Category Archives: Health

Borderline Personality Disorder (BPD)

  1. Symptoms: a pervasive pattern of instability in self-image, interpersonal relationships, and mood; difficult to be alone; intense, unstable relationships that can be seen as manipulative; mood may shift rapidly and inexplicably; intense anger that may be accompanied by temper tantrums, physical assault, or suicidal threats/gestures; identity disturbance, alternating between unrealistically positive view of the self and unrealistically negative views of the self; uncertainty about issues such as personal values, sexual preferences, and career alternatives; chronic feelings of emptiness and boredom; anxiousness; separation insecurity; submissiveness; depressivity; hostility; impulsivity; risk taking
  2. Diagnosis: Must have a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated in 5 of more of the following: 1. Frantic efforts to avoid real or imagined abandonment, 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, 3. Identity disturbance: markedly and persistently unstable self-image or sense of self, 4. Impulsivity in at least two areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating), 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior, 6. Affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety), 7. Chronic feeling of emptiness, 8. Inappropriate. Intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights), 9. Transient, stress-related paranoid ideation or severe dissociative symptoms
  3. Course and Outcome: recovery rqates are relatively high among those with BPD ; if treatment is initialized early in their twenties and followed through into their thirties and forties, only 1 in 4 still qualify got the BPD diagnosis
  4. Frequency of Disorder: overall lifetime prevalence of having at least 1 personality disorder is 10%; at least 50% of people that meet the diagnostic criteria for 1 personality disorder meet the criteria for another disorder; 75% of those who meet the diagnostic criteria for a personality disorder also meet the criteria for another syndrome such as major depression, substance abuse, or an anxiety disorder; BPD is among the most common personality disorder among patients treated at a mental health facility (both inpatient and outpatient setting) accounting for 30%; BPD is somewhat more prevalent in women than men
  5. Etiology: Genetic factors; environmental factors; parental loss, neglect, and mistreatment during childhood; problematic relationships with parents; lack of supervisions, frequently witnessing domestic violence, and being subjected to inappropriate behaviors by parents/adults (verbal, physical, and sexual abuse)
  6. Treatment(s): Psychotherapy; psychodynamic therapy; ½ to 2/3 of BPD patients discontinue treatment within the first several weeks; dialectical behavior therapy (DBT)- DBT shows a higher improvement in women than those who have treatment as usual, spent fewer days in psychiatric hospitals, reduced frequency and severity of suicide attempts; psychotropic medication, though there is no disorder specific drug


  1. Symptoms: gradually worsening (months to years) loss in memory and related cognitive functions
    1. Neurocognitive: cognitive problems in a number of areas, ranging from impaired memory and learning to deficits in language and abstract thinking; final stages: intellectual and motor functions may disappear almost completely
    2. Memory and Language:
      1. Retrograde amnesia: loss of memory for events prior to the onset of the illness or the experience of a traumatic event; late stage dementia
      2. Anterograde amnesia: inability to learn or remember new material after a particular point in time; early stage dementia
    3. Verbal Communication: sometimes subtle; may remain verbally fluent until very advanced; retain vocabulary skills and can construct grammatical sentence, but have trouble finding words and naming objects
      1. Aphasia: describes carious types of loss or impairment in language that are caused by brain damage
      2. Apraxia: difficulty performing purposeful movements in response to verbal commands
    4. Perception: problems identifying stimuli- such as visual, auditory or tactile sensations- in their environments (agnosia), but sensory functions are unimpaired
    5. Abstract thinking: bound to concrete interpretations
    6. Judgement/Social Behavior: failure of social judgement and problem solving skills
    7. Personality/Emotion: personality changes, emotional difficulties, and motivational problems; not part of diagnostic criteria; Hallucinations/delusions in at least 20% of dementia cases; may appear apathetic/emotionally flat; faces are less expressive; indifferent to surroundings; depression
    8. Motor behavior: may become agitated, pacing restlessly, or wandering away from familiar surroundings; Late stages may have problems with muscle control from the central nervous system
  2. Diagnosis: measurement of cognitive disorder; more precise from a neuropsychologist; testing may measure sensorimotor, perceptual, and speech functions; may instead use more focused tests towards specific impairments; may have patient copy a drawing
  3. Course and Outcome: downward projector overtime; lifetime disorder
  4. Frequency of Disorder: no obvious differences between prevalence in men and women; dementia in men is more likely to result from vascular disease or secondary to other medical conditions or alcohol abuse
    1. Ages 65 to 69: 1% have dementia
    2. Ages 75 to 79: 6% have dementia
    3. Age 90 and over: 40% have dementia
  5. Etiology: genetic; neurotransmitters: process of chemical transmissions within the brain is disrupted; Viral Infections; Immune system dysfunction; environmental factors
  6. Treatment(s):
    1. Medications: relieve cognitive symptoms by boosting the action of acetylcholine (Ach)
    2. Environmental/Behavioral Management: structured, daily schedule; use of signs and notes for early stage; in late stage tasks such as getting dressed need to be broken down into simple manageable steps;
      1. Knowledge of the environment: clearly labeled rooms and halls
      2. Negotiability: common rooms and dining area should be visible from patients room
      3. Safety and health: secure, but let patient remain active

