The Heart of Jacksonvile | Issue 4

HEART THE

OFJACKSONVILLE

ISSUE 4 | 2018

STOP A PUBLICATION OF

IN THIS ISSUE: How To Save On Health Care Costs Why Do I Have So Many Cardiologists?

How We Are Preventing Amputations 15-Minute Meals Under $5

ISSUE 4 2018

CONTENTS FEATURES: 4

Letter From The President

13

Patient Testimonials: What Our Patients Are Saying

14

How To Save On Health Care Costs

24 Philanthropy:

Treating The Uninsured

SERVICE LINE: 5

Updates In Innovation: Intravascular Lithotripsy (IVL)

6

Pioneers in Structural Heart: Our Structural Heart Clinic

7

Why Do I Have so Many Cardiologists?

10

Amputation Prevention

26

Social Media Recap: Team Pictures

30

Dr. Favorites: Insight Q&A

31

Word Search

8

Recipes: 15-Minute Meals Under $5

31

Cath Lab Thank You!

15

Marital Ups & Downs

16

Heart Attack 101

18

How to Spice Up Your Water

19

Assess Your Heart Risk

22

Benefits of Using Healthy Oils

23

Health Hacks

HEALTHY LIVING:

PROVIDER’S SPOTLIGHT: 12

Women’s Heart Health

14

Dr. Khatib named President of American Heart Association, First Coast Market

20

How Do Our Heart Doctors Stay Healthy?

28

Team Spotlight: Humans Of FCCI

PHYSICIAN’S SPOTLIGHT

Letter from the Dr. Yazan Khatib

PRESIDENT

Healthcare

2O2O What will healthcare look like in the next few years?

The next five years? The next 10 years? While I am not able to accurately answer all of these questions, I can tell you our vision for healthcare in 2020.

There are many customers in healthcare: physicians, administrators, insurance companies, and of course, patients. Healthcare looks different for each of these parties.

Patients are and always will be the top priority in healthcare. Without the patients who put their trust in us, we are nothing. As the years continue, patient-centered care will continue to grow, increasing personalization for each patient. Another aspect that continues to grow is the patient’s involvement.

From the time the patient makes the decision to seek care, patients will have the ability to shop for their healthcare. This means comparing quality and cost-effectiveness of facilities, physicians, and care plans.

As patients work with providers to craft a care plan, the patient’s role here also evolves into a partner in their care.

For physicians, quality will increasingly dictate how we practice medicine. This increases our motivation to ensure every patient leaves the appointment with all of their questions answered, to be convenient for the patient, and to always inspire hope in every person who comes through the door.

As innovators, we have consistently been among the first to bring new technologies to the area, from carotid stenting to structural heart procedures. Turn to page 5 to read about the new technology we are offering to patients with peripheral arterial disease and page 6 to learn about a few of our firsts in the field of structural heart procedures. As innovative technologies emerge, our collection of “firsts” will continue to grow. So will our roles as innovators. We are proud to teach this innovation to the next generation of physicians. Orange Park Medical Center is opening a Cardiology Fellowship program in July 2018. Our physicians will play a crucial role in this program and in passing off decades of experience.

It amazes me that it has already been two years since we have launched this publication. I couldn’t be prouder of the physicians, writers, photographers, producers, and most importantly, the readers, of this publication.

Sincerely, Yazan Khatib, MD President of First Coast Cardiovascular Institute

4 THE HEART OF JACKSONVILLE | Issue 4 2018

UPDATES IN INNOVATION

Dr. Khatib First to Offer New Technology for Patients with

PAD

We are proud to announce that First Coast Cardiovascular Institute is the first practice in Northeast Florida to offer patients with Peripheral Artery Disease (PAD) a new treatment method from Shockwave Medical called IntraVascular Lithotripsy (IVL).

“We are thrilled to be the first in Northeast Florida to offer this innovative technology,” says Dr. Yazan Khatib, President of First Coast Cardiovascular Institute, “PAD is a common cardiovascular disease and can be challenging to treat. IVL gives us another option for our patients and poses a lower risk of damage or injury to the arteries.”

The traditional treatment method for patients with PAD is a balloon angioplasty, which uses an inflated balloon to expand the blocked artery in hopes of restoring blood flow. Unfortunately, this treatment has a failure rate of approximately 50%. Physicians are hopeful that IVL will improve recovery outcomes for these patients.

IVL is an innovative therapy that uses a balloon catheter to break up calcified plaque in the arteries. This new technology is significant for patients with PAD as the disease is characterized by plaque buildup in the arteries. PAD blocks blood flow to the extremities, which can lead to pain, mobility impairments, and even amputation in extreme cases.

Issue 4 2018 | THE HEART OF JACKSONVILLE

5

PHYSICIAN’S SERVICE SPOTLIGHT LINE

PIONEERS IN STRUCTURAL HEART OUR STRUCTURAL HEART CLINIC

Structural heart disease is an abnormality in the structure of the heart. Although this sounds like it occurs at birth, structural heart disease may also occur as the heart progresses through a disease.

Traditionally, structural heart disease required open surgery, generating higher risk factors, lengthy recover times, and extensive hospital stays.

Technology in the past few years has advanced drastically- introducing catheter-based options that require only a small incision.

“If you would have told me 20 years ago that we would have the ability to treat structural heart disease without open surgery, I would not have believed it,” Dr. Vaqar Ali, Interventional Cardiologist at First Coast Cardiovascular Institute (FCCI), says, “What a blessing it is to be able to offer these technologies right in the heart of our community.”

