Let’s say you’ve taken important steps toward improving your health. You are trying to eat better, move more, and own your health. You are on the road to a longer, healthier life. Great! Your odds of getting sick have gone way down. However, not everything can be prevented. There are still some medical land mines out there that you need to know about.
For serious conditions including heart attacks, cancer, and stroke, knowing your own risk and familiarizing yourself with symptoms can literally save your life. For less serious but life-disrupting conditions like common infections and back pain, understanding how to avoid or manage them can help to make sure that you are sidelined for as short a time as possible. Here we’ll take a closer look at the factors that contribute to both life-threatening diseases and everyday ills, so you can try to prevent them—and know what actions you can take if prevention fails.
For many diseases there is a gender gap. For example, heart disease doesn’t always look the same in men and women. Accordingly, treatment isn’t provided in the same manner. If you don’t know what to look for, how can you get the care you may need?
There are also a number of misconceptions out there. Do you believe that breast cancer is the leading cause of death in women? It’s not even close! Find out what is so you can work to prevent that, too.
The truth is, disease is a part of life. But for many maladies, understanding illness and learning how to protect yourself can help prevent more serious consequences and help you recover more quickly.
When my son Alex was in fourth grade he had the nicest school nurse ever. Mollie was quickly able to figure out which kids were really sick and needed to go home and which kids just weren’t quite ready for that spelling test. No matter the ailment, Mollie made every child who came in to see her feel special.
During one month, we got more calls from Mollie than we had the whole previous year. The first one was that Alex wasn’t feeling great. He had a headache and fever, and she thought my wife, Jeanne, should come and get him. Jeanne took him to the doctor’s and sure enough, he had strep throat. He went on antibiotics and returned to school. Within a couple of weeks, he was back in Mollie’s office with the same symptoms. Jeanne got the call and whisked him back to be seen by our pediatrician. Again, his strep test was positive, so he went on another antibiotic and was soon better. When my wife got her third call from Mollie in as many months, she said in exasperation, “He can’t have strep throat again. It’s just not possible!” But sure enough he did. We even had him tested to see if he was a carrier, someone who just had the bacteria living harmlessly in his throat, but the test came back negative. Frustrated, Jeanne called me and said, “Here you are a doctor and we keep sending our kid to school sick. I thought you couldn’t get the same infection twice. What’s going on?” While it didn’t make Jeanne feel like a much better parent, it was reassuring to learn that with an infection like strep, there are enough different disease-causing bacterial strains for you to get it over and over again. The immunity you get from your first infection doesn’t protect you against all the other strains.
Your immune system is remarkable. Among its many functions, it is an extremely sophisticated defense, constantly on guard for a wide array of common microbial invaders. In some cases, your immune system is strong enough to eliminate potentially dangerous ones the first time they even attempt to infect your body. In other cases they infect you but the immune system “remembers” how to fight the invader, making it unlikely that you will experience that infection again.
The idea that you cannot be infected by the same pathogen more than once likely stems from this concept of immunity—one dependent upon the “memory” of past invaders that your body’s defense system largely keeps in immune cells known as memory B cells. If a familiar invader infects the body, these cells can quickly sound the alarm, activate your disease-fighting systems, and generate specific antibodies needed to fight off the infection.
This immune memory can be generated in different ways: It can develop after a naturally occurring infection or following a vaccination. The art of designing an effective vaccine is to create one that stimulates an immune response in your body that will last your lifetime without causing the illness you are trying to prevent. This isn’t so easy to do. The protection you receive from many vaccines is lifelong; for other vaccines it fades over time.
With certain diseases, once you have them, you are done. For example, it is highly unlikely that you will be infected with the exact same strain of flu twice; people did not come down with smallpox more than once; and when you have had measles you can cross it off the list. Unfortunately, the microbial world is pretty smart and finds ways to evade your immune system; small changes to some microbes allow them to bypass your immune system and cause infection again. For example, flu viruses continually mutate and change, leaving you at renewed risk for infection from new strains. That is why you need an annual flu shot. For other infections, your immunity begins to fade over time, leaving you vulnerable to infections against which you were once protected. That is why you need booster shots for diseases like tetanus and whooping cough. There are also medical conditions and medications that can interfere with your ability to mount a strong immune response.
