THIS ORIGINAL WSRE PRESENTATION IS MADE POSSIBLE BY VIEWERS LIKE YOU. THANK YOU. BRAIN ATTACKS AND BRAIN INJURIES. WE TALK CONCUSSIONS AND STROKES WITH NEUROLOGIST DR. TERRY NEILL ON THIS EDITION OF CONVERSATIONS. THERE HAS BEEN MUCH TALK RECENTLY ABOUT BRAIN INJURIES OR CON CUGS. MOST ATEXT FOCUSING ON THE SUICIDES AND PREMATURE DEATHS OF SEVERAL NFL FOOTBALL PLAYERS. MANY BELIEVE THESE DEATHS WB LINKED TO REPEATED HEAD INJURIES THESE PLAYERS MAY HAVE SUFFERED OVER THEIR CAREERS. BUT WHAT MIGHT BE MOST FRIGHTENING IS THE POTENTIAL BRAIN INJURIES OUR CHILDREN MAY SUFFER WHILE PLAYING YOUTH SPORTS. WE'LL DISCUSS HOW TO BEST PROTECT THEM. ANOTHER CONCERN OF BRAIN HEALTH IS STROKE. ACCORDING TO THE NATIONAL STROKE ASSOCIATION NEARLY 800,000 AMERICANS SUFFER STROKES ON AN ANNUAL BASIS. THE GOOD NEWS, THE ASSOCIATION SAYS NEARLY 80% OF THOSE ARE PREVENTABLE. DR. TERRY NEILL IS A NEUROLOGIST AND MEDICAL DIRECTOR AT SACRED HEART REGIONAL STROKE CENTER IN PENSACOLA, FLORIDA. DR. NEILL TRAINED AT THE UNIVERSITY OF ALABAMA BIRMINGHAM AND THE UNIVERSITY OF CALIFORNIA SAN FRANCISCO. HE SPECIALIZES IN STROKE AND TRAUMATIC BRAIN INJURY. WELCOME DR. TERRY NEILL TO CONVERSATIONS. THANK YOU FOR JOINING US. THANKS FOR HAVING ME. GLAD TO BE HERE. THERE HAS BEEN SO MUCH TALK RECENTLY IN THE MEDIA ABOUT THE NATIONAL FOOTBALL LEAGUE, BIG LAWSUIT PLAYERS SUING THE NFL, JUNIOR SAU RECENTLY COMMITTING SUICIDE, ALL COMING BACK TO THINK THINK PLAYERS MAY HAVE CONCUSSIONS THROUGHOUT THEIR CAREER AND IT'S CAUSING BAD THINGS TO HAPPEN. BEFORE THAT, FIRST WHAT IS A CONCUSSION? A CONCUSSION IS A MILD TRAUMATIC BRAIN INJURY. SO WE'VE ALL HEARD THE UNFORTUNATE SEVERE CAR ACCIDENTS WHERE SOMEONE HAS A SEVERE TRAUMATIC BRAIN INJURY. THIS IS OBVIOUSLY MUCH MILDER VERSION OF THAT BUT UNFORT HATLY IT'S AN -- UNFORTUNATELY AN INJURY TO THE BRAIN THE BRAIN USUALLY REGAINS FUNCTION FAIRLY QUICKLY BUT IS A MILE INJURY TO THE BRAIN THAT CAN PERSIST LONGER THAN THAT. WHEN YOU SAY IT RECOVERS QUICKLY, WHAT TIME FRAME DOES IT USUALLY TAKE? IT CAN VARY. YOU CAN ANYWHERE FROM SECONDS TO MINUTES THAT SOMEONE MAY FEEL BACK TO THEIR NORMAL SELF BUT IT MAY TAKE HOURS, DAYS, OCCASIONALLY WEEKS THAT THEY REALLY GET BACK TRUE BRAIN FUNCTIONING WHERE THEY CAN GO BACK TO WHAT THEY WERE DOING BEFORE PHYSICALLY AND SOCIALLY. WHAT KIND OF HIT TYPICALLY CAUSES A CONCUSSION? THERE'S MANY DIFFERENT TYPES BUT IT CAN BE ANY TYPE OF HIT TO WHERE EITHER TO THE SKULL DIRECTLY OR JUST A MOVEMENT A SUDDEN MOVEMENT OF THE HEAD THAT CAN OBVIOUSLY CHANGE THE MOTION OF THE BRAIN TO WHERE IT CONTACTS THE SKULL AND CAUSING THE NEUROLOGIC SYMPTOMS THAT P HAPPEN. SO LIKE IF YOU WERE IN A CAR WRECK, IS IT POSSIBLE THE BRAIN MOVES AROUND WITHIN THE SKULL; IS THAT WHAT YOU'RE SAY SOMETHING SUDDEN MOVEMENT OF THE SKULL ITSELF, IT DOESN'T HAVE TO BE A DIRECT BLOW TO THE SKULL, YOU SEE THAT OFTEN WHERE SOMEONE MAY HAVE FALLEN TO THE GROUND BUT DIDN'T STRIKE THEIR HEAD AND THEN THEY HAVE BRIEF SYMPTOMS AND THEN SOMETIMES SYMPTOMS THAT ARE UNDERRECOGNIZED. GOING BACK TO THE ISSUE THAT -- IS IN THE NFL, WHAT DO YOU MAKE OF THAT? I THINK OBVIOUSLY WITH SOME OF THE MORE HIGH