Beating Heart Disease
Hospitals Work Together to Provide Emergency Care for Rural Citizens
by Ed VanHoose
When former elementary school teacher Ann Rawlings of Waverly began to experience back pain, she attributed it to her love of sewing. After all, she spends much of her free time bent over a sewing machine.
So she ignored it.
When Ann began to have occasional heartburn, she attributed it to her new diet plan. When she couldn’t complete a walk with her husband, John, she ascribed it to being out of shape. After all, she was just beginning a new workout regimen to satisfy a resolution to lose a few pounds.
So she ignored both of those signs, too.
But when Ann returned from a walk that brought on pain, “like an 18-wheeler running over my chest and my shoulder blades” she could no longer ignore it.
Ann was having a heart attack.
Stories like Ann’s have become increasingly common in the United States. According to the American Heart Association’s 2009 publication entitled Heart Disease and Stroke Statistics, “[a]n estimated 80,000,000 American adults (one in three) have one or more types of cardiovascular disease (CVD), of whom 38,100,000 are estimated to be age 60 or older.”
When asked about the cause of the increase in the amount of heart disease in the United States, Dr. Marc Shelton, President of Prairie Cardiology in Springfield says, “The two biggest factors contributing to heart disease are obesity and smoking. Americans lead a much more sedentary lifestyle than even our recent ancestors, but we still eat the same amount.”
Dr. Shelton went on to discuss ways to combat obesity.
“There are many diets out there on the market. I think some of them have it wrong. The basic thing to remember is to eat reasonable size portions. I suggest people avoid overcomplicated diet plans. All of those cards and counting can get overwhelming. Right now I’m recommending the “No White” diet. It’s easy to remember, and effective. You simply don’t eat any foods that are white,” Shelton Says.
Paula Harwood, Supervisor of Prevention and Cardiopulmonary Rehabilitation at Memorial Medical Center also stresses the importance of exercise. “You should try to get in at least an hour of exercise each day. Even if it’s just to go for a walk, get up and move around.”
In Ann’s case, she had actually begun an exercise program, but the blockage was already too severe. “I just didn’t pick up that this would be happening to me because even though I’ve had high blood pressure, I don’t really have a cholesterol problem, so it was just such a surprise to find out I had two blockages. One was a 100 percent blockage and the other was 80 percent.”
Fortunately for Ann, Illinois has a program called Prairie STAT Heart which claims to be one of the first in the country to focus on streamlining emergency care. The program strives to meet the national goal of providing treatment within 90 to 120 minutes from a patient’s arrival at the community hospital. This insures that the patient located in the rural community receives emergent heart care as fast as or faster than patients in larger urban areas.
Since the launch of the Prairie STAT Heart Program in December 2004 in Springfield, Ill. and in August 2007 in Carbondale, Ill., the program has served 358 patients in the central part of the state and 24 patients in southern Illinois who suffer from ST-elevated acute myocardial infarctions (the worst kind of heart attack).
The challenge in rural communities has been to quickly determine which patients were having the worst kind of heart attacks and then to mobilize the transportation system and receiving hospital to move the patient to an experienced cath lab.
The cath labs at St. John’s Hospital and Memorial Medical Center in Springfield and Memorial Hospital in Carbondale employ highly specialized treatments and devices to provide the highest level of care in emergency situations.
For Ann that meant within minutes there was a rescue team at her door to transport her to Memorial Medical Center in Springfield.
“After John called the rescue squad, it seemed like they never did get here. But you know, when you’re in pain your perception of time is off. I had never felt anything like that. I’ve had three children and believe me, childbirth wasn’t anything to that. It was just too awful. So I was happy when they got here, but they were trying to figure out how to get a stretcher into our house.”
Ann resides in a split-level house with stairs immediately at the entrance.
“I told them ‘Don’t worry about it!’ ‘I’ll walk!’ And, I walked out to the front and got on the cart and said ‘Now, let’s get going!”
The rescue squad that picked Ann up immediately contacted Memorial and arranged to meet an ambulance en route. The ambulance met the rescue squad in a residential area and then took Ann the rest of the way to Memorial.
“Once I was in the ambulance, the paramedic started in on me with oxygen and blood pressure and gave me nitro. That slowed the pain down a little, but not enough. When we got to the hospital everything moved very quickly. I heard a man say, ‘Mrs. Rawlings you’re having a heart attack. We’re going to the cath lab. Then they ran. They took my cart and just ran to the cath lab. I arrived at 8:30 p.m. and by 10:30 I was done and in my room upstairs. It was a really quick response.”
Many patients recovering from heart-related illness are concerned with the level of activity they will have after the event. Ann found herself immediately beginning rehabilitation and even enjoying it.
