HealthNotes

Board Certified Cardiologist James Fitts, MD, listens to a lot of heartbeats in the course of a busy week. But when he’s doing laps in the Palm Desert Aquatic Center pool, Eisenhower’s Section Chief of Cardiology is only focused on his own heartbeat.

For nearly nine years, Dr. Fitts has been perfecting his freestyle stroke with Masters Swim Coach Ben Hobbins. As of this writing, Dr. Fitts was training for his thirtieth triathlon, the Iron Man 70.3 in Indian Wells/La Quinta in December 2023. This arduous event includes a 1.2 mile swim, 56 mile bike ride, and a 13.1 mile run. 

Dr. Fitts comes from what he calls “a genetic pool of runners.” In fourth grade, he could complete a 10K. He ran all through high school, college, medical school, and his internship and residency, participating in many marathons along the way. While working at Dartmouth-Hitchcock Medical Center in New Hampshire, Dr. Fitts took up biking. As his rides through the picturesque New England countryside grew more frequent, he realized he was just “one sport away from being able to compete in triathlons.”  [MORE]

Always a self-starter, Dr. Fitts decided to teach himself to swim. He participated in two triathlons in New England before moving cross country to join Eisenhower Health. His running and biking times were competitive, but swimming was another story. The first time he took part in a triathlon, he was last out of the water. 

Once settled in the Coachella Valley, Dr. Fitts signed up for Palm Desert’s Y Be Fit Reverse Mini-Triathlon. As usual, his swim time was underwhelming. After the race, the event host introduced Dr. Fitts to Ben Hobbins. “Work with him,” the host suggested. “He’ll make you a better swimmer.”

Hobbins has been coaching for more than 45 years. In high school, he lettered in swimming, cross-country, and track and field, and in college, he was an All-American swimmer at University of Wisconsin. After college, he played professional football in the Eurobowl Leagues — the NFL Europe predecessor. 

Today, Hobbins coaches the Desert Olympic Tritons, the U.S. Masters swim club, the Tritons USA Triathlon and Triton Tactical Teams he founded in 2013. The Tritons assistant coach is Ben’s daughter, Ashley-Anne, a nursing student and a 10-year volunteer at Eisenhower Health.

It quickly became clear to Hobbins, that as a self-taught swimmer, Dr. Fitts had picked up some bad habits. His stroke needed work. He tired too quickly. Most importantly, he needed to improve his breathing technique. “Swimming,” Hobbins explains, “is all about pattern breathing.” 

Progress through practice
After a few private sessions with Hobbins, Dr. Fitts began working out regularly with the Tritons. As a coach, Hobbins strives to understand each athlete’s individual goals and learning style. With Dr. Fitts, the goal is often training for his next triathlon, but every Triton swimmer is different. U.S. Masters Swimming has 50,000 members nationwide. While 10 percent compete, the other 90 percent are swimming for exercise, making new friends, and even learning to swim for the first time.

Both Dr. Fitts and Hobbins are happy to extol the health benefits of swimming, a sport Hobbins refers to as “the fountain of youth.” He has trained people who are dealing with tendonitis, shoulder issues, back pain, joint problems, heart issues and stroke, as well as a variety of injuries. 

Currently, Hobbins is working with a stroke survivor and a person with lung disease. Regardless of their general health, his athletes agree that swimming has improved their strength, endurance, and well-being. “The advice I would give to anyone looking into swimming,” says Hobbins, “is to develop a sustainable, reasonable routine. Don’t overdo it. Overtraining syndrome is a real problem with triathletes.” 

You don’t have to be a triathlete to overdo your workout, which is why Dr. Fitts emphasizes talking to one’s doctor before starting a new exercise routine. Most of his heart disease patients who swim have always been swimmers. Fitts recommends newbies start by getting comfortable in the water and working with a professional swim coach. 

An advantage of swimming for exercise is that it takes the weight off the bones and joints — one reason Dr. Fitts suggests water aerobics for patients with orthopedic issues. He now swims more than he runs. A decade ago, he suffered a hamstring injury while competing in a marathon. Since then, he’s experienced the gamut of runner injuries.  “Shin splints, stress fractures, turf toe,” he jokes, “I’ve had everything but plantar fasciitis.” 

As a cardiologist, Dr. Fitts is a big believer in the cardiovascular benefits of swimming. He cites a long-term study which found that compared to runners and walkers, swimmers had the lowest rate of cardiovascular events over a period of 13 years. Besides being a terrific aerobic exercise, swimming improves circulation, lowers blood pressure and cholesterol, helps with elimination, boosts metabolism, and enhances cardiovascular fitness and efficiency. In addition, swimming helps with stress reduction. Doing laps in the pool is a quiet, meditative activity that allows people to focus on their body, breath, and heartbeat.

To learn more about Eisenhower Desert Cardiology Center, visit EisenhowerHealth.org/DesertCard.

“A positive mindset goes a long way to improving your health,” says La Quinta resident Bob Hickam, a philosophy he has lived by since boyhood. 

He says he was “gifted” with a sunny perspective — something Hickam needed in August 2022 when he learned during a routine physical that his PSA (prostate-specific antigen) level was elevated. 

He hadn’t felt any symptoms, but followed up on his doctor’s recommendation and saw a urologist in Kirkland, Washington, where he was visiting family. A second test echoed the first — his PSA level was 6.9.

In the past, a PSA level of 4 or less was considered normal. But some men with a PSA below 4 have prostate cancer and others with readings between 4 to 10 do not, according to the National Cancer Institute. If a PSA level exceeds 10, the chance of cancer is more than 50%.[MORE]

Deciding on a treatment option
By November, another test showed Hickam’s PSA had jumped above 10. Then, an MRI (magnetic resonance imaging) revealed a possible lesion on his prostate. A biopsy confirmed prostate cancer. A bone scan brought some relief: his cancer was localized to his prostate. 

By then, Hickam — who believes in combining optimism with action — had been doing his own research into treatment options.  He met with an oncologist in Kirkland and chose radiation over surgery. His new medical team recommended external beam radiation therapy, delivered in 45 treatments over nine weeks, five days a week.  

In preparation, the urologist implanted tiny gold-seed metal “beads” (each about 3 mm) in Hickam’s prostate through a fine needle — a kind of tattoo to guide the radiation beam.

Needing to heal from his procedures before starting radiation, he returned to the Coachella Valley. He had moved there three years earlier to continue his 40-year career in golf course management at The Citrus Club, plus another La Quinta course. A year later, with the COVID-19 pandemic, and course ownership changes, he opted to retire. 

At home, Hickam continued his research and read about Eisenhower BIGHORN Radiation Oncology, and its use of stereotactic body radiation therapy (SBRT). 

Potential for short-course radiation
Not only does SBRT deliver high-energy, concentrated doses to a precise area, protecting surrounding tissues, it does so in just five treatments over one-and-a-half weeks. Hickam was intrigued. “I wanted to get back to my life faster if I could,” he says.

SBRT is also known as stereotactic body radiotherapy. It is also referred to as SABR, stereotactic ablative radiation therapy. This treatment requires no surgery or incisions. 

SBRT was initially used for early stage lung cancer. “However, over the last 15 years, we’ve learned that prostate cancer also responds well to SBRT,” says Bighorn Radiation Oncology’s Medical Director, Kamal Patel, MD, who is Board Certified in Radiation Oncology.

“SBRT isn’t simply convenient,” adds Dr. Patel. “It is powerful and effective — and like other forms of radiation, on par with surgery in success rates. Short-course SBRT has become a standard of care for all localized stages of prostate cancer, from low-risk to high-risk.”

For now, the BIGHORN team is focusing its use on early-stage cases. However, not all early-stage patients will qualify. Other factors are considered — for example, an enlarged prostate or significant urinary symptoms might disqualify someone.

Optimizing cure and quality of life
“The good news is for newly diagnosed prostate cancer, we are making great advances every day,” says Dr. Patel. “Prostate cancer is highly treatable and there are lots of options available.”
Patients with localized cancer typically have “an excellent chance for a cure and long-term quality of life,” he adds. “Going into treatment, we look to optimize both goals.”

The planning team includes radiation oncologists, radiation therapists, medical physicists and medical dosimetrists, to ensure each patient receives the most effective dose to kill the cancer cells with the least possible side effects. 

In order to implement prostate SBRT, the BIGHORN radiation oncology team upgraded their TrueBeam® radiotherapy system with Triggered Imaging®. In patients with fiducial markers (such as gold seeds in their prostate), Triggered Imaging technology allows the team to take pictures during the treatment to ensure the treatment is being delivered accurately. With this technology, if the patient moves, coughs, or sneezes, the machine will detect the movement and automatically stop. The radiation team will wait until the fiducial markers are back in position and then resume treatment.

On treatment day, Hickam lies on a special mold created for his body to minimize movement. Prior to turning the radiation beam on, the team aligns the fiducial markers. Then, the high-tech linear accelerator rotates around him and delivers the treatment in minutes. While the treatment is being delivered, the team takes real-time snapshots and confirms the dose delivery hit its targets. “If the markers are even slightly off,” says Dr. Patel, “the machine will stop immediately.”

After four more half-hour sessions, Hickam’s treatments were done. He felt no side effects except for a short period of fatigue. At a follow-up three months later, his PSA level had dropped below 4. “Dr. Patel said I should be very optimistic, and I am,” he says. 

Now Hickam, 65, can concentrate on following his daughter’s golf game at California State University, San Marcos, and on traveling to favorite places like Jackson Hole, Wyoming. 

He is especially grateful to BIGHORN Radiation Oncology. “Every single person I met,” he says, “from the front desk to the nurses, technicians, and Dr. Patel and his entire team, was amazing.”

For more information or to contact Eisenhower Lucy Curci Cancer Center, call 760.674.3602, or visit EisenhowerHealth.org/Oncology.