KHS Health Blog

In the year 2020, we as a community and a world have been exposed to many words and terms that we never realized would affect our lives. Such words as quarantine, isolation, masks, 6-ft distancing, yellow zones, purple zones, red zones and stay at home orders have led to further isolation/alienation from our communities, friends and families.

In the year 2021, as we start this new year we realize that the pandemic or coronavirus is not the only thing that can continue to change our world. Other diseases such as diabetes (10.5% of US population), heart disease (on average someone dies of heart disease every 37 seconds) and stroke (on average someone dies of a stroke every 4 minutes) still remain a constant threat to our livelihood. These diseases have taken a back seat to this pandemic but people are still suffering the consequences of these chronic diseases.

Cardiology is the study of the heart. In the realm of cardiology, there is even a term called Takotsubo Cardiomyopathy which in lay terms means "Broken Heart Syndrome". This is a disease in which the heart becomes so weakened by either severe physical or emotional stress that it is no longer able to function the way it should. The incidence of Takotsubo Cardiomyopathy has increased from 1.8% to 7.8% since the pandemic has started. This is a temporary condition which with correct medications and time can get better. Today, I think that mentally, many of us have suffered from "a broken heart" over this last year

All of these things have made me as a cardiology provider take a step back and really question what does heart mean to me? Does heart refer to only that organ in our body that is the center of our life? Does heart mean a place we live, a person in our life such as our mom or our dad, is it our best friend, our boyfriend, is it a feeling, is it an emotion, is it someone we've lost in the last year or somebody new in our family this year

I am asking that as a community, we share what the meaning of heart is to us. I would like to cover the walls of Kimball Health Services and Pine Bluffs Health Clinic with red hearts that contain what your meaning of heart is. I challenge our schools, our teachers, our businesses, our organizations and the community as a whole to cover the walls of our facilities with these positive, life-affirming meanings of what heart is!

I'd like to walk down the halls Kimball Health Services and the Pine Bluffs Clinic and be able to see the strength, endurance, hope and love that these communities demonstrate each and every day!

COVID-19 is a new disease and there is limited information regarding risk factors for severe disease. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. During these uncertain times there are many rumors via internet and other social medias which are making patients question their current medication regimes.

Patients with cardiovascular disease diagnosed with novel coronavirus (COVID-19) are urged to continue taking their angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) medications as prescribed, according to a statement jointly published by the American Heart Association (AHA), the Heart Failure Society of America (HFSA), and the American College of Cardiology (ACC).

Observations over the past several months have indicated that cardiovascular disease patients are at a higher risk of serious complications and death from COVID-19. The statement was issued in order to “dispel misinformation” on whether patients currently prescribed an ACEi or ARB for indications such as heart failure, hypertension, or ischemic heart disease should continue therapy after being diagnosed with COVID-19.

“Cardiovascular disease patients who are diagnosed with COVID-19 should be fully evaluated before adding or removing any treatments, and any changes to their treatment should be based on the latest scientific evidence and shared-decision making with their physician and healthcare team,” the press announcement stated.

According to the joint statement, there have been no experimental or clinical data to support claims related to benefit or harm related to ACEi or ARB use in COVID-19 patients. The associations urged that modifications to ACEi or ARB treatment should only be made after a full evaluation of the individual patient is completed by a physician. The statement also highlighted the urgency of obtaining additional research in this field in order to provide optimal care for cardiovascular disease patients diagnosed with COVID-19.

Ann Anderson, FNP has focused on the practice of general cardiology for nearly 20 years. She is a board-certified ANCC family nurse practitioner and is a certified cardiac device specialist with the International Board of Heart Rhythm Examinations. Joining the Kimball Health Services team in 2016, Ann sees family practice patients at the Pine Bluffs Health Clinic and offers cardiology clinics at both the Kimball and Pine Bluffs clinics.

When my patients turn 50, I tell them it is time to begin colorectal cancer screening. Many of my patients dislike the idea of “that test.” The idea of a colonoscopy makes many patients uneasy. I think I have heard every excuse in the book why they can’t get screened. Each year, colorectal cancer affects 140,000 people in the United States and more than 50,000 people die of it. It is the second leading cancer killer in the U.S. Colorectal cancer is preventable, if you get screened!

Colorectal cancer is a type of cancer that occurs in the colon or rectum. Abnormal growths, called polyps, can develop in the colon and rectum and can become cancerous. Screen tests such as a colonoscopy can find and remove these polyps before they turn into cancer. During a colonoscopy, a long, thin, flexible, lighted tube is inserted through the rectum and is used to check the rectum and colon. Most polyps and some cancers can be found and removed during the procedure.

For most of my patients, screening for colorectal cancer should begin when they turn 50 and be repeated every 10 years. Screening should begin early and should be repeated more frequently if they are at increased risk for colorectal cancer. Talk with your doctor to determine if you are a candidate for early screening.

