Playa Vista Medical Center wants to keep you updated on any newsworthy health topics. The following are some updates and articles of interest.
	Heart Surgeon Speaks Out On What Really Causes Heart Disease Dr. Dwight Lundell PreventDisease Thu, 01 Mar 2012 21:58 CST © We physicians with all our training, knowledge and authority often acquire a rather large ego that tends to make it difficult to admit we are wrong. So, here it is. I freely admit to being wrong. As a heart surgeon with 25 years experience, having performed over 5,000 open-heart surgeries, today is my day to right the wrong with medical and scientific fact. READ MORE I trained for many years with other prominent physicians labelled "opinion makers." Bombarded with scientific literature, continually attending education seminars, we opinion makers insisted heart disease resulted from the simple fact of elevated blood cholesterol. The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake. The latter of course we insisted would lower cholesterol and heart disease. Deviations from these recommendations were considered heresy and could quite possibly result in malpractice. It Is Not Working! These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated. The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences. Despite the fact that 25% of the population takes expensive statin medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before.  Statistics from the American Heart Association show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes. These disorders are affecting younger and younger people in greater numbers every year. Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped. Inflammation is not complicated -- it is quite simply your body's natural defence to a foreign invader such as a bacteria, toxin or virus. The cycle of inflammation is perfect in how it protects your body from these bacterial and viral invaders. However, if we chronically expose the body to injury by toxins or foods the human body was never designed to process,a condition occurs called chronic inflammation. Chronic inflammation is just as harmful as acute inflammation is beneficial. What thoughtful person would willfully expose himself repeatedly to foods or other substances that are known to cause injury to the body? Well, smokers perhaps, but at least they made that choice willfully. The rest of us have simply followed the recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity. Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine. What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods. Take a moment to visualize rubbing a stiff brush repeatedly over soft skin until it becomes quite red and nearly bleeding. you kept this up several times a day, every day for five years. If you could tolerate this painful brushing, you would have a bleeding, swollen infected area that became worse with each repeated injury. This is a good way to visualize the inflammatory process that could be going on in your body right now. Regardless of where the inflammatory process occurs, externally or internally, it is the same. I have peered inside thousands upon thousands of arteries. A diseased artery looks as if someone took a brush and scrubbed repeatedly against its wall. Several times a day, every day, the foods we eat create small injuries compounding into more injuries, causing the body to respond continuously and appropriately with inflammation. While we savor the tantalizing taste of a sweet roll, our bodies respond alarmingly as if a foreign invader arrived declaring war. Foods loaded with sugars and simple carbohydrates, or processed with omega-6 oils for long shelf life have been the mainstay of the American diet for six decades. These foods have been slowly poisoning everyone. How does eating a simple sweet roll create a cascade of inflammation to make you sick? Imagine spilling syrup on your keyboard and you have a visual of what occurs inside the cell. When we consume simple carbohydrates such as sugar, blood sugar rises rapidly. In response, your pancreas secretes insulin whose primary purpose is to drive sugar into each cell where it is stored for energy. If the cell is full and does not need glucose, it is rejected to avoid extra sugar gumming up the works. When your full cells reject the extra glucose, blood sugar rises producing more insulin and the glucose converts to stored fat. What does all this have to do with inflammation? Blood sugar is controlled in a very narrow range. Extra sugar molecules attach to a variety of proteins that in turn injure the blood vessel wall. This repeated injury to the blood vessel wall sets off inflammation. When you spike your blood sugar level several times a day, every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels. While you may not be able to see it, rest assured it is there. I saw it in over 5,000 surgical patients spanning 25 years who all shared one common denominator -- inflammation in their arteries.  Let's get back to the sweet roll. That innocent looking goody not only contains sugars, it is baked in one of many omega-6 oils such as soybean. Chips and fries are soaked in soybean oil; processed foods are manufactured with omega-6 oils for longer shelf life. While omega-6's are essential -they are part of every cell membrane controlling what goes in and out of the cell -- they must be in the correct balance with omega-3's. If the balance shifts by consuming excessive omega-6, the cell membrane produces chemicals called cytokines that directly cause inflammation. Today's mainstream American diet has produced an extreme imbalance of these two fats. The ratio of imbalance ranges from 15:1 to as high as 30:1 in favor of omega-6. That's a tremendous amount of cytokines causing inflammation. In today's food environment, a 3:1 ratio would be optimal and healthy. To make matters worse, the excess weight you are carrying from eating these foods creates overloaded fat cells that pour out large quantities of pro-inflammatory chemicals that add to the injury caused by having high blood sugar. The process that began with a sweet roll turns into a vicious cycle over time that creates heart disease, high blood pressure, diabetes and finally, Alzheimer's disease, as the inflammatory process continues unabated. There is no escaping the fact that the more we consume prepared and processed foods, the more we trip the inflammation switch little by little each day. The human body cannot process, nor was it designed to consume, foods packed with sugars and soaked in omega-6 oils. There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation- causing omega-6 fats like corn and soybean oil and the processed foods that are made from them. One tablespoon of corn oil contains 7,280 mg of omega-6; soybean contains 6,940 mg. Instead, use olive oil or butter from grass-fed beef. Animal fats contain less than 20% omega-6 and are much less likely to cause inflammation than the supposedly healthy oils labelled polyunsaturated. Forget the "science" that has been drummed into your head for decades. The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak. Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today. The cholesterol theory led to the no-fat, low-fat recommendations that in turn created the very foods now causing an epidemic of inflammation. Mainstream medicine made a terrible mistake when it advised people to avoid saturated fat in favor of foods high in omega-6 fats. We now have an epidemic of arterial inflammation leading to heart disease and other silent killers. What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.
	The cold, short days of winter bring us inside for comfort food, blazing fires, and winter treats like hot spiced cider. Being active during colder months is important, but may pose some challenges. We show how eating healthily and staying active can yield a different kind of comfort, the warm glow of good health. Staying Active during Winter Staying Active during Winter With all the holiday preparations, exercise is likely to be at the bottom of an already long to-do list. But there are several different ways to stay active without sacrificing the holiday celebrations. Read More Nutrition and Physical Activity Nutrition and Physical Activity Proper nutrition is extremely important for an active lifestyle. A nutritious diet requires a variety of food types, such as proteins, fats, and carbohydrates. We put together a basic guide to help give your eating plan a healthy boost. Read More Getting and Staying Active Getting and Staying Active Being fit doesn't require athletic abilities. A brisk walk several times a week is a great place to start. Here we define fitness, discuss its benefits, and show you how you can start to become more active. Read More Dietary Guidelines Dietary Guidelines Dietary guidelines, established in part by the U.S.D.A., suggest balance, moderation and variety, a sensible recipe for sound nutrition. Wishing you good health. Read More Credit: Blue Shield of California's Health Care Services Team
	A healthy heart and a long life often go hand in hand. Heart disease is a leading cause of death among Americans, but there are steps you can take to help strengthen your heart and reduce your risk. Being heart smart can put you on a path to heart health. Read about our latest Heath Update: The Heart-Smart Basics.
	It's what we do in response to a bout of insomnia that determines whether we will end up with long-term sleep problems. The fact is the sleep system tends to right itself after a few nights of insomnia—provided you make no adjustments to your sleep-wake cycle. Read about our latest Heath Update: Guide to Sleep.

