Issue link: https://www.epageflip.net/i/261964
BOULDER, Colo. — Dean Schultz and a friend had bicycled up to the amphitheater turnoff on Flagstaff Road one Saturday last May when Schultz felt his chest tighten oddly. At first, he ignored it. He was tired, had been tired for weeks, flying between Texas and Den- ver to care for an ailing relative. He told himself that, at 64, he was getting old. He blamed all the travel for messing up an exercise regimen that included cycling to work and riding up Flagstaff to the Walker Ranch over- look at least once a week. He wanted to press on. His friend, who knew that Schultz had a history of heart problems, talked him into turning around. "At first, I dismissed it, but then I thought it could be a twinge of angina," Schultz said. And that is how, four days later, Waldean Schultz, a fit and healthy man who had no reason to think that one of his coronary arteries was almost completely blocked by a calcium deposit, found himself undergoing a coronary angioplasty procedure. For the second time. "Don't think that you're protected from atherosclerosis beca use you exercise and eat right," said Boulder, Colo. cardiologist Jamie Doucet. Doucet administered that procedure on Schultz last year, installing a polymer stent in Schultz's left anterior descending artery, the artery so commonly blocked that cardiologists have nicknamed it "the widowmaker." "I can't tell you how many times I've walked into the ER and found someone having a heart attack, and when I ask about a family history of heart attacks, the guy tells me, 'Yeah, but I exer- cise,' " Doucet said. "Children of someone who died from a heart attack may live a different lifestyle than that parent, but it's not enough to overcome their genetic predisposition." Read his words again, especially if you're some- one who's disciplined about working out regu- larly — someone who takes the stairs instead of the elevator or ignores the paper cup of sour cream served alongside a baked potato. Even if you don't fit the profile of someone at risk for coronary dis- ease, a family history of heart disease can mean you're vulnerable. Remember Jim Fixx? The author of "The Com- plete Book of Run- ning," which helped pro- pel multitudes to lace up their jogging shoes, was the son of a man who died of a heart attack at age 43 — nine years younger than Fixx, who died while jog- ging in 1984. At the time, most peo- ple saw Fixx's death as ironic, not predictive. The autopsy found that all three of Fixx's coronary arteries were damaged by arteriosclerosis — arter- ies so thoroughly blocked that blood trickled instead of flowing. Like Schultz, Fixx was conscientious about exer- cising religiously and eat- ing conscientiously. Like Schultz, genetics trumped those best behaviors. But Schultz learned something from his first encounter with angina in 2007: Pay attention to the symptoms, and see a doc- tor. Back then, he'd felt a sudden tightness in his chest as he walked down his driveway to pick up the mail. Twice in the next few days, that strained sensation returned as he sat at his keyboard, and he arranged to see his physi- cian. Diagnosis: His left anterior descending artery was 80 percent blocked. Treatment: Install a stent. At the time, it was a stainless steel tube with slots, inserted with a balloon catheter that opens the steel mesh stent against the inner wall of the coro- nary artery. Doucet com- pares stents to Chinese finger puzzle traps. After the stent was installed, Schultz figured he was good to go. He monitored his diet. He exercised, faithfully wearing a heart rate mon- itor to make sure that he didn't exceed 140 beats per minute. (Doucet had warned him that pushing his heart rate higher than that could put additional stress on his heart.) So Schultz was sur- prised to learn, on that day last May, the same artery was blocked again — 90 percent this time — with scar tissue. The blockage was revealed in a coronary calcium scan, a procedure designed to look for the calcium deposits that caused Schultz's first angina episode. It also can locate the scar tissue that is often a problem with bare-metal stents, the type used in Schultz's first angioplasty. "With the bare-metal stent technology, 20 per- cent of the patients had to be fixed again, sometimes in six months, and if you were diabetic, that num- ber was closer to 40 per- cent," Doucet said. Last May in the proce- dure on Schultz, Doucet used a polymer drug-elut- ing stent, which is coated with medicine slowly and continuously released into the artery to discour- age scar tissue formation. "I didn't know that stents could have scar tis- sue build up around them," said Judy Schultz, Dean's wife. "We thought that he'd been taken care of." Schultz said the new stent made a dramatic change almost as soon as it was inserted. His chronic exhaustion disap- peared. When his wife arrived at the hospital to take