Ladies, we need to talk about your heart. It doesn’t seem to be on our radar, yet heart attacks are the No. 1 killer of women each year. Women and men, different in so many respects, experience atypical signs and symptoms of a heart attack. And if you’re under 55, take heed. There is a study that suggests that you are misdiagnosed seven times more often than men the same age when having a heart attack. Make sure your doctor hears your concerns. We thank PinnacleHealth for partnering with us to present this vital heart health information. They are an integral part of the region and have a vision for the future, which includes a new stateof-the art hospital, complemented by their excellent staff of physicians and personnel. PinnacleHealth wants to remain a leader in healthcare by offering cutting edge treatments, which includes those that improve heart function. You’re always helping others. Help yourself right now. Please take time to read the vital information included in this special feature. It could save your life. Love yourself … love your heart.
Managing Editor
Inside:
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Overall Excellence in Patient Care A vision for healthcare in our region.
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Fit-Friendly Worksite Program Promotes Heart Health Creating a wellness environment in the workplace.
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Center Stage – Profile The Heart Failure Center Providing care to help patients avoid hospitalization and ease symptoms.
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Pumped for Love – Profile High Blood Pressure a Special Concern for Women
Overall Excellence in Patient Care BUSINESSW
oman magazine recently spoke with Michael A. Young,
president and CEO of PinnacleHealth, to gain his perspectives on heart care in the region and how a holistic approach to healthcare affects many conditions, including heart disease. 1. Can you tell us a little about heart disease? It is estimated that 1/3 of Central Pennsylvanians suffer from a form of cardiovascular disease, and it remains the leading cause of death in Pennsylvania among both men and women. Diabetes and hypertension can lead to cardiovascular disease, genetics can play a role, and lifestyle habits like smoking and diet play a huge part. 2. What effect does the aging of the population have? Getting older increases our risk for heart disease. As we age, our arteries can clog and stiffen, and the heart compensates by working harder, thereby raising blood pressure. This can change the timing of its valves. For women, the risk of heart attack and stroke increases with age, especially after menopause. Low levels of estrogen pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels (small vessel heart disease). Pennsylvania ranks fourth in the U.S. by percentage of the population age 65 and older (behind Florida, West Virginia, and Maine), and one in five Pennsylvanians are 60 or older. By 2020, Pennsylvania’s 60-andolder population is expected to be 25 percent of the total population. Continued on next page.
Why women need to be aware.
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Recipe – Trout with Skillet-Roasted Peppers www.BusinessWomanPA.com
Michael A.Young, president and CEO of PinnacleHealth. Heart Health 2013
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The new PinnacleHealth West Shore Hospital under construction in Hampden Township with expected completion mid-2014.
Continued from previous page. PinnacleHealth has created a strategic plan called Vision 2017 that, in part, addresses these new demographics and the growing needs of this aging population. Heart disease is important, but we’re focused on addressing all healthcare needs, particularly in preventative care. For instance, helping patients effectively manage high blood pressure and high cholesterol, or helping them quit smoking and lose weight, can make the difference in developing heart disease or its severity. 3. PinnacleHealth added Heritage Medical Group and is opening a new hospital on the West Shore. What impact will these changes have on cardiac care and treatment and promoting healthy hearts? These new relationships are part of our vision for healthcare in the region. Now the PinnacleHealth Medical Group, the result of combining PinnacleHealth Family Care and Heritage, has expanded the availability of primary care services and our medical home model throughout Central Pennsylvania. The medical home model is designed to improve population health, better manage chronic diseases, and coordinate care, with a focus on prevention. By helping Central Pennsylvanians access services that help manage illnesses such as diabetes, asthma, and heart disease, patients may have greater success in preventing urgent or emergency situations. The new West Shore Hospital will offer interventional cardiology (heart catheterization) and a state-of-art ER. We are also expanding cardiac services at our Harrisburg Campus to 4
Heart Health
include new catheterization and electrophysiology suites, private patient rooms, and family waiting areas. Additionally, we average 55 minutes in unblocking arteries upon ER arrival. The national standard is 90 minutes. We’ve also received the highest quality designation, a Three-Star Rating, for heart bypass surgery and have Joint Commission disease-specific certifications in Advanced Heart Failure and Stroke, Spine Surgery, Stroke Rehab, and Advanced Diabetes. Those recognitions reflect our focus on comprehensive care. We’re a multidisciplinary system that is focused on total patient care. 4. In more general terms, what does the vision – including chronic disease management, improving health of the aging demographic, and better coordination of care – mean for the region? PinnacleHealth’s strategic vision is focused on developing a highly integrated system of care designed to increase access, enhance quality, and lower cost. Our vision to provide the right care at the right time in the right setting means offering a primary care office 10 minutes from work or home, just 20 minutes in distance to an outpatient facility, and a mere 30 minutes to a state-of-the-art hospital or ER. Based on our recent community health needs assessment, one out of every five people in Central Pennsylvania does not have a doctor. This, combined with the incidence of chronic illness, shows there is a need to improve access to affordable care. www.BusinessWomanPA.com
West Shore Hospital under construction.
