305: How to Spot and Prevent Strokes: Understanding the F.A.S.T. Signs and Risk Factors for Ischemic and Hemorrhagic Strokes | DOCTOR IN THE HOUSE

Dr. Rizwan Bukhari  00:00

Other types of stroke where someone might have a clot form inside the artery, that then prevents blood flow to a certain portion of the brain, and then that portion of the brain dies. Now, whatever type of stroke it is, whether it's ischemic or hemorrhagic, the symptoms of that stroke will depend on what part of the brain is affected.

Maya Acosta  00:21

This is the month of May. And this is when we talk about Stroke Awareness. This is going to be a three-part series. So there's so much information to cover. We're going to do it in three parts each year, nearly 800,000 people in the United States have a stroke. Yes. And 130,000 people die from strokes yearly. About 610,000 of these are the first four new strokes. This is the healthy lifestyle solutions podcast and I'm your host, Maya Acosta. If you're willing to go with me, together, we can discover how simple lifestyle choices can help improve our quality of life. Let's get started. Welcome back to another episode of the healthy lifestyle solutions podcast. I'm your host, Maya Acosta and

Dr. Rizwan Bukhari  01:07

I'm Dr. Rizwan Bukhari, and people call me Dr. Riz.

Maya Acosta  01:11

Yes, aka Dr. Riz. And this is another segment of DOCTOR IN THE HOUSE. Oh, right. And every Monday we have Dr. Rizwan Bukhari, that is a guest expert. And this is his segment doctor in the house. So Dr. Riz, before we get started on today's topic, I want to share some reviews of what people are saying about your segment. Are you ready? Yeah. All right, so much valuable information. I'm so glad I came across this show. I found this show because both my mother and my grandfather have type two diabetes. I've taken so many actionable and practical nuggets of advice to implement love tuning in. That was great. That's awesome. Yeah. It's great to hear. Here's another one. So informative. That type two diabetes episode was so informative and cleared up so many myths for me. Thank you again for this information.

Dr. Rizwan Bukhari  02:06

That's awesome.

Maya Acosta  02:07

Yeah, I really like this. So Dr. Riz, people are really finding value in what you have to say in these segments of doctor in the house. And you know, they're doing very well on social media as well.

Dr. Rizwan Bukhari  02:21

That's great. We want to get the word out. Yes, that's why we're doing this.

Maya Acosta  02:24

That's right. If you notice something different than if you're watching the video, you will see that there is a little plaque here between both of our mics. We recently celebrated 300 episodes of the healthy lifestyle solutions podcast. And this award came from podawards.fm. And that is an organization put together by Alex Sanfilippo. And he has all sorts of tools for podcasters. And so right now is the first time that I showcase this plaque. Well, congratulations. Yeah, thank you. And we did an episode previously where we talked about, you know, lessons learned from 300 episodes. Okay, I want to remind people, you have been here on your doctor in the house and you've covered heart disease. Yes, you talked about your work as a vascular surgeon. And we did a four-part series on diabetes in general with a focus on type two diabetes, risk factors and lifestyle changes that people can make to reduce the risk of type two diabetes. Any thoughts so far? Before we touch on today's topic?

Dr. Rizwan Bukhari  03:28

No, I'm really happy with the format. I like the idea that we're picking topics basically on a monthly basis. And we're breaking it down into several episodes, which are short, and to the point, people can follow them very closely.

Maya Acosta  03:42

Absolutely. I feel like we're becoming the go to for health. For health topics. This is the month of May. And this is when we talk about Stroke Awareness. And so we're gonna go into it. But before we do that, I thought it would be fun to do some rapid-fire questions like we did with type two diabetes. So we're going to see if you're gonna get these right or wrong. Okay. Oh, okay. Are you ready? I hope so, this is going to be a three-part series. So there's so much information to cover, we're going to do it in three parts. And so hopefully, we'll be able to cover some of these rapid-fire questions. In other words, answer them in this series, and we're going to also go through some myths. Alright, so here's the first one, high blood pressure is a major risk factor for stroke.

Dr. Rizwan Bukhari  04:28

That's absolutely true. Okay, smoking

Maya Acosta  04:31

can increase your risk of stroke. True. Eating a healthy diet does not impact your risk of a stroke. That is false. exercising regularly doesn't matter either. In terms of reducing your risk of strokes, that is false. Stress does not affect your risk of stroke. I think that is false. taking aspirin daily can prevent strokes. That is true. Very good. You got them right. All right. I had to, I had to think about some of these. Okay, so now here are some common myths strokes only happened to older people.

