What You Need to Know About Heart Disease

Central Park Lake 1

A young man at the pool asked me, “Why does blood get thicker with age?”

After telling him this wasn’t true, I asked where he got the idea.

“All the older men in the steam room are on blood thinners.”

Those men had an irregular heart rhythm called atrial fibrillation. Their doctors had prescribed anticoagulant medication to prevent blood clots in the heart from going to the brain and causing strokes.

This was an example of the common confusion about heart disease . . . and the general quality of health education in the community.

Every other organ of your body depends on the heart. It is both a muscular and electrical organ. The heart pumps blood to the lungs, and then it pumps oxygenated blood to all the tissues of the body.

The heart has its own built in pacemaker and its muscle tissue conducts the electrical signal to coordinate the contraction of the four chambers of the heart

Are you at risk for heart disease? Yes, we all are.

Two of the biggest risk factors for heart disease are beyond our control: age and genetics. The good news is that other risk factors are modifiable; these include high blood pressure, diabetes, high cholesterol, smoking and physical inactivity.

And even though having a sibling or parent with heart disease increases your personal risk, the knowledge of your family history can help you and your physician proactively reduce your risk, identify problems early and better manage any chronic condition.

There are four major types of heart disease: (1) coronary artery disease, (2) valvular heart disease, (3) arrhythmia and (4) heart failure.

The coronary arteries are the blood vessels that deliver oxygen-rich blood to the heart muscle. When one of these arteries are completely blocked, the area of the heart downstream is starved of blood – and dies. The result: a heart attack.

When a coronary artery is partially blocked, the area of heart muscle downstream receives less blood than it needs. The result is ischemia (decreased blood flow) and angina (chest pain). The symptoms include chest pain, fatigue and shortness of breath with activity.

Arrythmias are abnormalities in the rhythm of the heart beat or contractions. With tachycardia, the heart beats too fast; with bradycardia, it beats too slow. We can have premature or early beats and pauses or delayed beats. The symptoms of arrhythmias include chest pain, shortness of breath, palpitations or fainting spells. However, many patients have no symptoms at all.

Heart failure is a decline in the pumping ability of the heart. The symptoms include fatigue, shortness of breath on exertion and when lying flat, waking up at night short of breath, weight gain with fluid retention, and edema or swelling of the feet and legs.

The heart has four valves that allow the one-way flow of blood between the atria and ventricles (chambers of the heart) and through the aortic and pulmonary arteries. Valves can be narrowed (called stenosis) or leaky (called regurgitation).

To learn more about “What You Should Know About Heart Disease”, come to my next free public lecture on behalf of the Burnaby Division of Family Practice’s Empowering Patients series. You’ll learn if you are at increased risk, practical tips to reduce your risks and how to maintain your best health in spite of heart disease.

I’ll be speaking on Wednesday, March 1st at 7 p.m. at the Bonsor Community Centre at 6550 Bonsor Avenue in South Burnaby. Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

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Your Happiness and the Value of Goals

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The stage of the musical, Frozen at Disney’s California Adventure in Anaheim, California.

It’s the time of the year when I’ll be expecting patients coming in with new goals to improve their health. Many will be keen on starting a new exercise routine, eating a healthier diet, reducing alcohol or quitting smoking.

But for the rest of us, it will be business as usual. Most of the patients I care for will present one or more problems to be diagnosed, investigated or treated. These could be physical symptoms, relationship difficulties or challenges in their life circumstances.

Our brains are attuned to identifying problems. We see more of what’s wrong than what’s right. This negativity bias is part of our evolution. Our ancestors survived because they were able to detect problems and dangers early.

For most people today, our negativity bias is not such an advantage. In fact, it can lead to dissatisfaction and conflict in our relationships. Who wants to live with someone who can’t get anything right, and who can live with one who always finds fault?

Whereas appreciation and gratitude bring greater satisfaction and happiness, seeing the cup half full brings misery.

All of us want to be happy, but most of us look for it in the wrong places.

If your happiness depends on getting everything you want you may never find it or you won’t be able to keep it. The trick is to be happy with what you have and engaging with the world to achieve your positive potential.

In part, it is a way of being and seeing – being present and seeing with appreciation even that which does not last.

Consider the quick passage of the past year; life and all that we experience are fast and fleeting. Opportunities arise and pass away, and so do people, including our selves and those we love.

