Sometimes we don't know how far we've come until we look back at where we’ve been. Once a heart attack was a likely death sentence; if you survived, you were often crippled for life – oddly enough, sometimes due as much to the “therapy” of the time than the heart attack itself.
Three leading heart specialists recently discussed how the heart attack has been tamed as they reviewed the past, present, and future of cardiac care. http://bit.ly/6KTaQr However, my favorite example of just how far we’ve come is the story of a former President. I first heard this from Dr. William W. O'Neill of the University of Miami, Florida, and I am now adding additional details here.
In 1949, General Dwight Eisenhower had finished conquering Europe, beaten the Nazi Empire, and become one of the most recognized people in the world. He was a heavy smoker and that year he started having chest pain. His doctor told him to quit smoking and the general successfully lowered his cholesterol. The changes seemed to work; he was healthy enough in 1952 to seek and win the Presidency of the United States. Then in late September, 1955, President Eisenhower complained of chest pain on the 9th hole during an afternoon of golf. At that point, he thought he had just eaten too many onions on his hamburger at lunchtime.
He was staying with his mother-in-law in Denver and shortly after midnight, he woke up with severe chest pain. He asked his wife, Mamie, for milk of magnesia, but she was concerned enough to call his personal physician, who arrived around 2 a.m. President Eisenhower had a history of diverticulitis, a fairly common and sometimes painful digestive system problem. So, Dr. Howard Snyder concluded his patient’s symptoms were most likely due to upper gastric pain.
At about 3:00 in the morning, however, the President took a turn for the worse; he became ashy, sweated profusely, and for about 10 minutes Dr. Snyder couldn’t feel a pulse. He improved a little, but by 7:00 AM a call was placed to Fitzsimmons Army Hospital requesting an electrocardiogram. Today, this common test is easily administered and the ECG unit can be wheeled around a room using one hand; but, back then, it was so big that it had to be delivered on a truck. The ECG showed that the President had suffered a large heart attack.
Vice President Richard Nixon decided to call in a civilian heart specialist "because we cannot overlook the fact that many people in the country might have more confidence, however unfounded, in a civilian specialist of national reputation." There was consensus to consult Dr. Paul Dudley White of Massachusetts General Hospital in Boston, arguably one of America's foremost cardiologists. The heart attack led to President Eisenhower being hospitalized from August until mid-October.
(As an aside, on Monday morning, just 2 days after the President’s heart attack, Wall Street panicked and stock prices went into a tailspin. By the end of the day, the Dow Jones had dropped by 6% — a paper loss of $14 billion, the largest decline since the crash of 1929 and one that would exceed those following the assassination of President John F. Kennedy and the shooting of President Ronald Reagan.)
In the mid-1950s, the treatment of MI was 12 weeks of bed rest followed, hopefully, by recuperation. Unfortunately, 25-30% of people suffering such a heart attack died back then. One reason may have been the 12-weeks of hospitalization! Today, we know it is best to get people up quickly after a heart attack rather than let them lie in bed becoming more out-of-shape with each passing week. President Eisenhower survived the initial heart attack, including his long period of bed rest! -- but subsequently died in 1965 having been hospitalized at Walter Reed Hospital for months due to recurrent ventricular fibrillation and angina.
Today, President Eisenhower’s problem would have been fixed promptly, either with angioplasty or surgery, and he would have been in the hospital for 2 days. That is a clear example of where we've been with the treatment of heart attack compared to where we are today.
Sunday, January 3, 2010
Friday, January 1, 2010
Food Fight! Nope, not necessary. Getting kids to eat better.
The tranquil image of mom, dad, and the kids around the dinner table shares a reality with portraits of unicorns and dragons: Fun to look at but still fiction.
At least that’s a common experience of young parents. In re-reading a Los Angeles Times article recently, I had forgotten that one of the paper’s feature writers referred to one youngster as “a miracle child” for preferring vegetables – including mushrooms and beets – to junk food.
As an expert on that kid – he’s my oldest son, Aaron – the lessons from this nearly 20-year-old article written by the Times Kathleen Doheny are just as applicable today as they were when she first interviewed me.