For all these reasons, when it comes to infectious diseases, the best defense is to never let your guard down. Make sure you are fully vaccinated (including being up to date with your boosters) and practice good handwashing. Even if you’ve had “it” before, watch out. Never say you never have to worry.
While your immune system is very good at recognizing many invaders and preventing disease the second time you are infected, it is not fail-safe. It is important to remember, though, that for many diseases it is not only possible to be sick only once, it is possible to never get sick from them at all—thanks to vaccines!
Back pain is one thing I know about all too well. I’ve had back issues since I was a teenager. It’s one of the downsides of being six foot six and walking upright; it puts a lot of strain on my lower back. All through my twenties, a couple of times a year my back would “go out.” A strange term, but for me it meant excruciating pain traveling down my legs to my feet. It might come on while playing sports or just by simply getting out of bed. When this would happen, I would be incapacitated. Twice in my thirties, I blew a disc and needed operations to take the pressure off my nerve roots. Not fun.
I am not alone when it comes to knowing back pain. According to the NIH, nearly everybody has some that interferes with his or her day-to-day activities. It is one of the most common health-related reasons employees take off work and is the leading cause of job-related disability.
The back is a pretty complex structure composed of bones, muscles, ligaments, tendons, nerves, and discs all living together in very tight quarters. When everything works well, it is truly a thing of beauty. However, with aging, little changes start to happen. Back pain begins for most of us between ages thirty and fifty. As we age, bone strength and muscle elasticity and tone begin to decrease. The discs, which provide cushioning between your vertebrae, begin to lose fluid and flexibility, like old shock absorbers in a car. The passages between the vertebrae that allow nerves to pass can get constricted, causing pressure on the nerve roots and pain.
Many times pain begins after an injury or trauma from an accident: Lifting something too heavy, sudden movement, overexertion, or even overstretching. My worst episode of back pain came from doing exactly what I wasn’t supposed to do: Lifting with my back instead of my legs. I was leaning over into the trunk of my VW Golf to lift out a very heavy television set. There was no way to lift it without taking the weight in my lower back. All of a sudden I went down; it felt like I had been shot in the back. Three days later I was in the operating room having the pressure from a blown disc relieved.
However, physical trauma isn’t the only cause of back pain. When I’m stressed out, the tension tends to settle in my back. My shoulders tighten, my lower back goes into spasm, and I know I’m in for trouble. Obesity, poor physical condition, bad posture, smoking, pregnancy, stress, and sleeping “funny” can contribute to low back pain. Back pain can also result from arthritis or degenerative conditions in the bones or discs.
It used to be that when my back began to act up I’d head for bed to lie down until it felt better. It made intuitive sense. If you twist your ankle, you rest it until it is less tender, so why not your back? Well, it turns out that rest is not best when it comes to your back. While one to two days of rest shouldn’t be harmful, a 1996 Finnish study was one of the first to find that people who continued their regular activities without bed rest appeared to have better back flexibility than those who rested in bed for a week. Other studies suggest that bed rest alone may actually make back pain worse and can lead to secondary complications including depression, decreased muscle tone, and blood clots in your legs.
If back pain strikes you, talk to your doctor to determine the most effective combination of prescription drugs and over-the-counter analgesics to reduce inflammation and discomfort. For most people, lower back pain goes away within a few days when treated with a combination of pain relievers, moderate activity, and gentle exercise. Let your doctor know if you are currently taking any other medications before they prescribe new ones. Although cold and hot compresses have never been scientifically proven to quickly resolve low back injury, I find them helpful. Try them and see. You can apply the cold compress to the injured area several times a day for up to twenty minutes for two to three days. After that, apply heat for brief periods to relax muscles and increase blood flow. Warm baths may also help relax muscles. Gentle exercises that help keep muscles moving can speed recovery by strengthening your back and abdominal muscles. Any mild discomfort felt at the start of gentle exercising should disappear as muscles become stronger. If your pain persists and lasts more than fifteen minutes, you should stop exercising and contact a doctor. Most back pain should improve with these treatments, although some discomfort might linger.
