Supplement to the Tulsa World, Thursday, February 4, 2016
heart Health Meet a few of the people who have benefited from having great
CARDIAC CARE in our region
tulsaworld.com/hearthealth
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TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)
Latest cardiac procedure saved his life J
“Every day I look at it as a bonus day.” Jim Meehan, 75, of Tulsa
im Meehan knows firsthand what it’s like to have your chest cracked open for heart surgery and what it’s like to address heart problems through a non-invasive catheter. It’s a world of difference. The Tulsa native, now 75, had triple-bypass surgery in 2000 to clear several blocked arteries. In July 2012, he became only the seventh person to receive a transcatheter aortic valve replacement (TAVR) in Tulsa. It took four months to recover and return to work in 2000. It took him only four weeks to recover after the 2012 procedure. Meehan hopes local residents can appreciate the healthcare resource that the TAVR procedure represents to our community. He learned about it firsthand a few years after his 2000 surgery when he was first diagnosed with aortic stenosis, a heart valve problem. “It creeps up on you,” Meehan said of the cardiac condition. “You don’t really know you have a problem right away because it’s a gradual closing of the aortic valve. It means you can’t get enough blood through to properly oxygenate your body.” Meehan was still busy running Architectural Lighting Sales after his diagnosis, but his health kept deteriorating over the years. Meehan said he knew his heart condition had gotten really bad when he was running short of breath after taking as few as 30 steps. One of Meehan’s doctors in 2011 told him he had only a 20 percent chance of surviving another open heart surgery, given all his risk factors. But he mentioned that the Cleveland Clinic in Cleveland, Ohio, was performing an experimental non-invasive surgery for patients like him. It was known as TAVR.
Meehan traveled to Cleveland to see if he was a candidate but was turned down. “I wasn’t bad enough for them,” Meehan said of his health condition. When Meehan returned to Tulsa, he learned that Dr. Kamran Muhammad had recently left the Cleveland Clinic to start a TAVR program in Tulsa at Oklahoma Heart Institute. Meehan heard about a local public seminar on the innovative procedure that Dr. Muhammad was leading, so he attended the lecture. Meehan knew this was what he needed. Dr. Muhammad, an interventional cardiologist, performed his first TAVR surgery in Tulsa in May 2012. Meehan underwent the procedure two months later. Because it was still considered experimental surgery at the time, Meehan said he spent three weeks in the hospital waiting for Medicare to approve it. “When I woke up from surgery, it was like being totally cured,” he recalled. “It was like instant gratification.” Meehan can’t say enough about what the Oklahoma Heart Institute has meant to him and to other heart patients like him in Tulsa. “It is a tremendous place to have heart work done,” he said. Oklahoma Heart Institute holds an annual celebration for all of the TAVR patients and their families, and Meehan hasn’t missed a single party. He has been married for 52 years, has three sons, five grandchildren and one great-grandson. He’s grateful to still be alive to enjoy time with his family. “Every day I look at it as a bonus day,” Meehan said. “Without that procedure I probably wouldn’t be here.”
