How Can You Recognize and Respond to a Stroke?

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[00:00:02] Pete Waggoner: This is Neurology Now, the podcast that explores the fascinating and complex world of neurology.

[00:00:08] Pete Waggoner: Join us as we explore the human brain and beyond with expert guests who share their knowledge and insights. Welcome to the Neurology Now podcast. And on today’s show, we’re welcoming Dr. Matthew Ostrander from the Minneapolis Clinic of Neurology. And he specializes in strokes. And if you want to take that a step further, I know that’s our topic, Dr.. Ostrander, but if you want to take that a step further, what else do you work in? 

[00:00:32] Dr. Matthew Ostrander: Well, I, I see all neurology, but I have kind of a second board certification in vascular neurology. Which is basically a fancy term for stroke.

[00:00:41] Pete Waggoner: Okay, so we’re going to focus on that. Okay, I do have a quick question off the grid here. It’s quite interesting that it seems as though every study in Madison has a more official name. And, and then they have the one like this, so let’s get into the word stroke and, and, and really what the [00:01:00] origins of it is and how you see what that is. I mean, people have ideas, but how would you define that?

[00:01:07] Dr. Matthew Ostrander: So, yeah, so stroke, I mean, just the word stroke, I think even a lay person probably pictures something sudden. And that’s really, a key to stroke is that it’s a very sudden neurologic event. Throughout history, people have had various names for this, but used to call it apoplexy and things like that.

[00:01:28] Dr. Matthew Ostrander: But basically, it’s a sudden event. And it’s well, most of the time when people say stroke, what they’re talking about is an ischemic stroke. And an ischemic stroke or ischemia means lack of blood flow. That can happen in the heart or the brain, you know, for example, but in the brain, we call it a stroke and you get a sudden lack of blood flow from a blocked artery.

[00:01:50] Dr. Matthew Ostrander: That’s usually from a blood clot or a piece of plaque or something that just plugs up an artery. And as soon as you don’t have blood flow to a certain region of the brain, you have very [00:02:00] specific symptoms, because the brain is highly organized. You have one area controlling speech and one area controlling movement and one area controlling balance or vision.

[00:02:10] Dr. Matthew Ostrander: So the stroke will will cause these various different things depending on where it is. So that’s, you know, a ischemic stroke, which is most of what we’re talking about. Other types of stroke, you have hem, brain hemorrhages. That’s actually bleeding into, it’s kind of the opposite problem, bleeding into the brain tissue itself.

[00:02:28] Dr. Matthew Ostrander: A third less common type of stroke is a subarachnoid hemorrhage. We have bleeding over the surface of the brain. And that that is from a different, if you’ve ever, people, most people have heard of an aneurysm, and that’s what causes an aneurysm, a ruptured aneurysm will cause a subarachnoid hemorrhage.

[00:02:46] Dr. Matthew Ostrander: But so those are the kind of three main categories of stroke. But the key I like to make sure people remember is that it’s a very sudden event of neurologic symptoms. 

[00:02:57] Pete Waggoner: What are typical causes? 

[00:02:59] Dr. Matthew Ostrander: [00:03:00] So, you can kind of think of, you know, times you break it down into things you can control and things you can’t control. Things you can’t control, you know, your genetics or family history or your age. Most of us as, as we age, our stroke risk goes up.

[00:03:14] Dr. Matthew Ostrander: Things you can control that, you know, where a lot of our focus is high blood pressure, that’s really the, the number one treatable cause of stroke. Other things like high cholesterol, high or diabetes is another cause or all these things can raise risk for blood vessel disease. Other kinds of lifestyle things like diet can influence risk, stroke weight. 

[00:03:37] Dr. Matthew Ostrander: So those are, those are kind of the big categories I would say. 

[00:03:41] Pete Waggoner: So as far as knowing, I know you said it’s kind of a sudden events, are there warning signs leading up to that suddenness? Or are you just kind of like, wham? 

[00:03:52] Dr. Matthew Ostrander: So that’s a good question. And where it’s important to think about this is, some people have never heard the term TIA, transient [00:04:00] ischemic attack. Some have and you know, it gets confusing because even doctors use various terms like mini stroke and. But a TIA is a transient ischemic attack.

