Tools | education | resources for a healthier you!
Vascular Vitality Summer 2011
and risk of stroke PAGE 11
Are you at risk?
ATTENTION BABY BOOMERS:
What you need to know about vascular health PAGE 2
Peripheral Vascular Disease PAGE 4
The ABCs of
Aortic Aneurysms PAGE 9 A Publication of Cooper University Hospital Division of Vascular and Endovascular Surgery
Vascular Vitality A Publication of Cooper University Hospital Division of Vascular and Endovascular Surgery Joseph V. Lombardi, MD, FACS Head, Division of Vascular Surgery Director, Acute Aortic Treatment Center Director, Vascular Surgery Fellowship Jeffrey P. Carpenter, MD Professor and Chief, Department of Surgery Vice President for Perioperative Services, Cooper Health System James B. Alexander, MD, FACS Associate Professor of Surgery/ Vascular Surgery Jose L. Trani, MD Vascular Surgeon Associate Director, Vascular Surgery Fellowship
We believe that education is the key to better health, not only in treatment but in prevention and awareness. We have developed this publication as a tool for education
with articles devoted to your vascular health, information about diseases that affect the vascular system and the latest in treatments. It is our hope that you will read this publication, save it for future reference, and share it with friends and family. Communication with your primary care provider is vital to maintaining the health of your vascular system. Risk factors such as tobacco use, high blood pressure, diabetes, high cholesterol and a family history of vascular disease can significantly increase your risk. Talk to your doctor about screenings for abdominal aortic aneurysm, carotid artery disease and peripheral vascular disease—these simple, non-invasive screenings can be life saving. In good health,
Catherine Cristofalo, APN-C Amy Ward, APN-C Cooper Vascular Surgery CooperHealth.org 800.8.COOPER – 800.826.6737 Appointments: 856.342.2151 Locations: • Camden • Marlton • Voorhees • Washington Township • Willingboro Contributing writers: Tami Tobin Bloom Christine Wilkinson, MS, RD, LDN Art Director: Michelle Helfrich MH Design Company, LLC Cherry Hill, NJ
Joseph V. Lombardi, MD, FACS Head, Division of Vascular Surgery Director, Acute Aortic Treatment Center
Tools | education | resources for a healthier you!
Table of Contents Attention Baby Boomers: What You Need to Know about Vascular Health................................. 2
Peripheral Vascular Disease................................................ 4
Your Veins: Not Only a Matter of Being Vain....................... 6
The ABCs of Aortic Aneurysms............................................ 9
Vascular Screening & Testing: What to Expect................... 10
Concerning Your Carotid Artery........................................ 11
Nutrition Tips for Vascular Health..................................... 12
Recipe: Crustless Smoked Turkey & Spinach Quiche.......... 13
Recipe: Quinoa and Black Bean Salad............................... 14
Crossword Puzzle............................................................. 16
Attention Baby Boomers What You Need to Know about Vascular Health You probably don’t think about it much, but if you are over 55, your vascular system – the complex system of arteries and veins that carry oxygen-rich blood to and from your legs, brain and other vital organs – may be in need of some attention. Over time, these passages can narrow and thicken with fatty deposits called plaque, restricting or slowing blood flow. When the blood supply is reduced to vital areas, tissue damage, organ function, stroke and even death can occur. By 2015, the U.S. Census reports an expected 87 million people aged 55 and older will be stricken with some form of vascular disease, and this number is expected to continue to rise. “Maintaining a healthy vascular system is vital to the health of the over 55 population,” said Jeffrey P. Carpenter, MD, Professor and Chief, Department of Surgery; Vice President for Perioperative Services at Cooper University Hospital. “Aside from prevention, early diagnosis and proper treatment is the best course for vascular disease,” Dr. Carpenter explains. Public awareness of vascular disease heightens when a celebrity or public figure is struck down by a vascular event. The sudden death of U.S. diplomat Richard C. Holbrooke in December of 2010 sparked a flurry of interest in Aortic Dissection, which took Holbrooke’s life at the age of 69. Similar cases also claimed the lives of both Lucille Ball and John Ritter in recent years. Aortic Dissection, a tear in the inner layer of the aorta caused by hypertension, can occur suddenly without warning. CooperHealth.org 2
Vascular disease may not have any obvious symptoms in its early stages. If untreated, vascular disease can be life-altering. While vascular disease is more prevalent in males with a family history of the disease, the risk increases with age in both males and females. Talk to your primary care provider about your risk factors, how to keep your cholesterol and blood pressure levels within a healthy range, and whether you are a candidate for a vascular screening. Non-invasive, painless ultrasound tests can easily detect narrowing or blockages in the vascular system, allowing for accurate diagnosis and early treatment that can ultimately save your life. Once problems are detected, a vascular surgeon can treat these diseases. In many cases, minimally invasive endovascular procedures may be available. These catheter-based methods can be completed under local anesthesia, with most patients going home the same day as an outpatient or with an overnight stay required.
