July 2012 Health Matters

HealthMatters To Help People Be Healthy

Latest Technology Saves Hearts, Lives

HaysMed

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July 2012

HealthMatters

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Latest Technology Saves Hearts, Lives

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Exercise, Diet the Key to Prevention

Patients Get Care Closer to Home

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t is an honor to lead such a fine, talented and professional team at DeBakey Heart. I have been the operations manager at DeBakey Heart for four years. Part of my duties at DeBakey Heart include working with other cardiologists across America.

Without fail, each of those cardiologists has praised the skill and professionalism of cardiologists, cardiothoracic surgeon, nurse practitioners, cardiothoracic operating room technicians, cath lab technicians, cardiac progressive care unit, clinic nurses, office staff and facilities as being second to none.

DeBakey Heart Institute is fulfilling the dream of world-renowned cardiac surgeon Dr. Michael E. DeBakey of providing high-quality cardiac care to rural America. Oftentimes, when a cardiac event occurs, time is of the essence,

and we are extremely fortunate to have outstanding cardiac care available at a moment’s notice.

Three years ago, my mother traveled to DeBakey Heart from the southwest Kansas town of Elkhart. She was referred by her local family physician to correct what was believed to be a relatively minor cardiac condition. Dr. Christine Fisher, her cardiologist, discovered her condition was much more serious than originally thought, and she had triple bypass surgery and a valve replaced. Happily, all went well and her life was extended by the professionals at DeBakey Heart.

I urge you to read this issue of Health Matters to make yourself aware of all the services DeBakey Heart offers. It could help you save or extend a loved one’s life.

We’re here to help Dave Coen, DeBakey Heart

Lacey Dreiling, an ultrasound technician at HaysMed, right, performs one of several cardiac screening tests on patient Dan Legleiter in May in Hays.

heart

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for the future

“It’s important for young people to be aware the decisions they make at a young age can affect them in later years.”

Dr. Jeff Curtis, Interventional Cardiologist Page 4

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Curtis

hen it comes to heart disease, there is some good news.

Studies suggest there are several ways patients can reduce their risk of acquiring a life-threatening illness, or even prevent the disease altogether.

“While patients cannot control genetics — one of several factors thought to increase the risk of heart disease — diet and exercise can go a long way in keeping people healthier longer,” said Dr. Jeff Curtis, an interventional cardiologist at HaysMed.

Prevention

Health Matters

Carmen Winter, an exercise physiologist, left, works with patient Rosemary Wickham in May at HaysMed’s Center for Health Improvement.

In an ideal situation, however, prevention needs to begin when patients are young.

“So much of what we do is seeing people who are already at the bottom of the funnel with their heart disease,” Curtis said. “But the real story with these people started years ago because most heart disease that we deal with is acquired.”

Prevention can begin when patients are as young as 15. Curtis said it’s important for young people to be aware the decisions they make at a young age can affect them in later years.

Smoking and excessive drinking are bad ideas, he said, and even young people should pick and choose the foods they eat.

Diet, however, is something people of all ages can control, and making healthy lifestyle changes benefits all patients, even those who are older or already have been diagnosed with heart disease.

Health Matters

When it comes to nutrition, moderation is key.

“You can read all the cookbooks you want to, but when it comes down to eating healthy, it’s pretty common sense,” Curtis said. “Don’t eat too much.

Don’t go eat fast food. Limit the bad fats. Eat fruits and vegetables and lean meats in moderation.”

Get moving

When it comes to prevention, exercise is another important factor.

“Having a sedentary lifestyle is probably one of the top risk factors in heart disease,” said Stephanie Schaffer, director of the Center for Health Improvement. “But it’s also one of the most controllable risk factors that we as individuals have control of.”

Hays Medical Center recently launched the Exercise Is Medicine initiative, which encourages all patients to commit to at least 30 minutes of physical activity five times a week.