[00:04:10] Dr. Matthew Ostrander: And I tell people that’s, that’s basically a stroke where you get lucky, where suddenly you have a lack of blood flow to one part of the brain. You have very specific symptoms. You might go weak on one side, you might have trouble speaking, or trouble with vision or something like that. That could last, you know, minutes to hours and then totally resolve and you go back to normal.

[00:04:31] Dr. Matthew Ostrander: So that’s a very dangerous situation where you got to get, get in and get looked at and have certain tests to try to lower your risk of actually having a permanent stroke. 

[00:04:41] Pete Waggoner: My mother had, I believe three, they, they detected and so I believe they went undetected or she didn’t realize it.

[00:04:48] Dr. Matthew Ostrander: Yes. 

[00:04:49] Pete Waggoner: How does that happen? And is that normal? And how frequently do those types of things happen? 

[00:04:55] Dr. Matthew Ostrander: So that’s a good question too, that. So, you know, now with modern [00:05:00] medicine, MRI has kind of revolutionized what we can see in the brain. And so in the last several decades, it’s become, you know, pretty much standard of care to get an MRI.

[00:05:11] Dr. Matthew Ostrander: So the thing with MRI is you can see you know, I tell people any, any scar in your brain and your whole entire life is going to show up on an MRI. And there’s been studies on people, let’s say you do an MRI on everybody over age 65. I don’t remember the exact number, but it’s, it’s pretty dramatic. Like 30% of these people will have a stroke on the MRI that they never even knew about.

[00:05:36] Dr. Matthew Ostrander: So you can have strokes that you never knew about. If it was in an area of the brain that didn’t control a specific symptom, or, you know, or different specific function. So you can have a little stroke if it’s not an area that’s controlling your hand or your speech, then you might never even know it.

[00:05:54] Dr. Matthew Ostrander: So it’s common to have these, these events. And I don’t know if that was your mom’s case where things [00:06:00] she wasn’t aware of, or. 

[00:06:01] Pete Waggoner: Well, I asked her that doctor, and I, I, and, and she said she didn’t really notice. You know, it’s funny though, but she never had a I guess a major one after that. It was interesting.

[00:06:12] Pete Waggoner: However, she did develop dementia and 0Alzheimer’s. And I don’t know if that was a part of the process at all or not either. Is it? 

[00:06:19] Dr. Matthew Ostrander: It’s so it can be. So there’s Alzheimer’s, the most common type of dementia is Alzheimer’s, but that’s a very specific pathology in the brain in a specific process. There’s another term vascular dementia, where people can have basically dementia.

[00:06:34] Dr. Matthew Ostrander: I mean, I tell people dementia just means, you know, a deficit to the brain. You know, some kind of cognitive deficit to the point where you can’t do your normal function. You might not be able to pay your bills or things like that. You might need help for these things. So dementia can be kind of a broad term, but vascular dementia is dementia caused by basically a series of strokes, you know, damage to the brain from [00:07:00] strokes.

[00:07:00] Dr. Matthew Ostrander: So that’s where they’re, they’re related. Of course, you can have overlap where people have both types. But yes stroke and there’s another condition called microvascular disease where you get diseases, small blood vessels that can really impact the brain and eventually lead to dementia too.

[00:07:16] Pete Waggoner: A few moments ago, you mentioned the different types of strokes. Can you take us through how they differ and in terms of how the body is affected? 

[00:07:24] Dr. Matthew Ostrander: Sure. So, Well, you know, some of it is, is very similar, but, and I think that’s as a, you know, a diagnosing stroke is part of the immediate challenge. So when kind of the two broad categories is you have ischemic stroke and hemorrhagic stroke.

[00:07:40] Dr. Matthew Ostrander: So when somebody comes in, they have a stroke symptom, let’s say their left side is weak or something, they come to the emergency room. The first thing that doctors are trying to figure out is, you know, after they’re stabilizing things is, what kind of stroke is this that you do a CAT scan of the brain to make sure there’s no bleeding.

