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Your Weekly Checkup: Preparing for Death

“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

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Now that I’ve entered the third quarter of the game of life, I’ve often wondered how long I’ll live. It’s not a thought I considered during the first half. Since 1900, the average life expectancy around the globe has more than doubled, largely due to better public health, sanitation, and food supplies, and now approaches 80 years in most developed countries. Ten years ago, the oldest human being on the planet died at age 122. But is that a likely age for the rest of us? Probably not, yet more and more people are living to become centenarians. Genetic studies are analyzing how and why that happens, and ultimately we may be able to add years to our lives.

Regardless, it’s a given that we’re all going to die sometime, and most of us are unprepared for it. My wife and I came close three months ago in Muenster, Germany, when a suicide van plowed into the outdoor café where we were enjoying an afternoon beverage. Sitting two tables away from the van’s path and the human carnage it created made me realize how precious and fragile our lives are, and how one’s fate can turn on a dime. It’s important we not leave loved ones to grapple with residua of our messy lives, even as they wrestle with their own grief at our passing.

It may not be a pleasant topic, but here are some issues to consider so that your passing is as easy as possible for those who outlive you.

Buy a burial plot or make arrangements with a funeral home for cremation.
Make sure you and your significant other have up-to-date wills. Update names to recognize divorces, remarriages, additional children, etc.
Designate a power of attorney. A will is useful only after you die, but you should designate someone to exercise your power of attorney should you become incapacitated prior to death.
Consider a trust to shield income for the care and support of elderly or special-needs family members.
Decide how you want to handle your end-of-life care by writing a health care directive to be administered by your appointed power of attorney.
Give away, sell, or trash possessions you no longer want or use. Clean house now. Don’t leave your survivors with that burden.
Make sure your loved ones, especially the designated power of attorney, have access to your passwords, accounts, safe, and important papers. You should leave instructions in the cloud as well as in hard copy.
Decide how visible and public you want your illness and death, and how you want people to be notified. Some will opt for a social stage, while others want privacy.
Talk to your loves ones about your funeral. It may be a difficult conversation, granted, but there are many details, both religious and secular, to be decided: where/what to have; who to attend; who to deliver eulogies; type of music; prayer; and so forth.

Attending to these issues will help ensure you will rest in peace — or at least your loved ones will.

Your Weekly Checkup: The Controversy Around the HPV Vaccine

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Two weeks ago I wrote about the need for vaccinations to prevent common infections with viruses such as measles, mumps and whooping cough. I didn’t have space to discuss vaccination against a highly important and more controversial infection: the human papillomavirus (HPV). More than 200 related HPV viruses exist, with about 40 having potential transmission through sexual contact.

HPV infection remains one of the most common sexually transmitted diseases in both males and females. Many infections do not cause symptoms, and nine out of ten disappear spontaneously in two years. However, HPV types 16 and 18 have been implicated in causing cancers and HPV 6 and 11 in causing warts. Worldwide, HPV infection is responsible for half a million cases of cancer and more than a quarter of a million deaths every year, with the highest incidence in developing countries lacking resources to promote prevention or provide treatment. Nearly 80 million Americans (about one in four) are infected with HPV, with over 6.2 million new cases annually. HPV causes 32,500 cancers in American men and women each year. HPV vaccination can prevent about 30,000 from ever developing.

Effective HPV vaccines have been available for almost a decade. More than one hundred countries have adopted vaccine programs for females, and many are extending the indications to include males. However, widespread adoption of vaccination remains controversial.

While state-mandated immunization programs have increased the number of children vaccinated, many state legislatures do not require universal HPV vaccination. Objections include the concern that the vaccine might encourage sexual contact at earlier ages or promote higher risk sexual practices. To me, the argument that the vaccine will prevent sexually related cancers appears far more persuasive.

The Centers for Disease Control and Prevention (CDC), together with other professional associations, recommends that children 11 or 12 years old get two shots of HPV vaccine six to twelve months apart. In general, HPV vaccine is recommended for young women through age 26, and young men through age 21. The overwhelming evidence favors administration of the vaccine to prevent the precancerous and malignant disease conditions caused by HPV infection. The risks of the vaccine are within the range of complications noted with other vaccination programs and should not prevent vaccine administration. Parents and health care workers need to be educated that the benefits of HPV vaccination far outweigh any risks.

