The Good Heart - Weekly Tips

Weekly Tips

Topics

Anger/Hostility
Angioplasty/Stents
Anxiety/Worry
Assertion
Behavior Change
Being Critical of Others
Character Strengths
Cholesterol / Nutrition
Coping / Control
CPR
Depression
Depression/Stress
Diabetes and Heart Disease
Emergency Care
Exercise
Hypertension
Kind Acts; Positive Behaviors
Medications
Modifying Your Thinking
Morbidity and Mortality of Heart Disease
Negative Thinking

Optimism/Resilence
Personal Strengths/Character
Positive Emotions
Self Determination
Self Esteem
Smoking / Secondhand Smoke
Social Interaction / Support
Stress Management/Relaxation
Support
Traveling with Heart Disease
Triggers for Heart Attacks
Weight Control
Well-Being
Women and Heart Disease

Topic: Anger / Hostility

Negative emotions indicate a loss of physiological balance – a disturbed homeostasis – a loss of stability. One of these emotions, anger, can certainly leave us with an uneasy equilibrium. High levels of anger are associated with an increased risk that pre-hypertension will progress to hypertension and heart disease. (Player, 2007) Recovering heart patients will often argue their case for the value of anger – “You can’t live without getting mad. It wouldn’t be natural! You can’t walk around feeling happy about everything all the time!” They’re right. Anger serves us well. It’s motivating, allows us to feel powerful, helps in our efforts to externalize threat, and signals that something is important to us. Without it we might not feel motivated enough to fight for what’s right, to fight for what we believe in.

However, when it comes to the too frequent, sometimes inconsequential bouts of anger any one of us may experience day-to-day – we might ask – do we make too many things “important”? If you think the person who sees you approaching the checkout line in the supermarket moves noticeably faster in an attempt to jump ahead of you – to gain a few extra minutes in their day - if you think that’s important it might just make you angry. Did that or something similar to that moment occur in the past year? If it did, how has it changed your life? Not very much, you say …well…hmmm…maybe it wasn’t’ so important after all. If you expected a friend to call to confirm a lunch date – and your friend never called – no follow-up – your friend “forgot” – on an “anger scale” of 1 – 10, how angry did that make you feel? If it’s a missed lunch that can be rescheduled – your anger may be a “2” (not very important), but if it’s a personal slight that you think means you’re not very worthwhile, that you don’t measure up, or you’re not “good enough” to be called – then your anger may be an intense “10”. Not getting a call is a neutral occurrence. It has no true weight, no real value, no importance until you perceive it. The way it’s viewed is up to you and the way it’s viewed will determine exactly how you feel about it.

When you step out into the world today, if you happen to grow angry – about anything – quietly ask yourself how important the trigger is – is it more important than your heart? Let the anger be your cue to shape a constructive, problem-solving process. Maintain a good perspective. Practice the art of understanding – that is, understanding what the other person has done – even if you don’t particularly agree with what the other person has done. Put the situation in the best possible perspective – re-frame the way you choose to view the situation – then reclaim your balance. You’re in charge.
We hear so much today about inflammation - an immune response contributing to the process of artery-clogging atherosclerosis. Measuring levels of inflammation has become one way to predict whether or not someone is likely to have a heart attack. We've long been aware of cardiac risks for those regarded as hostile. Now we see that several measures of inflammation are more likely to be found in those with a particularly potent component of hostility - cynicism. Mistrusting the intentions of others triggers chronic vigilance - kind of a heightened awareness to the possibility of harm. When you meet someone for the first time - notice what it is you're likely to think about that person. Are you mistrustful? Do you decide who this person is just by their looks, their voice, their clothing? Are your immediate thoughts something like…"Oh, yes, I know his type…" "She may seem nice, but what does she really want?" How can you be so sure you "know" this person so quickly? Does everyone you meet know everything about you at the moment you're introduced? The assumptions you live with become your "rules of engagement"…For example, "You have to be careful about people. They'll take advantage of you if they get the chance."

This type of thinking might seem just fine - not only logical, but smart - being prepared for the worst means you won't get hurt. But…you are getting hurt. Feeling guarded, waiting for others to take advantage of you, means living in a state of arousal. With arousal comes constriction, turbulence - and inflammation. In the end, harm is more likely to come from your internal workings, rather than what others might do to you. Perhaps you could write a new, adaptive "rule" - for example, "There are those who may not always have my best interest at heart - but many will. Let me get more information before I jump to conclusions." Since regular exercise has been found to ease inflammation, perhaps you could practice your new way of thinking as you ride your bike, run on the treadmill, or get all those weeds out of your garden.
The angrier you are, the higher the likelihood you'll develop heart disease. If you've already been diagnosed with cardiac illness, your anger may contribute to a first or second cardiac event. If you're young and you're angry, you may develop heart disease earlier in life than the average person your age. A recently published Harvard study associated hostility with "poorer lung function and rapid rates of decline among older men". Know yourself. What are the triggers that most frequently lead to feelings of anger? Try to avoid waiting until you're facing the things that most often lead to anger. Think ahead. Practice, rehearse - before you arrive. How will you respond to what bothers you most? "I expect that when I get stuck in traffic I'll feel agitated, annoyed. Today I plan to handle this differently. Whether or not another driver does something that I don't like so much…I don't have to react. It's foolish of me to expect that every driver on the road will navigate the same way - my way. Many different models of cars, many different types of drivers. Let me be the best driver I can be. My heart is too important!"

Anger triggers the release of stress-related hormones that produce significant cardiovascular changes. Anger leads to unhealthy, damaging behaviors such as eating more fat, smoking, avoiding physical activity -- in short, self-destructive actions. Are there any other ways in which you might look at or perceive the things that lead you to respond with anger? Are these troubling things more important than your health? More important than your heart?

Topic: Assertion

Are you able to say "No"? If you spend your life trying to please everyone, you may wind up extending yourself beyond what is healthy for your heart. When you make the needs of others more important than your own needs, resentment, a form of anger, may follow -- triggering the release of stress hormones and contributing to long-term wear-and-tear on the cardiovascular system. Haven't you earned the right to say no at least some of the time? Experiment this month with a politely delivered "No."

Topic: Angioplasty / Stents

Some good news...
In a new study published in the Journal of the American College of Cardiology, researchers showed that for some people the function of the left ventricle of the heart improved within six months after a stent was placed in a blocked coronary artery after a heart attack. This improved function coincided with a decrease in the size of the heart tissue that had died from the heart attack. The "ejection fraction" (the measurement of the amount of blood pumped out of the heart with each beat) improved, and it appears that these improvements in heart function benefited long term survival.

A recent study, called the Courage study published in the New England Journal of Medicine, looked at using aggressive drug therapy and life style changes as compared with inserting a stent. Here are a few points ascertained from this and other recent research on "to stent or not to stent"...
- If you are having a heart attack, stents have been shown to be the better choice compared to drugs when implanted within 12 hours of a heart attack. Best practice strives for a less than 90 minute time frame from when someone arrives at the emergency room and when the angioplasty procedure is performed. Beyond 12 hours, one recent study found that there was relatively no difference between stents and drugs.
- If you are having unstable chest pains, both stents and bypass surgery prevents deaths and heart attacks when compared with drugs.
- For people with chronic stable angina or coronary artery disease with no symptoms, studies have shown no benefit with angioplasty and stents over drug treatment alone at preventing death and heart attacks. But if you are having chest pain that interferes with your lifestyle, stents have been shown to be better than drugs at preventing chest pain and improving your quality of life, although intensive medical therapy can be very effective. The important message here for those who have stable angina or have blockages with no symptoms, is that you have the opportunity to look at your options and talk with your cardiologist about the best approach for you - medications and life style changes or a stent. But remember, even if you decide to have a stent, lifestyle changes and drug therapy are a critical part of your treatment plan.
Many of you may have noticed that “drug-coated” (drug-eluting) stents have been in the news a lot over this past year. You may have some concerns about what you have heard if you have one of these stents. First, you should be aware that these newer stents have done their job – there is less chance of reclogging (called restenosis) than with the older bare metal stents. But what the research has shown, however, is that there is a slight increased chance of developing a blood clot on the inside of the drug-coated stent months, or even years, after it has been placed inside the artery.

If you have a drug-coated stent the chances are you will be fine. But the best way to make sure is to have an open dialog with your doctor, and that you continue to take the anticlotting medicine that he/she has prescribed for you (aspirin and Clopidogrel or Plavix), for as long as you have been told to take it.

Topic: Anxiety / Worry

If you’ve been diagnosed with heart disease you’ve probably been asked again and again about how and what you may be feeling. Any unusual discomfort? Do you experience recurring pain? Shortness of breath? Fatigue? How about your medication – any unusual reactions? Since your diagnosis has anyone asked you how you’re “feeling” emotionally? In fact, more frequent or intense negative emotional responses would not be unexpected at the time of a cardiac event. It might be assumed that as recovery proceeds, troubling feelings would lessen as confidence and optimism return. Some research investigations suggest this may be a costly and poorly supported assumption.

For some time we’ve known that it would not be unusual to leave the hospital following coronary artery bypass surgery feeling in control and upbeat, to then unexpectedly feel helpless and sad in the weeks ahead. Still, negative emotions are expected to remit (and usually do) as physical stamina is restored. What may not have been recognized is the potential for negative emotions to not only continue but to increase, placing a heart patient at greater risk of further complications. For example, patients fully energized and optimistic after successful completion of a program of cardiac rehabilitation have reported feeling greater sadness, even depression, one full year later. A study out of the Lown Cardiovascular Research Foundation in Massachusetts, in which patients were followed for more than three years, found that patient levels of anxiety regarded as “normal” at baseline did not indicate what levels of anxiety would be in the months and years following diagnosis.

