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Heart Health and Cholesterol

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DONEE PATTERSON, MD: Good Morning or good afternoon I should say. I am Dr. Donee Patterson from the Department of Medicine at Einstein Healthcare Center and I am the Director of Medical Community Outreach for the city of Philadelphia. As you may know, I usually host the Healthquest Live show every other Tuesday with the fabulous Sara Lomax-Reese, who is away today, so I will be conducting the show, pretty much hosting it by myself in her absence. I am looking forward to all your thoughts and comments on a very, very important topic. Let me start by saying, do you think you know everything there is to know about cholesterol and heart disease? Do you think you've heard it all? Well, we have some things to tell you that you just might not know so stay tuned. Do not turn that dial. This episode could save your life. So I just want to step back and say it is true that Einstein Healthcare Center truly cares about your health. We have state of the art facilities and top notch physicians and staff all over this great city. So I really want you to consider coming down and joining us because we are on live. We are remotely broadcasting from the Laundry Café on 5675 North Front Street. So come join us in the lovely unique venue. It is the Laundry Café and we are going to do free blood pressure screenings and we would love for you to come out and join us. We will be here until 1:00. We are giving out free gift cards. Again, the location is 5675 North Front Street, the Laundry Café, and we would love to hear from you. So we have discussed before that February is Heart Health Awareness Month and we want to remind our listeners that heart disease is any condition that impairs the function of the heart. It is the number one cause of death in the U.S. About 600,000 people die of heart disease in the U.S. every year. That's one in every four people that you know and there's about 900,000 Americans that have a heart attack every year. So with so many people having heart attacks and dying of heart disease, we wanted to explore some of the causes of heart disease and talk about how we can make each and every one of us less likely to be part of those statistics. Come on, WURD listeners. How can we avoid this deadly condition? I want to hear from you. What are you willing to do to keep your name off those staggering statistics? We'd absolutely love to hear from you. Log on to our Einstein Facebook page at Einstein Health or tweet us questions. Again, we are here live at the Laundry Café on Front Street. While you are thinking about that, let's turn to our very intelligent, Dr. Niku Thomas, who is a Board-Certified cardiologist at Einstein Healthcare Center. Welcome, Dr. Thomas.

NIKU THOMAS, MD: Thank you very much. It's great to be here.

PATTERSON: Awesome. So statistics say that one in four people die every year from heart disease. That's about 800,000 deaths per year. So how does the person know that they have heart disease and how does cholesterol play a role in that phenomenon? 

THOMAS: That's a great question. It can be very difficult for you to know for yourself that you have heart disease unless you develop symptoms of heart disease. Some of those symptoms can include chest pain, can include shortness of breath. Not everybody falls into the usual category of somebody who develops chest pain that goes into your left arm. For other people they might not recognize their symptoms when what they are really having is problems with blood flow to their heart. Sometimes the first hint that you get that you have heart disease is some kind of symptom, like chest pain or shortness of breath. Other times you don’t have any symptoms, but you can still have heart disease, even though you don’t have any symptoms to tell you that. 

PATTERSON: I know so many people tell me that they just ignore symptoms. What do you think about that? What should we tell those people?

THOMAS: That can be very dangerous. Usually you go through your youthful years ignoring symptoms and for the most part your symptoms will get better and you will go about your business, but as you get older, and depending on your family history, and sometimes your genetics, eventually your symptoms are going to mean something. It is always a good idea to let your doctor make that assessment, make that call, and let your doctor know what's going on. If you are developing, especially chest pain, you should talk to somebody about it. The first stop would always be your primary care physician, unless you have severe symptoms, in which case you should go to the emergency room of course, but don’t ignore your symptoms of chest pain. Don't ignore your symptoms of shortness of breath. There should be some explanation for it and a lot of the times it might not be heart disease, but if it is it is something you need to know about as early as possible because there are a lot of interventions and a lot of medications that can really help you do quite well even if you have heart disease. I guess the bottom line is don’t be afraid to go to your doctor fearing that you are going to end up with bad news and don’t assume that nothing is going on just because nothing has been going on for you in the past. 

PATTERSON: Absolutely. We know that high cholesterol is a serious health problem that affects about 50 million Americans. Let's talk a little bit about cholesterol. Can you remind our listeners what the different types of cholesterol are?

