The best lab test to assess Vitamin D levels is the “25 OH Vitamin D Level” test.

What Vitamin D level is considered deficient?

Ideal blood level: 40-70 ng/mL

Sufficient blood level: 30 ng/mL

Insufficient blood level: 21-29 ng/mL

Deficient blood level: 10-20 mg/mL

Severly deficient blood level: 0-10 mg/mL 

How do you treat patients with Vitamin D levels considered less than optimal?

21-29 ng/mL: Recommend 50,000 IU of Vitamin D2 (Once per week for four months)

Less than 20 ng/mL: Recomment 50,000 IU of Vitamin D2 (Twice per week for four months)

I would also advise patients to maintain a daily dosage (over the counter) of 2,000 IU to 5,000 IU of Vitmain D3. Three months after beginning treatment, I would check up on my patient’s 25 OH Vitamin D level.

WARNING

Anyone taking the clot-preventing drug Clopidogrel (Plavix) after receiving a stent in a coronary artery opening procedure should avoid a type of popular heartburn medications called proton pump inhibitors (PPIs).

PPIs include medications such as Nexium, Prevacid, Protonix, Aciphex and Prilosec.

The Clopidogrel (Plavix) Medco Outcomes Study was recently presented at the Society for Cardiovascular Angiography and Interventions (SCAI)’s annual scientific sessions.

The study reported patients taking both Plavix and PPIs experienced a 50% increase in the combined risk of hospitalization for heart attack, stroke, unstable angina (chest pain), or repeat revascularization. A more in depth review demonstrates patients who received a PPI had a 70% increase in the risk of heart attack or unstable angina; 48% increase risk of stroke or stroke-like symptoms’ and a 35% increase in the need for a repeat coronary procedure.

This study followed 16,690 patients taking Plavix for a full year following coronary stenting. The patients in the study were taking PPIs – Protonix, Nexium, Prilosec, and Prevacid for an average of nine months post stenting. This trial did not look at outcomes in patients on newer PPIs such as Aciphex or Kapidex. The experts report that PPIs decrease the efficacy of Plavix secondary to decreased absorption as compared to the population of patients who used Plavix alone.

Patients who receive a stent are prescribed Plavix to prevent clots from developing. Plavix does increase the risk of bleeding and GI upset; therefore, many providers have routinely given PPIs to patients taking Plavix to prevent gastrointestinal side effects.

The SCAI now suggest providers who are treating post stenting patients on Plavix therapy to consider prescribing histaminergic (H2) blockers such as Zantac or Tagament or antacids instead of a PPIs due to the high risk for adverse events with Plavix and PPI combination as demonstrated in this recent study.

If you are currently taking Plavix and a PPI, I would encourage you to discuss this combination with your health care provider. Perhaps a H2Blocker would be a better treatment for you.

]]> http://captaincardio.wordpress.com/2009/05/11/stent-patients-advisory-switch-heartburn-drugs/feed/ 0 Becky http://captaincardio.wordpress.com/2009/02/24/7/ http://captaincardio.wordpress.com/2009/02/24/7/#comments Tue, 24 Feb 2009 22:19:00 +0000 Becky Captain http://cardiowellness.wordpress.com/2009/02/24/7/ ]]>

What happened? One minute we are worshipping the sun, building solariums in our hospitals, gagging down cod liver oil, baking in the sun, and now in the 21st Century we have frightened ourselves out of the daylight. Why is that?

Well, unfortunately, over the past 20 years the relationship between sunlight and skin cancer has been blown out of proportion. AND as per our typical American tradition, we go to extremes when it comes to our health. So from Sun Worshipers to Sun Phobes we went. Wearing long sleeves, long pants, floppy hats, and slathering every inch of our bodies with sunscreen every time we go out in the sun. The cosmetic arena of the pharmaceutical industry helped us in our beliefs, too, as the once anti-sunburn cream turned into the new cancer prevention cream.
So let’s discuss sunburns. A sunburn is much different than a tan. The redness of a sunburn is caused from increased blood flow to the skin so that it can attend to cells that have been damaged by the sun. When damaged enough squamous and basal cells in the skin cannot repair themselves so they die off so they won’t replicate in a mutated state and cause cancers. Severely damaged melanocytes stay alive however. These cells replicate in a mutated way and present themselves later in life as cancer-melanoma. So the key here is not to not go into the sun; but, to go into the sun…just don’t burn.

