Health Smarts - Spring 2018

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Smarts Understanding risks, warning signs of heart disease and when to seek help

Staying heart healthy

ABCs of cardiac care The language doctors use

Good eats!

Healthy food is fuel for your heart

Shared decision making

Working with your provider to get the best care

Welcome LETTER

Enjoy Health Smarts 2018 Welcome to the first issue of Health Smarts for 2018. For some of you, this is your first issue, while others have been a part of our readership for the last year. We thank you for your support, and we look forward to providing you with valuable medical information. Health Smarts focuses on you and your overall health. You’ll find information about living a healthier lifestyle and practical tips to manage the issues we all face as we age. We invite you to explore our crossword puzzle that is not only fun, but also can help keep your brain in shape! You are receiving this magazine because your doctor participates in the Medicare Shared Savings Program Accountable Care Organization through Banner Health Network. The Medicare Shared Savings Program requires no sign up and does not change your Medicare benefits. Health Smarts magazine is included as an added bonus providing you with the latest information on health care trends and ways you can keep track of your health. Since February — the month of love and hearts — has just passed, we saw it fitting to focus on heart health. Meet one of Banner Health’s volunteers who shares his own experience living with heart disease and what he does to stay healthy. We’ll share some tips on how you can improve your eating habits for

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better health, what to look for in home health monitors, and a reference guide for heart procedures. You’ll get advice from medical experts on some healthy habits you can start today to help your heart, and you will learn about the importance of making your health care decisions in advance by completing “five wishes.” Banner Health Network includes a special team of heart specialists who collaborate with each other and with other medical experts. Our cardiologists and other medical professionals, are dedicated to providing exceptional, quality care while focusing on our mission of making health care easier, so life can be better. Our goal is to help you achieve your best personal health, and we’re honored to provide you with these valuable resources so you can make the best health care decisions. If you have questions about this program, please call us toll free at 855-874-2400. To your health,

Ann Marie Sun, MD Medical Director

Spring 2018 CONTENTS


8 Staying heart healthy

Understanding risks, warning signs of heart disease, and when to seek help

4 Doc Talk

What’s one tip you would give your patients to start a hearthealthy habit today?

5 Be Well

Taking care of your ticker with these simple steps


6 A shared view

Working with your provider to get the best care

11 ABCs of cardiac care


Know the language doctors use

12 Health Smarts

Home heart monitoring

13 Get Moving

Find the road to recovery after a cardiac event

14 Good Eats

Healthy eating for a healthy heart


15 Health Smarts Crossword

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‘What is one tip you would give your patients to start a heart healthy habit today?’

In starting and keeping a new healthy habit, it is essential to make sure you create a support and accountability system. Find a friend or family member who can encourage you when it’s tough, congratulate you on your successes and remind you about the goal you have set to stay on track.

When my patients ask “What exercise should I do?” My typical answer is “one that you like.” Too often people buy a piece of equipment and in a few months, it’s a hat rack. Find an activity that you want to do so that you’ll do it often. Remember moving a little is better than not moving at all.

The most important tip that I would give to patients wanting to start a heart healthy habit is for them to be realistic about which heart healthy habit they wish to engage in. Define specifically these goals and seek appropriate health professional advice to assist in achieving these goals.

Jacob Anderson, DO Faculty Clinician, Banner University Medical Center Family Medicine Residency

David M. Bell, DO Invasive Cardiologist CardioVascular Associates of Mesa (CVAM)

Joseph A. Caplan, MD Cardiovascular Disease Cardiac Solutions

Start small and build up. Making one small change at a time that can last is going to have a better long term result than trying to change all behaviors at once. For example, try to get in even fifteen minutes of exercise a day if you can, then once you see the results you will want to do more and more naturally. Don’t be too hard on yourself!

Smile more! Feeling under pressure in a meeting or a social situation? Upset over a family dispute? Try smiling! Even fake smiling works! Smiling has been found in studies to reduce heart rate and blood pressure during times of stress. Need some smile motivation? Try an online funny cat video to help get your smile on!