THOMAS: Sure. This topic has become quite complex. We used to just think of cholesterol as one number and then we started to understand that there are many different subtypes of cholesterol. What you've probably heard of before is there is the LDL cholesterol, HDL cholesterol, and there are triglycerides. Those are the three numbers that your primary care doctor or your cardiologist are most likely to discuss with you at first. Not all cholesterol is bad. We need cholesterol because your body uses it to make hormones in your body. Your body uses it to make - it's a building block for a lot of things in your body. Your body needs some cholesterol, but too much of, particularly your LDL cholesterol and its subtypes, can be dangerous, and can actually make you more likely to develop blockages in your blood vessels, but the HDL cholesterol, which we've come to know as the good cholesterol, is actually protective. This is the type of cholesterol that women tend to have more of before menopause, that we think helps protect them from developing heart disease when they are in their 30s, 40s, maybe even their early 50s, and then there are your triglycerides, which can be affected greatly by your diet. Diabetics will often struggle with their triglyceride numbers, but each of these three categories are important to understand because they're each related to your risk of developing coronary artery disease. 

PATTERSON: I want everyone right now to make sure they go get a pencil and a piece of paper because we are going to talk about where your cholesterol number should be. I just want to just say, repeat what Dr. Niku Thomas said, just in a phrase that the LDL cholesterol is the bad cholesterol and that's the cholesterol that can clog up a person's arteries. If the arteries are clogged to the heart a person can have a heart attack. If those arteries are clogged to the brain, a person can have a stroke, so it is very important for us not to ignore our cholesterol levels. We should know our numbers. Dr. Niku, can you remind people where their cholesterol values should be?

THOMAS: Well, that's a little bit of a complicated question because where your numbers should be depends on what else is going on for you in your body. If you are somebody who is young, who is in your early 30s, you do not have other conditions, like high blood pressure, you are not a smoker, which is a big issue in the city of Philadelphia, normal weight, no stress, then you can afford to have higher cholesterol numbers then somebody who does have these risk factors, who is a diabetic or hypertensive or who smokes. When your doctor is figuring out what your target numbers are for you, you should expect to answer a lot of questions that are related to other risk factors for developing coronary disease. The more risk factors you have, the lower we are going to want to drive your cholesterol numbers to protect you. So those risk factors are things like high blood pressure or needing to be on medication for your blood pressure even if your blood pressure is not high at the time you are talking to your doctor. Cigarette smoking is a big risk factor and anyone who smokes really should think about quitting because it really is not doing you any favors. Diabetes is such a strong risk factor that it is actually considered an equivalent of having coronary artery disease in our minds. We treat you as if you have it in terms of the goals that we set for you. Your family history of a first degree relative, you know a parent or a child, who developed heart disease at a young age is also another risk factor. You should expect to get questions about these risk factors and depending on how many you have, the number that your doctor wants to drive your bad cholesterol to, is going to be higher or lower. 

PATTERSON: Do you think that we can just generalize a little bit? I know that those numbers are very specific to doctors, but would you agree that total cholesterol should be, for most people, below 200, and that your HDL, which is your good cholesterol, should be as high as possible, but at least above 40, and that your bad cholesterol, now that's the tricky one. Bad cholesterol should be less then 130 for the general public, but if you have one or more risk factors, especially if you have had diabetes or you have had a heart attack or stroke, that really should be less then 70. Would you agree with that?

THOMAS: I would mostly agree with that. It's protective to have a total cholesterol less then 200 if that's the case for you. Most likely the rest of your cholesterol panel will be something that you can work with. In terms of your HDL cholesterol, yes, greater then 40 is a great goal, especially for men. For women, I would actually like to see their HDL cholesterol greater then 50. 


THOMAS: And when it comes to the LDL cholesterol that is where it becomes complicated. If you have zero or one risk factors we can sometimes wait until your LDL is over 160 before we need to start driving it down and usually we can start driving it down, you can start driving it down, by changing your diet and exercising and sometimes that's enough to get it to less then 130, but if you have two of those risk factors that I mentioned earlier, the high blood pressure, family history or smoking, then that's when you really need to, if your LDL is 130 or higher, that's when you need to start working on it and often changes in diet and exercise turns out to not be enough. They can help reduce your LDL, but sometimes you end up needing medication and the medications that are available are quite effective at lowering your, not only your bad cholesterol, but by doing so and by other mechanisms, they can actually lower your risk of developing coronary artery disease or complications from it. 

