1. Healthy Aging: The Top 3 Killers Lecture notes 8/1 Healthy Aging

2. What are the top 3 killers? Heart Disease-Top killer, and 2nd cause of disability. Several million deaths/yr.in US Heart Disease-Top killer, and 2nd cause of disability. Several million deaths/yr.in US Cancer-2nd leading cause of death w/ 2 million deaths/yr. in US, 5 million new diagnoses/yr. Cancer-2nd leading cause of death w/ 2 million deaths/yr. in US, 5 million new diagnoses/yr. Stroke- 3rd leading cause of death w/ >150,000 deaths and many more disabled Stroke- 3rd leading cause of death w/ >150,000 deaths and many more disabled

3. Heart Disease- Assessing the Risks Some risk factors Some risk factors –high blood pressure –smoking –sedentary –family history of heart disease –overweight –high saturated fat diet –STRESS!

4. Heart Disease- Patient presentation Chest pain or dizziness with exertion Chest pain or dizziness with exertion Pain in arm, jaw, neck, shoulder, ribs Pain in arm, jaw, neck, shoulder, ribs Heart Failure-Fatigue, pallor, dyspnea, pitting edema (right-venous edema Vs. left-lung edema) Heart Failure-Fatigue, pallor, dyspnea, pitting edema (right-venous edema Vs. left-lung edema) Coronary Ischemia- Syncope, confusion, dyspnea, chest pain Coronary Ischemia- Syncope, confusion, dyspnea, chest pain What about women and heart disease? What about women and heart disease?

5. Heart: HPP Increase water consumption Increase water consumption Decrease fat (increasing fruits/veggies) Decrease fat (increasing fruits/veggies) Higher fiber diet (wheat bran/oats) Higher fiber diet (wheat bran/oats) Physical Activity!!! Physical Activity!!! Weight reduction Weight reduction Stop smoking! Stop smoking! Stress management/reduction Stress management/reduction

6. Other health promotion thoughts... Supplementation-Vit. A, E, C, B Supplementation-Vit. A, E, C, B Use less salt, eat less fat Use less salt, eat less fat Limit alcohol use Limit alcohol use Mediterranean Diet-higher in fiber, fruits, veg, fish, omega 3 fatty acids, lower in fat and red meat Mediterranean Diet-higher in fiber, fruits, veg, fish, omega 3 fatty acids, lower in fat and red meat Biofeedback, yoga, breathing exercises, or other natural stress management strategies Biofeedback, yoga, breathing exercises, or other natural stress management strategies

7. Cancer - Skin Skin-most common CA (1 in 3 will get skin cancer) Over 1 million new cases/year and 10,000 deaths/year Skin-most common CA (1 in 3 will get skin cancer) Over 1 million new cases/year and 10,000 deaths/year 100% curable, if detected early 100% curable, if detected early Prevention- Wear sun screen and a hat, limit sun exposure Prevention- Wear sun screen and a hat, limit sun exposure Early detection: A, B, C, D! Early detection: A, B, C, D!

8. Early Detection Is The Key! A=Asymmetry of lesions A=Asymmetry of lesions B=Border’s irregularity B=Border’s irregularity C=Color variation C=Color variation D=Diameter >6mm or growth of sm. Lesion D=Diameter >6mm or growth of sm. Lesion –Give the patient a look, measure, draw pictures, take notes, re-assess regularly –you may be the only one to LOOK at the patient’s back and neck over several years

9. Cancer- Lung Leading cause of cancer death Leading cause of cancer death 25% of metastases to spine are from lung 25% of metastases to spine are from lung Prevention Prevention –Stop smoking! –Wear masks if the job demands –Avoid radon exposure

10. Cancer: Prostate and Breast 2nd leading cause of cancer death 2nd leading cause of cancer death 60% of spinal metast. from prostate 60% of spinal metast. from prostate Prevention Prevention – Lower fat intake/alcohol intake –Saw palmetto, Stinging nettles –Regular health screenings Annual DRE and PSA males > 50 (0ver 40 ?) Annual DRE and PSA males > 50 (0ver 40 ?) Monthly breast exams and bi-yearly mammograms (females > 45 or > 40 w/ risks) Monthly breast exams and bi-yearly mammograms (females > 45 or > 40 w/ risks)

11. Cancer: Colon Cancer: Colon Strikes 1 in 17 people (US) Strikes 1 in 17 people (US) 55,000 deaths/year in the US 55,000 deaths/year in the US Risks: Fam. History, high fat, low fiber diet, chronic constipation Risks: Fam. History, high fat, low fiber diet, chronic constipation Preventable-(yrly screen: fecal o. blood) Preventable-(yrly screen: fecal o. blood) –High fiber diet (30 grams/day), add CA++ –Lower fat in diet –Water!

12. Stroke 3rd leading cause of death 3rd leading cause of death 150,000 deaths/yr in US 150,000 deaths/yr in US Risk factors Risk factors –High BP –Prevent/reduce atherosclerosis –Overweight –Stress –Sedentary

13. Stroke- Patient Presentation Unusual visual disturbances Unusual visual disturbances unusual speech disturbances unusual speech disturbances unusual weakness or sensations in extremities unusual weakness or sensations in extremities dizziness dizziness syncope syncope HEADACHES-focal, progressive worsening of neurological loss HEADACHES-focal, progressive worsening of neurological loss

14. Stroke Prevention Quit smoking Quit smoking Increase physical activity!! Increase physical activity!! Lower BP, cholesterol, weight (monitor) Lower BP, cholesterol, weight (monitor) Diet- Diet- –Increase fish, fruits, veggies, grains in diet –Increase vitamin C, B, K+, CA++, Mg+ –Decrease meat based proteins and fat