Remembering Dr Adrian Grubs

Remembering Dr Adrian Grubs

Remembering Dr. Adrian Grubs

Capital Cardiology Associates is sad to learn of the passing of our colleague, friend, and founding partner, Dr. Adrian Welles Grubs
The following content is comprised of Dr. Grubs’ online obituary and an internal employee newsletter published in 2008 when Dr. Grubs announced his retirement from our practice.

Dr. Adrian Welles Grubs, resident at the Woodlands at Furman (Greenville, South Carolina), died suddenly on August 22, 2017, after a decades-long battle with Parkinson’s disease. He was born on January 21, 1933, at Cornwell-on-Hudson, attended the public schools of Monticello, N.Y. He then graduated from Norwich University in 1955. Following his graduation at Norwich, Dr. Grubs attended the University of Rochester School of Medicine. He served his internship and one year of residency in Albany, then served two years in the 5th Army medical unit, caring for Nike Missile crews. Leaving with the rank of Captain, he returned to Albany and completed his program of residency in cardiology.

He then practiced in Albany for 43 years, starting the cardiovascular unit at St. Peter’s Hospital. His group had offices in Albany and Troy, and Bennington, Vt. In his civic life, he served on several boards and committees, as well as the board of governors of the Albany Country Club, where he continued to enjoy golf and parties.

Dr. Grubs, one of the original founders of the practice that became Capital Cardiology Associates, retired on January 31, 2008. In reflecting about his career, Dr. Grubs stated that in those days cardiology seemed simple, but it wasn’t. Physicians only had four or five heart medications, and only right heart catheterizations were done. Cardiac surgery was only in its nascent stages, there was no such thing as a pacemaker, and the mortality of a heart attack brought into the hospital was 50%. It was a little better if the patient suffered a heart attack in the hospital because they were just beginning to do mouth to mouth resuscitation and chest compressions. Prior to that, doctors cut into the chest to directly massage the heart.

Medical highlights during Dr. Grubs’ career include improved testing, especially CT imaging, catheterizations, pacemaker development and his own integral involvement in developing and directing the first, second, and third Coronary Care Units at St. Peter’s Hospital. Much of the way it was developed is still in use today. He was Chief of Staff at St. Peter’s from 1975-1977 and on the Board of Directors for St. Peter’s from 1977-80. Dr. Grubs also served on the Medical Board of Albany Medical Center from 1977-78 and is mentioned in “Who’s Who of American MDs”.

In retirement, Dr. Grubs provided some cardiology coverage in Saranac Lake. He and his wife, Shirley, enjoyed extensive travels. He also had time to improve his golf game, splitting time in their retirement community in the mountains of South Carolina as well as their home in the Adirondacks.

Dr. Grubs is survived by his wife, Shirley Ullmann Grubs. They were married in 1956 and enjoyed 61 years together. He is also survived by three daughters, Lori Grubs (Dorie Perec) of Austin, Texas, Deanna Moerer (Kim) of Stroudsburg, Pa., and Dr. Robin Grubs (Dr. Roy Clark) of Export, Pa.; a grandchild, Colette Clark of Export; and a niece Barbara Sue Schildhorn of Kingston. A memorial service will be held, September 23, at 1 p.m. at Trinity Presbyterian Church in Travelers Rest, S.C. In lieu of flowers, friends are encouraged to make a gift to the charity of one’s choice.

To those of us who will miss his easy smile and joking manner (especially his cheer on the 1st of May), Adrian Grubs was as sweet as the whipped cream he loved to put on everything.

Enhanced Cardiac Access

Enhanced Cardiac Access

Enhanced Cardiac Access

When it's your heart... it just can't wait.

Three years ago, Capital Cardiology Associates (CCA) launched its Enhanced Cardiac Access program. Located within its Corporate Woods location, Enhanced Cardiac Access (ECA) provides same day evaluations of patients with potential cardiac symptoms such as chest pain, shortness of breath, or palpitations.

“We started the ECA after noticing how many patients we were seeing in the local hospitals’ Emergency Departments who could have been evaluated more rapidly had they been in our office,” says Dr. Lance Sullenberger, a cardiologist with Capital Cardiology Associates. Many of the patients presenting to the ED with chest pain or shortness of breath get admitted to Observation Status within the hospital. There, they may spend up to 48 hours completing testing. “In our office,” reports Dr. Sullenberger, “we control the testing, and thus we as cardiologists are able to complete the workup more rapidly, usually within a few hours. In most cases, patients are able to be sent home.”

