Health
What your doctor wants you to know

The fireworks have faded. The tree has been mulched. The eggnog is just a memory. Time to think about getting on with the rest of life.

Armed with the latest research from the National Institutes of Health and assistance from some Hawai‘i physicians, we’ve gathered a list of things your doctors wish you knew to face your future in the healthiest way possible.

Here are some tips on three important areas: cardiology, gerontology and pediatrics.

Cardiology

Forget what your doctor used to tell you about focusing on the lower number (diastolic) in taking your blood pressure. Instead, you need to pay attention to the upper number (systolic).

Because it measures how hard the heart is squeezing, the systolic is now considered a better measure of your risk of heart attack, stroke or kidney failure.

"We’re learning systolic hypertension is more important," said Dr. Mark Grattan, a cardiologist with Straub Clinic & Hospital. The upper number should fall between 90 and 130, and should no longer be 100 plus the patient’s age, the ballpark figure used in the past. If the systolic is too high, "the heart’s working too hard," said Grattan. "It’s banging on the blood vessels, and over years will injure them. The blood vessels become stiffer and more like lead pipes instead of the fine pliable elastic vessels they were when we were kids."

It used to be an apple a day for good health; now it’s an aspirin a day. That one simple little pill can help your heart, and as well may help protect your colon from cancer. That’s the advice for those older than 50 who have one of four major heart-attack risk factors: high blood pressure, diabetes, a history of smoking, elevated cholesterol.

"Anybody who has cardiac disease should be on an aspirin a day if they don’t have a bleeding tendency and are not on Coumadin (a blood thinner) or Plavix," said Grattan.

Aspirin affects platelets in the blood to stop clots from forming. But Grattan warns against taking more than one aspirin: "The complication risk (for gastritis, especially) goes up."

If you’re over age 50, see a cardiologist to evaluate for "silent heart disease," if you have those same four risk factors for heart disease.

"At least 33 percent of people will have coronary disease and not know it," said Grattan.

Women are especially vulnerable, because they often don’t acknowledge their symptoms or realize they’re related to their heart. Women may also mistakenly believe they’re not at risk because of protective hormones. After 50, that’s no longer true. Heart attacks and deaths go up sharply, to match those of men.

Don’t ignore an irregular heartbeat, atrial fibrillations or heart palpitations.

"People who have episodal atrial fibrillation are at high risk of stroke," said Grattan.

What these disturbances indicate is that part of the heart is not beating well and could form a clot that could move to the brain.

Watch for any one of these symptoms of a heart attack: Squeezing discomfort in your chest radiating to the jaw or down the left arm; pressure in your chest; upset stomach and nausea; shortness of breath.

Gerontology

Worry about progressive memory loss. It’s not a normal part of aging.

This may come as a surprise, said geriatrician Dr. Gary Johnson, but older people with memory loss need to be evaluated medically. It can be caused by treatable problems that have nothing to do with Alzheimer’s disease or dementia.

"People assume it’s old age and it may not be," said Johnson. "It could be a thyroid disorder or a vitamin deficiency, and both would be treated quite differently. There are a variety of things that can cause memory loss in an older person.

"Even if it is Alzheimer’s, there are treatments available that may help arrest the disease. There’s medication that will slow the disease down so they don’t change as rapidly. People have stayed fairly stable for two to three years. The newest is Exelon. Another is Aricept. Both slow disease progression, especially when started early."

Find out now about the cost of long-term care.

"People assume their health insurance will pay for long-term care and they get caught short when they find out it won’t," said Johnson.

People need to look seriously into the purchase of long-term care insurance.

"Baby boomers need to realize they can’t rely on Medicare or their own medical insurance," said Johnson. "Those policies do not cover long-term care."

He said individuals or their families often end up paying out-of-pocket (averaging as much as $6,000 a month) for nursing home care, until they’re impoverished and placed on Medicaid because of their poverty level.

Keep exercising. It will stall aging.

"The sooner we start, the better our later years will be," said Johnson. "Especially people with problems like osteoporosis (a thinning of the bones)." Women need to make sure they get a good calcium intake through earlier years to keep strong bones in later life.

The long-term Nurses’ Health Study of 72,488 women between the ages of 40 and 65 gives proof that those who exercise reduce their chances of stroke. The study found that each 3 1/2 hour-per-week increase in moderate activity led to a 19 percent reduction in total stroke and a 29 percent decrease in ischemic stroke (from a blood clot).

Take vitamin E. Gingko biloba can’t hurt either, even though the studies aren’t as definitive about its benefits.

"Vitamin E seems to have a big impact in several areas," including cognition, ameliorating heart conditions and even Parkinson’s disease, said Johnson.

Stay stimulated mentally by reading, working crossword puzzles, taking continuing education courses.

"Anything is better than sitting around watching TV," said Johnson. "Anything that provides mental stimulation is going to be helpful in warding off problems like memory loss. In retirement, look at doing something more cerebral, such as going back to university."

Pediatrics

At every stage of child-rearing, "family time" is crucial, said pediatrician Dr. Jeremy Lam.

Aside from the physical and medical needs, emotional support is crucial at every stage of a child’s development. It starts the day you bring a baby home and continues through childhood and adolescence.

Strong family ties — and parents who take time to attend the games and rehearsals and school programs — give children the best foundation for feeling part of a strong group.

Take your family time beyond your home.

Volunteer in your child’s classroom, chaperone school outings, serve as a "room parent," participate in athletic activities together. "There’s a very short time you can support them and it’s important to be there," said Lam. "But the average father might spend 10 minutes of quality time talking with his kid once every week."

Try family meetings to settle conflicts or work out differences as children get older.

"Having a positive relationship with you may also influence your child to live up to your expectations to keep a close tie with you," advises a new report from the National Institutes of Health about adolescent alcohol use. "Study after study has shown," notes the report, "that even during teen years, parents have enormous influence on children’s behavior."

[back to top]