healthmatters JEANES HOSPITAL
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Women and Heart Health: A Decade-by-Decade Guide
ALSO INSIDE ⑥ Diabetes: A Growing Problem ⑦ Knee Replacement Surgery Restores Patient’s Active Lifestyle www.jeanes.com
Women’s health matters
Women and Heart Health: From Your 20s to Your 60s—and Beyond
very minute, one woman in the United States dies from heart disease, while an estimated 43 million American women currently suffer from the condition, according to the American Heart Association (AHA). The risk of heart attack increases with age, but don’t wait until you’re older to put heart health on your radar. “It can take years for cholesterol to build up in the arteries, which may gradually block the blood supply to the heart or suddenly become unstable, break, and block the artery with a clot. Both of these situations may lead to a heart attack,” said Daniel Edmundowicz, MD, FACP, FACC, Chief of Cardiology at Temple University School of Medicine and Medical Director of Temple Heart and Vascular Center. Meanwhile, prevention is key. What can you do to beat the nation’s No. 1 killer? Here’s a decade-by-decade guide to keeping your heart healthy. YOUR 20s AND 30s: LAY THE GROUNDWORK FOR GOOD HEALTH What’s happening now: During your prime child-bearing years, you’re not likely to have any significant cholesterol buildup or blockage in your arteries because estrogen, a hormone that helps keep arteries flexible, is plentiful. Moreover, said Dr. Edmundowicz, “Your chance of developing clinical heart disease is related to how long you’re exposed to abnormal levels of risk factors (like high cholesterol) or bad habits (like smoking), and how susceptible you are to them.” Developing lifelong healthy habits now can help keep your arteries clear. Take-charge tactics: Practice a heart-healthy lifestyle. Lay the foundation for a healthy future by exercising at least 40 minutes three or four times a week, not smoking, and eating as much as possible a diet loaded with fruits, vegetables, whole grains, lean protein (such as fish), and healthy unsaturated fats (like olive oil). “It’s easy to be lax about living a healthy lifestyle when you are younger because the effects are not immediate, but the damage is still occurring,” noted Heather Rudalavage, RDN, a registered dietitian and nutritionist at Temple Health Women’s Care at Elkins Park. “But if you start practicing healthy habits now, you are more likely to stick with them throughout your lifetime.”
health matters // Winter 2014
Get a checkup. Even though the risk of heart disease is low now, you can still have high LDL (“bad”) cholesterol or high blood pressure, especially if these conditions run in your family. If that’s the case, work with your health care provider to tailor a prevention plan. “If your LDL cholesterol level is high in your 20s, there are healthy habits that might be easier to adopt before you may need cholesterol-lowering statin medication to get things under control,” Dr. Edmundowicz noted. Statins have been proven to decrease the risk of heart disease, as have ACE (angiotensin-converting enzyme) inhibitors for blood pressure control. Talk to your doctor about birth control. Oral contraceptives can increase blood pressure. Talk to your doctor about options that don’t put your heart health at risk. YOUR 40s: KEEP UP THE GOOD WORK What’s happening now: Unless you enter menopause in your 40s, your risk of heart disease generally remains low throughout this decade. Still, when you’ve got a family, perhaps aging parents to look after, and a hectic work schedule, it’s easy to let your health — and healthy habits — slide. Take-charge tactics: Put yourself at the top of your to-do list. Get yearly checkups so you can keep tabs on important numbers, such as cholesterol, triglycerides (a type of fat found in the blood), body mass index (BMI), and blood pressure. According to the Healthy Women Study, which Dr. Edmundowicz collaborated on, a woman’s LDL cholesterol levels in her 40s were more predictive of whether she was going to develop artery-clogging plaque after menopause than her LDL cholesterol levels during menopause. Here’s an overview of the numbers you need to know and your goals: • Total cholesterol: Less than 200 mg/dL • HDL (“good”) cholesterol: 50 mg/dL or higher • LDL (“bad”) cholesterol: Less than 100 mg/dL • Triglycerides: 150 mg/dL or less • BMI (the numerical value of your weight in relation to your height): Less than 25 To determine your BMI, visit www.heart.org or www.jeanes.com and search for “BMI calculator.”
• Fasting blood glucose: Less than 100 mg/dL • Blood pressure: Less than 120/80 If your doctor decides your risk for heart disease is high based on these and other factors, you may need to take steps to improve your health. This could include changing your diet, exercising, or even taking cholesterol-lowering statin medication. Talk to your doctor about your pregnancy history. Why is your pregnancy history important? According to the AHA guidelines for preventing cardiovascular disease, women who developed preeclampsia (pregnancy-induced high blood pressure) have double the risk of heart disease and stroke five to 15 years after pregnancy. “Having an issue with blood pressure or blood sugar during pregnancy puts you at higher risk for heart disease later in life,” Dr. Edmundowicz explained. Your doctor may want to monitor your blood pressure and blood sugar closely.
