Heartfelt with Dr Melissa Walton-ShirleyView all posts »
My Valentine to President Clinton: Niacin and a three-hour glucose-tolerance testFeb 14, 2010 21:52 EST
After Super Bowl Sunday there are always lots of armchair quarterbacks. However, on theheart.org forum, they weren't giving tips on how the Saints could have secured their win more easily. Comments have come fast and furious in an effort to help former President Clinton achieve a normal life expectancy. Some have been critical of the steps that led to his circumflex-artery stenting, yet others have wondered aloud if he's been given every advantage possible from current lipidology and medical-management strategies. I questioned whether or not glucose intolerance might be the secret driving force behind his disease progression. Ultimately, I wonder if our unsolicited advice should even be simpler.
The answer to our former president's healthcare woes is likely rooted in a statement he made in the first chapter of his book My Life. He spoke about the memory of his father, who drowned in a single-vehicle rollover just before he was born. He said it "infused" him "at a younger age than most" with "a sense of mortality. The knowledge that I too could die young drove me both to try to drain the most out of every moment of life and to get on with the next big challenge. Even when I wasn't sure where I was going, I was always in a hurry."
Although there's really nothing wrong with grabbing hold of life with both hands, it can be a problem if there's no time for proper exercise, appropriate diet, regular follow-up, and compliance with medications. Patients often ask me post-CABG if they can continue to work. I always answer that "work is good for all of us, but it's the schedule that can be a killer." I don't want any patient to work long hours to the exclusion of a lifestyle that allows for healthy choices. I strongly recommend the avoidance of night-shift work. I insist on regular exercise at least five days per week. I direct healthy food choices--ie, the Mediterranean diet and plenty of water for normal-EF, normal-GFR individuals. I recommend lower sodium intake and avoidance of trans fats. I direct many of our patients to a secondary-prevention clinic where Berkeley panels often unearth high insulin levels, abnormal HDL sub fractions, and the need for the addition of fish oil and niacin.
It's no secret that former President Clinton continues to burn the candle at both ends, often crisscrossing the globe. He seems to participate in every opportunity imaginable to contribute something to the world. His activities range from hostage negotiation to the oversight of rebuilding earthquake-ravaged Haiti. All of these missions are admirable and quite frankly, exactly what make Bill Clinton, well, Bill Clinton. However, if he's busy to the point that he can't get on his treadmill regularly, get the proper amount of sleep, stay on schedule with meds, make his stress appointments, or get his lipid profiles checked, he's working for the good of the world but to his own detriment. I must insist that he follow his own advice. To borrow a phrase from his 1993 message to the joint sessions of Congress on healthcare reform, he made the point that "we have to change our ways if we really ever want to be healthy." Although he was referring mostly to our US healthcare system in general, there would be no better advice to give someone who has been diagnosed with coronary artery disease. In that speech, he did hint at personal responsibility, and although he may be making a valiant effort, now would be a good time to examine all the issues surrounding his latest episode of unstable angina.
President Clinton, my wish for you is to "be healthy," and since it's February, Heart month, here's my Valentine to you: It's a heart-shaped box containing a three-hour glucose-tolerance test, a bottle of niacin, some fish-oil capsules, fresh nitroglycerin, eight hours of sleep per day, an hour of exercise five days per week, the Mediterranean diet, a quiet dinner with your wife, and a nice long phone call from Chelsea. I'll add a six-month follow-up with your cardiologist, including a lipid profile, BP check, annual echo, and stress cine. Continue on with your statin, your aspirin, your beta blocker, and your brand-new clopidogrel (or prasugrel?) prescription. By all means, carry on with your quest for a better world, but remember, your family and your admirers will always think it will be a better world with you in it.