Franciscan Heart Center's 2014 Heart Health! booklet

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heart Franciscan Heart Center

FRANCISCAN HEALTH SYSTEM • THE SOUTH SOUND’S LEADER IN HEART CARE

How heart-friendly is your kitchen?

Doctors’ advice to use today

RECIPES & TIPS

Heart-Healthy FOR THE Living WHOLE FAMILY! Local classes

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Franciscan Heart Center.

DR. FEGLEY

TAKE THIS RELATIONSHIP TO HEART.

“I want my patients to be engaged in their health, to ask questions.

We’re in this relationship together!”

When it comes to heart health, be sure to maximize your relationship with your primary care provider.

Your regular doctor is there to help you prevent and manage chronic conditions, and detect health problems early for the best possible outcome. And when needed, Franciscan Heart Center is everywhere you find Franciscan.

It begins with our caring family doctors attentive to your heart health. It includes our community educators to help you live your best life, whether you want to eat better or quit smoking. And all are backed by our exceptional cardiologists, heart and vascular surgeons, and other dedicated specialists conveniently located throughout Puget Sound. Your Franciscan team is focused on just one goal: getting you back to the life you love.

Janis Fegley, DO, division chief of primary care

No doctor? Let us help you find the primary care provider right for you. Call 1 (888) 825-3227 or visit www.FranciscanDoctors.org today.

‘Mom’ to six-year-old Andrea, Tina has an adorable reason to live heart-healthy!

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ter.

WE’RE WITH YOU EVERY STEP OF THE WAY. Tina knew she had a family history of heart disease. Her dad died of a heart attack in his early 60s; her brother had a six-way bypass at 52.

While gardening one day, Tina told her husband she needed more exercise.

“I usually don’t get breathless just turning over a few shovels of dirt,” she said. “And I was getting really tired at work.” Tina went walking the next day – and felt a slight squeezing in her chest. She called her doctor’s office.

“Tina came to me with vague complaints, which led me to think it was cardiac,” said Janis Fegley, DO, Tina’s primary care physician. “I performed an EKG and referred her to cardiology immediately.” That was Monday.

Tina saw the cardiologist Tuesday and had cardiac catheterization Wednesday – for a 90-percent blockage requiring two stents.

Today, Tina follows her medication regimen faithfully, avoids red meat, eats more fruits and vegetables and exercises more. “You hear about the importance of a heart-healthy lifestyle,” Tina said, “but it doesn’t hit home until it hits you. Life is precious.

Don’t wait — start now!”

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Heart Attack DR. WUTHRICH

HOW WILL YOU KNOW? We’ve all seen one on TV. The actor staggers, clutches his chest, and drops to the ground. In reality, a heart attack may look very different, especially in women.

Classic symptoms • Pressure or squeezing in the chest

“Women are more likely to have vague symptoms and not seek help right away. It’s critical they do: Women under the age of 50 are about twice as likely to die from a heart attack as men in the same age group.”

• Chest pain (from dull to sharp, stabbing)

• Weakness or radiating pain down the left arm

Other symptoms (seen especially in women) • Fatigue • Nausea, even vomiting • Cold, clammy skin • Shortness of breath • Dizziness

• Pain in the neck, jaw or shoulder blade • Indigestion or ‘full’ feeling • Ominous feeling that something is very wrong

Every second counts. Even if you are not sure it’s a heart attack, call 9-1-1 now!

Daniel Wuthrich, MD, cardiologist

FRANCISCAN + AHA|ASA + YOU Partnering to help you in the fight against heart attack, stroke and vascular disease.

Watch for events in your community or visit www.FHShealth.org/heart to find a Franciscan heart health talk or event near you.

Franciscan Health System is a proud sponsor of

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About Arteries PROBLEMS AREN’T ONLY FOUND IN THE HEART.

DR. DORZI

The role of arteries is to carry oxygen-rich blood from the heart to the body’s tissues. Several conditions interrupt this flow and can put you at higher risk for heart attack and stroke. Should you have a problem, your doctor may refer you to a vascular specialist for evaluation.

Peripheral artery disease (PAD) Blockages from fatty buildup can occur in any artery, including the legs. Make an appointment to see your provider if you experience any of the following symptoms: • Pain or tingling in your legs when you walk, that goes away when you stop • Painful cramping, numbness or tingling in your legs, feet or buttocks • Poor wound healing • Legs and feet turning bluish color Aneurysm An aneurysm is a weak area in an artery. It may begin as plaque and inflammation that cause the area to bulge like a balloon. A common site of an aneurysm is the aorta, the largest artery in the body that runs from your heart through your abdomen. This is called an abdominal aortic aneurysm (AAA). AAA is a silent threat generally found only through imaging. Be sure to have a yearly physical with your physician.

DID YOU KNOW? Medicare covers a one-time abdominal aortic aneurysm (AAA) screening ultrasound if you get an at-risk referral as a result of your “Welcome to Medicare” physical exam. Ask your provider about AAA screening at Franciscan.

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“Aggressive lifestyle changes and medications are first-line treatments for PAD. We can treat AAA and severe cases of PAD with new, minimally invasive surgical options such as stents.”

Omar Dorzi, MD, vascular surgeon

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Arrhythmias DR. GUPTAN

“We have many effective options for safely and effectively restoring and regulating heart rhythm.

However, certain arrhythmias can cause sudden cardiac arrest or other serious problems. If you have symptoms, see your health care provider.”

WHY HEARTS SKIP, STUTTER AND FLUTTER Does your heart occasionally race, flutter or even skip a beat? It’s generally normal, and more common as people age. However, if your heart races furiously, or if you feel faint, dizzy or short of breath, you should see your doctor right away. The heart has an intricate electrical system. If something goes wrong with the electrical pathways, it can create a rhythm disturbance, or arrhythmia. Treatment depends on the type and severity. Help may range from lifestyle changes and medication to surgery that can ‘burn away’ abnormal electrical pathways. Implantable devices, such as a pacemaker or defibrillator, can also be used to help hearts maintain a steady beat.

