Cardiac arrest survival triples after Denmark’s CPR push

CPR Saves lives. In the current issue of the Journal of the American medical Association, an article from Denmark documents the dramatic improvement in survival from out of hospital cardiac arrest. After instituting an extensive countrywide CPR program were among others children in elementary school were taught CPR, the survival rate went from 6% to 16% over a ten-year period. This dramatic demonstration underlines the reason why we have created this free program which is sustainable and being introduced to schools throughout New Mexico as well as businesses. If you want to put on a course we can help you do that.

Food Pyramid

What is the Food Pyramid?
By: Dr. Barry Ramo, M.D., FACC

Q: I find the dietary recommendations are becoming more and more confusing.  For years I was told eat more starches and less fat and now I understand that there may be a new food pyramid.  What are your current recommendations?

A: You are absolutely right the recommendations have become muddled.  I think the old food pyramid will be toppled in favor of a new one. In the early ‘90s the food pyramid was published by the United States Department of Agriculture.  This pyramid told us that starches were good and fats were bad.  These new guidelines stimulated the food industry to create a massive number of low fat products..  Suddenly snack foods appeared which were very high and carbohydrates but fat-free. Despite all this low fat fare, Americans got fatter, developed more diabetes and we sell the rate of heart disease and stroke fail to decline

What’s wrong with carbohydrates?  Not all carbohydrates are bad but simple sugars and refined starches seem to be. The high concentrations of simple sugars and refined grain products spike our blood sugar levels.  That in turn stimulates the production of insulin.  Refined grain foods into the bloodstream to sugar or glucose.  If the sugar isn’t immediately used to fuel activity the body produces a burst of insulin to Harriet out of our circulation and into fat and muscle sulfur storage of diet rich in refined carbohydrates and simple sugars leads to cells becoming increasingly resistant to insulin forcing the body to produce more.  Eventually, the pancreas which is the organ that produces insulin wears out and diabetes results.  Over the past 20 years we’ve seen an enormous increase in the incidence of adult onset diabetes.

Dr. Walter Willett a researcher at Harvard school of public health wrote a book called Eat Drink and Be Healthy which based on considerable research describes a new kind of food permit.  The basic premise it is that the base of the German has two important ingredients regular exercise.  And maintaining a normal body weight.  The new permit recognizes that there are good carbohydrates and bad carbohydrates as well as good and bad fats.

The good carbohydrates come primarily from whole-grain foods.  Refined grain foods such as cereals, pasta and bread and spike our BLOOD sugar levels.  This leads to insulin resistance and the extra BLOOD sugar turns into fat..  The best substitute our whole-grain foods.  There are many choices whole-grain wheat bread instead of standard white bread.  You have to check the label that indicates whole-grain is the first item listed.  There are some very good whole-grain pastas.  Brown rice is easy to make and substitute for white rice.  Additionally barley products are healthful.

The second finding is recognizing that there are some good kinds of fats.  These are monounsaturated fats such as canola oil or olive oil but peanut and other vegetable oils are also healthful.  These mono and polyunsaturated fats will actually reduce your bad cholesterol levels.

Similar to the old health permit there is an emphasis on fruits and vegetables be issued beaten in abundance.  Nuts and legumes are also healthful. You should also get daily calcium supplement which you can get from dairy products as well as taking a calcium supplement.

The diet emphasizes fish poultry and eggs as sources of protein.  What you should have sparingly are red meats pasta and potatoes.  Also included in this group would be white bread and refined starches.

The standard food permit clearly has not improved our health.  Recent studies suggest that people who followed this term and did not too any better than those who did not whereas Dr. Willett”s group found that those who followed the new peer amid type diet had a 40 percent lower risk for cardiovascular disease.

This diet is very similar to the Mediterranean diet which emphasizes fruits and vegetables and monounsaturated fats like olive oil.

Remember that at the base of all of this is regular exercise in making sure that the amount of energy that you take and is the same as that you utilize.

Finally you should not be confused into thinking that this new peer amid is the same as the Atkins diet.  It’s not the Atkins diet is not a healthy diet and it promotes a state of ketosis and contains high amounts of the bad kinds of saturated fat.  On the other hand there is a kernel of truth in the diet and it emphasizes reducing the amount of carbohydrate.

