Warning Shots: Understanding Transient Ischemic Attacks with Justin Vechayiem - Episode 149

Are you ignoring the body’s early warning system?

In the world of stroke care, there is a dangerous misconception surrounding the term "mini-stroke." Many people believe that because the symptoms go away, everything is fine. But in reality, a Transient Ischemic Attack (TIA) is a critical "warning shot" that requires immediate action.

In this powerful episode of the Caregiver Relief Podcast, host Diane Carbo, RN sits down with Justin Vechayiem, a Stroke Certified RN and Nurse Navigator. Together, they break down the life-saving differences between a TIA and a stroke, how to navigate the broken healthcare system, and why acting fast is the only option.

🧠 What You’ll Learn in This Episode

This episode is packed with clinical insight and compassionate advice for caregivers. Here is a breakdown of the critical topics Diane and Justin cover:

1. What is a TIA vs. a Stroke?

Justin explains that while an ischemic stroke is caused by a clot that permanently blocks blood flow and causes damage visible on a scan, a TIA is temporary. The clot blocks the vessel temporarily and then dissolves or passes through, meaning symptoms might only last 15 minutes to an hour. However, Justin warns that this is a major red flag that a full-blown stroke could be imminent.

2. The Critical Role of a Stroke Navigator

Navigating the healthcare system is difficult. Justin describes his role as a Stroke Navigator, where he guides patients through the entire continuum of care—from hospital admission to 90 days post-discharge. He helps coordinate appointments, clarifies medication instructions, and provides resources to ensure patients don't fall through the cracks.

3. Risk Factors & Prevention 🥗

You have more control than you think. Justin and Diane discuss the "Big Three" risk factors:

• Hypertension (High Blood Pressure): The number one risk factor for stroke.
• Hyperlipidemia (High Cholesterol): Specifically high LDLs and triglycerides.
• Diabetes: High glucose levels can damage vasculature and increase clotting risk.

They also discuss the importance of the Mediterranean Diet and maintaining physical activity, even if it's just 10-20 minutes of walking or chair yoga.

4. The "Do Not Drive" Rule 🚑

One of the most important takeaways from this episode: Never drive yourself to the hospital if you suspect a stroke or TIA. Justin explains that calling 911 triggers a pre-notification system where the stroke team is waiting for you at the door, ready to scan you within 20 minutes. Driving yourself wastes precious time and can be dangerous if your symptoms worsen behind the wheel.

📝 Episode Outline

• Welcome & Introduction to TIA (Transient Ischemic Attacks).
• Meet Justin Vechayiem: From Cardiac ICU to Stroke Navigator.
• What does a Nurse Navigator actually do?
• Defining the Medical Terms: TIA vs. Ischemic Stroke vs. Hemorrhagic Stroke.
• Why "Mini-Stroke" is a misleading term.
• The Risk Factors: Hypertension, Cholesterol, and Diabetes.
• Lifestyle Modifications: Diet, Exercise, and Weight Loss.
• Medications: Statins (Lipitor), Blood Thinners (Eliquis vs. Coumadin), and compliance.
• The importance of follow-up appointments with a Neurologist.
• URGENT ADVICE: Why you must call 911 and never drive yourself.
• How to talk to your doctor: Preparing questions and using Nurse Practitioners.

American Stroke Association | A Division of the American Heart Association

The American Stroke Association is a relentless force for a healthier world with fewer strokes.

www.stroke.org

💊 Medication Management & Advocacy

Diane and Justin touch on the importance of medication reviews. As we age, we are often prescribed more pills without removing old ones. Diane recommends reviewing your medication list with your primary care physician at least once a year to look for interactions or unnecessary prescriptions.

They also discuss the advancements in blood thinners, noting how newer drugs like Eliquis have better safety profiles and require less testing than older drugs like Coumadin.

https://www.ninds.nih.gov/health-information/stroke

Community Resources for Survivors of Stroke - Stroke Support Association

Caring for stroke survivors’ needs is a big, often full-time job. Therefore, it is essential that caregivers also take the time to prioritize their personal needs and care for themselves. Taking much-needed breaks and reaching out for help and support is critical for caregivers’ well-being when looking after a stroke survivor. Community resources, such as... Read More

Stroke Support AssociationMike Sasso

🔗 Helpful Resources

Recovery and prevention are easier when you have the right support system and information.

