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Show Tuesday, February 1, HERALD DAILY 2005 M T B3 Medication 1 BODY&ilD HEALTH NEWS FOR YOUR PHYSICAL AND MENTAL management WELL-BEIN- G Jim Miller Savvy Senior, Dear worryis that mytoo taking Port access valve surgery f New heart procedure causes less pain using small incisions ... i RIDDER t NEWSPAPERS "oseph Hoak has been active for more than 40 years. Bike riding, sailing, swimming, rowing he's done it all. At 73, he washes his own cars, mows his own lawn and, to the chagrin of his wife, Barbara, parks far away from the door at the mall. Hoak, who lives in Miami, also works three or four hours a day in Homestead, Fla., at H oak's Greenhouse & Nursery, a business he sold to his son. There, he walks over five acres, tending to the plants. As active as he is, he knows his body pretty well. So, he knew something was wrong in the summer of 2003 when he felt a little pressure around his chest and slight pain in his arms. Hoak's primary care physician sent him to an emergency cardiac center, where he was held for 24 hours. "They couldn't find anything wrong," said Hoak, whose family has no history of heart . The solution 2 To make the best use of your medicines, it's important to take an active role in decisions about your treatment, follow your treatment plan as prescribed, watch out for problems and get help in solving them should they occur. Most medicine problems can be avoided or solved by com- -' municating with your doctor andor pharmacist. Here are some key points to talk to your doctor about when a new' . drug is prescribed: I Ask about the risks and benefits of each medicine. I Find out what side effects the medicine may have, and ,. what to do if they occur. Tell your doctor about all the medicines you are already taking, if you are being treated by another doctor for something else, and if you have any allergies or side effects from any particular medicines. I Find out how often you will be monitored for the icine's effects. I Know and follow your treatment plan. For example, how long and how often you should take the medication, should it be taken with food, or not, and what to do if you miss a dose. Misuse Medication misuse refers . to giving the right medication but the wrong dose, the wrong medicine for a particu- lar condition, or two or more drugs that interact dangerously. Any of these scenarios in seniors can cause, aggravate, or contribute to problems, including: confusion, hallucinations, depression, dizziness, drowsiness, falls, insomnia, loss of coordination, dry mouth and memory loss, all of which can lead to a decreased quality of life, loss of independence, hospitalization and even death. disease. Hoak went to a cardiologist, who told him he had a leaky heart valve, but it wasn't serious and he should come back in six months. "By then I was getting fatigued after a few hours work," Hoak said. "Where I used to be able to walk a mile, I was getting out of breath after a quarter of a mile. And I was coughing continuously for months on end a dry hacking cough." Tests confirmed the leak was getting worse. Hoak's doctor recommended he see Dr. Joseph Lamelas, a Miami cardiovascular and thoracic surgeon skilled in port access valve surgery, a new, minimally invasive procedure performed through small incisions near the breast and in the neck or groin. Using tiny instruments, a surgeon can thread his or her way between the ribs to get to the valves. (Previously, surgeons had to break the breast bone and spread the ribs, to access the heart.) . Once the surgeon gets to the valve, "we cut different pieces out and remold it back to a normal-lookin- g valve," Lamelas said. "It's like plastic surgery of the heart. If that's not possible, then the valve has to be completely removed and a new valve implanted." (Again, using the new procedure.) The surgery, around for about five years, has gone through an evolutionary process "because the instrumentation that we had back five years ago was very primitive," Lamelas says. Today, there are about 5,100 cardiovascular and thoracic surgeons in the United States, according to the American Medical Association, and about 4 percent of them are trained for the procedure. Recovery time is two to three weeks, versus eight weeks for open chest surgery; pain and scarring are minimal. Hoak's mitral valve was progressively deteriorating. It may have been defective from birth or deteriorated with age. "In his case the support mechanism that holds the valve in place suddenly broke," Lamelas says. "It's like a parachute string. When you cut the string, . the parachute doesn't work. When the strings are broken, the valve begins to leak. As the defective valve has to undergo each heartbeat, there's more stress on the valve. That's why it breaks." In a healthy heart, four valves connect four chambers, acting as doors to keep blood flowing in one directioa Since Hoak's arteries were in good shape, and since he didn't need bypass surgery, Hoak was a good candidate for port access valve surgery, Lamelas said. Had he required bypass surgery, a surgeon would have had to approach his heart from all sides, which could not be done through a small incision fessionals are not trained to recognize how diseases and drugs affect older people. If a greater number of health care professionals had better training and understanding of medications and their effects in older people, many problems could be avoided. Dear Mary , Medication misuse is a big problem in the United States today. In fact, it's estimated that each year, 2.2 million Americans are hospitalized, and 200,000 more die, because of adverse reactions to medications. Here's what you should know. Medication can be a double-edge- d sword that has the power to heal and to harm. The right medication, in the right amount, to the right patient can produce medical miracles. But, medicine affects different people in different ways and can cause dangerous reactions. People over age 65 are especially vulnerable to medication problems, due to the biological changes that occur with aging, and because many seniors tend to take multiple medications at the same time for various health problems. Desonta Holder KNIGHT Savvy Senior many prescription drugs. Mom is 78 and fairly healthy, but currently is taking eight different medications for a variety of health problems. It seems like every time she to the doctor