Happy Heart #22

Dr. Mylan Cohen:

The physiologic effects of fear, of anger, of surprise, all of those things have an effect on the heart. You suddenly get a fast heart rate. Some people can really feel their heart pounding. And indeed, there is something called broken heart syndrome.

Dr. Chris Rogers:

People also need to be exercising and ambulatory. The most important function that a person can give to their venous system is walking, because every time you take a step, the foot and the calf contract and it's the muscles contracting that pushes the blood back towards the heart.

Dr. Lisa Belisle:

Hello, this is Dr. Lisa Belisle, and you are listening to show number 22, Happy Heart, which is airing for the first time on February 12, 2012, right before Valentine's Day, which also happens to be the 11th birthday of my third child, Sophie. Happy birthday, Sophie. This week's Happy Heart show involves interviews with Dr. Mylon Cohen of Maine Cardiology, Dr. Chris Rogers of the VAIN center at Portland Surgical, which is an affiliate of Mercy Hospital, and Jen Goldman of the American Red Cross. Happy Heart's a pretty appropriate thing to be talking about, Genevieve Morgan, wouldn't you agree?

Genevieve Morgan:

It certainly is right before Valentine's Day. The heart is such a great metaphor for so many things. What is it in Chinese medicine?

Dr. Lisa Belisle:

Well, we've talked about the five elements before and we're actually kind of we're two seasons away from the heart season. The heart season is the summer season. It's the season of joy and heat, and it's associated with the color red. Fire is the element and the emotion is laughter. But it's interesting when we talked about I believe in the Girl Power segment, we talked about different types of energy and power. We talked about yin within yang and yang within yin. Every season has an element of the other seasons in them. So it's funny that in the middle of winter we have a little bit of red hot heart Heat, Passion. Passion, exactly. And it's a perfect time of year of it because. Perfect time of year because things are starting to heat up. You know, we have in other parts of the world, not necessarily Maine, where we're still pretty deep in the winter, but we have. The SAP is starting to flow a little bit, things are starting to rise and wake up and life is starting again. So this is Chinese medicine. Heart is joy, laughter.

Genevieve Morgan:

What are some of the other organs associated with the heart in Chinese medicine, when you're doing acupuncture on patients?

Dr. Lisa Belisle:

Well, in acupuncture, all the organs are associated with the heart. That's interesting. Yes. All the five elements really can be tied back to the heart. And if you look at, we've talked about, about the kidney organ, and winter is the season of the kidney, and the element is water, and we've talked about that being fear. Well, that's actually the controlling element is water controls fire, which makes sense even from a rock, paper, scissors kind of standpoint, that water would control fire. So if you think about it from a western medicine standpoint, of course, the kidneys and the heart are very much related. We have congestive heart failure, which is an overage of fluid in the body.

Genevieve Morgan:

Well, the kidneys are a vascular organ as well. They pump blood. Blood is filtered through the kidneys. So that makes sense.

Dr. Lisa Belisle:

Yes. And that's one of the reasons why we decided to have Jen Goldman from the Red Cross on, because it's not just about the heart and the veins. It's also about what goes through the heart and the veins.

Genevieve Morgan:

Well, in cardiovascular health, it is about both pieces of that word. It's about the heart, but it's also about the arteries and veins that lead into the. That take blood away from the heart and bring blood to the heart. So talk a little bit about the challenges that people face because it's a terrible epidemic in our country. And what are some of the threats to heart health? And then let's talk about how we get happy.

Dr. Lisa Belisle:

Well, we have a lot of things kind of acting against us right now. And everybody knows about this 2/3 overweight, obese thing. So you have people are larger than ever before, they're more sedentary than ever before. They're getting less exercise than they ever used to. Their children are bigger and more sedentary than ever before. So all of these are strains on the heart. And simultaneously we have the anxiety associated with a difficult economy. You know, people are losing their jobs, they're having houses that go into foreclosure. They we're still dealing with military conflicts. I mean, it's a very challenging time. So we have.

Genevieve Morgan:

And that really meant that can really impact your heart health.

Dr. Lisa Belisle:

It really can. And in fact, we did Health wealth last week, show number 21, and we talked about the stress of finances on one's life, and it really, it does impact the heart. And Dr. Mylan Cohen is going to talk about a study that came out that proved a relationship between stress and traumatic events and sudden cardiac death. So we know that there is a direct physiologic relationship between stress and heart health, and that's sudden death over time. We have the whole type A personality, which is over time, stress on the heart can cause a weakening of that musculature and can lead to early death due to cardiac disease.

Genevieve Morgan:

So how can people intervene before they get to that critical stage? I know that in complementary and alternative methodologies, there's a lot of focus on stress release. So, for instance, in your practice, what are some of the tools you give people to protect their heart and keep their hearts happy?

Dr. Lisa Belisle:

Well, you talked about how organ systems are related, and I said that all the organ systems are related to the heart and the lungs. Of course, even Western medicine, but also Chinese medicine, are related to the heart. So, as I've said before, one of the first things that I teach people to do in my practice is teach them how to breathe. Because if you're not even getting the lungs that well oxygenated, then you can't get the oxygen into the blood and you can't aerate all the tissues of the body. And that's very important for stress relief physiologically.

