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M. P. Ravindra Nathan

"What lies ahead? The future of 'Obesity and Cardiometabolic risk" was a featured symposium, which was well attended, during the American College of Cardiology (ACC) Expo 08. Obesity is increasing globally as the poorer nations are becoming richer and food is available in plenty. Yes, South Asians are included.

Obesity may take over from cigarette smoking as the No: 1 cause for ill health in USA soon. A recent study suggested that "obese patients' lives are shorter but their medical bills are longer!" Researchers are closing in on the biological mechanism underpinning these risk factors and developing novel therapeutic approaches. A new drug just introduced - Rimonaband - appears to be promising.

Results of some of the important late-breaking trials presented are as follows: 'CREATE' study suggested that a new biodegradable drug coated coronary stent named Excel is safe and effective with low incidence of major adverse effects. 'ONTARGET' study presented by Dr. Salim Yusuf from Canada showed that a class of drugs, 'Angiotensin Receptor Blockers,' are just as good as ACE Inhibitors for heart failure.

ACCOMPLISH trial certainly accomplished the fact that combination therapy with Amlodipine/ Benazapril was effective in controlling high blood pressure. Numerous other trials involving blood thinning agents (MATRIX), lipid lowering drugs such as Crestor (ASTEROID), antidiabetic agents like 'glitazone' group (PERISCOPE), etc., were presented to a large audience. Translating these landmark trials to the front lines of clinical practice will benefit both practicing physicians and patients.

ACC Expo 2008 was simply amazing. On display were some of the most modern machines. State-of-the- art digital technology, which ensures outstanding image quality and high-speed responses ,were on hand to see in all facets of cardiovascular diagnosis - Echocardiography, CT angiograms, Nuclear imaging, MRI of heart (Magnetic Resonance Imaging), etc. As you have guessed, imaging is the future of diagnostic and to an extent therapeutic cardiology as well.

A series of pioneering technological leaps have clearly defined the direction and goal of imaging applications. Multi-detector CT and modern MRI have become the accepted alternatives - in many cases actually preferable - to more invasive techniques such as cardiac catheterization. Most researchers now feel that MRI is a better option for screening than angiography.

"Enodvascular intervention," (such as coronary and peripheral vascular angioplasty, stent repair of aortic aneurysms, etc.) a rapidly progressing exciting field, is simply driven by these modern technologies and ultimately our patients are the beneficiaries.

Some of the interesting new exhibits included 'Therapeutic Cooling System' by 'Innercool' therapies, a step in the hypothermia technology. This is quite useful in patients who suffer from heart attack, sudden death syndrome, coma from strokes, etc., to preserve the body functions till the recovery process starts. "We are," Dr. Lance Becker, director of University of Pennsylvania's Center for Resuscitation Science, believes, "at the forefront of a revolution in emergency medicine destined to save millions of lives in the years ahead."

By visiting some of the booths, you could get your blood tested, take simulated voyages through the arteries and veins of your body, sit down and have a Cappuccino and even get goodies such as a free LED light magnifier or monogrammed calculator/mouse pad, etc. Some booths like Toshiba invited you for a "lunch and learn" session where they showcased their latest advancements in cardiovascular imaging while distributing free lunches, to attract the attendees.

Finally, I must recommend an important book, which will help you maintain good health for many years to come. "Slay the Giant," by Dr. Elizabeth Klodas, MD. FACC, editor-in-Chief of, examines the power of prevention in defeating heart disease. This user-friendly book and translates the 'doctor-speak' to easy to understand advice with strategies in preventing and mitigating cardiovascular disease. Details are posted on the ACC Web site

Yes, this ACC.08 convention brought practicing physicians like me "new knowledge, new perspectives, and a new appreciation for the wondrous world of cardiology." Yes, this also gave us an opportunity to recognize our successes in science and clinical care and survey the present and future challenges at home and abroad. Global health has become the way of thinking for cardiologists and this was indeed a global convention with active participation from many countries, including India.

I extended my time in Chicago for two more days just to stroll down the 'magnificent mile' and around the parks holding the hands of my wife and my 3-year-old granddaughter, Anokha, and enjoyed some fine dining - from the healthy choice menu, of course.

