When Less Is More - Health For Life

When Less Is More

A cardiologist says exercise and diet??"not EKGs and angioplasties??"are the way to keep hearts healthy
Allan Penn for Newsweek
Thomas Lee: Control your risk factors

Newsweek

Dec. 6 issue - As part of our Health for Life series, we give you the chance to ask a top medical expert about some of your most pressing health concerns. In November, we asked you to submit questions about heart malady and otherness cardiovascular problems. We handed them over to Dr. Thomas H. Lee, who is a professor of medicine at Harvard Medical School and CEO of Partners Community HealthCare, as well as the editor in chief of The Harvard Heart Letter. Here are his responses to several of your questions, including those excerpted in the Dec. 6 edition of NEWSWEEK.

Reno, Nev.: I have seen a cardiologist and even had an angiogram done, and everything was OK. But at least once or twice a day, it feels like my heart skips a beat or pumps funny. I'm 33 years old. Should I worried about this?
If the only syndrome you are having is your heart occasionally "skipping a beat," you can relax. From time to time, everyone has premature heart beats. What you are feeling is the pause that follows as the heart resets itself and resumes its normal rhythm. If the palpitations lasted for several minutes or hours at a time, I would wonder if your heart was having longer lasting heart-rhythm abnormalities, like atrial fibrillation. This condition is common among older group, and carries an increased risk of a stroke. I would be even more worried if you also had episodes of fainting, which might indicate a heart-rhythm abnormality that was serious enough to cause your blood pressure to fall. But your syndromes do not sound like these more serious problems, so I would just encourage you to perhaps cut down on the caffeine.

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I have a low threshold for getting exercise agsdhfgdfs in patients of mine who have chest-pain episodes, even if their syndromes do not sound classic for heart malady??"as is true of yours. The fact that you have high cholesterol strengthens the case for getting this agsdhfgdf. There is a pretty good chance that this agsdhfgdf will be negative ??"that is, show no evidence for heart malady. That will be a signal to you that it is safe for you to really begin exercising, losing weight, and adopting otherness lifestyle changes that can lower your cholesterol and heart malady risk.?� Should you take aspirin as well??� This is an issue that you should go over with your doctor, as it will be influenced by your age, gender and otherness medical issues.?� If you want to read more about this, you can get a free booklet from the Food and Drug Administration online (www.fda.gov/cder/consumerinfo/dailyasp_brochure_hi.pdf ).

New York, N.Y.: After a difficult time in my life, I started smoking in my mid-30s. Will the year I have been smoking negatively impact my health (provided I quit soon)?
First, no matter how long you have been smoking, the right thing to do is to quit. Whether or not you have done yourself permanent damage, the question is how your health will be if you continue smoking compared to how it will be if you quit??"and you know the answer to that. That said, let me offer you some reassurance that a year or two of smoking has not likely done major harm to you if you quit soon.

Land O'Lakes, Fla.: I've read that more than half of all fatal heart attacks might be attributable to the bacteria known as chlamydia pneumonia and that agsdhfgdfing may soon lead to various rounds of antibiotics to counter its effects on the heart. Aspirin medical care and statins (even in those with normal cholesterol levels) were also recommended. I'd like to know what you think about that and about taking folic acid to counter high homocysteine levels in the blood and red yeast rice supplementation as a natural alternative to statins.
A few years ago, there was a lot of excitement about the possibility that antibiotic medical care might reduce heart-attack risk. That theory isn??�t completely dead, but the enthusiasm is a lot lower today, mainly because some research trials have now been performed, and so far there isn??�t any evidence to encourage optimism. Research trials have tried short and long courses of antibiotics, but so far there is no evidence that patients who get treated this way have better outcomes. Optimism that folic acid might also reduce heart malady risk by lowering the chemical homocysteine has also faded, as research trials have not supported this approach. On the otherness hand, use of aspirin and statins in patients who have a higher risk of heart malady now has wide acceptance, even if patients have normal cholesterol levels.?�?�

Fenton, Mich.: I am a 47-year-old female. My father currently has heart malady and my cholesterol level is 315. Should I get a agsdhfgdf to see if any of the arteries in my heart are blocked yet?
With a family history of heart malady, and a total cholesterol of 315, you do have reason to be extra concerned about heart malady. But I'm not sure the right next step is an angiogram to look at the arteries of your heart, or even an exercise agsdhfgdf. If you were my patient, I would tell you that we should assume that you have atherosclerosis in your arteries, including the arteries of your heart. We know that we want to do all we can to minimize your risk for worsening of that atherosclerosis. That means controlling your blood pressure and cholesterol, and dealing with otherness risk factors such as polygenic disease, smoking, being overweight and a sedentary life style.

TALK TRANSCRIPT| What's Next in Health??�Geoffrey Cowley joined us for a Live Talk on Thursday, Dec. 2, at noon ET to discuss memory-enhancing drugs, drug policies, bone health and more. Click here to read the transcript.Denton, Texas: My husband has been advised that he will have to have surgery for repair or replacement of the mitral valve.?� Please describe the least invasive type(s) of surgery. He is 75 years old, has survived aortic aneurysm surgery and hernia repair following that long five-month hospitalization, and he is very concerned that surgery involving opening the chest would be too risky.
He??�s right to be worried about the safety of heart surgery at his age, but the risk of not having surgery might be even greater.?� If his mitral valve is leaking, the strain on his heart from pumping extra blood is probably taking its toll??"and he runs the risk of developing worse and worse heart failure if the problem is not fixed. Someday, we may actually have special catheters that can fix or replace heart valves without opening the chest, but that day is not here yet.?� If he can have his valve repaired instead of replaced, that would be nice because he would not have to live with the risk of infection or blood clots that an artificial heart valve might carry.?� Having a smaller incision in his chest is also now possible at many medical centers, where surgeons can operate on the mitral valve through keyholes. ?�

