“From the 1950′s onward, epidemiological studies … identified personal characteristics as risk factors for the development of premature CHD [coronary heart disease] in previously health people. Of these modifiable factors,” The Lancet reports, “cigarette smoking, blood pressure and total blood cholesterol were most consistently and powerfully implicated.”

The bottom line is that cigarette smoking, elevated blood pressure and high serum cholesterol are the “big three” of heart disease causes. Yet despite the medical community’s knowledge of these factors, the message is still not getting out with proper emphasis in the popular media.

For example, the Feb. 21 issue of Newsweek published an American Heart Association sponsored advertorial on heart health. Both the group’s current president, Dr. Lynn Smaha, and President Elect Dr. Rose Marie Robertson, contribute commentaries to the magazine supplement titled, “A Heart Health Update.”

In his introduction, Smaha wrote about risk factors for heart disease, citing “high blood pressure and cholesterol levels,” but did not once mention cigarette smoking. When addressing “lifestyle factors” that affect heart disease risk, he refers to only two: living with an ill spouse, an alleged risk factor; and owning a pet, a purported protective factor.

In her commentary, Robertson’s first reference to heart disease risk factors omits cigarette smoking despite its significant role in causing heart disease. When she does mention smoking a few paragraphs later, it is only in passing and is given inappropriately low priority on the list of ways to reduce one’s risk of heart attack and stroke.

When asked to comment on the lack of attention given to smoking as a preventable cause of heart disease, both AHA doctors stressed that smoking is a key factor in causation, but said the intent of their articles was to focus on research strategies for treating disease. Unfortunately, general readers could not be aware of the authors’ intent, and the important message that smoking is one of the three major causes of heart disease is lost.

The American public has long relied upon the AHA for information about the causes of heart disease. But the message that young people will take home by reading the AHA’s Newsweek advertorial will not give them the guidance they need to resist the urge and pressure to smoke, nor will it help adults seeking information on ways to lower their heart disease risk.

If the AHA leadership cannot do a better job of alerting the public to the real risks of smoking, who can?

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“Bowel incontinence is much more debilitating, much more devastating because you can’t just wear a pad and go out in public. It is so stigmatized because of the odor issue that it greatly affects one’s social life,” explained Dorothy B. Doughty, president of the Wound, Ostomy and Continence Nurses Society (WOCN) based in California.

“It’s humiliating, never talked about, people make fun and that’s very painful. People become shut-ins, never wanting to leave their homes. It’s so embarrassing that it’s difficult to track numbers because so many people never want to even discuss it.”

WOCN estimates that 2 to 7 percent of the population suffer from it.

Bowel incontinence has various causes, including spinal cord injuries, neurologic problems, spina bifida and severe dementia. Damage to the nerves that control the anal sphincter is a leading cause. In women, childbirth can also result in continence problems.

“Sometimes vaginal deliveries can cause tears in the rectum,” said Doughty, a registered nurse and nurse practitioner. “But if you ask someone if they have bowel incontinence, they often times will say no, they have diarrhea. But they are not the same thing.”

According to Doughty, there is a difference between diarrhea, which is characterized by a liquid stool that is difficult to control, and would fall under the category of a bowel disorder. With bowel incontinence, the stool is normal and control is highly difficult.

The good news is there is help in most cases. Many continence centers across the country have expanded their regimens to include bowel incontinence programs, which depending on the case, can offer help in developing control. Gastroenterologists offer diagnosis and protocol for management, including medication and possibly surgery.

As for children, Doughty cautions parents to watch for signs of encopresis — a problem where children hold their bowel movements. This can cause extreme blockage that can stretch out the rectum, resulting in small amounts of liquid feces to leak out, resembling diarrhea. “The problem is really one of severe constipation, and while it is natural for some children to go through a stage of controlling their bowel movements, repeat occurrences can cause damage to sensory awareness in the rectum,” she said. Help should be sought from a pediatric gastroenterologist or continence center.

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Overt selenium deficiency has been primarily observed in some parts of China, where selenium soil levels are extremely low.

