By James Hubbard, M.D., M.P.H.

Retirement before age 65 increases your risks of heart disease and stroke. Researchers posted a study in the March 1, 2008 issue of the American Journal of Epidemiology after studying 16,827 Greek men and women for 7.7 to 12.5 years. Retirement age ranged from less than 45 to over 65. For every 5 extra years of working the total deaths were ten percent less than the retired at that age.

They took into account variables such as weight, activity, smoking, alcohol and gender. At enrollment they excluded people with chronic diseases such diabetes, stroke, cancer and heart disease. Most of the increased deaths seen in the early retirees were from heart diseases and strokes.

The cause of the increased mortality is unknown. I have often speculated about people who seem to be healthy and work into older ages, then when they finally retire tend to die soon afterwards. I have wondered whether it was just their age, or if they had lost a major reason for living. This study seems to lean toward the latter.

But that does not mean that there are a lot happy, early retirees who live long lives. Perhaps it has something to do with having a purpose to live, for instance, family, friends, hobbies or volunteering.

By James Hubbard, M.D., M.P.H.

I went to get my sleep lab test results from my pulmonologist (lung doctor) but only the preliminary report was available. My AHI (apnea-hypopnea index) score was 68. This is how many episodes of apnea (stop breathing) and hypopnea (decreased air movement to the lungs) I had per hour. An AHI over 30 is considered severe.

He ordered a cpap (continuous positive airways pressure) machine. It keeps my airways open while I am asleep so that I breathe properly. Within 2 days the company had called and I went in to be fitted. I would suggest you do this rather than just having the cpap mailed to you.

At the oxygen supply company I tried on several types of masks to see which one I liked. There were masks that covered the mouth and nose along with nasal biprongs that just seal your two nostrils. I chose a mask that covers the nose with a gel foam seal. It has a connector that rotates 360 degrees that then connects to airway tubing. The tubing consists to the main machine, which measures 8 1/2 inches wide, 8 1/2 inches long and 4 inches tall. Everything is portable enough for travel.

The main machine plugs in to a wall outlet and is quiet. It has a filter, heater and humidifier. The company programmed it to the proper amount of room air pressure (found during my sleep study) that blows into my nose (to keep my airways open). She said it may take a few weeks to get used to this pressure. I tried it. The air pressure stops blowing when i breathe out. It will take a little getting used to that aspect because I note some initial resistance to the initial part of my expiration. I will need to clean the tubing every few days and the filter every month.

In a week or two I will let you know how it is going.

By James Hubbard, M.D., M.P.H.

I forgot to mention some more hookups. There was a small microphone taped to the front of my neck to monitor snoring and a wire attached to both lower legs to watch for leg movements.

I took a sleeping pill (Ambien) that I had brought with me. They said it was ok to do. They wanted me to get some sleep or the testing was useless. I had very little trouble getting to sleep. The attached wires were not uncomfortable but it did take a little effort to make sure the wires to the portable device did not get tangled when I turned over.

During the night the nurse came in to hook me up to a CPAP (Continuous Positive Airway Pressure) machine. She said her tests were showing that I was having some sleep apnea. Apparently my breathing would slow or stop. This lowered my blood oxygen content. The reason for this was my airway would relax to the point of obstruction. After a few seconds my body would realize this and I would wake up a bit to correct it. Since this happens many times during the night I don’t get a good night’s rest and I wake up tired (also bad for the heart). The CPAP seals over my nose and emits enough air pressure to keep my airway open at all times. She had demonstrated this to me before bedtime and told me she would use it if she detected trouble.

With the CPAP on it was a little hard to get back to sleep, and I woke up a few times to adjust it. She actually fine-tuned the air pressure in her office.

At 6:15 AM she came in, unhooked me and brought in breakfast. I was welcome to shower. She said I was a very busy man at night with a lot of leg jerking, snoring and apneic episodes.

The only residual from my ordeal was some spots of gel in my hair. The physician will go read the reports, and we will go from there.

I will let you know.

By James Hubbard, M.D., M.P.H.

I am back from my overnight sleep study and it was pretty easy.

I arrived at 7:30PM and the nurse put me in the sleep room. It looked a lot like a nice motel room. It was large with a comfortable king-size bed, table and chairs, large leather chair, television with cable and a large bathroom with a shower, sink and toiletries. There was also an adjustable climate control and a closet.

I had to fill out a little paperwork and get my sleep clothes on, then the nurse came in to hook me up. This took about 30 minutes. I watched a video on sleep apnea while she was doing this. She scrubbed some spots to get off the body oil so the tape would stick. She taped a few wires to my scalp and forehead (to measure brain waves), to my jaw areas (to measure teeth grinding and gerd), to my temple areas (to measure eye activity) and to my upper chest (to measure heart activity). Then she put a strap around my upper chest and one around my abdomen (to measure breathing effort). These wires (20 of them) were then hooked to an portable apparatus about the size of an iPod. Next I was told to watch tv or read until I was ready for bed.

I called her to my room around 10:00 to tell her I was ready for bed. She hooked up the “iPod” to another machine. She also taped a leather strap to my index fingertip, and taped some nasal biprongs to go inside my nose. She said that this looked liked an oxygen hookup, but was really to monitor my breathing. I was told to call her if I needed to get up to go to the bathroom. The whole room was wired for sound and there was a small infrared camera on the wall to moniter me during the sleep. She turned out the light and left.\

(to be continued)

by James Hubbard, M.D., M.P.H.

I am having a sleep study done tonight. I will tell you how in went from a patient perspective.

I have been having feeling sleepy in the daytime after a good night of snoozing, and my wife says I snore very loudly (probably exaggerating). The test will look for signs of sleep apnea.

A lab employee called today to ask if I had any questions. She says I should be there by 7:30 PM to do the paperwork and get hooked up to all of the wires. I should eat dinner beforehand, bring bed-clothes and be in bed around 10:00 or 11:00. Apparently they will kick me out around 6:30 AM.

I asked if people have trouble fallling asleep with all of the wires and she said I could take a sleeping pill, such as Ambien, if I wish.

Will follow up tomorrow.

By James Hubbard, M.D., M.P.H.
Publisher, JHMFD

On The Oprah Show dated 5-13-08, I understand that they had on a physician that practices regression hypnosis (getting you to remember the distance past, in this case it was past lives.)   This type of hypnosis has been discredited for years.  The past remembrances come from suggestion references by the hypnotist.  In child abuse and other instances the therapist has used the power of suggestion to bring back memories which were later refuted as untrue.

See our article on this http://www.familydoctormag.com/medical-index/mental-health/how-hypnosis-works2.html.

We will try to find other expert opinions.

By James Hubbard, M.D., M.P.H

Good News!  If you stop smoking, you can lower your risk of dying almost back to the risk of those who have never smoked.  It takes some time and lung cancer risks never completely go away, but hey, did you really think it was a free ride?

“Most of the excess risk of vascular mortality due to smoking in women may be eliminated rapidly upon cessation and within 20 years for lung diseases,” the authors conclude in the study published in the  May 7, 2008 issue of the Journal of the American Medical Association.

The observers began studying over 100,000 female nurses in 1980.  Much valuable medical information has been gleaned from them over the years.  This most recent study reviews the rate of deaths among smokers, non-smokers and smokers who quit the nasty habit.  They found almost 3 times more deaths, from any cause, in the smokers.  The amount of smoking increased the risk.  More colon cancer was seen in the smokers, and 7 times more lung cancer.

Now for the good news (something patients ask me all of the time).  In those that quit smoking, the risk of death gradually became that of non-smokers over time.  The cardiovascular disease (heart, circulation, strokes) death rate risk was halved in those who had quit for five years.  By 20 years the overall deaths, including from lung disease, were close to the same in both groups.  Lung cancer risks were still 13 percent more (but had come down 87 percent) than in the never-smokers.

Since death was the endpoint in this observed study, the authors did not comment on nonfatal, debilitating disease.

The bottom line is that this study shows it is definitely worthwhile to quit smoking and the sooner the better.

James Hubbard, M.D., M.P.H.

It has now become easier for someone with no training to attempt to revive a person whose heart has stopped. The American Heart Association recommends that, if you witness someone who becomes unconscious, do not perform mouth-to-mouth unless you have training. Rather you should:

1. Call or have someone call 911.

2. Put the person on a flat, firm surface and repeatedly compress the mid-chest firmly and quickly until the ambulance arrives. Those easy compressions you see on TV programs won’t get it. The compressions need to be hard so that you are compressing the heart to circulate blood throughout the body.

See more information on this at the AHA website link: http://handsonlycpr.eisenberginc.com/.

They recommend this change after studies have shown that it increases survival, over the first few minutes, about as much as using mouth-to-mouth with compressions. They hope more people will be willing to do the compressions. If you have proper training in cpr, then the recommendation is to use the mouth-to-mouth method, along with chest compressions, but at a ratio of 30 compressions to 2 breaths.

Be a hero. Save a life.

An article in the periodical, Circulation, has details.

by James Hubbard, M.D., M.P.H.

I am really not sure what to make of this story, about some special powder helping a fingertip regrow. I know I always tell someone with a cut like that that it will grow back nicely by itself if it does not involve the bone or nail bed, but that one in the video that accompanies the story does look pretty bad.

We’re working on getting a specialist’s comments about this.

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by James Hubbard, M.D., M.P.H.

CNN.com tells the story of a self-taught guy who dropped almost half his weight. It looks like he is the poster child for how you lose weight healthily and keep it off. His big edge is his motivation, that he knew he had to do it, and would do what it takes.

Don’t miss the photos, which you can scroll through at the top of the story.