Cancer Articles (Dr. S.N White)

What about wine and alcohol?  Wine is a rich source of antioxidants, like other grape products. It also contains alcohol. Alcohol does raise HDL (good) cholesterol, and some studies have linked moderate wine consumption in countries like France and Italy to a lower incidence of heart disease. It is well known that alcohol should always be consumed in moderation and avoided during pregnancy. Perhaps the key to wine drinking is to consume wine only with meals. Even better, you may try diluting your wine with water, as is often done at Italian meals. The basic health rule is not to exceed one glass a day for women and two for men. Less research can be found on beer, but, again, a moderate amount may be beneficial. As with wine, if you choose to drink beer, do so with a meal. Drinking to excess may increase blood pressure and cause other health problems. Recent reports about red wine show that it contains substances beyond the alcohol which have some extra benefits. A nondrinker ...

How common are these trans fats in supermarket foods?  These hydrogenated fats are so favored by the prepared food industry that they have made their way into French fries (one of the richest sources of trans fats), other fried foods, breads and other baked goods, savory snacks, and many convenience and processed foods like potato chips, com and other chips, cookies, and crackers. For years they have slipped into our foods, and it was once thought that they were as good as the unsaturated fats from which they were originally made. A large study recently suggested that limiting consumption of trans fatty acids would be more helpful in preventing heart attacks than simply limiting overall fat intake or even saturated fat intake. It is a challenge to find ready to eat products without these fats added to them. Begin by avoiding foods that list “partially hydrogenated” oil or fat on the label. Margarine manufacturers are aware of this problem, so the old margarines that were based ...

Your choice of foods is one of the most powerful tools you have at your disposal to help in your recovery from heart disease and in preventing a future heart attack. A few simple guidelines will make choosing foods that are good for you easy Fortunately it’s getting easier and easier to find healthy foods in many restaurants, cafeterias, and supermarkets. More farmers’ markets have a wide array of fresh, convenient, and appealing vegetables and fruits that make the preparation of the ultimate, healthful meal a joy rather than a chore. Other heart-healthy lifestyle changes may mean learning new skills. You may need to learn to exercise if you have always been sedentary, and you may have to learn to deal with stress, but you already know what a delight eating can be. What you may need to learn is how to add some new food choices to your diet, and how to make these choices enjoyable. It may seem a lot of trouble to experiment with new foods at this point in your life. But once you’ve c...

Exercise has lots of benefits, but there are some risks. How much or how little you should do depends on your diagnosis. If you have survived a heart attack or have had heart surgery, you should first talk to your health professional about supervised exercise in an organized cardiac rehabilitation program. This chapter will build on what you learn in cardiac rehabilitation and provide you with tools to maintain a safe and healthy exercise program . Whatever the severity of your heart disease, you should discuss exercise with your physician or health professional before beginning any program. In addition, your physician may have prescribed medication such as beta-blockers  that limits the body’s ability to increase the heart rate. (Not all drugs affect your ability to exercise or to increase your heart rate.) When your physician prescribes any medication, discuss how exercise might affect it. If exercise is supposed to be so good for you, why do some young athletes die suddenly...

Exercise may be healthy, but how will it slow down or reverse my heart disease?  Studies have shown that regular exercise lowers the risk of death from a second heart attack ; there are about half as many heart attacks among people who exercise, as among those who don’t. Studies also show that heart disease risk factors such as blood cholesterol, triglycerides, lipids, high blood pressure, and obesity are lowered in people who get regular aerobic exercise. Angina attacks decrease in heart disease patients who follow an exercise program. Exercise has also been shown to improve glucose tolerance and retard the development of non-insulin-dependent diabetes. Exercise is also good for the heart muscle itself. When you do regular aerobic exercise , the heart beats faster, indicating that it is working harder that is, you are exercising the heart muscle. This causes an increase in the size of the muscle, and the amount of blood flowing to it. As the muscle strengthens, it can pump ...

Are some people more naturally stressed than others? There are ways in which some people typically respond to everyday situations, whether stressful or not, that result in physiological reactions that can contribute to heart disease . The strongest association with stress responses is in people who tend to get angry or hostile easily, who are fast-paced, always under time pressures, aggressive, distrustful, or cynical. This type of behavior in a person, familiar to most of us, is called Type A behavior . Books have been written about Type A behavior. People who exhibit this behavior are more likely to have a heart attack than those who are more trusting and calm. There are certain psychological characteristics of a Type A person such as hostility, cynicism, and anger that are strongly associated with increased heart attack risk. Those who have a high level of anger and hostility are at the greatest risk. Anger and hostility may cause the release of hormones such as adrenaline int...

