Introduction

Dr. Bob: Welcome to The Dr. Bob Show. I hope you've had a healthy week. I hope it's been a week that you've been exercising those 20 minutes, seven times a week. I hope you've been eating properly, getting lots of rest, and most of all, having that laughter in your life. I think you will enjoy this show that we've got for you. We're going to be discussing a lot of topics. We're going to be talking about those diet fads-are they important to you? We're going to be talking about exercise. We're going to be talking about chronic cough. Do you have a relentless cough? If so, we may help you find out how to stop that cough. We'll be talking about arthritis-some of the new treatments, and the different kinds of arthritis. We'll be talking about hoarseness. Do you have hoarseness and don't know why? We'll be talking about that to see what we can do and also we're going to be talking about the heart. We're going to be talking about what is a heart murmur. What is the importance of heart murmurs? We'll be talking about cholesterol and heart disease.

And how are we going to get all of that on this Dr. Bob Show? Well, it's going to be very easy. We're going to have just one guest and I am going to be talking about all those things the entire show. I've been requested to do that many times before. We'll do this twice a year…we will sit and we'll learn and we will see what we can do to make you more healthy, a little happier and certainly we'll learn how to live a better life. So, you'll want to stay tuned!

Topic 1: Dieting
We've got a lot of things to cover so let's get started. I thought I would take the letters that we've gotten, the questions that we have received, and put those into groups. And the first topic I think that leads the list (if we had a top ten list) would be about weight loss. "How do I lose weight?" "What kind of diets are best?" "Is this diet good?" "What do you think about dieting?"

Well, let's talk about this. Dieting is very, very difficult. Every diet that I've seen has worked and people lose weight. The problem is when they go off the diet, they seem to return back to their same weight and frequently (more often than not) people will gain a little bit more weight than they had when they started losing. What's going on in the body? Well, there are a lot of things that make it very difficult for people to lose weight. There is a thermal energy rule. That's just how much heat and energy you put out versus how many calories you take in. Your thermal energy is really going to determine how much you eat. There's no question about it. But there are some certain facts that make it very difficult for people that are overweight. For instance, take the average calories needs by a thin person to maintain her weight. If you take the same percentage of calories over weight for an overweight person, they have to reduce their calorie intake 15% more than the lean person. Why is that? Well, let's talk about what's going on in the body. There are several things that regulate our appetite. For instance, did you know that in our fatty cells there is a substance called leptin? Leptin can go to the brain and can tell the brain that, hey, we're having enough. It will suppress the appetite and increase energy. Do you know as we begin to lose fat, if we go on a diet and begin to lose some of that fat, we get a decreased amount of leptin and when the brain doesn't get as much leptin, the brain begins to say, slow down big boy, slow down young lady and also the appetite increases. So, as you begin to lose those fat cells, there are some things that make you want to eat and makes it very, very difficult. In the mid-brain, in the hypothalamus, there seems to be an area that regulates the body…that's a thermostat. There is a substance in the stomach that, as we eat this substance, cholecystokinin, it will go up into the brain and tell the brain that it doesn't need to eat anymore. When we eat food, insulin comes from the pancreas and it into the blood stream and helps manipulate other substances to tell the brain we don't need to eat. So there are a lot of things that help suppress the appetite. But when we go on diets, the reverse occurs and there's not as much insulin and we want to eat more. And there's not as much cholecystokinin and we begin to eat more. And so it's a vicious balance. So, what do I want you to do? If you really want to lose weight, it's a commitment, a change in your lifestyle. You've got to cut down on what you eat and you've got to exercise. To me, when people exercise, it needs to be aerobic exercise where you go out and walk, where you swim, where you do little things. You don't have to do a lot…20 minutes of walking is not much. But in addition, you should be doing some resistance exercise. So, four days a week do a little bit of your aerobics. Three days a week do a little bit of weightlifting. Increased muscle mass actually expends more energy and so if you'll do those things, you'll find that you'll be losing weight. But it's a commitment. You can't snack. I remember one doctor, who was very thin. I said, "What kind of candy bars do you like best?" And he said, "Candy is a luxury which I do not allow myself". Oh, wow, that's pretty tough because there are certain times we like to eat certain things. But if you have to lose weight, you really have to eat three meals a day. Eat proper meals, don't snack, stay away from bread, and certainly stay away from fatty foods! And now we've got to get over to another topic.

Topic 2: Chronic Cough
I want to talk now about a chronic cough. You know if you have a chronic cough. What's that cough like? Is it a dry cough or is it a rattling cough-like there's a lot of mucous, like you've been smoking too much? Why do smokers get a rattling cough? Well, every time you smoke, there are little cilia in the lungs that are destroyed. When we breathe in dirt or fumes or environmental pollution, what happens is the lungs secrete mucous and then the cilia move the mucous containing that dirt out of your system. But when you don't have those cilia because you're smoking, that mucous accumulates down there and you get a rattling cough. Do you have a rattling cough because of smoking? Then you've got damage to your lungs. Stop it. Talk to your doctor about a way to quit smoking.

There are other forms of chronic cough. Blood pressure medicine, once called an ace inhibitor, is probably the most common cause of a dry, relentless cough. People just cough their head off. They cough all day. It is a dry cough. They just cough and cough and cough and often, they won't go out into the public because they are coughing so much. People with allergies, with postnasal drainage cough to clear their throat and they cough all day and it's irritating to everybody around them. So drainage can cause cough. People with esophageal reflux disease, we call it GERD, can have a chronic cough. Acid can actually come all the way up into the throat where it causes rawness in the throat and people start coughing with that. There is a cough variant of asthma, where people that don't sit there and wheeze but they'll cough. Their pulmonary function studies are abnormal. These people will respond to medications. Frequently, exercise will make them cough more. They wake up in the middle of the night coughing. So, if you've got a chronic cough, I hope that some of those things are helpful to you. You may need to get a chest x-ray. If none of those have really proven out, maybe pulmonary function studies are indicated. Work out that plan with your doctor. Postnasal drainage, reflux disease, hoarseness secondary to cough, a variant of asthma, chronic cigarette smoking can all cause a chronic cough. Find out your cause. Work it out with your doctor and get rid of that cough.

And we'll be back soon with those next topics that we'll be talking about. I think we'll be talking about arthritis. I want to talk about different kinds of arthritis and some of the new treatments that are available and we'll also be talking about other things in the next segment.

Topic 3: Exercise for the Mature
Dr. Bob: You're a trainer? What does a trainer do?

Trainer: My role is primarily to facilitate an effective and efficient work out so that somebody basically gets more bang for their buck time wise.

Dr. Bob: Tell me about the advantages that you know of weight-bearing exercise to patient's health?

Trainer: First thing I'll mention is an increased metabolic weight.

Dr. Bob: Now, what is that?

Trainer: As you increase your percentage of muscle mass in your body, it doesn't mean for women that they are going to be larger, by any means. It just means it's not fat. It's muscle. It's active. It's a tissue that works in your body and does the work and metabolically it raises your ability to take in calories to a higher level.

Dr. Bob: So, when people get into their 50's and 60's, do they need to exercise.

Trainer: It's probably more important at that age than any other time. I would like to think that people work so that they can relax as they get a little older and if you're not in a positive health status, then you're not going to be able to enjoy it. They did a study several years ago with people 70 years old and a very small percentage could cross the street in the time that it took the light to go from "walk" to "don't walk."

Dr. Bob: Wow.

Trainer: So, it's important.

Dr. Bob: What are some other advantages that we get with older people with exercise?

Trainer: The first one, the one that's probably in the news the most has to do with osteoporosis and that is basically a porousness of the bone. They've done studies that have shown that if you do resistance exercise, you can actually increase the density of the bones which is going to help people as they get older.

Dr. Bob: How about broken bones?

Trainer: Well, it's also going to help from a stabilization standpoint. It's going to help them. You know, one typical cause of broken bones in elderly people is falling and if you've got more stability due to an increase amount of muscle, then your chance of falling will decrease.