Let’s look at the Skin Cancer facts (The UV Advantage 2003- Authors Holick and Jenkins)

Non-melanoma- caused by long term sun exposure

• Fewer than ½ of 1% die
• Claims 1200 lives annually

Melanoma-seen more often in people who do NOT receive regular sun exposure

• Comprises 10% of all skin cancers
• 85% of skin cancer deaths
• Kills 7,000 annually

With those facts we need to be cautious about going into the sun and not burn. But, let’s compare the sun risk with diseases that can be prevented by regular sun exposure:

• Colon, Breast Cancers 20-65% mortality rate
• Kills 138,000 annually.
• Osteoporosis affects 25 million Americans.

And every year 1.5 million people with osteoporosis suffer broken bones which can be fatal when the person is elderly.

(Yes, sun exposure reduces the risk of these cancers and osteoporosis)
The risk of sun exposure pales in comparison to the sun’s benefits. Sun exposure can not only result in fewer cases of internal cancers (breast, ovaries, colon, prostate, stomach to name a few) but can reduce fractures from osteoporosis, reduce rates of depression associated with seasonal affective disorder as well.

Look at the maps (above this post). Look where most of the Colon and Breast Cancers are located (red states)…in states with less sun exposure…states away from the equator.

With all the advances we have made in medicine over the past 20 years it is disturbing to know that Vitamin D deficiency and its’ disease states are once again on the rise in the United States. Yes, rickets (weakening of bone in children) and osteomalacia (vague aches, pains and weakening of bones in adults) are back on the rise.

What about fibromyalgia? Let’s shed some light on Fibromyalgia. Is it Fibromyalgia or is it really Osteomalacia? Fibromyalgia was basically unknown until about 15-20 years ago. Fibromyalgia symptoms are muscle pain and weakness. The condition is usually diagnosed when providers can’t find anything else to explain the vague muscle and bone aches. There is no specific test to confirm a fibromyalgia diagnosis. Guess what folks? Check your Vitamin D levels. Dr. Holick reported that between 40-60% of people who came to his clinic with fibromyalgia actually had Osteomalacia due to Vitamin D deficiency. There’s a lot to be learned from this. We all should get about 10-15 minutes of raw exposure to the sun two to three times per week. The key is not to burn. In cities north of Atlanta from November to February the sun’s rays are not strong enough to give us Vitamin D. Therefore, it is important for us to get adequate supplements during these months. I recommend the CardioDaily multivitamin as it is the only multivitamin I know that has 2000 IU of Vitamin D in it.

Most people ask what foods can we get Vitamin D from. An 8 ounce glass of Vitamin D fortified milk is suppose to contain 100 iu of Vitamin D. However, in studies most so-called Vitamin D fortified milks contained less than 20% the amount listed on the label. Although, milk, eggs, and salmon contain Vitamin D, they are in amounts too small to maintain adequate levels for our bodies. So in the winter months here in Kansas City (or any city north of Atlanta for that matter), make sure you take your CardioDaily. If you haven’t had your Vitamin D level checked you might want to have this done…you just might be surprised.

Questions you might have:
Do I advocate Tanning? Not true. I would advocate common sense when it comes to being in the sun.
Do I lie out in the sun for hours w/o protection? Not True.
Do I go out in strong sunshine w/o sunscreen on and does my skin get tanned? Yes. Why? I recognize my body needs a certain amount of sun exposure to be healthy.
Do I put sunscreen on after a certain amount of time? Yes. Why? I understand there are risks as well as benefits with being in the sun

Becky K. Captain, RN, MSN, CLS, BC, FNP-C
Nurse Practitioner

Does the following sound familiar? You know you’ve got to start exercising and you vow to park the car in the furthest parking space, hit the gym after work, sign up for an exercise class, and take the stairs.

But a week passes and before you know it, parking spots are opening up right in front of the stores and buildings, the elevator is already in the lobby and you’ve had an intense week of juggling work, kids and deadlines. How could you have ever thought you could fit in exercise when you have 100 things to do (including your bone density test)? Really, what were you thinking? You still have to organize the sock drawer and Tupperware cabinets. How can you exercise with those items in such chaos?

Been there? Many of us have.

So why does exercise seem so wonderful until we actually have to do it? Lack of motivation? OR is it a misunderstanding that leads us to believe motivation is something that will come to us if we wait long enough…that someday we’ll wake up and finally want to exercise. We must stop living in that fantasy. The reality of motivation—it is something we create—not something we wait for. So, stop waiting for the motivation to come to you—just do it! Make it happen today!

