2012 Medical Issues Posted by the Daily Dish

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Ask Dr. Arthur Agatston
Treatment for Sick Sinus Syndrome
Q: I am a 44-year-old woman who had a pacemaker put in about a month ago for sick sinus syndrome. Problem is . . . I don't feel better. Shouldn't I feel something different by now, or is it still too soon?
— Janet, Ohio
Dr. Arthur Agatston - Heart Disease Center A:

I’m sorry that you’re not feeling great, Janet. There could be a number of reasons for this.

Sick sinus syndrome is the name for a group of heart rhythm problems that stem from the sinus node — the little bundle of specialized cells in the upper-right chamber of the heart (the atrium) that generate the electrical impulse that makes your heart contract. In other words, the sinus node is your heart’s natural pacemaker. When it doesn’t work properly, you may experience a slower than normal heart rate (bradycardia) or a faster than normal heart rate (tachycardia), a heart rate that alternates between fast and slow (bradycardia-tachycardia syndrome), or even extra (premature) heartbeats or missed heartbeats.

The thing to know about a standard man-made pacemaker, however, is that it will only increase a slow heart rate, not slow down a fast one. So, when a doctor implants a pacemaker for sick sinus syndrome, it means that you were likely diagnosed with a slow heart rate.

That said, a patient with fast-heartbeat symptoms may get a pacemaker because the medications that would slow their heart rate to normal simply slow it down too much. In such cases, a pacemaker is put in to counteract the medications.

Another reason that you might not be feeling well is that sick sinus syndrome can sometimes be due to heart defects. Scar tissue from a previous heart surgery or from structural problems due to heart disease could affect the electrical system of the heart and cause uncomfortable abnormal heart rhythms. In addition, certain medications, such as calcium channel blockers or beta-blockers prescribed to treat high blood pressure (or to slow fast heart rates, as noted above) can cause bradycardia.

Furthermore, how you are feeling could depend on the type of pacemaker you have. Some heart rhythm problems are treated with a single-chamber pacemaker, which uses one wire lead to stimulate one chamber of the heart (the atrium). But other rhythm problems — such as those involving the atrioventricular (AV) node, for example — could require a dual-chamber pacemaker, in which one lead paces the atrium and another paces the ventricle.

More likely, the reason you aren’t feeling well is that it has only been about a month since your procedure. It takes about that long for the incision to heal, and you may feel numbness or fullness in the area around the pacemaker for a few months longer. I hope this is the case — that your issues are due to how recently you had the procedure.

But since I don’t know exactly what you mean when you say you’re not feeling better, I urge you to call your doctor to discuss your symptoms and to perhaps inquire about some of the things I have addressed above. You should also get checked out for other problems not related to the heart that may be contributing to the way you feel.

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9 Quick Tips for Working Out at Work

While a regular workout routine is an essential part of reaching your weight-loss goals, there will be times when your job or other obligations get in the way of exercising. Although Dr. Arthur Agatston, author of The South Beach Wake-Up Call, recommends a daily 20-minute exercise routine — alternating days of interval exercise with days of core-strengthening exercises — he suggests that even on those days when your schedule is too crammed for a full workout, you try to get in a 5- or 10-minute walk or simply incorporate more movement throughout the day. After all, some exercise is always better than none. If you can’t find time for fitness before or after work, here are 9 tips to help you squeeze fitness into your workday.

Park farther away from the office, or get off public transportation at an earlier stop and walk the rest of the way to work.
Take the stairs instead of the elevator, especially if you have just a few flights to climb.
Go for a walk during lunch. One way to do this is to pass by your usual salad spot on the corner and find one a little farther away. If you bring your lunch to work, use the time you save to take a walk around the block.
Walk over to coworkers’ desks when you need to chat with them or deliver messages rather than using e-mail, instant messaging, or the phone.
Instead of meeting friends in the office or over lunch, meet to take a walk.
Use your headset or cell phone and walk around while talking on the phone.
Stretch occasionally while sitting at your desk or keep a light pair of weights at work and do some upper-body exercises.
Do this simple core-strengthening exercise at your desk: Sit up straight on your chair, keep your feet on the floor, and your knees over your toes. Tighten your abs and straighten your back while keeping your neck relaxed. Hold this position for 10 seconds or longer. Repeat a few times.
If your office allows it, swap your chair for an exercise ball that you can sit on throughout the day. This will help improve your balance and tighten your core.

