Know the signs of a heart attack and don't ignore or dismiss them; quick action can be the difference between life and death

Many people who have a heart attack initially ignore the symptoms or dismiss them. For the best chance of survival and preserving heart function, you should not ignore these symptoms, and should get help quickly.

Heart disease is the leading cause of death in the U.S. and Kentucky. Nationwide, it causes about one in four deaths. The age-adjusted death rate from heart disease in Kentucky is 208.2 per 100,000 per year, according to the federal Centers for Disease Control and Prevention.

Below are some questions and answers about the symptoms and treatment of heart attacks and narrowed aortic valves, as reported by Gina Kolata for the New York Times.

How do you know if you are having a heart attack? Most people feel pain, pressure or squeezing in their chest and about one-third of people have symptoms in addition to or instead of chest pain that include abdominal pain, heavy sweating, back pain, neck and jaw pain, nausea and vomiting, Kolata reports. WebMD adds pain that radiates down one arm, indigestion or a choking feeling, extreme weakness, anxiety or shortness of breath, and rapid or irregular heartbeats to the list.

How can you decide if symptoms other than chest pain are actually from a heart attack? If your symptoms come on suddenly, or if they worsen over a period of hours or days, call 911 and get to an emergency room. "The best time to treat a heart attack is within one to two hours of the first onset of symptoms," says WebMD. "Waiting longer increases the damage to your heart and reduces your chances of survival."

Do women have different symptoms than men? "Probably not," Dr. Mary Norine Walsh, vice president of the American College of Cardiology, told Kolata. Walsh noted that women, however, are more likely to delay seeking treatment and doctors are more likely to dismiss their symptoms, especially if the woman is younger.

The American Heart Association says women often attribute signs of a heart attack to the flu, acid reflux or the normal aging process, even though it is the number one killer of women. It also noted that symptoms in women can be subtler, like shortness of breath, upper back pressure that feels like squeezing, lightheadedness or actually fainting.

What should you do if you are having heart attack symptoms? Call 911 for an ambulance to take you to the emergency room immediately. Do not drive yourself and do not have a friend or family member drive you unless you have no other choice. Kolata notes that paramedics are trained to treat heart attacks and are less likely to get stuck in traffic.

How can you find out if your local hospital is able to treat heart attacks quickly? Don't waste time fighting with your paramedic when you are having a heart attack, they will know the best place to take you, Kolata writes.

That being said, some hospitals are faster than others in treating heart attacks, but the time to research this information is before you are in the throws of a heart attack, Kolata writes. To find out this information, she suggest you ask each hospital what its "door to balloon time" is, which will tell you how long it takes the hospital to open a blocked coronary artery with a balloon after you arrive at the emergency room. If they don't have this information, ask if they take certain steps to speed up treatment. For example ask: Do paramedics transmit a patient's electrocardiogram to the hospital en route?; Does the ER doctor read the EKG and send out a single call to summon the cardiology team?; And are the team members on call required to be within 30 minutes of the hospital?

What are the symptoms of a severely narrowed aortic valve? There are three classic symptoms of this disease of aging: shortness of breath, a feeling of heaviness and pain in the chest, and fainting, according to cardiologists. They also noted that these symptoms are often mistakenly attributed to the normal process of aging.

How can a doctor know if symptoms are caused by a narrowed aortic valve? The doctor will listen  for a heart murmur in the patient’s chest and can order an echocardiogram, which will reveal the narrowed artery and the extent of the damage.

Should everyone with a severely narrowed artery have it replaced? Not everyone should undergo treatment, Kolata reports, so ask your doctor if you are a good candidate. The latest treatment is a transcatheter aortic valve replacement, or TAVR, which allows doctors to replace valves without doing open-heart surgery. High risk patients who would have been considered at too great a risk of dying from open-heart surgery have a chance to have a valve replacement, but sometimes elderly patients whose health is compromised are not good candidates.

Common heartburn medications are linked to heart attacks

Research made possible by data mining reveals evidence that a common group of heartburn medications is associated with a greater risk of heart attack, according to Stanford University researchers, Lenny Bernstein reports for The Washington Post.

The heartburn drugs in question are known as proton-pump inhibitors, such as Nexium, Prilosec and Prevacid. Bernstein writes that "they are some of the most widely used drugs in the world and that an estimated 113 million prescriptions for the drugs are written for them around the world each year."

Bernstein notes that the Stanford study, published in the online journal PLOS One, recognizes that it was not designed to show cause and effect, and agrees that a large, prospective clinical study could establish whether the drugs are actually causing more heart attacks.

But one of the authors of the study, Nicholas J. Leeper, an assistant professor of cardiovascular medicine and vascular surgery at Stanford, told Bernstein that the U.S. Food and Drug Administration "should be aware of these findings" and "we do think patients should think about their risks and benefits and should discuss their risk with their doctor."

Nigam Shah, lead author of the research, cautioned that because some of these drugs are now available over the counter, it is important to tell your physician if you are taking them.

The research combed through 16 million electronic records of 2.9 million patients in two separate databases (one database was from hospital patients and the other from private office or clinic patients) and found that people who take the medication to suppress the release of stomach acid are 16 to 21 percent more likely to have a heart attack, Bernstein reports.

The research theorizes that proton pump inhibitors may reduce production of nitric oxide from cells that line the inside of the circulatory system, including the heart. Lower levels of nitric oxide have long been associated with cardiovascular problems, Leeper told Bernstein. This theory is being tested in the lab.

The Stanford study found no association between medications that combat heartburn by blocking histamine production, like Zantac and Pepcid, and increased risk of heart attack.

A looming danger: About 1 in 3 U.S. adults are pre-diabetic, but only about 11% say they have received such a diagnosis

Before Type 2 diabetes develops, most people experience what is called prediabetes, where the blood sugar levels are above normal, but below diabetic, Dr. Philip A. Kern, University of Kentucky professor and director of the Center for Clinical and Translational Science, writes in a UK news release.

In America, approximately one in three adults are pre-diabetic, but only around 11 percent are aware of that condition, according to the federal Centers for Disease Control and Prevention. In Kentucky, 289,000 adults, or almost 9 percent, reported that they had been diagnosed as pre-diabetic, according to the 2015 Kentucky Diabetes Report.

"Without intervention, there is a high likelihood that prediabetes will progress to diabetes within three to 10 years," Kern writes. "People with prediabetes are also at 50 percent higher risk for heart disease and stroke."

When a person is prediabetic, many of the diabetic disease processes, like nerve damage, eye problems and heart disease, begin in the body even though the person doesn't have diabetes.

And because prediabetes often has no symptoms and can affect people of all ages, Kern writes, it is important to know your blood sugar levels, especially if you have one of the following risk factors: overweight or obese, fat distributed around the abdomen, history of gestational diabetes, family history of diabetes, symptoms of diabetes (increased thirst, frequent urination, fatigue, and blurred vision), or history of elevated blood sugar levels.

Kern suggests the following lifestyle changes to help prevent the progression of prediabetes to diabetes; he notes that these changes will also help reduce your risk of heart disease, stroke, high cholesterol and high blood pressure:

• Weight loss: Losing just 10 to 20 pounds can reduce the liklihood of prediabetes progressing to diabetes.
• Healthy diet: Choose low fat, low calorie and high fiber foods, like fruits, vegetables and whole grains.
• Exercise: Incorporate 30 to 60 minutes of moderate physical activity most days of the week.
• Sleep: Research has found that getting at least six hours of sleep each night can help reduce insulin resistance. He also notes that sleep apnea can worsen prediabetes.
• Medications: Some diabetes medications are prescribed to prediabetics to prevent the condition from progressing.

If you're interested in learning about opportunities to participate in research about prediabetes at UK, visit ukclinicalresearch.com or call (859) 323-2737.

Even nicotine-free electronic cigarettes can damage lungs; parents urged to warn teens about dangers of e-cig smoking

Kentucky has one of the nation's highest smoking rates, but electronic cigarettes, or e-cigs, are becoming more popular. These battery-powered vaporizers produce a vapor that usually does not contain nicotine. Some have claimed that e-cigs can help people quit smoking because the amount of nicotine can be reduced until it isn't present in the vapor. However, new research shows that other substances in e-cigs may damage the lungs.

Research has found that nicotine in any form damages the endothelial cells that line the lungs, and can cause them to become inflamed or injured. The new research has found that e-cigarette solutions without nicotine contain other substances like acrolein, which damage the lungs in other ways.

"This research reports that components found in commercially available e-cigarette solutions and vapors generated by heating them may cause lung inflammation," said lead researcher Irina Petrache. Long-term effects haven't yet been studied, but the results of this study warn that e-cig inhalation may involve adverse effects on lung health, she said.

Centers for Disease Control and Prevention research shows that e-cigarette use among middle and high school students has tripled. "The development and marketing of e-cigarettes has the potential of hooking a whole new generation on nicotine," Garry Sigman, director of the Loyola University Health System Adolescent Medicine Program, said. It's very addictive and can lead to health issues such as lung disease, heart disease, hypertension and nervous system problems, he said.

Sigman said parents need to made sure their children understand that e-cigarettes are just as addictive as other substances. "Nicotine is so addictive that with only a few inhales, it can create an addiction," he said. Because adolescents enjoy and use technology so much, the modern qualities of the e-cigs might make them seem cool. "Setting rules and monitoring behavior is essential to keeping our teens safe," Sigman said.

One of every three U.S. adults have a combination of risk factors that increase their risk for heart disease and diabetes

More than one-third of adults in the U.S. have a combination of health conditions that put them at higher risk of heart disease and diabetes, and this condition affects nearly half of adults aged 60 and older, according to a new study recently published in the Journal of the American Medical Association.

Image: healthyanswers.com

This combination of health conditions, when found in one person, is called metabolic syndrome. It includes abdominal obesity, high blood pressure, increased fasting glucose levels and abnormal cholesterol levels.

The study collected data gathered by the federal Centers for Disease Control and Prevention from adults 20 and older from 2003 to 2012. It found that about a third had a metabolic symdrome in 2011-12, and nearly half of those 60 and older did. Among those 20 to 39, the rate was 18 percent.

The study report says these were "concerning observations" because of the country's aging population. Hispanics, at 39 percent, were found to have the highest prevalence of metabolic syndrome among ethnic groups. Women had a higher prevalence than men in all age groups.

The American Heart Association says the best way to control the risk factors contributing to metabolic syndrome are to lose weight and increase physical activity. It also encourages patients to routinely monitor their weight, blood glucose, cholesterol and blood pressure and treat these risk factors according to established guidelines.

Senate Republican leaders killed the smoking-ban bill passed by the Democratic House but some of them say its time may come

By Melissa Patrick
Kentucky Health News

On Feb. 13, for the first time, the Kentucky House of Representatives passed a statewide smoking ban to prohibit smoking in workplaces and indoor places. The bill moved to the Senate for consideration. On the same day, a state senator proposed a nearly identical bill. And on Feb. 19, both bills were assigned to a committee that was never going to give them a hearing.

Sen. Julie Raque Adams

Sen. Julie Raque Adams, R-Louisville, sponsor of the Senate bill, said it and the House bill would have been approved by the Senate Health and Welfare Committee, which she chairs. But leaders of the Senate's Republican majority sent it to the Veterans, Military Affairs and Public Protection Committee, chaired by Sen. Albert Robinson, R-London, who, like Senate President Robert Stivers, R-Manchester, opposes it.

“The time has come and gone," Adams said of chances to pass the ban.

If the bill is dead, who killed it? The most common explanation offered during a series of short interviews with senators was the "leadership," members of which have publicly said the bill didn't have the support it needed to bring it to a vote. However, some senators said it did.

“Leadership is not willing to hear it,” said Amy Barkley, chair of the Kentucky Smoke-free Coalition. “It is a small group of people in leadership who don't want to bring it to a vote. Why should a small group hold it up?” Barkley said that she would like leadership to "allow a vote, regardless of the results."

Sen. Tom Buford, R-Nicholasville, said the leadership "makes the decision about whether we hear a bill or not."

Stivers has said he opposes the bill because it would be too much government intervention into private business, and Buford said many other Republicans feel likewise. He said many members of his party "just do not want anybody to tell anybody what to do anymore."

Sen. Perry Clark of Louisville, a libertarian-oriented Democrat and Public Protection Committee member, said Republican leaders strategically placed the bill in the committee.

"It doesn't look like it will [be passed] as long as it is in Albert Robinson's committee," Clark said. "He is adamantly opposed to it. They knew that when they put it in his committee. They could have put it in Julie's committee and she is adamantly for it," he said.

The co-chair of the committee, Sen. C.B. Embry, R-Morgantown, said "Leadership determines what we vote on and when we vote. All the committees serve at the will of the leadership."

"If leadership wants it to pass, it's going to be heard," said Sen. Dennis Parrett, D-Vine Grove, a member of the committee.

Stivers, asked where the leadership stood on the issue, said "Until I see, or other people see in the leadership group, that there is support in the caucus for the issue, it is not going to come to the floor. If there is, it will. I haven't seen that groundswell of support for the issue." Floor Leader Damon Thayer, R-Georgetown, said likewise.

Another obstacle contributing to the bill's death was the Republican policy of not allowing bills to reach the full Senate unless they are favored by a majority Republicans, who have 27 of the 38 Senate seats.

Perhaps another was indicated by the latest lobbying report from the parent firm of Philip Morris Cos., Altria Group, saying that its legislative agents were lobbying against it. The sponsor of the House bill, Rep. Susan Westrom, D-Lexington, has said Kentucky Farm Bureau was her main foe.

Still, some senators thought there were enough votes for it to pass a floor vote.

“It would pass the floor," Buford said. "I think when you turn the light bulb on and they all have to show their hand, it would pass." Parrett agreed, and so did Sen. Morgan McGarvey, D-Louisville, a co-sponsor of the bill.

While Adams said she thought likewise, she also said she could not say that with "full confidence" because she had found in talking to the senators that many of the potential "yes" votes in the Senate wanted a bill without amendments. The House added provisions that these senators needed time to "digest" and "this session just wasn't long enough for us to do it," Adams said.

Advocates and sponsors continued to work on the bill even after its unfavorable assignment. Early on, co-sponsor Dr. Ralph Alvarado, R-Winchester, explored fellow senators' interest in an amendment allowing local governments to opt out of the ban, trying to make it more palatable to those who strongly favor local control. The advocacy groups opposed such an amendment.

"We rolled it out there and I just don't know that we had enough support," Alvarado said. "I asked individual members what their thoughts were and I got a lot to switch their vote and some who came to the fence, but the fence is not a yes, so that makes it a bit tougher. It would probably get some votes."

Buford said the opt-out option "keeps us from getting a vote" because he thought most senators wanted the law, if passed, to be consistent among all 120 counties.

Sen. Julian Carroll, D-Frankfort, a Public Protection Committee member, said he also opposed the amendment. "I think to make it an effective health statement and to attack the problem associated with so many diseases that result from not only smoking, but secondhand smoke, we have got to attack the problem itself," he said.

Senate President Pro Tem David Givens, R-Greensburg, said the opt-out option "never really caught fire" but he was "confident that it would have caught some votes."

Plans to resuscitate the smoking-ban bill are already under discussion.

"It is not going away," Adams said. "It is very near and dear to my heart, not only from a health standpoint, but from an economic development standpoint – it is very good for business in Kentucky – and finally from a fiscal standpoint, because the savings that we could realize from implementing a smoke-free statewide policy are just too dramatic to discount."

Adams said that they "would take up the House bill in the interim and see what those amendments mean and see if we can't get those people a clean smoke-free bill."

But Alvarado remains interested in compromise. "I think having an all or none response is going to probably get more of a none, so you have to find some method of coming to the middle," he said. "We are hoping that as more and more people come to side with us that they will put pressure on legislators to say this is OK."

Even Stivers offered advoctes some hope when he said that he was "one of 38" senators and that he had been known to put bills on the floor for a vote, despite his opposition, if "there was support in this chamber for that issue" and noted that more Republicans were "wanting to push the issue forward."

Republican Caucus Chair Dan Seum of Louisville said, "I think it is an idea whose time will come. It is about education and moving people (forward). It is also a generational thing."

Givens said that he did see a future for a smoke-free Kentucky, complementing the proponents and how they have conducted themselves in the discussion.

"It is an advocacy effort," he said. "What is happening is the same as what happens with lots of pieces of legislation. There is a large educational component to it and by the proponents continuing the conversation, continuing to promote the effort, they are educating the populace and educating people that elect us – when they start to move the electorate, they certainly start to move us."

