The Heart of Jacksonville | Issue 7

HEART THE

OFJACKSONVILLE ISSUE 7 | 2020

The Prevention Issue Everything your doctor wants you to know

IN THIS ISSUE: Diet Trends: The Good, Bad & Ugly Busting Myths about Heart Disease Age is Just a Number: Science Agrees A PUBLICATION OF

Not sure if you’re aware but lying is bad. And you’ve been lying for a long time.

You say vaping isn’t smoking, but the nicotine in one pod equals an entire pack of cigarettes. You say you’re not Big Tobacco, but the tobacco giant that makes Marlboro cigarettes owns 35% of one of the largest e-cigarette makers.

You say you’re not marketing to teens, but your flavors say otherwise.

So let us school you on the dangers of lying. Lying leads to nicotine addiction. Lying leads more people to smoking.

Lying is producing lung disease, heart disease and cancer. Lying has landed hundreds of e-cigarette users in hospitals. Those are the facts. And the fact is lying kills.

It’s obvious to us — teachers, school administrators, parents, the American Heart Association, and especially students — that vaping is a life or death health threat. But the bigger epidemic in this country is even more sinister: your lying.

Sincerely,

THE AMERICAN HEART ASSOCIATION ON BEHALF OF EVERYONE AFFECTED BY THE VAPING EPIDEMIC IN AMERICA

NANCY BROWN

BERTRAM L. SCOTT

Chief Executive Officer, American Heart Association

Chairman of the Board, American Heart Association

ROBERT A. HARRINGTON, M.D., FAHA

KATELYN QUEZADA Youth Advocate & Volunteer, American Heart Association

President, American Heart Association

CALL OUT BIG VAPE ON THEIR LIES BY ADDING YOUR NAME AT QUITLYING.ORG

ISSUE 7 2020

CONTENTS FEATURES:

SERVICE LINES:

4

Letter From The President

19

Patient Testimonials: What Our Patients Are Saying

32

Social Media Recap: Team Pictures

35

Word Search

6 Atrial Fibrillation:

A Growing Epidemic 22 Why is the Risk for Amputation

Greater for People with Diabetes?

28 3 Shifts in Healthcare 30 The Financial Stress of Heart Disease

Back Cover Coupons For Your Health

30

The Financial Stress of Heart Disease

HEALTHY LIVING: 8 10

12 14

16 26

Exercises for Energy and Relaxation Age is Just a Number: Science Agrees Busting Myths About Heart Health Diet Trends: The Good, The Bad, and The Ugly The New Food Label Recipe: Satisfy Your Sweet Tooth Without Sugar

PROVIDER’S SPOTLIGHT: 5 Behind the White Coat:

Dr. Firas El-Sabbagh 18 Fast Facts: A Cup of Tea Makes

Everything Better 23 Behind the White Coat:

Dr. Bruce Krieger 20 Following a Plant-Based Diet:

Dr. Brett Sasseen 24 The Top 3 Questions to Ask Your Cardiologist 25 Fast Facts: Rethink the Drive-thru 34 Doc Favorites: Q&A

PHYSICIAN’S SPOTLIGHT

Letter from the

Dr. Yazan Khatib

PRESIDENT

Navigating the Health World — As a cardiologist, I see patients through the full spectrum of health every day. I see patients who are coming to adjust their risk factors so they can age as gracefully as possible. I also see patients who are coming to me as their last resort, who are nearing the loss of hope. While I am honored and privileged to care for patients on either side of the spectrum, I would like to see all of us putting an emphasis on prevention.

Navigating the health world is by no means easy. Enter the grocery store and you can lose yourself in the thousands of products being marketed as healthy. Even flipping to the back of a food product and assessing the nutrition label can leave us all in a state of confusion.

The internet is a double-edged sword. While it provides a myriad of resources to help build a heart healthy lifestyle, it is also filled with clashing opinions and myths.

We recognize that when it comes to lifestyle education, you likely trust your doctor the most. In this issue, we aim to make the complexity and confusion around the health world just a little bit easier. Wondering if a diet is worth the hype? Flip to page 14 to read our review of several diets, including the good, bad, and ugly. Have you heard about the new food label? We break down the new label for you to make it simple to understand. We also debunk myths about your heart health on page 12.

In this issue, we also welcome new faces to our practice.

Check out “Behind the White Coat” on page 5 to read more about Dr. Firas El-Sabbagh, an amazing electrophysiologist whose passion stemmed from an anatomy class he took in high school. We also chat to Dr. Bruce Krieger, a board certified pulmonologist, with an incredible reputation in the Northeast Florida community and a passion for teaching.

On behalf of the writers, photographers, and designers of this publication, we thank you for joining us for issue 7 of The Heart of Jacksonville. We hope to see you back for many more.

Sincerely, Yazan Khatib, MD President of First Coast Cardiovascular Institute 4 THE HEART OF JACKSONVILLE | Issue 7 2020

PHYSICIAN’S SPOTLIGHT

Behind the White Coat: Dr. Firas El-Sabbagh, Electrophysiologist When Dr. Firas El-Sabbagh was in high school, he took an anatomy class. Little did he know that anatomy class would set the trajectory for his career.

This anatomy class awoke an interest in the heart.

This interest continued throughout pre-medicine years, then medical school.

Cardiology was a clear choice but the next question was what to specialize in within cardiology.

Dr. El-Sabbagh decided on electrophysiology, after he participated in research studies at Cleveland Clinic on atrial fibrillation. “Now, after practicing for more than seven years, I have no doubt I am in the right field,” says Dr. El-Sabbagh, “Electrophysiology has become a lifestyle for me and I enjoy every minute of it, whether in the lab utilizing the most advanced technology or in clinic, providing my patients the same care I would like my family to enjoy.”

Now, Dr. El-Sabbagh is part of FCCI’s team of electrophysiologists. An electrophysiologist is essentially an electrician for the heart. He offers a full range of devicebased therapies, including pacemakers, implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) for heart failure management, as well as catheter ablation for atrial and ventricular arrhythmias.

