Healthcare in Hampton Roads - November 2010 Edition by Darden Publishing

Healthcare November 2010-April 2011

FOCUS:

LEADING EDGE

CAR DIAC CARDIAC SERVICES In Hampton Roads

Women & Heart Disease Q&A: Dr. Edward Chu, FACC Nutrition & Wellness

LETTER: Senator Mark Warner

CONGRATULATIONS on this issue of “Healthcare in Hampton Roads,” a publication that will give the health community an opportunity to share and promote the region’s most effective services to help residents stay healthy and active. Hampton Roads already is a proven leader in increasing quality and improving services in health care. In addition to the cutting-edge education programs available for medical training, the regions’ health care providers are nationally-recognized leaders in replacing paper charts with electronic medical records. By utilizing this technology, hundreds of medical facilities can share valuable information about a patient’s medical history, helping to reduce administrative costs and improve the quality of treatment. While Hampton Roads has taken the initiative to improve health care at the local level, there is still work to be done to fix the system as a whole. As I write this, Congress is working on proposals to reform our nation’s health care system. While it’s too early to say what the final legislation may or may not look like, Congress has already acted on several new opportunities this year that will improve the way we deliver health care to patients. The American Recovery and Reinvestment Act included billions of one-time dollars for health information technology to jumpstart efforts to modernize the health care system. The ARRA also made a billion dollar investment in comparatives effectiveness research, as well as prevention and wellness programs. Investing in comparative effectiveness research will allow doctors to collaborate with one another and find the effective treatment options and services. Similarly, preventative medicine will help reduce health care spending for patients and hospitals and improve the overall quality of care. Such reforms affect more than just our health care system. Health care providers in Hampton Roads know that by improving the quality of care, they can improve the quality of life for the entire community and can lead to greater economic viability. The quality of service provided in Hampton Roads can help the region stay competitive, by lowering the cost of care and improving productivity. As more significant reform is debated in Congress, the quality and affordability offered in the Hampton Roads region should serve as a blueprint for how our national health care system can be fixed. I will continue to rely on the expertise of the medical community so we can enact significant and practical reforms that reduce waste and cost and improve care for all Virginians. Best Regards,

Mark R. Warner

Healthcare

NOVEMBER 2010-APRIL 2011

features FOCUS: Cardiac Care

COVER STORY Leading Edge Cardiac Services in Hampton Roads Hampton Roads ranks among the best in the country for cardiac services provided by four major providers: Bon Secours Hampton Roads, Chesapeake Regional Medical Center, Riverside Health System and Sentara Healthcare.

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Keeping the Flow Going Unsung Heroes Mystery Among Us Women and Heart Disease

22 departments 24

Ask the Expert Q & A with Dr. Edward Chu, FACC

Nutrition and Wellness Childhood Obesity Epidemic

in every issue 2 28

Letter from the Publisher Health Directory

FROM THE PUBLISHER

Hello Neighbors

s a child I remember times when I got sick and my parents took care of me. I recall listening to dad and mom talk about the best way to make me feel better. Sometimes my sickness was brief, while others lasted for weeks. I remember going to the doctor’s office but not very often. Maybe it was a cost issue. I also remember doctors coming to our home, putting things in my ears, feeling my throat, taking my pulse and listening to my heart beat as they talked to my parents about my symptoms.

PUBLISHER

Paul Quillin Darden EXECUTIVE MEDICAL RESEARCH DIRECTOR

J. Wilson Futrell, Jr. ART DIRECTOR

I often thought my parents knew everything when they made me feel better. The earache pain was relieved by sleeping on a hot brick wrapped in a towel. My sore throat was relieved with hot salt water and my thirst was quenched with ice cubes. My weakness and fever were broke by staying in bed wrapped in blankets and drinking hot soup. But one time I remember visiting doctor after doctor yet no one knew what was causing red bumps under my skin. Chicken pox was suspected, but normally pox blisters are on top of the skin. This went on for weeks and eventually my fever grew worse. Finally my father took the practice of medicine into his own hands. One night he took me into the garden and did what seemed like some sort of magic on me. I thought he gave me syrup medicine to swallow, but months later I found out it was bourbon mixed with sugar and the blood of a frog…yes a frog! The next morning I woke up and the blisters under my skin rose to the surface and began oozing out a clear liquid that after a few days finally went away. It was then discovered that I did indeed have a rare form of chicken pox.

Sherril Schmitz CONTRIBUTING WRITERS

Susan S. Acker Dr. Edward Chu, FACC Brian Cole J. Wilson Futrell, Jr. Reesy Floyd Thompson

©Copyright 2010 by Darden Publishing. The information herein has been obtained from sources believed to be reliable: however, Darden Publishing makes no warranty to the accuracy or reliability of this information. Healthcare in Hampton Roads is a bi-annual publication with

Health care has changed a lot since those days. In the past my grandparents along with many folks in this area were told to go to Richmond’s MCV or Duke University in North Carolina to seek the best in medical attention. Today you can get the best medical advice and treatment with some of the best skilled surgeons and medical facilities right here in our own backyard of Hampton Roads, Virginia.

current distribution to area Chambers of Commerce, Military bases and a delivery program to selected health related businesses throughout Hampton Roads. To obtain a copy or to find a location nearest you, please contact:

Healthcare in Hampton Roads is our new publication with a mission to spread the word about the latest health topics, local awards, accolades and quality of healthcare available for people in all stages of their lives. I see it every day when I visit the sick and listen to their stories of how our health professionals from Hampton Roads saved a life or recommended a new procedure that put bounce back in their step.

DARDEN PUBLISHING

931 A Shoal Creek Trail Chesapeake, Virginia 23320 (757) 389-5473 darden.publishing@cox.net www.dardenpublishing.net

In upcoming editions we will present national health concerns in a way that you can understand and hopefully share your new found knowledge with family and friends so we all can live longer, healthier lives with confidence that we are in good hands right here in Hampton Roads. To Good Health! PLEASE SUPPORT.

Paul Q. Darden, Publisher

Healthcare in Hampton Roads

LEADING EDGE CARDIAC SERVICES IN HAMPTON ROADS:

Where Less Means Edited by J. Wilson Futrell, Jr.

ampton Roads is “America’s First Region” and home to some of the best healthcare services for cardiac care in the country as evidenced by the recognition the major local providers have all received when compared to providers across the country. Cardiac services offered locally have consistently met or exceeded national standards of care. This level of service is achieved by an unending commitment to the latest in technology and procedure protocols. But when it comes to providing the best in cardiac care, the theme is definitely “less is more.” Local providers constantly strive to lessen the time it takes to initiate appropriate treatment for patients with heart problems. They use a measurement called “door-to-balloon” time which is the time it takes to get a patient arriving at the hospital the appropriate interventional treatment such as the insertion of a small balloon into a vessel to open a blockage. This measure is monitored with ongoing efforts to further decrease the response time. The providers also use technology to lessen the procedure times for patients. New equipment decreases the amount of radiation exposure for the patient. Most significantly, surgeries which can be performed through small incisions or avoided altogether are increasingly taking the place of more traumatic traditional open heart surgeries. All of this effort to lessen the time and impact of treatments leads to more patient comfort, better outcomes, more rapid recoveries and a better quality of life for the patient. So, indeed, progress is realized through “less is more” when it comes to cardiac care. This cover story looks specifically at the cardiac services provided by the four major providers in Hampton Roads: Bon Secours Hampton Roads, Chesapeake Regional Medical Center, Riverside Health System and Sentara Healthcare. In this section, some of the leading-edge services are presented by provider. While the complement of services may vary somewhat between the providers, they all have proven track records for providing Hampton Roads with the latest in cardiac care which ranks among the best in the country.

Special thanks is extended to the providers for sharing and allowing the use of their information to help spread the word that “America’s First Region” is also home to some of America’s best healthcare.

FOCUS: Cardiac Care

Bon Secours Hampton Roads B

on Secours Health System provides cardiac services through its Heart and Vascular Institute which includes diagnostic and treatment services and an open heart surgery program at Bon Secours Maryview in Portsmouth, and diagnostic and treatment programs at Bon Secours DePaul Medical Center in Norfolk and Mary Immaculate Hospital in Newport News. Each facility provides comprehensive inpatient and extensive outpatient services which include comprehensive cardiac imaging and interventional services. The Heart and Vascular Institute was started as a partnership with Columbia College of Physicians and Surgeons. This partnership gives Bon Secours access to innovative, life-saving procedures being performed by one of the highest-ranked surgical programs in the country. The team of cardiologists, cardiac and thoracic surgeons, nurses, nurse managers, anesthesiologists, physician assistants and clinical assistants at Bon Secours all receive ongoing training and oversight from the Columbia University College of Physicians and Surgeons. This partnership allows the care team to receive hands-on training in actual surgery at the New York-Presbyterian Hospital/Columbia University Medical Center, ranked sixth among the nation’s top heart programs in 2009 by U.S. News and World Report, “America’s Best Hospitals.”

Healthcare in Hampton Roads

The partnership with Columbia puts the surgeons at Bon Secours Cardiovascular and Thoracic Specialists (BSCTS) on the front row of research breakthroughs at the University allowing them to quickly put new discoveries into practice here in Hampton Roads. Their access to Columbia’s extensive database is a valuable resource for clinical information. As part of the Bon Secours partnership with Columbia University, educational opportunities through lectures and symposiums, are extended to the entire Hampton Roads medical community. Other benefits from this partnership include new innovations and technology which may not be currently available in the region, a decreased need for patients to travel to multiple facilities for services and greater continuity of care for cardiac patients and their families. The Heart and Vascular Institute has received recognition for exceeding national standards for quality health care. The Institute has been designated by the United Health Premium Cardiac Specialty Center for offering quality, cost-effective cardiac procedures and cardiac care services. The Bon Secours Heart and Vascular Institute at Bon Secours Maryview has also been designated a Blue Distinction Center for Cardiac Care by Anthem Blue Cross/Blue Shield of Virginia. This designation means that Bon Secours has demonstrated expertise in deliver-