The lead investigator of the Lown study, Dr. Woldecherkos Shibeshi, reported increasing and persistent anxiety (increased during the 3 ½ year period) to be associated with a doubling of the risk heart attack or death. The level of anxiety measured at the start of the study had little predictive value. Participants feeling fearful immediately following a cardiac event who managed to cope with anxiety effectively during the three year follow-up period had better medical outcomes than those whose anxiety was either high or low in the beginning, but increased over time.

If you worry excessively, feel apprehensive, muscles tense, sleep is poor, and you’re irritable – you may be anxious. Due to its complexity, the treatment for anxiety is not “one size fits all”. The skills and techniques you use to manage anxiety should be specific, targeting and modifying the content of your particular worries and fears. For example, thoughts associated with generalized anxiety may require a very different emphasis of care than the thoughts associated with obsessive compulsive disorder or panic attacks. Whatever the form of your anxiety, if you have heart disease - even if it’s a year or two or more since you’ve had any type of cardiac event - excessive and persistent arousal resulting from anxiety may lead to further complications. If things have gotten worse – if you feel more worried and unsure than you did when this whole thing started – it may be time to talk with your doctors. Please don’t wait.

Many things are lost for want of asking. (English Proverb)

Humans are known to overestimate their level of control over various life situations, but there are times when feeling in control is just what we need. Sensing threat, (e.g., negative health information, job loss, financial uncertainty) anxiety and worry may be what you feel most if confidence in your ability to cope with the problem is low. Tension, feeling "on edge", sleeping poorly, and not being able to concentrate as you try to make sense of the morning paper, may be red flags signaling a mind filled with thoughts of "what if…?". Try changing course! If what you thought you'd be able to do is no longer feasible, create an alternate plan and find a way to see the original plan as less important. Brandstaedter and Rothermund (1994) found that older adults regained control when they were able to "de-emphasize the importance" of goals they felt were no longer achievable and devise new, "reachable" goals. If you've had a plan to retire next year but you're finances say "no, not yet", would you feel more relaxed if you delayed the original date by six months or a year? If after a heart attack you're trying to hold on to a physically demanding job - but not sure you can - would you feel confident once again if you found a less strenuous position and let go of what you've been struggling so hard to maintain? Instead of the energy-draining anxiety you've been feeling - a new plan, new direction, might be the catalyst for renewed vitality and enthusiasm - and a good night's sleep!

Topic: Behavior Change

In the October, 2007 issue of The Journal of Positive Psychology, Murray Levine reviews the origins of the novel “Pollyanna”, named for its resilient and relentlessly optimistic heroine, also known as the “Glad Girl”. Among the many uplifting ideas offered by Pollyanna, “Most generally it doesn’t take so long [to find something to be glad about]” may be one of the most to-the-point and (heart) relevant quotes in the Levine article.

Generally, if you’ve tended towards pessimism or optimism most of your life – that is who you are – that pretty much reflects disposition at birth combined with a lifetime of learning. In spite of a positive (“glad”) outlook, a diagnosis of heart disease may temporarily modify mood downward – and…perhaps surprisingly...for those tending towards negativity, mood may improve. Up or down, a change in mood is likely to be temporary – and, to some degree, based on how heart disease is perceived - either as a major setback or a second chance to live a healthier, happier, more meaningful life. “Setbacks” can leave us feeling vulnerable and unsure while “second chances”, fueled by gratitude and appreciation, can be energizing.

Where do you go from here? Here’s where Pollyanna’s “glad game” comes in. If you do nothing, the outlook you had prior to your cardiac event will prevail. If you decide that (for the sake of your heart) you want to maintain as much of a positive outlook as you possibly can, you’ll need to do some work. Norman Doidge, M.D., explains…as what is learned becomes a habit, it basically takes over a “brain map” and, “each time we repeat it, it claims more control of that map and prevents the use of that space for “good” habits”.

Dr. Doidge tells us the brain is not merely an “empty container” with learning a matter of “putting something in it”. To create a new “habit” – and, a way of thinking is a habit – repetition, correction, and persistence are required. The new learning (improved attitude) competes for space within this “map” – the only way the long-held negative attitude will relinquish its domain is if you persist. Small changes, practiced regularly, can make a difference. If your tendency is to (automatically) grumble and complain about life - you might start each day listing five things you’re grateful for. If your habit is to judge others negatively, you might practice searching for something positive about each person you meet, each person you know. If your tendency is to predict that the days will go badly…spend time looking for something that goes well. Being a “pollyanna” doesn’t mean you’re fooling yourself. It means that even as you see the difficulties that come with every life, you train your brain to attend to the other side – the good side. Before your heart attack, before bypass surgery or the implanted stent you needed, you knew…you knew when your mood was straining your health – you knew but you thought you would stay healthy anyway. Now you really know. Persist for the good.

Many millions of people are living with a chronic disease like heart disease, asthma or diabetes, and many millions are managing more than one health condition. Most chronic diseases have similar challenges and usually require self monitoring (e.g. of symptoms, weight), taking medications, sometimes several at various times during the day, making life-style changes (e.g. exercising, eating differently), and coping with the emotional side of dealing with the illness. With more and more people living longer and developing a chronic illness, healthcare providers may not have the time, resources or even the expertise to help patients manage their disease properly. But help is out there. Some insurance carriers have Disease Management Programs where nurses contact members with specific health conditions, provide phone counseling and send comprehensive written materials designed to help the individual manage their disease. Another resource is the internet. Ask your healthcare provider for information on internet based chronic disease self management programs for your particular problem. And this is where the Goodheart.com comes in. By receiving and reading these "weekly tips", by going-on line to read the more in-depth Health Topics, and by participating in the live web meetings, you can help manage your heart problem, particularly the emotional impact on your health and your life, learning to be more optimistic, and replacing negative feelings and behaviors with positive ones.

Are you ready to change a negative behavior or adopt a positive one? Or perhaps you are not quite ready, or have no desire to make a change at this time. Depending upon where you are in "the stages of change" cycle may help you to determine the best approach to use to help with a particular lifestyle change. According to James O. Prochaska, John C. Norcross and Carlo C. DiClimente, behavior change is a process of identifiable stages, occurring gradually, moving from being uninterested or unwilling to make a change in the near future (precontemplation), to seriously considering a change (contemplation), to making the necessary preparations for the change (preparation), to being actively engaged in making a change (action), progressing to maintaining the new behavior (maintenance) and finally to the termination stage where there is no temptation to return to previous ways no matter what. Think about a positive change you have made in the past. Can you identify the various stages you have progressed through to make that change? Now think about the lifestyles changes you know you should or would like to make. If there is a particular behavior you have no intention of changing any time in the near future (e.g. "I really enjoy being a couch potato"), put that behavior aside for now. If there is another behavior you are seriously considering doing something about (e.g. "I know I should and could eat less saturated and trans fat"), then concentrate on moving that particular behavior to the next stage. Get more information - learn the positive results of changing this behavior; the possible negative consequences of not making this change. Move the process into the next stage. Start to prepare to make the change (e.g. learn about what foods you should avoid, buy a new cookbook, go shopping with a list of appropriate foods). When you move into the action phase of actually trying to adopt the new behavior, try to have the support of a significant person. Reward yourself. Remember, there is no failure. You may slip, but often when changing a behavior, you can "recycle" through the changes many times before finally reaching the termination stage. You may want to consider purchasing Prochaska, Norcross and DiClimente's book Changing for Good (1994 Avon Books), to help you make some positive lifestyle changes.

Immediately following a health scare there's an acute awareness of one's behavior and everything about it that needs to change. Fear has a way of moving us to act and action offers a measure of control - control over whatever it is we fear most. "If I just do this or just do that, I'll be o.k. again." Fear gives way to determination. A stressed, soft, couch potato can be transformed into a dedicated good-health devotee! In spite of a diagnosis of heart disease there is joy - renewal! Suddenly weight is down, exercise up, food choices greatly improved, and you're managing stress, you hear yourself repeatedly uttering the words, "let it go". Fast-forward - six months after a heart attack or coronary artery bypass - old habits reappear. Mindfulness slips into "mindlessness". You "forget" to take your medication (but you've been feeling so good lately anyway). You haven't exercised for a few months because you've "been too busy" (but you'll get back to it, as soon as you get "caught up"). You're eating sugary deserts more frequently (But you've really been "good" - for so long). Do you recall what went through your mind at the moment you were given the diagnosis of heart disease? What were your plans - what were the goals you created to reclaim your health, to secure your independence, to save your life? Those goals were good goals - they still are! Time has a way of dimming fear and easing the disbelief you felt when you heard your doctor say "You've had a heart attack." If fear was once the motivation for change - what motivates you now? Your children? Your spouse? Unfinished work? The chance to feel invigorated once again? In the week ahead resume one - just one - of your original goals. Following the idea of "start low and go slow", add a second neglected goal in week two. As you "mindlessly" slipped out-of good habits you can "mindfully" slip back in.

Topic: Being Critical of Others

If you think of yourself as judgmental, finding what’s wrong with others easily and frequently, you may have developed a habit of critical thinking that will distance you from those around you. Too much distance, too much separateness may contribute to growing isolation. Being isolated may not be so good for the health of your heart. The next time you notice yourself being critical of someone, would it be possible to look for a positive characteristic – something you can admire or respect about that individual? Pay attention to whether or not thinking differently generates different feelings towards that person. When you’re busy with something really important, for example, improving yourself, there isn’t much time left to diminish others. How is your time best spent – finding fault or lifting yourself up to be a better person?

