Health & Wellness Apps For Patients

The number of apps over the past 5 years has exploded for both healthcare professionals and patients, alike. We are talking exponential growth. A recent count of the iTunes app store identified more than 13,000 healthcare and "wellness" apps! To help control this influx of apps the FDA has actually inserted itself and defined a difference between a "health" app and a "wellness" app.

A health app is categorized by the FDA as mobile software that diagnoses, tracks or treats disease.

A wellness app is mobile software that enhances or tracks the overall health of the user.

That said, there is a ton of crossover between the 2 classes e.g. a calorie counter that can then make recommendations about how to adjust your intake or a BP tracker that alerts you to call your physician when there are too many consecutive high numbers.

A relatively quick and easy way to identify successful patient apps is to check out which patient-centered apps have the most downloads in the iTunes Store and peruse the reviews written by patients (often the younger set). Here are some apps that I feel have transcended the niche medical category and gone into the widely used & useful category:

1. WebMD - This is the one of the major categories of patient apps - EDUCATION (the other categories would be DATA RECORDING/TRACKING, and the last would be MANAGEMENT). It's easy to use, full of reliable information, has a trusted brand, and offers side tools like a pill identifier. Oh yeah, and it's FREE and available for iPhone and Androids.

2. iTriage - A cool and rather progressive app that allows patients to find the nearest ERs and can often provide estimated waiting times (altho the accuracy on that is questionable). It also serves as a crude diagnostic tool when you provide symptoms and gives a ton of reference information on medications, procedures, conditions etc. It is FREE and available for both platforms.

3. BP Monitor or BP Tracker by HeartWise - Probably the most success I've had, from a personal standpoint, in getting my patients to use apps. While there are BP cuffs available at Walgreens and the Apple Store (http://store.apple.com/us/product/HB134ZM/A/ihealth-wireless-blood-pressure-monitor) that hook into the iPhone directly or wirelessly, the most common BP apps just serve as a substitute for the yellow legal pad on which most people record their daily reading. The benefit of these BP trackers is that they can be exported rather easily in graphic or tabulr form to the doctor by email or printed out in a presentable fashion. My patients that use them, love them.

4. Glucose Companion or one of the numerous other glucose/calorie tracking apps. There are several and they serve a similar purpose to the HTN apps listed above. Recently, apps like WellDoc are attempting to integrate their data with existing EHRs - and have been successful, improving the management of patients while physically seeing them less!

5. Gazelle - For many of us specialists, keeping track of patients labs' are a chronic issue and patients are often inconvenienced by the fact that we dont do labs in our office and often dont get copies of their recent bloodwork. This app by Quest Diagnostics allows pts to make appointments online and track their lab data and keep it on their phone!!!

6. Pill Reminder - Medication adherence has been identified by the mobile medical community as one of the low hanging fruits that we can address using these devices. This app by Drugs.com attempts to achieve success in this space. Logically, it sends reminders when to take meds as well as when you might need a refill and provides a drug reference geared towards patients.

7. My Fitness Pal or Calorie Counter - There are numerous apps in this space and I havent had time to sort thru all of them but they all attempt to acheive the same goal - provide the patient with info so that they may make healthful changes. Some even make recommendations. They vary is their ease of use and some will interface with a wearable device (FitBit or Nike product) that count your steps and monitor your breathing while you sleep giving you biofeedback info as well.

8. Google app - Still and likely always, the most common resource for health information. The results sometimes may be muddled but overall it often serves as a wonderful resource for information.

9. ZocDoc - For patients who are likely more progressive and do everything online. This app allows patients to find doctors in their area, put in their insurance info, and actually book an appointment online.

R.I.P. James "Tony" Gandolfini - What Can We Learn?

When I was living in Chicago, missing the brash Jersey attitudes and Italian delicatessens of my youth, The Sopranos provided me with a sixty minute journey back home every week. Whoever watched with us, as we hung on every word, would also be forced to endure my vocal alerts for every North Jersey sighting embedded in a TV drama that seemed so real. The Lincoln Tunnel exit, Route 3, Bloomfield Avenue, lots of cured meats and wet muzz - things that were unique to my home - Jersey.

The viewing of The Sopranos began to take on an event-like atmosphere, preceded by numerous pots on the stove, sausages and meat balls, gravy simmering, wine pouring, friends talking and congregating - until, that is, the intro began with its heavy baseline and Tony, arm out the window, cigar in hand, making all of us feel lucky to know him, and to not be on his bad side. The good bad guy.

