The Joyful Luxury of Bringing Home a Puppy

The world is under siege.  Muslim extremists in Iraq are “cleansing” the hijacked country of the world’s most ancient Christians. Men, women, and children are being slaughtered, after they’ve been tortured and raped. Jewish teenagers are being kidnapped and executed by similar extremists; people are being beheaded in city streets. These are the same missionaries of terror that pierced our false sense of security, destroying our towers and the thousands of innocents within. Our civilized world is unequivocally in peril. A return to the dark ages is at our doorstep.  Some say there is nothing to fear; it’s a minority who are at the source of this evil. Yet a minority can create catastrophic consequences. Witness the horror of Nazi Germany. And, a “minority” in the world of Muslims is likely well upwards of 200 million people. This is a minority in truth, but one demanding our unwavering attention and concern.  So how does a puppy fit in this story?

Yesterday my wife fell in love with a nine-week-old puppy. We had recently lost a dog to a sudden splenic rupture from cancer and in truth I believed it would be a long time coming before my wife would open herself up to another similar love. But I was mistaken. She informed me of her find and I immediately knew another dog would be coming home. I was sold on this notion with a simple question, “Isn’t this what life is supposed to be about?” Irrefutable. Life should be about love and puppies and the luxury and freedom to enjoy both. As a Preventive Cardiologist I couldn’t deny both the emotional and physical salutary impact of smiles and laughter engendered by the presence of a simple pup. Then I considered those in other parts of the world; Christians, Jews and non-radicalized Muslims fleeing and dying at the hands of terrorists. These individuals cannot enjoy the American luxuries of which I speak. We are a nation of fortune; but this fortune was built on the selfless sacrifices of our fathers and forefathers. Freedom is not an easy thing to gain but I fear it is quite easy to lose. Understanding this, we must be hyper-vigilant about safeguarding it. Yet its nemesis nips at our heels. Political correctness aside, when critically and honestly examining the world one must acknowledge there is but a single group that seeks to dominate all others. Yes, a minority threatens us, and most of the world abhors the actions of this minority. The minority, however, is fierce, brutal, enormous, powerful, determined, and patient. They will have their way if we do not face and stop them. If we fail, love and puppies, and other often-unappreciated freedoms will become our memories, and the dreams of future generations.

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The FH Foundation, Turning Hope into Reality

I spent Thursday and Friday in California. No, I wasn’t strolling on the beach or sipping local wines. Instead, I was engaged in strategic conversations during our FH Foundation Board of Directors Annual meeting. FH (Familial Hypercholesterolemia), as you know from prior posts, (if you don’t, please visit www.thefhfoundation.org or see my older blogs and FH/cholesterol articles at www.preventivecardiologyinc.com) is a common yet terribly underdiagnosed genetic disorder that elevates LDL cholesterol which in turn causes early and life-threatening heart disease. Affected patients cover a wide spectrum, having disease from before age ten to as late as 70 or 80 years old. We spent some time examining last year’s accomplishments, but more importantly we determined how to continue the process of converting dreams into reality. I’ve chosen to share this story with you for two reasons: First, FH must be conquered. Second and no less important, the Foundation epitomizes the power of a small group driven by unfettered passion, enthusiasm, and commitment.

Katherine Wilemon, the group’s founder, CEO, and tireless leader, suffered her heart attack shortly after the birth of her daughter. Though she had lifelong high cholesterol, and had experienced symptoms before the event, her genetic disease was initially unrecognized. And, in medicine, to be able to provide appropriate care we usually must know what it is we’re treating. Fortunately for Katherine – and her family -  she survived. Subsequently, wishing to turn a terrible event into a hopeful future, Katherine started the FH Foundation. That was just three years back. Since then, Katherine has not only surrounded herself with a growing group of highly effective and devoted patients, doctors, and businesspeople, she has travelled the world building awareness and interacting with every true FH expert. The FH Foundation has established a National FH Awareness Day. It has created the first and only Registry for FH patients in the US (Cascade FH). The FH Foundation spearheaded the establishment of ICD 10 codes for this disease, and it has initiated protocols to identify every single FH patient in our nation.

Our second Global FH Summit will take place this October in New York City. An array of nations will be represented. The list goes on and on. I recount this litany of achievements not to boast, but to demonstrate how the visions of an individual can burgeon, ultimately impacting the reality of so many. Coming away from two days of inspiring meetings I am certain the Foundation will continue to succeed. In short order FH will entirely emerge from the shadows. FH will become a disease on the tip of every doctor’s tongue, and consequently afflicted patients of all ages will no longer suffer and even die unnecessarily. Millions of people’s lives will be changed for the better. At the risk of being mawkish, I must state that my experience with the FH Foundation illuminated the fact that if more of us would only act with similar commitment and intention, we might just find ourselves in a peaceful and unified world. It’s a tall order I know, but the FH Foundation has given me a glimpse of the possibilities that can be born of the seemingly impossible.

