We are all just basically animals. We live our lives under the influence of
basic instincts. Like all other living things we strive to procreate and
survive. Then one day we are gone. I have thought a lot about these basic
axioms of life lately.
Scientists believe that women, especially those with children, typically
survive longer, even when stricken with a variety of ailments. Okay, that
makes sense since matriarchs have to provide for future generations. But as
we get older (whether male or female) and when reproductive potential wanes,
it seems almost as though nature is trying to get rid of us. Various parts
of our bodies begin to atrophy or deteriorate. Joints get brittle and sore
and infections take longer to heal. Time itself seems to go by more quickly.
It even becomes more difficult to fall asleep, stay asleep, and get a deep
restful slumber. That's too bad. When times are tough, health deteriorates
or pain and suffering seem to occupy much of a person's mind, most people
find sanctuary in bed. During this quiet time in the dark when others are
asleep, we find solace in reminiscing and fantasizing. Pleasant thoughts
make the night easier.
Many people have called or written to me about what comforts them at night,
when they are alone, afraid, or in pain. By far, their thoughts and
fantasies involve loved ones. As a doctor who has watched a broad spectrum
of pain and suffering over the years, it is clear that nothing affects
people more than affairs of the heart. It is natural to hark back to lovers,
friends, and especially those dreamy relationships and situations that
"might have been."
The other night I received three interesting phone calls. One woman from
Germany had just seen the movie Fat Chance on television. The movie (also
adapted for Arts and Entertainment network's Investigative Reports and
titled A Matter of Fat), chronicled the struggles of a few large people in
society. The woman (we'll call her Gretta for the sake of privacy) was moved
by a scene in which I appeared discussing what most large people hesitate to
reveal -- their innermost vulnerabilities. What can I say? The camera was
unobtrusive and silent. My mood was somber and reflective. It is not that I
am more sensitive than the other person. Or is it? Gretta felt that large
people are more sensitive. She identified with my thoughts. It seems that
years earlier, Gretta was in love with a very large man. His insecurities
were so stifling that he could not accept the obvious love of this wonderful
"thin" woman. Although she longed to spend her life with him, he let her
slip away. She married another man. The larger love of her life apparently
died in his early 30s. But even after many years of marriage to another man,
even in recent widowhood, she never forgot about her large lover. She needed
to tell me how wonderful large people are. She insisted that we must love
ourselves despite others' disdain of our "large" size, health problems (if
they exist), and social pariahism. Most importantly she said we had to let
others love us.
The second call was from a large young woman who had sought me out some
months earlier. She also saw that old movie. She was lonely and felt
isolated. She had never heard of Dimensions, NAAFA, etc. After she plugged
into these new resources her whole outlook changed. She called to tell me
that just knowing that there were other large people like her opened new
doors. She was bubbling over with enthusiasm for FAs and life in general.
UNDER THE KNIFE
The third call to me was more clinical in nature. It was from a large woman
who was a trained health care professional who felt that she had to share
her recent experience in surgery. Her relatively minor gynecological
procedure turned into a nightmare. Despite having been advised of the
increased risk of infection in large people, her surgeon decided to treat
her conservatively and expectantly rather than proactively, so her abdomen
became infected, requiring extensive drainage and antibiotics.
It was not her fault. She was conscientious. In the operating room she told
all those present that she realized that there would likely be looks of
contempt and derogatory comments like "how could she have let herself go."
She reminded them that obesity is not automatically a lifestyle choice. She
had not chosen to be harassed and humiliated all her life. She told them
that she had gone through enough self deprecation for many years, she did
not need their added scorn, especially not now as her life was on the line.
She advised them of clinical precautions.
Large people undergoing surgery are indeed at higher risk of infection with
Staphylococcus and Streptococcus, two organisms that are commonly present on
skin. These bacteria are easily transmissible, even in the operating room
and especially when extra hygienic prudence is not practiced by hospital
staff. Extra measures mean that strong prophylactic antibiotics need to be
given before and after the surgery and staff must take care to keep
everything clean and sterile.
My third caller also described interest in my last column about heart
irregularities. Like many of you who responded, she too had extrasytoles.
She had previously been prescribed certain medications to control these, but
her gynecological problem, the surgery, and subsequent infections had
altered her delicate metabolism. The heart rhythm problems exacerbated.
She wanted me to tell the medical establishment that large people have
special needs and, especially prior to stressful periods like surgery,
particular steps needed to be taken.
What about the medications for the heart? In my last column I discussed the
irritability that occurs in regular muscle cells in the heart either because
of infection, lack of oxygen, scarring, a surge of hormones, or an imbalance
of bodily chemicals. Anyone with heart beat irregularities should have an
EKG, A Stress Test, a Holter Monitor, and an Echocardiogram. If any of these
tests reveal abnormalities, further sophisticated investigations may be
required to delineate the problem and to decide on the best course of
action. Under most circumstances, no anatomical abnormalities are found and
drug treatment should be avoided.
Although some drugs will slow down or tame the fast or irregular heartbeats,
they are not without side effects. People who have essentially normal hearts
and occasional irregular beats of any configuration should not take
medication. Some are blessed in that they are blissfully unaware of their
irregular beats anyway. Most importantly, very few treatments have been
shown to prolong life. On the other hand, if irregular heartbeats make
people nervous or uncomfortable to the point that quality of life is
affected, medications may be appropriate. In this column I will deal with
some of the most common heart drugs used.
