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This is the second part of a series on aging well. – Janet

It all makes sense, but sometimes we need to hear this stuff anyway.  Eat right, get vaccinated, and get some sun, because Vitamin D protects your body and helps prevent cancer.  This is from How to Age Well, Part 1.   Part 2 is about how we all need to get off the couch, mentally as well as physically.

Jeremy Walston, M.D., a gerontologist at Johns Hopkins, co-directs the Biology of Frailty Program and is co-principal investigator of the Older American Independence Center.  He has spent his career studying how we age.  In addition to many studies on specific aspects of aging, he has looked at what healthy older people have in common — at what they eat and don’t eat, and how they live – and has come up with some practical tips.  I recently interviewed Walston for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.

Here’s more of what he had to say:

Keep Moving

exercise“Stay active as long as possible,” says Walston.  “Don’t sit for long periods of time, especially in the late afternoon or evening.  Studies show that those are low-activity times for many people, so it’s good to try to boost your activity during those times.”  Go for a walk after dinner.  Walking is good; in fact, you should walk a lot, or do some aerobic activity – there’s plenty to choose from. 

Just a few examples include taking a Zumba or Jazzercise class, riding a bike, swimming or doing water aerobics, hiking, jogging, or dancing.  In addition to getting cardiovascular exercise, “it’s also important to do exercises that help you stay flexible, that help your balance and gait, and that help strengthen your muscles.  Don’t forget your shoulders,” which are important for maintaining core body strength and higher levels of function.  And if you have an “orthopedic issue,” like knee or hip trouble, address it.  “It is essential to maintain your mobility as long as possible.”  This may mean that you need a knee or hip replacement – but it also could be something as simple as starting to use a cane.

However, while you’re staying active: 

Don’t Fall

balanceThe body literally takes a hit when you fall.  Many older people, who otherwise have been doing pretty well, take a turn for the worse after a fall.  Just being laid up for a few days, or even longer, can be difficult for the elderly because they tend to lose strength quickly. 

The best way not to fall is to be aware of the risk, and do your best to prevent it, says Walston.  “Things that can make you fall include not watching your medication; vision problems; weakness in the lower extremities; and balance and gait problems.” 

One huge risk factor is easy to fix:  “low lighting and a cluttered living area.”  Make sure your rooms are well lit – that you not only have enough lamps or ceiling lights, but that the bulbs are high-powered enough so you can see where you’re going.  And go after the clutter.  It doesn’t take much – maybe a stack of books or magazines that slips over, or a puzzle left by a grandchild on the floor – to make a walkway treacherous. 

Sometimes, you’re so used to looking at clutter that you don’t see it.  This is why Walston recommends bringing in an independent party – a friend or relative who is not used to your home, who can see potential trouble spots you haven’t noticed.

You can lower the odds of falling, as well, by working on your balance.  Tai Chi is a great way to do this, and many community centers offer classes (another bonus: taking a class helps you stay connected – see below).  Weights and exercises can also help your legs get stronger. 

Keep your mind active, too

puzzle“Cognitive risk factors include diabetes, elevated lipids, and high blood pressure,” says Walston.  Medications can keep all of these problems in check.  Even if you are currently being treated for these, it’s good to go the doctor for “tune-ups” every so often, to make sure you’re still on the right dosage.   

But other things can affect how well you’re thinking and functioning, too, and they may not be what you’d expect:

Poor hearing:  If you don’t feel connected, you may tend to withdraw from the conversation, smiling politely, not engaging, because you don’t know what people are saying.  This is bad.  “Get a hearing aid if you need one.”  It won’t just help your hearing; it will help your brain.

Personal note: I find this especially poignant.  There’s a feedback loop between our brain and the world.  We need stimulation to keep our brain going.  If we withdraw and isolate ourselves, we don’t get that feedback, and this hurts us mentally.  If all you need to do to help stop this from happening is get a dang hearing aid, swallow your pride and go get one!  Do it for your brain.

Physical inactivity:  Being active affects every part of your body.  It helps your heart work better, helps your lungs get more air, strengthens your muscles, and helps your brain work better.  Many studies have shown that older adults who are active are less likely to get dementia and Alzheimer’s. 

Depression:  If you are depressed, you are going to be withdrawn, you may not eat or sleep very well, and you may not get enough exercise.  All of these can affect your cognitive skills. 

Addressing all of these risk factors is good “cognitive protection,” says Walston.  And one of the most important ways to protect your brain is to stay active is to “interact with others more frequently.”  Stay connected.  Talking to people — volunteering, interacting with others in church, clubs, or other groups, being around family or friends – is good medicine. 