“Wherever I practice, my staff knows my patients are

VIP in my mind, and they are treated like family,” says Dr. El-Sabbagh. This treatment has not gone unnoticed.

In 2015, Dr. El-Sabbagh performed an ablation on a patient in Delaware. She did great till late 2018, when her atrial fibrillation came back.

“I was in Kentucky by that time and she reached out to me and insisted to travel to me for another ablation!” says Dr. El-Sabbagh, “It is a moment like that, which reminds me of how gratifying my work is.”

Issue 7 2020 | THE HEART OF JACKSONVILLE

5

SERVICE LINE

Atrial Fibrillation:

A Growing Epidemic Atrial fibrillation (afib) is a growing epidemic in the United States. The Centers for Disease Control & Prevention estimates there are 2.7-6 million individuals living with afib in the country. However, the American Heart Association (AHA) believes this number will grow to 12 million by 2050. That is a large portion of the US population.

Afib is a condition caused when your heart is beating irregularly. There are a number of risk factors for afib including high blood pressure, prior heart disease, family history and age.

When left untreated, or worse, undiagnosed, afib can potentially be indicative of an impending stroke. One in five individuals who suffer from a stroke also have afib, according to the AHA.

How to Prevent Afib Unfortunately, there are some risk factors for afib that are completely out of our hands, such as age (at least until we have figured out how to stop getting older). However, there are certain habits we can practice that decrease our chances of afib affecting us.

• Maintain a healthy weight | Maintaining a healthy weight is great prevention for any form of disease, but especially afib.

According to Harvard Health, overweight individuals have a 20-25% higher chance of afib, while obese individuals can have a 60% higher risk.

• Exercise | Aside from being a heart healthy habit, exercise is beneficial in reducing risk for afib and improving prognosis for patients diagnosed with afib.

6 THE HEART OF JACKSONVILLE | Issue 7 2020

• Alcohol Consumption | Binge-drinking (four or five alcoholic drinks) is known to be a big risk factor for afib, however, according to Harvard Health, even one to two drinks can affect a person’s risk of afib. Be mindful of your intake and practice finding a healthy balance.

Treatment & Management of Afib • Compliance | The most common medication prescribed for patients with afib are anticoagulants, such as coumadin.

Anticoagulants prevent blood clots from forming. When it comes to medication, one of the most important aspects is compliance.

If you find yourself unable to be compliant with your medication, talk to your healthcare provider.

• Keep an open relationship with your doctor | A strong relationship with your physician can greatly impact how your afib is managed. Be sure to be open with your physician about symptoms, medication compliance, and any other symptoms that may be impacting your day-to-day life.

• Ablation | An ablation is a procedure that is utilized to regulate heart rhythm and correct any irregularities that may be occurring. The procedure involves using energy to destroy a small area of the heart tissue that could be leading to abnormalities in heart rhythm.

Cleveland Clinic has found that 70-80% of individuals who undergo an ablation find massive improvement in afib symptoms. Talk to your doctor to see if an ablation could be right for you.

NORMAL

AFIB

Your Afib Management Team An electrophysiologist is a type of cardiologist who specializes in the rhythm of the heart. Your physician will likely refer you to an electrophysiologist if you are diagnosed with afib. First Coast Cardiovascular Institute (FCCI) houses two board-certified electrophysiologists, Drs. Cary Rose & Firas El-Sabbagh. Max Sapolsky, Physician Assistant, works rigorously with them as well.

Dr. Firas El-Sabbagh

Dr. Cary Rose

His advice for patients:

His advice for patients:

“When you start to feel symptoms, whether this is palpitations, shortness of breath or being more tired than usual, see your doctor. Don’t wait for symptoms to worsen as early intervention is very likely to prevent disease progression.”

“Afib can sometimes be asymptomatic.

Many people with sleep apnea, chronic obstructive pulmonary disease, and other chronic problems also have afib. Often times, patients find they have afib alongside other conditions when they see their doctor.

This means it is important to not skip your visits to the doctor, even if you are not feeling any symptoms.”

Max Sapolsky, PA-C His advice for patients: “Stress can increase your blood pressure, which is a risk factor for afib.

Take time out of your day to de-stress, whether this is an evening walk or spending time with your loved ones.”

To schedule an appointment with one of our electrophysiologists, contact us at 904.493.3333.

Issue 7 2020 | THE HEART OF JACKSONVILLE

7

HEALTHY LIVING

Exercises for Energy

The right exercises can give you an extra boost in the morning and help put you to sleep at night. Below are a few simple yoga exercises for energy in the mornings and exercises for relaxation at night.

Exercises for Energy

We can all relate to that feeling of fatigue or grogginess in the morning. That groggy feeling in the morning is because your body is awake, but part of your brain is still asleep, according to a study done by JAMA. However, there are tools to beat this morning-time daze and it only requires you to set your alarm back about 10 minutes. This tool is exercise, specifically yoga. The following exercises stretch your back, hips and chest to give you an extra boost in the morning after lying in a still position all night, according to The Yoga Journal.

1. Upward Salute

This pose stretches the spine.

2. Standing Forward Bend

This pose stretches all back muscles, increases blood supply and tones abdominal muscles.

3. Downward Facing Dog Pose

This pose fights bad posture and clears your mind.

4. 3-legged Downward Facing Dog Pose – with an Open Hip

This pose is the ultimate hip opener and good for stretching the waist and hips.

5. Low Lunge

This pose stretches your quadriceps, hamstrings, groin and hips.

1 2 3 451 Upward Salute Pose

8

Standing Forward Bend Pose

THE HEART OF JACKSONVILLE | Issue 7 2020

Downward Facing Dog Pose

3-legged with Open Hip Pose

Low Lunge Pose

vs.

Relaxation

Exercises for Relaxation

Yoga may also be helpful for those suffering from sleep insomnia. 30% of the population suffers from sleep insomnia, a condition that causes them to stay sleepless for most of the night, according to the Sleep Health Foundation. If you are finding yourself restless at night, try getting out of bed and doing these poses, suggested by The Yoga Journal.