PROFILE ATHLETES OVER TIME WHETHER TROY AIKMAN, MOHAMMED ALI THEY HAVE INJURIES WHERE THEY HAVE HAD TO STOP THEIR SPORT OR HAD PERMANENT NEUROLOGIC INJURIES. AS THAT NOTORIETY OCCURS WE SEE THESE CONCUSSIONS ARE MORE SEVERE THAN WE THOUGHT AN ESPECIALLY IN PATIENTS OR ATHLETES THAT HAVE MORE REPEATED CONCUSSIONS. NOW, I'VE READ THAT WHAT THE REAL ISSUE MAYBE WITH SOME OF THESE GUYS IS THE CUMULATIVE EFFECT. KIND OF EXPAND ON WHAT THAT MEANS. WELL, THE CUMULATIVE EFFECT IS THAT EVEN THOUGH IT DOESN'T APPEAR LIKE THERE'S BRAIN INJURY, IF YOU DID A BRAIN SCAN OR DID AN EXAMINATION ON A PATIENT, THAT THEY HAVE SOME TYPE OF INJURY TO THE BRAIN SUCH THAT THE NEXT CONCUSSION, MAYBE THE SECOND ONE, MAYBE TAKE IT IS FIFTH ONE UNFORTUNATELY CAUSES PERMANENT INJURY. SOME WHICH IS RECOGNIZED, SOME WHICH IS NOT. IT IS MY UNDERSTANDING A LOT OF TIMES THEY'RE FINDING AFTER THE ATHLETE HAS PASSED AWAY DURING THE AUTOPSY PROCESS, CTE, IS THAT -- WELL YOU CAN DO OBVIOUSLY THE AUTOPSY POSTMORTEM EXAMINATIONS OR OCCASIONALLY BRAIN SCANNING USUALLY MORE THE AUTOPSY AND THEY'LL SEE CHANGES WITHIN THE BRAIN THAT HAVE BEEN OCCURRING FOR YEARS. THIS IS WHAT THEY CALL A CHRONIC TRAUMATIC ENCEPHALOPATHY? THAT'S A RARE CONDITION BUT A CONDITION SUCH THAT USUALLY NOT THE FIRST THAT CAN BE THE FIRST OR SECOND EVENT OR AN EVENT TO WHERE CONCUSSION BUT THE PATIENT DIDN'T FULLY RECOVER. SUCH AS MAYBE THEY WERE RELEASED TO PHYSICAL ACTIVITY TOO SOON AND THE BRAIN HAS A DRAMATIC SWELLING OR INFLAMMATORY TYPE OF EFFECT SUCH THAT THERE'S CATASTROPHIC PROBLEMS. I GUESS THAT'S WHAT THEY SEE IN SOME FOOTBALL PLAYERS THAT PASSED WAY WAY. CHRONIC ENCEPHALOPATHY HAS TO DO WITH THOSE CUMULATIVE EFFECTS AS YOU MENTIONED, THROUGH REPEATED BLOWS TO THE HEAD. OR REPEATED INJURIES AND MAYBE THEY DIDN'T FULLY RECOVER BEFORE THEY WERE ALLOWED TO GO BACK. WHEREAS THERE ARE SUDDEN -- CERTAIN SUDDEN EVENTS THAT CAN CAN OCCUR THAT A PATIENT CAN DO POORLY AFTER THE FIRST CONCUSSION. SO I GUESS KIND OF DEPENDS UPON THE INDIVIDUAL SITUATION AND PERHAPS THE PERSON. IT DOES. IT CAN CAN CAN. ARE MEN OR WOMEN EITHER OR, MORE PRONE TO CONCUSSION? I THINK THE YOUNG MEN ARE OFTEN MORE ADVENTUROUS AND WOMEN PLAY SPORTS AS WELL BUT SOME OF THE I GUESS YOU WOULD SAY RISK TAKING BEHAVIORS WHETHER DRIVING THE WAY THEY SHOULDN'T OR THE HIGH VELOCITY INJURY YOU CAN SEE WITH THE SPORTS, LEAVES SOME MEN MORE PRONE TO HAVE THOSE INJURIES BUT ABSOLUTELY AS YOU MENTIONED WITH YOUNGER CHILDREN, OR SOME OF THE SPORTS THAT WOMEN PARTICIPATE IN ACROSS SOCCER, VOLLEYBALL YOU SEE CONCUSSIONS IN THOSE GROUPS AS WELL. ARE CHILDREN MORE LIKELY TO GET A CONCUSSION THAN ADULT? THEY HAVE A YOUNG BRAIN THAT'S STILL GROWING, IN SOME RESPECTS. BUT I THINK IT'S THE SAME IDEA IN THAT THEY CAN HAVE THE SAME INJURY AN ADULT CAN, USUALLY CAN RECOVER MORE QUICKLY BUT DEPENDS ON THE SEVERITY OF THE INCIDENT. I HAVE READ SOMEWHERE A LOT MAKES A DIFFERENCE ON HOW STRONG YOUR NECK IS. THAT'S WHY THERE ARE A LOT OF NOTE NOTORIETY WITH SOCCER THESE DAYS. THERE'S NOTARITY TO SAY IS IS HITTING THE BALL A PROBLEM BECAUSE YOU HAVE YOUNGER KIDS THAT ARE PARTICIPATING IN THESE SPORTS, PARTICULARLY