This is the second part of a series on aging well. To read part one click here

©Janet Farrar Worthington

Quality of life is the key:  our goal shouldn’t be just to live to a ripe old age.  No one wants to be old and decrepit (or decrepit at any age, frankly).  But old and healthy – now that’s an exciting goal.

Jeremy Walston, M.D., a gerontologist at Johns Hopkins, co-directs the Biology of Frailty Program and is co-principal investigator of the Older American Independence Center.  He has spent his career studying how we age.  In addition to many studies on specific aspects of aging, he has looked at what healthy older people have in common — at what they eat and don’t eat, and how they live – and has come up with some practical tips.  I recently interviewed Walston for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.

The secrets of healthy aging, he has found, aren’t so secret after all.  The best “fountain of youth” we have right now are some common-sense building blocks that can help everyone, at every age, live better.

Nutrition:  Make Every Bite Count

If you do it right, just about everything you eat can help your body.  This doesn’t mean you have to have an ascetic diet of nuts and berries, or be a food martyr who never eats birthday cake, macaroni and cheese, or a BLT with chips and a pickle.  But comfort foods and flat-out junk should be the exception, not the rule, and you should make most of your dietary choices good ones. 

Now, what does this mean?

Eat Fresh Fruits and Veggies

healthy food“Fresh fruits and vegetables are very important,” says Walston, “particularly ones that are rich in potassium.”  High-potassium fruits and veggies – including bananas, oranges, strawberries; dried fruits, like raisins, apricots, and prunes; spinach, tomatoes, avocados, beans and peas, and potatoes – are the best way for you to get potassium.  Potassium is also found in dairy products, in whole grains, meat, and fish.

Here’s some of what potassium-rich foods can do for you:  Blood pressure:  When you get your blood pressure tested, you’re told it’s one number over another one.  That number on the top is systolic blood pressure, and potassium can lower it by several points.  Heart: Potassium helps your heart beat, which happens about 100,000 times a day.  It can help regulate the heart rhythm, too.  Cholesterol:  Potassium, by itself, is not a designated cholesterol-lowering agent; however, if you are eating foods rich in potassium, this means you’re not loading up on saturated fat.  Just eating this good food instead of junk can lower your cholesterol.

Fresh fruits and vegetables are also are anti-inflammatory.  This is very important, because inflammation has been linked to many diseases, including several forms of cancer.  When you eat these healthy foods, don’t blow it, Walston adds:  “Don’t add salt and don’t overcook them.”

Get More Protein

Protein is increasingly important; we need it more now than we did when we were younger.  “Protein helps muscles function better, and it is also important to help maintain muscle mass.”  True, you can get protein from a cheesesteak sandwich, but it’s better to “choose high-quality protein that is low in fat,” says Walston.  Salmon, for example, is a great source of protein; so are chicken, lean beef and pork, eggs, beans, soy, and low-fat dairy products like yogurt.   “We need about 30 grams of protein at a sitting to stimulate muscle growth optimally,” and the best time to take in protein is after exercise; this helps the muscles recover and grow.  “You can also get it from a protein shake or energy bar.”

Get Plenty of Vitamin D

Vitamin D helps keep your bones strong.  It also helps keep your muscles, heart, brain and immune system healthy, and can help prevent cancer.  Having low levels of Vitamin D is bad: A study published in the Archives of Internal Medicine found that people with the lowest levels of Vitamin D had more then twice the risk of dying from heart disease and other causes, compared to those with the highest levels.  The researchers listed “decreased outdoor activity” as one reason that people can become deficient in Vitamin D.  You can get it in milk, oily fish, mushrooms, eggs, and meat.  You can also take a supplement.  The National Institutes of Health recommends 600 IU (international units) of Vitamin D a day if you’re under 70, and 800 IU a day if you’re over 70.

sunshineAnd get some sun:  “Your body needs direct sunlight exposure to activate the vitamin D.”  A pretty amazing reaction happens when the sun hits your skin: the UV-B rays activates vitamin D into a form that your body can use best.  You don’t need to bask in the sun for hours; just a few minutes – 20 or so – a couple of times a week  is plenty of time to gain this benefit.

Get your shots

Lower your risk of getting the flu, or pneumonia, or shingles by getting a shot.  Many pharmacies, grocery stores, and big-box stores like Walmart and Target offer these shots at a low cost.  Take them up on it.  The risks of getting one of these illnesses far outweigh the inconvenience and minor expense of a vaccine.   

Coming up next:  Part 2:  Keep Moving, Don’t Fall, and Keep Your Mind Active.

