Ask the Doctor: August 2008

Question: I am a 58 year old man, and was upset by the recent sudden death of Tim Russert. I haven’t been to the doctor in a while and have gained some weight. What do you recommend for me to do so I can get healthy and not have the same fate as Tim?

Answer: This is a question I have been asked more than a few times since Tim Russert’s sudden death. There are quite a few things you should do to take care of yourself. The first thing you need to do is to see a doctor for a routine physical. While all doctors differ slightly in what to they do routinely, there are standard things that all men over 50 should have checked on a regular basis. Your doctor can also help you with your lifestyle changes, so you can have the highest level of success.

First, you need your blood pressure checked every year. High blood pressure is a risk factor for heart disease. Normal blood pressure today is considered to be 120/70 or 115/70 if you have certain other risk factors. Any levels higher than that will increase your risk of a heart attack or stroke in the future. Based on your blood pressure, you can design a treatment plan with your doctor to get you back into the safe range with lifestyle changes and/or medications. The other risk factor for heart disease that needs to be monitored on a yearly basis is your cholesterol. The total cholesterol number is not as important as it used to be. The more important values are the HDL (good cholesterol) and the LDL (bad cholesterol). Your HDL should be more than 40 in order to reduce your risk of heart disease. Your LDL goal will vary depending on your other risk factors for heart disease, including family history, other medical problems like diabetes, and your personal history of smoking. You have to keep in mind that being male and over 50 are two separate risk factors, neither of which you can control. That’s why we have to work to control your other risk factors.

In addition to your blood pressure and cholesterol, smoking and fitness level ARE two things that you can control. If you are a smoker – even if it’s only the occasional cigar on the golf course – you need to quit as soon as possible. The cigarette smoke and the toxins that you inhale add inflammation to the body and the arteries, making any plaques you might have in your arteries unstable. When the plaques are unstable, heart attacks occur. There are many options and programs available to help you quit smoking, and you can talk to your doctor about which option is best for you. As for your fitness level, your heart is a muscle that needs to be worked out on a regular basis like any other muscle in your body. Before you start an exercise program, you need to consult your doctor to make sure you don’t need your heart checked first. Otherwise, regular cardiovascular exercise 3 to 5 times a week for 30 minutes is generally recommended.

There are some other tests that your doctor might order, based on your current symptoms and risk factors like an EKG, stress test, or cardiac calcium score. These heart tests are not done on a regular screening basis and should be ordered in the appropriate clinical setting. Keep in mind; they may not always be covered by insurance either. In addition, your doctor may recommend aspirin therapy with 81mg, or low dose, of aspirin. However, aspirin therapy is not recommended for everyone, so this is something else to discuss with your doctor before getting started.

The most important lesson to learn from Tim Russert’s tragic death is that the first sign of heart disease can be a fatal heart attack. This is why it is SO important to control the risk factors that you can, so that you can live a long and healthy life. Good luck!

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Women & Heart Disease: Here are the Facts

By Dr. Gail Dawson, MD, MS, FAAEP

About eight million American women live with heart disease, the #1 killer of women (and men) in the United States today!

Studies show the following:

• One in three women will die of heart disease.

• Women are less likely to survive a heart attack than men.

• About 38 percent of women will die within one year of a first recognized heart attack.

• About 35 percent of women heart attack survivors will have another heart attack within six years.

• Two thirds of women who have a heart attack fail to make a full recovery.

• Women tend to underestimate the symptoms of heart disease and are less likely to seek treatment.

• Heart disease is a lifelong condition – once you are diagnosed with it, you will always have it.

The very positive news is that women easily can change these statistics! Most risk factors of heart disease are controllable. Research shows that women can lower their heart disease risk enormously – by 82 percent – if they lead a healthy lifestyle.

What is heart disease?

The most common cause of coronary artery disease – commonly known as heart disease – is a narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart muscle. This process happens slowly over time, and is the major reason people have acute myocardial infarction (heart attack).

What are the warning signs of a heart attack?

Heart disease often has no symptoms, however, there are a few signs to watch for, and the signs in women may be different than those men experience. Women may feel pain in the center of the chest; in the ear, jaw or neck; or in the back or shoulder area. (Men tend to have crushing pain in the center of the chest that extends down the arm.) Other signs can be unusual tiredness or sudden extreme fatigue, problems with breathing, indigestion, or anxiety.

Heart disease symptoms may be milder in women than men. About 1/3 of women experience no chest pain at all when having a heart attack, and 71 percent report flu-like symptoms for two weeks to a month prior to having more obvious signs of a heart attack.

Can I reduce my risk of heart disease?

Making relatively simple changes in your daily eating habits will pay off quickly. By following this advice, you can reduce your chance of heart disease significantly:

• Control your blood pressure. Blood pressure is considered high when it reaches 140/90.

• Stop smoking. More than half of the heart attacks in women under age 50 are related to smoking. Women who smoke are at risk of dying 19 years sooner than non-smokers. Women who stop smoking for three years have the same risk as women who have never smoked.

• Get tested for diabetes. This medical condition is considered one of the major factors contributing to heart disease. Women with diabetes are two to three times more likely to have a heart attack. Controlling sugar makes a big difference in the development of coronary artery disease, as well as renal failure and stroke.

• Control your cholesterol levels. Too much cholesterol in your blood can build up (plaque) in your arteries and cause a narrowing of the arteries, which causes heart disease. Good cholesterol (HDL above 50 for women) helps remove bad cholesterol (LDL) from the blood. LDL levels should be at least under 140 for women, and the lower the better. Eating healthy helps maintain the good levels of cholesterol in your blood.

• Eat a heart healthy diet. Keep fat calories to less than 30 percent of the total calories you eat each day, and choose foods low in saturated fats, which raise your LDL. Avoid animal meats, butter, whole milk dairy products, cheese, and tropical oils (coconut, palm). Also limit trans fats, which are found in margarine, donuts, muffins and other processed foods. Choose foods with mono or polyunsaturated fats instead. Wise food choices include vegetables, whole grain foods, and low fat or nonfat dairy products. Some processed foods – frozen dinners and canned foods – can be high in saturated fats. When in doubt, read labels. Also remember to limit sodium to no more than 2.4 grams a day.

• Maintain a healthy weight.

• Try to exercise 30 minutes a day, a minimum of three to four times a week. Remember, your heart is a muscle. It needs regular exercise to stay in shape. At midlife, women can benefit from weight-bearing activities that keep bones healthier – walking, lifting hand weights, and even carrying groceries.

• If you drink alcohol, limit it to no more than one drink (12 ounce beer, five ounce glass of wine, one shot of hard liquor) a day.

• Do not take hormone replacement therapy to prevent coronary artery disease. It actually does more harm than good. Research now shows that estrogen plus progestin therapy increases the chance of developing heart disease, stroke, blood clots and breast cancer. If you need to take hormones, use the lowest possible dose for the shortest time needed.

Only two risk factors for heart disease are not controllable – these are your family history and age. If your father or brother had a heart attack before age 55, or if your mother had one before age 65, you’re more likely to develop heart disease. This does not mean you will have a heart attack; but it means you are at a higher risk.

To protect your heart health, be aware that every risk factor counts. If you have even one risk factor, you are more likely to develop heart disease.

What tests are conducted to determine if a person has heart disease?

If you are worried that you have signs or symptoms of heart disease, check with your physician right away. A physical exam may be all that is needed, but sometimes, more testing is necessary.

Imaging studies such as a stress echo or nuclear test will show the reaction of the heart muscle under stress. Patients walk on a treadmill or receive a drug to dilate the blood vessels or make the heart beat faster. In a stress echo, the cardiologist looks for abnormal heart movement under stress. A nuclear study tracks the flow of blood. If it can’t get to the heart muscle under stress because of a blockage, the heart will appear lighter in some areas on the scan.

A CT scan and cardiac catheterization provide a view of the inside of the coronary arteries, which supply blood to the heart muscle. If there is a blockage, it will show up as a narrow part in the blood vessel. A CT scan takes X-rays very rapidly. Patients lie in a machine while dye is injected. The heart rate needs to be slow enough to obtain clear images of the coronary arteries. During a cardiac catheterization, the cardiologist injects dye through a catheter that enters the leg and goes up into the coronary arteries, and then takes pictures. If an artery is blocked, the physician can open it during the procedure. Often a stent is placed to keep the artery open. A stent looks like a skinny tube made of metallic meshwork.

What should I do if I think I am having a heart attack?

Fast treatment can limit heart damage. Get to the hospital as fast as possible. Do not drive yourself. Chew an uncoated aspirin if you have one. This can reduce damage to the heart muscle. Once you arrive at the hospital, an electrocardiogram (EKG) and blood work will be ordered to help determine if you’ve had a heart attack. Even if the EKG is normal, you still may have had a heart attack, and more testing will take place.

Remember: the good news is that women can make a lot of simple changes in their daily routine to greatly reduce their risk of heart disease. It is never too late to start making these changes!

Dr. Gail Dawson is on the medical staff at Genesys Regional Medical Center in Grand Blanc and practices at Regional Cardiology Associates.  She obtained her medical degree from the University of Michigan and earned a fellowship in Cardiology at the Detroit Medical Center through Wayne State University.  She is board certified in cardiovascular disease, internal medicine, nuclear medicine, echocardiography, and coronary CT interpretation.

Go Red. Love Your Heart

February is not just the month when the true doldrums of winter set in but it is also the month of love when Cupid draws his bow and takes an aim right at your heart – the biological one that is. This month as you walk around and notice the splashes of pinks and reds all over card and chocolate shops remember that it is also National Heart Month where you are supposed to extol the same love and adoration to your ticker as you do your loved ones, minus the 5-pound box of chocolate.

In celebration of the National Heart Month, the American Heart Association has created the Go Red for Women campaign, a national movement developed to help bring awareness to the number one killer of American women today. The campaign focuses on raising awareness of heart disease including how the disease impacts women and also offers preventive information for women of all ages.

The Red Facts

It used to be that heart disease was considered to be an exclusively male disease. But the face of heart disease has significantly changed over the years. Now, one in three American women dies of heart disease. In 2003, almost twice as many women died of cardiovascular disease, which includes both heart disease and stroke, than from all cancers combined.

Heart disease is an umbrella term for a number of heart conditions including coronary artery disease, heart failure, heart arrhythmias and other ailments.

A woman’s best defense against reducing her risk and altering these scary national figures is becoming responsible for her own lifestyle behaviors. Protecting your heart does not, and should not, wait until you’re in your forties or fifties. Most doctors now recommend women in their twenties to start looking after their heart by eating right, exercising and keeping up with routine physical examinations.

Here are the American Heart Association’s ABC’s of reducing your risk of heart disease:

• Stop smoking

• Engage in some sort of physical activity every day

• Reduce your blood cholesterol levels to under 200 mg/dL

• Keep your blood pressure at less than 120/80 mmHg

• Keep a healthy weight

• Manage your diabetes effectively

• Reduce your stress levels

• Limit alcohol

The American Heart Association encourages all women to be able to call off their cholesterol and triglyceride levels and their blood pressure and waist size as quickly as they can cite their shoe size.

Act Now

On February 1, anyone can support the fight to prevent heart disease in women. As part of the Go Red campaign, all individuals nationally and locally are encouraged to wear red on February 1, which has also been coined as Wear Red Day. A red blouse, a red tie, even a red pair of earrings will demonstrate your dedication to raising awareness of this pressing public health issue affecting women all over this country.

The Go Red for Women campaign is filled with a host of other events and activities that you can partake in. For instance, you can get a heart check up, attend a Red Around Town event, cook heart-healthy recipes for yourself and your family or sign up for the Choose To Move challenge which is a 12-week program designed to get you moving and eating the right foods for three months.

The American Heart Association has also created a line of Go Red products that are available for purchase on their website. From educational materials to cookbooks and from jewelry to tote bags, all purchases go towards supporting the fight to prevent heart disease.

To join the campaign, visit: goredforwomen.org. The registration is free and you’ll receive a free monthly e-newsletter filled with heart-healthy tips, plus invitations to events in the Detroit area, as well as access to Go Red merchandise, special programs and more.

Have You Changed Your Oil Lately?

By Bruce Eisenberg, MD

I have been practicing primary care medicine for over twenty-two years, and I have recently begun to notice a trend that concerns me. Numerous patients with a wide variety of backgrounds – both on and off regular prescription medications – have been missing follow-up visits. Some of these are as far back as two to three years and most of these are male patients. I often ask these patients if they change the oil in their car on a regular basis. The answer is always yes. I then suggest that perhaps their own body deserves the same basic maintenance as their automobile.

Most patients are surprised by the length of time that has passed since their last appointment. Many patients state they have not come in because their diet and exercise have not been consistent, or they were in the process of quitting smoking, and they were waiting to come in when their cholesterol, blood sugar and blood pressure were improved. These are, in fact, the patients which need the most attention because they are at the highest risk. If behaviors are less than perfect, I tailor therapy and screening based on these historical patterns for early disease prevention.

Heart disease is the number one cause of death in America. Cancer is the second leading cause of death and illness. Even with the most meticulous balance of diet and exercise, many individuals are susceptible to these potentially life-threatening illnesses because of family history and what I refer to as a “21st century lifestyle.”

With this lifestyle, one may workout vigorously for one hour every single day and watch his diet. But, the other 23 hours of the day are spent sitting at a desk, using remote controls, operating computers, driving around in cars, riding elevators, and eating processed foods too high in sodium and fat. It is nearly unavoidable.

Historically, women have been better at regular follow-up visits because most of them are getting screenings from a gynecologist. Men, on the other hand, often never get into a routine of regular health maintenance.

Here are some general suggestions on how to improve your own health screening.

By age 20, all individuals should have a complete cholesterol profile and know their “good” HDL and “bad” LDL cholesterol as well as blood pressure. This should be repeated approximately every five years along with a diet, exercise, family history and general health assessment.

If there is a family history of illness such as diabetes, high blood pressure, high cholesterol or cancer the intervals should be adjusted. If there are any abnormalities or lifestyle changes such as smoking, abnormal body weight gain or loss, these intervals should be customized as well.

After the age of 40, prostate screening should be done on a yearly basis. A blood test called a PSA and a digital rectal exam are the usual ways this is done. Body mass index (the ratio of height to weight), blood pressure, heart and lung health, along with general blood and urine checks should also be performed regularly.

At the age of 50, (sooner if there are symptoms or a family history) colon cancer screening with a colonoscopy is recommended, with follow up every five years.

Consumers these days are bombarded with a tremendous amount of health information from the media. It is nearly impossible to make sense of this maze of information. One common mistake often made is when a patient alters a prescription medication, or adds a supplement, because of a study they heard about on the news. Please consult your health care professional before making changes and see if it is actually appropriate for you. Your health care provider should be the first one you consult with, not the last to know.

When your doctor asks you about the medications you are taking, be sure to include all medicines and their doses. Do not forget to also include all supplements and herbs you are taking because they may have important health implications, too.

One example is vitamin C. It has been shown not to prevent colds, but has been linked to lowering good cholesterol (HDL) and can raise the risk of heart disease in some patients.

Another topic in the media these days is erectile dysfunction or ED. Many men are reluctant to discuss this with their physician. Remember that the majority of men will have some degree of ED during their lifetime. What is not commonly known is that it is often related to the early blockage of arteries due to elevated cholesterol, blood pressure and smoking. If you are suffering from this condition be sure to seek treatment and be screened for underlying causes of heart disease as they are one in the same.

The next time you notice that little sticker in the corner of your windshield reminding you of your next oil change, think about when the last time you did a body check-up.

With careful attention to the calendar, you can make a positive step toward early detection and prevention of mechanical breakdown in your most precious vehicle – your own body.

Dr. Bruce Eisenberg is board certified in internal medicine. He is a graduate of Wayne State School of Medicine and has been voted one of the “Best Doctors in America” the last 10 years and has been recognized by Top Docs Detroit Monthly.

Men’s Health: February 2007

In our society, men are generally taught to withstand pain. There is also the feeling of invincibility that comes along with the male species. These two factors can prove fatal when men ignore heart attack or stroke symptoms and do not seek treatment quickly.

To avoid a heart attack, you should know the risk factors. The foremost risk factor is gender. According to the American Heart Association, men have a great risk of heart attack or stroke than women. Men are also more likely to have attacks at a younger age than women. And as part of the male lifestyle, things such as stress, inactivity, alcohol and other factors are contributors to these diseases.

Since early treatment is critical when someone suffers from a stroke or heart attack, it is important to understand the signs and symptoms. No man should ever ignore these symptoms and feel that they will “just go away.” In fact, oftentimes, symptoms of a heart attack are so mild, that you may just pass them off as muscle pain, joint pain, or strains. Knowing and understanding these symptoms, and your risk factors, can help with early diagnosis and treatment.

According to the AHA’s website, symptoms include:

1. Chest discomfort – Heart attacks generally occur with discomfort in the chest that lasts a few minutes, or comes and goes. It can be described as a fullness, pressure, squeezing or pain.

2. Discomfort in other areas of the upper body – Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

3. Shortness of breath – May occur with or without chest discomfort.

4. Other signs – These may include breaking out in a cold sweat, nausea or lightheadedness.

If any of these symptoms lasts a few minutes, it is important to call 9-1-1 and get help. Clinical data supports that as more time passes without treatment, survival rates decrease.

When it comes to stroke victims, it is equally important to understand the symptoms and to receive treatment immediately. Recent data has shown a significant decrease in stroke death when treatment is received within a few hours of symptoms presenting.

The American Stroke Association identifies the following symptoms as signs of stroke:

1. Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

2. Sudden confusion, trouble speaking or understanding

3. Sudden trouble seeing in one or both eyes

4. Sudden trouble walking, dizziness, loss of balance or coordination

5. Sudden, severe headache with no known cause

As with all illness, it is important to seek medical attention as soon as possible.

Although as men, you are taught to withstand a little pain and discomfort, do not ignore the symptoms of stroke or heart attack. Your life may depend on it.

February is National Heart Month: Get Heart Smart!

KNOW YOUR NUMBERS!

Knowing your numbers is an important part of keeping your heart healthy. These numbers can help you and your doctor determine your risks and mark the progress you’re making toward a healthier heart.

CHOLESTEROL

Total Cholesterol: Less than 200 mg/dL

LDL (“Bad”) Cholesterol goals vary:
— People who are at low risk for heart disease: Less than 160 mg/dL
— People at intermediate risk for heart disease: Less than 130 mg/dL
— People at high risk for heart disease including those who have heart disease or diabetes: Less than100 mg/dL (Some high-risk patient will have a goal of less than 70 mg/dL.)

HDL (“Good”) Cholesterol: 50 mg/dL or higher

BLOOD PRESSURE - Less than 120/80 mmHg

WEIGHT - Body Mass Index (BMI) is a measure of body fat based on height and weight. BMI values from 18.5 to 24.9 are healthy.

HEART DISEASE RISK ASSESSMENT - Log onto www.stjohn.org/SJHheartcare and take a free, two-minute heart check.

5 Simple Ways to Love Your Heart

It’s not hard to reduce your risk for heart disease. The American Heart Association encourages women to start today with small, simple actions like these:

1. Celebrate with a checkup: Let each birthday remind you that it’s time for your yearly checkup and a talk with your doctor about how you can reduce your risk for heart disease.

