Jaime Caballero, MD, on the Shift From Evaluation to Optimization in Pre-Surgical Cardiac Assessment

For decades, the phrase most patients heard before an operation was "cardiac clearance," a simple sign-off that the heart could tolerate anesthesia and surgery. Interventional cardiologist Jaime Caballero, MD, has watched that approach change firsthand. Today, the weeks before surgery can do more than identify potential problems. They can give physicians time to address those problems and help patients go into surgery in better shape. 

A patient who has simply received clearance may still have blood pressure that needs attention, an undiagnosed heart condition, or medications that need to be adjusted. Taking the time to address those issues before surgery can give patients a stronger starting point and help physicians anticipate problems before they arise.

 Better imaging, more precise risk assessments, and closer communication between specialties have also changed what happens during those weeks. Instead of treating the pre-operative visit as a simple yes-or-no decision, doctors can use it to get a clearer picture of the patient's cardiovascular health and decide what, if anything, needs attention before surgery. That extra preparation can be especially useful for older patients and those managing multiple health conditions.

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Why the Old Model Fell Short 

The traditional clearance model asked a straightforward question: Is this patient healthy enough to undergo surgery? That question still matters, but it doesn't tell doctors everything they need to know.

 A patient might appear to be a reasonable surgical candidate while still dealing with poorly controlled blood pressure, an undiagnosed valve problem, or a rhythm disturbance that could become more serious under the stress of anesthesia. A basic evaluation might catch the most obvious concerns while missing other issues that could affect the procedure.

 The idea of "clearance" also made it easy to treat the evaluation as the end of the process. Once the patient received sign-off, everyone could proceed to the operation. But the time between the evaluation and surgery can allow physicians to make changes that improve the patient's starting point.

 That makes earlier attention to cardiovascular health especially useful. Efforts focused on community education on heart disease have helped more people recognize conditions they might otherwise overlook. Bringing that same awareness into the pre-surgical setting gives physicians another opportunity to identify and address problems before they complicate an operation.

 Sharper Tools for Seeing Risk

Better tools have also changed how physicians assess patients before surgery.

Modern risk assessments look at more than a patient's medical history. Depending on the situation, physicians can consider functional capacity, biomarkers, the planned surgery, and other factors to get a clearer picture of what the patient may face.

When those assessments raise questions, additional testing can help answer them without automatically sending someone into an invasive procedure.

Stress echocardiography, cardiac CT, and newer echocardiographic techniques can show how the heart performs under different conditions and reveal problems that might not appear during a routine office visit. A resting electrocardiogram may look normal, for example, while a stress test can reveal an issue that appears only when the heart has to work harder.

The goal isn't to order every available test. Physicians can use the information they gather to determine who needs further treatment and who can safely move ahead with surgery. That approach can spare patients unnecessary delays and expenses when additional intervention won't change their care.

More hospitals can also offer these tools than in the past. Tests once associated mainly with major academic medical centers have become part of routine care in many community hospitals, giving more patients access to a deeper cardiovascular assessment before surgery.

From Evaluation to Actual Preparation

The biggest change in pre-surgical cardiac care comes after doctors identify the risks.

If a patient's blood pressure runs too high, physicians can work to bring it into a safer range before surgery. If the patient has anemia, the care team can address it before the procedure. Physicians can also review medications and decide which ones the patient should pause, continue, or start before surgery. 

In some cases, preparation may involve a procedure of its own. A patient with severe, symptomatic coronary disease, for example, may benefit from revascularization before undergoing a major non-cardiac operation. An interventional cardiologist can help determine whether a stent, additional medical treatment, or another approach makes the most sense for that particular patient.

The training behind those decisions is reflected in recognized medical directories of board-certified interventional specialists. But the goal isn't to intervene simply because an intervention exists. The goal is to determine what, if anything, will actually improve the patient's chances of a safe recovery from surgery. 

Timing also matters. Waiting too long to address a cardiovascular problem can leave a patient carrying unnecessary risk into the operating room. Treating a condition too aggressively, however, can delay an important operation without providing enough benefit to justify the delay.

That balance requires experience with complex cardiovascular disease. A physician's documented record of interventional cardiology practice can provide useful context when a surgical team decides how much preparation a particular patient needs.

