"DIRECT CONNECTION" IS MADE BY MPT TO SERVE ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

GOOD EVENING WELCOME TO YOUR "DIRECT CONNECTION".

JUST AHEAD TONIGHT WHY WOMEN ARE MORE AT RISK OF A STROKE.

WHAT TO DO ABOUT THAT RISK IS COMING UP.

BUT FIRST TONIGHT ARE YOU GETTING ALL YOU DESERVE FROM SOCIAL SECURITY?

MPT PRODUCED A NEW PROGRAM FOR PUBLIC TV STATIONS AROUND THE COUNTRY CALLED SOCIAL SECURITY AND YOU.

JOINING US NOW IS HOST MARY BETH FRANKLIN.

EVERYBODY WORRIES ABOUT THE SOLVENCY OF THE SOCIAL SECURITY TRUST FUND.

DOES THE FACT THAT WE HAVE INFLATION AND THAT'S REQUIRED A BIG COST OF LIVING INCREASE SOCIAL SECURITY IS PAYING OUT MORE MONEY, DOES THAT BRING CLOSER THE DAY THE TRUST FUND RUNS DRY?

>> MARGINALLY.

BUT THE REAL CHALLENGE FOR SOCIAL SECURITY FINANCES IS DEMOGRAPHICS.

FRANKLY THERE ARE SO MANY RETIREES RECEIVING BENEFITS AND THERE ARE FEWER WORKERS THAN THERE HAVE BEEN IN THE PAST WHO ARE PAYING TAXES THAT FUNDS CURRENT BENEFITS.

IT IS A MATTER OF DEMOGRAPHICS.

THERE ARE DIFFERENT LEVERS THAT CONGRESS CAN PULL ON BOTH THE BENEFITS AND THE REVENUE SIDE TO MAKE THE SYSTEM WHOLE.

BUT THE KEY IS WE NEED ACTION AND THE SOONER THE BETTER.

>> Jeff: IN THEORY WHEN THE TRUST FUND IS EMPTY BENEFITS DON'T GET CUT TO ZERO.

>> WHEN PEOPLE SAY SOCIAL SECURITY IS BANKRUPT THAT IS FLAT OUT WRONG.

YOUR FICO TAXES THAT WORKERS PAY ARE WHAT FUND CURRENT BENEFITS AND AT THE MOMENT WE HAVE EXCESS TAX REVENUES THAT HAVE BEEN COLLECTED OVER THE LAST 40 YEARS, AND IN ADDITION TO THE FICA PAYROLL TAXES WE ARE DRAWING DOWN ON THE TRUST FUNDS.

THE TRUST FUNDS THE EXCESS REVENUES ARE EXPECTED TO BE DEPLETED IN ABOUT 10 YEARS.

IF THAT HAPPENED AND CONGRESS DID NOTHING BETWEEN NOW AND APPROXIMATELY 2033, THERE COULD STILL BE ENOUGH ONGOING TAX REVENUES TO PAY ABOUT 80% OF PROMISED BENEFITS.

BUT FRANKLY, YOU ME AND ANYBODY ELSE IN THE COUNTRY WILL NOT BE SATISFIED WITH 80% OF THEIR PROMISED SOCIAL SECURITY BENEFITS.

THEY EXPECT CONGRESS TO ACT.

AND THEY WANT TO KNOW WHAT THEY CAN EXPECT SO THEY CAN PLAN.

IF HISTORY IS ANY GUIDE, IT'S HIGHLY UNUSUAL FOR CONGRESS TO CUT BENEFITS OF EXISTING OR NEAR RETIREES.

NOW, THERE COULD BE CHANGES IN THE LONG RUN FOR YOUNGER WORKERS.

AND THAT COULD BE A FACT OF LIFE.

BUT IT'S UP TO OUR LAWMAKERS TO LET US KNOW WHAT TO EXPECT SO WE CAN ALL PLAN FOR OUR FUTURE.

>> Jeff: DO YOU THINK AS LONG AS THAT WORRY IS ALLOWED TO HANGOUT THERE AND CONGRESS KICKS THE CAN DOWN THE ROAD OR ON THIS SUBJECT IGNORES THE CAN ALTOGETHER, THAT THIS IS SOMETHING THAT IS GOING TO CONTINUE TO ENTER PEOPLE'S THOUGHT PROCESS WHEN THEY ARE DECIDING WHEN THEY SHOULD CLAIM BENEFITS?

AND YOU HAVE THE CHOICE FROM 62-70, RIGHT?

>> THAT'S RIGHT.

AND I THINK IT REALLY DOES ERODE THE FAITH IN THE SYSTEM.

AND THAT IS A SHAME.

