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w w w . n c h m d . o r g
JOYSO OF HEALTH-SMART TRAVELS THE Tips for enjoying your time away and still keeping to good dining and exercise plans
YES, YOUNGER PEOPLE HAVE STROKES, TOO What to look for as signs of trouble WANT TO PLAY BETTER GOLF? Exercise that can get you in shape and improve your swing PRESERVING HEART FUNCTION WHILE SURVIVING CANCER How advanced technology at NCH is protecting the hearts of cancer patients PLUS
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SCOTT FUCHS, DO Physicians Regional Medical Center 8340 Collier Blvd., Suite 205 Naples, FL 34114
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ZDENKO KORUNDA, MD 4513 Executive Drive Naples, FL 34119
Medical Education • University of Nebraska, Omaha, NE. Board Certification & Advanced Training • Board Certified in Physical Medicine and Rehab and Pain Medicine by American Board of Physical Medicine and Rehabilitation • University of Nebraska, Omaha, NE; Pain Medicine Fellowship • University of California Irvine, Orange, CA; Physical Medicine and Rehabilitation Residency • Saint Petersburg General Hospital, St. Petersburg, FL; Tradition Rotating Internship Medical Education • M.D. Rutgers – New Jersey Medical School, Neward, NJ Board Certification & Advanced Training • Board Certified in Physical Medicine and Rehab and Pain Medicine by American Board of Physical Medicine and Rehabilitation • JFK Johnson Rehabilitation Institute, Edison, NH, Interventional Pain Fellowship • Rutgers – Robert Wood Johnson – JFK Johnson Rehabilitation Institute, Edison, NJ, Physical Medicine and Rehabilitation Residency • New York – Presbyterian/Queens Hosital, Flushing, NY, Medicine Internship
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Your Care. Personalized.
contents APRIL - JUNE 2019
CONCIERGE MEDICAL PRACTICE
22 YES, YOUNGER PEOPLE HAVE STROKES, TOO What to look for as signs of trouble.
16 THE JOYS OF HEALTH-SMART TRAVELS Tips for enjoying your time away and still keeping to good dining and exercise plans.
The Baker Center 201 8th St South – Suite 202 Naples, Florida 34102 239-331-2341 www.BrittenMD.com • Alpha Omega Alpha-Medical Honor Society • NCH Compass Award for Patient Care • Physician of theYear – Hackettstown Reg. Med. Center • Prystowsky Award for Overall Excellence in Patient Care • Resident of theYear Award for Excellence in Patient Care Let Dr. Britten provide you with Personalized Concierge Care!
28 WANT TO PLAY BETTER GOLF? Exercise that can get you in shape
32 PRESERVING HEART FUNCTION WHILE SURVIVING CANCER How advanced technology at NCH is protecting the hearts of cancer patients.
and improve your swing.
4 HEALTH WISE Dr. Miguel Madariaga discusses how vaccines protect you from disease. every issue
14 ASK THE EXPERTS NCH specialists answer your urgent health questions. 38 UP & COMING Information on health screens, workshops and support groups.
10 HEALTH BUZZ Tips to keep you feeling great.
12 IN THE SPOTLIGHT Please do have that important talk about aging.
40 LOOKING AHEAD What’s new and promising.
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NAPLES HEALTH APRIL - JUNE 2019
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HealthWise
How Vaccines Protect You from Disease
Expert Care For All Ages
O ne of the greatest achievements of public health is the use of vaccines. Vaccines have eradicated smallpox from the face of the earth and poliomyelitis from the Americas. Themortality and suffering from multiple other diseases also have been decreased by the use of vaccines. Despite the enormous benefits of vaccines, par- ents and patients hesitate about getting them. As a consequence, diseases considered extremely rare until recently are making a comeback. Measles, for
Shawky Hassan M.D., PhD
Despite the enormous benefits of vaccines, parents and patients
Fikiria Hassan M.D., PhD
for Experience!
hesitate about getting them.
