We're Not Doctors But We're Here To Help You

While other editors got it right the editors at TIME magazine didn't quite get it right. We felt that if you can walk away from any health advice then that's good advice. In this case its not what you can do for yourself its what you can do for someone else. This Sunday this editor's wife observed someone who passed out in church. Her concern was that the person was no longer with us and that enough wasn't done to aid them. The news articles and research indicates that something is always better than nothing.

"The Case Against Mouth-to-Mouth Resuscitation - The study measured survival by hospital discharge: 13% heart patients who received chest-only compressions were discharged from the hospital, compared with 7.8% of those who received conventional CPR. Of those who received no resuscitation whatsoever, only 5.2% left the hospital, showing that whether you do mouth-to-mouth or not, doing something is better than doing nothing." - TIME (Healthland)

When you go to the source of the most current research even they don't give the source of their information though we're certain that it's just a matter of math. You know the kind from your school days where A is to B as B is to C. For instance Arizona Health Science Center said:

"Every three (3) days, more Americans die from sudden cardiac arrest than the number who died in the 9-11 attacks. " - The Arizona Health Sciences Center (AHSC) 

That's not what the headline would indicate in the TIME article. We've got some experience, as should anyone with a loved one, with cardiopulmonary resuscitation (CPR) training. What we learned and were told is that we should first do no harm and we're taught how and when giving aid - to do no harm. We were told that the first few minutes were crucial to the individuals survival.

"You can lessen this recurring loss by learning this hands-only CPR method that doubles a person’s chance of surviving cardiac arrest. Watch physician researchers Gordon A. Ewy, MD, and Karl Kern, MD, demonstrate the easy, life-saving method that they developed at the University of Arizona College of Medicine." - The Arizona Health Sciences Center (AHSC) 

Change is a good thing but if you're unwilling to take a chance on this non-mouth to mouth method you can always become certified by the American Red Cross who still teaches the old fashion cardiopulmonary resuscitation (CPR) just like we did. However we're going to make the switch. Better is better to us and it's less to remember, not as intimate nor as personal.

"Prepare for Emergencies with American Red Cross First Aid, CPR and Automated External Defibrillator (AED) Courses - American Red Cross first aid, CPR and AED programs are designed to give you the confidence to respond in an emergency situation with skills that can save a life. Additional training in bloodborne pathogens, oxygen administration and injury prevention can be added to CPR and first aid training to prepare you to prevent and respond to life-threatening emergencies." - American Red Cross (Taking A Class) 

There are a lot of statistics given about the risk of heart disease or heart attacks without sufficient indication of what specific research, by whom and what was used to get these numbers. If we're certain of one thing its that things change.

"Less than eight percent of people who suffer cardiac arrest outside the hospital survive." - American Heart Association (AHA) 

What's true today, if you make a change those same things, won't be true tomorrow. If you've not made any changes then yes what was true yesterday can be true today. To be honest, even if you make changes what was true yesterday can still be true today. If you make a change then its not unusual to see a change reflected but nothing is guaranteed.

"Heart Attack Risk Assessment - It's essential that you measure your risk of heart disease and make a plan for how to prevent it in the near future. Use this tool to help you assess your risk of having a heart attack or dying from coronary heart disease in the next 10 years. It will also check to see if you may have metabolic syndrome, a group of risk factors that greatly increase your chances of developing cardiovascular disease, including stroke and diabetes. This Risk Assessment can be use by people age 20 or older who do not already have heart disease or diabetes." - American Heart Association (AHA) 

This tool might not change anything for you but like Continuous Chest Compression CPR - when you're in need sometimes a little can mean a lot. It can save a life and if you see a situation we hope you'll have the proper instructions. At the very least you'll view what you can - and do no harm.

The parishioner survived, did not suffer a stroke or heart attack but tests are still being performed. His condition is stable.

