When someone says heart attack you think of a dramatic pain that could possibly quickly end your life. However, the reality is twenty percent (American Heart Association 2022 data) of heart attacks are silent: there is no dramatic pain. The popularized notion of a load of bricks sitting on your chest does not always occur. Some experts expand that to fifty percent being silent heart attacks.
A Heart Attack occurs when heart muscle blood supply, bringing nutrients and oxygen, is decreased or stopped. You feel pain because of a blockage, partial or complete. Commonly silent heart attacks are written off as indigestion, sprain in the chest muscle, being tired, or just being run down. In retrospect, when you later recognized you’ve had an attack, you recall an experience such as shortness of breath and general discomfort which led to a night of poor sleep.
Often the most subtle body sensations are: not feeling quite yourself, suddenly sweating, becoming dizzy, and angina (pain from a decrease of blood to the heart muscle). For women the sensation of having a tight bra might be the only hint they’re having angina or heart attack. If these symptoms persist, they can lead to a heart attack. Angina may be reversible but the longer the lack of good blood supply, hence lower oxygen to the heart muscle, the more likely irreversible damage will kill heart muscle – that is a myocardial infarction- MI.
If you’re diabetic, recognizing your heart is talking to you may more easily be missed due to pain signals being dampened by neuropathy. Hence a diabetic person is at a greater risk for a silent heart attack.
Those with minimal symptoms, that is no warning sign, are often fooled or are misdiagnosed. The shortness of breath in a slightly obese woman is thought to be a blood clot coming from the leg to the lung or pain in the arm or shoulder is thought to be arthritis but in reality, could be a heart event. One helpful thing is that if your pain does not change with position or taking deep breaths then it is not musculoskeletal, and could be related to your heart. If you’re exerting yourself and your pain gets worse that would mean you’re not getting enough oxygen and the discomfort is related to your heart. If you feel better at rest when the need for oxygen to your heart muscle is less -then your symptoms could be related to the heart.
Past blogs discussed heart disease risk factors. Refresher – women 55 and older, men 45 and older, carrying excess weight, high blood pressure, high cholesterol, lack of exercise, positive heart history, smoker, family history, and of course Diabetes. You do not need to have a specific number to increase risk. Yes, there are young people with heart attacks because they use drugs or have a hereditary or congenital problem.
Not surprising if you have had a silent heart attack you are more likely to have a stroke, sudden death, or obviously another heart attack. Whenever a heart is stressed there is an increased risk for the heart to start beating in an irregular manner (arrhythmia) and cause blood clots to form.
Message – Pay Attention to changes in the patterns in your body. My mantra, you all know, if your body talks to you it’s important to listen. Pay attention to discomforts. their patterns, and predictability like with exertion. Note especially symptoms such as shortness of breath, weakness, fatigue, not quite feeling right, sweating, nausea, vomiting, lightheadedness, dizziness, pain in the back, arms like a sprain or pulled muscle, mild throat pain or chest discomfort,
Please consider the possibility that you are having a cardiac event. Remember they don’t have to be dramatic. Not everyone has the sensation of impending doom when they are having a heart attack. Not everyone clutches their chest like on the big screen!
Until today in this blog and in many media outlets you have read or heard ‘exercise with diet’ is the only way to lose weight. Well, I’ve got news from a group of researchers who state that eating within a specific eight-hour window can cause weight loss.
In a recently published JAMA Internal Medicine article, eating within a 12-hour time frame was compared to limiting caloric intake to an eight-hour time frame (7 AM to 3 PM in this study). Using the eight-hour window, individuals lost an additional 5 pounds over 14 weeks. The eight-hour window, however, wasn’t much help for shedding body fat specifically but a bonus was the lowering of the diastolic blood pressure (the second number in BP reading – the minimum pressure during relaxation and dilatation of the heart when the ventricles fill with blood). No other cardiovascular benefits were noted in the study details. The study include 59 participants, and as I stated above, ran for a 14-week period. I think it is especially noteworthy that an improved mood and sleep pattern were also seen. The detailed evaluation noted improved sub-scores for mood, vigor vs. activity, and fatigue vs. inertia. But this can have a subjective component, I feel. Important to note that within the study not everyone complied for seven days per week, the average was six days per week eating during the eight-hour period.
An earlier study this year (published New England Journal of Medicine), used the same concept – a time-restricted diet but adding a caloric restriction based on individuals’ activity level. In this study there were 90 participants, mean age of 43 – and 80% were women, all with BMIs from 30 to 60. All participants received weight loss counseling and energy restrictions followed by a caloric restricted diet of 500 cal per day below their energy expenditure. They were exercising 75 to 150 minutes per week depending on their baseline physical activity. They were analyzed for how much they exercised and they were restricted to eating from 8 AM to 4 PM.
However, these researchers found it didn’t result in a significantly greater amount of weight loss compared to just limiting your total caloric intake. Differing outcomes from similar studies are frequent in the medical literature. A careful review of specifics and outcomes is quite important for readers.
One difference between the two trials was the eight-hour time frame, the trial published in the New England Journal of Medicine studied it from 8 AM to 4 PM versus the 7 AM to 3 PM trial in JAMA Internal Medicine. So the question becomes does timing matter when it comes to eating? It matters. Regardless of the study differences, I believe the existence of benefits from adherence to a consistently limited eating time is best for our bodies.
Having your caloric intake limited according to energy expenditure appears to be relevant for weight loss. Hope this blog arms you with insights to help in your diet.
More than two-thirds of Americans are considered overweight or obese. What directly results is an increase in heart (cardiovascular) disease, diabetes, and cancer. Per the CDC data, more than 2/3 of Americans are considered overweight that being obese. The US spends the most per GDP on healthcare, approx. 3.6 trillion a year. Per capita, the highest worldwide spent than many countries with a longer life expectancy and better medical outcomes. So what’s up? What are we doing wrong?
A recent study, published in Nutrients, shows it’s our diet. Americans have a poor quality diet, which authors state is the primary cause of death in the United States. Fact is the majority of deaths per year are related to cardiovascular disease and other bad health conditions related to poor eating habits and obesity.
Many have tried to solve problems with fad diets, they are everywhere, with complex rules and schedules which some find nearly impossible to adhere to. Bottom line many studies have shown that eating whole foods and placing them in the center of your diet will benefit nutritional intake. Actually having a whole fruit that has high vitamins is better than having a supplement of high nutrient content.
Findings suggest eating a Whole Foods diet helps and promotes weight loss. It refers to acquiring nutrients through a diet with large amounts of non-starchy vegetables like carrots and string beans, fruits either frozen or fresh, whole-grain, and plant-based drinks (unsweet and soy or nut beverage, green tea decaf coffee, and tea).Look to seeds rich, in omega-3, (chai and flaxseed) to acquire this important body nutrient.Also recommended is to limit the amount of high-fat plant foods like nuts seeds coconut and avocado, dried fruit, and refined flours. Wheat, gluten foods like tofu, and soy protein are to be limited. Seriously noted is attention to moderate alcohol intake.
Absolute avoidance of refined flours added oils and solid fats, no sweets – you know that means candies, cookies, and pastries are recommended. Also absolutely, no artificially sweetened beverages, This diet ‘outlaws’ eating animal products such as poultry seafood eggs, and dairy.
This really is a new approach, incorporating some old well-known aspects. You all by now, know about the negative health impact of consuming processed foods, studies abound about the ultra-processed risk for heart disease. One study I am thinking of collected data from over 100,000 individuals, 18 and older, and tracked them for 5 1/half years. Findings that those consuming ultra-processed foods were at higher risk of cardiac disease, coronary artery, and also cerebral vascular all were statistically significant. Many other studies are available in the literature.
Please consider incorporating this regimen, especially a plant-based diet.
The American Heart Association (AHA ) just published updates to ‘Life’s Simple 7 ‘, a formula for assessing heart health. They have added sleep, thereby now making it ‘Life’s Simple 8™?’ for those age 2 and up.In this blog, I will recap changes to the previously known ‘Life’s Simple 7™?’.
No surprise, they upped the importance of diet specifying the DASH diet and the Mediterranean diet as being especially important for heart health. Another no-brainer, as far as I’m concerned, is qualifying exposure to nicotine specifically vaping and secondhand smoke. Also, the metrics favored the importance of blood lipids and glucose levels. Unchanged are criteria of Physical activity, BMI (body size), and blood pressure. The intent is to identify essential conditions – 8 – relevant to heart health. Using a weighted tool of these 8 distinct factors, a cardiovascular metric emerges ranging from 0 to 100 with scores below 50 indicating low cardiovascular health, those between 50 and 75 moderate cardiovascular health, and those over 75 indicating high cardiovascular health. Sadly only 20% of US adults have a high cardiovascular health standing.60% are estimated to have a moderate lifestyle in cardiovascular health. This data is based on the National Health and Nutrition examination survey (2013 and 2018). You can follow this link and learn your percentile from this online tool. FYI: one needs to create a login and password on the AHA site.Site questions include your answers to diet, physical activity, nicotine exposure, sleep health (new), body mass index, blood lipids, blood glucose (blood sugar levels), and blood pressure.
Adding sleep as a component for good heart health is the big news, I feel.Optimally sleeping is from 7 to 9 hours daily for adults. Children’s sleep points will vary on achieving age-appropriate optimal ranges.
Many of us use wearable technology to generate information regarding our diet, exercise, and sleep. This information is hopefully going to be used in the future. Interestingly self-reported sleep doesn’t always correlate with the objectives of sleep duration measured by these devices. I am sure many wearable tech studies are underway presently. Perhaps those studies will be a good subject for a blog post in the future.
Now’s a perfect time is now to think about how to safely enjoy summer. The next few blogs will cover care for common summer skin issues. I will share information and the management of Heat rash, Poison Ivy, Insects Stings, Sunburn, and Acne Breakouts.
Also known as miliaria rubra, occurs when sweat glands become clogged, resulting in redness (inflammation), swelling, and itching. The rash will occur especially in creases where sweat accumulates. Humidity, heat, and tight clothes will make rash commonly appear in areas like the groin area, buttock crease, and under breasts. Prevention is best, Many who are susceptible use agents such as Desitin®, a zinc oxide preparation to prevent and treat.However once a rash erupts, good hygiene and application of OTC hydrocortisone cream three times a day should help. If not improved after 4 days please see a dermatologist.
Learn to recognize this three-leafed plant and stay away from it.Once it’s on your skin and it itches you’ll scratch and spread it elsewhere. If you’ve been exposed to poison ivy, you must, within an hour, wash the body parts exposed, including the scalp, and hands, and take special care to wash under your nails.Clothes must also be washed. If you were out and wearing sunscreen that will create a barrier if you should inadvertently come in contact with Poison Ivy. Now if you have a mild case, the itching can be reduced by applying topical Hydrocortisone cream that’s available over the counter. Cold compress application can decrease the itching sensation. If an extensive area of your skin is involved you may need oral steroids to get control of the itching and the spreading and to suppress the inflammation. There’s always a risk of infection of the lesions. So keeping it clean trying not to scratch – under our nails is not very clean.
Insect stings are very concerning especially if you are allergic. If you know you are allergic and carry an EpiPen, you should notify those who are with you. Before you go outdoors think about the insect(s) you’re allergic to that might be present and where they might be. Do not use any scented products such as shampoos, soaps, lotions, perfumes, aftershaves, or sunscreens that might attract insects.
Again focus on the prevention. Wear protective clothing, and use bed nets and tent screens. Some repellents are chemical irritants to our skin. However, there are now many natural safe insect repellents.
Bumble bees, wasps, hornets, and yellow jackets all can inject their venom into your body with stingers, but only honey bees can leave the stinger embedded in your flesh. Should you be stung by a bee make sure there is no ‘stinger’ remaining in the skin. Use your magnifier from your smartphone to examine the sting area for a remaining ‘stinger’.If you are not sure whether or not the ‘stinger’ is still present,be safe and use a credit card and flick over the sting site. Then wash the area of the sting and apply a cold compress to reduce swelling and itching. You might apply hydrocortisone cream to further reduce inflammation.
The sting site should start to clear up in a few days.If swelling increases and/or redness intensifies you will need to seek medical care. Sting sites can get infected! Bites from insects such as spiders, fire ants mosquitoes, fleas, and ticks require special consideration. Information for a future blog.
Watch for my next blog on Sunburn, and Acne Breakouts
Every July new medical school graduates appear as interns on the floors of hospitals and clinics throughout the US. Interns are considered physicians in training and cannot practice medicine without supervision. Many have had undergraduate training out of the country. I wanted to share, at this time of year, a bit about changes at your local hospital that you must be aware of. No matter in July you are either already in hospital or about to be admitted into.
This sets up a challenging time for patients, as well as for the new interns. The senior residents are gone and maybe last year’s interns stayed on to become residents in the same program. Rotation also occurs with supervisors that are the ‘attending’. I mention this as they are responsible for your care. Their name is probably on your wristband.
The concern is how the hospital and medical training programs ensure continuity of care. This can be critical to your medical care if you happened to be in a hospital in early July.
