Vascular Disease, Blood Pressure, Stroke | On Call with the Prairie Doc | Feb 18, 2016

Vascular Disease, Blood Pressure, Stroke | On Call with the Prairie Doc | Feb 18, 2016


>>THE CIRCULATORY SYSTEM UNDER PRESSURE, NEXT “ON CALL WITH THE PRAIRIE DOC.”>>GOOD EVENING AND WELCOME TO ON CALL WITH THE PRAIRIE DOC.” VALENTINE’S DAY TAKES CENTER STAGE THIS TIME OF YEAR AND OUR THOUGHTS TURN TO ATTRIBUTES OF THE HEART. TONIGHT WE LOOK AT THE EFFECTS OF ENVIRONMENT, LIFESTYLE, AND GENETICS ON THE HEART’S CONTINUED AND PROPER STRENGTH AND RHYTHM. WE’LL LOOK AT SURGICAL AND NON-SURGICAL WAYS TO HELP PROTECT YOUR HEART AND AT BLOOD VESSELS THAT FEED OXYGEN AND NUTRIENTS TO THE CELLS OF THE BODY. FIRST, LET’S TAKE A LOOK AT THIS WEEK’S PRAIRIE DOC QUIZ QUESTION. IT’S A TRUE OR FALSE QUESTION. WHEN A BLOCKAGE OF AN ARTERY OCCURS, THE BODY CAN REPAIR ITSELF BY MAKING ANOTHER BLOOD VESSEL TO BYPASS THE BLOCKAGE. TRUE OR FALSE? VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED INTO A DRAWING TO WIN A SIGNED COPY OF “A PICTURE OF HEALTH.” I WROTE THIS BOOK WITH THE WONDERFUL ACCOMPANYING PHOTOGRAPHS BY DR. JUDITH PETERSON. WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW. REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN! WE ANSWER YOUR MEDICAL QUESTIONS ABOUT HEART DISEASE AS THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL. CALL IN QUESTIONS TO 1-888-376-6225 OR SEND US AN EMAIL. JOINING US TONIGHT FROM NORTH CENTRAL HEART IN SIOUX FALLS ARE DUSTIN WEIS AND MICHAEL BACHARACH. THANK YOU U DOCTORS, FOR JOINING US. AND YOU’RE THE NEW GUY. TELL ME A LITTLE BIT ABOUT YOURSELF, DUSTIN. YOU’RE FROM WHERE ORIGINALLY?>>I GREW UP IN OMAHA, NEBRASKA. THAT’S WHERE I DID MY HIGH SCHOOL AND I DID COLLEGE AT NORTH DAKOTA AND KANSAS. AND I DID MY MEDICAL SCHOOL AT UNIVERSITY OF NEBRASKA, IN OMAHA. I CONTINUED THERE WITH MY GENERAL SURGERY TRAINING, AND THEN I WENT TO YALE FOR VASCULAR SURGERY FELLOWSHIP.>>OH, WOW, YALE. SO THAT’S THAT EAST COAST THING. IS IT REALLY GOOD OUT THERE? [ Laughter ]>>I ENJOYED IT. I HAD A VERY GOOD EXPERIENCE. IT WAS NICE TO BE ON THE EAST COAST FOR A COUPLE YEARS, BUT MY WIFE AND MY FAMILY ARE VERY HAPPY TO BE BACK IN THE MIDWEST.>>YEAH. AND WE’RE GLAD — YOU’RE HERE — HOW LONG HAVE YOU BEEN HERE NOW?>>ABOUT A YEAR AND A HALF NOW.>>GREAT. SO, I MEAN, THIS IS A GREAT GROUP THAT YOU’RE WORKING WITH AND I’M HAPPY THAT YOU’RE HERE. ARE YOU LIKING IT?>>YEAH, VERY MUCH. IT’S BEEN A GREAT EXPERIENCE, I HAVE GREAT PARTNERS, VERY INTERESTING CASES. GREAT PATIENTS THAT ARE APPRECIATIVE OF THEIR PHYSICIANS. IT’S FUN TO WORK WITH THEM.>>WHAT’S THE MOST COMMON PROCEDURE THAT YOU PERFORM? YOU’RE A SURGEON. YOU KNOW, YOU’RE A VASCULAR SURGEON. YOU CAN CRACK OPEN THE HEART, DO BYPASS SURGERY AND YOU WORK ON VESSELS, LIKE MIKE, BUT YOU COME FROM A SURGICAL BASE.>>YEAH. VASCULAR SURGEON, SO I DO BOTH OPEN PROCEDURES, WITH A SCALPEL AND OPEN INCISIONS, PRETTY MUCH ON ANY BLOOD VESSEL, OTHER THAN THE HEART. SO I DO PERIPHERAL BLOOD VESSELS BUT NOT CORONARIES. I ALSO DO ENDOVASCULAR PROCEDURES AS WELL, PROCEDURES, RATHER THAN MAKING A INCISION, DISSECTING DOWN TO THE ARTERY, IT’S A PROCEDURE WHERE YOU GO FROM INSIDE THE VESSEL, TREAT EITHER THE BLOCKAGES OR THE ANEURYSM.>>ENDO, WITHIN. THAT’S KIND OF WHAT MIKE DOES BUT YOU CAME FROM INTERNAL MEDICINE, CARDIOLOGY AND THEN AN INTERVENTIONAL HISTORY.>>RIGHT, RIGHT.>>TELL US A BIT ABOUT YOUR STORY. YOU’RE FROM WHERE ORIGINALLY?>>I’M ACTUALLY A WISCONSIN NATIVE ORIGINALLY. AND WENT TO MEDICAL SCHOOL AT THE UNIVERSITY OF WISCONSIN. AND THEN I TRAINED IN MEDICINE AND CARDIOLOGY AT THE MAYO CLINIC. AND I DID, AFTER COMPLETING MY CARDIOLOGY FELLOWSHIP, I WENT TO THE CLEVELAND CLINIC AND DID AN ADDITIONAL YEAR IN BASICALLY VASCULAR MEDICINE AND VASCULAR INTERVENTION. SO I DID THESE ENDOVASCULAR TECHNIQUES. YOU HAVE TO REMEMBER, THAT WAS A TIME WHEN THIS WAS ALL VERY NEW.>>THAT WAS WHEN?>>ACTUALLY ’92, ’91 AND ’92. SO IT’S BEEN A WHILE.>>YEAH. AND RIGHT NOW YOU’RE ONE OF THE TEACHERS THAT TRAVELS.>>RIGHT. SO THEN I CAME HERE IN ’95. AND I STAYED A COUPLE OF YEARS ON STAFF AT CLEVELAND, THEN MOVED HERE, WANTED TO GET BACK TO THE MIDWEST. SO I NOW CONSIDER SOUTH DAKOTA HOME. I’VE BEEN HERE 20 YEARS.>>SO, AND THEN YOU TRAVEL WORLDWIDE BECAUSE TEACH THESE KINDS OF THINGS.>>YEAH, THE ADVANCES OF GETTING INTO THE TECHNIQUE THAT’S NEW, THERE WEREN’T MANY PEOPLE DOING IT. I’VE HAD AN OPPORTUNITY TO TRAVEL A FAIR AMOUNT AND TEACH. WE WERE ONE OF THE TRAINING PROGRAMS, DUSTIN HELPS WITH THIS, ONE OF THE TRAINING PROGRAMS FOR MAYO CLINIC, VASCULAR SURGEONS COME AND SPEND THREE MONTHS WITH US.>>I LOVE THAT, THE MAYO COMES TO YOU GUYS TO LEARN HOW TO DO THESE THINGS.>>I’M VERY FORTUNATE IN HOW THINGS HAVE WORKED OUT.>>GREAT. WE HAVE A QUESTION FROM LAST WEEK THAT CAME IN. AND I THOUGHT I MIGHT JUST START WITH THAT ONE. 63-YEAR-OLD WOMAN FROM SIOUX FALLS HAS A QUESTION ABOUT PERIPHERAL ARTERY DISEASE. PERIPHERAL MEANING MOSTLY LEGS, ARMS, I MEAN, THAT’S THE PERIPHERAL SYSTEM. A FRIEND HAD A NEW VEIN PUT IN THE LEG AND ONE YEAR LATER IT WAS BAD AGAIN. THEN THEY USED A VEIN FROM THE ARM AND THE LEG IS STILL BLOCKED. WHAT PROCEDURES CAN BE DONE FOR HIM? SO, LET’S TALK ABOUT, WAS IT A VEIN OR WAS IT AN ARTERY OR DID THEY USE A VEIN FOR AN ARTERY? EXPLAIN THAT.>>IT SOUNDS LIKE THEY MOST LIKELY DID A BYPASS. SO, WHAT THEY WOULD DO IS TAKE THE VEIN — USUALLY WE USE THE VEIN FROM THE SAME LEG. IF THAT VEIN IS INADEQUATE, WE USE THE VEIN FROM THE OTHER LEG. LIKE THE PATIENT WHO HAD THE SECOND PROCEDURE, YOU CAN TAKE THE VEINS OUT OF THE ARM. YOU THEN ATTACH THAT VEIN ABOVE WHERE THE ARTERIAL BLOCKAGE IS, YOU SEW IT THERE, YOU DISSECT THE ARTERY BELOW THE BLOCKAGE AND CONNECT THE VEIN THERE. AND, SO, THEN YOU’RE ACTUALLY BYPASSING AROUND WHERE THE BLOCKAGE IS.