Your Weekly Checkup: The Importance of Vaccines

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In 1796, Edward Jenner, the English country doctor often credited with saving more lives than any other person on this planet, initiated the concept of vaccination. He inoculated eight-year-old James Phipps, the son of his gardener, with pus from cowpox blisters on the hands of Sarah Nelmes, a milkmaid infected with cowpox from the udder of a cow called Blossom. Jenner then showed that the cowpox inoculation immunized Phipps against contracting smallpox.

While the adoption of vaccination remains strong in the United States, with less than 1 percent of toddlers not receiving any vaccines, trust in vaccinations appears to be declining, especially in small pockets of people living in insular communities. This puts under-vaccinated children at risk for contracting preventable diseases. The percentage of American adults who say it’s “very important” to have their children vaccinated has fallen, as has the percentage of Americans who strongly believe they have benefited from the development of vaccines over the past 50 years.

Medical quacks and charlatans with no medical knowledge disseminate misinformation to convince others that vaccines are bad or ineffective. The reality is that vaccination, along with the discovery of antibiotics, is one of the major public health success stories in the history of medicine. Despite this, the incidence of vaccine-preventable diseases such as whooping cough and measles, after falling to all-time lows, has begun to increase. This finding is troubling because vaccines work not only by inoculating individuals from contracting a disease but also by creating “herd immunity.” When more than 80% to 90% of a population is vaccinated, chains of infection are likely to be disrupted, stopping or slowing the spread of disease, which protects those few not vaccinated.

Person receiving a vaccination. (Shutterstock)

In 1998, Wakefield et al. published an article in the prestigious journal, Lancet, linking the measles, mumps, and rubella (MMR) vaccine to a new syndrome of autism and bowel disease. By the time the paper was retracted 12 years later due to flawed ethical and scientific standards, and claims of outright fraud, the damage had been done. Vaccination rates in the United Kingdom fell to 80% in 2003-2004 and are still below the level recommended to ensure herd immunity. In 2008, for the first time in 14 years, measles was declared endemic in England and Wales, with hundreds of thousands of children in the UK currently unprotected. Since 1998, multiple studies have provided strong evidence against the notion that MMR vaccination causes autism, reassuring concerned parents.

Lower rates of vaccination around the world is a primary cause of outbreaks among Americans, as under-vaccinated Americans may become infected while visiting places with weaker herd immunity and carry the virus back to the U.S. International travel also provides the opportunity for infected individuals to come in contact with susceptible Americans.

Readers, take note. Even when the vaccine is not 100% effective, as I wrote in a previous column about the flu vaccine, having some protection is better than none. Do not avoid taking advantage of this fundamental medical advance proven to save lives.

Your Weekly Checkup: Medical Device Malfunction or Degeneration

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Now that I’ve reached the ripe old age when I can leave my shoes on while traversing airport security screening, the TSA agent always asks before I enter the metal scanner, “Any device implants?” Thankfully, I am able to say no: all my body parts are still original.

According to a recent article, that’s not true for about 32 million Americans (1 in 10) who have at least one medical device implanted. Inserts range from simple items like eye lenses or birth control devices, to complex objects such as cardiac stents, pacemakers, defibrillators, and heart valves.

Creating an implant that can weather the body’s hostile internal environment over a long time period is a major challenge. Manufacturers must replicate the years of toxic impact the body exerts on an implant to be certain the device performs as it should, often for many decades. Even minor changes to a “tried and true” implant can sometimes be disastrous.

Hip implants are a case in point. Degeneration of the hip bone and joint from arthritis or injury can lead to pain, stiffness, and difficulty walking, often requiring total hip replacement. One type of implant is metal-on-metal in which the ball and socket of the device are both made of metal. Walking or running causes the metal components to rub against each other, eventually eroding the surfaces and causing tiny metal pieces to implant in the neighboring tissues. Some of the metal ions can enter the bloodstream to elevate cobalt, nickel, or chromium levels.

Patients often respond to these changes differently. Some experience no symptoms while others have an adverse reaction to the metal debris damaging the soft tissue surrounding the implant; they experience pain, loosening of the implant, and eventual device failure. The changes can impact general health, affecting nerves, heart, kidneys and thyroid. Some companies have recalled specific types of devices. The FDA states that, “All hip implants will need to be replaced eventually, and implant longevity is influenced by a patient’s age, sex, weight, diagnosis, activity level, condition of the surgery, and the type of implant.”

