116: Power of the Podcast: Stronger After Stroke
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See You Now is a podcast highlighting the innovative and human-centered solutions that nurses are coming up with to solve for today's most challenging healthcare problems. Created in collaboration with Johnson & Johnson and the American Nurses Association and hosted by nurse economist and health tech specialist, Shana Butler.

You can feel the human connection from our conversation. I want to be the person that answers their question and has no bias. We're making it an equal playing ground for everyone to elevate their care no matter where they are in the world. Who knew the power of the podcast? So I think that storytelling through the podcast has humanized stroke for a lot of people who maybe didn't have a current face on it.

We have listeners to the Stronger After Stroke podcast in 63 countries, and we've got almost 2,000 downloads in outlying U.S. territories. Talk about some lack of access to care. There are hospitals across the country and even in other countries that are prescribing the Stronger After Stroke podcast for education to their patients.

I can't have an hour-long conversation with every single one of our patients. And so to be able to give that out as a recording to the rest of the world has really expanded the availability of that hope to more people.

Welcome to See You Now. I'm Shawna Butler. Who doesn't love a great podcast? Obviously, See You Now listeners do. And podcasts are doing a lot more than entertaining and keeping us company. They're educating us, inspiring us, keeping us up to date on new research, creating community, and filling some very significant gaps in our access to health experts and health education. In the

In the 2024 annual report from the Commonwealth Fund, researchers compared health system performance in 10 peer countries, including the United States, to glean insights on where the U.S. needs to improve. The findings, while not unexpected, were nonetheless grim and troubling, and detail how Americans face greater barriers to accessing and affording health care than those in our peer nations.

Recognizing that podcasts appeal to everyone, nurses are taking their practice to the airwaves, producing and hosting podcasts that share their specialized expertise to reach people where they are and where they listen, and in doing so, are delighted by how their podcasts are effective in addressing the gaps in access to care, education, community, and professional education.

In our first of our three-part series, Power of the Podcast, we meet a nurse and podcaster from Louisville, Kentucky, who is taking her stroke recovery care expertise to listeners and learners all around the world. Let's listen in.

I'm Rosa Hart. I'm the stroke nurse navigator at the Norton Neuroscience Institute Resource Center in Louisville, Kentucky. I started as a nurse in the ICU taking care of stroke patients. I worked in the ICU for eight years, the last four years working as a nurse navigator. I've since expanded into also hosting the Stronger After Stroke podcast and

The Stronger After Stroke podcast is for stroke survivors and their families or anyone who loves them to answer frequently asked questions from our experts, as well as to interview stroke survivors who are sharing their stories, as well as what was helpful for them in their recovery to give them their best quality of life after stroke.

So the practice and the profession of a stroke nurse navigator, who are you taking care of? What kinds of things are you taking care of? Yeah. Walk us through that. Sure. So.

My day job as a stroke nurse navigator is calling patients after they get discharged to home from the hospital to make sure they understand what they need to do to prevent another one. Addressing those modifiable risk factors like blood pressure, blood sugar, cholesterol, and looking for things like atrial fibrillation, sleep apnea, etc.

And filling in the gaps of education, because we know that the normal person who's not brain damaged retains only about 10% of what they learn the first time. But that's a whole 90% that they still need reinforcement of, even if they heard it before.

And then also working at the Norton Neuroscience Institute Resource Center, we exist as a department to address the barriers that people encounter, be it financial or transportation that could keep people from coming to their follow-up appointments or being able to refill their medications that are keeping them from having a stroke.

Because a lot of the times if somebody starts a new expensive medication, like a blood thinner, like Eloquist, and they hear the cash price of it and don't know about the discount program, then they're like, oh, I'm just going to stop taking this because I can't afford it. And then within 30 days, they're back with a new stroke.

We also are able to address areas of quality of life and giving them like free exercise opportunities, music therapy, art therapy, Feldenkrais, some really great non-pharmacological interventions to improve their mobility and quality of life and building community with other people who have experienced stroke as well through stroke support groups.

So let's talk about stroke, because when you start diving into it, you realize there's a lot more to this than I think often might get portrayed in popular media or where people have seen things in a film or in a TV show. Right. And there are a lot of updates that have not necessarily made it into the public common knowledge or even medical common knowledge.

So first of all, there are two kinds of stroke. There's ischemic stroke, which is the majority of my patients, or TIA, where blood has been closed off from circulating through a clot, through stenosis. It's an obstruction that's preventing blood flow getting to the brain in a certain area.