>>SO IT’S INTERESTING, ARTERIAL MEANING THE FLOW IS FROM THE HEART OUT TO THE VESSELS. THE VEIN IS WHEN YOU’RE BRINGING IT BACK TO THE HEART. YOU TAKE ONE OF THE VEINS AND THEY HAVE VALVES, SO YOU NEED TO MAKE SURE THE VALVES ARE IN THE RIGHT DIRECTION.>>YEAH.>>AND THEN YOU BYPASS THAT ARTERY WITH A VEIN.>>YES, WITH THE VEIN. IT WILL DILATE, CARRY THE BLOOD FLOW AROUND THE ARTERIAL BLOCKAGE, YES.>>THE USE AS THE VEIN AS A NATIVE CONDUIT FOR BYPASS WORKS REALLY VERY WELL. THERE ALSO ARE PLASTIC TYPE, THINK OF AS PLASTIC, BUT THEY’RE GORTEX OR VARIOUS KINDS OF DACRON GRAPHS THAT ARE ALSO USED. EACH HAS ITS ADVANTAGES, OBVIOUSLY. VEINS NORMALLY WORK VERY WELL. OF COURSE, THE UNFORTUNATE THING ABOUT THIS SITUATION IS THAT FOR IT TO FAIL AFTER ONE YEAR –>>BAD.>>YEAH, PROGNOSTICALLY THAT’S NOT A GOOD THING.>>DOES IT MEAN THAT THAT PERSON HAD AN INHERITABLE PROBLEM? DOES IT MEAN THAT THEY’RE CONTINUING TO BLOCK OR CLOT?>>CERTAINLY COULD BE. COULD BE THAT THE RISK FACTOR MODIFICATION, MAYBE THEY’VE CONTINUED TO SMOKE OR PERHAPS THAT THEIR DIABETES IS DIFFICULT AND SO THAT THE BLOOD VESSELS DOWN BELOW WHERE THE BYPASS WAS INSERTED JUST CAN’T CARRY ENOUGH BLOOD FLOW ANYMORE, AND, UNFORTUNATELY, AS DUSTIN MENTIONED EARLIER, THERE IS A GROUP OF FOLKS, YOU KNOW, IN THAT 5 TO 10% RANGE THAT BASICALLY HAVE SUCH SIGNIFICANT BLOCKAGE THAT THEY DO END UP LOSING A LIMB.>>YEAH. AND THAT’S WHAT DOES HAPPEN NO MATTER WHAT YOU DO SOMETIMES. I MEAN, HOW OFTEN DOES THAT HAPPEN? I MEAN, YOU HELP THEM, YOU BYPASS THEM, MANY OF THEM DO VERY WELL FOR A LONG TIME. BUT SOME OF THEM DON’T.>>WELL, IT DEPENDS ON, YOU KNOW, HOW THEY PRESENT. SO, IF YOU HAVE PATIENTS THAT COME IN WITH ACUTE LIMB ISCHEMIA, MEANING HAVING PAIN IN THEIR FOOT AT REST OR HAVING A WOUND WITH VASCULAR DISEASE ON IT, THEN THE AMPUTATION RATE IS SIGNIFICANTLY HIGHER THAN PATIENTS THAT JUST HAVE CLAUDICATION OR PAIN WHEN WALKING. SOME STUDIES HAVE SHOWN IF YOU TAKE ALL PATIENTS WITH ACUTE — UP TO 40% WILL REQUIRE AMPUTATION, THE OTHER 40% WILL BE ALIVE WITH THEIR LIMB AND ACTUALLY THE MORTALITY CAN BE AS HIGH AS 20% WITH THAT AT SIX MONTHS.>>SO IT’S BAD DISEASE, ISN’T IT?>>YEAH, IT IS A SIGNIFICANT DISEASE. THAT’S WHY IT’S IMPORTANT TO CATCH IT EARLY AND TO DO LIFESTYLE MODIFICATIONS AND MEDICAL TREATMENT AS MUCH AS POSSIBLE. EARLY ON.>>SO, THE MOST IMPORTANT THING WE CAN DO TO HELP PREVENT VASCULAR DISEASE, LIKE THIS, THAT WE’RE TALKING ABOUT IS LIFESTYLE CHANGES. NOW, BEFORE WE ASK THAT QUESTION, THOUGH, IF I HAVE CLAUDICATION, IN OTHER WORDS, I HAVE ANGINA OF THE LEGS AND I’M FEELING PAIN WHEN I’M WALKING, WHEN I STOP, IT GOES AWAY, WHAT DOES THAT SAY ABOUT MY POSSIBILITY OF HAVING OTHER VASCULAR DISEASE, STROKES AND HEART ATTACKS?>>WELL, I MEAN, THERE HAVE BEEN LARGE STUDIES DONE IN THE PAST THAT GO BACK A NUMBER OF DECADES NOW THAT CLEARLY ESTABLISH THAT PEOPLE WHO HAVE BLOCKAGE IN THE LEG BLOOD VESSELS HAVE A VERY HIGH RISK OF HAVING BLOCKAGE IN THE HEART BLOOD VESSELS AND PROBABLY IN THAT 80% RANGE. SO IT’S VERY SIGNIFICANT. DOESN’T GUARANTEE IT. AND THERE ARE SOME FOLKS THAT ARE LUCKY THAT DON’T. BUT IT’S A VERY HIGH PERCENTAGE. NOW, NOT ALL OF THEM NEED TO HAVE SOMETHING DONE. THEY MAY HAVE BLOCKAGE THAT’S NOT CRITICAL, BUT IT IS A MARKER FOR TROUBLE, THAT’S RIGHT.>>ALL RIGHT.>>SOMETIMES AT THE BEGINNING OF A STROKE THERE IS A DISCONNECT BETWEEN ONE’S THOUGHTS AND ACTIONS DUE TO DAMAGE THAT IS HAPPENING TO THE BRAIN.>>MY DAY STARTED AS A NORMAL DAY. I MEAN, I GOT UP. I WAS GOING TO GO TO WORK. I HAVE MY ROUTINE, YOU KNOW, SHOWER, SHAVE, SHAMPOO. AND GET READY TO GO. HAVE SOME BREAKFAST. AND WHEN I GOT TO THE KITCHEN, THINGS WERE A LITTLE CONFUSING FOR ME. I GOT THE OATMEAL OUT OF THE CUPBOARD, AND I GOT THE BOWL OUT OF THE CUPBOARD. AND I GOT THE SPOON OUT OF THE DRAWER, AND I COULDN’T FIGURE OUT WHAT TO DO WITH THEM. SO I HAD THESE THREE OBJECTS IN MY HAND AND I WAS FROZE IN PLACE. MY WIFE CAME IN AND AT THAT POINT WHEN SHE CAME IN, SOMEHOW I FIGURED IT OUT AND I HAD THE BOWL IN FRONT OF ME AND I WAS SITTING AT THE TABLE. BUT AS I WAS EATING, THE STUFF WAS COMING RIGHT OUT. SO ONE OF THE TESTS I HAD WAS AN M.R.I. AND THE TEST RESULT SHOWED THAT I HAD A STROKE. ONE OF THE THINGS THAT I REMEMBER THE MOST IS THAT ONE OF THE PERSONS WHO MUST HAVE BEEN A SPEECH THERAPIST, AUDIOLOGIST, AND SHE SHOWS ME THIS PICTURE AND THIS PICTURE IS SOMETHING OUT OF DICK AND JANE. I KNOW I’M DATING MYSELF WITH THAT. AND IT’S A VERY SIMPLE PICTURE. AND I CAN’T TELL HER A THING. A DEFINING MOMENT FOR MYSELF IN MY RECOVERY, THE PHYSICAL THERAPY, THE OCCUPATIONAL THERAPY, BUT ESPECIALLY THE SPEECH THERAPY, BECAUSE THAT WAS THE HARDEST FOR ME, TO MY SURPRISE, ONE OF THE FIRST THINGS THE SPEECH THERAPIST DOES IS SHE PUTS THIS PICTURE IN FRONT OF ME AND SHE SAYS, CAN YOU DESCRIBE WHAT’S ON THIS PICTURE? AND I JUST — I GET EMOTIONAL ABOUT IT. BECAUSE IT’S THE SAME PICTURE THAT JUST A FEW DAYS, WEEKS AGO I WAS SHOWN AT THE HOSPITAL AND I COULDN’T DESCRIBE A THING. AND I TOLD THE SPEECH THERAPIST, YOU’RE GOING TO SIT HERE FOR THE NEXT HALF HOUR BECAUSE I CAN TELL YOU EVERYTHING THAT’S IN THAT PICTURE. AND I WANT TO PUT THAT PICTURE IN A FRAME BECAUSE I KNEW I WASN’T BACK ALL THE WAY BUT I WAS COMING BACK. SO YOU BETTER WATCH OUT. [MUSIC] >>WELL, THAT’S A GREAT STORY. THANK YOU FOR SHARING YOUR STORY WITH US. I MEAN, HE PRESENTED WITH AN INTERESTING ARRAY OF SYMPTOMS. YOU KNOW, HOW COMMON IS THAT? AND HOW COMMON ARE STROKES?>>WELL, YOU KNOW, I THINK HIS PRESENTATION’S ACTUALLY RELATIVELY COMMON. IT BECAME APPARENTLY AS HE DESCRIBED IT, HE REALLY DIDN’T UNDERSTAND WHAT WAS GOING ON. IT DIDN’T COME TO THE FOREFRONT THAT HE WAS HAVING A STROKE, HE JUST COULDN’T FIGURE OUT WHAT WAS WRONG. AND I THINK THAT THIS IS WHY WE, PERHAPS, DO NEED TO USE THE NAME BRAIN ATTACK AS OPPOSED, LIKE A HEART ATTACK, ONLY OF THE BRAIN, AS OPPOSED TO THE STROKE THAT SEEMS SORT OF ABSTRACT, MAYBE IT WILL RESONATE WITH PEOPLE. AND I THINK THAT MORE EDUCATION ABOUT THE KINDS OF SYMPTOMS THAT PEOPLE WILL HAVE.>>LIKE WHAT?>>WELL, THEY MAY HAVE WEAKNESS OR CLUMSINESS IN AN ARM OR A LEG, AND IT MAY BE TRANSIENT, IT MAY BE A RELATIVELY LIMITED-TYPE THING. THEY JUST CAN’T HOLD THE COFFEE CUP OR THEY DROP SOMETHING THAT THEY WOULDN’T USUALLY DROP. THEY MAY DEVELOP SLURRED SPEECH OR WORD FINDING PROBLEMS, LIKE HE COULDN’T DESCRIBE SOMETHING. MAY BE THAT YOU’RE SITTING ACROSS FROM YOUR WIFE AT THE BREAKFAST TABLE AND YOU WANT HER TO PASS SOMETHING AND YOU CAN’T ASK FOR IT. I MEAN, IT IS NOT ALWAYS THIS SITUATION WHERE YOU SUDDENLY FALL DOWN OR LOSE MOTOR FUNCTION IN AN ARM OR A LEG.>>IT CAN BE A VERY SUBTLE THING.>>YES.>>THE IMPORTANT POINT IS THAT IT CAN BE TRANSIENT. SO YOU CAN HAVE THESE SYMPTOMS AND ALL OF A SUDDEN YOU FEEL NORMAL AGAIN. BUT, STILL, IT’S A MAJOR PROBLEM. IT’S SOMETHING YOU NEED TO SEEK MEDICAL HELP IMMEDIATELY BECAUSE IT’S A SIGN THAT IF YOU DON’T GET TREATMENT SOON, YOU WILL HAVE A MAJOR STROKE.>>SO, THAT’S A TRANSIENT, ISCHEMIC EVENT. AN EVENT THAT HAPPENED IN THE BRAIN, GOES AWAY, IT SHOULD NOT MEAN, OH, IT’S BETTER AND I DON’T NEED TO DO ANYTHING ABOUT IT. IT MEANS YOU NEED TO GET IN. NOW, WHAT WOULD YOU DO? WOULD YOU SAY — LET’S SAY IT’S 9:00 AT NIGHT. WOULD YOU GO TO THE EMERGENCY ROOM OR WOULD YOU GO IN THE NEXT MORNING OR WHAT WOULD YOU DO?>>WELL, WHAT WE ADVISE PATIENTS, IF THEY HAVE A SPECIFIC NEUROLOGIC DEFICIT, MEANING THAT THEY HAVE CLUMSINESS OR THEY CAN’T –>>RIGHT ARM DOESN’T WORK.>>THAT SORT OF THING. THAT THEY SEEK MEDICAL ATTENTION IMMEDIATELY. EITHER THEY GO TO THE URGENT CARE CENTER, GO TO THE EMERGENCY CENTER, DESCRIBE THEIR SYMPTOMS, EVEN IF THEY’VE RESOLVED AND ARE NO LONGER HAVING ACTIVE SYMPTOMS. THEY CAN UNDERGO EVALUATION, MAY BE A BRAIN SCAN, MAY NOT BE, OR THERAPY CAN BE INITIATED. MAYBE IT WAS RELATED TO BLOOD PRESSURE THAT’S OUT OF CONTROL. OR IT MAY BE SOME OTHER THINGS. IT DOESN’T ALWAYS MEAN THAT YOU’VE HAD AN ACUTE PERMANENT DAMAGE TO THE BRAIN. BUT IT’S SOMETHING THAT YOU CLEARLY NEED TO HAVE EVALUATED.>>RIGHT.>>I WOULDN’T WAIT UNTIL THE NEXT MORNING.>>YOU WOULDN’T WAIT UNTIL THE NEXT DAY. WOULD YOU TAKE AN ASPIRIN BEFORE YOU GO TO THE EMERGENCY ROOM?>>LOTS OF PEOPLE DO. LOTS OF PEOPLE DO. THE ONLY PROBLEM IS THAT, REMEMBER, 50% OF STROKES THAT OCCUR THAT ARE ACUTE ARE HEMORRHAGIC, THEY INVOLVE SOME FORM OF BLEEDING. AND AS A RESULT, ASPIRIN MAY NOT ALWAYS BE OF BENEFIT TO YOU. SO I THINK THAT YOU’RE PROBABLY BETTER OFF IN SEEKING MEDICAL ATTENTION ON AN URGENT BASIS AND THEN ALLOWING THE CLINICIAN TO MAKE THAT DETERMINATION AS TO WHETHER YOU SHOULD BE ON ASPIRIN OR WHETHER YOU NEED BLOOD THINNER OR WHETHER YOU DON’T NEED EITHER ONE.>>SO IF YOU HAVE A T.I.A., WHICH IS EXACTLY AS HE DESCRIBED — BUT A T.I.A., IT’S GONE WITHIN AN HOUR OR SOMETHING LIKE THAT, RIGHT?>>LESS THAN 24 HOURS, TECHNICALLY.>>ALL RIGHT. BUT IF YOU HAVE A T.I.A., SOMETHING THAT GOES AWAY, WHAT IS THE PERCENTAGE THAT YOU’RE GOING TO HAVE A BIGGER STROKE OR YOU’RE GOING TO HAVE ANOTHER STROKE OR YOU’RE GOING TO HAVE A VASCULAR EVENT?>>WELL, THAT’S A LITTLE COMPLICATED TO ANSWER BECAUSE IT DEPENDS ON THE CAUSE. IF IT’S RELATED TO BLOCKAGE IN THE NECK BLOOD VESSELS, AND YOU HAVE SEVERE BLOCKAGE AND YOU’VE HAD A T.I.A. OR SMALL STROKE THAT THEN RESOLVES, YOUR RISK OF HAVING ANOTHER MAJOR EVENT IS ABOUT 10% PER YEAR. IF, HOWEVER, IT’S DUE TO ATRIAL FIBRILLATION OR SOME OTHER HEART EVENT, THEN IT’S A VERY DIFFERENT SITUATION, YEAH. >>RIGHT. BUT THEN THAT’S ANOTHER DIAGNOSIS THAT NEEDS TO BE MADE.>>THAT’S RIGHT.>>AND YOU TREAT THAT WITH A WARFARIN COMPARED TO ASPIRIN FOR THIS, FOR EXAMPLE.>>RIGHT. THAT’S CORRECT.>>WELL, WE HAVE QUESTIONS ABOUT THAT. BUT ANYTHING ELSE THAT WE SHOULD MAKE SURE THE PEOPLE REALIZE? A T.I.A., NEUROLOGIC EVENT MEANS GET TO THE EMERGENCY ROOM OR GET RIGHT IN TO THE CLINIC.>>RICK, MY OWN FATHER HAD AN EVENT, AND HE STAYED AT HOME WHILE MY MOTHER WENT TO A CONCERT. AND I CALLED HIM AND SAID, WHAT’S WRONG? AND HE SAID, GEE, MY ARM’S NOT MOVING SO GOOD. AND I SAID, WELL, DAD, YOU’RE HAVING A STROKE. AND HE SAID, NO, NO, I THINK I JUST SLEPT ON IT WRONG. I MEAN, THAT’S, UNFORTUNATELY, AND THAT WAS MY OWN FATHER, WHO IS A HEALTH PROFESSIONAL AND SHOULD HAVE KNOWN BETTER. BUT — AND, OF COURSE, HE LIVED IN A DIFFERENT CITY AND I HAD TO CALL A FRIEND TO GO GET HIM. YOU KNOW, IT WAS — BUT, I MEAN, BUT IT WAS — RIGHT.>>ISN’T A DAD OF A DOCTOR SUPPOSED TO BE SMARTER BECAUSE OF –>>HE SHOULD BE.>>HERE’S THE PICTURE. YOU KNOW, WE CAN LOOK AT THIS PICTURE OR THIS PICTURE. HOW ABOUT SHOWING ME, THIS IS A HEMORRHAGIC.>>YES. SO THIS IS A SITUATION WHERE YOU SEE THIS BLOOD CLOT HERE.>>PUSH HARD.>>YOU SEE THIS BLOOD CLOT RIGHT IN HERE THAT’S TRAVELED UP AND IT’S CAUSED — THIS IS ACTUALLY BLEEDING INSIDE THE BRAIN, THIS WHOLE AREA HERE. AND, SO, THAT’S A SITUATION WHICH YOU WOULD NOT PUT SOMEONE ON BLOOD THINNER.>>THIS IS BLEED. AND THEN THIS IS CLOTTING.>>I SEE, YEAH. SO THAT’S A SITUATION WHERE IF YOU HAVE A BLEEDING INTO THE BRAIN LIKE THIS, THAT’S NOT A GOOD — YOU WOULDN’T PUT SOMEONE ON BLOOD THINNER AT THAT POINT.>>WHAT DO YOU DO?>>WELL, IF, FOR EXAMPLE, THEY’RE ON BLOOD THINNER, YOU KNOW, SAY THEY’RE ON WARFARIN OR COUMADIN FOR SOME OTHER REASON, YOU’D STOP IT, CORRECT IT, YOU’D DO THOSE SORT OF THINGS. IN SOME CASES, IT’S A MATTER OF SYMPTOMATIC CARE. IF YOU GO TO THAT OTHER PICTURE.>>RIGHT, THIS ONE.>>SO, THIS IS WHERE YOU HAVE –>>PUSH HARD.>>WHERE YOU HAVE PLAQUE HERE THAT’S RESULTED IN PROBABLY A NARROWING. AND NOW THIS CLOT HAS OCCURRED HERE. IF THIS TRAVELS UP, IT WILL PLUG UP AN AREA AND THEN A WHOLE AREA OF THE BRAIN, THIS WHOLE AREA NOW, THERE’S NO BLEEDING THERE, BUT WHAT’S HAPPENED IS IT’S NOT GETTING ENOUGH OXYGEN AND BLOOD. SO THAT AREA THEN BECOMES DAMAGED AND THAT CAN RESULT IN A MAJOR STROKE EVENT.>>RIGHT. SO, A THING THAT HAPPENED 15 YEARS AGO WAS THE IMMEDIATE INTERVENTION OF A HEART ATTACK BY USING A CLOT BUSTER DRUG. AND THEN LATER WE WERE TALKING ABOUT INTERVENTION OF STROKES WITH CLOT BUSTER DRUGS. AND THEN THERE’S BEEN SOME ARGUMENTS THAT WE’RE NOT DOING THAT ENOUGH BECAUSE WE WAIT TOO LONG OR WE DON’T HUNT DOWN THE CASE OR THE PATIENT DOESN’T COME IN. COULD YOU EXPLAIN THAT, DUSTIN?>>WELL, YES. SO THE IDEA WOULD BE THAT BY GETTING RID OF THE CLOT, YOU’RE GOING TO REPROFUSE THAT AREA OR GET BLOOD FLOW BACK TO THAT AREA OF THE BRAIN.>>RIGHT.>>BEFORE IT’S IRREVERSIBLE. AND THE GENERAL RECOMMENDATION IS IF IT’S LESS THAN THREE HOURS, YOU CAN USE SYSTEMIC, WHERE YOU GIVE A MEDICINE THAT WILL ACTUALLY DISSOLVE THE CLOT. AND THAT’S SPECIFICALLY IF YOU HAVE AN EMBOLIC STROKE RATHER THAN A HEMORRHAGIC STROKE.>>RIGHT.>>AND THERE IS DEVELOPMENTS NOW WHERE PEOPLE ARE USING CATHETERS SIMILAR TO THE CARDIAC, THEY’LL GO UP AND THEY’LL TREAT THE SPECIFIC BLOOD VESSEL WITH THE LYSIS OR COMMONLY SUCTION OUT THE AREA OF THE BLOCKAGE.>>STENTS, OR GET THE BLOCK OUT OF THERE?>>I’M NOT FAMILIAR WITH A LOT OF INTERCRANIAL STENTING.>>MOST OF THAT IS DONE WITH — BUT THE ISSUE THERE REALLY BECOMES, THERE ARE A COUPLE OF POINTS, THERE ARE CHALLENGES FOR US, ESPECIALLY HERE IN SOUTH DAKOTA. ONE IS AN AWARENESS, AND AS WE KIND OF EMPHASIZED TO PEOPLE WHEN THEY HAVE SYMPTOMS, THEY NEED TO RECOGNIZE THAT THEY NEED TO SEEK MEDICAL ATTENTION. AND THE OTHER THING IS, YOU KNOW, WE’RE A GEOGRAPHICAL STATE IN WHICH PEOPLE LIVE QUITE FAR FROM MAJOR CENTERS SOMETIMES. AND, SO, THERE’S A TRAVEL, AND, SO, IF YOU DELAY IN COMING AND SEEKING MEDICAL ATTENTION BECAUSE YOU’RE NOT SURE OF YOUR SYMPTOMS AND THEN IT TAKES YOU A FEW HOURS TO GET SOMEWHERE THAT PERHAPS THAT MEDICAL THERAPY CAN BE PROVIDED, NOW YOU’RE OUTSIDE THE WINDOW. AND, SO, WHAT COULD HAVE BEEN PERHAPS MORE EASILY TREATED IN A LARGE METROPOLITAN AREA, YOU KNOW, THAT’S NOT A — THAT’S NOT NEARLY THE CHALLENGE THAT WE FACE HERE IN SOUTH DAKOTA.>>YEAH. SO, THIS IS THE HUGE THING BECAUSE MANY OF THESE PEOPLE ARE WAY PAST THE THREE-HOUR WINDOW. AND YOU CAN’T EVEN TREAT THEM WITH A THROMBOLYTIC.>>RIGHT.>>SO THAT’S DIFFERENT. LET’S JUMP INTO SOME QUESTIONS. WE HAVE AN 87-YEAR-OLD WOMAN, 87, WANTS TO KNOW, WHAT DO THE DOCTORS THINK ABOUT OPENING A BLOCKED CORONARY ARTERY?>>THAT MEANS THAT YOU PUT A CATHETER UP THERE, YOU BLOW UP A BALLOON THAT OPENS UP THE ARTERY AND THEN PUTS A STENT IN. MIKE?>>WELL, I DON’T WANT TO MAKE THE QUESTION MORE COMPLICATED THAN IT IS. BUT USING THE TERM “BLOCKED,” WE DEFINE BLOCKAGE BY THE DEGREE OF NARROWING. WE’LL CALL IT STENOSIS. OR IF IT’S TOTALLY BLOCKED. NOW, FOR MANY YEARS, IF THE ARTERY WAS STILL OPEN, EVEN IF IT WAS ONLY — IF IT WAS SEVERELY BLOCKED, WE CAN OPEN IT WITH A BALLOON OR A STENT. AND, SO, IT WORKS VERY WELL. IT OFTEN ALLEVIATES SYMPTOMS, IMPROVES CHEST PAIN AND SHORTNESS OF BREATH AND, IN FACT, YOU CAN EVEN ABORT A HEART ATTACK FROM OCCURRING — IF YOU CATCH IT EARLY ENOUGH. WHEN IT’S BLOCKED ENTIRELY AND THEN PERHAPS FILLS VIA SORT OF SOME NATURAL BYPASSES, SOMETIMES THOSE ARE PATIENTS THAT WE TREAT MEDICALLY. NOW, THERE’S A GROUP OF THOSE PATIENTS THAT ACTUALLY STILL HAVE CHEST PAIN. AND THEY WOULD BENEFIT. SO THERE’S SOME NEW TECHNIQUES. ONE OF OUR COLLEAGUES, HAS ACTUALLY BEEN DOING CHRONIC TOTAL OCCLUSIONS, HE’S OPENING UP SOME OF THESE BLOCKAGES THAT HAVE BEEN CLOSED FOR A LONG TIME, AND HE HAS SOME VERY UNIQUE TECHNIQUES WHERE HE CAN COME BOTH FORWARD AND KIND OF REVERSE THROUGH THAT AREA TO OPEN IT. SO THAT’S –>>IF THEY HAVE SYMPTOMS.>>IF THEY HAVE SYMPTOMS, THAT’S RIGHT.>>THERE IT IS.>>YUP.>>IF IT’S BLOCKED — I MEAN, IT’S SORT OF LIKE, MY MOTHER HAD ONE CAROTID ARTERY COMPLETELY BLOCKED. AND I EVEN THREW THE CASE AT YOU. YOU SAID, IT WOULD BE GREAT TO HELP BUT IT WON’T MAKE ANY DIFFERENCE BECAUSE SHE’S BLOCKED AND SHE’S ALREADY COLLATERALIZED, IT WON’T MAKE ANY DIFFERENCE. AND THAT KIND OF POINTS THAT OUT. HOW ABOUT AN 87-YEAR-OLD WOMAN WHO SAYS SHE HAS ATRIAL FIBRILLATION, THAT MEANS THE HEART IS IRREGULARLY IRREGULAR AND IS AT RISK FOR A CLOT FROM THE HEART, ON BLOOD PRESSURE MEDICINES, WARFARIN. I STILL HAVE A RACING HEARTBEAT, IS THAT NORMAL? AND THAT’S A GOOD QUESTION.>>YEAH.>>THE ANSWER IS, YOU CAN SLOW THAT HEART RATE DOWN A LITTLE –>>SO ATRIAL FIBRILLATION IS VERY COMMON. AND AS PEOPLE GET OLDER, WE’RE SEEING MORE AND MORE OF IT. IT IS — IS A RISK FACTOR FOR STROKE BECAUSE CLOTS CAN FORM IN THE UPPER CHAMBER OF THE HEART. AND, SO, BLOOD THINNER IS IMPORTANT. YOU GENERALLY — YOU’RE NOT DAMAGING YOUR HEART, EVEN THOUGH YOU’RE IN ATRIAL FIBRILLATION IF YOU CONTROL THE HEART RATE. SO, MEDICATIONS LIKE METOPROLOL OR CARDIZEM, THERE ARE A VARIETY OF MEDICATIONS THAT CAN SLOW THE HEART, IF THE HEART RATE IS STILL RACING, SHE SHOULD BE ON THOSE MEDICATIONS. THERE ARE NEWER TECHNIQUE, TOO, FOR PEOPLE WHO CAN’T TOLERATE A BLOOD THINNER. THERE ARE THESE NEW DEVICES, ATRIAL APPENDAGE DEVICES, THERE’S NEW TECHNOLOGY THAT’S OUT THERE, NOT WIDELY AVAILABLE BUT IT’S COMING. YOU KNOW, 87-YEAR-OLD, YOU WORRY ABOUT BLOOD THINNER, TOO, JUST BECAUSE OF THE RISK OF FALLS.>>FALLING. YEAH. SO THERE’S A BALANCE. PEOPLE AT A CERTAIN AGE WHEN THEY’VE HAD ONE FALL, EVEN THOUGH THEY HAVE ATRIAL FIB, AND THEY’VE BEEN ON WARFARIN, I’VE TAKEN THE WARFARIN AWAY.>>RIGHT.>>YOU THINK THAT THE NEWER AGENTS THAT ARE LIKE WARFARIN ARE ANY BETTER THAN WARFARIN?>>WELL, THERE IS SOME DATA NOW FOR SOME OF THE NEW ORAL ANTICOAGULANTS THAT ARE OUT THERE. WE’VE SEEN THEM ADVERTISED ON TV. BUT, IN FACT, SOME OF THEM DO HAVE A LOWER BLEEDING RISK. AND VERY HONESTLY ONE OF THE PROBLEMS IS THAT SOME OF THEM ARE FAIRLY EXPENSIVE. AND, SO, FOR SOME OF OUR PATIENTS IT’S MORE DIFFICULT.>>YEAH.>>YEAH, I MEAN, THEY DO — I THINK MOST OF THE PEOPLE RESPOND TO THOSE MEDICATIONS IN A SIMILAR MANNER, THEY’LL GET A MORE LEVEL THINNING OF THEIR BLOOD, WHEREAS, COUMADIN, THEY’LL HAVE TO ADJUST DOSING AND IT WILL KIND OF GO UP AND DOWN. AND, SO, IT IS MORE CONVENIENT FOR THE PATIENT. AND I THINK THE BLEEDING RISK MAY BE A LITTLE BIT LOWER BECAUSE YOU GET — YOU DON’T OVERANTICOAGULATE PATIENTS BUT THE DISADVANTAGE, WHAT I ALWAYS INFORM MY PATIENTS ABOUT, THE REAL HARD THING WITH THOSE, THERE’S NOT A REVERSAL AGENT FOR MOST OF THEM. MOST OF THE PATIENTS WILL COME IN, IF THEY DO HAVE SOME SORT OF TRAUMA OR FALL, WITH COUMADIN IT’S EASIER TO REVERSE AND THICKEN THEIR BLOOD. WHEREAS, THE NEWER AGENTS, IT’S NOT THAT EASY.>>THERE’S ONE THAT HAS REVERSIBLE, BUT MY SENSE IS THAT THERE’S NO MORE DANGEROUS DRUG THAN WARFARIN OR ALL THESE OTHERS. AND THERE’S ONLY ONE DRUG THAT I HAVE OUT THERE THAT I CANMONITOR THAT THEY’RE TAKING IT. AND THAT I CAN WATCH IT, HOW WELL THEY’RE RESPONDING. SO I CAN DO THAT WITH WARFARIN AND IT’S FOUR TIMES CHEAPER, EVEN IF YOU COUNT THE MONITORING. SO, COMPLIANCE, THEY SAY, 60% AT BEST. WITH ALL TAKERS ACROSS THE BOARD, IN TAKING YOUR MEDICINES. THAT’S WHY I’M A WARFARIN GUY. BUT THERE ARE TIMES WHEN THOSE OTHER MEDICINES ARE RIGHT. WOMAN FROM SIOUX FALLS ASKS, HOW MANY STENTS CAN YOU HAVE? [ Laughter ]>>NOT ENOUGH. [ Laughter ]>>I GUESS THAT’S — I GUESS IT DEPENDS ON WHERE HER DISEASE IS AT AND WHAT VESSELS ARE BLOCKED. YEAH, THERE’S NO LIMIT ON THE NUMBER OF STENTS A PATIENT CAN HAVE. BUT I WILL SAY, IF THERE’S A PATIENT THAT YOU’VE HAD THE SAME VESSEL THAT’S OCCLUDED MULTIPLE TIMES, YOU KEEP DOING INTERVENTIONS AND INTERVENTIONS, THE MORE YOU DO THE LESS LIKELY IT’S GOING TO BE A LONG-TERM FIX. AT THAT TIME THE STENT MAY NOT BE THE BEST PROCEDURE.>>LIFESTYLE CHANGES ARE THE MOST IMPORTANT THING WE CAN DO TO PREVENT HEART DISEASE. LET’S TALK ABOUT THAT.>>WELL, YOU KNOW, YOU’RE ABSOLUTELY RIGHT. AND I THINK ONE OF THE THINGS THAT, YOU KNOW, AEROBIC EXERCISE IS PROBABLY THE MOST IMPORTANT. IT HAS BEEN SHOWN TO PROLONG SURVIVAL. PEOPLE HAVE BETTER QUALITY OF LIFE AND IT SIGNIFICANTLY REDUCES THEIR CARDIOVASCULAR, CARDIAC MORTALITY AND MORBIDITY. SO, JUST WALKING, BIKING, SWIMMING, AEROBIC EXERCISE REALLY — AND THAT’S BEEN WELL SHOWN IN STUDIES PROSPECTIVELY LOOKING AT LARGE POPULATIONS. GETTING OUT THERE, WALKING REALLY IS A CRITICAL ISSUE. FOR MANY OF US, IT’S SOMETHING THAT’S HARD TO WORK INTO OUR DAILY ROUTINES. AND IT’S CHEAP. DOESN’T COST ANYTHING.>>NO PHARMACEUTICAL INDUSTRY — [ Laughter ]>>IT DOESN’T HAVE TO BE OVERLY STRENUOUS, EVEN 30 MINUTES THREE DAYS A WEEK MAKES A SIGNIFICANT DIFFERENCE.>>IT HELPS WITH WEIGHT AND CERTAINLY LIPID MANAGEMENT.>>MOOD.>>CHOLESTEROL.>>MOOD.>>EVERYTHING.>>YEAH.>>THERE ARE CERTAINLY MEDICATIONS THAT HAVE HAD A DRAMATIC IMPACT. ANTIPLATELET THERAPY, ASPIRIN, NOW SOME OF THE NEWER AGENTS THAT WE USE. CHOLESTEROL-LOWERING MEDICATIONS, AGAIN, IT’S BEEN — WHAT WE CALL THE STATIN MEDICINES, WHICH IS A HOST OF MEDICINES THAT WORK BY REDUCING YOUR CHOLESTEROL REALLY HAVE DRAMATIC EFFECT. THEY NOT ONLY REDUCE YOUR CHOLESTEROL, THEY PROBABLY — PROBABLY STABLIZE SOME OF THE UNSTABLE ELEMENTS IN THE INSIDE OF THE BLOOD VESSEL, THEREFORE, MAKING THEM LESS VULNERABLE TO RUPTURE OR HAVING A SUDDEN BLOCKAGE, BOTH IN THE HEART AND IN THE BRAIN. SO, –>>HOW MUCH SLEEP APNEA?>>WELL, SLEEP APNEA IS NOW RECOGNIZED AS AN IMPORTANT COMPONENT OR CONTRIBUTOR TO CARDIOVASCULAR DISEASE. FOR YEARS, WE DIDN’T REALLY UNDERSTAND IT, WE DIDN’T PAY MUCH ATTENTION TO IT. WE NOW KNOW THAT WHEN YOU HAVE AN APIC EPISODE, YOU DON’T BLEED, YOUR OXYGEN SATURATION DROPS AT NIGHT, YOU’RE NOT GETTING ENOUGH OXYGEN TO YOUR BRAIN AND OTHER PARTS, THAT IT IS DETRIMENTAL, TO SAY SOMETHING OF THE FACT THAT YOU FELL ASLEEP IN YOUR SOUP AT LUNCH. BUT, NO, IT’S REALLY — THAT’S NEWLY RECOGNIZED, I THINK, THAT THAT’S A CONTRIBUTOR AND, SO, WE’RE BEING MUCH MORE AGGRESSIVE ABOUT TESTING FOR IT. TREATMENTS NOW ARE MUCH BETTER, CPAP MACHINES ARE SMALLER.>>EASIER –>>FIT BETTER. ABSOLUTELY. YOU KNOW –>>HUGE THING.>>WE’LL SEE A LOT OF PATIENTS EVEN WITH LOWER EXTREMITY EDEMA, OR SYMPTOMS THAT YOU WOULDN’T THINK WOULD BE ATTRIBUTED TO SLEEP APNEA THAT IMPROVE.>>ONE OF THE MOST COMMON PROBLEMS OF ATRIAL FIB IS SLEEP APNEA, IT’S JUST NOT RECEIVED THE PRESS. THAT’S WHAT WE NEED TO DO. WE’RE GOING TALK ABOUT ONE OTHER LIFESTYLE CHANGE. ONE THING TO MAINTAINING A HEALTHY HEART IS TO MAINTAIN A HEALTHY DIET. THINK ABOUT THE FOOD YOU EAT.>>A HEART HEALTHY DIET HAS THREE MAIN FOCUSES. FIBER, FAT, AND SODIUM. INCREASE THE FIBER IN YOUR DIET BY INCREASING YOUR INTAKE OF FRUITS AND VEGETABLES. CHOOSE FRESH FOR THE MOST FIBER AND CHOOSE CANNED, FROZEN AND COOKED WHEN FRESH ISN’T AVAILABLE OR IN SEASON. ALSO, MAKE SURE YOUR GRAINS ARE WHOLE. LOOK FOR THE PHRASE WHOLE WHEAT OR WHOLE GRAIN ON THE INGREDIENTS WHEN CHOOSING A BREAD, PASTA, CRACKER, OR ANY OTHER TYPE OF GRAIN. REDUCES THE FAT IN YOUR DIET AND SELECT THE RIGHT FATS TO HELP REDUCE YOUR CHOLESTEROL AND IMPROVE YOUR HEART HEALTH. FOCUS ON THE GOOD FATS, SUCH AS OMEGA 3s, MONOUNSATURATEDS AND POLYUNSATURATEDS, THESE WOULD BE FOUND IN FISH, FLAX SEEDS, NUTS, AVOCADOS AND OILS SUCH AS CANOLA, FLAX, OLIVE AND PEANUT OILS. REDUCE YOUR INTAKES OF SATURATED AND TRANSFATS. THESE WOULD BE FOUND IN ANIMAL-BASED PRODUCTS SUCH AS BACON, BUTTER, CREAM, LARD, SHORTENING, AND COCONUT, ALONG WITH SOME PREPACKAGED FOODS. FINALLY, WORK TO REDUCE THE SODIUM IN YOUR DIET. EXCESS SODIUM INTAKE CAN AFFECT YOUR BLOOD PRESSURE AND POSSIBLY MAKE YOU RETAIN EXTRA FLUID. WORK TOWARDS A GOAL OF ONE TEASPOON OF SALT PER DAY, WHICH WOULD EQUAL 2,400 MILLIGRAMS. USE LESS SALT AT THE TABLE AND LOOK AT THE SODIUM CONTENT ON FOOD LABELS. TRY TO COOK WITH MORE FRESH FOODS INSTEAD OF PROCESSED. [MUSIC] >>WELL, AS WE WERE TALKING ABOUT LIFESTYLE CHANGES, WE REALLY HAVEN’T SAID MUCH ABOUT SMOKING. DUSTIN.>>I THINK THAT THE BIGGEST LIFESTYLE MODIFICATION THAT A PATIENT WITH CORONARY DISEASE CAN MAKE IS SMOKING CESSATION. THE PROGRESSION OF THEIR DISEASE, AS WELL AS THE DURABILITY OR HOW LONG ANY INTERVENTION THAT IS DONE WILL DEPEND ON THEM QUITTING SMOKING. AND, SO, ESPECIALLY PERIPHERAL ARTERY DISEASE OR BLOCKAGE IN THE LEGS, PATIENTS THAT COME IN AND QUIT SMOKING HAVE A SIGNIFICANTLY DECREASED RISK OF MORTALITY AS WELL AS AMPUTATION.