you’d better be-fast

Stroke can happen to anyone, anytime, anywhere. Stroke attacks the brain with devastating speed and destructive power, and is the third leading cause of death in the U.S. and the most common cause of disability in adults.

Neurologist Ramandeep Sahni, M.D., stroke director and regional director of stroke ambulatory services at Northwell Health in Westchester, doesn’t mince words when talking about the consequences of stroke. “When blood flow to the brain is impeded, millions of neurons are lost every minute,” she says. “Any delay in treatment can mean the difference between independence and profound disability.”

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At her Phelps Hospital/Northwell Health neurology practice in Sleepy Hollow, Sahni sees adults of all ages for a variety of neurological conditions: from worrisome symptoms such as dizziness, frequent falls or seizures to a diagnosis of a complex neurological condition like Parkinson’s. Sahni adds that “pronounced memory loss or confusion is a growing concern for many of my patients.”

Yet stroke is “the big one.” Sometimes called a brain attack, stroke occurs when the blood supply to the brain is disrupted, either by a vessel blockage or rupture. A stroke that doesn’t kill can lead to brain damage and long-term disability, especially in people over 65 with a history of one or more strokes.

The time from symptom onset to treatment at a stroke center or emergency department is measured in minutes. Most hospitals can treat stroke by administering a clot-busting drug called tissue plasminogen activator, or tPA. Though it’s become standard treatment for acute ischemic stroke, which accounts for about 80 percent of cases, the drug doesn’t work as well on larger, deadlier clots.
Enter endovascular thrombectomy, a surgical procedure that involves threading a catheter through an artery to reach the clot, where it is aspirated or broken apart. Thrombectomy widens the window of intervention from minutes to hours, thus minimizing the damage. Phelps Hospital, recently certified as an advanced Thrombectomy-Capable Stroke Center (TSC), is one of only two centers between New York City and Albany with this certification. But the Phelps stroke team, comprising more than a dozen specialized medical personnel, still relies on the general public to recognize and respond to symptoms that may indicate a stroke.

“Every adult should become familiar with these signs, the same way most adults can recognize the signs of a heart attack,” Sahni advises. “It can happen anywhere—at the golf course, your workplace, your kitchen.” Her team uses the acronym BE-FAST: Balance, Eyesight (or vision loss), Facial droop, Arm weakness, Speech difficulty, and Time. “That means, time to call 911,” she says, adding with emphasis, “Don’t drive a stroke victim to the hospital! EMS providers are trained in the rapid response that’s crucial to the outcome of a stroke. They can also make sure you are taken to the right center for appropriate treatment.”

Phelps is working to position itself as “the right center” for Westchester residents. After earning TSC certification last fall, the hospital began providing local EMS services with data to help them choose a thrombectomy center over other, possibly closer, hospitals. Using a mobile communications tool developed for hospitals and emergency services, ambulance crews can alert the hospital’s stroke team to stand by in less time than it takes to place a radio call.
.Thirty-five percent of Sahni’s stroke patients have a personal or family history of stroke. But, she says, many fail to take simple steps to avoid a future stroke. It was a key motivating factor in her decision to establish a stroke prevention clinic in her practice, which she calls “my passion.” She and her team developed an algorithm to help patients recognize known risk factors and uncover as-yet-undetected ones. “We help them take steps to manage their health with the goal of preventing future stroke,” she says.

A hectic schedule and high-pressure work environment have led Sahni to rely on family, friendships and endorphins as keys to maintaining work-life balance. With her physician husband and their three children, she enjoys family pickup games of basketball, and on weekends they follow their kids’ travel sports teams. She uses her downtime to focus on fun and exercise. “Working out clears my head and helps me be more present for my family and my patients,” she says. Her regimen includes high-intensity interval training, crunches to keep her core in top form, and hiking—often with friends. “And we don’t talk about work,” she adds.

Sahni is quick to acknowledge her colleagues at Phelps: a strong, cohesive team that routinely saves lives and preserves function in their patients. “One person can only have so much impact,” she says. “Not a day goes by without my being reminded we’re in this together, providing care every day.”

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