Entries Tagged as Heart & Vascular
Back from the Brink...
Quick Treatment Saves Life
On a warm June afternoon, Michael Hermes, 47, was dropping off umbrellas for a graduation party at his niece’s home in Napa when the first wave of dizziness hit him. He immediately asked his wife Michelle to drive him home to Vacaville. He was hoping that 40 minutes later, everything would be normal again.
But it wasn’t. Not only was he still feeling dizzy, but one side of his body felt numb. Years ago, he suffered a bout with encephalitis, and it felt similar. Could it be coming back? When his vision started to blur, he knew something else was really wrong.
He and Michelle headed for NorthBay VacaValley Hospital, where he was quickly assessed as a potential stroke patient. Soon, he was being introduced to Dr. Alan Shatzel via a teleconferencing robot. Dr. Shatzel, medical director of Neurology Services for the Mercy Neurological Institute in Sacramento, asked Michael a number of questions and used the robot’s cameras to take a closer look at his condition. CT scans were ordered and medication begun.
"I remember that I had one idea of the time line and my wife had another. Now I know why they were so persistent about what time we left Napa. They wanted to make sure I was in the time range to qualify for the medication." All he remembers is taking a medication they called IV-TPA, and then an ambulance ride to Mercy, with his son at his side.
When NorthBay launched its stroke program in 2010, it was in partnership with the Mercy Neurological Institute, which provides neurologists around the clock to teleconference with NorthBay staff and patients. In some cases, NorthBay can handle all the treatment necessary, but in cases such as Michael’s where advanced interventional procedures or surgery are required, patients are transferred to Mercy.
Since October 2010, the robot has been used for teleconference in 26 cases, and seven patients have been sent to Sacramento for surgical care.
In Michael’s case, stroke intervention was not only essential, it was urgent. By the time he arrived, his left side started to feel numb, too. "They told my wife to say goodbye, that if they didn’t do the interventional procedure that minute, I might not make it. I was praying like you wouldn’t believe," he recalls.
In Mercy’s advanced neuro-interventional bi-plane angiography suite, Dr. Lotfi Hacein-Bey, an interventional neuroradiologist, removed a clot from blood vessels in Michael’s brain stem. And a month or so after his stroke, Dr. Hacein-Bey placed a stent in Michael’s brain, improving the flow of blood.
Today, Michael is a walking miracle. Yes, he’s walking and talking and has no major memory issues. Michael, a produce manager for Food 4 Less in Woodland, says he received some powerful help in Mercy’s Acute Care Rehabilitation program. Balance and coordination are still an issue, especially on his left side. But he can eat without help, has good recall and can articulate thoughts without trouble.
Looking back, Michael realizes he could have made some healthier choices. He worked long hours, ate fast food on the fly and stopped taking his cholesterol medicine, even though his family had a history of high cholesterol and circulation issues.
He also had a long history of chewing tobacco, thinking that it was the smoke that presented the danger. "It’s a mistake a lot of people make," explained Dr. Hacein-Bey. "It’s the chemicals that cause harm. He was just as much at risk with chewing tobacco as with cigarettes."
He also erred in thinking he was OK because he was not overweight and was physically strong. "I thought I was in fairly decent shape, and that it couldn’t happen to me. I thought I’d save $40 a month, but now I’m religious about taking my medication."
His message to anyone on cholesterol medication is to take it seriously and not to skip a dose. And if you do have any problems, get in to the Emergency Department right away. Call 9-1-1 and give the team time to assemble, because when it comes to a stroke, every minute counts.
Dr. Shatzel agrees. "Patients who come to the Emergency Department immediately when symptoms occur have every opportunity to have full and complete recovery," says Dr. Shatzel. "Patients who have access to experienced stroke teams and comprehensive stroke centers like ours have the best chance of survival, minimal disability and many make a complete recovery.
"If Michael did not receive IV-TPA and subsequent transfer to our interventional center for definitive clot removal and vessel repair, he would likely have died or
at a minimum be severely disabled," admits Dr. Shatzel.
