Shore Health opens heart catheter­i­za­tion lab

Dorchester Star - - REGIONAL - By DENAE SPIERING dspier­ing@ches­pub.com

— Re­ceiv­ing ac­cess to car­diac pro­ce­dures on the Shore can be dif­fi­cult and in the case of an acute heart at­tack — deadly, but not any­more.

On Tues­day, May 2, Univer­sity of Mary­land Shore Med­i­cal Cen­ter of Eas­ton held a rib­bon cut­ting un­veil­ing their new state-ofthe-heart Car­diac Catheter­i­za­tion Lab­o­ra­tor y.

The new lab­o­ra­tory will aid in pro­vid­ing top notch care right here on the Mid-Shore that pa­tients pre­vi­ously ex­pe­ri­enc­ing a life threat­en­ing heart at­tack such as a STEMI, (ST El­e­vated My­ocar­dial In­farc­tion) would have had to travel else­where to re­ceive. That trav­el­ing was the ba­sis of es­tab­lish­ing a fa­cil­ity here in the com­mu­nity.

Orig­i­nally the hospi­tal in Eas­ton had one catheter­i­za­tion lab al­ready, how­ever pro­ce­dures done there were purely elec­tive and they were un­able to as­sist with heart emer­gen­cies such as STEMIs. Now with the ca­pa­bil­ity of two labs the hospi­tal is able to pro­vide both elec­tive pro­ce­dures and emer­gency car­diac care.

In the past some­one ex­pe­ri­enc­ing a STEMI was typ­i­cally taken to other fa­cil­i­ties any­where from a half hour to an hour away, and it is those pre­cious min­utes that could cost the pa­tient their lives.

“Time is mus­cle,” said Dr. Gary Jones, re­gional direc­tor of car­dio­vas­cu­lar and pul­monary ser­vices. “So for ev­ery minute of de­lay there is po­ten­tial loss for vi­able heart mus­cle un­til the blood has been re­stored to that area.”

“There is 90-minute win­dow,” Jones said. “That is the magic num­ber and the clock starts tick­ing the minute 911 is called.”

Jones said over the past sev­eral years he and ad­min­is­tra­tors from the hospi­tal met with of­fi­cials from the Mary­land In­sti­tute for Emer­gency Med­i­cal Ser­vices Sys­tems to re­view ex­actly how many pa­tients have suf­fered heart at­tacks in the area and the in­cred­i­ble num­ber of pa­tients who needed to have these pro­ce­dures done.

He said then un­for­tu­nately they looked at how many of them had to be trans­ferred some­times 60 to 90 min­utes away for those timely acute heart at­tacks.

Jones said that is the rea­son for their di­rec­tion and vi­sion to start this pro­gram. He said Eas­ton was ge­o­graph­i­cally the per­fect spot to meet the needs of pa­tients that were ex­pe­ri­enc­ing a much longer de­lay in be­ing pro­vided these ser vices.

Jones said those de­lays were due to traf­fic, weather, or just the mere dis­tance a pa­tient needs to travel to re­ceive the nec­es­sar y care.

“If you were to draw a ra­dius of re­sponse time around the ap­proved hos­pi­tals in the state that pro­vide these ser­vices,” Jones said, “on the western shore there is a tremen­dous amount of op­tions for pa­tients within 20 min­utes — but when you draw that same ra­dius around the mid­dle Eastern Shore there are large voids of ar­eas that re­quire a longer re­sponse time.”

Jones said the state looked at all that in­for­ma­tion and was able to es­tab­lish a sig­nif­i­cant un­met need and as a re­sult he said leg­is­la­tion was passed that en­abled the hospi­tal to ap­ply for a cer tifi­cate of con­for­mance which would pro­vide the nec­es­sary fund­ing re­quired to ful­fill that need.

He said the hospi­tal filed for the fund­ing two years ago, and last year on St. Pa­trick’s Day, March 17, they heard from the state, the fund­ing was ap­proved and he said he re­mem­bers it clearly be­cause he and the car­di­ol­o­gist went out and cel­e­brated with a green beer.

Once the fund­ing was ap­proved, the plan­ning and the teams to run them could be es­tab­lished.

Dr. Jef­fery Ether­ton is part of that team and said “We have every­thing avail­able to us right at our fin­ger­tips.”

“One of the best labs in the state,” Ether­ton said. “A state-of-the-art lab with all the equip­ment and things that you would need to have these pro­ce­dures per­formed.”

Ether­ton to­gether with Dr. Gabriel Sardi spe­cial­ize in per­cu­ta­neous coro­nary in­ter­ven­tion (PCI) also re­ferred to as an­gio­plasty with stent place­ment.

Ether­ton said he deals with the ar­ter­ies to the heart — the blood flow or lack of rather.

He said for his spe­cialty the catheter­i­za­tion labs func­tion in two ways. They can pro­vide in­for­ma­tion us­ing catheters that in­ject dye into the ar­ter­ies of the heart to de­ter­mine the anatom­i­cal struc­tures and blood flow through those ar­ter­ies and it can look for block­ages which can cause chest pain or a STEMI if those ar­ter­ies are blocked com­pletely.