1. Child’s Pose

This is one of the most relaxing yoga poses. This pose relieves hip and back strain.

2. Cat Pose

This pose may help manage digestive problems. It helps the body relax by stretching the spine and abdominal muscles.

3. Extended Triangle Pose

This is a full-body stretch and aides in reducing stress.

4. Extended Puppy Pose

This pose is helpful in reducing shoulder stiffness and improving flexibility.

5. Bridge Pose

This pose is good for reducing stress and relieving anxiety. It stretches your hips and thighs.

It also can improve blood circulation and prevent headaches and back pain.

1 2 3 45 Child’s Pose

Cat Pose

Extended Triangle Pose

Extended Puppy Pose

Bridge Pose

Issue 7 2020 | THE HEART OF JACKSONVILLE

9

HEALTHY LIVING

AGE IS JUST A NUMBER… It’s the oldest cliché. With every passing birthday, we hear the phrase, “age is just a number.” However, science is starting to agree.

According to a study published in The European Journal of Preventive

Here are a few tips to keep being active, while keeping your heart young:

Cardiology, the results of a simple exercise stress test can say a lot when it comes to how old you actually are. Researchers

Find your Beat

performance was a bigger indicator of

Exercise does not have to mean going to the gym.

Physical activity comes in many shapes and you can pick the one that resonates with you the most.

Whether this is a group fitness class, an evening walk with your spouse, or a dance class, every minute spent moving around benefits your heart.

survival than their actual age.

Limit the Time you Spend Sitting

The results

than actual years.

Many researchers have equated sitting for the entire workday with smoking. While the research for this correlation is up in the air, healthcare providers unanimously agree that sitting for an extended period of time is harmful. Many of us have stationary jobs but that does not mean we are tied to our desks.

If your job is a desk job, try a standing desk to help limit the time you sit. You can also use your breaks to take a lap around the office. Bonus points, this also improves your productivity. Even the simple act of tapping your feet can be beneficial.

What does this mean for you?

Break it Up

examined over 125,000 individuals who underwent an exercise stress test to assess whether their age based on exercise

Your age based on exercise performance is a better predictor of how long you will live than your actual age. Even better news is that over 55% of males and 57% of women between the ages of 50 and 60, were found to be younger in exercise capacity

If we could ever think of the perfect motivator to exercise, this would be it. You can literally keep your heart younger with every step you take. We know this sounds easier said than done.

10 THE HEART OF JACKSONVILLE | Issue 7 2020

The American Heart Association (AHA) recommends 150 minutes of physical activity a week. That is about 30 minutes, five days a week. However, for many people with a robust schedule, this seems overwhelming. The good news is that the AHA says even broken up, this time is beneficial. For example, 10 minutes in the morning, afternoon, and evening is just as valuable as exercising 30 minutes in one go.

but now SCIENCE AGREES

Issue 7 2020 | THE HEART OF JACKSONVILLE

11

PROVIDER’S SPOTLIGHT

BUSTING MYTHS ABOUT HEART HEALTH

TRUE OR FALSE

Your heart is responsible for supplying blood to all parts of your body. When your heart is not functioning to its fullest extent, it can cause a number of problems. Below we will be busting myths about heart disease so you are better prepared to take preventative measures against it!

1

If you have heart disease, resting is the best thing you can do.

2

If you are a longtime smoker, quitting won’t decrease your chances of heart disease.

FALSE. Heart disease can be

FALSE. No matter how long you

different for everyone, and it is important to talk to your doctor about what is best for you. In most cases, a sedentary lifestyle can increase your chances of blood clots in the legs, which can worsen your health, according to Harvard Health.

have smoked, the health benefits of quitting begin as soon as you quit. One year after quitting, your risk of heart attack decreases by 50%, according to Harvard Health. In 10 years, it will be as if you had never smoked before.

What you can do: Talk to your doctor about what fitness plan works best for you. Just walking 10 minutes a day can improve your heart health, according to the American Heart Association (AHA).

12 THE HEART OF JACKSONVILLE | Issue 7 2020

What you can do: Seek help. Quitting is not easy and may require help such as classes, smoking cessation, medication, nicotine gum and more. Always tell your doctor if you are having an issue stopping, your provider may have some helpful tips or suggestions.

3

Heart disease is an “old man’s” disease.

FALSE.

Heart disease is the leading cause of death in both men and women over the age of 65, according to the AHA. Although men and women can experience symptoms differently, both genders should be actively taking preventative measures to decrease their chances of heart disease.

What you can do: Be sure you are aware of your numbers. Always check your blood pressure, glucose levels and cholesterol no matter your gender.

5

High cholesterol, like high blood pressure, is a major risk factor for heart disease and stroke.

4

Vitamins and supplements can be used to decrease your risk of heart disease.

FALSE.

Although folic acid is associated with better overall heart health and stroke prevention, the evidence is not strong. Many clinical trials of vitamins and supplements have either failed to confirm a benefit or no conclusion could be drawn, according to Harvard Health. According to the AHA, there is no scientific evidence showing that supplements prevent or treat cardiovascular disease.

What you can do: Your body absorbs and uses the vitamins and minerals through food the best. Eat a wide variety of healthy food to gain all the vitamins and minerals you need, and decrease your risk for cardiovascular disease.

TRUE. High cholesterol is a major risk factor for heart disease. When there is too much cholesterol in your blood, it builds up on the walls of your arteries and they begin to narrow.

The process is called atherosclerosis, a form of heart disease. When the arteries become narrower, the blood flow to the heart is slowed down or blocked, causing heart disease and stroke.

What you can do: To reduce high cholesterol, you can reduce your saturated fat intake and eliminate trans fats. Increasing your omega-3 fatty acids, found in fish, can also decrease your high cholesterol.

