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M. P. Ravindra Nathan
WINDS OF CHANGE HIGHLIGHTS OF THE ACC CONVENTION 2008 - PART 2
By M. P. RAVINDRA NATHAN, MD, FRCP (LONDON AND CANADA), FACP, FACC

"When is the best time to prevent a heart attack?"

"May be 50 years before it occurs!"

That was the most important slide that came up on the giant screen as the famous cardiologist Eric Topol, from Scripps Foundation, La Jolla, Calif., began his key-note speech to a spellbound audience of about 1,000 doctors, on the third day of the American College of Cardiology (ACC) convention. Sounds incredible, doesn't it?

"Is this science fiction or what," the physician sitting next to me asked.

Not really. This scenario is likely to happen in the next two decades. Topol was talking on "The genomics of cardiovascular disease." Imagine a day when you can get the final answer to the question (which you were always afraid to ask), "Is there a heart attack in my future?"

During the past decade, human genome was sequenced, deciphered and decoded and now "genomes have started talking." Genomic contribution to human diseases has become clearer. It looks that we might be able to predict future cardiac events and perhaps many other diseases, including cancer by genomic sequencing and analyzing the genomic markers in a given individual. And you can take precautions to prevent them. Gene-based testing has a great future for risk detection, which then will let us define new targets for treatment with new pharmacogenetic therapies. Looks like genes are our destiny! How does that sound? Just wait.

ACC has just introduced its eagerly awaited Web site, www.cardiosmart.org. This will serve as a vital link between the doctor and his/her patients. The site will put a wealth of valuable information at your fingertips to help you understand many of the commonly encountered cardiovascular diseases and reinforce what your doctor recommends - diagnostic workup, treatment options and lifestyle modifications.

Emerging therapeutic strategies, especially cardiovascular risk reduction, was the topic of several discussions during the convention. Looking beyond the LDL (bad cholesterol) lowering and targeting the HDL (good cholesterol) in the management of 'dyslipidemia' is a concept, which is catching momentum. Even if you diligently take statin drugs (such as Crestor or Lipitor ) designed to reduce the level of LDL there may still be residual risk posed by a low level of HDL, a common problem in South Asians, which attenuates the 'plaque progression' in the arterial walls.

Current medications aimed at elevating HDL-C are limited and hence novel approaches are being explored. In addition to the older drugs like long-acting Niacin, fish oil, etc., newer drugs will be introduced in future. Diet and exercise will still be of paramount importance.

'Anitplatelet therapy' - using drugs such as aspirin to make the blood thin - was agreed by all panelists in a symposium, as the cornerstone therapy for a wide range of patients with 'atherothrombotic process' (hardening of the arteries) especially the so-called 'acute coronary syndromes.' Despite evidence from large clinical trials, the therapy remains underutilized, a cause for major concern. Hopefully, all the steps taken by the ACC and AHA (American Heart Association) to educate physicians will overcome this problem.

The study which triggered the most controversy during ACC '08 was the ENHANCE trial, presented by Dr. John J. P. Kastelein. The fall out from this study is still reverberating in the medical corridors all over USA. In essence, the study showed that Vytorin (Ezetimibe or Zetia ) + Simvastatin or Zocor) did not confirm a positive result as widely expected in patients with familial hypercholesterolemia. "ACC on Vytorin: Go back to statins" was being displayed everywhere. Media caught on to it and suddenly a lot of doctors stopped prescribing Zetia and Vytorin. I had to wield a lot of questions from my patients as well. However, many renowned cardiologists feel this is a premature conclusion and we have to wait till the completion of the study in 2012. For now, I do not recommend stopping the prescription of the combination drug Vytorin if and when indicated for the patients.

To be continued

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville, lives in Brooksville.


