Central  South  Dakota  Medical News
The Clinical View
by Phillip Hoffsten
 1 December 2004

THE SLOW, SILENT STRAIN

     When I was three years old, my family with my nine-year-old brother moved to Texas.  Different from South Dakota, Texas has a bunch of scary insects like tarantulas, centipedes, and scorpions.  The bites from these insects can be extremely painful and just to see them is scary enough.  My brother, being the prankster that he was, loved to terrorize his little brother (me) and periodically he threatened to put a tarantula in my chest of drawers.  I figured out how to take care of that by taking several pairs of underwear out of the drawer very carefully and hiding them under my mattress so I never had to open that drawer again.  Pretty soon, my brother is telling mom that I never chang my underwear and to prove it, he started putting a rock in my chest of drawers everyday.  I am sure sometimes he put in 2 or 3 rocks.  Since I never opened the drawer to find them, they accumulated pretty fast.  One day Mom opened the drawer and found all of these rocks wanting to know what I was doing saving rocks in my underwear drawer.  You can imagine the explanations that had to follow that incident.

     This silly little story provides a good example of how things happen slowly and then are found suddenly.  It provides an example of medical illness in people.  Outlined below are results of two recent studies demonstrating this principle.

 Several weeks ago, I wrote an article about “the metabolic syndrome”.  This is a group of findings that tend to occur in people that have insulin resistance.  These patients develop high cholesterols, high blood pressure, overweight and have an increased incidence of heart attack and stroke at a young age.  The basic problem of the metabolic syndrome is that the blood vessels throughout the body become corroded and don’t carry blood to the body’s organs in a normal manner.  Blood starved organs don’t work well and heart attacks and strokes result.  A recent article in the Journal of American Medical Association detailed a study in which a number of people with metabolic syndrome were followed over many years time.  They were matched to other individuals who did not have the metabolic syndrome.  The question raised was whether there was an increased incidence of Alzheimer’s disease (dementia) in patients with metabolic syndrome.  The emphatic answer was yes.  Having insulin resistance in the metabolic syndrome predisposes the person to the development of dementia that happens very slowly over a long period of time.  Then over a few years or less, the person can’t think adequately anymore.  They can’t remember and as the disease the progresses they can’t button their shirt.  Our nursing homes are now 90% populated by individuals whose basic problem is dementia.  The dementia doesn’t come from a virus or an adverse drug affect but rather comes from a long process of overweight, insulin resistance, high blood pressure, and high blood cholesterols.  When these abnormalities are addressed appropriately, the likelihood of stroke and heart attack has decreased but in my estimation even more important, a person lessens their chance of becoming demented.

     As a second example, an article in the Journal of the American Medical Association on November 03, 2004, published a 13-year study from Framingham, Massachusetts.  Framingham was a town selected by the National Institute of Health in the early 1950’s to represent cross section USA.  The government went to this town and asked residents to be part of a long term study to determine factors that seemed to affect disease and through the Framingham study over the past 50 years, we have learned the importance of high blood pressure, high blood cholesterols, diabetes and cigarette smoking as major factors in contributing to heart attacks.  A study begun in the late 1980’s addressed the effects of being overweight.  The basic effect of being overweight is giving the heart more flesh to supple with blood.  In addition to having more flesh to supply with blood, the overweight person has an increased resistance to get the blood to that extra flesh.  As a general rule, the overweight person is not in as good of a physical condition as normal weight individuals and the amount of pressure that their heart has to pump against is substantially increased.  As you might imagine, a heart pumping against a high blood pressure for a long time gets thicker and stronger to keep up with that high blood pressure.  The priming pump on top of the heart called the atrium has the job of pumping blood in to the big thick ventricle part of the heart that pumps blood to the whole body.  The body is built in such a way that the clock that runs the heart is located on the atrium.  When the atrium gets strained and begins to dilate, that clock short circuits and the person develops a condition called atrial fibrillation.  When that happens, the atria no longer have a rhythmic beat to prime the ventricles.  Instead, the atria just sit and quiver with no effective movement of blood.  This decreases the hearts output by about 20%.  While it may not sound like much, it is the difference between about 5 quarts a minute of blood to supply your body as opposed to having 4 quarts a minute or less.  This will have a very substantial impact on a person’s industry and ambition.  Weakness and fatigue are an expected result.  Patients come in to the clinic explaining that their heartbeat has gone way too fast and they feel terrible.  Somehow they think that something has happened suddenly, in fact, something happened very slowly over a long period of time and then the atrial fibrillation suddenly happened.

     These columns are directed to preventive medicine.  It is so much easier and favorable to prevent disease than it is to treat disease. The major causes of disability and death in the United States in 2004 is over 80% the result preventable disease processes that happen slowly and then one ugly day are found suddenly.  The healthcare professionals at your local clinics are well aware of this basic principle of medicine.  We work continuously to try screen for slowly developing disease processes and reverse these the best that we can.  With the Christmas season coming up and the massive amount of wonderful foods available, moderation remains a rule to keep in mind when going back for that third helping.