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Interview with Dr. Glen Tonnessen, Medical Director of Hunterdon Cardiovascular Services
Dr. Robert Pickoff interviews Dr. Glen Tonnessen, Medical Director of Hunterdon Cardiovascular Services
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Dr. Robert Pickoff, Chief Medical Officer for Hunterdon Healthcare, interviews Dr. Glen Tonnessen, Medical Director of Hunterdon Cardiovascular Services. Dr. Tonnessen discusses cardiac care at Hunterdon Medical Center.
Glen E. Tonnessen, MD
Medical Director
Hunterdon Cardiovascular Services
Transcript
Doctor Pickoff
Hi, I’m Doctor Robert Pickoff, Chief Medical Officer for Hunterdon Medical Center and today with me is Doctor Glen Tonnessen, cardiologist at Hunterdon Medical Center who is Medical Director of Hunterdon Cardiovascular Services for Hunterdon Healthcare and he’s going to discuss with us, cardiac care at Hunterdon Medical Center. Welcome Doctor Tonnessen. thanks for coming
Dr. Tonnessen
Thank you for having me.
Doctor Pickoff
So your group practices cardiovascular medicine at Hunterdon and who are, actually, the doctors in your group?
Dr. Tonnessen
Physicians in our group number nine. We have Doctor John Horiuchi, Doctor Andrey Espinoza, Doctor Ted Bialy, Doctor Ken Kutscher, Dr. William Schafranek, Dr Andrew Rudnick, Robert Lind, and Dubravka Starcevic.
Doctor Pickoff
That’s a big group.
Dr. Tonnessen
That is a large group. We have nine members. We practice the full gamut of cardiology and do everything from office based cardiology to acute care in the hospital.
Doctor Pickoff
And your offices are located in more than just on the hospital campus, right?
Dr. Tonnessen
We have an office here on the campus of Hunterdon Medical Center and also an office in the Clinton Wellness Center in Clinton, New Jersey.
Doctor Pickoff
Great. So in terms of the practice of cardiology at Hunterdon Medical Center, you’ve been here for… your group was established quite a long time ago. How has cardiology changed in your tenure as a cardiologist at Hunterdon?
Dr. Tonnessen
Well, when I came in 1993, cardiology at that that time was just really developing… new technology… new medications… and most community hospitals were basically first aid stations for more acute care hospitals. And over the last ten years, since 1997 when we did our first cardiac catheterization, we’ve been able to develop the services and provide cutting edge, up to date care in a community hospital.
Doctor Pickoff
And the cardiac cath lab is a technology that is about how old at Hunterdon?
Dr. Tonnessen
Cardiac Cath Lab was opened in 1997. Cardiac catheterizations have been practiced in cardiology since the late sixties but since the early nineties have been very common place in many hospitals across the country.
Doctor Pickoff
Just for the purpose of explanation… what is done in a cardiac cath lab?
Dr. Tonnessen
Cardiac Catheterization is the procedure that the lab is named for and that involves putting tubes or small catheters in through an artery in the heart, injecting dye, and taking pictures of the arteries that feed the heart in order to identify blockages.
Doctor Pickoff
Ok, now that has become a focal point of the treatment of heart attacks lately, of late, which I want to get into a little later, but other than cardiac catheterization, what other cardiac testing is done at the hospital by the members of your group?
Dr. Tonnessen
We provide the full range of cardiac testing whether it’s stress testing, nuclear imaging, echo cardiograms or ultrasounds of the heart, ultrasounds of arteries and veins, and then tests for arrhythmias and various devices to detect those.
Doctor Pickoff
So testing that you mentioned, for the most part, is done on patients who either have heart disease or have some issue related to their cardiac health. What about people that are interested in preventing heart disease? How do we approach that?
Dr. Tonnessen
Well, that’s a great question and really, the most important area in cardiology is the prevention of heart disease. I mean once we’re to the state of trying to detect it, the patient already has the disease, so in our outpatient facilities both at Hunterdon Medical Center and at the Clinton Wellness Center, we have very active early detection programs… risk modification programs to identify patients who don’t yet have coronary disease but are at a high risk of developing it as well as patients who just want a general assessment regarding their risk of perhaps having coronary disease… and what they can do to avoid that.
