Brown & Toland's HealthLink | Spring 2005

FITNESS

Before Competing In Athletics

The Sports Physical Is Important HealthLink

by John W. Wilson, M.D.

Spring 2005

4 Know Your Cholesterol Knowledge is power when it comes to your blood lipid levels.

6 Women’s Health What you know about heart disease in men may not apply to women.

8 Men’s Health Small changes in habits can pay big fitness dividends.

12 Healthy Seniors Check out the benefits of Medicare Advantage plans.

Brown & Toland’s HealthLink editor: Richard Angeloni, Corporate Director, Communications and Public Relations, Brown & Toland Medical Group, 415.972.4307. Brown & Toland’s HealthLink is published quarterly and printed in the United States.

Copyright 2005 by Health Ink Communications, 780 Township Line Road, Yardley, PA 19067, 267.685.2800. Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date health information.

Our articles are reviewed by medical professionals for accuracy and appropriateness. No magazine, however, can replace the care and advice of medical professionals, and readers are cautioned to seek such help for personal problems. Some images in this publication were provided by ©2005 PhotoDisc, Inc. PhotoDisc models used for illustrative purposes only. (205)

dolescents and young adults are advised to get a sports physical before they participate in an athletics program at school.

While it is not meant to replace a complete physical, it often becomes the only encounter with the physician that these young athletes may have.

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For this reason, it is helpful to have the patient’s primary physician conduct the sports physical. The main purpose of the physical is to screen for problems that may result in injury, illness or even, in rare circumstances, death. Statistics show that only about 10 percent of sports physicals result in a need for further evaluation, and that less than 1 percent of the athletes are ultimately denied clearance to participate.

Athletes should get their

sports physical several weeks before the start of preseason practice. This allows enough time for tests should any problems turn up. A common problem might be poor flexibility in the arms and legs, which may mean that the athlete is predisposed to injuries. Stretching may alleviate this problem.

Looseness in certain joints may mean that an athlete is at higher risk for some types of injury and may need a brace or some taping.

Words From Your Brown & Toland Doctor

A medical history can be very helpful for the physician. Commonly, questions will be asked about chronic illnesses, medications, significant allergies, symptoms with exercise, previous heart problems (particularly heart murmurs), skin rashes, concussions, heat exhaustion problems, wheezing or asthma, vision problems, weight problems and the loss of physical

Know your fats All fats are not the same in makeup or in their effect on the body.

NUTRITION

All Fats Are Not Created Equal ou need to consume some fat to maintain good nutrition. The American Heart Association (AHA) recommends you should consume no more than 30 percent of total calories from fat, while the USDA 2005 Dietary Guidelines recommend a range of 20 to 35 percent. analyses of recipes list the

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Although fat is not the body’s preferred fuel source, it supplies 9 calories for each gram which, in turn, powers physical activity and many of the body processes. It also adds satiety to meals — making us

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feel full longer after eating.

You can improve your diet by putting a little knowledge of fats and oils into practice.

A gram of fat Nutrition labels on food products and the nutritional

Brown & Toland’s HealthLink, Spring 2005

conditioning (deconditioning).

Certain conditions will keep the athlete from participating. Those with an active illness that might include fever or diarrhea should wait until they are better to avoid dehydration. A rare condition called carditis (inflammation of the heart) may result in sudden death with exertion. Special care is given when examining the cardiovascular system, searching for signs of carditis or other heart problems.

A new, undiagnosed heart murmur often becomes a condition that requires further evaluation prior to participation.

Additionally, a condition such as enlarged liver or spleen would need evaluation and treatment.

Otherwise, a rupture of these organs is possible

amount of fat in grams. You may find it easier to evaluate how much fat a food item or recipe contains by converting the grams into teaspoons.

Each gram of fat equals 9 calories. Five grams of fat is

equivalent to one teaspoon. So a serving of chips with 12 grams of fat contains almost 2.5 teaspoons of fat and 108 calories. A bowl of ice cream with 34 grams of fat contains 6.8 teaspoons of fat and 306 calories.

Saturated fats These fats are found mainly in animal-based foods such as red meat, poultry, lard, butter, cheese, whole milk and whole milk products, and in palm and palm kernel oil, coconut oil, cocoa butter and partially hydrogenated oils. They are solid at room temperature.

Saturated fats increase the level of LDL (“bad”) cholesterol in your blood.

Polyunsaturated fats Corn, sesame, cottonseed, safflower, soybean and www.brownandtoland.com

during contact sports.

