Cardiac Rehabilitation
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By Jessica Snyder with Elizabeth A. Jackson, MD, MPH
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Women’s heart health is an incredibly important topic, but unfortunately it’s not talked about nearly enough. Dr. Elizabeth Jackson has written a new book called An Ageless Woman’s Guide to Heart Health: Your Path to Lifelong Wellness, and in it she addresses crucial information that all women need in order to be their healthiest.
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In the following excerpt from An Ageless Woman’s Guide to Heart Health, Dr. Jackson provides some information on cardiac rehabilitation programs that many people decide to participate in after a heart attack, heart surgery, or percutaneous coronary intervention.
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“After being discharged from the hospital, women who have experienced a cardiac event should ask their doctors about enrolling in a cardiac rehabilitation program. It’s a well-known fact that women do not enter or complete these programs as often as men. There are several reasons why this may be happening. First, younger women are frequently balancing family and work obligations and are therefore reluctant to take the time to complete a rehab program. For older women, the issue is typically related to access. They are less likely to be able to drive and hesitant to ask family or friends to take them. Since women are usually older at the time of a heart attack, and may have other illnesses or mobility issues, some doctors may assume these patients are not interested in this type of program. However, even if a woman has difficulty walking, she can complete a cardiac rehab program and benefit tremendously. Data show that these programs greatly reduce mortality after a coronary event.
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“Cardiac rehabilitation is a structured program that often starts in the hospital with education about having a heart attack and the treatment plan, which is referred to as phase one. Phase two occurs as an outpatient, when the heart attack survivor visits a rehab facility several times per week over the course of several months Recently, Medicare increased coverage for the number of weeks a patient is eligible for cardiac rehabilitation, based on the benefits gained from such programs.
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“Cardiac rehab provides an evaluation of your cardiac and medical history, along with your baseline fitness. An exercise program is then tailored to you, and sessions are performed under the supervision of trained staff—with heart rate and blood pressure monitoring. Most programs also offer education and counseling on diet, stress, and smoking cessation. Participants learn to set reasonable goals, based on their individual condition, in order to achieve a heart-healthy lifestyle.
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“After phase two is completed, many programs offer the option to continue to exercise at the cardiac rehabilitation facilities, which is called phase three. During this phase, participants are not monitored as closely, but they do have the benefit of interacting with trained personnel who have come to know them. This can help patients stick to the program.
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“Cardiac rehabilitation programs are also beneficial to patients who have not experienced a heart attack. Anyone who has undergone a heart surgery or PCI will find cardiac rehab valuable for recovery and prevention of further problems. If you have a heart condition, particularly if you were recently discharged from the hospital, ask your health-care provider about what options are best for you.”
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Four Experts on Healthy Eating
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by Jess Snyder
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Choosing the healthiest foods for yourself and your family can be, quite frankly, exhausting. The Internet is full of countless articles featuring opinions of doctors, dietitians, nutritionists, health gurus, and average Janes who have figured out what works for them. To alleviate some of the confusion, we’ve asked four of our trusted sources for their wisdom on how to help make your quest for health a little easier.
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Dietitian Julie Feldman, author of Grocery Makeover, says that fiber is the way to go when you’re looking for a good snack for the family that won’t leave tummies rumbling thirty minutes later.
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“When deciding which foods to shop for and provide for your family, choosing mostly fiber-full carbohydrates is the way to go,” explains Feldman. “Fiber extends many benefits to our overall health and quality of life. Fiber is unique in that it is the only nutrient that we eat that we don’t break down and absorb. This creates a slow and steady source of energy for our bodies that does not cause a large production of insulin. When we eat this way throughout the day, we have energy, lack cravings, and are more likely to be physically active.”
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Many moms would agree with Dr. Elizabeth Jackson and author of An Ageless Woman’s Guide to Heart Health. Dr. Jackson urges women to remember the impact that choosing healthy habits has on not only themselves, but also on their families. She encourages women to be aware of the powerful example they have an opportunity to present.
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Dr. Jackson reminds women that “when you’re healthy, your family will benefit in many ways. The healthy habits you adopt are typically mimicked by your children. In many ways, women are the ultimate healthcare providers. We are generally responsible for grocery shopping, meal preparation, first aid, scheduling check-ups, and, of course, providing commonsense advice. As such, we have a wonderful opportunity to instill healthy habits in our children that will last a lifetime. Even if you’re not planning on having a family, you can still serve as a role model for friends, relatives, and coworkers.”
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For many people, the relationship with food extends beyond nourishment to trying to satisfy emotions as well as our stomachs with food. Ginger Vieira, a certified cognitive coach, personal trainer, and author of Emotional Eating with Diabetes, offered us some expert advice on developing a healthier relationship with food.
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“You are human. We all need and want friendship, love, and happiness,” explains Vieira.
“When you don’t have one of these things in your life, food can become a quick and easy … well, not a substitute, but a distraction. Macaroni and cheese cannot replace love, and it never will. It is simply a way to ignore your feelings, needs, wants, and even insecurities.
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“Instead of trying to hide the fact that you feel loneliness and crave something like love, could you try to acknowledge it? Could you actually pause in the moment when you would usually reach for food and say out loud, ‘What I really want is love, not food.’
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“If you are using food to cover, hide, or distract yourself from emotions over a certain part of your life, those emotions or that situation will never evolve. They will continue to be hidden, covered with calories.”
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So how do you get it all under control? Susan Weiner is a Registered Dietitian and Certified Diabetes Educator who is the coauthor of the upcoming book The Complete Diabetes Organizer. She has some great tips for managing the chaos and making sure food doesn’t take you by surprise.
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Weiner suggests, “A weekly meal schedule can help you make healthy choices that may help you control your blood sugar levels. You’ll also be more likely to manage your weight. Best of all, you won’t come home and feel anxious and worry about what’s for dinner.
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• Take inventory of your food
Make sure that you have all of the basic foods and ingredients you might need to plan healthy and well balanced meals for the week ahead.
• Plan your meals for the week
Check out some healthy cookbooks from your local library or look online for ideas on simple and healthy recipes which are within your calorie, carbohydrate and fat budget.
• Write down your meals for the week ahead
Try to keep a simple written plan of your meals for the week ahead. You are more likely to eat nutritious and portioned meals if you generally stay within your pre-planned menu guidelines.”
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I hope these tips will help you overcome some confusion and frustration and forge a path to improved health and well-being. From here, you can evolve and adapt your eating habits to your lifestyle in the healthiest way possible.
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Good luck!
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Book Release: Dr. Elizabeth Jackson Helps Women Improve Heart Health at Any Age
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FOR IMMEDIATE RELEASE
Spry Publishing | p: 877-722-2264 | e: info@sprypub.com
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Dr. Elizabeth Jackson Helps Women Improve Heart Health at Any Age
May 14, 2013, Ann Arbor
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Spry Publishing and renowned cardiologist Elizabeth A. Jackson, MD, MPH, today announced the release of An Ageless Woman’s Guide to Heart Health: Your Path to Lifelong Wellness. With resources and tips to help women make positive steps toward improving their overall health, An Ageless Woman’s Guide to Heart Health is every woman’s guidebook to enjoying a heart-healthy life.
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Heart disease has long been thought of as a men’s issue, though it is actually the leading cause of death in both men and women. While most published information on cardiovascular health addresses the topic from a male perspective, Dr. Jackson’s new book focuses exclusively on cutting-edge information that is relevant and impactful to women. An Ageless Woman’s Guide to Heart Health provides essential education on the differences between men and women when it comes to heart disease prevention, risk factors, symptoms, and treatments.
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Often at the helm of their family’s overall health, diet, and nutrition, a woman and her lifestyle decisions can affect not only her own well-being; they can determine the habits of her partner and children as well. By becoming better educated, a woman can have a profound, permanent impact on the health of the people around her.
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In a recent interview, Dr. Jackson discussed the inspiration behind writing her book. “Something that I feel particularly passionate about is our ability to improve our health on our own. When we look at exercise and nutrition and stress reduction it’s not like you need to have some pill that has side effects or that you need a medical person to help you through making a decision to take the pill. A lot of things we intuitively know how to do are important—eating healthy foods and being active and enjoying life have a tremendous ability to reduce your risk for heart disease.”
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Dr. Jackson is currently available for interviews and appearances in support of the release of An Ageless Woman’s Guide to Heart Health. She is a knowledgeable and engaging interviewee who is qualified to comment on a wide range of women’s health topics, including:
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- Cardiovascular health concerns that are unique to women; how heart health differs between women and men
- The impact of a woman’s health decisions on her family, friends, and others around her
- Improving heart health—and consequently, overall health and well-being—at any age
- Lifestyle considerations (diet, exercise, stress, sleep, etc.) and how they change throughout a woman’s life
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To receive more information on Dr. Jackson and a review copy of her new book, An Ageless Woman’s Guide to Heart Health, please contact Jeremy Sterling, Director of Marketing at Spry Publishing, jsterling@sprypub.com.
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About ELIZABETH A. JACKSON, MD, MPH
Elizabeth A. Jackson, MD, MPH, received her medical degree from Tufts University School of Medicine. She completed her residency in internal medicine at Brown University’s Rhode Island Hospital and attended the New England Medical Center in Boston, Massachusetts, for a fellowship in cardiovascular medicine. She also completed a research fellowship in preventative medicine at the Brigham and Women’s Hospital in Boston, Massachusetts. It was during her research fellowship that Dr. Jackson earned a Master’s in Public Health at Harvard University’s School of Public Health, where she also completed training in nutritional epidemiology.
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Dr. Jackson began work at the University of Michigan Health Center in 2007. She works as an attending cardiologist with an emphasis in women’s cardiovascular health and cardiovascular prevention. Dr. Jackson is board certified in Internal Medicine and Cardiovascular Disease and is a fellow of the American College of Cardiology.
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About SPRY PUBLISHING
Spry Publishing is a premier publisher of health books and media, offering valuable content on a wide range of medical subjects. With an extensive list of accredited authors, Spry Publishing specializes in educating both patients and healthcare professionals by delivering timely, relevant wellness information across an array of platforms.
Spry Publishing operates within the Edwards Brothers Malloy family of businesses, a century-old printing and publishing tradition that is currently the sixth largest book and journal manufacturer in North America.
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For more information about Spry Publishing, Elizabeth Jackson, MD, MPH, An Ageless Woman’s Guide to Heart Health or the contents of this press release, please contact:
Jeremy Sterling, Director of Marketing
Spry Publishing, 2500 South State Street, Ann Arbor, MI 48104
p: 734-546-5434 | e: jsterling@sprypub.com
www.sprypub.com
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What Is Angina?