COURTESY OF BON SECOURS HAMPTON ROADS

ing quality healthcare based on rigorous, evidence-based criteria established in collaboration with expert physicians’ and medical organizations’ recommendations. The Society for Thoracic Surgeons (STS) consistently ranks the Heart and Vascular Institute with lower than average complication rates, mortality rates and low rates of infection. The Society also ranked the Institute with above-average overall ratings. After just two years of partnering with Columbia University, Bon Secours Heart Institute has met or performed better than STS benchmarks for sternal wound infections and postoperative transient stroke for all cardiac surgeries, not just coronary Bon Secours Heart and Vascular Institute at Bon Secours Maryview partnered with Columbia University College of artery bypass procedures. Physicians and Surgeons to bring open-heart services to Western Hampton Roads. A look at some of the services offered by Bon Secours will demonstrate how this level of performance with a patient navigator, or staff representative, working alongwas reached. The Institute offers state-of-the-art services side the patient to assist him or her through the process from including two open heart surgery/cardiothoracic operating call to discharge. rooms, two cardiac catheterization laboratories, an electrophysAn example of an innovative surgery at Bon Secours Heart iology laboratory, cardiac treatment area, diagnostic cardiology, and Vascular Institute is the DAVID procedure. This complex cardiac wellness and rehabilitation program, noninvasive procedure is used to repair an aortic root aneurism, which is a vascular lab, 12 step-down telemetry beds, five cardiovascular weakness in the wall of the main artery from the heart. As the recovery/ICU beds, aorta swells and thins, the aortic valve can begin to leak. In many 12 private telemetry beds and six cardiac ICU beds. An expeditious response to patients’ cardiac symptoms is very important to improved outcomes. At Bon Secours An expeditious response to patients’ cardiac hospitals, emergency teams ensure that appropriate care begins symptoms is very important to improved outcomes. without delay. Physicians have written standing orders for At Bon Secours hospitals, emergency teams ensure patients who present with abnormal electrocardiograms, chest that appropriate care begins without delay. pain and acute coronary syndrome. At Maryview and DePaul hospitals, cardiologists are in the hospital from 7 am to 7 pm to instances, the aortic valve itself is fine. The DAVID procedure ensure that patients have rapid access to a cardiologist and can allows the surgeon to replace the problematic aorta while retainproceed with a diagnosis and treatment. Bon Secours tracks ing the patient’s aortic valve. This procedure is beneficial especially door-to-balloon times and the staff works in collaboration with for younger adults. By preserving the patient’s aortic valve, they Emergency Medical Services (EMS) personnel and the American avoid a lifetime of taking anticoagulant medications. In fact, Bon Heart Association to continuously review and improve, where Secours Heart and Institute surgeons repair, as opposed to replace, possible, processes to achieve better outcomes. Within the more than 25% of the heart valve cases referred to them. next year, all of the emergency departments in Bon Secours Bon Secours Heart Institute surgeons are incorporating the Hampton Roads hospitals are on schedule to become accredituse of Platelet Rich Plasma (PRP) on surgical wounds for its proven ed Chest Pain Centers. effectiveness at accelerating healing, inhibiting infection and Bon Secours hospitals are currently activating the “onereducing scarring. This innovative solution is made from the call” system. With this system, a physician who has identified patient’s own blood that is collected at the time of surgery. It is a patient in need of urgent cardiac intervention can make 100% compatible with the patient and poses no infectious risk one phone call and access to ground or air transportation is since it is made from the patient’s own plasma. arranged. This service also includes a streamlined process that Traditionally, heart surgery was done “on pump” or with performs all pre-admission testing at the time of other tests,

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Healthcare in Hampton Roads

FOCUS: Cardiac Care

so good that patients who have undergone heart valve or bypass surgery, and who also have a history of irregular heartbeat, are now getting this procedure at the same time. The cardiothoracic surgical teams are often invited to participate in a variety of clinical trials that are associated with Columbia University. Upcoming trials include studies comparing the effectiveness of various new techniques in cardiac bypass surgery and valve surgery. The knowledge gained from these clinical trials is disseminated to Columbia’s partner hospitals. It also means that the residents of Hampton Roads have access to the most innovative procedures and treatments offered anywhere in the world. Technology is also used outside of the operating room to help lessen the tension of family members. Cell phones are provided to families so they can leave the waiting area during loved one’s surgery with the assurance that they will be notified immediately when there is news. In the waiting area, telephones and computers with email service help anxious family members keep abreast of the patient’s progress. A part of providing leading-edge cardiac care is the reaching out to parts of the community at risk for heart disease. Bon Secours Heart Health Assessment is a free online cardiac risk assessment. This online questionnaire provides knowledge about heart disease while providing a personalized risk assessment which may motiLeft to right: H. D. Nair, MD, FACC, Caroline Inch, RN, Cardiac Nurse and K. C. Kurian, MD work in vate someone to seek preventative care or make collaboration to care for cardiac patients at Bon Secours DePaul Medical Center. healthier choices. In addition to this general health assessment, Bon Secours has programs targeted to women and Secours Heart Institute are now performing 25% of the isolated African-Americans. Bon Secours Hampton Roads is a certified coronary artery bypass graft surgeries “off pump.” HeartCaring hospital. HeartCaring is a Spirit of Women program Robotic surgery, where mechanical "arms" assist the designed to improve women’s heart health in the community. surgeon by working in a smaller space, is part of the minimally HeartCaring involves hospitals, physicians, and consumers in an invasive surgical program at Bon Secours Heart and Vascular effort to decrease the occurrence of death due to heart disease Institute. Often, minimally invasive procedures are done within women by increasing awareness and prevention. out having to break the sternum or chest bone and result in a African-Americans are at a greater risk for heart disease faster, less painful recovery for the patient. than the general population. Bon Secours’ “Let’s Get Real” In addition, new valve replacement and bypass techniques is a community outreach program that focuses on educating are being tested now at Columbia University and they will be African-American women about heart health in a culturally brought to Hampton Roads when proven safe and effective, sensitive way. The goal of this program is to raise awareness thus ensuring continued access to leading-edge cardiac care. and lower the risk for heart disease among African-American Bon Secours Cardiovascular and Thoracic Specialists are women in Hampton Roads. also using innovative techniques to treat atrial fibrillation in its The Bon Secours Heart and Vascular Institute joins other dedicated electrophysiology lab. This condition is caused by a providers in Hampton Roads in ensuring that the latest technology disturbance in the electrical impulses of the heart and results in an and practices in cardiac care is available to people right here at irregular heartbeat. A new treatment for this condition is being home. To learn more about the services provided by Bon Secours, successfully used at Bon Secours. An energy source is introduced please see the Directory section under “Where to Find It.” ■ to the surface of the heart which eliminates the sources of the disturbance to the heart's normal rhythm. The results have been COURTESY OF BON SECOURS HAMPTON ROADS

the patient attached to a heart-lung machine. Now, thanks to techniques pioneered and shared by Columbia University, BSCTS surgeons are performing a variety of “off pump” open heart surgeries. There is a decreased risk of complications during “off pump” open heart surgery. The “off pump” option is especially advantageous when treating heart conditions in the elderly and people with certain pre-existing conditions. The surgeons at Bon

Healthcare in Hampton Roads

hesapeake Regional Medical Center (CRMC) provides the latest techniques in cardiac care at Chesapeake General Hospital in Chesapeake. For its efforts, it has been recognized by the American College of Cardiology (ACC), the premier organization for monitoring quality performance indicators for cardiovascular services, as the nationâ&#x20AC;&#x2122;s No. 1 hospital for interventional cardiovascular outcomes. A key part of this success is the immediate medical attention patients with chest pain receive upon arrival at Chesapeake Regional. CRMC has a chest pain center which has been awarded full accreditation from the Society of Chest Pain Centers â&#x20AC;&#x201C; the only accredited center in the Hampton Roads region and only one of four in Virginia. To earn the designation, nationally recognized experts visited CRMC to verify

COURTESY OF CHESAPEAKE REGIONAL MEDICAL CENTER

Chesapeake Regional Medical Center

FOCUS: Cardiac Care

that heart attack patients are receiving the most advanced and best possible care. The society has strict criteria and only accredits those that closely follow the ACC and the American Heart Association’s (AHA) recommendations. What this means to the patient is that CRMC has implemented a carefully orchestrated system of checks and balances that takes the patient from the 911 call or walk in the emergency room to the appropriate necessary treatment. Chest pain is the most common reason patients come to the emergency room and speed in their treatment is important. For those who arrive by ambulance, the process begins before they even get to the hospital with the 911 call. As soon as Emergency Medical Services (EMS) crews arrive at the patient, the staff at CRMC is alerted to the patient’s status. EMS teams are able to perform EKG’s, which measure the heart’s electrical activity, in the field. The results are sent within seconds to the Emergency Room (ER). This early data allows the cardiac team to be in place as soon as the patient arrives at the ER. Doctors, nurses and technicians assess the data and prepare for the patient’s arrival. Upon arrival at the ER, the patient is assessed in the Chest Pain Center. The Center is a separate unit that provides the means to quickly and efficiently evaluate the causes of chest pain. It features an extensive monitoring system that includes advanced cardiac stress tests and an evaluation unit for individuals suffering chest pain without evidence of a heart attack. A highly skilled team with

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processes in addition to utilizing the latest equipment. To help physicians make their diagnosis, CRMC is also equipped with an advanced CT scanner. It provides 64-slice scans within seconds, giving the physician the ability to quickly diagnose patients and, in many cases, avoid a cardiac catheterization. CRMC’s cardiac catheterization labs are equipped with two sophisticated digital x-ray systems so physicians have a distortion-free, high resolution, three-dimensional image of the heart’s coronary arteries. The CRMC labs were the first in Virginia to acquire and utilize these sophisticated systems. Here, a dedicated team of cardiologists, interventional radiologists and vascular surgeons as well as specially trained nurses and technicians identify cardiac abnormalities and injuries. The injection of contrast media (or “dye”) to assist in viewing the coronary arteries in a procedure called an angiogram has been switched from manual to automatic. This process uses less contrast, is more efficient and exposes the patient to less radiation as it expedites patient throughput. The catheterization labs also have a state-of-the-art archival system that will allow cardiologists to compare images such as angiograms and echocardiograms on the same patient side-by-side. It also allows the physician to pull up ultrasound, EKG or other information on the patient right in the room. The physician can also rapidly access this information from his home, if necessary. This is an effective way in which electronic medical records and data systems directly and significantly improve the quality of patient care. In the cardiac catheterization lab, a As part of its recognition for being ranked as catheter is used to create a large opening No. 1 nationally for cardiac outcomes, CRMC’s in the vessel to increase blood flow in the catheterization labs received a No. 1 ranking in arteries of the heart. These are called “Procedures Success,” which means a high angioplasties. A small balloon is can be percentage of patients did not require open heart inflated inside the blocked artery to open surgeries after undergoing procedures in the lab. the blocked area. A coronary artery stent – a tiny coil or wire mesh – can be inserted and expanded to open the blockage. It is advanced knowledge in managing heart attacks provides rapid left in place to keep the artery open and contains medication therapy to decide whether immediate medical treatment is to reduce the chances of the artery blockage recurring. warranted, further tests are needed or observation is necessary. As part of its recognition for being ranked as No. 1 With these efforts in early assessment in place, CRMC is often nationally for cardiac outcomes, CRMC’s catheterization labs below the national standard of “door to balloon” time of received a No. 1 ranking in “Procedures Success,” which 90 minutes. means a high percentage of patients did not require open The efforts of CRMC to expedite care go on further. heart surgeries after undergoing procedures in the lab, and According to Sherwood Moore, Cardiovascular Service Line in “Angiographic Success”, indicating the labs experienced Administrator at CRMC, the hospital is working very closely a high number of first time successes when placing cardiac with the City of Chesapeake to focus on a new measurement stents. Medical center officials point out that these results benchmark of “EMS to balloon.” A multidisciplinary team show that patients are truly getting topnotch care at CRMC made up of city EMS personnel and hospital personnel is that prevents many from having to undergo more invasive working on setting goals which incorporate the time between open heart surgeries. when EMS personnel arrive on the scene to ascertain the CRMC offers specialized post procedure care in its patient’s condition and when the patient receives the appropridedicated Cardiac Step Down Unit. Here, patients receive ate intervention at the hospital. This effort is an excellent continuous intensive monitoring and specialized care without example of providing state-of-the-art care through integrated the intensity of the ICU. The unit has a nurse-to-patient ratio