PATTERSON: I must say that I understand that the national guidelines are that in general some people their LDL cholesterol can be 160, but I really feel uncomfortable with that because I think that people could be doing much better with their diet and exercise and get their cholesterol a lot lower then 160 because we don't want to wait around and have people have heart attacks or strokes, but you had mentioned medication. I know that a lot of listeners, they're really quite suspect about taking medications and no one wants to take medications and I just want to step back and say that we are not pushing any medication at all. We are not endorsing any specific medication, but as you said it really can save lives. Talk a little bit about the statins and how it really has changed the face of coronary heart disease in our country.

THOMAS: Yes. Well, we didn’t always have statins obviously. Before the statins were here we had to rely on things like niacin and the bile acid sequestrants, Cholestyramine and medications like that, that had quite a few side effects to reduce your cholesterol numbers and even then there was still a lot of what we call residual risk, meaning that even when people were on these medications, it didn’t protect them as much as we had hoped from having heart attacks, from having strokes. Once the statins were developed, they have been shown, they've been tested extensively and when people are on statins number one, they are able to achieve these goals that we have of low cholesterol numbers and yes, I mean, I would agree with you that most physicians would be uncomfortable letting someone's LDL cholesterol run around 160, but for patients who really want to delay their medications they can make an argument for trying out diet and exercise first to see if they can drive their LDL cholesterol down that way. That was what my main point was about that number.


THOMAS: But with the statins you are able to achieve these goals, sometimes with one medication, instead of needing more than one. Sometimes you still need more then one, but also your risk of getting a heart attack, your risk of dying from a heart attack, is reduced a lot when you are on a statin medication and so this is why your physician, your cardiologist, will probably be pretty enthusiastic, pretty excited to start you on this medication once they decide you need a medicine for your cholesterol. Whether you have heart disease already and have had a heart attack already, or whether you just are somebody who is at risk because of your diabetes or because of your high blood pressure or your cigarette smoking, the studies have shows that this class of medicines, the statins, can make you less likely to have a heart attack, and to die of a heart attack, to have a stroke and to die from it.

PATTERSON: Again, we are not endorsing any specific medicine, but if you have heart disease or your concerned you have heart disease, talk to your doctor about the things that you can do, including aspirins, which we may or may not get to today because we have a lot to talk about, but I wanted to talk about how at least 250,000 people die of heart attacks before they even get to the hospital and many of these deaths could have been prevented by quick acting or getting treatment right away. Do you have suggestions for people that are experiencing symptoms and they're at home? What can they do? What do you think they should do?

THOMAS: I would say if you are experiencing symptoms and they're not going away and they're severe, people tend to know when they are in so much pain that they need help and if you have that sense do not ignore that because these things can progress quickly and at some point you might not be able to get help. Once you really feel like this is more than I am used to, this is more than my usual tenderness in my shoulder, you need to call for help right away. Once you've done that, you can take an aspirin actually, most people have an aspirin sitting in their medicine cabinet somewhere. 

PATTERSON: Does it matter the dose?

THOMAS: If you have a baby aspirin you should chew four of them. If you have a full dose, 325 milligram regular adult aspirin, take that.

PATTERSON: The baby aspirin is 81 milligrams. 

THOMAS: That's right.

PATTERSON: Should they go lay down? Should they go in the back room and lay down? What do you think?

THOMAS: I would suggest call 9-1-1, call somebody after you call 9-1-1, if you have somebody in the house have them come and help you and yes I would relax once you know help is on the way, but don’t just lie down and try to let it go away on its own because if you are having a heart attack and it is a severe heart attack, meaning that it is a life-threatening one, time is of the essence and the faster you get to the hospital the greater your chances are of not having significant damage left over to your heart muscle. We have to take a break now.

