Rogue Valley Medical Center Health Newsletter Winter 

INTHISISSUE
Pacemaker Technology. . . . . . . . . . . 2
TomoTherapy:
Pinpoint Precision . . . . . . . . . . . . . . . 4
The Silent Thief . . . . . . . . . . . . . . . . . 5
Neonatal Intensive Care . . . . . . . . . 6
Target Heart Rate . . . . . . . . . . . . . . . 8
Guacamole Recipe . . . . . . . . . . . . . . 9
RVMC Gets with
the Guidelines . . . . . . . . . . . . . . . . . . 10
ASSET Program . . . . . . . . . . . . . . . . . 11
FINDYOURTARGET
HEARTRATEstory on page 8
Community Health Education . . . . 12

CELEBRATINGAMERICANHEARTMONTHINFEBRUARY

I
magine growing younger as you age.
Reversing the forces of nature, your body
gains the strength and the vigor that
eluded you 10, 20, even 30 years ago. This isn’t
Hollywood fiction. For John Nihen it’s real
life—life with a pacemaker.
“It was like magic,” says the eighty-
one-year-old Yreka, California, resident.
“Miraculously, I felt like I was 10 years
younger after they put the device in.”
2 | To find out more about the heart program, go to www.rvmc.org, keyword: heart
John Nihen with his wife, Sharon
A Walk in the Park
John’s journey to better health began five years
ago during a stroll through a park that took
an unexpected turn thanks to a distinctive
pain in his shoulder. Having survived a mild
heart attack years earlier, John knew the
warning signs. “I began to feel similar
symptoms,” he recalls. “Once it happens to
you, you recognize it.”
Wisely, he sought medical help right
Fountain of Youth
away. Doctors at Rogue Valley Medical Center
(RVMC) quickly concluded that John was
about to have a heart attack, “and it was
probably going to be a fatal one,” John says.
Modern Technology to the Rescue
Triple-bypass surgery “fixed the plumbing—
the arteries that were clogged,” John says. He
had another lingering problem, however: The
left and right sides of his heart were failing to
communicate, causing the heart to pump out
of sync. This led to chronic weakness, fatigue,
and shortness of breath. The solution was a
specialized pacemaker called a biventricular
ICD (implantable cardioverter defibrillator).
“These devices are implanted in people
who have survived cardiac arrest or are at
higher risk of dangerous abnormal heart
rhythms,” says cardiologist David Martin, MD,
who implanted John’s pacemaker at RVMC
using minimally invasive surgical techniques.
Pacemakers work by sending electrical
signals to the heart, stimulating it to beat more
Pacemaker technology renews Yreka man’s zest for life.
Failure﹕
Read
the
Signs
normally and, if necessary, “shocking” it back
into rhythm. The patient feels no discomfort,
and advanced wireless technology transmits data
to the doctor’s office automatically, over the
phone. “Most patients find life with a pacemaker
to be good and generally like their device,”
Dr. Martin says.
“Miraculously, I felt like I was
10 years younger aer they
put the device in.”
Oregon
Cardiology
—John Nihen, pacemaker recipient
One Happy Heart
John agrees wholeheartedly. “Before the
pacemaker I could barely walk across the room
without losing my breath,” he recalls; “but
afterward it was a piece of cake. I was able to
make the peak of the park hill that I’d never
been able to climb before.”
Once a proud smoker, John is now an
advocate for healthy living. “I have to admit I
played a part in this. I started smoking when I
was eight years old, and I was overweight,” he
says, believing that although today’s technology
has largely undone a lifetime of damage, “you
really do have to take care of yourself.”
Have No Fear
For those who may be wary of the surgery, this
octogenarian has some sage advice: “Don’t be
afraid. Put your heart in the hands of the people
who know what they’re doing. It’s a whole lot