BECAUSE SOCIAL SECURITY IS REALLY THE BEDROCK OF RETIREMENT INCOME FOR MOST AND AMERICANS.

I'VE HEARD PEOPLE SAY THE SYSTEM IS GOING BROKE I'M GOING TO GRAB MY BENEFITS AT AGE 62.

I DON'T THINK THAT IS A GOOD IDEA IN MOST CASES.

CERTAINLY IF YOU NEED THE MONEY TAKE YOUR BENEFITS THAT IS WHAT THEY ARE THERE FOR.

IF YOU ARE IN POOR HEALTH AND NOT LIKELY TO LIVE TO AVERAGE LIFE EXPECTANCY IT MAY BE WISE TO CLAIM REDUCED BENEFITS EARLY.

THE IDEA OF GRABBING YOUR BENEFITS AT 62 AND ASSUMING YOU'RE FULL RETIREMENT AGE IS 67 WHICH APPLIES TO ANYONE BORN IN 1960 OR LATER YOU ARE TAKING A 30% CUT IN YOUR BENEFITS FOR THE REST OF YOUR LIFE.

AND LET'S IMAGINE THAT YOUR WORST CASE SCENARIO COMES TRUE AND CONGRESS CUTS BENEFITS BY ANOTHER 20%, 10 YEARS FROM NOW.

HOW DID THAT WORKOUT FOR YOU?

WHAT I'D LIKE TO SAY TO PEOPLE IS THE IDEA OF CLAIMING SOCIAL SECURITY BENEFITS EARLY OUT OF FEAR IS LIKE SELLING YOUR STOCKS IN A DOWN MARKET.

THE ONLY THING YOU HAVE GUARANTEED IS YOU JUST LOCKED IN A LOSS.

>> Jeff: LET ME REMIND OUR VIEWERS IF YOU HAVE A QUESTION ABOUT SOCIAL SECURITY GIVE US A CALL ON THE NUMBER ON YOUR SCREEN OR SEND A QUESTION BY E-MAIL, THE E-MAIL IS LIVE QUESTIONS@MPT.ORG.

ALL OF THAT BEING SAID ABOUT THE ACTUARIAL REASONS TO WAIT BEFORE YOU CLAIM, ALMOST NOBODY WAITS UNTIL THEY ARE 70, RIGHT?

>> WELL, IN THE PAST IT WAS HIGHLY UNUSUAL FOR PEOPLE TO WAIT UNTIL AGE 70.

WE'RE SEEING THE NUMBERS CREEPING UP.

IT'S STILL SINGLE-DIGITS BUT FOR THE PEOPLE WHO ARE HEALTHY ENOUGH BECAUSE YOU WANT TO EXPECT TO LIVE A LONGTIME, AND WEALTHY ENOUGH IN OTHER WORDS IF I DELAY CLAIMING BENEFITS WHO DO I DO FOR MONEY INTREN?

FOR PEOPLE WHO PLAN TO KEEP WORKING PROBLEM SOLVED.

BUT THERE ARE OTHER PEOPLE WHO DO CHOOSE TO RETIRE AT 62 OR 65 OR WHENEVER AND STILL DELAY CLAIMING THEIR BENEFITS UNTIL AGE 70.

MAYBE THEY ARE DRAWING DOWN ON OTHER ASSETS THEIR IRA'S 401K'S MAYBE THEY HAVE RENTAL INCOME.

WHY WAIT UNTIL 70?

BECAUSE THERE IS A HUGE PAY OFF FOR EVERY YEAR YOU POSTPONE CLAIMING YOUR SOCIAL SECURITY BENEFITS BEYOND YOUR FULL RETIREMENT AGE UP UNTIL AGE 70 YOU GET AN EXTRA 8% PER YEAR.

IF YOUR FULL RETIREMENT AGE IS 66 AND YOU WAIT UNTIL 70, THAT IS AN EXTRA 32%.

NOW, HERE IS A REALLY DRAMATIC EXPLANATION.

THE DIFFERENCE OF CLAIMING REDUCED BENEFITS AT AGE 62 VERSUS CLAIMING THE MAXIMUM AT AGE 70, WOULD RESULT IN A 76% INCREASE IN YOUR SOCIAL SECURITY BENEFITS EVERY MONTH FOR THE REST OF YOUR LIFE.

NOW AS A CERTIFIED FINANCIAL PLANNER THERE IS NO INVESTMENT I CAN RECOMMEND TO YOU THAT IS GOING TO INCREASE YOUR INCOME BY 76% BY ESSENTIALLY INVESTING EIGHT YEARS OF YOUR LIFE.

>> Jeff: LET'S TAKE A PHONE CALL FROM MONTGOMERY COUNTY THIS IS JEFF.

