Heart attack season is upon us...

Heart attack season

In the U.S., the risk of having a heart attack during the winter months is twice as high as it is during the summertime. Why? There are a number of factors, and they're not all linked to cold weather. Even people who live in warm climates have an increased risk. Here are the areas you need to pay extra attention to this winter.

Cold temperatures: When a person gets cold, the body responds by constricting the blood vessels to help the body maintain heat. This causes blood pressure to go up and makes the heart work harder. Cold temperatures can also increase levels of certain proteins that can thicken the blood and increase the risk for blood clots. So stay warm this winter, and when you do have to go outside, make sure you bundle up in layers with gloves and a hat, and place a scarf over your mouth and nose to warm up the air before you breathe it in.

Snow shoveling: Studies have shown that heart attack rates jump dramatically in the first few days after a major snowstorm, usually a result of snow shoveling. Shoveling snow is a very strenuous activity that raises blood pressure and stresses the heart. Combine those factors with the cold temperatures and the risks for heart attack surges. If your sidewalk or driveway needs shoveling this winter, hire a kid from the neighborhood to do it for you, or use a snowblower. Or, if you must shovel, push rather than lift the snow as much as possible, stay warm, and take frequent breaks.

Winter weight gain: People tend to eat and drink more, and gain more weight during the holiday season and winter months, all of which are hard on the heart and risky for someone with heart disease. So keep a watchful eye on your diet this winter and avoid bingeing on fatty foods and alcohol.

Shorter days: Less daylight in the winter months can cause many people to develop “seasonal affective disorder” or SAD, a wintertime depression that can stress the heart. Studies have also looked at heart attack patients and found they usually have lower levels of vitamin D (which comes from sunlight) than people with healthy hearts. To boost your vitamin D this winter, consider taking a supplement that contains between 1,000 and 2,000 international units (IU) per day. And to find treatments for SAD, visit the Center for Environmental Therapeutics website at cet.org.

Flu season: Studies show that people who get flu shots have a lower heart attack risk. It's known that the inflammatory reaction set off by a flu infection can increase blood clotting which can lead to heart attacks in vulnerable people. So, if you haven't already done so, get a flu shot for protection. See flushot.healthmap.org to find a nearby vaccination site.

Dementia in general...

Dementia in general, and Alzheimer's disease in particular, count among the most frightening prospects of our senescence. My patients routinely convey this worry to me. I'm right there with them. And most of us know—first hand, through our social networks, or via media portrayals—how devastating it is for patient and family alike to deal with a condition that leaves intact the appearance of health, while destroying its inner essence.

And so most people are eager to know what they can do prevent dementia. There is abiding interest in brain-specific "superfoods," cognition-enhancing supplements, and pharmacotherapeutic advances. There is as well a booming market in mental calisthenics, from crossword puzzles to Sudoku, which purportedly keep the brain in fighting trim.

There certainly is some evidence to support a "use it or lose it" approach to brain health. A lifetime of cognitive activity, which I suppose in the vernacular would be "thinking," is associated with a lower risk of developing dementia. It is less clear that any specific approach is protective, or that mental gymnastics provide much defense once cognitive decline has begun. Much of this thinking about thinking remains wishful, and a work in progress.

But there are three areas where our knowledge about how best to mind our brains, and protect them, is quite well established.

1. The ankle bone is connected to the shin bone.

This expression we all know was never really just about our legs—it was about holism. Our bodies are healthy, or they are not; the status of any part affects the whole. The brain is a vital organ, vitally dependent on the health of the whole. A healthy brain requires a healthy vascular system, to deliver an appropriate blood supply. It requires healthy kidneys and a healthy liver to ensure that blood is free of toxins. It requires a strong heart to pump that blood under suitable pressure. And so on.

The notion that there are super foods or super supplements specific to the health of the brain is thus more about marketing than science. What is good for health overall is good for the health of the brain. And conversely, what is harmful to the body is harmful to the mind.

2. Mind the heart, mind the brain.

While there are aspects to Alzheimer's disease that are unique, overwhelmingly it and other common dementia's appear to be variants of cardiovascular disease. There may be genes that predispose someone to Alzheimer's, but it is garden-variety cardiac risk factors that tend to result in those genes being expressed as the condition itself.

Studies associate dementia with high blood pressure and dyslipidemia (high levels of the "bad" cholesterol variants). In particular, there appears to be a strong association between Alzheimer's and insulin resistance, a state associated with obesity and diabetes risk. Some experts have argued this link is so strong that Alzheimer's should be considered "type 3 diabetes."

3. Move the body, take the mind along.

Since Alzheimer's and related dementia's have much in common with cardiovascular disease, we have long had cause to believe that physical activity was protective. We have more cause now.

Hot off the presses is a study in the journal Stroke, indicating that routine physical activity protects brain function, prevents dementia, and preserves functional independent in older adults.

The study, followed over 600 adults in countries throughout Europe. Cognitive function was assessed along with lifestyle factors, including physical activity level. MRI scans were used to evaluate brain status directly. The punch line is that routine physical activity was associated with a reduction in the risk of dementia of any kind by about half. The effects were robust and independent of age and education, along with a number of other factors.

So, while mental calisthenics may protect the brain, conventional calisthenics almost certainly do. Exercise is a mind game.

Study after study after study after study that has shown an elimination of up to 80 percent of all chronic disease with the application of lifestyle as medicine has not carved out an exception for Alzheimer's. The evidence that we can alter gene expression with the power of lifestyle almost certainly pertains to Alzheimer's as it does to cancer. By minding our bodies, we can mind our minds too. We can best mind both by minding the short list of what matters most to health.

There is some evidence to support what most of us have heard about "brain foods." Fish consumption appears to protect brain function, most likely by contributing omega-3 fatty acids to the diet. An omega-3 oil supplement, 1 to 2 grams daily, is an alternative. Antioxidants in food appear to be protective as well, contributing to the reputations of blueberries, red wine, and green tea. But while an inventory of potential brain foods can be assembled, the evidence is much stronger for the importance of the overall dietary pattern.

Similarly, exercising the brain may be a good idea. But the preservation of good ideas may owe as much or more to exercising the body.

Alzheimer's remains scary. But we all have far more potential to prevent it than most of us exercise—by exercising, among other things. So take your head in your hands, and get in the game. Because it turns out that health promotion is a mind game too.

We're back...

We have been offline since Monday but promise to be up and running by November 5. Please keep all of those affected by the storm in your thoughts and prayers!

Sandy's on the way. Are you prepared?

No part of the country is immune from the effects of Mother Nature.

You don't have to become a survivalist, do you know what you would need if there is an evacuation and you 10 minutes or two days to prepare for an evacuation? The value of preparation, which includes having a plan A, B, C, D and E can be the difference between life and death for you and your pets. The devastating tornado that wiped out communities in and around Joplin, Mo., in 2011 offers another shocking reality check. When disaster strikes, you must be your own first responder. The right tools and the right plan can make a big difference.

Here are 10 tips to help kick-start your emergency plans.

1. Create an emergency contact list. Start with friends or family members who live nearby and can reach you or your pets quickly. Make sure they have keys, necessary codes or other information to access your home, grab the pets and evacuate. For every Plan A, have a Plan E. Most Plan A's don't happen, so Plan C has to be just as good.

2. Make an emergency kit. Fill a backpack with at least two weeks' worth of food for your pets and plan for at least a gallon of water per day, per pet. If your animal eats wet food, then it will consume less water.

3. Try camping, or at least learn a few skills. Hotels frequently change their policies during emergencies, so have a camping kit to set up wherever it is save, dry and unaffected by the current disaster event. If you lack that wilderness gene, stop by an outdoor shop for primers on purifying water or other survival skills. While you are there, stock up on a few tools, plates and a utility knife.

4. Practice makes perfect. Take a weekend and rehearse your emergency evacuation plan. It should include finding alternate exit routes for your neighborhood, just in case a downed tree or other issue creates an obstacle.

5. Take a certification course. For the best experience in planning for a disaster, learn from the experts. Sign up for a FEMA certification course or join your county emergency response team. It's one way to guarantee that you have first-hand info.

6. Invest in sturdy pet carriers. Whether your pet goes to a relative or an emergency shelter, it needs a safe place to stay, says Toni McNulty, team lead for animals in disaster with HumanityRoad.org @Redcrossdog on Twitter, a nonprofit organization that uses social media to fill the communications gap between those affected by disaster and those responding to disaster. Try a collapsible crate that is large enough to hold food and water bowls, and allows your pet to stand and turn around. "Get it ahead of time and let your pet get used to it. Mark with contact information. If your pet winds up in an emergency shelter, that contact information is necessary." It also helps to include a few favorite toys or bedding.

7. Stock the basics in an emergency bag. Be sure to include a leash (for dogs and cats), a collar with identification information, a harness and a muzzle, even if your pet is the sweetest in the land. "If an animal rescue person tries to pick up your pet, you don't want your pet biting," McNulty says. "Pets pick up stress, just like people in an emergency, and they can behave in a way that they normally don't."

8. Carry copies of documentation. Grab a waterproof container and use it to hold copies of your pet's vital information, McNulty says. The container should hold pictures of your pet, as well as a list of medications, allergies, vaccination records, a rabies certificate, and disaster contacts — inside and outside of the disaster area. When Johnnie Richey was killed in the Joplin tornado, his 9-year-old cocker spaniel was eventually reunited with the owner's sister, Kerri Simms. "Even though her brother is gone, she could retrieve his pet and have a little bit of her brother through that pet," McNulty says. "That's why it's so important that you have pictures and out-of-area contacts."

9. Carry photos that show you with your pet. To alleviate any confusion when it's time to recover your pet from an emergency facility, be sure to carry photos that show you and your pet together. McNulty says to attach those photos as proof of ownership on your pet's crate.

10. Don't wait for the second or third warning. If you live in an area that's known for weather emergencies, act as soon as you hear a warning, McNulty says. "When pets sense urgency, they hide and you lose valuable time trying to find them," she says. Keep leashes, collars and crates ready at a moment's notice, particularly if you live in a mobile home or vulnerable structure.

It also helps to bookmark a few key websites and Twitter addresses. Here are a few worth noting:
FEMA: For information regarding pets, check out the FEMA.org site before and during an emergency. (@FEMA on Twitter)

Pet-friendly lodging: In addition to checking HumanityRoad.org for frequent updates, McNulty often recommends Petswelcome.com and BringFido.com because these sites list hotels that accept multiple pets, exotic animals, birds and gerbils. But keep in mind that rules may change during emergencies.

The Red Cross: Although the Red Cross does not accept pets during emergencies, it's important to bookmark the site for evacuation information regarding your area.

Falls could indicate early onset Alzheimer's

Compared with older people with no signs of Alzheimer's, those whose brains show early signs of the disease are twice as likely to experience a fall, researchers have found.

In the new study, investigators looked at brain scans of 125 older adults who were participating in a study of memory and aging. The seniors were also asked to keep track of how many times they fell over the course of eight months.

An increased risk of falls was noted among individuals whose scans showed early signs of Alzheimer's. The study authors suggested that falls could indicate the need for an evaluation for the memory-robbing disease.

"To our knowledge, this is the first study to identify a risk of increased falls related to a diagnosis of preclinical Alzheimer's disease," study author Susan Stark, an assistant professor of occupational therapy and neurology at Washington University in St. Louis, said in a news release from the Alzheimer's Association International Conference.

"This finding is consistent with previous studies of mobility problems among persons with very early symptomatic Alzheimer's or mild cognitive impairment. It suggests that higher rates of falls can occur very early in the disease process," Stark added.

The study, which was slated for presentation Sunday at the Alzheimer's Association International Conference in Paris, found that of the 125 adults studied, 48 people experienced at least one fall.

The brain scans of the participants showed that higher levels of an imaging agent that binds to the abnormal protein growth that is a signature of Alzheimer's disease, was associated with a 2.7 times higher risk of a fall for each unit of increase on the scan.

