Wednesday, September 9, 2009

Everything You Always Wanted to Know About Heart Disease

Jamaican Children Should Know Their Grandparents
B. Waine Kong, Ph.D., JD., and Stephanie H. Kong, M.D.

In addition to Earl Woods (Tiger Woods’ father) who never met his beautiful grand childen, the lives of more than 200 people who live in the Caribbean are cut short each and every day by a preventable disease. While we are over-concerned about violence, accidents, AIDS and Cancer, Cardiovascular disease, including heart attack (myocardial infarction), brain attack (stroke), and heart failure (weak heart muscle) is responsible for the demise of half of our grandparents. Unfortunately, all our families have tasted the bitter fruit of a loved one leaving us too soon due to heart disease.

Imagine that a group of us were having a picnic lunch on the bank of a river when we look out and see babies floating in the water. I imagine that that some of us would jump in, rescue the babies and take heroic steps to revive them. More importantly, however, I would hope that some of the really smart members of the group would run upstream to stop whoever is throwing babies off the bridge. We must obviously provide great care to those who already have disease but we must teach and motivate those who are not yet affected to prevent disease as well as reduce individual risk factors.

Children deserve to know their grandparents so they will become GREAT grandparents. When you board an airplane, you are advsed that, in case of emergency, put the oxygen mast on yourself first and then take care of othes. If you are unable to function, you will not be able to take care of people who depend on you. Even the heart pumps blood to itself before sending it to the rest of your body.

If we are ever going to solve our social problems (juvenile delinquency, unplanned teenage pregnancies, underachievement, unhealthy habits and the crisis in our relationships) we need more grandparents in our communities. A child is only a grandparent away from growing up to be a healthy, happy, contributing member of society. Other children around the world take for granted that they will grow up knowing the nurturing and wisdom of their grandparents, and even their great grandparents, but, due to the high rate of deaths from cardiovascular disease, accidents and violence, children in the Caribbean are fortunate if they have one grandparent (almost always a grandmother) by the time they celebrate their 21st birthday. Who will pass on our legacy to our youth? An African proverb says: “When a grandparent dies, an entire library goes up in flames.”

While heart disease has been viewed as unavoidable in the past, we can now shout from the rooftops that it is preventable. Dying from a heart attack or stroke is no longer a fact of life that we have to accept. Diabetes, heart disease, obesity, high blood pressure, cholesterol and other chronic conditions consume too much of our health care expenditures. Preventive care reduces needless suffering and premature death, improves the quality of care, enhances the quality of our lives, and lowers costs. Yet, comparatively very little of our healthcare dollars are spent on “prevention”.

By following our “Seven Steps to Good Health,” you can live with the confidence that heart disease will not interfere with the quality of your life. You can’t live forever, but you can dramatically reduce the chances that heart disease or stroke will be the cause of your demise. Our success will, however, depend on a radical shift toward prevention and public health, even for those who are already overweight and have other risk factors. It is never too early or too late to adopt a healthy lifestyle.

While we all subscribe to the adage that “An ounce of prevention is worth a pound of cure,” we still allow the tyranny of the urgent (drowning Babies) to prevent us from taking wise steps to avoid disaster. So, an ounce of prevention is worth a pound of cure and a ton of trouble. Those who usually wait until the horse is out before closing the barn door should realize that, with heart disease, your first symptom is often your last. Half of all people who experience heart attack or stroke symptoms die before reaching a source of care.

The basic unit of life is a cell. Our body is made up of billions of them. Each one requires a constant supply of oxygen and other nutrients to stay alive, multiply and continue to do the jobs that Nature assigned them. Whenever the cells burn energy (oxygen) to accomplish their various tasks, they create waste. So, each cell also needs to have its “garbage” picked up. Cells are grouped to form organs which help us to move, taste, smell, think and do our work. The reason we get tired when we work or exercise is that we are using our oxygen faster than it is replenished. We catch up when we rest, catch our breath and re-establish input-output balance.

Most people, even cardiologists, associate the heart with love, bravery, cowardly behaviour and heart ache. We could go on and on about various characterizations of the heart in religious texts, art and literature, but we don’t have the heart. However, the function of the heart and blood vessels is really to deliver the oxygen and nutrients to each cell, pick up waste, cleanse and enrich the blood before sending it out again. This is a closed system that repeats itself about 70 times per minute, 24 hours a day, and 365 days per year for our entire lives. Our heart never takes a break, pumping 2,000 gallons of blood per day. As the good book says: 'We are fearfully and wonderfully made!’

Heart disease represents an “interference” with blood flow. This commonly takes the form of an obstruction such as atherosclerosis (gradual build-up of plaque in the blood vessels what we use to call “hardening of the arteries”) or an embolus (a clot), a haemorrhage (bleeding from a rupture at a weak area of a blood vessel), a spasm, or blood that is either too thick or thin to be pumped properly. Cardiovascular disease prevents our vital organs from getting all the blood that is needed. This can occur in the heart, in the brain or in an extremity like a toe or leg. When these parts of the body do not get enough blood, the cells simply starve to death.

