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Better Health D
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HEARTBURN: Best ways to keep chronic acid reflux in check, D2 EATING: Incorporating more heart-healthy foods in your diet, D3 TRAVEL: Mexico’s last countercultural coast, D5
| SUNDAY, FEBRUARY 16, 2020
Passion
for Perfection defines Baystate’s first female cardiac surgeon Dr. Kelly Wanamaker, who is among three percent of such women surgeons.
Cardiothoracic surgeon Kelly Wanamaker, M.D. recently became Baystate Health’s first female heart surgeon. By Anne-Gerard Flynn
Special to The Republican
Baystate has a number of women surgeons, including thoracic surgeons, but the Virginia-born physician is the first female hired specifically to do cardiac surgery at Baystate Medical Center which eight years ago opened its state-of-the art Davis Heart & Vascular Center. It is an impressive distinction, especially given national estimates that only about 21 percent of U.S. surgeons today are women, only about seven percent of active cardiothoracic surgeons are women and only three percent of cardiac surgeons are women. Dr. Nina Starr Braunwald, who became the country first female heart surgeon in 1963, is credited with a number of pioneering advances in the field of cardiac surgery. Braunwald, the first woman to perform open-heart surgery, was associate professor of surgery at Harvard Medical School and held appointments in the cardiothoracic surgical divisions of Brigham and Women’s Hospital as well as a number of other Boston area hospitals. As a board-certified cardiothoracic surgeon, Wanamaker is qualified to operate on the heart, lungs and other chest
organs as well as do general surgery. Being Baystate’s first female cardiac surgeon is not a distinction that so much defines Wanamaker as adds to a resume that reflects years of hard work in the field of medicine where she started as a registered nurse after switching from earlier plans to be a math teacher. She holds two undergraduate degrees from Virginia’s Old Dominion University in Norfolk as a result of her switch, one in psychology and mathematics awarded in 1994 and the other in nursing awarded three years later. It is a passion for perfection in what she does that comes through when Wanamaker talks about her work and career path that includes being credentialed recently as a fellow of the American College of Surgeons. A 2008 graduate of Pittsburgh’s Drexel University College of Medicine who did her residency in general surgery at Allegheny General Hospital - Western Pennsylvania Hospital as well as a year’s research fellowship in cardiothoracic surgery there, Wanamaker went on to do a two-year residency in cardiothoracic surgery at Brigham and Women’s Hospital/Boston Children’s Hospital and then did a one- year fellowship in cardiac surgery at Brigham, a teaching affiliate of Harvard Medical School. Before coming to Baystate, she worked as a cardiothoracic surgeon as well as staff surgeon at Lehigh Valley Health Network Heart Institute in Allentown, Penn. “The Brigham fellowship was no doubt the highlight of my life,” said Wanamaker of
a hospital where the late Dr. Lawrence Cohn, a pioneer in cardiac surgery who trained many cardiac surgeons during a five-decade long career, served as chief of cardiac surgery. “It is such a polished, wellthought out, well-structured program with meaning every step of the way in the systematic manner in which they train you.” Cardiac conditions in many patients today may be addressed through catheter-based procedures performed by interventional cardiologists, while openheart surgery is required for other patients. For example, Wanamaker said such surgery, in which the chest is opened and the body placed on the heartlung bypass machine, may be recommended for younger patients needing a new aortic valve or those patients with coronary artery disease affecting a number of arteries or done to fix a structural defect in the heart as well as trauma to the heart. Wanamaker keeps a model of the heart in her office to help patients understand the surgeries she performs to improve blood flow to the heart muscle impeded by a blocked or weakened artery as well as replace, or repair, a heart valve that can no longer regulate proper blood flow through the organ. “By far, coronary artery bypass grafting is the most common procedure across the board in the field of cardiac surgery,” said Wanamaker of the frequency of the operations she performs. “The second most common would be aortic valve replacement for aortic stenosis and mitral valve repairs for mitral
