Pregnancy and the heart

Waiting for a baby. Close-up of pregnant woman touching her belly while sitting in lotus positionHeart disease is not always a disease of the elderly. According to the American Heart Association, there are over 15,000 deaths due to heart disease annually in the U.S. in young women under the age of 55.

While most young patients have at least one risk factor for a cardiac event, many women underestimate their cardiovascular risk. These risk factors may come from family history, lifestyle, and unique to female patients: conditions that developed during pregnancy.

Major changes happen to the body during pregnancy to which the heart and vascular system must adapt. We now know that pregnant women can develop conditions which may signal a risk for heart problems in the future.

Conditions that have been linked to future heart risk include:

  • Gestational hypertension
  • Gestational diabetes
  • Preeclampsia
  • Spontaneous pregnancy loss
  • Preterm birth

The good news is there is plenty you can do to minimize your heart risk before, during, and after pregnancy. Here are a few tips to note when you’re trying to get pregnant and to ensure you have a heart-healthy pregnancy.

Eat heart-healthy

During pregnancy it’s more important than ever to have a balanced, heart-healthy diet. In particular, avoid excess salt and minimize your caffeine intake. Consider using OHSU’s My Pregnancy Plate as a guide on optimal nutrition during pregnancy.

Maintain a healthy weight

Weight gain is normal during pregnancy and the healthy amount can vary person to person. Talk to your OB at the beginning of your pregnancy to determine the optimal weight gain for you.

Exercise

As is the case outside of pregnancy, regular exercise is vital to cardiovascular health. Moderate exercise is typically okay for most pregnant women but discuss the specifics with your doctor.

Talk to your doctor

Make sure to discuss any medications you are taking with your doctor prior to pregnancy. If you have an existing heart condition, talk to your cardiologist before getting pregnant. Many women with repaired congenital heart disease can have a safe pregnancy, but the risk depends upon the person. Body changes can cause an increase in symptoms, even for women without preexisting problems, so it’s important for patients with a heart history to be monitored by a cardiologist throughout pregnancy.

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Dr. AAbigail, Khan_15 (CAR)bigail Khan is a cardiologist at the OHSU Knight Cardiovascular Institute focused on caring for adults with congenital heart disease and women who are pregnant or contemplating pregnancy and have existing heart problems. Her role as a cardiologist guiding these young women is an important one given that risk factors for heart disease are rising for women under 45, and pregnant women may have additional cardiovascular concerns.

At OHSU, a mother’s passion inspires

OHSU seems to run in the family for four of the six Mansoor siblings, and it all started with their mother, Salma.

Steven Mansoor, M.D., Ph.D., David Mansoor, M.D., Lori Mansoor, L.C.S.W. and André Mansoor, M.D. all work in different capacities at OHSU and three are graduates of the OHSU School of Medicine.

Their mother is no longer with them, but her passion for helping people, for science and for family is reflected in her children’s lives.

“Our family story at OHSU all started with her,” Steven said.

Her kids remember her as a very scientifically-minded person who wanted to be a physician but gave up her career to raise them.

Salma (pictured third row from the front, far right) posing with a group during her training at OHSU in 1972

Before that, Salma worked as a lab technician, and she did her training at OHSU.

Salma encouraged her kids to pursue careers in medicine. She fostered an interest in math and science in them, all the while nudging them toward helping professions.

Steven is the eldest of the siblings who went into medicine. A physician scientist, he has a cardiology fellowship at the Knight Cardiovascular Institute and serves as a Postdoc in the Gouaux Lab, where his research revolves around the structure and function of purinergic receptors. Steve has been affiliated with OHSU since 1996.

David, an assistant professor of Psychiatry, focuses on geriatric medicine. His practice includes a combination of dementia care and adult psychiatry, seeing patients with age-related psychiatric disorders linked to memory, cognitive impairment, depression and anxiety. He enjoys the complexity of care that goes into caring for older patients.

Lori says it was always her goal to work at OHSU because she knew about it from such a young age. She enjoyed visiting her brothers on campus while they were studying and wanted to be close to them – since she started in 2015, she’s been able to do just that, even meeting her brother at the OHSU Farmers Market for lunch during her orientation. Lori works with people who struggle with mental health and substance abuse issues as a therapist at the Avel Gordly Center for Healing, a culturally-specific counseling center.

André, the youngest of the Mansoors, is an assistant professor of Medicine. Like his brothers, he attended the OHSU School of Medicine and did his residency at OHSU. As a hospitalist, he cares for patients with a variety of medical problems.

