Transcription of Happy Heart #22
Male: You are listening to the Dr. Lisa radio hour and podcast, recorded at the studios of Maine Magazine in Portland, Maine and broadcast each Sunday at 11 am on WLOB-1310 AM and available streaming online at WLOBradio.com. Podcasts are available at doctorlisa.org. Thank you for joining us.
Dr. Lisa: Hello, this is Dr. Lisa Belisle and you are listening to show number 22, Happy Heart, which is airing for the first time on February 12, 2012, right before Valentine’s Day, which also happens to be the 11th birthday of my third child Sophie. Happy birthday Sophie. This week’s Happy Heart show involves interviews with Dr. Mylan Cohen of Maine Cardiology, Dr. Chris Rogers of the Vein Center at Portland Surgical which is an affiliate of Mercy Hospital and Jen Goldman of the American Red Cross. Happy Heart’s a pretty appropriate thing to be talking about Genevieve Morgan, wouldn’t you agree?
Genevieve: It certainly is right before Valentine’s Day. The heart is such a great metaphor for so many things. What is it in Chinese Medicine?
Dr. Lisa: Well, we’ve talked about the five elements before and we’re actually kind of … We’re two seasons away from the heart season. The heart season is the summer season. It’s the season of joy and heat and its associated with the color red, fire is the element and the emotion is laughter. It’s interesting when we talked about, I believe it was in the Girl Power segment we talked about different types of energy and power. We talked about yin within yang and yang within yin; every season has an element of the other seasons in them. It’s funny that in the middle of winter we have a little bit of red hot heart heat.
Genevieve: Passion.
Dr. Lisa: Passion, exactly and it’s a perfect time of year because things are starting to heat up. We have in other parts of the world, not necessarily Maine where we’re still pretty deep in the winter but we have the sap is starting to flow a little bit, things are starting to rise and wake up and life is starting again. This is Chinese Medicine, heart is joy, laughter.
Genevieve: What are some of the other organs associated with the heart in Chinese Medicine when you’re doing acupuncture on patients?
Dr. Lisa: In acupuncture all the organs are associated with the heart because …
Genevieve: That’s interesting.
Dr. Lisa: Yes, all the five elements really can be tied back to the heart and if you look at … we’ve talked about the kidney organ and winter is the season of the kidney and the element is water. We’ve talked about that being fear. That’s actually the controlling element is water controls fire which makes sense even from a rock, paper, scissors standpoint that water would control fire. If you think about it from a Western Medicine standpoint the kidneys and the heart are very much related. We have congestive heart failure which is an overage of fluid in the body.
Genevieve: The kidneys are a vascular organ as well. Blood is filtered through the kidneys so that makes sense.
Dr. Lisa: That’s one of the reasons why we decided to have Jen Goldman from the Red Cross on because it’s not just about the heart and the veins it’s also about what goes through the heart and the veins.
Genevieve: Cardiovascular health, it is about both pieces of that word. It’s about the heart but it’s also about the arteries and veins that lead into … that take blood away from the heart and bring blood to the heart. Talk a little bit about the challenges that people face because this is a terrible epidemic in our country. What are some of the threats to heart health? Then let’s talk about how we get happy.
Dr. Lisa: We have a lot of things acting against us right now. Everybody knows about this two-thirds overweight obese thing. You have people that are larger then ever before, they’re more sedentary then ever before, they’re getting less exercise then they ever used to. Their children are bigger and more sedentary then ever before so all of these are strains on the heart. Simultaneously we have the anxiety associated with a difficult economy. People are losing their jobs. They’re having houses that go into foreclosure. We’re still dealing with military conflicts. It’s a very challenging time.
Genevieve: That can really impact your heart health.
Dr. Lisa: It really can. We did Health / Wealth last week, show number 21 and we talked about the stress of finances on ones life and it really does impact the heart. Dr. Mylan Cohen is going to talk about a study that came out that has proved a relationship between stress and traumatic events and sudden cardiac death. We know that there is a direct physiologic relationship between stress and heart health and that’s sudden death. Over time we have the whole type A personality which is over time stress on the heart can cause a weakening of that musculature and can lead to early death due to cardiac disease.
Genevievee: How can people intervene before they get to that critical stage? I know that in complimentary and alternative methodologies there’s a lot of focus on stress release. For instance, in your practice, what are some of the tools you give people to protect their heart and keep their hearts happy?
Dr. Lisa: You talked about how organ systems are related and I said that all the organ systems are related to the heart and the lungs of course. Even Western Medicine but also Chinese Medicine are related to the heart so as I’ve said before one of the first things that I teach people to do in my practice is teach them how to breathe. If you’re not even getting the lungs that well oxygenated then you can’t get the oxygen into the blood and you can’t aerate all the tissues of the body. That’s very important for stress relief physiologically.
Genevieve: Yeah, because deep breathing also triggers the parasympathetic nervous system, the calming aspect of your central nervous system too.
