May 2010

HAVING SURGERY? HAVE YOUR HEART CHECKED

Cardiovascular disease is the number one killer of men and women in the US. For that reason cardiac complications are the most common surgical and post–surgical problems.
Often times the cardiac status of a patient is known ahead of time. Sometimes, it is silent and no one knows about it. It is important to have a good cardiac evaluation prior to surgery whenever possible. What does it entail?

The History

It is important to tell the surgeon and anesthesiologist about any symptoms that you may have. Shortness of breath, chest pain, pain when walking, and even a cough can be indicative of underlying heart disease. It is also important for them to know about whether you smoke, have high blood pressure, high cholesterol, diabetes, known heart disease and if you have sleep apnea. Don’t hold anything back!

The Evaluation

The initial evaluation may include an EKG and a CXR. If there is a suspicion of heart disease, a stress test may be ordered. Usually they order an echocardiogram with the stress test or a nuclear study called a thallium stress test. If the index of suspicion for heart disease is really high, they may recommend a cardiac catheterization. The more information that the doctors have (especially the anesthesiologist) the better they can tailor your care.

Complications

The most crucial time for the heart after surgery is the first 48 hours. Some patients may find themselves in the intensive care unit where they (and their hearts) can be monitored more closely.

Bottom Line

The best way to prevent cardiac complications as a result of surgery is to prevent cardiac disease. The way to do this is to make healthy choices, exercise and address health issues as they arise. Don’t wait for a surgery to force you to deal with problems that could have been evaluated and treated well beforehand! It is never too late to make changes. If you haven’t already, start now!

SLEEP GLORIOUS SLEEP

If you find that a good night’s sleep is harder to come by, you are not alone. A recent article (http://www.time.com/time/health/article/0,8599,1658166,00.html) points out the fact that sleep is a problem for all age groups. When it comes to infants and children, those who do not get the requisite 10 hours a night have a much greater chance of developing behavior and learning problems.

For adolescents, the reason for lack of sleep is not really surprising. Having two teenagers who have hyperactive fingers when it comes to text messaging, it is no mystery that many teenagers who are tired and not sleeping are using their cell phones to talk or text after lights out.

Adults who are tired and not sleeping are usually those who work longer hours. It looks like the more you work, the less you sleep. Why this happens is not entirely clear. What is clear is that we all need a good nights sleep!

If you have a baby or toddler, it is important to find out why they are not sleeping and work on solutions with their doctor. If you have teenagers, it is time to ban the cell phones at bedtime. And if you are an adult who works long hours (no, not you!?) it is time to work on getting your sleep. It will improve your mood, your health, and your energy level!

TAKE CARE OF THE CAREGIVER

My mother and father in law traveled all over the world, made great investments in real estate, spent time at the opera, museums and were up on all the latest plays in New York City. They were two of the more competent people you would ever meet. But, something happened when they both retired. Alzheimer’s disease raised its ugly head and my mother in law cannot recognize me. My father in law became her caregiver. He has taken care of her with patience and kindness, but now several years into her illness he is showing signs of Alzheimer’s disease as well.

I wondered if what was going on was major depression. However, the results of a recent study have given me insight. It appears that those who are married to dementia patients have an increased risk of developing it themselves. Husbands are at a greater risk than wives. They are twelve times more likely to develop dementia.

Researchers are not sure if the increased risk of dementia is due to caregiver stress or a shared environment. It is suspected that stress can actually destroy the part of the brain that is responsible for memory.

Watching what has happened to my in-laws has been horrifying. My father in law is stubborn and he refused help (until recently) in the care of his wife. I can only wonder if he could have avoided dementia himself if he had been willing to accept help. I think that his experience and that of countless spouses caring for dementia patients has shown us how important it is for all of us to pay attention and care for the caregivers.

DEPRESSED? GO GREEN!

It is estimated that 10% or 27 million Americans are on antidepressants. The good news is that they can be very effective particularly for severe depression. They also can be helpful for mild to moderate depression. The other thing that has been found to help mild to moderate depression is exercise. Thirty minutes or more a day three to five days a week can make a big difference. Exercise boosts endorphins, which improves mood. It also increases body temperature, which can have a calming effect. It can improve anxiety and boost self-esteem. If you exercise outside there is even greater potential improvement.

In fact, a recently released study has found that exercising in the great outdoors for just 5 minutes a day can improve mood and self-esteem. Outdoor activities included gardening, walking, bicycling and farming.