Healthcare in Hampton Roads

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COURTESY OF CHESAPEAKE REGIONAL MEDICAL CENTER

of one-to-four, bedside and central station monitoring equipment and a highly trained cardiac nursing team. In order to assist the patient’s return to a normal routine, CRMC has a cardiac rehabilitation service that is nationally certified through the American Association of Cardiovascular and Pulmonary Rehabilitation. The program is designed to return patients to a normal routine, answer questions and concerns they might have after having a cardiac event or procedure and help improve their overall health by identifying and reducing the risk factors that lead to cardiovascular disease. The program addresses the physical, emotional, nutritional and vocational needs of the individual. It includes a supervised, regular progression of activity designed to strengthen the cardiovascular system as well as increase muscular strength and Chesapeake Regional performs close to 20,000 surgical procedures a year in a wide range of specialties. flexibility. A more detailed look at cardiac rehabilitation services offered in the area and their impact is presented in the These measure the heart’s electrical activity and blood flow “Unsung Heroes” article later in this issue. through the heart’s chambers and arteries with the use of Since February, 2007, CRMC has been the official regional ultrasound imaging and low level radioactive dyes which show sponsor for the American Heart Association’s Go Red for blood flow and heart muscle efficiencies. Women campaign. As presenting sponsor in South Hampton Through its state-of-the-art facilities and practices as Roads, CRMC works with the AHA’s local chapter to offer evidenced by the national recognition for its programs, CRMC women opportunities to take action to reduce their risk of provides the latest in cardiac care for the people right here in heart disease. Hampton Roads. For more information on CRMC and its CRMC offers an array of other invasive and noninvasive cardiac services, please see the Directory section under “Where cardiac diagnostic tests and tools that use the latest technology to Find It.” ■ to further understand and identify cardiovascular disease. Healthcare in Hampton Roads

Riverside Health System R

COURTESY OF RIVERSIDE HEALTH SYSTEM

iverside Regional Medical Center provides cardiac services on the Virginia Peninsula through its Heart and Vascular Center located at the medical center in Newport News. It has been recognized three times as one of the nation’s 100 top cardiovascular hospitals by Solucient®, a leading provider of information and solutions to improve the cost and quality of healthcare.. This award for cardiovascular services objectively measures performance on key criteria at the nation’s top performing acute care hospitals. Hospitals receiving this designation have higher efficiency and

Healthcare in Hampton Roads

patient outcomes ratings as measured by procedure mortality, complications, length-of-stay and average costs than peer hospitals who have not received this designation. Riverside has also been designated a Blue Distinction Center for Cardiac Care by Anthem Blue Cross/Blue Shield which means that Riverside has demonstrated expertise in delivering quality healthcare based on rigorous evidence-based selection criteria established in collaboration with expert physician and medical organizations’ recommendations. Riverside Medical Group physicians have earned recognition by the National Committee for Quality Assurance (NCQA) for delivery of quality cardiovascular and cerebrovascular care. This Heart/Stroke Recognition Program, created by NCQA, the American Heart Association and the American Stroke Association awards recognition to physicians who demonstrate high quality in providing care to patients with heart or vascular conditions or who have had a stroke. In addition to recognizing physicians who deliver quality cardiovascular and stroke treatment, the Recognition Program was also designed to improve the quality of care that stroke and heart disease

FOCUS: Cardiac Care

patients receive. Twenty-six of the 27 physicians recognized in the Commonwealth of Virginia are Riverside Medical Group physicians. The interventional catheterization lab at the Heart and Vascular Center meets the American Heart Association guidelines for emergency intervention care of heart attack patients. This means that the lab has demonstrated a quick and effective means to diagnose and treat cardiac disease, thus often avoiding more invasive procedures and saving more heart muscle. A look at some of the ways Riverside has provided cardiac care recognized for quality and outcomes starts with the rapid delivery of emergency care. Riverside was the first in the region to begin a formalized STEMI Alert program to improve cardiac reperfusion times as measured by the “door-to-balloon” time. In a STEMI alert, the goal is to open a blocked artery as soon as possible. The STEMI program includes EMS, the Emergency Trauma Center, pharmacy, the cardiac cath lab and the interventional cardiologists. This program features rapid 12-lead EKG’s for chest pain and allows the emergency room physicians to implement the STEMI alert based on the results of the EKG. These EKG’s are obtained in the field by EMS personnel and the results can be sent to the emergency room. ER physicians can utilize the EMS 12-lead EKG to page the STEMI alert prior to the patient’s arrival. This fact alone can save 10-15 minutes of time and improve the chances of opening a blocked artery faster. The paging system alerts all STEMI providers at one time. When a STEMI alert is paged, all providers begin preparation for the patient’s arrival. The system also includes a prepared medication kit containing all the medications that might be necessary to care for a STEMI patient as well as a pre-printed protocol and record sheet. Air transportation for STEMI cardiac patients is provided by a partnership between Riverside and Life Evac of Virginia. The helicopter is based in West Point and is only minutes from Riverside Walter Reed Hospital in Gloucester and Riverside Tappahannock Hospital. Riverside also uses a new treatment called hypothermia that reduces the body temperature of the patient to reduce the incidence of brain injury after a heart attack. Riverside has three cardiac catheterization labs. In addition to utilizing balloon angioplasty and stents to open coronary artery blockages in the cath labs, Riverside interventional cardiologists also utilize intra-vascular ultrasound to examine artery walls and blockages. In this procedure, high frequency sound waves are used within the arteries to get a better indication as to the condition of the artery walls and the extent of the blockage. Other devices are used to remove blood clots from the arteries such as the Angiojet which removes clots before a balloon or stent procedure is performed. The Heart and Vascular Center uses an advanced 128-slice

CT scanner which produces three-dimensional images of a beating heart within seconds. This tool provides twice the imaging power using half the radiation of conventional CT scanners allowing physicians to more quickly and precisely diagnose and treat heart conditions. Riverside has an electrophysiology lab dedicated to the diagnosis and treatment of heart rhythm irregularities. Electrophysiological studies are used to diagnose and guide treatment of abnormal heartbeats. Using state-of-the-art equipment and techniques, including three-dimensional mapping, tiny catheters are used to create a map of the heart’s electrical system. Abnormal heart rates and rhythms can be corrected with pacemakers or through cardiac ablation procedures. This latter procedure eliminates any point on the heart which causes interference in normal heart rhythm. The cardiac surgeons at Riverside are performing Maze ablation procedures to treat chronic atrial fibrillation. This procedure can be performed through ports and replaces the more traditional open heart surgery that requires a major surgical incision in the

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Riverside uses a new treatment called hypothermia that reduces the body temperature of the patient to reduce the incidence of brain injury after a heart attack.

chest. This less invasive procedure is used in conjunction with open-heart surgery or as a stand-alone procedure. The electrophysiology lab also uses automated internal cardiac defibrillators to treat patients prone to sudden rapid heart rate. Devices are also placed internally which can treat congestive heart failure by synchronizing both sides of the heart to improve pumping efficiency. The addition of the automated defibrillator adds the security of emergency treatment in the event of sudden cardiac arrest. In addition to traditional cardiac bypass surgery, Riverside surgeons utilize the latest invasive techniques to repair the heart. In some cardiac bypass cases, the surgeons use a special technique called “off pump coronary artery bypass” for some patients who may be suited for this procedure. In these cases, the bypass surgery is performed without heart-lung bypass machine and usually results in less complications for the patient. Riverside surgeons use a procedure called Trans Myocardiac Revascularization or TMR. This procedure utilizes a laser to generate new channels in the heart muscle to nourish it in the presence of severe coronary artery disease. Riverside follows the Society for Thoracic Surgeons standard for using the internal mammary artery in heart bypass. Although this technique is not possible for all patients, Riverside uses it in a high percentage of cardiovascular procedures. It is associated with better long-term patient outcomes. The Cardiac Surgery ICU is designed around the immediHealthcare in Hampton Roads

FOCUS: Cardiac Care

ate recovery needs of open heart and vascular surgery patients. There are 14 cardiac care beds where each patient is closely monitored by a highly trained critical care nursing staff. Typically in less than 24 hours, patients are transferred to the telemetry unit which is staffed by specially trained cardiac nurses and provides continuous EKG monitoring for patients in a less intense environment with more flexible visiting hours. Riverside provides a cardiac surgery clinic where a nurse practitioner closely monitors patients during hospitalization and for a few weeks after discharge. For follow-up care, patients continue seeing the nurse practitioner at a specialty clinic so that additional monitoring and treatment can be rendered This provides continuity of care for the patients and reassurance that a provider is closely following their care. Riverside offers a comprehensive cardiac rehabilitation program through its hospital and fitness and health centers. For more information on rehabilitation services, please see “Unsung Heroes” later in this issue. To help assure the availability of the latest cardiac services, the cardiovascular physicians at Riverside participate in many clinical trials to develop new treatments for cardiac disease. Current studies include treatment for congestive heart failure and acute coronary syndrome, emergency treatment for heart

attack, early diagnosis of heart disease in diabetic patients and early detection of heart attacks before they occur. This early detection of heart attacks is the latest trial in which Riverside is participating. This trial is for the AngelMed Guardian implantable cardiac monitor and alert system. It is designed to reduce the time it takes patients to get to the emergency room during an impending heart attack. The system is composed of an internal implantable device about the size of a standard pacemaker with a lead into the heart, an external telemetry device, and a programmer that aids physicians in evaluating heart signals. It is designed to track significant changes in the heart’s electrical signal and then alert patients to seek medical attention, thus saving time and potentially patient’s lives. The latest technology at Riverside also extends beyond the hospital. Using the myHealth eLink, an online communication tool, patients can access their electronic medical records, view lab results sent by their physicians, request prescription refills, appointments and referrals, or send a question to their physician 24 hours a day, seven days a week. Through its services, Riverside is committed to providing the latest advances in cardiac care for the people of Hampton Roads. To find more information about Riverside, please see the Directory under “Where to Find It.” ■

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Healthcare in Hampton Roads

entara Heart, a part of Sentara Healthcare, is a comprehensive network of family practice and internal medicine physicians, cardiologists, cardiac surgeons, cardiac anesthesiologists and clinicians who provide cardiac services throughout an integrated system which serves both Southside Hampton Roads and the Peninsula. All of the community hospitals within Sentara provide a full complement of heart services except for heart surgery. Emergency heart care is provided in the community hospitals and if more advance care is needed, patients can be

transferred by ground or air transport to either Sentara Heart Hospital at Sentara Norfolk General Hospital in Norfolk or Sentara Virginia Beach Hospital in Virginia Beach for open heart surgery. All of the hospitals offer diagnostic testing, diagnostic catheterizations, emergency interventional cardiology and rehabilitation. Through community educational screening events and the diagnostic services provided through physiciansâ&#x20AC;&#x2122; offices, outpatient campuses and hospitals, people have access to one of the most experienced cardiac care programs available anywhere offering

COURTESY OF SENTARA HEALTHCARE

Sentara Healthcare

FOCUS: Cardiac Care

COURTESY OF SENTARA HEALTHCARE

patients a comprehensive range of cardiac services that include open heart surgery, heart transplantation, ventricular assist devices, valve surgery, electrophysiology, interventional procedures, diagnostic testing and cardiac imaging. The Heart Hospital Sentara Norfolk General Hospital was ranked in 2009 for the tenth time in Heart and Heart Surgery in

Sentara hospitals provide a host of services, including cardiac catheterization.

