Your Weekly Checkup: Winter Can Be Harmful to Your Health

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.

 

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: A New Vaccine for Shingles

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. 

 

Many readers have had chickenpox as a child. I know I did. A virus called varicella-zoster triggers the itchy blisters, along with fever, fatigue, and headache, normally lasting 5-7 days. After causing chicken pox in the child, this crafty virus lies waiting in the nerve tissues of the body, ready to be reactivated for an encore as shingles in the adult. Now the stage is set for potentially more dire consequences, affecting almost one in three U.S. adults.

Shingles symptoms range in severity from trivial itching to a very painful rash with nerve damage. In its most severe form, it causes strokes, encephalitis, spinal cord damage and loss of vision. Although shingles can occur anywhere on the body such as the face or near the eye, it most often presents as a single band of blisters that follows a nerve route encircling the left or right side of the trunk. The pain can be minimal, with a bit of itching, to excruciating, requiring narcotics for relief. Shingles most commonly affects people ages 50 or older, those with compromised immune systems such as HIV/AIDS, during cancer treatment or after organ transplant.

Shingles rash
A typical shingles rash. (Preston Hunt, Wikimedia Commons)

Here’s the exciting news: The Food and Drug Administration has just approved a new vaccine called Shingrix manufactured by GlaxoSmithKline for adults ages 50 and older. The FDA’s advisory panel has recommended the Shingrix over Merck’s Zostavax. The latter has been the only shingles vaccine available for more than ten years and was recommended for people ages 60 and older. That’s the one I got several years ago. Now, the Advisory Committee on Immunization Practices is recommending people like me receive the new one, Shingrix. Zostavax was given in one dose, and had shown a 51 percent reduction in shingles and a 67 percent reduction in nerve pain. Shingrix requires two doses, and the company said clinical trials showed it to be about 98 percent effective for one year and about 85 percent over three years. A drawback, however, is that more people had adverse reactions to Shingrix than to Zostavax, including fever and muscle aches. The side effects lasted a few days and were not considered serious.

So, readers, listen to the advice from experts. I am a staunch advocate of the benefits of vaccines and this is one vaccine not to pass up. You do not want to get shingles. Get the vaccine instead. I plan to do just that as soon as it is available commercially—either late in 2017 or January of 2018. Check with your doctor about availability and appropriateness.

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:

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.