Dr. Lance Sullenberger, Co-Medical Director of the Cardiovascular CT Scanning Suite at Capital Cardiology Associates

Dr. Sullenberger and his partners created the ECA by converting part of their office space into a rapid evaluation unit. “We hired a nurse with cardiac experience, invested in telemetry units found within hospitals, and set up a few patient bays. We then spread the word to our patients, the local primary care physicians, and the community that we could see patients with active symptoms.” Patients are typically referred by their primary care physicians, they walk-in, or they are call the CCA office. The patient evaluated in the ECA is initially triaged by a cardiac nurse; labs and an electrocardiogram are performed; and the patient is then seen by a Board-certified cardiologist. Patient evaluations may include exercise stress testing, nuclear stress testing, echocardiograms, or CT scanning of the heart, all performed within the CCA office. “Ninety-five percent of the patients evaluated within the ECA go home within a few hours. Only about 5% need to be admitted to the hospital, and when they do, we admit them directly to the cardiac floor rather than sending them to the ER,” says Dr. Sullenberger.

(From Right to Left) Dr. Sullenberger, the ECA nursing staff, and Dr. Jeffrey Uzzilia.

Enhanced Cardiac Access has been a huge success for the medical community as well as Capital Cardiology Associates. “We have already expanded once and are expanding again this summer. In our 3rd year, we counted just under 3500 patient visits to ECA.” According to Dr. Sullenberger, patients like the ECA because the cardiac evaluation is more rapid than that of the ED, and the copay is an office copay rather than the more expensive ED or hospital copay. Primary Care Physicians appreciate the ECA because it serves as an alternative to the ED for their patients with symptoms needing a more urgent cardiac evaluation than a routine cardiology appointment. Insurers like the ECA because, by avoiding unnecessary hospital or ED visits, it lowers the per patient total cost of care to the medical community by thousands of dollars.

Capital Cardiology Associates is the premier cardiology specialty group within the Capital Region. Capital Cardiology has two office locations in Corporate Woods in Albany and on Burdett Ave in Troy and cares for patients within the hospitals of Albany Medical Center, St. Peter’s Hospital, and Samaritan Hospital.

The Blood Test That Confirms A Heart Attack

The Blood Test That Confirms A Heart Attack

The Blood Test That Confirms A Heart Attack

How Capital Cardiology Associates Enhanced Cardiac Access can determine a heart attack

In the Enhanced Cardiac Access (ECA) Suite at Capital Cardiology Associates (CCA) is a sign that reads, “When it’s your heart… it just can’t wait.”

Many heart attacks surface a month in advance, the symptoms go undetected until the individual experiences common indicators like chest pain or pressure. Our ECA Suite is located on the 4th floor of our Corporate Woods office and is the only Capital Region walk-in cardiac clinic. It was specifically designed to serve patients and non-patients who need attention for chest pain, shortness of breath, palpitations, or rapid heart rate.

One of the key indicators that allows our cardiac team to determine whether a patient is having a heart attack starts with a blood test.

Cardiac patients will have their blood drawn by our phlebotomists. “The benefit of an on-site Blood Lab to our patients is that all of the work is done in house,” explains CCA phlebotomist Olana Crawford. “We test for troponin, a protein that’s released into the bloodstream during a heart attack. Your blood is drawn and processed in our lab down the hall.” CCA can provide ECA patient test results in under an hour if necessary. When your blood work is done here, the results are immediately sent your physician. If there are any critical issues, the results are taken to a nurse who calls your cardiologist who recommends treatment immediately.

“If we find that patient is having a heart attack, we get them admitted to the ER right away,” adds Crawford. When not administering blood tests for ECA patients, the CCA Blood Lab also processes blood work for our patients. These tests are ordered by doctors and can include baseline blood tests, “the kidney, the liver, to all cardiac tests. If it’s a specialized test that we can’t perform, we can collect the sample and send it to St. Peter’s. We get the results back in a few hours,” noted Crawford.

At Capital Cardiology Associates we are committed to providing the highest quality of health to our patients. Crawford’s level of passion confirms that promise. “I treat every single patient with the utmost care. We’re trained to draw blood from patient’s on blood thinner medications, we make sure you don’t have a large bruises, we use a special taping system, we make sure everything stays in one medical records systems. When you get your blood work done at CCA, the results are immediately sent your your physician. If there are any critical issues, the results are taken to the nurse, who calls the doctor and recommends treatment right away.” The CCA team also understand that at times, your health also applies to their mental well being. “At other testing facilities, blood results can take at least 7-10 days to be processed, unless you go to an ER. That’s a lot to time to wait and think, ‘oh no what went wrong?’ Here we get your doctor the answers as efficiently as possible”, said Crawford.

To learn more about Capital Cardiology Associates walk-in Enhanced Cardiac Access Suite, click here. Make an appointment to today at 518-292-6090

Written by: Michael Arce, Social Media Specialist, Capital Cardiology Associates.

Your Cholesterol Level Does Not Matter

Your Cholesterol Level Does Not Matter

Your Cholesterol Level Does Not Matter

How you and your Cardiologist can calculate your cardiac risk

The common “good” and “bad” cholesterol levels myth is not true

We have all heard over the course of the last several decades that one’s cholesterol level predicts their risk of heart attack and stroke. Patients frequently ask me, “How could I have heart disease – my cholesterol level is normal?” or report to me, “I don’t have to worry because my good cholesterol is high”. As a cardiologist, I have both bad and good news: Your cholesterol level does not matter!

As you likely already know, cholesterol is a type of fat found within all cells and is free floating in blood on molecules called lipoproteins. The two most common of these lipoproteins containing cholesterol are low-density lipoprotein (also known as LDL) which carries cholesterol to the tissues (“bad cholesterol”), and high-density lipoprotein (also known as HDL) which carries cholesterol to the liver to be flushed from the body (“good cholesterol”).

Cholesterol carried by LDL can invade the walls of blood vessels and lead to inflammation within the walls of these blood vessels. Cholesterol in this way forms the main constituent of “plaque” which builds up within the walls of blood vessels, in particular within the walls of arteries which carry oxygen-containing blood to the organs such as your heart and brain. This plaque can increase in size to eventually lead to a “clogged” artery, or the plaque can “rupture” which causes the blood near the ruptured plaque to clot. In the heart, these situations lead to chest pain (sometimes referred to as “angina”), shortness of breath, or a heart attack. In the head and neck, clogging or obstruction of an artery leads to stroke.

Why then does one’s cholesterol level not matter?

Cholesterol lipoprotein levels within the bloodstream are determined by two main factors. The first is the consumption of fats which alter levels of cholesterol metabolism: mainly saturated and trans-saturated fats. Saturated fats are found mainly within animal based foods such as fatty meat, butter, and cheese. Trans-saturated fats are found within processed foods such as margarine. The other major determinant for cholesterol levels within an individual is from genetics, which determines how much cholesterol lipoproteins circulate mainly by determining how much cholesterol the liver is able to remove from the bloodstream.

Yet, we know from observational data that these levels are only one component of a patient’s overall risk of developing plaque within the arteries, also known as atherosclerosis. Some patients with what appears to be an advantageous cholesterol risk profile (low LDL, high HDL) still have heart attacks and strokes. On the other hand, we all know those people who have terrible lifestyle habits and poor cholesterol levels, but who still do not have any adverse effects. That is because neither dietary cholesterol changes or genetic cholesterol metabolism alone can predict the predisposition of the artery wall to plaque formation, and it is the actual formation of plaque which really determines an individual patient’s risk of heart attack and stroke.

Most physicians thus look for ways other than cholesterol levels alone to determine risk of plaque formation. A common method is with a “risk calculator”, a validated (proven by studies) method of estimating the individual risk of a patient using known risk factors for developing atherosclerosis. The most common risk calculator was updated in 2013 by the American College of Cardiology and American Heart Association, and it utilizes not only cholesterol levels, but also age, sex, ethnicity, blood pressure, smoking status, and diabetes to help better gauge individual risk of having a heart attack or stroke.

When a patient’s risk is calculated to be over 7.5% (meaning the risk of having a heart attack or stroke is greater than 7.5% over the next 10 years), then most physicians will recommend that the patient consider starting a medication within the class known as statins to help lower the patient’s cholesterol level in order to alter their risk profile. A patient with what has been considered a normal cholesterol level can still be estimated to have a high enough risk based on other factors within the risk calculator that they would be told they need a statin! The issue is that, as a physician, I can only modify certain risk factors: I cannot change a patient’s age, sex, or ethnicity, but I can lower their cholesterol level — the basis of all plaque — and hopefully reduce their risk.

The second, more technological way, to determine risk is with an imaging study called a Coronary Calcium Scan. A Coronary Calcium Scan is a non-contrast, low-radiation, CT scan of the heart which takes about 30 seconds to acquire and costs about $50.

The heart scan is then reviewed for evidence of calcium within the arteries of the heart; the plaque within the heart arteries calcifies or scars over time and is easily seen on these scans. Using a standardized software, the amount of calcified plaque is scored by an automated process.

Image 1

Coronary calcium scores range from zero (normal) to the low thousands (see Image 1 and 2). Because tens of thousands of patients with different scores have been followed for years, we know that a patient’s coronary calcium score directly correlates to risk over time.

Image 2

Coronary Calcium scans are more predictive than risk calculators because they directly look for plaque formation within the artery walls. There is no test in the field of Cardiology which can portend a better prognosis for a patient than a score of zero on a Coronary Calcium Scan. Coronary calcium scores over 300 on the other hand are generally considered to be high-risk, and most physicians would agree that such a score warrants statin therapy. It is an important point that a coronary calcium score of zero in most cases indicates a patient who does not need a statin medication regardless of how high the measured cholesterol. Conversely, a high coronary calcium score indicates that a patient merits statin use regardless of how low measured cholesterol levels are.

What to make of all of this?

I find that many patients will tend to over value their absolute cholesterol levels rather than the entirety of their risk profile. While these levels are important, they only tell one “chapter” in what is essence “the book of your cardiac risk story”.

Ultimately, you as the patient and I as the physician care about your risk of having a heart attack or stroke and taking steps to gauge that risk accurately. Those numbers on your cholesterol blood tests tell only a fraction of that risk. Whether through a risk calculator or through a Coronary Calcium Scan, risk assessment is an important step in helping to decide if your risk (not your cholesterol levels!) need to be treated.

Written by: Dr. Lance E. Sullenberger, Capital Cardiology Associates board-certified cardiac physician.

Now Open Cardiac PET Suite

Now Open Cardiac PET Suite

Now Open: Cardiac PET Suite

Capital Cardiology Associates adds Cardiac PET Exam services to Corporate Woods location

Capital Cardiology Associates continues investment in patient health

Capital Cardiology Associates unveiled the latest cardiac resource this week with the opening of the Cardiac PET Suite in our Corporate Woods location. “This test scan uses the lowest radiation of any cardiac technology that is used to evaluate patients for significant coronary disease,” Capital Cardiology Associates board-certified cardiac physician, Dr. Lance E. Sullenberger stated. “What makes this opening unique is that there was no machine like this between New York City and Syracuse until today.”

The Capital Cardiology Associates Cardiac PET Suite team preps the exam room on opening day.

This test scan uses the lowest radiation of any cardiac technology that is used to evaluate patients for significant coronary disease

-Dr. Lance E. Sullenberger

During the one-hour procedure you’ll lie on a flat table that’s connected to the PET scanner and a computer. The table will slide into the scanner.

The Capital Cardiology Associates Cardiac PET Suite team receiving detailed training instructions.

The Capital Cardiology Associates Cardiac PET installation.

What is a PET Exam?

Cardiac Positron Emission Tomography (PET) exams help to evaluate heart health by measuring the blood flow brought by the coronary arteries to the heart muscle. This scan lets doctors see inside your body. A PET scan is different from an MRI or a CT scan, because it shows how your organs and systems are working. For decades, doctors have used cardiac PET scans to safely and accurately identify the presence or absence of coronary artery disease in people who have had symptoms and/or risk factors. Exam results can also indicate if any follow-up treatment is needed. Read more about the procedure, here.

Same day service

PET exams take less than one hour with CCA’s cardiac board-certified medical personnel. “The procedure allows our doctors to review high-quality images of your heart without the need for invasive procedures or higher radiation doses used in other tests,” stated Sullenberger. The PET Suite has been under construction for the past month with staff receiving detailed training for the past few weeks. The suite tested our first patient at 3pm on it’s opening day.

Capital Cardiology Associates Cardiac PET Suite is located on the 1st floor of our Corporate Woods, Albany location. Talk with your doctor to schedule an appointment or receive a referral for treatment.

Written by: Michael Arce, Social Media Specialist, Capital Cardiology Associates. Photo credits: Michael Arce, CCA, 2017.

Page 1 of 212