U.S. News and World Report, “America’s Best Hospitals.” Heart and Heart Surgery at Sentara Heart Hospital rose in the rankings from 38th in 2008 to 26th in 2009 with a mortality index superior to seven of the Top 10 programs in spite of the others’ higher name recognition and reputation which also contributes to the scoring. In 2008, Sentara Virginia Beach General Hospital was the second hospital in Virginia to achieve Disease-Specific Care Certification from the Joint Commission on Accreditation of Healthcare Organizations, the accrediting authority for hospitals, in its Treatment of Heart Failure and Heart Attack. A look at some of the latest services and technology offered by Sentara Heart will provide more insight into its recognized achievements in quality and clinical outcomes for patients right here in Hampton Roads. Sentara Heart provides disease prevention and education through forums, events and screenings throughout Hampton Roads. Pocket EKG® is a unique screening offered through Sentara that includes a 12-lead electrocardiogram (EKG), blood pressure check, cholesterol test and clinical counseling. After the screening, consumers receive a letter with their EKG result and a wallet-sized card that has the image of the EKG on one side and their name, medical history and medications listed on the other side. This card not only helps the holder keep track of his medical information, but it serves to expedite care should the person need to seek treatment for a cardiac problem. Quick response in addressing cardiac issues when they occur is important. In addition to working closely with EMS and ambulance services to quickly assess patients with the latest equipment and communications, Sentara Heart utilizes its Nightingale Regional Air Ambulance to transport critically ill cardiac patients 14

Healthcare in Hampton Roads

from community hospitals to the highly specialized care at Sentara Heart Hospital. Nightingale is a specialized medical transport helicopter that is equipped with high-tech cardiac and pulmonary equipment including an intra-aortic balloon pump and a sophisticated 12-lead EKG monitor to provide state-of-the art care in-flight. This balloon pump assists the distressed heart of a cardiac patient in maintaining blood flow until the appropriate intervention can be undertaken. The latest in diagnostic imaging used by Sentara Heart includes cardiovascular CT imaging and cardiovascular MRI. Using the fast 64-slice CT scanner, high resolution images of the coronary arteries of the beating heart are obtained. These precision images allow cardiologists to avoid invasive coronary catheterization for many patients and simultaneously identify alternative causes of cardiopulmonary symptoms. Patients most likely to benefit from the 64-slice CT are those whose complaints might indicate heart disease but who are not showing the classic symptoms. Other ideal patients are those who have had a stress test that is either inconclusive or suspected inaccurate. The cardiovascular MRI enables physicians to noninvasively image patients with a broad range of cardiac and vascular problems by imaging the heart muscle, large vessels and the sac around the heart or pericardium. It quickly evaluates the condition of damaged tissue without the use of radiation. For patients requiring heart surgery at Sentara, Sentara Heart Hospital and Sentara Virginia Beach Hospital form the core of the cardiac surgery program and use the same team of cardiovascular surgeons and cardiac anesthesiologists. The Sentara Heart Center at Virginia Beach General was built in 2005 and has a 46-bed dedicated cardiac unit with all private rooms, 10 pre- and postprocedure rooms, one dedicated cardiac surgery operating room, a four-bed cardiac surgery intensive care unit and two dedicated catheterization labs. Sentara Heart Hospital at Sentara Norfolk General, opened in 2006, is a dedicated heart hospital built from the ground up for cardiac care. Here, patients receive comprehensive cardiac services from diagnostics to open heart surgery and transplantation at one location. It has all-private rooms, including 112 inpatient beds and 45 pre/post-procedural rooms for patients undergoing interventional cardiac procedure. It houses five cardiac rooms designed to accommodate 2000 cardiac surgeries a year. There are six catheterization labs for diagnostic and interventional procedures. A parking garage with 450 spaces is available to heart patients and families. The latest imaging technology is utilized for both coronary bypass surgeries and for heart valve surgeries. At both Sentara Heart Hospital and Virginia Beach General, cardiac imaging called SPY® Intraoperative Imaging System is used before and after coronary bypass and is performed to provide immediate confirmation of a successful surgery. The system uses a dye that shows blood flowing through the veins and arteries allowing cardiac surgeons to use high quality images or video in real time during the procedure. This cutting edge technology allows cardiac surgeons to visually assess coronary circulation and confirm the quality of

bypass grafts performed during surgery. It can be used pre-bypass to confirm their operative plan and during the procedure to determine the need for any technical revisions to the bypass grafts. This confirmation improves surgical outcomes for the patient. At Sentara Heart Hospital, cardiovascular surgeons are using minimally invasive cardiac surgery for those who need heart valve surgery. In general, minimally invasive heart surgery means a surgeon will make a smaller incision without splitting the breast bone; will be able to see the heart with a camera for a better view of the heart and will use specialized surgical instruments that permit the surgeon to operate on the heart in a smaller space. With this technique, there will be less pain and scarring, less bleeding and fewer postsurgical infections, plus a shorter hospital stay and a quicker return to daily activities. The improved cosmetic results come from a three-inch keyhole incision on the right side of the chest rather than a 10-inch scar down the center as a result of more invasive surgery. Sentara Heart Hospital is looking to further enhance the benefits of minimally invasive heart valve surgery and other procedures by implementing a hybrid operating room concept which combines cardiac catheterization and surgical procedures within one location resulting in quicker, more efficient care. Once implemented, the surgeon and the cardiologist will be in the same room and will have the ability to perform hybrid surgeries involving both minimally invasive surgery and electrophysiological procedures to treat abnormal heart rhythms. For selected patients with end-stage heart disease, Sentara Heart Hospital offers heart transplantation and the implantation of Ventricular Assist Devices (VAD) as treatment options. The transplant team includes cardiologists, cardiothoracic surgeons, a dedicated infection disease specialist and immunologist, a nurse practitioner, certified transplant coordinators, pharmacists, social workers and other professionals and support personnel dedicated to the care of heart transplant patients. The perspective for treating end stage heart disease at Sentara has evolved to recognize that heart transplantation does not stand alone as a treatment, but is an option in the treatment of patients with advanced heart failure. Physicians at Sentara use the VAD and is implanted into the patient which assists the heart in those whose hearts are not in complete failure, but diseased enough not to be pumping blood sufficiently. It works in tandem with the heart to supplement its activity. According to Betty Crandall, Director of Cardiac/Vascular/Transplant Clinical Specialty Services at Sentara, this device can be used while a patient is waiting for a heart transplant or as “destination therapy” for those individuals who are not candidates for transplant. The earlier individuals approaching end stage heart disease are evaluated, the more options for treatment such as the VAD are available to them. These treatment options provide individuals with end stage heart disease a way to extend their quality of life. In order to facilitate the transition back to normal life, Sentara Heart offers cardiac rehabilitation programs that provide physical, psychological and educational support to cardiac patients. The cardiac rehabilitation program at Sentara Careplex Hospital in

Hampton has received certification from the American Association of Cardiovascular and Pulmonary Rehabilitation. This national recognition encompasses all aspects of patient care including improved outcomes, patient education and customer service. The cardiac rehabilitation program at Sentara Williamsburg Regional Medical Center CARES program received recertification in 2008 and the CARES program was presented the Outstanding Community Health Award from the Williamsburg Community Health Foundation. A more detailed look at cardiac rehabilitation services offered in the area and their impact is presented in the “Unsung Heroes” later in this issue. To help develop new procedures and treatments for cardiac patients, the Sentara Cardiovascular Research Institute was established to advance the understanding and treatment of cardiovascular disease. Physicians and registered nurse research coordinators have extensive experience in collaboration with government agencies and biomedical companies that sponsor clinical research trials. The

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Sentara Heart utilizes its Nightingale Regional Air Ambulance to transport critically ill cardiac patients from community hospitals to the highly specialized care at Sentara Heart Hospital.

Institute is exploring the opportunities to partner with Eastern Virginia Medical School and may initiate new trials here in Hampton Roads in addition to the third party-sponsored trials they participate in currently. The staff works with physician investigators to conduct research studies in all areas of cardiovascular care. Current trials include those researching new methods in catheterization, surgery, electrophysiology (heart rhythm) and treatment for heart failure. The trials have been designed to identify new, improved treatment methods and protocols while, at the same time, eliminating therapies and approaches to clinical care that are not as effective or may have been shown to be harmful. Ultimately, the work of the Sentara Cardiovascular Research Institute enables Sentara physicians and clinicians to improve clinical care delivery, patient outcomes and the overall health of the community. As described in this section, Sentara Heart provides comprehensive cardiac services right here in Hampton Roads which have consistently been recognized nationally as among the top tier in the country. For more information on Sentara Heart and its cardiac services, please see the directory section under “Where to Find It.” ■ As can be seen in this cover story, the major healthcare providers in Hampton Roads are constantly striving to improve the health and quality of life for patients with heart problems through less intensive and traumatic services. So truly less does mean more in cardiac care. The availability of leading edge, nationally recognized quality cardiac services right here in "America's First Region" can be considered one of the area's greatest assets that will continue to serve the people of Hampton Roads well for years to come. Healthcare in Hampton Roads

Maintaining good circulation of blood throughout the body or "keeping the flow going," not only involves a healthy heart. A healthy vascular system which branches from the heart throughout the body like the limbs of a tree is important as well. But just like the heart, this system can be prone to disease.

his vascular disease can affect blood flow in the arteries and veins throughout the body and rob vital organs and tissue of oxygen. Disease of the blood vessels outside the heart and brain is called peripheral vascular disease. While this term is usually used to mean disease in an artery or peripheral artery disease (PAD), problems may also arise in the veins such as varicose veins and spider veins. Peripheral artery disease occurs when the arteries that carry blood to the legs, arms or internal organs are completely or partially blocked as a result of atherosclerosis. In atherosclerosis, hard cholesterol substances or plaques are deposited in the walls of the arteries. These plaques cause hardening of the arteries and a narrowing of the inner channel of the arteries. The process is gradual and can begin early in life and continue through adulthood without causing any symptoms. As individuals advance in age, the atherosclerosis

• Family history of heart or vascular disease • Over age 50, especially in men2

SYMPTOMS It is also important to know the symptoms of PAD so that individuals can receive the appropriate diagnosis, treatment and intervention as soon as possible. Symptoms include: • Leg pain in one or both calves, thighs or hips • Buttock pain • Numbness, tingling or weakness in the legs • Burning or aching pain in the feet or toes while resting • Sore on the leg or foot that will not heal • One or both legs feel cold or change color (pale, bluish, dark reddish) • Loss of hair on the legs • Impotence If these symptoms are present at rest, the disease may be more severe.3

KEEPING THE

Flow may become advanced enough to cause a critical blockage which will inhibit adequate blood flow to muscle tissue and organs. It may affect the arteries that supply the brain with oxygen and result in a stroke or transitory ischemic attacks (TIA’s or mini-strokes), arteries in the kidneys and lead to kidney failure or arteries supplying the legs which can result in pain when walking or standing.1

RISK FACTORS In order to try to prevent or lessen the severity of PAD, it is important to catch it early. One should be familiar with certain risk factors that place the individual at greater risk. They include: • High blood pressure • Elevated cholesterol • Smoking or history of smoking • Diabetes • Obesity 16

Healthcare in Hampton Roads

GOING By J. Wilson Futrell, Jr.

