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Monday, August 29, 2011

Coronary Calcium Screening -- Does Everyone Need One?

I watched Sanjay Gupta's special "The Last Heart Attack" yesterday.  I had eagerly awaited it because I knew he would be talking to Bill Clinton, Dr. Dean Ornish, and Dr. Caldwell Esselstyn about plant-based diets and heart disease. 

We heard from one woman with a prior heart attack who turned down bypass surgery and is doing well by taking her medications and following a plant-based diet.  And, Bill Clinton discussed how he's changed his diet to improve his health as well.

An interesting aspect of the show was the discussion of coronary calcium scans.  Sanjay Gupta interviewed Dr. Agatston, the physician who came up with the concept of the scan, and ironically is the author of The South Beach Diet.  Dr. Agatston states that coronary calcium scans are "the standard of care."

I would disagree strongly.

A coronary calcium scan looks for calcium in the arteries of the heart.  If the scan finds zero calcium, that would indicate that a person's likelihood of a cardiac event in the next four years is essentially zero.  However, if you have a score greater than zero, you do have some risk.  The higher the score, the greater the risk.

But, it's not a harmless test.  It comes with a significant dose of radiation -- 2 to 3 milliSieverts, or the equivalent of 8 to 12 months of environmental exposure.  Further, the test doesn't tell us how tight narrowings are, and can't accurately state that a patient needs angioplasty or bypass surgery.  For these reasons, your HMO insurance likely won't cover it either.

Stress testing is still the standard of care because stress tests identify functional abnormalities -- in other words, they identify portions of the heart that may not get enough blood with stress, and these areas when revascularized (with bypass surgery or angioplasty) will provide symptomatic relief.

I had a patient recently come to me with just about every risk factor imaginable -- he's diabetic, high blood pressure, high cholesterol, strong family history of heart disease, and a history of smoking.  He wanted a calcium scan.  He didn't need a calcium scan to tell me that he's high risk.

I think a coronary calcium score might be reasonable to better risk-stratify someone at intermediate risk, or to help motivate someone who otherwise would not make lifestyle changes.

But, the bottom line (as it often is):  If you don't want a heart attack, live clean -- eat healthy, exercise, maintain a healthy weight, and don't smoke.

Monday, August 22, 2011

Heart-Attack Proof Diet??

Bill Clinton has been a vegan for one year. As a result, he's lost weight and feels well and has had no further need for invasive interventions to his heart.



Tune in to CNN on Saturday, August 27.  Sanjay Gupta is hosting a special called "The Last Heart Attack".  He talks to President Bill Clinton about his new diet, and to Dr. Caldwell Esselstyn, author of the book Prevent and Reverse Heart Disease.

See a clip from the special here.  I'll defnitely be tuning in.

Sunday, August 21, 2011

Hansen Dam Triathlon

I've done an Ironman and several half-Ironman distance races.  But I still love small races too.  It's a chance to just go full-steam and give it what I've got.

Today's Hansen Dam Triathlon was a 500 yard swim, 11 mile bike, and 5k run.

This is me and my friend Kenny, who was doing his first triathlon today!!
Swim 
I decided to take a slightly different strategy on the swim -- start at the front of the wave, go all out on the start, and push myself all the way through.  When the gun went off, there were about a dozen or so women who powered in front of me, but shortly thereafter I think I passed a couple of them as we rounded the first buoy.  On this rectangular course on a man-made lake, sighting the buoys for the turns was not a problem.  Swim time:  10:55 -- a minute and a half faster than the last time I did this race.  I was the fifth woman (out of 33) in my age group out of the water.  I credit my coach Gerardo Barrios with leading an awesome swim workout on Tuesdays and Thursdays and scheduling me to (begrudgingly sometimes) swim 3-4 times per week.

Bike
Not my strength.  Long legs=crappy levers.  That's my excuse.  One woman who finished the swim at the same time that I did went flying away on the bike.  I tried to keep her in sight but she was gone!  The bike had a couple of hills, but most of it was flat, along the roads around the park and over the Hansen Dam.  Two women passed me on the bike.  I was surprised there weren't more people who passed me.  Bike time: 33:22.  Over 3 minutes faster than my 36:43 of two years ago.

Run
There's an important rule in triathlon -- Never try anything new on race day.  Which would suggest that maybe I shouldn't have decided to try running without socks.  I figured it would take some time off of my second transition.  And it did.  But now I have a couple of blisters in my arches.

In short races, the run is my strength of the three sports.  I managed to catch the woman who flew ahead of me on the bike course.  The run took us through some trails of the Hansen Dam Recreation Center.  Now, the run is supposed to be a 5k, but I measured 3.21 miles on my Garmin.  At water stops, I'd grab a glass of water, take a sip and dump the rest on my head.  There were a few inopportune hills, like the one that is a quarter mile from the finish line.  I powered through that last hill, joked with the guy who I had run the last half of the trail with by yelling, "Don't let yourself get chicked at the finish!" as he, as a result, sprinted to the finish line just ahead of me.

(the definition of the word "chicked" is allowing oneself to be beaten in a race by a woman)

Run time:  27:47.  Two years ago was 24:49, but I really believe they made the run longer this year.

Overall time:  1:14:45.  Two years ago: 1:17:37.

Awards Ceremony -- "Podium"!!!!

Second place (out of 33) in my age group!!!  This would be my first time racing in LA in which I have podiumed in a triathlon in my age group.

So, getting older, getting faster -- a great day at Hansen Dam!!!