2. Get off the couch: Step, march or jog in place for at least 30 minutes most days of the week – you can even do it while watching TV.

3. Quit smoking in four steps: Can’t go cold turkey? Cut the number of cigarettes you smoke each day in half; then cut that number in half; cut it in half again; finally, cut down to zero!

4. Drop a pound or two: Cutting out just 200 to 300 calories a day — about one candy bar’s worth — can help you lose up to two pounds per week and gradually bring you closer to a heart-healthy weight.

5. Become a salt detective: Check out the Nutrition Facts panel on packaged foods to see how much sodium (salt) they contain. Aim for a total intake of no more than 2,300 milligrams (about a teaspoon of salt) per day.

Heart Attack Warning Signs

Some heart attacks are sudden and intense, like the “movie heart attack,” where no one doubts what’s happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

1. Chest discomfort - It can feel like uncomfortable pressure, squeezing, fullness or pain.

2. Discomfort in other areas of the upper body - Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

3. Shortness of breath - May occur with or without chest discomfort.

4. Other signs - These may include breaking out in a cold sweat, nausea or lightheadedness.

HEART-HEALTHY LUNCH IDEAS

A healthy diet and lifestyle are the best weapons you have to fight cardiovascular disease. It’s not as hard as you may think! Start by packing a heart-healthy lunch.

Sandwich – This easy-to-transport lunch staple can still be a healthy option when made with lean meats and piled high with veggies on whole grain bread or tortilla.

Fresh Fruit – Packed by nature, fruits like apples, oranges and grapes take little preparation and are available year round.

Fresh Veggies – Baby carrots and celery add a satisfying crunch, plus they travel well. Or pack a salad full of your favorite veggies of all colors – the more the better!

Yogurt – Non-fat and low-fat yogurt is a great source of calcium.

Water – Most of us don’t get enough – take this opportunity to hydrate yourself.

Dessert – Don’t forget something fun! Try low-fat varieties of pudding, pretzels or animal crackers.

Below are a few suggestions to help take some of the work out of packing a heart healthy, yet exciting lunch each day. The lunches contain 500-700 calories and less than 15 grams of fat. Use them to plan your menu in the days ahead and give your favorites a regular rotation on your lunch schedule.

MENU #1

• Turkey (three ounces), mustard and lettuce on whole wheat bread
• One small bag of baked potato or nacho chips
• One medium banana
• One 12-ounce diet soda

MENU #2

• Whole wheat pita stuffed with tuna, low-fat dressing, celery, sprouts and diced tomato
• One small can of bean soup with six saltine crackers
• One medium orange
• One large glass of water

MENU #3

• Two slices of vegetarian pizza (toppings include mushrooms, onions, tomatoes and pineapple)
• Two graham crackers
• Six ounces skim milk
• One handful of grapes

MENU #4

• One medium bowl of lean meat chili (prepared the night before). Drain the fat!
• Four saltine crackers
• One half-cup low-fat cottage cheese with pineapple slices
• One medium apple
• One large glass of skim milk

MENU #5

• Roast beef (three ounces), horseradish and tomato on rye bread
• A small tossed salad with carrots and low calorie dressing
• One medium peach
• One six-ounce glass of skim milk

MENU #6

• One medium chicken breast steamed with garlic and 1 cup wild rice (prepared the night before)
• One medium peach
• Walnut and orange salad made with low-fat mayonnaise
• One large glass of apple juice

MENU #7

• One chicken and lettuce-stuffed tortilla with 1/8-cup Colby cheese and salsa
• One small bag of baked tortilla chips
• One cup of non-buttered corn (prepared in the microwave at work)
• One large glass of water

MENU #8

• A small plate of penne pasta with red sauce (prepared the night before)
• One slice of whole-wheat garlic bread
• One medium apple
• One large glass of 100% grape juice