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Health CONSUMER REPORTS INSIGHTS


The do’s and don’ts of caring for your heart C


ardiovascular disease remains the No. 1 killer of men and women in the United States, in part because heart attack victims often don’t recognize the symptoms and


delay getting care. Of course, it’s better to identify heart dis- ease before you have an attack, but that’s not always easy. And doctors sometimes push high-tech tests and treatments when simpler measures are safer, cheaper and at least as effective. Here are several tests and what you need to know about them:


Stress test. This measures the


heart’s function while it is stressed by exercise or, in some cases, medi- cation. For people with symptoms of heart disease, a stress test should usually be the first test or- dered. And it should be combined with an electrocardiogram and an echocardiogram or a nuclear test, both of which produce an image of the heart. Coronary angiography. This is


the gold standard for confirming heart disease in people with worri- some stress-test results. It involves threading a flexible tube from the groin into the coronary arteries and injecting a dye to make block- ages visible on an X-ray. Going straight to such an invasive test is warranted only for people who are at very high risk of having heart disease or who have symptoms or an underlying condition that could make stress testing risky. CT angiography and electron beam computed tomography. These tests have almost no role in treating people without symptoms of heart disease and are of limited use even for those who do have them.


CT coronary angiography, a


noninvasive test that provides a three-dimensional image of the heart, is widely touted in direct-to- consumer ads. But it carries a hefty radiation dose and can regis- ter false positive results.


Recognize the symptoms Chest discomfort is the most common symptom, but women are somewhat more likely than men to experience other effects, such as nausea, shortness of breath and pain in the back or jaw. Women are also prone to an especially deadly reaction: denial.


If an area is tender when you push on it or hurts more when you breathe deeply, you’re probably


not having a heart attack. But if ex- ertion triggers or worsens the dis- comfort, it might be heart-related chest pain. Symptoms such as cold sweats and difficulty breathing are red flags, although they can be signs of other health problems.


Take action If you suspect you may be hav- ing a heart attack, call 911 immedi- ately. Then chew and swallow one 325-milligram uncoated aspirin (or four 81-milligram baby aspir- ins) to help prevent clots from forming in your coronary arteries. Don’t even think about driving to the hospital yourself or having someone take you. If you’re with someone who might be having a heart attack, ask whether an auto- matic electronic defibrillator (AED) is available.


Get the right treatment The hype for high-tech solutions


affects not only tests but also treat- ment, partly because some doctors and hospitals have a financial in- centive to keep the gadgets hum- ming and partly because of persis- tent, outdated notions. Heart disease is often described as something of a plumbing prob- lem. Under that model, cardiolo- gists pinpoint blockages using an- giography and then use angioplas- ty, or percutaneous coronary intervention (PCI), to snake a bal- loon into an artery and inflate it, crushing deposits of plaque that impede the flow of blood through the coronary arteries. In most cases, doctors also insert a metal stent to prop open the vessel. That might relieve angina, or chest pain on exertion, but it won’t necessarily prevent heart attacks. Yet some doctors recommend PCI immediately after angiography re- veals coronary narrowing, often while the procedure is still un-


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TUESDAY, SEPTEMBER 7, 2010


The Checkup 6voices.washingtonpost.com/checkup


Adapted from the Post’s daily health blog.


Got bedbugs? Don’t poison yourself. If you’re using pesticides meant for outdoor use to get rid of bedbugs in your home, the Environmental Protection Agency wants you to stop. Bedbugs are resurging, enabled in part by the EPA’s 1972 ban of DDT, which did a great job of eradication before it was deemed carcinogenic. The pest-control company Terminix last week released its list of the 15 most-bedbug-infested cities in the United States: Washington came in ninth. Apparently, many people are so bent on protecting their homes that they’re using products meant to keep golf courses insect-free indoors, even on their mattresses. But doing so can be hazardous to your health. “Never use a pesticide indoors that is intended for outdoor use. It is very dangerous and won’t solve your bedbug problem,” the agency warns. Officials in Ohio, which has some of the worst infestations,


have asked the EPA to reconsider its ban on the indoor use of propoxur, a neurotoxic pesticide that is effective against bedbugs. But it’s considered toxic to humans as well. — Jennifer Larue Huget


HEALTH SCAN ALAMY DIABETES


derway. Unless a patient has just had a heart attack or one appears imminent, there’s usually plenty of time to discuss alternatives, includ- ing drugs, exercise and a healthful diet.


If testing reveals severe blockag- es, immediate PCI or bypass might be necessary. Bypass often makes sense when major coronary arter- ies are blocked; PCI might be an op- tion if one or two vessels are blocked. Bypass or PCI can also be appropriate if symptoms don’t im- prove after three to six months of drug therapy.