©Janet Farrar Worthington

Regular disclaimer: This is a blog. It is not an encyclopedia article or a research paper published in a peer-reviewed journal. If a relevant publication is involved in the story, I mention it. Otherwise, don’t look for a lot of citations, especially if I’m quoting from a medical professional.

Do you feel connected, or tethered?

While you’re mulling that over, here’s another one: Can you handle downtime?  The art of loafing — made famous by such characters as Huckleberry Finn; the morbidly obese passengers of the spaceship, Axiom, in the Pixar movie WALL-E; and cats everywhere – has its good points.  There’s something to be said for taking some time to daydream.

Tell that to the experts who want to help us stay on task and be more productive.  “We’ve come to consider focus and being on as ‘good,’ and idleness – especially if it goes on for too long – as ‘bad’ and unproductive.  We feel guilty if we spend too much time doing nothing,” says Stanford psychologist Emma Seppälä, Science Director of the Center for Compassion and Altruism Research and Education.  She has written a book, The Happiness Track: How to Apply the Science of Happiness to Accelerate Your Success.

Goofing off in moderation can be very helpful, especially when you’re trying to think creatively.  In fact, Seppälä says, truly successful people “are successful because they make time to not concentrate.”  By just leaving the desk and taking a walk, for instance.  “As a consequence, they think inventively and are profoundly creative.  They develop innovative solutions to problems and connect dots in brilliant ways.”

Here are three simple ways you can “unfocus” your hard-working brain – and free it up for tackling problems in new ways:

mindless wanderingDo something mindless.  Don’t just sit there staring at your computer or focusing on one monumental task.  “To get a new perspective on something, we actually need to disengage from it,” Seppälä says. Don’t worry – your brain keeps right on working on a problem, even when you aren’t actively thinking about it.  Take a shower, or go for a walk around the block, or empty the dishwasher.  You and your brain will feel refreshed.

Do nothing at all.  Silence is powerful, says Seppälä.  Meditation or even just taking a “silence break” helps you think outside the box.  This is not that easy for many of us:  “When your mind wanders, thoughts and feelings can emerge that are not necessarily pleasant.  Being alone or being un-busy or quiet can open the door to troublesome thoughts or even anxiety.”  But hang in there.  If you keep at it, you can sit through these thoughts, “or walk through them, if your silent practice is a hike or a walk,” and “they will eventually pass, leaving room for free-flowing thoughts and daydreams.”  Doing nothing is its own form of exercise, and you get better with practice.

Play.  “We are the only adult mammals who do not make time for play, outside of highly structured settings like a Sunday neighborhood soccer game or playtime with a child,” says Seppälä.  Play stimulates positive emotion, and this, in turn, leads to “greater insight and better problem solving.”  Feeling good helps you see the bigger picture, instead of feeling trapped by the details.  If you’ve gotten rusty at playing, don’t worry – this is a skill that can be relearned.

And now, back to feeling constantly connected to the world:  this is not as good as thing as the smartphone makers would like you to believe.  Just ask Jenna Woginrich, who gave up her smartphone 18 months ago.   She wrote about it in the UK newspaper, The Guardian.

She didn’t just get a low-tech flip phone to “simplify.”  No, she jettisoned having a cell phone – any cell phone — altogether.

She doesn’t miss it.  She still has a computer and a landline.  “There are a dozen ways to contact me between e-mail and social media,” she says.  “My phone has become ‘the phone.’ It’s no longer my personal assistant; it has reverted back to being a piece of furniture – like ‘the fridge’ or ‘the couch,’ two other items you also wouldn’t carry around on your butt.  I didn’t get rid of it for some hipster-inspired Luddite ideal… I cut myself off because my life is better without a cell phone.  I’m less distracted and less accessible, two things I didn’t realize were far more important than instantly knowing how many movies Kevin Kline’s been in at a moment’s notice.”

connected cablesEven though her friends think her decision was nuts, she feels “rich,” she says, because the addiction was getting to her.  “I hated that anyone, for any reason, could interrupt my life.”  Worse, she adds, “I was constantly checking e-mails and social media, or playing games.  When I found out I could download audiobooks, the earbuds never left my lobes.  I was a hard user.  I loved every second of it. I even slept with my phone by my side.  It was what I fell asleep watching, and it was the alarm that woke me up.  It was never turned off… It got so bad that I grew uncomfortable with any 30-second span of hands-free idleness.  I felt obligated to reply to every Facebook comment, text, tweet and game request.”

No mas.  She got clean.  “I look people in the eye.  I eat food instead of photographing it and am not driving half a ton of metal into oncoming traffic while looking down at a tiny screen… And while I might be missing out on being able to call 911 at any moment, it’s worth the sacrifice to me.”

