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answes to both questions impact the patient the same:egula checkups, dietay changes, inceased execise,and possible blood pessue-loweing medication.

The physicians appoachThis physician did all the ight things. He took a thooughhistoy that uncoveed a stessful lifestyle that lackseceation, has no time set aside fo execise, and a dietthat is eliant on cafeteia o estauant food (which isloaded with salt). In addition he uncoveed a familyhistoy of hypetension in both paents that emeged at

the same time in life as the patient. The blood pessuewas taken by two people in the office, in diffeent bodypositions, at diffeent times duing the office visit, andepeated afte seveal deep beaths in ode to disceneactive high blood pessue (also called white coathypetension) fom consistent high blood pessue inneed of teatment.

Planning fo follow-up with daily blood pessue checksfo seveal weeks is appopiate, paticulaly in thissetting. The patient was supised he had elevated bloodpessue, and needed time to confim the diagnosis andcome to gips with the new eality of having a medicalcondition to live with and manage. The teating physicianmust always be sensitive to, and take into account, theindividual cicumstances of each patient and adjust theappoach to management accodingly.

This patient was lucky to have access to daily bloodpessue checks at his office building. Some patients willgo to thei local fie station o phamacy fo bloodpessue checks, while othes will puchase an automatedblood pessue cuff. These automated cuffs ae applied tothe uppe am and have a lage-fomat digital eadout othey pint esults that can be faxed, emailed, o easilytaken in had-copy to a follow-up visit. Multiple eadingsof the blood pessue help define the natue of a patientshypetension o may eveal that no theapy is equied.

Lown Forum 2 0 1 1 N U M B E R 1THE

LOWN CARDIOVASCULAR RESEARCH FOUNDATION

IN

SID

E 5 Patient pofile: Letting go fo you healthAssessing the value of cae among povides

6 A chai as teatment

7 NewsBeat8 Eating healthy

We can learn about highblood pressure and how itshould be managed bydissecting an example of atypical encounter between apatient and a doctor.

At the uging of his wife, a middle-aged lawye went to apimay cae physician. You should have you own doctoand not teat youself, she had egulaly eminded him.

Soon afte aiving at the doctos office, a medicaltechnician checked his vital signs tempeatue (98.6degees), height (59), weight (168 pounds), and bloodpessue (an elevated 163/89). The patient insisted,Please take that blood pessue again. I neve had highblood pessue befoe. The second eading poduced158/90. Lets ty again in the othe am. 162/88.

Now I have a poblem that I didnt think I had an houago, he thought to himself.

The physician confimed the eadings afte checking the

pessue lying down and sitting up, afte 20 seconds ofhypeventilating, and then again afte about 10 minutes ofeviewing the elevant medical histoy. The histoyincluded 10 to 12 hou wokdays; fequent tavel; take-outlunches and seveal evening meals at estauants peweek; financial stains with a motgage and tuitions; littletime fo execise; and a family histoy of hypetension. Hehad no histoy of smoking, chest pain, o shotness ofbeath. His physical exam and electocadiogam weenomal. The check-up was uneventful except fo twoissues: the weight and the blood pessue.

How should the physician appoach this patient? Howshould the patient appoach these new developments inhis health? In this cicumstance, and in most cases, the

2 Pesidents messageMeet the Lown Cente echo staff

3 Should I switch blood thinning meds?

Welcome Andi Bown4 High blood pessue (cont.)

continued on page 4

The Lown Foundation is gateful to the Max Kagan Family Foundation fo thei steadfastsuppot of ou wok fo moe than a decade. Thei contibutions have enabled us to advance ou

patient-centeed model of health cae hee in Bookline, acoss the county, and aound the wold.

High blood pessue: A common poblem, but often a difficult solution

Chales M. Blatt, MD

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MEET THE LOWN CENTEr STAFF

Echo testing team

When visiting the Lown Cente, you physician mayequest one o moe noninvasive diagnostic tests fo

you. Many of these tests ae pefomed by ou echotesting staff. Mary Lancaster-Pijar is the TechnicalDiecto of the noninvasive testing lab hee at the LownCente.

Gabe Galambos is a cadiac ultasoundtechnician who has been with the LownCente fo nine yeas. His favoite patabout woking hee is convesing with[the Centes] inteesting patientpopulation. Outside of wok, Gabe enjoystaveling and is a devoted Patiots fan.

Deb Lombardo is a egisteed cadiacsonogaphe who joined the Lown Centein Apil 2010. Oiginally fom Cape Cod, Debcompleted the echocadiogam pogam atBunke Hill Community College and latetained at Mass Geneal Hospital. She isegisteed though the Ameican registyfo Diagnostic Medical Sonogaphy and is a membe ofthe Ameican Society of Echocadiogaphes. Deb likesbeing pat of the Lown Cente team because of theemphasis placed on peventative medicine. He hobbiesand inteests include figue skating, eading non-fiction,taveling to new places, and spending time with family

and fiends.Lisa Sharpe is a egisteed diagnosticcadiac sonogaphe who has been withthe Lown Cente just ove a yea. Lisaeaned he BS in Applied Health andHuman relations fom Colby SawyeCollege. One of the easons she loveswoking hee is because of the

compassion and pofessionalism of the Lown staff.Outside of wok, Lisa enjoys cooking, gadening, andspending time with he husband, thee teenage boys,and numeous pets.

