From Fear to Advocacy: Lindsay Goff's Mission to Educate on Stroke Risks

Rich Bennett 0:00
Thank you for joining the conversation. I am joined by somebody I haven't seen in a while, Rania Nassar, and she said, Rich, we need to do a podcast on stroke awareness. And basically when Rania says jump, I say hi. So I. 

Ronya Nassar 0:17
Like the support. 

All 0:18
Route. 

Rich Bennett 0:19
Okay, we did do it. So we have Lindsey Golf joining us, who is with University of Maryland Medical Systems, Upper Chesapeake Health. I get that right. 

Lindsay Goff 0:28
Yes, sir. 

All 0:29
Are you sure? Yes. 

Lindsay Goff 0:30
I'm the primary stroke program coordinator for Upper Chesapeake Hartford Memorial, and we're opening Aberdeen. 

Rich Bennett 0:38
Oh, Aberdeen's diving not yet. 

All 0:40
You got it. Well, there's there's offices, February stops, offices that way. 

Ronya Nassar 0:44
Please tell me. 

All 0:45
Was that added in 

over there? 

Ronya Nassar 0:49
That's so funny. 

All 0:51
That there's nothing like that right now to be bothering me. Great. Sounds fantastic to know That would have been funny. Yeah, it would have been. 

Ronya Nassar 1:00
Really? No Aberdeen. Like, they have some. Like, that's really loud. That's actually really, really hush. 

That's right. Now, Aberdeen has some. Like they're offering some services, like inside already, but not all. 

Lindsay Goff 1:14
Outpatient. Yeah. Physician offices and then outpatient rehab. The freestanding portion of the inpatient OBS unit and then inpatient psych won't open until February. 

Ronya Nassar 1:26
Oh, wow. Very nice. A very. 

Rich Bennett 1:27
Nice serve. The TV kicks on. 

Don't worry time my brother with. 

Ronya Nassar 1:33
That's right. It was always him. 

Rich Bennett 1:36
Well especially if this subject. Yes because that's what he passed away from. 

All 1:40
Yeah. 

Rich Bennett 1:40
Start jump. So we're we Yeah. We're going to be talking about stroke because it's very important and I'm sure everybody is. I think everybody knows somebody that's had a stroke. Mm hmm. You know, whether a mini stroke or a major stroke or whatever. 

So I'm just going to. Well, actually, right now, I'll turn it over to you. 

Ronya Nassar 2:03
Turn it to me. 

Rich Bennett 2:04
Turn. 

Ronya Nassar 2:06
Well, I mean, again, I think this is a really important topic, and I'm glad Lindsay's here. I know that we are. So, you know, we talk about stroke in the U.S. It's it's one it's affects one in six Americans in Harvard County. Specifically, if we take out I think if we I think it might be the fifth leading cause of death in Harvard County. Really? I'm trying to remember what. 

All 2:27
We talked about it. We think about. 

Lindsay Goff 2:29
It. It would be the fourth. Yeah. Of death and the number one cause of long term disability in the United States. Yeah. 

Ronya Nassar 2:37
Yeah. So. Yeah, So it's, it's. It's more prevalent than people know. 

Rich Bennett 2:43
So I, it seems like to me those numbers are going up. 

Lindsay Goff 2:46
They are. And patients that are suffering, these acute ischemic strokes are getting younger than before. It's not just an older person disease process. The youngest patient I've had so far is 24. 

Rich Bennett 2:58
Why do we. Oh, I guess we probably didn't know. 

All 3:01
Yeah, we. 

Lindsay Goff 3:02
We can't really tell just yet. In order to determine if COVID is a factor, we need at least ten years of Right. And we're only three years in. So seven years we'll be able to either rule that in or roll that out as a risk factor. 

Rich Bennett 3:16
Wow. Okay. So that just blows me away. And you're seeing more younger people. Within the past three years. 

Lindsay Goff 3:25
In the last decade, there's been an increase in younger stroke patients. But is that are we recognizing these more because we have expanded our inclusion criteria for symptoms or is something else affecting it and affecting younger patients that you say? 

Rich Bennett 3:41
Because I mean, a lot of things like if you had parents that were addicted, whether it be to alcohol or drugs, could that be like one of the symptoms? 

Lindsay Goff 3:54
So it could be risk factors. Okay. Here you have your modifiable and your non modifiable. Also, the modifiable ones are your diet exercise that keeping your blood pressure under control, your cholesterol, your non modifiable are what you inherited. So that could be your age, your gender, your race. Those things play a you know, a factor into your risk for having a stroke later on in life. 

Ronya Nassar 4:19
So out of all of the so let's actually before I asked you know out of all the types of strokes, which ones are the most prevalent, why don't you give us like a breakdown of like the types of strokes that we that you see what are more prevalent like that? 

Lindsay Goff 4:31
Yes. Okay. So there's two different types of stroke. The first one is hemorrhagic stroke. So that means there is bleeding in your brain from a vessel that ruptures in your brain. 

All 4:42
Like hemorrhagic hemorrhage. 

Lindsay Goff 4:45
And when that blood lays on that brain tissue, then the brain tissue is. 

All 4:49
Dead. 

Lindsay Goff 4:50
Because it does not get oxygen. Those are only 12% of our strokes historically throughout the country and for Harvard. 

All 4:57
Really. 

Lindsay Goff 4:58
For Harvard County, we the second type of stroke, ischemic stroke, is a clot lodged in your brain and impeding blood flow to the rest of those blood or those brain tissues. So that is historically about 87, 88% of our strokes. 

Rich Bennett 5:15
So that because I remember reading a report last year or whatever where I think it was a paramedic where she cracked her neck, which caused her to have a stroke, would that be the second one to you said the blood clot. 

