The Heart of Jacksonville | Issue 8

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HEART THE

OFJACKSONVILLE ISSUE 8 | 2020

COVID-19 & Heart Disease: What You Need to Know

IN THIS ISSUE: What You Didn’t Know About Heart Attacks Vaping: Facts & Fiction A PUBLICATION OF

Jacksonville’s Top Walking Trails


ISSUE 8 2020

CONTENTS FEATURES: 4

Letter From The President

17

Patient Testimonials: What Our Patients Are Saying

28

Social Media Recap: Team Pictures

31

Word Search

Back Cover Screening Packages

Back to Better: Therapy for Military Families and Veterans

Find your care: Cohen Clinics provide individual, couples, family and group therapy for active duty military, National Guard/ Reserves, post-9/11 veterans and all military families.

The Steven A. Cohen Military Family Clinic at Centerstone, Jacksonville 7011 A. C. Skinner Parkway Jacksonville, FL 32256

(904)431-3500

centerstone.org/cohen

SERVICE LINES: 5 10 12 14 18

What You Didn’t Know About Heart Attacks Fact or Fiction? What You Need to Know About Vaping The Latest Clinical Research at FCCI Bulging Veins: Not Just a Cosmetic Problem Covid-19 and Heart Disease

HEALTHY LIVING:

18

COVID-19 and Heart Disease

6 8 22 24 26

Recipe: Smoothies Jacksonville’s Top Walking Trails Healthcare Buzzwords Defined Heart Healthy Lunch Ideas Preventing Heart Disease at Any Age

PROVIDER’S SPOTLIGHT: 9 13 16 20 21 30

Fast Facts: Find Your Calling Dr. Sumant Lamba Fast Facts: Sleep it Off! Dr. Daniel Thielemann Behind the White Coat: Dr. Ahmad Younes We Asked Our Providers: How do you De-stress? Fast Facts: Breakfast Is The Most Important Meal of The Day Dr. Ibrahim Fahdi Doc Favorites: Q&A


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PHYSICIAN’S SPOTLIGHT

Letter from the Dr. Yazan Khatib

PRESIDENT

No one could have seen 2020 coming. Certainly, when we sat down with the team in the beginning of the year to plan out our initiatives, goals and challenges, a pandemic was not on the agenda. Our hearts are with every individual who has lost a loved one as a consequence of this terrible disease. We are thinking of those who lost their jobs and healthcare coverage, as a direct result from COVID-19. Our respect is with the healthcare staff and all essential workers that have worked tirelessly to continue caring for our community, no matter how exhausting. This pandemic has taught us so much about who we are and who we want to be. While we always thought of ourselves as an innovative group, these times proved just how quickly we adapt. We went from doing a few televisits a year to over 500 televisits a month. We went from using televisits for basic follow ups and medication management to utilizing televisits for new patient visits. I am truly thankful for every member of our team for being so adaptive. I remember one particular incident when a patient drove to our office for his appointment. As he sat in the parking lot, he became very hesitant to leave his car. One of our physicians actually went out to his vehicle and conducted the appointment while the patient stayed in the car. We have always put patient convenience and comfort first. This moment was a true testament to that. I also want to remind everyone that in the face of this pandemic, let us not forget about the even bigger threat. Heart disease kills over 80,000 individuals in the US every month. Let us continue practicing prevention, not just for COVID-19, but for heart disease. Flip to page 24 for some heart healthy lunch ideas. Page 26 will give you ideas on how to tackle heart care at any age. We hope you find this magazine to be a resource for you during these challenging times. Thank you for tuning into issue 8 of The Heart of Jacksonville! Stay safe, First Coast. Sincerely, Dr. Yazan Khatib President of First Coast Cardiovascular Institute Interventional Cardiologist & Endovascular Specialist

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What You Didn’t Know About Heart Attacks We have all heard of heart attacks and the common symptoms that occur. However, what you may not know is that heart attacks actually come in different shapes and sizes. There are different types of heart attacks; each with their own severity, symptoms, and urgencies.

STEMI A STEMI means that a complete blockage has occurred in a coronary artery. According to Harvard Health, this means heart muscle cells cannot receive the oxygen and energy they need to function, causing cells to die. A STEMI should be treated immediately.

NSTEMI Different from a STEMI, this type of heart attack involves a partial blockage of the artery. Therefore a shortage of oxygen and energy is less severe than in a STEMI. NSTEMI can also be treated with urgency, but not all the time, according to Harvard Health.

Coronary artery spasm This type of heart attack is less common. It involves the coronary arteries constricting, or spasming. Over an extended period of time, a heart attack can occur. A coronary artery spasm is typically detected through an imaging exam that sees your blood vessels, called an angiogram.