Genevieve Morgan:

Yeah, because deep breathing also triggers the parasympathetic nervous system, the calming aspect of your central nervous system, too.

Dr. Lisa Belisle:

And the other thing that we do, at least in my practice, is I do a combination of acupuncture, nutrition, lifestyle counseling, and just counseling in general. So all of those things, if you think about that, can impact the heart. Acupuncture also has an impact on the sympathetic and parasympathetic nervous system, and we know from functional MRI studies that they impact the brain. We know that nutrition and lifestyle counseling can have a positive impact. If we can get people doing things that are better for their bodies, but also counseling in general. If we can get people to really examine what's going on in their lives and their transition, that makes them happy, that makes them unhappy, then we can help them get back to a place of having a happy and healthy heart.

Genevieve Morgan:

One last question. Where does salt fit in in all

Dr. Lisa Belisle:

this, salt is one of these nutritional elements that got a bad rap. And there have been so many. I mean, we are so good at finding nutritional demons.

Genevieve Morgan:

Yeah, eggs spring to mind.

Dr. Lisa Belisle:

Yes, they all, I think everything has at one point and we've talked about this, I think at past shows, but cholesterol is bad, fat is bad, carbohydrates are bad, protein is bad. Really pick anything and it's been proven to be bad.

Genevieve Morgan:

We really can't eat anything anymore.

Dr. Lisa Belisle:

Right. But really it's always about moderation and it always has been. And that's part one. Part two is it's about moderation and it's about how each individual is interacting with his or her foods. Some people can tolerate salt, some people, some people can't. You need a certain amount of salt because there is a sodium chloride exchange that occurs within the cells of the body. So you need some salt. You need good sodium chloride, good salt for your body because otherwise there's chemicals, you know, table salt that's going to be.

Genevieve Morgan:

And that comes in with sea salt or Celtic salt or kelp salt.

Dr. Lisa Belisle:

Yes, yes. And there is nutritionally better salt, but some people can't tolerate it. That's why people have been told for a long time, low salt diet. Well, some people can't tolerate any salt. So these are the people who will have higher blood pressure because of it. Everybody needs a little bit of salt. And in fact, if you don't have enough salt, then it can cause problems too. So you have to know whether you are a salt sensitive individual. You have to know also what you're eating. Because one of the problems in our culture with more processed food is that things people are adding stuff to the food that we're eating and we have no idea what it is.

Genevieve Morgan:

And how do you feel about alcohol and heart health? Because I know there are a lot of studies that say that one drink a day is heart protective. But I'm not sure where you come in on that.

Dr. Lisa Belisle:

Again, it's all about moderation and one's individual situation. Because we know that there's been a link between alcohol and breast cancer. So you have to know yourself, your family history, you have to know your set of circumstances, frankly. You have to know whether you have an addictive personality. Some people, it's all well and good to see. Yes, one glass of red wine is good for your heart, but if you have an addictive personality and you can't stop at one, you shouldn't have any. So I'm not a teetotaler and I'll enjoy my glass of wine or my chocolates because those are also good for heart health. But in the end, it's really about knowing yourself, taking the time to know not only what keeps your heart happy, but what keeps your heart and your body healthy and really taking advantage mindfully of those things that on a regular basis can be good for you. So this week it's going to be an interesting show. I know that we sometimes go far afield from the specific health topics, but this week it's a very health topic show. We have two doctors, very tight. Yep. And we have somebody from the American Red Cross. So we are talking about blood and veins and hearts. But what's really great is talking to Mylon Cohen. He's got a broader perspective even on the heart. So it doesn't matter how hard we try to keep it strictly medical, we still get a lot more interesting than that. We're looking forward.

Genevieve Morgan:

That's true.

Dr. Lisa Belisle:

Yes, it is. So we hope people are going to enjoy our Happy Heart show and we wish everybody the happiest of pre Valentine Sundays. The Dr. Lisa Radio Hour and Podcast is pleased to be sponsored by the University of New England. This week's Wellness Innovation segment, sponsored by the University of New England, is about motherly love. A recent study at the Washington University School of Medicine in St. Louis found that school age children whose mothers nurtured them early in life have brains with a larger hippocampus, a key structure important to learning, memory and response to stress. This new research is the first to show that changes in this critical region of the child's brain anatomy are linked to a mother's nurturing. The study validates something that seems to be intuitive, which is just how important nurturing parents are to creating adaptive human beings. The public health implications suggest that we should pay more attention to parents nurturing and we should do what we can as a society to foster these skills because clearly nurturing has a very, very big impact on later development. For more information on the University of New England, go to une.edu.

Dr. Lisa Belisle:

Today on the Dr. Lisa Radio Hour and Podcast we have a special Valentine's Day edition and we thought we would invite in one of our friends who is a cardiologist, which is a heart specialist. So thank you for coming in. Dr. Mylen Cohen.

Dr. Mylan Cohen:

Thank you for having me.

Dr. Lisa Belisle:

And Genevieve Morgan is sitting next to me.

