When someone experiences a stroke, brain cells are deprived of oxygen and other key nutrients, causing the cells to die and potentially resulting in permanent brain damage, paralysis, long-term disability and even death. The sooner someone gets treatment, the less damage may be done. This is why timely diagnosis and treatment play a critical role in stroke patient outcomes. Time is brain.

Sunnybrook is one of Ontario’s regional stroke centres and home for the North and East Greater Toronto Area Stroke Network. Our dedicated interprofessional stroke team care for patients across the spectrum of stroke recovery, including emergency and inpatient care, rehabilitation and prevention.

We spoke with Dr. Rick Swartz, Neurologist at Sunnybrook and medical director of the North and East Greater Toronto Area Stroke Network, to learn more about stroke and the importance of seeking help as soon as possible.

Recognizing stroke symptoms FAST

The Heart & Stroke Foundation introduced the acronym FAST as a way to remember the key signs of stroke.

• Face: Is the mouth or lower half drooping?
• Arms: Can you raise them both?
• Speech: Is it slurred or jumbled?
• Time to call 9-1-1.

If you or a loved one experience any FAST symptoms, it is important to call 9-1-1 immediately. Don’t try to sleep it off and don’t drive yourself. Calling 9-1-1 is the best way for an ambulance to take you where you need to go for urgent stroke care. The sooner you receive stroke care, the better chance of recovery.

What are the different types of stroke?

There are two types of stroke; ischemic (clot) and hemorrhagic (bleeding). Ischemic stroke is the most common type of stroke and occurs when there is an interference with blood flow to the brain, usually caused by a blood clot or narrowing blood vessels. Hemmorhagic stroke, commonly referred to as a brain bleed, occurs when an artery or vessel ruptures and bleeds into the surrounding brain. A common cause of brain bleeds could be long term high blood pressure or head trauma (traumatic brain injury).

What are some risk factors of stroke?

It is important to know that anyone can experience a stroke, regardless of age, sex or race. However, there are some factors, such as smoking, inactivity, unhealthy weight or diet and alcohol consumption, that can increase your risk of stroke. Many of these risk factors are modifiable, and making small lifestyle changes can help reduce your risk.

Individuals with other health conditions like high blood pressure and cholesterol, diabetes, atrial fibrillation and some forms of cancer are also at a higher risk. These conditions can result in the narrowing of arteries or the formation of clots/blockages, which could interfere with blood flow to the brain.

Your risk of stroke also increases as you age. Women are also at a higher risk, especially those who have experienced menopause or pre-eclampsia.

Stroke and stroke care is different for everyone, and the interprofessional stroke team at Sunnybrook is dedicated to making sure patients with stroke receive the timely and compassionate care they need.

More resources for stroke:

• To learn more about stroke, visit Toronto Stroke Networks.
• Visit our MyCare Stroke Care Pathway to learn more about what stroke care at Sunnybrook looks like.
• Sunnybrook is home to the North and East Greater Toronto Area Stroke Network, learn more about our Regional Secondary Stroke Prevention Clinic.

The post Time is brain: What you need to know about stroke appeared first on Your Health Matters.

The toolkit was uniquely co-designed by an interprofessional group of researchers, allied health professionals, stroke organizations and people with lived stroke experience, to create a person-centred, inclusive experience for users to learn about and access aquatic therapy.

“STARRT is the first aquatic therapy toolkit developed at Sunnybrook,” explains Dr. Marinho Buzelli, STARRT project lead. “This unique toolkit will help deliver a more specialized aquatic therapy experience to persons with stroke experience across Canada.”

The need for a stroke toolkit for aquatic rehabilitation

Stroke is a medical emergency resulting in a sudden loss of brain function and is often caused by an interference with blood flow to the brain. In Canada, stroke is the leading cause of adult disability as it can result in restricted movement, paralysis and impaired speech even after medical intervention. For many persons with stroke experience, the road to recovery is long and filled with many challenges. Aquatic therapy, which involves exercise in water, has been shown to have several benefits for people recovering from a stroke.

