In The Rising Podcast- A Health and Wellness Podcast

Strategies for Maximizing Recovery After Stroke: Expert Advice from Dr. Steve Hetts

November 01, 2022 Bettina M Brown/ Dr. Steve Hetts Season 2 Episode 167
In The Rising Podcast- A Health and Wellness Podcast
Strategies for Maximizing Recovery After Stroke: Expert Advice from Dr. Steve Hetts
Show Notes Transcript

This In the Rising podcast episode is titled "Strategies for Maximizing Recovery After Stroke: Expert Advice from Dr. Steve Hetts". In this episode, host Bettina M Brown discusses the importance of health in relation to stroke. She emphasizes that even individuals who may have other health conditions such as high blood pressure or an increased risk of cancer can still take steps to improve their overall health and well-being after experiencing a stroke.

Bettina's guest in this episode is Dr. Steve Hetts, a physician at the University of California, San Francisco. Dr. Hetts specializes in interventional neuroradiology, focusing on diagnosing and treating individuals with strokes, brain aneurysms, and other vascular issues in the brain and spine. He brings his 15 years of experience in this field to provide expert advice and insights.

The podcast dives into various topics related to stroke, including how to recognize the signs and symptoms of a stroke, the importance of seeking immediate medical care, and strategies for maximizing recovery after a stroke. Dr. Hetts shares his expertise and provides listeners with valuable information on how to navigate the journey of stroke recovery.

With strokes occurring in nearly 800,000 people each year in the United States, with a majority being first-time stroke survivors, this episode aims to empower listeners to take control of their health and improve their outcomes after experiencing a stroke.

Overall, this podcast episode serves as a valuable resource for individuals looking to gain knowledge and strategies for managing and recovering from a stroke.




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[00:00:00] Bettina M Brown: Hello, hello, and welcome to In the Rising podcast. My name is Bettina Brown and I'm the host of In the Rising, and I really love to talk about living your best life, following your hopes, your dreams, your goals, and making them a reality, turning your back on things that do nothing for you. And even though I love the idea of having your best life, the reality is sometimes we have medical conditions that we have to negotiate or go through to have the best life, right?

[00:00:43] Bettina M Brown: Not all of us are 100 percent healthy with nothing genetically happening and never having any other issues such as high blood pressure or increased cancer risk. But my goal is to talk about health today with regards to stroke. My guest is Dr. Steve Hetts, and he shares what we can do to talk about stroke, go through stroke if that is actually happening and how to get immediate health care so that you can have that best outcome possible.

[00:01:14] Bettina M Brown: And you know what? Strokes happen every year to almost 800, 000 people just in the United States. More than half a million, almost 600, 000 are. Brand-new first-time stroke survivors. So, living a life that is awesome does not mean that we have to negate our health conditions. So, I'm really excited for you to hear his conversation today.

[00:01:37] Bettina M Brown: Well, hello, hello. Welcome to In the rising podcast. I am really excited to have you here with me today.

[00:01:43] Dr. Steve Hetts: And I'm glad to be. Thanks so much for the invitation, Bettina. Absolutely. 

[00:01:50] Bettina M Brown: So I would like you to share your backstory and how you are an expert on this topic. 

[00:01:57] Dr. Steve Hetts: Happy to. So, I'm Steve Hetz. I am a physician at the University of California, San Francisco, and a professor there of interventional neuroradiology, which is a bit of a mouthful.

[00:02:08] Dr. Steve Hetts: But it's basically the specialty of folks who will diagnose and treat people who are having strokes or brain aneurysms or other problems with the blood vessels in the brain and the spine. And I've been doing that for about 15 years now. 

[00:02:27] Bettina M Brown: So Dr. Hetts, I know that as the time of our recording World Stroke Day is a few days out and it's something that affects so many people.

[00:02:35] Bettina M Brown: I see it on my side as a physical therapist. Share where your passion is into bringing out the word of, of people having a stroke or signs and symptoms and the possible delay about that. 

[00:02:49] Dr. Steve Hetts: Yeah. Stroke is a condition that it's incredibly important to come into the hospital right away. And I would love people to remember the acronym BFAST, B E F A S T, because it tells you what to do too.