I find it fascinating that as we have become more of an indoor-based society and have gotten away from working outdoors, depression has risen precipitously. Maybe the results of this study are reflecting exactly that. I think it is important that all of us evaluate our activity level, our relationship with the out of doors and think about reconnecting with our roots….like the ones in the ground. Maybe many of us would be able to get off some of the antidepressant medications.

FOOD: YOU CAN’T LIVE WITHOUT IT BUT…

Food is one of those things we cannot live without. There are those of us who are addicted to certain types of food. For some it is fat, and for others it is sugar. It is impossible to completely eliminate either of these from our diet and thus we cannot treat it like we treat other addictions. You just can’t avoid food. So, for those of us fighting the battle of the bulge, and our cravings for fat, sugar or other types of food what do we do? Diets don’t work. What we have to do is make small changes that we can maintain for life! That is what can make a difference. For some it may be avoiding the “white” food such as bread, pasta, potatoes and rice. For others, it may be eliminating red meat. It may be as simple as only eating whole foods and skipping anything processed. It is important for anyone who is struggling to maintain a healthy weight that (as Curly said in the movie City Slickers) you find that one thing that can make a big difference, make the change and you will be amazed at the results.

IT’S SPRING: GOT ALLERGIES?

Spring is filled with flowers, green grass, and for some…sneezing, wheezing and runny eyes and noses! The most likely cause of spring allergies is tree pollen. However, mold and animal dander can also be contributing.

How can you know for sure? Get allergy tested. If your doctor can pinpoint the cause of your symptoms, the therapy can be tailored to what you need. Treatment could involve allergy shots or medications and help you to avoid a lot of grief.

How can you tell the difference between allergies and a cold? Both can cause a runny nose and eyes, but a cold usually has fever, aches and pains associated with it and it usually ends within about ten days. How can you avoid allergies? You might want to avoid the heavy pollen times, which are the early morning and late afternoons, by staying indoors. Use your air conditioner and keep the windows closed. Wash your clothes if you have been outside and use the dryer. That will help filter out the pollens from your clothes.

If you can’t avoid pollen, you may need to try medications. There are many over the counter antihistamines now that include Benedryl, Claritan, and Zyrtec. They block the histamine reaction that is triggered by pollen. Decongestants such as Sudafed will dry up your nasal congestion. Steroid nasal sprays will reduce inflammation.

Often people with allergies will also have asthma. This may result in wheezing, shortness or breath and can have deadly consequences. That is why it is important to have your allergies assessed and treated.

WHY CAN’T MEN BE MORE LIKE WOMEN?

It is common knowledge that women have more empathy than men. I know many women wonder what it would be like if men could feel what we feel just once. Well girls, there is a way for that to happen. The hormone responsible for empathy is oxytocin. Both men and women have it, but women have more which enhances our empathetic response.

But now, the wish that men can feel what we feel can be fulfilled with oxytocin spray. In a recent experiment involving 48 men and 26 women, it was found that a nasal misting of oxytocin spray allowed men an unusual capacity for empathy. Initially both groups were given two tests. One test required the use of social cues using facial expressions to give the right answers in a game. The second test gave the participants scenarios and asked them to rate how emotionally moved they were. Women scored well on both tests. The men scored well on the first test using social cues but did not do well when they had to respond emotionally. However, when they were given the spray they scored equally as well as the women. They also did better when learning tasks that involved social cues. Unfortunately the spray only lasted two hours, but something is better than nothing.

The spray is not commercially available right now, but in the future may be quite helpful. If you take the man in your life to a sad movie, with one spray you may not be crying alone anymore!

FISH OIL IS GOOD FOR THE BRAIN

A recent study has now claimed that fish oil does not help brain function. The researchers took 700 men and women in their 70’s and randomly assigned them to take a total of 500 mgs of fish oil or olive oil for two years. They then tested their cognitive function at the end of the two-year period. They did not find a difference. Therefore, they concluded that fish oil does not provide improvement in cognitive function in the elderly.

That all makes perfect sense, right? I beg to differ. Most of the studies showing benefit of fish oil, especially when it comes to the heart used 1000 mgs of fish oil not 500 mgs. In addition, it may take more than 24 months to show a difference.

One of the things that cause public dismay is the conflicting advice that continues to be published in the media. This is especially an issue when it comes to supplements. If the wrong dose is used or the incorrect formulation, then the study results may not be valid.

I would hate to see my patients giving up taking their fish oil when it has so many benefits. It is good for lowering triglycerides, it is good for the heart, mood, skin and joints, and I believe in the proper dosage it is also good for cognitive function.

 

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