The most competitive fields, including family medicine residency, psychiatry, internal medicine residency, anesthesiology, and pediatrics, see more than 70 applications from one candidate.In 2020 the American Academy of Family Physicians (AAFP) said the most people ever matched to family practice residency. They offered 4935 positions they matched4470 with medical student graduates, of which 1555 are from US medical schools 1496 were from osteopathic medical schools. 779 matched were US citizens who graduated from international medical schools, and 458 places went to foreign-born international medical graduates. To put in perspective family medicine represents only 12.2% of all US medical graduates that matched in the 2022 programs.
IMGs -International medical graduates are either US IMGs or Non-US. IMGs can apply to US internships.US IMGs are citizens of the United States who graduated from international medical schools, while Non-US IMGs are not US citizens who graduated from international med schools. if you are a US citizen educated in one of the Caribbean medical schools, for example, you are a US IMG. There is fierce competition. Recently US IMGs matched at an approximate 59.5% rate while non-US IMGs matched at a rate of 54.8%.
FYI: recall interns are considered physicians in training and cannot practice medicine without supervision. The average medical intern salary is $65,000. – $30.74/hr. Extremes occur in Alabama pays $45,00 while Vermont ($86,435) and Washington state ($81,700) are highest
PLEASE It is your health so do not be afraid to ask questions, especially for clarification. You have a right to ask to speak to the attending physician.
It was a wonderful vacation, as I imagine anyone who has finally mentally and physically left the COVID safe ‘coup’. However, this is not what my returning blog is about.
NOW TO THE OFFICIAL BLOG!
It’s here again, cause it never left. The COVID-19 ‘numbers’ are up but what are the real numbers? Everyone has viral antigen tests at home and if they feel not so bad and test positive they just go to ‘ground’ till they stop shedding (spreading) viruses by testing negative. At least I hope they do. Truly presently we really do not know how many active cases there are in the US. The most reliable indicator is the number of hospitalizations I think broadcasting test positive numbers needs to stop, it’s a waste, it’s a waste of resources money, and talent as well as an artificial and misleading headline.
Yes, new SARS-CoV-2 sub-variants BA4-BA.5 are guilty, but so is nice weather going outdoors, meetings, and gatherings. Recall this virus can spread even outdoors but to a LESSER EXTENT. It is naive to think one is ‘safe’ from infection if outdoors.
Remember the whole logic of quarantining, especially in China, is because the hospitals can easily become overwhelmed by a sudden massive number of ill people. Please let this concept sink in, it is the only rationale for ‘lock-down’.
No matter what potential pathogens are endemic, pandemic, or epidemic, those of us with underlying conditions, poor immunity, and hence considered high risk should always be extra careful. This means avoiding exposure to ill individuals, social distancing, hand washing, and wearing a mask.
Yes, I know about monkeypox as the latest health concern, but honestly, gun issues are so much more concerning! If we all were to use basic common sense strategies when it comes to our health, I believe we can be safe from monkeypox.
It’s long been known that the Mediterranean diet, fiber, a modest amount of wine preferably red, and exercise can help to reduce the risk of a heart attack. There are many actions we can take to insure a healthy heart. After all Cardiovascular disease is the leading killer worldwide. 18 million people die every year according to the World Health Organization (WHO), and in the US alone the quote from the CDC is that heart disease takes a life every 36 seconds. Research now has suggested another helpful dietary consideration for us. Recent study strongly shows that both men and women eating avocados, will have a heart disease reduction of up to 21%
This study published in the Journal of the American Heart Association (JAHA) revealed that eating two servings of avocados makes the difference. A serving of an avocado is defined as half an avocado or half a cup of avocado roughly 80 grams. This amount was used in this Harvard School of Public Health study. American Heart Association (AHA) publishes suggestions as to a heart healthy diet. Perhaps now they wanted to add to the famous Mediterranean diet that’s rich in vegetables and fruits -avocados? Don’t forget the olive oil.
The study was formidable. It followed over 108,000 people, including 68,000 women. Government studies have used data from the healthcare profession, famously called the Nurses Health Study and the Health Professionals Follow Up Study. These offer ongoing data from decades. Participants completed a dietary questionnaire every 4 years for 30 years. Be sure, before starting, all were screened to make sure they did not have cancer, stroke, or any signs of heart disease.
Consuming two servings a week (serving -avocado a quarter a cup ) instead of the eggs, yogurt cheese, butter, processed meats, and bacon actually lowered the risk of heart attacks by 16 to 22%. However incidence of stroke were not decreased. Important point is that you’re swapping out offenders for avocado in your diet. Interestingly noted, if instead of pricy avocado an equivalent of olive oil or any other plants or even nuts was eaten –the same findings were noted.