Topic: Character Strengths

Nansook Park, Christopher Peterson, and Martin Seligman (2006), three leading authorities in the field of positive psychology, conducted a timely investigation of the populations of 54 nations with the goal of seeing how similar or dissimilar they may be in their interest and commitment to 24 "strengths of character". In the U.S. (and many other countries) the most commonly expressed strengths were kindness, fairness, honesty, gratitude, and judgment. The least identified were prudence, modesty, and self-regulation. Since being grateful fosters optimism, and both gratitude and optimism are solidly related to health and well-being, this is a good thing. But... placing less importance on self-regulation may not be such a good thing. When we eat too much, keep smoking when we know we shouldn’t, or push ourselves past the point of fatigue - we’re not in control - we’re not "regulating" what we do and feel. If the approximate 85,000 U.S. study participants didn’t view themselves as in control of what they do, then the obesity epidemic should not surprise any of us. The hundreds of thousands who die each year from heart disease should not surprise us. The rapidly growing number of diabetics losing limbs and lives should not surprise us. In this study the five strengths most valued are said to reflect "universal values for a viable society". They’re what makes cooperation, and ultimately survival, possible. However, if we fail to embrace the least valued strengths of prudence, modesty, and self-regulation, society won’t suffer - in fact, society will continue without us - it’s individuals who suffer - individuals and those who love them. A first step - ask yourself what it is you truly value. How much importance do you place on eating well, being healthy, feeling energetic, getting enough exercise? The way you feel, the health of your heart, is a result of thousands of small choices made day-after-day - choices that reflect what you care about most. If you had to choose between good health, independence, and vitality - or --- another piece of pizza or donut, which would it be? With every choice you make today... take a breath, wait 30 seconds - then decide.

Topic: Cholesterol / Nutrition

There's good cholesterol and bad cholesterol that we measure in our blood - is there good and bad cholesterol in the food we eat? No - no food contains good cholesterol. All the cholesterol in the food we eat is the same. This dietary cholesterol is attached to protein molecules (lipoproteins) that circulate in the blood. HDL (high density lipoproteins) carries the cholesterol to the liver to be disposed of (therefore it is called the good cholesterol), whereas LDL (low density lipoproteins), the bad cholesterol, carries cholesterol in the blood so it is deposited in the walls of our arteries. So where does fat fit into this picture? Cholesterol and fat are often mentioned together. The bad fat we eat (saturated fat) increases the body's production of cholesterol, thus increasing our LDL or bad cholesterol level in the blood. The good fats (poly and monounsaturated) on the other hand, do not raise our bad cholesterol level, but in reality, may actually help lower it a bit.
"Wraps" have become very popular. They are made with pitas, tortillas, or other various flatbreads, and they are filled with meats, cheese, salad ingredients and vegetables. Although they may be a healthier choice than some other lunch choices, be cautious. They may be higher in sodium, calories and fat than a regular sandwich. Even one with vegetable filling may have a considerable amount of dressing. Why not share a wrap?
The Journal of the American College of Cardiology confirms the importance of following a low saturated fat diet, even if you are taking a cholesterol lowering medication, like Lipitor or Zocor. Even one meal that has lots of saturated fat can interfere with the ability of HDL (good) cholesterol to fight inflammation, one of the important factors in the development of heart disease. Whereas a meal with unsaturated fats has the opposite effect - it improves HDL's ability to decrease inflammation.
Reading food labels: What does low fat or low sodium mean?

Here is what the different nutritional claims mean:

Fat and Saturated fat:
- Fat free: less than 0.5 grams of fat or saturated fat per serving
- Saturated fat free: less than 0.5 grams saturated fat per serving
- Low fat: 3 grams or less of total fat per serving
- Reduced fat or less fat: at least 25% less than the regular version
Trans fat:
- No trans fat: less than 0.5 grams of trans fat (It is recommended we eat as little trans fat as possible; in practical terms, that is less than 2 grams of trans fat for someone who eats 2000 calories/day)
Cholesterol:
- Cholesterol free: less than 2 milligrams per serving
- Low cholesterol: 20 milligrams or less per serving
- Reduced cholesterol or less cholesterol: at least 25% less cholesterol than the regular version
Sodium (salt):
- Sodium free or salt free: less than 5 milligrams per serving
- Very low sodium: 35 milligrams or less
- Low sodium: 140 milligrams or less
- Reduced sodium or less sodium: at least 25% less sodium than the regular version
Go Nuts!
Just reducing the fat in your diet is not the best way to lower your cholesterol. You should replace those foods high in saturated fat with foods that are high in polyunsaturated and monounsaturated fat. This actually helps lower the bad (LDL) cholesterol.

And happily - this means eating nuts! In addition to helping to lower your bad cholesterol, nuts are a good source of a variety of vitamins and minerals such as vitamin E and magnesium, and a good source of fiber. But remember, nuts are very caloric, so you should eat them in place of foods that are high in saturated fat without increasing the total number of calories you consume. So, go nuts!
Trans Fatty Acids – think Saturated!
I am sure most of you have heard the terms “hydrogenated”, or “trans fat”. Trans fatty acids are created when vegetable oils undergo a process, called hydrogenation, which makes the oils more solid. Hydrogenated oils allow foods to last longer on the shelves in the stores, and makes foods, like crackers and cookies, taste better. But trans fats act like saturated fats in the body, raising total and LDL (“bad”) cholesterol, and lowering HDL (“good”) cholesterol. As of January 2006, the FDA has required manufacturers to list trans fat on the nutrition label. Now you can see how much saturated fat and trans fatty acids there are in a particular food, allowing you to make more healthy food choices when you shop. So, don’t forget your glasses!
Lower is better! There is increasing evidence that if you have heart disease or are at high risk for it, getting your LDL cholesterol (low density lipoprotein -- the "bad" cholesterol) down very low helps protect against a heart attack, stroke, or dying early from heart disease. It is now suggested that lowering your LDL to under 70 mg/dl should be the goal. You should know what your number is, and then discuss with your doctor how best to get your LDL level down to below this new recommended guideline.
Soluble fiber may help to lower the cholesterol level in your blood. It seems to form a gel and binds with some cholesterol in the small intestine and takes it out of the body. To get more fiber in your diet, eat more fruits, vegetables and whole grain bread, cereals and grains. Legumes (dried peas, beans and lentils) are very good sources of fiber.

Look on the nutrition label on the package for the amount of fiber in the product. Then look at the list of ingredients to find whole grain listed as one of the first ingredients (e.g. whole wheat or whole grain oats). Be aware, however, that a food package that says "multi-grain" or "high fiber" are not necessarily whole grain, so be sure to look at the ingredients. The daily fiber recommendation for women over 50 is 21 grams (25 grams for 50 and under), and for men over 50 it is 30 grams (38 grams for 50 and younger).

Topic: Coping/Control

When the doctor says you have a serious illness, or you finally realize that your debts are too high and your assets too low, or you lose someone you love, or life grows narrow and more isolating as you care for a loved one who's ill - how do you adapt? How do you manage demanding, stressful experiences? Do you withdraw? Do you eat too much? Are you irritable? Do you start blaming yourself for every mistake you've ever made in life that's brought you to this circumstance? Do you endlessly complain to anyone who'll listen? Results of a study of hostile men, conducted by Dr. Loriena Yancura from the University of Hawaii, help us understand more about why it is our bodies don't fare well when we can't pull ourselves together during difficult times. Dr. Yancura found lower levels of HDL ("good" cholesterol) in hostile men who didn't cope well and higher levels of HDL for those who used positive coping strategies. Apparently the hostile men who didn't cope effectively, tended to perceive problems as "stressful" and reacted with anger towards others. They were self-critical and distant.

The value of HDL cannot be underestimated, If successful coping will help to raise the amount of protection afforded your cardiovascular system - any effort made to cope well will be more than worthwhile. A few suggestions…

…when you feel troubled, a first step might be to find quiet time. Take a long drive. Walk in the woods or park for an hour. Time alone stimulates your imagination. Solitude allows you to think of options, allows you to make plans and toy with ideas that don't seem to come when your mind is busy.

…emphasize the benefits or positive elements of the problem you face. The best of who we are shines through in the worst of times.

…try to see the negative aspects of your problem in a different light. Maybe the worry you're feeling is the feedback you need to tell you it's time to do things differently.

…separate the elements of your problem - those you can change and those you can accept. With acceptance comes relief.

…express your hurt, your worry, your sadness. This doesn't mean "venting" - venting can make us feel worse and is not an effective coping practice. Talking about how you feel can soften the heart, bring you closer to others, and let you see your strengths more clearly.

Getting to the heart of the matter…coping well means better health and longer life. You can do this.

We cope more successfully when we remind ourselves that the passing of time can do wonders. With time we know more. With time we have the opportunity to find solutions - solutions that can only come when our minds have time to incubate. That might mean as little as the 7 or 8 hours allotted to a night’s sleep. According to a recent New York Times article (May, 2007), "Sleep appears to play a role in helping people make big picture realizations". Dr. Jeffrey M. Ellenbogen of Brigham and Women’s Hospital in Boston reports that during sleep "brains may be sorting out information... making connections that can lead to new insights". A rested mind is less fragmented, more confident (and a rested heart may beat longer!). Rather than trying to force an outcome, rather than pushing too hard to solve a problem, trust the value of time and let your resting mind do the work. The answers will come.

We don’t always want to be sure. Ellen Langer says that "When we are fully engaged in our work, just as we are when we’re at play, we seek novelty rather than certainty." She adds that "Uncertainty keeps us situated in the present." How true. The scientist studying animal behavior may embark on his investigation with complete uncertainty using mindfulness to his advantage - never missing a detail. Walking down the street in an unfamiliar town, heightened awareness triggered by uncertainty may prevent you from getting lost. Without absolute certainty about how a long awaited picnic will go, you may be thrilled when the outdoor setting turns out to be far more beautiful than you had imagined and predicted rain showers fail to materialize - you’re in the present, you’re aware, the day in unpredictable - and that’s just fine!

Yes, there are times when novelty is welcome. Still, we’re motivated by an underlying desire for control. In his book "Stumbling on Happiness" psychologist, Daniel Gilbert, tells us that we actually like to "exercise" control. He states - "Being effective - changing things, influencing things, making things happen - is one of the fundamental needs with which human brains seem to be naturally endowed".our behavior from infancy onward is simply an expression of this penchant for control." Gilbert reminds us that when we lose our ability to control things we become "unhappy, helpless, hopeless, and depressed." Diagnosed with heart disease, an individual’s ideas about control can be dramatically shaken. In this case, you don’t want "novelty" - you want to know. You want to know if you’ll work again. You want to know that you’ll be able to live independently. You want to live. You want to know that you will live! The personal control you thought you had has been replaced with uncertainty. Before jumping to conclusions - gather information. Ask questions. If information you’ve been given is unclear - ask for clarification. Uncertainty may keep us situated in the present, but when it’s coupled with worry, it can throw us into an uncertain future. Avoid predicting the worst. Positive health outcomes are closely aligned with positive expectations. Create goals. Think about where you are, where you want to be, and how you’ll get there. If you can do these things…have you truly lost control? Perhaps not.

Topic: CPR

A recent study done in Japan and published in the March 17th issue of The Lancet found that for bystander (witnessed) cardiopulmonary resuscitation (CPR), chest compressions alone proved better than chest compressions with mouth to mouth breathing (the traditional method of CPR). The researchers found that performing any type of CPR was, of course, better than none, but people who received chest compressions alone had better neurological (brain) function. It is thought that when a bystander witnesses a cardiac arrest, the victim's body at this point is filled with oxygenated blood, and chest compressions will circulate this blood to the brain and other vital organs. The idea is to buy time until help arrives and a defibrillator can restore a normal rhythm to the heart. Proponents of chest compression only CPR (or continuous chest compressions, CCC-CPR), believe that it may encourage more bystanders to perform CPR. Some people may not perform CPR because they do not want to do mouth-to-mouth breathing. Others may not remember the sequence of ventilations to chest compressions and fear they may do it wrong. By simplifying CPR to chest compressions only, more bystanders may be spurred into action.

Topic: Depression/Stress

We hear again and again about how adversity contributes to the development of resilience and personal growth. Although true, it is also true that when adversity persists over time with little or no improvement in conditions of health or environment, individuals may begin to feel weakened, unable to rise above their burdens. We can’t predict when a “threshold” is reached. We can’t say just exactly when the difficulties of life stop being “character builders” and instead contribute to a deterioration of health. Helplessness and despair may set the stage for inflammation, damaging turbulence within artery walls, and suppression of immune function. Listen to your body. If the stressful conditions of your life have been going on for too long, pay attention to the way you’re feeling. If you have more aches and pains than “usual”, if you always feel as if you’re “getting a cold”, if minor wounds don’t heal as quickly as they normally would, if you’re irritable, or sleep patterns or appetite have changed – these may be signs of emotional and physical overload – un"named", unrecognized by you - this may be depression. It’s imperative that you discuss this with your general practitioner or cardiologist. Hearing your health care provider “name” what it is you’re feeling may be the first step towards lifting this “burden” – reawakening the possibilities of hope and vitality – clearing the path for “growth”.

Topic: Depression

If lately you’ve been feeling “blue” or “down”, you may be depressed. Health practitioners measure types of “clinical depression” using a diagnostic manual that outlines symptoms to look for as a way to accurately interpret what is observed. The greater the number of matching symptoms, the greater the diagnostic certainty. Without a doubt, manuals are useful. They offer caregivers a common language and help to increase confidence in treatment choices – but in the end, people’s emotions don’t always fall into the clear and absolute guidelines of a manual. With one symptom – feeling sad - you would fall far short of what’s required to indicate true “depression”, but that doesn’t mean you’re out of the woods – that doesn’t mean you can ignore the way you feel. Chronic sadness – all by itself - may have a significant and negative impact on the health of your heart.

Sadness interferes with motivation. You might glance at the bottle of medication you’ve been given for hypertension and not “feel like” taking it. You may put off making a needed follow-up visit to the doctor. Exercise seems like so much effort. Quality of sleep may be poor. Immune function may decline. Inflammation may increase. At TheGoodheart we recommend that if this is the way you’ve been feeling, talk to your doctor or therapist as quickly as possible. Treatment for depression works.

One of the first things your doctor may ask you to do is be more active. If you’ve been “dragging” around, barely able to do what you need to do, you might exit the doctor’s office feeling misunderstood – “he doesn’t get it”. Actually your doctor has just given you the best possible prescription – movement. You don’t have to “feel” like doing something to do it – taking a walk requires legwork – not “feeling” work. Start small. Walk for five minutes. If it’s hard to get out – make a list of easy to do activities you can do at home. Stretch, call a friend, sketch the tree you see every day as you look out your window. Clean out your briefcase or purse. Polish your shoes. Ride your stationary bike for three minutes. Buy beads and try to make something. Find a gallery in your area and look at someone’s art. Rake leaves. Trim a tree. Move. Action is one of the fastest and most reliable ways to lift mood. With action comes motivation – with motivation comes hope. Your heart does so much for you and asks so little.

Depression is a serious matter. It may contribute to the development of heart disease. It may lead to medical complications following a heart attack or coronary artery bypass surgery. Cognitive-behavioral treatment is highly effective for the treatment of depression, equally as effective as antidepressant medication. Many scientists and physicians believe that therapy and medication combined promise the best possible outcome. If depression is in some way “causative” when it comes to the progression of heart disease, or interfering when it comes to recovery, we would expect that successful treatment of depression would lead to a reduction in complications and recurrences of cardiac events – impacting positively on survival rates. To date, there are no studies suggesting that it makes a difference. We offer a few possible explanations for this unsolved mystery...

--- Waiting too long before seeking treatment for depression may mean a limiting of what might be accomplished once severe vascular damage has occurred.

--- If time spent in therapy is too short (as might be the case in a research study) true “change” might not take place. A patient may have a new “understanding” of the way they think and process information, yet cling to long and deeply-held beliefs about themselves and the world they live in - beliefs that interfere with commitment and persistence towards good health practices (e.g., exercise, taking medications as prescribed, eating well) and maintain perceptions leading to unhealthy levels of arousal.

--- A reduction in the frequency and intensity of negative feelings does not necessarily mean an increase in heart-protective positive feelings. If what is achieved in treatment for depression means no longer crying, no longer feeling sad, and no longer feeling irritable – that may not be enough. Perhaps improvement starts when we begin to experience joy, when we’re able to laugh, when we see ourselves engaged in life – when we live-fully and know what people are talking about when they use the term “well-being”.

If you think you may be depressed - please get help. Don’t wait until after you’ve been diagnosed with heart disease. At TheGoodheart, we never say “it’s too late”- where there’s life there’s hope – still, the longer you wait the more complicated and dangerous things become. Depression is a very serious matter.

There is growing clarity regarding the risks and underlying mechanisms associated with depression and heart disease. This is not a surprise to anyone who's ever experienced a bout of depression. If you were to ask them where their sadness was "felt", a gesturing hand held to the chest, tells the story. Depression sends the body into a downward spiral with the same constriction of blood vessels, rise in blood pressure, increased levels of unhealthy fats in the bloodstream, and turbulence within artery walls, experienced by the hostile, the anxious, or the fearful man. Personal habits begin to deteriorate as the depressed individual grows more withdrawn and less active. Memory fails, concentration and attention are poor, and a "rational" inner dialogue needed to lift the depressed individual up and out of despair may be impossible to muster. This may be the time for action, more than thought. "There is support for a causal link between physical activity and reduced clinically defined depression" is a statement of confidence we applaud and support (Biddle et al., 2000). If you've been diagnosed with heart disease while experiencing depression, the risk of a cardiac "event" or need for life-saving procedure (heart attack, angioplasty) is far more significant than with a diagnosis of heart disease alone. If you're sad much of the time, if you cry easily, or you've lost interest in activities that normally would give you pleasure - please discuss this with your primary care physician and cardiologist this week. That first five-minute walk can offer the promise of a brighter future with improved mood, better quality-of-life, and a greater sense of well-being! You are so worth it! Please don't wait.

Feeling inadequate, withdrawing socially, brooding, fearing rejection, irritability, and being in a "bad mood" much of the time may be signs of chronic depression or an "avoidant" personality style, or both. Recent studies support the idea that socially inept, chronic complainers, those living in a state of distress ("Type D"), may be at greater risk for heart disease than the hard-driving, time-urgent, aggressive individuals (Type A) previously considered. This seems reasonable. Distancing themselves from others, Type D's may be deprived of needed support. It's widely known that isolation increases the risk of death in the first year following a heart attack. Reluctant to engage in new activities, Type D's may fail to secure valuable health related information. Low mood may limit the desire to eat well and interfere with plans to exercise. The socially "comfortable" Type A is more likely to join a cardiac rehabilitation program or support group. Rather than avoiding people and situations, the Type A might show a dogged determination to take charge and advantage of anything and everything promising optimal health and speedy recovery. Whatever "type" you may be or if you're no "type" at all, a middle road might serve you well. You needn't be aggressive, but do take advantage of whatever support is available. You may never become a true optimist, but do make an effort to replace damaging negative thoughts by paying attention to what's going well in your life. Even if you're not socially at ease, make an effort to be with others. Focus outward towards the people you're with rather than inward towards yourself and your discomfort. Plan to "complain" as much as you like for one full hour each day. The rest of the day when a complaint comes to mind, tell yourself it's to be thought about at the appointed hour - and only then. Somewhere between an "A" and a "D" - let there be a "Y" - you.