The minimally-invasive technologies include:

CONDITIONS

TAVR :: (Transcatheter Aortic Valve Replacement) Dr. Ali was the first to perform TAVR at Memorial Hospital in 2014. Dr. Youssef Al-Saghir, Interventional Cardiologist at FCCI, followed by being the first to bring this technology to Clay County in 2016. The TAVR procedure is a nonsurgical approach to replace the aortic valve,

6

Structural heart conditions include: Atrial septal defect Patent foramen ovale Congenital heart disease Arterial/venous fistulae Narrowing of aortic valve Mitral valve leakage

THE HEART OF JACKSONVILLE | Issue 4 2018

offering hope for patients with diseased aortic valve. The benefits include avoiding the risk of open-heart surgery, shorter recovery, and overall improved results.

MitraClip :: Dr. Al-Saghir was the first in Clay County to perform the MitraClip procedure.

The procedure is used for patients with mitral regurgitation. Unlike traditional approaches, MitraClip requires only a small incision in the upper leg to reach the heart. The device allows the heart to pump blood more efficiently and reduces hospitalizations for heart failure.

WATCHMAN :: Dr. Ali was among the first physicians at Memorial Hospital Jacksonville to perform the procedure in 2016. WATCHMAN is a device used for patients with non-valvular atrial fibrillation seeking an alternative to long-term warfarin medication. The procedure takes about an hour and patients typically go home the next day.

This device has the potential to free patients from the challenges of long-term warfarin use.

ASD/PFO Closure :: Heart defects such as atrial septal defect (ASD) and patent foramen ovale (PFO) impact the heart’s ability to receive oxygen-rich blood. Traditionally, repair of these defects has been done through open surgery. However, new catheterbased procedures allow our physicians to go through the vein or artery to repair the defect and ensure the heart is receiving adequate blood flow.

SYMPTOMS

The meaning of structural heart disease is similar to what the name implies.

Symptoms of structural heart disease: Migraines Irregular heart beats Fatigue High blood pressure Shortness of breath Kidney dysfunction

SERVICE LINE

WHY DO I HAVE

So Many Cardiologists?

You’re at your appointment to see your cardiologist.

He schedules you for a followup with an Electrophysiologist.

Perhaps he’s asked you to see an Interventional Cardiologist for a procedure.

You are asking yourself what all of this means and why you need so many physicians.

Your heart, despite being just the size of a fist, is a specialized organ. New advancements and technologies have resulted in what is known as subspecialties of cardiology. These days, it isn’t just your cardiologist; it is a team of cardiologists. Each of these cardiologists focus on a different aspect of your heart, to ensure it all works cohesively together.

NON-INVASIVE CARDIOLOGY

ENDOVASCULAR SPECIALIST

A non-invasive cardiologist may often be your first point of contact when it comes to cardiology.

Non-invasive cardiologists are general in their work, and focus on detection and overall treatment of heart disease. Most treatments prescribed by a non-invasive cardiologist will be lifestyle changes or medications.

Endovascular medicine is a relatively new field, focusing on the treatment of diseased blood vessels. Contrary to traditional surgical techniques, endovascular therapies are minimally-invasive and can be performed in an outpatient setting.

Endovascular Specialists are passionate about amputation prevention. Patients typically asked to see Endovascular Specialists include those afflicted with coronary artery disease, peripheral arterial disease, carotid arterial disease and circulatory issues.

INTERVENTIONAL CARDIOLOGY If you require a procedure, you will likely be sent to an Interventional Cardiologist. This subspecialty focuses on the treatment and management of heart conditions using a catheter-based approach. These procedures are minimally-invasive, requiring only a tiny incision in the wrist or groin. You may be asked to see an Interventional Cardiologist to perform procedures such as an angiography, diagnostic heart caths, and stenting.

STRUCTURAL HEART SPECIALIST These cardiologists are focused on the evaluation and treatment of conditions impacting the structure of the heart to ensure the heart continues proper blood flow throughout the body.

ELECTROPHYSIOLOGY Electrophysiologists focus on heart rhythm (arrhythmia) disorders that can affect the body’s ability to effectively pump blood. The most common conditions treated by Electrophysiologists include atrial fibrillation, heart palpitations and syncope (fainting).

At First Coast Cardiovascular Institute, our teams of subspecialties integrate to ensure the patient’s care is cohesive and expedited. We coordinate the patient’s care so they can focus on their health.

To schedule an appointment, call 904.493.3333.

Issue 4 2018 | THE HEART OF JACKSONVILLE

7

PHYSICIAN’S RECIPES SPOTLIGHT

15 Minute Meals UNDER

5

$ Acai Breakfast Bowl Acai berries are known for being one of the most nutritious fruits in the world. It is claimed they are helpful for several health concerns, including arthritis, weight loss and high cholesterol. The berry is also filled with fiber and heart-healthy fats! Acai berries contain more antioxidant content than most other common berries.

INGREDIENTS PRICE 1 smoothie pack 1/2 cup of unsweetened almond milk 1 banana ½ cup granola ½ cup blueberries ½ cup strawberries

smoothie pack

$2.50

almond milk

$0.26

banana

$0.25

Total Price

granola $0.62 blueberries $0.80 strawberries $0.40

8 THE HEART OF JACKSONVILLE | Issue 4 2018

$4.83

Total prep time: 5 mins DIRECTIONS 1. Add half of a banana, 1 acai smoothie pack, ¼ cup strawberries, ¼ cup blueberries, and a splash of unsweetened almond milk to a blender. Make sure to add the softer ingredients first to make it easier on the blades.

2. Blend on low until the larger chunks of fruit are broken down. As you blend, gradually increase the speed, adding a splash of milk as needed. Blend until smooth.

