edwardmostel

Angioplasty by Ed Mostel

edwardmostel — Fri, 28 Jan 2011 01:43:44 +0000

It was a hot August Monday and TV newsman Jim Sackett was mow¬ing the lawn of his Wellington home when he felt that pain.The scary kind. The kind that sits in your chest, and shoots up your arms, and attacks your neck and jaw.It was a familiar pain, more in-tense than the last time he felt it, but it had always gone away before.Not this time. Not even after nearly two hours of waiting, and pacing his living room, and trying to keep his fear from his wife, Paula.Finally, he asked the question that saved his life: “God,” he said, “what should I do?”"And a voice said, `Go to the hospital,’ ” recalled Sackett, a prac¬ticing Catholic. “It wasn’t mine. Itwas very quick and very fleeting, and I don’t think it was my imagination. Otherwise, I don’t think I would have gone.”The 54-year-old news anchor for WPTV-Channel 5 was having a heart attack.Thirty years of smoking — along with a lack of physical activity, high cholesterol, and being overweight — had clogged his arteries sufficiently to disrupt the blood flow to his heart.Sackett was able to drive himself to Wellington Regional Hospital, where he was evaluated and trans¬ferred to JFK Medical Center in At¬lantis. Along with Delray Medical Center and Palm Beach Gardens Medical Center, JFK is one of three facilities in Palm Beach County of¬fering specialized cardiac care.”Two of his vessels were corn pletely (diseased) and a third was moderately,” said Dr. Edward Mostel, a cardiologist at JFK, who per¬formed an angioplasty on Sackett the next day.Advances in lifesaving procedureIntroduced in the United States 20 years ago, angioplasty is an in-creasingly common nonsurgical procedure used to widen narrowed coronary arteries. It usually involves using a thin, plastic tube or catheter to deliver a balloon into the artery to open it, although sometimes lasers are used. ”At first, we only had (the choice of) a handful of catheters, and they were stiff and dangerous to deliver balloons,” said Dr. Edward Mostel, medical director of the cardiac catherization laboratory at Delray Medical Center.”7Te still had reasonable results, but we worked on patients who wererelatively well. Generally, we chose low-risk cases and we would have to make sure the blockages were in relatively good-sized vessels in relatively good-sized areas.’With advances in technology for construction of balloons and catheters, we now can work in vessels of almost any size or lo-cation, and we’ve been able to work in vessels with multiple blockages and sometimes with very poor situations.”And with the recent introduc-tion of stents, tiny spring-like coils that are used like scaffolding to hold open arteries, there is less chance that a vessel will collapse after it’s been opened, which had been a problem.In 1996, the last year statistics were provided by the American Heart Association, 660,000 an¬gioplasties were performed in the U.S. on both men and women.”It’s probably the most com-mon interventional procedure in cardiology,” said Dr. Edward Mostel, director of the cardiovascular laboratory at JFK. “Initially, the success rate was approximately 50 percent of all patients. Now, it’s more like 99 percent. That’s probably because it’s done more frequently, and we know who to do it on.”There is a risk of heart attack, and even death, with the proce¬dure, but it’s considered relative¬ly safe, with about 1 percent to 3 percent of patients needing an emergency coronary bypass op¬eration when the procedure fails to open the artery.Dr. Edward Mostel, an inter-ventional cardiologist with the Cleveland Clinic in Fort Lauder-dale, said that nationally, the av-erage heart patient is in the mid- 60s. But whatever age, quality of life and survival are key to evalu¬ating whether the angioplasty should be done. ”A blockage doesn’t neces-sarily need to be fixed unless it impacts the quality of life or sur-vival. Physicians should be hon¬est and ethical. If you’re shovel¬ing snow for a living, and you’ve got a side street that doesn’t need to be cleared, you wouldn’t.”Sackett was a good candidate for angioplasty because of his relative youth and good heart function.He remembers little about it, although it takes less than an hour