Can You Have Severe Heart Disease but Good Cholesterol Numbers?
It’s actually possible to be a ticking time bomb with severe coronary heart disease while also having a “normal” cholesterol (lipid) profile.
This is why you shouldn’t assume you’re automatically out of the woods just because your cholesterol numbers came back terrific.
Not every heart attack sufferer had bad cholesterol numbers.
Perhaps you’ve heard that about one-half of people who suffer a heart attack have “normal” cholesterol. This brings to mind the interior of coronary arteries looking pretty good. And how can this be?
“Cholesterol is only one risk factor for CAD,” says Pilar Stevens-Cohen, MD, FACC, Department of Cardiology, South Nassau Communities Hospital.
CAD stands for coronary artery disease (a.k.a. heart disease).
“We recognize that it is only part of the picture,” she continues. “Diabetes [prevention of], smoking cessation, blood pressure management are all key factors in secondary prevention.”
Cholesterol Defined
“It’s a moving target,” says Dr. Stevens-Cohen. “When I was training, the bad cholesterol target was under 100.
“Now we say less than 70. Do we know how low to go? We also now recognize that LDL is only part of the equation.”
LDL is the “bad” cholesterol: high density lipoproteins.
“Newer tests, NMR [nuclear magnetic resonance spectroscopy], evaluating particle size [of LDLs], may be more helpful in managing patients than actual LDL levels.
“A person can seemingly have a good cholesterol panel, but when you do specialized testing, you see that their particle size is shifted and you should be managing them more aggressively.”
The bigger the LDL particles, the more desirable. A person can have normal cholesterol numbers, but if the particles are very small…this can mean heart disease — which can ultimately lead to an attack.
Another reason a person with normal cholesterol could have a heart attack is due to atrial fibrillation, an arrhythmia that can cause blood clots to form in the heart.
Dr. Stevens-Cohen is board certified in cardiology, nuclear cardiology, echocardiography and internal medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Explode
Why Even One Crumb of Gluten Is Harmful for Celiacs
Just one crumb of gluten may as well be an entire loaf of bread to someone with celiac disease.
Celiac patients can’t even have a tiny crumb; that’s all it takes to trigger their immune system into attack mode–on their own body!
Celiac disease is not like heart disease or diabetes, in which an offending agent (i.e., saturated fats, refined sugars) can occasionally be eaten without damage to the body.
In celiac disease, foods containing gluten must be eliminated 100 percent, down to the last crumb.
In fact, so strict must the elimination of gluten be, for people with celiac disease, that they should also avoid using cutting boards that gluten-containing bread was placed upon.
I wondered why those with celiac disease can’t occasionally eat something with gluten.
It’s as though the body can’t differentiate between an occasional pretzel and multiple daily servings of bread, cereal and pasta.
I was thinking of this as an “all or nothing” approach, which isn’t fair to people with celiac disease.
“Actually, it is all or nothing when it comes to eliminating gluten,” says Nicole Kuhl Visnic, CCN, a dietitian and nutritionist in Santa Monica, CA.
“When a person with celiac consumes gluten, there is an immune cascade that is occurring in the body, even if there are no obvious GI symptoms.”
In other words, the occasional pretzel may not cause any observable reactions in the celiac patient, such as diarrhea or upset stomach, but something unseen and unfelt gets triggered.
“For every patient with CD, there are eight patients with CD and no GI symptoms,” says Kuhl Visnic.
The immune response to this protein is so strong, that a person with celiac disease must avoid non-gluten foods that were prepared in the same facility as gluten foods are.
A pizza with a wheat flour crust, consumed after being gluten-free for 12 months, really will make a difference in the patient.
Kuhl Visnic explains, “The reason a little bit of gluten is harmful is because people with celiac disease have hypersensitivity to gluten. Kind of the way a light switch turns the light on or off, gluten turns the immune system on or off.”
In celiac disease, the body thinks that this protein is a foreign invader, and this faulty recognition triggers an immune attack on the protein molecules.
Eating gluten-containing foods means a chronic immune response that, over time, damages the inner lining of the small intestine, impairing its ability to absorb important nutrients.
This malabsorption leads to a litany of medical problems including brittle bones.
But can just one occasional pretzel in an otherwise gluten-free diet cause such damage?