The controversial fade-to-black finale without closure now takes on such a more profound tone - since we know what happens in real life. James Gandolfini's passing is sad for so many reasons - the term "untimely" hardly does it justice. The death of any young person - particularly from potentially preventable causes - is a tragedy. And events like this, because of their notoriety and widespread media coverage, have the opportunity to spur change.

 Gandolfini was such a young man at 51, leaving 2 young children and a wife behind; aborting a proud and accomplished acting career; and for those of us who hale from his home state of New Jersey, the former Rutgers grad's death cements his image in our minds as a small screen icon. Jersey has had so many famous residents (don't make me name them, 'cause I can) but none as "Jersey" as Gandolfini.

The fact that he was so famous/beloved and so young and didn't die of what so many young, famous people die of (addiction), makes the story so acutely interesting - not just in a Page 6 way, but more from a "what can I do to prevent that?" way.  The death of any young person is tragic and often engenders questions of how and why - yet the answers sometimes leaves us unsatisfied.

Objectively, Gandolfini was not the picture of health. He was likely technically obese and had a well-documented penchant for food and cigars - to the point that his last meal has been chronicled in every newspaper that reported his death - as if it had a direct relation to his sudden cardiac death. Which it very likely, did not. Would they have done that for a thinner man?

The fact is that out-of-hospital cardiac arrest occurs more than 380,000 every year in the United States alone - with the vast majority occurring inside the home. Many of those happen in people with no known heart disease. This is an incredibly strong argument for why ALL people should learn hands-only CPR - an unbelievably  simple skill that can literally make the difference between saving a life or watching someone die. This link will teach you all you need to know: http://www.heart.org/HEARTORG/CPRAndECC/HandsOnlyCPR/DemosandVideos/Demos-and-Videos_UCM_440561_Article.jsp.

 Less than one third of all cardiac arrest victims actually receive CPR - a shame when you can literally triple the likelihood of saving someone's life just by pushing on their chest to the tune of Staying Alive.

That said, how can you prevent a tragedy like this from happening to you or a family member? Knowing the obvious warning signs is  a good start: so, if you have chest discomfort that lasts more than a few minutes, or that goes away and recurs (particularly with exertional activity) - that's concerning and needs to be worked up by a doctor. Alternatively, some people may also develop left arm pain, jaw pain, nausea and/or diaphoresis (sweating) - equally concerning signs that merit a visit to your doc. Women and diabetics tend to present with somewhat atypical signs e.g. abdominal pain, back pain, shortness of breath. The take home message: if you are concerned with symptoms in or around your chest area and you have one or more of the risk factors described below: GO TO YOUR DOCTOR.

Once the event has occurred, damage has been done - so the real question is: who is at highest risk for having a cardiac arrest or heart attack at a young age? Contrary to popular opinion, early onset coronary disease has never been conclusively linked to a stressful job or life. In fact, it is more likely people's coping mechanisms (smoking, drinking, drugging, eating), triggered by their stress, that cause their cardiac events. Actual statistically proven risk factors for coronary artery disease include:

• Smoking
• High blood pressure
• Elevated cholesterol and/or triglycerides
• Family history in 1st degree relatives (father, mother, bro, sis) of CAD before 55 in males and 65 in females.
• Diabetes 
• Obesity

The above risk factors are vetted by numerous studies, but I will add one more that I feel likely contributes to a vast number of these cardiac embarrassments: lack of medical attention. Younger men in particular often veer away from medical attention despite the proverbial writing on the wall. They also tend to ignore symptoms that may herald an impending disaster. The fear of discovering something trumping the much less realistic seeming fear - that one may die from doing nothing. So, if you are one of these men (or women) - or live with one of them -  do not ignore your symptoms. Go see a doctor.

Cases like Gandolfini's and Tim Russert's death not too long ago, remind us that coronary disease and its sequelae can be devastating and without obvious preceding symptoms. In the interventional cardiology community we see these events fairly frequently, and most of them do not receive much fanfare. With the advent of so many new technologies and vastly improved treatment of heart attacks, we still are unable to save everyone. The key to better outcomes is better prevention.

Is Less Really More?

The smart folks at the American Board of Internal Medicine Foundation have published an additional 90 procedures (to the 45 that they listed last year) that they feel are overused and often times unnecessary. This is part of the Choosing Wisely initiative to encourage patients to ask more questions about the tests that they are having and the reasoning behind it.

Unfortunately, we have become a test-happy medical society in the US and the reasons for this are myriad. Firstly, old habits die hard. Doctors in a given specialty see similar diagnoses and have been doing the same testing routines for years. It is difficult to get physicians to change their diagnostic/therapeutic habits when they have been doing it with success for eons.

