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NO
MEETINGS IN JULY AND AUGUST
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CONTENTS
From Barbara
Two Patients
National Stroke Awareness Month
Seven Easy Ways for a Healthier Future
Theft Warning
Member Response to Survey
Female Heart Attacks
Keeping Safe in the
Tips to Keep your Skin Healthy
Tips to Beat the Heat
Statins
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FROM BARBARA
Well, I went on a bus trip over Memorial Weekend to the west coast of
The first day we went to the Hard Rock Casino in
The second day the bus made a couple of stops at shopping areas and, as
I really didn’t need anything and didn’t want to do the bus steps more than I
had to, I stayed on board. We then went
to a Holiday Inn whose handicap room was also good and here they did have a
roll-in shower. They even had an ironing
board and iron – but the iron was so high up that it would be impossible for
someone in a chair to reach it.
Just an aside – both Holiday Inns had king size beds in them. Why can’t we make the hotel/motel industry
understand that many disabled don’t travel with spouses or significant others
but with caretakers who we really don’t want to share a bed with. Both Holiday Inns offered to put a fold-up
bed in for us, but that takes away space that we need for our scooters or
wheelchairs.
That second night we went to a dinner theatre in
Now, the highlight of the bus tour – the next day we went to the
In order to do bus trips like this it is most important that the tour
director and the bus driver know that you use a scooter and are willing
to be there to assist you when needed.
Also took another plane trip to Long Island, this time taking a scooter
back – it’s important to call the airline at least 48 hours before your flight
and remind (or tell) them that you are bringing a scooter or power chair on and
what type of batteries it uses. I had
forgotten this on my previous trip to
Believe it or not, I took the newer scooter to leave on Long Island and
am now using the older (1998) one here – reason:- the
mechanics needed for the remote door in the back of the mini-van took up too
much room for the slightly larger new scooter and I had a harder time putting
it in and taking it out of the mini-van so I decided that as the older scooter
works perfectly, why knock myself out each time I needed to take the scooter
out. Remember we now have to “conserve
it to preserve it” – and that’s what I decided to do.
No problems going up or coming back down to
**********************************************
The below was e-mailed to us by member Bob Barry. Thanks, Bob – also, unfortunately its most likely true.
Two
patients
Two patients limp into two different
medical clinics with the same complaint. Both have trouble walking and appear
to
require a hip replacement.
The FIRST patient is examined within the hour, is x-rayed the same day and has
a time booked for surgery the following week.
The SECOND sees his family doctor after waiting 3 weeks for an appointment,
then waits 8 weeks to see a specialist, then gets an x-ray, which isn't
reviewed for another week, and finally has his surgery scheduled for a month
from then.
Why the different treatment for the
two patients?
The FIRST is a Golden Retriever.
The SECOND is a Senior Citizen.
**********************************************
In today’s mail (May 30th) I
received the May/June issue of
Celebrate
May as
National
Stroke Awareness Month
Learn
how to prevent strokes and
the warning signs to look for.
Nearly
five million people in the
Strokes
are a leading cause of death and disability in older patients. For each decade after age 55, the risk of
stroke doubles for men and women. The good news is 80 percent of all strokes
are preventable.
This
is the perfect time to familiarize yourself with the
warning signs of strokes and learn how they can be prevented.
What is a stroke?
A
stroke or “brain attack” occurs when a blood clot blocks an artery or a blood
vessel breaks, interrupting blood flow to an area of the brain. This deprives oxygen to the brain, which
causes brain cells to die, and brain damage to occur.
When
brain cells die during a stroke, abilities controlled by that area of the brain
are lost. These abilities include
speech, movement and memory. How a
stroke patient is affected depends on where the stroke occurs in the brain and
how much of the brain is damaged.
If
the symptoms of a stroke resolve within an hour to 24 hours, the diagnosis is
transient ischemic attack (TIA), which is commonly called a mini or brief
stroke. This kind of attack may be a
warning sign that you may develop strokes in the future. More than one-third of all people who have
experienced a TIA will go on to have an actual stroke. Research shows there is about a 10 to 15
percent chance of suffering a stroke in the year following a TIA. Consult with your physician to reduce your
chances of suffering an ischemic stroke.
Warning signs
The
symptoms of stroke depend on the type of stroke and the area of the brain
affected.
Common stroke symptoms include:
·
Sudden
numbness or weakness of face, arm or leg (especially on one side of the body);
·
Sudden
confusion, trouble speaking or understanding;
·
Sudden
trouble seeing in one or both eyes;
·
Sudden
trouble walking, dizziness, loss of balance or coordination; or
·
Sudden
severe headache with no known cause.
Severity of symptoms
can differ depending on the size of the stroke.
Patients who have a small stroke may experience only minor problems such
as weakness of an arm or leg. People who
have larger strokes may be paralyzed on one side or lose their ability to
speak.
A stroke is a medical
emergency. The longer blood flow is shut
off to the brain, the greater the damage.
Knowing how to recognize the symptoms of a stroke is important because
every minute counts. Immediate treatment
can save lives and enhance the chance of a full recovery.
Risk factors
The risk factors for stroke include
increasing age, family history, race, prior strokes, high blood pressure;
cigarette smoking, diabetes, heart disease and excessive alcohol consumption.
One
of the most significant stroke risk factors is age. Ninety-five percent of strokes occur in
people age 45 and older, and two-thirds of strokes occur in those over the age
of 65.
According
to a study by the National Institute of Neurological Disorders and Stroke,
older adults with sleep apnea may face a more than doubled risk of stroke. Researchers found undiagnosed sleep apnea
increased the risk of stroke by 2.5 times among the older adults.
If
you eat right, exercise regularly, don’t smoke, and manage illnesses such as
high blood pressure, heart disease and diabetes, you can greatly lower your
chances of suffering a stroke.
Recovery
While
it is possible to recover completely from a stroke, more than two-thirds of
survivors will have some type of disability.