As cardiologist, I find myself talking about the same diet that I talked about 10 years ago which was one that was rich in fruits and vegetables and low in saturated fat.  What is changed is the de-emphasis on starches that are high and refined starches and simple sugars.

POTATO CHIPS

POTATO CHIPS – WHY THEY ARE SO BAD
By: Barry Ramo, M.D., FACC

Q: I have heard you talk about potato chips and you act like they give you cancer. Why are they so bad?

A: I like potato chips and they have all but one of the food groups. Salt, fat and simple carbohydrates that spike your blood sugar. The only thing missing is the fourth food group: alcohol. Just kidding.

It you have a pack-a-day habit, you will consume more than five quarts of cooking oil a year. Even worse, the fat is trans fat or saturated fat so not only are you getting fat but so are your arteries. Your average potato chip is about 50 percent fat and 45 percent carb and a 1.2-ounce pack has 2.5 teaspoons of oil. That’s around 160 empty calories. No sugar but the simple carbs in a potato chip spike your blood sugar and that can make you hungry a few hours later. I guess you could say potato chips are the gift that keeps on giving.

The reduced-fat chips have about 20 fewer calories than the regular chips. Low fat does not mean low calories. An ounce and a half is 135 calories. I don’t know about you, but when I have chips I don’t count and I also have a soft drink or a beer. If you are trying to lose weight get those empty calories out of your diet. And if you skip the cola, you can eliminate the 8 to 10 teaspoons of sugar that each 8-ounce can has.

Dr. Barry Ramo is a cardiologist with the New Mexico Heart Institute and medical editor for KOAT-TV. Send questions for him to Albuquerque Journal Boomer, P.O. Drawer J, Albuquerque, NM 87103, or e-mail them to htaylor@abqjournal.com

Ideal Calcium Source

Ideal calcium source is from food, then pill form; Adequate amounts of vitamin D are also needed.
Barry W. Ramo, M.D., FACC

Q: I’m 48 years old and in good health. My mother had osteoporosis and I worry about it. I hear conflicting reports on how much calcium I should be getting and how I should get it. Is it better to get it from food or supplements? Are there any particular supplements that you recommend?

A: I am assuming you want to prevent osteoporosis. After age 30 you begin to lose bone and if you don’t take in enough calcium and vitamin D you will have a net loss of calcium. For a premenopausal woman that number is around 1.0 gram a day and 1,500 milligrams after menopause. So if you aren’t taking in that much calcium daily, your bones are thinning even faster. But what many women and men forget is that you have to get sufficient vitamin D.
Ideally, you should get all your calcium from food. I would suggest low-fat milk and other dairy products, such as hard cheese, cottage cheese or yogurt, as well as green vegetables, such as spinach. You can estimate your daily intake of calcium by giving each serving a value of 300 milligrams. So eight ounces of milk, an ounce of cheese or two cups of broccoli are a serving size.

There are a number of sources of supplemental calcium but don’t take more than 500 milligrams at a time as you won’t absorb it. Calcium carbonate works fine and it’s cheap. But chewable preparations might be preferable.

For those of you who think natural preparations are great, think again, as bone meal and oyster shells may be contaminated with mercury.
Vitamin D is key. Calcium won’t do it by itself and unfortunately a lot of people are gobbling down calcium pills and not getting enough vitamin D or don’t actually absorb or make enough vitamin D. You make vitamin D in your skin and liver. So if you don’t go in the sun or if you wear a sunscreen you could be vitamin D deficient. Eight hundred units (IU) is the current daily recommendation.

Many physicians are measuring vitamin D levels in the blood because some women and men don’t absorb vitamin D properly even at higher doses than 800 IU.

As a cardiologist, I would be remiss in not telling you that adequate calcium intake is important in helping control your blood pressure and even your cholesterol. Finally, cigarette smoking decreases bone density and studies in twins found that the smoking twin had about 5 percent to 10 percent less dense bone than the non-smoking twin. So if you’re looking for yet another reason to quit, having strong bones is a strong one.

