Heart Disease

The Best Exercise

2008-05-06T21:23:00.005-04:00

Look here: Doing The Perfect Push-up.

I've always said that the simple push-up, requiring no equipment and only a stretch of floor in your home (or hotel room!) is the perfect exercise, and now even WebMD and fitness experts agree! Although it offers no aerobic benefits, the push-up can be done in a way that works your whole body, and as a resistance exercise, it can help prevent osteoporosis. This is important for both women and men, both of whom may suffer from bone thinning. So in addition to your aerobic routine, add some push-ups to work multiple muscle groups, improve your core strength, and protect your bones. That's a lot of bang for no bucks!

Be well, Laurie

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Confused by Research on What to Eat? Here's Why

2008-04-29T12:07:00.001-04:00

Readers warning: what follows is a brief review of some of the flaws in nutrition research. If you're like me, your eyes glaze over whenever you try to get through study results, and frequently you end up with a headache and no more enlightened. Please try to bear with me because I hope I put this information in plain English, and that you actually will be enlightened by this discussion.

A new study published in the April issue of the Archives of Internal Medicine suggests that the "DASH" diet reduces women's risk of heart disease and stroke, and lowers their blood pressure. "DASH " stands for Dietary Approaches to Stop Hypertension. The DASH diet is comprised of lots of fruits, vegetables, and plant proteins (beans and nuts), and is low in animal protein. It includes a moderate amount of low-fat dairy products.

The DASH diet has previously been shown to lower blood pressure and reduce "bad" LDL cholesterol. Both are factors in the risk of developing cardiovascular disease (CVD) and stroke. Teresa T. Fung, ScD, of Simmons College, Boston and colleagues studied the eating patterns of 88,517 female nurses aged 34 to 59 to determine if sticking to a DASH diet affected a woman's risk of such diseases. The women did not have CVD or diabetes when the trial started. This type of study is called an "observational" study; it takes a group of individuals and follows some aspect of their life and how it influences their health over time.

In their study the researchers followed the nurses for 24 years. Over that time they asked the women to report what types of foods they regularly consumed over the previous year. The researcher's then divided the foods into specific categories, and assigned those categories a DASH score. The more fruits, vegetables, whole grains, nuts, and beans the woman ate and the more she adhered to the recommended low-fat dairy choices, the higher her DASH score became. Scores were lower in women who consumed more red and processed meats, salt, and sweetened drinks. Women with the highest DASH scores had a 24% reduction in heart disease and an 18% lower risk of having a stroke when compared to the women with the lowest DASH scores. The authors point out that the women with the highest DASH scores also appeared to live overall healthier lifestyles. They were less likely to be current smokers, more likely to exercise, and tended to consume high amounts of fiber and omega-3 fatty acids than the other study participants. This is a problem with an observational group; the study design doesn't control for other things that might influence the study's outcomes.

I mentioned here recently that I am currently reading In Defense of Food, by Michael Pollan. In this book Mr. Pollan points out, with numerous examples, how nutrition science is very flawed. One of his examples is the Nurse's Health Study (Belanger, C.F., Hennekens, C.H, Rosner, B., et al. "The Nurses' Health Study." American Journal of Nursing. (1978):1039-40), which is not the same study currently being discussed by Dr. Fung. The Nurses' Health Study of 1978 was also a long-term observational study that collected data on eating habits and health outcomes of more that 100,000 women over several decades. It is still considered one of the best studies of its kind, yet it has significant flaws.

One of these is it's reliance on food frequency questionnaires, which appear to have been used in this DASH diet study as well. A food frequency questionnaire asks an individual to recall what they have eaten over a certain period of time. In the 1978 Nurses' Health Study the questionnaire asked such things as "Did you eat chicken or turkey in the last 3 months?" and "When you ate chicken or turkey, how often did you eat the skin?" Other questions asked about vegetable intake, and whether or not the vegetable was steamed or fried, and if fried, in what kind of fat.

Now think about your diet for a minute. When was the last time you ate french fries? When you ate them, did you fry them yourself, or did you eat them at a restaurant? If cooked at a restaurant, what are the odds that you know what kind of fat they used to cook your fries? What are the odds that you recall how many times you ate french fries in the last 3 months? How about the last year, which was the period of recall for the DASH study? Do you see how unreliable this data might be?

There are several problems with relying on individuals to report their food intake, including the difficulty with recall and knowing how things were cooked, as I pointed out above. Another problem is that people don't tell the whole truth. Scientists know that people underestimate their food intake all of the time; they have even developed scientific figures to measure the degree of error that occurs with self-reporting of dietary intake. The studies that assess the validity of the food frequency questionnaires indicate that on average people eat 1/5 and 1/3 more volume than they indicate on these questionnaires, and it is likely that this underestimates the problem. This is because scientists know that there are 3,900 calories of food produced each day in America for each person living here, yet we admit to only eating 2,000 per person. So although there is some food waste, it can't be enough to make up the other 1900 calories per person and someone is eating them!

To try to improve the odds that a person's recall is accurate, scientists match the results of the food frequency questionnaires with the results of an individual's recall of their intake in the last 24 hours, which is thought to be somewhat more reliable. But again, think about what you ate in the last 24 hours. How typical of your "usual" diet was this intake? Personally, I ate fried onion rings tonight, from a restaurant. I rarely eat fried foods, and I have no idea what kind of oil they used. So this is not in any way typical of my intake, and would totally skew my data if this were the day of my 24 hour recall.

Research into how we eat and how our food intake influences our health are full of potential errors; the examples above are a portion of those errors. Let me tell you about one more study to really make this point clear.

My mom participated in the "Women's Health Initiative" study, specifically in the Dietary Modification arm of it. She was randomly assigned to the group that was supposed to decrease their fat intake to 20% of their total daily calories, increase their consumption of fruits and veggies to 5 or more servings a day and whole grains to 6 or more servings per day. They monitored their food intake (through those dietary recall sheets), attended nutrition education sessions monthly for the first year and then four times per year for the remainder of the study. The comparison group kept us their usual eating habits, received only standard nutrition guidelines, and filled out health records every six months. This was a large group, 48,800 women, who were followed for 8-12 years.

The researchers believed that they had removed the bias that was a problem with the DASH study because they randomly assigned women to the two groups, modified diet versus usual diet. This would divide the women who tended to eat better, exercise more, and not smoke into both groups and this would result in those factors having equal influence on the outcome of both groups. This was supposed to mean that the only factor being measured was the change in diet versus the "usual" diet of the control group. But once again nutrition "science" fails us. In addition to the problems outlined above about basing data on dietary recall, consider this: women in the dietary modification arm of the study got their dietary fat intake down to about 24% at their best point in the study period and at the end their fat intake had drifted back closer to 29%.

During that same time, women in the control group were hearing in the media that "low fat" was the way to go (WHI enrollment began in 1991 and the entire study period from enrollment to completion lasted 15 years; during that time the "low-fat diet" came into mainstream media discussions and into eating vogue). Hearing this low-fat mantra meant that the "controls" began to decrease their fat intake resulting in a reduction in fat in their diets that approached the percentage of dietary fat in the study group. This influence is called the "treatment effect." Additionally there was no effort made to control where the fat came from, so women who get their dietary fat from animal sources were lumped into the same group as those who get their fats from things like soy products, avocados and olive oil! When the results were announced in 2006 the New York Times printed the headline, "Low-Fat Diet Does Not Cut Health Risks, Study Finds." This is because in the end there was likely very little difference between the diets of the two groups!

I hope that this little research lesson has both enlightened you on a complicated subject and led you to a few of the same conclusions that I have come to: nutrition "science" is fraught with research errors and it's no wonder we're confused about what to eat!

Frankly I think I'm going to follow some of Michael Pollan's simple advice, the first of which is stated on the front of In Defense of Food:

"Eat Food. Not Too Much. Mostly Plants."

How does he define food? For that you'll have to read this really great book.

Bon Appetite! Laurie

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Reading Lists

2008-04-19T02:31:00.002-04:00

I am totally dry on what to write about today, and I am overdue to post (based on my plan to try to post twice a week). So while I was staring at my blog I noticed all those blog links that are on the side of the page. I thought, do I actually read these people? I don't mean the links to the other WebMD bloggers; it makes sense to put them there because the whole point is to promote the site and many of them I actually DO read, but what about those under the heading "Blogs We Read"?

I think I'll have to see about updating that list with the people that I actually read. Who are they? Well, there's Michelle the anesthesia resident in NYC who's about to graduate and has one of the cutest kids on the planet! There's the doc in Manhattan who cooks (and supplies recipes!) and talks about medicine, especially women's health issues. There's John, the ED nurse who's a glutton for nursing education punishment (I love school too John!), and Nurse K, also an ED nurse who has a great sense of humor about the chaos that is ED nursing. Then the ED docs, Ten Out of Ten, White Coat Rants and ER Stories. The folks over at M.D.O.D represent several areas of medicine, including a pathologist, and a handful of ED docs. Finally there's Dr. Smak, a family practice doc whose young son is fighting a brain tumor. That's all my medical favorites at the moment, but then there's the gardeners...one at NPR and my current favorite. So I hope you enjoy some working links to really good bloggers; it gives me great pleasure to share them with you!

While I'm at the updating, I think it's time to update my photo too....

Have a great day! Laurie

From the editor: We liked so many of Laurie's suggestions that we added some to the list on the sidebar. Thanks, Laurie!

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Tired? Get Off the Couch!

2008-03-30T22:45:00.000-04:00

From Reuters, 2/2008:

Feeling tired all the time? The solution is a steady effort of low intensity exercise, such as a daily stroll. Researchers at the University of Georgia have demonstrated that regular exercise can increase perceived energy levels as much as 20% and decrease fatigue by 65%, particularly in those who are currently sedentary.

The researchers gathered 36 people who did not exercise regularly and who said that they were always tired; they divided them into three groups. One group did 20 minutes of moderately intense exercise on a stationary bike three times a week for six weeks. A second group exercised for the same amount of time each week, but at a much lower intensity. The third group, who served as the controls, did not exercise at all. Both groups of exercisers reported a 20% increase in energy levels over those who did no exercise, but to the researchers surprise, the group exercising at the lowest intensity reported a greater reduction in tiredness than those who worked out harder.

Patrick O'Connor and his team at the university's exercise physiology laboratory previously studied individuals with cancer, heart disease, and other medical problems and published a study in 2006 that indicated that these individuals fatigue levels were reduced by exercise; in the current study the participant's fatigue was not associated with any known medical cause. The researchers are a bit puzzled about why the group who exercised less intensely seemed to fair better than those who exercised at higher levels. "It could be that moderate-intensity exercise is too much for people who are already fatigued and that might contribute to them not getting as great an improvement as they would had they done the low-intensity exercise," O'Connor said in a statement discussing their results.

As I've previously discussed here in the blog, many of us are not getting enough sleep, and many of us are overworked. O'Connor notes that there is a scientific basis for exercising improving energy levels; I have previously read studies that demonstrated improved mood and sleep with increased exercise time. As O'Connor says, "there's a scientific basis for it and there are advantages to it compared to things like caffeine and energy drinks."

I’m glad I took that gentle stroll with the dog today; despite feeling rotten with a cold, it did make me feel better. I've fallen off my exercise habit since I returned from vacation and I can tell the difference. Let this be a reminder to all of us to rededicate ourselves to at least a little daily exercise. Now that you have proof that you don't need to work out hard to feel better, what are you waiting for?

Take care, Laurie

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Colorectal Cancer

2008-03-24T15:25:00.000-04:00

Since a close member of my family is suffering from a colon cancer I thought I would take this opportunity to remind you that March is Colorectal Cancer Awareness Month.

This type of cancer is the second leading cause of cancer death, yet it is totally preventable! Interestingly, some of the same behaviors that are appropriate for preventing heart disease like not smoking, eating lots of fruits and vegetables, and getting regular exercise have all been shown to reduce the risk of developing colon and rectal cancer.

The risk of this type of cancer begins to increase at age 40, and this is the time that you'll be asked to do stool samples for your health care provider. You may be asked to apply a small amount of stool to a card, or to bring samples to the laboratory in a special container. Either way those samples are tested for blood, because the appearance of trace amounts of blood in the stool can indicate the presence of an early cancer.

After age 50, your health care provider will recommend a screening colonoscopy. This test involves giving you IV sedation to make you sleepy, then passing a very small, flexible scope into your lower intestine (the colon) via your rectum. It can be a bit uncomfortable, but not painful, and the outcome is well worth this discomfort. This is because the provider can directly visualize any colon polyps that are present and remove them. Colon polyps are usually a type called an "adenoma," which can develop into a cancer.

If polyps are found in your colon they are removed. This stops the risk that a colon cancer will ever develop in that location. How often this test is done depends upon the results of this test: if you have polyps that are found to be adenomas you'll need a repeat test sooner (5 years) than later. If there are no polyps you may be given a period of up to 10 years before you need to have another colonoscopy. One exception to the colonoscopy after age 50 rule is this: if you have a family member who has been diagnosed with colon cancer, you'll need to start your colonoscopy testing sooner, 10 years before the age at which that person was diagnosed. Since my family member is 82, it doesn't affect my testing start, which only a few years away. You can bet that I'll get it done though, since by having this test I stay on top of a preventable cause of cancer death.

Take care and get your colonoscopy!

Laurie

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The "Politics" of Food, Health, and Health Insurance

2008-03-16T22:19:00.012-04:00

Well, it's always hard to get back into the routine when one returns from vacation. This past week has been a whirlwind of getting laundry done and put away, getting back into household routines, and of course back to work. This includes blogging. Here is Sunday and I've almost been home a week already and I am just getting back to this.

It's nice to see that people are reading occasionally; it seems that I struck a cord by getting a little political in my post about childhood obesity. Seems some folks think that the government should not be responsible in any way for the country's obesity problem.

Well, lets take a look at the current effort that the government has made to educate the public about food and appropriate eating, namely the "My Pyramid" web site. Has anyone looked at this thing? I bet most of you have not, and if you have, you've walked away shaking your head, wondering how anyone thought that was actually going to help a person with a high school (or less) education learn to eat more healthily. How many people who need dietary instruction know that this educational tool exists or how to find it? How many have the computer access necessary to use it? How many get there and understand it?