POLYCYSTIC OVARY SYNDROME (PCOS)
Her weight gain signaled something serious D
ebbie Reed of Verdigris has fought a losing battle with weight gain her entire life. She recalls being 10 years old and taking only a half-sandwich on whole wheat bread and an apple to school for lunch and still being the heaviest child in her elementary class. Over the years she tried every kind of diet she could – Weight Watchers, Atkins, Jenny Craig, Slim Fast, Lean Cuisine – and still the weight never diminished. “I could never figure out what I was doing wrong,” Reed says. “Doctors just thought I was eating too much.” Reed launched her career as a hairstylist, got married and at age 25 gave birth to her daughter. It wasn’t until age 30 that a friend encouraged her to get checked out for a disorder called Polycystic ovary syndrome, or PCOS. PCOS is a hormonal imbalance that causes small cysts to form on a woman’s ovaries and often includes various problems ranging from acne, facial hair and weight gain to infertility, diabetes and a host of heart problems. Reed’s diagnosis was made through an OB/GYN at the time, but she didn’t give it much thought because she didn’t plan on having any more children. Nine years later, at age 39, Reed finally realized there was much more to PCOS. She recalls going for a walk and feeling heaviness in her chest. She had difficulty catching her breath. She laid down to rest, and the heaviness went away. As the week went on, however, the situation grew worse. Just getting from the car to the door became difficult. By Sunday, she couldn’t make it from the parking lot into church. That’s when her family and friends urged her to seek
Reed to an endocrinologist. “Let’s get this weight off,” the doctor said. “I’ll do whatever you tell me to do,” Reed responded. They discussed gastric bypass surgery, but her husband’s insurance wouldn’t cover it. The endocrinologist then encouraged Reed to try the Ideal Protein Diet. She lost 15 pounds the first week. “I had never lost that much weight in one week,” Reed said. “That motivated me.” Within one year, Reed lost 110 pounds. Everything was finally going well until two years later when something didn’t feel right again. It was more like heartburn, but Reed decided to get checked out. Doctors discovered another blocked blood vessel – this one was 92 percent closed. Dr. Smith repaired it surgically with another stent. Now 46, Reed realizes that PCOS is not only why she has struggled with weight her whole life but it’s capable of taking her life if she’s not careful. “If I had been like most people and blew it off when I felt something wasn’t right, I’d be dead right now,” she said. Reed, owner of Tulsa Hair Design, now eats a strict diet of high-protein shakes, lean meat and green vegetables because PCOS causes her pancreas to pump twice as much insulin into her body as it should. “It’s really important to educate young women who might have this problem but don’t know it,” Reed said.
“It ’s really impotant to educate young women who might have this problem.” Debbie Reed, 46, of Verdigris medical help. Dr. Robert Smith at Oklahoma Heart Institute in Tulsa performed an angiogram and found one of the arteries on the front of heart 90 percent blocked. He scheduled surgery and placed a stent in Reed’s artery to open it up. He also referred
BLOCKED CORONARY ARTERY (“THE WIDOW MAKER”)
He learned that strenuous exercise isn’t enough to prevent heart attack
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ave Schotter, 52, appears to be the picture of great health. He doesn’t smoke. He pays attention to what he eats. He exercises a lot. Little did Schotter know, though, a ticking time bomb was building inside him. It went off Thursday, Oct. 22, 2015. Schotter was at his job as a buyer for McElroy Manufacturing in Tulsa that day, feeling ill but trying to push aside what turned out to be cardiac warning sirens. The married father of one adult son told his boss he would work from his desk all day because he thought he had the flu. That afternoon, Schotter began feeling nauseous and drove himself home. His wife noticed that it took him a long time to climb the stairs and became concerned. “I think we need to go to the doctor right now,” Schotter recalled her saying. They drove to the nearby Warren Clinic Urgent Care where medical personnel quickly determined he was in cardiac distress and asked, “Why did you come here?” They immediately called an ambulance to transport Schotter across Yale Avenue to Saint Francis Hospital. “I was obviously in denial,” Schotter said. Emergency medical technicians assessed his health while they were still in the parking lot. They gave him oxygen, which helped, but the crushing pain in his chest was undeniable. Tests later indicated that Schotter had suffered a heart attack due to a blockage in his left coronary artery. That condition is commonly
ABOUT THIS SECTION Heart Health was produced by Tulsa World’s Advertising Department. For more information, call 918-581-8519.