Arteries take blood from the heart and veins return blood to the heart. With every beat, blood is pumped out of the heart and travels through the large arteries which branch out like the limbs of a tree until the arteries meet a network of arterioles connected to venules (capillaries). As blood passes through the capillaries, oxygen and nutrients are delivered to the cells, the waste and carbon dioxide are picked up and the blood flow continues through the veins. As blood passes through the kidneys, the blood is filtered and many of the impurities leave the body as urine. Once blood returns to the heart through the veins, it is pumped to the lungs where a great exchange takes place: carbon dioxide for oxygen. Carbon dioxide leaves the body as we exhale and new oxygen enrich the blood as we inhale. The oxygenated blood travels back to the heart, and once again is sent on its way to all the cells of the body.

If some of the cells of your heart do not receive enough oxygen because the blood supply is compromised, these cells die, possibly causing a heart attack. The chest pain you may encounter when the heart is starving for oxygen (angina) is the heart muscle screaming at you to send blood. If the heart muscle becomes flabby or is damaged (like an old girdle) and therefore not strong enough to pump the blood from the heart efficiently, you have heart failure.

The early warning signs of a possible heart attack are: tightness, pressure, squeezing or a burning sensation in the centre of the chest that may radiate down the arms; nausea, shortness of breath and sweating. If you experience these symptoms, seek the care of a medical professional (preferably an emergency room) immediately. At a moment like this, you will be ill-advised to drive your own automobile as there is a chance that you will black out before reaching the hospital. Here are the seven steps to Good Health:

1. Be spiritually active. An important study from the University of Texas tells us that people who attend church regularly, live seven to fourteen years longer than those who do not go to church. Apparently, the fellowship, good will, meditation, inspirational words and singing together increase our ability to cope. According to Dr. Malcolm Taylor: “If you have God, family and friends, you may stumble, but you will never hit the ground.”

2. Take charge of your blood pressure. Despite steady progress over the past thirty three years, uncontrolled high blood pressure is projected to increase by 60% over the next twenty years. Tell your doctor you want to keep your blood pressure as close to goal (120/80 mm Hg) as possible.

3. Control your cholesterol. Keep your HDL high (>1.0 mmol/L), and your LDL low (<3.4 mmol/l), and total cholesterol low (< 5.0 mmol/L). High cholesterol leads to plaque, which restricts the flow of blood. Diet, exercise, and statin therapy are the keys to maintaining healthy cholesterol levels.

4. Track your blood sugar and maintain ideal weight. Obesity and diabetes track each other. As the rate of obesity goes up, so does diabetes. If you are overweight, you run a high risk of developing diabetes which increases your risk of heart attacks, strokes, blindness, amputations and impotence. Why must sugar and fats accompany every expression of love and every celebration? By reducing obesity, we are taking a swing at diabetes. Three out of four diabetics will die from heart disease and stroke. If you have the following symptoms, you should consult a doctor: Fatigue, blurred vision, excessive thirst, frequent urination, unexplained weight loss and non-healing wounds and sores. These may indicate that you have diabetes.

5. Enjoy regular exercise (30 minutes per day-every day), follow a sensible diet and get a good night’s sleep! Move those muscles. Increase your intake of fruits and vegetables, reduce fats and sugars, but most of all, eat less. Every little bit you do can ether help or hurt your health a little bit. Twenty years ago, 50% of children walked to school. Don’t be a fat maker by insisting that others eat more of what they do not need and resist being a victim of a fat maker also. Let’s be more creative about demonstrating love for each other than to force feed the ones you most care about. If you don’t sleep well, get a sleep study and then follow your doctor’s advice. Sleep apnea, a significant contributor to hypertension and heart disease, is more common among those who are obese.

6. Don’t smoke. Nobody argues with this any more, not even smokers. Smoking constricts the arteries, increases carbon monoxide, lowers the good cholesterol, and is the primary cause of lung cancer. According to Benjamin Waterhouse (1754-1846):
"Tobacco is a filthy weed,
That from the devil does proceed,
It drains your purse, it burn your clothes,
And makes a chimney of your nose."

Smoking is our most preventable cause of premature death.

7. Access better health care, get a check up and faithfully take your medication as prescribed. It is no longer acceptable for the most vulnerable among us to receive the worst care. Just because some of us are poor does not mean that we should be relegated to poor care. All members of society deserve to receive respectful health care. If you are dissatisfied with the care that you are receiving, then seek care elsewhere. More importantly, it does no good for you to be evaluated by a physician, have your condition diagnosed and medication prescribed if you do not then fill the prescription and take it as directed.

It is difficult to imagine that with all the sunshine, ocean, open spaces, and such a strong sports tradition, that 20% of children living in the Caribbean are overweight. All aesthetics aside, being fat ought not to be perceived as anything other than unhealthy. Obese children become obese adults who run the risk of dying from diabetes, heart disease, stroke, and kidney failure. Since 1980, we have seen a 50% increase in the incidence of obesity every decade. This dramatic rise in obesity is inevitably accompanied by an equally critical rise in diabetes, resulting in over 20% of Caribbean adults suffering from this awful disease. How has a society where we use to “walk and talk”, succumb to this plague of inactivity, diabetes and obesity?