Genevieve Morgan:

Nice to meet you,

Dr. Lisa Belisle:

Mylan. I know your wife pretty well, which is one of the reasons I wanted to have you in. But you and I have a lot of. There's a lot of crossovers in what we have done professionally. You have a master's in public health from Harvard.

Dr. Mylan Cohen:

That's right.

Dr. Lisa Belisle:

Let's just start there. You're a different sort of cardiologist in that you have a broader. Well, not that other cardiologists don't, but you have a very broad view of heart health, public health, heart health, how it impacts our community and our society. Can you speak to that?

Dr. Mylan Cohen:

Well, the reason why I first thought about getting a degree in public health was while I was a cardiology fellow down in Boston, my chief came to me and felt that it might broaden my perspective, give me a background to do cardiovascular research. And so I participated in a summer program that was run by the Brigham and Women's Hospital at the time that really launched me into that area. Then in completing the master's of public health degree, it really was helpful in seeing a broader perspective, seeing the relationship between cardiac health and so many other things, like socioeconomic factors, emotional factors. And I have to say that perhaps today in my practice, I may not be practicing all of the breadth of public health, but. But it does inform some of the things that I do. And I think that it also helps me make comments on policy. And it can at times be helpful in affecting how the hospitals approach health on a larger basis.

Dr. Lisa Belisle:

And it's especially relevant because health, disease is such an important problem in our culture.

Dr. Mylan Cohen:

That's right. People don't realize that more women die of cardiovascular disease than breast cancer. It's a large killer of people in developed nations.

Dr. Lisa Belisle:

So you are from Maine.

Dr. Mylan Cohen:

Yes.

Dr. Lisa Belisle:

You went to Presque Isle to high school. How has that informed your decision to go on to be a doctor? Because I don't know how many people from your class went on and became doctors.

Dr. Mylan Cohen:

I once had a senior partner who introduced me. Once I came back to Portland, as said, this is Mylon Cohen. He's from Presque Isle, Maine, that breeding ground of Harvard cardiologists. I think I was the only physician in my graduating class in high school. But I think what it does is it gives me a great appreciation of the people of Maine, the patients that I see, just the Whole breadth of socioeconomic statuses. We see people who are out of work, we see people who work hard in the fields or on lobster boats. And then we see CEOs of companies and other people who are highly educated. And I think also knowing a little bit about where they come from in the state also is very helpful in relating to patients.

Dr. Lisa Belisle:

Would you say also that your medical career has been dictated by some of the personal experiences that you've had in your own health?

Dr. Mylan Cohen:

Sure, definitely. I think back to an individual who was a professor at the University of Vermont College of Medicine, where I went to school, who really was instrumental in guiding me towards cardiology. And around the same time that I met him, I actually had an illness of my own and ended up having to have a couple of pretty large operations while I was a medical student. And one of the fundamental things that I learned during that, which I still remember every day that I see patients, especially in the hospital, is the importance of just being asked, is there anything I can do for you or is there anything else that I can do for you before leaving the room? Just that simple question for a patient in the hospital, I find to be very helpful. And that's something that I may not have actually had insight into had I not been a patient myself.

Dr. Lisa Belisle:

Did people do that for you when you were going through your own health issues?

Dr. Mylan Cohen:

Yeah, not only did they do that, it was just the idea that someone was spending the time there and that they actually cared enough to see if there was anything that they could do to make me more comfortable.

Dr. Lisa Belisle:

So there is a relationship between actual physical health and emotional health that you recognized early on?

Dr. Mylan Cohen:

Oh, sure, sure. I think in general that. And there's actually studies to collaborate this, that people who have a better sense of well being, who are generally more happy, actually tend to have better health. On the flip side of that, people who have depression may have other associated physical illnesses.

Dr. Lisa Belisle:

And specific to the heart, there's higher

Dr. Mylan Cohen:

mortality both after heart attacks and. And after having open heart surgery in patients who are depressed compared to patients who aren't depressed.

Dr. Lisa Belisle:

So it is important for people to actually deal with their mental and emotional well being from a physical standpoint as well.

Dr. Mylan Cohen:

Yes, absolutely, yes.

Genevieve Morgan:

The heart also seems to be one of the first places where an emotional stress registers in the body. If you have fear, your heart starts to beat quickly. If you have heartbreak, your heart hurts. So I'm interested in what you have to say about that because it's something everyone can relate to.

Dr. Mylan Cohen:

So much is attributed to the heart, you know, the Soul. And at one point, it was thought to be the basis for your personality. But you're right. The physiologic effects of fear, of anger, of surprise. All of those things have an effect on the heart. And you mentioned a few of them. You suddenly get a fast heart rate. You feel. Some people can really feel their heart pounding. And indeed, there is something called broken heart syndrome. This is something that's been recognized for quite some time. And only recently, actually has been given a more formal name. But some people who have extreme emotional stress. Can actually develop a heart muscle weakness. A cardiomyopathy, if you will. And fortunately, most times, it's reversible. And also, there's something called anniversary death. It's not infrequent that a couple. If one of the members of that couple Dies after many years together, it's not unusual for the other member of that couple to die shortly after that. Or sometimes on the anniversary of the death of their spouse.