WHOOPING COUGH (PERTUSSIS)  

Please be aware that there is an increased incidence of whooping cough (Pertussis) in the LA County area. One of the main symptoms of this illness is a persistent cough. If you start to develop this, you should contact a physician as there is a vaccination to protect your family members - especially children - from contracting this. Playa Vista Medical Center has this vaccination.  

If there is an outbreak at your company then your employees should come in and be vaccinated.  If not, then it is strongly suggested that you look at the CDC and CA government guidelines and follow them as appropriate.  Following is the California Department of Public Health Website link for further information on Whooping Cough: http://www.cdph.ca.gov/HealthInfo/discond/Pages/Pertussis.aspx  

In addition to the new requirement noted above, the California Department of Public Health has provided the following recommendations:  

SUMMARY: CDPH recommends that all patients indicated for immunization against tetanus, diphtheria or pertussis be immunized with: 

• DTaP if age 6 weeks through 6 years; or 
• Tdap if age 7 years and older. 

For the 2011-12 school year only, all students entering 7^th through 12^th grades will need proof of a Tdap booster shot before starting school. This requirement:

• Begins July 1, 2011.
• Will be met by receiving one dose of Tdap vaccine on or after the 10th birthday.

The only reasons not to provide Tdap are documentation of a prior dose or a valid contraindication. Health care facilities and providers should institute policies to achieve these recommendations.  