Kuhl Visnic says, “Another way to think about it would be to consider the effects of adding a couple drops of cyanide to a glass of water. A couple of tablespoons would be more toxic than a couple drops, but a couple of drops is still toxic.”
The presence of the wheat protein in that tiny pretzel will activate “T cells,” which are the body’s defense against foreign invaders.
T cells then release certain chemicals that would be valuable in the event of a microbial attack.
But in the presence of gluten, T cells that are activated harm the intestinal cells that are responsible for nutrient absorption.
So if someone has celiac disease and you can’t understand why he or she thinks “one little bite” will indeed hurt, Kuhl Visnic explains, “The immune cells in someone with CD sit on the intestinal epithelial cells ready to pounce, as soon as gluten is recognized,” in any amount.
Nicole Kuhl Visnic specializes in custom-designed diets tailored to the individual and has worked with numerous celiac disease patients.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/ Mia Stern
Negative Celiac Blood Test, but Stool Sample Shows Antigliadins
What if the blood test for celiac disease is negative, but a stool sample is positive for elevated antigliadins?
Was your celiac blood test negative, but a stool sample positive for elevated antibodies for gluten?
]And suppose you don’t have symptoms that can be ascribed to celiac disease. What should you do?
How telling is that stool sample that shows an immune response to gluten? Gliadin is a component of gluten, and antigliadins are the antibodies.
Celiac disease cannot be diagnosed based on a stool sample.
However, a stool sample showing elevated antigliadins definitely means that an immune response is occurring to gluten.
This doesn’t necessarily mean celiac disease; it can also mean mere gluten intolerance.
A person can have the gene/s for celiac disease and gluten sensitivity; different genes are involved.
The elevated antigliadins can be the result of the gluten-sensitivity genes expressing themselves, not the celiac disease gene/s expressing itself.
If the person does not have symptoms, it gets trickier, since the symptoms will start vanishing once gluten is eliminated.
“Research is continuing to show that antibodies are predictive of certain degenerative diseases including celiac disease,” says Nicole Kuhl Visnic, CCN, a dietitian and nutritionist in Santa Monica, CA.
“Anti-transglutaminase antibodies are one type of antibody that may indicate a predisposition to celiac disease.
“However, there are other antibodies and markers such as antigliadin, glutenin, and gluteomorphin that may show up sooner than anti-transglutaminase antibodies.
“These markers alone are reason enough to eliminate gluten. Unfortunately, anti-transglutaminase antibodies are related to mucosal damage.
“Waiting for anti-transglutaminase antibodies to show up on the labs before you take action is like sticking your head in the sand.”
Transglutaminase refers to the blood test.
“The preventative medicine field has advanced greatly by way of lab testing. Cyrex laboratory has a new test for gluten sensitivity that is far more sensitive than stool tests.
“Doing this kind of test is important because it is not likely that an individual will take dietary restrictions seriously without ‘proof.’ Continuing to eat gluten, even small amounts, provokes an immune response that perpetuates the disease process.”
Can a person have celiac disease if the transglutaminase test is negative, but the stool sample has antigliadins?
Kuhl Visnic explains, “No. There are typically three steps taken to establish diagnosis for CD. The first step is a blood test (including transglutaminase), the second is biopsy of small intestine, and the third is implementation of a gluten-free diet.
“If the small intestine returns to its former healthy state following a gluten-free diet, a diagnosis is made.
“It’s important to understand that diagnoses are made late in the game. Celiac disease is a result of ongoing damage that has progressed to the disease stage.
“In the prevention model of health care, the goal is to prevent the damage from ever occurring.
“This is why it is prudent to avoid gluten if you have positive markers for gluten sensitivity.”
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- Abdominal pain
- Bloating or gas
- Brain fog
- Chronic diarrhea
- Constipation
- Fatigue or anemia
- Foul smelling or pale colored stools
- Headaches
- Mouth ulcers
- Osteoporosis/brittle bones
- Pain in the joints
- Rashes on the skin
- Unintentional weight loss
- Vomiting or nausea
- This list is not complete.
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Nicole Kuhl Visnic specializes in custom-designed diets tailored to the individual and has worked with numerous celiac disease patients.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Scorpp
Fast Resting Heart Rate Increases Death Risk from All Causes
An elevated resting heart rate is associated with an increased risk of death from all causes. This includes cardiovascular disease.
