For some patients their first symptom is trouble reading a newspaper. For others it’s a blind spot in the center of their vision. Age-related macular degeneration (AMD) is a progressive eye disease and a leading cause of vision loss among older adults.

AMD happens when the macula, located near the center of the retina, becomes damaged due one of  two forms of AMD – wet or dry.

Dry macular degeneration occurs when parts of the macula develop tiny deposits of protein, causing a  gradual loss of vision.

The wet form is less common but more severe. Wet AMD occurs when abnormal blood vessels grow under the retina and begin to leak blood or other fluids. This causes scarring of the macula, which can  result in rapid vision loss.

Luckily, there’s an effective treatment for wet AMD. Injections of anti-vascular endothelial growth factor (anti-VEGF) have become a common treatment for wet AMD. These medications are injected directly into the eye to slow the formation of blood vessels and prevent further vision loss.

All ophthalmologists at Trinity Regional Eyecare provide these sight-saving injections for wet macular degeneration.

“We have provided this treatment since it was first discovered with amazing results,” said ophthalmologist Darrell Williams, MD. “Prior to this therapy, we lost vision in many eyes. This joins modern cataract surgery as another of the greatest miracles of modern medicine for protecting vision and preventing blindness.”

Who is at risk for wet AMD? You are more likely to develop this condition if you have a  family history of AMD, are over 50 years of age or smoke cigarettes. Being overweight or having high blood pressure can  be risk factors as well.

Sadly, many people aren’t aware they have AMD until their vision is quite blurry. This is why it’s  important to have regular eye exams. For patients already diagnosed with AMD, the American Academy of Ophthalmology recommends daily monitoring of their vision using an Amsler grid, a square of  graph paper with a black dot in the center. If any part of the grid looks increasingly blurry or out of  shape, they need to contact their family ophthalmologist or optometrist.

When diagnosed and treated early enough, most patients can avoid severe loss of vision, and some patients will experience an improvement. The key is early diagnosis and treatment. For countless patients, this is the difference in being able to read, drive and continue lifestyle activities, which add greatly to quality of life.

Damar Hamlin, a 24-year-old Buffalo Bills safety, went into cardiac arrest on the  field in Cincinnati after taking a hit during the Jan. 2 game. Hamlin immediately collapsed upon standing, prompting the Bills’ medical staff to administer emergency medical treatment, which included CPR and an automated external defibrillation (AED). He survived and is still recovering from the incident.

Sudden Cardiac Arrest (SCA) is a life-threatening emergency caused by the sudden loss of all heart activity due to an irregular heart rhythm. When SCA happens, breathing stops and the person becomes unconscious and may gasp or shake as if having a seizure. Without immediate treatment, SCA can lead to death. Survival depends on people nearby calling 911, starting CPR and using an AED (if available) as soon as possible.

Because his incident occurred on national television, Hamlin, a young, professional athlete, raised public awareness of SCA from a situation that most would interpret as an anomaly. However, the American Heart Association reports that SCA is a leading cause of death in the U.S. There are more than  356,000 out-of-hospital cardiac arrests annually, 90% of them fatal. But what most parents don’t know is that SCA is the number one killer of student athletes. Sports-related SCA accounted for 39% of SCAs among those younger than 18 years of age.

Trinity Health’s Sports Medicine team of certified athletic trainers (ATCs) are trained to respond to any  contingency, whether injury management, mass casualty care, concussion management or emergency  response. “We have venue specific emergency action plans (EAP) in place at every location where we work,” said Barb Nesheim, a 24-year veteran of Trinity’s Sports Medicine Program. “Our EAPs include the location of the nearest AED at each venue.”

An EAP is a written list of life-saving steps to take when an emergency happens.

North Dakota is one of 17 states that has regulations that require AEDs in schools. However, there is no  language that specifically indicates AEDs should be available near athletic fields or during sporting  events.

“Although many schools have AEDs on site, access depends on where your athletic event takes place. If  you are on the football field at Minot High School, for example, the closest AED is located in the south  shed,” Nesheim explained. “In an emergency, ideally you would want to retrieve the AED and return to the victim within three minutes. If that’s not possible, then it’s not in the right place – survival ods decrease by 10% for every minute that passes from the time of collapse.”

North Dakota does not have a law requiring schools to have individual, venue-specific EAPs. Both  venue-specific EAPs and AEDs are considered gold standards of healthcare on sports sidelines. Darren  Armstrong, manager of Trinity Health Sports Medicine and Exercise Physiology, said that his department created and distributed 45 EAPs throughout Trinity’s service area, based on individual sites.