Natural Heart Care

The Mayo Clinic is known for quality health care and being in the forefront of research however when it comes to research review they're results not so forefront(y)! While the major publications (CNN,Reuters, US News and World Report, WebMD) find the review (based on a search of PubMed and MEDLINE databases, for literature on herbal supplements published between 1966 and 2008. Search terms included cardiovascular agents, complementary therapies, herb–drug interactions, and cardiovascular disease interactions) news worthy. We think their conclusions are very unnews worthy:

The authors encourage physicians to ask patients about concomitant use of herbal therapies, in particular among patients who are taking cardiovascular medications with narrow therapeutic windows such as digoxin and warfarin. Increases in research, which provides controlled clinical evaluations of herbal therapies and improvements in regulation and oversight of such therapies, are warranted. (Use of Herbal Products)

That reads more like a sticker on your drugstore medication than a careful well reasoned progressive scientific analysis.

Mayo's "Lean Enterprise Institute" which speaks of being "at the pinnacle of patient care, leadership keeps looking for ways to improve — and now they’re looking to lean." (PDF) We're all working with leaner resources and as patients will be making choices based on less income. What we don't need is for the best to do leaner research.

St. John's Wort is used to treat depression as a natural substitute to prescription drugs. As more and more people lose their jobs and health insurance natural and lower costs remedies seem more likely to be sought out.

"The "focus of cardiovascular research at Mayo is congestive heart failure. One of the questions that we've been dealing with is: What does the most dangerous snake in South America have to do with human heart failure? The answer is that the green mamba snake of South America and the human heart both produce very potent peptides that regulate heart and kidney function." Robert Simari, and I'm the chair of the cardiovascular research division at the Mayo Clinic in Rochester, Minnesota." (ABC News)

Natural remedies aren't unfounded in their claims for healthy results. The argument has to be what's best and affordable for those with and without the financial wherewithal to pay for the best treatment for the money. That's what real lean leadership should, in our opinion (though that should go without saying), be. What are the medical costs for such short cuts.

"Mayo Study Shows Stroke Incidence Related to Angioplasty Remains Steady over Past 15 Years - Research results 'somewhat surprising' because patients are older, have more complicated disease "Eighty-four patients, or three or four in 1,000 patients, had a stroke or a TIA, and 23 percent of those were mini-strokes, according to senior author Rajiv Gulati, M.D., Ph.D."

While such results for eighty-four patients is very good. We applaud this type of research from MAYO but for the suffering settling is not an option and any, especially natural or low cost, alternative would be desired. Scientific research is wonderful and we support it but it's not the be all and end all in every case or there would never be any side effects.

We do agree with MAYO's review conclusions. Before starting or ending any natural medicines or treatments please, please, please speak to your physician. More importantly try to find a physician who is knowledgeable enough about such treatments who can adequately address your condition and concerns. In our area there are plenty to choose from.

More Pepa Less Salt

The year was 1986 and our god brother was "knocked out" by two female rappers who wanted to "talk about sex, baby!" They were the multi-hued Salt & Pepa whose recent revival on VH1 and subsequent re-split has resulted in a separate show for the very bawdy Pepa.


What's this got to do with the recent news about the research on salt in our diets? We thought it timely. We've always known that too much salt has been harmful to us resulting in or contributing to hypertension, heart attacks and possibility leading to death. The life savings, to just our community would result in 2006, of 50,000* individuals.

We aren't our god brother and aren't a big Pepa fan. We like Salt. Pepa was too crude for our taste. If we keep the two a duo instead of a single act we'd, and in our opinion so would the women, be better off.

