[music plays] [no dialoge] >>Lori Banks: Coming up next on Being Well, Interventional Cardiologist Dr. Jeffrey Goldstein is here from Prairie Heart Institute to talk about a serious but not widely known condition called abdominal aortic aneurysm.
We'll talk about the causes, symptoms and treatment options, and most importantly what you can do to prevent it from happening in the first place.
Stay tuned for this informative program that could save your life.
[music plays] Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.
Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.
Proper health is important to all at Sarah Bush Lincoln Health System.
Information available at sarahbush.org.
Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.
More information online, or at 347-2255.
>>Singing Voices: Rediscover Paris.
>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.
Paris Community Hospital Family Medical Center.
HSHS St. Anthony'’’s Memorial Hospital, delivering health care close to home.
From advanced surgical techniques and testing, to convenient care for your family.
HSHS St. Anthony'’’s makes a difference each and every day.
St. Anthony'’’s.
Where you come first.
[no dialogue] Hello, and thanks for joining us for Being Well.
I'm your host, Lori Banks.
And today we have a new guest on the show, Interventional Cardiologist Dr. Jeffrey Goldstein.
Thanks for coming by.
>>Dr.
Jeffrey Goldstein: Thanks for having me.
>>Lori Banks: Well tell us first of all, what is an interventional cardiologist do?
>>Dr.
Jeffrey Goldstein: Well what I like to tell my patients is I'm a plumber.
So, interventional cardiologist specializes in opening blockages in arteries.
So, as far as the heart's concerned, an interventional cardiologist deals with patients who have hard artery blockages, so that may be patients who present with angina, or chest pain, or patients who present with a heart attack.
And for those patients we have a lot of minimally invasive procedures that we can do to open those blocked arteries, therefore the plumbing.
But I'm an interventional cardiologist that specializes in endovascular and vascular medicine, so I have a special interest in plumbing or blockages throughout the body.
So, I also not only take care of blockages in the heart arteries, but also in the carotid arteries, the aorta, arteries of the lower extremities, really all over the body.
>>Lori Banks: Alright, and we should also mention that you're with Prairie Heart Institute based in Springfield.
>>Dr.
Jeffrey Goldstein: Springfield, Illinois.
>>Lori Banks: And you see patients in Effingham and here in Charleston, correct?
>>Dr.
Jeffrey Goldstein: Yes, ma'am, yeah.
>>Lori Banks: Alright, so you make the rounds.
So, when we were talking to you about doing this topic, you know, we'd say "What would you like to talk about?"
And you suggested abdominal aortic aneurysm.
Why did you want to pick that?
>>Dr.
Jeffrey Goldstein: Well, it's abdominal aortic aneurysm is one of the most frequent place to have an aneurysm.
Maybe we should start with what is an aneurysm, and it's an enlargement or an abnormal out-pouching or enlargement of a blood vessel.
So, the normal abdominal aorta is about two centimeters.
So, once it gets 150% or one-and-a-half times its normal size, it's called an aneurysm.
So, once it's three centimeters or greater, it's an aneurysm.
So, back to why this is an area of my interest, aneurysms are quite common.
And they are usually asymptomatic, meaning you don't have symptoms, until they rupture.
And if they do rupture, most people do not survive.
So, it occurred to me a few years ago, boy, we are just not identifying every patient with aneurysms, and we're not treating them appropriately.
So, as part of my vascular practice, I specialize in diseases in the aorta, which is the main blood vessel of the body, and especially aortic aneurysms.
>>Lori Banks: Okay, I had never heard of that.
You hear of brain aneurysms, which usually are fatal.
I didn't know that they can happen, you said, really anywhere.
But the abdominal is the most common.
>>Dr.
Jeffrey Goldstein: Yes, so of the aorta, the most common place to have it is the abdominal aorta.
So, within the abdomen, you know, really between the belt line and the breast line, I guess, is your abdominal aorta, and that's where-- >>Lori Banks: How common is it for someone to have an aneurysm in the aorta?
How many people?
>>Dr.
Jeffrey Goldstein: Well it gets, it's more common in men than women.
It's more common as we get older.
The typical risk factors that predispose us to vascular disease also predispose us to aneurysmal disease.
So, high blood pressure, high cholesterol, diabetes, and worst of all, smoking.
So, in men over 65 years of age the incidence is about 5%, so that's one in 20, one in 20 men.
>>Lori Banks: That's pretty high.
>>Dr.
Jeffrey Goldstein: It's very high.