*Diplomats Of The American Board Of Allergy, Asthma &
NEW PATIENTS, CHILDREN & VISITORS WELCOME (239) 261-5599 New Address: 680 2nd Ave. N. Suites 201 & 202 | Naples, FL 34102 MOST INSURANCES ACCEPTED www. allergytoday .com • Allergy To Food, Drugs, & Insects • Hives, Eczema, Other Skin Allergy • Immune Deficiency Diseases • Autoimmune Diseases Our Specialties Immunology *Fellows Of: • American College Allergy, Asthma & Immunology • American Academy Of Allergy, Asthma & Immunology • American Association Of Certi ed Allergists & Immunologists • Allergy Of The Nose & Sinuses • Chronic Sinusitis & Hay Fever • Asthma, Cough, Wheezing • Shortness Of Breath, COPD
example, is causing a terrible outbreak in Washington State. Measles does not just cause rash and fever; 1 in 20 children with measles can get pneumonia, and 1 in 1,000 can get encephalitis (brain inflammation). People reject vaccines because of controversies and scares. Perhaps the most well- known is the fraudulent association between the measles vaccine and autism. An article published in a renowned medical journal triggered fear, but since then the article has been retracted and the author found guilty of scientificmisrepresentation. No evidence of autism triggered by vaccines has been found. Another common myth is that getting a disease naturally is “healthier” than get- ting the vaccine. Unfortunately, there is no way to know which person with a disease will develop complications. A lot of other rumors and inaccurate beliefs about vaccines circulate on the web and in social media.
Although we live in a time when the legitimacy of science is questioned by many, your best source of information is still your doctor or health care pro- vider. Ask him or her about vaccines and do not endanger your health or the health of your loved ones. MIGUEL MADARIAGA, M.D. NCH PHYSICIAN GROUP, INFECTIOUS DISEASE (239) 624-0800
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CLINICAL EXCELLENCE DRIVING PERSONALIZED CARDIOVASCULAR CARE SWICFT Cardiology | SWICFT Health | Southwest Florida Research
Board of Trustees Mariann MacDonald, Chair William F. Allyn Jay Baker Kevin Beebe Christina Carranza, R.N. Kerry Edwards George Ferguson, M.D. Thomas J. Gazdic, First Vice Chair / Treasurer Stephen Lange, M.D. John Lewis, M.D., Secretary Scott Lutgert Patrick Mulcahy Gregory Russo Michael A. Wynn NCH Corporate Officers Interim President and CEO Phillip C. Dutcher Chief Medical Officer Frank Astor, M.D. Chief Administrative Officer—NCH Physician Group Zach Bostock Chief Nursing Officer and Interim Chief
THE SOUTHWEST INSTITUTE FOR CARDIOVASCULAR FITNESS & TREATMENT Healthcare is changing. In an era when physicians face increasing pressure to see more patients with shorter visits, our group remains steadfast to the principle of taking the time to understand the total patient and their needs. We are also committed to maintaining an active relationship with our patients to optimize health and wellness. The SWICFT Institute was established to promote cardiovascular health and wellness through the delivery of the highest quality cardiovascular care, the latest cardiovascular diagnostic testing and treatments, and the most current preventative measures including lifestyle, diet, exercise and nutrition management. 2018 Collier County Medical Society Physician of the Year: Dr. James V. Talano 2018 NCH Physician of the Year: Dr. Sajan K. Rao
Operations Officer Jonathan Kling, R.N. Assistant Secretary Beth Martin Chief Strategy Officer Michael Riley VP/General Counsel Linda M. Roeback Chief Human Resources Officer Renee Thigpen Chief Experience Officer Gary Tomcik Chief Financial Officer Rick Wyles
Jordan Beaverson, PA-C Robert Baily, MD, FACC
SWICFT Cardiology 239.261.2000 ph. 239.261.2266 fax www.swicft.org
James J. Talano, MHA, FACHE James V. Talano, MD, MM, FACC
Sajan Rao, MD, FACC Jennifer Mazorra, NP-C Hashem Azad, DO Ariel De La Rosa, MD, FACC, FSCAI 625 9th Street N., Suite 201, Naples, FL 34102 9410 Fountain Medical Court, Bonita Springs, FL 34135 977 N. Collier Blvd., Marco Island, FL 34145
Magazine Coordinator Mary Trupiano
Naples Health magazine makes every effort to ensure information published is accurate and current but cannot be held responsible for any consequences resulting from omissions or errors. Opinions expressed by third party advertisers and contributors are not endorsed by nor necessarily the opinions of the magazine or publisher.
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NAPLES HEALTH APRIL - JUNE 2019
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Your Gift to NCH Will Help TransformHealthcare for Generations
As a not-for-profit hospital, philanthropy has enabled NCH Healthcare System to provide comprehensive, compassionate care for more than 60 years. Through the support of grateful patients and friends – like you – we are able to offer state-of-the-art facilities, cutting-edge services and world-class medicine.