[00:07:57] Dr. Matthew Ostrander: So with an ischemic [00:08:00] stroke, you don’t see any bleeding, but with a hemorrhagic stroke, you can see the blood in the brain very well. As far as symptoms, those symptoms can be very similar between ischemic stroke and hemorrhagic stroke. And it’s basically depending on what part of the brain is affected.

[00:08:17] Dr. Matthew Ostrander: So if the part of the brain that is controlling speech, if you have bleeding in that area, well, you’re going to have speech problems. Same thing can happen with ischemic stroke. If you have a lack of blood flow in that speech area, you’re going to have speech problems. So, you know, we can use some clues in some cases to try to, you know, say, well, this is more likely a bleed than a than a ischemic stroke.

[00:08:38] Dr. Matthew Ostrander: I’d say one of those things is that as you might imagine, with bleeding in the brain, it’s not it’s a little more dynamic. You get this bleeding and it can keep bleeding for a number of hours. So those types of strokes, people have a certain symptom and that can worsen over minutes to hours, and then they can also get other symptoms like depressed mental [00:09:00] status, where they’re just not waking up very well, or, or they have a bad headache.

[00:09:04] Dr. Matthew Ostrander: That’s starting to make a person like me think, well, this might be a brain bleed. Whereas an ischemic stroke is, they say it’s, you know, it’s usually maximum symptoms at the onset. And then you’re, oftentimes you even get a little better. And so they might have really severe symptoms when they get older.

[00:09:20] Dr. Matthew Ostrander: Hit the door in the emergency room and an hour later, they’re already spontaneously a little bit better. So those, that’s some of the difference between ischemic stroke and hemorrhagic stroke. The subarachnoid type stroke, that’s a whole kind of separate category where that’s the ruptured aneurysm.

[00:09:37] Dr. Matthew Ostrander: And that’s, that’s the unique thing about that is the person might not have, you know, traditional stroke symptoms like one side weakness or speech problems, but they almost universally have severely sudden headache and they’ll tell you it’s the worst headache of their life. They have never had anything like it.

[00:09:55] Dr. Matthew Ostrander: So that really clues people in to say, well, this is probably a subarachnoid [00:10:00] hemorrhage and that’s pretty easily diagnosed on a CAT scan in the emergency room. So those are some of the distinctions, you know, ischemic stroke, hemorrhagic stroke, and then hemorrhagic stroke broken down into bleeding in the brain and breathing around the brain.

[00:10:14] Pete Waggoner: When you’re aware of these symptoms and things happening, timing obviously matters for treatment. What steps should be taken immediately? And then what happens next? 

[00:10:27] Dr. Matthew Ostrander: So unlike some other medical problems, there’s not a lot you can do at home. If you see somebody you think is having a stroke or you personally feel like you might be having a stroke, you want to call 911.

[00:10:38] Dr. Matthew Ostrander: That’s the first thing because where it’s, you know, it’s different than heart attack. The problem with stroke is you don’t know if it’s a bleeding stroke or lack of blood flow. So, you know, I, I think, you know, a common question as well, should I take aspirin or something like that? But we tell people don’t do that because if you have bleeding in the brain, you take aspirin that could potentially worsen things. [00:11:00] So the main thing is calling 911. And a lot of people I think are kind of embarrassed to call 911 or they think, well, maybe isn’t bad enough, and then they get driven by a family member to the emergency room.

[00:11:11] Dr. Matthew Ostrander: And That happens still quite a bit, but it’s more difficult to get treated quickly that way. One is that when you show up to the emergency room in a car, there’s just less attention and it takes longer versus an ambulance where you’re going to get faster attention. 

[00:11:28] Pete Waggoner: Right. The other problem is there’s a waiting room for the other.

[00:11:32] Pete Waggoner: You got to wait through it. The other one takes you right in the back. Okay. Right. 

[00:11:36] Dr. Matthew Ostrander: And the other problem is it, you know, if you’re a passenger in a car and you worsen along the way to the hospital, that can be a really more dangerous situation too. So that’s some of the reasons we basically tell people to get in, you know, call 911.