Symptoms include heart disorders, joint damage, muscle weakness, and an increased incidence of liver cancer. The incidence of cancer also appears to be abnormally high in areas of low soil selenium.

Needs for selenium appear to increase during pregnancy, and infants given formula alone can become selenium deficient [Fan et al., 1990; Karunanithy et al., 1989].

An intravenous catheter will be inserted into your arm. This provides access for the administration of fluids and medications. You may be given supplemental oxygen through the nose or mouth. This is necessary during a heart attack to deliver needed oxygen to the body.

A series of tests will be performed to help the physician in making the diagnosis of a heart attack (myocardial infarction). An electrocardiogram (EKG) can determine if the heart is being deprived of oxygen and if your are truly having a heart attack. At times the EKG appears normal even when a heart attack is occurring. Changes on the EKG may not be apparent for several days. For this reason, the physician may recommend admission to the hospital for continued observation.

Blood tests can provide important information about heart muscle damage during a heart attack. When heart muscle dies, an enzyme called creatinine phosphokinase (CPK) is released into the blood stream. A special form of CPK, which is found only in heart tissue, can be measured. Another chemical, which is becoming more widely used to diagnosis a heart attack is troponin T, also found only in cardiac muscle cells. These blood tests will usually be repeated every 8 hours for the first day or two following a heart attack. They provide useful information about the degree of damage and when the heart attack may have first occurred.

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Everything new became a cure-all. Radio was a recent discovery–well, then, radio waves could cure rheumatism! Tibet was exotic. Therefore, many concoctions pretended to derive their origin from that far-off country.

Into this cornucopia of unscrupulous commercial activity, medical doctors advanced like early Ralph Naders. They fought against fake remedies, demanded accountability, and held aloft the flag of rigorous research.

When present-day medical boards investigate alternative practitioners, they mean to continue in that noble tradition. All unconventional cancer treatments look like snake oil to them. They want to protect people from being duped. Their intentions are good.

But many patients wish the government would just get out of their way and allow them to obtain the treatments they prefer.

The dynamic tension must be maintained between significant but opposing values in order to find a balance between protecting people from health care fraud and allowing them freedom of choice.

A CARDIOLOGIST’S PERSPECTIVE

EBCT is a new, noninvasive tool with the potential to help people with coronary risk factors answer the question, “Am I actually developing heart disease?” Research has shown that when there are small amounts of calcium in the walls of coronary arteries, there’s likely to be fatty plaque. And the more calcium that EBCT detects, the more likely it is that there’s a major blockage somewhere in the coronary arteries.

The most commonly used form of EBCT, the noncon trast variety, measures this calcium accumulation but can’t yet determine the location of blockages. The still-experimental contrast EBCT can locate blockages, but it requires the patient to have an IV (to infuse a chemical tracer) and the doctor to use a sophisticated computer program to interpret the data. As we saw in the NEJM study, technical difficulties with this process meant that only two thirds of patients had an adequate scan. So at this point, contrast EBCT is a very promising research tool, but it won’t yet replace the angiogram.

My patients often ask me whether it’s worth getting the regular, noncontrast form of EBCT that they’ve read about in the newspaper. They know they’ll have to pay for it themselves. We discuss how the test is done and what it means — that the calcium score is not a yes or no answer about the risk of a heart attack. For example, it can suggest that a person has plaque in his or her arteries but can’t tell us whether that plaque is interfering with blood flow to the heart muscle, which would spur us toward more aggressive testing and treatment. An angiogram, however, would give us this information.

Also, a low calcium score doesn’t let a person off the hook. People with low calcium scores can — and do — have heart attacks, raising the danger that someone who gets the allclear on an EBCT scan might wrongly think they can slack off on efforts to live a healthy lifestyle. In fact, studies show that the standard risk factors (such as high cholesterol and blood pressure) are just as reliable as EBCT at predicting a person’s risk of heart attack. In the end, I generally don’t recommend EBCT to my patients, but I am very willing to analyze the results if a patient decides to get a scan.