Daniel Edmundowicz, MD, FACP, FACC Chief of Cardiology at Temple University School of Medicine and Medical Director of Temple Heart and Vascular Center
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Heather Rudalavage, RDN Registered Dietitian and Nutritionist at Temple Health Women’s Care at Elkins Park
Women’s health matters
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YOUR 50s: KICK YOUR HEART HEALTH PLAN INTO HIGH GEAR What’s happening now: After menopause, at around age 54, the risk of heart disease rises. With the loss of estrogen, blood pressure tends to go up, along with both LDL cholesterol and triglycerides, while HDL (“good”) cholesterol declines or remains the same. Take-charge tactics: Don’t ignore troubling symptoms. If you have symptoms of heart disease, such as angina (tightness, pressure, or discomfort in your chest when you’re exercising or when you’re stressed), see your doctor. Seeking prompt medical treatment can help ward off a heart attack. Realize that women, more than men, may not have these typical symptoms. Instead, women may have less common signs such as extreme breathlessness, or abdominal or other gastrointestinal discomfort. Seek out silent disease. Even if you feel fine, you can still have heart disease that’s not yet causing symptoms. “Risk assessments, such as the Framingham Risk Scores, which doctors use to determine a patient’s individual risk of heart disease, can underestimate the risk of heart disease in women,” Dr. Edmundowicz noted. To detect any abnormalities, your doctor can do a physical exam and listen to the arteries in your neck and legs for sounds indicating turbulence in blood flow, caused by narrowing of the arteries. Also, ask your doctor about ankle brachial indexing, which compares the blood pressure measurement in the arm to that in the leg. “Typically, blood pressure is always a little higher in the legs than in the arms,” Dr. Edmundowicz noted. A reversal — that is, having higher blood pressure in the arms — could mean greater risk of heart disease. Another test to inquire about: a lowdose, non-contrast CT scan of your
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heart, which measures calcified plaque deposits in your arteries. A high calcium score indicates a high risk for heart disease. “These noninvasive tests are especially beneficial for women older than 55 without cardiac symptoms who don’t have other risk factors,” Dr. Edmundowicz said. YOUR 60s AND BEYOND: DON’T LET YOUR GUARD DOWN What’s happening now: The risk of heart attack is higher at this stage. The average age for a first heart attack is 70.3 years for women. The good news is you can still reduce your risk. Take-charge tactics: Exercise all of your options. In addition to exercising regularly, try to add more physical activity into your day. Take the stairs instead of the elevator, or run errands on foot. Keep close tabs on your risk factors. The numbers you started tracking in your 40s — blood pressure, cholesterol, and more — are especially meaningful now since the probability of heart attack is greater. Talk to your doctor about ways to keep these numbers under control.
Tailor a treatment plan. Work with your doctor to develop a personal treatment or prevention plan to manage your risk factors. Follow up as often as recommended, too, to make sure any medical interventions your doctor suggests are working.
SKILLED CARDIAC CARE FOR WOMEN For information on cardiology services or to make an appointment, contact: Temple Health Women’s Care at Elkins Park www.templehealthwomens.org 215-517-5000 Jeanes Hospital www.jeanes.com 215-728-CARE (2273)
Urgent Care health matters
When You Need Care Quickly...
llnesses and emergencies don’t always happen during doctor’s office hours. Fortunately, there are other places to seek medical care, too. But it can be confusing to know when you should head to an urgent care facility and what conditions are best treated at an emergency room or a trauma center. Here’s a quick guide to help you understand which to choose. URGENT CARE CENTER Temple ReadyCare is an example of an urgent care facility, which offers walk-in treatment for most non-life-threatening illnesses and injuries. That includes minor burns or injuries, sprains and strains, cold symptoms, minor allergic reactions, earaches, fever or flu-like symptoms, rash or other skin irritations, mild asthma, animal bites, and broken bones. Many of these centers also provide routine medical care, such as flu shots, wellness checkups, school physicals, and even X-rays. “We don’t provide ongoing medical care,” commented Marc P. Hurowitz, DO, MBA, FAAFP, the CEO of Temple Physicians, Inc. “Chronic conditions, such as diabetes or hypertension, are best treated by a primary care doctor.” Temple ReadyCare is staffed by Temple physicians seven days a week, including weekday evenings and most holidays. For a list of Temple ReadyCare hours at any of its four locations, visit www.templereadycare.com. EMERGENCY DEPARTMENT Emergency care, such as that provided by Jeanes Hospital’s Emergency Department, is designed for people with life-threatening symptoms, including chest pain or pressure, uncontrolled bleeding, sudden or severe pain, coughing or vomiting blood, difficulty breathing or shortness of breath, sudden
dizziness, weakness or changes in vision, and changes in mental status, such as confusion. “Emergency department patients may require a more intensive evaluation, laboratory work, X-rays, or CT scans,” said Dana Weber, MD, Chair of Emergency Medicine at Jeanes Hospital. If your symptoms are severe — for example, if you suddenly have weakness on one side — don’t drive yourself or ask to be driven to the emergency department. Instead, call 911 and wait for the emergency medical services team to arrive. “If something should happen in the ambulance, emergency medical personnel have equipment to evaluate and initially treat the issue,” Dr. Weber said. Emergency departments are staffed around the clock. For more information on emergency care at Jeanes Hospital, visit www.jeanes.com.