[00:11:52] Dr. Matthew Ostrander: And so, you know, that’s as an, as an individual basis, that’s basically what you can do, you know? 

[00:11:59] Pete Waggoner: How [00:12:00] about recovery and things that occur? I don’t think anybody really understands exactly what that looks like or how that works, but there may be some myths that you can bring to light on some truths through that.

[00:12:12] Pete Waggoner: So can you, can you kind of talk to some of the myths that are out there and then talk about really what it’s like? 

[00:12:18] Dr. Matthew Ostrander: Sure. So that’s, you know, it’s a big topic, you know, the stroke and stroke research. And it was a lot of attention to, you know, the first hours of what we’re doing and how to treat a stroke.

[00:12:31] Dr. Matthew Ostrander: But at the end of the day, you know, this person has suffered this problem. That’s, that’s gonna, in some cases affect them the rest of their life. So that it’s always a big question in clinic when people are, you know, seeing me after a stroke is, you know, what does the future look like? And it’s a very variable situation because the brain is very complex.

[00:12:52] Dr. Matthew Ostrander: You have very specific areas that do very specific things. And with a certain stroke, you might have one area that is [00:13:00] just not working at all because that’s what the stroke damages. At the same breath, it’s also important to remember that the rest of the brain is totally normal. So the person might not be able to talk, but they still know their family and still know what people are saying and things like that.

[00:13:17] Dr. Matthew Ostrander: So recovery is just, it’s kind of hard to put it in one basket. It’s just depending on the symptoms a person has. Some of the myths I’d say, you know, one is that it’s stroke is always devastating and it just depends on how big the stroke is, where the stroke is. So sometimes, like we were saying earlier, sometimes people have strokes so small, they don’t even know it.

[00:13:43] Dr. Matthew Ostrander: The other, you know, myth is that you can’t get better. You know, sometimes people are thinking, you know, they might be a week after their stroke and, you know, they feel like this is it, but that’s not really true either. There, there’s a recovery period where you really get dramatic [00:14:00] improvement in a lot of cases, you know.

[00:14:02] Dr. Matthew Ostrander: Even sometimes in the hospital, it’s just shocking what we’re seeing the first day versus the third day versus day seven, and then you see that person, you know, two months later, and it’s dramatic improvement in a lot of cases.

[00:14:15] Dr. Matthew Ostrander: So, some of the myths I’d say is just that it’s not going to get better. That period or improvement, it’ll go on for, you know, even a year or more. You know, I’m from my job, my seat, I have the advantage of seeing people. Sometimes I had a devastating stroke, you know, 20 years prior, and you can see how they got a lot better over even decades.

[00:14:42] Dr. Matthew Ostrander: So it’s not always a static process. The brain is just evolving and, and healing over time. But you know, it’s, it’s, there’s, there’s still not any way to, to sugar coat it, it is an injured brain. injured injury to the brain and often has [00:15:00] permanent problems from it.

[00:15:01] Pete Waggoner: It sounds like you deal with a lot of variables, don’t you?

[00:15:05] Pete Waggoner: Yeah, it’s really no two that are the same. 

[00:15:08] Dr. Matthew Ostrander: Right. You know, I, I think, I think it’s common. I see people very, you know, understandably very frustrated. Their family’s frustrated. They’re frustrated. They’re, you know, they’re kind of comparing themselves to someone else. He knew I had a stroke or why is this so much different?

[00:15:23] Dr. Matthew Ostrander: And sometimes I have to take a step back and use a different example. Like, you know, just my line of work, I, I feel like stroke is more like a car accident than it is than cancer or something like that, where people have had time to, you know, Kind of digest what happened to them. Stroke is, you know, it’s this immediate traumatic thing to the brain.

[00:15:46] Dr. Matthew Ostrander: And, you know, I think it’s so sudden, it takes people time to adjust. And, and it’s, yeah, so I’m always trying to kind of get people to realize, you know, that’s, that’s the case. And also trying not to [00:16:00] compare themselves to before their stroke. I mean, I think it just leads to frustration. So, and get them to really see, well, look, you’re, you’re better than you were last month.

[00:16:09] Dr. Matthew Ostrander: And, you know, I was trying to focus on the, the positive aspects of the recovery. 

[00:16:14] Pete Waggoner: You spoke a little bit about how the brain can rehabilitate itself over days, weeks, months, even decades. Is there ever, when you see this almost cognitive ceiling that you get to though, from the injury, or are you able to potentially wipe it out?

[00:16:34] Dr. Matthew Ostrander: There is certainly, you know, it’s good to say positive, but there’s very limp, you know, specific limits, I would say, and it’s you know, sometimes you have a stroke that is so severe that it’s really hard for the person to even understand how to work with the therapist, for example. So you get in that situation.

[00:16:51] Dr. Matthew Ostrander: It’s , you know, in some cases, unfortunately, really hard to make forward progress. And in those cases, it’s not like, [00:17:00] always true, but most of the time I’d say, you know, after a year from the stroke, most of the recovery has already happened. I think most neurologists would agree with that, but you know, it’s not impossible to keep getting better after that, but the bulk of what’s, what’s going to happen is already happened by then. 

[00:17:18] Dr. Matthew Ostrander: So there is, there is basically, you know, a level of a ceiling, you know, when, you know, when you’re, you’re trying to predict the future, could this person, you know, get back to work or driving or you know, I think a year into it, you kind of know those answers. 

[00:17:32] Pete Waggoner: So there is some time to get to really determining what it is to get there, which is encouraging for some.

[00:17:39] Pete Waggoner: And then when you get to that level, I mean, then you start probably getting into some level of acceptance as the patient and as the family, I assume. 

[00:17:47] Dr. Matthew Ostrander: Correct. Yeah.

[00:17:49] Pete Waggoner: How about you know, obviously, you know, you look at today from yesterday, how things have grown in medicine. What type of innovative treatments and or technologies are [00:18:00] available today in stroke rehabilitation that you’ve seen deployed and that you like?

[00:18:06] Dr. Matthew Ostrander: A lot of things have been tried and a lot of really exciting things, but unfortunately a lot of, you know, a lot of the things have not been proven to help yet. So you have very specialized things like, robotic exoskeleton type things and try to help people move.

[00:18:21] Dr. Matthew Ostrander: And some of that is still kind of a research mode, but still the bulk, the bulk of rehab is really with therapists physical therapy, you know. The three main therapy groups with stroke physical therapy, occupational therapy, speech therapy. And they’re working directly with, with the individual. There are fancier things, but at the end of the day, it’s hard work from all these, the person and the therapist and time.

[00:18:48] Dr. Matthew Ostrander: I think, you know, it’s a very common, I get asked question, you know, what can I do to speed this up? But it’s basically hard work and time, and the brain healing for the rehab portion.

[00:18:59] Dr. Matthew Ostrander: [00:19:00] But other, you know, stroke technology in general the immediate treatment that that field has just been revolutionized even the last 10 years as far as tools they have to get arteries open and things like that. And then even stroke prevention is, is really, just even the last decade or two, dramatically change. You have a lot of these newer blood thinners and better drugs for diabetes, better control of, you know, sensors for diabetes, better drugs for controlling cholesterol. So there’s a lot of innovation, a lot of still work going on in a lot of areas of stroke. So it is an exciting field. 

[00:19:39] Pete Waggoner: Along the lines of those innovations and we get into lifestyle things, you know, you kind of mentioned earlier things you can’t control, things you can’t control. What are some things that people that are listening to this could do in terms of lifestyle and changes that could significantly reduce their risk of having a stroke?

[00:19:57] Dr. Matthew Ostrander: Yeah, that’s a common, you know, problem and [00:20:00] things to things, things to know, but the, so the American Heart and Stroke Association. I’m not sure when it came out, but now they, they’re talking about the life, life’s essential eight and it’s, they have a little chart and these eight things and it’s eating better, and being more active, and quitting smoking, getting proper sleep, managing weight, controlling cholesterol, controlling blood sugar, controlling blood pressure. 

[00:20:26] Dr. Matthew Ostrander: I think those are kind of the bulk of things that can be done to dramatically lower your risk of stroke. Blood pressure is really probably number one, you know, other than smoking. But so I think if you, if you do those things you’re really lowering your risk.