Secondly, medicine is a business. And for doctors, it has not been a very good one of late. Reimbursement rates for everything from office visits to echocardiograms have plummeted and physicians are not immune to the squeeze of earning less money for the same amount of effort. Already, we are beginning to hear murmurs of doctors objecting to answering phone calls in the middle of the night when they're not getting paid for it. This used to be part and parcel of being a "patient of the practice" but this old style of long, personal relationships with your physician is waning. Five years ago less than 10% of all cardiologists were employed by a hospital and as of 2012, more than 60% of US heart doctors have some formal business relationship with a hospital system. Healthcare providers are having to see more patients in less time and modalities like telemedicine, pharmacy consultations, outpatient phone calls and remote monitoring will become more and more important in the years to come.

Finally, many tests and procedures are done for fear that the doctor may miss something and pay a much steeper penalty than wasting a few health care dollars on a test. Most patients that come in to the ER with chest pain can very readily be diagnosed with a good history and physical. Heart attack symptoms can be tricky but there are some universal features that put patients at higher or lower risk. However, the fear of missing any diagnosis, no matter how unlikely prompts serial blood draws, CT scans, stress tests and increased length of stay. Attempts to lessen the threat of lawsuits and financial demise from medical management have been met with a great deal resistance and so doctors will consider doing CT angiograms of every young woman who presents to the ER with shortness of breath and happens to be taking oral contraceptives - even if they have a very low likelihood pulmonary embolus.

Initiatives like ChoosingWisely.org are a great start in changing the consensus opinion of how patients should be managed and allowing the doctors who choose not to over-test to fall back on educated and validated medical opinions confirming that sometimes a good history and physical in addition to carefully selected testing (or perhaps no testing at all) is the best thing that can be done.

If nothing else, a perusal of this list of overused and over-ordered tests can give you good reason to ask your physician more questions about exactly why they are ordering the test and what will change as a result of the outcome? Is the test safe, what are the risks? The ChoosingWisely website also has answers to specific questions like 'Do I need a Chest XRay before surgery?' and 'When do I need a stress test?' It is a very worthwhile stop on your Internet travels so give it a read and take more control of your medical care.

Catheterization from the Wrist Taking Over

Just recently, cardiac catheterization from the wrist, or transradial cardiac catheterization, was featured on the Dr. Oz show and immediately we were fielding questions about it in the office and reading about it on the blogs.

Now, even more impactful, was the recent recommendation from the European Society of Cardiology that the radial approach should be considered as the first-line access site:

“The radial approach for percutaneous coronary interventions (PCI) was developed 20 years ago and is used for more than 50% of procedures in France, Scandinavian countries, the UK, Spain and Italy. Despite the advantages of radial access some countries in Europe such as Germany use radial access for fewer than 10% of PCI….

“Evidence has accumulated in the literature showing the benefits of radial over femoral access for PCI including reduced bleeding and improved survival. In addition, the development of smaller and thinner devices has made the radial approach increasingly practical.”

For most of us in the interventional cardiology world, the radial approach has been slowly gaining traction over the past 5 years in the US. As of 2007, less than 2% of all coronary stent procedures were done from the wrist but in 2012, according to the National Cardiovascular Data Registry (NCDR) more than 11%  were done radial style.

Patient safety and comfort are always a concern to physicians and the radial approach has shown superiority to the femoral (groin) approach in both categories. In terms of safety, numerous studies have shown significantly less bleeding complications as compared with the femoral approach. This is in large part due to the fact that unlike the radial artery, which is bordered by bone and connective tissue, the femoral artery lies right next to a large caliber femoral vein and complications can be difficult to identify at first because of the large potential space for blood to go, i.e. the thigh or abdomen. Women are actually at higher risk of groin complications from cardiac cath and currently Dr. Safirstein is the Principle Investigator of SAFE-PCI, a multicenter, randomized control trial looking at the benefits of the radial approach in women, run in collaboration with more than 25 of the best coronary centers of excellence across the US.

Comparing comfort of the 2 techniques, it is not hard to see why patients have preferred radial more than 90% of the time. Cath from the wrist allows patients to sit up immediately after the procedure (even when a stent is placed) with a pressure dressing over the small puncture site on the wrist. The femoral approach demands anywhere from 4-8 hours of lying flat so as not to disrupt the clot that forms over the femoral puncture site. This becomes particularly relevant in patients who have back pain issues or cannot lie flat for any reason.

From a cost standpoint, less complications mean less money spent on follow-up imaging studies, blood products that might be required, consults with other specialists, and of course, length of stay. The radial approach has been shown to save both hospitals and patients money and time in the hospital.