If the primary pacemaker in the heart is firing too fast or if rogue
pacemakers are trying to compete, causing too many extrasystoles, then
something may need to be done. These cells act like sponges in a bucket of
water, absorbing elements such as sodium and calcium too quickly, saturating
themselves early and firing abnormally. A surge of Adrenaline that can occur
with emotional excitement or physical stress of any kind, causes these
sponges to saturate too quickly or too often. It does this by widening the
holes in the sponges at places called Beta Receptors. Beta Blockers make the
holes in the sponges smaller, thus slowing down saturation and the
consequent irregular or fast rhythms. Of all the drugs available for this
purpose, only Beta Blockers not only usually help, but are likely to
actually prolong life in those with serious heart disease. Atenolol,
Esmolol, Propranol, and Metoprolol are often beneficial but only if used
very carefully in selected patients who really need them. As previously
mentioned, for example, undergoing the stress of surgery may cause heart
irregularities to exacerbate and be an indication for use of Beta Blockers.
SODIUM CHANNEL BLOCKERS
A specific class of drugs slows the influx of the element sodium into the
sponge-like pacemakers. In a hospital under emergency conditions,
intravenous drugs like Lidocaine and Procainamide are Sodium Channel
Blockers that are used to slow down very rapid heart rhythms. They are often
effective in the short term. Two other Sodium Blockers that were intended
for long-term use, Flecainide and Ecainide, looked promising at first
because they often had the desired effect of slowing down irregular rhythms.
However, a large study conducted on thousands of people had to be stopped
when it was found that candidates were often dying prematurely on these
medicines. It appears that the drugs were, in effect, just masking irritable
spots in the heart and were eventually proarrhythmic, i.e., causing these
cryptic irregularities to burst forth with a fury.
Digoxin, an ancient medicine from the Foxglove plant, has been used for
centuries and was one of the first botanicals that truly had a profound
effect on helping people with heart problems. You may recall from my last
column, I spoke of Atrial Flutter and Atrial Fibrillation. These
irregularities (which involve hyperexcitable cells in the top part of the
heart) often occur in combination with two potentially dangerous scenarios.
First of all, the heart action is not just irregular, it is too fast for the
chambers to adequately fill or empty. Secondly, the heart is usually in
failure as a pump. The latter circumstance is particularly problematic. In
fact, most doctors agree that it doesn't matter how irregularly a heart is
beating as long as it is pumping out at least 50% of its payload. However,
once the chambers get flaccidly large and balloon-like, blood backs up in
the body, causing lung congestion and ankle swelling. The interesting thing
about Digoxin is that it not only slows down the rapid rate, it can also
make the failing pump beat stronger and in some cases even help to convert
the irregular rhythm back to normal. Nature is truly the best medicine
cabinet in this case and, even in this day of high tech designer
medications, Digoxin remains the gold standard for most patients with this
CALCIUM CHANNEL BLOCKERS
Normally the heart has one pacemaker and a railroad of similar specialized
cells that carry electrical messages quickly to the rest of the heart in
anticipation of a contraction. These cells act like sponges with smaller
than usual holes called Slow Calcium Channels. Rather than undergoing the
rapid-fire action of regular heart muscle cells, these distinctive pacers
take their time producing a rhythmic action that allows for regular beating
several times a minute. However, when heart disease or the ravages of time
cause the sponge holes to open wider, dangerous rapid and often irregular
pacing results. Calcium Channel Blockers (Verapamil, Diltiazem) constitute a
relatively new class of drugs that not only combat this problem by slowing
the influx into the electrical sponges, they are also quite effective at
decreasing the force of the heart's contractions. Therefore, some are used
to lower high blood pressure as well as to slow down and often curb
POTASSIUM CHANNEL BLOCKERS AND OTHERS
Then there is what I call the "other" class of drugs whose mechanism of
action varies and is complicated. Sotalol is a sort of Beta Blocker with a
few extra properties that is used when other more traditional drugs in this
group are not quite doing the trick.
Bretyllium causes a sudden initial Adrenaline rush in the body followed by a
period of relative calm, slowing down irregular rhythms and decreasing blood
pressure. When administered too quickly (intravenously) it can cause severe
nausea and vomiting.
Amiodarone, although used successfully in Europe for years, remained on
North American physicians' "cautious" list until recently. A very powerful
antiarrhythmic agent, this drug has some very dangerous side effects. These
include skin rashes, damage to nerves, liver toxicity, eye scars, and most
seriously, Pulmonary Fibrosis (stiffening of the lungs). For this reason
Amiodarone is used when people have serious heart beat irregularities that
do not respond to other treatments. More recently, it has also been used by
paramedics in an attempt to revive cardiac arrest victims.
For the sake of brevity I could not go into all of the drug, pacemaker, and
even genetic treatments for heart problems that are either being developed
or actually in clinical trials. Magnesium and Omega-3 (Fish) Oil Compounds
are just two of many substances that are under investigation for their
Large people are often subject to cardiac problems but are usually treated
with drugs and dosages that apply to the "thin" population. Since over 50%
of Americans are now acknowledged by the NIH as being "overweight," it is
time that we demand proportionately greater research for a common problem.
AFFAIRS OF THE HEART
When times are tough and we take stock of our achievements and indeed the
meaning of life, perhaps it is that we are not just, after all, little
animals running around with rudimentary instincts. I concur with Gretta and
the many others who have shared their innermost thoughts with me on this
subject. Perhaps what sets us apart from other species is our need to be
needed, our love to be loved, and our hatred of being hated.
Do me a favor. If you are troubled and find peace (and perhaps even some
well-deserved pleasure) in bed, dismiss any bad thoughts you may have
tonight. Think about good times and good people. As Barbara Altman-Bruno
(Dimensions columnist, author, and my friend) once told me, "Let your dreams
be your guide."