“Every year, our Sports Medicine team participates in extensive training, where we practice different  scenarios that may lead to an injury. It’s our role to help develop the emergency action plans and our role to perform them at optimum level when we are on site. However, we want to partner with our contracts and schools so they can perform to the best of their ability when we are not available,” Armstrong added.

From November through March, Trinity’s staff of 15 ATCs are responsible for covering more than 600 athletic events. “Our athletic trainers are at a number of events and practices, but we are not at all of them,” Armstrong said. Data shows that even when bystanders intervene immediately by giving CPR during SCA, survival rates double or triple.

Partnering comes down to deciding who’s going to help the downed athlete, who is going to call for help, who is going to show the ambulance how to get to the gym,” explained Dawn Mattern, MD,  FAMSSM, medical director of Trinity Health Sports Medicine. “Do we know how to access the AED?  Those decisions have to be made for each specific site. If you don’t think those things through, you won’t have a good outcome.”

Trinity’s desire to create partnerships where all parties engage in the safety of athletes is a wish  Nesheim holds close to her heart. Last September, she was working a football game in Surrey when a  student athlete collapsed on the field due to SCA. Her quick response with the AED she had at the  field and the administration of CPR by trained bystanders resulted in a much different outcome than most. That night, unaware of the odds, the young football player became a one-in-ten survivor. “If we would have relied on the AED in the gymnasium that night, the patient might have been in trouble,” she said.

In addition to strong partnerships, Trinity’s Sports Medicine department aspires to secure adequate  funding to purchase additional AEDs for every athletic trainer to carry with them to all events, and not solely rely on the sports venue’s availability.

Following the Surrey incident, Nesheim shared her story online with The Matthew Mangine Jr.  Foundation. Born from tragedy, the foundation was established to educate communities on  preventable sudden death, promote the importance of properly executing EAPs, and advocate for the expanded use of AEDs in competitive youth and high school sports. Trinity Health is currently collaborating with The  Matthew Mangine Jr. Foundation to secure funding for additional AEDs for the Athletic  Training staff.

The American College of Cardiology estimates that approximately 100 to 150 sudden cardiac arrests  resulting in sudden cardiac death occur in competitive sports each year in the U.S. As the  area’s provider for athletic training and sports  medicine, Trinity Health is devoted to doing everything possible to ensure safe sport participation for all of our athletes, practice or competition.

If you would like more information about donating to Trinity Health Foundation to purchase AEDs, contact Cody McManigal at [email protected] or call 701-857-2430.

To learn more about the Matthew Mangine Jr. Foundation, visit: matthewmanginejrfoundation.org.

February is American Heart Month. This observance is a convenient tie-in to Valentine’s Day, also associated with hearts. However, American Heart Month is not meant to remind us about romance, cards, candy or flowers; it’s intended to bring focus on our cardiovascular health.

The term “heart disease” encompasses a wide range of cardiovascular problems. Several diseases and conditions fall under the umbrella of heart disease, which may present with a variety of symptoms.

Arrhythmias are abnormal heart rhythms. The symptoms you experience may depend on the type of arrhythmia you have — heartbeats that are too fast or too slow. Symptoms of an arrhythmia include:
• lightheadedness
• fluttering heart or racing heartbeat
• slow pulse
• dizziness or fainting spells
• chest pain

Atherosclerosis reduces blood supply to your extremities. In addition to chest pain and shortness of breath, symptoms of atherosclerosis include:
• coldness or numbness, especially in the limbs
• unusual or unexplained pain
• weakness in your legs and arms

Congenital heart defects are heart problems that develop when a fetus is growing. Some heart defects are never diagnosed. Others may be found when they cause symptoms, such as:
• blue-tinged skin
• swelling of the extremities
• shortness of breath or difficulty breathing
• fatigue and low energy
• irregular heart rhythm

Coronary artery disease (CAD) is plaque buildup in the arteries that move oxygen-rich blood through the heart and lungs. Symptoms of CAD include:
• a feeling of pressure or squeezing in the chest
• shortness of breath
• nausea
• feelings of indigestion or gas

Cardiomyopathy causes the muscles of the heart to grow larger and turn rigid, thick or weak. Symptoms of this condition include:
• fatigue
• swollen legs, especially ankles and feet
• shortness of breath
• pounding or rapid pulse

Heart infections may describe conditions such as endocarditis or myocarditis.
Symptoms of a heart infection include:
• chest pain
• chest congestion or coughing
• fever
• chills
• skin rash

Women often experience different signs and symptoms of heart disease than men, specifically with regards to CAD and other cardiovascular diseases.

