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MODERN HEALTH

By Shermakaye Bass |

In the last two decades, scientific research and tech-nology have revolutionized the medical field. Not only have treatments and medications been discovered for cardiovas-cular disease and birth defects, but preventative measures have been identified that enable would-be patients to avoid such complications alto-gether. Advanced medical technology has given us genet- ic screening tests, nuclear stress tests, Doppler blood-flow studies, and other exotie sounding developments; but, at the same time, modern liv-ing has created-or at least brought to our attention-diseases that had previously been thought obscure or nonexistent. These include eating disorders, alcohol and drug dependencies, and a current phenomenon that finas our children in worse shape than ever before.

This section examines all of the health problems just cited, and takes an in-depth look at how and why they occur, and what can be done in these modern times to check them.

“When you consider heart attacks and strokes, cardiovascular disease is the leading cause of death in the country,” says Dr. Jack W. Spitzberg, cardiologist for Presbyterian Hospital. “About 650,000 people die from it each year” Yet, it’s largely a product of lifestyle, many doctors claim, and recent studies have shown us that lowering cholesterol levels, checking high blood pressure, and staying away from cigarettes can drastically reduce our chances of becoming one of those statistics. Armed with awareness of the risk factors and some basic education about cardiovascular disease, unsuspecting sufferers can detect its early warning signs and seek medical treatment.

First, some background on various forms of heart disease. “Coronary artery disease is the most common and life-threatening,” says Dr. Jack Schwade, director of cardiology at Humana Hospital Medical City Dallas. Arteriosclerosis, a progressive condition where the arteries inner walls become narrowed by fat deposits, cholesterol, cellular waste products, and calcium, is the leading contributor to heart disease and heart attack. As the blood’s pathways become more obstructed, the arterial walls harden, prohibiting their ability to contract; in the event of total occlusion of a coronary artery (heart attack), “that part of the heart fed by the artery is killed and is irretrievable,” Schwade says. A heart attack also throws off the electrical impulse system which makes the heart beat in rhythm. “Most deaths occur within the first two hours due to a disruption of those impulses,” Spitzberg adds.

Strokes are equally dangerous occur-ences. Although the public sometimes confuses the term with heart attack, a stroke is a separate condition that involves “a cutting off of the blood supply to the brain or central nervous system,” Spitzberg explains. Or, less commonly, it can involve direct bleeding into the brain. Short-term effects may include slurred speech, glazed eyes, and temporary paralysis, and if someone has a “pure, bonafide stroke,” Spitzberg continues, permanent paralysis can result.

Some other cardiovascular complications are heart failure, uncoordinated heartbeat or arrhythmia, aneurysms, degenerative valvular disease, and hypertension (high blood pressure). The latter is the most common ’and most preventable. According to a booklet issued by Humana Hospital’s Cardiology Center, “people with hypertension are four times more likely to suffer! a stroke,” and the “wear and tear on the coronary arteries can lead to arteriosclerosis and the possibility of heart attack.” Most doctors believe that a high-sodium, high-cholesterol diet contributes to the disorder; thus, it’s crucial for high-blood pressure patients to control the problem through diet modification, medication, and medical supervision.

Heart failure “implies that the pump function of the heart has been weakened” Schwade notes, inhibiting its ability to push the blood forward. As a result, some blood backs up into the lungs and causes shortness of breath. The decrease in cardiac output leads to exhaustion and fainting among sufferers and limits their ability for physical activity. Various drugs to strengthen the heart and “diuretics to decrease the body’s excess fluids can make it easier for the heart to pump,” says Dr. James Rellas, a cardiologist affiliated with Trinity Medical Center and RHD Hospital. “People who suffer from heart failure can usually resume a normal life with the right treatment,” Spitzberg adds, “but they can’t go out and run a marathon” Heart failure is often the result of a previous heart attack and is also linked to degenerative valvular disease.

