Heart Health 2013

www.BusinessWomanPA.com Heart Health 2013 3

Ladies, we need to talk about your

heart. It doesn’t seem to be on our radar, yetheart attacks are the No. 1 killer of women eachyear.

Women and men, different in so many respects,experience atypical signs and symptoms of a heartattack. And if you’re under 55, take heed. There isa study that suggests that you are misdiagnosedseven times more often than men the same agewhen having a heart attack. Make sure your doctorhears your concerns.

We thank PinnacleHealth for partnering withus to present this vital heart health information.They are an integral part of the region and have avision for the future, which includes a new state-of-the art hospital, complemented by theirexcellent staff of physicians and personnel.PinnacleHealth wants to remain a leader inhealthcare by offering cutting edge treatments,which includes those that improve heart function.

You’re always helping others. Help yourselfright now. Please take time to read the vitalinformation included in this special feature. Itcould save your life.

Love yourself … love your heart.

Managing Editor

Inside:

3 Overall Excellence in Patient CareA vision for healthcare in our region.

6 Fit-Friendly Worksite ProgramPromotes Heart HealthCreating a wellness environment in theworkplace.

8 Center Stage – Profile

9 The Heart Failure CenterProviding care to help patients avoidhospitalization and ease symptoms.

10 Pumped for Love – Profile

12 High Blood Pressure a SpecialConcern for WomenWhy women need to be aware.

14 Recipe – Trout with Skillet-RoastedPeppers

BUSINESSWoman magazine recently spoke with Michael A. Young,president and CEO of PinnacleHealth, to gain his perspectives onheart care in the region and how a holistic approach to healthcareaffects many conditions, including heart disease.

1. Can you tell us a little about heart disease?

It is estimated that 1/3 of Central Pennsylvanians suffer from aform of cardiovascular disease, and it remains the leading cause ofdeath in Pennsylvania among both men and women. Diabetes andhypertension can lead to cardiovascular disease, genetics can play arole, and lifestyle habits like smoking and diet play a huge part.

2. What effect does the aging of the population have?

Getting older increases our risk for heart disease. As we age, ourarteries can clog and stiffen, and the heart compensates byworking harder, thereby raising blood pressure. This can changethe timing of its valves.

For women, the risk of heart attack and stroke increases withage, especially after menopause. Low levels of estrogen pose asignificant risk factor fordevelopingcardiovascular disease inthe smaller blood vessels(small vessel heartdisease).

Pennsylvania ranksfourth in the U.S. bypercentage of thepopulation age 65 andolder (behind Florida,West Virginia, andMaine), and one in fivePennsylvanians are 60 orolder. By 2020,Pennsylvania’s 60-and-older population isexpected to be 25percent of the totalpopulation.

OverallExcellence inPatient Care

Michael A.Young,president and CEO of

PinnacleHealth.

Continued on next page.

PinnacleHealth has created a strategic plan called Vision2017 that, in part, addresses these new demographics and thegrowing needs of this aging population. Heart disease isimportant, but we’re focused on addressing all healthcareneeds, particularly in preventative care.

For instance, helping patients effectively manage high bloodpressure and high cholesterol, or helping them quit smokingand lose weight, can make the difference in developing heartdisease or its severity.

3. PinnacleHealth added Heritage Medical Group and is

opening a new hospital on the West Shore. What

impact will these changes have on cardiac care and

treatment and promoting healthy hearts?

These new relationships are part of our vision for healthcarein the region. Now the PinnacleHealth Medical Group, theresult of combining PinnacleHealth Family Care and Heritage,has expanded the availability of primary care services and ourmedical home model throughout Central Pennsylvania.

The medical home model is designed to improve populationhealth, better manage chronic diseases, and coordinate care,with a focus on prevention. By helping Central Pennsylvaniansaccess services that help manage illnesses such as diabetes,asthma, and heart disease, patients may have greater success inpreventing urgent or emergency situations.