Woginrich says she’s glad to be back in the world again.  “It beats waiting for the notification alert telling me that I exist.”

You probably don’t want to give up your smartphone.  But think about putting more distance between yourself and it.  Loosen the tether, and see what happens.

 

©Janet Farrar Worthington

This post, as many Vital Jake posts do, came because of a conversation I happened to have with a guy at church.  He said he felt bad, and that he had been waking up with itchy eyes and a headache.  I asked him how often he changed his sheets, and he was stumped.  He didn’t know.  A few times a year, he said.

That’s not nearly enough (see below).  It’s also pretty gross.  Because even though a guy may consider himself a clean person – he showers daily, brushes his teeth, and wears clean clothes – if his sheets are chock full of days’ or months’ worth of his skin cells, dust mites, etc., then those sheets may be making him feel bad.

Sick in bedMaybe you made resolutions this New Year — things you want to do better, maybe a goal or two you hope to reach.  Here are two easy-peasy changes you can make in your life.  Both have the potential to make you feel better quickly.   

Change Your Sheets

Sheets can become gross fairly quickly.  I’m not even talking about that “what body fluids would a black light pick up?” way, either.   Sheets have to deal with a lot, including skin cells; food crumbs, if you eat in bed; dander and hair from humans and any pets; oils from the skin and hair; sweat; maybe some drool; residue from any skin care products you may use; and your own daily dirt, if you don’t take a shower or bath before bed.  All of these things can accumulate fairly quickly.  If you share your bed with a partner, a kid, and/or any pets, there’s even more of a buildup on those sheets.

dog in bedBacteria feast on sweat and oils.  Dust mites chow down on skin cells.  If you, like millions of Americans, are allergic to dust mites, this can be really bad – in terms of stuffiness, headaches, dry and itchy eyes, respiratory problems, and if you already have asthma, making it worse.  Most experts recommend changing your sheets at least once a week.  If your allergies are severe, you may need to change them every day.  My husband and I are both allergic to dust mites, and we have found, through trial and error, that we need to change our sheets every four or five days.  If we don’t, what happens is predictable:  we wake up with headaches and stuffiness.  When we change the sheets, we notice the difference immediately.   

Skeptical?  Try an experiment:  If you are having a headache, stuffiness and other respiratory symptoms — particularly if symptoms are worse when you first wake up — change your sheets and see how you feel the next morning.  At least, change your pillowcase, and if that helps, go whole hog and change the sheets and bedspread, too, and then keep doing it as often as you need to.

Then what?  Wash your sheets in hot water, or on the allergy or steam cycle in your washing machine.  If the water is cold or just warm, it’s not enough to kill the resilient, powerful, and evil dust mites.   

If you have fancy sheets that can’t tolerate hot water, you could find a washer with a steam cycle, get them dry cleaned – or better yet, get cheaper sheets that can take the heat. 

Also, vacuum your bedroom.  Look under your bed.  If there’s a lot of dust, guess what you’re breathing in?  If you have a fan either over the bed or aimed at it, check that out, too.  If there’s dust, that’s also blowing on you and your poor respiratory system all night long.  So vacuum or dust that, too, and don’t forget dust-trappers like curtains.  It all adds up.

Wash Your Towels

dirty laundryIf your answer to how often you change your towels is, “when they stink,” or “when they get gross,” maybe you need to have a better plan.   According to Steve Boorstein, who co-wrote a book called The Clothing Doctor’s 99 Secrets to Cleaning & Clothing Care, you should wash your bath towel often – like, after every three times you use it.  Bath towels tend to develop a distinct musty smell over time, for several reasons: 

One, we shed an estimated an estimated 1 billion skin cells every day.  A lot of them get rubbed off in our clothes, sheets (see above), washcloths, towels, and even in the washing machine (which also needs to be cleaned every so often, by running an empty load with a cup of vinegar or 1/4 cup of bleach.)

Two: Thick, luxurious bath towels may not dry out completely between showers, so they’re just a breeding ground for bacteria.  If you chuck your towel on the floor or in a hamper and then use it again, that constant dampness is basically hanging out the welcome sign for more bacteria to join the party, and stink up your towel.

Three: Fabric softeners not only make towels less absorbent, they can trap odors inside fabric.  So don’t use one on your towels and washcloths, and see if you notice a difference.

Bottom line:  If you can’t manage to change your towel a couple of times a week, then try to do it at least once a week.  Wash your laundry with hot water.  If you still feel like your towels aren’t getting clean, run bleach or vinegar through the washer.

