Better Health - February 2023

Better Health

Risk Factors

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It started like any other day for Joshua Choquette.

By K eith O ’C onnor Special To The Republican

He woke up, had breakfast, and went to work at Amherst Landscape. Later he went to the gym before ending the day by having a drink with a friend, a normal day for a healthy 28-year-old young man.

Joshua, however, had no idea that in less than 24 hours that he would be fighting for his life at Baystate Medical Center – a battle that he had to win, not just for himself, but for his two older brothers as well.

“I was bench pressing and felt a pop, like a tear in my chest, but I thought I had just pulled a muscle. Later that night after going to bed, I woke up at about 2 a.m. in excruciating pain, which had now traveled up the left side of my neck to the ear,” said Joshua, who soon found himself at the Emergency Department at Baystate Medical Center because he was suffering from an aortic aneurysm that had dissected.

The aorta is the largest artery in the body. It carries all the blood being pumped from the heart to the entire body. An aneurysm is a weak area in the wall of the artery that develops over time and produces a balloon-like bulging as the arterial wall progresses towards failure.

Dissection represents a partial rupture. Aortic dissection happens when there is a tear in the inner most layer wall of the aorta. As the tear extends along the length of the aorta, blood flows in between the layers of the blood vessel wall further weaking it, blocking off branches, or simply bursting completely through.

If left untreated, the condition results in death for over 90% of patients.

Joshua was one of the lucky

ones, about half of all patients with the condition die before arriving at a hospital. At Baystate - the only tertiary care center in western Massachusetts with cardiac surgery capabilities - he would soon learn the grim news that the odds of surviving surgery were “just 50-50.”

“You could see it in Joshua’s face. His whole world was turned upside down. But I knew the odds were better for a young, fit, relatively healthy young man like him,” his surgeon Dr. Siavash Saadat said.

Also in his favor, according to a recent study published in the journal JAMA Cardiology, death rates to repair an aortic dissection were nearly three times higher at low-volume centers when not done by a dedicated aortic surgeon like Dr. Saadat at an experienced high-volume center.

During the nearly 8-hour, highly complex, open-heart surgery, Dr. Saadat and his OR team identified the tear and removed the damaged portion of the aorta, replacing it with a manmade Dacron graft which keeps the blood from flowing into the aortic layers and directs it back to the correct “lumen” or channel within the vessel.

Joshua beat the odds - more than 13,000 people die from an aortic dissection each year in the United States - and survived the surgery. He returned home to recover after spending six days - some in the Cardiac Intensive Care Unit - in the hospital. But while his surgery was a success, Joshua would find himself back in the operating room just six months later.

“When you have a patient such as Joshua come in as an emergency, you don’t have a good grasp of what is going on with the remainder of the aorta, just that you need to repair the dissection immediately to save your patient,” Dr. Saadat said, noting the risk of death increases by 3-4% every hour if left untreated.

“For that reason, patients receive post-operative screening CT scans to check the aorta for any progression of disease. What we noticed was that Joshua’s aorta continued to get larger and was growing so rapidly and susceptible to another tear, that we decided to do a second surgery on the aorta,” he added.

Sometimes there is a silver lining to even the most terrible of tragedies. In Joshua’s case there was - his aortic aneurysm would go on to save the lives of his two brothers –Andrew, 30, and Daniel, 33, all of whom live in Ware.

About 20% of people with

an aortic aneurysm and dissection have a genetic predisposition to the disease. Since the illness is familial, even before genetic testing was done, Andrew and Daniel underwent CT scan screening. While ECHO cardiography can detect some thoracic aortic aneurysms, CT is the “gold standard” for detection and sizing of aneurysms.

“Ironically, before my brother had his dissection, I was having chest pains and assumed it was just stress, I made an appointment with my primary care doctor, which I later cancelled when I learned about the CT scan,”

Andrew said.

Joshua was worried for his brothers.