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By Jessica Snyder with Lisa Jackson
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Elizabeth Jackson, MD, is a renowned cardiologist who focuses on living a heart-healthy life. With every beat, this vital part of our bodies keeps us going. In her new book, Dr. Jackson shares with women of all ages what they need to do throughout their lives to care for their hearts.
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One of Spry Publishing’s newest titles, An Ageless Woman’s Guide to Heart Health, will be available in stores May 14, 2013. So that you don’t have to wait to begin taking care of your heart, featured below is an excerpt from this debut book by Elizabeth Jackson, MD.
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“What Is Angina?
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“When we or someone we know experience chest pain, our first thought is typically of a heart attack. In reality, many things may cause chest pain, including indigestion, gallbladder attacks, problems with the esophagus, and angina, to name a few. Angina, which literally means “squeezing of the chest” in Latin, is closely related to heart attack, as it’s caused by decreased blood flow and oxygen to the heart muscle. Just as with a heart attack, the reduced blood flow is most often a result of a narrowing of the coronary artery due to atherosclerosis, and the symptoms are very similar.
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“Angina can be described as pressure, heaviness, tightening, squeezing, or aching across the chest, particularly behind the breastbone. The pain can sometimes radiate to the neck, jaw, arms, back, or even teeth. However, unlike a heart attack, the supply of blood and oxygen to the heart is not completely cut off, and the condition can cause chronic chest pain.
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“There are two types of angina: stable and unstable. Stable angina is the most common and is what most people mean when they refer to angina. Patients with stable angina have symptoms on a regular basis; for instance, walking up the stairs always causes chest pain. Exertion is typically the trigger for stable angina, although severe emotional stress or a heavy meal can also bring it on—anything that causes the heart to demand more blood oxygen than the arteries can supply. The discomfort usually lasts from 1 to 15 minutes and is relieved by resting or placing a nitroglycerin tablet under the tongue. Nitroglycerin relaxes the blood vessels and lowers blood pressure, which improves blood flow.
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“Unstable angina is less common, but more serious. The symptoms are more severe and less predictable than stable angina. In addition, the pain is often more frequent, lasts longer, occurs at rest, and may not be relieved by nitroglycerin. While unstable angina is not the same as a heart attack, it warrants an immediate visit to your health-care provider or emergency room for further cardiac testing. This condition is often a precursor to a heart attack.”
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Jessica Snyder joined the Spry Wellness Blog as a contributor in 2012. She is currently working to obtain an undergraduate degree in English and Communications at the University of Michigan.
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Take Heart: An Ageless Woman’s Guide Is Coming Soon
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by Jess Snyder
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We’re nearing the end of February and as you may have noticed, we’ve been celebrating American Heart Month with a series of heart-related posts here on the blog. Although heart disease has traditionally been considered primarily a men’s health issue, actually more women than men have died from heart complications over the past few decades. Heart disease is the leading cause of death in both men and women, not cancer as many people believe.
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On May 7, Spry will release An Ageless Woman’s Guide to Heart Health: Your Path to Lifelong Wellness by renowned cardiologist Elizabeth A. Jackson, MD. The new book, written for women of all ages who are concerned with cardiovascular health, will provide an in-depth look at women’s heart issues from a female perspective. Dr. Jackson offers a wealth of valuable tips and resources aimed at helping you take manageable, positive steps toward understanding and improving your heart health.
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Over the next few weeks, leading up to the book release, we’ll share more about Dr. Jackson with you and we’ll be featuring some of the helpful information contained in her book. Whether you’re younger or older, fit or ailing, it’s never too late to make changes that can lead you—and those you love—to a healthier heart.
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Jessica Snyder joined the Spry Wellness Blog as a contributor in 2012. She is currently working to obtain an undergraduate degree in English and Communications at the University of Michigan.
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A Valentine’s Day Heart Health Reminder
by Jess Snyder
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Even though it’s Valentine’s Day—a day to indulge yourself by spending time with your loved ones, having a few chocolates, and maybe even a romantic dinner for two—it’s also an important day to stop and think about keeping yourself and your dear ones as healthy as possible, especially with regard to heart health. Here are 5 quick activities that could help you stay in tip-top shape for many Valentine’s Days to come.
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• Watch the salt! Most of us (and I mean the vast majority of us) are eating more salt than we should be by about 1,000 mg each day. Much of that salt comes from processed foods such as bread, deli meat, and pre-made dinners. Try eating fewer processed foods as a way to cut your sodium intake back a bit.
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• Count your drinks. Some alcohol, like red wine, has flavonoids in it, which can be anti-inflammatory and a decent excuse to have a glass, if you’d like to have one. Many doctors recommend 1 glass a day for women and 2 for men. However, too much alcohol can negatively affect your heart muscles, and it’s very easy to consume more calories than you realize in liquids. So, think before you drink!
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• Take a hike. No, really. Even a 30-minute walk each day can help to burn more calories and work out your heart. Some studies have shown that women who exercise regularly reduce their risk of cardiovascular disease by as much as 30 to 40 percent. Taking a family walk can also be a great idea if you have a spouse, parent, children, nieces, nephews, or grandchildren who could also use the exercise (and the quality time!). Walking can be a wonderful way to calm down and think, which leads me to my next point …
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• Chill out. Though the link between chronic stress and heart disease is unclear and still being researched, stress can definitely lead to other unhealthy lifestyle choices, such as drinking, emotional eating, smoking, or depression. By working to reduce your stress, you might find it easier to eliminate some of these other unhealthy habits, too.
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• Know when it’s serious. Everyone should be aware of the warning signs of a heart attack, whether it’s for their own benefit or to be supportive of someone for whom they care. The sooner a heart attack is recognized, the more efficient medication and treatment will be, which can mean that lives may be prolonged and saved. The most common signs of a heart attack are the ones many people are familiar with: chest and upper body discomfort, shortness of breath, sweating, nausea. However, women also need to be aware that many women won’t experience the characteristic chest pain if they have a heart attack. And as many as 75 percent of women may have symptoms similar to the flu for the week leading up to their heart attack. Be aware—if something doesn’t seem right, seek medical attention immediately.
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Hopefully these tips aren’t too painful, and maybe they’re a part of your lifestyle already. Keep up the hard work, and set yourself up for a happy heart.
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Jessica Snyder joined the Spry Wellness Blog as a contributor in 2012. She is currently working to obtain an undergraduate degree in English and Communications at the University of Michigan.
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National Wear Red Day
by Jess Snyder
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Ladies, there’s just something about wearing the color red. It gives you an extra lift and helps you feel a little more confident. Maybe that’s why the American Heart Association chose red to represent their awareness campaign for women’s heart disease.
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Go Red For Women is a campaign with the purpose of educating women about the realities of heart disease and how it is the number one killer of women in the United States today. The campaign was started in 2004, a year after the first National Wear Red Day was hosted by the American Heart Association to educate and empower women about their heart health by providing tools to help women take action to improve their well-being. Every year on the first Friday in February, women (and men) don red dresses, sweaters, blazers, T-shirts, jackets, and anything else you can imagine to make a statement about their commitment to fighting heart disease and educating women about its risks. Funds raised on National Wear Red Day help to supply up-to-date educational programs, research, and support materials specifically designed to teach women about the risks of heart disease.
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The first National Wear Red Day happened ten years ago, and in the past decade there have been some tremendous improvements in women’s heart health to celebrate! Fewer women (21%) are dying from heart disease and more women (23%) are aware that heart disease is their number one health threat.
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So get out there this February. Whether you organize a parade, put together a group of friends to do a fundraising campaign, or proudly don your favorite red heels, it all adds up to increasing awareness and saving lives.
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To learn more about the impacts of heart disease on women and what you can do about it, check out An Ageless Woman’s Guide to Heart Health by Dr. Elizabeth Jackson.
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Jessica Snyder joined the Spry Wellness Blog as a contributor in 2012. She is currently working to obtain an undergraduate degree in English and Communications at the University of Michigan.
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Prenatal Nutrition
by Jess Snyder
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During pregnancy, certain aspects of your nutrition become increasingly important not only for your health, but for your baby’s as well. You will very likely find that new concerns over what, when, and how to eat are often at the center of your attention. Your doctor should give you plenty of advice about what is best for you and your specific pregnancy, but here are a few of the main areas of concern that women generally have about their nutrition while pregnant.
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Nutrients
It is vital that pregnant women get sufficient amounts of protein, folic acid, calcium, and micronutrients, including iron. Additionally, pregnant women should drink 8 or more large glasses of water daily. Protein should comprise about 20% (which is about 60 grams) of a normal pregnancy diet. Most Americans already consume more than enough protein, however, animal sources of protein are very high in fat. These extra fats can build up and create additional weight gain, so be aware of the fat in your meat!
Supplements
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Many women will decide to take prenatal supplements throughout their pregnancy, as they can help to ensure that you’re getting all the nutrients you need each day. In addition to the benefits that you receive from taking supplements, many foods also contain high levels of folic acid, which helps to prevent birth defects. Foods such as leafy green vegetables, citrus fruits, dried beans, and peas are good sources of naturally occurring folate.
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Fish & Shellfish
While most foods are perfectly fine for pregnant women to eat, there are some that require a little extra caution. If you frequently eat fish in your regular diet, it’s a very good idea to talk with your physician about which types are OK for your pregnancy and which are not. Certain kinds of fish can be very high in mercury and should be avoided, such as shark, swordfish, king mackerel, and tilefish. However, other kinds of fish can be great sources of omega 3s and lean protein. Keep in mind that eating raw fish like sushi is generally off limits during pregnancy, due to risks that include bacteria that can cause food-borne illnesses and parasites that live in uncooked fish and can cause parasitic infections.
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Caffeine
For caffeine junkies, pregnancy might present an extra challenge. Pediatricians usually recommend that most women cut back significantly or even eliminate caffeine altogether. Some studies have shown that women who consume 200 milligrams or more of caffeine per day (which is roughly the amount of caffeine in a 12-ounce cup of coffee) are twice as likely to miscarry as women who consume no caffeine. Here is an interesting article about consuming caffeine during pregnancy, which includes a list of the caffeine content in several common beverages.
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As always, your first step toward a healthy pregnancy is consulting with your doctor about which dietary choices are best for you and your baby. Positive decisions about diet and nutrition that are made during pregnancy are some of the most important decisions you will ever make!
