Now that we have discussed the most common instigators of anger which puts you at risk for stroke and the symptoms of a stroke, what can you do about it? Dr. Adam Horvit spoke to the topic of stroke last night at the St. David’s Round Rock Health and Wellness Center. While his presentation was all encompassing on stroke, there were two topics he went over twice saying if the attendees left with anything he hoped it would be theses two.

Prevention

• 
Treat high blood pressure
• Control diabetes
• Stop smoking
• 
Treat elevated cholesterol
• 
Limit alcohol
• Exercise
• Risk of recurrent stroke
• Medication compliance

While preventative measures can be taken, Stroke can still occur in you or those around you. Remember, when it comes to Stroke think FAST.

Face

• Facial droop
• Uneven smile

Arms

• 
Arm Numbness
• 
Arm Weakness

Speech

• Slurry Speech
• Difficulty speaking or understanding

Time

• 
Call 911 and get to the hospital immediately
• Brain is Time. The quicker you get to the hospital the better your chances are

Attendees at the seminar were also offered free blood pressure and blood sugar checks by the St. David’s Round Rock Medical Center Staff. They were able to leave equipped with several factors that may affect stroke as well as the knowledge on what to do.

This isn’t all for stroke month as we will have Nutritionist Tarie Beldin host a cooking class on Thur., May 24th at 6:00 p.m. at the Health and Wellness Center at the CHASCO YMCA. She will cook with the DASH Diet (Dietary Approach to Stop Hypertension) in an effort to help you reduce your risk for stroke and other diseases. Space is limited and registration is required so sign up today by calling (512) 478-3627 or 888-868-2104.
Hope to see you there!

Holly Krivokapich
St. David’s Round Rock Medical Center
Health and Wellness Coordinator

This study is alarming considering the rise in sedentary jobs across the country. Don’t despair. For those with desk jobs, occupational health experts have developed a sit-stand workstation. These desks make computing comfortable for prolonged periods by allowing the flexibility to switch from sitting to standing with the flick of the wrist. Another option is the treadmill desk where you can slowly walk on the treadmill while working on the computer. If you don’t want to change your desk at work, incorporate standing and walking into your activities at least every hour. Climb the stairs. Bike or walk to work, if possible.

Prolonged sitting at work is not the only culprit. The average American sits for 90% of their leisure time. If an active lifestyle is not part of your leisure time, you are at risk for a number of health-related issues. For women, this includes diabetes and breast cancer. For all of us, it includes colon cancer, back pain and as stated above, risk of early death.

So whatever you do, get out of the chair and start moving. Consult a physical therapist if you need help establishing the right exercise program for you. Now, it’s time for me to walk my dog.

Diane Owens, PT, FACHE
Assistant Administrator
St. David’s Rehabilitation Hospital

• Sudden numbness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

Click here to take the stroke risk scorecard and see if you are at risk, then join us for the Stroke Awareness Seminar which will be held at the St. David’s Health and Wellness Center at the Chasco Family YMCA on May 10th from 6:00- 7:30 p.m. A physician from St. David’s Round Rock Medical Center will lead the seminar and we will be conducting FREE Stroke screenings, blood pressure and blood sugar checks. Please join us by registering at 512.478.3627 or 1.888.868.2104.

Holly Krivokapich
Health and Wellness Coordinator
St. David’s Round Rock Medical Center

According to the American Heart Association, stroke is the third largest cause of death, ranking behind ‘diseases of the heart’ and all forms of cancer as well as the leading cause of serious, long-term disability in the United States. Each day your blood pressure is too high, your chance of stroke increases. Often times an increase in blood pressure is so subtle you may not even realize it. Are the following common instigators of anger a common occurrence in YOUR life?

• Traffic jams
• Rude behavior
• Injustice
• Embarrassment
• Deadlines
• Financial headaches
• Humiliation
• Infidelity
• Physical pain
• Failure

Anger has become part of our daily routine. Anger escalates heart rate, breathing, arterial tension and cortisol levels, increasing chances for an episode of stroke in your life! While it’s a perfectly natural emotion in small doses, excessive anger has the ability to trigger one of the deadliest health conditions affecting our community to date…STROKE.

Click here to take the stroke risk scorecard and see if you are at risk, then join us for the Stroke Awareness Seminar (download info) which will be held at the St. David’s Health and Wellness Center at the Chasco Family YMCA on May 10th from 6:00- 7:30 p.m. A physician from St. David’s Round Rock Medical Center will lead the seminar and we will be conducting FREE Stroke screenings, blood pressure and blood sugar checks. Please join us by registering at 512.478.3627 or 1.888.868.2104.

Holly Krivokapich
Health and Wellness Coordinator
St. David’s Round Rock Medical Center

Dr. Terry Peery addresses attendees at the St. David’s Round Rock Medical Center ‘Importance of Sleep’ Seminar.

Today’s blog wraps up our Importance of Sleep focus for the month of April. A special thank you to Dr. Terry Peery who spoke to the attendees at our Importance of Sleep Seminar last night at the CHASCO Family YMCA. We hope those who attended learned not only the true importance of sleep but also what actions you can take to improve your sleep habits. Sleep is a basic biological need that is essential to our health, performance, safety, and quality of life and sleep deprivation has serious negative consequences. Five steps you can take to improve your sleep habits are:

1. Go to bed and wake up at the same time consistently. Keep these same hours during the weekend.
2. Don’t’ eat heavy meals for dinner or meals within three hours of falling asleep.
3. Don’t exercise within three hours of going to bed. Try and exercise in the morning if you can which boost your metabolism.
4. Do not have a television in the bedroom. This causes arousal and disrupts sleep.
5. Avoid stimulants such as caffeine or nicotine after 2:00 p.m.

Almost a third of Americans have some type of sleep disorder. Our Sleep Lab is designed to diagnose and evaluate these disorders, which can include sleep apnea, narcolepsy, insomnia or sleep-related seizures. Take the Epworth Sleepiness Scale to determine if you may be at risk for a sleep disorder. If your score is 10 or above, please consult your physician regarding a possible sleep disorder. Call 512-901-1808 for more information or to schedule a sleep study. Studies are scheduled daily, including weekend.

The topic for May will be Stroke Awareness so mark a spot in your calendar on May 10th as we will have a featured speaker and offer free Stroke screenings including blood pressure check, blood sugar check and stroke risk assessment cards. Check back on May 1 for more information on this seminar!

Holly Krivokapich
Health and Wellness Coordinator
St. David’s Round Rock Medical Center

I recently had the pleasure of attending the screening of an HBO documentary entitled, The Weight Of The Nation.  It’s about the obesity epidemic that our nation is facing today.  It is a realistic representation of a multifaceted problem.

More than two-thirds of U.S. adults age 20 and over are overweight or obese, while nearly one-third of the nation’s children and adolescents age 2 to 19 are overweight or obese.  Obesity contributes to five of the ten leading causes of death in America, including heart disease, diabetes, stroke, cancer, and kidney disease.  We are clearly in crisis.

Made in partnership with the Michael & Susan Dell Foundation and Kaiser Permanente, this series is comprised of 4 films that will debut on HBO on May 14th and May 15th beginning at 7:00 pm Central.  The portion presented at the screening was Children In Crisis.  We are facing, for the first time in our nation’s history, a shorter life expectancy for our next generation of children.  That, by itself, should be enough to motivate us to action.

Obesity is a preventable disease; it’s not a condition that we have to accept like a natural disaster.  We must begin to make the necessary changes in our culture to ensure a healthy life for ourselves and our children.  After all, our lives depend on it.

For more information about weight management and weight loss surgery, please give us a call at St. David’s Bariatric Center, 512-544-LIFE (5433) or visit us online at www.stdavidsweightloss.com.

1. Hypertension – Individuals with diagnosed obstructive sleep apnea are between 2-3 times more likely to develop hypertension*
2. BMI >30 – A Body Mass Index of over 30 is considered obese.
3. Excessive Daytime Sleepiness – With obstructive sleep apnea, sleep patterns are disrupted, resulting in excessive sleepiness or fatigue during the day.
4. Snoring/gasping for air – Extra tissue in the back of the airway can collapse or partially block the airway during the night, causing repetitive drops in blood oxygen levels. 
5. Cardiovascular disease – The prevalence of obstructive sleep apnea in patients with heart failure is estimated at 40% to 70% **

Take the Epworth Sleepiness scale to rate your level of sleepiness, then join St. David’s Round Rock Medical Center and Dr. Terry Peery, Neurologist and Board Certified Sleep Physician, this Thursday, April 26th from 6-7:30 pm to learn more and determine your risk and treatment options. Our free Sleep Disorders Seminar will be held at the St. David’s Health and Wellness Center at the Chasco Family YMCA. Please join us by registering at 512.478.3627 or 1.888.868.2104.

