tri-city cardiology...leg. most patients are able to resume normal activities immediately following...

4th Quarter 2018 www.TriCityCardiology.com

TRI-CITY CARDIOLOGY

Hot Topics in Cardiology

Dr. Craig D. Robison is an Interventional Car- diologist, Board Certi- fied in Cardiovascular Diseases, Echocardio- graphy, and Inter- nal Medicine. He received his Fellowships in Cardiovascular Dis- ease and Intervention- al cardiology as well as his residency and internship in medicine at the University of Utah, Salt Lake City. Dr. Robison earned his Doctorate of Medicine

from Keck School of Medicine at the University of Southern California. He received his undergraduate degree from Brigham Young University.

High Blood Pressure Redefined for the First Time in 14 Years

Nearly half of American adults could now be classified with hypertension (high blood pressure) under new guidelines released by the American College of Cardiology and American Heart Association (AHA) in November 2017. The treatment of high blood pressure is one of the best ways to help prevent the development of cardiovascular disease. Often called the “silent killer” because there are often no obvious symptoms, hypertension accounts for more heart disease and stroke deaths than almost all other preventable causes. Hypertension also contributes to the development of cognitive impairment and dementia. There are numerous risk factors which contribute to a higher risk of heart disease in persons with hypertension. Some of these risk factors cannot be changed, such as being male, having a family history of hypertension as well as hypertension being more

common as we get older. But many of the risk factors for heart disease in persons with hypertension can be managed in order to decrease your risk of developing heart disease including cigarette smoking, diabetes, high cholesterol, obesity, low physical activity, and an unhealthy diet.According to the new guidelines high blood pressure should be treated earlier with lifestyle changes. People with readings above 130 mmHg as the top number and 80 mmHg as the bottom are now considered to have high blood pressure. High blood pressure used to be defined as 140/90 mmHg. This is the first update to comprehensive U.S. guidelines on blood pressure de-tection and treatment since 2003. The new guideline is designed to help people take steps to control their blood pressure earlier. The change also means 46 per-cent of U.S. adults are identified as having high blood pressure, compared with 32 percent under the previous definition. This does not mean that these increased persons will be placed on medications for their high blood pressure, but that we should be having more discussions about healthy lifestyle choices on focusing on what we can do in order to prevent having to use medications to treat high blood pressure.

Leaders in Cardiovascular Excellence …Where Patients Come First

4th Quarter 2018www.TriCityCardiology.com

Highlights of Changes in New Blood Pressure Guidelines

The new guidelines put blood pressure readings in five different categories:

Normal: A top number less than 120 mmHg and a bottom number less than 80 mmHg.

Elevated: A top number between 120 mmHg and 129 mmHg, and a bottom number less than 80 mmHg.

Stage 1: A top number between 130 mmHg and 139 mmHg, or a bottom number between 80 mmHg and 89 mmHg.

Stage 2: A top number of 140 mmHg or higher, or a bottom number of 90 mmHg or higher.

Hypertensive crisis: A top number over 180 mmHg and a bottom number of 120 mmHg or higher.

The impact of the new guidelines are expected to be greatest among younger people. The prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45. The guide-lines stress the importance of home blood pressure monitoring using validated devices and appropriate training of healthcare providers to reveal “white-coat hypertension,” which occurs when a person’s blood pressure is elevated in a medical setting, but not in ev-eryday life. Home readings can also identify “masked hypertension,” when pressure is normal in a medical setting but elevated at home, thus necessitating treat-ment with lifestyle and possibly medications. The new definition also eliminates the category of “pre-hyper-

tension,” which has been considered an upper reading in the 130s and a lower reading in the 80s.Other changes in the new guideline include:Only prescribing medication for Stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of ath-erosclerotic risk (using the same risk calculator used in evaluating high cholesterol).Recognizing that many people will need two or more types of medications to control their blood pressure, and that people may take their pills more consistently if multiple medications are combined into a single pill.Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient’s plan of care.For most people who find themselves with high blood pressure, however, changes in diet and exercise routine –not medications-are often all that is needed to bring those numbers back down to normal. These changes include weight loss, a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, sodium reduction, and establishment of a struc-tured exercise program. Alcohol should also be limited to no more than 2 drinks per day. It is always good to partner with your physician to establish a treatment strategy that works for you.Craig D. Robison, MD, FACC