André remembers his mom’s passion for connecting with people in need through her work with Meals on Wheels. It was that same desire that drove him to pursue medicine.

“I wanted a career that would allow me to establish similar relationships,” he said.

The Mansoors’ mother was diagnosed with cancer and passed away in 2001 knowing that Steve and David had been accepted to the OHSU School of Medicine.

Steven, David, Lori and André are continuing their mom’s caring legacy and, like her, they continue to place family above all else. Steven and David lived together when they were in med school and André and Steven even did OB rotation nights together. The entire family gathers at their father’s home every Sunday for dinner and the siblings meet for lunch on the hill when they can.

“We’re a close-knit family,” Lori said. “We support each other with success and we’re vocal with one another about the things we love.”

“It all really began with our mom’s dream to help people,” Lori said. “OHSU will always be special to us.”

Ten things you need to know about our outstanding nurses

It’s National Nurses Week and we are proud of our hardworking nurses for the excellence they bring to their work each and every day.

Here are just a few things you might not know about our nurses and the amazing work they do here at OHSU.

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Be a leader, a scientist, a teacher — a nurse. All at OHSU. We are hiring nurses for a variety of clinical areas. Learn more at ohsu.edu/nursingjobs

Top five reasons to volunteer at OHSU

volunteer-weekIn 2015, more than 1,300 people volunteered their time at OHSU to help advance the boundaries of medicine, improve patients’ quality of life and share their genuine passion for serving our community in Oregon and beyond.

There are several reasons people choose to volunteer at OHSU – to gain work experience, to help save lives, to give back to a place that’s made a difference in their own lives. Every now and then, a friendly critter also gets the calling to help make a difference!

This National Volunteer Week, I rounded up five of the top reasons to volunteer at OHSU:

1. Make a difference
One of the top reasons to volunteer is to make a positive impact in others’ lives. It’s about giving back to our community and the people in it.

2. Be part of the discovery
Year after year, there are extraordinary breakthroughs in research influenced by the support of OHSU’s volunteers. Volunteers are provided with a multitude of free training and lecture series available to grow their knowledge base and light the way to new discoveries.

3. Gain professional experience
Interested in gaining experience in research or healthcare? Volunteering at OHSU provides the perfect opportunity to gain experience in any field. Whether that experience may be observing cavity fills in the School of Dentistry, developing patient interaction skills by entertaining children in the OHSU Doernbecher waiting areas or finding patients eligible to enroll in research studies, there is opportunity for everyone to get involved.

4: Become an active member of the community
OHSU’s expansive outreach programs throughout the state of Oregon provide the unique opportunity to get involved in the community, either on OHSU’s campus or at one of our affiliate partners.

Live in the Salem Area? Check out how you can volunteer at Salem Health.

5: Develop long-lasting connections
Volunteering at OHSU provides the incredible opportunity to shape and form connections with some of the most talented professionals in the world. OHSU’s sheer number of talented students, professors, doctors, nurses and numerous other professionals help to foster an environment of professional and personal growth.

Please join me in thanking the amazing volunteers here at OHSU – we’re very lucky to have them!

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sean-robertson

 

Sean Robertson is a volunteer digital marketing promoter for Research and Academic Volunteer Services and also volunteers with The P.O.L.A.R.I.S Research Team in Pediatric Hematology Oncology, as well as the Cord Blood Donation Program

 

 

Interested in volunteering?
Find out how to get started with Healthcare or Research and Academics.

Ask the expert: Should I take aspirin to prevent a heart attack?

This week you may have seen news headlines touting aspirin as a way to prevent heart attacks. But does that apply to you?

OHSU experts are cautioning against a run to the pharmacy until you know whether you meet the specific criteria required to benefit from the regimen. Many people with existing heart disease are advised to take a low-dose aspirin every day to prevent blood clots, the cause of heart attacks and most strokes. Whether healthy individuals should do the same to prevent heart attack and stroke, known as primary prevention, has been up for debate.

The news coverage this week comes from new guidelines released by a government panel of experts outlining who would benefit from taking daily low-dose aspirin for primary prevention.

In order to benefit from an aspirin regimen, according to the U.S. Preventive Services Task Force, healthy men and women must meet a strict list of criteria — including a high risk of heart disease and a low risk of bleeding side effects.aspirin

Specifically, the group recommends that adults in their 50s, who have a 10 percent or greater risk of developing cardiovascular disease, are not at risk for bleeding, and have a life expectancy of at least 10 years take a daily low-dose aspirin to prevent heart attack, stroke, and also colorectal cancer.

