Beyond the Byline: Who really did steal the kishka? – Wilkes Barre Times-Leader

December 31, 2019

Over the last two weeks, weve discussed both arrhythmia in general and its most common form, atrial fibrillation, or A-fib. In doing so, weve laid the groundwork to discuss the wide spectrum of options available to treat this irregular heartbeat.

Affecting between 2.7 and 6.1 million Americans, A-fib doesnt always present severe symptoms, but it does always increase risk of stoke and heart failure. So, treatment is necessary, and that treatment is focused on achieving a healthy heart rhythm and rate and preventing stroke-causing blood clots and heart failure.

Treatment begins with identifying and managing any inciting issues, improving overall wellness and then starting appropriate medications. The majority of people living with A-fib can manage their condition this way, by altering their lifestyles and using medicines to regulate their arrhythmia and avoid its potential complications.

Traditionally, heart rate has been controlled by medications like beta blockers that slow the heart rate, and clotting has been addressed using blood thinners such as warfarin (Coumadin) or other, newer oral anticoagulants.

New A-fib treatment guidelines published by the American Heart Association in January indicate that these novel oral anticoagulants, also known as non-vitamin K anticoagulants and NAOCs, are the recommended medical intervention to prevent stroke over the traditionally championed warfarin, except in patients with artificial heart valves or moderate-to-severe narrowing of the mitral valve. The NAOC class includes dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa.) Hows that for a mouthful!

NAOCs are the new standard, because there is evidence that they present less of a risk of severe bleeding and may be more effective in preventing clots than warfarin. Also, unlike warfarin, there is no need for constant testing to make sure there is enough of the drug in a patients bloodstream.

The guidelines also indicate that weight loss for overweight or obese patients lowers blood pressure, reduces risks associated with A-fib and can even reverse the condition.

For those who need intervention beyond exercise, healthy diet and medication, several procedures can improve quality of life.

Cardioversion restores a regular heartbeat. It can be done using medication, called pharmacologic cardioversion, or it can be accomplished electrically, by placing patches on the outside of the chest and sending a controlled electrical shock to the heart. Sometimes this is all thats needed, especially if some cause of the A-fib has been identified and eliminated before the arrhythmia has become settled for more than a few months.

If A-fib recurs, has been in place for too long, or if medication is ineffective or causes severe side-effects, a procedure called A-fib ablation can be done in the cardiac catheterization laboratory with narrow catheters passed through the blood vessels accessed through the groin. Using these thin catheters, specially trained cardiologists known as electrophysiologists can use microwaves to heat or extreme cold to freeze heart tissue. These induced scars cause interruptions in the abnormal electrical pathways which lead to irregular heartbeat. Ablation has few risks and is precise and generally well tolerated.

Special imaging and mapping equipment have made these procedures quite successful in identifying and eliminating the culprit areas.

For some folks, clot formation cannot safely be prevented with blood thinners, and implantation of the Watchman device is an option for those patients. Again, using catheters and imaging to guide the device, the small umbrella-like Watchman is opened in the left atrial appendage, the smallish outpouching in the hearts upper chamber where blood tends to stagnate and clot. The Watchman procedure is suitable for A-fib patients who do not have heart-valve disease.

Pacing is another valuable tool in the treatment of other abnormalities of the hearts electrical rhythm.

Pacemakers and implantable cardioverter-defibrillators (ICDs) are surgically implanted devices that are safely wired to the heart to manage rhythms that are too fast or too slow.

Pacemakers send electrical signals to the heart and are typically used to treat slow heartbeat (bradycardia). ICDs monitor heart rhythm and can deliver a small electric shock to the heart if its lower chambers, the ventricles, begin to beat dangerously fast or erratically.

State-of-the-art electrophysiology labs in Geisinger hospitals feature cutting-edge diagnostic and surgical equipment to perform these and other procedures.

For some patients, open-heart surgery is the best option to treat A-fib. When medications and less invasive procedures cannot improve a patients quality of life or are not an option because of other medical conditions, A-fib surgery with an experienced cardiac surgeon can be a life-changing therapy.

OK, now youre ready for your heart rhythm exam!

Casale

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December 31, 2019

If you live in the United States and watch TV, listen to the radio or read a magazine, youve certainly heard of A-fib. Commercials are EVERYWHERE marketing drugs that treat the condition. And for good reason, A-fib is common, growing and an important public health issue in our aging population.

Atrial fibrillation, A-fib or AF for short, is an irregular heartbeat and the most common type of arrhythmia, affecting between 2.7 and 6.1 million Americans, according to the Centers for Disease Control and Prevention (CDC).

