Pain from PAD? Exercise is best, says UK expert

If you have peripheral artery disease, or PAD, even a short walk can cause pain. This pain, called intermittent claudication, or IC, is caused when arteries in your legs become blocked with plaque. PAD is a serious disease, but the good news is that treatment is usually simple.

Exercise is generally the most effective treatment for PAD. Your doctor can recommend a program of Supervised Exercise Training, also known as cardiac rehabilitation.

What to expect from supervised exercise training:

  • A personalized exercise plan that works for you.
  • An assessment of your risk factors for heart and blood vessel disease.
  • Counseling and psychological/stress assessment.
  • Education and support to help you avoid tobacco and maintain a healthy weight and diet.
  • The opportunity to meet and share stories with other patients like you.

Benefits of supervised exercise training:

  • Reduce your risk of heart disease, heart attack and stroke.
  • Control other heart disease symptoms like chest pain or shortness of breath.
  • Stop or reverse damage to blood vessels in your heart and legs.
  • Improve your stamina and strength so you can enjoy work, hobbies and exercise.
  • Improve your confidence and well-being.
  • Monitor and control your blood pressure, cholesterol and diabetes.
  • Improve communication with your doctor and other healthcare providers about your progress.

Dr. Nathan Orr, a vascular surgeon at UK HealthCare, says that an exercise program not only helps patients walk longer distances, but can also help them avoid the need for complex surgery.

“A regular, directed exercise program will result in an improvement in your quality of life, an improvement in your overall health, and a lower risk of vascular disease progressing to limb loss,” Orr said.

Exercise training can work as well as medications and other more invasive treatments for PAD and IC, and it may be covered by your insurance. Contact UK Cardiac Rehabilitation at 859-323-5424 for more information.

Next steps:

Making the Rounds with Dr. Aaron Hesselson

Meet Dr. Aaron Hesselson: engineering healthier heartbeats

Making the RoundsWe caught up with Dr. Aaron Hesselson for our latest Making the Rounds interview. Dr. Hesselson started at UK HealthCare this fall, bringing with him nearly 30 years of experience in cardiac electrophysiology. He now serves as the director of electrophysiologic services at UK. 

What types of conditions do you treat?

Electrophysiology covers all of the electrical aspects of the heart. That means I treat patients with abnormal heart rhythms. These can vary from slow heart rhythms to very rapid heart rhythms. Treatments for these conditions can range from simple monitoring and reassurance to medication and sometimes surgical procedures that can help manage or cure a certain problem.

How did your career in medicine begin?

I left college as a biomedical engineer and I was very interested in maintaining my medical background for my first job. I came across a job listing in the local newspaper that asked for a biomedical engineer to do research at a hospital in Newark, N.J.

So, rather than just sending my resume in, I decided I would show up in person. I just said, “Hey, I just happened to be in the area and I’m interested in this.” I had an initial interview and then a few more interviews, and then I got the job.

What’s the best part about being a doctor?

As an engineer, the technical aspects of the job are very appealing. But more important is the gratification we get from taking care of our patients.

Very few doctors can say that they can cure a medical issue, but in some cases we are able to do that as cardiac electrophysiologists. And that, to me, is very big. To see the appreciation of the family, patient – that makes it all worth it.

Is there an experience that has shaped your patient-care philosophy?

Yes – being a heart patient myself. When I was in college, even before I had any inkling that I wanted to go into medicine, I ended up in an intensive care unit with a fractured sternum and a bruised heart.

My experience then as a patient very much influences how I approach my patients now. I approach it from the standpoint that I’m that patient lying in the bed. The patient doesn’t know what’s going on or know the technology. They don’t know the technical terms and they don’t know what that end point is: When is my time here in the hospital going to end?

I try to anticipate what they’re thinking lying in bed because I was there. Hopefully I can anticipate their needs and their questions and make them that much more comfortable and reassured so that they know, “OK, we’ve got a plan and I feel good about it.”

Watch our video interview with Dr. Hesselson, where he explains why patients should feel confident coming to him for their care.

