The Relationship Between Diabetes and Heart Disease

If you’re aware of your heart health, you’ve probably read and heard a lot about risks for people who have diabetes.  That’s because there’s a major connection between the two types of disease.

In fact, people who are diabetic are twice as likely to have heart disease than those who aren’t diabetic.  It’s also true that someone who is diabetic who has a heart attack is also more likely to die from that heart attack.

Some of the reason for this may be the common characteristics of people who are diabetic and those who are at risk for heart disease.  For example, many people who are diabetic are overweight, which is also a risk factor for heart disease. downloadDiabetics are also more likely to be sedentary and to have high blood pressure.  This combination of risk factors would make anyone at risk for heart disease. What may make diabetes a more special case for cardiac risk is the insulin-resistance that’s characteristic of it.

Insulin resistance is known to increase LDL and triglyceride levels (the bad cholesterol) and also cause HDL (good cholesterol) to be lower.  This causes the advancement of hardening of the arteries. Continue reading “The Relationship Between Diabetes and Heart Disease” »

How the Budget Deal Blunts Medicare Cost Increases, & Tweaks Social Security

620-medicare-social-security-cards-wallet[1]The bipartisan budget agreement reached by the White House and congressional leaders wards off a spike next year inMedicarepremiums and deductibles for millions of older Americans as well as ensures full Social Security disability benefits to millions who had faced steep cuts. The accord went to President Barack Obama after being adopted by the House of Representatives Oct. 28 and by the Senate Oct. 30.

In a letter to Congress, AARP CEO Jo Ann Jenkins applauded the agreement: “Your efforts to reach across the aisle and together find sensible solutions to significant problems are appreciated and commended.”

Newsletter: Get the latest on AARP advocacy programs affecting you »

Here’s a look at measures in the deal that affect the pocketbooks of older Americans.

Limits Medicare premium deductible increases. With no Social Security cost-of-living adjustment (COLA) for 2016, 70 percent of Medicare beneficiaries will see no increase in their monthly Part B premiums next year, despite the program’s increased costs. But because of a wrinkle in federal rules, the burden of paying for the increased costs was to fall on the other 30 percent of Medicare beneficiaries through an increase in premiums from $104.90 to $159.30. The budget deal softens the blow to $120 a month.

The reduction is financed by a $7.5 billion loan that will begin to be repaid through an additional $3 monthly surcharge on many of these same beneficiaries and a surcharge of up to $12 a month on higher-income beneficiaries. In years when there is a Social Security COLA, all beneficiaries will be subject to the surcharge. The loan is expected to be repaid within five years.

Limits the deductible increase in traditional Medicare. The deductible for everybody with traditional Medicare, which had been projected to increase by more than 50 percent in 2016, from $147 to $223, will be held to $167.

Replenishes the Disability Trust Fund. The fund that pays Social Security disability benefits was expected to run out of reserves late next year without a fix. Eleven million Americans — 7 out of 10 of them age 50 or older — would have seen a nearly 20 percent decline in benefits.

The budget deal prevents this cut by diverting a larger share of payroll taxes over the next three years to the disability fund, allowing it to pay full benefits through 2022. Currently, workers and employers pay a total of 12.4 percent of wages in the Social Security tax, most of which goes to retirement benefits. But for the next three years, 2.37 percent of wages — an increase of .57 percentage points — will be allocated for disability benefits.

Congress has approved similar reallocation of the payroll tax in other years.

Eliminates certain Social Security claiming strategies.Some couples have taken advantage of a strategy that arose from changes to the law in 2000 and maximized their benefits through Social Security’s “file and suspend” option. Here’s an example of how it works: A husband files for Social Securityat full retirement age and then immediately suspends his benefit. This allows his benefit to continue growing at 8 percent for every year he keeps his benefit on hold until age 70. Meanwhile his wife, who may not have qualified for benefits on her own, can collect a spousal benefit — worth up to half of her husband’s benefit.

AARP Sent the Following Letter to Congress on Oct. 14th, 2015

AARP has deep concern that for only the third time in over 40 years, there will be no Social Securitycost-of-living adjustment for 2016. To make matters worse, as a result, 30 percent of Medicare beneficiaries will see their monthly Medicare Part B premium dramatically increase, and all Medicare beneficiaries will experience an increase in their Part B deductible.

Congress should protect the 16.5 million Medicare beneficiaries — which includes new enrollees, people not collecting Social Security, and beneficiaries dually eligible for Medicaid — from the harmful effects of dramatically increasing premiums, due to there being no Social Security cost-of-living adjustment (COLA) as well as protect all Medicare beneficiaries from the large increase in their deductible.