“I bet my life that it was just bad luck for me and there was no way they would have aneurysms. Unfortunately, they did,” he said.

Risk factors for an aortic aneurysm include age, family history, lifestyle habits, medical conditions such as high blood pressure, which is also the biggest risk factor for aortic dissection, and several genetic conditions such as Loeys-Dietz syndrome.

Loeys-Dietz is a disorder that affects the connective tissue in many parts of the body and is often characterized by an enlargement of the aorta. All three brothers after genetic testing were found to have the syndrome. Symptoms of dissection may feel like a heart attack and include sudden, severe chest pain or upper back pain that radiates to the neck, and shortness of breath. Aortic dissection occurs in about 2 out of every 10,000 people, mostly seen in men ages 40 to 70, but can happen to anyone.

“Aortic aneurysms are like time bombs and people are typically asymptomatic until the dissection occurs.

Andrew’s aneurysm was big enough that we didn’t waste any time getting him into the hospital for surgery, in fact, his surgery preceded Joshua’s second operation, but Daniel’s was less severe and didn’t require immediate surgery,” said Dr. David Deaton, the Baystate cardiothoracic surgeon who would go on to operate on the other two brothers.

Joshua’s second surgery with Dr. Saadat occurred on February 17, 2022, after Andrew’s surgery took place on October 12, 2021. Daniel’s surgery was in 2022 on the day after Thanksgiving.

All three brothers had aortic root (root refers to the location on the aorta) aneurysms, which Dr. Deaton explained is

an aneurysm of the very first part of the aorta and is “as close to the heart as you can get.”

“Dr. Deaton was great throughout the entire process. He is an extremely knowledgeable surgeon who uses different visual aids to explain what he is going to do, how he is going to do it, your options and the possible outcomes,” Daniel said.

Joshua’s second surgery performed by Dr. Saadat was similar to what Dr. Deaton had to do for Andrew.

“For a root aneurysm, you replace the section of the aorta that is enlarged with an artificial tube called a Dacron graft. Because it is the root, surgery often involves replacing the aortic valve as well with a mechanical or biological valve. When you use a mechanical valve, patients must for the rest of their lives take an anticoagulant, which many people refer to as blood thinners, in order to prevent blood clots,” Dr. Deaton said.

However, Daniel’s condition, while still an aortic root aneurysm, did not require replacing his aortic valve in what is called a valve-sparing aortic root repair.

Daniel noted their mother, Desiree, was “always there for us” and all three brothers agreed it took an “emotional toll” on her.

She called the ordeal “18 months of chaos.”

“It hit us hard. We very well could have lost Joshua. Thankfully, Andrew and Daniel were not in an emergency situation like their brother. I’m relieved now that it is all behind us,” Desiree said.

“But I’ll never ever forget what Daniel said to me about having Thanksgiving. He told me he wanted me to make it, ‘The greatest ever,” just in case he didn’t make it. After he left the house, I broke down,” she added, thankful now for her three sons’ newfound health.

Top: From Left to Right: Joshua Choquette, Daniel Choquette, Andrew Choquette and Desiree Choquette in Front. Bottom: Baystate Health Cardiac Surgeons Dr. David Deaton and Dr. Siavash Saadat. (PHOTOS COURTESY OF BAYSTATE HEALTH)

for an aortic aneurysm include age, family history, lifestyle habits, medical conditions such as high blood pressure, which is also the biggest risk factor for aortic dissection, and several genetic conditions such as Loeys-Dietz syndrome.

Simple ways to make

Healthier Meals

Cooking foods at home is one of the simplest ways to gain greater control over personal health. Cooking at home is the easiest way to know precisely what you’re putting into your body each day. Cooking your own meals also enables you to customize recipes so they align with any dietary restrictions or personal preferences you may have.