SOCCER, MAYBE EVEN VOLLEYBALL, AND DO THEY HAVE THE NECK STRENGTH, SO TO SPEAK OR EVEN THE MUSCULAR STRENGTH IN GENERAL TO BE ABLE TO ABSORB THAT TYPE OF HIT TO THE HEAD. IN YOUR JUDGMENT, SHOULD KIDS BE HEADING A -- HITING A SOCCER BALL? THERE'S OBVIOUSLY CERTAIN TECHNIQUE IT IS SOCCER COACH ALSO TELL YOU YOU'RE MAYBE MORE PRONE TO HAVE INJURY THAN OTHERS BUT NO ONE REALLY KNOWS THAT. SO IT SHOULD BE AVOIDED WHEN POSSIBLE BUT IT'S A GAME THAT'S ALWAYS GOING TO HAVE HEADING SO YOU LOOK AT A CERTAIN AGE WHETHER 8 YEARS OLD, TEN YEARS OLD, NO ONE HAD THE EXACT AGE TO SAY LET'S SAY THAT THEY CAN BE RELEASED TO HEADING A BALL BUT YOU HAVE TO BE MORE CAREFUL DEPENDING ON AGE. GOING TO FOOTBALL ISSUE, I KNOW THIS IS SOMETHING THAT PROBABLY CONCERNS A LOT OF PARENTS IS THEIR YOUNGSTER WANTS TO PLAY FOOT BA. ONCE AGAIN, IN YOUR MEDICAL JUDGMENT, DO YOU HAVE AN AGE THAT YOU SAY MIGHT NOT LET MY KID PLAY TACKLE FOOTBALL UNTIL? IT'S TOUGH. IT'S TOUGH BECAUSE AGAIN, CERTAIN KIDS ARE MORE PHYSICALLY ADVANCED THAN OTHERS. AND CERTAIN CHILDREN HAVE MORE PHYSICAL ATTRIBUTES THAT THEY HAVE KNOWLEDGE TO TAKE A HIT THIS WAY COMPARED TO ANOTHER CHILD WHO DOESN'T HAVE EXPERIENCE. SO I WOULDN'T SAY THERE'S A CERTAIN AGE, I THINK IT'S ALL IN TECHNIQUES OF THE SPORT AND THE EDUCATION THAT THESE CONCUSSIONS CAN OCCUR AND WHEN IN DOUBT CERTAIN ACTIVITIES SHOULD BE DELAY AD LITTLE BIT. PROBABLY WHEN YOU AND I WERE COMING UP IT WAS THE OLD THING WELL YOU GET YOUR BELL RUNG. GET BACK IN THERE OR WHATEVER. BUT IN TODAY'S WORLD, NOW THAT WE KNOW THAT THIS IS SERIOUS BUSINESS WHAT SHOULD COACHES AND PARENTS LOOK FOR AFTER A KID QUOTE UNQUOTE GETS HIS BELL RUNG? IT'S AN IMMEDIATE CHANGE YOU KNOW THERE WAS SOME TYPE OF BLOOD WHETHER A HEADING EVENT OR A TACKLE, AND THAT TYPE OF EVENT WOULD LEAVE YOU MORE PRONE TO SOME INJURY. OBVIOUSLY IF A CHILD IS NOT ACTING NORMALLY, THEY SHOULD BE IMMEDIATELY REMOVED FROM THE FIELD, BE ASSESSED ON THE SIDELINES. AND BE HELD FROM THAT ACTIVITY UNTIL DEFINITELY THEY'RE BACK TO THEIR NORMAL SELF-BUT REALLY THE REST OF THE GAME. IF THERE'S ANY DOUBT THEY HAD ANY TYPE INJURY LIKE THAT. AND AFTER WEEK OR TWO OR THREE WEEKS, SHOULD PARENTS, ANY PARTICULAR THING THEY SHOULD BE LOOKING FOR? WE HAVE WHAT'S CALLED WHICH IS FORTUNATELY BECAUSE OF ALL THIS NOTORIETY NOT FOR GOOD REASONS WE HAVE PROTOCOLS CALLED GRADUATED PROTOCOLS TO WHERE CHILDREN WHETHER IT BE SOCIAL ACTIVITIES OR PHYSICAL ACTIVITIES, AND EVEN OF COURSE THE PROFESSIONAL ATHLETES THAT THEY GO ALONG THESE PROTOCOLS TO GRA ACTUALLY INCREASE ACTIVITY OR EVEN SOCIAL ACTIVITIES, TO SEE WHERE THEY MAYBE WITHIN THAT RANGE OF GETTING BACK TO THEIR NORMAL SELF. IF YOU HAD A SITUATION WHERE EITHER IN PEE WEE OR HIGH SCHOOL FOOTBALL WHATEVER WHERE A CHILD SUSTAINS A CONCUSSION, SEEMINGLY1 HEALS UP THEN HAS ANOTHER ONE1 QUICK THEREAFTER, WHAT DOES THAT1 TELL YOU?1 IT TELLS YOU THE BRAIN MAY1 NOT HAVE HEELED THE WAY YOU1 THOUGHT IT WAS GOING TO.1 WHILE CHILDREN ARE RESILIENT AND1 CAN RECOVER INJURY YOU WOULDN'T1 EXPECT THAT BRAIN IS STILL PRONE1 TO HAVE A WORSE INJURY THAN NEXT1 TIME.1 SO WHEN IN DOUBT BASED ON1 PROTOCOLS WE HAVE MENTIONED