[00:03:04] Dr. Steve Hetts: And, and the B stands for Balance. So, loss of balance is a symptom of stroke. E for I, loss of vision can be a sign of stroke. F for face drooping on one side. A for arm being weak on one side. S for speech being garbled or unable to speak at all. And then T is for time. You need to call 9 1 1 And so if you yourself are having stroke symptoms or if you see someone next to you having stroke symptoms.

[00:03:33] Dr. Steve Hetts: Call 911 so they can come into a level one comprehensive stroke center right away. 

[00:03:39] Bettina M Brown: And you emphasized also time that some people, we want to wait, right? We don't want to go to the ER. We don't want a 15 hour wait or what have not. but also share that there is a system that we organize people coming in.

[00:03:56] Bettina M Brown: Can you talk a little bit about that?

[00:03:57] Dr. Steve Hetts:  Yeah. And that's something that is improving over time and we have some way to go, but I can tell you that if someone is coming into our comprehensive stroke center with. a suspicion for a stroke then they go right to the top of the list. So there are no 15 hour waits to be evaluated.

[00:04:17] Dr. Steve Hetts: If you have severe symptoms of stroke, we're worried that you may have what's called an ELVO or emergent large vessel occlusion stroke. So that's a blockage of one of the big blood vessels at the base of the brain. And that's important for two reasons. One, it's a very severe kind of stroke. And two, it's the kind of stroke that people like me can treat and potentially give you a much better outcome right away.

[00:04:41] Dr. Steve Hetts: And so, people suspected of that come right into my angiography suite operating room and we start operating on them within minutes. Because what we've realized is for every minute of delay in restoring blood flow to somebody with this kind of stroke you can lose 2 million brain cells. And for every minute of delay in coming into the hospital, it translates into a week of healthy life later.

[00:05:07] Dr. Steve Hetts: So, time is really of the essence here. 

[00:05:11] Bettina M Brown: It is, and, you know, I've had this conversation with family recently where someone went in, they were having these symptoms and they were discharged and they said, but I only had a, but maybe I shouldn't have gone. Can you describe a little bit more what that is?

[00:05:26] Bettina M Brown: Because I think there's some confusion. out there as well. What I'm, what I'm hearing and seeing.

[00:05:30] Dr. Steve Hetts: Sure. So a transient ischemic attack or TIA, some people refer that as a mini stroke as well. It's basically stroke symptoms, but they're temporary. They go away. And it's important to pay attention to them and come right into the hospital because Number one, that can be the sign of an impending much bigger stroke.

[00:05:51] Dr. Steve Hetts: Or two, it can be a reflection of you have risk factors for stroke. If we can get those under control by potentially giving you blood thinners, changing your medicines, controlling your blood pressure controlling an irregular heartbeat, we can reduce the chance that you're actually going to have a big stroke later.

[00:06:09] Dr. Steve Hetts: And so, people shouldn't feel bad about coming into the hospital for a TIA. That's exactly what we want them to do so that we can get them on the right kind of therapy to prevent a big stroke in the future. 

[00:06:21] Bettina M Brown: And Dr. Hetts, explain, because there's a fear, right? If it's in your brain and, and there's, if, if something, if I get it fixed.

[00:06:31] Bettina M Brown: What is going to happen? What will my life look like? Can you share a little bit your own experience, what you've witnessed from those people who are actually going in and they're being fast and, and getting into the hospital?

[00:06:41] Dr. Steve Hetts: Oh, yeah. It's, it's the most amazing thing I've seen in my medical career.

[00:06:47] Dr. Steve Hetts: Basically, people come in and they can be completely paralyzed on one side, unable to speak. We pull the blood clot out, you know, within minutes. And then literally in our operating room, they wake up, they can move, they can speak. It's an incredible Lazarus like phenomenon. And it doesn't happen in every case.

[00:07:10] Dr. Steve Hetts: And it takes some people more time to recover. But there are definitely cases like that, and I think to understand how powerful this treatment is in the medical literature, there's this concept of the number needed to treat, like how many patients you have to treat with a new treatment to be sure someone will get a lot better, and for a lot of therapies, like certain kinds of heart attacks and things, that number is in about the 15 or 20 range.