JEFF THANK YOU FOR CALLING.

GO AHEAD.

>> YES.

I PLAN TO RETIRE AT THE AGE OF 65.

I'M WAS BORN IN 59 SO I'M NOT IMPACTED BY THE INCREASE.

IF I RETIRE AT 65 AND WAIT FOR TWO YEARS BEFORE I TAKE MY SOCIAL SECURITY, WOULD MY BENEFITS BE AFFECTED BY THE TWO YEARS THAT I DIDN'T EARN ANY MONEY?

AND WHEN I TOOK MY SOCIAL SECURITY?

>> THANK YOU FOR THE PHONE CALL.

>> YOU WERE BORN IN 1959 YOUR FULL RETIREMENT AGE IS 66 AND 10 MONTHS.

SO IF YOU STOPPED WORKING AT 65 AND YOU WAITED UNTIL YOUR FULL RETIREMENT AGE OF 66 AND 10 MONTHS YOU ARE PRETTY MUCH GOING TO GET 100% OF YOUR BEN FATES.

WHEN YOU GET THE BENEFIT STATEMENT IT ASSUMES YOU CONTINUE WORKING AND EARNING APPROXIMATELY THE SAME AMOUNT AS YOU ARE EARNING NOW THROUGH YOUR FULL RETIREMENT AGE.

YOU ARE SUGGESTING THE MIGHT RETIRE A YEAR OR TWO BEFORE YOU REACH THE FULL RETIREMENT AGE IF YOU HAVE BEEN A HIGH EARNER IT'S NOT GOING TO HAVE MUCH IMPACT AT ALL.

THE OTHER THING WHEN YOU LOOK AT YOUR ESTIMATED BENEFIT ESTIMATE AND I ENCOURAGE EVERYONE TO GO TO SSA.GOV AND SETUP YOUR MY ACCOUNT, SO 24/7 YOU CAN SEE WHAT YOUR ESTIMATED BENEFITS WILL BE AT VARIOUS AGES THOSE ESTIMATES DO NOT INCLUDE THE ANNUAL COST OF LIVING ADJUSTMENT.

AS YOU PROBABLY KNOW THIS YEAR IN 2023 BENEFICIARIES RECEIVED AN 8.ONTARIO% COST OF LIVING ADJUSTMENT THE LARGEST ONE IN MORE THAN 40 YEARS.

WHAT SURPRISES PEOPLE IS YOU DON'T HAVE TO CLAIM SOCIAL SECURITY TO TAKE ADVANTAGE OF THAT COLA.

ANYONE WHO IS 62 OR OLDER IN 2023 MEANING ELIGIBLE FOR SOCIAL SECURITY BENEFITS RECEIVES THAT COLA AND EVERY OTHER COST OF LIVING ADJUST MANY THAT IS AWARDED BETWEEN THE TIME YOU ARE ELIGIBLE AT AGE 62 UNTIL THE TIME YOU ACTUALLY CLAIM.

BOTTOM LINE IS THE ESTIMATED BENEFIT YOU GET FROM SOCIAL SECURITY IS ACTUALLY GOING TO BE BIGGER WHEN THEY FACTOR IN THE COST OF LIVING ADJUSTMENTS.

>> Jeff: FOR PEOPLE WHO THINK ABOUT THIS DELAYED CLAIMING DECISION FROM THE STANDPOINT OF A BREAK EVEN ANALYSIS.

YOU CALCULATE HOW MUCH YOU ARE FOREGOING AND HOW MUCH YOU ARE GOING TO GET I WAS TALKING TO A COWORKER WHO CALCULATED HIS BREAK EVEN WOULD BE AGE 84 AND IT IS A QUESTION OF ARE YOU GOING TO LIVE TO 84?

HA IS THE FAMILY HISTORY, THE HEALTH STATUS?

IS THAT A REASONABLE WAY TO LOOK AT IT.

>> THE FUNNY THING IS THE SOCIAL SECURITY ADMINISTRATION USED TO PUT A BREAK EVEN CALCULATOR ON THE WEBSITE.

IT SHOWS YOU HOW LONG YOU WOULD HAVE TO LIVE TO MAKE THE DECISION TO DELAY WORTHWHILE.

AND ESSENTIALLY IF YOU CLAIM EARLY AT 62 OR AT YOUR FULL RETIREMENT AGE, IT REALLY DOESN'T MATTER IF YOU LIVE UNTIL AVERAGE LIFE EXPECTANCY.

IT WILL ALL WORKOUT EVENLY.

BUT IF YOU LIVE LONGER THAN THE AVERAGE LIFE EXPECTANCY IS 84 FOR A 65-YEAR-OLD TODAY, THE LONGER YOU WAIT THE BETTER OFF YOU WOULD HAVE BEEN GETTING THE BIGGER BENEFIT.