Amrit Guptan MD, FACC, cardiologist and electrophysiologist

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Risk Factors for Cardiovascular diseases:

EASY CHANGE

3 Risk factors you cannot control:

• Age (men over 45; women over 55)

• Gender (more men have heart attacks earlier in life, but heart disease will kill more women)

• Family history

Here you’ll find small changes that make a difference

9 Ways to reduce your risk:

• Quit smoking

• Exercise 30-60 minutes daily or walk 10,000 steps

• Drink less alcohol, 2 drinks or less a day for men and 1 drink or less a day for women

• Limit stress

• Eat a balanced, Mediterranean-inspired diet

• Maintain a healthy weight

• Plan meals to cook at home

• Schedule regular check-ups

• Sleep at least 7 hours a night

© 2014, wellfedheart.com

You can cut your risk of heart attack and stroke up to 50% by adopting healthy lifestyle choices.

De-Stress Yourself: Chronic stress is more damaging than you think. It increases cortisol, a hormone that has a direct impact on our blood vessels, blood sugars and hormonal balance. This can lead to inflammation and increased risk for cardiovascular diseases.

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Know Your Controllable Symptoms Do any of these apply to you?

Fa

Waist Circumference Triglycerides

HDL

3 or more of these symptoms chronic diseases such Stroke A stroke occurs when a blood vessel in the brain becomes blocked, interrupting blood flow to the brain.

Signs include: trouble speaking, confusion, numbness and severe headache.

Type II Diabetes

Vascular Disease

Co Di

People with diabetes have a three times higher risk of developing cardiovascular disease. The same good habits that prevent heart disease can also prevent diabetes.

Clogging and hardening of the arteries occurs when blood vessels become damaged from chronic high blood pressure, cholesterol or fatty buildup and inflammation. Restricted blood flow can cause tissue damage, stroke or death.

One dise and Sym lifeas h hea No. for

Source: National Cholesterol Education Program 6

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mptoms

DL

EASY CHANGE

Fasting Blood Sugar Blood Pressure

Choose one symptom to improve Turn the page to see where you stand

mptoms can lead to ses such as:

dening curs ls from d erol nd tricted use roke

Coronary Heart Disease One of many cardiovascular diseases of the heart and blood vessel system.

Symptoms can be life-threatening such as heart-attack or heart-failure. It is the No. 1 cause of death for Americans.

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Vital Statistics EASY CHANGE

What’s your number?

Healthy

At Risk

High

TOTAL CHOLESTEROL (TC)

Less than 200

201-239

240 and

LDL (Lousy) Cholesterol

Less than 100

101-159

160 and

Women

60 or higher

51-59

50 or

Men

60 or higher

41-59

40 or

HDL (Healthy) Cholesterol

New guidelines for reducing the risk of heart disease can be confusing.

Ask your doctor how they apply to you.

TC:HDL RATIO

Less than 5:1

TRIGLYCERIDES

Less than 150

151-199

200 and

FASTING BLOOD SUGAR

Less than 100

101-125

126 and

CRP (measures inflammation)

Less than 1.0

1.0-2.9

3.0 or h

Systolic

Less than 120

121-139

140 or h

Diastolic

Less than 80

81-89

90 or h

BLOOD PRESSURE

WAIST CIRCUMFERENCE Women

Less than 35”

35” or g

Men

Less than 40”

40” or g

WAIST:HIP RATIO* Women

Less than 0.8

0.81-0.84

0.85 or g

Men

Less than 0.9

0.91-0.99

1.0 or g

19-24

25-29

30 or h

BODY MASS INDEX (BMI)

Waist:Hip Ratio Calculation Waist number Hip number

= Ratio

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Risk

High Risk

-239

240 and above

-159

160 and above

-59

50 or less

-59

40 or less

-199

200 and above

-125

126 and above

-2.9

3.0 or higher

-139

140 or higher

-89

90 or higher

Date

Your Numbers

Date

Your Numbers

35” or greater 40” or greater

-0.84

0.85 or greater

-0.99

1.0 or greater

-29

30 or higher

*The INTERHEART Study, sponsored by the World Health Organization, was conducted in 52 countries with almost 30,000 participants, with and without heart disease. Each person’s BMI and waist-to-hip ratio (WHR) measurements were taken, and weighted for 9 other risk factors including diabetes, smoking, activity, diet and hypertension (high blood pressure). The results? The WHR is a better predictor of heart disease than the BMI.

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Heart-Healthy Plate Make It Mediterranean No matter what your food culture, live longer and reduce your risk of chronic disease by adapting these principles of the Mediterranean diet: • Eat more fruits, veggies, beans,

nuts, seeds and grains • Use olive oil, nuts and avocados

as your main fat sources • Eat small servings

of non-or low-fat cheese and yogurt • Eat two to three servings of

baked or broiled fish weekly • Limit lean red meat

to once or twice a month

1/2 Fruits 1/2 Fruits and & Nonstarchy NonstarchyVegetables Vegetables

1/4 W Starc

• Apples • Cucumber • Artichokes • Dark Leafy

• Asparagus Greens (Spinach, • Avocado Collards, Mustard, • Berries Arugula, Kale, • Broccoli Swiss Chard) • Brussels • Eggplant Sprouts • Green Beans • Cabbage • Melon • Carrots • Mushrooms • Cauliflower • Onions • Citrus Fruits • Pears (Oranges, • Stone Fruits Grapefruit, (Peaches, Lemons, Nectarines, Tangerines) Plums, Apricots, Dates, Cherries) • Tomatoes • Zucchini

• Bar Bulg • Bro • Drie • Wh • Swe • Pot • Win

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1/4 L

• Low • Bea • Lea (suc Chu • Chi • Tofu • Egg • Nut • Fish

pinach, Mustard, ale, rd)

ns

EASY CHANGE Need help with serving sizes?

1/4 Whole Grains or or 1/4 Whole Grains Starchy Vegetables Starchy Vegetables • Barley (hulled is best), Bulgur, Buckwheat, Millet, Farro • Brown or Wild Rice, Quinoa and Oats • Dried Beans, Peas and Lentils • Whole-Wheat Pasta • Sweet Corn • Potatoes (Sweet or White) • Winter Squash

s

s

, icots, erries)

Use the plate model in addition to a food scale and these visual cues for a single serving of:

Lean protein

Cheese or nuts

1/4 1/4Lean LeanProtein Protein • Low-fat Milk, Yogurt and Cheese • Beans, Peas and Lentils • Lean cuts of Beef and Pork (such as Sirloin,Tenderloin, Chuck Shoulder Roast, Round tip) • Chicken and Turkey • Tofu, Tempeh • Eggs • Nuts • Fish

Pasta, rice, beans

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Sugar, Salt, Fat and Fiber What you need to know SUGAR

SALT/SODIUM

FAT

Guidelines

Guidelines

Guid

• Refined sugar promotes • Aim for less than 2300 mg daily (about 1 tsp) inflammation in the body and contributes to empty calories • African-Americans, adults 50+ • Sugar can raise your triglycerides and all people with hypertension or • 4 grams = 1 teaspoon sugar diabetes benefit from diets • Daily Added Sugar Guide with less than 1500 mg daily Women - up to 6 tsp (24 grams) • Eating foods high in potassium, Men - up to 9 tsp (36 grams) magnesium and calcium helps Children - up to 3 tsp (12 grams) reduce blood pressure

Tips • Look for sugar under other names: sucrose, corn syrup, fructose, cane juice or syrup, maple syrup, honey or blackstrap molasses • Minimize sugar substitutes like aspartame, xylitol, mannitol, sorbitol, stevia • Take advantage of fruits’ natural sweetness and have them for dessert, a snack or to sweeten up just about anything!