Your unrestricted support of NCH allows us to direct funding to where the need is greatest. Generous gifts of any size help NCH continue as the premier leader in healthcare for Southwest Florida and beyond. We invite all of you to join
us in our ongoing mission of “ helping everyone live a longer, happier and healthier life. ”
Ranked among the Best Hospitals in the Nation by U.S. News &World Report
Make your gift today!
NCHmd.org/donate (239) 624-2000
Health Buzz Tips to keep you feeling great
MAKING GOOD FOOD and drink choices while you’re breastfeeding will help you and your baby get the nutrients you both need. Follow a healthy eating pattern with these tips.
low in mercury. • Drink plenty of fluids. Your body needs extra fluids, like water and fat-free or low-fat milk, when you are breastfeed- ing. Try drinking a glass of wa- ter every time you breastfeed. • Limit drinks, such as soda, that contain caffeine and
EAT HEALTHY WHILE NURSING
• Check the Nutrition Facts label, and choose foods and drinks with less added sugar, saturated fat and sodium (salt). • Be selective in your seafood consumption, aiming for 8 to 12 ounces weekly of fish and shellfish that are high in healthy fats but TAKING CARE OF a spouse or family member at home can be emotionally and physically challenging. Meeting the physical demands of lifting, turning and transferring a loved one can put both the patient and caregiver at risk for injury. Use these proper lifting techniques to help prevent injury. • Keep your head and neck in proper align- ment with your spine. • Maintain the natural curve of your spine;
added sugars. Not drinking alcohol is the safest option for breastfeeding mothers. If you do choose to drink alcohol, have no more than one drink a day. —U.S. Department of Health and Human Services
do not bend at your waist. • Avoid twisting your body when carrying a person. • Always keep the person whom you are moving close to your body. • Keep your feet shoulder-width apart to maintain your balance. • Use the muscles in your legs to lift and/or pull. —American Academy of Orthopaedic Surgeons
LIFTING TECHNIQUES FOR HOME CAREGIVERS
TRY THESE TIPS for cooking healthily and creatively. • Use the zest from oranges, lemons and limes to add flavor to soups, salads, sauces, marinades and rubs. Grate or peel off only the colored part of the peel, leaving behind the more bitter white pith. • Try an herb vinegar on cooked MOST OF THE prescription drugs misused by teens come from the teens’ family and friends. Dispose of expired, unwanted or unused medicines before the medicines become a problem. April 27 is DEA National Drug Takeback Day, and you can
greens or in bean soup. The vinegar also enhances the flavor of fish and can add just the right amount of zip to party dips. • When cooking with wine, use small individual bottles of real wine; cooking wine and cooking sherry contain added salt. —The StayWell Company, retrieved from wanted or expired prescrip- tions to an authorized dis- posal location, or contact your local law enforcement to find where to bring your medi- cines for disposal. 2. FLUSH : Find out which medicines you can safely flush down the toilet.
COOK CREATIVELY
SAFELY DISPOSE OF YOUR PRESCRIPTION MEDICINES
3. TOSS : Follow simple steps to dispose of certain medicines safely in the household trash. —National Institute on Drug Abuse
search for your nearest disposal location at www.takebackday.dea.gov. Follow these three steps for year-round disposal. 1. RETURN : Take your unused, un-
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In the Spotlight
Do Have That Talk About Aging
T There is one thing you can do for your well-being that has nothing to do with diet, exercise or doctor visits. And that is to have a conversation with your loved ones about getting older. This matter can apply whether you are the person getting older or you are the child or spouse of that person, says Deb Logan, Executive Director of the Blue Zones Project, Southwest Florida.
says. “It’s really a part of worst-case- scenario planning. We all know there is premature loss of life. Accidents hap- pen. Someone in the family could get a bad diagnosis, and then your life goes into a tailspin; your brain goes into a fog.