Next steps:

  • The UK Gill Heart & Vascular Institute is a leader in diagnosing and treating abnormal heart rhythms. Learn more about Gill’s Heart Rhythm Program.
  • A new study about heart stents is in the news. Two of our experts explain what the study means and what patients and their loved ones should know.
heart stents study

Don’t overreact to new study on heart stents, say UK cardiologists

Dr. Adrian Messerli

Dr. Adrian Messerli

Written by Dr. Adrian Messerli and Dr. Khaled Ziada, interventional cardiologists at the UK Gill Heart & Vascular Institute.

A recently released study once again shines the spotlight on heart stents, a procedure performed more than 600,000 times per year in the United States.

In effect, the study raises real concerns that stent placement for the treatment of activity-related chest pain (angina) is no better than treatment with medications alone.

Dr. Khaled Ziada

Dr. Khaled Ziada

Given the relatively high prevalence of heart disease in our society, this study is understandably getting a lot of attention. Already, we have received quite a few inquiries from patients and their loved ones who are concerned and perhaps somewhat confused.

Here’s what it all means:

What the study said

A group of respected British cardiologists conducted the study on 200 patients with angina and who had a severe blockage in one of their coronary arteries.

All patients were on high-quality medication treatment. The researchers then compared stent placement in one-half of these patients with a simulated sham procedure in the other half of the patients.

After six weeks, there were no significant differences in patient-reported improvement of symptoms or exercise ability in either group.

This study is receiving considerable scrutiny. It was rigorously designed and undertaken with great care. Even so, it has very important limitations.

Understanding the study’s limitations

First, and perhaps most importantly, this study does not pertain to patients who have suffered a heart attack. We know for a fact, based on the findings of numerous studies, that when someone is having or has recently had a heart attack, placing a stent to open up a blocked artery is clearly the treatment of choice.

In these situations, a stent is frequently lifesaving and may improve longstanding quality of life.

Second, this study was conducted in a small sample of lower-risk patients with good heart function, mild symptoms and blockages in one artery only.

So the results do not necessarily apply to higher-risk individuals with more severe angina, those with blockages in multiple arteries or those whose heart function was abnormal to begin with.

In these patients, stenting or even bypass surgery can reduce symptoms considerably, and possibly even protect against future heart attacks or worsening heart failure.

Third, the study followed patients for six weeks.

In a larger study published in 2007 on similar patients with activity-related angina who were treated with medications only, most patients did well, but about one-third of them eventually required a stenting procedure or surgery when followed for four to five years.

What do patients need to know?

If you have already had a stent placed, know that you are not in any new danger. In fact, current-generation stents are remarkably safe and durable. If you or your loved ones happen to suffer a heart attack, you should be aware that in this circumstance, stents are ideal.

If you experience new symptoms of angina, you should consult your primary care doctor or a cardiologist. If the symptoms are not severe or very frequent, your doctor will likely prescribe a number of medications, possibly order additional testing and then monitor the situation.

Frequently, the medication regimen will reduce or eliminate angina. If a heart catheterization or stent placement is recommended, it is entirely reasonable to ask careful questions, ensure you are on appropriate medications and get a second opinion.

Finally, it is important to remember that chest pain is a symptom, not a condition.

The underlying disease, coronary atherosclerosis, is best treated with aggressive risk-factor modification, including tobacco cessation, a healthy diet, regular exercise and stress management.

We have known for many years that, in a stable patient, stents do not reduce future risk of heart attacks or death. Rather the emphasis should be medication therapy and, even more importantly, lifestyle measures.

The problem of overuse of stents in stable patients with angina has improved significantly over the last decade, but there is no doubt that there is room for further improvement.

When used appropriately, this procedure has a validated and critical role in the treatment of heart disease. We have placed several thousand stents over our careers, and have seen firsthand the benefits for many of our patients in Kentucky.

So for now, let us not overreact to the results of this small trial, and accidentally throw out the proverbial baby with the bathwater.