she gets a gos new prescription. I am con cerned that she is taking too many drugs, and that mixing all these different medications can't be a good. Is there any way to help mom manage her medications so she doesn't have to take so many pills? Medicated Mary j" ! . jr. ' , ir' . a . f . ' The problem Sawy resources American Society of Consultant Pharmacists: Provides a free packet of information on . medication-relate- d problems, including a list of danger ous drug interactions. They also of fer a nationwide list " rrf spninr rarp nharmarists that help older patients iden tify and prevent medication " problems. Visit www.senior- carepharmacist.com or call - v National Council on Patient ' information and Education: A nonprofit coalition that pro- vides free consumer publica-- : tions on the appropriate use of medicines and how to better manage them. Visit www. talkaboutrx.org or call The main reason medication-related problems occur with seniors is because very few doctors have any training in geriatrics. Too often, illness is misdiagnosed, overlooked, or dismissed as a normal part of aging because health pro- - Start small to get fit Photos by Dr. NURI Baptist-Hospit- "We cut different pieces out and remold it back to valve. a normal-lookin- g It's like plastic surgery of the heart." Dr. Joseph Lamelas cardiovascular and thoracic surgeon in Miami skilled in port access valve surgery About 90,000 valve surgeries are performed in the United States annually. Though the majority of patients (54 percent male, 4 1 percent female) are over age 65, Lamelas has operated on people in their 20s and 30s. Left untreated, the condition can lead to heart failure, cardio- myopathy, in which the heart muscle becomes inflamed and doesn't work as well, and ultimately death. Lamelas repaired Hoak's valve in October at Baptist Hospital's Cardiovascular Center in Miami, and Hoak recorded some of his feelings after the operation: Day 2: "I felt like I'd like to pull the plug. I hate to say it that way. I was very miserable. I was out of it. I was in intensive care for a day and a half. When you first come out of it, your mind's not working properly." Day 5: "I was up and down all day. I was good for one hour sitting in a chair, then I lay down for an hour ... I said, 'I want to go home. Can I go home.' . . . Ironically, when they' sent me home after five days, they gave me a big bottle of painkillers, and I never took one. I had discomfort, yes, but no pain." 'MBmg Dr. Joseph Lamelas shows how small an incision is required for port access valve surgery, as opposed to breaking the breast bone and spreading the ribs. Day 7: "I got up and got my breakfast, which consisted of fruit, cereal tea and toast. My voice was weak, my color was not good. ... I had mood swings. And I'm not a person who has mood swings. I'm generally up, not down." Day 1 1: "I was feeling pretty Lisa Liddane VALLBONAMiami Herald Joseph Lamelas, right, performs port access valve surgery on a patient's heart at in Miami The operation leaves a small scar and leads to a faster recovery. good most of the day, but I was taking a lot of naps." Today, Hoak is "doing fine, working two to three hours a day. All I have is a slight tenderness in my right breast. I never had any hurting or discomfort in the area of my heart." THE ORANGE COUNTY ; quickest and most effective way for her to burn calories. She had a hard time staying on the program. Some people sav pxprrisp ran hp difficult. But doing something you enjoy can make the tough moments worthwhile. Here's my motto: If you like doing it, you're more likely to stick to it. Q: But I don t like going to the gym. Do I have to? A: No. You can work out at home. Or outdoors, because nature is a free gym. The key. is to have the right tools, no matter where you are. Your Z most important tool is your body. But seek the help of a personal fitness trainer who. can design exercises for you chosen environment. Go to www.ideafit.com or www. Z g to find a trainer." Q: I've tried exercising, givj it a lot of effort in the begin- ning, but I find it difficult anc, end up quitting. What should J do differently? A: Start at an easy pace anS gradually build your endur- ance. You may have been pushing yourself too hard. Z Give yourself kudos for frac- tions of improvement. Go at -1 your own pace. Q: How do I know when ifj time to make changes or add Z to my workout program? A: Once exercise becomes easier. Your body is designed to adapt, so you have to keepu challenging it. Suggested guides: "The Home Workout Biblel by Schuler & Mejia (Rodale) "Full-Bod- y Flexibility" by Jay Blahnik (Human Kinetics)! REGISTER You've decided to begin exercising. Or you're looking to improve your fitness. Here are some frequently asked questions about fitness: Q: What are the components of fitness? A: They include cardiovascular condition (cardio), strength, flexibility, balance, hand-ey- e coordination, speed and agility. Most people who exercise regularly are strong in one or two components. Examples of cardio are walking, swimming, playing tennis, taking a dance class, riding a mountain bike. These activities get your heart pumping. Q: What kind of exercise do I need to be healthy? A: In a perfect world, you would regularly do cardio, strength and flexibility exercises. Balance training such as yoga and tai chi are important for older adults. But we're getting ahead of ourselves. Start small. Work on your cardio first and when you improve, add strength training to your regimen. The government recommends at least 30 minutes of moderate to vigorous exercise every day. This can include training for more than one component of fitness. Q: What if I can't complete 30 minutes during my first week? A: That's OK. No one expects you to do a workout if you've been sedentary. Aim for 15 minutes the first day. Add five minutes the next. Keep adding time or increasing speed or intensity as you improve. Remember: small steps. Q: What exercise is best for me? A: Simple: the one that you like or enjoy doing: A neighbor once told me that she didn't like running, but she did it anyway because it was the J nsca-lift.or- j " - ' I Lisa Liddane is a health and fitness writer for The Z Orange County Register and an American Council on Exercise-certifiegroupZ fitness instructor. Write JJ to her at the Register, Z P.O.Box 11626, Santa d , Ana, Calif. 92711 ore-malliddanecregister.com. il ; |