Depressed patients have been known to report feeling better the moment their physician hands them a prescription for an antidepressant - before they've taken a first dose. When asked why this might be, the reason given seems to involve a return of hope. Current theory (Snyder, Rand, & Sigmon, 2002) expands the original definition of hope from "a perception that one's goals can be attained" to "one can find pathways to desired goals and become motivated to use those pathways." Maintaining or recovering health always involves goal-setting and finding the necessary "pathways" to attain the desired outcome. A core element of depression, hopelessness, often triggers the thought, "No matter what I do, things won't get better", with the phrase, "No matter what I do..." reflecting chronic despair. A lack of drive is heard in the phrase, "I don't feel like exercising - so I won't." Hope may drive motivation but action precedes motivation - don't wait to "feel" like exercising before you take action. Exercise first - hope and motivation will join you.

A study monitoring participants free of heart disease found that those with a history of depression were four times more likely than those without depression to have a heart attack at some time over a 14-year period. Depression doesn’t have to be severe to interfere with heart health. Feeling “blue”, “teary”, or “sad”, is enough to lead to cardiovascular complications. Please, take a moment to talk to someone. Support from those around you is a powerful antidote to depression. Notice how you feel after you sit with a neighbor or friend for a while and, “just talk”.
Depression is frequently underdiagnosed and undertreated in patients with cardiovascular disease. If you're feeling sad much of the time, this may be a sign of depression. If you're feeling fatigued much of the time, this too, may be a sign of depression. Please don't assume this is a "normal" part of your heart health. Ask your primary care physician, cardiologist, or therapist about the feelings you're having. In the meantime, plan to do something today that is pleasing to you. Listen to music you like, look at something beautiful, fix something, rent a funny movie, go for a walk, call someone and share your day. If you're up to it, figure out something kind that you can do for someone. Count five things that you feel grateful for, no matter how small they might be.
Aproximately 20% of persons with heart disease suffer from major depression while another 20% experience a milder form of depression. Both major and mild depression have been associated with an increased number of complications following a cardiac event. If there is a day when you're feeling a bit better than others, make a list of activities that please you -- a list that correlates with what you're able to do physically. On a day when you're down or sad, choose one or two of those activities on your list and try to carry them out. Measure your mood before you do the activity on a 1-10 scale, then, re-measure your mood after you've finished it; see if there is any change in the way you feel. Your daily mood has so much to do with your recovery -- see what you can do to take charge of your mood.
If you're depressed, there may be an increase in blood levels of stress hormones, which can trigger the "fight or flight" response. This response is associated with increased heart rate, constriction of blood vessels, elevated blood fats, and an increase in blood pressure -- conditions that may lead to damage to the cardiovascular system and a reduction in the availability of a healthy immune response. Generally, depression responds better to action rather than thought. If you can find the smallest action or activity -- repair something, improve something, take a walk, give your dog a bath, go to the gym, prepare an attractive breakfast, stretch as you listen to music, meet a friend for coffee -- any simple, small action may lead to another simple, small action and so it goes. Move when you're down. For the health and safety of your heart, please let your doctor know when you're feeling "blue."

Topic: Diabetes and Heart Disease

Most people know that diabetes is a risk factor for heart disease, but what researchers found in a recent study published in the August 25th issue of The Lancet, is that after a heart attack there is an increased risk for patients to develop diabetes or impaired fasting glucose (blood sugar). Looking at more than 8000 men and women who have suffered a recent heart attack for a period of five years, the researchers noted that 33% of the patients developed diabetes or impaired fasting glucose, as compared with less than 2% in the general population. When comparing the lifestyle habits of those who developed diabetes to those who did not, there were no surprises. The researchers found that increased weight and BMI (body mass index) was associated with increased risk, as was eating less fruits and vegetables, fish and olive oil. Low levels of physical activity was also identified as putting post heart attack patients at higher risk for developing diabetes. This interesting study reinforces the importance of positive lifestyle habits for those with a history of coronary heart disease in helping to not only prevent a reoccurrence of a heart problem, but also in preventing new onset diabetes or fasting glucose impairment.

Topic: Emergency Care

A true story: a group of patients in a cardiac rehab program listened in awe to a fellow patient describe how her life was saved by her co-workers who “shocked” her with a recently purchased AED (Automatic External Defibrillator) in her office.

At the 2007 American Heart Association Scientific Sessions a review of out-of-hospital cardiac arrests showed a significant increase in survival that has occurred in the community with publically available AED’s. When a person suffers a cardiac arrest, the heart goes into “ventricular fibrillation” where it virtually stops beating effectively, and blood and oxygen cannot be pumped throughout the body. The only way to restore a normal rhythm is to “shock” the heart using a defibrillator. More and more these simple to use, very smart AED’s (which shock the heart automatically if needed) are available in various settings in the community (workplaces, restaurants, malls, fitness facilities).

According to the Medscape.com review article, what the reviewers found was that for patients who received bystander CPR followed by defibrillation (“shock”) by EMS when they arrived at the scene, the survival rate was 15%. If a bystander did CPR and then shocked the person using a community placed AED, the survival rate was 36%.

What can we do to increase the survival rate even more? Take a CPR course that includes using an AED. Although simple to use, it would be better to make yourself familiar with it before you ever have to use it. When you go to a public place like a restaurant or mall, look for signage of an AED on site. If there isn’t one, encourage the owner to purchase one. The more AED’s available, the more opportunity for a life to be saved.

A recent study of over 1200 people in rural Minnesota found that only 37% of men compared with 49% of women called 911 when experiencing a heart attack. What is most important here (although the gender differences are interesting), is that over half of the people did not call an ambulance to take them to the hospital. Although the reasons for this are varied (denial, embarrassment, not sure what the symptoms are, etc.), this decision can have a negative effect on your heart and your life. There has been much improvement in heart attack care. There is an emphasis on speed of “door to treatment” care, improving the time within which a person having a heart attack receives treatment. Some ambulances can transmit an electrocardiogram to the physician at the hospital, and then begin treatment while riding to the emergency room. Some patients are now able to go directly from the ambulance to the cardiac catheterization laboratory for an angioplasty. And almost always, the time it takes to get to the hospital is significantly reduced. The faster the clot in your artery is cleared, the quicker blood and oxygen can be restored to that area of your heart that was blocked from the heart attack. And don’t discount the 5% who suffer a cardiac arrest and are defibrillated and have a normal heart beat return while on the way to the hospital in the ambulance. Although the percentage of men and women in the study who were located in urban areas called 911 more often than those in the rural areas (65% for both men and women), there was still a significant number who did not. The point is, if you think you are having a heart attack, call 911 immediately, swallow or chew a whole aspirin, and expert help will arrive before you know it.

Topic: Exercise

A review of pedometer use, published in the November 11, 2007 issue of the Journal of the American Medical Association, showed some very positive results. Looking at a total of 26 studies with almost 2800 participants, three major positive changes emerged:
- Using a pedometer significantly increased physical activity. On average, participants increased their number of steps by over 2000/day, or almost 30%.
What a relatively simple, inexpensive way to make some lifestyle changes that can significantly improve your health! One important consideration, however, is that the researchers found that improvement only occurred if you set goals for the pedometer use. (For example, setting a goal for increasing the number of steps you take by 200 each week until reaching 10,000 steps/day.) Another way to ensure improvement was keeping a daily log. So however you decide to do it, purchasing and using a pedometer can help you achieve some positive changes in your life, in a simple easy to do manner. And, how about giving a pedometer as a holiday gift to someone you love?

Information on why exercise has a beneficial effect on cardiovascular disease may be more clearly explained by a recent study published online October 22nd in Circulation. Using the data from the Women’s Health Study, the researchers found that almost 60% of the positive effects of exercise was explained by the effect it has on known risk factors, but one half of that was the effect on inflammation. It addition to looking at several risk factors (hypertension, weight, diabetes, cholesterol, etc.), inflammatory markers like C-reactive protein (CRP) were also measured. The researchers point out that, interestingly, although a single bout of exercise led to a transient increase in inflammation, regular physical activity was associated with a consistent anti-inflammatory effect.

Once again as in other studies, this study showed that increasing levels of physical activity was associated with decreasing incidence of cardiovascular disease. Even moderate levels of exercise had a positive effect on risk factors, especially those related to inflammation and secondarily to blood pressure. Again and again, evidence indicates how important it is to make regular physical activity a part of our life. But remember, before beginning any program of regular exercise, talk with your doctor.

Some new evidence suggests that exercise that involves "interval training" may be better than longer bouts of continuous activity, even for those who have heart disease. Interval training is a form of exercise that involves alternating periods of more intense exercise with periods of lesser intense activity or rest. (Athletes have been doing this type of exercise for a long time.) What is so positive about interval training is that it allows an exerciser who could not do a continuous stretch of a more intense activity for a certain period of time actually spend more time doing it! For example, a person who could not jog for 5 minutes straight could probably jog for a total of 6-7 minutes if the person alternated jogging for 1 minute with walking for 3 or 4 minutes for a total of 30-40 minutes. According to the Harvard Heart Letter (October 2007,www.health.harvard.edu) interval training may be promoting certain changes to occur in the body helping to create new muscle fibers, burn fat more efficiently, promote growth of new blood vessels, make blood vessels more flexible, increase the body's ability to defend against harmful antioxidants, and decrease inflammation.