Silent heart attacks A silent heart attack occurs with no symptoms. This can happen to anyone but generally speaking, is more common in women and diabetics, according to Cleveland Clinic. However, just because it is silent does not mean it is any less dangerous.

MINOCA (Myocardial Infarction in the absence of obstructive coronary artery disease) This type of heart attack is less common, accounting for only 5-6% of all heart attacks. This form of heart attack is particularly unique because a cardiac cath will not show any signs of blocked arteries. Instead, MINOCA is determined based on irregularity in blood enzymes indicating damage to the heart muscle. MINOCA is more common in young patients as well as females, according to Cleveland Clinic.

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RECIPE

Mixed Berries Smoothie (221Kcal)

Did you know? Frozen fruits are frozen very shortly after harvesting, allowing them to fully ripen and reach their nutritional peak. This means that they are full of vitamins, minerals, and antioxidants.

Flavorful Smoothie Bowl

Tropical Smoothie

(400-600kcal)

(200kcal)

Base

• 1 cup frozen mango chunks

• 1 ½ cups frozen mixed berries

• 1 cup frozen strawberries

• 1 ½ banana

• 1 frozen banana sliced

• 2 tbsp peanut butter

• ½ cup milk (can substitute for almond milk)

• ½ cup of almond milk

• ½ cup water (can use coconut water too)

Toppings:

• ¼ cup orange juice (freshly squeezed)

• Fresh berries

• ¼ cup Greek yogurt (can substitute for almond or coconut yogurt)

• Banana slices • Chia seeds • Ground flax seeds Smoothie bowls are a refreshing option for a full meal, packed with vitamins and antioxidants. Adding nuts and different types of seeds can add healthy omega-3s to the mix, promoting brain health and fighting inflammation.

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• 1/2 cup of milk (can use regular milk or almond milk to cut down calories) • 1 banana • 1 ½ cups frozen mixed berries • ¾ cup Greek yogurt (can substitute for almond or coconut yogurt) Berries are very low calorie and nutritious as they are packed with vitamins and minerals. Strawberries are high in vitamin C, as 1 cup provides 150% of the recommended daily intake of vitamin C. Berries are also high in phytochemicals, which act as antioxidants.

Mangos contain a set of enzymes called amylases that break down complex carbohydrates into simple sugars. Moreover they contain plenty of water and dietary fiber, which aid in digestion.

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PHYSICIAN’S SPOTLIGHT

SERVICE LINE

Jacksonville’s Top

Walking Trails Physical activity is one of the best ways to get your heart pumping to improve your heart health. Walking is a great way to start! The American Heart Association (AHA) recommends 150 minutes of physical activity a week, which is about a 30-minute walk, five times a week. There are many trails around the First Coast to help you get started.

Jacksonville Arboretum & Gardens There are a variety of trails and nature walks that define the beauty of Jacksonville Arboretum & Gardens. Whether you are looking for a leisurely stroll or a challenging trail, there is something for everyone. The Lake Loop Trail is the easiest footpath. It is 0.3 miles long and encircles Lake Ray, a lake that is home to fish, turtles, amphibians, ducks, and other aquatic birds. Aralia Trail is one of the more difficult terrains, but the great scenery makes it worth it.

Jacksonville-Baldwin-Rail Trail If you are looking for history, you can find it at Jacksonville-Baldwin-Rail Trail. It houses the Camp Milton Historic Preserve, which was once the largest military camp of Confederate soldiers during the Civil War. Today, this beautiful trail has been transformed from an abandoned railway station to a walking trail covered by a 8 THE HEART OF JACKSONVILLE | Issue 8 2020

beautiful tree canopy–a haven for various wildlife including hawks, woodland storks, and stilts.

I live by the quote...

Castaway Island Preserve Castaway Island Preserve is the perfect place if you are looking for somewhere you and your dog can enjoy the outdoors. This 300 acre preserve lies along the intercoastal waterway and features a mile-long walk alongside vibrant flowers. There is even a wooden boardwalk that leads to an observation platform overlooking the waterway.

Julington-Durbin Creek Preserve The Julington-Durbin Creek Preserve offers more than just a hike. Visitors can take advantage of a wide range of outdoor opportunities including hiking, biking, horseback riding, and kayaking. There are many trails that delve into different natural landscapes, ranging from lower flatwood, sandhill, swamps, and marshes.

I slept and dreamt that life was joy. I awoke and saw that life was service. I acted and behold, service was joy.” – Tagore — Dr. Sumant Lamba

Issue THE HEART HEART OF OF JACKSONVILLE JACKSONVILLE Issue 88 2020 2020 || THE

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FACT OR FICTION:

What You Need to Know About Vaping

There is no doubt that smoking is one of the worst habits you can have for your health. Research suggests that you can undo years of damage when you quit. In recent years, vaping has come out as the newest and trendiest way to do it. However, all of the conflicting information around vaping has our heads spinning. We brought together research from the top organizations to determine: what is fact and what is fiction?