Center at Temple University Hospital, provides treatment for catastrophic injuries, such as those resulting from motor vehicle accidents, fire, gunshot wounds, and industrial accidents. Don’t worry about getting yourself there. Patients don’t walk into trauma centers; they’re transported to one by ambulance or helicopter. Unlike a regular hospital emergency department, trauma centers must have a certified trauma surgeon available in the building 24/7 so that patients can immediately be taken to the operating room, if necessary. For more information about trauma services at Temple University Hospital, visit www.tuh.templehealth.org.
CONVENIENT CARE RIGHT IN YOUR NEIGHBORHOOD Temple ReadyCare offers four easy-to-access locations. No appointment necessary. • Ft. Washington » 215-540-8404 • Jenkintown » 215-884-3800 • Northeast Philadelphia » 215-677-1475 • Port Richmond » 215-926-3535
TRAUMA CENTER A trauma center, such as the Trauma
Marc P. Hurowitz, DO, MBA, FAAFP CEO of Temple Physicians, Inc.
Dana Weber, MD Chair of Emergency Medicine at Jeanes Hospital
Diabetes health matters
To make an appointment with an endocrinologist at Jeanes Hospital, call 215-728-CARE (2273).
A Growing Problem
uring the last 30 years, the number of Americans diagnosed with diabetes has soared to now more than 25 million. Here’s a look at what you should know about both type 1 and type 2 diabetes.
David Ni, MD Endocrinologist at Jeanes Hospital and Fox Chase Cancer Center
TYPE 1 AND TYPE 2: THE BASICS Most of the food we eat gets turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ near the stomach, contains beta cells that produce insulin, a hormone that helps glucose get into cells. Type 1 diabetes is a genetic condition where the body attacks its own beta cells and the pancreas stops producing insulin. About 5 percent of all diagnosed diabetes cases are type 1. Although not preventable, type 1 can be managed with a combination of insulin therapy, nutrition, and frequent monitoring to keep blood glucose levels within healthy ranges. The majority of diabetes cases, however, are type 2, where cells resist the insulin the pancreas makes. Because lifestyle choices play a major role in type 2 diabetes, management typically focuses on healthy diet and exercise habits. Some people may also need oral medications or injectable insulin. DIAGNOSING DIABETES Signs of both type 1 and type 2 diabetes include frequent urination, being unusually thirsty, extreme
health matters // Winter 2014
hunger, unusual weight loss, extreme fatigue, and irritability. People with type 2 diabetes may also have frequent infections, blurred vision, cuts or bruises that are slow to heal, tingling or numbness in their hands or feet, and recurring skin, gum, or bladder infections. But some people with type 2 may not have any symptoms at all. Without proper management, both type 1 and type 2 diabetes can increase the risk for many serious complications such as nerve damage, kidney failure, heart disease, stroke, vision problems, foot problems, and possibly even amputation. With type 2, there are steps you can take to reduce your risk of developing the disease. “Lifestyle intervention is the most effective way to prevent this disease,” said David Ni, MD, an endocrinologist at Jeanes Hospital and Fox Chase Cancer Center. In fact, a study of people at risk for type 2 diabetes, conducted by the Diabetes Prevention Program and funded by the National Institute of Diabetes and Digestive and Kidney Diseases, found that those who dieted and exercised were twice as unlikely to get the disease, compared to those who took preventive medication. Maintaining healthy lifestyle habits is equally important for people living with type 1. MAKING HEALTHY CHOICES To prevent type 2 diabetes, take these steps: • Guard against weight gain. “Obesity is a big culprit for causing and complicating diabetes,” Dr. Ni said. The hormones that fat cells secrete can interfere with your body’s ability to use the insulin it produces. Excess weight also causes sleep apnea, which contributes to several factors, such as an increase in the stress hormone, cortisol, which can raise blood sugar levels. Keeping your weight under control can make a big difference. To purge excess pounds, watch portion sizes and stay away from sugary, high-carbohydrate snacks and beverages. • Get moving. Physical activity helps lower blood glucose levels by pulling glucose out of your bloodstream. To reduce your risk of type 2 diabetes, “exercise for half an hour a day, five times a week,” Dr. Ni said.
