Breathing Easy. Pump It Up. Time Is Tight HEART HEALTH ISSUE Minimally invasive procedure relieves cardiomyopathy symptoms

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1 Pump It Up Kow these umbers by heart HEART HEALTH ISSUE 2016 Time Is Tight Lear heart attack symptoms ad get help fast Miimally ivasive procedure relieves cardiomyopathy symptoms Breathig Easy UHS WILSON MEDICAL CENTER UHS CHENANGO MEMORIAL HOSPITAL UHS HOME CARE UHS PRIMARY CARE UHS FOUNDATION UHS BINGHAMTON GENERAL HOSPITAL UHS DELAWARE VALLEY HOSPITAL UHS SENIOR LIVING AT IDEAL UHS SPECIALTY CARE UHS MEDICAL GROUP

2 stayig power CARDIAC Recipe for heart health Spaghetti with turkey meat sauce A abudace of expertise Fellowship program i cardiology to begi July 2016 INGREDIENTS Nostick cookig spray 1 lb. 99 percet fat-free groud turkey 1 ca (28 oz.) o-salt-added tomatoes, cut up 1 C fiely chopped gree bell pepper 1 C fiely chopped oio 2 cloves garlic, miced 1 tsp. dried oregao 1 tsp. groud black pepper 1 lb. spaghetti DIRECTIONS 1. Spray a large ostick skillet with cookig spray. Preheat over high heat. 2. Add turkey; cook, stirrig occasioally, for 5 miutes. Drai fat ad discard. 3. Stir i tomatoes with their juice, gree pepper, oio, garlic, oregao, ad black pepper. Brig to a boil; reduce heat. Simmer covered for 15 miutes, stirrig occasioally. Remove cover; simmer for 15 miutes more. 4. Meawhile, cook spaghetti i usalted water. Drai well. 5. Serve sauce over spaghetti. Makes 6 servigs of 5 oz. sauce ad 9 oz. spaghetti. Calories: 330. Total fat: 5g. Saturated fat: 1g. Cholesterol: 60mg. Sodium: 280mg. >> EAT RIGHT. Get more heart-healthy recipes from the Natioal Istitutes of Health at healthyeatig. hlbi.ih.gov. UHS Hospitals will soo begi a accredited Fellowship Program that will provide cardiology traiig to physicias who have completed their medical residecies. Afzal ur Rehma, MD, PhD, will serve as program director ad Keyoor Afzal Rehma, MD, PhD Patel, DO, will serve as associate program director. Begiig i July 2016, the program will accept oe fellow per year for the three-year course of study, so oce the program is i full swig, there will be three cardiology fellows available to treat patiets. Dr. Rehma says that havig the Fellowship Program Keyoor Patel, DO icreases the overall quality of care i the UHS system. First, we will be able recruit more highly skilled residets because of the program, says Dr. Rehma. Secod, the fellow will be a fully traied iterist who will be able to provide patiet care, as well as participate i a higher level of academic discussio o cases. Dr. Rehma otes that this is oe of the beefits for patiets i a teachig hospital. There are lots of people workig i a learig capacity, icludig doctors, urses, techologists ad utritioists. That meas patiets are the recipiets of a abudace of expertise ad a abudace of attetio. Traiig time lie I the Uited States, physicias follow established educatio ad cliical traiig stages. Pre-medical (udergraduate) Medical school Itership Residecy Licesure Fellowship Board certificatio Cotiuig medical educatio Back i actio Cardiac rehabilitatio is key to a full recovery For patiets recoverig from a cardiac evet or procedure, UHS offers a atioally certified cardiac rehabilitatio program that begis upo admissio to the hospital ad cotiues well after discharge. Patiets sped weeks participatig i a comprehesive, medically supervised program of exercise, health educatio ad emotioal support. Idividualized exercise prescriptios help patiets build stregth ad stamia, as well as reduce risk factors for heart disease. >> GET MOVING. UHS Cardiac Rehabilitatio is available at UHS Bighamto Geeral Hospital ad UHS Delaware Valley Hospital. Call (Bighamto) or (Walto) for more iformatio. 2 STAY HEALTHY

3 UHS HEART AND VASCULAR INSTITUTE Resources for the heart Ivestmet i techology Catheterizatio lab ad electrophysiology lab reovatios Reovatios to the electrophysiology lab ad oe of the cardiac catheterizatio labs at UHS Wilso Medical Ceter are uderway to improve patiet care. Arrhythmias or irregular heartbeats are tested, diagosed ad treated i the electrophysiology lab. The catheterizatio labs are used for a variety of diagostic ad itervetioal cardiology procedures to treat a wide rage of heart ad vascular coditios. Both rooms are beig made larger ad are beig outfitted with the latest techology available to improve patiet care. As we re doig ewer procedures, they ofte require more techology ad equipmet, so we are expadig the size of the lab to allow this to happe, says Dr. Hisham Kashou, a itervetioal cardiologist at UHS. More room will also icrease efficiecy