The Social Security Trustees announced Oct. 15 that there will be no Social Security COLA in 2016, due to unusually low energy prices. However, the impact of very low energy prices on Social Security recipients may be overstated in the current cost of living formula, and as a result, the need for a COLA may be understated in this week’s announcement. Continue reading “AARP Sent the Following Letter to Congress on Oct. 14th, 2015” »

Breaking Free from Your Alcohol Addiction

At some point, having a drink with friends becomes more than a social event. You find that you don’t even go out with the group unless they plan to drink. You’ve fooled yourself into believing that when you are drinking alcohol, you have more fun and you’re more outgoing.

What your friends talk about is how outrageous you behave and how you’ll say anything to anyone. They’re laughing at you, not with you.  When you’re sober, you regret what you said or did.10846141_10152878994164400_2949797533172704497_n

You also ran up the credit card buying rounds for everyone and you lost money being too hung over to go to work the next day.  No matter how tired you are of listening to your family or friends tell you that you have an alcohol problem, in your sober moments you know that drinking is taking over your life. Continue reading “Breaking Free from Your Alcohol Addiction” »

How to Avoid a Heart Attack in Extreme Weather…


The arctic blast that brought tundralike temperatures to much of the country this winter has left behind more than frozen pipes and frost-nipped noses. During a typical winter, there are up to 36% more circulatory-related deaths than during warmer months.

And it’s not just cold weather that puts you at risk. Researchers have identified other types of weather—throughout the year—that trigger spikes in hospitalizations and death.

For details on the effects that weather can have on your heart, Bottom Line/Healthspoke to Barry A. Franklin, PhD, a leading expert in cardiac rehabilitation.

We hear a lot about cold weather being hard on the heart. At what temperature does this really become an issue? When it’s cold enough to wear a winter jacket, it is cold enough to think about the health of your heart. In fact, research that was recently presented at the European Society of Cardiology Congress 2013 shows that the risk of having a heart attack increases by 7% for every 18°F drop below 73°F.

Why exactly is cold weather so dangerous? Cold temperatures cause blood vessels throughout the body to temporarily constrict, raising blood pressure. Since the arteries that supply the heart are only about the thickness of cooked spaghetti, even a slight narrowing can cause reduced blood flow.

Winter temperatures aren’t generally a problem if you are young and active. But risk rises as you hit middle age and beyond. The risk is highest for adults who are ages 65 and older, particularly those with underlying health problems, such as diabetes, obesity or preexisting heart disease. For people in these groups, spending even a few minutes in below-freezing temperatures can trigger a 20- to 50-point rise in blood pressure.

That’s why I advise older adults, in particular, to stay indoors on the coldest days if possible. When you do go outdoors, don’t depend on a light jacket—you should really bundle up by wearing a hat and gloves and dressing in multiple loose layers under your coat. Each layer traps air that’s been heated by the body and serves as insulation.

And what about hot weather—does it harm the heart? Actually, heat kills more people every year than any other type of weather.

High temperatures, generally above 80°F, but especially greater than 90°F, can cause heat syncope (sudden dizziness and/or fainting)…heat edema (swelling in the feet/ankles)…and heat stroke, in which the body’s core temperature can rise above 104°F. People with atrial fibrillation or dementia are at a 6% to 8% increased risk of dying on hot days. Dementia affects the brain’s ability to regulate the body’s heat response.

Why is strenuous exertion so dangerous for many people during weather extremes? Snow shoveling provides a good example. This activity creates a “perfect storm” of demands on the heart. With snow shoveling, the real danger—particularly for those who are older and/or sedentary—is the exertion itself.

Moving snow is hard work. Each shovelful weighs about 16 pounds (including the weight of the shovel). If you lift the shovel once every five seconds and continue for 10 minutes, you’ll have moved nearly one ton of snow. This exertion can have adverse effects on the heart.

Here’s why: Snow shoveling involves isometric exercise and unaccustomed muscle tension, which increases heart rate and blood pressure. Your legs may stay “planted” when you shovel, which allows blood to pool and reduces circulation to the heart.

Also, people tend to hold their breath (this is known as a Valsalva maneuver, and it often occurs when people are straining to lift heavy loads) when they are wielding a shovel, which causes a further rise in heart rate and blood pressure. That’s why every year, we read or hear about people who dropped dead while shoveling snow.

Is there any way to reduce the risk associated with snow shoveling? If you have or suspect you have heart disease, I suggest that you don’t shovel your own snow. Hire someone to do it for you.