If you choose to have an EBCT scan to screen for coronary artery disease, I applaud your active participation in your own health care. I would caution you, though, that the most useful result of the test would be a “negative” or “normal” EBCT. This encouraging result would mean that you probably don’t have serious blockages. Your doctor likely won’t recommend further testing, and you’ll be able to continue focusing on symptoms and modification of risk factors. Likewise, if you have cardiomyopathy without any chest pain, a negative EBCT scan might let you avoid an angiogram.

A positive test, on the other hand, means you’ll need to review the results with a knowledgeable physician who can best judge the implications. That’s particularly true if you have cardiomyopathy, because the distinction between the different causes of cardiomyopathy is so important that other tests (such as a thallium stress test or an angiogram) may be needed even if your EBCT scan is normal or only mildly abnormal.

If you don’t have cardiomyopathy or any other symptoms of heart disease but do have an EBCT scan that indicates plaque buildup, it will be hard for your physician to determine whether you should have further testing — there just isn’t enough research on this topic. However, many researchers suspect that additional testing is worthwhile for people with a calcium score that’s higher than average, that is, above 400 to 500.

At present, EBCT is not the Holy Grail of diagnosis. I am hopeful that ongoing studies will tell us who can benefit most from this promising test. But for now, I can’t recommend it as a routine screen for clogged arteries, or as a substitute for established forms of testing in people with cardiovascular symptoms. Noninvasive methods that we have now, such as thallium stress tests, regular treadmill tests, and the simple analysis of risk factors, will continue to serve us well as we look for the subtle signs of coronary artery disease.

That’s why a newly popular — and controversial— method of scanning the coronary arteries is getting a lot of attention: electron beam computed tomography, or EBCT, a form of the familiar CAT scan (see picture). In EBCT, an x-ray scanner detects calcium buildup in the arteries, generating a number called the calcium score. Many studies have found that the calcium score correlates with the amount of artery-obstructing plaque. A new variation of EBCT called contrast EBCT can even make images that pinpoint the location of blockages, though this type of scanning isn’t yet widely available.

The appeal of EBCT is clear. It’s noninvasive, unlike angiograms, which require the cardiologist to guide a catheter into the heart from a distant blood vessel in the arm or leg. It’s fast, taking only about 15 minutes, compared to the hours needed for the most commonly used noninvasive screening method, the thallium stress test. And it’s relatively inexpensive — although it’s not generally covered by insurance, an EBCT scan can be performed for about $475. This has led to some EBCT clinics to advertise scans on the radio, in newspapers, and even on billboards. Predictably, the aggressive advertising has led to controversy. Although EBCT may be noninvasive, fast, and inexpensive, cardiologists aren’t so sure that it’s useful or worth paying for out-of-pocket.

A study in the December 31, 1998, New England Journal of Medicine sought to find out how useful and accurate EBCT could be. Researchers asked 125 people scheduled for an angiogram to undergo an EBCT scan, the still-experimental contrast form. With the angiogram representing the “true state” of each person’s coronary arteries, the reliability of the EBCT scan was judged by how well it matched the angiogram.

Overall, the EBCT scans were quite accurate when held up to this standard — about as reliable as the average treadmill stress test in identifying people with blocked arteries. EBCT accurately detected blockages 92 percent of the time and correctly ruled out blockages 94 percent of the time. The drawback appeared to be the difficulty of getting usable images with the contrast form of EBCT; only about two thirds of participants could be screened because the researchers couldn’t get good images in the others.

Unlike this fancier contrast form of EBCT, the regular, noncontrast form can’t make images. But its relatively simple action — measuring calcium buildup — has shown some promise. Another study in the same issue of the NEJM found that calcium measurements taken with noncontrast EBCT effectively track the amount of plaque in someone’s arteries. And in a new use for noncontrast EBCT, described in a November 1, 1998, report in the Journal of the American College of Cardiology, doctors can use the scans to identify the kind of cardiomyopathy a person has.