Lindsay Goff 5:29
So those are actually a vertebral artery dissection. So it's another. 

All 5:35
Yes. 

Lindsay Goff 5:36
So that's another vascular disease process. Your vertebral artery. Historically, when chiropractors adjust your neck, it can shear that artery in your neck, which supplies which flow to your brain. 

Ronya Nassar 5:49
I know what. 

All 5:49
You're thinking because you just talked about chiropractic, you. 

Rich Bennett 5:53
Know, every six weeks. Well, my neck. 

Lindsay Goff 5:56
I've never been to a chiropractor for my neck, but that is a no no in neurology. But I. I'm willing to try it. But that's very, very rare. Yeah, those are rare cases. Very, very rare. Generally, you have to have some sort of, you know, vessel disease or already like an injury to those vessels or they have to be weakened. 

Rich Bennett 6:18
Now, I know why you want to do this, right? You because you want to scare the hell. 

All 6:22
Out of me. I know. 

Ronya Nassar 6:24
I just thought this was a really good topic. 

Rich Bennett 6:26
I know it is. It is. 

Ronya Nassar 6:27
You know, I know it hits close to home. 

Rich Bennett 6:30
It's. It's a topic that needs to be discussed, and, well, my father had a stroke. Now he. He didn't die from it. My brother did. But both of them I mean, both of them are heavy smokers, which is, of course. 

Ronya Nassar 6:47
Always a risk factor. 

All 6:48
Smoking causes everything. 

Rich Bennett 6:52
Not in not in the best health, of course, and stress level. Good Lord. 

All 6:59
You factor. 

Rich Bennett 7:00
Of, you know, my blood, my blood pressure, my brother's blood pressure. You could always tell when it was high because his nose would turn purple. I mean, literally purple. 

Lindsay Goff 7:10
And that's. 

All 7:11
Not good. Yeah. 

Rich Bennett 7:13
No. 

All 7:13
And I good. 

Rich Bennett 7:15
I get it. I mean, every time I go to the doctor, I, you know, I'm sure if my blood pressure now both say it's good. It's like, yeah, I know I can get it better. 

I Yeah but I don't smoke or anything. 

Lindsay Goff 7:28
You know, there's a lot of things, I mean, risk factors and controlling those risk factors, whether it's the ones we can change so the modifiable or the ones we can't, which are the not or the non modifiable ones, they all play a factor into It increases your risk. But there are stroke patients that have strokes that don't have any risk factors or at the time of their stroke, they don't know that they have one or two of those risk factors like atrial fibrillation. I know this because five years ago my stepdad had a very large ischemic stroke and was a Baltimore City fireman. He was healthy. He ran every single day. He played soccer twice a week and suffered an ischemic stroke because he had an irregular heartbeat, afib and didn't know it. And that was where the clot came from. 

Rich Bennett 8:14
I was going to say, as a firefighter, wouldn't you have to get a physical every year? 

Lindsay Goff 8:17
Yes. But I mean, you don't have you know, you could be in and out of afib. So when you go to the doctor and they do your EKG or your echo, you could just not be in ether at that time. 

Rich Bennett 8:29
So with all the risk factors, what are some of the things that we can modify? 

Lindsay Goff 8:34
So that's a great question. 

All 8:37
So really. 

Lindsay Goff 8:37
Modifiable risk factors, I feel. 

Rich Bennett 8:40
Special. 

Lindsay Goff 8:42
The biggest one that you can do is smoking cessation. So if you smoke, please stop because I'm at a high risk for the plaque to build up in your neck. 

Rich Bennett 8:52
Or even chewing, right? 

All 8:53
Yes. 

Lindsay Goff 8:53
Any tobacco. 

Rich Bennett 8:54
In general? 

Ronya Nassar 8:55
In. Yes. 

All 8:56
Okay. 

Lindsay Goff 8:56
Tobacco products. You also want to control your blood pressure. So if you have high blood pressure, you want to keep on top of your medicine. You aren't sure if you have it. That's why it's very, very important to see a primary care doctor every year to get a physical. We check your cholesterol, so you want to keep your cholesterol numbers under control by either medicine or with diet exercise. You also the Age recommends 30 minutes a day of aerobic exercise. 

Rich Bennett 9:24
Overall, a big exercise. 

All 9:25
Yes. 

Ronya Nassar 9:26
Yogurt activity is great. And you know what? The best type of exercise, aerobic exercises. 

Rich Bennett 9:33
No, but I know you're going to tell me walking. Oh, okay. I could. 

All 9:36
Do that. Yeah. Can't beat that walking. Okay. Yeah, just walking. 

Lindsay Goff 9:40
Doesn't have to be running. It doesn't have to be. 

Rich Bennett 9:42
Well, you say aerobic exercise. Yeah. Yeah, that's. I'm thinking I'm having Zumba and all that. 

All 9:47
I mean, you could do Zoom. I know I can, but, you know, walking. 

Ronya Nassar 9:51
Is the best exercise. I think a lot of people think like, Oh, it's not, you know, you're just moving, but you. There's a point. A walk. 

Rich Bennett 9:57
Outside. 

Ronya Nassar 9:58
Yeah, there's a point of walking that's just so beneficial for our bodies. 

Rich Bennett 10:02
Mm. Well, it was for your mental health as well. Yeah. I mean it helps out a lot. 

Ronya Nassar 10:06
Which is huge. Goes into stress because yes. 

Lindsay Goff 10:10
The controlling stress is the other modifiable risk factor. 

Rich Bennett 10:15
So whether somebody else will drink it is another thing. Right. 