THAT1 THE CHILD SHOULD NOT BE RELEASED1 TO EVEN BASIC PHYSICAL ACTIVITY1 UNTIL THEIR SYMPTOM-FREE.1 THAT EVEN HAS TO DO IN THIS DAY1 AND AGE WITH TEXTING OR TALKING1 ON THE PHONE, USING COMPUTERS1 GOING TO THOSE ACTIVITIES OR1 HIGH LEVEL SCHOOL WORK CHILDREN1 MAY HAVE TO GO VERY SLOWLY AND1 PROGRESS TO THOSE THINGS AS WELL1 BEFORE EVEN THE PHYSICAL1 ACTIVITY CAN OCCUR.1 HOW WOULD WOULD THAT AFFECT?1 THE BRAIN, YOU'RE CHALLENGING1 THE BRAIN AND WE TAKE FOR1 GRANTED EVERY DAY WITH WE WALK1 AROUND AND DO THINGS, WE TEXT,1 WE DO THINGS THAT YOU WOULD NOT1 THINK WOULD STRETCH YOUR BRAIN1 -- STRESS YOUR BRAIN BUT THAT IT1 DOES IN THE SETTING OF ACUTE1 NEUROLOGIC INJURY.1 SO IF A CHILD CAN'T DO BASIC1 SCHOOL WORK YOU CAN IMAGINE THE1 RETURN TO PHYSICAL ACTIVITY,1 PARTICULARLY A CONTACT SPORT1 WILL BE DIFFICULT TO DO AND MAY1 LEAVE THEM AT RISK FOR A1 PERMANENT BRAIN INJURY OR A MILD1 INJURY.1 YOU SAY PERMANENT BRAIN1 INJURY.1 WHAT ARE SOME OF THE CONCERNS1 THAT PEOPLE SHOULD HAVE THAT1 HAVE HAD REPEATED CONCUSSIONS AS1 FAR AS WHAT MAY LIE IN THE1 FUTURE?1 I THINK EVERYONE HEARD OF THE1 OBVIOUS THINGS LIKE SOMEONE LOST1 CONSCIOUSNESS AND THEY WOKE UP1 AND NOT AS SHARP AS WHAT THEY1 WERE, YOU CAN MAGNIFY THAT EVEN1 TO OTHER ACTIVITIES SUCH AS YOUR1 ATTENTION TO CONCENTRATION,1 BEHAVIOR, IT CAN AFFECT SLEEP,1 YOUR BEHAVIORAL TYPE SKILLS,1 THEN THERE'S INSOMNIA AND1 WALKING ISSUES.1 IT'S THOSE COGNITIVE ISSUES LIKE1 ATTENTION TO CONCENTRATION AN1 BEHAVIOR, THAT ARE BIGGEST TO1 NOTICE.1 I READ QUITE A BIT MANY OF1 THESE NFL PLAYER VERSUS SAID MY1 MEMORY IS NOWHERE NEAR WHAT IT1 USED TO BE.1 WE'RE NOT TALKING ABOUT 70 YEARS1 OLD.1 THEY'RE IN THEIR 40s.1 YOUR THOUGHTS ON THAT.1 ABSOLUTELY, MEMORY SHORT TERM1 MEMORY, NOT USUALLY LONG TERM1 MEMORY CAN BE PART OF THAT.1 IS THERE ANYTHING YOU CAN DO1 TO TRY TO CORRECT THAT?1 IF YOU DISCOVER IT AHEAD OF1 TIME?1 I THINK THE TENDENCY WOULD BE1 TO GO AHEAD AND GET THEM BACK IN1 THE GAME, GET THEM BACK IN1 SCHOOL AS QUICKLY AS POSSIBLE.1 IT'S ACTUALLY COULD BE CONTRARY,1 IT COULD BE THAT GRADUALLY GET1 THEM BACK IN SCHOOL WORK, BASIC1 PHYSICAL ACTIVITY SLOWLY AND SEE1 HOW THEY DO.1 YOU WERE TALKING A MINUTE AGO1 ABOUT MOHAMMED ALI AND THE1 REPEATED HEAD BLOWS AS A BOXER.1 I THINK HE HAS PARKINSON'S1 DISEASE.1 DO YOU THINK THAT'S RELATED TO1 HEAD INJURY?1 IT'S DIRECTLY RELATED TO IT.1 HE HAS A UNIQUE FORM OF1 PARKINSON'S THAT'S RELATED THE1 TRAUMATIC BRAIN INJURY AND1 ABSOLUTELY AS YOU ASKED BEFORE,1 THAT WAS A CUMULATIVE EFFECT1 THAT WAS IRREVERSIBLE.1 SO HE MIGHT HAVE HAD SOME KIND1 OF TENDENCIES TO DEVELOP THAT1 NORMALLY BUT I THINK YOU HAVE TO1 SAY THAT THAT HEAVILY1 CONTRIBUTED TO IT1 DO YOU THINK REPEATED BRAIN1 INJURIES WOULD INCREASE YOUR1 CHANCE TO GET ALZHEIMER'S?1 I THINK ALONG WITH1 PARKINSON'S DEMENTIA, MANY1 DIFFERENT SORTS COULD BE RELATED1 TO THAT.1 ALZHEIMER'S BEING ONE OF THOSE.1 INTERESTING.1 I GUESS AS THIS -- THE POSITIVE1 THING ABOUT THIS IN THE NFL, IT1 WILL FOCUS MORE RESEARCH ON THE1 TOPIC FOR SURE.1 IT DEFINITELY WILL IN ALL1 SPORTS YOU SEE IN THE NHL, YOU1 SEE IT IN THE NBA, SOCCER AND1 OUR ACADEMY OF NEUROLOGY WE HAVE1 A SPORTS