Alcohol Use Disorder

  1. Symptoms: no single symptom defines alcoholism; may include onset of tolerance and withdrawal; drink more frequently and in larger quantities than the average person without alcohol use disorder; have cravings; drink to control how they feel, relieve negative mood states, avoid withdrawal symptoms from previous episodes, prepare for certain activities-such as public speaking, writing, or sex;
    1. 2 general areas of symptoms:
      1. Patterns of pathological consumptions, including impaired control over use of the drug and continued in spite of mounting problems
      2. Consequences that follow a prolonged pattern of abuse, including social and occupational impairments, disruption of important personal relationships, and deteriorating medical condition
    2. Short term effects of alcohol: slurred speech, lack of coordination, unsteady gait, nystagmus (involuntary to-and-fro movement of the eyeballs induced when the person looks upward or to the side), impaired attention or memory, stupor, and coma
    3. Long term effects of alcohol: experience blackout;, may be able to continue function without passing out; interfere with job performance; financial difficulties; problems with legal authorities, including drunken driving, public intoxication, and child/spousal abuse; organ problems with the liver, pancreas, gastrointestinal system, and endocrine system; cirrhosis of the liver; heart problems; various forms of cancer; nutritional disruption; injuries and premature death
  2. Diagnosis: a form of substance dependence disorder, referred to as alcohol use disorder; mild case has 2-3 symptoms, moderate case has 4-5 symptoms, severe case has 6 or more symptoms; must fit at least 2 symptoms from any of the categories over the last 12 months:
    1. Impaired control:
      1. Taken in larger amounts or over longer periods of time than was intended
      2. Persistent desire or unsuccessful efforts to cut down or control alcohol use
      3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or a recover from its effects
      4. Craving or strong desire or urge to use alcohol
    2. Social impairment
      1. Recurrent alcohol use resulting in a failure to fulfill major role obligation at work, school, or home
      2. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
      3. Important social, occupational , or recreational activities are given up or reduced because of alcohol use
    3. Risky use
      1. Recurrent alcohol use in situations in which it is physically hazardous
      2. Continued despite knowledge of having a persistent or recurrent physical or psychological problems that is likely to have been caused by alcohol
    4. Pharmacological criteria:
      1.  Tolerance
      2. Withdrawal
  3. Course and Outcome: age of onset varies widely from childhood/early adolescence to throughout the lifespan; initial exposure leads to impaired control, evidence of social impairment, and onset of pharmacological symptoms; mortality rate is higher in men who abuse alcohol; heart disease and cancer are twice as common; likely to smoke heavily; relapse is unlikely is able to remain abstinent for at least 6 years
  4. Frequency of Disorder: 21%  of college aged men and 35% of core city men met the diagnostic criteria and had a presence of 4 or more problems in the areas of employer complaints, marital and family difficulties, medical complications, and legal problems; prevalence rate for alcoholism among males who began drinking before the age of 14 is double than found among males who began drinking at age 18 (same patterns among women); 2 out of 3 males drink regularly in western culture of those 20% develop serious problems at some point in their lives as a consequence of prolonged alcohol consumption; lifetime prevalence rate in 30% for some form of alcohol use disorder; alcohol related disorders are clearly among the most common forms of mental disorder in the US; 24% of men and women who are assigned the diagnosis of alcohol dependence have ever received treatment for these problems; men outnumber women in a ratio of 2 to 1 to chronically abuse or become alcohol dependent
  5. Etiology: any of the following or any mix of the following:
    1. Social Factors: culture; initial exposure with drugs/alcohol is likely to occur among those individuals who are rebellious and extroverted and whose parents/peer model or encourage use; parents may model alcohol dependence, adolescents with alcoholic parents are more likely to drink alcohol than those whose parents do not abuse alcohol
    2. Biological Factors: lifetime prevalence of alcoholism among the parents, siblings, and children of people with alcoholism is at least 3 to 5 time higher than the rate in the general population; males have a much higher prevalence rate; 2/3 of the variance rate of alcohol is produced by a genetic factor; other genes that alter the risk for alcohol dependence may be genes involved in personality such as those that influence novelty seeking and sensation seeking; alcohol effects several different types of neurotransmitters, it may stimulate the mesolimbic dopamine pathway directly or it may act indirectly by decreasing the activity of GABA neurons; effect exaggerated activation of the endogenous opioid system in response to alcohol stimulation;
    3. Psychological Factors: Placebo effects and expectations for alcohol fall into the categories of:
      1. Transforms experiences in a positive ways
      2. Enhances social and physical pleasure
      3. Enhances sexual performances and experiences
      4. Increases power and aggression
      5. Increases social assertiveness
      6. Reduces tension
  6. Treatment(s): treatment is a difficult task, many people do not acknowledge their difficulties and relatively small numbers seek professional help; compliance with treatment is low and dropout rates are high; detoxification (removal of the drug which takes three to six weeks), may be given medications such as benzodiazepines and anticonvulsants to minimizing withdrawal symptoms; Disulfiram (Antabuse) can block the chemical breakdown of alcohol which makes the patient violently ill after consuming any alcohol; Naltrexone (Revia) is an antagonist of endogenous opioids that has been found to be useful in the treatment of alcohol dependence following detoxification which makes the patient not feel the high they normal would; acamproste (Campral) reduces the average number of drinks per day; SSRIs; group therapy such as alcoholic anonymous; cognitive behavior therapy: coping and training skills, relapse prevention, short-term motivational therapy

I LOVE MY TOBACCO (correction & update)

I need to make a correction to my recent post in regards to the state of Illinois law that I noted in my last blog. The state of Illinois did NOT pass a law, but rather a ban on smoking in a vehicle with a child under the age of eight. Why they can’t just pass a law making it illegal to smoke in a vehicle with an individual under the age of 18 like other states have done is perplexing to me.

During lunch the other day, my nurse practitioner friend, physician friend and I were discussing cigarette smoking and the health effects of such. My nurse practitioner friend recently visited her native home of Italy where she accompanied her father-in-law to his physician appointment. She questioned the physician if Italy had a lot of lung cancer patients as so many Europeans smoke cigarettes. The physician replied, “No,” due to the fact that they produce tobacco differently then America does. America has much more lung cancer cases than Italy. Hmmmmmmm…….what does that mean?????? Oh, yes……..we fertilize our tobacco crops with radioactive chemicals and tobacco plants absorb radioactive chemicals from dust particles in the air. Many Europeans roll and sometimes grow their own cigarettes according to my friend. There are, also, more fresh and naturally grown produce in Italy. An eggplant, cucumber, and other vegetables and fruits are actually the size that they are suppose to be. More to come………blessings…….