I love the work I do, helping my patients solve their problems, but my patients and I are most engaged when we turn those problems into goals. Problems can make us feel like helpless victims of life. When we transform them into our personal goals, instead of running from or struggling against what we don’t want, we move towards what we envision.

When a patient is struggling with anxiety, I may ask, “What is your goal? What does happiness look like to you?” “Is it seeing yourself managing and mastering the challenges of each day?” “Is it experiencing a sense of abiding peace and calm?”

When one is depressed, the goal may be to see one’s self and life with acceptance and gratitude, and to be engaged in meaningful activity.

Consider your values and your greatest virtues, and set your goals. Visualize with all your senses what success and happiness look like. Create a plan of action to get from here to there, and take at least one firm step each day in the direction of happiness.

As part of the Burnaby Division of Family Practice’s Empowering Patients I’ll be presenting a free talk on “Emotional Wellbeing” at 7 pm on Wednesday, January 11th, 2017 at the Confederation Community Centre in North Burnaby. Everyone of any age is welcome to attend. Please preregister by calling Leona Cullen at (604) 807-2372 or e-mail lcullen@divisionsbc.ca.

 

 

Posted in Emotions, Empowering Healthcare, Growth, Happiness, Healthy Living, Positive Change, Positive Potential, Purpose, Self-care, Your Calling, Your Goals | Leave a comment

How Do You See the Stress in Your Life?

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Stress is part of every human life, but it’s not necessarily bad.

Positive stress motivates us to change, get things done, learn and grow.

Without the gentle wake up calls from Mom and Dad, my kids may not have made it to school on time. Without their homework and exams, they wouldn’t be motivated to study. Without ambition, we wouldn’t push our limits and achieve our personal potentials. Without discomfort with the status quo, we wouldn’t be motivated to change the world.

Yet stress unrecognized or not managed is negative. It can take its toll on our bodies and our minds.

Consider how you experience stress. It can take the form of physical symptoms, such as a racing heart, palpitations, heartburn, diarrhea, constipation or insomnia. It can affect your thinking, making you more irritable, negative, distracted or forgetful. It can impact the quality of your work and your relationships.

The amount of stress in your life can tip the balance from positive to negative. For example, if a course or a job is too easy for you, you’ll be bored. If the demands of your job match your ability to meet them, you’ll be in a happy state of flow. But when the demands exceed your time or ability, you’ll feel stressed. I see this often in my patients whose workloads increase as companies downsize.

How we think about stress can influence how we experience it. The key is the locus of control. If we feel that we have no control over our situation, we begin to feel helpless, and helplessness begets anxiety. If we feel our situation will never improve, we may feel hopeless, and hopelessness begets depression.

Both anxiety and depression shade thinking and narrow perspective. When anxious, we overestimate our challenges and underestimate our ability to manage them. When depressed, we see the worst in our selves, the situation and the future.

We may fail to see the way out.

So how does this apply to you and the stress in your life today? How can you get out of the negative spiral from stress to anxiety and depression?

Start with your perspective. Take a step back and assess your situation. Consider the locus of control. What aspects of your situation are within your control? Accept what you cannot change, but accept your responsibility to change what you can.

In every situation, we have three potential choices: leave it, change it or reframe it. It may not always be possible or easy to leave a job or a relationship. Even if we cannot change a situation, we can change our perspective on it.

Part of our emotional reaction to a situation is due to the facts of the situation, but a large part of our reaction is due to what we bring into it. That baggage includes our memories of the past and our preconceptions.

In almost every situation, we can be agents of positive change. In big or small ways, we effect positive change in our world and in our selves.

 

Posted in Balance, Emotions, Healthy Living, Self-care, stress management | Leave a comment

5 Myths About Blood Pressure

Aneroid BP

On Thursday, December 8th at 7 pm, I’m presenting “What You Need to Know About High Blood Pressure” at the McGill Library 4595 Albert Street in North Burnaby. This free presentation is sponsored by the Burnaby Division of Family Practice and the Burnaby Public Library. Because seating is limited, please register by phone at 604-299-8955, in person or online at http://www.bpl.bc.ca/events/mcgill

Do you know your numbers?

You know by heart your birthdate and age, home and cell numbers, your address and maybe even your social insurance number.

But there’s one number that every adult should know: your blood pressure.

To understand why this measurement is so important, let’s explore five myths about blood pressure.

