How Obese People Who Can’t Get Out of Bed Control Their Enabler
It’s been said that the super morbidly obese person is skilled at “manipulating” their enabler or caregiver.
What makes someone continuously bring huge amounts of unhealthy food to their loved-one who’s so obese that they’re confined to bed?
“As is the case with drug addiction, changes in the chemistry of the brain can cause people struggling with food addiction to manipulate others if that’s what it takes to get more of their drug (food),” explains David Sack, MD, a psychiatrist specializing in addiction disorders, and CEO of Promises Treatment Centers in Malibu and Los Angeles.
How does a bedridden person manipulate someone who can ambulate and drive?
“If the enabler tries to stop enabling, the food addict may use a number of strategies to elicit compliance,” begins Dr. Sack.
“They may use threats, guilt and heartbreaking pleas that are extremely persuasive, especially when used against someone who is codependent.”
Mysteriously, TLC, the cable channel that airs most of these types of shows, has failed tremendously at addressing the enabler aspect of the super morbidly obese.
The bedridden individuals, some weighing over 900 pounds, are shown as calm, sweet and loving, and rarely shown having any kind of meltdown, and when a little meltdown IS shown, it’s usually not related to being refused food, but for some other reason, such as not having lost weight.
Nevertheless, when a fit occurs due to not being given food, I just can’t figure out why it’s so hard for the enabler to ignore these little outbursts.
When my elderly mother was disabled from depression, it severely weakened her body.
I’ll never forget the time, in the middle of the night, she went to the bathroom to use the toilet.
I had gotten up to supervise in case she fell at any point. She was extremely non-compliant.
After she was done relieving herself, still sitting on the toilet, she told me to help her stand up.
I was sitting outside the bathroom, its door open, giving us a full view of each other. I knew she was capable of getting off the toilet if she put her mind to it.
I refused to be an enabler and remained seated. She got mad and demanded I come over and help her off the toilet seat.
My job was to supervise in case anything went wrong. Nothing more. I knew she could get up without my help.
Still on the seat, she looked at me fiercely and ordered me to help her up. “No,” I said. “I’m helping you by NOT helping you.”
Finally, she got up — and seemingly effortlessly. I then accompanied her back to bed (to make sure she didn’t fall). I just didn’t have it in me to be an enabler, despite my mother’s attempt to manipulate me.
I imagine that sometimes, super morbidly obese people make angry commands while in bed, using authoritative or pleading voices to manipulate their enablers.
The enablers, being already psychologically dismantled from childhood emotional trauma, are not able to oppose the demands or pleas.
Another possibility is that the enabler of the obese is the one in control:
Dr. Sack says, “Those who are morbidly obese are also vulnerable to being manipulated by the people around them, who may have their own unconscious emotional needs (for example, feeling better about their own situation or feeling needed).”
Dr. Sack is a sought-after media expert and has appeared on “Dateline NBC,” “Good Morning America,” “The Early Show,” and “The Doctors,” among many other outlets.
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.
Whey Protein Benefit: Lowers High Blood Pressure
Whey protein may be a safe, cheap way to lower high blood pressure, a possible alternative to drugs that have side effects.
Lowering high blood pressure means cutting down on stroke and heart disease risk.
Whey Protein and Blood Pressure: Study
A study out of Washington State University found that daily consumption of whey protein resulted in at least a six-point reduction in average blood pressure of women and men who had pre-existing high blood pressure.
Though the 71 study participants were between 18 and 26 years, the study’s leader, nutritional biochemistry professor Susan Fluegal, says that older people with high blood pressure would probably get similar benefits from the whey protein.
Whey protein is low-cost and has not been linked to any adverse effects, says Fluegal in the International Dairy Journal paper.
In this study, results showed up in the first week and they lasted for the study’s six-week duration.
However, there were no results for study participants who had pre-existing normal blood pressure.
Whey Protein: Cause and Effect when It Comes to Lowering Blood Pressure
There may be a correlation between whey protein and a reduction in blood pressure readings, but a direct cause-and-effect has not been established.
“The Fluegal study and other studies supporting that whey protein can help reduce blood pressure have several variables that need to be researched further to ensure these findings are completely accurate,” says Dr. Keith Kantor, a leading nutritionist and CEO of the Nutritional Addiction Mitigation Eating and Drinking (NAMED) program, which treats substance abuse, mental illnesses and other illnesses.
