S m a l l w o r l d : H o w a m a n f ro m u g a n daB eC a m e a pat i e n t at u p Stat e

Being a minister of a churchin Uganda, Morris Bukenyabelieves in a God who

helps people heal. He alsorealizes his good fortune to livein a world that can be so small.

Bukenya, 54, wound up a patientat Upstate, 6,000 miles fromhome, because a daughter isfriends with a cardiologist inOswego. Bukenya recoveredfrom heart surgery at the homeof Dr. Moses Kyobe, a native ofUganda.

Bukenya was surprised to learn he had trouble with his heart,though in retrospect he says he shouldn’t have been. He sometimeswould become dizzy for no apparent reason. Sometimes he wouldbreak into a sweat, even before doing something strenuous. Hewould awake some mornings feeling as if he hadn’t slept.

“My wife sometimes would ask me ‘what’s wrong?’ and I wouldsay ‘I feel so bad,’” Bukenya recalls. Taken individually, eachsymptom did not seem serious. Grouped together, they pointedtoward heart attack.

He sought medical care in Uganda and was diagnosed with highblood pressure. His condition worsened, with chest pains thatcame and went, so Bukenya’s daughter arranged for him to seeKyobe. The church took a collection to help defray his expenses.That was in the spring of 2010. Bukenya went home withmedication. His condition grew worse and in September, hereturned to the United States in September with his wife, Christine.

i n t e r n at i o n a lo rg a n i z at i o na p p l a u d S u p S tat e ’ SC a r d i a C C a r e

Upstate University Hospitalreceived full accreditationfrom the Society of Chest

Pain Centers in December as anAccredited Chest Pain Center.

The society is an international not-for-profit that is focused onhelping hospitals improve quality,cost and patient satisfaction incardiovascular care.

Hospitals that are Accredited Chest Pain Centers have developedan expertise in dealing withpatients who arrive withsymptoms of a heart attack. Theirstaff emphasizes the importance of standardized diagnostic and

treatmentprograms for

chest painand heartattack.Theyalsoevaluate

and treatother

medicalproblems and

promote healthylifestyles that can reduce the riskfactors for heart attack. Upstate isan accredited Chest Pain Centerwith “PCI,” percutaneous

from the Up state Heart and Vascul ar Center , Up state Un ivers i t y Hosp i ta l

S y r a c u s e N e w Y o r k

Winter 2 012

H E A RT & VA S C U L A R N E W S

Morris Bukenya chuckles with his surgeon,Charles Lutz MD during a follow up appointment.

continued on page 7continued on page 5

Many women delayseeking care for heartattack because they miss

the subtle warning signs, and thisraises their risk of death or gravedisability.

Melanie Kalman PhD, anassociate professor in Upstate’sCollege of Nursing, is working tochange that. In collaborationwith a researcher at BinghamtonUniversity, she has createdacronyms — CURB and FACTSS —to help women remember thewarning signs and commonsymptoms of heart attack. Theirproject, called “Matters of YourHeart,” looks at whetherteaching women about the earlywarning signs of heart attack canhelp improve their response tosymptoms.

“Women have chest pain,”Kalman says, “but usually not thecrushing chest pain. It’s usuallymore of an ache. They will getunusual fatigue, and painradiating to the back, jaw,shoulder or arm.

“Women tend to get symptomssix months to a year ahead oftime, and they are nebuloussymptoms of being tired or shortof breath, indigestion or havingtrouble sleeping.”

Kalman and Pamela Stewart FahsDSN, a professor in rural nursingat Binghamton, developed aquestionnaire to measure awoman’s knowledge of heartattack symptoms and warningsigns. They created a pilot versionof an educational program. Usingan intramural research grant

from Upstate, they held small-group sessions with 141post-menopausal women. Theygave them the questionnaire,presented the program, and thengave them the questionnaire asecond time.

“The overwhelming majority ofthem did learn the symptoms.Most of the women didremember,” Kalman says.

The next phase of the projectrelies on funding from grantsfrom the Rural Nurse Organiza -tion and the Raymond Marsh

Fund and will compare aneducation program that uses theCURB and FACTSS acronymswith a program that does not.The researchers will also studywhether women retain theinformation two months afterthey learn it.

Kalman expects this work to takeplace this spring in the rural areasaround Binghamton and inSyracuse, and to involve hercolleague, assistant professorMargaret (Meega) Wells.

