Men’s Health: A Work in Progress

URMC is sponsoring a “Journey to Healthy Living” on Thursday, June 13, at the 9^th Men’s Health Day at Mario’s Italian Steakhouse. Scripts sat down recently with event organizer Dr. Jean Joseph for an interview about the state of men’s health. We regret that tickets to the event have recently sold out (as of June 4), but still thought it important to share his perspectives with you.

 Scripts:  Why an event focused solely on men’s health?

Joseph:  More than 10 years ago, we recognized that it’s not enough just to treat illness; we wanted to help men avoid it in the first place. So we came up with the idea of Men’s Health Day. Those of us in the medical profession see far too many patients who have waited until the last minute before seeking medical care – many of whom are suffering from an illness that could have been entirely avoided in the first place. Most of these patients are men. Heart disease, stroke and cancer take an alarming toll every year on men in our country. There is a reason why women in nursing homes significantly outnumber men: because men are dying five years earlier, leaving their friends and families to cope without them.

Scripts: What is it that men aren’t doing – and women are – that makes the difference?

Joseph:  If you discount genetics or environmental factors, there are many things men can do to live longer that they’re not doing now. What many are doing is indulging in a variety of self-destructive behaviors like smoking, unsafe sex, not wearing a seat belt, excessive drinking, and generally not getting regular checkups and ignoring their health until it’s too late. We’re not blaming guys. Some of the reasons for these are cultural; men are conditioned from an early age to understand that being reckless is “typical boy” behavior and that excessive partying and ignoring their health is manly. Women, on the other hand, have an advantage. Most have had regular checkups with a gynecologist since puberty and view being proactive about their health a positive thing.

Scripts: Are there simple steps that man can take to make a difference?

Joseph:  Education and self-awareness are the first steps to reversing the statistics. Getting regular checkups and adopting a healthier lifestyle are the next. With rising health costs and competition for services, it’s more important than ever for men to stay healthy and vigorous in order to live satisfying and active lives for as long as possible. And today, as long as possible could mean 90 to 100 years of age – or even more.

By presenting Men’s Health Day, we are aiming to provide an informal forum where men will receive solid information and feel free to ask questions. If you are a man age 45 or older, I encourage you to attend. And if you are a woman who cares about an older man, please pass this information on and urge him to attend.

Again, here are the details:

Men’s Health Day, open to men ages 45 and up

Thursday, June 13, 2013, 11 a.m. to 3:30 p.m.

Mario’s Italian Steakhouse, 2740 Monroe Avenue, Rochester, New York

Attendees will learn more about:

• Back pain
• Heart health
• Low testosterone
• Memory and nutrition
• Health care reform and how it will impact our community

Admission is free but space is limited and reservations are required. Call (585) 275-8762.

Jean Joseph, M.D., M.B.A., is a professor in the department of Urology and the Wilmot Cancer Center at the University of Rochester Medical Center. He is the head of the section of urologic laparoscopy and robotic surgery. Joseph is also the medical director of Patient- and Family-Centered Care at URMC.

Back in Sync: Simple Programming Tweaks Help Defibrillators Work Better

Too many of us take a healthy heartbeat for granted.

But for those living with defibrillators – nearly 200,000 are implanted in Americans each year – abnormal and potentially fatal beating patterns could strike at any moment. Fortunately, a new, world-wide trial led by URMC expert Dr. Arthur Moss shows that slight programming tweaks to these rhythm-resetting devices can help people with heart disease enjoy longer, higher quality lives.

The findings were published last week in the New England Journal of Medicine.

Moss says that implantable defibrillators are commonly programmed to fire when the heart rate exceeds around 170 beats per minute. The problem is, rates of 180 or 190 are not always dangerous, are typically short-lived, and might even be tied to increased activity or exercise. And since defibrillators aren’t always good at differentiating benign from harmful rhythms in this “in-between” range, patients must live against a backdrop of potentially painful, anxiety-provoking shocks.

