Thursday, April 25, 2013

Costs to Treat Heart Failure to Double by 2030


. . .a cost every one of us will pay whether you suffer heart disease or not.

The relationship between living with day-to-day stress and heart disease is well established.  Now comes a statement from the American Heart Association's journal, Circulation, predicting that the cost of treatment could be as high as $244 per year by 2030, more than twice the current cost.

The Heart Association statement predicts:
  • The number of people with heart failure could climb 46 percent from 5 million in 2012 to 8 million in 2030.
  • Direct and indirect costs to treat heart failure could more than double from $31 billion in 2012 to $70 billion in 2030.
Heart failure is a life-threatening condition that occurs when the heart has been weakened from heart disease, high blood pressure, diabetes and other underlying conditions, and can no longer pump enough oxygen- and nutrient-rich blood throughout the body.  

Heart failure is the leading cause of hospitalization for Americans over age 65, and research results from around the globe show that enduring high levels of stress in early adulthood leads to heart problems later in life.

"If we don't improve or reduce the incidence of heart failure by preventing and treating the underlying conditions, there will be a large monetary and health burden on the country," said Paul A. Heidenreich, M.D., M.S., professor of medicine at Stanford University School of Medicine and director of the Chronic Heart Failure Quality Enhancement Research Initiative at the VA Health Care System in Palo Alto, Calif.

"The costs will be paid for by every adult in this country, not just every adult with heart failure.   Research Awareness of risk factors and adequately treating them is the greatest need," Heidenreich said.

"Heart failure is a disease of the elderly," Heidenreich said. "Because our population is aging, it will become more common and the cost to treat heart failure will become a significant burden to the United States over the next 20 years unless something is done to reduce the age-specific incidence."

Suggested Reading

Co-authors of the statement are: Nancy M. Albert, Ph.D., R.N.; Larry A. Allen, M.D., M.H.S.; David A. Bluemke, M.D., Ph.D.; Javed Butler, M.D., M.P.H.; Gregg C. Fonarow, M.D.: John S. Ikonomidis, M.D., Ph.D.; Olga Khavjou, M.A.; Marvin A. Konstam, M.D.; Thomas M. Maddox, M.D., M.Sc.; Graham Nichol, M.D., M.P.H.; Michael Pham, M.D., M.P.H.; Ileana L. PiƱa, M.D., M.P.H.; and Justin G. Trogdon, Ph.D. 

Sunday, April 21, 2013

About Stress

Everyone complains about the stress in their lives.  About how tired and burned out they feel at times.  About how little they enjoy life.  About the low quality of their lives due to stress.  On top of this is the explosion in the numbers of people suffering stress-related illnesses later in life.  From obesity to heart disease to stroke to cancer to Alzheimer’s – the list of stress caused or stress related illnesses in endless.  The rapidly rising costs of stress related illness threatens to drown our economy and overwhelm our ability to pay for.

So What is Stress?
The first thing to understand about stress is that it is entirely normal feeling every individual experiences.

It’s our body’s reaction to the world around us; our feeling of being stressed is what stimulates us to adapt, learn and grow.  Recent research shows that new born infants have fully-formed “stress circuits” in their bodies.  These stress circuits are what allow each and every one of us to learn and grow and adapt in life.  Without stress in our lives, we wouldn’t have a reason to learn and grow.
Where stress becomes a problem is when the situation and events of our individual worlds come so regularly that haven’t the time to rest and recover.  

The Stress Cycle we use in this blog describes the emotional and chemical processes of your body and mind.  When you experience a stressful situation, whether an attack, an argument or accident, your body releases powerful hormones such as adrenaline and cortisol that saturate the organs of your body giving you the strength and focus you need to survive a dangerous situation.
Keep your body saturated in these compounds without allowing yourself time to recover and process, you are on a path that leads to physical and mental exhaustion, Burn Out and physical and mental breakdown.  Medical science links prolonged stress and saturation with stress hormones to obesity, heart disease, stroke, cancer, arthritis, mental illness, and Alzheimer’s.  Your prolonged stress is even linked to physical and mental problems in the lives of your children.

The Stress Cycle
To understand how stress works within your body and its effects, you have to understand where our body’s mental and physical reactions originate.  As mentioned, feelings of stress cause us to learn, adapt and grow.  The Stress Cycle comes from our animal survival mechanisms that have survived since our very earliest days in the forests and on the savannahs of Africa, and before.
It’s known in science as the Fight or Flight Reaction or cycle.

Let’s say it’s 100,000 years ago, and you and your family live with your clan in a small, movable camp on the forested edge of a large prairie-like expanse.  Your mother and father and perhaps your grandmother and grandfather live with you, along with your aunts and uncles, cousins, nephews and nieces.  Everyone pitches in to the survival of your clan by caring for your children while you dig for roots and tubers while gathering berries and green, or while you hunt or scavenge for meat or fish.  Other clan member practice simple industries such as tanning hides or weaving baskets when not hunting or gathering.  In the evenings your entire clan gathers around your fire to eat, tell stories, dance and sing.  Sounds pretty idyllic, doesn’t it.  A no-stress life.
Except that nearby is a marauding bear or lion, and it smells your camp.  Perhaps it’s an older animal unable to hunt deer, or it’s been injured, or perhaps it’s been poor hunting, and prey is scarce.  The animal is hungry, and hunger is a powerful drive.  To a hungry bear and lion, we’re food, so it prowls your camp looking for a chance for a tasty morsel.

Sitting around your campfire you don’t hear or see anything, you’re relaxed and enjoying your day.  Suddenly, the carnivore strikes, perhaps dragging away a member of your clan, or perhaps someone sees it in time, and throws a burning branch at it while everyone else goes into action, the women hustling the kids into safety next to the fire while the men pick up weapons and prepare to defend the clan.
So let’s stop here. What’s going on?  Every person in the camp is feeling intense stress at this moment.  Their personal and group survival is threatened.  Each clan member’s body reacts the same way.  The adrenal gland pumps adrenaline into your system, giving you amazing amounts of physical strength and mental clarity.  You become so mentally focused that time seems to slow to a crawl, and you’re aware of every part of the world around you.  You are in the midst of the Fight or Flight reaction – the ultimate stress reaction of any animal.

Return to today.  You’ve had a “stressful” day.  Perhaps you were late to work, or you had a run-in with a customer or co-worker, or received a traffic ticket or any number of other stressful events.  Remember how you felt at the moment?  You were suddenly filled with energy and an ability to focus because your adrenal gland just pumped a powerful hormone throughout your body.  Time even seemed to slow down, didn’t it?  It’s the modern version of Fight or Flight programmed into the core of our minds and bodies.  This is how every human reacts physically and mentally in a moment of emergency.
Let’s go back to our early human ancestors. After the attack – the bear or the lion has been driven away and no one is hurt – everyone in the clan acts, to use a modern term, as if they were wired.  Their bodies and minds are still drenched in adrenaline, everyone has gone from the normal tired we all feel at the end of a day to bounding with energy.   It’s going to take some time for these people to calm down.

All clan members sit by the fire and talk about the attack, laughing about how one person ran, another hid, kidding each other about how wide their eyes became, comforting the children.  Each is processing the event for him or herself, explaining it to each other, showing love and solidarity by making fun of other’s reactions to the event.  At the same time, the excess adrenaline in the each person’s system is being used so that after some time individuals become very tired.  Are going to sleep soundly tonight – except those assigned to remain awake and guard the camp.
Back to modern day.  When you’ve had some sort of stressing event in your day.  Didn’t it take some time to “come down” afterwards?  Didn’t you feel a strong need to talk about it?  That’s a perfectly normal reaction, that’s how the human Stress Cycle works. 

There are ways your Stress Cycle of life gets out of whack.
One occurs when someone suffers an event in which they have a Fight or Flight crisis, but without having the opportunity to process the event.  A typical situation here would be a soldier in combat who survives a fire fight.  Back in camp, the focus is preparing for tomorrow’s risk, not processing what happened today.   Military culture is such that talking about these events is seen as weakness, not a normal life process.  So there is little opportunity for a full emotional recovery before the next survival event.  Our bodies are not programmed to endure a survival crisis followed by another by another without an opportunity to recover both emotionally and physically.  Men and women suffering Post Traumatic Stress Syndrome, or PTSD, are enduring the emotional price for the lack of recovery time.  PTSD can also happen to people who have been in car accidents, shooting events, sudden and unexpected loss of a loved one, have been raped or assaulted, or other overwhelming personal event.