If you have back pain, try to keep active with moderate activity, gentle exercise, and anti-inflammatory drugs. If you don’t feel better after three days or if you have any muscle weakness or sensory changes, call your doctor.
I’ll never forget the phone call my wife got fourteen years ago. She had just called her best friend, Sarah, to tell her she was pregnant with our second child. Sarah had some news to share as well: She had just been diagnosed with breast cancer. She was thirty-nine, a mother of two kids under ten, and had no family history of breast cancer. My wife and she were dumbfounded—how could this happen? What they didn’t realize is that most women who get breast cancer don’t have a relative who had it.
Ever since researchers discovered mutations in two important breast cancer susceptibility genes, BRCA1 and BRCA2, the genetic component linking relatives with their likelihood of developing the disease has gotten a lot of attention. If you inherit certain mutations in these genes, you have an increased risk for developing breast cancer, particularly at a young age. Considering the publicity that these genes have gotten, and the link with family history, one could be forgiven for thinking that they are responsible for most breast cancer cases. Here’s what may surprise you: A look at the statistics proves this to be a misconception. Only 5 to 10 percent of breast cancer cases are considered to be hereditary (caused by a BRCA mutation or another known genetic link). Another 10 to 15 percent are classified as being familial (breast cancer runs in your family but no gene has been found yet to explain the risk). This means that 75 to 85 percent of breast cancers are likely to be nonhereditary in nature, just as in Sarah’s case.
While women who inherit the BRCA genes may have up to an 80 percent chance of developing breast cancer, the important thing to remember is that women without this mutation, the majority of women, have a risk over their entire lifetime of closer to 12 percent. Most cases of breast cancer occur in that low-risk group because far more women do not have the BRCA mutation than have it.
Another misconception that surrounds the disease is that many people incorrectly equate a diagnosis of breast cancer as a death sentence. Not only is breast cancer not the leading cause of death for women, it isn’t even the leading cancer killer. While breast cancer is far and away the most common type of non-skin cancer in women, when you look at cancer deaths, the picture is markedly different. Overall, for those who get breast cancer, the five-year survival rate is 89 percent, quite high when compared to many other cancers. Twice as many women die from lung cancer each year as die from breast cancer. Given that 80 percent of lung cancer is linked to smoking and is therefore preventable, why isn’t more being done to focus on eliminating that risk?
Most likely it’s because breast cancer resonates with women on many levels. Unlike the more equal-opportunity cancers, it rarely targets men. It also triggers body image issues associated with treatment, and, given its prevalence, has personally touched the lives of most women—forming an emotional connection to the disease. Additionally, awareness groups are experts at keeping the disease at the top of our minds. Hardly a month goes by when I don’t sponsor a friend or colleague doing a walk or run to raise money for breast cancer research. I can’t see the color pink without thinking about the disease. But there is a potential downside: It diverts attention from other conditions that could have a more significant impact on women’s health. For example, the leading cause of death for women is the same as for men: Heart disease. A survey conducted by the American Heart Association in 2005 found that only 55 percent of women knew this. This lack of knowledge really matters. Women who realized that heart disease was the leading killer were more likely to take steps to lower their risk.
So make sure you work to prevent breast cancer, but don’t forget that taking care of your health doesn’t stop there.
Family history is a crucial consideration when it comes to many cancers, including breast cancer. However, it is only one piece of the puzzle. Most women who have had breast cancer did not have a family history. There are a number of other factors that explain the bulk of breast cancer cases, and many factors that we don’t yet know of. Remember that you do have control over some aspects of risk in the lifestyle choices you make.
I don’t wish a heart attack on anyone, but particularly, I don’t wish one on a woman. It isn’t because I’m gallant (although I like to think I am); it’s because a heart attack in a woman is more likely to be missed, misdiagnosed, and undertreated. And when it comes to heart attacks, time is everything.