In 2009, a study titled Out of Sync: The State of A-fib in America suggested only 33 percent of people living with A-fib thought it was a serious condition and that less than half of those patients believed they were at higher risk of dangerous conditions or death as a result of their heart-rhythm disorder. Wrong.

When your heart beats normally, it contracts and relaxes in a regular pattern, moving blood from the upper chambers of the heart, the atria, to the lower chambers of the heart, the ventricles. During normal operation, the sinoatrial (SA) node, the hearts natural pacemaker, sends electrical signals regularly, to the atrioventricular (AV) node, the hearts gatekeeper, and the heart muscle contracts and relaxes in an orderly fashion.

But when either the SA node fires erratically or when other areas in the atria highjack the pacemakers function, the hearts atria begin to quiver (fibrillate); the resulting pattern is chaotic and inefficient; and the top and bottom chambers of the heart no longer beat in coordination. The most immediate effect of this uncoordinated beating is a marked reduction in the hearts pumping efficiency of around 15%.

Some people with A-fib dont have any symptoms, so without diagnostic tests like electrocardiogram (ECG), echocardiogram, and Holter monitoring, these folks might not know theyre living with A-fib. Among those with noticeable symptoms, heart palpitations, lightheadedness, extreme fatigue, shortness of breath and chest pains are common.

The risk of developing A-fib increases with age. Other risk factors include high blood pressure, obesity, European ancestry, diabetes, heart failure, ischemic heart disease, hyperthyroidism, chronic kidney disease, heavy alcohol use, and enlargement of the hearts left side chambers.

While A-fib can lead to chronic fatigue, additional heart-rhythm issues, and decreased blood supply to other organs; the most concerning complications are stroke and heart failure.

The CDC reports that A-fib increases a persons risk of stroke by 4 to 5 times. In addition, A-fib causes 15 to 20 percent of ischemic strokes, those resulting from interruption of blood flow to the brain because a blood vessel is blocked by a clot (in A-fib) or fatty deposit (atherosclerosis.)

When A-fib causes inconsistent blood flow from the atria to the ventricles, blood pools in nooks and crannies within the atria like leaves and debris collect in the backwaters of streams. The blood that puddles often clots. When clots break loose and travel throughout the circulatory system, they often wind up clogging brain arteries, causing a stroke. If not treated quickly, ischemic stroke will do lasting damage to the brain and can be deadly.

Another problem arises when A-fib causes the heart to beat so fast and erratically that it cannot fill with enough blood to pump adequately to meet the bodys needs. When the heart cannot provide the other parts of the body with a sufficient blood supply, heart failure develops. Heart failure leads to fluid buildup in the lungs and throughout the body and can make everyday physical activity difficult. The condition can be managed but is very serious.

The spectrum of treatments for A-fib begins with healthy lifestyle changes and medications that can regulate heart beat or prevent blood clotting. It includes heart-rate monitoring and may require invasive procedures that include the implantation of pacemakers, destruction (ablation) of abnormal heart tissue that is negatively influencing electrical pathways, and implantation of devices that ward off ischemic stroke.

Next week, well take a closer look at these therapies, and how the whole spectrum can improve quality of life for people with A-fib.

Casale

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December 30, 2019

The beginning of a new year is a fine time to take stock of things, especially your overall well-being.

Its true that taking care of yourself doesnt need to coincide with a grand event, like the start of another of our planets annual trip around the sun. Starting that exercise regimen youve been putting off can begin on any day, no matter how arbitrary.

But encouraging people to seize each day is not the same as discouraging new hope in the new year. In fact, we should all begin each year by making time for reflection, prioritization and making changes that will positively affect us and those to whom we are close.

Life can be hard, and any given year can be extremely difficult, which is why there is inherent value in beginning anew. There is opportunity to leave the troubles of a tough year behind and embrace better days.

By the same token, there is opportunity to build on a good year and, in the new year, amplify those things that made it successful. The new year can be a time to expand aspects of your professional endeavors and strengthen personal relationships.

But since health is my area of expertise and the reason for this column, well stick to tips for a healthy start to 2020.

Get active and stay active

The road to regular exercise, managed weight and cardiovascular health doesnt have to begin with buying an expensive piece of home-exercise equipment or joining your local gym. If youre a former athlete who understands the commitment and rigors of training at that level or just someone whos seeking the best shape of a lifetime, by all means, go for it.

But for most of us, adopting a more active lifestyle begins with realizing just how little we move on a daily basis. Start by taking 30-minute walks around your neighborhood or in the area of your place of employment during your lunch period. When walks begin to make you feel betterand they will increase your pace or duration. After time, consider graduating to a jog if youre able and incorporating mild muscle-toning activities.

If you despise exercising alone, explore group activities, like hiking clubs or beginner yoga classes, environments where people can encourage one another without the intensity of more advanced practitioners. Whatever you do, keep moving. Youll see that physical activity has a delightfully addictive quality.