If you are in good shape and want to shovel your own snow, it may be safer in the afternoon. In general, most heart attacks occur between —-6 am and 10 am, when heart rate and blood pressure tend to be higher. You’re also more likely to form blood clots early in the day.

Then be sure to shovel slowly…work for only a few minutes at a time…and keep your legs moving to circulate blood. And remember, it’s best to push snow rather than lift it. This helps keep your legs moving and takes less exertion than lifting. There are snow shovels designed for pushing snow.

What types of exertion are especially dangerous during hot weather? Racket sports, water skiing, marathon running and certain highly competitive sports seem to be associated with a greater incidence of cardiac events in hot, humid weather. Why? Heart rates are disproportionately increased. Electrolytes, such as sodium and potassium, also are lost, which can lead to dangerous heart rhythms.

What steps should people take to protect themselves in hot weather? Everyone knows to drink water when it’s hot. But even people who are consciously trying to stay hydrated often do not drink enough. Drink plenty of cool liquids before, duringand after heat exposure. If you’re sweating a lot, you might want to drink an electrolyte-rich sports drink such as Gatorade or Powerade. And be sure to wear lightweight, loose-fitting clothing when you go outdoors.

In addition, think about any medications you may be taking. Many common drugs, including certain antihistamines and antidepressants, have anticholinergic effects—they inhibit your body’s ability to cool off.

To help your body adapt to heat and humidity: As the weather grows hotter, gradually increase your daily exposure to the heat. The body’s circulation and cooling efficiency increases, generally in eight to 14 days. Afterward, the body is better able to cope with extremes in heat and humidity.

Source: Barry A. Franklin, PhD, director of preventive cardiology and rehabilitation at William Beaumont Hospital in Royal Oak, Michigan. He has served as president of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American College of Sports Medicine. Dr. Franklin is coauthor of 109 Things You Can Do to Prevent, Halt & Reverse Heart Diseases.


How to Know If You Have a Migraine Headache

Headaches come in all shapes and sizes.  But if you have chronic problems with painful, debilitating headaches you could be suffering from migraine headache.  There are several clues that you may be having a migraine instead of another type of headache.  You’ll want to start by keeping a journal of your symptoms so that you can track patterns in your pain and determine what type of headache you have.

People who suffer from migraine headache often have an early warning sign called the “aura”.  This is typically the feeling of seeing flashing lights.  You can compare it to the feeling of seeing spots when someone has taken a photo of you with a flash on their camera.  However, this feeling doesn’t go away for several minutes to an hour.  For many people this is the first sign they are having a migraine headache instead of another type.

Migraine headache is also usually accompanied by severe head pain on one side of the head about 30 minutes after the aura begins.  The pain can also be accompanied by nausea and even vomiting.  Pain can be so severe that you want to just lie in a dark, quiet room.  You may find it difficult to sleep while experiencing the pain of a migraine. Continue reading “How to Know If You Have a Migraine Headache” »

I Have Knee Pain! Am I Too Young for Knee Replacement Surgery?  


It’s a fact—people getting knee replacements just keep getting younger and younger. The number of knee-replacement operations in folks ages 45 to 64 has nearly doubled in less than 10 years. If arthritis is hurting your knees, no matter your age, the thought of knee replacement has almost certainly crossed your mind.

If you’re in your 40s or 50s or even early 60s, though, think twice. Getting a new knee or two this young might be a mistake. That’s especially true if you want to stay active now and in your later years. Even if you really need a knee operation—and not everyone with knee arthritis does—there may be a better surgical option.

We spoke with Jack Bert, MD, a nationally recognized expert in cartilage restoration who is an orthopedic surgeon at Minnesota Bone & Joint Specialists in Woodbury. Dr. Bert recently addressed his fellow orthopedists on the topic at a medical conference sponsored by the publication Orthopedics Today. He recommends that younger candidates for knee-replacement surgery consider a more conservative treatment that’s better for an active lifestyle. It used to be more widely used but has waned in popularity—it’s called high tibial osteotomy (HTO). We’ll see why—but first, what’s with all these hurting knees in people who aren’t very old?


One reason for the rise in osteoarthritis in middle age is that more people are active and involved in high-intensity sports, putting them at increased risk for knee injuries like tears to the meniscus (the knee cartilage that cushions the joint) or damage to the joint surface itself. These injuries, and often the surgery to repair them, are linked to an increased risk for arthritis at a young age. On the other side of the equation, arthritis is becoming more common in younger people who are obese because of the extra load on their knee joints. Being overweight by 10 pounds can put an extra 30 to 60 extra pounds of pressure on your knees with each step.

