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HOUSE CALL WITH DR. SANJAY GUPTA

Stroke Basics; Mini Strokes, Big Danger; FDA Approves Gardasil Cervical Cancer Vaccine; Brides Taking On Battle Of The Bulge

Aired June 10, 2006 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Good morning and welcome to HOUSE CALL. I'm Dr. Sanjay Gupta.
Imagine for a moment you're going about your day to day life and suddenly parts of your body go numb or stop working all together. Well, this is exactly what happens to more than 700,000 Americans this year. It's called a stroke.

The good news is the majority are preventable. Today, we're going to tell you just how do that, plus be aware of the warning signs in the first place.

First of all, Christy Feig is going to give us the basics about stroke.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Nancy Keshishian was driving to work one December morning three years ago at the age of 58, when her world literally turned upside down.

NANCY KESHISHIAN, STROKE PATIENT: All of a sudden, my vision went horizontal. It just spread and then retracted back to normal very quickly.

FEIG: Keshishian was having a stroke.

KESHISHIAN: I was physically fit, and I didn't have high cholesterol, and I didn't have high blood pressure. And it just never occurred to me.

FEIG: Eight-five percent of strokes like Keshishian's happen when a blood clot blocks a blood vessel in the brain. The arrests are caused when a blood vessel ruptures and bleeds. Some of us are at greater risk than others.

DR. RALPH SACCO, AMERICAN STROKE ASSOCIATION: People who have high blood pressure, diabetes, smokers, heavy alcohol use, people with heart disease, these are some of our risk factors that we're concerned about.

FEIG: And stroke symptoms can be difficult to recognize.

DR. CHELSEA KIDWELL, WASHINGTON HOSPITAL CENTER: A sudden onset of weakness or numbness on one side of the body, sudden severe headache, loss of vision, difficulty speaking or dizziness or imbalance.

FEIG: With stroke, every second counts. The current drug therapy that busts up those clots only works if given within three hours after a stroke starts. New treatments that reduce the amount of disability are on the way.

I'm Christy Feig reporting from Washington.

(END VIDEOTAPE)

GUPTA: And that clot-busting drug is called TPA.

Now the other treatment for Ischemic stroke, that's the kind caused by blockage, is surgery. During the operation, the blockage is either removed or in some cases an angioplasty is done, just like in the heart where the plaque blockage is compressed and a stent is inserted. And that reopens the artery.

Here to walk us through the latest treatments for stroke is Dr. Ralph Sacco. He's director of the Stroke and Critical Care Division at New York Presbyterian Hospital.

First of all, welcome, doctor.

SACCO: Thank you.

GUPTA: You know, what's interesting. The majority of stroke cases are caused by a blockage. The best treatment for many of these patients is TPA, but we read a recent study that showed in some cases, only 2 percent, 2 percent of stroke patients actually received this critical drug. Why is that? What can we do to increase the number?

SACCO: Well, you're right. Very few people, unfortunately, receive this effective medicine. It's about 2 percent right now in the United States of those 750,000 strokes.

The big reason is the majority of people do not get it in time. The majority of people don't recognize the warning symptoms of stroke and get urgent medical attention. And therefore, we don't have enough people coming in quick enough to use this important medicine.

GUPTA: And Dr. Sacco, I think you and I are going to try and hopefully change that by giving people some of the warning signs.

But let me ask you this. First of all, are there any newer treatments, perhaps treatments that can be used a little bit later even coming down the line for stroke?

SACCO: There are other treatments. I mean, when we approach stroke, the first thing we try to do is open up the blood vessel. And there are now new medicines to try to open up blood vessels, as well as devices we can use to open up blood vessels.

And then, the second area of important research is how we protect the brain. And there are some drugs -- important drugs that are being tested and hopefully will become available in terms of protecting the brain in the few hours after a stroke.

GUPTA: So maybe making the devastating effects of stroke not quite so bad.

