out of here.
You can't do this.
And he did it.
And the patient had thisrecovery.

(22:15):
We have a lot more sciencebehind it now.
Can you explain kind of whatthose acute therapies are that
T.
P.
A.
TNK as well as alteplase.

Will (22:24):
Yeah.
Oh man.
O.G remember, some days back,uh, that that show is awesome.
Yeah, I remember it did start inthe 90s.
Uh, and that's when we startedto get acute therapies or
treatments that could treatstroke in ways before we, we
never had been able to before,before that, you know we, we
admit patients to the hospitaland it was all about, you know,

(22:44):
rehab and, and trying to figureout what caused it, but sort of
being very powerless.
Then we started to get thesequote unquote clot buster drugs,
TPA thrombolytics.
Alteplase was, was the big onein stroke that was used as a
mainstay for gosh, until, untilrecently at most centers.
So we can only give that in thefirst, four and a half hours,

(23:07):
three to four and a half hoursof symptom onset or a last
known, well, last seen.
Well, so that's why it like asyou alluded to earlier on, it's
so important to get patients tothe hospital.
Recently in the last decade,we've started to expand our
treatments, not just the clotbusting drug, but we've been
able to reintroduce or we'vebeen able to introduce clot

(23:28):
retrieval.
And so that, uh, Has come aboutif you, if you have are familiar
with, with medicine at all, andyou've seen kind of a similar
pattern between cardiology andneurology, but cardiology was
able to make changes andidentify the right patients for
intervention far earlier than wewere in neurology.
And so you know, I'd say around2010, sometime around then there

(23:50):
started to be some, some newclot retrieving or stent
retrieving devices.
The technology improvementoccurred enough to help us.
And then we started to developalgorithms and imaging that
allows us to identify the rightpatients And, and in certain
software that, that says, okay,this is the area that's getting
less blood flow.
So we see clot, then we see sortof what we call a number on a

(24:13):
core infarctive at risk versusdamaged tissue.
And that mismatch we were ableto look at that in the trials
and see these are theappropriate patients for clot
retrieval.
So that can be done up to 24hours, but only in certain
patients.
It can be done longer than that,but, but just in general, we
look at it in the first 24hours, at least in our sites.
So those, those two treatmentshave been sort of the mainstay

(24:35):
now recently artificialintelligence has sort of creeped
in, especially with some of theimaging techniques with the
software we use and identifyingthe right patients.
So it's a very cool time to bein stroke treatment in the acute
treatment world, but, but, uh,an exciting time for patients.
I'd say,

Chris (24:50):
yeah, and a lot of times to well, you know, we work
together personally, we will goin and we'll talk to patients
who are experiencing stroke likesymptoms with some considerable
disability associated.
And so, you know, some of thosewill fall in that pocket of
patients who have the ability tohave that therapy.
We have that conversation withfamily members too, about the

(25:12):
risks and benefits discussed.
about, you know, using some ofthese medications and using some
of these modalities specificallykind of with the clot busting
medications.
Are there any significant riskassociated with it?
And, you know, how, howfrequently are we seeing those
those risks?

Will (25:30):
Yeah, it's unfortunately these treatments aren't without
risks, especially the clot clotbusting drugs.
So we have to be really carefulabout who we choose.
It's about a 3 to 5 percent riskof side effects like bleeding,
including bleeding in the brainthat can be devastating.
And so we have to weigh thoserisks versus benefits.

(25:51):
And there's certain patients wedon't give it the medication to
some patients who have very lowdisability from their stroke.
So, or, or, or even a mimic, wesuggest it's something other
than a stroke.
We try to avoid giving thatmedication.
And even the thrombectomy or theclot retrieval also has risks as
well.
Uh, that can cause tears in theartery that cause even worse

(26:13):
symptoms and worse disability.
So, so unfortunately you're notreally safe in the acute world,
but, but at least there aretreatments that can give you the
chance of the highest level ofchance of recovery.