Also, if you wash your face with the same washcloth day after day, you’re just rubbing that same dirt and bacteria right back onto your skin.  So don’t wash your face with a dirty washcloth, either.   If you can’t change it every day, at least, change it more often and see if you don’t feel better.

©Janet Farrar Worthington

grilled meatGood news for people who love barbecue, hot dogs, burgers, and steak cooked on the grill: It pays to eat your veggies.

The key to this story is something called “PhIP.” A few years ago, noted Johns Hopkins scientist Bill Nelson, M.D., Ph.D., director of the Sidney Kimmel
Comprehensive Cancer Center, began investigating its role in cancer. PhIP is a funny little word. (Pronounced “fipp,” it’s a short name for a long chemical
compound.) It sounds so harmless: “Hey, let’s get PhIP and go over to the club for some tennis,” or “I don’t give a PhIP what you do,” or “Let’s do some
PhIP shots!” But it’s not.

PhIP is found in meats cooked at high temperatures. It is a “pro-carcinogen,” a chemical that turns into something that can attack and mutate DNA, and is
known to cause prostate, breast, and colorectal cancer in rats. Unfortunately, we create carcinogens, or cancer-causing agents, with every steak we grill
or piece of chicken we fry, and PhIP is one of them. In 2007, Nelson and pathologist Angelo De Marzo, M.D., Ph.D., reported in Cancer Research
that when rats are exposed to PhIP, DNA mutations occur in the prostate. Since then, they have learned much more about this little sucker’s role as a
dietary contributor to cancer. I recently wrote about Nelson’s work for Discovery, the research magazine for the Brady Urological Institute at Johns
Hopkins.

The scientists have discovered that veggies help counteract the effects of PhIP. “When we fed rats tomato and broccoli along
with PhIP, the animals lived longer and showed reduced incidence and severity of prostate neoplasms (new, abnormal cell growth; particularly of PIN,
prostatic intraepithelial neoplasia – funny-looking cells that are linked to prostate cancer), intestinal cancers and skin cancers as compared to rats fed
PhIP alone,” says Nelson. “This provides even more evidence that eating vegetables may protect against cancer-causing agents like those in overcooked
meats.”

grilled veggiesThere is a twist to the story: Food safety pays off, too.
Nelson, along with De Marzo and scientist Karen Sfanos, Ph.D., has also explored the idea that prostate cancer may involve a combination of “environmental insults” – bad things in the diet, plus something else that weakens the body, like an infection. They wondered whether chronic inflammation, caused by bacterial infection, would make a difference in rats that had consumed PhIP. Using a specific strain of E.coli isolated from a patient with chronic prostatitis/chronic pelvic pain syndrome, they found to their surprise that the charred food plus the nasty bug seemed to have a systemic effect.

Together, E.coli and PhIP caused an increase in the development and progression of cancer in the skin and digestive tract. (Note: many people have E.coli in their gut and it is harmless, but some strains can get into meat when it’s processed and can survive if the meat is undercooked.) The rats that received the double punch of E.coli plus PhIP fared worse than rats that ate the PhIP alone. In one study, the bacteria- and PhIP-consuming rats developed more precancerous lesions within the prostate and might have developed even more problems – except they also died sooner.

In further experiments, they found that “when we inoculated PhIP-fed rats with E.coli in the prostate, the animals developed acute and chronic
prostate inflammation out of proportion to that seen with PhIP ingestion or E.coli inoculation alone, and had more prostate neoplasms, intestinal
cancers, and skin cancers,” says Nelson. “This hints that prostate infections and dietary carcinogens might interact to promote chronic prostate
inflammation and prostate cancers, and that prostate infections might augment carcinogen effects on other tissues, as well.”

What does this mean for you? One, that if these things cause changes in the prostate, it’s a pretty good bet that they are hurting you elsewhere, as well,
so take precautions: eat a veggie in addition to a potato. Potatoes are delicious, but they don’t help fight cancer the way green, leafy vegetables and
tomatoes do. Two, tomatoes and broccoli probably aren’t the only vegetables that can help diffuse the bad effects of charred meat; these are just the ones
that were studied in this particular investigation. Three, don’t eat undercooked meat. You’re not just risking food poisoning, which comes in like a
freight train and goes away quickly; you may be adding to your risk of developing cancer.

Nelson, along with De Marzo, Sfanos, and Hopkins colleagues recently published two papers on these striking new findings in the journals PLoS ONE
and Cancer Prevention Research.