Top-rated surgical groups The Consumer Reports Health


Ratings Center has teamed up with the Society of Thoracic Surgeons to publish ratings of heart-bypass sur- gical groups based on how their re- sults compare with national stan- dards for survival, complications and other measures. More than 1,000 such groups


perform bypass surgery in the United States. Almost all of these groups voluntarily submit per- formance data to the STS, and 221 of them agreed to allow Consumer Reports to publish the ratings they received from the STS: one star (be- low average), two stars (average) or


three stars (above average). Of the 221 groups, 50 received three stars, 166 were given two stars, and five garnered one star. Since the average performance of surgical groups has increased sub- stantially in the past two decades, it’s possible to get very good care from many two-star groups. People considering a group that has not made its rating available to Consumer Reports should ask that group about its performance. “Those groups should be willing to provide their results, and if they can’t share their information, then it’s best to look elsewhere,” said John Santa, director of the ratings center. Details about the ratings can be found in the October edition of Consumer Reports magazine; they’re also available online to sub- scribers at www.consumerreports health.org. The Consumer Reports listing includes two groups in the District that received three stars: Frederick Lough, MD, and Surgeons (George Washington University Hospital) and Washington Regional Cardiac Surgery (Washington Hospital Center).


Copyright 2010. Consumers Union of United States Inc.


Mom’s got a system for boosting the family’s immune system AnyBODY


Carolyn Butler F


aithful readers of this column will recall that last school year was a


particularly brutal one, minor-illness-wise, for the Butler family, complete with runny noses, hacking coughs and the not-so-occasional stomach flu. So as we come to the tail end of a perfectly healthy, happy, snot-free summer and head back to school —with all those germs! — Mom has decided to go on the offensive. My mission? To build up our immunity and prevent colds, viruses and infections as much as possible. That can be a tall order, says


Gerard Mullin, a Johns Hopkins Hospital internist and gastroenterologist. “The change of seasons weakens your immune system by draining your body’s neuroendocrine system and stressing it with the changes in day and night and coldness and warmth, all of which makes you more susceptible to catching a cold or flu.” He notes that being forced back into crowded places such as classrooms doesn’t help matters, nor do changes to bedtime and wake-up routines. “Going back to school and a stricter schedule, and not being able to hang out, sleep late and get up at 10: It’s a new rhythm and a different world for kids,” he explains. “Just like for the rest of us, not getting enough rest . . . plus dealing with the elements, the changing weather and stressors like school or work, can really hamper immune function.” But while it can be a challenge to boost immunity in this situation, it is possible, says Philip Tierno Jr., director of clinical microbiology and immunology at New York University’s Langone Medical Center. “People tend to . . . take special supplements figuring, ‘That will protect me,’ ” he says. “Well, no, your body is what you have to work on: You need to get your organ in perfect shape to be able to defend itself, because the normal body is well adapted to do that.” Experts agree that getting yourself into shape starts with good, balanced nutrition. That means avoiding processed foods, red meat and saturated fats; not overeating; and consuming produce and foods rich in omega 3


SANDY HAIGHT FOR THE WASHINGTON POST


fatty acids, such as salmon, says Mullin, who is also a nutritionist. “It’s interesting that in the fall, root vegetables like yams and carrots, which are all very rich in Vitamin A and antioxidants, which play a huge role in immunity, come up in our diet,” he explains. “If you focus on eating seasonal fruits and vegetables, you’ll get all of the


immune-boosting vitamins and minerals you need without having to think about supplements.” He adds that a wide variety of mushrooms, including shitakes and even plain old white buttons, have also been proven to improve immune function. And since, according to Mullin, it has now been firmly established that the gut is the center of immunity, he suggests regularly eating yogurt with probiotics, which help


maintain healthy gut flora. In addition to urging people to


eat their way to an optimal defense against colds, viruses and the like, NYU’s Tierno, the author of “The Secret Life of Germs,” offers these tips, which he says are all backed by research:  Get moving. Sedentary people are more likely than others to become ill. Exercise — even just a half-hour to an hour of walking — has been shown to keep you functioning and to boost immunity.  Stay rested. It’s essential to get enough sleep — ideally 71


⁄2 to nine


hours — because proper rest helps the body repair injuries caused by stress, illness and invading organisms such as viruses.  Don’t stress. Stress hormones can make you more susceptible to infection. So try not to get worked


up over that resurgent rush-hour traffic and focus on maintaining a less confrontational and low-stress lifestyle.  Look on the bright side. Optimistic people tend to have a better immune response.  Drink up. If you feel a cold coming on, consume plenty of fluids. This helps keep your organ systems functioning optimally and is very important for proper immune response.  Avoid germs. Many people don’t follow basic rules of hygiene. Tierno said it’s important to wash or sanitize your hands frequently —such as after using that germy shared pen at the supermarket — and to steer clear of coughing, sneezing or otherwise obviously ill people.  Get a flu shot. This is one of the simplest means of staying well, particularly for the very young, for older people and for those whose immune systems are compromised. And what about supplements? While drugstore shelves are filled with a plethora of powders and products touting their immune-boosting benefits, the evidence on effectiveness is decidedly lacking. “There’s all types of stuff out there, but even for patients who do have quite significant suppression of the immune system from cancer or HIV, really no pharmacologic means have ever been successful in stimulating the immune system,” says physician David Parenti, an infectious-diseases expert at the George Washington University Medical Center, who doesn’t “think that high doses of any vitamins or other immune stimulants are necessary.” Tierno does recommend taking around 2,000 to 3,000 IU (international units) of Vitamin D daily. But for the most part, claims about immune-boosting products “are bunk, because if you practice all of these diet and lifestyle rules you are going to be getting enough amino acids and vitamins already,” explains Tierney, who says he hasn’t been sick in more than five years.