The second way the Stress Cycle gets out of whack is when a man or woman is constantly “on”.  The Stress Cycle also mirrors our body’s energy cycle in which we expend our limited supply of energy and concentration without allowing time for our minds and bodies to recover. 
You may have job that requires you to work fifty to sixty hours per week, or your job requires that you be constantly available via cell phone or eMail.  You may have constant emotional run-ins with co-workers or your boss that stimulates your Stress Cycle and leaves you feeling amped up or wired and that takes time to pass, time you often don’t have because here comes the next crisis.

This long-term abuse of our natural Stress Cycle leads to exhaustion and burn-out.  In worse cases, unrelieved stress can lead to rage reactions where some petty little thing sets you off and you vent all your pent up emotions at something or someone completely unrelated.  An example is road rage.
Enduring years of never-ending, low-level stress causes long-term damage to your body and mind if you don’t learn to manage your Stress Cycles.  Stress is a known cause of obesity, heart disease, cancer, arthritis and on and on.  Stress is a known cause of Alzheimer’s Disease and is linked to non-Alzheimer’s memory loss and an inability to do the simplest household tasks later in life.  We’re talking about dressing yourself, or answering the telephone, or even to use a television control.

Not allowing your body and mind to recover from the stress you feel causes problems in all aspects of your life; the stress you feel is transmitted to the other members of your family and will even affects your children’s health and well-being throughout their lifetimes.
One thing I’ve learned researching this story is that the only person who can manage your Stress Cycle is you.  I have to control my cycle, you must control yours.  It really is that simple.  There is nothing the government can do.  We can’t outlaw stress.  While I can stress you out, only I can manage my Stress Cycle in a way that promotes my immediate health and happiness and prevents much more serious illness later in my life.

And there are many ways to this.
Re-framing.  This is a term of psychologists that means changing how you think about something.  If you work to accept that stress is a normal part of life, and that your Stress Cycle can be managed, you’ve taken a good first step in improving your quality of life.  Your Stress Cycle is something you learn to manage, especially allowing time for your body to recover and your mind to process the events of your life.   Stress and the Stress Cycle is normal, it is routine, it is programmed into our very minds and body so has to be accepted as a normal part of life.

Food.  Managing your Stress Cycle includes the choices you make of foods, but more importantly, how you prepare and consume food.  One way your stress affects your children is first, an over-reliance on fast foods, and second, the lack of family meals prepared by the entire family and consumed together sitting at a table without the distraction of television, radio or electronic devices.  The simplest explanation is that people who follow the Slow Food Movement do a better job of handling the stresses of their lives and managing their Stress Cycle.
  • Chocolate.  Research shows that the bodies of people who eat 1.5 ounces of dark, 60%+ chocolate a day handle stress differently, with the wonderful added bonus that people who regularly eat dark chocolate weigh less than others who consume the same number of calories per day.  (Known as the Kathryn Hepburn effect.)
Exercise.  It’s an old saw to say that peope who regularly exercise feel better.  Getting your heart rate up for thirty minutes at least three times a week helps cleanse your body of the by-products of stress.  And this doesn’t have to involve joining a gym or buying expensive running shoes.  Parking in the rear of a parking lot and walking at a comfortable pace to the door of the mall counts as part of your exercise. This is the way Olympic Champion and American icon Jesse Owens stayed within pounds of his best running weight throughout his long and healthy life:  he deliberately parked a few blocks further from appointments than he needed to, and walked.  No gym membership, no exercise coach, no running stairs.  He simply managed his life to include that most basic human activity, walking.

·         Since adding walking and bicycling as a normal part of my life since August of 2010, I’ve lost over fifty pounds and am no longer borderline diabetic.  I now walk the six blocks to the supermarket and the four blocks to my favorite coffee shop.  If you live in the suburbs were you must drive, simply add the ritual of parking across the parking lot from the store or a few blocks away from an appointment.  Walking an extra block here and fifty feet there adds up.
Friends & Family:  Like the pre-historic clan we imagined above, friends and family and critical to managing our Stress Cycles, especially the emotional side of the cycle.  Talking about stressful events is a tremendous release that allows us to process these events and to come to terms with our lives.