Holly Krivokapich
Health and Wellness Coordinator
St. David’s Round Rock Medical Center

*Peppard,P., et al., NEJM 2003;342:1378-1384 

** Javahari, S., Cur Treat Options in CV Med 2005;7:295-306 & Sin., D., et al., AJRCCM 1999;160:1101-1106

1. Do you snore loudly while sleeping?
2. Do you feel excessively tired during the day?
3. Have you been told you stop breathing or choke loudly while you are asleep?
4. Do you have a history of hypertension or Type 2 Diabetes?

If so you may not be getting the amount of sleep you need. Lack of sleep is a more serious condition than just feeling sluggish. It can lead to more serious health risks.

Join St. David’s Round Rock Medical Center and Dr. Terry Peery, Neurologist and Board Certified Sleep Physician, on Thursday, April 26th from 6-7:30 pm to learn more and determine your risk and treatment options. Our free Sleep Disorders Seminar will be held at the St. David’s Health and Wellness Center at the Chasco Family YMCA. Please join us by registering at 512.478.3627 or 1.888.868.2104.

Download the Event Flyer

Holly Krivokapic
Health and Wellness Coordinator
St. David’s Round Rock Medical Center

Ingredients:

• 1 lb. Chicken Breast – cut into small pieces
• 1 Tbsp. Cornstarch
• 1/2 Cup Low Sodium Chicken Stock
• 1/2 tsp. Pepper
• 1 Tbsp. Rice Wine (Sake)
• 2 Cups Chopped Broccoli
• 2 Tbsp. Sesame Oil
• 1 Cup Celery
• 1/2 Cup Yellow Onion
• 2 Slices Ginger (chopped)
• 2 Tbsp. Low Sodium Soy Sauce
• 1 Cup Shredded Carrots
• 1 Cup Pea Pods

Directions:

1. Marinate cubed chicken in cornstarch, salt, pepper and wine for at least 1 hour.
2. Heat pan or wok.
3. Add 1 Tbsp. sesame oil and marinated chicken. Stir until cooked through.
4. Remove from wok and place in separate bowl.
5. Add 1 Tbsp. sesame oil to hot wok.
6. Add ginger, stir for a few minutes, then gradually add vegetables and stock.
7. While vegetables are still crispy, add already cooked chicken and remaining seasonings.

Yield: 6 servings

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Protecting an active lifestyle. The 206 bones that make up our skeleton help form our shape and support our body weight. Bone is a living tissue that continues to grow throughout our lifetime. Joints occur where two bones meet, making the skeleton flexible: without them, movement would be impossible. We use our bones and joints every time we stand, sit, walk or perform any of our daily activities. When the ability to continue to do these things with ease and without pain is taken away, so is our mobility.

What Can Affect My Mobility?
There are a number of bone and joint disorders that can lead to your everyday tasks, favorite activities and a much loved sport becoming difficult, or even painful. These include Arthritis, Osteoporosis, Repetitive Stress Injuries (RSIs) and fractures (bone breaks).There are many causes, known and unknown, for these potentially debilitating disorders. The good news is that there is much that can be done to help prevent, treat and manage all of them. It is never too late to improve your bone and joint health!

How Can I Protect an Active Lifestyle?
Partner with your doctor to customize a plan to stay on top of your bone and joint health. This plan may include both medical and non-medical preventative, treatment and management options. Your part is to lead a healthy lifestyle:

• Consume a healthy diet rich in calcium and Vitamin D.
• Exercise to build your strength and protect and increase your range of motion.
• Maintain a healthy weight to ease the stress placed on your weight-bearing joints.
• Make positive changes to your environment to best suite your own situation, which may include using ergonomic equipment or assist devices.
• Avoid habits like smoking and consuming too much alcohol, caffeine and soda, which all have negative effects on your bones, joints, and overall health.

Remember, with modern medicine’s knowledge and increasing options for continued bone and joint health, you never need to become a spectator in the game of life.

The following websites and recommended reading are excellent sources of health education information.

• www.cdc.gov 
• www.womenshealth.gov

The Healthy Sleep Crusade is an initiative to drive urgency, awareness and action around sleep apnea, a disorder affecting nearly one in five people.

Research has clearly shown that restful and regular sleep is just as important to their patients’ health as exercise and a balanced diet.

Overcoming a sleep disorder and getting a good night’s rest has many benefits for overall health and quality of life. Sleep is important for learning and forming memories. Getting a good night’s sleep can give you more energy, and can increase your productivity and safety throughout the day. Perhaps most importantly, healthy sleep can greatly reduce the risk of serious health problems such as obesity, high blood pressure, heart disease, stroke, type 2 diabetes and depression.

Although sleep is critical to good health, many people do not get enough quality sleep. For some people, this lack of sleep is by choice. For other people, the lack of sleep may be from:

• A change in the body’s natural clock. Shift work and jet lag are examples of things that can lead to this kind of sleep loss.
• Taking certain substances, like drugs or alcohol, that can make sleep less restful.
• Trying to sleep in a place that is not relaxing (too hot, too noisy).
• A sleep disorder, like sleep apnea.

Sleep Apnea

Up to 20% of adult Americans have sleep apnea, but as many as 90% of them are undiagnosed.

“Obstructive sleep apnea is now recognized as a major risk factor for cardiovascular disease. It is important that those who experience consistent inadequate sleep receive treatment to prevent the development and progression of heart disease and other chronic medical conditions.”

Stanley Wang, MD, JD, MPH
Cardiologist, Austin Heart

Visit HeartHospitalofAustin.com and take our Simple Sleep Test. This is a brief online test that will help determine if you would benefit from an overnight sleep study.

Normally, I try to keep this blog focused on issues that impact patients directly, like how to take your own pulse, or how to prevent heart disease. But this time, I want to toot TCAI’s own horn a bit.

Last week, we hosted a symposium called EPLive here at St. David’s Medical Center in Austin. The first of its kind, this conference brought together the heavy hitters of electrophysiology to discuss live and pre-recorded EP procedures. Over 100 physicians, nurses, EP technologists, and industry representatives attended the two-day symposium, which contained a total of nearly 40 case presentations. Faculty included world-renowned electrophysiologists from major EP centers in Boston (MA), Akron (OH), Philadelphia (PA), Chicago (IL), Rochester (MN), New York, Stanford (CA), Los Angeles (CA), and Lancaster (PA), as well as Hamburg, Germany and Venice, Italy.

TCAI broadcast six live cases from our EP Lab on each day of the conference. While one of our physicians was focusing on performing the procedure, another TCAI physician walked conference attendees through the procedure and fielded questions from the audience. This unprecedented format allowed physicians to watch, live, complex cases being performed in real-time on anonymous (but very real) patients, with real challenges, trouble-shooting, and results. The sessions focused on ablation of atrial fibrillation and ventricular arrhythmias, as well as cardiac devices (such as pacemakers and defibrillators) and new technologies in electrophysiology.

As the brain-child of Dr. Andrea Natale (TCAI’s Medical Director) and the course co-directors, Drs. Francis Marchilinski, Paul J. Wang, and Amin Al-Ahmad, the goal of EPLive was to use actual procedures as a tool for teaching electrophysiologists how to implement the latest technological and technical advances in the field. Many of the cases sparked lively debate about the best way to approach a certain aspect of the procedure, and all prompted thoughtful questions from experienced and novice electrophysiology professionals.

According to attendees, the first-ever EPLive symposium was a huge success. We hope to host the conference again here in Austin in 2014.

In these studies,  surgical procedures were compared head to head with traditional medical treatment of diabetes.  The results show that inidividuals with Type 2 diabetes undergoing one of three different versions of bariatric surgery (gastric bypass, sleeve gastrectomy, or biliopancreatic diversion)  were significally more likely to lower blood sugar to normal levels than when treated with medication and diet and exercise counseling.

Researchers estimate that 80% of the 23 million adult Americans who have Type 2 diabetes are either overweight or obese.  With the prevalence of diabetes in the U.S. surging in tandem with the obesity rate, this becomes a very important study.

Some of the key findings:

• The surgery patients lost five times as much weight on average than those in the medical-therapy group.
• 75 – 95% of  patients had complete remission of diabetes two years after their procedures, and some were off of diabetes medication before being discharged from the hospital.
• In addition to lower blood sugar and weight loss, significant improvements were also seen in cholesterol and blood pressure.

Not every patient with Type 2 diabetes is a candidate for bariatric surgery, but at least now the door is open for conversations to occur individually on the best treatment options for diabetes management.

Grilled Corn Salad with Asparagus

• 6 ears corn, husk and silk removed
• 1 bunch asparagus spears, trimmed and cut into 1 inch pieces
• 1 (7 ounce) jar roasted sweet red peppers, drained and chopped
• 2 cloves garlic, minced
• 6 basil leaves, chopped
• 1 tablespoon olive oil
• 1 tablespoon balsamic vinegar
• salt and pepper to taste

1. Preheat an outdoor grill for medium-low heat and lightly oil grate.

2. Place the ears of corn on the grill and cook until the kernels are tender, about ten minutes turning frequently. Remove the ears from the grill and cool. Cut the kernels off of the cob.

3. Fill a large saucepan with lightly salted water and bring to a boil over high heat. Add asparagus and cook until just tender, about 1 minute. Drain in a colander and rinse immediately under cold, running water until well chilled. Set aside.

