HEART NEWS

prostate cancer, but the risk does increase with age. “In general, as we get older, our risk increases. So every decade of life it increases more and more,” he says. “Once we get into our 60s and 70s, that’s when we see more people presenting for treatment of prostate cancer.” There are not really any physical signs or symptoms of prostate cancer that men should watch out for, either. The best way to catch prostate cancer early is with a PSA (prostatespecific antigen) blood test performed annually. It is recommended that men get a prostate exam every year from the age of 50 up to 70. This age bracket is suggested because the prevalence of prostate cancer in men younger than 50 is quite low, and the disease tends to have a very slow progression, so beyond the age of 70 it is unlikely to have a serious impact on lifespan or quality of life. Some men do have trouble urinating due to an enlarged prostate, but this does not necessarily indicate that cancer is the cause. In these cases, it is up to the individual to follow up with a urologist for an examination to rule out the possibility of prostate cancer and receive appropriate treatment. If a PSA blood test shows that there is a possibility of cancer being present, a biopsy is performed to confirm whether or not this is the case. Sometimes, there is cause to avoid doing a biopsy, in which case an MRI or a more sophisticated form of PSA test may be administered. Ultimately though, a biopsy is the only way to definitively determine whether a patient has prostate cancer. Once a patient has been diagnosed with prostate cancer, the first primary treatment is to simply keep a close eye on the results of subsequent exams. If there are no major changes detected, then it is unlikely the patient will need further treatment. This is sufficient for well over half of those diagnosed with prostate cancer. For the minority who do need additional therapy, radiation or surgery is generally prescribed. “The prevalence of prostate cancer is very high,” says Essig. “There are many, many men who are walking around now who have a small area of prostate cancer in their bodies, and that will be there for 10, 20, 30 years, and they’ll never even know it. It just happens to be there and it doesn’t pose a threat to their lives. Prostate cancer is not synonymous with a death sentence or disability in the majority of people who have it. It is a very common thing to have prostate cancer – it is a less common thing to have it affect your life.”

HN

Understanding Valvular Heart Disease

The heart has four valves that keep blood flowing in the correct direction. These valves are the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, the valves do not open or close properly. If a valve doesn’t fully open or close, blood flow is reduced or blocked. If a valve does not close well and blood can flow in both directions, it is called regurgitation and may also need treatment.

Aortic Stenosis: The aortic valve is the valve between the left ventricle and the aorta. The heart pumps blood into the body through this valve. When this valve becomes narrowed (stenosis) and flow is restricted, pressure builds up in the left ventricle and left atrium. With time, this will get worse. With medications, symptoms can be controlled, but ultimately this valve will need to be replaced.

Historically, rheumatic fever was the most common cause of aortic valve stenosis. However, with antibiotics, rheumatic fever has become very rare. These days, some people have aortic stenosis because congenitally the valve is malformed with only two leaflets (bicuspid) instead of the normal three. With time this valve gets stenotic. However, the most common reason now is age-related. With age, calcium and scarring damage the valve and narrow it. About 20% of older Americans develop aortic stenosis. Symptoms don’t develop until the patient is 70-80 years old, and often patients can be asymptomatic for awhile. As the aortic valve opening is narrowed, the heart has to work harder to pump enough blood into the aorta and the body. The extra work of the heart can cause the left ventricle to thicken and enlarge. Eventually the strain can cause a weakened heart muscle and can ultimately lead to heart failure and other serious problems.

Most often, patients may have a heart murmur that is heard by their doctor. An echocardiogram may determine if, indeed, the aortic valve is thickened and narrowed. The valve narrowing may be classified as mild, moderate or severe. If severe, a determination will have to be made if it is symptomatic. Sometimes patients may not be symptomatic but, since they are not active, may be masking their symptoms. In these patients, it may be necessary to unmask any symptoms by stress testing. Untreated or undiagnosed, the heart KOLLAGUNTA SEKHAR, M.D. function may also start KSC CARDIOLOGY to decline.

Symptoms are chest pain, shortness of breath or passing out. Once symptomatic, it is critical that surgery be planned as quickly as possible. The risk of dying once symptomatic goes up. Surgical aortic valve replacement (SAVR) has been the standard for a long time. The valve can be replaced with a mechanical valve or with a biological (made of tissue) valve. The former lasts longer but requires lifelong anticoagulation, with Coumadin.