• National Institute of Neurological Disorders and Stroke (NINDS): For comprehensive health information and official resources on stroke, visit the NINDS Stroke Information Page.

💡 Key Takeaway for Caregivers

If your loved one experiences facial drooping, slurred speech, or weakness—even if it goes away after 15 minutes—go to the ER immediately. Recognizing a TIA is your chance to prevent a life-changing stroke before it happens.

Don't forget to advocate for yourself! Bring a recorder to doctor appointments, write down your questions beforehand, and don't be afraid to utilize Nurse Practitioners for more in-depth conversations.

Listen to the full episode now to get all the details on protecting your brain health!

Podcast Episode Transcript

Diane: Welcome to the Caregiver Relief Podcast, where we empower family caregivers and aging adults with the knowledge, tools, and confidence they need to navigate today's complicated healthcare world. I'm your host, Diane Carbo, rn.

Today we're diving into a topic that far too many families misunderstand or overlook, transient. Ischemic attacks, also known as TIAs or mini strokes. These events are often the body's early warning system and recognize them to make the difference between recovery and life changing stroke. I am honored to be joined today by Justin va.

Rn, BSN and a stroke certified rn, a stroke navigator, and a nationally certified stroke nurse who has guided countless patients and families through prevention, early recognition and recovery. Justin brings a wealth of bedside experience, clinical insight, and compassionate guidance that every caregiver needs.

Together. We're going to break down what a TIA really is and why it's so often missed, the signs you absolutely cannot ignore, and what caregivers should do in those critical first minutes. So grab a cup of coffee or tea. 'cause this is an important conversation that could save a life.

Diane: Justin, thank you so much for joining us today.

I appreciate it. I know, you took time away to do this, so I appreciate it. Before we dive in, can you share a little bit about your role as a stroke navigator and what inspired you to specialize in stroke care?

Justin: Sure. thank you so much for that introduction. Diane, that was, very nice of you.

appreciate the, the kudos. so yeah, my name's Justin Vechayiem. I am a, stroke nurse navigator. I have been in the healthcare industry for about 17 years now. I was originally a. telemetry nurse on the heart floor became a cardiac sub ICU nurse on the heart floor. So I was recovering open heart patients, POD one, and I became very familiar with some of the complications that arise from having coronary I, artery, bypass grafts, valve replacements, things like that, which is, strokes.

anything postoperatively, you do become at risk for stroke. one night on night shift at about 1:00 AM a, patient that I was taking care of that just had a cabbage times four, experienced a really big neuro change, where she had a dense left hemiparesis. had to get her off to a CT scan emergently.

It was positive for a large vessel occlusion. So she had, been brought emergently to the interventional radiology suite to have, a procedure called a mechanical thrombectomy where they were able to pull that clot out and restore the blood flow. And she was 100% back to normal following the stroke.

And that was my motivation that. Shifted my gears into the world of neurology. I was already pretty familiar with the heart. typically the transition is to, C-V-I-C-U. I didn't want to go that route. I wanted to be more challenged. The brain scared me. I wanted to learn and grow. So went down to neuro ICU and I worked down there with a very intense population for about seven years.

taking care of strokes, brain surgery, spinal surgery, surgeries, the whole mix of sepsis and hodgepodge of things, but, primarily stroke care post TNK. Post thrombectomy, things like that. and then eventually, about two, two and a half years ago, I transitioned into the navigator role, which is more of a,an overarching role, that has a broader scope, I think, where I'm able to impact patients on a.

On a broader scale. Yeah. what the ICU nurses do and the three east nurses, the floor nurses do, is incredibly important and very, I impact impactful at that moment. but I felt that I wanted to, care for the patients over the, expanse and the continuum of care to make sure that they were getting everything that they needed.

