Diabetes Awareness Month

Diabetes Awareness Month

HEART HEALTH

Diabetes Awareness Month

Striving for a life free of diabetes and its burdens

November is Diabetes Awareness month. The number of Americans living with diabetes is staggering: the Centers for Disease Control reported in July of 2017 that nearly 100 million people living in the U.S. have diabetes or pre-diabetes. The report finds that as of 2015, 30.3 million Americans – 9.4 percent of the U.S. population – have diabetes. As diabetes is becoming more prevalent in our communities, culturally, there is a concern that adults are treating their diagnoses as a condition that can be managed with medication, not as a disease that can cause long-term damage if left untreated. This month on HeartTalk presented by Capital Cardiology Associates, we discussed the impact of diabetes in the Capital Region from the medical and community health perspectives.

Theresa Beshara is a Nurse Practitioner in Family Health at St. Peter’s Hospital Diabetes and Endocrine Care Center. She has almost twenty years of experience working with diabetics, their families, and caregivers. Theresa attributes bad lifestyle choices as one of the main factors contributing to our nation’s diabetes problem. “We are more sedentary (than earlier generations); we don’t tend to exercise as much. Our diets are better than they were 20 years ago, but we still enjoy fast food meals. We do eat a lot more carbs, and it’s a matter of genetics: we can’t change that piece.” Diabetes does have a hereditary element; it tends to run in families. However, for most people living with diabetes, it is usually a combination of both genetics and lifestyle choices that influence risk factors.

“I think there is a stigma right now with Type 1 that you cause yourself to have it when really it is an auto-immune disease,” says Laura Greenaway, Development Director of the American Diabetes Association in Albany. On our recent HeartTalk episode, Laura shared her family history, how her sister was diagnosed with Type 1 and how different her childhood home went without sodas, sugary snacks, and candies that could be found in her friends and neighbors kitchens. “With Type 2, there is a misbelief that you ate too much, and people aren’t aware of the hereditary factor. Diabetes is a disease that isn’t talked about because it’s not visible. What we are trying to do is help educate people about the different causes, ways to prevent it, and what their risk is.”

As diabetes detection has improved through innovations in technology and testing, nothing replaces the importance of having a yearly discussion with your health care provider on your risk. It’s a talk that needs to happen earlier in life. “If we can get our teenagers to work with their parents to make better food choices, get them involved with an exercise program or school sports, those two things will help with prevention,” said Theresa Beshara. When we talk about the long-term damage unmanaged diabetes does to the body, it’s alarming how an excessive amount of sugar in the system, over time, affects the arteries and blood vessels. As the cardiovascular system stiffens, it causes the heart to work harder to push blood throughout the body. What takes years to develop eventually becomes high blood pressure or atherosclerosis, both triggers for stroke, kidney issues, peripheral vascular disease, and heart failure. This is the mission of the American Diabetes Association, a life free of diabetes and its burdens. “Diabetes is more than blood sugar monitoring; it is a disease that affects every organ in your body and can cause long-term damage if untreated. It is something we all should want to prevent,” said Greenaway.

Awareness. Education. Engagement. Prevention. Those are the goals for the American Diabetes Association during November. “When we talk with physicians or diabetes educators, our partners in the community awareness programs, we talk about the day to day things that people can do,” stated Felix Perez, Market Director for the American Diabetes Association. Capital Cardiology Associates is proud to join the cause to encourage at least 30-minutes of daily activity or exercise, a heart-healthy diet, living smoke-free, and making responsible choices with alcoholic beverages. If you’re ready to make a difference, stand up and be counted by clicking here.

Written by: Michael Arce, host of HeartTalk presented by Capital Cardiology Associates

Heart Failure in People Under 65

Heart Failure in People Under 65

HEART DISEASE

Too young for heart failure

Why more Americans under 65 are being diagnosed with heart failure earlier in life

Heart failure, also called congestive heart failure (CHF), is when the heart doesn’t pump blood as well as it needs to. While more than 200,000 cases are diagnosed every year, heart failure is typically found in patients over 65. The Journal of the American College of Cardiology published a article this summer that highlighted the rise in heart failure cases in people under the age of 65. According to experts, this is partially due to a “clustering of risk factors” in young adults, such as hypertension, high blood pressure, rising rates of obesity, and coronary artery disease.

The term heart failure is easily confused with cardiac arrest, which is when your heart suddenly stops beating. Heart failure is the result of long-term heart disease, like coronary artery disease, the buildup a fatty plaque in your arteries that can reduce blood flow, cause strain on your heart muscle, and trigger a heart attack. “What we also look for in heart failure patients is what caused the heart to get weak in the first place,” said Dr. Heather Stahura, a board-certified cardiologist at Capital Cardiology Associates. “Very infrequently, but it can happen, some medications can cause acute CHF. Some chemotherapies can cause heart failure to happen. In other people, once in a while, we’ll see a common cold virus that can attack the heart, making it function poorly. Most of the time, we see CHF as a continuum of a long-term process that stems from uncontrolled high blood pressure, cholesterol, and what I am seeing with young adults — hypertension.”

Heart failure risk for young adults

Researchers recently looked at the relationship between high cholesterol and blood pressure levels in early adulthood and the impact on heart health later in life. Their findings, published in the Journal of The American College of Cardiology found that “exposure to elevated (levels) during young adulthood (18 to 39 years of age) were associated with increased coronary heart disease and heart failure later in life.” The doctors cautioned young people that high blood pressure, diabetes, and smoking are modifiable risk factors, meaning that while genetics ultimately play a key role in your overall heart health, a healthy lifestyle can combat some risks. “What I am seeing with young adults is hypertension. They may be diagnosed with diabetes in their 30’s or 40’s and feel that a blood pressure reading of 170 is something they can take care of when they are older. But ten years or more of high blood pressure can weaken the heart and cause congestive heart failure,” noted Dr. Stahura.

Since heart failure is a long-term disease, daily activities like walking up the stairs, carrying groceries, or even walking from your car to your home can, over time, become a challenge. “The biggest symptoms that we see as cardiologists are shortness of breath either at rest or on exertion,” shared Dr. Stahura. “Fatigue, that’s the other symptom I see in a lot of people. Not being able to get out of bed, lacking the energy to play with your grandkids, loss of interest in things you used to do. Swelling in your lower extremities is something I will investigate. A little swelling around the ankles is common at the end of the day, but we’re talking about excessive swelling. Increase abdominal wall growth, where your pants are fitting tighter, could be an option. In advanced stages of congestive heart failure (CHF) where it is filling up your lungs, you can have pulmonary edema — fluid in your lungs — that can make breathing more difficult.”

The danger of heart failure is that there is no cure. This is why health care professionals stress the importance of regular visits with your doctor to monitor your risk, and if needed, recommend lifestyle changes to improve your heart health. It is possible to live with heart failure. Of the more than 6 million American adults living with heart failure, about 10 percent have advanced heart failure. Dr. Stahura outlined those treatment options. “There is a biventricular pacemaker that some patients respond well too. My electrophysiology colleagues at CCA would implant this device to try and re-synchronize the heart if the patient meets certain criteria. Our interventionists can place a mitral clip, a procedure where we cinch a very leaky heart valve. If you have a tight or stenotic heart value, like aortic stenosis, we will insert a TAVR valve, that alleviates the stress in your heart. We have plenty of options for each heart failure case. But always diet, exercise, and medication will be the cornerstone of therapy.”

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

World Health Day

World Health Day

HEART NEWS

America’s heart problem is now the World’s

Heart disease is no longer an American problem

World Health Day is a global health awareness day celebrated every year on April 7th, under the sponsorship of the World Health Organization (WHO), to call attention to the advancement of health in all people. This year, I sat down with Dr. Brion Winston, who in addition to being a board-certified cardiologist, also has an area of interest in public health. Our discussion began with data from WHO that in 2016, more people died of heart disease than of AIDS/HIV, malaria, and tuberculosis. Heart disease is responsible for one-third of all global deaths.

Why is heart disease exploding in developing countries?