First, let me say that I am blunt in my opinion in regards to health issues. We all make choices every day that effect our health; good and bad (me included). An individual IS responsible for their choices just as I am responsible for mine. It is NOT my fault if a person makes poor choices that harm their health nor is it someone’s fault if I make poor choices that cause me ill affect. Nor IS it my responsibility to pay for the treatment and care that develops from those poor choices, but that is for another discussion time. So, yes, I am steadfast in my opinion, HOWEVER, I am, also, very compassionate in caring for others. I desperately desire individuals to be educated as to how to make good and positive choices when it comes to their health. Often, I don’t believe that individuals are given all the facts, if not any facts, so that they may make good health choices. This is want I am striving to accomplish. My intent is NOT to offend anyone, but ONLY to help those who read my blog. So let’s tackle a touchy subject………TOBACCO USE!

I am going to address this subject in multiple sessions in hopes of not boring you or losing your attention. I have obtained the majority of my information from the American Lung Association, which provides a wonderful wealth of information and assistance to help a person quit smoking.

Session 1

During my clinic office visits, I talk to my patients who smoke cigarettes, about the harmful effects of cigarette smoke. The other day, I walked into the exam room occupied by a mother and her 42-year-old daughter (the patient), and the it literally wreaked of cigarette smoke. As I worked my way through the interview process, we came to the social history. The patient, who is suffering with multiple health issues, stated that she was attempting to quit smoking cigarettes and had recently cut-down to 0.5 pack per day from her usual 1 to 1.5 packs per day for the past 25 years. Kudos to her (and I did praise her for this effort). As we were discussing the harmful effects of cigarette smoking, I stated that cigarette smoking is not only harmful to the smoker, but to anyone around the person smoking in particular children. My comment was, “If you want to harm a child and cause them serious health issues, smoke with them in a vehicle.” Yes, yes, that indeed made the room quiet and earned me some horrified stares for a few seconds. GUILTY!!! Well, they actually took it pretty well. Because I do TRULY care about my patients and I desperately try to convey this compassionate during my patient visits. So you can imagine the excitement I felt today when my daughter reminded me of the Illinois law passed as of January 1, 2014, in regards to no smoking in a vehicle with a child present. Hallelujah!!!!! WOW, Illinois law makers, you have done something that I can truly support and be proud of (no sarcasm intended). Now my daughter has more of a solid leg to support her when she addresses those parents who pull up at daycare when she is dropping off her children and the smoke is literally rolling out of the windows of their vehicles with children in the back seats. (Hmmmmmm……..wonder where she gets that trait from?) Anyway, she has offended several parents in the past. But thank you, daughter, for caring about those helpless children, who would rather be breathing clean air rather then their parents inflicted polluted air that is causing them to feel rotten and possibly even causing them asthma, bronchitis, pneumonia, cancer, weakening their immune system, etc.

THE FACTS: To date, there are approximately 600 identified ingredients in cigarettes. When lit up, they put out more than 4,000 “HARMFUL” chemicals, 50 of which are “KNOWN” cancer causing chemicals and many are poisonous, as well. Some of these chemicals are actually found in household chemicals and labeled as poisonous. However, tobacco smoke does not carry a label for its toxins. A few of these tobacco smoke chemicals and other places they are present include:

Acetone found in nail polish remover
Aetic Acid found in hair dye
Ammonia which is a common household cleaner
Arsenic an ingredient in rat poison
Benzene found in rubber cement
Butane used in lighter fluid
Cadmium which is an active component in battery acid
Carbon Monoxide that is released in car exhaust fumes (a big enough dose of that will kill you won’t it?)
Fomaldehyde which is embalming fluid (getting a jump on things here)
Hexamine used in barbecue lighter fluid
Lead used in batteries
Naphthalene an ingredient in moth balls
Methanol which is a main component used in rocket fuel (fly me to the moon?)
Nicotine that is used as a INSECTICIDE!!!!!! (seriously?????? Doesn’t that kill things??????)
Tar that is used to pave roads (now that should make the lungs feel great and gummy!)
Toluene used to manufacture paint

I’m amazed!!! Why in the world would anyone want to put these harmful chemicals, poisons, cancer causing agents and lethal toxins in their body???!!! Because it makes me feel good…….RIGHT!!! So digest this information if you want, if not, remember, it is only YOU making YOUR health choices. I will be providing more interesting tobacco facts soon.

P.S. Secret time…….I was a cigarette smoker approximately 12 years ago!!! Thank the Lord, He bestowed upon me the blessing to quit!!! Your body is only lent to you by God for a short time. You are to cherish it and treat it with the utmost care and respect. Please don’t abuse it. I TRULY care about your health!!! Blessings until next time………

Acesulfame Potassium: Good or Bad?

So my blogging is not going as I would like.  I am having difficulty finding time to research and write.  Therefore, I am going to try a different approach to get more information out; brief and to-the-point information.

Today, my husband brought home a bottle of dietary supplement tablets that a friend gave him to try instead of drinking such mixtures as Propel, Gatorade, etc.  The bottle reads “sport drink tablets.”  The claim, as stated by my husband’s friend, is that the tablet/water mixture will provide a boost of energy.  Thank goodness my husband asked my opinion on the supplement before he used it.  

So, as I usually do, I read the label.  The first part didn’t sound harmful with such ingredients as sodium, vitamin B6, vitamin B12, magnesium, vitamin C, etc.  But…….the fine print has an ingredient called acesulfame potassium, which is a no-calorie artificial sweetener added to foods and beverages as a flavor-enhancer or to preserve sweetness.  It is 200 times sweeter than regular table sugar(sucrose).  It is added to such food items as candy, baked goods, frozen desserts, dessert mixes, tabletop sweeteners, alcoholic beverages, other beverages, and many other food/beverage items.  It is used alone or in combination with other artificial sweeteners.  

