Fall 2011
Heart tO HEART
Your resource for heart health
Putting Heart Attacks on Ice Who Is Ice-Worthy? Certain Heart Patients Are Candidates for Hypothermic Therapy The American Heart Association has been recommending hypothermic therapy for cardiac arrest victims since 2005. However, hospitals across the nation have been slow to implement this life-saving procedure. Recently, St. Elizabeth Health System became the first hospital in the area to introduce the therapy. During a cardiac arrest, the heart stops effectively pumping blood through the body, bringing on a cascade of problems, including injury to the brain and other internal organs. Each year, roughly 300,000 American adults suffer cardiac arrest. continued on page 2
Cardiology Experts Reduce Coronary Damage by Chilling Patients
If you were to suffer cardiac arrest, how would you like doctors to treat the cocktail of problems that result—straight up (chilled) or neat (at room temperature)? If you choose straight up, then you stand a better chance of preserving your organs and body functions, and ultimately, your quality of life. In fact, this is exactly what the heart experts at St. Elizabeth Health Center are doing. They are cooling cardiac arrest patients using a revolutionary new treatment called hypothermic therapy. Basically, this involves dramatically lowering a patient’s body temperature in an effort to slow down the damaging effects of a heart attack. “In the past, cardiac arrest patients could only be stabilized and then monitored,” says Jeffrey Fulton, DO, director of cardiothoracic surgery. “The brain becomes deprived of oxygen when the heart stops pumping, and in these cases,
the outcome for patients is bleak. But now – thanks to hypothermic therapy -- we’re able to slow down or even stop damage to the heart and brain and literally bring patients back to life.” The cooling treatments are often initiated by paramedics at the scene of a cardiac – Jeffrey Fulton, DO arrest after the patient gets a pulse back. First, the medics stabilize the unconscious patient the best they can with advanced cardiac life support procedures. Then while transporting the patient to the hospital, they may apply ice packs to the areas of
“ Thanks to hypothermic therapy, we’re able to slow down or even stop damage to the heart and brain and literally bring patients back to life.”
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Ice-Worthy
Putting Heart Attacks on Ice continued from page 1
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Who can have hypothermic therapy? Hypothermia can safely and successfully be induced in unconscious patients who have been revived from sudden cardiac arrest (e.g. they have their pulse back but do not wake up).
How do they get chilled? Patients may be cooled internally with a catheter of chilled saline solution or externally with special pads and/or a special, high-tech cooling bed, in which they are placed. During the cooling process, the patient remains in a coma-like state and is continually monitored to ensure they stay at the appropriate temperature.
When should someone receive the therapy? As soon as possible. That is why St. Elizabeth Health Center is working to bring local emergency medical services (EMS) squads up to speed with the treatment. The plan is to have the squads start life-saving hypothermia therapy the moment a cardiac arrest patient enters an ambulance. Treatment would continue upon arrival at St. Elizabeth.
Heart to Heart is published by
We hope you enjoy this issue of Heart to Heart, an informational newsletter published as a service by St. Elizabeth Health Center (SEHC). For more information about Heart and Vascular services, call 330-480-3151 or toll free 1-877-700-4647 or visit our website at HMpartners.org.
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Darla Purvis, RN (left), and Tammy Goda, nurse practitioner, apply specialized cold packs to a heart patient to induce hypothermia in St. Elizabeth Health Center’s emergency department. the body that have a lot of blood flow, such as the groin, armpits and neck.
survive without long-term brain damage from oxygen deprivation.
Once the patient arrives at St. Elizabeth’s emergency department, the hospital staff takes over. Using high-tech equipment, they induce hypothermia by cooling patients to a low body temperature. This slows down the body’s metabolism and reduces the amount of oxygen needed by the brain, thus preserving internal organs. When the patient is completely stabilized, they are gradually re-warmed.
“These are sobering statistics, but thanks to hypothermic therapy, the numbers are improving,” notes Patti Kostelnak, RN, cardiovascular community health educator. “Ten out of 100 cardiac arrest victims survive. Of those 10 people, five or six will go home with no long-term effects. Before hypothermia therapy, only about three would go home. This is tremendous because we previously could do nothing to improve the numbers.”
