Vascular Vitality by Michelle Helfrich

Tools | education | resources for a healthier you! 2015

Vascular Vitality ABDOMINAL AORTIC ANEURYSM: Beware of Pulsating Pain in the Abdomen PAGE 2

CHRONIC PELVIC PAIN IN WOMEN, VASCULAR Could it be Pelvic Congestion Syndrome? PAGE 3

VITALITY

Your Leg Pain Could Be PERIPHERAL VASCULAR DISEASE PAGE 4

Benefits of Choosing an ACADEMIC MEDICAL CENTER for Health Care PAGE 5

A Publication of Cooper University Health Care, Division of Vascular and Endovascular Surgery

VASCULAR VITALITY

A Publication of Cooper University Health Care, Division of Vascular and Endovascular Surgery

Dear Readers, We believe that education is the key to better health, not only in treatment, but in prevention and awareness. We have developed this publication as a tool for education, with articles devoted to your vascular health, information about diseases that affect the vascular system, and the latest in treatments. It is our hope that you will read this publication, save it for future reference, and share it with friends and family. Communication with your primary care provider is vital to maintaining the health of your vascular system. Risk factors such as tobacco use, high blood pressure, diabetes, high cholesterol, and a family history of vascular disease can significantly increase your risk. Talk to your doctor about screenings for abdominal aortic aneurysm, carotid artery disease, and peripheral vascular disease â&#x20AC;&#x201C; these simple, noninvasive screenings can be lifesaving. In good health,

TABLE OF CONTENTS Abdominal Aortic Aneurysm: Beware of Pulsating Pain in the Abdomen.....2 Chronic Pelvic Pain in Women, Could it be Pelvic Congestion Syndrome?......3 Your Leg Pain Could Be Peripheral Vascular Disease.. .....................4 Benefits of Choosing an Academic Medical Center for Health Care......................5 Vascular Surgery and Clinical Trials.................8 Your Circulation and Cigarette Smoking Do Not Mix ....................................9 Recipes.......................................................12 Nutrition Tips for Vascular Health.................13 Crossword Puzzle........................................14

Joseph V. Lombardi, MD, FACS Chief, Division of Vascular & Endovascular Surgery Associate Professor of Surgery, Cooper Medical School of Rowan University Program Director, Vascular & Endovascular Surgery Fellowship Program Director, Level One Vascular Emergency Program Director, Cooper Aortic Center

Tools | education | resources for a healthier you!

Catherine L. Cristofalo, MSN, APN Assistant Vice President of Advanced Practice Providers and Clinical Ambulatory Care

Amy E. Ward, MSN, APN Advanced Practice Nurse

Jeffrey P. Carpenter, MD Professor and Chairman, Department of Surgery Vice President for Perioperative Services, Cooper Health System

Tonya L. Hooper, MSN, APN James B. Alexander, MD, FACS Vice Chair for Education, Department of Surgery Professor of Surgery, Cooper Medical School of Rowan University Medical Director, Noninvasive Vascular Laboratory at Cooper University Health Care

Advanced Practice Nurse

COOPER VASCULAR SURGERY CooperHealth.org/Vascular

Jose L. Trani, MD

800.8.COOPER – 800.826.6737

Assistant Professor of Surgery, Cooper Medical School of Rowan University Associate Program Director, Vascular and Endovascular Fellowship and Residency Program Medical Director, Vascular Laboratory

Appointments: 856.342.2151 Locations: • Marlton • Willingboro • Voorhees • Camden • Washington Township CONTRIBUTING WRITERS: Sherlyn Accorsi Manager, Business Development & QA, Vascular Surgery

Francis J. Caputo, MD Assistant Professor of Surgery, Cooper Medical School of Rowan University Associate Program Director, Level One Vascular Emergency Program

CREATIVE DIRECTOR: Michelle Helfrich MH Design Company, LLC www.mhdesigncompany.com

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Abdominal Aortic Aneurysm: Beware of Pulsating Pain in the Abdomen

An aortic aneurysm is a bulge in the aorta that develops in areas where the aorta wall is weak. The aorta is the main blood vessel carrying oxygen-rich blood to other parts of the body. The pressure of the blood pumping through it causes the weakened section to bulge out like a balloon.

an aneurysm gets too large, it can rupture and cause life-threatening bleeding or instant death without any prior warning. A blood clot may also form in the aneurysm. Small pieces of a blood clot can break off and travel throughout the body. If a fragment of a clot gets stuck in the brain or a heart blood vessel, it can cause a stroke or a heart attack.