3. Pour the mixture into a bowl and top with coconut flakes, strawberries, blueberries, granola, and the banana as desired.

Source: Fitness Magazine

RECIPES

Turkey, Avocado, Arugula & Goat Cheese Panini There’s nothing better for a quick lunch than a warm-pressed panini, especially if it is heart healthy.

Avocado is one of the few fruits that will provide you with “good” fats. This keeps your cholesterol levels in a healthy range and help lower your risk of heart disease. Arugula is another heart-healthy ingredient in this panini. Arugula contains nutrients known to help control blood pressure levels, which in turn lowers the risk of heart attack and promotes heart health.

Total prep time: 8 mins INGREDIENTS PRICE 2 slices of whole grain bread

bread $0.38

½ cup of arugula

arugula $0.30

Half a ripe avocado - sliced

avocado $1.50

3 slices of oven-roasted deli turkey

turkey

$0.63

2 tablespoons goat cheese

goat cheese

$0.46

Total Price

$3.27

DIRECTIONS 1. Layer arugula and avocado on one side of the bread.

2. Spread goat cheese on the other side and top with turkey meat.

3. Close your sandwich and heat in a panini press. If you don’t have a panini press you can use a skilletflipping the sandwich on both sides and using something heavy like a pot to press it down into the skillet.

Source: Once Upon a Cutting Board

Roasted Chicken & Veggies Roasted chicken and veggies is a one-stop shop when it comes to an easy heart-healthy meal. All ingredients are placed into one pan and popped into the oven, and the results are charred veggies and juicy chicken.

In general, red meats have higher cholesterol and saturated fats than chicken and vegetables. These items can raise your blood cholesterol and make your heart disease worse. Unsaturated fats that can be found in vegetables can reduce the risk of cardiovascular disease, especially when cooked with heart-healthy cooking oils, such as olive oil.

INGREDIENTS

PRICE

2 medium chicken breasts, chopped

chicken breasts

1 cup bell pepper, chopped

bell pepper sliced

½ onion, chopped

onion $0.13

1 zucchini, chopped

zucchini $0.63

½ tomato, chopped

tomato

$.50

2 tablespoons olive oil

olive oil

0.29

Total Price

$1.15 $0.58

$3.28

Total prep time: 15 mins DIRECTIONS 1. Preheat oven to

500 degree F. 2. Chop all chicken

into bite-sized pieces.

3.

On a separate cutting board chop all veggies into large pieces.

4. Place chicken

and veggies

into a medium roasting dish or sheet pan – add olive oil and seasoning of your choice (i.e. salt, pepper, seasoning).

5. Bake for 15 minutes or until veggies are charred and chicken is cooked.

Source: Gimme Delicious

Issue 4 2018 | THE HEART OF JACKSONVILLE 9

SERVICE LINE

Woodrow Buie had reached the last resort.

He was facing a wound that could not heal without proper blood flow. It seemed that his options were becoming more limited and he was at risk for amputation.

H

is physician referred him to

We see Woodrow’s story every day at FCCI;

Dr. Khatib for a final opinion.

these are stories of those who have been told

Dr. Khatib performed an

nothing could be done for them, who come to

atherectomy on Woodrow in the

our clinic with little hope left. We are typically

First Coast Cardiovascular Institute (FCCI)

the only thing standing between the patient and

outpatient cath lab. An atherectomy involves

an amputation.

using a catheter to restore blood flow through

At the center of our organization is a robust

the artery. The procedure lasted two hours and

amputation prevention program. We have

was ultimately successful. Woodrow dropped

been saving legs for over a decade, with every

from an 99% blockage to 30% blockage. Despite

intention to continue growing our program

the intensity of the procedure, Woodrow says it

and eliminate unnecessary amputations. “We

was not painful or stressful on him. “I was in and

are proud to say this is the highlight of our

out the same day,” Woodrow says.

practice and what we do best,” Dr. Yazan Khatib

Woodrow says the quality of his life has

says, “we are truly pioneers in endovascular

improved significantly since the time he had

amputation prevention and one of the first to

the procedure performed. He is thankful for

do it nationally.”

the work of FCCI and Dr. Khatib. “I would

There are a number of perceptions when it

recommend him to anyone,” Woodrow says.

comes to amputation. There are stereotypes

10 THE HEART OF JACKSONVILLE | Issue 4 2018

AMPUTATION PREVENTION CENTER that individuals with bad kidneys, diabetes, or a non-healing wound will inevitably face amputation. We fight these stereotypes everyday by offering hope to patients with these conditions.

What is behind the success of our amputation prevention program? We house a team of endovascular specialists. Endovascular medicine is a relatively new branch of medicine, treating problems affecting the blood vessel.

With this approach, our physicians avoid open surgeries and are instead able to prevent amputations in an outpatient setting, with only a small incision in the wrist or groin. We then couple our specialists with fully-accredited, state-of-the art outpatient facilities. Our facilities are cost-effective while meeting the highest standards in the healthcare field.

But of course, specialists and a facility are nothing without compassion, drive, and innovation. This is what sets us apart. Each patient is like our own family member and there is nothing we will stop at to ensure the highest quality of life possible.

If you or one of your loved ones is facing an amputation, contact us at 904.493.3333.

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Issue 4 2018 | THE HEART OF JACKSONVILLE 11

PHYSICIAN’S SPOTLIGHT

DR. SHAHNAZ PUNJANI

WOMEN’S Heart Health Symptoms One Month Before a Heart Attack

A

Women report feeling symptoms roughly one month before the occurrence of a heart attack, according to Cleveland Clinic. These symptoms include fatigue, shortness of breath, and neck, jaw, or back pain. If you notice any of these symptoms, seek help immediately.

