The Heart of Jacksonville Clinic | Winter 2017 | Part 2

HEaRT

OF JACKSONVILLE CLINIC

Winter 2017

WORD OF MOUTH

GONE DIGITAL How patients are using online reviews to ямБnd a doctor

OUR MISSION To enhance quality of life by providing cutting-edge care with a team of compassionate experts and advance medicine through research, education and patient empowerment.

OUR VISION To inspire hope and excel in the care of individuals throughout the continuum of healthcare from wellness and prevention to the most complex disease states.

jacksonvilleclinic.org 904.622.9035

firstcoastcardio.com 904.493.3333

Letter from the Jacksonville Clinic Team Dear First Coast Residents, We couldn’t be more excited to be back for the second issue of The Heart of Jacksonville Clinic.

Jacksonville Clinic is expanding in team members and redefining our focus. We have welcomed several compassionate physicians over the past six months. Dr. Chris Rathburn, primary care physician, joins Jacksonville Clinic with a long-standing stellar reputation. Having served the Jacksonville community for more than 25 years, it is evident by his patients’ smiles that Dr. Rathburn treats each patient like a member of his own family. He has held various positions at Memorial Hospital, including chief of Internal Medicine and chairman of the Department of Medicine.

Welcome Dr. Rathburn (pictured above) and Dr. Taj (pictured on cover).

We are proud to welcome Dr. Taj to our Westside office (pictured on the cover). Dr. Taj was a hospitalist at Orange Park Medical Center for seven years and took the title of Physician of the Year in 2015-2016. We understand why.

Healthcare can unfortunately become a financial burden on patients. Costs are escalating. Aside from the financial hardships it can impose on patients and their families, the system can be difficult to During a time when navigate, with many elements a patient may feel for patients to juggle from concerned about their insurance to appointments and health, they should not treatments. During a time when have to face barriers in a patient may feel concerned about their health, they should not have to seeking the care they face barriers in seeking the care they need.

need.

The team at Jacksonville Clinic wants to remind every patient that we are your quarterback. We value every patient’s experience. Our patients can rest assured knowing we are doing everything possible to keep costs low. We also prioritize convenience for our patients. This means accepting most insurance plans, convenient locations and welcoming walkins. Patients can then put their time and energy into feeling healthy.

If you find yourself in need of a primary care physician (everyone should have one) or aren’t happy with your current doctor, schedule an appointment with us. We pledge to give you the best experience possible (superior waiting-room magazines included).

Sincerely,

The Team at Jacksonville Clinic

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Dr. Oscar Rodas greets his patient with a smile.

LOOKING FOR A DOCTOR?

Online Reviews May Be Your Answer If you were looking for a great place to eat, you would likely pull out your phone and let the online reviews guide your decision. If other customers have reported slow service or poor food quality, you would likely skip that choice. is is the same concept when choosing your doctor. ese days, word-of-mouth is more important than ever in healthcare, but we aren’t referring to the traditional word-ofmouth method we are accustomed to. Patients are spreading the word about their healthcare experiences online, leaving reviews on sources like Google, Healthgrades, insurance websites and social media.

According to a 2014 study by the American Medical Association, 35 percent of participants selected a physician based upon their online ratings, while 37 percent avoided a physician with bad ratings. Additionally, 59 percent of respondents said that physician-rating sites were somewhat or very important. ese numbers will only continue to grow.

It is clear online ratings are important to patients, but how important are they to doctors?

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As it turns out, very important: 85 percent of physicians read their own reviews, according to a ZocDoc survey. Beyond this, providers are using online reviews to elevate their standards of care.

A study published in the Journal of Medical Internet Research found that more than half of providers who responded to a survey said they used online ratings to find measures in order to improve patient care.

If you’re thinking of leaving a review, consider the company’s mission and vision. If your experience with the company aligns with their mission and vision, they have likely earned themselves a positive review.

At Jacksonville Clinic, our mission is to enhance quality of life by providing cutting-edge care with a team of compassionate experts. is means that every Jacksonville Clinic doctor you encounter should be at the forefront of any advancement in medicine and speak openly and compassionately to you about your options.