The effects of a stroke range from mild to severe and can include
paralysis, problems with thinking, problems with
speaking and emotional problems.
Numbness or pain may occur in patients who have suffered a stroke.
Rehabilitation
is an important part of recovering from a stroke. Through rehabili-tation,
patients can relearn or regain basic skills such as speaking, eating, dressing
and walking. Rehabilitation starts in
the hospital as soon as possible after the stroke and may begin within two days
after the stroke has occurred. Home
therapy or out-patient therapy usually continues as necessary after leaving the
hospital.
While
there are many rehabilitative treatments for strokes, the best way to keep yourself healthy is prevention.
~*~*~*~*~*~
Myths About Strokes
·
Strokes
are unpreventable.
·
Strokes
cannot be treated.
·
Strokes
only strike the elderly.
·
Stokes
happens to the heart.
·
Stroke
recovery only happens for a few months following a stroke.
Reality Checks About Strokes
·
Strokes
are largely preventable.
·
Strokes
require emergency treatment.
·
Strokes
can happen to anyone.
·
Strokes
are a “Brain Attack”.
·
Stroke
recovery continues throughout life.
Source: National Stroke Association
**********************************************
Another one from Elder Update’s
May/June 2007 issue –
Seven Easy Ways You Can
Make
Choices for a Healthier
Future
It
is easier than you might think to live healthfully. Making small changes in your everyday life
can allow you to live healthier and feel better. Following these seven tips will help you
start feeling better today!
1. Work out
It is never too late to start moving
more. Physical activity can help manage
health problems like arthritis, osteoporosis and heart disease. It can keep your body flexible, keep your bones
and muscles strong, keep your heart and lungs healthy and control high blood
sugar. Doctors say even 10 minutes of
physical activity a day is enough to make health improvements.
2. Exercise your mind
Just like your body needs exercise to stay strong, your mind also needs
a work out from time to time. One way to
keep your mind sharp is by continuing to challenge yourself. An active brain produces new connections between
nerve cells that allow cells to communicate with each other more effectively. This makes storing and retrieving information
easier. Try learning to play a musical
instrument, play a game or complete a crossword puzzle, learn a foreign
language, take a class, read a book or start up a new hobby.
3. Adopt a positive outlook
Your attitude has a lot to do with how good you feel, but it may also
impact how long you live. A study by the
Mayo Clinic found that optimistic people decreased their risk of early death by
50 percent.
4. Adopt a Pet
According to the Center for Interaction of Animals and Society, animals
can help you more effectively handle stress and survive a heart attack. Owning a pet may help reduce stress, assist
in dealing with grief and loss, make depression less likely, and often
increased feelings of personal security.
5. Take a nap
Taking a nap in the middle of the day can decrease your chances of a
heart attack. According to a study by
the American Medical Association, people who napped occasionally had a 12
percent lower risk of dying from heart disease and those who napped regularly
had a 37 percent lower risk.
6. Volunteer
Helping out in your community is a great way to stay connected. A study by the
7. Go nuts
The U.S. Food and Drug Administration suggests
that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated
fat and cholesterol, may reduce the risk of heart disease. Though nuts are a higher-fat food, they
contain heart-healthy unsaturated fat and may help lower low-density lipoprotein
levels (LDL), which is often called “bad cholesterol.” Try eating a handful of walnuts or almonds a
day. They are especially nutritious
because they are low in saturated fat and contain calcium and potassium.
FECPPSG Editor’s Note:- Remember, these “tips” are written for able-bodied
seniors. Please be careful when
following some of these “tips.”
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The following was e-mailed to me
earlier this year. Even though it’s
geared to the female body, I think some men can most likely relate to it. Barbara
THEFT
WARNING FOR WOMEN
Most of you have read
the scare-mail about the person whose kidneys were stolen while he was passed
out. Well, read on. While the kidney story was an urban legend, this one is
not. It's happening every day.
My thighs were stolen from me during the night a few years ago. It was just
that quick. I went to sleep in my body and woke up with someone else's thighs.
The new ones had the texture of cooked oatmeal. Who would have done such a
cruel thing to legs that had been mine for years? Whose thighs were these and
what happened to mine? Hurt and angry, I resigned myself to living out my life
in jeans and Sheer Energy pantyhose.
Then, just when my guard was down, the thieves struck again. My butt was next.
I knew it was the same gang, because they took pains to match my new rear end
to the thighs they stuck me with earlier. I couldn't believe that my new butt
was attached at least three inches lower than my original. Now, my rear complemented
my legs, lump for lump. Frantic, I prayed that long skirts would stay in
fashion.
It was two years ago when I realized
my arms had been switched. One morning I was fixing my hair and I watched
horrified but fascinated as the flesh of my upper arms swung to and fro with
the motion of the hairbrush. This was really getting scary. My body was being
replaced one section at a time. How clever and fiendish.
Age? Age had nothing to do with it. Age is
supposed to creep up, unnoticed, something like maturity. NO, I was being
attacked repeatedly and without warning.
In despair, I gave up my T-shirts.
What could they do to me next?
My poor neck suddenly disappeared faster than the Thanksgiving turkey it now
resembled. That's why I decided to tell my story. I can't take on the medical
profession by myself.
Women of the world...
WAKE UP AND SMELL THE COFFEE!
That really isn't plastic that those surgeons are using. You KNOW where they
are getting those replacement parts, don't you? The next time you suspect someone
has had a face "lifted," look again. Was it lifted from you? I think I finally found my thighs-- and I
hope that Cindy Crawford paid a really good price for them!
This is not a hoax! This is happening to women in every town... every night!
WARN YOUR FRIENDS!
P.S. I must say that last year I thought someone had stolen my breasts. I was
lying in bed and they were gone!!!! As I
jumped out of bed, I was relieved to see that they had just been hiding in my
armpits as I slept. Now I keep them hidden in my waistband.
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In our last newsletter
there was a survey “article” by the
Thanks, Rita.
