Preventing a Heart Attack

Cardiovascular disease remains the number one killer in the US for both men and women. Not cancer, fatal gun shots, automobile accidents or Alzheimer's disease as you may think. A heart attack or myocardial infarction will hit about a million people in the US this year and will kill about five hundred thousand men and women. The other five hundred thousand men and women will suffer a heart attack and survive but many are incapacitated either emotionally or physically or both. The good news is that heart attacks may be prevented.

Heart attacks don't spare the younger population either. With the rise in levels of obesity and diabetes in young adults of 20 and 30 years of age, this is a cause of great concern and alarm to doctors and official health authorities.

Genetics certainly play a big role in the cardiovascular risk but you can bypass this risk with preventive measures and even some medicines.

It is very important to know your cholesterol and blood pressure numbers to start with. For most people a LDL cholesterol (low density lipoprotein) or as I call it the "Lousy" cholesterol should be under 100 (for diabetics it should be 70) and the HDL cholesterol or as I call it the "Happy" cholesterol should be higher then 60. A good reading for a blood pressure in most people should be 120/80. Please note that patients with a large arm as compared with a regular size arm circumference, should have their blood pressure measured with a large cuff, just as children are measured with a child's cuff. (Yes, even children can have high blood pressure and for a variety of different causes.)



It is also important to know other parameters that can increase the risks for a heart attack such as your glucose (sugar) level, your level of accumulation of fat in the walls of your arteries such as in the carotid arteries, your heart rhythm and the presence (or not) of a heart murmur and others.

Here are some of the most important things you can do:


1) STOP SMOKING - Within a year, a former smoker reduces his heart attack risk by 50%. This is quite impressive.


2) EXERCISE and EAT HEALTHY - Exercise and diet are also fundamental in reducing heart attack risks. Exercising at least 30 minutes a day is associated with a 70% heart attack risk reduction in a year. This exercise could be a brisk walk for example. A good sweat.  A brisk walk 10 minutes a day will reduce by 50% a heart attack risk. Not bad at all if you think of it.

Sitting for more than 4 hours in front of a computer or a television is an added risk factor for a cardiovascular event. Prolonged sitting is associated with higher levels of inflammatory markers in the blood, higher body weight, lower levels of HDL, the good (happy) cholesterol indicating than sedentary behavior has it's own bad biology. Take a walk many times during the day, take the stairs instead of the escalator. Instead of going for a snack, go for a 10 min walk. Invite a friend or a family member to walk with you. It will encourage you to walk more.


3) EAT HEALTHY FOODS - Diet is fundamental. You are what you eat. You know you feel heavy and sluggish after a huge meal and you usually end up regretting it right after you finished your last bite. So limit the size of your portion. Fresh produce and other unprocessed foods are best. Vegetables, fruits, grains, nuts (limit the salt please), olive oils, low fat yogurt, fat free milk or soy milk, fish and some lean white poultry meat should be the preference. Try to avoid red meats, fried foods such as French fries, bacon, butter, whole milk, heavy cheeses, and certainly try to avoid refined sugar. You don't need to add sugar to your coffee or tea. It is a matter of acquired taste and you will soon get used to drinking or eating with less or no sugar.  Same thing for salt. Try to avoid it.

A good healthy diet that I recommend is a Mediterranean one with the products I mentioned above.


4) SLEEP  - Sleeping is very important for your health. It is known that chronic sleep deprivation leads to high blood pressure, weight gain and increase your risk of diabetes.


5) AVOID DEPRESSION, ANGER and HOSTILITY-  These feelings have a deleterious effect on cardiovascular health. Beware of these emotions and try to manage or control them as much as possible. You can try to do this alone or enlist the help of family members, friends or with a therapist if you feel you need it.


6) BE HAPPY - Think of good moments and good times, stay positive. Good humor, be happy, smile whenever possible, try to worry less than you normally do.

WHAT TO DO IN THE EVENT OF A HEART ATTACK?

If you believe you are having a heart attack, chew an aspirin (81mg) while waiting for an ambulance. In fact many doctors prescribe a daily baby aspirin (81mg) to everyone 50 years of age and over regardless of symptoms or history of a heart attack. That is unless you have a medical contraindication to aspirin (allergy, active peptic ulcer, dengue fever and others to be discussed with your doctor).