Dr. Kantor explains, “I will say that the whey protein used in the studies was not sweetened — which results in less of an impact on insulin levels, resulting in less inflammation — which can help reduce high blood pressure if the person is consuming whey protein on a consistent basis.
“Whey protein is also very filling, which indirectly can reduce cravings and the consumption of processed and fried foods which both are linked to increased risk for high blood pressure.”
If you have hypertension, don’t assume that having a whey protein drink every day — all by itself — will knock it down.
Lower Your High Blood Pressure
Feel free to add whey protein (no sugar added) as a convenient break from meat, poultry and eggs. But to treat hypertension, you should do the following:
• Lower salt intake. Speak to your doctor about this.
• Increase intake of fruits and fresh vegetables.
• Replace refined grains with whole.
• Take up strength training and cardio exercise.
• Lose excess weight.
• Quit smoking or don’t ever start.
Dr. Kantor has a PhD in nutritional science and a doctorate in naturopathic medicine, has appeared on CNN and Fox News Channel for his expertise, and has been an advocate of natural food and healthy living for 30+ years.
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: ©Lorra Garrick
Source:
sciencedaily.com/releases/2010/12/101208125624.htm
Low Blood Pressure: Symptoms, Dangers & How to Safely Raise
What are the symptoms of LOW blood pressure, how dangerous is this and how is it treated?
“Many people have ‘low’ blood pressure and are perfectly healthy,” says Susan L. Besser, MD, with Mercy Medical Center, Baltimore; Diplomate, American Board of Obesity Medicine and board certified by the American Board of Family Medicine.
“Assuming there is no reason for sudden low blood pressure — like dehydration, trauma, severe medical illness [e.g., right-sided heart failure] — if you are not having any symptoms, there is no need to be concerned about it.
“The most common symptom is fainting when you change position (like from lying down to standing).
“The treatment is to be sure you are well-hydrated and to add some salt to your diet (salt makes your blood pressure go up).” But don’t go overboard on the salt/sodium, either.
“There are prescription medications also, but you must talk with your doctor about that.”
Symptoms of Persistent Hypotension
In addition to dizziness or feeling light in the head, the suffer may experience any of the following: fatigue, blurred vision, nausea, trouble concentrating and even passing out.
The symptoms of a sudden drop in blood pressure can be caused by other conditions, but they are:
- Altered mental status, confusion or the appearance of being “totally out of it,” especially in the elderly
- Cold, clammy or moist skin
- Rapid shallow breathing
- Rapid weak pulse
This is a life threatening situation. The body is not getting enough blood. If the person has a pre-existing condition, namely chronic heart failure, a sudden drop in blood pressure is truly an emergency situation.
Many medical conditions and even prescription drugs can drop blood pressure.
The key issue, again, is how the patient feels despite the low blood pressure. For example, in a very fit, athletic individual, a BP reading of 90 over 67 may be normal.
But for an unhealthy, sedentary person whose BP is normally 130 over 80, a sudden drop to 90 over 67 could make them faint or feel ill.
Treatment for Low Blood Pressure
This depends on the cause, which a doctor can determine.
In the event of a more persistent low BP vs. an acute severe drop, the usual treatments include drinking more water, wearing compression stockings and taking a prescribed medication which can boost blood volume.
You should have a home blood pressure device and regularly take readings — after you’ve been sitting relaxed for five minutes.
Dr. Besser provides comprehensive family care, treating common and acute primary conditions like diabetes and hypertension. Her ongoing approach allows her the opportunity to provide accurate and critical diagnoses of more complex conditions and disorders.
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: Freepik.com/jcomp
Aortic Aneurysm: Are Pull-ups Safe to Do?
A leading aortic aneurysm repair surgeon answers if pull-ups are safe for patients to perform.
People who are diagnosed with an aortic aneurysm are typically warned that they must avoid straining with heavy weights.
This directive comes with a lot of ambiguity and is open to very subjective interpretation.
One hundred pounds sounds heavy, but to a trained powerlifter, it’s a walk in the park.
But what if a powerlifter is diagnosed with an aortic aneurysm?
Aortic Aneurysm, Pull-ups and Muscle Failure
The directive of do not strain with heavy weights would definitely apply to someone, diagnosed with aortic aneurysm, who is doing a set of pull-ups and keeps cranking them out, straining to get in those last two repetitions.
Straining is obvious because the last few reps are slow and labored, as opposed to knocked off with ease.
No matter how easy someone makes pull-ups look, he or she has a limit, when they begin approaching the so-called muscle failure, and the routine just becomes super nasty; pull-ups to muscle failure are a real bear.