[00:20:42] Dr. Matthew Ostrander: Then you get into, well, what does it mean diet? Well, there has been some studies on the Mediterranean diet. showing lower risk of stroke. So I think that’s another, you know, I tell people if they’re going to model their diet after some specific diet, I always recommend the Mediterranean diet, which [00:21:00] is basically more, you’re eating more vegetables, you’re eating, it’s not a low fat diet, but it’s healthy fats and nuts and olive oil and fatty fish.

[00:21:09] Dr. Matthew Ostrander: And those types of things. So that’s the diet I recommend. And then physical activity, just, you know, the American stroke or heart and stroke association recommends 150 minutes a week for individuals. So I try to tell people that, you know, that’s if you just walked, you know, brisk walk 30 minutes, five days a week, that would be, would be good.

[00:21:34] Dr. Matthew Ostrander: So I think those are some of the, some of the main things I would say. 

[00:21:38] Pete Waggoner: It’s interesting that you mentioned uh, the Mediterranean diet. I do a number of healthcare related podcasts, and that, that sounds like the wonder diet. Like everybody, it just doesn’t matter what we’re talking about. That’s the most popular one.

[00:21:52] Pete Waggoner: I that’s, I love it. It’s great. So. I might need to put that into play here. So, how about from the [00:22:00] support structure, obviously, oof, you can be pretty alone in this situation if you lose some functioning capability. How can a family member, loved ones, friends best support someone recovering from a stroke?

[00:22:14] Dr. Matthew Ostrander: Yeah, that’s a good question. I may, I think you know, it’s trying to be there for them in many different ways. You know, probably that the obvious things are just the logistics of if the person can no longer drive or they got to get to their appointments or things like that you know. And then just, they may have a physical disability need help with, with aspects of their activities of daily life. 

[00:22:39] Dr. Matthew Ostrander: So it’s trying to get those needs met, you know, whether it’s through family or hired help or care facility. So those are some of the, you know, logistical daily things. I think emotionally. Yeah, that’s, that’s tougher. You know, it’s probably a little different for each family and each person, but I think it’s just trying [00:23:00] to listen and trying to understand what the person is going through and what they might need help with.

[00:23:06] Dr. Matthew Ostrander: And there’s, we were touching on earlier too, it’s trying to get, come to grips with, okay, this is the, you, you do want to prove and stay positive, but it’s realizing this, like the current day is your new reality. And you’re trying to improve from that point. So I, I like to tell people to compare themselves to, to yesterday and not before the stroke.

[00:23:31] Dr. Matthew Ostrander: And I think that sometimes helps people and families going through this to, you know, helps families to remind their, their loved one that, you know, look, you’re, you’re better than you were a month ago. You know, you need to focus on the positive aspects of this. I think that’s, that’s some of the best advice I can think of for that.

[00:23:52] Pete Waggoner: Along these lines in terms of communication. So let’s say you have a situation where someone’s [00:24:00] speech has been, you know, after seven years, eight years, it is what it is. And it’s limited to just a couple of syllables. However, they cognitively can hear everything you’re saying and process it. What’s been interesting is, in a situation I’m aware of, is watching how others may communicate.

[00:24:20] Pete Waggoner: It’s a very interesting thing. What would you tell people that are speaking with someone that is in that case, where they can hear, understand, process, and you know, they get everything you’re saying, but for them to reply in a normal conversation is difficult. How do you go about that? And how do you communicate?

[00:24:38] Dr. Matthew Ostrander: Yeah, it is tricky and it’s so it’s, you know, it’s aphasia is what we’re talking about where you get this language and speech problem from a stroke. And I think some people think immediately, you know, it’s realistic to think this, but they think, well, why don’t you just write it down or why don’t you. But the stroke can affect written language spoken [00:25:00] language.

[00:25:00] Dr. Matthew Ostrander: So all these things are affected. What gets difficult is you get various degrees, you know, people talk about receptive aphasia, which is how I’m understanding or expressive aphasia is how I can speak. So you have various degrees of both of these things. Sometimes people understand very well. They know everything that’s going on in a conversation room.

[00:25:23] Dr. Matthew Ostrander: But if they try to engage, they just can’t get out what they’re thinking. That’s this expressive aphasia. I think that’s, you know, it’s very frustrating for them. Those people, they do better with, you know, you, you, you want to try to simplify what you’re asking, kind of yes, no questions, you know, it’s understanding what they can do, what they can’t do.

[00:25:46] Dr. Matthew Ostrander: Can they, predictably nod, yes, sir, or no, no, or say yes or no. It’s just trying to figure out where they’re at and meet them there. And engage them at that level that they can. Can understand. [00:26:00] understand. So it’s, Yeah, it’s, it takes work. And it’s, it’s can be real frustrating, but but usually there’s even just facial expressions, you know, sometimes it’s, it’s, it’s funny, I think for me and families or, you know, somebody’s, you can tell the patient’s rolling their eyes at us and, you know, they’re, yes, they understand exactly what’s going on, but they, you know, they can’t express it. 

[00:26:28] Pete Waggoner: And what I’m asking, you know, to be fair is probably rarer. I mean, there’s like not everybody experiences that. That’s just, you know, it just depends, but that’s not that frequent, I assume. Correct? 

[00:26:40] Dr. Matthew Ostrander: Well, it’s with it’s, you know, a specific type of stroke. So the most people have most of their language on the left side of the brain. And even, it’s a little split if you’re left or right handed, but. Even left handed people have most language in the left side of the brain. And when you have a devastating stroke to the left brain, it [00:27:00] usually causes pretty severe aphasia.

[00:27:03] Dr. Matthew Ostrander: But even then there’s variability in how much can a person say or, you know, or understand. So, that is a, it’s a common stroke syndrome. But you know, usually even with real severe strokes, usually, you know, you look out a year later and people have at least regained some ability to get a message across, you know, they’re, they might have a lot of trouble doing it, but they can still communicate.

[00:27:31] Pete Waggoner: Exactly. How about challenges of younger stroke survivors? Are there differences between being younger and older? And what would you, before you answer the first question, what would you consider a young stroke survivor? Sure. 

[00:27:48] Dr. Matthew Ostrander: So that’s a good question. I mean, the, I mean, in general, under 50, that’s pretty young for a stroke.

[00:27:56] Dr. Matthew Ostrander: So that I think most of the literature would kind of break it down [00:28:00] to under 50. But we certainly see strokes and, you know, all ages. And it’s very challenging because these people may be 20 years old or, you know, or 30 or 40 or they’re in the middle of their career or family obligations. And so it’s a lot, a lot of challenges there in, you know, mid-career working versus if you’re retired and you ever have a stroke, you’re, you’re not dealing with that part.

[00:28:28] Dr. Matthew Ostrander: But so the younger people that have had a stroke, it’s not only they’re trying to recover, but they’re also trying to figure out, okay, can I get back to work? Can I still do my job? Can I provide for my family?

[00:28:42] Dr. Matthew Ostrander: So it’s a process that takes months usually of trying to help them the best way you can, whether that’s, you know, getting back to work with modifications or, or getting approval for disability or something like that.

[00:28:57] Dr. Matthew Ostrander: That’s a real common [00:29:00] process in a younger stroke where you’re, you’re trying to get them through that. And those challenges. There’s a lot more challenges, I’d say, I guess, different challenges than if you’re more of a retired generation. 

[00:29:13] Pete Waggoner: And then, how about, we’ll finish on this, could you share a story of perhaps resilience or a memorable recovery journey that you experienced with a stroke survivor?

[00:29:24] Dr. Matthew Ostrander: Sure. So there’s been just so many that it’s, you know, it’s hard to, hard to, to pick one. But, years ago I did see, you know, it’s kind of like we were talking about before this aphasia. So I saw a very young woman, she like 22 years old and new mother and had a devastating stroke because it left middle cerebral artery territory.

[00:29:47] Dr. Matthew Ostrander: So she had severe aphasia and right sided paralysis. The stroke was so bad that she needed what’s called a hemicraniectomy where they remove the bone from the head. So that lets the [00:30:00] brain swell. And that’s a life saving procedure. So she basically had that done and she lived through all this.

[00:30:08] Dr. Matthew Ostrander: But it was months and months of recovery, but you know, I saw her walk into

[00:30:14] Pete Waggoner: Well, that’s you’re, you’re affected.

[00:30:16] Dr. Matthew Ostrander: Yeah.

[00:30:17] Pete Waggoner: You can take a second here. Wow. What a. The best part is the human part of this. Sorry I mean if you can keep going I think we all would love to hear what you saw.

[00:30:25] Dr. Matthew Ostrander: But yeah, it was a year later. She was able to walk in with her baby their baby. 

[00:30:31] Pete Waggoner: Whoa, so you said this was a while ago. Were you young? Oh, not that you’re young now, but I mean, I mean, was this, I mean, were you like in that, you know, not much older at that point or like, was that something you could really relate to saying, Oh my goodness.

[00:30:46] Dr. Matthew Ostrander: Yeah. I was in my stroke fellowship. 

[00:30:50] Pete Waggoner: Okay. So you’re 

[00:30:51] Dr. Matthew Ostrander: So it was pretty amazing just to, I guess it really reframed what I thought of recovery and what is [00:31:00] possible. I mean, the thing is she had major deficits, but she was, you could tell that she was driven. 

[00:31:08] Pete Waggoner: That’s amazing. So you think that her drive had something to do with getting through all of that, that she went through, no question. That’s what I’m hearing. 

[00:31:16] Dr. Matthew Ostrander: Yeah. I think just the, you know, to be so young and a new mother and you know, I think she obviously had a clear purpose. 

[00:31:25] Pete Waggoner: It’s amazing stuff. And I’m glad I asked that question. And I, I suppose you will never forget it the rest of your life. Yeah. 

[00:31:32] Dr. Matthew Ostrander: No, no. 

[00:31:33] Pete Waggoner: How rewarding was that?

[00:31:34] Pete Waggoner: So when you went into medical school, did you, did you think you would ever experience anything like that? 

[00:31:39] Dr. Matthew Ostrander: Yeah, I think you have a vague idea, but you don’t really know what’s ahead. So, I mean, I probably thought I did, but you don’t know the level. 

[00:31:49] Pete Waggoner: Yeah, the, the impact it has. And that’s wonderful. I, I have to tell you, you know, I speak with so many health care professionals, such as yourself and [00:32:00] doctors and physicians and things and every one of you never cease to amaze when it comes to sharing a tale like that.

[00:32:07] Pete Waggoner: And what I love is, you know, I think sometimes when we get into a patient provider relationship, it can be a little stoic and it’s professional. I think sometimes you lose fact of the site or lose sight of the fact that this can impact you as well. And it, it can fuel yield to keep going.

[00:32:29] Dr. Matthew Ostrander: Yes, yes. 

[00:32:30] Pete Waggoner: That’s awesome stuff. Well, doctor I’m sure you’re busy and have plenty of things to do. Definitely appreciate your joining the show here today and I found your information incredibly enlightening and appreciate your time to talk about really all of the aspects of strokes and, and what we need to know about that moving forward.

[00:32:47] Dr. Matthew Ostrander: Thank you. Thanks for having me. 

[00:32:49] Pete Waggoner: Thank you. That was Dr. Matthew Ostrander. And of course, that was our program. And we want to thank you for joining this episode of Neurology Now. We hope you found it informative [00:33:00] and engaging. If you enjoyed this episode, please subscribe to our podcast to stay up to date and to help us educate our community and beyond.

[00:33:08] Pete Waggoner: We welcome your feedback, comments, and suggestions for future topics, so please feel free to reach out to us through our website or email, or social media channels. Dr. Ostrander, it’s Memorial Day weekend when we’re putting this down. I hope you’re gonna enjoy it and take care of yourself and get some great sun.

[00:33:25] Pete Waggoner: It’s fantastic. 

[00:33:26] Dr. Matthew Ostrander: All right. Thank you. 

[00:33:28] Pete Waggoner: Thank you. You too. I’m Pete Waggoner. So long, everybody.

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