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Jessica Snyder joined the Spry Wellness Blog as a contributor in 2012. She is currently working to obtain an undergraduate degree in English and Communications at the University of Michigan.
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Eldercare: Creating Compatibilities
by Mary Ann Zettelmaier
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In the previous post I listed some of the most common risks to a safe living environment for the elderly among us. Now I’d like to suggest some modifications to a home that can make, or keep, it safe. The following isn’t an exhaustive list, but it may point you in the right direction for customizing a plan that meets your, or your elderly parent’s/neighbor’s/friend’s needs.
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THROW RUGS: Eliminate them wherever you can. If you still need them (e.g., on a bathroom floor that might otherwise be wet and slippery), you can do one of two things:
-Make sure they have a rubber backing (most bathroom products do), or
-Purchase some separate rubber backing, cut it to fit the rug, and put it under the rug.
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STAIRS: Again, decrease or eliminate their use. This may mean organizing activity to minimize their use, or, if possible, getting all the necessities for living (laundry facilities, bedroom, daytime living space) on one floor. If stairs continue to be necessary, make sure sturdy rails are in place, preferably on both sides, and consider doing something to highlight the edges of the stairs, e.g., painting the edges in a contrasting color. Night lights can also help, even if everything is on one floor.
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STOVES: This can be especially challenging, since cooking is such an integral part of life for so many of us. So what are the options, short of a brand new stove that may be too expensive? A reminder sign near the stove (STOVE OFF?) may help, as may a nightly routine that includes checking lights, open doors and windows and appliances that don’t have an automatic shutoff. Routines have their merits.
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Alternatively, if none of the above is workable, it may be time to consider some kind of food service, such as Meals on Wheels. Another alternative might be supplying meals from other sources. For years, prior to her moving to an assisted living facility, I made meals for my mother and froze them in single-serving sizes. Then all she had to do was remove them from her own freezer and microwave them. I simply made extra portions when I was cooking for my own family, so it was minimal extra work for me. Or, there’s always my husband’s solution: McDonald’s (help us!).
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CABINETS: This usually takes some help for an elderly homeowner, and if you’re the helper, do respect the fact that, for most women, a kitchen is her turf. Proceed with sensitivity. Basically, the important part is to get the necessities (everyday dishes, glassware, eating utensils and high-use cooking utensils) within reach without stretching or bending. The highest and lowest cabinets, shelves, and drawers need to become off limits for independent use, and that convenient little stepstool needs to disappear. It’s too much of a temptation.
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TUBS/SHOWERS/TOILETS: Thankfully, there are many aids that can keep a bathroom safe and usable. Consider an elevated toilet seat that fits over an existing toilet or a commode chair that works essentially the same way. Also, there are side rails available that attach to a toilet of standard height. The latter alternative is sometimes all that’s necessary. For tubs, there are tub transfer chairs, with seats on both the outside and inside of the tub. With a transfer chair, you can sit on the outside of the tub, get your legs over the edge, and then slide to the part of the chair on the inside of the tub. Some people have replaced a standard tub with a walk-in tub or shower. This may be a reasonable alternative for some, but there’s a price tag that may be beyond what a senior on a fixed income can afford. Additionally, some or all of the aids listed above may be covered by health insurance. As necessary, it’s worth a conversation with your physician.
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This gets us to the “I’ve lived here all my life/I don’t want to move” issue. Given this and the previous discussion, it may be necessary to initiate a conversation about alternative living arrangements. Basic safety issues can be a compelling argument, but it may also take discussions with other family members as well as with physicians and attorneys. I sympathize with anybody who has to engage in such a discussion: as necessary as it may be, it’s never easy.
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And under any circumstances, we’re left with those most basic of human needs: connection and communication. If you’re the senior citizen who has to modify or change your living arrangements, stay connected with your larger world. If you’re the friend or family member who assists an elderly person, keep in touch, and/or find somebody who’s nearby to do it for you and then communicate with you. All things being equal, isolation is probably the biggest risk for diminished quality of life in old age.
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Next time I’ll address some issues related to safety outside the home.
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Mary Ann Zettelmaier, MSN specializes in maternal-infant communication, with a comprehensive clinical focus on developing programs of family-centered care.
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Pulmonary Hypertension Awareness Month
by Jess Snyder
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November is Pulmonary Hypertension Awareness Month, so we’d like to join in and help spread the word. By learning more about pulmonary hypertension, you may be able to recognize symptoms in yourself or in a loved one.
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Pulmonary hypertension (PH) occurs when small arteries in the lungs become narrowed and cannot carry as much blood as they should. The heart therefore has to work harder to force blood through these arteries, creating higher blood pressure. This abnormal pressure is known as PH. Over time the right side of the heart can become larger as it struggles to move blood at the rate that the body requires. And as a result of this overworking, heart failure is common among people with PH.
Continue Reading…
The Insider’s Info on Cholesterol
by Julie Feldman
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There is nothing exotic or romantic about cholesterol—a waxy, fat-based substance that determines our cardiovascular health risks. Then why is it that cholesterol is the topic of dinner conversations and long walks on the beach? I think it is because of the idea that cholesterol is something we can impact or change. As a dietitian, there is no greater thrill than to see the results of my clients’ hard work revealed in the lowering of their cholesterol. By focusing on four main areas of your diet, you can put the “les(s)” back in cholesterol and improve your complete health profile.
