Great Smokies Medical Center of Asheville

Archive for the ‘1104’ Category

Welcome to GSMC!

Sunday, September 11th, 2005

Charlotte Pierce, RN, and Christine Mise, CMA, both joined our staff on September 19, and each came complete with several years of venipuncture experience.

Charlotte hails from the Seattle area where she was a nurse manager in post surgical recovery. She enjoys spending time with her family in North Carolina, going to the symphony, hiking, and crafting unique, whimsical walking sticks.

Christine hails from Baltimore, and has lived in North Carolina for six years. She enjoys music and spends her time doing many different activities with her three children, aged 6, 8 and 9 (Wow!) years.

Health Risks of Obesity

Sunday, September 11th, 2005

If you need a dose of reality about the health risks associated with diabetes, check out this formidable list: Type 2 diabetes, gallbladder disease, high blood pressure, high cholesterol and lipids, sleep apnea, coronary artery disease, osteoarthritis of the knee, fatty liver disease, gastroesophageal reflux disease (GERD), gout, low back pain, impotence, and some cancers, notably breast, uterine, and colon. The risk for these health problems to occur with obesity are strongest before age 55, and after age 74, there is no longer an association between obesity and the aforementioned diseases.

Dying for a Good Night’s Sleep?

Sunday, September 11th, 2005

Each night across America, an estimated 15 million people are, in effect, being asphyxiated in their own homes.

Obstructive sleep apnea (OSA) is a much more serious health problem than just the annoyance of snoring. When lying down to sleep at night, the airway can actually collapse or can become physically obstructed, resulting in a life and death struggle for oxygen. People afflicted with OSA may be unaware of their own apnea, but others in their households are not, as they may also become sleep deprived from long nights of their loved ones’ gasping respirations and physical restlessness.

Sleep apnea is defined as 10 or more episodes per hour of cessation of breathing in excess of four seconds. They must be accompanied by a four percent or greater decrease of oxygen levels in the blood and be followed by frequent awakenings in an attempt to breathe.

The body interprets the decreasing oxygen levels as an emergency and releases the stress hormone adrenalin to counter this perceived life-or-death situation. An excess of adrenalin contributes to high blood pressure, which is known to afflict about 50 percent of OSA sufferers. Failure of blood pressure to lower during sleep is a sign that high blood pressure may be caused by OSA.

Middle-aged men are more commonly afflicted than women of the same age, as are obese or overweight individuals. A neck circumference greater than 17 1/2 inches in men and 16 1/2 inches in women suggests risk for OSA.

Sleep apnea is associated with many health problems and can even be fatal, most likely from heart arrhythmias or motor vehicle accidents from driving while tired. Symptoms associated with sleep apnea include headaches on waking and dry mouth. The lack of deep, restorative sleep results in irritability, hallucinations, and inability to think clearly, which can lead to stressed relationships and poor job performance. Blood vessels in particular suffer under sub-optimal blood oxygen levels, contributing to angina, coronary artery disease, stroke and impotence. OSA can be aggravated by sleep deprivation, the use of alcohol, tobacco, and some drugs, and allergies that cause swelling of tissues in the nose and throat.

Sleep apnea is diagnosed by monitoring breathing cessation (apneic) events and lowered levels of blood oxygen (hypopneic) events in a sleep lab. For many, being wired, observed, and sleeping in an unfamiliar bed does not mimic a routine night of sleep. Years of research has revealed that the tone of small arteries (peripheral arterial tone) in the fingers directly correlates with apneic and hypopneic events.

An FDA-approved computerized device is available at GSMC for at-home monitoring to diagnose OSA. Simply wearing a specialized glove that holds a tiny computer and two devices that are worn on the fingers allows monitoring of heart rate, respiration rate, and oxygen saturation.

Once diagnosed, sleep apnea is routinely treated by Continuous Positive Airway Pressure (CPAP), which delivers room air under pressure by a facial or nasal mask. CPAP can effectively address the lowered oxygen levels. However, more than 40 percent of people with OSA cannot tolerate CPAP and others will not use it due to the aggravation.

Since the symptoms of OSA are more severe when people sleep on their backs, simply strapping a tennis ball to the back can inexpensively and effectively train people to sleep on their sides, resulting in great improvement of milder cases of OSA. Other treatments for OSA include weight reduction, desensitization to allergies, and specialized mouth splints that open the airway by pulling the lower jaw forward. In severe cases that do not respond to medical intervention, surgery may be necessary to reduce the volume of tissue in the throat.