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An Update From the 2014 American Society for Preventive Cardiology (ASPC) Annual Meetings

Two weeks ago was the ASPC’s Annual meeting in Boca Raton, FL. The event was superb. Internationally recognized experts in a variety of disciplines convened in Boca Raton for the three–day-event. Nearly 200 healthcare practitioners from around the country came to listen to Professors from Northwestern, Harvard, NYU, The Mayo, Columbia University, The Miami Miller School of Medicine, Emory, Ohio State, UCLA…  Topics such as the somewhat controversial 2013 ACC/AHA Cholesterol and Obesity Guidelines, the enormously under-recognized disorder Familial Hypercholesterolemia, and the vast sex differences in CVD presentation and treatment were discussed.

My lecture was entitled, “The Omega-3 Fatty Acids DHA and EPA: Caution when interpreting the Trials. It’s time to get back to the basics.”  The talk highlighted enormous limitations inherent in recent omega-3 studies. It is not only clinicians and laypeople who must understand such issues, but the press as well. Too many reporters – and even physicians in the news – misinterpret clinical studies, oftentimes sending not just misleading messages to the pubic, but potentially damaging ones as well.

DHA and EPA are the essential fatty acids found in fish, NOT flax, Chia, or olive/canola oil. These fatty acids have been studied in a variety of disorders ranging from heart attacks to dementias, ADHD, eye disease, inflammatory bowel disorders, and Rheumatologic ailments. The list is actually even more extensive than this. Their benefits are legion – anti-inflammatory, anti-oxidant, anti-arrhythmic, and anti-thrombotic to name a few. Scientists across the globe are spending their entire careers evaluating the myriad biological effects of these fatty acids. Although we still do not know precisely how DHA and EPA will fit into our medicinal armamentarium, we do know that they have an important role to play. More studies and clinical trials are needed. One thing is clear however. DHA and EPA are here to stay. They represent a component in our diets that should be emphasized, not neglected. Nearly daily fatty fish or fish oils should be a part of most people’s dietary habits.

Beyond the value of DHA and EPA is an even more important message though. The media, in their unbridled attempt to produce quick and enticing stories, often critically misses the mark. Consequently we all must be very careful about how we interpret what we read or hear. We must always be vigilant when drawing conclusions about our health as well as other consequential matters.

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The Glory of Gum – A Smoker’s Tale

Recently, on a medical sojourn, I was met at the airport by a garrulous woman driver. She was a young-appearing fifty year old who as it turns out had recently sustained a TIA, or “mini-stroke.” Although my first thought was atrial fibrillation, she actually had developed a near occlusion of her left carotid artery. Her right carotid artery, she informed me, had a mere 40% stenosis. Our discussion continued and I gleaned that she had a very strong family history of early onset vascular disease, several close relatives even dying quite young from their events. So my next thought was Familial Hypercholesterolemia. But no, her LDL was apparently normal. Then she fessed up. She had been – and continued to be – a smoker. Just like everyone else in her family! Shocking.

To smoke cigarettes nowadays is something I simply cannot wrap my head around. Cancer, stroke, heart disease, lung disease, wrinkles… Tobacco is devoid of any redeeming quality. It’s just plain bad. So why would anyone smoke in the first place? But, once an individual has experienced a near death event that is a direct consequence of tobacco, how in the world could she continue to smoke. My 40-minute drive took on a mission. I was going to get her to quit. I asked about her children and even grandchildren. We spoke about loss of limbs, dependence upon an oxygen tank, facial cancers and their attendant disfigurement, another stroke – the next one of course placing her in a wheel chair, unable to speak or care for herself. Then she dropped me at my destination. She was to pick me up several hours later. Before stepping out of the car I told her with stern authority that a cigarette should never again cross her lips. Chew gum I said. Gain weight if you must, but please don’t ever come near another cigarette. (I must confess; my tone was intentionally severe and perhaps even paternal. The impact I hoped would justify my behavior.)

I went through my day, completed my tasks, and eagerly awaited her return. Upon her arrival she stepped from the car and proudly and loudly through a mouthful of gum intoned that she had done it. She quit smoking. I am not certain whether her resolution will last an hour or a lifetime. For that moment though she was no longer a smoker. A gum chewer yes, but not a smoker.