Our mission also includes a dedication to advancing medicine through research, education and patient empowerment.

Every patient should walk away from their appointment feeling educated, empowered and confident in their health.

is means that whether you are just looking for prevention or whether you are seeking the most innovative therapies, you feel inspired with hope at every appointment.

Our vision as a company is to inspire hope in individuals throughout the continuum of healthcare from wellness and prevention to the most complex disease states.

If we’ve met our mission and vision, leave us a review!

Reviews are quick, easy and free to leave. They are also helpful to other patients seeking a doctor. If you have had a positive experience with us, let us and the world know! You can find us on Healthgrades, Vitals, Google, social media (Facebook, Twitter, YouTube, LinkedIn, Google Plus, Instagram) and insurance websites. If you prefer to stay anonymous, please do not hesitate to send us feedback on our website, www.jacksonvilleclinic.org.

Emergency Room Visits:

Hazardous toYour Financial Health?

$89.99 could help you avoid being another statistic.

Going to the emergency room (ER) often means having to e researchers estimated that patients may be responsible for Vascular imaging can detect the onset of many heart and vascular diseases so endure long wait times, high stress levels and an an average balance of $622, following an ER visit. we may Ahave uncomfortable environment. recent the studychance found yet for early prevention & intervention.

According to a study by Truven Health Analytics, 71 percent another reason to shy away from ER visits whenever possible.

The Issue: of ER visits were found to be unnecessary. Avoid being t patients Most health insurance pay for vascular screenings the presence Many go to hospitals that companies are in-networkwill withnot their another surprise bill victimwithout by visiting your doctor forof noncertain and even for high-risk insurance plans, signs knowing thissymptoms, will keep their medical bill at a individuals. emergency issues instead of making a trip to the ER. Making reasonable cost.have However, shocking reality is that even this decision comesconsider down to educating yourself. t If you one the or more cardiovascular riskif factors, you should getting screened. youtgo Check to the ERwith at a your hospital that is in-network, theto ERsee if you qualify for vascular screening coverage. insurance company • Know the warning signs of serious conditions such physician attending to your careallows may not be to in your network. at t If not, our package you be screened a low cost without having to worry about as heart disease or stroke that warrant going to the ER What does this mean for patients?Cardiovascular A shockingly highrisk medical insurance coverage. factors include a family history, diabetes, high bill. And this occurs insedentary roughly 2 inlifestyle, 10 ER visits, according toblood cholesterol, smoking, high pressure, being overweight.

Thetomore • Make regular or visits to your doctor and talk them risk researchers Zack Cooper and Fiona Scott Morton at Yale factors you have, the higher your risk for stroke, heart attack, andsymptoms other vascular openly about any you maydisorders. be feeling University.

Schedule your vascular screening today.

Thewhich $89.99 package includes: • Know medical issues can be cared for at urgent Hospitals often contract with physicians for their services, Aorta Screening care clinics such as common illnesses or minor injuries meaning that while hospital may beto in-network, the risk for abdominal aortic aneurysm (AAA) Anthe ultrasound test assess your • Request walk-ins at your doctor’s office for nonphysician is not. When you are cared for by an Carotid out-of- Artery Screening Anyour ultrasound test that measures blood flow to detect aemergencies carotid blockage life-threatening network physician, medical bill rises astronomically.

Ankle- Brachial Index (ABI) Test This test can detect a blockage in the leg

www.firstcoastcardio.com | 904.493.3333 Winter 2017

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Your Heart and Your Sleep:

What’s the Connection?

In 2011, Jacksonville Clinic recruited Dr. Daniel Thielemann, sleep medicine specialist. The addition of Dr. Thielemann brought the addition of a new Dr. Daniel Thielemann (above) specialty into our and Dr. Irram Hamdani (below right), practice — sleep Sleep Medicine Specialists medicine. Of all specialties, why did we choose sleep medicine to complement our cardiovascular and primary care services?

Sleep apnea and other sleep disorders are a major risk factor for

cardiovascular disease. Sleep apnea occurs in more than 18 million American adults, according to the National Sleep Foundation, and remains largely undiagnosed.