regurgitation. I also do aneurysm repairs.” She adds, “There are also diseases like aortic dissections that need to be emergently repaired and which we also see a lot of.” A dissection, that is, a tear, in the inner most layer of the aorta, the body’s largest artery that begins at the top of the heart’s left ventricle, can create a “false” channel for blood flow and impact the heart’s output of blood. A dissection can be caused by a number of conditions including chronic high blood pressure as well as a pre-existing aortic aneurysm, that is, a bulge in the artery wall that could rupture. Baystate has a dedicated aneurysm clinic where patients are closely watched for aneurysmal disease in order to prevent such ruptures. Aortic dissection surgery often addresses tears in the wall of the ascending aorta that can affect coronary arteries supplying blood to the heart, which is life threatening. “Mortality for this condition is quite high without or without surgery,” Wanamaker said. “The goal of dissection repair is complete resection of the tear, replace the aorta with a tube graft and restore normal blood flow.” The patient is put on the heart-lung machine for this surgery and the heart stopped, but for a time the machine itself is stopped during this surgery as space is tight for suturing and clamping off blood flood. The solution, Wanamaker said, is to stop the bypass machine from pumping once the body is cooled down to “quite a low temperature” to allow
for the temporary suspension of blood flow while selectively allowing some blood flow to the brain. This protects the body from neurological injury and is known as “hypothermic circulatory arrest.” “Hypothermic circulatory arrest temporarily suspends blood flow under very cold body temperatures,” Wanamaker said. “At cold temperatures, cellular activity levels slow significantly so blood circulation can be stopped for up to 40 minutes without harm to the patient. This allows surgery to safely be performed on the aorta when clamping to contain blood flow that is not desirable.” She added, “We are expedient in opening up the aorta.” “We look for the tear, cut out an extended area, sew in a tube graft, and basically create a new aorta,” Wanamaker said. She added that if the echocardiogram shows the aortic valve is leaking “oftentimes we can preserve the valve by just resuspending it once the dissection is fixed as that is what causes the valve to leak in many cases.” Wanamaker said the heart-lung bypass machine’s complex circuitry allows for blood from the body to be replenished with oxygen and its temperature controlled under a team of specialists. “It incorporates an extracorporeal circuit to provide physiological support in which venous blood is drained to a reservoir, oxygenated and sent back to the body using a pump. A team effort among surgeon, perfusionist and anesthesiologist is paramount for the successful use of the
cardiopulmonary bypass,” Wanamaker said. “Basically, the de-oxygenated blood comes out of the heart’s right atrium, goes into this machine, circles around, enters into the oxygenator and then comes back out and goes into the aorta.” She adds, “I tell patients that the heart-lung machine allows me to operate on a bloodless, motionless heart.” “It keeps the rest of the organs rich with oxygen and nutrients,” Wanamaker said. “And we give a solution to protect the heart every 20 minutes so it is protected when the heart is stopped.” Wanamaker said she feels her childhood has helped her “feel comfortable” working in a field still dominated by men. “I grew up with three older brothers and a father who was a Marine who coached my brothers in sports,” Wanamaker said. “I was always around men in my life and I think that has helped me to feel comfortable in my skin around all the guys.” She credits her mom with developing in her an interest “to look at the details.” “I do operate as a perfectionist,” said Wanamaker, the first in her family to graduate college. “I am very precise when I am sewing during surgery and at the end of the operation I go back and look several times to make sure nothing is bleeding. I have a natural instinct in wanting to look at the details, the fine details, and I think that comes from my mother. She would coach me as a child in cheerleading and make sure I had all my moves perfectly right as well as doing SEE PERFECTION, PAGE D3
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D2 | SUNDAY, FEBRUARY 16, 2020
THE REPUBLICAN | MASSLIVE.COM
The Best Ways to Keep
Chronic Acid Reflux in Check.
Tuyyab Hassan, M.D. Gastroenterologist, Holyoke Medical Center
Herbs & some meds
Battling don’t mix HEARTBURN IF YOU EXPERIENCE a burning sensation IS GERD SERIOUS? in your chest It can be. Chronic acid reor a bitter taste flux can cause the esophagus in your mouth to narrow, which interferes swallowing and can after eating, you with cause food to get stuck. Over time, chronic inflammation may be among in the esophagus can lead the 20 percent of to precancerous changes and cancer. About 10 to people who suffer 15 percent of people with GERD develop precancerous from chronic changes known as Barrett’s esophagus. An estimated 1 heartburn, in 200 people with Barrett’s develop esophageal cancer. also known as WHAT TYPES OF SURGERY ARE gastroesophageal WHO’S AT RISK AVAILABLE? reflux disease FOR GERD? People who are overweight In one procedure, the stom(GERD). or pregnant, smoke or take ach is wrapped around the and frequent burping. When symptoms occur more than twice a week for a few weeks, you may have GERD.