“There’s also considerable research to suggest that there’s a small amount of damage to the heart muscle with each delivered shock,” added Moss. “If we can eliminate unnecessary ones, this is going to be associated with less heart damage and improved outcomes.”

Indeed, over time, too many false alarms take their toll – and not just on the heart muscle itself. In fact, data from a 2002 trial comparing anti-arrhythmic drugs and defibrillators suggested that shocks are associated with reduced mental well-being. A recent review of more than 45 studies found that such emotional distress isn’t uncommon; between 11 and 28 percent of defibrillator patients had some form of depression and between 11 and 26 percent had an anxiety disorder.

The recent trial Dr. Moss led (the MADIT-RIT trial, or Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy, tapping 1,500 patients in 98 hospital centers in the United States, Canada, Europe, Israel, and Japan), revealed big boons for heart disease patients with defibrillators. The trial showed that setting the device to fire at a slightly higher rate (200 beats per minute) reduced the risk of experiencing a first unnecessary shock by 79 percent, compared to standard programming. Fewer shocks also corresponded with less energy delivered to the heart, which study authors believe ultimately contributed to the reduced risk of death. To their surprise, using this higher threshold for shock delivery also lowered the risk of death by an impressive 55 percent compared to patients whose devices ran on traditional programming.

You can hear Dr. Moss talk about the trial – and what it means people with defibrillators – in the clip below.

Lead investigator, URMC Professor Arthur J. Moss, M.D., is a world-renowned expert in the treatment and prevention of cardiac arrhythmias and sudden cardiac death. Moss’ team found that simply raising the heart rate at which defibrillator devices (ICDs) are set to fire – or deliver shock therapy – makes all the difference.

In 2002, Moss and the MADIT research group showed that ICDs are extremely effective in preventing death in patients at risk of irregular heart rhythms and sudden cardiac death, including individuals who’ve suffered a heart attack. The work changed medical guidelines nationwide, making thousands of heart attack survivors eligible for ICD therapy.

The MADIT-RIT trial is the first large-scale, randomized study designed to evaluate specific programming features to reduce inappropriate (unnecessary) therapy in patients with ICDs. The trial’s sponsor, Boston Scientific, was not involved in data collection or data analysis. Moss, who has led the MADIT trials since their inception in the 1990s, holds no stock in any device company, has never been a member of any corporate speakers bureau, and since Dec. 1, 2008, has chosen not to accept honoraria from Boston Scientific for any professional activity.

‘120 Over 80’: Frank Facts about Hypertension

One in three.

That’s how many local adults are milling about, living daily life with the kind of high blood pressure that paves the path for heart attacks, heart failure, stroke and kidney disease.

Fortunately, our region’s also rich in treatment and support resources. In fact, just last week, the American Society of Hypertension (the largest U.S. professional organization of scientists and healthcare professionals committed to eliminating hypertension) announced that we at URMC were first in the nation to earn its top-tier recognition for our evaluation, diagnosis and treatment of high blood pressure.

Of course, these terrific resources won’t be tapped unless people first “know their numbers” and appreciate their own risk, says cardiologist and hypertension clinic director Dr. John Bisognano. Below, we asked him to debunk some deep-seated myths surrounding high blood pressure.

Scripts: Many folks think “I’m young and fit…there’s no way I could have high blood pressure.” What would you say to teens and young adults who consider themselves the picture of health?

Bisognano: Certainly, it’s great that they’re feeling so well – but it’s really important to remember that high blood pressure is often passed through generations. Our own health habits are important, but they’re just one piece of a complex puzzle.

If you have hypertensive relatives, it’s likely that your genetic make-up puts you at risk for high blood pressure at some point in the future.  So be vigilant about staying fit (exercising thirty minutes a day, five to seven days a week), watching your salt intake and keeping your weight under control. These preemptive strikes will help you best avoid hypertension down the road – or at very least, delay its onset.

Scripts: Other people with slightly elevated blood pressure might assume that, since they don’t exhibit any obvious symptoms (e.g., no nervousness, sweating, etc.), the condition really can’t be doing any damage yet.

Bisognano: And to them, I’d say that’s precisely why hypertension’s been nicknamed “the silent killer.” Most people with high blood pressure feel fine, even great, most of the time. But that doesn’t mean active damage isn’t occurring.

Left unchecked, your arteries – strong, elastic “piping” that ferries blood back to your heart – can grow thick, stiff, and narrowed by fatty plaque build-up, putting vital organs like the brain, heart, and kidneys at risk. And of course, you have to remember that your heart is a muscle – you can only imagine the way this added stress might tax your heart over time, sometimes even to the point of it giving out.

Scripts: Okay, so what do you say to people making the opposite claim: “My family tree is riddled with high blood pressure – it’s my genetic destiny. There’s nothing I can do to avoid it, so why bother?”

Bisognano: Again, I’d tell them that their risk for hypertension is the result of a constellation of factors. While it might be their “destiny” to some degree,  even relatives swimming in the same gene pool exhibit varying levels of risk. It is certainly possible to delay the “inevitable” by adhering to healthy lifestyle habits (again, limiting salt intake, maintaining a healthy weight, and keeping up with regular aerobic exercise). What’s more, modern medicine offers many good drugs – with few side effects, and low cost – so it’s worth meeting with your physician to discuss a prevention or treatment plan that suits you.

Scripts: Others might say “My numbers are only higher because I’m nervous/was in a hurry to my appointment. It’s probably a false read.”  

Bisognano: And you know, that could be true. But to be safe, your doctor will want to make sure your blood pressure isn’t high at other times, too.  If your readings are elevated at your appointment, it’s a wise idea to double-check them by taking your blood pressure at home with a personal monitor. If you find that it rises often, that’s really powerful information; you’re lucky to have discovered it (as opposed to writing it off as mere nerves), because this means you can take steps to start treatment before damage occurs to your arteries and kidneys.

As far as the readings go, they’re less complicated that they sound. If you’re over 50, your doctor will focus primarily on the top number – the “systolic” measure, which gauges peak pressure during the time when your heart is contracting.  This generally should be under 140 (ideally under 130 in some people with diabetes or kidney disease). The bottom number –the “diastolic” reading, measuring pressure “between beats,” or while the heart is pausing to rest – plays a role too. As doctors, we like to keep an eye on it, particularly in younger people.

Scripts:  One last question. A lot of people are reluctant to take drugs if their condition is on the mild end of the spectrum. “I only have stage 1 hypertension,” they say, ” so prescription drugs aren’t worth the hassle or side-effects.” What might you tell them?

Bisognano: When it comes to your health, you really don’t want to split hairs. Even a little bit of high blood pressure can lead to thickening of the vessels, heart muscles, and other problems. At any stage, hypertension demands our attention – and an action plan.

That’s precisely why, at the University of Rochester, we’re gearing up to study drug administration in adults with this lower level of hypertension. We know it can cause damage, yet many people don’t want to take drugs for these minor elevations – although they really should. We’re hoping to come closer to a solution that fits both their health needs and their busy lifestyles.

URMC’s hypertension clinic brings together a team nearly two dozen specially trained clinicians who treat the most challenging forms of high blood pressure and are hard at work exploring better therapies. Experts hail from Cardiology, Vascular Surgery, Endocrinology, Nephrology, Pediatrics, Community and Preventive Medicine and URMC’s School of Nursing. To make an appointment with the team or learn more, call (585) 275-2475.

The Latest Claim: Some ‘Fried Foods’ OK for the Heart

No, it’s not carte blanche to toss aside the carrot sticks and gleefully chow down on drive-thru fare.

Rather, new research from Spain (which followed 40,000-some Spaniards for 12 years), suggests that not all “fried foods” deserve to be demonized. Researchers found that, so long as the cooking involves healthier fats, like olive and canola oils, the occasional indulgence might not significantly increase risk for heart disease. What’s more, it may even be a smart part of a balanced diet.

“Like so much nutrition advice, this all boils down to moderation,” said registered dietitian Tracy Cherry, a clinical nutrition specialist with URMC’s Cardiac Rehabilitation program. “Integrating a reasonable amount of heart-healthy oil into our cooking can go a long way toward keeping our diet interesting – and maintainable.”

In the interview below, Cherry talks about the rightful place for some “fried fare” on our daily plate.

Scripts: There seems to be a bit of a disconnect, here. In the U.S., the term “fried” is usually a dead giveaway that a food item is chocked full of fat, salt, and other unsavory ingredients – but this study is almost putting a halo on some fried foods. Can you expound?

Cherry: Here in the U.S., the notion of “frying” foods conjures up thoughts of battered fish fries and greasy, sugared donuts (which almost act like sponges to soak up fats!). But this study took place in Spain, where residents eat a more traditional Mediterranean diet; they’re rarely breading and deep-frying salty, sugary foods in Crisco-like fats – but rather, they’re stir-frying veggies or pan-frying undressed fish, using just a couple of teaspoons of olive oil. There’s a world of difference between these two concepts of what it means to “fry.”

Scripts: Tell us more about heart-healthy oils.

Cherry: Really, oils in general – especially olive and canola oils (though peanut, grape seed, and sunflower oils aren’t a bad second choice) – are more heart-healthy than solid, saturated fats, which tend to raise “bad” cholesterol levels in the blood, upping one’s risk for heart disease. 

But portion size matters, too. Oils and solid fats pack the same calorie content, tablespoon for tablespoon, so it’s smart to budget just a teaspoon of oil per serving when you’re cooking. That’s why stir-frying, sauteing and pan-frying are far better options; you can cook a really flavorful meal without having to douse it in a bath of bubbling fat. For an even leaner option, you can supplement the pan oil with a few splashes of water, or a cooking spray; it can help with the cost, too, and no one will be the wiser.

Scripts: You touched on this earlier, but does breading really make a big difference?

Cherry: You’d be surprised, but yes, it does. Again, it almost mops up oils – and the U.S. dietary guidelines recommend just one or two tablespoons of fats per person per day. (Remember, there are plenty of other sources that can supply fat – mayonnaise, peanut butter, olives, and walnuts – so there’s no need to “spend” all of your allowance in one place.)

Scripts: You talk about fats very matter-of-factly – as if they’re not necessarily bad. Why is that?

Cherry: It’s the truth! Back in the 80s and 90s, the party line was that all fats were evil; diet foods touted “no-fat” labels with pride, as Americans ruthlessly ridded the full-fat versions from their cupboards.

Now, we’re much savvier; we realize that small amounts of fat are beneficial, even essential, to our diet. Brain-building omega-3 fatty acids, found in foods like walnuts and fish, promote vigorous neurodevelopment in infants (even in-utero). Omega-3’s are also thought to help pull down triglycerides (bad fats in the bloodstream), help patients with arrhythmias (irregular heartbeats), and lower overall blood pressure.

Scripts: So, what’s the takeaway?

Cherry: I might sounds like a broken record, but it’s important: Moderation. Using modest amounts of healthy oils while cooking can go a long way toward creating a flavorful, heart-healthy meals that won’t derail your diet.

To learn more about heart care at URMC – including our cardiac rehabilitation programs – click here.

It’s February: Love Your Heart

Make no mistake: while the stereotypical heart attack victim in the movies might be male, heart disease is an equal opportunity killer. In fact, it’s the number one cause of death among women 20 and older, killing almost one every minute.

The good news? Research shows that, even if saddled with a family history of the disease, there are steps each of us can take to become more heart-healthy. Simple things — like following a proper diet, keeping active, not smoking, not drinking excessively, and partnering with a primary care doctor to monitor cholesterol, blood sugar, blood pressure and weight — can go a long way in lowering one’s risk for a heart attack or stroke.

So, in light of February being American Heart Month, we’ve tapped Dr. Gladys Velarde, director of our Strong Women’s Heart Program, to give a few quick tips (for everyone, and then especially for women) for maintaining for a healthier heart.

To hear her advice, watch the clip below.

Curious how the Women’s Heart Program is making a difference for patients here in Rochester? Click here.