WHAT I LIKE TO TELL MARRIED COUPLES IS THINK OF IT AS SPREADING THE BREAK EVEN AGE OVER TWO LIFETIMES.

BECAUSE ONE PERSON IS LIKELY TO DIE FIRST AND LEAVE THAT LARGER BENEFIT TO THE SURVIVING SPOUSE.

SO WHAT I LIKE TO TELL MARRIED COUPLES WHO ARE RELATIVELY CLOSE IN AGE IS PERHAPS YOU HAVE ONE SPOUSE THE ONE WITH THE BIGGER BENEFIT WAIT UP UNTIL 70 TO CLAIM THE BIGGEST BENEFIT POSSIBLE AND THE OTHER SPOUSE IF HE OR SHE IS NOT WORKING COULD CLAIM REDUCED BENEFITS EARLY OR IF THEY ARE WORKING WAITING UNTIL FULL RETIREMENT AGE WHEN THE EARNING RESTRICTIONS GO AWAY.

AND WHEN THE SPOUSE WITH THE BIGGER BENEFIT DIES THAT SECOND SPOUSE WILL STEP UP TO THE SURVIVOR BENEFITS WORTH 100% OF WHAT THAT DECEASED WORKER WAS COLLECTING.

IT IS A GOOD WAY FOR MARRIED COUPLES TO HEDGE THEIR BETS AND WHAT SURPRISED PEOPLE IF YOU ARE AN ELIGIBLE DIVORCED SPOUSE MARRIED AT LEAST 10 YEARS BEFORE DIVORCING AND YOUR ARE SINGER IF YOUR BENEFIT AS A SPOUSE IS LARGER THAN YOUR OWN, YOU MAY BE ABLE TO COLLECT ON YOUR X'S EARNINGS RECORD AND IF YOUR EXDIES YOU MAYBE ENTITLED TO A SURVIVOR BENEFIT.

>> Jeff: YOU SPENT A LOT OF TIME RESEARCHING THIS, WRITING ABOUT IT, THINKING ABOUT IT.

HOW WOULD YOU MAKE SOCIAL SECURITY THE INSTITUTION THE BENEFIT HOW WOULD YOU MAKE IT BETTER?

>> I WOULD LIKE TO SEE THE SOCIAL SECURITY ADMINISTRATION START REISSUING THE PAPER STATEMENTS AGAIN.

THEY STOPPED DOING THAT ABOUT 10 YEARS AGO BECAUSE IT WAS SO EXPENSIVE.

THE ARGUMENT IS WELL, THE INFORMATION IS AVAILABLE ON-LINE TO ANYBODY WHO WANTS TO GET IT.

BUT I THINK IT IS A VERY VALUABLE PERSONAL FINANCE PLANNING DOCUMENT BECAUSE YOU SEE NOT ONLY YOUR ESTIMATED BENEFITS AT VARIOUS AGES, WHAT YOUR DEPENDENTS YOUR SPOUSE OR MINOR DEPENDENT CHILDREN MAYBE ENTITLED TO IF YOU DIE OR BECAME DISABLED AND WHAT IS SO INTERESTING ABOUT IT IT GIVES YOU YOUR ENTIRE LIFETIME EARNINGS HISTORY OF HOW MUCH YOU MADE AND HOW MUCH YOU PAID IN PAYROLL TAXES.

>> Jeff: MARY BETH I WANT TO GET TO ONE MORE PHONE CALL.

THIS IS VICKY.

WHAT IS YOUR QUESTION?

>> MY QUESTION IS THIS.

62 YOU RETIRE AT 62 AND THEY TAKE A DEDUCTION BECAUSE ARE YOU NOT 65, WILL YOU GET THAT MONEY BACK?

>> IF YOU CLAIM BENEFITS EARLY YOU ARE TAKING A PERMANENT REDUCTION.

YOU'RE BASICALLY GETTING SMALLER CHECKS BUT FOR A LONGER PERIOD OF TIME BECAUSE YOU STARTED EARLY.

AND THE THING THAT I WARN PEOPLE IS IF YOU CLAIM BENEFITS BEFORE YOUR FULL RETIREMENT AGE NOT ONLY ARE THEY PERMANENTLY REDUCED BUT IF YOU CONTINUE TO WORK EARNINGS FROM A JOB AND YOU MAKE TOO MUCH MONEY, WHICH IS ABOUT $21,000 THIS YEAR, THEN YOU COULD LOSE MORE BENEFITS TO SOMETHING CALLED THE EARNINGS RESTRICTIONS.

