Cardiologist Dr. Andrew Hordes is the Heart & Vascular Center’s Certified Cardiac Device Specialist. He was one of the first to perform internal defibrillator procedures at Watauga Medical Center, as well as the first Micra procedure, using the world’s smallest leadless pacemaker.
Dr. Hordes recently renewed his certification for the International Board of Heart Rhythm Examiners (IBHRE). He placed in the top five percent of all scores and was offered an ambassadorship for the IBHRE. Worldwide, the IBHRE has about 50 ambassadors who assist in writing the exam, as well as mentoring others as they prepare to take the test.
Cardiac Resynchronization Therapy (CRT) is a treatment that Dr. Hordes says can make a significant impact on quality of life. He has a wealth of experience and knowledge in pacemakers, internal defibrillators, and CRT.
What’s the difference?
Unless they’ve had a personal experience with heart failure or heart attack, people often don’t know the difference between an internal cardiac defibrillator (ICD) and a pacemaker. Both devices are implanted into a patient’s chest, but they have very different functions.
A pacemaker helps control abnormal heart rhythms. It uses electrical pulses to prompt the heart to beat at a normal rate. It can speed up a slow heart rhythm, control a fast heart rhythm, and coordinate the chambers of the heart
An ICD monitors heart rhythm. If it senses dangerous rhythms, it delivers shocks. This treatment is called defibrillation. An ICD can help control life-threatening arrhythmias, especially those that can cause sudden cardiac arrest (SCA).
Most new ICDs can act as both a pacemaker and a defibrillator. Many ICDs also record the heart’s electrical patterns when there is an abnormal heartbeat. This can help the doctor plan future treatment (source).
Until the early 2000s, ICDs were mainly used for people who had already suffered a heart attack or were in the midst of heart failure. Dr. Hordes served as an investigator on a trial addressing the implications of expanding the use of ICD. The study found that anyone with poor ventricular function could benefit from an ICD – saving and extending lives.
But according to Dr. Hordes, it’s important to understand that with a defibrillator alone, the patient may not “feel” any better. The device will, however, save their life in the event of a sudden heart event.
Heart Pacing History
The innovation:
In the 1950s, physicians began treating heart failure patients with pacemakers, although the first pacemakers were external. On October 8th, 1958 the first internal pacemaker implantation was performed in Sweden (source).
The problem:
These early devices only had one wire pacing the ventricle of the heart. Because the pacemaker was only pacing the ventricle, and not the atrium, some patients suffered from “pacemaker syndrome.” Their atrium and ventricle became out of synch, making the patient very sick.
The innovation:
Enter “dual-chamber pacemakers” in the late 1970s. These devices improved the synchronization of the ventricle and atrium, but there was still a problem.
The problem:
Dr. Hordes explains, “When we’re born, our heart naturally paces itself from left to right. But our pacemakers paced from right to left, throwing off the motion of the wall in the center of the heart – the septum. The heart loses efficiency and quality of life for the patient. The treatment could actually create a condition called “left bundle branch block.”
To correct the problem with traditional pacemakers, cardiologists asked themselves, “What if we could control the timing between the right and left sides of the heart to more closely match the natural rhythm and create a more efficient contraction?”
And thus, Cardiac Resynchronization Therapy (CRT) was born. Not everyone will respond to this therapy, but when successful, CRT increases survival and quality of life, with 50% reduction in heart failure hospitalizations.
Who is a candidate for CRT?
- Patients who have experienced heart attack or suffer from heart failure, have scarring, or a problem with the heart’s electrical system (left bundle branch block).
- People with merely a weak heart that doesn’t stem from a heart attack (non-ischemic cardiomyopathy).
“In fact,” says Dr. Hordes, “the second group of patients are the ones who typically get the most benefit from CRT, as left bundle branch block is common with non-ischemic cardiomyopathy.” About 95% of Dr. Hordes’ patients receiving CRT show an improvement in heart function.
Some patients, whom Dr. Hordes calls “super-responders,” experience a significant improvement in heart function and quality of life. These patients feel much better and they live longer.
If you experience fatigue and shortness of breath with exertion – even with medication – contact your cardiologist today to see if CRT may be right for you. In addition to general cardiac needs and interventional cardiology (heart catheterization), you can receive CRT right here in Boone at the Heart & Vascular Center of Watauga Medical Center. Most patients report an improvement in energy levels, ability to exercise, and quality of life.
formerly The Cardiology Center
336 Deerfield Road
Boone, NC 28607
Phone: (828) 264-9664
Fax: (828) 264-8144
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A legacy is not something one merely inherits. It is something one creates. The legacy of Avery County’s Dr. Bill Tate is certainly no exception. His legacy in our region is his own, and it is his gift to the people he served as a physician for most of his life. While there has been a Dr. Bill Tate in Avery County for as long as there has been an Avery County, he crafted a unique role and a remarkable legacy.
Before Avery County was formed
William C. Tate (far right on front row) and Ronda H. Hardin (third from right on front row) led the staff at Grace Hospital in the 1930s. Byron Pritchett, the hospital’s laboratory technician, is in the front row wearing a white coat and necktie. Behind and to his left, is Mary Chappell, a senior nurse on the hospital staff. Pauline Lawrence, a nurse anesthetist, is to Chappell’s left.
