The Health Show Show 1299, 2013 February 20

This is the Health Show, a presentation of national productions.
Do you have high blood pressure?
Are you sure?
Most people with high blood pressure have no signs or symptoms, even if their blood pressure
readings get dangerously high.
In general, the lower your blood pressure is, the longer you live because it's less wear
and tear on the cardiovascular system.
On today's health show, we'll talk about hypertension and how to avoid it or live with it.
We'll also hear from the NIH about a new method of screening for coronary artery disease
using MRI technology.
And we'll hear a compelling story of how cops and other first responders in Chicago are
changing the lives of mentally ill kids.
I'm Bob Barrick.
And I'm Dr. Nina Sat.
And this is the Health Show.
Okay, quick quiz.
What are the symptoms of high blood pressure?
If you don't have a ready answer, chances are that's the right answer.
Most people with high blood pressure or hypertension show no symptoms, but they are at serious risk
of heart disease, stroke, and a number of other health problems.
And according to the CDC, almost a third of Americans are living with hypertension and
many don't know it.
Here to talk about hypertension is Dr. David Myerson, a cardiologist at Johns Hopkins and the
director of cardiology consultative services at the Johns Hopkins Bayview Medical Center
in Baltimore.
I spoke with Dr. Myerson and noted that checking for high blood pressure has to be one of the
easiest medical tests to perform ever.
So how can so many people not know they have it?
Well, they just don't bother.
They look the other way.
This isn't called the silent killer for nothing.
High blood pressure is something that can affect many, many people.
Even in African American and Indian Americans and Hispanic Americans, even more so, but
it's such an easy number to know.
You can go in the supermarket and put your forearm in a machine and know or ask the doctor,
but it's very important that you know because so many diseases follow from this.
Now we have the cliched picture of that type A personality, the stressed out business
man who has a drink in one hand, a cigarette in the other.
Is that really the face of hypertension in the new millennium?
Well, that is one of the faces of hypertension and that face is not going away.
That's also the face of heart disease and early heart attack and early stroke and early
death.
But the face of hypertension or high blood pressure is now a lean, educated, 45-year-old,
African American woman doctor of philosophy, for example, who you would look at her and
say, boy, she's active, she's lean, she does everything right.
She still may have severe high blood pressure.
Her blood pressure doesn't know a gender, it doesn't know a race, it just knows that
it ruins arteries.
And within general, in general, the lower your blood pressure is, the longer you live
because it's less wear and tear on the cardiovascular system.
I was just thinking about what happened when there was a big discussion in the media about
women being screened for breast cancer and at what age and women then being screened
for uterine cancer and at what age.
The American Heart Association supports the American Cancer Society.
We encourage women to check with their doctors and screen accordingly, but a woman is 10 times
more likely to die of heart and blood vessel disease than she used to die of breast cancer.
Let me repeat that because it is the case and it is very powerful.
A woman is 10 times more likely to die of heart and blood vessel disease than she is to
die of breast cancer.
There are risk factors for high blood pressure that you can't control.
Age, race, family history, but there are a lot that you can control.
Tell us about some of the risk factors that might make you a candidate for high blood
pressure.
Well, again, if you have a lot of high blood pressure in your family, you are at risk and
there are families, unfortunately, they will tell us that every uncle and every aunt that
they've had is either on dialysis or had a stroke or heart failure.
When that happens, please don't believe that history will not repeat itself because history
will repeat itself.
We can learn from the last generation that these are preventable diseases and please let's
do so.
So knowing what your history is and accepting it and saying, I can't change who my parents
were, but and I'll take the little additional things that they gave me that I don't want
like the high blood pressure.
I'm going to make sure that I identify that.
I'm going to treat it.
And especially for our diabetic patients, people with diabetes and high blood pressure get
heart and blood vessel disease sooner than almost everybody else in the population.
And you know, Bob, sometimes it's lifestyle things.
It doesn't mean throwing a ton of medications at people.
Sometimes if they lose as little as 8 to 12 pounds, if they reduce the salt in their diet,
carefully, if they reduce their alcohol consumption.
If they're more active and again, we're talking about activity that is an activity level
that is appropriate for a given person.
So I'm not asking our wonderful grandmothers to become marathon runners.
That's not fair.
What I am asking them to do is to walk as much as they can and as often as they can.
What are some of the other risk factors?
You know, being overweight is definitely one of them.
Are there other things you can look at in your life and say, you know, this might be
a problem.
Well, you know, those people who talk about white coat hypertension and that is they say
that only when they see the doctor wearing the white coat is their blood pressure high
and it doesn't seem to be high any other time.