Topic 4: Arthritis

Now, we want to talk about arthritis and hoarseness. Did you know that there are over 100 kinds of arthritis? Lupus, connective tissue disease, can cause arthritis. Psoriasis can actually cause arthritis. There is an ulcerative colitis, GI disease, that's often associated with arthritis. I would like to talk about the two most common types of arthritis and explain the difference between the two just a little bit. There's rheumatoid arthritis and osteoarthritis. Let's talk about rheumatoid arthritis. Rheumatoid arthritis usually occurs in synovial joints. These are diarthroid joints. Now, what does all that mean? It just means a joint that moves together that's got a lining called a synovium. Now, if that synovium becomes inflamed with rheumatoid arthritis, it's the body beginning to develop antibotics against itself. It causes inflammation of the synovium, really sore painful joints. What joints predominantly? Well, in the hands it's the knuckles and it's this knuckle right here. We call it the PIP, the proximal interphalangeal joint or the metacarpolphalangeal joint. So it affects the POP knuckles and this knuckle right here. These joints are osteoarthritis. Also, rheumatoid arthritis affects the large joints like the elbows, like the ankles, like this part of the foot that we have here. There is inflammation going on there so what can you do? Well, if you don't move, it doesn't hurt but that's the wrong thing to do because if you don't move, then the joints begin to scar down and they begin to contract. In the old days we used to see people whose hands were frozen like this that had rheumatoid arthritis. We don't see that anymore because we've got better medications. What are some medicines? Sometimes all it takes is simple aspirin.

Now, let me back up. People with rheumatoid arthritis frequently wake up in the morning and their joints are stiff and we can measure how severe the arthritis is by how long it takes them to unstiffen their joints. Put those hands in warm water, get a type of treatment where you can use warmth in the morning and then you take aspirin. We can take up to nine to twelve aspirin a day. If you get too much aspirin, you get a little ringing in your ears, and you certainly don't want to go above 16 aspirin per day. The NSAIDS, nonsteroidal anti-inflammatory, the Ibuprofen family, work on the inflammation of the synovium. Although those are irritating to the stomach. So we've come out with some of the newer ones that we have, Celebrex and Vioxx. Those are NSAIDS, Ibuprofen-like family, that don't seem to bother the stomach as much. But there are some newer medicines, some anti-tumor necrosis medications or medicine that works on a cellular level and just makes that pain go away. Your rheumatologist will be able to tell you what these newer medicines are so you'll want to know. If those initial simple things don't work, see if your doctor wants to send you to a rheumatologist for these special medications.

The other one is osteoarthritis. Osteoarthritis is wear and tear. It's predominantly in the knee where we just beat on our knee. You know, we are living longer so there are more and more people with osteoarthritis. There are two things that we can do. #1. Simple aspirin also works on that sort of pain. But there is an injection of
hyaluronic acid that we have, Synvisc, or Hyalgin. It's an injection once a week for three weeks. You can do that for six or seven months and it's like putting W-D 40 in those joints and makes them were they really move good. If after a while that doesn't work then probably the only thing left would be knee replacement. Knee replacements are wonderful and joint replacements in the hip are wonderful.

Topic 5: Hoarseness
And now, let's go to the next topic before we run out of time. I want to talk about hoarseness. A lot of times people have hoarseness and they don't know why. Well, the vocal cords are moving when we talk. Air goes by the vocal cords and they have to approximate-they have to be equal. If there is a little knot on one, then we get hoarse and we don't speak well. Sometimes if we've got hypothyroidism, a low thyroid, an inactive thyroid, you will have a low hoarse voice and the reason is, the vocal cord actually becomes swollen. Hypothyroid, we call it myxodema. Well, there's myxodema of the nerve that supplies the vocal cords and that nerve gets swollen and doesn't transmit activity.

