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High Blood Pressure

Physical Activity Offers Great Benefits to Those Living with a Health Condition

  • Posted May 01, 2018
  • hchadmin

Did you know that according to the American Heart Association (AHA), active people who have high blood pressure, high cholesterol, diabetes or other chronic health conditions are more likely to live healthier for a longer period of time than inactive people with the same conditions?

Actve children


The American Diabetes Association (ADA) says that physical activity can help lower your blood sugar, blood pressure and cholesterol levels. It also reduces your risk for stroke, relieves stress and anxiety and strengthens your heart, muscles and bones.

These benefits are important for everyone, but especially for those with chronic conditions like heart disease, diabetes and depression.

Because of the symptoms they experience, those who live with illness may find it challenging to get regular physical activity. The ADA and AHA offer the following tips:
•    Look for opportunities to be more active during the day. Walk the mall before shopping, take the stairs instead of the escalator or take 10–15 minute breaks for walking or some other activity while watching TV or sitting.
•    Don't get discouraged if you stop for a while. Get started again gradually and work up to your old pace.
•    Don't participate in physical activities right after meals or when it's very hot or humid.
•    It is recommended that diabetics check blood glucose before and after activity (if it’s too low, eat a piece of fruit, a few crackers or drink a glass of milk) and carry a snack to eat if you’ll be active for a few hours or more. If you have one, wear your medical alert I.D.
•    You can do this even if you've been sedentary for a long time, are overweight, have a high risk of coronary heart disease or some other chronic health condition. See your doctor for a medical evaluation before beginning a physical activity program.

In addition to getting regular physical activity, developing and maintaining a relationship with a primary care physician (PCP) who can coordinate your care is vital to your good health.

A PCP typically specializes in family medicine, internal medicine or general practice. If you don’t have a PCP, finding one is easy! Just visit your insurance carrier’s website, look for the “find a doctor” area and follow the instructions.

When you’re being treated for a health condition, it may not always be easy to decide where to go for care. For anything that is considered a life-threatening situation (like chest pain or sudden and severe pain) it’s best to go to the emergency room. For less severe matters that still require immediate attention, if you can’t get in to see your PCP, going to an urgent care facility can save you time and money.

Even if you require emergency or urgent care for your health situation, it’s always best to have a relationship with a PCP who knows your history and understands what is happening with your health over time.

As your trusted health partner for life, Holy Cross Hospital is committed to providing resources that promote well-being through body, mind and spirit and is dedicated to helping you Live Your Whole Life.


For Those Living with Heart Disease

  • Posted Feb 20, 2018
  • hchadmin

White Hearts in a circle image

Learning that you or a loved one has heart disease changes your life. However, educating yourself about this disease is the first step toward feeling better and making choices that can help you live a longer and healthier life.

According to the Centers for Disease Control and Prevention (CDC), approximately 11.5 percent of Americans have been diagnosed with heart disease. February is American Heart Month and the National Institues of Health offer the following suggestions to help navigate treatment if you or a loved one has been diagnosed:

•Making lifestyle changes. Not smoking, following a heart healthy eating plan, maintaining a healthier weight and becoming more physically active can go a long way in helping to keep your heart disease from worsening. 

•Taking medication. Medications are often used to treat high cholesterol, high blood pressure or heart disease itself. Be sure to take your medication exactly as your doctor prescribes. If you have uncomfortable side effects, let your doctor know. 

•Following doctor’s orders. Your doctor may recommend procedures to open an artery and improve blood flow. These are usually done to ease severe chest pain or to clear blockages in blood vessels.

As you know, having a primary care physician (PCP) who can coordinate your care is vital to your good health. If you don’t have a PCP, finding one is easy! Just visit your insurance carrier’s website, look for the “find a doctor” area and follow the instructions.

When you’re being treated for a disease or condition, it may not always be easy to decide where to go for care. For anything that is considered a life-threatening situation (like chest pain, major injuries or sudden and severe pain) it’s best to go to the emergency room. 

For less severe matters that still require immediate attention, if you can’t get in to see your PCP, going to an urgent care facility can save you time and money. 

As your trusted health partner for life, Holy Cross Hospital is committed to helping you Live Your Whole Life by nurturing well-being through body, mind and spirit.

 


Regular Screenings and Knowing Your Numbers Can Help Catch Heart Disease Early

  • Posted Feb 04, 2019
  • Christine Walker



According to the Centers for Disease Control and Prevention (CDC), about 610,000 people die of heart disease in the United States every year – that's one in every four deaths. That’s why, during American Heart Month, Holy Cross Hospital would like to encourage you to care for yourself and your loved ones by reminding you of the importance of regular health screenings.

Heart disease affects different populations in different ways. For example, according to the U.S. Department of Health and Human Services Office of Minority Health, both Hispanic-American adults and Asian-American adults are less likely to have heart disease than non-Hispanic White adults. African-American adults are more likely to have high blood pressure and more likely to die from heart disease than non-Hispanic whites.

For people of all ethnicities, knowing and properly managing your biometric numbers such as your weight, blood pressure and cholesterol levels, can prevent or delay heart disease and its complications.

Of special interest regarding blood pressure numbers, the American College of Cardiology (ACC) and the American Heart Association (AHA) have revised the guidelines for the detection, prevention, management and treatment of high blood pressure. The new guidelines – the first comprehensive set since 2003 – lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. Blood pressure categories in the new guidelines are:

•Normal: Less than 120/80 mm Hg

•Elevated: Systolic between 120-129 and diastolic less than 80

•Stage 1: Systolic between 130-139 or diastolic between 80-89

•Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg

•Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage

The best way to find out if your numbers are within a healthy range for your gender, height and age is to have annual health screenings. 

Additionally, having a primary care physician (PCP) who can coordinate your care is vital to your good health. 

A PCP typically specializes in family medicine, internal medicine or general practice. If you don’t have a PCP, finding one is easy. Just visit your insurance carrier’s website, look for the “find a doctor” area and follow the instructions.

If you have any changes in your health and you’ve got questions, call the nurse line offered by your medical plan. 

As your trusted health partner for life, Holy Cross Hospital is committed to helping you Live Your Whole Life by nurturing well-being through body, mind and spirit.

 
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Remember what I said about statistics?

  • Posted Dec 27, 2011
  • Alan Niederman, MD, FACC, FACP

One of the reasons that I write this blog is to point out the difference between the medical press and the lay press.  We have before us an excellent example.

Published in JAMA 2011; 306:2588-2593 is an article entitled “Association between chlorthalidone treatment of systolic hypertension and long-term survival."  This study is a 20-year follow-up of one of the original studies that represents the basis of our current understanding of blood pressure control and treatment, which is that you need to treat blood pressure because it prolongs life.  But does it?  This article is an answer to that question.

The original study enrolled  4,736 elderly patients with a mean age of 72 years old, between 1985 and 1988.  The treatment was with atenolol, a beta blocker, and chlorthalidone, a diuretic.  The placebo group got nothing, but there was a crossover if the placebo group participants pressure went too high.  This study would be unethical today since most physicians are convinced that this condition needs to be treated.  At the study endpoint, there was an important difference in the incidence of stroke and major cardiovascular events.

I have blogged before that the ACCORD study showed that strict control of both diabetes and hypertension independently do not provide better care in diabetic patients.  We now have an understanding of what happens to a large group of patients who were treated for hypertension that was primarily systolic.

Hypertension comes in three flavors.  You can have an isolated increase in the top or systolic number, an isolated increase in the bottom or diastolic number or an increase in both the systolic and diastolic numbers.  The last type is perhaps the most important.  Systolic hypertension tends to occur in women, and we at this point, 20 years later are no better in treating or diagnosing it.

We now understand that the systolic number maybe an artifact in this patient population which tends to be petite women.  This is because the blood pressure measurement becomes difficult when the brachial artery becomes non compressible by the blood pressure cuff because of calcification.  In English, if we simultaneously stick a needle in the artery and measure the pressure and at the same time measure it with a blood pressure cuff, the two numbers would be quite different.  The patient may not really have a high systolic blood pressure number.

This discrepancy between the actual and perceived values of blood pressure leads to over treatment in this group, and the symptoms of dizziness and fatigue as the actual blood pressure may be quite low on treatment.

What did this published article show? It was heralded as “blood pressure treatment prevents death." What the article actually showed is that we all die of something.  If it’s not a cardiovascular problem, it’s something else.  The treatment group had a death rate of 59.9% and the control group had a death rate of 60.5%.  The actual numbers were a gain of 105 days for the treatment group for all cause mortality and 158 days for cardiovascular mortality.  Each month of treatment resulted in one extra day in life expectancy.

It should be pointed out that after the study, all patients were treated in an ongoing manner.  The effect here is from just the time that the treatment difference occurred.  The five years that one group was treated and one not.

As Artie Johnson would say, “Very interesting."  The take-home message is that treatment of this condition does seem to matter when it comes to strokes and cardiovascular events, but in the long run, pick your poison.

For whom the bell tolls, it tolls for us.


The Scorecard

  • Posted Dec 22, 2011
  • Alan Niederman, MD, FACC, FACP

Every year the American Heart Association publishes statistics about the state of America’s cardiovascular health.  I could sum it up in one word, but my Webmaster won’t like it.  I should, however, at this juncture quote Mark Twain who said, “There are three lies: lies, damn lies and statistics.”

By nature of this kind of enterprise, the data is not current, but is the most recent available.  The year being reported is 2008.  Although not quite what we want, this data takes a long time to correlate and at least serves as a measure of how we are doing compared to the previous time frame.

The first point is that compared to the time frame 1971-2004, men now eat 10% more calories, and women eat 22% more.  The relevance of this will be pointed out below.

Stroke death rate fell 34.8% and now ranks as the fourth leading cause of death.

The AHA put together what they consider to be “ideal cardiovascular health” factors.  These include:

  • Smoking status
  • Weight
  • Physical activity
  • Healthy diet
  • Cholesterol
  • Blood pressure
  • Fasting glucose levels
  • Absence of heart or blood vessel disease

The data shows that 94% of us have one factor, and 38% of us have three of the seven factors.  50% of children meet four or fewer of the criteria.  How do you stack up?

21% of men and 17.5% of women still smoke.  15% of our population has a cholesterol over 240 mg/dl, but I think that this piece of information is not terribly useful.

37% of americans have abnormal fasting glucose levels, and 8% have diabetes.

33% of americans have hypertension.

67% of adults in the United States are overweight or obese, along with 31.7% of our children.  As discussed in my recent blog, The Tyranny of a Number, this is the true use of the BMI number.  It tells us what the characteristics of a large population are.  The prevalence of childhood obesity has risen from 4% to 20%.

In spite of all this, the death rate for cardiovascular disease fell 30.6% from 1998-2008.  That being said, cardiovascular disease accounts for one in every three deaths.  One person dies every 39 seconds.  1/3 of the deaths are in people less than 75 years old.  The death rate was 244.8 per 100,000.

The cost of the care for cardiovascular disease increased $11 billion from 2007-2008.  Total direct and indirect cost for 2008 is almost $300 billion dollars.  To put that in prospective, we spent $100 billion dollars a year to fight the war in Iraq.

Obviously we have work to do.  We all seem to be involved as only 6% of us are “perfect."  Perhaps the most important thing we need to do is not eat so much, followed closely by getting some exercise.  Seriously, we just can’t afford this.

Widespread smoking cessation classes, cheap medication for hypertension, cholesterol management (generic Lipitor) and diabetes and perhaps the “Unipill,” which would be one pill which combines all of your daily medication, would help.  Increasing access to doctors and paraprofessionals would help.  There is no shortage of ideas, just a shortage of will.

We can, as a society, pay now or pay more later.  No amount of decreasing doctor reimbursement will offset $300 billion a year.  We have to fundamentally change our system.

Happy holiday to all my readers.  Don’t have that extra dessert.


The tyranny of a number (Part I)

  • Posted Nov 08, 2011
  • Alan Niederman, MD, FACC, FACP

In my last set of blogs, I spoke about how our bodies seek revenge on us for trying to lose weight.  Lately, I have become interested in how we as physicians decide who is “fat” and who isn’t.

I became interested in the divisions of people into weight categories by the use of the BMI test.  The more I applied the test, the more I realized how the data looked so peculiar.  I decided to look into how this test came to be and how it has achieved such notoriety.  Inquiring minds want to know, and I for one am very surprised by what I found out.

First, let’s start with the problem.  Spend some time with me or any healthcare member these days, and you will see a constant stream of individuals who are clearly overweight.  It is not difficult to tell.  The problem is how do you quantify it, and does that quantification mean anything to the predictive value of their overall health.  As medicine is based on science (at times quasi-science), it is based on numbers.  You must be able to measure something to determine if you can change it and make it better or notice it is getting worse.

Blood pressure, heart rate, cholesterol, ejection fraction of your heart function are all numbers that signify that you are OK or in need of help.  Without numbers, we physicians are lost.  The generic “how are you feeling” doesn’t count.  I have to numerically “prove” you are OK.  That being said, someone decided that I needed a way to numerically determine that you are fat or obese.  If you are fat or obese you must be “not OK."

The number needed can be derived in many ways.  It, however, needs to be simple, fast and cost no money or time.  That is quite an order.  Weight doesn’t do it because 2 patients can weigh 200 pounds, but one can be underweight, while the other is morbidly obese.  The number has to be derived in some form.  The number we use most often at this point is known as the BMI or Body Mass Index.

This number is derived by taking your weight and dividing it by your height in inches squared, then multiplying by 703.  Are you still with me?  This yields a number which is then applied to the chart.  If the number is below 18.5 you are underweight.  18.5-24.9 you are ideal, 25.0-29.9 you are overweight and 30-39.9 you are obese.  Greater then 40, don’t go there.  Well, it must be scientific.  It has decimal points and everything.

Now what if I told you that Arnold Schwarzenegger, when he was Mr. Universe 7 times, was 72 inches and weighed 235 pounds, which made him obese.  Oh, Oh, we have a problem, Houston.

This must be scientific right?  Well, when I researched this, it is amazing what we get ourselves into as you will see in the next blog.


My body made me do it. Or how I learned to hate (Ghrelin Part II)

  • Posted Nov 03, 2011
  • Alan Niederman, MD, FACC, FACP

It’s that time of year again.  Over the holiday period, most people put on some weight.  Too many trays of cookies and pies and too many meals.  It’s just one of the challenges of the season.

The study that I cited in my last blog was done in Australia, and although small, points out some very interesting observations.  Like all good studies, it will serve as a starting point to perhaps begin to conquer our war on fat.

Remember this isn’t about fitting into your pants.  This is a huge problem for the United States and all developing countries.  Diabetes and obesity are condemning us to years of higher healthcare costs and significant morbidity and mortality in our affected population.

These researchers enrolled 50 obese patients without diabetes in a year long study.  They were given a 500 - 550 calorie diet for 8 weeks (YUM).  They used the substance Optifast and 2 cups of low starch vegetables for the three meals.  After weeks 9 - 10 those patients that lost 10% of their body weight were reintroduced to ordinary food, and at week 10, the Optifast was stopped.

After week 10 the participants received individual advice and counseling from dietitians with the aim of maintaining the weight loss.  They were also advised to exercise 30 minutes a day.  They were seen every two months and contacted often.  Remember, these are motivated individuals.

Mean weight lose at the end of 10 weeks was 29.7 lb. +/- 1.1 lb..  This was 14.0% of their initial weight.  Only 34 participants completed the one year study.  At the beginning of the study, the baseline weight was 208 lb., and at the end it was 212 lb.    Yes, at one year they had managed to get fatter.

Why does this happen?  Can it be stopped?  Is it possible to lose weight, or are we doomed?  It seems that our hormones doom us to gain the weight back.  They force us to eat by increasing our appetite.  Ghrelin actually stimulates the appetite so you will eat and produce more fat.  Leptin which is an adipocyte (fat) hormone drops as does the production of fat stores, and this drop also stimulates hunger to produce more fat, which raises the Leptin levels.  Furthermore, this perturbation of our hormonal system lasts for a year or longer.

This brings up the concept of body weight “set point.” Somehow, the body decides it “needs” to be fat and enlists an army of agents to keep and maintain this set point even if it is killing us.

These findings will point us in directions to push back on this.  If we can find a way to block these hormones maybe they will suppress appetite effectively.  How do we change the set point?  Can we envision a time when you can chose your weight, and it will be dialed in?

I for one chose to fight on.  If you hold to a diet that you incorporate into your lifestyle and exercise continuously, your body must at some point re-adapt to a different set point, veal parmigiana be dammed.

One can only hope...and try.


Dynamite Money: A not so funny thing happened on the way to the Nobel Prize for Medicine Part I

  • Posted Oct 13, 2011
  • Alan Niederman, MD, FACC, FACP

nobel

Photo from www.scientificamerican.com
 

In 1867, a Swedish chemist named Alfred Nobel invented Dynamite.  Dynamite was the first manageable explosive stronger than gunpowder.  When he died in 1896, he had 355 inventions and was worth $186 million dollars.

Four years before his death he read an obituary that claimed to be his.  Actually, his brother had died.  The obituary was titled “The merchant of death."  Whether this was the reason or not, he changed his will, and on his death, 94% of his assets went to establish a series of prizes for those that confer the “greatest benefit on mankind."  These prizes in physics, chemistry, peace, medicine or physiology, and literature were first awarded in 1901.

In 2007, Nobel Foundation was estimated to be worth $560 million.  Today, each prize is worth $1.5 million dollars.  You also get a diploma and a gold medal.  It is estimated that the value of the prize can also be leveraged by the recognition into far greater sums.  Up to three people can share a prize, and the prize cannot be given to someone who is dead.

When the Nobel Prize awards were begun, it was common to award prizes quickly after discoveries or events.  However, it soon became clear that, often, anything worth something was usually understood only after some time.  This still leads to egregious errors, such as never awarding the peace prize to Mahatma Gandhi because he had been assassinated before they got around to it.

One further example is the discovery of the structure of DNA.  In the early 1950’s, the structure of DNA fascinated scientists on many continents.  The understanding of DNA’s structure is rightly one of the most important milestones in medical history.  As published in Nature on April 25, 1953, Francis Crick and James Watson described the structure correctly.

The 1962 prize in Medicine went to Maurice Wilkins, Watson and Crick.  The prize at that point could not go to the person who had the AH HA moment because she was dead.  That person, Rosalind Franklin, had produced a “picture” of the double helix known as photograph 51.  She worked in Wilkins X Ray diffraction lab.  The story goes that Wilkins had secretly shown the picture to Watson and Crick, thus validating their thought process.

Dr. Franklin died in 1958 of Ovarian Cancer. She was 37.  In 2008, the nomination archives were opened, and she had not even been nominated.   The Chicago Medical School is now known as the Rosalind Franklin University of Medicine and Science.

This year's prize in Medicine went to three: two MDs and one Phd.  Drs. Bruce Beutler and Jules Hoffman split half the prize for their work on the activation on innate immunity, and Dr. Steinman won the other half for his discovery of the dendritic cell and its role in adaptive immunity.

Congratulatory calls went out.  But what happens if one doesn’t answer?


Five years and one million heart attacks and strokes Part II

  • Posted Sep 27, 2011
  • Alan Niederman, MD, FACC, FACP

In my last blog I documented the problem and some of the proposed fixes in a planned attempt to lower the stroke and heart attack rate.  Some good news is that there is finally a realization that often patients don’t get or take medications in the way we want them to because they simply don’t have the money to buy them.  One of the goals of this plan is to reduce or eliminate co-pays or deductibles for these medications.  Indeed one of the provisions of the Affordable Care Act, if it survives, is the elimination of the “doughnut hole."  The “doughnut hole” was another attempt by the Bush administration to get something without paying for it.  Everything has to be paid for at one point.  We as a nation should be able to decide what is important and figure out how to pay for it.  We went to the moon.  We have no excuse.

Medicare is planning to waive patient co-pays for blood pressure and cholesterol screening.  Smoking cessation work will also be waived.  In addition there is a new annual wellness visit in which these issues will be prominently featured.

Now let’s touch on the fun parts.  They, and you, know who “they” are are going to go after, our beloved french fries.  This has already happened to a great extent.  It is now almost impossible to smoke unless it is in your car and probably a sensor is being developed so that if you are smoking in your car the motor will turn off.  First it's texting, then it's talking and now smoking.  Soon cars will only be used to get from place to place.

Trans fats have already gotten the axe and have been virtually removed from food.  Salt is next up.  Soon, no salt will be allowed anywhere.  Reducing salt is definitely good for your blood pressure and certainly helps with fluid retention, and I am a big fan of avoiding pickles.

Part of this is of course missing the point.  It doesn’t matter if the french fries or potato chips don’t have trans fat.  You shouldn’t be eating them anyway.  And, if you are, you might as well have something that tastes good.  Is the government really supposed to be our mother?  Is effective health policy really run from McDonalds?  The figures quoted to date are that the reduction of trans fats in food is estimated to reduced 50,000 deaths per year, but I am not familiar with how that number is derived.  Perhaps we just eat smarter.

Don’t get me wrong.  I am enthusiastic that finally the problem maybe getting the attention it needs.  I write about these issues every week.  Many of our problems are self inflicted.  I, like most everyone else, eat too much, exercises too little and don't get enough sleep.

No matter how much government does, we ourselves need to take control of our own destiny.  We have to control what we eat, we have to monitor our own blood pressure and take responsibility for our own health.  It’s your problem.  Own it.  If your doctor won’t help, you find another; there are enough to go around.


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