Polls in the last year have shown that 57 to 66 percent of Kentucky adults support a smoking ban.

Another study suggests that lack of walking and other physical activity damages blood vessels and causes many health issues

If you are looking for a reason to commit to daily exercise in 2015, here are two: The U.S. surgeon general says most of us only exercise about half the recommended amount to be healthy, and a new study shows that this lack of activity damages our blood vessels, which contributes to much of what ails us.

Research at the University of Missouri School of Medicine, published in Medicine and Science in Sports and Exercise, found that going from high (10,000 steps a day) to low levels of daily physical activity (5,000 steps a day) for just five days decreases the function of the inner lining of the blood vessels in the legs, according to a news release from the university.

“The impairment we saw in just five days was quite striking,” Paul Fadel, associate professor of medical pharmacology and physiology at the university, said in the release. “It shows just how susceptible the vascular system is to physical inactivity.” Previous studies have found that a decrease in blood-vessel function is linked to early cardiovascular death and hypertension.

Kentucky is the ninth most inactive state, with almost one-third (30.2 percent) of Kentuckians reporting in a national survey that they did not engage in physical activity or exercise during the previous 30 days other than doing their regular jobs, according to the State of Obesity report.

A collective New Year's resolution by Kentuckians to increase their physical activity, if kept, would help improve almost every health issue that plagues our state: obesity, diabetes, high blood pressure, heart disease. Kentucky ranks fifth in obesity, 17th in diabetes and fifth in hypertension, and is projected to have more than 1 million cases of heart disease by 2010, the report says.

“Inactivity is typically going to lead to people being overweight and obese,” Fadel said. “The next step after that is insulin resistance, which leads to Type 2 diabetes and cardiovascular disease.”

So, how much activity do we need to keep our blood vessels healthy? 10,000 steps every day, says the surgeon general. But the reality is that most of us only take 5,000 steps a day, which is considered a low activity level. The research for this study is based on 30 minutes of moderate activity a day.

“We need to teach and explain to people about the physiology of their bodies and the physiology of the disease process and help them understand that inactivity plays a foundational role in the disease process,” John Thyfault, associate professor of nutrition and exercise physiology at the university, said.

“Then we give them behavioral tools, like pedometers, to monitor and help them achieve higher physical activity so they start to see and feel health improvements. These studies are proof we need to get people to understand their activity every day plays a role in their health, and that their health is not simply a matter of body weight and how they look in the mirror.”

Americans' sweet tooth blamed for increases in obesity and diabetes; new website explains the dangers of too much sugar

A new website called SugarScience is now available to help consumers understand the health dangers of sugar in our lives, Lisa Aliferis reports for NPR.

This University of California, San Francisco project examined 8,000 studies and research papers and "found strong evidence that over-consumption of added sugar contributes to three major chronic illnesses: heart disease, Type 2 diabetes and liver disease," Aliferis writes.

"Right now, the reality is that our consumption of sugar is out of whack, and until we bring things back into balance, we need to focus on helping people understand what the consequences are to having the average American ... consume too much added sugar," Laura Schmidt, a professor of health policy at UCSF and leader of this project, told Aliferis.

SugarScience is a user-friendly website that partners with health departments across the country to educate the public. Two departments have already agreed to participate in the outreach, Aliferis writes.

Schmidt told Aliferis that the food environment is the driver of the increased obesity of Americans in the last generation: "Sugar isn't just making us fat, it's making us sick."

"It's not like Americans suddenly lost their will power," she said. "The only major change in the diet that explains the obesity epidemic is this steep rise in added sugar consumption that started in the 1980s."

What our average daily diet of added sugar looks like

Schmidt said that while not all sugar is bad, we need to determine how much sugar is too much, pointing out that Americans consume the "equivalent of 19.5 teaspoons a day in added sugar, " Aliferis reports. She also suggest there is a need for federal guidelines to recommend a limit.

"SugarScience suggests the same limits advocated by the American Heart Association and the World Health Organization: no more than 9 teaspoons a day for men and no more than 6 teaspoons a day for women," Aliferis writes.

A taste of what the SugarScience website tells us is: Added sugar hides in 74 percent of packaged foods; fructose, a common type of sugar, can damage your liver more than other kinds of sugar; and one 12-ounce can of soda a day can increase your risk of dying of heart disease by one-third, Aliferis reports.

It also suggest the best way to cut down on sugar is to stop drinking sugar-sweetened drinks, saying this is where we get more than one-third of added sugar in our diets. Another suggestion is for us to read nutrition labels, suggesting that if a chemical on the label ends in "ose," it is probably sugar.

Dean Schillinger, a professor of medicine at UCSF and a primary care doctor at San Francisco General Hospital, is also part of the SugarScience team. He told Aliferis that beds in his hospital that used to be filled with AIDS patients are now filled with diabetes patients.

"The ward is overwhelmed with diabetes — they're getting their limbs amputated; they're on dialysis. And these are young people. They are suffering the ravages of diabetes in the prime of their life,"Schillinger told Aliferis.

"We're at the point where we need a public-health response to it, " he said.

A close call with his heart helped a 36-year-old man change his life; UK opening cardiovascular unit to help those like him

A lifetime of eating poorly and smoking a pack of cigarettes a day landed one man in the hospital with a heart condition that usually kills half of its victims; but quick thinking, surgery and a complete turn around in his lifestyle will hopefully allow him to reach his goal of walking his daughter down the aisle when she grows up, UKNow reports.