known as “the widow maker.” Schotter was lucky to be alive and at the hospital. The next day, he was wheeled to the Cath Lab where Dr. John Ivanoff inserted a catheter into the main artery in Schotter’s leg and was able to use it to place a single stent where the blockage was. “It opened up my blood vessel immediately, and the blood started flowing,” Schotter said. “I felt better almost immediately.” The entire procedure took only 20 minutes, and after resting a few more days in the hospital, Schotter went home Sunday. He was able to return to work Nov. 9, but his recovery work was just getting started. Schotter attended classes at the hospital to learn more about nutrition, exercise and managing his medications. Schotter said he thought he already knew most of those things, but “I learned something at every seminar I went to,” he added. He also began visiting the hospital’s Cardiac Rehab Center three times every week to exercise on a treadmill or stationary bike while being monitored. It’s a 12week program (36 total sessions) that he will complete later this month. It has definitely taught him many things, especially for a guy who was doing CrossFit training the week he had his heart attack. “I used to get so fatigued while doing CrossFit,” Schotter said. “I would drop to my knees and think, ‘I’m doing really great.’ I was actually being stupid. I was ignoring some obvious signs.” Looking back, he remembered a major warning he ignored while on a September trip to Las Vegas with his brother-in-law. “It was an event similar to what I experienced (Oct. 22),” Schotter said. “A lot of the same feelings, and I was stupid. I just ignored it.” He hopes others can learn from his mistake. “I had always maintained that if you work out, you can eat whatever you want,” Schotter said. “That’s not true.”
“I was being stupid . I was ignoring some obvious signs.” Dave Schotter, 52, of Tulsa
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DOUBLE OUTLET RIGHT VENTRICLE (DORV)
HEART VALVE REPLACEMENT
Congenital defects required
repairs to this child’s heart
A
firstborn child always holds a special place in a mother’s heart. In Courtney Johnson’s case, her daughter Katelynn’s birth meant even more. Katelynn was born in 2003 with several serious heart conditions that have led to a lifetime of learning for both mother and daughter and caused Courtney to change her career focus and become a nurse. Katelynn entered the world around 6 p.m., Courtney said, and immediately the doctors and nurses at Saint Francis Hospital knew something was wrong. Pediatric cardiologist Matthew Kimberling was called in. Around 11:30 p.m., he delivered some troubling news. “This is what’s going on,” Kimberling told Courtney and her husband. “This is what’s wrong, and this is what we’re going to do about it.” “It was a shocker for sure,” Courtney said. Katelynn had been born with two structural heart defects: double outlet right ventricle (DORV) and transposition of the great vessels. Transposition meant that the aorta and pulmonary artery, the primary vessels that bring blood into the heart and send it back out, were reversed and didn’t connect to their normal heart chambers. In a normal heart structure, the aorta connects to the left ventricle, the chamber that pumps blood into the body. The pulmonary artery normally is connected to the right ventricle, which pumps blood to the lungs to be oxygenated. In DORV, both arteries flow out of the right ventricle. That left no vessel connected to the left side of Katelynn’s heart. It was not something surgeons could correct immediately, and Courtney learned Katelynn would be dealing with this the rest of her life – however long that might be. “There are not a lot of older kids with this condition because they didn’t used to survive,” Courtney said. Fortunately, advancements in pediatric cardiology have changed that prognosis. Katelynn had her first major surgery when she was 9 months old. Known as the hemiFontan procedure, it’s designed to reduce the work of the right ventricle by placing a mesh device in the heart to reroute blood coming from the upper half of the body to flow directly to the lungs without going through the heart.