During a Heart Attack According to the Centers for Disease Control & Prevention, treatments are most effective when administered within an hour of the onset of heart attack symptoms. What does this mean for you? Know the symptoms of a heart attack so you can spot one if it’s happening. Women, compared to men, are less likely to experience chest pain as a heart attack symptom. Other symptoms they may experience include: Shortness of breath Fatigue Dizziness & lightheadedness Nausea Cold sweats Upper body discomfort

s women, we are mothers, daughters, sisters, caregivers, and a million other roles. Under all of these responsibilities, it can be easy to forget about our own health.

The reality is that every minute in the US, a woman loses her battle with cardiovascular disease, according to the American Heart Association. Heart disease is the number one killer of US women, outnumbering breast cancer by ten folds. While this is a sad reality, it is not one we are incapable of changing.

Dr. Shahnaz Punjani believes in this change, which is why she underwent training in preventive cardiology. “Preventive cardiology focuses on the risk factors of heart disease so that we do not have to get to a point of treatment,” Dr. Punjani says, “This is especially important in women. The smaller arteries of women often mean that treatments can be less effective.

Women are also more likely than men to have complications occur after a procedure.” Moreover, heart disease in women is more likely to be overlooked, compared to men. Dr. Punjani understands the busyness of everyday life and how health can sometimes fall to the wayside. The hassle of a work-life balance is one of the reasons female cardiologists comprise less than one fifth of the profession, according to the American College of Cardiology. Dr. Punjani is determined to serve the

12 THE HEART OF JACKSONVILLE | Issue 4 2018

community while simultaneously taking care of her own health. Here are Dr. Punjani’s tips for women of all ages: Start health screenings early By early, we mean as early as your 20’s. Know your numbers including blood pressure, cholesterol, glucose, and body mass index.

Have a relationship with a cardiologist who you speak to about risk factors. This is important for all women in their 20’s and older, but especially important for those with a family history of cardiac disease.

Diabetes Diabetes is a greater risk factor for cardiovascular disease in women than it is men, according to Harvard Health. If you are a diabetic, make sure you are taking care of your condition.

Smoking Smoking is an additional risk factor that has a greater impact on women than men in terms of heart health, according to Harvard Health. While it is easier said than done, quitting smoking and being cognizant of smokers around you pays off.

Food Diary As women, we pride ourselves on being multitaskers. However, sometimes this multitasking causes us to forget what we ate, or even eating alogether. Keep track of everything you eat in a food diary to ensure your meals are balanced.

PATIENT TESTIMONIALS

ONLINE TESTIMONIALS

Our patient’s opinions and experiences about our doctors and practice are extremely important to us; it’s why we do what we do. We love hearing what our patients have to say on the web!

After 8 years and about a dozen doctors, Dr. Ali found the blockage that caused me years of pain and suffering. If you’re in need of this type of medical attention, this is the man to see! Thank you Dr. Ali for the amazing work you and your staff do every day!” ~ A Healthgrades review

Dr. Lamba, who I also call ‘the life saver’, saved my mother’s life. A year ago she was on her deathbed for congestive heart failure. He put her on Entresto and inserted the CardioMEMS device in the heart to measure the pressure. God sent him to extend her life span and meet her great grandchild, who was born months after. I am writing this review from my own experience with Dr. Lamba. He is caring, dedicated, and gives his patients great attention.” ~ A Healthgrades review

My husband who is diabetic had a wound on his foot that was not healing due to lack of blood flow. Dr. Khatib was able to successfully perform an angiogram allowing more blood flow. Three other doctors had previously not been able to unblock the blood vessels. This doctor is incredible.

We couldn’t be more pleased. We would certainly recommend this facility again and again.”

First Coast Cardiovascular has been first rate in helping my wife and I maintain excellent cardiovascular health for years and overcome a number of serious issues.

Both medical personnel and admin staff are welcoming, helpful, and make the patient experience feel easy and comfortable.” ~ A Facebook Review

Exceptional doctor. If you have a heart problem, you will not find a more qualified or caring doctor. I and my whole family trust my heart care to Dr. Schimmel and no other doctor. He takes time with you and tells you exactly what he is doing and why.

If you ask a question he answers in terms you understand.”

~ A Healthgrades review From my 1st visit to my most recent EVERYONE in the office is so pleasant!

They are always smiling and patient with my questions and concerns. I’d recommend them to everyone.” ~ A Facebook Review Coming from out of state to here, Dr. Constantin is amazing. He listens, he explains medical conditions well, he’s extremely personable, and he answers all of my questions. He’s wonderful!” ~ A Healthgrades review

~ A Facebook Review

Issue 4 2018 | THE HEART OF JACKSONVILLE 13

PHYSICIAN’S SPOTLIGHT

CONGRATULATIONS,

Dr. Yazan Khatib!

Dr. Yazan Khatib has been elected President of the American Heart Association (AHA), First Coast Chapter, effective July 2018. He will serve for two years and will work to further the AHA mission of building healthier lives, free of cardiovascular disease and stroke.

“The American Heart Association is one of the most objective and reputable organizations nation-wide,” says Dr. Khatib, “I am honored to lead the First Coast Chapter as the AHA continues to advance in the fields of research, education, and community service.”

How to Save on Healthcare Costs The healthcare system is a complex network of insurance companies and medical facilities that are essential to everyone’s well-being. Between doctor’s appointments, prescription medications and other important tests, the price tag for quality healthcare can be rather daunting.

Thankfully there are ways to save money on your healthcare costs without sacrificing quality care.