The new West Shore Hospital will offer interventionalcardiology (heart catheterization) and a state-of-art ER. We arealso expanding cardiac services at our Harrisburg Campus to

include new catheterization and electrophysiology suites,private patient rooms, and family waiting areas.

Additionally, we average 55 minutes in unblocking arteriesupon ER arrival. The national standard is 90 minutes. We’vealso received the highest quality designation, a Three-StarRating, for heart bypass surgery and have Joint Commissiondisease-specific certifications in Advanced Heart Failure andStroke, Spine Surgery, Stroke Rehab, and Advanced Diabetes.

Those recognitions reflect our focus on comprehensive care.We’re a multidisciplinary system that is focused on totalpatient care.

4. In more general terms, what does the vision –

including chronic disease management, improving

health of the aging demographic, and better

coordination of care – mean for the region?

PinnacleHealth’s strategic vision is focused on developing ahighly integrated system of care designed to increase access,enhance quality, and lower cost. Our vision to provide theright care at the right time in the right setting means offering aprimary care office 10 minutes from work or home, just 20minutes in distance to an outpatient facility, and a mere 30minutes to a state-of-the-art hospital or ER.

Based on our recent community health needs assessment,one out of every five people in Central Pennsylvania does nothave a doctor. This, combined with the incidence of chronicillness, shows there is a need to improve access to affordablecare.

The new PinnacleHealth West Shore Hospital under construction in Hampden Township with expected completion mid-2014.

Continued from previous page.

4 Heart Health 2013 www.BusinessWomanPA.com

Getting patients into care as early aspossible offers the greatest chance forsuccess and the highest quality of life.

5. You are very focused on quality.

Can you explain this more?

Quality means that patients have thebest outcomes from the services theyreceive. The patient should receive thebest discharge instructions, greatfollow-up care, accurate test results,courteous service, quiet surroundings,and timely information. It means thatthey deserve to have their questionsanswered and feel welcome. Quality isabout the overall patient experience.

Patients might have the most skilled,educated, and experienced practitioners,but they also want communication,compassion, and kindness. Being ableto offer all these aspects is true qualityservice.

At PinnacleHealth, we offer a patientpromise that encompasses all thesethings. We truly believe that healing isfacilitated by comfort andconsideration. Our goal is patientsatisfaction. Final beam placement for the expansion of services at Harrisburg Hospital.


West Shore Hospital under construction.

PinnacleHealth employees sign the final beam for the expansion at CommunityGeneral Osteopathic Hospital.

Written by Rochelle A. Shenk

Being fit is something that encompassesboth our personal and work lives—it’s alifestyle. The American Heart Association’s(AHA) Fit-Friendly Worksites programrecognizes employers who promote a healthylifestyle. After all, adults in this countryspend the majority of their waking hours atwork, and many are in sedentary careers.

With obesity costing American businesses$12.7 billion per year in medical expensesand $225.8 billion in health-relatedproductivity losses, any program thatincreases physical activity of employees willpositively impact the bottom line.

Larissa Bedrick, director of communicationat the American Heart Association, said thatthe Fit-Friendly Worksites program wasinitiated in 2007 and “recognizes employersthat go above and beyond in creating awellness environment in the workplace.”

Worksites (for-profit companies and not-for-profits as well as schools) with 25 or moreemployees may earn recognition byimplementing physical activity practices suchas providing walking routes; promotingwalking programs, online newsletters, andtracking tools to motivate employees; andallowing staff to wear athletic shoes in theworkplace on designated “sneaker days.”

Additionally, worksites with multiplelocations and various activities spreadthroughout the locations can be viewed as awhole to become designated.

The worksite submits an application forrecognition (deadlines for submissions are

Fit-Friendly Worksite ProgramPromotes Heart Health


Jan. 31 and July 31), which is then reviewed by an AHAvolunteer panel. Bedrick said that the application encouragessmoke-free worksites. However, companies that do not have apolicy in place are not excluded from consideration. If acompany can show that their worksite is mainly smoke-free, itwill still be included in the selection process.