herself, and say that you are thinking about doing some planning yourself. A lot of fear certainly can be attached to the idea of coming to the end of life— again, on both sides. But the person you are talking withmay be relieved that you
If you had had conversations beforehand, it would make that situation a bit easier and much less stressful.” A GOOD CHECKLIST If you’re looking for further help in structuring your con- versation, Logan recommends visiting www.aarp.org and heading to the website’s “Pre- pare to Care” guide, which you can download and print. The guide will walk you through each step of the process and give you a template to work with. “You can think of filling it
“It’s for your peace of mind, whichever side of the conver- sation you are on,” Logan says. “It’s a win-win proposition. But it can be an uncomfort- able thing to talk about. And the longer we wait, the more uncomfortable it gets.” What topics are we think- ing of for this conversation? Things like your preferences if you get sick, whether you have
want to know his or her plans. Carrying around this information on one’s own can be a burden. When is a good time to have this dis- cussion? “It’s never too early,” Logan THIS MATTER CAN APPLY WHETHER YOU ARE THE PERSON GETTING OLDER OR YOU ARE THE CHILD OR SPOUSE OF THAT PERSON.
a living will, plans for after your death, whether you have a safety deposit box and where the box is. Everyone’s conver- sation will be slightly different. HOWTO START You may find it helpful to use this arti- cle as a jumping-off point and say, “I read an article about this, and I hear it’s good for our well-being. Just like we talked about when I (or you) went away to col- lege or got married, can we talk about this transition time?” Another strategy is to ask about whether your loved one has done any planning for himself or
out on a ‘just in case’ basis,” Logan says. “You don’t have to feel like you’re going to need it imminently. Do make sure that your loved ones know where to find your copy when you’re finished.” Logan adds that having the document can reduce the stress of having to think of everything and trying to guess what your loved one would have wanted. “If you’ve ever gone through a situation where you’ve lost someone, or someone was incapacitated in a significant way,” she says, “you’ll understand how impor- tant it is for the people left behind to have some help with their decisions.”
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NAPLES HEALTH APRIL - JUNE 2019
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Ask the Experts
Q :
My physician suspects I have obstructive sleep apnea. Why have I been referred to a sleep lab? Jose Ruben Valle, M.D., NCH Physician Group, Sleep Medicine, answers: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. It can affect a person’s ability to safely perform normal daily activi- ties and can affect long-term health. Approximately 15 to 25 percent of adults are at risk for sleep apnea. Men are more commonly affected than women. The main symptoms of OSA are loud snoring, fatigue and daytime sleepiness. A proper study is key to treating OSA. Testing is usually performed in a sleep laboratory. A full sleep study is called a polysomnography. A polysom- nography measures breathing effort and airflow, oxygen level in your blood, heart rate and rhythm, duration of the various stages of sleep, body position and movement of the arms/legs. Dur- ing the test, you are monitored by a technician and your results are read by a board-certified sleep physician. Home monitoring devices are also available. The devices are an alterna- tive to conventional testing in a sleep laboratory if the clinician strongly sus- pects moderate or severe sleep apnea and the patient does not have other ill- nesses or sleep disorders. You may be referred to a sleep lab instead of a home sleep test if you have underlying medical problems such as asthma, heart failure, COPD and sei- zure disorder.
not have hypertension and/or a cardio- vascular condition. However, current research suggests otherwise. Based on a recent study in The New England Journal of Medi- cine , physicians now think white coat hypertension might signal that you are at risk of developing high blood pres- sure as a long-term condition. You may also have a higher risk of developing certain cardiovascular problems com- pared with people who have normal blood pressure. This study concluded that ambula- tory blood pressure measurements are a stronger predictor of all-cause and cardiovascular mortality than in-office blood pressure measurements are. If you suspect you have white coat hypertension or experience blood pressure fluctuations in other settings, talk to your doctor. You may be asked to wear an ambulatory blood pressure monitor for up to 24 hours to track your blood pressure and determine if you need treatment. Diagnosing and managing blood pressure is key to good cardiovascular health.
APPROXIMATELY 15 TO 25 PERCENT OF ADULTS ARE AT RISK FOR SLEEP APNEA.
What is white coat hypertension? Shona Velamakanni, M.D., FACC,
Cardiologist, NCH Heart Institute, answers: Healthcare professionals who take your blood pressure in a physician’s office often wear white coats. Previ- ously, experts considered that poten- tial stress or anxiety created by a doc- tor’s appointment resulted in a higher blood pressure than would result in a more relaxed environment such as your home. If your blood pressure returned to normal after your doctor’s visit, the assumption was that you did
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of Health-Smart Travels Tips for enjoying your time away and still Joys The
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NAPLES HEALTH APRIL - JUNE 2019
keeping to good dining and exercise plans
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APRIL - JUNE 2019 NAPLES HEALTH
Is it possible to travel, dine out, and still stay on track with your healthy eating and exercise plan? The answer, according to Audrey McKernan of the von Arx Diabetes Center of Excellence, is a resounding “Yes!” The trick is to plan and to use every tool at your disposal. McKernan has many helpful tips, and she shares them with us here.