• Thoracic Aortic Aneurysm – a bulging, weakened area in the wall of the aorta, located in the chest. • Thoracic Aortic Dissection – a tear in the inner layer of the aorta, causing a ballooning of the aortic wall which can result in a rupture with lack of blood flow to vital organs. • Carotid Arterial Disease – also called Carotid Artery Stenosis, occurs when the carotid arteries, the main blood vessels that carry oxygenated blood to the brain, become narrowed. Carotid Artery Disease is responsible for 40 percent of all strokes. • Peripheral Vascular Disease – a slow and progressive circulation disorder that can involve disease in any of the blood vessels outside of the heart, and diseases of the arteries, veins, or lymphatic vessels, potentially causing inadequate blood flow to the brain, heart and legs. While the impact of vascular disease can be significant, you can take control of your vascular health.
Common diseases of the vascular system include: • Abdominal Aortic Aneurysm – abnormal enlargement of the abdominal aorta, located in the belly.
“Controlling or modifying preventable risk factors can significantly reduce your chances of developing vascular disease. Talk to your primary care physician about your risk factors and screening for vascular disease,” Dr. Carpenter advises.
“Risk factor awareness and clear communication with your primary care physician is the first line of defense in taking charge of your vascular health.” Jeffrey P. Carpenter, MD Professor and Chief, Department of Surgery Vice President for Perioperative Services Cooper University Hospital
Peripheral Vascular Disease
Peripheral Vascular Disease (PVD), sometimes called Peripheral Arterial Disease (PAD), impacts over ten million adults in the United States. This common and sometimes silent and dangerous condition affects the blood vessels outside of the heart and brain. Peripheral Vascular Disease is associated with poor circulation or “hardening of the arteries” and can lead to a significant increased risk of stroke or heart attack. When arteries that supply blood to the internal organs, arms and legs become blocked by plaque or fatty deposits, the flow of blood is slowed or stopped.
circulation or “hardening of the artery” is called atherosclerosis. Build-up of plaque causes the walls to narrow and decrease the body’s ability to effectively distribute oxygen. This can impact different organs and can lead to heart attack, stroke and limb pain, non-healing ulcers or even limb amputation,” explains Jose L. Trani, MD, Vascular Surgeon from the Division of Vascular and Endovascular Surgery at Cooper University Hospital. Peripheral Vascular Disease is most common in people over 50 and is seen more in men than women.
For many, symptoms of PVD can be cramping leg muscles during walking called intermittent claudication. In some cases, cramping may not be present, but a feeling of numbness or weakness might be a tell-tale sign of the presence of PVD. In patients whose PVD is more severe, insufficient blood flow to the legs may cause pain while resting, typically at night while lying down. When PVD is left untreated, the most advanced stages of the disease can lead to Critical Limb Ischemia. This level of severe artery blockage prohibits oxygen to flow to the limbs, and can lead to gangrene (tissue death) and may often require amputation.
Risk factors include: • Smoking • Age/Gender PVD affects both men and women, but those 50 years or older are at greater risk to develop PVD. • History of Heart Disease A family history of heart disease plays a significant role in developing PVD. • Diabetes Individuals with diabetes are at a greater risk for developing PVD. These patients are 10 times more likely to undergo amputation.
“Blocked arteries are caused by a build-up of plaque that attaches to the arterial walls. This decrease of
• High Blood Pressure The lining of the artery walls become damaged with high blood pressure. 4
Speak with your physician about your risk factors for Peripheral Vascular Disease and any symptoms you may be experiencing.
• Angiography is the most accurate test to detect the location and severity of the blockage. Catheters are inserted into the groin with a contrast dye injection.
Treatment options for PVD can vary by patient. Medications and lifestyle changes can sometimes manage PVD. If PVD is not well-controlled, your physician may suggest visiting a vascular surgeon to evaluate your specific case and the need for a surgical procedure to restore proper blood flow.
“Once identified, treatments for peripheral vascular disease can include lifestyle changes, medications, open surgery, balloon angioplasty and/or stent placement,” explains Dr. Trani. We would advise patients to stop smoking, maintain a healthy diet to lower cholesterol and monitor blood pressure and diabetes, and to speak with their vascular surgeon about steps to take to maintain a healthy vascular system to prevent small problems from becoming larger, life or limb- threatening ones,” advises Dr. Trani.
There are several different types of diagnostic tools to diagnose PVD. • Duplex ultrasound uses a Doppler probe on the skin over the arteries to locate the site of arterial stenosis or narrowing and to measure the amount of blockage. • CT Scan/MRI imaging is a non-invasive way of seeing the blood vessels and determining the amount of blockage.
Are You At Risk for Peripheral Vascular Disease? 1. Are you over the age of 50? 2. Do you smoke?
3. Do you have a family history of cardiovascular issues or diabetes? Yes
4. Are you more than 25 pounds overweight?
5. Do you have aching, cramping or pain in the legs while you walk or exercise? 6. Do you have tingling, numbness or coldness in your hands or feet?
If you answered yes to 3 or more of these questions, you may be at risk for Peripheral Vascular Disease. Speak with your physician about screening for Peripheral Vascular Disease.
“Pay close attention to symptoms like leg cramping or leg numbness when walking – these can be indicators of insufficient blood supply and should be evaluated by a physician.”
Jose L. Trani, MD Vascular Surgeon Cooper University Hospital
Your Veins Not Just a Matter of Being Vain The web of veins lying under your skin provides vital circulation flow and nutrients to your entire body. The three categories of veins include: superficial, veins lying closest to your skin; deep veins, which lie within groups of muscles leading to your body’s largest vein, the vena cava; and perforating veins, which connect the superficial veins to the deep veins. The most pronounced and cosmetically troublesome veins are called varicose, which can be seen through the skin. Varicose veins appear as blue, twisted and bulging and can sometimes be painful. These veins are not only a cosmetic concern, they can impact the quality of day-to-day life. Varicose veins are the result of reflux, resulting from weak or damaged vein valves, which open as blood flows to the heart and shut to stop blood from flowing backward. Blood pools in the veins causing enlargement and visibility through the skin. Varicose veins – and their less conspicuous variety, spider veins – can become painful and contribute to leg fatigue and restlessness. Left untreated, varicose veins can cause inflammation, ulcers, skin rashes, redness and itching. “Treating your varicose veins cannot only improve your appearance, it can relieve mounting symptoms and avoid future complications. Minimallyinvasive treatment options can wipe out the varicose vein problems quickly and efficiently,” explains James B. Alexander, MD, FACS, Associate Professor of Surgery/Vascular Surgery at Cooper University Hospital. Though both men and women are vulnerable to developing varicose and spider
QUICK TIPS! veins, women are four times more likely to get them. While there are things you can do to lessen your chance of developing varicose veins, certain factors contribute to the susceptibility, such as, multiple pregnancies, obesity, heredity, sedentary lifestyle, hormones and aging.