Let's get to some questions from our viewers, because these are important things. Let's start with Gina in Florida, who writes this question, doctor. "I recently read about an easy way for lay people to spot stroke symptoms. I believe it went by an acronym S.M.I.L.E. Are you familiar with this, doctor?

SACCO: I'm familiar with it, but it's not quite S.M.I.L.E. The real acronym is F.A.S.T. And the idea of this is to get people to recognize symptoms.

"F" is for face, where we ask people to smile and notice whether one side of their face is crooked. "S" is for speech. And we ask people to speak, to find out, for example, if their speech is slurred. "A" is for arms. We ask them to lift up their arms and notice if one arm is dropping or weak or something -- problem with motor function in the arm. And then "T" is for time. The key is if you have any of these problems in the face, arms, or with your speech, call 911 and get urgent attention.

GUPTA: That is very important there. We're keeping that up. F.A.S.T.

If you're concerned someone has a stroke, just remember the acronym F.A.S.T. We'll try and go through it again.

Let's keep with the e-mails, though. This one coming from an international viewer, Jane in Amsterdam.

"I fear having a stroke because I have high blood pressure and my life is very stressful. What are the signs to look for and what can I do to help myself?"

And doctor, we've talked about the signs, but for example, with someone with high blood pressure, that's a risk factor for stroke. What can they do as far as prevention goes?

SACCO: Well, there's a lot we can do with stroke in terms of prevention. High blood pressure is one of the biggest risk factors for stroke. And yet, there are many things we can do to reduce blood pressure. Some of those things are lifestyle. And we all have stress in our lives. Stress can definitely lead to increased blood pressure, but there are other things in terms of lack of exercise, eating improperly, smoking, heavy alcohol use.

These are things that are also lifestyle factors that will relate to increasing risk for stroke. So anything we can do to reduce risk factors will help. We don't know about stress. It's hard to measure stress. But anything we can do to treat high blood pressure is important.

GUPTA: And we're putting up warning signs. I'll tell you, doctor, as you're talking about the risks of stroke. I hope people are reading those. I think this could be a lifesaver.

But let's keep on topic here. You know, there's been a new study about some popular blood pressure medications out there that might cause birth defects when taken during pregnancy. So what can pregnant women do specifically if they have high blood pressure and are at greater risk for stroke?

SACCO: Well, there are many medicines to treat high blood pressure. And recently, there was a report in The New England Journal about the ace inhibitors, one class of medicines.

This class of medicines is very effective for treating high blood pressure, as well as reducing the risk of stroke. But there are other medicines that pregnant women may have to be thinking about, things called beta blockers, things even -- simple things with lifestyle factors and calcium channel blockers.

There are other medicines for high blood pressure that do need to be used. And we may have to think about ace inhibitors, particularly more in pregnant women.

GUPTA: OK, good stuff. We're talking about brain attacks, also known as strokes. We're taking a quick break, though.

Next up, what role does your family history play in your risk of stroke?

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: I thought I was going faint. My right side starting getting weak and my arm was getting weak, and my leg felt a little wobbly.

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: Mini strokes, find out why you can't afford to miss the signs.

Plus, birth control and migraines. Special stroke concerns for women.

First, take today's daily dose quiz. Can stress contribute to your risk of stroke? That answer, coming up.

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Before the break we asked, can stress contribute to your risk of stroke? The answer, yes. Unhealthy reactions to stress can contribute to high blood pressure, a major risk factor for stroke.

GUPTA: When we talk about stroke, you might be thinking of these catastrophic episodes you've seen on television. But in reality, about a million Americans each year will have stroke-like symptoms that clear up within minutes sometimes. Many people continue on with their day, not realizing that they just had a mini stroke. Interesting. Christy is back now to show us there's nothing mini about the danger these could pose.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): As a nurse's assistant at a major metropolitan hospital, Marilyn Monroe, yes, that's her name, had treated many stroke patients. She was walking out of a patient's room when it hit her.

MARILYN MONROE, MINI STROKE SURVIVOR: I thought I was going to faint. My right side started getting weak. And my arm was getting weak. And my leg felt a little wobbly.

FEIG: Marilyn had a Transient Ischemic Attack, a TIA. It's a mini stroke.

KIDWELL: These are blockages of the blood vessels to the brain, but then the blockage resolves on its own.

FEIG: Those most at risk, people with high blood pressure or cholesterol, diabetes, cigarette smokers. Men have a three-times greater risk than women.

The symptoms are usually the same as a stroke. Sudden loss of vision, difficulty speaking, numbness, tingling or weakness on one side of the body. The differences with a mini stroke -- the symptoms usually disappear within hours.

SACCO: People think that because they feel better and the mini stroke is now over that they're out of the woods and they're out of the risk period.

FEIG: But these mini strokes are serious business. And even if you've recovered from your symptoms, it's important you get medical treatment right away.

SACCO: There's evidence that in the first 90 days after a mini stroke, up to about 10 percent will have a major stroke. And in fact, half of those people will have their major stroke within 48 hours of their mini stroke.

FEIG: After a mini stroke, various drug therapies including aspirin or surgery can reduce your risk of a full stroke.

For Marilyn, it simply meant changing her diet and losing weight.

I'm Christy Feig reporting from Washington.

(END VIDEOTAPE)

GUPTA: All right, Christy, thanks.

And diet and weight do have a big impact on our health. Consider this, losing just 10 pounds may lower your blood pressure and improve your cholesterol levels at the same time.

Answering your questions on stroke this morning is Dr. Ralph Sacco. He's with the American Stroke Association. You just saw him as well on the piece.

Doctors, lots of e-mails coming in on this particular topic. So let's jump right back in with an e-mail from Sandra in Missouri.

She writes this, "My husband is 41 years old. His dad, aunt, and uncle have all had strokes. His older sister recently had a TIA. Is my husband at increased risk of stroke? Should he ask his doctor about taking a daily aspirin?"

Dr. Sacco, looks like there's a couple of questions in here. First of all, let's talk about family history. How important is heredity in stroke risk?

SACCO: Well, we're learning more and more about heredity and stroke risk. We know about heredity and family history for heart disease. And more and more evidence does suggest that some family history of stroke is important in terms of predicting an increased risk of stroke.

GUPTA: All right. And the second part of that was aspirin. Aspirin seems like a pretty benign drug. I mean, should you start taking this if you think you're at risk?

SACCO: Well, the data seems to indicate that taking aspirin may help prevent stroke, but it's still not totally clear. And in this case, that e-mail with somebody at 41 years old, they're a little on the younger side.

Evidence does suggest that over the age of 50, taking aspirin may reduce the risk of heart disease and maybe stroke, but we're still not totally clear.

The best thing is probably to get medical attention, make sure all your other risk factors are treated -- like high blood pressure, diabetes, all of the other things we talked about cholesterol. Getting them treated is probably even more important than taking aspirin.

And also, knowing what the warning signs. The American Stroke Association is trying to educate people to recognize these warning symptoms, so they get urgent attention when they do occur.

GUPTA: And we're trying to help you do that as well. I want to take a moment and just talk specifically about women and stroke. We talked about this briefly before, but they are more likely to die of stroke than men. And they have special risk factors as well, like birth control pills and hormone therapy, both of which increase the likelihood of stroke. And now there's new research about migraines, women and stroke.

One of our astute viewers, Dr. Sacco, wrote this. She has a question specifically about this topic. Julie says, "How concerned should I be about the increased risk of stroke due to auras from migraines?"

And doctor, first of all, put this in context. What is the relationship between migraines, vascular disease, and stroke?

SACCO: Well, we're getting more and more evidence that migraine may be a risk factor for stroke. It's not the strongest risk factor.

First remember, migraine occurs in a large proportion of the population, almost 10 percent. So not everyone with migraine is going to have a stroke.

However, there may be certain things with migraine that could be associated with stroke. So what we usually tell people, particularly women if they have migraine, they probably should not be taking oral contraceptives. If they have migraine, they probably should get other risk factors like high blood pressure, and their diabetes, and the weight control under control.