“We’ve used hypothermia therapy in surgery for years to reduce patients’ need for oxygenated blood,” says Dr. Fulton. “The cold slows down a person’s metabolism and lessens the brain’s need for oxygen. As a result, oxygen becomes available for other organs that might otherwise shut down. Meanwhile, hypothermia protects brain cells from being damaged.” According to research studies, less than 10 percent of full cardiac arrest victims survive outside the hospital. Of those, only about a third (3 to 4 percent overall)
Dr. Fulton fully agrees. “If I had a heart attack, I would want the medics who were transporting me to bypass the closest hospitals and take me to a specialized heart center like St. Elizabeth, which offers this life-saving therapy.” According to Kostelnak, the effects of hypothermic therapy are amazing. “Seeing a patient walk out of the hospital after being clinically dead is a really dramatic experience,” she says. In fact, it could give you the chills.
Are Cholesterol Medications Safe? Heart Specialist Dr. D’Souza Addresses Your Concerns
To take your cholesterol medicine or not to take it. That is the question. Faced with recent news reports on the possible dangers of cholesterollowering drugs (called statins), many Americans are wondering if they should follow their doctors’ orders regarding the medications. “This is a shame,” says cardiologist Penny D’Souza, DO, who practices at St. Elizabeth Health Center. “While some questions have been raised about the safety of cholesterol drugs when used by certain healthy patients, it is also apparent that statins are saving the lives of many people who are at risk of dying from cardiovascular disease. “It is important that people with heart problems keep taking their medications as prescribed,” she adds. “If they have concerns, they should discuss them with their doctor. Statins have been used safely for a long time by many, many people.”
Why do people take statins? Each year, statins are credited with saving thousands of lives that might otherwise
succumb to heart disease, which is the number one killer of both men and women in the United States. But while many experts endorse these drugs and would like to expand their use, others are claiming that for healthy people, the benefits do not outweigh the potential negative side effects.
Crestor is the second best-selling statin, behind Lipitor. According to new labeling on the drug, it may be prescribed for healthy men 50 and over and women 60 and over who have elevated inflammation in the body and one risk factor for heart disease, such as smoking or high blood pressure.
What is the controversy about?
What are the side effects of statins?
Some of the skepticism over statins For years, patients have complained that stems from recently published reports statins cause muscle aches. In addition, that the drugs may increase a person’s doctors must regularly check a patient’s risk of developing Type 2 diabetes by 9 liver enzymes to make sure the statins percent. However, experts do not elevate them to disagree over the validity of abnormally high levels. the blood test used to identify And now, evidence is new statin candidates. The pointing to a diabetes risk. test measures the degree “It is true that some of inflammation in the body, patients can experience rather than the level of bad side effects when taking (low-density lipoprotein or statins,” says Dr. D’Souza. LDL) cholesterol. Some “However, when someone experts say that inflammation has a significant risk of is not a direct cause of Penny D’Souza, DO cardiovascular disease, cardiovascular disease. the benefits of the drugs typically far “It is important to realize that the outweigh any potential negative side controversy over cholesterol medications effects.” is only directed at healthy people who So should I take statins? take them for preventive reasons,” explains Dr. D’Souza. “Statins are still an “For now, I strongly recommend important medication for patients with that people at risk of developing cardiovascular disease.” cardiovascular disease take statins to
What stimulated the debate? The debate heated up when the Food and Drug Administration (FDA) approved new criteria for the drug Crestor. Under those criteria, people with no cholesterol problems and no symptoms of heart trouble are candidates for statins. Currently, 80 million Americans already meet the guidelines for receiving statins, and about half of those actually take the drugs.
reduce bad cholesterol and give them some degree of protection against the possible devastating effects of the disease, such as heart attack,” says Dr. D’Souza. “As for healthy people, the jury is still out as to whether statins are necessary,” she adds. “For these individuals, the decision on whether or not they should take statins should be carefully considered on a case-by-case basis by a medical professional.”
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Get Fresh!
Local Farmer’s Markets Expand Your Healthy Food This fall, why not take advantage of the abundant harvest right in your own back yard? When you shop for produce at area farmer’s markets, you support the farms and businesses within your own community. Locally-grown foods are fresher, and therefore, tend to be healthier.
buy local, fresh commodities and to provide more markets for local agricultural producers. Call: 330.856.2340 or visit howlandtownship.org
Northside Farmer’s Markets – Downtown When: Tuesdays through October 15 from 1:30 to 3:00 p.m. Where: on Market Street at Federal Plaza in downtown Youngstown.
How to shop smart at farmer’s markets:
What: fresh local and regional produce and baked items.
