Heart Felt Class for Heart Health

Dr. Michael McCloud chats with students before
launching Week 4 of Mini Med School

There is no wonder that UC Davis School of Medicine has a world class reputation. Last weekend’s presentations at the 2012 Mini-Medical School clearly demonstrated the university at the cutting edge of medical science and education through communication.  Cardiologist Dr. Jeffrey A. Southard taught in one short hour what many people wait a lifetime to learn – the essentials about heart health and disease, and how to smartly manage our own fate as we age. And, as a real bonus, a prelude of what the UCD Med Center team will deliver in  groundbreaking procedures this week.

Hard Working Heart

Think, for a moment, about the job done by the heart. It beats every second of every day throughout our lives. It doesn’t take time off, or rest up after an injury or heal a broken valve before going back to work.  It just keeps on beating and pumping and making life possible.  Dr. Southard suggested we think about the heart as if it is a house – with plumbing (flow and pipes and valves that open and shut), an electrical system that fires impulses to keep the beat steady and rooms, or chambers, where constant work is happening in concert with the whole-house system.

Considering the vital and continuous demand on the human heart it’s not surprising that it breaks, fails and fibrillates. Think heart attack, coronary disease, atrial fibrillation, congestive heart failure, etc.  But, Dr. Southard says his aim is to keep the heart healthy and avoid acceleration of diseases that can, and often do, land people on a surgeon’s table and, in the extreme, a morgue.  

Some of the common causes of heart disease?  Chief among them are smoking, high blood pressure, high cholesterol, diabetes and genetics.  First line of defense? Exercise, thoughtful eating and drinking, and quitting smoking – very logical preventions but apparently a daunting prescription for Americans. Heart disease is the nation’s number one killer – accounting for more deaths than all cancers combined.

The Aging Heart

The most prevalent heart conditions include Coronary Heart Disease  – a narrowing or blocking in the plumbing that leads to the heart. Plaque, frequently formed because of high cholesterol intake, builds up on the walls of the arteries to the heart. This constricts blood flow and the heart may no longer be pumping adequate blood through the narrowed channels of the arteries.  The preventative or prescription? Diet and exercise. According to Dr. Southard, these two practices are fundamental and necessary. “It is the mainstay of therapy for your entire health,” he told the class.

We don’t want to hear this, but the prevalence of heart disease rises significantly as we age. Therefore, it’s logical that attention to diet and exercise should receive equal increased attention in the second-half of life. Unfortunately, we’ve come to equate “retirement” and later years as a period of well earned inactivity, while people a third of our age are sweating at the gym. Heart disease can and does affect longevity. The Doc reports that most people who make it past the age of 80 or so have not had heart failure along the way.

Remedies and Repairs

Conditions to be aware of include Coronary Artery Disease (mentioned above), Congestive Heart Failure (the heart doesn’t pump enough blood to the body and brain), Atrial Fibrillation (irregular heartbeat that ranges from mild to dangerous) and Valvular Heart Disease (traced to damage of one of the four heart valves). Heart disease, particularly Atrial Fibrillation, can also prompt a stroke.

How we handle any of these conditions varies according to the severity of damage and disease. When a heart ailment has taken hold, repairs can range from the placement of stents – tiny devices that are implanted in heart arteries to keep them open – to open heart surgery. There was an audible groan in the class when Dr. Southard said 60 percent of heart attacks happen in the population over the age of 65. Then, a measure of relief when he added that the best outcomes are also in this same demographic.

New Procedures Hold Promise for Older Patients

In some cases, heart patients are not good candidates for tried and true surgeries. In this arena, UC Davis is a national leader in using the Edwards Sapien TranscatheterHeart Valve to repair damage and increase longevity for qualified candidates. This procedure has been used in more than 60,000 cases worldwide and shown to reduce mortality by half. It is fast, does not require surgery or long recovery. The procedure was only recently approved in the U.S., but fully implemented in Canada and elsewhere. Our lagging behind is due to the political nature of FDA approvals and America’s litigious penchant. Dr. Southard said other countries have eliminated these objections by capping ‘damages’ and cutting political red tape.