Prevention

FYI

Cardiovascular screenings are available weekly in Hays and in the following locations on a quarterly basis: • Grisell Memorial Hospital, Ransom • Trego County Lemke-Memorial Hospital, WaKeeney • Logan County Hospital, Oakley • Graham County Hospital, Hill City Appointment required, please call:

The most important type of activity is aerobic, meaning it increases heart rate for a sustained period of time. Aerobic activity strengthens the heart and improves circulation, she said.

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Get tested

A third way to help prevent a lifethreatening heart disease event is early detection.

Hays Medical Center offers in-house

From the kitchen of The Center for Health Improvement

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cardiovascular screenings every Wednesday, as well as mobile screenings throughout the region.

The full screenings, which cost $75 and take about 15 minutes, check for peripheral arterial disease, an ultrasound stroke scan looking at the neck arteries, and an ultrasound scan in the abdomen to check for aneurysm.

Screening can help detect heart disease in the earliest phases, meaning it might be possible to manage with lifestyle changes or medicine.

In some instances, however, the screenings also have helped save lives.

“We had someone with a 90-percent blockage to the artery in their neck,” said

Serves approximately 53 Serving size: 1⁄4 cup 93 4.5g <1g 0 mg 12 g 25 mg 90 mg 2.6 g

Deb Miller, mobile ultrasound supervisor.

“That’s a stroke waiting to happen. ... That’s why we’re doing this.”

HaysMed also offers community blood screenings on the first Saturday of every month. The screening includes a cholesterol panel, which also could be helpful, Curtis said.

And if there’s a history of heart disease in your family tree, Curtis said it could be helpful to get checked regularly starting as young as 20.

“From a prevention standpoint, it’s just simply being aware and not having that invincible feeling (of ) ‘I won’t get heart disease’ and avoiding the things you know you shouldn’t do,” he said.

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But exercise doesn’t have to mean training for a marathon — workout regimens can be developed for everybody, regardless of physical limitations and needs, Schaffer said.

“Activities include things like walking, biking, running, swimming,” she said. “We don’t have to necessarily have our own equipment or belong to a facility. We all own the outdoors, and we can use the outdoors in many ways.”

As part of the EIM program, physicians are providing qualifying patients a piece of paper prescribing regular exercise.

Those forms are good for a free 30-minute fitness consult at CHI. Staff will visit with the patient and tailor a workout regimen based on individual needs.

Those patients are asked to call the phone number listed on the form to make an appointment.

••• Public punch card exercise classes at the Center for Health Improvement: Low and High Intensity Interval Training, Indoor/Outdoor “Potluck,” Sandbell Slam, Tabata Interval Training Xpress, Triple Threat and Tabata/HITT Training. $3 per class or $27 for 10 classes. Call (785) 623-5900.

Cardio exercise recommendations Alice Schrant and Rosemary Wickham continue their cardiac rehabilitation program at HaysMed’s Center for Health Improvement.

Health Matters

• Make you feel more relaxed and rested.

• Make you look fit and feel healthy.

In general, one should gradually work up to an aerobic session lasting 20 to 30 minutes, at least three to four times a week, accumulating a minimum of 150 minutes for the week. Exercising every day or every other day will help someone keep a regular aerobic exercise schedule. Aerobic exercises include walking, jogging, jumping rope, bicycling (stationary or outdoor), cross-country skiing, skating, rowing, and low-impact aerobics or water aerobics.

A simple exercise program should consist of: 1. Stretching: Slow lengthening of the muscles.

Stretching the arms and legs before and after exercising helps prepare the muscles

Prevention

for activity and helps prevent injury and muscle strain. Regular stretching also increases your range of motion and flexibility.

2. Cardiovascular or aerobic: Steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the body’s ability to use oxygen.

Aerobic exercise has the most benefits for your heart. Through time, aerobic exercise can help decrease your heart rate and blood pressure at rest and improve your breathing.

3. Strengthening: Repeated muscle contractions (tightening) until the muscle becomes tired. For people with heart failure, many strengthening exercises are not recommended.