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Cholesterol is manufactured in your liver, so it makes sense that when we eat animal-based foods there is going to be cholesterol in them—because those animals’ livers make cholesterol too! Our own livers make up to 4,000 mg of cholesterol per day, so it is important that we limit the amount of cholesterol we get in our diets. The American Heart Association recommends that cholesterol intakes be limited to less than 300 mg per day. To put that number in perspective, 1 egg has 213 mg of cholesterol (all of which is in the yolk), and one 4-ounce hamburger has about 100 mg of cholesterol. To see a complete list of the cholesterol content in common foods visit this link. A great way to decrease your daily cholesterol intake is to change a couple of meals each week from animal-based meals to vegetable-based ones. Several studies have confirmed that following a vegetarian or vegan diet helps to keep cholesterol levels in a desirable range.
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Total caloric intake impacts our cholesterol more than most people think. Overconsumption leads to weight gain, and we know being overweight increases our cholesterol and risk for heart disease. Most adults require between 1500 and 2500 calories per day, depending on gender, height, weight, age and activity level. Great websites including calorieking.com and myfitnesspal.com allow you to determine and track your target daily caloric intake, thus helping you to keep calories in check each and every day.
Fitting in fiber is essential to keeping cholesterol levels low. Fiber is helpful in this area in two main ways. First, fiber plays a unique role in the small intestine where it literally binds to cholesterol in the food that we have eaten and helps to excrete that cholesterol before it ever enters our blood stream. The fiber content in foods like Cheerios and Quaker Oatmeal is what allows them to boast about their ability to lower your cholesterol. Secondly, fiber helps to keep us feeling fuller for longer, thus reducing our daily intake and cravings for sweets. Adults need 25-35 mg of cholesterol each day. Children need 5 plus their age in grams of fiber each day. Fiber intake should be spread throughout the day and be included in part of each meal. Fiber is found naturally in foods like whole grain breads, cereals, pastas, rice, fruits, vegetables, beans, lentils and popcorn.
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Last but certainly not least is the requirement to change the types of fats you include in your daily diet. There are fats that are actually good for us. Those are the ones that help to keep your HDL (happy cholesterol) high, while keeping your LDL (lousy cholesterol) low. The types of magical fats that I am referring to are monounsaturated fats and a certain type of polyunsaturated fats called omega-3 fats. These fats, found in olive oil, canola oil, avocados, nuts, fish and flaxseed, should be included in small servings two to three times each day. Other fats, including saturated fat (butter, high-fat dairy, and meats), and trans-fats (margarine and processed liquid vegetable oils) negatively impact our cholesterol by making our total cholesterol and our LDL cholesterol go up. Many Americans were raised putting butter on everything. While removing butter from your daily routine may seem like a daunting task, rest assured that your taste buds will adapt. In fact, it only takes your body about three weeks to adjust to a new way of eating.
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There are very few things in life that we actually have control over. While some people have a genetic predisposition toward high cholesterol, the majority of us can control our cholesterol and should feel empowered to do so. After all, the only thing less romantic than cholesterol to talk about is a heart attack.
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When Should You Get a Mammogram?
by Jess Snyder
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Many women begin to receive mammograms at age 40, however, new research is causing a controversy within the medical community over when women should begin to receive annual or biannual mammograms. There are two opinions: one group is continuing to recommend that annual mammograms begin at 40, while the other group is advocating for an initial assessment at 40 which will then direct a personalized assessment of how often the woman should receive mammograms. Both sides are attempting to provide the most complete care for women by focusing on two different aspects of the diagnosis process.
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The first group of doctors is continuing to encourage an annual mammogram, preferring to err on the side of health versus harm. Even though the risk of developing cancer between the age of 40 and 49 is about 1%, women with a family history of breast cancer are at a much more significant risk of developing cancer. The time between when a cancerous growth begins and when it shows symptoms is called the sojourn time. For women in their 40s, that time is 2-2.4 years. So, if a woman does not receive annual mammograms and does have a cancerous growth, she may not have symptoms until it has been growing for 2 years. Since the 5-year survival rate is 98% for breast cancer that is caught early enough, doctors think that the few women who do develop breast cancer in their 40s may discover it early enough to experience the highest possible 5-year survival rate, if they receive annual screening. By screening all women over 40 annually, the one percent of women who do have breast cancer is given a much higher chance of survival.
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However, most women in their 40s who are told that they have a suspicious lump end up having a “false positive,” a growth that is not cancerous. Some healthcare providers think that the emotional stress of a false positive and the radiation from the x-ray are not worth the cost of an annual screening until the women are 50.
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Many who feel that the emotional stress and financial cost of annual mammograms at 40 are more damaging than previously indicated are now advocating that women should have an initial assessment at 40 to determine a personalized recommendation. This recommendation would be based on factors such as breast tissue density and family history. The breast has both glandular and fatty tissue, and women with more glandular tissue (or more dense tissue) exhibit growths that are more difficult to see on the x-ray. A woman with higher-density tissue and a family history where a first-degree relative, such as mother or sister, has had breast cancer may be recommended to have annual exams due to greater risk factors. However, a woman with low breast density and no family history of breast cancer may only need a mammogram every 3-4 years until she turns 50.
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Dr. Diana Petitti who has worked on the US preventative Services Task Force study says, “Personalized breast screening recommendations are better.” Talk with your doctor about your family history and your wishes in order to form the best healthcare plan for you.
