Kunihiko Umekita writes:
1) What would be the most effective
ways to inform Mr. O of his current health?
Coronary disease risk factors are cigarette smoke, cholesterol, physical
inactivity, overweight and diabetes. You (Mr.O) have many risk factors.
You had once been a heavy cigarette smoker, but you have cut down your
smoking from a pack a day to less than half a pack. It's O.K. But you must
stop smoking now, because, in 1990 about 417000 Americans died of smoking-related
illnesses. Nearly one-fifth of deaths from cardiovascular diseases are
attributable to smoking. Smoking-related illnesses cost about 50 billion
dollars annually in medical care. And the result of your cholesterol tests
are not positive: LDL -- 173 mg/dl; HDL -- 26 mg/dl. LDL is one factor
of CHD and CVD. The result indicates your LDL level is a high risk. Your
blood pressure indicates moderate to high hypertension, 165-105 mm Hg.
In addition your only exercise is walking across the street from your apartment
to your office and back.
Also, Mr. O is almost 20 kilos overweight.
So, Mr.O must consider his every food and reduce these risk factor effects
(for example, do exercise, stop smoking, eat food contain HDL etc.)
2) Because Mr. O delayed seeing a doctor when he suffered his first heart
attack, you will want to help him prepare for the right kind of behavior
in the event he should have another heart attack.
You must get help immediately. You must get to prompt treatment for heart
attack. So you can save your life. You should take the following actions.
a) Sit down or lie down. b) If symptoms persist for 2 minutes, call your
local emergency telephone number and you should say that you are having
a heart attack. Leave the phone off the hook so that medical personnel
can locate your address if you should become unconscious. c) If you have
nitroglycerin tablets, you should take up to three pills, one at a time
every 5 minutes. d) Ambulances are well equipped to provide emergency care
for people who are having heart attacks. It is usually better to have medical
personnel come to you. e) When we can get to the hospital faster by car
than by ambulance, have someone drive you. f) When you arrive at the emergency
room, you should announce clearly that you may be having a heart attack.
3) What should Mr. O do within the next few weeks to improve his health
outlook?
a) Mr. O needs to see a doctor and follow his doctor's instructions. He
should stay on medication. O's dietary and lifestyle changes also may help
control high blood pressure. For example reducing sodium in his diet.
b) If he loses weight, blood pressure
also returns to normal. Increasing physical activity can reduce blood pressure.
Before drugs are prescribed, these methods to control blood pressure are
often recommended for Mr.O with only mildly elevated blood pressure.
If Okada can not take these methods of control, I'll give him medication.
For instance, antihypertensives are available to lower high blood pressure.
Some, called diuretics, rid the body of excess fluids and salt (sodium).
Others, called beta blockers, reduce the heart rate and the heart's output
of blood. Another class of antihypertensives is called sympathetic nerve
inhibitors.
Sympathetic nerves go from the brain to all parts of the body, including
the arteries. They can cause the arteries to constrict or narrow, thereby
raising blood pressure. This class of drugs reduces blood pressure by inhibiting
these nerves from constricting blood vessels.
c) Reducing cholesterol levels in the blood and fat in the diet can prevent
heart disease and related deaths. So, I will take blood cholesterol tests.
This tests measure the amount of high-density lipoproteins and low-density
lipoproteins present in the blood."high cholesterol" level means
an excess of LDL in blood.
LDL-Cholesterol Categories:
Less than 130 mg/dL = Good or desirable level;
130 to 159 mg/dL = Borderline or high risk;
160 mg/dL or above = High risk.
The lower the HDL level the greater the risk for heart disease. Any HDL-cholesterol
level lower than 35 mg/dL is considered low. Quitting smoking, losing weight
(Mr.O is overweight), and becoming physically active may help raise O's
HDL-cholesterol level.
Next, I will consider the result of blood cholesterol tests, and determine
a medical plan (medication, ergotherapy etc.) and suggest what would be
best.
4) What should he do in the longer term to help prevent the occurrence
of another heart attack?
In the long term, you should change your life style. I heard that you once
had been a heavy cigarette smoker, but you have cut down your smoking from
a pack a day to less than half a pack. But even if you cut your cigarettes
to half, it is still bad for your heart. Smoking relates to many illnesses.
It is reported that nearly one-fifth of deaths from cardiovascular diseases
are attributable to smoking. So, it would be better for you to decrease
the amount of cigarettes little by little.
Another problem for you to prevent heart disease is cholesterol. It is
reported that among elderly Japanese-American men in the Honolulu Heart
Program Fourth Examination (1991 -- 93), 42 percent had cholesterol levels
greater than or equal to 200 mg/dL or were taking cholesterol-lowering
medication. As you can see from this report, decreasing your cholesterol
may lead to preventing your possibility of another heart diseases. Cholesterol
is a type of fat made by your liver and it is also contained in certain
foods that you eat, such as eggs, meat and dairy products. When you eat
these foods often, the amount of cholesterol in your blood is increased.
Foods high in saturated fat can also raise the amount of cholesterol in
your blood, because your liver turns saturated fat into cholesterol. Cholesterol
travels through the blood in different types of packages called lipoproteins.
The low density lipoprotein (LDL) delivers cholesterol to the body. The
high density lipoprotein (HDL) removes cholesterol from the blood stream.
It is important for you to reduce LDL and increase HDL. To reduce fat,
trim away all visible fat and boil, bake, or broil rather than fry meats.
You can reduce dairy products you take. You can use margarines instead
of butter. It would be good for you to eat egg yolks only three times a
week.
The third problem for you is that you are 20 kilos overweight. This probably
results from the fact that you hardly get out of the office to do exercise.
People with lower incomes and less than a 12th grade education are more
likely to be sedentary. The relative risk of coronary heart disease (heart
attack) associated with physical inactivity ranges from 1.5 to 2.4, an
increase in risk comparable with that observed for high cholesterol, high
blood pressure or cigarette smoking. Less active, less fit persons have
a 30 -- 50 percent greater risk of developing high blood pressure. To keep
your weight down, participate in routine physical exercise and control
your calorie intake.
Finally you should consider how your risk factors effect your current health.
Go to the hospital and take examinations regularly. I hope I will see you
then! This is the most important point.
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