Issue 7 2020 | THE HEART OF JACKSONVILLE

13

HEALTHY LIVING

DIET TRENDS:

THE GOOD, THE BAD, THE UGLY We live in a world with massive amounts of information constantly being thrown at us. A big chunk of that information is how to lose weight with diets. There are thousands of diets out there, each claiming to offer the quickest and longest lasting results.

However, instead of focusing on instantly losing weight, we should think about building healthy lifestyles. But, which diets are the best for a healthy lifestyle? Below, we will be debunking some of the most popular diet trends in the United States and which are good, bad, and ugly.

14 THE HEART OF JACKSONVILLE | Issue 7 2020

Mediterranean Diet

Low Carb Diet

Liquid Diet

One of the most heart healthy diets, which focuses on all major food groups, is the Mediterranean diet. This diet encourages you to have a high consumption of fruits, vegetables, whole grains, legumes, nuts, seeds and olive oil, while encouraging a low consumption of eggs, dairy products, and poultry.

Red meat is eaten rarely, according to the AHA. This diet originated from countries along the Mediterranean Sea where heart disease occurs less than in the United States.

Low carbohydrate (carb) diets have been all the hype lately. A low carb diet entails restricting carb intake and emphasizing protein and fat. Low carb diets can assist with weight loss.

However, when watching your carb intake, it is very important to be aware of the type of carb you are limiting.

Liquid diets can be one of the worst diets you could put your body through. This diet consists of only consuming liquids or foods that turn into liquid at room temperature.

Under a doctor’s instruction, this diet can be beneficial for those suffering from extreme digestive or swallowing issues.

The diet is packed with fiber, which slows digestion and helps control blood sugar.

When your blood sugar is controlled, your chances of diabetes, which is a major risk factor for heart disease, can decrease, according to Harvard Health.

Monounsaturated fat is also a big part of the Mediterranean diet. Monounsaturated fats are the healthy fats that may reduce your risk of heart disease and stroke by lowering bad cholesterol. Foods that contain monounsaturated fats include nuts, avocado, olive oil and more, staples in the Mediterranean diet.

Carbs fall into two major categories: natural or refined.

Refined carbohydrates have undergone a process that strips them of most of their essential nutrients such as fiber and b vitamins. Refined carbs can be found in breakfast cereals, white bread, pastries, and sugar-sweetened beverages.

These are the types of carbs you want to cut back on when practicing a low carb diet.

Not all carbs are bad, however.

Naturally occurring carbs can be found in heart-healthy foods such as fruits, vegetables, nuts, seeds, legumes, and whole grains. These types of carbs have not undergone processing and provide a myriad of health benefits from improved digestion to regulating blood glucose. These should not be cut out entirely during a low carb diet.

Our lives can become pretty busy, and it may seem easier to just grab a drink and head out the door. However, liquid diets can deprive your body of adequate nutrition, according to Livestrong.

Liquid diets can decrease your intake of the good carbohydrates that help maintain your energy and could cause malnutrition; both are negative for your heart health.

If you struggle with a busy schedule, try meal prepping instead. Meal prepping is a great way to save time because you pre-plan and make food ahead of time.

Most people store each day’s food in separate containers.

For example, on Sunday you make Monday—Friday’s food and store each in separate containers. This way, you can grab and go!

Sources: Mayo Clinic, Healthline, Harvard Health Issue 7 2020 | THE HEART OF JACKSONVILLE

15

HEALTHY LIVING

The New Food Label How the New Food Label is Creating More Educated Consumers Sometimes, change is good.

As is the case with the new food label. The Food & Drug Administration (FDA) set out new rules for food labels, the black & white chart on the back of food products that outline the nutrition facts. The new food label comes with a slew of changes, hoping to make consumers more aware of what they are putting in their bodies. Companies are being asked to update their food labels by 2020.

16 THE HEART OF JACKSONVILLE | Issue 7 2020

Here are the six big changes to look out for 1. Servings – We have all likely been thrown off by serving sizes. We may look at the nutrients of a food item and not take into account that the serving size may be obscurely small. Now, serving sizes are getting an upgrade to reflect realistic portions. For example, previously, a serving size for ice cream was ½ cup. Now, that has been changed to 2/3 cup.

2. Calories – The calories on the nutrition label are now bigger and bolder to stand out to consumers.

3. Fats – Previously, next to calories, you would have seen a place for calories from fat. This has now been removed as research suggests, it isn’t how much fat you consume, but rather the type of fat that matters. Types of fat range from those that are very harmful, such as trans-fat, to those that are beneficial for heart health, such as unsaturated fat.

from the FDA

Nutrition Facts 8 servings per container Serving size 2/3 cup (55g) Amount per serving

Calories

230 % Daily Value*

Total Fat 8g Saturated Fat 1g Trans Fat 0g Cholesterol 0mg Sodium 160mg Total Carbohydrate 37g Dietary Fiber 4g Total Sugars 12g Includes 10g Added Sugars

10% 5% 0% 7% 13% 14% 20%

Protein 3g

Vitamin D 2mcg

Calcium 260mg Iron 8mg Potassium 240mg

10% 20%

45% 6%

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.

4. Added sugars – Organizations such as the American Heart Association raved over added sugar being added to the nutrition label. Moreover, added sugar is being shown as a percent daily value.

This will help consumers know how much of what they eat consists of added sugar.

5. Nutrients – Out with the old, in with the new. Nutrients that are not widely deficient have been removed as requirements, such as vitamin A & C. On the other hand, nutrients that are commonly low in the American diet, such as vitamin D and potassium, are required to be listed.

The FDA hopes this will help improve deficiencies in those nutrients.

6. Footnote – At the bottom of the food label, you will find a footnote defining %Daily Value (%DV). %DV shows the percent of a certain nutrient in a product, in comparison to how much of that nutrient you need for the whole day. For example, if a product contains 20% DV of calcium, this means the product contains 20% of the calcium you need for the day. %DV is based on a 2000-calorie diet.