(Photo courtesy of the Tate family)
In 1910, before the county’s formation a year later, Dr. William C. (W.C.) Tate came to Banner Elk and spent half a century treating those who would otherwise have lacked access to even basic medical care. Dr. Lawson Tate, his son, followed suit, treating patients in the hospital his father founded.
In turn, Dr. William Cummings Tate II, “Bill,” began practicing alongside his father Lawson in 1977, and in his own more than forty years of treating the people of Avery County, he devoted himself to providing more than medical care, as he worked to make Avery County a better place. He has built upon the past and reached to the future, spearheading healthcare improvements in the region and helping to shape a twenty-first-century Avery County of which his grandfather’s patients could only have dreamed.
A graduate of the University of North Carolina’s medical school, Dr. Tate returned to Avery County, bringing his surgical training to serve his family and friends, and always deftly blending his concern for his patients with his wealth of knowledge. “He truly cares about every person he ever took care of,” says Dr. Thomas Haizlip, who joined the Tate Clinic in 1998, and was immediately impressed both by Dr. Tate’s willingness to support and trust him, and by the trust the community had in Dr. Tate. “I walked into a full clinic on day one because Bill said I was okay.“ Whether assisting a colleague in a procedure or teaching a new healthcare provider to best meet patient needs, Dr. Tate always brought a collegiality and spirit of cooperation to medical treatment.
Drs Tate and Hazlip in 2012
Building a “patient-first” surgical team
“He picked up and carried on father’s legacy,” Haizlip says, but he “never endorsed hierarchy,” despite his pedigree and academic degrees. “Every member of his team felt important and prized, valued as friends and colleagues, not hired help.” Sheri Cornett, a surgical technologist who spent decades working beside Dr. Tate in the operating room, agrees, “He never thought he was above anyone else and never treated anyone like second best because the patient always had first priority.”
That “patient-first” mentality explains much about Bill Tate’s choices, including his pivotal decision to spend his entire medical career practicing in Avery County.
Dr. Bob Clark notes Dr. Tate’s remarkable investment in his patients, who have always been the core of his practice. “He bypassed a lot of reward as a rural surgeon caring for rural people. He has always treated people like a part of his family.”
Serving his rural community
For many physicians, Avery County might lack the appeal of a big city. Dr. Charlie Baker recalls originally meeting Bill Tate when they were both students at the first Governor’s School at Salem College in 1963. He thought his new acquaintance was “a guy from the end of the world,” an amusing impression indeed when Dr. Baker himself later came to Avery County to practice.
He notes how a deep connection to the community has allowed Dr. Tate to benefit Avery County, from providing life-saving care to anyone who needed it, to his leadership in merging the historic hospitals of Banner Elk and Crossnore into today’s Cannon Memorial in Linville. “He has always been devoted to quality of care, to improving lives in the community.”
Dr. Clark agrees, noting that that Dr. Tate was frequently on call every other night and, throughout his career, took a wide range of emergency cases that couldn’t wait for a trip to a larger facility. “He’s given his life to mountain folk, people he knew wouldn’t be cared for otherwise,” Clark says, crediting Dr. Tate’s combination of extensive knowledge and love for people with allowing the people of Avery County “to live healthier, longer lives with a better quality of life.” As his colleagues, friends, and patients all recognize, when one is treating neighbors, family, and friends, there is a different dedication than to a stranger.
Dr. Tate “put the community ahead of everything,” says Dr. Haizlip, who notes that his longtime colleague and friend, in his dedication to “appropriate and modern care,” has always been driven to provide whatever his patients needed. “He was willing to take on difficult things, do the homework, do whatever someone needed to make sure people got the right care.” When new skills or tools were necessary, he learned them, and if he really couldn’t do a procedure, “he went with the patient to see it done and learn.” At the same time, he has always understood that there is more to healing than can be achieved with a surgical procedure.
Healing happens with community, kindness, and compassion
Perhaps even more remarkable than his vast skill and his lifelong commitment is his love for the people he treats. Carmen Lacey, President of Cannon Memorial Hospital, describes Dr. Tate as “the kindest, most compassionate surgeon I have ever known. He would do whatever it takes to make his patients comfortable.” He has consistently provided whatever care was required, as Dr. Baker notes. With Dr. Tate, “If you needed a doctor, you had a doctor…It wasn’t his job. It was a lifestyle.”
Dr. Tate has always recognized that community, faith, and family are vital to health and recovery. That focus is clear in his own life outside the operating theater. Whether playing with his grandchildren, laughing with his wife Donna, singing in the church choir, spending 20 years championing education as part of Avery County’s School Board, supporting the YMCA, or just hugging someone in the grocery store, Dr. Tate’s devotion to his family, his faith, and his community shine through in all.
“He absolutely loved this community,” Lacey said. The community loved Dr. Tate in return. In 2013, he was inducted into the Martha Guy Hall of Legends, acknowledging his contributions to Avery County. Even after his retirement, many of his former patients still considered Dr. Tate to be “their” doctor. The improvements he brought to their lives, and to the lives of everyone in Avery County, are his legacy, his own legacy, and the journeys of his family, his friends, and his patients are all the better for knowing him.
Dr. Bill Tate passed away on May 27, 2020, following a long illness.
