Health Connection - April 2021

Treating AFib: The Most Common Arrythmia

By Sujoya Dey, MD, FACC

The timing of your heartbeat is regulated by a complex network of electricity which starts in the sinus node, the heart’s natural pacemaker. When there is a dysfunction in the heart’s electrical system, this results in an abnormal heartbeat, or arrhythmia. If the heart beats more slowly than normal, it’s called bradycardia; if it beats faster than normal, the condition is called tachycardia. An irregular heartbeat is also known as a flutter or fibrillation.

While most arrhythmias do not cause complications, some can increase the risk of stroke or heart attack. By far the most common of these is Atrial Fibrillation, or AFib, a tachycardia which affects an estimated 2.7 million Americans.

Atrial Fibrillation (AFib)
As your heart beats, the top chambers of the heart, or atria, contract and push blood into the bottom chambers, or ventricles. In atrial fibrillation, coordination with the ventricles is disrupted due to electrical abnormalities in the pulmonary veins of the left atrium. This causes the atria to beat chaotically and irregularly. Symptoms may include heart palpitations, weakness, and shortness of breath, although some people never experience symptoms at all. AFib is episodic for most people and the irregular heart beat sometimes stops on its own:

• Paroxysmal AFib is when symptoms begin suddenly but spontaneously resolve within several hours to 7 days
• Persistent AFib lasts for more than 7 days, and sometimes requires treatment
• Permanent AFib is continually present (for 12 months) and does not respond to treatment

Stopping an AFib Episode
There are two approaches to treating atrial fibrillation. One is to control the heart rate in a strategy called rate control, and the other is to restore the heart’s normal rhythm in a strategy called rhythm control. Medications can be used to control heart rate and rhythm. Procedures called cardioversions and ablations are often first line therapies to restore the heart back into its natural rhythm.

AFib and Stroke Risk
In AFib, blood clots tend to form in a small pouch of the left atrium of the heart called the left atrial appendage (LAA). If a clot breaks off and travel through the blood stream, it can block blood flow in the brain and cause a stroke. For this reason, people with AFib must take anticoagulant medication (blood thinners) to reduce the likelihood of clot formation.

Treating AFib
Treating AFib is highly personalized and individualized to patient’s age, health lifestyle, and additional risk factors. One or more of the following modalities may be used:

• Drug therapy. Sodium and/or potassium channel blockers may be used to keep the heart rhythm stabilized. Blood thinners are prescribed to discourage clot formation.
• Catheter Ablation targets the tiny section of heart tissue that’s disrupting the heartbeat, applying energy to that spot to terminate it.For this minimally invasive procedure, an interventional cardiologist inserts a catheter into a blood vessel in the groin and threads it up to the heart using electro anatomic mapping. Once the catheter reaches the defective area of heart tissue, the troublesome cells are destroyed using radiofrequency waves, extreme cold, or a laser.
• Device therapy (WATCHMAN or Lariat) can be used to close off the LAA. This therapy does not reduce the incidence of AFib: It is used to reduce stroke risk by preventing clot formation in the LAA.
• Lifestyle modifications. There area variety of lifestyle changes that can reduce the frequency of AFib episodes. MarinHealth Medical Center offers an innovative lifestyle management program called Get into Rhythm: Living Well with Atrial Fibrillation (AFib). Get into Rhythm provides education, counseling, and integrative healing modalities to help participants avoid triggering an episode, and live healthier lives. A physician referral is required to enroll. For more information, please call 1- 415-927-6157.

Learn more about AFib and the world-class cardiovascular care delivered at MarinHealth’s Haynes Cardiovascular Institute.

A One-time Procedure that Reduces Stroke Risk for Life
Even after a successful ablation, AFib may recur. People need to remain on blood thinners to reduce stroke risk. For those who live an active lifestyle, and/or experience side effects from blood thinners, a device called the WATCHMAN FLX could be a long-term solution. The WATCHMAN FLX device is implanted via a catheter through a vein in the thigh and guided up to the heart. Then, the device is positioned to close off the left atrial appendage. The procedure is done under general anesthesia and typically takes about an hour. Over the next six weeks, heart tissue grows over the WATCHMAN implant. Patients continue to take a blood thinner for about 45 days, until their left atrial appendage is permanently closed off.