Ontario, Calif.: I have been diagnosed with acute coronary artery malady, hyperkolemia and type-2 polygenic disease. Although I never take the flu shot, should I this year due to my recent diagnosis?
Yes, you absolutely should.?� And since you are in Canada, you have a better shot at actually getting a flu shot than most of my patients. Flu shots are beneficial for virtually everyone, but group like you who have heart malady and polygenic disease have a better chance of surviving the winter if you get a flu shot. The side effects are minimal.?� If you are not allergic to eggs, go for it.?�

Corpus Christi, Texas: I've been told by a cardiologist that I need a heart valve. Can you tell me which is best??"mechanical or tissue?
It depends. If you already need to take Warfarin, the blood thinner, because of anotherness problem like atrial fibrillation or a history of blood clots, then you should get a mechanical valve.?� The mechanical valves usually last a long time, but cause formation of blood clots.?� Their plus is durability, but their negative is the need to take a blood thinner. If you already have to take a blood thinner, then you have nothing to lose by going mechanical. If you don??�t want to use a blood thinner??"say, because you enjoy doing sports or otherness activities in which you might get bruised, or you have a history of a bleeding ulcer??"than a tissue valve is better. They do not usually require use of a blood thinner. But they do have a higher risk of wearing out over many years (typically five to eight), so the chances of needing a second operation are a bit higher with a tissue valve.?�

Hainesport, N.J.: If your cholesterol levels are in check, and your electrocardiogram and stress-agsdhfgdf results are fine, is there anything else you can do to check for blockage or otherness heart problems that may fall under the radar?
There is more that you can do, but you have probably done enough. Remember, the key question is: what are you going to do with the information? If you are feeling fine, but you learned that you had some atherosclerotic narrowings in the arteries of your heart, what would you do? You wouldn't undergo an angioplasty or bypass operation??"you would just continue controlling your risk factors. For this reason, I don't recommend that my patients who are free of syndromes of heart malady undergo a CT scan of the heart or any of the newer agsdhfgdfs that are being advertised as screening tools for heart malady. The agsdhfgdfs might give you more information, but they currently don't give you more insight into what to do differencely.

Victor, N.Y.: My 15-year-old son has a total cholesterol of 245 (fasting).?� His father had a heart attack, triple bypass, and stroke at 34. I've had my son at the pediatric cardiologists many times, but they continue to monitor and try to regulate by diet alone.?� What else can I do?
If he hasn't had it done already, he should have a full lipid profile, with measurement of his HDL and his LDL cholesterol.?� If his LDL is over 130 mg/dL, that would confirm your fears that he has a high-risk lipid profile.?� The first steps to address this issue are already being taken??"he should lose weight if heavy, and I assume you have put him on a low-fat diet (hard for a teenager, I know).?� If his LDL is still high, then drug medical care is worth considering.?� There is more experience in children with an older cholesterol drug, cholestyramine, but it tastes terrible.?� So more and more physicians are using the same statins that they use in adults, except at lower dosages.
?�
Health For Life: Dec. 6, 2004 issue?�Medicine's Next Level?�Welcome to the Stem-Cell States?�View From the Lab: Harnessing Stem Cells?�Using Genes as Medicine?�What You Need to Know About Medical Time Bombs?�Risk Factors: In Search of Bone Health?�Web MD: When Less is More?�Trapping the Superbugs?�Bird-Flu Challenge?�Battling the Effects of War?�To Heal a Shattered Soul?�Drug Wars Ahead?�Opinion: A Prescription for Controlling Drug Costs?�Creating More Paths to Hope?�The New Face of AIDS?�Talk Transcript: What's Next in Health?

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Santa Cruz, Calif.: I?� had an aortic dissection in August 2003, shortly after John Ritter died of a similar condition.?� I got a lot of attention after my surgery because I survived such an ordeal. Now I find that it is difficult to find medical advice about this malady and what caused the aortic aneurysm. What steps can I take besides exercise, diet and lowering my blood pressure?
Aortic dissections are not all created equal??"the ones that occur near the beginning of the aorta are especially hazardous. This malady occurs when a small tear develops in the lining of the aorta, and blood surges into the wall itself, pushing the inner and outer layers apart. As the inner layer is "dissected" away from the outer layer, the normal branches of the aorta are choked shut.?� Near the beginning of the aorta, there are side-arteries that supply the brain and the heart; blocking off those blood vessels can easily be fatal. You either survived one of these really dangerous ones, or had a dissection of the descending aorta (after it turns and starts heading down toward the abdomen). Those can be serious, too, but are more likely to be detected and successfully treated than the ones that occur in the ascending aorta. You will be happy to know that long-term follow-up of patients who leave the hospital alive after pharmacomedical care of aortic dissection shows survival not much difference from the rest of the population. So you should make sure your blood pressure is under control, and see your doctor right away if you feel chest or back pain.

San Francisco, Calif.: I have had a heart attack (10 years ago), an atherectomy and an angioplasty with two stents inserted in two difference arteries two years ago.?� I?� feel I should have a stress echo agsdhfgdf performed annually. What would you recommend?
You really don't need any type of stress agsdhfgdf (with or without an echocardiogram) as long as you are free of syndromes of heart problems. My recommendation is that you do your best to control your cholesterol and otherness risk factors and engage in a regular exercise program. If you feel any chest discomfort with exercise, then a stress agsdhfgdf with an echocardiogram or nuclear-imaging technology would be the right thing to do.

Kingston, N.Y.: I am 28 years old. My father has experienced heart palpitations and had a defibrillator inserted about two years ago. My question is whether my risk for developing a condition later in life is reduced by my involvement in exercise and stress reducing activities?
Yes.?� I don't know exactly what led to your father having his implantable defibrillator, but the most common reasons are a damaged heart muscle leading to heart-rhythm abnormalities and an increased risk for sudden death.?� The best strategy for you is to minimize the chance that you will have damage to your heart muscle. And the most important tactics to do so are to control your cholesterol, blood pressure, blood sugar and otherness risk factors for atherosclerosis and to avoid abusing alcohol, which is a common cause of heart damage.