An aneurysm can develop in any section of the aorta, but the most common type is an Abdominal Aortic Aneurysm (AAA). It happens in Medicare now offers a one-time, the part of the aorta that passes no-cost abdominal ultrasound to qualithrough the abdomen. fying seniors within the first 12 months of enrollment. Men who have smoked at Thoracic Aortic Aneurysms least 100 cigarettes during their lifetime, happen in the part of the aorta as well as men and women with a family located in the chest area. They history of abdominal aortic aneurysm, may not produce symptoms also qualify for the Medicare screenuntil the aorta bursts, causing ing. Talk to your primary care physician chest or back pain. about this benefit.

MEDICARE BENEFIT

A frustrating fact is that most people with an abdominal aortic aneurysm do not have any symptoms at all. The aneurysm is usually discovered by X-ray during a routine exam for an unrelated health issue. Many aortic aneurysms will grow slowly for years before they are large enough to cause symptoms. And even then, a large aneurysm may not cause any symptoms thereby delaying a proper diagnosis.

A Thoracic Aortic Dissection is a tear that causes a ballooning of the aortic wall which can then rupture. Symptoms include constant chest or upper back pain that may feel like a “tearing” pain.

When symptoms do occur, pain in the abdomen is most common. The pain may be occasional or constant. Some people describe a pulsing sensation in the abdomen which can be a warning sign of an AAA. (Continued on Page 7)

Aneurysms can grow in size over time. As an aneurysm expands, it can start to cause symptoms. When

“AAAs remain a silent killer. If detected early enough, there are minimally invasive techniques to treat even the most complicated aneurysms.” Francis J. Caputo, MD Assistant Professor of Surgery, Cooper Medical School of Rowan University Associate Program Director, Level One Vascular Emergency Program 2

CHRONIC PELVIC PAIN IN WOMEN, Could it be Pelvic Congestion Syndrome? What is Pelvic Congestion Syndrome (PCS)? Chronic pelvic pain is a common problem in the United States. Chronic pelvic pain is defined as “non-cyclical” pain lasting greater than six months. It is estimated that more than one-third of all women are affected by this problem. Dozens of conditions can result in chronic pelvic pain. In many cases, the root cause is never discovered despite numerous tests and operations. For some women, however, pelvic pain is caused by a condition known as Pelvic Congestion Syndrome (PCS), varicose veins in the pelvic region, which may go undiagnosed simply because the symptoms may often be overlooked or ignored. A common sign of this syndrome is that the women may feel pelvic pain while standing, but not when they are laying down. This alone can sometimes make it difficult to diagnose because women are usually asked to lie down for a pelvic exam which relieves the painful pressure that brought them to the doctor in the first place.

The before-and-after of a patient with severe pelvic reflux and congestion.

What Causes Pelvic Congestion Syndrome? PCS occurs when varicose veins develop around the ovaries, similar to varicose veins that occur in the legs. The valves in the veins no longer function normally, blood backs up, and the veins become engorged or “congested” which can be very painful. In men, a similar condition can cause varicose veins to form on the scrotum, which is known as a varicocele. In women, however, these varicose veins are internal. Occasionally, varicose veins appear on the vulva, thighs, or buttocks.

Note the backfilling of the pelvic veins that produce discomfort and pain. Embolization reroutes the blood flow to competent or “working” veins to minimize pressure and relieve pain.

Who is most prone to develop PCS?

• Women between the ages of 20-45 in their childbearing years

• Women who have had multiple pregnancies

• Women who have experienced hormonal increases

• Hormonal dysfunction

• Polycystic ovaries

• Varicose veins in legs

BEFORE

AFTER

(Continued on Page 10) 3

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Your Leg Pain Could Be Peripheral Vascular Disease Many people assume sudden or noticeable leg pain is the result of an accidental injury, too much exercise, or the inevitable result of aging. However, not all leg pain is muscular.

PVD slowly and steadily restricts your circulation, and it is dangerous if left untreated. The main cause of PVD is plaque buildup (atherosclerosis) in a leg artery. This buildup of cholesterol, calcium, and fibrous tissue, either partially or completely, blocks blood flow to parts of the body other than the heart, such as the legs and arms. Due to the fact that narrowed blood vessels cannot carry oxygen-rich blood to these other body parts, the circulation stops functioning properly. Additionally, blood clots may form on an artery wall, narrowing the artery even further and making the blockage worse.

