Walk with a Doc Newsletter  

Are you taking a family vacation this summer? Here's an article that shows vacations are really good for you (http://n.pr/kSFnp). This also just in - the sun is hot. (why's he always talking about the sun? Do you think he has a sun-phobia? I bet he does, have you seen him? Sometimes he looks translucent. I bet $20 his Vitamin D level is negative. That's not a good example for a doctor to set. I think all doctors should have high Vitamin D levels. He should be ashamed of himself.)

Not that you asked, but I would like to invite you into one of our family travel conversations, for a moment. Just to provide a brief, unwanted glimpse into one of our annual drives to the Outer Banks.

Setting: Somewhere in Virginia, car having covertly exited Route 64 nine miles ago...

"Daddy, what are you doing?" my 11 year old Ally asks. "Why are we on this small road?"

"Hey sweetie, you're up! That must have been a great nap. I was watching u in the rear view mirror - You're so cute when you're sleeping."

"Dad, where are we. This isn't the highway. I want to get to the beach!" my son contributes.

"Good pickup Charlie. We're almost out of gas. We need to stop."

"...but dad, The stick is pointing between the 1/2 and the F - doesn't that mean we have 3/4 tank left?"

Very good Charlie.

Crickets.

"I actually have to stop and get some food. I'm so hungry. Ugh, I could eat a horse!"

"But Dad, Mom packed a whole cooler. It's filled with bananas, cantaloupe,and bran muffins - four delicious and refreshing snack items. It's right under your seat."

"Perfect! Thank you Ally."

More crickets.

"You know what, I forgot. I have to go potty."

"But Dad, we already passed a gas station, an Arby's, Wendy's, and rest stop saying Next Bathroom 73 miles!" Charlie announces with some passion. This wakes Krissy. 

After a few seconds of back arching, my wife smiles at me from the passenger seat. She rubs the sleep from her right eye and yawns.   

"Honey, I'm glad you are up. You know, you look so pretty when you're sleeping.

"Mom! Dad is trying to butter us up. He's doing it again!"

"Ally, I'm not. I love you." 

"David, where are we?"

"Look at this - all three of you are awake! This is FUN!"

"David, where are we?!"

"Dad we want to get to the beach!"

The car now somewhat rapidly ascends a curved, sloped entrance; depositing the minivan into a freshly paved hospital parking lot in rural Virginia.

"David what are u doing?!!"

"I have to go the bathroom sweetie."

"In a hospital?!?!"

"I figured it was the safest place if anything happens to me." I continue talking louder as I sweep around back of the car. "You have to admit, they have much more health care personnel here than an Arby's or Wendy's"  I pop open the back of the minivan. 

Krissy has fully awoken. She turns her head around, talking to me over her left shoulder. She's looking between both children, both extremely upset in the second row.  

"David! Who needs health care personnel to go the bathroom!"

I've been blindly rooting under the suitcase when my right hand lands on what must be a Jart (I had recently sharpened for the trip) "Ouch!! Doggone it!" I grab for the box with my left hand.   

"David, why are you tucking that box under your shirt?"   

"Is that a WWAD toolkit?! Oh no David....Don't you dare!"

"What box honeeeeey...", the shout lingers behind me as I take off across the sticky black parking lot. It is an appropriate, yet admittedly, quite ironic that Chariots of Fire is pumping out of the hospital PA system as I run. I'm ripping yard upon yard of canary yellow No Parking tape as I make my way in. After a couple hundred yards, I rapidly stumble through the automatic sliding glass doors, almost landing on the lovely receptionist.

I'm flushed and red as a beet. I wipe more than a couple beads of sweat from my forehead.

The somewhat experienced volunteer in pink warmly smiles, "How can I help you sir?"

I need 5 seconds to catch my breath

"Good morning. I wonder if I could quickly talk to someone about starting a walking program for your community? Any chance you could page Marketing stat overhead to the lobby?"

"I'm sorry sir. Could you please repeat that? I'm having such trouble hearing you over that troublesome person honking in the parking lot."

That same scene has been played out, with only minor variations, for the past 5 years.

Krissy, Ally, Charlie - thank you for your incredible patience.   

As treatment costs soar, AHA preaches prevention as savvy investment

July 25, 2011 | Marlene Busko

*This important article pulled from www.theheart.org 

Newark, DE - Public policies for primordial and primary prevention of CVD events are effective and worth the cost, according to an AHA policy statement published online July 25, 2011 Circulation [1].

"There has been concern that we could not afford prevention," lead author Dr William S Weintraub (Christiana Healthcare Services, Newark, DE) told heartwire. "This is not true. Prevention is most definitely affordable," he said.

This review conducted by the AHA Advocacy Coordinating Committee should provide evidence to facilitate programs and public policies to prevent CVD, he added.

"It is no longer acceptable to simply treat cardiovascular disease and stroke, but in addition we must redouble efforts to not only prevent disease but also prevent the development of risk factors," AHA president Dr Gordon F Tomaselli (Johns Hopkins University, Baltimore, MD) told heartwire. "True healthcare reform will be realized only when we focus attention on disease prevention and not disease management," he emphasized.

Most CVD can be prevented or at least delayed until old age, the authors write. Prevention may be primordial-preventing risk factors before they occur-or primary-modifying existing adverse risk factors to prevent an initial CVD event.

Whereas pharmacological interventions clearly reduce risk factors and prevent CVD events in clinical trials, there is less evidence about the value of public policies-such as those to reduce salt consumption, eliminate smoking, and encourage physical activity. This is largely because it is more difficult to conduct long-term cost-effectiveness analyses.

To investigate existing evidence about the value of CVD prevention, the AHA commissioned this policy statement, and the team reviewed over 200 papers.

Some of the main findings were:

• Every $1 spent on building biking trails and walking paths would save an estimated nearly $3 in medical expenses.
• Reducing average individual sodium intake to 1500 mg/day in the US would lead to an estimated 25.6% decrease in blood pressure and healthcare savings of $26.2 billion a year.
• Increasing tobacco taxes by 40% would reduce smoking prevalence by an estimated 15.2% by 2025, with large gains in life expectancy and quality of life and a total savings of $682 billion.
• For every $1 spent in wellness programs, companies would save about $3.27 in medical costs and $2.73 in absenteeism costs.

"Individual responsibility is a crucial first step, but environmental and policy changes are the most impactful ways to improve health," Tomaselli said. "[Changing] diet and sedentary behaviors is key," he noted.

By 2020, the AHA aims to "improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%," Tomaselli explained.

Reaching this goal will require individual efforts-from patients and healthcare practitioners-as well as global policy changes.

Some of the authors' recommendations to federal, state, and local policy makers are to:

• Improve food labeling and implement labeling in restaurant menus.
• Ensure that schools develop nutrition standards for meals and provide physical activity throughout the school day.
• Implement workplace wellness programs. - We know one that works
• Build communities with sidewalks and bike trails.
• Ensure that smoking-cessation programs are adequately funded.
• Ensure that neighborhood stores sell affordable fruits and vegetables, especially in poorer areas.

Physicians can play a role in counseling patients about the importance of making healthy lifestyle choices and controlling modifiable risk factors. "Cardiologists and perhaps more importantly primary-care practitioners will have to redouble efforts to emphasize the importance of diet, exercise, smoking cessation, control of blood pressure, glucose, and cholesterol as central to optimizing overall health," Tomaselli said. This is true for patients without heart disease or prior stroke and is as important for people who have already had an MI or stroke.

In addition, physicians need to advocate for changes in public policies that affect healthcare. "It is going to be important for practitioners to advocate for things that make living a healthy lifestyle the easiest and most affordable choice," Tomaselli said. This includes working with politicians and community planners to create safe and hospitable environments for people to be active and continuing to support such enterprises as mandatory physical education in schools.

"What we spend on cardiovascular disease is not sustainable. But we can afford to prevent it," Weintraub said. "Ultimately, we can't afford not to."