It may not be easy to follow but keeping to these measures may not only reduce the risk of a heart attack but will also make you feel better, healthier and happier.


Albert Levy, MD

Through Dr Levy's Stethoscope....

Family Medicine and the Role of the Family Doctor:
In a nutshell, my role is to care for the physical, mental and emotional needs of patients of all ages. I have been fortunate to have trained in all areas of medicine, including pediatrics, adult medicine, geriatrics, gynecology, obstetrics, general surgery, psychiatry, psycho-analysis as well as alternative therapies like acupuncture and Homeopathy. The purpose of my blog is to offer updated medical news and share important tips and advice.

Depression Survey

Over a four week period at the beginning of this year, we conducted a survey in our office with the help of one of our top students, Duncan Cheng, from NY Medical College. A Depression Questionnaire, composed by Duncan, (see below) was given to 70 patients over a period of 4 weeks while they were waiting to see their doctors. The intention of the survey was to evaluate if patients coming in with somatic complaints had underlying psychological concerns that manifested physically.

The results showed that 6 out of the 70 patients surveyed, or more than 8%, met the criteria for positive depressive symptoms

From these results we can conclude that when patients come to the doctor’s office, some of them do have hidden psychosomatic agendas. We encourage incorporating questions about mental health in every patient encounter as it could be life-saving to address psychological issues in patients. It also shows that patients should feel more comfortable expressing their feelings openly with their doctors, in addition to their physical symptoms.

More research still needs to be done to further support these findings.

Manhattan Family Practice
Patient Mental Health Questionnaire

Initials:_____ Age:_____ Race/Ethnicity:____________________

Sex: ___M___F

Were you born in New York? ___Yes___No

If no, what year or age did you come to New York? __________

1. Do you feel happy most of the time?___Yes___No

2. Are you content with your life? ___Yes___No

3. Do you enjoy things the way you used to? ___Yes___No

4. Are you usually calm? ___Yes___No

5. Do you have trouble sleeping? ___Yes___No

6. Do you often feel helpless?___Yes___No

7. Do you often feel tired? ___Yes___No

8. Is your appetite as good as it used to be? ___Yes___No

9. Is your concentration as good as it used to be? ___Yes___No

10. Do you ever have thoughts about killing yourself? ___Yes___No

O que É Homeopatia?

Muita gente fala sobre homeopatia no Brasil e na Europa, que agora está resurgindo como modalidade terapêutica aqui nos EUA. A homeopatia já era conhecida há mais de 2 mil anos, desde os tempos do Pai da Medicina, Hipócrates, e já estava em uso nos Estados Unidos desde dois séculos atrás. Caiu de moda com os avanços científicos, já que a homeopatia não se submete ao rigor científico da pesquisa para criar e administrar remédios homeopáticos.

 

No Brasil, na França, Bélgica e tantos outros paises, a homeopatia é uma das modalidades da medicina, e muitos médicos a praticam, seja em caráter exclusivo ou de forma complementar à madicina tradicional, como eu mesmo exerço. Ou seja, quando o paciente precisa de um medicamento homeopático, não hesito em lhe prescrever, especialmente se trata-se de alergias, asma, medos noturnos, traumas, depressão, anxiedade, prevenção do resfriado ou da gripe e tantos outras enfermidades.

 

 

A familia real Britanica tem o seu médico particular homeopata e se trata no hospital homeopático de Londres. Os remédios homeopaticos sao reembolsados pela saude publica em varios paises e provavelmente sera o caso aqui nos Estados Unidos. O problema é que os remédios homeopaticos sao bem baratos e a industria farmaceutica Americana colide com a homeopatia pois a veem como uma rival mais em conta e menos perigosa que os remédios alopaticos, da medicina tradicional. Entende-se que a industria farmaceutica gasta bilhoes de dolares em pesquisa cientifica obrigatoria antes de lançar qualquer produto medicamentoso no mercado e ela quer se resarcir destes investimentos. E como vimos acima, a industria homeopatica não tem esta obrigação.