The United States has taught the world that there isn’t enough money to pay for all the disease caused by obesity, lack of exercise, cholesterol, smoking and diabetes. However, the United States spends 20 cents of each dollar collected as revenue on health care. Still, the life expectancy of an average African American male is less than the life expectancy of Caribbean men. The United States has a so-called ‘state-of-the-art’ healthcare system, yet they are way behind the rest of the world in promoting health and well-being. When a patient has a disease, we treat the disease; similarly, when a large segment of our people has a disease, treat the country. If you want to reduce violence, crime and unwanted pregnancies, let children have the opportunity to know their grandparents---free from obesity, diabetes and heart disease.

The Caribbean needs a system that promotes health and not an expensive “healthcare system” that only treats disease. In a country like Jamaica, where the average household income is less than US$4,000 per year, we cannot afford to provide invasive and expensive medical services to treat illnesses that can and should have been prevented. A “System of Health” emphasizes prevention, while a “health care system” places emphasis on the treatment. By being proactive instead of reactive, we can inspire people to take health promotion and disease prevention seriously.

The Caribbean is composed of islands of sunshine and cool breeze. Europeans and Americans come to our islands to lose weight through exercise and heart healthy eating, so why can’t we take advantage of these home grown remedies? If we consider the fact that most of the disease that plague us and cost so much can be prevented, it becomes apparent that promotion of heart health and exercise would allow enormous savings for the health care system. In fact, just about all the heart attacks, heart failure, strokes, diabetes, kidney failure (diseases that kill 50% of us) could be prevented by making simple adjustments to our lifestyles. Being proactive in health can add 10 more years to enjoy the company of our grandchildren and guide them to a happy, healthy and productive life. The nursery rhyme about Humpty Dumpty is illustrative of those who lazily sit on walls only to have great falls and heart attacks that no physician, no matter how skilful can put them together again. If Humpty was not sitting around watching television and playing video games, his risks of heart disease would have been reduced. We can take an important message from this nursery rhyme by understanding that no matter how good our reactive plans in medicine and surgery may be, it will never be as good as prevention. A good doctor cures disease, a really great doctor prevent disease. If you are sick, you are not making money, you are spending it. Healthy people are much more likely to be wealthy people.

As far as the health and welfare of people living in the Caribbean is concerned, the challenges are unprecedented. But our greatest challenges present our greatest opportunities to excel. While our governments struggle daily with how to allocate our limited resources, it should be recognized that it would be a good investment to spend more on prevention. At present, less than 5% is spent on in this area and we need to increase our spending here to at least 25%. We should train “Community Health Advocates” for every community in our country and perhaps even identify the healthiest and most at risk communities. This way, we can educate and motivate our citizens to maintain good health.

The health of our peple is in perril. Just as it would be unconscionable not to have an infectious disease program, it is unacceptable not to have a cardiovascular disease prevention program. At the end of the day, we want a System of Health that actullly promote wellness, not just a healthcare system. Every citizen must recognize that if they do not take time to implement the seven steps to good health into our daily life, they will prematurely succumb to disease and abandon our grand children. God made us to be strong and physically fit, and by choosing to be “fat and lazy”, we will pay the price of dieing prematurely.


From: gabriella kadar
Sent: Tue, February 23, 2010 11:31:07 PM
Subject: Heart disease and Jamaicans

Good evening Dr. Kong,

I am a dental surgeon working and living in Toronto, Canada. Back in 1981
when I graduated from dental school I moved to Trinidad and worked in San
Fernando for 2.25 years. Partly because of this experience I've always kept
an eye on what goes on in the West Indies. I've travelled relatively
extensively around and my most recent trip was back to Grenada (sep.2009).
The last time I was there was May 1982!!

Toronto Trinis always ask me about when I'm going 'bakome'. I've been
'assimilated'......LOL. (I spent a day in Trinidad this time.)

I've been keeping my eye on this for quite some time:

Take a look at Olympic medal stats. Jamaica just suddenly went wild at the
Beijing games. Usain Bolt was born in 1986. You've got an entire generation
of young adults with intact dentitions. Interestingly Jamaica is the only
country where ONLY fluoridated salt is available. Elsewhere people have a
choice. Only in Jamaica is there such a huge improvement in dental health.

Jamaicans have always been exceptional. read: Jamaican Paradox.

When human beings possess a full set of teeth that function well they are
robust. There is a huge neuro-muscular-skeletal advantage provided by well
developed jaws, well developed face, wide nasal passages and a full

Jamaicans have just started 'kicking Olympic butt'. Watch out world!!!!

I've read your blog in regards to heart disease. I'll hazard a guess that
people who have well developed robust physiques probably live longer and
have healthy hearts. They sleep better, recover from physical exertion
better, oygenate better, have stronger neck muscles and back muscles.....
there's a whole lot of positives acruing from well developed facial and
masticatory muscles.

Jamaica has always had a very strong physical education/sport culture. What
has changed to make Jamaicans into Olympic champions? Salt fluoridation.


Dr. Gabriella Kadar
360 Bloor Street West, Suite 503
Toronto, Ontario M5S 1X1

416 924 3522