Next steps:

Eat more plants for a healthier heart, says UK’s Dr. Gretchen Wells

Dr. Gretchen Wells

Written by Dr. Gretchen Wells, director UK Gill Heart & Vascular Institute’s Women’s Heart Health Program

Most people don’t realize that the power to prevent many diseases is in their own hands.

By exercising – even a little – and quitting smoking, you greatly reduce your risk for diabetes, heart disease and even dementia. But perhaps the easiest way to tip the odds in your favor is to change your diet. If you’re looking for a way to eat healthier, consider a plant-based diet.

A plant-based diet is based on fruits, vegetables, whole grains and legumes. It excludes or minimizes meat, eggs and dairy products, as well as highly processed foods like bleached flour, refined sugar and some oils.

Numerous studies have linked a plant-based diet to lower risks of diabetes, high blood pressure and heart disease – as much as 30 percent, according to one Harvard study.

Don’t know where to begin? Here are some guidelines:

  • Veggies: Any vegetable, especially leafy green or yellow vegetables with high water content.
  • Fruits: No limits here, but deeply colored berries are a plus.
  • Starches: This includes starchy vegetables like potatoes as well as whole grains like oats, rice or quinoa.
  • Beans and legumes: These are starchy, but generally have a higher protein content. Consider beans, lentils and dried peas.
  • Nuts and seeds: Use sparingly to avoid weight gain.

You can adjust slowly to a plant-based diet. Adopt the popular “Meatless Mondays” trend in your home and add Tuesday, Wednesday, etc. as you go. Or experiment by adjusting your favorite recipes to be plant-based: make your chili all beans, or prepare a stir-fry with tofu or edamame instead of chicken.

Heart-healthy cooking demo at UK HealthCare

If you want some ideas, come to UK HealthCare on Saturday, Nov. 18, for “Feeding Your Heart and Soul” featuring best-selling cookbook author Jane Esselstyn. Esselstyn, who has spent most of her life advocating for a plant-based, meatless, whole-food diet, will demonstrate recipes from The Prevent and Reverse Heart Disease Cookbook, which she co-authored with her mother, Ann. You’ll also get the opportunity to taste some of her dishes and see for yourself that a plant-based diet can be healthy and delicious.

The morning will begin at 8 a.m. with an optional free yoga session. Esselstyn will take the stage for a brief lecture at 9 a.m., followed by a cooking demonstration at 10 a.m. and tastings at 11 a.m.

The registration fee for “Feeding Your Heart and Soul” is $15 and includes a free copy of The Prevent and Reverse Heart Disease Cookbook and tastings.

For more information or to register, call 859-218-0121.

Next steps:

Priscilla Riley

After a lifetime of heart problems, clinical study makes all the difference for Manchester woman

As a small child, Priscilla Riley, now 70, had rheumatic fever that damaged her heart.

Her heart problem meant she could not run and play with other children, she says sadly. She could only watch from the sidelines.

Her heart problem became something she just lived with, making adjustments as she could.

In 1993, she had open-heart surgery to replace two of her heart valves. Recovery was difficult: Riley spent several weeks in the hospital and two months recovering. But the surgery was successful and for a while, she felt better.

Gradually, though, the problems returned. One of the replaced valves was leaking. Riley began suffering from congestive heart failure – a potentially life-threatening condition in which the heart can’t pump enough blood to meet the body’s needs. Fluid builds up in the lungs making it difficult to breathe.

Her congestive heart failure would get worse and worse until finally, she would need a trip to the hospital. At one point, doctors removed 60-70 pounds of fluid from Riley’s body. She’d feel better, but then the fluid would begin to build up again. It was a cycle that happened over and over.

Finding the right care at UK

Because of her age and her previous surgery, Riley was not a candidate for traditional surgery. Doctors feared she would not survive.

Riley’s doctor at Manchester Hospital asked her to go to the Adult Congenital Heart Clinic at UK, but Riley said no.

“I’m stubborn,” she said, with a twinkle in her eye.

But by April of this year, Riley was so ill it looked like she might not make it. That’s when she came to UK and met Dr. Andrew Leventhal, an interventional cardiologist at the Adult Congenital Heart Clinic, part of the UK Gill Heart & Vascular Institute.