Degenerative valvular disease is a condition in which a defective valve doesn’t open or close properly, increasing the heart’s workload. It is caused by rheumatic fever, bacterial infections, congenital defects, or can be the natural result of aging, Schwade says.

“An aneurysm is an abnormal bulge in a vessel or a portion of the heart, and sometimes results from a scar from a previous heart attack,” Spitzberg says, adding that, “blood can flow into it and take energy away from the heart.” If an aneurysm bursts, it can cause severe hemor-rhaging and even prompt the collapse of the entire circulatory system. “Generally, the ones in the heart don’t rupture,” Spitzberg adds, but if an aneurysm goes unchecked, it can form blood clots and cause disturbances of the heartbeat’s rhythm.

Uncoordinated heartbeat, or arrhythmia, is when the electrical impulse system in the heart is disrupted, and the upper half of the heart is not coordinating with the beating of the lower half. That’s the definition given by Humana Hospital’s booklet “A Comprehensive Guide to Cardiac Care.” Schwade likens arrhythmia to a faulty ignition system in an automobile. “One of the most common types,” he says “is PAT-when the heart abruptly races then abruptly stops racing” PAT is not particularly dangerous unless it lasts a long time or the “racing” is extremely fast, he says. Heartblock, another type of arrhythmia, is when the impulses are slowed, Spitzberg says. “It can be serious in conjunction with a heart attack” if the heartbeat becomes so disordered that the heart gets confused, so to speak, and stops beating all together. Arrhythmia is usually treated by the implantation of a pacemaker.

Despite the seriousness of cardiovascular disease, new, improved stress tests can identify complications early on, and miracle-working medications can usually offset or alleviate them. “A nuclear stress test is now available,” says Rellas, “in which isotopes are injected into the patient to label red blood cells. We can then take pictures of the heart at rest and in motion, and this helps us identify the signs of heart disease and manage them”

Medications such as streptokinase and TPA can dissolve blood clots; inotropic agents are helpful in treating heart failure by making the heart beat harder; beta blockers and nitroglycerine can lower high blood pressure and preserve sick blood cells; and even aspirin has been proven to help prevent stroke, Schwade says.

If a person suffers a heart attack, advanced knowledge and treatments can save two out of three patients: By-pass surgery is a standard measure in which a vein from another part of the body is used as a “detour” around blocked arteries; and an even easier, newer procedure is angio-plasty. where a balloon is inserted with a catheter, then inflated to flatten the fatty material against the artery walls, unblocking the vessel. In the case of stroke, if the blocked artery lies outside the skull, it too can be surgically opened.

So there are more solutions than ever for cardiovascular disease, but “if people would do a lot of the things their mothers told them to do,” Schwade says, “they might be able to prevent the disease.” And if you have a family history of heart disease, suffer from hypertension, stress, diabetes, or obesity, it’s important to see your physician on a regular basis.

CHILDRENS HEALTH

Used to, parents had to work to get their children in the house before dark. There was always a neighborhood game of kick the can or run sheep run, and rounding up the kids was like trying to corral a herd of wild horse. Over the last 10-20 years, though, the problem has reversed. Sedentary pastimes like watching television and playing video games have become more popular among the younger set, and in many cases, working parents are simply afraid to let their kids play outside without supervision. As a result, the current generation of school-age children is in worse shape than previous generations. “I’d say there’s been as much as a 50 percent increase in obesity among children over the last decade,” says Tricia Loerwalde, wellness /fitness technician at Irving Community Hospital, which has recently instated nutrition and fitness programs for children.

“I think TV may be a major culprit,” fitness studio owner and instructor Jenny Ferguson opines. “It’s undermining physical activity. Kids are more likely to turn on a video game” than go outside and play. That may be so, says Dr. Joel Steinberg, a pediatrician in charge of the acute-care clinic at Children’s Medical Center of Dallas, but “it’s not that children are less interested in physical activity, They’re just given fewer opportunities.”