PATTERSON: Yes, we have to take a break now, but the take-home message there is call 9-1-1. Don’t just go lay down somewhere and be by yourself. Make sure you tell someone. We are going to take a break here. Again, I am Dr. Donee Patterson filling in for the incredible Sara Lomax-Reese in her absence. We are holding it down today at the unique Laundry Café at 5675 North Front Street. Come and join us for free blood pressure screenings and we are here until 1:00. We are giving away free gift cards. This is WURD 900 AM on air, online and in the community. Okay and we're back. Again, I am Dr. Donee Patterson. I am filling in for the incredible Sara Lomax-Reese in her absence and we are holding it down at the Laundry Café at 5675 North Front Street. We are here until 1:00 doing free blood pressure screenings and we are giving away free gift cards. I wanted to tell you that we will be talking to Ed Sinnamon from Einstein Cardiac Rehab Department. Isn't that an awesome name? Ed Sinnamon, and he will be telling us what cardiac rehab is all about and who should go to cardiac rehab. He will be here for us and then later in the show we will be talking to a patient, a very young person, who actually suffered a heart attack and how he felt and how it changed his life so don’t turn the dial. All right so I just want to go back to Dr. Niku Thomas and just talk to her a little bit. You know, every 20 seconds it's said that a person in the U.S. has a heart attack. Part of the workup when someone comes in and we're thinking that they've had a heart attack is to do an EKG or a stress test. Can you tell us a little bit about what an EKG is and what a stress test is and when a person should expect to get a stress test?

THOMAS: Sure. An EKG, a lot of people have seen this before, is an electrical mapping of your heart. A lot of people don’t realize that your heart, in addition to having its own blood vessels that give blood to areas of the heart, it has its own electrical wiring, obviously not real wires, but cells that conduct electricity and when part of the heart muscle has been damaged, that electrical signal can change and so the map that we see on EKG looks different in appearance once you have had some damage to your heart. When you come in and you suspect that you are either having a heart attack or that you have had one in the past, one of the first tests that your primary care or cardiology or emergency room physician will perform is an electrocardiogram, which we abbreviate by calling it an EKG. It is the electrical mapping of your heart to see if your map has changed to one of those patterns that looks like there has been damage. If we see that then that confirms our suspicion that the symptoms that you are describing were probably the result of a heart attack. It helps us to make that diagnosis.

PATTERSON: One of our callers had - actually she sent us a message on Facebook. Robin Richardson, she said, "Should you be concerned about having palpitations? Is that a sign of heart disease?"

THOMAS: Well, palpitations can be a sign of heart disease, but there are a lot of other causes of palpitations, anything as benign as not having enough water that day, having too much caffeine that day, to having a dangerous heart rhythm from not enough blood flow to your heart. There is such a wide range of things that can cause palpitations that it can be hard for you to tell for yourself if it is a significant problem. Sometimes you can guess. If you haven’t had palpitations ever and then you have had five cups of coffee in one day and you are feeling them, yeah, it most likely is from the caffeine, but again, it is always smartest to let your doctor make that call since your doctor understands everything else that's going on with you medically and can really make a better determination of what the likely cause is.

PATTERSON: Would you say if they are having other symptoms if it is related to a severe headache or blurry vision, numbness, tingling, that that's something that they should call 9-1-1 and seek emergency room attention for?

THOMAS: The palpitations that are a sign of heart disease can be associated with dizziness, passing out. I have actually had some patients who have in the past had palpitations and then passed out and not gone to the doctor and I would just like to really encourage you to not be one of those people. If you pass out get medical help. It does not necessarily mean there is something horrible going on with you, but there could be something very dangerous, and if you don’t get help, then you could have a really bad outcome. So if you are passing out, you need to see a cardiologist or an emergency room doctor, in fact, that same day preferably. 

PATTERSON: There's been some important people who have died from heart disease. How powerful would it be if we still had the likes of Luther Vandross or Rick James¸ Alex Haley, the great Louie Armstrong, the incredibly talented Richard Pryor, and even a little closer to home, our beloved Fatimah Ali, who I understand had heart disease and she was under a tremendous amount of stress and unfortunately was taken from this world in her 50s, which is way, way too young. What do you think that stress has to do with heart disease and having heart attacks?

THOMAS: You know, we have such a more complex understanding now of the way that stress affects the body. Not only is it - we used to think it was just your mind and carrying extra worry with you, but now we understand that it changes the chemistry of your body to be under chronic stress. Your hormone levels change and there are certain hormones that are released that will raise your blood pressure, that will cause changes to happen in the vessels of your heart and the vessels of your entire body. When that happens, that is going to create these changes that set the stage and set the chemistry for developing blockages in your vessels and once you get blockages in your vessels, they can be in your heart, they can be in your brain, they can cause heart attacks, strokes, they can cause problems with your kidneys. In general, I would say it is a good idea to be aware of how much stress you are under to try to reduce that level to the extent that you can and sometimes it is easier said then done. I understand that, but the point is that, it is not something to ignore. It certainly can make things worse. Some of the medications that we give for people with congestive heart failure directly work against these stress hormones. It does play a much bigger picture then we used to acknowledge. 