The nurse navigator role, essentially what we do is we follow up with patients and, contact them in the hospital when they're admitted for an acute scenario. we provide education resources. We kinda walk them through what the steps are going to be, as they're staying in the hospital. we also provide education to the stroke nurses on the stroke units, the, ICU, between multiple hospitals and, really enhance the stroke, education, the things that the nurses are able to provide to the patients.

We also provide support and resources to the nurses, the doctors. We collaborate heavily with the doctors, make sure that patients are able to get their follow-up appointments set up with the doctors. sometimes that can be very difficult, especially with neurologists. They're very, heavily booked. and then we do a lot of, discharge education, medication education, lifestyle modification, risk factor, adjustments and optimization.

and then we also follow up with them when they get out of the hospital. we make sure that we call them within five days to see how they're doing, make sure they're getting their appointments, getting their medications, and taking them how they're supposed to understanding them. 'cause a lot of folks don't want to take these different medications, but also don't realize how important they are to prevent a future stroke. Also we, make sure that they're getting their physical therapy, occupational therapy, speech therapy that they might have ordered, or, answer any questions they might have at that time. And then we also follow up with them in 30 days and 90 days. Just to make sure that everything's doing okay, getting better, getting back to normal, and, supporting them further.

we also have some support groups that we have each month, for folks that, want to get together and talk about their experience and, So they can relate to each other. 'cause sometimes it's a very isolating feeling, suffering a stroke. It's a new change in your life and you have to adjust.

So the support groups are also very helpful.

Diane: Absolutely. Yeah,

Justin: and we do a lot of community outreach as well, a lot of community education at different events.

Diane: The nurse navigator role is so vital now because a healthcare system's so broken, and if you can have a nurse navigator specific for your condition, you're a blessing in the world.

You really are. Because I do care management and it's similar, I help people navigate the medical delivery system, but mine are, a lot of it's dementia, but it's other things as well. But I'm not specific to stroke. I can't help people with stroke that don't have a nurse navigator. But I think that role is so vital and imperative, especially with our broken healthcare system now.

So kudos to you. Now Justin, I wanna start out simple. what exactly is a transient ischemic attack and how is it different from another type of stroke?

Justin: So a transient ischemic attack, is a little bit different from. An ischemic stroke. there, there's several types of strokes. Yes. So there's an isic stroke, there's a, and then there's a HERA hemorrhagic stroke, which is made up of two parts.

So a hemorrhagic stroke, can include a subarachnoid hemorrhage and an intracerebral hemorrhage. Those are the two types of hemorrhagic strokes, and I believe, that makes up about, it's either 13 or 17% of all strokes. I think 87% are ischemic strokes. so an ischemic stroke occurs when a blood clot from somewhere else in the body.

it could be from a DVT in your legs. it could be in your, that's a

Diane: deep vein. Thrombosis. It's a clot in your legs. To my listeners, yes. Yeah.

Justin: So it could travel from there and go to your brain. Yes, you could have a clot form in your atrial appendage inside of your heart. you could have atrial fibrillation, which is an irregular beating of the heart, which would allow the blood to pool in the chambers, and then that forms a clot and that can break loose and go to your brain.

or any, anywhere else in the body. you could also have an embol. Those are called emboli, which are, thrown out from somewhere else. Or you could have a thrombus, which occurs at the location, where clots form in that area, or stenosis. so an ischemic stroke is caused by a clot, and you can pick that up on a diagnostic scan, whether it be a CT scan or an MRI.

And that will show the damage that clot has caused by cutting off the blood flow and the oxygen and the glucose. And then that's what gives you the symptoms because it's essentially brain damage. So depending on where that clot blocks off the blood flow, those are the symptoms that are going to be displayed, whether it's, ataxia, which is like clumsiness of like your hands, your fingers, your legs.

three O, which is slurred speech. expressive or receptive aphasia, which would be difficulty getting the words out or understanding words. you could have blurry vision or a loss of vision, which is, typically a, a hemianopia, which is one side of your visual field in both eyes. you could have a total loss of vision.

one of the major signs that you can really pick up if you're having a stroke and you're by yourself is a facial group. If you look in the mirror and you try to smile, one side of your face is drooping. Can't raise your eyebrows on one side of your face. That's a big sign. And, weakness, hemiparesis on one side, if you like, lift your arms up and one side drifts down.