Now, if you take a man or a woman who's had a bypass operation, so coronary artery bypass graft surgery, and they continue to smoke cigarettes, their risk is 20%, so one in five.
And that's a lot of the patients that I see.
>>Lori Banks: Why are men getting it more than women?
>>Dr.
Jeffrey Goldstein: It's just one of those things.
Certain diseases are more common in men vs. women, different ethnicities, and so forth.
This is one that's more common in men.
But it's interesting, if you're a woman that has the aneurysm, it's much more likely to rupture.
So, they happen more in men, but if a woman gets it it's more likely to rupture or pop.
>>Lori Banks: And you had said earlier for people if they've had a coronary bypass, does that increase their risk of getting it?
>>Dr.
Jeffrey Goldstein: The surgery itself does not, but the risk factors that probably caused the patient to have coronary disease to the point where they need bypass are also the risk factors that predispose to aneurysmal disease.
So, if we just look at that population, it's one in five, where if we look in the general population it's one in 20./ >>Lori Banks: Okay so, and this is generally happening to our older population, so it's not really happening in younger people?
>>Dr.
Jeffrey Goldstein: No, it's less common in younger people.
Now having said that, I recently saw a 33-year-old woman who's got an aneurysm in both the thoracic and abdominal aorta.
>>Lori Banks: So, you had said it's asymptomatic.
Are there any symptoms at all that go along with it?
>>Dr.
Jeffrey Goldstein: No, that's why this is such an important thing for patients and healthcare providers to be aware of.
Abdominal aortic aneurysms are asymptomatic until they start to leak or they rupture.
So, really there's no warning sign until that happens.
And unfortunately, once that happens the risk of death is quite high.
So, once an aneurysm ruptures, 75% of people never make it to the hospital.
They die before they get to the hospital.
The 25% that make it to the hospital, half of them die within the hospital.
So, that gives you a mortality rate of close to 90%.
>>Lori Banks: That's very high.
>>Dr.
Jeffrey Goldstein: Yeah, so honestly we want to find these aneurysms before they become symptomatic, because at that point it's really too late.
>>Lori Banks: So, how does this progress along?
You've got the aorta sitting there.
How does it start to just get bigger and bigger, and what's making it do that?
>>Dr.
Jeffrey Goldstein: Well there's several theories or mechanisms as to how it happens.
But the risk factors we talk about predispose the artery to be unhealthy, okay.
And as that artery starts to grow and stretch, the wall gets thinner.
And as it gets thinner, it's weaker, and the more it stretches, and so forth.
It's kind of like that little bleb you get on your inner tube on a bike tire when you're a kid, and you'd watch it.
And you knew the bigger it got, the thinner it got, the more that your tire was going to pop pretty soon.
Same thing, as it gets bigger it gets weaker, and it starts to grow exponentially, meaning that the bigger it is, the faster it grows.
>>Lori Banks: So, if there's not a lot of symptoms, you might not know you have it.
What should someone do if they're watching, and they think well, I've kind of got some of the, I'm high risk for heart disease and things like that.
What should they be telling their primary care provider?
>>Dr.
Jeffrey: Well there's certain things, so, first of all it's so important that there's actually a law, and it's called the SAAVE Act, or the Screening Abdominal Aneurysms Very Efficiently Act.
Not a great name.
But what that act or law says is that every patient, every Medicare patient man between 64 and 75 who's ever smoked cigarettes, that's as few as 100 cigarettes in a lifetime, is eligible for a one-time screening exam at no copay, no cost to them.
Yep, so Medicare will pay for, once again, I'll just state it again, every man between 65 and 75 who has ever smoked, and also women with a family history, a first degree relative that had an aneurysm.
So, first of all those people all should get that screening, okay.
So, once you get into, once you're Medicare age, if you've smoked and you're a man, you should ask your primary care physician or any healthcare provider.
You know, your cardiologist, your primary care physician, if you're seen by a mid-level like a nurse practitioner, physician's assistant, any healthcare provider can order it.
>>Lori Banks: And what's the test called again?
>>Dr.
Jeffrey Goldstein: It's an abdominal aortic ultrasound, yep.
So, it's similar to the test a pregnant woman might get when she's pregnant.
It's using sound waves to image the aorta.
It doesn't hurt, it's not invasive, it takes less than an hour to do.
If you have a family history of abdominal aortic aneurysms, first degree relative, mom, dad, brother, sister, you should probably get that exam at age 50, okay?
So, that's the most important thing is doing the screening exam.
In fact, there's been several studies where they compared, they took that population of patients I just talked about, men 65 who have smoked, and half the group got a screening exam and half did not.