Getting patients into care as early as possible offers the greatest chance for success and the highest quality of life. 5. You are very focused on quality. Can you explain this more? Quality means that patients have the best outcomes from the services they receive. The patient should receive the best discharge instructions, great follow-up care, accurate test results, courteous service, quiet surroundings, and timely information. It means that they deserve to have their questions answered and feel welcome. Quality is about the overall patient experience. Patients might have the most skilled, educated, and experienced practitioners, but they also want communication, compassion, and kindness. Being able to offer all these aspects is true quality service. At PinnacleHealth, we offer a patient promise that encompasses all these things. We truly believe that healing is facilitated by comfort and consideration. Our goal is patient satisfaction. www.BusinessWomanPA.com
PinnacleHealth employees sign the final beam for the expansion at Community General Osteopathic Hospital.
Final beam placement for the expansion of services at Harrisburg Hospital. Heart Health
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Fit-Friendly Worksite Program Promotes Heart Health
Written by Rochelle A. Shenk Being fit is something that encompasses both our personal and work lives—it’s a lifestyle. The American Heart Association’s (AHA) Fit-Friendly Worksites program recognizes employers who promote a healthy lifestyle. After all, adults in this country spend the majority of their waking hours at work, and many are in sedentary careers. With obesity costing American businesses $12.7 billion per year in medical expenses and $225.8 billion in health-related productivity losses, any program that increases physical activity of employees will positively impact the bottom line. Larissa Bedrick, director of communication at the American Heart Association, said that the Fit-Friendly Worksites program was initiated in 2007 and “recognizes employers that go above and beyond in creating a wellness environment in the workplace.” Worksites (for-profit companies and notfor-profits as well as schools) with 25 or more employees may earn recognition by implementing physical activity practices such as providing walking routes; promoting walking programs, online newsletters, and tracking tools to motivate employees; and allowing staff to wear athletic shoes in the workplace on designated “sneaker days.” Additionally, worksites with multiple locations and various activities spread throughout the locations can be viewed as a whole to become designated. The worksite submits an application for recognition (deadlines for submissions are 6
Heart Health
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Jan. 31 and July 31), which is then reviewed by an AHA volunteer panel. Bedrick said that the application encourages smoke-free worksites. However, companies that do not have a policy in place are not excluded from consideration. If a company can show that their worksite is mainly smoke-free, it will still be included in the selection process. Fit-Friendly has gold and platinum levels, which may be renewed annually. A worksite may also receive an Innovation Award. Bedrick explained that this recognizes unique activities, policies, or actions a worksite undertakes to improve the wellness at the site itself or in the community. These awards are not renewable, and once a worksite is recognized for Innovation, it would have to reapply with a new activity in order to re-qualify. Donegal Insurance Group, Marietta, is a Fit-Friendly goldcertified worksite. Marissa Throckmorton, benefits administrator, said that 2012 was the first year that the company applied for the award. “We’ve really been pushing wellness and wanted to get recognition for the things we’ve done,” she said. Donegal has an onsite fitness center that’s been expanded to include both strength training and cardio areas, and it’s accessible both before and after work hours. Throckmorton said that she uses the facility as much as she can, and it’s a pretty busy place at lunch. “Fitness has become part of our corporate culture—you’ll see top-level executives using the fitness center or at some of www.BusinessWomanPA.com
our fitness events.” In the past year, Donegal inaugurated a wellness committee that hosted a number of events. About 80 staff members participated in National Walk at Lunch Day in April, while 70 people participated in a 10-week Biggest Loser program—the top three Biggest Losers each lost at least 10 percent of their body weight. Throckmorton explained that participants in this program were each assigned an ID; they were weighed by a nurse from Lancaster General Health; and results were posted each week. “Posting the weekly results helped motivate people and kept up interest in the program,” she said. Donegal also hosted its third annual health and benefits fair, which includes a number of health screenings. The Walk at Lunch Day spawned “Walking Wednesdays” where staff members gather and walk together. There’s also a Lunch & Learn program that’s been offered three times a year through Donegal’s health insurance provider. In September, Donegal began a campaign encouraging staff members to complete health/health risk profiles. Bedrick said that by recognizing efforts of worksites such as Donegal Insurance Group through the Fit-Friendly program, AHA hopes to encourage other worksites to implement employee programs that focus on fitness and health. For more information about how your workplace can become involved in the Fit-Friendly Worksite program, visit www.startwalkingnow.org. Heart Health
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Center Stage Written by Rosalba Ugliuzza
Brenda McCann was an active person growing up. She had played softball and bowled. She has never had high blood pressure or high cholesterol. So when she experienced fatigue and shortness of breath, she thought it was part of the aging process. Unbeknownst to her, her heart would take center stage in the years to come. Her cardiac journey began in January 2008 when McCann, 51, was supposed to undergo a hysterectomy. But once she was under anesthesia, her heart jumped to 300 beats per minute. Alarmed, doctors canceled the surgery and performed a heart catheterization instead. “They claimed normally when the heart races and does an irregular beat, it usually means there’s a blockage,” she said. By spring 2011, she had a pacemaker implanted, and in July 2012, she was diagnosed with congestive heart failure, due to the organ not pumping out enough blood. McCann said her heart was pumping out blood below average; between 20 to 25 percent. Doctors at PinnacleHealth performed a cardiac ablation to correct her heart rhythm problems. Though heart problems run in her family, McCann is the only member to have this surgery. “I guess I can say I’m lucky I went in for surgery or I might not have known the condition that I had was as serious as it was,” she said. In addition to her follow-up appointments at PinnacleHealth, McCann takes her heart medications and monitors her sodium and water intake. She and her husband, Howard, have also taken an organic approach to their lifestyle like growing vegetables from their garden and ignoring packaged foods and canned goods from grocery stores. “We bake our own bread. We can our own produce in the summer. It’s just something that we do,” she said. “Everything on my end contributes to longevity.”
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The Heart Failure Center Treating congestive heart failure, a chronic illness affecting about 5.8 million people in the United States, is a matter of micromanagement, according to Brijeshwar S. Maini, MD, FACC, director of Advanced Cardiac and Endovascular Interventional Laboratory, director of Cardiovascular Research and Education, and medical director of PHCVI Valve Clinic at PinnacleHealth. The PinnacleHealth Heart Failure Center helps to limit frequent hospitalizations and typical symptoms of shortness of breath, fatigue, and swelling in the ankles, feet, legs, abdomen, and neck veins. “More people get admitted to the hospital because of congestive heart failure than any other diagnosis,” Dr. Maini says. “We tailor our therapies to improve heart failure patients’ quality of life and keep these patients out of the hospital as much as possible.” Managing heart failure as an outpatient service at the Heart Failure Center includes: • Seeing providers on a frequent basis • Regular visits to monitor the heart and lungs • Education for patients and their families on recognizing complications and reducing symptoms • Reinforcement of diet and medication compliance • Early detection of worsening heart failure • Attending monthly support group meetings To contact the Heart Failure Center, call 717. 231.8445.
Brijeshwar S. Maini, MD, FACC
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Heart Health
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Pumped for Love Written by Rosalba Ugliuzza
Behind every great man, there’s a great woman. But for 77-year-old Eugene Borza, he has a sweetheart. Thanks to his wife of 37 years, WITF-TV president Kathleen Pavelko, Borza has overcome his latest health scare for the better. Last January, Pavelko was at her husband’s side when he underwent surgery to replace four blocked arteries at PinnacleHealth in Harrisburg. “My wife Kathleen is an angel. She decided she was going to take care of me because when you’re on a lot of meds, your mind is not working very well. She was there all the time,” said Borza, a retired college professor. “She was the basic source of support.” Borza had no medical and family history of heart disease. So the news came as a shock when he developed symptoms of shortness of breath and chest discomfort in March 2011. After a stress test proved negative, the couple consulted with their physician who initially thought the problem might have been gastric-related. “Our physician, Dr. Howard Cohen, suggested that only the ‘gold standard’ test (cardiac catheterization) could confirm the source of the symptoms,” said Pavelko. “That revealed four blockages that were repaired via surgery a few days later.” Borza is grateful for the excellent care the doctors and staff provided at PinnacleHealth. The couple, who have two children, have resumed a healthy, low-salt, moderate-fat diet and exercise regularly. Pavelko said it’s important that two people are present when they are consulting with a medical professional. “Each meeting is an invaluable opportunity to ask questions and expand your understanding of the situation,” she said. Borza said his wife did just that and he owes her a great debt. “She was right there with me, checking and double checking and expressing concern,” he said. “She was marvelous.”