According to a 2021 survey by the consumer market research firm Hunter, 71 percent of people in the United States plan to continue cooking more at home after the pandemic ends. Increased creativity and confidence in the kitchen, as well as the fact that cooking at home helps to save money and enables one to heat healthier, is driving the ongoing increase in dining in.

When cooking at home, cooks can consider various tips to make meals that much healthier.

Increase fiber intake

Fiber improves bowel regularity and helps a person feel full between meals. High fiber foods also help stabilize blood sugar levels. Two servings of

Tips to manage your

Cholesterol

fibrous foods at each meal and an additional fiber-rich snack each day can ensure your body is getting the fiber it needs.

Slow down eating

The pace at which a person eats a meal can affect his or her overall health. Healthline reports that fast eaters are more likely to eat more and have higher body mass indexes than slow eaters.

Choose whole grains

Choosing whole grain breads or cereals over refined grains can make for a more nutritious diet. Whole grains are linked to a reduced risk for type 2 diabetes, heart disease and cancer.

Swap Greek yogurt for other varieties

Greek yogurt contains up to twice as much protein as regular yogurt, providing roughly 10 grams per 3.5 ounces. Protein along with fiber helps a person feel fuller longer, which can manage appetite and reduce overeating. Greek yogurt also can replace mayonnaise or sour cream in certain recipes.

Add a vegetable to every meal

Vegetables are loaded with essential vitamins and minerals. Plus, they tend to be high in antioxidants that strengthen the immune system. Increase vegetable intake by eating vegetables with every meal.

Choose healthy fats

While a person should minimize the amount of oils and other fats used during the cooking process, when it’s necessary for a recipe, select the best fat possible. Olive oil is a monounsaturated fat that is packed with antioxidant polyphenols. It is considered a heart-healthy oil, and it may promote a healthy brain and memory function.

Cut out sweetened beverages

Sodas and other sweetened drinks are leading sources of added sugar in diets. Opting for water or naturally sweetened fruit juices can improve overall health.

Small dietary changes can add up to big health benefits.

We’re Here for You.

Cholesterol is present in the body and it also can be found in food. That can make it hard for people to understand why cholesterol is often seen in such a negative light. Any confusion surrounding cholesterol can serve as the perfect springboard to learn more about it.

What is cholesterol?

A waxy, chemical compound, cholesterol often gets a bad rap. However, the American Heart Association says it is actually needed to build cells. The liver makes all the cholesterol a person needs. Additional

from diet.

There are two types of cholesterol carried through the blood. Low-density liproprotein (LDL) transports cholesterol particles throughout the body. This is considered “bad” cholesterol because it can build up in the walls of the arteries. High-density liproprotein (HDL) picks up excess cholesterol and takes it back to the liver, which is why it is considered “good” cholesterol.

In terms of measuring cholesterol, a total cholesterol level of less than 200 mg/dL is desirable. High HDL numbers are best, and any amount less than 40 mg/dL is a red flag. In regard to LDL, less than 100 mg/dL is optimal.

Why is cholesterol concerning?

When present in the right amounts, cholesterol is instrumental in building healthy cells. When there is too much bad

cholesterol in the blood, that can pose a problem. That’s because it can increase risk for heart disease, warns the Mayo Clinic.

In high amounts, LDL cholesterol can deposit fatty residue in the blood vessels. These deposits will grow over time and harden, blocking off the flow of blood through the arteries and making vessels less flexible, a condition known as atherosclerosis. Sometimes cholesterol deposits break off suddenly from the walls of blood vessels and then form a clot that can lead to a heart attack or stroke. In addition to cholesterol, doctors will measure triglycerides during lipid profiles. The Mayo Clinic says triglycerides are a type of fat in the blood. Having high triglyceride levels also can increase risk for heart disease.

Managing cholesterol levels

High cholesterol is one of the major risk factors for coronary heart disease, though it is controllable. By making some changes and being cognizant of cholesterol numbers, individuals can improve their overall health significantly.