A person with aortic aneurysm, even if he (or she) has been knocking off pull-ups for years and is in tip-top shape, must end their days of pushing to the limits with this compound exercise.
Percentage of the Rep Max
To make this easy to describe, suppose an athlete’s rep max with pull-ups is 12. He starts feeling the heat at around rep 8. It’s a royal strain to complete 12.
If he has aortic aneurysm, would it be dangerous for him to complete, say, seven reps?
After all, this would be before he begins entering the straining zone. Seven, for this particular athlete, isn’t all that difficult.
“Yes, a percentage of maximal effort is a good way to look at exercise,” says Allan S. Stewart, MD, a cardiothoracic surgeon at HCA Florida Mercy Hospital in Coconut Grove.
The amount of recruitment of additional muscle groups is what causes the increase in catecholamine surge and consequently, the increase in blood pressure delivered to the weakened aorta.”
A pull-up recruits a significant amount of muscle fibers; it’s a classic compound exercise. Seven reps out of the 12 rep max would be 58 percent of the maximal effort.
To another person who isn’t as strong, seven reps could be this person’s rep max, in which case, he should do only two or three.
Dr. Stewart continues, “Working to failure is better accomplished with dumbbells than with a straight bar or with pull-ups — places where it is difficult to assess the strain mid-rep and also difficult to stop without a spotter.
“It is much safer to exercise with specific muscle groups, lighten the weight, and work towards failure.”
Guidelines for Doing Pull-ups with Aortic Aneurysm
In summary, treat pull-ups as you would with any other kind of lifting: Avoid anything that makes you strain, grunt, groan or really struggle. If that’s just one pull-up, then don’t do it.
If you’ve been doing 50 pull-ups and that’s your rep max, and then learn you have an aortic aneurysm, you can still do pull-ups, but not 50 anymore.
Probably not 40. Which number rep is that entrance into the next level of difficulty? Stop short of that transition.
If you find yourself slowing down with the tempo, this means you’re entering the straining zone. Stop. Don’t go there.
Play it safe by quitting several reps before it even gets difficult (the levels are challenging, difficult, and then straining).
By doing submaximal pull-ups, will you lose strength? Yes. You can do 10 sets of three pull-ups if your rep max is seven or eight.
If the RM is higher, you can do more than three in a set, but don’t venture into the straining zone. If the tempo is slowing down, you’ve overshot the boundary.
Research into the danger of doing pull-ups with aortic aneurysm is nonexistent, but putting stress on a weakened great vessel means that you place yourself in danger of an aortic dissection or rupture. Play it safe.
A pioneering aortic disease surgeon for 20+ years, Dr. Stewart has performed 5,000+ open heart surgeries and is the developer of a hybrid endovascular procedure for treating complex aortic aneurysms. In 2013 Dr. Stewart was recruited to lead the Center for Aortic Disease at Mount Sinai Hospital, later promoted to Associate Professor of Cardiovascular Surgery.
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.
Lifting Weights with Aortic Aneurysm: Detailed Guidelines
Are you fed up with the vague, non-descript guidelines of weightlifting for thoracic aortic aneurysm?
Finally, here are guidelines that you can make sense out of.
A diagnosis of a thoracic aortic aneurysm doesn’t mean you must give up lifting weights.
There are several problems with the standard guidelines or “restrictions” for people with a thoracic aortic aneurysm, when it comes to lifting weights.
Weightlifting guidelines for those with a thoracic aortic aneurysm attempt to be a one-size-fits-all template.
Vague Guideline #1: People with thoracic aortic aneurysm should not lift more than half their body weight.
The problem here is that obese people (with thoracic aortic aneurysm) who’ve never done strength training get a free pass for lifting a lot of weight, while lightweight but muscular, strong people who’ve been training all along (and then learn they have thoracic aortic aneurysm) get “punished” for being lightweight.
Shutterstock/LightField Studios
According to this guideline, a 280 pound obese man gets to work out with 140 pounds, while a 160 pound highly trained man gets limited to 80 pounds, even though the 160-pound, muscular man may be significantly stronger than the 280-pound fat man!
In fact, the very heavy man may struggle and strain with just 90 pounds, while the smaller man easily hoists half the big guy’s weight: 140 pounds!
Which man, then, will have the greater blood pressure spike and thus strain his aorta more? The 280-pound, weaker man!
“Obviously, these recommendations are guidelines, and cannot be universally applied,” says Allan S. Stewart, MD, a cardiothoracic surgeon at HCA Florida Mercy Hospital in Coconut Grove.