Issue 7 2020 | THE HEART OF JACKSONVILLE

17

PHYSICIAN’S SPOTLIGHT

FAST FACTS A cup of Tea Makes Everything

Better

Drinking tea may lower your risk of heart disease and stroke by reducing the “bad” cholesterol that can clog your arteries. Sit back, relax and enjoy your next cup of tea. Your cardiologist approves!”

— Dr. Vaqar Ali Cardiologist and Endovascular Specialist *The American Heart Association 18 THE HEART OF JACKSONVILLE | Issue 7 2020

PATIENT TESTIMONIALS

ONLINE TESTIMONIALS We love when our patients are so happy with their experiences, they choose to share it with the world! Check out what our patients are saying about us online.

I have been with them for many years. I trust them with my life. They are the very best physicians.”

~ Facebook Review

Amazing, caring, professional, punctual. I am so thankful for them!” ~ Facebook Review

Dr. Lamba is an awesome doctor. I feel that the staff and doctors in the office really care about their patients. I feel well advised under their care. I appreciate that they share their concerns and knowledge to help me improve my health. The office is always clean and ran smoothly. The medical assistants are always very welcoming and kind to me and my family. I truly appreciate that.”

~ A Google Review

I am always treated courteously and expeditiously. Dr. Schimmel is the best! The staff of First Coast Cardiovascular Institute are topnotch. I’m glad to be a patient there.”

I was impressed with the size of the office and the friendliness of the staff. The appointment went smoothly and the doctor was polite and spoke to me using terminology that I could understand. I felt welcomed and like my health was their genuine concern.”

~ A Google Review

The receptionist was very professional, spoke in a very calm voice and very positive! The scheduling assistant was very positive and smiled. It is always a very positive experience visiting this office!” ~ A Google Review

Best doctors, highly educated, and very caring. It is a very loving and caring environment. When you are there, you are in good hands.” ~ Facebook Review

I’ve been coming to First Coast Cardiovascular for many years. The staff and doctors are the best, and they’ve always taken excellent care of me. Thank you, a thousand times over.” ~ Facebook Review

~ A Google Review

These reviews have been edited for spelling and grammar.

Issue 7 2020 | THE HEART OF JACKSONVILLE

19

PHYSICIAN’S SPOTLIGHT

FOLLOWING A

PLANT-BASED as told by

DIET Dr. Brett Sasseen P lant-based diets

have been all the hype in the past few years.

In fact, sales of plant-based foods have grown by 11% in the past year, according to a report published by the Good Food Institute and the Plant Based Foods Association.

A plant-based diet is centered on fruits, vegetables, whole grains and legumes. Essentially, more of the foods consumed are derived from plants. Dr. Brett Sasseen has been following a plant-based diet for several years. He also encourages his patients to move their diet more towards plant-based, when appropriate. “Most patients come back with higher energy levels and feeling great, after reducing the amount of meat they eat,” says Dr. Sasseen, “Beyond just a plant-based diet, I recommend a whole food, plant-based diet, meaning most foods consumed should be minimally processed.” This means steering clear of foods with added sugar, artificial sweeteners, and refined grain products such as white rice.

A plant-based diet has shown immense benefits. A recent study published in JAMA found those who were strict with a plant-based diet had a 23% lower risk of type 2 diabetes. Moreover, diets that are predominately plant-based, such as the Mediterranean diet, prove beneficial as well. The Mediterranean diet has been shown to reduce risk of heart disease by controlling blood sugar and minimizing inflammation, according to a study in JAMA. 20 THE HEART OF JACKSONVILLE | Issue 7 2020

Wondering where to start?

Check out these plant-based breakfast, lunch and dinner options.

Dr. Sasseen also reminds his patients that a plant-based diet does not substitute the need for other health habits. “Sleep 7-9 hours a night and move around 30 minutes a day,” he says.

A plant-based diet may not be suitable for everyone.

Speak to your doctor before transitioning to a plant-based diet.

*Sources: healthline.com, 21 day vegan kickstart

Breakfast Oatmeal with berries

Breakfast tofu scramble

Yogurt with fruit and pumpkin seeds

Lunch Chickpea burger

Hummus and veggie wrap

Costa Rican rice and beans

Dinner Red beans and rice with collard greens

Black-eyed peas with sweet potatoes and greens

Spaghetti al Pisto

Snacks Carrots and apple slices

Fresh fruit

Issue 7 2020 | THE HEART OF JACKSONVILLE

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SERVICE LINE

Why is the Risk for Amputation Greater for People with Diabetes?

If you have diabetes, you are at a much higher risk for foot or leg amputation. This is due to the increased chance of developing non-healing wounds or foot ulcers. In fact, 85% of diabetes-related amputations are caused by foot ulcerations, according to the American Podiatric Medical Association.

Peripheral Artery Disease Foot ulcers from diabetes are caused by a few different conditions. The first is the close relationship between diabetes and peripheral artery disease (PAD). PAD causes a build-up of plaque in the artery wall and can lead to a blockage of the lower extremity, according to the Society for Vascular Surgery.

This narrowing of the arteries may cause ulcers or open

wounds and infections that may lead to amputation, according to the American Podiatric Medical Association.

Hyperglycemia Long-term hyperglycemia, or high blood sugar levels, is also particularly damaging to blood vessels, potentially causing decreased circulation. This can make it harder for the body to heal wounds, especially at the extremities like the feet and legs, according to Diabetes Daily.

Neuropathy Diabetes can also cause extensive nerve damage, or neuropathy. Neuropathy can worsen a patient’s ability to feel or recognize a small cut on their foot. If the wound is left untreated it can cause infection.

If the patient is diabetic, a simple cut can turn into an amputation.

If you have diabetes, there are ways to help reduce your risk of amputation. Check out these tips below from Diabetes Daily.

•Check your blood and glucose levels regularly. This is the number one tactic you can do to reduce your risk of amputation.

•Be proactive about your wounds.

Do not wait to seek medical attention if you see a wound on your extremities.

•Check your feet and legs every day. Before getting into bed do a quick check for cuts or wounds. If you are a patient with neuropathy you may not feel a wound happen, so it is important to check before it becomes too late. Grab a hand mirror to make sure you can examine your entire foot.

If you have a non-healing wound and have been told amputation is your only option, you can contact FCCI’s Amputation Prevention Center today at 904.493.3333.

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Proven success in reducing hospital admissions and catheters Close collaboration with your nephrologist and dialysis center 10-year tradition of caring for kidney disease patients with thousands of procedures performed

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firstcoastcardio.com | 904.493.3333

22 THE HEART OF JACKSONVILLE | Issue 7 2020

PHYSICIAN’S SPOTLIGHT

Behind the White Coat: Dr. Bruce Krieger Dr. Bruce Krieger has been serving the Jacksonville community for over 14 years.

Dr. Krieger says the most fulfilling part of medicine is seeing the change you make in a patient’s life, “Helping patients and families receive life-saving medical care with compassion is the most rewarding part of my career,” he says.

Dr. Krieger started his journey in medicine at the University of Pittsburgh, where he attended medical school. From there, he completed his Pulmonary/ Critical Care training at the University of California, San Diego.

In addition to patient care, Dr. Krieger has a huge heart for teaching.

His passion for teaching has been recognized through many teaching awards including, the University of Miami Faculty Teaching Award, the AOA Faculty Award, and the George Paff Teaching Award on four occasions. Dr. Krieger calls these awards one of the highlights of his career.

Outside of work, Dr. Krieger volunteers for the American Lung Association. He also enjoys golf, music, and spending time with his family.

Dr. Krieger is now accepting new patients.

To schedule your appointment, call First Coast Cardiovascular Institute at 904.493.3333.

Issue 7 2020 | THE HEART OF JACKSONVILLE

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PHYSICIAN’S SPOTLIGHT

?

The Top 3 Questions You Should be Asking your Cardiologist

Like many doctor visits, you may feel rushed or flustered during a one-on-one with your doctor.

You might even find that once you get home, you have another question you forgot to ask.

When it comes to your cardiologist, your appointment might be one of the most important meetings you have about your health. Cardiovascular disease is the number one cause of death in the U.S., according to the American Heart Association. Being prepared with written questions ahead of time just might help save your life.

But, which questions are the best to ask? Which answers will help you build a stronger heart once you leave the office and get back to your normal routine? Below is a list of the top three questions you should be asking your cardiologist. Your cardiologist is certainly a better source than Google!

1

What is my potential risk of having a cardiovascular issue in the future?

This question is essential because it will give you insight into the future of your heart health. If you know your future risk, you will know what preventative measure you should be taking. For example, your doctor says you have high blood pressure and it is increasing your chances of a future heart attack, and you need to act fast. You may want to stop smoking, get out of the house more to increase your activity level and add some veggies to your diet.

2

What symptoms indicate that my condition is becoming worse?

Many times, symptoms of heart disease or heart attack can go ignored. Peripheral artery disease (PAD) is a serious disease affecting the blood flow to your feet and legs, and it often goes undiagnosed. One reason it can go undiagnosed is because patients often chalk up their symptoms to age or leg pain. Heart disease symptoms are so broad and different for each person depending on age, risk factors and even gender. Knowing your symptoms can save your life.

3

What lifestyle changes can I make to improve my condition?

Although you should always be taking the medicine prescribed to you correctly, lifestyle changes are just as important in many cases. For example, for heart failure, it is primitive that you take your medications, aggressively reduce your sodium intake, eat healthier, exercise and make sure you are getting enough rest. These changes can improve the quality and longevity of your life.

If you have any questions or would like to schedule an appointment with one of our boardcertified cardiologists, please reach out to First Coast Cardiovascular Institute at 904.493.3333.

Sources: American Heart Association, CardioSmart, Everyday Health 24 THE HEART OF JACKSONVILLE | Issue 7 2020

FAST FACTS FACT

PHYSICIAN’S SPOTLIGHT

Rethink the drive-thru Nearly 1 in 3 adults consume fast food every day. When you are in a pinch and fast food seems to be your only option, try making healthy substitutes such as:

1. Order water instead of soda 2. Swap out the fries for fruit or a salad 3. Order a small portion option — Dr. Youssef Al-Saghir

Interventional Cardiologist and Endovascular Specialist

*US Centers for Disease Control and Prevention Issue 7 2020 | THE HEART OF JACKSONVILLE

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RECIPES

Satisfy Your Sweet Tooth Without

ADDED SUGAR Apples with Almond Apricot Sauce American Heart Association Recipe

Serving size: 4

The American Heart Association has done us another huge favor by introducing us to these incredible and easy baked apples. These apples are tasty and sugar free!

WHAT YOU WILL NEED:

INSTRUCTIONS:

• Cooking spray • 2 tbsp water • 2 large apples, cut in half and core removed • 1/4 cup chopped almonds • 2 tbsp chopped dried apricots • 1/4 tsp ground ginger • 1/2 tsp ground cinnamon • 1/2 tsp vanilla extract • 1 tbsp plus 1 tsp light tub margarine

1. Spray the slow cooker with cooking spray and pour in the water. Then, add the apple halves with the cut side up.

2. Stir together the remaining ingredients except for the margarine. Use a spoon to pour the mixture onto each apple half and top with 1 teaspoon of margarine.

3. Cook while covered on low for 2 to 2 1/2 hours or until just tender. Once removed, the apple will continue to cook. Be sure not to overcook them or they will become mushy.

4. Carefully transfer the apples to plates. Let the apples cool completely for about 30 minutes. The sauce will thicken slightly while cooling.

26 THE HEART OF JACKSONVILLE | Issue 7 2020

Sugar is everywhere: in our drinks, in our snacks and most importantly, in our favorite desserts. Studies have suggested that a higher intake of added sugar is associated with cardiovascular disease (CVD) risk factors, according to JAMA. If you are having trouble satisfying your sweet tooth while staying away from added sugar, try these delicious substitutes by the American Heart Association.