SECTION FOR SPORTS1 CONCUSSION, SPORTS INJURY.1 AS GOOD AS THAT SOUNDS, THAT1 SURE HELPED TO DEVELOP PROTOCOLS1 AND STANDARDIZE THINGS.1 I THINK COLT MCCOY WAS RELEASED1 A GAME OR TWO EARLY SO YOU HAVE1 TO HAVE INDEPENDENT ASSESSMENT1 OCCASIONALLY.1 AND THE PLAYERS LIKE IT OR NOT1 HAVE TO GIVE A LITTLE BIT OF1 INPUT TO SAY HOW DO YOU FEEL AND1 WHEN IN DOUBT YOU HAVE TO TAKE1 IT OUT OF THEIR HANDS WHICH WHEN1 YOU HAVE FINANCES AND OTHER1 ISSUES INVOLVED IT'S DIFFICULT.1 AND PARTICULARLY WHEN YOU GET1 DOWN ON THE HIGH SCHOOL LEVEL,1 THAT'S WHEN THERE SHOULD BE NO1 QUESTIONS ASKED BECAUSE THESE1 KIDS AREN'T PAID AT1 3 MILLION-DOLLAR A YEAR.1 TOUGH PROTECT THEM FOR THE1 FUTURE.1 I SIGH YOUNG KIDS IN CLINIC I1 TELL THEM THAT, THIS IS FOR YOUR1 FUTURE, NOT JUST IN SPORTS BUT1 FOR ACADEMICS IN YOUR CAREER AND1 THE IDEA IS IF WE CAN DO THIS1 THE RIGHT WAY THEY CAN BE1 RELEASED LATER ON IN THE WAY1 THEY WANT TO PARTICIPATE.1 LET ME SWITCH GEARS A SECOND.1 I KNOW ANOTHER AREA OF EXPERTISE1 FOR YOU, STROKE.1 WHAT IS A STROKE?1 THERE'S A COUPLE OF TYPES OF1 STROKE.1 THAT'S A NUMBER OF DIFFERENT1 TYPES BUT THE BIGGEST CATEGORIES1 ARE ISCHEMIC STROKE, BLOCKAGE OF1 ARTERY THAT LEADS TO PERMANENT1 BRAIN INJURY OR MILD BRAIN1 INJURY, SOMETIMES IF YOU'RE1 FORTUNATE ENOUGH IT'S TRANSIENT1 AND WE CAN TALK ABOUT THAT AS1 WELL OR A BLEEDING TYPE STROKE1 WHERE YOU HAVE HEMORRHAGIC1 STROKE WHERE YOU HAVE A BURSTING1 BLOOD VESSEL.1 WHAT'S THE DIFFERENCE BETWEEN1 THAT AN ANEURYSM?1 ANEURYSM HAS TO DO WITH A1 HEMORRHAGIC OR BLEEDING TYPE1 STROKE, WHERE YOU HAVE ABNORMAL1 ARTERY USUALLY BECAUSE OF THINGS1 LIKE HIGH BLOOD PRESSURE,1 SMOKING THAT DUE TO WEAR AND1 TEAR OF THAT ARTERY IT BECOMES1 MAL FORMS AND BURSTS AND CAN1 CAUSE CATASTROPHIC BRAIN INJURY1 OR EVEN DEATH.1 WHICH ONE IS WORSE FOR YOU?1 I THINK IT DEPENDS ON THE1 LOCATION OF THE INJURY.1 IT DEPENDS ON THE SIZE OF THE1 BLEEDING OR THE SIZE OF THE1 ISCHEMIC STROKE, TERRITORY OF1 THE BRAIN IT EFFECTS.1 FORTUNATELY WE HAVE TREATMENTS1 FOR BOTH BUT DEPENDING ON THE1 TYPE OF STROKE YOU MAY HAVE,1 THEN THERE'S DECISION MAKING1 WITH THAT.1 I MENTIONED OFF THE TOP OF1 THE SHOW THAT THE STROKE1 ASSOCIATION SAYS A GREAT MOVE1 STROKES ARE PREVENTABLE.1 SURE.1 WHY IS THAT?1 THE BASICS ARE SIMPLISTIC,1 ARE THE RISK FACTORS M THE1 COMMON RISK FACTORS ARE HIGH1 BLOOD PRESSURE, DIABETES, HIGH1 CHOLESTEROL, SMOKING, BLOCKAGE1 OF CAROTID IRREGULAR HEART BEAT1 SUCH AS ATRIAL FLUTTER.1 IF WE CAN CONTROL THOSE RISK1 FACTORS, IT DOESN'T PREVENT ALL1 STROKES BUT LIMIT IT IS SEVERITY1 NOT ONLY SEVERITY BUT PREVENTION1 OF SOME STROKES IN GENERAL.1 TAKE THE LIFESTYLE CHOICES1 AWAY.1 WHAT WOULD CAUSE FOR THE OTHER1 20% OR SO, WHAT WOULD CAUSE THAT1 TO HAPPEN?1 IS IT GENETICS?1 YOU DO HAVE CERTAIN1 SITUATIONS LIKE YOU SAID WITH1 ANEURYSMS THAT SOMEONE MAYBE1 PRONE TO FORM ANEURYSMS AND1 SOMETIMES WE DO SURVEILLANCE OR1 PRE-TESTING TO LOOK FOR THOSE1 THINGS.1 AND SOME PEOPLE ARE BORN WITH1 CERTAIN ANOMALIES THEY'LL NEVER1 KNOW WILL HAPPEN UNTIL1 UNFORTUNATELY A CATASTROPHIC1 EVENT HAPPENS BUT HONESTLY IT1 DOES COME DOWN TO RISK FACTORS1 SOME WHICH YOU'RE BORN WITH1 BECAUSE YOUR FAMILY WITH IT,1 THAT DOESN'T MEAN YOU'RE GOING1 TO HAVE THE SAME THING BUT AT1 LEAST YOU'RE MORE WARE OF IT TO1 PREVENT IT.1 ARE THERE TESTS YOU CAN RUN1 TO SEE IF YOU'RE POSSIBILITY IT1 WOULD AFFECT YOU?1 THERE'S CERTAIN GENETIC TESTS1 FOR CERTAIN TYPE OF THINGS AND1 CERTAIN BRAIN SCANS WE CAN DO,1 YOU CAN DO BASIC TESTING FOR1 THINGS LIKE ANEURYSMS.1 OR JUST AT CERTAIN AGE GROUPS1 YOU CAN DO TESTING TO SEE IF1 THERE'S A BLOCKAGE OF A CAROTID1 ARTERY OR THOSE TYPE THINGS.1 IS THERE A RESULT OF THUMB1 LIKE YOU REACH A CERTAIN AGE AND1 THEY SAY DO THIS OR THAT TEST,1 SAME THING WHEN IT COMES TO YOUR1 BRAIN?1 I THINK EVERYONE IN TERMS OF1 RISK FACTORS ARE DIFFERENCE.1 THE MEDICATIONS THEY'RE ON AND1 GENETICS AS WELL.1 SO THERE'S NO MAGIC AGE BECAUSE1 WE SEE STROKES IN UNFORTUNATELY1 YOUNG PATIENTS.1 WE SEE THEM IN PATIENTS THAT1 HAVE DONE WELL BUT THEN THEY1 HAVE THEIR FIRST STROKE AT AGE1 88.1 SO AGAIN AS SIMPLISTIC AS IT IS,1 THAT YOU WANT TO LOOK AT RISK1 FACTORS AND I WOULD SAY AROUND1 AGE 60 OR SO, A CAROTID1 ASSESSMENT IS PROBABLY A GOOD1 IDEA AND THEN IT SEEMS CRUDE1 ALSO BUT WE HAVE TO GO ON THE1 SYMPTOMS OF THE PATIENT THOUGH1 WE KNOW THAT WE'RE GOING TO1 CONTROL THOSE RISK FACTORS, HAVE1 THEY HAD ANY RECENT SYMPTOMS1 THAT MAY LEAD US TO FURTHER1 TESTING.1 WHAT SYMPTOMS MIGHT ALARM1 YOU?1 IN TERMS OF ISCHEMIC STROKE1 WE TALKED ABOUT HEMORRHAGIC A1 LITTLE BIT BUT ISCHEMIC, THERE'S1 A CONDITION CALLED A TIA.1 IT'S A TRANSIENT ISCHEMIC1 ATTACK, A WARNING SIGN OF A1 STROKE.1 SO YOU WANT TO PREVENT THAT1 OBVIOUSLY OR YOU WANT TO LOOK1 INTO SYMPTOMS BECAUSE IF YOU1 DON'T IT MAY CAUSE AN ACTUAL1 STROKE.1 SO IF SOMEONE HAS SUDDEN1 WEAKNESS OR NUMBNESS ON ONE SIDE1 OF THE BODY, SUDDEN SPEECH1 DIFFICULTY, SUDDEN VISION LOSS1 OR BALANCE PROBLEMS, ANYTHING1 THAT'S SUDDEN, NEVER HAPPENED1 BEFORE, NOT GOING AWAY AFTER A1 REASONABLE PERIOD OF TIME, 10,1 15, 30 MINUTES, THAT'S WHEN YOU1 WANT TO SEEK MEDICAL ATTENTION1 SOONER THAN NOT.1 THEN HEADACHE GOES INTO THAT AS1 WELL.1 I SEEK MEDICAL ATTENTION IF1 I'M HAVING TIA, WHAT DO YOU DO1 AT THAT STAGE IN THE GAME TO1 PREVENT FROM GOING FARTHER?1 USED TO BE THE OLD THING1 DIAGNOSE KNOW, AWDIOSE THAIRKS1 COME WITH WITH A SYMPTOM AND YOU1 DO BASIC TESTING AND THEY CAN GO1 OUT OF THE EMERGENCY ROOM BUT WE1 WILL ADMIT THESE PATIENTS WITH1 THE SUDDEN SYMPTOMS, ADMIT THEM1 TO THE HOSPITAL, DO TESTING,1 SUCH AS MRI SCAN, CAROTID1 ULTRASOUND, ULTRASOUND OF THE1 HEART, BASIC BLOOD WORK,2 WATCHING THEIR MONITOR AND OTHER2 TESTS AS WELL.2 IF IT LOOKS LIKE THEY'RE2 LEADING UP TO A STROKE, WHAT CAN2 YOU DO TO PREVENT?2 IT2 IF WE THINK SOMEONE COMES IN2 WITHIN A CERTAIN TIME PERIOD, IN2 THIS DAY AN AGE UP TO 8 HOURS2 BUT IN PARTICULAR UP TO 4 AND A2 HALF HOURS WE CAN GIVE CLOT2 BUSTING MEDICATIONS, THE2 MEDICATION IS CALLED TPA.2 THAT IS APPROVED UP TO AT LEAST2 THREE HOURS SOMETIMES FOUR HOURS2 TO BREAK UP THE CLOT WHEN2 ADMINISTERED BY IV.2 AT SACRED HEART WE HAVE OPTIONS2 TO DO INTERVENTIONAL CARE, WE GO2 THROUGH THE GROIN WITH A2 CATHETER, UP TO THE BRAIN, AND2 GIVE THE SAME MEDICATIONSER2 OTHER TYPE MEDICATIONS OR DO2 INTERVENTIONAL PROCEDURES TO2 PULL OUT CLOTS IN THE BRAIN.2 SO THE KEY IS BEING ALERT2 WHAT'S GOING ON WITH YOUR BODY.2 BE AWARE OF THE SYMPTOMS,2 SEEK MEDICAL ATTENTION, DON'T2 DRIVE YOURSELF TO THE HOSPITAL.2 CALL 911, GET THERE QUICKLY AND2 FROM THERE IT'S ON US THAT'S OUR2 JOB AFTER THAT.2 TELENEUROLOGY, WHAT IS IT?2 IT'S A SYSTEM THAT'S BEEN2 AROUND FOR A WHILE.2 PEOPLE GET ON SKYPE ALL THE2 TIME, THEY TALK TO EACH OTHER,2 THAT'S EXPANDED GREATLY WITH THE2 NUMBER OF COMPANIES IN THAT2 THERE'S A ROLLING COMPUTER CART2 IN A REMOTE ENERGY ROOM, I CAN2 DO IT ON A PHONE OR LAPTOP TO2 WHERE YOU'LL HAVE ACCESS TO SEE2 THAT PATIENT ON A WEBSITE TO2 EXAMINE THEM REAL TIME.2 AND SO SOME OF THESE SMALLER2 HOSPITALS THAT DON'T HAVE A2 NEUROLOGIST OR STROKE2 SPECIALIST, YOU CAN GIVE THEM2 IMMEDIATE CONSULTATION AND MAKE2 RECOMMENDATIONS TO THE HOSPITAL2 TO PROVIDE CERTAIN LEVELS OF2 CARE TO INCLUDE BRING THEM TO2 OUR HOSPITAL.2 SO IT'S BEEN A GREAT EXPANSION2 FOR OUR STROKE CENTER IN SANTA2 ROSA, CRESTVIEW, DESTIN, NOW2 PANAMA CITY.2 WHAT EXCITES YOU ABOUT2 TECHNOLOGY AS WE LOOK AHEAD IN2 THE MEDICAL FIELD?2 I THINK THE TELENEUROLOGY IS2 A GREAT EXAMPLE AND YOU CAN EVEN2 EXPAND BACK TO CONCUSSION ON THE2 FIELD.2 YOU CAN EXPAND IT TO OTHER2 COUNTRIES.2 WE CAN COLLABORATE WITH OTHER2 SPECIALISTS, OTHER COLLEAGUES,2 THAT'S SOMETHING TO BE HONEST IS2 SIMPLE AS THOSE THINGS YOU CAN2 COLLABORATE P AN TREAT PATIENTS2 RIGHT THEN AND THERE.2 SO WE CAN COME UP WITH FANCY MRI2 SCANS OR OTHER IMAGING2 TECHNIQUES WHICH CERTAINLY THOSE2 ARE EXCITED AND THOSE WILL GET2 BETTER AN EXPAND OUR FIELD, BUT2 I THINK THE NETWORKING SO TO2 SPEAK OF NOT ONLY IN OUR2 COMMUNITY BUT REGION AND2 NATIONALLY TO BE ABLE TO CONNECT2 THOSE DOTS TO GET PEOPLE IN2 TOUCH WITH THE SPECIALIST OR2 TECHNOLOGY TO GET THE BEST CARE2 RIGHT THEN AND THERE, EVEN IF2 IT'S A SMALL HOSPITAL.2 AMAZING WHAT TECHNOLOGY IS2 DOING FOR US, ISN'T IT?2 IT IS.2 IT REALLY S. I WANT TO COME2 BACK TO SOMETHING TALKING ABOUT2 THE STROKES FOR A SECOND AND2 KIND OF TIE IN WITH CONCUSSIONS.2 I'M -- MY MEMORY WAS JOGGED THE2 FOOTBALL PLAYER TEDDY BRUSKI WHO2 PLAYED FOR NEW ENGLAND PATE I2 DON'T THINKS -- PATRIOTS HAD A2 STROKE.2 DO YOU THINK THAT HAD ANYTHING2 TO DO WITH THE HITS?2 CAN CAN THE TWO WORK TOGETHER?2 I IF I'M NOT MISTAKEN I'M2 PRETTY FAMILIAR WITH HIS CASE2 BUT HE HAD A STRUCTURAL PROBLEM2 WRONG WITH HIS HEART AND SURE2 THE PHYSICAL ACTIVITY HE WAS2 GOING THROUGH, THAT PROBABLY MAY2 HAVE TIPPED HIM OVER THE EDGE TO2 LEAD TO THE STROKE BUT IT WASN'T2 THE CONCUSSION PER SE.2 SO IT WAS A DIFFERENT --2 DIFFERENT ISSUE THAT CAUSED THE2 STROKE.2 SO WE COULDN'T TIE2 CONCUSSIONS AND STROKES TOGETHER2 PER SE.2 NOT IN THIS CASE.2 TALK ABOUT, I WANT TO GO BACK2 BECAUSE I THINK THIS IS2 IMPORTANT AND MORE AND MORE2 MEDICAL INFORMATION COMES OUT2 AND IT SEEMS A LOT OF HOW OUR2 HEALTH ENDS UP IS DEPENDENT UPON2 US FROM A LIFESTYLE CHOICE.2 I WANT TO GIVE MYSELF THE LEAST2 CHANCE OF HAVING A STROKE2 LIFESTYLE.2 WHAT SHOULD I BE DOING?2 THE TYPICAL DIET THAT IN THE2 SOUTH, WE HAVE A DIFFICULTY OR2 DIFFICULTY CONTROLLING IS JUST2 COMMON SENSE, FRUITS AND2 VEGETABLES THE WAY YOU PREPARE2 FOODS, SMALLER