[00:07:34] Dr. Steve Hetts: You have to treat 15 or 20 patients to be absolutely sure, like, yeah, Somebody's going to get tremendously better for stroke because emergent large vessel occlusion strokes. It's too. It's incredibly powerful. So there is no reason to delay. Come in to get that treatment. If there's a suspicion for stroke because it's absolutely the best possible thing you can do.

[00:07:56] Bettina M Brown: Yeah. And a lot of times we are afraid of information, right? Because if that, if I go in, then it might be true that some things happen. I go in, I have this surgery. What kind of life am I expecting? Because from my, my end of as a physical therapist, a lot of individuals are very afraid of debility of. What if I need a walk or people will stare at me or if I talk funny, I, I won't say anything at the family reunion.

[00:08:22] Bettina M Brown: What are your thoughts and what is your experience with that kind of commentary? 

[00:08:27] Dr. Steve Hetts: Yeah, I think that's a very normal and logical way to think about things and stroke is a, is a terrible disease, right? It's the leading cause of chronic disability in the United States and around the world. And so coming in quickly.

[00:08:43] Dr. Steve Hetts: To get the blood clot removed to minimize the amount of disability is the absolute best possible thing you can do and to get preventative care to prevent strokes as well. So keeping up with your primary medical appointments to find out. Do you have an irregular heartbeat? Do you have high blood pressure?

[00:09:00] Dr. Steve Hetts: Do you have some of these other risk factors that can be controlled? I think in terms of the duration of disability, though, There was a really powerful article in the New England Journal a few years ago from Australia, which basically showed something like if you came in for the acute ischemic stroke and you had the blood clot removed, you ended up in sort of a rehabilitation hospital for about a week.

[00:09:22] Dr. Steve Hetts: On the other hand, if you didn't, if you were in the other group that didn't get that treatment, you were in the rehabilitation hospital for an average of over half a year. So again, even if you don't have a complete recovery, Even a partial recovery, it's likely to be much, much better if you get treated.

[00:09:39] Bettina M Brown: And that makes a big difference for your quality of life afterwards. Share with me the statistics or what you have observed and read in the literature, if you have one stroke, cause this is a big question, how likely am I going to have another 

[00:09:53] Dr. Steve Hetts: one? Great question. And it really varies by what caused your original stroke, whether it's an irregular heartbeat or whether it's a narrowing in a blood vessel in the neck or a narrowing of a blood vessel in the brain, for example, for that kind that has the narrowing of the blood vessel in the brain.

[00:10:10] Dr. Steve Hetts: you know, it's about a 20 percent chance you're going to have a second stroke within a few weeks of the first stroke, for example. So it can be very, very high. So again, that's why it's tremendously important to get diagnosed so we can either treat the acute stroke or if it was just a transient ischemic attack.

[00:10:29] Dr. Steve Hetts: Provide preventive either medicines or procedures to reduce the chance that you're going to have that big stroke later. 

[00:10:36] Bettina M Brown: And what would you tell other physicians who are, you know, they're still maybe they're not at UCSF in the middle of a city. They're more in a rural state like I am. What would you provide them as insight or what to look up?

[00:10:49] Dr. Steve Hetts: Right. And so the Approach to stroke in the United States is sort of a hub and spoke model. And so they're big level one comprehensive stroke centers, like where I am that have all the specialists who can, you know, operate, go through the blood vessels, pull blood clots out, seal off, bleeding blood vessels, things like that.

[00:11:09] Dr. Steve Hetts: And that expertise is not distributed all throughout every hospital in the United States. And so, you know, Appropriate triage to bring people into these level one stroke centers is really important so that you get brought to the closest, you know, comprehensive stroke center hospital, as opposed to, oh, I'm going to start in a very small hospital and they get transferred and transferred and transferred that can take a lot of time.

[00:11:32] Dr. Steve Hetts: And again, two million brain cells die each minute of delay. So reorganizing triage to get people sent into the comprehensive stroke centers is really important. I think in parallel to that and we get a lot of folks from rural California sent in here too, and it kills me that it can sometimes take hours to come in here in an ambulance or a helicopter.

[00:11:53] Dr. Steve Hetts: We're just starting now to work with robotics companies to develop systems that we may be able to deploy in rural hospitals so that if a patient came into a rural hospital, people like me could control that robot by remote control hundreds of miles away and do these sorts of procedures, you know, near a patient's home.