Jarrett Spriggs

Jarrett Spriggs told the University of Kentucky news service that if he skipped breakfast, he typically ate a "fast-food combo meal, plus an extra sandwich and two extra-large sweet teas" for lunch, followed up with only meat and potatoes for dinner and plenty of snacks, often a full-size bag of chips, and sugary drinks in between. Add to that ... a pack of cigarettes a day.

"A recipe for disaster," says the release.

The disaster hit in May when Spriggs, 36, woke up with "terrible chest pains" that "moved from my chest to my left arm," he said in the release. And despite the immediate 911 call, he and his wife Amy thought this would simply be a case of "expensive heartburn."

But instead, Spriggs was experiencing a rare type of a "deadly condition" called ascending aortic hematoma, which occurs when a tear develops in the inner wall of the main artery that carries blood from the heart. His specific condition is known as an aortic dissection and it often causes patients to bleed to death before they can reach a hospital, says the release. This is the same condition actor John Ritter died from in 2003.

Spriggs survived a five-and-a-half-hour hour surgery in which a portion of his diseased aorta was replaced with a tube made of cloth.

“Jarrett is a very lucky man, because the mortality rate for an aortic dissection is 50 percent, and the variant Jarrett experienced is pretty rare,” Dr. Hassan Reda, his UK HealthCare cardiothoracic surgeon, said in the release. “He acted quickly to get help, and he got to the right place.”

Post-surgery, Reda told Amy that Spriggs "had the heart tissue of an 80-year-old man and without some drastic changes, he likely would not live to see his 50th birthday."

This prognosis has led to some drastic changes in Spriggs' life. He told UKNow that it was a "wakeup call from God."  He immediately quit smoking; he now uses a diet and exercise phone app; and has involved the entire family in his efforts. He has lost almost 50 pounds in five months and says his motivation is to be alive to walk his daughter, who in now 10, down the aisle.

The UK Chandler Hospital is opening a new 64-bed cardiovascular unit in December to help patients like Spriggs. It not only incorporates many elements that already exist in the hospital, according to the release, but will add new features to improve patient recovery.

One of these new features is a guided walking path within the unit for patients and visitors to use. "Research demonstrates that when patients begin exercising in the hospital they are more likely to continue that activity at home," says the release.

The unit will also offer a "state-of-the-art interactive TV system in every patients room that will provide patients with information and educational materials about their diagnosis, their care team and their treatment plan." The information will also be available on patients' home computers.

“Cardiovascular disease, smoking, obesity and physical inactivity are the modern plagues of our society,” Dr. Alison Bailey, director of preventive and ambulatory cardiology and cardiac rehab at UK's Gill Heart Institute, said in the release. “The good news is that these are almost always reversible diseases that can be treated, if not cured. The goal of cardiovascular rehabilitation is to help patients shift back into a healthy lifestyle in a safe, fun environment.”

Appalachian Kentucky has much of what it needs to improve its poor health status, key federal officials agree

By Al Cross
Kentucky Health News

Appalachian Kentucky has the enthusiasm, creativity, people and facilities needed to greatly improve its dismal health status, two high-ranking federal officials said after looking at the problem on a recent tour.

Dr. Thomas Frieden, Rep. Hal Rogers

"I want to stir up our people to get involved in a grass-roots effort," U.S. Rep. Harold "Hal" Rogers, R-Somerset, who hosted Dr. Thomas Frieden, director of the federal Centers for Disease Control and Prevention, on a four-stop tour of his Fifth Congressional District in early August.

Rogers and Frieden were guests on KET's "One to One" Sunday afternoon, in a program recorded right after they returned from their trip, where Frieden said he saw much creativity and enthusiasm.

Using one of Rogers's favorite sayings, Frieden said, "If you plan your work and work your plan, you may very well have tremendous success."

Rogers said what struck him most about the trip was "the infrastructure we already have in place," including hospitals, health departments, doctors and other health providers, and he wants to "talk about enhancing them.

Rogers is in a position to do that with federal money, because he is chairman of the House Appropriations Committee. He is also co-founder, with Democratic Gov. Steve Beshear, of Shaping Our Appalachian Region, an initiative to improve the economy of Eastern Kentucky.

Asked by "One to One" moderator Bill Goodman where the role of government begins and personal responsibility for health begins, Frieden said, in an apparent reference to smoking bans, "You don't want to go to your job and get cancer as a result."

"We don't tell people what to do" at the CDC, he said, but offer communities choices from a list of proven programs. Earlier, he said smoke-free laws not only reduce smoking, but heart attacks among non-smokers.

Rogers said he asked Frieden what one thing he would recommend for improving personal health in the region, and the doctor replied, "Walk."

Frieden said walking is an especially good option for Kentuckians because they have such a beautiful state. However, many rural areas in the state lack sidewalks or other easily accessible places to walk.

"Physical activity is the closest thing we have to a wonder drug" for all sorts of ailments, Frieden said, "but you have to do something you love to do" in order to stick with it. He said it also helps children be good students: "The more physical activity they get, the better their minds will work."

That point was made a few days before the two men's trip, at the Kentucky Summit on Childhood Obesity and Physical Activity at the University of Kentucky.
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KET will look Monday night at why lack of sleep is bad for your health, and offer advice on improving sleep quality

We live in a country where a third of adults report that they get less than six hours of sleep a night, which doesn't seem like a big deal until you consider the health risks that are associated with insufficient sleep.

The next edition of KET's "Health Three60" will explore these risks and advise how to improve your sleep quality. The program, "Sleepless in Kentucky," will air Monday at 10 p.m. ET.

Host Renee Shaw and guests will explore links between sleep deprivation and weight gain, diabetes, heart disease, cancer, skin issues, anxiety, concentration skills and impaired motor abilities. They will also look into how screen time (TVs and computers) affects sleep.

The show will discuss sleep apnea, treatments and what to expect in a sleep study. These issues will be examined by Jay McGuire, manager of the University of Louisville Physicians Sleep Center, and Dr. Egambaram Senthilvel, pediatric sleep specialist with University of Louisville Physicians.

The program will also examine how to improve sleeping habits by changing our sleep culture, including discussion about what can be done in schools and the workplace.

Other guests will include Dr. Phillip W. Bale of Glasgow Primary Care; Dr. Barbara Phillips, professor and medical director of the University of Kentucky Sleep Laboratory; and Dr. Mohamed A. Saad, director of the University of Louisville Physicians Sleep Center.

The series is funded in part by the Foundation for a Healthy Kentucky. (Read more.)

Women leading Kentucky health: State health commissioner sees 'stars aligned' for Kentucky to finally get healthier

Health Commissioner Stephanie Mayfield Gibson

This is the third in a series of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick

Kentucky Health News

“The stars have aligned” and Kentucky has at last “created an infrastructure” to make the state healthier, says Dr. Stephanie Mayfield Gibson, commissioner of the state Department for Public Health.

“What a great time to be in my position,” Mayfield said in an interview, in which she enthusiastically ticked off a list of aligned stars:

• Her bosses, including the governor and lieutenant governor, who are “extraordinarily supportive of health care;”
• The expansion of the federal-state Medicaid program to households with incomes up to 138 percent of the federal poverty level;
• The Kentucky Health Benefits Exchange, branded as Kynect, where Kentuckians sign up for Medicaid or subsidized private insurance;
• The Kentucky Health Information Exchange, an electronic network that makes a wide range of health information easily available; and
• Programs that enhance the quality of care to get better outcomes and decrease costs, such as the programs to stop over-use of emergency rooms.

Mayfield says her top priority is to decrease exposure to tobacco, because so many of Kentucky’s health issues are related to its most famous crop. About 28 percent of Kentuckians smoke, and “The single most important factor that negatively impacts the health of the commonwealth . . . is exposure to tobacco smoke,” Mayfield said. “I want people well.”

She said Kentucky must also address the epidemic of painkiller abuse, which has made it one of the top three states in deaths related to abuse of opioids; and obesity, which is connected to cancer, diabetes and cardiovascular disease. Kentucky ranks in the top five in each of those diseases, and is in the top 10 for child and adult obesity.  

“Who wants the reputation for being number one in cancer deaths?” Mayfield asked. “We know we can do better. These are winnable battles.”

These and other issues are included in Kentucky Health Now, a plan Gov. Steve Beshear has set forth to improve the health of Kentuckians, with specific goals to be reached by 2019, the end of the next gubernatorial term. Beshear’s term ends in December 2015.

Mayfield is vice-chair of the team overseeing the effort, led by Lt. Gov. Jerry Abramson.  She seems to have the full confidence of Audrey Haynes, the secretary of the Cabinet for Health and Family Services, who lit up when asked about her, but Haynes said she had to make sure that Mayfield, a pathologist who ran the state health lab for seven years, was cut out to be the state’s top doctor.

“It’s a job where … you have to kind of have a better understanding of politics,” Haynes said.  “But I wanted her to rise above all that because she is the public health commissioner. Hers is more about the science.  I need her to be honest and tell the truth.”

Haynes said she told Mayfield, “You are going to tell people what they don’t want to hear sometimes, but always stick with science.  You have to rise above the rhetoric, no matter what.”

“And so I recommended her to the governor and they also fell in love with her.” She became commissioner on Oct. 1, 2012.

Kentucky’s health problems have mounted for decades, but Mayfield is optimistic that they can be overcome because of the Medicaid expansion and increased access to health insurance under the federal health-reform law. Thousands of people have sought care for problems that went untreated because they had little or no money or no insurance.

The federal government is paying the entire cost of those newly eligible for Medicaid until 2017, when the state will begin paying 3 percent, rising to the law’s cap of 20 percent in 2020.  Republican legislators and candidates for governor have voiced concern about the state’s ability to pay its Medicaid bills.

Mayfield said the state is working on controlling costs, through the managed-care system that began in 2011.  One target of cost control is the “super-utilizers” of emergency rooms, or those who come to hospital emergency departments 10 or more times per month.

Mayfield, who was put in charge of finding a way to reduce super-utilizers, said 80 percent of them have mental-health issues, so she is working on the problem with Medicare, the state Department of Behavioral Health and Kentucky’s three medical schools. Kentucky is one of six states accepted into the National Governors Association Policy Academy to address super-utilization.

Dr. William Hacker, who preceded Mayfield as commissioner, said her broad training and deep experience in the department uniquely qualified her to succeed Dr. Steve Davis, who was interim commissioner after Hacker retired.

“She is multidisciplinary and thinks beyond the public-health world,” Hacker said. “She has done an excellent job.”

Mayfield, who has been nationally recognized for her contributions to the state’s electronic health information exchange, also stresses the importance of using technology to improve the health of Kentuckians – especially those who live in rural areas, far from specialists.

Mayfield describes her style of leadership as one of action.  “If we say we are going to do something, then let’s build that infrastructure and let’s get it done,” she said.

Hacker said, “Dr. Mayfield is a thoroughbred.  She is on the go at 90 miles per hour.  She is focused on accomplishing goals.”