Is it true that stressful events can cause heart attacks?  Any cardiologist will tell you that both angina (chest pain) and heart attacks can be triggered by acute stress. Sudden heart attacks happen either because not enough blood and oxygen flow to the heart or because of arrhythmias, erratic or missed heartbeats. If you look at the list of effects of stress on the heart at the beginning of the chapter( Link ), you’ll see that the heart works harder and arteries constrict, reducing the amount of blood reaching the heart. Ventricular arrhythmias can also be triggered by stress. It has been suggested that stress may be a trigger for earlymorning heart attacks and death from sudden heart attacks and from stroke.

It’s never too late to lower your risk of heart disease. The risk of heart disease rapidly decreases once you stop smoking. In the first twenty four hours after quitting, your blood pressure and pulse return to normal, as do the oxygen and carbon monoxide levels in your blood. This alone relieves some of the extra stress you have been imposing on your heart. Within three months after quitting, you will experience a sharpening of the senses of taste and smell. Your circulation will be improved and your lungs may work at up to 30 percent greater capacity. After a year, your risk of CHD will be about halfway between a smoker’s and a nonsmoker’s. Abnormality of blood clotting due to a higher level of fibrinogen (a component of blood that makes blood clotting, possible) and platelets (particles in the blood that by aggregation make the clots possible) related to smoking will disappear, but it takes longer to undo the damage to the arteries. If your smoking has contributed to plaque de...

I know smoking tobacco is bad for my lungs and health, but why is smoking bad for my heart?  ELEVATED HEART RATE AND BLOOD PRESSURE  There are two especially harmful substances inhaled while smoking. The first is nicotine, the addictive ingredient in cigarettes. When it enters the bloodstream it increases the heart rate, causing the heart to work harder and increasing the need for oxygen in all the cells of the body. Research suggests that nicotine contributes to arrhythmias (irregular heartbeats). Smokers’ risk of sudden cardiac death is about three times that of nonsmokers’. Nicotine is blamed for elevations in blood pressure while the cigarette is being smoked, which means that a moderate smoker might cause his or her blood vessels to constrict and relax at a rate twenty or so times higher than usual a day. Researchers don’t know exactly how this affects the body over time, but they suspect it is damaging. They do know that when people already have high blood pressure, ...

What about cardiac rehabilitation centers?  A cardiac rehabilitation center is a facility located in your community, perhaps at a YMCA or in a hospital. These centers are staffed by nurses trained in the skills needed to supervise physical activity and provide guidance on medications, diet, and rate of recovery after a heart attack. Physicians are readily available if needed and are sometimes in attendance. These centers can make your recovery much easier and help you build confidence by meeting other people who are recovering successfully from a heart attack. Cardiac rehabilitation centers will help you implement the program outlined in this blog, and going to a rehabilitation center can be the very best way to get back to a normal life as soon as possible.  A cardiac rehabilitation program works on all of the risk factors and your individual program is designed to help you make the transition from knowing in your mind what you need to do to actually doing it. You wil...

While in the first week survival is still the key issue in your mind, for the next five weeks or so you should be planning physically, psychologically, and emotionally to return to full activity in your normal life. In this period you have to give it your best effort to achieve full recovery. Focus more than ever on taking your medications, quitting smoking, avoiding secondhand smoke, reducing stress, controlling depression, exercise, and diet, reducing alcohol intake, and lowering your weight if you are obese. 

What do I do after I go home?  The first week’s home care will depend on the treatments you began in the hospital for example, whether after your heart attack you received treatment that effectively opened up the blocked arteries preventing blood flow to your heart, or whether you had bypass surgery. And once again, your treatment plan in the first week home depends on the severity of the heart attack. You may be asked to make a return visit to your physician in this first week. But no matter the severity ofyour heart attack, it is more important than ever during this first week at home to keep an open lifeline to the hospital and your physician. In general, for the first week, expect to take it easy. You may be able to walk on a flat surface at a moderate pace for ten minutes twice a day (morning and afternoon), and you will need to set a new routine. For example, you may wake up, eat breakfast, take a break to do something sedentary, and let your food digest. Then maybe you...

Will I be an invalid for the rest of my life?   In most cases, as a survivor, you are not an invalid. It is no longer thought that you have to “take it easy” after a heart attack. An early return to work and to full exercise is a new goal in advanced cardiac rehabilitation. This is an important point to keep in mind, and friends and relatives caring for you must recognize this as well. Invalidism can and must be avoided. Invalidism has both physical and psychological repercussions, and you will enjoy a fuller recovery if you have confidence that healing is possible and that you can return to a productive life. There are some exceptional cases that require extra care, and if you are one such case, this would have been discovered during your hospital stay. People who have had major damage to the left ventricle of the heart, the chamber that pumps the blood out into the rest of the body, are at risk for cardiac arrhythmias and may not be able to return to full activity. Your hea...

