Smoke And Mirrors Part 1

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

We have all been there at one time or another. In order to avoid something we don't want to confront, we distract ourselves with something else. Everyone has heard the story of the guy (I will spare the ladies) who would turn up his radio volume to drown out the escalating rattle under his hood. This rattle eventually led to a blown engine. This may or may not be a true story, but the point hits the nail on the head. Most of us don't like to hear the "rattle under the hood". Our responses to conflict can mimic this response of turning up the volume. When confronted about something we are not comfortable with, we might simply change the subject, or get defensive and walk away. The reality of these responses, sadly, could lead to a "blown engine" in our lives. As you may have already figured out, I am about to discuss something that may be uncomfortable for some people. The topic is cigarette smoking.

Please continue to read this article. The information contained in it may really change your life. God wants you to come to Him with all your problems. Remember we all are sinners and fall short of the glory of God (Rom 3:23). No matter how hard we try we are not deserving of God's grace. We are all infected and impure with sin. When we display our righteous deeds, they are nothing but filthy rags (Isaiah 64:6 NLT). What is awesome is that God could have turned his back on us but instead, He reached out for us. But God showed his great love for us by sending Christ to die for us while we were still sinners. (Romans 5:8 NLT) We all have some sin in our lives. It can be an outward problem like smoking, excessive drinking of alcohol, or gluttony. Then there are those sins that are just between God and you. God wants us to overcome these problems because our bodies are a temple of the Lord (1 Co 6:19 NIV), and being healthy enhances our relationship with Him. But thank God! He gives us victory over sin and death through our Lord Jesus Christ (1 Corinthians 15:57 NLT). With the help of God, your family, and your friends, you can overcome and can acknowledge that the Lord is God! He made us, and we are his. We are his people; the sheep of his pasture (Psalm 100:3 NLT) .

I wasn't sure where God was leading me in my first article. While considering what to write, I kept coming back to cigarette smoking. Why, you may ask, of all things start with smoking? My fear was that I might lose readers before I had a chance to reach them, yet I still felt compelled to discuss this subject. I knew that if I could convince one person to quit smoking or give their hearts to the Lord, I would be successful. Another reason I started with smoking is pure statistics. In my first article I mentioned how our society's top killers are on the decline. Conversely, Chronic Obstructive Pulmonary Disease (COPD) is on the rise big time.

...Cigarette-fueled COPD rose by 102.8% from 1970 to 2002, according to Ahmedin Jemal, D.V.M., Ph.D., and colleagues of the department of epidemiology and surveillance research at the American Cancer Society.

By Peggy Peck, Senior Editor, MedPage Today September 13, 2005

Did you catch the phrase, "cigarette-fueled"? Smoking is directly linked to diseases like Emphysema and Chronic Bronchitis (both are considered COPD). It has also been shown to play a significant role in other diseases as well.

My experience also finds that those who do smoke are not comfortable discussing it. The reason likely goes back to the rattle under the hood. If they don't confront it, they won't have to deal with it, and maybe, somehow, the rattle will go away.

When confronted about quitting smoking, I have discovered three common responses.

1. Just don't want to.

2. It is too late; I have done too much damage.

3. I try and try, but I just can't quit.

Some fall under one, but there can be overlapping in certain instances. I would like to take each response individually and reply.

1. Just don't want to . I don't understand where these individuals are coming from. They may sincerely believe smoking isn't destroying their lungs. The data says otherwise.

According to information released by the British government, cigarettes contain a paint stripper, a toilet cleaner, the chemical in mothballs, a rocket fuel, and many other deadly poisons.

Action on Smoking and Health
A National Legal-Action Antismoking Organization
Entirely Supported by Tax-Deductible Contributions

Here is a list of some of the other chemicals and poisons commonly found in cigarettes (listed with the places these chemicals are commonly found).

• nicotine (bug spray )
• tar (road materials)
• arsenic ( rat poison )
• ammonia (cleaning products )
• hydrogen cyanide (gas chamber poison )
• DDT ( insecticides)
• butane ( lighter fluid)
• Carbon Monoxide (Car exhaust)
  

Sources: Dr. Joel Dunnington, Tobacco Almanac, Revised, May 1993

Aside from the addictive qualities of cigarettes, many of the above chemicals are not only poisonous, but also carcinogenic (cancer causing). I have never heard of any studies that have concluded there are positive health benefits to smoking cigarettes.

2. It is too late; I have done too much damage . I have heard this excuse many times and am often baffled by it. These people obviously don't recognize the healing ability of the body. Would we apply this same logic to someone who abuses alcohol or some illicit drug? Of course not! Let's look at some interesting data.

Recovery from smoking

1990 U.S. Surgeon General's Report on the "Health Benefits of Smoking Cessation," U.S. National Institute of Health, Medline Plus.

Within...
20 minutes: your blood pressure, pulse rate, and the temperature of your hands and feet will all return to normal. 8 hours: your blood oxygen level will have increased to normal and carbon monoxide levels will have dropped to normal. 24 hours: your risk of a heart attack will have decreased by 50%. 48 hours: Damaged nerve endings have started to regrow and your sense of smell and taste are beginning to return to normal. 72 hours: your entire body will test 100% nicotine-free and over 90% of all nicotine metabolites will now have passed from your body via your urine. You can also expect the symptoms of chemical withdrawal to have peaked in intensity. Your bronchial tubes are beginning to relax, thus making it easier to breathe. Your lung capacity has also started to increase. 10 days to 2 weeks: your brain and body have now physically adjusted to again functioning without nicotine and the more than 3,500 chemical particles and 500 gases present in each and every puff. 3 weeks to 3 months : your circulation has substantially improved. Walking has become easier. Your chronic cough, if any, has likely disappeared. Your overall lung function has improved up to thirty percent. 1 to 9 months: any sinus congestion, fatigue, and shortness of breath have decreased. Cilia have regrown in your lungs thereby increasing their ability to handle mucus, keep your lungs clean, and reduce infections. Your body's overall energy has increased. 1 year: Your excess risk of coronary heart disease has dropped to less than half that of a smoker. 5 to 15 years: your risk of stroke has declined to that of a non-smoker. 10 years: your risk of death from lung cancer has declined by almost half if you were an average smoker (one pack per day). Your risk of cancer of the mouth, throat and esophagus is now half that of a smoker's. 15 years: your risk of coronary heart disease is now that of a person who has never smoked. Risk of lung cancer has decreased by 80 to 90%. Your overall risk of death has returned to near that of a person who has never smoked.

As you can see, God made our bodies with the incredible ability to heal itself. Although healing comes in different forms, this may be the most common. Discontinue the source that is disrupting the body, and healing begins. One should not use the above data to justify continued smoking. Someone out there may conclude that they are still young and they may feel they can smoke a few more years and still recover fully. Unfortunately another smoking related (albeit less common) disease is lung cancer, and its progression can be far more aggressive. Lung cancer is far less predictable and the individual's recovery is not as certain. I will discuss lung cancer in future articles. The cigarette's grip also goes beyond the lungs. Heart disease and stroke can also be directly linked to smoking.

I want to stop at this time. Another one of our goals at Heartwise is to keep it simple. I don't want to overload you with too much information. I will discuss the last response in my next article along with what smoking does structurally to the lungs. I feel enough information has been given to the reader to help better understand the role of smoking in lung disease. My prayer is that if you smoke, or someone you love smokes, that you will use this information and take it to the Lord. Pray about what you have read and how to apply it to your or your loved one's life. Remember, God loves you more than we can fathom. For God so loved the world that He gave His only begotten Son, that whoever believes in Him should not perish but have everlasting life (John 3:16 NKJV). God can heal you. He wants to heal you. By doing so, you will be able to tell others that God took away your addiction to cigarettes. What a wonderful way to witness about our awesome Heavenly Father! Look for future Heartwise health seminars where I will go into more detail on the effects of smoking.

I will periodically place links to web-sites that I believe can be a great benefit to the reader regarding the topics discussed. GlaxoSmithKline is the pharmaceutical company that makes products like NicoDerm and Nicorette. These products can be purchased over the counter. They also developed an interactive web-site that can be very helpful in quitting smoking. It has information on addiction, as well as a savings calculator, trigger detector, slip meter, and health risk assessor. I really recommend this site to aid in quitting.

http://www.way2quit.com

Craig Ammerall, RRT CPFT

Smoke and Mirrors Part 2

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

In last months article I discussed the most common responses I hear from people when discussing quitting smoking. I looked at the chemicals that exist in cigarettes and compared them to where these chemicals could be commonly found. I also looked at the healing ability of the lungs following the cessation of smoking. This article I will focus on the final response. I wanted to discuss this response in more detail because of what I believe is the root cause of that response.

3. I try and try, but I just can't quit.

This is a difficult one. Addiction plays a major role in smoking. There is no denying that. The addictive properties of nicotine (active chemical in cigarettes) have been compared to that of drugs like cocaine and heroin. There are many theories why some have more addictive personalities than others. I have seen people who have smoked two packs of cigarettes a day for 30 years and quit "cold turkey". On the flip side, I have seen people who have smoked a half pack a day for 1 year and they can't snuff the habit. God created us all to be unique, this is a blessing. But when we get sick, our uniqueness can baffle even the best doctors and scientists. Remember, God's original plan was for to live forever without sickness and death. We were to enjoy an eternal rest in Him.

Science has discovered two of the major components of addiction to smoking are craving for nicotine (addictive substance of cigarettes) and habit. Like I said before, some people can quit "cold turkey", but the reality is that percentage is only one in fifty. So what happens when a person inhales cigarette smoke? When a person takes a puff off a cigarette, receptors in the brain get used to these substances in cigarettes. Each cigarette a person smokes strengthens these receptors need for more. Cravings aren't just in your head; they are those receptors "calling out" for a fix. It is like the old saying, "you can't eat just one potato chip". Like smoking, people also crave things like sugar and salt. People who smoke regularly actually increase the number of those receptors making quitting more and more difficult. When trying to quit, the receptors need for nicotine takes time to diminish. The amount of time it takes varies from individual to individual. Eventually, the intensity of cravings will begin to diminish. Those who have "slipped" and started smoking again, will often describe a buzz when they take that first puff. That sensation is attributed to the speed in which nicotine travels to those receptors. I believe one should seriously consider nicotine replacement. This allows stopping smoking and the damages from the cigarettes chemicals, while "weaning" down the nicotine which helps with the cravings. Quitting isn't easy, don't be hard on yourself. Your best approach is prayer, education, and support.