Eventually, the researchers wantto study whether education canimprove the way women respondwhen they experience signs of apossible heart attack. StewartFahs says, “having knowledgedoesn’t necessarily change yourbehavior. But if you don’t havethe knowledge, you’re unlikelyto change.”

Kalman says once theeducational program is perfected,the researchers will exploremethods of sharing theinformation. Three years agowhen they embarked on theresearch, they envisioned CURB or FACTSS on refrigeratormagnets. Now they like the idea of internet or mobiletelephone apps. ™

2 U p s t a t e H e a r t & V a s c u l a r N e w s W i n t e r 2 0 1 2

F o c u s o n W o m e n

t e a C H i n g w o m e n a B o u t H e a rt at ta C k m ay S aV e l i V e S

B e a l e rt f o r t H e S eS y m p t o m S :The heart attack symptom of crushingchest pain is classic for men, butuncommon for women, whosesymptoms are liable to be more vague.Researchers from Upstate’s College ofNursing and Binghamton Universitycollaborated on acronyms to raiseawareness of the common heart attacksymptoms for women:

f Fatiguea AnxietyC Chest discomfortt Tummy troubles (indigestion)S Shortness of breathS Sleeping difficulty

and the early warning signs ofheart attack for women:

C Chest discomfortu Unusual fatiguer Radiating painB Breathing difficulties

Melanie Kalman PhD Pamela Stewart Fahs DSN

Jennifer Denton and Karol White have never met,but they have lots in common. Neither seemed alikely candidate for a heart attack. Each was stunned to learn she needed heart bypass

surgery. Both have recovered nicely.

Their stories are not uncommon, says KristenIglesias, a nurse in Upstate’s Heart & VascularCenter. Symptoms of a heart attack are different forwomen, more subtle than those for men. “Womentend to overlook symptoms. I think they’re so busy

taking care of everything else and everyone elsethat they tend to put themselves last.”

Iglesias says many of her female patients have adifficult time relaxing and focusing on themselves.“I lay it out straight: I tell them ‘in order for you to be there for your family, you need to take care of you right now,’” — and she says that usuallyworks.

Denton and White agreed to share their stories:

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F o c u s o n W o m e n

C lo g g e d a rt e r i e S S e n d w o m e n S u Bt l e S i g n S

continued on page 4

Jennifer Denton, 57, ofBrewerton works part time as anoffice manager for a constructioncompany, and she teachesZumba exercise classes.

No one in her family has hadheart trouble, but Denton was asmoker. She started to get out ofbreath during her Zumba classbut thought that meant she wasworking harder than normal. Shewould reduce her intensity andpower through the class.

By May 2010, the shortness ofbreath troubled her enough tomention it to her doctor, whosent her to a cardiologist. Dentonhad a heart catheterization andlearned that three of her vesselswere severely blocked, which

can often lead to a fatal heartattack.

Early the next morning, Dr.Gregory Fink operated onDenton to bypass the diseasedvessels.

Within six months, she was backto teaching Zumba. And shemanaged to conquer cigarettes.“I have to attribute that to myfaith to my God, because I didpray about it,” she says. She triedquitting multiple times. Justbefore her stress test, she quit for good.

Karol White, 46, ofBaldwinsville was familiar withheart attack symptoms inwomen. She works in the health

care field as a branch managerfor GENEX, a national companythat provides cost-containmentand care management services.

But the odd sensation in herchest that developed in Octobermade no sense. “She felt athickening on her sternum, as ifa piece of Styrofoam was there. Itwasn’t painful, just odd.

White couldn’t understand it.She was healthy. She ate right,took no medications, walked fivemiles a day and had no riskfactors for heart disease.

If she rested, the sensationusually went away. Later itwould return. This went on forseveral days. When she danced

4 U p s t a t e H e a r t & V a s c u l a r N e w s W i n t e r 2 0 1 2

F o c u s o n W o m e n

S u Bt l e S i g n S continued from page 3

at a friend’s wedding thesensation returned. “I said ‘OK,something’s not right.’”

She went to her doctor. Helooked at her EKG and sent her tocardiologist Timothy Ford MD,who looked at the tracing andused a sonogram to examineWhite’s heart. He told her sheneeded to go to the hospital.