Stay up-to-date with free services. Those insured by the Affordable Care Act are entitled to certain free preventive services such as blood pressure screenings, colonoscopies, vaccinations and mental health screenings.

Ask about generic options for medication. There are many pharmacy programs that offer the same prescription medication at a significantly cheaper rate. Ask your doctor or pharmacist about possible generic alternatives.

Review your medications with your physician. If a particular medication is no longer essential to your health, ask your physician about removing it from your daily regimen. This can help lower your out-ofpocket costs for medication.

Schedule your office visits and procedures at the right time. It’s usually best to schedule expensive procedures at the beginning of the year to ensure your insurance will cover other routine appointments throughout the year.

Ask questions about your bill. If you don’t understand a specific charge on your bill, don’t be afraid to speak up. You can always talk to someone in the billing department (regardless of whether it’s a doctor’s office or hospital) to ensure that all the charges are accurate.

Bring your medical records to your appointment. This will help your physician determine if additional tests are necessary or not, saving you both time and money.

14 THE HEART OF JACKSONVILLE | Issue 4 2018

Ups&

DOWNS

Marital

HEALTHY LIVING

May Impact Men’s Heart Health

This probably isn’t the first time you’ve heard marital status impacts your heart health. Previous studies have shown that men who are married are less likely to develop heart disease compared to men who are single, divorced or widowed.

However, new studies suggest there may be more to the story than this.

If these factors regarding the quality of marriage have any effect on heart health, it is important to study the relationship of health compared to quality of the marriage overtime. A study published in the Journal of Epidemiology & Community Health uses the approach of longevity and quality of a marriage to understand how both affect heart health.

continuously good and those that were continuously poor.

The team believes this might be due to a “habitual” state- as in getting used to a common pattern- or differences in the way that some people perceive the quality of their relationship.

On the other hand, there were minor but significant differences between the improving and deteriorating relationships. The men in relationships that were ranked as improving over time had lower levels of low-density lipoprotein, or “bad” cholesterol, and a lower body weight compared to the consistently good relationships.

pressure were also found, which is a measure of cardiovascular risk. Conversely, males in the relationships that were labeled deteriorating were found to have significantly worse diastolic blood pressure.

In other words, how your relationship progressed, either positively or negatively, was the biggest judge of heart health.

In the end, it isn’t about where your relationship is but where it is going. Improving your relationship overtime also means you are simultaneously improving your heart health.

We call that a win-win.

Small improvements in cholesterol levels and diastolic blood

The Avon Longitudinal Study of Parents and Children (ALSPC) conducted this study and focused on the link between relationship quality over time and cardiovascular risk in married men.

The result indicated no difference in the measurement of cardiovascular disease (CVD) progression in men between relationships that were Issue 4 2018 | THE HEART OF JACKSONVILLE 15

PHYSICIAN’S SERVICE SPOTLIGHT LINE

Heart Attack A study found 2/3 of heart attacks go undiagnosed, showing us the threat behind the number one killer in US adults.

Organizations such as the American Heart Association have done a superb job in raising awareness about heart attack signs and symptoms. However, many questions still remain about heart attacks, their diagnosis, and warning signs.

minimal signs or symptoms, according to Harvard Health Publishing. Moreover, silent heart attacks can triple the chances of death from coronary artery disease.

While there remains much to be discovered about heart attacks, it is A recent study presented at the CMR 2018 important to be aware of the facts we in Spain found that routine testing is still do know and ensure we modify our missing 2/3 of heart attack occurrences. lifestyle accordingly. When most people When a diagnosis goes undetected, think of heart attack symptoms, they the patient is less likely to receive the think of chest pain in an extreme sense. medication necessary, increasing their However, our physicians emphasize that risk for heart disease in the future. Aside chest pain caused by a heart attack can from treatment, these patients will also vary in severity, from very mild to harsh. likely miss out on crucial conversations Other heart attack signs and symptoms concerning lifestyle modifications. commonly observed by our physicians include: Aside from this challenge, there is yet another barrier toward proper heart Cold sweats attack diagnosis- signs and symptoms.

Vomiting Most of us know some of the most common signs of a heart attack: shortness Nausea/indigestion of breath, chest pain, or fatigue. However, Squeezing sensation heart attacks do not always present in this Discomfort form. In fact, nearly half of heart attacks can be silent, meaning they occur with

16 THE HEART OF JACKSONVILLE | Issue 4 2018

101

Our battle against heart disease is a long one and it starts with us.

How to Prevent a Heart Attack: Sleep Although it may not seem like the most conventional risk factor, our bodies cannot function properly without a good night’s sleep. If you are waking up feeling tired and are constantly tempted by the snooze button, you may not be getting enough sleep. Try sleeping and getting up at the same times every day.

Smoking This goes without saying but the benefits of quitting are endless. Within five years of quitting, your risk of heart disease can drop down to that of a nonsmoker.

Know your Numbers Blood pressure, cholesterol, and glucose– know these numbers and keep tabs on them.

Relationship with your Physician You may be surprised at how much a healthy and open relationship with your physician can impact your health. Find a physician you feel comfortable with and who you would trust with your own family members.

Diet We cannot talk about the prevention of heart disease without also talking about the importance of a heart-healthy diet.

This means incorporating lots of vegetables, fruits, whole grains, and lean proteins into your daily regimen.

A report by the Centers for Disease Control and Prevention showed that for three decades, deaths related to cardiovascular disease continually decreased. However, during 2011 and 2014, heart disease deaths rose by 3%, an unexpected twist. This means our work is not done. Our battle against heart disease is a long one and it starts with us.