The Harvard Heart Letter suggests some guidelines for interval training. You can go by how you feel changing your workout pattern each day, or you can make it more consistent. Your short bursts of exercise should be hard enough that you are out of breath, and your rest or periods of less intense exercise should be long enough so that you are ready to do the more intense exercise once again, but not so long that you are back to your pre-exercise level. An example of a program of interval training can be: warm-up for 5 minutes; walk very briskly or jog for 1 minute; walk at your exercise walking pace or a little slower for 3-4 minutes, then walk briskly or jog for 1 minute again. Repeat the walk - walk briskly/jog - walk again cycle for a period of 30 minutes or more. And of course, always cool down for at least 5 minutes at the end of your exercise session. You will be using more calories than if you walked at your usual exercise pace for the entire time, and you are getting all those other positive benefits that help your heart. But remember, interval training may not be for you. Be sure to check with your doctor or health care professional before starting a program of interval training or any exercise program.

The American College of Sports Medicine and the American Heart Association have now updated the 1995 guidelines for exercise for (1) healthy adults under age 65 and (2) adults over 65 or adults 50-64 with chronic medical conditions, such as heart disease. Here are the highlights of the guidelines for adults over 65 or adults 50-64 with chronic medical conditions:
1. Do moderately intense aerobic exercise at least 30 minutes a day, 5 days a week or vigorously intense aerobic exercise at least 20 minutes a day, 3 days a week.
  - Moderately intense means working at about a level 5-6 on a 10 point scale and you should see a noticeable increase in heart rate and breathing; vigorously intense is 7-8 on the 10 point scale (0 equals sitting and 10 is an "all out effort").
  - Depending on your fitness level, for some, moderately intense may mean a slow walk, for others it may be walking briskly.
  - If you can exercise more than 30 minutes, go ahead! By doing more, you can improve your fitness level further, and may improve management of your medical condition and decrease your risk for other health problems.
  - Moderately intense exercise can be performed in at least 10 minute increments accumulating 30 minutes in a day.
  - This activity is in addition to routine activities (housekeeping, shopping) or moderate activities that are less than 10 minutes in duration.
2. Do resistance training to increase muscular strength and endurance: 8-10 strength training exercises, 10-15 repetitions each, on 2-3 non-consecutive days a week.
  - Use a weight that allows 10-15 reps for each exercise
  - The level of effort should be moderate to high. Moderate is 5-6 on a 10 point scale and high intensity is 7-8 (0 = no movement; 10 = maximum effort).
3. Do flexibility exercises: stretch the major muscle groups, 10-20 seconds each stretch. Repeat each stretch 3-4 times.
  - Perform stretching exercises at least 2 days a week (preferable all days you do aerobic or resistance exercises) for 10 minutes.
4. If you are at risk for falling, perform balance exercises.
5. If you have a medical condition for which physical activity is therapeutic, perform the activity in the manner that effectively and safely treats the condition.
6. If you have a chronic condition that does not allow you to exercise at the minimal recommended levels, try to engage in regular physical activity according your ability, to avoid being sedentary.
7. Have a physical activity plan - how to obtain sufficient physical activity for each recommended type of activity.
For more information, or to read the recommendations in its entirety, go to the American College of Sports Medicine’s website, acsm.org. And please remember, before beginning any program of regular physical activity, talk to your doctor.

A recent study published in the Journal of the American Medical Association this month, found that even a small amount of physical activity can improve fitness levels in sedentary people. What this study showed was that with even just 75 minutes of moderate intensity exercise per week (like walking or cycling), sedentary individuals became more fit. When compared with the group of non-exercisers, there was a significant improvement in fitness. The researchers divided their study participants into 3 groups of increasing levels of activity. They noted there was a "dose-response", that is, the more exercise someone did, the more fit they became. Although 75 minutes is less than what is currently recommended (30-90 minutes on most days of the week), it is heartening to know that improvements can be realized with less. The participants stuck with their exercise program, probably because they felt this amount of exercise was realistic and achievable. (Self efficacy, which is the confidence or belief in the ability to perform a given desired behavior, has been shown to be a good predictor of adherence to an exercise regimen.) So, if you are a couch potato, take heart! Start with just a few minutes of exercise a day. As you feel stronger, you may decide to increase the time you are devoting to physical activity. But remember, always check with your doctor before beginning an exercise program.

As you get older, your tendency to take a tumble increases. People who have been active all their lives and continue to be so in their later years have better balance, and therefore, less falls than those who are inactive. A recent French study looked at how physical activity affects balance by having those who participated in the study undergo the Sensory Organization Test that evaluates how well people use their senses to maintain balance and equilibrium under different conditions.

The results of the study, published in the International Journal of Sports Medicine, found that regular exercise, like walking, improved both strength and balance. Those individuals who were always active and remained so had the highest scores, and those who were inactive had the lowest. Even those who were once active but no longer exercised did not score well. But the most promising and encouraging findings was that individuals who were sedentary all their lives but started exercising after retirement, scored almost as well as those who were active throughout their lives. The important message here is that it is never too late to start! Again, regular physical activity proves its worth! But please remember, before beginning a program of regular exercise, check with your doctor first.

A recent study on obese men found that those who were moderately or very fit had a 70% lower mortality rate than unfit obese men, and actually fitness level had a greater impact on mortality than weight did. Of course exercising and losing weight would be the most beneficial to your health, but even if you do remain overweight, becoming more fit can help you live longer. Remember, always check with your doctor before beginning an exercise program.

Here’s another good reason to exercise on a regular basis. Many studies have shown that aerobic exercise (walking, bicycling, etc.), which we all know enhances cardiovascular fitness, also helps older people stay sharp and improve problem-solving skills and other mental abilities. The American Heart Association recommends at least thirty minutes of moderate exercise on most days of the week – for your heart and your mind! Be sure to check with your doctor before starting an exercise program.

Although your metabolic rate, (the rate at which your body uses calories), to a large extent, cannot be changed, you may be able to boost it a bit. Metabolic rate depends on many factors that you can’t change – age (it tends to decrease as we get older), your sex (men tend to have higher rates), and genes. But exercising regularly may help increase your metabolic rate, at least temporarily. And having more muscle and less fat can also increase your rate, even at rest. Be sure to check with your doctor before starting an exercise program.
Several recently published studies support the notion that doing whatever you can to burn more calories every day helps not only your heart and blood vessels, but helps you live longer and with less pain. Even doing little things throughout the day is beneficial. Walk the dog, climb stairs, sweep your sidewalk, go square dancing, etc. - even little bits of activity during your day can help.
Strength (resistance) training should be a part of your regular exercise program. Enhancing muscular strength and endurance allows you to perform everyday tasks with less physical stress and helps maintain functional independence. The stronger you are, the less stress there is to your cardiovascular system when you lift, hold, or carry something. Be sure to check with your doctor before beginning a strength-training program. If possible, work with an exercise specialist or personal trainer when you first begin to help ensure you are performing the exercises correctly.

Resistance exercises can be done using elastic bands, hand-held weights (dumb bells), or various types of weight machines. You should perform one set of 8-15 repetitions of 6-10 exercises involving the major muscle groups. (An additional set may be added, but any additional gains will not be proportional.) You should do resistance training 2-3 days per week, on non-consecutive days. Be sure to warm up before doing strength-training exercises, or do them after the aerobic part of your program.

Start with a weight that is comfortable. Do 8 repetitions of a particular exercise, and, over time, gradually increase the number of repetitions to 15. After time, if the weight begins to feel too easy after performing 15 repetitions, you may want to increase the amount of weight to the next level.

Weight training exercises should be done slowly. Try counting "one, two" on exertion, and "one, two, three" on release. Do not hold your breath. Maintain a normal breathing pattern.
Starting a walking program is a great way to help modify feelings of anger, stress and impatience!

If you would like to start a walking program, purchasing a pedometer may be helpful and motivating. Start your program by walking about 4,000 steps every day. Each week, try to increase the amount of steps you walk daily by 200. This will help you gradually increase the amount of walking you are doing. Ultimately, if possible, work up to a goal of 10,000 steps/day. Remember, when you wear a pedometer, you'll be counting all the steps you take, even when you are just doing tasks around the house. You'll see -- it adds up!
Another way to begin a walking program is to start by walking 5-10 minutes every day. Then try to add 5 more minutes to your daily walk every week, until you're walking about 30-60 minutes every day. Remember, you don't have to do the whole hour all at once. You can do 5 minutes here, a 15-minute walk later, 10 minutes another time, etc. As long as it adds up to 30-60 minutes every day.

Topic: Hypertension

In previous weekly tips, the Goodheart.com discussed the importance of controlling hypertension, and of starting to make lifestyle changes to reduce your blood pressure if it is in the “pre-hypertension” range of 120-139/80-90 (see www.thegoodheart.com; Weekly Tips: Previous). In an editorial and seminar articles appearing in the August 18th issue of the Lancet, the authors say that hypertension is “uncontrolled and conquering the world” as it is anticipated that 1.5 billion people will be hypertensive by the year 2025, and the risk for someone becoming hypertensive is 90%. The editorial and follow-up articles point out that many people still believe that high blood pressure can be cured (as opposed to controlled), and that you can stop taking your medication when it is in the normal range. (Even President Bill Clinton believed this!)