“Dr. Tate was a third-generation physician serving Avery county. Even as his body failed him, he continued to find fulfillment in serving others by providing medical care to the community and asking nothing in return. I’ll always remember Dr. Tate for his quick wit, love for life and his family,” remembers Chuck Mantooth, President and CEO of Appalachian Regional Healthcare System.
Nurse and kidney donor Adura Wiseman
March 4, 2020
If you’ve lost confidence in humanity, this story might just change your way of thinking. It’s a testament of faith, hope, compassion and selflessness.
In December, 2019, Audra Wiseman, a medical surgical nurse at Charles A. Cannon Jr. Memorial Hospital in Linville, NC was at home one evening scrolling through Facebook, as she does on most days.
She came across a somewhat familiar name, Shannon Perdue, and the plight of the local 47-year-old high school teacher suffering from kidney disease. “I remembered her. She was my daughter’s 9th grade English teacher at Avery County High School,” Audra said.
Audra recalled traveling to London with her on a school trip in 2015. “I just remembered how wonderful she was,” she said. But Audra didn’t really know Shannon much beyond that experience. In fact, she described their relationship as a “casual acquaintance,” saying, “we hadn’t talked since the trip.”
Upon reading social media and talking to others in the close-knit Avery County community, Audra learned that Shannon’s kidney disease prognosis was not good.
Treatment Options for Kidney Disease
According to the National Institutes of Health, kidney disease means your kidneys are damaged and can’t filter blood the way they should. This damage can cause wastes to build up in your body and cause problems, such as swelling, nausea, weakness, poor sleep and shortness of breath. Kidney disease can lead to other health problems, such as heart disease. If you have kidney disease, it increases your chances of having a stroke or heart attack.
Shannon Perdue’s type of kidney disease is a genetic condition called Polycystic Kidney Disease (PKD). Several of Shannon’s relatives have had PKD, including her grandmother, her aunt and her father — who died from the disease at the young age of 59.
In May of 2019 nephrologists told Shannon that she would need to start thinking about undergoing nightly peritoneal dialysis, which cleans the blood of impurities.
While peritoneal dialysis has many advantages over other types of treatment, it still presents many difficulties for patients. For most people it must be done seven days per week and requires a permanent catheter outside the body. Patients run the risk of infection and weight gain. They also need ample storage space in their homes for supplies, equipment and the dialysis machine. Finally, patients must receive intensive training on what the procedure involves and how to use the equipment safely.
The other option for treating Shannon’s kidney disease is through kidney transplant — a surgical procedure to place a kidney from a living or deceased donor into a person whose kidneys no longer function properly.
Currently, more than 100,000 people in the United States are on the national transplant waiting list for a donor kidney.
Unfortunately, many may never get the call saying that a suitable donor organ — and a second chance at life — has been found. It’s estimated that every day in the United States, 20 patients die because of the lack of donor organs.
Shannon went on the transplant list in October, 2019, not knowing how long she would have to wait.
On a positive note more than 6,000 healthy people in the U.S. donate a kidney to someone they know each year. About half are blood relatives of the kidney recipient. The other half are spouses, friends or acquaintances. About 100 come forward wishing to anonymously give the gift to someone they’ve never met.
The Decision to Donate
Avery County High School teacher, and kidney recipient, Shannon Perdue
As Audra Wiseman learned more about Shannon, she felt a strong sense of wanting to help. “As a nurse, taking care of others just comes natural. I have seen what people with kidney disease have to go through and it’s not a good situation,” she said. Audra knew that if Shannon had to wait for a kidney from the transplant waiting list, it would take far too long. She knew the best way to help Shannon would be to donate one of her own kidneys.
But Audra’s decision was not made lightly. “I just started praying about it,” she said. In December, Audra contacted Shannon through Facebook to ask for contact information for the Center for Transplant Services University of Tennessee Medical Center (UTMC) in Knoxville. “I wanted to learn more,” she said. Ashley Dennis, the Living Donor Coordinator for the Organ Donor Council in the UTMC Center for Transplant Services answered every question for her.
There were a number of conditions that Audra had to meet prior to donating. First and foremost her blood type had to match and she had to have healthy kidney function. “They also performed lots of tests…CTs of my abdomen, mammograms and 28 different blood tests,” she said. While Audra underwent all of the testing she did not keep in touch with Shannon.
Audra also realized that she had to think about the impact it would have on her own life: What are the health risks? How long is the recovery? How would it impact her family? What bearing would it have on her ability to work and make a living?
Regarding her family’s response Audra said, “My husband was obviously concerned, but very supportive.”
When asked how having only one kidney might jeopardize her health, Audra shared a personal detail that few people know, “Well, my daughter has one kidney. She’s living proof that you can live with just one.” That moment seemed to crystallize why she would donate a kidney to someone she barely knew.
Then the question arose, what if your daughter needs a kidney one day? She responded, “Then someone will give her one. It’s easy enough that everyone should donate.” She continued by saying, “Our body is God’s body. He has just loaned it to us while we’re here on earth.” From this comment it was clear that Audra’s selflessness arises from a combination of unique personal experience and a strong Christian faith.
While Audra understands there are risks with any surgery, a review of data seems to support her assertion that after donating a kidney, a person can live exactly the way they lived before donating—a long, healthy, active life with virtually no restrictions.
