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 Natural Awakenings Lancaster-Berks

Fast Reaction, Education Key to Stroke Treatment and Prevention

Jun 30, 2017 12:25AM ● By Sheila Julson

According to the American Heart Association and the American Stroke Association (AHA/ASA), stroke is the fifth leading cause of death in the U.S., and it’s a major contributor to adult disability.

Of the three types of stroke, the most common is ischemic, occurring when a clot cuts off blood flow to an area of brain, depriving brain cells of needed oxygen and resulting in damaged brain tissue. A hemorrhagic stroke occurs when a patient suffers a bleed in the brain.

A third type of stroke, transient ischemic attack (TIA)—also referred to as a mini stroke or warning stroke—is when one experiences stroke symptoms such as slurred speech, difficulty speaking, paralysis or numbness to parts of the body and even changes in vision or balance for a brief period of time. These TIA symptoms often resolve within minutes or hours; however they should be evaluated as a medical emergency. Stroke symptoms left unevaluated may result in long-term cognitive defects, permanent speech problems or difficulty performing daily tasks.

Through education, medical advancements and training, and steadfast efforts to get Americans to adapt to healthy, lower-stress lifestyles, stroke is now treated more efficiently and even being prevented. Cesar Velasco, an Emergency Department Registered Nurse and Stroke Program Clinical Coordinator for Lancaster Regional Medical Center and the Heart of Lancaster Regional Medical Center, has been involved in the hospitals’ award-winning stroke program since 2015. Velasco shared information with Natural Awakenings about stroke warning signs and how quick reaction is key to survival.

What are some signs of stoke?

We recommend members of the community to use the AHA/ASA early stroke recognition tool which is an acronym called F.A.S.T. “F” stands for facial droop or numbness; “A” stands for arm weakness or numbness; “S” is a change in speech—slurred speech, inability to answer questions, or difficulty in understanding what is being said.

The “T” is for time—time is of the essence. It’s important to call 911 and seek medical attention for any of these symptoms immediately. Unfortunately during the first year I took over as Stroke Program coordinator, about 40 percent of stroke patients drove themselves to the hospital. Part of that was due to lack of education in the community. We’ve found that appropriate patient education really reduces the risk of stroke, or disability from stroke, if they’re more aware of what their risk factors are.

What are the major risk factors of stroke?

Know your numbers. High blood pressure is the highest risk factor for a stroke of any kind. Know your baseline cholesterol. Simply adjusting your diet and increasing your activity can improve cholesterol levels. Obesity is another risk factor. Poorly managed blood sugars in diabetics can also contribute to stroke. Smoking is another risk factor.

There are some things you cannot control, such as genetics. Also gender; women are at a higher risk of stroke than men. Some neurologists say that’s partly due to the hormonal changes women go through during life. Taking birth control can cause blood clots. African-Americans are at higher risk of having a stroke. Another demographic at a higher risk of stroke is the Hispanic/Latino community. Being of Hispanic heritage, I’m involved with the local Hispanic community’s radio station to provide education and outreach.

How has the Stroke Program at Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center been instrumental in treating and preventing stroke?

At both of our hospitals, we’ve established a strong Code Stroke Alert process. Activation begins in the field with our local EMS providers, who do a phenomenal job in the early recognition and management of our stroke patients. This saves valuable time in allowing us to prepare for a stroke patient who arrives by ambulance that may need immediate attention. The brain can age rapidly when it is deprived of oxygen and nutrients. Seconds go by and quickly turn into minutes, aging the brain by weeks. Research suggests that within an hour of having a stroke, the brain can age two to three years if treatment is not received in a timely manner.

The AHA/ASA recently awarded the Stroke Silver Plus Quality Achievement Award to our program. The award measures hospitals for the quality of care they provide to stroke patients—not only during the acute phase, but also during the steps of stroke recovery and prevention. Optimal stroke care includes patient and family education, providing resources for rehabilitation and understanding risk/symptom management.

What is your vision for growing the hospitals’ stroke program?

The goal for the program is to continue to provide the best possible care for our stroke patients at both of our hospitals. That involves continued training of our staff and use of advanced technology specific to stroke management. Our emergency department nurses and physicians are trained annually in acute stroke care and best practice methods. Since 2014, we have seen how internal employee education has effectively improved the ability of our hospital staff to recognize and treat stroke patients according to the AHA/ASA guidelines.

Expansion of our program this past year included the addition of our own in-house neurologist, Dr. James Pacelli. He has been a great addition to our program in providing stroke patient care in the acute setting and inpatient/outpatient continuum of care.

In addition, we continue to partner with Penn State Hershey Medical Center, who has given us easy access to their neurological team through a telemedicine device. It’s a computer on wheels that we can roll into any emergency department exam room and use at a patient’s bedside within 15 minutes of arrival. We can make contact with a neurologist through the phone and connect them visually through the computer screen so the doctor and the patient can see each other and conduct a live exam. That has expedited our ability to find appropriate measures of treatment since inception of our stroke program in 2014.

What are some additional things people can do to prevent stroke?

Keep tabs on your health and get an annual checkup with your family doctor, especially if you have existing risk factors for a stroke. The end result of not managing those factors could be a long-term disability.

Practice a healthy lifestyle. Decreasing stress and de-cluttering of the mind can be achieved with daily/routine physical activity. Take the time to slow down and realize what’s really important—taking care of ourselves and taking care of one another.

For more information about Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center, visit

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