Acesulfame potassium is, also, known as acesulfame K, Ace-K, or Sunett.  It was first approved as a sweetener in 1988 by the FDA, who has set an acceptable daily intake of up to 15mg/kg of body weight per day.

So what is acesulfame potassium?  It is a salt containing methylene chloride, a known carcinogen.  Long-term exposure to methylene chloride can cause such side effects as mental confusion, depression, mood problems, kidney and liver impairment, vision impairment, depression, nausea, headaches, cancer in humans, including breast tumors, and insulin stimulation by the pancreas, which may cause hypoglycemia.  

Of all the artifical sweeteners, acesulfame potassium has undergone the least amount of testing and long-term studies.  To date, the FDA has not required further safety testing. 

As with any food or beverage item that you put into your body, try to be aware of the ingredients and what they truly are and if they have any potential harmful effects on your health.  So many of our diseases and illnesses are caused by what we ingest and long-term exposure.  It’s like I tell my patient’s who smoke, you don’t pick up a cigarette and take a few puffs and get cancer.

Until next time (sooner I hope)………………………………………many blessings:)

Heart Disease and Women

I was approached by a long-time family friend the other day and was shocked to learn that she had recently undergone coronary artery bypass grafting.  She always seemed so vibrant and full of life with an abundance of energy.  Recently, however, she had been experiencing a new symptom of occasional mild shortness of breath.  NO pain!  She mentioned it to her health care provider who was savvy enough to put her through an EKG(electrocardiogram) and cardiac stress test.  The EKG was negative for findings, however, she did not pass the cardiac stress test.  Shortly thereafter, she had three coronary artery bypass grafts.  Her words to me were, “Women are different.  I had no pain.  I could have died if I hadn’t mentioned the shortness of breath to my doctor, which I really didn’t think much about.”

Women often present with atypical symptoms of heart attack or pending heart attack.  I could tell many stories.  Such as the women who only experienced a “twinge” of discomfort between her shoulder blades while climbing stairs and actually was having a heart attack.  Or the women who presented to her health care provider with right shoulder pain thinking that she had pulled a muscle.  Her physical exam was negative for any cardiac findings. After three days of the pain progressively getting worse, she presented to the emergency department and was found to be having a heart attack.  And so on.  These scenarios are not meant to frighten anyone, but to alert you to the fact that WOMEN DO NOT PRESENT IN THE SAME MANNER OR NECESSARILY EXPERIENCE THE SAME TYPICAL SYMPTOMS WHEN HAVING A HEART ATTACK OR WHEN CARDIAC BLOCKAGE IS PRESENT AS IS OFTEN DIALOGUED.  Why is this?  No one seems to have the answer.  So what we do as health care providers is educate the public of what to watch for and when to seek immediate medical attention.


First, what is a heart attack or, otherwise known as, a myocardial infarction(MI)?  A heart attack occurs when the flow of oxygen-rich blood suddenly becomes blocked in one of the heart’s arteries.  The heart muscle is not able to receive the oxygen-rich blood supply due to the blockage and the heart muscle begins to die.  The most common cause of a heart attack is due to a build-up of a waxy substance called plaque in one of the coronary arteries.  This plaque accumulates along the walls of the arteries.  This is known as atherosclerosis.  Over time, the plaque can rupture inside the artery.  The body reacts by forming a blood clot on the surface of the plaque.  If the clot becomes large enough, it can completely block the flow of blood and a heart attack can occur. 

A less common cause of heart attack is when a coronary artery suffers a severe spasm or tightening, which stops the oxygen-rich blood flow.  There are several possible causes of coronary artery spasm that include: 1) certain drugs such as cocaine; 2) cigarette smoking; 3) exposure to extreme cold; and, 4) emotional stress or pain.

All coronary artery blockage has the same affect whether it be from plaque or severe artery spasm.  The heart muscle on the other side of the blockage dies and is replaced by scar tissue.  There are varying degrees of damage.  The heart muscle damage may go unnoticed, cause long-term and devastating health problems, or death.  Heart muscle damage may lead to heart failure and life-threatening irregularities in heart beats, known as arrhythmias.

Heart attacks are a leading killer of both men and women in the United States. The good news is that excellent treatments are available for heart attacks. These treatments can save lives and prevent long-term or life-threatening disabilities, especially if early treatment is received when the heart attack is occurring. Approximately half of all deaths from heart attacks occur within one hour of the onset of the first symptom and before the individual can reach the hospital.

Risk Factors

Approximately every 34 seconds in the United States, a heart attack occurs. Over 1 million individuals suffer a heart attack each year and many of them die. Heart attacks are the number 1 cause of death in the United States for both men and women.  Age does not always equate with cardiovascular health.  For instance, a middle-aged individual who eats a diet high in fat, smokes cigarettes, and leads a sedentary lifestyle(lacks physical activity), may very well have a poorer cardiac health status than an older adult who has maintained a healthy diet, leads an active life and exercises, and doesn’t smoke cigarettes. 

General risk factors for heart attack that can be controlled include: 1) cigarette smoking; 2) high blood pressure; 3) high cholesterol; 4) being overweight or obese; 5) eating an unhealthy diet that is high in saturated fat, cholesterol, and sodium; 6) sedentary lifestyle or a lack of routine physical activity or exercise; and, 7) high blood sugar due to diabetes or insulin resistance. When certain risk factors occur together, it is called metabolic syndrome. These include obesity(having a body mass index [BMI] over 30), high blood pressure, and high blood sugar. Having a waist circumference of 35 inches or greater places an individual at risk for metabolic syndrome. In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn’t have metabolic syndrome.

Risk factors for heart attack that cannot be controlled include: 1) age; the risk for developing heart disease for men increases after age 45 and after age 55 for women(which is usually after menopause occurs); 2) family history of heart disease that appeared at an early age; before age 55 in a father or brother and before age 65 in a mother or sister; and, 3) preeclampsia which is linked to a lifetime risk of heart disease. This is a condition that can develop during pregnancy. The two main symptoms are elevated blood pressure and increased levels of protein in the urine.