Johns Hopkins University School of Medicine studied mortality among 80,000 kidney donors over the past 15 years, comparing them to healthy people with both kidneys. The study, published March 10, 2010 in JAMA, The Journal of the American Medical Association—60 years after the first documented kidney transplant in the U.S.—shows the procedure carries little long-term medical risk for the donor.
After numerous visits to UTMC, Audra was fully convinced that donating her kidney to Shannon Perdue was something she wanted to do.
A Big Celebration
Thursday, January 30, is a day that Shannon Perdue will never forget. “I was in my classroom trying to implement a new technology and Penny Ward (another teacher) came in and said, ‘they need you in the front office right away,’” Shannon said. When Penny and Shannon walked into the office they were met by Bev Baird and Audra Wiseman.
Right then, with just the four of them in the room, Audra Wiseman uttered the words, “Ms. Shannon, I’m going to give you a kidney.”
Shannon was overwhelmed by the moment. “We all hugged…Everybody cried…It was beautiful…Audra was giving me the greatest gift,” she said. Shannon said the good news filtered out at school very quickly. For the next hour, people kept coming by Shannon’s classroom. “A little while later the school made an announcement over the intercom and everyone celebrated with me,” she said.
When Audra Wiseman was asked about the moment she told Shannon, she humbly replied, “There was a lot of crying, a lot of happiness.” Audra quickly added, “My daughter loved Shannon Perdue. I can’t imagine our community losing that resource…when the kids at the high school learned about her, they were lining up to do it, too.”
And there, in that instance, Audra selflessly deflected the praise away from her heroic act, to instead celebrate Shannon.
Transplant Day and Beyond
On the evening of March 3, Audra Wiseman and her husband arrived at UTMC and spent the night in preparation for the transplant surgery the next day, March 4.
The procedure, a robotic nephrectomy, took three hours. Audra and Shannon had adjoining rooms to expedite the handoff of the life-saving organ.
Audra recovered in the hospital for three days after surgery. She will not be able to drive for a few weeks. Because she won’t be able to lift more than a few pounds at a time, she will need some assistance with activities of daily living.
Audra will go back to UTMC for evaluation at one week, one month, six months and then at the one-year anniversary of her organ donation. She will also miss eight weeks of work.
While the procedure only took a few hours, Audra’s gift to Shannon will bind them for life.
It has been said that timing is everything. Fortunately for Betty Redman, she has been in the right place at the right time, not just once, but at least twice – at least where her heart health is concerned.
Despite a family history of heart problems, Redman had been healthy most of her adult life. “My father died at age 52 with a heart attack, and my mother, although she lived to be 84, was paralyzed from a stroke at the age of 62. She received good therapy, and was able to retain her mobility to a point.”
However, things began to change for Redman in the last decade when she was diagnosed with atrial fibrillation; she responded well to medication, but had occasional mini-strokes.
Still, she said, it wasn’t too serious — until last year.
Uncovering hidden heart conditions
While in physical therapy at The Rehabilitation Center of Cannon Memorial Hospital (CMH) due to a shoulder injury, an observant and compassionate therapist, Day Watson, was concerned when Redman had pain in her left arm and back following her treatment. Her vital signs were erratic, which was alarming to Watson.
“Day told me I needed to call my cardiologist right away. By the time I got home, after we had stopped for lunch, Day had already called Dr. Helak, who was my cardiologist in Boone at the time,” said Redman. “I went in and he began running tests. We discovered that I had more of a problem than I thought.”
Left to right: Fred France, Betty Redman, and Stephanie Platt
Redman had major blockages, which required extensive interventions, so she was transferred to Asheville for stents. That was May 10, 2019. After that, she was referred back to CMH, where she began cardiac rehab and met Stephanie Platt.
A registered nurse with Appalachian Regional Healthcare System since 2012, Platt has a passion for caring for cardiac patients. And it was this passion along with her instinct that led to Redman’s next intervention.
After several sessions of her recommended therapy, Redman was “working away” on one of the machines one day when Platt told her and her husband, Fred France, that Redman’s heart was pausing.
“I was watching the telemetry monitor and began noticing pauses,” Platt related. “They were less than two seconds, initially, but the fact that she was having them at all concerned me.” At the same time, Redman recalled with a chuckle, “I didn’t know what my heart was doing – I was not feeling any of it. I was on the machines going 90 miles an hour.”
At that point, Platt contacted Redman’s cardiologist in Asheville, who asked about her symptoms: was she dizzy or light headed? “No, but she is very fatigued, you can see it when she walks in the door,” Platt replied.
Platt was frustrated that her observation wasn’t taken seriously.
A nurse’s intuition, observation, and tenacity
“That was difficult,” she said. “But, we continued to monitor her. I sat down with Betty and Fred the next session and told them that she was still having some pauses.”
Upon Platt’s recommendation, Redman followed up with Dr. David Kimmel, her primary physician locally, who agreed that she needed to wear a heart monitor.
“Once we touched base with Dr. Kimmel, I felt better,” Platt said. “He understood. We were on the same team, caring for this patient together and figuring out what was going on.”
Redman received the heart monitor, wore it for two weeks as suggested and mailed it back in. “I still thought I was fine – and kept going to rehab.”
But, she was still having pauses, Platt recalled. “And, I continued to send strips of the pauses to her cardiologist in Asheville. I was certain that something was wrong with her, but was told it was okay; they did not express concern.”