Nutritional changes for heart health should be sustainable. I don’t believe in diets. I believe in implementing healthy eating habits that lead to long term health. Make one healthy nutritional change a week that you can sustain for the long term.

Kelly Guld, MD Interventional Cardiologist Tri-City Cardiology

Sarah Payne, DO Gerontology Medical Director Banner Hospice

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Victor Sein, DO, MPH, FACC Interventional Cardiologist CardioVascular Associates of Mesa (CVAM)


Take Care of Your Ticker

Improve your heart health with these simple steps By Leigh Farr Here’s the really good news about your heart — you don’t have to run marathons, eat a strict vegetarian diet or buy a pricey gym membership to enhance your cardiac health. Making a few tiny tweaks to your lifestyle can make a big difference. “If you take tiny steps, anything that you do will have a big impact,” said Marilyn Cryan, a registered dietitian for Population Health Management at Banner Health Network. Even if you’re improving your lifestyle habits for the first time, said Cryan, taking those first steps at any age will benefit your heart. “It’s never too late,” she said. “A lot of my patients are at advanced ages and when they make even the smallest changes, their quality of life improves. Whatever we can do to change our lifestyle through exercise, diet, stress management and not smoking has a big impact on our chance of developing heart disease.”

On the Move

Staying active is key to maintaining normal blood pressure, cholesterol and sugar levels. Just adding a little extra activity to your daily routine can be beneficial. Cryan recommends starting with 30 minutes of activity a day—or even as little as 10 minutes if you find yourself working too hard, and doing things you find are enjoyable. “Everything counts whether it’s cleaning or taking a walk with your family after dinner,” said Cryan. Be sure to start slowly and always consult with your doctor before starting a new activity. “Only go as far as your body will allow you,” Cryan said. “Definitely talk to your doctor and make sure you have the all-clear to exercise in the first place.”

Heart-Protective Diet

Snacking on healthy foods is a key ingredient to improving your heart health.

“Diet is huge. I like to encourage my patients to eat lean protein, lots of plant food and whole grains,” said Cryan. “Rather than focusing on what you can’t do, I like to focus on adding in more vegetables or upgrading what you currently eat.” For example, she said, if you like to eat pasta as a side dish, try swapping it with the whole grain, quinoa. “Quinoa has a high protein content and also has a lot of fiber. Protein helps keep you satisfied throughout the day so that you can sustain your energy and make better choices. Fiber is really important when it comes to heart health because it can pull excess cholesterol from the body.” For breakfast, Cryan recommends trying fiber-rich oatmeal and adding some almond butter in it for extra protein. “If you eat a balanced meal for breakfast you’re more likely to make a better choice at your snack because you’re not going to be starving at that point,” she said.

Slow Down and Enjoy

Studies show that stress takes a toll on the heart by causing high blood pressure. To add tranquility to your day, Cryan recommends “belly breathing.” “Breathing exercises help relax the muscles and that can decrease blood pressure,” she said. “We breathe very shallow generally so if you take in a deeper breath and watch your belly expand as you inhale and then your belly contracts when you exhale, you can start to notice your mind might slow down a little bit and your muscles might feel more relaxed.” |



VIEW Working with your doctor to get the most appropriate care By Debra Gelbart


he concept of “shared decision-making” with your doctor can take several forms. It can mean deciding together the best course of treatment for an illness, making sure you understand your doctor’s recommendations, and completing “advance directives”— those instructions for health care providers if you are unable to express your wishes verbally for your medical care. Shared decision-making is the optimal approach for the most appropriate medical care that patients receive, said Sarah Payne, DO, medical director for Banner Home Care and Hospice. “I’ve found that some patients want to simply follow a doctor’s

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orders and not participate in their treatment decisions,” said Dr. Payne, who has also spent eight years as a primary care physician. Others want to partner with their physician in deciding the best course of treatment for them within the viable options presented by the doctor, she added. “Ideally, all patients will want to work with their doctor in determining the best course of action.” Dr. Payne recommends that all patients ask their doctor general questions about their health or questions related to their doctor’s prescription for treatment. “If a patient doesn’t ask questions in person, they have an opportunity to ask questions online through the Banner Health patient portal or your doctor’s website,” she explained. “I can then answer questions potentially at any time I happen to be online, too.”


