To Your Heart: February 2012

t o your

HEART

A newsletter for friends of King’s Daughters Heart & Vascular Center

LESS IS MORE Minimally invasive heart surgery helps woman return to her life faster.

Page 2

Know the Signs of a Stroke and Seek Help Immediately.

ALSO INSIDE...

• sudden, intense headache • dizziness

• sudden weakness on one or both sides of the body • sudden loss of sight, especially in one eye • sudden difficulty speaking or understanding others • nausea • paleness or sweating • changes in vision or hearing • loss of sensation in the hands or feet

What you should know about preventing stroke | Page 4

A new approach to cardiac caths | Page 6

Vol. 3, No. 1 | February 2012

THE

MINIMAL APPROACH

Minimally invasive heart surgery means less pain, faster recovery for some patients

L

ast spring, Janet Combs’s health had reached a crisis. Her left leg hurt. Her left kidney hurt. She had no energy. She’d given up her job. She couldn’t even vacuum or wash the dishes without ending up in bed for the rest of the day.

Extreme fatigue made the Viper, Ky., resident a prisoner in her own home. At age 45, it was definitely not the life she wanted.

She was a victim of her family tree. Her father passed away of a massive heart attack at age 60. Combs had high cholesterol but couldn’t tolerate medications to lower it. Seven years previous – at the age of 38 – she’d had a cardiac catheterization and received a stent to her left anterior descending artery.

And she was a smoker.

In June last year, Combs was again in the cardiac cath lab; cardiologist Matthew Shotwell, M.D., placed additional stents in her right coronary and circumflex arteries. The left anterior descending artery also was blocked but couldn’t be stented again. Bypass surgery was needed.

She was referred to the cardiothoracic surgeons of the Kentucky Heart Institute for follow-up.

Combs had heard a lot about minimally invasive surgery and wanted to know if the surgeons could do her procedure that way. On Nov. 3, she met with cardiothoracic surgeon Eric Bronstein, M.D., who agreed she was a good candidate for minimally invasive techniques.

“There’s a lot of hype these days about minimally invasive heart surgery,” Dr. Bronstein said, “but it’s not right to lead patients to believe every surgery can be done using these approaches, or even that it is the best option in all circumstances.

“It is just one tool in the arsenal,” he said, adding, “the overriding concern has to be what is best for the patient.”

Because Combs needed just a single vessel bypass, she was a perfect candidate. Dr. Bronstein also wanted to use the da Vinci robot to assist in harvesting the artery to be used in the bypass. The da Vinci reduces trauma to the chest wall, he said.

“He described to me how he would do the surgery and how he would use the robot,” she said, “but honestly, I didn’t want to know a lot about it because it would just scare me.

“My family just can’t believe how well I’ve done.”

—Janet Combs heart surgery patient

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TO YOUR HEART

“I trusted him, and I was ready.”

On Nov. 10, Janet Combs underwent a minimally invasive bypass of the left anterior descending artery. That evening, Combs was up walking and sitting in a chair. She went home on Friday, Nov. 12. Her sister, who had come from Arizona to help in the recovery, was amazed. She expected weeks of limitation and slow progress.

“I’ve been doing great,” Combs said during an early December follow-up visit. “My family just can’t believe how well I’ve done.”

The benefit of minimally invasive surgery isn’t in the bypass itself, Dr. Bronstein said, but in reduced trauma to muscles and bones that surround the chest cavity. The surgery is performed through a series of small incisions made between the ribs on the left side and chest.

“That’s not to say there’s no pain involved,” Dr. Bronstein noted. “The space between the ribs is very sensitive. But that pain subsides more quickly than the discomfort of a healing breastbone.”

In a traditional open-heart procedure, the surgeon cuts the breastbone to gain access to the heart, then wires it closed following surgery.

“I had the surgery because I wanted to have a life,” Combs said. “I want to go back to work. I want to do something.