Are you familiar with what your pulse normally is when you’re at rest? If not, you’d better get familiar with it — because research shows that it’s a risk factor not to be ignored.
This is the conclusion by researchers from the Ronald O. Perelman Heart Institute at New York-Presbyterian Hospital/Weill Cornell Medical Center; over 9,000 patients were studied.
This conclusion applies to tracking resting heart rate over time.
Study authors urge doctors to track the pattern of patients’ HRs over the years, rather than relying upon a single reading.
The Study Is Something to Think About
“Based on this study, we believe that an elevated heart rate seen over a number of years is worrisome, signifying that these patients need further evaluation to see what might be causing the high heart rate,” says lead investigator and cardiologist Dr. Peter Okin in the paper.
The researches followed patients for an average of five years, and found that readings of 84 beats/minute or more were associated with a 55 percent higher risk of cardiovascular death, as well as a 79 percent higher risk of all-cause death.
Cardiovascular risk factors such as hypertension were adjusted for.
Normal RHR should be between 60 and 80 beats/minute according to some cardiologists, while others extend that range to 100 bpm.
- A 16 percent greater risk of death from cardiovascular disease, and a 25 percent increased risk of death from all causes, came with every extra 10 beats/minute greater than normal resting heart rate.
Why would an elevated resting heart rate be associated with more cardiovascular disease anyways?
Faster resting heart rate increases automatic nervous system activities, and this heightened response is connected to increased risk of atherosclerosis (plaque buildup inside arteries) and abnormal heart rhythms, as well as heart ischemia (restricted blood supply).
“Heart rate remains a significant predictor of increased mortality,” says Dr. Okin in this report.
Should you panic if your resting pulse is frequently over 80 and especially 102 or so?
Most cardiologists are not concerned if a patient’s resting pulse is between 80 and 100 — especially if that patient shows no signs of cardiac abnormality elsewhere and reports no concerning symptoms.
But what if many times when you take your pulse, it’s a little above 100 — even though you’ve been at rest for a while?
“The resting heart rate range can be deceiving,” says Yaser Elnahar, MD, a cardiologist with Hunterdon Cardiovascular Associates in NJ, whom I interviewed for this article.
Dr. Elnahar continues, “The best way to look at this data is to evaluate resting heart rates in young professional athletes (40-60 beats per minute) — since their hearts are well-trained and more efficient at pumping the same amount of blood at less work.
“In people who exercise regularly, don’t smoke and don’t consume much caffeine, I would question the hydration, weight and any other medical conditions that are causing the fast resting heart rate.”
If such an individual keeps well-hydrated, tests negative for medical conditions, is of a healthy weight, restricts caffeine and doesn’t smoke — yet STILL often has a resting heart rate on the fast side (e.g., 102 or even in the 90s), then it’s quite possible that this person has too much anxiety going on.
Leading a stressful life can keep the heart rate on the fast side for extended periods.
The patient may be a jumpy or edgy type of person who can’t really maintain calmness for too long. Something is always up, giving that person the jitters.
The complete study is in the July 2, 2010 online European Heart Journal.
Dr. Elnahar has publications in the Journal of Atrial Fibrillation, the Journal of Clinical Medicine and Research, Reports in Medical Imaging, and more.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: Freepik.com
Source: sciencedaily.com/releases/2010/08/100812151640.htm
Does High Cholesterol Mean You Should Take Statin Drugs?
If you have high cholesterol, statin drugs may come to mind as something you must necessarily take.
As to whether or not high cholesterol is an automatic green light for taking statins:
“Absolutely not! Since half the people with high cholesterol never have heart disease, we are overprescribing medications with significant costs and side effects,” explains Dr. Larry Santora, MD, a cardiologist with Orange County Heart Institute and Research Center, and author of “OC Cure for Heart Disease.”
Dr. Santora continues, “If you have high cholesterol and a zero coronary calcium scan, you can safely be treated with diet and exercise for five years.”
My brother’s coronary calcium score was not zero (he won’t reveal the number), but he did say that the score prompted him to “aggressively” treat his condition, and the treatment includes a statin.
My mother never had a coronary calcium scan; she had a catheter angiogram which revealed near-complete blockage in all major coronary arteries – she underwent quintuple bypass surgery only a few hours after the angiogram.
Immediately after, she was put on a statin and continues to take the statin today. Her cholesterol profile, pre-surgery, was poor.