“Fit people would have more ease in lifting heavier weights, but they are also the ones who are more likely to ignore the guidelines.
“Deconditioned people usually won’t lift 50 percent of their body weight, or they wouldn’t be deconditioned!”
Vague Guideline #2: People with thoracic aortic aneurysm should not lift more than 50 pounds.
Gee, does this mean it’s okay, then, for someone with a thoracic aortic aneurysm to lift 40 pounds – over his or her head – 20 times in a row?
A highly trained person with recently diagnosed thoracic aortic aneurysm may find it easy to lift 40 pounds over his head 20 times (no straining at all, and thus, no aortic root strain).
Whereas a deconditioned patient must strain just to push 40 pounds up only once. This guideline is way too ambiguous.
This vague guideline also doesn’t distinguish among different kinds of lifting.
For instance, a leg press of more than 50 pounds (e.g., 80 pounds) is very easy even for deconditioned people. So why should this be prohibited?
Whereas, a dumbbell bent-over row of 45 pounds would require most untrained women to strain – to do even one repetition, yet according to this guideline, it’s acceptable!
Dr. Stewart explains: “Isolated arm work, like dumbbell curls, will impose little strain on the root. The rule of thumb is that if you are stressing your core (things that make you go Hmmm!), it’s straining your root pressure.”
So if dumbbell curls are okay, does this mean it’s safe for women with aortic aneurysm to curl a 45 pound barbell (less-than-50-pound-rule), even if they must strain to get the reps out?
According to the International Registry of Acute Aortic Dissections: Patients often ask exactly how much weight it is permissible to lift.
Unfortunately, it is not possible to provide a blanket answer to that question, as it all depends on the patient’s size, muscular strength, physical fitness, and how the weight is actually lifted.
Rather than try to define a numerical limit, it may be more appropriate and useful to explain that patients can lift whatever weight they can comfortably lift without having to “bear down” or perform the Valsalva maneuver.
So if you can curl a 100-pound barbell without straining, the absence of straining is your clue that this resistance is not dangerous to your aortic root.
In other words, avoid anything that makes you strain, grunt, or want to grunt or moan.
Vague Guideline #3: Very frightening to those newly diagnosed with a thoracic aortic aneurysm who are weightlifters is when they hear, “Don’t lift more than 10 pounds.”
According to this rule, a highly trained individual, strong as a bull, but recently diagnosed with a thoracic aortic aneurysm, is now rendered prohibited from lifting his or her own baby and even a large watermelon!
The 11-pound bowling ball becomes a 9-pounder. Don’t move the ficus plant; don’t place the 15-pound dog in the car or handle a 12-pound suitcase.
Athletes or even sedentary people, newly diagnosed with a thoracic aortic aneurysm, will exclaim, “This can’t be real!”
A rule this strict is given because it virtually guarantees there will be no aortic dissection triggered by heavy lifting, and it’s easier for a cardiologist to be this strict than to open up the floodgates for endless questions that would result from broadening the restriction to 50 pounds or half one’s body weight.
Vague Guideline #4: People with aortic aneurysm should flat-out avoid lifting weights.
This restriction is the easiest for a physician to administer.
It minimizes patient questions about hypothetical scenarios involving weightlifting exercise or lifting weights on the job, and reassures the doctor that the patient was given the safest recommendation possible – should a dissection occur.
Dr. Stewart says, “. . .the variability (in guidelines) results from an ignorance about the contribution of weight bearing to the risk of dissection.”
Dr. Stewart adds that “the only real data comes from studies on athletes with normal aortas, where a pressure catheter was placed in the aorta during lifting.
“It was demonstrated that lifting an excess of 50 percent of one’s body weight puts a supra-physiologic stress on the root.
“It seems fairly obvious, that if the root is already diseased, then a supra-physiologic load would be bad.
“No correlation has ever been found, however, that weightlifting will lead to dissection.
“What does seem intuitive, though, is that subjecting a weak piece of pipe to high pressure, will further increase the weakness of the pipe until it breaks (or in the case of the aorta, dissects).”
A pioneering aortic disease surgeon for 20+ years, Dr. Stewart has performed 5,000+ open heart surgeries and is the developer of a hybrid endovascular procedure for treating complex aortic aneurysms. In 2013 Dr. Stewart was recruited to lead the Center for Aortic Disease at Mount Sinai Hospital, later promoted to Associate Professor of Cardiovascular Surgery.
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.