And then there's hemorrhagic, which is a bleeding, which is what it sounds like bleeding in the brain. The bleeding strokes usually have a lot worse outcomes and take a lot longer to recover from.

The ischemic strokes, though, since 1995 have had an incredible new scope of treatment that's available through clot-busting medications that we can give IV as well as endovascular neurosurgery that can pull the clot out of somebody's brain and then restore function. It's like flipping a light switch and those parts of their body that were not responding at all just come back on. Yeah.

And I've seen this happen. So in 1996, this was highly controversial. So, I mean, that's pretty recent for a lot of practicing nurses when they started. If somebody had a stroke, then it's like, I'm sorry about your luck. We're going to get some rehab, but you're pretty much stuck that way. But now...

Since we have these clot-busting medications, we have the endovascular neurosurgery, and then we also have incredible innovations in rehabilitation therapies. And we've learned so much about neuroplasticity and how those injured and killed neurons can be replaced by the existing nerves. They can learn to connect in new ways.

that will allow people to regain function even years later. There's still people seeing recovery 15 years after a stroke. And that's really important messaging that needs to get out to the medical community as well as the community at large so that they know this is why it's important to call 911 at the first sign of stroke, because then we can potentially reverse these effects of the stroke.

In the United States, we have about 800,000 people a year do have a stroke. And the age at which people are having stroke is getting younger all the time. And that can be for a lot of different reasons. We're making barely a dent in people less likely to die of stroke, but it's still the leading cause of disability worldwide.

So this is not just the United States problem. This is a global problem. And some risk factors are genetic and can't be controlled for. But there are a lot of lifestyle things that we can do to prevent them. And the number one preventable risk factor is having uncontrolled high blood pressure. A lot of Americans have that and don't realize it.

More people are maybe realizing once they get one of these fancy new rings that can measure blood pressure at home or one of those fancy smart watches that can measure their blood pressure at home. Hopefully you're going to see your primary care provider. But if your blood pressure top number is over 120, that means you have high blood pressure and you're at an increased risk of having a stroke no matter what your age is.

So, the most common experience with stroke is that there is a fairly involved recovery process. There's the emotional part. There's the physical. They may not be able to process information. They may not be able to speak. They may not be able to feed themselves.

There are a whole host of effects. See more about what does recovery look like in a common scenario. Yeah. So not everybody can go straight home after they have a stroke. A lot of people need to start by going to an acute rehab, which is not a long-term care nursing home. It's actually a special hospital designed for rehabilitation where a physical occupational and speech therapist can work with you three or four hours a day and

to really build up that stamina that you need to go home and have your best recovery outside of a hospital setting.

They'll have you do physical things to regain your strength as well as teach you coping mechanisms if you need to learn how to do things a different way. Like if your right arm is not working and you're right-handed, then they'll be teaching you how to use your left hand while also rehabbing that right arm, but also how do you function in the meantime and teaching the family as well.

And then once they're discharged from acute rehab to home, then they can have either home health therapy if they're not strong enough to go to outpatient therapy.

where they may go to outpatient therapy a few times a week. That can be for months or it could be for years after. There are some people that are still going for years because they're still seeing improvements. So the word on the street was for a long time that however you are six months after a stroke is how your recovery is going to be. And we have found that is not true. The rate of improvement does slow around after six months.

However, telling people that how you are at six months is how you're going to be makes them stop trying. And that's why they get stuck. Whereas if you...

let them know that if you're intentionally working with it, even if you can't go to physical, occupational, or speech therapy because your insurance is maxed out and you can't get any more visits covered, there are free things you can participate in like online support groups where you can do group exercises and get that encouragement to keep working on what you've learned in those therapy visits and continue to see improvements.

It is an ongoing process. It's frequently going to be, you know, a year, years. So let's talk about the Stronger After Stroke podcast and have a listen to a clip starting with how you introduce the show.

- Hello and welcome to the Stronger After Stroke podcast. I'm your host, Rosa Hart, stroke nurse navigator for Norton HealthCare. And today I get to meet with a stroke survivor who is not what you expect when you think of a stroke survivor. This is Russell Deakins. - Yes. - Thank you for being with me today, Russell. - Thank you.

And he has a really incredible story to share and it's not entirely uncommon. So I'm really thankful you're willing to share what having a stroke at your age was like for you because it's actually more and more common. So can you tell us, first of all, what was your life like before you had a stroke? - So before my stroke, I was the typical 30 year old male.