Doctor Pickoff
Is there something that people should know, to look for, in terms of how they would know that they have a problem, with symptoms, or some change in the way they feel?
Dr. Tonnessen
Yes, there are the classic signs of heart disease which are chest pain, shortness of breath, inability to perform exercise at levels that you previously could. There are significant differences in the presentation of heart disease in men and women and there’s been a lot published and discussion about how the manifestations of heart disease in women can be different. They may not have classic chest pain. They may only have weakness, malaise… feeling of a flu-like illness. All can be subtle manifestations of heart disease in women that are not always easily recognized to the inexperienced observer.
Doctor Pickoff
That’s very interesting. What about the term “cardiovascular disease” to describe cardiology, really implies more than just the heart? It implies the vascular system, the blood vessels that make up the circulatory system and the arteries in the body are also an area that cardiologists specialize in as well, right?
Dr. Tonnessen
Correct. In the last fifteen years there’s been a growing emphasis and a realization that cardiology doesn’t just involve the heart, but really the blood vessels that are an extension of the vessels of the heart… are really one organ system and therefore the practice of cardiology now involves really the entire vascular system and that may involve blood vessels in the neck called the carotid arteries which feed the brain. It might involve the blood vessels that go to the kidneys or the blood vessels that go to the legs. So all of those areas are areas, that as cardiologists, we follow, we test for, we look for disease in those areas and we can treat them if needed.
Doctor Pickoff
So if someone has a disease in the carotids, the blood vessels in the neck, the presentation of that is… can be fairly dramatic, leading to a stroke. I assume that’s what you mean. Is there a role for this type of your type of specialty in the treatment of stroke?
Dr. Tonnessen
Yes, and again, a growing area here is the treatment of blockages which cause strokes. Obviously we try to detect these before patients develop strokes because that’s really a very serious presentation and we try to avoid it but when patients do come with those kind of acute illnesses, we can treat those areas with medications. There are now… we can use stents. Previously, really, the only option was for a patient to have surgery and now for certain patients, in certain groups, there are other options which involve balloons and stents and can enable patients to avoid surgical procedures.
Doctor Pickoff
Besides the dramatic presentation of a stroke, how would I know if I had, for instance, a blockage in the artery in my leg or my kidney… what does one look for?
Dr. Tonnessen
Again, this would depend on the area, so, for instance, a blockage in the arteries that feed the neck and the head, the carotid arteries… the symptoms might just be mild dizziness, light headedness. It could be a loss of vision for just a few minutes or a few hours… inability to find words, or losing things… losing speech for periods of time which then comes back. It could be very different for blockages in the arteries in the legs. For instance, that will often manifest itself as cramping when patients walk. If they go up a flight of stairs, they’ll get heaviness in their legs. It could be cool extremities… the toes… the feet are cold. And just the most common presentation of that would be a patient that just finds they can’t walk as far as they used to be able to walk without getting cramps.
Doctor Pickoff
And that would trigger someone to seek, at least, some consultation with their physician.
Dr. Tonnessen
Yes. They should see their physician. There are tests that can be ordered that can diagnose them.
Doctor Pickoff
Good. Now if a member of the community goes on the Internet and looks at a Web site that we participate in… which is the Hospital Compare Web site… which people can find, actually, at www.hospitalcompare.hhs.gov. There is a whole bunch of data that hospitals submit there on how they do, quality-wise, in treating specific diseases, and one of the diseases that I know you’re involved in which is heart attack… there are a number of measures listed on that Web site to show how closely we follow national guidelines in the treatment. Among them… and there are a lot of them… but among the ones that I think are the most interesting are… the use of aspirin, which has become central in the treatment of a heart attack… aspirin when you show up… aspirin when you go home… as well as how long it takes once you present with a heart attack to be taken to the cardiac cath lab to have an angioplasty done and an opening of the artery that is causing the heart attack. How do those become so critical that they’re a part of what we measure in publicly reported data? What’s the importance of these data?