The next part of addiction is related to a person's habits. Successful quitters have partially contributed their quitting to changing their habits. Many people who smoke describe certain patterns in their daily habits. Examples include, lighting up at the breakfast table every morning. Another would be smoking during breaks at work. Changing these habits can greatly increase the success of quitting. Try going for a walk in the morning, and eating breakfast on the deck or patio. Sit in your car at your break times and listen to the radio. Get away from others who smoke at those breaks. If stress is a trigger, than stick a lolly pop in your mouth instead of a cigarette. Sit down and make a list of times and stressors which give you the biggest urge to smoke. Devise a plan to alter those triggers. This along with a knowledgeable approach to the chemical cravings will greatly increase the chances for long term success.

The task at hand may seem daunting, but hold your head up. With a little help from God and just sticking to your guns, kicking the habit can be done. If it doesn't help to think of your future, think of others. If you're married, think about how quitting will extend your life and allow you to spend many more years with your spouse. If you are a parent or grandparent, think about the quality time you can spend with those kids. Finally, don't forget the powerful witness you can be. Quitting smoking is a major milestone. It is no different than quitting porno, drinking, or drugs. You praise God for the help He gave you and that could change someone else's heart or help them with addictions in their life.

Craig Ammerall, RRT-CPFT

 

Lung Remodeling

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

I have discussed, in detail, smoking’s role in lung disease. I have shown how both physical and habitual addiction play a huge role in smoking. I gave tips on how to quit tobacco. What I haven’t discussed yet is how smoking slowly incapacitates the lungs gradually stealing a little bit of each breath taken.

Anyone who knows my wife Melissa knows her love for remodeling. She is constantly thinking of ways to modernize and improve the value of our home. Often her ideas will be bigger than our wallets, but we always find a way. I tell her that she has “caviar dreams with a tuna fish budget”. She hates when I say that. Being more frugal with our money I will complain, but more often than not, give in. We both always look back and agree it was well worth it.

I want to look at another type of remodeling. This type doesn’t improve the appearance or function, it actually does the opposite. Since God created us perfectly, any remodeling to one’s lungs, or any part of our body, would be detrimental. Smoking does exactly that. The years of abuse to the lungs from smoking begin by debilitating the lungs ability to clean themselves. The tar and chemicals in cigarette smoke paralyze the cilia, which are microscopic hairs that “sweep” the dirt and mucus out of the lungs. This inability to clean the lungs leads to increase risk of infections (bronchitis, pneumonia) which does even more damage to the lungs. There are also glands in the lungs that produce mucus. Smoking can increase the amount of mucus the lungs produce. Not only is there more mucus, but the size of these glands actually increases greatly. Mucus glands that normally can only be seen by microscope become so dilated they actually become visible to the human eye. The glands actually turn into “pits” that trap mucus making it almost impossible for the person to cough and clear them. Not only do the mucus glands become enlarged, but the airways themselves do, as well. The dilation of the airways make the cough become less effective due to the airways inability to collapse which helps force mucus out of the lungs. Like with the paralyzed cilia, mucus stays trapped often “plugging” off smaller airways which again can lead to severe breathing problems and infection. This increase mucus production is often a symptom of Chronic Bronchitis.

Another process that occurs with chronic lung disease actually affects the part of the lungs where oxygen and carbon dioxide are exchanged. These are microscopic air sacs that are called alveoli. These air sacs begin where the smallest airways end. What happens is that these small airways become so inflamed that air gets it the alveoli easily, but those same airways collapse when exhaling. This failure to exhale completely leads to over inflated alveoli which interfere with proper gas exchange leaving these people with over-inflated lungs. Take a full breath and only exhale half the air from your lungs. Do this over and over. This is what air trapping feels like. Certain areas of the lungs eventually become so distended that “popping” of a lung can occur. This “popping” is called a pneumothorax. In most cases, this isn’t fatal, but with patients with severe lung disease, a pneumothorax could be life threatening. The name of this air trapping disease is called emphysema.

Typically, a long term smoker ends up with one or both of these diseases. These chronic diseases are called Chronic Obstructive Lung Disease, or COPD. Quitting smoking can slow the process of these diseases, but once a patient starts exhibiting symptoms, the disease will progress. The rate of progression depends on the overall health of the individual, and the treatment plan in place. I didn’t mention lung cancer because I feel it is important to discuss this deadly disease in more detail. I will do so in future articles.

This lung “remodeling” I discussed is a one way project. When a person gets to the point I discussed, much of the damage accrued cannot be reversed. Advanced lung disease is a chronic and debilitating disease that often leads to debilitating health problems. Thanks to modern medicine, many of the symptoms can be controlled.This along with a good diet and exercise program can lead to a more productive life. Make no mistake though; continued smoking during this stage of disease is only like tossing kerosene on a fire, hastening the disease process. If you smoke and you are symptom free, count your blessings. Quit now and you have a great chance to live a normal life. If you continue to smoke, eventually, like taxes and death, lung disease is going to eventually catch up to you. Continued blessings as you pray and ask for God to help you as you free yourselves from cigarette smoking’s grip.

Craig Ammerall, RRT CPFT

Diagnosing COPD

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

Memories of childhood can be spotty at best. The only things that seem to stand out are really good times, or really bad times. I can vividly remember as a child instances when I was sick. I recall sleepless nights trying to position myself to minimize coughing. Other times when I had a stomach flu, I recall the horrid anticipation of my next stomach wrenching, or sprint to the bathroom. I guess these stand out because I don't recall being sick much as a child, and they were really "bad times". What really stands out for me was my mothers uncanny ability to diagnose and treat. From kissing my forehead or stomach to confirm a fever, to Vicks vapor rubs and home made croup tents. To this very moment, every time I smell Vicks, memories race back to those early days. Moms have a God given instinct to help their children during times of sickness. I see this same instinct in my own wife. It really is quite amazing to witness.

Disease diagnosis at a more serious level can be more difficult. Identifying a cold or stomach flu is one thing, but more serious diseases have more riding on accurate diagnosis. Treatment plans and recovery can be greatly affected by how accurately the disease is diagnosed. COPD is even more perplexing. Since the disease itself is so broad, and symptoms vary, it is likely that it is under diagnosed. More than any other question I field, "what is COPD, and how do I know if I got it?", leads the pack. The next two articles I will explain diagnosing and treating this disease.

I believe the first place to start in diagnosing begins with the lost art of a history and physical. Now a days it seems that many doctor's offices are more worried about numbers than quality time with their patients. There are many places were fingers could be pointed, but that is not the intent of this article. So much can be learned about a patient based on their history, and that of their families. Things like previous illnesses, smoking habits, and second hand smoke exposure are keys to aiding the physician in COPD diagnosis. Other issues like environmental allergies, work conditions, and social life are equally important. As for the physical, identifying any unusual physical traits are important. Watching a patient breathe, listening to heart and lungs sounds are valuable tools along with basic vital signs such as heart rate, temperature, and breath rate. A thorough history and physical will "point" the physician in the direction needed concerning what diagnostic tests are needed.

The following are common diagnostic procedures a doctor may order to confirm COPD as well as asses the severity level of the disease.

X-Ray A chest x-ray is an important tool in the diagnosis of lung disease. There are certain abnormalities a doctor will look for to aid in diagnosis. Some of these abnormalities include, chronic changes such as enlarged lungs due to the air trapping we discussed in the last article. The enlarged lungs lead to flattened diaphragms, which are the muscles that allow the lungs to expand and contract. This decreased ability for the diaphragms to contract leads to an increase work of breathing. The physician may also look for abnormal markings such as scars that will help confirm previous infections.

CT Scan Another radiological exam similar to an x-ray is a CT scan or computerized tomography. In more extreme cases of COPD this test gives a much more detailed "picture" of the lungs. This scan literally gives a slice by slice view of the lungs and heart detailing every vessel, scarring, and potential infection, and lung mass. This test also better defines the amount of "air trapping" in the lungs. This trapped air will show up as what are called blebs, or bullae. This test works by having the patient lie on a bench or table inside a small tube. A typical CT scan takes just a few minutes.

ABG An ABG, or arterial blood gas involves blood being drawn from an artery in the patient's wrist or arm. This blood is significant because it reflects the lungs ability to exchange oxygen and carbon dioxide (waste gas). A normal blood gas will reflect good blood oxygenation and a balanced Ph (acid/base status). An abnormal ABG will often show low oxygen levels which is called hypoxia and in many patients with COPD, an elevated CO2 level. The body will compensate this by producing HCO3, or bicarbonate which is a base. This offsets the acidic state that would occur from the high CO2 levels. This is informative because this process is indicative of COPD in more severe cases. This test is also important because many insurance companies and governmental agencies require this test to asses the need for supplemental home oxygen.

PFT This test is probably the true definitive diagnosis of COPD. A PFT, or pulmonary function test, involves the patient blowing into a tube using different breathing techniques. Based on predicted values provided by the computer, a patient's lung function is obtained through this test. How much air the lungs hold along with the speed in which the air can be exhaled and inhaled are important values provided by this test. This test also measures the lungs ability to diffuse oxygen through the lungs into the blood stream. The importance of this test is multi-fold. Not only does it tell the doctor the extent of the disease, it also can estimate lung function if treatment options such as lung reduction (partial removal of a lung or lungs) are considered in treatment as well as estimating the tolerance of anesthesia for surgery. Part of the test includes giving a bronchodilator (medicine which dilates the airways. ie albuterol) which in some COPD patients improves lung function. This will aid the physician on the medical treatment side of the disease. A PFT is also a great trending parameter. Repeating the test every six months to a year can really asses the treatment plan and clue the physician in on medicine dosing as well as alternatives to the medicines being given.

Bronchoscopy A bronchoscopy can be both a diagnostic and therapeutic procedure. The test involves a pulmonologist (lung specialist) inserting a small video scope into the lungs through the wind pipe. The doctor can visualize all of the larger airways to assess the damage accrued. If necessary samples can be obtained that would evaluate the presence of viruses, bacteria, or fungus's as well as the potential for cancer cells. On the therapeutic side, the bronchoscope can be used to clean the lungs via a suction channel in the scope. This is done for more extreme cases where patients can't clear their own lung congestion.

There are also other diagnostic procedures, albeit less common, that may be considered based on the physician's prerogative. Examples include, a sleep study, nutritional assessment, and exercise testing.

The next article will discuss treatment options available to patients with COPD.

Craig Ammerall, RRT CPFT

 

Treating COPD

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

"Take two aspirin and call me in the morning". Everyone has heard that famous quote one time or another in their lives. I Googled this quote to find the origin and came up with 415 hits. I couldn't lock in on the exact source of this phrase, but believe the context has to do with the multipurpose uses of the drug. Some articles talked about patients complaining about not feeling well without being specific and the doctor, in frustration, mockingly saying "just take two aspirin and call me in the morning". The diversity of COPD may lead some doctors to throw up their hands and quote that famous phrase. I discussed already how God has made each of us unique, and how diseases differ. Not only due they differ in progression, but in treatment as well. There is many different options in treatment. Some work by themselves, some work in combination with others. I will discuss common treatment options and try to help the reader get a better understanding of what is being prescribed to them.