And they followed those patients over five years.
The patients who got that one screening exam were 75% less likely to die from an aneurysm.
>>Lori Banks: That's pretty good odds.
>>Dr.
Jeffrey Goldstein: It's remarkable.
>>Lori Banks: Yeah, considering 90%, you know, if they're untreated you die from./ >>Dr.
Jeffrey Goldstein: Yeah, so you know, it's hard to find any other noninvasive, inexpensive test that we have that saves lives as efficiently as that test does.
>>Lori Banks: And when did that, I had never heard of that SAAVE law, when did that go into effect?
>>Dr.
Jeffrey Goldstein: Well that's the problem.
It's been in effect for many years now, but a lot of people are not aware of it, including a lot of physicians.
And that was kind of the epiphany I had is, you know, we have this, it's free for our patients, but we're not ordering it.
And it saves lives.
So, I'll give you an example.
If you have a 5.5 centimeter aneurysm, there's a 50% chance you'll be dead in five years.
So, and that aneurysm, once again, we don't feel it, you don't know it's there unless you look.
So, by doing that ultrasound we can identify it and then treat it.
And if we treat an aneurysm electively, the mortality or the chance that you'll die is just around 2%.
LIke I told you, if it ruptures and we have to treat it, the chance that you'll die is about 90%.
So, what we want to do is we want to identify the patients at risk.
We want to do this easy screening exam, and then find the aneurysms that need to be fixed, and fix them electively where the mortality is very low, rather than when it's an emergency and almost certain death.
>>Lori Banks: So, are the majority of ones that you're treating ones that have been caught early?
>>Dr.
Jeffrey Goldstein: The majority, yes.
So, you know, what we do at Prairie Cardiovascular is we're very aggressive at screening the appropriate patients.
And not every aneurysm we find needs to be fixed today.
But like I said, they do grow.
So, once we find one, we put them in our surveillance program.
And depending on the size, let's say it's between three and four, every year we check it.
If it's greater than four centimeters, we check it every six months.
And it's agreed upon that an aneurysm of five to five-and-a-half centimeters, that's when the risk of rupture is pretty significant, and that's when it's time to fix it.
So, we identify them, we follow them, we treat the risk factors, when and if they need to be fixed we do it electively before it's an emergency.
>>Lori Banks: So, I think I know the answer, but when people, when it ruptures and people die, what's causing them to die?
Is it just massive blood loss?
>>Dr.
Jeffrey Goldstein: Exactly.
>>Lori Banks: Okay.
>>Dr.
Jeffrey Goldstein: So, the aorta is the largest artery in our body.
You know, it comes directly out of the heart, so yeah.
Once that ruptures, it's pretty quick.
>>Lori Banks: Pretty serious.
>>Dr.
Jeffrey Goldstein: Yep.
>>Lori Banks: Okay, so if you're fortunate enough to have the test and someone like you sees that there's one, and they can get in there and fix it, how do you go about fixing it?
What kind of treatment options do you have?
>>Dr.
Jeffrey Goldstein: Right, that's a great question.
So, traditionally, you know, traditionally the repair has been surgical.
And surgery's come a long way.
In fact, Albert Einstein died from an aneurysm.
He had a ruptured aneurysm, yep.
And his surgery really consisted of wrapping his aorta.
They thought they could reinforce it, so basically with something like cellophane they wrapped it.
And that wasn't enough.
His aneurysm ended up rupturing, and that's what killed him.
But what the surgeons do these days is they open the abdomen to expose the aorta, and then the diseased part of the aorta is actually opened up and a synthetic graft, so an artificial tube graft, is sewn in it's place.
Then the aorta is closed over that graft, the patient's abdomen is closed.
And that's a very good operation.
We've been doing it for a long time.
But it's a very serious operation, and there's serious complications that go along with it.
More and more over the last several years, we've been doing something called endovascular aneurysm repair, where...
It's a minimally invasive technique where, through two small needle holes in the arteries in the groin, we can advance a stint covered with a graft type material to realign and reinforce the aorta.
And what that does is it creates a new conduit or tube where the blood flows through, and the blood can no longer get into the aneurysm, or the weakened part of the vessel.
That procedure is what I specialize in.
And in fact, we do those under conscious sedation, so the patient's awake during the procedure.
They get it done, they stay one night in the hospital, go home the next day.
>>Lori Banks: Well that sounds better than being cut through the middle.
>>Dr.
Jeffrey Goldstein: It's amazing technology.
It's a really fantastic advancement in therapy for this.