Physicians are also leveraging the power of stem cell therapy. Stem cells taken from adult bone marrow (and other parts of the body) can regenerate in targeted organs. Dr. Southard and his colleagues are focused on the potential of such stem cells to treat heart disease without surgery. Patients receiving this cutting edge treatment will be followed for two years and assessed along the way. UC Davis has a state of the art facility at its Institute for Regenerative Cures in Sacramento.

After arming students with information and warnings, Dr. Southard offered his heart healthy rules. “If it tastes good, leave it alone,” he joked (I think). “Eat healthy, exercise, have portion limitation, control your blood pressure, don’t smoke, visit your primary care doctor and avoid seeing me.”

Note: If you want to comment and can’t, EMAIL ME and I’ll post your comment here.

Love Your Liver for Longer Life

Eager Mini-Med students ready for Saturday class

I regret to report that I am not qualified to summarize the recent Mini-Med School  session on the skin. To do that, I’d need at least six years of medical school (rather than my current 18 weeks) and a library of forensic photos of skin lesions (I prefer more nonrepresentational art). The lecture focused on what can happen to the skin as we age, occasionally using our face as a canvas for spots, growths, tags and other unpleasant additions to once-youthful skin. The morphology is far too complex for this blogger’s brain but let me summarize in two succinct points:1. Aways wear sunblock (sun is the major factor in aging skin) 2. Pay attention to anything on your skin that changes with time or worries you and see your doctor about it (skin cancers can and do sneak up without warning).

On to a body part that’s more digestible (sorry) - the liver.  Christopher Bowlus, MD and professor of gastroenterology and hepatology, introduced his lecture by saying he’d talk about “digestive issues after the age of 50 ... which, actually, is most of them.” Ah, yet another portend of the aging process.

A Hernia Where?
The malady of GERD (Gastroesophageal Reflux Disease ) came up first (please notice the paltry pun here) and drew rapt attention as GERD is fairly common - and mostly just annoying, but can grow to be a dangerous condition leading to cancer of the esophagus. GERD develops when acid from the stomach moves up and into the esophagus because the esophageal sphincter no longer prevents this action. A hiatal hernia can be the cause. The sphincter opens and closes to keep acid from traveling up (much like another such muscle keeps other matter from traveling down at will). This acid causes burning, pressure, discomfort and can get bad enough to feel like a heart attack, reports Dr. Bowlus. “I sent my own dad to the emergency with heartburn.”

A hiatal hernia  is not uncommon and can be diagnosed with an endoscopy. Treatments range from taking over-the-counter acid suppressants like Zantac or Prilosec, or simple Tums or Mylanta. However, when such band aids don’t work it’s important to look more closely at what’s happening. If the lining of the esophagus has changed and has the look of the structure of the stomach, this could indicate a precancerous or cancerous condition.

GERD happens to men more than to women and predominantly to white men. There’s a rise in esophageal cancers that’s being traced to this nation’s obesity epidemic. Risk factors include being a white male over the age of 50 and overweight.  (There were lots of sideways glances from women to their male partners during this lecture.)

Baby Boomers Face Increased Risk
Dr. Bowlus also talked about liver health and disease - he says he considers the liver the most fascinating organ in the body. Go figure. Liver disease is the 10th leading cause of death among men and the 12th in women. A scary characteristic about the disease is that symptoms often don’t appear until it is, literally, too late. The risk rises significantly between the ages of 45 and 54. Most common causes are alcohol, chronic hepatitis, the use of certain medications and the growing incidence of fatty liver disease. 

A safe level of alcohol (4 ounce servings) for most women is 1 drink a day and for men, it’s about 2 per day, according to many studies.  The Doc clearly announced that no, you may not save up your drinks and enjoy them all over the weekend.  Studies show about 20% of alcoholics will develop liver disease such as hepatitus, and many other diseases are associated with alcohol consumption.

Hepatitis B is a chronic infection that, in Asia and Africa are transmitted at birth, is the leading cause of death in Asia and greatly impacts immigrants to the U.S. from those countries.