Dr. Lisa Belisle:

With this in mind, do you ask patients specifically about their relationships. Or about what's going on in their lives emotionally?

Dr. Mylan Cohen:

It often comes up. I can remember one patient in particular. Who would always develop increased chest pain. On the anniversary of her spouse's death. And so now I know that a few months before the anniversary comes up, I see this patient in the office. And I'll specifically prescribe some medications that help the heart slow down, Blunt the effects of adrenaline. And decrease the chances of her having a heart attack. And then, later on, after this period of time has passed, we can stop the medications, and she does just fine.

Dr. Lisa Belisle:

So that's a way that, instead of just saying to a person, oh, you look like you might have x, I'm going to give you y drug. And then stay on it indefinitely. You sort of. You're able to move and shift with what you know to be herbalife.

Dr. Mylan Cohen:

That's right. For this particular patient, that seems to be a pretty good strategy. It works for her.

Dr. Lisa Belisle:

And you were describing, before we came on air. A study that had to do with another way of dealing with a heart issue. Atrial fibrillation and yoga. Can you tell us about that?

Dr. Mylan Cohen:

Yes. Actually, there was an article that was published in a medical journal just a couple of weeks ago. That indicated that yoga is helpful in improving people's sense of well being. Who have atrial fibrillation. Atrial fibrillation is an arrhythmia. It comes from the two top chambers of the heart. They're not beating in any organized fashion. And when that happens, oftentimes, people can feel a very fast heart rate and it can be uncomfortable to some people. Other people don't even know that they're in atrial fibrillation. This study looked at the effects of yoga and patients, patients who have atrial fibrillation and found that it improves their overall sense of well being and it reduced the symptoms that they were having. It didn't prevent the recurrences of atrial fibrillation, but people felt better when they were in it.

Genevieve Morgan:

What are some other preventative measures people can take to protect their hearts?

Dr. Mylan Cohen:

Well, certainly taking care to maintain a good diet and to exercise regularly are two things that are certainly helpful. Certainly not smoking and getting enough sleep. Reducing stress is also helpful. Those are the primary things. If you know that you have high blood pressure or high cholesterol, taking measures to control those is certainly helpful. And that doesn't necessarily mean medications at first. Oftentimes it does in patients. But just exercising, losing weight is often enough to control. And paying attention to diet is often enough to control hypertension in many people.

Genevieve Morgan:

Can you just drill down a little bit on exercise? Because I'm always as the wellness editor at Maine Magazine, I'm always telling people to exercise, but there's aerobic exercise and anaerobic exercise. And what is your recommendation for?

Dr. Mylan Cohen:

You know, it's as simple as just exercising by walking three times per week. It's been shown that if you can walk 30 minutes three times per week, you reduce your chances of a heart attack by half. So the thing that I tell patients is just move. You know, walk in. Patients who have joint problems and feel that they can't walk far, I'll often encourage them to swim because that's non weight bearing and even just floating in a pool. Moving around a little bit in a pool is going to be helpful for those people.

Dr. Lisa Belisle:

I know that you have a special interest in diabetes and I'm wondering if you've seen any change in the number of patients coming in with diabetes or Pre diabetes in your practice or within the state of Maine since you began

Dr. Mylan Cohen:

practicing diabetes is an epidemic. And because our population is getting larger, the incidence of adult onset diabetes or type 2 diabetes is increasing. And of course, with the onset of diabetes, there's a very tight relationship with development of cardiovascular disease. So the incidence of diabetes is rising. It's not surprising that heart disease is also increasing in those patients. So anything that we can do to reduce the onset of diabetes will be helpful. And that means careful attention to diet, exercise, weight reduction, those things are very helpful in reducing adult onset diabetes.

Dr. Lisa Belisle:

Have we gotten better about offering services for patients who need them in this area?

Dr. Mylan Cohen:

That's an interesting question. I would probably have to defer to some of my colleagues in endocrinology and diabetology. I think there's a lot more that we can do for patients. There's a lot that we can do from the public health perspective, tying in the question you asked me initially. I mean, in Maine we are. We have long cold winters generally, and so it's a little harder for people to get out and walk and be active in the winter. But even simple things like redesigning areas of towns with better sidewalks, moving things closer together so that people can walk from point A to point B, just simple things like that would encourage physical activity, which then of course improves cardiovascular health, helps people lose weight, et cetera. And then from an architecture standpoint, there are things that we can do with public buildings. Make sure that the stairs are easier to find than the elevator, for example, and encourage people who can walk upstairs to actually take the stairs rather than to ride.

Dr. Lisa Belisle:

I know that you and Dr. Dora Mills graduated from the University of Vermont at the same time. So it's interesting because she was the state director of the, the Maine cdc. Do you think there's something about being a Maine high school student that causes you to be more interested in public health?