Issue 4 2018 | THE HEART OF JACKSONVILLE 17

PHYSICIAN’S HEALTHY SPOTLIGHT LIVING

How to Spice Up Your Water We all know how important it is to stay hydrated throughout the day. After all, more than half of the human body is made of water.

But let’s face it – sometimes it’s hard to reach for another glass of plain, tasteless water day after day. Here are some of our tips to make that tall glass of water much more delicious!

Lemon Lemons are packed with vitamin C, a powerful antioxidant that protects your cells and may lower your risk of developing CVD or hypertension. Squeeze some lemon into your water first thing in the morning for a fresh burst of energy to get you ready for the day.

Berry Blast Add a handful of blackberries, raspberries, and blueberries to your water for an extra blast of fiber in your diet. If you want to shake things up even more, stir in a splash of sparkling water.

Citrus Bliss Oranges are another source of vitamin C that strengthens your immune system and may prevent you from catching a cold. Squeeze a whole lemon, lime, and orange into a pitcher of water. Let refrigerate for two hours then serve over ice.

Tropical Twist It’s no wonder pineapples are a summertime staple. They are rich in manganese, a mineral that helps protect your skin from the sun’s harmful rays. Add chunks of pineapple, strawberries, and kiwi to your water as desired for a little taste of paradise no matter where you are.

Cucumber Cubes For a fresh alternative to traditional ice cubes, try freezing sliced cucumbers overnight then adding them to your water the next day. This low-calorie drink is a great way to help you maintain a healthy weight.

Ahhhhh hhhhhh hhhhhh!

18 THE HEART OF JACKSONVILLE | Issue 4 2018

HEALTHY LIVING

Assess Your Heart

Risk

Early detection is key in treating heart disease before it escalates into a more serious condition like a heart attack or stroke. It’s important to recognize the symptoms and consult with your doctor if they start to interfere with your daily routine. Take the quiz below to find out more about your heart health.

1

Do you experience chest pain or discomfort (tightness, pressure, etc.)?

a. No, this doesn’t sound like me. b. Occasionally. c. Frequently, even when I’m sedentary.

2

Are you physically active? a. Yes, I like to exercise several times a week. b. Not really – but I feel fine. c. No, I’m unable to be physically active.

3

Have you had any dizziness or lightheadedness recently?

a. Not at all. b. Sometimes. c. Yes, consistently.

4

Do you smoke or drink alcohol?

5

Do you feel short of breath easily?

a. Rarely. b. Yes, on a social basis. c. Yes, multiple times a week.

a. No, this doesn’t sound like me. b. Occasionally. c. Yes, even with daily activities such as walking and standing.

6

Have you experienced prolonged weakness or fatigue?

a. Never. b. Sometimes. c. Regularly.

7

Do you visit your doctor regularly?

a. Yes – I have a routine checkup once a year. b. Only when there’s an issue I want to discuss. c. Not as much as I should.

If you answered mostly A’s It sounds like your heart health is in tip-top shape. It’s important to keep your annual primary care appointment though to make sure your health remains at its best.

If you answered mostly B’s You may be experiencing some symptoms that could be indicative of heart disease. We have providers who specialize in different branches of cardiovascular medicine to ensure we meet every patient’s individual needs. Call us at 904.493.3333 to schedule an appointment today.

If you answered mostly C’s Many of these symptoms typically occur in serious cases of cardiovascular disease such as heart attack or heart failure. Call us today at 904.493.3333 to schedule an appointment with one of our boardcertified cardiologists to discuss these warning signs.

Issue 4 2018 | THE HEART OF JACKSONVILLE

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PHYSICIAN’S SPOTLIGHT

How do our Heart Doctors Stay Heart Healthy

Dr. Vaqar Ali

20 THE HEART OF JACKSONVILLE | Issue 4 2018

?

PHYSICIAN’S SPOTLIGHT

Vaqar Ali, MD Cardiac & Endovascular Interventions Join a running club! I run with my crew a few times a week and it keeps me feeling fit and stress-free.

Ziad Alnabki, MD Cardiac & Endovascular Interventions Do not assume that any age is immune. Even in my 30’s, I make sure to know my numbers and watch my dietary, exercise, and sleep patterns. Heart disease doesn’t discriminate based on age.

Dr. Ziad Alnabki

Andrea DeNeen, MD General Cardiology One of the most important dietary recommendations I can make is to keep foods as fresh as possible and avoid processed foods (i.e. anything with a shelf life, or with ingredients that sound like chemicals).

Be adventurous with cooking and trying new flavors.

Make your own salad dressings and sauces. Also, don’t forget to find ways to keep joy in your life.

Spend quality time relaxing with friends and family.

Brett Sasseen, MD Interventional Cardiology My favorite ways of staying healthy are eating lots of blueberries, greens, and fish. I also run on my lunch break whenever I get a chance.

“A new cancer diagnosis is challenging. Being there with you to guide you through this situation in a more personalized way is gratifying.”

-Hema Vankayala, MD

Dr. Andrea DeNeen

Medical Oncology | Radiation Oncology | Hematology Gynecologic Oncology | Diagnostic Imaging

CancerSpecialistsNF.com Dr. Brett Sasseen

Issue 4 2018 | THE HEART OF JACKSONVILLE 21

HEALTHY LIVING

How to Use What Type of

OIL

And Benefits Sometimes the foods we eat may seem

One way to replace unhealthy fats with a

healthy, such as baked chicken or sautéed

healthier option is by looking for nontropical

vegetables, but the type of oils used to

vegetable oils for cooking and preparing

cook these foods may contain unhealthy

food. You should substitute these oils in

fats that increase cholesterol and blood

place of solid fats like butter, margarine or

pressure.

shortening to lower your cholesterol, blood pressure and risk for heart disease.