Other conditions require special precautions. An athlete with one functional eye should wear eye protection.

A male with an undescended or absent testicle may require a protective cup in certain sports. A wrestler with ringworm may have to cover the rash while medications are used to clear the infection.

As athletes become comfortable with their primary physician, they may use this opportunity to ask about other health-related issues, including such important topics as sexually transmitted diseases and substance use.

A sports physical can easily become a complete wellness physical in order to update immunizations, order screening laboratory tests and discuss other concerns. Sports physicals that are set up through a school usually are focused only on sportsrelated concerns.

Most athletes will encounter no problems at the sports physical. Those who do are

usually treated and cleared for full participation. In the rare instance when something critical is discovered, it may mean the difference between life and death. For this reason, the sports physical is supported by the American Academy of Family Physicians, the American Academy of Pediatrics, the American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine. The goal of the sports physical is to allow the athlete to participate fully and safely. Consider scheduling one well before the next sports season. ■

sunflower oils contain polyunsaturated fats. They are liquid at room temperature. They can reduce total cholesterol and lower LDL cholesterol levels, but they shouldn’t be consumed in excess because they may also reduce the level of HDL (“good”) cholesterol. The fat in seafood is also mainly polyunsaturated.

Trans-fats Although they are found naturally in small amounts in some foods, most trans-fats are found in hydrogenated vegetable oils — such as margarines and shortenings — and in many commercially made baked goods and fried foods. They won’t have to be listed on food labels until 2006, but you know they’re present if partially hydrogenated vegetable oil or margarine is listed among the ingredients.

Trans-fats tend to raise blood cholesterol levels, increasing LDL and lowering HDL cholesterol. They should supply less than 1 percent of your total daily caloric intake. ■

Monounsaturated fats These are the primary fats in olive, peanut and canola oils and most other oils made from nuts and seeds. They raise HDL cholesterol as they lower LDL cholesterol.

Monounsaturates are some of the most healthful fats you can eat, but even they should be consumed in moderation. www.brownandtoland.com

John W. Wilson, M.D., specializes in Family Medicine. He is a graduate of the University of Texas Southwestern Medical School and is currently practicing in Daly City. His practice Web site address is http://jwwilsonmd.family doctors.net. His telephone number is 650.994.9090, and his e-mail address is JWWilsonMD@aol.com.

TECHNOLOGY

Paper Charts and Filing Systems Make Way for

Electronic Medical Records n late 2004, Brown & Toland Medical Group launched the first phase of an electronic medical record (EMR), making it one of the first large independent practice associations (IPA) in the nation to make such a product available to its physicians.

In the first phase of the project, Brown & Toland launched the clinical lab results module of the EMR, which allows physicians to access, in real time, results from patients’ lab results.

“This is the first time that a medical group like Brown & Toland is making lab results available for all patients within the community,” says Gloria

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Austin, Brown & Toland’s chief executive officer.

“We are particularly proud that we are introducing an EMR that will

The EMR, the Touchworks electronic medical record system, is part of an overall physician practice suite of services, including IDX Flowcast , new practice management software that is also part of Brown & Toland’s project.

“The advantages to the San Francisco community as a whole are enormous.

Doctors and patients alike benefit from having the right information available at the right time. As more information comes online from more of our network, it will only get better,” notes Peter Alperin, M.D., a medical director for Brown & Toland. ■ TM

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benefit the patients of San Francisco. Hospitals and physicians will benefit from the efficiency that this service offers.”

COOKING WITH OIL AND FAT Butter has 108 calories and 12 grams of fat (almost 8 grams of saturated fat) per tablespoon. Because it’s derived from animal fat, it also contains 33 mg of cholesterol per tablespoon.

Margarine contains no cholesterol, up to 2 grams of saturated fat and 34 to 100 calories per tablespoon.

The softer the margarine, the less saturated it is.

Margarine contains trans-fat, so it shouldn’t be used in excess. Tub margarines have the least amount of these fats.

Olive oil has 120 calories and 14 grams of fat per tablespoon. It’s considered one of the most healthful of the fats because 75 percent of its fat is monounsaturated and 13 percent is saturated.

Canola oil, which has the same number of calories and the same amount of fat as olive oil, is considered the second most healthful. Sixty percent of its fat is monounsaturated and 7 percent is saturated.

Vegetable oils such as corn or soybean rank third. They also have the same number of calories and the same amount of fat, but 20 percent of the fats are monounsaturated and 13 percent are saturated.

