Month: February 2017

The holiday season is officially under way and with that comes much entertaining, rich food and, sometimes, overeating. Everyone wants to celebrate, but moderation should be the watchword. Today, more than two thirds or 68.8 percent of Americans are overweight or obese, including 74 percent of adult men, according to the American Heart Association. One in three children is considered overweight or obese, a number that has tripled since 1971. Being overweight isn’t just about how you look or what clothes you can wear, it affects your health, your quality of life and, in fact, your life span.

Those who are overweight, and especially those classified as obese, are at risk for heart disease, diabetes, hypertension, asthma, GERD and sleep apnea. Let’s talk about these risks and what you can do to achieve and maintain a healthy weight.

How does being overweight affect my heart? Each extra pound forces your heart to do more work even when accomplishing basic tasks such as getting up, walking or climbing stairs. When you think of this extra load weighing on your heart day after day, year after year, you can see how it can take a toll. Many people who are overweight also have high cholesterol. Sometimes this is because of the foods that they eat, other times it can be genetic. When you have high cholesterol, you have fatty deposits within your arteries. If these deposits become thick enough, they can greatly narrow your arteries, thus making it difficult for blood to flow. In some cases, the cholesterol builds up to the extent that arteries become blocked, which can lead to a heart attack or stroke.

When your body is carrying extra weight, the strain can elevate your blood pressure. Elevated blood pressure is called hypertension. If your blood pressure gets too high, and is left untreated, it can lead to heart attack or stroke.

Those who are obese are also at risk of developing metabolic syndrome. Metabolic syndrome is not a disease but a cluster of symptoms that greatly increases your risk of heart disease, stroke and diabetes. These include having high blood pressure, having high blood sugar, having high cholesterol, and having excessive weight around your abdomen. It is estimated that one in six Americans (47 million) have metabolic syndrome.

As you can see, being overweight affects your heart in multiple ways, and it is often this combination that leads to heart disease or an early death.

How does being overweight lead to diabetes? Being obese almost by default causes insulin resistance, which can eventually lead to Type II diabetes. Diabetes, combined with the health issues already facing someone who is significantly overweight, greatly elevates your risk for heart disease.

How does being overweight lead to asthma? According to the American Thoracic Society, recent studies have shown that obese children and teenagers were twice as likely to have asthma as those with a healthy body weight. Other studies have shown that it is more difficult to manage asthma in the obese. In fact, one study showed that obese adults with asthma are almost five times more likely than non-obese asthmatics to be hospitalized because of breathing issues. Studies of mice have shown that obese mice react more strongly to allergen and pollution triggers in terms of constricted airways. I was involved in research in the University of New Hampshire with Dr. Anthony Tagliaferro, a professor of nutrition in its Department of Molecular, Cellular and Biomedical Sciences. Our study, which was conducted with women only, clearly demonstrated the ties between inflammation, obesity and asthma. We were trying to determine whether insulin resistance was the trigger that led obese people to develop asthma. At this time, this has not yet been proven, but our research pioneered that of others in showing that there is definite connection between obesity and asthma.

Obesity plays a role in part because asthma is a disease of inflammation — specifically, inflammation of the lungs. Those who are obese seem to suffer from a chronic, low-grade inflammation throughout their body, which makes them more prone to developing asthma. In addition, the lungs of obese people are under-expanded so they are forced to take smaller breaths. This forces their airways to become more narrow and more prone to irritation, which makes them susceptible to asthma.

The facts are that asthma in obese individuals is more severe, does not respond as well to treatment, and is becoming a major public health issue.

How does being overweight lead to GERD? Gastroesophageal reflux disease or GERD is a chronic digestive disease. It occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe or esophagus. The backwash of this acid, or reflux, irritates the lining of your esophagus and causes GERD. Both acid reflux and heartburn are common digestive conditions that many people experience on occasion. However, when these symptoms are experienced at least twice each week or interfere with daily life, or if your doctor can see damage to your esophagus, then you may have GERD. Left untreated, GERD can lead to serious lung disease, including interstitial pulmonary fibrosis; the backwash of stomach acid can also get into the lungs, causing chronic irritation. (See Dr. Windt’s October 2016 column on pulmonary fibrosis for details.)

In 2006, the New England Journal of Medicine published a study that noted that even small changes in weight in a normal-weight person can trigger the onset of GERD or increase the severity if you already have acid reflux. The study outlined a clear correlation between an individual’s body mass index (BMI) and the presence of GERD symptoms. Investigators found that people who were overweight (as defined by a body mass index of 25 to 30), were almost twice as likely to develop acid reflux as those of normal weight, and people who were obese (a BMI greater than 30) had nearly triple the risk of GERD symptoms such as heartburn, acid regurgitation, chest pain, and difficulty swallowing. Even more surprising was the fact that small gains in body weight in a person of normal weight (BMI of 21 to 25) also increased the likelihood of developing GERD.