March is Colorectal Cancer Awareness Month, a time to remind everyone of the importance of getting screened. Here are some additional facts on Colorectal Cancer Screening from the CDC.

• If you are age 50 to 75 years old, you should get screened for colorectal cancer.
• The U.S. Preventative Services Task Force recommends screening beginning at age 50. Some groups, including the American Cancer Society recommend starting earlier, at age 45.
• The vast majority of new cases of colorectal cancer (about 90%) occur in people who are 50 or older.
• Millions of people in the United States are not getting screened as recommended. They are missing the chance to prevent colorectal cancer or find it early, when treatment often leads to a cure.
• If you think you may be at increased risk for colorectal cancer, learn your family health history and ask your doctor if you should begin screening before age 50.

Source – www.cdc.gov/cancer/colorectal/basic_info/screening/

Dr. Broomfield has been practicing medicine in rural settings for over 25 years. Like the country doctors before him, Dr. Broomfield is committed to providing quality family health care to his patients, no matter where they are. He even makes the occasional house call. Board-certified in family medicine, he joined the Kimball Health Services medical staff as our medical director and chief of staff in September, 2013. He sees patients in the Kimball Health Services Clinic and Pine Bluffs Health Clinic. He also offers a skin care specialty clinic at each facility twice a month.

Heart failure is a chronic, progressive condition that starts slowly and gets worse over time. Many people don’t realize they are experiencing heart failure because the symptoms can be similar to normal aging. Heart failure is the result of the heart’s muscle gradually losing the ability to pump enough blood to supply the body’s needs. This can happen for a variety of reasons including injury to the heart muscle from a heart attack or high blood pressure. Generally, the heart either becomes weak and unable to pump blood or it may become stiff and unable to fill with blood. Both conditions ultimately lead to retention of extra fluid which is referred to as congestion. This is why a person’s experiencing the symptoms of heart failure are referred to as having congestive heart failure.

How Common is Heart Failure?

Heart failure is a growing problem in the United States. It is estimated that there are nearly 6.5 million Americans over the age of 20 who are dealing with heart failure. A major killer, heart failure can directly account for about 8.5% of all heart disease deaths in the United States and is a contributor in about 36% of all cardiovascular disease deaths.

Risk Factors

Having read thus far, you may be asking yourself, am I at risk for heart failure? Heart failure can occur at any age, but most people are at a greater risk as they get older.

Here are some other risk factors to be aware of:

• High blood pressure
• coronary artery disease
• Heart attack
• Damage to the heart valves of history of a heart murmur
• Enlarged heart
• Congenital heart disease
• Family history of enlarged heart
• Diabetes
• Obesity
• Sleep apnea
• Severe lung disease

Symptoms

The symptoms of heart failure are often dismissed as part of the normal aging process. Extra fluid or congestion is the primary factor in the symptoms of heart failure. Symptoms can occur over a period of time or they may all occur at once.

• Shortness of breath with simple activities
• Trouble breathing when resting or lying down
• Waking up breathless at night
• Needing more than two pillows to sleep
• Tiring easy
• Frequent coughing
• Coughing that produces a pink or bloody mucus
• Dry, hacking cough when lying flat in bed
• Swelling of feet, ankles or legs
• Increased need to urinate at night
• Swelling of the abdomen
• Lack of appetite and nausea
• Fatigue
• Cold legs and arms
• Difficulty concentrating

Diagnosis

Heart failure is diagnosed by your healthcare provider based on your signs and symptoms, a physical examination and through special tests designed to measure heart function. Your provider may order an echocardiogram, or “echo”, which is an ultrasound of the heart to measure ejection fraction, the thickness of the heart wall and the flow of blood through your heart valves.

Treatment

If heart failure is detected and treated early, you can continue to live an active lifestyle. Your healthcare provider will work with you to determine your best course of treatments. Treatments can include medication, devices and lifestyle changes such as quitting smoking, changing your diet and increasing exercise.

Living with Heart Failure

Heart failure is a very serious and life-changing disease, but with appropriate management and lifestyle changes, you can maintain quality of life for a long period of time. The key is to educate yourself on your condition. Knowledge is power! It is also important for you to meet regularly with your healthcare provider, take your medications as directed, adhere to dietary recommendations and exercise as directed. Finally, you will weigh yourself daily. Large changes in weight may be an indication that you may need to adjust your treatment plan. Following these step and the advice of your healthcare provider gives you the best chance possible to stay one step ahead of heart failure.

Ann has been caring for heart failure patients since starting in cardiology in 2001, assisting patients with diagnosis and treatment in both outpatient, inpatient and infusion clinic settings. Ann was also a co-author of a book chapter on heart failure and has spoken nationally on this topic to other healthcare providers and patients. Ann offers cardiology clinics at both the Kimball and Pine Bluffs clinics.