Palliative Care

Palliative Care

Palliative Care
offers an extra
level of care to
patients and
their families

RESOURCES FOR CAREGIVERS
TO IMPROVE QUALITY OF LIFE

Palliative care focuses on relief from pain, the symptoms and the stress of serious illness to improve quality of life for patients and their families. It is a team-based approach, involving specialty-trained doctors, nurses, and social workers who work with the patient’s other health care providers to offer an extra layer of support.

While its beginnings trace back with the hospice movement of the 1960s, palliative care is not end of life care and can be delivered alongside curative treatment. “Palliative care is a combination of specialty of care providers, just like in cardiology and pulmonary and cancer specialists, it’s also a service and certain skill set,” explained Dr. George Giokas, chief medical officer of St. Peter’s Health Partners (SPHP) palliative care service line. “Essentially, it’s an extra layer of support for patients and their families that have a serious illness, working with your doctors. We aim to provide the best possible care.”

Palliative Care Team

The palliative care team is assembled depending on the patient’s needs, location, and situation. “The beautiful thing about palliative care is that it is not just one staff person or provider. It’s the amazing coupling of a nurse practitioner, physicians assistant, or registered nurse and also a social worker,” noted Catherine Markey, Social Worker. In the Capital District, Dr. Giokas and his team are embedded in local hospitals and physicians offices. Their goal is to be present when they are most needed: at the beginning of treatment. “We are involved in supporting patients at any stage of their disease trajectory but frequently at the onset, the first moment you are diagnosed with stroke, heart failure, or heart attack. That moment is optimally appropriate to introduce palliative care,” said Dr. Giokas.

For those outside the medical community, not much is known about this service to patients and their families. One area is long-term care. “Most illness that palliative care works with, and honestly, most illness that people have are not sudden events that you have, heal from, and then it’s all over with. That might happen with a car accident, but for most people with heart failure or emphysema, or most cancers, people were living with it for decades at some time,” Dr. Giokas outlined. He also outlined the “healing” process, noting that in the physical sense, healing is a role for physical therapists and their staff. A palliative team looks beyond the diagnosis to help patients live their best life while living with their disease. “People don’t get better by themselves; they are usually in a community our family that supports the healing process.”

According to the CDC, approximately 53 million Americans are currently serving as informal caregivers for patients with a variety of illnesses. The other aspect of palliative care is providing support to caretakers and family members by explaining the medical treatment and discussing stress areas. The daily demands of administering medications, accompanying the patient to physician visits, and preparing prescribed meals can lead to stress for family members and spouses, especially when they are trying to raise a family or care for themselves. Dr. Giokas acknowledges that part of the challenge is offering advanced care for a growing, aging population that has a wide spectrum of health problems. “It’s rare for us to treat just one condition, like heart disease. Patients often have a mild element of emphysema, COPD, diabetes, or arthritis. As a team, we work with the provider to treat all of the patient’s problems.”

The role of women as caregivers

Heart disease is the leading killer for men and women in the United States. Assitance and care will typically fall onto family members and spouses — most of whom are women. Studies show that more than 50% of women in America will care for a family member at some point during their adult lives. In a recent survey among California residents, 16% were serving as caregivers; of these, an estimated 59% to 75% were women, most of whom were married. Their average age: 51 years old. The strain of caring for a heart disease patient has recently been identified as an independent risk factor, putting the caregiver at almost 2-fold higher risk of coronary artery disease. “We can explore the ways to cope with that stress, whether it’s bringing in more resources from the community, additional family members to help, or working on long-term coping strategies that deal with the hard emotions of dealing with heart failure in your life,” Markey added.

In recent years, many states have created these cross-disciplinary task forces and passed legislation to educate providers and the public. For example, Vermont requires health care providers to demonstrate competency in identifying and engaging patients who could benefit from palliative care. In our area, very few patients ask for palliative care. Most referrals come from physicians when they discuss the role of a caretaker with family members. “I often hear from patients and their families how much time we spend with them. On average, it’s about an hour per visit. Our follow-up visits can potentially be just as long. We get to know them and ask questions on topics that they are not used to discussing in the medical setting. I often hear people saying that they don’t feel alone anymore when dealing with their illness; they feel like they have someone walking with them,” Markey shared.

For more information on palliative care options, please ask your doctor or health care provider at your next appointment.

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.

Purpose in Life

Purpose in Life

HEART HEALTH

Waking up with a positive attitude
at any age helps your heart health

It’s important to have a purpose
of life at every age in life

A recent study explored the role of life purpose in your heart health. Researchers from the University of Michigan School of Public Health and Health System followed nearly 7,000 adults over the age of 50 in the US Health and Retirement Study. Their findings were telling, having a purpose in life may decrease your risk of dying early. It’s also a modifiable risk factor that improves both physical and mental health.

Dr. Robert Benton is a board-certified cardiologist and Director of Clinical Research at Capital Cardiology Associates. Since 2011, Dr. Benton and fellow Capital Cardiology Associates physician Dr. Scott Morris, along with two clinical nurses, have participated in the “Walk With A Doc” program in Troy. Locally the walks happen on the second Saturday of the month. During the winter, the walks take place inside Robison Gym on the campus of Sage College. In the summer, the walks are outdoors at Troy Riverfront Park. Dr. Benton sees dual benefits in walking: the first is that walking is one of the best exercises for people of all ages and abilities. The second is the social aspect. “We talk about sports and politics, life… people get to know each other,” adds Benton. These small steps help to create a purpose in life that may move participants further from the risk of heart disease.

Defining a purpose in life

Purposeful living has been defined in various ways. In general, purpose in life can be defined as “a self-organizing life aim that stimulates goals,” promotes healthy behaviors, and gives meaning to life. Dr. Benton expanded on how purposeful living may have health benefits. “It’s concrete, those who have an aim in their life, a true meaning; they see the value in their life when they wake up every day.” Researchers found that people who didn’t have a strong life purpose were more likely to have cardiovascular and blood conditions. Dr. Benton concurred. “Lack of purpose leads to feeling hopeless. Those without hope are less likely to take good care of themselves.” The team examined studies that report that those who with a strong purpose in life engage in healthy behaviors, sleep better, have lower instances of stroke, depression, and diabetes. Simply put, being near death leads to a lower value in life, creating an opening for chronic illness.

Purpose in life is not solely an American value. A Japanese study investigated ikigai, which is defined as “something to live for, the joy and goal of living.” Globally, as adults age, our life purpose changes as we age. In our younger years, we tend to focus on our family and career. Fulfillment could be raising children, caring for older parents, building a career or business. Dr. Benton touched on the importance of having that feeling of accomplishment as a positive force in our life as we age.” Sometimes you might find a little fuzziness in life. It might be hard to set or finish goals on a timetable if you are retired or don’t have a specific function. For these folks, you need to find another way to contribute, either volunteer or become involved with a community group, that offers the opportunity to feel a purpose,” he said.

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The role of stress in our daily life

One myth is that as we near retirement, life stresses will lessen. This is not true. “I have conversations with my patients on their lives, their interests, their stress (children or older parents they may care for). I try to find out about their life,” says Dr. Benton. “It’s important for me to have that conversation with them. Especially when you meet a person who’s had good blood pressure control, suddenly they come in, and their blood pressure reading is sky high or abnormal. I ask, ‘what else is going on in life?’ Who would not have some challenges in life that lead to more stress? This is related to high blood pressure, higher cortisol levels; these both cause long term damage from your body reacting to stress. I want to know what is stressing them out to cause them not to feel well.”

Stress leads to depression, which creates a feeling of hopelessness. Dr. Benton explained how stress and depression could attack your heart. “It’s important that if you feel it or are a friend or loved one of someone feeling hopeless that you talk with a doctor. This feeling of hopelessness can lead to takotsubo, better known as broken heart syndrome. This is when people go through terrible stress, and they have what looks like a heart attack, it’s scary to us. The theory is the severe outpouring of adrenaline causes decreased blood flow to the heart. We see this more and more. Obviously, they are acute situations. What helps? Activities, exercise, and having a sense of purpose in life.”

Syracuse University researchers found that vacationing is good for your heart. Taking time off improves your metabolic health as well as your mental health. Lowered metabolic risks are associated with improvements to overall heart health risks over one’s lifetime. They also found that vacation time is available to nearly 80 percent of full-time employees, but fewer than half utilize all the time available to them. “It’s vital, and I’m even going to do this for the first time in years, take a vacation,” said Dr. Benton. And if you can’t get away, he urges the need to “take a break to slow down. Meditate. Practice mindfulness. You are not built to go full speed 24/7.”

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.

Telemedicine

Telemedicine

HEALTH TRENDS

Technology is bridging gaps in health care coverage with a virtual solution

TELEMEDICINE IS CHANGING THE FACE OF HEALTHCARE

In 1962, they imagined a future where a child who tried to use a “sick day” as an excuse to miss school (to avoid taking the dreaded “Space Calculus Test”), had his plot foiled by a house call with the doctor. In this scenario, the call to the doctor was answered immediately with the dedicated physician appearing on a monitor screen. He was able to see the patient, diagnose the problem, told Mom that her son was “fine”, and needed a full day of school. This scene played out on an episode of “The Jetsons” during a time when people had an optimistic view of medical advancements and diagnostic instruments of the future.

Today, technology is bridging gaps in health care coverage, offering a virtual solution for patients to communicate with their doctor when distances, location, or access present physical barriers. This is called “telemedicine,” and it is changing the face of healthcare. Telemedicine is defined as a cost-effective alternative to the more traditional face-to-face way of providing medical care with a distinct set of guidelines and insurance coverage approval steps. The goal of telemedicine is to deploy the latest technology to provide real-time communication between the patient and their doctor. This year, OakBend Medical Center, located in just outside of Houston, Texas, launched a telemedicine cart that allows cardiologists to virtually examine patients to determine whether they should be admitted to the hospital. We connected with Dr. Long Cao, a preventative cardiologist with Oak Bend Hospital, on a recent episode of HeartTalk presented by Capital Cardiology Associates.

“I was skeptical about how the patients would respond,” Dr. Cao shared. He was approached by hospital administrators who presented their rollout plan for the telemedicine cart. Dr. Cao’s apprehension was appropriately based. The technology’s start was a far picture than what was portrayed in the 1960s. “Everyone starts thinking of the early days; the early 2000s were when delays and images were fragmented. It felt primitive,” said Cao. As high-speed internet connections strengthed, pictures became clearer, sound quality improved, and data was transmitted in seconds — downloads opened almost immediately.

More than screen time

Video-conferencing is more mainstream thanks to webinars we attend, replacing in-person meeting. FaceTime enables us to “talk” with friends and family on our phones as though we were in the same room. “There are no delays; they can hear me, see me on screen. After a few minutes, we have a relationship, and they tell me what’s wrong and what is bothering them,” noted Dr. Cao. His patient visits are similar to the Jetson’s calling on their dedicated physician. “When the patient logs on, they see me waving and smiling. I try to make a joke to break the ice. I tell them, ‘Next you are going to see my hands come out of the side of the computer,’ and they start laughing. I introduce myself and say this doesn’t replace me being in front of you. The patients are very receptive.”

The telemedicine cart looks like any other piece of medical diagnostic equipment; however, Dr. Cao pointed out that it is loaded with the latest technology. It has multiple cameras and attachments that allow physicians to make remote patient visits. “The stethoscope attachment is very nice; it’s attached via Bluetooth. As I bring up the apparatus to listen to their heart, they can hear their heartbeat — see everything that I see on the monitors, making them actively involved and participating in their examination. There is also a sound wave feature that allows me to view the S1, S2, S3, and S4 (EKG) waves. This allows us to diagnose heart failure. It’s interspersing how these instruments are more accurate over distance than if they were in person. There is also an attachment for a camera that can zoom in 1000X, beyond what our human eyes can view. This camera can zoom into the wound to the point where I can see hair follicles and wound edging,” said Dr. Cao.

Hands off but still delivering a high-quality of care

Dr. Cao explained the importance of keeping the structure of the doctor visit, similar to the examination he would perform in person. There is a trained technician, either a medical assistant or registered nurse with the patient during the exam. “They would perform the exam while I ask the patient or technician questions on what they see or feel,” stated Dr. Cao. He sees roughly 30 patients a week using the cart. An estimated 7 million patients in the United States will use telemedicine services this year alone. As the services become more available, health care experts point that demand will continue to rise.

Telemedicine is also transforming patient care in rural and urban areas by offering advanced, specialized, and preventative care to patients that would not have local access. “Right now, we are at a time where we are seeing many heart failure patients. They are severe patients, but they can be managed if they are treated with appropriate medications. I’m not seeing heart attack patients. Those patients need to be seen immediately. However, for patients who have had a heart attack or have a week heart, who need monitoring of their medications, if there is a reservation on counseling them over the phone, this technology allows me to look at them, see their fluid levels, and treat them. Just being able to look at their leg swelling or other problems, listening to their heart, telemedicine allows me to adjust their medications or treat them at that time versus having them travel,” commented Dr. Cao. There is also a benefit to the physician. The downtime that would be spent traveling to the patient’s location can be directed to care and visits. “By removing the space barrier, I can segue and care for them. I could see them every month instead of them missing visits and needing hospital treatment.”

In the early 2000s, telemedicine was primarily paid out of pocket as it was seen as concierge medicine. Now that technology is more mainstream, insurance companies combined with patient demand has allowed for growth opportunities. New York became the twenty-second state to require private insurance companies to cover telehealth services when New York Governor Andrew Cuomo signed the State’s telehealth parity law, which went into effect Jan. 1, 2016. This law also authorized the New York Medicaid agency to increase coverage and reimbursement of telemedicine.

And what does the future hold for telemedicine? Will we ever live in a time where our dedicated physician is just a button away? “I could see the future where every house would have a monitor, and you will contract with a physician for treatment,” shared Dr. Cao.” We are also trying to introduce this to the EMS (Emergency Medical Services), my focus is on the heart, but there are trauma patients where we can start examining the patient while they are en route to the emergency room. For heart attack patients, I can see their EKG, exam the patient, and know that if this a severe heart attack, we can prepare the Cath lab for treatment. Where time is tissue – either in a stroke or heart attack – this technology can save lives.”

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.

Live To Be 100

Live To Be 100

HEART NEWS

How to Live to Be 100

You don’t have to be
a superhuman​ to live
longer and better

When someone celebrates their 100th birthday, a reporter typically asks, “What’s your secret to a long life?” We will hear every answer from, “Eat ice cream, to I drink wine, to run a mile every day.” In reality, the average life expectancy in America today is higher (now up to 78.6 years according to the CDC Health, United States, 2017 report ) than in any other period in history. It’s important to note that while we are living longer, in part to advances in medicine and technology, we could also be living better.

Cancer and heart disease are still the top two causes of death among (adults ages 45-64) Americans. Never smoking is the first “low-risk lifestyle factor” identified by researchers at Harvard University. Last year, they studied almost 30 years of data collected from over 120,000 patients. One plus: there has been a steady downward trend in smoking since 1965 when 42% of U.S. adults smoked. The target is to reduce the national prevalence of cigarette smoking among adults to 12% by next year. Researchers noted that life expectancy rates should have risen more due to the decline in tobacco use; however, that gain was counterbalanced by the high rate of people with poor diets and sedentary lifestyles. Exercising for 30-minutes a day, having a normal body mass index, and eating a healthy diet are the second, third, and fourth low-risk lifestyle factors targeted in the study. And with good reason, between 2013-2016, just over 70% of adults over the age of 20 were considered overweight, including 38.9% with obesity.

The 9 Factors To Living Longer

Dan Buettner is a National Geographic Fellow and multiple New York Times bestselling author. He has discovered five places in the world ­– dubbed Blue Zones – where people live the longest, and are healthiest: Okinawa, Japan; Sardinia, Italy; Nicoya, Costa Rica; Ikaria, Greece, and Loma Linda, California. In his TED Talk series, Buettner shares the nine evidence-based common denominators in the highest proportions of people who reach age 100. Dr. Kevin Woods, a Board-certified cardiologist with Capital Cardiology Associates, explained the history and significance of Blue Zone research. “Much of what I first read reinforced what I thought the scientific and medical literature stated was healthy and gave me more information to encourage my patients to have better outcomes. Also noteworthy, not only is their life expectancy longer, but their quality of life is better. In their later years in life, these people were still active and had fewer instances of chronic health issues.” Buettner’s TED Talk shows images of people well into their “golden years” still chopping woods, engaging in sports, enjoying an active life. One example was Ellsworth Wareham, a cardiothoracic surgeon from Loma Linda who “retired” at 74 but would still assist in operations at the age of 95.

The nine factors identified in healthy living seem simple to follow on the surface. Dr. Woods addresses two factors with his patients. “Having a sense of purpose was very important in these societies. Throughout life, there wasn’t a retirement age per se; people stayed active in their 90s and over 100. You don’t need a gym membership or treadmill for this lifestyle. It’s staying active, taking the steps, going up hills, walking instead of driving. Also, surround yourself with people who follow healthy habits.” That final point is vital. Beuttner calls it “The Right Tribe.” In his talk, he explains how positive friendships, like how Okinawans create small groups of five friends that commit to each other for life, shape healthy behaviors. “I’m sure we have all had workout buddies throughout the years that helped motivate us, likewise if you are going out to eat and you dine with people who are also mindful, it will be easier to keep those healthy habits,” said Dr. Woods.

Committing to Healthy Living

Dr. Woods expressed the challenge many of us face when making changes to our daily habits and structure. “Healthy living is a lifestyle. It’s not just exercise and nutrition; it is also support.” Currently, a handful of communities and States are urging their lawmakers to create laws that foster healthy policies. In February, California’s State Assembly proposed discouraging sugary beverages through measures including a soda tax and warning labels. This is the third time California lawmakers have considered the idea. Dr. Woods pointed to the connection to heart disease. “A 12 ounce can of soda has over 40 grams of sugar — that’s over ten teaspoons of sugar in one drink. Whether you are talking about refined carbohydrates: white bread, pasta, rice, simple sugars added to soft drinks, or sugar substitutes — they all have a variety of ill-effects. One is increasing your insulin, which can cause weight gain, hypertension, or plaque to build up in the arteries. I think people don’t realize how unhealthy these ‘little things’ are sometimes.”