“I have my energy back. I’m planning for the future, instead of sitting in a chair.”

Minimally invasive heart surgery is one of many valuable tools and techniques available at King’s Daughters Medical Center, says cardiothoracic surgeon Eric Bronstein, M.D. “The most important thing for patients to know is that King’s Daughters makes all of the latest techniques and advances available to its surgeons, and to our patients, so we can deliver the most appropriate, effective and safest care,” Dr. Bronstein says.

In every circumstance, King’s Daughters heart surgeons are committed to doing the right thing for each patient. Sometimes, this means a patient will have bypass surgery performed using minimally invasive techniques, as in the case of Janet Combs.

In other cases, the patient may be best served by undergoing a

traditional procedure, he says. “We want patients to ask us about all of the available options and techniques,” Dr. Bronstein said.

“We have every tool here to tailor our care to each patient and do exactly what is best for them.”

Dr. Bronstein recently joined King’s Daughters from St. Joseph Regional Medical Center in Paterson, N.J., where he was director of the Division of Thoracic Surgery and also had served as chief of cardiothoracic surgery.

He is a member of Cardiothoracic Surgeons of Kentucky, a group that also includes surgeons Robert Fried, M.D., and JC MacHannaford, M.D. To reach Dr. Bronstein, please call his office at (606) 326-9847.

FEBRUARY 2012

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STROKE: It’s an Emergency!

STROKE SIGNS AND SYMPTOMS sudden, intense headache dizziness sudden weakness on one or both sides of the body sudden loss of sight, especially in one eye sudden difficulty speaking or understanding others nausea paleness or sweating changes in vision or hearing loss of sensation in the hands or feet CALL 911 IMMEDIATELY IF YOU EXPERIENCE ANY OF THESE

EXPERTISE IN

NEUROLOGICAL DISORDERS

Although the signs that someone is having a stroke aren’t always as clear as those of a heart attack, a stroke is a true medical emergency that must be treated immediately.

In fact, an ischemic stroke patient loses 1.9 million neurons every minute until treatment begins. For every hour that a stroke goes untreated, the brain ages 3.6 years.

Lost brain cells don’t regenerate. That’s why we say, “Time Lost is Brain Lost,” and emphasize the importance of rapid identification and quick treatment for patients with stroke.

There are two major types of stroke: ischemic stroke and hemorrhagic stroke. In an ischemic stroke, blood flow to the brain is blocked, either by a clot or narrowed arteries. In a hemorrhagic stroke, a blood vessel bursts or ruptures, cutting off the blood supply and causing a bleed in the brain. In either case rapid identification and treatment are essential! Patients who get treatment within three hours of symptom onset have the best outcomes … and the best hope to return to a normal life.

Manage your stroke risk 1. If your blood pressure is high, work with your doctor to lower it.

2. Find out if you have atrial fibrillation. A-fib increases your risk. If you have a-fib, follow your doctor’s orders regarding treatment.

3. If you smoke, stop.

4. If you drink alcohol, do so in moderation.

5. Don’t take prescription drugs for non-medical reasons. Drug abuse can lead to stroke.

6. Find out if you have high cholesterol and, if you do, work with your doctor to control it.

7. Have your blood sugar checked. If you are diabetic or pre-diabetic, follow your doctor’s recommendations to keep your blood sugar under control.

8. Include exercise in your daily routine.

9. Follow a low-sodium, low-fat diet and include more fresh fruits and vegetables.

10. Talk to your doctor about specific steps you can take to lower your stroke risk.

We’ve just released a new brochure that contains valuable information on stroke and the best doctors to see to prevent it. To receive your free copy, call 1-888-377-KDMC (5362).

R E A C H I N G

N E W

H E IGHTS

IT’S ALL IN THE WRIST:

Innovative cardiac cath procedure is

more convenient, comfortable

C

ardiologists at King’s Daughters are pioneering a new approach to cardiac catheterization.