What are my chances of getting back to my normal life?  The quality of your life after a heart attack will depend on how much of your heart muscle has been injured and the location of the damage: your dietary regimen, medications, and exercise are all determined by the condition of your heart after the heart attack. Many survivors will be able to return to a fully active life as long as they control their risk factors and follow generally accepted disease precautions. For some, the damage may be so extensive that total freedom to live as full a life as before may be unrealistic. But more and more medical research findings show that most individuals with a heart muscle that has been damaged can resume full activity by the fourth week after the episode, and this includes sexual activity, physical activity, and return to work. Throughout the entire recovery period, bear in mind the value of the psychological support of a spouse or a close friend.

What are stents?  New advances in the surgical management of coronary artery disease include the growth of the use of stents. These are implants made of inert material that are put in an artery to open it up. Stents have had great success in helping people who have very narrowed arteries. Advances are still being made in this area and it’s too early to know how successful they will be in the long run. It is important to be treated at a medical center that has had experience with these newer procedures to be sure of getting the best care. It seems that stents are a step beyond angioplasty; is that correct?  Yes. In angioplasty the coronary arteries are opened, but in 30 to 40 percent of patients, the arteries become narrowed again over time, and ECG exercise treadmill tests show that the blood flow through these arteries is poor. A stent could help prevent a recurrence of this narrowing, which is typical of many angioplasties. Are there other types of intervention?...

What is an angiogram?   An angiogram, also called coronary angiography, is based on “cardiac catheterization,” which refers to the insertion of a catheter a small flexible tube into the heart. This invasive procedure is performed in a hospital. The tube is inserted under local anesthesia through an artery in the arm or groin area of the leg and carefully guided into the heart. After the catheter has reached the heart, a dye is injected that allows the heart’s arteries to be measured for narrowing due to atherosclerosis. This procedure is considered the most definitive way to determine how much atherosclerosis you have and is regarded by many cardiologists as the mainstay of heart disease diagnosis. When an angiogram is done, the doctor might find the narrowing so serious that the catheter is then immediately used as a tool to open the clogged artery seen in the angiogram. This procedure, called angioplasty or balloon angioplasty, is done by inflating a balloon in the artery to...

Yes. During a heart attack, some heart muscle cells that lack sufficient blood and oxygen become damaged, releasing various enzymes into the bloodstream. A blood sample may be drawn every few hours to look for these enzymes as one way to diagnose whether a heart attack has occurred and how much muscle has been damaged. After a heart attack, your physician will always take blood samples to measure blood cholesterol and fractions of blood cholesterol. These tests can reveal your level of risk of developing a future heart attack. These fractions include measures of highdensity lipoprotein cholesterol (HDL), often called the “good” cholesterol, and low-density lipoprotein cholesterol (LDL), often called the “bad” cholesterol. Levels of triglycerides (a type of fat in the blood) are often measured at the same time.

Just how important is physical activity?  Pretty important. We know that people who do not get regular exercise have about twice as many heart attacks as people who do. They also have higher cholesterol and triglyceride levels, higher blood pressure, and more excess weight than those who get regular aerobic exercise. No matter what the degree of overweight, sedentary people are more likely to develop Type 2 diabetes, and in a more severe form that is, their blood sugars will be higher.

Oral contraceptives pose a risk for heart disease because they raise slightly the level of LDL cholesterol while at the same time lowering the level of HDL. However, among nonsmoking women under forty who take birth control pills, there is only a slight increase in the risk of heart disease. But when women in the same age group smoke, are overweight, and take birth control pills, they are about five times more likely to suffer a heart attack.

It makes sense that the more risk factors present, the worse the risk. But risk factors are thought to be more than just cumulative; when several are present in your life, it is believed that they can actually multiply the risk of heart disease. Research studies are still attempting to quantify the elements of risk. It is very difficult to isolate the value of each risk factor, since people who smoke, for example, often have high blood pressure, too. And people with high blood pressure are often stressed and get little exercise. Fortunately for all of us, protective factors are more than cumulative as well: combine good food choices with exercise and weight control, and their benefits add up to more than the sum of the individual factors. Trying to rank risk factors can be risky in itself. Doing so can lead to underestimating the importance of any of the single factors. But if we had to choose a couple of risks to put at the top of the list, they would have to be high blood cholester...