Leventhal is a co-principal investigator on a study of a new replacement heart valve called the Sapien 3, and he realized Riley might be a candidate.

The trial, known as COMPASSION 3, tests the efficacy of the Sapien 3 valve as a replacement for a diseased pulmonary valve. The Sapien 3 has already been approved for replacement of the aortic valve.

“The COMPASSION Trial is an excellent example of new technology that will help bridge the gap for adults with congenital heart disease who still need specialized follow-up care,” said Leventhal.

Instead of open-heart surgery, the replacement valve is inserted through a vein in the patient’s leg and threaded up to the heart. The incision in Riley’s leg required only a single stitch.

‘I feel so much better’

The procedure went exactly as doctors had hoped, and Riley was on her way home two days later.

“If it hadn’t been for a small problem with her blood pressure being low, a problem she’d had before this procedure, she could have gone home the very next day,” said her friend and pastor Anthony Lovett, who accompanied Riley to the procedure.

“It still blows my mind,” Lovett said. “The recovery was minimal – no recovery, really. Get her blood pressure regulated and head on home, no problem.”

And unlike the open-heart surgery she had in 1993, Riley felt better almost immediately.

Months after her surgery, she continues to do very well. She feels 100 percent better, she said, and is able to do things she could not do before. The valve completely fixed the leak.

“I’m cooking again,” she said. “I wasn’t able to cook before. And I help my son with his laundry.”

When she talks to Dr. Leventhal, tears fill her eyes.

“How are you feeling?” he asks.

“I’m good,” she tells him. “I feel so much better.”

Priscilla Riley

Priscilla Riley talks with Dr. Andrew Leventhal at a recent appointment.

Next steps:

Author of heart-healthy cookbook to speak at UK on Nov. 18

Popular cookbook author Jane Esselstyn is coming to UK HealthCare on Nov. 18 for a lecture and cooking demonstration about the benefits of a plant-based diet for heart disease prevention.

Esselstyn, a former health educator, has spent most of her life advocating for a plant-based, whole-food diet. A collection of her recipes is featured in The Prevent and Reverse Heart Disease Cookbook, which she co-authored with her mother, Ann.

The event is part of the UK Gill Heart & Vascular Institute Women’s Heart Health Program’s “Feeding Your Heart and Soul” initiative. Dr. Gretchen Wells, the program director, is an enthusiastic voice in the campaign to reduce the incidence of heart disease in Kentucky.

Numerous studies have linked a plant-based diet to lower risks of diabetes, high blood pressure and heart disease – as much as 30 percent, according to one Harvard study, Wells said. Plant-based doesn’t mean vegetarian, however: Smaller amounts of lean meats such as chicken or fish are OK.

“One of our missions at the Gill is to educate Kentuckians about lifestyle and encourage them to make changes that reduce their risk for heart disease,” Wells said. “Jane can provide them the tools to live healthier lives, so bringing her to Lexington was a logical fit.”

The event takes place in the UK Albert B. Chandler Hospital Pavilion A Auditorium and will kick off at 8 a.m. with an optional free yoga session. Esselstyn will take the stage for a brief lecture at 9 a.m., followed by a cooking demonstration at 10 a.m. and tastings at 11 a.m.

Some of the recipes Esselstyn will be demonstrating include: kale bruschetta, corn muffins with jalapenos and salsa, chocolate-raspberry mango parfait, smoky little devils (a healthy take on deviled eggs), and several salad dressings. Samples of most recipes will be available for tasting following the demonstration.

The $15 registration fee includes the tastings and a copy of her Esselstyn’s cookbook.

Registration ends Nov. 10 and is limited to the first 125 people. Free parking is available in the UK HealthCare parking garage at 110 Transcript Ave., directly across South Limestone from Chandler Hospital.

To register, contact Karen Michul at or call 859-218-0121.

Next steps:

flu shot heart

A flu shot may protect your heart, says Gill Director Dr. Susan Smyth

Dr. Susan Smyth

Dr. Susan Smyth

Written by Dr. Susan Smyth, the medical director of the UK Gill Heart & Vascular Institute.

Flu season is here, which means it’s time to get your flu shot.

It’s common knowledge that the flu vaccine prevents the misery of influenza and helps protect vulnerable populations, such as the elderly, young children and the chronically ill.

But did you know that getting a flu shot might also prevent a heart attack or stroke?

The flu can be dangerous, even deadly

Influenza, or the flu, is a highly contagious respiratory viral infection easily spread from person to person when people with the flu cough, sneeze or talk. Flu can cause high – sometimes dangerous – fevers as well as chills, sore throat, cough, congestion, muscle or body aches, and headaches. Some people, commonly children, may also have vomiting and diarrhea.

And flu can be dangerous: according to the Centers for Disease Control and Prevention, as many as 49,000 flu-related deaths occur each year.

How a flu shot might help those with heart problems

While anyone can have complications from the flu, people with cardiovascular problems are at higher risk to develop them, which can lead to respiratory failure, pneumonia, heart attack and/or stroke, and can also worsen pre-existing conditions like heart failure, diabetes or lung disease, including asthma.

A study published in the prestigious medical journal JAMA found that getting a flu vaccine reduced the risk of heart attack, stroke, heart failure or other major cardiac events – including death – by about a third over the following year.

It’s possible, although not yet proven, that flu increases the risk of a clot forming in blood vessels and/or that flu virus can provoke inflammatory changes in the blood vessels that contribute to heart attacks.

Help prevent the spread of flu

The best way to prevent influenza is to get vaccinated every year. The CDC recommends that everyone 6 months and older get a flu vaccine every fall. While most people have no side effects from the vaccine, some people might develop a mild fever, muscle aches or mild arm soreness.

Although some people claim that the flu vaccine actually causes the flu, this is simply not true.

Everyday preventive actions, such as avoiding close contact with infected people, covering your mouth and nose when coughing or sneezing, and frequent handwashing are also recommended to help reduce the spread of germs that cause the flu.

It is important to remember that the more people who get vaccinated against the flu, the fewer people who are likely to have it. By lowering your own risk you are also lowering the risk for those around us – your children, your grandchildren, your coworkers and friends.

And finally, if you have a higher risk for heart attack or stroke, talk to your doctor about whether a flu vaccine is a wise choice for additional, potentially life-saving protection.

Next steps:

Adrianne Rogers

Gill gives Lexington woman, 23, new heart and new life

Growing up, Adrianne Rogers was an active athlete, pursuing interests in basketball, football, skateboarding and motocross racing. She was skilled enough to play up on a varsity softball team as a middle-schooler.

But at age 13, she began to experience an inexplicable decline in performance and endurance. She chalked it up to “being out of shape” and tried harder. But her decline persisted. At Rogers’ annual well visit two years later, her pediatrician heard a heart murmur. Rogers was referred to a cardiologist, and after an EKG, and echocardiogram and a heart catheterization, she received a one-in-a-million diagnosis: restrictive cardiomyopathy.

Restrictive cardiomyopathy occurs when the walls of the lower chambers of the heart become rigid, making it harder for them to pump blood out to the body properly. While many cases are mild, some are severe enough to cause heart failure – a sometimes-fatal condition resolved only by a heart transplant. Restrictive cardiomyopathy is usually diagnosed in the elderly. It’s an extremely rare diagnosis in teens.

Rogers was benched from sports of any kind. Diuretics and blood pressure medicine helped control her condition. But by the time she was a senior at UK, she began having episodes of atrial fibrillation. Her atria – the upper chambers of the heart – were struggling to keep a normal rhythm.

Atrial fibrillation, or Afib, is associated with higher risks of stroke and heart failure, so Rogers went to see Dr. Andrew Leventhal, director of the Kentucky Adult Congenital Heart Program at the UK Gill Heart & Vascular Institute. Leventhal is among an elite group of cardiologists with special training to recognize and treat the issues that affect adults with congenital heart defects.

Rogers instantly bonded with Leventhal.