Dr. Rizwan Bukhari  05:07

That is not true at all. strokes can happen to people of many different ages.

Maya Acosta  05:12

And I want to say that you're starting to see younger patients have a stroke.

Dr. Rizwan Bukhari  05:17

Yeah, we've touched on this, in many of my visits, where I'm starting to see disease of all sorts at younger ages. And stroke is one of those things that I see in younger people as well.

Maya Acosta  05:30

Right? Oh, wow. Strokes always cause immediate and severe symptoms.

Dr. Rizwan Bukhari  05:35

Well, not necessarily, there can be sound strokes, and people not necessarily know the habit of stroke itself just means death to the brain tissue. And whether that causes symptoms or not, has a lot to do with what's affected strokes cannot be treated, that is a myth. strokes can be treated. And of course, the faster you can diagnose and treat a stroke, the better the outcome.

Maya Acosta  06:00

Yeah, strokes only happened to people with high blood pressure, high blood

Dr. Rizwan Bukhari  06:03

pressure is one of the symptoms or is one of the risk factors, but it's not the only risk factor. So strokes can happen to people who do not have high blood pressure,

Maya Acosta  06:12

right? If someone is having a stroke, they should be given an aspirin immediately.

Dr. Rizwan Bukhari  06:17

I would not do that. I would leave that up to the healthcare professionals to decide what to do.

Maya Acosta  06:23

Right. There are so many things that we as lay people don't know about what is happening at a moment when there's a medical emergency strokes are always accompanied by physical symptoms.

Dr. Rizwan Bukhari  06:35

No people can have silent strokes.

Maya Acosta  06:37

Okay, once someone has had a stroke, there is no point in trying to improve their recovery.

Dr. Rizwan Bukhari  06:44

I absolutely disagree. Rehabilitation is a very important part of the stroke process.

Maya Acosta  06:51

Yeah. Okay, great. We're going to talk so much about all of this. Hopefully, by the time you listen to these three episodes, you will know how to explain all of this to someone else. All right, so Dr. Riz May is recognized as Stroke Awareness Month in many countries, including the United States, Canada, and the UK. And we want to mention these countries, because maybe we have listeners there as well. So it's not just in the United States. And during this month, there are various organizations, health professionals podcasters, in communities that aim to raise awareness about stroke, and its prevention, as well as educate people about the signs and symptoms of stroke and the importance of timely treatment. And that's really important, I now have learned how important it is to give treatment immediately if possible. A stroke is a serious medical condition that can have a significant impact on a person's life. So it's important to recognize his warning signs, we will talk about that and take appropriate action as quickly as possible doctor is in preparing for this three-part segment on Stroke Awareness month for the month of May, I did a little bit of research and pulled up some statistics Each year, nearly 800,000 people in the United States have a stroke. Yes. And 130,000 people die from strokes yearly, or about 610,000 of these are first or new strokes. Yes, ma'am. So that means that people suffer second, third strokes.

Dr. Rizwan Bukhari  08:24

Absolutely. In fact, that's when I see a lot of patients with strokes, I'm one of the doctors who deal with strokes a lot. It's a part of my specialty. I'm not a neurologist, but there are certain significant aspects of stroke that I deal with and treat a lot. And so when I see a patient who's had a stroke, I know that they are at increased risk for having another stroke.

Maya Acosta  08:48

Okay, this is it's perfect. This is why I want you to focus on Stroke Awareness because I know that you do treat patients and you know a lot about this disease. So according to the statistics that I just mentioned, that means that on average, someone in the United States has a stroke every 40 seconds, and someone dies of a stroke every four minutes. So the medical costs associated with strokes are significant. The CDC reports that the total direct medical costs of stroke in the United States in 2017, were estimated to be $34 billion. And this does not include indirect costs, such as loss of productivity and wages. The average lifetime cost of care for a stroke survivor is estimated to be around $140,000. And those

Dr. Rizwan Bukhari  09:39

Numbers don't surprise me. And again, I think those are underestimates. I think that the direct cost of and when we talk about direct cost, I mean, they're talking just about the medical care. You know, there's the indirect costs, and that so I think stroke actually costs our country and the people who have strokes, hundreds of billions of dollars. Yes, yes. Not only the strokes itself, but the loss of wages, and then the rehabilitation and then the expenses for taking care of someone who's had a stroke for the rest of their life. All of those things really add up. So it really is way more than in the mid 30 billions of dollars.