FITNESS COLUMN


WATER IS THE ULTIMATE DRINK
By ACHUT MASHRUWALA

We all know that the Earth consists of 70 percent water and 30 percent land. We also are aware that our body is made of 70 percent water and 30 percent are rest of the elements. Since 70 percent of our body is water, we can say that water level determines the functionality of our body. Water is essential for digestion and absorption of food, blood circulation and temperature regulation. Water also carries nutrients and oxygen to cells, and removes toxins and other wastes.

Let's look at some of the common effects of water:

Our liver is made of 90 percent of water. Therefore, most of our digestive enzymatic and chemical reactions in the body require water as a medium. It moves nutrients, hormones, antibodies and oxygen through the blood stream and lymphatic system. Water is the most preferable solvent of the body and therefore, most of things (nutrients, protein, waste, etc.) in our body can be dissolved in water and circulated (moved) easily through the body. Our stomach is a mixture of acid and enzymes that break down food. Water makes this process smooth; means it eliminates the sour burp, acid reflex, heartburn, etc.

If you have acid reflex or heart burn, avoid regular milk and ice-cream. Just drink regular or cold water to prevent heartburn. Constipation is the most common symptom of dehydration. Increased water intake and intake of fiber cures the symptom.

The "body water" also, cushions joints and protects tissues and organs, including the spinal cord, from shock and damages. Water lubricates our joints. The cartilage tissues found at the ends of long bones and between the vertebrae of the spine, hold lots of water, which serves as a lubricant during the movement of the joint. When the cartilage is well hydrated, the two opposing surfaces glide freely, and friction damage is minimized.

If the cartilage is dehydrated, the rate of "abrasive" damage is increased, resulting in joint deterioration and increased pain. To keep joints lubricated, it is a total myth to say that "you need to eat fatty and grease (oil, ghee)." All you need is WATER.

People with rheumatoid joint pain must increase their intake of water, which helps them to decrease the pain. Also, incorporate the flexing exercises to increase the blood circulation to the joints.

Brain tissue is 85 percent water. Although the brain is only 1/50th of the body weight, it uses 1/20th of the blood supply. With dehydration, the level of energy generation in the brain is decreased. Depression and chronic fatigue syndrome are frequently the results of dehydration. Migraine headaches may be an indicator of critical body temperature regulation at times of "heat stress." Dehydration plays a major role in bringing on migraines. Dehydration causes stress and stress causes further dehydration.

The best way to handle headaches is to drink lots of water and do activities that you like. Also, stretching exercise, yoga, meditation and face massage helps to relive headaches and migraines.

When you are studying or working under stress, keep water handy, not coffee. If you have to have a coffee mug, then fill your mug with water.

Now, the most important topic: weight loss

Water contains zero calories. In an article "Water Bearers," (Shape magazine) Elizabeth Austin notes that "water is the single most important nutrient you take in every day. It's fat-free, cholesterol-free, low in sodium and completely without calories."

When you are dieting, water is your appetite suppressant. Drink a glass of cold water and your hunger will be satisfied. Anyway, most of us gain weigh because we misunderstand our body signal of needing water with needing food. More food makes you lazy; laziness stops you from exercise; and no exercise, means weight gain. Studies have recommended that if you are overweight according to average height and weight comparison charts, you should add one glass of water to your daily requirement (8 glasses) for every 25 pounds over your recommended weight.

Drinking water also is vital during exercise. I always have my clients drink water in between each repetition of exercise. My first and last piece of advice for each client is drink water. Always carry a water bottle when you go for a walk, long drive or in class. An easy way to figure out the amount is half of your body weight; for example, if you weigh 150 pounds, then drink 75 ounces of water.

Let's look at common consequences of dehydration:

" Dehydration leads to excess body fat, poor muscle tone and size;

" Decreased digestive efficiency and organ function;

" Increased toxicity in body;

" Joint and muscle soreness;

" Headaches and migraines;

" Heat strokes in kids and adults;

" Constipation, acid reflex, heartburn, etc. (common symptoms in digestion);

" Stress on kidneys by not providing diluted waste;

" Decrease in blood and nutrient circulation;

" Breathing problems.