Dr. Mylan Cohen:

I never really thought of that. I think that's probably something that's just part of someone's nature. I guess I can't point to any single thing growing up in Maine that made me think that I really had to pursue any background in public health. I have to admit that it was something that really kind of came about almost by accident while I was in training. But I do feel that the people who I know who grew up in Maine, who go into medicine or other health fields, do seem to have a real tie to communities, have a tie to the people that they take care of, have a real sense of responsibility, health of people. They come in contact with who are from the state.

Dr. Lisa Belisle:

There are very interesting things that are happening within the healthcare system right now, within the country, within the state, but even within your practice.

Dr. Mylan Cohen:

That's right.

Dr. Lisa Belisle:

Can you tell us a little bit about what's been going on?

Dr. Mylan Cohen:

Well, two days ago, something really momentous happened in Portland. There were two large cardiology groups, Cardiovascular Consultants, Consultants of Maine and Maine Cardiology Associates. And as of two days ago, both of those practices integrated with Maine Health, the parent organization of Maine Medical center, to form Maine Medical Partners, Maine Health Cardiology. This was four years in the making. It required oversight by the Federal Trade Commission and the Attorney General's office in the state of Maine. And we're very excited now, two days into this new organization, that we're going to be able to do a lot of things much, much better to improve the cardiovascular health of the citizens of the state of Maine. This is going to allow us to care for people regardless of their ability to pay. It's going to allow us to do even better at bringing new technologies and new methods of caring for patients with very complex cardiovascular disease, bring new techniques and high technology to bear on these diseases. And it's also going to allow us to recruit and retain top notch cardiovascular specialists. So we're very excited about it.

Dr. Lisa Belisle:

What's in the future of Dr. Mylan Cohen? What's up next for you?

Dr. Mylan Cohen:

That's a good question. I don't know. I'm just trying to get through this first, first week, I think of our newly established practice.

Genevieve Morgan:

Are you going to eat any chocolate on Valentine's Day?

Dr. Mylan Cohen:

You know, I am a definite chocolate fan, I have to say a little bit more. I like dark chocolate. And if you believe the research that was sponsored by Nestle and Hershey's, it may actually be good for your vasculature as well. But I guess it's like everything, everything in moderation. So I tell my patients if they want to have a little piece of chocolate, that's okay. Just make sure that it's not a lot. And same with things like coffee and even alcohol for that matter. The right amount of alcohol is actually favorable for cholesterol and can be favorable for high blood pressure. But in excess, it can drive the blood pressure high, it can make cholesterol higher. It can also cause heart muscle weakness or cardiomyopathy. So it's a great example of just the right amount.

Dr. Lisa Belisle:

So you're gonna eat chocolate. We know that you didn't address it. All right, but what makes your heart happy? What are you going to do?

Dr. Mylan Cohen:

What do I do?

Dr. Lisa Belisle:

Yeah. What's your future hold and what gets you your heart Happy.

Dr. Mylan Cohen:

What makes me happy? First of all, my family. You mentioned Maya at the beginning of the of the interview. And so spending lots of time with my family is very important.

Dr. Lisa Belisle:

And you have a sophomore who is

Dr. Mylan Cohen:

sophomore in high school, Cape Elizabeth.

Dr. Lisa Belisle:

Yeah.

Dr. Mylan Cohen:

And what we all enjoy doing in the summer is sailing. We have a sailboat. We find that incredibly relaxing to cruise the coast of Maine bicycling. And then some of my colleagues will be horrified to find out that I've actually started riding a motorcycle. I find that very relaxing. And my wife has taken it up as well. And I also enjoy reading and in the winter, downhill skiing, although this year hasn't been a great year for that. And then sometimes just being at home in front of the fireplace and enjoying a good book. And then I've mentioned yoga before. I also enjoy yoga.

Dr. Lisa Belisle:

So you are a doctor who practices what he preaches.

Dr. Mylan Cohen:

I try as much as I can.

Dr. Lisa Belisle:

Yes, you are. All right. Thanks so much for coming in and talking to us today.

Dr. Mylan Cohen:

Thanks for having me.

Dr. Lisa Belisle:

This week's Maine Magazine minutes also has to do with having a happy and healthy heart. And our wellness editor for Maine magazine and co host, Genevieve Morgan is going to talk to an interesting physician within the community, another interesting physician who is doing things that make people's hearts happier.

Genevieve Morgan:

That's true. Lisa, thanks. We have today in the studio Dr. Chris Rogers from Portland Surgical Associates, which is now part of Mercy Hospital. Am I correct?

Dr. Chris Rogers:

Yes. We joined up with Mercy Hospital as an official relationship about 14 months ago.

Genevieve Morgan:

Well, welcome.

Dr. Chris Rogers:

Thank you.

Genevieve Morgan:

Now, you do something different than cardiovascular surgery. You emphasize the vascular part of that word. Can you explain what that is and how that relates to the heart?

Dr. Chris Rogers:

Sure. Our practice has been general surgery for 20 plus years. And in general surgery training, there is some vascular surgery training. Some of that vascular surgery training deals with the venous system, and that's the part of our circulatory system that returns blood to the heart. So it's imperative to have a good, healthy return system for that pump in order for it to be, quote, happy.