When Traveling • Try to stay in a house or apart- ment, so you can cook your own meals and are not at the mercy of restaurants or markets. • Try to travel by car if possible, so you can pack your own healthy foods, such as a cooler or lunch salads, fruits and cool water. You can also find healthier eating spots along the route and plan your stops around those spots. • Bring healthy snacks, such as nuts or string cheese, that will tide you over in case your meals are delayed. • Stay away from vending machines and drive-thru windows. • Factor healthy food into your vacation budget. Don’t settle for cheap junk food. Plan to spend a bit more for fresh food, and cut back on other expenses. • If you’re staying with relatives or friends, call ahead and discuss food preferences. Offer to make a supermarket run when you arrive to get the things you and your family like to eat. • Offer to make a lightened-up ver- sion of a family favorite. Remem- ber to keep portions small. • Bring at least one dish that you
know you and your family can eat to a holiday or family party. • If a buffet is your option, survey the whole buffet first and start by filling your plate with salad, fruits and vegetables. • Try to stick to your normal eating schedule. • Don’t skip breakfast or let your- self get too hungry, lest you go off the rails when you do finally eat. • If you’re traveling for business and are given a box lunch, eat the protein, vegetables and fruit and skip the rest. • Try not to conduct business around the dessert table. Move your discussion away from the food to avoid eating mindlessly. • If you’re going on a cruise, call ahead and discuss your dietary requirements with the company. Fitness on the Road You almost always can find ways to get in some movement while traveling. Exercise, too, requires a bit of plan- ning ahead, but you can achieve it. Try these tips. • Choose a hotel with a gym or pool, or rent an Airbnb near walking trails or a park.
Don’t skip breakfast or let yourself get too hungry, lest you go off the rails when you do finally eat.
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NAPLES HEALTH APRIL - JUNE 2019
Named A “ Best Regional Hospital ” by U.S. News & World Report
Named high performing in: • Heart Bypass Surgery • Heart Failure Treatment • Abdominal Aortic Aneurysm Repair • Hip & Knee Replacement • Colon Cancer Surgery • COPD Treatment
NCH Downtown Baker Hospital
-David Axline, MD Interventional Cardiologist Dr. Axline has been putting patients first at NCH since 2005.
NCHmd.org
• Consider renting bikes and riding together. • If you’re traveling on business, wake up an hour early and squeeze in some activity. • Before you travel, check with your gym to see whether it offers reci- procity in areas you’re traveling to. Some gyms offer this service. Dining Out Sometimes when you are on the road, you simply cannot avoid eating out. And even when you stay home, you may have visitors who want to check out the local restaurants. Don’t just throw up your hands and resign yourself to buy- ing a larger clothing size. Here are our best strategies for sticking to a healthy diet even if you’re not the cook. • Ask the waiter not to bring bread and butter.
• Pack your sneakers and a few changes of workout clothes. • Bring lightweight, easy equipment with you, such as a jump rope and exercise bands. • Familiarize yourself with work- outs you can stream on your com- puter, tablet or phone. YouTube has many free workouts of every type—yoga, Pilates, strengthen- ing and stretching workouts, and nearly everything else you can think of. • Use the step tracker on your phone or watch to challenge yourself and your family to get in 10,000 steps each per day. • If you’re stuck in an airport, walk the terminals to get in your activ- ity. • Take the stairs whenever you can. • Plan a sightseeing walking tour with the family.
If you’re having alcohol, stick to red wine or light beer, but be aware of the size of your glass.
Care that comes to you.
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prepared, and avoid dishes with lots of butter or oil. • Drink a glass or two of water before your meal to control your appetite. • If you’re having alcohol, stick to red wine or light beer, but be aware of the size of your glass. Wine glasses in particular have gotten quite large. When You’re Back If, when you get home from your trav- els or say goodbye to your guests, you find that you did get off your healthy
• Portions can be very large. Con- sider splitting an entrée with a friend, or ordering an appetizer as your entrée. • If you’re having a sandwich, con- sider a wrap or an open-faced option. • Choose fish, such as salmon or cod. Choose lean meats, such as pork loin or chicken breast. • Avoid anything fried and instead opt for roasted, grilled or stir- fried. • Order broth-based rather than cream-based soups. • Get dressing and sauces on the side.