• Maintain a low-sodium/high-fiber diet • Exercise regularly • Avoid sitting with your legs crossed at the knees • Avoid standing or sitting for long periods of time, or wearing tight garments that inhibit circulation
“Varicose veins are commonly seen as people age. Veins have a tendency to lose elasticity, causing them to enlarge and become varicose. We also see varicose veins appear during pregnancy, when blood volume increases, causing circulation changes,” says Dr. Alexander.
will fade. Multiple injections may be needed to treat the vein, depending on its size and location. Recovery is approximately five days.
If you are one of the 40 million people in the United States with troublesome varicose veins, there are minimally invasive and effective treatments to solve the problem. A painless and non-invasive ultrasound test is the best way to get an accurate diagnosis of reflux. Vascular surgeons from the Cooper Vein Center will discuss the best course of treatment for your individual needs. In some cases, a combination of procedures will deliver the best results.
Phelebectomy is used when larger veins become swollen and inflamed. Physicians remove individual vein clusters from the leg through a series of small incisions. This minimally-invasive procedure is done under local anesthesia using micro-instruments and magnification. No stitches are required and patients are typically back on their feet immediately.
Several options are available for the removal of your varicose veins, and all are minimally invasive and performed in Cooper’s out-patient offices. Most patients are back on their feet in as little as a day or two, and can resume normal activities within a week.
Compression stockings may also be suggested to support the veins to prevent swelling and stopping the blood from flowing backward.
Radiofrequency Ablation (RFA) delivers heat to the vein wall, shrinking and sealing off the abnormal vein. RFA requires no incisions and is performed under local anesthesia and with ultrasound.
TIPS TO PREVENT OR Lessen varicose veins
Watch your weight and your diet. Maintain a lowsodium/ high-fiber diet. You can increase your daily fiber through whole grains, fresh
Endovenous Laser Therapy (EVLT) uses ultrasound guidance of laser energy to collapse and seal off the damaged vein. No surgical incisions are made. Sclerotherapy is a non-surgical procedure injecting a solution directly into the vein. Over time, the vein
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Talk with your physician. Always speak with your physician before making any lifestyle changes like diet and exercise. Your physician will discuss how best to approach incorporating these tips into your life.
fruits and vegetables. Also, be sure to include your recommended allowance of vitamins and minerals.
The Cooper Vein Center has vascular surgeons at five convenient locations – Camden, Marlton, Willingboro, Voorhees and Washington Township – to assess and treat your varicose veins. The staff at Cooper Vein Center will provide appropriate documentation to submit to your health insurer.
Exercise regularly. Incorporate more exercise and activities into your day and you will not only boost your circulation and lessen the chance of developing varicose veins, but your overall health will improve. Watch how you sit & stand. Avoid sitting with your legs crossed at the knees, standing or sitting for long periods of time, or wearing tight garments that inhibit circulation. For more information on treatments available for varicose or spider veins, or to schedule a consultation to explore which procedure might be right for you, call 856.342.2151.
“While you cannot control some of the factors contributing to varicose veins, there are some things that can be done to lessen the problem.”
James B. Alexander, MD, FACS Associate Professor of Surgery/Vascular Surgery Cooper University Hospital
The ABCs of Aortic Aneurysms the lower part of your body and a ruptured aneurysm in this location can cause life-threatening bleeding. An abdominal aortic aneurysm may not produce symptoms and can be discovered accidentally through ultrasound or CT scans when looking for other conditions. Sometimes they can be detected by physical exam revealing an abnormal prominent pulse in the abdomen. When symptoms do appear, they can be abdominal and back pain.