When starting any exercise program, it is important to first visit with your physician.

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A sedentary (inactive) lifestyle is one of the top risk factors for heart disease.

Fortunately, it’s a risk factor we can do something about. Regular exercise, especially aerobic exercise, has many benefits.

It can: • Strengthen your heart and cardiovascular system.

• Increase energy levels so you can do more activities.

• Increase endurance.

• Lower blood pressure.

• Improve muscle tone and strength.

• Improve balance and joint flexibility.

• Strengthen bones.

• Help reduce body fat and help you reach a healthy weight.

• Help reduce stress, tension, anxiety and depression.

• Boost self-image and self-esteem.

• Improve sleep.

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Latest technology saving lives across northwest Kansas

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icheale Dewey knows firsthand how important it is to have cardiac care nearby when it’s needed.

She credits physicians at DeBakey Heart Institute at HaysMed for helping save her life — twice.

“It’s a great place,” she said. “DeBakey should have top honors, that’s for sure.”

Since opening its doors in 1998, the institute has treated thousands of northwest Kansas patients for cardiovascular complications.

“We want people to know that they can have as good quality of care here as they can get in Kansas City, Wichita, Denver,” said Dr. Christine Fisher, an interventional cardiologist at HaysMed. “We have tremendous experience and very, very good outcomes.”

Dewey, a Hoxie resident, suffered a “sudden death” heart attack about six years ago at her home. Her husband performed CPR until help arrived, and she was flown to HaysMed, where Fisher installed a defibrillator, which will shock her heart in the event of an arrhythmia.

As she was preparing to leave the hospital a few days later, she suffered a major setback. The prognosis wasn’t good, but Dewey was given a drug that helped her recover.

“I’m the miracle,” she said.

“She’s the miracle worker,” Dewey added, gesturing to Fisher.

Lab work

Many patients with possible cardiac issues are treated in the cath lab. Using a small catheter, doctors can obtain diagnostic images or deploy stents to relieve blockages in blood vessels.

Heart caths traditionally have been done through a small incision in the leg.

Recent advancements, however, have made it possible for the procedure to be done through the radial artery in the wrist. The procedure improves patient comfort — patients are able to be mobile soon after surgery.

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Dr. Elizabeth Ashworth, right, cardiothoracic surgeon at HaysMed, performs an operation in May with the help of registered nurses Theresa Haines, left, and Ron Williams.

Miracle Workers

Dr. Richard Markiewicz, right, performs a diagnostic heart catheterization procedure through a patient’s wrist.

The latest addition to cath lab services in Hays, however, is the ability to stent arteries in the neck to prevent a stroke, which is caused when blood flow to the brain is restricted severely. Dr. Richard Markiewicz has been performing the procedure in Hays since December.

“I believe I’m the busiest carotid stent implanter in the state of Kansas,” he said.

The procedure is accomplished by making a small incision in the leg, much like a traditional heart cath. The catheter is taken to the neck artery to deploy the stent.

Previously, all blocked neck arteries were treated with open surgery. Now, for selected patients, the minimally invasive stenting approach results in a shorter procedure and a faster recovery time, Markiewicz said.

“The patient is ambulatory in an hour afterward, as opposed to going to ICU after surgery and having a surgical wound,” he said.

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This image shows the right coronary artery in the heart where a thin plastic tube was inserted to check for blockage in the blood vessels during a diagnostic heart catheterization procedure.

Much like when Hays began offering the radial heart caths, the carotid stenting is on the leading edge of medicine, Markiewicz said. And that’s the goal of DeBakey Heart Institute.

“I think that all started, really, when

In

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DeBakey came out here and established a program,” he said. “He pioneered bypass surgery, and he brought it to rural America ... and I think it’s been passed down along the way and Hays has stayed out on the cutting edge.”

Health Matters

Heart of the operation While many patients can be treated with heart stents, some cases of heart disease are so severe they are treated best in the operating room.