>>Lori Banks: So, what-- is it the doctor's choice?
Or why would someone have the full open incision, when they could have the minimally invasive, and when do you have to make the choice--?
>>Dr.
Jeffrey Goldstein: Well to be fair, I mean the surgery is a more durable procedure.
So, once you get the stint graft, the minimally invasive, we have to keep an eye on it because there is more of a chance that there could be a leak or migration of that stint.
So, every year that patient gets a CT scan.
Now, if we follow these patients over the long term, much more patients, much more of the patients survive the minimally invasive procedure than the surgery.
But over the subsequent 10 years or so, there's a catchup where the minimally invasive procedures may have more complications, may require further procedures.
So, in the long run they're equivalent.
So, getting back to your question, if you're a young, healthy patient who's likely to do very well with surgery, you're a low risk for surgery, then that may be your best option.
Now, as most of these patients are older, if you're an older patient with things that make surgery a higher risk, like lung disease or heart disease, kidney disease, then the minimally invasive procedure you're more likely to do well with.
So, those are kind of the decisions we make when we see these patients.
And patient preference factors into it also.
>>Lori Banks: So, if you have the minimally invasive, you said you stay in the hospital a night and you go home the next day.
If you have the full incision, what's the recovery like for that?
>>Dr.
Jeffrey Goldstein: It's usually a week in the hospital.
And the first several days your gut doesn't work very well, so you've got an NG tube, if you know what that is, a tube down your nose into your throat to help decompress your bowels.
>>Lori Banks: It doesn't sound like fun.
>>Dr.
Jeffrey Goldstein: Yeah, I'm going to stop there because I don't want to scare people.
But yes, the minimally invasive procedure is a walk in the park compared to the surgery.
>>Lori Banks: It sounds a little, not that I'm a, you know, a heart surgeon expert, but it sounds a little bit like the same kind of procedure that you do to do stinting in the heart, like when people need a stint.
Are they kind of along the same lines?
>>Dr.
Jeffrey Goldstein: The same technology that we use for heart artery procedures is really, this is really an extension of that.
And yeah, similar therapies, procedures for treating blockages in other places: the carotid arteries, the leg arteries.
So yes, you're right.
>>Lori Banks: So, if you have it fixed, can it come back again in a different spot in the aorta, in the abdominal area?
>>Dr.
Jeffrey Goldstein: It can, it can.
So, it's less likely.
This is the most common place to have it.
But yes, can the aneurysm kind of elongate as we get older?
Yes, it can.
If you have an abdominal aortic aneurysm, you have an increased likelihood of having a thoracic, so one in the chest, or even popliteal, which is the arteries behind the knees.
>>Lori Banks: Okay, so who makes the best patients?
That if they have this, what should they be doing to make sure that, you know, or lessen their chances of it coming back someplace else?
>>Dr.
Jeffrey Goldstein: There's one thing, the most important thing, and that's to stop smoking.
Stop smoking.
>>Lori Banks: Okay, so smoking is the worst for you.
>>Dr.
Jeffrey Goldstein: Yeah, so we have risk factors, so those are factors, things that kind of excel the progression of disease, and we mentioned it earlier.
But smoking is the number one.
I mean, if you look at the worst risk factor for developing an aneurysm or for an aneurysm growing, it's cigarette smoking.
>>Lori Banks: And why is that?
I mean, I can kind of guess why.
>>Dr.
Jeffrey Goldstein: You know, there's thousands of different chemicals, many of them affect the blood vessel, affect the constriction, health, the wellbeing, I should say, of the artery wall.
And you know, when the blood vessels are not well-nourished, they become weak, they become diseased, and then you start to have this abnormal expansion.
>>Lori Banks: What about for people who are diabetic, because that affects the vascular system?
Are they at greater risk for something like that?
>>Dr.
Jeffrey Goldstein: They are, but the, you know, and diabetes is a very important risk factor, especially for vascular disease.
When we look at aneurysmal disease, cigarette smoking's much higher than diabetes.
But yes, diabetes, smoking, high blood pressure, high cholesterol.
And then, you know, there are syndromes where it runs in the family.
You know, there's familial aneurysmal disease.
>>Lori Banks: Yeah, I forgot to ask that, if ti's genetic.
>>Dr.
Jeffrey Goldstein: It is, so that's why it's important if you have a family history, that you get your screening, okay?
If you have a first degree relative who had an aneurysm that ruptured, you're more likely to have an aneurysm that'll rupture.