Hepatitis C is more prevalent in the U.S., and traced to sharing needles, getting tattoos and, prior to1992, blood transfusions. Baby boomers beware! According to a recent study our generation is at pretty high risk. Dr. John Ward of the Centers for Disease Control calls it “a silent epidemic.” The recent CDC report predicts that one of every 3 baby boomers “is living with hepatitis C infection.”

The Big, Bad ‘C’

Colon cancer topped off the Doctor’s list of gastroenterological threats. The 3rd most common cause of death in men and 2nd in women, the occurrence dramatically increases after the age of 50. Risk factors include smoking, alcohol use, obesity and family medical history. Stool-based screening tests that we are advised to get annually after the 50th birthday may reveal small amounts of blood. Since cancers bleed, this would be an indication a closer look is needed. Unfortunately, a closer look most often means a colonoscopy or a similarly “uncomfortable” procedure.

Being exceptionally bright mini-medical students we all could extrapolate what “uncomfortable” actually means. I am stunned that, in the digital era, in a time when CERN physicists are dabbling with atoms traveling faster than the speed of light and neuro-imaging scientists are essentially able to ‘read’ a mind, our scientific genius can’t devise a less “uncomfortable” procedure to examine the colon. Nonetheless, very recent studies in the New England Journal of Medicine affirms the procedure is highly effective and critical to saving lives.

Week four of UCD’s Mini Medical School, orchestrated by the Department of Internal medicine and Dr. Michael McCloud, takes a close look at medications (I think we take too many) and the heart (we all need just one in good working order).

COMMENTS
From Mollie:

One of the networks was telling the children of the elderly when they should take away their parents cars.I think that should be up to Motor V. They also were talking  about how many accidents the elderly have. I thought why don't you look at sixteen year olds and how many accidents THEY have... This is one reason we need to fight ageism unless we want

some one else telling us what to do.

> 

Mini Med School Brief #2

Hospital to Home - A Winding Road




Dr. Michael McCloud opens the class

Week 2 of UCD’s Mini-Medical School focused on a topic that most of us would rather ignore until necessity bares its teeth and makes us pay attention. Deborah Bakerjian,PhD, RN concisely outlined the continuum of care that we - or a loved one - may experience during and after a hospital stay. Lacking knowledge of the health care system, any one of us can be drawn into a labyrinth that rivals the London Underground overlaid with a street map of the infamously complicated city. In the case of health care, it’s not only easy to get lost, it’s also dangerous. So, like my fellow undergrads, I Iistened up!

Bakerjian, an assistant adjunct professor at the Betty Irene Moore School of Nursing at UC Davis, advised us: “You are a member of the health care team and you are the center. The more empowered you are, the better the outcomes.” The time to assume that role is now, when we’re well and determined to stay that way!

 
Some Smart Moves

Step one, she says, is to designate a personal advocate - someone familiar with your medical history and your intentions regarding the level of life saving care you expect. After all, when we are admitted to a hospital we may not be in the best mental and physical condition - think stroke, heart attack, unconsciousness. The advocate will have access to your health records, know your wishes and be able to help guide your care when you are not at the top of your game.

 

The California Patients Bill of Rights has an online form that makes it easy to designate an advocate in writing and prepare other documents such as a POLST (Physicians Orders for Life Sustaining Treatment) , a Durable Power of Attorney and an Advanced Directive that specifies the level of care you want and do not want. These documents, when signed by a Notary Public, are legal and enforceable. You can find out more about the benefits of this kind of planning ahead by reading an inspiring story about a Sacramento woman’s advanced planning, by by Sacramento Bee writer Anita Creamer.

 Follow the Roaming Records?

But, it’s not just emergency and end-of-life decisions that call for an advocate. That responsible friend can also help guide your journey back to health. As an expert in the process, Bakerjian admits that, as patients move through the system from hospitalization to after-care, there are ample opportunities for information to go astray.  Consider that a person may have seen more than one team in an ambulance, the emergency room, another in surgery, intensive care, and a hospital recovery room. Each will have sets of records as will an individual’s personal physician; it’s easy to grasp the concept of many moving parts that don’t necessarily fully mesh with each other. In addition, an emergency may have taken a patient to a hospital not in their insurance network - necessitating a transfer. Bakerjian pointed out that although electronic medical records are the ideal solution for such cases, they are not yet reality. Most often, your records and history cannot be immediately shared between all hospitals.

