50 million Americans have elevated blood pressure or hypertension (systolic blood pressure greater than 140 and/or diastolic blood pressure greater than 90).  Many people are unaware of their high blood pressure because they have no symptoms. Hypertension increases the risk for heart attack, stroke, kidney failure and heart failure.

Normal blood pressure                     < 120 / 80
Pre-hypertension                               120-139 / 81-89
Hypertension                                     >140 / 90

How do I know if I have high blood pressure?
Most people with hypertension have no symptoms.  Blood pressure may be elevated for a number of years before it is identified.  Symptoms such as headache, dizziness, blurred vision, shortness of breath or swelling in legs may be associated with elevated blood pressure.

What causes hypertension?
Most patients with hypertension have no identifiable cause for their hypertension.  Only 5% of patients will have medical conditions such as thyroid, kidney, or hormonal problems causing their elevated blood pressure.

What can I do if my blood pressure is high or borderline high?
Lifestyle modifications can help reduce blood pressure.  Losing weight (even 5-10 pounds) can improve blood pressure.  Eating a diet rich in fruits, vegetables, and low fat dairy products, and low in saturated and total fats can reduce blood pressure up to 10-15 points.  Limiting salt in the diet and limiting alcohol to no more than 2 drinks pre day for men and 1 drink pre day for women is recommended.  Regular exercise can help reduce blood pressure.  Cigarette smoking has been shown to raise blood pressure, so now is the time to quit. Making changes in your lifestyle can prevent hypertension.

If blood pressure is not controlled with lifestyle changes, medications may be required.  Often, diuretics or water pills are considered as first line therapy, but there are many different types of blood pressure medications.

Why should high blood pressure be treated?
Elevated blood pressures increase the risk for heart attack, stroke, kidney failure, and overall mortality.

For more information on high blood pressure guidelines, visit www.nhlbi.nih.gov/guidelines/hypertension/index.htm.

Diabetes mellitus is a condition with elevated blood sugars due to inadequate insulin secretion or insulin resistance.  There are two types of diabetes, type 1 and type 2.  Type 1 diabetes is caused by antibody destruction of the pancreas usually seen in childhood.  Often, children become acutely ill with nausea, vomiting, weight loss and ketoacidosis (build up of acids in the blood).  Type 2 diabetes or adult onset diabetes is due to resistance of cells in the body to use the existing insulin.  Type 2 diabetes is often seen in overweight adults.  For many, type 2 diabetes is initially asymptomatic and may exist for years before it is diagnosed.  More than 90% of Americans with diabetes have adult onset diabetes.

Diabetes is defined as: Blood glucose 126 or higher after an overnight fast, on more than one occasion or a random blood glucose greater than 200 with symptoms of diabetes.

Symptoms of diabetes may include frequent urination, excessive thirst, blurred vision, excessive fatigue, weight loss or weight gain.

Risk factors for diabetes include obesity, family history of diabetes, lack of physical activity, age over 45 years old, race (increased risk in African American, Hispanic American, and American Indian), and gestational diabetes during pregnancy.

Uncontrolled diabetes can lead to a number of complications.  Diabetes increases the risk for heart attack and stroke.  Diabetes can damage the kidneys and is the leading cause of kidney failure in the U.S.  Uncontrolled blood sugars can damage the eyes leading to blindness, and damage nerves in the body causing numbness, weakness, and pain.  Diabetes can affect the circulation to extremities leading to sores or amputation.

The best way to prevent complications is to control your diabetes, blood pressure and cholesterol.  Target blood pressure to less than 130 / 80.  Work to lower bad cholesterol (LDL) to less than 100.  Avoiding alcohol and quitting smoking can decrease the risk of complications.  Exercise helps the body use insulin better, lower glucose, lower blood pressure and cholesterol, and helps with weight loss.  Hemoglobin A1C is a blood test that measures blood glucose control over the last three months (target:  less than 7).  The American Diabetes Association recommends targeting blood sugars to 90-130 mg/dl before meals and less than 180 mg/dl two hours after a meal.

Diet and exercise can be effective in controlling diabetes.  For some, medications may be required.  There are several classes of diabetic medications available.  If pills are ineffective or not tolerated, insulin may be used to control diabetes.

Diabetes can be a silent disease.  You may feel fine even if your blood sugar is high.  It is important to check your blood sugars every day and take your medicines to prevent problems in the future.

For more information, visit the American Diabetes Association at www.diabetes.org.

Minor injuries can lead to significant distress. After an injury, the following steps can help with recovery.

-Resting the injured area can help, but early return to activity with range of motion exercises is also important.
-Icing the injured area can help reduce swelling.
-Compression using an ACE wrap can give added support to the injured area and help control swelling.
-Keep the injured area elevated above the heart to limit swelling.

Acetaminophen can be used to help decrease pain, although it has no anti-inflammatory effects.  Anti-inflammatories such as aspirin, naproxen, and ibuprofen help with pain and decrease inflammation.  Caution is advised when using anti-inflammatories, as they can raise blood pressure and cause stomach irritation.

If an injury does not improve with time or is associated with numbness, tingling, or weakness, see your doctor.

Colds or upper respiratory infections are a common reason for doctor visits.  Most upper respiratory infections are caused by viruses.  Antibiotics are ineffective against viral infections.

Sore Throat: try gargling with warm salt water, sucking on cough drops/hard candy, and using over the counter throat sprays or lozenges.  Acetaminophen can also help decrease the pain.

Nasal Congestion: using a humidifier, guaifenesin (found in most cough syrups), and decongestants can help.  Decongestants, such as pseudoephedrine, can also cause elevations in blood pressure.

Coughing is a normal response to irritation of the airways.  If a cough is productive of phlegm, it is best not to suppress the cough.  If the cough is nonproductive, cough syrups with dextromethorphan can help decrease the cough.

If the symptoms of the cold last for more than 7 to 10 days, or are associated with shortness of breath, chest pains, or high fevers, contact your physician.

High cholesterol increases the risk for heart attack, stroke, and overall mortality. Cholesterol levels in the blood are primarily due to diet and family history.

Guidelines
Total cholesterol < 200 for most individuals
Triglycerides < 160
HDL (good cholesterol) < 45 in men or >50 in women
LDL (bad cholesterol) goal based on risk factors

<160  if 0-1 risk factor
<130   if more than 1 risk factor
<100  if known heart disease, stroke or diabetes
<70 optional goal if heart/vascular disease and diabetes

Risk factors:  high blood pressure, smoking, age (men >45 years, or women >55), family history of early heart disease (father or brother with heart disease before age 55 or mother or sister with heart disease before age 65), or HDL < 40.

HDL “good” cholesterol helps carry cholesterol away from arteries and is protective against heart disease.  HDL cholesterol can be increased by exercise, quitting smoking, weight loss, and eating fish/taking fish oil tablets.

LDL “bad” cholesterol builds up in arteries forming hardened plaques that can clog up the arteries.  As the level of LDL cholesterol increases, the risk for heart disease also increases.  LDL cholesterol can be lowered by weight loss, exercise, quitting smoking, and following a balanced diet low in saturated fats.

Triglycerides are another bad type of cholesterol.  Triglycerides can be reduced by exercise, quitting smoking, weight loss, and limiting sugars/starches.

For more information, see www.americanheart.org.

Memory loss can be a troubling problem for many individuals. Many are left wondering if this might be a normal part of aging, or a serious health issue. Many conditions can lead to memory loss including Alzheimer’s disease, Parkinson’s, hypothyroidism, vitamin B12 deficiency, and depression. Blood tests and x-rays may be required to evaluate problems with memory. Certain medications can also contribute to memory problems. Signs or symptoms that may indicate memory issues include:

Inability to learn new things
Difficulty managing finances
Depression
Getting lost in familiar spaces
Forgetting old facts
Making up details to fill gaps in memory
Continually repeating  stories
Wandering from home
Agitation, paranoia, or other behavioral problems
Poor judgement or forgetting manners
Lack of concern for appearance or hygiene
Inappropriately crying out
Mumbling or gibberish in speech
Failure to recognize family
Difficulty with daily living activities

If you are having trouble or concerns about memory loss, talk with your doctor. Medications are available to help slow the progression of such memory loss.

What are the risks for a heart attack or stroke?
Risk factors for vascular disease include high blood pressure, smoking, diabetes, high cholesterol, being overweight, inactivity, age and family history.