I have a feeling about that.
And my feeling, Bob, is that life is a series of white coats.
Let me repeat that.
Life is a series of white coats, whether you are driving your car and somebody cuts you off
or somebody sends you a bill that's 50% higher than the estimate or somebody didn't credit
something that they were going to or a healthcare insurance company says we're not paying
for the care or whatever and you don't know how to fight it.
I mean, life is, this happens 12, 14, 20 times a day for most people.
So what I would urge them to do is to accept the fact that this is the way they respond.
And it's so called a hot responder and you have a little bit of a choice in this.
I know that it's some people just flow off the handle, but you can either decide when
somebody is going to cut you off at your driving bar in the car.
Thank goodness you didn't get into an accident and you can say, oh my good, I don't know
where they got that license and kind of thank all we didn't get into it.
It's instead of getting into a shouting match and having your turn purple in the face
and having your blood pressure go up to 240 when you're doing it.
Let me tell you an interesting story about a 93 year old man that was a patient of ours.
He was doing beautifully.
He was physically and mentally intact and active and he didn't carry his clubs, but at
least he could ride on the corner.
And he could still hit a golf ball from time to time.
And somebody asked him, what was his secret?
Mr. Jones, what's your secret?
And he says, well, my secret is this.
He said, when it rains, I let it.
And what I'm trying to say by that is that there were things that you can't control.
We can deal with them a little bit better.
But if you know that you're the type of person who is a hot responder, that the blood pressure
is always up when you see the doctor's white coat, life is a series of white coats and
maybe that has to be taken a little bit more seriously.
Can it tell us the difference between primary and secondary hypertension?
Are you a primate 90 to 95% of people with hypertension have primary?
But what is the difference between the two?
That's a great question.
It's a very interesting Bob that the kidneys actually control how blood pressure is maintained
in the body.
That in some things in the brain.
But largely the kidneys and the little glands on top of the kidneys call the adrenal glands.
And when the kidneys get enough blood pressure, the hormones that the adrenal glands and the
kidneys secrete say, go ahead and get rid of fluid and go ahead and get rid of salt and
things of that nature.
And when they are getting too little blood pressure, then they hold on to salt and hold on
to water and secrete hormones that elevate blood pressure.
So a secondary cause would be something from an actual abnormality in the blood supply
to a kidney or in some form of growth that is secreating hormones that are elevating blood
pressure.
But primary hypertension to go back to the original question.
Primary Mary is when we really don't have a cause, it just happens in a given genetic
and a given individual and a given family, there's nothing specifically wrong with any particular
organ system.
And those people have to be very, very careful because they again, during a lifetime, have
an increased risk of stroke, of kidney damage, of loss of vision, of erectile dysfunction,
memory loss, fluid and their lungs, they engineer all of those things.
The good news for secondary high blood pressure is that sometimes those causes are treatable.
And if somebody does have a narrowing in an artery that nourishes a kidney, which is
called renal artery stenosis, then that lockage could be opened and a number of times the
blood pressure will then even normalize or tend to normalize.
And so the doctors can look for hormonal things or other vascular things which would cause
high blood pressure and those would be the secondary.
And when you can't find a cause, that would be primary high blood pressure or primary
hypertension.
Dr. David Myerson is a cardiologist at Johns Hopkins and director of cardiology consultative
services that the Johns Hopkins Bayview Medical Center in Baltimore.
Still to come, screening for coronary artery disease may be as easy as MRI.
This next on the health show.
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I'm Bob Berrick.
And I'm Dr. Nina Sacks.
Testing for heart disease or the potential for heart disease can go a long way towards
keeping this killer out of our lives.
Now a new imaging technique may make screening for coronary artery disease easier and more
accurate.
Joe Bolinfi from the National Institutes of Health explains.
Coronary artery disease is the most common type of heart disease and is the leading cause
of death in the United States.
Coronary artery disease happens when the coronary arteries, those are the blood vessels that
supply blood to the heart muscle, become hardened and narrowed.
This is due to the build up of cholesterol and other material called plaque on their inner
walls.
Plac build up in the arteries can lead to serious problems including heart attack, stroke,
and even death.
Researchers are now investigating a new way to look at these arteries before any symptoms
of coronary artery disease appear.
So it's almost like trying to image a spaghetti on a trampoline.
Dr. Ahmed Gheri, but the NIH, explains, capturing images of the blood vessels of the heart
is a challenge.
The problem with looking at the vessels that supply the heart is, as you can imagine, it's
a smaller vessel, it's about 2 millimeters, and it's sitting on a moving organ, which
is beating at least 60 to 90 beats per minute, which is also sitting on the diaphragm, which
is what we use to breathe.