Can’t get good avocados or they’re too expensive think walnuts or almonds substitute. It is very easy to spread any sandwich, especially ones with high cholesterol with some avocado instead of butter or margarine or processed meat or cheese. Avocados are particularly rich in polyunsaturated fat and fiber and also contain monounsaturated fat. The same is also found in olives, olive oil, almonds and a variety of seeds such as flax and pumpkin. There are other things with lower price points than avocado such as beans, chickpeas, lentils, and quinoa which are enjoying popularity in salads.
Avocados had the lowest levels of pesticides among the 46 foods recently tested, followed by sweet corn, pineapple, onions and papaya. Issued yearly since 2004, the EWG report uses US Department of Agriculture (USDA) test data to rank 46 foods that are the most and least contaminated with pesticide residues. The USDA staffers prepare the food as consumers would — washing, peeling or scrubbing — before testing each item.
You are thinking avocados have fat, but our body does need some fats, so it is not totally wrong to have some sources of mono & polyunsaturated fats. These are and can be healthy choices. It’s the saturated fats and trans fats that raise LDL or commonly referred to as the ‘bad cholesterol. Recall saturated fats are found in butter eggs, coconut, palm oil, and of course fatty cuts of pork and beef cuts and don’t forget the skin on chicken. Please don’t think if you burn the skin of the chicken on the grill and eat that it’s OK. Proteins that are burnt black are carcinogenic. Carbohydrate that is charred, think bread, acts as charcoal and can absorb toxins in the gut.
Use the above information to help your heart and that of your loved ones. Spread the word and avocado!
Don’t let the last two years of viral pandemics deter you from enjoying life. For many, travel is one of the real joys of life. If you are like most of us you are planning a trip very soon. We are all ready to get back to the ‘old normal’ and abandon the ‘new normal’. I am not suggesting that the coast is totally clear nor that the authorities of healthcare have given the all-clear signal. There are still outbreaks in many countries of the Omicron sub-variant B.2. The UK just reported last week a daily average of 75,100 new cases. The dominant culprit there is the sub-variant B.2. This is a concern, but as yet we have not seen dramatic outbreaks in the United States, and we may not in the future. This variant appears not to cause severe illnesses, witnessed by the fact there has been no increase in deaths where there are outbreaks. Many are vaccinated and some are still wearing masks but I really think we’re on the downhill of this pandemic. I feel this so strongly, I will be traveling the day this is posted and will be crossing the pond to Europ.
Before we get to personal particulars, we need to consider if you are in the group recommended to have a 2nd booster. On March 29, 2022, the CDC made recommendations, following the FDA, for a second booster vaccine. In summary, certain immunocompromised individuals and people over the age of 50 who received an initial booster dose at least 4 months ago are eligible for another mRNA booster to increase their protection against severe disease from COVID-19. At this time, not much hard data for the merit of this exists. A study from Israel was just published in NEJM. This large study (1.2 million adults over 60) showed a second booster( fourth shot of Pfizer mRNA vaccine) provides short-term protection and a modest absolute benefit. Those who received a second booster were 78 percent less likely to die of Covid-19 than those who had received just one booster shot. Protection against infection appeared to peak four weeks after the second booster and by week 8, protection disappeared. Again this is an ongoing study, and only short duration data is available on these older adults.
Traveling safe means pre-planning and thoughtful packing. Your customary medications must be packed, and carry two days’ worth on your person in case luggage is lost. Recent imaging studies for conditions you are recovering from should be printed and packed. Should you need a refill early for your trip, ask the pharmacy, as they usually will accommodate your need. I carry a typed one-page summary of my medical history including medications. I don’t take my insurance cards unless staying in the US. I am packing masks with me, although shortly (April 18) airplanes in the US will follow others (British Airways, Icelandair, EasyJet) dropping requirements to wear while onboard. Yes, my hand sanitizer (80% alcohol) is on my person. Yes, airplanes are cleaned after flights but I keep it handy for onboard use in the lavatory or before meals and snacks.
I am not discounting a distinct possibility that an outbreak of new variants could emerge while I am on vacation. It has happened, usually, when a large number of individuals become infected, a new or sub-variant arises. Remember Delta variant gave way to Omicron variant and Omicron to its sub-variant- B.2. You know I will be wearing a mask. I don’t count on being able to buy masks, neither should you even if you are staying in the US. A short supply of products like masks is possible. Be prepared for your safe trip.