And we also get hoarseness that we have with hypothyroidism. There is a nerve, the recurrent laryngeal nerve, that really controls the muscles that control the vocal cord. Sometimes cancer of the lung can cause hoarseness. So persistent hoarseness is something that you'll want to see your doctor about. It could be cancer of the vocal cord but usually it's a singer's nodule and it's inflammation, something there that's very, very minor. So, if you've got hoarseness that persists longer than two weeks, sometimes if you're like me, you just talk too much (teachers-they will talk so much that they often get hoarse). Usually there is a singer's nodule or a "you just talk too much nodule" and sometimes we get hoarse with that. Postnasal drainage from allergies is a very common cause of hoarseness that people have Some of the asthma medications (the steroid anti-inflammatory metered dose inhalers, Flovent, Beclovent, Pulmicort) can all cause hoarseness in people. They cause weakness of the muscles that control the vocal cord. And that's all the time in this segment and next segment we're going to be talking about your heart. We'll be talking about murmurs and cholesterol and chest pain and anything that comes to my mind.

I hope you're enjoying this as much as I am-I think I could talk forever.

I hope you're enjoying this as much as I am-I think I could talk forever.

Dr. Bob: Missy, how long have you been a runner?

Missy Kane: I've been a runner, I guess or been a walker, 25+ years and I'm still going.

Dr. Bob: What do you like to do now? Run or walk?

Missy Kane: Both. I like to do a combination. A lot of people think you have to do one but really with a little bit of a bad knee, I combine both and it works a lot better for me and I think variety is a spice of life.

Dr. Bob: What is "runner's high?"

Missy Kane: It's a true occurrence-the endorphins (and you know this because you run all the time) but endorphins are produced in your body from exercise, whether it be running or walking a lot, or swimming. Your body produces these things and they act as a feel-good, natural drug in your body. So, even if you feel bad, you can go out and exercise, and you think, "I feel so much better" and it's a physiological fact that it's happening.

Dr. Bob: I would think walking wouldn't give you as much benefit as it would me because you know, you're in such great shape.

Missy Kane: Well, I think walking really can but I think you do the same thing. I sometimes add even small weights to my walking. I may walk twice a week 45 minutes to an hour and then the next day do 30 minutes of something more intense. So with walking, if you get a long enough walk or get those weights going, or get a little bit of a faster pace going, you can burn off the calories and get your heart and muscles toned.

Dr. Bob: And what does exercise do to your cholesterol?

Missy Kane: It dropped mine and mine was genetically a little bit high and when I tried to watch my diet a little better, and you do better than I do, I found that eating more low fat foods and getting more exercise really helps that HDL, LDL level. So my level, my ratio level is great.

Dr. Bob: And what do you think exercise does as far as weight loss?

Missy Kane: If I did not exercise, I guarantee, I'd be larger. I know in high school, I wore three sizes bigger than I do now. It's the only way to get your weight down, the only way.

Dr. Bob: Do you plan to exercise the rest of your life?

Missy Kane: I have to.

Dr. Bob: You have to.

Missy Kane: And I want to.

Dr. Bob: And you want to. Why do you want to exercise for the rest of your life?

Missy Kane: It's just the natural way to keep yourself looking better than your age. (Laughter)

Topic 7: Heart

Dr. Bob: Dieting? Got a bad cough? Got some hoarseness? Got arthritis? Work on those. And now we're going to talk about the heart. There is so much to say about the heart. Let's talk about what the heart is and what it does.