Tips

Tips • Highly processed and prepared foods can contribute 75% or more to sodium intake • Foods highest in potassium: sweet potatoes, squash, coconut water, avocado, spinach, swiss chard, beans and legumes • Foods highest in magnesium: leafy greens, sesame and pumpkin seeds, beans, legumes and whole grains

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• Increa polyun at roo • Reduc those • Avoid listed "hydro • Focus reduc heart some

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• Add o sardin to ma marin • Use a or ma • Broil, of fryin • Cook and c • Nu o

aily

+ sion or

m, ps

ed

onut

mes :

FAT Guidelines • Increase intake of mono- and polyunsaturated fats, those liquid at room temperature • Reduce intake of saturated fats, those solid at room temperature • Avoid foods containing trans fats, listed in the ingredients under "hydrogenated" • Focus on omega-3’s, known to reduce inflammation and prevent heart disease, stroke and some cancers Tips • Add omega-3’s: salmon, herring or sardines. Use flax and walnut oils to make your own dressings and marinades • Use an avocado in place of butter or mayonnaise • Broil, bake and roast instead of frying • Cook primarily with olive oil and canola oil • Nuts are a good source of healthy fats

FIBER Guidelines • Fiber is found mostly in plant foods.

Although it is indigestible, our bodies use fiber to aid in the digestion process • Fiber keeps us full longer, stabilizes blood sugar and reduces cholesterol • Aim for 21-38 grams of total fiber per day • Increase fiber slowly, it may take time for your body to adjust Tips • Add beans, legumes and whole grains to soups, sauces and other dishes • Choose breads, cereals and crackers that say “100% whole grain” • At breakfast, add ground flax, oat bran or wheat germ to your yogurt, hot cereal or smoothie • To help lower cholesterol, consume foods high in soluble fiber such as citrus fruits, oats, brussels sprouts, pears and mushrooms

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Understanding Labels How to Read a Food Label Ignore nutrition claims on the front of the package; the truth is on the Nutrition Facts label. Use this guide to make informed choices.

Is this serving size reasonable?

If you know you’re going to consume twice as much, multiply the numbers by 2 Limit these nutrients Aim for at least 3-5 grams of fiber per serving Most adults need between 1,500 and 2,000 calories per day.

Adjust your numbers as needed.

Nutrition Facts Serving Size: 1 cup (226 g) Serving Per Container: 1 Amount Per Serving

Calories 170

Caleries from Fat 27 % Daily Value*

Total Fat 3g Saturated Fat 1.5g Trans Fat 0g Polyunsaturated Fats 1g Monounsaturated Fats 0.5g Cholesterol 5 mg Sodium 80 mg Total Carbohydrate 25g Dietary Fiber 0g Sugars 18g Protein 10 mg

6% 8% 0%

1% 3% 8% 0%

Vitamin A 15% • Vitamin D3 20% Calcium 20% • Iron 10% *Percent daily are based on a 2,000-calerie diet. Your daily values may be higher or lower depending on your calorie needs:

Calories: Total Fat Less than Sat Fat Less than Cholesterol Less than Sodium Less than Potassium Total Carbohydrate Dietary Fiber

2,000 65g 20g 300mg 2,400mg 3,500mg 300g 25g

Calories per gram: Fat 9 • Carbohydrate 4

•

2,500 80g 25g 300mg 2,400mg 3,500mg 375g 30g

Protein 4

Other Ingredients: Cultured Pasteurized Grade A Milk. Sugar,Peaches, Modified Corn Starch, Kosher Gelatin, Natural and Artificial Flavor, Aspartame, Potassium Sorbate Added to maintain Freshness, Acesulfame Potassium, Citric Acid, Vitamin A Acetate, Vitamin D3

The 5/20 Rule 5% or less is low and 20% or more is high

Watch out for added sugars highlighted below Get enough of these nutrients

Ingredients are listed in descending order by weight

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Food Terms

EASY CHANGE

• Highly processed: A food that is far from it’s original form like refined grains. Also, look for added chemically-derived ingredients.

• Empty calories: Calories in our foods that deliver little or no nutritional value such as sugar, alcohol and highly refined or processed foods.

• Nutrient dense: A food that provides a large amount of nutrients for its calories.

Eat more foods that don’t have food labels, such as fresh fruits and vegetables.

Five Golden Rules of Food • Build from breakfast.

Research shows those who start their day with breakfast weigh less and maintain stable blood sugars.

• Eat the rainbow. Think color when preparing meals & snacks.

The more colorful, the better!

• Get hooked on fish.

Meatless Monday, Tuna Tuesday and Salmon Sunday. You get the idea: less meat and more fish with heart-protecting omega-3’s.

• Make grains whole. Three daily servings of whole or minimally processed grains, such as oats, quinoa and bulgur, will reduce your risk of cardiovascular disease, diabetes and obesity.

• Learn to love legumes. Beans, lentils, peas, soybeans, and nuts are all great choices - high in fiber, protein, iron and other minerals.

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How Heart-Friendly Is Your Kitchen?

PHASE IN PHASE OUT 1. Homemade dressings, marinades and sauces

1. Store-bought dressings, marinades and sauces

2. Plain, low-fat yogurt.

Add real fruit and/or honey

2. Fruit-flavored or “fruit-on-bottom� yogurts

3. Whole grains: barley, quinoa, oats, whole-wheat pasta, bulgur and 100% whole grain bread and crackers

3. Refined grains: couscous, pasta, white or flavored rice and enriched bread or crackers

4. Low-fat milk, unsweetened iced tea, coffee, flat or sparkling water

4. Sugary drinks: flavored waters, sweetened teas and juices

5. Legumes: black, white, navy, kidney, garbanzo beans, lentils, peas and edamame

5. Canned baked beans, chilis and soups

6. Fresh or frozen veggies; steamed, sauteed or roasted

6. Mashed potatoes and veggies with added cream and butter

7. Plant-based fats: avocados, nuts and nut-butters and plant-oils (olive, flax, walnut)

7. Margarine, butter, mayonnaise, lard, animal fats

8. Canned fish: herring, tuna, salmon, sardines

8. Preserved meats

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?

