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New research shows that losing weight or
controlling salt intake may allow some older people
to stop taking drugs for high blood pressure
Researchers at the Bowman Gray/ Baptist
Hospital Medical Center and three other medical
centers found that either weight loss of at least 10
pounds or control of dietary salt, or both, "were fairly
effective substitutes for medication for up to half the
participants," said Mark Espeland, Ph.D., director of
the coordinating center for the TONE (Trial Of
Nonpharmacologic Intervention in the Elderly) study.
Espeland and Walter H. Ettinger, Jr., M.D, who
directed the TONE clinic at Bowman Cray, stressed they
were talking not only about reducing use of table salt
but also the salt - sodium - in processed food. The
goal: Limit sodium intake to 1,800 milligrams a day.
- ? ? C.I* C.......
That's not as easy as it sounds* because a high
sodium food may not taste salty. For instance; a
chicken pot pie may have 1,020 milligrams of sodium;
canned ravioli, 1,200 milligrams; one dill pickle, 930
milligrams; or a Reuben sandwich, 2,555 milligrams
TONE'S weight loss program focused on both
control of calories and increased exercise
"One of the remarkable things about this study is
that people maintained their weight loss or low
sodium diet for 2 ft years," said Ettinger.
Espeland said either weight loss or control of
sodium was effective with men or women, blacks or
whites, those between 60 and 70 and those between 70
and 80. Before the study began, the high blood pressure
of all participants had been controlled by a single
blood pressure medicine such as a diuretic, calcium
channel blocker or beta blocker.
"Changing one's diet and exercise seems to make
sense as an alternative," said Espeland, professor of
public health sciences (biostatistics). "TONE was a
study to see if lifestyle interventions could be jf
substituted for medication in controlling high blood
pressure in an older population"
Such actions could result in millions of dollars in
savings for patients "People want to get off these
medications because they are expensive" .
Espeland said.
Ettinger, professor of internal medicine and public
health sciences added that there had been skepticism
that people could stick to diets since the typical pattern
is for people to gain weight back soon after loss
"Most people found the diets to be acceptable;" dl
he said. "Several said they enjoyed their new diet
better,than what they had been eating. The results
suggest this may work long-term.*
? Patients should always check with their doctors
before discontinuing any medication.
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' February
American Heart Month
FreshStart Smoking Cessation Classes
February 10,13,17 & 20, 7 p.m. - 8 p.m.
Center for Health Promotion
One Piedmont Plaza, 2nd floor
1920 W. First Street
Healthy Eating for Diabetes
tuesdays, 2 p.m. - 3 p.m.
February 11 - Counting Carbohydrates
February 18 - Dining Out & Eating Right
February 25 - Survival Skills
$10 per class
Center for Health Promotion
One Piedmont Plaza, 2nd floor
1920 W. First Street
Weight Management Program
February 13,19 & 20, 5 p.m. - 6 p.m.
Overview and Question-&-Answer Session
Center for Health Promotion
One Piedmont Plaza, 2nd floor
1920 W. First Street
Saturday, February 22, 8 a.m. - 5 p.m.
Community CPR Training
Anderson Conference Center
Winston-Salem State University
Tuesday, February 25, 8 a.m. - 2 p.m.
Family Heart Symposium
Calvary Baptist Church
5000 Country Club Road
Health
For information on these events, general health care
information, or to schedule an appointment with a
physician, call 716-2255, or toll-free 800-446-2255.
http://www.bgsm.edu
t j
Stacie Lipscomb, congestive heart failure coordinator, explains the symptoms of heart failure
to a patient
" T Tow are you sleeping, Mr. McDonald?" "Are you
I I waking up short of breath?" "What about
JL JL swelling - have you had any weight gain?''
Freddy McDonald, 51, of Lincolnton, isn't at his
doctor's office. He's getting a telephone "check-up" from
Stacie Lipscomb, R.N., congestive heart failure coordinator
at Wake Forest University/Baptisl Heart Center.
Since July, the Heart Center has been telephoning
certain heart failure patients between clinic visits with
the goal of catching potential problems early enough to
avoid hospitalization.
"Historically, physicians have treated heart failure by
putting out fires," said Barry Rayburn, M.D., assistant
professor of internal medicine (cardiology), and director of
the heart failure clinic. "The patient would become acutely
sick and be admitted to the hospital. With telephone
management, we're working to catch problems in time to
treat them in the clinic."