>>DEATH RATE OR LOSING A LEG.>>YES.>>IF YOU REALLY LOOK AT ALL THE THINGS, YOU KNOW, WE TALK ABOUT HIGH BLOOD PRESSURE AND DIABETES AND ABNORMAL CHOLESTEROL, ACTUALLY SMOKING CESSATION IS WORTH THREE OF THOSE OTHERS. SO, IF YOU’RE GOING TO DO SOMETHING — THE BANG FOR YOUR BUCK IS TO STOP SMOKING.>>STOP SMOKING. I MEAN, IT’S HUGE. I MEAN, YOU GUYS SEE THOSE VESSELS. THE QUESTION ABOUT WHETHER THEY’VE BEEN SMOKING OR NOT IS ALMOST OBVIOUS.>>WE SEE PARTICULARLY IN OUR WOMEN PATIENTS, AND ONE OF THE THINGS EPIDEMIOLOGICALLY THAT’S BEEN DISAPPOINTING IS THE FACT THAT SO MANY YOUNG WOMEN ARE STILL SMOKING. WE’VE REALLY NOT MADE A HUGE IMPACT. WE HAVE YOUNGER WOMEN WHO COME WITH SEVERE ARTERIAL DISEASE, IF THEY WOULDN’T HAVE SMOKED THEY WOULDN’T HAVE IT.>>THEY JUST WOULDN’T HAVE IT. IT’S A BIG DEAL. MY MOM SMOKED. I DID AS MUCH AS I COULD TO TRY TO GET HER TO QUIT SMOKING. AND I FAILED. BECAUSE IT’S A TOUGH HABIT. >>IT IS A TOUGH HABIT.>>I MEAN, YOU KNOW, I HAVE TO SAY, IT’S NOT — THE WAY I LOOK AT IT, WITH THE PEOPLE THAT I’VE CARED FOR THROUGH THE YEARS, THE ONES THAT WERE SMOKERS WERE NO NICER OR MEANER THAN THE PEOPLE WHO WERE NOT THE SMOKERS. I MEAN, IT’S NOT A MORAL ISSUE. I MEAN, THEY’RE GOOD PEOPLE WHO SMOKE. AND THERE ARE MEAN PEOPLE THAT DON’T. YOU KNOW WHAT I MEAN? IT DOESN’T HAVE ANYTHING TO DO WITH THAT. IT’S JUST — AND SOME OF THEM I THINK MAY HAVE — DEPRESSION IS TREATED SOMEWHAT BY IT. WHO KNOWS WHY PEOPLE CANNOT QUIT. BUT IT’S AN IMPORTANT, IMPORTANT THING.>>IT’S VERY ADDICTIVE, VERY DIFFICULT TO QUIT. AND SOME PATIENTS, WHEN YOU SEE THEM, YOU’LL TELL THEM THEY NEED TO QUIT SMOKING, THEY’LL TALK ABOUT THEIR PARENT THAT SMOKED THEIR WHOLE LIFE, SOMEBODY THEY KNOW WHO SMOKED THAT DIDN’T HAVE PROBLEMS. UNFORTUNATELY, WE DON’T KNOW HOW PEOPLE RESPOND TO IT. THERE ARE SOME PEOPLE, LESS COMMON THAN NOT — MORE COMMON THAN NOT, LESS COMMON THAN NORMAL, THAT DO SMOKE AND DON’T HAVE PROBLEMS, BUT THE MAJORITY OF PEOPLE WILL DEVELOP DIFFICULTY, PROBLEMS. LIKE DR. BACHARACH SAID, YOU KNOW, WHEN WE SEE THESE YOUNG WOMEN WITH PERIPHERAL ARTERY DISEASE, IT’S PRETTY MUCH, IF THEY WERE NOT SMOKING, THEY WOULD NOT BE IN THAT SITUATION.>>YOU KNOW, WE HAVE THE SOUTH DAKOTA QUIT LINE, WE HAVE BASICALLY RESOURCES FOR EVERYONE, WHETHER THEY — AND MANY OF THEM ARE, IN FACT, FREE OF CHARGE. SO, IT REALLY IS INCUMBENT UPON THE INDIVIDUAL TO SAY, YOU KNOW, I CAN’T DO THIS ANYMORE, I HAVE TO STOP.>>WHAT ABOUT NONSMOKE TOBACCO PRODUCTS? MY PERSONAL BIAS IS WAY BETTER THAN SMOKING, BUT, STILL, THEY’RE PROBLEMATIC. WHAT’S YOUR TAKE?>>YOU’RE TALKING ABOUT THE BLUE CIGARETTE-TYPE THINGS?>>YEAH, YOU KNOW, I DON’T KNOW WHAT — THEY’RE LITTLE AEROSOLIZER THINGS.>>YOU KNOW, AT THIS POINT, I’M NOT AWARE OF ANY SPECIFIC DATA THAT SUGGESTS THAT THEY’RE SAFE. OKAY. THERE HASN’T BEEN ENOUGH LONGITUDINAL STUDIES TO SAY THAT THEY’RE DANGEROUS OR THAT THEY CONTRIBUTE TO VASCULAR LUNG DISEASE, THE WAY WE KNOW CIGARETTES DO. BUT I THINK THAT THERE’S THESE — THERE’S STILL CONCERN, AND I KNOW AT THE N.I.H. LEVEL THERE’S STILL SIGNIFICANT WARNINGS ABOUT, YOU KNOW, –>>NATIONAL INSTITUTE OF HEALTH.>>AND, AGAIN, IT’S ONE OF THESE THINGS, MANY OF THESE YOUNG PEOPLE ARE USING THEM AS OPPOSED TO REGULAR CIGARETTES. SO WE MAY NOT KNOW FOR A NUMBER OF YEARS NOW WHETHER THERE’S REALLY SIGNIFICANT DETRIMENTAL EFFECTS FROM THEM.>>59-YEAR-OLD MAN FROM YANKTON, WE NEED TO TALK ABOUT ABDOMINAL AORTIC ANEURYSM, LET’S DO THAT, THAT’S THE BIGGEST FACTOR, RISK FACTOR FOR SMOKING, ISN’T IT? I MEAN, THE NATIONAL RECOMMENDATION FOR ULTRASOUND OF THE ABDOMINAL AORTA, AS A SCREENING TOOL, IS FOR MEN WHO HAVE SMOKED.>>SMOKING AND FAMILY HISTORY ARE THE TWO HIGHEST RISKS FOR ABDOMINAL –>>ABDOMINAL AORTIC ANEURYSM.>>YES, THAT IS TRUE. WE RECOMMEND, IF YOU’RE MALE, OVER 65, SMOKER, YOU SHOULD HAVE AT LEAST ONE SCREENING, ULTRASOUND OF YOUR AORTA TO LOOK FOR ANEURYSMS. ACTUALLY RECOMMENDS, ACTUALLY, FEMALES, 65, SMOKERS AS WELL, OR FAMILY HISTORY. IF YOU HAVE A FAMILY HISTORY, MALE, USUALLY WE SCREEN THOSE PATIENTS AT 55. THE SCREEN IS IMPORTANT, MOST PATIENTS WILL NOT KNOW THEY HAVE AN ANEURYSM UNTIL IT’S ENLARGED TO THE POINT IT RUPTURES OR CAUSING SIGNIFICANT PROBLEMS. IT REALLY IS A DISEASE THAT SCREENING IS IMPORTANT. BECAUSE IF YOU FIND IT, IT’S VERY TREATABLE. BUT IF IT’S SOMETHING THAT IS NOT FOUND BEFORE IT DOES RUPTURE, IT’S VERY HIGH MORTALITY.>>ONCE THEY BREAK, THE CHANCE THAT WE CAN SAVE YOU IS VERY LOW. NOT ZERO, BUT IT’S VERY LOW.>>I HAVE A DEAR FRIEND, WHO — WHOSE NAME IS VERY SIMILAR TO YOUR NAME, WHO WAS A PATIENT OF MINE, LEANED ON ME, SMOKER, YOU KNOW, HAD FINALLY QUIT. CAME IN ONE DAY TO THE EMERGENCY ROOM, SEVERE PAIN, WE GOT HIM TO SIOUX FALLS. YOU GUYS — IN TO THE ABDOMINAL SURGERY. AND LOST HIM ON THE TABLE. AND I JUST — I THINK ABOUT THAT GUY. EVERY TIME I THINK OF AN ABDOMINAL AORTIC ANEURYSM, IF I’D ONLY SCREENED HIM, IF I’D ONLY DONE WHAT I COULD DO TO HELP HIM.>>YOU KNOW, BOTH THE VASCULAR SOCIETY, SURGICAL SOCIETY, AS WELL AS THE VASCULAR MEDICINE SOCIETY NATIONALLY HAVE ADVOCATED A MORE AGGRESSIVE SCREENING FOR THAT VERY REASON. MANY PATIENTS, ESPECIALLY IF THEY’RE WELL NOURISHED, IT’S HARD TO FEEL AN ANEURYSM WHEN YOU GO UNDER EXAM.>>BIG BELLY.>>BIG BELLY, THAT’S RIGHT. BUT, IN FACT, AGAIN, THEY’RE INSIDIOUS. SO MANY PEOPLE HAVE THEM AND ARE UNAWARE THAT THEY HAVE THEM.>>DO YOU RECOMMEND SCREENING, ULTRASOUNDS OF THE ABDOMINAL AORTA, MOVING FROM TOWN TO TOWN, SOMETIMES AT CHURCHES?>>TYPICALLY NOT, ALTHOUGH I WOULD TELL YOU THAT IF THERE’S — IT’S IMPORTANT TO KNOW YOUR FAMILY HISTORY, IF YOU CAN. YOU KNOW, WHAT DID YOUR GRANDFATHER DIE FROM? WHAT DID YOUR UNCLES DIE FROM? IS THERE ANEURYSMAL DISEASE IN YOUR FAMILY? AND A REALISTIC ASSESSMENT OF YOUR RISK FACTORS. DO YOU HAVE HIGH CHOLESTEROL? HAVE YOU BEEN A SMOKER? DO YOU HAVE HIGH BLOOD PRESSURE? THOSE ARE THINGS THAT, YOU KNOW, I THINK THAT –>>CAN THEY ASK THOSE — AND THEY ASK THOSE QUESTIONS AT THOSE FAIRS.