Something like that. so those are all the signs that occur. The signs and symptoms from a stroke and a TIA, transient ischemic attack is just like a stroke, except it's temporary. It's transient. The symptoms, they come on and they go away. So a clot, like in an ischemic stroke, may have traveled from somewhere else in your body, temporarily got lodged in your brain, causing those symptoms.

But then it either gets reabsorbed or it passes through and the symptoms resolve. And it's usually like 15 minutes, maybe an hour at most. and then everything goes back to normal. It cannot be detected on a scan such as a CT scan or an MRI scan because there was no permanent damage it passed through already, or was reabsorbed.

So A TIA is essentially what a lot of folks consider a mini stroke. it's like a warning sign that you could potentially be at risk for having a true stroke.

Diane: Yes, mini stroke is misleading and it's even dangerous. I know I, I have, I did home care and I have people that I would go visit, elderly and I had this one, patient and friend that I would go see once a month.

And she would have, TIAs these short, and by the time she called 9 1 1, they had resolved and there was nothing done for her. One day I'm driving with her, I took her out to lunch and she's driving her truck. She lived out in the country and loved her truck, so I'm in her one 50 and she's driving. We were just finishing lunch and going back to her home.

And her speech slurred and she started talking Garbly, gooped to me and I said, Charlotte, you gotta. I gotta get you over. So I, we slowed down, thank God we were on a country road, and I got into the other, the driver's side. I pushed her over and took her to the hospital and that was the first time that they ever caught the stroke in time that the, in the TIA in time to say, yes, there's an issue here.

And,Because it is so it goes away, the symptoms go away. They are warning signs. But, and people don't understand why a TIA is such a strong predictor of a future stroke. Can you talk about that a little bit?

Justin: It's like a, like we mentioned earlier, a stroke is caused by that clot, right?

TIA is probably a smaller clot that's passing through and it's not getting stuck. it could be a signal that you have other issues that are going on inside of maybe your carotid arteries. Maybe there's stenotic or thrombose. So if a clock gets stuck there, it's gonna block blood flow to your brain.

That's gonna be a stroke. Or a clot from here could break loose or they are breaking loose and just being, reabsorbed or passing through the body. you could have stenosis within your vessels inside your brain that would make it easier for a clot to get stuck. if you're having repeated TIAs, that's probably what's happening.

and maybe not all of your risk factors are addressed appropriately. 'cause we can do a lot of things to prevent stroke or at least reduce your risk of stroke. there's lots of lifestyle modifications, there's lots of, medications that can optimize things that you can't really address with lifestyle, 'cause you have your modifiable risks, your non-modifiable risks.

they really are warning signs. They're like red flags, little mini red flags because they're, they really

Diane: are. and, a lot of seniors ignore that, Yeah. And, I know with my friend Charlotte, she was a diabetic, but she. Ate badly and just gave herself extra insulin. Made me crazy.

Yeah. and she wasn't active at, at all and,she had a, a, a. It resulted in a massive stroke eventually, but she did nothing, to improve her lifestyle. What kind of changes would a person make if they're having, a lifestyle or medical management strategies can reduce, the risk of a full-blown stroke after a TIA?

Justin: usually, so when a patient has a TIA and they come to the hospital Then we're able to do a full stroke workup, a lot of times, One of the things I really want to touch on is, especially folks that live out in the country Yes. that are far away from healthcare. A lot of times folks will have a TIA or experience those stroke-like symptoms and they'll say to themselves, oh, I'm gonna go lay down.

I'll feel better if I rest. those kinds of things. And they'll fall asleep and then they wake up the next day and now their deficits are permanent. And they've fallen out of the window to actually receive treatment. Yeah. So that's why it's really important, like Diane saying, is if you have a TIA or any of those stroke-like symptoms, seek immediate medical attention.

Even if the symptoms go away, you should still go to the hospital because they can do this workup where they can identify where they can optimize things for you. It actually received treatment such as TNK or TPA, as many might know, or a mechanical thrombectomy which could save your life or at least preserve a meaningful life.