"I really think it was a matter of everything lining up," Michael says. "That’s why I believe in a higher power. I’m not done yet."
Stroke Facts
- A stroke is the sudden death of brain cells due to inadequate blood flow.
- Stroke often occurs without warning.
- More than one-half million people in the United States experience a new or recurrent stroke each year.
- Stroke is the third leading cause of death in the United States and the leading cause of disability.
- Stroke is the leading cause of disability in the United States.
- Strokes kill about 160,000 Americans each year, or almost one out of three stroke victims.
- Three million Americans are currently permanently disabled from strokes.
- In the United States, strokes cost about $30 billion per year in direct costs and loss of productivity.
- Two-thirds of strokes occur in people over age 65 but they can occur at any age.
- Strokes affect men more often than women, although women are more likely to die from a stroke.
- Strokes affect blacks more often than whites, and are more likely to be fatal among blacks.
- Treatment to break up a blood clot, the major cause of stroke, must begin as soon as possible, with limited time frames for stroke treatments to be effective.
Source: Dr. Alan Shatzel, medical director Mercy Neurological Institute
Stroke Support forSurvivors & Caregivers
The New Beginnings Stroke Support Group meets the third Tuesday of every month at 10 a.m. in Community United Methodist Church, 1875 Fairfield Ave., Fairfield.
The group started in November 2001 at the urging of stroke survivors and caregivers. For more information, contact Noreen O’Regan at (707) 816-7255 or e-mail her at Noreen.oregan@gmail.com.
Pain Reveals Hidden Danger
Nobuko McClellan (center) enjoys time with her daughter, Janet, and her grandson, Duran, 2.
Nobuko McClellan, 60, tried to convince herself that she was just tired. After all, she had just moved into a new home in Vacaville, and she’d been in overdrive, trying to get everything fixed up just right. She’d painted. She’d carried in boxes. She’d put heavy books into the bookcase. It was just too much.
So she went to bed on July 24, 2010, trying to convince herself that she’d be fine in the morning.
By 2 a.m., she could hardly breathe. “It was painful to inhale, it was painful to exhale,” she recalls.
She called a friend who took her to NorthBay VacaValley Hospital where they ran a battery of tests, specifically checking for heart issues, as she’d had angioplasty seven years earlier. Her heart was fine, but she wasn’t. “My whole body was in pain,” she says.
With pain medication, her symptoms receded, and she was released. But it happened again the next day, so she returned to VacaValley Hospital.
“This time, they did even more tests,” recalls her daughter, Janet, who was camping and out of reach during the first ordeal.
“I called her to tell her that we got home safely, and she said she was in the Emergency Room!”
On the second visit, a CT Scan, EKG and MRI were all ordered, as doctors tried to figure out the source of McClellan’s pain. While that remains a mystery, they did find something else, something potentially life-threatening: A splenic artery aneurysm.
“I didn’t even know what a spleen was,” says Janet. “So I started researching it. They used to remove spleens because they thought they didn’t serve a purpose, but now they realize they filter infections.”
While the aneurysm—approximately 3?4" in diameter—wasn’t threatening McClellan’s spleen or her life, it posed a risk if it were to enlarge or rupture.
An aneurysm occurs when the walls of a blood vessel balloon outward, creating weakness in the vessel wall. In McCellan’s case, it had formed in the splenic artery.
Although a splenic aortic aneurysm is the third most common type of abdominal aneurysm, they typically have not been treated at NorthBay Medical Center. In the past, patients were referred outside of Solano County for extensive abdominal surgery. But Seph Naficy, M.D., a vascular and cardiothoracic surgeon, thought McClellan’s case might be a good candidate for an endovascular procedure.
Sending a wire catheter from the groin into the abdominal artery, then into the celiac artery and then into the splenic artery, he was able to place 10 wire coils and a stent graft across the neck of the aneurysm.