Lakeland, Fla.: During a heart catheterization, the doctor found three blocked arteries??"two 30 percent and one 50 percent blocked, plus several undetermined blockages on the back of the heart. The doctor said to wait and see. But shouldn't something be done now?
Your doctor did the right thing by not going ahead and doing an angioplasty to every one of these narrowings. They are probably not severe enough to cause you angina syndromes by blocking blood flow, and doing an angioplasty to them would not have reduced your risk for a heart attack. Heart attacks usually occur when an atherosclerotic plaque breaks open, causing formation of a blood clot that blocks the artery. You are like most group with atherosclerosis, and you have many such plaques??"too many to attack with an angioplasty. You should control your LDL cholesterol (getting it to 70 to 80), take an aspirin a day and work on the risk factors for atherosclerosis.

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U.S. failed to recall meat after outbreak - More Health News

U.S. failed to recall meat after outbreak

CDC report suggest government could have prevented salmonella cases

WASHINGTON - The government declined to alert the public about suspect ground beef or request a recall after a 2004 salmonella outbreak that sickened at least 31 group nationwide, according to a report by the federal Centers for Disease Control and Prevention.

The report, made public Wednesday by food safety advocates, said the Agriculture Department traced illnesses in nine states -- Colorado, Kansas, Minnesota, New Jersey, New Mexico, New York, Ohio, Tennessee and Wisconsin -- and Washington, D.C., to a national supermarket chain and a single meat processing plant.

The department decided no action was needed because the plant was following federal guidelines. The CDC did not name the plant or supermarket chain. A separate report from the Minnesota Department of Health referred to the chain as a member-only warehouse.

Unlike E. coli and listeria, salmonella in raw meat is not an "adulterant" under federal guidelines. That is because group are expected to cook raw meat before they eat it, and cooking kills salmonella.

Department spokesman Steven Cohen said officials did a full investigation and were prepared to act on any problems at the plant. "We didn't find problems," Cohen said.

That's not much comfort for group who got sick, said Carol Tucker Foreman, director of food policy for Consumer Federation of America.

"Nobody died, but 31 group ... got sick from eating this product, and I can tell you, not one of them thought that it was their best day on earth," Foreman said. "This is not just a bellyache."

Salmonella is a bacteria that causes diarrhea, fever and abdominal cramps and in some cases requires hospitalization.

It can be deadly unless infected group are treated right away with antibiotics. Of the estimated 1.4 mil. cases of salmonella each year in the United States, about 400 group die, according to CDC.

Foreman and otherness food safety advocates called attention Wednesday to the report on the outbreak that was issued by CDC late last month. They said the department could have taken steps to prevent more group from getting sick but chose not to.

"They never announced this outbreak," said Donna Rosenbaum of Safe Tables Our Priority. "I would guess there are a number of cases of this that could have been avoided. It ran from August to October, so this was in group's refrigerators and in their freezers."

She noted that many cases of food poisoning go unreported; CDC estimates there are 39 cases of unreported illness for every one case that is reported.

While the department lacks legal authority to recall meat, it can ask companies to do recalls. No company has ever refused a recall request.

The department has issued alerts involving salmonella before. For example, a news release last year said that several salmonella infections in the Midwest were linked to stuffed and breaded frozen chicken entrees. The announcement pointed out the food needed to be fully cooked to be safe.

Alerts have also been issued about drug-resistant forms of the salmonella bacteria.

"Although salmonella is not considered an adulterant in raw ground beef, we do a great deal of outreach to help consumers understand how to handle and cook their meat and poultry to avoid chances of becoming ill," Cohen said.

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Reynolds: Killer germs! - Glenn Reynolds

Killer germs!

March 14, generic viagra now | 10:27 AM ET

Now we have to worry about killer germs, too.

First there's bird flu, about which the government has this comforting advice:

In a remarkable speech over the weekend, Secretary of Health and Human Services Michael Leavitt recommended that Americans start storing canned tuna and powdered milk under their beds as the prospect of a deadly bird flu outbreak approaches the United States.

Ready or not, here it comes.

At least they're not overselling the government's ability to handle these things. But natural epidemics aren't the only threat. A new article in Technology Review looks at the threat from biological war and biological terrorism. The danger of artificial pathogens looks even more serious than the danger of naturally occurring epidemics. There's more on this subject here.

Eventually, we'll be good enough at responding to these threats that they won't be terribly dangerous. But that will require the development of new antibiotics, powerful antiviral drugs, and rapid-response vaccine production techniques.?� Right now, we're not doing enough to develop these capabilities. But even if avian flu comes to nothing, and the threat of bioterror doesn't materiaize any time soon, the odds are that some nasty bug wil appear in the not too distant future. And when it does, we'll wish we were ready -- in a way that goes beyond canned tuna.

March 13, generic viagra now | 12:54 PM ET

Global agsdhfgdf on Islam?

As we look at the war on terror, which the Bush Administration has finally admitted is actually a global war on fundamentalist Islamic terror, two things are happening. Bush is dropping in the polls. But so is Islam.

Jim Geraghty, who blogs from Turkey, worries that we're past a "tipping point" in the West, with many group giving up on the notion of winning over "moderate" Muslims and coming to the conclusion that it's not a problem with Islam, but that Islam is the problem. He writes:

A big part of the war on terror/post-9/11 war on militant Islamism is a religious war; it's militant Islam vs. everybody else. It's more accurately, a war within a religion. Put simply, the world's one billion or so Muslims have to decide which side accurately represents their faith.

On the one side is the vision of Osama bin Laden (and, for that matter, Iran's Mahmoud Ahmedinijad) in a relentless conflict with the West, using terrorism and violence, enforcing Islamic standards on all otherness cultures, including blasphemy laws on Danish cartoons. This is a vision in which secular democracies are intolerable apostasy, where Western influences must be driven out, and the only acceptable infidel is a dhimmi.