Treatment

I. Bronchodilators These medications are used to relax the smooth muscle in the airways increasing the diameter of the "tubes" in the lungs, therefore creating less resistance (constriction) to the flow of air in and out of the lungs. These drugs can be taken either by pill, or through an aerosol, or metered dose inhaler (MDI). There are both fast acting, or rescue bronchodilators, and there are maintenance. Maintenance means they are to be taken regardless of how one feels. Possible side effects include increase heart rate, "jitteriness", and in few cases an antagonistic, or opposite effects (More wheezing and shortness of breath).

Examples include: Albuterol, Proventil, Ventolin, and Max- Air are all fast acting, or a rescue bronchodilator. I'm most cases these should only be used on an add needed basis. Sevevent is long acting and is to be taken on a regular frequency regardless of symptoms .

Tidbit: There are medications that are categorized as bronchodilators that dilate the airways a little bit differently than those listed above. Examples of these include Atrovent, and Spiriva. Atrovent is often used in combinations with fast acting bronchodilators to maximize bronchodilation.

II. Steroids This medication is used to decrease the inflammation inside the lungs. Often in COPD, not only do the airways go through a constrictive phase, but airway inflammation is part of the process. Steroids can be taken either orally, or through an aerosol or MDI. Like the bronchodilators, direct administration through inhalation is very effective and has far less side effects than the oral route. Oral steroids are very effective, but have to be given in cycles, and tapered off slowly to prevent complications.

Side effect to oral steroids are many. They include, weight gain, increased blood sugar, and increased risk of infections. Patients on oral steroids must be monitored closely and the physician must really asses the risk/reward avenues of the medications. Side effects of inhaled steroids are much less common, but do include, mouth sores (Thrush), and some mild side effects outside the lungs.

Examples of inhaled steroids include: Flovent, Azmacort, and Pulmicort. A very common medication used for COPD is called Advair. This is a combination drug consisting of Serevent, which is a bronchodilator, and Flovent, which is an inhaled steroid. This medication is proven to improve lung function in COPD patients. This is considered a maintenance medication and should be take twice a day regardless of how the patient feels.

Tidbit: It is very important for the patient on inhaled steroids to rinse their mouths aggressively with water after inhalation to avoid the mouth sores.

III Methylxanthines This very scientific sounding medication is actually more common than you may think. There is a reason why COPD patients love their coffee in the morning. That reason is that caffeine is a common methylxanthine. These people will often say that their coffee helps them breathe better. This class of medication relaxes smooth muscle, which dilates the airways. The medication also helps relieve congestion. Side effects include nervousness, or jitteriness, racing heart, and diuresis (frequent urination).

Physicians may order another form of this drug called theophylline or aminophylline. They may also encourage drinking coffee on a controlled basis.

Tidbit: Foods that contain methylxanthines not only include coffee, but can also be found in chocolate, colas, and black teas.

Those are the more common medical treatments for COPD.

IV Other Considerations There are other medications and modalities that may be used to help patients with COPD that I will briefly mention. Mucolytics help dissolve mucus, and expectorants make it easier for the mucus to be coughed up. Cough suppressants may be considered primarily when a person needs rest and sleep due to coughing. This is rare though because coughing helps clear mucus. Many COPD patients have sinus problems, and medications that treat that condition can be beneficial as well.

There are devices out that help COPD patients cough up mucus. Vibro-percussors can be used to vibrate over the chest regions to mobilize, or move secretions around. A device called a Flutter Valve is common as well. This device is blown into and causes "shaking" in the lungs moving secretions around. There are also vests that cause vibration in the chest as well.

Severe Cases These patients may need to be on supplemental oxygen to help maintain adequate oxygenation. Lung reduction surgery may be a consideration as well to help lung function. I also mentioned a bronchoscopy which can be really beneficial in relieving lung congestion. This is usually done in cases where patients are slow to recover.

This wraps up my series on COPD. I hope everyone who has this disease really takes charge of their lives and seeks proper treatment. A good diet and healthy lifestyle along with good physician care can help control this disease. Don't forget family and especially God.

May God bless you as you strive to better your lives.

Craig Ammerall, RRT CPFT

 

The Effects of Smoking on the Unborn Fetus

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

Have you ever read a book or watched a movie and get to the ending and realize that the story hasn't really come to a conclusion yet? You had thought that all the pieces were in place for a great ending? The story was all wrapped up? A great story that fools you into believing it is over is fun for me. A few years ago I watched The Lord of the Rings with a friend of mine. The Lord of the Rings took that same theory to the next level but in doing so lost a lot. That movie could have ended four times before it officially ended.

I was on a quest to do a thorough investigation on the effects of smoking. I covered what a cigarette consists of along with the detrimental effects it causes to the human body. What I covered would include adults and kids alike. I was ready to close the door on smoking when I received a phone call asking about information on the effects of smoking on the fetus. God has a funny way of flicking you in the ear and saying "hey buddy, you forgot something pretty important". This important topic never crossed my mind. It was clear to me that God had called me to discuss this because someone out there needs this information. The story wasn't over yet.

Before I talk about what smoking does to the unborn child, a basic understanding of how the fetus develops and matures is important. When a woman conceives a child, the fetus must be nourished and protected. This is done in the uterus. The uterus is much like a cocoon that protects the butterfly. The life source, or bridge between the mother and fetus is the placenta and umbilical cord. Whatever the mother takes into her body crosses that placenta and umbilical cord and enters the fetus. What mom eats, drinks, or smokes will cross that bridge. So if mom drinks alcohol, or does drugs, the baby also "drinks, injects, or snorts" those same things. Cigarette smoking isn't that much different. I already discussed the multitude of chemicals in cigarettes. Things like carbon monoxide, butane, formaldehyde, along with the the variety of other poisons in smoke that enter mom's body also pass through the vessels of the placenta and umbilical cord and enter the fetus. The difference with smoking is that the smoke from cigarettes really destroys the mother's lungs. The fetus' lungs are not affected like that because the fetus does not use their lungs to breathe. Their anatomy works differently until birth so that the oxygen and carbon dioxide are exchanged without the use of the fetus' lungs.

So what exactly does smoking do to the fetus? Possible complications include:

• Smaller infant(for gestational age)
• Stillborn infant
• congenital limb reduction
• Increased nicotine receptors in baby's brain
• Increased likelihood of child smoking as a teenager
• Possible physical and mental long-term effects
• Birth defects, e.g.

The first two complications are a result of effects of smoking on blood flow to the fetus. There was a recent study on smoking's effects on the fetus and placenta. This study focused on infant size and gestational age.

Light cigarette smokers gained an average 90 g less at term than non-smokers, entirely due to the smaller size of the light smokers' newborn infants. Heavy smokers gained 533 g less than non-smokers, only one-third of which was due to the smaller size of the heavy smokers' newborn infants. As smoking increased, placentas enlarged and developed microscopic lesions characteristic of underperfusion from the uterus. This underperfusion was probably periodic rather than continuous because the smokers' decidua had few of the arterial lesions that are characteristic of chronic low blood flow. Pregnancies were a mean 1.5 days shorter in smokers than in non-smokers, due to more frequent amniotic fluid infections in the smokers.(1)

This peer-reviewed article conclusively links smoking to low birth weight and possible pre-mature birth.

Another important point about the complications listed involves the increased nicotine receptors in the fetus. This is important because although the baby isn't smoking, the addiction is there. I have personally seen babies that are born having nicotine withdrawals. They often present as very agitated and difficult to pacify. Getting them to sleep or take a bottle is usually a monumental task. This addiction can rare it's ugly head later in life. This is why babies born to smokers have a much better chance of becoming smokers themselves as teens or adults.

So what is the answer? The obvious answer is to not smoke while carrying a baby. Unfortunately there are many who are so addicted, or don't realize the extent their health plays on the fetus. Stopping smoking while carrying a baby can really reduce the risks of fetal complications. The body has an amazing ability to heal. This goes for the fetus as well. The fetus can overcome much of the damage that has occurred especially if the mother quits early in her pregnancy. The fetus and placenta will heal and normal development can progress. If you are a woman smoking while pregnant I implore you to quit. Ask God for the power to do so. Not only are you affecting your health, but the health of another of God's children. This child of God has no control the destiny in front of them. That responsibility rests solely on your shoulders. Being born in this world is difficult enough under normal circumstances. Imagine starting off behind the eight ball. Having a birth defect or learning disability such as mental retardation, or attention deficit is an almost impossible hill to climb for anyone. Claim victory over your health and the health of your unborn child and praise God for your deliverance.

Craig Ammerall, RRT CPFT

References
1. The effects of cigarette smoking on the fetus and placenta
R. L. N aeye11Department of Pathology The Pennsylvania State University College of Medicine Hershey, Pennsylvania, USA 17033
1Department of Pathology The Pennsylvania State University College of Medicine Hershey, Pennsylvania, USA 17033

Alph-1 Antitrypsin Deficiency(AATD)

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

Prologue: I wanted to follow up my COPD articles with a paper by a colleague of mine Jamie Pepper. Jamie is a respiratory therapist who has done a lot of research on an often ms-diagnosed disease that can mimic many of the symptoms I presented in my articles about COPD. My thoughts were that there could be some out there that present with some of the symptoms I discussed without having any of the history that I brought forward.

Craig Ammerall, RRT CPFT

___________________________________________________________________

Alpha-1 Antitrypsin deficiency (AATD) is the most prevalent, potentially fatal hereditary disease of Caucasians. It has been identified in virtually all populations. Most common in individuals of Scandinavian, British, Spanish, and Portuguese descent. It is estimated that there are 100,000 Americans who have AAT deficiency. AAT deficiency occurs in approximately 1 in 2,000-7,000 live births in Europe and North America. AAT is responsible for up to 3% of chronic obstructive lung disease cases in the U.S. In the U.S. fewer than 5% of all individuals with AAT deficiency have been detected, but many of the remaining 95% are thought to be suffering from respiratory symptoms, but have incorrect diagnoses, such as chronic bronchitis, emphysema, or asthma.

AAT is a protein that circulates in the blood. It is also called alpha1-proteinase inhibitor by some scientists. The liver makes most of the circulating AAT in the blood. AAT protects the tissues of the body from being damaged by proteolytic enzymes, especially neutrophil elastase. AATD is a genetic disorder characterized by the production of an abnormal AAT protein. The liver cells cannot secrete the abnormal protein, which then accumulates within the cells and results in a marked reduction of circulating AAT levels. It is believed that the retained abnormal AAT protein over time leads to liver injury in some affected persons. In the lungs, low levels of AAT allow for the destructive effects of neutrophil elastase to go unchecked; this results in damage to the alveoli, eventually leading to emphysema as young as 30 years of age. People with AATD are at high risk for developing life-threatening liver and lung disease.

AATD is classically associated with the early onset of severe emphysema. It is also associated with the development of cirrhosis of the liver, primary carcinoma of the liver and the vasculatides. It can appear as a chronic lung disease such as emphysema, chronic bronchitis, COPD, bronchiectasis, and asthma. It can appear in adults as early as 30, especially in smokers. Some persons with AATD can live completely normal life spans without significant symptoms, especially if non-smokers. AATD is the leading genetic cause of liver disease in infants and children and is the second most common indication for liver transplantation in this group in the U.S. The risk of hepatocellular carcinoma is increased in persons with AATD.

Common signs and symptoms of AATD are: shortness of breath, wheezing, chronic cough and sputum production (chronic bronchitis), recurring chest colds, eyes and skin turning yellow (jaundice), swelling of the abdomen, gastrointestinal bleeding, decreased exercise tolerance, non-responsive asthma or year-round allergies, unexplained liver problems or elevated liver enzymes, and bronchiectasis.

Diagnosis: A positive family history of AATD is the greatest risk factor for AATD. Implications for finding all family members who may be carriers are of great importance. ATS/ERS recommendations for AATD testing are: COPD, early onset emphysema (regardless of smoking history), family members of known AAT- deficient patients, dyspnea and cough occurring in multiple family members, liver disease of unknown cause, adults with bronchiectasis with evident etiology, patients with asthma whose spirometry fails to return to normal with therapy, unexplained panniculitis and anitproteinase-3 vasculitis, unexplained vasculitis, particularly of Wegener’s granulomatous type, and hepatocellular carcinoma.

Testing for at-risk patients is as follows: A baseline examination to include: a physical exam, PA and lateral x-rays and high resolution CT scan of the lungs, pulmonary function test, including spirometry, lung volumes, and diffusion capacity, arterial blood gases, liver function test, liver ultrasound examination, alpha fetoprotein. In general, testing for AATD consists of an immunoassay for AAT levels followed by phenotyping. Phenotyping is performed if the level of AAT is abnormal and/or there is a known family history of AATD, and if there is otherwise unexplained liver disease or emphysema. Newer testing methods utilize a finger stick test that measures both AAT levels and genotype.

Treatment of AATD includes smoking cessation, avoiding environmental pollution, development of an exercise program, particularly a pulmonary rehabilitation program. Other treatment includes, stopping alcohol consumption, development of a personalized nutrition program, reduce stressors, influenza/pneumonia vaccinations, hepatitis A& B vaccines, aggressive treatment of lung infections, aggressive evaluation of liver complications, bronchodilator therapy, corticosteroids, and supplemental oxygen. There is a specialized, specific treatment for AATD called augmentation therapy. Augmentation therapy increases the lung levels of AAT. It is not a cure, and it does not reverse the lung damage that has occurred, nor treat or prevent AATD related liver problems. Augmentation therapy, a derivative of human plasma, is used to increase the concentration of AAT in the blood and lungs. Last of all, there are two major types of surgery for patients with AATD; lung volume reduction surgery, and organ transplantation of lung or liver. Surgery is one of the last options. Utilization of surgery is for those who do not respond to more conservative therapy, and/or have extensive damage of the lungs or liver.

By Jamie Pepper, RRT, CPFT

References:
American Thoracic Society/ European Respiratory Society Statement: Standards for the Diagnosis and Management of Individuals with Alph-1 Antitrypsin Deficiency. AM J Respir Crit Care Med 2003; 168:818-900.

Resources
Bulletin of the World Health Organization: Alpha-1 antitrypsin Deficiency:
Memorandum from a WHO meeting 1997; 75 (5): 397-415.

www.alphaone.org
www.lungusa.org
www.utdol.com
www.alpha1.org

 

The Dreaded "C" Word!

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

I am pretty sure it was my freshman year in high school. I was on the junior varsity soccer team. The season was still early, but we were struggling in just about every facet of the game. Apparently the coach felt that team discipline was the core of the problems. His philosophy was that a disciplined team can overcome many of the deficiencies it possesses. According to the coach, the center of this discipline issue revolved around one player. During a team meeting he called this player out. This particular guy on the team was sort of the team clown. He frequently goofed around and where there was a practical joke, his presence wasn't far away. Coach went on to point out that this one player was beginning to affect other players on the team. If this wasn't stopped, it wouldn't be long, and the whole team was at a threat. He felt his only option was to "cut out" the cancer before it "kills" the team.

I want to spend some time talking about the subject of cancer. I truly believe that if you were to line up ten people and ask them what their greatest fears were, I am almost positive that cancer would be at near the top of most lists. It is not unheard of for people to refer to cancer as the big "C", or the dreaded "C". As if not saying the word "cancer" would some how place a hedge of protection around them from actually getting the disease. Almost akin to "knocking on wood". Unlike most other diseases, cancer truly has no boundaries. That is why I believe people have that fear. First of all, cancer is still very serious; I will show some statistics that don't bode well for most of us. The good news is that, as Americans, we still live in the greatest country in the world. Despite the many problems with health care, we still have the best doctors and scientists available trying to find cures and treatments. My job is to educate. That is the best, first line of defense. Ask any military general the best preparation for an attack on the enemy, and he will say first --- educate. Research your enemy; find out their routines and trends (Intel). This will give the attacker the upper hand. The same applies to fighting disease. If the individual who has cancer is prepared, and knows as much as possible about what is in front of him, there are fewer surprises. This will make things somewhat easier as they research doctors and treatment plans.

There are some vital statistics that must be understood when it comes to cancer. So who exactly is at risk of getting cancer? Sadly, everyone is at risk of some form of cancer. The risks increase as ones age does. 77% of the reported cancer cases are at the ages of 55 or older. Lifetime risks for men are slightly less than 1 in 2, and slightly more than 1 in 3 for women. In 2007 it is estimated that there will be 1,444,920 cases of cancer reported. Of those reported cancer cases, 559,650 are expected to die. That is roughly 1,500 people per day. In the United States, cancer trails only heart disease as the number one killer. Is there any good news in the statistics? The good news is that the relative survival rate between 1996 and 2002 was 66% which is up from 1975-1977 when the survival rate was 51%. (1) This solidifies the fact that the United States is doing a much better job of diagnosing and treating cancer.

Not long after the coach cut that particular player loose, the team started showing signs of improvement. We went on to win more games than we lost, and significantly improved in every facet of the game. By eliminating the source of the problem before it was too late, the team was able to "heal", and began the road to recovery. If you or a loved one is experiencing cancer I pray that God gives you strength as you prepare and battle this dreaded disease.

My next article I will focus on what cancer is and how it comes about. After getting an understanding of cancer, I will focus specifically on lung cancer and the diagnosis and treatment options available.

By Craig Ammerall, RRT CPFT

References

(1) American Cancer Society. www.cancer.org

 

The "Ancer" in Cancer Part 1

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

"Communication works for those who work at it."
John Powell

We have all been there...We don't want to come across as stupid, so we just nod our head and agree. You have been there, I have been there, we all have. It can be pride--assuming we have all the answers, or in many situations the fear of appearing uninformed. It wasn't long ago; I was in a room treating a patient while a doctor was talking to the patient and family. He was describing what he felt was wrong with the patient. He did seem hurried, and was using "big" words that appeared to be sailing over these people's heads. To some extent he may have seemed intimidating. After a brief synopsis of his conclusions he hurriedly asked, "Any questions". The three family members and the patient all looked at each other nervously waiting for one of the others to speak up. No one did. The doctor said "okay... have a good day" while scurrying out of the room with his long lab coat drifting behind him like Superman's cape. It wasn't long before one member admitted he didn't understand what was conveyed by the doctor. Like dominoes, the others fell in line admitting the same. I spent time making what the doctor said understandable.

Who's at fault here? Is it the doctor? Well--yes it is. By coming across busy and talking "above" these people, he intimidated them. If he had simply taken a few extra minutes and talked at that family's comprehension level, they may have understood better. They may have also been more apt to ask questions without fear of troubling the doctor. Then the family is not at fault? Wrong! The family and patient have a responsibility to ask when they don't understand. Despite the doctor's poor bedside manners, he works for them. He is their employee. Therefore, they should have told that doctor to slow down and speak to them at their level. If the doctor has a problem with that, the patient and family have every right to seek another physician's council. Health care is a team effort. To be successful, all sides need to work together. Better communication leads to better patient compliance which leads to better patient outcome.

I relayed this story because barely a day goes by that a patient or family member doesn't ask me about the disease they are dealing with. I don't mind helping when I can. That isn't the point. The point is that many of the questions they have should already have been answered. In some cases months the questions should have been answered months, or even years earlier. As I continue to explore the topic of cancer, my goal is to give you tools to help you better communicate with yours or your love one's physician. This article, or future articles, is by no means going to answer all the questions that will arise during that journey. Everyone has heard the saying, "knowledge is power". If well educated, the physician is no longer going to talk "down" to you, and you will be more likely to ask the appropriate, intelligent questions. This will enhance the patient/family/doctor relationship allowing for improved care--and yes-- the before mentioned improved patient outcome.

So what exactly is cancer? Simply stated, cancer refers to a number of diseases characterized by development of abnormal or mutated (altered) cells that divide and multiply uncontrollably. These cells have the ability to invade normal areas of the body impeding that part of the body's normal function. These abnormalities can be found in just about any area of the body. These cells often develop into tumors which continue to grow at an alarming rate. (1) For example, in the lungs, these tumors can grow and block large segments of the lungs impeding on oxygen delivery. There are also certain types of cancers, like leukemia, that don't form as tumors. These cancers form in the blood and blood-organs where they circulate through other tissues where they grow. (2) When a cancer originates in one area, or organ, and spreads to other areas, this is termed metastasis. For example when a cancer originates in the lungs and has spread to the brain and liver, it is still called lung cancer which has metastasized. The lung is the primary source.

Cancer begins with a mutation in the DNA, or "instruction manual", of the cell. The DNA code instructs the cell on how to grow and divide. Even normal cells have a chance to mutate, but under normal circumstances, these cells will correct themselves, or just die off. The mutated cells don't do this, they just continue to grow and multiply becoming cancerous. Mutations also cause cancerous cells to live beyond their normal life span allowing these cells to accumulate often out of control. (1)

Experts believe that cell mutation is just the initial phase of cancer. Other changes in the cell must also occur to increase the chances of acquiring cancer.

1. An initiator to cause a genetic mutation. What is the cause of this genetic mutation? One could be born with this (inherited), or have a predisposition. There is also outside influences that can play a part. Things like hormones, viruses, and inflammation can lead to genetic mutations.
2. A promoter to cause rapid cell growth. Promoters are literally the gasoline on the flame. These promoters cause the cells to divide rapidly. This rapid cell division is what leads to tumors. These promoters could be inherited, or come from outside influences as well.
3. A progressor to cause cancer to become aggressive and spread. Like initiators, and promoters, a progressor can be inherited, or come from outside influences. Progessors make cancers more aggressive which in turn more likely to spread. Without these progessors, the tumor is more likely to be benign (non-cancerous), or less likely to spread. (1)

The term "carcinogenic" is often tossed around without most even knowing what the word means. This word is used to describe something that has the ability to increase one's chance of getting a certain type of cancer. Asbestos and cigarettes are powerful carcinogens that can increase the chance of getting lung cancer. Over exposure to ultra-violet radiation, or the sun, increases the chance of getting skin cancer. Certain chemicals such as those found in cleaners and insecticides, if improperly used or handled, can increase the chance to get certain cancers as well.

You may be asking, "is there anything that doesn't cause cancer?" Well the not so obvious answer is yes. Fortunately, our society has spent many dollars exploring this very topic. What causes many cancers today wasn't known ten, fifteen, twenty five years ago. Like I have been harping all along, education is the best defense. Identifying the risks is very important. What we have inherited cannot be controlled, but knowing our family history is very important. Things we can control like smoking, excessive drinking, or over exposure to the sun is important. Even foods we eat must be watched carefully.

Should we become obsessed about getting cancer? I believe this is a big mistake. There are many studies that show stress is a contributor to many ailments like heart disease, stroke, and yes, even cancer. We shouldn't become so obsessed that everything we come in contact with we stress ourselves out over. Simple awareness is enough. Remember a "merry heart does good like medicine..." (Proverbs 17:22). This verse in the Bible is more than just walking around with a smile on your face. Its meaning goes much deeper. Our attitudes can have a bearing on many aspects in our life. This includes our approach to our health as it obtains to cancer.

I want to finish with this. If someone were to approach you and tell you they had a "magic pill" that would keep you free from any illnesses--would you take it? I can't imagine anyone saying anything but yes! But the truth is there is no magic pill. Now if I told you that if you that if you were to abstain from vices like smoking and excessive alcohol use; be familiar with carcinogens; and apply health principles found in the Bible; and that theses things could greatly improve your chances of not getting diseases like cancer--would you do them? The choice is yours.

Craig Ammerall RRT, CPFT

References
(1) The Mayo Clinic - http://www.mayoclinic.com
(2) American Cancer Society - http://www.cancer.org

 

The "Ancer" in Cancer Part 2

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

Now that we know what cancer is, I want to focus specifically on lung cancer. The first thing that needs to be looked at is signs and symptoms of lung cancer. We will then investigate possible exposures that increase one's risk.

Typically, in the early stages of lung cancer, there are few if any symptoms. These don't usually start until the later stages. When symptoms do occur, they usually include the following.

• A new cough that doesn't go away
• Changes in a chronic cough or "smoker's cough"
• Coughing up blood, even a small amount
• Shortness of breath
• Chest pain
• Wheezing
• Hoarseness (1)

There are different suspected causes of lung cancer. It is estimated that 90% of lung cancers are a result of smoking cigarettes. We discussed in earlier articles that there are approximately 4,000 cancer causing substances in cigarettes. The individual who smokes cigarettes has a 25 times higher chance of obtaining lung cancer while pipe and cigar smokers have a 5 times greater chance than non-smokers. (2)

Passive smokers are those who don't smoke cigarettes but reside with someone who does. The passive smoker has a 24% greater chance of getting lung cancer than the non-smoker. It is estimated that 3,000 deaths from lung cancer are attributed to passive smokers each year. (2)

Another cause of lung cancer is asbestos. Asbestos is a silicone fiber found in insulation of buildings, brakes and other areas. Asbestos is banned today, but still can be found in many older buildings and vehicles. People who smoke and have been exposed to asbestos have a 50 to 90 times greater chance of getting lung cancer than the non-smoker. (2)

Radon Gas is a natural, chemically inert gas that is a natural decay product of uranium. It decays to form products that emit a type of ionizing radiation. Radon gas is a known cause of lung cancer, with an estimated 12% of lung cancer deaths attributable to radon gas, or 15,000 to 22,000 lung cancer-related deaths annually in the U.S., making radon the second leading cause of lung cancer in the U.S. (2) Again, smokers who have been exposed to radon gas have a much greater chance of getting lung cancer. (2)

Although most lung cancers are related to tobacco use, not all smokers do get lung cancer. This lends credo to the studies being done that suggest that there may be some genetic predisposition to getting lung cancer. (2) Family history and excessive alcohol use have also been linked to lung cancer. A person's sex also plays a role in determining risk because women smokers have a greater risk of getting lung cancer than men do. No one knows exactly why this is but the data supports this theory. (1)

As we can see, quitting smoking is paramount to decreasing the risk of obtaining lung cancer. The longer a person stays away from cigarettes, the risks decrease dramatically. The damaged cells in the lungs will be replaced by healthy cells allowing for healing to occur.

The next article will examine diagnosing lung cancer. We will give a sort of case study of someone who finds out they have lung cancer and what that person must go through to get diagnosed and treated.

Craig Ammerall RRT, CPFT

References
1. www.mayoclinic.com
2. www.lungusa.org

 

The "Ancer" in Cancer Part 3

[The content of this article is for educational purposes only, and is not intended to diagnose or treat a particular ailment. Please consult your physician as for your best plan of care.]

John had just received a phone call from his employer’s physician. Apparently his routine chest x-ray showed an unusual area of concern. The doctor had told him that there appeared to be a mass of some sort on his left lung’s upper region. John was then told he would need to follow up with a specialist to further investigate.

This is often how someone finds out they have lung cancer. In this case we just described, cancer is not a certainty. There are many things that can cause this type of marking on a chest x-ray. Things like infection from bacteria, fungal invasion, or just scarring can cause similar markings on an x-ray. After a thorough history and physical is obtained by the physician, the doctor can either “sit” on the situation for a while or do a follow up x-ray, or order a CT scan, or computer tomography which is a detailed view of the lungs or are of concern. If the CT scan warrants further investigation, than a diagnosis is the next step in the process. There are two ways to get a biopsy of the area in concern. The first entails inserting a needle through the chest into the mass and aspirating (withdrawing) fluid from the mass and getting a laboratory diagnosis. This is usually aided by CT scan to help the physician guide the needle in the right place. The second way is via bronchoscopy. This involves the physician using a scope through the nose into the wind pipe then into the lungs. The doctor can inspect all of the airways to see if there are other areas of concern that did not show up on the x-ray or CT scan. Biopsies will then be taken internally. The physician can pass forceps through the scope into the area of concern and take pieces of the mass to send to the lab. He can also take a brush and scrub cells off the mass and smear them on slides to send to the lab. With a bronchoscopy, the physician can also obtain fluid specimens to send of for other tests such as infection and fungal invasion. In both cases, the pathologist should have enough to work with to obtain biopsies and other materials obtained.

John is following up his tests at the doctor’s office. The physician got the results back from the pathologist and tells John that indeed he does have lung cancer. The physician will now discuss the options available for John in treating the disease. Before treatment is considered, it is important to find out the cell type of the cancer. Different types of cancers are treated differently and progress differently. Lung cancers, also known as bronchogenic carcinomas ("carcinoma" is another term for cancer), are broadly classified into two types: small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC). This classification is based upon the microscopic appearance of the tumor cells themselves. These two types of cancers grow and spread in different ways, so a distinction between these two types is important. (1)

Small cell lung cancer (SCLC) comprises about 20% of lung cancers and is the most aggressive and rapidly growing of all lung cancers. SCLC is strongly related to cigarette smoking, with only 1% of these tumors occurring in nonsmokers. SCLC metastasizes rapidly to many sites within the body and are most often discovered after they have spread extensively. Referring to a specific cell type often seen in SCLC, these cancers are sometimes called oat cell carcinomas.(1) NCLS are the most common form of lung cancers and account for about 80% of all lung cancers.(1) Under this category, there are three main types of cancer depending on the types of cells found in the tumor.

Adenocarcinomas are the most commonly seen type of NSCLC in the U.S. and comprise up to 50% of NSCLC . While adenocarcinomas are associated with smoking like other lung cancers, this type is especially observed as well in nonsmokers who develop lung cancer. Most adenocarcinomas arise in the outer, or peripheral, areas of the lungs.

Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls.

Squamous cell carcinomas were formerly more common than adenocarcinomas; at present, they account for about 30% of NSCLC. Also known as epidermoid carcinomas, squamous cell cancers arise most frequently in the central chest area in the bronchi.

Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of NSCLC.

Mixtures of different types of NSCLC are also seen.

Other types of cancers can arise in the lung; these types are much less common than NSCLC and SCLC and together comprise only 5%-10% of lung cancers.

Bronchial carcinoids account for up to 5% of lung cancers. These tumors are generally small (3-4 cm or less) when diagnosed and occur most commonly in people under 40 years of age. Unrelated to cigarette smoking, carcinoid tumors can metastasize, and a small proportion of these tumors secrete hormone-like substances. Carcinoids generally grow and spread more slowly than bronchogenic cancers, and many are detected early enough to be amenable to surgical resection.

Cancers of supporting lung tissue such as smooth muscle, blood vessels, or cells involved in the immune response can rarely occur in the lung.

As discussed previously, metastastatic cancers from other primary tumors in the body are often found in the lung. Tumors from anywhere in the body may spread to the lungs either through the bloodstream, through the lymphatic system, or directly from nearby organs. Metastatic tumors are most often multiple, scattered throughout the lung, and concentrated in the peripheral rather than central areas of the organ. (2)

Now that John knows what type of cancer he has he will undergo treatment for it. Treatment options vary by progression, location, and cell type of the mass. Common treatments involve chemotherapy, radiation, and surgery. A combination of these treatments is plausible as well. There are also other, less common treatments that you may want to discuss with your physician as well. As discussed in previous articles, educating yourself is important. Don’t be afraid to ask questions. It isn’t wrong to seek a second opinion—in fact; your doctor would probably recommend that.

By Craig Ammerall, RRT CPFT

References
1 www.medicinenet.com/lung_cancer/article.htm
2. http://www.cancer.gov/cancertopics/types/lung

 

Caring for the Caregiver

I sat on the edge of the exam table waiting for the physician to enter the room. My feet swayed back and forth, my heels bouncing off the side of my perch. I felt downright silly to be there. As is true for many men, my wife had insisted that I get an examination and even scheduled the appointment. The nurse checked me in the usual expressionless manner, but I noted that she took my blood pressure several times in each arm. “The doctor will be in shortly,” she said as she left.

I had commented to my wife of only six months that something didn’t seem right with me. I felt run down and tired most of the time, and by day’s end, it was all I could do to get home from work and crawl into the recliner. Yet I had great difficulty falling to sleep at night. The more fatigued I felt, the more concerned I became that something was wrong with me. I said nothing to my family; I kept telling myself that I must be strong for them.

Five years prior to my doctor’s visit, my life had suddenly shifted. My family dynamics had really never been the norm in the first place. My mother had been diagnosed with multiple sclerosis shortly before my birth, and I spent much of my childhood watching my father care for her. My older brother and sister had grown and moved out before my mother required more intensive care. My father was tender and loving with her care—a stellar example of God’s love. She relied on him for everything. I never heard my father complain or show contempt toward the challenges that life had placed on him. Then in the spring of 1991, my mother called to inform me that the doctors were running tests on my 58-year-old father. The tests would later point to Alzheimer’s disease. Over the next several years, as his disease progressed, I transitioned into the role of caregiver for both of my parents. My mother was unable to lift a finger to scratch an itch, but had a mind as sharp as a tack; my father had the endurance of a mountain climber but the mentality of someone lost. Two weeks after my marriage, my parents moved in. I had become the primary caregiver, provider, and problem solver for many people at once. Now 10 months later, I sat in the doctor’s office exhausted—not able to realize the cause of my fatigue, though it was right in front of me.

The doctor entered the room sooner than I expected and asked how I felt.
“Fine,” I responded. “Just a little tired.”
We danced the question game of family history—cardiac and major body systems. All negative. Finally he told me that he was concerned about my blood pressure being elevated and wondered if I normally had high blood pressure. No, never had an issue, I said. I was only 30 years old and had been active until the past year. He sat down and told me that my resting blood pressure was 200/110.

“What changes have recently occurred in your life that could cause stress?” he asked.
“How long have you got, Doc?” I said.
Caregiver stress was the diagnosis. Recognizing that I needed help was the medicine.

Caregiver Stress
Being a caregiver has highs and lows; it can be rewarding and overwhelming. One of the utmost difficulties in caring for an elderly family member is the change in the caregiver’s life. This change can bring on stress that immediately becomes part of their daily routine. Warning signs of caregiver stress include: denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, and irritability. Stress signs can differ between different caregivers.

Caregiving can affect a caregiver’s ability to work, their personal and professional relationships, their finances, and their physical and emotional well being. Caregiving also affects the caregiver’s time, energy, and role within the family unit. It can be difficult to juggle the role of caregiver and decision maker while still allowing the cared-for individual to have feelings of independence.

Stress from caregiving can have both primary and secondary effects. Primary effects are those the caregiver experiences from caregiving itself. The physical demands of bathing, dressing, transferring, and other forms of care may be overwhelming physically and emotionally to the caregiver. In a study monitoring the effects of stress in caregiving, researchers followed 76 caregivers before the death of a loved one and 129 caregivers providing care within the month following death. All the caregivers were considered primary caregivers, meaning they provided all the hands-on care of the loved one. Sixty-four percent helped with toileting, hygiene, dressing, and eating, while 82 percent did all the shopping, housework, cooking, and transportation. The burden the caregivers experienced was evident in the results. A fifth of the caregivers felt their own health had been declining within the past year, and of that group, 94 percent reported declining health problems kept them from doing their usual activities. Nearly 30 percent had signs of major depression.

Secondary effects are the strains placed on other aspects of the caregiver’s life, such as the choice between being a caregiver and being attentive to other family members. A father caring for his parents also needs to care for his own children. Family life is disrupted, as are career paths, friendships, personal interests, and activities. For some, the secondary effects may be more stressful then the actual care of the elderly family member. Many times the caregiver may feel pulled in many directions and start to withdraw. This withdrawal may be self-destructive and jeopardize the care structure for the inflicted person.

Caring for . . . Yourself
The emotional demands of caregiving can be considerable, resulting in sadness, depression, anxiety, and anger—particularly if the caregiver feels trapped. Decreased social activity due to the demands of the caregiving can cause an emotional withdrawal from the caregiver’s social support systems.

One of the most important ways to combat stress is for the caregiver to put aside feelings of guilt and first take care of himself or herself. The caregiver’s health is important; eating properly and having a regular exercise routine can help reduce stress levels.

Many times a caregiver may feel alone and inadequately equipped for the task at hand. They may have difficulty approaching the situation objectively and fall into the web of memories and easier days. For most caregivers, helplessness, not fear, is the overwhelming emotion attached to their situation. By becoming educated about local support systems and taking the initiative, the caregiver can minimize some of the feelings of helplessness. Talking openly to friends and joining a support group are beneficial ways to reduce the self-imposed guilt felt by the caregiver. Knowing the support options from federal and local governments can help alleviate worries regarding finances. Without government assistance, many families would be unable to provide care appropriately.

A Job Well Done
It’s important to remember that caregiving is a job—a job with rewards, stress, and responsibilities. As with most jobs, the caregiver can function at a higher level if they approach caregiving by learning about the family members’ condition, strategies for caring, and alternative means of care.

Although caregiving is stressful, many caregivers gain a sense of accomplishment and satisfaction of a job well done. Support and encouragement from others help in buffering the effects of stress. Contacting other caregivers and talking openly allows for mutual alliances to be formed in the shared struggles.

My parents have passed on now, but I was able to readjust my life to counter the effects of stress and enjoy my time with them without the feeling of burden. By tapping into my own support systems—God, family, church, and health assistance from the government—I was able to maintain my health and provide complete care for my parents. My stressors remained the same during the eight years that I took care of my parents, but my ability to manage the effects of the stress remained strong. I’ve never regretted a day spent taking care of my parents and look forward to meeting them in heaven someday.

By Ron Mahlo

 

 

Learning about the Gallbladder and Bile System

Anatomy and Function

The biliary system essentially consists of the liver, the bile ducts, the gallbladder and the ampulla of Vater. Biles main function is to aid in the absorption and digestion of fats. Bile is made by the liver and then secreted into tiny tubes or ducts in the liver. The bile then travels through these small ducts within the liver, join other ducts within the liver and eventually exiting the liver and becoming one large duct outside called the common hepatic duct. This portion of the bile system is sometimes called the “biliary tree” because the way it resembles a tree with leaves, twigs and branches that eventually all combine to form a common trunk. The gallbladder is a hollow, pear-shaped, muscular “bag” that has one opening through another duct called the cystic duct. The cystic duct eventually meets the common hepatic duct where they join to form the common bile duct. This duct continues on to join the duodenum (the first part of the small intestine) through a structure called the ampulla of Vater. Within this structure is a muscle “valve” called the sphincter of Oddi which prevents the flow of bile into the small intestine except at specific times. The liver makes about a quart of bile over the course of an entire day but the body only uses a significant amount of bile when food is present in the duodenum. Because of this, the flow of bile is diverted into the gallbladder during most of the day. Since the gallbladder can only hold about ¼ cup of fluid, it has a remarkable ability to concentrate the bile and reduce its volume by as much as 90%. When food reaches the duodenum after being eaten, the body releases a hormone called cholecystokinin (CCK) which stimulates the sphincter of Oddi to open and the gallbladder wall to contract which squirts the stored, concentrated bile into the duodenum where it mixes with the food to aid in absorption and digestion.

Gallbladder Disease

The presence of gallstones is a very common condition that can lead to gallbladder disease. During the concentration of bile, small cholesterol particles can come out of solution and form a layer of sludge within the gallbladder. If this sludge does not get completely evacuated from the gallbladder during contraction it can gradually build up over time. The sludge will usually separate into clumps that eventually become stones. Sometimes many smaller stones are formed and at other times one or two very large stones may form. If these stones become large enough to block the cystic duct when the gallbladder contracts they can inhibit the flow of bile from the gallbladder. This can lead to the classic symptoms of pain in the right, upper abdomen with associated nausea or vomiting shortly after eating a meal. Since the stones are freely floating within the gallbladder, they may not block the flow of bile with every meal and symptoms may only occur intermittently. If a stone becomes impacted in the neck of the gallbladder, symptoms may become severe and constant requiring urgent intervention to obtain relief. Occasionally, smaller stones may pass through the cystic duct and reach the common bile duct during a gallbladder contraction. These stones may pass harmlessly into the small intestine through the ampulla of Vater. However, if they become impacted at the sphincter of Oddi they can cause life-threatening conditions such as pancreatitis or cholangitis.Even without the formation of stones, a gallbladder may produce symptoms when it fails to contract properly when stimulated by CCK. A normal gallbladder will eject most of the bile it contains when stimulated. When a gallbladder can only eject 35% or less of its volume with each contraction it is considered diseased. In this condition, the typical gallbladder symptoms of right-sided upper abdominal pain, nausea and vomiting will often be present constantly but with less severity than with gallstones.

Diagnosis

Gallstones may be diagnosed most easily with ultrasound. Because the stones are higher in density than the surrounding tissue and bile they will absorb or reflect more sound waves leaving a “shadow” on the ultrasound screen. CT scans and plain x-rays will not usually show gallstones unless they contain significant amounts of calcium. If a patient has typical gallbladder symptoms but their ultrasound does not show any stones a HIDA scan may be ordered. This study involves the placement of an intravenous catheter and injection of a non-harmful radioactive substance that is gathered up by the liver and secreted into the bile. A special type of camera that recognizes radioactive waves is then used to visualize the liver and the gallbladder. Once the gallbladder is full of the radioactive bile, its volume is calculated and a second injection of the hormone CCK is performed through the same intravenous catheter. The volume of the gallbladder is again determined and compared to its full volume. The difference in these two volume measurements is calculated by the physician reading the study and expressed as a percentage number called the ejection fraction. An ejection fraction less than 35% is an indication that the gallbladder is not functioning properly.

Treatment

Many studies have been performed to determine if an effective medical treatment for gallstones exists. A drug was developed that is effective at dissolving gallstones but even when the gallstones were gone most patients still had symptoms. In most cases, the gallstones came back very rapidly after the medication was discontinued. This has lead most physicians to realize that once symptoms occur from gallstones the only proven effective treatment is surgical removal of the gallbladder. However, if gallstones are present but the patient has no symptoms then no intervention is needed in most cases. Surgical removal of the gallbladder remains the mainstay of gallbladder disease treatment. Over the past 15 years, laparoscopy has become the preferred method for gallbladder removal. Today, over 95% of gallbladder removal operations performed in the United States are completed laparoscopically. Most of these patients go home on the same day as their operation. For this procedure, a surgeon typically uses 3 or 4 small incisions, a video camera and specialized instruments to remove the gallbladder from the cystic duct and the undersurface of the liver. Since the gallbladder mostly contains fluid, it can usually be removed from the abdomen through an incision no larger than ½ inch. Occasionally, a larger incision must be made when a large stone or multiple stones are present. In a few instances, laparoscopic removal of the gallbladder cannot be performed safely and open surgical technique is required. Sometimes an unanticipated situation or complication found during laparoscopic gallbladder surgery may require conversion to open surgical technique as well. Open surgery usually requires a longer hospital stay and is typically more painful due to the presence of a large incision. Major complications of gallbladder surgery occur in less than 5% of patients by most recent studies. Homeopathic “gallstone-cleansing” techniques have been proclaimed effective and safe by many homeopathic practitioners and lay-people. These treatments usually involve the ingestion of significant quantities of olive oil and citrus juice in an attempt to cause vigorous contraction of the gallbladder to eject all of the stones into the small intestine. Some remedies include a special pectin rich diet for several days before the cleansing which has been shown in some animal studies to soften gallstones. Though these remedies may have been helpful for some people there have been no human studies to confirm its effectiveness or document the risks. Since life-threatening conditions such as pancreatitis and cholangitis can occur with passage of gallstones, these risks should be fully considered before trying any homeopathic remedy.

After Gallbladder Removal

Most patients are eventually able to tolerate any foods they enjoy after their gallbladder has been removed. However, many patients will experience problems such as nausea, bloating and diarrhea with certain foods during the first few months following surgery. A few patients will experience these symptoms regardless of their diet during the first few months following surgery. A small percentage will have these symptoms persist and require significant diet changes, lifestyle modification or medication to manage their condition. Usually fried, greasy or spicy foods tend to cause the most symptoms but any food could become poorly tolerated following gallbladder surgery.

Other Similar Conditions

Several other different diseases can cause symptoms similar to gallbladder disease. Irritable Bowel Syndrome (IBS), peptic ulcers, gastritis or gastroesophageal reflux disease (GERD) may all mimic symptoms of gallbladder disease. These diagnoses should be considered whenever gallbladder studies are normal but typical symptoms are present.

Conclusion Points

Gallstones are very common. Usually, only symptomatic gallstones need treatment. A poorly functioning gallbladder may also need treatment. Medical or homeopathic treatment has not been proven effective.

Most patients are able to lead a normal life without their gallbladder.
Surgical removal of the gallbladder is effective and carries a relatively low-risk for most patients.

By David King M.D.

 

When The Heart Attacks

A tear rolled gently down Michelle’s cheek as we talked. At 39, she appeared healthy; however a heart attack had taken its toll. A strong family history, a stressful job, and a high cholesterol level were contributors. She was in denial. A 39 year old female should not have had a heart attack. As we prayed together, the slow process of healing had begun. Today, a vibrant Michelle boldly speaks about heart disease, giving hope while emphasizing awareness and knowledge of the problem. In the next few minutes, I want you to learn about a disease touching everyone, a disease that can be treated, prevented and yes, even reversed.

Cardiovascular disease is unfortunately all too common and yet we do not hear in the media as much about this disease as the numbers would indicate. Let me share some numbers. Over the next 24 hours, 3,000 Americans will suffer a heart attack. This is nearly the same number of persons who died in the tragedy of September 11, 2001. In fact in women, cardiovascular disease poses a greater risk than cancer and all other diseases combined. This is not just an American problem, but a growing worldwide problem. Cardiovascular disease (heart attack, strokes, heart failure, rhythm problems) is now the leading cause of death in the world claiming approximately 13 million lives a year. The numbers continue to rise.

There are many areas to explore in cardiovascular disease. In Part I of this series, I want you to gain a more complete understanding of a heart attack. Then in Part II, we will focus on lowering the risks of having a heart attack. The heart attack is the battle, but preventing a heart attack and reversing the causes are the war.

John is a 45 year old executive who exercises daily, took no medications and in general felt “great”. One morning while preparing for the commute to work, John developed chest pressure, a new feeling for him. He was having a heart attack, sometimes referred to as a myocardial infarction. An artery supplying the heart with oxygenated blood was completely blocked. Without its blood supply, the heart muscle began to die, producing the symptoms he was experiencing.

What is a Heart Attack?

A heart attack occurs when an artery supplying the heart muscle becomes blocked and blood filled with oxygen cannot reach the heart muscle. The real enemy is obstruction of blood flow in the coronary arteries. This leads to muscle death—a heart attack. If the artery is small, the heart attack can be small but if an abnormal rhythm develops, even a small heart attack could be fatal. If the obstruction is in a large artery or in an important location, the heart attack can be devastating. Sometimes the terms coronary artery disease or coronary arteriosclerosis are used to describe blockages. These terms may include heart attacks as well as conditions where the arteries are partially blocked.

Symptoms of a Heart Attack

A symptom is an abnormal feeling that tends to persist. A symptom of a heart attack could be a pressure in the chest, chest pain, extreme sweating, a racing heart, extreme shortness of breath, discomfort in the arms, back, neck or jaw. Sometimes a heart attack might feel like indigestion. Some heart attacks present with a feeling of extreme fatigue. The list could go on and on, but people experiencing a heart attack do not feel right. If you don’t feel “right”, get help immediately.

Diagnosis of a Heart Attack

The diagnosis of a heart attack is made by the symptoms and usually an electrocardiogram (EKG). Blood work can detect the slightest injury to the heart and help in making a diagnosis. Other tests used may include a sound wave picture of the heart called an echocardiogram or an angiogram where dye is injected into the arteries of the heart to detect blockages.

How do Arteries Become Blocked?

Cholesterol is a substance in the blood that is comprised of different types of lipids. Lipids are fats and can gradually build up on the inside of blood vessels and become calcified or hardened. Other chemical elements become involved making the blockage larger and larger. Blood has a difficult time passing through the arteries and cannot reach its destination thus causing symptoms to develop.

What Causes the Heart Attack?

Different processes can disrupt the flow of blood. Sometimes a small blockage called a plaque may become unstable. If a plaque, which could be described as a pimple, “pops”, there could be major problems even if there is just a 30-40 % narrowing. When the pimple pops or ruptures, the body sees this as an injury. If you had a cut on your finger, your body would repair the damage by clotting. Cells would be recruited to the area. Inside the arteries, cells are summoned in an elaborate mechanism to repair the damage. These cells mean to do their job, but in the process they can clog up the artery, stopping blood flow and thus causing a heart attack. This is the type of heart attack John experienced.

Sometimes a coronary artery becomes clogged with lipids over years and years and gradually become blocked until no blood can pass through. This is another type of heart attack. A heart attack can also occur when an artery spasms. There may be no blockages at all. The artery just closes. Two possible causes of spasm are high altitudes when the oxygen content is lower and certain chemicals such as cocaine and cigarettes. A final type of heart attack is when a clot from elsewhere in the body can float into the artery and jeopardize blood flow. The most common type of heart attack is when the small blockages become unstable and rupture.

Unfortunately, there are no diagnostic tests to predict which plaque will rupture. If such a test existed, it would be possible to predict heart attacks. When John’s plaque ruptured, the recruited cells helping with the damage formed a clot resulting in a loss of blood flow causing severe pain.

I know this is not light reading but what could be more important than learning about a disease which could directly affect you, your family or friends. I hope I have piqued your interest to learn more.

What Can Go Wrong?

There are several adverse things which can happen if blood flow to the heart is not restored quickly. Because of the lack of blood flow to the heart, the electrical system could be damaged, causing dangerous fast or slow heart rhythms. When these rhythms occur, the heart might be beating so fast or slow that it is unable to pump blood to the body. Sometimes the muscle itself will be too weak and unable to pump oxygenated blood. Without oxygenated blood the organs of the body cannot function. The heart valves controlling the direction of blood flow depend on muscles that may be damaged during a heart attack. Blood flow might move in the wrong direction because the valve is not working properly. This presents a problem. During a heart attack, it is even possible that a dead muscle may break open or rupture. This problem is usually fatal. As you can see, getting immediate treatment could save your life.

John’s problem was diagnosed quickly and treatment was initiated. The cornerstone in the treatment of a heart attack is to first restore blood flow to the heart and then help prevent development of problems related to the lack of blood flow. The quicker the better. Long-term treatment includes trying to halt or even reverse the disease process. This is called regression.

Treatment During a Heart Attack

The good news is that modern medicine has many methods to restore blood flow during a heart attack. These may include angioiplasty with stents or the use of clot busting medications. When dangerous fast rhythms develop, the heart can be shocked. Pacemakers are useful in treating dangerously slow rhythms. Sometimes surgery is needed to bring extra blood to the heart or repair damage to the heart. Many medications are available which can lower the work load of the heart; thin the blood and lower cholesterol levels. Treatment must be initiated as soon as possible. It is estimated that one in three, who suffer a heart attack, does not make it to modern medicine in time.

Remember treating a heart attack is the initial battle, but winning the war requires altering the body chemistry to prevent cardiovascular disease from developing in the first place. In Part II, I will focus on methods to lower your risk of having a heart attack. I want to convince you that preventing a heart attack is preferable to experiencing one . . .

By: James L. Marcum, MD FACC

James L. Marcum, M.D. FACC is the author of “Heartbeat” A Biblical Approach to Understanding and Preventing Heart Disease (Pathway Press). He is a behavioral cardiologist practicing with The Chattanooga Heart Institute. He is director of Heartwise Ministries: A television, radio, print, and seminar ministry dedicated to promoting Biblical principles to treat and prevent cardiovascular disease. Doctor Marcum is married with two children and enjoys outdoor activities and gospel music. For details, visit www.heartwiseministries.org or PathwayBookstore.com

 

Winning The War: Preventing A Heart Attack

In her forties, Janet had a slim build with blue eyes that seemed to emit a light of their own. Her mom experienced a devastating heart attack when Janet was fifteen. She visited me because she was terrified of having a heart attack at any moment. This thought literally plagued her every day. I shared with Janet, some of the techniques available to lower the risk of having a heart attack and tried to give her a sense of control when her world had been turned upside down. Let me share some of these thoughts with you.

It is estimated that 90% of cardiovascular disease is acquired and only ten per cent is purely genetic. Yes, we give this disease to ourselves. Studies have indicated that 80% of all heart attacks before the age of 65 could be prevented. There are conditions which raise the risk of heart attack we can control. Previously we learned about cholesterol plaques that develop and become unstable. This could lead to a heart attack. What predisposes this to occur?

Risk factors are variables increasing the risk of developing a given condition. In cardiovascular disease there are several known factors which increase the chance of having a heart attack. Some of these factors we can control while others we cannot control.

One risk factor you cannot control is your family history. Genetic material is passed down from generation to generation. If you have defects in this material, you might inherit a condition making you more susceptible to a heart attack. If you have a family history of heart disease, you want to work even harder in lowering the risk factors which are controllable.