Maya Acosta  10:21

Now stroke can have long-term effects on a patient including physical, cognitive and emotional effects in some patients may experience paralysis and weakness on one side of the body, difficulty speaking and understanding the language, there's changes in the vision. Others may experience cognitive changes, such as difficulty with memory or attention, and emotional changes as depression and anxiety. And these effects can have a significant impact on a patient's quality of life and ability to perform daily activities. You just mentioned rehabilitation therapies, and in a future interview that I have for this month of May, you're going to hear from Lee Stroy, who you and I have already interviewed in the past, he was in the film, a teachable moment. And that link is going to be in the show notes. It's a documentary about four stroke survivors. And we actually bring up the fact that not everybody can afford rehabilitation. When you're going through rehabilitation after a stroke, you might need a physical therapist, a speech therapist, occupational therapist, have a psychiatrist and at least he was telling me that even though he had insurance, each time he went to one of the specialists a copay was $50.03 times a week, four times a month, 12 months a year. And here we are, you know, and suddenly you can't afford rehabilitation. And if you don't recover fully, it's not because you don't want to it's probably because you couldn't afford it.

Dr. Rizwan Bukhari  11:51

Right. There are extreme financial barriers to healthcare in general. But definitely there are financial barriers to physical therapy and, and stroke rehabilitation. Yeah, absolutely.

Maya Acosta  12:06

Yeah. So what we're going to focus on Dr. Risk, you know, for the most part is prevention. But I think it's important to give people facts about what it all is. I was wondering if you'd like to talk about celebrities that have suffered strokes, so I googled to see which celebrities have suffered a stroke. And the first name that came up not in any particular order, was Sharon Stone. And I had forgotten that she had a stroke at one point, right. Did you know about it? Yeah, I'd heard about it. Yeah, she suffered a stroke in 2001. She had a hemorrhage. You're going to tell us in a little bit the differences in the strokes, so she had a subarachnoid hemorrhage. She has since recovered and became an advocate for Stroke Awareness. There are other celebrities, Luke Perry. Absolutely. He suffered a stroke in 2019 and passed away from the complications. Sadly, yes, Dick Van Dyke. We grew up watching him. He suffered a minor stroke in 2013 and was able to make a full recovery. Right, I thought we can continue Dr. risk to talk about the role that you play in working with stroke victims. First, if you can explain to us what is the stroke? What are the different types of strokes? And then how do you work with patients when it comes to like the carotid artery. I know that in your main lecture on the relationship between nutrition, really lifestyle, and atherosclerosis, you go down the list of things that people can suffer from heart attacks, strokes, loss of a limb, you know, death. Yeah, tell us about strokes.

Dr. Rizwan Bukhari  13:44

Well, stroke means the death of brain tissue. And so that can happen in a variety of ways. And the two kind of classic ways we describe it as either ischemic or hemorrhagic. ischemic means that there's been blockage to the blood flow, which then means that the that the brain tissue dies hemorrhagic means that there's been some sort of bleed in the brain that then injures the tissue the brain tissue and causes the brain tissue to die. So for example, Sharon Stone had a subarachnoid hemorrhage, that hemorrhage that bleeding in the brain caused damage to her brain. But she was fortunate enough to make a full recovery from other types of stroke, where someone might have a clot form inside the artery that then prevents blood flow to a certain portion of the brain, and then that portion of the brain dies. Now, whatever type of stroke it is, whether it's ischemic or hemorrhagic, the symptoms of that stroke will depend on what part of the brain is affected, and you had gone through an extensive list of things that happen to people with strokes. So the brain is largely responsible for controlling and managing everything in our body. So just depending on where the stroke is, it can affect just about anything on our body, from physical things to sensory things to emotional things. Many stroke victims just become depressed because of what's happened to them. Yeah.

Maya Acosta  15:16

What is the percentage of you said ischemic and hemorrhagic what is the percentage which one is more common,

Dr. Rizwan Bukhari  15:23

the most common type of stroke is ischemic, which means like a blood flow due to some sort of blockage that comprises in different estimates anywhere from 70 to 90% of most strokes, and then hemorrhagic strokes are the remainder, okay, hemorrhagic strokes can either occur due to rupture of an artery, either due to high blood pressure causing the artery to bust. Or it could be due to an aneurysm in the brain that ruptures and causes the artery to bust.