DeBakey Heart Institute also offers a wide range of surgical services, such as bypass surgery, valve repairs and repair of aortic aneurysms.

In addition to vascular surgeries, cardiothoracic surgeon Dr. Elizabeth Ashworth also operates on patients’ lungs.

“We basically can cover just about everything, from head to toe,” Ashworth said.

One recent advancement has been the introduction of a minimally invasive procedure using stents to treat aortic aneurysms.

“We don’t have to open up the abdomen the way we used to, which was a lengthy stay in the hospital and a lot of discomfort,” she said. “Now I make two little incisions ... and the patients often go home the next day.”

Bypass surgeries are the most common cardiac operation done at HaysMed. About 10 to 15 surgeries are done each month.

While some surgeries are scheduled in advance, Ashworth responds to many emergency situations.

“Our team is on-call basically 24/7, and we’re very accustomed to emergencies and mobilizing very quickly,” she said.

Ashworth also leads a vein clinic that treats ailments such as varicose veins.

Those treatments range from simple injections to laser to surgery.

The vein treatments have been in high demand since the clinic started in 2005.

HaysMed is the only hospital in western Kansas that offers complete cardiac care, meaning interventional cardiology and open-heart surgery.

Thus, Ashworth treats patients from the Russell area west to the Colorado border.

“I feel very privileged to provide care for a lot of these people because they are not anywhere near cardiac care,” she said.

“We have people come in by helicopter, by fixed-wing (airplane), by car, by ambulance, how ever we can get them here and are able to take care of them very rapidly.

“I think patients feel at home here and Health Matters

“I think patients feel at home here and know we genuinely care about them, and our whole goal is to get them better.”

Dr. Elizabeth Ashworth

know we genuinely care about them, and our whole goal is to get them better.”

Keeping pace

DeBakey Heart Institute also treats many patients with irregular heartbeats.

Since Fisher began work as one of the hospital’s first cardiologists 15 years ago, installing pacemakers and defibrillators has become a passion for her.

“As I started doing it more, I just really

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enjoyed it,” she said. “And as the devices became more sophisticated, it became more interesting.”

Fisher recently underwent training to become a board-certified cardiac device specialist.

Pacemakers are used to help regulate heart arrhythmias, and defibrillators can help shock the heart back to life in the event of a severe heart attack.

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The newest devices installed in Hays are a combination of both.

All three models installed in Hays are small enough to be implanted surgically in the chest, whereas the earlier models were so large they had to be placed in the abdomen.

Heart rhythm problems are common in seniors, and Fisher said more electrical devices are installed in Hays than in many larger cities due to the area’s aging population.

In fact, three representatives with Boston Scientific — the medical supplier HaysMed uses for its devices — have fulltime jobs servicing the hospital.

“We really do cover the whole western half of the state,” Fisher said. “So it’s a very large area.”

A recent innovation will enable the hospital to check patient devices electronically through an Internet-based process known as remote monitoring.

Patients can be given a monitoring device they can place over the pacemaker or defibrillator, and physicians in Hays then will be able to read the data and determine if there’s a problem.

That technology especially will be useful since Hays serves such a large area of Kansas, Fisher said.

It’s also hoped this process will help doctors catch potential problems earlier.

“Often these patients would stay home for several days before they would come in and now we can just call them and say ‘How are you doing?’ “ Fisher said. “By intervening early, we can keep them out of the hospital.”

Dr. Elizabeth Ashworth performs a procedure in the operating room in May at HaysMed.

DeBakey Heart Institute • Average of 135 heart surgeries per year • Average of 1,000 caths performed each year • Patients having heart surgery come from 32 counties in western Kansas • 22 Cardiovascular Outreach Clinics in the region • 2,222 patients were seen by the DeBakey Heart Institute last year • More than 350 heart screenings were completed last year.