Lindsay Goff 10:18
Yes. So drinking is another one. We focus more in neurology about smoking cessation. Okay. More studies that correlate smoking cessation to increasing your risk for ischemic stroke. There's not as many with alcoholism, but with other drug use, such as cocaine. IV drug users can have more ladies, so those are more put you more at risk. 

Rich Bennett 10:42
Now, what about the vaping? 

Ronya Nassar 10:46
Great question. See, the issue is, is there's just not much out about vaping yet. But if you think about it, you know what we always say especially is that, you know, you're not whatever it is, you should be only inhaling oxygen into your body. And obviously we don't when you're vaping, you're not inhaling oxygen to your body and putting oxygen to your body. So obviously it's not going to be good. Is there correlation for vaping with a lot of stuff yet? Not necessarily, because again, we there still needs to be so much research out there. One thing we do know is that it's not good because we don't want to be inhaling anything with oxygen. 

All 11:22
Yeah. 

Lindsay Goff 11:23
Any foreign substance? Yes. Entering your way in general. Not from the environment. 

All 11:28
Yeah. 

Rich Bennett 11:29
So with like diabetes you have screening, you can do with and there's a lot of your bloodwork determines a lot of other things. Is there anything, any type of screening to the that's out there where you can see if you're a risk of having a stroke. 

Lindsay Goff 11:48
Yes, there are. And thank you for mentioning that last one. So diabetes is another modifiable risk factor. And there's a lot of different tests that you can do that physicians do and that we do on all of our patients to make sure that we don't have a secondary stroke. But the biggest screenings that we can do, our carotid artery, ultrasounds to make sure that the plaque isn't built up in your neck and that plaque can break off and then go into your brain, or it can narrow the arteries and cause a clot from something else from somewhere in your body. So we look at your neck. We get you also can get an ultrasound of your leg so your calves to make sure that you don't have any clots in your legs. 

Rich Bennett 12:30
No shame. 

All 12:32
About. 

Rich Bennett 12:33
It because you're going you're going from one part of the body all the way down to the other part. Why? 

Lindsay Goff 12:39
Because clots can come from anywhere in your body. But those are the two largest parts of your extremities. 

All 12:46
The. 

Rich Bennett 12:47
Neck and the legs. 

Lindsay Goff 12:48
Yes. So that's where a lot of clots come from. They also can come from your heart, from your right, from that aortic arch. 

Rich Bennett 12:56
Well, which explains why the walking I would think walking is probably going to be one of the biggest things. 

Lindsay Goff 13:02
Keep that blood flow going. So that's our ultrasounds that we look at. Like I said, with your neck, with your legs, and we do blood pressure screening. So keeping your blood pressure under control. And we also, again, the cholesterol screenings, we do the A1 c screening is those are the biggest things that we can do to screen for stroke. 

Rich Bennett 13:21
So with the legs, we'll lose, what do you call them. 

All 13:26
The compression brace? Yeah, yeah. Yes. We use that to make sure it's okay. 

Lindsay Goff 13:34
Yes. I CDs, we, we call them in the hospital but yes. 

Rich Bennett 13:37
As TDs. 

All 13:39
As well. 

Rich Bennett 13:39
As. 

All 13:43
Like with something else. No, no. 

Rich Bennett 13:46
Now okay those things are not they're great because my I had to get a pair for my daughter with the fracture shoulder because she's just and her one leg kept so not. 

All 13:55
Mm. 

Rich Bennett 13:56
And put homemade in things but holy cow. Feels like don't put them around your neck like this. I didn't do things like. 

All 14:07
They squeeze her. Yeah. Yeah. Squeeze. 

Lindsay Goff 14:09
It causes that heart to push that blood all the way down there, so it's a good thing. 

Rich Bennett 14:15
All right, So. And I've heard, like, if if you think you're having a heart attack, they say to cough really hard. Mm. 

Lindsay Goff 14:22
No, I've never heard that. 

All 14:23
Never heard that there was no. 

Lindsay Goff 14:25
Honestly coughing very hard. So we've, we do see this very infrequently. But if patients cough or strain themselves very, very hard, whether it be with exertional exercise or having a bowel movement or prolonged periods of forceful coughing can also cause a clot to dislodge in your body and go to your brain very infrequently. 

Rich Bennett 14:51
Now, I got to find that where I'll find that out and they call them and. 

All 14:55
All that wasn't from wasn't from our podcast. 

Rich Bennett 14:57
No, no, it's probably YouTube universe yourself. 

All 15:01
Yeah. 

Lindsay Goff 15:01
No, instead of instead of coughing, if you think you're having a heart attack or a stroke, you should call 911 instead of cough. 

Ronya Nassar 15:06
But so what are the what? 

Rich Bennett 15:08
A lot of times I mean, because you may not have time and Oh wow. 

Ronya Nassar 15:15
But what are the so what are the signs then for someone to look for if they are having a stroke? 

Lindsay Goff 15:20
So all of the signs that we look for, we go with the B fast algorithm. So the B is for balance. So we look for any gait abnormalities, any loss of coordination, any balance issues with an acute onset. We look for the E in the B faces eyes. So any visual disturbances, if you have any blurred vision or spots in your vision or loss of peripheral vision, the F in B fast is for your face. So we look for any facial drooping, we look for any acute onset of the worst headache of your life. We look for the A and B fast. Is your arm. So we see if there's any weakness on one side of the body or the other, or numbness or tingling or pins and needles. The S and B fast is for speech. So we look for any. 

All 16:12
Like slurred. 

Lindsay Goff 16:13
Swallowing, any slurred speech, any speech, abnormalities, difficulty getting your words out or finding your words. And then the T is in B fastest for time. So all of these symptoms are time sensitive and we have a four and a half hour treatment window for a clot busting medicine that we can get into later. But that B fast algorithm has all of the symptoms of stroke. 