Cinnamon Quinoa with Peaches American Heart Association Recipe

Serving size: 6

Quinoa is extremely nutritious. It is packed with protein, fiber, vitamins, potassium, antioxidants and more. It is also versatile; you can make it into a healthy dessert to satisfy your sweet tooth with this recipe from the American Heart Association.

WHAT YOU WILL NEED:

INSTRUCTIONS:

• Cooking spray • 2 1/2 cups water • 1 cup uncooked quinoa • 1 tsp ground cinnamon • 1 1/2 cups fat-free half-and-half • 1 1/2 tsp vanilla extract • 2 cups frozen peach slices thawed (sliced or diced) • 1/4 cup plus 2 tbsp chopped pecans (dry roasted, coarsely chopped) • 2 tbsp chopped pecans (dryroasted, coarsely chopped)

1. Spray the slow cooker with cooking spray and pour in the water.

2. Stir in the quinoa and ½ teaspoon cinnamon. Cook while covered on low for 2 hours or until the water is absorbed and the quinoa is tender.

3. While the quinoa is cooking, stir together the half-andhalf, ½ teaspoon cinnamon and vanilla extract.

4. Pour the quinoa into bowls and top with the peaches.

Pour in the half-and half mixture on top and shake the pecans over top.

Maple Vanilla Latte American Heart Association Recipe

Makes 1 serving

It is winter time, you are in your robe and snuggled up to a fire, but something is missing. Usually you would go for a cup of hot cocoa but you are trying to watch your sugar intake. Instead, try this sugar-free, steamy hot latte with maple and vanilla.

WHAT YOU WILL NEED:

INSTRUCTIONS:

• 2 cups unsweetened almond milk • 2 tsp vanilla • 2 tbsp sugar free maple syrup • 1 tbsp of cinnamon

1. Stir all ingredients together in a small saucepan and warm over medium low until completely heated through and warm to drink.

Issue 7 2020 | THE HEART OF JACKSONVILLE 27

SERVICE LINE

3 Shifts HEALTHCARE; it is confusing, perplexing, and always changing.

The truth is, every day is one step closer to dramatic shifts in healthcare.

20 years ago, if you needed to go to the doctor, you would likely ask a family or friend for a recommendation, see the physician, then follow the exact steps they prescribed.

Now, seeing a physician would likely start with an online search to find the physician nearest to you, a review of their online ratings, followed by a call to your insurance company or the physician office inquiring about cost. When you see the physician, you are likely participating actively in your care, instead of simply attaining a check list.

1 2 3

28 THE HEART OF JACKSONVILLE | Issue 7 2020

in Healthcar Shift #1: From Volume to Value

Physicians used to be judged on the volume of patients seen, tests prescribed, and procedures performed. Now, healthcare is centered on value. Value means the most effective care provided with the least amount of dollars.

Shift #2: Patient Participation & Experience

Patient experience matters. This may seem like an obvious statement, but in reality, the idea of a patient having an enjoyable experience visiting a physician is a relatively new concept. Healthcare providers are more focused on this patient experience, from the time the patient enters the facility to the time they see the physician.

Shift #3: Enter Technology

As technology seeps into our lives, it is no surprise it has found its way into our healthcare. One example is telemedicine. Telemedicine allows you to visit your physician virtually for eligible services such as a followup appointment or medication management.

Your smartphone is likely a pivotal tool in your life and now you can also use it to enhance your health. If you are looking to improve your lifestyle, there is an app for just about everything. Looking to eat healthier?

MyFitnessPal can track all of your calories for the day and allows you to search for the nutrition information of over 5 million foods. Looking to track your steps?

Google Fit can track all of your activities. The possibilities are endless.

re Affecting Your Care What does this mean for you?

Shop the market when it comes to choosing a physician. Don’t be afraid to ask for a cost estimate of the services you need. At First Coast Cardiovascular Institute (FCCI), when you call to schedule an appointment, our schedulers are equipped with a cost estimator tool that can predict the cost of your visit.

What does this mean for you?

Take a minute to provide your feedback at the physician’s office. Whether this is a patient feedback survey or an online review, let the physician’s office know how they did so your experience continues to be at the forefront of care. At FCCI, patient feedback is reviewed daily to ensure we are constantly evolving our patient experience to meet your expectations.

What does this mean for you?

Try choosing one risk factor you would like to improve on and find an app that can help you do this. You may be surprised how much easier a lifestyle change can become with some friendly help from technology.

Also, if you are on a tight schedule, consider a practice that allows you to visit your doctor virtually. At FCCI, we are able to hold televisits for eligible services such as medication management, review of test results, and follow-up appointments. This service provides our patients with added convenience.

Issue 7 2020 | THE HEART OF JACKSONVILLE 29

SERVICE LINE

THE FINANCIAL STRESS OF More than Half of Americans with Heart Disease Experience Financial Hardship Heart disease is a costly illness.

The CDC estimates cardiovascular disease costs the US $200 billion annually. With such a high cost, it is no surprise this financial stress is oftentimes passed on to patients.

A

study recently done by Yale University found that nearly half of Americans under the age of 65 with cardiovascular disease experience financial hardship, directly stemming from medical bills.

Moreover, 20% of these individuals say they cannot afford to pay their medical bills at all and cut back on essentials such as food or medication. Hardships were reported even for the insured.

According to the study, the average heart disease patients shells out $2,000 annually in out-of-pocket costs. More than half of this is to cover the cost of their medication.

With such high costs and an unpredictable burden, it is more important than ever for healthcare consumers to be aware of cost as a factor in seeking care.

Here are a few tips to cutting back on healthcare costs:

Ask for Generics Many medications have a generic or less expensive version that works just the same.

30 THE HEART OF JACKSONVILLE | Issue 7 2020

Talk to your doctor about a generic option for your medication. Moreover, different pharmacies may offer different pricing for the same medication. Shop around at different pharmacies to find the best price.

Understand your health benefits, prior to renewing your health insurance Insurance is a complex world, but one that is worth taking the time to understand.

Prior to signing up for health insurance or renewing your current plan, take the time to understand your health benefits. Go beyond looking at just the premiums. Consider the deductible and the network of physicians the plan allows.

Look for a Physician’s Office that Values Price Transparency Surprise medical bills are an unfortunate common occurrence in healthcare. With price transparency increasingly being prioritized in healthcare, it is a good time to ask if your provider values your dollar.

HEART DISEASE How First Coast Cardiovascular Institute (FCCI) Values Price Transparency & Keeps Cost Low: No surprise medical bills You are able to receive an estimate of the cost of your visit, prior to your appointment.

This ensures you are prepared for any costs that are coming.

Quality over cost FCCI believes strongly that in the face of hardship, patients should be focused on their health, not their finances. We have created a cost-efficient environment that allows us to offer a slew of cardiovascular testing and procedures at a fraction of the cost, compared to hospital systems.

Eliminating unnecessary medical care The Lown Institute estimates the US may be spending $200 billion every year on unnecessary medical care.

This is a statistic we are actively seeking to change, starting with ourselves. We compare our utilization of certain cardiovascular tests to the national average and consistently find, that we are under the 50th percentile for utilization. This demonstrates our commitment to responsible utilization of medical care.

Issue 7 2020 | THE HEART OF JACKSONVILLE

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SOCIAL MEDIA RECAP

JACKSO 32 THE HEART OF JACKSONVILLE | Issue 7 2020

ONVILLE Issue 7 2020 | THE HEART OF JACKSONVILLE

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PHYSICIAN’S DOCTOR SPOTLIGHT FAVORITES

Doctor Insight

Q

What’s the best way to start the day?

Q&A

Q

What motivates you to work hard?

Q

If you could add 4 hours to your day, what would you spend that 4 hours doing?

Dr. Yazan Khatib – The best way Dr. Sumant Lamba – Many of our Dr. Andrea DeNeen – One of my patients come to us with little to start my day is with a cup of favorite hobbies outside of work is tea. Afterward, I enjoy spending hope they can get better. I am knitting. Although I enjoy the clinical time with my daughter, Yasmine, motivated to keep going when I aspects of patient care and training prove them wrong. as I drive her to school. new cardiologists, I wish I had the Dr. Imran Farooq – Being able Dr. Vaqar Ali – I start my time to knit! to provide the best care to my morning by going for a run. No Dr. Ibrahim Fahdi – Family time is so better way to start the morning patients is what motivates me to precious to me. If I had four more hours continuously learn and become than with a bit of fresh air and in the day, I would spend them around better every single day. exercise! my loved ones.

I consider myself very fortunate Dr. Youssef Al-Saghir – To Dr. David Swain – I would be at the and blessed to be in a position to relieve stress throughout beach with my wife and kids! do what I do. the day, it is best to be well prepared. I always give myself Dr. Alan Schimmel – Seeing my What do you like to do on extra time in the mornings to son follow my footsteps into rainy days? prepare for the busy day ahead. medicine.

Dr. Ziad Alnabki – The best way Dr. Brett Sasseen – For many Dr. Firas El-Sabbagh – If I’m off, I like to start the day is by making patients, lifestyle change can be to stay at home and read (many times, sure to wake up early, exercise electrophysiology articles) and sip difficult but necessary. When and eat a nice breakfast! coffee. I enjoy listening to the rain. my advice leads to a patient becoming healthier, it really Dr. Irram Hamdani – The best Dr. Daniel Thielemann – Warm, rainy motivates me to keep helping way to start the day is with days put me in a nostalgic mood. If the others. relaxing exercise. For me, that is wind isn’t blowing, I like to open the taking a long walk on the beach if Dr. Bruce Krieger – Helping windows to hear the rain and take in the weather is nice. not only the patient, but their the fresh air. I usually read or watch an families, is what motivates me. old movie.

Q

34 THE HEART OF JACKSONVILLE | Issue 7 2020

Dr. Cary Rose – I am a very big movie buff. I like to hunker down with a long movie, some popcorn, my two kittens and a glass of wine. Sometimes, I also just like listening to the rain!

WORD SEARCH

WORD SEARCH R E C G W E I G H T L E S R L L L Y I T G O C T O R R S E T S Y R N R R C C R U I N T E D F T O O N S R E S E I D T E Y L S C T Y S T S R E I I E F S S E L T I S E P V S O E Y E O R F E E E R E T E T R T D C Y L I E L P R T O H S L S E S O H L O D C L E O R E E R T O E S H O T R Y E H R F E O G O S C O S R U R W S E I R E T R A L O I

C

P

T R L

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B

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Y A R E E O E O T E R S R L

GROCERY STORE

CHOLESTEROL

DIET

LIFESTYLE

ARTERIES

VEINS

BLOOD PRESSURE WEIGHT

Issue 7 2020 | THE HEART OF JACKSONVILLE

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FREE COUPONS for your Health Our FREE screenings can detect the onset of vascular diseases, so we may have the chance for early prevention & intervention.

Venous screening is a test that takes about 20 minutes to determine your risk level for venous disease. The test involves taking an ultrasound scan of the leg to assess vein function and identify vein blockages that could lead to Chronic Venous Insufficiency.

You may be a good candidate for this free screening if you are experiencing:

FREE

Vein Screening

FREE

• Unexplained swelling • Varicose, spider or reticular veins • Changes in skin color (red or brown)

• Ulcers on the legs • Pain when standing that is less noticeable when legs elevated • Itchiness

The ankle brachial index (ABI) test can detect peripheral arterial disease by comparing blood pressure in the ankle to blood pressure in the arm. The test takes about 15 minutes to perform.

You may be a good candidate for this free screening if you are experiencing:

Peripheral Arterial Disease Screening

• Leg pain • Muscle cramping in the hips, thighs, or calves while walking • Coldness in the leg or foot

• Hair loss on the legs • Non-healing ulcers or wounds • Smooth, shiny skin that is cool

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*THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT.