Cholesterol – What is it and Why is it Important?

Posted on by Michael Chananie

A recent U.S. study that followed 36,375 adults over the course of 27 years has yielded new findings that may affect the treatment of low-risk cardiovascular patients.

None of the individuals in the study had a history of heart disease or diabetes, and all had a low 10-year risk for events such as heart attack or stroke. Most had levels of what we call “bad” cholesterol that would not be considered significant enough to warrant a prescription for a cholesterol-lowering medication such as a statin.

Over the course of 27 years, 1,086 of those in the study died of cardiovascular disease, and 598 died of coronary heart disease.

What does this mean exactly? It means that there is a segment of the population whose cholesterol levels do not qualify them for a statin prescription, but whose moderate levels of “bad” cholesterol will result in cardiac death all the same.

You may wonder why a moderate cholesterol problem couldn’t be solved through diet and exercise. Unfortunately, while diet and exercise can help mitigate cholesterol issues for many people, some people have a genetic predisposition to high cholesterol.

“You can always minimize the effects of your genetics through diet and exercise. But for some people, no matter how meticulous they are with their diet, and no matter how much time they spend in the gym, their cholesterol levels are going to be problematic,” says Christopher Di Giorgio, MD, board-certified cardiologist in the Englewood Health Physician Network.

Cholesterol management is a complicated and often misunderstood aspect of human biology. According to Dr. Di Giorgio, a common misconception is that having cholesterol in your system—at any level—is bad for you, when in reality cholesterol serves an important purpose. It is responsible for keeping the blood moving smoothly.

“Just as your car needs oil,” says Dr. Di Giorgio, “your heart and blood vessels need cholesterol. Problems arise when the components of your cholesterol are not present in the right quantity and quality.”

Cholesterol is transported through the blood attached to complex particles called lipoproteins. There are two main types of lipoprotein: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). When you hear doctors refer to “good” cholesterol, they mean HDL; when they refer to “bad” cholesterol, they mean LDL.

Keeping cholesterol levels healthy means keeping the “good” (HDL) cholesterol levels high and the “bad” (LDL) cholesterol levels low.

The function, and malfunction, of cholesterol in the body is the subject of much ongoing research—especially as there is still no consensus on what exactly makes cholesterol “good” or “bad” for you.

“A person’s cholesterol is the result of a combination of genetic factors (which are non-modifiable) and dietary factors (which are modifiable),” says Dr. Dr. Giorgio. “Dietary recommendations depend on the type of cholesterol. For high triglycerides (a type of fat found in the blood), for example, the recommendation is low carbs (and brown carbs, such as whole wheat products, are better) and minimal refined sugars. For high LDL, the recommendation is to reduce foods high in saturated fats.”

The information gathered during this study doesn’t answer the question: For whom are statins appropriate? We know for certain they are appropriate for patients whose cholesterol levels pose a clear and present danger to their health. But what about those whose levels pose a clear but perhaps distant danger to their health?

Studies such as this one are important because they ask whether there are better and more efficient ways to serve patients over their lifetime, and they acknowledge that our understanding of biology is constantly evolving.

Posted September 2018

Ask the Doctor: Dr. Dennis Katechis

Posted on by Michael Chananie

What is the difference between good and bad cholesterol, and what dietary choices can we make to make sure we have more good cholesterol than bad?

Dr. Katechis: Bad cholesterol, or LDL (low-density lipoprotein), contributes to the formation of plaque in the body’s arteries—not just the coronary arteries, but also the arteries that bring blood to the legs, arms, brain, and rest of the body. Good cholesterol, or HDL (high-density lipoprotein), is responsible for bringing the bad cholesterol back into the liver to be metabolized. The amount of bad cholesterol produced in the liver, and how well the liver metabolizes it, is to some extent determined by genetic makeup—but a healthy lifestyle and a diet low in saturated fat will help the process run more efficiently.

If your cholesterol levels are off, will you experience any physical symptoms?

Dr. Katechis: No, and that’s one of the most important things for patients to understand and appreciate. The same applies to high blood pressure, another risk factor for heart disease. High cholesterol causes zero symptoms until changes have already taken place inside the arteries. This is why it is important to have your cholesterol checked once a year.

Truth or myth: Young people don’t have to worry about their cholesterol.

Dr. Katechis: Myth. It’s important for young people to schedule an early visit to their primary care physician, who will not only give blood tests, but look at other potential risk factors that determine risk profile, such as family history, diabetes, smoking, obesity, and high blood pressure. If some of those factors are added to the profile of a young person who already has high cholesterol, that person may be a candidate for cholesterol-lowering therapy at a young age.

Posted September 2018

Ask the Doctor: Dr. Mahesh Bikkina

Posted on by Michael Chananie

September is National Cholesterol Education Month—a good time for those of us who are concerned about our heart health to make sure we’re doing everything we can to support healthy arteries, control our cholesterol levels, and cultivate a healthy lifestyle.

What is cholesterol, and why should you be concerned about it?

Dr. Bikkina: Cholesterol, a form of fat produced predominantly by the liver, affects the blood and circulatory system throughout the body. When certain types of cholesterol levels are high, the blood vessels can incur damage, and damaged or blocked blood vessels can cause heart attacks and strokes. At normal levels, cholesterol is essential for normal cellular function, particularly certain hormones.

Is all cholesterol bad for you?

Dr. Bikkina: No. LDL (low-density lipoprotein), or “bad” cholesterol, causes plaque to form in the body’s arteries. HDL (high-density lipoprotein), or “good” cholesterol, helps to keep the effects of bad cholesterol under control.

To what extent are our cholesterol levels a result of our lifestyle, and to what extent a result of genetic predisposition?

Dr. Bikkina: Genetic makeup is one of the main factors in cholesterol health. Whether your liver produces more or less cholesterol, and how efficiently cholesterol is broken down in your body, depends upon your genetics. That said, the lifestyle aspect of cholesterol control should not be ignored. Avoiding certain types of fatty foods and carbohydrates, working out regularly, and supporting your overall health also affect cholesterol levels.

Truth or Myth: A low-fat diet is the best way to regulate cholesterol levels.

Dr. Bikkina: Myth. It is actually less about a low-fat diet and more about choosing the right kinds of fat. Perhaps the most common misconception about cholesterol is that the optimal diet is a low-fat, high-carb one, when in fact, not all fats are bad for you. Unsaturated fats, found in foods such as avocados, fish, olives, nuts, and seeds are shown to help lower the risk of heart disease and stabilize blood sugar levels.

Posted September 2018

The Future of Precision Medicine

Posted on by Michael Chananie

You can match a blood transfusion to a blood type… What if matching a cancer cure to our genetic code was just as easy, just as standard?” asked President Barack Obama, addressing a crowd of health representatives in the East Wing of the White House, in January 2015.

Precision medicine is a new approach to disease prevention and treatment that takes into account a patient’s genes, environment and lifestyle, and customizes medical decisions based on that information. This is a departure from traditional medicine, wherein medical decisions were made for patients based on the typical characteristics of the disease they have, rather than their bodies’ unique characteristics in relation to that disease.

Dr. Steven Brower is the medical director of The Lefcourt Family Cancer Treatment and Wellness Center, as well as chief of surgical oncology at Englewood Health.

“Everything used to be about treatment,” he said. “You would make the diagnosis and then hopefully deliver the most appropriate surgery, radiation or chemotherapy. But it was a therapy based on a tumor type, not so much an individual patient’s tumor.”

Dr. Brower explained that what has changed is the foundational questions doctors ask themselves when faced with making decisions for their cancer patients. “The questions were once: what is best for all breast cancer patients? What is best for all lung cancer patients? Well today, precision medicine is just about that patient, that particular tumor, at that moment in time,” Dr. Brower said.

Instead of using what Dr. Brower refers to as “a shotgun approach” to all tumors, doctors are now studying cellular and molecular characteristics and genes in order to provide customized treatment to their patients. Removing the generalizations means that doctors will only embark upon treatment that is appropriate for their patients, potentially eliminating needless surgeries, invasive tests and wasted efforts.

Advancements in diagnostic technology play a major role in pushing forward the mission of precision medicine. The invention of the MRI/ultrasound fusion biopsy has revolutionized the process of detecting prostate cancer and strategizing treatment. Determining whether a prostate cancer patient is high or low risk is crucially important because the treatments for prostate cancer can range anywhere from surveillance of the cancer, to surgery or radiation treatment.

“In the past it was pretty much a blind biopsy. Now, this new MRI/ultrasound fusion biopsy more accurately determines whether a patient has high-risk prostate cancer or low-risk. And by making this determination, physicians can better inform patients about their treatment options,” Dr. Brower said.

Each week at Englewood Hospital an elite group of medical professionals gather in a kind of round-table setting. At the table sits experts in medical, surgical and radiation oncology, as well as experts in genetics, survivorship and pain management. Specialists in all types of cancer are present to discuss thoroughly the best and most precise options for new patients.

“It’s like the patient is getting an opinion, not from one doctor, but from 20 different people. We consider the various new targets that have been introduced so that precision medicine is considered for each patient,” Dr. Brower said.

Precision medicine teaches us that information is power. Dr. Brower and his colleagues at Englewood Hospital arm their patients with information that will empower them to become active participants in their own medical decision-making.

“It used to be that all the information patients got about a disease came from doctors—that’s very old school. Today, there are thousands of advocacy groups out there for patients with cancer that are extraordinarily encyclopedic in their knowledge,” Dr. Brower said.

Dr. Brower urges his patients’ to pursue advocacy groups to connect with other patients who have been treated for similar kinds of cancer. These connections allow patients to trade information and feel more secure in the recommendations given to them by their personal doctors. Patients can access the National Cancer Institute and American Cancer Society websites to begin this process.

Posted September 2018

Discussing Medical Ethics

Posted on by Michael Chananie

You may not know the members of the Medical Ethics Committee at Englewood Hospital—perhaps you’ll never need to. Yet it is important to understand the significant role they play in our community, each and every day. Jeffrey Matican, MD, co-chair of the committee, sheds light on this devoted and essential team.

 What is medical ethics?

Bioethical dilemmas, which usually arise when patients are doing poorly, can be difficult for physicians and families alike. Sometimes there is conflict or confusion among family members. The Medical Ethics Committee may get involved to help family members and the medical team work toward a common goal or treatment plan.

An example is the management of medical devices at the end of life. Advanced heart failure patients with implanted devices such as pacemakers and defibrillators can present an ethical dilemma. As the patient declines, at what point do the patient, family, and physicians decide to turn off the device and let nature take its course? Dealing with such situations can be very emotional and challenging for patients and families. The committee is there to help.

Families also frequently need help in weighing the benefits and burdens of artificial nutrition, as in cases of dementia patients who have feeding tubes. The Medical Ethics Committee might facilitate a discussion with the patient and family on the appropriateness of various options, and help families work through these challenges.

 What is the central role of the Medical Ethics Committee in the hospital?

In my view, medical ethics is the basis of medicine, and guided by three principles: respect for the patient, fostering communication, and finding common ground. It’s about respect for people’s autonomy, and it’s about communication.

Medical Ethics Committee

The Medical Ethics Committee is composed of physicians, nurses, clergy, social workers, and a member of the community. It meets monthly and provides consultations throughout the hospital, as needed.

The committee has three main responsibilities. First, medical policy formulation, which pertains to clinical policies, such as “do not resuscitate” (DNR) orders, declaration of brain death, and withdrawal of care, as well as administrative policies related to organizational ethics, such as vendor relationships and HIPAA. Second, educating hospital staff (doctors, nurses, and ancillary staff) and the community on topics such as advanced directives and health care proxies. Finally, providing families, physicians, and nurses with consultations on ethical dilemmas.

The committee also assists in mediating medical dilemmas. Sometimes, for example, there may be different perspectives involving the patient themselves, their family, and the medical team who are focused on what’s medically and personally in the best interest of the patient’s quality of life. The prevailing principle is that patients who have the capacity to make decisions have the right to self-determination. It’s their decision, and the committee supports them.

Teaching medical residents

Once a week, medical residents shadow me in my cardiology practice, to see firsthand what a physician’s office is like and to observe my relationships with patients who have been under my care for 10, 15, 25 years. This is unlike the episodic care that residents experience in the hospital setting. I want the residents to know how to be a doctor in the broadest and deepest sense.

During this time, I try to impart these three pillars of the patient–physician relationship: respect the patient, listen to the patient, and emphasize that communication is the most important part of the relationship.

I explain to our medical residents, “You are not going to learn everything you need to know during residency, or even in four or five years. Learn how to learn; keep an open mind; learn from your colleagues and patients. It’s about lifelong learning. This is what it really means to be a doctor.”

Posted September 2018

New Program Director of Urologic Oncology Shares Thoughts on the Future of Urology

Posted on by Michael Chananie

Maz Ganat, MD, recently joined the cancer team at Englewood Health. As the program director of urologic oncology at The Lefcourt Family Cancer Treatment and Wellness Center, he intends to bring fresh eyes to a field that is in the midst of dramatic scientific and technological progress. Prior to coming to Englewood, Dr. Ganat completed a fellowship at Memorial Sloan Kettering Cancer Center.

What drew you to the field of urology?

I chose urology as my specialty in my third year of medical school. It’s a small field – people don’t usually know what it entails.

When I discovered it in my rotation, I was surprised to learn that urology is such a balanced mix of medicine, surgery, and technology. I get to do clinical procedures, prescribe medicine that really helps patients, and be in the operating room doing open, endoscopic, and robotic surgery. I found that mix worked well for me.

What’s new in the field of urology?

Over the past two or three decades, increased knowledge and technological advancements have allowed for improved detection of prostate cancer and a decrease in overtreatment.

A major addition to the field is the multiparametric MRI, which led to the creation of the MRI fusion ultrasound biopsy technology.

And what exactly is the MRI fusion ultrasound biopsy?

The conventional systematic biopsy uses ultrasound to take 12-14 random biopsies of the prostate. With fusion-guided biopsy, patients first go in for an MRI. The radiologist reads the MRI, noting any suspicious lesions. Then when the patient comes in for the biopsy, we superimpose the marked-up MRI image onto the real-time ultrasound image. That way, we can precisely target the areas of highest interest. We typically need to take only three or four samples of the prostate this way.

We still often do the traditional, systematic biopsy, but MRI fusion considerably improves our ability to home in on significant prostate cancer.

What does the advent of the MRI fusion biopsy mean for patients?

The ultimate goal of this technology is to decrease over-diagnoses – meaning, ideally, we want to pick up only those cancers that are significant and require treatment. We’re not there yet, but that is certainly the goal with this technique.

Our hope is that, eventually, the MRI fusion biopsy will help eliminate unnecessary invasive tests and surgeries, as well as allow us to provide patients with more complete and more accurate information on their options.

Besides prostate cancer, what kinds of issues do you treat in your practice?

The field of urology is broad. In terms of urologic oncology, the top diagnoses we treat – other than prostate cancer – are bladder cancer and kidney cancer.

In general urology, we deal with problems like kidney stones and bloody urine. Some urologists focus on, and treat, female sexual dysfunction.

Though my main focus is urologic oncology I also practice general urology. I treat a lot of cases of kidney stones, which are very common – and the incidence continues to rise.

What excites you about the future of urology?

In urologic oncology, as in all branches of oncology, we’re seeing a push toward genetic testing. Genomic analysis is the future of the field. In some cancer cases, we’re focusing on immunotherapy.

Both of these fall under the category of precision medicine. They represent efforts to find the right treatment for the particular patient, rather than use a standard treatment that may not work.

In terms of technology, robotic surgery has been established for more than a decade now – especially in prostate cancer. More than 90 percent of prostate surgeries are now done robotically. This is one of my main focuses at Englewood Health.

What do you want people to know about your work at Englewood Health?

I want to emphasize to patients that if they seek treatment for a urologic issue at Englewood Health, we will discuss all of their options and draw on the latest technologies and methods, when appropriate. We want to help patients make the choices that will best serve their health.

For us, the doctor-patient relationship comes first. With all the advancements that are happening in the field, what we will continue to emphasize is open dialogue and the availability of accurate and helpful information for our patients.

Posted September 2018; Updated January 22, 2020

Transitioning Your Teen From Their Pediatrician to an Internal Medicine Specialist

Posted on by Michael Chananie

Irina Tartakovsky, MD, is an internal medicine specialist with Englewood Health who has been in practice for more than 25 years.

Transitioning your teenager from pediatrician to internist

Around the age of 16—sometimes earlier, sometimes later—most kids start to feel out of place in the pediatrician’s office. As an internist, I take care of young adults age 18 and over. By that age, most feel that they’d like to talk to a doctor one on one, rather than with a parent in the exam room. I leave it up to patients whether they want their parent with them or not; whatever they are comfortable with.

Heading off to college is a big transition, and I like to make it an opportunity to educate my young patients. One of the most important subjects is drugs and alcohol. I try to raise the issue without intimidating them, so they feel comfortable enough to open up and ask questions or express concerns. As they transition into adulthood, they appreciate having someone they can confide in, someone who will address their concerns without preaching.

How can all patients help their doctor take better care of them?

Before you go to an appointment, write down your concerns and questions in order of priority. That way, we can deal with the most important things first.

If something worrisome comes up, don’t wait. Let’s diagnose it, treat it, and deal with it. When patients wait too long before seeking medical help, what started as a simple issue can become more complex and difficult to treat, and the consequences can be more serious.

Why is it important to find a doctor with whom you feel really comfortable and can have an open conversation?

It’s all about the continuity of care. Over time, if you stay with a physician, the continuity of care is what drives that relationship; it takes time to develop trust. The key is that you feel comfortable asking for help and that you have access to the doctor.

Internal medicine is about engaging everyone in a holistic way. The internist is the one who puts it all together for you. We aren’t dealing just with labs and test results; we are dealing with human beings. I try to engage my patients in preventive care, to have them get involved and be their own advocates. This is especially important for patients with chronic conditions, such as hypertension, diabetes, and high cholesterol. I recommend that they be consistent with their follow-up and participate in managing their condition. It’s a long-term commitment to your health—to your life.

Your background brings something special to the care of patients. What made you want to be a doctor?

My family came to the U.S. from Odessa, Ukraine, when I was just under 12 years old, and we settled in Forest Hills, Queens. When I was 12 or 13, my family befriended a physician who helped me to explore the world of medicine. I loved math and science. It was the combination of these things that made me want to be a doctor. From that time forward, I never even thought of doing anything else. Everything I did was always toward that goal of medicine. You know it in the depths of your soul.

What do you consider to be one of the greatest joys of being a physician and an internist, specifically?

My relationships with patients. As an internist, you get to know people on a very deep level. It’s not just their physical health—it’s their emotional health, as well. People open up and say, “I haven’t told anyone about this before.” It shows they are really comfortable and feel they can confide in me as their physician. I have a great appreciation for that, and I never take it for granted. It is very special to me.

Posted September 2018

High-tech Innovations That Are Advancing Radiation Therapy for Treating Cancer

Posted on by Michael Chananie

“Our treatment of patients has really advanced just in the last five years with newer, more accurate technology,” shares Dr. David Dubin, chief of radiation oncology at The Lefcourt Family Cancer Treatment and Wellness Center at Englewood Health. “With more sophisticated radiation technology and advanced imaging capabilities, we now can provide treatments that are easier on the patient and even more effective.”

Dr. Dubin explains how these advancements are expanding medicine’s ability to treat more challenging tumors in lung, prostate, and breast cancers.

Stereotactic Body Radiation Therapy (SBRT)

Our goal is to treat a tumor with minimal healthy tissue exposed to radiation. The challenge is that, outside of the brain (which can be immobilized), parts of the body are moving all the time. For example, the lungs are not static. They move up and down, forward and back. It is a challenge to minimize the amount of damage to healthy tissue. We need to know at any point in time, where the tumor is in that moment. It takes a lot of technology. As part of treatment planning, a 4-dimension CT scan is taken so that every location can be identified during treatment. A lot of work goes into the treatment planning, with the help of two radiation therapy physicists.

Lung Cancer

In lung cancer, radiation therapy is used to treat very localized, small tumors that have not spread and can easily be seen on a CT scan, and for patients who are not candidates for surgery due to prior lung surgeries, who have more advanced disease or advanced age. With SBRT, the side effects and complications are generally less than surgery and the results are excellent.

For SBRT we have several options. Either we suppress diaphragmatic motion by compressing the abdomen. If that is uncomfortable or unsuccessful, we utilize “gating,” in which the machine is turned on only during part of the breathing cycle, when the tumor is in the proper location. This avoids treating normal, unaffected lung. We also utilize makers placed by our pulmonologists near the tumor, which can be imaged in real time and compared to a computer model. This assures proper delivery of the radiation. The most common protocol for SBRT for lung cancer is three treatments, one week apart. SBRT has a 90-percent cure rate for very small lung cancers—it’s a real advance.

Prostate Cancer

In men, the prostate sits just against the wall of the rectum. The rectum can move a lot, with digestion, gas, stool, etc. When treating prostate cancer with radiation therapy, we place tiny metallic markers, or “beacons,” into the prostate that can be identified on a CT scan, and then during real-time treatment using radiofrequency. The technological intelligence of our systems allows a tumor to be targeted, like GPS, so that higher-dose, more accurate treatments can be delivered.

To minimize side effects, Dr. Dubin injects a bio gel in the space between the prostate and the rectum prior to treatment, which moves the rectal wall away from the prostate and protects the rectum during treatment. With SBRT, Englewood Health can treat prostate cancer in five every-other-day sessions. The standard treatment would be 8–9 weeks of daily treatment.

Intensity Modulated Radiation Therapy (IMRT) combined with Deep Inspiration Breath Hold (DIBH) for treating Breast Cancer

To treat breast cancer, Englewood Hospital’s radiation therapy team uses prone breast positioning, whereby the patient lies on her stomach and the breast hangs into a well, falling away from the body, to protect the heart and lungs.

For patients who need to be treated lying on their backs, the team practices Deep Inspiration Breath Hold (DIBH), during which the patient holds her breath briefly, on cue. By expanding the lungs, the heart is pushed down and back, further away from the area that is being radiated. This requires an advanced digital camera system to identify exactly where the body is at any point. Englewood Hospital is one of the only facilities using this new system, which ensures more accuracy and less healthy tissue

Posted September 2018

Teaching the Next Generation of Physicians and Scientists at Englewood Health

Posted on by Michael Chananie

This article was published in September 2018, nearly two years prior to the death of Dr. Dardik in May 2000.

On most afternoons, Herbert Dardik, MD, can be found in his office at Englewood Hospital, hosting a discussion with a group of students—some days surgery residents, other days high school students.

Dr. Dardik, chief emeritus of vascular surgery and general surgery, performed vascular surgery for more than 57 years. Now 82, he’s retired from the operating room, but still keeps office hours, works in the vascular research lab, and continues to teach vascular surgeons, surgery residents, and aspiring medical students.

A Founding Father of Vascular Surgery

Dr. Dardik, widely recognized as a founding father of vascular surgery, was recently presented with a Lifetime Achievement Award from the Society for Vascular Surgery—the first surgeon from a community hospital to receive this prestigious award. In fact, he has received two lifetime achievement awards; the other is from the Society for Clinical Vascular Surgery.

“They recognized that I was doing academic work right here in the community at Englewood. Our work showed that research could be done in a community hospital, and these organizations began to ask, why can’t others do it? Today, many other community-based physicians are doing research.”

Vascular Surgery Training Program at Englewood Hospital and Medical Center—for Nearly 40 Years

When founded by Dr. Dardik in 1978, the vascular surgery fellowship (specialty training) was only the eighth such program in the nation. The hospital also trains general surgeons and internal medicine residents. Over the years, Englewood Health has trained more than 50 vascular surgeons, as well as dozens of general surgeons and countless general practitioners.

Vascular Research Lab at Englewood—Celebrating 30 Years

Englewood Health’s Vascular Research Lab allows surgery residents to conduct research and publish as part of their training. All of this has helped to make Englewood a leader in vascular surgery in the New York metropolitan area. “I say to surgeons, don’t throw away the books. There is a lot of joy in keeping the data and maybe even reporting on it.”

High School Shadow Program Inspiring Students for More Than 20 Years

“One of my biggest passions is high school students. At Englewood, since 1996 we’ve had a shadow program, where 10 high school seniors come for a full day every week and rotate out to different areas and specialties. They are exposed to all aspects of how a hospital works—right down to how the instruments are sterilized. By the end of the school year, they have seen the entire hospital. Many of them go on to careers in healthcare. On other afternoons, two groups of eleventh graders get a chance to learn about science. They learn research, safety, and how to deal with scientific challenges. These  students have no idea what medical research is like. They might like it!”

Did you always want to be a doctor?

“Actually, I wanted to be a pianist. When I was told I had no talent I had to find something else. I went to college in the Bronx with a lot of other great students and got caught up in the competition. All of a sudden, I was in medical school! I didn’t want to be a surgeon, didn’t think I’d be a vascular surgeon. And I would do it all again! I tell the high school students we mentor, you may be ready to make up your mind, but be open to new possibilities. It’s so important.”

 

New Tools for Treating Heart Disease

Posted on by Michael Chananie

Advancements in Technology Help Patients Avoid Heart Surgery

Several new advancements in technology used to treat heart disease can potentially help people with heart disease avoid open heart surgery. Dr. Aron Schwarcz, an interventional cardiologist with Englewood Health, explains two of these new tools used in Englewood Hospital’s Cardiac Catheterization Lab.

What is a CTO?

A chronic total occlusion (CTO) occurs when a coronary artery (a vessel supplying blood to your heart) is completely blocked for more than three months. “There are many people living with chest pain and with other symptoms, such as shortness of breath or general fatigue, for which the source may be a chronic total occlusion of an artery, but it may go undetected,” says Dr. Schwarcz. “There is a large population of people not getting adequately treated.”

Dr. Schwarcz co-led the development of the Chronic Total Occlusion (CTO) program at Englewood Health, the only one of its kind in northern New Jersey. Now in its third year, the CTO program has a 90-percent success rate and, with the new technology, doctors are able to treat even more complex cases.

Who is the typical patient qualifying for the CTO program?

“Patients who have symptoms and a diagnostic catheterization, or angiogram, showing a CTO, but heart muscle in the area still functioning,” may be eligible for the CTO program, shares Dr. Schwarcz.  “If that is their only blockage; or if they are not a candidate for cardiac surgery, for example because of health, age, or previous cardiac surgery; or if they are looking for alternatives to open heart surgery, CTO treatment may be an option.”

How is CTO treated?

The procedure is performed in the cardiac catheterization lab similar to other coronary interventions, where a catheter is placed into the artery of the leg or arm and advanced to the heart. “With new technology we can either go through the blockage or around it using the vessel wall, or go through the nearby collateral vessels in the heart and backward through the blockage,” explains Dr. Schwarcz. “Then we open the artery with a balloon angioplasty and place a stent.”

What if I’ve previously attempted treatment for a CTO in the past and it failed?

“Even if there has been a previous attempt at fixing a CTO which wasn’t successful, it is still possible that, with the new technology, it can be successful now,” asserts Dr. Schwarcz. “It’s worth an evaluation,” he adds.

What other new innovations are being used in the Cath Lab?

The Impella® heart pump is a device that supports the heart’s function during procedures, and allows Englewood Hospital’s interventional cardiologists to perform more complex procedures in a safe and efficient manner. “Like other procedures performed in the Cath Lab, the Impella is inserted into the artery in the leg using a tiny puncture. It is then advanced with wires into the main pumping chamber of the heart,” says Dr. Schwarcz. “It helps support the heart’s pumping function.”

Why is the new technology important in CTO treatment?

“We can now perform interventional cardiology procedures for patients who, in the past, would have been assessed as poor or high-risk candidates for a procedure, especially those with very poor heart muscle function. For example, patients considered high-risk surgical candidates or evaluated as too high-risk for surgery, we can now treat with stenting procedures. It gives us another alternative to surgery,” explains Dr. Schwarcz. “Also, for people who come to the hospital with heart attacks and super low blood pressure, we can improve survival by placing an Impella. Patients who are in cardiogenic shock (for example, from a severe heart attack) can be treated in a safe manner, where in the past there might not have been an option for them. This is especially important for patients who are too sick for cardiac surgery. We now have more treatment options for saving a person’s life.”

Doctor’s Orders? Unwind.

Dr. Schwarcz emphasizes the importance of taking time to relax. “It’s always important to occasionally disconnect. Give yourself time to unwind at the end of the day. Listen to music, read a book, or do whatever works for you to unwind.” As for Dr. Schwarcz, he enjoys lingering over a Sunday breakfast with his family and playing basketball outside with his kids. Dr. Schwarcz recommends spending time with family. “Reconnecting with family and friends can be very important.”

Posted September 2018