“Reducing dietary salt is one of those rare interventions that has a huge health benefit and actually saves large amounts of money. At a time when so much public debate has focused on the costs of health care for the sick, here is a simple remedy, already proven to be feasible in other countries,” said Lee Goldman, MD, MPH, senior author, executive vice president for health and biomedical sciences and dean of the faculties of health sciences and medicine at Columbia University. The American Heart Association (AHA) reports that salt consumption among Americans has risen by 50 percent and blood pressure has risen by nearly the same amount since the 1970s - despite evidence linking salt intake to high blood pressure and heart disease." (University of California San Francisco UCSF)

If we do an equal share of seasoning say instead of three shakes of the salt shaker do one and half and one and half of pepper. Or if that's not possible because for us adding salt is more of an automatic response regardless of how the food is prepared. We don't even taste the food before grabbing the salt. What we learn from eating out with friend, or at least what the men learn, is that your hostess is insulted by an automatic salt reach. Try some spices if pepper is your "salt." For some of us its spicy hot and for others its spicy sweet.

Now if only VH1 learns the same lesson cause we really don't want to talk about Pep! We will use her to emphasize a point that will help us all live longer use a celebrity to help us be a better we.

Reducing the salt and not eliminating salt from our diet is a couching activity we can take. It's not a pill but since it took the Food and Drug Administration (FDA) two (2) months to decide that Meridia can kills us. So waiting for a pill we can take might not be the scientific solution. Salt reductions might just be the science we need. It doesn't take making drastic changes that can't be maintained. It can only help. We can start this new year, new decade with a reasonable dedication we can sustain and so can you!

Smoke Attacks

Knowing is not enough; we must apply.
Willing is not enough; we must do" - Goethe

Maybe its just us but we like to go to the source and maybe only "squints" can get away with submitting a "uncorrected proofs" prepublication copy. We were never allowed to submit such a thing when we were in school but that was a long time ago. The Goethe quote comes from the pages of the report. What they found and published as a scientific evidence was the title "Secondhand Smoke Exposure and Cardiovascular Effects - Making Sense of the Evidence" concludes that: "...that data consistently demonstrates that secondhand-smoke exposure increases the risk of coronary heart disease and heart attacks and that smoking bans reduce this risk. Given the prevalence of heart attacks, and the resultant deaths, smoking bans can have a substantial impact on public health."

This might be news to smokers and the paid defenders of the "right to smoke"campaign but for those of us challenged breathers this isn't news. While some people might remember the movie Basic Instinct for Sharon Stone's legs - for us it was the lighting of her cigarette that preceded the crossing. That kind of smoke attack strikes us whenever we see a dangerous gang of smokers crowding the entrance of some public building. You have to take a deep breath before crossing their path and holding it until you can clear the area. This same type of physical reaction can occur whenever a person is terrified of being attacked.

The Center for Disease Control and Prevention (CDC) issued a statement in support of the report saying:

• "Exposure to secondhand smoke could cause acute coronary events, such as a heart attack.
• Evidence suggests that even brief secondhand smoke exposure might trigger a heart attack.
• Smoke-free bans decrease acute coronary events."

One of the wonderful things about our smokefree DC though there is no smokefree MD or VA. Whenever we travel south and stop through VA we have to share air space with smokers separated only by a door or partition. Whether or not Virginia adopts or makes any changes to current laws or not is yet to be determined. To those of us desperate to breath we'll just have to hold our breaths until then.

Bill Maher who we credit with the "thinning the herd" comment smoked up until a few (more than nine) years ago. Who knew that he was actively pursuing that goal. Now we know!

While we certainly felt attacked and all but the most dense of smokers thought somehow blowing their smoke in the air was effort enough for us as long as it wasn't in our faces. It's doubtful that even this report will be received with any more belief. To again quote Maher not as long as our Government "is a Mafia that wants a cut."

