IMPULSE: The Summer 2015 publication, a service of ICE

When it comes to your health, it’s all about seeing the

connections

contents F E AT U R I N G

We are all connected We are all simply a bundle of connections; physically, mentally and emotionally. How well we realize and embrace that truth will determine how healthy we are today and will be tomorrow.

D E PA R T M E N T S

3 from the heart

A personal message from Dr. Asad Qamar

4 ice spotlights

Meet one of our vein care specialists and learn what makes ICE Vein Care such a tremendous resource for the people of Central Florida in our Employee and Department Spotlights.

5 patient spotlight

We feature a father/son connection in our Patient Spotlight that illustrates just how important connections can be to a healthy, healing outcome.

15 the beat

New technologies and procedures give us fresh perspectives on the state of our health.

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FROM THE HEART

A PERSONAL NOTE FROM OUR FOUNDER

Making the connection This next issue of IMPULSE is an exciting examination of “connections;” the ways we are all dependent on the inter-connectivity of the systems that sustain us as well as the ways that they impact our lives.

ICE itself is a study in connection. Just as our cardiovascular system connects to our respiratory system and our muscles connect to our bones, so do the disciplines of ICE connect with one another to impact the overall health of our patients.

We offer our patients everything from Cardiovascular to Primary Care to the highly specialized discipline of Vein Care and Limb Salvage. Why? Because it is all connected.

We Are All Connected goes a little deeper into that idea by examining the ways specific connections can have an impact on our health as a whole. We look at cardiovascular health and how it connects to primary care. We also look at vein health and the particular ways it can have a surprising impact on our overall health.

“Just as our cardiovascular system connects to our respiratory system and our muscles connect to our bones, so do the disciplines of ICE connect with one another to impact the overall health of our patients.”

When you are through with this IMPULSE our goal is for you to have learned a little something about yourself, your health, and about how you are only as strong as your weakest connection.

I hope that you enjoy this issue of IMPULSE as much as we all enjoyed bringing it to you. As always, I am so grateful to the physicians and staff at ICE for helping us all make a real difference by making connections with the patients and the people in our lives.

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

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SPOTLIGHTS

P R O F I L E S O F PAT I E N T S A N D C A R E P R O V I D E R S

EMPLOYEE

TomPA-C, Tran MPAS Tom Tran brings a unique and lauded background to the special challenges associated with venous disorders. He worked his way through college and went on to become a registered nurse in the intensive care unit at Shands hospital in Gainesville.

Tran accepted positions with several emergency departments throughout Florida before capitalizing on his interest in venous health by inventing a medical device — the Transcatheter Extractor — and starting his own company to sell his device throughout the United States. “I often removed a patient’s catheter through surgery,” he says, “This device allows for less downtime for the patient and takes them out of the operating room and into the doctor’s office.”

He was named Physician Assistant of the Year for the State of Florida in 2007 and appeared in numerous articles throughout the nation. Today, Tran lends his talents and vast experience to ICE, is actively involved as a board of trustees member of the Physician Assistant Foundation and is an adjunct instructor at Nova University’s physician assistant program.

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D E PA R T M E N T

Vein Care Vein Care at ICE is a revolutionary resource for the treatment of PAD, problem veins, complications from diabetes, spider and varicose veins and the more serious vein disorders that can eventually lead to loss of a limb. For those in dire need, the numbers are frightening: almost one of every 200 Americans has suffered an amputation—about 97% of those to a lower limb. The real tragedy? Many of those losses could have been avoided with swift and adequate intervention. ICE Vein Care was created to do exactly that. ICE combines all of the myriad specialties involved with reversing the declining health of an arm or leg and matches them with the technology, facilities and staff necessary to get the job done.

Examination rooms, labs, testing and treatment facilities plus, medical professionals hand-selected for their skills and dedication. All of it is focused on the singular mission to treat and manage peripheral vascular diagnoses. ICE will do whatever it takes to save a limb and give a patient their life back.

PAT I E N T

Michael Rice (Sr. and Jr.) The Rice family was reeling from a tragedy that took one of their members much too soon; Michael Rice Jr. lost his daughter—Michael Rice, Sr. his grand– daughter. Just then Michael Sr., who was a diabetic, began having trouble with his legs and Michael Jr. began experiencing unexplained blackouts. Something had to be done and ICE was that something. After Dad had stents put in both legs correcting his circulation problems, he urged Michael to go to ICE about the blackouts. A series of tests revealed that Michael needed a pacemaker and with that fix, both broken hearts in this family could again focus on mending.