4. Combine the corn, asparagus, roasted peppers, garlic, basil, olive oil, and balsamic vinegar in a large bowl; season with salt and pepper to taste. Serve at room temperature or chilled.

Healthified Tiramisu Parfaits

• 4 oz. low fat cream cheese
• 3/4 cup low fat ricotta cheese
• 1/2 cup powdered sugar
• 1 tsp. vanilla
• 6 oz. Yoplait Vanilla Yogurt (fat free)
• 1/3 cup cold espresso or strong coffee (brewed)
• 2 Tbsp. coffee flavored liqueur
• 3 oz. package of Lady Fingers, cut into 1/2 inch cubes
• 1 oz. semi-sweet baking chocolate (grated) ~ 1/4 cup

In a medium bowl, beat cream cheese with electric mixer on medium speed until smooth. Beat in ricotta cheese, powdered sugar and vanilla until creamy. Beat in yogurt until well blended. In a small bowl, mix espresso and liqueur.

In 8 small parfait glasses, layer half of the Lady Fingers, half of the espresso mixture and half of the cheese mixture. Sprinkle each with 3/4 tsp. grated chocolate. Repeat Layers.

Cover and refrigerate at least 1 hour to blend flavors. Makes 8 servings

180 Calories, 7g fat, 20 mg cholesterol, 24 g carbohydrate, 125 mg sodium

Quinoa Salad with Tomatoes, Zucchini & Feta

• 1/2 cup quinoa
• 1 cup water
• 2 tsp freshly squeezed lemon juice
• 2 tsp extra virgin olive oil
• Kosher salt and fresh ground black pepper, to taste
• 1-2 tsp fresh mint leaves
• 1 cup chopped ripe tomatoes
• 1 cup chopped cucumber
• 1/2 cup crumbled feta

In a small sauce pan, bring the water to boil. Add quinoa, reduce heat to summer, cover the pan, and cook 15 minutes or until the liquid is absorbed. Remove from heat and set aside, covered, for 10 minutes. In a small glass jar, combine lemon juice, olive oil, salt and pepper, and shake until the dressing is emulsified.

Combine quinoa, mint, tomatoes and cucumber in a large mixing bowl. Pout in the dressing, and toss gently to combine. Transfer to a serving bowl, top with feta, and serve at room temperature.

An ounce of prevention is worth a pound of cure. This has never been truer than in the area of medical and hospital safety. To highlight National Patient Safety Awareness Week, St. David’s Medical Center’s own Chief Medical Officer, Dr. John Marietta, and Chief Nursing Officer, Susan Griffin, offered up a few ideas about the most effective ways to protect patients when they are in the hospital.

The Agency for Healthcare Research and Quality makes the following recommendations to help prevent medical errors:

•     Be an active member on your health care team.
•     List all medications you take, including over-the-counter medicines, and give this list to your physician and bring it with you every time you come to the hospital or emergency room.
•     Inform your doctor of any allergies you may have, as well as any reactions to medicines.
•     Make sure you can read the prescription that is written for you.
•     Make sure all health care workers wash their hands before caring for you. Do not be embarrassed or too shy to ask health care workers to wash their hands.
•     If you are having surgery, make sure your physician and surgeon agree on exactly what will be done.

ASK, ASK, ASK:

•     About your condition and treatments
•     What is supposed to happen
•     Why a test or procedure is being done
•     When test or lab results will be available
•     The physician, nurse, and/or pharmacist for information on medicines that are prescribed and how they should be administered, as well as whether they may cause any side effects
•     A family member or friend to be with you to help be an advocate
•     If you do not understand the physician’s instructions, ASK, ASK, ASK until you are satisfied

We want to help make your stay at our St. David’s HealthCare facilities as safe as possible.

For more information please see the list of resources below:
National Patient Safety Foundation: www.npsf.org
Institute for Healthcare Improvement: www.ihi.org
Anesthesia Patient Safety: www.anesthesiapatientsafety.com
Agency for Healthcare Research and Quality: www.ahrq.gov
Joint Commission:: www.jointcommission.org

March is National Nutrition Month; where we help return the focus to the basics of healthy eating. Today, we want to talk about how you can include a colorful variety of fruits, vegetables, whole grains, lean proteins and dairy on their plates every day.  Even though Spring may still be more than a month away, there are plenty of colorful, seasonal foods to fill your plate.  A rainbow of color creates a palette of nutrients.  Healthy eating involves more than just calorie counting.  In fact, most children do not get all of the essential nutrients needed for their growth and development.  If you are a busy working Mom with a household of picky eaters – how can you make sure your family has enough color in their diet?

Green – produce in shades of green contain antioxidants and may help reduce cancer and promote healthy vision.

            Fruits – Avocado, grapes, honeydew, kiwi

Vegetables – Artichoke, asparagus, broccoli, green beans, green peppers and leafy greens such as                                spinach

Orange/Deep Yellow – contain nutrients to protect the immune system, protect vision and reduce the risk of cancer.

            Fruits – Apricot, mango, cantaloupe, peach and pineapple

            Vegetables – Carrots, orange or yellow pepper, corn and sweet potato

Purple/Blue – have antioxidant and anti-aging benefits and may help with memory, urinary tract health and reduce the risk of cancer.

            Fruits – Blueberries, blackberries, plums or raisins

            Vegetables – Eggplant or purple cabbage

Red – can help to maintain a healthy heart, immune system and reduce cancer risk.

            Fruits – Cherries, cranberries, pomegranate, red/pink grapefruit and watermelon

            Vegetables – Beets, red peppers and tomatoes

White/Tan/Brown – contain nutrients that may promote heart health and reduce cancer risk.

            Fruits – Banana, pears, dates and white peaches

            Vegetables – Cauliflower, mushrooms, onion, parsnips, turnips and potatoes

Aim for at least 3 different colors on your plate.  Rather than grilled chicken and a baked potato; top the chicken with salsa, add mashed sweet potatoes and a spinach salad with strawberry slices.  The more colorful your plate, the more visually appealing it is, the more flavor it has and the more nutrients it contains.

Have your children help you plan meals that contain at least 3 colors and have them help prepare part of the meal.  The more involved children are with the meal planning and preparation, the more likely they will be to eat or at least taste the different colors and foods.  Remember, it can take up to 20 times for a child to try a food until they don’t hate it!  Don’t give up, offer healthy options along with foods they are familiar with.  Also, we are the greatest role models for our children, when they see mom and dad eating healthy and being physically active, they are more likely to follow in our footsteps.

Visit www.eatright.org for more National Nutrition Month tips.

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Everybody loves a good BLT sandwich, but have you ever enjoyed a BLT salad? This leafy concoction maintains all the flavor, including the bacon, and is only 151 calories per serving.

BLT Salad

• 1 cup cubed whole-wheat country bread
• 2 teaspoons extra-virgin olive oil
• 4 medium tomatoes, divided
• 3 tablespoons reduced-fat mayonnaise
• 2 tablespoons minced chives, or scallion greens
• 2 teaspoons distilled white vinegar
• 1/4 teaspoon garlic powder
• Freshly ground pepper, to taste
• 5 cups chopped hearts of romaine lettuce
• 3 slices center-cut bacon, cooked and crumbled

1. Preheat oven to 350 degree. Toss bread with oil and spread on a baking sheet. Bake, turning once, until golden brown, 15 to 20 minutes.
2. Cut 1 tomato in half. Working over a large bowl, shred both halves using the large holes on a box grater. Discard the skin. Add mayonnaise, chives (or scallion greens), vinegar, garlic powder and pepper; whisk to combine.
3. Chop the remaining 3 tomatoes. Add the tomatoes, romaine and croutons to the bowl with the dressing; toss to coat. Sprinkle with bacon.

We hear it all the time—exercise can help prevent a heart attack. But what if you’ve already had a heart attack? How soon is too soon to get back in the game?

February is American Heart Month, and it’s also the perfect time to kick start an exercise program. Not only can exercise improve heart muscle function, but it also helps keep off excess weight—and can reduce the devastating effects of heart disease.

Exercise can begin as early as one week after suffering a heart attack. However, patients should always seek medical clearance from their physician before starting any exercise program.

Once a person has been cleared for physical activity, cardiac rehabilitation experts suggest patients choose activities that are fun and suit their needs, but can also be done year round. Walking, swimming, cycling, jogging, skiing, rowing, arm ergometry and aerobic dancing, along with many other forms of cardiovascular exercise, are great for improving your heart’s function.

Start exercising at a low intensity (especially if you’ve been sedentary for much of your life). From there, patients can progressively increase the duration to 150 minutes a week (30 minutes, five times a week), which may take a couple of weeks.

Also, use the Borg Rating of Perceived Exertion Scale to progress your activity. According to the Centers for Disease Control and Prevention, the Borg Rating of Perceived Exertion is a way of measuring physical activity intensity level. Perceived exertion is how hard you feel like your body is working. It is based on the physical sensations a person experiences during physical activity, including increased heart rate, increased respiration or breathing rate, increased sweating and muscle fatigue. Although this is a subjective measure, a person’s exertion rating may provide a fairly good estimate of the actual heart rate during physical activity. We recommend patients try to stay between 11 and 13 (fairly light to somewhat hard) on the Borg Rating of Perceived Exertion Scale when exercising.

Also, incorporate strength-training and flexibility exercises into your workout to maintain muscular strength and endurance, as well as full range of motion in your joints. Flexibility can also improve your balance. Make sure you stretch slowly and hold for a minimum of 15 seconds per muscle (and do not bounce).

Remember to take time to warm up and cool down—three to five minutes for each. The warm up prepares your body for exercise through increasing blood flow to the working muscles and steadily increasing your heart rate and blood pressure. The cool down slowly decreases your blood pressure and heart rate to ensure you do not become light-headed, dizzy, or faint.

Patients are commonly referred to an outpatient cardiac rehab program to begin their journey toward a more rigorous workout regime and a healthier lifestyle (if your doctor has not referred you to an outpatient cardiac rehab program, you should inquire about it). Cardiac rehab programs, which are recommended by the American Heart Association and the American College of Cardiology, can increase a patient’s chance of survival. Most patients remain in cardiac rehab for approximately 12 weeks.

If you still need some extra incentive to inspire you to have a change of heart, consider this—research shows many patients who go through cardiac rehab show almost no signs that they ever had a heart attack if they commit to an exercise program and adopt a long-term healthy lifestyle. So after about three years, it’s as if they never had one.

The words “cord blood” may not mean very much to you, but for some patients, those two words may mean the difference between life and death.

Right now, you may be asking yourself “what is cord blood?”
Cord blood is blood that is left in the umbilical cord and placenta after the birth of a baby. The umbilical cord and placenta are usually discarded after a baby is born.

This special blood is a rich source of stem cells which can treat a number of illnesses and life threatening diseases.

Now you may be thinking “wait, aren’t stem cells tiny embryo’s?”
The types of stem cells that are found in cord blood are not the same as embryonic stem cells. These stem cells are simply in the blood of the placenta and umbilical cord and are typically disposed of after birth. These cells have proven to be life saving in the face of several diseases and illnesses such as leukemia, lymphoma and disorders of the immune system, just to name a few. This program is not controversial and is supported by many faith based communities because of the difference in the type of stem cell.

St. David’s Medical Center in downtown Austin is the only facility in the city currently offering free cord blood collection and donation. Until now, the only option for cord blood collection was through a private bank that requires a fee for collection and storage. Cord blood that is collected and donated may be used to treat someone who is a match with a life threatening disease such as leukemia, aplastic anemia or genetic blood disorders like sickle cell anemia.

Here’s a snapshot at the process of cord blood donation:

• Receive information about cord blood collection and donation from your doctor during your prenatal visits.
• Discuss screening done for all cord blood donors with your doctor. Most healthy moms are able to donate, but there are some common reasons you may not be able to donate such as a twin pregnancy.
• Decide if participation in this program is right for you and your family.
• Instead of discarding your umbilical cord and placenta after delivery, your baby’s cord blood will be collected by your physician after the baby is born. This process does not pose a risk to you or your baby, and it not painful to you in any way at all. Once the cord blood is collected, the placenta and umbilical cord are disposed of per Texas law.

The decision to collect and donate cord blood is personal for each and every family. Your options include – storing your cord blood at a private bank, donating and storing your cord blood to a public bank, or discarding the cord blood after delivery. Understanding those options may help you choose whether you would like to be a cord blood donor.

You may never know if someone’s life could be saved by the use of this special blood, but how special is the thought that you may be giving a child a second chance at life or helping a child live a normal, healthy life!

For more information about donating cord blood, please check out Texas Cord Blood Bank’s website at:
http://www.bloodntissue.org.

• Screening Tools for Blood Cord Donors
• FAQs about Blood Cord Donations

*All information used with the permission of Texas Cord Blood Bank.

In honor of National Heart Month, the Centers for Disease Control (CDC) has launched a national education and prevention initiative called Million Hearts™.  The goal of the campaign is to prevent 1 million heart attacks and strokes over the next five years.  Did you know that over 80,000,000adults, or 1 in 3 people, in the U.S. have some form of heart disease?  Or that more than 2 million Americans suffer heart attacks and strokes each year?  According to the CDC, cardiovascular disease is the leading cause of death in this country, and it accounts for more than $444 billion is health care expenses and lost productivity.  And here’s a staggering pair of statistics from the CDC:  on average, someone dies every 4 minutes of a stroke, and every 34 seconds, someone in the U.S. has a heart attack.

The good news is that most heart attacks and strokes are preventable.  The Million Hearts™ website is a great resource for information about prevention and treatment of heart attack and stroke, and provides practical instructions for how you can reduce your risk of these deadly conditions.  I’m a particularly big fan of the five-point action plan that CDC offers individuals for reducing their risk of heart attack and stroke:

• Prevent heart disease and stroke in your family by UNDERSTANDING the risks.
• GET UP and GET ACTIVE by exercising for 30 minutes on most days of the week.
• KNOW your ABCS:
  • Appropriate Aspirin Therapy
  • Blood Pressure Control
  • Cholesterol Management
  • Smoking Cessation
• STAY STRONG by eating a heart-healthy diet that is high in fresh fruits and vegetables and low in sodium, saturated and trans fats, and cholesterol
• TAKE CONTROL of your heart health by following your doctor’s instructions for medications [and] treatment.

Cruise the Million Hearts™ website, and check out the My Life Check tool from the American Heart Association and the American Stroke Association for more practical, easy-to-use advice on how you can improve your heart health.  This February, skip the box of Valentine’s Day chocolates.  Instead, give yourself the gift of ensuring that you’re not one of the 2 million Americans who suffer heart attack or stroke this year. Your loved ones will thank you for it!

• Flowers and a movie
• Massage (try a couple’s massage!)
• Day at a spa
• Personal trainer for a  month
• Professional photography session
• Hiking/camping trip
• Yoga class membership

Have a happy and healthy Valentine’s day from St. David’s Bariatric Center!

In September 2011, Dr. Kim performed a left parietal craniotomy and a computer-assisted resection of a malignant tumor using the Stealth Image Guided System.  After an acute stay, Mr. Mealy was transferred to St. David’s Rehabilitation at North Austin Medical Center. After surgery, he had right sided weakness, aphasia and visual field defect. He admitted to the rehabilitation program unable to walk and required moderate assistance to transfer from the bed to the chair. He discharged from inpatient rehabilitation after three weeks walking five-hundred feet.

Dr. Everett Heinze, his neurologist and medical director for St. David’s Rehabilitation stated: Mr. Mealy made excellent progress in inpatient rehabilitation and when transferred to the outpatient day program  he continued to improve beyond our expectations.

For his follow up care, Mr. Mealy continued with comprehensive therapy in the outpatient setting and attended the Neurological Day Program at St. David’s Rehabilitation Hospital where he continued to progress. When discharging from the day program, he told his therapists, “I still haven’t ridden my bike yet.” His physical therapist, Mike Burroughs, Sr. PT, knew they couldn’t discharge him from therapy without trying to ride his bike. So, for his final session, Mr. Mealy brought his bicycle to therapy and celebrated his graduation from therapy with his first bike ride in five months.

Guest post by Blanca Duncan, MD

Because the outcome of pregnancy depends on your emotional as well as physical well being, it is important to find a doctor than meets not just your medical needs but also one that you are compatible with. Selecting a doctor to deliver your baby is a very important and personal decision. Following are some steps to help you in choosing the best Obstetrician Gynecologist for you.

Where to begin your search for ob/gyn?
Internet sites that provide basic information on doctors in your area are a good source. Some sites include: healthgrades.com; yelp.com.

Ask around for recommendations. An excellent source of referral is a trustworthy medical professional. Consider asking friends and family members who they see and if they recommend the doctor.

Pregnancy can be financially trying. Make sure the doctor you are considering is in your network of providers. Talk to your insurance. If it is a requirement for your insurance coverage to see someone in your network, you may want to narrow your list to include only physicians in your network.

The doctor’s office as well as the hospital facility where the physician delivers should be included in your decision. You will visit the doctor’s office several times and you may need to get to the hospital quickly. Therefore, the locations should be convenient to your job and home. In addition, you should feel comfortable in both settings. Assess the friendliness of the office staff. Get to know the hospital; ask about availability of tours to the labor and delivery unit.

What to look for in an ob/gyn doctor?
A provider with whom you feel safe and relaxed is key to optimizing your pregnancy and childbirth experience. Below are some things to consider in choosing a doctor.

Doctor’s personality

• Is the doctor easy to communicate with?
• Are things explained in a manner that you understand?
• Do you feel that your concerns are validated and addressed?

Doctor’s practice outlook

Write down any specific concerns about your pregnancy. Find out what the doctor’s outlook is in regards to things that are important for you. For example if you have a specific birth plan such as at home birth or natural birth, find out the doctor’s perspective on this. If you are considering vaginal birth after cesarean section find out if the physician and hospital would be supportive.