PORTIONS OVER2 LARGER PORTIONS.2 BETTER FOUR MEALS A DAY THAN TWO2 MEALS A DAY.2 BASIC EXERCISE EVERY WEEK, HALF2 AN HOUR A DAY MAYBE 4 TO 5 TIME2 AS WEEK, THEN AGAIN REINFORCED2 IT BUT ALL THE RISK FACTORS WE2 TALKED ABOUT ALREADY.2 LIKE SMOKING AND THINGS LIKE2 THAT.2 SMOKING, EXCESSIVE ALCOHOL2 USE, AND THEN THE RISK FACTORS2 WITH HIGH BLOOD PRESSURE, AND2 HIGH CHOLESTEROL AND DIE BEA2 TES.2 I SAW -- DIABETES.2 I SAW A MAP, U GUESS IT WAS A2 STROKE MAP THAT THERE'S CERTAIN2 PART OF THE COUNTRY THAT HAS2 MORE STROKES THAN?2 WHY?2 WE LIVE IN THE STROKE BELT,2 SOME MAY HAVE TO DO WITH ACCESS2 TO MEDICAL CARE, SOME OF THOSE2 MORE INDIGENT AREAS BUT THAT'S2 EVERYWHERE IN THE COUNTRY AS2 WELL.2 IT MAY COME DOWN TO THINGS LIKE2 LIFESTYLE DECISIONS.2 FOOD PREPARATION, OUR DIET,2 EXERCISE, ABILITIES AND THOSE2 THINGS MAYBE GEOGRAPHIC.2 KIND OF INTERESTING.2 AS FAR AS EXERCISE ANY2 PARTICULAR TYPE OF EXERIZE IS2 BETTER, ONE OVER THE OTHER?2 I THINK AS WE GET OLDER WE2 TRY TO THINK WE'LL LIFT WEIGHTS2 THE WAY WE DID BEFORE, IT WON'T2 HAPPEN.2 KNOW IT CAN'T FOR ME.2 BUT I THINK THE CARDIO EXERCISE2 IS -- AGAIN MAYBE AT LEAST A2 HALF HOUR DAY, FAST WALKING,2 FASTER WALK -- RUNNING IF YOU2 CAN, BUT IT'S JUST LISTENING TO2 YOUR BODY AND DOING WHAT YOU2 THINK YOU CAN DO.2 CONSISTENCY, RIGHT?2 RIGHT.2 SURE.2 YOU DON'T HAVE TO RUN A2 MARATHON.2 NO.2 WITHIN THE INDIVIDUAL WHATEVER2 THEY FEEL LIKE THEIR TOLERANCE2 IS.2 IF SOMEONE TWOONTS KNOW MORE2 ABOUT NUMBER ONE CONCUSSIONS AND2 STROKES, DO YOU HAVE A WEBSITE2 THAT YOU WOULD RECOMMEND THEY GO2 TO?2 THE AMERICAN HEART2 ASSOCIATION IS GOOD FOR -- GOOD2 STROKE WEBSITE AND THE AMERICAN2 ACADEMY OF NEUROLOGY HAS A2 CONCUSSION SUBDIVISION WITHIN2 THAT THAT YOU CAN PICK UP A LOT2 OF THESE THINGS.2 OKAY.2 WILL THAT GIVE COACHES AND2 PARENTS KIND OF AN IDEA OF2 PROCEDURE ON THE FIELD?2 THE ACADEMY WEBSITE HAS A2 GOOD SERKS ON QUESTIONS AND THEN2 ON EDUCATION IN THAT WAY.2 IT'S A GREAT WEBSITE FOR2 COACHES, FOR PARENTS AND FOR THE2 CHILDREN THEMSELVES.2 THEN SACRED HEART STROKE2 CENTER, DO YOU HAVE A WEBSITE2 WITH INFO ON IT?2 THE SACRED HEART WEBSITE2 ITSELF HAS A NEUROSCIENCE2 DIVISION ON THERE THAT'S WHERE2 THE STROKE WEBSITE SHOULD BE,2 PRETTY INFORMATIVE AS WELL.2 INTERESTING CONVERSATION.2 WE CERTAINLY APPRECIATE YOU2 SPENDING TIME WITH US.2 SURE, THANK YOU VERY MUCH.2 APPRECIATE IT.2 DR. TERRY NEILL, THE MEDICAL2 DIRECTOR FOR THE SACRED HEART2 REGIONAL STROKE CENTER,2 OBVIOUSLY HE'S A NEUROLOGIST, WE2 CERTAINLY APPRECIATE HIM2 SPENDING TIME WITH WITH US2 TODAY.2 BY THE WAY, IF YOU WOULD LIKE TO2 CATCH ON OUR PAST CONVERSATIONS2 YOU CAN DO SO AT2 WSRE.ORG/CONVERSATIONS.2 AND OF COURSE WE'RE ON FACEBOOK2 AS WELL.2 ALL YOU HAVE TO DO IS SEARCH OUT2 CONVERSATIONS WITH JEFF WEEKS2 AND YOU CAN LIKE US, LOVE US,2 SAY HELLO, WHATEVER YOU NEED TO2 DO.2 WE'D LOVE TO HEAR FROM YOU.2 I TRULY HOPE YOU ENJOYED THE2 BROADCAST.2 AND WE GREATLY APPRECIATE YOU2 WATCHING.2 I'M JEFF WEEKS, TAKE GOOD CARE2 OF YOURSELF, WE'LL SEE YOU SOON.2 ??2 [CAPTIONING PROVIDED BY WSRE-TV2 AND COASTAL CAPTIONING]2 ??2 SUPPORT FOR THIS PROGRAM IS2 PROVIDED IN PART BY THESE2 CORPORATE SPONSORS.