IMPULSE: A quarterly publication of ICE, April 2014

impulse SPRING 2014 /// THIS QUARTERLY PUBLICATION IS A SERVICE OF

LIMBSTITUTE

giant steps

be your best Ways you can improve the health of your hardest working organ.

Put your best foot forward INSTITUTE FOR MEDICAL EXCELLENCE

what do you care?

Improving your health

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SERVICES

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innovation. compassion. excellence.

OF

contents FEATURING

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beat your best Empower yourself with these state-of-the-heart tips, tactics, and technologies to help you improve the health of your hardest working organ.

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giant steps Limbstitute has made giant strides utilizing the latest techniques and technologies to improve limb health—but the first steps are yours.

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what do you care?

It’s your body—what are you doing to care for it? Here are some things you can do today to enhance your overall health and quality of life tomorrow.

DEPARTMENTS

4 : from the heart

A personal message from Dr. Asad Qamar

5 : nice to know

Our patients speak from the heart

6 : the beat

The latest news, stats and information

14 : on ice

Meet the people who are at the heart of ice

15 : heart and soul

Expressions of the (he)art

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from the heart

Put your heart in it We at ICE are so pleased to bring you this latest evolution in our IMPULSE series. You may have noticed it’s a little more substantial than previous editions. We wanted a larger forum to be able to treat subjects more indepth and to make the communications more informational and ultimately more useful. This first issue in our new format is focused on empowerment.

We want you to know how much control you have when you “put your heart” into your own heart health, the health of your limbs, and your overall wellness.

Empowered cardiac health means so much more than “quit smoking and exercise more.” We explore some tools available to you that go beyond simply good advice. For someone who may have very real concerns about their heart health right now, we want to share some insights and open up a dialogue that provides knowledge and hope and helps alleviate anxiety that can be downright frightening.

We added the Limbstitute to our ICE family because the incidence of PAD (peripheral artery disease) is becoming almost epidemic among people atrisk. Rather than wait for symptoms to progress and develop into a serious limb-threatening condition, there are things that can be done before arterial problems force an invasive medical intervention.

Primary care is one of the areas where personal involvement in you and your family’s health has been the focus of many studies and spawned innumerable lifestyle choices that are the talk of daytime TV and impassioned discussions around the office water cooler. We want you to know what choices you have out there that are both worthwhile and supported by the physicians in our IME offices. We want you to take control of your health. We want you to feel the joy that comes with results directly attributable to something you did for you.

Please enjoy this latest IMPULSE. There’s a lot of good information in here and a real opportunity for you to make a healthy difference in your own life.

As always, thank you for reading.

Sincerely,

Asad U. Qamar, MD FACC, FCCP, FSGC, FACP, FSCAI Cardiologist

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We want you to feel the joy that comes with results directly attributable to something you did for you.

nice to know

Tom Behan Listening to the doctor and making lifestyle changes have been the key to success.

Tom Behan is a man who has enjoyed a “new lease on life” after he had his mobility restored following a series of procedures with Dr. Qamar at The Institutue of Cardiovascular Excellence.

Tom is one more example among many who truly understands what a marvelous gift it can be to regain a part of everyday living that he had feared was lost to him forever. He can now look forward to some very specific benefits….

“I have so many things to look forward to for the holidays and in the New Year. I can’t wait for our family dinner, especially because I love my mother-in-law’s special holiday dish. We also have an eight-day European river cruise on the Danube scheduled where we plan to visit Hungry, Slovakia, and Germany followed by three days in Prague.”

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the beat

CARDI AC

B R EA KT HROUG H

Silicone Sheath A form-fitting sheath containing sensors worked flawlessly to provide a complete picture of a rabbit’s heart function without interfering with the heart’s performance.

Heart rhythm, temperature, and electrical activity were some of the things monitored. A huge improvement over sensors glued or sewn to a heart, the silicone sheath approach must next be approved for human study.