“We are ca­pa­ble of pass­ing a thin lit­tle wire — a bal­loon or a stent into those ar­ter­ies and un­block them to re­store fresh blood flow to the heart to stop a heart at­tack or al­le­vi­ate chest pain,” Ether­ton said. “The sec­ond labs af­fords us the ca­pa­bil­ity of very quickly get­ting a pa­tient on the ta­ble here in the hospi­tal and have this life-sav­ing pro­ce­dure per­formed.”

“We have to not only have the pa­tient into hospi­tal from the be­gin­ning of that ter­ri­ble event oc­cur­ring to them, said Ether­ton. “But on the ta­ble in the catheter­i­za­tion lab­o­ra­tory and a bal­loon open­ing that artery within 90 min­utes.”

“So the clock is tick­ing im­me­di­ately when that hap­pens, stud­ies have shown that if you get the artery open within that 90 min­utes the pa­tient has a six times greater chance of liv­ing,” Ether­ton said.

Ether ton said aid­ing in the re­sponse time is the abil­ity to have the new­est equip­ment as far as imag­ing and that it is as as good as any lab in the en­tire state with in­cred­i­ble res­o­lu­tion to see and mea­sure.

“We can ac­tu­ally place a very thin catheter in­side the artery and take a pic­ture to make sure our stents are in the right place, that they are the cor­rect length,” Ether­ton said. “We can mea­sure the flow through the ar­ter­ies as well, and we can record the images and play them back.”

But Ether­ton said it’s not only the equip­ment that makes this new unit so spe­cial.

“It’s the hu­man as­pect of it too,” Ether­ton said. “We have as­sem­bled a team whose spe­cialty is to as­sist us per­form­ing these pro­ce­dures — we have highly skilled nurses and tech­ni­cians work­ing be­side us. It’s that all to­gether pack­age that makes it a state-of the art.”

Dr. Ben­jamin Remo is also part of that team and his spe­cialty is elec­tro­phys­i­ol­ogy. He said he is like the elec­tri­cian and Ether­ton and Sardi are like the plumbers.

Dr. Remo mon­i­tors the elec­tri­cal sys­tem of the heart and said the heart ac­tu­ally has a group of spe­cial­ized cells that run through­out and it co­or­di­nates to the dif­fer­ent ar­eas of the so that it can pump as ef­fi­ciently as pos­si­ble.

“When the elec­tri­cal sys­tem is ab­nor­mal it can lead to ab­nor­mal func­tion known as an ar­rhyth­mia,” Remo said. “With our pop­u­la­tion here on the Eastern Shore we see a lot of ar­rhyth­mia.”

He said peo­ple may not know that they have an ar­rhyth­mia but they may ex­pe­ri­ence the symp­toms of one — rac­ing heart or pal­pi­ta­tions, short­ness of breath, fa­tigue, chest pain or may even pass out. He said some ab­nor­mal heart rhythms can cause death if they are dan­ger­ous enough.

The tra­di­tional way to deal with an ar­rhyth­mia was with pace­mak­ers, de­fib­ril­la­tors, or med­i­ca­tions and when all of these op­tions failed the next step is an elec­tro­phys­i­ol­ogy study — EP stud­ies, which in­clude putting ar­ti­fi­cial wires up through the leg and into the heart and mea­sure the elec­tri­cal sys­tem of the heart.

“I re­late it to when an elec­tri­cian comes to your house and they have a wire finder,” Remo said. “They are try­ing to find out if the wires are func­tion­ing prop­erly or not.”

An elec­tro­phys­i­ol­o­gist’s tools in­clude “an ex­tremely ad­vanced com­put­er­ized map­ping equip­ment that we can ac­tu­ally map out what the heart looks like on the in­side,” Remo said.

He equates it to one of the most com­pli­cated videos games ever played. He said it is that map­ping that al­lows his team to place catheters in the heart at the cor­rect lo­ca­tion with­out dam­ag­ing the nor­mal heart struc­tures.

“Dr. Remo has a catheter that has twenty dif­fer­ent sen­sors,” Jones said. “It is able to mon­i­tor si­mul­ta­ne­ously twenty dif­fer­ent parts of the heart — it’s fas­ci­nat­ing.”

“You take a reg­u­lar EKG and put it on steroids — that what he is look­ing at.” Jones said. “It helps him to find and iden­tify the elec­tri­cal ir­reg­u­lar­i­ties and he can then per­form a cather­iza­tion.”

Remo’s equip­ment is mo­bile and can travel from lab to lab.

“Hav­ing that equip­ment mo­bile is an in­cred­i­bly im­por­tant as­pect,” Remo said.

“Be­cause my pro­ce­dures tend to be a lit­tle on the longer side and by na­ture are elec­tive pro­ce­dures,” Remo said. “We def­i­nitely need two labs to ac­com­mo­date all the pa­tients we an­tic­i­pate see­ing, es­pe­cially be­cause with Dr. Ether­ton’s pro­ce­dures they are a mat­ter of life and death — an im­me­di­ate thing.”

Remo said the labs will also ease bur­dens on emer­gency med­i­cal ser­vices and emer­gency rooms here and in other ar­eas.