A homeopatia como o nome indica, estuda as patologias que se curam com substancias encontradas na natureza e que por similitude podem ocasionar os mesmos sinais e sintomas mas em diluiçoes infinitesimais, causam a cura destes mesmos sintomas

Um exemplo clássico é o arsênico que, se ingerido in natura, pode causar sufocação por constrição dos brônquios; se diluído, esse mesmo arsênico poderá causar dilatação dos brônquios. Portanto, a mesma substância, que pode matar em dose encontrada na natureza, pode salvar uma pessoa, se ingerida em forma super diluída. Nesse caso, usa-se o Arsenicum Album no asmático. Não tente diluir o arsênico em casa –isso deve ser feito em uma fábrica especializada, com máquinas muito especiais.

 

Visitei as fábricas em Lyon na França e fiquei impressionado com a técnica, a higiene e asepsia rigorosa com que eles manuseiam seus produtos, até a transformação em pequenas bolinhas homeopáticas. Também produzem cremes como o Arnicare para traumas, o Calendula para queimaduras e mordidas de mosquitos, colírios para inflamações oculares, comprimidos para o stress e assim por diante.

 

Um dos produtos mais populares é o Oscillococcinum, também chamado Oscillo, que vem num tubinho cheio de bolinhas minúsculas e que deve ser tomado ao primeiro sinal de que você vai ter uma gripe –seus poderes de reduzir a duração e a severidade da gripe estão mais do que provados. Uma das vantagens da homeopatia é que ela pode ser administrar em bebês, crianças, adultos, grávidas, idosos, além de não tem contra-indicação, não interagir com outros remédios e ter custo bem mais acessível do que o de remédios convencionais.

 

Vale lembrar que a homeopatia trata os sintomas. Se o paciente tem pneumonia bacteriana com tosse e febre, ele precisará de um antibiótico e poderá utilizar remédios homeopáticos para a tosse e a febre, mas não poderá se curar sem o antibiótico, remédio da medicina clássica.

 

Se tiver um câncer com sintomas de náusea, provavelmente precisará de cirurgia, quimioterapia e ou radioterapia, mas podera tomar remédios homeopáticos para a náusea. Não se trata a doença com homeopatia; sinais e sintomas, sim.

 

Gosto muito de usar homeopatia quando possível, especialmente para pessoas alérgicas a remédios, problemas psicosomáticos, asma, alergias, ansiedade, depressão e em pacientes que já tomam uma grande quantidade de remédios convencionais e que precisam de alguma coisa para dormir ou para a fadiga e o cansaço.

 

Is It a Cold? Is It the Flu? Is It an Allergy? And do I Stay at Home?

"Season of mists and mellow fruitfulness..." and in my office it is the season for giving FluMist (nasal spray) or Flu Shots to the majority of my patients. It used to be a must-have preventive vaccine for those most at risk, like asthmatics, diabetics, people over 65 and young children. Now most people want to be vaccinated so they can feel more protected when they go about their normal work and travel plans during the fall and winter seasons.



Another good reason to be vaccinated is to stop the spread of the influenza virus to those around you and in the community. This year's vaccine covers three strains of the virus out there, including the H1N1. Some people with low immunity can develop infections from the flu or pneumonia so it is very important that we all responsibly take action to protect them and ourselves.

Suppose you do find yourself with a runny nose, sneezing, nasal itching, watery eyes and you do not know what to do. You may actually be suffering from nasal allergy symptoms and require an allergy medicine, (tablet or inhaler).

Or you may be running a slight temperature and you are sneezing, coughing and feeling generally run down. You need to make decisions:

A) Do I go to work?
B) Do I go to the doctor?

Normally, I would say that if you are unable to perform your duties well because of your health condition and if you are sneezing and coughing, then it is best to stay at home as you can be contagious. Germs circulate rapidly.



If after two to three days of resting, drinking plenty of liquids, eating chicken soup, breathing in fresh air, maybe taking over-the-counter flu medications to relieve the symptoms you are still feeling the same then you should go to your doctor to check if you have an infection that can be treated by antibiotics.