“If not for my dad’s insistence on Dr. Qamar I might not be here today. He insists Dr. Qamar saved his legs and my life and I agree.”

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H E A R T- H E A LT H Y R E C I P E S

DISHES SO GOOD AND SO GOOD FOR YOU!

NUTRIENT INFORMATION

Linguine

1 cup of each per serving Serves 4

• 8 oz dried whole-grain linguine • 1 tsp olive oil

• 1/2 of a small red onion, thinly sliced • 1 small zucchini, halved, thinly sliced crosswise

• 1 small yellow summer squash, halved, thinly sliced crosswise • 2 tbsp water

• 1/4 tsp pepper

• One 15.5-oz no-salt-added cannellini beans, rinsed and drained

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• 1 large tomato, chopped

• 2 tbsp chopped fresh basil • 2 tbsp balsamic vinegar • 1/4 tbsp salt

• 1/4 cup shredded or grated Parmesan sauce

DIRECTIONS

1. Prepare the pasta using the package directions, omitting the salt. Drain well in a colander.

2. Meanwhile, in a large nonstick skillet, heat the oil over medium heat, swirling to coat the bottom. Cook the onion for 3 to 4 minutes, or until tender-crisp.

3. Stir in the squashes, water, and pepper. Cook for 6 to 8 minutes, or until the squashes are tender-crisp, stirring occasionally.

4. Stir in the beans, tomato, basil, and vinegar. Cook for 3 minutes, or until heated through, stirring occasionally.

Stir in the salt.

5. Serve the bean mixture over the pasta.

Sprinkle with the Parmesan.

Dietary Exchanges 4 starch, 1 vegetable, 1 very lean meat

the American Heart Association’s Simple Cooking with Heart ® Program.

INGREDIENTS

Calories 346 Total Fat 5.0g Saturated Fat 1.0g Trans Fat 0.0g Polyunsaturated Fat 1.0g Monounsaturated Fat 2.0g Cholesterol 4mg Sodium 272mg Carbohydrates 62g Fiber 12g Protein 15g

Recipe copyright © 2015 American Heart Association. This recipe is brought to you by

with Cannellini Beans and Summer Squash

Fruit Salad with Lemon-Mint Yogurt Dressing INGREDIENTS

DIRECTIONS

Dressing

1. In a small bowl, whisk together the dressing ingredients.

• 1/2 cup fat-free vanilla yogurt • 1 tbsp chopped fresh mint • 1 tsp honey • 1/2 tsp grated lemon zest • 1 tbsp fresh lemon juice Salad

• 1/2 cup cantaloupe balls • 1/2 cup blackberries • 1/2 cup raspberries • 1/2 cup fresh or canned pineapple chunks, packed in their own juice, drained (fresh preferred) • 4 sprigs of fresh mint (optional)

2. In a medium bowl, gently stir together the salad ingredients except the mint, being careful not to crush the berries. Spoon onto small plates and drizzle with the dressing. Garnish with the mint sprigs if so desired.

NUTRIENT INFORMATION

1/2 cup per serving Serves 4 Calories 66 Total Fat 0.5g Saturated Fat 0.0g Trans Fat 0.0g Polyunsaturated Fat 0.0g Monounsaturated Fat 0.0g Cholesterol 1mg Sodium 26mg Carbohydrates 15g Fiber 3g Protein 2g

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It’s all

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con nec ted

Connections abound in the world around us.

Not only in our relationships with one another but in the very real connections that we have within ourselves.

Our entire physical, emotional and many would say spiritual wellbeing is connected to the systems and the health of those systems that comprise our physical bodies.

Philosophers and quantum physicists make a point of saying “everything in the world is connected.” Spiritualists maintain “we are all one” and poets have been writing about our “connectedness” forever. ¶ ICE was founded upon a vision of connection— linking the importance of patient-centered, compassionate care with the state-of-theart technologies that continue to define medical science today. ICE recognizes those connections and actively manages them to maintain the overall health of its patients.

The Hip Bone’s Connected to the Thigh Bone….

Like the old song says, physically we are all a series of connections. So much so that the very real connections between our health and the various physical systems within our bodies are obvious.

We are comprised of many discrete systems that have evolved to work together to keep us alive: Cardiovascular and Respiratory…Digestive and Excretory…Endocrine and Immune…Skin and Nervous System…Skeletal and Muscular.

Our lungs provide the oxygen our circulatory system must have… Our muscles and skeleton work together to expand and contract the lungs so they can do their job…

Our heart powers the

oxygen-enriched blood throughout the body to carry nutrients and life-sustaining cells…Our digestive system extracts the nutrients from our food that all our other systems need to sustain them...And controlling everything is our brain, sending and receiving messages all along your nervous system….

All of the disciplines represented within ICE— Cardiovascular, Primary Care, Vein Care—are as interconnected as the systems of the body to provide a more complete approach to patient health.

A patient being treated for vein disease may really need the help so they can walk—to strengthen their heart. A cardiovascular patient may be having trouble with their weight—enter nutrition

counseling from primary care. A routine check-up in one of our family care offices may uncover a patient’s concerns about a sudden shortness of breath—which would prompt a visit with our cardiovascular team.

ICE provides the connections that help maintain a patient’s health, of course. But ICE is also deeply embedded within the community, connecting regularly with charities and citizens’ groups to keep the community healthy. Finally, ICE is tightly connected to the medical community itself; keeping tabs on the rising stars, the emerging trends, and the latest technologies to keep providing the superior level of care it has become known for.

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The Cardiovascular Connection

THE HEART BRAIN

Dr. Qamar founded ICE in 2009 with a single location and a nurse practitioner and cardiovascular as its principle discipline. The cardiovascular connection to overall health is obvious. The heart pumps blood. Blood travels arteries and veins throughout the body. Without the oxygen and nutrients borne along by the circulatory system, the body couldn’t function—practically, the very definition of connectiveness.

But Dr. Qamar made another important connection at ICE when he put the two sides of heart health together. The physical side—the hard-working, pumping machine connected to arteries and veins. And the emotional side—the compassionate heart that helps put patients at ease and speed recovery. Cardiovascular health is much more than providing a high level of medical competence and the latest machines and procedures.

It's an acknowledgement that a healthy heart is key to our overall physical and emotional wellbeing.

That’s why patients who sometimes come for a seemingly non-heart related problem will have their entire cardiovascular system examined—healthy veins and arteries are critical to overall heart health.

And finally, why the staff at ICE from Dr. Qamar to the receptionist take great pride in providing a level of compassion and comfort that is so welcoming, many patients describe it as feeling more like a visit to an old friend than a doctor's office.

For centuries, the heart was considered to be the center of our thinking, feeling world. It was the source for all emotion, courage, and wisdom.

Love was said to originate in the heart and countless sonnets were written to and about the fickle organ. Can it be that science is finally proving what centuries of poets and lovers have known all along?

In 1991, Dr. J. Andrew Armour introduced the idea of a “heart brain.” Dr. Armour, an early pioneer in neurocardiology, came to the rather startling conclusion after extensive research that the heart has its own, complex network of neurons, neurotransmitters, proteins and support cells—similar to but separate from the brain.

What’s more, in the book Neurocardiology edited by Dr. Armour and Dr. Ardell, the doctor draws even closer parallels between the brain and heart. The heart’s “little brain” has such an elaborate network— over 40,000 neurons strong—that it can act independently of the brain itself to “learn, remember, and even feel and sense.”

The Primary Care Connection There is an undeniable connection between a healthy cardiovascular system and keeping it healthy through adequate nutrition, avoiding illness and disease, maintaining a healthy outlook and keeping to a schedule of regular check-ups with physicians trained to do all of that. ICE makes that connection real with its staff and facilities devoted exclusively Primary Care and Family Practice.

The original compassionate, patient-centered approach to care that ICE was founded upon applies perfectly to family practice.

So, ICE established its family practice connection for patients as a complement to its cardiovascular services.

ICE physicians and staff trained specifically for primary care serve as the first line of defense for patients in need of regular checkups and medical services— everything ranging from common bumps and bruises to more serious ailments and illnesses.

THE MIND/BODY CONNECTION

A family practice is the ideal place to intervene and head off lifestyle habits that could be sabotaging overall health like smoking, poor eating and little to no exercise.

The National Institutes of Mental Health (NIMH) tells us “up to 65 percent of coronary heart disease patients with a history of heart attack experience various forms of depression. Though such emotions are not unusual, they should be addressed as quickly as possible.

Major depression can complicate the recovery process…. Prolonged depression in patients with cardiovascular disease has been shown to contribute to subsequent heart attacks and strokes.”

On the positive side, according to the Cleveland Clinic, the mind/body connection is so strong there are mind-body exercises that have been proven conclusively to improve health. The key

is the mind’s inability to distinguish between something imagined and something real. When we remember something frightening, heart rates go up and the palms sweat as if we were really in that situation. But, imagine something pleasant, calming, soothing—and heart rates go down, stress hormones dissipate and we experience peace.

Exercise those thought processes, cultivate periods of calm and inner peace and the body will respond by reducing pain and anxiety, enhancing sleep, decreasing the need for pain meds after surgery, reducing recovery times and actually shortening hospital stays.

Even stress. Life today can be a never-ending pressure cooker, with stress at home, on the job and other areas raising blood pressures and creating circulation problems.

According to the American Psychological Association, “how you respond to stress may be a greater risk factor for heart problems than smoking, high blood pressure, and

high cholesterol.”

Regular visits with a primary care physician can recognize those dangers before they get too serious and give patients the time and tools to correct them.

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The Venous Connection ICE made the connection between vein health and overall health as a natural outgrowth of its cardiovascular focus.

Not only do healthy veins play a vital role in the efficiency of the circulatory system as a whole. But veins that are unhealthy—which often occurs in the legs—can lead to significant health concerns for the entire body.

Even more significantly, they can lead to serious problems like venous eczema, blood clots, skin ulceration, much more serious vein diseases, and in rare instances, skin cancers.

ICE has designated examination rooms, labs, testing and treatment facilities, and a team of medical professionals dedicated to treating venous diseases and abnormalities. Many

More than 25 million Americans suffer from some form of venous disorder.

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The most common vein disorders are spider veins and varicose veins. Spider veins most often appear in the face or legs as a tiny web of red or black threads.

They cause cosmetic concerns but spider veins are almost never a serious health issue.

Varicose veins are a different story. At the benign end of the scale, they cause no problems other than in appearance. But if left untreated, varicose veins can be a constant source of discomfort.

patients come to ICE with venous complications due to diabetes. The rise of that insidious disease is directly related to the growing epidemic of limb loss in America. Studies show that almost one of every two hundred Americans has had an amputation—97% of those in a lower limb. What is tragic is that many of those amputations could have been averted with the types of treatment ICE Vein Care can provide.

VEIN DISEASES Chronic venous insufficiency (CVI) is a condition often associated with varicose veins. According to the Vascular Disease Foundation, upwards of 20 percent of adults suffer from it. Vein blockages, damaged vein walls or valves in the veins that aren’t doing their jobs properly can all cause CVI. Blood pools. Skin becomes discolored.

Skin ulcers can form. CVI can degrade the immune system to such an extent that the risks of heart disease, diabetes, stroke, and obesity more than double.

Worse than that, CVI can also cause DVTs to form—deep vein thrombosis—a disease that creates blood clots in the large veins of the legs. DVTs can cause everything from severe discomfort and chronic weakness in the legs—to death. If a piece of a clot were to break off and travel to the brain or lungs it could mean a stroke or a pulmonary embolism. Over 300,000 American die every year from those—and the contributing factor in most cases? Vein disease.

So, How Connected Are You? The short answer is, very. We’ve learned about many of those connections. From the systems in our bodies… to the ways they impact our overall health… to how what we do can have a major effect on all of it. But perhaps the most important connection we can make today is the one that links our health directly to the facilities and physicians of ICE. Why? Because of the connections within the ICE disciplines of cardiovascular, primary care and vein health. No matter where we first involve ICE with our health concerns—chest pains, stubborn flu, swollen legs and ankles, whatever the problem may be—ICE has the resources to treat both our specific health issues and our overall health at the same time.

TA K I N G T H E M E A S U R E O F PA D

Doctors at ICE discover a correlation between “skinny legs” and PAD and develop an alternative screening method to x-rays that is just as accurate—a measuring tape!

Tissue Loss in PAD Patients Presenting for PTA

Taha Baig: Orlando, Florida // Asad Qamar and Abbas Ali: Ocala, Florida ICE

I N T E G R AT I V E MEDICINE The days of tightly focused care to treat a patient’s ills—e.g. heart attack, stroke, migraines, leg pain— without considering the patient’s health as an inter-connected whole are ending. There’s even a name for it: Integrative Medicine.

Medical schools are offering courses in it.

Hospitals are offering new services to their patients to support it.

Doctors are widening their treatment protocols to take advantage of it. Now, treatment for a patient who suffers a heart attack may also include sessions with a nutritionist to insure a healthier diet...Antidepressants prescribed early on to combat a common side-effect of serious heart problems...

Stress-reduction techniques to promote healing...Herbal medicine...

Exercise recommendations like yoga or tai-chi.

The key is connection and acknowledging that treating a person as a whole instead of focusing on a singular acute or chronic condition can affect a person’s overall health.

Background At ICE, serving 25,000 patients across 10 counties in Central Florida, patients who underwent peripheral interventions (PTA) presented tissue loss. Peripheral Arterial Disease (PAD) has significant mortality and morbidity. Diagnosis is important to assess for further complications. In our studies patients with skinnier legs had severe bilateral PAD. Currently PAD is assessed initially with ABI but this method is inaccurate in diabetics. We investigate a simpler physical exam method to assess PAD with a measuring tape.

Methods From patients undergoing PTA, 60 had usable images for analysis. Initial x-rays of maximum soft tissue in pixels were converted to cm and analyzed, calibrated against catheter of known size. Image J software was used for analysis. Patients with severe bilateral PAD had tissue loss of 9-11cm compared to cath lab staff volunteers. To verify the accuracy of these measurements, patients with both x-ray and tape measures were analyzed against controls. Amongst subjects with Xray and tape measurement available, regression analysis showed a very close correlation between circumference measured by either technique.

Results

Conclusion Patients who presented for PTA to ICE had a significant tissue loss of 11cm on x-ray in comparison to staff volunteers; 4.5cm on tape measurement in comparison with controls. Our data suggests people with an increased risk of PAD can be effectively screened by a simple tape measurement and recommend taking maximum calf circumference of at risk patients, with <34cm as abnormal.

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the beat T H E L A T E S T T I P S , T I D B I T S A N D T E C H I N H E A LT H C A R E

A surgical team in the Netherlands fitted a 22-year-old woman with a plastic, tailor-made skull printed from a 3-D printer. “We used to create an implant by hand in the operating theater using a kind of cement, but those implants did not have a very good fit. Now we can use 3D printing to ensure that these components are an exact fit. This has major advantages, not only cosmetically, but also because patients often have better brain function compared with the old method.” source: Dr. Bon Verweij, Leader of the team at University Medical Center in Utrecht

Chemo is so yesterday

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Latest news on the cancer-fighting front is immunotherapy — harnessing the body’s own immune system to fight the disease. “It’s not an overstatement to say this is a turning point in cancer research, especially for patients with melanoma,” says J. Leonard Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society. “Treatments for cancers of the kidney, lung and pancreas could be up next.”

How pregnant are you?

A brain defibrillator

The NeuroPace RNS® system includes sensors implanted in the brain that can spot a seizure coming on and zap it before it happens — great news for the 840,000 epileptics who suffer uncontrollable seizures. source: www.neuropace.com

Clearblue has developed a better pregnancy test that not only provides a “Yes or No?” answer, but estimates how far along you are.

An Apple a day Doing current fitness trackers a giant one better, the Apple Watch — with your iPhone — logs your steps, your heart rate, and other health markers, to put a whole lot of health power on your wrist.

Image: Hadrian / Shutterstock.com

Image: Matthew Mientka

Skull printed on a 3D printer

St Vincent’s heart photo via twitter @MarkWBurrows

Finally a Hep C Cure — no really.

Hepatitis C kills 15,000 Americans a year.

Treatment up to now helped a mere 30 to 40% of those infected with the disease. But today, a pill — FDA-approved Sovaldi (sofosbuvir) — cures up to 90% of Hep C patients when combined with another new drug, Simeprevir.

“Before, it was like fighting a war with flyswatters, but now the big guns have arrived.” source: Douglas Dieterich, MD, Professor of medicine in the division of liver disease at Mount Sinai Hospital, NY

by the numbers SOMEONE IN THE U.S. DIES FROM HEART DISEASE ONCE EVERY

90 40

Calling Dr Frankenstein!

First transplants of dead

85.6 million

Zap your migrane!

seconds

SOMEONE IN THE U.S. HAS A STROKE ABOUT ONCE EVERY

seconds

AMERICANS ARE LIVING WITH SOME FORM OF CARDIOVASCULAR DISEASE OR THE AFTER-EFFECTS OF STROKE

27 percent OF ALL CANCER

hearts into living patients

A team of Australian scientists was able to revive dead hearts from cadavers and successfully transplant them into patients. The hearts had stopped beating for about twenty minutes when they were treated in an oxygen perfusion machine and injected with a perservative to keep them “fresh.”

Cefaly is a prescription device approved by the FDA that prevents migraines. It attaches to the forehead where an electrode delivers precise impulses to the trigeminal nerve. source and image: www.cefaly.us

DEATHS ARE ATTRIBUTED TO LUNG CANCER It’s by far the leading cause of cancer death among both men and women.

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Tavares

Ocala

Williston

Summerfield

The Villages

CARDIOLOGY PRIMARY CARE VEIN CARE LIMB SALVAGE PHONE 352.854.0681 FAX 352.854.8031 OCALA 4730 SW 49th Rd OCALA 3515 SE 17th St Ste 100 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

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