ONCE YOU GET TO FULL RETIREMENT AGE ANY BENEFIT YOU LOST DUE TO THE EXCESS EARNINGS YOU WILL GET BACK IN THE FORM OF LARGER FUTURE BENEFITS.

>> Jeff: MARY BETH WE HAVE TO LEAVE IT THERE.

THE HOST OF SOCIAL SECURITY AND YOU WHICH AIRS THURSDAY AT 8:00 P.M. ON MPT.

THANK YOU SO MUCH FOR YOUR TIME.

>> THANK YOU, JEFF, APPRECIATE IT.

[*] >> Jeff: AND JOINING US NOW TO TALK ABOUT YOUR HEALTH IS THE DOCTOR PROFESSOR OF NEUROLOGY AT MARYLAND'S SCHOOL OF MEDICINE AND DIRECTOR OF THE UNIVERSITY OF MARYLAND MEDICINE'S STROKE PROGRAM.

DOCTOR THANK YOU FOR JOINING US.

WE WANT TO TALK ABOUT STROKE IN WOMEN IN PARTICULAR.

ARE ANY OF THE RISK FACTORS DIFFERENT IN WOMEN?

>> YEAH, I THINK IT'S HELPFUL TO DIVIDE THAT UP INTO BEFORE AGE 50 AND AFTER AGE 50.

AFTER AGE 50, THE RISK FACTORS ARE SIMILAR AND SO WE FREQUENTLY TALK ABOUT THE BIG FOUR BEING HIGH BLOOD PRESSURE, DIABETES, HIGH CHOLESTEROL AND HISTORY OF SMOKING.

THE GOOD NEWS IS THAT ALL FOUR OF THOSE ARE TREATABLE AND CONTROLLABLE TO SOME EXTENT.

AND THEN YOU SHOULD ADD IN AS A FIFTH FACTOR OBESITY AND POTENTIALLY SLEEP APNEA, WHICH IS A RISK FACTOR FOR BOTH MEN AND WOMEN.

BEFORE AGE 50, OBVIOUSLY THERE ARE DIFFERENCES BECAUSE WOMEN CAN BECOME PREGNANT AND SO PREGNANCY IS A CONDITION WHERE THE BLOOD YOU HAVE AN ENHANCED TENDENCY FOR BLOOD CLOTS AND ALSO IN THE FOUR TO EIGHT WEEKS AFTER PREGNANCY THERE IS AN ENHANCED TENDENCY FOR BLOOD CLOTS.

THAT IS AN INCREASED RISK TIME FOR WOMEN TO HAVE STROKES.

AND BIRTH CONTROL PILL USE BECAUSE ESTROGEN CONTAINING BIRTH CONTROL PILLS THEY ENHANCE THE TENDENCY FOR CLOTS TO DEVELOP IN THE BODY AND THAT CAN LEAD TO STROKES.

LUCKILY, THE RISK IS FAIRLY LOW BUT IT'S HIGHER IN WOMEN OVER AGE 35 AND WOMEN WHO SMOKE.

AND AT OUR MEDICAL CENTER WE PROBABLY SEE ABOUT FOUR TO SIX WOMEN WHO HAVE A STROKE WHILE TAKING BIRTH CONTROL PILLS.

SO ALTHOUGH IT'S RELATIVELY RARE IT'S SOMETHING THAT DEFINITELY DOES HAPPEN.

>> Jeff: IS THERE ANYTHING THAT WOMEN IN THAT AGE GROUP CAN DO TO MITIGATE THE RISK OF ORAL CONTRACEPTIVES OR PREGNANCY RELATED STROKES?

>> FOR ORAL CONTRACEPTIVES DO NOT TAKE THEM IF YOU ARE A SMOKER AND ESPECIALLY A SMOKER OVER AGE 35 OR 4 0.

AND ANOTHER GROUP WHERE THERE IS A LITTLE BIT OF CONCERN IS WOMEN WHO HAVE MIGRAINE WITH WARNING SYMPTOMS CALLED AURA AND THERE ARE SOME CONCERN IF YOU HAVE A MIGRAINE WITH AURA AND YOU TAKE BIRTH CONTROL PILLS, YOU MAY HAVE SLIGHTLY HIGHER RISK.

SO IF YOU HAVE MIGRAINES IT WOULD BE BEST TO GET THOSE UNDER CONTROL AS WELL.

AND ALSO ASSESS THE INDIVIDUAL RISKS WITH YOUR PROVIDER.

FOR PREGNANCY, THE IMPORTANT THING IS TO HAVE EARLY ACCESS TO PREGNANCY CARE AND MAKE SURE THAT THE BLOOD PRESSURE IS WELL CONTROLLED THAT THERE'S NO WHAT WE CALL GESTATIONAL DIABETES WHICH IS DIABETES DEVELOPING DURING PREGNANCY.