him home, she was amused to find Schultz "flirting with the nurses." Schultz is back to his Saturday rides up Flagstaff, and to riding his bicycle to and from work. "He's a new person," said Judy. 4A Daily News – Tuesday, February 18, 2014 RANDAL S. ELLOWAY DDS IMPLANT DENTISTRY 2426 SO. MAIN ST., RED BLUFF 530-527-6777 Ask yourself the following questions: Are you missing one or more of your natural teeth? Do you have a complete or partial denture that is no longer completely comfortable? Have you ever been embarrassed by a denture or a bridge? If you answered "yes" to one or more of these questions, call us today at (530) 527-6777 to schedule an evaluation appointment. We would be pleased to evaluate your oral health and discuss treatment options with you. 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Research in the BMJ last week showed that breast cancerscreening was nearly as unreliable as screening for prostate can- cer, and should probably not be offered routinely to women over 50. The paper covered a 25- year study in Canada, in which 89,835 women between the ages of 40 and 59 were randomly assigned to have five annu- al screening mammograms or taught to self-examine for breast cancer. A total of 3,250 women in the mam- mography group and 3,133 in the self-examination arm developed breast can- cer, and 500 in the screen- ing group died compared with 505 in the latter group. So there was no real difference. The researchers showed that mammogra- phy overdiagnosed by 22% by finding tumours that over this 25-year peri- od did not develop into cancers causing symptoms or death. A previous study from Malmo put overdiag- nosis of clinically insignif- icant breast cancers at 10%. In the UK, women are invited for mammo- grams every three years if they are between 50 and 70 years of age. There has been growing controversy as to how use- ful screening is for some time. A recent report from the Swiss Medical Board said that regular screening saved one or two women out of 1,000, but found inaccurate results in 100 out of 1,000 women, causing psychological stress and unnecessary treatment. It recommended that no new breast-screen- ing programmes be set up and that existing ones were given a time limit. So is this enough to put you off, or do you think the benefit of finding an earlier cancer (which is usually thought to offer a better chance of normal life expectancy) merits a mam- mogram? The solution To have a mammogram or not is a personal deci- sion, and it is now reason- able to question whether you should. Experts have argued over this latest study, with a Harvard radi- ologist questioning the quality of equipment in the study and whether women who were suspected of having breast cancer were allocated to the mammo- gram group. Both would have skewed results, he says. In an editorial accom- panying the research paper, Mette Kalager from the University of Oslo argues that deaths from breast cancer are falling due to better treatments such as Tamoxifen, rather than because of earlier diagnosis by screening. A review in the journal Can- cers is worth reading because it runs through key research studies and their critiques. So it is fine to be unsure as to what to do: research is showing that it should be a decision, and not just a given. Dr Luisa Dillner is head of research and development at BMJ. Latest on the drug meant to improve female sex drive A drug that aims to improve female sex drive needs more trials before the Food and Drug Administration will consid- er approving it. Sprout Pharmaceuticals said Tuesday that the FDA wants more data on the company's drug, flibanserin, which promises boost sexual desire in women. It was previously rejected by the FDA In 2010, the FDA rejected an approval application for flibanserin after a panel of advisers unanimously voted against it, the Associated Press reports. That rejection was based on its side effects and lackluster evidence of effectiveness. What's next The FDA told Sprout Pharmaceuticals that the company needs to complete three more human studies on the drug, Bloomberg reports. It recommends Sprout study how flibanserin interacts with other medications and if it impairs driving from sleepiness. The company said it expects to resubmit its application for approval later this year, after the trials are complete. Side effects About 10 percent of women taking the drug have reported sleepiness as a side effect, TIME reports. The 2010 rejection also cited fatigue, dizziness and nausea as other side effects. Who could be treated by the drug If approved, pre- menopausal women with hypoactive sexual desire disorder, or a lack of sexual appetite, could be eligible for flibanserin. Before prescribing the drug, doctors would have to rule out other causes for a decreased sex drive, such relationship problems and hormone disorders. American Heart Month: Heeding angina symptoms saved man's life