Katelynn had a second surgery at 18 months of age. This time, the surgeon removed the mesh patch from the first surgery and a wall, called a baffle, was built into the right upper chamber of Katelynn’s heart to reroute the blood coming from the lower half of her body into the blood vessels that go to the lungs. It took Katelynn only one week after each surgery to recover and leave the hospital, Courtney said. “It’s amazing,” she said. “Children are so resilient, and they bounce back so quickly.” Courtney said she is so grateful for the care her daughter has received over the years at Saint Francis. Katelynn, now almost 13 years old, is in the sixth grade at Heritage Intermediate Grade Center in Coweta. She has had several catheterization procedures done over the years at Saint Francis, and one other open heart surgery at age 6. That surgery was done at The Children’s Hospital at OU Medical Center in Oklahoma City. Doctors had hoped to implant a defibrillator to help regulate Katelynn’s heartbeat, but they were unable to do so because of an infection. Katelynn will probably need that in the future, doctors told Courtney, but they are not sure when. “For the most part, she’s a pretty average 12-year-old,” Courtney says of Katelynn. Katelynn Johnson, 12, of Coweta Katelynn cannot participate in strenuous sports Courtney decided to become a nurse. such as track and soccer Courtney, who also has a 9-year-old son, where athletes are exerting themselves for now works full time in the Intensive Care Unit long stretches of time, but she is involved in at OSU Medical Center in Tulsa. gymnastics without any problems. “She is absolutely the reason I became a “She’ll never be able to do things that nurse,” Courtney said about Katelynn. “I’ve quickly tire the heart,” Courtney said. been through things a lot of people haven’t Courtney was still in college when Katebeen through. I want to help them underlynn was born, and as a result of living stand what is going on with their loved one.” through her daughter’s medical challenges,
“Children are so resilient, and they bounce back so quickly.”
CARDIOMYOPATHY
Continuing cough led to his diagnosis R
oss Greenawalt, 45, thought maybe the bronchitis he had been treated for the previous summer had returned. That experience landed him in a hospital E.R. Little did he know this cough was the beginning of something worse. The married Tulsa resident travels quite a bit in his job at a company that produces television graphics. The cough got so bad by July that it was interfering with his life. Coughing led to hacking, which led to dry heaves. It was a constant cycle without end. “I had no energy,” Greenawalt said. “I could not sleep longer than a few hours at a time because of the cough. I had zero quality of life at that point.” He also had to give up performing as an acoustic musician on the side. Greenawalt sought medical attention, and doctors ran a test for asthma. That wasn’t it. COPD, maybe? Nope. The answer finally emerged when Greenawalt was on a trip to North Carolina in early August. He had a severe coughing attack during the flight and noticed swelling in his legs and ankles. It concerned him so much that he went to an urgent-care center there, and a physician’s assistant suggested Greenawalt might have a heart problem. Back in Tulsa, doctors performed an echocardiogram on him. Greenawalt remembers it well. It was the morning of Aug. 13. They told him he had severe cardiomyopathy and needed to see a cardiologist immediately. The next morning, Greenawalt met with Dr. Heather Cha at St. John Hospital. She explained that his heart was weak. The ejection fraction (EF) is a measurement of how much blood the heart pumps out with each contraction. A normal heart’s EF is between 55 and 70 percent. An EF below 35 percent is severely abnormal and puts a person at high risk for sudden cardiac death. Greenawalt’s EF was 20 percent. That explained all he had been experiencing. The left ventricle of Greenawalt’s heart was failing, and in straining to work hard to keep up, the muscle had stretched out and enlarged. The heart’s inability to push enough blood around was causing fluid to collect in his extremities and lungs, causing the coughs. It was amazing he was still alive. Dr. Cha started Greenawalt on medications immediately. He was also instructed to wear a LifeVest – an external defibrillator capable of shocking his heart if a life-threatening abnormal heart rhythm was detected.
“It ’s night and day how I feel now and how I felt before.” Ross Greenawalt, 45, of Tulsa
Greenawalt also began attending Cardiac Rehab exercise sessions three times per week at St. John. It’s a supervised program of physical therapy for cardiac patients. Greenawalt was feeling better after losing 50 pounds and was able to begin performing music again. In November, Greenawalt had another echocardiogram to see if his heart had improved. Unfortunately, it had not. The next step came Dec. 7. Greenawalt gave up the LifeVest for an internal defibrillator that was surgically implanted in his chest and connected to his heart. Doctors made an incision under Greenawalt’s collarbone, ran two electrical leads to the heart and inserted the pocketwatch-sized device in his chest. Greenawalt is happy to be alive. He’s getting ready to travel again. Not having the coughing fits makes everything so much better. “I don’t know if there’s a whole lot more they can do,” Greenawalt said. “I’m just looking to keep my quality of life. It’s night and day how I feel now and how I felt before August.”