Determine if the doctor’s scope of care meets your specific needs

If you have special health needs such as diabetes, heart disease, or very complicated pregnancy history, find out how much experience the doctor has treating these areas. You may want ask if the doctor work in conjunction with a maternal fetal specialist (a doctor that specializes on high risk pregnancy).

Once you have narrowed your choices, you may want to interview a few providers and compare notes until you find the one that you feel is the best choice for you.

For patients with Parkinson’s Disease, recent research points to BIG benefits from participating in the LSVT BIG program. Based on a randomized trial, patients receiving 16 hours of one-to-one training within four weeks reported greater improvement in the motor function that other types of treatment.

The BIG program originated from LSVT LOUD for Parkinson’s patients. In LSVT LOUD, patients work with a speech therapist to speak loudly. This program has proved to improve speech intelligibility in Parkinson’s patients. Expanding on that principle, BIG Therapy uses high amplitude movements at a high intensity.

June 18, 2010 (Buenos Aires, Argentina) — In a comparative study, 4 weeks of supervised physiotherapy consisting of repetitive high-amplitude movements yielded greater improvements in motor performance in patients with Parkinson’s disease than either Nordic walking or non-supervised in-home exercises.

Patients with Parkinson’s should ask their doctor if they might benefit from BIG or LOUD therapy. LSVT BIG and LOUD therapists work in the St. David’s Rehabilitation Hospital Texas Step Program for Parkinson’s patients.

Q:  The first thing I notice about you is how healthy you look.

A:  I feel healthy and I am healthy.  Losing 135 pounds made a huge difference in my health.

Q:  What type of health issues were you dealing with?

A:  My blood pressure skyrocketing and I had a severe case of sleep apnea.  I found that as I grew older, not only was my health becoming worse, but my ability to lose the excess weight was becoming more difficult.

Q:  What made you look at surgical options for weight management?

A:  My primary care doctor looked at me one day when I was there for an appointment and asked, “When are you going to stop battling this weight?”  It was the spark that I needed to prompt me to look for a solution.  And I didn’t have to look far.  I was caring for postop bariatric surgery patients at the time and I saw what a difference it was making in their lives.

Q: And what difference has weight loss surgery made in your life?

A:  My blood pressure is normal and my sleep apnea is gone.  I’m wearing clothes that haven’t seen the light of day in at least 10 years.  But, most profound is the sense of relief that I experience every day – the relief that  don’t have to be constantly at war with myself and my issue with food.  I feel like I’ve gotten my life back.

Interested in seeing if weight loss surgery is right for you?  Visit our web site at stdavidsweightloss.com or give us a call at St. David’s Bariatric Center – 512-544-LIFE (5433)

One of the things I have always loved about EP is the myriad of cutting edge technologies we use on a daily basis.  With technologies such as integrated control and video systems, 3D mapping, remote navigation, telepresence and a dizzying array of ablation technologies that include radiofrequency, cryo and lasers, a modern EP lab resembles something closer to a video game or mission control at NASA than an operating room.  And as a member of a generation raised on video games, I feel right at home.

Now, we didn’t get to this point of high tech integration overnight.  It has taken years and years of advances to get us to where we are now.  With that thought in mind, I’d like to look back on the advances of this past year and some promising pieces of technology we might see in the coming year.

• New Irrigated Catheter Designs – Several companies are in the midst of studies new irrigated catheters that promise better lesion formation with more efficient cooling.  These more efficient designs allow for lower saline flow rates than those currently on the market.  This will help offset some the fluid overload issues we see with current catheters.  One thing to watch with these new catheters will be how lab practices change due to the lack of temperature feedback from the catheter.
• Force Sensing Catheters – Contact force has always been a factor in creating good lesions, but up until now, physicians have not had a reliable way of determining how much force they are actually applying to the tissue.  That will change with the catheters currently being studied as both competing technologies, magnetic sensor based and fiber optic sensor based, will allow physicians to determine contact pressure down to one gram.  Ideally this should allow for better, more consistent lesion formation while also helping prevent complications from applying too much pressure.
• Multielectrode RF – While this technology has been studied for several years, the EP community was able to see more data this year along with broader investigational use.  The idea of being able to create complex lesion sets with a single application is very intriguing.  Unfortunately, the current non-irrigated implementation of this technology has had difficulty in creating deep lesions.  In addition, several centers and studies have reported a significant rate of silent embolization in cases utilizing the current system.  The addition of irrigation electrodes has the potential to solve both of these issues.
• Cryo Balloon – This year, the cryo balloon became just the second device to receive an indication for paroxysmal atrial fibrillation from the FDA.  Since receiving that indication, the cryo balloon has enabled many centers that were not previously equipped for AF ablations to perform this complex procedure.  As the device is limited to isolation of the pulmonary veins, it does have its limits, but it has the potential to be an important tool in the EP toolbox.
• Laser Balloon – The laser balloon is another device that has been in studies for several years, but has recently gone through a redesign of the laser console and of the balloon itself.  These changes have made the system much more user friendly than previous iteration and even allow for one handed operation of the balloon by the physician.  While the laser balloon is similar to the cryo balloon in the fact that it is basically limited to isolating the pulmonary veins, it provides the physician with the ability to target specific regions around the pulmonary veins.  In addition to more localized ablation, the laser balloon also allows physicians to actually see where the lesions are being placed via an endoscope located within the balloon itself.
• Radiometric Temperature Sensing Catheter – The last technology I want to mention is a newer system that allows for the measurement of actual tissue temperature.  This device integrates passive radiometric sensors into the tip of an irrigated ablation catheter rather than the traditional thermocouple or thermister found in most ablation catheters.  The systems works by detecting microwaves emitted from heated tissue during radiofrequency ablation.  This enables the physician to see the temperature of the tissue three millimeters from the tip of the catheter.  As I mentioned earlier, one of the drawbacks of newer irrigated catheter designs is that they provide no real temperature feedback during ablation.  This system has the potential to remedy that issue.

As you can see, this upcoming year promises to be another year filled with exciting advances in EP.  Hopefully these new technologies will allow the EP community to provide broader access and improved outcomes for our patients.  It will certainly be interesting to see what we think a year from now

Neck pain will affect nearly 75% of all people at some point during their lives. Sedentary people tend to be more susceptible which with an increasing population of work place “sitters” the trend of sufferers with neck pain can be expected to worsen.

The average person seeks relief with medication, heat, cold, traction, chiropractic care, physical therapy, injections or even surgery. Many of these interventions have not been proven in efficacy and some have actually been shown to provide temporary relief only. What’s the poor person who suffers from neck pain to do? One answer has just been proven. Exercise!

A federally funded study published this past week in the journal, The Annals of Internal Medicine looked at 272 people with neck pain without a specific cause for at least 2 weeks and no longer than 3 months. The individuals were divided into three treatment groups. The first group received 12 weeks of Chiropractic care with a focus on spinal manipulation. Those patients also received limited massage, stretching, heat and/or cold. The second treatment group was prescribed medications such as NSAID’s, analgesics, and/or muscle relaxants. The third group was provided with 2 one hour-long sessions to be evaluated to determine and learn the specific neck exercises required for their condition. They were to perform the exercises 6-8 times a day. They were also given information on basic neck anatomy and postural education. All groups were recommended to stay as active as possible.

Results and measurements were taken beginning at 2 weeks after initiating treatment continuing for up to one year. Primary outcome measurement was patient-rated pain. Secondary measures were self-reported disability, satisfaction, medication use and general health status.

For pain, both the chiropractic care groups and self-exercise groups had a statistically significant advantage over the medication group. No important differences in pain were found between the chiropractic and exercises groups. Results in the secondary measures were similar.

The conclusion is that learning self treatment exercises in only 2 visits is as effective as 12 weeks of chiropractic care while both are significantly superior to medication alone. Additionally, the benefit gained from exercises was seen for one year after instruction, when the study concluded. In may be surmised that this benefit would continue with ongoing performance of the exercises.

Good news for neck pain sufferers! To find the right neck exercises you should consult a physical therapist specifically trained in neck and spine care.

Here at TCAI, our Atrial Fibrillation (AFib) Nurse Educators are always looking for new ways to educate AFib patients.  AFib is a complex disease that’s hard to wrap your head around as a patient, and the treatment and management options can be confusing.  The confusion is compounded by the fact that you can’t actually see AFib, and some patients don’t even feel symptoms of the disease.  Yet, AF increases the risk of stroke five times and accounts for about a third of hospitalizations for cardiac rhythm problems.  Apps like AFib Educator make it easier for visual learners (myself included) to understand this costly, often debilitating disease that affects more than 2.5 million Americans.

The app is broken down into four sections: About the App, Demo Videos, AFib Management Videos, and AFib Facts.  The first and last sections are, in this reviewer’s opinion, not particularly useful.  The user is likely to look at each of these sections once and never tap on them again.  The app is geared toward healthcare providers, who are likely already familiar with facts about AFib, though there is a handy “Send AFib Facts” button in the AFib Facts at your Fingertips section that allows the provider to e-mail the list of facts, ostensibly to the patient.