It is important that individuals know the baseline numbers in their lipid profile, including HDL, LDL and triglyceride levels. Doctors may differ in their interpretations of how cholesterol levels factor into the bigger picture of a person’s lifestyle and overall health. But people can still do their best to keep bad cholesterol levels down.

•Make changes to a diet to reduce consumption of foods high in saturated fats, trans fats and animal proteins.

•Reduce weight to have a body mass index lower than 30.

•Increase exercise which will help boost HDL naturally.

•Quit smoking which can lower levels of HDL.

•Consume alcohol in moderation Alcohol tends to increase total cholesterol levels.

Individuals are urged to speak to their doctors if they have concerns about cholesterol.

Cholesterol is a complex topic that can be difficult to understand.

4 Common Heart Conditions

According to the World Health Organization, an estimated 17.9 million people die each year from cardiovascular diseases, which are a group of disorders of the heart and blood vessels.

The sheer volume of deaths caused by heart disease each year suggest there’s little people can do to avoid it. However, the Canadian organization Heart & Stroke notes that healthy behaviors like eating a heart-healthy diet and

exercising regularly can help individuals delay the onset of heart disease by as much as 14 years. Education is another valuable asset in the fight against heart disease. Individuals who are aware of common heart illnesses can discuss them with their physicians and take measures to reduce their risk.

Angina

Heart & Stroke notes that angina is another word for chest pain. The discomfort associated with angina, which can feel like squeezing, suffocating or burning, is caused by a temporary disruption in the flow of blood and oxygen to the heart. Though angina symptoms typically do not

last long, they are considered warning signs for heart attack and should be discussed with a physician immediately after they appear.

Atherosclerosis

Atherosclerosis is characterized by the buildup of plaque on the interior wall of an artery. That buildup makes the walls of the artery thick and hard, thus restricting the flow of blood, and can potentially contribute to a blockage. The experts at Johns Hopkins Medicine note that risk factors for atherosclerosis include high cholesterol, high blood pressure, obesity, and a poor diet that includes lots of saturated fats. Atherosclerosis can cause angina, though many individuals with the condition

experience no symptoms until it has reached an advanced stage. Blockages in the leg may cause cramping when exercising or walking, while those in the arteries of the heart can cause heart attack. Blockages that develop in the brain can cause stroke.

Cardiomyopathy

The Centers for Disease Control and Prevention notes that cardiomyopathy often goes undiagnosed, making it hard to determine just how common the condition is. But the CDC estimates that as many as one in 500 adults have cardiomyopathy. Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump oxygen-rich

blood to the body at optimal capacity. Heart & Stroke notes that cardiomyopathy can lead to heart failure. Early stages of cardiomyopathy may not produce any symptoms, but as the disease gets worse individuals may experience fainting, irregular or rapid heartbeats, light-headedness, and swelling of the hands and feet, among other things.

Coronary artery disease

Heart & Stroke notes that coronary artery disease (CAD) is the most common form of heart disease. CAD occurs when one or more of the coronary arteries narrows or becomes blocked. CAD causes damage or disease to major blood vessels that

supply blood, oxygen and nutrients to the heart. Certain risk factors for CAD, such as age, are beyond individuals’ control. However, many risk factors are within a person’s control. Individuals can speak to their physicians about how to maintain a healthy blood pressure and a healthy weight, limit stress, and reduce their cholesterol, all of which can lower risk for CAD.

Heart disease claims the lives of millions of people each year. Recognizing common heart conditions and how to prevent them can help individuals lower their risk for this deadly, yet often preventable disease.

Cardiovascular disease is the leading cause of death across the globe.

The basics of Cardiac Arrest

On a Monday night in early January 2023, the Buffalo Bills were in Cincinnati to take on the hometown Bengals. The game was a highly anticipated, primetime matchup between two of the best teams in the National Football League, but it would be interrupted and ultimately postponed after Bills safety Damar Hamlin suffered a frightening injury during the game. After tackling Bengals wide receiver Tee Higgins, Hamlin stood up, only to fall flat moments later. Medical personnel rushed to Hamlin’s side, and it was later determined he went into cardiac arrest.