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Top image: Shutterstock/Mladen Zivkovic
Aortic Aneurysm: Is High Intensity Interval Training Safe?
A leading aortic disease surgeon explains about aortic aneurysm and high intensity interval training cardio.
If you’ve been diagnosed with an aortic aneurysm and have always been a fitness enthusiast, you’re likely wondering if high intensity interval training (HIIT) is safe.
Medical literature has very scant information on the safety of cardio for people with aortic aneurysm.
Apparently, there have been no studies on the risk of aortic aneurysm dissection in people who engage in high intensity interval training.
“The goal is avoid high stress on the aortic root,” says Allan S. Stewart, MD, a cardiothoracic surgeon at HCA Florida Mercy Hospital in Coconut Grove.
“To this end, the goal is to minimize the adrenaline rush.
“When looking at blood pressure during cardio, the biggest impact is in the first 10-15 minutes of exercise.
“To ameliorate that stress, I tell my patients to ramp up slowly. More specifically, I advise that runners start with a 15 minute mile and then gradually start to increase the speed.
“Cyclists similarly, should begin with a 12-14 mph speed for 15 minutes on flat ground before taking a steep hill.
“There is little in the way of hard scientific evidence to support these recommendations, but the goal is to allow for the body to acclimate to intensity.
“I do not advise anyone with an aneurysm meeting the criteria for repair, to do level 7 or above in intensity.”
In short, a person whose aortic aneurysm is less than 5 cm can safely do high intensity interval training – but the following criteria must be met:
The patient must also have a tri-leaflet aortic valve; must not have a connective tissue disorder; and must not be experiencing symptoms from the aortic aneurysm!
So does this mean that it truly is safe for a person with aortic aneurysm, to engage in high intensity interval training?
Here is what another aortic disease surgeon, Dr. Eric Isselbacher, says in a 2005 issue of the journal Circulation:
Aerobic exercise is generally safe, provided the patient does not have a hypertensive response to exercise.
Consequently, should a patient wish to engage in vigorous aerobic exercise (eg, running or biking), it is prudent to obtain an exercise treadmill test—on β-blockers and/or other baseline antihypertensive medications—to assess the physiological response to exercise and ensure that the systolic blood pressure does not rise above 180 mm Hg.
Minimizing blood pressure response will minimize stress on the aortic root.
According to Dr. Stewart, it can be safe for one with aortic aneurysm (not meeting repair criteria) to reach an intensity level of 7 and above – out of an intensity scale of zero to 10.
Ten means your fullest effort over a 30-second or less period of time.
Think of running up a hill as fast as possible. Level 10 high intensity interval training workouts can also involve pedaling, stepping and jumping.
Level 10 leaves you feeling battered and unable to talk.
Level 9 also produces compete breathlessness within 30 seconds, but a tiny portion of you feels you could have gone a wee bit faster or harder.
So how can high intensity interval training be safe for someone with aortic aneurysm?
Assuming that the patient meets the criteria mentioned previously, does not have a hypertensive response to cardio, and slowly ramps up, as Dr. Stewart advises, high intensity interval training will not strain the aortic root in one who has an aneurysm.
Don’t let the extreme tachycardia (increased heart rate), that follows a high intensity interval training segment, be misleading.
Panting forcefully to recover oxygen levels will not pressurize the weakened vessel wall of someone with aortic aneurysm.
The stress of high intensity interval training is on the lungs.
Dr. Stewart adds, “Sustained cardio is fine. It is not the length of the exercise, but how it commences that causes the difficulty.”
So how should one with aortic aneurysm commence high intensity interval training?
Do a 10-15-minute, slow ramp-up. Using a treadmill as an example, suppose your HIIT maximum speed is 10 mph (for 30 seconds), alternating with slow walking.
You will do a very brief run at 5, 6, 7, 8 and 9 mph preceding it – after you’ve warmed yourself up for 10-15 minutes with walking that escalates to a 4 mph pace.
To minimize a blood pressure spike, each submaximal speed interval will be preceded by a 10-second, 5 mph jog. E.g., when it’s time to run 8 mph, run first for 10 seconds at 5 mph, then run 15 seconds at 8 mph.
That 5 mph for 10 seconds will act as a bridge between the recovery walks and the speed intervals.
When you get to 10 mph, add another bridge: After the 10-second, 5 mph jog, run 5 seconds at 8 mph, and then jump to 10 mph for no longer than 30 seconds. After concluding any speed segment, always slow down gradually!