Study performed by John Rogers from the University of Illinois and reported in Nature Communications

Many studies on the benefits of aspirin and fish oil have been done on the two singly. But a new study on combining the two indicates that the one-two punch could be used to treat everything from chronic arthritis to heart disease, cancer, even Alzheimer’s.

The key is inflammationreducing molecules called resolvins. Resolvins shut off—or resolve—inflammation. Aspirin triggers the body to produce resolvins. They’re found naturally in omega-3 fatty acids. Using the dynamic duo together puts extra muscle in the fight against irritants that cause the body to produce an inflammation response. Inflammation is at the heart of the debilitating effects caused by most chronic diseases.

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“You absolutely can reverse at least some of the damage of even severe heart disease.”

— Dean Ornish, MD, founder and president of the Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco

NEW R EP ORT

Stem cells to improve circulation?

A new study at UC Davis Vascular Center is examining the potential for using a patient’s own stem cells to improve circulation in the lower extremities. Bone marrow is harvested and then stem cells are extracted and injected at various sites in the lower leg muscles. “Our own research in mice has shown that adult human stem cells are very efficient at targeting areas of low oxygen and promoting the formation of new blood vessels,” said Jan Nolta, director of the UC Davis Stem Cell Program and Institute for Regenerative Cures. “This next stage of our research will determine if the treatment truly offers hope for people without other options and who are at risk of losing a limb.”

—UC Davis Health System

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PHOTO CREDIT: RODGERS ET AL.

Aspirin and Fish Oil—The Dynamic Duo

by the numbers The number of Americans killed annually by heart disease: approximately

1 MILLION The number of Americans that will have a heart attack this year:

OVER 920,000 The number of women who die each year from heart attacks:

OVER 267,000

Six times more than the number of women who die from breast cancer.

Someone in the United States dies from cardiovascular disease every

33 SECONDS

H E ALT H T I P

Add 2,000 steps a day to slash your risk of heart disease.

Exercise is good; we all know that. This is the first study to link “how much” with a quantifiable result. Over 9,000 adults in 40 countries participated in the study that showed an 8% reduction in risk for getting CVD (cardiovascular disease).

— Dr. Thomas Yates from the University of Leicester in The Lancet

Roughly equivalent to 9/11 repeating itself every 24 hours, 365 days a year.

FAS T FAC T

Being slim reduces heart disease risk better than fitness.

A Swedish study of almost 750,000 men showed that fit but overweight men had almost twice the risk of heart disease compared to unfit but slim men and four times the risk compared to fit, slim men.

— from a study published in the European Heart Journal

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be your best Your state-of-the-heart health starts with you.

Learn what you can.

Do what you can.

T

he Institute of Cardiovascular Excellence has set the standards of cardio care for hundreds of Central Floridians and continues to do so with diagnostic tests, cath procedures, angioplasties, and other medical interventions to ensure

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the cardiovascular health of our patients.

Every day, we see the consequences of choices people make in their lives and the damaging effects our modern day lifestyle can have on their health.

We’d like to do all we can to interrupt the harmful cycle of cause and effect by

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empowering our patients—even before they become patients—by arming them with the tools to either avoid cardiac problems before they get started or help reverse some of the damage if heart disease has already gained a foothold in their lives.

I N S T I T UT E

Be on the lookout Heart disease is sneaky. Its symptoms can look like a hundred other things. Still, we want you to call or come to ICE if you exhibit any of the following.

Pain in the chest is the easy one.

Sometimes it is described as burning, fullness, pressure, or like “an elephant sitting on my chest.” Medically, the condition is called angina and it can range from mild discomfort—no dramatics—to a severe squeezing pain or ache. Don’t try to self-diagnose.

Don’t chalk it up to heartburn or “the fish I had last night.” We know you don’t want it to be a heart attack. We don’t either. But don’t wait, hoping against hope. Call 9-1-1 or the Institute immediately. The first hour after a cardiac event is optimum for us to administer medical intervention—clot buster drugs or angioplasty—that can head off permanent heart damage.