She feared heart surgery, but new technology made it non-invasive
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arcia Velia had a good reason to fear having cardiac surgery. Her mother had open heart surgery 16 years ago. Doctors had a difficult time getting her mother’s heart restarted afterward, and she suffered a stroke. She died two weeks later. All of that led Velia to leave her home in upstate New York and move to Oklahoma to help care for her father. Velia, 68, and her husband live in Peggs, a small town between Locust Grove and Tahlequah. The retirees have three children, six grandchildren and four great-grandchildren. Three years ago, she was diagnosed with atrial fibrillation, an irregular heart rhythm, and aortic stenosis, a heart valve problem where the valve does not open well, often restricting blood flow. Doctors told Velia then that she would need a heart valve replacement at some point, but she was determined to put it off as long as possible. “I never wanted to have them cut me open to do surgery,” Velia said. “I just ignored everything, even though I couldn’t do a lot.” “I could vacuum a little,” she explained, but most household chores left her winded and needing to rest. She required three pillows and a fan blowing on her at night just to sleep. Her day of reckoning came the Saturday before Halloween last fall. She had taken several of her granddaughters to a pumpkin patch when her breathing got worse. Not wanting to frighten her grandchildren, she waited until afterward and asked her daughter to take her to the nearby hospital in Tahlequah. Doctors told Velia that she couldn’t wait any longer to have her heart valve replaced. She asked to be transferred to St. John Hospital in Tulsa and left by ambulance in the middle of the night. Dr. Heather Cha used several tests to confirm the diagnosis, but Velia definitely was not strong enough for any open heart surgery. Around noon that day, Velia felt like she was going to pass out, and she was rushed to the ICU immediately, where she did lose consciousness. She recalls waking up around 11 p.m. She remained there for several days with strict monitoring and more tests. Dr. Cha explained that Velia had severe aortic stenosis and four blocked heart arteries. The good news was that the team of cardiologists and cardiac surgeons could replace the valve in a non-invasive way that did not require cutting open her chest. Transcatheter Aortic Valve Replacement (TAVR) is a new surgical procedure that allows the new valve to be placed into the heart by way of a catheter. The cardiologists also addressed the four blockages by using catheters to place stents in those areas. It was a far different procedure than what Velia’s mother had faced a decade and a half ago. The surgery took place on a Wednesday, and Velia went home the following Monday. “The stuff with my mom really had me worried,” Velia said. “I just left it in God’s hands. This procedure (TAVR) became available, and I’m just glad He kept me alive long enough to have it done.” Velia is now back to doing “everything” when it comes to household chores. “I can feel the difference,” she said. “It’s just remarkable.”
“I can feel the diference. It ’s just remarkable .” Marcia Velia, 68, of Peggs
Free seminar can help you prevent having a stroke You probably know that not smoking, eating a healthier diet and exercising regularly can help prevent heart disease, but there’s a whole lot more you can do to reduce the risk factors. Aberdeen Heights, an assisted-living facility, will host a free seminar with Dr. Neil Agrawal at 6 p.m. Wednesday, Feb. 17, and you’re invited to attend. Dr. Agrawal is a noninvasive cardiology specialist and surgeon at the Oklahoma Heart Institute in Tulsa. He also sees patients at the Institute’s clinics in Cushing, Grove and Henryetta. Aberdeen Heights, 7220 S. Yale Ave., also will provide chef-prepared refreshments at the seminar. For more information, call 918-496-0123.
Dr. Neil Agrawal
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