Dr. Lisa: The other thing that we do at least in my practices, I do a combination of acupuncture, nutrition, lifestyle counseling and counseling in general. All of those things if you think about that can impact the heart. Acupuncture also has an impact on the sympathetic and parasympathetic nervous system and we know from functional MRI studies that they impact the brain. We know that nutrition and lifestyle counseling can have a positive impact if we can get people doing things that are better for their bodies but also counseling in general. If we can get people to really examine what’s going on in their lives and their transitions that makes them happy, that makes them unhappy, than we can help them get back to a place of having a happy and healthy heart.
Genevieve: One last question, where does salt fit in, in all this?
Dr. Lisa: Salt is one of these nutritional elements that’s got a bad rap. There have been so many. We are so good at finding nutritional demons.
Genevieve: Eggs spring to mind.
Dr. Lisa: Yes, I think everything has at one point, and we’ve talked about this I think in past shows, but cholesterol is bad, fat is bad, carbohydrates are bad, protein is bad. Really, pick anything and it’s been proven to be bad.
Genevieve: We really can’t eat anything anymore.
Dr. Lisa: Right but it’s really about moderation and it always has been. That’s part one. Part two is it’s about moderation and it’s about how each individual is interacting with his or her foods. Some people can tolerate salt. Some people can’t. You need a certain amount of salt because there is a sodium chloride exchange that occurs within the cells of the bodies. You need some salt. You need good sodium chloride, good salt for your body because otherwise there’s chemicals, table salt that’s got chemicals in it.
Genevieve: That comes in with sea salt or Celtic salt or kelp salt.
Dr. Lisa: Yes and there is nutritionally better salt but some people can’t tolerate it. That’s why people have been told for a long time low salt diet. Well, some people can’t tolerate any salt so these are the people who will have higher blood pressure because of it. Everybody needs a little bit of salt and in fact if you don’t have enough salt then it can cause problems too. You have to know whether you are a salt sensitive individual, you have to know also what you’re eating because one of the problems in our culture with more processed food is that people are adding stuff to the food that we’re eating and we have no idea what it is.
Genevieve: How do you feel about alcohol and heart health because I know there are a lot of studies that say that one drink a day is heart protective but I’m not sure where you come in on that.
Dr. Lisa: Again, it’s all about moderation and one individual situation. We know that there’s been a link between alcohol and breast cancer so you have to know yourself, your family history. You have to know your set of circumstances. Frankly you have to know whether you have an addictive personality. Some people it’s all well and good to say yes one glass of red wine is good for your heart but if you have an addictive personality and you can’t stop at one you shouldn’t have any.
I’m not a teetotaler at all, enjoy my glass of wine or my chocolates because those are also good for heart health but in the end it’s really about knowing yourself. Taking the time to know not only what keeps your heart happy but what keeps your heart and your body healthy and really taking advantage, mindfully, of those things that on a regular basis can be good for you. This week it’s going to be an interesting show. I know that we sometimes go far afield from the specific health topics but this week it’s a very health topic show. We have two doctors.
Genevieve: Very tight.
Dr. Lisa: Yep, and we have somebody from the American Red Cross that we are talking about blood and veins and hearts but what’s really great is talking to Mylan Cohen, he’s got a broader perspective even on the heart. It doesn’t matter how hard we try to keep it strictly medical we still get a lot more interesting then that.
Genevieve: That is true.
Dr. Lisa: Yes it is. We hope that people are going to enjoy our happy heart show and we wish everybody the happiest of pre Valentine Sundays.
Dr. Lisa: The Dr. Lisa radio hour and podcasts is pleased to be sponsored by the University of New England. This week’s wellness innovation segment sponsored by the University of New England is about motherly love. A resent study at the Washington University School of Medicine in Saint Louis found that school-aged children whose mothers nurtured them early in life have brains with a larger hippocampus, a key structure important to learning, memory and response to stress. This new research is the first to show that changes in this critical region of the child’s brain anatomy are linked to a mother’s nurturing.
The study validates something that seems to be intuitive which is just how important nurturing parents to creating adaptive human beings. The public health implications suggests that we should pay more attention to parents nurturing and we should do what we can as a society to foster these skills because clearly nurturing has a very, very big impact on later development. For more information on this study go to eurekalert.org through the doctorlisa.org website. For more information on the University of New England go to une.edu
Male: This portion of the Dr. Lisa radio hour and podcast has been brought to you by the University of New England, UNE an innovative Health Sciences University grounded in liberal arts. UNE is the number one educator of health professionals in Maine. Learn more about the University of New England at une.edu.
Dr. Lisa: Today on the Dr. Lisa Radio Hour and Podcast we have a special Valentines Day edition and we thought we would invite in one of our friends who is a cardiologist, which is a heart specialist. Thank you for coming in Dr. Mylan Cohen.
Dr. Mylan: Thank you for having me.
Dr. Lisa: Genevieve Morgan is sitting next to me.
Genevieve: Nice to meet you.
Dr. Lisa: Mylan, I know your wife pretty well which was one of the reasons I wanted to have you in but you and I have a lot of … there’s a lot of crossovers in what we have done professionally. You have a master’s in public health from Harvard.
Dr. Mylan: That’s right.
Dr. Lisa: Let’s just start there. You’re a different sort of cardiologist then that you have a broader … Not that other cardiologists don’t but you have a very broad view of heart health, public health, heart health, how it impacts our community and our society. Can you speak to that?
Male: The reason why I first thought about getting a degree in public health was while I was a cardiology fellow down in Boston my chief came to me and felt that it might broaden my perspective, give me a background to do cardiovascular research. I participated in a summer program that was run by the Brigham Woman’s Hospital at the time that really launched me into that area. Then in completing the master’s of public health degree it really was helpful in seeing a broader perspective, seeing the relationship between cardiac health and so many other things like socioeconomic factors, emotional factors.
I have to say that perhaps today in my practice I may not be practicing all of the breadth of public health but it does inform some of the things that I do. I think that it also helps me make comments on policy and it can at times be helpful in effecting how the hospitals approach health on a larger basis.
Dr. Lisa: It’s especially relevant because health disease is such an important problem in our culture right?
Dr. Mylan: That’s right, yep. People don’t realize that more women die of cardiovascular disease than breast cancer. It’s a large killer of people in developed nations.
Dr. Lisa: You are from Maine.
Dr. Mylan: Yes.
Dr. Lisa: You went to Presque Isle to high school, how has that informed your decision to go on to be a doctor? I don’t know how many people from your class went on and became doctors.
Dr. Mylan: I once had a senior partner who introduced me once I came back to Portland as … He said, “This is Mylan Cohan, he’s from Presque Isle, Maine, the breeding ground of Harvard cardiologists.” I think I was the only physician in my graduation class in high school. I think what it does is it gives me a great appreciation of the people of Maine, the patience that I see, the whole breadth of socioeconomic statuses. We see people who are out of work. We see people who work hard in the fields or on lobster boats and then we see CEO’s of companies and other people who are highly educated. I think also knowing a little bit about where they come from in the state also is very helpful in relating to patients.
Dr. Lisa: Would you say also that your medical career has been dictated by some of the personal experiences you’ve had in your own health?
Dr. Mylan: Sure, definitely. I think back to an individual who was a professor at the University of Vermont College Medicine where I went to school who really was instrumental in guiding me towards cardiology. Around the same time that I met him I had an illness of my own and ended up having to have a couple of pretty large operations while I was a medical student.
One of the fundamental things that I learned during that which I still remember everyday that I see patients especially in the hospital is the importance of just being asked is there anything I can do for you or is there anything else that I can do for you before leaving the room. Just that simple question for a patient in the hospital I find to be very helpful and that’s something that I may not have actually had insight into had I not been a patient myself.
Dr. Lisa: Did people do that for you when you were going through your own health issues?
Dr. Mylan: Yeah, not only did they do that it was just the idea that someone was spending the time there and that they actually cared enough to see if there was anything that they could do to make me more comfortable.
Dr. Lisa: There is a relationship between actual physical health and emotional health that you recognized early on.
Dr. Mylan: Oh sure. I think in general that … There are actually studies to collaborate this that people who have a better sense of well being who are generally happier actually tend to have better health. On the flip side of that people who have depression may have other associated physical illnesses.
Dr. Lisa: Specific to the heart.
Dr. Mylan: There’s higher mortality both after a heart attack and after having open heart surgery in patients who are depressed compared to patients who aren’t depressed.
Genevieve: It is important for people to actually deal with their mental and emotional well being from a physical standpoint as well.
Male: Yes absolutely, yes.
Genevieve: The heart also seems to be one of the first places where an emotional stress registers in the body if you have fear your heart starts to beat quickly, if you have heartbreak your heart hurts. I’m interested in what you have to say about that because it’s something everyone can relate to.
Dr. Mylan: So much is attributed to the heart. The soul, the … At one point it was thought to be the basis for your personality, but you’re right the physiologic effects of fear, of anger, of surprise, all of those things have an effect on the heart and you mentioned a few of them. You suddenly get a fast heart rate, some people can really feel their heart pounding and indeed there is something called broken-heart syndrome. This is something that’s been recognized for quite some time and only recently has been given a more formal name.
Some people who have extreme emotional stress can actually develop a heart muscle weakness, a cardiomyopathy if you will. Fortunately most times, it’s reversible. Also, there’s something called Anniversary Death. It’s not infrequent that a couple, if one of the members of that couple dies after many years together it’s not unusual for the other member of that couple to die shortly after that or sometimes on the anniversary of the death of their spouse.
Dr. Lisa: With this in mind do you ask patients specifically about their relationships or about what’s going on in their lives emotionally?
Dr. Mylan: It often comes up. I can remember one patient in particular who would always develop increased chest pain on the anniversary of her spouse’s death. Now I know that a few months before the anniversary comes up I see this patient in the office and I’ll specifically prescribe some medications that help the heart slow down, blunt the effects of adrenaline and decrease the chances of her having a heart attack. Later on after this period of time is passed we can stop the medications and she does just fine.
Dr. Lisa: That’s a way that instead of just saying to a person oh you look like you might have X, I’m going to give you Y drug and then stay on it indefinitely you’re able to move and shift with what you know to be her emotional state.
Dr. Mylan: That’s right for this particular patient that seems to be a pretty good strategy. It works for her.
Dr. Lisa: You were describing before we came on air a study that had to do with another way of dealing with a heart issue, atrial fibulation and yoga. Can you tell us about that?
Dr. Mylan: Yes actually there was an article that was published in a medical journal just a couple of weeks ago that indicated that yoga is helpful in improving people’s sense of wellbeing who have atrial fibulation. Atrial fibulation is an arrhythmia. It comes from the two top chambers of the heart. They’re not beating in any organized fashion and when that happens oftentimes people can feel a very fast heartrate and it can be uncomfortable to some people.
Other people don’t even know that they’re in atrial fibulation. This study looked at the effects of yoga in patients who have atrial fibulation and found that it improves their overall sense of wellbeing and it reduced the symptoms that they were having. It didn’t prevent the recurrences of atrial fibulation but people felt better when they were in it.
Dr. Lisa: What are some other preventative measures people can take to protect their hearts?
Dr. Mylan: Certainly taking care to maintain a good diet and to exercise regularly are two things that are certainly helpful. Not smoking and getting enough sleep, reducing stress is also helpful. Those are the primary things. If you know that you have high blood pressure or high cholesterol, taking measures to control those is certainly helpful. That doesn’t necessarily mean medications at first. Often times it does in patients but just exercising, losing weight is often enough to control and paying attention to diet is often enough to control hypertension in many people.
Genevieve: Can you just drill down a little bit on exercise because I’m always as the wellness editor at Maine Magazine I’m always telling people to exercise but there’s aerobic exercise and anaerobic exercise. What is your recommendation for …
Dr. Mylan: You know, it’s as simple as just exercising by walking three times per week. It’s been shown that if you can walk 30 minutes three times per week you reduce your chances of a heart attack by half. The thing that I tell patients is just move, walk. Patients who have joint problems and feel that they can’t walk far I’ll often encourage them to swim because that’s non weight bearing. Even just floating in a pool, moving around a little bit in a pool is going to be helpful for those people.
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Dr. Lisa: I know that you have a special interest in diabetes and I’m wondering if you’ve seen any change in the number of patients coming in with diabetes or pre diabetes in your practice or within the state of Maine since you began practicing.
Dr. Mylan: Diabetes is an epidemic, and because our population is getting larger, the incidence of adult onset diabetes or type II diabetes is increasing. Of course with the onset of diabetes there’s a very tight relationship with the development of cardiovascular disease. The incidence of diabetes is rising, it’s not surprising that heart disease is also increasing in those patients. Anything that we can do to reduce the onset of diabetes will be helpful and that means careful attention to diet, exercise, weight reduction. Those things are very helpful in reducing adult onset diabetes.
Genevieve: Have we gotten better about offering services for patients who need them in this area?
Dr. Mylan: That’s an interesting question. I would probably have to defer to some of my colleagues in endocrinology and dietology. I think there’s a lot more that we can do for patients. There’s a lot that we can do from the public health perspective, tying in the question you asked me initially, in Maine we have long, cold winters generally and so it’s a little harder for people to get out and walk and be active in the winter. Even simple things like redesigning areas of towns with better sidewalks, moving things closer together so that people can walk from point A to point B. Just simple things like that would encourage physical activity which then of course, improves cardiovascular health, helps people lose weight, etc. Then from an architectures standpoint there are things that we can do with public buildings. Make sure that the stairs are easier to find then the elevator for example and encourage people who can walk up stairs to actually take the stairs rather then to ride.
Dr. Lisa: I know that you and Dr. Dora Mills graduated from the University of Vermont at the same time so it’s interesting because she was the state director of the Maine CDC. Do you think there’s something about being a Maine high school student that causes you to be more interested in public health?
Dr. Mylan: I never really thought of that. I think it’s probably something that’s just part of someone’s nature. I can’t point to any single thing growing up in Maine that made me think that I really had to pursue any background in public health. I have to admit that it was something that really came about almost by accident while I was in training. I do feel that the people who I know who grew up in Maine who go into medicine or other health fields do seem to have a real tie to communities, have a tie to the people that they take care of, have a real sense of responsibility to improve the health of people they come in contact with who are from the state.
Genevieve: There are very interesting things that are happening within the health care system right now within the country, within the state but even within your practice.
Dr. Mylan: That’s right.
Genevieve: Can you tell us a little bit about what’s been going on?
Dr. Mylan: Two days ago something really momentous happened. In Portland there were two large cardiology groups, cardiovascular consultants of Maine and Maine Cardiology Associates and as of two days ago both of those practices integrated with Maine Health the parent organization of Maine Medical Center to form Maine Medical Partners, Maine Health Cardiology. This was four years in the making, it required oversight by the federal trade commission and the attorney generals office in the state of Maine. We’re very excited two days into this new organization that we’re going to be able to do a lot of things much better to improve the cardiovascular health of the citizens of the state of Maine.
This is going to allow us to care for people regardless of their ability to pay. It’s going to allow us to do even better at bringing new technologies and new methods of caring for patients with very complex cardiovascular disease, bring new techniques and high technology to bear on these diseases. It’s also going to allow us to recruit and retain top-notch cardiovascular specialists. We’re very excited about it.
Dr. Lisa: What’s in the future of Dr. Mylan Cohen? What’s up next for you?
Dr. Mylan: That’s a good question. I don’t know. I’m just trying to get through this first week I think of our newly established practice.
Genevieve: Are you going to eat any chocolate on Valentine’s Day?
Dr. Mylan: I am a definite chocolate fan, I have to say. A little bit more … I like dark chocolate and if you believe the research that was sponsored by Nestle and Hershey it may actually be good for your vasculature as well. I guess it’s like everything. Everything in moderation so I tell my patients if they want to have a little piece of chocolate that’s okay, just make sure that it’s not a lot. The same with things like coffee and even alcohol for that matter.
The right amount of alcohol is actually favorable for cholesterol and can be favorable for high blood pressure but in excess it can drive the blood pressure high, it can make cholesterol higher. It can also cause heart muscle weakness or cardiomyopathy. It’s a great example of just the right amount.
Dr. Lisa: You’re going to eat chocolate, we know that. You don’t address specifically …
Dr. Mylan: I might have a glass of red wine too.
Dr. Lisa: A glass of red wine, all right but what makes your heart happy? What are you going to do?
Dr. Mylan: What do I do?
Dr. Lisa: Yeah, what’s your future hold and what gets your heart happy and help you?
Dr. Mylan: What makes me happy? First of all my family, you mentioned Mia at the beginning of the interview and so spending lots of time with my family is very important.
Dr. Lisa: You have a sophomore who’s …
Dr. Mylan: Sophomore in high school.
Dr. Lisa: Elizabeth.
Dr. Mylan: Yep and what we all enjoy doing in the summer is sailing. We have a sail boat. We find that incredibly relaxing to cruise the coast of Maine. Bicycling and then some of my colleagues will be horrified to find out that I’ve actually started riding a motorcycle. I find that very relaxing and my wife has taken it up as well. I also enjoy reading and in the winter downhill skiing although this year hasn’t been a great year for that. Then sometimes just being at home in front of the fireplace and enjoying a good book. I’ve mentioned yoga before, I also enjoy yoga.
Dr. Lisa: You are a doctor who practices what he preaches?
Dr. Mylan: I try as much as I can.
Dr. Lisa: Yes you are. All right, thanks so much for coming in and talking to us today.
Dr. Mylan: Thanks for having me.
Announcer: Our bodies are often the first indicators that something isn’t quite working. Are you having difficulty sleeping, anxiety or chronic pain issues? Maybe you’ve had a job loss, divorce or recent empty nest. Dr. Lisa specializes in helping people through times of change and inspiring individuals to create joyful, sustainable lives. Visit doctorlisa.org for more information on her Yarmouth, Maine medical practice and schedule your office visit or phone consult today.
Dr. Lisa: This week’s Maine Magazine Minutes also has to do with having a happy and healthy heart and our wellness editor for Maine Magazine and cohost Genevieve Morgan is going to talk to an interesting physician within the community, another interesting physician who is doing things that makes people’s hearts happier.
Genevieve: That’s true Lisa thanks. We have today in the studio Dr. Chris Rodgers from Portland Surgical Associates which is now part of Mercy Hospital am I correct?
Dr. Chris: Yes, we joined up with Mercy Hospital as an official relationship about 14 months ago.
Genevieve: Welcome.
Dr. Chris: Thank you.
Genevieve: You do something different then cardiovascular surgery. You emphasis the vascular part of that word, can you explain what that is and how that relates to the heart?
Dr. Chris: Sure, our practice has been general surgery for 20 plus years and in general surgery training there is some vascular surgery training. Some of that vascular surgery training deals with the venous system then that’s the part of our circulatory system that returns blood to the heart. It’s imperative to have a good healthy return system for that pump in order for it to be “happy.”
Genevieve: What are some of the signs that your veins aren’t working the way you would like them too?
Dr. Chris: Some of the visible signs can be as simple as small spider veins on the surface of the skin and then people who have more advanced problems can have more large, ropey-looking or wormlike veins underneath the skin that bulge out and are kind of unsightly for folks. Then as the vein system degrades or deteriorates then people can have some leg swelling and changes in the skin and fat texture to the tissues and pigmentation problems where they get a very deep brown pigmentation in the skin. That’s actually the iron pigment from blood that’s leaked out of the veins because they’re under a tremendous amount of pressure.
Genevieve: That sounds painful.
Dr. Chris: The swelling is very uncomfortable for people and people also describe an itching and burning sensation but primarily it’s a pressure and swelling that they’re sensing. Some of the inflammation can become painful and the ultimate end organ that gets damaged is the skin. As the inflammation evolves people start to break down their skin and have what’s called a venous ulcer and that’s a sign of very advanced vein disorders.