Drs. Safirstein and Fusman both are proficient in radial cath and Dr. Safirstein served as the Director of Transradial Intervention at Morristown Medical Center. Later this year, he will be Course Director for the annual Mid-Atlantic Radial Symposium (MARS2013), hosting world-renowned experts who will educate both physicians and cath lab staff from NY/NJ/PA on everything transradial!

Nutritional Value of Equine Cuisine

There has been a lot of banter recently about the use by fast food royalty, Burger King, of horse meat in their burgers. Morally and objectively, it seems not "right" to use Mr. Ed and his relatives as a source of sustenance, but then again, there have been a few famous pigs on the big screen as well - and we mean real pigs, of the porcine sort. If we can look at this scientifically, we might find that equine-based foodstuffs may actually have some benefits.

Firstly, there are many countries, not just the 3rd world sort that actually do eat horse meat -

just look to our northern neighbors where horse is frequently featured on the menu. “Horse is delicious,” says David McMillan, Joe Beef’s co-chef. “It’s like health food compared to beef! It makes you a strong lover, too,” he adds.

Also, according to NutritionData.com, the strip steak has about the same amount of calories as horse (117 vs 133 calories per 100 grams), though many other cuts of beef have significantly higher calorie counts. The meats also have very similar amounts of fat, cholesterol and protein when lean cuts are compared. Where the meats really differ is iron concentration, with horse meat having double the iron (21% vs 10% DV) that beef contains. Horse meat also contains substantially more vitamin B12 (50% vs 21% DV), but less B6, niacin and folate. But the most striking difference is the omega-3 fatty acid concentration in horse meat, which contains 360 mg (per 100 grams) compared to just 21 mg in strip steak.

Now, we are not advocating for you to start eating horse meat and understand the stigma attached to it but it always helps to know the facts before siding with the neigh-sayers. Sorry, couldn't resist.

Read more: http://ideas.time.com/2011/12/28/the-case-for-eating-horse-meat/#ixzz2Jfr9WGkG

The ABCs of Eating Right & Exercising

Depsite the advancements in medical therapy for diseases like hypertension (high blood pressure), high cholesterol, and diabetes, very few treatments are as effective, or as longlasting, as weight loss, exercise and proper nutrition - and of course, smoking cessation in those that smoke. However, I also realize that exercising every day and eating "right" can be challenging on many levels, not the least of which is understanding how to eat right and what type of exercise is best. These type of lifestyle changes also require us to change our habits, our schedules, and most frustratingly, the comfort-giving routines that we have been entrenched in for weeks, months and sometimes years.

The DASH diet. DASH actually stands for Dietary Approach to Stop Hypertension. The basics: eat lots of fruits, vegetables, whole grain, low-fat dairy foods, as well as poultry, fish, meat, nuts and beans. The amounts of added fats, red meat, and sugary drinks and foods are limited - as is salt.
So how good is this diet? the NIH studied patients on the DASH diet as if they were studying a new medicine and found that:

• Patients with pre-hypertension who followed the DASH eating plan experienced an average drop of 6 mm Hg in systolic blood pressure and 3 mm Hg in diastolic blood pressure.
• Patients with hypertension experienced reductions of 11 mm Hg in systolic blood pressure and 6 mm Hg in diastolic blood pressure.

Not too shabby for changing the food that you eat. Most pharmaceutical companies would brag about this type of data if they could reliably produce it.

Furthermore, a recent study published in Circulation: Cardiovascular Quality and Outcomes pointed out that the DASH diet decreases the 10-year risk of heart attack..

You need more reasons you say? How about the fact that U.S. News & World Report just ranked the DASH diet as Best Overall Diet. A panel of experts in diet, nutrition, obesity, heart disease, diabetes and food psychology reviewed 29 diets and ranked them according to safety, short-term and long-term weight loss, how easy they were to follow, nutritional completeness, diabetes prevention and management, and heart disease prevention.

The diets were ranked according to a star system, with five stars being the best score. Below are the diets which ranked best:

• DASH diet - 4.1 stars. Nutritionally complete, safe, can prevent and control diabetes, also promotes heart health.
  
• TLC diet - 4 stars. TLC stands for Therapeutic Lifestyle Changes. This diet was created by the National Institutes of Health (NIH) to reduce levels of cholesterol. The panel said it is a healthy, well rounded diet. However, the dieter is left very much on his/her own.
  
• Mayo Clinic diet - 3.9 stars. Experts say it is safe and nutritious, and moderately effective for those aiming to lose weight. How can you go wrong with the Mayo?
  
• Mediterranean diet - 3.9 stars. The diet is rich in vegetables, fruits, olive oil, and other healthy nutrients. It was criticized for being too different to what Americans are used to and may consequently be hard to keep up.
  
