Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Phylicia Rashad Discusses Peripheral Artery Disease

Many members of Phylicia Rashad’s* family have had peripheral artery disease (P.A.D.), strokes, and heart attacks. In a candid interview with me, she describes how her healthy lifestyle (regular exercise, no smoking, and a Mediterranean diet) has helped her to beat the odds and avoid the disease.

Dr. Val: I’m so sorry to hear that 8 of your relatives have suffered stokes or heart attacks. What was that like for you?

Ms. Rashad: All of these relatives of mine had diabetes. At the time of their deaths, P.A.D. was not a recognized condition. It wasn’t regularly diagnosed until the 1990s. I remember my father complaining of his legs cramping a lot. At the time we chalked it up to him being on his feet all day as a dentist, but I wish we had known that it was a sign of something much more serious. Things were different back then – people just accepted that if you had diabetes, you were going to lose toes or limbs. They accepted that as we age, we’d likely have a stroke or a heart attack. No one thought about preventing that from occurring.

Dr. Val: What do you do differently to help insure that you don’t follow in their footsteps?

Ms. Rashad: I eat differently, and have done so for decades. I also get regular exercise. Unfortunately, my hard working family was in the habit of coming home, having dinner and relaxing on the couch after work. This contributed to their diabetes and P.A.D. issues. Interestingly, my relatives who worked on a farm lived into a ripe old age with no chronic disease. Read more »

Peripheral Artery Disease: Phylicia Rashad’s Story

Many members of Phylicia Rashad’s family have had peripheral artery disease (P.A.D.), strokes, and heart attacks. In a candid interview with me, she describes how her healthy lifestyle (regular exercise, no smoking, and a Mediterranean diet) has helped her to beat the odds and avoid the disease. To listen to our conversation, please click here. Ms. Rashad begins speaking at about minute 10:30 of the podcast.

Dr. Val: I’m so sorry to hear that 8 of your relatives have suffered stokes or heart attacks. What was that like for you?

Read more »

Peripheral Artery Disease: Red Flag For Stroke and Heart Attack Risks

Peripheral Artery (Arterial) Disease (P.A.D.) is an under-recognized and under-diagnosed condition, yet it serves as an important warning sign for those at high risk for stroke and heart attack. Even though we have an inexpensive and non-invasive test for P.A.D. very few people have the test done. I interviewed Dr. Gary Schaer, Director of the Cardiac Cath Lab at Rush University Medical Center in Chicago, about P.A.D. and also spoke with actor Phylicia Rashad about her family’s trials and tribulations with P.A.D. This post is devoted to Dr. Schaer’s insights on the medical aspects of the disease, and the next post focuses on Ms. Rashad’s personal story.  To listen to the entire podcast of our interview, please click here.

Read more »

Office Safety: Do You Know How To Use A Defibrillator?

Would you know what to do if someone in your office collapsed in front of you and became unresponsive? Having a defibrillator handy could save their life – and it’s important for you to know how to use one. I interviewed Dr. Jon LaPook, Medical Correspondent for CBS Evening News with Katie Couric, to get his take. [Interesting factoid: Jon became passionate about cardiac defibrillators after a friend of his died while exercising at a gym in NYC. The health club did not have a defibrillator on site – which could have saved his friend’s life.]

*Listen to the podcast*

Dr. Val: What is a defibrillator?

Dr. LaPook: It’s a machine that can convert a life threatening heart rhythm (like ventricular tachycardia or ventricular fibrillation) back into a normal beating pattern. It uses a pulse of electricity to do this. These machines are potentially life-saving.

Dr. Val: Why is it important for offices to have them on hand?

Dr. LaPook: About 1.2 million people in the United States have a heart attack every year and 300,000 of those have “sudden death.” The reason why these people die is not because of the heart attack, but because of the irregular heart rhythm that accompanies it. When the heart isn’t beating in a coordinated fashion, it can’t pump blood effectively and people pass out and ultimately die if there’s no intervention.

If a defibrillator is used to administer a shock to the chest during one of these life threatening heart rhythms, there’s a much higer chance that the person’s life will be saved. For every minute of delay (from the time a person collapses) to receiving a shock to the chest, their chance of survival decreases by 7-10%. So it’s very important for people to get defibrillation quickly.

