Ultrasound is a powerful diagnostic modality which is non-invasive, painless and does not
involve needles or radiation. Echocardiography [cardiac ultrasound] tells us about the
structure of the heart. We assess the size and function of each of the four chambers
of the heart. We evaluate the function of all four valves. We can detect fluid around the
heart and can estimate pressures within the heart. Carotid ultrasound outlines plaque or
blockage in the blood vessels carrying blood from the heart to the brain. Carotid plaque is
the common cause of strokes and is treatable. The abdominal aorta is easily visualized and
measured by ultrasound. Abdominal aortic aneurysm is the fifth most common cause of
death and is preventable if identified early.
Outlines the circulation to and from the legs [or arms.] Peripheral arterial disease
(PAD) refers to a blockage in the circulation which provides blood and oxygen to the legs.
Symptoms of PAD include pain, cramps, heaviness or fatigue of the legs especially with
walking. Advanced disease can lead to skin ulcers, gangrene or amputation. Treatment options
include surgery, stents or medications. Peripheral venous disease impairs the circulation
of blood back to the heart. Symptoms include swelling, itching or discoloration of the limbs.
Stress testing is required to unmask blockage in the arteries in the heart (i.e. those blood
vessels which fan out over the surface of the heart to supply the beating heart with blood
and oxygen.) Blockage in these vessels are the most common disorder in our society. It is the most
common cause of death or disability when complicated by a heart attack, congestive heart failure or sudden death. Blockage in these vessels typically causes chest
pain or discomfort. However, some people present only with shortness of breath or fatigue.
Unfortunately, for one in four people, the first presenting complaint is a heart attack or sudden
Some kind of stress is required to unmask blockage. The treadmill test is most commonly
used. This involves walking not running. The treadmill starts quite slow and every 3 minutes
increases in speed and elevation until the patient reaches the target heart rate. Often a scan
of the heart is performed before and after stress to improve the accuracy of the test. That
scan may involve injection of a trace radioisotope (nuclear stress testing) or it may involve
ultrasound pictures (stress echocardiogram).
A non-walking stress test is also available for those individuals who are unable to walk for
whatever reason. It is an equally safe and accurate alternative to the treadmill. A medication
is given intravenously which in a sense "exercises" the heart without the legs and lungs
having to exercise. We currently use Lexiscan for our non-walking stress tests. This
medication has fewer side effects than the older agents and the images are better.
A variety of monitors are available to record the heart rhythm. This is especially helpful to
correlate the heart rhythm with symptoms such as palpitations or fainting. Different kinds of
monitors are available which differ primarily in the duration of the monitoring interval. Choice
of monitors depends largely on the frequency of the patient's symptoms. For example, the
Holter monitor will monitor 24-48 hours. An MCOT will monitor three to four weeks. An
implanted loop recorder will monitor for up to three years!
Pacemaker and AICD monitoring:
We utilize representatives from Medtronic, St. Jude and Boston Scientific. Home monitoring
is also available for many pacemaker or AICD models. Home monitoring reduces the number
of office visits and is especially helpful for elderly patients or those with transportation
problems or patients who travel from outside of the area.
Weight gain is a hazard of our modern lifestyle, which unfortunately contributes to poor health. Shedding those extra pounds is often more effective than medication in addressing health issues as diverse as high blood pressure, diabetes, sleep apnea or arthritis.
Losing weight can be a very frustrating task. Many of us are unable to exercise as we would like. Many of us are on medications which tend to promote weight gain.
We are very pleased to have found a program which is effective, scientifically sound and affordable. We have partnered with a company called ‘Ideal Protein.’ The principal behind their program is to lose weight, without losing muscle mass. This is a problem with many of the popular advertised diets. They promote weight loss, which consists partially of loss of fat, but also loss of muscle. We need to retrain that muscle, especially as we are getting older, to maintain stability and avoid falls.
Our experience with Ideal Protein has been extremely successful. Early on, four of our employees completed the program. They lost a combined total of 184 pounds. They reported that they did not feel hungry and did not feel tired. In fact, they were more energized.
You are welcome to join us at one of our regular workshops to learn more about Ideal Protein. Spouses and others are welcome to join in as well.
Sleep apnea is a treatable condition. The goals of therapy are to both improve quality of life as well as to reduce strain on the heart to avoid long term complications.
Almost all patients with sleep apnea can be managed effectively. Treatment can be life changing by improving the quality of sleep and restoring energy during the day.
There is no one solution that works for everyone. We offer multiple modalities to accomplish the above goals.
CPAP therapy remains the most effective treatment and a good place to start. We add a little air pressure to keep the airway from collapsing. This is delivered by a device that sits on the bedside table. It is about the size and shape of a clock radio. This blower is attached to the patient with an air hose and a small mask, which typically fits over the nose.
CPAP therapy does take some getting used to. Obstacles are encountered initially, such as mask fit and pressure desensitization. Our practice is unique in helping patients through this transitional phase. It is not uncommon to require some tweaking of the mask type and/or size, especially in the 1st 30 days. In our experience, about 80% of patients do extremely well with CPAP, when appropriate compliance support is available.
There are several alternative options also available for patients who are unable to tolerate CPAP therapy.
Those with mild to moderately severe sleep apnea, often respond well to an oral (or dental) appliance. This is a mouth piece that can be molded by a qualified dentist or orthodontist. The device opens the airway by pulling the lower jaw forward (together with the base of the tongue.)
Inspire (also known as glossopharyngeal nerve stimulation) is an excellent choice for patients with moderate to severe sleep apnea, who have failed on CPAP. This is a new therapy, which was approved in 2015. It is unique in that it does not involve a mask, a mouthpiece or any upper airway surgery. It does involve an implant, which gently stimulates a nerve to open the airway during sleep.
We have a network of providers for services not available in the office.
Dr. Steljes utilizes St. Rose Hospital for: diagnostic coronary
angiography, intracoronary stent placement, intravascular ultrasound and rotational coronary
atherectomy, permanent pacemaker implants, loop recorder implants, and transesophageal
CT coronary angiography is available in local imaging centers. Tilt table tests are available at
Desert Springs or Sunrise Hospitals.