Called transradial catheterization because doctors access the heart through the wrist, the new procedure is more comfortable, convenient and has lower risk of complications.

Several King’s Daughters cardiologists are offering the new technique to their patients, including Edward Ha, M.D., Richard Paulus, M.D., and Sriharsha Velury, M.D., said Stacy Patrick, vice president of Patient Services and chief nursing officer.

The radial technique was first developed in the 1980s, but recent advances in miniaturizing instruments and devices have made the technique more accessible for everyone.

Traditionally, cardiac catheterization has been performed through the femoral artery, which is the very large artery in the leg near the groin.

“This is a technique that has served us well for more than 20 years,” Dr. Velury said. However, it has one major drawback. “Patients have to lie on their backs for four to five hours after the procedure waiting for the artery to seal.”

This problem is solved with radial access, he said. “The radial artery seals more quickly, we can see easily if there is any bleeding, and patients can sit up in bed, eat, and visit with their

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TO YOUR HEART

“... patients can sit up in bed, eat, and visit with their families soon after the procedure is done.”

—Sriharsha Velury, M.D., on the benefits of radial access families soon after the procedure is done.”

While the radial approach offers significant benefits, it’s not for everyone, Dr. Velury said.

“Some patients have a unique anatomy in their hands and wrists,” he said, “which won’t permit radial access. Others may have vascular disease or other conditions that would prevent us from using this particular approach.

“However, for the majority of patients, radial access is not only possible, it is preferred because it reduces the risk of bleeding complications, speeds recovery and dramatically improves the patient’s experience,” Dr. Velury said.

For more information about radial access cardiac catheterization, please call the Kentucky Heart Institute at (606) 324-4745.

Kentucky Heart Institute cardiologists Edward Ha, M.D., Richard Paulus, M.D., and Sriharsha Velury, M.D., are at the forefront in radial access cardiac catheterization.

FEBRUARY 2012

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different beat.

You dance to a

You always have. But if your heart rhythm is off, it can throw your whole life out Jignesh Shah, M.D. John Van Deren, M.D. Terence Ross, M.D.

of tune. Rhythm problems — flutter, skipping, irregular beats or racing — can make it difficult for you to enjoy life the way you want. If heart rhythm problems are standing in your way, you really should see a specialist.

King’s Daughters electrophysiologists are the experts when it comes to the rhythms of the heart. They have extensive backgrounds in treating all types of cardiac rhythm problems, offer medical management and interventional procedures, graduated from top programs in the country and are board certified or board eligible.

There are effective treatments – but it takes a specialist to know what’s right for you.

For more information about our cardiac rhythm specialists, or to schedule an appointment, call us at 1.866.HEART.KY.

To Your Heart is published four times a year by King’s Daughters Medical Center, Ashland, Ky., and is mailed, free of charge, to Kentucky, Ohio and West Virginia residents.

President/CEO: Fred L. Jackson; Chief Operating Officer: Kristie Whitlatch; Vice President of Patient Services and Chief Nursing Officer: Stacy Patrick; Medical Director, Heart and Vascular Center: Richard Paulus, M.D. To contact us about To Your Heart, please call toll free 1-888-377-KDMC.

Marketing/Public Relations Staff: Carrie Bennett, Erin Bounds, Beth Caruthers, Tom Dearing, Kellie DeLaney, Kevin Herrman, Tammi Holbrook, Errin Jewell, Jerry Pennington, Keri Stewart, Obadiah Williams and Kerry Winkler.

To Your Heart is published for the purpose of disseminating health-related information for the well-being of the general public and its subscribers. The information obtained in this publication is not intended for the purpose of diagnosing or prescribing. Please consult your physician before undertaking any form of medical treatment and/or adopting any exercise program or dietary guidelines. To Your Heart is copyright 2012 by KDMC. All rights reserved. Subscriptions are free. To be included or taken off the mailing list, contact us by email at info@kdmc.net or call 1-888-377-KDMC.

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