Diagnosing high blood pressure is a simple matter – just have your blood pressure checked periodically. It is important to get the numbers under control before “target-organ damage” can occur (to your heart, kidneys, eyes, etc.). And once it is diagnosed, and an effective treatment has been started, be sure to continue to take your medications and to make certain lifestyle changes (e.g. decreasing your salt intake) even after your blood pressure is within normal limits.
In another related article published in the August 22/29 issue of the Journal of the American Medical Association, the authors discussed that hypertension is now increasing in children and adolescents as obesity is on the rise, but can go undiagnosed. So be sure your pediatrician pays attention to your child’s or grandchild’s blood pressure when having a physical exam.

Another reason to throw away your salt shaker! Almost everyone knows that eating foods high in salt and sprinkling salt liberally onto your french fries can raise your blood pressure. And decreasing salt in your diet can lower blood pressure and prevent hypertension. But interestingly, in a recently reported study, researchers contacted subjects who had participated in two randomized trials that had looked at the effects of decreasing salt on hypertension 10-15 years after the study was completed, and determined the amount of cardiovascular events experienced by the participants. The findings showed that those who decreased their salt intake reduced their risk of a heart problem by 25-30%. The researchers thought that in addition to increasing blood pressure, salt may decrease the flexibility of blood vessels and increase myocardial (heart muscle) fibrosis (scarring), and increase the size of the heart. So even if you don't have high blood pressure, here is a relatively simple way to decrease your cardiovascular risk. The American Heart Association recommends we limit our salt intake to 2300 milligrams, less than one teaspoon/day. (If you have heart failure, you should reduce your salt intake to less than 2000 milligrams/day) Throw away your salt shaker! Read food labels at the supermarket to determine the sodium (salt) content of food, and select the low salt options of food choices. Go on line to www.nhlbi.nh.gov and www.americanheart.org for more information. You will see that your preference for salt actually decreases after just three months on a low salt diet!

In the general population, an individual is said to have hypertension, or high blood pressure, when blood pressure is 140/90 or above (either number can be elevated for a diagnosis to be made). Normal blood pressure is less than 120/80 (both numbers). But blood pressure measurements in between those numbers (120-139/80-89), called prehypertension, may have taken on more significance than formally realized. In a study published in the May issue of the American Journal of Hypertension, the researchers found that cardiovascular risk was almost the same in people who progressed from normal blood pressure to prehypertension (particularly in the higher readings of 130-139/85-89), as those with sustained, long-standing hypertension or the higher levels of prehypertension. What does this mean to us? It indicates that if you have blood pressure readings in the prehypertension stage, get busy! Try to incorporate some lifestyle changes that may help reduce your blood pressure to normal range, such as regular exercise, weight loss, decreasing salt in your diet and some relaxation techniques. Work with your health care provider to achieve your blood pressure goals. Although medications are not usually prescribed for prehypertension, under certain circumstances there may be some compelling indications to add pharmacological intervention in addition to life style modifications. One additional comment. People with diabetes or chronic kidney disease have different blood pressure goals and should work closely with their physicians to achieve them.

Does a cup of delicious hot cocoa sound tempting to you? Well maybe not now with the warm weather upon us, but perhaps when the weather turns chilly once again. And the good news about hot chocolate (could there be more good news in addition to the wonderful taste?) is that it may actually lower blood pressure. In a study published in the April 9th issue of Archives of Internal Medicine, the researchers conducted a literature search of previously published studies and compared blood pressure lowering effects of cocoa to black and green tea. Both cocoa and tea are rich in the group of antioxidants called polyphenols, but the type of polyphenol in cocoa (procyanidins) differs from that in tea, and seems to have a positive effect on blood vessels, lowering blood pressure. The participants in the study drank flavonol-rich cocoa (240-480 kilocalories/day) every day for a median of two weeks, and tea consumption was 4-6 cups a day for a median of four weeks. Both groups were compared to control subjects. In the groups that drank cocoa, their systolic blood pressure (the top number) dropped an average of 4.7 mm Hg, and their diastolic blood pressure (the bottom number) decreased an average of 2.8 points. Blood pressure in the tea drinking group was not reduced. Keeping in mind the calories in a cup of cocoa, when you are giving yourself a treat, you may want to consider substituting a cup of cocoa or other polyphenol- rich foods like dark chocolate for other high fat, high calorie desserts.

Be sure to have your blood pressure checked periodically. One of the major risk factors that contribute to coronary artery disease is high blood pressure. If you have not been diagnosed with high blood pressure and your systolic blood pressure (the "top number") is running 120-139, or your diastolic blood pressure (the "lower number") is between 80-89, that is considered pre-hypertension. Try to make some lifestyle changes that may help to lower your blood pressure, including regular exercise such as walking (check with you doctor first), eating less salt (sodium) and losing weight if you're overweight. If you have been diagnosed with high blood pressure and are taking medications to control it, be sure to continue taking your medications as prescribed.
Whether or not you're taking medication for high blood pressure, experiencing more positive emotions may help you maintain or improve your numbers. In a study of men and women over 65 who were guided in raising the amount of positive feelings in their lives, those not taking antihypertensive medications were successful in lowering both systolic (upper number) and diastolic pressure (lower number). Even those on medication found that increasing positive emotions had a health benefit. Their diastolic (unfortunately, not systolic) pressure was lowered. Each morning this week choose one positive word to focus on. As you drive to work, or walk your dog, or pick up the newspaper, or plan your day at the office - think about the word you've chosen - repeat the word, play with the word in your mind. See what results. See if focusing on a positive word has the effect of guiding your attitude for the day. Good choices: Humor, patience, joy, acceptance, curiosity, excitement, hope.

Topic: Kind Acts; Positive Behaviors

Intense aggression can place tremendous stress on the cardiovascular system. Facing physical harm, aggression may be the instinctive - life-saving - response that helps us externalize a threat. Day-to-day most "threats" are social, rather than physical - related to status, wealth, attractiveness, and possessions. The promotion you don't get, the friend who takes forever to return your calls, the neighbor whose car is newer, bigger than yours, the co-worker who looks better than you do, the colleague who's decidedly smarter, the old friend who's earning ten times more than you'll ever earn, and the sales clerk who ignores you…all circumstances that might lead to feelings of threat - threat that may not cause you to behave aggressively, but may certainly elicit aggressive "thinking". Behaving aggressively or "thinking" aggressively - either way, the brain gets the same message and the body responds - ready to go to battle - vigilant - blood pressure up, vessels constricted, heart pumping hard and fast - the personal slight is the threat.

Practicing a new attitude, a new way of thinking, can help you succeed in having the calm, stress-buffering response you prefer - the response that lets you feel a sense of competence - "in charge" of the way you think. You want more out of life in order to achieve happiness. Well, everybody else wants pretty much the same thing. As you observe others in their quest for the good life, you can continue to focus on how diminished you think you are, how "less-than" you are - or…realizing how similar we all may be, respond with greater generosity and compassion.

Feeling genuinely good about your neighbor's success, may lead to a positive emotional state without a new car - and your good feelings will last longer than they would - getting a new car (bursts of happiness related to acquiring a new car or winning the lottery are short-lived and not found to increase overall levels of happiness or well-being). When you think about how difficult it might be to do the job of the store clerk, facing demanding customers all day - you may feel compassion rather than annoyance when service is less than perfect.

If you're in the habit of responding aggressively - with irritability, frustration, negative judgment, and annoyance - changing your habit will take time and require repetition and persistence. And…no matter how determined you are to change - there will be days when you "slip" back to old, "over-learned" patterns. In those moments - show yourself a little compassion - let it go - be grateful for the opportunity to try again. "Heart-fitness" is the goal.

Topic: Medications

A nice, simple study reported in the September 10th issue of the Archives of Internal Medicine gave us some important information about the risk of not taking your medicines. The researchers asked the participants in the study, all who had a history of heart disease, how often they took their medications. What they found was that those who reported taking their medications 75% of the time or less had more than twice the risk of having another cardiovascular event than those who took their medications most or all of the time. This increased risk is equivalent to having diabetes or smoking. Why not be more compliant with your medicines? This is a risk that can be easily controlled. Be sure you understand why you take a medication, how it can help you, and the negative effects of not taking it. If you tend to be forgetful, use helpful cues to remind yourself to take your medicines, or ask a family member or friend to help you. If you believe a medicine may be causing some uncomfortable side effects, talk to your doctor. Often the side effects may resolve with continuous usage, or your physician may be able to change to another similar medicine that won’t have the same side effects. If your medication is too expensive, again check with your doctor or pharmacist – there often is a less expensive alternative. The bottom line is don’t put yourself at increased risk by not taking your medicines – this is a “risk factor” that you can easily do something about.

The October issue of the Cleveland Clinic's newsletter, Heart Advisor, pointed out in several different articles, how certain medications/vitamins may actually be performing "double duty".
1. Statins, those cholesterol-lowering drugs like Lipitor and Zocor, not only lower your cholesterol level to help prevent heart disease, but a recent study published in the journal, Neurology, has shown that people who have had a stroke and continued to take their statin medication after their stroke, were 4.7 times less likely to die or to be dependent on others for care than those who had stopped taking their medication. Statins also seem to decrease inflammation and help prevent blood from clotting, which can decrease the risk of stroke.
2. We all know that sufficient amounts of vitamin D are necessary to help us absorb calcium which is necessary for bone health. Now research has shown that vitamin D can decrease inflammation, lower blood pressure, and may be directly involved in reducing cholesterol, and thus may reduce your risk of heart disease.
3. The results of a French study presented at the Alzheimer's Association International Conference on Prevention of Dementia in June found that people whose risk factors for heart disease were treated with blood pressure lowering medication, medicines to control diabetes including insulin, a cholesterol-lowering drug, or a blood thinner, showed a slower cognitive decline than those who did not take medicines for their heart.
How nice it is to learn that medications we are taking for one reason may actually help us reduce the risk of, or help control, another medical condition. Just another reason to keep taking our medications as prescribed by our physicians!