better than heart disease and a whole lot better
than dying. The
experts at RVMC
are the most
dedicated, effective
people I’ve met.
They’ve given me
the best five years
of my life.”
John Nihen
Heart
H eart failure causes many telltale symptoms. If
you experience any of these signs on a regular
basis, see your doctor for a heart health checkup:
• Shortness of breath
• Persistent coughing or wheezing
• Water retention: swelling in feet, ankles, hands,
or abdomen
• Fatigue
• Poor appetite or nausea
• Memory loss or confusion
• Heart palpitations, feelings of “racing heart”
Southern
C ardiology Consultants and The Heart Clinic
became Southern Oregon Cardiology (SOC)
on January 1, 2010. Together they will continue to
provide the same physicians, giving the same high
level of cardiac care. If you have any questions
about your heart care or about Southern Oregon
Cardiology, please call (541) 282-6606. SOC is
located at 520 Medical Center Drive, Suite 200,
Medford, Oregon 97504.
| 3
 Gallstones Gone Without Surgery Thanks to Spyglass
T
he more precise the image, the more
successful the diagnosis and the
treatment. That’s why Rogue Valley
Medical Center (RVMC) is now using Spyglass
technology for diagnosis and treatment of
gallstones and bile duct conditions.
“Spyglass is the most accurate technology
available today,” says Anthony Haulk,
MD, a board certified gastroenterologist of
Gastroenterology Consultants, who is also on
staff at RVMC.
With Spyglass, Dr. Haulk can see live
images deep inside the body as never before.
He can directly view and then remove
gallstones, which are soft, pebble-shaped
4 | To find out more about Spyglass, go to www.rvmc.org, keyword: Spyglass
objects that can cause excruciating pain and
complications from infection.
Evaluating and treating these problematic
stones formerly required open surgery,
laparoscopic surgery, or ERCP (endoscopic
retrograde cholangiopancreatography), a
technique that uses X-ray and contrast dye.
No Surgery
Spyglass is a minimally invasive, outpatient
procedure. The Spyglass is a scope that uses a
camera with a 6,000-pixel fiber-optic probe.
Dr. Haulk guides an endoscope through
the digestive system and inserts the Spyglass
through a catheter to get direct views of
gallstones. He can then place a small probe
against the stones to break them up with shock
waves without damaging the bile ducts.
“This is a tremendous advantage for us and
ultimately for the patient,” says Dr. Haulk.
What Are Gallstones?
Peter Adesman, MD, a board certified
gastroenterologist of Gastroenterology
Consultants, treats patients with gallstones
and bile duct problems almost every day.
He says that 90 percent of gallstones are made
when the liver secretes bile that is abnormally
saturated with cholesterol. The cholesterol
crystallizes to form stones that migrate into
the gallbladder or common bile ducts, growing
like snowballs until they block an exit. This can
lead to very painful gaslike symptoms, fever,
and chills. Eventually, bacteria may build up
behind the blockage, causing serious infection.
What Causes Gallstones?
Though anyone may develop gallstones,
Dr. Adesman says a high-fat diet is a big risk
factor. Gallstones are also more common in
women than in men, and generally they are
found in people over 40. Dr. Adesman advises
patients to keep their “good” cholesterol
(HDL) levels at or above 40 for men and
50 for women and their total cholesterol below
200 (see sidebar on page 10).
The Silent Thief Are you at risk of an aneurysm?
Can
I
Do?
Y
ou can know your common heart
dangers: high cholesterol, high blood
pressure, and heart disease. But a silent
thief lurks. Its name: aneurysm.
An aneurysm is a bulging “blister” on
the wall of an artery. The most serious trouble