A 2003 study looked at the symptoms most often seen in women who’d experienced a heart attack. The top symptoms didn’t include “classic” heart attack symptoms such as chest pain and tingling. Instead, the study reported that women were more likely to say they experienced anxiety, sleep disturbances, and unexplained fatigue. Eighty percent of the women in the study reported experiencing these symptoms for at least one month before their heart attack occurred. Common heart disease symptoms in women include:
• Dizziness or lightheadedness
• shortness of breath or shallow breathing
• fainting or passing out
• anxiety
• nausea or vomiting
• pain in the jaw, neck or back
• indigestion or gaslike pain in the chest and stomach
• cold sweats

There are many risk factors for heart disease. Some are controllable, and others aren’t. The Centers for  Disease Control and Prevention says that approximately 47% of Americans have at least one risk factor for heart disease, such as high blood pressure, high cholesterol, smoking, obesity or physical inactivity.  Smoking, for example, is a controllable risk factor. People who smoke double their risk of developing heart disease. People with diabetes may also be at  higher risk for heart disease because high blood glucose levels increase the risk of heart attack, stroke or CAD. The American Heart Association (AHA) reports that people who have both high blood pressure and diabetes double their risk for cardiovascular disease.

Uncontrollable risk factors for heart disease include family history, ethnicity, sex and age. Men  are at greater risk for heart disease than women. In fact, the CDC estimates between 70 and 89% of all  cardiac events in the United States occur in men. Also, age can increase your risk for heart disease. From ages 20 to 59, men and women are at a similar risk for CAD. After age 60, however, the percentage of men affected rises to between 19.9 and 32.2%, compared to 9.7 to 18.8% of women of the same age.

Prevention
It’s important to take charge of your overall health now, before a diagnosis may be made. This is  especially true if you have a family history of heart disease or conditions that increase your risk for  heart disease. Taking care of your body and your heart can pay off for many years to come.

Healthy blood pressure and cholesterol numbers are some of the first steps you can take for a healthy heart. A healthy blood pressure is considered less than 120 systolic and 80 diastolic, which is often expressed as “120 over 80” or “120/80 mm Hg.” Higher numbers indicate that the heart is working too hard to pump blood.

Your ideal cholesterol level will depend on your risk factors and heart health history. If you’re at a high risk of heart disease, have diabetes, or have already had a heart attack, your target levels will be below those of people with low or average risk.

Find ways to manage stress. Don’t underestimate chronic stress as a contributor to heart disease.  Speak with your doctor if you’re frequently overwhelmed, anxious, or are coping with stressful life events, such as moving, changing jobs, or going through a divorce.

Embrace a healthier lifestyle by eating healthy food and exercising regularly. Make sure to avoid foods high in saturated fat and salt. Doctors recommend 30 to 60 minutes of exercise on most  days for a total of 2 hours and 30 minutes each week. Check with your doctor to make sure you can safely meet these guidelines, especially if you already have a heart condition.

Making these changes all at once might not be possible. Discuss with your healthcare provider which lifestyle changes will have the biggest impact. Even small steps toward these goals will help keep you at your healthiest.

Treatment
Treatment for heart disease depends on the type of heart disease you have as well as how far it  has advanced. Treatment falls into three main categories:

Lifestyle choices can help you prevent heart disease. They can also help you treat the condition and prevent it from getting worse. Your diet is one of the first areas you may seek to change. Likewise, getting regular exercise and quitting tobacco can help treat heart disease.

Medications may be necessary to treat certain types of heart disease. Your doctor can prescribe a medication that can either cure or control your heart disease. Medications may also be prescribed to slow or stop the risk for complications.

Surgery or a medical procedure may be necessary in some cases to treat the condition and prevent worsening symptoms.

Heart disease requires a lifetime of treatment and careful monitoring. Many of the symptoms of heart  disease can be relieved with medications, procedures and lifestyle changes. When these methods fail, coronary intervention or bypass surgery might be used.

If you believe you may be experiencing symptoms of heart disease or if you have risk factors for heart disease, make an appointment to discuss with your doctor. Together, the two of you can weigh your  risks, conduct a few screening tests and plan for staying healthy.