Health Disparities and Strokes: Addressing the Impact of Genetics and Inequities in Minority Communities with Dr. William T. Choctaw, MD, JD

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Coming up on this episode of the
Healthy, Wealthy and Wise podcast.

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So what are some of the common
signs of stroke in women?

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And I say in women, distinguishing
women from men, because one of the

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things that I've learned in my 50 years
of health care, And the whole, um,

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healthcare, uh, industry has learned, um,

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education has learned.

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Welcome to the Healthy, Wealthy,
and Wise podcast with Dr.

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William T.

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Choctaw, MD, JD.

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This podcast will provide you with
tools and actionable information

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you can use to help live a more
healthy, wealthy, and wise life.

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It's powered by the over 50 years
of medical experience of this Yale

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University medical school trained
surgeon, who is also a Western

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State Law School trained lawyer.

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with executive experience being a former
mayor of Walnut, California, as well as

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the current chairman of the nonprofit
Servants Arms and as president of

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Choctaw Medical Group, Incorporated.

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This is the Leadership Masterclass
Edition already in progress.

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We talk a lot about relationships.

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I particularly talk a lot about
that, but one of the very important.

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Relationships in our lifetime, for all of
us, is that doctor patient relationship.

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That doctor patient relationship.

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And what's my point about that?

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My point is that it is a
very unique relationship.

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Uh, um, in my 50 years of practice
before I retired, I treated

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a lot of husbands and wives.

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Um, and many of them who would come to
me individually, and the conversation

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would go something like this, Now doctor,
this is between you and me, right?

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I do not want you to discuss this.

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And I said, no problem.

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Because I took an oath anyway, so
I, I, I'm, that, that's my job.

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That's my responsibility.

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Uh, That, that what you say
to me, you say it to me.

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Uh, and even though, uh, you know,
the husband may be my good friend and

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not all that stuff, it doesn't matter.

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You know, it's, it's an old.

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Um, and so my point is that you should
be able to trust that relationship.

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And what else am I saying?

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What I'm saying is that when you go to Dr.

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A's office and, um, he walks into
the room and if you immediately

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or later on start to feel
uncomfortable for whatever reasons.

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Trust that feeling, right?

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Trust that feeling.

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And, and my point is, that sometimes
that relationship does not work.

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Not your fault, not the doctor's fault.

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It's just not there.

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That's the way I view it.

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Uh, and that's okay.

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Move to another doctor and
feel comfortable doing that.

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A lot of times we patients Uh,
patients feel obligated, you know,

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well I don't want to get the doctor
upset, well I don't want her to get

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mad at me, well she seems like a nice
person but she's just really busy.

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All those things do not excuse
poor physician behavior,

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poor physician behavior.

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One of my jobs as chief medical officer.

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Um, um, uh, type at Citrus Valley
and a lot of these other places is,

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I was in charge of the physicians.

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Um, and as chief of staff, um, and
we had about a thousand, or still

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are, about a thousand physicians on
staff between the three hospitals.

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My job was to deal with the problem
docs, you know, and, and there's a

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pattern, there's a pattern, and part of
that pattern has to do with attitude.

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Part of that has to do with attitude,
and I would give lectures like this

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about What to do and what not to do.

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Bottom line is, uh, I would say you
doctors were worried about being sued.

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I said, let me give you
a basic amount of advice.

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Patients are amazingly, um, uh,
tolerant of physicians, amazingly

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tolerant, uh, because they,
you know, God has blessed us.

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And so they're going to give you the
benefit of the doubt, whatever it

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is, whatever, whatever, whatever.

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Um, and I said, in general.

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You'll be fine, except for
one exception, one exception.

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I said, if you are a jerk, J E R
K, J E R K, uh, they will sue you.

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And I don't blame them,
I would sue you too.

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So my bottom line to them
was, don't be a jerk.

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You know, just be nice, be human.

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If it's not working on your side,
transfer the patient to another physician.

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There's nothing wrong with that.

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But my point is, it's a relationship.

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It's a relationship.

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And relationships are based
on mutual respect, mutual

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trust, and good communication.

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Especially with people who've had strokes.

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And that sort of thing, because when
an individual has had a stroke, that

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involves the whole family, whole
families involved, uh, in terms of the

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recovery and a bunch of other things.

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So again, and I purposefully put
in some redundancy into these

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discussions, uh, different types of
stroke, ischemic and hemorrhagic.

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The ischemic stroke, ischemic stroke is
a stroke that's caused by Um, a hardening

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of the arteries, uh, atherosclerosis, uh,
these are things that we're careful about

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if we have high blood pressure, uh, if
we have high cholesterol, um, um, if we

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have hypertension because we don't want
those vessels to become so damaged that

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they build, build up this plaque within
the walls and it decreases the amount of

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blood that can get to that brain tissue.