Chris (26:24):
Exactly.
And, you know, like you said, alot of this, too, is kind of
weighing the risk and benefitsand a lot of, you know, just for
context for folks who aren'tmedical, as we said before, when
it was first introduced in theearly 90s, you know, this is
almost 30 years plus of data andstudies, trials that have been
utilized in order to see whatwould be the risk benefit

(26:45):
associated with patients andwhat patients fall into a bucket
of patients are going to be ahigher risk.
And so this isn't anything kindof knee jerk.
This isn't anythingexperimental.
Uh, this is potentially you knowdebilitation saving therapy for
some patients that we willdefinitely have discussions with
the family as well as thepatient to to decide, you know,
if they want to take that risk.
And and if they want to alsotake the chance of benefiting

(27:08):
from those therapies.
So one of the reasons forstarting the show as we talked
about a little bit on the onsetis to kind of highlight some of
the health care disparities thataffect people
disproportionately.
There was a recent article thatlooked at all that data that we
talked about before, you know,kind of these studies have been
going on for years now, butparticularly during the

(27:28):
pandemic.
There was a study that came outby the CDC that was a stroke
mortality assessment thatoutlined increased mortality on
African American populations ascompared to Caucasian cohorts in
terms of stroke.
What are some of the factorsthat you believe are associated
with, with, this glaring datathat we have from that study?

Will (27:50):
That's a great question.
So I think there's really somekey pieces to that, you know,
race and ethnicity, as you'vealluded to, are key parts of
that socioeconomic status,geography, uh, gender, uh,
education, awareness, and eventies into that insurance status.
So kind of looking at apatient's race and race and
ethnicity, African Americans andHispanic Americans have a higher

(28:12):
incidence of stroke compared towhite Americans.
Um, African Americans inparticular suffer higher
mortality rates and worseoutcomes after a stroke.
Stroke severity tends to be moresevere in current earlier stages
in African Americans andHispanics.
And these groups are alsounfortunately more likely to
have recurrent stroke.
And within the socioeconomicsfactor, you have access to care.

(28:35):
So individuals from lowersocioeconomic backgrounds often
have less access to health careservices, which can delay
diagnosis and treatment ofstroke.
Uh, they have within thatsocioeconomic status, they have
less preventive care.
So economic hardships limitaccess to preventative care and
management of risk factors suchas hypertension, diabetes, uh,
and dyslipidemia.

(28:56):
And then you look at educationawareness.
Unfortunately, stroke signs, um,there's educational disparities
that affect the awareness ofstroke symptoms.
We've seen it and you've seen ithere, you know, within our
center.
Where unfortunately people don'trecognize the stroke symptoms.
They, they tell a family memberto take a nap and maybe it'll go
away.
Um, so that lower awareness canlead to delays in seeking
emergent care, which is crucial

Chris (29:18):
yeah, and you know, like you said, a lot of this too,
throughout the pandemic foradditional context, we not only
saw it in stroke, but we saw itin presentations for, um, MIs or
heart attacks, right?
So folks are coming in daysafter the fact, you know, they
had that initial pain response.
And a lot of that, like yousaid, is due to, A, people

(29:39):
didn't want to go to theemergency department because
that's where all the sick COVIDpatients were.
And then B, also, you know, it'ssome of those, um, pre existing
confounders that play a role inyour overall health.
So things like diabeteshypertension, access to care
access to your medications andprimary care too.
So all those things, you know,kind of play a role in the whole

(29:59):
picture of of your health yourcommunity health as well.

Will (30:03):
And the other thing that breaks my heart on the inpatient
side that you may not see asmuch as insurance status.
You know, that, that impactstreatment and recovery.
Patients without healthinsurance or with inadequate
coverage, they, may not getoptimal care for stroke risk
factors on the outpatient side,but also on the acute side, when
they have delays and gettingdischarged to a rehab center,

(30:25):
because they don't haveapproval.
And as we know in medicine,early rehab is one of the best
things for stroke recovery.

Chris (30:33):
Yeah.
How, you know, and that gets toanother point too.
There was another article, Ibelieve it was in NBC news where
they talked about kind of thatdisparity that you're speaking
of too, not only the initialstroke, but the aftercare.
How much, you know, let's say ifsomeone is not a candidate or is
outside the window for you knowtech to place or all to place
and you know, they, they havethese deficits that are now, the

(30:56):
new normal, unfortunately, howimportant is that post stroke
care that, that rehabilitationin terms of gaining or regaining
some functioning and the qualityof life and going forward.

Will (31:08):
Yeah, absolutely critical.
Absolutely critical.
They have to have good access toearly rehab.
That's kind of the key to toimprovement and recovery.
If you don't get that earlyrehab, there's delay and then
there can be more side effects.
And so getting goodcomprehensive care from, you
know, preventing clots in yourlegs to physical therapy,

(31:29):
occupational therapy, speech,speech therapy.
Getting really good follow up,uh, and speech therapies to make
sure you're not aspirating.
All these are key parts of notjust recovery from stroke, but
prevention of, of some of theside effects that unfortunately
occur because of the stroke.
Yeah.