Fit-Friendly has gold and platinum levels, which may berenewed annually. A worksite may also receive an InnovationAward. Bedrick explained that this recognizes uniqueactivities, policies, or actions a worksite undertakes to improvethe wellness at the site itself or in the community. Theseawards are not renewable, and once a worksite is recognizedfor Innovation, it would have to reapply with a new activity inorder to re-qualify.

Donegal Insurance Group, Marietta, is a Fit-Friendly gold-certified worksite. Marissa Throckmorton, benefitsadministrator, said that 2012 was the first year that thecompany applied for the award.

“We’ve really been pushing wellness and wanted to getrecognition for the things we’ve done,” she said.

Donegal has an onsite fitness center that’s been expanded toinclude both strength training and cardio areas, and it’saccessible both before and after work hours. Throckmortonsaid that she uses the facility as much as she can, and it’s apretty busy place at lunch.

“Fitness has become part of our corporate culture—you’llsee top-level executives using the fitness center or at some of

our fitness events.”In the past year, Donegal inaugurated a wellness committee

that hosted a number of events. About 80 staff membersparticipated in National Walk at Lunch Day in April, while 70people participated in a 10-week Biggest Loser program—thetop three Biggest Losers each lost at least 10 percent of theirbody weight. Throckmorton explained that participants in thisprogram were each assigned an ID; they were weighed by anurse from Lancaster General Health; and results were postedeach week.

“Posting the weekly results helped motivate people and keptup interest in the program,” she said.

Donegal also hosted its third annual health and benefits fair,which includes a number of health screenings. The Walk atLunch Day spawned “Walking Wednesdays” where staffmembers gather and walk together. There’s also a Lunch &Learn program that’s been offered three times a year throughDonegal’s health insurance provider. In September, Donegalbegan a campaign encouraging staff members to completehealth/health risk profiles.

Bedrick said that by recognizing efforts of worksites such asDonegal Insurance Group through the Fit-Friendly program,AHA hopes to encourage other worksites to implementemployee programs that focus on fitness and health.

For more information about how your workplace canbecome involved in the Fit-Friendly Worksite program, visitwww.startwalkingnow.org.


Center StageWWrriitttteenn bbyy RRoossaallbbaa UUgglliiuuzzzzaa

Brenda McCann was an active person growing up.She had played softball and bowled. She has never hadhigh blood pressure or high cholesterol. So when sheexperienced fatigue and shortness of breath, she thoughtit was part of the aging process.

Unbeknownst to her, her heart would take center stagein the years to come.

Her cardiac journey began in January 2008 whenMcCann, 51, was supposed to undergo a hysterectomy.But once she was under anesthesia, her heart jumped to300 beats per minute. Alarmed, doctors canceled thesurgery and performed a heart catheterization instead.

“They claimed normally when the heart races and doesan irregular beat, it usually means there’s a blockage,” shesaid.

By spring 2011, she had a pacemaker implanted, andin July 2012, she was diagnosed with congestive heartfailure, due to the organ not pumping out enough blood.McCann said her heart was pumping out blood belowaverage; between 20 to 25 percent.

Doctors at PinnacleHealth performed a cardiacablation to correct her heart rhythm problems. Thoughheart problems run in her family, McCann is the onlymember to have this surgery.

“I guess I can say I’m lucky I went in for surgery or Imight not have known the condition that I had was asserious as it was,” she said.

In addition to her follow-up appointments atPinnacleHealth, McCann takes her heart medicationsand monitors her sodium and water intake. She and herhusband, Howard, have also taken an organic approachto their lifestyle like growing vegetables from theirgarden and ignoring packaged foods and canned goodsfrom grocery stores.

“We bake our own bread. We can our own produce inthe summer. It’s just something that we do,” she said.“Everything on my end contributes to longevity.”