In a clinical trial, 96% of people were able to stop taking blood thinners 45 days after getting WATCHMAN FLX. MarinHealth Medical Center was one of the first hospitals in the nation to be granted the use of the original WATCHMAN implant as it was still in the pipeline for FDA approval. The device has been in use in Europe since 2005 and more than 100,000 WATCHMAN procedures have been performed worldwide, with excellent outcomes.

Listen to Arun Raghupathy, MD, FACC's Healing Podcast discussing the Watchman procedure as an alternative to blood thinners for AFib patients.

Sujoya Dey, MD, is an Electrophysiologist at MarinHealth Cardiovascular Medicine | A UCSF Health Clinic and Medical Director of Electrophysiology at MarinHealth Medical Center.

Give Your Children a Healthier Future by Vaccinating Against Cancer

By Anjuli Basu, MD

When you think about what causes cancer, the first thing that pops into your head is probably smoking. You may also be aware of the risks of a high-fat, low-fiber diet, alcohol dependency, or exposure to carcinogenic chemicals. But did you know that roughly 45,400 new cancers diagnosed each year are linked to the human papillomavirus (HPV)?

The most common HPV-associated cancer is cancer of the cervix, but the virus is also linked to cancers of the vulva, vagina, penis, anus, and oropharynx (back of the throat, tongue, and tonsils). While smoking and alcohol consumption are also implicated in oropharyngeal cancers, HPV is thought to be the cause of 70% of such cancers in the United States. In fact, HPV-positive oropharyngeal cancer is rising swiftly among white men in the US. Thanks to the development of the Gardasil vaccine, parents now have the ability to protect their children from developing these cancers in adulthood.

An estimated 79 million people in the United States are infected with HPV. In fact, genital HPV is the most common sexually transmitted infection in the US. According to the Centers for Disease Control and Prevention (CDC), 80% of sexually active people will become infected with the virus at some point during their lives―at least four out of every five women by age 50 as well as an as-yet undetermined number of men. Because HPV often has no symptoms, most people with HPV don’t even know they have it. There is no treatment for an HPV infection.

While one’s immune system usually clears up HPV within a couple of years, the infection sometimes lingers, and can cause precancerous changes known as dysplasia. If these abnormal cells aren’t found and removed, they can become cancerous. About 10% of women with a cervical HPV infection develop long-lasting HPV infections that can lead to cervical cancer.

Gardasil 9 is the only vaccine that helps protect your son or daughter against nine different strains of HPV that can cause cancer in adulthood. That’s why the CDC recommends vaccinating both boys and girls around age 11 or 12, when they are scheduled for inoculation against meningococcal disease and tetanus, diphtheria, and whooping cough. The HPV vaccine is recommended by numerous groups, including the American Cancer Society, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

Receiving the Gardasil vaccine at 11 or 12 protects the child before teen years, when sexual experimentation is common. The HPV virus can be transmitted through sexual contact of many kinds—actual intercourse is not necessary for transmission. To your son or daughter, the Gardasil vaccine is just another shot the doctor needs to give them. To you, it’s an insurance policy that will protect your child from certain cancers for the rest of their life.

Anjuli Basu MD, is a board-certified internal medicine and pediatric care provider at MarinHealth Primary Care | A UCSF Health Clinic in Larkspur.

IBS – The Inside Story

By Ripple Sharma, MD, FACG

April is IBS month, the perfect time to examine this common syndrome that affects between 25 and 45 million Americans – roughly one person in five.