• Weight Watchers - 3.9 stars. This diet was praised for the emotional support dieters receive, as well as being an easy one to stick to.

Above you will find links to where you can find and download the DASH Diet (YOU DO NOT HAVE TO BUY THE BOOK BECAUSE ALL THE INFO IS PUBLISHED FREE HERE) and all the other Top 5 diets. The best of them are free but others come with a fee and for some, that is a motivating factor, i.e. 'I payed for it, I better do it' phenomenon.  Each of the above diets are good for you and often times the one that seems most appealing and realistic for you will be the best one. At the very least, if you are not a structured diet person, here's a few simple tips on how to lose weight:

1. Limit your portion size. A good rule of thumb is that each portion should be no bigger than your fist.
2. Limit your intake of rice, pasta, potatoes and bread. These complex carbohydrates are heavy in calories, low in protein, and all eventually are converted to sugars. Replace the starchy sides with vegetables, e.g. curry roasted or pureed cauliflower (tastes like mashed potatoes), quinoa, string beans, etc
3. Eliminate all sugary drinks from your diet - particularly sodas. Empty calories with no nutritional benefit.
4. Exercise 4-6 days per week. Even 30 mins of walking on the treadmill with a modest incline would be greatly beneficial to you in the longterm. '

Here's to a healthier, thinner, you in 2013!

Top 5 Heart Healthy Gift Ideas from CCNM

It's that time of the year when we stress about, er, take joy in, buying gifts for others. But what to get for those trying so hard to develop good healthy habits? Fret not! We have procured a list of healthy, good habit-forming gifts that are safe and doctor-approved. Let's get to it:

1. What's healthier (and tastier) then a basket of fruit? Not much. Keeping it local,  Denville mainstay for the past 70 years, J&M Gourmet Foods, has a great selection of fruit baskets that will deliver locally on the same day or ship it overnight. The Famous J&M Fruit Basket for $49.95 is our go-to selection but there are numerous others from which to choose.

2. Did you know that gardening can burn up to 1,260 kJ an hour while also working those core muscles? Once the winter snow thaws and the green begins to show its time to get out there and get healthy. So why not do it with some new tools. For the guys who do the heavy lifting, cutting, pruning there are plenty of power tools to satisfy even the manliest of gardeners. Check out Home Depot or Lowe's for the latest deals on cordless hedge trimmers, lawn mowers, etc. And for the ladies, new gloves, gardening tools and even plants/seeds ordered online are an awesomely healthy way to get spring started. Check out White Flower Farms  for the best online plant selection.

3. This device that looks like its from 2021 is worn like a watch and does actually tell time. However, it tells much more than that. The Nike Fuelband also monitors your daily activity and translates that into energy spent. It counts your steps and uses an accelerometer to calculate your level of exertion. It then syncs with your mobile device wirelessly and can give you daily reports about how you've done. If you also want to keep an eye on your shut-eye the Fitbit One Wireless Activity and Sleep Tracker also monitors your sleep cycle and can actually be set to wake you at the optimal point in the cycle so that you'll srise feeling well-rested and ready to go.

4. Full disclosure: I want this gift! We are finally at the point in our technological advancement where we no longer have to be impeded by annoying swinging wires while we run or connection points that no longer connect well. Welcome to the wonderful world of wireless accessories. They connect to any iPod, iPad, iPhone, Android, or any other Bluetooth enabled device, so you can listen and control your music play, advancing or rewinding the track and pausing from up to 32-ft. away. It even has a microphone that lets you make or take calls on your cell phone — the music stops when a call is in progress, and resumes playing when you hang up. So good.

5. Finally, from Circulation, the journal of the American Heart Association, it was previously reported that moderate intake of alcoholic beverages (1 to 2 drinks per day) is associated with a reduced risk of coronary heart disease in populations. That's good! We can use that evidence-based data for a great gift idea. Why not support the local wineries of NJ and grab 2007 Unionville Red Montage Big O, which has won multiple national awards and the distinction of Best Wine in NJ from the Star Ledger and Tastings.com. Or, go to your local store and pick up a bottle of red wine for a friend. Remember though, the benefits only exist in moderate intake!





From all of us at CCNM, have a Happy Chanukah, Merry Christmas, and a Healthy New Year!!

So many of us lead busy lives and eating healthy is a challenge when you're in the run. I hear from patients so often that time is a limiting factor, particularly when it comes to breakfast. The temptation to grab something quickly and get on with the day is usually stronger than the desire to find something good for you. However, there are options available that are markedly more heartsmart than the sausage and egg coronary killer. WebMD has done the work for us in sorting out the bad from the not as bad and we've posted their slideshow below. Take a look and get your day started in a better way:

http://on.webmd.com/T6w67Y

Does Work Stress Lead to Heart Disease?