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Diet Tip: Please Read the Label

A good deal of my time with patients is spent teaching. I teach about theories regarding plaque formation, consequences of a ruptured plaque – heart attack being the most feared – and the spectrum of cardiac risk factors. In discussing risk factors I then delve deeper. I discuss LDL particles and why counting them is so important. I discuss the role of inflammation in heart disease. We talk about eating a balanced and healthful diet, and of course we always discuss achieving and maintaining an optimal weight.

For the last few years I have been working with a gentleman in his forties who suffers from premature coronary artery disease. He’s already had one stent and our mission is to prevent a second event. And so we have systematically and effectively mitigated each of his risk factors. Except for his weight. As hard as we’ve tried, we have failed. His stubborn 15 to 20 pounds of excess overweight has been a thorn in both of our sides.  He really has tried quite hard. He’s trimmed portions, eliminated all simple carbohydrates, stopped drinking excess alcohol, and religiously exercised an hour a day. Yet, no weight loss… Until his last visit.

The other week my young patient entered the room with draping pants and a flouncy shirt. His clothes were not those of an older, larger brother. They were his. Somehow he had done it. He had lost 19 pounds. And his smile betrayed his brimming desire to let me know his secret.  So here it is. He started reading labels. Though we had previously discussed the importance of label reading, I apparently had failed to adequately emphasize the point. Now here he stood, proving the power of the label. What he had discovered is quite fascinating. My patient, a lover of coffee, had been consuming over 3,600 calories each week in the form of coffee creamers. Although the creamer labels revealed a mere 20 calories per serving, he had failed to recognize just how many servings he used per cup of coffee. It wasn’t until he had counted the bottles of creamer he used on a weekly basis, along with the total number of calories per bottle, did he recognize just how caloric and fattening was his coffee creamer habit. He responded to his newfound knowledge with discipline and resolve, and in three short months without doing anything other than eliminating excess coffee creamer he achieved his desired weight.

The lesson here is simple: Know exactly what you’re consuming. Be careful about portions. And don’t be misled. Do the math if you’re having trouble losing weight. Count the calories you consume and eliminate those you don’t need. This basic approach worked magic for my patient; I’m confident it can do the same for you.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Time for a Food Police Force?

Incessantly the media, scientists, doctors, self-proclaimed experts of this or that pronounce they have found the answer to some burning issue. Mostly the matters involve health. What fat is best, or are carbohydrates better than saturated fats, or is fish oil really any good, or is the rampant use of statins the product of evil pharmaceutical propaganda. The list is interminable. And everyone has a voice. Actors and actresses somehow as a consequence of their on-screen fame have absorbed knowledge beyond that which is possessed by even our greatest scientists. Newscasters weigh in and authors sell their latest tomes with promises of truth. The whole dance of the experts would be quite amusing were it not so dangerous.

What seems to be missing from all those who have managed to communicate so easily with the almighty is a sense of responsibility. When people voice their opinions with such certitude, and their audience believes in their veracity with such solidarity, what is truly opinion then masquerades as fact. As a consequence, fiery battles flare among opposing sides. The vegans pound their fists shouting, “Not even a drop of oil! No fat at all!” The Wheat Belly folk eschew the grains, while the dairy exorcists discard the milk, and the Atkins aficionados chow down on meat and more meat. Get them together on TV and you have a firestorm.

Now bring in the politicians and celebrities. They take whatever “science” they find most convincing and try to turn it into law. No large sodas for the sugar busters; no trans fats for practically everyone (that one I have to admit is compelling), nothing with a face for the vegans. In short order there won’t be much left to eat at all.

I have my own take on the diet issue. In short I’m fairly certain we are all quite different, and consequently do better with different diets. As a generalization though I’d recommend moderation in all things, avoiding processed foods, eating a balanced diet, maintaining an optimal weight, and exercising daily. Perhaps that prescription would make a good law.

Fundamentally it comes down to this. We should all be permitted to eat whatever we wish as long as it doesn’t harm anyone but us. Government should not have the right to tell an individual what he or she can or cannot consume. There is a key caveat though. This holds true, “as long as it doesn’t hurt anyone else.” So what do we do about the ailments that occur as a consequence of food-induced obesity – diabetes for one? Do we penalize the consumers of sugar who as a consequence of their dietary predilections become obese and diabetic? Do they pay higher health insurance premiums? Probably not a popular notion. How about the smokers, should everyone foot the bill for his or her heart disease, COPD, and lung cancer treatments? Clearly these issues are slippery slopes, ones upon which I have no desire to tread.

I will emphasize one point however, and of this I am sure. No one knows what diet is best for all mankind. And until such a discovery is made, creating a food police force is probably not a good idea at all.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Perspective

Sitting on a plane I run through the possible subjects to discuss in this week’s blog post. I consider health related matters but cannot bring myself to settle on a topic. I feel compelled instead to introduce a subject that tortures me far more than do the demigods of media and science. It is the conflagration of Muslim extremism that threatens to engulf our world. Wow, where did that come from you might be wondering. In a word, sadness. I am sad for the young Christian girls of Nigeria who have been stolen from their families, and in a 10th century style forced to convert to Islam and threatened with slavery or marriage to Muslim men. They most likely will never again lay their eyes upon their parents, siblings, and other blood relatives. I am sad for the woman who sits beside her 20-month-old child in a Sudanese prison awaiting a sentence of torture followed by hanging. Her crime: marriage to a Christian. I am sad for all the men and women in other nations forced to follow their religious beliefs in silence, lest they be silenced for good. I am sad that the world watches as so many suffer and I am sad we have lost perspective as we fan the flames of our own relatively petty issues. And finally I am sad for us as we watch a world that will most likely collide with ours, potentially ending the freedoms we now take for granted, ones our ancestors struggled so hard to leave as a legacy for us to enjoy.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Response to “A New Gender Issue: Statins” an Article by Roni Caryn Rabin

There appears to be an endless supply of medically related stories in the lay press that serve nothing more than to create mass misunderstanding of science and medicine. Surely their provocative messages sell papers and airtime. But they have an often-ignored downside as well. Tuesday we saw another such article. In the New York Times’ Rabin piece, a prevalent fear of medications is fueled, and the integrity of a prominent physician is impugned. (Full disclosure – I too unabashedly receive compensation from pharmaceutical companies for consulting and educational purposes.) Statistics are cited; the quintessential anti-statin doctor is quoted; and fabricated conclusions are rendered. The science of statin therapy is much too complex for a single cursory article to do it justice. In fact, entire conferences are devoted to the subject matter. And yet a sweeping conclusion – with potentially devastating ramifications – has again been made. Women reading this article will do what one would expect, either discontinue their statins on their own, or hopefully discuss such an action with their doctors prior to doing so. The article is meant to be terrifying, citing exceedingly rare muscle complications and referring to an unproved complication of statins, memory loss. So much is left unconsidered. For starters, the ACC/AHA risk scoring system cited by Ms. Rabin likely underestimates, not overestimates, CVD risk in women. And, as the leading cause of death in US women is cardiovascular disease, we do not want to make the mistake of under-evaluating and under-treating this segment of the population.

Today in the office I saw a young woman who suffers from premature heart disease that would not have been detected or appropriately treated had the guidelines been followed to a tee. Yet her coronaries have been non-invasively imaged; significant disease was detected; and yes, statins are being utilized. As a result, her life may very well have been saved. Doctors must be able to think and act with fluidity, moving both within and beyond the guidelines, in order to render the best care we can. Articles such as Ms. Rabin’s serve solely to diminish our ability to do so.

To demonstrate more clearly why we need to drastically broaden – not shrink – our efforts to identify and treat cardiovascular disease in women here are a few chilling and sobering statistics:

  • Women are 15 times more likely than men to die within the year following a heart attack.
  • Women with angina have twice the morbidity and mortality as men with angina, even in the absence of obstructive coronary artery disease.
  • 64% of women dying suddenly from heart disease had no prior symptoms.
  • Women under 50 are three times as likely as men under 50 to die after a bypass operation.
  • Marriage decreases cardiovascular risk in men, yet increases it in women (a frightening statistic, yet one that provides fodder for some excellent jokes).

Other similar statistics abound. The point is that we unambiguously understand that women are at great risk for heart disease. Sadly though, we currently have inadequate clinical trials assessing their risk. The appropriate answer is to fight even harder to identify and treat women at risk. It is not to dismiss our vast and growing understanding of the salient role cholesterol plays in the genesis of cardiovascular disease. It is not, as this article implies, to withhold a medication that has done more to thwart heart disease than any other therapy in the last century. I entreat all in the press to be more circumspect and responsible in your reporting. You have a great influence on your readers. Please wield it with caution.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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The National Lipid Association – A Glimmer of Hope

The field of Medicine is undeniably in turmoil. Patients are unhappy with long wait times in doctors offices coupled with ever shortening visits with their physicians. Doctors are dismayed by their unprecedented spike in “busy work,” instigated predominantly by insurance companies and governmental mandates. The fallout from more time spent on paperwork is of course less time spent with patients. There are after all only 24 hours in a day.  So it is eminently fair to say that neither doctors nor patients find themselves happy with the current course Medicine is following. Oftentimes outlooks are so bad that many of us in the field feel there is no hope. In essence we believe the battle has been lost; there is no chance of recovery.