For more information, visit

Advance directives

A key aspect of shared decisionmaking is advance directives. Advance directives are legal documents for your medical providers, and loved ones. They are written instructions that specify your wishes for medical care and/or end-of-life care, if you are not able to verbally make those decisions. “If you think about it, your family and friends will also have been

traumatized by whatever has happened to you whether it might be a severe infection, stroke or other serious event,” said David Edwards, MD, chief medical officer for postacute services at Banner Home Care and Hospice. “Don’t you have a responsibility to make this easier for those who are trying to help you?” “Advance directives MUST include the option of ‘doing nothing’ about the problem, which can be applicable for many patients, particularly those who are chronically ill, or at risk of side effects from the medications or procedures being offered,” said

Carlos Ventura, MD, an internal medicine physician and specialist in geriatrics with Banner Medical Group at Verrado Health Center in Buckeye.

Where to start with advance directives

Drs. Payne, Edwards and Ventura agree that a great place to start preparing your advance directives is through a concept called Five Wishes developed by the nonprofit organization Aging with Dignity. You essentially provide five pieces of information on prepared documents: ■■ The person I want to make care

decisions for me when I can’t ■■ The kind of medical treatment I want or don’t want ■■How comfortable I want to be ■■How I want people to treat me, and ■■ What I want my loved ones to know. “Five Wishes walks people through several questions that help frame the dialogue to understand some of the values and specific medical interventions that you have preferences for,” Dr. Edwards said. “It also allows you to leave a message for those who you care for in the event you cannot communicate.” |



THE SYMPTOMS YOU SHOULDN’T IGNORE Risk factors, early warning signs and when to seek treatment By Meghann Finn Sepulveda Photos by Rick D’Elia


eart disease is the leading cause of death among men and women, claiming the lives of more than 600,000 people in the United States every year, according to the Centers for Disease Control and Prevention (CDC). Understanding your risk, identifying the early warning signs and knowing when to seek medical treatment

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are ways to prevent and manage heart disease.

Risk factors

Several health conditions can increase your chances of developing heart disease, which is why it’s important to know your risk. “High blood pressure, high cholesterol, diabetes, hypertension, obesity and smoking can all contribute to heart disease,” said Martha Gulati, MD, physician executive director of the Heart Institute at Banner – University Medical Center Phoenix. “If you have any of these risk factors, talk to your doctor about preventive health care recommendations such

as lifestyle changes and medication management so you can be proactive against developing heart disease.” While Dr. Gulati says that 80 percent of heart disease is preventable, unfortunately there are certain risk factors such as age and family history that can’t be controlled. This is especially true for John Kressaty, 69, a Mesa resident and volunteer at Banner Heart Hospital. At 13 years old, John was diagnosed with mitral valve prolapse


Find out more about expert heart care near you by visiting

and an enlarged heart a few years later. He was under the care of a cardiologist and was well aware that his heart condition may require future treatment. In 1993, while living in Wisconsin, John began having trouble breathing. Doctors determined he needed a mitral valve repair, which was the first of many cardiac surgeries. In 1996, John collapsed and lost consciousness while exercising. Emergency responders were able to revive him and rushed him to the hospital where he had an implantable cardioverter defibrillator placed in his chest. Several years later, shortly after moving to Arizona, John required a second defibrillator followed by a heart transplant, which was performed at Banner – University Medical Center Tucson in 2001. “My father’s side of the family always had heart problems,” he recalled. “It was inherited.” Heart disease also took the life of his daughter, who suffered from sudden cardiac death at the young age of 24.