Brown & Toland’s HealthLink, Spring 2005

3

STAYING HEALTHY

For Good Health

Know Your Cholesterol Level he amount of cholesterol in your blood has a lot to do with your chances of getting heart disease; in fact, it’s one of the major risk factors for this illness. The higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack.

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Cholesterol is a fat-like substance produced by your liver; it is necessary for building cell walls and in the production of hormones. Cholesterol is also found in some of the foods you eat.

When you have too much cholesterol in your blood, it builds up in the walls of your arteries. Over time, this buildup causes “hardening of the arteries,” meaning that the arteries become narrow and that blood flow to the heart is slowed down or blocked.

High blood cholesterol does not cause symptoms. Many people are unaware that their cholesterol level is too high.

Blood carries oxygen to your heart and other vital organs. If enough blood and oxygen cannot reach your heart, you may feel chest pain. If the blood supply to an area of the heart is completely blocked, the result is a heart attack.

High blood cholesterol does not cause symptoms, so many people are unaware

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that their cholesterol level is too high. That’s why it’s important to find out what your cholesterol level is. If your level is high, you can take steps to reduce it.

Keeping your cholesterol within healthy limits is important for you no matter what your age or gender, whether you have heart disease or not. Everyone age 20 and older should have a blood cholesterol test at least once every five years.

The most accurate test is the “lipoprotein profile,” which is done after fasting.

A lipoprotein profile measures: Total cholesterol LDL (“bad”) cholesterol, which is the main source of cholesterol buildup and blockage in the arteries HDL (“good”) cholesterol, which helps keep LDL cholesterol from building up in the arteries Triglycerides, which are

Brown & Toland’s HealthLink, Spring 2005

another form of fat in your blood If it’s not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol level.

Understanding the cholesterol treatment guidelines Current guidelines for treatment of high cholesterol come from the National Cholesterol Education Program III, overseen by the National Heart, Lung, and Blood Institute. The guidelines are used to determine a person’s risk of experiencing a heart attack within 10 years.

A person’s cholesterol level is one part of the equation for determining risk for heart disease.

Other risks for heart disease include smoking, obesity, diabetes, high blood pressure, family history of heart disease, gender and age (over 45 for men and over 55 for women).

Treatment for high cholesterol depends on how many other risk factors are present.

Treatment If you have high cholesterol, your goal is to reduce

your LDL level enough to cut your risk of developing heart disease or having a heart attack. The higher your risk of these illnesses, the lower your LDL should be.

You can lower your LDL level through lifestyle changes such as a cholesterol-lowering diet, exercise and weight management.

A low-saturated-fat, lowcholesterol diet has less than 7 percent of calories from saturated fat and less than 200 mg of cholesterol. If this diet doesn’t lower your LDL enough, you can add soluble fiber to your diet.

It’s important to control your weight in order to control your LDL, especially if your HDL level is low, your triglycerides are high or your waist circumference is too great (more than 40 inches if you’re a man or more than 35 inches if you’re a woman). To get enough exercise, aim for 30 minutes of moderate physical activity most, if not all, days. (In some people, there are genetic reasons that the LDL level can’t be lowered by these methods.

In others, these methods just don’t work well. In both of these cases, medications may have to be added.)

To reduce your risk for heart disease, it’s also important to control your blood pressure and to stop smoking.

Your doctor may prescribe cholesterol-lowering medication in conjunction with lifestyle changes.

Maintaining your lifestyle changes will keep your medication dose as low as possible and lower your risk of heart disease in other ways. There are several types of drugs available for lowering cholesterol, including statins, bile acid sequestrants, nicotinic acid and fibric acids. A new drug category called cholesterol absorption inhibitors was recently approved. These drugs block cholesterol absorption in the intestine.

How statins work By blocking a liver enzyme that helps to make cholesterol, statins lower LDL cholesterol. They may also protect against heart disease by decreasing the formation of plaque in artery walls, preventing plaque from breaking open and by reducing clot formation.

“If you take one of these drugs, there’s a good chance it will lower your www.brownandtoland.com

DIABETES CARE

Dig Into These

cholesterol by 20 to 30 percent within a few weeks,” says Michael Lauer, M.D., director of clinical research in the department of cardiovascular medicine at the Cleveland Clinic Foundation in Cleveland, Ohio.

“They’re taken once a day and they’re long-term, meaning once you’re prescribed a statin, there’s a good chance

you’ll stay on it for the rest of your life.”

Initially, your doctor may monitor you for liver and muscle toxicity, the most serious side effects of statins. But such side effects are uncommon, says Dr. Lauer, occurring in only 1 percent to 3 percent of patients.