AND REALLY THE BLOOD PRESSURE IS I THINK THE MOST IMPORTANT FACTOR AND OF COURSE AVOID SMOKING DURING PREGNANCY AND AVOID ANY DRUG USE.

>> Jeff: NOW, WHAT ABOUT STROKES THAT ARE CONNECTED TO A HEART RHYTHM ABNORMALITY CALLED AFIB, ARE WOMEN MORE LIKELY TO GET AFIB OR TO HAVE THAT COMPLICATION OF IT?

>> ONCE AGAIN IT'S IMPORTANT TO LOOK AT AGE.

BECAUSE BEFORE AGE 75, MEN DEFINITELY HAVE HIGHER RISKS OF AFIB COMPARED TO WOMEN.

BUT OVER AGE 75, AFIB IS THE LEADING CAUSE OF STROKE IN WOMEN.

AND THAT'S PARTLY BECAUSE WOMEN LIVE LONGER AND SO THE PERCENTAGE OF WOMEN OVER AGE 80 IS SIGNIFICANTLY HIGHER THAN THE NUMBER OF MEN.

AND SO BECAUSE WOMEN LIVE LONGER, THERE ARE A LOT OF WOMEN OVER AGE 75 WHO HAVE AFIB RELATED STROKES AND IT'S ESTIMATED THAT THERE ARE ABOUT 50,000 MORE WOMEN DISABLED FROM STROKE EACH YEAR IN THE U.S.

COMPARED TO MEN.

AND ALSO MANY SOME PEOPLE MAY NOT REALIZE THAT ABOUT 60% OF THE DEATHS IN THE U.S. DUE TO STROKE ARE WOMEN.

AND THAT IS PARTLY AS A RESULT AS I SAID WITH THE FACT THAT WOMEN LIVE LONGER AND THERE ARE HIGHER NUMBER OF WOMEN IN THE OVERAGE 80 GROUP.

AND SO INTERESTINGLY WE'RE TRYING TO START ONE PROGRAM AT THE UNIVERSITY OF MARYLAND MEDICAL CENTER TO SCREEN WOMEN FOR AFIB IF THEY ARE OVER 70 AND IF THEY HAVE RISKS FOR AFIB, SUCH AS HIGH BLOOD PRESSURE, DIABETES, OR HISTORY OF HEART FAILURE.

>> Jeff: IF YOU FIND WOMEN IN THAT SITUATION, OR MEN IN THAT SITUATION, ARE ANTICLOTTING MEDICATIONS ALWAYS PRESCRIBED?

AND MAYBE TALK A LITTLE BIT ABOUT THE RISKS AND BENEFITS OF THOSE DRUGS.

>> THE ANTICLOTTING MEDICATIONS ARE VERY EFFECTIVE.

THEY CAN REDUCE THE RISK OF STROKE BY 60-70%.

BUT UNFORTUNATELY THEY ARE UNDERUTILIZED IN THE UNITED STATES.

SO THERE ARE A LOT OF PATIENTS WHO SHOULD BE ON THEM WHO ARE NOT.

AND THAT OCCURS FOR SEVERAL REASONS INCLUDING THE FACT THAT SOMETIMES CLINICIANS OVERESTIMATE THE RISK OF BLEEDING OR PATIENTS MAY NOT BE FULLY AWARE OF THE RISKS OF STROKE.

BUT THE MEDICATIONS ARE EFFECTIVE IN BOTH MEN AND WOMEN.

AND SO USUALLY THE DOCTOR WILL LOOK AT THE PATIENT'S AGE, WHETHER THEY HAVE HEART FAILURE, WHETHER THEY HAVE VASCULAR DISEASE ELSEWHERE IN THE BODY.

BUT IN GENERAL, THE MAJORITY OF PATIENTS OVER AGE 65 WITH AFIB SHOULD BE ON ANTI-BLOOD THINNING MEDICATIONS OR MEDICATIONS THAT IMPAIR THE CLOTTING SYSTEM AND THEY SHOULD HAVE REGULAR FOLLOW-UP WITH THEIR PHYSICIANS TO MAKE SURE THAT THEY ARE ADHERING TO THE MEDICATION AND TAKING IT AS PRESCRIBED.

>> Jeff: LET'S FOCUS FOR A BIT ON YOUR WORK AS DIRECTOR OF THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM STROKE PROGRAM.

THAT IS SOMETHING THAT AFFECTS ALL OF THE INSTITUTIONS IN THE SYSTEM?

>> YES.

ONE THING WHICH WE DID WAY BACK IN 2019 WE STARTED A STROKE CLINICAL NETWORK ACROSS THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM.