Warning signs

Heart disease can lead to a heart attack, which occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely, according to the American Heart Association. Symptoms of a heart attack can vary greatly between men and women. “The classic symptoms, most commonly experienced in men, are chest pain, chest pressure and shortness of breath,” Dr. Gulati said. “Many women often experience these symptoms as well but may also

John Kressaty, a volunteer at Banner Heart Hospital, chats with volunteer program coordinator, Maggie Mitchell as he prepares to begin his shift. John has also made use of the hospital’s services in dealing with his own heart issues in the past. Below: John restocks the storage closet for prayer shawls in the volunteer office.

have profound fatigue, pain in their neck, jaw or back, or develop more subtle symptoms that mimic indigestion and are often ignored.” Numbness, weakness, dizziness, nausea and cold sweats could also be signs of a heart attack. Dr. Gulati says it’s important not to ignore these symptoms and call 911 if you think you’re having a heart attack. “Trust your body,” Dr. Gulati explained. “If something has changed or just doesn’t seem right, get checked out by a medical professional.”


Treatment for heart disease depends on the condition and the extent of the damage, but often includes lifestyle changes, medication, surgery and cardiac rehabilitation. John, who underwent an 11-hour aortic dissection surgery in 2011 at Banner Heart Hospital, also suffered a heart attack and stroke in 2014. “During my recovery, I had some setbacks,” he said. “I kept up with my HEART continued on page 11 >> |


Inpatient procedures

SPEAKING from the heart

Cardiac procedures you should know

By Brian Sodoma Heart tests and procedures have their own unique language that can be confusing if you don’t know the medical terminology your doctor is using. This table explains some of the most common tests and procedures a heart patient may encounter and they are listed below.

Non-invasive, office-based tests

EKG (ELECTROCARDIOGRAM) What it is: A portable machine with 12 electrodes attached to areas of the chest. They measure the heart’s electrical activity. How it helps: Detects irregular heart beat (arrhythmias) or potential structural abnormalities, as well as areas with previous injury or that are high risk for injury. STRESS TEST What it is: Electrodes attached to a

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patient that monitor blood pressure and heart function, usually while the patient exercises on a stationary bike or treadmill. How it helps: Helps guide treatment for those with heart disease, heart disorders or arrhythmias (irregular heart beat). ECHOCARDIOGRAM What it is: A noninvasive ultrasound of the heart. A technician uses a medical ultrasonic transducer passed over the surface of the upper body to take photos of the heart. How it helps: Detects heart disease, assesses overall heart function. ARTERIAL DUPLEX SCAN What it is: An ultrasound of the major arteries in the arms, legs and neck. How it helps: Recognizes carotid artery disease (plaques that clog the carotid arteries), peripheral vascular disease and PAD (peripheral arterial disease) — narrowing of the peripheral arteries in various areas of the body.

CARDIAC CATHETERIZATION What it is: A catheter, or small tube, is inserted into a heart chamber or vessel, usually starting in the groin area. Under an X-ray-type movie, a dye is pumped into the catheter to help create images of the heart’s blood flow. How it helps: Detects a variety of heart conditions including blockages or narrowing of the arteries, and can also serve as a tool for interventions needed by heart disease patients, like the placing of a stent to help open a coronary artery if there’s blockage. CORONARY ANGIOGRAM What it is: Performed during a cardiac catheterization, it is an X-raytype movie in which a dye is pumped into the coronary arteries to evaluate blood flow. How it helps: Locates clogged coronary arteries, which supply the heart muscle with blood. PERIPHERAL ANGIOGRAM What it is: Another catheter test using dyes and x-ray images, specifically for the arteries throughout the body, most commonly to evaluate the arteries supplying blood to the legs. How it helps: Detects blood vessel problems like aneurysms, arteriovenous malformation, tumors and clots. TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE) What it is: An ultrasound producing pictures of the heart, as well as arteries leading to and from the heart. It uses a thin tube traveling through the mouth, throat and into the esophagus. How it helps: Offers a clear picture of the upper heart chambers to identify

