November 25, 2004

Bill Clinton Could Save Your Life

Running Healthy with Dr. Jeremy Torstveit

Information on coronary heart disease (CHD) has been widely available, so it is almost impossible to plead ignorance on the subject. Furthermore, CHD is so common 500,000 new cases in the United States each year - that it has touched almost every family. That's why it never ceases to amaze me that it takes a celebrity illness to bring in flocks of patients seeking screening and therapy. The "Clinton Effect" is causing thousands of people to abandon their denial and say, "It could happen to me." Options for evaluating keep changing. Former President Bill Clinton's previous stress tests were okay. How could he have severe blockages, we wonder. Does everyone need a heart catheterization?

Screening for CHD

Let's look at the two general groups: those with symptoms and those without. People who experience chest, arm, neck, or upper abdominal pressure or pain or fatigue and shortness of breath on exertion or after eating should have an exercise electrocardiogram, also known as a stress test. If the stress test is positive, referral for heart catheterization is indicated. Depending on the location and severity of the blockages, stents can be placed or a coronary bypass recommended. If the symptomatic patient has a negative stress test and thallium heart study, the evaluation is not over. Many people have negative stress tests and still have significant blockages. The electron beam CT scan (EBCT) identifies the amount of calcium, a main ingredient of plaque, in the coronary arteries. I believe it should be performed on everyone who has heart symptoms but a negative stress test.

The EBCT should also be considered for people who feel fine. Remember that 250,000 people die suddenly from CHD with no previous symptoms or warnings. Motors let go without warning after running perfectly well; the same is true for the heart. Doctors in the past have listened to the heart, done a resting EKG, and told the patient, "You're healthy as a horse." That seat-of-the-pants approach for men 40 and older and women 50 and older may no longer be adequate now that we have new and improved electronics. At these ages or even earlier, if risk factors such as high blood pressure, diabetes, high cholesterol, obesity, or smoking history are present, the EBCT is your best bet.

EBCT now mainstream

The EBCT, a special CAT scan of the heart, is quick and painless, except for the $500 to $700 price tag, which may or may not be covered by insurance. Screening blood tests should be done at the same time. A cardiologist can then determine, with 'a high degree of certainty, what risks are present and whether further testing and treatment or risk reduction practices are necessary.

I've discussed the EBCT in Running Healthy previously and now highly recommend it. Every year we've seen a number of our 40ish racers unexpectedly needing coronary bypass or stents or even dying of heart attacks. This test may save a life. The EBCT should be done in a heart center, and have only the heart checked. Other studies, such as total body scans, done at some facilities subject the patient to too much radiation for any potential gain.

If you haven't heard, the arthritis medication Vioxx has been voluntary withdrawn from the market because it reportedly has been associated with the development of heart and artery problems in some people. An alternative is Celebrex, a similar drug that is believed to be safe. Stop taking Vioxx and check with your doctor.

The Center for Disease Control has recommended flu shots, predicting that a fairly bad bug will be visiting this winter. The vaccine will be more effective than last year's, and supplies will be more readily available. Since immunity takes some time to develop after getting the vaccine, get it early. The flu was responsible for 50,000 deaths last year and made many other sufferers wish they were dead. Check with your doctor or local health clinic to see when you can get your shot. It's cheap insurance.

This is my last column for 2004, my last chance to grind at my readers to get your physicals, screening, and exercise programs going. While you're getting your race cars revamped and revitalized for next year and while you finally have some time away from the track, do yourself and your family a favor and get everyone checked up.

1 thank my wife, Nurse Shawn, for reviewing and preparing my articles to submit for publication. I also thank Dr. Ken Desser for his wise consultation. Have a happy and safe off-season. I'll leave you with a few suggestions that are scientifically proven to extend life span:

1. Exercise 30 minutes a day. "

2. Get married and stay married.

3. Keep your blood pressure 125/80 or lower.

4. Keep a pet, four-legged or feathered. (Some two-legged pets can actually be hazardous to your health!)

5. If you are able, take one aspirin every day.

6. If old enough to do it legally, drink one alcoholic beverage daily.

7. Lower cholesterol - take Lipitor or other statins if necessary.

8. Avoid unwanted stress (competitive stress is okay).

9. Get a colonoscopy if you're 50 or older.

10. Treat chronic depression aggressively.

11. Take a defensive driving course, and always wear your seat belt.

12. If more than 20 pounds overweight, lose it.

13. For men 40 and over, get a PSA blood test yearly.

14. For women 40 and over, get a mammogram and pap smear yearly.

Dr. Jeremy Torstveit is a pediatric and adult cardiovascular surgeon, thoracic trauma surgeon, and international instructor and lecturer. The president and co-founder of the Children's Heart Project, an international philanthropic service to poor countries for the development of children's heart surgery, formerly competed in NHRA's Top Alcohol Dragster class and now serves as a track physician at some NHRA events. Send questions or concerns about specific health issues to Dr. Jeremy Torstveit, 329 W. Cypress, Phoenix, AZ 85003; fax, (602) 254-2625; e-mail, [email protected]

Copyright National Hot Rod Association Oct 15, 2004