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track, don’t despair. Just resume your normal rou- tine as quickly as possible. Get up the next morning and exercise. Stock your house with healthy foods and get rid of the trig- ger foods you may have
• Choose restaurants that cook to order rather than restau- rants that serve buf- fet-style. • Check the menu online before you go
Don’t get discouraged and give up.
so you have some healthier options in mind. That way, if you’re feeling pressured or hungry at the res- taurant, you will be more likely to choose a healthful option. • Ask the waiter how things are
accumulated. Don’t get discouraged and give up. If you fall off the wagon for a few days, the important thing is to get back to your healthy habits the very next day and continue this daily routine.
FA ST F OOD , I F YOU MUST Sometimes no other options exist aside from fast food. Here are some healthier choices there to keep in your back pocket.
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APRIL - JUNE 2019 NAPLES HEALTH
YES,
YOUNGER
PEOPLE
HAVE
STROKES,
TOO
WHAT TO LOOK FOR AS SIGNS OF TROUBLE
22 NAPLES HEALTH APRIL - JUNE 2019
Eddie Denson and his girlfriend, Sarah
LASTAUGUST when Eddie Denson, 43, of Naples, woke up in the middle of the night, it took him a while to understand what was going on. The ICU nurse had experienced a regular day, if you can call working full-time, going to school full-time and performing his clinical hours “regular.” Already an R.N., Eddie had gone back to school to get his A.R.N.P. degree to allow him to become a Nurse Practitioner. That day, he had taken his final exam and was looking forward to boosting his career. “I was feeling a little tired, but being tired was noth- ing new for me,” he laughs. He and his girlfriend had dinner as usual. He told her he wasn’t feeling great, though he couldn’t put his finger on exactly what was wrong. “We went to bed around 10:30 p.m., doing our normal routine, checking our phone, social media,
that kind of thing.” He went to sleep around 11:15 p.m. “Then, out of nowhere, I woke up,” Denson says. “I remember it was 2:02 a.m. My right arm was asleep. I tried to sit up and realized I couldn’t sit up. I tried to move my right leg and couldn’t. That’s when I started to panic, and right away I knew I was hav- ing a stroke.” He continues: “I tried to yell but it was all slurred. My girlfriend finally woke up. I said, ‘I’m having a stroke,’ but she couldn’t understand what I was saying. So she turned the lights on and saw that my face was drooping and then she understood what was happening.” It’s understandable that his girlfriend would take a minute to realize that the situation might be a stroke. Eddie was just 43, exercised regularly and was other- wise a very healthy person. But strokes in younger people do happen, says
23 APRIL - JUNE 2019 NAPLES HEALTH
Dr. Viktoria Totoraitis, Medical Direc- tor of the stroke program at NCH. With younger people, she says, strokes are generally not caused by disease in the blood vessels, usually the culprit in older people. Older people who have strokes often have atrial fibrillation, plaque buildup in the arteries and other vessel-related problems. Many of these problems can be exacerbated by lifestyle factors, such as smoking and high cho- lesterol. In younger stroke patients, life- style factors are generally not to blame. STROKES IN YOUNGER PEOPLE When she sees a stroke in a younger person, Dr. Totoraitis says, the strokes generally are not caused by lifestyle fac- tors like smoking or poor diet. Younger patients may have cardiac anomalies that they were born with. “For example,” she says, “there could be a weakness in one of their blood vessels that has always been there. Or they could be missing a vessel, or a vessel may be too small.” Another possibility she screens for is an autoimmune disorder, such as lupus. She will perform a rheumatologi- cal screen on younger patients to help determine if this factor is at play. Another test she will perform is an echocardiogram (ECG), to check the IN YOUNGER STROKE PAT IENTS , LIFESTYLE FACTORS ARE GENERALLY
NOT TO BLAME .