Because it’s very common for both parents to work, children are left in a “latchkey situation, where they come home from school to an empty house and are forbidden to go outside and play,” Loer-walde adds. So they spend their time inside watching MTV or playing with the computer, munching on junk-food. “And when the parents come home from work, they’re too tired to go for a walk or take a bike ride with their children,” she says. Nutritional values suffer in much the same way: Parents may feel too drained to cook a well-balanced meal, and it’s easier to grab a burger or taco at the fast-food restaurant down the street; so today’s kids -mostly due to the fact that both parents work -are getting less physical activity and eating less-balanced meals, experts say.

Another factor Steinberg feels is the “school system’s decreased requirements for physical education among students.” And the activities that are offered don’t really emphasize lifelong fitness, he says. “Team sports teach strength, speed, and agility instead of flexibility, endurance, body-fat content, and cardiovascular fitness.” The kids who are involved in school sports in addition to PE usually only participate in a single seasonal sport, Loer-walde says. “A child may play football or soccer, basketball or volleyball, but not both.”

As a result of decreasing emphasis on PE in school, the American Academy of Pediatrics has launched a campaign to encourage parents to approach their children’s schools about requiring more PE, the kind that focuses on long-term fitness. However, Loerwalde says that in the last few years, the Irving elementary schools have substituted PE activities in lieu of daily recesses. “I think the schools should only reinforce what families provide at home” Loerwalde says. “Schools can’t be responsible for our children’s well-being.”

Experts agree that widespread fear of crime might also have some bearing on kids’ lowered fitness levels. In addition to the latchkey dilemma and waning activities at school, the current awareness of child molestation and kidnapping has frightened some parents; and even if they once allowed their sons and daughters to go outside and play, the rash of child abductions and abuse has made them wary about that – particularly in urban areas, where crime rate is higher. It all adds up to “a bad situation for our kids” Loerwalde declares. “And parents have to get involved to turn it around. But there are going to have to be some major family lifestyle changes.” She and Steinberg both recommend alloting so much time a week for the family to be physically active. “I think walking or jogging, biking, tennis, swimming-aerobic activities -are the best, and these are things the whole family can do together. This would decrease the risk factors of being overweight and would improve their cardiovascular systems,” Steinberg says; he suggests the family do this at least three times a week, and each outing should consist of a minimum of 30 minutes of aerobic activity. Parents have to take the initiative, he adds, and they must stick to the routine. “Kids know that if mom and dad are on the bowling league, come league night, nothing is going to interfere with those plans,” Loerwalde says. “Well, parents need to place the same amount of significance on family activities, and stick to them no matter what.” It’s up to the mother and father to set a good example. For instance, if the father sits on the couch all weekend watching football, that’s what the boys are going to do. “My mother always exercised when I was growing up, so I started doing it when I was a teenager,” Ferguson says. “Attitudes about fitness develop at an early age, and if you start exercising early, you’re more likely to make it a part of your life.”

The same goes for nutrition, says Nancy Skodack, MSRD, director of food and nutritional services at Humana Hospital Medical City Dallas. Skodack, who recently finished a book (“Let’s Get Cooking”) geared toward educating young children about nutrition, says “food attitudes are embraced early in life, and kids cement them through observation and practice.” Skodack stresses not just drilling kids on the four basic food groups, but giving them a choice in their eating habits. “Give them guidance to reach the right decisions, because they’re going to eat what they want to for the most part. Influence them by involving them; for example, a mother might say, “This evening’s meal is chicken; I’d like to suggest baked orange chicken or. . which would you prefer?” And if the child suggests hamburgers instead, tell him you had already planned to cook chicken, but ask if he wants hamburgers another night that week.” That way you’re encouraging their involvement and creating a positive feeling about food choices, Steinberg warns against endorsing negative eating patterns by overfeeding children or pacifying them with food. “Make meals a routine where the family sits down together-without the TV on, because it distracts from how much or how little you eat” he adds.