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 ©Janet Farrar Worthington

 

CigarettesA broken heart.  Shoveling snow.   Being a weekend warrior.   Eating like a pig, no offense to pigs.  What do these things have in common?  They all have the potential to cause a heart attack.  They could kill you. 

“But wait!” you may say.  “I exercise.  I have a good diet.  Gosh darn it, I’m heart-healthy!”  And that, with the use of prescription medicines, if you need them, is the best way to take care of your heart, says cardiologist Curtis Rimmerman, M.D., of the Cleveland Clinic, who also contributes to a blog called Health Essentials for that institution.   

But even so, he adds, there are some things that can trigger a heart attack.  All of them relate to sudden stress on the heart.  He categorizes them as the four “Es” – Exertion, Exposure to cold, Emotion, and (over) Eating.  (Shoveling snow could fit into three of these four categories, by the way; four if you also actively hate it as you lift each heavy shovelful.)

Sudden or overexertion.  The thing about exercise is, you need to ease your way into it.  Aerobic exercise means your heart works harder, causing you to take in more oxygen.  It is important, Rimmerman says, not just to hurl yourself into an activity that will leave you gasping for breath and have your heart working overtime.  Slowly build up your strength and endurance.  Some bad examples:  Playing a vigorous game of basketball or football if you’re not used to it.  Deciding, since you used to bench-press 150 pounds in your twenties, that this is a good weight for you to start with now that you’ve got that new gym membership, and forcing yourself to do it.  Spending your weekend doing heavy lifting of furniture or books or anything, if you haven’t done hard physical labor in years.  Sudden heart stress has even been known to happen after too much exertion in the bedroom.   And again there’s the classic example:  Shoveling snow. 

Ride the HorseCold Weather.  When it’s cold, your arteries constrict.  This raises your blood pressure.  Add intense physical activity, and your heart could feel the strain doubly.   Every year, Rimmerman says, more than 11,000 people go the hospital with problems related to snow-shoveling.  Most are orthopedic issues – oh, my aching back! – but 7 percent are cardiac, and many of those cardiac events are heart attacks.

Extreme emotions.  Maybe it’s a sudden, fierce surge of happiness; maybe it’s acute grief.  Both extremes, happiness, and sadness, can affect the heart’s electrical impulses, and both can set off a heart attack.  Rimmerman explains that this is because of the body’s “involuntary and sudden increase in heart rate and blood pressure brought on by a surprising event.”  Have you ever heard of someone dying, and then very soon afterward, someone close to that person has a heart attack or dies, as well?  The risk of having a heart attack is greatest within the first 24 hours after a loved one dies, but it remains higher than normal for a month, Rimmerman says. 

A subset of this is would be a category called “having a short fuse:” A 2002 Johns Hopkins study of more than 1,000 physicians, published in the Archives of Internal Medicine, found that young men whose knee-jerk response to stress is anger have three times the normal risk of developing premature heart disease.  In the study, such men – whether they vented their anger or bottled it up – were five times more likely than calmer men to have an early heart attack, even if they didn’t have a family history of heart disease.  Their short fuse was the risk factor.   “In this study, hot tempers predicted disease long before other traditional risk factors, like diabetes and hypertension, became apparent,” reported Patricia Chang, M.D., lead author of the study.  “The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management.

dirty handsEating a huge meal.   A Harvard-led study at the 2000 American Heart Association’s Scientific Sessions found that eating an unusually heavy meal can increase the risk of a heart attack by about four times within two hours after eating. That was the first time that this, by itself, had been proven as a risk factor.  “We hope that the results of our study will help convince people to be more cautious about eating exceptionally heavy meals, especially for people who have coronary artery disease or have suffered a previous heart attack,” said the study’s lead author, Francisco Lopez-Jiminez, M.D.  The investigators asked nearly 2,000 men and women about what they had eaten just before their heart attacks.  Of these, 158 said they had eaten a heavy meal within 26 hours before the heart attack, and 25 had eaten a big meal within two hours before the heart attack.

When you stuff yourself and your body begins the task of digesting what you just put into it, it releases many chemicals, such as norepinephrine, into the bloodstream.  This can cause your heart rate and blood pressure to rise.  Your heart works harder.  Higher blood pressure can act as a power-wash of your arteries, causing chunks, or plaques, of cholesterol to break loose and to form a clot.  This, in turn, can block a blood vessel, cutting off blood flow to the heart – triggering a heart attack or stroke. 

In addition to too much food, too much alcohol, drugs, or even caffeine also can trigger a heart attack in people who already have some heart disease.  Here’s a sad example:  In 2013, “Sopranos” star James Gandolfini died at age 51 after eating a decadent meal, including a lot of foie gras and two big orders of fried prawns with  mayonnaise chili sauce.  He washed it down with four shots of rum, two Pina Coladas, and two beers.   A few hours later, he had a massive heart attack.   