Many of our women patients at ICE thought only men suffered heart attacks until they experienced a pain in their arm or shoulder, abdomen or anywhere but their chest. Truth is, woman have heart attacks, too.

However, their symptoms are often more subtle. Women are more likely to feel faint, dizzy, and experience nausea or shortness of breath. They may have a persistent headache or backache. A radiating ache in the jaw is very common—and often self-diagnosed as a bad tooth. Be on the lookout for these. Over half of the deaths from heart disease occur in women — six times the number that will succumb to breast cancer.

We want to help Don’t wait for symptoms to appear.

No symptoms is no guarantee of a healthy heart. Half of the people who

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will experience a “heart event” this year will have no prior symptoms.

That’s why the American Heart Association recommends that regular cardiovascular screening tests begin at age 20! Call us and make an appointment if you’re over 20 and have never had a heart screening.

It’s better to know where you stand before symptoms begin. After that, our physicians will determine the frequency of follow-up exams based upon what risk factors—cholesterol, family history, etc.—we find.

Reduce your stress levels. That is easier said than done sometimes, especially in today’s world. But we can help you find active ways to keep stress under control, from medication to meditation and other stress control techniques. By the way, exercise is a powerful stress reliever—with a two-for-one benefit!

Want to take a more active role in your heart health? We can help you with that as well.

Eat fish—at least two servings a week. Fatty fish—like salmon— are high in omega-3 fatty acids, which have been shown to lower triglycerides, reduce plaque in arteries, and even reduce heart arrhythmias. When you come to us for diet advice, you can be sure fish— or fish oil—will definitely be on your menu plan.

Exercise is a great place to start.

The physicians at ICE can tailor an exercise plan designed to your exact fitness level and capabilities. We’ll monitor your progress and celebrate with you when you reach your fitness milestones.

Floss! We see many patients whose hearts have been compromised by bacteria—the same kind that causes gingivitis. Healthy gums will reduce the incidence of harmful bacteria that can cause inflammation, which can harm your heart.

Eat right. Rather than accept the oft-repeated advice to simply eat a low-fat, low-carb diet with lots of fruits and vegetables, let experts at the Institute advise you. We’ll help create a diet you can actually live with that accounts for your own tastes and your own weight loss expectations.

Take aspirin. Consult with us first before beginning any aspirin regimen. But usually, one regular or two baby aspirin a day is the amount we prescribe to our patients to realize the maximum benefit.

Sleep well. There is ample evidence that poor sleep patterns can result in a host of heart ailments. Between seven or eight hours is about right. Below five is harmful. So is sleeping too much. If you are concerned you have a sleep disorder, tell us. We’ll put you in touch with medical experts who can best evaluate your situation.

A healthy heart is a product of what we can do for you and what you can do for yourself before the Institute of Cardiovascular Excellence ever gets involved. So, take your heart in your hands. Take an active role in the process. You’ll feel better, look better, and live a more enjoyable life—something we both want for you.

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giant steps Limbstitute has made giant strides utilizing the latest techniques and technologies to improve limb health—but the first steps are yours.

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innovation. compassion. excellence.

L IM B S T IT U TE

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imply put, the Limbstitute was created to save legs.

We provide comprehensive vein care and incorporate the latest technologies—closing off veins with radio waves for example— to get the best results. We’re also wound care specialists and experts in artificial skin grafts. We do whatever it takes to save a limb and give a patient their life back, we do.

Every day, we see and treat patients who come to us with symptoms that can be as innocuous as a little swelling at night or as debilitating as severe pain that impairs their ability to walk.

Many times there are a combination of symptoms—restless leg syndrome, night cramps, fatigue, constant aches and pains.

The most important step—the giant step—we want our patients to take is to come in when they have symptoms like those and let us evaluate their situation before it gets any worse. Personal empowerment comes with education, with knowing what symptoms to look out for, and bringing them to the attention of someone who specializes in knowing what they all mean. Only until we know what we are dealing with can our specialists set upon the right path to saving a leg—even saving a life.

Should I exercise? It’s a question our patients often ask. The answer is maybe. Don’t begin a walking program without checking with us first. Sometimes, depending on a patient’s condition, exercise would be the worst thing they could do.

Even when exercise is an option, with circulation that may be compromised, the key is care and moderation.

Limbstitute experts will advise you every step of the way with what exactly you can do and for how long.

It may involve walking or swimming.

Some of our patients begin with light housework. We’ll perform regular testing over time to monitor your progress.

Many of our patients who suffer from Raynaud’s Disease—poor circulation in their hands and feet— know to stay warm when they need to. They wear gloves and warm socks and we advise them to add a hot water

“The whole point of the Limbstitute is to save limbs.

It’s what we do.”

— Tom Tram, PA

bottle to their regimen when it gets really cold. A variation that can help circulation is a hot and cold treatment.

Alternate between a hot water bottle and cold—frozen peas work perfectly—to simulate circulation. Just don’t overdo either one.

Eating right goes without saying.

Nutritionists at the Limbstitute can be instrumental in helping control dietary issues that contribute to diabetes.

We may recommend certain herbs to enhance your circulation. Did you know cayenne, garlic, gingko biloba and ginger added to your food or taken in capsule form could have a positive effect on blood flow?

We go even further than diet and herbs with a proprietary prescription-

grade supplement called Vasculera.

It decreases inflammation in veins while at the same time making them stronger. We’re the leading Vasculera specialist in Central Florida.

Ask us about other holistic approaches that have proven effective in increasing circulation, including hydrotherapy, reflexology, yoga and stretching, and acupuncture and massage. For those disciplines that we don’t offer at the Limbstitute— acupuncture for example—we maintain close working relationships with a wide network of local specialists and direct our patients to those whom we think may provide the most beneficial effects.

Medical specialties that are beyond the scope of the Limbstitute but that still impact the limb health of our patients—orthopedists, lymphedema specialists, rheumatologists and more—we consult with on a regular basis to give our patients every chance for an optimum result.

Finally, we see so many patients at The Limbstitute who are there because they took up smoking at some point in their lives. If they still smoke, we advise them strongly to quit—and we provide consultation to help with that. Of all the things you can do to improve circulation, quitting smoking is at the very top of the list.

Do you suspect you may have a circulation problem? Exhibit one or more of the symptoms mentioned earlier? Please, take that first giant step and come see the comprehensive vein care specialists at the Limbstitute.

Let us evaluate your condition, advise you, and intervene with whatever procedures may be indicated. We’re here to help you salvage a limb and your life. It’s the only reason we’re here and it’s the only thing that we do.

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what do you care?

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innovation. compassion. excellence.

I N S T I T UT E

F OR

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It’s your body—what are you doing to care for it?

Here are some things you can do today to enhance your overall health and quality of life tomorrow.

N

o one cares about you—or should care— like you do. You know what’s going on, when something feels “off,” or when something hurts. But the primary care physicians with IME certainly come in a very close second. We’re here to provide care for the “everyday maladies” of life, as well as guidance you’ll need to help you take better care of yourself.

Regular checkups are the perfect way to begin. Blood tests, chest X-rays, EEGs, and exams that document blood pressure are important. Your IME physician will evaluate tendencies for diabetes and uncover the beginning of cardiac problems and myriad other conditions and diseases. Our doctors are an excellent resource for all those medical questions you always wanted to ask.

Like what’s the best way to Quit Smoking? We all know smoking is bad for you. The only question many of our patients have is how to quit. We can help with that. There are several effective methods. An IME primary care physician can recommend which method might be right for you.

Eat Healthy. Two out of every three Americans is overweight or obese, and the numbers are escalating. Obesity exposes you to everything from heart disease to cancer, arthritis, depression, kidney stones, fatty liver disease, and erectile dysfunction. To make it worse, there are a million diets, fads, and trends people dabble at—none that result in lasting success. Ask one of the physicians

at IME for advice on the best ways to lose weight and keep it off.

Don’t Stress. It causes everything from gray hair to heart attacks and can damage every system in the body from respiratory to circulatory to the nervous system. Are you stressed?

Your IME primary care physician will evaluate your stress level and prescribe an appropriate remedy.

Sleep. If you suffer from a lack of sleep— seven to eight hours is the target, under 5 hours is bad—it will have a negative effect on judgment and mood. Kids will find it harder to learn in school. And a serious sleep deficit over time can lead to a host of health problems including obesity, diabetes, cardiovascular disease and even death. Tell your primary IME physician if you feel you have a sleep problem. We’ll evaluate your condition and steer you toward experts who can provide the right treatment.

Get A Flue Shot. Especially if you are in any of these at-risk groups: caretaker for a child under 2 years, any child 6 months to 19 years, 50 and older, pregnant, have a chronic condition, live in a nursing home.

The flu virus can be serious, even deadly, because it involves the lungs and can cause pneumonia. So, make an appointment once a year. Come in. Get the shot.

Exercise. Everyone knows they could probably do more. But almost no one pays attention to the fine print: Consult your physician before beginning any new exercise program. The physicians at IME are here to help before you start

and do more harm than good. See if your heart, your joints, your core, your respiratory system and your circulatory system will be able to keep up with all of your good intentions.

Drink Water. You don’t need an IME physician to tell you that. Drink at least one glass to start the day. Room temperature or cold—the debate is still going on. Water helps flush toxins, hydrate tissues, jumpstart the metabolism, promote weight loss, keep you regular, boost the immune system, improve skin tone, increase energy and lessen fatigue…to name a few. How much water? Another debate. Some say five glasses a day, some say eight to 10.

Some say more. We say drink what you can and don’t overdo it.

Take A MultiVitamin. A comprehensive blood test will tell your IME physician a lot about your health. He or she may very well recommend a multivitamin.

Even the most conscientious diets can fall short every so often. A multivitamin is a sure way to bridge the gap.

According to the CDC, over 40 percent of men and women take one every day.

Your IME physician is your first line of defense—and offense—in the constant struggle to maintain good health for you and your family. Lean on us when you need to. Ask for our help when you have questions. Use us. We’re here to help you take better care of yourself.

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on ice

DEPARTMENT SPOTLIGHT

Ultrasound Kim is the Vascular Supervisor in the Ultrasound Department of the Institute of Cardiovascular Excellence and counts herself as a lucky member of a very special family. “There are eleven of us in the department and we treat ourselves and most especially our patients as one big extended family. We put ourselves in a patient’s place. We know how we’d like to be treated so that’s what we do. Dr. Qamar demands that level of commitment from each one of us and we are all an extension of him. Of course, it helps that it’s in our nature to be that way…Our department is excellent. But not all ultrasound departments are created equal. For instance, a lot of places allow just thirty minutes for an ultrasound study. Some patients, if they’re in

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a wheelchair or are in a lot of pain, that’s not enough time. We allow half again as much time— forty-five minutes per ultrasound. It makes all the difference…Our equipment is all top-notch. I’m not a machine person, but our machines are brand new. Whatever we need, Dr. Qamar sees that we get it…At the end of the day, the most rewarding thing about being a part of this family at ICE is being able to help someone. I’ve had patients come in with some pretty difficult problems. Dr. Qamar is able to operate and make them better.

And we helped. I know that’s why I was put in this place—to do this.”

“That’s why I was put in this place—to do this.”

— Kim Terrell

heart and soul Sculpture by Kelly Decaire presented to Dr. Qamar in appreciation of the medical care her husband was provided by ice

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Remember when Mom used ice to make it all better?

As adults, our health issues may be more complex, but the answer is still

put ice on it.

Ocala 4730 SW 49th Rd. Tavares 2754 Dora Ave. Summerfield 10435 SE 170th Pl. Williston 412 W. Noble Ave. The Villages 1050 Old Camp Rd. The Villages 1950 Laurel Manor Dr., Bldg 240 352.854.0681 // ocalaice.com // limbstitute.com 16 \\

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