===================
Member Response to Survey
How old are
you? 69 years.
What was your previous
occupation? Secretary for Western Electric for 6 years,
stay-at-home Mom for 17 years, part-time travel agent for 15 years.
How long have you known
you have post polio syndrome? 18-20 years
What would you like the
public to know about post polio? First of all, I'd like them to know that
there is such a thing. Most people are totally unaware. I'd like them to
realize that even though most of us "keep on going",
we suffer from weakness, pain and fatigue. That our present problems are
not just "growing older", but something we overcame years ago,
and now are struggling with again.
What hurts the most
psychologically or emotionally about having post polio? Not being able to
do many things I used to be able to do; having to miss out on activities
because I'm not sure about accessibility; having to set priorities on what I
can accomplish in a day; not being able to get into people's homes because
of steps. People not understanding how
difficult it is for me to get around.
What frustrates you the
most about your post polio? The resentment able-bodied people show when
special accommodation is made for handicapped people; i.e., going to the head
of the line, etc.
The discourtesy many show by stepping directly in front of my
wheelchair, failing to hold doors open when they see me coming.
(This applies to other disabled people also.)
What special or adaptive
equipment do you use to participate in normal living?
Braces on both legs, forearm crutches, back corset; wheelchair when traveling.
Grab bars in shower, raised toilet seat with rails, can only sit in chairs with
arms or I can't get up.
To better explain our
differences, complete statement for up to 5 problems you experience due to PPS:
I have to pace myself and plan my day in advance in order to get through it. I
try to rest after lunch and take a short 20 minute nap; and take frequent rest
breaks. Sometimes I have "pain episodes" that can last for weeks,
other times I have no pain at all.
I
stay active with outside interests, alternating between things I can
do on my feet and "on my seat".
I have had a very good life, and continue to have a good life, despite polio
and PPS and thank God every day for the ability to get up and stand on my feet.
FECPPSG Editor’s Note:- If you would like to send us your answers to
the questionnaire, we’ll put it into the newsletter also.
**********************************************
My sincere
apologies to our member who sent me the following article.
After reading it, I forwarded it on to a cardiologist I have faith in
and who sent it back stating it was an excellent article and should go into the
newsletter – HOWEVER, the name of the original sender got deleted. Please let me know who you are so we can
credit you in the next newsletter. – Barbara
====================
FEMALE
HEART ATTACKS
Did you know that women rarely have the same dramatic
symptoms that men have when experiencing heart attack...you know, the sudden
stabbing pain in the chest, the cold sweat, grabbing the chest & dropping
to the floor that we see in the movies. Here is the story of one woman's
experience with a heart attack.
"I had a completely unexpected
heart attack at about
"After that had seemed to
subside, the next sensation was like little squeezing motions that seemed to be
racing up my SPINE (hind-sight, it was probably my aorta spasming), gaining
speed as they continued racing up and under my sternum (breast bone, where one
presses rhythmically when administering CPR). This fascinating process
continued on into my throat and branched out into both jaws.
"AHA!! NOW I stopped
puzzling about what was happening--we all have read and/or heard about pain in
the jaws being one of the signals of an MI happening, haven't we? I said
aloud to myself and the cat, "Dear God, I think I'm having a heart
attack!" I lowered the foot rest, dumping the cat from my lap, started to
take a step and fell on the floor instead. I thought to myself "If
this is a heart attack, I shouldn't be walking into the next room where the
phone is or anywhere else.......but, on the other hand, if I don't, nobody will
know that I need help, and if I wait any longer I may not be able to get up in
moment."
"I pulled myself up with the
arms of the chair, walked slowly into the next room and dialed the
Paramedics... I told her I thought I was having a heart attack due to the
pressure building under the sternum and radiating into my jaws. I didn't
feel hysterical or afraid, just stating the facts. She said she was
sending the Paramedics over immediately, asked if the front door was near to
me, and if so, to unbolt the door and then lie down on the floor where they
could see me when they came in.
"I then laid down on the floor
as instructed and lost consciousness, as I don't remember the medics coming in,
their examination, lifting me onto a gurney or getting me into their ambulance,
or hearing the call they made to St. Jude ER on the way, but I did
briefly awaken when we arrived and saw that the Cardiologist was already there
in his surgical blues and cap, helping the medics pull my stretcher out of the
ambulance. He was bending over me asking questions (probably something
like "Have you taken any medications?") but I couldn't make my mind
interpret what he was saying, or form an answer, and nodded off again, not
waking up until the Cardiologist and partner had already threaded the teeny
angiogram balloon up my femoral artery into the aorta and into my heart where
they installed 2 side by side stents to hold open my
right coronary artery.
"I know it sounds like all my
thinking and actions at home must have taken at least 20-30 minutes before
calling the Paramedics, but actually it took perhaps 4-5 minutes before the
call, and both the fire station and St. Jude are only minutes away from
my home, and my Cardiologist was already to go to the OR in his scrubs and get
going on restarting my heart (which had stopped somewhere between my arrival
and the procedure) and installing the stents.
"Why have I written all of this
to you with so much detail? Because I want all of you
who are so important in my life to know what I learned first hand."
1. Be aware that something
very different is happening in your body not the usual men's symptoms, but
inexplicable things happening (until my sternum and jaws got into the act ). It is said that many more women than men die of
their first (and last) MI because they didn't know they were having one, and
commonly mistake it as indigestion, take some Maalox or other anti-heartburn
preparation, and go to bed, hoping they'll feel better in the morning when they
wake up....which doesn't happen. My female friends, your symptoms might
not be exactly like mine, so I advise you to call the Paramedics if ANYTHING is
unpleasantly happening that you've not felt before. It is better to have
a "false alarm" visitation than to risk your life guessing what it
might be!
2. Note that I said "Call the
Paramedics". Ladies, TIME IS OF THE ESSENCE!