Since a lot of patients with aortic stenosis now are older and more frail with other conditions, open surgery has been risky. Many patients have bad lung disease, cancer and/or poor exercise capacity. Most of these patients would not have been candidates for surgery. Now we have technology that permits this valve to be replaced percutaneously, like a stent. The TAVR approach (Transcatheter Aortic Valve Replacement) delivers a fully collapsible replacement valve to the valve site through a catheter. The new valve is placed inside the diseased one. Originally, it was done only in patients at high risk. Now it is approved for severe stenosis in patients with moderate and even low risk.

Since this is a catheter-based technique, it is done by a combination of interventional cardiologists and cardiac surgeons. Usually, in most hospitals, the case is discussed by a team of interventional cardiologists, surgeons, and other cardiologists detailing risk and why the patient is too high a risk for open surgery. A CT scan is done to assess vascular anatomy and the size of the valve to be placed. A heart catheterization is also done to assess any blockages present, too. Since this is done like a complex stent procedure, the patient usually can go home in 24-48 hrs.

So in summary, patients with high or prohibitive risk for surgery can be looked at for possible TAVR. In patients who are not high risk, if younger than 65 years, surgical replacement would be recommended. If over 65, a decision can be made based on risk factors.

This column is sponsored by KSC Cardiology, and the opinions expressed herein may not reflect those of CFHN or of its advertisers. BIO: Dr. Kollagunta Chandrasekhar, better known as Dr. Sekhar (pronounced Shaker) has been practicing cardiology in Winter Haven for 25 years. Dr. Sekhar is the Chief of Staff at Bay Care Winter Haven Hospital as well as the Director of the Heart Function Clinic and the Cardiac Rehabilitation program at Bay Care Winter Haven Hospital and the Chairman of Cardiology at Advent Hospital in Lake Wales. He is a member of the Heart Failure Society of America, the American Heart Association, the American College of Physicians, and the American Society of Nuclear Cardiology. To schedule an appointment, please call (863) 508-1101.

TIP-TOP SHAPE AT ANY AGE

DR. CARRIE GODDIN

Proper Focus and Mindset Can Help Men Stay Fit and Healthy Over the Decades

by PAUL CATALA

For the average man, the body is in its best physical shape in the early to mid-20s. But time can take a toll by age 30, when muscle strength starts to decrease by as much as 3 percent to 8 percent every 10 years. By age 40, reaction time starts to slow. At age 50, bones become brittle. The good news is that proper focus and mindset can help men of any age maintain and even further develop a stronger body and mind. That’s the consensus of three staff members at Winter Haven’s Bond Clinic we spoke with for this special edition on men’s health Dr. Carrie Goddin, Bond Clinic’s director of physical therapy and rehabilitation department, says one of the most important aspects of physical health as men age is maintaining flexibility. Flexibility begins to decrease in men after age 40, so she says developing proper warmup and stretching techniques early and maintaining those are key ways to keep up regular fitness routines. “When you’re a young athlete, everyone tells you to stretch and you say ‘okay,’ and you do it for about 30 seconds and that’s it. But as you get older that gets much more important,” says Goddin, who has a doctorate degree in physical therapy from the University of Central Florida. “You need to ease into things and include good posture and core stability so you don’t overextend and injure yourself.” Nicholas Olgee, a certified athletic trainer at Bond Clinic and trainer for the Florida Tropics professional soccer team, explains that as men age, they lose 1.5 percent of maximum physicality per year by age 35. He says a man should be able to maintain and counterbalance all aspects of physical training and exercise and not “overdevelop” one area. “Ideally, you can listen to your body,” Olgee says. “You can’t expect increases forever and ever, but you should be able to maintain posture reinforced movements. Things get harder to do, and you want to make things easier on yourself.” As for flexibility, they reiterate that flexibility helps prevent everyday injuries. According to Texas Health Resources, one of the largest nonprofit health systems in the United States, flexibility helps men avoid muscle and disk strains from turning over or getting out of bed; shoulder strains from lifting; backaches from going from seated