The other potential side effects, which are rare, include constipation, headache or nausea.

Maintain a hearthealthy lifestyle No matter which cholesterol-lowering medication you take, it’s important to remember that diet and exercise also lower cholesterol and are a valuable part of your treatment strategy. Don’t think you can just take a pill. ■

Alternative Medication If you do experience signs of liver or muscle toxicity because of statin use, your doctor may reduce your dose or switch you to a different statin drug.

Or the doctor may prescribe an alternative cholesterol-lowering medication, such as nicotinic acid (niacin), a B vitamin that works in the liver to affect the production of blood fats, lower triglyceride and LDL cholesterol levels and raise HDL cholesterol. Unfortunately, however, “many people don’t tolerate niacin well,” says Dr. Lauer.

A class of drugs called fibrates is another option. “They primarily act by reducing triglyceride levels,” says Dr. Lauer. “They might be the better drug to use if someone has more of a triglyceride disorder than high LDL cholesterol.”

Diabetes Diet Tips ot long ago, having N diabetes meant a strict diet with limited food choices and no sugar. Now researchers know that the healthy diet recommended for all people meets many of the dietary goals for those with diabetes.

Eat a healthy diet When you have diabetes, your diet can be similar to the diet of people without diabetes. More than threefourths of your plate should be filled with a combination of these foods: cereal, pasta, beans, whole-grain bread, vegetables and small amounts of fruits.

Also eat low-fat sources of protein, such as skinless chicken, fish or lean beef.

Based on the average diet, you need about 50 grams of protein a day. The number of protein grams in a serving is listed on food labels. To keep track of your protein intake, multiply the number of grams by the number of servings.

If you have kidney problems, talk with your doctor about eating less protein.

Try cooking with little or no fat. You can broil, bake, roast, poach, steam or microwave without adding fat. Before cooking, trim fat from meat and poultry.

Try main dishes with pasta, rice, beans and vegetables instead of meat.

Because you have diabetes, you are at an increased risk for heart disease, especially if you have poor eating habits. When you avoid fatty foods, you can better maintain your weight and blood fat levels.

Plus, you are less prone to heart disease.

Don’t sabotage your diet Like everyone, you should avoid foods high in fat or cholesterol. Eat only small amounts of saturated fats such as butter and other whole-milk products.

Check food labels for fat content. Food labels now list the total calories in the food and the calories from fat. Divide the calories from fat by the total calories. If the result is more than 30 percent, limit how much of that food you eat.

Even though sugary foods raise blood sugar levels more than other foods do, it is OK to eat them once in a while. As with total calories, moderation is key.

If you drink alcohol, drink in moderation only.

The American Diabetes Association (ADA) warns that drinking alcohol on an empty stomach can cause low blood sugar, which can be dangerous.

In some cases, low blood sugar can cause fainting or seizures. Consumption of alcohol also makes control of blood sugar erratic and unpredictable.

Have smaller, more frequent meals You may need to eat frequent small meals throughout the day instead of a few large meals. This can help avoid wide swings in blood sugar with too high or too low levels.

Your doctor or a dietitian can help you develop a meal plan that’s right for you. The ADA recommends that all adults with diabetes see a dietitian every six months to one year to help with meal plans. ■ To learn more, visit the ADA Web site at www.diabetes.org.

Yet another option is the newest drug category called cholesterol absorption inhibitors, which block cholesterol absorption in the intestine.

www.brownandtoland.com

Brown & Toland’s HealthLink, Spring 2005

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HEALTHY CHOICES

WOMEN’S HEALTH

The Lowdown on

Vitamins

Women and the Risk of

Heart Disease f an older man complains of chest pain, his doctor will probably think heart attack. But if an older woman has chest pain, her doctor may think first of indigestion. And even if a woman is diagnosed with heart disease, the recommended treatment may be less aggressive than for a man with the same stage of disease.

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By Peter Alperin, M.D., Medical Director, Brown & Toland Medical Group

itamins are a diverse group of naturally occurring compounds that are required for proper nutrition. They are commonly divided into water-soluble (B vitamins, C, folate, biotin, pantothenic acid) and fat-soluble (A, E, D, and K).

Importantly, water-soluble vitamins aren’t stored well in our bodies, while we can build up reserves of fat-soluble compounds.

Over the past 30 years, a tremendous amount of research has addressed the benefits of various vitamins.

Researchers have looked at questions such as the true optimal intake of a vitamin, or whether higher doses result in protection from certain diseases. Remarkably, the sum total of the data has only created more questions.

It does not appear that most people need to take vitamin supplements if they eat a balanced diet with proper amounts of fruits and vegetables. Taking a multi-vitamin once a day won’t hurt you, but it is likely unnecessary.

Certain groups of people, however, should take vitamins. Pregnant women need increased amounts of iron and folate. People subscribing to a vegan diet (no animal products) need vitamin B12 supplements, as this is only found in animal products. Certain medications may also interfere with proper vitamin metabolism, necessitating supplementation.

The research into super doses of various vitamins is also inconclusive. B vitamins are often touted as “stress protectors” or “anti-oxidants.” While this may be true, no studies have definitively shown that they confer any disease protection. Many people take extreme doses of vitamin C, but the data for any benefit is also lacking. In fact, super doses of watersoluble vitamins usually pass out of your body through your urine very quickly.

Vitamin E also has received significant press over the past several years. It falls into the anti-oxidant category, and some early evidence suggested that it

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Brown & Toland’s HealthLink, Spring 2005

Why is there such a difference in treating and diagnosing heart disease in men and women?

“I think there’s a belief held by many men and women, physicians and laymen alike, that heart attacks are solely a man’s problem.

But coronary artery disease is the leading cause of death of both men and women in the United States,” says Marianne J. Legato, M.D., founder of the Partnership for Women’s Health at Columbia University. Her female patients tell her they worry more about cancer, yet 250,000 women die of heart attacks each year, compared with 40,000 who die of breast cancer.

Why women are at risk Although both men and women are susceptible to heart disease, the reasons they develop it are different.

Women typically have smaller hearts and narrower arteries than men do, so it takes less plaque to block a coronary artery and impair the flow of blood and oxygen to a woman’s heart.

The female hormone estrogen is believed to provide partial protection against heart disease. After menopause, however, as the body gradually stops producing estrogen, the

risk of developing the disease steadily climbs.

The symptoms of heart disease in women are different from those in men, which can make it more difficult to diagnose. Women’s symptoms include angina (or chest pain), chronic breathlessness, chronic fatigue, dizziness, edema, rapid heartbeat and nausea.

Men’s symptoms include sudden pressure, fullness, squeezing or pain in the center of the chest that lasts for more than a few minutes or goes away and then comes back; pain that radiates from the center of the chest to the shoulders, neck or arms; chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath; and sudden onset of rapid heartbeats.

If a woman has a heart attack, she is twice as likely as a man to die within a year, according to the American Heart Association (AHA). If she doesn’t die, she is twice as likely to have a second heart attack.

Besides heart size and the estrogen factor, each woman’s risk for heart disease may be increased by other factors, including: Family history. You’re at greater risk if your father had a heart attack before age 55 or if your www.brownandtoland.com

mother had one before age 65. Hyperlipidemia (high blood fat) also runs in families.

Obesity. Your risk increases if you are 20 percent to 30 percent overweight.

Where you carry your weight. Fat concentrated around your midsection puts you at greater risk.

You’re at less risk if fat is on your hips and thighs.

Cholesterol. Risk increases with a high overall cholesterol count in which good cholesterol (HDL) is low and bad cholesterol (LDL) is high.

Diabetes. Women with diabetes have double the risk of heart attack.

High blood pressure.

This condition is a major risk factor for a heart attack and the most important risk factor for stroke, according to the AHA. Smoking. A tobacco habit or exposure to www.brownandtoland.com

secondhand smoke raises the risk of stroke and heart disease and can cause early onset of menopause, adding to risk.

Sedentary lifestyle.

Women who don’t exercise triple their risk.

Stress. Constant stress may increase your risk.

Taking care of yourself Heart disease doesn’t happen overnight. Years of neglect can create silent damage, setting you up for a heart attack. That’s why it’s important to practice prevention, no matter what your age. The AHA

recommends that screening for heart disease risk factors begin at age 20. Screening includes measuring blood pressure, body mass index, waist circumference and pulse every two years. For healthy adults, here are ways to protect heart health: Stay active. Exercise at least 30 to 60 minutes, preferably every day.

Aerobic activities such as walking, running and swimming provide the most cardiovascular benefits. Always check with your doctor before increasing your activity.

Eat a heart-healthy diet.

Limit your daily fat intake to 20 to 35 percent of your total calories. Only 10 percent should be saturated fat; the rest should be polyunsaturated or monsaturated fats.

Limit your daily cholesterol to 300 mg a day.