FICTION

FACT

FACT

Vaping is better for me than traditional cigarettes.

E-cigarette companies are allowed to advertise.

Most people that use e-cigarettes are young.

It is common for vaping to be used as an alternative to traditional cigarettes with the thought that it is less harmful. However, e-cigarettes still contain nicotine, the substance that makes cigarettes addictive. Nicotine has been shown to harden artery walls, which can lead to a heart attack, according to the American Heart Association. Additionally, e-cigarettes contain hundreds of harmful substances.

Advertising for traditional cigarettes has been banned for over 50 years, according to NPR. However, this ban does not apply to e-cigarettes and unfortunately many adults and teenagers are adversely affected by these advertisements. Young adults who see vaping advertisements in retail spaces are twice more likely to start vaping, according to a study in the Journal, Pediatrics.

Every day, nearly 3,500 young adults start vaping, according to the American Heart Association. What is most concerning about this staggering statistic is the effect this has on long term habits. Young adults who use e-cigarettes are more likely to smoke in the future, according to the CDC.

August 2019 marked the outbreak of e-cigarette, or vaping product use-associated lung injury (EVALI). Over 2,800 individuals were hospitalized and 28 deaths occurred with this outbreak, according to the CDC. E-cigarettes, or vaping, were found to be associated with most of these EVALI cases. While there remains much to be known about this outbreak, it does give us a hint of the potential catastrophic effects of vaping.

FICTION Vaping is a safe smoking cessation tool. It is true that vaping is often times used as a tool to help individuals lay off traditional cigarettes. Sometimes, vaping does succeed in helping people quit traditional cigarettes. However, there is simply not enough research to suggest that vaping is a safe smoking cessation tool. If you are looking to quit smoking, consider exploring other options such as joining a support group, going cold turkey, and talking to your doctor about additional resources that may be available to you.

As much remains to be known about e-cigarettes, our providers encourage everyone to tread with caution. We must remember that at one point in time, we did not know traditional cigarettes were harmful. Now, smoking is considered to be the leading cause of preventable deaths, according to the CDC. It will be awhile before we can successfully measure the long-term effects of e-cigarettes. In the meantime, use your healthcare provider as a resource.

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FAST FACTS

The Latest Clinical Research at First Coast Cardiovascular Institute (FCCI) One of the most important ways to advance medicine is clinical research. In 2007, FCCI established a clinical research department that has since enrolled nearly 3,000 patients. Housing research allows our patients to be the first to benefit from exciting new technology in the field. FCCI is proud to be taking part in the following research studies:

V-Wave Interatrial Shunt This is a minimally-invasive implanted interatrial shunt device intended for treating patients with severe symptomatic heart failure. The shunt is designed to regulate left atrial pressure, provide symptom relief, decrease hospitalizations, and improve quality of life.

CardioMEMS HF System This device is implanted in your pulmonary artery and takes daily pressure readings from the comfort of your home. The data is then sent wirelessly to your doctor for constant monitoring. The sensor is small and does not require any batteries or wires and does not interfere with any daily activities. This device has helped dramatically reduce heart failure-related hospitalizations.

Zilver PTX This is the world’s first FDA approved drug-eluting peripheral stent. Drugeluting stents are small mesh tubes with a coating that expends a drug over time to keep blockages from coming back. Zilver PTX is used for the treatment of restenosis in above-the-knee femoropopliteal arteries.

Sleep It Off

Detour System FCCI is the first clinic in Florida to perform the Detour procedure. It is intended for patients suffering from peripheral arterial disease with a blockage in the main artery of the thigh. The procedure provides a new way for blood to travel down the leg.

Life-Below the Knee (BTK) At the moment, there are limited treatment options for patients suffering from critical limb ischemia (CLI), a serious form of PAD. The Life-BTK study aims to change that with its new drug eluting stent. The ESPRIT BTK stent used in this study scaffolds the treated vessel, preventing acute recoils, eluting everolimus to reduce the vessel re-narrowing, and resorbs into tissue over time. The Life-BTK study provides a superior treatment for patients with CLI below the knee over previously used methods.

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PHYSICIAN’S SPOTLIGHT

Detour System

As a patient at FCCI, you may be asked to participate in a research study. A member of our Research Department will review the study with you and answer any questions you may have. To learn

Get 7-9 hours of sleep Getting the recommended 7-9 hours of sleep could do more than just make you feel refreshed. Consistently getting less than 7 hours of sleep can contribute to a myriad of heart conditions including stroke and coronary heart disease. So hit the snooze button again, your body will appreciate it.”

more, call our office at 904.493.3333.