Myth #1: “It’s just a number.”

It’s more than a number. It’s one of your vital signs (e.g. heart rate and temperature, not your astrological sign).

Blood pressure is the measurement of the pressure of blood inside your blood vessels, specifically, the brachial artery of the upper arm. A normal blood pressure of 120/80 (“120 over 80”) represents a systolic pressure of 120 mm Hg (when the heart contracts) and a diastolic pressure of 80 (when the heart relaxes).

Of course, we need a normal amount of pressure to deliver blood to all your vital organs, but chronically high blood pressure (hypertension) damages those organs and arteries themselves.

Myth #2: “I don’t need to worry about it.”

High blood pressure damages the walls of arteries throughout the body, including the kidneys, brain, heart, eyes and extremities. Over time, it contributes to atherosclerosis (narrowing of arteries), manifested as progressive kidney failure, loss of circulation to your feet and legs, dementia, loss of vision, erectile dysfunction, heart failure (weakness in the pumping of the heart) and angina (chest pain due to impaired circulation to the heart muscle).

The catastrophic end results are premature heart attacks, strokes, blindness, kidney failure requiring dialysis, amputations of toes and feet, aneurysms (the expansion and rupture of blood vessels in the chest, abdomen or brain) and end stage heart failure.

Myth #3: “If I feel good, it can’t be bad.”

A lot of us might assume that if we feel good, we must be healthy and our blood pressure couldn’t be a problem. There’s a common misconception that individuals with high blood pressure are stressed out or angry like Donald Duck. Mickey Mouse is just as likely to be hypertensive.

High blood pressure may be caused by medical conditions such as kidney disease or an overactive thyroid, by medications including ibuprofen or an unhealthy lifestyle; however, 95% of people with high blood pressure have essential hypertension that is often genetic. Blood pressure also increases with age.

In fact, one in five adults has high blood pressure, and your lifetime risk for developing hypertension is 90%. Your risk may be even higher if you have a family history of high blood pressure, heart disease, kidney failure or strokes.

Myth #4: “It’s only high at the doctor’s office.”

White coat syndrome is a genuine condition wherein the patient’s blood pressure is much higher when taken by a doctor or nurse than at home. I ask my patients to measure and record their home blood pressures with a reliable machine (that we compare to our office equipment).

If blood pressure is only elevated at the clinic but never at home or work, we don’t prescribe medications. However, some people have a significant rise in their blood pressure with any stressful situation, including their work. If the blood pressure is high at least 8 hours/day (i.e. at work) in addition to the medical clinic, it should be treated.

Myth #5: “If I start a medication, I’m stuck on it for life.”

As a physician, I want my patients to maintain safe blood pressure levels and avoid the long-term complications. Medications have a potent effect in lowering blood pressure but they are not addictive and don’t make the body dependent any more than before they are started.

I have many patients who have been able to reduce the doses and numbers of medications they take through major lifestyle changes. Some now have normal blood pressures without any drugs.

These potent lifestyle changes include quitting smoking, limiting or stopping alcohol, increased physical activity, weight loss (if overweight), eating more fruits and vegetables and less red meat, and limiting sodium (salt) in the diet.

So get to know your numbers – especially your blood pressure. Most adults should check their blood pressure at least once a year and more frequently if they have a personal or family history of high blood pressure.

Dr. Davidicus Wong is a family physician. To learn more about upcoming health education events, see the BDFP website at divisionsbc.ca/burnaby. For more on achieving your positive potential in health: davidicuswong.wordpress.com.

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The Daily Management of Stress

Ducks at Ellison Provincial Park (Davidicus Wong)

In my last column, we saw stress as an essential part of our lives.

It can be positive when it moves us to change and grow, but it affect our minds and bodies in negative ways when we are overwhelmed. This happens when there’s just too much of it: more than we can handle given the time, abilities and support that we have at hand.

But sometimes, it is our perspective that needs to change. It’s been said that 20% of our emotional reaction is due to the reality of a situation; 80% is what we bring into it – our assumptions, attitudes and memories.

Most of us don’t think much about stress until we are right in the middle of it. Suddenly, we’re overwhelmed. What can you do each day to maintain a healthy balance and manage stress more positively?

Be a good parent to yourself.

The best advice I can give my patients is essentially the advice my good parents gave to me.