At HMC Gastroenterology, patients are assessed to determine the best treatment. Here, Tuyyab Hassan, MD, an HMC gastroenterologist in Holyoke and Westfield, answers common questions about GERD.
WHAT CAUSES GERD?
GERD occurs when stomach acid backs up into the esophagus—a muscular tube that connects the throat to the stomach—instead of moving through the gastrointestinal tract. The acid causes a burning sensation, sore throat or cough, hoarseness
certain medications—such as calcium channel blockers for high blood pressure, asthma drugs, painkillers, sedatives and antidepressants—are at risk. Those who have a hiatal hernia—in which an opening in the diaphragm allows the upper part of the stomach to bulge into the chest—are also predisposed.
HOW IS GERD TREATED?
ing the head of your bed to prevent acid from rising into the esophagus. Also, avoid or reduce your consumption of foods and drinks that trigger symptoms, such as coffee, tea, chocolate, mint and tomato sauce. If these measures don’t work, you may need to take an over-thecounter antacid medication. Stronger medications, which are available over-thecounter and by prescription, include H2 blockers and proton pump inhibitors, which reduce acid production in the stomach. If medications aren’t effective, surgery may be an option.
lower esophagus to strengthen the area and prevent acid from rising into the organ. Another procedure involves implanting magnetic beads around the lower esophagus to strengthen it.
Herbal remedies may be used to treat symptoms of many conditions and can often be a viable tool in an overall health plan.
But there is a dearth of research evaluating the use of herbal medicines, particularly in clinical trial. However, The Mayo Clinic says about one-half of adults in the United States reports having used at least one dietary supplement in the previous month, though research indicates that only about 34 percent of people who take herbal supplements tell their doctors about it, even those who are taking a prescription medication. Just because a substance is naturally derived does not make it entirely safe to use in all instances. In fact, many herbs can interact poorly
with other drugs. According to the article “Use of Herbal Medicines and Implications for Conventional Drug Therapy Medical Sciences,” published in 2013 by researchers at the University of Texas and Texas Tech University Health Sciences Center, although many benefits can be derived from the use of herbs, potential areas of concern include possible product contamination and/ or adulterations, potential toxicity and high potential of known and unknown drug/ herb interactions. Herbal medicines are not standardized and monitored like prescription and over-thecounter medication, so safe use cannot be guaranteed. The information provided here should not replace the advice of a qualified physician. However, these are some known medication-herbal interactions that can occur.
Heart health
Several popular supplements, including Coenzyme Q-10, St. John’s Wort and Danshen, can interact with
HMC Gastroenterology has two locations: 11 Hospital Drive, 3rd Floor, Holyoke, and 94 North Elm Street, Suite 206, Westfield.
common heart medications. It is important to read how these herbs can interact with Warfarin, calcium channel blockers, anticoagulants, and digoxin, among others. Interactions can include everything from reductions in drug efficacy to increased risk of bleeding to irregular heartbeat, states the Mayo Clinic.
Women’s health
Women who are going through menopause and have experienced hot flashes, painful menstruation and other vaginal conditions may take black cohosh. But there is concern that black cohosh may enhance liver toxicity when taken with certain medications, such as astorvastatin, acetaminophen and alcohol, according to Drugs.com.
Colds and respiratory health Historically, goldenseal has been used for various health conditions of the skin, ulcers and respiratory infections. Goldenseal is a potent inhibitor of liver enzymes. A 2012 review from the National Institutes of Health found that goldenseal has a high herbdrug interaction risk.