Overall, getting our kids back in shape is going to require some creativity and perserverance on the part of parents. “Sometimes it’s going to be inconvenient,” Loerwalde says, “but it’s a question of whether or not you want your kids to grow up to be healthy, or to live with the risk of having a heart attack at age 30. This should be just as important as any of the other things we spend our time and money on.”

SUBSTANCE ABUSE

Substance abuse – alcohol and drug addiction – is one of the most controversial and enigmatic diseases being examined by the medical/psychiatric field today. A mammoth problem that costs our society an inestimable number of lives and billions of dollars each year, chemical dependency is often looked upon as a result of lack of morality rather than a product of the addict’s environment or genetic predisposition. Although the factors that breed addiction are sometimes vague and often hard to pinpoint, current statistics paint a very clear picture:

“In Texas, the number of problem drinkers needing intervention in 1987 is estimated at 1,846,066,” says Pat Langan of the Dallas Council on Alcoholism and Drug Abuse, “and the number of drug users is approximately 1,550,145. . .The number of children between ages 13 and 17 who drink alcohol is about 417,733.. . The economic cost of substance abuse statewide -which includes cost of the substance, property damage, loss of work time, related injuries, etc. -is an estimated $13 billion” . . Nationally, 70 percent of the population drink, one in seven citizens are chemical dependents, and, according to the Council, only one in 35 people will go for help and succeed in kicking their addiction.

Those figures speak volumes in terms of how devastating and wide-spread the disease really is, but they don’t reflect the underlying causes. What’s wrong with our society, our families? Why do so many people turn to substance abuse? “We’re sort of stuck in a society that emphasizes immediate pleasure,” Myra Byanka, substance abuse coordinator at Green Oaks Hospital, responds. “We’ve learned to be selfish and self-centered, and excess is a natural by-product of that.”

However, the core of addiction can only be examined on an individual basis, by looking at an abuser’s environment and family history, genetic coding, and behavioral patterns: Some of the factors are an abusive or negligent childhood; family history of alcoholism or drug abuse -“which suggests a genetic link,” says Dr. Edgar Nace, MMD, chief of services for substance abuse programs at Timber-lawn Psychiatric Hospital-“early exposure to alcohol or drugs, poor attention span, tendency to be easily frustrated, personality disorders such as antisocial behavior, passivity or aggressiveness, and narcissism.” All personality sufferers tend to be self-centered and have trouble tolerating, regulating, or recognizing their feelings, he adds. Both Nace and Jack Ew-ing, program director of St. Paul Hospital’s substance abuse program, agree that about 50 percent of chemical dependents have pre-existing psychiatric problems.

But therein lies part of the controversy over the disease. Basically, there are two schools of thought, says a faculty member of Richardson Medical Center’s substance abuse program. “Some camps focus on chemical dependency as the primary diagnosis,” the problem in and of itself, and they see the patients’ behavioral problems as a direct result. “Others look for deeper, psychological problems” that addicts are seeking to escape. “They might suffer from manic states or anxiety and try to self-medicate these physiological states,” Byanka adds.

In other words, sometimes it’s the chicken that came first, other times the egg. “I think you have to look at it from both angles,” Ewing says. “That’s why the patient’s abstinence is so important when we’re assessing him. You have to get him chemical-free to see what he’s really like. If the (behavioral) problems persist once the patient is abstinent, it’s necessary to treat him from a psychiatric standpoint as well.”

Another point of contention in the field is the biochemical issue, whether or not a person is biochemically setup for addiction. “There is no such thing as an addictive personality,” Byanka attests. There are some people “who have an abnormal reaction to the presence of drugs in the brain, and are therefore at greater risk of developing a chemical tendency,” she says. “That’s a hereditary tendency, but that doesn’t explain why a person who has the genetic coding for alcoholism might not have the desire to drink.” Or, why some-one who isn’t biochemically compelled to addiction becomes an addict.

There are many unanswered questions about who is affected and why. For instance, men are four times more likely to become alcoholics than women, Nace says, but scientists don’t know why. Women, on the other hand, comprise the bulk of prescription-drug dependents, Ewing says. Marijuana and cocaine abuse seem to be more evenly distributed among the sexes. But not just with adults. “We’ve seen an alarming rise in the number of adolescents and young adults who are abusing alcohol, cocaine, inhalants, a hybridized and stronger form of marijuana, and these very dangerous designer drugs,” says Dr. Larrie Arnold, Medical Director of Brookhaven Psychiatric Pavilion of RHD Memorial Medical Center. “The disease progresses much more rap-idly in younger people and the physical and psychological damage can be severe.”

One thing doctors do know is that addiction is a progressive illness that cannot be cured, but can only go into remission. And for those who do not succeed in kicking their habits, the long-term physical effects can include death. “Alcoholism targets the body organs-the liver, brain, pancreas, stomach, and esophagus. It is the most physically damaging and the most deadly of all drugs, Byanka says. ” Methamphetamines and cocaine aren’t as damaging to the brain as alcohol,” but abusers run the risk of suffering heart attacks, convulsions, and confusion in certain areas of the brain, which can cause a victim to stop breathing. That’s what happened to John Belushi. Though the long-term effects of marijuana are still being studied, none of (he evidence has been conclusive; the biggest known threat is to the lungs, Nace says. It can cause the same problems as cigarette smoking, but it takes less marijuana to do so: “One joint is equivalent to 15 cigarettes in terms of lung damage,” he adds.

The psychological effects can be detrimental to the abuser as well as his family; The dependent becomes irrational, erratic, paranoid, defensive, and develops disfunctional relationships. “It’s a family illness,” Dotsie Graham of Charter Hospital says. “Kids learn to drink and drug away their feelings because that’s what mom and dad did. . .Then there is the whole issue of denial. Nobody wants to admit there is a problem; it’s not acceptable and “what will the neighbors think?” But there is help, there is hope. It’s a treatable disease if the sufferer and the family educate themselves and accept the responsibilities of it. You have to act tough and follow through in order to break the cycle.”

EATING DISORDERS

It’s no secret that Americans place a certain emphasis on looking good; and they expect the people around them to look good also. A case in point: According to the University of California at Berkley, approximately 28 percent of the country’s population is on a diet at any given time, and even more alarming, 60 percent of all American women tried to lose weight last year. The cause for alarm is that many times, diets are a precursor to eating disorders: “I don’t think I know an eating disorder sufferer who didn’t start by dieting,” says Dr. Sandra Steinbach, MD, medical director at Baylor University Medical Center’s Eating Disorder Program. Anorexia nervosa, bulimia, and compulsive overeating-the three most common types – affect “as many as 5 million Americans,” notes Beth Roseland, program director of Advance, a clinic at Hughley Memorial Hospital in Fort Worth that specializes in eating disorders; all three aspects of the disease are potentially fatal.

Although the three syndromes are closely interwoven, each is characterized by specific eating patterns and psychological factors: Anorexia, singled out by Steinbach as “the most visible and life-endangering,” is the strict limitation of food intake, “a refusal to maintain normal body weight” due to an obsessive fear of getting fat, Lucy Letton, program director of the Rader Institute in McKinney, explains. “Anorectics have a severly distorted body image.” Convinced they are overweight even though the scale tells them otherwise, (hey usually lead very controlled, self-restrained lives. As the disease progresses, many sufferers cease menstruating and risk losing the ability to reproduce.