All she could think of was, “Ihave to cook dinner… I have a

dog to walk… I have thesereports...” Once admitted, shequickly learned that one vesselwas 100 percent blocked, asecond was 95 percent blockedand a third was 60 percentblocked.

Surgeon Charles Lutz MD did atriple bypass on White. She saysshe went home from the hospitalwith Lutz telling her that “My heart should last another 50 years.”

Three months after surgery,White says her life is prettymuch back to normal. She’swalking a couple of times a weekand slowly building back to fivemiles.

“It’s so surreal to me that ithappened,” White says. “I haveto remind myself that I had heart surgery.” ™

Knowing changes everything SM

www.upstate.edu/hvc

3 Accredited Chest Pain Care

3 Heart Failure Program —Silver Achievement

3 Open Heart Surgery

3 Minimally Invasive Heart Surgery

3 Robotic-assisted Heart Surgery

3 Valve Replacement and Repair

3 Vascular Surgery & EndovascularServices

3 Arrhythmia Center with MagneticNavigation Expertise

We’ve Got You Covered!

Lisa Montanaro, 50, ofLiverpool has been apatient in several hospitals

across Central New York and theUnited States because she hasbeen pacemaker dependentsince age 28. She came toUpstate for the first time this fall.

Montanaro says problems withthe sinus node in her heartsurfaced in her 20s. Sheunderwent ablation, which atthat time was an experimentalprocedure to destroy tissue thattriggered the irregular rhythm.The node was damaged beyondrepair during the procedure, andshe had a pacemaker implantedin 1989.

Leads sewn to the outside ofMontanaro’s heart have to bereplaced periodically, requiringsurgery, and her pacemakerbattery also requires changing.So she is a frequent hospital

patient. “I’ve been inMassachusetts General. I’ve beenin Long Island hospitals, theCleveland Clinic, Community-General, St. Joe’s, Crouse.” Shewon’t return to some hospitals,but she plans to come back toUpstate.

Charles Lutz MD operated onMontanaro with just threeincisions. In previousoperations, Montanero was leftwith eight incisions, more painand a longer recovery.

“This was top of the line,” shesays of her care at Upstate. “Dr.Lutz, you can talk to him. He’sgentle, he’s understanding. Andthe nurses were phenomenal.”

She was impressed by the Heartand Vascular Center, and theway beds are situated around anursing station in the post-operative area. “They sit rightthere, and they look at you. If

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P a t i e n t s F i r s t

paC e m a k e r pat i e n t C a l l S u p Stat e ‘ t o p o f t H e l i n e ’

Lisa Montanaro raves about the care shereceived at Upstate.

S m a l l w o r l d continued from page 1

you grimace or you moan or yougroan, they’re right there asking‘can we help you?’”

Montanaro offers a three-wordcritique: “Keep it up.” ™

uganda

A stress test and catheterization that revealed blockages of 70 percentand 90 percent in two vessels. “I realized I was looking at death, rightat death itself,” Bukenya says.

Charles Lutz MD operated the next day.

Bukenya is feeling much better and healing fast. His recovery includesa plan for losing weight and trimming his diet of salt and sweets. Hesays he believes in the power of prayer in healing. “I also believe thatGod works through doctors, that He gives them the brilliancy to see things and do things well.” ™

6 U p s t a t e H e a r t & V a s c u l a r N e w s W i n t e r 2 0 1 2

G o o d T o K n o w

The aorta is the body’s mainartery, carrying blood fromthe heart to all the vital

organs and throughout the body.An abdominal aortic aneurysm— written in medical shorthandas AAA — is a weakening in thewall of the aorta that causesa widening or"ballooning" of a portionof the artery itself, muchlike a blister of an old-fashioned rubberinner tube.

Aneurysms mayenlarge andrupture or breakopen. Severe andoften fatal internalbleeding results.

Rupturedaneurysms are the10th leading causeof death in menolder than 55 andthe 15th leading causeof death overall. Althoughruptured AAAs kill more than15,000 people per year, mostdeaths are preventable.

risk factors You are at greatly increased riskif you are: • over the age of 60• smoke• have a family history• suffer from high blood

pressure.

Although AAAs are morecommon in men than women,aneurysms tend to rupture at asmaller size in women. It is

therefore just as important forwomen to determine if they areat risk.