Yes, this is a lot of fussing around with the treadmill’s controls, not to mention the added burden of those bridges on your max efforts, but if you have a thoracic aortic aneurysm and want to safely do high intensity interval training, you must take precautions.
A pioneering aortic disease surgeon for 20+ years, Dr. Stewart has performed 5,000+ open heart surgeries and is the developer of a hybrid endovascular procedure for treating complex aortic aneurysms. In 2013 Dr. Stewart was recruited to lead the Center for Aortic Disease at Mount Sinai Hospital, later promoted to Associate Professor of Cardiovascular Surgery.
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.
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Source: circ.ahajournals.org/content/111/6/816.full
Aortic Aneurysm: Safe Weightlifting Techniques
Dr. Allen Stewart, aortic repair surgeon, comments on safe weightlifting techniques for people with aortic aneurysm.
Aortic aneurysm: safe weight lifting techniques – there are several.
When a fitness enthusiast is told he or she has an aortic aneurysm, the physician may warn the patient that it’s not safe to continue lifting weights.
Safe weightlifting techniques are mandatory.
Lifting weights increases blood pressure. High blood pressure, even momentarily during lifting weights, can tear the already-weakened inner wall of the aneurysmal aorta, causing fatal internal hemorrhaging.
Safe strength training techniques include avoiding straining.
“Don’t lift heavy weights” is a common admonition for those with aortic aneurysm. But what does “heavy” mean? It’s all relative.
If bench pressing a 60-pound barbell is difficult, then this is heavy for you.
If you warm up with a 180-pound barbell to prepare for 300-pound bench presses, then 180 pounds is light for you (for this particular exercise).
Let’s look at a situation in which a man strains to complete 12 chin-ups. He begins with some effort, but past half-way, things get hairy.
He begins grunting at rep # 10. He barely cranks out the last rep: a 12 rep max with a compound exercise.
Safe weightlifting means no 12 (or fewer) rep maxes.
But what about percentage (of reps) of the 12 RM, using the same resistance?
This man is diagnosed with aortic aneurysm; would it be safe to stop at just half the reps of chin-ups?
Another example is a woman, newly diagnosed with aortic aneurysm, who normally does 12 RM Smith machine squats (135 pounds).
Thirteen reps are too difficult. How about if she just does around seven reps at 135 pounds?
“Yes, a percentage of maximal effort is a good way to look at exercise,” says Allan S. Stewart, MD, a cardiothoracic surgeon at HCA Florida Mercy Hospital in Coconut Grove.
Maximal effort is exactly that: With all your might, you cannot do one more repetition.
“The amount of recruitment of additional muscle groups is what causes the increase in catecholamine surge and consequently, the increase in blood pressure delivered to the weakened aorta,” continues Dr. Stewart.
“Working to failure is better accomplished with dumbbells than with a straight bar or with pull-ups (places where it is difficult to assess the strain mid-rep and also difficult to stop without a spotter).”
So what does this mean?
Dr. Stewart concludes: “It is much safer to exercise with specific muscle groups, lighten the weight, and work towards failure.”
There is “mechanical” failure and there is “metabolic” failure.
Mechanical: The weight can no longer be lifted because it becomes too heavy.
Metabolic: The athlete still has strength to continue lifting, but the muscle “burn” is so intense that another rep is impossible. This debilitating burn can be instigated with even a very light resistance load.
In the case of squats and other compound routines, many muscle groups are recruited, and at a 12 RM (and even more so with a 6-8 RM), there will be a surge in those catecholamines and hence a major blood pressure spike.
The resistance becomes too heavy to continue lifting, even though muscle “burn” may be minimal, if at all existent.
An athlete with aortic aneurysm that does not meet criteria for surgical repair, should do only around half the reps of his or her 12 RMs for compound routines.
For arm isolation work (e.g., dumbbell curls, triceps kickbacks, triceps rope), a 12 RM is fine.
Freepik/jcomp
Those with aortic aneurysm who want to complete 12 reps (or 10 or 8) with compound moves (exercises involving more than one joint) must then use 20-30 percent less resistance!
An aortic aneurysm, when it comes to lifting weights, means things will never be the same again – your safety is priority.
If your 12 RM bench press is 200 pounds, and you have aortic aneurysm, stop at six or seven reps with this load.
Or, do 12 reps at 140 to 160 pounds. Do not push through to true metabolic failure at this lighter weight, either.
Stop when you’re almost there. And don’t even handle the loads that would be for 10 or less RMs.