 
“Every time we move we are vulnerable,” Bakerjian  says.
 

Speeding Recovery

Upon release from a hospital, a patient may be sent to a skilled nursing facility (a SNF). The advocate can help select which facility would best suit the patient - and research the quality of facilities www.nuringhomecompare.gov before making that choice. Considerations include staffing level, the results of health inspections, complaints and deficiencies noted in inspections. It’s also important to know that SNF’s are not required to have a physician on site. Most skilled nursing facilities are not like a hospital with doctors, RNs and LVNs readily available. Bakerjian lauds the growing use of Nurse Practitioners in SNFs because their presence shows improved health outcomes for patients. An  advocate can monitor medical visits and intervene if necessary. That said, Bakerjian pointed out that SNFs are the nation’s second-most regulated industry, just behind nuclear power. Nonetheless, caution and research are advised.

 

Learning without Experience often Necessary

Health events requiring hospitalization, rehabilitation and skilled nursing care are, thankfully, not a commonly repeated experience for most people. However, this lack of experience can create ignorance that’s dangerous. Health records with allergies listed, medications taken, past health history and Advance Directives can help mitigate the chance of information getting lost or not communicated from one entity to the next.  Having those documents accessible and available to a health advocate is critical. Understanding these vulnerabilities in the system is important according to Bakerjian. She freely admits that records from hospitals are “often incomplete,” that emergency department treatment can be “missing,” lists of medications “may be inaccurate” and other balls in the healthcare court can go astray.

 The take-away from week 2 of Mini Med School, a free community service created by UCD Department of Internal Medicine geriatrician Dr. Michael McCloud? Just buckle down and take care of business! Complete legal paperwork that can protect you and guide your personal care according to your wishes, and make some trusted person your advocate. Then, relax and do something fun like bungee jumping or sky diving without worrying about those troublesome, what-if details!

 Next week we learn about skin. Stay tuned and perhaps I’ll be able to pass along some miracle cream, eye lift serum, age spot remover or, at least, a better attitude through understanding of the body’s biological concept of “face time”.

Secrets of Health Aging Revealed

Mini-Med School for Mere Mortals Starts 2012 Sessions

I’m back in medical school for the third time - Mini Medical School that is. Right there in the front row taking notes on my iPad as preeminent faculty of the UC Davis medical and nursing schools  cover topics that ought to interest anyone who wants to age well. In fact, the population of our Sacramento community is very interested. Each year the free 6-week seminar draws hundreds more requests for seats in the auditorium than are available.

The star and host of the show is Dr. Michael McCloud, one of a handful of geriatricians in Northern California. Witty, wise and a master of the turned phrase he orchestrates the weekly sessions that range from nutrition and brain health to medicine and fitness - even an occasional talk on why beer is the perfect health food (as if anyone doubted that). The program is a unique offering of our local, prestigious medical school. One that, should students listen well, can change and improve the quality of our years in ‘Life’s Second Half.’

Week one included a thorough overview of nutrition that I summarize here so that you may further explore the nuggets of information. The caveat is, of course, do your research and consult with your own physician - I am a simple (my husband might disagree with that adjective) blogger and returning student, not a medical expert. 

Less is More

The lesson delivered by Marilia Braun, PhD and outpatient dietician for UCD had at its core a message that many of us will find challenging to swallow - there is substantial research indicating that the amount of food we eat takes a significant toll on our health as we age. For example, as we grow older we have less lean muscle mass, the tissue that burns calories. Nonetheless, we persist in taking in the same amount of calories as when we were much younger. Is this denial or lack of education about the dynamics of the aging process? Whatever the source, there is now compelling scientific evidence that if we want enjoy a long life we need change our eating habits.  