When left untreated, sleep apnea causes breathing to shallow, disturbs the body’s natural sleep cycle, and negatively affects the body’s circulatory system. New research has linked this disorder to depression, and various types of heart disease including atrial fibrillation and coronary artery disease.

Dr. ielemann is trained as a neurologist with a subspecialty in sleep medicine, while Dr. Irram Hamdani is triple board certified in sleep medicine, pulmonology and critical care.

Both have dedicated their lives to restoring a healthy night’s sleep for their patients.

In addition to this, we have two sleep laboratories fully accredited by the American Academy of Sleep Medicine.

Here, patients are administered a sleep study to determine the proper diagnosis.

At-home sleep studies are also available for patients who qualify. Once a diagnosis is made, a wide range of effective treatment strategies are available. e majority of sleep problems can be improved, controlled or eliminated.

“Our sleep medicine services are about more than just diagnosing the sleep disorder and ensuring they have the proper CPAP machine and equipment,” Dr. Hamdani says.

(CPAP – continuous positive airway pressure – therapy includes a small machine, a hose and a mask. e therapy supplies constant air pressure and is a common treatment for sleep apnea.) Dr. Hamdani continues, “We educate patients on how to use their equipment and ensure their treatment is working.” is dedication has led to higher than average CPAP compliance rates.

Additionally, we’ve all had a bad night’s sleep and know there’s nothing worse than feeling fatigued and exhausted all day. is is the battle sleep disorder patients face every day.

“We treat sleep disorders in terms of total cardiovascular health, hoping to improve quality of life for these patients and drastically reduce their chance of developing heart disease,” says Dr. ielemann, Director of Sleep Medicine Laboratories. “Sleep disorder treatment is a preventive mechanism against heart disease.”

To be able to accurately diagnose and treat sleep disorders, we have two board certified sleep medicine specialists.

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Dr. Hamdani works with her patients to find the best CPAP machine for each patient’s comfort level.

WHAT WE TREAT

OUR SERVICES INCLUDE:

There are many different sleep disorders.

We treat all of them for our adult patients, including but not limited to:

• Diagnostic testing • Titration testing including CPAP and BiPAP

• Obstructive sleep apnea (OSA) • Maintenance of Wakefulness Test (MWT) • Restless legs syndrome (RLS) • Multiple Sleep Latency Test (MSLT) • Insomnia • Home sleep test • Narcolepsy • Idiopathic hypersomnia (daytime sleepiness without an obvious cause)

• Follow-up with a sleep medicine specialist

• Circadian rhythm sleep disorders • Parasomnias (behaving in a way that’s undesirable during sleep, such as sleepwalking)

Working toward better sleep and heart health Sleep apnea is recognized as a serious health problem that may impact patients who suffer from heart disease. As a leading provider of innovative sleep products and solutions, ResMed is committed to educating patients and physicians about the health risks of sleep apnea for patients with cardiovascular conditions.

Speak with your doctor to learn more about the importance of sleep and its effect on heart health.

ResMed.com © ResMed 2016

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Jacksonville Clinic’s Guide to a Healthier Night’s Sleep A good night’s sleep sets the tone for a productive and positive day.

“I always tell my patients that sleep is about more than just not feeling tired throughout the day,” says Dr. Angelito Tecson, primary care physician.

“Sleep is a critical aspect of a comprehensive lifestyle; one that often is forgotten.” Check out our physician-approved tips for a healthier night’s sleep.

SLEEP AT THE SAME TIME EVERY NIGHT Commit to a sleep schedule and make sure you sleep at the same time every night. This technique will help regulate your body’s clock and make sure you stay asleep throughout the night, according to the National Sleep Foundation.

KEEP THE TEMPERATURE OF YOUR ROOM BETWEEN 60-67 º FARENHEIT

This may seem like a random number, but there is science behind it. While you are trying to sleep, your internal body temperature decreases. The National Sleep Foundation recommends that setting your thermometer between 60-67° F can help your body initiate a great night’s sleep.