Why does this happen? Abdominal obesity seems to be the culprit. Too much fat in the abdomen compresses the stomach, increasing its internal pressure and triggering acid reflux. In addition, overweight people tend to eat fatty foods, which in turn causes more episodes of heartburn.

How does being overweight lead to obstructive sleep apnea? Obstructive sleep apnea is a common and serious disorder in which breathing repeatedly stops for 10 seconds or more during sleep. The disorder results in decreased oxygen in the blood and can briefly awaken sleepers throughout the night. Besides repeated awakening during the night, symptoms include daytime sleepiness and loud snoring when asleep. Sleep apnea has many different possible causes, but in adults, one of the most common causes is excess weight. This is because the excess weight affects the soft tissue of the mouth and throat. During sleep, when throat and tongue muscles are more relaxed, this soft tissue can cause the sleeper’s airway to become blocked. Left untreated, obstructive sleep apnea can lead to serious complications, including cardiovascular disease, accidents and premature death.

What can be done? The good news, for all of these conditions, is that better health and better quality of life are achievable by losing weight. Often, even a small weight loss can have a big impact in terms of improvement. For example, with GERD, if you lose just 10 percent of your weight — a relatively reasonable goal — you can significantly ease your GERD symptoms or reduce the frequency of symptoms. There are no similar “magic” weight-loss numbers for asthma, diabetes, COPD or heart disease, but losing weight will improve those conditions, sometimes dramatically.

Dr. Mark Windt is an allergist, immunologist and pulmonologist who has been treating allergies, including food allergies, and respiratory illnesses, for more than 30 years. He is the medical director for the Center for Asthma, Allergy and Respiratory Disease in North Hampton, a facility he started in 1985. Dr. Windt is also an adjunct professor at the University of New Hampshire and founder of the Probiotic Cheese Company (www.theprobioticcheesecompany.com). For information, visit www.caard.com or call 964-3392.

Opioid deaths continued to surge in 2015, surpassing 30,000 for the first time in recent history, according to CDC data released recently.

That marks an increase of nearly 5,000 deaths from 2014. Deaths involving powerful synthetic opiates, like fentanyl, rose by nearly 75 percent from 2014 to 2015.

Heroin deaths spiked too, rising by more than 2,000 cases. For the first time since at least the late 1990s, there were more deaths due to heroin than to traditional opioid painkillers, like hydrocodone and oxycodone.

In the CDC’s opioid death data, deaths may involve more than one individual drug category. Many opioid fatalities involve a combination of drugs, often multiple types of opioids, or opioids in conjunction with other sedative drugs like alcohol.

In a grim milestone, more people died from heroin-related causes than from gun homicides in 2015. As recently as 2007, gun homicides outnumbered heroin deaths by more than five to one.

These increases come amidst a year-over-year increase in mortality across the board, resulting in the first decline in American life expectancy since 1993.

Congress recently passed a spending bill containing $1 billion to combat the opioid epidemic, including money for addiction treatment and prevention.

Much of the current opioid predicament stems from the explosion of prescription painkiller use in the late 1990s and early 2000s. Widespread painkiller use led to many Americans developing dependencies on the drugs. When various authorities at the state and federal level began issuing tighter restrictions on painkillers in the late 2000s, much of that demand shifted over to the illicit market, feeding the heroin boom of the past several years.

Drug policy reformers say the criminalization of illicit and off-label drug use is a barrier to reversing the growing epidemic.

“Criminalization drives people to the margins and dissuades them from getting help,” said Grant Smith, deputy director of national affairs at the Drug Policy Alliance. “It drives a wedge between people who need help and the services they need. Because of criminalization and stigma, people hide their addictions from others.”

DURHAM — The NH Agricultural Experiment Station will host a spring seminar series at the University of New Hampshire featuring distinguished researchers who will discuss various aspects of sustainable agriculture.

The first seminar is set for Monday, March 6. The seminars are free and open to the public, and will be held from 1:10 to 2 p.m. in James Hall, Room 46.

The following guest speakers and topics are scheduled:

■ March 6: Chuck Nicholson, Penn State, “Environmental and Economic Impacts of Localizing Food Systems: An Empirical Analysis of Dairy Supply Chains in the Northeastern United States.”

■ March 20: Michel Cavigelli, USDA/ARS, Beltsville, MD, “Long-Term Agricultural Research at the Farming Systems Project.”

■ March 27: William Tracy, University of Wisconsin, Madison, “Breeding Sweet Corn for Organic Systems.”

■ April 3: Michael Timmons, Cornell University, “Developing Sustainable Aquaculture Through Aquaponics: Reflecting on 30 Years of Recirculating Aquaculture Research.”

■ April 10: Dewayne Ingram, University of Kentucky, “Analyzing Landscape Plant Production Systems and their Potential Environmental Impact and Cost using Life Cycle Assessment.”

For additional information, please contact Anita Klein, NH Agricultural Experiment Station faculty fellow, at anita.klein@unh.edu. Information on parking is available at https://www.unh.edu/transportation/visitor-parking.

This seminar series is supported by the NH Agricultural Experiment Station, through joint funding of the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the state of New Hampshire; UNH College of Life Sciences and Agriculture; and Celebrate 150: The Campaign for UNH.

ROCHESTER – Cindy King, who has chronic obstructive pulmonary disorder, feels a sense of security knowing that regular visits from Frisbie’s paramedics not only help her to manage her disease, but that they may reduce the need for her to be readmitted to the hospital.

King, a Rochester resident, is part of a new pilot program that helps monitor patients recently released from Frisbie Memorial Hospital, a move that helps not only the patients, but also reduces hospital readmission costs through preventable hospitalizations.

Frisbie’s Mobile Integrated Healthcare Program is designed to mitigate gaps in care — post hospital discharge — and reduce chronic disease-related health complications by bringing medical services to the homes of individuals who have primary diagnoses of chronic obstructive pulmonary disease and congestive heart failure. The model employs community paramedic providers to better promote continuity of care, standardize chronic disease management and improve overall health outcomes.

Gary Brock, director of EMS for Frisbie, said they had applied for a grant through the Institute for Health to begin the mobile program, and when they didn’t get the grant, the hospital administration decided to fund a pilot program. Brock said they began with COPD and CHF patients on a part-time basis. They hope to continue and expand the program to encompass additional medical conditions, possibly including substance abuse disorders in the future.

“Eventually, we would like to be able to offer the service to all who are considered high users of the hospital,” Brock said. “That means people who are frequently admitted or seen in the emergency room. It’s a win for the patient and for hospital costs. The administration saw the value in that we may reduce admissions through better overall management of population health, allowing the hospital to recoup the costs of readmissions. We are bridging the gap between the release of a patient from the hospital and their ongoing care. Sometimes people do not know how to get the equipment they may need and we will help. We can educate them about taking better care of themselves, and we can monitor their health.”

Specifically, Community Paramedic Providers will provide follow-up care for patients discharged 24-36 hours from hospital and at high risk for emergency department utilization and/or hospital readmissions.

The CPP will assess the patient’s home for safety issues, assess prescriptions and conduct medication reconciliation, provide education on medical condition(s) and resources available to patients, provide support for patients with medical conditions deemed at high risk for emergency department utilization and/or hospital admissions and integrate acute and primary care in homes by using interactive, mobile technology and electronic medical records to relate evaluations and assessments to a medical team.

Brock said they have had 19 inquiries about the service already and are actively seeing seven people. They make daily phone calls to the residents in addition to their scheduled visits.

King, 58, said she has become close with paramedic Valeri Previe, who visits her regularly and offers her that sense of security.

“I went into the hospital with bacterial pneumonia,” King said. “No one told me about cleaning out my nebulizer. Now Valeri teaches me how to take better care of myself, so things like that do not fall through the cracks. She’s like my bridge to better care.

“When we started the program, we weren’t sure how the residents would feel about us coming into their homes,” Previe said. “What we found is that they welcome us, because it helps them feel more secure, knowing someone is looking out for them. Our visits are not chaotic like most EMS visits to their home would be in an emergency. Its relaxed and Cindy likes when I come.”

Previe’s help for King began immediately. She assessed her medication and discovered a discrepancy that she corrected through King’s doctor.

“We found she had two medications with the same purpose, one she had been taking before her hospitalization and a second added after,” said Previe. “We also discovered her heart rate was high and recommended a heart monitor. The doctors listened to our concerns and hers, agreed and we made the adjustments.”

Brock said their purpose is not to compete with home care services. He said many of the people they see are not home bound, are not eligible for home care but can still benefit from someone checking in and keeping an eye out for them.

“We are the first in the state to offer this service through the hospital,” Brock said. “We started in October and are part time, but we hope to eventually be running seven days a week, full time. This actually offers a whole new career path for EMS.”

King is still employed and wants to continue working. She is not ready to retire but feels a sense of security knowing if she needs them, the paramedics will come to her place of employment, too. By monitoring her, the hope is that she does better at home, can return to work and the need for hospitalization is reduced.

“I used to panic, which of course made things worse for my breathing,” King said. “I was embarrassed about the number of times I went for help, so I went from hospital to hospital. Now, I know I can call Valeri. I feel calmer and don’t immediately think I am dying.”

“For most of the people we are seeing this way, the outcomes have been very positive,” Brock said. “We are exploring the idea of at home electronic monitoring, for things we can track by computer and add another level of oversight. That may reduce the need for us to visit as often.”

“She is a trouper,” said Previe, of King. “She wants to maintain her normal and we feel like we can help her to do that. We come and check her vitals to track her condition. We watch for red flags and can address them before they become serious enough to require hospitalization. For Cindy, her lungs are like a campfire with burning embers. One infection can be enough create a breeze and to fan the fire. We can see it right away, where she might not.”

Members of the mobile team keep detailed logs of the care they give, and share information with the person’s primary care physician. They are compiling data to show the value of the service at the same time.