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| HEALTH TRIBUNE | Wednesday, June 26, 2002, Chandigarh, India |
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The heart is the place where the body, the psyche and the spirit all converge. The heart disease presents a rich model for examining the relationship between one’s lifestyle and health. There is an alarming increase in the incidence of heart diseases in modern times. Increasing levels of stress have played an important role in this modern "epidemic". Coronary artery disease: new intent technology Info capsule
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Managing stress to stay away from operation table
The heart is the place where the body, the psyche
and the spirit all converge. The heart disease presents a rich model for
examining the relationship between one’s lifestyle and health. There
is an alarming increase in the incidence of heart diseases in modern
times. Increasing levels of stress have played an important role in this
modern "epidemic". What is stress? This most overused word in
the new age vocabulary represents simply the body’s reaction to
change. It can be a reaction to a physical or emotional stimulus. It is
not necessarily a negative phenomenon. Positive stress keeps us on our
toes and enhances our performance. Positive stress coupled with
relaxation is a good method to enhance performance. It is the dynamic
force that distinguishes between the active business of living and
passive existence. Stress becomes a negative force when it hampers our
ability to work efficiently and relax. Stress is not just a mental or
emotional state. Scientific studies have shown that stress increases
blood pressure and cholesterol levels. It increases the permeability of
arterial walls to cholesterol, i.e. arteries absorb more cholesterol. It
also decreases the "good" cholesterol (HDL). It decreases
estrogen levels, leading to irregular menstrual cycles and an increase
in the incidence of heart disease in women (normally women are
"protected" from heart disease till menopause due to the
presence of normal levels of estrogen). It also causes an increase in
blood clotting (which can lead to a heart attack), more smoking,
drinking and food intake and a rise in arrhythmias (irritability and
irregular beating of the heart). The ideal reaction to a stress
situation is to respond to challenges or difficulties fast and
efficiently and then to relax. It is when we lose the ability to return
to the baseline — to relax — that the stress response becomes
chronic. When this happens stress hormone levels remain high, causing
anxiety, insomnia, coronary artery spasm and increased blood clotting.
Stress management techniques are not just another type of tranquiliser.
They do not bring relaxation or peace from outside. Instead they help us
to quiet down the mind and body sufficiently to experience an inner
sense of peace. Self-esteem and happiness —one that comes from not
from getting but rather from being, not from doing but from
undoing. There are basically two ways of dealing with stress. One is to
avoid it — but this is not always possible or even desirable. The
other way is to change how you react to a situation — react in a
positive and healthy way by increasing your stress threshold and making
your fuse longer. Awareness is the first step in healing. One has to
quiten the mind to experience what we have, all the time. Good planning
is very important to prevent important issues from snowballing into
monstrous emergencies. One must set SMART goals — Specific,
Measurable, Action-oriented, Realistic and Timely. I was taught these
goals by my teacher — Dr Mark Shanahan, Chairman, Cardiac Surgery —
in Sydney as part of my training in cardiac surgery. I realised that the
same goals were equally apt in life in general. One should not worry
about the future all the time. When you do so you lose twice; you miss
the joy of the present moment and you decrease the chances of future
success. Do plan for the future, but don’t live there. It is important
to understand that good judgement can come only from experience.
Mistakes are inevitable. If you let them come in your way or stop
working for fear of mistakes, you cease to learn. Instead of living in
fear, one must view life as a challenge to be enjoyed. As another of my
respected teacher, Dr J.S. Gujral, would say before our exams — just
because you have not done well in one question does not mean that you
must let it spoil your other answers too. Again I find that this applies
very aptly to life too; one must not let one mistake come in the way of
the rest of our life. Stress has to be managed so that it becomes a
positive force in your life. We must learn to relax, not how to become
lethargic. We must manage stress, not avoid it. We must live in the
world more fully, not withdraw from it. Only when we take care of
ourselves can we also give more fully to others. It is very important
to take a break once in a while. A vacation helps in rejuvenating us and
recharging our batteries. A relaxing and enjoyable hobby can work
wonders. When taking up a sport one must keep in mind that it must be
something that can be enjoyed and not endured. A useful tip here: be on
good terms with your wife!! Always make certain that you spend quality
time with your family. My cardiologist colleague, otherwise a Type A
personality, finds that he can truly relax after a long stressful day
only when he spends time with his one-year-old daughter. The body has a
great capacity to heal itself when given a chance to. People tend not to
give the body a chance to recover from one stress before hitting it with
another. And many people compound the problem by smoking, consuming
alcohol, taking drugs and leading a sedentary life. Regular exercise
helps by relaxing the body and the mind, makes the heart stronger,
improves oxygenation, regulates blood pressure reduces weight, increases
fat metabolism, produces sound sleep and increases stamina. Exercise
causes the arteries to secrete a special hormone (EDRF) which produces
an increase in the size of the arteries. Exercise should be aerobic.
This refers to any activity that gets the body moving and raises the
heart rate for an extended period of time, e.g. brisk walking, jogging,
etc. In contrast, activities that require sudden bursts of energy such
as sprinting or power lifting are anaerobic and are not recommended as a
part of stress management. Exercise riggers the release of several key
neurotransmitters that boost awareness. Regular exercise trains the body
to react in a positive way so it can cope better with anxiety-provoking
events. Exercise boosts libido by releasing mood-elevating beta
endorphins. Yoga definitely helps. Stress leads to isolation from self
as well as from others. The very word "yoga" (Sanskrit) means
union.It achieves union with self and others and increases our awareness
about the inner self. It has been shown to reduce stress hormone levels
in the blood, regulate the heart beat and blood pressure and facilitate
normal functioning of the inner lining of the coronary arteries. It is
basically a preventive measure. Its four major components are stretching
exercises, relaxation, breathing techniques (pranayama) and meditation.
Stretching exercises loosen up tense muscles. The best way to manage a
stressful emergency, especially if you are the leader of a group which
is depending on you, is to consciously calm down the senses and let the
brain take over. This is another vital "mantra" which Ihave
learnt from Dr Mark Shanahan. In an acute disaster which is threatening
the life of a patient it is best to cool down and think rationally.
Losing temper at the nurses or assistants will only add to the mess as
then mistakes will multiply. It is very important to build your
self-esteem and confidence — acknowledge your qualities, spend time
with people who make you feel good (social support is a very important
part of therapy). Learn from your mistakes but do not torment yourself
with criticism. Be kind to yourself and do what you enjoy. Do not
perform only out of guilt or duty. A relaxing hobby can do wonders for
the whole system. Stress management is a holistic approach and
encompasses other important factors. Cessation of smoking and avoidance
of drugs is paramount. Nicotine (in tobacco), caffeine (in tea, coffee
and cola drinks) and drugs like crack and amphetamine are wonderful
except that they are addictive, injure the lining of and constrict the
coronary arteries, increase the tendency for blood to clot, are
carcinogenic and hasten death. Alcohol should be totally avoided or
taken in moderation (1-2 ounces per day) if at all. Diet should be
predominantly vegetarian with very restricted use of desi ghee and
butter, fried food, excess salt and sugar, foods rich in chemical
additives. It should be rich in fibre and in green leafy vegetables and
fresh fruit. Do count your calories. If you love eating go out and
exercise after having that gulab-jamun. The only known side-effects
from these lefestyle changes are desirable ones. Thus stress can be
converted into a dynamic positive force for those who can learn to cop
with its effects. The writer is a Senior Consultant and Cardiac
Surgeon, Fortis Heart Institute, Mohali. |
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Coronary
artery disease: new intent technology The coronary artery disease is assuming epidemic
proportions in developing countries and India is no exception. While
primary prevention is still the best means to control this disease,
there have been landmark developments on the therapeutic front in the
last decade. Coronary stent is one such modality, which has emerged as
a strong bullet. The use of stents is a common intervention to treat
stenosis in coronary arteries. Since stents were introduced in the
early 1990s, in-stent restenosis (ISR) has proved to be the major
limitation of interventional cardiology. While stents have the
advantage over other techniques to prevent vascular recoil (pinching)
and negative remodelling (decrease in vessel lumen area), ISR has been
estimated to occur in up to 30 per cent of the patients who receive a
coronary stent. This may now be overcome by the use of drug eluting
stents which rely on targeted drug delivery to prevent the development
of restenotic lesions without causing adverse systemic effects. A
number of therapeutic agents are being investigated for their efficacy
in drug-eluting stents. One such agent is sirolimus (rapamycin) which
is a naturally occurring antimicrobial agent. It is a cytostatic drug
that stops cell division very early in the cell cycle (see figure)
without causing cell death. The vessel injury following stent
implantation enables the cells to proliferate (S-phase). Sirolimus not
only blocks this proliferation but also allows normal healing to
occur, mostly by 30 days. New growth of endothelial tissue covers the
stent and minimises the risk of thrombosis with in the stent. Hence
pathological changes in the vessel wall are avoided. The other agent
being investigated in clinical trials is paclitaxel. It is a cytotoxic
drug which has the potential to cause the death of the dividing smooth
muscle and endothelial cells. This could compromise the healing
process after stent deployment and increase the likelihood of adverse
clinical events, especially late stent thrombosis. The final results
of the clinical application of paclitaxel-coated stents in humans are
awaited. The European Community (EC) has recently given approval to
the clinical use of sirolimus-eluting stent (CYPHER, Johnson &
Johnson) and United States Food & Drug Administration approval is
expected shortly. This stent has proved to be safe and efficacious in
the prevention of ISR in both diabetic and non-diabetic patients
without any incidence of acute, subacute or late thrombosis. In fact,
in the recently reported results of RAVEL study involving CYPHER
stent, there was a zero per cent restenosis rate, no late lumen loss
and an event-free survival of 97 per cent at 210 days. Another large
study (SIRIUS) carried out in the USA in challenging high-risk
patients showed an ISR rate of 2 per cent at eight months follow-up.
The CYPHER stent has also been used as successfully in the treatment
of ISR, proving to be a feasible and safe modality in all angiographic
forms of ISR (ISR Pilot Study) in a wide spectrum of patients. In this
particular form of treatment, the drug eluting stent is telescoped at
the site of the previously deployed stent. This strategy has resulted
in good short-and-medium-term outcomes. Drug-coated stents represent
a breakthrough technology that offers a viable alternative to other
approved technologies for treating the occlusive coronary artery
disease in a wide plethora of patients. Each drug used on a stent will
need to define its own therapeutic window, and the differences between
the drugs will need to be considered by physicians in determining
patient treatment. While the initial cost of such stents may be a
deterrent to their frequent use, these devices are likely to prove
cost-effective and elligible patients will derive long-term benefits
from their use. The writer is Senior Consultant and Interventional
Cardiologist, Mukat Heart Institute, Chandigarh.
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Info capsule London: Many of us will have enduring childhood memories of being urged to eat our greens. Happily, this long-held nutritional mantra turns out to have some basis in science. Research has revealed that green vegetables pack a greater nutritional punch than more anemic-looking produce, such as potatoes and swede. Broccoli's intensely green hue hints strongly at its nutritional potential, so no wonder that scientists have discovered it to be rich in a plethora of disease-protective nutrients. Many of the health-giving properties vegetables offer are often ascribed to the vitamins and minerals they contain. However, apart from these nutrients, vegetables are also rich in a class of substances known as phytochemicals. While less well known than vitamins and minerals, phytochemicals nonetheless have the capacity to wield significant biochemical power in the body. Research conducted over the past decade has revealed that broccoli is brimming with two phytochemicals known as sulforaphane and indole-3-carbinol (I3C). Scientists have discovered that both of these substances stimulate enzymes that help to deactivate cancer-causing substances in the body. Not only that, but there is increasing evidence that filling up on broccoli (and other vegetables from the same plant family, such as sprouts and cabbage) may help reduce our risk of succumbing to cancer.
Observer News Service
Bush's war on fat
New York: President George Bush has turned from his war on terror to the war on fat, using his own body as a model for America to get fit. With a punishing week of diplomacy ahead of him, Mr Bush chose to turn his nationwide radio address down a novel path for a head of state and inform Americans that "exercise is a daily part of my life, and I urge all Americans to make it an important part of your lives". "I insist", said Mr Bush of his own staff, "that they take time off, out of their daily grind, to get some exercise". Mr Bush is one in a long line of jogging, health-conscious Presidents — including his predecessors Bill Clinton and Jimmy Carter — on top of which he has a daily regime of weight training. At 55, he can bench-press five repetitions of 85 kg and run five km in under 25 minutes. "Regularly hiking through a park can add years to your life", Mr Bush said in his weekly radio address. He said Americans should eat fruit and vegetables rather than fatty foods and refrain from smoking and excessive drinking.
Observer News Service
Obesity linked to hunger hormone
San Francisco: People with a genetic disease that causes constant hunger and morbid obesity have elevated concentrations of a hormone that has recently been linked to appetite, new research reveals. Among 18 people with a condition called Prader-Willi syndrome, their blood concentrations of the hunger hormone ghrelin were 4.5 times higher than in blood from people of similar weights, said David E. Cummings of the Department of Veteran's Affairs at the Puget Sound Health Care System in Seattle. "These patients have higher ghrelin levels than recorded in any other humans," he said. Mr Cummings reported his findings at the 84th annual meeting of the Endocrine Society.
UPI
Anti-obesity protein
Tokyo: Anti-obesity drugs now have a newer target. A protein has been discovered that links gluttony and weight gain. During the course of experiments, it was seen that mice lacking this protein could indulge in fatty food but remain as slim as mice on a lower-fat diet, according to a new study. The study, reported by Nature journal, could come as a ray of hope to help morbidly obese people lose weight. Researchers at Kyoto University in Japan have identified the hormone called gastric inhibitory polypeptide (GIP) as the cause behind this. The hormone is secreted into the bloodstream by the small intestine in response to ingested foods, particularly fatty ones, and it binds to cell-surface receptors on distant fat cells, signalling food intake. If this sequence is disrupted, mice burn excess fat rather than store it, and they become obesity resistant.
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