“I just fell in love with him,” Rogers said. “It was clear that he knew a lot about my condition and was committed to keeping a close eye on me.”

In need of a transplant

People like Rogers who are diagnosed with heart defects as children face unique challenges as they become adults, Leventhal says.

“It wasn’t that long ago that children with heart defects didn’t survive to adulthood,” he explained. “Technical advances in cardiac surgery have improved outcomes dramatically, but that presents a new issue: Patients who reach adulthood have outgrown their pediatric cardiologists and the facilities that provide treatment – typically children’s hospitals. Simply transitioning to an adult cardiologist isn’t the best fit either, since their heart problems can be very different from cardiac conditions that begin during adulthood.”

Leventhal followed Rogers carefully as she slipped in and out of Afib three times in a year. Medications and cardioversions (a procedure that attempts to shock the heart into a normal rhythm) weren’t working. Her cardiac index — a measure of how much blood her heart was pumping — was low. Rogers wouldn’t survive long without a heart transplant.

Leventhal made a call to Dr. Maya Guglin of UK HealthCare’s Heart Transplant Program, who immediately began the process to put Rogers on the priority wait list. She received her new heart about a month later, and on Dec. 28, 2016, she left the hospital with a new lease on life.

Rogers describes waking up after surgery to a strange feeling.

“I was laying there and felt something weird and a little uncomfortable on my back,” she says. She then realized that the sensation she was feeling was that of a healthy, beating heart.

“It had been so long since I’d felt a real heartbeat that I didn’t even recognize it at first.”

Grateful for a second chance

Rogers follows up regularly at the Gill under the care of Dr. Navin Rajagopalan, medical director of heart transplantation.

“Adrianne is taking great care of the gift she has been given,” Rajagopalan said. “I always have a moment of gratification when the surgery is completed and the patient is doing well, but it’s especially rewarding when we can help a younger person recover and live a normal, healthy life.”

She now visits the gym regularly for strength training and has used her recovery time to take up skateboarding, painting and guitar. She returns to UK in the fall and will graduate in December.

“It’s crazy how good I feel,” Rogers said. “I really haven’t felt well since I was 11 or 12, so this all feels amazing.”

At each follow-up appointment she makes a point to see every member of her care team, all of whom made her feel like she was their only patient, she says.

“They were so accessible and helpful; I felt super-comfortable during my time in the hospital waiting for a new heart,” she says. She even painted gifts for Donna Dennis and Heather Ross, who were responsible for coordinating her care pre- and post-transplant.

Paying it forward

While Rogers was hospitalized and waiting for her new heart, she was visited by a young man who’d recently had a heart transplant of his own.

“He really calmed my nerves and made me realize this was doable,” she says.

So, when Dennis asked Rogers if she would talk to another transplant candidate, she was more than willing to pay it forward.

“I can give them an experience to relate to, and they see that a transplant isn’t so scary,” she said.

Leventhal wants young people diagnosed with heart defects to understand the importance of regular follow-up care with a cardiologist trained to work with these unique conditions.

“Even if you’ve been told you’re cured, even if you’re feeling good, you need to have a relationship with a cardiologist who specializes in treating adult patients with congenital heart defects,” he said. “Adrianne’s story is the perfect example of someone who was careful about managing her defect but still became critically ill. Thankfully, she was wise to keep up with her care and seek help when she didn’t feel well. That was a huge factor in this success story.”

Check out the video below to see Adrianne talk about life after her heart transplant.

Next steps:

DASH diet

The DASH diet is easy to follow and good for your health

Do you want to eat better, but don’t know where to start? Consider the Dietary Approaches to Stop Hypertension, or DASH diet.

The DASH diet was initially created to help lower blood pressure. But studies have also found the DASH diet to be one of the best options to prevent heart disease, stroke, diabetes and even some forms of cancer. Research also shows the DASH plan is safe and effective for short-term and permanent weight loss.

The best news is the DASH diet is easy to follow because it does not restrict entire food groups. Because the plan focuses on fresh fruits and veggies, controlling your calories is easier, too. Learn more about the DASH diet below.

What is the DASH diet?