Cardiomyopathy, a broad term for weakness and disease of the heart muscle, stems from a range of causes — from viruses to genetics to coronary artery. Knowing the cause of a person’s cardiomyopathy is crucial to picking the right therapy, such as bypass surgery for clogged arteries, but it’s been hard to find a reliable, noninvasive method for making the assessment. The study found that EBCT scans were about 92 percent accurate in determining whether cardiomyopathy was caused by clogged arteries.

A.You can strengthen abdominal muscles without purchasing anything. Simply lie on your back and with your knees bent, try exhaling and pulling your abs in toward the floor. Relax, inhale and let your abdominal muscles move outward.

A. Next, lift your head and repeat the inhalation and contraction moves. Relax again. Next, lift your head and arms off the floor as you repeat this move. A Pilates-type move would have you rapidly lift and lower straight arms as you raise your head and draw in your abs. It’s part of the “100″ series, named for the number of times you aim to pump your arms.

I know you said that you have a painful lower back, but that may be because you are exercising wrong. I want to offer you this careful instruction for a safe abdominal curl.

Lie on your back with your knees bent and your feet on the floor. Tuck your hips into a slight pelvic tilt so that your lower back is close to the floor, then raise your legs and cross one ankle over the other. Support the back of your head lightly with your fingertips. Your elbows should be extended to the sides, close to your head. Keep your neck in good alignment with your spine; don’t tuck your chin forward toward your chest.

With a slow, controlled movement, lift your torso straight up until your shoulder blades clear the floor. Exhale with each lift; for an added challenge, pause slightly at the height of the contraction. Think of pulling your navel to the floor with each lift. Begin with 8, but work up to two sets of 12 repetitions. If you perform them correctly, there is no need to do an astronomical number of curls.

And again, if you have any discomfort in your back, simply lie back and do the abdominal strengtheners mentioned at the beginning.

Stroke or a cerebral vascular accident is an occurrence in the brain that can cause impairment in motor skills, speech, sensation, vision and also emotions and intelligence.

These symptoms occur when some part of the brain is cut off from its blood supply, depriving it of its needed oxygen and nutrients. The most common ways deprivation of blood occurs are; “(1) a clot forms in an artery; (2) the wall of an artery ruptures and causes a hemorrhage (bleeding); or (3) a piece of a clot, having formed elsewhere in the body, breaks loose, travels to the brain, and plugs a blood vessel.

Cerebral thrombosis, cerebral hemorrhage, and cerebral embolism, are the names given to each specific occurrence.

Several factors or combinations of factors can lead to stroke, such as, high blood pressure, nervous tension, heredity, exercise, and diet. High blood pressure can increase the chances of a stroke by speeding up the rate of arteriosclerosis deposits in arteries and high blood pressure may be more likely to cause a rupture at weaker points on the blood vessels than lower blood pressure.

Nervous tension relates to stroke because it increases blood pressure dramatically. Avoiding stressful situations, especially after a stroke, is highly recommended. Heredity can be linked with strokes because of the genetic susceptibility of some to higher levels of cholesterol in their blood, which leads to arteriosclerosis. Others may inherit tendencies to be over weight. Both of these causes are related to one another.

Exercise, or lack of exercise is another contributor to having a stroke. The main reason being, exercise slows down the rate of hardening arteries, by lowering blood pressure and slowing down the rate of the heart. A person’s diet can also be one the causes that leads to stroke. A diet high in fats, and cholesterol is unhealthy since it is known that cholesterol crystals are deposited in the arteries.

One or several of the body functions can be impaired after a stroke, depending on the severity. What functions are affected is determined by the location of the brain involved. Normally, when the right side of the brain is involved, the left side of the body is affected. When the left side of the brain is involved, the right side of the body is affected.

In a majority of stroke victims, paralysis or weakness usually occurs to one side of the body. Full recovery can range from days to years. Sometimes a full recovery is not possible if the stroke caused permanent brain damage.

Prevention of strokes can only occur in the areas that are controllable. One cannot choose his or her ancestors, but one can choose to live healthier life styles. Sensible diets low in fats, sodium and cholesterol, regular exercise, and avoiding stress when possible can be the first steps to prevention. Also, regular monitoring of blood pressure and cholesterol levels may be beneficial.