Our kids were raised vegetarian. (Lacto-ovo vegetarian specifically, meaning we ate dairy and egg products.) Still, I do recall telling the reporter about my son, Aaron: "It's a somewhat surreal experience to be in the grocery store and the things he is grabbing are not Ding-Dongs and Hostess Twinkies, but apples. If you say `cake,' his face will light up like a Christmas tree, but he only takes one or two bites and he's finished."
A miracle child? Hardly. The article noted that my wife and I were careful about what food we had in the house. A box of cookies was about as dangerous as it got.
As quoted: "I have to wonder if parents accidentally undermine their own goals by giving the kids access to junk food." After all, "If you don't expose them to it, they don't know it's a choice."
The L.A. Times writer added that we avoided dinner-time hassles with Aaron by not making a big deal over what he eats. "We don't sit down and say, `You must eat everything on your plate,' " McGuire says. "Some days he eats very little, and a few days later it's growth-spurt time and he eats everything."
Support from the Pros
Like all good reporters, Ms. Doheny talked to others, too, for her article “Food Fight! Children Versus Parents Over Veggies.” Elisabeth Schafer, then a professor of human nutrition at Iowa State University, cited flavor as an obvious reason why kids and veggies don't mix.
"Most vegetables tend to have a fairly strong flavor that tastes even stronger to children than it does to adults," she says. That's because kids' sense of taste is more acute than adults'.
Sociology is a factor, too. "Interactions within the family are a very powerful determinant of food aversions," she says. "The children watch what their parents eat. They pick up both verbal and nonverbal cues at mealtimes." The result: If parents don't eat vegetables, it's unlikely the kids will.
I recall the hypocrisy of certain friends and acquaintances who wanted their kids to eat their vegetables, which mom or dad (or both!) actually hated. Also, when around other young parents, I marveled at all the complaints about kids and junk food. Since most toddlers and preschoolers don’t have a lot of disposable income and rarely shop on their own, I wondered how these little rascals were getting their junk food fixes. Oh, yeah, that would be mom or dad.
One other expert endorsed our “easygoing approach” with food. Ellyn Satter, a Madison, Wis., family therapist who specialized in eating problems, wrote the 1987 book "How to Get Your Kids to Eat." She recommended resolving food conflicts by defining zones of responsibility.
"The parent's responsibility is for what, when and where," Satter says. "The child's responsibility is for what and how much."
Translated, that means it's a parent's job to select and prepare healthy foods and determine when and where dinner will be served. It's also up to parents to limit access to snacks and junk foods. Easiest: If it’s not in the house, your kids can’t eat it; at least not during the hours they are home!
Two big pieces of advice not in the article: make desserts occasional treats (or even rare ones) and consider fruit as a side dish.
I grew up in the Midwest where meals almost always involved dessert: pie, cake, ice cream, pudding. (Or combinations, such as pie ala mode!) The “healthy” options were along the lines of fresh berries with whole cream or strawberry shortcake, sometimes with a side of ice cream. I can hear my smaller arteries slamming shut as I write this. With my own kids, desserts were uncommon and almost always separated by hours from the main meal. There is no need for a child to connect “dinner” and “dessert” in the same time/space continuum.
However, I did serve – and still do – fresh fruit with most evening meals. (Yes, I am the family chef and chief grocery shopper.) When many parents think of side dishes for kids, they think of things like mashed potatoes, macaroni and cheese, potato chips, and French fries. Not me: a side is fresh melon, berries, mixed fresh fruits, or an occasional frozen or canned fruit (since fresh peaches are sadly unavailable for most of the year).
Raising a pair of vegetarians was not all that tough. Aaron is a Junior at Duke University and, although I have made it clear that whether he eats meat or not is his own choice now that he is on his own, he still chooses to be a vegetarian. I like to think he was raised right but I know he was fed right.
At least that’s a common experience of young parents. In re-reading a Los Angeles Times article recently, I had forgotten that one of the paper’s feature writers referred to one youngster as “a miracle child” for preferring vegetables – including mushrooms and beets – to junk food.
As an expert on that kid – he’s my oldest son, Aaron – the lessons from this nearly 20-year-old article written by the Times Kathleen Doheny are just as applicable today as they were when she first interviewed me.
Our kids were raised vegetarian. (Lacto-ovo vegetarian specifically, meaning we ate dairy and egg products.) Still, I do recall telling the reporter about my son, Aaron: "It's a somewhat surreal experience to be in the grocery store and the things he is grabbing are not Ding-Dongs and Hostess Twinkies, but apples. If you say `cake,' his face will light up like a Christmas tree, but he only takes one or two bites and he's finished."
A miracle child? Hardly. The article noted that my wife and I were careful about what food we had in the house. A box of cookies was about as dangerous as it got.
As quoted: "I have to wonder if parents accidentally undermine their own goals by giving the kids access to junk food." After all, "If you don't expose them to it, they don't know it's a choice."
The L.A. Times writer added that we avoided dinner-time hassles with Aaron by not making a big deal over what he eats. "We don't sit down and say, `You must eat everything on your plate,' " McGuire says. "Some days he eats very little, and a few days later it's growth-spurt time and he eats everything."
Support from the Pros
Like all good reporters, Ms. Doheny talked to others, too, for her article “Food Fight! Children Versus Parents Over Veggies.” Elisabeth Schafer, then a professor of human nutrition at Iowa State University, cited flavor as an obvious reason why kids and veggies don't mix.
"Most vegetables tend to have a fairly strong flavor that tastes even stronger to children than it does to adults," she says. That's because kids' sense of taste is more acute than adults'.
Sociology is a factor, too. "Interactions within the family are a very powerful determinant of food aversions," she says. "The children watch what their parents eat. They pick up both verbal and nonverbal cues at mealtimes." The result: If parents don't eat vegetables, it's unlikely the kids will.
I recall the hypocrisy of certain friends and acquaintances who wanted their kids to eat their vegetables, which mom or dad (or both!) actually hated. Also, when around other young parents, I marveled at all the complaints about kids and junk food. Since most toddlers and preschoolers don’t have a lot of disposable income and rarely shop on their own, I wondered how these little rascals were getting their junk food fixes. Oh, yeah, that would be mom or dad.
One other expert endorsed our “easygoing approach” with food. Ellyn Satter, a Madison, Wis., family therapist who specialized in eating problems, wrote the 1987 book "How to Get Your Kids to Eat." She recommended resolving food conflicts by defining zones of responsibility.
"The parent's responsibility is for what, when and where," Satter says. "The child's responsibility is for what and how much."
Translated, that means it's a parent's job to select and prepare healthy foods and determine when and where dinner will be served. It's also up to parents to limit access to snacks and junk foods. Easiest: If it’s not in the house, your kids can’t eat it; at least not during the hours they are home!
Two big pieces of advice not in the article: make desserts occasional treats (or even rare ones) and consider fruit as a side dish.
I grew up in the Midwest where meals almost always involved dessert: pie, cake, ice cream, pudding. (Or combinations, such as pie ala mode!) The “healthy” options were along the lines of fresh berries with whole cream or strawberry shortcake, sometimes with a side of ice cream. I can hear my smaller arteries slamming shut as I write this. With my own kids, desserts were uncommon and almost always separated by hours from the main meal. There is no need for a child to connect “dinner” and “dessert” in the same time/space continuum.
However, I did serve – and still do – fresh fruit with most evening meals. (Yes, I am the family chef and chief grocery shopper.) When many parents think of side dishes for kids, they think of things like mashed potatoes, macaroni and cheese, potato chips, and French fries. Not me: a side is fresh melon, berries, mixed fresh fruits, or an occasional frozen or canned fruit (since fresh peaches are sadly unavailable for most of the year).
Raising a pair of vegetarians was not all that tough. Aaron is a Junior at Duke University and, although I have made it clear that whether he eats meat or not is his own choice now that he is on his own, he still chooses to be a vegetarian. I like to think he was raised right but I know he was fed right.
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