Maya Acosta  15:52

Okay, when working with the carotid artery, are you working with someone who's already suffered a stroke? Or is that is it just because a person has been diagnosed with a blockage? Or how does that all work?

Dr. Rizwan Bukhari  16:04

Well, it's very interesting, if you go back a few decades, the only time we treated strokes, as surgeons, was once somebody had a stroke, then we went and cleaned out their carotid artery to try to prevent them from having another stroke. And that's because we had no good ways of detecting the blockages ahead of time. Now, if you fast forward a few decades, we now have lots of different technologies available to us to help detect blockages, we now have lots of studies that show at what level of blockage, we should go ahead and clean out that artery in order to try to prevent a stroke.

Maya Acosta  16:39

Okay, when a patient comes to you, they may or may not have had a stroke.

Dr. Rizwan Bukhari  16:44

Yep, the majority of carotid surgeries I do now to clean out a carotid artery to prevent strokes are actually for symptoms. They're for patients who have not had strokes. And that's because we've gotten so good at detecting and determining these blockages ahead of time, either on purpose because we were looking for it, or by accident because they were looking for something else. And then they noticed a blockage

Maya Acosta  17:08

that helps me to understand a lot better because I wonder well, why are you looking there in the first place? Are they like type two diabetes patients? Have they had a heart? You know, a heart condition? And that's why you decide to check the Corrado?

Dr. Rizwan Bukhari  17:21

Absolutely, we know the patients who are at risk for having stroke, the stroke caused by carotid artery blockages is atherosclerosis. That's the primary disease I treat. And so I know, I know the patients who are at risk for atherosclerosis based on lifestyle risk factors and other risk factors. And then, so if we know that patients have a certain set of risk factors, then we have a higher suspicion for it. And we will go looking

Maya Acosta  17:47

Oh, that makes a lot of sense. Do you? Have you just talked about technology? Do you have the technology, the equipment at your North Texas Vascular Center where you are able to diagnose or look for do this kind of test? Absolutely.

Dr. Rizwan Bukhari  18:00

I mean, the technology has existed since the 50s. And it's continued to improve. We utilize ultrasound in the office and we can we can diagnose carotid artery blockages very well. There are other technologies as well, such as CAT scans and MRIs, which also can look at the carotid arteries. And they're all complimentary. They look at different things. And they look at them in different ways. But the primary way that we mostly look for carotid artery blockages is the ultrasound. Because it's noninvasive. It doesn't cost a lot of money. And it's highly accurate. Well, it's highly accurate when done by the right personnel.

Maya Acosta  18:46

I see. Yes. Now I can already hear some of our listeners asking, well, how can I figure out if I'm at risk for a stroke? Could I also have like a CAT scan? Or what was the other thing that you said MRI, oh, a CAT scan or an MRI? Or an ultrasound or an ultrasound?

Dr. Rizwan Bukhari  19:04

The primary thing most people are gonna get is an ultrasound and ultrasound

Maya Acosta  19:07

now because you know, we've had people come up to us and ask, is there a way that they can check to see if they have blockage in their heart arteries and their main artery? So, you know, we're probably going to get the questions about the stroke. You reducing the risk of strokes as well. Yeah.

Dr. Rizwan Bukhari  19:24

Yeah. And, and yes, people can easily get their carotid arteries checked. It's not a difficult exam. It's actually not even a very expensive exam. But I mean, if insurance is going to cover it, there's going to have to be some sort of medical indication to do so. But people can actually also pay out of pocket to

Maya Acosta  19:43

All right, okay doctor is so I'm so glad that you just told us what you do. And how you know to check the carotid artery just to see if a person is at risk for a stroke before we talk about risk factors and actually the signs of knowing you know when a stroke is coming on before We talk about that. Let's talk about how a stroke is diagnosed. We're going to skip to that part first, because I wanted to emphasize timely treatment, what are some of the things that the physician will ask in order to diagnose what sort of stroke has happened and what the treatment will be.

