Get ready to ride RAGBRAI

In a few weeks, I will be one of more than 10,000 bicyclists who will spend a week riding across Iowa as part of RAGBRAI (the Register's Annual Great Bike Ride Across Iowa).

 

 It will be the fourth time I've done it, so I've learned a little about how to prepare and a lot about how not to. (This is a picture of me at the end of last year's ride, at the Mississippi River.)

 RAGBRAI, usually a shade under 500 miles, is seven fun but long days on a bike followed by nights in a tent.

 In the coming days I'll be posting some tips about how I get ready. Even if you have no intention of ever riding so far, what I've learned can help just about any cyclist. For instance: You think Floridians can't train to ride hills? I'll show you how.

 For background on RAGBRAI, go to the official site or read a piece I wrote two years ago about the experience .

--Jim Verhulst, Times staff writer

Exercise: attitude adjustment

Do some physical activity this week to strengthen your heart, your bones, or as a stress reliever, instead of doing it for a smaller clothing size. The change in perspective may be all it takes to get you off the couch and back in action.  

Irene Maher, Staff Health Writer

Meatless Monday

Eat one meatless meal today. Just give it a try. Make a mushroom lasagne or chunky chili with diced tomatoes, bell pepper and corn served over rice, brown preferably. Without really trying you'll likely boost your fiber intake and reduce saturated fat, two very heart healthy things to do.

Irene Maher, Staff Health Writer

What stopped Michael Jackson's heart?

Michael Jackson was anything but a typical middle-aged American man.

And he certainly didn't fit the popular image of a guy at risk for sudden cardiac arrest. An overweight, hard drinking, 60-something male, who smokes and lives on fast food, yes. But not thin-as-a-rail, dancer extraordinaire Michael Jackson, who died Thursday at age 50 as he was about to embark on a series of London performances. (When this photo was taken in March, he was announcing those shows, which promptly sold out).

What might have happened to stop his heart?

Reports that he might have received a high dose of Demerol, a synthetic narcotic similar to morphine, were rampant Friday. The Los Angeles County Coroner's Office was expected to hold a press conference later tonight, although it could be weeks before complete toxicology reports are complete.

But even beyond the Demerol, some Tampa Bay area medical experts say it's not difficult to imagine the possibilities.

In cases of sudden cardiac arrest, cardiologists first suspect undiagnosed coronary artery disease, small plaque deposits  in the arteries of the heart, said Tampa cardiologist John Dormois. This is the bad cholesterol we hear so much about. These  deposits become a problem if their thin covering ruptures, launching a potentially deadly chain of events.

First, the body responds to the rupture by signaling the blood to immediately form clots. These clots quickly fill the artery and within minutes can completely block blood flow to the heart and other vital organs. This interruption in blood flow throws the heart into a potentially lethal, abnormal rhythm, where it quivers rather than beats steadily. When that happens, the patient needs immediate CPR or an AED, a mechanical device that shocks the heart back to a normal rhythm. “If not restored within 5 minutes, the patient will most certainly suffer brain damage. After 10 minutes there is no chance for recovery. You probably die,”  Dormois said.

    

Next on the list of possible causes of cardiac arrest is a drug interaction. “This is a big concern,” says University Community Hospital interventional cardiologist Carlos Leche. And it doesn't have to be anything exotic. Over-the-counter medications commonly taken for colds and flu can interact with common prescription drugs, triggering an abnormal heartbeat. “The group that we’re most concerned with are antibiotics known as quinolones,” says Leche. They are prescribed to treat everything from nail fungus to pneumonia.

Quinolones are particularly dangerous when combined with medications for anxiety, pain, insomnia and some older antidepressants. Together, they can set off a deadly electrical storm in the heart. That’s one of the reasons doctors always ask patients about all their medications.

“We always tell our patients to ask us first before taking anything prescribed by another doctor, to make sure it’s safe,” Dormois said.

Doctors must rely on their patients for this critical information or on an alert pharmacist who catches a potential problem before filling a prescription. But that isn’t fool-proof.

“When patients have prescriptions filled at several different pharmacies, there’s no way to check for drug interactions,'' said Tampa General Hospital Pharmacist Drew Silverman. Some chronic pain sufferers, he said, deliberately fill prescriptions all around town, so it doesn’t appear to any one pharmacist as though they are taking too much of a particular drug.  

Finally, sudden cardiac arrest can result from an overdose of any sedating medication, whether taken alone or in combination with other drugs. One such drug is Demerol. In high doses, sedatives can suppress the part of the brain that controls respiration, causing you to stop breathing. “Your blood oxygen level goes so low, it can trigger sudden cardiac arrest,”  Leche said. 

Bottom line: Michael Jackson was no ordinary man. But the experts agree that his sad end  is an opportunity for people who think they are safe from a cardiac disaster to reconsider, and take health precautions that could save their lives.

Irene Maher, Times staff writer

Photo: AP

Beat the heat: Don't forget Fido and Fluffy

Our theme this week is how to beat the heat. Don't forget, heat can hurt pets, too. Never leave a pet in a car on a hot day, even if the windows are cracked. Go out for play or walks in the early morning or late evening. Remember that older and overweight pets are more likely to overheat. Also be aware that asphalt, concrete, brick and decking material can be very hot under your pet's feet. If pets must stay outside, provide shade, cool water and protection from storms. This link may also be helpful.