problems like blood leaking backwards through the valve, blood clots and other concerns. CORONARY ANGIOPLASTY AND STENTING What it is: An inserted balloon is used to open blocked coronary arteries. A stent is a metal mesh tube that expands inside the narrowed artery and can be placed immediately after angioplasty, if needed. How it helps: Narrowed arteries open so that blood can flow through. PERIPHERAL ANGIOPLASTY AND STENTING What it is: A procedure that uses an inserted balloon to unblock blood vessels throughout the body, most commonly for the vessels supplying blood to the legs. A stent can be introduced as well. How it helps: Keeps blocked blood vessels open. PERMANENT PACEMAKER IMPLANTATION What it is: The battery-powered pacemaker is placed under the skin near the collarbone on the left side of the chest with electrodes implanted into areas of the heart. Usually about the size of a watch, it senses heart rhythms and gives electrical stimulation to the heart when needed. How it helps: Pacemakers are recommended for those with bradycardia (slow heartbeat) or other irregular heart rhythms (arrhythmias) that may occur as a result of congenital abnormalities or sustained injury/damage to the heart.

Inpatient, hospitalbased procedures

TRANSCATHETER HEART VALVE REPLACEMENT (TAVR) What it is: Using a catheter or small

openings rather than opening the chest, a replacement valve is placed inside a damaged aortic valve. How it helps: The new valve regulates blood flow for people with symptomatic aortic stenosis or those seen as intermediate or high-risk valve replacement patients. Check with your doctor or cardiologist to see if you might be a candidate for this procedure. LEFT ATRIAL APPENDAGE CLOSURE What it is: The LAA, or left atrial appendage, is a small ear-shaped sac in the muscle wall of the left atrium. This surgery closes the LAA off from the atrium. How it helps: Those with atrial fibrillation may have blood collect in the LAA to potentially form clots, increasing the potential for a stroke. LAA closure may be recommended for some of these patients. CORONARY ARTERY BYPASS GRAFTING What it is: An open-heart surgery where an artery is relocated from the chest wall and stitched to the coronary artery. How it helps: This procedure could be beneficial for those with severe coronary artery blockages, one of the primary causes of a heart attack. SURGICAL VALVE REPLACEMENT What it is: An open-heart surgery where an artificial valve replaces a damaged native valve. The most commonly replaced valves are the aortic and mitral valves. How it helps: Helps those with aortic valve stenosis or valve regurgitation to avoid heart failure. Sources: Dr. Ashish Pershad, M.D., Healthline, WebMD, American Heart Association

>> HEART continued from page 9

rehab schedule and it helped me regain my strength to spend time with my family.”

Long-term outlook

Today, John takes more than a dozen daily medications to treat congestive heart failure, post-polio syndrome and sleep apnea, but is feeling well. He spends four hours a week volunteering at Banner Heart Hospital, a promise he made to the staff just days before he received his new heart. While he knows his limits, and is restricted from lifting more than ten pounds, John is able to do some chores around the house and is hopeful he can start playing golf again with his wife, Kim. He is optimistic about his future and encourages others with heart disease not to give up. “Listen to what your doctor says,” he added. “You’ll get through it.”

Do you have a story to share about something you read in this magazine? Let us know! Call (602) 747-7990 or (888) 7477990 or email HealthSmarts@ |



Home heart

monitoring The importance of caring for your heart

By Julie Maurer Feel a fluttering in your chest? Your physician may send you home with an electrocardiogram monitor, also known as an EKG monitor, to check if your heart is the cause. “If we have a patient who is concerned about an irregular heartbeat, we would send them home with one,” said Paul Hurst, MD, chief medical officer at Banner Heart Hospital. “You may have the symptoms, but it could not be related to the heart at all.” He noted that fluttering in the chest may not be related to heart problems, but it is important to determine if there is a cardiac concern. “Sometimes it can be insignificant, other times it can put someone at risk for stroke or sudden collapse and

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even death,” Dr. Hurst said. “With the EKG monitors we can determine the risk and treat it appropriately.” Home-based EKG monitors are now more efficient, connecting with your smart phone and sending data directly to your physician. Dr. Hurst recommends the AliveCor app. “It’s very accurate and allows patients to record an irregular heartbeat when they have a symptom,” he noted. There are different kinds of EKG monitors, some a patient wears 24-hours a day with a band around or monitor leads on their chest, and some that they carry in their pocket to pull out when they have symptoms. “They hold the device in each hand to be able to record the heart beat,” Dr. Hurst said.