In fact, pain experienced in the legs while walking could be a symptom of a very common circulatory condition that is difficult to diagnose. When plaque builds up in any of the blood vessels outside of the heart (arteries, veins, or lymphatic vessels), the result is peripheral vascular disease (PVD). This condition is also referred to as peripheral artery disease.

The challenge of identifying PVD early is that many individuals who have it do not experience any (Continued on Page 6)

The risk factors for peripheral vascular disease include conditions that cannot be controlled as well as lifestyle habits and health issues that are controllable. RISK FACTORS THAT CANNOT BE CHANGED ARE:

RISK FACTORS THAT CAN BE REDUCED OR CONTROLLED INCLUDE:

• Being over age 50

• Smoking and/or use of other tobacco products

• Type 1 Diabetes

• Heart disease

• Being male (men are at greater risk than women)

• High cholesterol

• Being postmenopausal

• High blood pressure

• A family history of high cholesterol, high blood pressure, or peripheral vascular disease

• Being overweight

• Lack of exercise

• A history of heart disease

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TRAINING TOMORROW’S PHYSICIANS: Academic medical centers are hospital systems that train and educate medical students, residents and fellows, providing them hands-on experience so that they develop into the next generation of physicians. These institutions may call themselves University Health Systems or academic medical centers or any combination of those words. There are definite pros for a patient to choose an academic medical center for their health care needs: • We often hear patients ask, “Are you going to do my procedure?” This question is often the result of a misunderstanding of an academic medical center, where patients feel as though they are exposed to “inexperienced residents or trainees”. The attending doctor who is providing care for you is always

What benefits do patients receive when choosing an academic medical center for their health care? ultimately responsible for your hospitalization. And, yes, your doctor is intimately involved in your care and procedures. The added benefit of resident participation means that an extra pair of intelligent eyes and skillful hands are available to you instantly during your stay in the hospital, even when your doctor is not. Every detail is scrutinized and digested 2 to 3 times before a decision on your care is made together with your physician. These “learners” are researching your condition, being tested hourly on your medical (Continued on Page 14)

“Academic teaching hospitals are the preferred locations of most physicians who require treatment.” Joseph V. Lombardi, MD, FACS

Chief, Division of Vascular & Endovascular Surgery Associate Professor of Surgery, Cooper Medical School of Rowan University Program Director, Vascular & Endovascular Surgery Fellowship Program Director, Level One Vascular Emergency Program Director, Cooper Aortic Center 5

(Continued from Page 4)

symptoms. Approximately 50% of people correctly diagnosed with peripheral vascular disease are symptom free. The most common warning sign of PVD is lower leg pain when walking, climbing stairs, or exercising. Another warning sign – instead of feeling pain – is that you may experience heaviness, tightness, weakness, or cramping in the legs when walking. (This is called intermittent claudication—a painful tightening in the calf muscle.) It’s all too easy to assume that the pain indicates something other than a circulatory problem. While at rest, the muscles need less blood flow, so the pain goes away. A variety of non-vascular sources of leg pain can make it difficult to determine what the discomfort is telling you, including: • Arthritis (pain in the joints) • Spinal stenosis, sciatica (painful back problems) • Peripheral neuropathy (pain as a result of nerve damage) • Multiple sclerosis • Osteoarthritis of the hip While not as common as leg pain, these may also be warning signs of peripheral vascular disease: • Changes in skin temperature and appearance (especially brittle, shiny skin on the legs and feet) • Loss of leg hair • Non-healing sores over pressure points (heels, ankles) • A reddish-blue skin color on the legs

To determine if someone has PVD, a doctor will most likely check for a weak or absent leg pulse. This may reveal a blockage in the leg artery. Other noninvasive tests used to confirm blockage and a diagnosis of peripheral vascular disease are: Checking leg blood pressure, a CT scan, or MRA (magnetic resonance angiography), and ultrasound. Once the diagnosis is confirmed, your doctor will decide the best treatment based on your symptoms. Severe symptoms can prompt a vascular surgeon to discuss restoring blood flow to the legs. Improved circulation should lessen and eliminate leg pain. However, the majority of patients do not require a procedure to restore flow. Lifestyle changes are typically first suggested as proactive ways to manage PVD’s risk factors. Patients can actually improve their walking with conservative measures. If lifestyle changes and/or medication do not improve blood flow and leg function, the doctor may consider other forms of treatment. Minimally invasive procedures include: • Inflating and deflating a special balloon in the leg artery to push the plaque out of the way (angioplasty) (Continued on Page 11)