Well, the heart is a pump. The human heart has four chambers. Two of them we call ventricles. One of them pumps the blood out to the body and the other one pumps the blood back up to the lungs. Now, when the blood goes to the lungs it picks up oxygen, then it comes back to the strong side of the heart (the left side of the heart, we call it) that pumps out well-oxygenated blood to the rest of the body. The blood nourishes the muscles and the tissues of the body. It gets rid of the oxygen and then that blood comes back where it gets nourishment. It comes to the right side of the heart and the right side of the heart zips the blood up to the lungs to get oxygen and the cycle starts all over. Now, this heart is a muscle, an amazing muscle. It pumps about 60-70-80 times a minute. Actually women's heart rate is a little faster than men. With women, their pulse, their heart rate is about 75 a minute. With men it is about 70 a minute. As you get in better shape, it's really interesting. I examined a young, trained athlete the other day and his pulse rate was about 48 which is a wonderful thing for the doctor to see in a young person, because that means they have been exercising. But the muscle requires nourishment. Where does it get its nourishment? Well, it gets its nourishment from the coronary arteries. It is really very interesting that as the left side of the heart, the heart that has the good blood in it, as it pumps, the blood goes out. That's the good blood with oxygen in it. As the heart rests, the blood tries to come back in the heart but it's stopped by what we call the aortic valve. In that aortic valve is where the blood comes back and goes into those coronary arteries. It is a beautiful thing to see. Now, those coronary arteries are where the problem begins. If they don't supply the heart with enough nourishment, then we begin to get chest pain. That's what angina is. There is an insufficient flow of blood but some blood goes through the heart as the heart begins to work more (like when we're exercising, we're doing something, we're lifting, we're pulling), well then the coronary artery might not supply enough nourishment for the needs of that muscle that's working so we get a cramping pain in the chest. That's called angina. Angina usually only lasts two or three minutes. It goes away with rest. When you get a crushing, substernal chest pain, stop what you're doing, rest a little bit, and see if it goes away. Pay attention to that pain. If it comes back the next time you begin to exercise or walk or do some lifting, then see your doctor and ask, "do you think that pain means something?" Because the doctors now can do electrocardiograms that can see an abnormality. Or they can do a stress test where you exercise on a thread mill and the electrocardiogram shows the effects of not enough blood for that muscle. That's a stress test. If it's abnormal, then we frequently do a cath. When we do a cardiac cath, we inject dye that shows the outline of the inside of the coronary blood vessel. It will tell us if it is nourishing the heart or not. If it's blocked, what can we do? Well, you guessed it. We can do angioplasty. If you've got a vessel and it's closed off, if that pipe is rusty, the doctor goes in there with a little wire that has a balloon. You blow up the balloon and for some reason, that blood vessel just stays opened. Now, in our modern day, not only do we put that balloon in there but we put in what we call a slinky, a stint. It's a wire chamber that keeps that part of that blood vessel opened. The problem with a stint, with that slinky that we have there, is that sometimes we begin to get some scarring around that and it begins to close up a little bit. We're learning a little bit more about that. Sometimes we put a little radiation in with that stint that doesn't bother the rest of the body but keeps that scarring from occurring.

Now, what is a heart attack like? Well, a heart attack is when that same coronary vessel suddenly doesn't give any blood to a certain part of the heart and that part of the heart that's working doesn't get any blood. Then we have a heart attack. That hard muscle dies and what we can do is we can try to reestablish that circulation within 90 minutes. If we can get the patient to the hospital and get in the cath lab and they can open up that blood vessel all the way, then that muscle hasn't died long enough to where it's permanently dead and we can revascularize, we can get the blood flow going back to that heart muscle. The heart muscle becomes red and pink again and it doesn't even know it's had a heart attack.

Now we've got to begin to work on lifestyle changes. We've got to exercise. We've got to know what our cholesterol is and here we come in with cholesterol. And we only have got a minute to talk about that. Good cholesterol, happy cholesterol (as Dr. George Krisle calls it)-that's the HDL. You want that HDL to be over 35. You want it to be as high as you can get it. Not many things really make the HDL go up. There are some newer medications that will. Exercise will. Sometimes a glass of wine a day will make the HDL go up. I don't like to advise that anybody drink a glass of wine a day for their heart. The lower cholesterol (LDL) we can lower that by diet, by exercise, and by medications. So, if you've got heart disease, if you've got any warning signs of cramping, hard chest pain, you be sure and talk with your doctor. Let him work out that program. Let's keep a happy, healthy life. After all, heart disease is the most common cause of death in America.

Conclusion:
I hope you have enjoyed this show as much as I have. I wish I had more time. I was having such a good time talking. Remember, you've got to be sure that you're exercising. You've got to be sure that you eat right. Get eight hours of sleep. We'll talk more about that sometime. And most of all, have laughter in your life.

If you have a question for Dr. Bob, write to The Dr. Bob Show - 6700 Baum Drive, Suite 1, Knoxville, TN 37919 or send your e-mail to letters at letters@drbobshow.com