Do NOT try to drive yourself to the ER--you're a hazard to others on the road,
and so is your panicked husband who will be speeding and looking anxiously at what's
happening with you instead of the road. Do NOT call your doctor--he doesn't know where you live and if it's at
night you won't reach him anyway, and if it's daytime, his assistants (or
answering service) will tell you to call the Paramedics. He doesn't carry
the equipment in his car that you need to be saved! The Paramedics do,
principally OXYGEN that you need ASAP. Your
Dr. will be notified later.
3. Don't assume it couldn't be
a heart attack because you have a normal cholesterol count. Research has
discovered that a cholesterol elevated reading is rarely the cause of an MI
(unless it's unbelievably high,and/or
accompanied by high blood pressure.) MI's are usually caused by long-term
stress and inflammation in the body, which dumps all sorts of deadly hormones
into your system to sludge things up in there. Pain in the jaw can wake
you from a sound sleep. Let's be careful and be aware. The more we know, the better chance we could survive...
A cardiologist says if everyone who
gets this mail sends it to 10 people, you can be sure that we'll save at least
one life.
**Please be
a true friend and send this article to all your friends you care about.**
**********************************************
Once again reprinted
from the May/June Elder Update newsletter. This is their
“Summer Survival Guide” and still applies even though this is our July/August
issue (it also goes for the other 49 states).
Keeping
Safe in the
Skin
cancer is the most common type of cancer in the
Ultra
violet radiation from the sun is the main cause of skin cancer. There are three common types of skin cancers.
Basal cell carcinomas are the most
common, accounting for more than 90 percent of all skin cancers in the
Squamous cell carcinomas also rarely spread,
but they do so more often than basal cell carcinomas. This type of skin cancer commonly looks like
a red, scaling and thick patch on the skin.
When this type of cancer goes untreated, it can develop into a large
mass.
The
most dangerous of all cancers that occur in the skin is melanoma. Melanoma can
spread to other organs, and when it does, it’s often fatal. Most melanomas are brown or black looking
lesions. Signs that might indicate a malignant
melanoma include change in size, shape, color or elevation of a mole. The appearance of a new mole, pain, itching,
ulceration or bleeding of an existing mole should be checked.
The
good news is all skin cancers can be cured, if they are discovered and brought
to a doctor’s attention before they have a chance to spread. Make sure to check your skin regularly for
signs of abnormality. The most common
warning sign of skin cancer is a change on the skin, especially a new growth or
a sore that does not heal.
~*~*~*~*~*~*~*~*~
Tips
to Keep Your
Skin
Healthy
The
best way to maintain healthy skin is to completely avoid prolonged sun
exposure. However, it is impossible to
avoid the dun at all times. While you
cannot erase the effects of the sun on your skin, you can easily prevent more
damage and protect yourself against sun related illness.
Stay out of the sun during peak hours
Avoid
the sun between
Use sunscreen everyday
Sunscreens
are rated according to a sun protection factor (SPF), which start at SPF2 and
reach up to SPF50+. The higher the
number means the longer the protection.
Products with at least a 15 SPF are recommended. Look for products whose label says “broad
spectrum.” This means the sunscreen
protects against both Ultra Violet A and UVB rays. Also choose a water resistant formula, which
will stay on your skin longer, even if you get wet or sweat a lot. Do not assume that buying a high SPF sunscreen
will automatically prevent sunburn, no matter how long you stay in the sun. Always remember to reapply the lotion
throughout the day if you plan to spend a long time outdoors.
Wear protective clothing
Look
for sunglasses with a label stating the glasses block 99 to 100 percent of the
sun’s rays. Wear loose, lightweight, clothing
made from natural materials like cotton when in the sun. This will allow your skin to breathe
better. Also wearing a wide-brim hat
will shade your neck, ears, eyes and head.
Check your skin often
Look
for changes in the size, shape, color, or feel of birthmarks, moles, and
spots. If you find any changes that
worry you, visit your doctor. Yearly
skin checks by a doctor are recommended as part of a regular physical exam.
~*~*~*~*~*~*~*~
Tips
to Beat the HEAT
Prevention
is the best way to avoid heat related illness.
The following are some easy ways to stay cool throughout hot and humid
summer months.
1. Stay hydrated with cool non-alcoholic
beverages.
2. Wear lightweight clothing.
3. Limit strenuous physical activity.
4. Seek out air-conditioned environments.
5. Take a cool shower or bath.
6. Remain indoors during peak heat hours (
**********************************************
The following article is reprinted
with the permission of the San Francisco Bay Area Polio Survivors’ Newsletter
editor, Phyllis Hartke, who very kindly e-mailed it
to me to save my retyping it. Thank you,
Phyllis!!
STATINS:
Benefits
and Risks
For
Polio Survivors
Elizabeth Sandel,
MD;
Chief of Physical & Rehabilitative
Medicine
Kaiser Permanente Foundation,
Presentation to:
Transcribed
and by edited by Phyllis Hartke, with editorial
assistance of Stella Cade and Dr. Sandel
© Copyright
2007, SFBAPS
Reprint permission
must be obtained directly from SFBAPS. Email sfbaps@aol.com.
INTRODUCTION
When I was asked to speak I thought
that I should make this relevant to my practice and to your lives. The one
thing that kept coming to mind was the issue of statin
drugs. They are one of the most commonly prescribed medications and for good
reasons. This issue comes up a lot in my
practice, not just for people with a history of polio. Other people too also
have had symptoms that are suggestive of possible side effects to the
medication. So that is why I chose the
topic. I hope it will be of interest to
you.
I will not ask for a show of hands
of number of people who are on statins. I can imagine
probably it is in the range of 40 to 60 percent.
Q= What are nongeneric
names for statins?
A= lovastatin
is Mevacor, simvastatin
is Zocor, atorvastatin is Lipitor, pravastatin is Pravachol. Vytorin is actually a combination drug. Vytorin is Zetia plus simvastatin
(Zocor).