Days went by as football fans across the nation prayed for Hamlin’s recovery. Good news arrived by the end of the week, as doctors treating Hamlin reported his condition showed marked improvement. Indeed, within days of that news, Hamlin was on his

way back to Buffalo, much to the delight of millions of people across the country.

Hamlin’s story made international headlines and left many people across the globe asking questions about cardiac arrest.

What is cardiac arrest?

The National Heart, Lung, and Blood Institute reports that cardiac arrest occurs when the heart suddenly and unexpectedly stops pumping. One of the dangers of cardiac arrest is that blood stops pumping to the brain and other vital organs. In the days after doctors first shared news regarding Hamlin’s recovery, praise was heaped on the medical personnel, including Bills assistant athletic trainer Denny Kellington, for their rapid response, which saved Hamlin’s life and helped preserve the 24-year-old safety’s neurological function.

How dangerous is cardiac arrest?

The NHLBI notes that cardiac arrest is a medical emergency. In fact, the NHLBI indicates that nine out of 10 people who have cardiac arrest outside of a hospital die. That makes the recovery of Hamlin, who was administered CPR on the field for several minutes prior to being transported to the hospital, all the more incredible.

What are the symptoms of cardiac arrest?

Johns Hopkins Medicine notes that there are no symptoms in some cases of cardiac arrest. However, individuals may experience these symptoms prior to cardiac arrest:

· Fatigue

· Dizziness

· Shortness of breath

· Nausea

· Chest pain

· Heart palpitations

· Loss of consciousness

What causes cardiac arrest?

The suddenness of the injury to Hamlin undoubtedly left millions of people confused about how the condition could affect a young professional athlete seemingly in peak physical condition. Specifics about Hamlin’s medical history are protected by privacy laws, so unless Hamlin chooses to share that information, the public will not learn about why he suffered from cardiac arrest. However, Johns Hopkins reports that there are three main causes of the condition.

· Arrhythmia and ventricular fibrillation: Arrhythmia is a condition marked by problematic electrical signals in the heart that lead to an abnormal heartbeat. Ventricular fibrillation is a type of arrhythmia that causes the heart to tremble rather than

pump blood normally. It is the most common cause of cardiac arrest.

·Cardiomyopathy: Cardiomyopathy is a condition in which the heart is enlarged. Johns Hopkins notes that when a person has cardiomyopathy, the heart muscle thickens or dilates, which causes abnor mal contractions of the heart.

Coronary artery disease:

The NHLBI indicates that most people who experience cardiac arrest have heart disease, even if they didn’t know it beforehand. The most common type of heart disease is coronary ar tery disease, which is marked by the buildup of cholesterol inside the lining of the coronary arteries. That buildup leads to the formation of plaque which can partially or completely

block blood flow in the arteries of the heart.

Certain behaviors or lifestyle choices also can trigger cardiac arrest. For example, the NHLBI reports that heavy alcohol consumption or recent use of cocaine, amphetamines or marijuana can cause cardiac arrest. Severe emotional stress and physical exertion, including that which is typically required of competitive athletes, also can trigger cardiac arrest. The Damar Hamlin incident thankfully appears to have had a happy ending. But millions more people could be vulnerable to cardiac arrest. More information is available at nhlbi.nih.gov.

Let’s grow together.

At Health New England, our mission is to improve the health and lives of the people in our communities by providing outstanding service, delivering superior value, and acting as a leading corporate citizen. This mission is the foundation that guides us every day, especially during these challenging times.

As your local health plan, we pride ourselves on the meaningful difference we have made in the lives of our members for more than 35 years. We look forward to another 35 years of being here for you every step of the way.