Improve your nutrition by eating 5 to 13 servings

(or 21/2 to 61/2 cups per day) of fruits and vegetables, depending on your daily calorie needs.

Eat three servings (or about 3 ounces) of whole grains every day.

Limit your daily salt and sodium intake to 2300 mg.

Have your blood fats checked at least every five years. If your levels are high, you will need to follow a special diet to lower them. If diet alone is unsuccessful, lipid-lowering medication may be necessary.

Have your blood pressure checked at least every two years. If your pressure is high, and your healthy diet and exercise don’t lower it, you will need medication to bring your blood pressure into normal range and keep it there.

Have your blood sugar checked at least every

five years, especially if you have diabetes in your family. Controlling your blood sugar will decrease your risk for heart disease, as well as eye and kidney disease. All three of these things — lipid levels, blood pressure and blood sugar — may be checked at more frequent intervals, depending on your risk factors Don’t smoke. Becoming a nonsmoker will reduce your risk for many diseases, including heart disease.

Maintain a healthy weight. Your body mass index (BMI) should be between 18.5 and 24.9.

If you’re overweight, combining a more healthful diet with exercise will help you shed excess pounds.

The symptoms of heart disease in women are different from those in men, which can make it more difficult to diagnose.

Control stress. Make time for stress-reducing activities, such as relaxation exercises.

Know the danger signs.

Don’t ignore the following signals of heart distress: intense pressure or crushing pain in the chest; lightheadedness, breathing difficulty or shortness of breath; a feeling of severe indigestion that doesn’t go away after taking an antacid; and a feeling of impending doom. ■

Brown & Toland’s HealthLink, Spring 2005

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MEN’S HEALTH

Potbellies A Warning Sign for Later Problems ou were a pretty good jock in high school, and in your 20s you tried everything from racquetball to running. But in middle age, even your softball glove is gathering dust. For recreation, you surf — the Web, not the waves.

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Your diet couldn’t be more manly: No one’s ever had to ask you “where’s the beef?” And you wouldn’t be caught dead visiting a weight-loss center to deal with that thing around your waist you jokingly call a beer belly.

“We can predict with a fair degree of accuracy who’s going to have a heart attack.”

— Walter R. Thompson, Ph.D., a fellow of the American College of Sports Medicine and a professor of kinesiology, health and nutrition at Georgia State University

It’s all part of that cavalier male attitude toward health that also makes men less likely than women to see a doctor.

The fact is, you might not care as much about looks as your wife does, but that fat around your abdomen is no laughing matter. A man’s potbelly often warns of later problems ranging from heart disease to cancer, diabetes, arthritis, back pain and sleep apnea.

“We can predict with a fair degree of accuracy who’s going to have a heart attack,” says Walter R. Thompson, Ph.D., a fellow of the American College of Sports Medicine and a professor of kinesiology, health and nutrition at Georgia State University.

“It would be those who don’t have a very healthy diet, have hypertension or are obese — which characterizes about 85 percent of

the middle-aged male population between the ages of 35 or 40 and 60.”

Not all of them will have heart attacks, of course, but it’s still enough to worry even a manly man like you. Fortunately, says Dr. Thompson, you can do something about it without running marathons and living on bean sprouts. Small changes in habits can pay big dividends.

The good news is …

“The good news is that when men embark on a

balanced diet and exercise program, they lose inches faster than females because their greater muscle mass acts as a calorie burner,” says Ann Louise Gittleman, author of Super Nutrition for Men. Consider Chuck Stetson, 56, managing director of a private equity investment firm in Manhattan. A college ski team member, he ran and played squash till about five years ago. Last year, his doctor gave him a wake-up call: He was obese, his total cholesterol exceeded 200

and he was inactive.

“All three things put you at high risk of a heart attack,” notes Mr. Stetson, whose father died recently of a heart attack.

Four months after enrolling in the Cooper Wellness Program in Dallas, the 6-foot Mr. Stetson had dropped 15 pounds, to 210. “I’ve got a lot more energy,” he says. “It’s really night and day.”

Mr. Stetson increased his aerobic workouts from a weekly total of 40 minutes to three hours and boosted

REAL MEN, REAL MENUS “Low-quality, high-fat foods would fatten up any human being,” says psychotherapist Connie Tyne. “Treat yourself to high-quality foods that nourish your body and help you get from one meal to the next without creating cravings that lead you to eat anything you can find.”

Some tips to chew on: Divide your plate into quarters. Fill one quarter with lean meat or fish, another quarter with a piece of bread and a little pasta, rice or potato, and half the plate with vegetables, salad or fruit.