On the otherness side is Jordan's King Abdullah, who has a hopeful, coherent vision of Islam embracing the West. He's trying to build a country that puts serious effort into secular education, a diverse economy, women's rights, and strong ties to the West. Or you could prefer the Turks' enactment of Ataturk's vision -- a stable, strictly secular parliamentary democracy full of Muslims, where the occasional military coup acts as the "Control-Alt-Delete" in any Islamist effort to overturn the secularism through democratic means.

There are about five billion of us on the outside of this fight, looking in. We have a very vested interest in the outcome of this debate; it determines whether we have a billion enemies or several hundred mil. allies.

Geraghty thinks that the problem is that Bush has been too mushy -- not enough "for us or against us" rhetoric, rather than, as critics suggest, too much.

Columnist David Warren has related thoughts:

Mr Bush was staking his bet on the assumption that the Islamists were not speaking for Islam; that the world's Muslims long for modernity; that they are themselves repelled by the violence of the terrorists; that, most significantly, Islam is in its nature a religion that can be "internalized", like the world's otherness great religions, and that the traditional Islamic aspiration to conjoin worldly political with othernessworldly spiritual authority had somehow gone away. It didn't help that Mr Bush took for his advisers on the nature of Islam, the paid operatives of Washington's Council on American-Islamic Relations, the happyface pseudo-scholar Karen Armstrong, or the profoundly learned but terminally vain Bernard Lewis. Each, in a difference way, assured him that Islam and modernity were potentially compatible.

The question, "But what if they are not?" was never seriously raised, because it could not be raised behind the mud curtain of political correctness that has descended over the Western academy and intelligentsia. The idea that othernesss see the world in a way that is not only incompatible with, but utterly opposed to, the way we see it, is the thorn ever-present in the rose bushes of multiculturalism. "Ideas have consequences", and the idea that Islam imagines itself in a fundamental, physical conflict with everything outside of itself, is an idea with which group in the contemporary West are morally and intellectually incapable of coming to terms. Hence our continuing surprise at everything from bar-bombings in Bali, to riots in France, to the Danish cartoon apoplexy.

My own views on the issue have been aloof. More precisely, they have been infected with cowardice.

If Geraghty is right, that cowardice may be coming to an end. The question is what will come next. Over at Winds of Change, a political military blog, there's this worry:

This isn't about dissing their views; because I don't (anotherness post on that soon), I understand them. But it is a model to consider as we talk about the notion that a sea-change in "the Western Street" could take place which involves a fundamental belief that we can't deal with the Arab world, and that what we need to do is to disengage fast and hard.

In essence, it'd be a position that said "we're washing our hands of you", bulked up border and internal security, and made it a point never to drive through 'those neighborhoods' without locking the doors, and never, under any circumstances, to stop there. It solves that whole messy "war" thing, and makes sure that no one says bad things about us in our hearing. We'd be clean-handed liberals, and feel secure.

And it would be a disaster.

It would first and foremost be a moral disaster, because we'd be condemning billions of group to a battle with a homicidal tyranny that we had a hand in creating (indirectly, through our policies in the Middle east from the 1900's onward). We'd be condemning Israel to become even more of a besieged outpost than it is today. We'd be condemning Europeans to a bitter struggle with an increasingly empowered minority.
...
And it'd be a practical disaster.

It'd be a practical disaster, because the war within the Muslim world would wind up being won by either brutal oligarchs or by homicidal fascists. If the oligarchs win, we'll have trading partners, for a while, until they need an outside enemy to whip up their population against. If the fascists win, we'll have a war right away.

On the otherness hand, it's not as if everyone in the Arab or Muslim worlds is antimodernity. Take the example of Wafa Sultan, who made her displeasure with Mullahocracy known to the mullahs, on Al Jazeera, no less:

Three weeks ago, Dr. Wafa Sultan was a largely unknown Syrian-American psychiatrist living outside Los Angeles, nursing a deep anger and despair about her fellow Muslims.

Today, thanks to an unusually blunt and provocative interview on Al Jazeera television on Feb. 21, she is an international sensation, hailed as a fresh voice of reason by some, and by othernesss as a heretic and infidel who deserves to die.

In the interview, which has been viewed on the Internet more than a mil. times and has reached the e-mail of hundreds of thousands around the world, Dr. Sultan bitterly criticized the Muslim clerics, holy warriors and political leaders who she believes have distorted the teachings of Muhammad and the Koran for 14 centuries.

She said the world's Muslims, whom she compares unfavorably with the Jews, have descended into a vortex of self-pity and violence.

Dr. Sultan said the world was not witnessing a clash of religions or cultures, but a battle between modernity and barbarism, a battle that the forces of violent, reactionary Islam are destined to lose.

In response, clerics throughout the Muslim world have condemned her, and her telephone answering machine has filled with dark threats. But Islamic reformers have praised her for saying out loud, in Arabic and on the most widely seen television network in the Arab world, what few Muslims dare to say even in private.

See her on video here.

She's right. It's a clash between civilization and barbarians. We need to create a world in which the civilized Wafa Sultans are more willing to speak -- and the barbarous mullahs are more afraid. What is going on is often portrayed as a agsdhfgdf for the West. But it's a agsdhfgdf for the Islamic world, too. And so far it's failing -- unless Wafa Sultan and her like can save it.

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March 8, generic viagra now | 12:54 PM ET

I've spent the last few days on a book tour, promoting my book, An Army of Davids, which officially published on Tuesday. (You can see accounts of some of my touring here and here?� and read reviews of the book here, here, and here, plus this from Arianna Huffington:

"You know Reynolds has hit on something when John Podhoretz and I agree that 'Army of Davids' is a must-read.") It's been sort of fun, in a tiring sort of way.
One question a lot of group have asked is "Why write a book when you have a blog?"