The HeartFailure Center

Treating congestive heart failure, a chronic illnessaffecting about 5.8 million people in the United States, isa matter of micromanagement, according to Brijeshwar S.Maini, MD, FACC, director of Advanced Cardiac andEndovascular Interventional Laboratory, director ofCardiovascular Research and Education, and medicaldirector of PHCVI Valve Clinic at PinnacleHealth.

The PinnacleHealth Heart Failure Center helps to limitfrequent hospitalizations and typical symptoms ofshortness of breath, fatigue, and swelling in the ankles,feet, legs, abdomen, and neck veins.

“More people get admitted to the hospital because ofcongestive heart failure than any other diagnosis,” Dr.Maini says. “We tailor our therapies to improve heartfailure patients’ quality of life and keep these patients outof the hospital as much as possible.”

Managing heart failure as an outpatient service at theHeart Failure Center includes:

• Seeing providers on a frequent basis

• Regular visits to monitor the heart and lungs

• Education for patients and their families on recognizingcomplications and reducing symptoms

• Reinforcement of diet and medication compliance

• Early detection of worsening heart failure

• Attending monthly support group meetings

To contact the Heart Failure Center, call 717. 231.8445.

Brijeshwar S. Maini, MD, FACC


Pumped for LoveWWrriitttteenn bbyy RRoossaallbbaa UUgglliiuuzzzzaa

Behind every great man, there’s a great woman. Butfor 77-year-old Eugene Borza, he has a sweetheart.

Thanks to his wife of 37 years, WITF-TV presidentKathleen Pavelko, Borza has overcome his latest healthscare for the better.

Last January, Pavelko was at her husband’s side whenhe underwent surgery to replace four blocked arteries atPinnacleHealth in Harrisburg.

“My wife Kathleen is an angel. She decided she wasgoing to take care of me because when you’re on a lot ofmeds, your mind is not working very well. She was thereall the time,” said Borza, a retired college professor. “Shewas the basic source of support.”

Borza had no medical and family history of heartdisease. So the news came as a shock when he developedsymptoms of shortness of breath and chest discomfort inMarch 2011. After a stress test proved negative, thecouple consulted with their physician who initiallythought the problem might have been gastric-related.

“Our physician, Dr. Howard Cohen, suggested thatonly the ‘gold standard’ test (cardiac catheterization)could confirm the source of the symptoms,” said Pavelko.“That revealed four blockages that were repaired viasurgery a few days later.”

Borza is grateful for the excellent care the doctors andstaff provided at PinnacleHealth. The couple, who havetwo children, have resumed a healthy, low-salt,moderate-fat diet and exercise regularly.

Pavelko said it’s important that two people are presentwhen they are consulting with a medical professional.

“Each meeting is an invaluable opportunity to askquestions and expand your understanding of thesituation,” she said.

Borza said his wife did just that and he owes her agreat debt.

“She was right there with me, checking and doublechecking and expressing concern,” he said. “She wasmarvelous.”


Written by Stephen T. Sinatra, MD, FACC

Like heart disease, high blood pressure (also known ashypertension) has always been thought of as a man’sproblem—but it just isn’t so. As it turns out:

• Women are more likely to have high blood pressure becausethey have smaller arteries than men.

• After age 55, more women develop high blood pressurethan men.

• Even a mild elevation in blood pressure (around 130–139mmHg systolic, or 85–89 mmHg diastolic) has been foundto actually double a middle-aged woman’s cardiac risk.

• High blood pressure affects one out of every four womenand kills significantly more women than men.

Considering these statistics, women need to be aware of anumber of life circumstances and lifestyle choices that canmake maintaining optimal blood pressure a unique challenge:

• Birth control• Pregnancy• Menopause• Metabolic syndrome • Diastolic dysfunction • Painkillers • Emotions • Birth Control

Oral contraceptives may elevate blood pressure slightly.Usually a woman’s numbers will stay in the normal range, butthey should be checked regularly because high blood pressureis a potential side effect—particularly for women with afamily history of hypertension or a personal history of kidneydisease, obesity, or hypertension during pregnancy.