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High Blood Pressure a Special Concern for Women Written by Stephen T. Sinatra, MD, FACC Like heart disease, high blood pressure (also known as hypertension) has always been thought of as a man’s problem—but it just isn’t so. As it turns out: • Women are more likely to have high blood pressure because they have smaller arteries than men. • After age 55, more women develop high blood pressure than men. • Even a mild elevation in blood pressure (around 130–139 mmHg systolic, or 85–89 mmHg diastolic) has been found to actually double a middle-aged woman’s cardiac risk. • High blood pressure affects one out of every four women and kills significantly more women than men. Considering these statistics, women need to be aware of a number of life circumstances and lifestyle choices that can make maintaining optimal blood pressure a unique challenge:
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• Birth control • Pregnancy • Menopause • Metabolic syndrome • Diastolic dysfunction • Painkillers • Emotions • Birth Control
Oral contraceptives may elevate blood pressure slightly. Usually a woman’s numbers will stay in the normal range, but they should be checked regularly because high blood pressure is a potential side effect—particularly for women with a family history of hypertension or a personal history of kidney disease, obesity, or hypertension during pregnancy. Pregnancy Many women with high blood pressure deliver healthy babies (high blood pressure during pregnancy is called eclampsia). But pregnancy—and the increased blood volume required to nurture a growing fetus—can potentially raise blood pressure to extremely high levels. For this reason, expectant mothers also should have blood pressure readings taken routinely. Hypertension can develop rapidly in the last three months of pregnancy. When this happens, a woman may need treatment—even after delivery. Menopause Normal age-related hormonal declines often cause a woman’s arteries to become less elastic and more constrictive, thus contributing to high blood pressure. On their own, these changes are reason enough to pay extra attention to your lifestyle choices that affect cardiovascular health. But the situation is further complicated by the use of hormone replacement therapy (HRT) to minimize or eliminate other symptoms of menopause, like hot flashes and night sweats. Conventional HRT involves the use of manmade pharmaceutical substitutes for the hormones the body is no longer producing enough of. These synthetic hormones may be problematic, however. In 2004, results from the large Women’s Health Initiative (WHI) study showed that synthetic hormones like Premarin and Provera could push blood pressure up steeply. An alternative to HRT is individually tailored bioidentical hormones derived from natural plant sources. I believe these are a much better option for women who want to use some type of HRT. Metabolic Syndrome Data from a five-year National Health and Nutrition Examination study of adults with hypertension revealed three risk factors for high blood pressure that are more significant for women than
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men: low HDL cholesterol levels, elevated triglyceride levels, and excess abdominal fat (waist girth of more than 35 inches). This profile is largely consistent with metabolic syndrome, a widespread asymptomatic condition that often leads to diabetes and heart disease. I’ve found that women with these characteristics typically don’t respond well to medications for high blood pressure. They do better with lifestyle changes that include exercise and weight loss, stress reduction, and diet modifications, such as restriction in simple sugary carbohydrates and targeted nutritional supplements to support normal blood pressure levels. Diastolic Dysfunction Another reason that women have a tougher time with high blood pressure is their tendency to have more diastolic dysfunction (DD) than men. DD is a condition in which the left ventricle of the heart—the chamber that generates your systolic blood pressure—becomes stiff. This is the No. 1 cause of heart failure in women. DD may have to do with women’s smaller blood vessels and declining energy levels in the heart. Fortunately, the latter can be combated by taking the “Awesome Foursome,” my name for the four supplements that are crucial for cellular energy production and important for ensuring that your heart has the raw materials and energy substrates necessary to maximize its efficiency. I call this Metabolic Cardiology. Painkillers Daily doses of non-aspirin painkillers, such as extrastrength acetaminophen (Tylenol) and nonsteroidal antiinflammatory drugs (NSAIDs) like ibuprofen (Advil and Motrin), increase the risk of developing high blood pressure. A 2005 Harvard study found that women who took more than 500 mg of acetaminophen daily (the amount in one extra-strength tablet) had a 93 to 99 percent greater risk of developing hypertension within three years than women who took less. Likewise, women who took more than 400 mg a day of over-the-counter NSAIDs (the equivalent of two ibuprofen) had a 60 to 78 percent greater risk for hypertension than women who took less than that amount. If you take painkillers regularly, be sure to inform your doctor and find out about safer medications. I recommend Traumeel, a homeopathic remedy available in health food www.BusinessWomanPA.com