• Take cash. Not all vendors take credit cards or checks. • Bring recyclable bags to help keep our earth green.
Northside Farmers’ Market – Elm Street
• Pack a cooler and ice packs to store any perishable products you buy.
When: Saturdays through October 29 from 9 a.m. to noon.
• Talk with the vendors. They can often offer tips on cooking their produce and may even provide recipes.
Where: at Elm Street (1221 Elm Street) and Illinois Avenue across from Wick Park on the Unitarian Church grounds. 330.518.6971
• Arrive early for the best selection and freshest produce. • Choose dark colors. The most intensely colored fruits and veggies are packed with the most nutrients. For example, dark green leaf lettuce contains much more vitamins and minerals than light green iceberg lettuce.
Howland Farmer’s Market When: Saturdays through October 15 from 9 a.m. to 1 p.m. Where: Richard E. Orwig Park on East Market Street (adjacent to Howland High School) Howland, Ohio What: seasonal local vegetables, artisan breads, cheese, cut flowers, eggs, fruits, grass-fed meats, herbs, honey, hot sauces, jams and jellies, maple syrup, pastries, potted plants and more.
What: fresh local and regional produce and baked items.
Attend Harvest Day at Villa Maria Farm Saturday, October 1, 2011 Noon to 5 p.m. Admission: free Harvest Day offers a healthy way for you and your family to enjoy a fun-filled afternoon. Take a ride into the country to the Villa Maria Farm (only 10 miles east of Youngstown) and take pleasure in crafts, free hayrides, children’s games, pumpkin painting, circle drumming, fair trade goods, fresh produce and prepared foods, and more. Directions to the event are given in the listing on page 5 for Villa Maria Farmer’s Market.
Special features: The Howland Farmer’s Market is a community service to provide a place where the public can 4 | Heart to Heart
Special features for both Northside markets: Community yard sale held at the Elm Street location, where market goers can also find community information tables and occasional entertainment and educational events. EBT Ohio Direction Card and WIC farmers’ market coupons are accepted at both markets. Call: 330-518-6971 for updates or directions for either of the Northside markets.
Grow Youngstown CSA (Community Supported Agriculture)
Hours and locations: produce is ordered in advance and can be picked up on Tuesdays at the following locations and times through October 10: • F airgreen Neighborhood Garden – 4 to 5 p.m.
Choices • T rumbull Neigbhorhood Partners – 4 to 5 p.m. • Y MCA Davis Branch – 6 to 7 p.m. Available fruits and veggies: seasonal produce from growers who raise 30 or more crops each, including heritage varieties and organically grown, certified organic and sustainably grown products. For more information or to place orders, visit www.growyoungstown. org/csa.html or call 330-286-0688. Special features: By creating a local direct market, Grow Youngstown tries to support area farmers and consumers, keep food revenues in the city, and lessen our carbon footprint.
Villa Maria Farmer’s Market Hours: Wednesday, Thursday and Friday – noon – 5 p.m.; Saturday – 10 a.m. – 2 p.m. Where: 288 Villa Drive (at Villa Maria Farm), Villa Maria, PA 16155 724-964-8920 x3385 Directions from Youngstown: Take 422 East to the Pennsylvania border. One mile past the state line, turn right (south) on Evergreen Road. In another mile, turn right at a big blue sign with the number 4. Follow the produce signs. Available fruits and veggies: peppers, green and yellow beans, eggplant, potatoes, a variety of lettuces, leeks, onions, garlic, heirloom and conventional tomatoes, pumpkins and gourds, red and green cabbage, cauliflower, broccoli and herbs. Special features: The farm sells all naturally raised produce, and 50 percent of the proceeds are donated to the less fortunate.