According to OHSU cardiologist Dr. Michael Shapiro, “These new recommendations reflect a greater consensus regarding a narrower role for aspirin in the primary prevention of cardiovascular disease. In other words, one must exceed a certain threshold of risk for a vascular event, and this must be balanced by risk of bleeding, in order to benefit from daily low-dose aspirin.”

He added, “There is now recognition that statins are by far the most effective and safest agents for primary prevention. Statins are safer than aspirin by an order of magnitude.”

Our experts agree that low-dose aspirin is still an extremely effective therapy for secondary prevention and should be recommended routinely to heart disease patients if they have a low risk of bleeding.

Be sure to check with your doctor if you’re wondering if low-dose aspirin is right for you, and before starting any new medication. Learn more about the best ways to prevent heart disease at the Center for Preventive Cardiology at the OHSU Knight Cardiovascular Institute.

Caring for athletes at the U.S. Olympic Training Center

olympic_signWith the 2016 Summer Olympics just a few months away, Olympic-bound athletes are hard at work preparing for their events.

Many of these athletes are training at one of three U.S. Olympic Training Centers.

Recently Jacqueline Munch, an orthopaedic surgeon in OHSU’s Sports Medicine program, served a two week rotation at the U.S. Olympic Training Center in Colorado Springs, CO.

She answers a few questions about her experience:

1. What was your role at the Olympic Training Center?

I was the primary care and orthopaedic sports medicine doctor in charge of care for the athletes. I volunteered with a physical therapist and a massage therapist, and we worked alongside the on-site staff, including physical therapists, athletic trainers, and chiropractors.

The Olympic Committee sports medicine staff depends on volunteer medical providers to diagnose and treat athletes at the training center.

2. How did you get this opportunity?

I did my fellowship in Sports Medicine and Shoulder Surgery at the Hospital for Special Surgery (HSS) and my fellowship director is an Olympic team physician.

As his fellow, I got a window into the world of sports medicine for Olympic athletes.  He wrote a letter in support of my application as a volunteer.

3. What types of athletes did you treat?

I worked with the men’s and women’s wresting team, the men’s gymnastics team, paralympic swimmers, shooting athletes, modern pentathletes and men’s and women’s weightlifters.

Figure skaters practiced off-site, but presented on occasion to the sports medicine department for treatment or therapy.

team at desk4. What kinds of injuries did you see and treat?

Probably the most common problems that I saw were shoulder-related issues, especially with the gymnasts where there are such strong forces put on the shoulders. I also saw a variety of overuse injuries.

Fortunately, none of the athletes suffered any major injuries during my rotation.

What did you most enjoy during your volunteer rotation?

Watching the men’s gymnastics practice – these athletes were working so hard and were doing such amazing things. I also really enjoyed getting to know the athletes as actual people, not just as elite athletes.

The athletes I met were dedicated, hard-working, down-to-earth people.

5. What did you learn working with Olympic athletes that will be useful for your treatment of patients at OHSU?

At the Olympic Training Center, I had immediate exposure to the mechanism of injury, as I was seeing injuries right after they happened.

Working in this environment also exposed me to new techniques for injury rehabilitation, as I got to work side-by-side with the therapists on site.

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pete_dahlgren

Pete Dahlgren is the Project Coordinator for the Department of Orthopaedics and Rehabilitation which is dedicated to diagnosing and treating common and complex bone and joint illnesses, injuries and diseases.

Your cardiologist is in the kitchen

If you are a patient at the OHSU Knight Cardiovascular Institute some typical questions you might ask your cardiologist could include:

How is my blood pressure?
Should I be concerned about my cholesterol?

But how about…
What should I cook for dinner?Kaul_cooking

As part of the institute’s Heart Protection Kitchen cooking demonstrations, OHSU cardiologists are trading stethoscopes for aprons to show off their hidden talents in the kitchen.

Usually led by OHSU’s executive chef along with a registered dietitian, our healthcare providers are periodically stepping in to cook heart-healthy meals for their patients.

The “Your Doctor Will Cook for You Now” series recently kicked off with a class taught by Dr. Sanjiv Kaul, CEO of the OHSU Knight Cardiovascular Institute. His goal was to teach attendees how to cook a traditional Indian meal that is low in saturated fat and sodium while high in fiber.