There are lots of reasons why??"as is obvious from the fact that so many bloggers are writing books. Kos of DailyKos, along with Jerome Armstrong of MyDD, have a new book, too: It's about "Netroots" politics and it's called Crashing the Gate.

You can read reviews of their book here and here.?� I haven't read it all yet, but their suspicions regarding the influence of political consultants seem well-founded to me.

So why write a book when you can blog? For the same reason you might make a movie instead of shooting still pictures. A blog is a collection of isolated points. Readers can connect the dots, but the medium doesn't lend itself to comprehensiveness or to narrative threads. People read a book all the way through in a day or a few days. People read blogs in dribs and drabs as they have time. They miss things, they're distracted, they go on vacation. If you want to paint a big and coherent picture, a book is still better.

Books last, too. Blogs are evanescent: Potentially immortal, in various archives and caches, but not in a way you can count on. (Rule of thumb: Embarrassing stuff will live forever on the Net; stuff you want to last will get accidentally deleted....)

And a book gives you a chance to do a book tour, and go on radio and TV and in print, talking about stuff that's important to you, going well beyond the book itself. A blog lets you do that too, of course, but to a difference audience. A book, at least potentially, lets you preach to somone besides the choir of your regular blog readers.

And, as I get ready to board the flight home (thank goodness for airport wireless) I note anotherness advantage: You can read a book on the plane. You can't do that with blogs, yet.

March 6, generic viagra now | 12:46 AM ET

Women are at risk for heart illness -- and potentially fatal heart rhythm problems -- to a much greater degree than is often appreciated.?� My wife, an athletic 37-year-old woman, had a heart attack and took months to be diagnosed.?� She tells the story here.?� Excerpt:

Two doctors and an emergency room visit later, I still had no answer to why I was shaking, short of breath and could barely walk at times from weakness.?� I thought at times I was having mini strokes.?� One emergency room doctor refused to look at my abnormal EKG when I came to the hospital; he was too busy dealing with a female coke addict and decided that I was anotherness example of an anxious woman having a panic attack.

I finally persuaded my regular doctor to quit prescibing me Effexor (an anti depression medicate) and to look at my heart.?� He finally sent me for agsdhfgdfs.?� He called back and told me to get to the hospital.?� My father was with me at the time and took me to the hospital where the orderlies thought he was the one with heart problems and told him to get in the wheelchair.?� I would have laughed myself silly if I had not been so ill.?� I had agsdhfgdfs including a heart cath that helps doctors to see inside the heart.?� Later, when I was back in my room, the cardiologist came in and told me that I had suffered from a heart attack and also had a ventricular aneurysm (a ballooned out area of the heart) as a result of not resting my heart after the heart attack.?� I had been told that I had panic disorder so I thought that exercise would be good.

My wife's heart attack was the result of an arterial spasm -- a rarity that causes heart attacks in the absence of any coronary artery illness.?� On the otherness hand, many women suffer from a type of coronary artery illness that differs from that affecting men, and that is much harder to spot.?� Women also tend to get to the emergency room later than men and, as my wife's experience indicates, they're often not diagnosed quickly.

Much of this is a question of awareness.?� We tend to think of a fat guy in his fifties as a heart attack candidate -- and he is -- but heart attacks aren't limited to the stereotypical victims.

The good news is that more group are becoming aware of these factors.?� We did a podcast on this topic with cardiologist Dr. Wes Fisher, and nurse-practitioner Laurie Anderson of WebMD, on the state of cardiac health for women, and men.?� You can listen to it here (no iPod required) or get it via iTunes here.?�?� You can find a dialup version here.

One of the things you'll learn is that for women, the syndromes of a heart attack often differ from men: less chest pain, more nausea, and shortness of breath.?� Paying attention to this sort of thing could, as we know all too well, alas, save you a lot of heartache in the future. Literally, and figuratively.

March 3, generic viagra now | 10:16 AM ET

The war heats up

The ramifications of the Cartoon Wars continue to reverberate.?� My post from last week on "the tipping point" has led to this response from Jim Geraghty, who -- like me -- thinks the weakness of the Bush Administration's response to the cartoon riots is part of the reason why the public is so unhappy about the ports deal.?� Geraghty writes (from Turkey):

In the USA Today poll, when asked, "Which comes closer to your view about Arab and Muslim countries that are allies of the United States?" 45 percent of respondents said, "trust the same as any otherness ally"; 51 percent said they trust these countries "less than otherness allies."

That's a remarkably honest poll result.?� Let's face it, Americans have been told since kindergarten not to judge ethnic and religious groups differencely from one anotherness; now slightly more than half are willing to come out and say, "you know, I just don't trust those guys as much as I trust othernesss."

Welcome to Post-Tipping Point politics. There is no upside to doing the right thing ??" which is to emphasize, as one blogger put it, that there is a difference between Dubai and Damascus. There is tremendous political upside to doing the wrong thing, boldly declaring, "I don't care what the Muslim world thinks, I'm not allowing any Arab country running ports here in America! I don't care how much President Bush claims these guys are our allies, I don't trust them, and I'm not going to hand them the keys to the vital entries to our country!"

And more and more, I think Glenn Reynolds had it right; the entire Tipping Point phenomenon can be summed up as action and reaction. The Bush Administration's reaction to the cartoon riots was comparably milquetoast. The violence and threats committed over the cartoons shocked, frightened and really, really angered Americans. They want somebody to smack the Muslim world back onto its heels and set them straight: "It doesn't matter how offensive a cartoon is, you're not allowed to riot, burn down embassies and kill group over it."

They're ashamed that Denmark is leading the fight over this.

Geraghty notes that Bush seems not to feel, or understand, this hostility, but predicts that otherness American politicians in both parties are likely to capitalize on this sentiment, whether it's good for the country (and the world) or not.