And migraines should be treated. And there are good medicines out there to try to reduce the risk of migraine. But migraine isn't the number one risk factor for stroke, but it is something we think about.

GUPTA: All right. We're talking about the risks. We're talking about the treatment as well. And when we come back, we're talking about recovery. Stay with us.

UNIDENTIFIED FEMALE: Life after stroke, from rehab to brain recovery, how long does it take?

First, this week's medical headlines in "The Pulse."

(BEGIN VIDEOTAPE)

JUDY FORTIN, CNN CORRESPONDENT (voice-over): A vaccine developed to prevent cervical cancer has cleared the final hurdle on the government approval process. The FDA gave the OK for distribution of Gardasil. Tests show it protects against four types of human papillomavirus or HPV, a common sexually transmitted virus that causes most cervical cancer.

New research shows that they also help at preventing most vaginal cancers associated with HPV.

A controversial drug to treat multiple sclerosis is headed back to the market with restrictions. Tysabri was withdrawn by the manufacturer of Biogen in 2005 when three patients in the drug's clinical trial developed a rare viral infection of the brain. Two of them died. The FDA is allowing the drug to be prescribed, but under specific criteria.

Judy Fortin, CNN.

(END VIDEOTAPE)

(COMMERCIAL BREAK) GUPTA: We're back with HOUSE CALL. On average, a stroke occurs every 45 seconds, which means about 25 people have had strokes since this show began.

Answering our questions on what some call "brain attacks" is our guest. He's Dr. Ralph Sacco. He's director of the Stroke and Critical Care Division at New York Presbyterian Hospital.

Great questions coming in, doctor. Let's get back to our inbox now. We have a question from Geri in Michigan, who asks this. "Is a CT scan the only diagnostic method for confirming a stroke?" Doctor?

SACCO: Well, cat scans are the most frequently used, but not the only one. An MRI, a magnetic resonance imaging, can also confirm stroke. But right now, there are more Cat scans out there. For us, the most important thing is get an image quickly so we can define the type of stroke and see if you're eligible for that acute treatment.

GUPTA: How...

SACCO: The CT scans are the ones right now the most frequent.

GUPTA: How quickly would it show up on a CT scan?

SACCO: A CT scan can sometimes be delayed in terms of showing the stroke. However, CTs are helpful for ruling out a bleeding stroke. If you had a bleeding stroke, you wouldn't be eligible for those clot busters we talked about.

GUPTA: All right. Let's keep going here.

Let's get to another question from Deanna in Oregon, who writes this. "I had a small stroke early in 2003 and recovered nicely." That's good. "However, some symptoms reappear when I'm tired or stressed. How long do symptoms normally last?" Doctor, is this something she should be concerned about?

SACCO: Well, symptoms after a stroke can persist. And they can come and go.

I often will tell my patients sometimes like it's almost like if you broke an arm, and you have a scar there, it'll hurt sometimes.

Well, sometimes after a stroke, there's still a scar. And on bad days, if you're not feeling well, if you're tired, if you have the flu, you may get some of these symptoms back.

We call it sometimes peeling the onion, where sometimes we'll get down and there's some symptoms will come back. It won't mean necessarily you're having a new stroke unless the symptoms are different. And then you'd want to get urgent attention.

GUPTA: All right. Well, we're talking with Dr. Ralph Sacco about brain attacks or stroke. And we're also be checking in on our Fit Nation. Stay with us.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: This is one of our best dresses. We stock size 6, a size 14, and a 20.

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: Dress sizes are going up, but have no fear. We'll show you what some brides are doing to make their sizes go down.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: Push!

CROWD: Two, three, four, five.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

GUPTA: To learn more about stroke, click on the American Stroke Association's Web site at strokeassociation.org. There, you're going to find the latest news in resources for life after stroke.

Our guest is Dr. Ralph Sacco. You know, one of the things interesting, Dr. Sacco, was that F.A.S.T. acronym that you talked about earlier. Roger, if you could put that up again for a second. Just talk us through this, because I think a lot of people need to pay attention to the symptoms and signs to look for, either themselves or a loved one.