On the Job:  The workplace is the single largest source of stress in a modern American’s life.  All too often, you may be required to work long hours in difficult circumstances that sap both your emotional and physical energy, and don’t allow your body and mind the recovery time it must have for you to be healthy.  Stress related disability claims in the U.S. are exploding, leading to higher employer insurance premiums.
  • If you’re an employee in a situation that demands what could be called over-performance, keep in mind that you are setting yourself up for illness and disability later in your life.  I can’t be any more blunt than that.   This may require you to talk about this with your boss.  You may just have to draw a sharp line between your job and your home life, and enforcing it by turning off your cell phone, by not checking messages and emails, and focusing on family and friends – and your personal recovery from the demands of your week.
  • If you’re an employer, manager or supervisor, your best strategy for your personal long-term success is to realize that you must allow the people you supervise time to recover from the demands of their jobs or your employee turnover and disability costs are going to grow.

Bear in mind that unless you are the owner of the business or organization, you are both boss and employee.  In the old saying about something rolling down hill, this is another way of saying I can relieve my stress by making it someone else’s problem.  It’s important you keep your role as an employee and an employer in mind, and don’t pass your stress on to someone who may not have your capacity to manage their body’s and mind’s Stress Cycles.

If you are an owner of business, whether you are self-employed or have employees, research has shown that because you have control over your schedule, you have the control needed to truly manage your stress cycle.  Even though you may take work home, you’re in a position to focus on your home life.

Lifestyle:  How a person chooses to live their day to day life has a large impact on your Stress Cycle.  For example, research has shown that people who take part in community gardening projects weigh less and are less bothered by day to day stresses.  People who attend church or belong to civic groups have built themselves a personal support system that allows them to get away from the daily stresses of job and family while maintaining friendships with people you can simply talk to when needed. 
  • Volunteer.  An interesting piece of research from the last several years shows that if you feel like you don’t have enough time in your life to meet all of its demands, you can create time by volunteering.  This sounds backwards, but hard research shows that people who regularly give time to a charity feel less time pressured and less stressed. Interesting, no?
  • Laugh.  Laughter is a great stress release.  Unfortunately, not everyone has a sense of humor.  If you do know how to laugh, then use laughter to manage your Stress Cycle.  Read funny authors both old and new.  Regularly watch those sitcoms that give you a giggle.  Go to comedies or screen them in your home.  Among my personal favorites are Laurel & Hardy.  I’ve seen some of their movies such as Demon Machine or Towed in a Hole any number of times, but they still get me giggling still.
Mindful Awareness.  Mindful awareness is a simple technique derived from the Buddhist practice of meditation that is amazingly effective in helping manage a person’s Stress Cycle.  Current scientific research shows that men and women who practice mindful awareness do a much better job of  managing their Stress Cycles, tend to be less obese, have fewer relationship problems, report being happier and more satisfied with their lives, and so on.  It has even been shown that practicing Mindful Awareness is an effective treatment for AIDS and HIV infection, measurably lowering a patient’s infected cell counts. 

Therapy.  There are times and situations where the stresses of our lives are simply overwhelming, and we need professional, trained help.  Men and women suffering the life destroying, personally debilitating illness of PTSD require professional or professionally supervised help.   People suffering the symptoms of physical and mental exhaustion or burn out need at least medical help and probably some psychological support if they are to recover today and not suffer serious disability later in life.
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We'll be exploring stress and it's affects on your life, and ways you can better manage your stress in upcoming posts.

The purpose of The Stress Blog is to explore the science behind your Stress Cycle, to help you understand how it works and to learn of practical ways you can manage how stress affects you today and in your future.   If you are experiencing symptoms, please contact a physician or other health care professional for diagnosis and treatment.  Information presented in this blog is strictly educational and is not intended for diagnosis or treatment of any illness or condition.
Suggested reading from Powell's Books, the world's largest single site new and used bookstore.

by Joseph Solberg