By: Kathy Hubbard
Stroke. The word causes my blood to go cold. My family has had more than their fair share, which is why I’ve probably written more about strokes than any other subject. I’m always keen to talk about BE FAST, the easy to remember acronym for Balance, Eyes, Face Drooping, Arm Weakness, Speech Difficulty and Time to call 911.
You know the drill. If someone experiences sudden loss of balance or coordination, they have a sudden change in their vision; one side of their face droops or feels numb; they have a sudden weakness or numbness in one arm; or have slurred speech, trouble speaking or confusion, it’s time to call for emergency medical aid.
I asked Bonner General Health’s Emergency Department Manager and Stroke Coordinator, Ryan Kerouac, RN, CEN (registered nurse, certified emergency nurse) if he would give us an update on stroke protocol and walk us through the procedure when a patient is brought into the Emergency Department.
He said, “Stroke protocols are always changing based on what is working and what is not. The most recent update came in early 2026. It has to do with wake-up strokes. Wake-up stroke is the most difficult stroke to deal with for the hospital side of things. What it essentially means is that the person went to sleep without any stroke symptoms and woke up with them.
“That matters a lot for us because we have a limited amount of time to give medications to help dissolve the clot that is blocking blood flow. Over the last five years a lot of research has gone into how to address this situation. Fortunately, at the same time CT and MRI have been becoming better and better.
“Now it is recommended that patients that come in as a wake-up stroke get evaluated by MRI or CT perfusion to see if the brain tissue is still savable. If the brain tissue is still savable then we give the medication to dissolve the clot. Before we had no way of identifying if the brain tissue was savable or not. BGH is currently working this update into our protocol with our State and Regional partners.”
When I asked Kerouac if there was anything new in stroke rehabilitation, he answered, “Stroke rehab is painfully slow. Most people that have significant improvement take a clot dissolving medication in the first four hours of symptoms. Once the brain tissue dies, it is very hard to restore function. I would think of stroke rehab as re-learning to do the task you once did without thinking. It can be done, it’s just slow and requires a lot of dedication over many months. Avoiding a stroke is the best way to rehab!”
What one can do to avoid having a stroke? He said, “The normal health lifestyle is what prevents a stroke, not smoking, staying active, and maintaining a normal BMI.”
Kerouac said that atrial fibrillation (A-fib) is the biggest risk because when your heart beats incorrectly it can cause blood to pool in the atria, clot, and cause a stroke. He also said that prolonged high blood sugar can cause more subtle small strokes, so keeping your A1c in a normal range is very important. And, of course he said, don’t smoke.
I asked him what he wanted our readers to know about strokes. He said, “That time is the most important variable in strokes. I have seen dozens of patients with minor stroke symptoms put going to see a doctor off for too long. The longer they wait, the more lasting the symptoms and disability are.
“I have also seen dozens of people with severe stroke symptoms come to the ER within the first hour or two of the symptoms and get discharged from the hospital with minor disability or none at all. Every minute that the clot is blocking blood flow to the brain tissue is dying.
“There is nothing we can do to regrow that tissue, it is lost forever. That’s why when you notice the symptoms of a stroke, it is so important to get treatment right away. That’s the lesson I want people to understand. If you have stroke symptoms, get seen by a doctor.”
Kerouac said that BGH sees a potential stroke victim every day of the year and although many of them prove to be something else, they did the right thing by going in.
Kathy Hubbard was a charter member of Bonner General Health Foundation. She can be reached at [email protected]. This article was written for publication in the Bonner County Daily Bee on June 3, 2026.