Rich Bennett 16:35
With, with that, because it used to be just fast. 

All 16:38
Yes. 

Rich Bennett 16:39
When did they had to be? 

Lindsay Goff 16:41
So they added the B and the E a couple of years ago to encompass what we call posterior circulation strokes. Okay. These are strokes that are could be in your cerebellum. So these strokes have very vague symptoms. They can mimic complex hemiplegia, migraines or just cluster headaches. They can also mimic vertigo with dizziness. So I've had patients that have a history of vertigo and they take med, you know, medicine for it and have these symptoms and tell me that they this feels different, this dizziness or this balance or this difficulty walking is different for me. 

Rich Bennett 17:18
How many times has somebody come in thinking they have a stroke or having a stroke? I'm going to get the name of it wrong and it ends up being a Bell's Palsy. 

Lindsay Goff 17:32
Bell's Palsy. So we do see that very frequently with Bell's Palsy. It's you're going to see the facial right and the numbness. You don't typically have slurred speech. If you do, it's just because of that side of your face is drooping, but it is isolated to the face. So you don't have any other involvement with your arms, with your legs. Generally, this is from a viral infection that causes this. Bell's palsy. 

All 17:56
Really affects. 

Lindsay Goff 17:57
That facial nerve. 

Rich Bennett 17:58
I realize that. 

All 17:59
Yeah. 

Rich Bennett 18:00
I thought that could be hereditary. 

Lindsay Goff 18:02
Now, generally, Bell's palsy is comes from a viral infection or an injury to that facial nerve. 

Rich Bennett 18:11
An injury to the. To the facial nerve. 

Lindsay Goff 18:14
Yes. I mean, from trauma, from it can be swelling, it could be inflammation, but it could. 

Rich Bennett 18:19
Happen right away. 

Lindsay Goff 18:20
It should. 

All 18:21
Yes. You'll see. Should be delayed. 

Lindsay Goff 18:24
So it could be delayed. I mean, with all patients, it's unrealistic to give you you know, it's going to happen at this time. But we do see it shortly. 

Rich Bennett 18:33
Mean years. 

All 18:35
Later now, not later. 

Rich Bennett 18:38
When I got. 

All 18:38
Kind of small. Yeah. 

Lindsay Goff 18:41
Generally 12 to 24 hours later. 

All 18:43
Okay. Yes. Wow. 

Lindsay Goff 18:45
With the swelling, any kind of swelling that you have, any spinal cord swelling that can also cause injury to that nerve. 

Ronya Nassar 18:53
But regardless, just calling 911 and going immediately, even if you have just suspicion, putting it off is going to make it worse, right? 

Lindsay Goff 19:02
Yes. And time is brain. So every minute that the brain cells are not perfused, we lose 1.9 million cells for every minute that they don't get blood flow with oxygen. So that's why it's very, very time sensitive. We have, again, four and a half hours from symptom onset to give patients that have a clot stuck in their brain, the clot busting medicine. So that's a very short time frame. So historically in Harford County, we like to, you know, have we experience these symptoms? We want to just lay down, sleep it off for our primary care doctor in the morning, because we don't want to be a burden burden to the E.R. But those patients, again, wake up outside of a treatment window. 

Rich Bennett 19:45
All right. So if let's say you're off the grid, you know, cell phone or nothing and you're having symptoms of a stroke, what can you actually do? Because you can't call 911. So what can you actually do to help yourself or is there. 

All 20:02
Anything in your track? 

Lindsay Goff 20:03
That's a very hard question. Yes. Start your truck to the closest more area. And there are a lot of things and a lot of tests that we need to do. We need to start patients on certain medications after they suffer a stroke. 

Ronya Nassar 20:17
It's not like it's a heart attack. So like when you have a heart attack, there's it's different. Like you might want to like, I don't know, take aspirin or something like that right away. But it's it's different. It's a totally different beast than than stroke, for sure. Or than heart disease or any other, you know, thing. Like if the whole like, you know, if A happens B needs to happen, if you have symptoms, the automatic thing is you just need to go call 991 and go to the emergency room. 

Rich Bennett 20:47
So are there are there more deaths caused by stroke than heart attack? 

Lindsay Goff 20:52
It's it's hard to say. So stroke, if you suffer an acute ischemic stroke or a hemorrhagic stroke, it doesn't death doesn't happen immediately. Thankfully, our stroke patients die from complications from stroke. A lot of it is aspiration pneumonia or hemorrhagic strokes. That all depends on multiple different factors with how fatal they can be if they're on blood thinners, how large the bleed is. There's a couple of different things. 

Rich Bennett 21:20
So, okay, 

if somebody has a stroke 

because you might like mine, like a friend of mine had mini strokes, what is a mini stroke? 

Lindsay Goff 21:31
So a mini stroke. This is a question that I would love to clarify for the public. So we say mini stroke, it actually means a TIAA. So a transient ischemic attack. 

Rich Bennett 21:45
It's easy for you to say. 

Lindsay Goff 21:47
So this means that someone has an acute onset of all of these stroke symptoms. So the be fast algorithm, they have an acute onset of these neurologic symptoms that present like a stroke. What classifies this as a TIA or mini stroke is when the symptoms completely resolve within 24 hours. Meaning meaning that there's no residual deficit left from it. So if anyone has any residual deficit from an event like this, they actually had a stroke and not a mini stroke. Mini strokes can put you at a 48% chance higher of a risk to have a larger ischemic event in three months, within three months out of TIA or mini stroke means that a clot was lodged somewhere which caused the symptoms and then it travel down one artery or another, either to the left or to the right. And that's why the symptoms were resolved. But that doesn't mean that there's a clot somewhere. 

Ronya Nassar 22:49
Which again goes back to you need to go to the emergency room. 

Lindsay Goff 22:53
Yes. 

Rich Bennett 22:56
Wow. Yes. Well, I took your microphone. 

All 23:00
Away. 

Rich Bennett 23:00
But go ahead. 

Ronya Nassar 23:02
So what if you have a stroke like in your sleep? Like, will you wake up in the morning and know that you had a stroke? 

All 23:10
Or is it you just didn't you don't know. 

Lindsay Goff 23:14
Yes, you should. You will know. Yes. So if you wake up with neurologic deficit, that is indicative that you had a stroke and there's damage to those brain cells. If you wake up and you don't have any symptoms, then like I said, there was a clot lodged somewhere and then it traveled down. But you wouldn't know because if you didn't wake up with the symptoms, then there's no way to know. 

Rich Bennett 23:42
Okay, four years. 

My doctor had me on the baby aspirin regimen, whatever you call it. Yes. It recently took me off of it because my blood pressure's fine. But is is there any reason why? Because that helps prevent stroke, right? 

All 24:00
It does. 

Lindsay Goff 24:00
Aspirin is a platelet inhibitor, so. Or a platelet aggregation inhibitor. So it means it prevents those clots from forming and sticking together. Okay. Platelets form together to form a clot. So we want to decrease that by preventative with aspirin every day. 

Rich Bennett 24:19
I but he told me on 81 milligram, you know, baby aspirin, but is there any harm in still doing especially when you get my age? 

Lindsay Goff 24:28
I mean, my recommendation is always to consult your physician first. But with stroke patients and cardiac patients, we do preventatively put them on aspirin and a Plavix. So a dual antiplatelet therapy. 

Rich Bennett 24:43
Okay. And I already mentioned the issue of strokes hereditary. 

Lindsay Goff 24:47
No, you didn't ask me that. 

Rich Bennett 24:48
Is it. 

Lindsay Goff 24:49
So stroke itself is not hereditary, but your non modifiable risk factors are. 

Rich Bennett 24:55
Similar to diabetes. 

Lindsay Goff 24:56
Yes. So your diabetes, your age or gender, your race, those are also things that you're inherited with. There are some clotting disorders that you can inherit that cause your body to clot one of them more frequently, such as factor five. But you don't inherit a stroke. You can inherit the non modifiable risk factors which put you at a higher risk for stroke. 

All 25:20
Yeah. 

Rich Bennett 25:21
Who's are men or women at a higher risk? 

Lindsay Goff 25:25
Oh. Oh, so this is a hard one. So they're they're. 

Rich Bennett 25:28
Unlike asking these. 

All 25:29
Hard. 

Ronya Nassar 25:31
They're good. 

Lindsay Goff 25:32
Yes. They're almost equal when we look at it. So the male patient population is slightly higher and it varies between different studies. So I don't want to give you an exact percentage, but like I said, it varies from one study to the next state to state. But men are at a higher risk for having a stroke compared to Caucasian and Hispanic populations. African-American males are at a even larger percentage for a risk factor for stroke. 

Rich Bennett 26:04
Why? 

Lindsay Goff 26:05
Is it because of their inherited risk of high blood pressure, high cholesterol, diabetes of African-Americans also have sickle cell? So this. 

All 26:14
Is. 

Rich Bennett 26:14
Irony. What do you think about. 

Lindsay Goff 26:16
That, that a lot of people don't, you know, don't think about or that they miss, but that causes the red blood cells to be misshapen and shaped more sharp so they get stuck in vessels more so than people that don't have sickle cell. 

Rich Bennett 26:31
Okay. Now we know smoking plays a big part in this. What about as far as air quality? Yeah, I think of light. Los Angeles has always been known like the smog capital of the world, you know, and with the wildfires in Canada, I'm sure that has. And how does that play a risk to. 

Lindsay Goff 26:50
So again, there's not many studies on it. Right. Look at it. But smoking cigarettes and tobacco products, that's specifically what they study. So it's hard to say. Does it play a factor or not? But definitely cigarette smoking and tobacco usage definitely does. 

Rich Bennett 27:06
Asbestos. 

Lindsay Goff 27:08
Asbestos, but not really. That's more for cancer. We don't know that. But again, having cancer could increase. 

Rich Bennett 27:16
Yeah, I always wondered about that. 

Lindsay Goff 27:17
Okay, that will increase your risk for abnormalities in your clotting factors. 

Rich Bennett 27:24
Holy cow. 

All 27:25
Yeah. Yes. 

Ronya Nassar 27:26
It's a lot. I mean, if you think about it like, you do need to just kind of go throughout your life living, you know, you're. 

Rich Bennett 27:32
Scared. 

All 27:35
But you that. 

Rich Bennett 27:35
Live in health, you take care of yourself. 

Lindsay Goff 27:37
And just. Yeah, just taking care of yourself and decreasing the risk factors because you want to eliminate almost everything that you can. So that you don't have an ischemic stroke right in the future. But I mean, these patients that do suffer strokes when we see them, when they come to my stroke support group, when we round on them afterwards, they do express that fear that it's like living, you know, like a ticking time bomb. But that could be said for cancer, that could be said for acute coronary syndromes, stroke. This could be, you know, again, how do we know? So we have to just prevent it and eliminate our risk factors. 

Rich Bennett 28:15
Something you just said. And I'm glad you brought it up. The stroke support group. 

All 28:20
Yes. 

Rich Bennett 28:21
Are you the only one out there or because that's the first time I've heard of that. 

Lindsay Goff 28:25
So there are many. 

All 28:26
Okay. 

Lindsay Goff 28:26
Good resource where you can start. And where I direct patients to is the American Heart Association website. 