Budget Shopping = Better Eating

EASY CHANGE

•

•

•

•

•

•

•

Take a list.

Purchase frozen fruits and vegetables in the off-season. Purchase locally grown produce in-season, when they’re less expensive.

Buy in bulk. Nuts, grains, dried fruit and whole-wheat pastas.

Menu planning saves time and money. Work leftovers (in the fridge or freezer) into your menus.

Store brands are often cheaper than using coupons. Coupons may save money, but they often are for highly processed foods. Check labels!

Stock up on canned goods when often-used items are on sale.

Get your omega-3’s economically from canned salmon, sardines and herring.

For snacks on-the-go, packing your own saves money.

Savvy grocery shoppers save money by always going with a list (and never shopping hungry).

Commit to adding two heart friendly foods to your next grocery list and check labels when in doubt.

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Physical Activity EASY CHANGE

Sitting: The New Smoking

Think beyond exercise for your health.

Focus on minimizing time spent sitting and maximizing frequent bouts of standing or walking.

We all know it’s important to exercise 30-60 minutes per day. Research reveals that it’s just as important to also reduce sitting time. The more interruptions you can make in your prolonged sitting, the better.

How much do you sit?

Add up the hours, you may be surprised!

Work

Hours

B

Commute

S

Socializing

L

TV

S

Computer

D

Entertainment

D

Waiting (ie: bus stops, airports, waiting rooms)

T

Total

Ideas for Movement

• Stand during meetings or phone calls

• Get up during commercials on TV

• Stand while folding laundry, riding on the bus or train

• Rethink your office; are there any high countertops you could work at on your computer?

• Set timers on your phone or send email reminders to get up and move Moving adds up!

Your body burns 3x as much energy walking or doing light activities than it does at rest.

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Food & Activity Log

EASY CHANGE

Tracking our daily food intake and activities makes us accountable for the choices we make, setting us up for greater success.

Keep a journal for three days, recording all your activity and food intake.

From there, you can see where your need to improve.

There are a lot of online food and exercise tracking programs, as well as apps. If you like pencil and paper, here’s what to include:

Breakfast Snack 1 Breakfast Lunch Snack 1 Snack 2 Lunch Dinner Snack 2 Drinks/Fluids Dinner Total Drinks/Fluids

What I Ate

How Much

What I Ate

How Much

Total Depending on your goals, you can also track servings of fruits and vegetables, fish, whole grains and lean proteins.

Pay attention to foods that contribute to excess sodium, sugar and fat.

Activity

Duration

Activity

Duration

Including goals in your food and activity log will result in more favorable outcomes.

Here are a few examples of goals to set: Goal 1: Cook dinner at home

Pack lunches at night Goal 2: Drink more fluids Goal 3: Set alarm to get up from

computer every 30 minutes

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Meal Planning EASY CHANGE

Start saving time and money

Cook Once, Eat Twice

Here’s a common complaint: “Eating healthy at home takes too much time.”

By doubling or tripling favorite recipes, you’ll have leftovers in the fridge or freezer to save time on busy nights.

Our answer: In just 15-20 minutes of planning, you’ll be organized for the coming week’s meals and snacks. Note how you can count on leftovers to create tomorrow night’s meal in many of our recipes. You can also use cook-ahead options such as slow-cookers and doubling recipes.

Meal Planning Tips: • Incorporate 2-3 new recipes each week, mixing our recipes with yours. Plan to use what’s already in your freezer and pantry, too.

• Make tonight’s dinner tomorrow’s lunch.

There’s a space for lunch (M-F) as a reminder to pack leftovers for lunch the next day or for a fast dinner.

• After planning for 3-4 weeks,

all you’ll have to do is rotate your

menu plans on a seasonal basis.

For more heart-healthy recipe

ideas, go to wellfedheart.com.

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Sample Meal Planner

”

e ote ht’s ead

ck

s,

basis. cipe om.

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Walk Away Slow-Cook Chicken Serves 4 plus leftovers

Cook Once, Eat Twice Save leftover chicken and broth for soup

1 whole chicken, 4-5 pounds 1 large onion 3 Tbsp combined of your favorite dried herbs/spices

1. Rinse and dry chicken.

2. Roughly chop onion and place in bottom of slow-cooker.

3. Combine herbs and spices in a small bowl and gently

rub on chicken.

4. Place chicken in slow-cooker on top of onions.

Set on low for 3-8 hours depending on your appliance.

5. Before serving, drain the broth and save for the

Barley Chicken Soup on the next page.

Per 3.5 oz serving: 177 calories, 27g protein, 0 carbohydrates, 7g fat (2g sat, 4g mono/poly), 83mg cholesterol, 0g fiber, 70mg sodium

Seasoned Cook For a savory bird, add 1/2 a lemon in the cavity and choose spices such as thyme, sage and basil. For a Latin flare, use chili powder, cayenne pepper, paprika and cumin as pictured here.

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Barley Mushroom Chicken Soup Serves 6

6 cups water 1 cup cooked chicken, shredded ½ cup hulled or pearled barley 2 cups mixed greens

(spinach, beet greens

or swiss chard), chopped ½ tsp each salt, pepper and

dried thyme

tly

1 Tbsp olive oil 1 medium onion, diced 1 cup red pepper, diced 4 cloves garlic, minced 2 cups mushrooms,

bite-size pieces 2 cups broth from

Slow-Cook Chicken

or store-bought

ce.

avocado and 1. Heat oil on medium heat in a large pot.

Sauté onion, pepper, garlic and mushrooms until soft; orange salad

about 5 minutes.

oker.

nd r

Mushrooms are high in vitamin D and beta-glucans, a fiber that lowers cholesterol Serve with arugula,

2. Add chicken broth and water to onion mixture;

bring to a boil then reduce heat to medium low.

Stir in chicken and barley.

3. Simmer until barley is tender; about 30 minutes

for pearled barley, 60 minutes for hulled.

