Dr. Kevin Most: Daylight Saving and Luke Perry Stroke

Steve Cochran and Dr. Kevin Most

Daylight Savings Time

It is not by mistake that March has National Sleep Awareness Week and it starts right after daylight saving time change where we lose an hour of sleep. This week, all of our normal sleep patterns will be thrown off as we adjust to the time change and the extended hour of daylight at the end of the day. We have discussed the advancements that have been made in Sleep Medicine, the importance of identifying sleep apnea, sleep disorders, treatments for insomnia. This next week you may see stories or news on sleep.

Well it is Monday March 11th and we just completed our “Spring Forward” this weekend to bring us to DST. The concept of DST was first conceived by Benjamin Franklin in 1784, yet it took until World War 1 until it was established. For many they look forward to this day as it gives them longer daylight and is a sign that summer is right around the corner. For others it was a loss of an hour sleep and now a mess up of our circadian rhythm, you might ask how this minor switch can impact us but it does. Remember the change from day to night is a gradual change that our body adapts to thru the year, as we change to daylight saving that difference is not minutes but a complete hour in one fell swoop.

Be very careful driving to work today and be careful at work today. The Monday after the DST change has shown that more traffic accidents happen this day and more work injuries occur on this first Monday of daylight saving time. The main reason for this is that individuals are more tired as their body has not had a chance to regulate to this new timing

Studies and data has shown that the risk of having a heart attack increases by 10% in the first 3 weeks after switching to DST each spring. The overall rate for stroke was close to 10% higher in the two days after daylight saving time. The risk of illness and injury drops off after a few days as our internal circadian clocks adapt

What can we do to regulate more quickly?
1.) Set your alarm a little early the few days before the change, this helps you wake up on Monday under the new time structure
2.) Eat a healthy breakfast first thing in the morning, this teaches your body that this is the start of the day
3.) Go for a walk the sunlight and exercise will help you adjust your internal body clock
4.) Put your children to bed a little bit early to get them regulated as well
5.) Sleep in longer on Sunday morning

Luke Perry Stroke

We learned last week that Luke Perry did not survive the stroke he experienced 5 days early. Mr. Perry died at the age of 52, which many find unusual to have a stroke at that age. In the United States 800,000 strokes a year occur, resulting in 150,000 deaths and disability in many more. It may surprise you that 35% of all strokes occur in individuals under the age of 65. This is not just an advanced age disease.

There are 2 many types of strokes. The first and most common are ischemic, or embolic strokes. These strokes make up 85% of all strokes and are caused by blocked of a blood vessel in the brain. The treatment for these is to identify it quickly and either remove the clot with a catheter into the brain or dissolve the clot with a drug. Time is of the essence. The sooner the stroke is identified and treated the less time the brain goes without blood and is able to respond to treatment.

We use the acronym- FASTER for our education for the public
F- Look for facial drooping
A-Arm weakness or asymmetric arm movement
S- Stability , loss of coordination
T- Talking slurred or confused speech
E-Blurred or double vision
R- React or respond call 911

With these symptoms do not put the individual to bed to see if they get better, get them in for treatment

The other type of stroke is termed Hemorrhagic – this is when a blood vessels bursts and there is a bleed into the brain. These are only 15% of the strokes we see but have a much higher rate of death. The treatment for these is brain surgery where a doctor goes in thru the skull and places a clip to stop the bleeding. Risk factors for these type of strokes include high blood pressure or a family history of aneurysms.

One different sign with this type of stroke is that people may have a very bad headache that starts suddenly, often described as the worst headache of their life. They then have worsening symptoms.

The big message for patients is to know the risk factors that increase your chance of stroke
High Blood pressure
Smoking
Diabetes
High Cholesterol
Poor diet
Excess alcohol

Treatment for stroke has changed dramatically since I was a medical resident. In the past when a patient came in with a stroke, we controlled their blood pressure and essentially tried to teach them to walk again, or eat with their other hand, essentially just working on their rehabilitation.

Fast forward to now, in some parts of the country we have mobile stroke units that go to the patients house, complete the CT scan in their driveway and begin the treatment for the stroke before moving them to the hospital. We are fortunate to have one of those units here at CDH and have shown that we have been able to cut almost an hour off the delay for treatment. I believe there are over a dozen of these units in the country but we need to have thousands to make the impact we could on stroke care.

We also have the capability of inserting a catheter thru a blood vessel in our leg, up into the brain, to the point where the clot is blocking the blood flow, and then remove the clot, which restores the blood flow and in many cases minimizes any future disability.

The take home message is know what the risk factors are and try to minimize them in your life and know how to identify a stroke and act on the signs you may see. This is a condition we can minimize risk and maximize outcomes by being informed.

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