The purpose of this column is to call attention to implants that may not be functioning as optimally as they did after insertion. Patients experiencing new symptoms should not just “tough it out,” but should contact their health care professional promptly for evaluation. The problem may be trivial, requiring a minor adjustment, or significant, requiring device replacement.

If you are that patient, do not put off your checkup.

Your Weekly Checkup: Cybersecurity of Medical Devices

“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

Order Dr. Zipes’ new book, Damn the Naysayers: A Doctor’s Memoir.

*****

“Daniel, it’s me, John,” I said over the phone.

“Oof.” I heard him grunt in the background.

“What’s the matter?” I asked.

“This damn defibrillator. It’s shocked me five times in the last hour! Just keeps going off. I barely catch my breath when the next shock hits. I’m going crazy with it, Daniel. You’ve got to make it stop.”

“Call 911 and get to an emergency room. They’ll know what to do.” I heard a crash. “John, did you hear me?”

No answer. “John? John!”

A woman picked up the phone. “I’m John’s wife, Doctor. He just fell to the floor. He’s not moving! My God, I think he’s dead!”

*****

This excerpt from my novel, Ripples in Opperman’s Pond (iUniverse 2013), depicts a man (John) with an implanted electronic defibrillator that has been hacked to deliver repeated shocks to his heart that eventually kill him.

Is this fiction that tells the truth? Can this happen in real life? Could malicious hackers inflict damage or disruption of normal implanted device operation by taking advantage of wireless software communication between health care providers and patients’ devices to jeopardize patients’ health or even kill them?

Along with cyber-attacks of companies and countries, cybersecurity of implanted medical devices such as drug infusion pumps, electronic monitors, pacemakers, and defibrillators has been under recent scrutiny. A report by Muddy Waters Research claimed that electronic medical devices manufactured by St. Jude Medical (now Abbott, St. Paul, MN) were at high risk for device hacking that could lead to rapid pacing and battery depletion. However, researchers attempting to reproduce the Muddy Waters’ claim failed to generate any clinical harm or affect essential device function.

Abbott has provided information on a firmware fix with enhanced cybersecurity for those wishing to pursue it. However, the reality is that no clinical reports of such hacking have been published, and most experts consider the theoretical risk of a cybersecurity breach of an individual patient’s device to be less than the actual risk of the firmware update. While most patients, after considering risks and benefits, reacted conservatively to the news of a potential device risk and decided not to undergo the fix, several thousand patients offered the firmware upgrade opted for it, and underwent reprogramming, generally without problems.

It is important to stress that the cybersecurity risks to health care are not restricted to Abbott, or to implanted medical devices. The risks exist for any healthcare system connected to the Internet, more so for large facilities such as hospitals than for individual patients. Hospitals are prime targets, especially since personal health information can be worth millions of dollars. A cyberattack can disrupt an entire hospital system, compromise medical records and put patients at risk. Many pieces of medical equipment have computing and other needs requiring Internet connectivity that can make them vulnerable to attack. Constant security surveillance is critical. As a case-in-point, recall the 2017 global cyberattack with the WannaCry virus that crippled the UK’s National Health Service and FedEX, and infected more than 300,000 computers in 150 countries. It was dubbed “the biggest ransomware outbreak in history.”

Hacking of individual medical devices may just be a thing of novels. So, those of you with pumps, pacemakers and defibrillators can relax — at least for now. But in the future…?

Your Weekly Checkup: The Coffee-Cancer Connection

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In last week’s column I discussed the potential beneficial effects of coffee and caffeine on the heart. After reading the column my editor rightly asked, “Wait a minute. What about cancer?” He called my attention to the preliminary ruling of a Los Angeles Superior Court judge that coffee purveyors must warn consumers about a potential cancer risk. According to California’s Safe Drinking Water and Toxic Enforcement Act of 1986, also known as Proposition 65, businesses with more than 10 employees must warn consumers if their products contain one of many chemicals that the state has ruled as carcinogenic. One such chemical is acrylamide, which causes cancer in rats given high doses not comparable to anything we ingest.

Acrylamide is created almost anytime we cook starches at temperatures above 250 degrees Fahrenheit, whether it is toasted bread, French fries, breakfast cereals, snack foods like potato chips, cookies, pretzels, and crackers, or roasted coffee beans. It is found in about 40 percent of the calories consumed by Americans. There appears to be no way to roast coffee beans without producing some acrylamide.