At this point Platt was adamant. “You have to listen to what you know, and trust what you know, and continue to fight for your patients.”
Two and a half weeks after she had returned her monitor, Redman said, she and her husband were coming home from grocery shopping when her cell phone rang.
“It was my local cardiologist, Dr. Helak. He said, ‘you’ve got to go to the hospital in Boone right now.’ That was a shock to me. I told him I couldn’t do that, that we had $300 worth of groceries in the car and I had to go home to put them up.”
The two agreed that she would go to the hospital the next morning, a Saturday, to have a pacemaker procedure performed by Dr. Andrew Hordes. “I went to the hospital at 8 a.m., and five minutes later, I was in a hospital gown with a heart monitor on,” she said. “I needed a pacemaker, they told me, but I had to be weaned off of my blood thinners, first. So, they monitored me until it was safe, and on Monday afternoon, I got my pacemaker. I came home on Tuesday afternoon and went back to cardiac rehab as soon as they cleared me. And now I’m doing fine and going to physical therapy two days a week.”
Redman and France, who have been permanent High Country residents since 2000, can’t say enough about the compassionate care they have experienced through this situation.
“I’m a great believer in therapy — and the fine folks in this local hospital system are the best,” she said.
The road to recovery and “graduation”
“I’m doing well now and will always be grateful for the care that I have received at Cannon Hospital, and most recently, by Stephanie, Beth Ann Scott (Exercise Physiologist) and Velma Greene (Respiratory Therapist) who monitored me very carefully to make sure I was ok,” she said. “I credit Stephanie for saving my life, and Drs. Kimmel and Helak, for listening to Stephanie’s concerns. Those people are very good. I can’t say enough for them.”
For Platt, the situation was just as pleasant. “Betty and Fred are one of the sweetest couples I’ve ever met. They are so supportive of each other. When we discovered that she was having these (new) problems, we did our best to encourage her. We reassured her that she was in the right place and that we would take care of her.”
Platt said she is “truly blessed” to be working in a position that affords her the opportunity to build a strong rapport with her patients and to advocate for them.
“I consider my patients as family, even after they complete our program,” she said. “It’s people like Betty and Fred who make it all worthwhile. I am thankful that they allowed me to care for Betty during her cardiac rehab.”
In February 2017, Platt was presented with the opportunity to become the Cardiopulmonary Rehab Nurse at Cannon. “I truly feel that God knew where I needed to be and led me to this position,” Platt continued. “I am thankful and blessed to be the nurse for this program and to be able to care for each patient that comes through the program.”
Platt said, she never thinks about it as going above and beyond. “I’ve been given the tools and ability to help someone and that’s just what I do.” But, she’s also quick to say, it’s not just one single person who deserves the credit for these great outcomes. “It’s everybody working together and we do work very well together. I am thankful for the personal care that our staff gives to our patients.”
[click_to_tweet tweet=”“It’s everybody working together and we do work very well together. I am thankful for the personal care that our staff gives to our patients.” – Stephanie Platt, RN” quote=”“It’s everybody working together and we do work very well together. I am thankful for the personal care that our staff gives to our patients.” Stephanie Platt, RN”]
Left to right: Stephanie Platt, Betty, and Beth Ann Scott on Betty’s “graduation” day.
Beth Ann Scott, Exercise Physiologist and site supervisor for the program at Cannon Memorial Hospital, had this to say: “We are fortunate to have staff at both of our rehab programs who are invested in working in cardiopulmonary rehab. We have well-educated and professionally qualified individuals who all have their heart in truly caring for our patients. We all keep the best interest of our patients as top priority.”
Patients may be in cardiac rehab at least three months and staff get to know them really well. “Our patients become part of our rehab family,” Scott added.
Redman “graduated” from cardiac rehab in January, 2020, and she is doing well. She will continue to follow up with her providers to ensure she stays active for many years to come.
More About Cardiac and Pulmonary Rehabilitation
The Appalachian Regional Cardiac and Pulmonary Rehabilitation Program is a physician-referred medically supervised exercise program. Each patient is provided with multidisciplinary care from several healthcare professionals which include a medical doctor, exercise physiologist, registered nurse, respiratory therapist, behavioral health specialist and clinical dietician.
Cardiac Rehabilitation is designed to help restore cardiac patients to an optimal physical, vocational, recreational and emotional status with the ultimate goal of preventing further disease progression. Patients are strongly encouraged to make various lifestyle changes for the purpose of reducing coronary risk and improving quality of life.
Pulmonary Rehabilitation is designed to improve lung function, reduce symptom severity, and improve quality of life. It plays an important role in helping patients with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment.
What to Expect At Cardiac Rehab
A “typical” patient is referred to Cardiac and Pulmonary Rehabilitation usually by his or her primary care provider, cardiologist, pulmonologist or surgeon after experiencing heart or lung- related issues.
Patients complete an initial orientation appointment with a registered nurse to discuss and review their medical history, medications and goals for the program. The patient will also have a blood pressure assessment and EKG performed at this interview. Next, a ‘new start appointment,’ is scheduled for the patient to work one-on-one with an exercise physiologist to begin their program.
The program consists of 36 sessions, lasting about three months and including a focus on exercise, education, nutrition and mental wellness, while being medically supervised by the clinical staff.