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Beyond Diet and Exercise: How to Protect Your Heart

As you’re following the South Beach Diet lifestyle, you already know about the heart-healthy benefits of making nutritious food choices and exercising regularly. But if you have a moderate or high risk of heart disease, lifestyle changes alone may not be enough to ensure a healthy heart. While leading a healthy lifestyle is always recommended, your doctor may also suggest certain medications and/or supplements that will help lower your risk of heart disease. Here's a snapshot of some commonly prescribed medications and supplements that can help protect your heart.

Statin drugs: Over the past 30 years statin drugs such as Mevacor, Pravachol, Lescol, Zocor, Crestor, and Lipitor have changed the prognosis for tens of millions of people who are at risk for heart disease or who already have it. Not only can statins reduce levels of the dangerous LDL cholesterol by 20 to 60 percent with few side effects, they can also mildly lower triglycerides and raise good HDL. Furthermore, numerous clinical trials have shown that these drugs may help prevent heart attacks and strokes: When combined with other drugs or with prescription niacin, statins can cause the regression of soft plaque, the type of plaque that can rupture and damage blood vessel walls, causing a blood clot to form. If the clot is large enough, it can block blood flow to the heart muscle, causing a heart attack. Statins can also reduce inflammation and improve the overall health of the blood vessels.


Aspirin: Taking low-dose aspirin every day or every other day if you are at risk for heart disease thins the blood slightly, making it less sticky and thus less likely to form clots that may precipitate heart attacks and strokes. Be aware, however, that aspirin has been shown to have very little effect in those who have no risk factors for heart disease. Also, some people, particularly those prone to gastrointestinal ulcers, cannot tolerate aspirin therapy. Before taking any form of aspirin regularly, consult with your doctor about whether aspirin therapy is right for you.


Fish oil supplements: Just as Dr. Arthur Agatston, author of The South Beach Wake-Up Call, advises people to eat fish high in beneficial omega-3 oils (such as wild salmon, herring, trout, and sardines) at least twice a week, he also follows the current American Heart Association (AHA) guidelines with regard to omega-3 supplements. The AHA recommends combined eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — the two major types of omega-3 fatty acids — in a dose of approximately 1,000 mg (or 1 g) per day in patients with coronary heart disease. For people with high triglycerides, Dr. Agatston agrees with the FDA recommendations for considerably higher doses of omega-3s from prescription fish oils (4 g per day) but he advises you to be certain your doctor monitors your cholesterol, since prescription fish oils can raise levels of bad LDL in some people.


Niacin: This B vitamin (B3) is available over the counter as a dietary supplement, though Dr. Agatston recommends higher doses (available by prescription only) for those at risk for heart disease. In combination with a statin, niacin can be a very effective agent for slowing or reversing atherosclerosis and preventing recurrent heart attacks and strokes. Niacin can increase HDL and it can also lower LDL as well as triglycerides. While certain forms of niacin are associated with flushing and itching of the skin in some people, this unpleasantness generally disappears within an hour. In some people with diabetes, niacin can raise blood sugar levels; however, this effect is generally mild. If you think niacin could help you, discuss its use with your doctor.

While diet and exercise can go a long way toward improving your heart health, sometimes medications and/or supplements are also required. Your doctor will help you determine what prevention program is right for you.

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How Omega-3s Benefit Your Health

All fats are not created equal: Some are good (unsaturated), some are bad (saturated), and some are really terrible (trans fats). Among the good fats are omega-3 fatty acids, which offer a number of health benefits, including helping to lower your risk of heart disease and stroke.