While either the coils or the stent graft may have been enough to prevent future problems, Dr. Naficy felt it best to take the “belt and suspenders” approach, going above and beyond to ensure the patient’s safety, he says.
McClellan checked in to NorthBay Medical Center’s Same Day Center around noon, and she was home by 5 p.m., ready to heal. “I was walking by the second day,” she says. “It’s amazing.”
Dr. Naficy agrees, pointing out that the technology is key. “The CT scan showed us something we wouldn’t have seen otherwise. She had no symptoms, but we were able to protect her from a possible rupture. And we were able to do it in a much less invasive way, so she’s up and walking as soon as possible and back to living her life.”
Photo (A) shows the aneurysm branching off the splenic artery. (B) shows a catheter placed into the splenic artery aneurysm. (C) shows coils placed into the aneurysm which will clot the blood flow in the aneurysm. (D) shows a covered stent placed across the entry point into the aneurysm.
A Good Fit
NorthBay Partners With Firm, Creates Custom-made Solutions
It's nice to know when someone has your back. For Seph Naficy, M.D., who specializes in vascular and cardiothoracic surgery, that someone is actually a couple of colleagues who are at his side during procedures, standing by their devices, and ready to make changes at a moment's notice.
They are Richard Smith and Kevin Bowman of Medtronic Inc., clinical specialists, but so much more. "They don't just represent a powerful and innovative company," says Dr. Naficy, "They have been very attentive with their support and availability."
That means that at least one of them will be in the operating room during procedures that involve their devices, ready to consult if plans change. In the case of Paul Nolin (see story on page 10), that's exactly what happened. "Our primary role is to discuss the case strategy, primary plans and a series of alternative plans with physicians," explains Smith.
Medtronic was founded in 1949 as a medical equipment repair shop. Now it is a multinational company that uses technology to transform the way debilitating, chronic diseases are treated.
Smith and Bowman are based out of the Santa Rosa division, so they're geographically close, which is a plus, says Dr. Naficy. Then again, they cover 44 hospitals in California and Hawaii, so they're traveling a lot.
The advantage of doing 20 to 25 cases each month is that they make a lot of contacts with specialty doctors.
"Recently, Dr. Naficy consulted with a doctor from Baltimore via the Medtronic network regarding a specific patient he was treating. They can share direction, approach and strategy, and best practices," explains Smith.
"These doctors are a special breed. They're a subset of a subset of doctors. They're highly specialized. They never stop learning, and they're always feeding off each other for information. They're constantly reaching out to the thought leaders in their industry to strategize on how to do things better," said Smith.
Endovascular abdominal aortic aneurysm repair has been around since 1990, when Juan C. Parodi performed the first one in Buenos Aires. Medtronic has had a number of devices in the pipeline for more than a decade, explains Dr. Naficy. "They are on the cutting edge."
The devices themselves are made of nitinol, a self-expanding metal, and Dacron cloth, hand-sewn perfectly to fit the patient's vessel. Physicians are able to place the device inside a patient's vessel, and the heat causes it to expand to the appropriate width.
All measurements are handled via highly accurate CT scans and the Intervascular Ultrasound (IVUS) technology, which involves a catheter that takes images via ultrasound.
Devices are often placed in several pieces and conjoined during the procedure. It's no cakewalk, but then Smith and Bowman are always up for a challenge. "I love my job," says Smith. "We make a great product, we're involved with a high-caliber audience who value our services, we're treated well by our company, and we get to be involved in life-saving procedures. What's not to like?"
Help for His Heart, Close to Home
Ray Simonds is your prototypical local boy. He went to elementary school in Fairfield and graduated from Armijo High School. In FFA, he raised cattle and sheep and showed them off at the Solano County Fair. After college, he invested his business locally and he sunk his family's roots deep into the community.
So it only made sense to him to have major heart surgery right here in his hometown.
Lugging a box one weekend in April this year, the 72-year-old real estate appraiser felt the classic sign of a heart attack—chest pain. At NorthBay Medical Center he learned major heart surgery was the best option to clear a four-way obstruction.