Bulimia, also referred to as bulimia nervosa or bulimarexia, can be equally dangerous but is generally less apparent than anorexia. Commonly known as binge/purge syndrome, it’s a disease whose sufferers consume large quantities of food in a short time period (Roseland says two hours is the average), then “purge” themselves in one of several ways through self-induced vomiting, laxatives diuretics, excessive exercise, strict dieting or fasting. Like anorectics, bulimics have a paradoxical fascination with food and being thin, but unlike anorectics, an unable to control their eating; once the) start, Roseland says, it’s hard for them to stop. “They binge on high-calorie foods – some with whatever they can get then hands on, like a gallon of ice cream or a jar of peanut butter. Others are more discriminating. They will go to the grocery store for their “binge food” she adds. Often a bulimic’s entire day is spent planning “what he or she is going to eat and how,” Steinbach says. “It’s a whole way of thinking.”

Compulsive overeaters exhibit many of the same traits as bulimics, but rather than purge, they may go through a series of diets or fasts trying to drop weight. “They’re non-compensatory eaters,” Steinbach adds; and it can be difficult to distinguish a compulsive overeater from someone who is obese: the former may be biologically and psychologically predisposed to the disorder, while obesity stems primarily from genetic or physiological circumstances.

Despite their differences, eating disorders often overlap. “Sufferers will go from one set of symptoms to another,” Letton says. For instance, an anorectic occasionally purges (though the binges are comparable to a normal meal), and a bulimic may go for days without eating. “It’s a spectrum in which one category blends into another,” Steinbach says. “These people abuse food as a substance.” Food, like drugs or alcohol to a chemical dependent, becomes an addiction. Other common denominators include feelings of inadequacy, low self-esteem, feelings of lack of control over one’s life, difficulty making decisions, inability to relax, and particularly among anorectics and bulimics, “clouded thinking due to deficient glucose levels, which affect their ability to function properly,” Steinbach notes.

If the symptoms seem complicated, the causes for eating disorders are even more baffling. “There is no one reason for developing the disease,” Letton says. “It affects people with a certain set of criteria.” The sufferer’s family background- whether there is a history of chemical abuse, physical or sexual abuse, an emphasis on high achievement- social pressures, genetic or biological factors, major life changes, and feeling obligated to “have it all” play key roles in an eating disorder’s development. Patients tend to come from the middle to upper class, and until recently, most were thought to be female. “We’re finding increasing numbers of men who are binge/purgers or anorectics though – as many as 10-20 percent who seek help are men,” Letton attests.

Regardless of the reasons for its development, eating disorders have serious medical repercussions, Roseland warns, and can ultimately lead to death. The list of side effects ranges from severe dental problems to constipation, gastrointestinal complications to joint deterioration, adult-onset diabetes to cardiac arrest. “Early detection and treatment is critical,” says Dr. Arnold Mech, Medical Director of the Psychiatric Services Unit at HCA Medical Center of Piano. “In just a matter of weeks, people with eating disorders can cause significant damage to themselves.” Psychologically, a victim may withdraw, become unusually secretive or depressed, or even consider suicide. The treatments are as myriad, and success depends on the patient taking the disease seriously.

Like other substance abusers, eating disorder victims have trouble admitting there is a behavioral problem. “They don’t see it as life-threatening” Letton says. Once they’ve acknowledged they need help, the process of unlearning lifelong behavior begins. It’s also necessary to treat the family, so parents don’t “get into a power struggle with the sufferer over food,” Steinbach says. “A lot of times, the family thinks it can control the eating. . . but it’s up to the patient. And he or she feels their body is the only thing in their world they can control.” Of equal importance is “teaching a victim what normal amounts of food look like, what they feel like in the stomach,” Letton says. Rose-land adds that bringing exercise into moderation is also a factor and so are unlearning compulsive behavior and gaining spiritual strength. “An individual who feels the need to keep everything in perfect order needs to know when things are out of their hands,” Roseland says. All these experts agreed that inpatient treatment or hospitalization is the most effective measure, followed by ongoing outpatient therapy -support groups like Overeaters Anonymous as well as individual therapy.

“I think it’s a treatable disease,” Steinbach concludes. “If the patient will take the treatment seriously and continue to seek help, she has a good chance of recovering. It’s like any addiction in that aspect,” but unlike other substances the food habit can never be “kicked.”

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