Following Super Bowl Sunday, this may be particularly distressing news. But, the  loss of muscle mass, inactivity, hormonal changes and other factors mean that if we want to live long and well, the nachos and pizza and beer need to be put away and replaced with conscious eating and restricted calories. If that sounds distressing, consider this: according to Dr. Braun, research shows that a 25% to 60% reduction in calories can extend life by a full 50%. The diet also delays many age-related diseases - the kind that make us feel and act ‘old’ from the inside out and radically alter our enjoyment of life. Think arthritis, diabetes, cancer, osteoporosis, dementia and the host of disease demons we fear most.

What do we need in our bodies to thrive in the second half? Unless you are a serious athlete or a brawnet construction worker, about 1600 to 2000 calories a day. Carefully chosen calories that include the right grains, veggies, protein and good fats. Yes, it takes work and effort. But so do insulin shots, chemotherapy, recovery from stroke and heart disease and other changes we are forced to make in response to a medical crisis. Somehow, me thinks a restricted diet is less painful and far more promising. 

Praise for Protein 

Dr. Braun’s lecture also included five more recommendations - not requiring major lifestyle changes but clearly most effective when implemented within a calorie restricted diet (I’ll include links to more information about calorie restricted diets at the end of this blog). Her strategies include attention to protein intake. Too little protein can contribute to muscle loss (even when you are eating enough calories). And, muscle loss is inevitable when we become less active. She suggests “supplementation” of an additional 16 to 30gm a day, depending on your weight.  Some top food sources for protein include chicken breast, top sirloin, pork loin, salmon and yogurt - but in far smaller portions than we generally eat. 

Supplementing the Diet

Our aging bodies also need additional Vitamin D . Deficiencies in D can come from a variety of factors including the color of your skin (darker absorbs less D from sunlight than lighter skin). Increased intake of D may reduce occurrence of infectious diseases, diabetes,  Alzheimer’s and related dementias, and mortality rates. The recommended dose is about 1000 to 2000 IU of D3 a day - depending upon the source (check out the links on this one). 

Next on her list as Strategy 4 is making certain to get enough Omega-3  - an essential fatty acid that is known for anti-inflammatory qualities, production of insulin, acting as an anti-oxidant and other beneficial effects with polysyllabic medical names that only confuse us Muggles - so I won’t go there. According to Dr. Braun’s handout we don’t get nearly enough of this stuff - an average of 0.023 gm a day when the recommended intake is between 1.1 and 1.6 gm a day. Our bodies do not produce Omega 3 and the best sources are fatty fish such as salmon and sardines, halibut and tofu among other foods.

Strategy 5 is to include Probiotics in your diet - these “good bugs” strengthen the immune system, reduce inflammation, act positively on bowel function and reduce respiratory infections. We can spoon or slurp these miracle microbes in yogurt and kefir or by taking supplements.

Antioxidants are also critical to healthy aging. There is a whole host of benefits to the body and brain from antioxidants and they are found in may sources - fruits, grains, brightly colored vegetables, fish, meat and the convenient supplement. Wait! Did I fail to mention red wine and dark chocolate? (This diet isn’t all bad.) Antioxidants provide protection against the production of “free radicals” - those renegade incomplete atoms that cause damage - even wrinkles on the face can be a byproduct of free radicals production. 

Let me also mention that a question about which supplements to choose from among the confusing array available provided a simple answer from our UC expert - Sam’s Club and Kirkland products are highly tested and well rated (and likely less expensive) than many other brands. Dr. McCloud adds that no matter where you purchase supplements, remember to check for a USP label and for companies that produce large quantities of products rather than a select few. (The FDA isn't yet involved in this sometimes controversial 'supplements' arena.)

This is a very abbreviated account of a Mini-Med lesson but I hope it inspires further research - along with a curiosity about the great community program sponsored by the UC Davis School of Internal Medicine.

Here are links to information about the topics presented in the Nutrition seminar. I’ll add more as the 2012 Mini-Med session continues:

www.cdc.gov/aging

www.hnrc.tufts.edu

Links from Dr. Michael McCloud:

www.healthfinder.gov

www.medlineplus.gov

www.ACPonline.org

Focused on physicians there is also a rich, no nonsense area for “patients and Families”