He added that in some instances, a cardiologist can implant a small device under a patient’s skin in the chest to measure the rhythm. Physicians prescribe at-home EKG monitors, and they are not typically for long term use. Most patients have them for a couple of weeks to a few months at a time. Dr. Hurst noted there are many options, so patients can find the right type of monitor best suited for their cardiac needs. “The first consideration is whether they really need it — talk with your health care provider,” Dr. Hurst said. “If you do, then the patient should discuss with their doctor which kind works the best for them.” For patients with a known heart rate issue, such as atrial fibrillation, there are ways to monitor your heart rate with over-the-counter tools, such as a wrist band. “The EKG monitors measure electrical activity of the heart and are the most accurate, which is why it is prescribed by your physician,” Dr. Hurst said. “The wrist band measures the heart beat with a pulse of light and is less accurate, and is used mostly for the patient’s personal tracking of their heart rate. We don’t collect that data.” High blood pressure patients can also monitor their condition by using devices at home. “The blood pressure cuffs around the upper arm are more accurate than the ones that go on the wrist or finger,” Dr. Hurst said. Patients who have a heart condition or suspect they may have one should discuss with their physician how they can best monitor their health at home.


On the road to healthy Cardiac rehab vital for living an active life

By Susie Steckner If you’ve suffered a cardiac event, like a heart attack, the road to recovery could be complicated. Cardiac rehabilitation, otherwise known as cardiac rehab, could be the key to improving your health. A combination of monitored exercise and life-changing education as prescribed by a patient’s cardiologist or primary care doctor, cardiac rehab focuses on getting your entire cardiovascular system back into shape. Patients who participate in cardiac rehab at Banner Heart Hospital in Mesa have access to a complete gym. It’s there that medical staff work with patients who are hospitalized, as well as people receiving outpatient care, to help them recover from surgery or any heart-related medical treatment. “Our ultimate goal is to provide a safe environment and teach patients how to live heart healthy for the rest of their lives,” said Lucy Williams, an exercise physiologist at Banner Heart Hospital who has worked with cardiac rehab patients for the past 12 years. According to the American Heart Association, cardiac rehab is good for a number of reasons. Heart patients who participate in this medicallysupervised program could experience such things as an increase in energy, weight loss, and a decreased risk of a future cardiac event. In addition, the program encourages and educates patients on how they can manage their risk factors so they can make better choices when it comes to their

own heart health. In order to qualify for cardiac rehab, patients must have a referral from their doctor and a qualifying diagnosis or surgical event such as heart attack, heart bypass surgery, heart valve replacement surgery, stable angina and others. If you are a cardiac patient, talk to your doctor to see if participating in a cardiac rehab program is right for you. Depending on your insurance, Medicare allows up to 36 sessions as long as the patient shows progress. Banner Heart Hospital is one of the largest free-standing heart hospitals in the nation. The hospital’s cardiac rehab program is tailored to individual patient needs and is designed to help patients recover from a heart event or surgery. Cardiac rehab is also available at other Banner Health hospitals in Arizona including: ■■Banner Boswell Medical Center Sun City ■■Banner Del E. Webb Medical Center–Sun City West ■■Banner Desert Medical Center Mesa ■■Banner Thunderbird Medical Center–Glendale

■■Banner–University Medical

Center Phoenix ■■Banner–University Medical Center Tucson Cardiac rehab is a team effort; a comprehensive approach to recovery. Patients take part in a combination of EKG-monitored exercise, educational classes focused on topics such as heart healthy eating and strategies to reduce stress, Williams said. Patients also learn about their individual cardiac events and procedures, as well as the signs and symptoms to watch for in the future. “Cardiac rehabilitation is a very important part of a patient’s recovery,” Williams said. “In fact, cardiac rehabilitation is now considered a class 1A treatment (the highest recommended level of treatment). This means cardiac rehabilitation is just as important as life-saving medications like beta-blockers and statins.” Williams added, “We want to see our patients gain confidence after a cardiac event and get back to or start living an active life.” |