“Over the past decade, there have been important advances in medical and interventional treatment of peripheral arterial disease. People are receiving better treatment with improved quality of life thanks to the progress that has been made.” Jose L. Trani, MD Assistant Professor of Surgery, Cooper Medical School of Rowan University Associate Program Director, Vascular and Endovascular Fellowship & Residency Program Medical Director, Vascular Laboratory 6

(Continued from Page 2)

The before-and-after of a patient with an AAA

If an abdominal aortic aneurysm is suspected, your doctor may use ultrasound or CT scanning to investigate it. When an AAA is confirmed, a vascular specialist will use several imaging tests to gather more information regarding its size, shape, and exact location in the abdomen. (CT scans and MRIs are typically used to diagnose thoracic aortic aneurysms.)

Here’s a before-and-after of a patient with a large abdominal aortic aneurysm with a minimally invasive delivery system in place before deployment. The completed repair shows complete exclusion of the aneurysm greatly reducing the patients risk of rupture. This patient went home the following morning and back to work the following week.

Per preventive screening guidelines from the Society for Vascular Surgery and the Society for Vascular Medicine and Biology, abdominal ultrasound screening is recommended for the following people: • All men age 60 to 85 • All women age 60 to 85 who have cardiovascular risk factors • All men and women age 50 and older with a family history of abdominal aortic aneurysm Some of the same risk factors for a heart attack also increase the risk of abdominal aortic aneurysm, including:

BEFORE

• Plaque in the artery walls (atherosclerosis) • High blood pressure • Diabetes • High cholesterol • Smoking • A family history of aortic aneurysm

AFTER

in place, the stent-graft creates a new passageway for blood flow without pushing on the aneurysm. After an endovascular stent-graft is inserted, you must visit your doctor regularly to monitor its position with CT scanning. For people who are not candidates for endovascular repair, open surgery is an option. During the procedure, a synthetic graft is stitched into place to connect it with the healthy aorta on either side of the diseased area. After surgery, the new synthetic section of the blood vessel functions like a normal, healthy aorta.

Treatment of abdominal aortic aneurysms continues to evolve by offering patients more sophisticated solutions. The endovascular approach remains a preferred treatment for AAAs. During an endovascular procedure, the surgeon inserts a stent-graft inside a catheter (a long, thin tube) and guides it to the site of the aneurysm. Once securely

Again, your doctor will want to see you regularly to conduct a physical exam and run diagnostic tests. The (Continued on Page 14)

“Exciting advances in minimally invasive techniques and devices for aneurysm repair are making this procedure safer and more durable for our patients.” Jeffrey P. Carpenter, MD Professor and Chairman, Department of Surgery Vice President for Perioperative Services, Cooper University Health Care 7

Vascular Surgery Technology Clinical Trials Vascular Surgery is a field of medicine where the technology is always evolving. In order to evaluate the efficacy of this technology, it has to go through a trial period as required by the FDA before it can be used in the community, also known as “FDA Approved”.

as aortic aneurysms, aortic dissections, and peripheral vascular disease. In order to participate in a clinical trial, a patient must sign an informed consent. An informed consent is necessary to clearly communicate the requirements of the study to the participant. The informed consent includes the risks presented during the trial, treatment procedure, and potential benefits. While not everyone is eligible to participate in a clinical trial, a screening process is in place to determine if a patient is a candidate for a clinical trial.

A clinical trial is a study involving human volunteers that is designed to answer specific health questions. The drugs and devices tested in clinical trials may or may not yet be FDA Approved. A clinical trial can compare a new drug or device to the standard of care or follow the outcomes of patients who have received a surgical implant device, such as a stent. Clinical trials allow physicians and hospitals to provide the newest methods of treatment to patients. Most often in vascular surgery, this new technology is geared towards treating complex diseases in a minimally invasive manner that at one time required major open operations.

Participating in a clinical trial can benefit the medical community as well as the trial participants. Clinical trials can help medical researchers discover better treatments or a cure to certain medical conditions. Participants receive the opportunity to play an active role in the progress of medicine as well as the potential to help others in the future. Clinicaltrials.gov provides a brief description of the clinical trials that are going on in the USA. If you are interested in participating in clinical trials, you can ask your vascular surgeon if you qualify for any current clinical trials.