An aneurysm is a weakened area of a blood vessel that expands or bulges. Many aneurysms occur in the aorta, the main artery moving blood from your heart to the rest of the body. Most aneurysms are caused by arteriosclerosis, or “hardening of the arteries” which weakens the aortic wall, while others can be the result of genetics or trauma. When an aneurysm expands to the point of rupture, severe internal bleeding can occur. If a ruptured aneurysm is not discovered and treated quickly, a patient may not survive.
• Thoracic Aortic Aneurysms (TAA) are a bulging, weakened area in the wall of the aorta which can rupture or dissect, potentially causing life-threatening bleeding. Many people with thoracic aortic aneurysms do not notice symptoms until there is a rupture, when chest or back pain may occur.
Aortic aneurysms are most common in men over 60. Also, women with risk factors have an elevated chance of developing an aneurysm. Cigarette smoking, diabetes, high blood pressure and high cholesterol all contribute to the chances of developing a life-threatening aneurysm.
• Thoracic Aortic Dissection (TAD) is a tear causing a ballooning of the aortic wall which can rupture. An aortic dissection can be life-
There are several types of aortic aneurysms: • Abdominal Aortic Aneurysms (AAA) are located in the abdomen. The abdominal aorta supplies blood to
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Star basketball player for Camden High School, Kevin Walls graduated in 1984 and was recruited to play for the University of Louisville Cardinals. In excellent condition, having only suffered a knee injury, Kevin was shocked to hear from his doctor that he had a life-threatening tear in his aorta. Kevin was rushed to Cooper University Hospital, where Joseph V. Lombardi, MD, Director of the Cooper Aortic Center, explained Kevin’s condition as an aortic dissection and the need for surgery to make the repair. With new, minimally-invasive endovascular techniques, surgery could be performed by accessing the aorta through a small incision in the leg. Today, Kevin is back on the court thanks to Dr. Lombardi and the endovascular repair that saved his life. 9
Vascular Screening & Testing What to Expect
Vascular disease is one of the leading causes of death in the United States. Untreated vascular disease can have life-threatening consequences if left undetected and untreated. There are often no warning signs or symptoms associated with certain vascular diseases.
lar Surgery at Cooper University Hospital. Individuals included in this category are: • 55 years of age or older • History of hypertension (high blood pressure) • History of diabetes mellitus • Current or former smoker • History of high cholesterol, heart disease or stroke • Family history of aortic aneurysms
“Screening for vascular disease includes non-invasive tests that can detect narrowing or blockages in the vascular system as well as weakening of the arterial “Early detection of vascular disease is critical. We wall, otherwise known as aneurysms. The screening for recommend vascular screening tests for patients consid- vascular disease is non-invasive and highly accurate, ered to be at increased risk for vascular disease, explains allowing for early diagnosis and treatment,” explains Catherine Cristofalo, APN-C, an Advanced Practice Cristofalo. Nurse with the Division of Vascular and Endovascu-
How do I get a screening? Your Physician: Talk to your physician about your risk factors. Your physician can recommend the best course to take for your individual situation and refer you for a general screening or a specific study. Health Fairs: Community health fairs offer a wide range of health services and screenings. Limited vascular screenings may be offered at this type of event. Medicare Program: Medicare recipients may be entitled to a one-time screening to detect Abdominal Aortic Aneurysm (AAA) as part of the “Welcome to Medicare” physical exam. Note: The physical exam and the screening referral must fall within the first twelve months you have Medicare Part B. The ultrasound exam does not need to be within that timeframe. People with Medicare who meet the following criteria may be eligible: Participants must get a referral for an ultrasound screening from a physician or other qualified non-physician practitioner as a result of their “Welcome to Medicare” physical exam. Participant has never had an AAA ultrasound screening paid for by Medicare. Participant has at least one of the following risk factors: – a family history of Abdominal Aortic Aneurysm (AAA) – .is a man aged 65 to 75 who has smoked at least 100 cigarettes in his lifetime Certain other risk factors may apply. Please refer to Medicare guidelines and speak with your physician about your risk factors and this valuable screening program. Screening reports should be directed to the patient’s physician for review. Your physician will determine if any type of follow-up is necessary. *Screening guidelines reprinted from the Society for Vascular Surgery (SVS). 10
Your carotid arteries, located under your jawbone on either side of your neck, are the main vessels of blood supply to the brain. When these vessels become narrowed by the build-up of plaque – deposits of fatty substances, cholesterol, calcium and waste products – it is called Carotid Artery Disease or Carotid Artery Stenosis. These plaque deposits, or atherosclerosis, can lead to stroke, a slowdown or complete blockage of blood to the brain. Stroke is the third leading cause of death in the United States.