Two recently published studies concerning the class of cholesterol-lowering drugs known as statins, reported some interesting results. The researchers concluded in a June 7th article published on-line in Lancet that "statins seem to be a remarkably safe group of drugs when used at their usual doses." They reviewed all papers published between 1985 and 2006 on the safety, side effects and effectiveness of statins. Several studies showed the ability of statins to decrease the risk of cardiovascular death, non-fatal heart attacks, stroke and the need for stents and bypass surgery. The only well-documented side effects associated with taking statins are muscle pain and toxicity, and effects on liver enzymes, both of which are rare at the standard doses.* If a side effect does occur, it usually occurs within six months of starting the statin, or with increasing doses, or with addition of an interacting medicine like gemfibrizol (Lopid).

The second study, published on-line in the July 30th issue of Circulation, looked at the benefits and risks of statin use in those people with very low LDL (low density lipoproteins - the "bad" cholesterol) levels of less than 60 mg/dl. Some people with heart disease who take statins achieve an LDL level less than the intended goal of less than 70, even as low as 50 or 40. Doctors may be unsure of whether to stop treatment - whether or not it was safe for people with such low LDL levels to continue taking their statins. The researchers looked at over 4000 patients taking statins, 60% of them with LDL levels less than 60. In the 2 years of follow-up, not only did the researchers not find any risk associated with very low LDL levels, there was a significant decreased risk in mortality observed in all groups taking statins with a 49% decrease in those with LDL levels less than 40. The authors of the article started joking that "you can’t be too rich, too thin, or have too low a cholesterol level."

*Standard/usual doses: atorvastain (Lipitor) = 10-20mg; fluvastatin (Lescol) = 40-80mg; simvastatin (Zocor) = 20-40mg; pravastatin (Pravachol) = 40mg; rosuvastatin (Crestor) = 10mg; lovastatin (Mevacor) = 40mg

This month, the Harvard Heart Letter published an interesting article on aspirin. Here are a few of the main points. Aspirin is taken to help prevent heart attack or stroke because it keeps blood from clotting as readily as it normally does. The negative side to this is that it can increase the risk of bleeding causing a less common form of stroke (hemorrhagic), or bleeding ulcers in the stomach. Taking aspirin decreases your chance of heart attack or stroke by about 25%. But whether or not you take aspirin depends upon your risk of having a having a cardiovascular event as weighed against the negative side effects of taking it. The recommendations for taking aspirin were summarized in this informative article.
- If you think you are having a heart attack, first call 911, then swallow (or chew) one full (325mg) regular aspirin, or four “baby” aspirin (81mg).
- If you have had a previous heart attack or stroke caused by a clot, or have any other form of cardiovascular disease like angina, blockages in your coronary arteries or peripheral arterial disease, you are at higher risk. It is recommended you take an aspirin every day unless your doctor has told you not to.
- If you are over 40 and have diabetes, both the American Heart Association and the American Diabetes Association recommend you take a low dose aspirin every day. If you are between 30-40, have diabetes and at least one other risk factor (smoking, hypertension, increased cholesterol), it is also recommended.
- For those with kidney disease, and especially if you are on dialysis, the National Kidney Foundation recommends a daily aspirin.
- If you do not have a heart problem, but have one or more risk factors for heart disease (obesity, smoking, hypertension, family history, sedentary, high cholesterol), and are older (>65 for men and >55 for women), then you should probably take a daily aspirin.
Remember, whatever your risk, you should not start taking aspirin without discussing it with your doctor first. Be sure to ask what dose of aspirin is best for you (a regular aspirin – 325 mg, or a lower dose like 81 or 162mg), and whether or not you need to take something to protect your stomach (like Prilosec), as coated aspirin does not really do this.

The Harvard Heart Letter is a monthly publication with many informative articles. For more information on how to subscribe go to www.health.harvard.edu.

And some more good news...
Keep taking your beta blocker (e.g. Coreg, Lopressor, Toprol)! We have known for a while that the class of drugs known as beta blockers can decrease the risk of another heart attack in those who have had one, and can increase survival. In an article published in the Annals of Internal Medicine, researchers analyzed data from four studies and looked at over 1500 patients, most of whom took beta blockers. They noted that those who took beta blockers actually had a decrease in fatty plaque in their coronary arteries when compared with those who did not take beta blockers. Another very good reason to remain compliant with your medication regimen!

The American Heart Association (AHA) has published new guidelines for the use of non-steroidal anti-inflammatory drugs (NSAIDS), like ibuprofen (Advil, Motrin) and COX-2 inhibitors (Celebrex) for people with heart disease or those at high risk for getting it. The AHA's expert panel stated that more studies have shown an increased risk of a cardiovascular event, and thus prompted them to issue the new scientific statement. The panel recommends what is called a "stepwise" approach to treatment of musculoskeletal pain, beginning with such therapies as use of heat or cold, or physical therapy first, before taking any medications. If medication is needed, the AHA suggests trying acetaminophen (Tylenol) or aspirin first. The next steps include trying those NSAIDS with the lowest "COX-2 selectivity", like Naproxen, and if not enough pain relief is achieved, then trying other NSAIDs, with the more selective COX-2 inhibitors as the last choice. The American Heart Association's statement stresses that no matter what medication is used, it should be at the lowest dose necessary to control pain and taken for the shortest period of time possible. If you have musculoskeletal pain that needs medication to get relief, be sure to discuss the choice of medication with your doctor.

A few weeks ago, an article on the front page of the Sunday New York Times described a man in his 40's who had suffered a heart attack a few years previously. His doctor emphasized to him that he must lose weight and exercise, and was actually considering recommending gastric bypass surgery to him. The man got the message and began losing weight and exercising regularly. He was very pleased with his progress, and decided that he could now discontinue taking all his medications since he had lost a considerable amount of weight and was becoming very fit. He was scheduled to see his physician to show him how well he was progressing, but before he was able to keep that appointment, he suffered another serious heart attack and had bypass surgery performed.

The critical message here is how important it is to comply with all aspects of your therapeutic regimen. Lifestyle changes are of utmost importance in preventing a first time event or recurrence of a heart problem. But what also is as important is compliance with your medication regimen. Taking your medicines as prescribed is of vital importance in your treatment plan. Sometimes you may not feel any better, but the medicines are helping (for example if your blood pressure was 160/90 before taking medications and is now 110/70 while taking them, you probably will feel no differently). And stopping some medications abruptly (like beta blockers) can have very serious consequences. If you are having some discomforting symptoms that you think may be due to a medication you are taking, be sure to talk with your doctor before stopping it. If you cannot afford a medicine, talk with your doctor or pharmacist about a less expensive possibility. And set up some cues that will help you to remember to take your medications (like placing them next to your coffee pot), and for helping you remember to refill your prescription before you are completely out of the medication.

To learn more about your medications, there is an online resource that is packed full of information. In addition, this site can also tell you about the benefits and risks of herbs and supplements, like coenzyme Q10. Go to www.medlineplus.gov and click on drugs and supplements. Medlineplus has lots of other medical information, so you may want to take some time to review the site.

Not good news for grapefruit and grapefruit juice lovers – it can interfere with some prescription drugs. Grapefruit may interfere with enzymes that normally help the body break down and remove some medicines. This may cause a build-up of these medicines in the blood and this can lead to potentially dangerous side effects. Unfortunately, there does not seem to be any safe amount of time between taking these drugs and eating grapefruit. If you love grapefruit or grapefruit juice, check with your physician or pharmacist to see if it will interfere with any of the medicines you take.

A good way to save money is to have your prescription filled with a generic drug. But some people may worry that the generic drug is not as good or as safe as the brand name drug. But there is stricter federal scrutiny over the generic drug industry in recent years, and they must be as safe and effective as the brand name drug to get FDA approval. In order for the generic drug to be considered interchangeable with the original drug, the active ingredients must be the same. But they may contain different inert ingredients. Because of this, there is a slight chance that someone may have a reaction or side effect to the generic drug. If this does happen, you should talk to your physician. Generic drugs cost less because of the very significant cost to develop a new drug, not because the generic drug is inferior.
Medication Check-up:
Periodically, review all your medications with your physician. Your primary care doctor or internist is probably the best person to do this with. You might take medicines that are prescribed by different doctors, and you might take some over-the-counter medicines like aspirin or cold tablets now and then. Or you might take vitamins and/or supplements. Make a list of all the medicines you take and their dosages. Include things you take regularly and things you take now and then. Include any vitamins and supplements, eye drops, and sleep medicines. Make an appointment with your doctor and go over the list. Be sure there are no adverse interactions, and that you are taking the correct medications and the correct dosages. Carry the list with you at all times. Update the list when there are changes.
Questions to ask your doctor about your medications:
When your doctor prescribes a new medication, you should understand what the drug is and why you are being told to take it. Also, if you are already taking a medication but don't really understand the reason why you are taking it, you should find out. Here is a list of questions to ask your doctor about your medications:
- What are both the brand and generic names of this medication?
- How will this medication help me? What is it supposed to do?
- How long will it take before the medication starts to work? How will I know if it's working?
- How much should I take? When and how do I take it?
- What do I do if I miss a dose?
- Are there any special instructions to follow while taking this medication?
- How long will I be on this medication? Will I need refills?
- Are there any common side effects associated with this medication? What do I do if I experience any of them?
- Can I take this medication with the others I already take, including any over-the-counter ones?
- Will you need to see me again to check up on how I'm doing? If so, when