“We have had a lot of suc­cess with pa­tients who were strug­gling with these symp­toms de­spite the use of med­i­ca­tion and de­vices,” Remo said. “You can imag­ine that’s a prob­lem for pa­tients be­cause they are al­ready fa­tigued from their symp­toms but now they have fear and anx­i­ety.”

Those con­cerns led to a lot of emer­gency room vis­its, but now these pa­tients can have pro­ce­dures done lo­cally rather than driv­ing a long dis­tance.

Along with these tal­ented doc­tors there is a team of ded­i­cated nurses and sup­port staff that form two teams and work around the clock, 24 hours a day seven days a week. The two teams ro­tate calls and Jones said he can not say enough about their ded­i­ca­tion.

“They are on call ev­ery other week,” Jones said. “Ev­ery evening and ev­ery week­ended that sig­nif­i­cantly im­pacts what they can do in their per­sonal lives and to me, that’s a pretty sig­nif­i­cant sac­ri­fice.”

“Remo and Ether­ton live in this com­mu­nity,” Jones said. “They don’t travel here, they are ded­i­cated to pro­vid­ing this ser vice to our area.”

“Jeff (Ether­ton) and I are the two new­est mem­bers to this group,” Remo said.

“This group has been here for 35 years and all of us take pride in the fact that we live here,” Remo said. “It’s a priv­i­lege to take care of our neigh­bors who are in this com­mu­nity with us and all the hard work Gary (Jones), Jeff (Ether­ton) and Gabriel (Sardi) have done. I feel like we are well placed to take care of our com­mu­nity here on the Eastern Shore for at least 35 more years.”

“The en­tire car­diac team that has been here for a long time is just fan­tas­tic and we are now a new ex­ten­sion of them re­ally,” Ether­ton said.

“When we ded­i­cated our­selves to pro­vide this ser­vice for the com­mu­nity, we knew we would have to pro­vide it 24 hours a day, 7 days a week,” Ether­ton said. “We care for com­mu­nity that’s the im­por­tance of this.”

“We didn’t just come here from Bal­ti­more, Wash­ing­ton or Philadel­phia and to just do a pro­ce­dure ev­ery now and then; we live here — we are neigh­bors,” said Ether­ton. “We pro­vide this to the com­mu­nity — to the whole five -ounty re­gion on 24/7 ba­sis and if we say we are go­ing to do it, we have to be here — we feel hon­ored to do it for this com­mu­nity — we just feel very blessed that the univer­sity of Mary­land and Shore Re­gional has us here to do it for the com­mu­nity.”

Ether­ton adds that they all ben­e­fit from this as well be­cause they are giv­ing back to their com­mu­nity and said it is a won­der­ful op­por­tu­nity.

Since the lab opened in the end of March, the teams have per­formed 20 in­ter­ven­tions on an elec­tive ba­sis.

“Sev­eral of them have been fairly dif­fi­cult pro­ce­dures,” Ether­ton said. “They are ones that in the past that would have been done in Wash­ing­ton, Bal­ti­more or Philadel­phia but we were able to do them here.”

Jones said there will still be pa­tients from the re­gion who still will be taken to other ap­proved cen­ters sim­ply be­cause the trans­port time will be quicker.

“It’s not about get­ting ev­ery­one to come here,” Ether­ton said. “It’s about get­ting the pa­tient to the care they need within that 90-minute win­dow. It’s a mat­ter of what is the best over­all out­come for the pa­tient.”

Jones said it is im­por­tant to ac­knowl­edge the won­der­ful emer­gency ser­vice providers, the post-op nurses and ev­ery­one else who aids in sav­ing and en­sur­ing the lives of their pa­tients. He said it is a team ef­fort from start to fin­ish.

CON­TRIB­UTED PHOTO

On Tues­day, May 2, Univer­sity of Mary­land Shore Med­i­cal Cen­ter in Eas­ton held a rib­bon cut­ting cer­e­mony for their new state-of-the-art Car­diac Catheter­i­za­tion Lab­o­ra­tory. Pic­tured from left are Bob Frank, se­nior vice pres­i­dent for op­er­a­tions, Dr. Ti­mothy Shan­na­han, Dr. Jef­frey Etheron, John Dil­lon, chair­man of the hospi­tal board, Dr. Gary Jones, re­gional direc­tor of car­dio­vas­cu­lar and pul­monary ser­vices, Dr. Ben­jamin Remo, Dr. Gabriel Sardi and Ken Kozel the hospi­tal’s pres­i­dent and CEO. The rib­bon was cut in the new per­cu­ta­neous coro­nary in­ter­ven­tion lab­o­ra­tory, re­cently com­pleted.

CON­TRIB­UTED PHOTO

On Tues­day, May 2, Univer­sity of Mary­land Shore Med­i­cal Cen­ter in Eas­ton held a rib­bon cut­ting cer­e­mony for their new state-of-the-art Car­diac Catheter­i­za­tion Lab­o­ra­tory. Pic­tured above is the large screen that will en­able the doc­tors to see images of in­side the heart ob­tained in many of the new pro­ce­dures now avail­able in the labs.

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