It has since improved significantly, despite no change in eating habits.
Dr. Santora continues, “On the other hand, if you have normal cholesterol, but one other risk factor like diabetes, etc., you may be one of the potential heart attack victims who has normal cholesterol.
“If you get a heart scan and have plaque or calcium, being on cholesterol meds will reduce dramatically the heart attack risk.”
Risk factors for heart attack that many people cannot name are: sleep apnea, insomnia, less than six hours of sleep a night, chronic mental stress, insulin resistance or pre-diabetes, and excess belly fat even though the rest of the body is not “overweight.”
Dr. Santora adds, “The new paradigm approach for cholesterol should be: 1) This person has high cholesterol; can this patient get a heart scan and not be put on medications?
“2) This patient has normal cholesterol; should this patient be on cholesterol medications?
“The $300 or less for a scan will more than pay for the savings in medications and lives.”
Even if your insurance will cover the cost of statins, statin drugs serve up a lengthy list of possible side effects, some of which are serious (though rare).
Why would a person with normal cholesterol, but a high calcium scan score, be put on a statin?
Because statins are also designed to slow the progression of coronary plaque buildup.
Many natural supplements have the same cholesterol-lowering effects of statins, such as vitamin B3 (niacin), plant sterols, aged garlic extract, fish oil, green tea extract and turmeric.
Exercise also has the same effect, especially intense exercise.
Dr. Santora’s areas of interest include interventional cardiology – coronary stenting; cardiac CT – CT angiography, and coronary calcium screening with EBCT. He is board certified in cardiovascular disease and internal medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
What Happens During an MRA? Patient Describes Procedure
You know what an MRA is, but what exactly happens during an MRA – here is my firsthand account.
I had an MRA – no, not MRI, but MRA, as in magnetic resonance angiogram.
An MRA is a type of MRI, actually.
Perhaps your doctor has told you that you should have an MRA.
Or maybe you’ve already made the appointment for the magnetic resonance angiogram.
There are many reasons to have an MRA, and just because your doctor has ordered this procedure, doesn’t mean it will find something wrong with you.
What’s an MRA like?
After filling in the paperwork, you’ll wait.
The technician who did my procedure was the person who came into the waiting room to summon me.
I was led to a room and told to slip into two gowns (I don’t remember the reason why two were necessary, but it made sense at the time).
I then waited in an area for people waiting to get an IV portal inserted into their arm for the contrast dye.
What happens during an MRA?
The procedure uses contrast dye to make the blood vessels visible. So I waited briefly, then was called into a room where a nurse prepped me for the IV portal.
Then I was sent back to the little waiting room.
The technician then summoned me. I had asked for a chance to speak to the cardiologist who’d be present.
I was also told I couldn’t wear earplugs (magnetic resonance procedures produce loud noise) because I had to wear headphones to be able to communicate with the technician during the exam.
I briefly spoke to the cardiologist, and then was taken to the MRA room.
I lied on the table. The technician placed some heart monitor leads on my chest.
I had been told that during the procedure I’d be having to hold my breath, usually for 20 seconds at a time.
The technician placed a thick, weighty rectangular-shaped thing on top of my chest, and did something with the IV portal, though she did not inject the dye.
The dye is injected from another room. I don’t know how this works, but after I had lied on the table, she had rigged something with the IV portal, while I was lying flat with my eyes closed.
I was told the test would take an hour, more likely an hour and 15 minutes.
A little hand pump was placed in my other hand and I was told that if I needed to be taken out of the MR tube, to squeeze the pump.
The MRA was of my heart (I’ll get to the reason in a moment), so my head was completely in the tube.
Many times I was told (through the headphones by the tech) to “Inhale, exhale, now take a deep breath and hold.” Then she’d say, “Breathe.”
This pretty much defined the experience, though there were several points during which she told me to relax for a few minutes while she made adjustments from the other room.
Believe it or not, only the last few minutes of the procedure involved the contrast dye.
She alerted me when she was giving it to me (while I was still inside the tube). I had no reaction to it. Next thing I knew, the exam was done.
Why did I have the MRA? I had had a visit with a cardiologist as part of heart disease screening (both parents have heart disease).
He detected a Class II heart murmur. The subsequent echocardiogram was normal, so the only thing he could think of that was causing the murmur was pulmonary stenosis (narrowing of pulmonary artery). A magnetic resonance angiogram would detect this.