Genevieve Morgan:

What are Some of the signs that your veins aren't working the way you would like them to?

Dr. Chris Rogers:

Well, some of the visible signs can be as simple as small spider veins on the surface of the skin. And then people who have more advanced problems can have more large ropey looking or worm like veins underneath the skin that bulge out and are kind of unsightly for folks. And then as the vein system sort of degrades or deteriorates, then people can have some leg swelling and changes in the skin and fat texture to the tissues and pigmentation problems where you get a very deep brown pigmentation in the skin. And that's actually the iron pigment from blood that's leaked out of the the veins because they're under a tremendous amount of pressure.

Genevieve Morgan:

That sounds painful.

Dr. Chris Rogers:

The swelling is very uncomfortable for people. And people also describe sort of an itching and burning sensation, but primarily it's pressure and swelling that they're sensing. Some of the inflammation can become painful. And the ultimate sort of end organ that gets damaged is the skin. As the inflammation evolves, people start to actually break down their skin and have what's called a venous ulcer. And that's a sign of very advanced vein disorders.

Genevieve Morgan:

But that's why you're here, to intervene before it gets to that stage.

Dr. Chris Rogers:

Right.

Dr. Lisa Belisle:

One of the reasons that we're having you on Maine Magazine Minute specifically is because Maine Magazine about a year ago recognized that wellness was an important aspect of living in our state, that people in our state not only moved here for emotional and psychological reasons, but also to be healthier, to live a healthier life. And Genevieve, last year had interviewed three doctors. I'm one of them. And this year is interviewing three doctors that are doing great things within the state. You've had to do different things within the state, interesting things within the state. Tell us how things have changed for you.

Dr. Chris Rogers:

Well, the sort of traditional surgical background has always been a very procedure oriented, very acute care oriented, and by acute care, people coming into the hospital being sort of immediately ill and working with them. And so that process is very much a find a sick person, fix a sick person sort of process. And you don't actually go out and find them, but they come to you because they're that ill. And then a part of general surgery is what's called elective surgery, where people come in with a problem and you fix it by mechanical means. And one of the things that we have always recognized, especially regarding the venous system, is there's a big element of sort of preventive or sort of stalling kind of care, but definitely preventive. It doesn't always have to be interventional. It doesn't always have to need a surgical procedure or some other procedure associated with it.

Genevieve Morgan:

Right. So take care of things early and it won't be critical later on.

Dr. Chris Rogers:

Yeah, taking care of things early. The best thing that people can do, and we really promote this in our practice, is try to have people achieve a normal body weight. For instance, because obesity is directly linked to disorders of the venous system, people also need to be exercising and ambulatory. The most important function that a person can give to their venous system is walking, because every time you take a step, the foot and the calf contract and it's the muscles contracting that pushes the blood back towards the heart.

Dr. Chris Rogers:

so females multi parity or having had multiple children and heredity has a huge basis. We don't know any of the real genetic links, but there's definitely a genetic tendency for family members to have varicose veins. And it probably relates to the connective tissue structures either supporting the veins or in the vein walls themselves. And then the other 25% are men. And men usually don't come in because they're self conscious about their veins. They come in because their legs hurt. So most of the women we see earlier in the disease process and they make up the majority of the patients, the men are a lesser percent, but they come in with much more advanced problems. And so our job really is to sort out an individual, find out their unique history, find out some of their unique family history, and then get down to what the real pathology in a patient is. So that starts with obviously the history, then a physical examination that encompasses listening to their heart, checking the arterial side. Dr. Cohen probably talked about the heart pump and healthy arteries and hardening of the arteries and things like that. So a vein doctor wants to check that side too, because there's crossover between chronic arterial and chronic venous problems and you have to sort those issues out as well. So once we get that basic physical exam done, then we can sort of see the pattern that a person's varicose veins or spider veins have or which leg is swollen and which isn't, and start to kind of mentally conceptualize what the underlying problem is. Because it's not really a skin problem per se. This. The skin is the end organ that's getting damaged. It's really a much. You have to carry it down sort of anatomic layers. Our bodies are made up of skin, then a fat layer and then a muscular layer. There's two venous systems. There's a superficial venous system in the fat layer and skin, and then a deep venous system and in the muscular layer. And the deep venous system is generally healthy in most people, unless they've had a deep vein blood clot or they were congenital born without valves in their veins. And it is the valves that I'm

Genevieve Morgan:

ultimately, the predominant condition you see is in that superficial.

Dr. Chris Rogers:

Correct.

Genevieve Morgan:

In the fat level.

Dr. Chris Rogers:

Correct. And so then you see that pattern of surface phenomenon and say, okay, the next layer down is the sort of larger return veins. And if you think of a skeleton, the up and down direction is called the axial direction. So we're looking at those axial veins and where they pipe into the deep system. The deep system carries most of the blood back to the heart. As I said, most of the time, that's fine. The superficial system is the system that gets damaged most of the time. And it's thought to be because the superficial system is only supported by the fat structure of the body. It doesn't have the thick muscles and connective tissue within that muscular system.