The lesson here?  You can’t help some things, like excessive grief.  But what you can do is try to start off with as clean a slate as possible.   Eat some stuff that’s not fried, not covered in cheese, not fatty, and not bad for you.  Eat some fruits and vegetables.  Try to exercise regularly; you don’t have to climb mountains or run marathons – start by walking.  Walking is good.  Don’t drink a lot of alcohol all at once.  Remember, moderation in all things.  And if you have a problem with anger or stress, get some help dealing with it.  Your heart will thank you.

©Janet Farrar Worthington

Prostate Exam“Hey, buddy!  It’s me, your prostate.  How’s it going?  I know you’re busy, but … I’m just going to put it out there.  You’re ignoring me.  You never call, you don’t even text — and you don’t get me checked.”

Okay, that wasn’t actually your prostate, but let’s face it, for most men the prostate is not a top health priority.  It falls in the category of “obscure body parts” that includes the spleen, the medulla oblongata, and the little thing that hangs at the back of your throat.

Most men reckon that the prostate is best dealt with on a need-to-know basis.  Unfortunately, you will need to know about the prostate sometime, because this troublesome gland is the source of three of the major health problems that affect men:  Prostate cancer, the most common major cancer in men; benign enlargement of the prostate (BPH, for benign prostatic hyperplasia), one of the most common benign tumors and a source of urinary symptoms for most men as they age; and prostatitis, painful inflammation of the prostate, the most common cause of urinary tract infections in men.  Some men are unlucky enough to deal with more than one of these over the course of their lifetime.

Today, I want to talk to you about prostate cancer.  Because when it’s caught early, it is usually curable.  Equally important:  In its earliest, most curable stages, prostate cancer produces no symptoms and you feel perfectly fine.  The best way to not die of prostate cancer is to find it when it’s still curable.  As Patrick Walsh, M.D., the great Johns Hopkins urologist and my longtime co-author, puts it, “If you can expect to live at least 10 to 20 more years and don’t want to die from prostate cancer, you should be screened.” 

Start When You’re 40

Screening involves two things:  A blood test for PSA (prostate-specific antigen) and a digital rectal exam that takes about a minute.  You should start when you’re 40, and depending on your results, you may not even need to get screened every year.  The PSA test is like a barometer for the prostate – but it’s best served up as a continuum, not a cut-and-dried, one-shot reading.  Another Johns Hopkins urologist, H. Ballentine (Bal) Carter, M.D., came up with a concept called PSA velocity.   Years ago, using an excellent database called the Baltimore Longitudinal Study of Aging (BLSA), he was able to look at the blood of men over a period of many years.  He looked at their PSA levels, and watched as they changed, or didn’t change, over time.   He has published many articles on this, and Patrick Walsh and I have written about it in several books (most recently, the Third Edition of Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer, which has everything you could possibly want to know about PSA and the many ways to test it.)

Here’s the most basic information you need to know:

Get the Test

If you are in your forties, and you have a PSA level greater than 0.6 ng/ml (nanograms per milliliter), you should get your PSA measured every year. 

If you are in your fifties, and your PSA is greater than 0.7, you should get your PSA measured every year.  (These numbers come from Carter’s research. In another study, urologists Stacy Loeb, now at New York University, and William Catalona of Northwestern University, found the numbers to be slightly higher; 0.7 for men in their forties and 0.9 for men in their fifties.) 

This first PSA test is your baseline.  From this, your doctor will watch your PSA to see if it changes.  If you have a low PSA level (between 1 and 4 ng/ml), any increase is alarming.  In a study using data from the BLSA, Bal Carter and colleagues found that if PSA climbs more than 0.2-0.4 ng/ml per year, this is a predictor of death from prostate cancer.  This is really important:  No matter what your number is, if it keeps going up, you need to have it checked out.  Especially if you are in a high-risk group for prostate cancer — if you have a family history of the disease, or if you are an African American.  The number shouldn’t be changing very much.  If it is changing, and you don’t have a good reason for it (like a urinary tract or prostate infection; see below) you need to get a biopsy.  If no cancer is found and it’s still going up, you need to get a repeat biopsy in several months.  (There are other reasons why PSA can go up, including BPH, but this is more common in men in their sixties and older.  For men with a PSA greater than 4, an average, consistent increase of more than 0.75 ng/ml over the course of three tests is significant.)