Eat well

With the wealth of research-based information available today, keeping a diet that benefits your health is becoming easier than its been in the past.

Eat mostly plants. I know this isnt the mouth-watering advice you wanted to hear, but its been made increasingly clear that a diet high in fruits and vegetables is the best option for cardiovascular health, immune system strength and general wellness.

Have your juicy steak occasionally, but keep your daily proteins to lean meats, fatty fishes high in Omega-3 fatty acids, nuts and other plant-based proteins. And make sure the fats youre consuming are heart healthy, such as those found in good olive oils and avocados.

Quit smoking

Now for the broken-record portion of the column, Ill remind you again that smoking is the single worst thing you can do for your health. The moment you quit, youll begin the journey back to a healthier you.

Breaking from the chains in which cigarettes have had you fettered almost immediately lowers blood pressure, heart rate and carbon monoxide level in your blood. Soon after, youll have improved circulation and lung function. Within in a year, youll have an easier time breathing and lose that pesky cough, and as the years roll on, youll significantly reduce your chances of having a major cardiovascular event or getting cancer.

Take a moment

Slow down.

Step away from the frenetic pace of life for a moment.

Close your eyes and focus on your breathing. Listen to your breath as its drawn slowly in through your nose and exhaled slowly out of your mouth. Do this repeatedly until you feel an unmistakable calm rush over you.

This is what it feels like to be present in a moment, to tune it all out and just be. Find more of these moments this year. Find a quiet space to practice this simple method of meditation regularly and take the time you need to reset your mind and body and appreciate what it is to be alive.

I hope you all have a safe and happy New Years celebration and that your journey to a better, healthier and happier you starts now.

Casale

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December 29, 2019

WILKES-BARRE From the largest expansion of voting rights in 80 years to establishing a state-based marketplace to reduce health care costs to a sweeping executive order targeting gun violence, Pennsylvania continued its comeback in the first year of Gov. Tom Wolfs second term, including the implementation of many of his top priorities and expansions of his key initiatives.

So says the governor himself.

In 2020, Wolf said he will continue to fight to invest in infrastructure, reduce climate change, raise the minimum wage, tackle poverty, reform our probation system, expand gun safety laws, and even more to improve education, reduce health care costs, and enhance the quality of life for all Pennsylvanians.

The governor cited the following 2019 highlights:

Major Reforms and Progress

Voting: Signed the most significant reforms to Pennsylvanias election law since it was established more than 80 years ago. Pennsylvanians can now vote by mail, and they have more time to register and submit mail-in and absentee ballots.

Climate Change: Took action against climate change by signing an executive order that begins the steps necessary for Pennsylvania to join the Regional Greenhouse Gas Initiative, a regional cap-and-trade program that limits carbon dioxide emission. He also acted to reduce air pollution, including methane, from natural gas wells and pipelines with the approval of changes to the states air quality regulations that are part of his Methane Reduction Strategy.

Criminal Justice Reforms: Building off Pennsylvanias nationally recognized criminal justice reforms like the Clean Slate Law, Wolf signed two Justice Reinvestment Initiative bills that make major reforms to probation and other areas that will save money by cutting red tape and investing in programs proven to reduce recidivism.

Supporting Military Families: Introduced the PA GI Bill, a first-of-its-kind program that provides family of military members with assistance paying for college, which he signed into law in June. Pennsylvania National Guard members can now apply for the program.

Boosting PA Agriculture: Made historic investments in Pennsylvanias agriculture industry through his PA Farm Bill. The program is based on the governors six-point plan to protect the longevity of agriculture, and the rollout of its grant programs is already underway.

Licensure Reform: Signed legislation that cuts bureaucratic red tape to make it easier for new Pennsylvanians, including military spouses, with an out-of-state occupational license to work.

Rainy Day Fund: Announced a $317 million deposit into the commonwealths Rainy Day Fund, the largest transfer in nearly two decades.

State-Based Exchange/Reinsurance: Signed a historic reform that will move the online health insurance marketplace from the federally hosted HealthCare.gov to a state-based exchange, as well as create a reinsurance program. The new programs will save money for people purchasing plans through the Affordable Care Act while increasing access to health insurance.

Rural Health: Continued to work to ensure Pennsylvanians in every part of the state have access to health care within a reasonable distance by signing a bill establishing the Rural Health Redesign Center Authority and the Pennsylvania Rural Health Redesign Center Fund, which support the Pennsylvania Rural Health Model.

Youth Tobacco Use: Signed legislation raising the minimum age to purchase tobacco products to 21 and expanded tobacco laws to include e-cigarettes and other vaping products.

