Directory of health resources for healthcare professionals.

Don’t forget the vegetables and fruit. In the last twenty years there has been a huge expansion in the variety of vegetables and fruits in stores. You are no longer limited to seasonal vegetables, such as cabbages, brussel sprouts, carrots, and peas. You can now buy broccoli, zucchini, peppers, eggplant, avocados, and dozens of other vegetables all year round.

The same goes for fruits. Oranges come in all shapes, sizes, and degrees of sweetness, and you can buy fresh pineapple, grapes, melons, kiwi fruits, papaya, mangoes, and guavas. As with vegetables, you are no longer limited to seasonal fruits such as apples, plums, and pears.

The rule is to eat at least five portions of fruit and of vegetables every day. They are not only enjoyable, but they can be a positive aid to improving the circulation. Recent research suggests that antioxidant substances, which are found in abundance in fruit, vegetables, and cereals (antioxidants include vitamins C and E), are vital to the health and integrity of the arterial walls. They may even help to reverse the changes of atheroma, so eat up!

Changing your style of eating will do more than just reduce your cholesterol levels, it may also improve your circulation, and will, in any case, be very pleasant and fulfilling.

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Cholesterol, of course, was the big story of the 1980s. As in the Framingham Study, the British Regional Heart Study found that the higher the blood cholesterol level, the greater the heart attack risk. Those in the top fifth for cholesterol (280mg/dl or more) had three times the heart attacks of those in the bottom fifth (less than 212mg/dl). However, there were some heart attacks in those with a relatively low cholesterol level, suggesting that there is no level of blood cholesterol at which there is no heart attack risk. This is perhaps not surprising, as even the lowest levels of cholesterol here would be considered very high in, say, China, where a blood cholesterol level above 155mg/dl is very unusual. Perhaps in the U.S. everyone has too high a cholesterol level.

Professor Michael Oliver, now retired, spent most of his career in the University of Edinburgh’s Cardiovascular Research Unit. He worked for years on the reasons for Scotland’s unenviable position as the country with the most “heart” deaths. He points out that the southern French smoke as much as the Scots, eat as much fat as the Scots, and have high cholesterol levels, yet they have far less trouble with angina and have fewer heart attacks.

Professor Oliver is convinced that it is not the amount of cholesterol in the blood that determines the heart attack risk, but the quality of that fat (Oliver 1993). He compared the heart attack rates of Scots, Finns, Swedes (who have a low heart attack rate), and southern Italians (with an even lower heart attack rate than the Swedes).

Crucial to the heart attack rate in these four populations was the level of linoleic acid in the blood. The higher the linoleic acid level, the lower the heart attack risk. The levels were negligible in the Scots and high in the Italians and Swedes.

Linoleic acid is a polyunsaturated fat, found in cereals and some vegetable oils such as olive oil, which is heavily used in cooking by the Italians and other Mediterranean countries. Linked with the linoleic acid intake is what has been called the “Mediterranean diet,” with its reliance on fish, citrus fruits, garlic, green vegetables—all substances, according to Professor Oliver, that help prevent the blood clotting that is the first step towards a heart attack. Not surprisingly, Professor Oliver endorses a Mediterranean-style of eating for everyone, and especially for those who already have evidence of heart disease.

Interestingly, he also directly links smoking with high blood cholesterol and linoleic acid levels. His team’s research showed that coronary-prone people, such as people with angina or who have already had heart attacks, do not eat much food that contains linoleic acid. Smokers were even more selective about their choice of food: They had real dislikes for foods containing the protective fats. The more cigarettes they smoked, the less linoleic acid they had in their tissues. They ate less fish and less vegetable fiber than nonsmokers. The difference also applied to alcohol consumption: Smokers drank more than nonsmokers.

Professor Oliver postulated that smoking injures the taste buds, so that food containing protective fats and oils tastes less pleasant, and is rejected, perhaps subconsciously. Smokers also add more than the normal amount of salt to their food, a habit that tends to suggest that smoking changes—or, to be more accurate, poisons—the ability to taste.

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What brings on the pain? Most angina starts with exercise. Physical effort brings it on, and rest relieves it. Your doctor will wish to know how much exercise produces the pain, and how long it lasts after you start to rest.

Angina is graded according to how much exercise you can take before the pain starts, so try to estimate how many stairs you can climb, how far you can walk on a flat surface, or up a slope, or whether you can run for a bus, dig in the garden, or make love. Don’t hesitate to list all the times you have noticed the pain: your doctor will not be embarrassed.

For some people, angina occurs while they are resting, or even wakes them out of a sleep. This is a serious sign, and needs urgent assessment in a coronary care unit. Prompt investigation and treatment can prevent an imminent heart attack.

The same goes for angina that doesn’t go away immediately upon rest, or keeps returning several times a day. If your pain is coming more often than it was, is more severe, or is lasting longer, see your doctor immediately.

The next question is: What do you do when the pain starts? Do you try to walk through it, or stop until it goes away? The correct answer is always to stop and let it subside completely. The pain is a sign that the heart is trying to cope with an imbalance between the supply of oxygen to the heart muscle and the oxygen needed for it to fulfill the demands on it for energy.

Suffice it to say here that this imbalance must be corrected quickly if damage to the heart muscle is to be avoided—and the fastest way to do that is to rest. Resting quickly eases the demands made on the heart.

When the demand of the heart for oxygen exceeds the supply, the condition is called ischemia—the medical term for lack of blood to an organ. Because of this, angina is sometimes given the label of “ischemic heart disease.”

Gone are the days when you would be handed a few pills to put under your tongue and told to live with the pain. If angina is suspected, the cause must be determined and, if possible, treated. Thus there will be routine blood tests to rule out problems such as anemia; there will be different electrocardiographic tests, including twenty-four-hour monitoring and treadmill tests, to pinpoint defects in the coronary artery system and the extent of any ischemia; there may be radioisotope or echocardiography tests to show how the heart muscle is beating; and finally an angiogram to see if bypass surgery is feasible.

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The good news is that heart disease in women can be reversed. The bad news is that a surprisingly high number of women, aged 50 or over, don’t know that heart disease is the leading cause of death in their age group. Moreover, even though 80 percent of those women surveyed said they had taken a cholesterol test, only 50 percent knew that 200 was a desirable cholesterol level. This lack of awareness of basic health knowledge could prove to be very dangerous in light of the recent studies that show that, given the proper attention, it may be possible to control heart disease in older women.

In one study, lovastatin, a new and promising cholesterol-lowering drug, seems to work well in women. The drug has already been proved effective in men. According to researchers, the main benefit of lovastatin is that it reduces “bad” cholesterol (LDL) which has been linked to heart disease.

Another study, involving both women and men with existing heart disease, discovered that when LDL levels were lowered, blockages of the arteries that serve the heart also decreased. It is known that if one or more of these vessels is blocked it could result in angina, heart attacks, and other serious problems.

In still another study, conducted at Harvard University, researchers have learned that the lower doses of estrogen may be just as effective as heavier ones in reducing heart-attack risk in postmenopausal women. The study showed that a dose of .625 milligrams provides just as much protection against heart attack as twice that dosage does. Researchers say that the smaller dose reduced LDL levels by 15 percent within three months. The smaller dose also raised HDL or “good” cholesterol levels. For every one percent drop in LDL, there is a two percent drop in heart-attack risk, according to the researchers.

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While it may be impossible to decipher the language of politicians as to who knows more about health care costs and who can do more to reduce them, the average American has several clear-cut options in order to save money. Here are several things you can do to cut the cost of your health care costs:

1) Get itemized bills. That is the only way to ensure that you (and your insurance company) are actually getting what you pay for. You should know exactly what you pay for, and how much. Before you visit your family doctor, find out what the charges will be for the office visit and other necessary services.

2) Don’t go to a specialist unless it is absolutely necessary. Many people make the mistake of paying a specialist for routine treatment which could have been taken care of just as effectively, and at a lower cost, by a family doctor. Check with your family doctor before you see a specialist.

3) Don’t pay for insurance coverage you won’t collect. Before you buy extra insurance to cover a specific disease, make sure you understand your regular health insurance coverage. Many times, extra or “special” policies duplicate coverage which is already provided by your regular health insurance policy, and your insurance company will not let you collect more than 100 percent of the cost.

4) Get more than one opinion. Whenever you have to decide on surgery or from among different methods of treatment, you should get, at least, a second opinion. You can ask your doctor for referrals, or you if you feel uncomfortable doing that, you can contact your county medical society and get a list of physicians in your area. Many specialty groups, such as the American Academy of Dermatology and the American Academy of Pediatrics, will also provide referrals.

If the second opinion differs from the first, then you get a third opinion.

5) Make sure you and your family get all your vaccinations. Such immunizations can prevent many illnesses and conditions that require expensive medical treatment. Be sure you keep accurate records, and get boosters as they are needed.

6) Practice preventive care. Whenever it comes to your health, you should exercise as much control as possible. By doing all you can to prevent health problems—quit smoking, control your blood pressure, maintain your ideal weight, eat sensibly, and get regular exercise—you improve your health and as a consequence, reduce the amount of money you have to spend on doctors and medicine.

7) You can also join a Health Maintenance Organization (HMO). These organizations encourage preventive care and their services often cost less than conventional ones. Also don’t be afraid to go to younger doctors who charge less. They are fresh out of school and know all the latest information.

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The most commonly recommended limit for sodium is 2,400 milligrams per day or 1/2 to 1 1/2 teaspoons per day (1/8 to 1/2 for children). Here are six proven ways to help you keep from exceeding that amount:

1) Use herbs and spices, not salt, for cooking and for use at the table.

2) Look for low-sodium, reduced sodium, or unsalted products. Low-sodium foods contain less than 140 milligrams of sodium per serving; reduced sodium indicates that normal sodium levels have been reduced by up to 75 percent. (Milk and yogurt are lower in sodium than most cheeses.)

3) Try to avoid processed, packaged and ready-to-eat foods. Such foods contain large amounts of sodium. When you cook things yourself, you can control the amount of sodium used in the preparation process. Try halving the amount of salt in your favorite recipes. Also, be sure to taste food before you salt it, adding a pinch at a time.

4) Rinse canned vegetables before you use them and wash away some of the sodium.

5) Avoid salty condiments such as soy sauce, pickles and green olives.

6) Use salt substitutes. While substitutes are available they should be used carefully. People who suffer from diabetes, heart or kidney disease, or who are receiving other medical treatment should consult with their doctors before using a salt substitute.

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It doesn’t take long for a fire to get out of control. Even a small flame can grow into a virtual inferno in under one minute. Most fatalities in home fires occur between 10 p.m. and 6 a.m. when most people are sleeping. Having smoke detectors on every level of your home, including the basement, will give you an “early warning system” so you and your family will be able to make a safe emergency exit.

Your first line 0f defense against small household fires is a fire extinguisher. You should keep a fire extinguisher on every level of your home, including your basement. Make sure you read all the instructions and know how to use the extinguisher, and check each extinguisher every month to make sure they are ready to use in case of fire.

You and your family should have occasional fire drills in order to practice the safest and quickest Way 0f escape. If fire strikes, try to remain calm and remember to follow these procedures:

1) Alert everybody in the house.

2) Don’t try to extinguish the fire if you can not do it without endangering life.

3) If your clothes catch on fire, drop to the ground and roll over and over.

4) Crouch down below the smoke in a room and crawl to safety.

5) Test the warmth of all doors before you open them. If a door feels cool, open it a crack to check for smoke. If there is no smoke, keep going. Close the doors behind you as you go.

6) Go straight to a predetermined meeting place outside your home.

7) Always use a neighbor’s phone to call the fire department.

The facts are clear, there are plenty of health hazards around the house. They can have a definite impact upon your overall health if you don’t watch out. You should avoid unnecessary exposure to chemicals. Some common household chemicals can be harmful to your health.

The important fact is that you should be well prepared for any emergency. This would include having an emergency first aid kit, a book that details first aid procedures, and being familiar with emergency phone numbers.

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There are a number of private, state government, and federal government organizations that make cash grants to help cover medical expenses. These grants sometimes are restricted to people who have low income or other special circumstances. Some of these fund sources also have other restrictions such as, living area, type of medical problem, age, and so forth. Here are some tips that can help you locate these funding sources:

State Government Sources

Most states have an office called the Department of Health and Human Services. It is usually located in the state capitol. Often they have funding programs and can also point you to other money sources. Look in the telephone book for the phone number of these offices.

Federal Sources

Medicare — covers persons who are receiving social security, certain disabled people, and people with chronic renal disease. Contact your local social security office.

Migrant Workers Programs

This program is for migrant agricultural workers who suffer seasonal unemployment. Grants are supplied to institutions and individuals. Call (202) 535-0500 for more information.

Veterans Hospitalization and Home-Based Care

The Veteran’s Administration provides a wide range of excellent medical services. These benefits can be obtained by veterans who have been honorably discharged, receive a VA pension, or have a service connected disability. In some cases a spouse or child could also qualify for benefits.

Many corporations provide some medical grants for individuals. Sometimes you have to be an employee to receive these grants. Here are a few foundations which give medical grants.

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