spots are the aorta (the main blood vessel
leading from the heart) and the brain. When an
aneurysm in one of these areas bursts, it can be
life-threatening.
Finding the culprit before it ruptures is key
to surviving this dangerous condition. But here’s
the rub: “An aneurysm often has no symptoms,
no warning signs,” says Mark Eaton, MD,
FACS, of Oregon Surgical Specialists, PC.
“It’s important for people at risk to get regular
screenings.”
Heart Patients Beware
Doctors have discovered a connection between
aneurysms and heart health history. “We know
that conditions that cause the artery walls to get
thinner or weak can lead to an aneurysm,” says
Dr. Eaton. These include high blood pressure
and hardened, narrowing arteries, known as
atherosclerosis, a precursor to heart disease.
“But the latest studies show that even people
who have had surgery to correct heart problems
are at a continued greater risk,” he adds.
Veterans of coronary artery bypass graft
(CABG) surgery may be more likely to develop
an aneurysm. This surgery involves rerouting
blood flow to the heart through a new artery or
vein taken from another part of the body. The
grafted artery can develop weak spots where a
bulge can form.
What
I f you’re a member of the “CABG
club,” don’t fret. There are steps
you can take to lower your risk of an
aneurysm:
• See your doctor regularly. Your
cardiologist can monitor the arteries
and perform tests to detect weak
areas or the beginnings of a blister.
• If your doctor prescribes blood
pressure medicine, take it. Less
pressure on the artery walls means
less chance of bulging.
• The same goes for cholesterol-
lowering medication; follow your
doctor’s recommendations to
prevent plaque buildup in the
arteries.
• Exercise, eat a heart-healthy diet,
and don’t smoke.
• Contact Oregon Surgical Specialists,
PC, at (541) 282-6680 to see if you
qualify for a screening under the
medical guidelines.
| 5
 Big Care for Tiny Patients
D
iapers, car seat, sleepers, crib…
When preparing to welcome
a new baby into the world,
expectant parents have the standard
checklist covered. But before making the
inaugural trip home, one item is essential
to a newborn’s safety and well-being:
expert medical care.
The Neonatal Intensive Care Unit
(NICU) at Rogue Valley Medical Center
(RVMC) provides round-the-clock support
for newborns in need. The NICU team
recently welcomed a fourth neonatologist,
Jacqueline Wilk, MD, enhancing its
already unwavering quality of care for
the tiniest patients.
A Mother’s Touch
“It is a beautiful thing to help a sick baby
recover and go home with their family,”
says Dr. Wilk. As the mother of a four-year-
old son, she brings a parent’s compassion
to the job, working tirelessly to heal and
Jacqueline Wilk, MD
6 | Read more about the Neonatal Intensive Care Unit at www.rvmc.org, keyword: Neoatology
Jacqueline Wilk, MD,
strengthen her patients. Yet she is never too
busy to connect with anxious families and
ease their fears. “I encourage them to ask a
lot of questions,” she says. “We’re more than
happy to talk with them and give them any
supporting information we can.”
It was this personal touch that drew
the NICU team to Dr. Wilk. “We hunted
for quite a while before we found the right
person to join us,” says Lee Harker, MD,
neonatologist and chair of the Women and
Children’s Department at RVMC. “Having
a new neonatologist fresh from her training
program helps us be sure we stay on the
leading edge of care. Yet at the same time,
we feel very strongly it’s not just the ability
to be a qualified physician but the personal
qualities that make a difference.”
Baby Boom
Increasing the pool of physicians in the
NICU affords a dual advantage: it not
only allows the team to continue providing

Supports
joins the Neonatal Intensive Care Unit.
RVMC
NICU
24/7 care as the patient population grows but also
gives the doctors more time to provide educational
outreach to birth centers that refer babies to
the NICU.
When the unit opened in 1972, one physician
and a nurse practitioner oversaw the babies’ care.
“It’s a beautiful thing
to help a sick baby recover and
go home with their family.”
—Jacqueline Wilk, MD
Since then RVMC has become known throughout
the region for its neonatal expertise. As patient
volumes have risen steadily, so has the need for
more doctors. On average the NICU is home away
from home to as many as 18 babies a day; over the
next five years, that number is expected to grow
to 25.
CMN
the
Peace of Mind for New Parents
Why deliver at a birth center with a neonatal R ogue Valley Medical Center
(RVMC) is grateful to
Children’s Miracle Network for
intensive care unit? “We can’t always predict ahead
of time which full-term babies will need specialized supporting children’s health
care,” says Dr. Harker. Only about 50 percent programs in our communities.
of the RVMC neonatal patients are anticipated This nonprofit organization raises
premature or high-risk infants. The others are full- funds for 170 hospitals throughout
term or late preterm babies born with unexpected the United States and Canada,
championing the cause of hope
complications or illness. Although these cases are
rare compared with the majority of normal, healthy and healing for the smallest
births, choosing a patients.
birth center with
a NICU can offer RVMC offers the only inpatient
peace of mind. “It’s pediatric department, neonatal
always preferred to intensive care unit, maternal fetal
deliver at a center medicine clinic, and pediatric
with neonatal oncology services in southern
intensive care Oregon and northern California.
instead of having to Children’s Miracle Network
be moved to it,” Dr. funds support RVMC for vital
Harker says. “It’s medical equipment, programs,
better for the baby services, training, and charity
and the family.” care for children.
| 7
 Tortoise or Hare: Target Heart Rate in Exercise
Y
ou’re halfway through your morning
jog. Soaked in sweat, panting for
air, you have a fleeting wish to stop
at the nearest Starbucks for a breather and
a latte, but you press on, spurred by the
exhilaration of a successful run. Or is it?
“Overdoing it when exercising can
actually cause more harm than good,” says
Laura Imperia, cardiac rehab nurse and
fitness guru. “When you push too hard,
you’re not providing enough gasoline to
your muscles. You lose power and strength,
and soreness and fatigue set in.”
So what’s a body to do? Take the
talk test, Laura says: “Exercise at a level
of intensity where you can still hold a
conversation. That means your oxygen
needs are being met.”
In scientific terms the goal while
exercising is to maintain your target heart
rate, which is between 55 percent and
85 percent of your maximum heart rate.
Laura Imperia
8 | To find out more about recovering from a heart aack, go to www.rvmc.org, keywords: cardiac rehab
To calculate, follow this simple formula:
220 minus your age, multiplied by 0.55
to 0.85.
For example, for a healthy 40-year-old,
the target heart rate is between 99 and
153 beats per minute:
220 – 40 = 180 (maximum heart rate)
180  0.55 = 99
180  0.85 = 153
Keep in mind that these numbers are
for the average person. Target rates may
be lower for heart patients or higher for
hardcore athletes. Talk to your doctor to
determine what’s right for you.
When you sense you’re redlining
your heart rate gauge, Laura recommends
slowing or stopping until your breathing
returns to normal. “Better to slow down
and go a little longer. The tortoise won the
race in the end.”
A Healthier Guacamole
Diet advice and a recipe from Nichole Hanks, RD, Diabetes Education, Rogue Valley Medical Center
C
ardiovascular disease is the nation’s
number one killer. Since 1963 the
American Heart Association and
the U.S. Congress have recognized February
as American Heart Month. They urge
Americans to learn more about heart
disease and to make lifestyle changes to
be heart-healthy.
You can do this by keeping up your
good exercise habits, including lots of non-
starchy vegetables and fiber in your diet,
and using good portion control with all the
rich food available.
This doesn’t mean you can’t eat food
that is delicious. Here is a recipe that
includes all the flavor of a good guacamole,
with beans for fiber and fewer calories. It is
still smooth and appetizing: and if served
with baked chips, your Mexican meal can be
heart-healthy. Enjoy during the Super Bowl!
GUACAMOLE
INGREDIENTS INSTRUCTIONS
1 cup frozen lima beans (preferably mature) • Boil the lima beans for 5 minutes, then drain
and rinse with cold water and let cool. Pat
1 medium tomato, chopped
beans dry with a paper towel and remove any
1 medium ripe avocado skins that come off when pinching each bean.
3 tablespoons lime juice • Drain the chopped tomato in a colander.
¼ teaspoon salt • Purée half the avocado with the lima beans,
¼ cup minced fresh cilantro lime juice, and ¼ teaspoon salt until smooth.
1 jalapeno, minced after seeds and stem removed • Cube the remaining avocado and mix together
with the purée, tomato, cilantro, jalapeno,
1 tablespoon minced red onion onion, garlic, and cumin. Add salt and pepper
1 clove garlic, minced to taste.
½ teaspoon ground cumin • Add the avocado pit and cover with plastic
wrap to keep the dip from discoloring.
Black pepper and salt to taste
Remove the pit when you are ready to eat.
✃
Serves 4. Per serving: 140 calories; 7.5 grams fat;
13.5 grams carbohydrates
For more healthy recipes, go to www.rvmc.org, keyword: recipes | 9
 Know
Your