4. Stir in mixed greens and seasonings in final

10 minutes of cooking.

Per serving: 166 calories, 12g protein, 21g carbohydrate, 5g fat (1g sat, 3g mono/poly), 19mg cholesterol, 5g fiber, 291mg sodium

Seasoned Cook Make a double batch and freeze for a quick weeknight dinner.

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Basic Grain Salad X 5 Serves 4

1. Cook grain. The rule-of-thumb is 2 parts water to 1 part grain; bring grain and water to boil, reduce to simmer and without stirring, simmer until water is absorbed. (Time varies between grains; 15-60 minutes.)

If you’d like a cold grain salad, try 2 cups shredded or chopped cooking the grain a day ahead and vegetables (beets, carrots, storing in the refrigerator overnight.

Basic Salad

2 cups cooked whole grain (brown rice, millet, quinoa, barley, bulgur) or legumes (lentils, black-eyed peas, cannellini, kidney, or black beans)

scallions, red onion, Brussels sprouts, radishes) ¼ cup dried or ½ cup fresh fruit, nuts, seeds or olives

Dressing 2-3 Tbsp olive, flax or walnut oil 2 Tbsp fresh lemon juice 1 Tbsp vinegar (apple cider, red or white wine, champagne, balsamic, etc)

2. Choose the combination of vegetables you’d like. Shred, dice and chop into small pieces and add to grain in a medium sized salad or mixing bowl. Do the same for any dried fruit, nut or olive you’d like.

3. In a small bowl, whisk together olive oil, lemon juice, vinegar and herbs. Pour over salad and stir/toss.

4. Taste! Adjust ingredients as needed.

Add lemon juice, lemon zest or more herbs/spices for a little more

*zing* or 1 tsp honey to add a little sweetness. Salt and pepper Per serving using barley salad: 172 calories, 3g are optional. protein, 26g carbohydrate, 7g fat (1g sat, 6g mono/

1-2 tsp dry (1-2 Tbsp fresh) favorite herbs/spices (parsley, dill, basil, oregano, coriander, cilantro, etc)

poly), 0mg cholesterol, 4g fiber, 9mg sodium

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Variations 3 Grain/Bean: edamame, quinoa Using the same quantities from Vegetables: spinach, red onion the basic salad and dressing recipes, Nuts: slivered almonds, switch up the ingredients. dried cranberries Here are 5 ideas: Oil: olive Lemon Juice: yes 1 Grain: barley Vinegar: omit Vegetables: cherry tomatoes, Herbs/Spices: fresh mint grilled squash Fruit/Nuts: omit 4 Grain: bulgur Oil: olive Vegetables: ribbon-cut mixed Lemon juice: yes greens (spinach, kale, basil) Vinegar: red wine Nuts: substitute red pepper Herbs/Spices: parsley, basil Oil: olive

Lemon Juice: yes 2 Grain/Bean: black beans Vinegar: substitute dijon mustard Vegetables: shredded carrots, Herbs/Spices: garlic, pepper, napa cabbage anchovy Fruit: substitute 1/4 cup salsa Oil & Lemon Juice: omit 5 Grain/Bean: green lentils Vinegar: red wine Vegetables: green onions, Herbs/Spices: chopped cilantro red cabbage

Fruit: mandarin oranges Oil: 4 drops sesame oil Lemon Juice: substitute aji-mirin (sweet rice vinegar) Vinegar: rice or white wine (2 Tbsp) Herbs/Spices: ginger, mint

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Blueberry Salmon Fillets Serves 4

This dish packs 10x the potassium to sodium, helping to reduce blood pressure Serve with a whole grain and slaw on the next page

1 pound salmon 1 Tbsp olive oil ¼ cup shallots, diced 2 cloves garlic, minced 1¼ cups fresh or frozen (thawed) blueberries 1 Tbsp balsamic vinegar 15 leaves of basil, roughly chopped 1 Tbsp honey 3 Tbsp water

1. Preheat oven to 350°. Place salmon on nonstick

baking sheet and place in oven; check at 7 minutes.

Salmon is done when just firm to the touch.

2. Meanwhile, in a small pan, heat oil on medium heat.

Add shallots and garlic and sauté until soft;

about 3-5 minutes.

3. Add blueberries, vinegar, basil and honey. Warm through,

stirring occasionally, then add water. Simmer for a few

more minutes until berries are soft and basil aromatic.

4. Transfer to blender or food processor and blend.

Spoon over salmon fillets.

Per serving: 303 calories, 24g protein, 17g carbohydrates, 15g fat (4g sat, 11g mono/poly), 57mg cholesterol, 1g fiber, 60mg sodium

Seasoned

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Cook Experiment with other fruits such as strawberries or pineapple. Save extra sauce for tomorrow’s lunch wrap.

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.

ough, ew c.

Tangy and Sweet Brussels Sprouts Slaw Serves 6

1 pound brussels sprouts ½ cup dried cranberries or apricots ¼ cup roasted, shelled sunflower seeds ¼ cup red onion, finely diced ¼ cup olive oil 1 Tbsp balsamic vinegar ¼ cup lemon juice 1 Tbsp honey 1 tsp ground coriander Pepper to taste

1.

To prepare sprouts, cut off stem and peel away wilted or discolored leaves. Shred by cutting into thin slices, similar to how you’d cut a mushroom, or pulse in a food processor.

Packed with vitamin C & K If you like coleslaw in the summer, you’ll love this version in the winter, when Brussels Sprouts are at their peak

2. Toss brussels sprouts, dried fruit, sunflower seeds

and red onion in a medium-mixing bowl.

3. In a small bowl, whisk together olive oil, vinegar,

lemon juice, honey and coriander.

4. Add vinaigrette to salad mixture, toss and enjoy!

Per serving: 188 calories, 4g protein, 20g carbohydrate, 12g fat (2g sat, 10g mono/poly), 0mg cholesterol, 4g fiber, 44mg sodium

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Garlicky Recipe Green Beans Headline Serves 4

Serves

Garlic is used in

½ tsp black pepper 1 Tbsp olive oil ½ pound green beans, rinsed and cut to desired length ½ cup low-sodium chicken broth or water 4 cloves garlic, minced Pinch of salt (optional)

cuisines all over the World for its unique and pungent flavor and loved for its added health benefits. It aids in reducing total cholesterol, blood pressure and inflammation.

1. Heat sauté pan over medium heat with black

pepper and oil.