Dr. Rizwan Bukhari  20:18

So we generally look for what we call lateral lysing symptoms. And those are symptoms that are speak to one side of the body or the other, you might look for a facial droop on one side, or the inability to move the arm on one side, or numbness on one side, or have funny, tingling or sensation or the inability to move their hand. And because strokes, and when they're affecting the brain, they affect one side of the brain, typically at a time. And so like the left brain controls the right body, the right brain controls left body. So we we look for what we call lateral arising symptoms. If someone can't move the right hand, then we suspect they might have a stroke in their left brain, right? There's kind of Different Strokes, clinically, that okay, there's something called a TIA. Okay. That means transient ischemic attack, that's what we call often call a mini-stroke. That's where something happens. And it's gone very quickly. A TIA means that you had a mini event, and then you recovered very quickly, so you didn't damage the brain permanently transient ischemic attack. And those usually lasts less than a few minutes to last less than an hour or two. And then there's something called a rind, R I N D reversible ischemic neuro neurologic deficit, that's something that lasts longer than a TIA, but also eventually goes away. And typically within a few hours to a few days, again, there's whether or not there's permanent damage to the brain is kind of as borderline, whereas a stroke is typically something that has permanent damage to the brain. Okay. Okay. So if you can, the whole idea behind, you know, if someone has a TIA, they're going to get sent to me, I'm going to look at their carotid artery, hopefully find a blockage, fix it and prevent them from having a stroke, okay, if someone is having a stroke in progress, this is where this is to speak to what you were saying, which is, you want to get to the emergency facility as fast as possible for for a couple of reasons, so that they can diagnose it, but also, the faster you get to the facility, the higher the high likelihood that they can treat it effectively, and mitigate the symptoms of the stroke and or the damage to your brain.

Maya Acosta  22:49

Okay, so you end up at the hospital. And some of the things that will happen is, the doctor will ask, what are the symptoms that the person is having? They'll ask about medical history, they'll do a physical or neurological examination, maybe some blood work and a CAT scan an MRI, and then they'll kind of run the studies and then from there conclude the form of treatment? Correct. When I was doing some research through the American Stroke Association, they talked about treatments for both ischemic and hemorrhagic. What's the difference and how those are treated?

Dr. Rizwan Bukhari  23:25

Well, just to speak to something you said earlier, for example, when someone's having a stroke, and someone says, give them aspirin? Well, if they're having a hemorrhagic stroke, if you give them aspirin, you're actually thinning their blood. And you might make their hemorrhagic stroke worse. Oh, wow. Okay. So hemorrhagic and an ischemic stroke are kind of opposites. One is because you're bleeding. And one is because you're not getting enough blood flow. And so they're treated in different ways. When you get to the to the doctor and you have a stroke in progress. One of their primary responsibilities is to try to determine, are you having an ischemic stroke or a hemorrhagic stroke? Because they're treated differently?

Maya Acosta  24:07

Okay, that helps to clarify a lot. Now, one question I had, just because I, too want to be informed. So you just touched on it, which is you want to get to the doctor as soon as possible. Does that apply for both types of strokes? It's because if you can get to if it can be diagnosed within three to four hours of the onset of this happening, and then you get to the hospital three to four hours, then that determines the kind of treatment you'll get. It also reduces the risk of the damage that can happen from a stroke. Is that also true for the hemorrhagic?

Dr. Rizwan Bukhari  24:42

Well, it's not really going to be up to the patient in the field who's experiencing the stroke to figure out what kind of stroke they're having. They really need to get to the emergency facility as soon as possible period because that's where they're going to determine Are you having a hemorrhagic stroke? Are you having an EMIC stroke, and then they can decide your form of treatment. Either way, faster treatment, reduces the damage to the brain and improves your likelihood of you know, less symptoms in the future or or even recovery.

Maya Acosta  25:16

Excellent. What are the signs that a stroke is happening? You know, basically how to spot a stroke? What are the risk factors? And then we'll continue in the second part and third part giving everyone information. But let's go on to talk about that what is happening during the stroke?