RVMC Gets with the Guidelines Heart

Numbers

F M
or two years running, the American Heart Association has aintaining good cholesterol, blood
granted its Get With The GuidelinesSM Gold Performance sugar, and blood pressure levels can
Achievement Award—the highest designation—to the help thwart a heart aack. Aim for these
skilled team of cardiac experts at Rogue Valley Medical Center numbers, measured in milligrams per
(RVMC). This means when you or a loved one is suffering a heart deciliter (mg/dL):
attack, RVMC is the place to be.
“In the complex hours and minutes of treating a heart attack, • Total cholesterol: Less than 200 mg/dL
we have a system for making sure every patient is treated with
• LDL (“bad”) cholesterol: Less than
high-quality, consistent, proven methods of care, no matter when 130 mg/dL (or 100 for people at risk
you come in—weekends, nights, holidays, all the time,” says of heart disease)
Brian Gross, MD, cardiologist with Southern Oregon Cardiology.
• HDL (“good”) cholesterol:
This precision team, made possible by the ASSET (Acute ST-
Women: Men:
Segment Elevation Task Force) program, involves the coordinated More than 50 mg/dL More than 40 mg/dL
effort of paramedics and hospital staff throughout the region.
• Triglycerides: Less than 150 mg/dL
Compared with national standards, ASSET RVMC saves more
patients in less time than other hospitals. • Fasting glucose (blood sugar): Less than
“It’s like any team sport—the more you play together, the 100 mg/dL
more you practice, the better you are,” says Dr. Gross, adding that • Blood pressure: Less than 120/80 mmHg
the heart patient is a vital player in the process. (millimeters of mercury)
Don’t waste time driving yourself to the ER, Dr. Gross says.
Dialing 9-1-1 activates the ASSET program’s chain of lifesaving Source: American Heart Association
events. Paramedics alert the cardiac catheterization team at
RVMC, charting a beeline to rapid, outstanding treatment.

10 | Read more about GWTG at www.rvmc.org, keyword: Guidelines


a
Part
Asante Foundation Supports ASSET
Your
Community
W A
ho is the key player in the ASSET
program’s success? You—the patient.
By knowing the signs of a heart attack
and when to call 9-1-1, you can trigger the medical
attention that saves lives. That’s why generating
awareness of heart attack symptoms is so important.
Over the past three years, the Asante Foundation
took this project to heart, helping spread the word
about heart attack and how to recognize one.
Funded through a Health Resources and
Services Administration (HRSA) grant from the U.S.
Department of Health and Human Services, the
Foundation conducted community presentations,
teaching people about the ASSET program and
how to detect the signs of a heart attack. Working
with ambulance services in Josephine County, the
Foundation educated rural residents about the
importance of calling 9-1-1 to improve the transfer
time between Three Rivers Community Hospital and
Rogue Valley Medical Center (RVMC) when needed.
“ASSET is an amazing project, and the partners
deserve great recognition for the work they have
done,” says Sandra Olson, retired director of research
Become
of
and development for the Asante Foundation. sante is a community-supported
“We were happy to support it by building greater organization. To support the
awareness.” work of Rogue Valley Medical Center
HRSA was equally impressed. Following a site or Three Rivers Community Hospital,
visit by federal representatives, Sandra recalls, “They to honor someone, or to learn about
were absolutely incredulous about this project and its planned gis, contact the Foundation
outstanding results. We should be very proud of this in Medford at (541) 789-5025, in
locally built program.” Grants Pass at (541) 472-7300, or
The Asante Foundation is dedicated to online at www.asante.org—click on
improving the health and the wellness of our make a donation.
community. To learn how you can help, call the
Foundation at (541) 789-5025.
What Is the ASSET Program?
ASSET (Acute ST-Segment Elevation Task Force)
is an agreement among five local hospitals and
eight emergency ambulance services to immediately
route heart attack patients directly to the RVMC
Emergency Department, where they go straight to
cardiac catheterization. Since 2003 this program
has saved more than 800 lives and helped patients
maintain their quality of life.
To make a gi, go to www.rvmc.org, and click on “Ways to Help” | 11
Asante Community
NONPROFITORG
Health Education Series USPOSTAGE

PAID
PERMITNO


EBARNETTRD MEDFORDOR
MEDFORDOR -

Come. Learn. Enjoy.
Discover healthy living at our ongoing
Community Health Education series. For a
monthly calendar, visit our Web site:
www.rvmc.org/classes-events

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contact Asante Communications and Marketing at
(541) 789-4241. Articles in the RVMC Your Health newsleer are
intended for general information only and should not be construed
as medical advice or instruction. For diagnosis and treatment of
specific conditions, consult your physician.

© Asante Health System.

All rights reserved. No part of this
publication may be reproduced in
any form except by prior wrien
RVMC

permission. Printed with soy ink

on recycled paper. ♼

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