The best way to prevent flu is always to remember to:

1) Wash your hands regularly
2) Exercise and keep active
3) Eat nutritious meals with plenty of fruit and vegetables
4) Drink plenty of fluids (but try to avoid sodas and sugary drinks)
5) Get good sleep and rest
6) Don't forget your flu shot!

If in any doubt, call or email your doctor's office for personal advice.

How a Family Doctor Diagnoses Depression

According to a new survey from the Centers for Disease Control and Prevention, one in 10 Americans over age 12 are now taking antidepressants which is a fourfold increase in the prevalence of antidepressant use since the late 1980s.



When a female patient, a mother of two, came to my office for her regular check up this past Summer, she didn't seem her usual self. At 48 years old, she looked tired and complained of difficulty sleeping. When I questioned her further I learned that she was not enjoying all the things she used to in the past. She couldn't understand why she was feeling overwhelmed, irritable and anxious. She was not surprised when I told her it was depression but she was reluctant to take medication. I explained that it could help her cope more easily and she agreed to try it out and come back for follow-up. Now she comes to see me once every few weeks to check in and manage her symptoms and discuss any issues she may have. She says the medication has helped her tremendously and she has started to notice the difference.

Most patients don't come in saying, 'I'm depressed". They come in with all kinds of different symptoms like headaches, anxiety, trouble sleeping, for instance, but after a deeper consultation they will reveal their depression

Most family doctors are best placed to take on the role of therapist with their patients if they take the time to ask the right questions and notice the signs. Some patients are resistant to seeing mental health professionals as they are either in denial or simply can't afford the time or the money.



Many psychiatrists agree that screening for and treating depression in the doctor's office is a necessary expansion of a family doctors' duties. Dr. Gary Small, a psychiatrist and director of the UCLA Center on Aging says "Part of what we do as psychiatrists is teach doctors how to diagnose and treat depression so that a lot of depression can be handled in primary care".



The report, published Wednesday, draws on a survey of over 12,000 Americans over the age of 12. It showed that women were the largest consumers of antidepressants: 23 percent of all women ages 40 to 59 reported taking antidepressants. This does not necessarily mean that women are more depressed than men but that they are more open to seeking help and therapy from their doctors.



Of course, no patient should be treated with medication alone for depression. Follow-up is key so we can talk about adjusting the dosage or stopping the medication as needed. If I see a deeper need for psychotherapy I have an excellent network of professionals I refer to and work together with.



Although the survey captures how many patients are on antidepressants, it does not necessarily represent the true number of patients being treated for depression. Some antidepressants are prescribed for anxiety, neurological pain, fibromyalgia, sleep problems, and menopausal hot flashes.



There is certainly less stigma today attached to seeking help for depression. Talking to your family doctor about your symptoms, your stresses and anxieties will help them decide if an antidepressant will help you cope more effectively and to prescribe the right treatment for you.

Vitamins – To Supplement or Suppress?

Many of my patients have been asking my opinion on the recent news on the risks of taking vitamin supplements. Studies have shown that there is a slight increase in mortality risk from taking vitamin supplements and an increased prostate cancer risk in men who took Vitamin E. So should we be taking multi-vitamins at all?



I had already been advising my patients to stop their vitamin supplements four to five years ago unless absolutely necessary. For me this would be in the case of patients who have a Vitamin B or D deficiency, pregnant patients who need folate and pre-natal multi-vitamins or those with cognitive impairment (pre-dementia) when I would recommend a Vitamin B complex.



The issue of vitamin E was raised a few years ago after studies indicated an increase in cerebral hemorrhage hence I do not recommend it. Now the study on prostate cancer further confirms the risks associated with this vitamin.

Iron supplements are out of the question unless there is a clear deficiency and a need for replacement

Calcium is recommended in small doses due to possible association with kidney stones and the controversy around women and calcium deposition in the heart.



As a nation with a more than adequate supply of nutritional food at our disposal, there is little need to take supplements. And yet the latest surveys show that one third of Americans take vitamins and nearly half of people over 50 take multi-vitamins, spending nearly $10 billion on vitamins last year.



I would rather give the money spent on monthly vitamins to the millions of malnourished human beings in Africa and other underprivileged areas of the world.