“I started rehab the very next week. The first time you go, you have a consultation with Paula. She explains everything you’re going to do. It’s funny, but I’ve never been on a treadmill. I had been walking at my own pace, and when the treadmill started it was so slow that I almost fell on my face! I take a lot of kidding from the other patients about that. I’m mastering it now though, since they increased the speed.”
Throughout the rehabilitation program, patients are monitored and encouraged, not only by the staff, but by each other.
Ann says, “You kind of get to know everybody and help each other. If we forget something, someone is always quick to point out, ‘You forgot to stretch!’ I like to kid some of the men because they don’t like the stretching. I always tell them they’re cheating. It’s just the teacher coming out in me.”
When asked about her plans for the future, and the impact that the program has had on her Ann says, “After my heart attack, I’m just like normal. I just thank God and everybody involved that I’m like that. You come home and you’re thankful for the simplest activities like seeing your grandchildren. I might not have been doing that. So these people, from right here in town, all the way to the hospital – I am thankful for them all.”
FIVE “F’s” FOR HEART HEALTHY EATING
When implementing a heart healthy eating lifestyle, many may believe that you must completely renovate your eating habits. But by making a few changes as outlined below, you can jumpstart into a lifetime heart healthy eating plan.
The next time you are in the baking aisle or organic foods aisle at the grocery store, hunt down a bag of ground flaxseed meal. Sprinkle one tablespoon on your cereal or in your yogurt, soup or applesauce to get the valuable omega-3 fats. Omega-3 fats are natural anti-inflammatories that also improve blood flow and interfere with blood clotting. Aim for five tablespoons each week.
The American Heart Association (AHA) recommends eating fish, especially the oily kind, at least twice a week. Try to find ways to add fish to your healthy eating lifestyle as long as it is not deep fat fried. Your goal is 8 ounces of fish, preferably salmon, tuna or sardines, each week.
Your body needs fat for many important functions, so a healthy eating plan includes some fat. However, you must watch the type of fat you choose. Saturated fats and trans fats may raise your risk of heart attack and stroke, because they increase the “bad” LDL cholesterol in your blood. Conversely, unsaturated fats lower your risk because they decrease your LDL cholesterol and maintain a protective level of “good” HDL cholesterol. So, replace saturated and trans fats with unsaturated fats – monounsaturated and polyunsaturated. Best strategies to use here:
- Use olive, canola or peanut oil in cooking.
- Enjoy nuts in small portions.
- Choose soft tub margarine over stick margarine, solid shortening or butter.
- Consume only three-ounce portions of lean red meat – pork, ham, beef, lamb – up to four times a week or less.
- Limit processed meat such as bologna, wieners, bacon, sausage and pepperoni.
- Choose fat-free or low fat dairy products.
We should be getting at least 25 grams of fiber daily, but most of us don’t even reach half of this each day, so we have some work to do here. The type of fiber isn’t so important as both soluble and insoluble fibers are linked to lower risk of heart disease. The best way to get a jump on fiber is to eat a high fiber cereal (5 grams or more per serving) each morning. Add flaxseed meal, fruit and a few nuts to boost the fiber higher. The array of high fiber cereals is vast with one to suit most everyone. If you aren’t crazy about cereal for breakfast, eat it as a snack later in the day. Whole grain foods – bread, crackers, brown rice, whole wheat pasta, and so on – are the best sources of fiber. Check out the food label looking for at least a 3 gram fiber allotment per serving. Fresh fruits and vegetables also provide some fiber.
This slogan was used during a campaign by Produce for Better Health several years ago to get us to consume five servings of fruits and vegetables daily. It has since been replaced with the slogan “fruits & veggies, more matters” with recommendations to eat 2 cups of fruit and 2½ cups vegetables daily. Regardless of the slogan, we need to get fruits and veggies in as part of a heart healthy lifestyle. These foods provide many nutrients and fiber as well as disease-fighting phytochemicals – natural substances that work as a team to protect our health. Only fruits and vegetables, not pills or supplements, can provide all these nutrients together. Make it simple: fresh/dried fruit on cereal and juice at breakfast; vegetable salad at lunch; fruit for snack; vegetables at dinner.
There are many other strategies to use to get a jump into a heart healthy eating lifestyle, but if you can start with these five, you will be well on your way to a lifetime of good health.
Sara Lopinski, MS, RD, LDN
Center for Living at St. John’s Hospital
Steps for Preventing Heart Disease
The Illinois Department of Health in its Heart Disease and Stroke Prevention
Program urges Illinoisans to:
- Build physical activity into your family’s routines and playtimes.
- Support and encourage daily, quality physical education in all school grades.
- Reduce time spent watching television and other sedentary behaviors, such as computers or
- Create more opportunities for physical activity at work.
- Eat five to nine servings of fruits and vegetables each day.
- Consume reasonable portion sizes. (Avoid “supersizing.”)