I encourage you to look at your SFBAPS
April 2007 Newsletter. There is a lot of good information in it. I learned a lot reading it. Of particular
interest is the interview with Dr. Golomb, the UC San
Diego researcher who continues to do clinical trials studying statins and their side effects.
Another theme that applies here that
I want to discuss is that of benefits vs. risks. As physicians we are always trying to figure
out whether the benefit-risk ratio is high.
The other Hippocratic precept involved here is “do
no harm”. We can’t always accurately
predict in which people there may be side effects.
In my practice, always flashing on
the screen or wall as I see people is “First, do no harm.” If there is something else we can do before
we give patients medication that will be done.
I prescribe medication but I am very conservative in my prescription of
medication. Some of you who I have been
privileged to treat or care for know that I am really not too willing to stick
my neck out and try new things that are not FDA approved. For example, drugs for fatigue and so forth
for polio survivors.
So, with all that said and going
back and reviewing all this literature, I think certainly there is a major role
for statins in the prevention of cardiovascular
disease.
SCREENING
These are the cardiovascular artery
disease (CAD) screening guidelines:
1.
Adults 40-82: screen annually if no
risk factors: Total cholesterol, LDL, HDL, Triglycerides (TGs)
2.
Adults 18-82 with any non-lipid
coronary artery disease factors: tobacco, hypertension (BP>139/89 or on
hypertension medication; low HDL (<40); family history of premature CAD; age
(men: 45; women: 55)
3.
All adults with CAD, diabetes,
vascular disease, kidney disease, metabolic syndrome: increased fasting
glucose; abdominal obesity; elevated Triglycerides (TGs),
elevated Blood Pressure (BP); low HDL (any three); Coronary Risk Calculator:
BP, ratio of TC to HDL
I base these guidelines on the Kaiser
Permanente cholesterol guidelines which are reviewed every two years. All the
clinical practice guidelines Kaiser has are reviewed every two years, and I
participate in the stroke guidelines. It is an incredible process. A group of
physicians review all the literature for the last two years and update the
guidelines. There is a lot of interaction and a lot of discussion and so forth.
When reviewing guidelines on the
Kaiser Permanente intranet, I found quite interesting the fact that
So, if you are between the ages of
40 and 82 and do not have any risk factors, you still should have an annual
cholesterol screening. That screening should consist of a thorough cholesterol panel --
the LDL (that’s the “bad one”), the HDL (that’s the “good one”), and the
triglycerides (TGs). Dr. Golomb makes
the point, and it’s a good one, that it is really not the actual value but the
ratio of the total cholesterol to the HDL that is important. If your HDL is pretty high, you are in
pretty good shape unless your total cholesterol is high.
Q -- What happens to people who are
beyond 82?
A -- That’s a very good point. The questions are based on research, and the
research is in this population (40-82). There doesn‘t seem to be necessarily a
benefit in the population beyond that.
If you make it to the decade of the 80s, probably genetically you have a
good predisposition. As the old elderly
lose more muscle mass, there may be a higher incidence of side effects. They say that by about age 20 you begin to
lose muscle mass.
What are the risk factors for heart
disease, or we could say stroke? In
general, what we are talking about here is atherosclerosis. So it could be arteries anywhere, but the
ones where the most research has been done is in the coronary arteries (heart
arteries). Scientists don’t really
understand the process completely. We call it atherosclerosis, but the latest
literature suggests that there may be an inflammatory component. That is beyond our discussion here.
Q= How accurate are the blood tests
for cholesterol?
A= Pretty accurate.
Kaiser Permanent intranet has on it
a Coronary Risk Calculator. Kaiser
patients can ask their physician to calculate the risk, plugging in certain
numbers -- your age, your gender, your cholesterol level and your HDL level,
your diastolic BP, and whether you smoke, and whether you have diabetes. It
will calculate your ten-year risk of developing or having a MI (myocardial
infarction) or heart attack. The
calculator is based on a large population-based study, so the risk result is
credible.
You want to try to control
hypertension. By controlling that you
can bring down the cholesterol. The guidelines are pretty much the same
everywhere, 139 to 140 for diastolic, and 89 to 90 for systolic blood
pressure. What’s interesting in the
guidelines is there is some benefit if you bring down further to 120 over
80. I almost think there’s too much
reduction in blood pressure in some older individuals. But the guideline that
we use in medicine is basically, if you are not symptomatic, if you are not
feeling the effects of low blood pressure, low is probably better. In general you are aiming for at least 139
over 89, and probably lower than that.
NON-PHARMACOLOGICAL TREATMENT
1.
Tobacco cessation
2.
Physical activity (30 minutes per
day)
3.
Diet: fats: 25-35% of calories;
fiber: 20-30 grams/day; cholesterol: <200 mg/day
4.
Omega-3 fatty acids (from fish:
salmon, herring, tuna, sardines, mackerel) or fish oil supplements: 1-3
grams/day; two servings per week
5.
Plant oils: flaxseed, canola,
soybean, olive oil; nuts/peanuts/other legumes
6.
Alcohol in moderation; fruits and
veggies
7.
Avoid saturated fats: tropical oils;
trans-fatty acids, hydrogenated oils: zero!
8.
Weight: as little as 10% reduction;
avoid fad diets; BMI: less than 25
Tobacco is a major contributor to coronary
artery disease. Certainly, nobody smokes
in this group, unless you involuntarily smoke.
Maybe I am assuming too much.
So then, how do we advise
people? There is a lot we can do in
terms of exercise and nutrition, so we certainly should try that
first.
One of my interests in advising
people is nutrition, so I want to talk a little about that. It is your health
education. I’m not sure the word has been effectively transmitted to people
about the risks of some of the food that is on the shelf at the grocery
store.
Transfats.
There’s now a lot of talk about transfat and
“no transfat” on labels. How often do you see that on the label? All the time. I’ve done a lot of research on transfat, otherwise known as hydrogenated oil.
Transfats are actually, I think, a major
culprit in the rise in cholesterol level in the world because now you have
mass marketing in processed foods throughout the world. There are some transfats
naturally present in certain substances -- dairy products and meat. But in general, it is in processed
foods.