Enter the National Lipid Association (NLA). Currently boasting over 3,000 active members, the NLA is a group of diverse doctors, nurses, dietitians, scientists, and exercise physiologists whose governing goal in participating in the organization is to improve healthcare. I just returned from the 2014 Annual NLA meetings in Orlando Florida and was once again struck by the authenticity of this sentiment. Meetings began as early as 6 AM and extended well into the evening hours. And the seats were not bare. They were filled by groups of highly focused and engaged individuals. Ranging from Cholesterol Guideline discussions, to basic science talks on drugs’ mechanisms of action, to lectures reinforcing the need to amplify our efforts to identify and treat patients with the not so rare but highly lethal disorder Familial Hypercholesterolemia, the topics were fascinating and irrefutably pragmatic. The attendees were riveted. Side conversations were plentiful, including promises of new clinical trials and better ways to help our patients. The pace was quick and the excitement, palpable. All this at a medical meeting!

Although uniformly doctors are troubled by Medicine’s fall from grace, rays of hope were clearly visible at the NLA meeting. Beneath our acrimony doctors, nurses, and others in medicine still have at their core the desire to help. We genuinely want to be the ones who people look to during their oftentimes-darkest moments. We also most definitively strive to keep people from experiencing such grim periods. The best way to achieve these goals is to continuously learn. Curiosity, inquiry, dialogue, knowledge, and caring are the cornerstones of the practice of Medicine. And these are the elements that beat at the heart of the National Lipid Association.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Legalizing Marijuana, What Might the Future Hold?

With all the excitement and controversy swirling around the legalization of Marijuana, as a physician I have no choice but to consider what negative ramifications might be in store for our country. Here are just a few of the many issues we must all consider.

What could be the adverse health consequences of rampant and regular marijuana use? Over the past few years, studies have begun to demonstrate unfavorable psychiatric fallout from marijuana. Schizophrenia, and other disorders of psychosis, it seems can be expressed in predisposed individuals who utilize the drug. The incidence of schizophrenia is already one in a hundred. The toll this disease takes on not only the patient, but also the entire family, is enormous. A life-long disease with no cure in sight, schizophrenia leaves its victims unable to function adequately in society, often leading to homelessness and premature death. There is also of course an associated financial burden our society bears from the disease. Imagine then the consequence of even a minor uptick in the frequency of this disorder. Anyone who understands schizophrenia would agree that saying it would be horrific is a gross understatement.

Then there is heart disease. Just last week a study was published citing an association of marijuana with premature heart attacks. Right when doctors are making inroads into reducing heart disease, we may now be unleashing a new and previously unrecognized threat. Remember the days of the great cigarette ads, “LSMFT. Lucky Strike means fine tobacco.” In days of old, tobacco use was the norm; nearly everyone smoked. Socially, it was the thing to do. Then came the studies proving the relationship between tobacco and heart attacks, strokes, chronic obstructive lung disease, and of course death. Following the studies there were lawsuits. The tobacco industry paid dearly for being less than forthright about the potential downside of smoking. The attorneys did quite well, bringing in personal gains of a billion dollars. Tobacco’s victims however did not do so well.  Will marijuana become the tobacco of our future? Have we just begun yet another global experiment testing the effects of a substance on us, the American populace? If so, let’s at least prepare for the fallout.

To protect our society as best as we can, I propose the following. Wherever marijuana becomes legalized, set aside a large portion of tax revenue for future payment of medical expenses related to marijuana’s use. Also, be sure to allocate enough funds to cover the lawsuits that will surely follow our inevitable acceptance of marijuana’s health dangers. Perhaps not just the marijuana sellers will be held accountable. If a government earns revenue through taxation of marijuana, might not the government be liable through complicity? I would also recommend that all marijuana users be forced to sign a waiver of liability. Let the finest attorneys craft this document so it can be as solid as is legally possible. Then, when the lawsuits start flowing in, marijuana enthusiasts will have a much tougher time blaming others for their choice. They need to be fully informed of the potential risks of marijuana, and their understanding must be well documented. Let’s not repeat the tobacco experiment with all its attendant errors. If marijuana is to be the next widespread health hazard, let’s at least protect the nation’s financial interests. Clearly our country is not in a position to take on any more debt.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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