The risk factors for carotid artery disease include: Family history of carotid artery disease or atherosclerosis Age • Before age 75 men have the greatest risk • After 75 women have the greatest risk Smoking High Blood Pressure
numbness in the face or limbs, trouble speaking, loss of vision or balance problems. In this type of episode, symptoms are usually temporary, disappearing within 24 hours. Symptoms should not be ignored, as they may be a precursor to a larger stroke. Getting medical attention immediately is imperative,” explains Joseph V. Lombardi, MD, FACS, Head of the Division of Vascular Surgery at Cooper University Hospital.
The severity of a fullDiabetes blown stroke can be similar to that of a miniObesity In addition to a physistroke, but with critical Inactivity cal exam, a physician outcomes. A stroke can may listen to the arteries through a stethoscope for an cause lasting brain damage with permanent paralysis, abnormal whooshing sound called bruit (pronounced speech problems or even death. bru-ee). Not all diseased arteries will produce this sound. If this sound is detected by your physician, Warning Signs of Stroke! further testing may be recommended. Diagnostic If you or your loved one notice any of the warning testing for carotid artery disease will provide your signs of stroke, seeking immediate medical attention is physician with a detailed measurement of plaque build- urgent. up and the necessary information to decide a course • Weakness or loss of sensation to one side of the body of treatment. Treatment can include lifestyle changes, • Loss of vision in one or both eyes medication and/or surgery. •S lurred speech or problems with language While carotid artery disease and the slow build-up of plaque may not reveal noticeable symptoms, there are • New onset confusion and/or loss of memory distinct warning signs for stroke. “The first sign of • Trouble swallowing carotid artery disease in some patients can be a Talk to your physician about lifestyle changes to Transient Ischemic Attack (TIA) or “mini stroke”. This reduce your risk factors for stroke. can happen when a blood clot temporarily blocks blood to the brain. Symptoms can appear as weakness or High Cholesterol
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Nutrition Tips for Vascular Health Eating a healthy, well-balanced diet can help keep your body in tip-top shape from the inside out. A healthy diet and exercise play an important part in maintaining your vascular health. Check out some of these tips for keeping your blood pumping smoothly. Aim for 5 to 9 Servings of Fruits and • Unsaturated fats, especially those high in Omega-3, Vegetables a Day: can help reduce your risk for cardiovascular disease. • Not only are they high in fiber, but they have plant sterols and stanols which have been found to • Try using oils like canola and olive help reduce your bad cholesterol. when cooking; eat fish, like salm• Make sure to eat the rainbow to on and tuna; and add nuts, like get all the benefits fruits and walnuts and almonds to your vegetables have to offer. Try red meals. peppers, mangos, lemons, spinach, blueberries, eggLimit Saturated Fats, plant, and onions, just to Trans Fats, and name a few! Cholesterol: Choose Healthy Fats:
• Saturated fat, like those found in fatty meat, whole milk, and butter, should only be eaten on occasion.
Pass on the Salt:
• Trans fats should be avoided when possible. These are typically found in stick margarine, baked goods, and packaged foods. Look at the ingredients list for the word hydrogenated; if it’s there, choose something else. • Cholesterol intake should be less than 200 milligrams per day. Some foods high in cholesterol include fatty meat, whole milk, cheese and shellfish.