— Dr. Daniel Thielemann

* CDC Issue 8 2020 | THE HEART OF JACKSONVILLE

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BULGING VEINS: IT’S TRUE— the blue, bulging

Not just a cosmetic problem Varicose veins also known as “chronic venous insufficiency” can be a serious issue of the legs. While the term varicose veins seem ominous, this disease can lead to an array of

veins- referred

medical issues.

to as varicose

carry more pressure on their legs such as

veins are often

extended periods of time, are more likely

associated with the elderly. Nearly a quarter of US adults have varicose veins. Many worry about the appearance of varicose veins, but there can be more to varicose veins than just a cosmetic concern.

According to Cleveland Clinic, those who being overweight, pregnant or standing for to be affected by varicose veins. Varicose veins can also be genetic, thus affecting women more than men.

Why Choose the Vein Center at First Coast Cardiovascular Institute (FCCI)? FCCI houses one of the most comprehensive venous teams in the area. The physicians at FCCI have been treating complex venous issues for over a decade in Northeast Florida. When you visit the Vein Center at FCCI, we are not just caring for your vein health; you are receiving a full assessment of all of your risk factors, signs and symptoms. This comprehensive approach to vein care is paramount to a successful treatment plan and long term prognosis.

How can you tell if your varicose veins are just

Our services take place in an outpatient setting, keeping your costs low and our services convenient. If you need a procedure, you will find our freestanding catherization laboratory is like no other. We have performed thousands of procedures in our cath lab with superior outcomes. Our lab offers lower out-of-pocket costs for patients, coupled with access and

a cosmetic problem or if they are indicating

comfort.

a vascular issue? Jason Roberts, Director of

Schedule your free vein screening.

While not all cases of varicose veins are dangerous, sometimes, varicose veins can signal a larger, vascular issue including, Deep Venous Thrombosis (DVT), Pelvic Congestion, May Thurner Syndrome, and Venous Stasis Ulcers.

our Vein Clinic, says to be on the lookout for symptoms, including:

• Increased swelling around your ankles • Pain • Hot or warm to the touch • Calf discoloration • Bulgy leg veins • Non-healing sores • History of DVT

We are proud to offer free vein screenings for our community. The test takes about 20 minutes and can determine your risk level for venous disease. The screening involves taking an ultrasound scan of the leg to assess vein function and identify vein blockages that could lead to vascular disease.

Call us at 904.493.3333 to schedule your free vein screening.*

*THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT.

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PATIENT TESTIMONIALS

PHYSICIAN’S SPOTLIGHT

ONLINE TESTIMONIALS

Behind the White Coat:

Patient reviews are the heart of our practice. Nothing is more heartwarming than seeing we made the experience of visiting a doctor’s office just a little bit easier.

Dr. Ahmad Younes Interventional Cardiologist & Endovascular Specialist As a child, Dr. Younes was sick and was constantly in the hospital. During one of his stays, Dr. Younes admired his physicians and was inspired by their ability to make patients feel better. After experiencing firsthand how a physician could change peoples lives for the better, Dr. Younes knew he wanted to be a physician. Years into his medical education, Dr. Younes experienced the sudden and traumatic death of his father. His father died due to an unexpected heart attack. At the time, Dr. Younes knew that the heart attack could have been prevented if his father’s health was checked regularly. Dr. Younes chose to honor his father by dedicating his career to cardiology and prevention. When choosing a sub-specialty, Dr. Younes chose interventional cardiology because of its potentially vast impact on the quality of life. As an interventional cardiologist at FCCI, Dr. Younes specializes in: • percutaneous coronary interventions • endovascular procedures leading to limb salvage 16 THE HEART OF JACKSONVILLE | Issue 8 2020

• pulmonary embolisms • catheter based treatments • venous disease management • IVC filter retrieval • carotid artery interventions • renal artery stenosis • aortic stenosis management with transcatheter aortic valve replacement (TAVR) • patent foramen ovale (PFO) • atrial septal defect (ASD) closure Dr. Younes recalls one particular patient where he experienced the true impact he was able to have on not just the patient, but her family. Dr. Younes was called to evaluate a young, pregnant woman with twins in the intensive care unit. The woman was suffering from a lifethreatening blood clot that went to her lungs, causing her to be in shock. Dr. Younes was able to extract the blood clot in the cath lab. He saved her and her twins’ lives. “It was the happiest moment in my career; when I saw her walking to my clinic on a later follow up, visiting with both of her babies.”

During this pandemic, the staff was

courteous, took all the precautions, and I was in and out in a timely manner.”

~A Healthgrades review

They are an excellent choice for your

cardiac & vascular issues. They have innovative & knowledgeable physicians. Everyone that works in this facility has a pleasant & caring

The doctor was absolutely amazing. I was so overwhelmed that I actually cried because he took the time to listen to me and talk to me about my health and didn’t rush me. I had almost lost faith and my determination. He reminded me that I’m a survivor and I (with his help) will fight. The office staff was also amazing. Very personable and smiling. They were knowledgeable and fast. Thank you!”