Almond and Lemon Crusted Fish with Spinach

Healthy eating, healthy heart By Michelle Jacoby When properly cared for, the heart can run like a well-oiled machine, tirelessly pumping vital oxygen throughout our bodies and ensuring good blood circulation. But all machines, including your heart, require the proper “fuel” to keep them running smoothly. But when it comes to making sure your body has what it needs for a healthy heart, what you eat is even more important than making necessary lifestyle changes. “Diet plays a very important role in maintaining good heart health,” said Margaret O’Brien, registered dietitian and certified diabetes educator with Banner Health Network.

Food is fuel

According to research funded by the American Heart Association (AHA), cardiovascular disease—including coronary heart disease, high blood pressure, and stroke—remain the leading cause of death in the U.S. as of 2017. While this statistic may be sobering, there is good news. Additional research shows the AHA’s healthy diet score has improved in both children and adults—largely due to increased consumption of whole grains, fruits and vegetables; and a decrease in sugar-sweetened bever-

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age consumption. “While more whole grains and produce, and less sugar, contribute to a healthy heart, we also know that trans fats and saturated fats, and foods high in cholesterol and sodium can contribute to an unhealthy heart,” said O’Brien. Limiting how much saturated and trans fat you eat is an important step to reducing blood cholesterol, which can build plaque in your arteries and increase risk of heart attack and stroke. The best way to reduce these fats in your diet is to limit solid fats, like butter, margarine and shortening, when cooking and eating. Other tips include trimming extra fat off meat, choosing lean meats and checking food labels for words like “partially hydrogenated.”

Back to basics

While it may be challenging to change your eating habits, once you know which foods to eat more of and which foods to limit, you’ll be on your way to a heart-healthy diet. “It’s all about balance,” said O’Brien. “Heart-healthy foods aren’t radical, unconventional foods you can’t find at the grocery store. In fact, it’s the opposite. You can find lean meats, chicken, fish, whole grains,

Zest and juice of 1 lemon, divided 1/2 cup sliced almonds, coarsely chopped 1 tbsp finely chopped fresh dill or 1 tsp. dried 1 tbsp plus 2 tsp. extra-virgin olive oil 1 tsp kosher salt Freshly ground pepper to taste 1-1/4 lbs cod or halibut, cut into 4 portions* 4 tsp Dijon mustard 2 cloves garlic, slivered 1 lb baby spinach Lemon wedges for garnish Preheat oven to 400 degrees. Coat a rimmed baking sheet with cooking spray and place fish on sheet, spreading each portion with 1 tsp mustard. In a small bowl, combine lemon zest, almonds, dill, 1 tbsp oil, 1/2 tsp salt and pepper. Divide the mixture among the fish portions, pressing it onto the mustard. Bake the fish until opaque in the center, about 7 to 9 minutes. Meanwhile, heat the remaining 2 tsp oil in a Dutch oven over medium heat. Add garlic and cook, stirring, until fragrant but not brown, about 30 seconds. Stir in spinach, lemon juice and the remaining salt; season with pepper. Cook, stirring often, until the spinach is just wilted, 2 to 4 minutes. Serve the fish with the spinach and lemon wedges. Source: Eating Well * Look for U.S. wild-caught Pacific halibut, U.S. Pacific cod or Atlantic cod from Iceland and the northeast Arctic.

olive oil and fresh fruit and vegetables at any supermarket.” O’Brien cites two diet plans that are focused on heart health: the Mediterranean diet, which emphasizes eating primarily plant-based foods and decreases the risk of heart disease; and the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes portion control and nutrient-rich foods, and helps lower blood pressure. “Both diet plans tout small changes and attainable goals. It’s about sustaining the changes, then making more as you become more comfortable,” she says. “Even if you incorporate elements of them, you’re still going forward.”