The DASH plan is promoted by the National Heart, Lung and Blood Institute, part of the National Institutes of Health. The plan helps reduce the risk for serious health problems because it is low in:

  • Saturated fat
  • Cholesterol
  • Total fat
  • Red meat
  • Sweets
  • Sugary beverages

The DASH diet encourages:

  • Fruits
  • Vegetables
  • Fat-free or low-fat milk and dairy products
  • Whole-grain foods
  • Fish
  • Poultry
  • Nuts

The DASH diet is also rich in important nutrients such as:

  • Potassium
  • Magnesium
  • Calcium
  • Protein
  • Fiber

Tips for following the DASH diet

To reduce the amount of sodium in your diet, try these steps:

  • Choose fresh, frozen or canned vegetables that have low sodium or no added salt.
  • Use fresh poultry, fish or meat instead of canned, smoked or processed options.
  • Limit cured foods such as bacon and ham, foods packed in brine, and condiments.
  • Cook rice or pasta without salt.
  • Cut back on frozen dinners, packaged mixes, and canned soups or broths.
  • Rinse canned foods such as tuna and canned beans to remove some of the salt.
  • Use spices instead of salt to flavor foods.
  • Add fruit to breakfast or have it as a snack.
  • Treat meat as one part of the whole meal, instead of the main focus.

Some days you might eat more sodium or fewer foods from one group than the plan suggests. But don’t worry. Try your best to keep the average on most days close to the DASH plan levels.

Following the DASH diet

Here’s how much of each food group you should eat every day, based on eating 2,000 calories per day.

6-8 servings of whole grains. A serving size is about one slice of bread, 1 ounce of dry cereal or 1/2 cup of cooked rice or pasta.

4-5 servings of vegetables. A serving size is about 1 cup of raw, leafy vegetable or a 1/2 cup of cut-up raw or cooked vegetables.

4-5 servings of fruits. A serving size is about one medium fruit; 1/4 cup of dried fruit; 1/2 cup of fresh, frozen or canned fruit; or 1/2 cup of real fruit juice.

2-3 servings of fat-free or low-fat dairy. A serving size is about 1 cup of milk or yogurt or 1 1/2 ounces of cheese.

Up to 6 servings of lean meat, poultry, fish. A serving size is about 1 ounce of cooked meat, poultry, or fish, or one egg.

4-5 servings per week of nuts, seeds, legumes: A serving size is about 1/3 cup or 1 1/2 ounces of nuts, 2 tablespoons of peanut butter, 2 tablespoons or 1/2 ounce of seeds, 1/2 cup of cooked, dry beans or peas.

2-3 servings of fats and oils: A serving size is about 1 teaspoon of soft margarine, 1 teaspoon of vegetable oil, 1 tablespoon of  mayonnaise or 2 tablespoons of salad dressing.

Up to 5 servings per week of sweets: A serving size is about 1 tablespoon of sugar, 1 tablespoon of jelly or jam, 1/2 cup of sorbet or gelatin or 1 cup of lemonade.

Next steps:

UK's collaborative nature has allowed the ECMO (Extracorporeal Membrane Oxygenation) program, which provides emergency support to patients, to thrive.

UK leads the way in life-saving ECMO transport

Technology plays an enormous role in advancing the quality and effectiveness of medical treatment. New technology tends to arrive first in larger, academic medical centers and subsequently spreads into the smaller city and community hospitals. As the technology continues its march to the far corners of the world, many academic hospitals consider it a moral responsibility to support the smaller hospitals, much like a big sister teaches her little sister how to ride a bike.

ECMO is a fitting example of this process. Extracorporeal membrane oxygenation (ECMO) technology provides emergency mechanical support for desperately ill patients by mimicking the natural function of the heart and lungs. This allows the patient to rest and heal from a variety of severe cardiac and respiratory illnesses, such as flu, pneumonia, cardiomyopathy or heart attack. External pumps and oxygenators remove carbon dioxide from the blood, replace it with life-saving oxygen and then return it to the patient’s circulatory system. The patient’s heart continues to beat, but stress on the heart and lungs is diminished because the ECMO machine does much of the pumping. While ECMO doesn’t fix the underlying problem, it supports the patient hemodynamically until they can get treatment or heal on their own.