~ A Google review

personality.”

~ Facebook review

Very professional from the front office

throughout. I was very pleased at the service I received and the time I was given to ask all my questions and concerns.”

~ A Healthgrades review

I was very impressed with First Coast Cardiovascular Institute. From the time I walked in until the time I left, I was treated as if I was the only patient. I had little to no wait. The staff was great. I would recommend them to anyone. The doctor was wonderful.”

Very polite and professional; they made me feel that my health is a priority to them!” ~ Facebook Review

All of the people at First Coast Cardiovascular are kind, caring and always look out for the patient. I feel very well taken care of when I’m at their office. I would recommend them without reservation!” ~ A Healthgrades review

~ A Google review These reviews have been edited for spelling and grammar. Issue 8 2020 | THE HEART OF JACKSONVILLE

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SERVICE LINE

COVID-19 & HEART DISEASE: COVID-19 has significant impacts on us as a nation. Even for individuals who did not contract COVID-19, the pandemic may still have negative consequences on our health through an increase in unhealthy habits and fear of seeking treatment.

To date, there is no evidence that high risk patients are more likely to contract the virus. In this case, an ounce of prevention is truly more valuable than a pound of cure. Help reduce your risk for contracting COVID-19 through:

What if I have Heart Disease?

• Practice social distancing: at all times stay 6 feet away from others.

As you are aware through many CDC alerts, patients who are older and/or have underlying conditions, defined broadly as heart disease, diabetes, obesity, hypertension and others, are at increased risk to have complications if they contract COVID-19.

• Double down on personal hygiene: make sure you practice hand washing very frequently for 20 seconds each time with soap and preferably warm water. This becomes especially crucial after touching things/items that have been touched by others.

10% of COVID-19 patients with pre-existing heart conditions die, versus <1% of healthy individuals, according to Harvard Health. Moreover, these patients are also more likely to be hospitalized, with 40% of COVID-19 related hospitalizations being tied to cardiovascular disease or stroke, according to the American Heart Association.

• Do not share personal items: this includes towels, pens, utensils, food etc.

Although there is still much to be learned about COVID-19’s effect on heart conditions, we know that COVID-19 is likely to trigger:

• Wipe common surfaces frequently, including shopping carts, door handles, etc.

• Thrombotic Manifestations | abnormal clotting- complications can include heart disease or stroke. • Vascular inflammation | inflammation of the blood vessels, which can result in decreased blood flow • Myocarditis | inflammation of the heart muscle that can cause trouble for the heart in pumping blood • Cardiac arrhythmias | heart rhythm disorder than can cause your heart to beat too fast or too slow 18 THE HEART OF JACKSONVILLE | Issue 8 2020

• Wear a mask if you have to go out in public: Make sure the mask covers your nose and mouth and has two or more layers of washable, breathable fabric, according to the CDC.

• At the end of the day practice common sense and you will offer yourself and your family the best protection.

WHAT DO YOU NEED TO KNOW? attack patients dying at home. The American Heart Association says to be on the lookout for these potential heart attacks symptoms: • Shortness of breath • Chest pain • Pain or discomfort in the arms, neck, jaw, or stomach • Lightheadedness, vomiting or nausea If you are feeling any symptoms of a heart attack, do not fear going to the emergency room. Hospitals are a safe place to seek care.

Heart Health While Quarantining Another potential long-term effect of COVID-19 is the unhealthy habits we have fostered. As many of us are preferring to stay at home, there is less opportunity for physical activity. Additionally, under such tense times, many of us may be stress eating. These unhealthy habits exacerbate obesity, high blood pressure and diabetes – key risk factors for cardiovascular disease. Try these methods to practice heart healthy habits while quarantining: • Don’t bring junk food into the home. Remember, if you don’t buy it, you can’t eat it.

Heart Attacks & COVID-19

• Go to the grocery store with a plan.

Aside from the harmful effects of contracting COVID-19, the pandemic has created a sense of fear around visiting the emergency room, even in the most urgent of cases. Over half of cardiologists reported seeing 40-60% reduction in hospital admissions related to heart attacks, according to a twitter poll conducted by @angioplastyorg. This has resulted in an increase in at-home mortality, with more heart

• Try protein-dense snacks that will fill you up quicker such as nuts and seeds. • Swap out what you already love! For example, try frozen Greek yogurt over ice cream or dark chocolate over milk chocolate. • Look to YouTube and apps to find at-home exercises that don’t require any equipment.

