web1_R-Collins-mug-shot.jpg

Ex-WB officer accused of rape to receive $33K pension

web1_lloyd.price_.jpg

‘Mr. Personality’ coming to F.M. Kirby Center

<p>Growing up in Bayonne, N.J., Scouting was a big part of my life. Troop 19 was sponsored by our parish and many classmates and friends were scouts along with me and my brother Don.</p><p>As I write this, I can see a framed photo on my bookcase of me receiving my Eagle Scout badge with my mom and dad, our Scoutmaster Mr. Papson and Mr. Lapinski, representing the parish. I don&#8217;t remember the Scout Executive&#8217;s name and it&#8217;s hard to believe that the svelte, uniformed young man is actually me.</p><p>Scouting offered not only a sense of belonging and camaraderie but access to camping, hiking and outdoor pursuits that has stuck with me to this day. Another aspect that fit me perfectly was the notion of learning a great variety of subjects by working on &#8220;merit badges.&#8221; You needed 21 to reach the rank of Eagle and you could keep going. Guess who did &#8230; 29, I think.</p><p>You see, I loved learning about various hobbies, trades, careers etc. My brother accused me of dabbling in stuff. I confess. I did &#8220;get into&#8221; many things that soon got shelved, figuratively and often literally. Tennis, slot cars, electronics, archery, ham radio, racquetball, model trains, track and field, and on and on.</p><p>Now don&#8217;t jump to conclusions, I didn&#8217;t have ADHD, just insatiable curiosity. I do indeed have interests that have persisted. Mary and I have been together for 45 years, after all.</p><p>Photography, fishing, books, travel and of course science and medicine came into my life and have never left.</p><p>What&#8217;s this have to do with heart failure?</p><p>Last week I promised that this week we&#8217;d talk about treatment of heart failure, yet I&#8217;ve been tempted instead, to write of many different things that people have asked about; but a promise is a promise after all.</p><p>To review, heart failure is a syndrome of symptoms like shortness of breath, painful legs, sudden weight gain along with signs like noisy breathing, puffy, swollen legs and findings on tests, like dense lungs on a chest X-ray, certain abnormal blood studies and elevated pressure on the heart&#8217;s right sided structures. This is the result of excess fluid building up in lungs, the tissues of the limbs, and indeed throughout the body. The fluid backs up because the heart is inefficient in pumping it forward and the kidney can&#8217;t keep up with the need to excrete extra fluid.</p><p>Why&#8217;s the heart unable to do its job? Lots of reasons.</p><p>Too little blood feeding the heart muscle, valve narrowing or leaking, a primary weakness of the muscle from viruses, drugs, immune problems, and many other causes can lead to heart failure.</p><p>Treatment falls into two main categories, those aimed at the physiologic abnormalities that all types of heart failure share, and those directed precisely at the causative disease.</p><p>General treatments focus on getting rid of the excess fluid. &#8220;Water&#8221; pills or injections, known as diuretics, come in many varieties, but all work by affecting the kidneys and or the hormonal systems so that more water than normal is passed out of the body as urine. Other drugs can force blood vessels to stretch, allowing more blood to be accomodated within the circulation, so less leaks out into the surrounding tissues. Mechanical maneuvers like elevating legs, sitting upright, sleeping on extra pillows, wrapping legs with elastic dressings and dietary changes like salt avoidance and fluid restriction are important.</p><p>Other drugs can augment the heart&#8217;s &#8220;horsepower&#8221; or its contractility in cardiology-speak.</p><p>More importantly, we need to determine the cause of the heart failure and focus treatments precisely on the problem at fault. Coronary artery narrowing from hardening of the arteries (atherosclerosis) may require medicines, angioplasty and stents with catheters or actual bypass operations in the OR.</p><p>Valve abnormalities also may be treatable with medicines alone or if more advanced, may be dealt with by catheter-based procedures or perhaps valve repair or replacement at operation.</p><p>Weakened heart muscle function from the reversible effects of drugs (prescription or illicit), and sometimes from auto-immune disorders may improve with discontinuation of the offending substance, or sometimes with immune system inhibiting medicines.</p><p>Sometimes though, things are so far gone that we need to actually consider advanced treatment options that replace the heart&#8217;s pumping action. Permanent options include heart transplantation, total artificial heart placement or &#8220;ventricular assist devices&#8221; that aid but don&#8217;t actually replace the heart. A wider variety of temporary mechanical replacement and support devices are available to buy time for support while heart &#8220;fixes&#8221; get a chance to work.</p><p>Modern cardiac care is really remarkable in the number of options available to deal with failing hearts &#8230; almost as many as there are merit badges to earn. </p><style>
.neFileBlock {
	margin-bottom: 20px;
}
.neFileBlock p {
	margin: 0px 0px 0px 0px;
}
.neFileBlock .neFile {
	border-bottom: 1px dotted #aaa;
	padding-bottom: 5px;
	padding-top: 10px;
}
.neFileBlock .neCaption {
	font-size: 85%;
}
</style>
<div class='neFileBlock'>
<div class="neFile"><img class="neImage" src="https://www.timesleader.com/wp-content/uploads/2019/02/web1_casale_edit-3.jpg">
<div class="neCaption"></div></div><div class="metaInfo"><photo0>https://www.timesleader.com/wp-content/uploads/2019/02/web1_casale_edit-3.jpg</photo0><caption0></caption0><photoCredit0></photoCredit0></div></div>
<div class="metaInfo"><bylineMeta><p>By Alfred Casale</p><p>To Your Health</p></bylineMeta></div><div class="metaInfo"><shirttailMeta><p>Dr. Alfred Casale, a cardiothoracic surgeon, is associate chief medical officer for Geisinger and chair of the Geisinger Heart Institute. Readers may write to him via ae@www.timesleader.com.</p></shirttailMeta></div>

Heart failure: Myriad ways to treat it