PRIORITY POPULATIONS: CDPH recommends that all patients without documentation of full immunization against pertussis be fully immunized at the earliest opportunity, particularly:  

Women of childbearing age: CDPH recommends that all women of childbearing age be vaccinated with Tdap, preferably before pregnancy, but otherwise during or after pregnancy -- pregnancy is not a contraindication to vaccination (1, 4). The American Academy of Pediatrics (AAP) recommends that unvaccinated pregnant adolescents be given the same consideration for Tdap vaccination as non-pregnant adolescents (1). The Advisory Committee on Immunization Practices (ACIP) prefers Tdap vaccination in the immediate postpartum period (4). AAP, ACIP, and the American College of Obstetricians and Gynecologists (ACOG) recommend that, when given during pregnancy, it is preferable to administer Tdap during the second or third trimester to minimize the coincidental association of Tdap vaccination with adverse outcomes, which occur most often during the first trimester (1, 2, 4, and 6).  

Other close contacts of infants: CDPH recommends that birth hospitals and other immunizers provide Tdap to all close contacts of infants without documentation of Tdap vaccination, especially parents and childcare providers. Contacts should be immunized before mother and baby are discharged after birth, regardless of when the contacts received any prior doses of Td.  

Health care personnel: CDPH recommends that all health care personnel, particularly those who have direct contact with infants and pregnant women, be immunized with Tdap to protect their patients and themselves. Effective September 1, 2010, the Cal/OSHA Aerosol Transmissible Disease Standard requires all hospitals, outpatient medical facilities, and other employers covered by the standard to offer Tdap immunization to their employees who may be exposed to pertussis. Employees who decline to be vaccinated must sign a declination form.  

Patients with wounds: CDPH recommends that providers administer Tdap (instead of Td or TT)whenever tetanus toxoid is indicated for wound management in patients 7 years of age and older.  

VACCINATION INTERVAL: When the risk of contracting pertussis is elevated, as at present, ACIP and AAP recommendations permit any interval between doses of Td and Tdap. In contrast to the grave potential risks of susceptible persons becoming infected and transmitting pertussis to vulnerable infants, the most common adverse reaction to tetanus or diphtheria vaccines is a local reaction at the injection site, which may be more likely after an increased number of prior doses (9); however, recent studies and reports suggest that doses of Tdap given after previous Td or DTaP are well tolerated at intervals as brief as 1-18 months (3, 7, 8). An undocumented history of immunization with Tdap or Td is not a valid reason to avoid or delay administration of Tdap. California Department of Public Health (CDPH), Immunization Branch July 2010.  

CONTRAINDICATIONS: The only contraindications to immunization with Tdap, both rare, are:• a documented history of anaphylaxis after receipt of Tdap, DTaP or their ingredients; or • encephalopathy occurring within 7 days after immunization against pertussis that was not due to another identifiable cause (5, 6).  

USE BEYOND LICENSED AGE GROUPS IS PERMITTED BY LAW:  

7-9 Years: CDPH recommends administration of Tdap to children 7 through 9 years of age whenever vaccination against tetanus, diphtheria, or pertussis is indicated. Existing data suggest that the use of Tdap at these ages is safe (7, 10); in Canada, Tdap is licensed for persons 4 years of age and older.  65+ Years: CDPH recommends administration of Tdap to persons 65 years of age and older. Local and systemic events after Tdap vaccination have been reported less frequently in adults less than 65 years than in adolescents (5, 11). Published data on the safety and vaccine efficacy of Tdap in persons 65 years and older are limited. Even if the immunogenicity of Tdap is found to decline with age, any additional protection provided could help to limit transmission and protect the vulnerable. Use of Tdap beyond licensed age groups may or may not be covered by private insurers.   

RATIONALE: Pertussis (whooping cough) is highly contagious and is spread by inhalation of respiratory droplets or aerosols. A high level of community immunity is needed to reduce the incidence of pertussis, but immunity from immunization or disease wanes over time. Most children vaccinated for pertussis before kindergarten are susceptible again by early adolescence. Tdap immunization rates in adolescents and adults are currently low. As a result, pertussis continues to circulate widely, resulting in the hospitalization and death of young infants who are too young for routine immunization with DTaP. As of July 15, 2010, there have been five reported 2010 infant deaths due to pertussis in California. Close contacts, most often mothers, are the most common known source of pertussis in infants (12). Thus, vaccinating household contacts, health care personnel, and child care workers against pertussis is recommended at least 2 weeks before their contact with young infants (5, 6). Increasing community immunity through widespread immunization will also decrease the chances that vulnerable infants will be exposed to pertussis. Immunization will also prevent debilitating cases of pertussis in older children, adolescents, and adults. 

SCHOOL VACCINATIONS

If your child is starting kindergarten, middle school or college this year, your back to school checklist not only includes pencils and notebooks but also those dreaded vaccinations.