In younger people, however—and by younger, we mean up to around 60 or so years old—the arthritis is often limited to one side (compartment) of a given knee, either because that’s where the injury occurred or because of gait issues, like being bowlegged or having “knock knees” deformities, which tends to put more wear and tear on the inner or outer part of the knee. If you’re discussing surgery, your orthopedic surgeon will likely recommend a “partial knee replacement” if your arthritis is confined to just one of the compartments of your knee. But here’s why even that may be a bad choice.

“When you do a knee replacement in a young person, you’ve committed that poor patient to having two or three knee revisions (implant re-dos) in their lifetime,” says Dr. Bert. That’s because knee implants wear out in 10 to 12 years. In very active people, the lifespan is on the short end of the range. “Every time you do a revision, the success rate of the implant drops significantly,” he adds. That could leave you with painful untreatable knees in your 60s or 70s when you hopefully have many more years to go!


So what about the alternative—the high tibial osteotomy mentioned above? At a recent medical meeting for orthopedic surgeons, Dr. Bert recommended that surgeons perform this HTO procedure, in which a wedge of bone is cut out of the shinbone (tibia) under the healthy side of the knee. The opening is either closed or opened further, and a bone graft added to fill the space to align your leg better and take pressure off of the arthritic knee joint surface. A plate is then screwed over the repaired bone. By shifting your weight off of the damaged side of the joint, the procedure can relieve pain and improve function. Studies have also shown that by reducing the load pressure on the injured part of the knee joint, HTO allows new cartilage to grow back to some extent, providing a little more comfort and protection.

The advantages over a knee replacement are obvious. You’re preserving your own knee joint and delaying, or possibly even preventing, the start of a cycle of repeated knee replacement that may not help for your entire life. Even if you eventually need a partial or total knee replacement, you may be able to hold out long enough to take advantage of new techniques being researched that use stem cells or other biological approaches to preserve the joint. Research also shows that the success of a total knee replacement, if you do eventually need one, is just as good in people who’ve previously had an HTO as in those who go directly to knee replacement.

HTO is also a better choice if you’re a runner, play competitive tennis or are otherwise very active, Dr. Bert says, because you really can’t resume high-intensity activity at nearly the same level after having a knee replacement.


Dr. Bert admits that HTO is a tough sell to patients. The main reason is that recovery time is longer than that for knee replacement. Patients are on crutches for six to 12 weeks, or even longer in some cases, because the bone has to heal, versus only a few days after a partial knee replacement for most healthy middle-aged people. “We’re a society that wants a quick answer to everything, so it’s a challenging discussion for a surgeon to have with a patient,” he says.

You do need to be committed to the recovery phase if you’re going to do this. The operation itself has a low rate of complications, but if you put pressure on the knee too soon, the bone may not heal well.

You may be hard-pressed to find a surgeon who does HTO, too. The main reason is that partial and total knee replacements have become so successful that there’s less interest in HTO. At the conference of orthopedic surgeons, Dr. Bert asked for a show of hands of who has performed the operation. Fewer than one in 10 of the surgeons in the room raised a hand. “It’s not being taught universally in orthopedic residency training programs, so some surgeons feel very uncomfortable doing the procedure,” says Dr. Bert.

If you’re under age 60 (or even 65), and are a candidate for a partial knee replacement, consider nonsurgical options first. Exercise may help quite a bit—see Bottom Line’s  You Need Exercise—Not a Knee Replacement, and The Ultimate Knee Workout. Get physical therapy, and work with your doctor, who may prescribe injections, pain meds, knee braces and other short-term approaches to help you stay active.

If it’s really time for a knee operation, though, ask your surgeon about HTO before considering a partial or total knee replacement. Each medical case is different, so it is not the best option for everyone. But it’s worth exploring. If your doctor doesn’t do HTOs, seek a second opinion. Make sure any physician you’re considering for an HTO has done at least 30 to 40 of the procedures because there is a learning curve. You may have to head to a large medical center to find an experienced surgeon.

Source: Jack Bert, MD, is an orthopedic surgeon and adjunct clinical professor at the University of Minnesota School of Medicine, and medical director of the Minnesota Bone & Joint Specialists in Woodbury. He is the founder of the Cartilage Restoration Center of Minnesota and is a nationally recognized expert in cartilage restoration and speaks throughout the world on the subject.

Continue reading “I Have Knee Pain! Am I Too Young for Knee Replacement Surgery?  ” »