Seems to me that it would be much more practical to get kids moving at school and provide them with access to healthy foods first. It's a fact that what many kids learn becomes an influence at home when the child says "let's find the healthy fast foods on the menu", or asks for a piece of fruit instead of chips. The government is already in there folks, and in my opinion they are not meeting people where they live.

One more point before I pass onto other subjects, if you think that the government is not involved in food and health, I strongly encourage you to read two books by Michael Pollan. The first, The Omnivore's Dilemma: A Natural History of Four Meals, and the second, In Defense of Food, An Eater's Manifesto. The first traces how food policy has changed the way we grow and distribute food to the detriment of both the farm land and our health. The second, which I am about 1/3 of the way into, is breaking apart much of the "knowledge" that I was taught about food and health. It seems that we may have been sold a bill of goods when it comes to the idea of a low fat diet being good for our health. But more on that when I finish reading the book.

Finally, if you are following the candidate's plans for health care in the US after they are elected, then this article will likely be of interest. Seems that Hillary and Obama aren't too far off from one another with their plans, but McCain's taking the usual tact of his party: give people money to 'encourage them to purchase their own insurance.'

Yeah, and how many of you are going to pay bills with your "economic stimulus" money rather than purchase a new item to stimulate the economy? People are basic and pragmatic. They are getting behind in their bills due to the current recession and when that check comes, I'll bet at least 75% of them will use the money to pay off a looming bill. The rest will do the instant gratification thing and spend it on an item to make them happy; but they aren't saying to themselves, "Let me spend this money to stimulate the economy."

Same with health insurance. If they are given tax credits it's not like they'll ever see cash that they can spend on insurance. If they are given cash, do you think they will know where to turn to spend their money on health insurance? Do you think they can understand how to get it, what policy will provide their family with the best coverage for their dollar, and how to fill out the paper work? I'd guess not.

In fact, I think they'd spend the money on those bills that are piling up, because right now it works just fine for them to go to the ER when they need medical care. They get assistance there to fill out the paper work for free care, and in the end it never costs them a dime for that visit. Never mind that it's not a good way to get ongoing medical care or that hospital's are having a difficult time with budgeting for all this free care. People deal with what's right in front of them, the bills or the illness, not the best option for the long road ahead.

Take care.

~Laurie

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Vacation - Bon Voyage!!!

2008-03-07T22:58:00.002-05:00

During this week I'll be setting sail on Princess Cruises Caribbean Princess. This is my second Princess cruise and this year we're headed to the Eastern Caribbean.

I'm going to swim in the pools, soak in the hot tub, get several massages in the spa, snorkel in the blue-green waters off of the island of St. John, sail on retired America's Cup sailboats, watch great entertainment, and eat like it's nobody's business! One of the best parts of Princess Experience is afternoon formal tea, complete with freshly baked scones with real whipped cream! Last year I managed to eat like crazy and be active enough to come home only 2 pounds heavier, so wish me luck! See you in a week!

~Laurie

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Getting Your ZZZ's

2008-03-03T22:50:00.002-05:00

Reuter's News, February 28, Washington: American's habits, including late night television and Internet surfing are resulting in less and less sleep, according to the Centers for Disease Control and Prevention (CDC). So what you say?

According to experts at the CDC, lack of sleep can be a nightmare to one's physical and mental health, and sleep loss is a poorly recognized public health problem. Sleep researchers have linked chronic sleep loss with obesity, diabetes, hypertension, stroke, cardiovascular disease, depression, and increased cigarette smoking and alcohol consumption.

The CDC surveyed 19,589 adults in four states. Ten percent reported they did not get enough sleep or rest every single day of the prior month, and 38 percent said they did not get enough on seven or more days of the prior month. Surveyors talked with individuals in New York, Hawaii, Delaware and Rhode Island; they asked how many days in the prior month individuals got inadequate sleep, without asking how many hours they actually slept.

In addition to this information the CDC collected and released additional data that was collected nationwide. The combined results showed that across all age groups the number of adults who report sleeping six or less hours a night has increased significantly between 1985 and the present. The National Sleep Foundation recommends that adults get seven to nine hours of sleep every night.

According to CDC behavioral scientist Lela McKnight-Eily, who led this study, American adults are spending time doing everything but sleeping, including watching TV, surfing the Internet, or in some cases working; in other circumstances there is some type of sleep disorder or physical problem that interferes with a good night's rest. Lifestyle choices place sleep on the back burner, as if we can catch up on sleep when we have more time, such as on the weekends.

McNight-Eily is concerned that adults don't realize that sleep is very important to overall health, and that chronic sleep loss is related to deterioration in both physical and mental health. Darrel Drobnich, CEO of the National Sleep Foundation notes that each year several thousand people die in the US from motor vehicle accidents that occur due to sleepy drivers.

McKnight-Eily recommends that the first step to getting a good night's sleep is to visit your primary care provider to assess whether the sleep problems are related to lifestyle choices or a physical problem. If getting an adequate night's sleep remains a problem after physical health issues are either eliminated, individuals need to address lifestyle choices that are interfering with their sleep. Most important are establishing a routine sleep schedule that is maintained as much as possible, avoiding late-night stimulants such as caffeine and cold medications; they should also avoid excessive alcohol, which can initially put you sleep, but may later awaken you in the night with an inability to go back to sleep.

During the week of March 2 I'll be away on vacation, where I never have trouble sleeping. But right now it's 10:50 PM and I'm writing this blog when I still have to finish packing, shower, and set my clock to get up at 6 AM. Looks like I'll not be getting my 7 hour minimum sleep tonight. Have a great week!

~Laurie

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The Disconnect in Childhood Obesity

2008-03-01T10:33:00.016-05:00

Parents of many children who would be considered as overweight or obese do not see their child as being too heavy; many actually think that their child is about the "right" weight. In research published in the February edition of Diabetes Care, Dr. Asheley Cockrell Skinner of the University of North Carolina at Chapel Hill notes out that this misconception on the part of the parents means that the child will also fail to see their weight as a problem. Dr. Skinner and colleagues say that an important first step in preventing childhood obesity is the recognition that there is a problem. Without this recognition they say, families will not take steps toward diet and lifestyle changes that will prevent continued weight gain.

The researchers interviewed 104 adolescents with type 2 diabetes and their parents about their understanding of the adolescents' weight, eating, and exercise habits. To assess ideas about weight the teenagers and their parents were asked if the teen was "very overweight, slightly overweight, about right, slightly thin, or very thin?" Among the teens in this group, 87% were overweight by standard measurements (weight, BMI), yet only 41% of their parents and 35% of the teens considered their weight to be a problem. Among teens whose BMI was above the 95th percentile 40% of parents and 55% of the teens thought that the child's weight was "about right." For both parents and teens an underestimation of weight was associated with a poorer dietary choices and exercise habits.

The frequency of obesity (BMI greater than the 95th percentile) among adolescents in the US was 4.6% among teens 12-19 years old in 1963-1970, and 6.1% between 1971-74; it rose to 15.5% between 1999-2000. Research has shown that there is a strong relationship between childhood obesity and insulin resistance (a marker of early diabetes) in young adults. Clearly something must be done to improve understanding of what overweight and obesity are, and their implications for health. As these researchers point out, "addressing misperceptions of weight by adolescents and their parents may be an important first step to improving weight in these patients."

One approach may be addressing the kids directly through school programs that target increased activity. In one trial of students in California, decreasing TV viewing and video game playing from 12 to 8 hours per week led to a smaller increase in BMI among the study group versus the controls who continued their usual level of TV and game activities. A "Kids 'N Fitness" program that promotes health and wellness in classrooms across the US has shown to decrease weight among at-risk children.

At my age we laugh about how we used to hear our parents and grandparents say, "when I was a kid..." but now we're in their shoes, aren't we? When I was a kid, we weren't allowed more than an hour of TV a day, and that hour was carefully chosen. When we got home from school we had a snack and then it was out the door until dinnertime to play, actively, with our friends. I was an adolescent in that period between 1971-74, when the obesity rate was 6.1%, and I know why. When is this country going to put physical activity back in the schools and make an active effort toward public education about the consequences of obesity? Isn't it time we stopped wasting money on wars, and created a budget that provides healthcare for all, and TV advertising to compete with Coke, Pepsi, and McDonalds?

Take care and have a salad today, Laurie

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In-Flu-End-za?

2008-02-25T14:52:00.000-05:00

We're seeing a lot of flu "A" in my emergency department. The local university, my grad-school alma mater notes that despite the having the greatest number of students vaccinated this flu season, they also have the greatest number of students on campus who have been diagnosed with flu. So what happened? Vaccine mismatch - that's what.

Each year in February experts meet under the authority of the Food and Drug Administration to decide what flu strains will be included in the vaccine for the following flu season. They try to predict which virus strains will be the most likely to spread in the following year.

Flu season begins in the Far East and this data is used to help predict what will strike the US, but like all medicine, this prediction is partly scince and partly art (a guess based on knowledge). Most years the prediction is fairly accurate, but this year the experts and the manufacturers didn't so so well. Last winter they recommended a certain strain of flu "A" be included in this year's vaccine, but the manufacturers weren't able to find samples that would grow properly in the production process.

Unfortunately for those of us out here on the front lines, this missing strain of flu "A" is the most prevalent one we're seeng this year, accounting for about 60% of all the cases of flu, and next year's production may not be any better. For the first time ever the expert panel has recommended a complete change of next year's vaccine. Each year the vaccine is "travalent," meaning that it is made up of the three currently most common strains of flu; manufacturers have been asked to completely overhaul next year's vaccine, which may make production difficult. It may help that two of the three newly recommended strains were included in the 2007 vaccine for the Southern hemisphere, making it possible that manufacturers will have a bit of a "jump start" on the new production plans.

Let's hope they're right! This year's vaccine is about 85% effective at preventing illness in young, healthly individuals, despite my alma mater's experience. Unfortunately college students aren't really my biggest concern; it's the elderly, the very young, and the chronically compromised that I have to worry about, and this year the vaccine has let them down. Let's hope we get it right in 2008-09.

Wash your hands and stay well! Laurie

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How's Your Blood Pressure?

2008-02-17T22:51:00.001-05:00

How's your blood pressure? Are you at "goal?" Controlling blood pressure is critical to one's cardiovascular health. It is a well-established fact that when a person has uncontrolled hypertension (blood pressure or B/P) there is a significant increase in the risk of heart attack and stroke. Yet despite this well-known fact, the rate of good B/P control has reached a plateau in men in the US, and rates of uncontrolled hypertension in women are actually rising!

In Washington, DC and many southern states one in four women has high blood pressure that isn't well controlled, a deplorable fact given how much we know about blood pressure management, how many inexpensive medications we have available to us, and how many options there are to health care providers to refer their patients to dietitians and exercise programs such as cardiac rehabilitation to learn the lifestyle changes that will lower blood pressure!

In the study that documented these trends, which appears in the February 11th edition of Circulation, study author Dr Majid Ezzati (Harvard University, Boston, MA) notes that while some states are doing better than others with blood pressure control, the trend is consistent: Men are not gaining any better control and women's blood pressures are actually worsening overall.

Dr. Ezzati speculated that some of the contributing factors may be the obesity epidemic, which is hitting women harder than men, and the fact that women are less likely to have access to good health care. Dr. Ezzati also suggests that health care providers may have become complacent about measuring B/P at office visits and addressing numbers that are out of range.

He notes that providers can be reluctant to add medications to the patient's regimens and that they often don't address lifestyle changes. I know that I often hear from my colleagues that they don't have time to address lifestyle changes in a short office visit or that they don't bother, because they don't believe that patients are likely to make behavioral changes. I don't buy that though, as there is evidence that that when a health care provider takes the time to address a needed behavioral change and links that need to the patient's current health status, the patient is more likely to make that change. As an example, I am more likely to get someone to consider stopping smoking if I say to them, "Your chest x-ray shows evidence of damage to your lungs from your years of smoking. You should talk to your health care provider about how s/he can help you to quit smoking." I do this all the time in the ED, and I said something similar to people when they were under my care as a primary care provider.

One of Dr. Ezzati's theories may have been upheld in another recent study, which suggests that both gaining a patient's agreement to follow a medication plan and increased medication prescriptions are needed in order to control B/P. In a study designed to examine barriers to blood pressure control over time, lead investigator Dr Michael Ho (Denver Veterans Affairs Medical Center, CO) reported that although it is important to increase therapy by adding medications, it also matters whether or not a person is actually taking their medications as they are prescribed.

The study looked at 10,000 individuals with hypertension and cardiovascular disease in a managed care setting. The results indicated that approximately 1/3 of patients in the group with consistently elevated B/P did not have either an increase in the dose of their current medication or additional medications added. Another third of the patients had medication changes made by their health care provider, but did not take them as prescribed. Dr. Ho emphasizes that communication between the prescriber and patients is critical to improving outcomes. He notes, "Doctors all want to bring blood-pressure levels under control, but sometimes intensifying therapy might not be the right approach. The correct response might be to simply get the patient to take the medication."

I could not agree more and I have to point out that the best health care providers are those who encourage communication between themselves and their patients, by knowing what questions to ask and how to ask them in order to find out if the medications are being taken correctly. These include, but may not be limited to:

"How often do you forget to take your medications?"

"Are you able to afford the medications that have been prescribed for you?"

"Do you have any trouble taking your medications the way they are supposed to be taken?"

These questions assume that sometimes we forget to take our medications and that it's ok, and gives one an opportunity to strategize with the person to find memory aides that will help them remember to take their medications. It also gets to the root of potential financial problems with obtaining meds and allows the provider to seek out less expensive alternatives to current prescriptions.

Finally, these questions allow for any other concerns the patient has to be brought to light, for example how to schedule medications safely. I once had a patient reveal to me that she'd been getting up in the middle of the night to maintain the medication schedule given to her in the hospital, when she could have easily adjusted her medications schedule to her usual daily home routine. She would not have done that for long, I can assure you! She would also have stopped taking the medication before she would have admitted to me that she wasn't willing to get up in the night, assuming that I'd think less of her because she didn't make her medication-taking a priority. So it pays to ask, and in an inviting manner if you want to hear the truth.

Take care, Laurie

Related Topics:

Your Healthy Heart: Women's Guide

10 Ways to Control Your Blood Pressure

Technorati Tags: hypertension, heart disease, heart health, blood pressure, obesity

Romance is Good for Your Heart

2008-02-13T13:46:00.000-05:00

My plans for bi-weekly posts went out the window this past week due to a family member's surgery. It was elective, but things never go quite as planned, do they? As the token member of the health care community in my family I spent some time at the hospital, and gladly, but that meant I didn't post as planned. Things are going great there now, and I hope to return to my posting plan. I am even going to try to get ahead, so that there will be posts to go up while I'm away on vacation in a few weeks. We'll see how that goes; sometimes I'm a crazy person thinking that I can accomplish all the things on my list!

Thursday is Valentine's Day of course. Here are a couple of interesting valentine facts: the US Greeting Card Association reports that nearly 1 billion greeting cards are sent in the world for Valentine's Day; this makes the holiday second only to Christmas in terms of cards sent. They also estimate that 85% if these cards are sent by women; no surprise there I think!

Although Valentine's Day was originally acknowledged as a celebratory holiday for various early Christian martyrs named Valentine, the first written association with romance appears to be a poem written in 1382 by Chaucer (The Canterbury Tales), called the Parlement of Foules. It was written to honor the first anniversary of the engagement of King Richard II to Anne of Bohemia ,who were married at age 14.

Here at Web MD there is a great article about the benefits of chocolate for your health that will make it that much easier to indulge your sweet tooth this week. I didn't know that it's botanical name, Theobroma cacao, translates to "food of the Gods." For those of you thinking about a little romantic interlude with your Valentine it might be a good idea to eat a little dark chocolate together. It contains the chemicals phenylethylamine and serotonin, which are thought to be mood boosters and mild sexual stimulants.

Planning a Valentine's Day meal for your loved one? Think about your menu carefully and you could make it romantic and heart-healthy! How about starting with a glass of red wine (130 calories, 5 grams of carbs)? It's flavonoids have an antioxidant effect in the body, may raise HDL ("good") cholesterol levels and may help prevent blood clotting in vessels.

For appetizers, try a seafood item, such as shrimp cocktail: three ounces have only 130 calories, 1 gram of fat, and 12 grams of carbohydrate. But here's the good part, it's a low-fat, high-protein treat that contains lots of zinc and mood-brightening, heart-healthy omega-3 fatty acids. Avoid frying your seafood appetizer, which really increases the calories and heart-unhealthy fat. For your main course, try broiled salmon with steamed vegetables (about 590 kcal, 40 g fat, 5 g carbs). Choose colorful vegetables that are high in flavenoids, which boost immunity and heart health. The protein in this meal choice can also increase the production of dopamine, a mood enhancer that will make you feel good.

For desert try chocolate-dipped strawberries: 6 berries contain 180 kcal (that's only 90 for each of you), 9 g fat, and 24 g carbs. Strawberries contain anthocyanins, which are chemicals that improve blood flow to the body, so of course that's good for your heart!

While planning that romantic dinner for two, keep in mind that just being in love can improve your health. Various investigations have shown that loving relationships can help prevent plaque build-up in the arteries and protect against cardiovascular disease, boost the body's disease-fighting antibody levels, reduce levels of stress hormones, and lengthen our lives. All good reasons to treat that special loved one to a special Valentine's Day treat!

Happy, Heart-healthy Valentine's Day to all! Laurie

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A Vote for Health

2008-02-04T11:17:00.000-05:00

Among the current headlines at WebMD is space dedicated to the US Presidential candidates and their positions on health care. Please read this and anything else that you can find about this topic. Then please, vote - vote with you mind, heart, and information! Health care is a critical issue to this election and although I won't try to unduly influence you, here a few thoughts from someone who lives in the system every day, trying to do my absolute best to take care of you and your loved ones.

The US health care system is a bit broken, but it's not a total disaster. There are lots of really great health care providers - docs, NP's (nurse practitioners) and PA's (physician's assistants) - out there working really hard, but there aren't enough of us. Putting restrictions on the reimbursement and ability to practice of advanced practitioners such as NP's and PA's just further handicaps the system, especially in rural areas.

There are great, good, not-so-good, and really bad health care providers in all walks, be it MD, NP, or PA. People should be scrutinized on an individual basis for poor outcomes, not on the basis of their degrees and initials. There is enough work for all of us, and given the declining enrollment in schools for all primary care professions (but especially medical doctors) and the increasing numbers of "boomers" in the system, the country is going to need all of us that it can get!

An emphasis on prevention and wellness promotion is a very good thing. Many candidates SAY they endorse this. My apologies in advance to all of you who are struggling with your weight, or smoking cessation, or addiction, but the system has to stop coddling these behaviors. We need an insurance system that provides people with the support, tools, educational resources, and incentives to improve their health.

We need a system that helps people to find someone to take care of them as a primary care provider and discourages use of the ER for every little sniffle and sprain. By discourage I really mean penalize for misuse and abuse. But first we need to make options for them to do otherwise readily available. In my opinion we have to stop paying for visits to the ER like I see every day, in which an individual says to me, "I have an appointment with my doctor later today/tomorrow/2 days from now, but I just couldn't wait any longer for this stubbed toe/sore neck/ankle sprain/cough I've already had for 2 weeks" (or insert your favorite simple problem here).

We need to give incentives to companies to pay for employee wellness programs and to include adequate breaks in their day for exercise. There are any number of research studies that demonstrate increased worker productivity on the job and improved overall health when they are given the opportunity for a 20-30 minute exercise break or organized stretching session during the work day. So what if companies lose an additional 1/2 hour of work time if the time that is actually spent working is more effective?

Insurers need to provide adequate incomes through reimbursement to health care providers for both sick care and "well" visits in which people are taught to control their diabetes, cholesterol, or diet, or make a quit smoking plan. Health care providers who make the effort to become certified as specialty educators, (certified diabetes educators are one example) and maintain that certification through continuing education, should not have to fight to be reimbursed for providing diabetes education to patients. When a person with diabetes learns enough strategies and effectively applies them to reduce their overall blood sugar readings to a certain degree they decrease their risk of developing heart disease by 25-35% Tell me that doesn't save money!

Finally, we need to find a way to control malpractice claims. There is a role for personal responsibility in health care, and I shouldn't have to look over my shoulder every minute worrying about whether or not an individual is going to follow my instructions and return to see me in the office or the ER if something in their condition changes.

Your vote is an opportunity to influence the country's progress for the next four years. The ability of our country's health care system to improve health outcomes and controlling costs is critical to the health of hundreds of thousands of baby boomers who are coming of age. Please consider your vote thoughtfully.

Take care,

Laurie

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The ENHANCE Study, Bad News for Vytorin, or Not?

2008-01-29T16:38:00.000-05:00

Vytorin, the drug that was purported to lower cholesterol in a unique manner, has fallen off the crest of it's wave, or has it? News out this week, highlighted in today's edition of Time magazine points to the results of the ENHANCE study as "evidence" that Vytorin doesn't work. As usual the media seems to be jumping the gun to create a controversy. Despite the current evidence-based belief that lowering LDL cholesterol has a positive effect on cardiovascular disease reduction, the media is purporting that Vytorin is a failure at disease reduction.

You are probably familiar with Vytorin's "food and family" advertisements, such as this one at U-Tube; they are really eye-catching in their colors and reflections of food in the choice of people in the ads. These advertisements are correct on at least one point; the body's different cholesterol levels are affected by both what one eats and genetics. The advertisements also state that when the Vytorin pill was compared to the cholesterol lowering ability of other statins alone that it was more effective at lowering LDL cholesterol, and their study evidence supports that statement.

Vytorin is a pill that combines the statin simvastatin (Zocor, produced by Merck Manufacturing) and ezetimibe (Zetia, produced by manufacturer Schering-Plough) into one pill. Ezetimibe's method of lowering cholesterol is to prevent the building blocks of cholesterol from being absorbed in the intestinal tract, rather than preventing their manufacture in the liver, which is how the statin drugs work. The ENHANCE study compared Vytorin alone to Zocor alone, and measured their effectiveness on plaque size in the carotid (large neck) arteries. This is where the real controversy lies for me. To my knowledge there is no evidence that plaque size alone will predict disease outcomes. There are a multitude of factors involved in disease development, including plaque make-up (the kind of cholesterol particles inside it), its stability and location, and a person's genetic factors that determine whether or not plaque becomes a problem in a given individual.

Dr. Michael Richman discusses the results of the ENHANCE study here in his blog. He's not ready to give up on Vytorin yet, because he believes that there is enough clinical evidence that lowering LDL cholesterol lowers the risk of developing cardiovascular diseases, including heart attack and stroke. I have to agree with him there; we certainly have years of evidence from Framingham alone to support this hypothesis.

Dr. Richmond sites Dr. Robert Harrington from the Duke Clinical Research Institute, who says that ENHANCE was not meant to be an "outcomes" study, meaning that the measurement of markers such as plaque size have never been proven to be equal to the risk of disease development or progression. In other words, there are other factors involved in the development of cardiovascular disease that are not measured by plaque size alone. One such example is the still-developing evidence that the one of the reasons that statins are effective is their anti-inflammatory properties. Dr. Harrington is involved in one of three large clinical outcomes studies of Vytorin currently underway, and he notes that until these results are known, we have to rest on our current knowledge that lower LDL equals lower disease rates.

Vytorin has certainly been shown to reduce LDL cholesterol, and it was on that basis, as well as its safety profile, that it was FDA approved for use in controlling cholesterol. If you are currently taking Vytorin because you could not control your LDL cholesterol level on a statin alone, and you and your health care provider are happy with your results, then I would not be in a rush to stop taking the drug.

In health,

Laurie

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Today is the first day...

2008-01-25T12:13:00.000-05:00

Ok, so in an effort to stick to the PLAN to blog more, I am starting off the week with a "short one," not an epic blog. We'll see how it goes.

Headline at Web MD today relates that researchers at the University of Connecticut* (right in my back yard) have been studying the effects of the superfood broccoli on the outcomes of oxygen deprivation to the hearts of rats. Seems they fed broccoli extract to the rats along with their regular chow; the control rats got plain water. After a month they subjected the rats to oxygen deprivation to simulate a heart attack, and the rats that had been fed the broccoli extract faired better than the controls. When compared to the controls the broccoli fed rats had better heart pumping ability, less heart muscle damage, and higher levels of heart-health chemicals (no explanation of what was measured in this summary article) during the oxygen deprivation.

It's no surprise really that the broccoli extract was heart protective. Broccoli contains two strong antioxidants, selenium and sulforaphane ; there is also evidence that these antioxidants may help fight various types of cancer. So if you needed more evidence to eat your veggies to protect your heart, this study would support those healthy choices. Hate broccoli (especially cooked, like me)? Try shredding it into your salad, like cutting cabbage for slaw. How about one of these recipes? For more general tips for finding ways to increase your intake of these nutrient-rich foods here are some great tips for "sneaking" superfoods into your diet here.

* Reported in the Journal of Agricultural and Food Chemistry.

Happy eating and disease fighting! Laurie

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Technorati Tags: diet, nutrition, healthy eating

Bloggers' Stress and Heart Attacks

2008-01-10T15:12:00.000-05:00

Good thing I went for a long, brisk, walk-jog with the dog today, part of my resolution to improve my aerobic fitness and lose another 5 pounds. It also helps me to relax, and I was incredibly stressed out today by a long list of things to do, including writing a new blog entry.

Seems I am not the only one who's stressed by the need to create fresh content in a timely manner that actually interests my readers. This week the New York Times reported on the December 28th heart attack of Giga Omni Media's Om Malik, the driving force behind the company's multiple profitable blogging sites, including gigaom, which features Malik's writing, along with others. The Times points out that it can be very stressful to stay ahead of other writers in a topic area, and to keep the content lively and interesting.

Members of Malik's team, however, also report that he had a few bad habits that probably contributed to his heart disease, including smoking cigars and cigarettes and drinking lots of coffee. Mr. Malik himself is quoted as saying, "Friends and family have purged my apartment of smokes, scotch and all my favorite fatty foods -- I am even going to be drinking decaf."

Malik has a tough road ahead of him because it sounds like he's being forced to make a lot of significant life changes under "do or die" circumstances. This forced change works really well for some people, who think "I have to do this or I'll surely hasten my death." For others however, it causes resentful defiance, that can be expressed as,"I'll show them who's in control; I'll do what I please!"

Under any circumstance it can be difficult for us to maintain good health habits even when we want to, because it's easier to fall back on old habits when the going gets tough. We eat, drink too much coffee or alcohol, or smoke because we think that these habits help us to reduce stress and they are often associated in our minds with feeling good. So at this time of the year, while our resolutions to improve our health by eating better, drinking and smoking less (or not at all) or losing weight are fresh in our minds, ask yourself, "When I am unable to keep my resolutions why is it that my plans fail?"

It's my opinion that we set ourselves up for failure because we don't properly change our thinking about the challenge we face. Let's take my favorite resolution as an example. A person will say, "I'm going on a diet." When you read the word 'diet,' what are the first words or thoughts that come to your mind? Deprivation? Starvation? Losing all the good food from your life? The memory of some past dieting failure(s)? Suppose instead you choose not to go on a "diet" but that you tell yourself, "I am going to learn new eating habits that are healthier for me." From the start I'd guess that you feel less threatened by this statement.

You are not telling yourself that you aren't going to have dessert, or chocolate, or chips (my personal favorite), but you are committing yourself to a healthier lifestyle. Who can argue that that concept is a threat to your fun? In fact, research tells us that if we associate being healthier with positive feelings we are more likely to embrace that change because we will feel better.

Next you have to set yourself up with some measurable goals that have a time frame attached to them. If you don't, you'll keep finding excuses to put the change off because you still haven't given yourself the tools to succeed. Suppose you don't know where to begin; your goal might be, "I will call within the next week to make an appointment with a dietitian." Or, if you know what you need to do, pick one small place to start, such as, "I will add a salad to 2 meals a week starting one week from now." This might be followed with "the following week I will measure my carb portions and limit them to one serving based on the label serving size."

You might want to leave the "biggie" that's in your mind, such as controlling the sweets until you have had some success with the easier steps. This helps you to build what's called "self-efficacy," which is the belief that you can accomplish something. Once you are successful with solving a problem, the research tells us that you will be more likely to build upon those past successes to find strategies that will work for your more difficult challenges.

If you have words of advice on how you were successful at changing your tough habits, please share them with all of us here. We can all use some new ideas and encouragement year round when it comes to making life-altering habit changes, and I'll even send the link to Mr. Malik to offer our encouragement.

By the way, Malik's blog often has multiple posts a day (although he has a lot of help)! I'll be happy to accomplish two a week this year. I think if I set a goal to write one less epic post a week (short and sweet as they say), then I could get it done. Now about that time line...

Take care, Laurie

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Technorati Tags: Om Malik, GigaOm, resolutions, heart health, heart attack, diet, exercise, fitness

10 Tips for Eating From Salad Bars

2008-01-03T16:01:00.000-05:00

I recently read a great article about eating from salad bars and wanted to share some tips with you. This meal choice can be very heart-healthy or it can be worse than a fast food burger and fries, depending upon your choices. Here are my suggestions, with a nod to my favorite dietitans, who helped me to tune up this article.

Choose the high in folate and vitamin C dark leafy greens instead of iceberg lettuce. Good choices are spinach, endive, mixed "baby" greens containing multicolored lettuces and romaine.

Choose vegetables from "all the colors of the rainbow," such as red radishes, peppers and tomatoes, green peppers, cucumbers and broccoli, yellow peppers, purple cabbage, orange carrots, and tan (fresh) mushrooms. Avoid veggies in marinades, dressings, sauces, or mayonnaise, which add fat, salt, and calories that you can't control. Avoid things or eat limited quantities that were probably once canned such as artichoke hearts and asparagus out of season, because they can be high in sodium. Limit quantities of olives, because they are high in sodium (about 10 medium olives equals 825 mg of salt, more than 1/3 of what the average person should consume in a day). On the flip side olives are a source of monounsaturated, heart-healthy fats and can be enjoyed in moderation if you like them.

Ditto choosing colorful fresh fruits from the bar, because they contain lots of vitamins A and C, carotinoids, fiber and potassium. Most have no fat as long as they are not bathed in a syrup (avocados are the exception, but again this is a monounsaturated fat). Just be mindful of the serving size of fruits especially if they are are canned or dried, as the calorie count will be higher, or if you have diabetes and are carb-counting.

Add beans: just 1/2 cup of chickpeas or kidney beans add about 5 grams of fiber and 7 grams of protein. This will help to fill you up and will stay with you for longer than the veggies and greens alone. Count the sodium into your day if you are limiting sodium intake as this serving size can give you about 360 mg of sodium. (If you're adding beans to a salad at home rinse then first to remove a large portion of the salt).

Choose lean meats and fish such as chicken or turkey (white meat) that looks roasted (avoid the breaded pieces), tuna without mayo, or shrimp. Watch the salt content here too, don't have both beans and tuna or cured meats (bacon, ham, or salami) on the same salad or you'll OD on sodium.

If you really want the cheese, choose a tiny sprinkling of a highly flavored cheese like parmesan, feta, or blue, otherwise you'll be adding a lot of fat calories and salt. Choose low-fat options if they are available.

Avoid dressed items like pasta salad, tuna with mayo, coleslaw, or potato salad for what I hope are obvious reasons (fat, calories and salt you can't control sound familiar)?

Limit toppings such as croutons, nuts & seeds, and fried noodles & onions. They are very tasty and I can't help wanting a little crunch, but they can contain a lot of calories and fat.

Dressing can be low or high fat, depending on your choice. Creamy dressings tend to be higher in fat and calories than vinaigrette's and Italian dressings. Creamy dressings are about 160 calories per 2 tablespoons and contain about 16 grams of fat! Compare that to a reduced calorie dressing or "light" dressing, where you get about 60 calories and 6 grams of fat per serving. If you like it, dress with lemon or vinegar and olive oil, which are often available on the salad bar. These allow you to really control the fat that you place on the salad. If you have the option of putting your dressing on the side, do so. Then you can dip a corner of you forkful of veggies into the dressing just before you put it into your mouth. You'll get an initial blast of flavor without an excessive amount of dressing on your otherwise healthy salad.

I don't know about you, but sometimes I really want bread with my salad. If you do be sure to pick a whole grain option, thereby increasing your fiber and B vitamins.

Salads are a great option for a meal, but remember that salad bars are full of items that are there to entice you to purchase them because they add weight to the salad and increase the store's profits. Those items can also put weight on the customer due to high fat and calorie consumption. Don't be tricked into purchasing lots of items that aren't good for you by following these easy steps to a healthy salad bar meal!

Bon Appetite! Laurie

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Technorati Tags: diet, nutrition, healthy eating, heart health

Happy New Year!

2007-12-31T16:18:00.000-05:00

On Christmas Eve I met a 29 year old woman who has 5 children ranging in age between 2 1/2 months and 10 years old. Whew! Makes me tired just thinking about it.

We got talking, and she told me that she had to tell her children that she is their Santa Claus. She said, "they wanted a whole lot of stuff for Christmas like game systems and electronic toys that I can't even afford. It would be one thing if they appreciated it, but if they were broken in a day, they wouldn't care." Then she got a big smile on her face, and she told me, "they are really looking forward to Christmas though, because we are going to bake cookies and make hot chocolate." Makes my eyes well up just remembering her smile and her obvious love for her children.

New Year's eve is a time of taking stock and making resolutions. This year, my goal is to love my child like that.

Happy New Year to one and all! Laurie

You Can be Fat and Fit (and Live Longer!)

2007-12-17T13:34:00.000-05:00

Men and women who are judged fit on a treadmill test but who are overweight or obese have a lower risk of death than those of appropriate weight but have low fitness levels.

In a study published in the Journal of The American Medical Association researcher and exercise physiologist Steven Blair of the University of South Carolina tracked 2,600 people over age 60 years to determine how physical fitness and body fat affected their death rates over a period of 12 years. Blair found that those in the lowest 5th of fitness levels were four times more likely to die than those in the top 5th of fitness levels. This level of fitness provided protection against death whether an individual was of normal weight, overweight, or obese.

Blair thinks his findings are important because people in the US and many other countries are increasingly inactive and obesity rates are high, and at the same time many of these countries populations are aging. "We should not ignore obesity," Blair said. "But what happens all too often is we focus nearly exclusively on obesity and forget the activity and fitness part."

Blair's team assessed participants' fitness using a treadmill test, seeing how long they could walk while the treadmill's workout increased in intensity. They measured body mass index (BMI) a figure that is calculated from a person's height and weight, as well as waist circumference and percent body fat. Their results showed that even a small effort to improve fitness levels provides a health benefit and that people who are sedentary now don't need to take drastic steps in exercise frequency or intensity to make gains. "If you're overweight or obese and you're sedentary and unfit and you start taking three 10-minute walks a day and you do that at least five days a week, you're not going to lose an enormous amount of weight," Blair said. "You're going to still be heavy. But you're going to be much healthier if you do that," Blair said. Blair also recommends healthy eating patterns, including lots of fruit, vegetables, and whole grains.

According to the Centers for Disease Control (CDC), more than 1/3 of the US adult population is obese; obesity is a major risk factor for cardiovascular disease (CVD), some types of cancer, and type 2 diabetes. The CDC has also found that more than 1/2 of adults in the US do not participate in regular physical activity. Exercise can cut your risk of dying from CVD, as well as lowering your risk of stroke, colon cancer, hypertension, and type 2 diabetes.