Two other risk factors no one has control over are age and gender. The older you become the more likely the chance of a heart attack. Men older than 45 and women over 55 have an increased likelihood of having a heart attack. Even though women tend to have increased risk later in life, it is more likely a woman will die of cardiovascular disease than breast cancer and all other diseases combined. Once the age of 65 is reached, men and women have an equal risk of heart attack.

Janet definitely had a genetic predisposition, but there were many factors that Janet as well as you and I can modify. These include:

1. Smoking
2. Cholesterol levels
3. Diabetes
4. Hypertension
5. Obesity

These are definite factors which increase the risk of heart attack. For example, quitting the use of cigarettes can lower the risk up to fifty percent. Other factors which may play a role in increasing the chance of heart attack include stress, low levels of substances called antioxidants, high levels of homocystine, and chronic inflammation.

Just think by stopping smoking, eating the right foods, exercising regularly, keeping the weight, blood pressure and cholesterol down, and lowering stress, the chance of having a heart attack could be reduced tremendously. Sounds too easy? Why don’t we see people doing these things to lower the risk?

Remember some people just don’t have the knowledge to properly care for their bodies. Also, society does not make it easy. The cigarettes are still out there. Fast food, or should I say fast fat, is all around. We live in a mechanized world where movement is minimized. A mentality exists suggesting that modern medicine has a pill to “fix” everything.

Stress is our middle name. We stay up late, work harder, multitask more and our family schedules are busier than ever. Cell phones, beepers, internet, and television cause information overload. Often we cope by developing bad habits. This might include smoking, overeating, drinking, and in general numbing our senses to the stress. Needless to say, it takes a focused person to lower stress when society provides so many roadblocks.

How do we get the desire and motivation to change risk factors? I believe in a God who created the world and gave laws to govern. For instance, whether or not you believe in the law of gravity, if you jumped off a skyscraper there would be consequences. Likewise if you violate God’s law in caring for your body, there will be consequences. The body chemistry will change and disease will develop.

I definitely believe God has the ability to heal. There is the sudden healing which occurs in the blink of the eye, but more often there is a slow healing which occurs over time. God, when asked, give individuals “power” to make changes. This power changes the body’s chemistry, just like a medicine might, but with a lower cost and without side effects.

God can give us the power to exercise, eat better, lower our stress and keep our blood pressure down. Yes, God can even give us the power to learn how to rest. In Genesis, the God of the universe worked six days and then what did He do? He rested. Again when we violate universal laws there will inevitably be consequences, however, when we make positive changes, our chemistry changes for the better, lowering the risk of heart attack.

It is not trendy to write an article about God being the solution to chronic cardiovascular disease. Remember, unless we really understand the problem, we cannot address the long lasting solution. The real problem is our lifestyles. I believe God has the answers to our lifestyle weaknesses and is the real source of truth in this world. In this well-marketed world, it is difficult to know who or what to believe. Every day there seems to be a new and improved diet. This supplement is the cure then that one, this medication is great, but the next thing we know it is off the market. This treatment can prevent aging; this surgery will cure the problem. This herb will help you think better. The data shows this concoction prevents cancer. The list goes on and on. I think you get the picture, but how does anyone really know what to believe.

The truth is in the Bible and this is where I suggest starting in the treatment of chronic cardiovascular disease as well as preventing the disease from developing in the first place. Note, I said chronic disease. This is fighting the war and not the initial battle which usually needs modern medicine. Not only does God give the power to make good choices thus changing our chemistry for the good, the Bible also gives suggestions in the treatment and prevention of disease. Let me give two examples.

We spoke about rest earlier. In today’s world we are always on the go. God, in His infinite wisdom, created the world and rested. Now if it was important enough for the God of the universe to rest and make this one of His natural laws, then surely it must be a valuable treatment for diseases and maintenance of the body God designed. If you broke your arm, you would rest the arm allowing the healing process to occur. If you broke the law of gravity there would be consequences, when we break the law of rest, there are also chemical consequences. The body is designed to rest. All over the world as we see societies going and going and going, the rates of heart attack are climbing.

Years ago, Americans slept nine or more hours each night. Today the average American reports seven hours of sleep and often this sleep is described as poor sleep. Some are stimulated by large meals at night others by late night TV, the internet, or a number of other stimulants including caffeine. Sleep patterns are changed. Rest is disturbed. Our chemistry is altered. We are designed to rest in order to restore our bodies and replace worn out cells. We need a break from this sensory overload constantly bombarding our bodies. Rest helps us cope with stress and lowers the harmful stress chemicals.

There are many examples in the Bible teaching us how to change our chemistry. I want to close by quoting Proverbs 17:22: “A merry heart does good like medicine.” We know that people who laugh produce higher amounts of a substance called endorphins. These wonderful endorphins counteract stress hormones. There is a saying that has been around a long time, “laughter is the best medicine.” I challenge you, don’t be afraid to laugh and be happy.

Through applying the teaching and the knowledge gained through studying, the Bible-the real source of truth, Jane’s body chemistry began to change. She learned about God’s laws given to promote health. The real problem was addressed and healing, the real solution was achieved. I am glad to say 10 years have passed and Janet has no sign of cardiovascular disease. She is winning the war against cardiovascular disease.

Be a seeker of knowledge. Ask for the power to eat right, exercise, and lower stress. Praise God! “We are fearfully and wonderfully made.”

James L. Marcum, M.D. FACC

James L. Marcum, M.D. FACC is the author of “Heartbeat” A Biblical Approach to Understanding and Preventing Heart Disease (Pathway Press). He is a behavioral cardiologist practicing with The Chattanooga Heart Institute. He is director of Heartwise Ministries: A television, radio, print, and seminar ministry dedicated to promoting Biblical principles to treat and prevent cardiovascular disease. Doctor Marcum is married with two children and enjoys outdoor activities and gospel music. For details, visit www.heartwiseministries.org or PathwayBookstore.com

Heart of a Woman—Part 1

Heart disease in women differs greatly than in their male counterparts. This series is intended to educate everyone on the extent of heart disease in women. In Part one I want to emphasize the extent of the problem. Did you realize that cardiovascular disease (CVDZ) is the number one cause of deaths in females? 1in 5 females have heart disease, yes that equates to nearly 8 million in the United States. Less than 10% of women realize that CVDZ is the number 1 cause of death. 1 in three deaths are related to CVDZ, whereas 1in 30 deaths are related to breast cancer. 38% of women die within one year of their heart attack compared to 25% of men. The life time risk of developing CVDZ is 32% and the lifetime risk of breast cancer is 13%. Have I got your attention yet?

A recent New England Journal article (NEJM Vol.356 NO.5) states that women who are exposed to air pollution have a higher number of cardiovascular events. This disease has gender differences. More women than men die from CVDZ each year. Why are there differences and what should we do about it? Why do women have more “silent heart attacks”? Why are women under informed about heart disease? Is the fairer sex under more stress? Do they eat more chips?

I hope I have your attention. Let’s define what cardiovascular disease entails. Any problem with the heart or blood vessels would fall into this category. This would include heart attacks, high blood pressure, strokes, aneurysms, funny heart beats, problems with the heart valves, and any “blockage” of a blood vessel anywhere in the body. Yes, this is a broad disease. Most deaths are related to blockages in the blood supply to the heart-leading to heart attacks (50%). The list would also include heart failure and even inflammation of the lining of the heart which is called pericarditis. A slow or fast heart beat could also be a manifestation of cardiovascular disease.

Let me get back to our goal in Part 1 which is to emphasize the problem. Did you realize that after the age of 65, one in three women have CVDZ? As February is dedicated to heart health, I want you to spend a moment in thinking about your heart health. I do not want you to be a statistic. God has great plans for you. In Part two, we will start to explore the symptoms and tests used to diagnose CVDZ. If you have specific questions send them in.

Until next time….JMarcum MD FACC

Nutritional Nuggets

Fast Food Fruit
How many of us have a sweet tooth in the morning? Have you ever thought of having a fruit breakfast? Three to four pieces of appetizing, no prep fruit suits any lifestyle.

Pomegranates, figs, grapes, mangoes, strawberries are meant to delight and cheer us with God's love as we begin our day.

The human body is designed to be cleansed inside every day. And you guessed it! There is no better way than with the high-water content, the perfect packages that are fruit. Fruit works best when eaten alone and will heal the digestive system with time.

The beauty of a fruit breakfast is that we can get our day off to a good nutritious start and have time to thoroughly enjoy our Bible study. The Savior's requirements are not burdensome. His ways are a delight.

By Ann Walton

A Good Investment

Do you want to get more for your money from the food you eat and the supplements you take? Fiber is made to do precisely that. Fiber is not digested and absorbed into our bodies. But it is the key to the use of those nutrients that are. Recommendations for daily intake of fiber range from 20-35 grams. Some societies consume 40-60 grams daily. Gradually introducing fiber-rich foods into our meals is the best route to take and with more exercise we are able to tolerate more fiber.

With two kinds of fiber to choose from, it gets easier to maintain a healthful amount of fiber in our diets. Water-soluble fiber (dissolved by water) slows down the progress of food through the intestinal tract and allows more time for absorption. This quality helps to control blood sugar levels. Also this decreases the need for insulin. We know now that this plays a significant role in keeping cholesterol levels low. This slowed digestion process has a dramatic effect on the prevention of cardiovascular disease. This benefit is a key factor for those who want to improve this condition. Fruit and beans contain water-soluble fiber. Pears have high fiber content with 9 grams/cup. Cooked lentils have 16 grams/cup.

Insoluble fiber breaks up congestion in the intestinal tract and keeps it tidy. Thus it maintains a larger surface area for the absorption of nutrients. Vegetables and grains contain insoluble fiber. One pound of carrots has 14 grams and All-Bran has 17.6 grams/cup. Water is necessary with insoluble fiber, but it is best added in between meals.

A sketch of a fiber-balanced diet would look like this:
Breakfast-3 pieces of fruit-5 grams
Lunch-1 cup of cooked beans with vegetables-10 grams, a salad-5 grams
Supper-cooked vegetables such as potatoes, yams, turnips with rice or bread-5-10 grams

Oats, barley and psyllium contain both soluble and insoluble fiber.

As the organs return to their intended purposes, there will be more capacity to savor the sweet abiding of Christ and His words will drench every fiber of our being.

This fiber-rich brownie has soluble and insoluble fiber and tastes...well, you'll have to try it!

Fiber Brownie (10 grams of fiber per recipe)
2 T. roasted carob flour
2 T. wheat germ
1 T. psyllium powder
1 T. coconut oil
1 T. honey

Mix all ingredients together with a fork. It takes a few minutes. Then shape with your hands into a 2-inch square. Enjoy!

Recommended Reading: New Choices in Natural Healing, Prevention Health Books

Ann Walton