 The Team Around the Patient

Pre-surgical optimization also depends on communication. Surgeons, anesthesiologists, primary care physicians, and cardiologists each bring a different perspective to the patient's health. When they share that information early, they can build a more complete plan.

The cardiologist isn't simply there to issue a final verdict. The cardiologist becomes part of a larger conversation about the patient's health, the planned operation, and what needs to happen before the procedure.

Patients should be included in that conversation as well.

It helps to understand why a doctor wants to change a medication, why surgery might need to wait a few weeks, or why a particular symptom needs further attention. When patients understand what their doctors are trying to accomplish, they're better positioned to follow the plan and recognize when something changes.

That kind of communication can make the process feel less like a series of appointments and more like one coordinated plan.

What Optimization Can Mean for Recovery

Preparing a patient before surgery can also affect what happens afterward.

A patient who enters surgery with better-controlled blood pressure, properly managed medications, and known cardiovascular risks may handle the physical stress of the procedure more effectively. That preparation can reduce the likelihood of complications such as arrhythmias or cardiac strain and may make the recovery period easier to manage.

The same preparation can help the patient transition back to regular cardiovascular care. Once the cardiologist has reviewed the patient's health and medications, the care team has a clearer understanding of why certain changes occurred and what to monitor afterward.

Something that happens during surgery can also change the patient's longer-term cardiovascular care. A medication started before the operation may need to continue afterward. A new finding may call for additional follow-up. Instead of treating the pre-surgical evaluation as a one-time appointment, physicians can use what they learn throughout the process to guide the patient's post-surgical care.

 Looking Ahead

 Technology will give physicians even more information to work with before surgery. Wearable devices can already track heart rate, rhythm, and activity between office visits, giving doctors a more continuous view of how a patient is doing.

 Machine learning may add another layer by helping doctors identify patterns across large amounts of surgical and cardiovascular data. As minimally invasive cardiac procedures continue to develop, physicians may also gain more options for addressing cardiovascular problems before a patient undergoes another type of surgery. 

The basic idea behind optimization is simple. The weeks before surgery aren't just a time to decide whether a patient's heart can handle the procedure. They're also an opportunity to identify problems, address manageable risks, review medications, and provide the patient with a better starting point. 

Physicians such as Jaime Caballero, MD, approach pre-surgical cardiac care with that broader view rather than treating clearance as the final step.

For patients, the difference may come down to having a few more questions answered and a few more problems addressed before they reach the operating room. Those steps can help patients enter surgery as prepared as possible and give their care team a clearer understanding of what they need before, during, and after the procedure.

This is a guest blog entry.

How to Rebuild Strength and Mobility After an Injury

Photo courtesy of Pexels

An injury can force you to pause your usual routine. You probably struggle with things that used to be easy, like going down the stairs. Your usual workout might seem impossible, but you won’t be stuck this way forever, especially if you give your body a hand. 

Strength and mobility can come back with the right approach. Your body needs time to heal and regain what it lost, so it’s important to rebuild it gradually. Here are some ways to help with getting there safely.

Follow Your Doctor’s Recovery Plan

After an injury, your doctor has the best view of what your body can safely handle. Follow their guidance to protect healing tissue. Ignoring their restrictions can slow progress or contribute to post-injury chronic pain.

Stick to the activity limits and follow-up appointments your doctor recommends. Ask when you can return to specific activities, like lifting and running. If you notice new symptoms in the injured area, report them to your doctor instead of brushing them off.

Work with a Physical Therapist

An injury can change how you move, even after the pain fades. You may shift your weight and rely too much on another side of your body. Physical therapy can help correct these habits while rebuilding strength and mobility in a controlled way.

Find a physical therapist who works with your type of injury. They can assess your movement and create exercises that match how your body can currently move. Follow the prescribed routine while paying attention to form. As your body gets stronger, your therapist can adjust the challenge so you keep progressing safely.