• Salt plays a major role in maintaining a healthy blood pressure, and many Americans get way too much.
• The recommendation is 2300 milligrams per day. That’s only one teaspoon
• Some foods high in salt are Chinese food, salad dressing, pasta sauce, canned goods, and snack foods like chips, pretzels and crackers.
By following some of these guidelines, you can help reduce your risk for vascular disease and gain a healthEat Plenty of Fiber-Rich Foods: ier lifestyle. It’s never too late to make a change, and • The recommendation for daily intake is 25-35 grams even small changes can add up to big results. Talk to per day. your doctor or a dietitian for a plan that’s right for you. • Make half of your grains “whole” – pick whole grain For more information, please visit: The National Heart, breads, pastas and cereals. Lung, and Blood Institute at: www.nhlbi.nih.gov. 12
Crustless Smoked Turkey & Spinach Quiche
Serves 8 (serving size: 1 wedge, 1/8) Ingredients Cooking spray 3/4 cup (4 oz) cubed smoked turkey (such as Jennie-O) 1/2 cup chopped onion 1/4 teaspoon freshly ground black pepper 3/4 cup (3 oz) shredded Swiss cheese, divided 1 cup fresh baby spinach leaves 1 cup fat-free cottage cheese 1/2 cup evaporated fat-free milk 1/4 cup (1 oz) shredded reduced-fat cheddar cheese 2 large eggs 2 large egg whites 1/2 cup all-purpose flour (about 2-1/4 oz) 1 teaspoon baking powder Preparation
large bowl; stir with a whisk. Lightly spoon flour into a dry measuring cup; level with a knife.
1. Preheat oven to 350°. 2. Heat a large nonstick skillet over medium-high heat. Coat pan with cooking spray. Add turkey, onion, and pepper to pan; sauté 4 minutes or until ham is lightly browned.
5. Combine flour and baking powder in a small bowl, stirring with a whisk. Add flour mixture to egg mixture, stirring with a whisk until blended. Pour egg mixture over ham mixture.
3. Sprinkle 1/4 cup shredded Swiss cheese in a 9-inch pie plate coated with cooking spray. Top with ham mixture.
6. Bake at 350° for 45 minutes or until a knife inserted in center of quiche comes out clean. This dish is a wonderful healthy addition to a Sunday brunch. Or whip it up on Monday to enjoy for breakfast all week long.
4. Combine remaining 1/2 cup Swiss cheese, spinach, and next 5 ingredients (through egg whites) in a
Recipe from cookinglight.com
Quinoa and Black Bean Salad Serves 4 to 6 as an entrée or 8 as a side dish Ingredients: For salad 1- 1/2 cups quinoa 1- 1/2 cups cooked black beans, rinsed if canned 1- 1/2 tablespoons red-wine vinegar 1- 1/2 cups cooked corn (cut from about 2 large ears) 3/4 cup finely chopped green bell pepper 2 pickled jalapeño chilies, seeded and minced (wear rubber gloves) 1/4 cup finely chopped fresh coriander
with a kitchen towel and lid, until fluffy and dry, about 10 minutes (check water level in kettle occasionally, adding water if necessary). 4. While quinoa is cooking, in a small bowl toss beans with vinegar and salt and pepper to taste. 5. Transfer quinoa to a large bowl and cool. 6. Add beans, corn, bell pepper, jalapeños, and coriander and toss well.
For dressing 5 tablespoons fresh lime juice, or to taste 1 teaspoon salt 1-1/4 teaspoons ground cumin, or to taste 1/3 cup olive oil
Make dressing: 1. In a small bowl whisk together lime juice, salt, and cumin and add oil in a stream, whisking. 2. Drizzle dressing over salad and toss well with salt and pepper to taste. 3. Salad may be made one day ahead and chilled, covered. Bring salad to room temperature before serving. The great thing about this salad is that it’s really flexible. Change the quinoa to whole grain pasta, and choose the vegetables you like. Like tomatoes? Add them! Like red peppers better than green – change it! Tailor the dish to your liking and enjoy!
Preparation: 1. In a bowl wash quinoa in at least 5 changes cold water, rubbing grains and letting them settle before pouring off most of water, until water runs clear and drain in a large fine sieve. 2. In a saucepan of salted boiling water cook quinoa 10 minutes. 3. Drain quinoa in sieve and rinse under cold water. Set sieve over a saucepan of boiling water (quinoa should not touch water) and steam quinoa, covered
Recipe from epicurious.com Christine Wilkinson, MS, RD, LDN is a cardiac dietitian for Cooper University Hospital. 14
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threatening. Symptoms of an acute aortic dissection include constant chest and/or upper back pain, described as “tearing.” The pain may move from one place to another.
Good to Know! Medicare recipients are entitled to a FREE, one-time screening to detect Abdominal Aortic Aneurysms (AAA).
Every second counts when it comes to aneurysm ruptures. Diagnosed early, aneurysms can be repaired by a vascular surgeon. Know the warning signs of back and/or abdominal pain and go to the nearest emergency room.
Eligibility is within the first 12 months of Medicare enrollment. Please refer to Medicare guidelines for this valuable screening opportunity.
•E at foods low in saturated fats, cholesterol, and sodium. • Achieve and maintain a desirable weight. • Exercise regularly – at least 30 minutes of exercise most days of the week. • Limit the amount of alcohol you drink. Excessive alcohol use is defined as drinking more than three drinks per day. (One drink equals 12 ounces of beer or wine cooler, 5 ounces of wine, or 1.5 ounces of 80-proof liquor.)
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The National Stroke Association™ recommends:
• Manage other risk factors: –F ind out if you have heart rhythm problems, such as atrial fibrillation, which increases the risk of blood clots that can lead to stroke. If you have atrial fibrillation, you should take anticoagulant (bloodthinner) medications as prescribed. – Talk to your doctor about circulation problems that can increase your risk for stroke.
• Quit smoking and using tobacco products. • Control high blood pressure, cholesterol, diabetes, and heart disease. • Have regular checkups with your doctor. • Have your doctor check your lipid profile and get treatment, if necessary, to reach a lipid goal of LDL less than 100 and HDL greater than 45.
“Learning the signs and symptoms of stroke will lower the risk of permanent damage and death. As soon as you notice symptoms in yourself or a loved one, call 9-1-1.”
Joseph V. Lombardi, MD, FACS Head, Division of Vascular Surgery Director, Acute Aortic Treatment Center
Vascular Vitality Crossword Puzzle:
Test your vascular smarts
3 5 4
9 10 11
1. 2300 milligrams per day recommendation (pg. 12 ) 4. Fatty deposits in arteries (pg. 2) 7. Weakened and expanding area of blood vessel (pg. 6) 12. Responsible for 40% of all strokes (pg. 3) 13. Laser energy to treat veins (pg. 7) 15. Medicare Act to Screen for Abdominal Aortic Aneurysms (pg. 10) 16. Veins seen through skin (pg. 6) 17. Weakness or loss of sensation to one side of the body (pg. 11) 18. Number one risk factor for PVD (pg. 4)
2. Temporary clot blocking blood to the brain (pg. 11) 3. Non-invasive test to detect PVD (pg. 5) 5. Arteries located on either side of your neck (pg. 11) 6. Affecting blood vessels outside of heart and brain (pg. 4) 8. Hardening of the artery (pg. 4) 9. No more than 200 milligrams per day (pg. 12) 10. Treatment for veins delivering heat to vein wall (pg. 7) 11. Tear in inner layer of aorta (pg. 9) 14. Pain while walking (pg. 4)
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O V A U
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Vascular Vitality A Publication of Cooper University Hospital Division of Vascular and Endovascular Surgery 1.800.8.COOPER CooperHealth.org