Married, kids, job, athletic. I took care of myself. I wasn't the definition of fitness, but I did enjoy running half marathons, 5Ks, and playing in the yard with the kids.

I don't know if that's the typical 30-year-old male. I don't know many who run races. What kind of races were you running? So I like to compete in half marathons, 5Ks. So half marathons, pre-stroke, I had done five of them.

After my stroke, I set a goal to complete another one. - Oh, well we'll hear about that and see how that worked out. So before you had a stroke, was there anything that kind of led up to it where you expected something to happen or did it come out of the blue? - It somewhat came out of the blue. I was just burning vacation days and,

My stroke happened on a Wednesday. Well, I woke up the Tuesday before and I remember telling my wife while I was getting them ready for work and school and typical fall life that I felt like I was going to have a migraine. Like I said, I was 30 years old, hadn't had them since high school. So 10, 12 years before, since the last migraine event. So it was very unusual. It was. It was a weird feeling.

But that day came and went and cooked dinner and helped out and it was a normal day. The Wednesday of my stroke, I remember waking up the same way and just not feeling right. Something going on upstairs felt weird. I helped get the wife and kids out the door. And then at noon that day, I got the cold chills like we all have and I felt like I was going to get sick.

I walked to the bathroom. I got sick like we've all done. And then I couldn't stand up.

At that point, I knew it was something more than a migraine. Is that when you called 911? Did you do that? I did not. My parents live in my neighborhood and my dad has a home office. So I actually crawled back to the living room, picked up my cell phone and called my dad. I told him I said something was wrong, that I had gotten sick and I couldn't stand up.

At that point, he drove over, he came in the house and he, you know, son, let's stand up. That wasn't the case. And that's when he called 911. Because he knew that wasn't like you. That was not me. You're not one to just lay around the house. I was burning vacation days, so I was relaxing, but that is not me. If there's anybody that could stand up, it was me. Initially, the ambulance, they took me to the hospital and that's when the whole journey began.

So in this episode, Rosa, you were talking with Russell about his experience, what his recovery has been like and how he's navigating this new normal. And throughout the episode, you're educating people on stroke as well. At the end, you invite listeners and viewers to leave a comment about what they learned or something that they'd like to learn more about. I love that. So how was Stronger After Stroke born? Whose idea, energy is behind all this great work?

So during the pandemic in 2020, I started a food review podcast and I interviewed local business owners and nonprofit leaders in Louisville, Kentucky about that.

And through that experience, the higher ups in my office recognized that I know how to do a podcast. And they were like, we need to do a podcast. Would you like to do one on stroke since you do podcasts and stroke is your thing? And I was like, yes. So they said, well, take some time and think of some topics that you might want to cover and who you might want to interview.

Two hours later, I had a two-page list of all the topics that needed to be covered based on frequently asked questions and exactly who I needed to interview with a couple of additions later. But for the most part, like we have 110 neuro providers in the Neuroscience Institute. I knew who these people needed to see, but they have a nine-month waiting list.

And so to be able to give them access to at least these commonly asked questions and get those answers, so to tide them over while they're waiting to get in with these experts is,

was huge. And so I think as soon as they saw the clear need for the content, like that we have the content, we have the experts and we have the survivors with these amazing recovery experiences that we can interview, then that really got the ball rolling in creating the Stronger After Stroke podcast. And I'm only one person. I

I can't have an hour-long conversation with every single one of our patients. With the 800,000 people out there who are having strokes? Right? I mean, not even all of our own patients, let alone all of them. I couldn't before. But now I've been able to interview the neuro experts at the Norton Neuroscience Resource Center, as well as some of the experts that we have consult with us.

We've had a certified sex therapist as well as a pelvic floor therapist come on. And we had a conversation about sex after stroke and the physical as well as emotional components of finding a new normal that works for you in a way that lets you know how to have those conversations with your partner, which professionals you can reach out to for specific help. And then we have resources in the show notes.

to let you know how to find someone in your area to reach out to for specific help. And things like that, migraine and stroke, a fib and stroke. We have one of our therapists talk through some coping strategies for anxiety and depression, which is so huge after stroke, and letting people know they're not the only one feeling like this. So in addition to interviews with experts, we also have interviews with stroke survivors, right?

of all ages. They may be nearing retirement or retired. They may be young parents. They may be young single people. They may be athletes or not, but from all walks of life. And so to be able to give that out as a recording to the rest of the world is

has really expanded the availability of that hope to more people. I think that especially after the pandemic, we are also starved for human connection. And so anytime we can focus on the human experience and hear from another real person and empathize and feel what they're feeling, then I