Dr. Berkowitz is cur-rently chairman of the Department of Cardi-ology at Banner Des-ert Medical Center. He is board certified in Cardiovascular Dis-ease, Vascular Medi-cine, Nuclear Cardi-ology, Interventional Cardiology, and In-ternal Medicine. He has advanced train-ing from Columbia University and New York University, and specializes in coro-

nary and peripheral vascular disease diagnosis and management. He is one of the leading experts in the treatment of varicose veins, and founded the Tri-City Cardiology varicose vein program. Dr. Berkowitz con-sults at the Dobson, Baywood, Gilbert, San Tan Val-ley, and Scottsdale offices.

Latest Advances in VenousDisease Offers Patients the

Least Invasive Treatment Solutions

Do your legs ache, hurt, or swell by the end of the day? Do you have large painful varicose veins? For some people, varicose veins are a source of embarrassment but for many, however, these abnormal blood vessels lead to significant medical issues. Approximately 30% of the US population, or 25 million people will de-velop venous insufficiency or “venous reflux disease.” Complications such as phlebitis (inflammation), blood clots, infections, or leg ulcers can occur in those that develop advanced venous disease. There are new options for treating this common disorder that offer an outpatient, less invasive solution with quick recovery and excellent results.Normally, the job of the veins is to bring blood back to the heart and lungs. Healthy veins in the legs function as one-way valves, keeping blood moving upwards in the right direction. In people who develop venous disease, the veins dilate because of pressure from blood pooling behind defective valves, allowing blood to leak backwards away from the heart remaining in the legs. The veins become congested causing aching, throbbing, itching, burning, and swell-ing. In advanced cases, this can progress to

skin rashes, inflammation, infection, and ulceration. It is recommended that all patients with venous disease should be wearing compression stockings, participate in weight loss and exercise, and elevate the legs on a daily basis.We are proud to be one of the first Vein Centers to offer the latest and least invasive options for treating venous disease. VenaSealTM is the first catheter that does not use thermal or laser energy or chemical sclerosants. The VenaSeal catheter delivers a medical glue adhesive to close defective diseased veins. Like radiofrequency ablation, a small catheter is introduced through a small needle-stick into the diseased vein. This allows deliv-ery of small amounts of an adhesive, a clear liquid that rapidly seals the vein closed. This novel procedure is performed without the use of tumescent anesthesia, avoiding multiple needle sticks and eliminating any risk of thermal nerve injury. After a treatment the cath-eter is quickly removed, a bandage is placed over the puncture site and there is no requirement for further compression. For those individuals highly allergic there may be an increased risk of hypersensitivity such as a skin rash. After a treatment the blood in the faulty veins is immediately rerouted to healthy veins in the leg. Most patients are able to resume normal activities immediately following the procedure.If you have symptoms and suspect venous disease please talk with your doctor. The specialists at the Tri-City Vein Center can provide a comprehensive as-sessment of venous disease and develop a patient-spe-cific treatment plan.M. Joshua Berkowitz, MD, FACC, FSCAI, FSVM


Tri-City Cardiolo-gy welcomes Craig D. Robison, MD as one of its newest In-terventional Cardi-ologists. Dr. Robison completed his Cardi-ology training pro-gram at the Universi-ty of Utah, Salt Lake City. Dr. Robison is passionate about in-volving patients in the decision-making process by listening to their thoughts and

concerns and together formulating a care plan.Dr. Robison specializes in the treatment of acute heart attacks, coronary atherosclerotic disease and stent implantation using minimally invasive catheter-based techniques via the radial artery in the arm ap-proach. He also specializes in the invasive evaluation and management of heart failure and assessment of valvular heart disease.