On the menu:

  • Chicken and Broccoli, Kashmiri-style
  • Daal (mixed beans and lentils), Punjabi-style
  • Red Cabbage, Bengali-style

In addition to his recipe instruction Dr. Kaul gave health tips for cooking at home, such as using dried beans instead of canned to avoid added salt. His most important piece of advice: cook more! According to him, it’s the best way to know exactly what’s in your diet and avoid unnecessary saturated fat and sodium.

Check out the full schedule of cooking classes on our website, and try out Dr. Kaul’s Kashmiri-style chicken and broccoli recipe below!

Chicken and Broccoli, Kashmiri-Style

Makes 6 servings

Ingredients

6 bone-in chicken thighs

1 large head of broccoli, trimmed into florets 2-inch long and 1-inch wide

2 tablespoons mustard oil (if not available, any other vegetable oil can be used except olive oil)

6 cloves

6 peppercorns

3 crushed cardamom pods

1-inch cinnamon stick, crushed

1 bay leaf, broken into 6 pieces

2 heaping teaspoons fennel powder

1 heaping teaspoon ground ginger

1 heaping teaspoon ground turmeric

½ teaspoon salt

½ teaspoon Kashmiri cayenne chili powder (if not available, mix ½ teaspoon regular chili powder with 1 teaspoon paprika)

Boiling water

Preparation

Preheat oven to 350˚F.

Coat a baking sheet with nonstick spray. Place chicken on the prepared baking sheet and bake for 20 minutes. Remove from oven. When chicken is cool enough to handle, remove and discard skin and trim away any fat. With a pointed knife, poke 4 to 5 holes in each chicken thigh; set aside.

Heat mustard oil over medium heat in a skillet or saucepan. When oil is hot, add cloves, peppercorn, cardamom, cinnamon, and bay leaf. Stir for 1 to 2 minutes then reduce heat. Add fennel powder, ginger, turmeric, salt, and chili powder, and stir for 2 minutes.

Add enough boiling water to the mixture to fill the pan 1 inch deep. Stir and raise heat back to medium to bring the mixture to a boil. Place chicken in the pan and cook for two minutes. Turn the chicken over, then add broccoli to the pan with the chicken. Reduce the heat and cover with a tight lid. Allow to cook for 10 minutes, and then stir so that the broccoli is immersed in the liquid. Cook for another 15 minutes on low heat.

Nutrition information (per serving): 177 calories, 9 grams total fat (2 grams saturated fat, 5 grams monounsaturated fat, 2 grams polyunsaturated fat, 0 grams trans fat), 69 mg cholesterol, 290 mg sodium, 496 mg potassium, 8 grams total carbohydrate, 3 grams fiber, 2 grams sugar (0 grams added sugar), 16 grams protein

Life after breast cancer: Discovering the new normal

For survivors, completing treatment and becoming cancer-free doesn’t mean their journey is over. At this year’s Komen Breast Cancer Issues Conference, Sue Best, L.C.S.W., M.S.W., of OHSU’s Palliative Care Team, will lead a panel of experts from across Oregon to answer the question: “What does the new normal look like after breast cancer?”

Here are three topics attendees can learn about at the conference:

  1. For some, the physical and mental effects from treatment can linger or become permanent. Learning how to cope with the new ways your mind and body have changed can be challenging. It’s hard to be the person you were before because of the lingering physical and emotional issues you’re dealing with. Learn new ways to alleviate common physical issues post-treatment and how to navigate through the many emotions one encounters post-treatment.
  2. It’s normal to be afraid of recurrence. Making healthy lifestyle choices and learning what works for you and your body is key to keeping yourself healthy and stress-free after treatment.
  3. Don’t assume life will go back to the way it was before diagnosis. Re-entry into everyday life is a lot more difficult than most people anticipate. A cancer diagnosis completely affects your life and the lives of your friends and family. Becoming cancer-free doesn’t erase that history. Remember that everyone copes with life after diagnosis differently – there is no right or no wrong way; it’s whatever way works best for you

Learn more
“Life After Breast Cancer: Discovering the New Normal” is scheduled as the closing session for the annual Komen Breast Cancer Issues Conference on Saturday, March 5. A limited number of registrations will be accepted beginning at 8 a.m. For more information, visit the Komen Breast Cancer Issues Conference website.

Bringing hand therapy to Ghana

Each year, the American Association for Hand Surgery selects a single applicant to receive the Vargas International Hand Therapy Award.

The purpose of the award is to foster an exchange of educational ideas between hand therapists in the AAHS and in the host country, resulting in improved patient care for upper extremity problems.