Crisco was the first of the hydrogenated
vegetable oils, and I believe the beginning of some of the really
serious health problems in our country.
Do you remember your mother always having a can of Crisco in the back of
the refrigerator? She used it for baking
pies and other foods. The Crisco lasted forever and now we know why. It is the
preservative of transfat that allowed it to keep
forever.
And then we had the various margarines
coming out, and so forth. I eat
butter but not often. Pure butter does not have transfat;
just the saturated fat and the caloric content are issues. Again, keep everything in moderation.
What we really have is the presence
of transfat in everything imaginable that sits on the
grocery shelf. You turn the box over and it says expiration date 2015. How could this be food? You have to religiously read the label.
Even more problematic is that
manufacturers can apparently list transfat as “0” if
the minimum percentage is below a certain number, I think 1%. So there is still some transfat
there. It is not completely about
label-reading, but I think it is the best we can do.
Transfat does all the worst things. The
FDA says there is no safe amount. You’ll
see the Kaiser Permanente guidelines read something like less than 1% of diet
should be transfat. It should be “zero“! This is very difficult. This is why I think probably fresh fruits
and vegetables are so important. It’s not so much that they are wonderful,
which they are, but if you are not eating processed food and you are eating
fresh fruits and vegetables and fresh things you are not getting transfat.
Regarding meats, they contain
transfat but also have saturated fat, also not best
for you.
Transfats are worse than saturated fats
because they prevent the breakdown of cholesterol by the body. You have natural mechanisms in the
body that break down cholesterol. They
lower HDL and raise the LDL. NY Times
recently published an article about the mechanism of how transfat
does not allow breakdown of cholesterol.
I don’t recall what Journal article they were quoting. You have to make a campaign out of completely
avoiding transfats.
Q= How often have red meat?
A= Again, everything in
moderation. If you have it occasionally,
that’s fine. If you have it every night, not a good thing.
First, you are missing the two days of the week you are supposed to have fish.
The omega fatty acid, either pill or the fish, as part of your diet, I
think is probably a good thing.
Q= But then you have to watch the
other way because you can‘t just eat fish. There are some fish you can‘t eat.
So you are limited to three types of fish.
A= And then there‘s mercury.
Swordfish, my favorite fish, is completely out now. As to types of fish, salmon leads the
list. Regarding tuna, you have to be careful
about mercury in tuna. You don’t want albacore tuna because of the
mercury issue. The tin mackerel is high
in mercury, so you need to be careful with that. Sardines are acceptable.
Q= What
about bread?
A= Bread gets stale but it doesn’t
necessarily go moldy, even without the transfat.
Ice cream.
You have probably observed that some ice cream when left out of the
freezer does not melt or only melts slightly. That’s because of transfat. Some
versions of Ben & Jerry are transfat-free. There
are only two brands that I have found that do not have transfat. They are Haagen Daaz and Breyers. You may need to read the labels of some of
the newer products because ice cream can have additives which might have some transfat, but in general, Haagen Daaz and Breyer’s are very
safe.
The other way that you get transfats is pretty much unavoidable. It is when you go out
to eat or when you buy fresh pastries. If you buy, make and eat your own food,
you can really get a handle on it. You
can really make a campaign out of this, but it is important to be vigilant.
Q = Any
data on Meals on Wheels programs as far as transfats?
A= I bet, chances are, that unless
somebody is really vigilant about it, it is in the food. The same may apply to hospital food and
school lunches.
There are also other treatment means
involved with diet.
Fiber.
Some of the
ways to treat high cholesterol is finding resins that absorb cholesterol from
the gut. Fiber can help reduce
cholesterol, not in a huge way, but certainly something to consider. And there
are other benefits of fiber in the diet as well.
Q= For a
year I ate oatmeal daily for breakfast, and my cholesterol went down. Of course
I was on meds too.
A= Definitely.
Q= Does oat bran have the same
effect as cooking the oatmeal?
A= I think either way. The issue is
more the fiber than the oatmeal itself.
Use steel cut oatmeal, not the instant packets. The steel cut oatmeal
can be cooked in the microwave or on he stove top.
Q= Granola?
A= There are all different types of granola, so again, you have to read the labels.
Plant Oils -- I actually listed everything here on the good
side because there is a lot of confusion about this. You want to avoid all the tropical oils --
coconut and palm. The good ones are:
flaxseed oil, canola oil, soybean oil, and olive oil. Corn oil and safflower oil are also OK.
Now nuts, actually peanuts, are pretty high in saturated fats but there are
added benefits to nuts and legumes. Peanuts are in the legumes
category as far as cholesterol lowering. Because of the saturated fats, keep in
mind moderation. By the way, peanuts
have been shown to actually reduce the incidence of diabetes. So there is a benefit in peanut butter, but
again, 30% saturated fat so you have to be careful.
As far as weight reduction goes,
even just 10% off your weight will advantageously affect your cholesterol, or
your lipids, I should say.
Basal metabolic index (BMI) is used to access your risk of heart disease because it
correlates to a measure of obesity. You
can calculate your BMI by going into Google on the
Internet to look at the charts. You want to aim at a number less
than 25.
According
to Wikipedia, BMI is intended to be used as a means of “classifying sedentary
(physically inactive) individuals with an average body composition. For these
individuals, the current value settings are as follows: a BMI of 18.5 to 25 may
indicate optimal weight; a BMI lower than 18.5 suggests the person is underweight while a number above 25 may
indicate the person is overweight.”
The next best measurement guide for
heart disease is waist size - 35 for
women, 45 for men. Weight reduction is something you can do to decrease the
risk of heart disease or to treat and even manage diabetes and
cholesterol. And exercise is an
additional benefit.
Q= Are eggs still considered bad for
your cholesterol?
A= The weekly recommendation
I think is one or two eggs.
Q= Is there
good dairy and bad dairy?