At least three-quarters of the world’s deaths from cardiovascular disease (CVD), or heart disease, occur in low- and middle-income countries. Heart disease very treatable and preventable if caught early. One factor affecting the poorest people in these places is the lack of detection. Dr. Winston explained how the diagnostic evaluation of heart disease in developing countries would be pretty basic, at best. “You would be able to find electrocardiography in many clinics but remember, in poor and developing nations, the standard of health care delivery is often a fee for service. If someone has a severe health problem, they will show up to the emergency department, often accompanied by their family, they will talk with the doctor and the patient. The doctor will say, ‘this is what I think is going on, and this is what it will cost’ and there is a fee for service right up front. With that in mind, the choices for diagnostic evaluation may be limited in some places.”

“Taking to the later phases of treatment, surgical treatment for heart disease in poorer nations are quite limited, maybe to aspirin, things like catheterization labs – you’ll find poorer countries don’t have them,” stated Dr. Winston. Treatment and procedures of heart disease like balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), coronary artery bypass or valve repair and replacement is costly once heart disease advances. “But, with the example of India, they have many hospitals which have prospered with the economic development over the last 30 years, these sites are considered ‘medical tourism’ where Americans will travel overseas for heart procedures in India. These are for-profit hospitals that run efficiently, conducting a high volume of surgical procedures. The costs of some of these procedures would be a fraction of what a patient would pay and there are some people willing to travel for this.”

Awareness and education are an important component that is missing in developing countries. The most important behavioral risk factors of heart disease and stroke are an unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. Americans are bombarded with public health messages informing us of the increased risks of a poor diet, smoking, and lack of exercise; this is not the case in other parts of the world. “In my practice and taking with my colleagues, many of whom are from South Asia (India and Pakistan), there is a high incidence of heart disease in people from these lands when they come to the US, if they follow a US diet that is high in fat, then we may see development of heart disease even earlier,” says Dr. Winston. “Overall, while we have made substantial improvements in reducing smoking in the United States but in South Asia and China, there is still a large amount of that population that still smokes, combine that with a richer diet – that will add to this problem as well.”

A “better life” might be a slow killer

Economics is an underlying cause of fostering the bad behavior that leads to heart disease. In some countries, soda is cheaper than bottled water. This year, Canada recently updated its Food Guide to offer advice on what to eat, what not to eat, and how to eat. Half of the plate is fruits and vegetables, a quarter for whole grain foods, the final quarter for protein. They also removed dairy as a category, urging citizens to have a glass of water with meals. In the African nations of Tanzania and Zambia, clean water does not flow from their taps. A can of Coke is less than and safer than clean water. This choice adds up; according to the Human Sciences Research Council the cost of eating healthy in South Africa is 69% more than the alternative.

The opposite is true in other parts of the world. “As standards of living have improved in South Asia as well as in China, people are following more of what we tend to think of as a Western Diet, a high fat, high energy diet – we rating to see more diabetes and related heart disease. It’s both an issue that we have made progress of infectious disease as well as the economic shift which has lead to people eating richer diets putting them at greater risk for heart disease,” notes Dr. Winston.

A global problem

Heart disease is the number one killer of men and women in America. It is also responsible for one-third of all global deaths. This global problem is going to need a large solution that addresses access to health care and preventative treatment. A WHO report estimates that Africa has about one doctor for every 5000 people. In underdeveloped nations, community health care workers fill the void of serving patient’s who don’t have access to a doctor or even a hospital. In South Africa, Mexico, and Guatemala, a study shows that these health care workers were able to screen adults for cardiovascular disease when access to a physician was not available. Armed with a mobile app, instead of traditional paper, these volunteer professionals were able to diagnose patients efficiently and at less cost compared to standard care.

There is hope in solving the global heart health problem. While there will certainly be a growing demand for cardiologists worldwide, it wasn’t that long ago that the HIV/AIDS crisis seemed impossible to contain. Money for research, governments pushing for public health policies, and dedicated medical professionals will need to unite around the world to fight heart disease – together.

Written by: Michael Arce, Capital Cardiology Associates Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Luke Perry Stroke

Luke Perry Stroke

PATIENT EDUCATION

Stroke is no longer
an “old age” risk

Adults as young as
40 are now at risk.

Here’s what you need
to ask your doctor.

Luke Perry’s death, just four days after FOX announced that it would be re-booting “Beverly Hills, 90210”, the TV show that made him 90’s icon, came as a surprise to fans who were hoping he would return as “Dylan McKay.” This role cemented Perry’s iconic image as the standard of cool for the generation who grew up after Jim Stark, the troublemaking teen played by James Dean in the epic 1955 film “Rebel Without A Cause.” The two characters not only shared similar backstories, dangerous loners who lived on the edge; the actors also shared a striking similarity in appearance.

The news report that The Los Angeles Fire Department responded to a “medical assistance” call at Perry’s home on Wednesday, February 27, dominated the headlines. At first, officials say Perry was talking to first responders and was fully conscious. This was just days after TV announcement; fans were shocked to learn that the star, at 52 years old was hospitalized due to a massive stroke. We were all saddened when the news broke the following Monday of his passing.

Redefining stroke

Stroke, as with many other forms of heart disease, is often thought of as an “old person’s” health concern. While there are more than 200,000 stroke cases in the US every year, making it the fifth leading cause of death in our country, the primary age affected is 60 years old and up. However, recent health trends have shown a growth in diagnosis with adults aged 41-60. “People can have strokes at any age,” says Maryellen King, Nurse Practitioner at Capital Cardiology Associates. Ultimately, if you have a concern about your risk of stroke, heart attack, or heart disease make an appointment with your doctor or primary care provider, today.

The traditional factors that put you at risk for stroke are lifestyle, diet, physical activity – which are controllable — tobacco use and smoking double the risk of stroke when compared to a nonsmoker. Smoking increases clot formation, thickens the blood, and increases the amount of plaque buildup in the arteries. Abusing alcohol and drugs (cocaine, amphetamines, and heroin) have been associated with an increased risk of stroke. The uncontrollable risk factors are your family history, age, race, gender, and prior heart health history.

There are also uncommon causes of stroke which are usually congenital (birth disorders) or rare vascular blood vessel diseases.

The recommendations for adults in their 40’s who are concerned about lowering their risk of stroke, heart attack or heart disease are:

• Eat a healthy diet, including reducing salt intake.
• Engage in regular physical activity and maintain a healthy weight.
• Manage stress.
• Avoid tobacco smoke.
• Take your medication as prescribed.
• Limit your alcohol consumption.

What is a stroke?

The National Stroke Association defines a stroke as “a brain attack.” Essentially, you have an instance where you’re losing blood flow to a part of the brain. “There are different types of stroke, hemorrhagic (bleeding in the brain), embolic (a blood clot that travels),” says King. Hemorrhagic strokes are less common; only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths. They can occur as a cerebral aneurysm, a congenital malformation of the arteries in the brain that can rupture. “There is no way to know if you have an aneurysm or not. If it ruptures, you can have bleeding on the brain, and people can die from that. They would experience sudden severe headache, the bleeding in the brain, patients will say the worst headache of their life. It’s not a warning sign, that’s a symptom,” stated King.

The other form of stroke is called an ischemic stroke. This can happen when a sticky, fatty material called “plaque” builds up in a blood vessel in your brain. Plaque slows your blood flow. It may cause your blood to clot. This can stop the flow of blood completely. This kind of stroke can also happen when a clot travels to your brain from another part of your body, even if you don’t have plaque buildup in your vessels. The most common cause of this type of stroke is A-Fib (atrial fibrillation) when your heart has an abnormal rhythm that produces the opportunity for a clot to form in the left side of the heart, dislodge and travels up and through to the brain.

A patent foramen ovale (above) is a hole in the heart that didn’t close the way it should after birth. The condition affects about 25% of Americans, but many do not know it.

The other type of embolic stroke would be a patent foramen ovale (PFO) or some different kind of congenital hole in the right and left sides of the heart. “The sides of your heart are supposed to be separate; blood comes from the right side of the heart is pushed to the lungs. It comes to the left side of the heart and gets pushed through the body. When there is a hole between the two sides, clots form and can travel from one side to the other,” said King. Most patients with a PFO do not have any symptoms. However, the condition may play a role in migraine headaches and it increases the risk of stroke, transient ischemic attack and heart attack.

Advances in testing

For patients who present stroke symptoms (Numbness or weakness in your face, arm, or leg, especially on one side. Confusion or trouble understanding other people. Difficulty speaking. Trouble seeing with one or both eyes. Problems walking, staying balanced, or loss of coordination. Dizziness. Severe headaches that come for no reason.) there are testing procedures. “The only way to find the holes in the heart would be with an echocardiogram, an ultrasound of the heart, to evaluate to see if a PFO has formed,” said King. Echo tests are performed by specially trained technicians at Capital Cardiology Associates. The test is painless, has no side effects, and usually takes an hour. “Using an echocardiogram (ECG) we can inject ‘fizz’ essentially, a trace amount of agitated saline that we call a ‘Bubble Study.’ These tiny bubbles can be seen on an ECG moving across the septum,” King explained. An ECG allows a physician to view the heart’s structure and check how the heart functions.

The other test available is the Transcranial Doppler (TCD), a non-invasive ultrasound method used to examine the blood circulation within the brain. A specially trained technician at Capital Cardiology Associates Imaging Suite performs this test to determine the amount of blood flow to specific areas of your brain. “The main reason that we started doing this is to detect a shunt or a hole in the heart,” shared Dr. Jeffrey Uzzilia of Capital Cardiology. “Patients that had a stroke, one of the reasons why they had a stroke that is not obvious at the time, is they can have a hole in their heart where a blood clot can form somewhere in the body and cross through that hole from the right side of the heart to the left. Once that blood clot is on the left side of the body it can travel anywhere in the body, including the brain and cause a stroke. Something like a PFO that everyone is born with, for most people it will close, for about 25% of people it will stay open. The TDP is the most accurate, sensitive test to detect that. It’s a very easy thing to see. There’s a good portion of patients, like Luke Perry, that you are shocked as to how young they are when they have a massive stroke,” said Dr. Uzzilia.

Written by: Michael Arce, Marketing Coordinator, Capital Cardiology Associates Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

The Life of Heart Transplant Survivor

The Life of Heart Transplant Survivor

PATIENT STORY

The Life of Heart
Transplant Survivor

How a new heart changed one man’s life

The phone rang at my desk. It was Dr. Sullenberger. “Mike, you should come upstairs. There is a patient I want you to meet, David Gray. He has a story you need to hear.” I grabbed my recorder and walked upstairs to the 4th floor of our Corporate Woods location, unsure what to expect. This was the first time I had been called to meet a patient. Dr. Sullenberger introduced me to David Gray, a normal looking man wearing a hoodie sweatshirt and blue jeans. He smiled, we sat down, and David started opening up. He shared his remarkable survival story with the passion that makes you sit up and take notice.

David Gray (left) with Dr. Lance Sullenberger (right)

David Gray is a heart transplant survivor. His life changed forever in the summer of 2010, September 23rd to be exact. He speaks with such detail, you feel like you were in the hospital room when he received the diagnosis from Drs. Jeffrey Uzzilia and Lance Sullenberger that, what he thought were allergies, was in fact, viral cardiomyopathy, a disease of the heart muscle that causes it to become enlarged, thick or rigid. When David says cardiomyopathy, it just rolls right off his tongue. “Then I met Dr. Ian Santoro, my injection fraction was at 34%, it was recommended that I get a defibrillator, I got that. Glad I did because it saved my life. I fell on the floor and it shocked me four times, it brought me back to life!”

It was at that point, that I realized that David is going on his ninth year of telling this story. His journey continued after getting an Implantable Cardioverter Defibrillator (ICD). He blinked a few times, and the smile that was on his face cleared as a more serious tone came over his demeanor. He mentally focused as he shared this part of his story. Five years after receiving his implant, David’s ICD saved his life.

“I had just gotten done mowing the lawn,” David began. He went to sit in his chair in the garage to watch TV to cool off. “I said to my wife, ‘Hey, do you want anything from Stewart’s? I’m going to play the Lotto.” He looked right at me and stated the exact time and date; it was 5:30 pm on May the 30th. “She was like, ‘Naw, I don’t want anything.’ I told her, ‘Don’t leave, something is wrong.’ Next thing I remember, she’s in my ear saying, ‘I’m calling 911! Are you okay?” David recalls getting up and sitting in the chair but doesn’t remember falling to his garage floor, his forehead narrowly missing the snowblower parked nearby.

His defibrillator saved his life.

He sat in the chair in his garage for 20 minutes before going to the store. That’s when he got a call. “They told me that I was in full cardiac arrest and needed to come in right now. That started my summer off,” said David. “Dr. Sullenberger brought me in July of 2015 and said we needed to have a family meeting. I brought my wife and two kids in, I remember saying, ‘Really? I need a heart transplant evaluation! Are you serious?’ I was perfectly healthy my whole life. I thought I was just getting old.” David’s heart condition was degrading. A heart transplant was needed to save his life. We talked about what happens after you get this kind of diagnosis. How mind-boggling the news, terminology, and explanation can all be. The worst part is when you get home with a head full of questions left unanswered, so you get on the computer. “I googled heart transplant surgery — biggest mistake in my life, I didn’t need to know that. And I googled organ donation,” he said.

David rattled off facts so matter of factly, that after speaking with him, I realized was part of his impeccable memory recall. When it comes to organ donation in the United States, “New York is number 50 in the country. We’re at about 25% of per capita registered, we’re on the bottom of the pile. A New Yorker dies every 18 hours waiting for a transplant,” David stated. At the end of January 2016, an Intra Aortic Balloon Pump was inserted through Dave’s shoulder, another temporary solution until his open-heart surgery to implant a left ventricular assist device (LVAD).

“I knew nothing, absolutely zero about the heart or cardiology. Now I know more than I ever wanted to know in life!”

David Gray

Heart Transplant Survivor, Patient of Capital Cardiology Associates

Hear David's Story

On HeartTalk presented by Capital Cardiology Associates

HeartTalk is a weekly half-hour Sundays at 1PM on Newsradio 810 and 103.2 WGY and iHeartRadio. You can listen on-air or on the iHeartRadio app.

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“I smiled, I stayed strong during the entire process,” he recalls. The implant of an artificial heart made it possible for David walk his daughter down the aisle for her wedding, his major goal for that summer. He was able to return home, live a “normal life”, get back to the things that kept him busy, and most importantly, be with his family. Now David waited for a heart donor. Four months later, he got a phone call in late August that changed his life: a heart had been found for him. The next day he underwent surgery and on September 14th, he was discharged from the Westchester Medical Hospital. His body had accepted the new heart.

Today, David Gray lives like most retirees in the Capital Region. He keeps busy with his projects. David makes beer, cans jam and tends to his five beehives. “This year I have 42 pounds of honey!” he exclaimed. He fishes in the summer and hunts in the fall. But there is one thing that makes David quite unique to men his age: he’s survived heart failure, open-heart surgery, and in his mid-50’s, David is a patient advocate. “I have always helped people, it’s just different now,” David said.

He started small, working with support groups online and in person. He volunteers his time with several organ donor groups, New York State Donate Life, the Center for Donation and Transplant at Albany Med, the American Heart Association, “but my number one priority is with Westchester Medical Hospital”, he said, where he visits on a weekly basis. “My new life is that I visit patients. I talk with patients who come through from Capital Cardiology, I spend twelve hours a day down there.” This year he started visiting area high school students, sharing his story with young people.

David Gray walking with his daughter at her wedding

In a 2012 study, researchers found that the average life expectancy in heart transplant recipients was a little over 9 years, although researchers found a “relatively high quality of life even 10 years after surgery.” For David Gray, it’s obvious to anyone who speaks or meets with him for any amount of time that he is making the most of his new heart. He writes to politicians, celebrities and speaks to anyone who will listen about the need for organ donors. Personally, he has thanked everyone involved with his heart transplant, from the first nurse who saw him at the beginning of his diagnosis to the mother of his heart donor. An estimated 2,000 donor hearts become available in the United States each year. There is a tremendous need for donors across the country. Approximately 3,000 people are on a heart transplant waiting list at any given time, according to the University of Michigan. “We need more heroes, that’s all I can say,” David said. Anyone 16 years old or older can enroll in the New York State Donate Life Registry. Learn more by clicking here.

Written by: Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.