A patient on ECMO is supported around the clock by a large, highly coordinated team, including specialized nursing care, nurse practitioners, physicians and perfusionists, as well as respiratory, physical and occupational therapists. It’s an expensive process, and hospitals with smaller patient volumes often cannot support its cost.

As the technology has been adopted by more hospitals around Kentucky, they have turned to UK HealthCare for support. UK HealthCare has been using ECMO to treat its patients since 1993, and today it offers an innovative, coordinated program to assist surrounding hospitals.

Getting the program off the ground

In some cases, a hospital already has ECMO technology but doesn’t have the infrastructure to support patients long-term. In other cases, a patient needs ECMO, but the hospital doesn’t have the technology. In both cases, a place like UK is well-suited to assist.

Michael Sekela, MD, now surgical director of the UK Gill Heart & Vascular Institute, first conceived the idea of ECMO transport in the early 1990s. But at that time, ECMO technology had not yet matured. “It took a long time to get the ECMO technology reliably to that level,” he said, “and it is best undertaken by a hospital with high treatment volumes and a relatively large catchment area.”

2016 data from Vizient (a think tank of hospitals around the country that embrace information sharing for performance improvement) ranks UK HealthCare No. 10 in adult ECMO patient volume, treating more patients than centers with loftier reputations, such as Cleveland Clinic, Mayo Clinic and Johns Hopkins.

As Sekela’s email inbox filled with requests for help, he recognized the need for a more formal model to support smaller hospitals and the patients they serve. “There is a large unserved need, as many institutions do not have the infrastructure in place to embrace this service,” he said. “We have the skills and the resources, and we already serve large swaths of regional and rural hospitals in and adjacent to Kentucky.”

But building such a program from the ground up would be no easy feat.

Positive reactions

For more than a year, a team at UK HealthCare worked on a blueprint for transferring ECMO patients safely to UK. The team included Sekela, Dr. Jay Zwischenberger (chairman of the Department of Surgery), Dr. Paul Tessmann, Dr. Anil Gopinath, Dr. Walt Lubbers and Patti Howard from Emergency Medicine, as well as EMS Manager Matt Ward, Mechanical Circulatory Support (MCS) Manager Julia Akhtarekhavari, MCS Coordinator Thomas Tribble and Chief Perfusionist Chuck McClendon. The plan had to support multiple scenarios (hospitals that offered ECMO but could not support a patient long-term, and hospitals that did not offer ECMO but had a patient who needed it). Any patient transport needed the space and equipment to accommodate a highly skilled team of EMTs, paramedics, critical care nurses trained in ECMO, and perfusionists. If the patient was at a hospital without an ECMO service, a surgeon was added to the transport to connect the patient to the ECMO equipment before they were transported to UK.

UK is the only center in Kentucky offering adult ECMO transport – in fact, you’d have to travel more than three hours in any direction – as far east as Charlottesville, as far north as Indianapolis, as far west as Nashville – to find another center with the same service.

Initial response to the fledgling program has been extremely positive. Wayne Lipson, MD, a cardiothoracic surgeon at Baptist Health in Madisonville, Ky., says the service helped save one of his desperately ill patients earlier this year. He describes the transfer process – from the phone call to patient transport – as seamless. “Mike [Sekela] showed up with his team at 2 a.m., less than five hours after we made the call,” he said. “Transporting a patient like this is a very difficult process, and it’s a testament to UK HealthCare that their system is so responsive.”

“Having this service available enables our team to treat more complex patients closer to home. We are armed with the knowledge that the UK HealthCare team will support us when we need it,” Lipson said

Sekela credits the team’s methodical approach to transport issues and meticulous planning and training for the service’s fantastic early success.

“This program exemplifies the collaborative culture at UK,” Sekela said. “Many months of planning and training with Emergency Medicine, Cardiovascular Surgery, Nursing and Perfusion were significant factors in the program’s success.”

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