Archive for September, 2017
By American Heart Association News
Sammy Rabin doesn’t like to brag but, until he learned he needed triple bypass surgery, he’d considered himself “the poster child for good health.”
He’d been exercising regularly for 30 years, ate a vegetarian diet and ran marathons.
“I did everything I could to stay healthy,” said Rabin, 65, the director of operations for a travel company in Fairfield, New Jersey. “I had to, because I had genetics working against me.”
Rabin’s father, Jack, died of a heart attack when he was 68. His brother, Arthur, died from one when he was only 46.
But Rabin had always felt fit and strong and so he wasn’t concerned when he felt a mild pain in his chest in 2013 while training for the Philadelphia Marathon.
“I thought I’d pulled a muscle, even when it hurt for three days straight,” he said.
But on the fourth day, when the pain started radiating down his arm, he realized it wasn’t something to toy with.
He called his cardiologist to describe his symptoms and, before he’d even finished, the doctor stopped him mid-sentence and said he wanted Rabin in his office the very next morning.
A stress test, heart scan and angiogram revealed serious blockages in three of Rabin’s coronary arteries. The doctor said the situation was so serious, he wanted to do bypass surgery that night.
But Rabin put the brakes on that notion.
“I wanted some other opinions,” he said.
He talked to five other cardiologists, and four of them recommended surgery.
The fifth? He suggested stents, but with the caveat that, if Rabin went that route, he’d never be able to run like he had before.
“I decided to have the surgery,” he said.
Giovanni Campanile, M.D., Rabin’s cardiologist, said it’s rare for someone like him to have such severe coronary blockages.
“I told Sammy that if he didn’t live the kind of healthy lifestyle he did, he might have had a heart attack 10 years earlier,” said Campanile, director of Ornish Intensive Cardiac Rehabilitation at Morristown Medical Center in New Jersey.
The bypass surgery went well and Rabin was soon walking the hospital corridors. Released after only five days, he was jogging slowly within three and a half weeks.
But the recovery wasn’t without its bumps. Several weeks after surgery he had a bout of pericarditis, an inflammation of the fluid-filled sac called the pericardium that surrounds the heart. An anti-inflammatory cleared up the condition and he hasn’t had a relapse.
According to Campanile, at least once a year and for the foreseeable future, Rabin will undergo testing to measure blood flow through his coronary arteries. And, if he continues living his healthy lifestyle, his long-term prognosis is excellent.
Still, Campanile cautioned, when it comes to heart health, Rabin’s story highlights the importance of looking beyond the numbers, such as cholesterol and blood pressure, and taking your family history into account.
“Because both his father and brother died of heart attacks, Sammy knew to see a doctor when he was having those chest pains,” said Campanile. “That probably saved his life.”
Two years to the day following his surgery, Rabin ran the 2015 New York City Marathon. While his time of 5 hours, 10 minutes, 6 seconds was his slowest ever and well off his personal best of 3:36:43, he no longer keeps his eye on the clock.
He has bigger things on his mind.
“That marathon was the most meaningful and rewarding one ever for me,” he said. “After crossing the finish line, I had tears mixing in with my sweat. I felt blessed to be running at all.”
By American Heart Association News
Self-care is more important to your overall health than pretty much anything else, and the term is catching fire. But what does it really mean?
A new scientific statement issued Thursday by the American Heart Association outlines the importance of self-care in the prevention and management of heart disease and stroke. After all, self-care contributes 40 percent to a patient’s health, followed by social circumstances and environment accounting for 20 percent, and inadequate medical care accounting for only about 10 percent, according to the report published in the Journal of the American Heart Association.
This reality highlights the critical need for healthcare providers to tell patients how to take care of themselves and for patients to follow through on tending to their own well-being.
What is self-care?
Self-care is the process heart disease and stroke patients adopt to maintain, monitor and manage their medical conditions. Self-care is also vital for preventing cardiovascular diseases.
It encompasses the basics of having a healthy lifestyle, but also includes more practical things such as adhering to a drug regimen and paying attention to new or worsening symptoms.
Where did the idea of self-care originate?
The concept is as old as time. Before the advent of modern medicine, people only had themselves and their communities to alleviate sickness.
However, during the 1960s and 1970s social changes spurred people to take a more active role in their health, said Barbara Riegel, Ph.D., R.N., a professor of nursing at the University of Pennsylvania. Self-care has become a more integral treatment component as evidence of its effectiveness has mounted.
“There is really strong outcomes data on the effects of self-care, but I don’t think we put as much energy into it as we should,” said Riegel, lead author of the new statement.
Why is it especially important now?
The world’s population is getting older and heavier, and age and weight are major risks for chronic conditions, particularly heart disease and stroke.
By 2050, the global population of those 60 and older will more than double, from 841 million in 2013 to more than 2 billion in 2050, according to a United Nations report. Meanwhile, a recent New England Journal of Medicine study found that 17 percent of the world’s population — nearly 108 million children and 604 million adults — is obese.
The sicker population will further burden the health care system, increasing the need for cost-effective treatments. It’s much less expensive for patients to adopt an exercise program than to wind up in the hospital having a heart attack — and better for them too.
How do self-care and medical care intersect?
They are complementary.
Patients still need to visit their health care providers to ensure their conditions are properly diagnosed and monitored. Doctors or other medical professionals will develop a treatment plan that likely combines elements of traditional medicine such as prescription drugs with self-care measures.
What are the obstacles to self-care?
Not all doctors take time to discuss the importance of self-care and particular strategies with their patients, said Gina Lundberg, M.D., clinical director of the Emory Women’s Heart Center in Atlanta.
She said that sometimes patients won’t heed doctors’ advice even after being presented with the bleak scenarios that are likely to stem from the failure to take medication or follow recommendations to make lifestyle changes such as losing weight.
“Lifestyle is so important that noncompliance here may cause the greatest harm,” said Lundberg.
Another problem is that conditions like high blood pressure or high cholesterol don’t have physical manifestations, making it easier for patients to justify ignoring advice.
And adopting healthy changes like eating a more balanced diet doesn’t immediately show results. It’s easy to get frustrated and resort to old eating habits when the scale doesn’t budge after weeks of forgoing ice cream.
Modifying behavior can be a tougher road if patients lack family and community support. Riegel recalled an instance when a family’s primary cook balked at adapting recipes or preparing special meals to accommodate the patient.
“You want family participation and positive reinforcement,” said Riegel.
There are also environmental barriers to improving health that are beyond the control of patients, their families and doctors. Some neighborhoods lack safe places to exercise or stores that sell healthy, affordable food. Restaurant portions can be enormous.
“Health is a shared responsibility,” said Riegel. “Communities need to put in sidewalks. The media needs to get the word out about health. No one can do this alone.”
By American Heart Association News
When the crushing headache and other sudden problems first hit Brooke Bergfeld, she assumed they were childbirth-related. The pain came on just a week after her new son was born, after all.
Fortunately for Bergfeld, her mother knew better. She quickly called 911 after recognizing the headache, weakened left arm, slurred speech and drooping face as signs of a stroke.
Bergfeld, 29, is among the slowly growing group of younger people to suffer from the disease. The trend is surprising to some because stroke – the world’s second-leading cause of death and a leading cause of adult disability – has long been considered a health problem of the elderly.
“I would have never thought it would be something that happened to me in my 20s,” said Bergfeld, who lives in Bismark, North Dakota, and has fully recovered aside from anxiety about the possibility of another stroke. “Don’t wait until tomorrow to go in if you don’t feel right today; it could happen to anybody.”
Stroke experts have long known the disease can strike people of any age, and research in recent years has graphically illustrated it.
A 2016 study of New Jersey hospitalizations published in the Journal of the American Heart Association found that strokes more than doubled in people ages 35 to 39 between 1995 and 2014 and rose in groups up to age 55. A 2017 study in the journal JAMA Neurology also showed increases in people ages 35 to 44 from 2003 to 2012. There was a 42 percent increase in men and 30 percent increase in women, according to the analysis of stroke hospitalization records.
Mary G. George, M.D., lead author of the JAMA Neurology study and senior medical officer and deputy associate director for science with the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention, said experts don’t understand why the increase is happening. The uptick is “really concerning” because up to 80 percent of strokes are preventable, she said.
The study did offer some possible clues. From 2004-2012, there was an increase in the number of people between 18 and 64 who were at high risk in three or more of five common stroke risk factors: high blood pressure, obesity, diabetes, high cholesterol and tobacco.
Carolyn Brockington, M.D., director of the Stroke Center at Mount Sinai, St. Luke’s & Mount Sinai West Hospital in New York City, notes hormones may lead to abnormal blood clotting in some women during pregnancy, after delivery, or in those taking hormone supplements, thus raising some women’s risk of stroke.
Still, a lot is not known when it comes to young people because much previous research concentrated on older people, said Ralph L. Sacco, M.D., professor and Olemberg Chair of Neurology at the Miller School of Medicine at the University of Miami in Florida.
“More focused research on the causes of this alarming rise in the rates of stroke in younger ages is greatly needed,” said Sacco, president of the American Academy of Neurology and a past president of the American Heart Association.
Better medical therapies and improving risk factors will be necessary to reduce stroke for people of all ages, Sacco said.
James Burke, M.D., and Lesli Skolarus, M.D., suggested better brain scans using magnetic resonance imaging could partly explain the increase in young people in an editorial to the JAMA Neurology study. However, a 2015 study found the improvements were just as likely to rule out a stroke as to diagnose it.
More younger people may be getting diagnosed because some transient ischemic attacks, formerly known as “mini-strokes,” have been formally classified as actual strokes, Burke and Skolarus wrote. Transient ischemic attacks, also known as TIAs, are temporary blockages of blood flow to the brain. Before 2009, symptoms that went away within 24 hours were classified as TIAs. Since then, lasting brain damage even from fleeting symptoms is considered a stroke.
Sacco, however, does not believe that to be a factor. TIAs often go unrecognized, and not everyone who has one is hospitalized, he said. If classification was an issue, “it would likely be observed across all age groups and even more so for older patients,” Sacco said.
Birth defects such as holes in the heart or injuries that cause blood vessels to narrow also could lead to stroke among younger people, Brockington said.
Chicago resident Brady Johnson is a prime example.
The marathoner and Air National Guardsman was born with arterial venous malformation, a blood vessel defect also known as AVM, a tangled web of malfunctioning blood vessels in the brain.
Twelve years ago, when he was 31, he started having severe headaches. He attributed them to the stress of a new job and relocating to a new city, but after a brain scan doctors recommended immediate surgery. The next day had a stroke on the operating table as the AVM bled into his brain, he said.
“I did not think that it struck somebody who ran and was in shape,” said Johnson, who was told at a rehabilitation center that he would never speak clearly, read, drive or have children. “I couldn’t understand how this stroke was going to rock the rest of my life like this.”
Approaching rehabilitation like basic training, he sang to improve his speech, trained his right side to mirror his left side and re-learned to walk.
Johnson eventually got married and retired, and he’s now stay-at-home dad to his sons, ages 11 and 6. He still struggles to use the right side of his body.
Ignoring his headaches for months probably contributed to his stroke, Johnson said.
“Please find a family doctor no matter where you move to, no matter where you’re at in your life because a family doctor can help save your life,” he said.
By American Heart Association News
In South Dallas, the heart health statistics are grim. More residents die from heart disease and diabetes than elsewhere in the city, and being hospitalized for high blood pressure is much more common.
The Bonton neighborhood of South Dallas is among the poorest, with an annual per capita income of between $13,000 and $17,000. Its residents are mostly African-American and are among the 19 million Americans who live in a food desert—meaning they live at least 1 mile from a grocery store that sells fresh fruits and vegetables. The nearest grocery store in Bonton is more than 3 miles away.
Five years ago, resident Daron Babcock planted a vegetable and herb garden in a lot next to his house to give the community fresh produce options. In 2014, Babcock and other residents broke ground on a city-owned lot to start Bonton Farms.
The 52-year-old executive director said the farm’s purpose goes beyond making healthy food accessible—it’s also about making it affordable. Bonton residents pay less for the heirloom tomatoes, sweet onions, okra and other produce than customers from other parts of the city.
“Food security is the bigger issue and it’s the thing we should be talking about,” said Babcock, who recently learned the city approved the farm’s final plans to build a brick-and-mortar grocery store and café on a lot next to the farm.
“In communities like Bonton, even if you had a grocery store, the things people can afford are the processed foods. It’s a much more complex issue than just access. It has to be access to affordable nutritious food,” he said.
It is a view backed up by research.
A study published last week in Circulation: Cardiovascular Quality and Outcomes found that income is a much stronger predictor of cardiovascular disease risk than proximity to a grocery store.
Cardiologist Arshed A. Quyyumi, M.D., co-director of the Emory Clinical Cardiovascular Research Institute at Emory University in Atlanta, led the study and said the findings suggest that “giving people [access to] food is not going to be the answer necessarily. This is a much deeper problem which has much more to do with understanding and education, affordability and so on.”
There has been a push by federal and local governments in recent years to bring grocery stores that carry healthy foods to communities where they are scant. Programs in Louisiana and Minnesota, for example, hope to entice grocers to sell produce in low-income and rural areas.
[Healthy food movement gaining steam with food trust funding]
In Louisiana, a state with high rates of diabetes, high blood pressure and obesity, the New Orleans-based nonprofit Market Umbrella is working with the state government to bring local fruits and vegetables to rural areas.
Executive director Kathryn Parker said those efforts are a win-win for farmers and Louisiana residents.
“We can do a lot to have more fruit and vegetable production in our state to feed our people,” said Parker.
In addition, grocers may help the economies of areas where local produce is hard to come by because they generate jobs, Parker said.
As studies on food security and health ramped up during the past two decades, researchers found adults in households that can’t regularly buy nutritious foods are more likely to develop heart disease or have a stroke, according to a recent report on food insecurity from the U.S. Department of Agriculture. Those facing food insecurity are also more likely to have high blood pressure and diabetes, both risk factors for cardiovascular disease.
Such news has serious long-term health implications for the 16 million American homes considered “food insecure,” meaning they can’t regularly buy nutritious foods.
The USDA’s Alisha Coleman-Jensen, Ph.D., a food security expert who co-authored the report, said “food deserts may be a factor in food insecurity, but they’re not one of the most important factors affecting whether a household is food insecure or not.”
Bonton Farms sales and marketing director Patrick Wright grew up in the South Dallas neighborhood, which along with the surrounding area has a population of roughly 3,100. He has relatives and neighbors, whose families have lived there for generations, with diabetes and high blood pressure.
The 49-year-old father said working at the farm has helped him and other residents improve their eating habits. His meals of baked chicken, squash, tomatoes and other produce from the farm have come a long way from the fried foods, sodas and sugary buns he used to eat.
“We are living beings and we need live food,” said Wright. He said the farm plans to offer cooking classes at the market for residents.
“We got the fresh healthy food, it’s here,” said Wright, who helped clear the land for crops. “But that’s not good enough, just to provide it. We also have to educate people on it.”
By American Heart Association News
Sandra Ortiz’s father suffered from high blood pressure and Type 2 diabetes and when he died she witnessed the devastating toll. She wanted desperately to avoid the same fate.
With a strong family history of high blood pressure, Ortiz knew she was at a higher risk of developing health issues. She’d experienced hypertension and gestational diabetes during her fourth pregnancy in 2011, but after delivery her tests returned to normal.
Then in February 2016 a visit to a clinic for an injury showed she had elevated blood pressure. Ortiz planned to follow up with her doctor during her annual check up the following month, but felt so ill that she went to the emergency room a few weeks later. Her blood pressure was 175/100 mmHg.
“It was very scary for me,” she said. “All I could think about was stroke and heart attack.”
One-in-three Americans have high blood pressure, and among those who have been diagnosed, 45.6 percent do not have it under control.
Understanding family history is important to honing in on the cause of high blood pressure, whether it is genetic, poor eating habits or lack of exercise repeating itself across generations, said Eduardo Sanchez, M.D., chief medical officer for prevention and chief of the Center for Health Metrics and Evaluation for the American Heart Association.
“Even if you have a family history of high blood pressure, that doesn’t mean you can’t take actions to avoid some of the experiences your family members have had,” he said. “Don’t accept the fact that you are going to have high blood pressure. Do something about it. Change your lifestyle and take medication if you need it.”
Ortiz’s family is confronted with blood pressure issues every day. Her father suffered from it and her sister has high blood pressure and Type 2 diabetes. Her mother did have high blood pressure, but has gotten it under control through diet and exercise.
Part of the challenge of recognizing high blood pressure is that there are often no symptoms, making regular check-ups that include blood pressure readings an important way to track changes.
For those with high blood pressure, checking it regularly is important for identifying any changes, Sanchez said.
“It gets you into a routine and reminds you of the other things you need to do, like eating a low-salt diet, getting exercise and taking any needed medication,” he said.
Ortiz struggled with the idea of taking medication to control her blood pressure.
“I was totally against it,” she said.
The San Jose, California, resident found support and motivation through Go Red Get Fit, a Facebook group-based, social media campaign by the AHA designed to help women from diverse communities make health changes that become lifelong habits.
“Seeing women from all walks of life who have gone through heart surgery or had triple bypass, I realized it could have been me,” she said.
A recent study showed positive impact from web-based lifestyle counseling, which includes video clips featuring characters discussing their high blood pressure diagnosis and efforts to make lifestyle changes, as well as tools for tracking diet and level of physical activity.
Study participants who used the counseling reduced their systolic blood pressure by 10 mmHG – an effect similar to adding an additional blood pressure-lowering medication.
Ortiz, now 43, worked with her doctor to lower her numbers.
“I went home and immediately started walking,” she said.
She also eliminated the fast food that had become a mainstay in her busy life of juggling four children and full-time work. She cut her sodium intake and she began spending Sundays prepping meals for the next week to assure healthy food would be on the menu.
“I went from not eating anything green to making smoothies with kale in them,” she said.
After three months, she’d dropped 30 pounds and felt full of energy.
“I wasn’t sluggish anymore,” Ortiz said. “I felt the best I ever had in my life.”
Mary Ann Bauman, M.D., an internal medicine doctor and national board member with the AHA, said limiting sodium and making lifestyle changes is crucial for controlling high blood pressure.
“Little changes can make big differences. Even losing a few pounds can help bring your blood pressure down.” she said. “If you bring your top number (systolic) down by 10 points you can decrease your risk for cardiovascular disease and stroke by 30 to 50 percent.”
Ortiz’s blood pressure stabilized initially with her healthy changes, but it crept up again — driven by genetics.
“I felt defeated,” she said. “I had done all this work and I still had to take medication,”
Ortiz said part of her resistance to the medication stemmed from fear of side effects, but she found that maintaining a healthy diet and regular exercise has mostly negated them.
The changes Ortiz made also had an impact on her 18-year-old daughter Yesenia, who lost 25 pounds by joining her mom at the gym and making similar changes to her eating habits. The entire family is eating more fruits and vegetables, though, sometimes that means sneaking them into smoothies, Ortiz said.
“It’s still hard to get them to follow what I have changed personally, but the shopping list is definitely not the same,” she said.
Four new research projects focused on children’s heart health were announced Thursday by the American Heart Association (AHA).
Experts say that helping children maintain ideal cardiovascular health is more effective than taking a wait-and-see approach and treating disease in adulthood. The aim of the AHA’s Strategically Focused Research Network for children is to help reach that goal through studies looking at childhood obesity, maintaining ideal heart health, congenital heart disease and rheumatic heart disease.
The network will dole out a total of nearly $15 million to four institutions, with each center receiving $3.7 million over four years, starting July 1. They are:
Developing evidence-based strategies to strengthen the health system’s response to rheumatic heart disease to improve diagnosis and prevention globally. In many countries, rheumatic heart disease is the most common acquired heart disease in children and young adults and affects an estimated 33 million people worldwide as of 2013. The research is led by Craig Sable, M.D., at the Children’s National Health System in Washington, D.C.
Aiming to prevent or predict congenital heart disease and improve decision-making between parents and physicians. The team will use machine-learning data mining algorithms to approach congenital heart disease as a family disease to look at causes, as well as the impact of maternal-fetal environment on health. The research is led by Martin Tristani-Firouzi, M.D., at the University of Utah.
Hoping to bridge the gap in heart-health knowledge between birth and early adulthood. Although almost everyone is born with ideal cardiovascular health, more than 90 percent lose it by age 50, said Bradley Marino, M.D., of Northwestern University, who will lead the research. The project will provide evidence for innovative practices to preserve heart health in children, stimulating new approaches to research.
Tackling childhood obesity by understanding its genetic influences and developing effective interventions for the one-third of U.S. children and adolescents who are overweight or obese. The research team led by Jennifer Li, M.D., at the Duke Center for Pediatric Obesity Research wants to know if gut bacteria affects a young person’s chances of becoming obese and how obese children respond to weight loss therapy. They’ll also look at how to best engage families to treat obese children and which obesity treatments are most effective.
The children’s research network is one of several networks funded by the AHA. Other Strategically Focused Research Networks study prevention, hypertension, disparities, women’s health, heart failure, and obesity.
The AHA will launch new networks focused on vascular disease and atrial fibrillation in 2018.
Ovarian cancer is often dubbed “The Silent Killer” because it typically goes undetected until it has progressed into later stages. Sadly, only 19% of ovarian cancers are detected in the early stages according to the National Ovarian Cancer Coalition. The signs and symptoms of this silent killer are often described as being vague and therefore dismissed as a mild discomfort or an annoying illness. As a result, this cancer is typically detected by healthcare providers in the later stages when women are usually experiencing more severe symptoms and the condition is dire.
While the symptoms of ovarian cancer may be vague, it is important to know what they are. More importantly, it is important to note that the persistent occurrence of these symptoms is more of a key indicator of the condition. As a general rule, if a woman experiences some of the following symptoms for more than 2 weeks, she should contact her healthcare provider:
- Bloating, upset stomach or heartburn
- Pelvic/abdominal pain
- Back pain
- Menstrual changes, frequent urination or constipation
- Pain during sex
While family genetics does play a role in ovarian cancer, only 5-10% of ovarian cancers have a genetic link. Therefore, all women should be aware of the symptoms and have an annual pelvic exam as part of their personal healthcare plan. Ovarian Cancer is detected after a woman experiences the above symptoms on a persistent basis and a healthcare provider begins to notice a change in the size of the ovary through a rectovaginal pelvic exam. If ovarian change is suspected, a transvaginal sonogram or a blood test called a CA-125 may be ordered. However, it is important to note that the “Pap Test” does not detect ovarian cancer. Pap tests detect the early stages of cervical cancer.
For over 40 years, Lebanon Family Health has been helping women to take control over their personal healthcare with affordable access to annual pelvic exams and pap test screenings. We offer free and low cost services based on income and accept some insurance plans. Making an annual well-woman exam is something all women can do to take control of her personal health. Call 273-6741 to schedule an appointment or visit our web site at www.lebanonfamilyhealth.org.
By Youth Advocate Programs
Families who eat dinner together are doing more than feeding their bodies. Parents who take the time to plan and prepare family dinners regularly promote love and bonding and contribute to a lifetime of good emotional and physical health for their children. Children who eat dinner regularly with their families enjoy:
- Better academic performance
- Higher self-esteem
- Greater sense of resilience
- Lower risk of substance abuse
- Lower risk of teen pregnancyLower
- Lower risk of depressionLower likelihood of developing eating disorders
- Lower likelihood of developing eating disorders
- Lower rates of obesity (thefamilydinnerproject.org).
Family dinners naturally bring families together with an immediate reward for hungry children-dinner! With busy lives and hectic schedules, family dinners require planning, coordination, and commitment. Here are some steps to help you pull off routine family bonding around the table.
- Involve your Kids-Allow your kids to contribute to the planning of the menu to ensure meals they will eat. This provides a great opportunity to help your children learn to plan. Prepare a shopping list and take your kids to the grocery store. Allowing your kids to help prepare dinner is fun, provides time for bonding, teaches life skills, and give children something to be proud of.
- Be positive-If your family is not accustomed to family meals, they might resist at first. Be positive and resist nagging. Instead, tell your children you love them and you want to spend this time together. During dinner, tell your family about your day and ask about theirs. Offer praise and resist criticism.
- Plan-Schedule dinners for days and times that work. Get agreement from family members to attend dinner. Be realistic as well. Your family may not be able to share dinner 7 nights a week. Shoot for 3-5 nights per week. Make sure to let them know what’s on the menu.
- Unplug-Shut off the TV and don’t allow electronics at the table. Be sure to model the desired behavior through your own actions.
Making mealtime a priority, and keeping it positive will have a lifelong impact on your children and offer routine opportunities for your family to come together and enjoy each other.