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Atherosclerosis: the Silent but Deadly Stalker

The deadliest enemies tend to be the most quiet and stealthy.  They don’t announce themselves or make a lot of noise as they stalk us.  When they finally strike, it’s often too late to deal with them effectively.

That’s so true of the most deadly killer of all, atherosclerosis.  Don’t let the long name fool you into thinking he’s some obscure medical geek that you’ll probably never meet.  He is the killer of about 1/3 of adults and he substantially attacks over half of adults.  He is the usual root cause of the number one cause of death, heart disease, and the number five cause of death, stroke, besides leading to massive numbers of non-fatal but crippling attacks on nearly every organ system in the body.

So let me introduce you to him so that you’ll know him.  Atherosclerosis is the name for the process of damaging plaque-formation on the inner walls of your arteries.  Eventually that plaque can block off vital circulation to your:

  • heart, causing a heart attack
  • brain, causing a stroke
  • kidneys, causing kidney failure
  • limbs, causing peripheral artery disease which sometimes leads to amputations

Atherosclerosis starts stalking us much sooner than you might think.  Fatty streaks are already found on the inner arterial walls of many teens, especially those with some of the known risk factors for atherosclerosis.  Those risk factors, for adults as well as teens, include:

  • smoking
  • diabetes
  • elevated lipids (cholesterol and triglycerides)
  • high blood pressure
  • lack of exercise
  • obesity
  • stress
  • family history of heart disease or stroke

So how do we know if he’s stalking us?  One way to at least suspect him is by knowing how many of the above risk factors we have.  Also, if we’re having symptoms such as chest pain, we can have a stress test or other testing of the heart.  Of course we would really like to know what’s happening before symptoms show up.  Nowadays there are more aggressive, yet non-invasive ways to look into this.  And they are quite affordable.  So besides just getting cholesterol and diabetes panels, we can get:

  • an inflammation panel from a heart lab that indicate if there is plaque-generating inflammation inside our arteries
  • simple imaging such as a coronary calcium score which shows whether we have calcified plaque around the arteries of our heart
  • a sophisticated but affordable ultrasound (called CIMT) which looks at the walls of our carotid arteries in the neck. This generates an artery age and indicates whether there is active inflammation or plaque that would suggest a greater risk for stroke or heart attack.

So, yes, atherosclerosis is a generally silent stalker killing more people than cancer or any other scarier-sounding killer.  But there are ways to flush him out into the open.  Even better, there are then ways to disarm him before he strikes.  If you haven’t taken a good look around for him, get with your doctor soon and do some serious exploring.

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Thankful

So, how are you feeling, Bobby?”

Well, really I feel pretty great… certainly better than I deserve!

As a physician, I don’t get that answer a whole lot.  Most of my time is spent either tracking down what’s causing someone to feel poorly, or at least trying to correct unhealthy pathways that are leading toward sickness.  But having some sense of the countless things that can potentially go wrong with the human body does give me an appreciation for what an amazing apparatus it is and how much is going right at any given time.

A sentence in the New Testament of the Bible says, “Every good thing given and every perfect gift is from above, coming down from the Father of lights….”  The human body is one of those remarkable good gifts, and this time of year is a good time to stop a moment and be amazed and thankful for it.

Consider just a few of its stunning qualities:

  • There are 2.5 trillion red blood cells in your body at any moment. To maintain this number, about two and a half million new ones need to be produced every second by your bone marrow.
  • Overall, 25 million new cells are being produced by your body each second
  • As you read this article, nerve impulses are traveling to and from your brain as fast as 170 miles per hour
  • You have 60,000 miles of blood vessels tucked inside of you. End to end they could go around the earth twice and have 10,000 miles to spare.
  • The acid in your stomach is strong enough to dissolve razorblades.
  • Fortunately, you get a new stomach lining every three to four days to keep you protected from that harsh acid bath.
  • The surface area of a human lung is equal to a tennis court, allowing for plenty of surface area for oxygen to be absorbed into the blood stream.
  • So far researchers have counted over 500 different liver functions.
  • Your nose can remember 50,000 different scents and many are strongly tied to memories.
  • Even earwax production is necessary for good ear health. It’s actually a very important part of your ear’s defense system protecting the delicate inner ear from bacteria, fungus, dirt, insects and dehydration.
  • Tears and mucus contain an enzyme (lysozyme) that breaks down the cell wall of many bacteria. And so the mucus that lines your nose and throat, as well as the tears that wet your eyes are helping to prevent bacteria from infecting those areas and making you sick.
  • In one day, your heart beats 100,000 times; about 3 billion beats in a typical life time.
  • The ear has over 25,000 tiny hair cells to help us hear each and every sound
  • As you look around, your brain is almost effortlessly translating the 2-dimensional light patterns hitting the back of your eye into a full color 3-dimensional world for you to enjoy and interact with.
  • It takes 17 muscles to smile and 43 to frown; give your face the easier job today.

We have been created with an amazing servant, our body.  As we approach this Thanksgiving I hope you’ll take a moment to be thankful for this amazing gift, to steward it well,  and to use it to serve your Creator and your fellow creatures.

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Hypothyroidism

Well I know I’m tired, but we do have three young children in diapers and I’m not sleeping well.  It’s probably just normal exhaustion.”