stores or online at www.traumeel.com. You can buy it as a topical cream or sublingual tablet, and it works great for various muscle aches and pains— without the potentially devastating effects on blood pressure. Emotions Years ago, I conducted a fascinating coed study on stress and the heart with my cardiac patients. Before and after a workshop, I measured each person’s blood pressure, as well as the level of stress hormones in their urine. I found that the women who expressed their emotions and networked with one another during the workshop had lower levels of stress hormones and lower blood pressures. This is a good point to remember—the value of spending time with other women, and of talking to moms, sisters, and girlfriends about health and other life issues. You may be able to lower your blood pressure by reestablishing or strengthening some of these valuable connections. Stephen T. Sinatra, M.D., FACC, is a board-certified cardiologist and assistant clinical professor of medicine at the University of Connecticut School of Medicine. He is the founder of heartmdinstitute.com and the author of a monthly written newsletter entitled, Heart, Health & Nutrition. Sinatra is a fellow in the American College of Cardiology and the American College of Nutrition. His latest books are The Sinatra Solution/Metabolic Cardiology, Earthing: The Most Important Health Discovery Ever and his latest book released in November 2012, The Great Cholesterol Myth.
Heart Health
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Trout with Skillet-Roasted Peppers
Recipe Serves: 4; 3 ounces fish and 1/3 cup pepper mixture per serving Ingredients 1 tablespoon olive oil, divided use 2 medium poblano peppers, ribs and seeds discarded, thinly sliced 5 ounces grape tomatoes or cherry tomatoes, halved (about 1 cup) 1 medium garlic clove, minced 1 to 2 teaspoons balsamic vinegar 1/2 teaspoon salt, divided use 1/4 teaspoon pepper Paprika to taste 4 trout fillets or any other thin mild fish fillets (about 4 ounces each), rinsed and patted dry 1 medium lime, cut into 8 wedges Cooking Instructions Heat a large, nonstick skillet over medium-high heat. Add 1 teaspoon oil, swirling to coat the bottom. Cook the peppers for 4 to 6 minutes, or until beginning to richly brown on the edges, stirring frequently. Gently stir in the tomatoes. Cook for 2 minutes, or until soft, stirring gently and frequently. Remove from the heat. Gently stir in the garlic, vinegar, and 1/4 teaspoon salt. Transfer to a small bowl. Cover to keep warm. In the same skillet, heat the remaining 2 teaspoons oil over medium-high heat, swirling to coat the bottom. Sprinkle the pepper, paprika, and remaining 1/4 teaspoon salt over both sides of the fish. Cook for 3 minutes on each side, or until the fish flakes easily when tested with a fork. Transfer to a platter. To serve, squeeze 4 lime wedges over the fish. Spoon the poblano mixture on top. Serve with the remaining lime wedges to squeeze over the poblano mixture if desired.
Nutrition Analysis (per serving) Calories . . . . . . . . . . . . . . . . .189 Total Fat . . . . . . . . . . . . . . . .7.5 g Saturated Fat . . . . . . . . . . .1.5 g Trans Fat . . . . . . . . . . . . . .0.0 g Polyunsaturated Fat . . . . . .2.0 g Monounsaturated Fat . . . .4.0 g Cholesterol . . . . . . . . . . . . .67 mg
Sodium . . . . . . . . . . . . . . .332 mg Carbohydrates . . . . . . . . . . . . .6 g Fiber . . . . . . . . . . . . . . . . . . .1 g Sugars . . . . . . . . . . . . . . . . . .3 g Protein . . . . . . . . . . . . . . . . . .24 g
Dietary Exchanges: 1 vegetable, 3 lean meat
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Cook’s Tip No need to slow-roast poblano peppers to get deep flavor. All it takes is quickly cooking them in a hot skillet and letting them steep a bit. Squeezing lime wedges over both the fish and the topping “lifts” and defines the flavors of the various ingredients. If you aren’t a true lime lover, though, you may want to skip the second spritzing. This recipe is brought to you by the American Heart Association’s Face the Fats campaign. Recipe copyright © 2009 by the American Heart Association. Look for other delicious recipes in American Heart Association cookbooks, available from booksellers everywhere, and at deliciousdecisions.org.
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