Dr. Barry Ramo is a cardiologist with the New Mexico Heart Institute and medical editor for KOAT-TV. Send questions for him to Albuquerque Journal Boomer, P.O. Drawer J, Albuquerque, NM 87103, or e-mail them to htaylor@abqjournal.com

Drinking Dr. Pepper

DRINKING DR PEPPER
Barry W. Ramo, M.D, FACC

Q: Does drinking diet drinks, especially Dr Pepper containing phenylalaline and phenylketonurics, affect the liver, kidneys and weight even when a person goes to the gym and works out three times a week?

A: You are correct that Dr Pepper contains phenylalanine, which is an amino acid normally converted by the body into tyrosine. Infants born with a deficiency in the enzyme that does that conversion have a disease called phenylketonuria. Assuming you have the normal amount of the enzyme, you shouldn’t have to worry about drinking Dr Pepper. If you have phenylketonuria, you shouldn’t drink it.

Dr. Barry Ramo is a cardiologist with the New Mexico Heart Institute and medical editor for KOAT-TV. Send questions for him to Albuquerque Journal Boomer, P.O. Drawer J, Albuquerque, NM 87103, or e-mail them to htaylor@abqjournal.com

Starting an Exercise Program by Dr. Ramo

Q: My doctor told me I have the metabolic syndrome and will develop diabetes if I am not careful. She told me I had to exercise, but I hate exercise. Do you have an alternative.

A: No, there is no alternative to exercise.  I make one prescription to virtually every patient I see. I want you to walk 30 minutes a day. That can be translated into any form of aerobic exercise. When you doctor tells you to not smoke or to exercise, studies have shown that message has a powerful impact and not surprisingly patients sometimes do  follow our advice. I try to figure out ways to motivate people, but on a personal level, I want them to know I will be disappointed if they don’t follow through.

Exercise is critical in managing the metabolic syndrome.  First most people with metabolic syndrome) Exercise increases your metabolic rate not only during exercise but the benefit lasts all day. The self affirming returns of exercise motivates you to stay on your diet. Aside from the benefits on cholesterol levels, blood pressure, and waist line, I am impressed that research in animals showing exercise improves cognitive function and may grow new brain cells is enough to keep me on the treadmill. So how do you begin?  One reason people don’t exercise is that they have not found a pleasurable form. So your first order of business is finding a form of aerobic exercise that you can stick with.  My suggestion go over to the gym and try out various type of equipment to see you find a workout machine you like. Some people like a treadmill, an elliptical trainer or a stationary bike. I find that some patients enjoy the group activity that comes with spinning.

Whether you’re riding  a bike, jogging or using an elliptical trainer, don’t push it so hard that  you conclude you would rather have a heart attack than jog. You want to exercise to the point that you can carry on a conversation but not sing. On a 20 scale, that’s about an 8 to 11.
Some folks want to measure their heart rate in order to determine if they are working hard enough. I find the sing test works just as well but if you are one who was toilet trained at age six months and obsessively want to measure yourself. I would buy a Pulsar watch system to monitor your rate assuming your machine doesn’t have one. Sports medicine folks tell you should be about  around 85% you maximum predicted heart rate (220-your age in years) times 85.  So if you’re 50 years old your maximum heart rate would be 170.  That means a heart rate of around 120.  But if you’re feeling that I wouldn’t worry about your heart rate.

You should try to exercise for at least 30 minutes a day and do  strengthening exercises twice a week.  As you consider a program, you need to ask what is realistic. If you have to ride 30 minutes to a gym, change clothes and then shower after a workout, is that going to be realistic. It may be far better to speed walk in your neighborhood because that is something you can do. I find that exercise during lunch has worked for me.  It cuts calories and also does not take away from work. To stay on track with exercise, you have to have incentives until you find that you enjoy it (that actually does happen). Treat yourself to something after a work out. For me it’s a shower (that’s a treat for everyone else also). Try a cup of coffee, a quiet period to read the paper and have a cool glass of water. Keep a log of your progress,  you will be rewarded when you look back at your accomplishments and of course weigh yourself four or five times a week.  Taking a picture of yourself once a month if your losing weight might keep you exercising.