Genevieve: That’s why you’re here to intervene before it gets to that stage.
Dr. Chris: Right.
Dr. Lisa: One of the reasons that we’re having you on Maine Magazine Minute specifically is because Maine Magazine about a year ago recognized that wellness was an important aspect of living in our state. People in our state not only moved here for emotional and physiological reasons but also to be healthier, to live a healthier life. Genevieve last year had interviewed three doctors, I’m one of them and this year is interviewing three doctors that are doing great things within the state. You’ve had to do different things within the state, interesting things within the state. Tell us how things have changed for you.
Dr. Chris: The traditional surgical background has always been a very procedure oriented, very acute care oriented and by acute care people coming into the hospital being immediately ill and working with them. That process is very much a find a sick person, fix a sick person sort of process. You don’t actually go out and find them but they come to you because they’re that ill. Then a part of general surgery is what’s called elective surgery where people come in with a problem and you fix it by mechanical means.
One of the things that we have always recognized, especially regarding the venous system, is there’s a big element of preventive or stalling care but definitely preventive. It doesn’t always have to be interventional. It doesn’t always need a surgical procedure or some other procedure associated with it.
Genevieve: Taking good care of things early and then you won’t be critical later on.
Dr. Chris: Yeah, taking care of things early and the best thing that people can do and we really promote this in our practice is try to have people achieve a normal body weight because obesity is directly linked to disorders of the venous system. People also need to be exercising and ambulatory. The most important function that a person can give to their venous system is walking because every time you take a step, the foot and the calf contract and it’s the muscles contracting that pushes the blood back towards the heart.
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Dr. Chris: Females multi parody or having had multiple children and heredity has a huge basis. We don’t know any of the real genetic links but there’s definitely a genetic tendency for family members to have varicose veins. It probably relates to the connective tissue structures either supporting the veins or in the vein walls themselves. The other 25% are men and men usually don’t come in because they’re self conscious about their veins. They come in because their legs hurt. Most of the women we see earlier in the disease process and they make up the majority of the patients. The men are a lesser percent but they come in with much more advanced problems.
Our job is to sort out an individual, find out their unique history, find out some of their unique family history and then get down to what the real pathology in a patient is. That starts with the history then a physical examination that encompasses listening to their heart, checking the arterial side that Dr. Cohen probably talked about the heart pump and healthy arteries and a hardening of the arteries and things like that. A vein doctor wants to check that side too because there’s crossover between chronic arterial and chronic venous problems. You have to sort those issues out as well. Once we get that basic physical exam done then we can see the pattern that a person’s varicose veins or spider veins have or which leg is swollen and which isn’t and start to mentally conceptualize what the underlying problem is.
It’s not really a skin problem per se. The skin is the end organ that’s getting damaged. You have to carry it down anatomic layers. Our bodies are made up of skin, then a fat layer and then a muscular layer. There’s two venous systems, there’s a superficial venous system in the fat layer and skin and then a deep venous system in the muscular layer. The deep venous system is generally healthy in most people unless they’ve had a deep vein blood clot or they were congenital born without valves in their veins. It is the valves that I’m ultimately trying to get to.
Genevieve: The predominate condition you see is in that superficial, in the fat level.
Dr. Chris: Correct. Then you see that pattern of surface phenomenon and say okay the next layer down is the larger return veins. If you think of a skeleton, the up and down directions called the axial directions so we’re looking at those axial veins and where they pipe into the deep system. The deep system carries most of the blood back to the heart; most of the time that’s fine. The superficial system is the system that gets damaged most of the time and it’s thought to be because superficial system is only supported by the fat structure of the body, it doesn’t have the thick muscles and connective tissue within that muscular system.
Genevieve: That makes sense as we age and gravity takes its toll and weight and starts to break down.
Dr. Chris: Right and we’re talking about some of the demographics and age is a demographic and age is related to worsening vein problems. It’s because our connective tissues lose their elastic property, it makes the vein wall weak so the vein can dilate or get bigger and what that does is it pulls apart very thin connective tissue valves in the vein that are supposed to be only going in one direction up towards the heart. If the valves are pulled apart then they don’t function as a valve and they just let blood tumble back towards the feet. That pressure is what causes the big bulging veins and then ultimately the surface phenomenon on the skin.
Genevieve: I’m sure there are many of our listeners out there that would like to learn more. How do they contact you at Portland Surgical Associates?
Dr. Chris: We are part of Mercy Hospital so I’ll plug Mercy. You can get to us through the Mercy website and through the Mercy switchboard. A direct telephone number would be 553-6500. We have information about our venous practice on portlandsurgical.com. We’re also linked to the American College of Phlebology which is… phlebology is the study of veins so the American College is the major academic college that’s organized and helps certify physicians who are practicing in the venous system. They have excellent patient education materials right on their front page, American College of Phlebology.