Tri-City Cardiology welcomes Ephraim Weiss, MD as one of its newest Interven-tional Cardiologists. Dr. Weiss completed his Cardiology train-ing program at New York University Lan-gone Medical Center. Dr. Weiss believes in shared decision mak-ing and strong commu-nication between him-self, his patients and their family members.

Dr. Weiss specializes in the management and treat-ment of coronary artery disease and heart attacks using stent implantation through the radial artery. He also specializes in the treatment of peripheral vascular disease using treatments such as atherec-tomy, drug coated balloon angioplasty, and stenting to the renal, carotid and lower extremity arteries.

Tri City Cardiology Welcomes Two New Interventional Cardiologists

Partnering with CommunityBased Organizations

Tri-City Cardiology advocates to effectively connect and partner with local organizations involved in community service and community based education. Giving back to the community is important to our mission of preventative medicine and community awareness of cardiovascular conditions. We recently partnered with the Mesa Fire and Medical Department to provide education and safety information to the public. Our message focuses on the signs and symptoms of a heart attack and hands-only CPR. We also continue to work with the American Heart Association, Feed My Starving Children, Angel Tree Program, and Operation Shoebox.


Amy Kleinhans, AGNP Tri-City Cardiology

The Heart Rhythm Annual Scientific Sessions is one of the most important and influential scientific gatherings of electrophysiologists and cardiologists in the world. Amy Kleinhans presented “How does Remote Monitoring Improve Patient Outcomes” at the Heart Rhythm Society’s 39th An-nual Scientific Ses-sions in May of 2018

at the Boston Convention & Exhibition Center.Remote monitoring is a vital feature available to patients with Pacemakers and Defibrillators to ensure that these devices are working optimally for the patient’s condition. It utilizes the ability to detect and report abnormalities quickly, and allows the patient to be monitored from the convenience of their own home.Amy Kleinhans has served as faculty at the Heart Rhythm Society’s Annual Scientific Sessions, and is certified by the International Board of Heart Rhythm examiners as a Certified Electrophysiology Specialist. Amy is a Certified Adult Gerontology Nurse Practi-tioner with over 10 years of cardiovascular nursing experience. Tri-City Cardiology would like to congratulate Amy on her contributions to patient care and professional education in this area of cardiovascular medicine.

The Patient Experience At Tri-City Cardiology, patient satisfaction is a top priority and we value our patient’s feedback. Hear what our patients have to say about their experience.

I feel this is the best run and most organized department that I have been in. They always know your name, are on time, and they always introduce themselves. I have worked in the operation for 45 years as a nurse and it’s a pleasure to see such caring people. Marie

Dr. Sung is thorough in his examination and questioning of your health issues. He relates his findings clearly and his suggestions of any treatment needed. Very personable, he shakes your hand when meeting you. I never have given a 5 star recommendation for any doctor before but he is definitely a 5 and feel fortunate to be in his care. Mesa, AZ

Dr. Kahlon is exceptional. He merges knowledge, expertise, and caring to make you feel comfortable and secure. He is very well-respected by other medical professionals and has truly earned that respect. Mesa, AZ

I’ve been a patient of Dr. Ed Perlstein’s for over 17 years. He is a wonderful man, an outstanding doctor, and I have complete confidence in him. Phoenix, AZ


Customer Service Focus:• We rank in the top percentiles for patient

satisfaction• Patient Satisfaction is a top priority with

every patient • We utilize Press Ganey to compile patient

satisfaction scores Quality Care Focus:

• Million Hearts Model Participant with Medicare• Heart Stroke Recognition Program through NCQA • Accredited with Banner Heart Hospital for

Heart Failure • Particpant in Medicare’s Quality Payment Program (QPP) • American College of Cardiology PINNACLE Registry• Accredited Nuclear, Echo, and Vascular Labs with ICANL,