2. Place green beans in pan and toss until coated.

3.

Add broth and garlic to pan. Cover and simmer.

Check at 5 minutes. The liquid should be absorbed and the beans crisp tender. Add more broth if necessary.

4. Plate and add a pinch of salt on top.

Per serving: 55 calories, 2g protein, 6g carbohydrate, 4g fat (0g sat, 4g mono/poly), 0mg cholesterol, 1g fiber, 159mg sodium

Seasoned Cook Sautéed baby tomatoes or mushrooms go well in this dish as shown here.

Green beans out of season?

Don’t hesitate to use frozen.

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Tuned-Up Tuna Casserole Serves 4

4 ounces whole-wheat pasta such as fusilli or bow tie 1 medium onion, chopped (approx. ½ cup) 1 cup broccoli florets (about 1” in diameter) 3 medium mushrooms, chopped, divided ¼ cup nonfat milk ¼ cup low-sodium chicken broth 2 tsp dried oregano

1 Tbsp each cornstarch and whole wheat flour 1 cup, plus 2 Tbsp shredded low-fat cheddar cheese 5 ounce can tuna (in water), drained 2 sardines (canned), drained and chopped ¼ cup black olives, pitted and sliced

1. Pre-heat oven to 350°. Cook pasta in 2 cups water until tender – drain

and let cool, retaining water.

2. Sauté onion, 2 mushrooms and broccoli in 2 Tbsp pasta water until onions

are transparent and lightly browned, approx. 5 minutes. If necessary,

add 2-3 more Tbsps of the pasta water. Set aside to cool.

3. Finely chop the remaining mushroom and lightly sauté in 1 Tbsp pasta

water until water evaporates, about 2 minutes.

4.

In a separate bowl, whisk together the milk, chicken broth, cornstarch, whole-wheat flour and oregano. Then, add to sautéed mushroom.

Simmer until thickened and then thin with the remaining pasta water until it has the consistency of gravy.

5.

Place the noodles, tuna, sardines, olives, vegetable mixture and cheese (except 2 Tbsps), in a large bowl. Toss thoroughly. Add mushroom sauce and mix again. Place in oiled 8- inch square baking dish. Top with remaining cheddar cheese and bake for 30 minutes.

Per serving: 367 calories, 27g protein, 31g carbohydrates, 16g fat (8 sat, 6 mono/poly), 72mg cholesterol, 5g fiber, 200mg sodium

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DIY Pizza Choose Your Crust

1 Wholesome Whole-Wheat Make your own whole-wheat pizza crust. Yields 8 slices.

1 cup warm water 1 tsp yeast 1 Tbsp honey 1 Tbsp olive oil

½ tsp salt

2 ½ cups whole-wheat flour (can mix with whole-wheat pastry)

1. In a medium mixing-bowl, add

yeast to warm water then wait

a few minutes for yeast to activate.

2. Add all other ingredients and stir.

After most flour has been incorporated, begin using hands

to knead the dough into a ball.

Dough should be sticky and

moist. If clumpy and dry,

continue to add 1 tablespoon

of water until dough sticks together.

3. Form into a ball and leave in

bowl, covered, for 1 hour to rise.

4. Preheat oven to 450°.

5.

After dough has doubled in size, spread over a non-stick 9x13 baking-sheet, add toppings of your choice, and bake for 10-15 minutes.

Per slice: (without toppings): 150 calories, 5g protein, 30g carbohydrate, 2 g fat (0 sat, 2 mono/poly), 0mg cholesterol, 5g fiber, 148mg sodium

Seasoned Cook DIY means happy and healthy families. Set up a “pizza bar” including everyones’ favorite toppings.

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2 Creative Cauliflower Make a cauliflower crust.

Enjoy this grain-free crust

with a fork. Yields 8 slices.

3 cups cauliflower florets

2 egg whites

2 tsps dried oregano, basil, sage and/or thyme

½ cup low-fat mozzarella cheese, shredded

1. Preheat oven to 450°. Place

cauliflower florets in a food

processor and pulse until a

uniform “rice” texture is obtained.

2.

Place cauliflower florets in a microwave-safe bowl, add 3-4 Tbsp of water and cook on high for 4 minutes.

5.

Pour mixture out on non-stick baking sheet or parchment paper. Bake for 12 minutes, take out and add toppings. Bake for another 5 minutes.

Per slice (without toppings): 38 calories, 4g protein, 3g carbohydrate, 2g fat (1 sat, 0 mono/poly), 4mg cholesterol, 2g fiber, 60mg sodium

Seasoned Cook Quick & Easy Crust Use whole-wheat tortillas, pitas or flatbreads that are high in fiber (>5 g/ serving) for a crust that is lower in calories, fat and salt than traditional pizza crust.

Read the Nutrition Facts for nutritional analysis.

3. Strain cauliflower of excess

water using paper towel or tea

towel-lined strainer.

4. Place cauliflower and remaining

ingredients in bowl and mix.

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Healthy Snacks Snacking tips

Keep your blood sugar stable and your hunger at bay by emphasizing snacks with whole grains, healthy fats and lean proteins.

Plan Ahead Keep snacks individually portioned and conveniently located in your desk drawer at work, or at eye-level in the pantry or fridge.

Keep tempting,

unhealthy snacks off the counters

Whether we’re at home or on the go, it’s tempting to grab convenient snacks that are quick and often, unhealthy.

Plan for two snacks daily and keep items on-hand.

10 Snack Ideas • Hummus or yogurt-dip with carrots, celery, cucumber, cherry tomatoes or radishes • Apple or veggie slices with nut butter

• High-fiber crackers or leaf-lettuce with mustard and a slice of low-sodium cheese, lean protein or avocado • Fresh fruit with low-fat cottage cheese or plain yogurt • String cheese and piece of fruit • Popcorn • Tuna or chicken salad on crackers, lettuce or with raw dipping vegetables • Hard-boiled egg • Roasted garbanzo beans • Small corn or WW tortilla with beans and low-fat cheese, melt for quesadilla

and out of sight.

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Caramelized Onion and Cannellini Bean Dip 1 Tbsp olive oil 1 sweet onion, sliced 1 sprig fresh rosemary 1½ cups canned cannellini beans, drained and rinsed 2 cloves garlic 2 tsp fresh lemon juice Ground pepper and/or cayenne pepper to taste (optional)

1. Over medium heat, heat olive oil in skillet.

Add onions and rosemary sprig; sauté until very

soft or caramelized. Remove rosemary stem.

