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May 2, 1997     Cape Gazette
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May 2, 1997

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HEALTH & FITNESS New tests assess cardiac patients more efficiently By Kerry Kester Beebe Medical center initiated a new, statof-the-art protocol on Friday, April 25, and in less than a week, the hospital is seeing signif- icant improvement in cardiac pa- tient care. The protocol, introduced only 14 months ago, changes standard laboratory testing for those pa- tients who seek medical attention for chest pain. The laboratory test focuses changes the manner in which physicians determine whether a patient should be admitted to the hospital for ardiac care. Under the former procedure, a laboratory test called a CK-MB, measuring a muscle protein, would show whether damage had occurred to the heart muscle. If damage had occurred, the heart muscle would release this protein that could be tested in the blood. The disadvantage was that the testing would have to begin within a relatively short period following a heart attack to determine ab- solutely whether the attack had occurred. Before the new protocol, physi- cians would have less information with which to work. The result was that they would often have to make admission decisions based on clinical information, cardio- gram results and the levels of one muscle protein. New tests offer specificity The new technique adds much more specific information through adding two more muscle protein tests, Myoglobin and Troponin. The additional test procedures allow physicians more accuracy in diagnosis in a shorter period of time. "Using them all together, they're Mghly specific," said Kathleen Remain, M.D., a pathol- ogist at Beebe Medical center. Robert Jesse, M.D., director of cardiology at the Medical College of Virginia and one of those in- strumental in developing the pro- tocol, presented a teleconference seminar to Beebe Medical center practitioners on Wednesday, April 23 to explain how the new tests work. "Basically, Myoglobin is a heat protein," said Jesse. "It comes out of the dying muscle Cells fairly rapidly." The test, he said, provides car- diac.specific information. Al- though the CK-MB shows whether there is muscle damage, it lacks specificity, he said. However, when the Myoglobin and Troponin tests are combined with the CK-M B, the type of mus- cle damage is clearly marked. "Together they're able to cap- ture all the MIs [myocardial in- farctions, or heart attacks]," said Jesse. Patients get quick results Romain said the new testing can find cardiac patients who would not otherwise have been identi- fied. For example, consider a patient in the emergency room with chest pain: Outward signs indicate the pa- tient is not at high risk for having a beart attack. The electrocardiogram (EKG) is negative. The CK-MB is normal and the patient has low cholesterol. The only indicator that the pa- tient may be at high risk for heart attack is the patient's family histo- ry of cardiac problems. Before Beebe's new cardiac testing, the patient would have to be observed for long periods, sometimes without a definite di- agnosis. However, consider that the Tro- ponin test is positive. Physicians are given an early warning that the AT THE HEART OF CARDIAC CARE PART I OF A TWO-PART SERIES patient is indeed having a heart at- tack. The patient can now be actively treated. Changing the way practitioners think in terms of cardiac care is what is essential for best care, said Jesse. Previously, physicians were trained to "rule out" heart attacks. With the new testing options, the mindset needs to change to "rul- ing in" heart attacks, said Jesse. Those patients undergoing mas- sive heart attacks or are beginning to have a heart attack are readily detected with the EKG and CK- MB. The smaller heart attacks are those less likely to be discovered, particularly if the patient has few or no other risk factors. Annually, about 6 million peo- ple are admitted to U.S. hospitals for chest pain. "The bottom line is I think you need an early marker,,' said Jesse. "What you look for in these lower risk patients is, 'Is it safe to send them home?'" Tests are cost effective In addition to the new testing procedure offering better, more accurate cardiac problem indica- tors, the protocol significantly re- duces the cost of cardiac care. "'It's a big dollar item," he said. "People don't realize the amount of money we're spending, and the issue of healthcare is to do more for the people who need it," he said. For example, he said, statistics show that somewhere between $3 and $13 billion is paid out annual- ly in lost productivity, lost wages and insurance claims. That figure, he said, is for money that didn't need to be paid. "Somewhere between one and one and a half million patients were admitted...who really didn't need to be there," said Jesse. Less conclusive tests and clini- cal diagnoses led doctors to the "safe" rather than "sorry" side of the admission decision. The cost for Beebe to imple- ment the new testing procedure was minimal, said Remain, from the standpoint that the hospital foresaw new laboratory develop- ments and when it updated during the past sev'eral years, purchased the equipment that is now being used for the new protocol. "It seems to be working quite well," said Remain. '`The lab can better help the doctor make an im- portant decision in cases of chest pain - admit or not admit." o, Program on heart treatment set for May 7 The Heart Center at Christiana Hospital will of- fer a free program called "Keyholes and Lasers", pertaining to the latest advances in open heart surgery, at Shawnee Country Club in Milford. Renowned cardiovascular surgeon Gerald Lemole, M.D., will discuss two of the latest ad- vances in open heart surgery. Lemole performed the tri-state's first coronary bypass and was a member of the surgical team for the first successful heart transplant in the United States, He will discuss "keyhole" surgery, which re- quires just a tiny three-inch incision for many pro- cedures which previously re- quired much larger scars. Lemole will also discuss high-tech laser surgery for the relief of chronic angina or chest pain. "Keyholes and Lasers" will be held on Wednesday, May 7 and will begin at 7 p.m. Seating for the free one-bour program is limited and registra- tion is required. LEWOIm To make reservations, call 1-800-372-9900. Learn to use strategies to reduce or eliminate back pain Millions of Americans experi- ence back pain each year. Ath- letes, ecretaries, mechanics, and mothers require their back to per- form difficult tasks throughout the day often without consideration to posture and spine mechanics. Sixty-two percent of individuals that have experienced back pain in the past will experience back pain again. Typically, severe lumbar spine disorders are the result of recur- rent episodes of low back pain of increasing frequency, intensity, and duration. Extreme positions or maintain- ing an extreme position for a pro- longed period of time may lead to injury. The spine is composed of 24 vertebrae. The cervical (n6ck re- gion) consists of seven vertebrae, the thoracic (trunk region) con- sists of 12 vertebrae and the lum- bar or low back consists of five vertebrae. A shock absorber called a "disc" is fixated between each vertebrae or bone. This complex structure is stabi- lized by a network of ligaments and controlled by multiple layers of muscles. The spine is curved to provide a cushiony spring in addition to the shock absorbing discs. Injury to the muscles, ligaments or discs may occur during sports, work or leisure. Proper education and knowledge may help decrease the risk of injury during such ac- tivities. Posture awareness is a major part of injury prevention. Avoid- ing excessive forward bending limits strain and tension on the spinal structures. For example, when lifting a suitcase, one should bend the knees and squat rather than keep- ing the legs straight and bending forward to reach and lift the suit- Case. Another "risky" polition is sit- ring in slouched position which excessively curves the spine. A simple solution is to utilize chairs with back support or lum- bar rolls. When driving in the car, simply roll up a towel and place it to sup- port the low back. Exercise is another preventative component of back pain. General muscle strength and fitness abso stresses of work and play. In addition, exercise may help the individual control weight which affects stresses transmitted to the back, Walking, swimming and bicy- cling are examples of general strengthening and fitness exercis- es. (Please check with your physi- cian prior to starting an exercise routine.) HEALTH TOPICS GINA KONIN Gina Konin is a licensed physical therapist and athlet- ic tratne at Lewes Physical Therapy on Savannah Road in Lewes.