Dr. Tonnessen
Well, these are part of several developments which have proven to be very predictive of who survives a heart attack and who doesn’t have to come back to the hospital with another heart attack after their first. So things like how quickly patients get aspirin, how quickly, when they get discharged… do they stay on aspirin? All those predict if a patient is going to have another event. So following programs which follow those guidelines closely have been demonstrated to have better outcomes. The patients who receive aspirin quickly, who receive drugs like beta blockers when they go home from the hospital… those patients live longer, do better, and have less repeat events.
Doctor Pickoff
The other thing that’s on the Web site is measurement of how frequently patients, let’s say with heart failure, or a weakening in the pumping function of the heart… how frequently they are re-admitted back to the hospital after being sent home and there’s been a lot of national attention on how to get people once they are discharged from the hospital to not need to come back to the hospital, to be re-admitted. Are there things that people with heart failure can do once they are released from the hospital to make sure that they remain well and don’t have to be re-admitted?
Dr. Tonnessen
There are things. The first is to take the medicine that they’re prescribed. Unfortunately now for patients with heart failure, there are several different medications that they need to be on… and sometimes there’s a tendency on patients’ parts to think that all those medicines aren’t necessary… and really, in heart failure, they are necessary… even though it’s three or four, sometimes five different medications. The other thing is to be involved with a practice that has an active heart failure program. We do have a program that’s focused on patients with heart failure… that involves more frequent follow-up… attention to diet. Weighing yourself daily or at least several times a week and recording your weight is probably one of the most important things that heart failure patients can do. There are risk factor modifications, dietary changes that need to be taught, and patients wouldn’t necessarily know what foods to avoid… things like that. So there are a lot of programs, both in the hospital and then outside of the hospital which can help keep people from coming back into the hospital.
Doctor Pickoff
That’s great information. What’s coming up in the future for cardiology at Hunterdon, and really, just in general? What can we look forward to?
Dr. Tonnessen
Well the big push in cardiology has been rapid and effective treatment of patients who are having heart attacks and that’s been the focus of our primary angioplasty program… to treat patients who come in with heart attacks. How quickly can we get them to the lab and how quickly can we open up that artery? In the future, there’s going to be continued development of the use of stents. There are now probably bio-absorbable stents that will be coming onto the market in the future, and those are stents which are placed and then dissolve over time so they don’t stay in the body… whereas now they’re permanent. Electrophysiology, or the study of heart rhythms and the treatment, is something that’s very exciting and using the different types of devices to change patients heart rhythm when they have a sudden arrhythmia is something that continues to grow, and it’s something we’ll be offering here at the medical center.
Doctor Pickoff
One final question… the importance of… just going back to the “door to balloon time,” could you just explain… if someone is stricken with a heart attack and is brought to Hunterdon, let’s say… off hours… in the middle of the night… what are the steps, what falls into place to allow quick, rapid and effective treatment of this at Hunterdon?
Dr. Tonnessen
Well Hunterdon Medical Center is unique for a hospital of its size, in as much as we have developed a program that has probably the best door to balloon time, measuring how long it takes a patient to get from the door of the emergency room to the cardiac catheterization lab and the artery open. The national standard for that is ninety minutes, and the vast majority of hospitals have been unable to crack that barrier. Here at Hunterdon Medical Center we have been able to do that in a little over sixty minutes, for over two years now, and we’ve been able to demonstrate increased survival rates for patients. Patients, again, live longer. They have less damage to their heart if the artery is open as quickly as possible.
Doctor Pickoff
That’s great! Congratulations on that. I want to thank Doctor Tonnessen for joining us today. If you would like more information on this topic, you can visit the Hunterdon Healthcare Web site at www.hunterdonhealthcare.org. If you need a physician you can call the Hunterdon Healthcare physician referral service at 800-511-4462. Thanks very much for listening.