Heart Failure Clinic Offers Well-rounded Patient Experience

By Megan Garcia

Walter Reed Bethesda Public Affairs staff writer

A display shows the progression of heart failure during National Heart Failure Awareness Day at the Walter Reed National Military Medical Center in Bethesda, Maryland on Feb.14. Medical professionals from various clinics around the hospital set up tables, displays and handed out information to patients and staff to promote the awareness of heart health. (Photo by Megan Garcia, WRNMMC Public Affairs/Released)

James McNeill, a retired Army veteran who served 24 years, has suffered from high blood pressure since the 1980s. As a result, he frequented the cardiology department at the former Walter Reed Army Medical Center and continued to visit the clinic at the Walter Reed National Military Center in Bethesda, Maryland. However, on Aug. 22, 2015, he realized there was something more serious going on during one of his visits to the medical center.

“I passed out in the doctor’s office,” said McNeill, who is now 70 years old. “They took me to the emergency room in the hospital, and that’s when I was diagnosed with congestive heart failure.”

As a result, McNeill was referred to the Heart Failure Clinic.

The Heart Failure Clinic treats patients who have been diagnosed with congestive heart failure or who are at risk for the disease. A physician, three nurse practitioners and a registered nurse run the clinic Tuesday and Wednesday from 8 a.m. to 4 p.m. in the Cardiology Department. “The clinic helps patients know how to better care for themselves when they have congestive heart failure, what they need to do in terms of taking their medications [and] their diet, and how they can help themselves feel better,” said Cathy Franklin, a nurse practitioner who works in the clinic.

Patients receiving care in the clinic are placed in one of three classes. Class A consists of people who are at risk for heart failure and who generally suffer from diseases such as high blood pressure, high cholesterol and diabetes. Class B consists of people who have been diagnosed with heart failure, and Class C consists of people who have actually been hospitalized for heart failure.

“Once you are in a class, you can’t go back, so we try to keep the A’s from getting to the C’s,” Franklin said. “If you control those risk factors, sometimes you can prevent them from getting heart failure later.”

Franklin said some symptoms that might point to someone who may be experiencing heart failure are shortness of breath, swelling in the ankles and feet, a decreased exercise tolerance, rapid weight gain, and an inability to sleep at night.

From left to right: Joan Loepkerduncan, the head nurse of cardiology services ; Stacy Walsh-Pouch, a nurse practitioner in the cardiology clinic; and Mary West-Furlow, an adult cardiovascular sonographer in the cardiology clinic, stand behind a display table at the Walter Reed National Military Medical Center in Bethesda, Maryland, on Feb. 14. The table was a part of various exhibits that educated people on congestive heart failure and various other heart diseases during National Heart Failure Awareness Day. (Photo by Megan Garcia, WRNMMC Public Affairs/Released)

“We have patients weigh themselves every day, and if they start to gain weight, like three pounds overnight or five pounds in a week, then they are going to give us call,” Franklin said. “If they notice they can’t lay flat at night, they are going to give us a call.”

The staff educates patients on how to make healthier food choices in order to help them keep their weight under control.

“We tell them to stay away from high-sodium foods such as sausage, bacon and ham, and to eat any kinds of fresh fruits and fresh vegetables, and to use fresh meats without salt, such as chicken, fish and turkey,” Franklin said.

Patients are also referred to a nutritionist for more, in-depth counseling.

“They will contact you and let you know what you should be doing, but it’s up to the patient to make the changes,” McNeill said. “I did away with a lot of salt and fried foods. I already drunk a lot of water, but I increased my intake. I also cut out a lot of breads.”

In addition to maintaining a healthier diet, Franklin stresses a good exercise regimen and urges patients to try and exercise for at least 75 minutes a week.

McNeill said he’s been unable to do as much exercise as he would like due to a recent back injury, but prior to that, he would walk every day between 20 to 25 minutes. With the alteration also in his diet, he started feeling better.

“I noticed a change in my breathing and my blood pressure, and I wasn’t as tired as much,” McNeil said.

Aside from exercise and nutrition, the clinic staff also works with clinical pharmacist to ensure patients get the proper medicine.

“There are certain medications that heart failure patients need to be on,” Franklin said. “We get them on those medications, so they can feel better and live longer. We start them off low and take them to the proper doses.”

Overall, McNeill said he’s grateful for the staff and for what he has learned through the clinic.

“It’s been great,” McNeill said. “I have a great nurse practitioner, Stacy Walsh-Pouch. She’s very firm and concerned about your health, and she explains things to you in a way you can understand. We can sit and have conversations about me and my family. She’s not only concerned with you, but how things are at home to make sure that you have plenty of support from your family. Once you leave there, she continues to call and check on how things are with you. Every time I visit, I’m thankful for it.”