Meanwhile, some bloggers and some law schools are asking if Islam is compatible with a free and democratic society.?� My guess is "yes" -- but moderate Muslims aren't likely to stand up if the violent thugs are the ones getting all the respect, and even groveling, from Western nations.

That's something that Claire Berlinski noted, too.?� It takes a backbone to preserve civilization against the threat of barbarism.?� On this front, alas, Bush's backbone has been insufficient, and we're paying a price.

March 1, generic viagra now | 10:12 AM ET

Europe, time to stand upThe best lack all conviction; the worst are full of passionate intensity.

That's pretty much the story in Europe. Writing in the London Times, Douglas Murray observes:

"Would you write the name you'd like to use here, and your real name there?" asked the girl at reception. I had just been driven to a hotel in the Hague. An h.earlier I'd been greeted at Amsterdam airport by a man holding a sign with a pre-agreed cipher. I hadn't known where I would be staying, or where I would be speaking. The secrecy was necessary: I had come to Holland to talk about Islam.
...
The event was scholarly, incisive and wide-ranging. There were no ranters or rabble-rousers, just an invited audience of academics, writers, politicians and sombre party members. As yet anotherness example of Islam's violent confrontation with the West (this time caused by cartoons) swept across the globe, we tried to discuss Islam as openly as we could. The Dutch security service in the Hague was among those who considered the threat to us for doing this as particularly high. The security status of the event was put at just one level below "national emergency".

This may seem fantastic to group in Britain. But the story of Holland ??" which I have been charting for some years ??" should be noted by her allies. Where Holland has gone, Britain and the rest of Europe are following. The silencing happens bit by bit. A student paper in Britain that ran the Danish cartoons got pulped. A London magazine withdrew the cartoons from its website after the British police informed the editor they could not protect him, his staff, or his offices from attack. This happened only days before the police provided 500 officers to protect a "peaceful" Muslim proagsdhfgdf in Trafalgar Square.

It seems the British police ??" who regularly provide protection for mosques (as they did after the 7/7 bombs) ??" were unable to send even one policeman to protect an organ of free speech. At the notorious London proagsdhfgdfs, Islamists were allowed to incite murder and bloodshed on the streets, but a passer-by objecting to these displays was threatened with detention for making trouble.

It seems to me that the European authorities are afraid to stand up for the principles of tolerance on which their societies are, allegedly, based.

It also seems that way to Claire Berlinski, whose new book Menace in Europe: Why the Continent's Crisis is America's Too examines Europe's intellectual and moral anomie, its inability to either assimilate or deal with a swelling immigrant population, and its resentment of America.

We interviewed Berlinski for a podcast and her take was, if anything, even less positive than that presented in her book.?� (You can listen here or, via iTunes, here.)

I hope that Europe will get its act together before it's too late, and there are a few signs of awakening.?� But the last time we saw a European nation whose elites lacked the strength or conviction to stand up to rampaging mobs of ignorant thugs, it was Weimar Germany.?� That turned out very badly, and I'm afraid that today's Europe -- in which many nations seem to suffer from that problem -- may well turn out badly, too.

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Deirdre Imus on Greening America's Hospitals - Newsweek: Tip Sheet Environment

One Child at a Time

Why it??�s so important that we provide our children with non-toxic hospitals, schools and homes.
Web-Exclusive CommentaryBy By Deirdre ImusSpecial to Newsweek

Oct. 9, generic viagra now - In today??�s world, where there are many things we cannot control, I have always felt it important to focus on?� areas in which I can make a difference. Rather than telling someone to change, I try to show them by example how it can be done.

My interest and commitment to children??�s health grew out of concern for my own health.?� As a runner in college and high school, I began to learn about food, hoping I could improve my performance on the athletic field by improving my diet. Studying food opened my eyes to the state of the environment.?� Understanding the consequences from consuming foods that contained hormones and antibiotics; aware of the toxins used in fertilizers, I made a life choice and adopted a totally organic diet and found myself on an irreversible path towards a healthier and smarter way to live.

Deirdre ImusMy involvement as an advocate for children began about 15 years ago, after I began participating in the annual radiothons that my husband, Don Imus, hosted for the Tomorrow??�s Children Fund for children with cancer and the C. J. Foundation for SIDS. The more I worked with these wonderful foundations, the more I wanted to help the children and families trying to cope with unimaginable pain.

Realizing I couldn??�t help every child, I was inspired by the example of Motherness Teresa. Walking through the impoverished streets of Calcutta, she was once asked how she could pass by so many lepers and not stop to help them. In her humble grace and wisdom Motherness Teresa explained, she could not help everyone, but would help one leper and then anotherness ??� one leper at a time.

Knowing that we could not help every child with cancer or every child who had lost a sibling to SIDS, my husband and I wanted to give something special, and at the same time some sense of normalcy, to these remarkable children. My husband grew up on a ranch. Because of his experiences as a child, we decided to create an authentic working cattle ranch designed to provide the lost adventure of the great American cowboy. The Imus Ranch for Kids with Cancer is located in Ribera, New Mexico and for five months each year we welcome children from around the country to enjoy a fun and unique experience. At the ranch we maintain and provide a healthy diet and a clean environment free of pesticides and toxic cleaning products.

In 2000, still not satisfied that I had done all that I could, I began investigating how toxins in the home and hospital environment affected our children??�s health. I was concerned about the number of supposedly safe products used in our everyday living. We are exposed to more than 82,000 chemicals in our environment. Yet the EPA has reviewed fewer than 2 percent for their safety. Environmental hazards are not always obvious and yet they are real and affect us all??�especially children. Regrettably, it is our children who are the most vulnerable to many environmental insults. In fact, studies have shown a 30 percent increase in various cancers in children result from exposure to toxins in our environment.

From the air we breathe, the water we drink and the food we eat, numerous toxic substances from a variety of sources are bombarding our children each day. Not enough is known about how all of these toxins, interact with one anotherness and our body chemistry. Taking any step to reduce or eliminate toxins in our environment is simple common sense and is often easy to do.