My wife’s explanation certainly made sense, but it was so easy to check a thyroid level that we went ahead anyways.  And low and behold, it showed that besides her “normal exhaustion” she was also hypothyroid (having an underactive thyroid gland).  Once this was treated at least some of her exhaustion eased up.  The rest had to wait until our kids (eventually seven of them) were all sleeping through the night.

So how does hypothyroidism usually show up?  It has many symptoms, most of which are very non-specific.  They include fatigue, dry skin, cold intolerance, constipation, weight gain, hair loss, depression, and menstrual disturbances.

And what causes it?  Worldwide iodine deficiency remains the foremost cause of hypothyroidism.  But in the U.S. where iodine intake is adequate, autoimmune thyroid disease (also called Hashimoto’s disease), is the most common cause of hypothyroidism.  In Hashimoto’s disease one’s own immune system is slowly attacking and knocking out their thyroid gland.

Hashimoto’s disease sometimes also shows up with temporary throat pain, full-out exhaustion or painless thyroid enlargement.  If left untreated long enough (rare in the U.S.), hypothyroidism can eventually lead to myxedema coma where a person exhibits marked fluid retention, slowed mental status and even heart failure.

If you’re one of the legions of folks who are fatigued and perhaps struggling with weight gain, the odds are it won’t turn out to be hypothyroidism.  But then again, it’s easy to check and if it really is hypothyroidism then you have something you can readily treat and improve.  The most commonly recommended blood test is called thyroid stimulating hormone (TSH).  If your thyroid is going low, the TSH will go the other way and be abnormally high.  If that turns out to be the case, thyroid hormone levels and thyroid antibody levels can also be checked to define the type of hypothyroidism.

About the only type of hypothyroidism to still have a normal TSH is something called euthyroid sick syndrome or nonthyroid illness.  In other words, if a person has some other severe illness their thyroid may partially shut down until they begin to recover.  There is some controversy as to how to treat these cases but the main approach is to treat the underlying severe illness which then allows the thyroid to recover on its own.

For being such a small gland, perched like a plump butterfly at the base of the front of the neck, the thyroid exerts an amazing amount of control on the rest of the body.  So if you’re getting symptoms suggesting that your chubby butterfly is getting sluggish, get a blood test.  It’s easy and it may allow you to only have to wrestle with “normal exhaustion.”

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Risky Behaviors

Why do you have a question about wearing seat belts?  You’re a doctor not a policeman.”  This adolescent was expressing a rather common question among both youth and adults.  But the reality is the answer to that question, especially among youth, may have more impact on their health than almost anything else we will talk about in their visit.

What do adolescents and young adults (say age 10-24) die from in the U.S.?  Only 5% die from heart disease and other congenital diseases.  Seventeen percent die from a mix of causes such as infections and various uncommon maladies.  The three other causes that make up all the rest are suicide (11%), homicide (13%), and unintentional injury (accidents) at a whopping 48%.  Obviously the fact that suicide and homicide make up nearly a quarter of the deaths of youth is heart-breaking.  But today we want to focus in a little more on the nearly half of deaths in youth which are caused by accidents.

Out of these accidental deaths, almost ¾ of these are from motor vehicle accidents, and a substantial percentage of these involve alcohol.  Another 7% of accidental deaths in youth occur from unintentional poisoning, 5% from drowning, 3% from other recreational vehicle crashes, and 2% from firearms accidents.

Just to name one other example of accidental injury, over 25,000 traumatic brain injuries needing emergency room treatment occur in youth from bicycle accidents every year, usually in youth not wearing a helmet.

What about other behaviors that may cause disease or other unwanted outcomes?  Although 15-24 year olds make up only about a quarter of sexually-active individuals, they incur almost half of the sexually-transmitted infections, including 17% of the new HIV infections.  Also, three quarter of a million teens become pregnant each year, although the numbers are trending down a bit.

Substance abuse shows some slight drop in alcohol and tobacco use, but other substances such as marijuana, meth, and prescription drug abuse are not falling off or are increasing.

Finally, over the last 20 years, the US has experienced an obesity epidemic. In 1991, only four states reported an obesity prevalence rate over 15%, and no states reported rates above 20%.  In 2009, every state except for Colorado reported an obesity prevalence rate at or above 20%, with 9 states exceeding 30%, including Tennessee.  Between 1980 and 2008, obesity among adolescents shot up from 5% to 18%.

So, life happens, and we certainly can’t control it all… but our choices bring consequences, some sooner and some later, some good and some not so much.  High tech medicine can certainly bring life-extending treatments for many maladies.  But, for adults, and even more-so for youth, a few consistent good choices may make a world of difference – choices such as:

  • Buckling your seat belt every time you drive or ride in a car.
  • Not driving when you’re impaired or buzzed nor riding with someone else who is.
  • If you’re on a bike, motorcycle, snowboard, 4-wheeler or similar fast-moving objects and you have a brain, protect it with a helmet.
  • Skip the unhealthy, addicting substances that will wreck your life, health, and freedom in the long run, even if they’re advertised as making you feel cool and in in the short run.
  • Save yourself sexually for the person you’ve committed to be with for a lifetime
  • Skip the sugary drinks and refined carbs (starches) and go easy on the portions
  • Stay physically active and limit your screen time (phones, computers, t.v.)

No doubt these sound old-fashioned, but they can impact your life and health more than the most expensive, high-tech treatments.  So, it can be a corny cliché from grade B movies, but somehow in real life it still has some remarkable power:  “Make good choices… and keep on making them; they make a difference.”

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