AND ONE THING THERE ARE A COUPLE OF GOALS OF THAT IS WE WANT TO HAVE THE SAME LEVEL OF CARE REGARDLESS OF WHICH INSTITUTION YOU PRESENT TO.

AND IF YOU PRESENT TO THE EMERGENCY ROOM ON THE EASTERN SHORE OR IN THE GREATER BALTIMORE AREA WE WANT TO MAKE SURE THERE WERE CONSISTENT PROTOCOLS IN TERMS OF PATIENTS WHO ARE EVALUATED FOR EITHER CLOT BUSTING MEDICATION OR POTENTIALLY INTERVENTIONAL THERAPY FOR STROKE.

INTERVENTIONAL THERAPY FOR STROKE CAN BE REMARKABLE IN THAT THE PHYSICIAN CAN PULL OUT A CLOT FROM THE BRAIN WHICH IS OBSTRUCTING THE BLOOD FLOW AND THAT CAN LEAD TO A SIGNIFICANT IMPROVEMENT IN THE PATIENTS.

AND WE'VE SEEN SOME WHO HAVE REMARKABLY IMPROVED WITHIN THE FIRST 24 HOURS.

AND WE HAVE A FEW VIDEOS ON OUR WEBSITE OF PATIENTS WHO HAVE BENEFITED TREMENDOUSLY FROM INTERVENTIONAL TREATMENT.

I ENCOURAGE VIEWERS WHO HAVE INTEREST IN THAT TO LEARN MORE ABOUT THE INTERVENTIONAL TREATMENTS FOR STROKE AND ALSO TO SEEK URGENT MEDICAL ATTENTION.

THOSE PROCEDURES ARE MOST USEFUL IF THEY CAN BE DONE WITHIN SIX HOURS OF STROKE.

THEY CAN BE HELPFUL FOR SELECT PATIENTS UP TO 24 HOURS OF STROKE BUT IT'S IMPORTANT TO SEEK RAPID ATTENTION IF YOU ARE IN THAT CIRCUMSTANCE.

>> Jeff: AND TO DO THAT YOU NEED TO KNOW THAT YOU NEED RAPID ATTENTION, RIGHT?

YOU HAD YOU NEED TO ABLE TO RECOGNIZE THE SYMPTOMS OF A STROKE IN YOURSELF OR IN SOMEBODY NEARBY.

>> YES, DEFINITELY.

AND THE PATIENT ACTUALLY EXPERIENCING THE STROKE THEY MAY NOT BE ABLE TO CALL 911 OR THEY MAY NOT BE ABLE TO RECOGNIZE THE SYMPTOMS IN ALL CIRCUMSTANCES.

AND SO IF YOU HAVE ATREL FIBRILLATION OR HYPERTENSION OR DIABETES OR HEART PROBLEMS IT'S IMPORTANT THAT YOUR FAMILY MEMBERS BE AWARE OF THE WARNING SIGNS AND EDUCATE YOUR SIGNIFICANT OTHER YOUR CHILDREN, OR PEOPLE THAT YOU COME IN CONTACT WITH, TO RECOGNIZE THE WARNING SIGNS OF STROKE.

THERE'S ONE TOOL WE USE CALLED BE FAST.

WHICH STANDS FOR BALANCE, EYES, FACE FOR FACIAL DROOP, SPEECH, FOR SPEECH PROBLEMS, AND A FOR ARM WEAKNESS AND THEN T FOR TIME.

AND TIME IS TO REMINDER TO CALL 911 IN CASE THE PERSON HAS ONE OR MORE OF THESE SYMPTOMS.

AND FOR THE ARM WE ASK THE PATIENTS TO HOLD-UP THEIR ARMS FOR 10 SECONDS IF ONE SIDE DROPS TO THE GROUND OR IS FADING ON ONE SIDE AND IF THERE'S CLEARLY ASYMMETRIC WEAKNESS THAT COULD BE A POTENTIAL SIGN OF STROKE THAT IS IMPORTANT FOR THE FAMILY MEMBERS TO KNOW.

>> Jeff: HOW MUCH HAS STROKE CARE CHANGED SINCE YOU GOT INTO THE FIELD OF NEUROLOGY?

>> IT'S BEEN LIKE A LIGHT BULB.

BACK WHEN I WAS DOING MY RESIDENCY, I DON'T WANT TO DATE MYSELF, BUT DOING MY TRAINING THERE WAS NO SPECIFIC TREATMENT FOR SOMEBODY HAVING AN ACUTE STROKE.

AND IN THE MID-1990s THE YOU USE OF CLOT BUSTING MEDICATIONS ARRIVED ON THE SCENE AND IN 2015 WAS THE FIRST DEMONSTRATION THAT THE INTERVENTIONAL THERAPIES WERE USEFUL.