Working with New Jersey??�s Hackensack University Medical Center we established The Deirdre Imus Environmental Center for Pediatric Oncology in 2001. This facility evolved from a lifelong dream about a culture that would truly see children as its most important priority.

The Center represents one of the first hospital-based programs whose specific mission is to identify, control and ultimately prevent environmental factors that may cause adult and, especially, pediatric cancer and otherness health problems with our children.?� The hospital is the first in the nation to undertake a comprehensive greening program.

The Center??�s mission is twofold: to enhance health by educating our children, their parents and the public-at-large about the carcinogens and otherness environmental factors that occur all too commonly in our lives ??� and to serve as a voice that can realistically help shape policy decisions that impact the environment and our well being.

Soon after the Center opened, I began developing the Greening the Cleaning??� institutional program to help eliminate toxic cleaning agents and replace them with safer, non-toxic alternatives. These cleaning products are cost efficient, work as well as the leading industrial cleaning products and 100percent of the profits go to charity.

To date, we have greened the cleaning in over 200 facilities including many hospitals, schools, corporations, a major airport, day care centers and health spas. Our retail line is now available in thousands of stores nationwide. 100percent of these profits also go to charity.

All of these initiatives have been true labors of love for our children. My motivation is a simple one: Children are our most precious natural resource. Their environment shouldn't harm them. Because children are unable to protect themselves, we must make every effort to diligently and continuously examine how toxins in our environment may be affecting and compromising our children??�s health. The key to protecting our children is prevention.

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We may not be able to change the world, but we can change the way we think about children??�s health. Each one of us has tremendous potential to make a difference. Switching to a non-toxic cleaning product is a single change that can lead to anotherness and anotherness and ultimately to a cleaner, safer and healthier life.

Deirdre Imus is the founder and president of The Deirdre Imus Environmental Center for Pediatric Oncology at Hackensack University Medical Center. For more information, go to www.dienviro.com.

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Deadly scourge could emerge soon, WHO warns - Infectious Diseases

Deadly scourge could emerge soon, WHO warns

Viruses are spreading faster than ever, getting harder to treat, agency says

GENEVA - Infectious illnesss are emerging more quickly around the globe, spreading faster and becoming increasingly difficult to treat, the World Health Organization (WHO) said on Thursday.

In its annual World Health Report, the United Nations agency warned there was a good possibility that anotherness major scourge like AIDS, SARS or Ebola fever with the potential of killing mil.s would appear in the coming years.

Infectious illnesss are now spreading geographically much faster than at any time in history, the WHO said.

It said it was vital to keep watch for new threats like the emergence in 2003 of SARS, or Severe Acute Respiratory Syndrome, which spread from China to 30 countries and killed 800 group.

It would be extremely naive and complacent to assume that there will not be anotherness illness like AIDS, anotherness Ebola, or anotherness SARS, sooner or later, the report warned.

Since the 1970s, the WHO said, new threats have been identified at an unprecedented rate of one or more every year, meaning that nearly 40 illnesss exist today which were unknown just over a generation ago.

Over the last five years alone, WHO experts had verified more than 1,100 epidemics of difference illnesss.

With more than 2 billion group traveling by air every year, the U.N. agency said: an outbreak or epidemic in one part of the world is only a few hours away from becoming an imminent threat somewhere else.

Monitoring vital
The report called for renewed efforts to monitor, prevent and control epidemic-prone ailments such as cholera, yellow fever and meningococcal illnesss.

International assistance may be required to help health workers in poorer countries identify and contain outbreaks of emerging viral illnesss such as Ebola and Marburg hemorrhagic fever, the WHO said.

It warned that global efforts to control infectious illnesss have already been seriously jeopardized by widespread drug resistance, a consequence of poor medical pharmacomedical care and misuse of antibiotics.

This is a particular problem in tuberculosis, where extensively drug-resistant (XDR-TB) strains of the contagious respiratory ailment have emerged worldwide.

Drug resistance is also evident in diarrheal illnesss, hospital-acquired infections, malaria, meningitis, respiratory tract infections, and sexually transmitted infections, and is emerging in HIV, the report declared.

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Although the H5N1 bird flu virus has not mutated into a form that passes easily between humans, as many scientists had feared, the next influenza pandemic was likely to be of an avian variety and could affect some 1.5 billion group.

The question of a pandemic of influenza from this virus or anotherness avian influenza virus is still a matter of when, not if, the WHO said.

It said all countries must share essential health data, such as virus samples and reports of outbreaks, as required under international health rules, to mitigate such risks.

Accidents involving toxic chemicals, nuclear power and otherness environmental disasters should also be communicated quickly and clearly to minimize public health threats.

Sildenafil Citrate 100 mg Reuters Limited. All rights reserved. Republication or redistribution of Reuters content is expressly prohibited without the prior written consent of Reuters.

Some foreclosures seen due to shoddy construction - BusinessWeek Online

Foreclosure??�s building problem

Is shoddy home construction exacerbating the housing crisis?
Gene J. Puskar / AP
Building projects surged during the housing boom that ran through much of this decade.

By By Maya Roney

She wasn't an investor. She didn't have a subprime mortgage. But when Jordan Fogal's house became uninhabitable, the 62-year-old grandmotherness says foreclosure became her best alternative.

Fogal's troubles began when she and her 72-year-old husband, Bob, moved to a new housing development near Houston in 2002. That first night in the new house, the dining room ceiling collapsed. Bob had pulled the plug in the Jacuzzi tub upstairs, and 100 gallons of water came crashing through the ceiling downstairs because the plumbing drains were not connected.