 Do Low-Impact Exercises

Don’t force your body to go back to your old HIIT workout right away. Low-impact exercises let your body move without placing heavy force on the injured area. Gentle yoga, heel raises, wall push-ups, and other controlled movements can stretch muscles and improve mobility. You can even do low-impact exercises outdoors when your recovery plan allows. Stretching at a park, for example, gives you fresh air and a more enjoyable rehab session.

Gradually Add Resistance Training

Once basic movement becomes easier, your muscles need a new challenge to regain lost strength. 

Resistance training gives you that by making muscles work against an external load. It can also help improve joint support.

Use equipment like light weights or resistance bands. Start with the lightest resistance, then add more as your injured area gets stronger. Your physical therapist can help determine which weight is appropriate for your recovery stage.

Support Recovery with Protein

Your body needs protein to repair damaged tissue and rebuild muscle. So, make sure you get enough of it during mealtime. Include a protein source with regular meals and snacks. Eggs, Greek yogurt, chicken, and fish can all contribute. Pair these foods with a balanced diet that provides enough overall energy. Good nutrition gives your recovering body the building blocks it needs to grow stronger again.

Build Back Everyday Endurance

An injury can make ordinary activities feel tiring because you’ve spent less time moving. Rebuilding your daily endurance helps prepare your body for the walking, standing, and working you used to do daily.

Start with manageable activities and gradually increase the duration. Try spending a few extra minutes doing household chores, like vacuuming or folding laundry, before taking a break. As these tasks become easier, you can slowly spend more time on them. This helps your body build the stamina needed for normal daily life again.

Endnote

Injury recovery takes patience, but you can still take an active role in getting stronger. Use the ideas above to support your healing and improve your range of motion. Gradually challenge your body a little more every day, and you’ll bounce back stronger and more mobile than before.

Amy Wilson is a passionate health writer dedicated to making complex medical topics accessible and engaging and covers a wide range of topics from nutrition and fitness to mental health and wellness.

5 Common Causes of Back Pain That Chiropractic Care Can Address

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Back pain is one of those problems that can start with something that seems completely ordinary, and what makes it frustrating is that the discomfort can linger long after the original activity is forgotten.

While some back pain requires medical treatment, many causes are related to movement, posture, or spinal problems, which chiropractic care can help address. Understanding what may be behind your back pain is a useful first step because treating the pain without considering its cause can make it harder to prevent the problem from returning.

1. Poor Posture and Long Hours of Sitting 

Spending most of the day sitting can put considerable stress on the muscles and structures that support the spine, particularly when you sit with your shoulders rounded or your lower back unsupported. 

The problem becomes more noticeable when you work at a desk for several hours without changing position. Over time, certain muscles might become tight while others weaken, creating an imbalance that can contribute to stiffness and discomfort. 

This does not mean that one bad sitting position automatically causes back pain, but remaining in the same position for too long can increase the likelihood of such symptoms. However, chiropractic care can be used to strengthen the body's ability to move and manage these stresses.

2.  Muscle Strains From Lifting 

You do not have to be an athlete to strain your back because minor activities like lifting a heavy box or gardening can place more demand on your back muscles than they can comfortably handle. A strain can cause localized pain, stiffness, and difficulty moving normally. Some people notice this discomfort immediately, while others only realize something is wrong several hours later.

On the brighter side, a chiropractor can evaluate how the spine and surrounding joints are moving and determine whether chiropractic treatment is appropriate. Likewise, gentle mobility work and advice about movement can also form part of a broader recovery plan.

3. Spinal Joint Stiffness 

The small joints connecting the vertebrae help the spine bend, rotate, and move during everyday activities, so when movement becomes restricted, you might experience stiffness, particularly after remaining in one position for a long period.

Joint stiffness can develop for several reasons, including inactivity, repetitive strain, or age related changes, but with the right chiropractic treatment involving specific manual techniques, things are expected to improve.

If you are researching options such as QSM3 chiropractic care, it is still important to have an individual assessment because the most appropriate treatment depends on the underlying problem rather than the name of a particular technique or approach.

4. Previous Injuries 

An old back injury can also continue influencing how you move long after the initial pain has disappeared. For example, a person who injured their back years ago may unconsciously change how they bend, walk, lift, or sit. 

Those compensations can place additional stress on other muscles and joints, eventually contributing to recurring discomfort. This is where chiropractic assessment comes in, as rehabilitation exercises may also be recommended to restore confidence and function. The important point is that recurring pain after an injury deserves evaluation rather than repeatedly treating each episode as an isolated problem.

5. Reduced Mobility and Lack of Physical Activity 

The back generally functions better when the body is regularly moving, so long periods of inactivity leads to stiffness, reduced strength, and poorer tolerance of normal physical demands. Someone experiences back discomfort, becomes less active because they are afraid of making it worse, and gradually loses strength and mobility. 

When they eventually return to normal activities, the body may struggle with previously manageable demands. For appropriate patients, chiropractic care can be one component of a broader approach that includes gradual physical activity, mobility exercises, strengthening, and healthy movement habits.

When Does Back Pain Need More Than Chiropractic Care?

Finally, chiropractic care can be appropriate for some mechanical forms of back pain, but it is not the right solution for every cause of discomfort. Severe pain, numbness, unexplained weight loss, or changes in bladder function should be medically evaluated promptly. 

These symptoms can indicate conditions that require treatment beyond routine musculoskeletal care. Even when symptoms appear relatively mild, persistent pain is worth discussing with an appropriate healthcare professional so that the underlying cause can be properly assessed.

Endnote 

Chiropractic care can help address certain mechanical causes, particularly when combined with appropriate exercise and lifestyle changes. However, the most important step is understanding why the pain is occurring and choosing treatment based on the individual, rather than assuming that all types of back pain should be managed the same way.

Amy Wilson is a passionate health writer dedicated to making complex medical topics accessible and engaging and covers a wide range of topics from nutrition and fitness to mental health and wellness.

Konstantinos Marmagkiolis, MD, on TAVR's New Frontier

Few developments in modern cardiology have transformed patient care as rapidly as transcatheter aortic valve replacement (TAVR). What began as a last-resort option for patients considered too frail for open-heart surgery has evolved into a mainstream treatment used across a growing range of clinical situations.  

Interventional cardiologist Konstantinos Marmagkiolis, MD, has seen that evolution firsthand in the catheterization lab, where the conversation around severe aortic stenosis has shifted from whether a patient can withstand surgery to which minimally invasive approach best suits their needs.

Aortic stenosis, the progressive narrowing of the valve that controls blood flow from the heart, was once viewed as an unavoidable consequence of aging that many patients simply could not survive having corrected. That outlook has changed. 

As technology has advanced and clinical evidence has grown, TAVR has steadily expanded to patients across the risk spectrum, reshaping who can benefit from treatment.

Image Source: Unsplashed

From Inoperable Patients to Everyday Practice

When TAVR first entered clinical practice, it was reserved for patients with virtually no other treatment option. These were individuals whose age, lung disease, previous surgeries, or overall frailty made open-heart surgery prohibitively risky. For them, the choice often came down to a novel catheter-based valve replacement or a gradual decline. Early clinical trials demonstrated that the procedure not only offered a less invasive alternative but also significantly improved survival compared with medical therapy alone. 

That success led to a series of additional studies. Researchers expanded from high-risk surgical candidates to intermediate-risk patients and, eventually, to lower-risk individuals who previously would have been referred directly for surgery. At each stage, the evidence continued to support broader use. The steady expansion reflects the thoughtful approach to structural heart disease that defines modern interventional cardiology, in which treatment decisions are increasingly tailored to the individual rather than relying on a single standard approach.

The result has been a fundamental shift in the management of aortic stenosis. A diagnosis that once prompted difficult conversations about whether treatment was even possible now opens the door to multiple options. Heart teams consider anatomy, age, life expectancy, valve durability, and patient preferences, with minimally invasive treatment becoming the preferred option for a growing number of patients.

Why the Indications Keep Widening

Several factors continue to drive that expansion.

The first is advances in device technology. Newer valve designs fit more precisely, reduce leakage around the valve, and are available in a wider range of sizes, allowing physicians to treat anatomies that earlier devices could not accommodate. Improvements in delivery systems have also made procedures faster, more predictable, and associated with fewer complications.