Dr. Val: How do you use a defibrillator?

Dr. LaPook: When you first see someone collapse and become unresponsive, all you have to do is get the defibrillator and press the “on” switch. It will talk you through the next steps. Remember that the first step is always to have someone call 911 so that EMS will be on its way while you continue CPR. Then you expose the victim’s chest so that you can apply two sticky pads, and the defibrillator will tell you where to put the pads. Then it will analyze the victim’s heart rhythm and decide if it requires a shock to get it beating in a coordinated way. If a shock is recommended, the machine will announce that and ask you to step away from the person. Once the shock has been received, it will then give you instructions for CPR (which includes chest compressions and rescue breaths) until EMS arrives or a pulse is able to be felt. If a person doesn’t require a shock, the machine will not give one – so there’s no risk of harm to the victim.

It’s important for people not to be intimidated about defibrillation because it’s really very simple and can save a life.

Dr. Val: What are a person’s chances of surviving a cardiac arrest?

Dr. LaPook: Nationally, your chances of survival (without intervention) are about 4-6%. If you receive CPR, your chances increase to 15% but with a defibrillator – especially if it’s used quickly – the chances are 40% or higher.

Dr. Val: What do you think about the new research suggesting that rescue breaths may not be as important for CPR as initially thought?

Dr. LaPook: I spoke to Dr. Rose Marie Robertson, who is the Chief Science Officer at the American Heart Association, and she said that in a “witnessed arrest” (when you actually see someone collapse) it doesn’t seem to make a {big} difference if you do rescue breathing (i.e. mouth-to-mouth resuscitation) or not. The reason they studied this is because one of the main reasons why people don’t perform CPR is the “ick” factor of mouth-to-mouth resuscitation. As it turns out, chest compressions alone are about as successful at saving lives as traditional CPR.  However, if you’ve been trained to do the rescue breathing technique, you should definitely use it. The key to CPR is “hard and fast” chest compressions, about 100 compressions per minute.  Whatever form of CPR you use, the key to success is using the defibrillator as soon as possible, ideally within several minutes.

Dr. Val: What should people working in an office environment know about first aid?

Dr. LaPook: The most important thing is for people to be trained in CPR, the Heimlich maneuver, and defibrillator use.

Dr. Val: Are there enough defibrillators out there nowadays?

Dr. LaPook: Not at all. At the very least, defibrillators should be in every single health club in America. I also think they should be installed in every office building and be widely available at schools.

A cardiologist friend of mine told me about some parents who lobbied for their daughter’s school to purchase a defibrillator. (They were in tune to cardiac issues in children because their daughter had an arhythmia called Wolff-Parkinson-White syndrome.) Two years after the school purchased the device, the girl  – only 13 years old at the time – collapsed while walking past the nurse’s office at the school. The nurse saved her life with the very defibrillator that her parents fought so hard for. So defibrillators are incredibly important, and although they’re not inexpensive (about $1200), you really can’t put a price on life.

*Listen to the podcast*

*Check out Dr. LaPook’s defibrillator training video with Katie Couric*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Awkward Moments in Medicine

I recently wrote about some awkward moments that I’ve had with my patients over the years. However, I think that Shadowfax’s blog post may win the award for most distressing patient encounter.

A hospitalized, elderly man was very ill and had requested to be considered DNR (do not resuscitate). Many years prior he had had a defibrillator implanted so that his heart would be automatically shocked if it went into an abnormal rhythm. His family gathered around him as he died peacefully from old age coupled with infection. The defibrillator, however, correctly recognized an “abnormal heart rhythm” (i.e. a flat line) and continued to shock the deceased man’s heart at regular intervals, causing his chest to twitch in front of his pained family members. The hospital’s defibrillator magnet (the off-switch for the device) had been misplaced, and so physicians were left to call neighboring hospitals and cardiologists to try to shut the machine off.

In the process of trying to locate the magnet, the doctors had to identify the brand of the defibrillator – a Saint Jude device. As it happened, one of the doctors receiving the request for the magnet was Catholic, and recognized the grim irony of the situation.

Saint Jude is the patron saint of lost causes.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »