Tuesday, April 2, 2013

What Cardiologists Tell Their Friends

By Redbook | Healthy LivingMon, 1 Apr, 2013 9:45 AM EDT

What's better than having a fashionista or a foodie as a BFF? Being pals with a heart doctor. The health advice these experts give their nearest and dearest can help you live longer, healthier, and more sanely.

By Lisa Mulcahy, REDBOOK.

"Go easy with the exercise"

"A lot of my female friends are very focused on staying fit, and that's great. But new research shows that running even 20 to 25 miles a week, which a lot of women log, can actually age your heart. Repeated excessive effort can overstretch the heart muscle, causing micro-size tears--damage that is often seen in marathon runners. The scary truth is that it can reverse the benefits of cardio exercise, putting you in the same fitness boat as couch potatoes who never work out! I have a friend who is a triathlete--she swims, runs, and bikes every day--and I told her, 'If you want to see the Olympics in 2052, start cutting back your workouts now.' It's fine to run, but don't clock more than four running days per week or more than about four miles per run. The other three days? Take a walk!" --James O'Keefe, M.D., preventive cardiologist at Saint Luke's Mid America Heart Institute in Kansas City, MO

"Try not to wake up before 5 a.m."

"One friend of mine, a CEO of a very successful company, prides himself on getting out of bed at 4:30 to get a jump on his business competition. I told him, 'If you don't let yourself sleep till 5, you're setting yourself up for a heart attack.' He laughed, 'I'm too rich to die!' But he listened when I told him that most people's internal clock resets itself every morning at approximately 5 a.m. Wake up before that and your stress hormones can surge--this is one reason why most heart attacks occur around 3 or 4 a.m. Making this adjustment won't destroy your career, but it potentially will save your life." --Lisa Matzer, M.D., cardiologist in Los Angeles

"Don't use the Pill past age 40"

"If a friend of mine who is over 40 mentions to me that she's on the Pill, I'm not shy about advising her to get off it right away. As you get older, you really have to pay attention to how estrogen can potentially cause damage to your heart. Most women don't think about this when choosing contraception, but birth control pills can lead to blood clots that could cause a heart attack or stroke in women in their mid-30s to late 40s. The good news? Once you go off the Pill, your hormones regulate quickly and your heart-attack or stroke risk will go away in about six weeks." --Karla Kurrelmeyer, M.D., cardiologist with the Methodist DeBakey Heart & Vascular Center in Houston

"Any soda is too much soda"

"Most of us grew up with the idea that soda in moderation can be part of a healthy diet. But science is now telling us that those who drink just one serving a day have an increased risk of a heart attack. A can of regular soda packs the equivalent of 14 teaspoons of sugar, and unlike the white stuff in solid foods, liquid sugar in soda is absorbed by the body immediately. That's one reason why drinking soda regularly results in low levels of HDL, the protective cholesterol that prevents heart attacks. If friends or family members still drink regular soda, I tell them to quit it." --Jeff Ritterman, M.D., cardiologist in Richmond, CA

"Think twice about throwing surprise parties"

"A woman I know was thrown a birthday party--she walked into a dark room, everyone yelled 'Surprise!' and she was so stunned that she instantly suffered heart-attack symptoms and ended up in the ICU. She experienced a condition called 'broken heart syndrome,' which is most common in women. Shock, fear, or extreme nervousness can temporarily impair the heart's ability to function, possibly because the surge of hormones like adrenaline overloads the blood vessels. You don't always have the power to prevent a shocking event in life, but you can let your friends know you'd prefer it if the party really wasn't a surprise!" --Ilan S. Wittstein, M.D., cardiologist at Johns Hopkins University School of Medicine in Baltimore

"Listen to your intuition: If something feels off, get to a doctor"

"When friends ask me about heart-attack symptoms, I always stress the importance of their own intuition. Women don't often present with the crushing chest pain men do. Almost every female survivor I've treated has told me that her gut said something was very wrong before she went into cardiac arrest, even if she showed no symptoms. One woman I know felt some arm pain and body aches and had a 'funny feeling' about it, but her doctor told her the problem was probably muscular. Sure enough, she suffered, but thankfully survived, a massive heart attack. So if you feel any symptoms that nag at your intuition--discomfort that's unusual, intense, or just gives you a bad vibe--listen to it, and call 911 right away." --Suzanne Steinbaum, M.D., attending cardiologist at Lenox Hill Hospital in New York City and author of Dr. Suzanne Steinbaum's Heart Book

"Pack your bags--you need a vacation"

"My friend is a really high-powered executive who thought she was perfectly healthy--until her doctor discovered a coronary blockage that required a stent. She was shocked, and exclaimed to me, 'I'm too young for this!' I told her that heart disease absolutely can happen to a woman in her 40s; if you don't take time to recharge your batteries, stress hormones like cortisol may be putting you at risk. I told her she had to start leaving the office on time: Studies have found that working more than 11 hours a day can raise your odds of heart disease by 67 percent. She made a real effort to change her lifestyle, and got her health back on track." --Shyla High, M.D., cardiologist in Dallas

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Monday, March 11, 2013

Eating Disorders, Dieting and Body Image: One Therapist’s Perspective

By Kenneth Bruce, Ph.D, Clinical Psychologist  March 10, 2013

Being a psychologist is a challenging and intensely rewarding experience.

In my day job, I am a psychologist. Sounds humble enough, right? In my therapy role, I work with many types of patients, but mainly with women who have an eating disorder (usually anorexia or bulimia). It’s the world’s best day job, and I mean that sincerely.

I should probably tell you how I came to be so lucky as to become a psychologist (and to be working mainly with women clients) in the first place. First thing, is that I was blessed with wonderful parents and gentle older siblings. Growing up, my family taught me to respect and help myself and others too. They were all strong and resilient role models, who –happily—also never took themselves too seriously; this made the whole process more fun.

I was lucky also because my family made the repeated point of showing me that women were in some ways different from men, but always equal to them. This left a lasting and positive impression on my attitudes towards both women and men for sure.

Now, let’s fast forward through adolescence and on to university, where the deal to become a psychologist was clinched for me. The real hook to become a psychologist happened at the University of Toronto. It was one of those fabled “A-ha” moments. I was taking an abnormal psychology class, and the professor was showing us a video of an elderly, heavily European-accented therapist interviewing a young woman with schizophrenia. You know, hallucinations and delusions, the real deal.

The interview was amazing: the woman with schizophrenia was discussing the most unbelievable and bizarre things (hearing voices, being followed by the FBI, aliens landing in the back yard, and on and on…) and I saw that the interviewer was not judging or acting shocked or surprised in any way. In fact, the interviewer was being genuinely interested and full-on empathic. As a result of how the interviewer acted, the woman with schizophrenia somehow felt comfortable enough then to reveal amazingly bizarre personal and intimate thoughts and feelings. And the result was that the interviewer was able to offer her some much-needed understanding, compassion and help, too. I was riveted.

So, what hooked me to become a psychologist was partly that video, but mainly the reaction of the majority of my classmates. Many were laughing out loud in reaction to what the person with schizophrenia was saying. I’d like to think mostly their laughter was the novelty of it, or maybe their nervousness, but I am sure some of it was ignorance, insensitivity and a little condescension too. The seeds of my desire to help de-stigmatize mental illness for the public at large, and to help those psychologically in need was planted that day. The focus on eating disorders came a little later on.

Fast forward to after grad school– I needed a job, obviously, and hopefully I could find a career too! I liked biology and genetics, I liked what shaped long-lasting personality problems, and I liked how the environment shapes everything along the way. I had been studying alcoholism, but what initially drew me to eating disorders as a specialty (or career) was that eating disorders, like alcoholism, are surprisingly so biologically determined. Obviously the environment is important in causing eating disorders too, and the intersection of the two is what is so fascinating.

In the public at large, and even in the psychology community, people with eating disorders can get a bad rap. They are often misjudged as difficult to engage in treatment, or worse, little entitled princesses deserving of their suffering.