Another safe weightlifting technique for aortic aneurysm: avoid “super slow” or “negative” training. Move loads quickly to minimize time that blood pressure is high.
Best move: Convert to a 15-20 RM minimum. Dr. Stewart explains, “Reps cause failure of the muscle group more than higher weight, which necessitates recruitment of other muscles and more straining.
“I believe that higher reps with lesser weight is a safer option. Breathing is essential!!! Avoidance of Valsalva is important.”
It’s especially important for those with aortic aneurysm to exaggerate exhalation during the “positive” (concentric) portion of the lift, to prevent pressure-buildup in the thoracic cavity.
Inhale very deeply during the “negative” or release portion.
A pioneering aortic disease surgeon for 20+ years, Dr. Stewart has performed 5,000+ open heart surgeries and is the developer of a hybrid endovascular procedure for treating complex aortic aneurysms. In 2013 Dr. Stewart was recruited to lead the Center for Aortic Disease at Mount Sinai Hospital, later promoted to Associate Professor of Cardiovascular Surgery.
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.
Following Aortic Aneurysm: CT Scan vs. Echo vs. MRI
A cardiologist gives imaging information about following an aortic aneurysm.
If you’ve been diagnosed with an aortic aneurysm, perhaps you’ve been wondering what is the most accurate imaging tool for which to “follow” it.
Whether your aortic aneurysm was picked up by a CT scan, echocardiogram or MRI, you’ve most likely been told by your doctor that serial imaging is in order (depending on size of the dilatation).
As for which imaging modality is best for serial following, the answer varies from one medical journal to the next.
“The most important factor is that at any particular institution where the patient is being followed with serial imaging, then one single modality (MRI, CT or echo) should be used for serial measurements,” explains Renee P. Bullock-Palmer, MD, a board certified cardiologist based in NJ.
If at all possible, make sure that the technician who is conducting the test is the same person every time.
Dr. Bullock-Palmer continues, “That being said, especially for younger patients where there is the associated risk of repeated radiation exposure, then a non-radiation type test is preferred, and thus MRI or TEE would be better than CT.”
TEE stands for transesophageal echocardiogram.
Transesophageal Echocardiogram
“TEE being more invasive in that this procedure is performed similar to an endoscopy, then MRI would be the preferred modality for serial imaging, particularly in the younger patient.”
If your aortic aneurysm was first detected by a CT or CAT scan, it’s important to have another, immediate scan via either MRI or TEE.
The reason is that sometimes, the interpretation of a CT reading is overestimated.
This happens when the slice of the aorta is done at an angle, or obliquely, rather than head-on, or, to put it another way, perpendicular to the curvature of the vessel, or to the linear dimension, in the case of the abdominal aorta.
If you’re having trouble visualizing this, then take a hand mirror that’s circular.
Catch the sun in it and cast the reflection of the sun on the wall. Move the mirror about and you can manipulate the shape of the reflection.
Angle the mirror in certain ways, and the reflection becomes more oval-like. Get a more head-on reflection and the shape is a circle.
The elongated reflection is akin to an overestimated reading of aortic diameter. An MRI or TEE will be more accurate as to true diameter.
The reading from a standard echocardiogram can also be overestimated, in that the interpreter may tack on one or two millimeters and conclude that the aortic aneurysm has “grown,” when in fact, it might still be the same size as it was the last time it was imaged.
Some people are afraid of MRIs, but remember, at least with an MRI, you will not be exposed to radiation.
MRI is highly sensitive, and the loud knocking noises, and length of test, are worth the more accurate reading of aortic aneurysm diameter.
Dr. Bullock-Palmer specializes in and has a passion for cardiac imaging as well as cardiovascular health of women.
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: BruceBlaus/CC
Can Beta Blockers Shrink Abdominal Aortic Aneurysm?
A leading vascular surgeon discusses beta blockers can shrink an abdominal aortic aneurysm.
Many people with abdominal (and thoracic) aortic aneurysms wonder if taking beta blockers will shrink the bulge.
A beta blocker belongs to a class of drugs designed to lower high blood pressure.
Do beta blockers have a shrinking effect on an aortic aneurysm?
“With regards to beta blockers, there is no data that I am aware of that helps shrink abdominal aortic aneurysm,” says Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
“There is, however, data that indicates that AAAs expand at a slower rate in patients who are on beta blockers than those who are not.”
In general, an aortic aneurysm expands at the rate of 3 to 5 millimeters per year.
This doesn’t sound like a lot, but in aneurysmal terms, it’s very relevant.