“I’ve had the chance to observe how aquatic therapy has changed the lives of so many with stroke experience,” says Shaylene Leibl-Smith, a recreation therapist at Saskatchewan Health Authority and a member of the STARRT advisory team. “From stress and pain management, freedom of movement, confidence building and connecting with others, it’s rewarding to see the progress individuals can make participating in aquatic therapy.”

Sharing lived experience to empower survivors

Danny Foran is the patient partner that is sharing his own stroke journey to help and empower other survivors. As a member of the STARRT co-design team, Danny’s experience using aquatic therapy informed some of the benefits, exercises and caregiver supports identified in the toolkit.

Dr. Marinho Buzelli, STARRT project lead, and Danny Foran, transferring his experience with stroke to help design the toolkit.

In 2012, Danny suffered a serious stroke that left him paralyzed on the left side of his body. In addition to different on-land rehabilitation exercises like physiotherapy, Danny joined an aquatic therapy club for stroke survivors. Since pursuing aquatic therapy, Danny has felt an improvement in his balance, strength and endurance, and has even learned how to swim using his right arm.

“Not only has swimming helped me physically, but it’s also supported my mental health since suffering my stroke,” explains Danny. “Swim clubs like the Oakville Strokers allow survivors to meet with each other in and outside the pool, which is a very empowering and motivating experience.”

Rehabilitation can be a frustrating experience for persons with stroke experience, who struggle with movements and activities that they could do before having a stroke. Danny hopes that sharing his experience to design resources like STARRT, will help survivors on their rehabilitation journey, and provide them with both physical and mental benefits and comfort.

“It’s been rewarding to participate in the design process of STARRT,” adds Danny, “I’ve been able to transfer my knowledge of aquatic therapy into an accessible tool for others.”

Danny participating in aquatic rehabilitation after suffering a stroke that left him paralyzed in one side of his body.

Optimizing recovery through aquatic therapy

STARRT is designed to teach persons with stroke experience, caregivers and health care professionals about the benefits of aquatic therapy, answer questions about what to expect from an aquatic therapy class and showcase aquatic therapy pool locations across Canada via an interactive map.

There are currently over 700 pools in Canada that patients and caregivers can explore in the STARRT toolkit. From swimsuits to medications to snacks, STARRT also provides a list of what you might need at an aquatic therapy session, as well as different strengthening, balance, aerobic exercises and games you can try in the pool.

“When designing STARRT we wanted persons with stroke experience to inform the foundation of the toolkit,” adds Dr. Marinho Buzelli. “The goal of this project is to help persons with stroke experience reap the physical benefits from aquatic therapy, and feel more confident and independent in their functional ability by providing them with all the information they might need in one location.”

If you or someone you care for is interested in learning about the rehabilitation benefits of aquatic therapy post-stroke, or would like to learn about aquatic therapy facilities near you, visit STARRT.ca.

The post Let’s get STARRT-ed: Empowering stroke survivors with access to aquatic therapy appeared first on Your Health Matters.

The stroke was a surprise for the 25-year-old.

How did it happen? Should other young people be worried?

This is an age group is not typically associated with stroke, but doctors say it’s important to be aware that stroke affects people of all ages.

Dr. Mark Boulos, a Sunnybrook neurologist and stroke expert, answered our questions about TIAs, Hailey’s unexpected health event, and tips for stroke prevention.

Note: Dr. Boulos is not Hailey Bieber’s doctor. His responses are based on the comments she shared in her YouTube video about her TIA.

What is a stroke and how does it compare to a mini-stroke or TIA?

A stroke is when blood flow to the brain gets interrupted, leading to damage to the brain. This can be caused by blocked blood vessels or hemorrhaging.

A “mini-stroke” or a TIA happens when you have transient deficits due to lack of blood flow to a specific part of the brain, but when you do scans, you don’t see any damage. And while they may not leave a mark on the brain, TIAs are still important to pay attention to as they can be warning signs for future stroke.

We don’t typically associate TIAs or strokes with young people. How did this happen in Hailey Bieber’s case?

In her YouTube video, Hailey mentioned that she did have some risk factors, which wouldn’t typically be problematic on their own. But together, it looks like they created the perfect storm.

She mentioned that she was on birth control, and some forms of birth control in young women increases the risk of stroke a little bit. Not very much, but that would have been a risk factor for her. She also noted that she suffers from migraines, and the combination of using some forms of birth control and having migraines can further increase the risk of stroke.