I think that the impact of that is going to go a lot farther than just delivering a message. And that's one reason that I've always emphasized the importance of us doing the interviews in person, especially with stroke survivors. But even with the providers I've interviewed, like sometimes they're like, can we do this on Zoom? And for the most part, I really want to keep

those interviews in person because I think you can feel the human connection from our conversation. When we're making eye contact in real life, we're

And when I'm seeing them tear up from sharing their story and they're seeing my emotional response, I think that the listener can pick up on those nonverbal intangibles. And that provides them with some of that solidarity that they may be feeling if they're a stroke survivor or even just that empathy, if it's something they never would have experienced otherwise. You know, I,

On that, the format that you have is that you are using video as well as interviewing in person. And I think particularly for this subject where you're talking about stroke and it does have a physical manifestation, whether that is facial paralysis or drooping or something to do with motor control issues.

that element that you have, the visual representation, I think is really important for the content and the mission. So for people to be able to see what somebody looks like in survival, what somebody sounds like, and I think also boosting their comfort and their confidence because so many people, the depression comes from the isolation of, I don't want to be out in public. I don't

You know, if I'm having trouble feeding myself or I have to have somebody help me unzip my pants so I can go to the bathroom or zip them back up. There's all of these things that contribute to people remaining isolated and not being out in community. So I think that there's another therapeutic piece for the people who are on your podcast for them to build confidence. I

I think you're right about that, but I'm going to build on that with my selection of those stroke survivors is specific to people who were not going to support groups because they felt like because there was no visual evidence that they had a stroke, they felt guilty for their emotional needs and they felt like

Like, I'm so much better off than I could have been. I don't want to go to a support group and say, I need help when I'm sitting next to somebody in a wheelchair who can't walk. And they're like, what needs do you have, really? And so I really wanted to highlight in the visual aspect of the Stronger After Stroke podcast that

Stroke survivors could be anyone. You don't know by looking at somebody if they've had a stroke. They could look perfectly normal, but they don't feel that way. And actually, the more that they look normal, the lonelier they may be. Giving a voice to those people who can't speak for themselves so that they can at least hear it and know someone else is out there who has had this experience and they're not as alone.

They share the things that worked for them and what resources were helpful for them in their recovery. And especially in our aphasia episode, our stroke survivor talks about what it was like when she couldn't even say her own name and then what she was feeling and the things she can put into words now that she couldn't then. So being able to give that to people has been so rewarding for me.

In the topics that you cover, there's this wonderful range. I mean, there is the science, the therapy, the treatment, the state of where we are, what's best and available so that I think people are more educated about it. But then you've also got the really practical pieces of managing travel. Yeah. Yeah. Thinking about what does...

athletics look like for me. You mentioned the sex and intimacy when I was listening to that episode. It's a two-part series about the issue of consent, you know, from the standpoint of... With aphasia. Yeah, with aphasia. So it's, you know, I think that just the level of awareness, I was grateful and I was surprised. But so these topics are far ranging. And then the resources, like where to be able to go, right?

You have one on music therapy, which I absolutely love. And in the show notes, it says how to find a neuro music therapist near you or that you can meet with virtually online. Yeah. You've got stuff on communication, on nutrition. You know, you mentioned that you've got this long waiting list.

We have one of the best migraine specialists in the country, Dr. Brian Plato, and his office does have a nine-month waiting list to get in to see him. And there's some overlapping symptoms for people who have migraine with aura, and then they may have visual changes and knowing how to describe when to go to the ER versus when you can wait and see.

have a routine follow-up with a provider. And primary care providers are not able to answer those. Even other neurologists may not be able to answer some of those really specific questions. And so having access to that level of expertise is a gift.

So when you think about improving access, looking at the waitlist times, being able to intervene and getting people at least forestalling some worsening of their condition, how do you see using the podcast and storytelling and providing expert information that's evidence-based, that's from a trusted source, how do you see that as transforming care delivery so that we are improving access, we are improving equity?

That's a big question, but I have no doubt that you have a lot of thoughts about this and a lot of experience on it as well. So I think that storytelling through the podcast has humanized stroke for

for a lot of people who maybe didn't have a current face on it. And so I hope that's raised awareness for one thing about the frequency of need and a population that's not necessarily an older population, but it may be a rural population. We have, um,

listeners to the Stronger After Stroke podcast in 63 countries, and we've got almost 2,000 downloads in outlying U.S. territories. Talk about some lack of access to care. They'll probably never see a comprehensive stroke center in their life, but they will have access to that expertise.