When an abdominal aortic aneurysm reaches a minimum size, surgery is strongly recommended to repair the problem.
Until then, the patient practices “watchful waiting” which includes yearly scans, and blood pressure control, since higher blood pressure produces increased tension in the inner wall of the aorta – which can tear or rupture the aneurysm.
Dr. Gashti continues, “According to LaPlace’s law, arterial hypertension (high blood pressure) increases aortic wall tension and has been related to an increased rate of expansion and rupture.
“So since beta blockers lower blood pressure and the rate of the aortic pressure wave, they should inhibit AAA expansion and therefore rupture.”
An abdominal aortic aneurysm will never shrink spontaneously.
There are no known drugs that can produce a shrinking effect. The only means of repair are surgery or stent grafting.
An AAA doesn’t necessarily keep getting bigger and bigger; some do remain small, but there is no way to tell if this will be the outcome; hence, the patient must maintain watchful waiting and regular imaging for life unless surgical repair is done — such as an endovascular graft as shown below.
Usually an abdominal aortic aneurysm does not cause symptoms, and most are detected by accident when the patient is being imaged for an unrelated issue.
A person can go his entire life with an AAA and never know it and live to a ripe old age.
Unfortunately, once one is discovered by accident, the knowledge of its existence changes things dramatically in that the patient now must make sure his blood pressure is consistently low, usually must take beta blockers to help ensure this, and must avoid heavy straining weightlifting.
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm. He received his medical degree from University of New England College of Osteopathic Medicine and has been in practice for more than 20 years.
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: BruceBlaus
Can Lifting Weights Cause Aortic Dilatation (Enlargement)?
A vascular surgeon who performs aortic repairs answers if weightlifting can cause aortic dilatation.
“With regard to aortic dilatation in athletes, these kind of exercises (lifting weights) do in fact, over a long period of time, result in a compensatory dilatation of vessels, including the aorta,” says Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
When an athlete, particularly one who does weight lifting, learns he has an enlarged or dilated aorta, his first instinct might be to conclude that working out caused this, and that it’s a good thing, not a bad thing.
Unfortunately, aortic dilatation in the truest sense is a crushing blow to a person who lifts weights.
The diagnosis of pathological dilatation (dilation or enlargement) isn’t always determined by just one reading off of one slice of the great vessel.
A more definitive imaging test may detect a smaller diameter, and reveal that the measurement, when taken in context with the entire aorta, actually shows a normal structure.
An athlete, upon learning that a slice of his aorta is at the upper limits of normal, or borderline aneurysmal in terms of centimeter measurement, wants to know if exercise can lead to this as part of a remodeling of the vessel as it adapts to greater cardiac output.
Dr. Gashti explains that the compensatory dilatation of the aorta comes about from “the need for increase in supply of blood to the exercising tissues/organs.
“For example, a patient who is being scheduled for creation of an arteriovenous fistula (artificial connection between artery and vein) for hemodialysis (machine-filtering of waste from blood), is told to exercise the intended arm so that when the time comes for surgery, the vein and the artery are larger and therefore they would have a better fistula.”
Aortic dilatation is a rather broad term, and indeed, it can refer to an aneurysm.
In the event of exercise-induced enlargement, Dr. Gashti says, “But the dilatation in this situation would be diffuse rather than focal, such as an aortic abdominal aneurysm.”
“Diffuse” means evenly distributed; in terms of the aorta, this would mean enlargement that’s uniform, as though it’s simply part of the vessel – a scaled up vessel, you might say, but still with normal proportions or dimensions.
“Diffuse dilatation of a vessel is immuned from the pressures that may lead to rupture, and therefore are generally of no concern,” says Dr. Gashti.
“Focal” means an isolated section of the aorta that’s enlarged. It appears bulging on an imaging test.
It can also appear sac-like, maybe even on just one side of the vessel. In short, the overall picture looks abnormal.
The diameter dimensions along various slices do not follow a normal pattern of increase and decrease.
“There is actually a condition called “arteriomegally” that describes this diffuse dilatation of vessels with no significant sequelae,” adds Dr. Gashti.
The bottom line is that there is no evidence that lifting weights can cause an aortic aneurysm, which, by definition, is a pathological process.
However, exercise indeed can cause a diffuse enlargement that does not result in any abnormal dimensions or weak vessel walls, and the athlete thus has no restrictions on activity.
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm. He received his medical degree from University of New England College of Osteopathic Medicine and has been in practice for more than 20 years.
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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