There are, however, various types of cooking oils that contain the healthier fats

There are many ways to use these oils in

that are more beneficial for your heart

your everyday cooking routine. One way

health.

is to use them as a base to create your

Here is a list of common cooking oils that contain the “healthier fats” according to the American Heart Association:

own salad dressings, marinades, dips, and sauces. In addition to these oils, avocado and sesame oils are also heart healthy and provide a burst of flavor in dressings and

OILS THAT CONTAIN HEALTHIER FATS

• Canola • Corn • Olive • Peanut

• Safflower • Soybean • Sunflower

Asian cuisines in particular.

Remember, it isn’t just about the foods you are consuming but also how these foods are prepared. Choosing healthier cooking oils can give you added flavor and benefits for your heart health.

22 THE HEART OF JACKSONVILLE | Issue 4 2018

HEALTHY LIVING

HealthHacks In a world that’s constantly on the go, it can sometimes be challenging to make your health a priority every day. Trying to balance all of your responsibilities can be hectic, especially if you’re dehydrated, stressed or tired from lack of sleep. We’ve compiled a list of our favorite health hacks that are simple enough to incorporate seamlessly into your daily routine.

Stay hydrated. When you’re dehydrated, you may experience symptoms such

as a headache, dizziness and fatigue. We’ve all heard the theory that it’s best to drink 64 oz. of water a day, but the truth is it varies for each person depending on your lifestyle. The easiest way to stay hydrated is by simply drinking water whenever you feel thirsty. Sounds easy enough, right? However, we all know that even a simple task can be difficult to remember during a chaotic day. To stay on track with your hydration needs, try downloading an app that will send you reminders throughout the day to drink up.

Add some greenery to your indoor space. Many studies have shown that

bringing a little bit of nature indoors does wonders for your mental health. In addition to freshening the air and eliminating toxins, seeing greenery has also been proven to reduce stress, boost productivity, and improve your mood. Succulents such as Echeveria and Sempervivum are perfect because they are small, easy to maintain and suitable for most indoor environments. They also double as an extra piece of décor!

Use aromatherapy for a better night’s sleep. Everyone dreams of getting 8

hours of uninterrupted sleep every night. But let’s face it – this rarely happens. If you have trouble unwinding at the end of a long day, there are various aromatherapies you can use to help you relax and reduce anxiety right before bedtime. Try spritzing a few pumps of essential oils such as lavender or chamomile on your pillow.

Reduce your sugar intake. Too much sugar can have negative effects on

your health by causing inflammation in your joints or skin and even contributing to heart disease. One easy way to limit your sugar intake is by cutting out sweeteners in your daily cup of coffee or tea. This could cut out as many as 70 calories from sugar per cup!

Practice good posture. If you’re sitting slouched all day, not only can it

contribute to lower back pain, but it can also interfere with your breathing. When your shoulders are hunched over it can constrict your chest cavity and prevent you from getting the optimal amount of oxygen with each breath. Sitting up straight ensures that your lungs have room to “breathe” properly. Good posture can even boost your confidence!

Issue 4 2018 | THE HEART OF JACKSONVILLE 23

PHILANTHROPY

Treating the Uninsured:

Inspiring Hope in a Time of Crisis Roughly 28 million US adults under the age of 65 are uninsured, according to the Centers for Disease Control & Prevention. It’s usually these patients that need care the most.

W

e strive towards compassionate, yet cost-effective care.

This means we want to keep patients out of the hospital,

and particularly out of the emergency room.

Organizations such as We Care Jacksonville & Volunteers in Medicine are non-profit organizations who provide excellent care to uninsured and underserved adults in Duval County.

Through their services, they are able to keep uninsured and underserved adults healthy and out of the hospital.

We have partnered with We Care & Volunteers in Medicine to provide cardiac services for their patients. In 2017, we were named one of the top cardiology providers for We Care patients.

Volunteers in Medicine also counts us among their top cardiac providers. We provide vascular testing for up to hundreds of patients a year, free of charge.

Dr. Khatib points out that the treatment of We Care & Volunteers in Medicine patients is no different than any other patient.

“Operationally, our providers actually do not know they are treating a We Care or Volunteers in Medicine patient,” Dr. Khatib says, “it is usually only when a patient is referred to another provider for follow-up tests or treatments that the financial background of the patient is known to a provider.” This keeps care consistent and compassionate.

Sue Nussbaum, MD, Executive Director of We Care speaks of our partnership with deep gratitude: “Our partnership with First Coast Cardiovascular Institute (FCCI) has given us the opportunity to help more patients receive access to cardiac services that they didn’t have before,” Sue says. Dr. Khatib understands the importance of this access, “We Care patients come to us in a time of crisis.”

Organizations like We Care and Volunteers in Medicine are able to thrive through the generosity of time and talent from the doctors and nurses such as our own.

24 THE HEART OF JACKSONVILLE | Issue 4 2018

Our partnership with First Coast Cardiovascular Institute (FCCI) has given us the opportunity to help more patients receive access to cardiac services that they didn’t have before.

Sue Nussbaum, MD

Issue 4 2018 | THE HEART OF JACKSONVILLE

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SOCIAL MEDIA RECAP

JACKSO 26 THE HEART OF JACKSONVILLE | Issue 4 2018

ONVILLE Issue 4 2018 | THE HEART OF JACKSONVILLE 27

TEAM SPOTLIGHT

Humans Dr. Constantin “The biggest challenge of a physician’s career is how personally demanding it is. The hours are long, and there is always pressure when caring for your patients. Sacrifices have to be made, which can affect your family, your relationships, and other aspects of your life. That has been the biggest challenge throughout my journey and that challenge continues. I either feel guilty for letting my patients down or guilty for letting my family down.