  1. Be good: live in accord with your values.

My parents both taught and modeled ethical behaviour. Doing the right thing keeps your conscience clear and helps you sleep at night. Telling the truth is easier than remembering all the lies you could tell. Being kind just makes you feel good.

Doing work we are passionate about with people we care about makes each moment more meaningful.

  1. Think before you speak or act: reflect. If you are operating on automatic, you may end up far from your original destination. If you respond only to your emotions, you’ll be reactive in what you say and do.

Throughout your day, pause and reflect upon your words and actions. “Am I being mindful of my words? Am I doing good work? Am I helping or harming?”

  1. Choose good friends, and talk to them. We all need the support of friends we trust and who love us without question. They listen when we need to vent, and they care about us enough to set us straight when we’re on the wrong path.

The value of such a support group is even more important when we grow up and cope with the many roles and stages of our lives, including parenthood, relationship crises, midlife and retirement.

  1. But remember family comes first. I didn’t get it when my mom told me this during my teens. “Friends and girlfriends come and go, but family is always here for you.” She was right again.

Too often we neglect our partners and children because of work and other misplaced priorities. If we wait too long, we mistake family relationships to be the source of our stress.

The time you invest in your most important relationships is never wasted.

  1. Go out and play. We all need regular (aim for daily) exercise. It can keep you fit, burn off steam and help you manage the rest of the day.
  2. Don’t skip meals. Schedule regular healthy meals to keep your energy up and your body healthy. What you save in time by skipping a meal, you lose in fatigue and poor health.
  3. Take a break. Our brains and bodies were not designed to work without a break for more than a few hours at a time. We all need regular breaks to maintain our attention and energy.
  4. Go to bed. Get enough sleep each night.
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Say What Needs to be Said: The Positive Potential of Your Relationships

On Thursday, November 24th at 7 pm, I’ll be speaking on the topic of healthy relationships at the Tommy Douglas Library 7311 Kingsway (at Walker Avenue). This free presentation is sponsored by the Burnaby Division of Family Practice and the Burnaby Public Library. Because seating is limited, please register by phone at 604-522-3971, in person or online at http://www.bpl.bc.ca/events.

blank sand beach

As family doctors, we carry a heavy responsibility and profound privilege to serve each patient at every point in this precious human life. We share in our patients’ dreams and aspirations, support wellbeing, treat illness, and provide comfort at the end of life.

I continue to enjoy the soul-renewing service of delivering a newborn baby into the arms of a mother. I see every baby as a bundle of potential.

As a physician, I share in that child’s parents’ and our society’s responsibility in the realization of that child’s uniquely positive potential.

But at the end of our lives, the greatest tragedy is not that we have failed to reach our potentials but rather we die not knowing how much we were loved.

How many times are we moved to act with kindness and generosity – giving up our place in line, offering a kind word and donating to others in need – but hold back and let the moment pass? How many times do we let the sun set without saying what needs to be said? We seem to be given countless days as we go about the busyness of living, distracted by the news of the day and preoccupied with the world of material things. Yet when we lose the special people we have taken for granted, we realize we were short one precious day when we could have expressed how much we cared.

How do we get off track?

The biggest illusion in life is our case of mistaken identity. We get so caught up in our personal autobiographies that we mistake ourselves as separate and alone. We begin seeing every one else as for us or against us. We value those who serve us but not when they seem to work against us.

This may be the biggest problem in the world today: the illusion of our separateness, and the perception of a world of “others.” The “others” are no longer three-dimensional individuals who share with us the same emotions and needs with their personal dreams and stories. They become our enemies or our scapegoats. They literally become objects of our hate and fear. They represent the darkness that lies within our own hearts.

The antidote for our disconnection is remembrance of our connection – all that we share. Begin with family and friends. When we argue and disagree, we may begin to separate; but the alternative is to see different opinions and different goals as different points of view – an opportunity to deepen our understanding.

In everyday life, we take cognitive shortcuts based on caricatures (2-d stick people versions) of even those we know best, and we interpret what they say and do with assumptions we don’t check out. This leads to greater misunderstandings and separations.

For example, if your friend doesn’t call you back, you might assume she’s avoiding you and not that she didn’t get your text or lost her phone. If your brother brings up an embarrassing event from your past, you could take it as a personal attack rather than affectionate ribbing.

We are worse still with people we don’t even know but perceive as different based on outward appearances: clothing, accents, skin colour and position. We may even be guilty of the ridiculous assumption that the “other” is less important and of less value than ourselves.