You know, and then there's other diseases that people may have heard of, like Marfan's disease, which is a disease that involves the aorta but predisposes patients to aneurysmal disease.
Certain patients are born with two aortic valve leaflets, rather than three.
That's called a bicuspid aortic valve.
That's not uncommon or infrequent.
And then there's people more likely to have an aneurysm of the ascending aorta.
So, yes.
>>Lori Banks: Alright, so how should someone, if they've seen this show and they're thinking, oh geez, I might be at risk, how should they approach their primary care?
How should they bring this up or what should they say?
Hey, I saw this TV show and I think I should have this?
>>Dr.
Jeffrey Goldstein: Doc, I think I'm at risk for an aneurysm, and I think I need a screening exam.
>>Lori Banks: Simple as that.
>>Dr.
Jeffrey Goldstein: I think so, yeah.
And you know, once again, if you're a man between 65 and 75, if you've ever smoked, you get that screening exam.
If you're a woman of Medicare age with a family history, you get a free screening exam.
So, those two are paid for by Medicare, yeah.
I should say man or woman with a family history.
Now, in my practice, if you're a man or a woman with a family history of aneurysm, I do the test at age 50.
So, obviously that's not Medicare age, so there will be a cost associated with it.
But I think it's important.
>>Lori Banks: So, when you have the test, does the radiologist read it or do they send it to someone like you to see what it is?
>>Dr.
Jeffrey Goldstein: But you know, theirs, it's performed by a vascular stenographer, and then it's usually read by somebody who's competent in reading vascular ultrasound studies.
So, a lot of times that's a radiologist, vascular surgeon, vascular internist, or cardiologist.
>>Lori Banks: Okay, so then it's, from there you look at that, you see what the size is, and then you make some determinations.
>>Dr.
Jeffrey Goldstein: Exactly, so if it's a normal sized aorta, you're probably done, unless something comes up in the future that would require looking at it.
But you probably don't need to look again.
If it's between three and four centimeters in diameter, then we're going to look at it once a year.
If it's between four and five, every six months.
Once it gets over five centimeters, it's time to start planning to get it fixed.
And definitely at five-and-a-half centimeters, for what we're talking about, the abdominal aortic aneurysm.
>>Lori Banks: It sounds like just such a simple test to save something that really is life threatening, and you don't know you have it.
>>Dr.
Jeffrey Goldstein: That's the whole point.
If, since it's asymptomatic if we don't look, you don't know.
And if you have one, there's a good chance it'll kill you.
So, if you're at risk, get the screening exam.
It may save your life.
>>Lori Banks: I want to ask you one little bit here.
As a cardiologist, what advice do you have for people for heart health?
What do you do, Dr. Goldstein, to keep your heart healthy?
I can tell by the way you look, you're slender build, you look like you keep in shape.
What advice do you give your patients for just general heart health that we could all take away from this?
>>Dr.
Jeffrey Goldstein: Well personally, and I can't overemphasize, but I think regular exercise is very important.
So, you know, that's part of my daily routine.
You know, I think people should try to exercise six days a week.
You know, I try to get at least an hour in on those days.
And then, you know, I think everything in moderation.
So, you know, I don't eat like a rabbit.
But you know, I try and eat mostly healthy, and sometimes I, you know, go out to a restaurant and have something I shouldn't.
But I think if in general you do, you follow, you know, low fat, low cholesterol, high fiber diet, keep active, so regular exercise, and then be aware of what your risk factors are.
You know, if you have the risk factors we've talked about several times today, make sure you're staying on top of it and make sure your physician's helping you treat it.
And I think that'll keep you heart healthy.
>>Lori Banks: Alright, well thanks for all your advice and for clueing us in on AAA.
I can't say it.. abdominal aortic aneurysm.
I didn't know anything about that, and hopefully our viewers now are a little more educated and will get that screening.
>>Dr.
Jeffrey Goldstein: Hey, I appreciate the opportunity, thank you.
>>Lori Banks: Thanks for coming by.
>>Dr.
Jeffrey Goldstein: Thanks.
>>Lori Banks: Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.
Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.
Proper health is important to all at Sarah Bush Lincoln Health System.
Information available at sarahbush.org.
Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.
More information online, or at 347-2255.
>>Singing Voices: Rediscover Paris.
>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.
Paris Community Hospital Family Medical Center.
HSHS St. Anthony'’’s Memorial Hospital, delivering health care close to home.
From advanced surgical techniques and testing, to convenient care for your family.
HSHS St. Anthony'’’s makes a difference each and every day.
St. Anthony'’’s.
Where you come first.
[music plays]