Irritable bowel syndrome, more commonly known as just IBS, is a functional gastrointestinal (GI) disorder that affects the large intestine. Patients with irritable bowel syndrome can have other problems like bloating, gas, or wanting to poop more often. IBS is caused by changes in the nerves that control sensation and motility of the bowel, which can present as abdominal pain, bloating, and changes in bowel patterns. IBS can be worsened by stress and anxiety. Remember, IBS is a real medical condition, but it is not life threatening, and will not lead to other serious diseases.

The symptoms of IBS can range from mildly annoying to disabling, affecting a person’s self-image, social life, and ability to work or travel. There are three different types of IBS, all of which present with abdominal pain associated with bowel movements as well as bloating, and sometimes, mucous in the stool.

1. IBS with constipation (IBS-C), as the name indicates, is characterized by infrequent bowel movements, with hard or lumpy stools. You may have to strain to have a bowel movement, and you may feel like you still “have to go” when you are done.
2. IBS with diarrhea (IBS-D) is characterized by diarrhea and urgency. In addition to loose stools, one may experience nausea, abdominal pain, bloating, and gas.
3. IBS with mixed bowel habits (IBS-M), is the most common type of IBS and presents as constipation alternating with diarrhea.

Treating Irritable Bowel Syndrome
IBS is a chronic condition, and most patients will go for long periods time without symptoms. Irritable bowel symptoms or flares can often be managed by changes in lifestyle, the type of food one eats and working on coping mechanisms for stress. Some changes in the diet can help and are safe to try. Working with a multi-disciplinary team including your primary care physician, gastroenterologist and dietician can help one come up with an effective treatment strategy.

For patients who have a lot of bloating, try to slow down how fast you eat, do not overeat and avoid drinking carbonated drinks can introduce gas into the bowels and may cause belly pain.

For patients with changes in bowel habits, a gastroenterologist may recommend dietary changes, starting a fiber supplement or a particular prescription medication to help with symptoms.

Psychological stress makes it harder to live with any condition, including IBS. Some people will feel better with practicing relaxation techniques and participation in regular exercise or a hobby. Acupuncture may be helpful in managing anxiety and pain perception. Therapeutic massage can also have a relaxing effect. Both of these integrative treatments are available at MarinHealth Integrative Wellness Center.

IBS symptoms are not caused by psychological disorders and are definitely not “in one’s head,” but cognitive behavioral therapy can help relieve symptoms for some people with irritable bowel syndrome.

There are several medications that can be used to treat the symptoms of IBS. Smooth muscle relaxants reduce intestinal cramping, antidiarrheal medications or laxatives are useful, depending on the type of IBS you have. There are specific neuromodulators and antibiotics that may be part of the treatment regimen. If you are experiencing significant symptoms from irritable bowel syndrome, please meet with a gastroenterologist to discuss your symptoms.

If you regularly experience abdominal pain, bloating, constipation or diarrhea, or have unexplained weight loss or vomiting, talk to your doctor to see if IBS could be the culprit. With proper treatment and lifestyle changes, most people can reduce troubling symptoms and effectively manage their condition. For help finding a doctor, click here.

Ripple Sharma, MD, FACG is a board certified gastroenterologist with particular interests in liver and inflammatory bowel diseases, along with colon cancer screening and prevention.