Now, as I write this, I have a friend with a family history of prostate cancer; his father, uncle, and grandfather have all had it.  He is 51.  His PSA has gone up more than 0.2 ng/ml each year over the last two years.  His urologist has not recommended a biopsy.  In my opinion, his urologist is an idiot.  A lot of doctors are still lulled by low numbers; it used to be that any PSA below 4 was considered “safe.”  That’s not true. 

[Tweet “The key is, is your PSA going up, and if so, how fast? #prostatecancer”]

What if You Don’t Have a Baseline? 

What if this is your first PSA test?  Says Walsh:  “If you are in your 40s, 50s, or 60s and you have never had a PSA test, if you get one and your level is greater than 2.5 ng/ml and you can expect to live at least another 15 to 20 years, you should have a biopsy.  If your biopsy finds no cancer, you should continue to have your PSA level rechecked at regular intervals, using both the total PSA level and the speed at which it rises over time to determine whether and when you need to have a repeat biopsy.” 

When Can You Stop Screening? 

That’s a good question.  Again, your PSA track record determines a lot.  In his research, Bal Carter showed that if PSA testing were discontinued at age 65 in men who had PSA levels below 0.5-1.0 ng/ml, it would be unlikely that prostate cancer would be missed later in life.  A more recent study suggested that it is safe to discontinue PSA testing for men aged 75-80 with PSA levels lower than 3 ng/ml.  However, the men aged 75-80 who had PSA levels greater than 3 remained at risk of developing life-threatening disease.   This also depends on your general health.  If you are in your seventies, you don’t have any other health problems and can expect to live a good long life, for your own peace of mind you may prefer to keep on getting tested.  

In the Case of PSA, Numbers Really Matter

If PSA is so important, why do you need the rectal exam?  Because the PSA test is not foolproof.  About 25 percent of men who turn out to have prostate cancer have a low PSA level — say it’s 1.2, and it goes up a little over time, maybe to 1.8 — one that, despite an increase, doesn’t get flagged as suspicious.  For several reasons, including the way some tumors make PSA, you need a “back-up” plan (I admit, pun intended).   Conversely, the rectal exam is not perfect, either.  In many men with prostate cancer, the tumor may be in an inopportune spot, just out of finger’s reach, where it simply can’t be felt by a doctor.  In other men, cancer is “multifocal”– there are several patches of cancer, not just one – and the prostate feels uniform in consistency.  It’s deceptive, but the doctor’s finger doesn’t have a microscope on it and doesn’t always know when it’s being fooled.  Most normal prostates feel soft.  Cancer feels hard.  But if it’s in several places, or too small to feel yet – even though it’s growing and dangerous – a doctor could touch it and not know. 

This is why you need both tests, instead of an either-or approach for early detection.  It’s like using the breast exam and mammogram together to find breast cancer in women.  In one study of 2,634 men, investigators found that the PSA test and the digital rectal exam were nearly equal in cancer-detecting ability – but they didn’t always find the same tumors.  So if only one technique had been used, some cancers would have been missed.  Together, these two tests make a formidable team.

Really Important Things You Need to Know Before the PSA Test That Your Doctor Might Not Tell You

Don’t ejaculate for at least two days before you have your blood drawn.  This can raise your PSA level, throw off the test, and scare everyone unnecessarily.

Whatever you do, make sure to have the test before the rectal exam.  (The rectal exam can stimulate the prostate and cause more PSA to show up in the bloodstream and again, make your PSA level seem higher.)  I tell you this because my husband once had the test before the exam, it made his PSA number higher, and we got scared.  His doctor should have known better.

If you are taking Proscar or Avodart for BPH, or Propecia for hair loss, all of these drugs lower PSA.   They can make it seem artificially low, and if you have cancer, it might be missed.  (To correct for this, if you have recently started taking one of these drugs, your PSA level should be multiplied by 2.0.  If you have been taking it for five years or longer, your level should be multiplied by 2.5.)

If you have had surgery or a laser procedure to treat BPH, this can make your PSA much lower.  Don’t focus on the number; watch what it does.  If your PSA begins to increase steadily, you should see a urologist.

If your PSA test shows a significant increase, repeat the test in the same lab.  In 25 percent of these cases, the reading will be back down to its former level.  Says Walsh:  “If there is a clear-cut elevation, ask your doctor about prescribing antibiotics to rule out a possible infection.  Often, men receive ciprofloxacin or levofloxacin for three to four weeks and have the PSA measured again.  If it is elevated again, you should have a biopsy, using a different antibiotic when you have this procedure, to avoid infection from resistant bacteria.”

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 ©Janet Farrar Worthington