All 28:33
Okay, you can put it. 

Lindsay Goff 28:33
In by zipcode. And that will give you the different stroke support groups in that area. I do know that our stroke support group at Upper Chesapeake Medical Center is once a month and it is the second Wednesday of every month from 1030 until 12. There are other ones that are in Baltimore County and in Baltimore City, but mine is the only one in-person in Harford County at this moment. 

Rich Bennett 28:58
Only when it's in-person. 

All 29:00
Yes, really, A. 

Lindsay Goff 29:03
Lot of them went virtual with COVID. 

Rich Bennett 29:04
And just stuck with. 

All 29:05
It. 

Lindsay Goff 29:06
Yes. But my goal when 2023 started was to get the stroke support group back and in person. And now we have 17 to 20 regular attendees. It's patients, their caregivers, their families, spouses of patients that had stroke. So this is open, everybody. 

Rich Bennett 29:23
So once somebody has a stroke, they're at a very high risk of having another stroke, right? 

All 29:29
Yes. 

Rich Bennett 29:32
Is there something that they need to besides changing, I want to say, habits or lifestyle? Yeah, that they need to change because it's. 

Lindsay Goff 29:45
So how so how do we prevent a secondary? Yes. After you've had one. This is a question that we get all the time. So in the hospital, when someone suffers a stroke and we look at the risk factors, that's the first thing that we look for and we look at the non modifiable. So what they're born with, if they don't have any of those, then we look at the modifiable. Do we look at do they smoke, What is their diet like. We checked their cholesterol, we checked their a1c, we checked their blood sugar and then we also check, like I said, the carotid artery in the legs. We will check your heart to make sure that there's no clots coming from there. And we'll also do extensive cardiac monitoring to make sure that you're not in atrial fibrillation, that irregular heartbeat, without you knowing about it. We call these strokes that we don't know where they came from, cryptogenic strokes. So before these patients and before my patients leave the hospital, the goal is to figure out where the stroke, where the cause was so that we can treat it with a dual antiplatelet therapy, aspirin and Plavix. We put them on a statin preventatively, and then we can also put them on a blood thinner if we do find that they are in afib, which caused the stroke. 

Rich Bennett 31:02
For those of you listening, the reason that Lindsey and Rhonda are laughing sometimes it's not a funny subject. She's just wrong words out that are throw me off. 

All 31:16
I'm like, who? 

Rich Bennett 31:18
Yeah, I There is no way in hell I'm going to remember all these words you threw out at me. I can't wait to just transcribe this one too. 

All 31:27
So that's. 

Ronya Nassar 31:27
Why if you're having symptoms, you need to. 

All 31:30
Go to the emergency room. 

Ronya Nassar 31:31
To have the doctor. 

Rich Bennett 31:33
Wow. 

Lindsay Goff 31:34
I realize 

management has come a long way and I mean in the fifties and the sixties, we used to call it masterful inactivity. So when someone had a stroke, there wasn't much that we could offer them. There wasn't studies on the importance of, you know, early mobilization after stroke. There wasn't clot busting medications and there weren't, you know, procedures that could pull clots out of brains or drain the blood from brains. So it's drastically changed since the fifties, in the sixties, the fifties and the sixties, not just with risk factor modification, but diagnosed crisis and treatment has come very far. 

Rich Bennett 32:15
I want to go back back a little bit because one of the things you mentioned was stress. Yes, stress is a cause of it. And you said you're the youngest patient you had was 24. 

Lindsay Goff 32:28
Yes, sir. 

Rich Bennett 32:29
Okay. Yes. And hopefully you'll never see any anymore younger than that. But and I know you really can't. There's no records to show to show this. This is just opinion from both of you. Do you think the way the world has changed with the 24 seven news, the social media, all the negative stuff out there, 

COVID causing a big mental health problem with teens and everything, do you think that's good? That is going to be a, I guess, almost like a risk factor in the future. 

Lindsay Goff 33:12
So definitely with it's good and bad. So with the way the world is right now, with social media and we can use it for things like this to get that awareness out, right? That's the good part with social media, with COVID, we didn't see people staying home more that were working from home, that didn't have an active lifestyle because they were afraid to leave their houses. Is that going to be a factor? Yes. Maybe we have patients that, you know, became depressed through COVID, which, you know, staying on lockdown causes depressions that caused people to smoke at home when they didn't before or to increase their usage of tobacco. But I mean, it's negative and positive. But I'm trying to take the positive parts of. 

All 33:56
Right. 

Lindsay Goff 33:57
COVID and getting using social media and getting the awareness out there to people that are doing well. 

Rich Bennett 34:05
And the reason I bring that up is and I'm sure you go out, speak into groups right. But with something like this, you're probably focused on the old elderly, elderly. You're probably focused on the people like me, the older group, correct. 

Lindsay Goff 34:20
You're not that old, But yeah. 

All 34:22
Yes, I do. I do. Focus. When you want to move to favorite, I do. 

Lindsay Goff 34:28
Focus on. Yes. We go to a lot of nursing homes, assisted living facilities, we independent living facilities. We focus on that patient population. And you know, the over 65 because they're are a higher risk. The risk increases as you get older. We also have been doing education in Harford County schools. So we are okay to get Harvard County Public schools. We are going into churches and speaking to church groups and we're speaking to everyone. It's not just, you know, if we teach younger people what the signs and symptoms of stroke are, they can recognize right in their family members, their grandparents, their neighbors, their teachers, other family members. 

All 35:10
Okay. 

Ronya Nassar 35:11
How do you think about it? It's not just stroke that we're seeing in younger people. It's there's a lot of other I mean, younger I mean, heart attacks. We're seeing it in younger and younger. 

