Heart Care – Expert Advice From a Surgeon

How to stay out of my Operating room (by a heart surgeon)

Heart disease is the leading cause of death for both men and women in the US, with one in four deaths attributed to it.

The culprit, generally, is coronary artery disease, in which plaque builds up in your arteries, blocking blood supply to this most vital organ. It can cause heart attack, heart failure and arrhythmias.

Aside from being deadly, coronary heart disease was projected to have cost the country more than $108 billion in 2010. This includes the cost of health-care services, medication and lost productivity.

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Imminent Threat

Who’s most at risk for a heart attack? Those of us with high blood pressure, diabetes, high cholesterol or a smoking habit, and those of us who are obese.

Unfortunately, more than 90 percent of Americans are not as healthy as they could be, according to a paper published in Circulation, a journal of the American Heart Association.

When many Americans go to the doctor, they get a standard physical exam without tests to check their hemoglobin A1c and their fasting glucose, which can reveal whether they have diabetes. Also overlooked, oftentimes, are blood-pressure readings that are taken on three separate visits, which can reveal hypertension, or even fasting blood tests to assess the ratio of good cholesterol to bad cholesterol.

Most patients sitting in the doctor’s office are obese and yet have never had their body mass index calculated nor had it explained to them.

In our office, we do the belly-button check. If you can’t see it, then yes you are overweight. Belly fat is worse than any other fat on your body because it indicates fat around your vital organs.

Smoking is obviously a problem, and it’s also something that people tend to lie to themselves about. So when patients tell me they smoke half a pack a day, I round it up to a pack a day.

In all fairness, patients can’t be blamed for not knowing their true health status. Unfortunately, most doctor visits are targeted to a patient’s complaint. For example, someone who has come in complaining of a sinus problem will be treated for a sinus problem and will not be risk-stratified for heart disease, even though he or she may be obese or may smoke.

There are numerous reasons people don’t get a comprehensive evaluation, such as insurance coverage, time constraints and reimbursement.

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Reduce Your Risk

Okay, I know you’ve heard it before, but it’s true: Stop smoking, eat well and exercise. A few key changes can make an enormous difference in your health. Your lifestyle is not only your best defense against heart disease; it’s also your responsibility—and not something that can be dealt with in a few minutes in your doctor’s office. The approach to a better life includes the following:

1. Getting active: Make the time! Start with walking and chart your progress. Also park farther from your destination and take short brisk walks throughout your workday.

2. Manage cholesterol: Eat foods that are low in cholesterol, trans fats and saturated fats, as well as foods high in fiber. Schedule a cholesterol screening, maintain your proper weight and, if your doctor prescribes cholesterol medication for you, take it!

3. Healthy eating: Stock your kitchen with healthy food. Buy less junk and more produce. Also eat from each of the basic food groups and, at least twice a week, have some fish. And whatever you do, stay away from preservatives.

4. Lower your blood pressure: Reduce sodium, limit alcohol and stress.

5. Control your blood sugar: Have it checked regularly. Also, reduce your consumption of simple sugars, such as sodas, candy and desserts. And engage in moderate-intensity aerobic exercise, which helps your body respond to insulin. And, again, take medication or insulin if it is prescribed for you.

6. Lose weight: It’s crucial to know the recommended calorie intake for your age, gender and level of physical activity. Also track calories. Even if you only do it for a few days, you’ll learn a lot about your habits. Finding out the amount of calories you take in, compared to the ones you burn off allows you to plan accordingly.

7. Stop smoking: Work towards replacing the craving you have for tobacco with healthier options, and if you backslide figure out why and try, try, try again. Also talk with your health-care provider or look for a smoke-cessation program. Many hospitals and public health departments offer hotlines and group support with trained staff.

I recommend that people take care of their bodies the way they take of their cars—or at least should take care of their cars.

Also visit your doctor for risk stratification to determine if you are prone to heart disease, diabetes, high cholesterol or high-blood pressure. If you do, or if you smoke or are obese, your doctor may want to do an EKG, a stress test or an echocardiogram.

All this may take extra time and money, but, as with your car, it’s the right thing to do so you aren’t stranded on Monday when you have to go to work, or on Saturday when you have to buy groceries, or later this afternoon, when you pick up the kids from soccer practice.

Or you might look at caring for your health like you do going to the DMV to get your car registered. Yes, it’s inconvenient, but the consequence of having expired tags when you get pulled over is something you don’t want to deal with, so every year you take care of it.

The common denominator here is consequences.

Most people don’t see their doctor as regularly as they do their mechanic, because many of us do not take seriously the imminent threat to our health from not following our doctor’s recommendations. Most people think that you go to the doctor only when you’re sick.

No matter where you stand, it’s never too late to make better choices for your health. But you need a goal, a plan and the commitment to live better.

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My Prescription

1. Follow up with your doctor for maintenance as you would for care for your car.

2. Don’t wait until you break down.

3. Be a good steward of your health and know your status.

4. Be inquisitive and informed; patients who ask questions and are knowledgeable tend to get better care.

Remember, you can stop heart disease in its tracks. Start small and make one change at a time. Before you know it, you’ve abandoned poor choices and begun making powerful ones.

Get your children on the program with you: More than a third of American kids are overweight, which can be the foundation of lifelong problems. Set a good example for your family, and you will reap the benefits.

by Moses DeGraft-Johnson, MD




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