(This concludes the series)

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



Almost 9 out of 10 of us suffer from back pain as we age. The lower back pain is the most common type of back pain; yet it's not a disease. It is a symptom. The discs between our vertebral columns make the vertebral column movable. These discs between are made of fibrocartilagenous structure; it feels like jelly. It functions as joint and ligaments in between two vertebral bones, which makes the vertebral column flexible.

The dislocation of discs, lose of moisture and volume of the discs are major cause of back pain. Most of us have lower back problems because our disc between any lumbar vertebrae is dislocated, or lost moisture and its volume to function normal.

The most common cause of low back pain is overstretched or injured muscles that support the lower back. Muscles and connective tissues can become hurt from lifting or carrying heavy objects incorrectly. Muscles in the back also can become weak from a lack of exercise. Low back pain also is commonly caused by:

" Bad posture
" Standing or sitting in the same place for a long time
" "Slipped" disk; a "slipped" disk is when a disk between vertebrae bulges past the bones and presses against a nerve.
" Being overweight
" Osteoporosis (thinning of bone)
" Osteoarthritis, which is the break down of tissues or bones of the joint
" Fibromyalgia, which is an illness that causes achy, tender muscles; the person with fibromyalgia may also sleep poorly, have headaches, and often feel tired
" Serious illnesses such as cancer, infection or another illness can cause low back pain, but this is rare.

For people over age of 30, the stretching exercises are the best solution to easy the pain as well as gradually get rid of the pain. These exercises help relax the disc between the vertebra; they also provide necessary oxygen and nutrients to discs. The fully oxygen rich discs help vertebra to move better without pain. There are several stretching exercises for back. These stretch exercises must be done regularly at least 20 to 30 minutes daily.

* Pelvic Tilt (lower back stretching exercise):

Lie on back, knees bent, feet flat on floor. Tighten buttocks and abdomen, flattening small of back against the floor. Hold for a count of five. Slowly relax. Repeat five to 15 times.

* Basic Twist (lower back stretching exercise):

Lie on back, arms stretched out to the sides. Bend knees and bring knees up close to your chest. Take a deep breath; exhale as you slowly lower knees (keep knees together) to floor to the right or as close to the floor as is comfortable. Pause! Inhale as you slowly return your knees to chest; exhale as you slowly lower knees to left side, inhale as you return your knees to chest. Repeat about three times.

* The Cat (back stretching exercise):

Begin on all fours, hands directly under your shoulders and knees directly under your hips. Inhale as you drop tummy toward the floor and look up over your head. Exhale as you bring your tummy back up, rounding your back as you tuck your chin in and tuck your tailbone in. Move slowly back and forth between these two positions pausing on each pose. Repeat about 3-5 times.

* The Cobra (back and chest stretching exercise):

Lay flat on stomach, forehead to ground, with arms bent and palms down on the ground under the shoulders. Push downward with arms as you raise your upper torso and arch your back. Hold for three full breaths before slowly bringing the upper torso back down to the ground.

* Shoulder, Back and Arms Stretch:

Stand with knees slightly bent. Interlace fingers, extend arms forward at shoulder level. Turn palms out and reach your arms further until you feel a stretch. Hold 10-20 seconds. Repeat.

* Wall Back Stretch (back/neck stretching exercise):

Stand up with your back against the wall. Try to press the small of your back and the back of your neck toward the wall. Hold for 10-30 seconds. Do not overstretch!

Young men and women in their 20s and early 30s should focus on back strengthen exercises once or twice a week along with daily back stretch exercises. However, I strongly recommend to perform the back strengthen exercise under professionally trained supervisor because it may cause serious damage if it is not done correctly.

The weak abdomen muscles and excess fat are one of the top causes of back pain. The only way to strengthen your abdomen muscles are sit-ups and crunches. Perform about 10 to 15 crunches with 2 to 3 sets everyday and you will feel strength in your abdomen muscles and less pain in your back.

Yet, the loss of excess fat is extremely important, which will only be reduced with regular aerobic and cardio exercises. Other supportive recommendations are a massage once a month. Massage helps body muscles to relax; the specifically back pain massage helps elevate those discs that have pressed between vertebrae. Also, increase intake of water and reduce intake of lipids (high in oil, ghee, butter, etc.)

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

Payal Patel

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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