ICAEL, and ICAVL

Jacob Green, MD

Jay Shechter, MD Praneet Sharma, MD

Loan Nguyen, MD

Hicham El Masry, MD

Todd Perlstein, MD

Satya Atmakuri, MD

Kai Sung, MDJoshua Cohen, MD

Arman Talle, MD

Arun Kolli, MD

M. Josh Berkowitz, MDJaskamal Kahlon, MD

Kelly E. Guld, MD

Ephraim Weiss, MD

Sreedivya Chava, MD

Craig Robison, MD

James Del Giorno, MDThomas Ritchie, MD

David Kassel, MD

Duane Heinrichs, MD

Ryk Linden, MDEd Perlstein, MDMark Stern, MD

Established in 1979, Tri-City Cardiology has become widely known for its progressive and innovative approach in the specialty area of cardiovascular disease. Our Vision at Tri-City Cardiology is to be among the best providers of cardiovascular care in the entire country.

Our practice consists of 24 board certified physicians coming from some of the top medical universities and fellowship programs in the country. Our sub-specialty programs include Echocardiography, Nuclear Cardiology, Peripheral Vascular, and Interventional Cardiology; and each is led by a board certified cardiologist. Our Electrophysiologists are board certified in Clinical Cardiac Electrophysiology. The physicians at Tri-City have been frequently recognized as “Top Doctors” in the Phoenix Magazine, an honor ranking them among the best physicians in the Phoenix Metro area.

Visit us online at www.TriCityCardiology.com


Making some small substitutions in your favorite dishes can not only save you calories during your celebration, but also those left over meals you may be eating the following week. It only takes an extra 500 calories per day to gain 1 lb. in a week!

Mashed PotatoesCook only half the potatoes you normally would and substitute cauliflower. Simply cook 1 or 2 heads of cauliflower and blend in with the potatoes, season as usual.

Sweet PotatoesUse butternut squash in place of the sweet potatoes. Add cinnamon and a pat of butter or dollop of sour cream to make them sweet and creamy.

Canned Cranberry Sauce Ditch the canned. Buy a bag of fresh cranberries. In-stead of using a whole cup of sugar as stated in the directions, use 1/4 cup of sugar and sweeten with Stevia and orange zest.

Green Beans with Creamed Soup and Onion StringsSaute fresh green beans with slivered almonds, onions, and butter.

Gravy If prepping ahead of time, place the gravy in the freezer or fridge so you are able to skim off the fat.

Stuffing Instead of regular bread, there are multiple varieties that are reduced calorie or low carb breads. Add in extra celery, raisins or apples.

Egg Nog Egg Nog can have over 350 calories per serving. Try cinnamon-apple flavored tea or orange-spiced tea with a cinnamon stick. You can also substitute soda water with a splash of cranberry instead of alcohol.

The holidays can be a struggle for weight loss, so focus on weight maintenance. Enjoy your favorite holiday foods in moderation, go for an extra walk and food journal if it helps keep you focused on your portions of food.

Heather Duquette-Wolf, R.D., C.S.S.D.

1520 S. Dobson Rd., Ste 209, Mesa, AZ 85202 • 6750 E. Baywood Ave., Ste 301 & 506, Mesa, AZ 852063530 S. Val Vista Dr., Ste 103, Gilbert, AZ 85297 • 36543 N. Gantzel Rd. Bldg. 15, Ste. 101, San Tan Valley, AZ 85140

8765 E. Bell Rd., Ste 110, Scottsdale, AZ 85260

Vein Center6402 E. Superstition Springs Blvd., Ste 114, Mesa, AZ 85206

8765 E. Bell Rd., Ste 110, Scottsdale, AZ 85260

Main Phone: (480) 835-6100 • Central Fax Number: (480) 461-4243

Website:www.TriCityCardiology.com www.TriCityVeinCenter.com

The physicians and staff at Tri-City Cardiology look forward to providing patients and their families with very good care and service.

Multiple Convenient Locations

tri-city cardiology...leg. most patients are able to resume normal activities immediately following...

Documents