Prevent a heart attack

.
Heart attacks continue to be the number one killer in the US. Heart attacks are also one of the major strains on the national and personal health budgets. It is essential that you know your risks for the development of heart disease and take the necessary steps to decrease the chance of a premature heart attack.

Heart attacks, the major manifestation of coronary heart disease (or atherosclerosis, plaque), continues to be the leading cause of mortality in the US, and will continue to be so as longevity increases, and as the number of senior citizens increases. And, yes, many of us feel that we know what puts us at risk for a heart attack, and what we have to do in order to decrease that risk. But do we really know enough? And do we do enough?

Most of us know the detrimental role of smoking, diabetes, obesity, lack of exercise, and hypertension. Many of us also know of the role of cholesterol, including the “good cholesterol” (HDL) and the “bad cholesterol” (LDL), or even triglycerides. Certainly we know that it’s better to be born with “good genes.”

But what about the more recently recognized risks factors and tests to better detect a potential heart problem early, when there’s still time to delay or prevent a heart attack?

Look at one cholesterol related example: We now can look not only at the total LDL and HDL, but also at their respective subclasses (These are not routinely done unless your physician specifically asks for them). There are at least two important LDL patterns, “predominantly small particles LDL,” also known as B Pattern, and “predominantly large particles LDL,” known as A Pattern. Pattern B is the dangerous one, and it’s the one that can usually be managed by lowering dietary fat intake. In contrast, Pattern A individuals may not benefit, or even become worse with severe dietary fat restriction. Similarly, there are other subclasses and markers, each of which has its own significance and therapeutic implications.

Inflammation of the coronary arteries accelerates the formation of coronary plaque. Cardio-CRP is one such marker of inflammation, and helps identify those at risk of a first and subsequent heart attack, even when the cholesterol risk is low.

Newer blood tests, such as the extensive profile offered by the Berkeley HeartLab, (partially on the basis of technology developed at Berkeley Unversity) or the VAP profile (by Atherotech, Inc.) go much further into analyzing inflammatory markers, cholesterol subclasses, and the benefit effect of certain drugs in the management of cardiac risk factors.

Early detection of plaque formation has become easier too. We’re all familiar with the common treadmill stress test, stress ECHO’s, nuclear Thallium or MIBI test, or even cardiac catheterization. But newer tools have evolved. A modern “fast cardiac CT scan” in experienced hands can show calcium in existing plaque, and thus estimate the degree of atherosclerosis. Computerized coronary angiography, which is only minimally invasive, can even better assess the extent of plaque formation. A carotid ultrasound, with particular attention to inflammation (usually reported as “intimal thickening”) may be useful in risk assessment.

Many other developments are just below the horizon. However, an important problem hindering the use of many new techniques is coverage by the health insurance companies as well as Medicare. They traditionally take years before paying for some of these very important tests.

Regardless, we’ve come a long way in our ability to identify the risk of coronary heart disease, and to detect it early. At our practice, early detection and prevention is a cornerstone. Information is a powerful tool, become informed! We’re here to help you live a longer, healthier life…

The many faces of asthma

Bronchial asthma, usually simply referred to as asthma, is a common condition, affecting well over 20 million Americans, increasing every year. The disease affects both children and adults, and its severity can vary from very mild to deadly. It account for more than 400,000 hospital admissions and more than 4,000 deaths every year.

While most people think of asthma as a disease of the lungs, in reality it’s a chronic condition of the bronchi, the airways that carry air in and out of your lungs. In asthma, the bronchial linings (mucosa) become inflamed, and become sensitive to a variety of irritants. The tiny muscles that surround the bronchi tighten and the mucus glands that are imbedded in the bronchial mucosa produce extra mucus.

Some people think of asthma as occasional wheezing. But in reality, asthma has many faces. It can indeed present as wheezing, mild and short lived, or as a chronic persistent condition, but it can also present in other forms such as a chronic or intermittent cough, excess mucus production, or shortness of breath at rest or associated with exercise.

The frequency and severity of asthma symptoms vary widely. Some people have infrequent “attacks,” or flare-ups, and are otherwise symptom-free, while others have severe, chronic symptoms. But no matter what your symptoms are, you must think of asthma as a chronic condition.

What triggers asthma or an asthma attack depends on how susceptible you are. Common triggers include allergens such as dust, molds, animal dander and cockroaches; tobacco smoke; viral respiratory infections; strenuous exercise; exposure to very cold temperatures; certain foods and food additives, and certain drugs such as the beta blockers used in the treatment of heart disease. Sometimes, psychological factors play a role. Hyperventilation, or excessive breathing, seen in some patients with anxiety, can lead to an asthma flare-up.

Asthma is usually easy to diagnose, but its severity should be thoroughly evaluated by a qualified physician. Occasionally, the diagnosis is elusive, and it has to be distinguished from other diseases that can masquerade as asthma.

Asthma is treatable. New research and an ever-increasing understanding of asthma have lead to better treatment. It is now clear that the overwhelming majority of flare-ups, hospitalizations and deaths can be prevented. But the success of treatment depends on the skill of the treating physician, and the patient’s compliance. Too frequently, especially in milder cases, there is a reluctance to treat or be treated, which may lead to disastrous outcomes.

Treatment depends on severity and triggers, and must be individualized. It ranges from the occasional use of bronchodilators (puffers), to long-term use of inhalers and oral plays a significant role, immunotherapy (allergy shots), or the use of a relatively new anti-allergy injectable medication (Xolair, omalizumab) may be appropriate. Relaxation methods, regular exercise and a thorough understanding of your condition are very helpful.

So if you have asthma, see to it that your needs are properly addressed, and take your treatment seriously; your mind and body will thank you for it. Need help? Contact us.

Don’t let fitness take a holiday

.
The holidays are over; there's no need to let fitness take a holiday now.

Fitness is an elusive concept. According to the President's Council on Physical Fitness, it is "the ability to carry out daily tasks with vigor and alertness, without undue fatigue, with ample energy to enjoy leisure-time pursuits and to meet unforeseen emergencies." Yet physical fitness means different things to different people. One fact is clear: if fitness is the goal, exercise is the way to get there.

There are four basic elements of physical fitness: cardiovascular endurance, muscular strength, muscular endurance, and flexibility. Each can be measurably improved with regular exercise. But keep in mind that exercising to build physical fitness is not the same as working out to improve athletic performance. To be physically fit, you should develop all four elements, not just one or two.

While each element is a part of fitness, the most important one is cardiovascular endurance. Physiologically, cardiovascular endurance is the sustained ability of the heart, blood vessels, and blood to carry oxygen to the cells, the ability of the cells to process oxygen, and the ability of the blood, once again, to carry away waste products. Since every cell in the body requires oxygen to function, there is no more basic element of fitness than this, to see that the heart, lungs, and circulatory system do their job.
Cardiovascular endurance is built up through exercises that enhance the body's ability to deliver ever larger amounts of oxygen to working muscles. To achieve this, the exercise must include the large muscle groups (such as in the legs) and, most importantly, it must be sustained.

Muscular strength is the force a muscle produces in a single effort (a lift, a jump, a heave), as when you swing a mallet to ring a carnival bell. Muscular endurance is a measure of the ability to perform repeated muscular contractions in quick succession, as in doing twenty push-ups in a minute. Although muscular endurance requires strength, it is not a single all-out effort.

Muscular endurance and strength are interrelated, but are quite distinct. Endurance enables you to maintain a sustained effort, while strength will give extra force to your golf swing or tennis serve. Gains in strength come most quickly from exercising with the maximum amount of resistance, usually weights, that you can lift comfortably in a few repetitions, working at below your maximum level and gradually increasing the number of times you perform an exercise.

Flexibility refers to the ability of the joints to move through their full range of motion. It varies from person to person and from joint to joint. Good flexibility is thought to protect the muscles against pulls and tears, since short, tight muscles may be more likely to be overstretched. Some people find that stretching hamstring and lower-back muscles alleviates lower-back pain, and calf stretches help prevent leg cramps.
Developing strong, flexible muscles is important for everyone, not just for athletes and body builders. Well-conditioned muscles and joints help you perform better physically, assist you in maintaining good posture, and may help prevent injuries and chronic lower-back pain.

Most certified personal trainers are very good, but watch out for the overzealous ones, they may hurt you.

Need help? feel free to contact my office (contact information on the side bar).

New Year's resolutions revisited

.
I hope you were able to stick to your health-related New Year's resolutions. I didn't make any, so I'm absolved.

The three most common and important health-related resolutions are: weight loss (or weight control), increasing physical activity/exercise, and smoking cessation. Have you done your share? Most Americans forget about their resolutions by the end of January. Don't let it happen to you.

New Year's resolutions... why wait?

.
As 2010 approaches, many of us are ready to make New Year’s resolutions. Some of the most popular resolutions have been to make a commitment to fitness, stop smoking, and lose weight. But times are changing, and so do the resolutions. Now, despite economic difficulties, and may be because of them, more people are resolving to change their lifestyle, enjoy life more, and devote more quality time to their family. In short, many people are deciding to have a less stressful life, and also that less is more.

In reality, 50% of those who start an exercise program drop out within 6 months (or much less...) and their treadmills become dust collectors; too many lost pounds are rapidly regained, and cigarettes continue to be a big seller. And soon after you enjoy a few days of the rest, daily stresses resurface. So how do you succeed?

Don’t try to make too many changes. Identify the issues most important to you, and concentrate on the top two. For many, this translates into increasing exercise, and managing stress.

Exercise: For beginners, it is extremely important to make realistic goals. Trying for a six minute mile on the first day is not realistic and potentially dangerous. Cardiovascular exercise is the most important, with stretching and moderate muscle strengthening next.

Start exercising slowly. Gradually increase the intensity and duration in small increments until a relatively high level of exercise can be tolerated. Even if you are a regular exerciser and took a “holiday break,” restart at a lower level, and progressively return to your usual level. If you’re sedentary or over 35 years old, or are not known to be in excellent health, see your health care provider before strenuous exercise.

Stress: What is stressful to one person may not be stressful to another. Stress is best defined as a situation which requires a behavioral adjustment (Dr. Herbert Benson, Mind/Body Medical Institute). Stress increases the body's adrenalin production, and with it physiologic changes occur, including a rise in heart rate and blood pressure. This was the flight-or-fight response of the cave man, frequently unsuitable for dealing with “modern” stress. Some stress is important as a motivator for daily function and long-term achievement, but excess stress takes away from life’s enjoyment and productivity, and can make hypertension and other medical conditions permanent.

The Relaxation Response is an effective antidote to stress, which can be learned and practiced by almost anyone. It can be elicited by many techniques, including meditation, diaphragmatic breathing, imagery, yoga, and progressive muscle relaxation. All techniques involve a brief, intense focusing of attention, and the passive disregard of everyday thoughts. For a good example look at the blog Stress, Relaxation and the Mind-Body Connection, on the left hand column (September 2009).

There is a wonderful synergism between exercise and stress management. With regular exercise, the body produces its “relaxation hormones,” endorphins; and with relaxation management, the likelihood to succeed in exercise increases remarkably.

People who exercise regularly and practice stress management say that, to them, these habits have become an addiction. What a great “addiction” to have…