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ACCESS TO CARDIOLOGY SERVICES The
practice of cardiology has changed dramatically in the last decade. Advances in coronary angioplasty and
stent technology have markedly reduced the number of open-heart surgical
procedures performed for the treatment of coronary artery disease. Emergency angioplasty and stent deployment
have become widespread and commonplace treatments for the management of acute
heart attacks to reduce the damage from this type of event. Newer pacemaker technology (which has
resulted from advances in computer technology) now allow
patients to live much more active and normal lifestyles by adjusting the
heart rates according to activities.
Some pacemakers improve heart pump function in patients with
congestive heart failure allowing these patients to also have improved
lifestyles. Implantable
defibrillators have lessened the risk of sudden cardiac death in patients
with certain life-threatening underlying cardiac conditions. Advanced imaging techniques have been
able to identify many patients at risk of cardiac problems before the
problems actually occur. These
technologies have also placed an increasing demand for cardiology
services. The lay press has also
published information regarding many of these new technologies (for example,
see the latest issue of Time magazine for September 5th)
which has also increased patient demand for services. As a result, cardiologists nationwide
have been hard-pressed to deal with the increasing demand for services. To compound the issue, the long hours
required by the specialty coupled with the high risks of the procedures and
the associated legal liability issues, the number of cardiologists in the
country has been diminishing. The
number of new cardiologists graduating from training programs has also
dropped dramatically as the long hours and the difficulty of the specialty
have made it much less attractive for newer graduates. To make matters worse, the
reimbursement for many of these procedures has been steadily declining since
1992 as a result of Medicare physician payment reforms thus further limiting
the number of people wishing to enter into this subspecialty. Due to all of these problems, access
to cardiovascular services across the country has become severely
limited. The declared
a state of emergency in 2004 for access to these services and felt that the issue
was not going to be resolved anytime soon. The
issue of access to care certainly has not gone unnoticed at our clinic. We have never seen a higher demand for
visits and access to our services than we are noticing currently. Patients have been frustrated (as have
we) at the time it has taken sometimes to have people come into the office
for visits. Unfortunately, there
are only so many people who can be seen in a single day while trying to
maintain a quality care environment. In
an effort to deal with this increasing demand for cardiology services, our
nursing staff has been playing an increasingly active role in seeing patients
as has been true nationwide. Two
of our registered nurses are working on advanced practice nursing licensure
that will allow them to do more in-depth patient follow-ups and visits. All of our nurses are currently
assisting in routine treadmills for many of our follow-up patients. By utilizing our nursing staff more
effectively, we are attempting to see people in a more timely
manner. This also frees up the
physician to do things that only physicians are permitted to do such as
stress echocardiograms, heart catheterizations, stent procedures and
pacemaker implantations. By
planning ahead, patients can gain access to The Clinic for annual follow-ups
by scheduling these well in advance and not calling at the last minute prior
to leaving for the winter.
Follow-up visits may be scheduled many months in advance or even set
up for next year before you leave the office from your current visit. As always, should you develop symptoms
that you believe require attention, you are free to call the office to
discuss the symptoms with one of our nursing staff members who will then
assist and direct you in the appropriate direction. We are doing our best to try to
provide you with timely and quality cardiovascular care. We thank you for your understanding
and patience.
- NEW MEMBER OF OUR STAFF Cynde
Watkins joined the nursing staff at The Helena Cardiology Clinic in February
2005. She is VALVULAR REGURGITATION The
four valves of the heart are designed to allow flow of blood through the
valve in its intended direction.
The Mitral and Tricuspid valves open during diastole (the resting
phase), permitting blood to flow from the top chambers (Atria) to the lower
chambers (ventricles) and close during systole (the pumping phase). The Aortic and Pulmonic valves open
during the pumping phase permitting blood to travel to the body and lungs,
closing during the rest phase to prevent blood from flowing back into the
heart. Valvular
regurgitation is defined as backward flow of blood through a valve when it is
closed. Regurgitation is readily
and commonly seen during the echocardiogram since the development of color
flow mapping and the increased sensitivity of the ultrasound equipment over
the years. Almost always, we find
some regurgitation of the heart’s valves. This is not necessarily an
abnormal finding. We
classify regurgitation as trivial, mild, moderate, and severe with some
overlapping descriptions such as trivial-mild or moderately severe. The classification of regurgitation
requires an experienced technician with good ultrasound equipment and, more
importantly, a skilled physician to interpret the data. The technician has to be able to
obtain the proper angles and accurate measurements of such things as chamber
size and wall thickness as well as clear pictures of the valve’s
opening and closing motion.
During the Doppler phase of the ultrasound study, the technician uses
the proper settings to show the shape of the regurgitant
jet and measure the duration and velocity of the blood flow. The interpreting physician then has
the task of putting all the information together in the report and making
recommendations if any treatment is required. While
some regurgitation is significant and requires treatment, most are just
normal variants that we all have.
- Willie Wilcox, R.C.S. REMINDER: BRING LIST OF MEDICINES Keeping
accurate and current medication lists can be a daunting task to say the least
but it is imperative that each and every patient or their caregivers be
responsible for knowing what medications their doctors are prescribing,
including the dose of the medication and how the medication is to be taken
each day. Patients may have multiple
doctors all of whom are prescribing medications, therefore making it very
difficult for the physicians and nurses to keep up-to-the-minute tabs on your
medications without your help. A
simple list with the name of the medicine, dose and how
often the medicine is taken can be very easy to manage when brought to every physicians office at every visit. The list can then be updated right
there before you leave their office. Once
your list is made it should be carried with you at all times. In the event you should become ill or
need emergency services a complete and accurate list can give emergency
personnel a quick view of what some of your health issues may be. When at the doctor’s office the
list will allow the physician to make sure your medications are being taken
properly and to see what changes have been made since your last visit by
other physicians. You
are one patient keeping track of one patient’s medications. We are one clinic trying to keep track
of hundreds of patient’s medications. Your cooperation is greatly
appreciated. REMEMBER: Medication
List: “Don’t leave home without it!”
- Lisa R.
Cummings, L.P.N. |
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