Welcome Dr. Crouch
Cardiothoracic Specialist Joins St. Elizabeth’s Staff Oftentimes, a negative can lead to a positive. Such was the case with Dr. Ray Crouch’s family history of cardiovascular disease. “Of all the rotations in surgery, cardiothoracic surgery is the one that really spoke to me,” he says. Ultimately, his family’s heart problems ended up being Dr. Crouch’s catalyst for helping many other people with the same health issues. And now, Ray Crouch, MD, has brought his 14 years of experience and expertise as a cardiothoracic surgeon to St. Elizabeth Health Center, where he is making a positive impact on many lives. But it is not only patients who he helps. He is also making an impression on future surgeons. “I enjoy interacting with the surgical residents here,” he says. “Hopefully my experience can allow me to pass along my knowledge and skills. On the flip side, I learn things too. Serving as an instructor forces you to stay on your toes and to keep up with new technologies. It also enables you to be a positive influence in the students’ career path.” Prior to joining St. Elizabeth, Dr. Crouch practiced at The Park Cardiothoracic & Vascular Institute at Jefferson Regional Medical Center in Jefferson Borough, Pa. He served as co-director of Cardiothoracic Surgery and Director of Vascular Surgery at Jefferson Regional Medical Center. He earned a bachelor of science degree in biology in 1984 from the University of California, Riverside before going on to earn his doctor of medicine
“ I’ve only been at St. Elizabeth a short time, but I’ve been very impressed so far with both the facilities and the people.” Ray Crouch, MD, cardiothoracic surgeon, St. Elizabeth Health Center
degree in 1989 from Hahnemann University School of Medicine, where he was also a masters candidate in human physiology. Dr. Crouch’s post graduate training included serving a fellowship in cardiothoracic surgery at the Virginia Commonwealth University/Medical College of Virginia and as both a general surgery resident and research fellow at Cleveland Clinic. He is a board certified general surgeon and thoracic surgeon. “I’ve only been at St. Elizabeth a short time, but I’ve been very impressed so far with both the facilities and the people,” he says. “I like the fact that St. Elizabeth is large enough to have an academic environment, yet small enough to offer personal care.” A native of California, Dr. Crouch currently resides in Gibsonia, Pa., with his wife, Joanne, a registered nurse and home-maker, and their three daughters, Emily, 15; Allison, 10, and Tess, 9.
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Meet Dr. Fulton
Cardiothoracic Surgeon Finds ‘Instant Gratification’ in Helping People As medical director of cardiothoracic surgery for St. Elizabeth’s Heart and Vascular Center, Jeffrey Fulton, DO, has the opportunity to improve the lives of many people. And that is exactly why he wanted to go into medicine in the first place. “I decided to go into medicine at a very young age because I thought the whole concept of treating and helping people was very appealing,” says Dr. Fulton. “What I enjoy most about my work is the instant gratification you get when you have the ability to truly change someone’s life for the better in a very short period of time.” Considering that St. Elizabeth Health Center is a thriving, busy hospital, Dr. Fulton and his colleagues at the Center have the opportunity to feel this “instant gratification” time and time again. Each year, the cardiac surgeons perform more than 350 open-heart surgeries, 2,000 cardiac catheterizations and 600 angioplasties. “We practice quality medicine here, and our patients tend to be appreciative,” says Dr. Fulton. “In emergency situations, you know that if you hadn’t intervened, the patient might not have made it. This is one of the things that make cardiothoracic surgery a rewarding field.” Prior to joining St. Elizabeth, Dr. Fulton practiced at the Park Cardiovascular Institute in Jefferson Hills, Pa., where he was also a physician at RAJ Cardiovascular Associates. Before
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that, he was a member of Main Line Cardiothoracic Surgeons, P.C. in Wynnewood, Pa. “It was an easy decision to come to St. Elizabeth,” he says. “This is a very good and well respected hospital that has won numerous awards. It’s also the busiest hospital in the area. I’ve never regretted my decision in the four years I’ve been here.”
in cardiothoracic surgery and became hooked. I liked the precision of the procedures and the fact that our patients generally had very good outcomes.”