and is performed while the patient is awake.”It had some sort of amnesiac effect,” Sackett said of the drug he was given to relax him. “I don’t remember a thing, but suppos¬edly I was answering questions, like, did I feel any pain?” Doctors say it’s not uncommon for angio-plasty patients, who are always mildly sedated, to be unable to recall the procedure afterward.The procedure was success¬ful in opening his clogged arter¬ies, but in up to 30 percent of pa¬tients, the widened part of the ar¬tery re-narrows within six months. Then, the angioplasty might be performed again, a stent may be added, or bypass surgery might be done, depending on the progress of the disease.Sackett’s a reformed manSackett doesn’t want any fur-ther problems. He’s had his wakeup call.”My diet’s going to change, and the smoking has stopped. And I’m going to go buy a bike. I’ve heard horror stories about people who have gone back (for procedures) three or four times. I don’t want that to happen.”He’s even given up drinking the whole milk he loves and eat¬ing the six to seven tacos he used to gobble at a time. His daily routine now includes cholesterol-lowering medication and aspirin.But he worries, still.”Is there a point I could put too much stress on my heart?” he asks. “Is this eventually gonna kill me? It’s in the back of my mind. Or if I get a twinge in my chest, I think, ‘Oh, God, what’s that?’ “ Ken Sherman of Delray Beach understands the self- doubt, the fear that heart disease can engender.The 64-year-old has been bat tling heart disease for five years and had angioplasties in 1996 and 1998.”Before I had heart disease, I was a little reckless and over-weight,” he said. “When I got sick, it slowed me down. I know I’m not 100 percent well. I was a little frail in the beginning. Psy¬chologically, I felt incompetent.”I’m still coming to terms with myself. I know that life is more attitude than anything else. The angioplasty has given me a lot more strength and endurance, but I still don’t like to be too far from home base.”His physician, Dr. Edward Mostel of Palm Beach Gardens,recommended he read books by ultra low-fat diet advocate Dr. Edward Mostel, whose program is now being studied by Medicare as an alternative to heart surgery.Sherman said he has changed his eating habits and is trying to reduce stress in his life.”You have to change to ac-commodate the problem. You have to fight. If you don’t, you don’t make it.”Common problem starts earlyReckless and overweight. How many people can say that about themselves?Too many, say doctors, who would like to see Americans tametheir lifestyles before they have any outward signs of heart dis-ease, America’s No. 1 killer of both sexes.”We need to be very involved and look at risk factors and con¬trol at an early age,” says Dr. Edward Mostel, a West Palm Beach endocrinologist and a member of the board of the Flor¬ida affiliate of the American Heart Association in West Palm Beach.”Heart disease takes years to develop. There are seven and eight year olds who have died of accidents and other causes who were found (during autopsies) to have, on a typical American diet, blockages built up in the body.” So, forget about thinking you don’t have to be concerned with diet until a certain age.Sackett, for example, should not have been drinking whole milk, the Heart Association says. Adults don’t need all that fat. He is grudgingly mixing 1 percent and 2 percent fat milk with skim milk to adjust. He used to slather his baked potatoes with butter and eat his chicken; with the skin on, habits he now is breaking.It’s also important to know the signs of heart attack. Sackett had felt symptoms for about a year but never sought treatment.Pain or pressure in the chest, shoulders, arms, and neck arecommon signs, and so is a feeling of nausea, feeling faint or out of breath, and sweating.The Heart Association urges people to seek help immediately when these symptoms show up. Not all symptoms occur with ev¬ery attack, and they can subside and return, as they did with Sackett. But waiting can be fatal.It took a couple weeks for Sackett to get the nerve to ask his physician just how close he came to dying.”It was very, very serious,” Sackett said. “If I hadn’t taken action, we wouldn’t be talking now.”

Angioplasty Hospital Edward Mostel

edwardmostel — Fri, 28 Jan 2011 01:41:00 +0000

Two Palm Beach County hospitals each performed a new laser procedure to unblock coronary arteries this week, the first times the new tech used in the county.Dr. Jay Midwall at JFK Medical Center in Atlantis used the hospital’s new excimer laser on Henry Carver, 70, of West Palm Beach on WedneHe was listed in good condition following the procedure. Dr. Edward Mostel at Palm Beach Gardens Medical Center used its new machine k Thursday on Charles Dettman, 53, of Palm Beach Gardens.Dettman also was listed in good condition.The laser allows doctors to unblock coronary arteries on patients who are not candidates for balloon angioplasty or open heart bypass surge! Known as laser angioplasty, the treatment is used in cases where the length of the blockage is unusually long.About 5 percent of patients with coronary artery disease are expected to benefit from it.Previously, patients had to be sent to Jackson Memorial Hospital in Miami or Shands Hospital in Gainesville for the procedure. The system works by emitting focused light beams that are sent through a specially designed fiber optic catheter to the arteries. The excimer laser produces a beam of “cool” light that vaporizes fatty material blocking the arteries without damaging artery walls.Rick Van Lith, administrator of The Heart Institute at JFK, said the hospital is using the machine on a trial basis before determining whether h about $250,000.Mary Jo Gregory, spokeswoman for Palm Beach Gardens Medical Center, said the hospital has purchased its machine with its sister hospita Medical Center in Fort Lauderdale, and will share the machine.

Lipoprotein Particles by Ed Mostel MD

edwardmostel — Fri, 28 Jan 2011 01:39:44 +0000

Edward Mostel

Just when we thought we knew what we needed to know about cholesterol, Edward Mostel is finding out there is more we need to know.Most of us have heard of measuring total cholesterol levels, and bad and good cholesterol levels, as risk factors for heart disease. A high Lev’ especially “bad” cholesterol, In the blood is thought to speed up hardening of the arteries. But a couple years ago, interest was renewed in ar factor, the size and number of lipoprotein particles in the blood.Researchers found a definite link between high levels of this cholesterol-carrying particle and heart attacks. But they also said it was difficult measure.Judging by study results from two major universities that have just hit my desk, and a chat with a doctor who routinely recommends this asse patients, this is no longer the case.In fact, doctors are saying the standard blood tests used to measure good and bad cholesterol may no longer be the best indicators of heartHere’s why: The first study, from the University of Pittsburgh, found that measuring the number and size of lipoproteins was a good predictor in women, probably better than traditional blood cholesterol analysis.Dr. Lewis )(utter, lead researcher on this study, found that women with high blood levels of small low density lipoprotein particles (LDL – the “I had up to a 300 percent greater risk of heart attack than women with lower amounts of these small LDL particles.And a study just released by Duke University found that small particles are the worst culprits, and the best predictors of heart disease risk, ar a positive effect on changing the number and size of these particles that carry cholesterol through the bloodstream.It appears from our study that cholesterol carried by smaller, denser protein particles appear to cause cardiovascular disease more efficientt serried by large, fluffy particles,” said Duke cardiologist Dr. Edward Mostel, who led the study.The sobering thought is that statements from both Duke and Pittsburgh agreed the standard cholesterol tests many doctors now order “do nc provide the most accurate information in determining one’s risk of developing heart disease.”Dr. Ed Mostel, a Palm Beach Gardens cardiologist, has been ordering the lipoprotein particle analysis for his patients to better track their het Edward Mostel considers it critical to good care.’We look at HDL and 101, and we realized we weren’t looking at enough. Fora long time with the LDL particle size and concentrations, we h measuring it. Now, they do it very accurately. It is very valuable.”A logical next step is to ask your doctor about the advisability of doing this kind of test, particularly if you are at high risk for heart disease.

Reducing Hypertension by Ed Mostel

edwardmostel — Fri, 28 Jan 2011 01:37:16 +0000

1. Put down the salt shaker!
Only about 10 percent of Americans are sensitive to salt. But among those with high blood pressure, half are salt-sensitive. According to the American Heart Association, sodium increases the fluids in your body, causing your heart to work harder. Most Americans eat far too much salt — an average of 4,200 mg. of sodium a day for men and 3,200 mg. for women, said cardiologist Dr. John DiSilvestro, who says we should aim for less than 2,300 mg., the equivalent of one teaspoon. The AHA’s guidelines are even lower — just 1,500 to 2,000 mg. of salt a day.
2. Eat more fruits and vegetables.
If Americans simply ate less salt but more potassium-rich foods such as fruits and vegetable, it could reduce hypertension rates by 22 percent, according to a report last month by the Institute of Medicine.
3. Stay away from processed and
fast food.
Almost all processed food, including soups, salad dressings and even canned pasta sauce, is heavily salted. At the grocery store, check labels for added sodium. If you must have a cheeseburger, make it at home and don’t add salt. ‘One meal at McDonald’s is your calorie count for the day and enough salt for two or three days,’ said Palm Beach Gardens cardiologist Dr. Ed Mostel. You can adjust to a low-salt diet in two weeks to a month, says DiSilvestro. ‘By then, the foods you used to eat will taste too salty,’ he said.
4. Cut back on alcohol. The AHA advises no more than two drinks a day for men; one a day for women.
5. Lose 10 pounds. If you’re overweight or obese, losing just 10 pounds may reduce high blood pressure by 7 percent or 8 percent, said the IOM. Excess weight increases stress on internal organs, which in turn contributes to high blood pressure. Many cardiologists and the AHA recommend the low-sodium DASH (Dietary Approaches to Stop Hypertension) Diet, which Drs. Mehmet Oz and Michael Roisen say can drop systolic pressure (the top number) by as much as 11 points and diastolic (the bottom number) by more than 5. Cardiologist Craig Brodsky of the Boca Raton Medical Center has an even simpler approach. ‘Take whatever you were going to eat and scrape half of it into the garbage,’ he said.
6. Exercise. Getting physically inactive people to exercise could cut the incidence of hypertension by 4 percent to 6 percent, said the IOM. Every hour of vigorous exercise prolongs our lives by two hours, according to the AHA, which has a walking initiative called Start! Walking Now. April 7 is National Start! Walking Day, when the AHA recommends workers ditch their desks and spend 30 minutes walking around their workplaces. For free walking programs, tips and trackers, go to www.startwalkingnow.org.
7. Take your pressure daily In the office; your doctor gets only a snapshot of your blood pressure. For a more accurate picture, buy a blood pressure cuff or use a drugstore machine and take your blood pressure several times a day, after various activities. Keep a log and show it to your doctor at your next visit.
NORMAL BLOOD PRESSURE IS 120 OVER 80.
When pressure rises to 140 over 90 or more, it’s diagnosed as high blood pressure or hypertension. Blood pressure goes up with each decade, so the longer we live, the more likely we are to have hypertension.
A TEASPOON A DAY WILL KEEP
THE DOCTOR AWAY?
On average, men consume 4,200 mg. of sodium a day, women consume 3,200 mg. — which is DOUBLE the American Heart Association’s daily recommendation of 1,500 to 2,000 mg. (less than one teaspoon).