ad be safer for patiets ad staff. New techology allows doctors to do the work they eed to do, to see structures withi the heart, with a lower radiatio dose to patiets. The upgrades required a sigificat ivestmet, but they are importat for patiet care ad are a part of our commitmet to cardiovascular care withi our commuity, says Kim Pilarchik, admiistrative director of the UHS Heart ad Vascular Istitute. As we re doig ewer procedures, they ofte require more techology ad equipmet, so we are expadig the size of the lab to allow this to happe. Hisham Kashou, MD The special guest speaker at our commuity s most recet Natioal Wear Red Day was Adrea Wittema, who had suffered a heart attack while still i her 40s. A wife, mother of two ad busy uiversity professioal, she had bee i very good health. Her blood pressure ad cholesterol were fie, ad she was t overweight, so a heart blockage was the last thig she expected could happe to her. But happe it did. While focusig o ruig errads ad pickig up my childre from camp oe day last August, I suddely felt ill, she said. Uusual pai had crept ito her chest ad jaw. At first she was tempted to just go home. But my guardia agel guided me to tur my car the other way ad go to UHS Wilso Medical Ceter. By the time I got ito the Emergecy Room, I had to be resuscitated. The cliical team told me that a piece of plaque had dislodged i a artery, causig a blood clot. If I had t sought immediate treatmet, I could have died. The team at UHS Wilso acted quickly, takig Ms. Wittema to the Cath Lab, where the clot was removed ad stets put i. Due to her decisio to seek prompt treatmet, ad to the collective expertise of the cliicias who cared for her, she has recovered well, with little or o damage to the heart muscle. Ms. Wittema credits the cardiac resources of UHS with savig her life. These resources are expasive, ad they are available to everyoe who lives i the Souther Tier. As the heart leader, UHS is committed to offerig the latest i cardiovascular care. Every year our program becomes more sophisticated, addig ew diagostic tools ad treatmet optios that ca add years ad quality to people s lives. Recet advaces i itervetioal cardiology ad cardiac surgery have icluded the use of drug-coated stets, implatable defibrillators ad specialized valve techiques, alog with improvemets i ultrasoud for a clearer picture of heart fuctio ad abormalities. Our work has received regioal ad atioal recogitio. But we re proud of aother area of our heart services as well. It comes uder the headig of awareess, educatio, prevetio ad early itervetio. We wat you, like Ms. Wittema, to have the edge whe dealig with ay heart issue. That s why we ecourage you to lear all you ca about heart health, read Stay Healthy Magazie, visit our website at uhs.et ad stop by the UHS Stay Healthy Ceter at the Oakdale Mall. By stayig i touch with all the iformatio available to you today regardig cardiovascular fitess, by adoptig a heart-healthy lifestyle ad by seekig treatmet right away if symptoms appear, you too will be guided i the right directio for a lifetime of welless. Matthew J. Salager, FACHE Presidet ad CEO of UHS

4 get healthy CARDIOMYOPATHY BREATHING >>MINIMALLY INVASIVE PROCEDURE RELIEVES CARDIOMYOPATHY SYMPTOMS easycecile Fik has had good health for most of her 72 years. But whe ormal daily chores i her South Plymouth household bega to leave her short of breath, she kew somethig was wrog. I would go outside to feed the rabbits ad chickes, ad just walkig ad liftig their water got to be too much, says Ms. Fik, a mother of six adult childre, who lives with her husbad, Keeth, ad a watchdog amed Rusty. Alog with a fast heart rate ad evidece of a leakig heart valve, her cardiologist foud sigs that she eeded further specialized care. Ms. Fik sought treatmet from the UHS Structural Heart ad Valve Ceter i Johso City, which offers expert diagosis ad treatmet of complex diseases ad deformities of the heart muscle ad valves. 4 STAY HEALTHY

5 UHS STRUCTURAL HEART AND VALVE CENTER We evaluate ad treat both cogeital ad acquired heart coditios with a team approach, says Alo Yarkoi, MD, FACC, fellowship-traied itervetioal cardiologist ad director of the UHS Structural Heart ad Valve Ceter. Our cliic is composed of highly-traied valve coordiators, urse practitioers, heart surgeos ad cardiologists, who thoroughly evaluate patiets ad guide them through treatmet optios, some of which are ot available elsewhere i the regio. SYMPTOM RELIEF Dr. Yarkoi diagosed Ms. Fik with hypertrophic cardiomyopathy, a disease that causes abormally thickeed heart muscle ad affects oe out of every 500 people. Some people ever show symptoms, while others experiece arrhythmias, shortess of breath, faitig ad (rarely) heart failure. Ope heart surgery is ecessary i some cases, but Ms. Fik was eligible for a miimally ivasive treatmet called alcohol septal ablatio, which uses a catheter to access the heart ad deliver a therapeutic solutio of alcohol to the problem area. This procedure targets the area of thickeed heart muscle, thiig it to allow more efficiet heart fuctio ad alleviate symptoms, says Dr. Yarkoi. I November 2015, Mrs. Fik was admitted to UHS Wilso Medical Ceter for the oe-hour procedure, which was performed uder light sedatio. She was observed for two days i the hospital ad set home with a sigle restrictio: ot to lift heavy objects for a week. She says the oly discomfort she experieced was from a temporary exteral pacemaker that she wore durig her hospital stay. I had o pai ad the staff ad doctors were great to me, Heart of it all she says. I started feelig better the first week, ad ow I ca go all day log. Aside from takig a blood pressure medicatio, life is ow back to ormal, she says. The shortess of breath is all goe. I m so glad I had it doe. REGIONAL HEART DESTINATION Sice opeig i July 2014, the UHS Structural Heart ad Valve Ceter has successfully expaded the umber of highly specialized, miimally ivasive treatmet optios it offers to patiets, icludig: Trascatheter Aortic Valve Replacemet (TAVR): TAVR addresses aortic steosis, a valve deformity that affects about 25 percet of people over the age of 65. It ca be a boo for patiets who caot udergo traditioal ope heart surgery due to age or illess, ad typically requires oly light sedatio ad a two-day hospital stay. Sice UHS first offered TAVR i December 2014, over 50 TAVR procedures have bee performed with extremely successful results. The ceter I would go outside to feed the rabbits ad chickes, ad just walkig ad liftig their water got to be too much. Cecile Fik Valve cliic coordiator guides patiets through complex care To ease the jourey from diagosis through recovery, patiets at the UHS Structural Heart ad Valve Ceter ad their families work closely with Valve Cliic Coordiator Kara Mucilli, RN, BSN, who helps coordiate idividualized care plas ad serves as a lik betwee patiets ad a collaborative team of physicia specialists, urses ad hospital staff. Ms. Mucilli, who joied the UHS Structural Heart ad Valve Ceter team i 2015, has 10 years of cliical experiece, icludig five years i ivasive cardiology at UHS. Evaluatig ad diagosig patiets with valvular heart disease is complex care that relies o close commuicatio, ad we emphasize a team eviromet to optimize the patiet ad family experiece, says UHS Structural Heart ad Valve Ceter Director Alo Yarkoi, MD, FACC. We are excited to be joied by a experieced urse who is dedicated to carig for ad chagig the lives of her patiets. follows protocols that reduce hospital stays, bed rest ad the potetial for complicatios, says Dr. Yarkoi, who is fellowship-traied i the procedure. We exceed the atioal average i all TAVR quality bechmarks. Trasapical TAVR: A ew TAVR optio has recetly bee added to make the procedure available to patiets who caot udergo the traditioal approach through a leg vei. The trasapical approach accesses the heart through a small icisio betwee the ribs. Atrial Septal Defect (ASD) Closure: This procedure ca offer a alterative to ope heart surgery for patiets with ASD, a opeig i the heart wall that allows blood to mix improperly betwee the two top heart chambers. The hole is closed with a small, umbrella-shaped device that is iserted through a catheter. The procedure typically requires oly light sedatio ad hospital observatio for 24 hours. Patiets ofte experiece immediate relief from shortess of breath, says Dr. Yarkoi. It ca also reduce the lifetime risk of stroke ad help prevet heart damage. Balloo Mitral Valvotomy: This valve repair procedure ca be a miimally ivasive alterative to valve replacemet surgery for patiets with mitral steosis, a arrowig of the mitral heart valve that ca cause fatigue ad shortess of breath. The valve is wideed usig a balloo iserted via a catheter ad the removed, alleviatig symptoms. SH Alcohol septal ablatio I this procedure, a few drops of a alcohol-based solutio are ijected ito a small brach of the mai artery supplyig the thickeed heart muscle. Illustratio courtesy of Staford Health Care. Hypertrophic cardiomyopathy affects 1 out of every 500 people. >> CUTTING EDGE. The first of its kid i the Souther Tier, the UHS Structural Heart ad Valve Ceter evaluates ad treats structural heart disease, which ecompasses a wide rage of coditios ivolvig the heart muscle, heart chambers ad, most commoly, the heart valves. To make a appoitmet, call