PATTERSON: No when I was talking to Sara Lomax-Reese she had encouraged me to make sure that I mentioned that people do something to decrease their stress every day, something for themselves, even if it is just five minutes. We really need to do that. I have to admit that I don’t always do something for myself every single day to decrease stress and I would like to hear from people. Give us your comments on Facebook or tweet us. What do you do to decrease your stress? I want to step back for a second and I want to talk to the owners of this awesome concept of this Laundry Café. We have here, unfortunately I am only going to be able to speak to one of them, but we have here Brian Holland and Tyrone Atkins. Can one of you guys come over for us? I believe we have Brian Holland here.


PATTERSON: We are just going to ask Dr. Niku just to hang on with us for one second.  Hi Brian! Good afternoon. 

HOLLAND: How are you?

PATTERSON: Thank you so much for hosting this event for us today.

HOLLAND: Okay, thank you for having me.

PATTERSON: Speak right into that mic so people can hear you.


PATTERSON: So how did you come up with this awesome concept of this Laundromat Café?

HOLLAND: Well, first we wanted to address a need and we felt that many of the services that were in the neighborhood were lacking as it relates to laundry products and laundry services and we were quite frankly disappointed with many of the locations that we had seen and we felt that people who were here should not have to travel to King of Prussia or to other areas to get great services so we thought we'd start right here right now.

PATTERSON: So how long have you been here?

HOLLAND: Since April of last year.

PATTERSON: Okay, all right. Well, I absolutely love it. I think if people don’t know about it it is at 5675 North Front Street.

HOLLAND: That's correct.

PATTERSON: It is a huge, pretty, quaint place. I have four kids so I know a little bit, something about laundry and I was really tempted to bring my laundry today, but my husband told me I couldn’t bring it, but I think that it is a really nice place here. I think people should come and check it out. Anything else that you want to tell us about your unique atmosphere here?

HOLLAND: We would just say that we are committed to community and 20 percent of our footprint is dedicated to community and community-related services and programs and we try to do things that are helpful and uplifting. We have computers throughout the store to add value so parents can have their students do homework while they are here and doing their laundry. We have free WIFI. We try to do programs like this, but we are as committed to giving back to the community as we are for serving the community and so we hope that we do that. We hope that we do it well.

PATTERSON: All right, there you have it. 5675 North Front Street. It was so nice meeting you. Awesome. Thanks for having us. We are going to try to reach one of my guests today. His name is Brian Bullock, as soon as Troy gets him on the line for me. He is a young gentleman who actually had a heart attack and Troy just let me know when he is on line. He actually had a heart attack at a young age and I really want you to listen to this man's story. He has something to say and if you've ever had a heart attack or you have questions about cholesterol, or heart disease, please hit us up on Twitter, give us questions on Twitter or Facebook. Our Facebook page is Einstein Health and I also want to do a shoutout right now to the Einstein practice. It's Einstein Physicians at Olney. They are now accepting new patients. It is located here where we are on Olney Plaza on North Front Street. We have two MAs here, medical assistants, doing blood pressure screenings, Theresa Revez and Maria Hernandez. If you need your blood pressure checked we encourage you to come out and get your blood pressure checked. Do we have Brian Bullock on the line? Brian?


PATTERSON: Oh, awesome. Thank you so much for coming. 

BULLOCK: Thank you. Thank you for having me.

PATTERSON: Now we said before that every 20 seconds someone in the U.S. has had a heart attack and right now I want to introduce to our listeners, Brian Bullock. I just want to say thank you for joining us today.

BULLOCK: Thank you so much, Dr. Donee, for having me. I appreciate it. It's good to be here. 

PATTERSON: Now can you tell the WURD listeners how old you were when you had your heart attack?

BULLOCK: Absolutely. I was actually 31 years old. I was just a few months away from my 32nd birthday and was in June of that year and woke up and had a heart attack.

PATTERSON: What were you thinking when the heart attack began?