>>IF YOU CAN PICK ONE TEST, I’D TELL THEM, WELL, I DON’T BELIEVE IN THE CAROTID ULTRASOUND THING, THE PERIPHERAL LEG ULTRASOUND. IF YOU CAN PICK ONE, 50 BUCKS, WHY NOT DO THE ABDOMINAL AORTIC.>>YOU KNOW, ACTUALLY THE A.B.I., ACTUALLY CORRELATES WITH THE CORONARY DISEASE. AND THAT CAN BE DONE WITH JUST A BLOOD PRESSURE CUFF. SO, I WOULD TELL YOU THAT THAT’S ACTUALLY — THAT WAS A TEST, THAT’S THE TEST I’D GO FOR, JUST BECAUSE IT’S THE MOST COST EFFECTIVE, I THINK. AND IT’S NOT OPERATOR DEPENDENT. I MEAN, IT’S VERY EASY TO DO.>>VERY INTERESTING.>>SO, I MEAN, FACT THAT THERE’S PERIPHERAL DISEASE IN THE LEG SAYS THAT THERE’S CORONARY DISEASE, IS AN IMPORTANT THING AGAIN.>>I TELL PATIENTS ALL THE TIME, YOU KNOW, IF YOU HAVE — I GREW UP IN AN AREA WHERE THERE WAS LOTS OF IRON AND CALCIUM IN THE WATER. SO THAT THE PIPES WOULD GET PLUGGED UP.>>YEAH.>>I TELL THEM, I SAID, IF YOU HAVE THAT, IT DOESN’T JUST GET PLUGGED UP IN THE KITCHEN OR BATHROOM, RIGHT? IT GOES THROUGH THE WHOLE HOUSE. NOW, THERE ARE CERTAIN AREAS WHERE IT’S MORE LIKELY. YOU KNOW, UNDER THE SINK, THAT KIND OF THING. BUT THE FACT IS, IT’S A SYSTEMIC DISEASE. IT’S A DISEASE THAT POTENTIALLY AFFECTS ALL OF THE ARTERIES. AND THAT’S WHAT YOU HAVE TO EMPHASIZE, RECOGNIZING THAT YOU HAVE TO ADDRESS, THEY HAVE AN ANEURYSM, YOU NEED TO ADDRESS THEIR HEART. IF THEY HAVE PERIPHERAL VASCULAR DISEASE, YOU NEED TO ADDRESS THEIR HEART AND CAROTID ARTERIES. YOU NEED TO LOOK AT THE WHOLE, RECOGNIZING THAT THE DISEASE PROCESS INVOLVES ALL OF THE POTENTIAL ARTERIES. THAT’S RIGHT.>>THE NEXT QUESTION IS ABOUT DIABETES. HOW BIG OF A RISK FACTOR IS DIABETES FOR VASCULAR DISEASE?>>IT’S A SIGNIFICANT RISK FACTOR. I MEAN, WHEN WE SEE PATIENTS WITH PERIPHERAL ARTERY DISEASE OR CORONARY DISEASE, YOU KNOW, WITH LIFESTYLE MODIFICATION, ANOTHER THING IS IF THEY ARE DIABETIC, TO MAKE SURE SURE THEIR BLOOD SUGAR IS CONTROLLED AS WELL AS POSSIBLE.>>THE OTHER THING, I WOULD ADD TO, THE DIABETES, THEY’RE AT INCREASED RISK FOR LIMB LOSS COMPARED TO NONDIABETICS.>>RIGHT.>>AND PART OF THAT ISN’T ALWAYS JUST THE BLOCKAGE. IT’S THE FACT THAT THEY DON’T HAVE GOOD FEELING IN THEIR FEET, THAT THEY INJURE THEIR FOOT, AND THEY GET A SORE, AND THEN IT GETS INFECTED.>>WELL, AND THEY’RE WALKING ON A PEBBLE, THEY DON’T KNOW THERE’S SOMETHING GOING ON.>>EXACTLY. SO, EASY THINGS, GOOD SHOES, LOOKING AT YOUR FEET ON A DAILY BASIS. IF YOU HAVE TROUBLE WITH YOUR NAILS, GO TO A PODIATRIST. YOU KNOW, JUST GOOD NAIL CARE. GOOD HYGIENE THINGS. THEY MAKE THE DIFFERENCE BETWEEN KEEPING YOUR LEG SOMETIMES.>>I REALLY LIKE TO ENCOURAGE PEOPLE TO WASH THEIR FEET. I MEAN, YOU KNOW, IT’S WAY DOWN THERE, YOU KNOW, AND I HAVE TO WASH MY HAIR, I WASHED EVERYTHING ELSE. GET DOWN, YOU KNOW, GET A SHOWER CHAIR AND GET DOWN AND CLEAN YOUR FEET. AND KEEP THE HYGIENE THERE. IT WILL KEEP A LOT OF THAT PROBLEM, BECAUSE IT GETS SCALY AND TROUBLE. SO WORK ON KEEPING YOUR FEET IN GOOD ORDER.>>IT’S IMPORTANT, PATIENTS WITH PERIPHERAL ARTERY DISEASE, A LOT OF THEM WILL GET BY FINE, ONCE THEY DEVELOP A WOUND ON THEIR FOOT, THEY WON’T HAVE ENOUGH PROFUSION TO HEAL THAT. THAT’S WHEN THERE IS A RISK OF LIMB LOSS, RUN INTO PROBLEMS.>>PARTICULARLY DIABETICS. THAT WAS THE QUESTION, 59-YEAR-OLD FROM YANKTON, ABOUT DIABETES. HOW DOES THAT AFFECT THE HEART AND HOW DOES HAVING LOW BLOOD SUGAR READINGS IN THE 20s AFFECT THE HEART? LOW SUGARS MEANS YOU’RE TOO TIGHT. I MEAN, I’M AFRAID OF THAT AS WELL.>>YEAH. YOU KNOW, NEITHER DUSTIN OR MYSELF ARE EXPERTS IN DIABETES. SO, I DON’T WANT TO OVERSTATE THIS. BUT CERTAINLY THE BLOOD SUGAR NEEDS TO BE IN A CERTAIN RANGE. IF IT’S FOR HIGH, IT’S BAD, IF IT’S TOO LOW, IT’S BAD. IF YOU GET THIS LOW, YOU CAN PASS OUT, YOU CAN, YOU KNOW, –>>BRAIN CELLS.>>YOU GET WHAT WE CALL HYPE GLYCEMIC TO THE POINT WHERE YOU CAN’T FUNCTION NORMALLY. I CAN’T TELL YOU THAT IT HAS A DIRECT EFFECT ON THE HEART. ALTHOUGH WE DO KNOW THAT WHEN THE BLOOD SUGARS ARE VERY HIGH FOR LONG PERIODS OF TIME THAT IT’S VERY DETRIMENTAL TO THE INNER LINING OF THE BLOOD VESSELS.>>SO WE HAVE A PERSON ASKING ABOUT ATRIAL FIB AND WARFARIN, XARELTO, WE ANSWERED THAT EARLIER, SHE SAID, IS IT NORMAL TO HAVE ONGOING DIZZINESS WITH ANY OF THE MEDICINES THAT SLOW THE HEART AND ALSO LOWER THE BLOOD PRESSURE?>>WELL, YEAH, THAT’S THE CRITICAL INFORMATION. YOU KNOW, IS IT DIZZINESS AND VERTIGO OR IS IT A SENSE OF LIGHTHEADEDNESS? IF IT’S LIGHTHEADEDNESS, WHEN DOES IT OCCUR? DOES IT OCCUR WITH STANDING OR ANY TIME? THE MEDICATION, LIKE METOPROLOL, WHICH IS A BETA BLOCKER MEDICATION, WILL BLUNT YOUR NORMAL RESPONSE, SO WHEN YOU GO FROM SITTING TO STANDING, NORMALLY YOUR HEART RATE INCREASES TO KEEP THE BLOOD PRESSURE UP AND BLOOD FLOW TO YOUR BRAIN BECAUSE YOU’RE NOW GOING AGAINST GRAVITY. IF YOU’VE BLUNTED THAT RESPONSE, NOW ALL OF A SUDDEN YOU GET LIGHTHEADED BECAUSE BLOOD FLOW ISN’T THERE. SO YOU HAVE TO BE MORE CAREFUL ABOUT GETTING UP SUDDENLY. YOU HAVE TO DO THOSE THINGS. IF YOU’RE DIZZY ALL THE TIME, LIGHTHEADED ALL THE TIME, THEN THAT’S AN INDICATION THAT SOMETHING’S NOT RIGHT, THESE ARE THE MEDICATIONS — YOU’RE ON TOO MUCH MEDICINE OR THERE’S ANOTHER ISSUE GOING ON AND YOU SHOULD SEEK MEDICAL ATTENTION. IT’S AMAZING HOW MANY OF THOSE PASSING OUT FROM TOO MUCH MEDICATION HAPPENS WHEN THEY STAND UP TO SING AT CHURCH. [ Laughter ] WHY IS THAT? 76-YEAR-OLD FEMALE FROM BROOKINGS HAD QUADRUPLE BYPASS SIX YEARS AGO, HAS NINE STENTS, HAS BEEN ON COUMADIN, STILL NOT REGULATED. HER CARDIOLOGIST TELLS HER SHE STILL CAN’T DO — HE CAN’T DO ANYTHING FOR HER ANYMORE. SHE IS STILL HAVING PAIN AND BREATHLESSNESS AND DISCOMFORT. THIS HAS BEEN OFF AND ON FOR THE LAST SIX YEARS. DO YOU HAVE ANY SUGGESTIONS?