First check your state’s vaccination requirements and the American Academy of Pediatrics’ childhood and catchup immunization schedules. If your child is behind on any shots, an online catch-up schedule from the Centers for Disease Control (“CDC”) and prevention can help.

Schedule a back-to-School physical as soon as possible. It’s safe for children to get all the vaccinations for their age group in one appointment. Children on Medicaid or without insurance coverage can get them free, except for an administrative fee of less than $20. These are available through the Vaccines for Children Program. Please contact them for further information. Finance should not be a reason to not immunize your child.

Kindergarten, Grade School

Most kids starting kindergarten need four shots if they have had all of their early childhood immunizations. Children ages 4to 6 should get their fifth shot of the DTaP vaccine against diphtheria, tetanus and pertussis, or whooping cough. They also need their second shot of the MMR vaccine against measles, mumps, and rubella, and the final shots of the vaccines for polio and varicella, or chicken pox. Make sure your child has had the three shot series for hepatitis B, which is required in most states. The AAP also recommends that hepatitis A series if your child has not had it yet.

PLEASE NOTE THAT PLAYA VISTA MEDICAL CENTER DOES NOT PERFORM THE SCHOOL ENTRY EXAM "REPORT OF HEALTH EXAMINATION FOR SCHOOL ENTRY."

PLEASE SEE YOUR CHILDREN'S PEDIATRICIAN FOR THIS (i.e. they have the equipment inhouse to perform the lead & anemia tests and they routinely carry all of the childhood vaccines).

Middle School

Students starting middle school should get the Tdap vaccine against tetanus, diphtheria and pertussis. The vaccine covers the same diseases as the DTaP but is a different vaccine for this age group. Current whooping cough outbreaks make this shot preferred over the Td booster which covers only tetanus and diphtheria. Most states require either the Tdap or Td.

The AAP recommends that kids 11 to 12 receive the vaccine against bacterial meningitis, MCV4 (some states require this). Teens who have not had this shot or the Tdap should also get them.

Although not required, to prevent cervical cancer, middle school girls should receive three doses of the human papillomavirus, or HPV vaccine. Two versions of the vaccine are available: HPV2 protects only against cervical cancer, while HPV4 also prevents other genital cancers and genital warts. Girls can receive the first dose as early as age 9. HPV4 is also available to boys age 9 to 18 because it protects against genital warts.

Check that your child has been vaccinated for hepatitis A and B, as well as chicken pox (teens are at high risk to develop complications). Most states require the hepatitis B series and kids 11 to 15 can get the two dose formulation, Recombivax HB.

Students Starting College

• Tetanus-Diptheria-Pertussis vaccine

• Meningococcal vaccine*

• HPV vaccine series

• Hepatitis B vaccine series

• Polio vaccine series

• Measles-Mumps-Rubella (MMR) vaccine series

• Varicella (chickenpox) vaccine series

• Influenza vaccine

• Pneumococcal polysaccharid (PPV) vaccine

• Hepatitis A vaccine series

* Recommended for previously unvaccinated college freshmen living in dormitories.

Health Talks is a program provided to educate the residents of Playa Vista and the surrounding communities of Marina del Rey, Del Rey, Playa Del Rey, and Westchester, about health issues, prevention, and screenings to lower health risk factors. This program is run by Alia Matthews a licensed Physician working for Playa Vista Urgent Care.

Future Talk Dates and Subjects to be determined.

Previous 2008-2010 Talks Included:

• Patient Heal Thyself
  
• The Seven Healthy Habits
  
• Screening Tests That Can Save Your Life
  
• Exercise Facts for Adults and Kids
  
• Birth Control Options and Healthy Sexuality
  
• Cosmetic Medicine--Non Invasive Methods to Improve Your Appearance
• Colds and Flus
• Heart Healthy
  

Playa Vista Medical Center  Welcomes any suggestions from the community on topics of interest to be presented.

Playa Vista Medical Center prides itself in participating in various community activities such as the annual LAX/Coastal Chamberfest, Westchester Stars and Stripes Annual Parade and Picnic, Annual William O'Neil and Company Wellness Fair, Villa Marina Block Party, Otis College Student Wellness Fair, Jet to Jetty Fun Run, providing Clinic Tours to various schools in the area, and presentations by Dr. Kent Shoji, President and CEO, to various community groups. Please contact Susan Karpiel at 562-883-0629 or via email susankarpiel@verizon.net for any inquiries on participation in an upcoming community activity.