Daily Multivitamin is all you need…

Daily multivitamin is all you need, doctors say; Nutrients should come from the food you eat

Barry W. Ramo, M.D., FACC

Sorry, guys, we hate to tell you but the experts say there’s no pill that will prevent a body part from going kaput. But it can’t hurt to take a multivitamin, says Dr. Barry Ramo, an Albuquerque cardiologist. Other than that, he and other health experts say, if men want to stay healthy they need to eat healthfully, exercise, keep socially active and not smoke. Taking supplements other than a once-a-day multivitamin doesn’t make sense, for the most part, says Ramo. “If you’re going to get your vitamins, then get them from your food,” he says. “I find that people who take vitamins, they don’t exercise and they’re overweight.” Michael Lichtenberger, owner of R. Downs Nutrition Center, which carries vitamins and a variety of supplements, says research he has read says everyone should take a one-aday multivitamin because of nutrient depletion from the soil in which veggies are grown. “So there are nutrient deficiencies based on our current diets,” Lichtenberger says. “One way of addressing that is with a multi.” Men’s health concerns include prevention of prostate cancer, cardiovascular disease and other cancers. Certain key nutrients for men are B6, B12 and folate, which Lichtenberger says can help prevent heart attacks. Men also should make sure their multivitamin has magnesium, which can help prevent cardiovascular disease. To help with prostate health, he recommends a vitamin with an herbal supplement called saw palmetto, especially for men age 50 and older. “That’s what I’d want to see: B6, B12, folate, magnesium and saw palmetto. Those would be core in a multi (vitamin).” Ismael Khalef, an herbalist at Pharmaca, recommends food-based, natural source multivitamins, which he says the body more easily absorbs. He also recommends that men look for a multivitamin that contains herbal extracts to help prevent prostate cancer. In addition to taking a multivitamin, Khalef says men should consider taking Omega-3 fish oils, which can help lower cholesterol and prevent heart attacks, Khalef says. Pharmaca carries a variety of supplements for heart and brain health, as well as for keeping the libido active. While supplements line the aisles of health food stores, Jeremy Gleeson, an endocrinologist for Lovelace Sandia Health System, says men who maintain a well-balanced diet don’t need to take a multivitamin. Though, he says, as people get older, a multivitamin could be helpful as gaps appear in their diets. And, he warns, men shouldn’t take iron supplements, which can lead to hemachromatosis, a condition that can damage the body’s organs. Ramo, who writes a column for the Journal’s monthly magazine Boomer, adds that people should remember to spend time outside so they don’t become deficient in vitamin D. Men should also remember to drink their milk – or take calcium supplements. “Men think they’re immune to osteoporosis,” Ramo says. “I tell people that they want to have a bone scan. They should get enough calcium and vitamin D.” He also recommends people have their vitamin D levels checked by a doctor.

Dr. Barry Ramo is a cardiologist with the New Mexico Heart Institute and medical editor for KOAT-TV. Send questions for him to Albuquerque Journal Boomer, P.O. Drawer J, Albuquerque, NM 87103, or e-mail them to htaylor@abqjournal.com

3 Easy Steps to Breaking Bad Habits

Think bad habits like nail biting and knuckle cracking are hard to break? Experts offer simple solutions.
WebMD Feature
Reviewed by Louise Chang, MD

We may be loath to admit it, but most of us have at least one bad habit. And while some bad habits — such as smoking — can pose serious health risks, others like nail biting, throat clearing, and knuckle cracking are really just plain irksome (for us and for the people that love us). Odds are you have been biting your nails or cracking your knuckles for a long time. So how can you be expected to break these bad habits now? Where there is a will, there is a way. No matter what your bad habit — whether nail biting, knuckle cracking, cuticle picking, chronic coughing, or throat clearing — WebMD’s cadre of experts have a simple three-step solution that can be customized to whatever habit needs breaking. “The more you do it, the more difficult it is to get rid if it, but every single bad habit can be broken,” says Patricia A. Farrell, PhD, a clinical psychologist in Englewood, N.J. and author of How to Be your Own Therapist.

