Ka Wai Ola - Office of Hawaiian Affairs, Volume 33, Number 5, 1 May 2016 — Stroke awareness key in improving chances for better health outcomes in Hawaiʻi [ARTICLE+ILLUSTRATION]

Stroke awareness key in improving chances for better health outcomes in Hawaiʻi

By Don Weisman May is Stroke Awareness Month and your knowledge of stroke warning signs could save your life, or the life of your loved ones. Stroke is a disease where the arteries leading to and within the brain are suddenly blocked or ruptured, causing that part of the brain to be permanently damaged.

In fact, stroke is the leading cause of disability in the United States, and many people's lives are permanently affected by it. While stroke has fallen to the No. 5 cause of death on

the mainland United States, unfortunately, it remains No. 3 cause of death in Hawai'i, surpassed only by heart disease and cancer. Importantly, Native Hawaiians are especially at risk for stroke. The loeal research studies have shown that Native Hawaiians are having strokes 10 years earlier than other ethnic groups, although the reasons for that disparity are still unclear. What is clear is that stroke ean be cured and the disability ean be avoided if treated immediately in a timely fashion. This requires greater community awareness to recognize stroke warning signs and the actions to take when stroke occurs. Hawai'i's medical eommunity is working to try to reduce the impact of stroke in our state by improving the stroke system of care. Reducing the time to treatment ean save millions of brain cells in a stroke patient, reducing the risk of death and disability. However, the improvements being made in the EMS and hospital systems will not result in better patient outcomes unless stroke is recognized quickly and 9-1-1 is called to deliver the

patient to a hospital prepared to provide the best available treatment. "Until the mid-1990s there were limited treatments available for stroke patients," explained Dr.

Kazuma Nakagawa, neurointensivist at The Queen's Medical Center and president-elect of the American Heart Association/American Stroke Association Hawai'i Division.

"The U.S. Food and Drug Administration approved the use of a "clot buster" drug called tPA in 1996 whieh has dramatically changed the outlook for ischemic stroke patients who receive treatment quickly," he described. "The tPA breaks up the clot like what Drano does to your clogged plumbing system. I've seen patients go from half paralyzed with incomprehensible speech to completely normal within minutes of giving the tPA." A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is blocked by a clot, bursts or ruptures. When that happens, part of the brain cannot get the blood and oxygen it needs, so it and brain cells die. When the stroke is caused by a clot, tPA, if administered in less than 4.5 hours from the stroke's onset, ean mean the difference between life and death or severe disability. However, only a small percentage of Hawai'i patients arrive at a hospital eapahle of treating stroke within that 4.5-hour window. The reasons range from not understanding the stroke warning signs to denial of the symptoms. And almost half of all Hawai'i stroke patients arrive to the hospital by means other than EMS, whieh ean result in delays in treatment. "Too many families are trying to bring their loved ones by them-

selves using their private vehicle, whieh is causing significant delay in care. For every minute that passes during a stroke, almost two million brain cells die from the laek of oxygen," Nakagawa continued. "When someone quickly recognizes stroke's warning signs and calls 9- 1- 1 it sets in motion a process that will reduce the time to treatment and allow for early diagnosis on the way to the hospital. The EMS personnel have the ability to contact hospitals before patient arrival to ensure that the equipment and personnel needed to quickly treat the patient are prepared for the patient's arrival. If a hospital is not prepared to treat the patient immediately, the EMS team ean bypass that hospital and proceed to the nearest strokeready hospital. And by alerting the hospital in advance, it ean allow the hospital's stroke team to meet the patient upon arrival. The faster that treatment is delivered, the chances for a better outcome increase." Recognizing a stroke has been made easier by the American Stroke Association's development of the F-A-S-T stroke awareness eampaign. "F" stands for facial droop, usually on one side. "A" stands for arm weakness or numbness, again usually on one side. "S" stands for difficulty speaking, or speech slur. "T" stands for time; time to eall 9-1-1. If you witness someone having those warning signs, don't hesitate, immediately eall 9-1-1. ■

Don Weisman is the Amenean Heart Association 's Hawai'i Government Reīations Director and Communications and Marketing Directorfor Hawai 'i andAIaska.

You ean help to prevent the risk for stroke by making simple lifestyle changes. Things that you control include: • High blood pressure — High blood pressure is the leading cause of stroke and the most important controllable risk factor for stroke. By reducing your systolic blood pressure by 10 mmHg, you ean reduce the risk of stroke by almost 40%. Reduce salt intake and exercise at least 30 minutes per day, 5 days per week to help control your blood pressure. •Cigarettesmokingor chronic use of nicotine products — In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk. • Diabetes — Diabetes is an independent risk factor for stroke. Limit your consumption of sugary products, especially sugary drinks whieh are the leading source of sugar in our diets. • Poor diet — Diets high in saturated fat, trans fat and cholesterol ean raise blood cholesterol levels. Diets high in sodium (salt) ean eontribute to increased blood pressure. Diets with excess calories ean contribute to obesity. Also, a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke. • Physical inactivity and obesity — Being inactive, obese or both ean increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs, and do whateveryou ean to make your life more active. Try to get a total of at least 30 minutes of activity on most or all days.

Dr. Kazuma Nūkagawū

Stroke is a disease that occurs when arteries leading to and within the brain are suddenly blocked or ruptured. - lllusMion: Courtesy of the Amenean HeartAssociation