Consider yourself armed and ready for all of the cold- and flu-fighting to come. health-science@washpost.com


A spiritual take on maintaining health “THE AFRICAN AMERICAN GUIDE TO LIVING WELL WITH DIABETES” (NEW PAGE BOOKS, $15.99) Dietitian Constance Brown-Riggs’s self- help diabetes guide includes the basics, such as body mass index charts, a graphic showing how to read the nutritional infor- mation on food labels and a section on how the body processes sugar. But Brown-Riggs reaches out to the approximately 4 million African Americans with the disease by fo- cusing on spirituality “because people of color tend to be people of faith,” she writes. Each chapter ends with a passage called “For Your Spirit,” which is often a Bible


story. She also discusses how beauty ideals in the community that allow for curvy bodies are “good news for our self-esteem but not so great for our health.” The book ends with a two- week sample menu of healthful Caribbean and soul food fa- vorites.


FITNESS


Dance to a different beat “CARNAVALWORKOUT” (ACACIA, $16.99)


There’s no need to wait until March for Carnaval, no need to fly to Rio to celebrate the holiday. Cue up that DVD player and pop in “Carnaval Workout” for a sweatier and slightly more awkward version of your own! Smiley instructor Kimberly Mi- guel Mullen leads at-home exercisers through three dance segments, plus the warm-up and cool-down, adding up to a 47-minute workout. The first (and the second . . . and maybe third) time through, dancers will need to get used to really moving their hips and mastering the difference between “snake arms” and “vanity arms.” “Carnaval Workout” is a car- diovascularly challenging workout that showcases a dance style not typically used in mainstream American aerobics classes.


PARENTING


All about babies PUREBEBE


If you drop by the mommy blog www.purebebe.com (“pure


baby”) only once, do it on a Friday. That’s when Heather Fruz- zetti, a mother of two in Loudoun County, posts hilarious kid quotes as a recurring feature called “Fantastically Funny Fri- day.” Her readers contribute such gems as this conversation between a 4-year-old named Connor and his mother, which occurred while unpacking a train set. Connor: “Why do these trains look so old?” Mom: “Because they belonged to grandpa when he was a little boy.” Connor (who had clearly seen some sepia-toned photos): “Really? Back in the olden days, back when things were brown?” Other posts on the blog are about “everything safe, healthy and pure for babies ages 0-3 years,” such as homemade baby food, pool safety and making kitchens eco-friendly.


— Rachel Saslow


QUICK STUDY FIBROMYALGIA


Tai chi may help improve quality of life THE QUESTION Might the pain and fatigue of fibromyalgia be relieved by tai chi, the mind-body exercise of Chinese origin that combines gentle, graceful, continuous movements with deep breathing and relaxation techniques? THIS STUDY involved 66 people, mostly women, who averaged 50 years old and who had had fibromyalgia for 11 years, on average. They were randomly assigned to participate in a one- hour tai chi class twice a week and to practice tai chi at home for at least 20 minutes daily or to participate in one-hour classes twice a week that included information sessions (on coping strategies, pain management, nutrition, etc.) and stretching exercises and to practice stretching at home for 20 minutes daily. After three months, tai chi practitioners report- ed less pain, better sleep, improved physical functioning and better life quality overall, compared with the others. Their scores on a standardized scale for fibromyalgia symptoms fell, on average, 28 points (from 63 to 35 on a 0-100 scale, with higher scores reflecting more-severe symptoms), compared with a nine-point drop (from 68 to 59 points) for the others. WHO MAY BE AFFECTED? People with fibromyalgia, a chronic condition characterized by widespread muscle pain, extreme tenderness at various points on the body and fatigue. It affects women more than men. CAVEATS Data were based on the participants’ ratings of their pain and their answers to questionnaires. The number of par- ticipants was small, and the study did not assess long-term ef- fectiveness. The results may have been influenced by partici- pants’ beliefs and expectations, although the researchers said they tried to de-emphasize tai chi by telling participants that the study would test the effects of two types of exercise pro- grams, one combined with education. FIND THIS STUDY Aug. 19 issue of the New England Journal of Medicine. LEARN MORE ABOUT fibromyalgia at www.nccam.nih.gov/ health and www.rheumatology.org.


— Linda Searing


The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment’s effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.


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