Yeah. As far as your question, Diane, in, in terms of what can you do to prevent stroke medications, lifestyle modifications. So I think the important thing to go over are the primary risk factors for stroke. so unfortunately, as we get older, we become more at risk for stroke because of our vasculature.

it, it can get stiffer, hardened. Narrow, it's stenotic, things like that. Our organs don't work as well. It's just the natural process of things. so then, we become at higher risk for other things such as hypertension, which is the number one risk factor for having a stroke, which is caused by stiffened blood cell, blood vessels, kidney dysfunction, things like that.

or cardiac dysfunction. then the second one would be hyperlipidemia, so that would be high cholesterol. that could be, LDLs, which are the low density, lipoproteins or, triglycerides are the two that we really look out for. And then you guys have probably heard about HDLs. Those are the good ones.

Yeah. the third highest risk factor is diabetes. So diabetes is, where you have to take insulin 'cause your body's unable to manage the, your blood glucose. those little particles of glucose will float around in your blood. They'll combine with thrombin, they'll combine with platelets and all of that stuff.

And clump together, and that's what causes clots. diabetes also, messes up your vasculature, the inside of your vasculature. Making it rough, helps it get stiffer. So diabetes is not good as well. And it, it affects your kidneys and if it affects your kidneys, it affects your blood pressure and detoxifying your body.

Yeah, so diabetes is also very bad. All three of those things. Can be addressed with lifestyle modification. a lot of folks as we get older, we're less active. Yes, if we're less active, but we're still eating the same amount of food, we gain weight. When we gain weight, that puts a lot of stress on our body, on our muscles, on our joints, on our organs, everything.

So then everything's taxed. So one of the best things you can do as you get older is maintain a healthy diet, which is typically a Mediterranean diet. Yep. very lean meats, grilled, not deep fried. chicken fish, lots of vegetables. low carbs, like what they eat in the Mediterranean, Yeah. Olive oil rather than vegetable oil or canola oil, maybe grape seed oil. those things. Are better for you? Yeah. Less, less beef, less pork, so no bacon, unfortunately. again, everything in moderation, right? if you're eating in moderation, like the things that you enjoy, that should be fine as long as you're also offsetting that with exercise.

as we get older, it is harder to exercise.

Diane: But

Justin: if you contain it. Like walks, 20 minute walks, getting your heart rate up, doing some lightweights, some chair yoga or regular yoga if you're able to Pilates. it

Diane: chi is really good too,for seniors for their balance. So I always.

Throw that in there, but I, you're absolutely right. The thing is seniors, sometimes can't even do 20 minutes. So I encourage them, if you can just do 10 minutes, three times a day, it's something, just make the effort because it can be the difference between, a quality of life and,a life where you no longer are able to move at all.

Justin: Yeah. Yeah. And if you can do those things through exercise, through diet, you may not need as much or any medication. 'cause we don't want to be on medication if we don't have to be on medication. 'cause medication, it fixes some things at the expense of other things. there could be side effects, could damage other parts,

but everything in moderation. For example, nowadays you hear these, drug ads for manjaro

Diane: or yeah,

Justin: guardians, things like that. those address diabetes, which is great. But they've also been popularized for weight loss.

Diane: Yes. Which is

Justin: also okay. because the diabetes, the hypertension, the hyperlipidemia.

Pretty much follows the course of obesity.

Diane: Yes. So if

Justin: you can check your weight, you may not have to be on those kinds of medications. the other medications that, you may get or have already heard about, for example, for hyperlipidemia or high cholesterol would be Lipitor. Yeah. Or other statins, like Crestor, things like that.

but Lipitor is the go-to for stroke, treatment and prevention. Lipitor at a higher dose at 40 milligrams, usually if you have a TIA, the doctors will give you a 40 milligram dose, a high intensity statin is what they call it. Because at that dose, it has neuroplastic capabilities, neuroprotective capabilities, and anti-inflammatory properties on top of the cholesterol reducing effects.

So it's really, Powerful medication that we can use for, treating TIAs and for stroke prevention. But also if you don't have to be on it, it's better because, a lot of folks complain about achy muscles, achy joints, some cognitive deficits maybe from it. try to do the things that you can do naturally that's better.