There are some normal cardiovascular changes that are associated with aging.  These include:  1) heart valves lose elasticity and stiffen, thus decreasing the heart conduction ability; 2) the left ventricular wall thickens; 3) increased potential for postural hypotension(drop in blood pressure with position change to sitting and/or standing); 4) increased risk of arrhythmias(irregular heart beats); 5) arterial elasticity decreases, which increases the risk for systolic hypertension(reflected in the top blood pressure reading) and left ventricular hypertrophy(enlarged left ventricle); 6) increased risk for “silent” heart attack; 7) decreased blood perfusion to vital organs and distance parts of the body(due to the arteries stiffening); 8) veins thicken, which causes the tiny valves in the veins(especially the distant leg veins) to allow the backflow of blood, increasing the risk for varicosities(varicose veins) and lower leg swelling after sitting or standing for prolonged periods of time; and, 9) decreased cardiac ability to handle stressful activities such as shoveling snow.  Although these changes are associated with the older adult’s aging cardiovascular system, it doesn’t necessarily indicate the older adult will have debilitated cardiac functioning.  Being vigil in remaining physically active with an exercise program, not smoking cigarettes, maintaining a normal BMI(body mass index) or weight, eating a healthy diet, and controlling blood pressure and cholesterol, the older adult can lead a healthy life and maintain a healthy cardiac status.


Not all heart attacks occur with the sudden onset of crushing chest pain. In fact, symptoms of a heart attack may develop over a course of hours, days, or even weeks. Approximately one-third of heart attack suffers have no pain at all. These individuals are most likely to be older, females, and diabetics. Remember that we are all different, therefore, our symptoms may be different. In fact, some individuals have no symptoms at all. But, generally speaking, many heart attacks start slowly as mild pain or discomfort in the center or left side of the chest that often lasts for more than a few minutes, or goes away and comes back. This may be new chest pain or discomfort or a change in the usual pattern of chest pain or discomfort for those individuals with a known heart condition, such as angina, or occurring when at rest. Angina is chest pain or discomfort that usually lasts only a few minutes and occurs with activity and goes away with rest. Heart attacks that occur without any symptoms or very mild symptoms are called silent heart attacks. Even if symptoms are mild does not make the heart attack less deadly.

So, let’s discuss typical heart attack symptoms. These include chest pain or discomfort. This is often described as a feeling of heaviness in the chest, pressure, fullness, squeezing, or actual pain in the middle or left side of the chest. It can be mild or severe. It can be constant or come and go. There can be accompanying discomfort or pain in one or both arms, upper back, neck, jaw, face or upper part of the stomach. Shortness of breath may occur with the pain or discomfort or before other symptoms occur. Other symptoms include nausea, vomiting, or a sudden onset of dizziness, feeling lightheaded or breaking out in a cold sweat. Symptoms may, also, include a feeling of indigestion or heartburn, a loss of energy, feeling unusually tired or fatigue, and difficulty sleeping.

Not everyone having a heart attack has typical symptoms. If you’ve already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur. The more signs and symptoms you have, the more likely it is that you’re having a heart attack. Specifically, in regards to women, they may experience no chest pain or discomfort at all. They may experience other symptoms such as shortness of breath, pressure or pain in the lower chest or upper abdomen, pressure or squeezing in the upper back, or become suddenly dizzy, lightheaded, faint, or extremely fatigued. Often, a women will dismiss her symptoms to the normal aging process, heartburn, or having the flu.


You can lower your risk of developing heart disease and preventing a heart attack from occurring in most cases. Even if you already have heart disease, you can still take steps to lower your risk of suffering a heart attack. These steps involve following a heart healthy diet that includes a variety of fruits, vegetables, whole grains, lean meats, poultry and fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, cholesterol, sodium, and added sugars.

Work with your health care provider to determine your heart disease risk. Create a reasonable weight-loss plan that involves diet and physical activity. Be as physically active as your health allows. Physical activity can improve your overall health and sense of well-being. Talk with your health care provider about what types of activities are safe for you. Controlling your weight helps you control risk factors for coronary heart disease and heart attack. Stop smoking if you do smoke. Your health care provider can assist you with resources and other treatment plans if needed to help with this.


All chest pain should be evaluated by a health care provider. If you experience any of the above listed symptoms, never wait more than 5 minutes to get checked out. And PLEASE, go directly to an actual emergency department and NOT an urgent or prompt care unless an emergency department is not available. This wastes vital minutes, which in turn can have a fatal outcome.

Know the warning signs of a heart attack so you can act fast to get treatment for yourself or someone else. The sooner you get emergency help, the less damage your heart will sustain.

Do not drive to the hospital or let someone else drive you unless it is optimal to save life-saving minutes for you or the individual suffering with the symptoms. It is vital in any situation to call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room or meet the patient in route and begin life-saving treatment. Take a nitroglycerin pill if your health care provider has prescribed this type of treatment.

***REMEMBER***CALL 9–1–1 for help right away if you think you or someone else may be having a heart attack. You, also, should call for help if your chest pain doesn’t go away as it usually does when you take medicine prescribed for angina. Talk with your health care provider and develop a plan.