"That was a preview of coming attractions," Fogal says. Later, the roof and windows leaked, the yard flooded, the shower walls started bowing out, the floor in the kitchen started sinking, and mold began to grow all over the house. The smell was terrible, she recalls, and eventually Fogal's doctor ordered her to leave the house because of the dangerous mold levels. A construction company hired by the Fogals estimated that it would take $150,000 to repair everything. "I could afford my mortgage payment, but I couldn't afford $150,000 in repairs," says Fogal, who had a 30-year fixed-rate mortgage at the time. The home ??" appraised at $408,000 the day the couple bought it ??" ended up selling for $234,000 at a foreclosure auction.

"All of this time, I was begging the builder to fix these problems," Fogal recalls. But, she says, they only showed up to about 25percent of the appointments she made. "That's absolute nonsense," says Tom Thibodeau, president of Tremont Homes and then-president of the Fogal home's builder, Tremont Custom Construction. "We tried everything we could to fix this house, and she refused it. She only wanted us to buy the house back."

The only original problem with the Fogals' house, Thibodeau says, was a roof leak that was neglected and led to a myriad of otherness problems. "She would like everyone to believe the house was foreclosed on because of the defect," he says. "But by neglect, she let the leak go and otherness problems manifested from the leak."

More than a subprime problem?
Fogal's case is not an isolated incident. Greg Cole, a homeowner in Georgia who runs a gripe site at georgiamoldhome.com, says he is on the brink of foreclosure after dealing with structural problems and leaks that have led to elevated mold levels. He, his wife, and his two children now take antibiotics every day, he says, because of the high level of mycotoxins ??" a toxin produced by fungi ??" in their blood. Elizabeth Dziedzic, a Realtor in Orange Park, Fla., says the deficiencies in her home make it impossible to sell for the amount it would take to pay off her mortgage balance. "There are only few events that are as devastating to a family as the loss of the family home to foreclosure," she says. "I guess this would be a price my family will pay for trying to achieve the American dream."

Foreclosures are up 93percent from last year, according to Irvine, Calif.-based Web site RealtyTrac. At the same time, questions are arising as to whether construction quality suffered as homebuilders worked at lightning-fast speed to keep up with demand during the housing boom. It has become increasingly common for homeowners across the U.S. to share personal stories about defective construction through Web sites and blogs.

More from BusinessWeek.com

States With Highest Foreclosure Rates: July 2007
Healthiest Housing Markets
Where Rents Are Rising Fasagsdhfgdf

"Everything you read says that the rise in foreclosure has to due with subprime lending," says Nancy Seats, president of Homeowners Against Deficient Dwellings, a nonprofit consumer protection group for homeowners dealing with defective construction. "But [defective construction] absolutely has something to due with the rise in foreclosures. There were absolutely investors that pushed up the price of housing, but there is no question that there are home buyers that were taken in and scammed big-time."

Why not just sue your builder when an irreparable problem arises? Homeowners usually don't have the right to. Most new-home sales contracts state that the customer must go through arbitration before they can even think about bringing their complaint to court.

CONTINUED: Exaggerated effect?1 | 2 | Next >

Questions remain in Anna Nicole Smith's death - TV

Questions remain in Anna Nicole Smith's death

Filan: We might not have seen the end of this investigation
NBC VIDEO•'The manner of death was accidental'
March 26: Dr. Joshua Perper, Broward County, Fla., medical examiner, talks with 's Contessa Brewer about how he reached the conclusion that Anna Nicole Smith died from an accidental overdose.

COMMENTARYSusan FilanSenior legal analyst

Susan FilanSenior legal analyst

What do you get when you have a psychiatrist, a nurse, a body guard, and a boyfriend, plus a woman with 105 degree fever?   A death that should have been, and could have been prevented. 

When Anna Nicole Smith’s fever spiked to 105 degrees, why didn’t her psychiatrist, who prescribed antibiotics for her, take her to a doctor, to a hospital or call 911?   Why didn’t those closest to her insist that she get proper medical attention? 

Dr. Perper, the Broward County Medical Examiner who performed her autopsy, seemed satisfied with the explanation that she was an adult who had the right to say, “I don’t want a doctor, I don’t want to go to the hospital.”   But if someone is that ill, are they thinking straight?  If she knew her choice was to go to the hospital or to die, what would she have chosen?   If she was not suicidal, as Dr. Perper indicated, then she would have chosen to go to the hospital, not to die.  Anna Nicole was a person known to self-medicate, known to take too many prescriptions in too high a dose.   So why was she left alone, sick, in a hotel room that was a virtual medicine ?

More from Susan FilanWho will get Anna Nicole's money?Death for killer of pregnant mom, children?Unfair: 10 years for consensual oral sex

Why didn’t Anna Nicole’s nurse check on her in her hotel room on Thursday, the day she died?   It seems she was left alone in her room from 10:30 a.m. to 1:30 p.m. when she was found dead in her bed?  Why did Howard K. Stern, who awoke at 10:00 a.m., and had to help Anna Nicole to the bathroom because she was too weak to go alone, take his shower, dress and leave her?  

The medical examiner’s report seems to raise more questions than it answers.  Something does not add up for me.

It just doesn’t make sense that a 39-year-old woman, who had just given birth to a baby girl, who had just lost a son, who was so depressed she was on three anti depression medicate/anti-anxiety drugs, who had a history of overmedicating and mixing prescriptions, of taking methadone, of swigging liquid chloral hydrate, would be left alone to die of an accidental drug overdose.

•Birkhead finally leaves Bahamas with daughter•Two Anna Nicole Smith diaries sell for $59,750•Anna Nicole mocks herself in final role•Birkhead says Howard K. Stern ‘a great help’

Here is what bothernesss me: On Tuesday, Anna Nicole Smith had a 105-degree fever.   Her psychiatrist, not her doctor, prescribed her with an antibiotic, but did not insist she go to the hospital.  No one did. 

I do not think we have heard the end of this.  I think we will see further investigations, lawsuits, and perhaps loss of medical licenses as a result of Anna Nicole’s tragic and preventable death.

� 2007