The Secret Life of Fat

Sunday, September 11th, 2005

Who would have imagined that a seemingly passive slab of belly fat could turn on its accommodating host by deploying sophisticated biochemical weapons that undermine health?

Though this “Attack of the Killer Fat” sounds like the title of a low budget movie, understanding the concept may go a long way toward removing the stigma of a presumed deficit in motivation or character so often directed at obese individuals by leaner, although under-informed, people.

The vital role of fat in assuring survival of the species results in the body’s no-holds-barred tactics that are a formidable opponent for any strategy (e.g., a very low calorie diet) which opposes it, resulting in the body’s survival switch, in effect, becoming stuck in the “on” position, perpetuating a vicious cycle designed to maintain fat stores at all costs.

Researchers have found that adipocytes (fat cells) are part of a living, sophisticated organ (fat) that secretes powerful hormone-like chemicals which determine how we feel and function. Fat has important work to do . . . and it never sleeps.

Chemical signals are broadcast from their fatty bunker and enter the general circulation where they influence immune function, mood, energy production, appetite, reproduction and, in particular, inflammatory responses that can result in pain and chronic illness.

These chemical signals are emitted by fat cells and macrophages. Macrophages are specialized white blood cells that reside in tissues where they perform their job of walling off and cleaning up debris from infection, injury, and toxicity. They surround and “eat” the offending threat, secrete potent chemicals to destroy it, and promote healing. In addition to these life-sustaining, beneficial tasks, macrophages are also involved in harmful inflammatory processes when their response to injury or infection becomes out of proportion to the threat.

Macrophages are probably most notorious for their presence in plaque, that ticking time bomb in the walls of arteries. When the thin cap over plaque ruptures and the plaque spills into a coronary artery, macrophages in the plaque spew their inflammatory brew of chemicals into the blood stream causing a clot to form, resulting in a heart attack. (Heart disease is more accurately depicted by a model of inflammation than by the simplistic model of sludge accumulating in a pipe.-Ed.)

Inflammatory chemicals secreted by macrophages in fat may explain the well-known association of obesity with many diseases-hardening of the arteries, Type II diabetes, arthritis, high blood pressure, and most cancers.

Among the many chemicals secreted by fat cells and macrophages is the beneficial adiponectin, which enhances metabolism and burns fat. Adiponectin levels fall as obesity increases. Cytokines are another example of chemicals released by fat that increase the likelihood of clot formation, heart disease, insulin resistance, cancer, and other inflammatory states. Cytokine levels rise as obesity increases.

The study of obese mice by researchers at Columbia University determined that the fat of leaner mice contains only a few macrophages, while the fat of extremely obese mice is composed of a remarkable 40 to 50 percent macrophages. Researchers theorize that as obesity increases, overstuffed fat cells can burst, requiring even more macrophages to clean up the debris.

Pharmaceutical companies will likely be tripping over themselves to develop the first miracle drug on the block that targets and stops the inflammatory consequences associated with obesity. But, don’t rush to be first in line at the pharmacy counter for these new drugs.

Because inflammation is essential to a healthy immune response, any drug that interferes with it will most certainly have undesirable side effects.

Vioxx, the anti-inflammatory drug recently pulled off the market because of the increase of heart attacks and strokes in its users, not only intervened with the adverse effects of inflammation (resulting in pain relief), but also interfered with the critical immune-protective functions of macrophages (resulting in side effects).

The spare tire that hangs over the belts of 15 million obese Americans is a particularly obvious sign that predicts increased risk for inflammatory illnesses. However, even lean people can have visceral fat, the dangerous fat hidden in and around the abdominal organs that is associated with risk of heart disease and other inflammatory diseases.

What is the relevance of all this in the life of an obese person? While some obese people have no obvious health problems, many others have a variety of inflammatory disorders that occur as a direct result of being fat, leaving them stuck in a vicious cycle of obesity, poor health, and a quality of life that defies the expression “fat and happy.”

Can obese people with inflammatory disease regain their health? Since being fat results in inflammation, it is only fair that losing that same fat results in reduced inflammation.

However, it is no longer considered adequate to treat obesity with a simplistic “calories in, calories out” approach. Because we are each biochemically unique, no one diet will fit all. A focus including nutrient-dense foods (such as fish and colored vegetables) and excluding nutrient-deficient foods (such as sodas, processed foods, and sugar) forms the foundation of various successful diets.

Two simple blood tests that measure inflammation (hsCRP and fibrinogen) can help identify and monitor those at risk from obesity-driven inflammation. Researchers have found that these inflammatory markers decrease with reduction of body weight and waist girth attained by exercise and dietary changes.

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