A diagnosis of PAD is critical in that people with the disease are six to seven times more likely to have a heart attack or stroke.4 Upon examination of the individual, the physician will consider any symptoms that are present and look for signs such as weak or absent pulse in the extremities, specific sounds detected with a stethoscope and changes in blood pressure in the limbs at rest or doing exercise.5 In addition to reviewing the symptoms and signs, physicians use imaging tests in the diagnosis of PAD. These tests include the use of high frequency sound waves (ultrasound) to detect and measure blood flow. This is a noninvasive procedure in which a probe is placed on the skin overlying the arteries and can detect the site and severity of the arterial obstruction. Angiography is an invasive procedure used in which an x-ray dye is injected into the arteries. The dye highlights any blockage in the arteries that will show up on x-ray video. This test is usually done in more severe cases where

patients will also need angioplasty or surgery.6 Along with the invasive and noninvasive procedures used to diagnose PAD, the providers in Hampton Roads offer many options in providing the latest in intervention and treatment for PAD. Bon Secours provides specialized vascular services at its Vascular Center at Bon Secours DePaul Medical Center in Norfolk. It provides state-of-the-art and nationally certified vascular services for early detection and treatment of disease. This center also has a fully digital imaging system that can acquire, archive and retrieve images for rapid processing and comparison. The interventional team of radiologists, cardiologists and vascular surgeons perform balloon and stent placements as well as thrombolysis which dissolves or breaks up blood clots thereby decreasing the need for invasive procedures. Catheters that utilize tiny jets of pulsating water are used to open blockages in peripheral arteries. The team can also treat bulges or weaknesses (aneurisms) in the walls of the aorta, the main artery leading from heart down through the abdomen. They can perform a procedure which involves inserting a stent or “endograft” into an abdominal aortic aneurism without making an incision in the abdomen. Recovery from this procedure is considerably shorter than with traditional (open) aortic aneurism surgery. Chesapeake Regional Medical Center utilizes its cardiovascular rooms to perform procedures on the arteries leading to the brain, kidney and legs. The physicians use balloons and stents to clear blockages and open constrictions. They are placed at the blockage through the use of a catheter which is inserted through a small incision in the groin. They utilize a digital imaging and archiving system where the physician can view and compare old and new images of the patient’s arteries right in the room. Any digital images taken from diagnostic procedures as well as other patient information are available for the physician in the room. Their digital imaging equipment also uses image-enhancing software referred to as “Stent Boost” during diagnostic angiographies which enhances the small, hard-to-see stents that are in place. This saves time and reduces then patient’s exposure to radiation, thus making it safer. Riverside Regional Medical Center has three dedicated vascular intervention suites for the treatment of peripheral vascular disease. Riverside vascular surgeons, cardiologists and

interventional radiologists perform interventional procedures using balloons and stents to open blocked arteries in the pelvis and leg to restore blood flow. They use endovascular stents to treat aortic aneurisms resulting in patients going home in two to three days after the procedure rather than seven to ten days associated with having major surgery. Riverside vascular surgeons also perform venous ablation procedures to treat varicose veins. This is an outpatient procedure which can be done in the surgeon’s office and does not require any hospital stay.

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... cause a critical blockage which will inhibit adequate blood flow to muscle tissue and organs.

Riverside physicians staff a specialty clinic for the diagnosis and treatment of vascular disease. Located at Riverside Regional Medical Center in Newport News, the clinic will offer patients and their primary care physicians a unique one-stop location for these services. Eliminating the need for multiples referrals and locations, the team clinic physicians will work together to design the best treatment plan for each patient. Sentara offers comprehensive vascular services for all disorders involving the peripheral arteries and veins. The more advanced services are offered at the Vascular Center at Sentara Norfolk General Hospital in Norfolk and at the Sentara Advanced Vascular Centers in Newport News and Virginia Beach. The Vascular Center at Sentara Norfolk General Hospital has dedicated vascular inpatient beds including a vascular intensive care unit, a peripheral interventional (endovascular) suite, dedicated endovascular pre- and post-procedure area, peripheral vascular lab and dedicated surgical suites. In 2005, Sentara Norfolk General Hospital became the nation’s first certified Joint Commission Disease Specific Vascular Center by the Joint Commission on Accreditation of Healthcare Organizations, the national accreditation authority for hospitals. Along with the Vascular Center at Norfolk General, the Sentara Advanced Vascular Treatment Centers combine diagnostic, endovascular and vein services under

one roof. The treatments available help restore blood flow through the arteries of the neck and lower extremities, repair aneurisms in the aorta, eliminate or reduce varicose and spider veins and provide vascular access for kidney dialysis. Wherever possible, minimally invasive procedures are utilized. The use of stents for aortic aneurisms is designed to prevent the necessity of invasive surgical procedures. For treatment of lower extremities, vascular surgeons use the latest in catheter technology. In addition to the use of stents and balloons, physicians use catheters which utilize laser energy pulses that vaporize the plaque, or a rotating, tiny blade at its tip to smoothly and precisely shave off and remove the plaque causing the blockage. At the Sentara Advanced Vascular Treatment Center, the Vein Center of Virginia treats patients suffering from varicose and spider veins. Endovenous Laser Therapy is used as an alternative to surgical stripping to treat varicose veins and is done in one hour with the patient’s immediate return to routine activity. Minimally invasive surgical treatments are available to treat varicose veins which result in only a few days of downtime with minimal discomfort. The vascular surgeons at Sentara Norfolk General Hospital were the third site in the country to implant the HeRO (Hemodialysis Reliable Outflow) device. This device is implanted in patients to provide a successful under-the-skin vascular access for ongoing dialysis for patients who have lost all the major vessels available in the chest area for dialysis. Through their commitment to the latest technology in the treatment of peripheral vascular disease, all of the major providers in Hampton Roads are making sure that we are “keeping the flow going.” For more information or specific locations, see the Directory section under “Where to Find It” later in this issue. ■

1 Stoppler, Melissa Conrad, MD, “Peripheral Vascular Disease,” MedicineNet.com” 2 Sentara, “Minimally Invasive Procedures for Improving Circulation to the Legs” 3 eMedicineHealth, “Peripheral Vascular Disease,” eMedicineHealth.com, page 3 4 Sentara, “Procedures for Improving Circulation to the Legs,” May 10, 2007 5 MedicineNet.com, “Peripheral Vascular Disease,” page 5 6 MedicineNet.com, “Peripheral Vascular Disease,” page 5

Healthcare in Hampton Roads

Continuum of

Cardiac Care Services

Unsung

HEROES By J. Wilson Futrell, Jr.

t was a special evening of anticipation and achievement as the food (heart-healthy, of course) was served and the crowd gathered for the evening’s events. After the meal, the group prepared for the presentation portion of the night. Most of those present were older people, some accompanied by proud family members. As the presentations got underway, individuals were called up to receive recognition and a certificate memorializing their accomplishments.

Everyone walked calmly, but deliberately, to the front of the room when his or her name was called to receive the certificate and then returned to his or her seat. One particular gentleman was called and he got up and made his way without difficulty to the front of the room to receive his recognition. There seemed to be a special reception for this gentleman as he approached the front of the room. Upon his arrival, it was noted how he made his way to the front with relative ease and how that was in stark contrast to just a matter of weeks before when he could hardly get out of a chair and if he tried, he became out of breath. Upon hearing this, the entire room stood up with applause and there was not a dry eye in the house. This gentleman really did have an accomplishment for which to be proud. He had not only been made well, but he was whole again. The occasion of this celebration was graduation night for a group of individuals who had been in cardiac rehabilitation to further complete their recovery from recent heart problems. The presenters in the front of the room were the special nurses who ran the cardiac rehabilitation program at the hospital – the same nurses who, several years earlier, had proposed to develop a program at their hospital to meet the need to make patients’

Healthcare in Hampton Roads

recovering from cardiac events whole again. They successfully received the funding to proceed and on this night, the results of their efforts were unmistakable and clear. Cardiac rehabilitation may not always grab the headlines as much as new technology, equipment and buildings, but these special rehabilitation professionals work tirelessly to make people whole again. They are truly “unsung heroes” to a lot of people recovering from cardiac events. This story is true and it happened years ago in a hospital outside of the Hampton Roads area and was indicative in some cases how such programs had to struggle to survive. But today, the providers in Hampton Roads all have comprehensive cardiac rehabilitation as a key part of their services to their patients with the goal of returning them to a normal life after what may have been a debilitating heart problem. Individuals who may benefit from cardiac rehabilitation are those who have had angina or chest pain, balloon angioplasties or stent placement, coronary bypass surgery, valve repair or replacement, heart attack, heart transplant or other cardiovascular disease. A specific look at the services provided in rehabilitation programs will demonstrate the commitment providers make to

the patient with these problems. Cardiac rehabilitation is a physiciansupervised program which addresses the physical, emotional, nutritional and vocational needs of the individual. It is designed to strengthen the cardiovascular system and increase muscular strength and flexibility. It also aides in the patient’s return to work and resumption of normal activities. The program is usually divided into three phases. Phase I begins in the hospital after the patient has experienced a major heart problem. It consists of personal evaluation and consultation and includes education about risk factors, nutritional counseling and a low-level exercise program. Planning for the next phase may begin prior to discharge. Phase II is on an outpatient basis and requires a physician’s referral. It consists

of a six-to-twelve week supervised exercise program with three sessions a week that is tailored specifically to each patient. Exercise sessions consist of warm up and cool down periods. The program utilizes equipment such as treadmills, rowing machines, exercise bikes, stair steps and resistance training and is usually in a group setting. It is designed to help the heart use oxygen more efficiently and the body to build strength and stamina. Cool down periods increase flexibility. Further educational sessions on risk factors, medications, nutrition and stress management are included. Phase III is the maintenance phase of cardiac rehabilitation because it emphasizes long-term lifestyle changes. The individual will continue with a prescribed exercise program and learn

to monitor his own heart rate and symptoms related to heart disease. While this phase is not supervised directly by a professional, many of the providers in Hampton Roads offer classes at their affiliated fitness centers located throughout the area where the individual may enjoy the support of others as well as facility staff in establishing exercise and other good health habits as a regular part of their lifestyle. Many of the programs in Hampton Roads are accredited or are seeking accreditation from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Accreditation by the AACVPR ensures that programs “contain specific core components that aim to optimize cardiovascular risk reduction, foster healthy behaviors and compliance to those behaviors, reduce disability and promote an active lifestyle for patients with cardiovascular disease.”1 The cardiac rehabilitation centers at Chesapeake Regional in Chesapeake, Sentara Careplex Hospital in Hampton and Sentara Williamsburg Regional Medical Center in Williamsburg are currently certified and the cardiac rehabilitation centers at Bon Secours are currently preparing for certification. The commitment that providers in Hampton Roads make to providing leading-edge technology for the diagnosis and treatment of heart problems extend to the efforts for the patients’ recovery and return to a normal daily routine. The “unsung heroes” who are there to help make the individual whole again as part of the continuum of cardiac care services may just never be “unsung” again but are now part of the front line in the battle against the effects of heart disease. ■ AAA/AACVPR Scientific Statement, Core Components of Cardiac Rehabilitation/Secondary Prevention Programs, Circulation, 2000; 102:1069, American Heart Association, Inc.