A Patient’s Story health matters
Knee Replacement Surgery Restores Patient’s Active Lifestyle
urrently, about 27 million Americans live with osteoarthritis (OA), a potentially debilitating disease in which cartilage — the tissue that cushions the ends of joints — breaks down over time, according to the Centers for Disease Control and Prevention. If you’re among them, don’t wait to take action. That’s the advice that James “Skip” Montell, a 57-year-old administrative assistant for a Philadelphia Common Pleas Court judge, would give to anyone with OA who is considering total joint replacement—a procedure where an arthritic or damaged joint is removed and replaced with an artificial one. Montell speaks from experience, having undergone a double-knee replacement at Jeanes Hospital in June 2013. “I should have had the surgery five years ago,” said Montell, who worked for the Philadelphia Housing Authority until five years ago, when he retired from the industry. “When you work construction, you’re always carrying heavy stuff. The wear and tear on my body just caught up with me,” he said. His knees continued to bother him, despite shots of cortisone and Synvisc (a medication injected into the knee to replace the lubricating synovial fluids found in this joint), as well as pain relievers and numerous scoping procedures to ease the discomfort. “As an active person, I had a hard time riding my bike. I couldn’t swim, either,” he said. Simple things like walking up and down stairs were difficult, too. Several months after having surgery, however, Montell is back to his active lifestyle. “I walk a lot,” he said. “I’m back to all the normal activities I used to do and I haven’t taken a Motrin in months. I can even take the steps without pain. It’s wonderful.” BIG-CITY EXPERTISE WITH A PERSONAL TOUCH Joint replacement surgery is a specialized procedure that requires a high level of skill. In addition to the clinical expertise of experienced surgeons and a team of dedicated nurses and rehabilitation specialists, patients at Jeanes Hospital have the added benefit of a personal touch. Instead of being handed off to multiple fellows throughout their Gary W. surgical experience, patients are Muller, MD treated by the same orthopaedic Orthopaedic surgeon from the initial consultation, Surgeon at preoperative preparation, and Jeanes Hospital surgery, to post-surgical follow-up, and rehabilitation.
Before surgery, riding his bike was a painful prospect, but now biking is a breeze for James “Skip” Montell, thanks to personal dedication and surgeon Gary W. Muller, MD.
WE’RE HERE FOR YOU Jeanes Hospital provides personalized orthopaedic care for the full spectrum of musculoskeletal conditions and injuries, from arthritis, back pain, fractures, dislocations, osteoporosis, and sports injuries to joint replacement and special procedures for the hand and spine. To make an appointment, call 215-728-CARE (2273).
“You get a lot of individual care at Jeanes Hospital,” said Gary W. Muller, MD, an orthopaedic surgeon who has practiced at Jeanes Hospital for 32 years. GETTING PATIENTS INVOLVED For joint replacement surgery to be successful, however, patient education — and involvement — is key. Before surgery, people are encouraged to attend an hour-long total joint replacement education class at Jeanes Hospital. The class covers the benefits of the surgery and what to expect both in the hospital and after discharge. It also includes a tour of the orthopaedic unit and a question-and-answer session. During rehabilitation, patients are prescribed exercises to do between physical therapy sessions to help them get back on their feet faster. “I tell my patients that joint replacement is a two-person operation. I do my part, but the rehab and the exercises afterwards are up to you,” Dr. Muller said. In other words, you’ll need to do your homework.
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“AFTER HAVING THE
CHANCE TO LOSE SO MUCH WEIGHT, I CAN SAY THE COMMITMENT IS WORTH IT.”
Today, he is more than 115 pounds lighter, and has embraced his new lifestyle, visiting the gym more often, consuming smaller portions, and eating healthy. “They call me ‘skinny’ at the office now, and that’s a great feeling,” he said. He’s also off his blood pressure medication and he’s out of the diabetes danger zone.
Jeanes Hospital, the only Quaker-founded acute care hospital in the United States, is part of Temple Health. The hospital provides communities in Northeast Philadelphia, Montgomery County, and Bucks County with advanced medical, surgical, and emergency services. Health Matters is published quarterly by Jeanes Hospital to provide its community with health, wellness, and safety information; however, it does not replace the advice of your physicians. You should always consult your physician regarding any medical concerns and before making any changes in your lifestyle, physical activities, or treatment plan. If you would like to be removed from our mailing list, call Jeanes Hospital at 215-728-3313 and request removal from Health Matters distribution.
BARIATRIC SURGERY CHANGED SEAN’S LOOK, HIS HEALTH, AND HIS DIRECTION. Before Sean underwent weight-loss surgery at Jeanes Hospital, the 40-year-old telephone company account manager was 100 pounds overweight, packing 327 pounds onto his 6'2" frame. He also had prediabetes and high blood pressure that required medication to control.
Sean before surgery
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Published on Jan 3, 2014