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Hemorrhagic stroke, on the other hand,
similarly, if you have very, very high

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blood pressure, uh, many times that's
those small vessels can rupture, um,

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and burst, otherwise, and anything
that stops that blood from getting to

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the brain tissue where it's supposed
to go is a stroke, is a stroke.

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They're little strokes,
and they're big strokes.

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I had a phone call about a year ago, uh,
somewhere a year ago, 2023, from a 50 year

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old male who called and said, you know, I,
I, I don't feel good, I, I, I'm confused,

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and I don't know what's going on, and
blah, blah, blah, blah, blah, blah.

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And fortunately there were others in the
house with him, where he was renting,

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and the lady got on the phone, I said,
tell me what's going on, and she said, I

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don't know he's just moving sort of slowly
and and I sometimes I can't understand

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what he's saying so I said you need to
get him immediately to the emergency

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room blah blah blah blah blah and indeed
he was having a stroke fortunately it

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was a small stroke um and and my point
is that initially when it happens,

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um, uh, you don't know what it is.

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Um, and his stroke was
caused by hypertension.

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His blood pressure at the time
was like 200 over something.

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Um, very, very high.

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Like most people, he didn't check
his blood pressure every day.

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Um, even though he knew he had
high blood pressure, uh, and he was

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on high blood pressure medicine,
but he didn't take it every day.

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Like Many people.

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And so my point is, that's just one
example of one person who, you know, if I

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think 60 is young, 50 people are babies.

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to me.

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You know, so my point is it can happen.

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It can happen.

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Um, and just to digress, just talk
about blood pressure, which can

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cause that bleeding type of stroke.

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Many people think that they know
when their blood pressure is high.

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You do not.

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You do not know when your
blood pressure is high.

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Um, that's why blood pressure
is called high blood pressure.

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the silent killer because you
don't know when it's happening.

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Um, a lot of times if you're
stressed or upset, your blood

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pressure may be not high.

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Um, so my point is the only
way you know what your blood

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pressure is, you need to check it.

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That's the only way you know.

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So what are some of the common
signs of stroke in women?

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And I say in women, distinguishing
women from men, because one of

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the things that I've learned in
my 50 years of healthcare care.

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And the whole, um, healthcare, uh,
industry has learned, uh, education has

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learned that men and women are different.

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Men and women are different in
terms of how they experience

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various types of medical conditions.

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Uh, and there was no
nefarious reason for that.

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Basically back in the seventies,
when I went to medical school,

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a lot of the data was based on
studies that only included men.

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that only included men.

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These were studies that were
done in the sixties and the

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fifties, whatever, whatever.

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There were not a lot of
women in those studies.

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They were men.

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Think about heart attack, uh, women
were not included in those studies

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that had a thousand patients with
heart attack, it only included men.

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But yet, when we physicians gleaned
that information, we applied it to

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everybody, and that was a mistake.

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And that's why now you have, uh,
physicians who specialize in heart

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disease in women, you know, uh,
because there is a difference.

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So my point is, these are some
of the signs of stroke in women.

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Numbness or weakness of the face.

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Trouble speaking, understanding speech,
visual problems, trouble walking,

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dizziness, severe headaches with no
other cause, um, uh, nausea and vomiting.

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Let me also say, if you are not
able to write down all this stuff,

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everything that I say is on the church
website, it's on the church website.

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You go to, uh, STSBC, uh, go to events,
scroll down, uh, to masterclass.

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Click on Masterclass and go to the bottom
of the page and the whole PowerPoint that

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I'm talking about is right on the website.

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Um, I should give Shelly kudos for
doing that because it was her idea

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and it was brilliant, just brilliant.

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So my point is if you're not a fast
note taker, don't worry about it.

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I don't want you to stress because I
don't want you to, I want you to relax.

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That's why the room is real cool.

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You know, it's pretty nice colors.

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We want you to relax, but please
go to the website and tell your

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friends, just go to the website.

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It's all there.

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It's all there.

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Yes, ma'am.

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Yes, they are.

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Thank you for saying that because in
addition, instead of going to events,

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if you go to another part of the website
called, um, uh, ministries, scroll down

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to the bottom of the page, you'll see
health and health and wealth and wise

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podcast with my picture click on that.

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And this was if I was excited about.

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Uh, her putting the popcorn on.

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She has an embeddable player
on the church website.

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Now, you're saying, what's
an embeddable player?

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Well, well, uh, the podcast professor
taught me what a embeddable player

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is, but it's a podcast term.

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Right?

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So that every single podcast, and,
and these are all broken down in

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a podcast from the Masterclass,
are on the church website.