Patients who are older and/or have underlying conditions, defined broadly as heart disease, diabetes, obesity, hypertension and others, are at increased risk to have complications if they contract COVID-19. Issue 8 2020 | THE HEART OF JACKSONVILLE

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PHYSICIAN’S SPOTLIGHT

We asked our providers:

How do you de-stress: Brenda Murphy, APRN

Cecilia Pitts, APRN

I will either listen to music while running or sit along the shoreline listening to the ocean.

Merdijana Ahmetovic, APRN

I love video games, reading, exercise, and of course, spending time with my family.

Donna Geiger, APRN I will ride in my convertible, if it’s not raining, or go to the beach!

I hug and kiss my 3 sweet children and I am all destressed!

Lucy Walling, APRN Gina Luncan, APRN Gym! I also love spending time on the water.

Max Sapolsky, PA-C

For my wife and I, it’s taking time together for activities like gardening, cooking, working out, and reading.

Marjie Matheny, APRN Exercise! I do kickboxing and Krav Maga a few times a week. I also love to hike on the weekends.

After a long day of work, there is nothing better than kicking my feet up, staying home and relaxing!

Sherita Bentley, APRN To de-stress, I like to try new places to eat!

Liliana Torrealba, PA-C I will go roller skating or go to the beach!

Meagan LeMaster, PA-C I like to watch football games and cheer on the Jags!

Erin Voss, PA-C I relax by going on hikes or taking small road trips.

Ashley Jarrell, PA-C I like to spend time with my husband and go on outdoor adventures!

FAST FACTS

PHYSICIAN’S SPOTLIGHT

Breakfast is the most important meal of the day. Skipping breakfast can nearly double your risk of dying of heart disease. Try starting your morning with a heart-

Nicole L’HommeDieu, PA-C Melanie Bautista, APRN I focus my attention on how grateful I am to have such an amazing support system in my life, including my family, friends, and coworkers!

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I would sing to my patients who were sedated and ventilated thinking they wouldn’t remember. Little did I know, when they got better, they came to see me and remembered every song I sang to them!

healthy breakfast such as low-fat yogurt with fruit or oatmeal.”

— Dr. Ibrahim Fahdi * Journal of the American College of Cardiology

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HEALTHY LIVING

Healthcare Buzzwords

DEFINED

Healthcare is always evolving. We are on a constant mission to be able to provide better care with less cost and more convenience. With that comes buzzwords that we hear in the news, at our doctors’ appointments or when enrolling for insurance. This glossary will help you learn some of the words buzzing around healthcare these days.

+

Value-Based Care

Value-based healthcare refers to changes in healthcare from a model of quantity to quality. Healthcare providers are incentivized based on the quality of care they provide, rather than the amount of services.

$

Cost-efficient

20-25% of healthcare spending is deemed unnecessary, according to a study published in JAMA. Cost-efficient care refers to the method used to overcome this excessive healthcare spending by providing quality care with the least amount of resources.

Population Health Population health is the collection of health outcomes of not just one

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individual, but the health of those living in a given place together. This involves different disciplines working together to achieve the best outcomes for a community.

Social Determinants of Health A study published in Health Affairs found that 70% of health outcomes are guided by factors other than healthcare. Did you know factors such as your zip code, employment status or education can impact your health? These factors are a few examples of social determinants of health, which are the conditions someone lives and works that influence their health, according to the World Health Organization. These conditions impact the behaviors we develop, which ultimately influence how we take care of our health.

+

Evidence-based Healthcare

Evidence-based healthcare is the foundation in which great clinicaldecision making stands. It means using scientifically based research to determine the best course of care for each patient.

Patient Engagement Patient engagement means that the patient takes an active role in their care. An engaged patient doesn’t just simply listen to their physician; they make sure they understand, ask questions, and take advantage of educational resources available to them. Have doubts about how effective this can be? A study performed by Concentra split 170,000 patients into two groups: one group received an average level of support from a health coach while the second group received enhanced support. The group with more support had

5.4% lower medical costs, 12.5% fewer hospital admissions, and 20% fewer heart surgeries.

Responsible Utilization Nearly a quarter of healthcare spending is considered unnecessary. Responsible utilization refers to a practice’s commitment to eliminating unnecessary healthcare services and using resources in the most cost-effective way possible.

Preventable Hospitalizations A study published in the National Center for Biotechnology Information found that one in 10 hospitalizations were preventable. These hospitalizations could have potentially been avoided with outpatient treatment and disease management.