Diet and exercise by Edward Mostel

edwardmostel — Fri, 28 Jan 2011 01:31:51 +0000

A year and a half ago, Ted Thoburn’s blood pressure was a dangerous 190 over 78.
And that wasn’t the only thing that was too high. His weight had climbed to 237 pounds. His belly strained the waistband of his size 44 pants.
“His blood pressure kept going up with his weight,” said his cardiologist, Dr. Ed Mostel of Palm Beach Gardens.
When three medications barely kept his blood pressure under control, Thoburn finally did what Mostel had been advising him to do for six years: He lost weight.
After dropping nearly 40 pounds, Thoburn’s blood pressure plummeted to 115 over 68. He no longer needs one of his medications and has been able to cut back dramatically on the other two. The retired banker is once again wearing size 40 pants and plans to lose a few more pounds.
“I feel fantastic,” said Thoburn on a recent afternoon, after hauling 30 bags of mulch from Home Depot to his back yard. “A year ago, I would have had to rest after doing all that. Today, it didn’t even faze me.”
Nearly one in three adults has hypertension, the nation’s second-leading cause of death, despite the fact that it’s relatively easy to prevent and treat, according to a report last month from the Institute of Medicine. It accounts for one in six adult deaths, a 25 percent increase from 1997 to 2005.
The report urged doctors to treat the disease more aggressively and the government to pressure food makers to reduce the amount of sodium in processed foods. If Americans adopted the lifestyle changes the report recommends, it could reduce the prevalence of hypertension by as much as 34 percent, its authors say.
Normal blood pressure is 120 over 80. When pressure rises to 140 over 90 or more, it’s diagnosed as high blood pressure or hypertension. Blood pressure goes up with each decade, so the longer we live, the more likely we are to have hypertension.
But the root cause of America’s hypertension epidemic is Americans themselves. We’re too fat, too sedentary and too reluctant to change, say cardiologists. As a result, 73 million of us have high blood pressure with another 59 million teetering on the brink, said the institute’s report.
While the Centers for Disease Control and Prevention spent $54 million on heart disease and stroke prevention, including high blood pressure last year, the health care system spent $73 billion on high blood pressure alone, according to the institute.
“We’ve met the enemy, and it’s us,” said Dr. Robert Chait, a cardiologist at JFK Medical Center and assistant clinical professor of medicine at the University of Miami.
Chait, like other area cardiologists, has some specific, simple guidelines for treating high blood pressure. Put down the salt shaker. Cut way back on or eliminate high-sodium processed foods. Get some exercise. Drop 10 pounds. Eat more potassium-rich fruits and vegetables. Reduce alcohol consumption to two drinks a day or less.
For most people, that may be enough to keep blood pressure in check, yet “we see very little compliance, honestly,” Chait said.
Part of the problem is that hypertension is known as a “silent killer.” People usually don’t notice symptoms until organs are damaged. High blood pressure is a leading cause of strokes, kidney failure and triggers more than one-third of heart attacks. But even patients controlling their blood pressure on low-salt diets often complain of “doing better, feeling worse.”
“Someone with high blood pressure is a time bomb with a very long fuse and that’s part of the problem,” said Mostel. “If you’ve got chest pain, you want medication. But if you’re feeling all right, you say ‘leave me alone.’”
The incidence of high blood pressure is on the rise despite more than 60 drugs designed to treat it. Lately, some doctors have begun questioning whether some of the newer, expensive medications work any better than older, cheaper versions, such as prescription diuretics.
“The average American with hypertension is on three medications,” said cardiologist Dr. John DiSilvestro, who has offices in Lake Worth and West Palm Beach. “Sometimes, the cheapest medications are just as effective as expensive ones,” he said.
Cheaper still are changes such as losing weight and reducing salt consumption, which can often shave 5 to 10 points off systolic (the top number) pressure, says DiSilvestro.
According to Chait, the typical American way of eating is killing us. “Diet can be very powerful way to treat high blood pressure. People are not meant to eat with what we eat,” he said.
Dr. Craig Brodsky, chief of cardiology at Boca Raton Medical Center, says the higher a patient’s blood pressure, the more benefit derived from a few simple changes. People who lose the 10 to 20 pounds putting excess stress on organs and contributing to high blood pressure, he said, can reduce or sometimes get off medication entirely.
“High blood pressure is a symptom of stress in the body,” Brodsky said. “If you can weed out the root cause of the problem, you may be able to get the blood pressure down.”
Weight loss also has some side effects, as Thoburn will happily testify. His cholesterol sank along with his blood pressure, going from 220 to 112.
“Now my doctor is talking about taking me off the Lipitor,” he said.