24 NAPLES HEALTH APRIL - JUNE 2019
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Do you have a problem wound
Dr. Viktoria Totoraitis
health of the heart. “With younger patients, we may do an esophageal ECG,” says Dr. Totoraitis, “to get a bet- ter look at the heart.” With an esopha- geal ECG, the probe snakes down through the esophagus, right next to the heart, meaning it gives a closer and more detailed look at the heart. Doctors will also perform bloodwork on a young stroke patient to look into not only auto- immune disorders but also blood clot- ting abnormalities, and to round out the picture of what is going on medically. As with any disorder, Dr. Totoraitis says, she talks to the patient about his or her family history as well as his or her own medical history. She would want to know if anyone in the family has had an early stroke (or a stroke at all), as genet- ics can play a role, and whether the patient has had any autoimmune disor- ders or a previous transient ischemic attack (TIA, or a temporary blockage of blood flow to the brain). She will also dig into the lifestyle fac- tors such as smoking, diet, exercise and blood pressure, all of which can contrib- ute to an early stroke. WHATTO LOOK FOR So, how do you know if you are at risk for an early stroke? The truth is you can- not know for certain, but you can look for a few things. You can be on the look- out for out-of-control migraine head- aches, says Dr. Totoraitis, to the tune of a few a week. Migraines can slightly increase the risk of stroke. “If you have
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26 NAPLES HEALTH APRIL - JUNE 2019
migraines,” she says, “get them under control.” In addition, she says, have your vascular risk factors monitored and controlled early. “If you have high blood pressure, start monitoring it and stay on top of it.” These days, Eddie Denson is doing just fine. He began his work officially as a nurse practitioner in December, and, he says, “Physically, I feel great.” But his doctors never did nail down exactly what the cause was of his stroke. He did have slightly elevated blood pressure, which could be related. But the truth is, “It came out of nowhere,” he says. Luck- ily, as a nurse, he knew what a stroke looked like and how to get help for him- self. When he got to the hospital that night, he was given a tPA agent, or a “clot buster.” It worked, and he was able to go home after a few days in the hospital, with no lasting damage. While he was in the hospital, his doctors found that he had a patent foramen ovale (PFO), or a small hole in the heart. This condi- tion can possibly contribute to a stroke. His physicians are still not sure of the exact cause for his stroke or if the PFO closure is indicated. Fortunately for Eddie, he won’t have to travel far to have the Amplatzer PFO Occluder device implanted, if necessary. NCH is the only location in Southwest Florida to offer the device and procedure at this time, so he’ll be able to take care of his medical needs close to home. He also takes aspi- rin regularly to avoid blood clots, and he has gone on blood pressure medication and a statin for his cholesterol. He con- tinues to work with his doctors to inves- tigate what happened. In the meantime, he is grateful to be doing well. “I get a lit- tle dizzy and tired from time to time,” he says, “but other than that, I feel great.” Dr. Totoraitis sees a huge benefit in simply being informed that you can have a stroke when you’re younger. And then, her advice is, “Pay attention to any symptoms you might be having, and get screened as soon as something pops up, so we can catch things early and give you as much help as we can.”
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APRIL - JUNE 2019 NAPLES HEALTH
WANT TO PLAY BETTER GOLF?
EXERCISE THAT CAN GET YOU IN SHAPE AND IMPROVE YOUR SWING
PHOTOGRAPHY BY KEVIN BIRES
Golfers are not known for doing a lot of preparation before a day on the course. In fact, some players don’t do any more than call ahead for a tee time. But the truth is, some physi- cal preparation can help you play better and avoid injuries. Golf has a different effect on the body from most other activities. Why? The sport requires rotational movement, for one thing, and also requires movement in only one direc- tion, with one side of your body. So, how best to handle these challenges? We asked two experts: Matthew Brooks, Program Coordinator for NCH’s Whitaker Wellness Cen- ter, and Madeline Marck-Sherk, an intern at the Wellness Center and a member of the Florida Gulf Coast University women’s golf team.
28 NAPLES HEALTH APRIL - JUNE 2019
GETTING IN SHAPE Before you get out on the course, take the time to strengthen your lower body and the muscles of your core, meaning your abdomen, back and sides, including the deep muscles in those areas. Strength in these areas is critical to a good golf game. “Power is generated from the legs, and you transfer that power from the lower body through the core,” Brooks says. “That’s what carries into the swing.” “Many people believe that your game gets its power from the upper body and arms. But it has nothing to do with that,” Marck- Sherk says. “Power comes from the rotational movement from the core and power from the legs.” “That can be where we start to see shoulder injuries,” Brooks adds. “When people try to kill the ball with the upper body.” To avoid injury and improve your game, try these moves. • Russian twist: Sit on the floor,
RUSSIAN TWIST
STANDING TWIST
Matthew Brooks, NCH Whitaker Wellness Cen- ter Program Coordinator, demonstrates three moves to deploy before getting out on the golf course.