In Blue Zones, there is no need for public health policy. Loma Linda’s grocery stores have bins of beans and grains, but no meat section. Their McDonald’s advertises veggie burgers. Neighborhood kids sell fresh fruits. Families participate in sports or recreation events together while making time for church on the weekends. While the idea of healthy living may seem far fetched in the urban and rural communities that makeup the Capital Region, Dan Buettner puts the value of commitment in perspective. “You have to realize where people live the longest is not because they try or because they have some heroic sense of individual responsibility. It’s because they live in an environment where the healthy choice is the easy choice.” He points to Fort Worth’s recent turnaround as a repeatable success story.

After being ranked 185th out of 190 five years ago in 2013, Fort Worth is now in the top 20 percent of the country’s metropolitan cities. It was a five-year community effort. Texas Health Resources, their health system, partnered with community leaders, neighborhoods, businesses, schools, grocery stores, restaurants, and faith-based organizations to invest in social health. Their goal was to address obstacles to healthy living before people became ill or developed chronic problems. Fort Worth set goals to make it easier for residents to move naturally, eat better, develop healthy social circles, and live with purpose. They improved access to fresh produce in stores and a citywide ordinance that banned smoking in public spaces. They shared the vision to make the healthy choice the easy choice, and they accomplished it together.

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.

Fish Oil Controversy

Fish Oil Controversy

HEART HEALTH

Results from a new study makes fish oil a controversial topic in cardiology

“Fish oil can be a controversial topic in cardiology, partly because there is conflicting data.”

Americans spend more than $1 billion a year on over-the-counter fish oil supplements. Food companies are now adding omega-3 fatty acids to milk, yogurt, cereal, chocolate, cookies, juice, and hundreds of other foods. Natural sources can also be found in flaxseeds, chia seeds, walnuts, pumpkin seeds, and canola oil. Fish oil has been successfully promoted to protect against heart disease along with claims to relieve symptoms of depression, rheumatoid arthritis, and dry eye syndrome. There are claims that fish oil decreases the risk of cancer.

The results of the OPERA (Omega-3 Fatty Acids for Prevention of Postoperative Atrial Fibrillation) trial, published in December of 2018, provided strong evidence that fish oil supplementation does not lead to increased bleeding during surgery. Dr. Connor Healey, a board-certified cardiologist with Capital Cardiology Associates, explained the concern. “In general, for fish oil to be effective it needs to be taken in high doses but there were concerns that at these high doses there was a signal that perhaps this leads to higher bleeding. For a lot of our patients that are on aspirin, Plavix, or other blood thinners, that’s a big area of concern.” The trial also revealed that higher omega-3 fatty acid levels were associated with a lower risk of bleeding, warranting the reconsideration of existing recommendations to stop fish oil or delay procedures before cardiac surgery. This new data adds to the mixed evidence for improving heart health. .

What makes fish oil controversial?

“Fish oil can be a controversial topic in cardiology, partly because there is conflicting data,” stated Dr. Healey. In January of 2019, a study reported in the New England Journal of Medicine found that omega-3 fatty acid supplements “did not result in a lower incidence of major cardiovascular events or cancer than placebo.” Earlier research reported in the same journal in 2013 also reported no benefit in people with risk factors for heart disease. However, numerous studies show that people who eat a lot of fish have much lower rates of heart disease. “This leaves cardiologists a bit uncertain as to what we should be recommending,” adds Dr. Healey.

What is safe to surmise is that while fish oil supplements can improve many of the risk factors for heart disease, there is no clear evidence that it can prevent heart attacks or strokes.

“If you have questions on this, they should be addressed on the individual level with your doctor,” says Dr. Healey. The World Health Organization (WHO) recommends eating 1–2 portions of fish per week. As the massive amount of fish oil studies have produced ambiguous results, if you are currently taking fish oil capsules prescribed by your doctor — they are an approved and effective treatment for people with high blood triglyceride levels — continue to take them as directed by your doctor and have a conversation about their benefits or your concerns at your next visit. If you are taking fish oil capsules as a supplement, talk with your doctor or health care provider about their nutritional value. Also consider changing your diet to the Mediterranean style diet, endorsed by the American Heart Association, the American College of Cardiology, and the Mayo Clinic as “a heart-healthy eating plan.”

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.