It seems logical that stress, and in particular job-related stress, where we spend so much of our time and effort, would contribute to health issues. So many of my patients report that they have had "a lot of issues at work" in the same breath as their description of chest pain-type symptoms. And there is that urban myth about people working so hard that it resulted in their demise. But most of these myths often have a kernel of truth and recently, a group of British researchers performed an analysis of 13 studies performed between 1985-2006 assessing job strain as a risk factor for coronary heart disease, i.e. heart attacks.

Of the nearly 200,000 patients analyzed, 15% reported significant job strain and after some savvy statistical analysis that involves terms like hazard ratios and reverse causality, these smart guys found that job stress does indeed appear to be linked with higher rates of heart attacks. Their interpretation as described in the published abstract stated the following:

Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking.

 

So, those of you smoking to deal with a tough day of work - cut it out! The smoking will hurt you way more than your distasteful boss.

 

The American Heart Association is not as confident in linking stress to heart disease and bluntly states on their website that...  "although stress is not a confirmed risk factor for either high blood pressure or heart disease, and has not been proven to cause heart disease, scientists continue to study how stress relates to our health. And while blood pressure may increase temporarily when you're stressed, stress has not been proven to cause chronic high blood pressure."

 

The AHA then goes on to give several recommendations for how to manage stress in your life (some good, some not that good) which you can find here:

 

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Stress-and-Blood-Pressure_UCM_301883_Article.jsp

 

In my opinion, stress contributes more to mental anguish and anxiety than anything else and often triggers our coping mechanisms - which may be good (e.g. exercise, reading, yoga, etc) or more often bad (smoking, drinking, festering, etc). The key is to try to minimize the bad coping mechanisms, avoid situations that are stressful if possible, and enjoy life.

 

The Lancet, Volume 380, Issue 9852, Pages 1491 - 1497, 27 October 2012

Carry Your ECG With You Forever

Next time you have an electrocardiogram (ECG) done, take it with you forever by snapping a pic of it with your phone. If you are lucky enough to have an iPhone or Droid (or any phone with a decent camera) the quality of the ECG image will be very decent.

This could come in very handy if you were to ever end up in an ER or doctor's office who wanted one for comparison. And that happens more commonly than you might think.

This is a quick, cheap an easy way to answer what potentially may be a very important question: is this finding on your ECG new?

This may be particularly important in those patients with chronically abnormal ECGs at baseline. Certain findings on an ECG, such a left bundle branch block, can prompt fairly aggressive courses of action if they ate thought to be a new finding. Obviate that by carrying yours on your phone.

Check Your Blood Sugar With Your iPhone or iTouch

It seems like this should be something that's more theoretical than realistic but technology seems to be not only catching up to medicine, but outpacing it.

The iBGStar Blood Glucose Monitoring System is now being sold at Walgreens for $74.99 and the Apple Stroe for $99.99 and the article below summarizes all the benefits of checking, recording and even managing your blood sugar with the assistance of this peripheral device and accompanying app.

Mobile medicine getting more impressive all the time...

http://www.imedicalapps.com/2012/05/doctors-prescribing-iphone-ibgstar-blood-glucose-peripheral/

Article: Medical Tests | Unnecessary Medical Tests & Treatments

Medical Tests | Unnecessary Medical Tests & Treatments
http://www.consumerreports.org/cro/magazine/2012/06/many-common-medical-tests-and-treatments-are-unnecessary/index.htm

(Sent from Flipboard)

App for atrial fib

http://www.imedicalapps.com/2011/12/pharmaceutical-sanofi-aventis-useful-medicalapp-patients-heart-arrhythmia/

Transradial in the Spotlight

As some of you know, the transradial approach to cardiac cathterization is a specialty of CCNM's Dr. Jordan Safirstein. The use of the wrist to access the heart, instead of the groin, has now moved beyond niche procedure and is growing in frequency every year. The lack of associated bleeding complications and improved patient comfort have begun to wear down even the most staunch femoral supporters. While Europe and Asia have zoomed ahead of us in their utilization of the radial artery for cath, the U.S. has begun to catch on. The NJ Star-Ledger recently published a great article along with an online pictoral display of the entire procedure from beginning to end. Check it out here:

• Pictures of transradial cardiac catheterization
• NJ Star-Ledger's A second opinion on unclogging arteries: Catheters through wrist, not groin

Super Goal Monday

With the big game on Sunday, and the big food that goes along with it, many of us (or maybe just me) are still  on our "Holiday" will-power hiatus and looking for an excuse to start serious food restriction.