Genevieve Morgan:

That makes sense. As we age and gravity takes itself tall and weight and starts to break

Dr. Chris Rogers:

down, and we're talking about some of the demographics, and age is a demographic, and age is related to worsening vein problems. And it's because our connective tissues lose their elastic property. It makes the vein wall weak so the vein can dilate or get bigger. And what that does is it pulls apart very thin connective tissue valves in the vein that are supposed to be only going in one direction, up towards the heart. And if the valves are pulled apart, then they don't function as a valve and they just let blood tumble back towards the feet. And that pressure is what causes the big bulging veins and then ultimately the surface phenomenon on the skin.

Genevieve Morgan:

I'm sure there are many of our listeners out there that would like to learn more. How do they contact you at Portland Surgical Associates?

Dr. Chris Rogers:

Well, we are part of Mercy Hospital. So I'll plug Mercy. You can get to us through the Mercy website and through the Mercy switchboard and direct telephone number would be 553-6500. And we have information about our venous practice on portlandsurgical.com and then we're also linked to the American College of Phlebology, which is phlebology is the study of veins. And so the American College is the major academic colleges that's organized and helps certify physicians, physicians who are practicing in the venous system. And they have excellent patient education materials right on their like basically their front page, American College of Phlebology.

Genevieve Morgan:

Well, we can link to that right from the doctor.

Dr. Lisa Belisle:

And thank you for coming in.

Dr. Chris Rogers:

Thank you.

Genevieve Morgan:

Dr. Chris Rogers is just one of the many excellent medical professionals operating in our state today. We are lucky enough to have a statewide system of care from Eastern Maine Medical center through Mercy Hospital and Maine Medical center and Southern Maine Medical center where many of these medical professionals work, live and play in our lovely state. To read about three exceptional doctors, please pick up the April 2012 wellness issue of Maine Magazine at your local newsstand or visit us online@themainmag.com.

Dr. Lisa Belisle:

There are so many things that we could have on our show for give back for our Valentine's Day show, but we chose to have Jen Goldman on from the American Red Cross. She's going to talk a little bit about something that has to do with both the veins and the heart as described by the doctors who were on earlier. And that is blood. Hi, Jen.

Jen Goldman:

Hi, Lisa.

Dr. Lisa Belisle:

Tell me, you were telling me off air, what is the difference between your part of the American Red Cross and the other part?

Jen Goldman:

Well, we are actually one Red Cross. I work specifically for blood services. We make sure that the blood supply and Maine is where it should be. The other part of the Red Cross that we do work with is disaster services and disaster services is the part of the Red Cross that responds to fires or emergencies. You probably hear more about disaster services on the news than you do about blood services.

Dr. Lisa Belisle:

Blood services are very relevant. Today it's snowing out. I'm hoping by the time this show airs, it's not snowing anymore and it'll be a beautiful spring day, of course, but not likely. What happens when it snows in Maine with regard to blood?

Jen Goldman:

Well, that's a very timely question because here we are in the middle of winter, and we do actually right now have an urgent need for blood. What happens in the winter? We need to collect 300 units of blood every day. In the winter we have snow, which in a lot of cases we have to cancel blood drives because of the snow, which can wipe out 300 units of blood a day. The other thing that happens in Maine when it snows, our demographics tend to be older donors. So when it snows, older people are less likely to drive to blood drive. So we really, really struggle and need to find new donors during the winter months.

Dr. Lisa Belisle:

What are some of the criteria for being able to give blood in Maine?

Jen Goldman:

You have to be 17 years old and weigh at least 110 pounds. Although recently, in the past couple of years, 16 year olds can give blood with parental or guardian signature on a permission slip. You also have to be in good health the day you give blood.

Dr. Lisa Belisle:

And there's an entire screening process that people go through to give blood, Is that correct?

Jen Goldman:

When you arrive to give blood, we do what's called a health history, which I always refer to as a mini physical. It's about five to ten minutes long. And they'll take you into a little booth and they'll take your temperature, they'll check your iron levels, they'll check your blood pressure, and they'll ask you a series of questions about medications you might be on, where you've traveled recently. And assuming you pass all these tests, then you move on to the part where you actually give blood.

Dr. Lisa Belisle:

What types of things are hospitals using the blood for?

Jen Goldman:

Hospitals use the blood for lots of different things. The things that you probably hear the most about are trauma, car accidents. Oftentimes somebody can end up in the hospital after a car accident and need anywhere from three to 30 units of blood. Cancer patients use blood. Organ recipients use blood. People who are transfusion dependent obviously use blood. So that's why the need is so great. In Maine, the Red Cross provides the blood to all 39 hospitals in the state.

Genevieve Morgan:

And you can only get blood from a person? Correct.

Jen Goldman:

I mean, at this point, you can only get blood from people. And in fact, the reason it's so difficult to keep the supply up is because blood at this point in time can't be manufactured. We. We can only get blood from people.

Dr. Lisa Belisle:

So we need Maine people to go and donate blood. And there are many locations that I know are available to people in Maine.