The website of the American Cancer Society reports that “there are currently no cancer types for which there is clearly an increased risk related to acrylamide intake.” The International Agency for Research on Cancer calls it a “probable human carcinogen,” based primarily on animal research, but then hedged, saying “drinking coffee was not classifiable as to its carcinogenicity to humans.” Most studies show that drinking coffee actually may lower the risk of several types of cancer, including head and neck, colorectal, breast, endometrial, and liver, or exert a neutral effect.

Based on the available evidence I have seen, I would conclude that the potential health benefits from drinking coffee outweigh the cancer risks, which are unclear, but do not seem substantial, if they exist at all. If you are worried about whether your lifestyle increases your risk of cancer, I would suggest the five greatest choices you can make to reduce that risk and live longer: stop smoking (cigarette smoke contains acrylamide), limit alcohol intake, maintain a healthy weight and diet, and exercise. If acrylamide exposure is of concern, cut back on the snack foods rather than coffee.

Your Weekly Checkup: Are Electronic Cigarettes Safer?

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Electronic cigarettes, invented and patented only 15 years ago, have surged to prominence with predicted sales in the billions of dollars. They are designed to deliver nicotine as an aerosol that simulates smoking without real smoke. E-cigs consist of a mouthpiece, a liquid-filled cartridge containing concentrated flavors and variable amounts of nicotine, an aerosolizing component, and a battery-powered heater that converts the liquid into vapor mimicking cigarette smoke. Used cartridges can be replaced or refilled and are good for about 150–300 puffs, compared to 10–15 puffs in a single conventional cigarette.

Whether e-cigs reduce the number of cigarette smokers — currently about 37 million Americans — or create more smokers than quitters is controversial. E-cig smokers may be merely substituting one form of nicotine addiction for another. A study that just published found that participants using e-cigarettes were less likely to quit smoking after six months compared with those who did not use e-cigarettes.

Manufacturers have claimed e-cigs are safer than traditional cigarettes because they do not burn tobacco or expose users to the known toxic chemicals in tobacco smoke, which is the component primarily responsible for tobacco-attributable harm. However, the FDA has prohibited manufacturers from marketing that statement, reporting that e-cigarette cartridges and solutions contain nitrosamines, diethylene glycol, and other contaminants potentially harmful to humans [PDF]. A recent study found many of the volatile organic compounds identified in e-cigs to be carcinogenic. Significant levels of highly toxic arsenic, chromium, manganese, nickel, and lead have also been found.

In January 2018, an expert committee of the National Academies of Sciences, Engineering, and Medicine concluded, “There is no available evidence whether or not e-cigarette use is associated with clinical cardiovascular outcomes (coronary heart disease, stroke, and peripheral artery disease) and subclinical atherosclerosis (carotid intima media-thickness and coronary artery calcification).” They did note that heart rate increased after e-cig nicotine exposure, while a recent report found that blood pressure also rose acutely after e-cig exposure.

My conclusion at the present time is that vaping may be safer than traditional smoking, but we need more studies to be sure. Nicotine is addicting, whether in an e-cig or conventional cigarette. The safest recourse is not to smoke. Period!

Your Weekly Checkup: Smoking Is Even Worse for You Than You Thought

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I smoked cigarettes for about two years during college and medical school (1960-62) but quit after I attended the autopsy of a smoker who died from cancer of the lung. It was gruesome. I smoked a pipe for another 4 or 5 years and then quit, smoking nothing for the last 50+ years.

A recent study has confirmed the wisdom of stopping smoking. This National Longitudinal Mortality Study (NLMS) followed 357,420 participants from 1985 to 2011. It showed that cigar, pipe, and cigarette use significantly elevated the risk of tobacco-related cancer mortality, as well mortality from most other examined causes of death. Mortality was higher even among nondaily current cigarette users. While increased mortality from cigarette smoking is well known, NLMS established that cigar and pipe smokers were also vulnerable, though the mortality risks for daily pipe and cigar smokers were lower than for daily cigarette smokers.

Sadly, use of combustible tobacco products, including cigars, pipes, and cigarettes, continues to represent the leading cause of preventable deaths in the United States. Most smokers become addicted during their youth. In 2014, the Surgeon General estimated that cigarette smoking caused approximately 480,000 deaths annually.

The Food and Drug Administration, recognizing the addicting power of nicotine, hopes to reduce the number of U.S. smoking deaths by proposing a limit of 0.4 milligrams of nicotine per gram of tobacco, about a 97 percent reduction from present levels. Using simulation models, experts estimated this would cause approximately 5 million smokers to quit in the year after policy implementation. That number would increase to 13 million within five years and would continue to grow because of sustained increases in cessation and decreases in smoking initiation. Unpredictable consequences include whether smokers would smoke more to compensate for the loss of nicotine, would seek other sources of nicotine, and whether black market high-nicotine cigarettes would appear.

