The Heart of Jacksonville Clinic | Winter 2017 | Part 1

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CATCH US IF YOU CAN How First Coast Cardiovascular Institute is changing the healthcare landscape in Northeast Florida

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Letter from the President Dear First Coast Residents,

Thank you for joining us for the second edition of The Heart of Jacksonville Clinic. Since the last edition, we’ve had some extensive changes in our practice. We have opened two new freestanding, outpatient catheterization laboratories. You’ll find a feature on these stateof-the-art laboratories on page 5. We have grown our team with the addition of new board certified physicians, whose work you Dr. Yazan Khatib President of FCCI and Jacksonville Clinic

will find intertwined in these pages.

We have also redefined our mission and vision as a practice. Having had the privilege of leading this group for nearly 15 years, I’ve found that a mission and vision evolve over the years. Our patients, their needs and their families have dictated how we choose to run our practice. As the landscape of healthcare evolves, we choose to ensure patient care consistently stays at the forefront. Our mission as a company is “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.” This statement captures the principles in which we believe medicine should be practiced. Compassion should never be lost. We have a drive to consistently be the first to bring the latest technologies to the First Coast. And we must never forget that an educated patient will always

We hope that any patient, no matter where they are on the continuum of health, can turn to us during their time of need.

remain an empowered patient. Our vision as a company is “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.” Our vision is timeless. Through our extensive range of services, including cardiovascular medicine, primary care, sleep medicine, wound care and pulmonology, we hope that any patient, no matter where they are on the continuum of health, can turn to us during their time of need. You’ll find these statements displayed in the lobbies of each of our offices. More importantly, you’ll find these values instilled in each of our team members, from our physicians to our administration. Sincerely, Yazan Khatib, MD President of First Coast Cardiovascular Institute & Jacksonville Clinic

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Updates in Innovation Dr. Youssef Al-Saghir grew up thinking he would join his family of engineers. “I originally wanted to follow my family tradition,” Dr. Al-Saghir says. “But the combination of an interest in electrical engineering, a fascination with the heart, and a desire to help others shifted my dream to becoming a cardiologist.” Dr. Al-Saghir went on to pursue his dream at Ross University School of Medicine. He then continued to cardiovascular disease and interventional disease fellowships at Utah Health Sciences Center.

Dr. Youssef Al-Saghir with one of his many patients who benefits from his passion for cardiology.

Dr. Al-Saghir is now the Director of Clay County Operations for First Coast Cardiovascular Institute. During his extensive time in Clay County, he’s been the first to bring a set of new, cutting-edge technologies to the area through our partnership with Orange Park Medical Center.


Mitral regurgitation is a condition caused when the heart’s mitral valve doesn’t close completely. This can cause blood to flow backward, resulting in inefficient blood flow throughout your heart and body. This can lead to fatigue and significantly reduce quality of life for patients. The condition occurs in nearly one in 10 people aged 75 years and older, according to research found on The Lancet.

MitraClip is the world’s first percutaneous mitral valve repair therapy.

For patients with mitral regurgitation, Dr. Al-Saghir is the first to perform the MitraClip procedure at Orange Park Medical Center. MitraClip is the world’s first percutaneous mitral valve repair therapy. The device allows the heart to pump blood more efficiently. Benefits of MitraClip include: • Improved safety

• Improvement in patient symptoms

• Reduction in mitral regurgitation

• Reduction in hospitalizations for heart failure

Unlike surgery, the procedure does not require opening the chest. MitraClip requires only a small incision in the upper leg to reach the heart. The device is then guided through a catheter to the mitral valve. The MitraClip device is about the size of a dime and provides an option for patients who are too high-risk for open-heart surgery and have no other treatment options available to them.

The TAVR device can help open diseased aortic valves and increase blood flow.

Every patient is unique. If you think these therapies may be right for you, call First Coast Cardiovascular Institute at 904.493.3333 to schedule an appointment.


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The TAVR procedure offers hope to patients with a diseased aortic valve. The heart valves are thin membranes attached to the heart wall, and they open and close to regulate blood flow. As we age, these valves can get narrower due to calcium buildup or scarring. This narrowing is called aortic stenosis. When the narrowing begins to restrict blood flow, a patient may be a candidate for TAVR. TAVR can be an effective option to improve the quality of life for patients who might otherwise have limited choices for aortic valve repair. Benefits include: • Avoiding the risks of open-heart surgery

• Shorter hospital stay

• Shorter recovery time

• More immediate results

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Dr. Omer Zuberi coaches his patients on diet, exercise and lifestyle.

Deaths Relating to

Heart Disease Drop Heart disease remains the number one killer in the United States. Many efforts have been made to raise awareness on the prevention of heart disease. Organizations such as the American Heart Association and American Stroke Association have succeeded in making this their number one mission and spreading the word around prevention. e vast amount of awareness surrounding the prevention of heart disease has not gone to waste. A report published in the Journal of the American Medical Association (JAMA) highlighted the recent decline in cardiovascular mortality. From 2011 to 2014, the annual rate of decline for all cardiovascular diseases fell from 3.69 percent to 0.23 percent in men. Women also showed a significant decline, down from 3.98 percent to 1.17 percent. Results of the National Health and Nutrition Examination Survey in 2011-2012 indicated that Americans improved in controlling smoking, high blood pressure and high cholesterol, three major risk factors for heart disease. While this is a step in the right direction, there remains much work that needs to be done.

Building a strong relationship with your doctor is an important component in ensuring you are receiving the best care for you. Consider discussing these factors next time you visit your doctor. They are crucial factors for the prevention of heart disease. 1. Stress: When you are experiencing irregular stress, your body may hold extra adrenaline that can stimulate the heart and cause it to skip beats, creating increased palpitations. It’s important to let your doctor know if you are anxious or stressed about any particular issue. 2. Exercise: The health benefits of daily exercise are well known. But sometimes even if you exercise daily, you may experience chest pains. It’s important to alert your doctor if this happens. It could be a matter of less strenuous exercise or many other factors. 3. It happens to the best of us: If you skipped a dose of your medication, don’t worry, just remember to take it the next time. Just let your doctor know that you may have missed a dose or two. It may make a difference in how your test results look. 4. Vitamins and supplements: Herbal remedies and supplements are great for some medical issues, but could potentially impact your cardiovascular health. Let your doctor know if you are taking, or plan to take, vitamins and other supplements.

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Designed for Convenient Access, Comfort and Care

Convenience carries several implications. Convenience means being there for patients when they need it the most. It means providing service without imposing a financial hardship on the patient. It also means ensuring the patient is receiving their care in a comfortable environment. First Coast Cardiovascular Institute (FCCI) learned the importance of each of these elements while serving patients. In 2007, we opened the first freestanding outpatient cardiac and peripheral vascular catheterization laboratory (cath lab) in Jacksonville, Florida. e cath lab was designed with patient comfort at the forefront. Our cath lab has seven private postprocedure recovery 05

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rooms, where patients can rest before going home. Most patients undergoing procedures in the cath lab will go home the same day. Our cath lab is home to a team of board certified specialists in vascular and cardiovascular medicine. Each of these board certified specialists has achieved the highest mark in the healthcare field and ensured they are experts within their field. Since its inception, we have performed thousands of procedures in our cath lab. e success of our first cath lab has inspired us to open our second freestanding cath lab in Palatka, Florida. Our cath lab in Palatka is less than half a mile from Putnam County Community Hospital. It houses five recovery rooms and encompasses the same quality care that has earned us accreditation by the Accreditation Association for Ambulatory Health Care, Inc. for both facilities. Moreover, our cath labs are a cost-effective solution for patients. Without the expense of running a hospital, we can offer patients lower out-of-pocket costs for their care.

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A CoST-EFFECTiVE SolUTion FoR pATiEnTS Since its inception, we have performed thousands of procedures in our cath lab saving our patients time and money, without sacrificing quality and comfort. Our cath labs are located in Duval and Putnam Counties and are staffed by a team of board certified specialists in vascular and cardiovascular medicine.

Type of procedures performed in our cath labs: FCCI’s cath lab is nationally recognized as a leader in providing the highest level of care in the treatment of patients with arterial disease and blockages. DiAGnoSTiC HEART CATHS allow the doctor to see the vasculature of the heart for the treatment of coronary artery disease (CAD). CARoTiD AnGioGRApHY allows the doctor to see the vasculature of the head

and neck for the treatment and prevention of stroke. pERipHERAl AnGioGRApHY allows the doctor to see the vasculature of the legs and arms for the treatment of peripheral artery disease (PAD). pERipHERAl REVASCUlARiZATion allows the doctor to treat severe PAD

through atherectomy devices, balloons, and/or stents. Re-establishing the arterial blood flow to the patient’s extremities is necessary for the treatment of non-healing wounds, discomfort when walking, cramping, and swelling or discoloration. Amputation should always be the last resort. HEmoDiAlYSiS ACCESS mAnAGEmEnT: Dialysis patients routinely need their grafts or fistulas un-clogged to maintain adequate filtration during the dialysis procedure. We are proud providers of such services on an outpatient basis. VEnoUS FilTER inSERTion: Venous filters are placed into patients who are at risk of venous clots in the legs breaking loose and causing a stroke or pulmonary embolism. piCC linE inSERTion: PICC (peripherally inserted central catheter) lines are for patients who will need long term IV access for antibiotic, medical or chemo treatments. A long IV is placed in the upper arm that is designed to deliver the treatment in the central venous system and can safely stay in place for an extended period of time. Winter 2017

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How FCCI is

GiVinG VETERAnS A CHoiCE our active duty military and veterans have dedicated their lives to our country. First Coast Cardiovascular institute (FCCi) is now dedicated to them.

In the past, the only choice veterans had to receive healthcare was local Veteran Affairs (VA) healthcare facilities. While these facilities are a strong resource, veterans were often left with the struggle of long wait times, excessive driving distances, and lack of access to certain specialists. In 2014, the Veterans Access, Choice, and Accountability Act was established as a means of ensuring that veterans receive the timely care they deserve. The Act expanded the number of facilities veterans have to access care, creating veteran choice program (VCP) sites. These VCP sites are healthcare facilities where veterans can seek service when local VA healthcare facilities have long wait times, lack a certain specialist or are located a considerable distance from the veteran’s home. FCCI is a VCP site. This means our doors are always open to serve veterans and their families. We ensure veterans are able to receive expedited care by offering same-day appointments. Additionally, we have conveniently located offices in Duval, Clay, St. Johns and Putnam Counties, eliminating long driving distances. We also save veterans hassle and time by housing many specialties under one roof, including cardiology, sleep medicine, pulmonology, wound care and primary care.

Not only do we have the privilege of serving veterans, but we are proud to call Dr. Michael Illovksy, a retired Navy captain, a member of our team. Dr. Illovksy was awarded the Legion of Merit for his service. His 20-year Navy career took him on adventures around the world, which he would be happy to share with you. Call 904.493.3333 to schedule an appointment with one of our board certified specialists.


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Patient William Cassels knows our dedication to veterans better than anyone else. He is a veteran who had lost his right leg and was on his way to amputating his left leg. One last-minute phone call to FCCI saved him from becoming a double amputee. “I lost my right leg above the knee five years ago. The only thing the doctor could do for my left leg – if the pain got bad enough – was amputate that leg. The pain had gotten to the point where it was not manageable so I was on my way to the amputation table. One of my podiatrists said, ‘Before you do that, are you willing to look at something different?’ I said, ‘I’ll look at anything to save a leg.’ She left the room and came back with a Post-it ® note that had a name, phone number and an address. She said go there now, they are waiting on you. Dr. Khatib saved my leg. It doesn’t get any better than that,” says Cassels.

How to Spot a Stroke



We’ve all heard the terms heart disease and stroke often talked about together. One key difference between the two is awareness. We both know that at the first sign of chest pain or shortness of breath, we should head to the nearest emergency room. But what are the warning signs behind a stroke? If you aren’t sure what the answer is, you are far from alone. A National Stroke Association survey found that one in three Americans were not able to name a symptom of stroke. According to the American Heart Association (AHA), a stroke occurs when blood vessels, responsible for carrying oxygen and nutrients to the brain, rupture or are blocked. The brain is therefore unable to receive the oxygen and blood it needs to function and brain cells begin to die. Stroke is the fifth leading cause of death and the number one reason behind disability, according to the AHA.



The AHA and the American Stroke Association (ASA) recommend remembering the simple acronym, F.A.S.T., to spot a stroke: F - Face Drooping - Look for droopiness in the face that could take the form of an uneven smile. A - Arm Weakness - Raise both arms. If one is weak or drifts downward, this could be a major warning sign. S - Speech Difficulty - Be alert for slurred speech. T - Time to Call 911- If you spot any of these symptoms in yourself or your loved ones, call 911 as soon as possible. Additionally, the AHA and ASA recommend looking out for: • Trouble seeing in one or both eyes • Trouble walking, dizziness or a lack of balance • Harsh headache with no known cause Talk to a cardiologist about how you can lower your risk for heart disease and stroke. Call 904.493.3333 to schedule an appointment with a physician at First Coast Cardiovascular Institute.

While devastating, a large number of strokes go unnoticed. According to a British study, 70 percent of people who had a minor stroke did not know that it occurred. The consequences of not seeking treatment can be disastrous and may increase your chances of having another stroke. Despite these staggering statistics, the majority of strokes are avoidable. An estimated 80 percent of strokes are largely preventable, according to the AHA.

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Physician Spotlight Dr. Shahnaz Punjani In 2015, First Coast Cardiovascular Institute (FCCI) established an Interventional Vascular Medicine fellowship. This year’s fellow is an interventional cardiologist hailing from Massachusetts and possibly one of the kindest souls you will ever meet.

Dr. Shahnaz Punjani has chosen to spend a year dedicated to advancing her skills in endovascular medicine. Endovascular medicine refers to the art of fixing vascular blockages through catheter-based procedures without surgery. “We have one of the most active Vascular Medicine programs in the Southeastern United States, especially in the evaluation and treatment of all forms of arterial and venous disease,” says Dr. Yazan Khatib, president of FCCI. Outpatient catheter-based procedures are minimally-invasive with little to no downtime, keeping patients out of the hospital. When vascular blockages are treated in a timely manner, the occurrence of a heart attack or stroke can significantly decrease.


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Approximately 5,000 cardiovascular procedures are performed at our state-of-theart outpatient facility and affiliated hospitals every year. “The procedures I am learning to do require only a tiny incision,” Dr. Punjani says. “Most patients go home the same day.” Dr. Punjani’s road to medicine began at Medical College in Pakistan. During her time in medical school, she was a gold medalist and distinction holder. She went on to complete her internal medicine residency at St. Barnabas Hospital in Bronx, New York, where she received the “Best Resident” award during her second year of residency training. She worked as an internist before pursuing her cardiology training, during which time her compassionate care was admired.

“Dr. Punjani has a huge passion for patient care, with a heavy dose of humility and grace,” says Dr. Khatib. “Patients enjoy working with her.”

“I once had a patient during my time at Veterans Administration Medical Center who started wheezing while he was talking to me,” Dr. Punjani recalls. “I insisted on a chest X-ray, but little did I know how detrimental the results were.” The X-ray results led to a CAT scan that confirmed the patient had cancer of the lymph nodes. “My oncologist said she (Dr. Punjani) saved my life, because it was a very aggressive form of lymphoma and we caught it in time before it spread,” the patient said. “I am now 100 percent (cancer) free and in remission.”

completed a Preventive Cardiology fellowship at Brown University and Echocardiography and Cardiovascular fellowships at Yale University before finding her home on the First Coast. “Dr. Punjani has a huge passion for patient care, with a heavy dose of humility and grace,” says Dr. Khatib. “Patients enjoy working with her.” You’ll see Dr. Punjani learning from the experts at FCCI’s Outpatient Catheterization Laboratory or seeing patients at Orange Park Medical Center. Outside of patient care, Dr. Punjani loves nature and traveling.

It is stories like these (and there are many) that have inspired Dr. Punjani to continue pursuing her medical education. She

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The Only Outcome That Matters — Our Patients’ Health A Dedicated Care Team for Chronic Heart Failure Our team is passionate about reducing incidents of chronic heart failure. Nearly five days a week, Dr. Sumant Lamba, and his team of experts, dedicate their clinics to treating patients with chronic heart failure. Utilizing state-of-the-art technology, including constant hemodynamic monitoring, our services can reduce hospital admissions and improve quality of life — because the only outcome that matters is that of our patient. Same-day appointments available

Accepts most insurances

Serving Duval, Clay, Putnam and St. Johns Counties P: 904.493.3333 F: 904.493.2222


What You Need to Know About the Cutting-Edge Field of Cardiology These days, it takes a team of experts to keep your heart healthy. The field of cardiology is divided into subspecialties Dr. Satish Goel to ensure patients receive expert care. At First Coast Cardiovascular Institute, you can get all these cardiology services under one roof. We know you don’t have time to juggle multiple appointments and offices. Why should you have to? You can find a team of board certified heart specialists in one practice. Dr. Satish Goel has specialized in cardiology and chosen to undergo additional training to become an expert in electrophysiology, a subspecialty in cardiology.


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Electrophysiology is a field focused on heart rhythm (arrhythmia) disorders. Your heart can beat too fast or too slow, which can affect the body’s ability to effectively pump blood. This can lead to a variety of disorders including: • Atrial Fibrillation • Palpitations • Syncope/fainting • Variety of abnormal rhythm disorders • Suddden Cardiac Disease • Stroke “Most other heart diseases affect people over the age of 65. Heart rhythm disorders are unique in that they can really happen to anyone at any age,” Dr. Goel says.“We are caring for patients from all walks of life.” Electrophysiology is a constantly evolving field, with innovative devices at the forefront.

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“One of the major reasons I was attracted to the field is device implantation and management,” Dr. Goel says. Devices are used to manage heart rhythms. These devices include pacemakers, defibrillators and cardiac resynchronization therapy. “Electrophysiology is largely dependent on cutting-edge technology,” Dr. Goel says.“That’s what makes the field so exciting. These technologies are constantly being advanced, improving care for patients at a rapid pace.” Ultimately, it is a commitment to the health of First Coast residents that inspires Dr. Goel to get up in the morning. “When I am rewarded with a patient doing well and feeling healthy, it inspires me to keep going,” says Dr. Goel.

Physician Feature Meet Dr. Jonathan Constantin Dr. Jonathan Constantin always thought he would be an outside linebacker for the New York Giants. “It wasn’t until later in life that I realized God didn’t give me the physicality for that,” Dr. Constantin laughs.

Dr. Jonathan Constantin

After coming to this realization, Dr. Constantin found himself gravitating toward medicine. “The origin of the word ‘doctor’ means to teach,” Dr. Constantin says. “I work for the patient as a resource to

help them be successful.” Dr. Constantin attended medical school at the University of Medicine and Dentistry of New Jersey. He then went on to complete his residency at Thomas Jefferson University Hospital. When it was time to go into his specialty, Dr. Constantin decided on cardiology. “As you go through medical school, you decide what specialties you like and don’t like,” he says.

“I always loved cardiology because of the primary care aspects of cardiology, such as managing chronic diseases and lifestyle education.” He went on to pursue a cardiology fellowship at Drexel University. Dr. Constantin is now board certified in cardiovascular diseases, nuclear cardiology, echocardiography and internal medicine. Dr. Constantin believes in involving the patient in their care. He believes a patient’s understanding is paramount for a successful treatment plan. “A doctor can make the proper diagnosis, give the best advice and do all the right things,” Dr. Constantin says. “But if the patient walks out the door and doesn’t recognize how they are involved in their care, it is not going to be a successful program.” Dr. Constantin puts prevention at the center of care. He does this through encouraging lifestyle modifications. “I’m always the happiest guy in the world when patients are able to make healthy lifestyle changes, whether that’s embracing a healthy diet or quitting smoking,” he says. Dr. Constantin is a member of the American College of Cardiology, American Heart Association, Physicians for Social Responsibility as well as several other national and local organizations. Outside of clinic, he enjoys physical activity and spending time with his daughter.

9822 Tapestry Park Circle, Suite 202 | Jacksonville, FL 32246 O: 904-642-3257 | F: 904-642-7997 | TF: 888-345-5069

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Roasted Vegetable Quinoa Linguine Our friends at Native Sun love this roasted vegetable quinoa linguine recipe (our doctors love it too). Quinoa linguine is made from quinoa instead of wheat and provides a myriad of health benefits. Quinoa pasta is a great source of protein as well as iron. It is also gluten-free for those individuals with celiac disease who still crave pasta (you’re only human after all).


Preparation Instructions

Coconut oil to grease pan

1/4 tsp. fresh ground pepper, divided

3 yellow squashes, sliced

16 oz. quinoa linguine

2 zucchini, sliced

10 oz. fresh spinach

1 pt. grape tomatoes

15 oz. butter beans

10 oz. mushrooms, halved

1/4 cup chopped sun dried tomatoes

1/2 red onion, sliced

1 tbsp. olive oil

1/4 tsp. salt

1. Preheat the oven to 400°F. Grease a baking sheet with coconut oil to prevent sticking. 2. Add squash, zucchini, grape tomatoes, mushrooms and onion to the baking sheet; sprinkle with half the salt and pepper; bake for 40 minutes or until edges of vegetables are beginning to brown. Meanwhile, cook linguine according to package directions. 3. Place spinach and butter beans in a large bowl, top with cooked linguine; toss to wilt spinach; top with roasted vegetables, sun dried tomatoes, olive oil and remaining salt and pepper. Toss well.


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Advancing Medical Knowledge:

Our Clinical Research Department “By being active participants in clinical research, we ensure our patients are the first to benefit from exciting new technology in the cardiovascular field.” — Dr. Yazan Khatib, President of FCCI

Each regulatory coordinator works closely with a team of physicians, combining clinical expertise with knowledge and passion.

e Clinical Research Department at First Coast Cardiovascular Institute (FCCI) contributes to the development of medicine through innovative research. Our team collaborates with top pharmaceutical and device companies to give patients access to the latest advancements in medicine. One of the ways we accomplish this goal is through clinical trials. Clinical trials are research studies involving people and help in identifying new treatments. “Many of our patients choose to participate in clinical trials,” says Regina Moore, Director of Clinical Research. “Each clinical trial is different and has very specific entrance guidelines.” Our clinical research department Regina Moore, Director of Clinical manages more than 20 clinical trials Research and is supported by three full-time regulatory coordinators. All three are either certified clinical research professionals (CCRP), certified clinical research associates (CCRA) and/or registered nurses. Each coordinator works closely with a team of physicians, combining clinical expertise with knowledge and compassion.

FCCI has been involved in many premarket trials for stents that have since been FDA approved. A stent is a wire mesh tube that is placed in the narrowed arteries. e use of stents restores normal blood flow and aborts heart attacks. Stents also save patients from a potential stroke and Dr. Khalil Afsh, prevent amputations. FCCI has worked Medical Director of closely with top manufacturing companies Research during approval process for different stents. We’ve had the privilege to work with Boston Scientific, Medtronic, Cook Medical, Abbott, and many other prestigious organizations, placing us at the forefront of rapid changes in the cardiovascular field. Additionally, we have been involved in many pre-market trials for drugs that subsequently receive FDA approval, like our work with Xarelto. Xarelto is a blood thinner used for patients with atrial fibrillation and can reduce the occurrences of stroke and blood clots. “By being active participants in clinical research, we ensure our patients are the first to benefit from exciting new technology in the cardiovascular field,” says Dr. Yazan Khatib, president of FCCI.

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The Connection Between PULMONOLOGY AND CARDIOVASCULAR MEDICINE A patient undergoes a cardiopulmonary stress test to assess how well his lungs, heart and muscles are working.

As a board certified pulmonologist, Dr. Irram Hamdani specializes in diseases of the lungs and airway. Patients who may need to see a pulmonologist include those who had childhood asthma, smoked in the past, or are experiencing shortness of breath, chronic coughs or occupational exposure. Dr. Hamdani’s expertise is an ideal complement to our cardiovascular services. We offer a range of diagnostic pulmonary services that can detect the occurrence of a pulmonary issue. In the event the diagnostic test shows a cardiology problem instead of a pulmonary issue, a team of board certified cardiologists is just down the hall. Housing cardiology and pulmonology under the same roof ensures patients receive expedited and comprehensive care when they need it the most. “Patients are always relieved to know they don’t have to shuffle to multiple testing centers or doctors’ offices,” Dr. Hamdani says. “I can speak with each cardiologist directly so the patient is receiving personalized care.” One of our core diagnostic tests is the cardiopulmonary stress test. Cardiopulmonary stress testing is a state-of-the-art technology used to assess your heart and lungs based on how well they work individually and together. is test has a wide range of utility including defining the level of functionality decline that warrants a heart transplant. “Traditionally, this technology has been exclusive to large hospital systems,” Dr. Yazan Khatib, president of First Coast Cardiovascular Institute (FCCI) says. “We are proud to be the only outpatient practice in Jacksonville able to offer this service to our patients at lower out-of-pocket costs.” Additionally, certain illnesses may require the work of both a pulmonologist and cardiologist. For example, pulmonary hypertension is a form of high blood pressure affecting both the lungs and the heart. For a condition like this, the expertise of both specialties ensures the patient is receiving the best care possible. 15

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We treat: • Pulmonary hypertension • Chronic obstructive pulmonary disease (COPD) / emphysema • Interstitial lung disease • Lung diseases related to neuromuscular weakness • Asthma • Cough

Our pulmonary services include: • • • • • • • • •

Pulmonary function test Cardiopulmonary stress testing Six minute walk test Evaluation of home oxygen Bronchoscopy with biopsies Oxygen therapy Evaluation for home oxygen Inhalers Lung cancer screenings | Endobronchial Ultrasound (EBUS) & Superdimension Bronchoscopy • Smoking cessation

We are committed to providing convenient and cutting-edge multi-specialty care to each patient. Call 904.493.3333 to schedule an appointment with our physicians.

PATIENT SUCCESS STORIES as Told by Our Fabulous Team

David Swain, DMP “I had a patient that had a wound on his foot for 8 years that prevented him from walking. The patient had seen many physicians over that time with no success. I was able to heal his wound in 4 weeks after correcting a foot deformity through surgery, eliminating his chronic infection with IV antibiotics, addressing his vascular disease, and utilizing a placenta graft for closure. The patient has completed his physical therapy and is now actively walking and enjoying his family.” Dr. David Swain

Brenda Murphy, ARNP

“I witnessed one of our cardiologists respond to a heart attack in the middle of a hurricane. The doctor drove through the hurricane. He had record time of 36 minutes, door-to-balloon time. Had it not been for the dedication of the doctor and the team, this patient would have been a mortality statistic.” Maxwell Sapolsky, PA-C “I had a patient who had developed idiopathic cardiomyopathy, meaning we didn’t know the cause, but her heart was weakened significantly. She was extremely upset that she wouldn’t be able to ride her motorcycle, because her LifeVest (a wearable defibrillator) might shock her heart while riding. Luckily, with the proper medications I started her on, her heart recovered enough function that she didn’t need the LifeVest or a defibrillator/ AICD (automatic implantable cardioverter-defibrillator). She was so happy she could ride her motorcycle again and her heart had returned to nearly normal!” Lucy Walling, ARNP “I had a patient who had chest pain everyday for a year. He was distraught because he had seen many physicians and no one could help him. One of our physicians cathed and stented him. He has no chest pain to complain of anymore and he is all smiles.”

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The Save a Leg, Save a Life Foundation One of the people who has benefited from the work of the SALSAL Foundation is Carla Urff. Carla has been a diabetic since the age of 11. She found out she had peripheral artery disease (PAD) at the age of 37. “Within two years of the diagnosis, they told me I needed to prepare for amputation because I had developed gangrene in the foot,” Carla said. She had several surgical procedures, which bought her some years, but were not a permanent solution. “He told me, ‘I can

Dr. Desmond Bell shares a laugh with Carla Urff, one of the many patients who has benefited from the SALSAL Foundation’s work.

Nearly half of unhealed diabetic foot ulcers result in death within five years. In fact, 85 percent of lower-limb amputations in patients with diabetes are preceded with a foot ulcer, according to Diabetes Care.

“Dr. Khatib started cleaning out my arteries and stenting, putting stents in my legs and my heart,” Carla says. Dr. Khatib worked on her for five and a half hours straight to get the first stent in.

New Cardiovascular Horizons estimates the costs associated with amputations are $10-20 billion, every single year. These figures are staggering. The consequences of amputations are devastating, yet many amputations can be prevented through early screenings and care.

“He was not going to stop. He told me, ‘I can fix this’,” Carla says. “I can’t tell you how overwhelmed I was, knowing that I was so close to amputation, that there was actually help out there.” Carla now lives a healthy life without the fear of amputation.

The Save a Leg, Save a Life (SALSAL) Foundation aims to reduce the incidence of lower-extremity amputations through education and patient advocacy. The SALSAL Foundation works closely with First Coast Cardiovascular Institute to inspire hope in those patients told nothing could be done for them.


fix this.’ I can’t tell you After developing gangrene a second how overwhelmed time and having three I was knowing that, toes turn black, Carla so close to amputation, decided to search the there was actually internet for a solution. She found the SALSAL help out there.” Foundation and contacted Dr. Desmond Bell, the founder and president of the SALSAL Foundation, as well as a top wound care specialist. “He sent me to an interventional cardiologist, Dr. Yazan Khatib, who confirmed he could help me,” Carla says.

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Winter 2017

It is stories like Carla’s that inspire Dr. Bell to spread the mission of the SALSAL Foundation. “We are trying to educate people so they can be proactive and avoid getting to a state where amputation is their only choice,” Dr. Bell says. To learn more about the Save a Leg, Save a Life Foundation or to donate to the cause, visit Donations help raise awareness and assist those in need to purchase diabetic shoes, socks and supplies for PAD screenings.

New Year’s Resolutions Dr. Yazan Khatib “Get more quality sleep!”


Dr. Alan Schimmel “Hydrate, hydrate, hydrate – drink more water throughout the day.”

Dr. Vaqar Ali “Play more golf, of course.”

Dr. Youssef Al-Saghir “We could all take more time for ourselves and reduce our stress levels.”

Dr. Omer Zuberi “Visit Disney World with my son, Aariz.”

Dr. Sumith Aleti “Visit my home country of India with my wife and children.”

Dr. Sumant Lamba “I would like to go to every soccer practice of my three boys on the weekends.”

Dr. Brett Sasseen “I need to focus more on getting my fruits and veggies in daily.”

Dr. Shahnaz Punjani “Being new to the Jacksonville area, I would like to make some new local friends!”

Dr. Andrea DeNeen “Take some time each day to practice mindfulness.”

Dr. Michael Illovsky “I would like to turn my phone off during dinner time to connect with my family.”

Dr. Jonathan Constantin “Take on a new hobby I can share with my daughter, Samantha.”

Dr. Gary Snyder “My wife and I want to visit my daughters and granddaughter in New York more often in 2017.”

Winter 2017

Dr. Ameeth Vedre “Listen to my favorite music more.”

Dr. Satish Goel “I would like to be more eco-friendly in my home and in our practice.”

Dr. Daniel Thielemann “I have a lot of new books I’d like to read this upcoming year.”

Dr. Irram Hamdani “Cook more at home and eat out less.”

Dr. David Swain “Get more creative…I paint, play the guitar and want to add some more creative skills to my tool box!”

Dr. Desmond Bell “I am determined to create more public awareness for peripheral artery disease with my non-profit organization, the Save a Leg, Save a Life Foundation.”

T he H eart of J acksonville C linic


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