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Jessica Snyder joined the Spry Wellness Blog as a contributor in 2012. She is currently working to obtain an undergraduate degree in English and Communications at the University of Michigan.
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Dr. Moyad: Eggs
by Mark A. Moyad, MD, MPH
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While eggs have taken some bad press over the years, I wanted to give you some reasons to reconsider eating them:
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- Low in calories (70 to 80 calories each)
- Good source of high-quality protein (good for muscles and to suppress appetite)
- Natural source of vitamin D
- Natural source of choline (may improve brain health or memory)
- Great source of lutein and zeaxanthin
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You may not have heard of the last two compounds, but both were recently tested in pill form to potentially preserve eyesight in patients with macular degeneration. Age-related macular degeneration (AMD) is a major cause of blindness in older individuals. It affects the central vision of the individual. One of the best ways to handle this disease still remains simply preventing it in the first place. Some of the common risk factors for AMD include age, family history, gender (females), high cholesterol and/or blood pressure, obesity, smoking, sunlight exposure, or low dietary, blood, and tissue levels of lutein and zeaxanthin. Doctors have found that lutein and zeaxanthin accumulate in the retina and are especially concentrated in the macula region of the eye, which has the greatest concentration of cone receptors needed for central vision and high-resolution vision. Lutein and zeaxanthin are eye antioxidants and may protect the macula from light-promoted oxidative damage to the retina and retinal pigment areas.
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Dark green leafy vegetables and eggs are generally the best dietary sources of these nutrients. While the amount of total lutein (0.3 mg) and zeaxanthin (0.2 mg) in a single egg yolk may not seem large, the easy absorption of these compounds into the blood stream make it arguably one of the best sources of these eye health nutrients from food. The fat in an egg probably improves its absorption. Some other lesser sources are corn, peas, brussels sprouts, cabbage, and other leafy greens.
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Dr. Moyad’s Top Picks: Lutein/Zeaxanthin
Kale: 16–22 mg
Spinach: 7–12 mg
Lettuce: 2–3 mg
Broccoli: 2–3 mg
Eggs: 0.5 mg
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Since kale is arguably the best source of lutein and zeaxanthin, I thought I’d include a quick suggestion on how to use it.
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Dr. Moyad’s Kale Salad
Mix washed and finely chopped kale with some cannellini beans, dried tart cherries, fresh lemon juice, olive oil, sea salt, and pepper. Add a dash of Sriracha sauce if you like food spicy. Can be stored in the refrigerator for 3 or 4 days.
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As a wrap up to our discussion on eggs, we should mention that the cholesterol content of eggs continues to decrease thanks to more efficient farming methods. While it probably doesn’t make sense to eat several eggs every day, both the egg white (main protein source, 15 to 20 calories) and the egg yolk(choline, vitamin D, mineral and eye health compound source) have value in your diet and may just benefit your eyes.
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The Bottom Line
Even though you may have heard in the past that you shouldn’t eat eggs, it turns out that they may provide multiple health benefits.
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REFERENCES:
Weigert G, Kaya S, Pemp, et al. Effects of lutein supplementation on macular pigment optical density and visual acuity in patients with age-related macular degeneration. Invest Ophthalmol Vis Sci 2011, 52:8174–8178.
Ma L, Lin XM. Effects of lutein and zeaxanthin on aspects of eye health. J Sci Food Agric 2010, 90:2–12.
Krinsky NL, Landrum JT, Bone RA. Biologic mechanisms of the protective role of lutein and zeaxanthin in the eye. Annu Rev Nutr 2003, 23:171–201.
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This article was excerpted from Dr. Moyad’s Promoting Wellness Newsletter—Winter 2012. Sign up to receive free newsletters from Dr. Moyad and Spry Publishing here.
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Mark A. Moyad, MD, MPH, is the primary author of over a hundred medical articles and numerous books. He maintains a consulting practice on complementary medicine at the University of Michigan Medical Center, Department of Urology.
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Dr. Moyad: PSA Screening
by Mark A. Moyad, MD, MPH
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The U.S. Preventive Services Task Force (USPSTF), which is a diverse authoritative medical group, basically discouraged routine mammograms a few years ago. Now, the USPSTF discourages routine PSA screening. This recommendation by USPSTF did not come as a surprise because a large recent study in Europe and the United States did not show a clear benefit for PSA screening, in general. The USPSTF had a knee-jerk reaction, a move that was not unexpected by the medical community.
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However, the big story on screening was completely missed! It has been known for a long time that if a man (or woman) is in very good health then the probability that cancer screening might be beneficial is much greater as compared to a man (or woman) who is not heart healthy or has multiple other health problems. This is going to make sense if you think about it.
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If you have heart disease or another serious medical condition and you are likely to die young, then PSA screening for prostate cancer is not likely to make a difference in your life expectancy. On the other hand, if you are very healthy and likely to live a long life, then your prostate cancer risk will more often impact your life expectancy.
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Since cardiovascular disease (CVD) has been the leading cause of death in men and women for over 100 years, it makes sense for men (and women) to try and reduce their cardiovascular risk to as close to zero as possible by working with their doctors and other health care professionals. Further, to increase men’s life expectancy even more, we need to aggressively reduce alcoholism, diabetes, infections, obesity, smoking, and the number of accidents and violent acts affecting men. Men should be encouraged to consider carefully screening tests, such as colon and prostate cancer screening, or other high-risk selective screenings, such as skin cancer for those at an elevated risk. These messages deserve as much, if not more, attention as the current PSA recommendation from the USPSTF.
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We have to accept the fact that some men have been over-diagnosed and over treated for prostate cancer, but we also have to recognize the fact that screening has saved the lives of many HEALTHY men. Perhaps we need to talk about triaging preventive medicine similarly to how an emergency room evaluates patients. In other words, take care of conditions with the highest probability of causing death first and then work on the rest of the items over time. With that in mind, reduce your cardiovascular risk to as close to zero as possible and then let’s reignite the discussion on cancer screening. You should have some candid discussions with your doctor to determine what best fits you based on your overall health profile. Remember that, overall, healthier patients may benefit more from screenings.
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The Bottom Line
Perhaps you heard that the U.S. Preventive Services Task Force (USPSTF) is now discouraging routine PSA (Prostate Specific Antigen) screening, but there is more to the story on who may or may not benefit from a PSA screening test. Turns out, if you are really healthy then PSA screening could save your life, but if you are very unhealthy then PSA screening might not improve your life expectancy.
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REFERENCES:
Crawford ED, et al. Comorbidity and mortality results from a randomized prostate cancer screening trial. J Clin Oncol 2011, 29:355–361.
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This article was excerpted from Dr. Moyad’s Promoting Wellness Newsletter—Winter 2012. Sign up to receive free newsletters from Dr. Moyad and Spry Publishing here.
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Mark A. Moyad, MD, MPH, is the primary author of over a hundred medical articles and numerous books. He maintains a consulting practice on complementary medicine at the University of Michigan Medical Center, Department of Urology.
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Caring for Family: Part II
by Mary Ann Zettelmaier, MSN
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The core of family-centered care rests in communication and dialogue, which means that both caregivers and families are responsible for making it work. So where to start?
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I would suggest that step one involves some homework on the part of you and your family, and it’s called an Advance Directive. This is basically a written statement of the scope and limits of care that you want, as well as an identification of who can/will/should advocate for you if you are unable to speak for yourself. There are many formats that can be used. Some can be found online, some institutions can provide them, and attorneys can incorporate them in your will. Clearly, this involves some serious thought on your part as well as an equally serious conversation with your partner, your adult children, and whoever else you consider “family.” And it may well change depending on your age, your children’s ages, and/or your life circumstances.
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Once you’ve settled on an Advance Directive, the next question is “What do I do with it?” Make sure that your physician and your designated advocate both have copies of it. If you’re admitted to a hospital or other facility, make sure you provide a copy for your medical record. In these days of electronic medical records (EMRs) that are supposed to talk to each other, my experience has been “don’t count on it.” Carry a copy with you, or at least carry contact information for where to find it, especially if you’re traveling. Personally, I carry information about how to contact my patient advocate, as well as a small card in my wallet that says, “DO NOT RESUSCITATE.” (It’s OK … I’m old.)
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Having done your homework, you’re now ready to engage in a conversation with caregivers at the actual time of care. In my experience as a caregiver, I’ve found that if patients and families have thought about, and can answer, two questions, they’re a long way down the road of getting the care they want and need. These are:
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1. What is important to you (during your hospital stay, when your baby is born, for your hospice care, etc.)?
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2. How can I/we/caregivers help you?
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That may not sound complex or sophisticated, but a caregiver who is really invested in family-centered care can take your answers to those two questions and build a plan of care that addresses your needs and concerns. Sometimes it’s necessary to negotiate and clarify what’s doable, what’s realistic, and what your deeper concerns are. For example, and specific to maternal and newborn care, parents frequently indicate that it’s important that their baby stay with them, or that they want to learn baby care, that a mom wants help with breastfeeding, that they want to know about progress in labor, that they do or don’t want medication for discomforts in labor. Sometimes they want significant family member(s) to stay with them. Sometimes it’s really important that they know right away how their baby is doing. The latter is especially important if there are anticipated problems with the baby’s health.
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I could probably write a whole book of responses to the two core questions that I’ve received over the years. Overwhelmingly parents’ and families’ requests are reasonable and doable, or at least amenable to negotiation to achieve concrete results.
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So, you may have caregivers who initiate a conversation about care, or you may not. Under any circumstances ask YOURSELF those questions, preferably ahead of time, and be prepared to state your case in a way that will encourage people to help you. Saying, “This is what’s important to me …” is usually a good start. Sometimes you need to identify which person will most likely help you get the results you need. It may be a physician, a direct caregiver, a nurse-manager, a charge nurse or care coordinator, or a nurse-midwife/practitioner/clinical specialist. Those are the typical titles of people to ask for if you need help. Some institutions even have people who are designated as patient/family representatives or advocates. Again, it’s helpful if you have a copy of an Advance Directive and/or have written down what’s important to you. Remember, too, that care can be an ongoing negotiation, especially if circumstances change. So keep talking.
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Next time, I’ll discuss physical structures and caregiver standards that support family-centered care. Stay tuned.
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Read other articles in Mary Ann Zettelmaier’s Caring for the Family series.
Caring for the Family: Part I
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Mary Ann Zettelmaier, MSN specializes in maternal-infant communication, with a comprehensive clinical focus on developing programs of family-centered care.
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