Pregnancy

Many women with high blood pressure deliver healthybabies (high blood pressure during pregnancy is calledeclampsia). But pregnancy—and the increased blood volumerequired to nurture a growing fetus—can potentially raiseblood pressure to extremely high levels.

For this reason, expectant mothers also should have bloodpressure readings taken routinely. Hypertension can developrapidly in the last three months of pregnancy. When thishappens, a woman may need treatment—even after delivery.

Menopause

Normal age-related hormonal declines often cause awoman’s arteries to become less elastic and more constrictive,thus contributing to high blood pressure. On their own, thesechanges are reason enough to pay extra attention to yourlifestyle choices that affect cardiovascular health.

But the situation is further complicated by the use ofhormone replacement therapy (HRT) to minimize oreliminate other symptoms of menopause, like hot flashes andnight sweats.

Conventional HRT involves the use of manmadepharmaceutical substitutes for the hormones the body is nolonger producing enough of. These synthetic hormones maybe problematic, however. In 2004, results from the largeWomen’s Health Initiative (WHI) study showed thatsynthetic hormones like Premarin and Provera could push

blood pressure up steeply. An alternative to HRT is individually tailored

bioidentical hormones derived from natural plantsources. I believe these are a much better

option for women who want to use sometype of HRT.

Metabolic Syndrome

Data from a five-year National Healthand Nutrition Examination study of adults with

hypertension revealed three risk factors for highblood pressure that are more significant for women than

High Blood Pressure aSpecial Concern for Women

{


men: low HDL cholesterol levels, elevated triglyceride levels,and excess abdominal fat (waist girth of more than 35inches).

This profile is largely consistent with metabolic syndrome,a widespread asymptomatic condition that often leads todiabetes and heart disease.

I’ve found that women with these characteristics typicallydon’t respond well to medications for high blood pressure.They do better with lifestyle changes that include exerciseand weight loss, stress reduction, and diet modifications, suchas restriction in simple sugary carbohydrates and targetednutritional supplements to support normal blood pressurelevels.

Diastolic Dysfunction

Another reason that women have a tougher time with highblood pressure is their tendency to have more diastolicdysfunction (DD) than men. DD is a condition in which theleft ventricle of the heart—the chamber that generates yoursystolic blood pressure—becomes stiff. This is the No. 1cause of heart failure in women.

DD may have to do with women’s smaller blood vesselsand declining energy levels in the heart. Fortunately, thelatter can be combated by taking the “Awesome Foursome,”my name for the four supplements that are crucial for cellularenergy production and important for ensuring that yourheart has the raw materials and energy substrates necessary tomaximize its efficiency. I call this Metabolic Cardiology.

Painkillers

Daily doses of non-aspirin painkillers, such as extra-strength acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil andMotrin), increase the risk of developing high blood pressure.

A 2005 Harvard study found that women who took morethan 500 mg of acetaminophen daily (the amount in oneextra-strength tablet) had a 93 to 99 percent greater risk ofdeveloping hypertension within three years than women whotook less.

Likewise, women who took more than 400 mg a day ofover-the-counter NSAIDs (the equivalent of two ibuprofen)had a 60 to 78 percent greater risk for hypertension thanwomen who took less than that amount.

If you take painkillers regularly, be sure to inform yourdoctor and find out about safer medications. I recommendTraumeel, a homeopathic remedy available in health food

stores or online atwww.traumeel.com. You canbuy it as a topicalcream or sublingualtablet, and itworks great forvarious muscleaches andpains—without thepotentiallydevastatingeffects onbloodpressure.

Emotions

Years ago, Iconducted a fascinatingcoed study on stress and theheart with my cardiacpatients. Before and after aworkshop, I measuredeach person’s bloodpressure, as well as thelevel of stress hormones intheir urine. I found that thewomen who expressed theiremotions and networked withone another during the workshophad lower levels of stress hormonesand lower blood pressures.