Chris (31:44):
In our practice here in Milwaukee, do you see kind of a
similar disproportionate strokepresentations to the E.
R.
As well as kind of a postrecovery.
Do you see it in mass as is kindof alluded to in these studies?

Will (32:00):
I see it is an interesting area and and Columbia ST Mary's
Milwaukee because you have thisChange.
You have this big shift betweena very wealthy area on the east
side and then the west, uh, areal change in socioeconomic
status education, awarenessinsurance and coverage and race
and race and ethnicity.

(32:21):
I see Very much similarpresentations, but there's a lot
more.
I'd say patients who who sufferfrom that disparity of care who
are coming in later.
Their, their, their strokes tendto be much younger than, than
uh, the, the high income folks.
I feel like I, in thesepatients, I'm seeing a lot more
uncontrolled risk factors.
I'm seeing a lot more, you know,uncontrolled diabetes,

(32:43):
hypertension, dyslipidemia, andunfortunately also drug use.
Some of the medications likecocaine can can cause strokes if
used repeatedly over time.
Yeah.

Chris (32:54):
And you know, that kind of brings us to our next point
to how do those things play arole?
So like blood pressure, forinstance, diabetes and other
chronic illnesses, how does thatcontribute to your risk over
time?
And does it exponentially putyou in a cohort of patients that
is going to be at higher riskwith stroke?

Will (33:11):
Yeah, the education.
This is such an importantquestion because talking about
these and talking about themuntil I'm blue in the face is
something I like doing becauseas an inpatient as a
neurohospitalist and you, Dr.
Ford, we see the patient whenthe disease is already hit.

Chris (33:29):
Right.

Will (33:30):
And, you know, so much of it, I would love to be able to
change before they get to us,because that's really when when
the magic happens, if you will.
So, uh, control blood pressure.
They, they, uh, every time Italk to patients, I always talk
about blood pressure.
It's, it's high blood pressureis the leading cause of stroke.
Regular monitoring and effectivemanagement of it through diet,
exercise and medications cansignificantly reduce your stroke

(33:53):
risk.
Thank you.
Cholesterol.
So diet and medication highcholesterol can can lead up to
fatty deposits in your arteries,increasing your stroke risk
managing diabetes.
So controlling your, your bloodsugar keeping diabetes under
control is crucial as high sugardamages the blood vessels over
time, making clots more likely.
So regular monitoring andtreatment is essential.

(34:15):
Maintaining a healthy weight.
This kind of ties back into dietexercise, cholesterol,
hypertension.
So the, the, the, the, the dietI talk about with my patients is
the Mediterranean diet.
That, that's really critical.
It's one of the diets that can,can reduce your risk of heart
attack and stroke.
But just being overweightcontributes to other stroke risk
factors such as high bloodpressure and diabetes.

(34:36):
So maintaining a healthy weightis important.
Increasing physical activity.
Regular physical activity cantie into those other risk
factors.
Quitting smoking is extremelyimportant.
Limiting your alcohol intake,especially in a city like
Milwaukee.
And then just treating atrialfibrillation, some heart rhythm
management managing sleep apnea,things like that, and just

(34:58):
getting regular medicalcheckups.
So I, I talked to all mypatients about establishing a
relationship with a primary carephysician that alone, I think,
can, can mitigate a lot of thesebecause then you'll tie back in
and they'll talk about bloodpressure and all the other key
issues and preventing stroke.

Chris (35:13):
Yep.
You know, I think exactly youhit the nail on the head, right?
So, like I said, we see a lot oftimes that initial presentation
where the stroke process iscomplete, you have you know, the
extremists of the presentationor the disease process, but it's
that old adage, right?
That ounce of prevention.
And so it can't express more andmore how important it is to

(35:37):
establish primary care to getthose regular checkups.
Because having a primary doctorreally will tie you into all
those things as Dr.
Taylor alluded to, you know,kind of having, having that
compliance with your medication,especially if you have disease
processes, such as atrialfibrillation, being on
anticoagulants, making sure thatyour heart rate is controlled,
you know, those things, Ibelieve it was Kareem Abdul
Jabbar recently did a PSA onabout atrial fibrillation.

(36:00):
And he talked about, you know,how it increases your risk, you
know, up to 15 fold for havingthings like stroke if it's
uncontrolled.
And so I think kind of drivingthat home for folks is something
that can, can really be keybecause, you know, a lot of
times atrial fibrillation canbe, you know, kind of under the
surface and you're not feelingit and you're just kind of
hanging out and everything isfine until it's not.

Will (36:24):
Absolutely.
Absolutely.
Yeah.
Atrial fibrillation is one ofthose conditions that it's
really critical to get inplugged in with a cardiologist
or an electrophysiologistbecause you get heart remodeling
from that heart failure strokeanother critical condition.
Yeah.

Chris (36:42):
Yeah.
And it kind of brings it back tothe other point to, you know, as
you said, to be with thatglaring disparity.
here in the city of Milwaukee,you kind of have a tale of two
cities.
So we, we got a lot of work todo on our end in terms of trying
to even that plan field for, youknow, the access to primary
care, as well as the ability forfolks to get to their primary
doctors and also afford theirmedication and having insurance

(37:05):
that will cover these, you know,it's all this we got alot of
work to do.

Will (37:11):
It's, it's one of those, you know, Milwaukee, like many
urban areas has significanthealth disparities that I feel
like are just this complexinterplay of all these factors
racial and ethnic disparitiesaccess to health care,
socioeconomic disparities, fooddeserts, you know, um, air
quality and then COVID 19.
You talked about that earlier.

(37:33):
It just, I, I, I think we alsojust highlighted and intensified
existing health disparities inMilwaukee.
Yeah, it's really unfortunate.

Chris (37:41):
Yeah, I gave a lecture at the beginning of the pandemic
to MPS and a lot of parents hadthe, you know, like, how is
COVID causing this?
How it's like COVID didn't causeall these problems.
It's just highlighting it.
It's putting it, you know, onthe podium for everyone to see.
And like you said, it'sunfortunate and some folks are

(38:03):
still experiencing both physicalas well as mental.
Effects from COVID as well as,you know, some of the glaring
disparities that have beenexacerbated because of it.
So We're going to keep pressingon though.
We're going to keep, you knowefforts like this to kind of get
the message out and see if wecan, we can get the folks in
power to, to make a move.
So, one of the things I wantedto touch on was the difference

(38:27):
between what, what folkscommonly call a mini stroke.
What is the difference betweenthat mini stroke and sort of
that fulminant stroke, thestroke when you're having that
large vessel occlusion, one sideof your body numb, unable to
speak, et cetera.
How do those two differ and arethey related at all?

Will (38:44):
Yes, that is an excellent question.
Uh, so when people talk about amini stroke, they're typically
talking about a transientischemic attack or maybe just
even just a minor stroke.
So it's important.
They all tie into each other.
I think that's definitelycritical in that once you have a
stroke, your highest risk ofanother stroke is within the

(39:04):
first couple of weeks from thatstroke.
That's another reason why, evenif you had a mini stroke, he's
still got to get treatment.
And get the right medications.
So let's just break down acouple of terms.
So transient ischemic attack.
What that means is that thepatient has had symptoms, but
less than 24 hours and there'sno evidence of damage on on

(39:25):
neuroimaging and theneuroimaging I'm talking about
is, is, is MRI.
So there's no so basically apatient will have some very
brief, Beach changes or briefvision loss or brief you know
weakness in their body andthat'll go away completely,
complete resolution.
It's still extremely importantto treat those.
Like I said, because once youhave a TIA transient ischemic

(39:48):
attack, or even ischemic stroke,a full stroke, your highest risk
of recurrent stroke is withinthose first couple of weeks.
So then you've got your TIA ortransiting ischemic attack.
Then the more severe version ofthat is sort of maybe a mini
stroke.
And that can be sort of a verysmall stroke within the brain
that occurs.
It's in a small territory, uh,that affects just very isolated

(40:09):
symptoms.
Maybe just simply.
Your facial weakness.
And then all the way to you knowlarger stroke, those can be
things that were, it blocks oneof those major arteries as we
talked about earlier on thatcontrols a vast amount of brain
territory.
And the, those strokes can beabsolutely debilitating.
And even there's a danger ofdeath with those, unfortunately.

(40:31):
So those can.
And cause patients tounfortunately require 24 hour
care, feeding tube, things likethat.

Chris (40:39):
So even like, just to highlight, even though a lot of
folks said, Oh, it's just a ministroke.
I had this, I can't tell you howmany patients I've seen that
said, I had a history of ministroke.
That's about it.
It wasn't a full stroke.
These, these things are reallystill pretty significant.
It's not anything you shoulddismiss.