Heart Attack Squared

On our way to the office we stumbled on things you really should be aware of while getting away from stories that aren't as important as you might think. The story was that a new drug that might be a better way to prevent a second heart attack in some patients and the chances looked good. The study was presented at an European Society of Cardiology (ESC) and published yesterday in the New England Journal of Medicine. We went to NEJM and couldn't find it searching by the European Society of Cardiology or the University of Sheffeld which was conducting the research and we kept finding shiny articles that did appeal to us though we couldn't find the article on the drug. Then we searched for PLATO (the study's code name) and there were an editorial and an article. The editorial was free hence linked here. And the bad news from the editorial was: "The whole story concerning the adverse effects of ticagrelor may require evaluation in a much larger number of patients, something that may be beyond the capacity of a randomized trial. We should carefully monitor patients receiving this drug to establish the overall impact of its side effects. Finally, efforts to develop new effective and safe antithrombotic drug regimens should not be discouraged by the perception that an increase in antithrombotic efficacy is necessarily associated with a higher risk of bleeding."

Reading the abstract however gives you a different conclusion altogether: "In conclusion, in patients who had an acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor, as compared with clopidogrel, significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke, without an increase in the rate of overall major bleeding but with an increase in the rate of non–procedure-related bleeding."

You might die from standard treatment using current drugs but this new drug will kill less people so it's better! So the choice is change your lifestyle or take drugs that might kill you and don't change a thing? Hum? Hard choice to make.

Chocolate Heart Health

Chocolate saves a heart from breaking and now every news report is saying the same thing without asking the same question on aspirin - "How much is enough?" The Stockholm/Boston report says that even a little is better than none but with our obese lifestyle any excuse is a good excuse to eat chocolate. Not any candy mind you, the review of the data says it must be chocolate. We're giving "kisses" as our wedding favors and its great to know we're being life savers even if we didn't consciously make the decision.

We can only access the free abstract which says: "Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI. Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed."

From the very same Journal of Internal Medicine is a cautionary article publised earlier in the year: "The epidemic of obesity took off from about 1980 and in almost all countries has been rising inexorably ever since. Only in 1997 did WHO accept that this was a major public health problem and, even then, there was no accepted method for monitoring the problem in children."

While the reference is to Asia, Latin America and others to Swedish men obesity is a local problem with deadly consequences. Chocolate seems an easy solution to us the very lazy. Anything but diet and exercise and anytime the suggestion is adding chocolate to the mix whether it's coffee or candy - its the right perscription. A couple of kisses every other day sounds like just about the right amount IF we were to self medicate and we won't. We do have some extras though. There is a bag on the side of the bed so until their gone - what can it hurt?

While the review was of heart attack survivors the: "(o)bjectives. To assess the long-term effects of chocolate consumption amongst patients with established coronary heart disease. Design. In a population-based inception cohort study, we followed 1169 non-diabetic patients hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program." The news is reporting this as newest, greatest, latest health information clearly it isn't but we suggest that everyone use caution when following any advice, including ours.

Aspirin Cures Cancer

Another review of prior research finds that the most popular form of cancer can be cured or reduced with one of the cheapest and most popular drug on the market. What the report abstract does not answer is how much or how little is necessary to get the results. The danger is in playing doctor instead of seeing a doctor and as long lines form at the emergency room and longer wait times for scheduling an appointment with our favorite physician we may try to fix ourselves. Or even worse to delay treatment rather than seeking the advice of a qualified professional.

If we answer the question do we risk you the reader making the "self fix it" decision yourself? When the news of aspirin's amazing properties began to surface to the news we would personally supplement our own medical regime with a single aspirin before bed despite prior warnings to the contrary and usually when our own perscriptions had been depleted. As far back as March 2005 the New York Times reported: "Because aspirin carries a risk of bleeding, doctors do not currently advise healthy women or healthy men with no clear risk of heart disease to take aspirin to prevent heart attacks or strokes. The study results are unlikely to change that practice."

Don't self medicate! Don't self medicate! Don't self medicate! Now how much is enough? The report does not suggest however earlier reports suggest a baby aspirin amount of a single tablet. Our own usage was always in excess of the recommended amount. A single dollar store tablet is 325 mg and the recommended amount in a child dosage is 85mg.

