Heart Health Awareness Month

Hearts fill our Februaries, and not just because Valentine’s Day is around the corner. February is also the month when the spotlight shines brightly on heart health as campaigns to raise awareness of cardiovascular diseases and promote heart-healthy living are featured around the globe.

Cardiovascular diseases are diseases that affect the heart and circulatory system and, according to the World Health Organization, they cause more deaths annually than any other disease worldwide.  While there are many diseases that affect heart health, three of them – coronary artery disease, high blood pressure, and cardiomyopathy – are described below.

Coronary Artery Disease

Coronary artery disease is the most common form of heart disease in the United States and is caused by plaque buildup in the walls of the arteries. The arteries supply the heart with oxygen-rich blood. As the plaque, which is comprised of cholesterol and other substances, accumulates over time, it restricts the passage of blood (and therefore oxygen) through the arteries. This is a problem because a person can suffer a heart attack if the heart is deprived of the oxygen it needs.

Even if a heart attack does not occur, coronary artery disease can damage the heart and lead to other health conditions, such as an irregular heartbeat (also known as arrhythmia), and even heart failure, which happens when the heart is unable to effectively pump blood through the body.

High Blood Pressure

High blood pressure, or hypertension, is a common cardiovascular condition, with more than 3 million new cases per year recorded in the United States. When a person has high blood pressure, it means that their heart is working overtime to supply the body with the oxygen-rich blood it needs. The heart may need to exert more energy for a variety of reasons, including plaque buildup, genetic factors, and certain prescription medications.

High blood pressure can go undetected for years, causing further damage to the heart and arteries over time. If it is uncontrolled, high blood pressure and the damaged arteries it creates can lead to a variety of other health problems, such as organ and tissue damage, heart attack, and stroke.

Cardiomyopathy

Less common than high blood pressure, but still garnering 200,000 new cases per year in the United States, cardiomyopathy refers to a disease of the heart muscle itself. Cardiomyopathy causes the heart muscle to become enlarged or rigid, or in rare cases, causes scar tissue to replace heart muscle tissue. This damage weakens the heart and makes it difficult to pump blood effectively and maintain a steady rhythm, which can lead to heart failure and arrhythmia.

Cardiomyopathy can either be genetically inherited or acquired, meaning a person can either be born with it or develop it over time for one reason or another. There are multiple types of cardiomyopathy and the severity of the disease differs widely from person to person.

Improving Heart Health & Reducing Your Risk

Fortunately, it is possible to protect heart health and reduce your risk of developing or worsening one of these heart diseases. Some key elements of reducing your risk of heart disease and/or managing conditions like those described above include:

• Eating a diet rich in fruits, vegetables, and whole grains
• Avoiding food with added sugar and salt
• Enjoying lean meats, fish, beans, and nuts
• Being physically active
• Not smoking and avoiding secondhand smoke
• Getting regular health checks, even when you feel healthy

As always, speak with a trusted healthcare provider if you are concerned about your heart health, think you should be tested for a specific condition, or if you have any other health concern.

So, as we exchange heart-shaped tokens of affection with our loved ones this February, let’s remember our own hearts and show them some love as well.

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National Eating Disorders Awareness Week

February 21-27 is National Eating Disorders Awareness Week!

Awareness of eating disorders has gone up substantially in recent years. Even if health class in school doesn’t get the message across, pop culture has helped start the conversation about both the physical and emotional tolls eating disorders can have. When it comes to eating disorders, most of the focus is on women, but men are susceptible to eating disorders, too. Let’s look at two common eating disorders – anorexia nervosa and bulimia nervosa – and how they affect both men and women.

Anorexia nervosa, or simply anorexia, starts with a fear of gaining weight and an obsession about body weight that leads to self-starvation and excessive weight loss. For women, this is usually a dramatic decrease in food intake, or no eating at all. For men, this can be associated with compulsive exercise, frequently weighing himself, or a preoccupation with body building. No matter what gender, there is excessive dieting, denial of hunger, or thoughts of being “fat” despite continued weight loss.