The take home message is obvious: quit smoking, whether it is a cigarette, cigar, or pipe. It may be the toughest battle you’ll ever fight, but the rewards are well worth it. And don’t resort to e-cigarettes. More about them next week.

Your Weekly Checkup: Learning from Nature to Reduce Cholesterol

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Nature has much to teach us if we are smart enough to listen.

For example, in 1928 an English doctor named Alexander Fleming returned to his messy hospital lab after a long vacation. He noted that a mold growing in the dish containing Staphylococcus bacteria had inhibited growth of the bacteria. The name of the mold? Penicillium. Louis Pasteur said, “Fortune favors the prepared mind.” Fleming’s mind was prepared and nature led him to the birth of antibiotics, revolutionizing the treatment of infections.

In modern times, statin drugs that reduce cholesterol, especially the “bad” LDL cholesterol, have revolutionized treatment of atherosclerosis, the fatty cholesterol build up in arteries that leads to heart attacks and strokes. But what if the cholesterol buildup is so great, it overpowers the statin effect? Are there other choices?

Yes, because nature opened another door likely to precipitate another revolution.

In 2005, a study found that a specific group of African Americans had very low cholesterol levels and virtually no heart disease. Researchers sought the reason and established that these people were born with a specific gene that was underperforming and was responsible for their low cholesterol. Scientists set about creating a drug that could block that gene, to reproduce nature’s experiment.

They created a new medicine, evolocumab, that opposed the gene’s function. In a recent study of over 27,000 individuals with preexisting atherosclerotic cardiovascular disease, almost all of whom were already taking a statin, those treated with evolocumab had a major drop in cholesterol—particularly the bad LDL cholesterol—to low levels never seen before, with a significant reduction in heart attacks and strokes. The downside is that the medicine is expensive and must be administered by injection. Nevertheless, nature has opened the door to an approach potentially more powerful than statins in preventing heart attacks and strokes.

Your Weekly Checkup: Don’t Sabotage Your Health with Ultra-processed Foods

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As I ate my cereal for breakfast this morning, I read the ingredients listed on the box. In addition to the usual alphabet of vitamins, the cereal contained phosphorus, zinc, iron, magnesium, syrup, sugar, fats, and a variety of oils, salt, glycerin, molasses, soy, lecithin, corn starch…and the list went on. Can all these be good for me, I wondered?

According to a recent article in the British Medical Journal, ultra-processed foods packed with artificial flavors, additives, or emulsifiers typically contain more calories, sugar, fats, and salt than non-processed foods. People relying on such a diet tend to be more overweight and more likely to have cardiovascular problems or diabetes. A study in 2016 found that 50-60% of the calories in the average American, Canadian, and United Kingdom diets come from this kind of food, and more of the developing world is beginning to eat this way.

Several studies have also found a link between processed foods and cancer. Eating lots of processed meat like hot dogs is associated with an increased risk of bowel cancer. French researchers, analyzing 24-hour dietary records of nearly 105,000 adults in the NutriNet-Santé study, an ongoing web-based cohort launched in 2009, found that a 10% increase in the proportion of ultra-processed fats and sauces, sugary products, and drinks was associated with an increased risk for overall cancer, and ultra-processed sugary products were associated with an increased risk of breast cancer.

What might be the cause of a cancer relationship? Ultra-processed foods can contain contaminants with cancer-causing properties such as those found in heat treated processed foods. In addition, food packaging may contain carcinogenic materials that come in contact with the foods. Some food additives such as sodium nitrite in processed meat may be carcinogenic.

Importantly, food experts caution against strict interpretation of these results because of many confounding factors such as the lifestyle of those who eat these products: they may be more likely to smoke, not get enough exercise, and not eat healthy foods that might reduce risks of cancer.

What is the best advice? Eat a balanced and diversified diet containing real foods such as fresh, dried, ground, chilled, frozen, pasteurized, or fermented foods like fruits, vegetables, rice, pasta, eggs, meat, fish, or milk. Resist—as much as possible—mass produced packaged breads and buns; sweet packaged snacks, confectionery and desserts; and sodas and sweetened drinks. Avoid reconstituted meat products with added preservatives found in some meats, poultry, and fish nuggets. Instant noodles and soups, frozen or shelf stable ready meals, and other food products made mostly or entirely from sugar, oils and fats, modified starches, and protein isolates are probably not good, either. They often contain flavoring agents, colors, emulsifiers, humectants, non-sugar sweeteners, and other additives to disguise undesirable qualities of the final product.