A family history is of specialconcern. Seek a screening examfrom your health care provider if

one of your family membershas had an AAA.

Symptoms Usually no symptoms

precede an AAA. Mostare found by

chanceduringroutineexamination,over thecourse oftreatment ortesting forotherailments.

Occasionally, aperson may

experience low back painor abdominal pain that couldsignal an enlarging or rupturingAAA. This requires urgentmedical attention.

diagnosis AAAs may be found when yourhealth care provider examinesyou by feeling for a prominentpulse on your abdomen (belly).Imaging studies such as anultrasound, CT scan, or MRI canhelp to confirm the diagnosisand get a more accurate pictureof the aneurysm and its size.

treatment Medication alone cannot make

an aneurysm go away or preventan AAA from rupturing. Smallaneurysms can be closelywatched over time and poselittle to no risk of rupture. If anAAA grows, the risk of rupturegoes up and it should berepaired.

Surgery is a safe, effective, anddurable procedure. Surgeonsreplace the weakened portion ofthe aorta with an artificial graftmade of strong textile orpolymer material. The graft iscarefully matched to the aortaand sewn in place withpermanent sutures.

Advances in technology nowallow vascular surgeons to repairAAAs by delivering stent graftsinside the blood vessels. Theseprocedures can be performedthrough needle punctures orvery small groin incisions whichare minimally invasive ways totreat AAA and are associatedwith a faster recovery and alower risk of complications andblood loss. Endovascular AAArepair is not appropriate foreveryone, however. The decisiondepends on the patient and theanatomy of the aneurysm.

prevention If you smoke, quit.

Keep your blood pressure undercontrol.

If you are at increased risk orhave a family history ofaneurysms, talk to your healthcare provider about a screeningexam. ™

a B d o m i n a l a o rt i C a n e u ry S m : t H e S i l e n t k i l l e rBy Michael J. Costanza MD, Division of Vascular Surgery and Endovascular Services

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G o o d t o K n o w

k e e p i n g y o u r S e l f S a f e i n t H e S u n

By Jackie Fredericks, PharmD.

You may be aware of the dangers of sunburn, but did youknow certain medications increase your risk? And this is notsimply a summertime issue. The sun shines (ok, maybe notbrightly) year-round, so your protection must continuethrough all seasons.

A variety of medications can increase your skin’s sensitivityto the sun by increasing the skin’s absorption of ultravioletlight, which releases energy and damages cells. Of course,this will occur in the area most exposed to the sun and canresult in exaggerated sunburn, with or without blistering.Multiple classes of medications — including certainantibiotics, anti-inflammatory pain relievers, anti-arrhythmics, hormones, and antipsychotics — are knownfor causing this type of reaction.

Always check with your doctor or pharmacist if you havequestions about prescription or over-the-countermedications, and use an effective form of sunscreen forprotection.

Also, make sure to read your medication’s recommendedstorage instructions. You may be asked to keep amedication in the refrigerator, at room temperature or evenin the freezer. Not following the instructions can meanyour medication loses its effectiveness. ™

C l i p - a n d S aV e

coronary intervention, which isemergency treatment that reduces the amount of heartmuscle permanently damaged byheart attack.

To become accredited, Upstatehad to:

1. reduce the time from thepatient’s onset of symptoms tothe diagnosis and treatment;

2. treat patients more quicklyduring the critical window oftime when the integrity of theheart muscle can be preserved;and

3. monitor patients when it isunclear whether they arehaving a heart attack, to makesure they are not sent home too soon.

“People tend to wait when theythink they might be having a heartattack, and that’s a mistake,” saysGregory Fink MD, chief of cardiacsurgery at Upstate. “The averagepatient arrives in the emergencydepartment more than two hoursafter the onset of symptoms, butwhat they don’t realize is that thesooner a heart attack is treated,the less damage to the heart and the better the outcome for the patient.”

Accreditation through the societyis more collaborative than othertraditional certification models.

continued from page 1

The accreditation process beginswith a document that details keyelements of optimal care. Itscontent is derived from peer-reviewed medical journals,professional society guidelines andthe body of clinical insight ofparticipating clinicians.