[00:12:11] Dr. Steve Hetts: And I think that Is, you know, my dream that everybody could get very high-level treatment very near their home. We're not there yet but I think within this next decade with a lot of innovations and connectivity between hospitals and robotics and, you know, resources in the public health system, we're going to get there.

[00:12:32] Bettina M Brown: And that is very interesting point that you make that, you know, we can use individuals where they're at. To move them in other places. And, and because I know listening to this, like, well, I don't live in a big city and I don't live and we don't always know that when we're lay people, what's a level, a trauma one center, what's the trauma to, you know, we don't know the differences, but that's kind of important to, to also know, as you look at where you're going to live, what.

[00:12:58] Bettina M Brown: What kind of health care is out there? I'm going to ask you two final questions. What made you so interested in this area of health care? Was there some experience you had or was just the brain always like your light spot? 

[00:13:14] Dr. Steve Hetts: Yeah, great question. And so, a couple of different things, you know, even way back in high school, I was interested in biology, but my mother got diagnosed with Parkinson's disease at a young age.

[00:13:24] Dr. Steve Hetts: So I develop sort of a personal interest in the functioning of the brain. And then during college, I actually had the opportunity to spend a summer with some of the neuro interventional radiologists here at UCSF, seeing what they did, and they were one of the first groups in the world that did this sort of work, and it was just amazing way back in the 1990s.

[00:13:42] Dr. Steve Hetts: And so that. really influenced the rest of my career and you know, helped me decide, wow, this is a way I can help people in their moment of dire need. And my final 

[00:13:53] Bettina M Brown: question is, is the title of my podcast is in the rising. So it's also, you know, for your patients, how they can rise up and, and, and go through this situation.

[00:14:01] Bettina M Brown: But Being a practitioner as well, there are some things we look forward to. What do you see yourself, either in your career, for yourself, or UCSF, rising up to so far as your interest in this area? 

[00:14:14] Dr. Steve Hetts: Yeah, great question. And I, I think, you know, it touches on a lot of the things we've talked about. Stroke, you know, when I started my career, 15 20 years ago was a terrible diagnosis, and we expected that people would not get better from it.

[00:14:28] Dr. Steve Hetts: And now, with these improved techniques and tools, we can treat people and now many of them get completely better or partially better. And so continuing that trend, you know, being able to organize health care around the country so that patients get efficiently triaged into ambulances to come to the comprehensive Stroke Center to develop new technology so we can deliver.

[00:14:51] Dr. Steve Hetts: eventually some of these where people live. I about the next decade because we're going to make furth and you know, I've helped all of the University of you know, mission statement is basically to make California the safest place to have a stroke. And so I really think that, you know, this is going to be a great decade to make strides in improving patients outcomes from this terrible condition.

[00:15:21] Dr. Steve Hetts: Yeah. 

[00:15:22] Bettina M Brown: Well, thank you so much, Dr. Hetz, for your insight and your energy. You can feel it through, through our Zoom content that this is something that you're passionate about and really want to help other people go through. In that moment, that is not the greatest for them. So thank you so much for all the work you do and thank you for all your future patients on all the work that you will help them with.

[00:15:43] Bettina M Brown: Thank you for your time. 

[00:15:44] Dr. Steve Hetts: And thank you so much, Bettina. I really appreciate it. 

[00:15:48] Bettina M Brown: So thank you so much for listening to today's podcast. And if you feel that this information would be beneficial to someone, you know, it is my ask. That you share it with that person, the more information that we put into the hands and ears of those that it can make a difference for, the better their life may very well be.

[00:16:08] Bettina M Brown: And I really encourage you to learn more about being fast, be fast, and have that information because you never know if you are that individual that just knowing that acronym may change the life of someone that you know or don't know very well. So, thank you again for your time because you know what?

[00:16:27] Bettina M Brown: That time is something we don't get back. It's that one resource that never replenishes itself. I thank you so much for listening to in the rising podcast. And if you did like this show, and if you do like overall all the episodes, I welcome you to leave a review. The more reviews we have, the further our reach can be to make a bigger impact.

[00:16:49] Bettina M Brown: And until next time, let's keep building one another up!