Awareness crucial in coping with ischemia

By Phyllis Benson
Feature Writer
“The best health consumer is the educated health consumer,” said Peter F. Cohn, M.D. The cardiologist was in Sacramento recently to lecture at the University Medical Center.
Cohn, chief of cardiology at the State University of New York Health Sciences Center at Stony Brook, is noted for his re-search in the area of silent myocardial ischemia. Ischemia is the deprivation of blood to the heart.
He and his wife, Dr. Joan K. Cohn, have authored a book called Heart Talk: Preventing and Coping with Silent and Painful Heart Disease. The book is designed to educate the patient and health consumer.
Cohn’s goal is helping health consumers understand silent ischemia, sometimes called “painless angina.” He believes consumers can better cope with the disease if they understand the disease and methods of coping with it, including diet, exercise, and medication.
Detecting heart problems in older people is complicated by factors like nerve problems or other painful disease such as arthritis. Silent myocardial ischemia is especially difficult to diagnosis because of the absence of symptoms.
Although medical exercise tests are used in diagnosing some heart problems, Cohn cautioned, “For older people with no previous history of heart problems, we do not recommend a routine exercise test unless risk factors are present like smoking, diabetes, or high blood pressure.- At ages over 70 we’re not going to routinely screen for this, either.”
He advises older patients to consult with their personal doctor regarding exercise tests for diagnosing ischemia.
“Doctors must be more careful in prescribing for older people,” Cohn warned. For example, beta blockers useful in some heart treatments slow heart rate. This can be a problem because the heart rate in elderly patients already may be slower.
Cohn feels many factors are actually in favor of retirees. He said, “Retired people have a different stress profile. They are retired; family problems have stabilized. Stress is not as much a problem as with a younger person.”
“Diet is not as much a factor,” he continued. The diet a person had as a young person and throughout their earlier years has already changed the blood vessels. Most damage has already been done. Usually a radical dietary change will not make much difference.
He makes one dietary exception: “If someone has high cholesterol at 65 and is destined to be 85 if they take care of themselves or die in five years if they don’t, then of course diet is a factor.”
Cohn collaborated with his wife, a psychotherapist, to help readers better understand the problems of ischemia. He believes that medical doctors frequently do not communicate well with patients. He said, “We don’t always deal with the psychological factors. And we need to help the family coping with an ill family member.”
His wife is also a cook and nutritionist, so their project included recipes of low fat, low cholesterol, and low salt diets. Recipes in Cohn’s Heart Talk book are heavy on fish and poultry. The recipes use spices for flavor enhancement instead of salt.
“Turkey is never out of season at our house,” Cohn said with a laugh. We’re all for exercise. We’re even for sex.
“For older folks walking is the number one exercise. Swimming is always the best, but not everyone has access to a year-round pool.”
Cohn concluded, “The best health consumer is someone who-reads up on the problem; someone who is not afraid to ask questions of the doctor.”

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