Here’s why. During a heart attack, blood flow to some of the heart muscle is reduced or cut off, usually by a plaque or a clot in an artery. When this happens some heart muscle dies. If a significant amount dies, the heart may stop pumping entirely and the patient could die. Treatment is directed at restoring blood flow as quickly as possible to minimize the amount of muscle damage and improve heart function and chances of survival. This can be done by administering a clot-busting drug or by inserting a thin tube into the blocked artery to open it up.
Although heart disease is sometimes thought of as a “man’s disease,” it is actually an equal-opportunity killer. As the leading cause of death in both men and women in the United States, it is responsible for one in every four deaths among women. And, despite the larger role breast cancer detection plays in our conversation about women’s preventative health, a woman is seven and a half times more likely to die from heart disease than from breast cancer.
When you think of the symptoms of a heart attack, what comes to mind? Here are some that might: Crushing chest pain that may shoot down an arm, heart palpitations, shortness of breath, and sweating. These iconic descriptions are typical male symptoms that have been well publicized. While chest pain is still the leading symptom in women, it is not unusual to see a different set of subtler symptoms. Women are more likely than men to report unusual fatigue, indigestion, sleep disturbance, and shortness of breath. The pain they feel may be just in the neck, back, or jaw.
Not only are women slower to identify their symptoms as those of a heart attack; they are also more likely to delay treatment. They often discount their ailments, thinking they are stress-related or gastrointestinal, and are reluctant to call 911. All of these delays can have serious consequences. And it gets worse. Once a woman gets to the hospital she is likely to get less treatment for her heart attack than a man. It takes a strong advocate to make sure that the right diagnosis is made and that treatment starts promptly.
Women need to be aware that their heart attack symptoms may be very different from men’s. Whether you have classic symptoms, such as chest pains, or more ambiguous symptoms of fatigue and indigestion, know the signs. Everyone, if you think you might be having a heart attack, call 911 and say, “I think I am having a heart attack.” Then crush up an aspirin and swallow it (it can prevent further clot formation), sit down, and wait for the ambulance to come. Get to the hospital and demand a thorough evaluation. It’s okay to be wrong, but if you are right, you might just have saved your own life.
Every year my children’s elementary school would end with an awards ceremony. One of the honors was for perfect attendance. Through the roar of the applause for these kids, my wife and I would turn to each other and simultaneously mouth the words “Typhoid Marys.” While we understood the school wanted to recognize these kids for their efforts to get to school (not to mention that the school was reimbursed for every day a student was there), we were convinced the determination to attend came more from parents who wanted to get them to school. We were also fairly certain that one of these kids was the child sneezing all over my son, causing my wife to have to take the day, or week, off from work to care for him after he came down with a terrible cold.
Our conditioning to get somewhere even when we feel terrible carries over even as we age. You know the feeling. You wake up in the morning with a sore throat, a headache, and a stuffy nose. You know you’re sick and the only question that remains is whether you will spend the rest of the day on the couch or “tough it out” and head into the office.
Had you woken up with the high fever, body aches, and weakness typical of a bout of the flu, it’s unlikely you would be having this internal debate; you probably would have had no choice but to stay in bed. But when it comes to the common cold, we tend to judge ourselves to be simply “under the weather” and show up to work despite our symptoms—often to the chagrin of our coworkers, who can’t help but notice the crumpled tissues littered around our desks.
It turns out they have reason to be dismayed. The phenomenon known as “presenteeism” is widely recognized among infectious disease experts to be a problem. One of the factors that contributes to presenteeism seems to be a general misunderstanding of exactly how sick is too sick to show up for work. There is a feeling that you are doing people a favor by coming in. Not only do people who come to work despite feeling unwell tend to be less productive; they also expose their coworkers to their illness, further threatening health and productivity within the workplace.
Another contributor to presenteeism is a workplace that does not have a liberal sick leave policy and an economy in which staying home increasingly means not getting paid. This was a big issue in 2009 during the pandemic of influenza. When I was the acting director of the CDC, one of the key public health messages we put forward was for people to stay home when they were sick. In theory this made a lot of sense: Limit the contact people had with others when they are sick and you will reduce the spread of disease in the community. However, we lack a safety net in America to allow large numbers of people to stay home when ill. A survey conducted by Robert Blendon and colleagues at the Harvard School of Public Health found that if parents needed to stay home for seven to ten days to take care of themselves or a sick child, 44 percent thought that they might lose pay and have money problems and 25 percent reported that they were likely to lose their job. According to the Bureau of Labor Statistics, forty million private sector employees have no paid sick leave. It makes it hard to do what is best.
So given that it is frequently too difficult to do the right thing, when should you stay home? Here are four questions to consider:
• Are you contagious and is your illness dangerous? The common cold is contagious, but it tends to be more annoying than dangerous unless it is spread to someone with an immune disorder. It also spreads to others before you have symptoms (though you spread it more once you are coughing and sneezing).
• Are you well enough to do your job? If you aren’t, there really isn’t much value in going to work.
• Do you work in a setting where you can reduce your contact with others and limit spread? If you have a door you can close, you’re in good shape. If you are dealing face-to-face with coworkers or customers all day, you’re putting others at risk. In our newsroom, the senior producers work around a large table with less than a foot between workstations. Our World News anchor, Diane Sawyer, is quick to send home anyone who comes in sick. She knows that is the only way to keep the whole team healthy.
• Would you like your colleagues to stay home if they were as sick as you are? Make sure you don’t hold yourself to a higher standard than you would others.
Your answers to those questions should help you decide what to do.
If your work supports you taking the day off (and it should!), clear off the couch, break out the orange juice, and find your favorite daytime drama, preferably on ABC! You can catch up on lost time at work when you are feeling better in a couple of days.
Calling in sick to the office is pretty easy when your symptoms are severe. If you are still able to walk around despite your symptoms, as is often the case with the common cold, this may seem like a harder call to make. The important thing to keep in mind when you are sick is that you are often doing your office mates, as well as your employer, a big favor by staying home. While your absence for a day or so may mean lost productivity, infecting others multiplies the problem.
We’ve all heard the adage that someone died of a broken heart. While the concept sounds romantic, it is anything but. When a loved one dies, the pain is so palpable. While for most of us it’s only an emotional trauma, it turns out that there is an actual medical condition based on physical symptoms, called broken heart syndrome. It is the name for sudden heart failure following a major shock, like the death of someone close to you.
Japanese doctors first recognized this syndrome in the early 1990s. They thought the enlarged heart that characterizes this condition, when seen on X-rays, looked like the flowerpot-shaped Japanese octopus trap, takotsubo, and named it as such. Also known as stress cardiomyopathy, it almost exclusively affects postmenopausal women.
It may be that as many as 1 to 2 percent of patients who are diagnosed with a heart attack in the United States are actually suffering from broken heart syndrome. While the symptoms are similar to heart attacks and can include chest pain, shortness of breath, and an irregular heartbeat, what is actually happening to your heart is totally different. A heart attack occurs when the muscle doesn’t get enough oxygen to meet its needs, usually due to a blocked artery. It leads to permanent heart muscle damage. Broken heart syndrome may present in the same way, but there is no blockage in blood flow. It is likely the result of a surge in adrenaline and other hormones that overwhelm the heart muscle and inhibit its ability to pump properly. The heart takes on a different appearance. The left ventricle becomes swollen, but the rest of the heart functions normally.
Broken heart syndrome can be caused by both emotional and physical stress. Many of the women who suffer from it are healthy and active, not people you’d expect to have a heart problem. Stressors can come in all shapes and sizes, some related to sadness and some more generally connected to higher states of agitation. In a report in the New England Journal of Medicine, doctors from Johns Hopkins University documented cases as a result of deaths in the family, heated arguments, public speaking—even a surprise birthday party! Experts aren’t sure why middle-aged women are at greater risk for a broken heart, but differences in hormones are one possible cause.
While broken heart syndrome can be fatal, almost all patients recover fully without any residual heart damage. It recurs in a small percentage of women and unfortunately there doesn’t seem to be any way to prevent it.
In stressful situations, if you feel like you are experiencing heart-attack-like symptoms, seek treatment right away, but don’t assume it’s a heart attack. Let your doctor know if you have just experienced an unusually emotional event. While very rare, you can die of a “broken heart.”
When you enter the hardware store near my home, you pass a sign requesting that you turn off your cell phone. When I questioned why the store was a “quiet zone,” the owner replied it had nothing to do with noise reduction. He had brain cancer and didn’t want to risk that radiation released by cell phones in the store could worsen it. I’m sure there’s nothing anyone could say about the absence of solid proof that cell phones cause brain cancer that would change his mind.
About 227 million Americans own a cell phone and most use it every day (some people it seems are on it every minute). What really happens to you when you hold a small, electromagnetic-wave-emitting device against your ear for hours on end? Do the waves penetrate your skull? Do they have any effect on your brain?
For years the scientific community has been trying to address these questions, searching for evidence of any danger. They have examined the issues from every angle: Exploring the effects of radiation on the brain, tracking brain cancer rates over the years of increased cell phone use, and comparing brain cancer patients’ cell phone usage to those without cancer. Thus far, the overwhelming majority of studies have not supported any connection between cell phone usage and damaging effects, let alone cancer, but that has done little to quell worries among the public. Let’s examine the research.
While we know that cell phones emit radiation, not all radiation causes cancer. For our purposes, you can divide radiation into two groups: Ionizing and non-ionizing. Ionizing radiation is produced by X-rays and UV light and has the ability to directly damage DNA in your cells. By doing so, it can cause cancer. Cell phones emit an entirely different kind of radiation. They work by using electromagnetic energy, a form of non-ionizing radiation that produces radiofrequency (RF) waves, similar to FM radio waves and microwaves. Those RF waves go from your phone to the cell tower transmitting your signal. While RF waves don’t damage DNA directly, at high levels RF waves can produce heat that can penetrate tissues. One small study looked at what happened to your brain when you held a cell phone up to your head for fifty minutes. It found a 7 percent increase in how your brain uses glucose in the area nearest the phone antenna. However, the study’s authors make an important point: It isn’t known whether the increased brain glucose metabolism is good, bad, or irrelevant.
From an epidemiological standpoint, if cell phone use causes brain cancer, we should have seen a similar upsurge in the disease as cell phones became more popular. The National Cancer Institute, which tracks cancer rates in the United States, found no increase in the rate of brain cancers between 1987 and 2007, the period of rapid increase in the use of cell phones. Data from Scandinavia, a region that was one of the first to introduce cell phones, similarly has found no increase in brain cancers. However, given that some cancers develop slowly, epidemiologists will continue to monitor these trends.
Many researchers have also looked at who developed brain cancer to determine if their cell phone usage was different from that of people who did not develop brain cancer, but the results have been inconclusive. In 2000, the international scientific community attempted a definitive study called Interphone. It was the largest study ever undertaken of cell phone use and brain cancer and included more than five thousand people with brain cancer, in thirteen different countries, all of whom were matched to similar people who did not have cancer. Unfortunately, the results actually caused more confusion than clarity. For those people who used cell phones the most, they did find an increased risk for two types of brain tumors, gliomas and meningiomas, especially on the side of the head that was their usual side for using their cell phone. But they found that people who used cell phones regularly had lower rates of brain cancer than people who never used cell phones. In fact, for everyone except those in the highest group of users, cell phone use decreased the risk of brain cancer. This does not make sense biologically. Normally there would be some adverse effect in occasional and moderate users if high users were developing cancer. Instead it showed beneficial outcomes of using cell phones. The conflicting results within the same study were attributed to bias and problems with the study itself. So much for clarity!