Genevieve: We can link to that right from the Dr …
Dr. Lisa: We will put it on the doctorlisa.org website so people will very easily find you and your practice. Thank you for coming in.
Dr. Chris: Thank you.
Genevieve: Dr. Chris Rodgers is just one of the many excellent medical professionals operating in our state today. We are lucky enough to have a statewide system of care from Eastern Maine Medical Center through Mercy Hospital and Maine Medical Center and Southern Maine Medical Center where many of these medical professionals work, live and play in our lovely state. To read about three exceptional doctors please pick up the April 2012 wellness issue of Maine Magazine at your local newsstand or visit us online at themainemag.com.
Male: This segment of the Dr. Lisa radio hour and podcast is brought to you by the following generous sponsors. Mike LaPage and Beth Franklin of RE/MAX Heritage in Yarmouth, Maine, honesty and integrity can take you home. With RE/MAX Heritage it’s your move. Learn more at rheritage.com and by Tom Shepherd of Shepherd Financial. With offices in Yarmouth, Maine the Shepherd Financial team is there to help you evolve with your money. For more information on Shepherd Financials refreshing perspective on investing please email [email protected].
Dr. Lisa: There’s so many things that we could have on our show for Give Back for our Valentine’s Day show but we chose to have Jen Goldman on from the American Red Cross. She’s going to talk a little bit about something that has to do with both the veins and the heart as described by the doctors who were on earlier and that is blood. Hi Jeny.
Jen: Hi Lisa.
Dr. Lisa: You were telling me off air what is the difference between your part of the American Red Cross and the other part?
Jen: We are actually one Red Cross. I work specifically for blood services. We make sure that the blood supply in Maine is where it should be. The other part of the Red Cross that we do work with is disaster services. Disaster services is the part of the Red Cross that responds to fires or emergencies. You probably hear more about disaster services on the news then you do about blood services.
Dr. Lisa: Blood services are very relevant today, it’s snowing out. I’m hoping by the time this show airs it’s not snowing anymore and it will be a beautiful spring day of course but not likely. What happens when it snows in Maine with regard to blood?
Jen: That’s a very timely question because here we are in the middle of winter and we do actually right now have an urgent need for blood. What happens in the winter, we need to collect 300 units of blood every day. In the winter we have snow which in a lot of cases we have to cancel blood drives because of the snow which can wipe out 300 units of blood a day. The other thing that happens in Maine when it snows, our demographics tend to be older donors so when it snows older people are less likely to drive to blood drives. We really struggle and need to find new donors during the winter months.
Dr. Lisa: What are some of the criteria for being able to give blood?
Jen: In Maine you have to be 17 years old and weigh at least 110 pounds. Although recently in the past couple of years 16 year olds can give blood with parental or guardian signature on a permission slip. You also have to be in good health the day you give blood.
Dr. Lisa: There’s an entire screening process that people go through to give blood, is that correct?
Jen: When you arrive to give blood we do what’s called a health history which I always refer to as a mini physical. It’s about five to ten minutes long and they’ll take you into a little booth and they’ll take your temperature, they’ll check your iron levels, they’ll check your blood pressure and they’ll ask you a series of questions about medications you might be on, where you’ve traveled recently and assuming you pass all these tests then you move on to the part where you actually give blood.
Dr. Lisa: What types of things are hospitals using the blood for?
Jen: Hospitals use the blood for lots of different things. The things that you probably hear the most about are trauma, car accidents, often times somebody can end up in the hospital after a car accident and need anywhere from three to thirty units of blood. Cancer patients use blood, organ recipients use blood, people who are transfusion-dependent obviously use blood. That’s why the need is so great in Maine. The Red Cross provides the blood to all 39 hospitals in the state.
Genevieve: You can only get blood from a person correct?
Jen: At this point you can only get blood from people. In fact, the reason it’s so difficult to keep the supply up is because blood at this point in time can’t be manufactured. We can only get blood from people.
Dr. Lisa: We need Maine people to go and donate blood and there are many locations that I know are available to people in Maine.
Jen: We have probably six to eight blood drives every day, six days a week and sometimes on Sundays. Our blood drives run from Ft. Kent down to Kittery. We have two fixed sites in Portland and Bangor and actually a third fixed site in Lewiston at Central Maine Medical Center. We have businesses running drives every day. We have schools running drives and then we have community drives at churches and synagogues and rotaries.
Dr. Lisa: This is for a pint of blood but people can also do a platelet donation is that correct?
Jen: They can donate platelets but they do have to go into one of our fixed sites.
Dr. Lisa: That takes a little bit longer.
Jen: It does take a little bit longer than donating whole blood. We have a vast selection of movies though for donors who are giving platelets to watch during the process.
Genevieve: What’s the number one reason people don’t give blood?
Jen: Can you guess the number one reason people don’t give blood?
Dr. Lisa: Needles.
Jen: Not needles, any other guesses?
Genevieve: They think it’s unsafe?