So you are prescribing podcasts. I am, yes. I love that. One of the other things that we discussed in a prior conversation, you mentioned that, you know, while this is public facing and it's meant for, you know, patients, the general public, you have found colleagues who find this useful and they're putting it into their practice or as far as how they prescribe it, but also how they're learning. So say just a little bit more about

how this particular form of outreach and education, you know, the ancient wisdom of storytelling, that art combined with the technology to produce it and to distribute it, how is that impacting colleagues and healthcare professionals in education?

Most nurses would not identify as a neuro nurse. The Stronger After Stroke podcast has been very empowering for a lot of my colleagues who do not have as much experience with stroke to at least kind of know kind of where to turn. There are hospitals across the country and even in other countries that are prescribing the Stronger After Stroke podcast for education to their patients.

as a tool. And that has been incredible. And I think that the effectiveness of this tool, Four Stroke, just demonstrates how well people can learn from a podcast as a platform. And so I've really been encouraging other nurses and other specialties to share their expertise. Maybe it's in epilepsy, maybe it's in diabetes.

But nurses are able to put things into words that patients can understand. And so I've really encouraged other nurses to use their voice. And there are lots of ways to make a podcast that can be effective at getting their message out there.

You mentioned other nurses who are using their expertise in this format. Who are some of the nurses and some of the podcasts that you also prescribe with that you listen to and learn from? Oh, yeah. Well, as a former ICU nurse, I love Kaylee Dayton's Walking Home from the ICU podcast.

She has been such a great leader in transforming ICU care and preventing delirium. The ABCDEF bundle is something we as nurses were taught in my neuro ICU and we put into practice, but it is very rare that you would find that before, but she has learned

really gotten the message out there through her podcast and interviewing patients and they're sharing their stories of the result of those sedating medications and the feeling trapped through the lack of mobility. And,

I have really admired how she has put herself out there as a nurse practitioner, even when her message was going against the current prevailing practice. But she followed the evidence and the path of the patient's stories, right? She accumulated the evidence through the patient interviews as well as, you know, other studies that were being done. And so I'm thankful she's been able to do that. I've been very delighted by her.

not only forms of podcasts, but I'm thinking of Hadley Vlahos, who's talking about hospice care, and she uses stories on Instagram. I've been following Nurse Hadley since I was in the ICU, I think, because I really related to that end-of-life care that Hadley so beautifully portrays in story form. It's storytelling combined with

a way to capture it and then a way to distribute it and to find platforms where people want to go and get their information. And there are so many different places right now where people are getting their information, and it's not always the best information. I think a lot about Michelle Lichman and the work that she does with the diabetes community and the deaf and the disability community. So I just see this opportunity.

And nurses who are really jumping in because they see the need and they know that with their information and their experience and their trust, their competence, they are able to reach a lot more people. And meet those people where they're at, right? Hadley reaches people on Instagram because that's where they're at.

And so if you see a population that's suffering from a lot of misinformation in that niche on Pinterest or on Instagram, let's create some content that's accurate and put it on Instagram and on Pinterest so they can find it and learn how to use those platforms and market the truth. Absolutely. I was going to say, jump on the latest TikTok dance trend and let's dance our way through diabetes and delirium and...

And all sorts of, you know, depression. My goodness. Dancing in depression. Music. That might work. We could maybe dance our way out of depression. I think that there's a lot of potential for that. Special thanks to Stroke Nurse Navigator and Stronger After Stroke podcast host, Rosa Hart.

Coming up in part two of our Power of the Podcast series, we've taken Rose's podcast recommendation and we're introducing you to ICU nurse practitioner and host of Walking Home from the ICU podcast, Kaylee Dayton. This is a huge change in our perspective, our knowledge, and our approach to critical care medicine that does require in-depth education. I felt very divinely guided to start the podcast Walking Home from the ICU because

And I named it that because I wanted that to be the goal of critical care medicine. What if we had patients awake and mobile right away? Let them communicate their needs, treat their needs, let them connect with their families, let them know what was going on. They could get their own bodies going. They could walk. We would just have to push a ventilator behind them. To have patients go back to their lives that they lived before, whatever that looked like. Many of our patients could really walk home from the ICU.

I've had the honor of interviewing a lot of experts throughout the world. When podcast listeners reach out with questions, if I can't answer them, I'm going to find someone that can, and we'll do an episode on it. For See You Now, I'm Shona Butler. Keep listening.

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