>>WELL, YEAH, I MEAN, I’LL TAKE THAT. SO, YOU KNOW, SHORTNESS OF BREATH AND LIMITATIONS WITH FUNCTIONAL ACTIVITIES, DOING THE THINGS THAT YOU NORMALLY DO, DAILY ACTIVITIES, IS A FUNCTION NOT ONLY OF THE BLOCKAGE BUT BASICALLY IT’S REALLY — IT’S PREDOMINANTLY THE FUNCTION OF THE HEART, HOW WELL THE HEART’S PUMPING. IS THE HEART REGULATED? IS THERE — AND SOMETIMES WHEN THERE’S BEEN SIGNIFICANT DAMAGE TO THE HEART, THERE ISN’T MUCH TO DO TO IMPROVE THE PUMPING FUNCTION. BUT WHAT YOU DO, YOU CAN PUT PEOPLE ON MEDICINE. YOU LOWER THEIR BLOOD PRESSURE A LITTLE BIT SO THE HEART DOESN’T HAVE TO WORK SO HARD. THERE ARE SOME THINGS THROUGH EXERCISE THAT CAN BE DONE. NOWADAYS THERE ARE SOME SPECIALIZED PACEMAKER, RHYTHM-MANAGEMENT TOOLS THAT CAN BE USED TO TRY AND IMPROVE THE CARDIAC FUNCTION. YEAH, SO SOME OF THIS — SO THERE’S NO ONE THING. JUST FIXING THE ARTERY DOESN’T ALWAYS FIX THE PROBLEM.>>THERE WE GO. 68-YEAR-OLD WOMAN FROM WALL, WHAT CAUSES THE ENZYME TROPOMIN TO ELEVATE? WE USED TO LOOK AT L.D.H.s, C.K.s, ALL THAT, NOW WE HAVE TROPONIN, WONDERFUL ENZYME.>>IT’S RELEASED FROM THE MYCARDIAL CELLS WHEN THERE’S DAMAGE. A COUPLE OF DIFFERENT KINDS BUT WE’RE TALKING REALLY ABOUT CARDIAC. AND IT IS AN INDICATOR THAT THERE’S BEEN SOME DAMAGE OR THAT THE HEART MUSCLE, THE CELLS HAVEN’T GOTTEN ENOUGH BLOOD AND OXYGEN. SO IT’S RELEASED. AND WE CAN DO JUST A BLOOD TEST AND CHECK IT. AND, SO, IT’S ONE OF THE TOOLS THAT WE USE TO TRY AND DETERMINE WHETHER SOMEONE’S HAD AN ACUTE HEART ATTACK. THE DIFFICULTY WITH IT IS THAT, YOU CAN’T ALWAYS COMPARE WHAT YOU GET FROM WESSINGTON SPRINGS COMPARED TO WHAT YOU MIGHT GET IN BROOKINGS OR SIOUX FALLS. THAT’S NUMBER ONE. NUMBER TWO, THERE ARE A FEW THINGS THAT CAUSE A PROBLEM.>>FIVE SECONDS.>>RENAL DYSFUNCTION, A FEW OTHERS THINGS THAT WILL GIVE YOU RESULTS.>>IT’S A DIFFICULT ISSUE.>>YEAH.>>AND NOW, FOR THE WINNER OF TONIGHT’S PRAIRIE DOC QUIZ QUESTION. WHEN A BLOCKAGE OF AN ARTERY OCCURS, THE BODY CAN REPAIR ITSELF BY MAKING ANOTHER BLOOD VESSEL TO BYPASS THE BLOCKAGE. TRUE OR FALSE? THE ANSWER IS TRUE. IT WAS FLORENCE McDANIEL WHO IS A DEAR FRIEND OF OURS FROM BROOKINGS WHO ANSWERED THE QUESTION CORRECTLY. THANK YOU, FLORENCE, FOR PARTICIPATING. AND A BOOK WILL BE IN THE MAIL TO YOU SOON. WE’LL BE RIGHT BACK AFTER THIS. [MUSIC] [ COUGHING ]>>SORRY. FLU. [ WHISTLING ] >>YOU’RE NOT YOU WHEN YOU HAVE THE FLU. GET VACCINATED. STOPPING THE FLU STARTS WITH YOU.>>GEORGE IS A MIDDLE-AGED FRIEND WHO IS PHYSICALLY ACTIVE, NON-SMOKING, RELATIVELY-THIN, NON-STRESSED, HAS LOW CHOLESTEROL, AND LAST MONTH HAD HIS THIRD HEART ATTACK. WHY IS HE STRICKEN WITH THIS CONDITION? WHAT CAUSES BLOCKED BLOOD VESSELS, OR ATHEROSCLEROSIS, AND HOW CAN GEORGE, OR ANY OF US, PREVENT ATHEROSCLEROSIS AND THE RESULTING HEART ATTACKS, STROKES, OR LEG AMPUTATIONS? PATHOLOGISTS HAVE FOUND ON THE AUTOPSIES OF YOUNG SOLDIERS WHO’VE DIED IN WAR THAT EARLY ATHEROSCLEROSIS IS OCCURRING IN DISTURBINGLY HIGH NUMBERS. ASIDE FROM GENETIC INFLUENCES, THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE LISTS THE MAIN CAUSES FOR ATHEROSCLEROSIS AS SMOKING, HIGH AMOUNTS OF CERTAIN FATS AND CHOLESTEROL IN THE BLOOD, HIGH BLOOD PRESSURE, AND HIGH AMOUNTS OF SUGAR IN THE BLOOD. THE INSTITUTE STATES THAT THE MOST IMPORTANT STEP TO PREVENT VASCULAR DISEASE SHOULD BE WITH LIFESTYLE CHANGES. IF YOU SMOKE, QUIT. EAT A MODERATE, BALANCED DIET WITH ENOUGH FRUITS AND VEGETABLES. EXERCISE REGULARLY. AND PERIODICALLY MONITOR YOUR BLOOD PRESSURE AND BLOOD SUGAR. GEORGE HAS BEEN DOING ALL THAT. SCIENTISTS AND THE PHARMACEUTICAL INDUSTRY HAVE LONG SOUGHT A SIMPLE PILL TO PREVENT VASCULAR DISEASE AND PILLS TO CONTROL BLOOD PRESSURE AND BLOOD SUGAR HAVE HELPED. ALTHOUGH HIGH CHOLESTEROL LEVELS ARE A RISK FACTOR, UNFORTUNATELY, STATIN AND LIPID-LOWERING MEDICINES HAVE PROVEN ONLY MEAGER BENEFIT IN OUR FIGHT AGAINST ATHEROSCLEROSIS. GEORGE HAS CONTROLLED HIS BLOOD PRESSURE, SUGAR, AND BEEN TAKING A STATIN PILL FROM THE BEGINNING. A MALICIOUS, LESS-KNOWN, AND YET TREATABLE RISK FACTOR FOR VASCULAR DISEASE IS SLEEP APNEA. THE CONSEQUENCE OF PROLONGED PERIODS OF LOW OXYGEN CAUSED BY SMOKING OR SLEEP APNEA IS ATHEROSCLEROSIS. IN A 13-YEAR AUSTRALIAN STUDY OF 30 TO 65-YEAR-OLD PEOPLE, FIVE TIMES AS MANY PEOPLE WHO HAD MODERATE TO SEVERE SLEEP APNEA, 33%, DIED COMPARED TO THOSE WHO SLEPT WELL AT NIGHT, 6%, THE DIFFERENCE MOSTLY FROM VASCULAR DISEASE. NOW WE CAN TREAT SLEEP APNEA WITH CONTINUOUS POSITIVE AIRWAY PRESSURE, OR C-PAP, WHERE A NOSE OR FACE-MASK AIR-PRESSURE DEVICE PREVENTS OXYGEN LEVELS FROM DROPPING HARMFULLY LOW DURING SLEEP. RECENT STUDIES INDICATE THAT THE USE OF C-PAP BRINGS A SIGNIFICANT REDUCTION IN DEATH RATE. ANOTHER WAY TO TREAT SEVERE SLEEP APNEA IS WEIGHT LOSS, BUT ACCOMPLISHING SIGNIFICANT AND PERMANENT WEIGHT LOSS REMAINS A VERY DAUNTING TASK. I ADVISE MY PATIENTS THAT UNTIL WEIGHT LOSS OCCURS, WE BEST TREAT SLEEP APNEA WITH C-PAP. GEORGE WILL BE HAVING A SLEEP STUDY SOON. [MUSIC] >>I SINCERELY THANK OUR GUESTS TONIGHT, DUSTIN WEIS AND MICHAEL BACHARACH, FOR VOLUNTEERING TO COME TO OUR STUDIO AND HELP WITH OUR PROGRAM. THANK YOU, GENTLEMEN.>>THANK YOU FOR HAVING US.>>NOW ONTO OUR FLU SEASON UPDATE. THIS WEEK I ADMITTED A PATIENT IN OUR COMMUNITY WITH INFLUENZA A, AND THE PATIENT HAD NOT BEEN TRAVELING OUT OF OUR LOCAL AREA. THE BUG IS AROUND US, WHEREVER WE ARE. THERE WILL BE MANY ADDITIONAL CASES OF INFLUENZA THIS YEAR BUT HOPEFULLY FEWER THAN IN RECENT YEARS. THE NUMBERS MAY STILL GO VERY HIGH BEFORE WE’RE THROUGH AND THE PEAK MAY BE DELAYED TO MARCH OR EVEN APRIL, BUT IT WILL GET HERE. DO NOT DELAY, GET YOUR FLU VACCINE NOW TO REDUCE YOUR CHANCES OF CATCHING THE FLU BUG. THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT “ON CALL WITH THE PRAIRIE DOC,” UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE. AND THANK YOU.>>THANK YOU.>>THANK YOU. >>WHETHER YOU AVOID DAILY DANGERS IN YOUR HOME, HOW ABOUT PREVENTING DIFFERENT CANCERS OR IS IT TOO LATE TO GET A FLU SHOT? IT IS “ASK ANYTHING” NEXT TIME “ON CALL WITH THE PRAIRIE DOC.”

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