If your conscience tweaks you after sneaking that jelly donut or a side of bacon with those eggs, remember what I’ve said before: moderation in all things, including moderation.

Your Weekly Checkup: The Raw Water Fad

While we rafted down the Snake River in the U.S. Rocky Mountains on a family vacation many years ago, our guide encouraged us to taste the sparkling clear mountain stream water. We did, and it was wonderful—until we got home. That’s when my wife, three children, and I began to experience abdominal cramps and diarrhea. The diagnosis, later confirmed by the hospital lab, was obvious: giardiasis, an intestinal infection caused by giardia, a protozoan parasite found in food or water contaminated by feces from infected animals. Treatment with an antibiotic cured us, but not before we had each lost five to ten pounds.

Drinking unfiltered, untreated “raw water” has become the rage in many places, particularly on the west coast. Proponents claim unprocessed water has healthy and natural minerals normally removed from treated or filtered water, and eliminates contamination from chemicals found in tap water, such as fluoride or lead leached from old pipes. They ignore the fact that raw water can still contain pesticides and a plethora of bacteria—giardia being just one—from animal excreta. That hasn’t stopped companies from bottling and selling 2.5 gallon bottles of “natural spring water” for thirty-five dollars and more.

Drinking “natural” water is risky. Millions of people living in developing countries would love to have our access to water treated to remove bacteria, parasites, pesticides, and other contaminants, instead of being exposed to water-borne diseases such as cholera, which is still a global threat.

It’s important to stress that everything “natural” is not necessarily good for you: poison ivy is natural; a bee sting is natural; and so is a snake bite. And everything “processed” is not necessarily bad. Fluoride in the drinking water is considered one of the top ten health achievements of the past century because of its ability to prevent tooth decay. I wish it had been in my drinking water when I was growing up; I could have avoided the five or six cavity fillings at each dental visit!

Why people shun advances known to improve health, under the mistaken belief that “the old ways were best,” is one of life’s mysteries. This brings to mind the anti-vaccination movement I touched on in a past article on the shingles vaccine. While many alternative approaches to health care can be beneficial and complementary to “usual” medicine, one must be wary of bogus claims and an attitude of “don’t confuse me with facts.”

It is true that we suffer from an aging and crumbling infrastructure, and that many locations still use lead pipes, tragically exemplified in Flint, Michigan. However, the challenge is to fix the system, not to add more risk by drinking unprocessed water. My advice: Don’t do it.

Your Weekly Checkup: My New Year’s Resolution — Exercise!

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

“Whenever I get the urge to exercise, I lie down until the feeling passes.” This quote, repeated often, is attributed to Paul Terry, founder of the Terrytoons animation studio. The precise source is less important than the thrust of the message: although said in jest, its impact is harmful to your health!

Despite the fact that study after study has validated the benefits of exercise, many Americans still sit all day at work, watch TV at night, and drive short distances instead of biking or walking. They do not realize that even mild exercise such as walking slowly or performing household chores like vacuuming, washing windows, or folding laundry can be beneficial. Two recent studies, one from Harvard investigators and the other from the Karolinska Institute in Stockholm, examined the exercise patterns of a large number of people, and found that the most active folks reduced their mortality by 50 to 70 percent compared with the least active, sedentary participants.

One of the most exciting recent discoveries about the benefits of exercise comes from the Liverpool John Moores University in the United Kingdom. They found that a single exercise session can offer immediate protection to the heart through a mechanism called “ischemic preconditioning.” Exposing the heart repeatedly to short episodes of inadequate blood supply (ischemia), such as might occur during strenuous exercise, protects the heart to resist a longer, more serious episode of ischemia. The investigators found that a single vigorous workout provided cardioprotection lasting 2-3 hours, while repeated exercise sessions weekly yielded even greater and longer protection. The benefits of exercise can help mitigate the negative impact of other risk factors such as diabetes, obesity, and high blood pressure.

What should you do for 2018?