BULLOCK: Well, it was strange. It was strange to be honest. You know, it was all of the classic symptoms. I am big guy, but I have always stayed fit. I had just completed my second ultra marathon. I've done a lot of running, played on sports teams and was very, very active. I can tell you that the last thing that I thought was happening was a heart attack, but it absolutely was all of the classic symptoms. As I said, I had just woken up and I was laying on my back and I sat up to get up and get my day started and I just felt this incredible pressure and couldn’t catch my breath and I was sweating just like I had just run three miles and it is just as it is described. It's like an elephant standing on your chest and again, I knew the symptoms, but because I was only 31, because I was so active, I said this cannot be a heart attack. 

PATTERSON: I want people to know. You said you are a big guy, but he is really not that big. He's just a pretty average size guy. I don’t want you to think that he is 300 or 400 pounds. He played basketball and he was on two softball teams so this is a guy that was pretty fit, and like he said, he was running marathons. Were you aware of any family history or heart disease or did you think that stress was that major in your life at the time to have a heart attack?

BULLOCK: No. I don’t have any family history of actual heart attacks. We have the medical history or diabetes, high blood pressure, some cholesterol issues, but no one in my family has actually had a heart attack. I was actually the first and only. I pray that it stays that way. Had I had a history then I probably would have you know really understood what was happening, but I didn't. In terms of my stress level, my son was a baby then and so we had a growing family. Obviously I was working, but it wasn’t any what I would describe as overly stressed. I would say it was the typical stress, maybe a little more. I tend to be a stressful guy. I heard you talking earlier about the importance of managing stress and I think you can't talk about that enough. I do have to be diligent about - of handling my stress, but I wouldn’t describe my life as overly stressful. 

PATTERSON: Well, I think your story is pretty amazing. I want to make sure I emphasize to people that we are not advocating any medication, but tell them your story about you know if you wanted to take medicine and how you were a little resistant to that at first. 

BULLOCK: I think having a heart attack at 31, obviously, again, I was in pretty good shape, excellent shape I would say and it was sort of a curse because obviously after an event like that you do get prescribed medicines and I was taking the cholesterol medicines, the aspirin, everything, Coumadin, and what happened with me is because, again, I was young, I just was hardheaded. I said this is just some freak thing. I'm strong. I exercise. I don’t need to be diligent about taking medicine. Well, that is the worst decision that anyone could possibly make. As a result of that, I got sick again. In fact, more than twice.

PATTERSON: You have had multiple heart attacks, right?

BULLOCK: Yeah, it has been a total of five actually, all in the same place. My heart disease is - I don’t want anyone to think I am about to fall over. It is all in the same place and thankfully the damage to my heart muscle is, I would describe, is minimal, but the reason that it was multiple and the reason why it is in the same place is because of not being diligent about taking my medicines. Now as I have gotten older, it has been 15 years, I am much more diligent. It is a daily thought and I have never missed my medicines. I never miss my exercise and I absolutely do control my stress. It is important. 

PATTERSON: So since you have had the mindset I am going to take my medicine. I am going to see my cardiologist. I am going to exercise. I am going to eat right. It has been about four or five years since you have had an incident. Is that correct?

BULLOCK: That's correct. That's correct and as you said, my mindset changed. It absolutely changed. From some stern talkings from my cardiologist that helps too, but it got to the point, Dr. Donee, that I had to make a change. I was tired of being in the hospital. I was tired of just living that way. It is a matter of taking some pills every day. It really is that simple. Now, again, the exercise is important and it is a mindset, but it is important and things turned around. I just had my last stress test back in November and I am doing great, absolutely great. 

PATTERSON: Brian, I think that today you are going to save lives. People are going to hear your story and they're not going to ignore their symptoms and they're not going to just poo-poo taking medicine and you are going to save lives today. I appreciate you being honest and being transparent today.

BULLOCK: Absolutely. I appreciate it.

PATTERSON: What advice - we only have a little bit of time left - but what advice do you have for people who think that this could never happen to me? 

BULLOCK: I think that's the first thing is to not think that it cannot happen to you because it can and I heard you talking earlier about paying attention to your body. Get in tune with your body. I think that is one of the things that has come out of this with me is that I am so in tune with my body. Any sort of change or feeling I am very, very diligent about going to the doctor, but it really is making sure that you are in tune with your body, monitoring your cholesterol. Prevention is the best thing. Listen to your doctor when they talk about your cholesterol, your blood pressure, and that exercise, I can't talk about that enough. It is so important and if you are feeling any of those symptoms go to the doctor. Do not hesitate.