At least in my opinion, I don't want to, yeah, I

Diane: agree. I won't take a statin because I've had too many patients have side effects. Now, I do take Zetia, which is another form of anti-cholesterol, but it doesn't affect me negatively, like some of the, with that. people have the flu-like symptoms, the aches, sometimes they don't go away if they develop them, if they've stayed on it for a while.

I really tell pe my patients and you're right, the more medications we take as we, we are as we age. Justin, I've been in nursing homes, passing meds, and people get 30 pills in a day, Yeah. The thing is, we keep adding pills. Nobody takes anything away. And then as we get older, our livers don't detoxify as well, and we have drug interactions.

So the less, the fewer pills you can take, the better, yeah. And I, I do encourage that bet. if you need blood thinners, you need blood thinners. If you need, insulin, you need insulin, don't stop taking that. and it does. Your goal is to make healthy choices every day for a better quality of life.

Justin: You want to minimize the ME medications? Yes. Yeah. Take the ones that you absolutely need.

Diane: Yes. And

Justin: maybe not take the ones that you may not need if you can change things naturally yourself. So

Diane: I encourage my clients, and I encourage all my family caregivers and listeners out there, you should take your list of medications to your doctor twice a year.

The problem is. Pain management doctor orders you one thing, the rheumatoid, the rheumatologist orders you something else, the cardiologist, and there's no coordination of efforts on those meds. So you need to sit down with your primary care physician and go over those meds. Every six months and say, what can I decrease?

What can I get rid of based on my present, blood tests and results? And, that Dr. May have to talk to other doctors, but you need to make sure that somebody knows. That you're on all of these things and you as an advocate for yourself, need to address those issues. and go over that list with your doctor on a regular basis.

I know I say twice a year and people go, yeah, I'm not gonna do that. at least once a year. Go over those meds because you don't know now as you get older what's going to interact, what's gonna, cause you might be on something for a while and all of a sudden, because you have another medication, you're gonna have an adverse reaction and nobody's gonna know what it is.

I think it's really important.

Justin: Yeah. Very important. very important. Especially, you mentioned the blood thinners, right?

Diane: Yes.

Justin: If you're in AFib, you're gonna be on a blood thinner because then you're at very high risk for having a stroke. yeah. you can't really stop that medication.

Yeah. And if you're on that and you do have a stroke, but the doctors don't know that you're on that. Yes. Add a different medication, say like they might add on an aspirin. Yes. Which is a typical treatment for A TIA. But then now you're on a blood thinner and an aspirin, which increases the risk of bleeding.

Yes. A bleeding stroke. So it's really important, like you say, that all of the doctors know. 'cause a cardiologist might say, Hey, it's okay for your blood pressure to be 160 over 80 because I want better perfusion to your heart and to your kidney, your liver, all your organs. But a neurologist is gonna say, you're out of your mind.

I need that below one 40 over 90 or else they're gonna have a stroke. yes. we need blood pressure medications and all of that stuff accordingly to find that balance for, cardiac health and brain health, which are essentially the same thing.

Diane: I think one of the amazing technologies that's occurring is we have different types of blood thinners, just not just Heparin and not just Coumadin anymore because Coumadin I know 'cause I did home care.

I've done all kinds of types of nursing. We would always have people, if you eat spinach or something, it gets your, it throws it off your, clotting time and people would take too much or too little or their body would just adjust and, They would have extra bleeding. So I think that, and you, and they had to go once a week to have their, their, clotting times checked.

And I know that's dramatically changed now, which is a blessing because I think it encourages more compliance with something that's a more stable than a drug like. A lot of people still may have to be on Coumadin. But making sure that you have that, that once a week, I don't know if it still is once a week, Justin.

You should, you would know better than I would, to follow up to make sure that the blood level, the time is good. The timing, the clotting time is good,

Justin: right? Yeah. They have to maintain a therapeutic level if they're on coated. Yes. They have to have their blood drawn like once or twice a week, and it's a pain.