Care plans are customized for each patient, based on their health history, current health status and the event/diagnosis that resulted in the need for cardiac or pulmonary rehab. Rehab staff also work with patients to develop an exercise plan to use once they have completed rehab.
“We develop strong rapport with each one of them, and at times, with their family members, as well,” Platt continued. “When they graduate, they are encouraged to reach out to us if they ever need anything. We have numerous graduates who come back to visit and keep us updated on how they are doing.”
Appalachian Regional Healthcare System has two cardiac and pulmonary rehab locations, one at Cannon Memorial Hospital in Linville in the Sloop Medical Building and one at the Paul H. Broyhill Wellness Center in Boone.
By Kathryn Hackenholt-Wrenn
From the very beginning, Roger Mashke has always had a knack for interacting with and helping people. Whether it was running a successful television business or working as a volunteer firefighter, leaving a positive impact on another individual has always been his main source of motivation. That’s why when given the opportunity to volunteer for Charles A. Cannon Jr. Memorial Hospital, he knew it was what he wanted to do. Four years later, Mashke is still one of the most dedicated volunteers we have at Cannon Memorial Hospital and Appalachian Regional Healthcare System (ARHS) as a whole.
Roger began his career as an employee for his father’s television servicing company, the first ever television company to be opened in western New York. At just sixteen years old, he was taking service calls and learning to fix TVs. From there, he went on to join the army and worked with electronics and in the lab at the Utah base where he was stationed. After his time in the army, he moved to Florida with his wife, Barbara, to continue his work in electronics and sales by opening his very own Radio Shack franchise which he would own for the next thirty years.
Roger and Barbara met while in high school. After five years together, they tied the knot and began their sixty-year marriage. “She was a red-headed Irish girl. We got along great. We are lucky we never fought,” says Roger.
Together the couple raised four kids, two boys and two girls. While raising four kids full time, Barbara also worked as a dental assistant. Between the two of them, Roger and Barbara were able to provide themselves and their kids with a comfortable and happy life full of adventures and worthwhile experiences.
Six years ago though, Roger got the shock of his life. He was told his wife, Barbara, had suffered a stroke and was not expected to live. The providers at Cannon Memorial Hospital assured Roger that they were going to do everything they could to save Barbara’s life, and that is exactly what they did. Not only did they save Barbara’s life, Roger and Barbara enjoyed three more happy years of marriage they never expected they would have. After her severe stroke, Barbara spent three years in long-term care at Life Care Center before she passed.
After being given the lifesaving care Roger’s wife needed, mixed with his love for interacting with others, volunteering for Cannon was an opportunity he couldn’t pass up.
“I was looking to volunteer and they had been saying they needed one here for about three months. I figured, ‘well, why not,’” says Mashke.
To this day, you can find Roger volunteering at the Cannon Memorial Hospital gift shop. His volunteer position gives him the ability to continue doing what he loves while making a difference whether it be big or small.
“I like being involved. I like meeting people. Volunteering gives me some purpose. It gives me a reason to get up in the morning and get my butt going,” says Mashke.
Want to become an ARHS volunteer?
Volunteers are valued members of the ARHS patient care team and are always welcome at Cannon Memorial Hospital, Watauga Medical Center and several administrative offices within the healthcare system. Schedules are flexible and there are a variety of work areas available including our pet therapy program (PAWS), our cancer center, human resources, and more.
Volunteer Requirements
All volunteers must meet the following criteria before they are able to serve:
- Minimum age of 14
- Attend hospital orientation
- Receive a TB test
- Complete a competency test
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Few moments in life are more captivating than the birth of a child. For nervous parents, it is the culmination of all of their thoughts, dreams, plans and prayers over the last nine months. It is the end of one chapter and the beginning of the next. In the waiting room, excitement is palpable, as aunts, uncles, and grandparents-to-be, all eagerly await the opportunity to wrap their arms around the new baby for the very first time. And for the doctor in the room, who has spent a lifetime delivering babies, this precious moment of shared delight is one he will cherish for the rest of his life.
After delivering more than 2,000 babies during his 40-year career as a pediatric and family medicine doctor in Avery County, Dr. Charlie Baker retired in June. Since opening his solo practice in 1979, The Baker Center for Primary Care, a member of Appalachian Regional Medical Associates, has grown to become the cornerstone of accessible healthcare in the community. And although many consider him to be a bona fide local, this mountain doctor’s journey to the High Country just might surprise you.
[click_to_tweet tweet=”After delivering more than 2,000 babies during his 40-year career as a pediatric and family medicine doctor in Avery County, Dr. Charlie Baker is set to retire this June.” quote=”After delivering more than 2,000 babies during his 40-year career as a pediatric and family medicine doctor in Avery County, Dr. Charlie Baker is set to retire this June.”]
Buried treasure
Charlie Baker and his sister Cilie
Charlie and his sister Cilie spent many summer vacations searching for buried treasure around their grandmother’s old antebellum home in Atlanta, GA. It was rumored that a previous owner of the house had buried his treasure on the grounds of the home in anticipation of Civil War General William T. Sherman’s famed March to the Sea in 1864. After years of investigating, the children felt vindicated when at last they discovered a clue in the form of a few Confederate bills hidden in the walls.
“Outside of those bills, we never did find that treasure,” he said. “But I’ll never forget those memories. My grandmother, Irene and I used to sit on the front porch swing together and talk for hours. She taught me to ask questions in life, to be inquisitive, to read and appreciate Sherlock Holmes, and to give freely of my time.”