holding your feet off the ground. You can hold a weighted ball or a small dumbbell in your hands, or if that additional weight is too much, start with nothing. Rotate the weight or your empty hands to either side of your body, keeping your feet off the ground. Start with 10movements, rest for 10 seconds, and repeat twice. As you get stronger, add more repetitions. • Standing twist: Use a cable machine at the gym or a resis- tance band. Position the machine cable or wrap the band around a pole at shoulder height. With your side toward the machine or pole, pull the cable or band straight across, in line with your shoulder. You will be twisting and strengthen- ing your core and your shoulders. Try 10 on each side. • Palloff press: Again, you can use a cable machine or resis- tance band and pole. The cable or band should be around sternum height, and your feet should be about hip distance apart. Stand with your side toward the machine or pole. With the cable in your hand, press out, then press back in. The point is to use your core muscles to stop yourself from rotating toward the cable. “This stabilizes the shoulders and the core all at once, which is really good for golf,” Marck- Sherk says. Start with 10 reps on each side. • Squats: Stand with your feet slightly wider than your hips. Bend your knees and push your butt back as though you’re sitting in a chair. Keep your knees over your toes and your
PALLOFF PRESS
back straight. Squat down until your hip joint is lower than your knees. Start with two sets of 12 squats. • Standing leg curls: You can do leg curls on a designated machine at the gym, but you can also do the exercise without a machine. Stand with your legs hip-width apart. Bend one knee so the foot is behind you, but keep the knees together. Hands can be on hips, on a chair, or above the head for extra balance training. Flex your foot and lift that leg toward your butt, then return the leg parallel to the floor. Start with two
29 APRIL - JUNE 2019 NAPLES HEALTH
sets of 15 on each side. For added intensity, add an ankle weight. WARM UP BEFORE YOU SWING
Just before you play, be sure to warm up well. The best way to warm up is to make movements similar to the movements you will use in the game. So do some leg swings and arm circles. Circle your hips like you are hula-hooping. Hold your arms out slightly and twist so your arms wrap around you one way and then the other, for a gentle twist. Pick up your smallest club and do a few short half-swings. Work your way up to bigger swings with larger clubs. If you are delayed for a very long time between holes, stay loose with some of these moves. STRETCH AFTERWARD After you finish your round, take a few minutes to stretch those same muscles you used. • Rotation stretch : Put a club across your back and bend your elbows behind the club. With feet shoulder-width apart, rotate to one side until you feel a stretch. Hold for a count of 10 seconds. Repeat on the other side. Repeat both sides two more times.
ROTATION STRETCH
OVERHEAD SIDE-BEND STRETCH
• Overhead side-bend stretch: Hold your club with your hands wider than shoulder width, and lift the club above your head. With feet shoulder-width apart, bend to one side until you feel a side stretch. Hold for 20 seconds. Repeat on the other side. Repeat both sides two more times. • Shoulder and triceps stretch: Hold a club vertical with one hand, with your hand just over shoulder height. With the other hand, grab the club from behind near your waist. Bring your hands as close together as you can and feel the stretch. Hold for 20 seconds each side. Repeat twice.
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SHOULDER AND TRICEPS STRETCH
BACK AND LEG STRETCH
HIP STRETCH
Brooks demonstrates the best stretches
ON YOUR OFF DAYS For some good cross training, you may want to try yoga, Brooks says. Yoga will help improve your overall flexibility, as well as strengthen your hips and legs.
• Back and leg stretch: Stand with feet hip-distance apart and hang over to reach for your feet, shins or knees, wher- ever you can reach. Hold for 30 seconds. Repeat. • Hip stretch: Sit on a chair, at the edge. Cross one ankle over your knee. Feel the stretch in your hip, or put pressure on the thigh of the upper leg to increase intensity of the stretch. Hold for a count of 20. Switch legs and repeat on the other side. Repeat series twice.
to do following your golf game.
“Yoga is also good for the mind, and golf is such a mental sport,” Marck-Sherk says. “If you can clear away your stresses and stay in the moment, it will help your game.”
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APRIL - JUNE 2019 NAPLES HEALTH
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