SO THAT WAS THE CLOT RETRIEVAL OR CLOT REMOVAL FROM THE BRAIN AND CIRCULATION.

THAT IS REALLY LED TO A MASSIVE CHANGE ACROSS THE COUNTRY.

BECAUSE NOW THERE ARE MANY HOSPITALS WHICH ARE SO-CALLED COMPREHENSIVE STROKE CENTERS WHICH CAN HAVE THE CLOT RETRIEVAL AVAILABLE 24 HOURS A DAY.

IF YOUR LOCAL HOSPITAL IS NOT A COMPREHENSIVE STROKE CENTER AT LEAST THEY SHOULD BE LINKED WITH A COMPREHENSIVE STROKE CENTER SO PATIENTS CAN BE TRANSFERRED QUICKLY WHEN THE SYMPTOMS DEVELOP AND IF IT LOOKS LIKE A POTENTIALLY LARGE STROKE.

>> Jeff: AND THAT IS HOW THE SYSTEM WORKS.

THE IDEA IN THAT SITUATION IS NOT THAT YOU NEED TO FIGURE OUT WHERE THE COMPREHENSIVE STROKE CENTER IS AND GET YOURSELF THERE.

JUST GET INTO THE SYSTEM.

>> RESIDENTS OF MARYLAND ARE FORTUNATE BECAUSE THE LEADERS WITHIN THE STATE AND THE EMERGENCY MEDICAL SERVICES THEY HAVE GIVEN A LOT OF THOUGHT AS TO HOW TO SEND PATIENTS TO THE BEST HOSPITAL IN THE FOR THE PARTICULAR CIRCUMSTANCE.

AND SO IF IT LOOKS LIKE POTENTIALLY A LARGE STROKE AND A DEVASTATING STROKE MANY TIMES THE PARAMEDICS WILL TAKE YOU DIRECTLY TO A COMPREHENSIVE STROKE CENTER AND BYPASS THE SMALLER HOSPITAL NEARBY.

AND SO THAT'S BEEN USEFUL IN TERMS OF ALLOWING MORE PATIENTS TO HAVE ACCESS TO OTHER THERAPIES AND POTENTIALLY HAVE A LIFE-SAVING TREATMENT.

>> Jeff: LASTLY, LET'S SPEND A SECOND ON TIA EVENTS AND THEIR PREDICTIVE ABILITY TO SAY THAT SOMEBODY WITHOUT TREATMENT IS AT RISK OF A SERIOUS STROKE.

>> YES.

IT'S IMPORTANT FOR VIEWERS TO KNOW ABOUT THE CONCEPT OF TIA'S WHICH ARE CALLED MINI STROKES.

AND THAT MEANS THAT SOME PATIENT ALSO HAVE TEMPORARY WEAKNESS OR TEMPORARY LOSS OF VISION OR TEMPORARY SPEECH PROBLEMS AND THE SYMPTOMS MAY LAST FIVE, 10, 15 OR 30 MINUTES AND THEN THEY WILL RESOLVE BY THEMSELVES.

AND IT'S IMPORTANT NOT TOIC THOR THAT BECAUSE -- IGNORE THAT BECAUSE IT CAN BE A WARNING SIGN OF A STROKE AND SOMETIMES YOU MAY GET ONE WARNING BEFORE GOING ON TO DEVELOP THE FULL-BLOWN STROKE IF YOU HAVE THOSE SYMPTOMS AND RISK FACTORS THAT WE'VE DISCUSSED LIKE HIGH BLOOD PRESSURE OR DIABETES OR ATREL FIBRILLATION IT'S IMPORTANT TO GO TO THE EMERGENCY ROOM AND SEEK MEDICAL ATTENTION AND HAVE AN EVALUATION BY A NEUROLOGIST IF NOT IN THE EMERGENCY ROOM THEN HOPEFULLY QUICKLY AS AN OUTPATIENT.

>> Jeff: HE IS DIRECTOR OF THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM'S STROKE PROGRAM.

DOCTOR THANK YOU FOR YOUR TIME.

>> THANK YOU, JEFF, A PLEASURE TO SPEAK WITH YOU TONIGHT.

>> Jeff: AND THAT IS "DIRECT CONNECTION" FOR THIS WEEK.

WE'RE BACK FRIDAY WITH STATE CIRCLE AND LATEST ON MARYLAND POLITICS JOIN US FRIDAY AT SIN P.M. AND FOLLOW US ON TWITTER AT MPT NEWS.

FOR ALL OF US AT MPT THANK YOU FOR WATCHING AND HAVE A GOOD NIGHT.

[*]