Here’s how:
Step No.1: Make It Conscious
The first step is to figure out when — and why — you bite your nails, crack your knuckles, or engage in any other bad habit. “If you can notice when you are doing it and under what circumstances and what feelings are attached to it, you might be able to figure out why you are doing it and be able to stop,” says Susan Jaffe, MD, a psychiatrist in private practice in New York City.

Step No. 2: Put It in Writing So It Really Sinks In
“Log it,” says Janet L. Wolfe, PhD, a clinical psychologist in New York City and author of several books including What to Do When He Has a Headache. This will help you establish a baseline, she says. “Put down the antecedents, the emotions surrounding the knuckle cracking and what goes through your head when you crack your knuckles,” she says. “This will make your bad habit more conscious.” Wolfe suggests keeping the log for at least a week. The next step is to analyze the data and look at what your usual triggers are. “Do you do it when you are anxious or bored?” James Claiborn, PhD, a psychologist in South Portland, Maine, and the co-author of The Habit Change Workbook, agrees. “Write out a list of the pros and cons of this behavior and keep a record of when you do it,” he tells WebMD. “Measurement of anything tends to change it and makes people much more aware in the first place.”

Step No. 3: Bait and Switch
Once you realize when and why you are biting your nails, cracking your knuckles, or engaging in any other bad habit, the next logical step is to find a not-quite-as-annoying temporary or permanent replacement for it. “If you are a nail biter, try gum,” Jaffee says.” For throat clearing, the competing response may be some sort of slow exhaling because it is impossible to do that and clear your throat at same time,” Claiborn says. “Develop a way of breathing whenever you feel the urge to clear your throat. You can see some changes in a very short period of time. There will be a major reduction in throat clearing within days.” If knuckle cracking is your way of coping with stress, Wolfe, says, “Try getting your hands in a position where you won’t be able to crack your knuckles. Or stroke the fabric of your sleeve, doodle, or do something else with your hands.” Meditation may also help break bad habits, she adds. Once you have identified the triggers, you can do meditation to distract yourself next time you are in a trigger situation. Another tactic involves placing a large rubber band around your wrist, says Farrell. “Every time you become aware that you are [engaging in a bad habit], pull it back and allow it to snap so it creates a discomfort,” she tells WebMD.

View Article Sources
SOURCES: Patricia A. Farrell, PhD, clinical psychologist, Englewood, N.J.; author, How to Be your Own Therapist. Susan Jaffe, MD, psychiatrist, New York City. James Claiborn, PhD, psychologist, South Portland, Maine; co-author, The Habit Change Workbook. Janet L. Wolfe, PhD, clinical psychologist, New York City; author, What to Do When He Has a Headache.

Welcome!

Welcome to “Dr. Ramo’s Blog.” The purpose of this blog is to attract individuals, groups, and other organizations interested in Project Heart Start, health education and compression-only CPR within New Mexico. Every Monday and Wednesday this blog will post interesting articles and tips related to health education.

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Chest Compression Alone CPR is Associated with Better Long-Term Survival Compared to Standard CPR

Background

Little is known about the long-term survival effects of type-specific bystander CPR in the community. We hypothesized that dispatcher instruction consisting of chest compression alone would be associated with better overall long-term prognosis compared to chest compression plus rescue breathing.

Methods and Results

The investigation was a retrospective cohort study that combined 2 randomized trials comparing the short-term survival effects of dispatcher CPR instruction consisting either of chest compression alone or chest compression plus rescue breathing. Longterm vital status was ascertained using the respective National and State death records through 31st July 2011. We performed Kaplan Meier method and Cox regression to evaluate survival according to the type of CPR instruction. Of the 2496 subjects included in the current investigation, randomized deaths and 236 long-term survivors. Randomization to chest compression alone compared to chest compression plus rescue breathing was associated with a lower risk of death after adjustment for potential confounders (adjusted HR=0.91; 95% CI [0.83-0.99], p=0.02).

Read the full report by clicking here.

Conclusions

The findings provide strong support for long-term mortality benefit of dispatcher CPR instruction strategy consisting of chest compression alone rather than chest compression plus rescue breathing among adult cardiac arrest patients requiring dispatcher assistance.