There is also the challenge of breaking down the science aspect of medicine in a method that allows patients to understand.

If you know how to help somebody but they can’t understand you, it’s challenging to help them.”

28 THE HEART OF JACKSONVILLE | Issue 4 2018

TEAM SPOTLIGHT

of FCCI Dr. Swain “My grandfather became sick. He had diabetes, which led to foot ulcers, and eventually, a leg amputation. As much as I wanted to save him, my grandfather died from his illness. The head of the committee who wrote student referrals for medical school asked me to go to a conference they put together about podiatry. I really

didn’t know what podiatry was, but I went to the conference and listened to a podiatrist, Dr. McDonald, talk about his profession and how he helps people like my grandfather. The feeling of having the knowledge and capability to save people like my grandfather helped me decide what path I was going to take.”

Issue 4 2018 | THE HEART OF JACKSONVILLE 29

PHYSICIAN’S DOCTOR FAVORITES SPOTLIGHT

Q&A

Doctor Insight

Q

If you could only accomplish one goal in life, what would you want it to be?

Dr. Sasseen: To be a health care provider for people without access to health care or financial means here and in other countries.

Dr. Lamba: To have love in my heart.

Dr. Schimmel: To raise two young gentlemen.

Q

Who has impressed you the most with what they’ve accomplished?

Dr. Ali: I really admire the Jacksonville Jaquars’ owner, Shad Khan.

Dr. Constantin: My daughter, for all of her hard work and eternal smile.

Dr. Khatib: My father. At the age of 83 he is still working full-time.

He is an eternal optimist and amazing role model.

Dr. Zuberi: Mohammad Ali, for his activism and dedication to social change.

Dr. Al-Saghir: My family doctor.

His compassion was the reason I decided to go into cardiology.

Dr. Alnabki: Dr. Khatib. His compassion for patient care is contagious.

Dr. Punjani: Gandhi, for his positive influence on people.

Dr. DeNeen: My children. Their optimism keeps me going.

Dr. Illovsky: My navy brothers, who inspired hope in so many people.

Dr. Snyder: My wife. She has done an amazing job raising our family and keeping me sane.

finished high school. In the past 18 months we have visited 9 different states on three different small road trips in the southeastern United States.

Q

What’s something you’ve been meaning to try but haven’t gotten around to?

Dr. Goel: I love to be outdoors.

I think finding new hiking trails in Jacksonville would be something I would love to do if I had time.

Q

What is the best way to start the day?

Dr. Thielemann: I like to start the day by stimulating my mind; I usually grab a book to read.

Do you and your family enjoy Dr. Hamdani: I like to start the traveling? day with some exercise. I enjoy walking on the beach in the Dr. Swain: I decided after my third child was born that I would mornings when the weather is like to take all of my children to nice. all 50 states before the oldest

Q

30 THE HEART OF JACKSONVILLE | Issue 4 2018

WORD SEARCH L M K N B A X 0 D N M Q L T D D P E B Z

I R E M E A L P L A N N I N G L A P X U

O Z I Q K O S H E A R T C L I N I C W Q

G H L D A T G E K K M O L M D M R L S H

N Q V A H W B C P N O I T N E V E R P H

I E F L E T A R D Y H O B R A C J G Z G

K R Z N H R O D A R Z F X O M A S W T Y

O A Z J J X Q K K U R U B B O I R O T G

O C P D Z U L H T L A E H S N E M O W O

C E H F H D W Y F S F H X V B H T V S L

P W L S V D Z T L U L W W C G T S J B O

X D K T S A O C T S R I F C M E S M H I

R C L R X C X T N E M T A E R T E E I D

S V Z K Z S K C A H H T L A E H N R S R

C D C P H Y S I C I A N H M M O T A B A

H T L A E H T R A E H G M L A D I V U C

X D F V W U R I Q A J M H L H N F E Q S

L I T H O T R I P S Y V E D B L B Q E P

H H N L Z J M C I G R F M E J M I M Y M

O B I Q P J Y U Y S C Z S D U H M Z V E

PREVENTION CARDIOLOGY HEALTH HACKS FIRST COAST LITHOTRIPSY HEART CLINIC WOMENS HEALTH PHYSICIAN COOKING OIL TREATMENT WE CARE HEART HEALTH FITNESS CARBOHYDRATE MEAL PLANNING

THANK YOU! THANK YOU, STELLAR! We are grateful to Stellar for constructing our new cath lab at our AC Skinner office.

Stellar was able to capture our passion for innovation, patient-centered care, and comfort by designing a lab reflective of these values. Every single day, we have patients who comment on their enjoyable experiences. Thank you!

Our AC Skinner cath lab is located at: 7011 AC Skinner Parkway, Jacksonville, FL 32256 THANK YOU, BLUE OCEAN CONSTRUCTION! Thank you to Blue Ocean Construction for turning our Palatka office into a world-class, premier catherization lab. Thanks to your hard work, we have successfully treated hundreds of patients in an environment that is comfortable, safe, and innovative.

Our Palatka cath lab is located at: 205 Zeagler Drive, Palatka, FL 32177 Issue 4 2018 | THE HEART OF JACKSONVILLE

31

OUR MISSION

OUR VISION

To enhance quality of

To inspire hope and excel

life by providing cutting-

in the care of individuals

edge care with a team of

throughout the continuum

compassionate experts and

of healthcare from

advance medicine through

wellness and prevention

research, education and

to the most complex

patient empowerment.

disease states.

www.firstcoastcardio.com 904.493.3333