Irene Maher, Staff Health Writer

Know the signs of heat stroke

I've been spending some time at sports camps this week, for both personal and professional reasons. I've been taking my son to a baseball camp at Ed Radice Park in northwest Hillsborough County, and I also spent some time at the Spartan Baseball Camp at the University of Tampa for a story I wrote this week on safely exercising in these brutally hot conditions.

It's been good to see coaches at both camps giving kids frequent water breaks and time in the shade. And it's also been good to see the kids carrying coolers packed with lunches and plenty of drinks.

Heat stroke and heat exhaustion are serious conditions. Below are some tips from the Centers for Disease Control and Prevention for recognizing warning signs of heat stroke, and what to do if you see someone with these warning signs.

Warning signs of heat stroke may include:

- An extremely high body temperature (above 103°F)

- Red, hot, and dry skin (no sweating)

- Rapid, strong pulse

- Throbbing headache

- Dizziness

- Nausea

- Confusion

- Unconsciousness

What should I do if I see someone with any of the warning signs of heat stroke? 
 
If you see any of these signs, you may be dealing with a life-threatening emergency. Have someone call for immediate medical assistance while you begin cooling the victim. Do the following:

- Get the victim to a shady area.

- Cool the victim rapidly, using whatever methods you can. For example, immerse the victim in a tub of cool water; place the person in a cool shower; spray the victim with cool water from a garden hose; sponge the person with cool water; or if the humidity is low, wrap the victim in a cool, wet sheet and fan him or her vigorously.

- Monitor body temperature and continue cooling efforts until the body temperature drops to 101-102°F.
If emergency medical personnel are delayed, call the hospital emergency room for further instructions.
Do not give the victim alcohol to drink.

- Get medical assistance as soon as possible.

(Photo: flickr.com)

Richard Martin, Times Staff Writer

Health and numbers: How much do you want?

So I'm at a conference on health reporting for the next few days. And we're learning lots about ways to interpret -- and manipulate -- the kind of medical statistics that are the nuts and bolts of research.

Moral of the story: It's supposed to help me do a better job of conveying information to you.

But the academic-types teaching us think readers deserve a lot more specific numbers that we tend to give them in the print media, where the rule of thumb is the fewer numbers the better, because they just make reader's eyes glaze over.

Any thoughts? Is it enough know that a certain drug would reduce your risk of, say, a heart attack by 33 percent? Or would it be valuable to know that 2 in 1,000 people on the drug experienced a heart attack, compared to 3 in 1,000 without it?

My take: More information is clearly valuable, if I can write about it in plain English.

-- Letitia Stein, Times health reporter

Beat the heat: Who's at risk?

Our theme this week is how to beat the heat. You don't have to be running on a sun drenched beach at noon to develop heat illness. Adults over 65, children age four and younger, very overweight people, and anyone with a medical condition like heart, kidney or lung disease could be at risk for heat illness even with very limited activity. If they are outside or don't have access to air conditioning, check on them for symptoms several times a day. Extreme heat can cause confusion; they may not be able to ask for help. According to the CDC, an electric fan cannot prevent heat illness.

Irene Maher, Staff Health Writer

Are you uninsured by choice?

People assume that most Americans without health insurance simply cannot afford it. But U.S. Census figures paint a more complicated picture. Among the estimated 45 million uninsured Americans are 17.6 million who have annual household incomes of $50,000 or more. Even more surprising, 9.1 million uninsured Americans earn more than $75,000 a year. That means many Americans are simply choosing to live without health coverage.

This could create a bit of an issue as President Obama and Congress work to overhaul the nation's health system. One of the things they've been talking about is requiring every American to have health insurance.

If you're uninsured by choice, we'd like to hear from you. Contact health writer Richard Martin at rmartin@sptimes.com or at (727) 893-8330.

Crunches: BAD for your health!?!

This has to rank up with research showing that chocolate has health benefits as the Best News Ever.

The exercise torture known as "the crunch" may be doing a lot of us as much harm as good, according to an intriguing feature in the New York Times magazine. What's more, the whole concept of "core" workouts may be flawed.

The piece explores the "mythology" oh-so-popular popular among fitness trainers that core strengthening should focus on the abdominal muscles. You know these drills: Suck in your belly while doing crunches, or curl up very slowly, focusing on one spinal ligament at a time.

You may get six-pack abs. But the regimen may also hurt your back.

The key is how much pressure you're putting on your spine. A fitness expert interviewed in the piece, Stuart McGill, a professor of spine biomechanics at the University of Waterloo in Canada, suggests that we'd be much better off thinking of a core workout in terms of all the muscle groups around the spine. That includes the abs, but isn't focused exclusively on them.

Kinda makes sense, huh? I always get little scared during the Pilates move when you curl up on your spine, pushing your legs in the air, so your body resembles a side-ways "J." If I move my head, will something snap, I'd wonder, debating whether to look at the instructor and see if my form was correct.

Be sure to check out the New York Times video highlighting "right" and "wrong" exercise moves for core strengthening. But be warned. It may not be "all abs, all the time," but it doesn't look easy. The move called "stirring the pot" isn't for the lazy!

-- Letitia Stein, Times health reporter