AVOID CAFFEINE 4-6 HOURS BEFORE SLEEPING We’re as guilty as anyone for grabbing a cup of coffee first thing in the morning to help us feel energized, but when bedtime is fast approaching, Harvard Medical School recommends avoiding any sort of caffeine 4-6 hours before bed. This includes caffeine found in coffee, tea, chocolate, soda and any other source.

DON’T EXERCISE 2-3 HOURS BEFORE BED Exercise helps you feel alert. While this is a benefit of exercise, focus on winding down by avoiding exercise 2-3 hours before bed, according to NIH MedlinePlus.

SCHEDULE AN APPOINTMENT WITH YOUR SLEEP MEDICINE SPECIALIST

If you’re experiencing difficulty sleeping, schedule an appointment with one of our board certified sleep medicine specialists by calling 904.854.2540. Common signs of a sleep disorder include excessive daytime sleepiness, snoring and irritability.

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Foods to Help You

Sleep Better

Nuts Walnuts, almonds, cashews and pistachios are known for their positive effects on heart health, but there are other benefits as well. Cleveland Clinic says a handful of nuts will help improve your serotonin levels, a hormone that contributes to healthy sleep.

Bananas Bananas are well known for their high potassium levels, but in case you need another reason to love bananas, they are also a great source of tryptophan. Tryptophan is an amino acid linked to increased quality of sleep.

Protein and Carbohydrate Combination According to the National Sleep Foundation, pairing protein with carbohydrates makes the perfect bedtime snack combination. Carbohydrates make tryptophan available to the brain while proteins are the building blocks of tryptophan. Have cereal with milk, or cheese and crackers, to prepare your body for a good night’s sleep.

Dr. Angelito Tecson, primary care physician, Jacksonville Clinic

Cherries or Cherry Juice Cherries contain melatonin, a chemical responsible for your internal time clock. What does this mean for you?

Melatonin can help you fall asleep quicker and sleep longer, according to an article from IU Health.

Water We know — water is not technically a food, but it just wouldn’t be a proper health article if we didn’t talk about the benefits of H2O. Drink enough fluids to keep you hydrated through the night and avoid waking up thirsty. Be careful though — drinking too much will cause you to wake up to go to the bathroom throughout the night and disrupt your sleep.

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Signature Duck We believe in indulging in the foods you love eating. For us, Orsay’s Signature Duck dish is definitely on our list of cravings. Its rich and juicy taste, topped with crispy carrots, always leaves us wanting more.

Don’t forget that the key to a healthy lifestyle is moderation.

Split a heavy meal like this with a friend or ask the waiter to box up half of it to enjoy at a later time.

After enjoying a heavy meal, keep your next meal light. There’s no reason not to have the meals you love as long as you keep moderation in mind.

Place a “swoop” of puree on your serving plate, add lentils, place sliced duck and poultry jus. Last, top with crispy carrots.

Carrot Puree

Seared Duck Breast

Crispy Carrots

2 lbs peeled and diced carrots

4 duck breasts (skin on)

8 peeled carrots

1 carrot

1 qt. medium dice mirepoix

1 celery rib

Thyme

Chicken stock

Salt

1 qt. lentils

Chopped garlic

Salt

Pepper

½ lb bacon 2 qts. chicken stock

Salt

Pepper

1. Using a peeler or mandolin slicer, thinly peel long strips of carrot.

Lentils 1 yellow onion

Pepper

1. Caramelize onion, carrot and celery. Add lentils and stock.

1. Cover parsnips with chicken stock in medium pot. Add salt and pepper.

2. Sauté lardon shaped pieces of bacon, drain and reserve.

2. Cook over medium heat until tender.

Remove thyme.

3. Cook lentils over low heat until tender.

Spread lentils onto a sheet pan.

3. Puree and push through a chinois.

4. Sauté mirepoix with thyme, chopped garlic, salt and pepper.

5. Combine lentils and bacon with mirepoix. Season.

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1. Start duck breast skin side down in a cold pan that is set to medium-high.

3. Drain, keep warm.

2. As fat renders out, spoon hot fat on to the duck breast to assist cooking.

Roasted Poultry Jus

3. Remove from heat when desired temperature is met (we recommend barely medium).

1. Roast carcass in oven until deeply golden brown, use to make stock.

4. Let rest and then slice on the bias.

Winter 2017

2. Fry in 350º oil.

1 poultry carcass

2. Take stock and reduce until it will coat the back of a spoon.

HOW MUCH WATER

do you really need?

Drs. Ulises Caraballo and Zwinda Ortiz-Roldan encourage their patients to carry a water bottle with them to avoid dehydration.

It seems like we’re always being told to drink more water, but how much water is really enough? Water supports your energy levels, brain function, and improves weight control. But when it comes to how much water we should drink, it seems like every source you turn to has a different number.

The general rule many of us are familiar with is to aim for at least eight cups of water a day. However, the exact number of cups does not determine whether or not we are adequately hydrated. According to the Centers for Disease Control and Prevention (CDC), healthy people do two things to ensure they are getting all the water they need. They drink water when they are thirsty and drink water at every meal. Does that seem too simple?

There is no magic number to know you are getting all the water you need. The amount of water you need depends on your environment, activities and physiological state. According to the CDC, there are certain conditions that may require someone to consume more water.

This includes: • Running a fever • Experiencing diarrhea or vomiting • Participating in more physical activity • Spending time in a hot climate Lauren Dimitrov, Registered Dietitian and Nutrition Expert, says you can monitor yourself to assess if you are adequately hydrated without counting cups. The first sign is urine. “Yellow, especially

Winter 2017

dark, is one of the first signs of dehydration,” Dimitrov says.

“Clear to light yellow urine is a good sign you are hydrated.”

Perspiration is another sign of hydration to consider. “If you are hot or exercising and don’t sweat, you may be dehydrated,” Dimitrov says. She also suggests dry skin, dry mouth and fatigue as possible signs of dehydration to watch out for.

Remember to drink your water throughout the day. Keep a water bottle with you at all times and a cup of water at your desk. Stay hydrated when you need it the most and look out for any signs of dehydration.

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FACE THE NEW YEAR WITH JACKSONVILLE CLINIC’S NEW

Medical Cosmetic Services

Jacksonville Clinic is committed to providing a comprehensive approach to wellness.

“Many patients come to us with medical issues; we are successful in treating them internally,” says Dr. Khalil Afsh, Director of Internal & Cosmetic Medicine. “But what happens when the patient looks in the mirror and sees signs of aging or scarring? ey are not entirely well!” Dr. Afsh adds, “Wellness is an ‘inside out’ treatment. Ensuring they are happy with their appearance is an integral part of our approach to wellness.” Each patient can walk confidently into our clinic knowing they will be treated both internally and aesthetically. We make sure they walk out the door feeling and looking their best.

Cosmetic medicine, otherwise known as aesthetic medicine, should not be confused with plastic surgery. Aesthetic medicine includes non-invasive or minimally-invasive

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cosmetic procedures with the goal of improving the effects of aging and physical appearance. Despite the stigma surrounding cosmetic procedures, aesthetic medicine has minor downtime and low risk.

Aesthetic medicine has become increasingly popular in modern medicine as more people flock to minimally-invasive cosmetic procedures. As the Academy of Aesthetic Medicine states, “e needle is increasingly replacing the scalpel.”

Our physician, Dr. Afsh, works with our patients to improve physical appearance utilizing the latest advancements in aesthetic and cosmetic medicine. Science and technology are used at their best. Our team reverses the damage caused by sun exposure as well as the natural loss of fat in the face that

Before dermal filler

may give an aged appearance. is is accomplished through neuromodulators, dermal fillers, advanced radio frequency and ultrasound technologies, noninvasive facelifts and fat grafting.

Successful treatment of focal lipodystrophy is accomplished through liposuction. Laser liposuction is a modality used to improve outcome after liposuction procedures. Continued follow-up for skin treatments and nutrition services are done following liposuction procedures to yield a better outcome; a service that is unique. Combining our deep knowledge and experience in medicine, we ensure that each patient is simultaneously building a healthy lifestyle to look and feel healthy.

After dermal filler

OUR COSMETIC SERVICES INCLUDE: • Injections of neurotoxins and dermal fillers • Chemical peels • Non-surgical facelifts • Cosmetic dermatology treatments • Acne treatment • Microdermabrasion • Microneedeling • Treatment of cellulite • Noninvasive body contouring • Hair restoration • Fat grafting • Platelet rich plasma treatments

Dr. Afsh is one of the very few to be board certified by the American Academy of Aesthetic Medicine and proud to be a member of the American Academy of Cosmetic Surgery and the American Society of Liposuction Surgery.

• Laser treatments • Scar management • Vein treatments • Liposuction • Nutrition services • Skin care

Effective March 1, 2017, call 904.580.8800 to schedule a consultation.

• Women’s intimate health • Laser hair removal • Stem cell treatments

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2017 Social Media

RECAP

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Jax Clinic FCCI @hearthealthjax

Thanks for another great year! #jaxdocs #hearthealth

Winter 2017

2017

New Year’s Resolutions

“I’ve been given the opportunity to

“I am focused on becoming

“I’ve been meaning to write my

record in Nashville with my band,

healthier than ever in 2017.”

own cookbook. Maybe 2017 is

‘No Known Cure’. This year will be the year to make it happen!”

Dr. Jairo De La Hoz

the year to make it happen.”

Dr. Oscar Rodas

Dr. Chris Rathburn

“I want to travel more and keep

“I am looking forward to

“I will spend more quality

crossing items off my bucket list.

launching the aesthetics

one-on-one time with my

Ziplining in New Zealand is up

program!”

young children.”

next!”

Dr. Angelito Tecson

Dr. Khalil Afsh

Dr. Nivali Ravi

“I hope to volunteer in my

“I’d like to make at least

“I am looking forward

church more often and

10,000 steps per day and

to teaching my

continue to participate in

playing racquetball helps!”

granddaughter Spanish.”

Dr. Mohammad F. Taj

Dr. Ulises Caraballo

more community service.”

Dr. Zwinda Ortiz-Roldan

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Chocolate Sorbet with Warm Cherries Every once in awhile, our sweet tooth kicks in and we can’t bear saying no to a sweet treat. Check out this chocolate sorbet recipe from our

friends at Publix Aprons™ Cooking

School. The best part is its both

dietitian and chef approved. “From a cardiovascular standpoint, sorbet is a great alternative to ice cream,” says Lauren Dimitrov, Registered Dietitian & Nutrition Expert. “It has zero grams of fat. Just remember to keep portion size small.”

Indulge yourself — all of the flavor, none of the fat.

Ingredients

Method

2 tsp. canola oil

1. Heat oil in a large nonstick skillet over medium heat.

1 tbsp. sugar

1/8 tsp. kosher salt 2 cups fresh sweet cherries, pitted or thawed frozen unsweetened cherries

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Pinch grated lime zest 1 ½ tsp. lime juice 1 pt. chocolate sorbet

Cancer Doesn’t Care. We Do. CancerSpecialistsNF.com

2. Add sugar and salt and cook, stirring constantly, until sugar is almost dissolved, about 2 minutes.

3. Add cherries and cook, stirring constantly, until softened, 2-3 minutes. Remove from heat and stir in lime zest and juice.

4. Place 1/2 cup scoop of sorbet in each of 4 serving bowls. Spoon cherries evenly over sorbet.

Serves 4

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Download Our New “Jax Docs” App for iPhones and Android!

Our new app gives First Coast residents and our patients access to a library of videos featuring health talks with our doctors and other educational videos. We know your time is valuable, so we stay short and to the point with videos you can watch in the waiting room, at home or on your coffee break.

We believe education is empowerment.

Our app allows you to: • Access health talks from a team of board certified specialists including cardiology, primary care, wound care and sleep medicine

• Watch videos about cutting-edge treatment options and upcoming procedures • Learn what you can do to prevent and manage conditions

• Get to know our doctors • Conveniently access our social media and contact information • Access our patient portal

Download the app today by searching “Jax Docs” in the app store!

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