What causes heart attacks and strokes?
Most heart attacks and strokes are caused by blood clots plugging an artery supplying either the heart or the brain.  Each minute that the tissue does not receive new blood, cells of the heart or brain die.  Although most strokes are caused by blood clots, some strokes may be due to bleeding from a ruptured blood vessel in the brain.

What are the signs and symptoms of a heart attack?
The signs of a heart attack are not the same for everyone, and certain individuals may have very little symptoms at all.  Chest pain, often described as pressure or squeezing sensation, in the center or left side of the chest may be present.  Symptoms may be persistent or may come and go. People with diabetes, women, and individuals with a prior heart attack may not have the typical symptoms or little symptoms at all to suggest they are having a heart attack.

What are the signs and symptoms of a stroke?
They symptoms of a stroke are not the same for everyone.  Sudden weakness or paralysis in a part of the body, numbness, tingling, vision changes, speech or memory difficulties, or headache may be associated with a stroke.

If you have symptoms of a heart attack or stroke, immediately call 911 to be taken to an emergency room to be evaluated. Talk to your doctor about what you can do to reduce your risk for a heart attack or stroke.

Heartburn may be a symptom of a condition called acid reflux disease.  Heartburn is caused by stomach acid splashing up into your esophagus causing burning, pressure or discomfort. Acid reflux disease or GERD (gastroesophageal reflux disease) often is caused by weak muscles at the top of the stomach allowing acid up into the esophagus causing symptoms and possible irritation to the esophagus.

What are the symptoms of GERD?
Frequent heartburn, regurgitation of food, a sour or bitter taste in the mouth or belching may be due to acid reflux.  For some, symptoms may include burning chest pain, trouble swallowing or sore throat.

Do particular foods aggravate acid reflux disease?
Some foods which commonly aggravate acid reflux disease include carbonated beverages, chocolate, mints, alcohol, and acidic foods such as citrus or tomato-based foods.

Are there any lifestyle changes that can help manage acid reflux disease?
Watching what you eat can help control acid reflux.  Avoiding fatty meals and eating smaller meals helps reduce heartburn.  Acid reflux can also be reduced by losing weight, avoiding tight clothing (belts or pants), and quitting smoking.  If you symptoms are often at night, avoid eating 3-4 hours before going to bed or consider raising the head of your bed 6 to 8 inches by using wooden/concrete blocks.

What medicines should I take for my heartburn?
There are a number of products available over the counter to help with heartburn.  Antacids help neutralize stomach acid and often provide temporary relief.  H2 blockers such as ranitidine and famotidine decrease the amount of acid produced in the stomach.  These medications can be used before a meal known to cause heartburn or used afterward to treat symptoms.  Proton pump inhibitors of PPI’s block the production and secretion of stomach acid.  These medications must be taken on a daily basis to effectively control heartburn.

When should you see your doctor about you acid reflux?
Persistent acid reflux can cause damage to the stomach and esophagus leading to scarring, ulcers or increasing your risk for cancer.  If you have heartburn 2 or more days a week, difficulty swallowing, weight loss, or symptoms uncontrolled by medicines, talk to your doctor.

Following the suggestions below may help prevent many issues further down the road.

MEN:

Testicular Cancer-monthly self testicular exam
Prostate Cancer-digital rectal exam and PSA blood test yearly (starting age 45)
Colon Cancer– hemoccult test for blood in stool yearly,
Colonoscopy every 10 years (dependent on family history and doctor’s advice)
Sigmoidoscopy (every 3-5 years) along with barium enema
Start testing at age 50 and follow recommendations from your physician on followup exams/procedures.
Periodic cholesterol monitoring
Periodic blood pressure monitoring

WOMEN:

Cervical Cancer – pelvic exam and pap smear yearly (starting at age 18 or beginning of sexual activity) Follow your physicians advice on followup exams.
Breast cancer – monthly self breast exam and yearly breast exam by your physician
Mammogram- Baseline exam (ages 30-40 years), Yearly (ages 40-50)
Colon Cancer– hemoccult test for blood in stool yearly,
Colonoscopy every 10 years (dependent on family history and doctor’s advice)
Sigmoidoscopy (every 3-5 years) along with barium enema
Start testing at age 50 and follow recommendations from your physician on followup exams/procedures.
Periodic cholesterol monitoring
Periodic blood pressure monitoring