...retur ning to a normal life Healthcare in Hampton Roads

Mystery

By Reesy Floyd-Thompson

among Us

“You have high blood pressure.”

oday, if you hear these words, you’re closer to successfully treating your condition than 17 million Americans. That’s because they’re unaware they even have it. With the advancements Hampton Roads has made, and continues to make in matters of the heart, you’re living in one of the best places possible to receive such a diagnosis. According to the American Heart Association, more than 74 million Americans have high blood pressure—that’s 1 in 3 adults. In 2005, high blood pressure was listed as a contributing factor or primary cause of 319,000 deaths in the U.S., and it has become the second most common reason for doctor’s visits in this country. Dubbed “the silent killer,” high blood pressure – or hypertension – can be asymptomatic. When you consider that it is a contributing factor to heart disease—the leading cause of death in the United States, stroke—the third leading cause of death in the United States, heart attack and kidney disease, “the silent killer” lives up to its name. To understand high blood pressure, one must have a basic knowledge of how blood moves through the body. Oxygen and nutrients are provided to the organs and cells through the circulatory system. In short, arteries carry oxygenated blood away from the heart and veins return blood to the heart. Blood pressure is the ease of blood flow through the blood vessels and the force that keeps the blood moving, all of which is powered by the heart. Various factors can cause the blood vessels to harden and narrow, and when this occurs, the heart has to work harder to pump blood through the smaller openings. This is high blood pressure. Blood pressure is measured in two ways. The first measure is systolic – that’s the top number - which records the pressure when the heart contracts. The second measure is diastolic, the bottom number, is the force when the heart relaxes. The two values combined are the basis for determining if your blood pressure is normal, somewhere in the middle, or high. Blood

Healthcare in Hampton Roads

pressure readings are the determination of how hard blood pushes against the walls of the blood vessels – or how hard it is working to push through your body. When blood pressure goes up (if uncared for), over time the extra demands placed on the heart to pump blood and oxygen to meet the body’s needs, will enlarge and weaken the heart. Damaged blood vessels may be unable to supply the heart and organs with the blood and oxygen its needs. Organs, in particular the heart, that do not get enough blood and oxygen will not function properly— and can cause many other diseases and disorders. “My father had high blood pressure so I had a feeling the train was coming down the track sooner or later,” said William Jackson, a Hampton Roads native, recently diagnosed with high blood pressure.

Diagnosis Blood pressure is measured by a device called a sphygmomanometer, commonly referred to as blood pressure cuff. This is a quick and painless test. The blood pressure cuff inflates momentarily stopping blood flow. With a stethoscope, your health care provider will listen for the sound of the first and last blood pulse and determine your blood pressure by reading the gauge on the blood pressure cuff. Optimal blood pressure level is below 120/80 mm Hg. Blood pressure readings between 120/80 and 140/90 mm Hg are considered pre-hypertension, and blood pressure measures of 140/90 mm Hg and above are hypertension. Blood pressure is variable, and can be affected by body position, exercise, eating, stress and sleep patterns. High blood pressure occurs when blood pressure goes up and stays elevated. Jackson was diagnosed with hypertension with a blood pressure of 160/100 mm Hg.

COURTESY OF CHESAPEAKE REGIONAL MEDICAL CENTER

Good news — Hampton Roads is making incredulous strides in cardiac care. Despite the rise in deaths from heart disease across the country, in Hampton Roads the mortality rates for cardiovascular disease decreased between 2000 and 2007, in no small part to the regional and national cardiac care specialist working within our community. Cardiology in Hampton Roads is exploding with new technology and experienced experts in the field. Throughout the state, our region has become the epicenter of heart-related cases and has upped the ante to remain competitive on a national level.

Risk Factors In 95% of cases, the cause of primary hypertension is unknown—a mystery for doctors. When the cause is known — the remaining 5% is known as secondary hypertension. Once the [primary] condition is treated, in most cases the blood pressure lowers to normal levels. Though doctors cannot pinpoint an exact cause for primary hypertension, there are certain risks factors that increase one’s chances of developing it. Among those with risks for hypertension are people with a family history of the condition, people over the age of forty, those who are overweight, those who smoke and drink alcohol, women who take birth control pills, people who eat a lot of salt, and another big mystery for doctors — AfricanAmericans. Jackson, who is African-American, had several risk factors for hypertension. Statistics show that African-Americans are 50- to 100-percent more likely to develop high blood pressure, and account for 40-percent of all high blood pressure cases. AfricanAmericans also develop hypertension at younger ages, have a harder time keeping it under control, and are more likely to die from complications arising from it. High blood pressure can be controlled — but better yet, it can be prevented.

Treatment and Prevention Treating hypertension and preventing it follow the same course of action. Despite what is unknown about its cause, studies have shown lifestyle modifications — or changes in habits— help to control blood pressure levels. People with pre-hypertension should make changes too – before developing hypertension. Weight management: As body weight increases, blood pressure rises. The best way to decrease the risk of high blood pressure is to maintain a healthy weight. The American Heart Association recommends

at least 30 minutes of exercise every other day, whether it’s a 10K run or walk around the block, even light exercises can lower risk of high blood pressure. Alcohol consumption: Alcoholic beverages should be limited to one glass for women and two glasses for men per day. Sodium intake: Excess salt leads to excess fluid, which, in turn, leads to increased pressure on the heart. Reduce sodium intake. Read labels. Many prepackaged foods contain high levels of sodium. Choose products low in sodium and high in nutrients. Diet: Maintaining a healthy diet full of fruits and vegetables will boost your overall heart health by reducing both blood pressure and cholesterol. Weight management is an added bonus. Relaxation: It is also important to take time to relax, whether it’s a session of yoga, a long walk, or even just a couple of deep breaths. Small changes can make a big difference. “When the doctor gave me the news, I started walking more, paying more attention to what I ate and the doctor gave me some pills to take. When I went back for an appointment, my blood pressure was down to 130/90, still high but much better.” Jackson says. If lifestyle changes are unsuccessful, prescription alternatives are available. Discuss all treatment plans with a physician. The Hampton Roads medical community at large is doing its part to raise awareness and educate residents on the dangers of hypertension. Preventative care classes are available across our area offering education, exercise and nutrition counseling, along with local blood pressure screenings. Supportive structured programs for making positive lifestyle changes are available in many neighborhoods, hospitals, churches and clinics. ■

High blood pressure—the mystery among us. Doctors are unsure what causes it, and there is no known cure. Doctors are unsure why if affects African-Americans at rates twice that of their counterparts, or why it’s more deadly. And despite the serious nature of such a condition, high blood pressure has no detectable symptoms. Many of the mysteries of high blood pressure will remain unsolved but whether or not you have hypertension need not be a mystery to you.

Healthcare in Hampton Roads

Women Are Not Men When It Comes To Heart Disease Men’ Symptoms When a man develops heart disease, many times he will have pain in his left arm and chest. Signs for a heart attack include pain in the chest moving to the left arm, shortness of breath and sweating. “Men’s symptoms are more recognizable as heart disease or a heart attack,” said Dr. Tore Hinnant, a family physician at Currituck Internal Medicine and Family Practice in Moyock, N.C. “Men experience more the feeling that their chest is being crushed. They have the classic symptoms and will often grab their chest,” she added.

Women’s Symptoms Symptoms for women are more complicated. In addition to possibly having chest pains, women can also have jaw pain, shoulder pain on any side, abdomen pain, dizziness and nausea, Hinnant said. “Because their symptoms are not limited to just chest pains and the left side pain, it can be harder to diagnose,” Hinnant said. “Many women and clinicians do not consider those symptoms to be heart disease or a heart attack. They think it is something else and do not get the proper treatment,” she said.

One Problem Creates the Big Statistics

By Susan Smigielski Acker

Heart disease is the number one killer for women and men. However, the tell-tale signs for heart disease and heart attack are not the always the same for them. 22

Healthcare in Hampton Roads

One of the main problems with women and heart disease is lack knowledge. A 2006 survey conducted by the American Heart Association found that 43 percent of women are unaware that heart disease is the leading cause of death among women, said Lisa Davenport, Marketing Communications Director for the Hampton Roads Chapter of the American Heart Association. To set the record straight heart disease, stroke and other cardiovascular diseases kill nearly half a million women in the United States every year. This is more than the next five causes of death combined including all forms of cancer, she said. Women who are victims of a heart attack are more likely than men to die within a few weeks, she added.

The problem continues not just with the general public, but with the medical community. Women are less likely to receive the same treatment as men. Davenport points to research that suggests fewer women than men with suspected acute heart attack symptoms are referred for noninvasive tests, and fewer women than men who test positive for heart disease are recommended for further testing and treatment.

Knowledge is Power In order to prevent a heart attack, if a woman suspects she has heart disease she needs to advocate for her heart health, Davenport said. “If you know the signs, that they are not chest pains, but can be jaw pain, back pain and even extreme fatigue then you can say to your doctor ‘I know the symptoms. Could you check for heart disease?’” Davenport said. She recommends women visit the American Heart Association’s website that focuses on women and heart disease – www.goredforwomen.org – prior to visiting their doctor. Ask for the tests. “A woman should have her cholesterol checked with a blood test and her blood pressure taken,” she said. A woman’s HDL should be below 50 and blood pressure should below 130/80. Blood sugar should also be controlled with a glucose level below seven. Hinnant recommends when a woman has her annual physical, she should ask for her Body Mass Index (BMI) to be checked. In the case of a possible heart attack, women need the proper tests when visiting a doctor or emergency room. “If a woman thinks she is having a heart attack, then she or her loved ones need to make sure an EKG is performed,” Hinnant said.

Changes in Thinking The tide is turning in having medical professionals and the public be aware there is more to heart disease for women. “Currently there is a push to educate the public and the medical community about the differences between men and women when it comes to heart disease,” Hinnant said. The American Heart Association is working to educate not only the public, but the medical community as well. The association launched the Get With The Guidelines campaign to help first responders, such as paramedics and emergency room doctors, not to rule out heart disease when a patient does not have the obvious signs such as chest pains, Davenport said. Hospitals can be certified by the American Heart Association after completing the training. “This is something to look for when choosing a hospital if you have or think you have heart disease,” she said.

The Risk Factors The first risk factor is smoking – do not smoke. “Some people say they if they stop smoking, they will gain weight, causing their risk of heart disease to increase, but that’s just vanity. Smoking is the number one preventable cause of death,” Davenport said. Age is a factor. While heart disease can happen at any age, it escalates as a person grows older. “It starts to increase in your upper 40s,” Hinnant said. However, women who have yet to reach their 40s are not immune from heart disease. “It used top be thought women who have not gone through menopause did not have to worry about heart disease.

Their symptoms and risk factors were discounted as something else such as anxiety or their time of the month,” said Dr. Wayne Old, a cardiologist with Cardiovascular Associates in Chesapeake. “But if a 35-year-old woman smokes, has high cholesterol and a family history of heart disease, she is at high risk and her symptoms need to be taken seriously,” he said. Of the 21,800 women under the 65 years old who suffer from a coronary event each year, 37 percent were under age 55, Davenport said. Family history is a factor. “If you have first degree family member (parent or sibling) who has heart disease or heart attack, then you are at risk,” said Old. “Those with a family history of heart disease need to work harder at having a healthy lifestyle,” he said. Another variable is at what age the family member had the heart attack. “If a mother or sister had a heart attack before age 65, that is a concern, if a male member had the heart attack before age 55, it is also a risk factor,” he said. Being overweight increases the risk of heart disease. Weight control is important especially belly fat, Old said.

PREVENTION is Key KEEPING WEIGHT IN CHECK and NOT SMOKING are important ways to keep heart disease from starting. Ways to keep weight in check include eating five servings of fruit and vegetables, eat low-fat sources of protein and limit trans fat, Hinnant said. “Eating at least five servings of fruit and vegetables not only prevent heart disease, but many other illnesses as well, she added. EXERCISE is a key. Exercising at least 30 minutes a day, most days of the week is extremely important, Old said. “A good brisk walk for 30 minutes is great,” he added. If you can barely carry on a conversation, but not be able to sing, then you know you are doing your walk right, he added.

“Research shows that people who have a lot of belly fat are more at risk,” he said. For women their waist should measure no more than 35 inches and for men the waist should be 40 inches or less.

Put Yourself First It is common for women to put others first, such as children, husbands and aging parents. However, women must also take a stand with themselves, putting their health first. “Many women put their family first when it comes to health, thinking they need to take care of them. We tell women if you do not take care of your own health, you will not be there to take care of your loved ones,” Davenport said. ■

Healthcare in Hampton Roads

ASK THE EXPERT

▼▼▼ Dr. Edward Chu, FACC How likely am I going to die from heart disease?

(blood fat) levels and blood sugar.

In the U.S., you have a 1 in 3 chance of dying from cardiovascular disease, that is a heart attack, heart failure or stroke. This is a death every 37 seconds. When you think of all the health concerns people have in preventing cancer or accidental death, you have more than double the chance of dying from a heart disease than cancer, and 15 times the risk of dying from heart disease than an accident.

What do you mean when you say heart failure?

How do I know I am having a heart attack? The signs that mean a heart attack is happening include chest discomfort (pressure or squeezing), discomfort that travels to the back, arm or neck, and shortness of breath. These signs could be severe and abrupt or mild and start slowly.

How do I know I am having a stroke? The signs that mean a stroke is happening include sudden weakness or numbness of the face, arm or leg, difficulty with speech or vision, and sudden trouble with loss of balance or coordination.

What should I do when I think I am having a heart attack or stoke? Time is heart muscle and time is brain tissue. When the heart or brain is deprived of blood, the damage occurs very quickly. Call 911 and direct your care to a facility that is dedicated to these problems. They have heart attack and stroke teams ready to provide state of the art treatment from rapid treatment with a balloon or stent to open arteries in the heart to open heart surgery, if required. Stroke programs have streamlined the time to a head “CT” scan and use of a “clot buster” to open the blocked artery to the brain.

What can I do to prevent a heart attack? Preventing a heart attack requires that we lead a heart healthy life style: no smoking, watching your weight, regular physical activity, and early identification and treatment of your blood pressure, cholesterol

Heart failure mean that the heart can not do what it is supposed to do in supplying blood to the body, especially the kidneys and muscles; without an excessive amount of fluid. The heart can be weakened and/or damaged, typically from a heart attack, or be too stiff, typically from uncontrolled hypertension to function normally. The body can sense it is not getting enough blood and will retain salt and water to improve blood delivery. This will result in symptoms of shortness of breath with activity or when laying down in bed, or swelling of the legs or belly. Early identification and treatment is critical in this setting because we have medications and implanted devices that can reduce symptoms, occasionally improve heart function and even help prevent sudden death.

I’ve tried to diet but I can’t lose weight. It can be my simple four words: walk more, eat less. Fad diets generally result in very temporary weight loss, but a lifestyle change will result in sustained weight loss. Walking from the farthest (and generally easiest) parking spot at the store, walking up stairs, walking with friends during lunch and after dinner are good examples. Exercise that can keep heart rate up for 30 minutes however will generally build muscle and burn calories. You don’t have to go to a gym, just buy comfortable walking or jogging shoes. Eating less means smaller portions, no seconds, no snacks, no dessert, no sweetened drinks (especially soda) and less bread or potato.

Can you recommend a specific diet? There are many common elements to successful diets that result in a reduction in total calories. Portion control requires finding foods that can make you feel as if you are full but the true commitment to change how we eat long term requires a change in eating habits. Unfortunately, calories are now very cheap. We don’t need to hunt for meat or gather fruits,

FOR YOUR

HEALTH

vegetables or corn like our ancestors did. We don’t burn the calories to get the food which long time ago did not have the high calorie per ounce content we have now. We now hunt at McDonald’s or Kentucky Fried Chicken. I try to use the concept of watching what a cow eats. Well, the answer is grass and a lot of grass to get that big and fat. Just changing your menu to salads will not be sustainable or even help you lose weight, especially if you add chicken, bacon bits, cheese and tons of smothering salad dressing. I do recommend increasing the fiber content in your diet with plentiful vegetables or greens, use the principle that less processed (as an example whole wheat) usually is more fiber. Protein and small quantities of fat are usually filling for a longer period of time than fast carbohydrates or sugars, such as sweetened breakfast cereals or snacks. I have personally tried the South Beach diet by Dr. Agatston and it seems to be a diet that you can maintain. There are many diets that are out there but pick one that you really can enjoy. PS. One hundred calories means a mile of walking.

What should my blood pressure be? Your blood pressure should be less than 120/80 and will likely need treatment if it is greater than 140/90. If you have diabetes, kidney problems or a known cardiovascular condition, than you may need treatment to get your blood pressure treated to even lower levels.

What do they mean when someone tells me to have a low salt diet? Avoiding foods that are obviously salty include chips and dips, cheese, most fried foods and fast foods. Salt is the least expensive spice and is the major ingredient in salad dressing, processed meats, canned foods, pasta sauces and prepared or ready to cook meals. One teaspoon of salt

has 2300 mg of sodium, and the target when treating cardiovascular disease is 2000 mg. Watch the salt content and watch your blood pressure come down without medication!

Can I know if I have diabetes or high cholesterol without going to a doctor? Although there are no symptoms of high cholesterol, symptoms suggesting diabetes including urinating often, being very thirsty or hungry, unusual fatigue or weight loss and blurry vision. Generally, seeing your doctor and getting screened for these disease requires blood tests.

How do I stop smoking? Smoking is a habit and an addiction to nicotine. Medications and will power will let you escape the addition but habits are formed over a lifetime. There are triggers in your daily life that will keep you smoking, identifying them and avoiding them is critical. Common triggers include friends and family that smoke, drinking, meals, or simply the way we deal with stress or loneliness. Finally, think about the money you can save (a pack a day at $5 per pack + tax, is $2,000 dollars a year.

I am going to die anyway, why make the effort now? Although you are likely to die of a cardiovascular problem, your quality of life including working, walking and breathing, will be effected often decades before you die. Most heart attacks and stroke do not results in death but leave you debilitated.

What is the effect of my family history? Can I change what happens? Your family history can directly determine how likely you can develop hypertension, diabetes, high cholesterol levels, obesity, and perhaps even a predisposition to nicotine addiction. Certain diseases such as aneurysms and blood clots, have a

clustering effect among family members. Unfortunately we can not change our genetics but I often use the poker example that you can not change the hand you are dealt but you can change how you play it. You can get dealt a very good hand and lose; good example of this is having a poor diet and smoking. You can get dealt a bad hand and still do well; attention to diet and exercise can delay a disease from becoming manifest for years and perhaps even decades. This is when doctors and preventative therapy have the most impact.

I have heard about the cardiac wonder drug, what is it? Well, if you asked some, it would probably be Viagra but the truth is that a certain class of drugs called the “statins” has made a substantial global impact on cardiovascular disease over the past 10 years. The statins are drugs such as atorvastatin, simvastatin or rosuvastatin that can directly treat high cholesterol levels but seem to have an effect on the improving blood vessel function, blood clotting, and even the ability to reduce the likelihood for a heart attack or stroke.

Well, now that you mention Viagra. Viagra, Cialis and Levitra are drugs specifically used for erectile dysfunction. If you have difficulty attaining or maintaining an erection, you should see your doctor. Erectile dysfunction can be one of the early ways that hardening of the arteries will be seen. Unfortunately, it usually occurs when the usual cardiac risk factor suspects are around such as hypertension, diabetes, and smoking. Treating these conditions will help your cause. You should have a detailed history and physical examination before starting these drugs. Your will also need to understand that if you take these drugs, there can be a fatal interaction when taken with nitrogylcerin (including Imdur, Isordil, Nitrobid, to name a few.)

DR. EDWARD CHU, FACC Medical school: undergraduate at Brown University in Providence, RI; residency: Letterman Army Medical Center in San Francisco, CA; clinical and research fellowship: University of California, San Francisco, practicing in VA since 1997, currently chief of the cardiovascular service line for Riverside Health system and chairman of the department of medicine at Riverside Regional Medical Center and board certified in cardiovascular disease, interventional cardiology and echocardiography. Healthcare in Hampton Roads

NUTRITION AND WELLNESS

e’ve lived our lives in the finest and easiest living conditions in all of human existence—-the 20th and 21st centuries in the United States of America. We have so much to be thankful for. We have unlimited opportunity and we have the fattest and least conditioned population on planet earth.