I hope you find this information educational and helpful. Please feel free to comment. As always, blessings until next time……………………………………………………………………

General Health Facts

As you can probably tell by now by reading my posts, my passion is teaching about health and providing important health facts to encourage others to make healthy choices.  I have not blogged for a couple of months due to having surgery and just now getting back into the flow of life.  This morning, I attended my department’s faculty meeting.  After the meeting, one of my collaborating physicians (whom I haven’t been able to speak with in several weeks) stopped me and said that he wanted me to know that he hadn’t drunk any soda in 3 weeks!  “It’s amazing that when you stop drinking soda, your GERD (acid reflux) goes away,” he stated and smiled.  I have to add that he has nicknamed me ‘Debbie Downer’ from the SNL show.  “Jokingly,” he told me, as I am always telling others all the bad facts about what we eat.  But, as he said,  “What God gave us is always going to be healthier than what is man made.”  I love that doc!:)

Anyway, I would like to share some general health information:

1)  BODY COMPOSITION:  There are a number of changes in body composition that occurs as the body ages that can have an impact on nutrition and overall health.  I remember back to sitting in one of my very first nursing classes and listening to my professor tell the class that as we age, our need for caloric intake decreases and the need for physical activity increases in order to maintain a stable body weight.  How depressing I thought.  Well… I am.  At a place requiring less caloric intake and more physical exercise to maintain my same weight, not to mention the diet and exercise adjustments required if I want to lose weight.  And those pounds have a way of slowly sneaking up on us without us realizing until there is an extra 10 – 15 pounds taking up body residency.

In regards to body composition, one such change as we age is the loss of lean muscle mass.  This loss is due to a reduction in physical activity, hormone production and alterations in nutrition.  If caloric intake continues at the rate consumed at a younger age, the older adult will gain weight in the form of fat, not muscle.  Even though the need for caloric intake decreases (usually in direct response to a decrease in physical activity) the need for vitamins and minerals does not decrease.  In fact, based on the type and amount of food intake, there may actually be a need for vitamin/mineral supplements.

Even though the U.S. Department of Agriculture Food Pyramid has come under scrutiny in the past and has been replaced, some of the basic food recommendations still remain prudent.  Based on an 1,800 calorie diet, and under normal circumstances:  1 – Eat 6 – ounces of grains daily such as whole-grain cereals, whole grain breads, rice or pasta.  Choose cereals high in vitamin B12.  2 – Eat 2-1/2 cups of vegetables, especially dark-green and orange vegetables, and dried beans and peas.  3 – Eat 1-1/2 cups of fruit daily.  4 – Drink 3 cups of mild or other calcium-rich foods daily such as low fat milk or yogurt or low fat cheeses.  5 – Eat 5-ounces of lean meat, beans and other sources of protein, such as low-fat meats and poultry, and include fish, eggs, beans and nuts as protein sources.  Bake, broil or grill foods rather than fry them.

Vitamin requirements specific to the needs of older adults include:  1 – Vitamin D is important to maintain bone mineralization and to facilitate proper absorption of calcium in the body.  Calcium cannot be properly absorbed without an adequate amount of vitamin D.  Good food sources of vitamin D include liver, milk and juices  fortified with vitamin D and fish such as salmon.  2 – Calcium is important to help maintain or slow loss of bone mineral density.  Several servings of calcium rich foods/liquids daily are recommended.  3 – B vitamins are very important.  Vitamin B6 is necessary to metabolize protein and fat.  Vitamin B12 is required for the process of cell division and central nervous system functioning.

***Alert****Excess intake of vitamin B6 such as with supplements, can result in toxic side effects leading to sensory neuropathy (nerve damage that usually results in numbness and/or tingling in the feet and hands).  Use of vitamin/mineral supplements should always be under the direct supervision of a health care provider.  Fat-soluble vitamins such as vitamins A, D, E and K are stored in the body and not excreted in the same manner in which water-soluble vitamins are, therefore, taking large amounts of these fat-soluble vitamins could result in toxic side effects.  This is further compounded by the fact that there is as much as a 15 percent decrease in water content and an increase in body fat as we age.  The extra fat means that the effects of fat-soluble vitamins and drugs may be increased, and the reduction in water content means that water-soluble vitamins and drugs exist in more concentrated amounts.

2)  SLEEP:  I can’t say enough about getting a restful and uninterrupted nights sleep.  Sleep is when the body repairs itself and rids free radicals and toxins from the system.  An adequate restful nights sleep is important for overall health and well-being.  There are five recurring stages of sleep:  Stage 1 – This stage lasts approximately 5 – 10 minutes and is characterized by light sleep or drowsiness.  If a person is awakened during this stage, they may feel as if they haven’t even been asleep.  Stage 2 – This stage is characterized by a period of light sleep from which the person is easily aroused.  Brain waves slow, eye movements stop and heart rate and body temperature decrease.  Stages 3 & 4 – Theses stages are characterized by slow-wave or delta sleep.  Sleep is deep with stage 4 being more so than stage 3. ***Sleep stages 1 – 4 compromise non-REM sleep and last from 90 – 120 minutes total.  REM sleep – This stage of sleep is characterized by rapid eye movements, rapid respiration, increased heart rate and blood pressure, increased brain activity, and temporary paralysis of the limbs.  Dreams occur during this stage.  It is believed that REM sleep is necessary for psychological restoration, learning, memory and concentration during the day.  REM sleep is greatest during infancy and early childhood and decreases during adolescence and young adulthood with the greatest increases occurring in the older adult.  It IS extremely important to get a restful nights sleep.

3)  SLEEP APNEA:  This is an important topic.  Many, many individuals have undiagnosed sleep apnea which can lead to elevated blood pressure, lower leg swelling, enlarged heart after a prolonged period of time, excessive daytime drowsiness, decreased thought processes, irritability, low energy levels, headaches, as well as other symptoms/results.  Sleep apnea, also known as obstructive sleep apnea, is an intermittent, temporary pause in breathing during sleep.  These pauses can occur multiple times during the night and last for approximately 10 seconds each time it occurs.  These interruptions can lead to hypoxia (lack of adequate oxygenation to tissues).  Research shows that older adults who suffer from hypoxic episodes are more likely to experience sudden death, stroke, angina and uncontrolled high blood pressure.  If you or your partner experience heavy, loud snoring; choking, coughing or struggling to breathe while sleeping; extreme sleepiness during the day; headaches in the mornings; trouble concentrating; and, frequent nighttime awakenings, it is recommended that you talk with your health care provider and and get tested for sleep apnea with a sleep study.  Proper treatment can extremely improve overall health and a sense of well-being.  ***Tip:  Some antidepressants such as Amitriptyline (Elavil) and Sinequan (Doxepin), can have sedating effects and should be taken in the evening.  Other antidepressants such as Sertaline (Zoloft) and Paroxetine (Paxil) have stimulating effects and should be taken in the morning.  If you take an antidepressant, please check with your health care provider to determine what the best time of day is to take your medication.