Here are six ways to create your motivation.

1. Don’t Count the Calories Burned
One of the ways to keep exercising is not counting the calories burned or weight lost. There are more important things transforming in your workout, such as new-found self-esteem, stress reduction, increased endorphin levels (happy hormone), improving memory and cognition and adding longevity to your life, to name a few.

2. Be Accountable
Hold yourself accountable. Mark an “X” on your calendar every time you exercise. Seeing your motivation (or lack thereof) in black and white helps to keep you focused on your goal.

3. Join Up!
Join a club, exercise class, or exercise with a buddy or a dog. Statistics tell us that we are more consistent with exercise when we do it with a companion. Just knowing someone is waiting for you to exercise helps you to show up and get it done.

4. Challenge Yourself
Sign up for a local 5K walk/run or bike trip. It will help you stay focused on your exercise goal while accomplishing a new activity. Not only will you benefit from the exercise; but, from your community involvement too.

5. Reward Yourself
Put a dollar or two in the jar every time you complete a workout. When you have enough money, treat yourself to a massage, new CD, workout outfit, session with a personal trainer, or new piece of sport/exercise equipment.

6. Motivate Your Mood
Often people will say it’s my mood that either motivates me to exercise or not. Regardless of your mood prior to exercise—exercise has been known to improve your mood. Work out your aggressions in the gym instead of at home or work. The only obligation in any lifetime is to be true to yourself. So, ask yourself what the secret to YOUR success is. Listen to your answer. Then practice it. See you at the gym or out on the sidewalks and trails!

I met Mr. Smith in July of 2007.  He came to the Preventive Clinic based upon a strong recommendation from a life long friend.  Mr. Smith informed me at our first visit that he had come to reduce his risk factors for heart disease.  Mr. Smith was full of kindness.  He exuded his benevolence at his first Clinic appointment where he started our meeting with kind words for the patient who had referred him to me.  Over the past year, Mr. Smith and I have been meeting to optimize his health and reduce his risk for heart disease.  During this time, I have come to have a deeper connection with Mr. Smith and have learned more about his life and his kindness.  Perhaps this trait, his kindness, will and/or ultimately added just as much quantity and quality to his life as reducing his heart risk factors.

In the book Meaning & Medicine (Bantam Books, 1991) Dr. Larry Dossey states, “Altruism behaves like a miracle drug, and a strange one at that.  It has beneficial effects on the person doing the helping-the helper’s high; it benefits the person to whom the help is directed; and it can stimulate healthy responses in persons at a distance who may view it only obliquely.”  

Kindness enhances us psychologically as well as physiologically.  How is this?  Our body manufactures chemicals called endorphins.  Endorphins are naturally occurring morphine-like substances that create a feeling of bliss within us.  Not only do they provide us with a “feel good experience” but, the endorphins also reduce pain messages being delivered to the brain.

When you choose to become a kinder person, you are not only improving the well being and health of yourself but of those you come into contact with, too.  Your kindness has a ripple effect.  It has the magical ability of causing even those who have witnessed the act to spontaneously feel good. 

Authors Allan Luks and Peggy Payne mention some of the benefits of “doing good” in their book The Healing Power of Doing Good (Fawcett Columbine, 1991).  These include a more optimistic and happier outlook on life, sense of exhilaration and euphoria, increase in energy, feeling of being healthy, decreased feelings of loneliness, depression and helplessness, sense of connectedness with others, greater sense of calmness and relaxation, increased longevity, stronger immune system, reduction in pain, reduction of excessive stomach acid, reduction of high blood pressure, and improved circulation to name a few.

It was this past winter during one of our meetings that Mr. Smith was speaking of places in Liberty, Missouri.  I told him I was familiar with Liberty and that I visit my grandmother in an assisted living facility there.  I was certain he wasn’t aware of this facility as it is a small facility and not well known.  I was wrong.  Mr. Smith informed me both his parents had lived in that facility and he and his wife visit a few people there on a monthly basis.  He immediately added my grandmother’s name to the visit list.  What a wonderful act of kindness. 