In my case, the MRA turned out completely normal, and my cardiologist has concluded that the murmur is a “functional flow” type which can develop in athletes (of which I am). It is harmless.
I had my next routine screening two years later, and the cardiologist said, “You have the smallest heart murmur in the world. I don’t hear it.”
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: MRI Jan Ainali, CC
The Insulin Resistance Connection to Juices and Fruits
Can drinking huge amounts of juice daily lead to insulin resistance?
Are you a big juice drinker and wondering if this might cause insulin resistance, a harbinger of type 2 diabetes?
We grow up hearing how good juice is for us, and though juice contains antioxidants, it also contains sugar in the form of fructose. This is natural sugar.
However, there’s a problem here. Fructose, when eaten in its natural state — with whole fruit — gets metabolized nicely by the body, namely because the fruit’s fiber slows the absorption of this sugar.
Juice is minus most, if not all that fiber, so now we have fructose being consumed in its unnatural state.
Instead of it going to the muscles for energy, it goes to the liver. Enough sugar going to the liver can result in problems, such as “fatty liver.”
So then, can drinking a lot of juice cause insulin resistance or a prediabetic state?
“Too many calories can cause insulin resistance, whether from fruit, fruit juice or other foods,” says Craig Stump, former chief of the UA Division of Endocrinology, Diabetes and Metabolism (2006 to 2016), University of Arizona, Southern Arizona VA Healthcare System.
Dr. Stump continues, Fruit juices do tend to be calorically dense (i.e., it is easy to add a fair number of calories to the diet by drinking too much).
“In our clinics for obese children and adolescents we ask them to abstain from all caloric beverages in an attempt to reduce overall caloric intake.”
This also depends on the kind of fruit juice. Some fruit juices are naturally lower in sugar than others.
For example, an eight ounce glass of juice extracted from fresh blueberries does not contain as much sugar as an eight ounce glass of juice extracted from oranges.
On the other hand, watch out for juices that come in bottles, as oftentimes, these have added sugars.
Stay away from juices that are marketed towards “moms” of young kids; these often contain artificial colors and other synthetic chemicals.
Dr. Stump says, “I think huge repeated spikes in sugar (juice, soda, Gatorade, etc.) and corresponding large spikes in insulin could contribute to insulin resistance.
“However, insulin resistance is not a straightforward diagnosis in people who are not injecting insulin.
“It can be estimated with a HOMA (fasting insulin and glucose measure) or an oral glucose tolerance test, but these are not perfect in an individual patient (better for looking at larger groups of individuals).
“A high triglyceride and low HDL can also provide evidence for insulin resistance.
“It can only be quantified with certainty in the laboratory with a euglycemic-hyperinsulinemic clamp procedure (not done clinically).”
When you hear about the epidemic of prediabetes among America’s kids, these are kids who are sedentary, overweight and often have a poor cholesterol profile.
They may be drinking lots of juice, but along with the juice, plenty of sugary sodas, ice cream, cookies and candy.
A healthy active adult should feel free to drink juice, but make it organic with no sugar added.
Optimally, juice fruit at home to ensure that you are getting a 100 percent natural beverage.
But don’t go crazy with juice consumption, as it does indeed cause significant blood sugar spikes (fructose is rapidly absorbed into the bloodstream, causing the pancreas to go overboard pumping out insulin to lower the blood sugar level.
If this pattern occurs often enough, the pancreas becomes overworked and your body’s cells may become less efficient at utilizing the sugar that the insulin brings to them for energy. This is how insulin resistance develops.)
The healthiest way to consume juice is in solid form: in the form of fruit, to get the fiber that goes with it.
And no, taking a fiber pill with a liter of juice won’t cut it.
Restricting simple carbohydrates (i.e., eat apples instead of apple juice; whole-grain bread instead of white; wild rice instead of white), plus rigorous exercise and weight control, will go a remarkable way in preventing insulin resistance.
Dr. Stump’s
research interests included insulin resistance resulting from physical inactivity, obesity and the metabolic syndrome, and identifying biological markers to predict progression of diabetes. Dr. Stump passed away in May 2019 after a brief illness.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
19 Questions to Ask Your Shoulder Arthroscopy Surgeon
Have these 19 shoulder arthroscopy questions ready for your surgeon.
Don’t wait until the day of your shoulder arthroscopy to ask these crucial questions to the surgeon.
If you’re suffering from shoulder pain and have decided to see a “shoulder doctor,” take these questions with you just in case the doctor says you might need an operation.
It is not impossible for a doctor to tell a patient that an operation might be needed, even though the patient has not had any imaging tests of the shoulder.
Someone I know was told by a doctor that he might need knee arthroscopy or a total knee replacement, even though no imaging tests had been done on his knee.
Now, suppose you’ve had an MRI of your painful shoulder and the report says you have tears in the tendons.
There’s a chance that you’ll need arthroscopy of your shoulder; so when you see the orthopedic doctor, be prepared.
He might say you need shoulder arthroscopy, so bring the list of questions below, which were prepared by Edmond Cleeman, MD, a board certified orthopedic surgeon who specializes in sports medicine and arthroscopic surgery of the shoulder, knee and hip.
Preliminary Questions to Ask Surgeon About Shoulder Arthroscopy
Shutterstock/Rocketclips, Inc.
1. Ask the doctor about his/her experience with this procedure (do they perform 10/yr or 100/yr).
2. Ask about alternatives to surgical treatment (i.e., activity modification, medications, physical therapy, steroid injection, PRP injection, etc.)
3. Is there a downside to postponing surgery? For example, a rotator cuff tear left untreated over time will enlarge, retract, scar, atrophy, and eventually become irreparable. On the other hand, a labrum tear may do well without surgery.
4. Ask the doctor to draw a picture of the problem (i.e., torn RC) and a picture of how it is repaired.
I found this tremendously helpful for patients to better comprehend the problem.
6. Ask the doctor for a reputable website to get more info (lots of misinformation out there).
I often refer my patients to the AAOS (American Academy of Orthopedic Surgery) website – has accurate info.
7. Is the operation covered? Make sure the doctor’s office gets preauthorization from insurance company. Does the hospital and anesthesia accept your insurance?
Final questions to ask surgeon regarding arthroscopic surgery of shoulder:
1. What are the risks of surgery?
2. What are the success rates for the procedure? In biology and medicine there is no such thing as 100% success (does not mean that a nonsuccessful outcome equals a complication or mistake).
3. What is the patient’s expectations (important question for the doctor to ask: Surgery may reduce almost all pain but maybe the patient can’t throw the ball as hard as before the injury).
4. What kind of anesthesia (regional block – numb up the arm or general anesthesia)?
5. Can patient go home same day or is overnight stay necessary?
6. How much pain will there be post-op? What kind of medication needed?
After RC surgery there is significant pain, especially at night. Get pain prescription prior to surgery date so it can be filled.
7. Will a sling be necessary and for how long?
8. Return to work? Return to sport?
Preop questions to ask surgeon regarding arthroscopic shoulder surgery:
1. Ask if need to stop certain meds (i.e., aspirin and other blood thinners).
2. When to stop eating (usually midnight)?
3. Should someone accompany you home?
4. Where to go and at what time?
Dr. Cleeman is a highly experienced orthopedic surgeon and sports medicine specialist at Manhattan Orthopedics. He is committed to performing advanced minimally invasive procedures, allowing his patients to go home the same day.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health.
Will a Failed Knee Replacement Worsen if Not Revised?
Find out what likely will happen with your knee if you don’t have revision surgery for a failed total replacement.
You’ve had a total knee replacement and, over time, things have gotten worse, leading to a diagnosis of a failed implant.
You’re told you’ll need “revision” surgery: a replacement of some or even all of the hardware.
Suppose you’re afraid to undergo revision surgery for a loosened knee replacement and are wondering if the situation will simply stabilize over time and be managed with painkillers, cold packs, gentle exercise, acupuncture, etc.
There’s bad news if you’ve been hoping that your failed total knee replacement will magically stop getting worse.
For this article I asked a hip and knee replacement surgeon if a failed TKR will necessarily continue getting worse and worse, rather than stop declining and taper off to a standstill status.
“‘Yes; as time goes on, the loosened implants lead to more bone destruction around the joint, and lead to an increased risk of fracture around the joint replacement,” says Jeffrey A. Geller, MD, Associate Chief, Division of Hip & Knee Reconstruction; Director, Minimally Invasive Hip & Knee Replacements, Columbia University Medical Center, New York, NY.
“Pain worsens, but the bone around the replacement weakens, making likelihood of fracture higher as time goes on,” continues Dr. Geller. “Typically the pain worsens and walking becomes more difficult.”
If you’ve been diagnosed with loosened knee replacements, it’s not an issue of whether or not you should undergo the revision surgery; it’s an issue of when, unless you have concurrent medical conditions that contraindicate the revision surgery.
You have to decide if you can continue living in pain, or take that chance with the revision procedure.
My father’s failed TKR generated so much pain that he had no problem deciding on the revision surgery, which so far, has been going well.
How successful is revision surgery?
Dr. Geller explains, “Patients feel much more stable and sturdy just about immediately.
“The recovery is similar to a regular total knee replacement, i.e., three months or so, but the difference is readily apparent.
“If a patient is quite aged, depends on medical comorbidities….better to fix it rather than subject patient to heavy-duty pain meds or risk of falling from pain and weakness in the knee.
“It is generally safer to try to intervene electively for the knee than do an urgent surgery for a fractured wrist or hip.”
Dr. Geller specializes in arthritic disorders of the hip and knee. He has extensive training in joint replacements and performs surgery using some of the latest, most advanced minimally invasive techniques.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/DeepMeaning
Does Insulin Resistance Always Make You Gain Weight?
Will insulin resistance make you gain weight?
It’s easy to conclude that insulin resistance will lead to weight gain.
Insulin resistance is when the body’s cells no longer utilize this hormone efficiently, resulting in blood sugar levels that are higher than normal, but not high enough to be considered diabetes.
Insulin resistance is a precursor to prediabetes. Either the insulin receptors on cells start shutting down, and/or the pancreas fails to produce adequate amounts of insulin.
This hormone is necessary for shuttling sugar out of the blood and to the cells so that the cells can use the sugar for energy.
When glucose metabolism becomes impaired, it’s easy to see why fatigue can be a symptom of insulin resistance.
With insulin resistance, excess sugar ends up in the blood. This sugar then goes to the liver, where it is converted to fat.
This fat then ends up in the bloodstream and circulates throughout the body — and hence, the possible weight gain associated with insulin resistance.
However, weight gain doesn’t have to be the outcome, says Dr. David Edelson, MD, board certified in internal and bariatric medicine, one of the top obesity experts in the U.S., and founder and medical director for thin-site.com and HealthBridge.
Dr. Edelson explains, “With good lifestyles, a diet low in high-glycemic carbohydrates and inflammatory fats, lots of exercise, good sleep patterns, high intake of omega-3 fats (fish oils, nuts, olive and olive oils, fatty fishes, avocados), supplements of chromium, vitamin D and cinnamon (a great insulin sensitizer), there is no need to have weight gain.
“It’s just that people with insulin resistance need to be that much more vigilant about keeping their lifestyles on track than those without.”
The best time to eat a high carbohydrate meal, if you must have a high carb meal, is within one hour of vigorous exercise, when glucose metabolism is most efficient. Don’t eat a lot of carbohydrates close to bedtime.
Another good time to eat a lot of carbs is before exercise, but this may impair your session, depending on how much you eat and what kind of exercise you intend on doing.
You don’t want to be having to hop off the treadmill every 10 minutes to use the restroom, for instance.
To burn carbohydrates and fat most efficiently, perform intense exercise sessions at least three times a week.
Shutterstock/Dmitry Kalinovsky
This means high intensity interval training, strenuous weight workouts and other rigorous aerobic activity.
The more intensely you exercise, the faster your resting metabolism will be and the more fat your body will burn at rest, including while you sleep!
Good sleep patterns, like Dr. Edelson says, will help a person with insulin resistance avoid weight gain.
Sleeping less than seven hours a night, and more than nine, has been associated with weight gain.
Plus, disrupted sleep has been associated with insulin resistance (Spiegel, et al).
To avoid weight gain if you are insulin resistant, pay strict attention to what you eat, not just when.
In addition to eating “good” fats, restricting “fast-acting carbs” and saturated fats, and avoiding trans fats, aim for 25-35 grams of fiber a day, and eat protein with your carbs to slow their absorption into the bloodstream.
Dr. Edelson is widely recognized as one of the nation’s top weight loss experts, and was listed in NY Magazine’s “Best Doctors of 2014” issue.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.