Well…..that is enough information for now.  I plan on addressing women and atypical heart attack presentation with my next blog.  Hope that you enjoyed the information and can put it to healthy use.  Blessings until next time……………………………………………………………………………………………………………………………..

March is Colorectal Cancer Awareness Month

Not because I work for a division of gastroenterology and hepatology, but……March is ‘Colorectal Cancer Awareness Month.’ I am sharing my interview talking points that will broadcast live on a local radio station Thursday morning. The DJ is actually going to undergo a live colonoscopy to promote colorectal cancer screening. In order to share a wealth of information with my readers that could possibly save a life, I am posting my interview. I hope that you find the following informative and useful. The information may not pertain to you at this time in your life, but please share with friends and family as early detection of colorectal cancer and routine screening DOES save lives!

1. With March being recognized as colorectal cancer awareness month, can you tell the listeners what colorectal cancer is?

Colorectal cancer is a common and can be a lethal disease. It is a cancer that occurs in the large intestine, that is otherwise known as the colon and rectum which is the last few inches at the end of the colon. Cells that line the colon become abnormal and grow into an uncontrolled mass of cells. Colorectal cancer usually begins as a polyp or polyps, which usually start out as benign or noncancerous tissue, but if left in place, overtime can become cancerous.

2. What is the incidence of colorectal cancer in the United States?

Globally, colorectal cancer is the third most commonly diagnosed cancer in males and the second in females. In the United States, of cancers that affect both men and women, colorectal cancer is the second leading cause of cancer-related deaths. According to the CDC, in 2009, 51,848 people in the United States died of colorectal cancer; that was 26,806 men and 25,042 women. It is, also, one of the most commonly diagnosed cancers in the United States. Annually, approximately 142,820 new cases of colorectal cancers are diagnosed, of which 102,480 are colon and the remainder are rectal cancers. This turns out to be approximately 1 in 19 people who will develop colorectal cancer.

3. Are there any risk factors for getting colorectal cancer?

The risk of developing colorectal cancer is influenced by both environmental and genetic factors. Low socioeconomic status is associated with an increased risk for the development of colorectal cancer thought to be at least partially due to the lack of adequate screening for the disease. Unhealthy lifestyle behaviors such as physical inactivity, unhealthy diet that is high in fat especially animal fat, low in calcium, folic acid or folate, and fiber, cigarette smoking, excessive alcohol intake, and obesity are thought to play a role in the development, as well. Age, however, is the most common risk factor for the development of colorectal cancer. It is most common in people 50 years of age or older encompassing 9 out of 10 people of this age group, and as noted, both men and women can be affected. Individuals with a family history of colorectal cancer in parents, brothers, sisters, or children are somewhat more likely to develop colorectal cancer themselves, especially if the relative had the cancer at a young age. If several close relatives have a history of colorectal cancer, the risk is even greater. Other risk factors include a personal history of colon or rectal polyps or if the individual has a disorder known as inflammatory bowel disease; with Crohn’s or ulcerative colitis being the two most prevalent of the inflammatory bowel diseases.

4. How is colorectal cancer detected?

There may be no warning symptoms early in the disease. This means that an individual may have polyps and even colorectal cancer without knowing it. However, some individuals do have symptoms that include a change in bathroom or bowel habits such as diarrhea or constipation, bright red stools or dark stools, feeling that their bowels do not empty out completely, stools that become narrower than usual, unexplained weight loss or fatigue, unexplained stomach pain, bloating or fullness, cramping, or increased gas, and nausea and/or vomiting. However, these symptoms may be caused by other health conditions, so it is important to see your healthcare provider for further evaluation. Given that symptoms may not occur until the disease is more advanced is why colorectal cancer screening is very important and can save lives.

5. What types of screening options are available?

Gastroenterologists, such as SIU HealthCare, Division of GI, conduct screenings to help detect, as well as, prevent colorectal cancer by finding and removing polyps before they become cancerous. Several tests are available for colorectal screening. These include annual fecal occult blood test, which is testing a sample of stool for blood on three consecutive specimens. If this test is positive for blood, then other tests are needed to find the source of the blood, such as a colonoscopy. Not all cancers or polyps bleed, however. Other screening methods include flexible sigmoidoscopy every five years, which is performed with direct visualization using a lighted flexible colonoscope, but only on the lower portion of the colon and rectum; both fecal occult blood test and flexible sigmoidoscopy together to increase the chance of finding polyps and/or cancer; a double-contrast barium enema every five years where barium is instilled into the large intestine to outline the colon and rectum and x-rays are taken; and, colonoscopy, which is the gold standard of colon cancer screening and the preferred method because of its thoroughness and advantages of examination. A colonoscopy entails using a lighted flexible scope as with a flexible sigmoidoscoy, but the entire length of the colon and rectum is inspected and if any polyps are detected during examination, they can be removed at that time. This is the most comprehensive and complete method of colorectal cancer screening. It is recommended every 10 years unless polyps or suspicious or cancerous tissue is found and then the timing of repeat examination is altered.

6. Who should be screened for colorectal cancer?

Anyone, male or female, 50 years of age or older should be screened for colorectal cancer and should discuss screening options with their healthcare provider. If an individual is under the age of 50, but believe that they could be at increased risk for developing colorectal cancer, they should talk with their healthcare provider, as well, to discuss possible earlier screening recommendations.