All 35:20
Mm. 

Ronya Nassar 35:20
We continue to move on. We keep seeing a lot of health issues in younger people and it can be a lot due to lifestyle changes and. 

Rich Bennett 35:29
Mhm. 

Ronya Nassar 35:30
So you know obviously stroke is important but it's not just stroke, there's so many other, you know, health issues that we've been seeing in younger kids lately and I think that's like really important to kind of note. 

Rich Bennett 35:42
Oh yeah, absolutely. Because I and the kids 

need to know what to look out for. Yeah, because, you know, I know as my sister found my dad laying on the floor and, you know, of course you didn't have 911 back then. I you actually had to call. Yeah. His rotary. 

All 36:04
Phone. Yeah. And that Yeah. 

Ronya Nassar 36:06
Break the back screen for it to go back. 

Rich Bennett 36:09
But I mean at least. Yeah. I mean that is a plus there where the social media can help you can put it out there. I just think about how it drives stress up of people because you know, well, you know how it works. You start looking at negative stuff. You're always looking at the negative stuff, the positive stuff is what we need to get out there and have them look at more. 

All 36:32
Yes. 

Rich Bennett 36:33
So you do go out and talk to other groups. How do people get in contact with you to have you come and talk? 

Lindsay Goff 36:39
So that's a great question. 

Rich Bennett 36:41
Yeah, but it wasn't a hard question. 

Lindsay Goff 36:44
So I get the contacts for from my community outreach group. So we have a group of 40 nurses that go out into the community and do diabetes education, smoking cessation, blood pressure screenings. They get me the contacts to also go into these facilities with them to teach whoever we're speaking to about the risk factors and do stroke education. So also you can get a hold of me at upper Chesapeake. My information can I will provide it to Rich, so it will be on there. But I'm easy to get a hold of because I am the district coordinator for all of our free county. 

Rich Bennett 37:20
You're the only one there. 

Lindsay Goff 37:21
Yes, sir. 

Rich Bennett 37:22
Would you stop calling me so. Oh, you're not. Oh, yeah, but you keep calling me, sir. Maybe feel. 

All 37:28
That's. 

Lindsay Goff 37:29
Just to have. 

Ronya Nassar 37:29
I was I was going to add to sort of like about Harvey and Hillsborough and we were, you know, Lindsay just mention community outreach. We work very closely with community outreach to provide some of the classes that are really important to help with the risk factors that we mentioned earlier. So one of the things that's huge, we talked about diabetes prevention and the Carver County Health Department partners with Upper Chesapeake to offer a diabetes prevention program, classes in English and in Spanish. So. 

Rich Bennett 37:55
Oh, wow. 

Ronya Nassar 37:55
Yes. So yes. So the class, you know, can be overwhelming to some people. It's a year long. However, it's an evidence based class, meaning it works. 

Rich Bennett 38:05
For long class. 

Ronya Nassar 38:06
Year long class. They start you know, first we start off with, you know, meeting weekly, then it tapers off to biweekly and then, you know, less than that, right, that year. But it's a class. It's proven to help you lose weight, lower your A-1 C It's really, really a means absolutely amazing. So we have that class. We also offer smoking cessation, which we've kind of gone back to talking about how, you know, we know smoking is bad for you. And in Harvard County, we have such a high smoking rate still with adults, but we also offer smoking cessation that's permit cessation and prevention to as well. We also have an individual who goes out and does presentations about smoking cessation to people. So those are really, you know, to, I guess, really important. You know, we have the stroke support group, we have smoking cessation classes, prevention, we have diabetes prevention. The hospital also offers diabetes self-management or a diabetes self-management program, which is DSM-V, they call it. That's also really important. So if you have diabetes, this is another evidence based, meaning it's proven to work to help you, you know, manage your diabetes. So that's also really important. 

Rich Bennett 39:14
Ones that claims. STAUFFER Diabetes one the prevention. 

Ronya Nassar 39:18
Yeah, we have classes running all year. 

All 39:20
Oh, you do? 

Ronya Nassar 39:20
Yes, we have one. I think we have a cohort new core, new English cohort running soon, and I think we're also looking to get another Spanish cohort running. 

All 39:28
Okay, Well, yeah. Huh. Not to say no. 

Rich Bennett 39:36
I can, I can edit that part. 

All 39:39
And you're not. 

Rich Bennett 39:40
Supposed to be talking. 

All 39:44
Know she's. 

Lindsay Goff 39:44
A director. 

All 39:45
Yeah. 

Ronya Nassar 39:46
That's my producer over. 

All 39:47
There. 

Ronya Nassar 39:48
For public. 

All 39:49
Health matters. 

Rich Bennett 39:51
Let me take you out for her. 

All 39:53
I mean, I got a spare. I mean. 

Rich Bennett 39:55
Do you have. Do you have anything else before? Before I ask Lindsay if she does get ready, she. Stephanie Lindsay If she does. 

Ronya Nassar 40:04
No, but I think I have a really good question. I want to ask Lindsay that you. 

Rich Bennett 40:07
Well, then you do have something else. 

Ronya Nassar 40:09
I well, you know, so when Rich does his podcast with us, the whole department, the one question he asks, usually everybody is why are you in this position? And you know, what's something really awesome that you like about your job? You know, what got you here? And so I love when he asked that question to the people that work at the department. So I would love it if I could ask Lindsay to. 

All 40:31
Have because I got to hear your questions now. 

Lindsay Goff 40:34
So I have the best job in the world. So my title is the Primary Stroke Program coordinator. If you asked me five years ago if I would have this job, I would say. 

Rich Bennett 40:45
What is there? 

Lindsay Goff 40:48
I actually was in school. I did a year of school to be a Pedes primary care and PE because A, what was my passion? Oh, practitioner again. And then my stepdad had that large ischemic stroke five years ago, and it changed not just his life, but my mom's life and, you know, my life. So I've lived through it. I've. I just will never forget seeing him in that hospital bed. And he couldn't talk to me because of the stroke, and he had aphasia. So I will never forget that fear in his face. And then the fear, you know of me recognize that he had a stroke and I wasn't sure if he was ever going to be able to talk to me again. And so that fueled my, you know, passion for neurology. I was an E.R. nurse at Sinai, so I did a lot with strokes and we did the thrombectomy so clot retrievals there. I had experience giving the clot busting drug and I got to see it work and I got to see these patients get better. I took that knowledge from Sinai and I went to Franklin Square and helped them up their stroke response unit in the emergency room. So that's kind of how I was introduced to this role. My mentor, Ashley, was the stroke coordinator at the time at Franklin Square and which prompted me to apply this job a year ago when it became open. So, wow, that's why I'm here. I want to make a difference, you know, a larger difference on a larger scale. 

Rich Bennett 42:11
Man Yeah. 

All 42:12
It's a great response. 

Rich Bennett 42:14
So I don't hear that question anymore, but I can't. 

All 42:17
I remember it and I look at you because I. 

Rich Bennett 42:19
Have done it in a long time. Yeah, because. Well, now I talked to so many people have been on other. But you've only been on two interviews, right? Yeah. So I can ask you the question always is. Yeah, it wouldn't work well. 

All 42:32
Huh? What is it? 

Rich Bennett 42:33
So out of all the show, all the interviews you've been on, which is only two, is there anything a host has never asked you that you wish they would have asked you? 

Ronya Nassar 42:44
What did I. What did I not ask you? 

Rich Bennett 42:46
So, yeah. And so what would be that question? What would be your answer? See, doesn't work when somebody is doing. 

Ronya Nassar 42:52
Well, it's more awkward because I'm here and I was. 

All 42:54
One of the two people interviewed. 

Lindsay Goff 42:59
So if I could put a message out there to the public that stroke does not just affect the elderly patient population, young people can have strokes, healthy people can have strokes, and the importance of recognizing and controlling those risk factors. It's what is going to drastically change any prognosis and decrease your risk for having a stroke or having any kind of cardiac event 

made wrong. 

Rich Bennett 43:29
You did good. Thank you for bringing her on. I don't remember any of the words you said, but I. 

Lindsay Goff 43:37
I did learn from it. Did you learn something from it? 

Rich Bennett 43:40
Well, to be fast, I knew about the fast. I didn't realize all the risk factors mean I knew Smoot When there is a new drug, it. Oh, well. 

Lindsay Goff 43:51
No, no, it's okay. 

All 43:52
Go ahead. 

Rich Bennett 43:52
No good. Oh, and diabetes. Because diabetes runs in my family. My brother had diabetes. My sister has it. My younger brother does knock on wood, I don't. 

All 44:04
Know. You know. 

Lindsay Goff 44:05
And that I mean, you can also get that's type one that's hereditary. But type two diabetes. Right. You can control. So if you don't have type one, you want to control that risk for having type two. 

Rich Bennett 44:18
Yeah. And I, I eat healthy except when it gets close to Christmas and Thanksgiving. No. 

Lindsay Goff 44:26
No, you're not a Thanksgiving person, are you? 

Ronya Nassar 44:28
That's my favorite. Oh, that's my favorite holiday. 

Rich Bennett 44:30
Usually one plate. That's it. 

Lindsay Goff 44:32
Oh, no. My cousins and I, we have a we have a. 

Ronya Nassar 44:34
Mountain to method. 

Lindsay Goff 44:35
Well, we have a contest to see who can eat as many plates. But it's never me. It's my cousin. Oh. 

Rich Bennett 44:41
I use I used to pig out. I used to pig out. But no Christmas time now, especially if the kids bring me chocolate covered Oreos. Oh. Oh, yeah. 

Ronya Nassar 44:50
I don't know if you know this, but he's actually Santa. 

Rich Bennett 44:53
Yeah. 

All 44:53
Play Santa. Really? Yeah. Huh. 

Ronya Nassar 44:56
Can say, you know Santa? No. 

All 44:57
So Santa is. 

Lindsay Goff 45:00
Another thing that I would like the public to know is that sure symptoms can be very mild and can be very vague. They can also be transient so they can come and go. So anything that feels different or abnormal, please call 901 and come to the hospital. 

Rich Bennett 45:16
They all correct me if I'm wrong, but almost like Lyme disease. They can mimic other things, right? 

Lindsay Goff 45:22
You can. So there are many strict mimics, like I said, migraines, cluster headaches. There's a type of migraine that does cause neurologic symptoms So complex hemiplegia like migraines, disease processes such as myasthenia gravis can mimic stroke. There are a lot of different things that Bell's palsy can cause the facial drooping and the numbness. There are a lot of different things that can be stroke mimics, but those are the largest or the most famous ones. 

Rich Bennett 45:50
Yeah, all those big words you just said. 

All 45:53
Yes. Yeah. 

Rich Bennett 45:55
Man, I'm lost or not because of the words. 

Lindsay Goff 45:58
I know there are other big words, but. 

Rich Bennett 46:01
Saranya What did you learn from this? 

Lindsay Goff 46:04
I learned already done this whole interview. 

All 46:06
I will say I've already done this whole thing with everybody knew the whole the whole business. 

Ronya Nassar 46:11
Yeah. 

Rich Bennett 46:12
That's where you know, actually. So all of you listening, I want your input. Let me know what you learned from it. And if there's something else that you want us to cover when it comes to health, let Me know.