Jen: No, the number one reason people don’t give blood is because nobody’s ever asked them to give blood. We go into the middle schools and the high schools and we encourage kids to get out there and ask their parents, ask their teachers, ask people who have never given blood to give blood because if they’re not a blood donor it’s probably because nobody’s ever asked them.
Dr. Lisa: Is there a certain blood type, I know there’s A and there’s B and there’s O and there’s AB and there’s positive and negative and some people get confused about this but is there a certain type that you like to see?
Jen: We’re always looking for O negative blood. O negative is the universal blood type and what that means is if you were in a car accident and taken into the hospital and they didn’t know your blood type they would automatically give you O negative blood. We use a lot more O negative blood then we do other blood types.
Dr. Lisa: How did you get into this line of work?
Jen: Good luck?
Dr. Lisa: Good but what makes you … You’re sitting across from us, you’re so passionate about what you’re doing. Even when you came in the door you were so passionate about this. What makes you so passionate about this?
Jen: I really feel like whether I have a good day or a bad day in the office I’ve made a difference in lives at the end of every day. It makes me feel good about the work I’m doing.
Dr. Lisa: How can people find out more about your organization?
Jen: People can call 1-800-red-cross to make an appointment. They can also go to our website www.redcrossblood.org. It’s a great website, very comprehensive and I suggest people check it out.
Genevieve: Out of a 1.5 million population to get 300 units a day people have to give regularly, consistently.
Jen: We encourage people to give regularly. People can give whole blood every 56 days and we really do have a lot of people who show up on that 56th day ready to give another pint. Most of them have been touched in some way, they’ve had a family member or a loved one need blood but there really are a lot of dedicated donors but we need more dedicated donors. We can always bring the blood drive to you. Our job at the Red Cross is to make it as convenient as possible for you to give blood. We’ll bring the bus to you. We’ll come to your place of business and set up a blood drive but just call us at our Forest Avenue location and we’ll make it easy for you to give blood.
Genevieve: Just to be perfectly clear, the body replenishes the pint that you give within 56 days.
Jen: Yes the body does replenish the blood quickly. The average adult has 10 to 12 units of blood in their bodies so we encourage people, write it on your calender every 56 days and become a regular blood donor.
Dr. Lisa: For this virtually painless experience people can go to your website as you’ve already mentioned and we will link through on the Dr. Lisa website. We thank you for coming in today Jen.
Jen: It’s been a pleasure and I hope to see both of you and all your listeners at a blood drive in the near future.
Female: This is Dr. Lisa Belisle, you have been listening to show number 22, Happy Heart airing first on February 12th 2012 on WLOB radio. In this show we spoke with Dr. Mylan Cohen of Maine Cardiology who suggested that doing anything even moving about in the water in a pool or having some chocolate or doing things that made our hearts happy could be good for our hearts. Dr. Chris Rodgers of the Vein Center at Portland Surgical affiliated with Mercy Hospital spoke about the relationship between other parts of our body, our veins and our heart and how everything is interrelated.
Jen Goldman of the American Red Cross left us with an important message which is that often people don’t do things because they aren’t asked. They don’t give blood because they aren’t asked. I would suggest as would Genevieve Morgan and the other members of our radio team that perhaps we need to be asking more of our listeners. We need to ask you on this Valentine’s Day to go out and do things to make your heart happier and healthier. In other words, love yourself. It’s cliché I know, but we’re often told we need to love our children, love our spouse’s, love our partners but love yourself first. Go out and do good things for yourself that make yourself happy, make your heart happy and healthy.
Subscribe to our podcast, Dr. Lisa Belisle, through iTunes and get us in your inbox on a weekly basis so you can listen to us while you’re out doing heart healthy activities such as biking or running or walking around a track. Forward our emails to your friends and family, go to doctorlisa.org to become a newsletter subscriber. Connect with us on Facebook at the Dr. Lisa page. We’re asking you to love yourself. We’re asking you to love us and we’re asking you to listen to us again next week as we talk about Gaining Ease on February 19th which will be our 23rd show.
This is Dr. Lisa Belisle, thank you for being part of our world; may you have a bountiful life.
Male: The Dr. Lisa radio hour and podcast is made possible with the support of the following generous sponsors: Maine Magazine, Mike LePage and Beth Franklin at RE/MAX Heritage, Robin Hodgskin at Morgan Stanley Smith Barney, Dr. John Herzog of Orthopedic Specialists in Falmouth, Maine, Tom Shepard of Shepard Financial, Pierce Atwood, UNE the University of New England, and Akari. The Dr. Lisa radio hour and podcast is recorded in downtown Portland at the offices of Maine Magazine on 75 Market Street.
It is produced by Kevin Thomas and Dr. Lisa Belisle. Editorial content produced by Chris Cast and Genevieve Morgan. Audio production and original music by John C. McCain, our assistant producer is Jane Pate. For more information on our hosts, production team, Maine Magazine or any of the guests featured here today visit us at doctorlisa.org. Tune in every Sunday at 11 am for the Dr. Lisa radio hour on WOLB Portland, Maine 1310 AM or streaming WOLBradio.com. Podcasts are available at doctorlisa.org.