Haynes said Mayfield “led massive change at the lab” and knows “how to cajole and support and lead” – and when to be firm. “There are times you have to stick to your guns. You have to choose sort of your poison and you have to say ‘I’ll give you this, but I’m not giving this.’ I needed somebody that didn’t feel the political pressure to give in, and that would stick with it. And really just be a great public face of public health.  And she is all of that.”

Health issues facing Appalachia, focus of CDC director's tour, could be a forewarning of where the country is heading

The chronic health issues of Appalachia, the focus of a recent tour by the head of the federal Centers for Disease Control and Prevention, are really no different than the chronic health issues the entire country faces; they are simply more concentrated in one area, Laura Ungar writes for The Courier-Journal and USA Today.

"It's about proportion and intensity rather than something unique that's happening there," Jesse Roman, chairman of the Department of Medicine at the University of Louisville, told Ungar. "The problem is larger and more visible there, but they're not alone."

Ungar describes the health challenges of one couple in Appalachia, 48-year-old Alisha Blankenbeckler and her husband, Tony. Alisha has diabetes, bowel and bladder problems and is on oxygen. Her condition makes it hard to take care of her husband who has heart disease and hip problems since being struck by lightening in 2010. He takes 11 pills a day; she takes 30.

"Dying is something I think about every day," Alisha told Ungar.

This story, Ungar reports, is common in the Appalachian region, which is considered one of the nation's unhealthiest regions.

Heart disease prevalence is 84 percent higher in the region than the national average, diabetes is 47 percent higher, and lung cancer kills at a rate 83 percent higher. The region has the highest-in-the-nation smoking rates, with nearly a third of adults smoking cigarettes, and Kentucky has the highest number of deaths caused by cancer.

"We're in the stroke belt, the diabetes belt, the coronary valley. We get all those labels," Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health at Hazard, told Ungar. "We're in a sad state here."

Some experts say Appalachia "may be a harbinger of where the country is headed if we don't rein in epidemics like obesity," Ungar writes. Obesity spawns "diabetes, heart disease and many cancers and spanning all socioeconomic levels/."

CDC Director Tom Frieden recently toured Eastern Kentucky to "find out more about the underlying causes of the region's ills and how to treat them -- and in the process gain traction against the rising burden of chronic disease that ails the nation," Ungar reports.

"The Appalachian region is just like the rest of the U.S. — only more," Frieden said on the tour. "We want to help an entire community and a whole nation."

Ungar writes, "Appalachia, like some blighted urban areas and Native American reservations, mixes several ingredients of poor health: doctor shortages and access-to-care problems; stressful, unhealthy lifestyles; low education levels; and insidious poverty."

Alisha Blankenbeckler told Ungar that at times she has had to stretch her insulin by taking less than the prescribed amount and once needed to go to the hospital but didn't because she had no insurance or money to pay the bill. She recently got insurance through the state's Medicaid expansion, and her husband is on Medicare, but that doesn't guarantee access to all the care they need because of required Medicare co-payments, medical equipment that is not covered, and gas to get to the doctor. The couple gets disability benefits of $1,427 a month.

Though more than half a million Kentuckians have enrolled in health insurance through the Affordable Care Act, "access to health care is difficult in Appalachia," Roman told Ungar.  "And there seems to be something about culture — a sense of fatalism, that whatever happens, happens."

Ungar writes that Friden and Benjamin Sommers, assistant professor of health policy and economics at the Harvard School of Public Health "say improving the health of Appalachia and like communities will not be easy, because it depends on changing seemingly intractable socioeconomic disparities and personal health habits."

Frieden said that while outreach and health education is crucial, he will "listen and take cues from local communities about how best to attack their particular health problems. If he finds an effective program, he said, he will replicate it and fit it to other communities."

If you've had a stroke, learning how take your pulse and recognize an irregular heart beat could prevent second stroke

Regularly monitoring your pulse after a stroke is a simple and effective first step in detecting an irregular heartbeat, which is a major cause of having a second stroke, according to research recently published online in Neurology, the medical journal of the American Academy of Neurology.

“Screening pulse is the method of choice for checking for irregular heartbeat for people over age 65 who have never had a stroke. Our study shows it may be a safe, effective, noninvasive and easy way to identify people who might need more thorough monitoring to prevent a second stroke,”  Bernd Kallmünzer, author of the study, said in a release.

Stroke is the leading cause of death in the United States, killing nearly 130,000 Americans each year, according to the Centers for Disease Control and Prevention. In 2010, stroke was the No. 5 killer in Kentucky, according to the American Heart Association.

For the study, 256 participants, all who had experienced the same type of stroke, and the patients´ relatives were given instructions on how to take a pulse and how to detect an irregular heartbeat. The manually taken pulse measurements were then compared to electrical recordings of the pulse. Six people in the study had false positive results and 17 people had false negative results.

“The low rate of false positives in this study shows that health care professionals, caregivers and patients can be guided to use this simple tool as a first step in helping to prevent a second stroke,” Kallmünzer said in the release. For more information about the signs and symptoms of stroke click here.

Choose a diet specific to your health needs, and recognize that even small changes will create a healthier you

Dieting doesn't just mean cutting back on calories anymore. Now you can choose a diet based on specific outcomes such as weight loss, heart health or diabetes control, writes Travis Thomas, assistant professor in the Division of Clinical Nutrition at the University of Kentucky College of Health Sciences.

Nutrition professionals embrace having more than one choice in dieting, recognizing that a single diet plan doesn't suit all people, Thomas writes. The goal is to "tailor a diet strategy to the goals and personalities of each patient," with the understanding that a structured diet plan makes dieting easier.

But just because there are plenty of diets to choose from doesn't mean they are equally recommended.