It's important for all of us to find ways to become more active. I think that I have suggested this before, but if you're looking for last minute holiday gifts then purchase a pedometer for someone you love who needs to be more active. Ask them to get one for you and set up a little friendly competition. In fact, I am going to make a point of dusting mine off and putting it on every day. Then I'll do my best to get in those 10,000 steps most days of the week, and every few days I'll log them in here in the blog. Who wants to see if they can walk more than me in a week? It will do us both good!

Take care, Laurie

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Technorati Tags: fitness, obesity, gifts, heart disease

4 Early Signs of Ovarian Cancer

2007-12-07T07:03:00.000-05:00

Off the "Heart" Track, But Important to Me

I've been meaning to write about ovarian cancer warning signs for some time, because too many people think that the symptoms are too vague to recognize, leading too many women to overlook symptoms that could signal this frequently deadly cancer.

Recently I came across references to a set of common symptoms that may suggest that ovarian cancer is present. These symptoms should be promptly discussed with a woman's health care provider. An expert panel, including individuals from the American Cancer Society, the Gynecologic Cancer Foundation, and the Society of Gynecologic Oncologists have published the following list of concerning symptoms:

Bloating of the abdomen (anywhere between the bottom of the ribs and the area between the hip bones {pelvis}, from side to side).
Pelvic or abdominal pain.
Trouble eating or feeling full quickly (also known as early satiety).
Urinary symptoms as might also be experienced with bladder infection, such as urinating more frequently, having to go urgently, or having pain with urination.

I actually make the point about the urinary symptoms because it highlights one of the potential problem with this list; they actually describe symptoms that could be attributed to many things, some of which are of no consequence.

Last year a patient in my primary care practice developed vaginal bleeding, even though it had been several years since her last menstrual period and we considered her to be post menopausal. She neglected to mention this bleeding for a while because a member of her family had told her that sometimes this "just happens." When she did tell me she also mentioned feeling full quickly while eating and some abdominal pain. My first thought was that she might have endometrial cancer, a cancer of the lining of the uterus, which commonly causes bleeding after menopause. Fortunately the uterine biopsy that we did was negative, but the nearly simultaneous ultrasound showed an ill-defined mass in her abdomen that prevented us from seeing her right ovary. We had accidentally found ovarian cancer together. She had surgery to remove her ovaries, uterus, and the grapefruit-sized tumor, and more than a year later she remains free of cancer.

Many women aren't so lucky. The abdomen is a fairly large open area (called a "potential space" because of its capacity) with the ability to stretch to accommodate a fairly large growth before it is noticed. This is because there are few nerve endings to pick up pain signals until a tumor is pressing against other organs that have these pain sensors. Once a tumor is this large, it will often have already spread to other organs, such as the stomach, liver and intestines.

The American Cancer Society estimates there will be 22,430 new cases of ovarian cancer in 2007 in the United States. While 93% of women diagnosed with early stage ovarian cancer will survive more than 5 years and many of them will be cured, only 19% of ovarian cancers are found at the early stage before they have spread to other organs. This results in ovarian cancer being the 5th leading cause of cancer death among women and it accounts for more deaths than any other cancer of the female reproduction system.

The important thing for women to know is that they can really help their health care providers to detect ovarian cancer at an early stage, if they are suspicious about a certain pattern of symptoms. If you develop any of the symptoms described above, pay careful attention to their persistence, especially beyond an episode of treatment. Take those urinary symptoms for example. If you see your health care provider for symptoms that might be associated with a bladder infection and it is either not that, or it seems to be but you don't get better despite the right treatment, this warrants further investigation. Now think about bloating and abdominal pain. Many women have these symptoms with their menstrual cycles, but if your period comes and goes, and by the third week you are still feeling bloated or having pain, it needs to be evaluated further. Feeling full early into eating a meal is a big trigger for me. If I hear this complaint from a woman I consider ovarian cancer at the top of my list of potential diagnoses; you should too. If you have any family history of ovarian cancer you should really be on the lookout, and question early on if you have symptoms of concern.

Because ovarian cancer symptoms can be vague or mimic so many other things, it pays to be persistent if you are concerned. If you are not taken seriously seek a second opinion, preferably with an OB-GYN surgeon who is familiar with female cancers. Let your local medical community members think you are little nuts because you keep complaining about your symptoms until someone listens. If you are wrong - so what! If you are right, the life you save will be yours.

For more information:

Ovarian Cancer Symptoms May Begin Months Before Diagnosis
Hope for Earlier Detection?

Take care,

~Laurie

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Technorati Tags: ovarian cancer, womens health

Giving Thanks

2007-11-21T20:28:00.000-05:00

The American Council on Exercise estimates that between pre-meal snacking and Thanksgiving Dinner the average American consumes 4500 calories on Thanksgiving Day. In fact, we also gain an average of 7 pounds between Thanksgiving and the day after New Year's Day. That's a lot of calories! So first off, I think that we should all be thankful that we live in a place where food is that plentiful, and offer up a prayer or hopeful thought for those who won't be eating that well tomorrow.

Since many of us will overindulge over the holidays, here are some suggestions to help you get through them without all that weight gain:

1. Eat a low calorie and low fat breakfast and lunch on the holiday to conserve some calories for the big feast. Don't skip meals however, because you'll be very hungry and then it's really hard not to over eat.

2. Put small portions of the heavy calorie things on your pre-dinner snack plate: vegetable spreads (they are usually held together with oil or mayo), cheese, and dips are some examples. Most of us eat without thinking, especially while socializing, so put a lot of lower calorie items on the plate as well, such as raw fruits and vegetables and whole-grain crackers. That way you won't consume a ton of calories but you'll still be nibbling like everyone else and won't feel out of place.

3. A snack of veggies, fruit and whole-grain items can also have a lot of fiber in it; this will help you to feel full and tends to control eating when you sit down to the full meal.

4. Go help in the kitchen or round up all the kids and take them out for a walk or to play a game outdoors instead of snacking. If you stay busy you'll snack less and it's even better if you're burning some calories before your meal.

5. When it comes time to eat the big meal, pick your very favorite things and consider not eating things that are traditional, but not all that important to you, such as rolls, or a dish like candied sweet potatoes. If you really want it, then eat it, but try to moderate your portions of these items. A small amount of something can make you feel just as satisfied, and you'll feel really good about your self-control.

6. Push away from the table and get everyone to go for a 20 minute walk after dinner. Tell them 10 minutes out from the house, and 10 minutes back, they can do it! The dishes can wait (they'll still be there) but you'll all feel great about taking a walk and it will help equalize the dessert. If there's a dog in the house take it with you though, because you don't want to come back to find the turkey carcass on the floor!

7. Make physical activity a regular habit. It will help keep your metabolism revved up and can help to lower stress levels. Who doesn't need that during the holidays?

8. Monitor your calorie intake for the week or so before and after each holiday event. If you watch your portions and intake of high calorie foods for the week around the big event, whether it's a holiday party or family meal, you'll be more likely not to gain weight over the holidays.

Best wishes for a wonderful day!
Laurie

Gratitude is born in hearts that take time to count up past mercies.
Charles E. Jefferson (1860 - 1937)