What Are Omega-3 Fatty Acids?
Omega-3s are called essential fatty acids because they are required by the body for good health and must be obtained through food and/or supplements (the body can’t make them on its own). There are three types of omega-3s, each essential for optimal health. Two of them, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are found mainly in cold-water fish, such as herring, sardines and salmon. EPA and DHA are extremely effective at reducing inflammation and preventing the formation of blood clots, thus reducing the risk of stroke and heart attack. The third kind, alpha-linolenic acid (ALA), is found in plant sources such as flaxseed, walnuts, and dark leafy greens. Once ingested ALA is converted to EPA and DHA, the types most readily used by the body.

Foods and Omega-3s
The best and most natural way to increase your intake of omega-3s is to eat more oily fish (at least two servings per week) and dark leafy greens, and to add ground flaxseed and walnuts to your diet in moderation. The American Heart Association recommends getting 1 gram daily of EPA and DHA, preferably from oily fish, although it says that an omega-3 fatty acid supplement could be considered in consultation with your physician. Dr. Agatston agrees with these recommendations. For people with markedly elevated triglycerides (bad blood fats), higher doses of prescription fish oils can be quite effective when used under a doctor’s care.

A Word of Caution
Be advised that people with certain medical conditions, such as those taking anticoagulants, those with bleeding disorders, or those with uncontrolled hypertension, should always consult with their physician before taking fish-oil supplements. Also note that certain fish, including swordfish, king mackerel, albacore tuna, and tilefish, can contain high levels of mercury. Women who are pregnant or may become pregnant, nursing mothers, and children should avoid fish high in mercury.

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Sleep Better Tonight!

How many hours of sleep did you get last night? If you’re like most Americans, you’re not catching enough zzzz’s, which can take a toll on your health. What’s more, recent studies also show being sleep deprived can affect your ability to lose weight and keep it off. As you’re following the South Beach Diet, there’s no doubt that you’re already paying close attention to eating healthy, but making certain you clock in enough sleep each night should also be part of your routine. Getting the recommended minimum of eight hours of sleep each night will not only help you stick to your healthy eating plan, but will also combat stress-related weight gain. If counting sheep isn’t working for you, try these five tips to help you sleep better soon:

Create a regular sleep routine. Try to go to bed at about the same time every night and wake up at about the same time each morning, even on the weekends. Some people find that setting a bedtime alarm as well as a morning alarm is a good reminder of when it’s time to go to sleep and arise. You’ll find that once your body adjusts to a regular routine, you’ll start to wake up refreshed.


Reserve your bed for sleeping and sex only. Avoid stressful, sleep-depriving activities, such as watching TV news or scary movies — or paying bills! — around bedtime. Some people find that a hot bath or soothing music before going to bed helps. If insomnia does strike, leave the bed and walk around for a while.


Don’t go to bed hungry. If you tend to get the midnight munchies, don’t head for the ice cream. Instead, enjoy a protein-rich snack, such as reduced-fat cheese, or a slice of deli turkey breast before heading to bed.


Avoid caffeinated beverages or other foods containing caffeine after about noon. Caffeine can stay in your system for up to 24 hours.


Refrain from exercise three hours before bedtime. Regular exercise is encouraged during the day because it can give you more energy and help you sleep better at night, but it also releases the hormone epinephrine, which can make you more alert. That’s why it’s best to exercise earlier rather than later if you suffer from insomnia.

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Reduce Your Risk of a Stroke

Approximately 795,000 Americans suffer a stroke each year. To call attention to this important health issue, the American Heart Association observes American Stroke Month during May. A stroke occurs when a blood clot blocks an artery leading to the brain or when an artery ruptures and releases blood into the brain. As you’re following the South Beach Diet, you’re already well on your way to improving your health and reducing your risk of stroke by eating nutrient-dense, wholesome foods and exercising regularly. But there are also other preventive steps you can take to reduce your risk of a stroke. Here are some lifestyle changes that can help:

Control your blood pressure. High blood pressure, also known as hypertension, can put you at greater risk of suffering from a stroke. High blood pressure stiffens and narrows your blood vessels, forcing the heart to work harder. Blood pressure can be controlled with regular exercise, a healthy diet, and by avoiding stress.