Pick an activity you enjoy and are likely to continue: dancing, bowling, golf, walking the dog, or playing with your children or grandchildren.
Start small: maybe 10 minutes initially, and gradually increase the duration and intensity over time.
Exercise with friends: If you need motivation, plan to exercise with friends at a fixed time, four or five days a week. Knowing your colleagues are waiting is more likely to keep you in the game.
Write it down: maintain a diary that details what you do, and your response to it. Finding that you can exercise longer with greater ease is a superb incentive to continue to even greater heights.

Exercising enables you to take control of your own health and well-being, reduce stress, maintain mental acuity and productivity, and decrease the risk of heart disease and some forms of cancer. Make it your number one New Year’s resolution!

Your Weekly Checkup: The Four-Legged Prescription to Combat Loneliness

You might think living in a time of widespread social media such as Facebook, Twitter, Instagram, and LinkedIn would dispel feelings of loneliness and relegate isolation to a thing of the past. Not so, particularly in the elderly. In Britain and the United States, about one third of people older than 65 live alone, and in the United States, half of those older than 85 live alone. Studies in both countries show that 10 to 46 percent of people older than 60 are lonely. England offers a telephone hot line, The Silver Line Helpline, that receives about 10,000 calls weekly from older folks seeking contact with other people. The Brits view loneliness as a serious public health issue deserving national attention.

Why is loneliness important? Loneliness is an aversive signal much like thirst, hunger or pain. In fact, it can now be quantified and studied on a cellular level. Neuroscientists at the Massachusetts Institute of Technology identified a region of the brain called the dorsal raphe nucleus that they believe generates feelings of loneliness, and is also associated with depression. Increasing evidence links loneliness to physical illness, functional and cognitive decline and is a risk factor for early death.

What can lonely folks do to combat these feelings? Pets, especially dogs, provide companionship that reduces loneliness, anxiety, and feelings of depression. Owning a dog can foster interaction with other people, stimulate activity (e.g., walking the dog), and lead to improved mental and physical health. Almost half of American households own at least one dog. Dog owners are more likely to exercise, have a better cholesterol profile, have lower blood pressure, be less vulnerable to the physical effects of stress, and be more likely to survive a heart attack. Pet owners, especially single person households, reduce their chances of dying from heart disease by as much as 30 percent. Just owning a dog is no substitute for regular physical activity, eating a heart-healthy diet, stopping smoking, and getting regular medical care. That said, dogs seem to be good for your heart in many ways.

Frankie, my 8 ½-year-old Doberman, named after the female protagonist in my first novel, The Black Widows, recently passed away, but brought me much joy. She and I walked many happy miles together. It’s now time for me to find her replacement. For those of you who are alone and lonely, I encourage you to do the same. Select a breed that fits your needs. Your dog may not only become your best friend, but also save your life.

Your Weekly Checkup: How Much Water Should I Drink?

We’ve all heard the admonition, “Drink eight 8-ounce glasses of water each day for optimal health,” with a further warning that it must be water — not coffee, carbonated beverages, or other fluid sources. That amount equals two quarts or half a gallon of water daily. It’s hard to trace the source of the advice, or to find credible scientific evidence to support it. How are we even to know to whom this caveat applies — sedentary older folks or normally active people working in offices and exercising several hours each week? Young or old? People living in temperate or hot climates? Healthy or sick individuals? Athletes or couch potatoes? Nevertheless, it is common to see people in every category lugging around bottles of water, sipping and slurping throughout the day as they engage in their normal activities.

That’s a lot of liquid. For what reason? Because our bodies are about 60% water, supporters claim a wide range of health benefits from drinking such large quantities of water: reductions in cancer, heart disease, constipation, fatigue, arthritis, angina, migraine, hypertension, asthma, dry cough, dry skin, acne, nosebleed, and depression; improved mental alertness and weight loss. But solid proof is lacking for most of these.

Can there be harm from drinking so much water? Probably not, except for infrequent cases of causing a low sodium concentration in the blood, ingesting pollutants in the water, or maybe a guilty conscience for non-achievers.

So, how much water is enough? It depends…

Some situations require additional fluid intake:

athletics
illnesses causing fever, vomiting or diarrhea
living in a hot, dry environment
high altitudes
long plane flights
kidney stones
pregnancy or breast feeding

For the rest of us, if you rarely feel thirsty, and your urine color is normally pale yellow, you’re probably getting enough fluid. The fluid can come in any form: tap or bottled water, coffee, tea, soft drinks, milk, juices, beer (in moderation), and even in foods such as watermelon and spinach.