Crossword PUZZLE NAME OF CROSSWORD ACROSS 1 Kept in shape 7 Fast-food acronym 10 S&L protector 14 Threat ender 5 1 16 17 18 19 20 23 26 27 28 29 0 3 31 32 33 37 38 39 40 41 43 44 45 46 47 48 51 52 53 6 5 57 58 62 63 64 65

(2 words) Gun owners’ org. Unthought-out List of typos Wolf, say Gen. Robert — — Long time (2 words) Censor Loop trains Stage awards Aberdeen kids Thousands of seconds Snowmobile part Luanda’s location CD- — Braced oneself Lassie’s refusal Yale athlete Home page address Strong alkali Tiara Commuter vehicle Run a fever Render assistance Magna — laude All, in combos Unmanned spacecraft Flight stat Thick carpets Unexpectedly (4 words) — — speed U.K. lexicon Light one’s fire Jeans partners 2001, to Livy Ms. Fawcett Shriveled from heat

6 Mach 1 exceeder 6 67 Rendezvous DOWN 1 Namath or Pesci 2 Bobby — of hockey 3 Belg. neighbor 4 Woodsy spaces 5 Legally impede 6 “Dizzy” of baseball 7 Pays homage 8 Noisy fights 9 Tigers, e.g. 10 Giveaway 11 Ocean, in Mongolian 12 Grenoble’s river 13 Board game 21 Muppet frog

2 2 23 24 25 29 30 32 33 34 35 36 42 46 47

Rustics Alps’ Mont — Veranda Lawn tool — up (in hiding) Play banjo What a —! City neighbor Animal that hisses Gazing at Reuben purveyors Last car on a train Kind of card Popular candy bar (2 words)

8 4 49 50 51 52 54 55 59 60 61

Sulks Kashmir cash Web-footed mammal Throat clearers Cake ingredient Alley yowlers Hitchhiker’s need 1040 org. Make doilies Codgers’ queries




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To find more classes near you, visit

Planning Ahead for Caregivers Thursday, March 22; 10 – 11:30am Mesa Red Mountain Library, 635 N. Power Road, Mesa Free, but registration is required—call (602) 839-6850. Alzheimer’s disease/dementia is a condition that can last for 8–10 years and will require additional help and care as the condition changes. Caregivers will learn about medical, legal and financial decisions that are needed, along with how to find help and pay for care in the home, community and residential settings. Brain Health Program, presented by Banner Alzheimer’s Institute Thursday, April 5; 9:30am – Noon Cahill Senior Center, 715 W 5th St., Tempe, AZ 85281 Free, but registration is required—call (602) 839-6850. Your brain is so much more than memory! In this program, learn about the different domains of your brain, such as cognition, language, attention visuospatial, executive function and, of course, memory. By starting with a discussion of the difference between ‘normal aging’ and something more serious and a self-assessment, the Brain Health Program can act as your ‘personal trainer’ by teaching you activities to aid in strengthening domains that you want to improve. Also reviewed are lifestyle factors related to brain health. At

the end of the Brain Health Program, participants will create an individualized action plan toward improved brain health. This program is designed for cognitively healthy adults. Note: You will also receive a Brain Health Program Self Evaluation form. This needs to be filled out prior to the class. Please bring the completed form to class. Behaviors: Expressing What Words Cannot Monday, April 23; 2–3:30pm Banner Sun Health Research Institute 10515 W. Santa Fe Drive, Sun City, AZ 85304 Free, but registration is required—call (623) 832-3248. This session reviews changes in communication as dementia progresses, and covers the most common types of behavior problems while posing a variety of solutions that caregivers can easily utilize.

For life’s potential emergencies

Have you ever wondered, is this an emergency? If you aren’t sure, or you need a nurse’s advice about where to get care, call us. We are here to help. 24 hours a day.

Banner Health Nurse On-Call: (602) 747-7990 or (888) 747-7990

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