6 stay healthy HEART HEALTH PUMP it up >> KNOW THESE NUMBERS BY HEART Your heart, a robust yet small muscle roughly the size of a fist, pumps blood through the body, deliverig oxyge ad utriets ad carryig away waste. To accomplish this essetial task, the heart beats roughly 100,000 times per day, aroud 35 millio times per year, ad more tha 2.5 billio times durig a average lifetime. Here s aother umber worth kowig: Three as i there are three key areas where the right choices ca pump up your heart s health ad lower your risk for heart disease. The top risk factors you ca modify to sigificatly improve your heart s health ivolve weight, exercise ad tobacco. Whe I see patiets who are overweight, are sedetary ad/or who smoke, I tell them it s time to be proactive, stresses Keyoor Patel, DO, a medical cardiologist at UHS. Decreasig modifiable risk factors is worth the effort, reports the America Heart Associatio, sice a heart-healthy lifestyle ca prevet up to 80 percet of heart disease ad stroke. To begi takig proactive heart-healthy steps, cosider how close you come to hittig the followig umbers. If you re off the mark, talk to your doctor about takig actio. 6 STAY HEALTHY

7 PREVENTION 18.5 to 24.9is the ormal BMI for most adults. A BMI of 25 to 29.9 is cosidered overweight; a BMI of 30 or more is cosidered obese. Extra weight puts uhealthy stress o your heart. To determie if your weight is icreasig your risk for heart disease, measure your body mass idex (BMI), calculated with your weight ad height. To fid your BMI, talk to your doctor or visit cdc.gov ad search BMI calculator. Whe someoe s BMI is too high, I suggest droppig 1 or 2 pouds a moth so by the ed of the year they ve lost 12 to 24 pouds. Eve losig 3 to 5 percet of your body weight ca decrease heart disease risk, Dr. Patel advises. There is a caveat, Dr. Patel adds. A healthy weight, he says, is ot based solely o what the scale says. It eeds to reflect a healthy diet. Slashig calories without regard for proper utritio ca trigger other risk factors for heart disease, so i the ed you re ot doig all you ca to protect your heart s health. 0is the umber of cigarettes allowed daily. Chemicals i tobacco smoke damage blood cells ad vessels ad impair heart fuctio ad structure. All this damage icreases risk of atherosclerosis, a disease that results i a waxy substace, called plaque, that builds up i your arteries ad over time limits the flow of oxyge-rich blood through your body. The UHS Stay Healthy Ceter offers several opportuities to help you quit tobacco use ad stop smokig. For iformatio, call ,000steps a day is the recommeded daily step cout. The Surgeo Geeral recommeds 30 miutes of activity most days of the week. Cumulatively, a half hour of costat activity equals roughly 10,000 steps. Stayig active accomplishes two imperative goals. First, it burs calories to help lower your BMI. Secod, it icreases your heart s stregth, just as exercise stregthes ay muscle. Whe your heart is stroger, it ca pump more blood through the body with every beat ad work at maximum level with less strai. If 10,000 steps is too much for you, start with 1,000 steps ad gradually add steps util you hit 10,000, Dr. Patel recommeds. It s more of a goal. The poit is to stay active. If you go to the supermarket, park i the farthest spot. Take the stairs istead of the elevator if we re oly talkig about a couple of floors. A FEW MORE NUMBERS Eatig a balaced, utritious diet, gettig plety of exercise ad ot smokig ofte reduces or resolves additioal risk factors associated with heart disease. These factors ad their associated healthy umbers iclude: CHOLESTEROL: A total score of less tha 180 mg/ dl is cosidered optimal. BLOOD PRESSURE: Less tha 120/80 mmhg is the goal. FASTING GLUCOSE: Associated with diabetes, glucose should be less tha 100 mg/dl. Because heart health risk factors overlap, I do t recommed focusig o oe risk factor. What you wat is a 360-degree view of all your risk factors combied, emphasizes Afzal ur Rehma, MD, PhD, maagig director of the UHS Heart ad Vascular Istitute. So if your cholesterol levels are elevated, you re obese ad you live a sedetary lifestyle, you wat to begi with a healthy diet ad exercise before turig to medicatio that addresses oly cholesterol. The same is true for high blood pressure. O the other had, Dr. Rehma adds, if you have all modifiable risk factors for heart disease uder cotrol ad oe umber still is t where it should be, the it may be time to discuss medicatio. Lookig at cardiac disease risk factors as oe complete