Steer clear of vending machines but if you have to, pick options low in salt, sugar and fat.

Always have a veggie or fruit plate with dip in the fridge, ready to go when hunger strikes.

2. Add onion and all other ingredients to food processor and blend until smooth

Make your own granola

Per 2 Tbsp: 55 calories, 3g protein, 9g carbohydrate, 1g fat

(0 sat, 1 mono/poly), 0mg cholesterol, 2g fiber, 2mg sodium bars or mini-muffins Simple Dill Yogurt Dip (shown with veggies ) for a snack with 1 cup non-or low-fat greek yogurt 1 Tbsp red or green onion, finely diced ¼ cup English cucumber, shredded 1 Tbsp fresh dill or 2 tsp dry

ingredients you know and trust.

1. Mix all ingredients in a bowl and serve.

Per 2 Tbsp: 14 calories, 1g protein, 2g carbohydrate, 0g fat, 1mg cholesterol, 0g fiber, 15mg sodium

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Heart-Friendly Kitchen Basics Basics In the Pantry Grains q Barley* q Brown rice q Bulgur* q Rolled oats q Polenta q Quinoa* q Whole-wheat bread, pita or tortilla wrap* q Whole-wheat pasta* q Whole-wheat or rye crackers _____________ _____________

Nuts & Seeds Dried Fruit q Almonds* q Flaxseeds q Sunflower seeds q Walnuts q Pecans q Raisins q Apricots* q Cranberries* _____________ _____________ _____________ _____________

Oils q Olive* q Olive oil spray q Canola q Sesame q Flax q Walnut _____________ _____________

Seasonings* q Allspice, basil, bay leaf, black pepper, cayenne, chili powder, Canned Goods q Broth, low-sodium cinnamon, (chicken, vegetable coriander, cumin, curry blends, dill, or beef)* Beans/Peas q Tomatoes, diced, marjoram, (canned and dry) oregano, pepper, low-sodium q Black beans* red pepper flakes, q Tomato or pasta q White (cannellini, navy)* sauces, low-sodium rosemary, sage, salt, regular or q Black olives* q Kidney q Fish (salmon*, tuna*, smoked paprika, q Garbanzo thyme, turmeric herring, mackerel) (chickpeas) _____________ Salsa* q Lentils* (brown, q _____________ green, black, red, _____________ _____________ French)* Other Staples _____________ q Split peas q Honey* _____________ _____________ q Soy sauce, _____________ low-sodium Vinegars q Hot pepper q Cider Produce Basics sauce q Red wine* q Onions* q Ketchup q White wine* q Garlic* q Maple syrup q Balsamic* q Seasonal fruit q Mustard: dijon*, q Sherry q Seasonal whole-grain _____________ vegetables q Baking soda _____________ q Fresh herbs _____________ _____________

q Baking powder q Cornstarch* q Flour, whole-wheat* and whole-wheat pastry* q Sugar q Vanilla extract _____________ _____________ In the Fridge q Eggs q Parmesan cheese q Milk, low-fat* q Yogurt, low-fat* q Butter, unsalted q Lemon and lime juices* q Lean protein _____________ _____________ In the Freezer q Edamame* q Green beans* q Mixed vegetables q Peas q Berries* q Homemade broth* q Lean protein _____________ _____________ *Item used in the recipes in this booklet

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s

Fresh Ingredients 1. Walk Away Slow-Cook Chicken • 4-5 pound whole chicken • 1 onion 2. Barley Mushroom Chicken Soup • 2 cups mushrooms • 1 red pepper • 2 cups mixed greens • 1 onion 3. Basic Grain Salads • 1 cup cherry tomatoes • 1 squash 4.

5.

• Parsley and basil

Blueberry Salmon Fillets • 1 pound salmon • 1 shallot • 1 1/4 cups blueberries • Basil Tangy and Sweet Brussels Sprouts Slaw • 1 pound Brussels sprouts • 1 lemon • 1 red onion

6. Garlicky Green Beans • 1/2 pound green beans • 1 cup mushrooms or cherry tomatoes (optional) 7. Tuned-Up Tuna Noodle Casserole • 1 cup broccoli florets • 3 mushrooms • 2 cups low-fat, shredded cheddar cheese 8. Family Pizza Night

Make your own list of your favorite fresh toppings

9. Caramelized Onion and Cannellini Bean Dip • 1 sweet onion • Rosemary 10. Simple Dill Yogurt Dip • 1 bunch green onions • 1 English cucumber 35

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Summary 8 Easy Changes = Big Gains Making big changes can be daunting, but little ones don’t have to be.

Consider taking one easy step per week to boost your heart health.

1. Keep up with regular health screenings.

2. Use the heart-healthy plate as a guide to plan meals.

3. Eat more fresh, unprocessed foods.

4. Learn how to read the Nutrition

Facts Label on food and beverage products. Watch out for excess sugar, salt and fat. Emphasize foods with fiber.

5. Shop with a food list;

make sure heart-friendly foods are on it.

6. Create movement in your day.

7. Keep a food and exercise

journal - with goals - so you can track your progress.

8. Get seven or more

hours of sleep each night.

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Making the Connection CONDITIONS THAT MAY ALSO AFFECT YOUR HEART HEALTH Gum disease – It is believed that people with gum disease (inflammation) are more likely to have heart disease than those whose gum tissue is healthy.

It is now known that harmful bacteria can travel from the mouth through the bloodstream. Take scrupulous care of your oral health.

Diabetes – Diabetes increases the risk for heart disease three-fold. Manage diabetes closely with your doctor. If you’re pre-diabetic don’t smoke, lose excess weight and adopt other healthy lifestyle choices to reduce your risk.

Sleep apnea – Up to 83 percent of people with heart disease also have sleep apnea. Sleep apnea is a condition in which people unknowingly stop breathing several times a night. If you suffer from daytime fatigue or your bed partner complains of your snoring, ask your doctor about your sleep health.

Obesity – Extra weight increases blood fats, which in turn raises triglycerides and “bad” LDL cholesterol and lowers “good” HDL cholesterol. The good news is that losing just 10 pounds can help lower your blood pressure and start you down the path to a healthier heart.

For more information about conditions that can affect your heart health, visit www.FranciscanHeart.org.

BLUEBERRY BREAKFAST BLAST Serves 1-2 This is a great basic breakfast drink.

It’s packed with antioxidants, vitamins and essential minerals to get your day off to a heart-healthy start.

