H E A RT & VA S C U L A R NEWS Fa l l 2 0 1 1
U p s TaT e r aT e s high in ConsUmer r e p o rT s The September issue of “Consumer Reports” magazine includes an exclusive rating of heart surgeons — and Upstate’s cardiac surgery program makes the list. The 2011 Society of Thoracic Surgeons coronary artery bypass surgery ratings can also be found at www. ConsumerReports.org/health. The data, from 2009 to 2010, looks at overall performance, complications and other quality measures. n
w e lCo m e d r . s Z o m B aT h y Tamas Szombathy MD, FACC, has joined Upstate’s clinical faculty in the division of cardiology as an assistant professor of medicine. He comes from Tufts University and St. Elizabeth’s Medical Center in Boston, MA where he completed a fellowship in clinical electrophysiology.
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C h i l ly T r e aT m e n T s av e s wa r m - h e a rT e d m a n t 75, Ray Kimball is a veteran of the Empire State Senior Games. He was competing in racewalking on June 9 in Cortland. Without warning, he collapsed. His heart had stopped beating correctly in a rhythm known as ventricular ﬁbrillation.
“I don’t think I made it halfway through the ﬁrst lap,” Kimball recalls. Paramedics used a deﬁbrillator to restart his heart and raced him to Upstate’s Cardiac “Cath” Lab where Danish Siddiqui MD performed emergency cardiac catheterization. Once stabilized, Kimball underwent bypass surgery with Gregory Fink MD, Upstate’s chief of cardiopulmonary surgery. The skill and precision of Upstate’s cardiac surgery team repaired Kimball’s heart. A more rudimentary technique known as “chill therapy” is credited with preserving his brain. When the heart stops beating and then is revived, cytotoxins are released into the bloodstream that can cause irreversible damage to the brain.“Chilling the patient with strategically placed ice packs slows blood ﬂow and the absorption of cytotoxins, improving chances for the patient to survive neurologically intact,” explains Andre Poirier RN of the “Cath” Lab. Kimball was hospitalized 11 days. He continued healing for eight weeks. Today he’s walking two miles per day. “I feel good,” he says. “It’s just a matter of healing up.” He hopes to be back on his bicycle soon, if not to race, just to ride. n
He is board certiﬁed in Internal Medicine; Internal Medicine and Cardiovascular Disease; Nuclear Cardiology and Echocardiography. Ray Kimball and his wife, Dorothy, live in Chaumont, outside of Watertown.
Syracuse New York
Pat i en t s Fi rs t
T e e n r e v i v e d o n l aC ro s s e f i e l d Rural/Metro dispatcher is a renewed advocate of automated external deﬁbrillators (AED) after his teenage son was brought back to life by an AED on the lacrosse ﬁeld June 15.
Sean Boland of Fayetteville was at his son’s all-star tryout at Fayetteville-Manlius High School. He went for refreshments at the nearby mini market and was on his way back to the ﬁelds when the Manlius Fire Department Ambulance ﬂew by. He said to himself, “I hope that’s not for Daniel.” Then his cell phone rang as he turned into the parking lot. The voice on the other end — he still isn’t sure who it was — said, “We’re doing CPR on your son. We just hit him with the AED, and he’s back.” Boland doesn’t remember sprinting the length of the ﬁeld to get to his son, who by then had been revived.
survival depended on swift action
“Without the AED, I don’t think he would have made it, to be honest with you,” Jordan says. “That AED, it was effective, that’s for sure.” Cochran faintly remembers falling. Then he remembers being awakened. He was on his back on a stretcher, and his arm hurt, where he was ﬁrst hit by the lacrosse ball. His dad was there. His mom, in tears, met the ambulance when it arrived at Upstate.
home from Upstate hours later Cochran went home from the hospital the next morning and was back on the lacrosse ﬁeld within days. His family felt gratitude. “The nurse, and the coaches and the FM trainer, they all came together. These four strangers came together and saved my son’s life,” Boland says. “I don’t know how to thank them.” n
Dan Cochran, 15, is a junior at Jamesville-Dewitt High School. His parents are Danielle and Sean Boland.
Cochran, who plays defense, recalls that he was doing drills. His arm got checked by the lacrosse ball in one. Then the coaches assigned 4-on-3s, to see how defensemen could work together. “I was playing up near the goal. Some kid passed the ball to someone else. I ran up to try to cover that guy, and the guy tried to shoot. So I tried to turn clockwise to get out of the way of the shot, and it ended up just hitting me,” he recalls. The ball struck a speciﬁc area of the heart, with the exact force and at the precise stage of the heartbeat to cause what’s known as commotion cordis, one of the more common causes of sudden cardiac death in young athletes. Cochran’s heart had stopped. His survival depended on swift cardiopulmonary resuscitation, CPR, and rapid deﬁbrillation. Coaches and bystanders came to Cochran’s aid. Among them was Mike Jordan RN, an operating room nurse at Upstate whose son was also trying out. He had never performed CPR on a human, but his training kicked in. After the AED shocked the teenager, Jordan did not make it through his second set of compressions before Cochran began pushing his arms away.
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Pat i en t s Fi rs t
a B a By a n d o p e n h e a rT s U r g e ry T h e s a m e d ay xpectant mother Tashiko Melendez awoke Aug. 17, 2010 with no clue that her life, and that of her baby, would depend on the expertise and collaboration of her obstetrician and multiple specialists at two Syracuse hospitals.
was it labor? She was due to deliver her second son by Cesarean section at Crouse Hospital in another six weeks. He would be a little brother to her ﬁrst son, Jaxson. As the day progressed, Melendez developed pain in her chest and back. Since she had never experienced labor, she recalls, “I wondered if this might be it, even though I was only 34 weeks along.” The pains were constant and eventually became unbearable. Melendez’s mother took her to the emergency room at Crouse. Initial tests showed that the baby was ﬁne and Melendez was not in labor. Then a sonogram revealed the cause of her pain: a tear in her aorta, the largest artery in the body that carries blood to and from the heart. Melendez was in the midst of a life-threatening emergency. With deliberate speed, she was whisked through the hallways that connect the two hospitals to Upstate’s operating room. Melendez’s obstetrician, Alexandra Spadola MD, of Upstate’s Perinatal Center delivered baby Joseito by C-section, and the newborn boy was returned to the Crouse Neonatal Intensive Care Unit.
Immediately after, Melendez was prepped for open-heart surgery with Charles Lutz MD. She remembers feeling terriﬁed.
an Unusual diagnosis Melendez had what is known as a Type A aortic dissection, which occurs in the ascending aorta, the part that branches into coronary arteries that supply the heart with oxygenated blood. Seventy percent of cases are brought on by high blood pressure, which Melendez had. The aorta withstands signiﬁcant pressure changes with each heart beat. Over Tashiko Melendez with baby Joseito. time, an elevated blood A year later, both are doing well. pressure can weaken the lining of Melendez continues to be the aorta causing it to tear. followed by Dr. Lutz, who smooth recovery expects no further complications “Aortic dissection is a fairly as long as her high blood common diagnosis, but not pressure is controlled with during pregnancy. High blood medication. pressure is usually a major Although dramatic, this is another contributing factor. But it’s example of the cooperative relationalways a serious situation requiring ship between the Crouse and Upstate immediate surgical intervention,” hospital teams. For decades, the two says Dr. Lutz, who replaced the institutions — one a community damaged portion of Melendez’s hospital, the other an academic ascending aorta with a Dacron tube medical center — have enjoyed a graft. “Ms. Melendez was fortunate symbiotic relationship, where to be treated so quickly and in complementary services and such a collaborative environment.” professional expertise combine to It would be seven days before beneﬁt patients, professional staff, mother and child could be students and employees. n reunited. Baby Joseito remained in the NICU while Melendez recovered at Upstate.
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Good to Know
w h aT i s v e n o U s d i s e a s e ? what is venous disease? Understanding of the functions of the vascular system is an important part of understanding venous diseases, which can be sudden or chronic. The vascular system is made up of a pump known as the heart, which circulates blood and oxygen throughout the body through tubes called arteries. The veins are the tubes that return the blood to the heart. Within the thin walls of the veins are valves that permit the blood to ﬂow in only one direction. These valves open during contraction and close when the muscle is relaxed to prevent blood ﬂow from going backward. If the valves close tightly they are called competent valves. If they don’t, they are considered incompetent. Over time, veins can be damaged or weakened and several problems can develop.
By Kwame Amankwah MD, Associate Professor of Surgery, Division of Vascular Surgery and Endovascular Services, Upstate Medical University
Roughly 12 percent to 15 percent of the population has varicose veins, which are bulging, discolored veins that are sometimes described as “a bag of worms under the skin.” They tend to occur in women and can develop or become worse during pregnancy. They may be painful, ranging from a full, heavy ache to itching and burning or cramping when standing for a long time. Some veins may be painful to touch and occasionally can bleed. Left untreated they can lead to chronic venous insuﬃciency. Intermittent leg elevation, good exercise and stocking support can treat varicose veins. If they are painful or bleeding, the veins can be removed or ablated, using a special laser device.
venous Thrombosis A condition known as thrombosis exists when clots form, blocking the interior of blood vessels. Blood flow Valve
Deep Venous Thrombosis, DVT, describes the formation of a thrombus, or blood clot, in the deep vein system. It can occur in one or more veins of the leg, causing reduced blood ﬂow back to the heart and signiﬁcant leg swelling. The condition is serious because it can lead to a pulmonary embolism, when a piece of a clot breaks loose and travels to the heart and lungs, causing problems with breathing and heart function and quickly leading to death. DVT accounts for 600,000 hospital admissions per year, with 200,000 thousand deaths as a result of pulmonary embolism. Symptoms may include sudden leg swelling, aching pain and skin discoloration. Treatment includes blood-thinning medication, along with leg elevation, leg stockings and a plan that includes exercise.
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Good To Know
These therapies may continued for three months or more, to help prevent the development of chronic venous insuﬃciency.
event like DVT — the scarring and thickening prevent the valves from closing properly and maintaining one-way ﬂow.
Superﬁcial thrombophlebitis can develop in a varicose vein where blood ﬂow has slowed. It can occur after injury, exercise, surgery, or because of a blood clotting disease. The vein becomes irritated, and a small clot sticks to the vein wall. This superﬁcial vein does not have muscle surrounding it like deeper ones, which can squeeze and move the clot off the wall. This is why superﬁcial thrombophlebitis rarely causes pulmonary embolism.
When a person stands or sits for a long time, blood pools in the veins, and the ﬂuid may leak into the surrounding tissue, resulting in ankle swelling. The leg may ache, or feel heavy by the end of the day. At night when the legs are elevated, the aching and heaviness is lessened, and by morning, the legs are less swollen and less painful.
Symptoms include a tender cord-like structure, sensitive to touch, which may appear red, warm and swollen in the area around the affected vein. Superﬁcial thrombophlebitis responds readily to warm, moist heat applied to the area. Over-thecounter ibuprofen and elevation of the leg will also help.
Chronic venous insufficiency When the valves inside the veins become injured — as a result of long-standing varicose veins, or an
Chronic venous insuﬃciency cannot be cured. Leg elevation compression stockings are the best current treatment. If the swelling is not controlled it can lead to more swelling, which irritates the skin and tissue beneath the skin. This will cause the skin to develop a permanent reddish brown color, and the skin gradually will become thick and leather-like. The skin can also become dry and itchy. A break in the skin can lead to development of a painful sore or venous ulcer. If these ulcers become infected, it may require being admitted to the hospital for antibiotic and other treatments. n
f r e e va s C U l a r s C r e e n i n g aT T r a C T s 1 6 5 The Division of Vascular Surgery and Endovascular Services conducted the 7th annual Vascular Screening Program in June at Bethany Baptist Church. This year’s event screened 165 people, bringing the total Central New Yorkers screened to well over 1,000 over the last several years. Participants received free, non-invasive tests for three of the most prevalent vascular diseases, including carotid ultrasounds to evaluate for the risk of stroke, abdominal ultrasounds to detect aortic aneurysms, and lower extremity blood pressure measurements to evaluate the circulation to the legs. n
praCTiCe opens i n C a m i l lU s Timothy D. Ford MD is the new medical director of Upstate Cardiology West, at 5700 W. Genesee St., Camillus in Suite 128 of Medical Center West. This satellite oﬃce of Upstate’s Department of Medicine, Cardiology Division opened in January and is accepting new adult cardiology patients. The oﬃce is staffed by Dr. Ford, Danish Siddiqui MD, and Jeanne Pietrzak NP. The phone number is 488-2372. n
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Good To Know
w h y y o U r d o C T o r m ay r e C o m m e n d s U r g e ry w i T h a ro B oT n a m e d d a v i n C i atients facing surgery have the same desires as their surgeons: reduced risk of infection and blood loss, brief hospital stays, minimal pain and scarring, and quick recovery. Often patients have heard about the da Vinci surgical robot and ask whether it is an option in their situation.
The answer: It depends. It depends on the type of operation, the extent of disease, whether the hospital has invested in a robot, the surgeon’s judgment and experience, and the patient himself or herself. As for any minimally invasive surgery, pregnant women and people with bleeding disorders or signiﬁcant cardio-pulmonary conditions are not candidates. (Health insurers, by the way, generally treat robotic surgery like any minimally-invasive procedure.) Some surgeons believe the robot is a tool that allows them to perform certain operations better. Here’s how: The da Vinci is designed for use during complex procedures in small, hard-to-reach spaces. Four arms enter the patient through 1- to 2centimeter incisions or “ports.” One is a camera. That camera’s view is magniﬁed up to 15 times to a console where a surgeon sits near the operating table. He or she manipulates the camera and three other arms using controls that look like computer game joysticks. The robot’s hands have better dexterity than human hands, and they have no tremors. They ﬁt into miniscule spaces where a surgeon’s hands would not.
Cardiac surgeon Charles Lutz MD, examines one fo the interchangeable arms of the da Vinci surgical robot, while Karkiehalli Dilip MD observes one of the monitors.
“The visualization with the robotic system is much superior to conventional surgery,” Charles Lutz MD, director of robotic and minimally invasive cardiac surgery at Upstate, told The Post-Standard newspaper. At the same time, plenty of surgeries are still best done in the conventional open fashion, where surgeons have access to a wide operating ﬁeld. Upstate doctors use the da Vinci for some mitral and tricuspid valve repairs, single vessel coronary artery bypasses, atrial-septal defect repairs and tumor removals. n
pa r k e r l e C T U r e f e aT U r e s m i n i m a l ly - i n va s i v e s U r g e ry p i o n e e r A pioneer of minimally-invasive mitral valve surgery, including roboticassisted techniques, will lecture Oct. 5 at Upstate Medical University. Randolph Chitwood MD, will give the second annual Frederick B. Parker MD Endowed Lecture in Cardiothoracic Surgery from 8 to 9 a.m. in Weiskotten Hall. Chitwood is the senior associate vice chancellor for health affairs at East Carolina University. He is director of the East Carolina Heart Institute and Chief of the Division of Cardiothoracic and Vascular Surgery. The lecture honors Parker, long-time surgery professor and chair at Upstate, who retired in 2001. Last year’s event featured Toby Cosgrove MD, chief executive oﬃcer of the Cleveland Clinic. The lecture is open to the public. n
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Frederick B. Parker MD, Professor Emeritus, Cardiothoracic Surgery
Good to Know
a n a l ly f o r T h o s e w i T h h e a rT fa i l U r e failing heart cannot pump eﬃciently enough to meet the body’s demands. Vigilant care can help improve function and maintain quality of life.
Untreated or undertreated hypertension, injury to the heart muscle or valves, cardiovascular disease, and congenital heart problems are just a few of the causes of chronic heart failure, explains cardiologist Robert Carhart Jr. MD, FACC, professor of medicine at Upstate Medical University and director of Upstate’s Heart Failure Center. “We also treat patients who have heart damage caused by viral infections or cancer treatments,” says Dr. Carhart, “and those who have other conditions such as diabetes.”
Heart failure patients are monitored and encouraged by the specialists in the cardiology department, and connected to the resources they need at Upstate’s Heart and Vascular Center and cardiac rehabilitation program. Upstate’s new heart failure nurse coordinator is making these services accessible and seamless.
At Upstate’s Heart Failure Center, Dr. Carhart and his team develop individualized patient care programs to monitor and treat the breadth of issues associated with congestive heart failure: stress on the cardiovascular system which affects the lungs, kidneys, and liver; and blood pooling and ﬂuid build-up that causes swelling and shortness of breath. “Heart failure has many proﬁles,” Dr. Carhart says, “and it demands lifelong, consistent attention to avoid progression that can become a downward spiral.” “At Upstate, we are seeing encouraging developments on every front in the treatment of heart failure, no matter what its origin,” assures Dr. Carhart. “We are evaluating new medical treatment protocols and researching advancements in assistive, implantable devices such as pacemakers and deﬁbrillators.” Upstate’s commitment to outstanding care for heart failure patients is designed to keep patients out of the hospital and pursuing healthy lifestyles that can help their hearts function at the highest possible level. The program’s effectiveness and comprehensiveness has earned the unique-in-theregion designation as a silver performer from the American Heart and Stroke Association’s “Get with the Guidelines” Heart Failure performance program.
Robert Carhart Jr. MD, FACC confers with cardiology fellows Vasundhara Muthu MD, seated, and Prasad Cherian MD about a stress echocardiography study done in the Heart and Vascular Center.
“We emphasize to our heart failure patients that recognizing symptoms and listening to their bodies’ signals on a daily basis are good ways to stay ahead of a condition that, although not curable, can be best managed as a team effort,” says Dr. Carhart. n
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h e a rT a rT
NUTRITION: Serving Size: 1 Kebob with 1/3 cup rice Calories: 325 Carbohydrate: 32g Protein: 26g Fat: 4g Sodium: 500mg (Values are approximate)
g r i l l e d T r o p i C a l T e r i ya k i k e B o B s any grill favorites can be high in saturated fat and sodium, but you can keep your diet heart healthy by enjoying the bounty of fruits and vegetables this season brings. Choose meats that are lean. Flavor them with herbs, spices, or low sodium sauces. Try these Grilled Tropical Teriyaki Kebobs for a healthy take on a summer meal! — Danielle Stegman, RD
INGREDIENTS: Sauce: 15 oz. (1 bottle) low sodium soy sauce 1/2 cup pineapple juice (from fresh pineapple or from can) 2 tsp. sesame oil 2 tsp. vinegar 2 tsp. ground or 1 tbsp. fresh ﬁnely minced ginger 2 tsp. garlic powder or 1 tbsp. fresh ﬁnely minced garlic Pepper to taste
Artist Ludwig Stein, a professor at Syracuse University, donated his series of Valentine paintings to Upstate University Hospital, in memory of his wife, Dr. Nancy Jermanovich, and their 22 years together. On their second Valentine’s Day, Stein presented Jermanovich with a painting which featured a stylized heart. When she asked where her painting was the next year, an annual tradition was born. Until Jermanovich’s death in 2000, Stein presented her with a new painting every Valentine’s Day. The collection of 22 works is displayed in the hospital’s Heart and Vascular Center. n “Throbber” (above) and “Straight to the Heart” are two of the 22 painting Ludwig Stein donated to Upstate University Hospital.
2 skinless boneless chicken breasts, 1-2 inch cubes (about 1 pound) 1 pint cherry tomatoes, washed 1/4 lb. snow peas, washed 1 fresh pineapple, cut into 1 inch chunks (may use canned pineapple chunks, 20 oz. can) 2 cups whole grain rice, cooked kebab skewers
11.225b 911 8.3k agkc
DIRECTIONS: 1. Combine all teriyaki sauce ingredients in bowl and whisk until combined evenly. 2. Marinate cubed chicken breast in most of teriyaki sauce for 2 hours. 3. If using wooden kebob sticks, soak in water for about 5 minutes to prevent from catching ﬁre on the grill. 4. Begin to assemble the kebobs – alternating chicken, pineapple, tomatoes, and snow peas. 5. Grill kebobs until chicken reaches an internal temperature of 165 degrees. 6. Serve over whole grain rice and enjoy! Makes approximately 5 kebobs
Knowing changes everything.
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newsletter staff Editors: Karen A. Gibbs MSN, RNC, Nurse Practitioner, Cardiopulmonary Surgery Amy Tetrault RN, Head Nurse, Cardiac Catheterization Lab Melanie Rich, Director Amber Smith, Senior Editor Marketing and University Communications
Karen A. Gibbs
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