Bulimia nervosa, or just bulimia, is characterized by self-induced vomiting to counteract binge eating. This eating disorder is similar for men and women, presenting as a feeling of being out of control while eating a large amount of food, then using laxatives or diuretics to purge the food out and control weight gain. For both genders, this behavior stems from an emotional insecurity about the body’s appearance. Those with bulimia can often fixate on a certain body part (abs, thighs, arms, etc.) and spend inordinate amounts of time working out.

Both of these eating disorders can have severe emotional and physical effects. But what if you start to recognize those symptoms in a friend or family member? How do you start that difficult conversation in hopes of getting them help? This is how the National Eating Disorders Association recommends approaching the subject:

• Set a time to talk – don’t rush the conversation, set aside a time away from distractions to discuss your concerns
• Communicate your concerns – share specific examples of when you were worried and why you think those instances may be indicating a problem
• Avoid conflicts – it’s common for a friend to refuse to acknowledge the problem. Stay calm and re-emphasize your feelings of concern, make sure they know you’re there as a support system rather than an accuser.
• Avoid placing blame – try not to use “you” statements like, “you are acting irresponsibly.” Instead, shift the focus onto yourself with statements like, “I’m concern about you because you haven’t been eating much.”
• Don’t give simple solutions – statements like, “If you would just start eating again, everything would be great,” don’t help and only exacerbate the situation
• Encourage talking to a professional – whether it’s a doctor, a counselor, a nutritionist, or another healthcare professional. If you feel comfortable, offer to go to their first appointment together. Dealing with eating disorders is difficult for both sides, so don’t be afraid to talk to someone about you, as well as your friend.

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Understanding Chiari Malformation

Chiari malformations, also known as Arnold-Chiari malformations, are a defect in the cerebellum, the part of the brain that controls balance. Normally, this part of the brain is housed in a space at the bottom of the skull, above the funnel-like opening to the spinal canal, called the foramen magnum. In people with Chiari malformations, the cerebellum is located below the foramen magnum.

The resulting pressure on the cerebellum and brain stem may affect functions controlled by these areas, such as balance, and block the flow of spinal fluid.

Causes

• Primary or congenital (more common): Caused by structural defects during fetal development, such as genetic mutations or lack of proper vitamins or nutrients
• Acquired or secondary (less common): Spinal fluid is drained excessively from other areas of the spine either due to injury, exposure to harmful substances, or infection.

Classification

Chiari malformations are classified by the severity of the disorder and the parts of the brain that protrude into the spinal canal.

• Type I (acquired): the lower part of the cerebellum (cerebellar tonsils) drops down with no brain stem involvement. May have no symptoms and be noted accidentally when a patient is having tests for a separate issue.
• Type II (classic): involves the extension of both cerebellar and brain stem tissue. The nerve tissue that connects the two halves of the cerebellum (cerebellar vermis) may be partially or completely absent.
• Type III (most serious): Not only the cerebellum and brain stem, but part of one of the brain’s fluid-filled cavities (the fourth ventricle) protrude. This usually causes severe neurological defects.
• Type IV (cerebellar hypoplasia): involves an incomplete or underdeveloped cerebellum. In this rare form of Chiari malformation, the cerebellar tonsils are located in a normal position, but parts of the cerebellum are missing.

What are the symptoms of a Chiari malformation?

Many patients have no symptoms and a Chiari malformation is found by accident. But, the following symptoms may be present:

• Neck pain
• Balance problems
• Muscle weakness
• Numbness or other abnormal feelings in the arms or legs
• Dizziness
• Vision problems
• Difficulty swallowing
• Ringing or buzzing in the ears
• Hearing loss
• Insomnia
• Depression
• Headache (made worse by coughing or straining)
• Issues with hand coordination and fine motor skills

Symptoms in babies and children:

• Vomiting, irritability when being fed, excessive drooling, a weak cry, gagging or vomiting, arm weakness, a stiff neck, breathing problems, developmental delays, and an inability to gain weight

Diagnosis

In order to determine if a Chiari malformation is present, the doctor will first check the following to see if anything is out of the ordinary:

• Cerebellar functions: memory, cognition, balance
• Spinal cord functions: touch, reflexes, sensation, and motor skills

The doctor might want the patient to have an X-ray, CT scan or MRI to conclusively determine if a Chiari malformation is present.

How are Chiari malformations treated?

There are few ways to treat Chiari malformations, and some cases may require no treatment at all.

• People with no symptoms: need no treatment
• Mild symptoms (like pain): treated with analgesics
• More severe symptoms: surgery

Although rare, Chiari malformation is a neurological defect that can affect the daily routine of those afflicted by it. Timely diagnosis and treatment are sought to improve quality of life for these patients.

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Hospital Marketing is Becoming Increasingly Important

Changing health systems and uncertain financial situations are forcing hospitals around the world to better promote themselves to patients and referrers in order to stay competitive. However, marketing measures vary greatly across institutions and countries.

Fotos: Sebastian Forkath

Promotional newspaper at Jianhe County Hospital in China

A Growing Global Trend
A freeway winding through the lush mountains of China’s remote Guizhou Province is flanked by brightly colored billboards advertising care in private hospitals. They are mostly about andrology – medical services for men – but some showcase skin or diabetes treatments. Most of the other billboards praise the region’s famous liquors. High-profile hospital advertisements like these are still a rare phenomenon in China, but they are part of a growing global trend.

While healthcare institutions have been rather reluctant to adopt promotional activities in the past, attitudes are changing. “Most hospitals in the U.S. still spend less than one percent of their total operating revenues on marketing, whereas most retail businesses spend upward of 10 percent,” said Patrick Buckley, a leading U.S. healthcare marketing expert. However, the share of hospital income spent on promotion is very likely to rise in the coming years.
 

“Most hospitals in the U.S. still spend less than one percent of their total operating revenues on marketing.”

Patrick Buckley, U.S. healthcare marketing expert

Directing Patient Flows Towards Your Hospital
Buckley sees marketing as an “absolute necessity,” especially for U.S. hospitals: “The U.S. healthcare system is more competitive than many others.” And competition is what drives marketing. Ironically, patients are rarely eager buyers. Most would rather stay away from what hospitals offer. “However, when a person does have a health-related event that requires treatment, you definitely want your hospital to be at the top of his or her mind,” writes Buckley in his book.1 “Moreover, hospitals and health systems are continually affected by external forces over which they have no control: politics; changes in government regulations; declines in reimbursement; the growth of alternative medicine; the rise of consumerism.” In this changing environment, marketing is one way for hospitals to control patient flows.

Jianhe County Hospital uses flyers to build its image.

Different Styles of Raising Awareness 
This is also true outside of the U.S. A study on private hospitals in Brazil, for example, found that administrators think marketing is highly important. A well-planned and well-implemented marketing strategy might lead to “the attraction of new clients, which generates higher billing and a higher capacity of investment,” say the study’s authors.2 Another study carried out recently in India suggests that marketing in developing countries could influence patients’ hospital choices by addressing such issues as quality of treatment, transport convenience, and cost.3 In many European countries, however, practitioners are a key target group because they act as gatekeepers by referring patients to hospitals.

Of course, the way marketing is conducted varies greatly. The Brazilian study found that clinics with inferior infrastructure and less equipment employ simple forms of promotion, such as direct mailing or newspaper advertisements. Only hospitals with better infrastructure can use more expensive media, such as television. This is different in a richer country like the U.S., as Buckley observes: “Typically, the biggest component of a hospital’s advertising is TV, as it provides an opportunity to convey emotion and to build image. Yet, online advertising is definitely increasing.” Numbers are hard to track, says Buckley, but he estimates that digital advertising makes up around a quarter of hospital advertising spending in the U.S.

                                                                                                                                                                                                                          "People want content.”

Patrick Buckley, U.S. healthcare marketing expert

What Matters Most To Customers
In addition to experimenting with shiny billboards along highways, private hospitals in China are also trying out media advertising and social media. Public hospitals, on the other hand, are not allowed to advertise directly. Instead, they try to cooperate with local media so that they receive positive coverage (such cooperations between public institutions and state media are common throughout China) or they promote themselves via their own websites – though the results are sometimes underwhelming.

A sample study conducted by experts from Shanghai's Fudan University found that only a third of China’s public hospitals currently have their own websites, and that information on medical care and insurance policies often fails to meet the demands of increasingly aware consumers.4
“People want content,” Buckley agrees. Therefore, hospitals should not cling to “vanilla” campaigns, as he calls them (advertising only their advanced technology and concern for patients), but rather should talk about what matters most to their clients: quality and safety.

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