Health, Beauty, Wellness

Health, in a Nutshell N uts are a nutritious treat! They contain mostly “good,” unsaturated fat and a variety of heart-healthy components like fiber, plant sterols and arginine, which widens and relaxes blood vessels. Hazelnuts, pistachios, cashews and other nuts contain great benefits, but here are some special examples:

ALMONDS: Almonds contain Vitamin E, which helps the body develop healthy nerves and cells in the heart and lungs, and may help stop plaque buildup in arteries. One ounce of almonds contains 8% of your daily calcium—as much as one-third of a cup of milk!

WALNUTS: One ounce contains omega-3 fatty acids, Vitamin E and 8% of the daily value of folate, a B vitamin that protects against birth defects and may also help fight cancer and heart disease.

BRAZIL NUTS: According to the Journal of Nutrition, selenium may help protect against cancer. Brazil nuts have about 210 times as much selenium as other nuts!

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Exercising for Two P regnant women don’t have to give up endorphin rushes or the other great benefits of exercise. The American Pregnancy Association recommends the following types of exercise for pregnant women:

WALKING: Wear good shoes to decrease pressure on your feet and avoid slipping when participating in this safe activity.

SWIMMING: Considered the safest exercise for pregnant women by many health care professionals, swimming offers a toning, cardiovascular workout without adding stress to the joints.

KEGEL: While Kegel exercises may not be beneficial for aerobics or aesthetic improvements, they are hugely beneficial for bladder control, hemorrhoid prevention, and stronger pelvic muscles that contribute to easier delivery. Also, they can be done anywhere, without anyone knowing!

Remember to stay away from high-stress activities like water-skiing and talk to your doctor before making any changes to your exercise regimen during pregnancy.

The days of open-heart surgery are medical history. Arash Salemi, MD, clinical chairman of cardiothoracic surgery at RWJBarnabas Health— Northern Region, calls a new procedure to replace failing aortic valves nothing less than “a game changer.” The procedure, transcatheter aortic valve replacement (TAVR), offers a minimally invasive option for surgeons to replace an old, narrowing valve, giving ever-more patients many more years of good heart health.

Here, Dr. Salemi dives deeper into TAVR and its benefits for patients, which include no incisions, a shorter recovery period and, most importantly, fantastic long-term results.

Q: What is TAVR? Is this considered among the more minimally invasive heart procedures? A: Transcatheter aortic valve replacement is aortic valve replacement without the need for an incision, without needing a heart-lung machine and without having to stop the heart. It is a suture-less technique. TAVR is minimally invasive both physiologically and anatomically. Physiologically, the standard of care for 50 years has been open-heart surgery, stopping the heart, during which time you replace the valve while organ function is sustained by the heart-lung machine. TAVR is less invasive physiologically because the heart maintains its pumping function throughout the procedure. It is anatomically less invasive because, typically, there are no incisions and you don’t need to enter the breast bone as you would with a surgical approach.

Q: What makes TAVR a better procedure than other valve replacement operations? A: In terms of intermediate-term outcomes, TAVR and surgical replacement are similar. But TAVR, because of its minimally invasive nature, provides a much quicker recovery period. Patients generally are in the hospital for a day or two after the procedure. With open-heart surgery, while the longerterm results are similar, the recovery phase can last as long as six weeks. 32 Vicinity Magazine

Q: How has it changed the way surgery is performed? A: It has changed the way we evaluate patients with aortic stenosis. It is very common for patients over age 65 to have some degree of narrowing. When the narrowing becomes severe, treatment is warranted and necessary. We have achieved great results with open-heart surgery, but over the past decade, TAVR has allowed us to provide care to a broader base of patients with a quicker recovery time.

Q: Who is a candidate for TAVR, and who is not? A: TAVR was first invented for patients at too high risk for standard valve replacement. Until TAVR, surgery was only for those patients who we thought could tolerate the operation. That means a large cohort of patients were left without treatment of a progressive heart condition. There are no medical therapies for aortic stenosis—no diet, no exercise regimen, no medication that can treat it. As the technology developed, we began to conduct clinical trials on patients who were healthier. These have demonstrated that patients ranging from low to high risk with open heart surgery all benefit from TAVR. Everyone with a narrowing of the aortic valve is now a candidate for TAVR and should warrant an evaluation.

Q: What happens during the procedure? A: The TAVR procedure generally takes about one hour. Patients are typically sedated, with general anesthesia used in only about 15 percent of patients. It is typically performed through the arterial blood stream—95 percent of cases are performed through the femoral artery in the leg. A catheter with the new aortic valve is passed through the blood stream and X-ray guidance is used to position it inside the patient’s diseased native valve. Then the new valve is expanded into that space. The old valve is pushed aside against the aortic walls, giving the patient a brand-new valve to allow adequate blood flow.

March 2020 Arash Salemi, MD

Q: What is the recovery like? A: The patient recovers in the Intensive Care Unit overnight where we monitor blood pressure and heart rhythm. About one-third of our patients go home the following day, another third the day after that and the rest shortly thereafter. The average length of stay is a day and a half. There may be some soreness at the puncture site in the leg, but it is minimal. Patients typically take a baby aspirin as a blood-thinning agent every day thereafter, and we may add additional antiplatelet agents for up to six months, depending on the case. Patients are advised to take a couple of weeks off to get back on their feet and follow up with their doctors. There are no long-term restrictions.

Q: How is the TAVR program at Saint Barnabas Medical Center (SBMC) expanding, and why? A: Because of the great outcomes and quick recovery, our TAVR program is expanding rapidly. We are streamlining our patient workflow and are expanding our team of surgeons, support staff and operating room locations so we can see patients three to five days a week and perform procedures expeditiously. We are also actively involved in numerous clinical trials in this space so that we may offer the most current therapies to our patients.

To learn more about the TAVR program at SBMC visit RWJBH.ORG/TAVR, complete the form and select Livingston - Saint Barnabas Medical Center.

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