Lower your cholesterol. LDL (low-density lipoprotein) cholesterol is referred to as the “bad” cholesterol because it forms atherosclerotic plaques that can cause injury to the delicate linings of artery walls, including those of the carotid arteries leading to the brain. LDL cholesterol can be lowered through diet modifications (such as eating apples, beans and other legumes, and oat bran) and regular exercise.


Quit smoking. Smokers are four times more likely to have a stroke than nonsmokers. Smoking narrows your arteries, raises your blood pressure, and also lowers your protective HDL (high-density lipoprotein) cholesterol. The American Heart Association offers support and advice to help you stop smoking.


Treat your sleep apnea. Do you snore loudly or feel tired even after a full night’s sleep? If so, you could be suffering from sleep apnea, a condition characterized by frequent stoppage of breathing during sleep that can increase your risk for stroke, particularly in middle-aged and older adults. In the most common form of sleep apnea, called obstructive sleep apnea, a person temporarily stops breathing for a few seconds or up to a minute because his or her airway is obstructed or blocked by the soft tissue in the rear of the throat, which collapses and closes during sleep. Sleep apnea often occurs in people who are overweight or obese. Losing just 10 percent of your weight could reduce apnea episodes by more than 20 percent.


Avoid trans fats. Eating high amounts of artery-clogging trans fats has been linked to an elevated risk for stroke, particularly in those who eat a generally unhealthy diet. Trans fats can be found in deep-fried foods and products made with hydrogenated or partially hydrogenated oil. Baked and processed foods such as cookies and crackers often contain trans fats, which can lower your good HDL cholesterol. Be sure to check the Nutrition Facts panel before purchasing but at the ingredients list as well. Products that claim to have “0g trans fats” can still have small traces of trans fats in them, so look out for words like hydrogenated and partially hydrogenated in the ingredients list, which will indicate the presence of some trans fats.


Drink alcohol in moderation. Studies show that excessive drinking can increase stroke risk; however, the results are inconclusive. On the flip side, studies show that drinking one glass of red wine (Phase 2) each day may offer some protection.

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How to Get the Benefits of Vitamin D

Are you getting enough vitamin D? Chances are, you may not be, even if you spend a lot of time in the sun. New research shows that many Americans are woefully deficient in this key nutrient, a deficiency that’s linked to a host of ailments, including type 2 diabetes, high cholesterol, hypertension, and — yes — obesity. In fact, studies have found that a deficiency in vitamin D can hamper a person’s ability to lose weight effectively. So how do you know if you’re deficient? And if you are, what should you do about it? Here are some suggestions.

Get tested. Ask your doctor if you can have a vitamin D analysis done as part of your routine blood test. If you have a 25-hydroxyvitamin D level below 20 ng/ml (nanograms per milliliter), you are considered deficient in D. Optimal levels are 30 to 40 ng/ml. Some doctors, however, feel that a level above 50 ng/ml is more desirable.

Catch some rays. Vitamin D is known as the sunshine vitamin because the body produces it after being exposed to sunlight. Studies show that spending 10 to 15 minutes in the sun while unprotected (that is, without sunscreen) two to three times a week can boost your vitamin D levels. If you’re planning to be out in the sun for more than 15 minutes, however, be sure to apply the appropriate amount of sunscreen.

Eat vitamin D–rich foods. Eating a healthy diet can help increase your vitamin D levels. Foods that are natural sources of vitamin D are sardines, mackerel, herring, and salmon. Vitamin D–fortified foods, such as low-fat or fat-free milk, reduced-fat cheese, and some whole-grain cereals, can also help you get more of this vitamin into your body.