Vulnerable Populations: Moved to overhaul the commonwealths programs to protect vulnerable populations by signing an executive order directing state agencies to work together to identify areas of improvement and create a plan to ensure all Pennsylvanians have access to the care and services they need. The executive order established the Council on Reform, which delivered recommendations on changes that should be made so the commonwealth is better serving vulnerable Pennsylvanians.

Childhood Sex Abuse: Signed three bills that mirror the Grand Jurys recommendations after its investigation into child sexual abuse by Catholic clergy. The new laws abolish Pennsylvanias criminal statute of limitations on childhood sex abuse and extend the timeline victims have to file civil action against their abusers, as well as increase penalties for failing to report child abuse by a mandated reporter and make conversations with law enforcement agents exempt from non-disclosure agreements.

Campus Sexual Assault: Has been a steadfast supporter of campus safety and nearly three years ago established Its On Us PA, the nations first statewide campaign, and this year enacted two major legislative changes sought for years. One encourages students to report sexual assault by providing them immunity for violating drug, alcohol, and other minor student conduct policies. The other change requires post-secondary institutions to offer students online, anonymous options to report a sexual assault or misconduct.

Rape Kit Backlog: In April, the Pennsylvania State Police announced they cleared the backlog of forensic rape kits. Pennsylvania also made improvements to the Sexual Assault Testing and Evidence Collection Act, including establishing time lines for submitting, testing, and storing rape kits.

Public School Funding: Since taking office in 2015, Gov. Wolf has made good on his promise to fight for our schools and now secured more than $1.2 billion in public education funding since taking office. With this years funding increase, Pennsylvania has doubled investments in early childhood education during Gov. Wolfs time in office.

PAsmart: Pennsylvania continued to build Gov. Wolfs STEM and career readiness initiative, PAsmart, and the governor secured a $10 million increase to $40 million for PAsmart, where the governor secured a $10 million increase for a total $40 million investment in 2019. In the inaugural year, the administration awarded nearly $10 million in PAsmart grants to 765 schools to expand computer science classes and teacher training. The administration has added thousands of registered apprenticeships and increased CTE students earning industry certifications by 50%.

Reform: Kids in Pennsylvania will stay in school longer because the legislature approved Gov. Wolfs plan to raise the school dropout age from 17 to 18 and lower the required age to start school from 8 to 6.

Higher Education: Over the past five years, funding for higher education has increased by $188 million. Pennsylvania foster kids can also now attend college tuition-free, thanks to a bill signed by Gov. Wolf.

Gun Violence Reduction: Continues to fight to combat gun violence in communities across Pennsylvania. A law signed by Gov. Wolf that requires domestic abusers to turn in their guns took effect in April. In August, he signed an executive order calling upon state agencies to target the public health crisis of gun violence. The governor continues to fight for increased gun violence reduction measures, including universal background checks, safe storage legislation and Extreme Risk Protection Orders.

Anti-Choice Legislation: Continued to uphold the rights of Pennsylvanian women by vetoing anti-choice legislation, following through on a steadfast vow to support women and their ability to decide the healthcare that is best for them. He also fought back against federal anti-choice legislation, denouncing national efforts to take away the right for women to make their own healthcare choices.

Equality: Continued to push for equality for all Pennsylvanians. He called for the legislature to expand non-discrimination laws to include LGBTQ citizens. He spoke out against decisions by the White House to reduce transgender and LGBTQ protections.

Also advocated for immigrants and refugees, repeatedly reminding Pennsylvanians that our commonwealth was founded on inclusivity.

Pennsylvania officially recognized Juneteenth, the day honoring the announcement of the abolition of slavery reaching the furthest point of Texas. Juneteenth National Freedom Day will now be held June 19th each year in Pennsylvania.

Recreational Marijuana: Supported Lieutenant Gov. John Fetterman as he embarked on a listening tour to gather opinions on recreational marijuana legalization. Lt. Gov. Fetterman produced a report on the feedback he heard while visiting all 67 counties. In response to the lieutenant governors report, Gov. Wolf called for several actions, including for the General Assembly to seriously debate and consider the legalization of adult-use, recreational marijuana.

Acts of Kindness: Encouraged Pennsylvanians to participate in 1-4-3 Day by committing acts of kindness in honor of Fred Rogers, who used the numbers 1-4-3 to represent the letters in the words I love you. Across the state, Pennsylvanians heeded the call and filled the day with kind words and good deeds.

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Wolf

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December 28, 2019

PLYMOUTH At Midnight Mass, a young man arrived with his family and I noticed he was wearing two red socks.

Very festive, I thought, so I stopped him and told him it was good to see him in the Christmas spirit.

Beyond the Byline: Who really did steal the kishka? - Wilkes Barre Times-Leader