For Charlie, volunteering time with his grandmother usually manifested itself at the church. It was there that he found choir practice to be particularly distressing because it occurred at the same time on Saturday morning as Captain Midnight, his favorite television show.
“My grandmother did not seem to understand that I needed to be home during the episode so that I could use my Captain Midnight cereal box decoder to figure out each week’s secret message,” he joked.
Mr. Conscientious
Charlie’s parents were members of what is often referred to as the Greatest Generation. After surviving the Great Depression they married just before World War II. Like many other young men at the time, Charlie, Sr., enlisted in the Army to go fight the Third Reich while his new bride, Sarah, stayed in Atlanta to teach school. After the war ended, Charlie, Jr. was born in 1946 and the family moved to Charlotte, NC.
Charlie’s interest in medicine first developed when he was six years old. His parents took him to see an allergist who had a profound impact on his life.
“My doctor was a polio survivor and I remember that he took care of me from his wheelchair,” he said. “During the 1950’s polio was deadly, and yet he was able to not just overcome it, but to also help others. Something about that resonated with me. He was very supportive when he learned that I wanted to be a doctor.”
For those that know him, it is not surprising to learn that the young doctor in training went on to be recognized as Most Conscientious in his high school annual. He credits his nose to the grindstone mentality in life to his mother, who always pushed him to do his best.
War and peace
Charlie went on to study pre-med at Davidson College. It was there that he also decided to branch out and take other courses like modern drama, abnormal psychology and romantic poetry. One poet, by the name of William Carlos Williams, stood out in particular to Charlie. In addition to poetry, Williams also served as a general practitioner and as a pediatrician during the 1950s.
“Williams said that being a doctor gave him the privilege to be where important things are happening in people’s lives and that fed his heart. Williams is a big reason why I am a general practitioner and a pediatrician today,” Charlie shared. “For him it was not only about taking care of patients, it was about then reflecting on what that meant in the big picture.”
The Vietnam War began a few years before he started medical school at the University of North Carolina at Chapel Hill (UNC). At the time, Charlie was burned out on medical school, but knew if he quit, he would be drafted. Charlie considered going to language school so he could learn Russian, avoid the Vietnam draft and go to Germany to interrogate defectors. This plan would have also allowed him to follow in his father’s footsteps. However, as fate would have it, all of the Russian language classes were full. It was then that Charlie’s academic advisor, Ike Taylor, James Taylor’s father (world renowned singer and songwriter), encouraged him to at least try to pass his medical school final exams before making a decision.
And so it was that Charlie spent the remaining weeks of his first year of medical school under the spring trees in Chapel Hill studying the biochemical pathways, the Kreb cycle, the brachial plexus nervous system and more. Needless to say he scored well on the exams and so decided to stick with medicine.
Romantic at heart
Charlie and Ann on the Island of Innishmann
All the while Charlie continued to audit creative writing and poetry classes. It was actually an Irish playwright, John Millington Synge, who inspired him to take his then girlfriend Ann to the Island of Inishmaan, off of the coast of Ireland, during his third year of medical school in 1972.
It was there that Charlie proposed at a rocky ocean overlook known as Synge’s Chair. It is said that the late poet used this location as his seat for creative inspiration.
“Our plan was to camp out on the island,” said Charlie. “But a local village woman asked us if we needed a place to stay. She then cleaned out her chicken barn and put down fresh straw. It was modest to say the least, but it was also beautiful and everything we needed. I guess you could say I’m a romantic at heart.”
The happy couple went on to spend the following year in England. Ann was accepted into the Edinburgh College of Art while Charlie managed to secure a scholarship at UNC so that he could complete part of his fourth year of medical school in Edinburgh. To help supplement their living expenses, he worked as an orderly at the Edinburgh Psychiatric Hospital.
“They couldn’t find any Scots to take that job,” he joked. “Working as an orderly at a psychiatric hospital was difficult to say the least, but it also allowed us to stay together.”
And stay together they did. During their year in England, the couple married and returned often to the Island of Inishmaan where it all began. Still madly in love today, Charlie and Ann will celebrate their 47th year of marriage later this year.
Emergency powwow
Charlie with son Daniel on the Sioux Reservation.
After he completed two years of pediatric residency, Charlie made a deal with Ann. If he got to pick where the couple lived for the next two years, she could decide where they lived for the following two years.
Once the deal was struck, Charlie decided that the Bakers should move to the Pine Ridge Sioux Indian Reservation in South Dakota. Shortly after moving there, Ann realized she was expecting their first child.
“Although it was the first time in our lives that we were a minority, the Native Americans were very welcoming to us,” he said. “They would invite us to their powwows. I remember one powwow where Ann, who was 38 weeks pregnant at the time, reached over and put my hand on her stomach. The baby was kicking at the same beat as the ceremonial drums.”
Charlie was at the hospital the night that Ann called him to say that she was going into labor. “I’ll never forget Charlie just told me to walk the 200 yards from our hut over to the hospital so the baby could be delivered,” Ann quipped. “I still give him a hard time for telling his very pregnant wife, who was going into labor, to walk to the hospital.” Charlie often jokes that the distance she had to walk seems to get longer each time she tells the story.