Aim for less saturated fat. It’s found in fatty cuts of meat, baked goods and full-fat dairy products.

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Brown & Toland’s HealthLink, Spring 2005

Switch to lean meats and fish. Experts say omega-3 fatty acids in fish such as salmon, mackerel and sardines protect against heart disease.

Use monounsaturated and polyunsaturated fats.

They lower cholesterol and heart disease risk.

You’ll find them in milk, nuts, avocados, olives, soybeans and vegetable oils made from soy, flaxseed, corn and canola.

Add fiber, fruits and vegetables. Raw produce is especially good.

Cut back on sugars. Avoid foods with lots of sugar, such as soda, candy and cookies.

www.brownandtoland.com

his strength training from 40 minutes to an hour. He went from 10 minutes a day to half an hour several times a week on a treadmill. And he added a pleasant hour-long weekend jog through Central Park.

He’s not eating less, just more healthily, even in restaurants. Focusing on vegetables and lean meats, he skips butter and sauces on meats and limits salad dressing, bread and potatoes.

Likewise, in 16 months 5-foot-11 Bob Redden, 54, lost nearly 30 pounds to fall below 200. He also lowered his blood pressure — without drugs. How? By boosting his weekly aerobic workouts, taking up yoga and kayaking, and following the Cooper Wellness Program’s food principles.

director of the Cooper Wellness Program, says men often tell her: “I’m totally in control of my environment, I’ve got a fabulous career, but I feel like I’m completely out of control with my body.”

“Making these choices — losing fat and gaining muscle — makes you

powerful, both physically and mentally,” she says.

Once skeptical, Mr. Stetson agrees. “It doesn’t take much effort to do it at all. I’m kicking myself wondering why I didn’t do this five years ago. My family’s a lot happier, and I also know I’ve got a longer life expectancy because of it.” ■

MEN ON THE

MOVE

You don’t have to run a marathon every day to improve your health. A growing body of evidence indicates that just half an hour of moderate physical activity most days, like walking, can cut your blood pressure and body fat and improve your cardiopulmonary fitness. You don’t even need 30 minutes straight. Three 10-minute chunks will work fine.

Here’s some advice to run with: Consult your doctor first. Don’t start a fitness program until you do.

Build activity into your day. Take stairs, not elevators. Park farther away so you’ll walk more.

Trade the riding mower for one you push.

Consider hiring a trainer. Make sure a reputable group, such as the American College of Sports Medicine, certifies the trainer.

Find an exercise buddy. Your pal can move you to exercise when you don’t feel like it.

Join a fitness club. The camaraderie and classes may help keep you on a schedule.

“I learned how to take responsibility for my health,” says Mr. Redden.

The long-time computer programmer also changed jobs, becoming a boat captain in the Florida Keys.

“My doctor gave me a choice: I could take more blood pressure medication or lose weight.”

Psychotherapist Connie Tyne, L.M.S.W., executive www.brownandtoland.com

Find weekend fitness fun. An activity such as canoeing, hiking or camping is an incentive to work out during the week to get ready.

If you golf, forget the cart. If carrying a bag is too demanding, use a pull-cart or a caddy.

Look for age-specific leagues or outdoor clubs.

Try tennis, golf, basketball, softball, bicycling, hiking — whatever you enjoy.

Volunteer to coach your children. Don’t watch from the bleachers. Get physically involved in practices and workouts.

Set a goal. Sign up for a long bike ride, for instance, then use that as a training incentive.

FAMILY HEALTH

Give Immunization

Your Best Shot as this ever hapH pened to you? On the day she’s supposed to get her shots, your infant wakes up with the sniffles. You or your doctor decides to hold off on the vaccination. The opportunity slips by and, for one reason or another, your child never gets that shot.

She wouldn’t be the only one. For a variety of reasons, every year nearly one million children under age 2 aren’t fully immunized against polio, whooping cough, tetanus, diphtheria or other preventable diseases, according to the U.S. Centers for Disease Control and Prevention.

Most parents catch up by the time children go to school, because most schools require up-to-date immunizations. Still, many children go unprotected in their most vulnerable years.

Overcoming confusion and fear Some parents slip because they’re confused about when vaccinations should or should not be given. “Most parents — and many physicians, as well — think that a baby with the sniffles or a low-grade fever or an ear infection should not get a shot,” says Jerold Aronson, M.D., a member of the Pennsylvania chapter of the American Academy of Pediatrics. “These types of minor illnesses aren’t enough reason to delay an immunization.”