A= If you can, go with nonfat
milk. All those areas where you can just
let the fat go, that’s what you want to do.
For dairy, there is this issue of a miniscule amount of transfat. I would
not worry about transfat in dairy. With meat, there’s saturated fat and that’s a
big issue there.
You can become obsessive about this,
but what you really need to be concerned about are the percentage issues. There has to be some sort of a balance in
your diet. Some days you can eat cheese
but not every day because of the high saturated fat content. You should avoid cheese most of the time
because of this.
As far as weight reduction, what
works best? Pushing yourself away from table helps, but what works best, and
for those in wheelchairs this may be difficult, is just getting on the scale
every day. And you cut back on your food intake, right?! So forget all these
diet books. It is a lot cheaper too.
Q= I achieved weight loss by
drinking a lot of water and not eating as much and in three years dropped from
140 lbs to 126 lbs.
A= Some of
that might be muscle mass. You want to make sure you’re not continuing to
reduce below your ideal weight, so that would be something to look at, and then
the nutritional aspect of a balanced diet.
Another thing I’d like to say, take
a regular multivitamin every day. I advise that for everybody.
STATIN RISKS
1.
Birth defects; contraindicated for
women of childbearing age
2.
Cancer: not confirmed; liver
disease: caution but rarely a problem
3.
Renal disease: lower doses
4.
Muscle disorders: <1% of
population; rarely rhabdomyysis (brown urine);
increased risk with chronic kidney disease, advanced age, female gender, low
body weight, antibiotics, fibrates and niacin, and
grapefruit juice consumption! Genetics? Exercise? Decreased levels of coenzyme
Q10?
5.
Cognitive disorders: varies
depending on statin? Pravastatin:
better choice?
6.
Neuropathy
Statins:
I don’t want anyone in the audience to think I
am advising you in particular. I am just
giving you generalities. Talk to your
own physician as to specifics on your condition or how you are managing your
cholesterol issue.
Statins are now the first line of treatment
because they are so effective at lowering cholesterol and LDL.
It appears they are pretty well tolerated. They are extremely effective
in lowering cholesterol. There have been
a huge number of studies showing efficacy for people with coronary artery
disease.
Take statin
drugs with caution or in lower doses if you have renal disease. Liver disease is probably not a major issue,
but sometimes you see the liver enzymes going up and that‘s something that
should be monitored with periodic blood tests when you start on a drug. They say three times the normal is OK but I
would say, if it happened to me, I would want to come
off that drug if my liver enzymes went up much at all.
That being said, I think for those
who don’t want to go the statin route, you could ask
your physician about alternatives, and one alternative would be niacin. It
actually raises HDL, the good lipid/cholesterol, better than statin drugs.
Niacin. Good drug and awesome vitamin, so what’s wrong
with that? With high doses you can get symptoms of flushing and so forth. It
can raise blood sugar and also cause liver disease. For people who have
pre-diabetes it can move them into the diabetic category.
Q= Many years ago when they first
found out I had high cholesterol. I became anemic. I could hardly stand up
anymore, and my doctor said she had never heard of that before.
A= If you can’t tolerate the statins, there’s the fibrates,
a class of drugs like the statins but that do not
work through the same enzymatic pathways that the statins
do.
Just a caution about combination
drugs, there was a newer statin that came out and
was quickly removed from the market. It was actually using combination with Gemfibrozil (Lopid). They pulled that
combination drug off the market because of serious side effects..
Zetia looks like it has a pretty good track record so
far. When combined with Zocor,
it forms a drug called Vytorin. This works through a different mechanism, so
any side effects will be different.
There may be fewer side effects with Zetia,
but we don’t know yet.
Q= Statin
reaction: In 2005 my doctor put me on Lipitor. In about a week I noticed a reaction, which within
six weeks had become a very bad reaction from Lipitor,
and I took myself off the drug. I had
muscle problems, and a stiff neck. I couldn’t move my head. I had the pounding
headache like I had when I first came down with polio. After taking myself off
the drug, I wouldn’t take anything else my doctor was trying to give me. Now in
December when Zetia came out, he put me on Zetia. So far, so good. My husband
said I looked like a zombie when taking Lipitor. The side effects did reverse pretty quickly
after going off Lipitor.
A= You did right to take yourself off
that drug. Other drugs may work better. Zetia often
has good results when you have problems taking a certain statin. Zetia works
through a different mechanism. It blocks absorption in the stomach. That might
be another option. The only way to know if it is the drug or
not is to take yourself off the drug.
You need to do that under your
doctor’s supervision. How do you
know if one tiny fraction of the population will have side effects? We know
it’s genetics but we can’t pin it down beyond that.
Let’s move on to that whole issue of risk. Again, this
is just a review. I want to emphasize
that the side effects profile is pretty good for statins.
That being said, for every drug, if we had your genetic map available to us and
we knew how the medications we give people interact with your genetic map and the proteins produced
in the genetic processes, we would be able to correctly select the medication
that was right for you.
The other thing I like to do is ask people if anybody
in their family had a bad reaction or good response to a medication. Because again you are trying to get at that genetic predisposition.
In the previously raised case
scenario, obviously something was probably genetically biased for her to have
that reaction to that drug or drugs of that class. And again, she probably had a genetic
advantage of one drug over another given the reversal of symptoms and recovery
of lost function the original drug caused her to experience.
We are always trying to find precisely the right
medication, such as with antidepressants.
If one doesn‘t work we will try something else. Each one does something different and affects
the body differently.
It is interesting, because in the
case of anti-inflammatory drugs, like Motrin and Naproxen, they actually
come from different subclasses. What I
find is that when someone is nonresponsive to Motrin
(ibuprofen), they will respond to naproxen.
A non-physician colleague was
telling me that he had a lot of back problems and he had to try some new drug
because he did not respond to the non-steroidal anti-inflammatory drugs. I
asked which ones he took. He said Advil, Motrin and ibuprophen
(these are all the same drug!), and now he is on some drug I‘ve never heard of
that is new to the market. I said, “I
think actually all you ever tried was one, so maybe you should try Alleve or Naprosyn.” I always try to utilize older drugs that
have more of a “track record” before trying new drugs.