Large academic tertiary care hospitals have access to the latest clinical trials involving disease processes such

“Clinical trials are the standard by which new technology is evaluated, not only for safety, but also for effectiveness against proven methods.” Francis J. Caputo, MD Assistant Professor of Surgery, Cooper Medical School of Rowan University Associate Program Director, Level One Vascular Emergency Program 8

Your Circulation and cigarette smoking Do not mix Cigarette smoking is the number one preventable cause increases blood pressure, and causes the arteries to of death in the United States. It is well known that narrow or become smaller. Also, nicotine causes the smoking causes disease of release of fat and cholesterol the lung tissue – otherwise There are over 4000 chemicals in cigainto the bloodstream which known as chronic obstrucleads to hardening of the rettes, hundreds of which are toxic and tive pulmonary disease – arteries. Nicotine dependence more than 70 cause cancer. Nicotine is and is associated with is the most common form of the chemical in cigarettes that causes many different types of chemical dependence in the addiction. It is a stimulant that causes cancers. Smoking also leads United States. the heart to beat faster, increases blood to disease of the arteries, pressure, and causes the arteries to narSmoking can lead to a which are the blood vessels row or become smaller. stroke in several ways. Most that carry oxygenated notably, it can cause the blood to all of the tissues main arteries supplying in the body. When the arteries degenerate or develop significant plaque from smoking, (a process called the brain, the carotid arteries, to become filled with atherosclerosis), it can result in heart attack, stroke, plaque. As the degree of plaque increases, there is an aneurysm, peripheral arterial disease (PAD), limb increase in the likelihood of suffering a stroke. Stroke can lead to paralysis, loss of speech, inability to walk, loss, erectile dysfunction, or even death. Quitting smoking is critical to improving one’s overall health, or even death. and halting the degeneration of the arteries and Peripheral arterial disease supply blood, rich in oxygen prevents these problems from occurring. to the muscles and tissue in the arms and legs. SmokThere are over 4,000 chemicals in cigarettes, hundreds ing can cause PAD by reducing adequate blood supply of which are toxic and more than 70 cause cancer. to the limbs which may lead to leg pain with walking, gangrene and possibly amputation. Smokers are more Nicotine is the chemical in cigarettes that causes addiction. It is a stimulant that causes the heart to beat faster, likely to develop PAD than non-smokers. (Continued on Page 15)

“Quitting smoking is critical to improving one’s overall health. The positive effects of smoking cessation start within 48 hours of your last cigarette.” Catherine L. Cristofalo, MSN, APN

Amy E. Ward, MSN, APN Cooper University Health Care

Cooper University Health Care 9

(Continued from Page 3)

How is PCS diagnosed?

What are the Symptoms of Pelvic Congestion Syndrome? • Pain is the number one complaint — Just before the onset of the menstrual cycle — At the end of the day — After prolonged standing — During or just after intercourse — During later stages of pregnancy

• Irritable bladder • Varicose veins on vulva, buttocks, legs • Feeling of fullness • Swollen vulva/vagina • Abnormal menstrual bleeding • Tenderness to touch in lower abdomen • Pain during intercourse • Painful menstrual periods • Backache • Vaginal discharge • General lethargy • Feelings of depression

What other conditions can mimic PCS? In most cases, the diagnosis of pelvic congestion syndrome is not obvious and the diagnosis can only be made after ruling out some other disorders. Other disorders that may have the same symptoms as pelvic congestion syndrome include:

• Endometriosis • Fibroids • Uterine Prolapse

A thorough history and physical examination by your gynecologist is necessary to rule out more common causes of your symptoms. Ultrasound is usually the first test of choice because it is painless, effective, and only takes about 30 minutes. It can assess the uterus and other organs in the pelvis. It can also help visualize the blood flow and assess the presence of varicosities in the pelvis. However, CT scan, MRI and/ or a venogram could all be utilized as well.

What are the treatment options for Pelvic Congestion Syndrome? Embolization: This is a non-surgical, outpatient procedure. No incisions or stitches are required and there is no sensation inside while this is happening. After treatment, patients typically return to work and light activities the following day, returning to full activities a few days later. In addition to being less expensive and less invasive than surgery, embolization offers patients a safe, effective, minimally invasive treatment option. It successfully blocks abnormal blood flow in 95-100% of cases, and 85-95% of women experience improvement in their symptoms shortly after the procedure. Although symptoms are improved, the veins are never normal, and, in some cases, other pelvic veins may require further treatment.