Some parents cite fear of side effects for skipping immunizations. The risks of the diseases prevented by vaccines are much greater than the risks of immunization, which are minimal.

Working with your doctor Keeping your child’s immunizations up to date requires a partnership between you and your physician. Parents should map out immunization schedules with their doctors while their baby is still a newborn. Remember that two or more shots can often be given at the same time. Your child may require up to four shots at any given visit A few simple suggestions can help you keep up with an immunization schedule: Whenever possible, have immunizations done during well-baby visits and checkups.

Check your child’s immunization status at every visit to your doctor’s office.

Keep your own record of immunizations in a handy, secure place. Bring it to your doctor at every visit so that it can be updated. ■ Brown & Toland’s HealthLink, Spring 2005

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HEALTHY SENIORS

Brown & Toland Reduces Costs and Improves Care With

Old-Fashioned House Calls ouse calls are no longer a bygone medical tradition for many Brown & Toland Medical Group patients, thanks to Health Net’s recent partnership with Care Level Management (CLM), a national medical management company.

H “We are very encouraged that this program will enhance practice efficiency for our physicians and provide better care to our members.”

— Stan Padilla, M.D., vice president of medical group services and chief medical officer, Brown & Toland

program will enhance practice efficiency for our physicians and provide better care to our members.”

CLM is a national company that specializes in the medical management of high-risk patients. Two full-time board certified internists, Virginia Scialanca, M.D. and Lola Reis, M.D., will provide care in the San Francisco area. ■

The Home Visiting Physician program is available to qualifying Health Net Seniority Plus members, and will assist Brown & Toland physicians with the management of high-risk elderly and homebound patients. Patients will receive the individual attention of a doctor in the comfort of their own homes, a practice that has been proven to prevent unnecessary hospital admissions and emergency room visits, better manage expensive prescription drugs, and improve coordination of care.

Working with the patient’s Brown & Toland primary care physician (PCP), the CLM physicians will assess the individual’s high-risk status and assist in the provision of needed home-based services, while the PCP will continue to be responsible for coordinating all other care, such as specialist referrals and other outpatient care.

“This program provides value to both our physicians and our patients,” says Stan Padilla, M.D., vice president of medical group services and chief medical officer for Brown & Toland. “We are very encouraged that this

Vitamins, continued from page 6 protects against heart attacks. Recent studies, however, have shown the exact opposite — high doses may actually increase the risk of heart attack and stroke.

Too much of a given vitamin may be toxic. While this may occur with any of

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the vitamins, the fat-soluble compounds, especially, may cause problems because they are stored in fat cells, making them longer-lasting and more difficult for the body to eliminate.

All in all, taking a single multi-vitamin a day is no big

Brown & Toland’s HealthLink, Spring 2005

deal. It won’t hurt you, but it may very well be unnecessary. With super doses, you may be “flushing” your money away and, in extreme cases, actually causing harm.

Talk with your doctor.

Until next time, stay healthy. ■

Peter Alperin, M.D., a medical director at Brown & Toland Medical Group, also is in active practice at Mills–Peninsula Hospital and is an assistant clinical professor of medicine at the University of California–San Francisco. www.brownandtoland.com

www.brownandtoland.com

Brown & Toland’s HealthLink, Spring 2005

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FOR MEDICARE BENEFICIARIES

Medicare Advantage Plans Offer Ease of Access and Expanded Benefits

C

onsumers who become eligible for Medicare, including those approaching their 65th birthday, have choices available to them beyond traditional Medicare.

Medicare beneficiaries will have access to benefits that include doctor’s visits and unlimited generic drug coverage.

informational meetings sponsored by these health plans.

To learn more about these meetings, please fill out the enclosed business reply card and return it to Brown & Toland Medical Group. We’ll be glad to give you meeting times and locations, as well as more information about these two programs. ■

Brown & Toland partners with two of the largest health maintenance organizations (HMOs) in California — Health Net Security Plus and PacifiCare Secure Horizons — to give Medicare beneficiaries affordable and comprehensive coverage. This coverage includes hospitalization, emergency care and access to an extensive network of private practice physicians.

By enrolling in either Health Net’s Seniority Plus plan or PacifiCare’s Secure Horizons plan, Medicare beneficiaries will have access to a wide range of important benefits that include doctor visits and unlimited generic drug coverage.

To find out more about these Medicare Advantage plans, we encourage you to attend one of the

PRSRT STD U.S. POSTAGE The Doctors Behind Every Good Health Plan

P.O. Box 640469 San Francisco, CA 94164-0469

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