PATTERSON: Absolutely. Thank you so much, Brian. We appreciate you. Be well.

BULLOCK: Thank you and you are doing just a great, great show today. Congratulations. Thank you.

PATTERSON: I appreciate it. Thanks.

BULLOCK: Okay, all right.

PATTERSON: So we are going to turn a little bit and we are going to talk to someone who knows what happens after a person has had a heart attack. We are going to talk to Ed Sinnamon, who is from Einstein Cardiac Rehab. Don't you just love that last name? Sinnamon with an "S". Before time totally gets away from us I wanted to talk to Ed about what is cardiac rehab. First of all, thanks for joining us.

ED SINNAMON: Thank you very much for the opportunity. It's a pleasure to be here.

PATTERSON: No problem. Let's jump right into this. What exactly is cardiac rehab?

SINNAMON: Well, essentially there are three phases. Normally after you've been through the ER, if you've had a heart attack, as the gentleman, or a stent procedure or a coronary bypass, you will be consulted by usually the physical therapy department at Einstein and they will go through some internal exercises to get you ready to go home and then we come in in what is called phase two, where generally most insurance companies will offer 36 covered sessions under most people's plans, which usually takes approximately three months for the exercise program. 

PATTERSON: So who is actually a candidate to get this cardiac rehab? Can anybody just walk on the street or do you have to have…

SINNAMON: No, occasionally we have people come in with family members and want to be in the program, but technically you have to have a written script from either your internal medicine doctor or your cardiologist to get started with the program. 

PATTERSON: So this program is for someone that might have congestive heart failure, they might have had a heart attack before or they might have had a bypass. Is that correct?

SINNAMON: That is correct. It gets a little bit difficult in regards to the heart failure patients. It depends on whether you've had blockage-related heart failure or viral. So we do have to go through that process with the insurance, but we can try to get you covered.

PATTERSON: Okay and so if a person had a heart attack maybe four or five years ago, is it still a benefit for them or does it have to be an acute heart attack?

SINNAMON:  That's a good question. A lot of it will go through your cardiologist if you are actively following with them or your internal medicine doctor can certainly…what happens is as human beings we tend to fall back on our former ways of doing things and people tend to put weight back on, have their cholesterol not properly managed, so certainly three, four years down the road, we use the term secondary prevention. We try to get people in so that they won't have another heart attack like the gentleman. 

PATTERSON: Absolutely, absolutely. Tell us exactly where your office is located and what people need to do to reach you. 

SINNAMON: We are located at 1 Penn Boulevard in the Old Germantown Hospital Building, if people are at all familiar with that, on the Second Floor, Room 200. Do you want the phone number?


SINNAMON:  215-951-8260 is our phone number.

PATTERSON: That was Ed Sinnamon from the Cardiac Rehab Department and we only have a short time left. We are going to back to Dr. Niku Thomas. I just want to answer one of the questions that came over on our Facebook page. This question was from Debbie Reed, who is actually in Maryland and she asked, "Is getting a cardiac workup part of a routine physical?" I just want to say, as a family doctor, it is not actually part of your routine physical. Everyone is not going to get an EKG. Everyone will get their heart listened to and if there are palpitations or irregularities there, then your doctor will say something, but everyone will not get an EKG. Dr. Niku Thomas, can you speak a little bit about who should get an EKG? I can talk to as a family doctor if you'd like. 

THOMAS: Sure. I agree that not everybody needs an EKG when they get a routine checkup and your family physician is the best person to make the determination of whether or not you are someone who needs one. What you should expect when you go in for a checkup is to tell your doctor any symptoms that you've been having, have your doctor review with you any diagnoses that you carry. I had spoke earlier in the program about the diagnoses that are going to be flagged as risk factors for developing heart disease and the number of those diagnoses that you have and your age and whether you are male or female are all going to come into play when your family physician or your primary care doctor is deciding whether or not you need a cardiac workup. 

PATTERSON: And you need to know your family history, right?

THOMAS: You absolutely need to know your family history so ask whoever you need to this is not the time for people to be shy about what's been going on with them. It helps everybody in your family to know whether somebody has had a heart attack or somebody has been diagnosed with a stroke or cardiovascular disease when they were in their forties, thirties, fifties even. The more people share about this the more helpful it is going to be for everyone else in the family.

PATTERSON: I think people, one take home message, if you haven’t heard anything we've said today, is if you haven’t seen your doctor, you need to see a doctor. You must know your numbers. It is almost irresponsible not to know your numbers. Know your blood pressure. Know your cholesterol and get checked out. If you don't know your family history, ask the people that are still living. Be persistent. Say what did grandmom die of? What did grandad die of? Know your family history. We only have a little bit of time left and so we would be remised if we did not talk about prevention. So let's talk a little bit about prevention. We talked about it before, but I just want to make sure that this point gets driven home. If you do any of these things, you must, must consider making a change because our WURD listeners, we are going to be healthier in 2014, but we have to make changes. I don’t care if you are the thinnest person in the world or the biggest person in the world, there are things that you can do to be healthier. If you smoke, you must stop smoking. A lot of people say, oh, I am just going to do it. I say pick a date. Let's all pick a date now. Let's say by Easter, everyone is going to have talked to their doctor and have a plan to stop smoking because you will be so much heathier and I want to encourage people to get active. I don’t care what you do. You can hula-hoop. You can jump rope. You can walk the stairs in your house. You can mall walk, whatever you have to do, but you have to get more active. Just as Brian Bullock, our previous caller, said, it is not just about being healthy, or thinking that you are healthy, it is not just about moving around. It is actually about doing and making big changes like eating a heart-healthy diet. I want people to, when they look at their plate, half their plate is full of fruits and vegetables and only the protein portion is about the size of your fist. I know that is a big change for many of us, but that is the changes that you need to be healthy. I want people to get their blood pressure checked and I don’t want you just to go to your doctor and they tell you that your blood pressure is borderline. We don’t believe in borderline blood pressure anymore. You have to decrease your salt and we have to make sure that you exercise and if your blood pressure is not to a perfect goal, you talk to your doctor and be insistent that your blood pressure or your cholesterol or your diabetes be under better levels. We are going to talk about also having a stress-free life. I am still waiting to hear your Facebook comments or your tweets about how to improve decreasing stress. What do people do? Do they do yoga? Do they meditate? Do they take a bath? What can people do every day? I want suggestions. I want those suggestions for myself and talk to your doctor about taking an aspirin. I don’t like the term baby aspirin because I don’t want you to think it is just for babies. This is big important stuff here we are talking about. An aspirin, in some cases, can save your life. So talk to your doctor about if you are a candidate for aspirin. I want you to eat the rainbow and I am not doing a Skittles commercial. I am talking about lots of different colored fruits and vegetables, the oranges, the reds, the yellow, the green, because they have different antioxidants and they help to clean out your arteries and help you to be healthy. Last, but not least, I don’t want you to forget about your children. Childhood obesity is huge and we can't forget about our children. We need to teach them the right thing to do. Dr. Niku Thomas, we only have a few seconds left. Do you have any parting thoughts that could help our WURD listeners today?

THOMAS: Well I am so glad that you had one of these patients call in. He did a fabulous job of making so many of our points. He made them much more eloquently then we ever could. Do not ever ignore your symptoms no matter who you are, how young you are, how athletic you've been. He was doing things that we all do. We think we are healthy, we are only 30 years old, we run a couple of marathons, well, most of us haven't, but you could even be someone who has and still end up in the position that he was in with having a heart attack at age 31, but it is not an excuse not to do what you can to try to reduce your risks because his outcome could have been a lot more severe and I am sure he knows that, but maybe because he was so active running marathons, he has had minimal damage to his heart even after having had five heart attacks. So consider that. Quit smoking. Exercise is great for your cardiovascular fitness, for your stress level too, for quitting smoking. I would say stay fit, see your doctor, be responsible, eat well and do something to reduce the stress in your life and take your medications if they are prescribed for you.

PATTERSON: Absolutely. So we want to thank the owners of the Laundry Café just for this awesome concept. We want to thank the Physicians at Olney, who again are now accepting patients. You can call us at 1-800-EINSTEIN if you need a physician. I also want to thank all the people who came out and got their blood pressure checked today and thank you so much, Troy, for being a calming force for me today. I was a little nervous about this show. I am Dr. Donee from Einstein Healthcare Center and my motto is that I wish you the best of health.


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