But the results of a study using magnetic resonance imaging or MRI technology are promising.
Dr. Gheribe says the new technique is almost cinematic in the way it can capture one still
image that is close to perfect.
It's almost like imaging a race car, and it's moving very fast.
So if you take one shot at it, your chances of success is less than if you take multiple
shots at it, your chances of getting an image with less blur increases.
Researchers have used the MRI technique to measure the thickness of coronary artery
walls in 26 patients who have at least one risk factor for coronary artery disease.
They also measured 12 patients with no risk factors.
We found that this technique is quite successful, not in imaging them, but also is sensitive
and more precise in separating the two groups.
Dr. Gheribe points out that other imaging techniques involve some risk, including exposure
to radiation, whereas this MRI-based option has virtually no risk at all.
It just goes in the scanner and there's no contrast or dye involved.
It's just simply going and lying down for 30 minutes or so.
Researchers emphasize that currently there is no reliable way to non-invasively image
coronary artery disease in its early stages.
And the disease can be treated with lifestyle changes and medications to lower cholesterol.
The potential for this technique, says Dr. Gheribe, is early screening to directly detect
hardening or thickening of coronary artery walls, which is a direct measure of early stage
coronary artery disease.
So somebody with risk factors or things he has problems in that area might come and look
at their vessel wall in the coronary arteries and see if it's thickened or not.
At a certain point, if it is thickened, then we can say, okay, this is a little bit above
the normal.
Dr. Gheribe notes, more research with this technique is needed to better identify exactly
what a normal thickness is for coronary arteries, but if validated, another potential use could
be to test the effectiveness of a drug or other intervention.
Now I can actually see if this is working.
If what I've done has resulted in improvement in this vessel wall.
For more information on this research, visit nidk.nih.gov for details on coronary artery
disease, visit nhlbi.nih.gov.
This is Joe Bolinfi.
When mentally ill young people get into trouble with the law, the first responders to the
situation have a tremendous responsibility.
The way they react often has a large say in the future of those troubled kids.
Joe DeSo from WBEZ and Chicago has the story.
As a 13 year veteran of the Chicago Police Department, Julie Joyce has seen her share of
violent kids, kids who are abusing their parents, her siblings, or others, kids who appear
to be out of control.
And at that moment, she realizes that police officers have a decision to make.
If somebody is in danger of hurting themselves or others, then we have to take the proper
steps to address that.
And I call it talking a person off a ledge.
That's how you should kind of talk to them.
You know, which side do you want them to go over?
Do you want them to fall off the end or do you want them to come to safety?
She does everything she can to bring them back from that ledge.
I talk about my personal life and I tell them, I really do understand what you're going
through.
I'm not sick myself.
No, I'm, you know, never suffered a psychotic episode, but I know what it looks like.
And I know how much you're hurting.
And I'm here really to help you.
I'm not here to hurt you.
So whatever it takes, whatever I can come up with, sometimes we'll have to stand outside
and smoke for a while or sometimes I have to stand there couch and talk for a while.
And sometimes they'll just stand there and scream my face and call me all kinds of
names.
But I think at the end of it, they realize that I'm not leaving and I haven't yet jumped
on them or tackled them or cuffed them or so.
I think it does build that level of trust a little more.
What Officer Joy Soffin tells the subject she encounters at work is that she brings personal
experience to roll call.
She has an 18 year old son at home named Christopher who suffers from ADHD and bipolar disorder.
And he said a rough time early on in his illness, he was wrongly diagnosed and improperly
medicated.
It was corrected but soon came adolescence and with it hormonal changes that only added
to the complications of living with his disorders.
Add teen angst to the mix and it equaled fits of rage.
I always joke about that.
I am professional.
I'm a professional spackler.
I can fix anything with spackle.
Gorilla glue and duct tape.
But it wasn't just the mental illness that Joyce and her son were trying to cope with.
It was dealing with the system that offers few options when things get bad.
Now, Christopher was first in the hospital.
He was 12 years old.
12 year old boy who has to be searched.
Shrip searched.
He wasn't there for drugs or trying to kill himself.
He was there for medication adjustment.
They don't tell you what's going on.
The only time they call you is let's say they called me at one in the morning and say,
Hi, Ms. Joyce.
We had a restrainer son for 15 minutes and 2.5 seconds and then we shot him up.
We took him to a hospital when he had to go.
It killed me.
It's like taking your child to jail.
You know, like my kid did nothing wrong and he would say that, what did I do wrong?
And I would say you did nothing wrong.