At Upstate, when someone arrivescomplaining of chest pain thatmay be signaling a heart attack, he

or she goes directly to the “CathLab” for a cardiac catheterization.Doctors determine if any blockagesin the arteries that feed the heartneed to be stented, or if bypasssurgery is required. This allhappens within the first 60 to 90minutes of arrival — by a hospitalstaff so skilled and knowledgeableabout treating chest pain that itearned status as an AccreditedChest Pain Center. ™

By Danielle Stegman, RD, CDN

Indulge your sweet tooth this season andtreat your heart well! This dessert ispacked full of antioxidants, vitamins andminerals, fiber, and even has omega-3fatty acids from walnuts. The darkchocolate contains flavonoids from theextract of the cocoa bean. Theseflavonoids have been linked to improvedheart health in some studies!

PREPARATION: Finely chop walnuts and almonds. Meltchocolate on low in sauce pan. Dip fruit and popcorn intomelted chocolate and set on wax paper. While chocolate isstill soft, sprinkle nuts and cinnamon on top as desired.Refrigerate to cool and serve.

U p s t a t e H e a r t & V a s c u l a r N e w s W i n t e r 2 0 1 2

newsletter StaffEditors:Karen A. Gibbs MSN, RNC, Nurse Practitioner, Cardiopulmonary SurgeryAmy Tetrault RN, Head Nurse, Cardiac Catheterization Lab Melanie Rich, Director Amber Smith, Senior EditorMarketing and UniversityCommunications Designed by Upstate Marketing and University Communications

12.0

18 0

112

300

UB

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www.upstate.edu

C e n t e r N e w s

B ro C C o l i S o u pFrom Wegmans Food Market

INGREDIENTS:1 Tbsp pure olive oil 1 pkg (8 oz) chopped onions 1 cup (4 oz) leeks, thinly sliced 1 cup (4 oz) celery, thinly sliced 1 Tbsp garlic,chopped 2 Bay leaves Salt and pepper to taste 3 Tbsp pan searing flour 2 lbs broccoli florets, chopped 2 cartons (32 oz each) chicken stock 1 container (6 oz) plain Greek yogurt Wegman’s Italian Classics Bruschette toastsMild white cheddar, shredded

PREPARATION:You will need a stockpot and a blender or stick blender.Heat olive oil in stockpot on medium. Add onions, leeks, celery, garlic and bay leaves;

season with salt and pepper to taste. Cook, stirring often, about 10 minutes, untilsoft but not browned. Stir in pan-searing flour; cook 1 minute.

Add broccoli and stock; bring to simmer on high. Reduce heat to low; continue tosimmer until tender, about 10 minutes.

Remove soup from heat. Discard bay leaves. Add soup and yogurt to blender, workingin batches, and add to another pot. Or, puree soup in stockpot with a stick blenderuntil smooth. Taste and adjust seasonings.

Garnish each serving with toast and cheese.

H e a rt a rtArtist Ludwig Stein, a professorat Syracuse University, donatedhis series of Valentine paintingsto Upstate University Hospital, inmemory of his wife, Dr. NancyJermanovich, and their 22 yearstogether.

On theirsecondValen -tine’s Day,SteinpresentedJermano -vich witha paintingwhichfeatured astylizedheart.When sheaskedwhere herpaintingwas thenext year, an annual traditionwas born. Until Jermano vich’s death in 2000, Stein presentedher with a new painting everyValentine’s Day. This one iscalled “For Your Collection.”

The collection of 22 works isdisplayed in Upstate’s Heart &Vascular Center. ™

NUTRITION:Each 1-cup serving contains 130 calories,10 grams carbohydrate, 3 grams fiber, 8 grams protein, 6 grams fat, (including3 grams saturated fat), 15 milligramscholesterol, and 460 milligrams sodium.

NUTRITION::Complete nutritional data will depend on the food you choose for dipping. One 1.45-ounce darkchocolate candy bar contains 228 calories, 13 grams of fat, 2 milligrams cholesterol, 2 milligramssodium, 25 grams of carbohydrates, 3 grams of fiber, 19 grams of sugar and 2 grams of protein.

Karen A. Gibbs

Amy Tetrault

“For Your Collection” is one of the22 painting Ludwig Stein donatedto Upstate University Hospital.

H e a rt - H e a lt H y Va l e n t i n e C H o C o l at e !™LOVE YOURHEART

INGREDIENTS:1 bar dark chocolate 1 orange4 strawberriespineappleair popped popcornwalnutsalmondscinnamonwax paper