U.S. News and World Report recently posted the Best Diets Rankings for 2014, evaluating 32 of the most popular diets. They were evaluated on ease to follow, nutrition, safety and effectiveness for weight loss and whether they were against diabetes and heart disease.

Many of the trendy diets like Atkins, which ranked No. 29; Zone, No. 22; and Paleo, No. 31, are near the bottom of the U.S. News rankings. The DASH diet, developed to fight blood pressure, and the TLC diet, or Therapeutic Lifestyle Changes diet, ranked Nos. 1 and 2.

Thomas says it is important to recognize that no one diet is right for everyone, and to remember that our dietary needs change throughout life. For example, certain medical conditions such as pregnancy have specific dietary recommendations that many popular diets don't support. He also notes that sometimes the list of restrictions in some diets is not sustainable.

And for those who find following a rigid diet plan overwhelming, Thomas recommends starting small.

Making small lifestyle changes that include the attributes found in the top-rated diets is also effective in improving overall health, Thomas writes. Incorporating a balanced diet high in fruits and vegetables, paying attention to what you eat and including structured exercise will "improve overall health without the perceived rigidity of a traditional diet plan."

"Recognize that significant diet overhauls may be difficult to maintain long-term and are not always indicated or scientifically validated," Thomas writes. "Consider starting with small, manageable changes to help you on your way to a healthier life."

For more information on diet and lifestyle go to www.choosemyplate.gov.

Paducah Baptist and Ashland hospitals 'above average' in Consumer Reports' ratings of hospitals for heart surgery

Baptist Health Paducah
(formerly Western Baptist Hospital)

By Melissa Landon
Kentucky Health News

Consumer Reports has reported ratings of hospitals for heart-valve and coronary artery bypass surgery based on hospitals' reports to the Society of Thoracic Surgeons. More than 400 hospitals in 45 states have been rated, based on "medical records showing whether patients survived the procedure and how they fared on other important measures, including complications," the magazine says.

Although more than 1,000 hospitals send data to STS, only 400 allowed it to be shared with Consumer Reports. Of those did, "20 percent (83) were above average, 75 percent (310) were average and 4 percent (18) were below average," the magazine reports. Robbin Cohen, a cardiothoracic surgery professor at the University of Southern California, said the STS has very high standards, so hospitals with average scores do a very good job.

King's Daughters Hospital, Ashland

King's Daughters Hospital in Ashland and Baptist Health Paducah (formerly Western Baptist Hospital) were the only Kentucky hospitals ranked above average for either type of procedure (and in their cases, only for bypasses). King's Daughters recently agreed to a huge settlement with the federal government for doing unnecessary heart procedures.

Four Kentucky hospitals were listed as below average for both procedures: Lourdes Hospital in Paducah and Jewish Hospital, Norton Hospital and Norton Audubon Hospital. Two were listed as below average for bypass and were not listed for valve: Baptist Health Lexington and Baptist Health Madisonville.

Several hospitals near Kentucky were on the list. Mercy Health-Anderson Hospital in Cincinnati was rated below average for bypass and was not listed for valve surgery. In Missouri, Poplar Bluff Regional Medical Center and Cape Girardeau's Saint Francis Medical Center were rated below average on both.

In Tennessee, Nashville's Tristar Centennial Medical Center and Saint Thomas Midtown Hospital were below average on both, but Saint Thomas West Hospital, was above average for bypass and below average on valves. In Knoxville, the Univerity of Tennessee Medical Center and its Fort Sanders Regional Medical Center were below average on both, and Parkwest Medical Center was above average on bypass and below average on valve. Wellmont Holston Valley Medical Center in Kingsport was below average on both, and Johnson City Medical Center was above average on bypass and below average on valves.

The top hospitals in the nation were Baystate Medical Center in Springfield, Mass., Borgess Medical Center in Kalamazoo, Mich., and Cleveland Clinic, which attracts some Kentuckians. To see the full list of ratings, click here.

Study indicates that vitamin D can help prevent early death from cardiovascular disease and cancer

Elderly people with a vitamin D deficiency are more at risk for death from cardiovascular disease and cancer, according to a large-scale study by the Mount Sinai health system of New York and a group of international collaborators, published in the June issue of BMJ, formerly British Medical Journal.

Paolo Boffetta of the Tisch Cancer Institute at Mount Sinai led a collection and analysis of data that showed a significant association between low vitamin D levels and risk of death not only from cardiovascular diseases and cancer in older people with a history of cancer, but death from all causes.

Other studies showed that vitamin D helps prevent issues like hypertension, diabetes and bone loss, but these new findings suggest it might be even more important than previously known. "Going into our study, the effect of vitamin D supplementation on risk of death was not clear," Boffetta said. "Our analysis confirms the protective nature of this substance, especially in elderly patients."

Sunlight, as well as food and supplements, provide vitamin D. Because elderly people generally get less sun, they're more likely to have a vitamin D deficiency. Though researchers don't yet know how much vitamin D is ideal, the study results do argue that people with a vitamin-D deficiency are more likely to die early than those who don't have such a deficiency, Boffetta said.

Researchers use data from eight different studies including 26,018 men and women between ages 70 and 79. During the study, 6,695 participants died—2,624 from cardiovascular diseases and 2,227 from cancer. Participants with the lowest levels of vitamin D had a risk ratio of 1.57, which was double the death risk of the people with high concentrations of the vitamin.

"Vitamin D's protective effect is clear," Boffetta said. "If our results are confirmed in additional studies, it could lead to recommendations for greater vitamin D supplementation in foods and to a better understanding of its role in cancer prognosis." (Read more)