As you see, my grandmother lives for visitors, mail, and outside food.  She is 91 years old and quite forgetful.  So on my next visit to see grandmother, I placed a note on her table reminding her the Smiths who were friends of mine might be stopping by.  Soon, my mother, sees the note.  “The Smith’s?   That’s Mrs. Smith’s son, the lady who I took piano lessons from.  She was a real nice lady.” My mother has fond memories of her piano recitals too.  She did a duet with another one of Ms. Smith’s students at a recital.  They never practiced together until the day of the recital.  Ms. Smith had just played the different part of the duet during their piano lesson and come recital day the two girls who hadn’t met became connected and created a fond memory together.  Making this much more than a solo event.

Just recently, I had the opportunity to see Mr. Smith again.   He had lost 10 pounds, changed his eating habits, prevented diabetes and subsequently significantly reduced his heart disease risk.  Briefly I had mentioned his mother was a piano teacher.  His eyes widened and said, “Yes, she was.”  I told him my mother’s name and that she had taken lessons from his mother.  He went on to inform me that he had visited my grandmother the previous month.  

Mr. Smith has made positive lifestyle changes and his physiological risk factors are now minimized.  Just as importantly as living a “heart healthy” lifestyle, he continues to deliver random acts of kindness which as we have come to know enhances us both physiologically and psychologically as well.  One would only predict his life will continue to be enriched. 

It’s interesting that the beneficial effect of helping others holds the power to not only affect our own health, but the health of our entire tension filled society. To better ourselves and our community, not only should we exercise, eat healthy, have our risk factors assessed; but, we should all strive to deliver acts of kindness daily.  We meet a lot of people and come across many connections daily.  One never knows how our acts of kindness will positively affect others….perhaps for generations to come.  With Mr. Smith, this has come Full Circle and it started in the 1950s with his mother teaching my mother piano.

Living Your Priorities

I saw a patient today who was tearful over her current predicament. She is overweight, has high blood pressure, high cholesterol, and is now pre-diabetic. She broke out in tears stating she felt “she had failed herself.” She felt sad that she had just let herself go over the past several years and now must fight to prevent diabetes and heart disease. How many of you have felt just that way?

In my practice setting, I am often the first person who tells patients they are diabetic, pre-diabetic, have high blood pressure or that they are obese with increased abdominal fat– all of which will lead to diabetes, heart disease and poor health if they continue their current lifestyle. Please note, this isn’t the first patient to become tearful or sad over her current situation. In fact, both grown men and women experience this same emotion. The key point to remember here…and as I tell my patients….this is NOT about where you have been…But it is about where you are going.

Starting right now at this very moment we will make our health a top priority. Yes, this means making changes. Some changes might be a little uncomfortable and you may be on unfamiliar ground at times. But, not only will you add years to your life by making positive lifestyle changes; you may find a better quality of life too. Here are some basic priorities to healthy living and tips to incorporate them into your life.

1) Complete some type of exercise on a daily basis.

You can’t wait for the day to begin because you get a chance to exercise today. (That’s the spirit!) Change your way of thinking. Change your life so this is a priority.

If you are taking your children to baseball practice or piano lessons, etc, put on some walking/jogging clothes and exercise while they are completing their activity.

Instead of meeting your friends to “catch up” over dinner or after work for a few drinks- meet at the local community center, join a class together and see each other weekly. If you can’t afford a class… meet at a park and walk/jog together.

It will not happen unless you MAKE the time.

Additionally, you will surprise yourself how many people will see you as a role model and work exercise into their lives too…all because you did.

2) Choose to eat healthy today.

Get protein for breakfast, lunch and dinner. Eat 4 fruits and 4 vegetables daily. These are the basics of healthy eating. This is your priority for your daily diet. Don’t go for the bagels, English muffins, candy bars, chips, etc…until you have had the basics. In most cases you will not feel the need to eat so much of the other non healthy food choices once you have had the basics. If you are still hungry you can have all the vegetables you want. Then, utilize Joan O’Keefe’s Three Bite Rule from her current blog.

3) Get 6-8 hours of sleep daily.

I know it is difficult some nights to get an adequate amount of sleep due to demanding schedules. But it should be one of your daily priorities, as an adequate amount of sleep contributes to our daily health.

These are 3 basic interventions to healthy living. Make them your priority. Your life and your loved ones are depending on it. My parents often stated, “Don’t lose sight of your goals or priorities.” It is so easy to do in this world today-so much hustle and bustle and so many distractions. It is important that you take the time to make the best decisions for your health on a daily basis. Your health today is a reflection of your past decisions, but your health tomorrow is a reflection of your decisions today.

No matter what our backgrounds are, our troubles, failures or successes in life…we all have the same inner guidance to change our lives and change our health for the better.

Becky