The real meat of the app lies in the middle two sections, the first of which features fantastic videos and real-time EKGs of the heart in normal sinus rhythm and AFib.  These digitally animated videos are realistic and detailed, and mesmerisingly capture what’s actually going on in the heart when it’s in regular rhythm versus AFib.  The AFib Management Videos section is equally as fascinating, depicting the heart’s inner workings after rate and rhythm control drugs are applied.  The most telling video here is the AFib & Stroke Risk clip, which shows a clot forming in the upper chambers of the heart and traveling to the brain, demonstrating the real risk of AFib to the patient.

What’s missing from this app?  Here is where its sponsorship by a pharmaceutical company is evident—nowhere in the app is there any mention of cardiac ablation—a promising course of treatment for many AFib sufferers.  It would be great to be able to show patients animations of the ablation process, since our AFib Nurse Educators are often educating patients prior to cardiac ablation procedures.  The app also fails to provide much information on anticoagulation, a big piece of the education process for AFib patients.

All told, though, AFib Educator is a useful app with beautifully-made videos that could serve as a very effective visual aid on a tablet or smartphone at the patient’s bedside or during a doctor’s office visit.

1.  Eliminate “all or none” thinking.  Realize that we are going to slip up and just because we do does not mean that the day/month/year is shot.  Do not give up on your healthy aspirations just because you ate a cookie (or several!), or abandoned your exercise plan for a few days.  Like the song says, pick yourself up, dust yourself off, and start all over again!

2.  Take baby steps.  I’m not sure what you do, but my plans always end up very complex and elaborate.  I think that I can go from a relatively sedentary activity level to climbing mountains in a matter of a month…and liking it!  Not a realistic, achievable, or enjoyable goal.  When planning out your health resolutions, think incrementally.  If a daily 2 mile walk is your goal, go for a quarter of that distance three days a week, and gradually add more distance and more days as time goes by. Baby steps will help you to make your goal achievable and a permanent part of your daily routine.

3.  Make new habits.  Old habits die hard, and it seems like giving birth to new ones is equally difficult.  The key is to set yourself up for success with the development of a routine.  I don’t remember a time when brushing my teeth was not a part of my bedtime routine.  I’m sure it was an activity that was reinforced by my parents over and over again.  Now, not brushing my teeth before bed would just seem strange.  It has become a habit by repetition through the years.  We all have various means for reminding ourselves to do something that is not a part of our daily routine:  iphone calendar reminder, notes stuck to the refrigerator door, a phone message that you leave for yourself.  Think about ways that you can prompt yourself to adapt your new resolutions as part of your daily routine.  Once that habit forms, it will be almost as effortless as brushing your teeth!

Traveling during the holidays and have some questions?  Here are some important travel and holiday tips from Dr. Linda Fonseca, Maternal Fetal Medicine physician with St. David’s Medical Center.

 Q- What recommendations do you have for women who are pregnant and traveling during the holiday season?

A- “Air travel is generally safe during pregnancy in the absence of obstetrical or medical complications. It is therefore important to ask you doctor first before making travel plans. If you are planning to fly this holiday there are a few things to consider. First, you must use your seat belt at all times since air turbulence cannot be predicted. Seat belts should be placed low on the hipbone. Secondly, the potential risk of blood clots from long periods of immobilization and low cabin humidity has been a cause for concern despite the lack of evidence of such events during pregnancy. The use of support stockings and periodic movement of legs are preventative measures that can be used to minimize the risk of lower extremity blood clots. Thirdly, it is best to avoid consuming gas-producing drinks while flying because entrapped gases expand in high altitudes. Stay hydrated by consuming water or juice. Finally, whole body scanners at airports have been a recent concern to all travelers even thought radiation exposure is minimal. If you remain concerned it is reasonable to ask for a different screening method such as wand scan or full body pat- down.”

“Regardless which method of travel you choose, it is always important to consider how far along you are and the potential for complications at the time of travel. The most common obstetric complications occur in the first and third trimester. So if you must travel during these periods it would be reasonable to have your prenatal records with you and your doctor’s contact information. Also make sure to take anti-nausea or heart burn medications because it is not uncommon to feel sick during a road trip or flight.”

Q- At what time during pregnancy should a woman no longer consider flying to travel?

A- “This is an individualized decision between you and your doctor however each airline has its own policy. Most airlines will allow you to fly up to 36 weeks. Remember the closer you get to term the more common it is to go into labor or have blood pressure problems unrelated to travel.”

Q-There are so many holiday gatherings and meals at this time of year, is there anything a pregnant woman should avoid eating for health reasons?

A- “Yes, holiday meals can contain food items that should be avoided during pregnancy because of the concern for infection. It is unsafe to consume unpasteurized milk or cheese. Unless it clearly labeled as pasteurized then you must avoid brie, feta, camembert, blue cheese and Mexican queso blanco/fresco. You must also avoid deli meat or uncooked meat and poultry. It is also important to stay away from pate, meat spreads and refrigerated lox. Sushi may contain uncooked seafood and shellfish and should also be avoided. Uncooked eggs can be found in some homemade Caesar salad dressing, hollandaise sauce, mayonnaise and custard recipes so it is important to ask the cook before consuming. Home made egg nog recipes call for raw eggs and alcohol and therefore should not be consumed. Store bought egg nog contains pasteurized eggs and does not contain alcohol so it can be consumed safely during pregnancy. Because there is no amount of alcohol that is considered safe during pregnancy it should be strictly avoided.”

Q-  Do you have any special travel recommendations for women who are pregnant and have a past history of pre-term labor or premature rupture of membranes?

A- “It is best not to travel after 23- 24 weeks (viability) with this obstetrical history because of the high risk of recurrence and the need to be near a tertiary center should these complications recur. If travel cannot be avoided but can be planned in a patient with such history it would be best to do travel prior to 23 wks and after 34 wks because management of the mother and baby are less critical.”

Q- If a woman who is pregnant and traveling starts to not feel well, what is the best course of action?

A- “If she is traveling by air she should tell the flight attendant immediately so that medical help can be enlisted. If she is traveling by car the patient or her travel companion can call her physician to address the concerns. If it is an emergency (labor, bleeding) then she should find the nearest hospital. It is always important to know the names, addresses and phone numbers of hospitals that are located along the travel route or nearest the final destination in case of emergency.”

Great information for woman throughout this holiday season.  Tell us about your holiday traditions and advice for surviving the holiday season while pregnanct!

~Meg

[Image Credit]

1.  Plan what you will eat.  When you arrive at a party, scope out all the food choices and make a deliberate decision about what you put on your plate.  Following a plan that includes some healhy choices of fruit, lean protein, and vegtables will help you sample foods you enjoy without abandoning healthy habits.

2.  Tastes, pinches, and bites DO count!  Make your food selection and then walk away from the table and enjoy your meal.  Close proximity to those tempting morsels can lead to continued eating, even if you are no longer hungry.

3.  Avoid alcohol and save your calories for the main meal.  Alcohol provides many calories and essentially no nutrients.  Do your waist line and your friends a favor this year and be the designated driver.

Remember that the holiday season is a time for friends and family.  Make sure the time you spend with your loved ones is your priority.  Happy Holidays from all of us here at St. David’s Bariatric Center!

During the holidays we are all participating in many activities that generally bring happiness, but may also cause stress.

If you are pregnant, be sure to listen to your body this holiday season! Here are some tips to take care of yourself and your unwrapped present during this time of year:

• Make sure you are getting plenty of sleep – you are growing an entire human being, congrats! That is hard work. Make sure to take time out for yourself and rest when you body tells you to.
• Stay hydrated! During the winter months people generally don’t drink enough water since the temperatures outside are dropping. Water is key to a healthy pregnancy and feeling well. Being dehydrated can lead to fatigue and even uncomfortable contractions. Make sure to keep a water bottle with you throughout the day and take small, frequent sips!
• Eat smaller meals, but eat often- This is especially important for women who are farther along in pregnancy. As the baby grows, he or she will push on your stomach causing you to feel discomfort if you are eating a large meal. Small snacks throughout the day may help you avoid tummy discomfort and heartburn. We often see women in labor & delivery reporting abdominal pain after eating a Christmas feast! Eating smaller meals can most certainly help avoid this discomfort.

What tips have you received for surviving the holidays while pregnant? Share with us, we would love to hear them!

Happy Holidays-

Meg

The term Holiday Heart Syndrome was coined in the 1970s, when physicians began noticing an increase in heart rhythm disturbances in patients around the holiday season.  Most commonly, the sufferer of this syndrome is young, healthy, and does not normally drink in excess.  Imbibing a modest to large quantity of alcohol, though (which many of us do at holiday parties) can over-stimulate the electrical system of this otherwise healthy person’s heart and cause rhythm problems, most commonly Atrial Fibrillation.  Rhythm disturbances associated with Holiday Heart can also be caused by fluid overload, associated with all the salty foods we tend to eat during the holidays.  Luckily, most cases of Holiday Heart Syndrome go away on their own within 24 hours.  But some can persist or recur, increasing the sufferer’s risk of stroke or cardiomyopathy.