1 cup frozen blueberries thawed, or fresh in season 1 cup nonfat plain yogurt 1 medium ripe banana, roughly chopped Suggested garnish – fresh mint Can also add finely ground flax seeds, nuts, tofu, or other favorite fruit.

1. Place all ingredients in blender or food processor, blending until smooth.

2. Check texture. Add ice for a thinner taste.

Per serving: 155 calories, 7g protein, 32g carbohydrate, 1g fat, 0g sat fat, 1g mono fat, 2mg cholesterol, 4g fiber, 88mg sodium

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When Less is More DR. LUBER

“Minimally invasive techniques mean less risk of infection, surgical stress, recovery time and scarring — and more time back with family and friends.”

MAJOR SURGERY, MINOR INCISIONS Today, less may be more when it comes to heart surgery and new technology. Heart surgery once routinely required a 10-inch incision and equally long hospital stay. Today’s minimally invasive options use much smaller incisions. Patients generally stay just two to three days in the hospital. Franciscan heart surgeons are using these groundbreaking techniques (for appropriate candidates) in coronary bypass surgery, and heart valve repair and replacement, with excellent outcomes for their patients.

Dr. Luber was one of the first surgeons in the state to perform minimally invasive coronary bypass surgery, at St. Joseph Medical Center.

John Luber, MD, FACS, cardiothoracic surgeon

If you are looking for a heart surgeon proficient in minimally invasive surgery, call Karen at Franciscan Cardiothoracic Surgery Associates at (253) 426-6700.

Learn more or watch our videos on the web at www.FranciscanHeart.org.

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Help FOR YOUR HEART-HEALTHY LIFESTYLE Ready to quit?

FREE! Freedom from Tobacco Support Group Multiple locations to choose from.

No registration required; drop-ins welcome. Call for more information: (253) 223-7538.

Want to lose weight?

Franciscan Center for Weight Management Weight Loss Surgery Full range of surgical options, including gastric bypass and sleeve gastrectomy, to help patients reduce and manage their weight for life and lower the risk of chronic health problems.

Learn more about our Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgery Center of Excellence at St. Francis Hospital at www.FranciscanWeightLoss.org.

Be a nutrition novice no more!

• Franciscan Outpatient Nutrition Education Center Individual nutrition counseling, body composition analysis and more.

Call (253) 426-4926.

FHS200L HeartDietBook2014_00.indd 40

• Healthy Heart Nutrition Series Covers types of fat, label reading, recipe substitutions, strategies for dining out and more. Call 1 (888) 825-3227.

Dealing with diabetes?

Certified educators help you manage diabetes and live well.

Call (253) 426-6753 or visit www.FHShealth.org.

FREE Franciscan Health eNews Tailor topics to your health needs and interests. Subscribe today at www.FHShealth.org/eNews.

Free blood pressure checks Monitor your blood pressure between doctor visits at our Heart Check Center™ kiosks: • Commons Mall, Federal Way • Tacoma Mall, Tacoma • South Hill Mall, Puyallup A.W.A.K.E. Support Group The “Alert Wakefulness and Keeping Energetic” (A.W.A.K.E.) supports Continuous Positive Airway Pressure (CPAP) wearers and their families, and covers topics related to obstructive sleep apnea.

For more information, call (253) 985-6951.

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Franciscan Heart Center IT’S EVERYWHERE YOU FIND FRANCISCAN. CARDIOLOGISTS

Daniel Wuthrich, MD

Franciscan Heart & Vascular Associates

Kevin Zhou, MD

Tacoma (253) 627-1244

William Bilnoski, MD, FACC Raed Fahmy, MD, FACC Mahender Gaba, MD, FACC Amrit Guptan, MD, FACC Theodore Lau, MD, FACC Raza Orakzai, MD, FACC Rosemary Peterson, MD, FACC R. Antonio Secaira, MD Javier Yuvienco, MD, FACC Patti Aramburu, ARNP Ashley Kauzlaric, ARNP Michelle Williams, ARNP

Auburn & Federal Way (253) 939-1230

Venkatesh Kandallu, MD Robert Middleton, MD

Sandra Hughes, ARNP Federal Way only Burien (253) 939-1230

Joel Tañedo, MD, FACC, FSCAI

Gig Harbor (253) 627-1244

William Bilnoski, MD, FACC Raed Fahmy, MD, FACC Mahender Gaba, MD, FACC Theodore Lau, MD, FACC

Lakewood (253) 627-1244

Mahender Gaba, MD, FACC Raza Orakzai, MD, FACC Rosemary Peterson, MD, FACC R. Antonio Secaira, MD

Franciscan Specialty Clinic Enumclaw (360) 802-5760 Jeffrey Rose, MD, FACC

Patrick Reagan MD, FACC Federal Way only

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VASCULAR SURGEONS

HEART SURGEONS

Franciscan Vascular Associates

Franciscan Cardiothoracic Surgery Associates

Tacoma (253) 382-8540 Lab service on site

Tacoma (253) 272-7777

Craig Hampton, MD, FACS

Todd Kihara, MD

Susan Hecker, MD, MPH

Jennifer Barnett, ARNP Pamela Charboneau, ARNP Rachel Sammis-Falk, PA-C

Omar Dorzi, MD Lakewood (253) 985-6160 Lab service at hospital Omar Dorzi, MD Gig Harbor (253) 530-2620 Lab service on site Omar Dorzi, MD Auburn (253) 833-8032 Lab service on site John Diaconou, MD

Michael Cavanagh, PA-C Lance Keck, PA-C

Federal Way (253) 833-8032 Lab service on site John Diaconou, MD

John Luber, MD, FACS, FACC

Jerry Papson, PA-C Doug Rossi, PA-C Sean Shipley, PA-C John Stoneman, PA-C OTHER FRANCISCAN HEART CENTER SERVICES Cardiac Rehabilitation (253) 426-6768 Heart Failure Clinic (253) 627-1244 Heart Valve Clinic (253) 426-6700

Enumclaw (253) 833-8032 Lab only

Visit www.Franciscanheart.org today.

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Talk to a doc 24/7 for $35.

*

Introducing Franciscan Virtual Urgent Care

Get care now at www.FranciscanCareNow.org or (855) 356-8053. *If an in-person visit is needed to reach a diagnosis, then the fee will be refunded.

Due to federal regulations, patients who participate in government-funded insurance programs such as Medicare and Medicaid are not eligible for telemedicine “virtual visit� services at this time.

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