The list can go on and on ! It's a sample concept. Water ("Amrit) is widely available. So drink up!

Achut Mashruwala of Fitness Guru Inc. can be reached at (813) 857-5103 or e-mail andy@fitnessguruone.com




Payal Patel
TIME FOR BACK-TO-SCHOOL PHYSICALS
By PAYAL PATEL, M.D.

It is that time of the year again when children will be returning to school, so besides getting all their school supplies, forms, orientation taken care of, it also is important to schedule a yearly physical with the pediatrician. This is an essential part of their back-to-school preparation since it not only addresses their physical well being, but also encompasses the social, behavioral, emotional aspect of their daily school and home life.

During a yearly physical, usually recommended on or after your child's birthday annually, but can be scheduled before school starts, the well-being of the child is addressed. This is different from a quick sports physical at the school, or a walk-in clinic, because it gives the pediatrician an opportunity to review the history, development, any illness, shot records, vision, hearing, labs as needed, anticipatory guidance such as safety precautions, nutrition, behavior, sleep, school, social and emotional issues.

The pediatrician will obtain a full history if the child is being seen for the first time to get details on past ailments such as asthma, heart problems, etc., development history such as speech or motor delays, significant family history, hospitalizations, surgeries, school performance, social and emotional problems at home, as well as school.

On a typical yearly physical exam, weight and height and BMI (Body Mass Index) are taken and plotted on a growth chart to make sure that physical development is following a normal curve. When physicals are done on a yearly basis, this is a great chance to pick up any abnormal weight gain or loss, height issues that may arise in an around puberty, which may point to any problems that need to be addressed such as obesity, delayed or lack of normal growth, etc., which may be missed otherwise until its too late.

A vision screen and hearing screen are vital especially for kids who are 4 to 6 years old because they are unable to express a visual or hearing problem even if they do have one. It also is a good age for screening for speech or development problems that may affect them in school and be referred to the right sources for help. Behavior can be addressed to see how they do at home versus school setting to pick up learning problems, or even attention issues that may impact their education. These screening tools are ongoing for other ages and may incorporate more or less depending on the child's age as well as demeanor at the office.

It is a good time to review shot records especially at the 4- to 6-year-old level when kindergarten entrance shots will be given such as the second MMR vaccine, fourth polio, fifth DTaP and the now-required second chickenpox shot, which is mandatory for those entering kindergarten this year. During the 11- to 13- year physical, the Tdap (Tetanus Booster), a required seventh-grade shot, is given along with possibly other recommended shots around this age.

A physical will address everything, from skin issues such as moles, birthmarks, to dental problems, heart murmurs, scoliosis (abnormal curving of the spine), genital exam to monitor proper development as well as screen for hernias, etc. is important. Those going to participate in sports will be tested for motor strength, any muscle sprain, or past fractures that may still impact their sport performance, as well as heart or lung problems such as family history of sudden death, heart attacks under 50, chest pain, asthma (exercise induced) to screen optimally. Lab testing may be done to screen for anemia, electrolyte abnormalities and cholesterol issues as determined by the doctor.

This is a good chance for the pediatrician to address anticipatory guidance such as nutrition, exercise, school performance, friends and family relations, peer pressure, smoking, alcohol, drugs, sex for adolescents, and dealing with the emotional and social aspect of being an adolescent.

Since, school is just around the corner, call your pediatrician and schedule a physical at your earliest convenience. The lengthy aspect of a yearly physical is an assurance to your child's physical and mental well-being and should be enforced by all parents. Wishing everyone a happy and a healthy school year. Dr. Payal Patel is a board-certified pediatrician at Sunshine Pediatrics, 18928 N. Dale Mabry Highway, Suite 102, Lutz. For information, call (813) 948-2679.



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