We need new rules of engagement. The goals of conversation are not to get our point across and get what we want but rather for personal connection, mutual understanding and cooperation.

As a separated human being in your individual life, you will never be able to achieve and hold onto all that you seek. Together we are better.

Our place in this world becomes clear when we remember our very real connection with all of humanity. As infants we are connected to our mothers through the umbilical cord; we are dependent on our families as we mature and grow; we create a network of connections with our friends, in school and at work; we become participants of the greater society; we discover our uniquely positive potentials – our gifts to the world, and we help others and the rest of the world achieve theirs.

But in each day there lies a profound potential – the potential to nurture each of our relationships in many ways big and small. We can express our potential for love in countless forms – by forgiving and apologizing; by giving without expectation; by expressing gratitude. We can say we care with words, with actions, with a smile, a hug and a gentle touch.

Each day is a gift with which we can make a positive difference in the lives that we can touch, and let them know that they make a difference to us. At the end of life and at the end of the day, that may be all that really matters.

 

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Our Stories and How They Affect Our Relationships

 

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Cousins hiking in Banff – Davidicus Wong

Self-care is essential to healthcare. How you live each day impacts your future health.

The four foundations of self-care are emotional wellbeing, healthy eating, healthy physical activity and healthy relationships. Each day in my practice, I see patients whose problems are directly or indirectly related to difficult relationships. On the other hand, a supportive family, mutually positive relationships and a network of good friends support both physical and emotional wellbeing.

Difficult relationships at work, conflicts at home and problems in school can be major sources of stress or the causes of depression or anxiety.

It makes sense to take stock of your relationships, do what you can to get away from or get help with abusive situations and do what you can to improve relations with the people in your life. Though we recognize that our relationships produce the drama in our lives, it’s hard for most of us to know what we can do to make them better.

It can start with reflection on the art of storytelling.

We all love a good story.

That’s one of the keys of a compelling TED talk. We can get wrapped up in a good novel and miss our bus stop or be so caught up with the Game of Thrones that we don’t realize that we’re consuming a whole bag of potato chips.

It is with stories that we make sense of our lives. It begins with the stories our parents tell us, the stories taught in school and the stories told through media. We sometimes mistake our stories for reality.

Like my mom, I loved reading, and every week, we would each reach our borrowing limits of library books – twenty in those days. Books opened my mind to many views, seeing through others’ eyes.

I was drawn to family practice because of my patients’ stories – the ups and downs of daily life, their challenges and triumphs and their joys and sorrows. My profession opened my heart to the experiences and feelings of others.

When we seek to understand the backstory of others, we open the door on compassion. Each of us, even siblings in the same family, may have uniquely different stories of childhood. Those early life experiences shaped our sense of self – who we are, how we fit in the world, how we felt loved or how we did not.

If our sense of self is rigid and doesn’t allow for growth and change, we can get stuck in the same old story as our lives change anyway. If we see ourselves as unchanging personalities with well-worn habits and permanent character flaws, the future will be a self-fulfilling prophecy.

If in your life story, you are the sole protagonist and everyone else is an antagonist in a world of danger and scarcity, life will remain a struggle and a futile fight to win. You may even compete with your loved ones and friends and fail to fully connect.

What is the premise of your life story?

Did you come into this world alone, expecting to leave the same way?

Or are you connected to every person in your life and through your life the entire world – accepting, sharing and giving forward love in its many forms – discovering and giving back to the world your unique gifts.

Every human being has the same basic needs – for warmth, clothing, food, shelter and love, and we share the same range of emotions. But each of us tells a unique story. We relate best when we understand each others’ stories.

Be mindful in your communications. We may talk to be understood, but we must listen first to understand.

And we understand better with a phone call than by text. Face to face is better than phone.

Words are best interpreted in the context of body language and facial expressions. These nonverbal cues deepen the meaning of words. We can see how others feel and how our words may affect them.

On Thursday, November 24th, 2016 at 7 pm, I’ll be speaking on the topic of healthy relationships at the Tommy Douglas Library 7311 Kingsway (at Walker Avenue). This free presentation is sponsored by the Burnaby Division of Family Practice and the Burnaby Public Library. Because seating is limited, please register by phone at 604-522-3971, in person or online at http://www.bpl.bc.ca/events

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