“Pelvic congestion syndrome is an underdiagnosed dilemma; however, more gynecologists are becoming aware of the benefits of embolization therapy.” Joseph V. Lombardi, MD, FACS

(Continued from Page 6)

WHETHER SUGGESTED PROACTIVELY OR AS A TREATMENT PLAN TO REDUCE THE PROGRESS OF PERIPHERAL VASCULAR DISEASE, EXPECT THE FOLLOWING RECOMMENDATIONS FROM YOUR DOCTOR:

• Quit smoking (also avoid secondhand smoke and use of other tobacco products) • Eat foods low in saturated fat • Lose weight and maintain a healthy body weight • Begin or continue with an exercise program that includes walking (several times a week) • Drink less alcohol • Control high cholesterol through medication (per doctor’s recommendation) • Use medication to reduce the risk of blood clots developing (per doctor’s recommendation) • Monitor and control Type 1 Diabetes (maintain healthy blood sugar levels) • Monitor and control high blood pressure

• Inserting a stent to keep the artery open

an appointment to see your doctor and determine what the pain is telling you.

• Breaking up and removing plaque from the blood vessels (endarterectomy)

BEFORE-AND-AFTER OF A PATIENT WITH PVD.

If peripheral vascular disease is severe enough, creating a detour around the narrowed or blocked artery area with bypass surgery may be necessary.

Below is a before-and-after shot of a typical angioplasty and stenting procedure for a patient who failed conservative therapy and had severe symptoms. This patient walked out of the hospital the same morning pain free.

Leaving PVD undiagnosed and untreated can lead to serious issues, such as constant pain, development of ulcers or dead tissue (gangrene), and possible amputation of toes or a small part of the foot. PVD also increases the risk of heart disease and stroke.

BEFORE

AFTER

With early detection and proper treatment of peripheral vascular disease, it’s possible to maintain a good quality of life and long-term health. If you are over the age of 50 and have lower leg pain when walking, climbing stairs, or exercising, do not ignore it. Make

“Peripheral arterial disease is both a marker for severe systemic atherosclerosis and can be debilitating and life-altering. Hence, it warrants thorough evaluation and thoughtful management.” James B. Alexander, MD, FACS Vice Chair for Education, Department of Surgery Professor of Surgery, Cooper Medical School of Rowan University Medical Director, Noninvasive Vascular Laboratory at Cooper University Health Care 11

Kale & Quinoa Salad Serves 2

INGREDIENTS

DIRECTIONS

2/3 cup water 1/3 cup quinoa 3-1/4 kale leaves, cut into small pieces 1 tablespoon olive oil 2 teaspoons lemon juice 1/4 teaspoon Dijon mustard 3/8 large garlic clove, minced 1/4 teaspoon fresh cracked black pepper 1/8 teaspoon ground sea salt 1/3 cup pecans 1/3 cup currants 1/4 cup crumbled feta cheese **nuts and dried fruit can be added**

1. Bring water to a boil in a saucepan. Stir quinoa into the boiling water, reduce heat to medium-low, place cover on the saucepan, and cook until water absorbs into the quinoa, about 12 minutes. Remove saucepan from heat and let rest covered for 5 minutes. Remove cover and allow quinoa to cool completely. 2. Put kale in a large mixing bowl. 3. Whisk olive oil, lemon juice, Dijon mustard, garlic, pepper, and salt together in a bowl until oil emulsifies into the mixture; drizzle over kale. Add cooled quinoa, pecans, currants, and feta cheese to the dressed kale and toss to incorporate. Source: allrecipes.com

Banana Oatmeal Chocolate Chip Cookies Makes 16 cookies

INGREDIENTS

1 cup oat flour 3/4 cup old-fashioned rolled oats 1/2 teaspoon baking powder 1/3 teaspoon baking soda 1/2 teaspoon salt 1/2 cup raw sugar 1/3 cup canola oil 1/3 cup plain soy milk 1/2 teaspoon vanilla extract 1/2 ripe banana, cut into small pieces 1/4 cup chopped walnuts or other nuts 1/3 cup semisweet vegan chocolate chips (such as Tropical Source)

DIRECTIONS 1. Preheat oven to 350Â°. Combine first 6 ingredients (through sugar) in a bowl. Whisk together oil, soy milk, and vanilla in a separate bowl. Add wet mixture to dry ingredients; stir to combine. Fold in banana, walnuts, and chocolate chips. 2. Line a baking sheet with parchment paper. Scoop dough onto pan with a small ice-cream scoop. Bake 25 minutes or until golden brown, turning baking sheet halfway through. Let cool on a wire rack. Source: health.com X 12

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Nutrition Tips for Vascular Health Eating a healthy, well-balanced diet can help keep your body in tip-top shape from the inside out. A healthy diet and exercise play an important part in maintaining your vascular health. Check out some of these tips for keeping your blood pumping smoothly.