Consider a supplement. Consult with your doctor about taking a daily vitamin D supplement if you cannot get adequate amounts of vitamin D from foods and/or sun exposure and especially if you are pregnant or considering pregnancy. The recommended intake by the Institute of Medicine in 2010 is 600 IU daily if you are 19 to 70, and 800 IU if you are older. Many researchers, however, suggest that 1,000 IU of vitamin D a day is a better goal for everyone. While vitamin D supplementation is safe up to 10,000 IU a day, make sure you consult with your doctor about taking the appropriate dose. Recently, the US Preventive Services Task Force (USPSTF) proposed that postmenopausal women not take low-dose calcium and vitamin D supplements daily to ward off bone fractures. The USPSTF said there was no evidence to support using the low-dose supplements — defined as 400 IU of vitamin D with 1,000 milligrams of calcium carbonate — as protection against fractures. There was "inadequate evidence" as to how higher doses — meaning more than 400 IU of vitamin D paired with 1,000 milligrams of calcium — might affect bone fracture risk, the task force noted. To make better use of a vitamin D supplement, take it with your largest meal. Researchers believe that the nutrient, which is fat-based, is absorbed better with food that also has some fat content.

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How Lack of Sleep Affects Your Weight — and Your Health

It’s not just poor diet and lack of exercise that’s making Americans fatter and sicker these days — there’s a third leg to the stool: sleep deprivation. Across the country, there are 70 million people struggling to get a good night’s sleep. Some have trouble falling asleep, some can’t stay asleep, and for others it’s a combination of both. The causes can range from a lumpy mattress to a serious health condition like sleep apnea.

Lack of sleep is a huge stressor on the body and is associated with numerous physical and emotional problems, including diabetes, heart disease, stroke, a weakened immune system, and depression. It can also affect your weight. People tend to weigh more when they sleep less.

Studies show that when you don’t get enough sleep it hinders your body’s ability to metabolize food properly. Lack of sleep interferes with the production of two important hormones, leptin and ghrelin, which help regulate your metabolism and hunger levels. Leptin is produced in your fat cells; it suppresses hunger and lets your brain know when your stomach is full. Ghrelin is produced in your stomach cells; its job is to stimulate your appetite, slow your metabolism, and decrease your body’s ability to burn fat (levels of ghrelin normally increase before meals and decrease afterward).

With less sleep, your body produces lower levels of appetite-suppressing leptin and higher levels of appetite-boosting ghrelin. This means you’ll not only be tired from lack of sleep, you’ll also be hungry and you won’t feel satisfied even after you eat, which can set the stage for long-term overeating and weight gain. Additionally, if you’re sleep-deprived and feeling exhausted, you’re less likely to have the willpower necessary to stave off cravings for sugary and starchy carbohydrates and other unhealthy foods.

So, how can you break the cycle of sleeplessness? Ideally, you should be getting a minimum of eight hours of sleep every night. People with certain health conditions may need even more. Unfortunately, the average American adult is getting only 6.7 hours of sleep a night, and many get even less than that. If you’re concerned about how your sleeping habits are affecting your weight and your health, it’s time to discuss your sleep issues with your doctor and possibly consult a sleep specialist.

Dr. Arthur Agatston feels that many people simply are not aware of the critical role a good night’s sleep plays in their lives and, therefore, they just don’t make time for it. Since most sleeping problems are caused by poor bedtime habits, you can start safeguarding your sleep by following these tips adapted from Dr. Agatston’s recent book, The South Beach Wake-Up Call:

Remove distracting electronic equipment like computers or smartphones from your bedroom.
Refrain from caffeine, alcohol, and spicy foods before bed, and don’t eat a big meal right before going to sleep. If you’re hungry, choose a healthy snack that contains some good carbohydrates and lean protein.
Make sure your bedroom is dark and quiet at night. Consider investing in heavy curtains or a white-noise machine if you think it would help.
Create a comfortable bed by adding a foam, down, or hypoallergenic mattress topper, and try to replace your mattress every seven to ten years.
Stick to a schedule of going to sleep and waking up at about the same time every day.
Start keeping a sleep log and discuss the results with your doctor or a sleep specialist if the results call for it.

[ami]

Healthy Living Advice
Sleep Better Tonight!
How many hours of sleep did you get last night? If you're like most Americans, you're not catching enough zzzz's, which can take a toll on your health. What's more, recent studies also show being sleep deprived can affect your ability to lose weight and keep it off.
Learn how to get better quality sleep:
http://www.southbeachdiet.com/diet/the- ... r_20120827