Mental well-being
Herbal remedies may help people treat anxiety, insomnia
GERD symptoms can be To schedule an improved by maintaining a healthy weight, eating low-fat appointment, call foods, quitting smoking, not 413.540.5048. eating two to three hours before bedtime, and rais-
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and depression. Kava and St. John’s Wort are two herbs used for these conditions. There is some evidence that use of kava while taking CNS depressants, such as benzodiazepines and sedation drugs, can increase risk of drowsiness and motor reflex depression, says NIH. St. John’s Wort has many documented significant interactions with oral contraceptives, coumadin, immunosuppressant drugs, and benzodiazepines, among others. Taking St. John’s Wort in conjunction with other antidepressants can lead to serotonin-related side effects. Although herbs can be used successfully, caution is needed when combining them with other medications. They should be treated just as any drug and discussed with a medical professional or pharmacist prior to use.
Cardiothoracic surgeon Dr. Kelly M. Wanamaker recently became Baystate Health’s first female heart surgeon. (PHOTO BY ANNE-GERARD FLYNN, SPECIAL TO THE REPUBLICAN)
Perfection CONTINUED FROM PAGE D1
all the chores in the house right down to folding the towels a certain way. We had a very structured household.” She also credits her mother, the second youngest in a family of 13 who left home young to find a 30-year-career in the U.S. Department of Agriculture and raise a family, with being her model in terms of “being independent and a go-getter.” “I was interested in the sciences early on, but math was my strength. I had good mentors in high school who encouraged me in that so I thought I would be a math teacher,” said Wanamaker of her own early direction in college. However, taking a course in anatomy sparked in part by her own interest in fitness – she is a runner and was captain of her college cheerleading team – got her more interested in medicine and she investigated nursing as a career. “We didn’t have the internet back then but I opened up a newspaper and starting looking at ads and saw ads and ads for registered nurses and I said to myself that is what I am going to do. I am going to be a nurse,” Wanamaker recalled. “I stayed in college, got my second degree in nursing and when I saw an opening at a Norfolk hospital for an internship in cardiac ICU, I applied.” While getting her nursing degree, Wanamaker had been accepted to do a summer internship for nursing school students at Yale New Haven Hospital during which she took care of patients following their cardiac surgery. “It was a big panel interview and I was a brand-new nurse,” she said of the application for the cardiac ICU internship in Norfolk. “You were supposed to be a floor nurse before being an
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ICU nurse and I wondered if I would get it. I did and I recovered open-heart surgery patients.” Wanamaker said she always knew she “wanted to do more” in medicine and considered becoming a nurse anesthetist, but realized while observing open-heart surgery that she was “much more interested in what the surgeon was doing.” “I’m not a big life planner. I see something that interests me and I go for it,” said Wanamaker who was a nurse for six years when she decided to go to medical school. “I kept my job as a nurse, and went back to school to first take some pre-requisite courses. The surgeons I worked with as a nurse at the time were all very supportive. I still keep in touch with some of them.” One aspect that has always fascinated her about cardiac surgery, Wanamaker said, is how acutely sick a patient can be and “how quickly you can help them and see immediate benefit from what we do as cardiac surgeons.” “No other medical specialty does what we do,” Wanamaker said. “We stop the heart in doing what we need to do to help a patient.“Wanamaker said she has had a “variety of patient reactions” when she introduces herself as their cardiac surgeon. Some reactions she describes as a “disappointment still in 2020” and relates discussing surgery with a patient referred to her by a cardiologist and the patient responding by thanking and then shaking the hand of a male colleague with her. Other reactions she refers to as “the polar opposite” when patients tell her they are excited to have a female cardiac surgeon and when asked to clarify say they know she will be meticulous in operating and have a bedside manner they like. In applying for surgical
residencies after medical school, Wanamaker said she did in some interviews get asked questions about her personal life – such as whether she planned to have a family – that raise legal issues around employment discrimination in being asked. Being a cardiac surgeon can be disruptive at times to one’s personal schedule regardless of the surgeon involved, but Wanamaker said she accepts that challenge and adds one “important piece is having a partner who supports you.” Wanamaker does in Albert Morgan, a pharmacist whom she says “has seen me every step of the way since I was in general surgery.” Wanamaker said she likes how cardiologists and surgeons work together today to decide if a patient needs, for example, to have openheart surgery to replace an aortic valve or if a minimally invasive transcatheter aortic valve replacement (TAVR) is the better procedure where a replacement valve is threaded in place with a catheter and recovery time is shorter. “The cardiologists and the surgeons at Baystate interact on almost a daily basis as a team formulating what is best for the patient,” Wanamaker said. “For example, with TAVR, we as surgeons would get together with the cardiologists and go over films and the patient’s history to decide if TAVR is better for the patient or open-heart surgery. This is helpful to get different points of view in the room.” She also enjoys mentoring future surgeons and when asked what she would say to any young woman interested in cardiac surgery, she quickly responds, “Come find me.” “I am a great motivator, probably something from my cheerleading days,” Wanamaker said. “And I continue to love what I do more and more each day.”
How to incorporate more heart-healthy foods Diet and heart
into your diet
health go hand in hand. The American Heart dishes. For example, the AHA choosing chicken and fish Association notes suggests replacing half the over red meats. That’s because red meats, which meat in recipes for that a healthy diet ground include beef and lamb, have burgers, meatloaf or meatsaturated fat than balls with cooked chopped and lifestyle are the mushrooms. The mushrooms more chicken and fish. Saturated can be finely chopped with a fats increase blood cholesbest weapons to terol levels and can worsen or food processor, and fight cardiovascular knife heart disease, while the then sautéed in some olive unsaturated fats in fish like oil until they’re soft. They diseases, which salmon can actually reduce can then be mixed in with the risk for cardiovascular the lean meat, and the meal the World Health can be cooked as it normally issues like heart failure and Organization says would. At the breakfast table, ischemic stroke. When preparing poultry, remove the add fruit to a bowl of cereal kill more people skin, as most of the saturated to make for a more flavorful fat in poultry is found just morning meal. across the globe beneath the skin. each year than any Dairy products When purchasing dairy Grains other disease. When buying grains, the products, the DHHS recom-
Men and women do not need degrees in nutrition science to create heart-healthy diets for themselves and their families. In fact, the familiar calls to “eat your fruits and vegetables” many adults recall from childhood lessons or nights around the family dinner table still bear weight today. A diet that is rich in fruits and vegetables is a hallmark of a healthy lifestyle. And supplementing such a diet with other heart-healthy foods is a great way to reduce one’s risk for cardiovascular disease.
Fruits and vegetables
mends sticking to fat-free or low-fat options. Replace whole milk with fat-free or 1 percent milk and buy only fat-free or low-fat cheese. When snacking, reach for fatfree or low-fat plain yogurt or cottage cheese. You can even add fruit or vegetables to such snacks to make snack time even more hearthealthy.
DHHS recommends reading the ingredients list on the package before purchasing. Make sure whole wheat or another whole grain is the first item listed in the ingredients list, and choose only those products that say 100 percent whole grain. Instead of preparing white rice as a side dish, serve brown or wild rice, quinoa or oats.
Proteins
A heart-healthy diet is easy to design and just as flavorful as less healthy alternatives.
Healthy proteins are another way people can promote heart health with their daily diets. When choosing proteins at the grocery store, the AHA recommends
The U.S. Department of Health and Human Services notes that fruits and vegetables are healthy whether they’re fresh, frozen, canned, and/or dried. The AHA advises eating fruits and vegetables with every meal and snack, and that may require a little creativity as you sneak them into favorite
“
WE’RE LIVING IN AN
AMAZING TIME.
”
- Bernie
Bernie lived with atrial fibrillation (AFib) for years. And then one day he woke up not feeling very well. “They diagnosed me with fluid in the sack around my heart,” he explains.
Bernie was the first WATCHMAN patient at Baystate Medical Center. “They gave me the feeling, seriously and honestly, that they cared about my wellbeing. I no longer live in fear of a stroke. I can enjoy my life,” he says. To watch Bernie’s life-changing story, go to BaystateHealth.org/Bernie. 11348
3130364-01
Because of this, Bernie’s cardiac care team at Baystate Medical Center could not put him back on blood-thinner medication. So his doctors recommended an innovative new procedure called the WATCHMAN, in which a device is surgically inserted into the left atrial appendage
of the heart to help prevent clots in patients with AFib.