Jen Goldman:

Yeah, we have probably six to eight blood drives every day, six days a week, and sometimes on Sundays. Our blood drives run from Fort Kent down to Kittery. We have two fixed sites in Portland and Bangor, and actually a third fixed site in Lewiston at Central Maine Medical Center. We have businesses running drives every day. We have schools running drives. And then we have community drives at churches and synagogues and rotaries.

Dr. Lisa Belisle:

Now, this is for sort of a pint of blood, but people can also do a platelet donation, is that correct?

Jen Goldman:

They can donate platelets, but they do have to go into one of our fixed sites.

Dr. Lisa Belisle:

And that takes a little bit longer.

Jen Goldman:

It does take a little bit longer than donating whole blood. We have a very. A vast selection of movies, though, for donors who are giving platelets to watch during the process.

Genevieve Morgan:

What's the reason, number one reason people don't give blood?

Jen Goldman:

Can you guess the number one reason people don't give blood?

Dr. Lisa Belisle:

Needles.

Jen Goldman:

Not needles. Any other guesses?

Genevieve Morgan:

They think it's unsafe?

Jen Goldman:

No. The number one reason people don't give blood is because nobody's ever asked them to give blood. We go into the middle schools and the high schools, and we encourage kids to get out there and ask their parents, ask their teachers, ask people who have never given blood to give blood because if they're not a blood donor, it's probably because nobody's ever asked them,

Dr. Lisa Belisle:

is there a certain blood type? I know there's A and there's B and there's O and there's ab and there's positive and negative. And some people get confused about this. But is there a certain type that you like to see?

Jen Goldman:

Well, we're always looking for O negative blood. O negative is the universal blood type. And what that means is if you were in a car accident and taken into the hospital and they didn't know your blood type, they would automatically give you O negative blood. We use a lot more O negative blood than we do other blood types.

Dr. Lisa Belisle:

How did you get into this line of work?

Jen Goldman:

Good luck. Good.

Dr. Lisa Belisle:

But what makes you so. You're clearly. You're sitting across from us. You're so passionate about what you're doing. Even when you came in the door, you were so passionate about this. What makes you so passionate about this?

Jen Goldman:

Well, I really feel like whether I have a good day or a bad day in the office, I've made a difference in lives at the end of every day. So it makes me feel good about the work I'm doing.

Dr. Lisa Belisle:

How can people find out more about your organization?

Jen Goldman:

Well, people can call 1-800-Red Cross to make an appointment. They can also go to our website, www.redcrossblood.org. it's a great website, very comprehensive and I suggest people check, check it out.

Genevieve Morgan:

Well, and out of a million, 1.5 million population to get 300 units a day, people have to give regularly, consistently.

Jen Goldman:

Well, we encourage people to give regularly. People can give whole blood every 56 days. And we really do have a lot of people who show up on that 56th day ready to give another pint. Most of them have been touched in some way. They've had a family member or a loved one one need blood. But there really are, there are a lot of dedicated donors, but we need more dedicated donors. We can always bring the blood drive to you. Our job at the Red Cross is to make it as convenient as possible for you to give blood. So we'll bring the bus to you, we'll come to your place of business and set up a blood drive. But just call us at our Forest Avenue location and we'll make it easy for you to get give blood.

Genevieve Morgan:

And just to be perfectly clear, the body replenishes the pint that you give within 56 days.

Jen Goldman:

Yes, the body does replenish the blood quickly. The Average adult has 10 to 12 units of blood in their body. So we encourage people write it on your calendar every 56 days and become a regular blood donor.

Dr. Lisa Belisle:

Well, for this virtually painless experience, people can go to your website as you've already mentioned, and we will link through through on the Dr. Lisa website. We thank you for coming in today, Jen.

Jen Goldman:

Oh, it's been a pleasure and I hope to see both of you and all your listeners at a blood drive in the near Future.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle. In this show, we spoke with Dr. Mylan Cohen of Maine Cardiology who suggested that doing anything, even moving about in the water in a pool or having some chocolate or doing things that made our hearts happy could be good for our hearts. Dr. Chris Rogers of the Vein Center Portland Surgical, affiliated with Mercy Hospital, spoke about the relationship between other parts of our body, our veins and our heart and how everything is interrelated. And Jen Goltman of the American Red Cross left us with an important message, which is that often people don't do things because they aren't asked. They don't give blood because they aren't asked. And I would suggest, as would Genevieve Morgan and the other members of our radio team, that perhaps we need to be asking more of our listeners. We need to ask you on this Valentine's Day to go out and do things to make your heart happier and healthier. In other words, love yourself. It's cliche, I know, but we're often told we need to love our children, love our spouses, love our partners, but love yourself first. Go out and do good things for yourself that make yourself happy, make your heart happy and healthy. Subscribe to our podcast Dr. Lisa Belisle through itunes and get us in your inbox on a weekly basis so you can listen to us while you're out doing heart healthy activities such as biking or running or walking around a track. Forward our emails to your friends and family. So we're asking. We're asking you to love yourself, we're asking you to love us, and we're asking you to listen to us again next week as we talk about gaining ease on February 19th, which will be our 23rd show. This is Dr. Lisa Belisle. Thank you for being part of our world. May you have a bountiful life.