The most common symptoms of Holiday Heart Syndrome are palpitations, feeling like your heart is “jumping around” in your chest, and dizziness or fainting.  If you experience these symptoms, especially if you’re otherwise healthy and you’ve been back to the punch bowl a few times, your heart is telling you to stop drinking, sit down, hydrate well with water, and get some rest.  If the symptoms last for more than 5-10 minutes, it’s a good idea to go to the emergency room.  Even if they go away fairly quickly, though, it’s not a bad idea to tell your doctor; you could have a greater propensity toward heart rhythm disturbance in the future.

So how do we prevent Holiday Heart Syndrome?  According to one of TCAI’s Nurse Practitioners, D. Kay Zedlitz, ACNP, “the key is moderation.”  It’s okay to indulge in some festive food and drink, but don’t go overboard.  One alcoholic beverage per day for women and two for men is what’s widely considered moderate; if you go over your daily limit, consider abstaining the next several days to let your system rest.  Remember: alcohol is a toxin to the heart.  Try alternating alcoholic and non-alcoholic beverages (preferably water) at holiday parties, and limit your proportions of rich, salty foods.  Your heart will thank you for it.

[image credit]

A new study confirms once again the role of exercise in maintaining good health. From Alzheimers to cardiac health to diabetes, research consistently touts the benefits of exercise. With a new study by Macmillan Cancer Support, we can add cancer to the data. The Macmillan researchers conducted a comprehensive evidence review of over 60 studies and recently published a comprehensive report.

The findings:

1. Emerging evidence show that achieving sufficient activity levels can reduce the risk of dying from breast cancer by 30-40% and the risk of dying from bowel cancer by 50%.
2. Physical activity of 150 minutes of moderate intensity physical activity a week is appropriate for otherwise healthy cancer survivors.
3. Physical activity after treatment for cancer can reduce the impact of some debilitating side effects, such as swelling around the arm, anxiety , depression, fatigue, impaired mobility and weight changes.
4. Comprehensive rehabilitation cancer services should include physical therapy to encourage and recommend appropriate levels of activity.

Healthcare professionals are not sufficiently aware of the new evidence. More than half know little of nothing about the benefits of activity in preventing or managing side/long term effects and only 6% talk to their patients about physical activity.

St. David’s Rehabilitation Hospital has launched a comprehensive cancer program to address the data listed above. Teaming up with the St. David’s Breast Resource Center and NeuroTexas Institute, St. David’s developed an interdisciplinary team of neurosurgeons, oncologists, general surgeons, and certified lymphedema, occupational , speech and physical therapists, the St. David’s Rehabilitation program provides a setting for cancer patients to receive comprehensive cancer rehabilitation services.

This new data only confirms another benefit of exercise. It’s never too late to develop this healthy and life-saving habit.

Whether you are visiting one of our facilities or work for St. David’s HealthCare, please be sure to join us in telling someone Thank You today.

Our allied health professionals (nurses and technologists) were tapped for some heavy-hitting sessions in Venice.  Barbara Thomas, the Director of Electrophysiology (EP) Services and the Atrial Fibrillation (AFib) center, was the co-chair of the allied professionals track at the meeting and served on a panel discussing the role of EP nurses in different national health systems.   Tami Metz, the Manager of TCAI’s EP Lab, spoke about ablation of ventricular arrhythmias.  Our resident Coordinator of EP Education, Matthew Dare, gave a presentation about new technology in the field.  Cindy Williams, one of our AFib Nurses, presented on the nurse’s role in AFib Ablation, touting our unique Nurse Navigator program, where AFib patients have a nurse follow them from initial through two years’ post-procedure.  One of our nurse practitioners, Kay Zedlitz, delivered her perspective on improving patient outcomes using Cardiac Resynchronization Devices.

TCAI physicians stole the show in Venice.  Doctors Gallinghouse, Canby, Sanchez, Horton, Natale, and Burkhardt all shared their expertise, experience, and research results on just about every subject in EP.  Dr. Andrea Natale, the Medical Director of TCAI, was co-president of the conference, participated in a lively debate about whether AFib ablation should be first-line therapy in caring for patients with AFib.  Based on studies conducted by TCAI, Dr. Natale came down on the “pro” side of the debate, explaining that, for patients with a normal heart, ablation can be an effective first tool that the physician reaches for in curing AFib.

Speaking of TCAI research, several of our research fellows presented abstracts and posters in the conference.  Dr. Luigi Di Biase, Senior Research Fellow, extended his stay in Italy so he could accept the prestigious Valsalva Award in Bologna, Italy.  The award, given by the Italian Institute for Cardiovascular Research, honors distinguished, young researchers who have made significant innovations in cardiovascular research.

So next time you think of Venice, think of all the great knowledge that’s gained and shared every October at the Venice Arrhythmias conference.  Because, how romantic can a gondola ride be when you’re in AFib?

image credit : Chiara Marra

The NICU (neonatal intensive care unit) at St. David’s Medical Center was recently voted: “Best Preemie Team” by the Austin Chronicle – 2011 Best of Austin edition!

Our team comes with experience, compassion, dedication to neonates and their families; but their top priority is the exceptional care they are able to give.

“Each baby and each family has unique needs.  We strive to understand those needs so that we can provide the best care for our patients and their family.” say’s NICU director Rhonda Sageser.

The NICU provides care to babies that are born prematurely, which is less than 37 weeks gestation, as well as infants that are born needing extra help.  For some babies, it may just be some transitional difficulties with breathing.  But for other babies, it could be something life threatening that requires closely managed expert care or possibly even surgery.

Whether the issue is big or small, our NICU team at St. David’s Medical Center can handle it all.

Check back for upcoming interviews with neonatologist Dr. Jennifer Desireddi & more information about our Baby Matters program!

~*~Meg

But before we get into the how, let’s talk about the why.  Why is it important to know how to check your own pulse anyway?  If you have Atrial Fibrillation (AFib), checking your pulse is a quick and easy way to tell if you’re in or out of rhythm.  While many people feel terrible when they’re in AFib—palpitations, dizziness, shortness of breath, and decreased stamina, to name a few—some folks have no idea when they go into AFib.  This can be especially dangerous for people with undiagnosed AFib, since the heart rhythm disorder is one of the top causes of stroke.  If you don’t know you’re in AFib, you can’t take steps to protect yourself from its potentially debilitating effects.

And since AFib affects more than 3 million Americans, mostly over the age of 60, I would argue that everyone age 60 or older should take their pulse on a regular basis to (at the very least) see if it’s fast or slow, regular or irregular.

So here’s how to do it:

1.  Turn your left hand so that your palm is face-up.
2. With the index and middle fingers of your right hand, draw a line from the base of your thumb to just below the crease in your wrist.  Your fingers should nestle just to the left of the large tendon that pops up when you bend your wrist toward you.
3. Don’t press too hard, that will make the pulse go away.  Use gentle pressure.
4. Wait.  It can take several seconds—and several micro-adjustments in the placement of your two fingers on your wrist—to find your pulse.  Just keep moving your fingers down or up your wrist in small increments (and pausing for a few seconds) until you find it.
5. Notice whether your pulse is regular (keeps time like a metronome) or irregular (more random, fast-slow, fast-slow).  An irregular pulse is a tell-tale sign of AFib or other heart rhythm disturbances.
6. To take your pulse rate:
   1. Find a watch with a second hand and place it on your right wrist or on the table next to your left hand.
   2. After finding your pulse, count the number of beats for 20 seconds.
   3. Multiply by 3 to get your heart rate, or beats per minute (or just count for 60 seconds for a math-free option).
   4. Normal, resting heart rate is about 60-100 beats per minute.

Questions about what you find?  Speak to a Nurse Navigator by calling (877) 887-7737, or consult your physician.

Here are a few FAQs about Race for the Cure.

Q:  Is this something in which occasional exercisers can participate?

A:  Of course!  You can choose to participate in the timed race, or the untimed walk which is a pet friendy, family friendly walk of a little over 3 miles, or you can choose the 1 mile family walk.

Q:  What if I begin to feel too tired during the walk?

A:  You should slow down if you are getting too tired, and you can always stop and rest.  Water stations will be available for you along the walk as well.

Q:  Do you have to be a member of a team to participate?

A:  It’s not required that you join a team, but you are certainly welcome to join one.

Q:  Is there a fee to join Race for the Cure?

A:  Yes.  The fee is $30 online, or $40 on the day of the race at the registration tent.

Q:  How is the money that is raised by this event used?

A: 75% of net funds raised locally is used locally.  The Komen Austin provides funding to local non-profit healthcare organizations for breast health services for the  underserved men and women in Travis, Bastrop, Hays, Williamson and Caldwell Counties. The remaining 25 percent funds the national Susan G. Komen for the Cure® Grants Program, which funds groundbreaking breast cancer research.