“Because Hays is the outpost for cardiology in northwest Kansas, we have to have a way to get patients who have emergencies the care they need as quickly as possible.”

Saving time, lives

HaysMed’s newest interventional cardiologist, Dr. Aaron Doonan, began work in August.

Since then, he has helped launch a new protocol called Clinical Decision Unit (CDU) to help expedite care for patients admitted to the emergency room with chest pain.

Those patients are given red charts, and staff knows to order diagnostic tests, such as stress tests, right away, he said.

“What we usually do is try to rule out the most lethal problem, which is usually the heart problems, quickly,” Doonan said. “That way we can move on and try to figure out something else, if it is something else.”

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Dr. Aaron Doonan, interventional cardiologist

Doonan

The initiative went live in February.

Another set of protocols that will apply to Critical Access Hospitals in the area began in June. Treatment protocols based on geography, simply called Level One, were implemented to help area patients access help sooner for cardiac emergencies.

In Focus

“Because Hays is the outpost for cardiology in northwest Kansas, we have to have a way to get patients who have emergencies the care they need as quickly as possible,” he said. “Every minute that is delayed in the patient getting treatment can equal more heart damage.”

Health Matters

FYI

Remote cardiac rehabilitation is available at the following sites: • Atwood • Colby • Jetmore • Kinsley • Lakin • Ness City • Oakley • Oberlin • Quinter • Smith Center • Tribune • WaKeeney

The area has been divided into two zones. The first consists of all hospitals within 70 miles of Hays, and the second includes all hospitals farther away.

“Protocols for each zone are a little different because when you lie outside that 70-mile radius, it’s going to take you longer to get here,” he said. “We give different medications; we try to facilitate some sort of improved blood flow before patients get here.”

Anytime a patient comes to a transfer center with chest pain, area health care providers will have a to-do list. The list begins with giving patients aspirin and conducting a stress test, for example.

HaysMed is working closely with EagleMed on the initiative; an immediate transfer to Hays will be triggered if an area hospital suspects a patient is suffering a heart attack.

“Once the patient gets here, they’re taken emergently to the cath lab,” he said. “It’s another thing to reduce the time that it takes them to get here.”

After surgery

Taking care of a patient, of course, doesn’t stop with surgery.

The 22-bed Cardiac Progressive Care Unit’s staff is trained to help people reHealth Matters

Did

you know?

Since the inception of DeBakey Heart Institute in 1998, more than 1,750 open-heart surgeries have been performed in Hays. cover physically, emotionally and spiritually.

“The CPCU nurses have set an extremely high standard of care for their delivery,” said CPCU manager Karen Aten.

“And they consistently meet that on a daily basis.”

The average daily census in the unit is about 20 patients, she said, and the average length of stay is between three and five days.

During their stay in the unit, patients begin physical and occupational therapy.

They are taught how to do basic skills for their continued recovery at home.

Aten has been managing the unit since 2000, and since that time, she has seen the number of beds grow from two to 22.

“Hays Medical Center has increased their capacity to meet the needs of the community,” Aten said.

Within a month after surgery, patients head to the Center for Health Improve-

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Dr. Christine Fisher, left, and Amy Choitz, clinical coordinator, examine a patient’s records in May at the Cardiac Rehabilitation Clinic at HaysMed’s Center for Health Improvement.

ment to begin rehabilitation. Cardiac rehab has been recognized as a standard of care for patients following most types of heart surgery.

Most patients have rehabilitation in which they are taught various exercises to boost cardio and respiratory endurance and build muscle strength, three times a week for as long as 12 weeks.

“For patients who have had a bypass surgery or a really invasive procedure, some of it is getting them back into their daily routines — grocery store, bathing themselves,” said Carmen Winter, an exercise physiologist. “Eventually, we want to get them into a higher level exercise program they can maintain on their own.”

Cardiac rehab staff monitors patients’ heart rates and rhythms during rehabilitation. In fact, using a computer connection, staff also monitors the EKGs of patients undergoing rehab in other area hospitals.