What causes eating disorders? Good question, indeed! Well, it’s hard to develop an eating disorder without dieting somewhere along the way. Dieting is very common in most western societies (with about a third to a half of women being on a diet at any one time). Eating disorders (thankfully) are less common: Anorexia affects about 1% of adolescent and adult females, bulimia affects about 2% of same. Other similar eating disorders (varying in symptom definitions) can affect up to 10% of women. Men are affected too, but much less frequently: about 10% of anorexia and bulimia cases are men.

What is the role of dieting in eating disorders? Diets come and go, and vary from one country to another as well (and, by the way, none of them is particularly effective in the long run for the average person– sorry everyone!) But the rates of anorexia and bulimia are roughly the same around the world, however, which means that the role of society’s push to diet on the development of eating disorders is surprisingly less than you might think.

Dieting is socially-driven, but not all dieters develop an eating disorder. So it’s not just dieting, but something else too: Why do some dieters develop an eating disorder, while others are spared?

Well, genetics and biology seem important, as do prenatal and perinatal stressors. Puberty is important, obviously as well: Eating disorders are relatively rare before puberty. This may also be a biological process, although it’s the peak time when adolescent girls feel the societal pressures to be thin as well.

Developmental factors play a role too. Childhood adversity (particularly sexual abuse), and being overweight in childhood too, are predisposing factors for eating disorders. The body becomes a source of guilt and shame.

Genes also shape personality, and traits like perfectionism and impulsiveness seem to be risk factors for eating disorders as well.

Finally, not everyone who diets takes it seriously. People with an eating disorder become consumed by their caloric restriction; dieting becomes perceived as a necessity for self-worth and survival.

If you are concerned that you, or someone you love might be suffering, here are five tell-tale red flags that suggest a possible eating disorder:

  1. Increasingly driven focus or preoccupation with food, dieting weight or shape, to the exclusion of formerly valued interests and activities.
  2. Intensely engaging in weight-control behaviors (strict dieting, eliminating or limiting calorie-dense foods, intense and prolonged exercising to burn calories, misuse of appetite suppressants, laxatives, diuretics or enemas to lose weight).
  3. Intense guilt, shame, anxiety or anger around eating. Refusing to eat normal portions or expected types of food. Refusing regular meals and snacks.
  4. Precipitous or marked weight loss or refusal to maintain a normal weight for age and height.
  5. Frequent episodes of excessive or out-of-control eating (emptying cupboards or fridge, eating much more than normally expected, large amounts of money spent on food) or evidence of self-induced vomiting after eating.

So how to treat eating disorders? Well, this leads me to an old and tired (but still funny) joke. How many psychologists does it take to change a light bulb? Answer: just one, but the light bulb has to want to change.

So, engaging the person with an eating disorder in treatment is the first step, obviously. If she/he is not on board with the goals of therapy, nothing good happens in the long run. This can get scary in severely underweight cases, but the principal remains the same: the patient has to want it. Helping her find what she wants (and why) is the therapist’s job, and their job together is achieving what they want together. This usually means helping patients feel less distressed, or be less impaired, by preoccupations relating to weight and shape. It can also mean finding other sources of autonomy and self-worth (like family, school, and friends).

Hopefully, another benefit is that the underweight patient’s weight normalizes, and binge eating or vomiting (if present), will cease. The idea is not to make the patient happier with her shape, but to make her weight and shape less dominant in the bigger picture of her life.

Roughly half of patients will improve after a cycle of therapy, and it can take many cycles before everyone gets better. That’s encouraging, but we need to do better, obviously.

For me, it’s highly rewarding trying to help each new patient. And I wouldn’t do any other job, or dream of any other career. Well, ok, maybe a race-car driver could be cool too.


About Kenneth Bruce

Ken Bruce is a clinical psychologist, specializing in treating eating disorders (anorexia, bulimia and binge

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eating disorder), anxiety disorders, stress, depression, grief and relationship difficulties. Ken has been a psychologist at the Douglas Mental Health University Institute over over 13 years, and an Assistant Professor for over a decade at McGill University. Passionate about therapy, he now works in private practice. You can visit Ken at his website at PsyPrestige.com