The second is growing clinical experience. As medical centers perform more TAVR procedures, outcomes continue to improve, and the learning curve becomes less steep. Procedures that once required general anesthesia and intensive care are now frequently performed using conscious sedation, with many patients returning home within one or two days. This move toward streamlined, minimally invasive valve therapy has made TAVR a practical option for patients who want to avoid a lengthy recovery and return to their normal routines sooner.

The third factor is the growing body of clinical evidence. Long-term follow-up from the landmark clinical trials has begun to answer questions about valve durability that once made some physicians hesitant to recommend TAVR for younger patients. The concern was that transcatheter valves might not last as long as surgically implanted valves, potentially requiring additional procedures later in life. The accumulating evidence has been reassuring, providing clinicians with a much clearer understanding of long-term valve performance. Physicians who follow the growing body of clinical trial data can now counsel patients with far greater confidence than was possible only a few years ago.

New Populations Entering the Conversation

The expansion of TAVR is no longer limited to traditional surgical risk categories. Attention has increasingly turned to patient populations that were once considered poor candidates or excluded from early studies.

Bicuspid aortic valve disease, a congenital condition in which the valve has two leaflets instead of three, was historically viewed as a difficult anatomy for TAVR. Improvements in imaging and increased procedural experience have made treatment possible for many of these patients, opening new options for younger individuals who often develop aortic stenosis earlier in life.

Patients with failing surgical bioprosthetic valves represent another important area of growth. Rather than undergoing a second open-heart operation to replace a worn-out tissue valve, many patients can now receive a transcatheter valve placed within the existing prosthesis, reducing the risks associated with repeat surgery. 

This approach reflects a broader trend in interventional cardiology and structural heart care toward treating increasingly complex conditions through the least invasive option available.

There is also growing interest in whether patients with moderate aortic stenosis, or those with severe disease who have not yet developed symptoms, may benefit from earlier intervention. Traditional practice has favored waiting until symptoms appear before recommending valve replacement. 

However, emerging evidence suggests that damage to the heart muscle may begin before patients notice symptoms. If ongoing clinical trials demonstrate a clear benefit to earlier treatment, the number of patients eligible for TAVR could expand significantly.

 What This Means for Patients

For patients, the practical impact of these advances is significant. A diagnosis of severe aortic stenosis no longer carries the same sense of uncertainty it once did. Many people who might have been considered too high-risk for treatment a decade ago can now undergo a procedure that allows them to return to normal activities within days rather than facing a lengthy surgical recovery.

That does not mean TAVR is the right choice for every patient. Surgical valve replacement remains the preferred approach for certain anatomies and some younger individuals, and treatment decisions should be made by a multidisciplinary heart team that evaluates the complete clinical picture. 

Physicians who emphasize shared decision-making and individualized care, an approach reflected in the professional work and clinical philosophy of experienced structural heart specialists, are often best positioned to match each patient with the treatment option most appropriate for their needs.

The role of the interventional cardiologist has expanded alongside these technological advances. Today’s specialists must be skilled in advanced imaging, valve selection, procedural planning, and the management of complications that may occur during or after treatment. The training and continued education required to support this growing field of structural heart care are extensive, which is why the specialty continues to attract physicians committed to advancing cardiovascular medicine.

 Looking Ahead

The evolution of TAVR is far from complete. Researchers continue to study valve-in-valve procedures, develop strategies for more complex anatomies, and evaluate whether earlier intervention can improve long-term heart function. Device manufacturers continue to refine valve technology, and each new generation has the potential to expand treatment options for additional patient groups.

For clinicians like Konstantinos Marmagkiolis, MD, the most remarkable part of TAVR’s evolution is how dramatically the field has changed. A therapy that was once limited to the sickest and most fragile patients has become a central component of aortic stenosis treatment across the risk spectrum.

The expanding role of TAVR represents more than a technological achievement. It reflects a broader transformation in cardiovascular care, in which treatment decisions are increasingly personalized, and patients who once had few options now have meaningful alternatives.

As research continues and technology advances, aortic stenosis is being redefined from a condition patients simply endure to one that can be effectively treated and managed. That progress, built on years of careful investigation and growing clinical experience, stands as one of the most important developments in modern cardiovascular medicine.

This is a guest blog entry.