Comfort Food Goes Healthy: Some Smart Substitutions

By Pam Riggs, MS, RDN, CSOWM

• Pizza: Add fiber to this family favorite by using a whole wheat or cauliflower crust, available in the frozen food section of your supermarket. Top with a variety of colorful veggies, sliced olives and Canadian bacon (a lower in fat option to pepperoni). Of course, you’ll also want to add some pizza sauce and part skim shredded mozzarella. Just read the label on any packaged sauce, since many of them can be high in added sugar.
• Macaroni and Cheese: Make whole wheat pasta noodles the mac in your Mac & Cheese. Another option is to use cauliflower (which also makes a healthier fettuccini Alfredo). Reduce the fat content by using low fat cheese, or try a stronger flavored cheese that will provide the taste you crave with a smaller amount.
• Chili: Use extra lean ground turkey instead of beef or make your chili vegetarian. The addition of beans is a great way to add lots of fiber and reduce the overall fat and calorie content. And don’t forget that adding diced, cooked vegetables like peppers, onions, and mushrooms, provides a nutrient and flavor boost.
• French Fries: Oven-baked sweet potato fries are a delicious and nutritious alternative. You can find many easy recipes for these on the web. For something ever closer to the real thing, try “frying” shoestring potatoes in an air fryer for a delicious and satisfying crunchy that rivals your favorite drive-in.
• Mashed Potatoes: White potatoes do have some nutritional value as they are rich in potassium, but the butter and cream typically added to this comfort dish can make it a nutritional nightmare. Use skim milk or a little low-fat ricotta instead and mix in some baked or fresh-minced garlic for a flavor boost. You can also skip the potatoes and try a mashed cauliflower recipe instead.
• Loaded Baked Potato: Instead of all that bacon, butter, and cheese, try topping your potato with low fat sour cream or Greek yogurt and chives. Add broccoli or spinach to get your dark leafy greens. The more “loaded” and colorful it is, the more satisfying you’re likely to find it. And remember, opting for a sweet potato instead of your standard Idaho Russet will add more fiber, calcium, and vitamins A and C to your diet.
• Mexican food: Whether you’re having tacos or tostados, choose corn tortillas over wheat. Corn tortillas have half the calories and twice the fiber of wheat tortillas. Experiment with fish, shrimp, or chicken fillings. Go easy on the cheese, nix the rice, and skip the sour cream, or replace it with plain Greek yogurt. Enjoy more healthy fixings instead, like shredded cabbage, black beans, fat-free refried beans, homemade salsa, lettuce, and guacamole. Of course, you can always skip the tortilla and whip up a tasty burrito bowl instead.
• Chocolate Chip Cookies: Just the act of baking can be a comfort for many people, and there’s no need to give it up. Look for healthier add-ins, such as oatmeal or dried fruit. And experiment with using less sugar. In many recipes, you can reduce the sugar by up to 25% and still get delicious cookies. Try replacing an egg in your recipe with a mix of ground flaxseed and water (1 TBS flax to 3 TBS water = 1 whole egg). You’ll boost the fiber and omega 3 fat content of your cookie recipe!
• Pasta: Whole wheat noodles are not your only option for a healthier take on pasta. You can choose from a variety of gluten-free pastas made from chickpeas, rice, quinoa, or blended grains. Or, you can try using spaghetti squash or zucchini noodles as substitute for pasta. Just keep in mind that a serving of pasta is far less than you might think – just two ounces or about a cup of cooked pasta. That’s often half of what you might be served in a restaurant!
• Chicken Pot Pie: Load your pot pies with extra veggies, leave out the bottom crust, and top with a flaky, fat-free crust. Ready-made phyllo dough can be used for low-fat, flaky top crust.
• Burgers: There are a variety of switches you can make for healthier burgers. For starters, use a whole wheat bun. If you’re cutting carbs, skip the top bun, or try a lettuce wrap. Buy the leanest ground beef patties you can find or switch to extra lean ground turkey. Or, try one of the new plant-based meat substitutes – they taste just like the real thing! Try hummus as an alternative to mayonnaise, skip the cheese, and replace that tasteless iceberg lettuce with more nutritious greens like romaine, spinach, or arugula.
• Alcoholic Beverages: Many American adults – especially women – have increased their alcohol consumption during the pandemic, including drinking to greater excess and with greater frequency. It’s time to take a hard look at whether you’re drinking more than you should, and consider dialing back. If you’re concerned about gaining weight or overindulging, you can find hundreds of delicious mocktail recipes on the web. It’s easy to improvise if you have sparkling water, lemons, and limes on hand.

The bottom line is that occasionally we all may feel the need to indulge in some comfort food. So when that times comes for you, remember to be mindful. Eat slowly, taste every single bite and make a few healthy swaps if possible. This will allow you to enjoy a little treat without the guilt.

Pamela Riggs is a Registered Dietitian Nutritionist at MarinHealth Integrative Wellness Center.