This is a good point to remember—the value of spendingtime with other women, and of talking to moms, sisters, andgirlfriends about health and other life issues. You may be ableto lower your blood pressure by reestablishing orstrengthening some of these valuable connections.

Stephen T. Sinatra, M.D., FACC, is a board-certified cardiologist andassistant clinical professor of medicine at the University of ConnecticutSchool of Medicine. He is the founder of heartmdinstitute.com and theauthor of a monthly written newsletter entitled, Heart, Health &Nutrition. Sinatra is a fellow in the American College of Cardiologyand the American College of Nutrition. His latest books are TheSinatra Solution/Metabolic Cardiology, Earthing: The MostImportant Health Discovery Ever and his latest book released inNovember 2012, The Great Cholesterol Myth.


Trout withSkillet-Roasted Peppers

Nutrition Analysis (per serving)

Calories . . . . . . . . . . . . . . . . .189Total Fat . . . . . . . . . . . . . . . .7.5 g

Saturated Fat . . . . . . . . . . .1.5 gTrans Fat . . . . . . . . . . . . . .0.0 gPolyunsaturated Fat . . . . . .2.0 gMonounsaturated Fat . . . .4.0 g

Cholesterol . . . . . . . . . . . . .67 mg

Sodium . . . . . . . . . . . . . . .332 mgCarbohydrates . . . . . . . . . . . . .6 g

Fiber . . . . . . . . . . . . . . . . . . .1 gSugars . . . . . . . . . . . . . . . . . .3 g

Protein . . . . . . . . . . . . . . . . . .24 g

Dietary Exchanges: 1 vegetable, 3 lean meat

RecipeServes: 4; 3 ounces fish and 1/3 cup pepper mixture perserving

Ingredients

1 tablespoon olive oil, divided use2 medium poblano peppers, ribs and seeds discarded,

thinly sliced5 ounces grape tomatoes or cherry tomatoes, halved

(about 1 cup)1 medium garlic clove, minced1 to 2 teaspoons balsamic vinegar1/2 teaspoon salt, divided use1/4 teaspoon pepperPaprika to taste4 trout fillets or any other thin mild fish fillets

(about 4 ounces each), rinsed and patted dry1 medium lime, cut into 8 wedges

Cooking Instructions

Heat a large, nonstick skillet over medium-high heat.Add 1 teaspoon oil, swirling to coat the bottom. Cookthe peppers for 4 to 6 minutes, or until beginning torichly brown on the edges, stirring frequently.

Gently stir in the tomatoes. Cook for 2 minutes, oruntil soft, stirring gently and frequently. Remove fromthe heat.

Gently stir in the garlic, vinegar, and 1/4 teaspoonsalt. Transfer to a small bowl. Cover to keep warm.

In the same skillet, heat the remaining 2 teaspoons oilover medium-high heat, swirling to coat the bottom.Sprinkle the pepper, paprika, and remaining 1/4teaspoon salt over both sides of the fish. Cook for 3minutes on each side, or until the fish flakes easily whentested with a fork. Transfer to a platter.

To serve, squeeze 4 lime wedges over the fish. Spoonthe poblano mixture on top. Serve with the remaininglime wedges to squeeze over the poblano mixture ifdesired.

Cook’s Tip

No need to slow-roast poblano peppers to get deepflavor. All it takes is quickly cooking them in a hotskillet and letting them steep a bit.

Squeezing lime wedges over both the fish and thetopping “lifts” and defines the flavors of the variousingredients. If you aren’t a true lime lover, though, youmay want to skip the second spritzing.

This recipe is brought to you by the American Heart Association’sFace the Fats campaign. Recipe copyright © 2009 by the AmericanHeart Association. Look for other delicious recipes in American HeartAssociation cookbooks, available from booksellers everywhere, and atdeliciousdecisions.org.


Documents

Heart Health 2013