She also recently had COVID, which can also increase your chance of blood clots.

She mentioned she had been on a plane, too. If you’re on a plane and you’re sitting in the same spot for a long time, clots can develop in your legs then travel through your body, including to your brain via something in the heart called a Patent Foramen Ovale, or PFO, which she mentioned she had in her YouTube video. That would have been a trigger as well.

To elaborate on PFOs, there is this connection between the two sides of the heart, which is supposed to naturally close when you are a fetus. In 25 per cent of the population it doesn’t close, leaving a hole in the heart, or a PFO. This isn’t typically a problem, but it can become a problem.

Clots are usually kept on the right side of the heart, which controls the circulation to the lungs. If the clot stays in there, it’s actually OK. The trouble is that a PFO could facilitate a clot going from the right side of the heart to the left. The left side of the heart pumps blood to the rest of the body, including to the brain. If a clot gets into the left side of the heart and goes up to the brain, that could lead to a stroke.

The combination of all these factors could have led to Hailey’s TIA.

These risk factors are all so common. Should young people who have these risk factors be worried about TIAs or strokes?

Statistically, TIAs and strokes are not common in young people. They do happen, but if you’re young and healthy, the risk is minimized. It is important, however, to be aware that stroke can strike at any age.

In general, while the factors mentioned are common, more context is needed around the risk of stroke.

If you’re on some forms of birth control, this can increase your risk of having a stroke, but the risk is minimal. About eight in 100,000 women who are on birth control will have a complication like a stroke. The risk of stroke in women who use some forms of oral birth control is further increased in those with migraines. If you’re worried, have a discussion with your doctor.

If you’re going to be in a plane for a long time, stroke risk prevention is very simple. Walk around, stay hydrated, move your legs to help prevent clots from developing. Just don’t sit in the same spot for a long time.

PFOs are present in about 25 per cent of people, but that doesn’t mean 25 per cent of people will have a stroke. In fact, many people with PFOs never even realize they have them.

It’s important to speak with a health-care professional if there are concerns about risk factors for stroke.

How can people reduce their risk of stroke?

There are things that always help prevent overall vascular risk factors: exercise, healthy eating, not smoking, keeping your cholesterol in check, monitoring your blood pressure, getting enough sleep every night and checking for sleep apnea. To avoid stroke, these things are important for everyone, including young people. 

And of course, knowing the warning signs of stroke to get help right away is important. The earlier a person is treated, the greater their chances of recovery. Knowing the warning signs can help you act fast to get the help needed, if you or someone you know is experiencing a stroke.

The post Hailey Bieber’s mini-stroke shines a light on stroke and young people appeared first on Your Health Matters.

But she says that never crossed her mind when she was deciding on her specialty.

“I didn’t ever really think about it that way. I was just interested in the specialty and persisted and had lots of people help me out along the way,” she says. “It’s such an incredible field to be in and I feel so privileged to be able to do this work.”

Neurovascular intervention is the procedural side of caring for patients with diseases involving the head, neck and spinal cord.

“It’s usually done in a minimally invasive way, with small tubes that go in through the artery in the leg or the wrist and then we perform procedures to try and help patients with a variety of problems,” Dr. Hawkes says.

One of the most common conditions treated by neuro-interventionalists is large-vessel ischemic strokes, which are strokes that cause a large blood clot somewhere in the body, blocking a major artery. Patients suffering from hemorrhagic strokes, which result from bleeding in the brain, can also be treated by a neuro-interventionalist.

Dr. Hawkes says this kind of treatment has “changed the game” for these stroke patients.

“Their outcomes are much better. We see patients come in unable to move one side of their body, not able to speak, and then they walk out of the hospital and go back to their regular lives,” she says. “It’s incredibly rewarding.”

Taking care of her patients is one of the many reasons Dr. Hawkes loves the work she does.

“They come in very sick and it’s the worst day of their lives. Their families are devastated and sometimes, we’re really able to help them,” she says, adding it’s also exciting to see how treatments continue to develop for patients. “This field is changing so fast. There’s a lot of new technology and new devices that make these procedures quicker so patients can have more benefit and fewer problems related to the procedure. It makes it really interesting and something you can continue to enjoy for your whole career.”