Well, the gig is up and thanks to my awesome office staff, I have an excuse to get my BMI closer to where it should be. The women have initiated a Super Goal Monday Weight Loss Challenge.

After gorging on offensively hot wings, a plastic football full of pretzels and (hopefully) the sweet taste of a Giants victory, we will begin a 3 month competition to see who can best reverse the damage of the above. Weekly weigh-ins and a financial incentive will keep us honest and aqt the end of 90 days, we will all be better for it.

For privacy and safety reasons (mine in particular), I am not allowed to post results of any of the weigh-ins although I'd really like to. Unfortuantely, I'll just have to give vague, non-numerical updates. These types of weight loss challenges are wonderful ways to help you and your colleagues/friends/neighbors/family members to get healthier, using a team approach and exchanging ideas about what works and what doesnt. There are also several online options to facilitate a group weight loss challenge and I've provided a few below. Check it out if you feel so inspired. And fo course, GO GIANTS!!!

Ideas for a Weight Loss Challenge at LiveStrong

WeightLossWars

Healthier School Lunches Are on the Menu

After 15 years, the school lunch ladies will be dishing over some healthier grub to our children, says the National School Lunch Program.

With an additional six cents per meal, the schools could hardly figure out where to spend first. Fortunately, most of the improvements come in the form of omissions, including smaller portions, calorie limits, less fats and zero trans fat. There are some increases too, such as those in "dark green vegetables", whole grains, and fruits.

Despite an attempt to discount tomato paste (and thus pizza) as a vegetable Congress was able to successfully reverse that and maintain its status as equal to one veggie serving.

"It was a bit unfortunate that some groups had powerful friends in Congress and basically tried to sort of short-change [kids] and create some confusion with these standards," said Agriculture Secretary Tom Vilsack.

"Our response was to set up minimum requirements. You have to have a minimum level of dark green vegetables, you've got to have a minimum level of red or orange or yellow vegetables."

And coming on the heels of these changes will be laws affecting school vending machines.

Here are the quick bullet points:

• Offer a minimum of 8 to 10 ounces of whole grains. No more than two desserts a week may be used to meet this minimum
• Offer at least a half cup per week of dark green vegetables
• Offer at least 3/4 cup red/orange vegetables for grades K-8, and at least 1 1/4 cups in grades 9-12
• Offer at least a half cup of beans or peas
• Offer at least a half cup of starchy vegetables. There is no limit on starchy vegetables
• Offer at least a half cup of fruit in grades K-8 and at least 1 cup of fruit in grades 9-12
• Offer at least a half cup (grades K-8) or 3/4 cup (grades 9-12) of "other vegetables," which may be met with any of the above vegetables except for starchy vegetables
• Allow tofu as a meat alternative
• Get federal reimbursement only if they offer at least a half cup of a fruit or vegetable
• Contain no fewer than 550 calories for grades K-5, 600 calories for grades 6-8, and 750 calories for grades 9-12
• Contain no more than 650 calories for grades K-5, 700 calories for grades 6-8, and 850 calories for grades 9-12
• Obtain less than 10% of total calories from saturated fat
• Have zero trans fat
• Limit salt according to grade level
• Offer at least a cup of low-fat or skim milk

Read the whole article on WebMD 

The Future Is Here

When I asked my patient yesterday of he had been recording his blood pressures he cooly whipped out his Droid and showed me his recorded and graphed BP - which had a very reassuring negative slope to it. He used The HeartLite app for the Droid and all of you with SmartPhones can do the same.

The Truth About Shoveling Snow

With the snowiest weeks ahead, we thought it would be good to uncover the truth about shoveling snow. Slips and falls, not cardiac catastrophes, are the most commonly seen winter-related injuries - but heart problems account for almost every recorded death in reported studies.

It is quite possible that you have heard about the risks of shoveling snow on the news, or possibly from your doctor, and most likely from your spouse. However, it is very unlikely that anyonw has shown you the proof that it can be deleterious to your cardiac health.

 "It's a dangerous activity. People who are middle aged or older with a history of heart problems simply should not shovel snow," said Barry Franklin, director of Cardiac Rehabilitation and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Mich.

But why? In an ABC News report, Franklin lays it out fairly well explaining that many people may not realize that a shovel full of wet snow can weigh as much as 15 to 16 pounds. So he said that if someone is shoveling snow at a rate of 12 shovelfuls per minute, they will have moved nearly a ton of snow if shoveling their driveway in just 10 minutes.

