Reducing the Risk of Second Stroke by Changing the Patient’s Lifestyle [Interview][Transcript]

Dr_John_Rogers_second_stroke_risk_reductionGuest: Dr. John Rogers
Presenter: Neal Howard
Guest Bio: Dr. John Rogers is Associate Chief of Cardiology and Director, Cardiac Pacing and Tachyarrhythmia Device Therapy at Scripps Clinic Medical Group in La Jolla, California. He is skilled in syncope, electrophysiology and implantation of pacemakers and internal cardiac defibrillators and CRT devices.

Segment overview: Dr. John Rogers, MD, FACC, Associate Chief of Cardiology and Director, Cardiac Pacing and Tachyarrhythmia Device Therapy at Scripps Clinic Medical Group in La Jolla, California, discusses talking to patients about lifestyle management for best outcomes to reduce the risk of a second stroke.

Transcription
Health Professional Radio – Reducing the Risk of Second Stroke

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Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard, thank you for joining us today. Our guest in studio is Dr. John Rogers, Associate Chief of Cardiology and Director Cardiac Pacing and Tachyarrhythmia Device Therapy at Scripps Clinic Medical Group located in La Jolla, California. And he’s here with us today to talk about some of the lifestyle changes that patients need to undertake, to prevent a second stroke. Thank you for returning to Health Professional Radio Doctor.

Dr. John Rogers: Thank you for having me back Neal.

N: Thanks. In other segments we talked a little bit about the causes of stroke, we talked about some of the new technology that’s around for monitoring heart health. Today I’d like to talk a bit about some of the lifestyle changes that we as patients need to take in order to prevent that second stroke. We’ve done the things that caused the first stroke, now we’ve things in the perspective, we want to get that second half of life underway in a much more healthy manner. Let’s talk about some of the lifestyle changes that you tell your patients that they need to take when they’re talking with you about their current heart condition.

R: Well, thank you Neal, that’s a great great question and a wonderful topic and I think it would help a lot of people. When I have a patient who has had a stroke, we talk a lot about, why they had a stroke, if we are able to find the reason why they have a stroke, keeping in mind that about 20 to maybe 40% of patients we may not know why they’ve had a stroke. So if we know why, we can address their risk factors, if we don’t know why, we keep looking to find why and we certainly address all the risk factors as well. And so the risk factors include high blood pressure, if a patient’s blood pressure is elevated we’re going to work on giving that bound to normal levels, regardless of their age, regardless of any other comorbidity they may have. We really want to make sure that their blood pressure is under good control. Likewise, high cholesterol is a risk factor for stroke. If we think about what causes stroke, as I mentioned previously is 85% of strokes are ischemic. An ischemic stroke cause maybe a blocked up artery. So the same risk factors that we to blocked up arteries, are the same risk factors that cause a stroke, again high cholesterol is one of those, so I’ll talk with my patients about dietary modifications, exercise, and a lot of times, if they already had a stroke or have a vascular disease, we’re going be talking about being on medication such as a Statin or other drug to their cholesterol down. Generally we get their LDL cholesterol below 80, a pretty aggressive treatment but that’s what I would do and what I recommend to my patients who have vascular disease or had a stroke, in fact the neurologists in the hospital will automatically play somebody on a Statin regardless of their cholesterol numbers who have had a stroke.

N: When it comes to recommending life style change, how often do you talk directly to the patient and how often has the stroke left the patient in a condition where others have to be instructed about their particular lifestyle when it goes above and beyond just healthy eating and a statin?

R: Yeah, that’s a great point. A lot of times patients are left debilitated enough where a lot of this conversation has to happen with family members or other people who are providing care for the patient. Typically, it’s a spouse, or a son or daughter, or other family members that we’re having this conversation with. They’re maybe cognitive problems after stroke, there may be the physical problems after stroke, or a patient may not be able to put their medications out correctly in a pillbox on a daily basis and they have to have help. So the conversation really has to happen with the patient and with any care provider they have or somebody who’s assisting them.

N: Now do you find that it is often difficult for you to talk to family members when emotions possibly run high or if they’ve had experience with other family members who have had a stroke and their experience is totally different from these family members.

R: I think the conversation really comes around to telling a patient, ‘Look you’ve had a stroke and you survived that stroke, and our goal at this point is in addition to the rehab and the physical therapy to try to get back as much loss function or cognition as possible, is to do everything possible to prevent a second stroke.’ And I think that most of the time, when we talk about the risks of a second stroke, which maybe have a higher chance of being fatal than the first stroke and most patients, especially the family members are very open to everything we discuss. Now, during that forward and actually doing it may be hard when the patient is out of the doctor’s office, if a patient’s resistant to the changes that may be necessary. But for the most part, I think families are pretty receptive, patients are pretty receptive, when we’re talking about, ‘We need to make sure you don’t have another one.’

N: You mentioned stroke patients also dealing with diabetes, is having diabetes double any other risk factors that may be present?

R: It’s interesting Neal. We’re having diabetes almost that seems to multiply the risks. So if diabetes is present, then having high blood pressure, the risks are magnitude higher. Having high cholesterol, the risks are magnitude higher, maybe not doubling it but maybe even more so. Smoking as well, will increases stress dramatically, especially in the setting of diabetes.

N: Is there ever an instance where no matter what you do, a second or third stroke is on its way? Is there ever a condition where the initial stroke guarantees subsequent stokes?
R: I think it’s not necessarily guarantees it, but certainly increases the risks dramatically. I think that if the first stroke was caused by a heart rhythm problem, atrial fibrillation, and that’s due to a blood clot forming in the top chambers of the heart, the atria breaking free and being pumped out of the heart of the brain and not treating that with anticoagulation, not identifying it and not treating with anticoagulation. I think it’s probably certain that somebody will have another stroke, a second or third stroke and each time that stroke occurs in succession the risks of dying from that is much higher.

N: In wrapping up Dr. Rogers, I’d like to ask a question that has to do with the type of stroke that can be detected early and maybe prevented. How do you prepare a patient who is at risk factor for stroke? They manage their lifestyle, they take all the advice, and the stroke occurs anyway, what type of preparation do you have for the patient who may not be the best candidate for one or other type of treatment?

R: I think the best thing that we have is education, and awareness, and making sure that our patients are aware what a stroke is, and how to identify it, and that they really need to call 911 and get taken into the hospital to get to the stroke early, to hope for stop it early. I think we have posters up in our exam rooms, and then in the offices, in waiting rooms, let’s say “Here are the signs of the stroke. Make sure you know these.” And I talk to patients that have risk factors, high blood pressure, diabetes, high cholesterol, they’re smokers, family histories of stroke, it’s just to say, ‘Let’s just quickly review the signs and symptoms of a stroke to make sure you’re aware of those. Because of these risk factors, you may be at a higher risk so if you are suddenly not able to move a part of your body or you’re slurring your words, or your family says that you are even if you don’t think you are, always there on the side of caution and 911.’ So it’s really education and awareness is the best way and treating those risk factors is the best way to prevent that stroke.

N: Is there any place that we can go and learn more say online about specifically, lifestyle management when it comes to preventing that second stroke?

R: I think the resources that exist from the American Heart Association and the American Stroke Association are probably the best resources in learning all things about stroke, awareness, signs and symptoms, how to prevent a first or second stroke are all located there. Easy for patients to see.

N: Thank you for coming in today.

R: My pleasure Neal, thank you for having me.

N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard, in studio with Dr. John Rogers, Associate Chief of Cardiology and Director Cardiac Pacing at Scripps Clinic Medical Group. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.