The key question regarding statin drugs for polios is about the muscle. Also, very rarely,
neuropathy. In the case of
neuropathy you would get sensory symptoms of numbness and tingling. I think probably this is
an area where you are going to have to put out a little bit of an alert for
your physician.
According to the Kaiser Permanent
guidelines, you should get baseline CK bloodwork
drawn and if you have symptoms, a follow up is indicated. CK is creatine kinease, that‘s the
muscle enzyme. A lot of you always have muscle symptoms, so you might want to
have a CK done after starting, when they test the liver function. If there is a difference in your function,
and especially pain, make sure that is looked into.
And by the way, another very tricky
aspect of this is the CK level doesn‘t always go up. There have been cases where people who had
muscle biopsies had major damage to muscle without their CK level being
elevated. I am not recommending that you
have a muscle biopsy. Just be aware that CK level may not reflect accurately
muscle damage that is occurring.
That being said, let’s look at
exercise’s effect on CK levels. If I go
out and do really vigorous exercise and break down some of my muscle cell
membrane, some of this is going to be secreted into my blood stream and my CK
level will go up. Now if I am a runner, for example, and they do a CK blood
test after a marathon, you can see an elevation. The systems fail if there is
so much of that floating through the blood stream that it damages the
kidneys. The sign is brown urine. But by the time it gets to that point, you
are probably close to what we call rhabdomyolysis
which is really severe damage to the muscle and kidneys.
Q= On the
handout on statins it indicates if you have muscle
pain then there’s damage occurring to the kidneys?
A= Kidney damage depends on the CK level. It depends on how much damage
occurred to the kidneys and how much of that CK is secreted and circulating
throughout the body.
Q= So if you have muscle pain and
you just started on the statin, then we should
definitely get a CK level done, regardless of how much muscle pain it is?
A= I would say, check the CK level in the initial period. If there is a change that you note in
your symptoms, I would definitely ask for a CK level. What I meant by renal disease is if you have any kidney problems then lower the
dose. The other place it comes in is if
you are breaking down huge amounts of muscle, then through the secretion
through the kidneys you can damage them. You don’t want to wait for the brown
urine. If you are experiencing an increase in muscle pain, you need a CK
level.
Q= Isn’t Lipitor
considered the best statin drug on the market?
A= It’s all marketing. I have to rely on the chief of cardiology at
Kaiser because they’re the folks who developed the guidelines. They read the
literature and make recommendations based on the research. They do not send me
samples of Lipitor over the others. I can’t tell you
there’s anything wrong with being on it. I can just tell you the chief of
cardiology in
Study participants are often on combination
drugs. Drug companies would
be better off testing individual drugs.
Also, there’s the problem of their cherry-picking the participants. Often people with multiple conditions are not
included.
I don’t want to leave the audience
with an alarmist message. After folks came off the problem drugs, they
recovered gradually the function they had lost when on the drug. This seems to be true of polio survivors as
well.
Q= Is Grapefruit juice contraindicated
when on statin drugs?
A= Grapefruit juice will affect that
break-down of the statin drugs by the liver. What it
does is raise the level of the drug you are on. The literature indicates that
it would take a quart of grapefruit juice a day to have this affect, but I
would really try to avoid it altogether.
Q= What
about co-enzyme Q?
A= There is nothing conclusive
whether co-enzyme Q is helpful for polios, so no comment on this issue.
Q= Regarding
increase in pain, anything specific about statins and
post-polio?
A= If you are working with residual physical
capacity, even if your incidence of this in the post-polio group is 1% or less,
you don’t want it. You’re not at
increased risk for it. But because of the polio you already have some of the
symptoms, and that makes the alert for this issue more problematic and
difficult to assess.
Q= I have muscle pain from walking;
my legs went numb but not are not weak My doctor had no comment.
A= No comment. (laughter).
There is a lot of ambiguity. There is no algorithm, if this then that. I’m
just saying be alert to these matters. In some cases it may be very dramatic.
When the drug is withdrawn it is even clearer that the drug was the cause. It
may be more subtle than that, so you just must be aware.
Cognitive Problems
I wanted to say one more thing about
cognitive side effects of the statin drugs. This has
come up in my practice. A large part of my practice other than post polio is
brain injury or non-traumatic brain disorder rehabilitation. One patient had progressive memory and
cognition problems. She was taken off lovastatin and
the symptoms went away.
Blood-Brain Barrier
Now here is one thing about statins, and this is something I learned very recently.
There are some drugs that cross the blood-brain barrier. They go from the blood
to the brain to a mechanism that relies on whether they are lipophilic,
which means they have an affinity to attach to the brain membrane and that
permit the transport into the brain. What I’ve learned in my recent reading is lovastatin and simvastatin (Mevacor, and Zocor) are lipophilic, so they go into the brain at higher
concentrations than prevacor, which is hydrophilic,
which tends to stay in the blood and not go into the brain. So I am thinking if
someone has cognitive side effects, maybe they should be on prevacor
(Pravastatin) and not the lipophilic
type of statin drugs.
Final message. Be aware of your symptoms. Monitor
yourself. Ask your physician. Look for
material on the Internet, but always with a partly jaded view. Even with guidelines there is a lot of
material and new literature daily.
BEST ADVICE
1. Get a baseline creatine
kinase (CK); recheck when liver function studies are
checked and if changes in muscle symptoms occur.
2. Discontinue the statin
if CK 10 times normal; but for PP patients, there’s a lower threshold than 10.
3. Avoid combinations or statin plus niacin or statin plus
fibrate.
4. You may have symptoms and sympathy
with normal CK levels.
5. Recommend a trial of withdrawal of the
drug and consideration of another treatment if side effects encountered.
© Copyright 2007, SFBAPS
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