The researchers noted that Alzheimer's has been linked to balance and gait disorders, as well as problems with visual and spatial perception, which could put people with the disease at higher risk for falls. Based on their findings, they added, these symptoms may appear before other more obvious signs of the disease, such as memory loss and impaired thinking.

"Growing scientific evidence suggests that 'silent' biological changes may be occurring in the brain a decade or more before we can see the outward symptoms of Alzheimer's," Maria Carrillo, Alzheimer's Association senior director of medical and scientific relations, said in the news release. "According to this study, a fall by an older adult who otherwise has a low risk of falling may signal a need for diagnostic evaluation for Alzheimer's."

The study authors concluded that additional research is needed to improve early detection and intervention in Alzheimer's disease. Lowering the risk of falls, they added, could also have an economic impact since these incidents contribute to higher rates of disability among older adults, premature placements in nursing homes and more than $19 billion in direct medical costs in 2000 alone.

Insomnia Major Driver of Costly Workplace Accidents & Errors

A national study led by Harvard Medical School researchers found that insomnia was associated with a much higher percentage of workplace accidents and errors than any other chronic condition. These errors were also more costly. Researchers estimate that insomnia costs employers $31.1 billion annually.

Researchers conducted a cross-sectional survey of commercially insured individuals. Participants were asked about nineteen chronic conditions including diabetes, arthritis, and depression. Researchers looked into medical and pharmaceutical claims to confirm these conditions, and those that reported insomnia were then screened to ensure that their insomnia was not caused by other chronic conditions. Participants were also asked if they caused damage, work disruption, or mistakes that cost their company $500 or more.

Those who suffered insomnia were responsible for 7.2 percent of all costly workplace accidents or errors, which is a 40 percent higher risk than workers with any other condition. These mistakes were also associated with higher costs. 23.7 percent of all costs spent on workplace accidents or errors were generated by individuals with insomnia.  Insomnia related errors cost on average $32,062, while non-insomnia errors cost $21,914 on average. This difference was even seen when researchers controlled for educational level, age, and other demographic factors.

To learn more about this read Time Magazine article.

Medicare open enrollment starts today...

Medicare open enrollment is just around the corner Oct. 15 - Dec. 7. Whether you’re a person with Medicare, a caregiver, or professional helping clients to review their coverage options, we’ve got some helpful tips for you to keep in mind this season.

Tips for Consumers

1. Start early - Yes, open enrollment runs until Dec. 7. But the best time to start thinking about whether you want to change your drug or health coverage is now. If your circumstances have changed—for example, you’re taking different medications, or you’ve heard that your plan is changing—it’s important to have time to review all your options. And if you need personalized assistance, it’s easier to schedule an appointment now than if you wait until after Thanksgiving.

2. Pay attention to your mail - This is the time of year that you’ll start to get a lot of information.
Your Part D or Medicare Advantage plan sends out an Annual Notice of Coverage in September, which explains any changes happening to your plan and/or to your benefits in 2013.
If you get help paying for your Medicare, such as through the Medicare Part D Low Income Subsidy (Extra Help) or Medicare Savings Programs, you may receive mail from Social Security or Medicare asking you to verify your income or informing you of changes to your subsidy. You may also get a letter if your plan is ending service in your area, or has not met quality standards for three years. Save all of these letters, and have them on hand as you discuss your options with an SGIA (Strategic Growth Insurance Associates) counselor.

3. Review, review, review - Many people are happy with their current coverage, and would rather not check what other options are available to them. But this is a very important step, and can save you money. What should you look for? We like to remind people of the 4 Cs:

• Cost - How much have you spent in premiums, deductibles, and co-payments in 2012? How will these amounts change in 2013??
• Coverage - Does your plan cover all of the medications you believe you will need in 2013?? Do you want to get your health care and drug coverage through one single plan? If so, you should review your Medicare Advantage options.
• Convenience - To what extent will your plan restrict access to certain medications you need in 2013, such as through prior authorization or quantity limits? Can you use the plan at the pharmacy of your choice? Can you get your prescriptions through the mail if you prefer to?
• Customer service - Is your plan responsive when you have a question?