The 2015 winner of the Vargas Award was OHSU’s Adam Crelling, a Certified Hand Therapist in the Department of Orthopaedics and Rehabilitation.

Adam shares his story:

adam2Education and the sharing of knowledge are the fundamental objectives of The Vargas Award. As the 2015 recipient of the award, I was able to help fulfill these objectives during my 2 week visit to Komfo Anokye Teaching Hospital (KATH) in Ghana.

The focus of my trip was to help continue to educate the local physiotherapists on evaluation and treatment techniques of hand and upper extremity cases.

With the hopes of providing a more dynamic team approach, Dr. Lana Kang, an orthopedic hand surgeon from New York City, and I were able to arrange travel times to visit KATH that were overlapping.

This allowed us to simultaneously educate and reinforce new practices and procedures across the local care team (surgeons, residents and physiotherapists). Additionally, we were able to model effective collaboration between the surgeon and therapist.

In order to help local therapists better understand alternative therapeutic techniques, emphasis was placed on “co-treating” patients. Significant time was spent reviewing the mechanism of injury, the structures involved, neuro-anatomy, surgery performed, treatments and goals.

A variety of custom orthoses were fabricated. Local therapists were able to observe the construction and application of these devices.

Throughout the 2 week volunteer trip, I had the unique opportunity to directly participate in patient care while working alongside local therapy providers.

With the Vargas International Hand Therapy Award offered by AAHS, the Ghana Hand Therapy Program as well as other international missions they support will continue to successfully grow. It was an honor and true pleasure to have been awarded the 2015 Vargas Award.

Savor the flavor of eating right

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All too often, I hear from patients that in order to eat “right,” they have to give up everything that tastes good. I wholeheartedly disagree! First of all, nothing is off limits on a healthy diet, but there are certainly foods to enjoy in moderation (such as highly processed foods).

That leaves a plethora of plant foods that are packed with both flavor and nutrients. For those who feel that eating well means eating cardboard, I encourage you to try these three tips to heighten your enjoyment of healthier meals.

1. Eat seasonally.
Eating produce at the peak of freshness significantly improves the flavor and the nutrients. Anyone who has tried a tomato in February knows that it doesn’t compare to a red, juicy tomato in August.

If you’re feeling limited with fresh produce options this winter, try frozen fruits and vegetables, which are often even more nutrient-dense than fresh because they are harvested in season and frozen immediately (rather than being shipped fresh from many, many miles away).

2. Broaden your recipe repertoire.
Trying to modify your old recipes to be healthier is usually a step in the right direction to eating more healthfully, but just leaving out the fat or sodium often leaves the meal rather tasteless.

Try out new heart-healthy recipes that incorporate herbs, spices, or vinegar to season the meal and are brimming with whole foods such as vegetables, fruits, whole grains, legumes, and nuts. I love Million Hearts as a source of heart-healthy nutrition information and recipes, along with 28-day meal plans that include recipes and grocery lists.

You can also look for new cookbooks at the library to get some fresh ideas.

3. Eat mindfully.
Sometimes, we tend to eat in autopilot, sitting at our desk or in front of the TV, only to look down and find an empty plate with no real recollection of the meal. By eating more mindfully, not only do we enjoy the food (and if I work hard to prepare a meal, I definitely want to enjoy it!) but we also tend to reduce portions which helps with weight management.

To begin practicing mindful eating, try savoring your food by putting down your fork between bites and chewing thoroughly. Focus on the meal (put down the phone and turn off the TV), slow down and recognize your body’s cues that tell you to stop eating once you feel satisfied but not stuffed.

For more tips on eating mindfully, check out this handy chart.

March is National Nutrition Month, and this year’s theme is “Savor the Flavor of Eating Right.” I hope you use these tips to truly enjoy healthier foods, making better choices because they are delicious, not just because they’re “right.”

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Tracy Severson, RD, LD, is the dietitian for the Center for Preventive Cardiology at the Knight Cardiovascular Institute. She specializes in nutrition counseling for cardiovascular health and weight management.

 

 

Why 96,000 Square Miles?

OHSU Health Fair at Pioneer Square.

President Robertson is fond of saying that OHSU has a 96,000 square mile campus, serving Oregonians “from Enterprise to Coos Bay, from Portland to Klamath Falls.”

This blog aims to highlight that breadth. 96,000 Square Miles (96K for short) will focus on the people of OHSU, the Oregonians we serve and the ripple effect of our work in Oregon and beyond.

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