Worries were stoked recently when the WHO’s International Agency for Research on Cancer added cell phones to a long list of exposures that are possibly carcinogenic in humans. Their approach is to include any item with a possible cancer link, to encourage future research and to alert those who are risk-averse to change their behavior. To be on this list, which includes everything from gasoline to pickled vegetables, there only has to be minimal evidence of a connection.
So where does that leave us today? The scientific evidence thus far does not support a connection between cell phone use and cancer. It doesn’t make sense biologically and I am somewhat reassured by the stable brain cancer rates. However, I understand the concerns. This is a constantly changing arena and there is uncertainty given so many conflicting studies. But unlike environmental risks, over which you have little control, the use of cell phones is totally optional. If you are worried about developing cancer from using a cell phone, don’t use one! There are still many people who only use conventional phones. If you need to use a cell phone and are concerned, then minimize your exposure by using a hands-free device, such as Bluetooth or the speakerphone function. Texting instead of talking will also reduce your exposure by increasing the distance from the phone to your head. If you must speak on the phone, keep your calls short.
One last thing. I can’t leave this topic without a bit of a rant. While there is some debate about dangers of cell phone use and cancer, there should be no debate that cell phones can be dangerous. Cell phones in the car are a clear menace and there should be more uproar about these risks. A study by researchers at the University of Utah found that a driver using a cell phone, handheld or hands-free, is as impaired as a person driving with a blood-alcohol content of .08 percent (above the legal limit in most states). Texting while driving is even worse. It increases your risk of having an accident almost twenty-five-fold. If you are really concerned about cell phones and health, here is where your focus should be.
There has been no plausible explanation for exactly how the low-level, non-ionizing radiation emitted by a cell phone could cause brain tumors. Given the dramatic increase in worldwide cell phone use, the fact that there has been no corresponding surge in the cases of brain cancer weakens the chances of a true relationship. However, it’s easy to make simple changes to reduce your exposure. If you are really concerned about cell phones and your health, whatever else you decide to do, add this to the list: Turn yours off the next time you get in your car.
In 2010, Beau Biden, the forty-one-year-old Delaware attorney general and son of Vice President Joe Biden, had a stroke. That’s right, a stroke suffered by someone in his forties. While the risk for stroke goes up as you age, 10 to 15 percent of strokes occur in people younger than forty-five, making it critical for everyone to know the signs and symptoms to help themselves and others.
Here are some: Numbness and weakness on one side of the body. Confusion. Slurred speech. By any measure, these should be alarming symptoms. Yet in many cases, those who experience these telltale signs of stroke ignore them. According to the National Stroke Association, 42 percent of adult stroke sufferers wait an average of thirteen hours, and up to twenty-four hours, after the onset of symptoms before heading to the hospital.
Stroke is currently one of the leading causes of death and disability. On average, every forty seconds someone in the United States has one, which adds up to almost eight hundred thousand strokes per year. Strokes that are not deadly can lead to paralysis, permanent speech impairment, and emotional problems.
There are two basic types of strokes: Ischemic strokes, in which blood flow to part of the brain is cut off, and hemorrhagic strokes, in which a blood vessel in the brain bursts. Ischemic strokes are nine times more common than hemorrhagic ones, but both damage brain tissue.
Individuals who are at an increased risk of having a stroke include smokers, those with high blood pressure, heart disease, or diabetes. Individuals who have had transient ischemic attacks (TIAs)—“mini” strokes—are also at risk. TIAs occur when there is temporary blockage in an artery that keeps the brain from getting the blood it needs. Symptoms can last for just a few minutes or hours and can be warning signs that a bigger episode could be coming.
In nearly any case of stroke, early treatment is linked to a higher chance of surviving with the least amount of permanent neurological damage. This is especially true for ischemic strokes. With this type of stroke, administration of a clot-busting chemical known as tissue plasminogen activator, or tPa, has been shown to limit damage if it is given early enough after the onset of symptoms. This approach was confirmed in a 1995 study published in the New England Journal of Medicine that looked at hundreds of stroke patients and found that those treated within three hours after symptoms first appeared had a greater chance of being alive three months after their ordeal. If you wait too long to go to the hospital, you risk damage to more brain tissue and may miss the time frame during which tPa can work.