Aim for 5 to 9 Servings of Fruits and Vegetables a Day:

Choose Healthy Fats: • Unsaturated fats, especially those high in Omega-3, can help reduce your risk for cardiovascular disease.

• Not only are they high in fiber, but they have plant sterols and stanols which have been found to help reduce your bad cholesterol. • Make sure to eat the rainbow to get all the benefits fruits and vegetables have to offer. Try red peppers, mangos, lemons, spinach, blueberries, eggplant, and onions, just to name a few!

• Try using oils like canola and olive when cooking; eat fish, like salmon and tuna; and add nuts, like walnuts and almonds, to your meals. Limit Saturated Fats, Trans Fats, and Cholesterol: • Saturated fat, like those found in fatty meat, whole milk, and butter, should only be eaten on occasion.

Pass on the Salt: • Salt plays a major role in maintaining a healthy blood pressure, and many Americans get way too much.

• Trans fats should be avoided when possible. These are typically found in stick margarine, baked goods, and packaged foods. Look at the ingredients list for the word hydrogenated; if it’s there, choose something else. • Cholesterol intake should be less than 200 milligrams per day. Some foods high in cholesterol include fatty meat, whole milk, cheese, and shellfish.

• The recommendation is 2,300 milligrams per day. That’s only one teaspoon a day. • Some foods high in salt are Chinese food, salad dressing, pasta sauce, canned goods, and snack foods like chips, pretzels, and crackers. By following some of these guidelines, you can help reduce your risk for vascular disease and gain a healthier lifestyle. It’s never too late to make a change, and even small changes can add up to big results. Talk to your doctor or a dietitian for a plan that’s right for you.

Eat Plenty of Fiber-Rich Foods: • The recommendation for daily intake is 25-35 grams per day. • Make half of your grains “whole” – pick whole grain breads, pastas, and cereals.

For more information, please visit: The National Heart, Lung, and Blood Institute at: www.nhlbi.nih.gov.

(Continued on Page 14) 13 X

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(Continued from Page 5) • University hospitals who have a primary medical school welcome both private and governmentprovided health care coverage. Often, these hospitals are located in urban areas and are considered to be “safety net” hospitals, and will admit patients who cannot afford private insurance but have health coverage from a government program (such as Medicare and Medicaid).

history and current ailment, and are passionate about doing a great job. It is an environment where the most important culture is that which produces the best patient outcomes. Most doctors themselves feel more comfortable in this environment when they, themselves, are hospitalized because they understand the aforementioned benefits to overall patient care. • Academic medical systems often build “centers of excellence” which focus on certain diseases or conditions, such as an Aortic Center, Vein Center, Cancer Centers and others. They will group the doctors and support staff that specialize in these areas in order to create a unique team that is performance and quality driven. Over time, the reputation gets out and local/ regional community hospitals count on these centers accepting challenging patients either in consultation or in transfer. Ultimately, these academic centers are used for caring for complex patient issues.

• An academic medical center can also offer a patient access to board certified physicians in all major specialties, working side by side, to provide a comprehensive continuum of care 24/7. Most often, Board certification is a requirement for provider employment within a University Health System.

(Continued from Page 7) doctor will use the information gathered from these visits to monitor the progress of your treatment.

• Medical professionals who teach have resources and standards that go beyond what is required of private practice models of health care. For example, these professionals must fulfill strict requirements to maintain privileges and credentialing at their academic institution. There are rigorous standards that must be maintained in a teaching program that benefit education, research and, most importantly, patient care. Their medical school affiliation also means they must meet requirements to publish papers, journal articles and/or books. • The professionals who work in academic medical centers are often very involved with research. They are the people who run clinical trials or who are on the lookout for new ideas, innovative technologies, and treatments in their field. In particular, when you have a rare disease or undiagnosed symptoms, these extended interests may provide answers that will not be forthcoming from a community-based practice which does not have access to the latest clinical trials and devices. The availability of clinical trials usually indicates that the doctors have a regional or national reputation in what they do, otherwise these companies would not trust their products or treatments in that setting.

If you have been diagnosed with an abdominal aortic aneurysm or have received treatment for an aneurysm, it’s important that you lead a heart-healthy lifestyle. It is up to you to take any prescribed medications, attend follow-up appointments, and be an active member of your health care team.

You can help improve your health by: • Quitting smoking • Treating high cholesterol • Managing high blood pressure and diabetes • Exercising regularly • Eating a heart-healthy diet • Maintaining a healthy weight • Reducing stress and anger • Taking prescribed medications as directed • Following up with your doctor for regular visits

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(Continued from Page 9) Smoking can interfere with sexual health as it can cause damage to the arteries that supply the penis resulting in Erectile Dysfunction. An erection cannot occur if there is not enough blood flow to the penis. The nicotine in cigarettes can narrow the arteries that supply the penis, causing not enough blood flow to achieve an erection.

attempt at smoking cessation. The benefits of quitting smoking are numerous including reducing the risk for cancers, heart disease, stroke, PAD, lung disease, and infertility. The positive effects of smoking cessation start within 48 hours of your last cigarette. Blood pressure will decrease, heart rate lowers, carbon monoxide levels in the blood return to normal, oxygen levels in the blood increases, the chance of having a heart attack decreases, and ones sense of taste and smell improves. Within the first year of quitting smoking circulation and lung function improves, and shortness of breath and coughing will decrease.

Aneurysms occur when 1-800-QUIT-NOW is a free telephone walls of the arteries become support service that is available to help weak allowing expansion. smokers who are interested in quitting. This could potentially Combining medications and counseling lead to artery rupture and is recommended for the greatest success. internal bleeding would MD Anderson Cancer Center at Cooper result, which could be life offers a Smoking Cessation six-week threatening. Smokers are group along with individual counseling. more likely to develop anFor more information, call 856.673.4254. eurysms than nonsmokers and continued smoking can cause aneurysms to grow and expand. Resources are available to help smokers achieve success with asbtaining from cigarettes. There are over Buergerâ&#x20AC;&#x2122;s Disease (thromboangiitis obliterans) is a the counter nicotine replacement medications (nicotine vascular disease that affects smokers. This condition patch, gum, lozenge), prescription nicotine replacecan strike young patients (ages 20-40) and can ment medications (nicotine inhaler and nasal spray), unfortunately result in limb loss due to poor circulation. prescription non-nicotine medications (buproprion SR, It would otherwise be uncommon for a person of this Chantix), counseling, support groups, and alternative age group to experience problems with blood flow that therapies (hypnosis, acupuncture). 1-800-QUIT-NOW results in an amputation. is a free telephone support service that is available to It can be very difficult to quit smoking. Research sug- help smokers who are interested in quitting. Combingests that nicotine may be just as addictive of a sub- ing medications and counseling is recommended for stance as heroin, cocaine, or alcohol. Quitting smoking the greatest success. MD Anderson Cancer Center at may take a patient several attempts before achieving Cooper offers a six-week Smoking Cessation group success. Personal stress, weight gain, and uncomfort- along with individual counseling. For more informaable symptoms of withdrawal (anxiety, irritability, tion, call 856.673.4254. increased appetite) can cause a person to fail at their

TEST YOURVitality KNOWLEDGE Test your Vascular Knowledge! 1

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1. These aortic aneurysms happen in the part of the aorta located in the chest area. (page 2) 2. Type of vascular disease where plaque builds up in any of the blood vessels outside of the heart. (page 4) 7. Treatment for PCS. (page 3) 8. A bulge in the aorta that develops in areas where the aorta wall is weak. (page 2) 10. Students training to become doctors. (page 5)

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3. Vascular disease that affects smokers. (page 15)

11. Chronic pain in women can be misdiagnosed in this region. (page 3)

4. Painful tightening in the calf muscle. (page 6)

14. These medical centers train and educate medical students. (page 5)

5. A long, thin tube. (page 7) 6. Used to diagnose PCS. (page 10) 9. Preferred treatment for AAAs. (page 7)

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12. A study involving human volunteers. (page 8)

13. Quitting smoking. (page 15)

15. The chemical in cigarettes that causes addiction. (page 9)

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16. This creates a new passageway for blood flow. (page 11)

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Vascular Vitality VASCULAR VITALITY A Publication of Cooper University Health Care, Division of Vascular and Endovascular Surgery 1.800.8.COOPER CooperHealth.org