Dr. Hawkes says one of the things that makes working at Sunnybrook special is it’s one of the few places that has all three disciplines — neurologist, neuroradiologist and two neurosurgeons — represented in the neurovascular surgery department.

“It’s a dream job for me,” she says. “Being able to talk to my colleagues from neurosurgery or neuroradiology, to ask their opinions — it really helps patients and it helps me continue to grow. I’m new to the field, and I want to keep learning and advancing my skills, and I can do that at Sunnybrook.”

As someone working in a field with few women, Dr. Hawkes knows it isn’t always easy to be in rooms where you don’t see anyone else who looks like you. But for anyone interested in pursuing a specialty like neuro-intervention, she hopes they won’t be deterred by that.

“You’re in the right place. You made it. There’s a reason you’re there,” she says. “There may not be someone who looks like you in that room in particular, but you can find your community and find mentorship.”

The post ‘It’s a dream job for me’: Dr. Christine Hawkes on breaking barriers & finding her place at Sunnybrook appeared first on Your Health Matters.

All of the things that the brain is responsible for – physical and mental – are part of brain health. While often spoken about separately, mental health is a central part of brain health – they are not separate or distinct.

Mental health is brain health.

Understanding this can help to reduce the stigma that continues to be associated with mental illness, which, like any physical disorder or disease, is a health problem and requires appropriate treatment.

One of most important things that people don’t often realize is that the three major brain conditions of our lifetime; stroke, dementia, and depression, are all inter-related. They are all happening in the same organ, and if person has been diagnosed with one of those three conditions, their risk of the other two conditions increases.

That is to say: if an individual has a stroke, it increases their risk of having post-stroke depression and developing dementia; if someone has dementia, there is an increased risk of developing depression and having a stroke; and having clinical depression, increases the risk of going on to have stroke and/or dementia.

What affects brain health

Any disruptions to the brain can affect the way it works. The brain is an incredibly vascular organ – there are a rich supply of arteries and veins that help with the delivery of nutrients to the brain, as well as the removal of toxins and by-products of metabolism, to keep it healthy.

When that blood flow is interrupted, it affects brain function and that results in changes in the way information travels along the brain’s pathways. This can impact how we move, how we sense things like hearing or touch, the way we think about the world and people around us, how we perceive a situation, and how we behave.

It is important that brain conditions are understood and treated from multiple perspectives at the same time. Traditionally, the various medical specialties that deal with brain conditions would treat disorders individually; for example, if a person has a stroke and needs a blood clot removed, they will be seen by a neurosurgeon or neurologist. If a person has depression, they will be treated by a psychiatrist. If a person has dementia, they might see a neurologist or a psychiatrist.

But the new way of understanding and treating brain conditions involves a broader and more collaborative approach.

A multi-disciplinary approach to brain health

Sunnybrook’s Garry Hurvitz Brain Sciences Centre will connect brain health experts from across medical disciplines in the same building.

Bringing brain specialists together to collaborate with one another will help enhance a patient’s treatment, education, and will pave the way for possible new discoveries of the causes and potential treatments of brain conditions.

For stroke, depression, dementia, and other brain conditions, including sleep disturbances, anxiety, Amyotrophic Lateral Sclerosis (ALS), tremor, and others – having a broad range of the brain specialities and disciplines, including neurology, neurosurgery, psychiatry, psychology, and more, working together for improved patient care, is really the way of the future.

For more information about brain health:

• Learn more about Sunnybrook’s Garry Hurvitz Brain Sciences Centre
• Q & A with Dr. Levitt about Sunnybrook’s Garry Hurvitz Brain Sciences Centre
• Learn more about the Hurvitz Brain Sciences Program at Sunnybrook

If you need help in an emergency, please call 911 or visit your local emergency department.

If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources:

• Find a local crisis resource at sunnybrook.ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text: 45645 (4:00 p.m. – midnight Eastern Time)
• Kids Help Phone
  • Phone: 24-hour, toll-free, 1-800-668-6868
  • Text: 686868 (24 hours, 7 days a week)

The post Why mental health is brain health appeared first on Your Health Matters.