When the Heart's Not Strong Enough
Heart failure is a long-term condition that occurs
when the heart muscle is not strong enough to meet the
cause is coronary artery disease - the heart cannot get
enough oxygenated blood to the body because of
hardening of the arteries or damage from a heart attack.
The chief symptoms of heart failure are fatigue,
weakness and shortness of breath. There is no cure for
heart failure, but there are medications that can strengthen
the heart's contractions and help control the symptoms of
heart failure.
Sometimes, a cold or a change in diet can disrupt the
delicate balance achieved by the medication. Then, the
heart acts more like a dam than a pump. Fluid begins to
leak into the lungs, causing shortness of breath, or into
the abdomen, feet and legs, causing swelling.
If these symptoms are caught early, the problem can
often be managed with a change in medication. That's
why all the clinic's patients are taught to look for overnight
weight gain of more than two pounds or waking up at
night short of breath - what Lipscomb calls "red flags."
If the heart failure isn't managed quickly, oral
medication won't work and the patient must be hospital
ized and treated with intravenous drugs - drugs injected
directly into the veins.
The Heart Center follows 15-20 patients by phone -
those who are very sick, have recently had their medication
changed or who are newly diagnosed. All patients seen in
the Heart Center can call 24 hours a day if they notice
warning signs.
The ultimate goal is fewer hospitalizations for patients
like McDonald and a better quality of life.
McDonald said a combination of a new medication
and monitoring his symptoms has made a world of
difference to him.
"When I first started going to see Dr. Rayburn, I had
just about given up and didn't think there was any hope
for me. I couldn't even walk from the car to my first : Z
appointment. Now, I walk a mile a day." ,??
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Causes about 40,000 deaths in the United E
year and contributes to an additional 225,000dewipiSM E
Is the only heart condition that is increasing in ifKlMHfl E
Is the leading cause of hospitalization among peop)I^S^| n
age 65 and older I ~
^
When Edith Gladstone's husband had
heart bypass surgery, she memorized a
brochure about CPR (cardiopulmonary
resuscitation) and put it away in a safe place.
"I thought if 1 ever had to do it, I
would run and get the book out," said
the Kernersville woman.
But when Gladstone's husband, Howard,
suddenly stopped breathing last November,
she knew there wasn't time to get the book.
She called 911 and immediately began CPR
- relying on what she had memorized six
years earlier.
"I'm one of those people who was
* A
always going to take the course and never
did," Gladstone said. "But 1 knew the airway
had to be cleared and where to put my hands
and how many compressions were needed
for each breath."
Rescue workers believe Gladstone's
efforts saved her husband's life.
"She was doing perfect CPR," said Lynn
Morrison, an emergency medical technician
with Kernersville Rescue Squad, who
responded to the call. "I think it made a
huge difference for him."
j As a result of her experience, Gladstone
says she's a strong advocate of CPR training.
"It's really important for everyone to
learn it," she said. ?
CPR combines rescue breathing and chest
compressions to keep the brain temporarily
supplied with oxygen. Without CPR, the
brain and other organs die within four to
six minutes.
i
Kathy North (center), assistant coordinator of Life Support
Education, teaches CPR.
CPR is part of the "chain of survival," a
series of actions that improve someone's
chances of surviving cardiac arrest. The
steps include calling 911; performing CPR;
restarting the heart using early defibrillation,
a brief electric shock; and early advanced
medical care, which includes both emergency
medical services and a well-prepared hospital.
v
Forsyth County and surrounding
counties have a good system in place for
responding to cardiac arrest, said Roy Alson,
M.D., assistant medical director of Forsyth
County EMS and assistant professor of
emergency medicine at Bowman Gray School
of Medicine. But the weak link in the chain
is the number of citizens who know CPR.
Learning CPR
Bowman Gray/Baptist Hospital Medical
Center and Laerdal Medical Corporation are \
sponsoring a community CPITtraining day
on Feb. 22 at Anderson Conference Center
at Winston-Salem State University. Free one
hour classes will begin on the hour from
8 a.m. to 5 p.m. Both pediatric and adult
CPR will be offered. Call HeartLine at
1-800-716-7730 to schedule an appointment.
i ne ineme ror tne training day is,
"Could you save someone you love?"
"When you're trained in CPR, the person
you're most likely to save is someone you
know or love," Alson said. "More than 80
percent of heart attacks happen at home and
an additional 10 percent happen at work."
Many of the illnesses or accidents that
can cause a child's heart to stop - choking,
electrical shock or pneumonia - also happen
at home. *
"CPR provides a window of opportunity.
It buys time so there is a chance to apply
the next steps in the chairi of survival,"
Alson said.