package also clearly poits out where ad how the patiet ca take charge of their ow health. Whe patiets realize that they have the power ad resposibility to reduce as may health risks as possible, the it is much easier to achieve success. It s the healthiest midset you ca have to protect your heart, Dr. Rehma says. SH UHS welcomes ew cardiologist UHS is pleased to aouce that Roma T. Pachulski, MD, FRCP(c), FACC, has joied the UHS Heart ad Vascular Istitute. Dr. Pachulski is board certified i cardiovascular disease, cliical cardiac electrophysiology ad iteral medicie. After earig his medical degree from the Uiversity of Ottawa i 1983 ad the completig his fellowship i cardiology at the Uiversity of Ottawa Heart Istitute, Dr. Pachulski wet o to become a recogized cardiac specialist ad educator of other physicias. I additio to his cliical ad classroom cotributios, Dr. Pachulski has also authored four medical books ad is frequetly ivited to guest-lecture at medical cofereces. Dr. Pachulski comes to UHS from South Texas Heartbeat, where he was recogized for performig may leadig-edge cardiac procedures, such as ablatio for treatmet of cardiac arrhythmias ad automatic implatable cardioverter defibrillator (ICD) implatatio. Coditios he treats iclude agia ad acute coroary sydrome ad aortic aeurysm. To make a appoitmet with Dr. Pachulski or ay of the other cardiologists at the UHS Heart ad Vascular Istitute, call >> STRESSED OUT? Chroic stress ca icrease the risk for heart disease. Fid out why ad what you ca do about it at UHS Stay Healthy Magazie olie at uhsstayhealthymag.com.

8 aroud the system HEART ATTACK TIME is tight >>LEARN HEART ATTACK SYMPTOMS AND GET HELP FAST I blockage i the heart, where it iflates a tiy balloo to reope the blocked vessel. The widow for this lifesavig treatmet is kow as door-to-balloo time, or D2BT. Natioally, the goal for hospitals has bee 90 miutes, but UHS Wilso has beat that time, with a media D2BT of 65 miutes i This critical time reductio has bee accomplished by streamliig key stages i the process. First, patiets ca be evaluated i the ambulace by emergecy persoel. UHS Wilso Medical Ceter parters with ambulace agecies equipped with DOOR TO BALLOON TIME (D2BT) the LifeNet Health system, a high-tech data exchage UHS program that lets life 65 MINUTES support providers respod NATIONAL to a 911 call, assess the 90 MINUTES patiet s heart with a 12-lead electrocardiogram (EKG) ad trasmit EKG results to the Wilso ED. The ED team reviews the data while the patiet is e route to the hospital ad if ecessary, cotacts the cardiologist ad his team, ad prepares the cardiac catheterizatio lab. With this system, a patiet arrives i the ED with the team already up to speed, the cath lab ope ad the cardiologist ready. recet years, hospitals across the coutry have adopted practices for treatig heart attack victims that focus o the time it takes for the patiet to get the most effective treatmet. I cases of ST-elevated myocardial ifarctio (STEMI), the goal is to get the patiet from the emergecy departmet (ED) ito the catheterizatio lab as quickly as possible. There, a slim catheter ca be itroduced ito the groi or arm ad guided to the Eve patiets i rural areas ca take advatage of this quick-respose system. Patiets who arrive at the ED at UHS Delaware Valley Hospital or UHS Cheago Memorial Hospital ad are diagosed with STEMI ca be treated with clotbustig drugs ad swiftly trasported to UHS Wilso via ambulace or helicopter if doctors determie catheterizatio is ecessary. This process caot begi, however, util the perso havig the heart attack (or a compaio) calls 911. The worst heart attacks we get are with people who fail to recogize the symptoms, says Paul Traverse, MD, a itervetioal cardiologist at UHS Wilso. You eed to call 911, says Dr. Traverse. Do t take matters ito your ow hads or worry about botherig emergecy services. The worst outcomes come from failure to recogize symptoms or delayig trasport to a emergecy room. SH Recogizig symptoms Lear all the warig sigs for heart attack, begiig with the fact that classic chest pai is ot always preset, ad ayoe both me ad wome may suffer atypical symptoms. Therefore, if you suffer oe or more of the followig symptoms, eve if you re ot sure it s a heart attack, call 911 withi five miutes of whe symptoms begi. chest pai, pressure or discomfort that may remai steady or come ad go discomfort i the upper body, which may iclude pai i oe or both arms, shoulders, eck, back or jaw shortess of breath dizziess or lightheadedess fatigue or weakess excessive cold sweats uexplaied ausea ad vomitig pai i upper abdome idigestio UHS STAY HEALTHY