7. Why are these screening tests important?

Although colorectal screening, especially with colonoscopy examination, is effective at preventing and detecting colorectal cancer, fewer than half of Americans 50 years of age or older have been screened. According to the CDC, 2010 statistics showed that Illinois ranked among one of the lowest states in being up-to-date with colorectal screening by any method, ranking in the mid to upper 50th percentile range. The most important strategy to prevent colorectal cancer from occurring, is to remove polyps before they become cancerous. If detected early, the 5-year survival rate is over 90%. The longer cancer is allowed to progress undetected, the harder it is to treat and the greater the risk for poor outcome.

8. Most individuals are apprehensive or reluctant to perform the bowel cleansing or preparation required for a colonoscopy. Can you address this process for the listeners?

Again, colonoscopy, because of its obvious thoroughness and benefits of the exam with polyp detection and removal, is the preferred method for early detection of colorectal cancer. It does require colon cleansing prior to the procedure. If the colon is not properly emptied or cleaned out, the gastroenterologist may miss polyps or abnormal tissue during the exam. A poorly prepared colon may lead to an incomplete exam, a missed cancer diagnosis, or the need to repeat the colonoscopy screening sooner than usual recommendation. Therefore, it is of extreme importance to consume all of the bowel preparation and follow all of the instructions provided by the healthcare provider. However, there have been new developments in bowel cleansing with lower volume preparations. The bowel preparation prescribed by your healthcare provider would be based on your individual circumstances. I always tell my patients, that if you can forgo a few challenging hours of bowel preparation, the benefits of having a thorough and complete colonoscopy are well worth the challenge and may even save your life.

9. What can an individual do to reduce their risk of colorectal cancer?

Get screened for colorectal cancer routinely starting at age 50 and earlier is there are special risks or concerns, be physically active for at least 30 minutes daily, maintain a healthy weight, eat a healthy diet low in fat and containing fruits and vegetables, take a daily multivitamin containing folic acid or folate and selenium, limit daily alcohol consumption, and do not smoke or stop smoking if you do smoke.

Take away……….
Again, get screened for colorectal cancer routinely starting at age 50 and earlier is there are special risks or concerns. Three out of four cases of colorectal cancer occur in people with no known medical risk factors. Many people do not have early warning signs or symptoms; therefore, screening is critical. Less than 50% of all Americans 50 years of age and older are screened within recommended timeframes. Early detection can save lives.

Blessings until next time…………………………………….

Let the Journey Begin Progress

Well…..I feel that I have failed miserably! NOT in the fact that I haven’t made great strides in my dietary changes and overall health status, but that I have not kept my posts up. I failed to even post in January. Why or why do I have to have a full-time job? But that’s another topic for another day as the latest national dependency level is up around 51% I believe. But, please don’t quote me on that figure.

So, this post will be brief as I have not had time to complete the research that I wanted to. My topic is in regards to soda. Here are the facts and progress. As I stated in my last post, I am a sugar junky. So that burst of Mt. Dew every morning not only provided me with a caffeine fix, but a bolus of sugar, as well. Even though I only drank approximately 12-ounces of Mt. Dew every morning, it was way more than enough to cause health issues; unforeseen health issues. I often tell my patients, you don’t smoke your first cigarette and immediately get cancer (not only lung), but it takes repeated cellular insult to injury and that repeated pounding away at healthy cells until they finally give up and can’t repair themselves any longer. That’s when the erratic cell growth takes over called cancer. So, those of us who have “bad” dietary behaviors and habits, are constantly pounding away at our once healthy vibrant cells until they finally give out exhausted. Oh, then I’m sick and wonder why. But usually I have experienced bothersome symptoms first and for a while, but I ignore them. Now not all diseases fit this mold, but let’s face it, we are what we eat, our environmental exposure, and genetics.

So, on Lent, I gave up the Mt. Dew (I needed a motivation day). It was tough for a few days to a week. I had weaned myself down enough hoping I wouldn’t get the dreaded caffeine headache, which I didn’t. I needed a new crutch now. I had some Lipton Raspberry White Tea which is loaded with antioxidants and is sweet. It worked well. I was gradually feeling GOOD! My brain was clearing of it’s progressively fogging that was beginning to concern me and my mood overall improved. I didn’t feel the daily fatigue that I had been experiencing for quite sometime. I eventually ran out of the white tea, which is not available in my area and cannot be purchased online. So, I started drinking Arizona Green Tea with honey and ginseng. After 10 days, I truly feel great! Getting off of the soda has cleared my brain, provided me with mental mood stability, and I feel healthy, the first time in along time. Yes, I’ve had cravings, but I am past giving into those cravings now. I knew that I was destroying my health by my choice and addiction in consuming soda on a daily basis and for the past 20+ years.

I will be addressing diet soda soon. There are SO many ill effects from drinking diet drinks. Excessive use can cause extreme health consequences. I had a patient in clinic the other day who previously drank one case of diet soda a day. She is currently down to one 6-pack daily. She is morbidly obese, has bilateral breast cancer, diabetes mellitus, sleep apnea, hypertension, and more. It is a vicious cycle when you start abusing your body and feeding it processed foods and unhealthy foods and fluids. I had another patient with the same pattern, however, he doesn’t have the same health issues, but did have prostate cancer. He consumed a case of diet soda a day, as well. He purchased so much of the wicked drink that he actually was given a free soda machine for his garage. WOW! Now that’s a gift to be proud of. Why doesn’t that work for other items such as gas, etc? Anyway, more to come on the diet soda issue when I get my data together.

So, please, if you consume soda, diet or regular, STOP!!! You will feel SO much better. I take a Protandim supplement and Vitamin B12 supplement daily, eat an apple, drink 6 glasses of filtered water, and eat healthy for the most part, and I TRULY FEEL GREAT!!! I’m still working on my diet, but I am getting there.

Best of luck and may God bestow His blessings upon you……………………………………………………………