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Judy Siegel-Itzkovich, THE JERUSALEM POST Feb. 20, 2005
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The recent announcement that better prevention and treatment of heart
disease is saving so many lives that cancer has overtaken it as the foremost
cause of death in the US and Israel was welcome news. This is not because
cancer is a more "pleasant" disease, but because cardiovascular diseases
tend to hit people in their prime, while cancers generally affect older
people. But there is still plenty to do, as every year 15,000 more Israelis
are diagnosed with heart disease, and anyone who has reached his fifth
decade has a four-in-10 risk of suffering a heart attack.
Most general practitioners are so pressed for time that they have little
opportunity to talk to their patients about preventing disease, and the
Health Ministry's focus has always been on coping with disease through
hospitalization rather than on prevention. The health funds spend only a
small percentage of their income on health education and disease prevention.
But now a new book has been published in Hebrew that empowers people of all
ages. Called Halev: Hamadrich Hamaleh Livriut U'leshikum (The Heart: A
Complete Guide to Health and Rehabilitation), the 416-page, NIS 94 volume by
Keter (www.keter-books.co.il) calls on people to take their own health to
heart.
Its authors are unusual: Prof. Raphael (Rafi) Carasso and Ofir Vogel are not
cardiologists. Carasso, who has his own weekly health magazine on TV's
Second Channel (Mondays at 7.20 p.m.), is chairman of the neurology
department at Hillel Jaffe Medical Center in Hadera and heads its pain and
complementary medicine clinics. He also teaches at the Technion's Rappoport
School of Medicine and is a psychobiological researcher and expert on aging.
Ofir Vogel is a naturopath involved in rehabilitation of heart patients at
Assaf Harofeh Medical Center in Tzrifin through the use of relaxation
techniques and proper nutrition, as well as reducing blood pressure and
medication by improving lifestyles.
Because of their backgrounds, they have written a book for the general
public that is very different from what it would have been if authored by
cardiologists. Carasso and Vogel take a much more holistic and
interdisciplinary view of the body, with much space given to the interaction
between a person's lifestyles and emotional state on the one hand and risk
of heart disease on the other.
Only last week, US researchers reported at the Second International
Conference on Women, Heart Disease and Stroke in Atlanta that married women
who avoid conflict with their spouses by keeping their feelings to
themselves ("self-silencing") had more than four times the risk of dying
compared to women who always show their feelings. The researchers also
showed that men whose wives come home upset have a double risk of developing
heart disease. Another research team at the conference found that women
dismissed from their jobs face not only emotional distress, but a higher
risk of cardiovascular disease.
The Keter book is written in a very upbeat tone: "Unlike the past, when
heart disease was the end of the road to many, today the present and future
are more optimistic," they write in their introduction. "If we are careful
to protect our heart, even if it partially betrays us, one can rehabilitate
oneself in confidence and continue to live long, healthy, satisfactory and
full lives."
Each of seven main subjects is highlighted by tabs printed on the edge of
each left-handed page. Beginning with an intelligent layman's guide to the
mechanics of the circulatory system, Carasso and Vogel note that if put end
to end, there are 96,000 kilometers of blood vessels from large arteries
to tiny capillaries in a single human body. They go into detail about what
can go wrong with this transport system and the pump that keeps it moving,
the symptoms of a heart attack and what to do [call an ambulance and in the
meantime suck on or chew an aspirin tablet appropriately called Godamed].
But people shouldn't wait for that late stage. They should be as aware of
their current general blood cholesterol, low-density lipoprotein and
high-density lipoprotein levels (and the ratio between them), their blood
pressure readings and homocysteine, C-reactive protein, triglyceride and
blood sugar levels as they are of their shoe and shirt sizes. There is a
helpful chart listing weight and height, with calculations of body mass
index.
They put much emphasis on the danger posed by smoking, the influence of
one's age and family history, amount of physical activity and daily stress.
Are you a Type A personality who is always rushing about, a workaholic who
never relaxes, a high-achieving perfectionist hostile to anyone or anything
that delays you? Or are you a Type B, who takes things easier and get
satisfied more easily while remaining interested in achievement? Type As are
twice as likely to get a heart attack as Type Bs.
The authors also explain all the various technologies for diagnosis heart
disease, from electrocardiograms, X-rays, blood enzyme and stress tests to
ambulatory ECG monitoring, angio-CT, radioactive heart monitoring and
Doppler ultrasound. Catheterization for diagnosis and angioplasty for
freeing up clots in the coronary arteries are discussed in depth, along with
charts of the various families of cardiology medications, including their
generic and commercial names in Israel, and how they work.
Since knowing details in advance is the best way to prevent anxiety, Carasso
and Vogel provide much digestible information on coronary bypass surgery,
what side effects to expect and how to promote your own positive thinking
about returning to a normal life. Regaining the same sexual functioning one
had before a heart attack or surgery a subject commonly ignored by
cardiologists is given emphasis. There is even detailed advice to family
members on how to cope "when somebody dear to you has a heart attack."
More than half the volume is devoted to physical and emotional
rehabilitation from a cardiac event. You are told what to expect during the
first hours and days in the hospital, and what physical exertion you're
allowed while Type As are advised not to start working on their laptops
and using their cellphones from their beds. Nineteen different exercises for
relaxing and getting your muscles nimble that need only a chair are
presented.The elderly, diabetics, hypertensives and people with circulatory
problems are given special advice on the limits and types of exercise during
rehabilitation. Many heart patients have to reform their lifestyles
completely. A change in diet is a major part, and the book gives solid
nutritional advice to reduce cholesterol levels, improve vitamin and mineral
intake (if needed) and be aware of the glycemic index of foods.
A whole chapter is devoted to emotional coping. It's natural to react to
being suddenly felled with anger, denial, anxiety, shock and/or depression.
Younger people are usually more shocked than older people, they note, but
each reacts according to their personality, personal situation and support
system. Regarding rehabilitation after a heart attack, a "fighting spirit"
and viewing recovery as a positive challenge or mission is very beneficial,
they advise. Not only the spouse or partner is affected by your sudden
vulnerability, but also one's children. Patients who join a support group,
have religious faith and have a close relationship with a person to share
one's worries have a much lower mortality rate within six months of heart
surgery.
The authors cite a fascinating piece of research published in the
prestigious journal Science way back in 1980. Rabbits with identical genetic
background were fed high-cholesterol food for two years in a laboratory. The
aim was to learn how fatty foods cause atherosclerosis. To the researchers'
amazement, it was discovered that rabbits housed in lower cages were
significantly healthier than those in higher cages. After much
investigation, they learned that the lab assistant charged with feeding the
animals used to fondle, talk to and play with those within her reach in the
lower cages, but was unable to do so with those out of reach. A controlled
study comparing rabbits getting emotional and physical attention and those
that were starved for affection showed that the former were 60% less likely
to get clogged arteries than those that were left alone. (Add to my to-do
list: Talk to and tickle our two-year-old bunny Vanilla more often!)
The comprehensive volume is rounded out with practical information on
getting aid from the National Insurance Institute and the Income Tax
Authority; rehabilitation programs subsidized by health funds; frequently
asked questions; a medical word list; and a food glycemic index.
Everyone should take this book and its advice to heart.
Judy Siegel-Itzkovich
Health and Science Reporter and Software Reviewer
The Jerusalem Post
POB 81,
91000 Jerusalem
ISRAEL
Phone: 972-2-5315665
02-5315665
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