What advice is reasonable for healthy adults living in a temperate climate, performing mild exercise? Listen to your body! If you’re thirsty, drink. Advocates like to advance the dire threat that feeling thirsty means you’re already dehydrated. However, that alarm lacks credibility since feeling thirsty precedes actual dehydration, so there’s time to prevent it. If you’re not thirsty, there’s no need to drink, unless you fit one of the special categories mentioned above. We have enough worries in life without adding one more!

Your Weekly Checkup: Winter Can Be Harmful to Your Health

We’ve all read that dreaded headline: “Massive heart attack kills man while shoveling snow.” Is it true? Does winter increase the risks for having a heart attack, or could the sudden stress of physical activity in a couch potato be the cause? A recent study from Sweden of more than 280,000 patients suggests that cold air temperature can trigger a heart attack. The investigators found that the number of heart attacks per day was significantly higher during subzero Celsius temperatures compared to when it was warmer.

But winter brings many changes in addition to temperature. The hours of sunlight diminish, which can affect a variety of body functions including mood, body temperature, sleep/wake cycles, and secretion of hormones such as serum cortisol and melatonin. For example, seasonal affective disorder (SAD) is a well-established condition characterized by depression during the winter months, and is treated by exposing patients to a light therapy box emitting 10,000 lux of light each morning to simulate an earlier sunrise. Blood pressure is higher during the winter, as is cholesterol, upper respiratory infections, and the flu. Stroke mortality peaks in January, with a trough in September.

Interestingly, mortality is higher during the winter even in Los Angeles, where the winter temperatures remain mild. A study of over 220,000 deaths from Los Angeles County almost 20 years ago showed that the mean number of deaths was a third higher in December and January than between June and September. An increase in deaths peaked around the holiday season and then fell, raising the question of whether the stress of overeating or drinking during the holiday season, or perhaps sitting down to a turkey dinner with that disagreeable relative, might be a cause. Holiday hedonism is not the likely cause, because in Australia and New Zealand, the same winter influences on mortality occur during their winter months of June through August. In addition, sudden death also peaks in infants during the winter.

So, what can we conclude? Heart attacks, sudden death, and total mortality all increase during winter months, impacted by cold temperatures and other influences as well, such as shorter hours of daylight. My advice is to keep warm and continue your usual activities, diet, and medications. But be alert and check with your physician if you become aware of any new symptoms indicative of a change in health status. And stay happy! It’s good for your health!

Your Weekly Checkup: How Well Do Your Medications Mix?

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.
—William Osler

We live in an era of polypharmacy. Many people, particularly the elderly, ingest five or more drugs daily for a multitude of common problems such as high blood pressure, arthritis pain, depression, diabetes, and so on. Most of these drugs, when prescribed and carefully monitored by a physician, help relieve symptoms, and some are even lifesaving. However, unintended consequences can cause important side effects.

The greatest risk factor for adverse drug-related events is the number of drugs prescribed. For example, the risk of an adverse drug effect is 50 to 60 percent if four drugs are taken chronically, and almost 100 percent with eight or nine drugs.

It is critical that patients review their entire drug list, including dietary supplements, at each visit with their physician or pharmacist. Often, a physician’s role is to educate patients about what drugs not to take, and to de-prescribe drugs rather than add more. A general recommendation for the patient is to take a drug for the shortest time possible and at the lowest effective dose.

Here are a few common drugs and their side effects to watch for:

Proton pump inhibitors (for example, Prilosec): loss of electrolytes such as potassium, magnesium, calcium; bone loss and fractures; perhaps dementia and kidney disease
Statins (for example, Lipitor): muscle pain; type 2 diabetes
Hypnotics (for example, Ambien): delirium, falls, bone fractures, and motor vehicle crashes
Selective serotonin reuptake inhibitors (for example, Prozac): falls, loss of sodium
Fluoroquinolone antibiotics (for example, Cipro): Achilles tendon rupture
Sulfamethoxazole/trimethoprim antibiotic (for example, Bactrim): elevated potassium
Opioids (for example, OxyContin): addiction, constipation, nausea, dizziness, somnolence

Drug-drug interactions are of significant concern. Alcohol, statins, warfarin, calcium channel blockers, and many additional drugs can affect the metabolism and/or action of other drugs, which can increase or decrease the drug’s effects. The presence of medical issues such as obesity, kidney, liver or heart disease can impact a drug’s action. When in doubt, check with your physician, and never start or stop a drug without his or her knowledge.