So, let’s get out there and make a difference!  Let’s choose to walk for health, walk for hope.  To find out more information, register, or locate a team please visit www.komenaustin.org.

by Blanca Duncan, MD

Q: At what age should the first visit to an gynecologist take place?

The American College of Obstetricians and Gynecologists recommends that the first visit take place between the ages of 13 years and 15 years.

Q: What topics are typically discussed during the initial visit?

Screening and preventive health measurements including educational information and guidance.

Discussion of common health concerns shared by many young women such as:

• Menstrual cycles: normal and problematic
• Nutrition and exercise
• Sex and sexuality
• Birth control
• STIs
• Alcohol, drugs, and smoking
• Mental health
• Acne

Q:What exams are performed?

• General physical exam
• External genital exam

A pelvic exam is not usually performed at the first visit unless there are problems.

Q: What happens during an external genital exam?

The doctor looks at the vulva, which is the external female genital area. This is a good opportunity to learn about the body and the names for each part.

Q: What are the Pap test and Pelvic exam?

The Pap test checks for abnormal changes in cervix that could lead to cancer. It is recommended at the age of 21 years.

Although a pelvic exam will not likely be needed, the adolescent should understand what one is.

The pelvic exam has three parts:

1. Looking at the external female genitalia
2. Using a speculum to look at the vagina and cervix. When a Pap test is performed, a small brush is used to obtain a sample of cells from cervix.
3. Assessing the internal organs with a gloved hand

Q: How often should visits take place?

Typically visits should occur yearly, or as appropriate depending on arising health issues.

Q: Why is it important for adolescent to visit ob/gyn?

Gives patients and parents the chance to meet the health care provider, alleviate fears, develop trust, and start a physician-patient relationship.

Assists adolescent in negotiating entry into the health care system when she has a specific health need.

To learn more about women’s services at St. David’s Round Rock Medical Center click here

Joe McWilliams, RRT|Director Respiratory Care
St. David’s South Austin Medical Center

Forget the witches, ghosts, and goblins, here’s something really scary: more than 250,000 people die each year from sudden cardiac arrest (SCA). SCA claims more lives than breast cancer, lung cancer, or AIDS annually.

Sudden cardiac arrest is exactly what it sounds like—one minute, a person is walking around, living their life, and the next minute, their heart stops and, if they don’t receive prompt treatment, they die. Victims suddenly collapse without warning, become unresponsive, and stop breathing. Sadly, more than 90% of SCA victims die before reaching the hospital, but this doesn’t have to be the case. Immediate treatment—in the form of CPR and, if available, use of an Automated External Defibrillator (AED)—can double the chances of survival.

So what can you do about SCA? Here are a few suggestions from the Heart Rhythm Society that could save a life (maybe your own!):

• Take the Heart Rhythm Society’s SCA Quiz and assess your own risk of SCA
• Take action if you see SCA occur:

1. Know the signs of SCA (sudden collapse, unresponsiveness, no breathing/gasping breaths)
2. Call 911 ASAP
3. Start CPR immediately.
4. Use an AED if one is available
5. Learn CPR—It’s easier than ever!

Hands-Only™ CPR is just as effective as traditional CPR with breaths. All you have to do is push hard and fast on the center of the chest. How fast is fast? 100 beats per minute—conveniently, the same bpm as the Bee-Gees tune, “Stayin’ Alive.”

Check out the American Heart Association’s awesome Hands Only CPR resources here.

Check out these other great resources for more info on SCA:

• Cardiac Arrhythmias Research and Education (CARE) Foundation
• Hypertrophic Cardiomyopathy Association
• Parent Heart Watch
• Sudden Arrhythmia Death Syndromes Foundation
• Sudden Cardiac Arrest Association
• Sudden Cardiac Arrest Coalition
• Sudden Cardiac Arrest Foundation

Have a safe and happy Halloween!

Jamie LaRue, RN

Friendships buffer everyday stress and help keep you healthy.

Research shows that social interaction, laughing, smiling and feeling connected to others helps release the “happiness hormones”, serotonin and endorphins. These hormones increase your energy level, boost your immune system, minimize pain and reduce stress.

Chronic stress is known to impair the immune system, leading to increased colds and illnesses such as high blood pressure, heart disease, diabetes and yes, influenza – the common flu.

So the next time you’re feeling run down, tired and under the weather, ask yourself, ‘Am I enjoying enough time with my family and friends?’ Maybe all you need is more time to relax with your friends – take time, whether minutes or hours, with your favorite connections to stay healthy.

In addition to friendships, you can help strengthen your immune system by:

• getting enough vitamin C on a daily basis; natural foods are best, but if you choose a supplement, aim for 200mg per day.
• including vitamin E rich foods in your diet, such as seeds, vegetable oils and grains.
• eating your carrots; beta-carotene is essential to building infection fighting cells.
• choosing a variety of fruits and vegetables; these provide a boost of bioflavenoids which help to protect the cells in the body.
• maximizing your zinc intake to strengthen the production of your white blood cells; foods such as fortified cereal have the largest concentration.

To kick off Breast Cancer awareness month here are 5 myths about breast cancer from Brenda Baumann, director of The Breast Center here at St. David’s Medical Center

Myth 1: I don’t need a mammogram until 50 years of age-

A new study by researchers at the University of Missouri found that screenings in women ages 40 to 49 detected smaller cancers with less chance of spreading to the lymph nodes- which makes them easier to treat –and these cancers might not have been detected on a clinical exam.

Mammograms save lives of women in their 40’s. Women should begin screenings at age 40 and annually thereafter.

Myth 2: Mammograms cause cancer-

The radiation dose during a mammogram is low. It is the amount you would receive from flying for LA to Paris – a trip most of us would not give a second thought about taking.

Myth 3: If Breast cancer does not run in your family, you are not at risk-

Most women diagnosed with breast cancer do not have a family history and many who do have a family history will never develop the disease. The danger lies in a false sense of security. Every woman should talk to her doctor about her individual risks, including age, hormonal factors, and breast density.

Myth 4: Monthly self exams are not necessary-

Though you may have heard advice suggesting self exams do not save lives, many experts still encourage them since mammography and clinical exams are not perfect. Using all three methods is your best chance of early detection. Early detection can improve your odds of being cancer free with less dramatic treatments. Download an instructional self exam card here.

Myth 5: Breast cancer always appears as a lump-

Signs of breast cancer can take many different forms. See you doctor immediately if you notice any of the following:

• A change in the size or shape of your breast
• A dimpled or puckered appearance to the skin that resembles an orange peel
• An itchy, scaly area
• Nipple discharge other that breast milk
• Pain on one spot
• Swelling or redness of the breast
• An inverted (pulled inward) nipple if it has not always appeared this way
• A lump

Join us this month in supporting awareness and raising money to find a cure! If you would like to join the St. David’s Healthcare team, simply log on to komenaustin.org, click “join existing team” and search for St. David’s Healthcare.

Thanks for all the great information Brenda!

-Meg

Sometimes, the leads stop working properly or become obsolete and need to be taken out, usually to make way for new leads.  They can be difficult to extract because, over time, scar tissues grows over them.  During lead extraction, a sheath, or tube, is inserted threaded over the existing lead and inserted through a vein in the chest wall and into the heart.  The sheath helps free the lead from any scar tissue that may have developed around it, helping the doctor to gently pull the lead from the heart muscle.  Sometimes a laser is required to remove excess scar tissue that has grown around the lead.

Removing these adhered leads poses a risk of damaging the heart, which is why it used to be standard practice to do this complicated extraction procedure in the operating room (OR).   Nowadays, though, most high-volume Electrophysiology (EP) centers (TCAI included) do lead extractions in the EP Lab itself, with an OR and a cardio-thoracic surgeon (and his or her surgical team) on-call in case of emergencies.  A study published in the July 2011 issue Heart Rhythm, the journal of the Heart Rhythm Society (see full citation below), validated the safety of this approach.  The first of its kind, the study compared the safety and effectiveness of extracting leads in the OR versus the EP lab and found them to be essentially equal if a rapid-response surgical team is on-call to assist with any emergencies that might require surgery.

The study found that the most common complication associated with lead extraction was damage to blood vessels or chambers in the heart, which if it is serious enough, sometimes needs to be corrected with open heart surgery.  The major predictor of these complications during a lead extraction, according to the study, is age of the lead being extracted.  Older leads, have had more time to become adhered to other structures in the heart and are usually more difficult to extract.  Whether the extraction was done in the EP Lab by an electrophysiologist or in the OR by a Cardio-Thoracic Surgeon did not significantly impact the rate of complications, as long as there was a surgical team standing by to intervene in the EP lab in the event of complications.  We look forward to further study on this important matter—as the population of folks with cardiac devices ages, so will their leads.

REFERENCE: Francheschi, Frederic, MD, Dubuc, Marc MD, FHRS, Dharo, Jean-Claude, MD et al.  “Extraction of Transvenous Leads in the Operating Room Versus Electrophysiology Laboratory: A Comparative Study.”  Heart Rhythm, vol. 8, issue 11. July 2011.