One patient case with an especially satisfying outcome involved a relatively young man who had multiple cardiac arrests. “Considering his unstable state, we wouldn’t have operated on him if he were older,” says Dr. Fulton. “But we went ahead and took him to the Dr. Fulton graduated magna cum laude operating room, all the while wondering from the University of Pittsburgh with a how much neurological damage he bachelor of science degree in 1986. After would have. The happy surprise was earning his doctor of osteopathy degree that he woke up from surgery and left the “ In emergency situations, you know that hospital 100 percent neurologically intact.” if you hadn’t intervened, the patient Dr. Fulton is clinical assistant professor the things that make cardiothoracic for the department of surgery at Northeast surgery a rewarding field.” Ohio Medical Jeffrey Fulton, DO, medical director of University’s Rootstown cardiothoracic surgery, St. Elizabeth Health Center campus. He was previously clinical assistant professor of cardiothoracic surgery for the Ohio at the Philadelphia College of Osteopathic University College of Osteopathic Medicine, he served a rotating internship Medicine, medical director of the at Conemaugh Hospital in Johnstown, cardiovascular and telemetry units at Pa.; a general surgical residency at Albert Jefferson Regional Medical Center, Einstein Medical Center in Philadelphia, and an off-pump training preceptor for and a cardiothoracic surgery residency Guidant Corporation. at University of Massachusetts Medical Center in Worcester, Mass. The doctor resides in Poland, Ohio, with his wife, Tina, an attorney who is currently “When I went to college and started the staying home to care for their three sons, pre-med program, my desire to go into Luke, 11; Jack, 8, and Cole 6, who are medicine solidified because I was around all active and enjoy athletics. “In my free a lot of other students who motivated time I do things with my family,” Dr. Fulton me,” Dr. Fulton notes. “Then in the fourth says. “I also like to golf.” year of general surgery, I did a rotation
might not have made it. This is one of
Recipe Roundup
Invent-Your-Own Pasta Primavera Here is your chance to bring out the creative chef in you. Start with hearthealthy olive oil and roast the vegetables of your choice. If you haven’t roasted veggies before, you’re going to love this – because roasting brings out their best flavors. Toss them with whole-wheat pasta and low-fat cheese, perk them up with spices, and – shazam! – you’ll have a nutritious, low-fat entrée that will tantalize your taste buds and make your cardiologist proud. Veggie ideas: Choose your favorites at your local farmer’s market (or from your own garden). Some options include peppers (green, red, orange and/or yellow), zucchini and other squashes, tomatoes, green beans, asparagus, broccoli, cauliflower, eggplant, carrots and peas. Clean the veggies, discard their stems and seeds, and slice or chop them up. Makes about 8 servings.
Pasta Primavera Ingredients: ¼ cup extra-virgin olive oil, divided Additional veggies of your choice (go for a rainbow of colors) 1 tablespoon Italian seasoning 12 to 16 ounces whole wheat pasta of your choice 1 medium onion, sliced 2 cloves garlic, minced 1/3 cup chopped fresh basil leaves 1/3 cup chopped fresh parsley 3 tablespoons balsamic vinegar ½ cup grated Parmesan or Romano cheese Directions: Preheat oven to 450 degrees F. Line a baking sheet with aluminum foil. In a bowl, toss your veggies of choice (but not the onion and garlic) with 2 tablespoons olive oil and the Italian seasoning. Arrange on baking sheet and roast 15 minutes in oven until tender. While veggies are roasting, bring a large pot of water to boil. Add pasta and cook according to package directions; drain. Heat remaining olive oil in a large skillet. Stir in the onion and garlic and cook until tender. Mix in cooked pasta, basil, parsley, and balsamic vinegar. Gently toss and heat the dish through. Remove from heat and transfer to a large bowl. Salt and pepper to taste, while remembering that less salt is best (since sodium can raise your blood pressure). Toss with the roasted veggies and sprinkle with cheese.
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1044 Belmont Ave PO Box 1790 Youngstown, Ohio 44501-1790
Save These Dates ICD Connection Formerly known as the ICD Support Group, ICD Connection brings together people who have an implantable cardiac defibrillator (ICD), along with their family members and friends. Participants can ask questions, share experiences and learn more from presenters, as well as from other patients. Meetings are free and refreshments are served. To register for the next meeting, call the Humility of Mary Healthline at 330.480.3151. Stroke Survivors’ Support Group At monthly meetings for this group, stroke survivors and their families listen to an educational speaker, ask questions, socialize and share feelings, issues and tips with one another. Some members have only recently experienced a stroke, while others had a stroke a number of years ago. For more information, including meeting dates, times and locations, contact Mary Ann Cashier at 330.480.2876. Heart Failure Support Group This group offers patients and their families an overview of heart failure and what you can do to self-manage this chronic illness. Meetings are held at two locations, as follows:
• St. Elizabeth Health Center: 3 to 4 p.m. on the first Wednesday of each month. To register, call 330.480.3991. • St. Joseph Health Center For more information and to register for the above programs, call 330.841.4327. Mended Hearts Support Group If you have experienced a cardiac event, such as a heart attack, you may still be reeling from the aftereffects. You may suffer from depression, worry that you could experience more heart problems, or want help changing your lifestyle so that you can be healthier. Consider attending the Mended Hearts Support Group’s next meeting to learn how you can enjoy a rich, rewarding life after heart disease. Discussion topics include lifestyle changes, depression, recovery and treatment. For more information about these free meetings (including times and location), call 330.729.3782.