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SERVICE RECIPES LINE

Heart-Healthy Lunch Ideas Minestrone Soup American Heart Association (AHA) Recipe Minestrone soup is a perfect, healthy, versatile lunch filled with your favorite veggies. Below is the AHA’s healthier version of the soup, swapping out regular pasta or rice for whole grain pasta and reducing sodium. Ingredients

Directions

• 1 medium yellow onion peeled and chopped • 4 medium carrots chopped (makes about 2 cups) • 5 sliced celery sticks (makes 2 cups) • 2 cups green beans chopped • 1 tablespoon Italian seasoning with no salt added • 1 1/2 teaspoons garlic powder • 1/4 teaspoon salt • 1/4 teaspoon ground black pepper • 1 can no salt added, diced tomatoes • 1 can salt-free kidney beans • 1 can salt-free chickpeas • 3 cups low-sodium chicken broth • 3 bay leaves • 1 chopped zucchini • 1 cup chopped spinach • 1 cup whole wheat pasta • 2 teaspoons canola oil • 1 cup chopped parsley, for garnish

1. Add all the chopped vegetables into a four quart bowl or larger slow cooker. Pour in Italian blend, garlic powder, salt, and pepper and stir.

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2. Pour the drained canned tomatoes, kidney beans, garbanzo beans, chicken broth, and bay leaves but do not stir. Keep the vegetables at the bottom closer to the heat source so they can cook thoroughly. Cover with lid and cook 5 hours on high or 10 hours on low. 3. Thirty minutes before serving, remove bay leaves then stir. Add chopped zucchini and spinach to bowl. Cover and let cook on high heat. 4. Prepare the pasta according to package directions. 5. When the soup is finished cooking, pour into bowls, top with parsley and enjoy a heart healthy lunch!

Tired of feeling drowsy after lunch? Give your heart and body a heart-healthy boost of nutrients that will fuel you throughout the rest of your day.

Roasted Vegetable Quinoa Salad Recipe from Eating Well

Serves 4

Quinoa is high in protein but low in calories, making it a great replacement for rice or other high-carb grains, especially for people with diabetes, according to Medline. Quinoa boosts your good cholesterol and will leave you feeling satisfied after your lunch break. Ingredients

Directions

• Cooking spray • 1 small zucchini cut into 1-inch pieces • 1 cup halved mushrooms • ¼ teaspoon salt • ¼ teaspoon ground pepper • 2 cups water • 1 cup quinoa • ¼ cup white-wine vinegar • 2 tablespoons olive oil • 1 tablespoon chopped parsley • 1 teaspoon chopped rosemary • 1 teaspoon chopped oregano • 1 teaspoon mustard • 1 clove garlic, minced • 1 ounce semi-soft goat cheese or reduced-fat feta cheese, crumbled

1. Preheat oven to 400°F. Lightly coat a shallow baking dish with cooking spray. 2. Add zucchini and mushrooms. Lightly coat with cooking spray and ¼ teaspoon of the salt and the pepper. Cover and roast for 10 to 15 minutes or more until vegetables are just tender. 3. While the veggies are roasting, add water, quinoa, and the remaining ⅛ teaspoon salt in a saucepan. Bring to boiling; reduce heat. Simmer covered, for 15 minutes or until quinoa is tender then drain if necessary. 4. Combine vinegar, olive oil, parsley, rosemary, oregano, mustard, and garlic and mix well to create the vinaigrette. Add vinaigrette to cooled vegetable mixture and toss to coat. 5. Top the quinoa with the vegetable mixture and add the cheese. 6. You can also add chicken or fish for an extra boost of protein!

Kale-Turkey Wrap Recipe from Eating Well

Makes 3 wraps

Sandwiches and wraps are some of the most popular lunches, so it can be difficult to avoid bread on your lunch break. Although whole grain bread has its benefits, try swapping the bread out for kale leaves for a light, but filling lunch. Ingredients • 1 tablespoon cranberry sauce • 1 teaspoon Dijon mustard • 3 medium kale leaves • 3 slices deli turkey of your choice • 6 thin red onion slices • 1 firm ripe pear, cut into 9 slices

Directions 1. Mix cranberry sauce and mustard in a small bowl. Spread on kale leaves. 2. Top each leaf with a slice of turkey, 2 slices of red onion and 3 slices of pear. 3. Roll each leaf into a wrap. 4. Serve and enjoy! Issue THE HEART HEART OF OF JACKSONVILLE JACKSONVILLE Issue 78 2020 2020 || THE

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HEALTHY LIVING

PREVENTING HEART DISEASE

The choices you make everyday are essential to your heart health and quality of life as you age.

AT ANY AGE

No matter your age, eating a healthy diet and maintaining physical activity will reduce your risk for heart disease. The first step of decreasing your risk is to educate yourself on what you can do. Over the years, unhealthy habits, like lack of exercise, smoking and poor diet, can truly take its toll on your health. However, there are easy steps you can take at any age to get your heart health on track. See below for some healthy tips at any age:

Prevention in your

20s

If you start prevention as early as your 20s, you are on the right track. Here are some more tips to be sure you are keeping up with your health in your 20s: • Find a primary care doctor and get checked regularly. Make sure you know your numbers for blood pressure, cholesterol and glucose. These numbers can be an indicator for your individual risk for heart disease. • Be active. Being active is easier done at a younger age. Those who start being active younger are more likely to keep this habit as they age. The American Heart Association (AHA) recommends 150 minutes of exercise a week. • Do not smoke. Smoking significantly increases your risk of heart disease. The earlier you kick the habit, the earlier you can start reversing the damaging effects. 26 THE HEART OF JACKSONVILLE | Issue 8 2020

Prevention in your

30s

Your 30s are about balancing work, family and self care. Here are some tips to lighten your load: • Be health conscious as a family. Make exercise a family activity with daily walks or playing outside. Instilling healthy habits as a family will help ensure children carry these habits into their adulthood. • Be aware of your family history. Having an older family member with heart disease increases your risk. Find out which risk factors you can control through prevention and which are out of your hands. • Learn to reduce stress. Stress can increase your risk of heart disease. It is common to worry about your family and forget about your own self-care. Make sure to take at least 10-15 minutes a day to de-stress whether this is meditation, a mini exercise, or a hot bath.

Prevention in your

40s

Prevention in your

50s

Prevention in your

60s +

Your 40s are definitely not too late to start making healthy choices. These choices will improve your quality of life in the long run.

This is the time to make sure you are well-educated on signs and symptoms of heart disease. Keep your healthy habits going!

It is unavoidable, but older age is a risk factor for heart disease. Here are some tips to live a longer and healthier life:

• Maintain a healthy weight. As you age, your metabolism begins to slow down. It is important to eat a heart healthy diet and maintain regular exercise to stay healthy and prevent heart disease.

• Educate yourself of the signs of heart attack or stroke. There is more to a heart attack than chest pain and more to a stroke than just numbness on the left side. There are many different signs and they can even differ for men and women.

• Ask your doctor for an anklebrachial index test. This test determines your risk for peripheral artery disease, a disease where plaque builds up in your arteries and disrupts blood flow.

• Check your blood sugar levels. By the time you are 45, you should have your fasting blood glucose testing done. • Listen to complaints about snoring. Never brush off something as simple as snoring. It can be a sign of a more serious health issue, such as sleep apnea.

• Have an open relationship with your doctor. Use your provider as a resource to develop a personalized lifestyle plan that works best for you.

• Maintain a healthy weight. As you age, your body needs fewer and fewer calories. Excess weight can cause a strain on your heart and increase your risk of heart disease or worsen an existing condition.

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SOCIAL MEDIA RECAP

JACKSONVILLE 28 THE HEART OF JACKSONVILLE | Issue 8 2020

Issue 8 2020 | THE HEART OF JACKSONVILLE

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WORD SEARCH

PHYSICIAN’S DOCTOR FAVORITES SPOTLIGHT

WORD SEARCH

Doctor Insight

Q

What was your first car?

Q

Dr. Ibrahim Fahdi – Barbados

R K A I E Q Q U I N O A U L

Q

Dr. Andrea DeNeen – As the oldest of 5 children, my parents provided cars for us to drive/share but I did not own one until I graduated from medical school in 1997. My parents gifted me a 1985 5 series 6 speed BMW. I drove that until I was able to buy my first new car in 2005- a 6 speed Audi A4 that I still drive. What was your first concert? Dr. Bruce Krieger – George Szell conducted the Cleveland Symphony’s performance of Antonin Dvorak’s The New World Symphony.

Q&A

P R G L K T A A S R I S N L

What was your first job?

Q

Dr. Yazan Khatib – My first job was a doctor. I was very lucky in that my father supported me through medical school and that allowed me to finish early and with great grades. Dr. Ahmad Younes – Chemistry lab tech Dr. Vaqar Ali – Clinical Research assistant at Loyola university hospital Chicago.

What was the first country you ever visited?

Dr. Cary Rose – The first country I ever visited was Mexico. I went to college at UCLA and we would drive down for the weekend to see the white sand, really blue ocean waters, and ride horses on the beach in Ensenada. The people were so nice and welcoming. The food was just incredible and the funniest thing is that although I lived in Southern-California, I didn’t speak a word of Spanish!

I T I K Y C E E N E A A I U Q I A N E L T A U N I E D P L E E R A C Y T I L A U Q A I R T E P Y A E Q Y A E Q V F I D K L E I V A P I N G E E A O V K P I A I I S I F I P K N L A A N L U O L N A N U N A L L I R E L E E I L S P L O S L I A R T E Q E Q E O N A L E E R A I H V D A A

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E E P A C S D N A L K A L N

QUALITY CARE

QUINOA

TRAILS

LIFE PURPOSE KALE

LANDSCAPE HIKE

VAPING

VEINS

Dr. David Swain Stone Temple Pilots 30 THE HEART OF JACKSONVILLE | Issue 8 2020

Issue 8 2020 | THE HEART OF JACKSONVILLE

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