Will (40:55):
Oh, exactly.
No, absolutely not.
Well, and the thing that I thinkis important to highlight too,
with these, you know, quoteunquote, mini strokes.
Is that by the time you're atthat point, you've, your body
has sustained a significantamount of damage from, from
time, you know, hypertensionremodeling of those tiny
arteries or maybe you justthrew, you had atrial

(41:15):
fibrillation, you threw a clot,but it broke up.
Well, you, you still got to seektreatment.
You can't just ignore that.
Um, and if you do,unfortunately, it could be
disastrous the next, next timeit

Chris (41:25):
occurs.
Yeah.
Yeah.
So definitely take it seriously.
Definitely make sure that if youdon't feel right, we're always
here for you.
Dr.
Taylor and I'll be happy to seeour colleagues as well, but
definitely come on in.
Well, Dr.
Taylor, I want to thank youagain for your time here.
You know, just to kind of wrapit up.
Are there any, you know, tips,tricks, any, anything that you

(41:46):
want to leave our listeners withto help reduce their risk for
stroke, if they're experiencingstrokes, anything you want them
to know?

Will (41:55):
Absolutely.
I, you know, I do want to talkagain about high blood pressure
and how important it is to finda primary care position that you
trust.
Somebody you connect with.
So getting that blood pressurecontrolled, get your blood
pressure measured.
Blood pressure ties intoeverything.
It increases high bloodpressure, increases your risk of

(42:15):
dementia.
Even slight increases in yourblood pressure increase your
risk of heart attack and stroke,peripheral vascular disease,
like I said, dementia.
Um, take care of yourself.
I think that's also the otherpart for me.
I've noticed within within theworld we live in COVID 19 income
disparities, things like that,you really have to focus on

(42:38):
taking care of yourself, um, youknow, no matter what position
you're in, if you can because noone else will and it allows you
to take her.
So control your blood pressure,find a primary care physician
and take care of yourself.

Chris (42:51):
Absolutely.
And, you know, even if you don'thave insurance, there's a number
of free clinics throughout thecity of Milwaukee.
I know MLK has some of ourfamily medicine clinic through
Ascension, Wisconsin also hasone.
There was a program I'll give,uh, G a quick shout out here.
There was a program back when mywife and I were in medical
school.
We started a blood pressure.
barbershop project thateventually evolved at Juice

(43:13):
Clippers now.
So Juice Clippers is off of Dr.
Martin Luther King Jr.
Avenue.
There's an entire free clinic inthe back of Juice Clippers.
So as Dr.
Taylor said, the first part iscontrolling your blood pressure,
knowing where your numbers are.
If you don't know, you can, youcan go to these clinics and you
can find out that's the firststep to protecting yourself as
well as making sure that you're,you're, you're preventing some

(43:35):
of these.
Bad outcomes down the road.
Awesome.
Well, Dr.
Taylor, I want to thank you somuch again.
I'm sure I'll see you around thehospital pretty soon.
So thanks again for coming outand I hope your day goes well.

Will (43:50):
Absolutely.
Absolute pleasure.
I think what you're doing isextremely important.
Education is extremelyimportant.
I feel like it's good for thesoul, especially as people who
provide emergent care to get theeducation out there to prevent
people from coming up to us.
We want to reduce our business.

Chris (44:05):
Yeah, the goal is to be out of business.
Yes, sir.
All right, my friend.
Thank you very much.
Have a good one.
So that's it.
So I want to thank Dr.
Taylor for joining us today andgiving us some really good

(44:26):
information about stroke, strokeprevention, as well as what to
do and what to expect whenyou're at the emergency
department is very important.
If you're demonstrating anysigns of stroke, or if you have
any concerns about a familymember to proceed directly to an
emergency department, or call 91 1, feel free to look at any of

(44:49):
the information provided withthis.
episode on the show notesregarding strokes, as well as
the importance of establishingprimary care and how that
prevents you from manifestingstrokes in the long run.
Again, I want to thank everyonefor listening.
As always, I truly appreciateeverything that you're doing.

(45:11):
You all have provided thus farplease continue to give us
feedback.
Please continue to reach out.
If you have any questions aboutthis episode or any other
episodes, we always areinterested in your show ideas.
Feel free to let us know, asalways take care of yourselves,
take care of each other.

(45:33):
And if you need me, come and seeme.