SACCO: That's right. It is so critical. F.A.S.T. Face, ask them to smile. See if the face is crooked or abnormal. Arms, lift up your arms and see if they're difficulty or wobbling. Speech, if the speech is slurred, or they're having trouble speaking. That's -- these are warning symptoms and signs of stroke. Time is urgent. And that's the "T". So if you have any of these warning signs, to get urgent attention.

And what we need to focus on particularly if African-Americans, they're at highest risk for stroke. And there's a huge campaign right now. The power to end stroke from the American Stroke Association, particularly focused on getting to this important population group.

GUPTA: One of the things you like to do as a part of the American Stroke Association, we like to do as well, is try and educate people about this. I think we saved lives when people pay attention to this. I'd like to thank you for being our guest with us this morning, Dr. Sacco. Thank you very much.

SACCO: Thank you.

GUPTA: We're not done yet, everyone at home. Stay with us. We're going to go to boot camp to discover the latest front in the weight loss wars.

(COMMERCIAL BREAK) GUPTA: Welcome back to HOUSE CALL. Well, in this week's look at our fit or not so Fit Nation, we're focusing on brides. In addition to the stress of planning a wedding, the majority can add the stress of also trying to lose weight. Now a look at how some brides are taking the battle of the bulge to a whole new level.

(BEGIN VIDEOTAPE)

JEANNIE POSNER, SHOP OWNER: This is one of our best dresses that you have on right now. We stock it in a size 6, a size 14, and a 20.

GUPTA (voice-over): The obesity epidemic radically changed the way new Natalie's Bridal Sop does business. Five to 10 years ago, owner Jeannie Posner sold mostly size 6 and 8s. Now, it's more like 8 to 14.

POSNER: We're also seeing an increase in brides that are looking up dresses that are over size 18 to 24.

GUPTA: Posner says designers have been slow to adjust. Many bigger dresses are special order at other shops, but she's careful to stock hundreds of dresses size 16 and up.

POSNER: One of the things we hear all the time is it's so nice to try on a dress that's zipping.

GUPTA: Because no matter what your size, survey show a bride's number one concern is how will I look in the pictures?

UNIDENTIFIED FEMALE: Two!

UNIDENTIFIED FEMALE: Three!

STACEY C.: I don't want to look back at my wedding pictures 20 years from now and go, "I didn't look as good as I could.

GUPTA: So Stacey C. went on a diet and put herself in a kind of bridal boot camp.

STACEY C.: Five, six, seven, eight, nine, hu-ah.

UNIDENTIFIED MALE: I've got to tell you guys a secret. You just did 110 push-ups in one sitting.

HEIDI ZIEGELE, INSTRUCTOR: Lots of people panic before weddings.

GUPTA: Boot camp instructor Heidi Ziegele says they designed this intense 30-day workout to jumpstart a fitness plan or get you in shape for a big event.

ZIEGELE: Because you know, the type of workouts we do is an all over condition. So they lose a lot of fat. And you know, looks great for a wedding day.

STACEY C.: 10. This sucks!

GUPTA: Stacy hates exercise, but she's thrilled with the results.

STACEY C. I dropped almost 32 pounds in between when I first bought my dress and now.

GUPTA: That's four dress sizes.

UNIDENTIFIED FEMALE: We took in the sides, both sides. And we're taking the front off.

GUPTA: The seamstress took this in three times.

STACEY C.: See, this one makes me feel skinnier, like in.

GUPTA: Most women aren't as successful at battling their bulge, but no matter if you're a 2 or a 20...

UNIDENTIFIED FEMALE: I'm going to walk out feeling beautiful. Yay!

(END VIDEO CLIP)

GUPTA: All right, good luck to all of the brides out there.

We're out of time for today, unfortunately. Tune in next weekend for another edition of HOUSE CALL. Make sure to e-mail us your questions as well at HOUSECALL@CNN.com.

Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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