Our use was daily and though aspirin doesn't protect women from heart attacks their studies showed less usage provided an equal amount of results from a less frequent amount of aspirin. "Regular use of low-dose aspirin does not prevent first heart attacks in women younger than 65, as it does in men, a 10-year study of healthy women has found... ...The amount of aspirin taken by subjects in the Women's Health Study - 100 milligrams every other day - is less than the amount one gets from taking a baby aspirin, which contains 81 milligrams, every day. But the researchers noted that the smaller amount still had the intended effect on blood clotting, as evidenced by blood analyses, by reduced risk of stroke and by the greater incidence of bleeding" the March 2008 New York Times reported.

Aspirin is still a medicine and like any medicine its got its up cancer curing side and its bleeding ulcer, suicide pill of choice down side. Lets leave the prescribing to the professionals.

The Positive on The Negative

The hippie, feel good, new age, "let it all hangout" lifestyle is vindicated once again especially for our targeted concern. US News reported today: "The new research, detailed in the journal Circulation, also found that women with a high degree of cynical hostility — defined as harboring hostile thoughts toward others or having a general mistrust of people — were at a higher risk of dying in general..."

Circulation: Journal of the American Heart Association had the facts in abstract form and you are invited to look at their numbers or purchase the full study which involves our subset of diabetic women without the obvious "lose weight" advice. We can do this and we suggest that we all take the advice to watch something funny on TV for thirty (30) minutes each day with surprising results. Begin listening at three minutes and fifty seconds (3:50) into the podcast. "The findings, presented at the Experimental Biology conference in New Orleans, show that after one year the group prescribed laughter saw a 26 per cent rise in their good cholesterol. Patients who took the medication without any extra laughter had just a 3 per cent rise. The group watching comedy programmes also saw a drop of 66 per cent in the amount of harmful C-reactive proteins, which increase the risk of heart disease, in their bodies. While the control group also saw a fall in the amount of the proteins, it was much smaller at 26 per cent over the course of the year."

How do you know what makes a person optimistic? Food Consumer found from the study: "Optimism was described as expecting that good, rather than bad, things will happen. The nearly 100,000 participants were asked such questions as "In unclear times, I usually expect the best," or, conversely, "It is safer to trust no one."

Does it really make that much of a difference? If you asked that question don't count yourself as an "up" person. WebMD translated the figures: "Optimistic African-American women had a 33% lower risk for death than African-American women who were pessimists. Among white women, the survival advantage for optimists was 13%. African-American women who scored highest for hostility and cynicism were 62% more likely to die than African-American women who scored lowest." Don't worry be happy!

Worst / Best Attacks

What we try to do here is to look at national news health stories and find how they relate to our jursidiction. Sometimes that's pretty simple and fairly easy to do and then came ABC News Men's Health Coverage. Their report based on Circulation's article appears to go beyond what's included. Now if we were physicians or more medically trained we might be better able to decipher the contents. What's missing from the story and the full text of the article are the specifics by state of the best hospitals for treatment of heart problems. Our jursidiction (DC, MD and VA) are not in the top or the bottom of the list.

The report authors place their emphasis on changing the process for treating individuals with heart problems. In an emergency situation such information is crucial. The rule of thumb is you have twenty (20) minutes to receive treatment for a heart attack if you are to survive without any permanent damage or if you are to fully recover from your "episode." Like somehow this is the next installment of "This Is Your Life - the series." This IS your life and not a reality show slated for the new fall season on ABC-TV.

The problem with the reports findings according to the authors are: "At the time of the measurement, there were no financial incentives for hospitals or the community to focus on this aspect of care. In fact, hospitals are penalized by reducing readmission rates, as this would adversely affect hospital revenues." (PDF)

Their solution: Another study on how the rates can be improved for all hospitals. Our opinion: You might not want to spend your 20 minutes trying to get to New Jersey it just might be that hospitals there just have higher revenues (read profits) and NOT better care. In any event the authors state that the differences aren't very large between the best and the worst which is a very LARGE concern to all of us.