After he mentioned he heard good things about the cutting-edge "beating heart" surgery being done in a hospital in another county, he learned he could do the same right here, close to home. In fact, the same surgeon—Dr. Ramzi Deeik—would probably be the surgeon at either place.
NorthBay Heart & Vascular Center's team of heart surgeons specializes in the "beating heart" procedure— mending the heart without stopping it. Such a measure not only limits the risk of infection, it also has been shown to reduce recovery time. Ray also discovered his surgery would be done in a much newer, more sophisticated cardiovascular surgery suite in the Fairfield hospital.
Ray got to stay close to home to have the surgeons he wanted and the procedure done the way he thought best.
Three months later, Ray bid a fond farewell to the cardiopulmonary rehab staff in NorthBay Medical Center. When he graduated from his post-surgery recuperative regimen, a 12–week course of therapy, he was feeling as good, or better, than he did before major heart surgery.
"It's been real good," he says of his treatment, especially the rehab work. "The gals here keep an eye on you and make you do the work."
And he especially appreciated the fact he didn't have to travel. "You're right here," he says. "It makes it easier on you and your family. If I had done this somewhere else, it would have been a burden."
His Health at Home treatment immediately after surgery provided not only the monitoring he needed, but also security and peace of mind. He had someone there to watch over him, explaining how his recovery would progress.
Though he has graduated from the cardiopulmonary rehab program, he isn't about to veer from his course of recovery. "My eating habits are completely different," he explains. And he avoids stress.
Staying close to home meant he could fulfill his duties as a director of the Solano County Fair, something he's done for the last 32 years.
He, like NorthBay Healthcare, understands what a long-term commitment to the community means.
Norman's Journey
When it comes to matters of the heart, everyone's experience is different. Some stroll into the Emergency Department with "a little indigestion" and shortness of breath, while others are rushed in on a gurney suffering cardiac arrest.
In some cases, a simple stress test can start the journey, which could lead to an interventional procedure or open heart surgery. Response and treatments are as diverse as the patients themselves.
Caring at critical moments in the ICU
The first hours after a cardiac event are a critical time in a patient's path to recovery, and especially so during the first 24 hours following cardiac surgery. Helping to shepherd patients along at this time is Jamie Chohon, acute care nurse practitioner.
When Muscle Matters
NorthBay Cardiac Rehabilitation is a nationally certified program located inside NorthBay Medical Center. The staff works directly with the cardiology team to provide care for patients once they are discharged from the hospital. Patients entering the cardiac rehabilitation program are ready to learn and put into practice the tools they'll need to live successfully with their heart condition. The program includes exercise to strengthen the heart, nutrition counseling, and lifestyle counseling that focuses on modifying risk factors.
Surgical Team focuses on Heart of the Matter
NorthBay Medical Center's unique situation and location will make it one of the most sought-after heart programs in Northern California, says Dr. Ramzi Deeik, director of Cardiac Surgery Clinical Outcomes at the NorthBay Heart & Vascular Center. The cardiothoracic surgeon has been with the program since its planning stages.
If it’s an Emergency, We’re Here to Help
Patients entering the Emergency Department with chest pain are immediately placed in a protocol that will quickly identify if a patient is having a heart attack. The first step is giving the patient an electrocardiogram (ECG or EKG), a diagnostic tool that measures and records the electrical activity of the heart. The standard test is called a 12-lead electrocardiogram because it measures the electrical activity of the heart from 12 points of view. In a heart attack, part of the muscle dies and is electrically silent, no longer radiating energy. Interpretation of these detailed views allows diagnosis of a wide range of heart conditions.
It's His Special-TEE
The goal of the energetic cardiac anesthesiologist is to educate his
colleagues and the community on the wonders of the Transesophageal
Echocardiogram—also known as TEE.
The diagnostic procedure is the best way to look at the heart and its valves."It offers a 4-D experience," Dr. Roos explained. "That's like 3-D in motion."