Staff in Hays also wears headsets, enabling instant communication with other hospitals if a problem arises.

The rehabilitation process, however, is more than just exercise. The goal is to help patients make permanent changes that could help them manage their heart disease.

“We want to work with them on understanding what their target cholesterols are, what their target blood pressure is,” said Amy Choitz, clinical coordinator. “We have a big treatment plan for them. A lot of it looks like exercise, but it’s just really a whole lifestyle modification.”

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Closer to home Dr. Christine Fisher, an interventional cardiologist at HaysMed, uses a stethoscope to listen to the beating heart of Doreen Wildeman, Grainfield, during a checkup in May with the DeBakey Heart Outreach Clinic at Gove County Medical Center in Quinter.

Outreach clinics bring attention to patients in rural areas Page 14

D

oreen Wildeman greeted her doctor with a hug.

“You are one swell person,” she said.

After being diagnosed with a heart arrhythmia, Wildeman had a pacemaker installed nearly 15 years ago in Hays.

Dr. Christine Fisher was the cardiologist who put it in, and she was the doctor seated next to Wildeman at Gove County Medical Center for a routine checkup.

Outreach

The cardiology services offered at HaysMed’s DeBakey Heart Institute have proven so popular the institute’s cardiologists have taken the show on the road.

Fisher travels to 11 regional hospitals to conduct cardiology outreach clinics each month. In total, HaysMed cardiologists visit 22 area hospitals each month.

Wildeman, along with the 30 other patients Fisher visited May 22 in Quinter, appreciates the opportunity to receive services closer to home.

Health Matters

Wildeman visits with John Graves, a representative of Boston Scientific, as he checks her pacemaker during her appointment in Quinter.

Health Matters

“I don’t have to make a trip to Hays. I’ve had to make a lot.”

Doreen Wildeman, Grainfield patient (heart attack) here and needed emergent intervention, we had to ship them to Wichita,” he said. “That’s a four-hour drive.”

He also said he has appreciated the relationship he has with Hays cardiologists as a referring physician. The specialists are always cooperative and ready to help when he has a patient in distress, he said.

When it comes to outreach, however, the weather doesn’t always cooperate.

The medical team drives to most outreach locations, but flies to the more distant communities, such as Tribune. They have braved ice-packed roads. There have been times the plane hasn’t been able to land because of low clouds and visibility.

But there’s no doubt the long days and sometimes uncertain circumstances are well worth it, Fisher said.

“I’ve done this for years, and I enjoy those outreach clinics because the patients are always very nice,” she said.

Dr. Michael Machen, a family practice physician at Gove County Medical Center, talks about serving the people of Gove County.

FYI DeBakey Heart Institute offers outreach cardiology clinics in the following locations: Lincoln Atwood Norton Great Bend Oakley Colby Oberlin Dighton Quinter Ellsworth Phillipsburg Goodland Plainville Hill City Scott City Jetmore St. Francis Larned Tribune Lakin WaKeeney Ness City

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“I don’t have to make a trip to Hays,” Wildeman said. “I’ve had to make a lot.”

To be sure, outreach clinics make for long days. For the cardiology team, which includes a physician, certified nurse assistants and medical device representatives, work begins when they leave Hays at 7 a.m. The day ends about 12 hours later — or more.

The day is spent seeing as many patients as possible. Some patients need to have pacemakers and defibrillators checked, some are follow-up from a recent surgery and others are new patients reporting possible cardiac symptoms.

Dr. Michael Machen, a family medicine physician in Quinter, said he appreciates the outreach services.

“It’s convenient and it’s reassuring for some of these patients that they don’t have to drive so far,” he said. “Some of them are a little bit frail, and for their families to take them to and from Hays can be difficult.”

Machen, who has been practicing medicine in Quinter for 15 years, said having heart services nearby has improved patient care throughout northwest Kansas.

“If you had somebody that had a

Outreach

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