The actual delivery was hard and proved to be life-threatening. Shortly after their son was born it was determined that his heart rate was dangerously low. Charlie, who was the only pediatric doctor on the reservation, immediately started to use a mask and air bag to resuscitate his own son.
“In that moment I was a doctor first and a dad second,” he said. “I was emotional of course, but this is what I had been trained to do and I knew I could do it better than anyone else.”
Fortunately, their son Daniel survived the ordeal. His proud father also likes to mention that he went on to graduate from Davidson.
Art in the city
After their two year stint in South Dakota, it was Ann’s turn to decide where they lived next. Eager to pursue her own career goals, she was accepted into the Master of Fine Arts Program at Carnegie Mellon University in Pittsburgh, PA.
It was there that she thrived as an artist and sculptor. She also won an award at the Three Rivers Arts Festival for her sky art. The enormous kite-like fabric sculpture was hung between three downtown buildings in Pittsburgh. The sculpture also appeared in color on the front page of the Sunday Pittsburgh newspaper and on the cover of the Carnegie Museum catalog.
Meanwhile, Charlie worked at an inner city clinic for one year and then completed his pediatric residency the following year at the Pittsburgh Children’s Hospital. He also moonlighted in the hospital’s emergency department for extra cash. When their two years were complete in Pittsburgh, Dr. Charlie Baker was board certified in both pediatrics and family medicine.
Ann Baker’s Sky Sculpture
The mountains are calling
The Bakers decided to make their next move a joint decision. After all of their travels, the couple longed to return to North Carolina. And so it was a moment of serendipitous delight when Charlie discovered a help wanted ad for a doctor in Avery County.
The couple made a two-week trip to check out the area and soon fell in love with the mountains. In 1979, Dr. Charlie Baker opened his solo medical practice inside of Garrett Memorial Hospital, which later became Sloop Memorial Hospital. Sloop Memorial Hospital then merged with the old Cannon Memorial Hospital in Banner Elk, NC, to form what is today the Charles A. Cannon Jr. Memorial Hospital in Avery County.
“I purchased three lab coats when I moved to the mountains and I never put one on,” he said. “I don’t hold myself in such esteem that I’m more important than anyone else. Not to mention lab coats and ties are notorious sources of bacteria.”
Charlie does admit that being a mountain doctor means that he is always on call. He often tells his medical students, whom he has taught for more than 30 years, that they better keep their prescription pads on the ready when they go into the grocery store.
“That’s what is different about practicing medicine in the mountains,” he said. “If you live in a rural community, you are part of it. It is not so much a job, but more of a lifestyle. Some of my patients have become my best friends and some of my best friends have become my patients.”
Over the years, Charlie has developed a routine at the office. Before leaving at the end of each day he reviews his patient list for the next day. He jokes that after practicing medicine for 40 years in the community, he recognizes every name on the list.
“That will be the hardest part about retiring,” he said. “I have to say goodbye to patients that I have looked after for generations. In many cases, I have had the privilege to deliver the mother and then deliver and take care of her daughter and granddaughter.”
[click_to_tweet tweet=”“That’s what is different about practicing medicine in the mountains. In a rural community, you are part of it. It’s a lifestyle. Some of my patients have become my best friends and some of my best friends have become my patients.” – Dr. Baker” quote=”“That’s what is different about practicing medicine in the mountains,” he said. “If you live in a rural community, you are part of it. It is not so much a job, but more of a lifestyle. Some of my patients have become my best friends and some of my best friends have become my patients.””]
Good tracks
Charlie is proud to leave the health of the community better than he found it. Before his arrival in the High Country, patients would often have to scramble when a doctor left town or died. For this reason, he is glad that his practice joined Appalachian Regional Medical Associates, part of Appalachian Regional Healthcare System in 2013.
“All things considered, joining the healthcare system was the right decision for my patients,” he said. “It allowed my practice to grow from a handful of providers to a good and sustainable number today. It actually all came full circle for me the other day when we hired a new nurse practitioner, whom I had delivered.”
Since joining the healthcare system, The Baker Center for Primary Care also began operating as a same-day clinic Monday through Friday and on Saturday.
“None of this would have been possible if it were not for my wonderful staff,” he said. “I could not have asked for better clerical people, better medical assistants, better nurses or better doctors to work with through the years. It is because of this group of folks that I can tell my patients, even though I’m leaving, that they are still in great hands.”
Charlie said that he is most looking forward to spending more time with his wife, kids and grandchild. His son Daniel went on to work in the Peace Corps and now has a little girl of his own. Charlie and Ann also have a daughter, Alice, who is a veterinarian in Colorado and a daughter, Kate, who is a school counselor in Portland, Oregon.
“My wife has stuck with me here for 40 years and we are ready to be more available grandparents,” he said. “I am also looking forward to writing more poetry. I have a few stories to tell.”
From all of us at Appalachian Regional Healthcare System, we would like to thank Dr. Charlie Baker and his wife, Ann, for their years of service in the High Country. As a couple, you braved the frontier and left good tracks for the rest of us to follow.
Cardiologist Dr. Andrew Hordes is the Heart & Vascular Center’s Certified Cardiac Device Specialist. He was one of the first to perform internal defibrillator procedures at Watauga Medical Center, as well as the first Micra procedure, using the world’s smallest leadless pacemaker.