Dr. Rizwan Bukhari  25:32

Well, I think that the one thing I want to touch on that we haven't touched on yet is, how do you recognize you're having a stroke at home? Okay, because you have to recognize something's happening in order to say, okay, oh, my goodness, I need to get emergency care fast. Well, there, I just use the word fast. Okay, so that's an That's an acronym that's often used. And it stands for facial asymmetry. That means that maybe you might have droopiness, on one side of the face or the other, it might be a droopy lip, droopy eyelid, or your cheek is droopy. But it means that one side of the face looks different than the other. So facial asymmetry, okay, then the next letter A stands for arm, okay, you might be that you have arm weakness, or arm numbness, or something in the arm, it could be the fingers, or, or the whole arm itself. But some sort of that's what I'm talking about set. That's that fancy word, I use ladder arising symptoms. Okay? Well, one of your arms is having some sort of problem, whether it's sensation or movement. And it can be the whole hand or it can be some fingers, but something's happening. So that's the A, we've touched on the F and the A, and then the S is speech. And so if you have slurred speech, or the inability to talk, that that is a possible sign of a stroke, okay. And then, and then the T is T is stands for time, because as we talked about, the quickness to which this is addressed, the time in which you get to the emergency facility has a strong impact on your ability to be treated and recover. Yes. And we often use that number for hours. So you know, don't sit around and wait three and a half hours thinking this is gonna get better. And by the time you get to the emergency facility, it's four and a half hours, and you're outside that range. Although we are beginning to be able to treat patients in that four to six-hour range maybe a little bit longer. But we know, the best outcomes are, the faster we can treat them, the better their outcome is. Yeah,

Maya Acosta  27:48

yeah, this is wonderful stuff. I'm so glad that we're covering all of this. And I'm going to try to put bullet points in the show notes so that people can remember fast. Can you tell us a little bit about the risk factors.

Dr. Rizwan Bukhari  28:00

Yeah, and that's actually not really any different than many diseases we treat. There are fixed risk factors that you just have, depending on whether it's your your gender, your age, some genetics, some of those things may be a previous history of something. Those are fixed risk factors that you can't change. Maybe a prior history of a stroke or a for family history. Those are fixed risk factors that you can't change, right? Then there's the modifiable risk factors. And those are the things that we can focus on and do something about. Those are things that are common diseases that contribute to the possibility of having a stroke. And those might be things like high blood pressure, smoking, diabetes, high cholesterol, physical inactivity, obesity, or being overweight, carotid artery disease, excessive alcohol intake, illicit drug use, and sleep apnea. And then I'm going to throw in there atrial fibrillation, and I save that for last because that requires some explanation. Atrial fibrillation is actually where blood where the heart is not functioning exactly correctly. And instead of beating normally, it's kind of beating in an irregular way, and it can form blood clots, and those blood clots can then be ejected out of the heart. And then they can go to the brain and block off an artery and cause an ischemic stroke. Those are the modifiable risk factors. And I know that's a lot to talk about. Yeah, and a lot to say. And you know, we can really expound upon those in further episodes.

Maya Acosta  29:41

Oh, yes. We're actually going to go into detail in the next few episodes. I want to give you guys some resources, my listeners, because I really, you know, my goal with every episode that I share is to give you resources so that you can do your homework and take control of your health. There's this wonderful stroke assessment that you can find The American Stroke Association website, and I'm going to put a link in the show notes. And what it does is it's like a checklist. You go through it and you answer the questions, it'll ask you about your blood pressure, whether you have type two diabetes, and other questions that can possibly put you at risk for having a stroke. And you're gonna tally those up and have a number and then you can assess yourself. And so that's going to be one, one resource. And another great resource is a cardiovascular guide that you put together on how to prevent cardiovascular disease. And we have a link for that it's bit.ly/joindrriz so you will join our newsletter. But in return, you get 20 pages of information on not only learning what cardiovascular disease is, and how Dr. Ris as a vascular surgeon, treats that disease. You learn about what your risk are for other things. And then we talk about lifestyle modifications, which will go into detail as well with the stroke topic. Dr. Riz, in the next episode, we're going to dive into risk factors associated with women in general, women are at higher risk of having strokes, and more specifically, women of color. And so we're going to focus on that, why is that? What are those risk factors are unique to women. And then we're going to talk about solutions. And then in the third part of it, we're going to dive even deeper into the resources. And we're going to demo for all of you how to take your blood pressure and Dr. Riz, we'll talk about some of those devices that you can have at home. Before we wrap up. Is there anything you would like to tell our listeners about this topic?

Dr. Rizwan Bukhari  31:50

Well, I'd say that I think stroke is largely ignored and unrecognized. We all talk about heart disease a lot. But stroke is right up there is one of the leading causes of death and disability in the United States. And there's so much we can do personally in our lives to reduce our risk of stroke that I think it's important to talk about. Yeah,

Maya Acosta  32:15

yeah. And I'm so glad that you're here to do so to to inform our listeners. So thank you again, and we'll catch you in the next one. All right. Take care. You've been listening to the healthy lifestyle solutions podcast with your host Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave an honest review as well at ratethispodcast.com/HLS. This helps us to spread our message. And as always, thank you for being a listener.