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Every single one.

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And there are about a hundred.

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We started doing all this a
year, uh, a year ago, January.

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So we're, we're going on, they're
all on the church website.

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So you can look at the podcast and you can
look at the Masterclass uh, PowerPoint.

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under the events, or you can go in the
ministries and listen to them, and with

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the podcast, I break them down into
20, 30 minute, uh, uh, sound bites.

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Because a lot of times podcasts aren't
designed for like an hour and all that.

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Um, so if, if you, if it's confusing,
you say, no, I just want to hear about,

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you know, The different types of strokes.

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I don't want to hear all those.

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Then listen to that particular podcast.

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What, what the podcast professor does, uh,
Brother Hamlin, he breaks each masterclass

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down into three or four podcasts.

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So you can pick and choose.

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Uh, but that is delivered to you by
the grace and intelligence of Ms.

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Shelley Shaw.

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Shelley Shaw was not my idea.

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I had no idea about it.

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She just did it.

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And I said, Oh my God.

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Yes.

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Oh, okay.

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Yeah.

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Yeah.

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That's fine.

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Go ahead.

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It could.

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It could.

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Yeah.

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Yeah.

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That could be certain unique
qualities that people have.

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that are not normal or regular.

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And you say, you know, so, so you, you
don't worry, but what does that mean?

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You don't do that normally.

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Blah, blah, blah, blah, blah, blah.

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Yeah.

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Uh, I entered those real small,
subtle types of things because what's

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happening is that the brain is not
functioning normally the way it does.

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And the brain is, is, is amazing
in terms of how it functions.

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But if you throw it off a little bit, You
many times you can notice that Yes, ma'am.

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Mm-hmm,

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susceptible, uh, that, uh, you
know, then quite honestly, then

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there's no way for you to know.

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I, you know, you may talk to family,
particularly older family who may

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have some idea, you know, when you
have your Thanksgiving dinner or you

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get together, um, that sort of thing.

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But, uh, plus I, I don't know
a lot about my family history.

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I just don't know.

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So what I do then, I just assume that
I, I may very well have that risk.

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and try to do everything that I can on
my side, on my part, to mitigate that.

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But again, you're right, um, many times
if you don't have that information,

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there's no way for you to know.

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Good question.

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Thank you.

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Uh, for men, in terms of some
common stroke signs, and remember

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that there's overlap, there's
overlap, um, and that's okay.

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But the point I want to make is That it's
not a hundred percent the same with both.

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That, uh, as the book says,
men really are from Mars, and

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women really are from Venus.

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Risk factors, and again, some of
this is redundant, but I'm going to

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go over them very quickly anyway.

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Obesity is a risk factor,
like a lack of exercise.

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Sleep apnea can be a risk factor.

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In other words, if you don't get that
good, REM sleep at night, rapid eye

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movement sleep, many times that can
throw off the functionality of the

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brain and can make you susceptible.

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Alcohol use we talked about, smoking,
diabetes, cardiovascular disease,

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high cholesterol, high blood pressure.

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These are all factors that can
contribute to, um, um, stroke.

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Yes.

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Well, that's a good question.

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Theoretically, if you use
a sleep apnea machine, that

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helps you with the sleep apnea.

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So, I would think, and I don't know
exactly, but I would think, If you use

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the machine and it helps to sleep apnea
or mitigates it, then that would lessen

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your risk from that particular issue.

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Yeah.

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Dr.

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Choctaw, could you please repeat
The questions when, when asked, when

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they ask, because we can't hear the
questions that the audience is asking.

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Okay.

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Thank you so much.

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The last question she asked was, uh, if
you use the, uh, the, the machine, uh,

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for sleep apnea, would that decrease
your risk of stroke from sleep apnea?

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And I said that I think it probably would.

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Uh, in general, um, because it improves
your sleep apnea, and I would think

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if it improves your sleep apnea,
that that would, that would increase.

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Uh, decrease the risk of you having
problems, excuse me, with the sleep apnea.

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Thank you.

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I will do that to make sure
those of you online can hear.

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Okay.

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Uh, uh, causes of stroke we talked about.

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Some other causes of stroke, uh, are
people who have, uh, atrial fibrillation.

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Uh, atrial fibrillation is
a type of quivering of the

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heart, the atria in the heart.

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The heart is atrial and ventricle,
but sometimes instead of

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squeezing down and pumping out
the blood, the heart will quiver.

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We call that fibrillation.

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And sometimes when that quivering occurs,
it can cause the heart to throw off clots

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that can go up to the brain and block a
part of the blood supply to the brain.

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Thank you for listening to the Healthy,
wealthy, and Wise Podcast with Dr.

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William t Choctaw, MDJD.

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