We all know being overweight and sedentary causes major health problems, so why are we living longer (1900 average life span: 47 years. 2000: 77 years)? Because our much maligned health care system’s superb detection and treatment technology is doing its job. And why does the cost of health care keep going up? Demand. The demand for more and more expensive care because we aren’t taking care of ourselves. And we’re just the mini-beginning. The current adult generation was comparatively active and lean as kids. They had fewer fast food options, more physical education in school, and played outside in their neighborhoods until dark. They didn’t have computer addiction, and many didn’t even have remote controls to their televisions. Daily living wasn’t as full of “automatic” things, i.e. car windows were actually rolled down. The rate of CHILDHOOD OBESITY has tripled since 1970. Remember the term “adult onset diabetes”? That identified it as developed from lifestyle, not from birth. We don’t hear that anymore because too many of our children are developing it. It’s now called “Type 2 diabetes”. Daily P.E. classes in American schools have decreased: elementary 8%, middle 6.4%, high school 5.8%. Combining that with simple carbohydrate lunches and school vending machines should make it very clear that this is a job for parents and families. If you exercise regularly and practice good label reading nutrition, you probably have active kids, maybe even participating in team and individual sports. If you skip breakfast, are a fast food regular, know what junk food is but buy it anyway because it’s easy and the whole family likes it, come home from work then grab a beer & the remote… you get the picture. And so do your kids. If that sounds even a little like you, your kids are paying for it.

Help your kids — who don’t understand this — kids are instant gratification slaves. Forget the aphorism: “If it isn’t broke, don’t fix it”. Practice some preventive maintenance. Give “preemptive” a positive spin. Change your oil before things break down. Be a parent. Take charge. While ages 13 to 18 are great years to help shape a young person (they actually listen to us more than they let on), the growth years of 7 to 13 are the key physical opportunity to reduce the chance of future heart disease and other related health problems. Remember, kids need the same things adults do: improved nutrition, cardiovascular (walking, running) activity, more lean muscle/less body fat, and good joint range of motion (flexibility). Science has clearly proven that strength training can be safe and effective for ages 7 and up. The nervous system has almost fully developed, so improved coordination (brain to muscle communication) is highly trainable with life long benefits. That’s why, if trained in correct biomechanics, kids develop strength gains before increase in muscle size. And through physical play, as additional benefits, they improve balance, speed, agility, quickness, reaction time, …all as a result of improving their neuromuscular (mind to muscle) signals. Just by playing and having fun. Encourage it; schedule it.

The good news is we can do something about it. And what your kids need is exactly what will benefit you too. It’ll benefit you now, and your kids forever. For your kids, these are habit and tissue forming years. All fat cells allowed to develop are like life long receptive sponges. They’re always waiting, and always a problem. Active kids get less of them.

Families in the

LAND OF

PLENT

After you limit their computer/tv time, and they’re being more active, you’ll have the chance to do some helpful research. Try: http://www.acefitness.org/ofk/youthfitness http://www.actionforhealthykids.org http://www.shapeup.org/prof/child.php If raising kids teaches us anything (I have 4 over 20) about all our relationships with others, it is that WE DON’T CONTROL OUTCOMES. We have a lot of control over our intentions, some control over our actions, but not outcomes. So, relax. Just set a good example, and hopefully, one family at a time, we can have a positive impact on what is much more than just health care costs — this is about our children’s opportunity to have healthier adult lives. ■

Practice Better

Schedule More

NUTRITION

ACTIVITY

SET A GOOD EXAMPLE • Eat a health breakfast, i.e. whole grain cereal with fruit and skim milk. • Eliminate junk food from the home. Sodas, crackers, chips, pizza, pasta, white rice, candy, cookies, ice cream, macaroni & cheese, fried anything…

START IN THE STORE BRIAN COLE is the owner of Personal Training Associates with private studios in Port Warwick, Hilton Village and Virginia Beach. He can be reached at (757) 599-5999. The website is www.BRIANCOLEandASSOCIATES.com

Y…

• Learn to read labels and teach your kids • Don’t focus on calories. Susceptibility to eating disorders is too dangerous, particularly by our daughters who are often trying to emulate ridiculous airbrushed paper-thin role models. Instead focus on healthy choices. We all need calories; just make them nutritious. And then increase activity to burn more.

SET A GOOD EXAMPLE • Commit to a daily walk, preferably when the kids are home. • Develop a brief comprehensive calisthenics and flexibility routine you can do daily, preferably when the kids are home. I know you’re already pretty busy when the kids are home. But you’re not doing anything as important as improving your health and increasing your energy while being a good role model.

KEEP IT FUN • Find some additional play activities that kids will like. • Local recreation leagues have numerous opportunities.

DO SOME OF IT TOGETHER • In addition to finding some team sports for the kids, invite them into your activities.

Healthcare in Hampton Roads

HEALTH DIRECTORY

HEALTH AND FITNESS CENTERS PENINSULA Brian Cole Personal Training Associates Port Warwick, Main Street Hilton Village & Virginia Beach (757) 599-5999 Riverside Wellness & Fitness Center 12650 Jefferson Avenue Newport News, VA 23602 (757) 875-7525 Sentara Center for Health & Fitness 4001 Coliseum Drive Hampton, VA 23666 (757) 766-2658

Bon Secours Maryview Medical Center 3636 High Street Portsmouth, VA 23707 (757) 398-2200

CHESAPEAKE REGIONAL MEDICAL CENTER http://chesapeakeregional.com SOUTHSIDE Chesapeake General Hospital 736 Battlefield Blvd. North Chesapeake, VA 23320 (757)-312-8121

SOUTHSIDE Bon Secours Harbour View Health Center 5818 Harbour View Blvd. Suffolk, VA 23435 (757)-673-5800

W. Stanley Jennings Outpatient Center 844 Battlefield Blvd. North Chesapeake, VA 23320 (757) 312-6800

Bon Secours Health Center at Virginia Beach 828 Healthy Way Virginia Beach, VA 23462 (757) 467-0680

NAGS HEAD The Outer Banks Hospital P.O. Box 849, Nags Head, NC 27959 (252) 449-4500, 1-877-359-9179 Toll Free info@theobh.com

Chesapeake Regional Lifestyle Center 800 Battlefield Blvd. North Chesapeake, VA 23320 (757) 312-6132 Explore Health with Sentara Center Great Neck Square 2126 Great Neck Square Virginia Beach, VA 23454 (757) 481-7656

RIVERSIDE HEALTH SYSTEM www.riversideonline.com PENINSULA Cardiovascular Center of Hampton Roads Port Warwick Medical Center 11803 Jefferson Ave., Suite 110 Newport News, VA 23606 (757) 873-0360

GLOUCESTER Riverside Wellness & Fitness Center 7516 Hospital Drive Gloucester, VA 23061 (804) 693-8888

Riverside Diagnostic Center 850 Enterprise Parkway, Suite 1500 Hampton, VA 23666 (757) 251-7800

HOSPITALS AND FACILITIES

Riverside Heart Center 500 J. Clyde Morris Blvd. Newport News, VA 23601 (757) 594-2075

BON SECOURS HAMPTON ROADS HEALTH SYSTEM http://bonsecourshamptonroads.com

Bon Secours Heart Institute 3636 High Street Portsmouth, VA 23707 (757) 398-2000

Riverside Regional Medical Center 500 J. Clyde Morris Blvd. Newport News, VA 23601 (757) 594-2000

PENINSULA Bon Secours Mary Immaculate Hospital 2 Bernardine Drive Newport News, VA 23602 (757) 886-6000

MIDDLE PENINSULA Riverside Walter Reed Hospital 7519 Hospital Drive Gloucester, VA 23061 (804) 693-8800

SOUTHSIDE Bon Secours DePaul Medical Center 150 Kingsley Lane Norfolk, VA 23505 (757) 889-5000

WILLIAMSBURG Riverside Diagnostic Center 120 Kings Way, Suite 1200 Williamsburg, VA 23185 (757) 345-6700

Bon Secours Harbour View Health Center 5818 Harbour View Boulevard Suffolk, VA 23435 (757)-673-5800

TA P PA H A N N O C K Riverside Tappahannock Hospital 618 Hospital Road Tappahannock, VA 22560 (804) 443-3311

Bon Secours Health Center at Virginia Beach 828 Healthy Way Virginia Beach, VA 23462 (757) 467-0680

EASTERN SHORE Riverside Shore Memorial Hospital 9507 Hospital Ave. P.O. Box 17 Nassawadox, VA 23413-0017 800-834-7035

Healthcare in Hampton Roads

SENTARA www.sentara.com PENINSULA Sentara Advanced Vascular Treatment Center Port Warwick III, 2nd Floor 1051 Loftis Blvd. Newport News, VA 23606 (757) 736-9302 Sentara CarePlex Hospital 3000 Coliseum Drive Hampton, VA 23666 (757) 736-1000 Sentara Port Warwick 11803 Jefferson Avenue Newport News, VA 23606 (757) 736-9898 SOUTHSIDE Sentara Advanced Vascular Treatment Center 3300 South Building, 1st Floor 397 Little Neck Road Virginia Beach, VA 23452 (757) 470-5570 Sentara Bayside Hospital 800 Independence Blvd. Virginia Beach, VA 23455 (757) 363-6100 Sentara BelleHarbour 3920 A Bridge Road Suffolk, VA 23435 (757) 983-0000 Sentara Greenbrier HealthPlex 713 Volvo Parkway Chesapeake, VA 23320 (757) 282-4025 Sentara Heart Hospital 600 Gresham Drive Norfolk, VA 23507 (757) 388-8000 Sentara Leigh Hospital 830 Kempsville Road Norfolk, VA 23502 (757) 261-6000 Sentara Norfolk General Hospital 600 Gresham Drive Norfolk, VA 23507 (757) 388-3000 Sentara Obici Hospital 2800 Godwin Boulevard Suffolk, VA 23434 (757) 934-4000 Sentara Princess Anne 1925, 1950, 1975 Glenn Mitchell Drive Virginia Beach, VA 23456 (757) 507-1000 Sentara Virginia Beach General Hospital 1060 First Colonial Road Virginia Beach, VA 23454 (757) 395-8000 WILLIAMSBURG Sentara Williamsburg Regional Medical Center 100 Sentara Circle Williamsburg, VA 23188 (757) 984-6000

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Nationally Ranked Heart Care. Close To Home.

or the eleventh year, Sentara Heart Hospital made the annual list of the nationâ&#x20AC;&#x2122;s top 50 hospitals for heart care and heart surgery by U.S.News & World Report. Our continued focus on quality made ours the only hospital in the region to be recognized as one of Americaâ&#x20AC;&#x2122;s top hospitals. For heart care, we commend our Sentara Heart physicians, anesthesiologists, nurses, and clinical teams for their expertise in achieving these rankings. And weâ&#x20AC;&#x2122;re pleased to assure patients and their families that top-quality heart care is available right here at home. For more information about the ranking, go to sentara.com/usnews.

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