Yet, considering that most stroke victims wait at least thirteen hours before seeking care, it is clear that most Americans experiencing a stroke are missing this narrow window of benefit. Even patients who know the warning signs of a stroke—those who have had a stroke before—were unlikely to seek care soon enough because they did not judge their symptoms as serious. This needs to change.
To encourage people to take action and avoid denial, the National Stroke Association has a quick set of tips for determining whether someone is experiencing a stroke, so quick action can be taken. Known by its acronym, FAST, it involves the following memorable pointers:
• FACE: Ask the person to smile. Does one side of the face droop?
• ARMS: Ask the person to raise both arms. Does one arm drift downward?
• SPEECH: Ask the person to repeat a simple phrase. Does it sound slurred or strange?
• TIME: If you observe any of these signs, call 911 immediately because time matters!
For this and more information, visit www.stroke.org/site/PageServer?pagename=SYMP.
For stroke treatment, time is of the essence. The worst thing you can do when you are having the symptoms associated with a stroke is to ignore them or pretend that they are not serious. Don’t make that mistake. If you or someone you know is exhibiting any of the signs of stroke, call 911 immediately.
My wife recently went for an eye examination and was shocked to find that her doctor had lost more than one hundred pounds from lap-band surgery. The doctor explained that although she knew she was overweight, what concerned her most was that she was holding it all in her middle. She knew that excess belly fat was a predictor for future health problems. My wife came home surprised that the optometrist’s shape spurred her into action more than the numbers on the scale.
As if the list of things to watch for good health isn’t long enough already, add body shape to the mix. Numerous studies have shown that where you put on your weight can have an effect on your health. No one likes to be referred to as a piece of fruit, but when it comes to body shapes that cause concern, it’s as, well, comparing apples to pears.
Your particular body shape is determined partly by where you deposit fat. There are two types of fat: Subcutaneous and visceral. Subcutaneous fat is the under the skin, “pinch an inch” kind that most people commonly think of when they think of fat. Deposit your fat subcutaneously on your hips, thighs, and butt, and you will be more pear-shaped. Visceral fat is internal fat that is located around your organs. Deposit a lot of visceral fat in your belly and you will have a larger waist and appear more apple-shaped. Unlike subcutaneous fat cells, visceral fat cells are very metabolically active, producing hormones that can cause insulin resistance, a precursor to type 2 diabetes.
In some studies, the relationship of your waist measurement to your hip measurement is more closely tied to early, hidden signs of heart disease than other common measures of obesity, including your body mass index (BMI) and the waist circumference alone. Although the importance of body shape has not been accepted by the entire medical community, it hasn’t stopped a veritable “belly fat” industry from pushing books, diets, and exercise regimens focused on reducing visceral fat.
Unfortunately, the reality is that a lot of what determines your shape is out of your control. If your parents were apples, you will have a predisposition toward becoming one, too. Women tend to put on more belly fat once they hit menopause; men put on more belly fat than women during their younger years. Although I am convinced by the science that belly fat is more dangerous than other fat, in the end I don’t pay much attention to body shape. Here is why: It isn’t that “pears” are at no risk and don’t have to pay attention to their health. You can be pear-shaped and be quite unhealthy.
Regardless of which fruit you resemble, you need to do the same things to be healthy: Eat a balanced diet and get exercise. Aerobic exercise and an appropriate diet are great ways to reduce both visceral and subcutaneous fat, improve your cardiovascular health, and reduce your risk for diabetes and other diseases.
Although the debate rages on, there does seem to be some validity to the idea that your waist size, and how it stacks up to your hip size, affects your risk for diabetes and heart disease. If you had your choice, you’d do better being born a pear than an apple. However, the fact is that carrying too much fat on your body is unhealthy, period. Instead of worrying about whether you are an apple or pear, aim to be the healthiest apple or pear you can be.