I don't like getting poked by needles. but you also need to make sure that level is good because that's going to help prevent a stroke from occurring. But now we have these new medications that you don't have to do that.

yes. Eliquis, Xarelto, axa, you guys have probably heard of all these medications.

Eliquis is pretty much the go-to, I think nowadays. Yes. A lot of people will, get it prescribed for AFib, but also for. DBTs or pulmonary embolisms, things like that. And it's a pretty stable, it's, it's half life is a little shorter,if you need surgery or procedures to be done, you can be transitioned to heparin a little bit easier.

it's a lot safer. It has a better safety profile. Coumadin can go up and down and swing and burn. Oh,

Diane: it real, I'll tell you what, af a, all the nursing I've done, I've been in situations where, people just don't get their, they don't feel right, so they don't get their blood test and then their blood, the thinning, their clotting times are not right and they go off and, I think that.

Now it's easier to be more compliant with these new medications. And I think they're a blessing. I really do.

Justin: They're a bit pricey, but yes, cover them, But it's better than the alternative.

Diane: Exactly. Exactly. how important is follow up after a TIA and what questions should caregivers or seniors ask during that follow up appointment?

Justin: Follow ups are very important because, if you've suffered a TIA, like we said earlier, that's a warning sign. That's a red flag that you're at risk for having a full blown stroke. So following up with a neurologist, someone that's a brain specialist, not just your primary care or going to your cardiologist, you need that brain doctor.

They're gonna help guide you and make sure that all of your symptomology is improving and kind of address what they can do to help recovery. And also, keep track of your medications. because if you've had a TIA, they'll probably put you on a baby aspirin and a Lipitor at the very least, and they'll want to make sure that your hemoglobin A1C, which is like your diabetes indicator.

Is correct. so you might need medications such as like Metformin or Glu or Glucophage or actual insulin or those other medications we talked about. they're gonna want to. Make sure they optimize everything for you so that you do not end up with a full blown stroke. Yeah. 'cause a lot of people will just write it off and will say, ah, I was just a TIA, I'm okay.

I don't need to see the doctor. Yeah. This and that, But a neurologist is really gonna be able to tell and keep track of you if you're safe, if you're taking the medications, if your blood pressure is good. if you need to get your heart checked for atrial fibrillation, if you have a patent foramen val in your heart, which is a hole in your heart.

Yeah. they want to make sure they're doing all the things to rule out all of the risk factors that you might have. Yes. To make sure to prevent it. you don't want a full blown stroke to happen. 'cause that can be permanent. and it's already too late. If you've had one, most of the time, you can get treatment.

You can seek treatment if you do it in time. If you seek treatment within four and a half hours and you qualify for clot busting medication. It's possible for that to be reversed. Or if you seek treatment within 24 hours and it's a large vessel occlusion, you could potentially have a mechanical thrombectomy, which is a done under angiography with a small catheter, and they can suck that clot out.

So it's really important, not only follow up, but if you have those symptoms and you recognize those symptoms to seek immediate medical attention, call 9 1 1. Don't drive yourself. Thank you to the hospital. Thank you. You could crash yourself. You could hurt somebody else. or maybe you go to the wrong hospital that can't even provide these treatments.

Diane: Yeah.

Justin: if you dial 9 1 1, they'll get you to the right hospital. 'cause they'll pre notify, they're receiving center that coordinates everything. The headquarters, they'll direct you to the right hospital. They'll pre notify the hospital. The doctor will be waiting there for you. The stroke team will be waiting there for you.

They'll get you your CT scan within 20 minutes to identify. If you have a large vessel occlusion, they can do the,the NIH scale to test how bad the disabilities are. They can qualify you for TNK, the clot busting medication or the mechanical thrombectomy, and potentially save your life. if you just drive yourself, it's like a crapshoot, Yes. I've had some horror stories when people drove themselves and it's not good. one of the things, I want to ask you is, a person has a TIA and it, they, it, it gets resolved quickly. I still encourage them to go to the er. I still encourage them to call the ambulance and go to the ER or have a family member drive you, whatever.

Diane: 'cause people think, oh, it's okay. I am fine. But they don't realize that it's, a big blaring warning sign that it's could be something awful.