"So the physical demands are really, really substantial," said Franklin. When you couple that with the cold air that they are breathing, which causes the coronary arteries to constrict, in many respects you've got a perfect storm for heart trouble," said Franklin.

"Being out in the cold, some of the warning signs may be camouflaged," he added.

Cold weather and hard work can mask those symptoms, delaying people's responses and sometimes leading them into more trouble.

"We really encourage people beyond the age of 50 to try to hire a neighborhood kid to do it," he added.

Not everyone is at risk for a heart attack while shoveling, of course and people in cold climates often have "conditioning," according to Dr. Randal Thomas, director of the Mayo Cardiovascular Health Clinic in Rochester, Minn.

Studies published in the Lancet and the American Journal of Cardiology show that the incidence of heart failure goes up in the week after a blizzard. The Lancet study, based on death certificates in eastern Massachusetts after six blizzards from 1974-78, demonstrated that coronary artery disease-related deaths rose by 22 percent during the blizzard week and stayed elevated for the subsequent eight days, suggesting that the effect was related to storm-related activities, like shoveling, rather than the storm itself.

Similarly, the AJC article, based on medical examiner records from three Michigan counties, found that there were more exertion-related sudden cardiac deaths in the weeks during and after blizzards, and that 36 of the 43 total exertion-related deaths occurred during or shortly after snow removal.

Here are some tips from Brigham and Women's Hospital cardiologist, Daniel Forman M.D.,director of Exercise Testing Laboratory and Cardiac Rehabilitation.

Certain individuals should consult their doctor before shoveling snow:

• People who have previously had a heart attack or other cardiovascular disease.
• People with a history of chest pain or angina.
• People with medical histories of high blood pressure, diabetes or high cholesterol levels.
• People who smoke or who have other cardiovascular risk factors.
• People who do not exercise regularly.

For those who wish to shovel snow, follow these general tips to help stay healthy:

• Dress warmly and be sure to protect extremities such as your nose, ears, hands and feet. This is important because cold weather can reduce circulation, aggravating heart disease.
• Stretch your arm and leg muscles as you would before any exercise; this minimizes musculoskeletal injury and strain.
• Also warm up your cardiovascular system with a light activity such as marching in place or walking before shoveling. Warming up is an important means of modifying cardiovascular strain.
• Don’t eat a heavy meal or drink alcohol prior to shoveling (this is not a good way to work off a big meal!). Avoid stimulants such as caffeine or nicotine, which increase heart rate and cause blood vessels to constrict.
• Use a shovel with a small blade. It is safer for your heart as well as your back and joints to lift smaller and more frequent amounts of snow than to haul a few huge shovelfuls. Likewise, it is important to have a shovel that is suited for your height.
• Pace yourself. Start out shoveling slowly, and don’t try to clear the entire area at once.
• Take frequent breaks to give your heart a rest. Use the time off to drink plenty of water and stay hydrated. Also make sure you are eating normally and taking your routine medications. Push the snow rather than lifting and throwing it.
• If you must lift, do it properly. Spread your hands along the handle for more leverage, stand with your feet hip-width apart, and bend at the knees (not at the back).
• Do not twist or throw snow over your shoulder. Scoop in a forward motion and step in the direction you throw the snow to avoid lower back pain the day after shoveling.
• Know the warning signs of a heart attack. Stop immediately and seek emergency medical help if you experience heart attack symptoms such as chest pain, shoulder, neck or arm pain, shortness of breath, dizziness, fainting, sweating or nausea.

OMG! CardiacConsult is now on Twitter!

If you understood that article title than this might be relevant to you. Otherwise, let me clarify for the less social media-inclined.

Twitter.com is a service that allows you to tell your "followers" what you are doing, reading, liking, cringing at, in less than 140 characters.

All sorts are tweeting these days form the Queen of England to... your neighbor.

Our Twitter handle is @CardiacConsult, so meet us there to find out interesting health news and related items that may, or may not, suit your fancy. It's only about a sentence worth so how bad could it be? See you there...

Would You Want to Read What Your Doctors Write?

Of course you would. And 95% of the patients surveyed agreed with you. And even stranger, so do most physicians. At least, that's what Tom Delbanco and his colleagues asserted in a questionnaire-based study using Open Notes, a system that allows patients to review all of the notes there docs are scribing.

View the abstract here from the Annals of Internal Medicine

But how much open-ness is too much? Will the doctors be reluctant to be blatantly honest in their assessment of patients if they know it will be read? And will patients fear being completely open when they know that their chart is more visible now - even if it's just to them?

Here's a quick article from the Atlantic on the topic.

Let's hear your comments...