We have to get your medication fixed and I can't help you.
And it breaks your heart.
Many families dealing with mental illness refer to the lack of dignity and sensitivity.
They often face at the hands of figures of authority.
Little training or understanding of the complex needs of those living with mental illness
can often exacerbate a tense situation.
This issue exists in many areas of authority, including police departments.
That's why agencies like the National Alliance on Mental Illness or NAMI suggest public
safety officers undergo training on how to deal with mentally ill subjects.
Susanne Andrecaitis is the executive director of NAMI of Greater Chicago.
And she says that when NAMI first approached the Chicago Police Department, they said,
No, we don't need that.
But the incidents continued and it became clear to people inside and out of the police
department that something needed to be done.
So they looked at crisis intervention team training or CIT.
That's a program devised to teach police officers to de-escalate a situation, improve
safety, and provide crisis prevention.
It took a few years, but this led to a pilot CIT program within the CPD.
And the program was a success by most measures.
In the year and a half, two years that they evaluated the pilot program, they documented
465 encounters between CIT trained officers and individuals in the community who were
having a crisis, a mental health crisis.
And there were no injuries to the individuals either.
So both of those things together convinced the Chicago Police Department that this was
a good program.
By the mid-2000s with the help of NAMI and others in the community, Chicago established
its own crisis intervention team training program.
And it's since expanded from the several dozen officers that trained in its pilot program
to today were hundreds of officers that received CIT training.
CIT officers work hard to prevent mental ill subjects from ending up in jail.
They redirect them to services in the community or hospitals.
But it wasn't until a few years after it launched that officer Joyce heard of the CIT program,
and it was a perfect fit, a marriage of her passions, and she jumped on the opportunity.
Following her training, Joyce began working with fellow officers who wanted to
expand their CIT program into a new area.
They worked once again with NAMI and other stakeholders to develop a program for kids
and adolescents.
It wasn't just our ideas, it was everybody's ideas.
So I think collaboratively it's an excellent program, I think.
And it was also great being the first department in the nation to do it.
They now had an advanced CIT training program for youth.
An officer, Julie Joyce, even asked to participate on one of the training panels.
But she didn't do it alone.
She had a partner.
She told my mom I would talk, I would answer any question whatsoever.
We did it together the first time, sink or swim, and it was amazing.
He was amazing.
He really surprised me.
They asked me things like, how do you react to your triggers?
How can we as police officers and how can we as crisis workers?
How can we react to something like this and how can we help cope with the situation?
The decision to go in front of her fellow officers and reveal so much of her personal life,
being talking about her son's mental illness, wasn't an easy one for Joyce.
A lot of stigma is attached, but it's worth it.
For Christopher, for Officer Joyce, and for her brethren and Blue.
One guy was very happy.
He came up, he was like, you know what, to be honest, I'm not going to lie, I thought
this program was dumb.
Came up to think the Lord I met you.
But that's happened numerous times, I think, isn't it?
People have thanked him and hugged him and told him how proud they are of having them.
Slip me 20 bucks in the background, I'm sorry.
And for Joyce, the rewards of watching her son connect with fellow officers like that
meant to hold that more.
Just seeing that, it's almost like he graduated from Harvard.
You know, like you're, I can only imagine what a parent feels like when a kid graduates
from an Ivy League school, but that's kind of how I felt.
Look at him, look at him.
Because if you would have asked me when he was five years old, if we would be sitting,
you know, here or there or anywhere, I could have told you we wouldn't know we were doing
tomorrow.
I mean, I could never fathom that we would come this far.
And then he would be on this journey with me.
By doing the CIT training, he's also speaks more openly, especially around his peers.
So now his peers have started to look at him like a role model and reach out to him
for help.
So it's kind of going full circle.
What was the car ride home like after that first time together?
I just told him how proud I was of him, the whole way home, and then he asked me what was
to eat.
But I also told him, you know, that the one thing that officers would remember was what
he said.
When they're on the street, they're always going to remember your voice is going to be
in their head.
Do this, don't do this, try not to do this.
That will stay with them for the rest of their career.
And that story comes to us from Joe DeSau from WBZ in Chicago.
That's all the time we have for this week's health show.
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You can explore the archive for any programs you might have missed or would like to hear
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I'm Bob Barrett.
And I'm Dr. Nina Sack.
Stay healthy and be sure to join us next time for another edition of the health show.
Dr. Nina Sack is a practicing member of the American College of Gastroenterology.
Bob Barrett is producer of the health show.
Dr. Alan Chartock is executive producer.
The health show is a presentation of national productions, which is solely responsible
for its content.