Justin: Exactly. Yeah. So yeah, if you do experience a TIA, you should go to the ER even if the symptoms have resolved.

Diane: yes, you should. And they may send you home because, you'll start having a record of Yeah, and they, I know with Charlotte,they would send her home and she would say, why do I need to go?

Wow. and there we are driving down a country road and I had, I was like, oh my God, she's having a stroke right there. and it was a TIA, thank God it was a TIA, it was not resolved by the time I got her to the hospital, which was the first time they actually gave her a definitive diagnosis.

Yeah. and the key to a he healthy qua better quality of life is to follow the recommendations of the doctor. So many seniors seem to poo it because it did go away. yeah. Yeah.

Justin: And there's also, some, still some lingering distrust of the healthcare system. Yeah. a lot of, a lot of folks.

Don't believe doctors, and that, that's tricky. Yeah. because, nobody goes into this kind of profe profession trying to swindle anyone or harm anyone. Like we all are in this profession because we want to help each other. Yeah. We wanna help the human race,

Diane: Yeah.

Justin: and these doctors, they go to school, especially the neurologist for years.

Yes. And then they get certified and they're specialists and they see. Thousands of patients and they collect data and run programs and, all of this stuff, the data that's gathered from around the entire nation, throughout the world is then utilized to create this evidence-based care, which then we receive.

Diane: Yeah.

Justin: it's all the healthcare professionals working together to make this whole thing work and keep us safe.

Diane: I recommend that all my family caregivers create a question, and seniors create a list of questions you wanna ask while the doctor's there. Medicare only pays for a 15 minute appointment, and in that 15 minutes, God help us.

We're sup the doctor's supposed to, listen to us assess, diagnose and treat. And document. So there, you don't have a lot of time and I know seniors especially and a lot of caregivers are hesitant to take up too much of the doctor's time. I encourage my clients to say, Hey and family caregivers, you are employing that doctor.

You actually are his employer and he's practicing on you. but be respectful of this time and. Write questions down before you're there And if you and bring a recorder, I tell them, bring a recorder because you are going to hear words that you don't understand. Ask them to repeat those words in plain, simple English.

And then I tell them to. Go home and listen to that recording, listen to it with other family members so that you get, to understand what the doctor, is or the nurse navigator even is saying to you because, I'm sure you have more time in your role to spend with a client than a doctor does,And some of the, and even some of the floor nurses. that's why I love your role. yeah. Justin, I wanna thank you so much for your time today. Are there any last bits of wisdom you wanna share?

Justin: like you mentioned, when you go to see the doctor, right?

Diane: You

Justin: have your notes, you ask about your medications.

You let 'em know what your heart rate has been at home, what your blood pressure has been at home, any other burning questions that you might have. Write all of that down because when you get in front of the doctor. Oh, doctor, they

Diane: get

Justin: intimidating, and you might forget. Yeah. And you don't get to ask them.

Yeah. another good thing I would say in regards to that is if the doctor that you're seeing has a nurse practitioner Or. Maybe see them also. yeah, because they can spend more time with you. Yes. And they can answer more of those questions. And oftentimes, especially the nps, they're much more empathetic and they understand the human aspect of it a little bit more.

Absolutely. They can help guide you so you could perhaps see the NP. Three months and then the neurologist in six months, and then the NP again in another three months or six months, depending on,

Diane: that's a nice, that's a good suggestion. I had never thought about that, so I really like that.

Justin: Yeah. offsets things and gets you, More, contact and information.

Diane: Yes. Yes.

Justin: The mps, they speak directly with the doctors 'cause they're working under the doctor, But they're telling you essentially the exact same thing that the doctor would say.

Diane: Yeah.

Justin: You just don't have that medical license.

They are required to practice.

Diane: Trust me, they have a lot of experience behind them, the nurses, because I love nurse practitioners. they're the wave of the future because we have a shortage of doctors and specialists now and it's frightening. So thank God we have nurse practitioners to help us, but, Justin, thank you so much for your time.

And to my family caregivers out there, you are the most important part of the caregiving equation. Without you, it all falls apart. So please learn to be gentle with yourself. Practice self-care every day because you are worth it.