PrESIDENTS MESSAGE

Attitude and appoachVikas Saini, MD, Pesident

As the political debate on health cae

continues to heat up in Washington andon Beacon Hill, thee will be a bight spotlight on the costof cae. Despite this inceased attention, the cost of caehas neve been the focus hee at the Lown Cente. Ouemphasis is on attitude and appoach. We focus on thehuman connection between docto and patient, and weuse that as ou compass in assessing the vaiousteatment options based on whats best fo the patient(whethe itd be pevention activities, pesciptionmedicines, invasive pocedues, o sugey). Pacticingthis way, we believe we use fewe esouces.

Defining the best couse of action is neve simple since

each patient is unique. It seems as though this pactice isgetting lost with younge physicians. They often seem todo little moe than use a checklist when addessing apatients health issues. This is undestandable; in thedive to educe eos and achieve highe quality of caewith lowe costs the emphasis has tuned to potocols,guidelines, and checklists.

I find this unfotunate, not because such tools ae notuseful o necessay, athe because pacticing medicine ismuch moe than a checklist. Caing fo an octogenaian, a40-yea-old with kids, an athletic nonagenaian, o a 70-yea-old couch potato equie diffeent appoaches and

consideations. It is the esponsibility of the physician toecognize those diffeences and administe a couse ofaction that specifically addesses the individual patientsneeds.

Because each patient is a unique case, thee ae timeswhen outcomes ae uncetain. If it is unclea whethe atest o pocedue may o may not be helpful, both thephysician and patient have an ethical obligation toconside the cost of a test o teatment when makingdecisions about the patients cae.

In the midst of such uncetainty, pomoting an attitudeamong physicians and patients of stewadship ofesouces equies geat thought and cae. In a ecentconvesation with one of my Havad medical students itbecame clea that little is taught about this in medicalschool cuicula. Howeve, these convesations ae goingto incease as we gapple with the challenge of caing foa lage, aging population.

Hee at the Lown Cente, we believe that anindividualized appoach with a geneous helping ofhealthy skepticism towads the latest highly-toutedtechnique is the best path to the goal of cost-effective,humane cae.

2 L O W N F O R U M

Annual appeal thank youAs we begin the new yea I want to extend my heatfeltthanks to all those who contibuted so geneously to theLown Foundation. You suppot fo ou boade missionis a meaningful way of sustaining a community.

I would also like to offe a special thanks to JessicaGottsegen who is esponsible fo managing the day today details of ou annual appeal, and to Claudia Kenneywhose egula input has poved invaluable to this effot.

-V.S.

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L O W N F O R U M 3

QUESTION FrOM A PATIENT

Bian Bilchik, MD

I have atrial fibrillation and Itake Coumadin (generic:

warfarin), I saw a commercialfor a new blood thinning drug calledPradaxa. Should I switch?

Most people with atial fibillation equie blood thinningmedication, which helps educe the isk of stoke.Appoved in the 1950s, wafain has been the bestoption. Howeve, in Novembe 2010, a new bloodthinning dug called Padaxa (geneic: dabigatan) wasappoved by the FDA to be sold in the United States.

A temendous amount of inteest is being paid to thispotential altenative to wafain and its easy to see why.Patients ae often fustated with wafain because itequies fequent blood tests, modification in diet andavoidance of leafy, geen vegetables, and it can inteactwith othe medications. Taking wafain can be time-consuming and intefee with ones lifestyle.

On the othe hand, Padaxa sounds pomising. Initialstudy esults show that Padaxa is not only as effectiveas wafain, but it may be slightly safe. Also, Padaxadoesnt appea to intefee with ones diet and itequies fa fewe blood tests. Its the fist time in ove50 yeas that wafain has a seious competito.

Possible concensThis is a band new dug, and it is not clea whichpopulations would benefit most and who might be moeat isk. Olde patients ae often not well epesented inthe testing tials, and questions emain unansweedaound patients who ae at a highe isk fo bleeding and

falling (often the eldely). Now that Padaxa is available,thee will be many moe patients who take it, and in ayea o two well have a much bette idea of how Padaxa

does in diffeent types of patients.

Padaxa has some additional shotcomings whencompaed to wafain. Padaxa is shot-acting, whichmeans it must be taken twice a day (wafain is taken onlyonce a day). Also, the cost fo Padaxa is significantlyhighe (appoximately $200 a month) and it is not yetclea which insues will pay fo Padaxa and how muchthey will cove. Convesely, new advances in homemonitoing fo those taking wafain wee ecentlyappoved and ae coveed by Medicae and someinsues. This can decease the amount of blood testing atthe doctos office that is associated with wafain.

The Lown Goups viewWhen a new class of medications is developed withsignificant implications fo ou patients, we pefe to waitat least one yea befoe we ecommend a tansition to thenew theapy. What gives us cause to pause fo thispotentially useful and effective medication is that itspedecesso had significant issues duing its tial peiod.One of the easons the olde vesion of dabigatan wasnot appoved was because it caused live poblems,howeve this seems to be soted out with the newvesion, Padaxa.

Padaxa epesents the fist of seveal new blood thinningmedications coming to the maket. Padaxa couldpotentially eplace Coumadin, as long as its safe and costeffective. But fo the time being, well wait befoepescibing Padaxa until we see how it does now that itseaching a fa geate numbe and vaiety of patients.

LOWN FOUNDATION STAFF UPDATE

Welcome Andi BownThe Lown Foundation is pleased towelcome Andi Bown as ou newDiecto of Development. Since aivingin ealy Novembe, Andi has puttogethe a dynamic plan to enegizeou fundaising effots to suppot theFoundations wok.

Andi sees temendous oppotunity in pomoting oupatient-centeed appoach. Im delighted to wok fo anoganization that has been such an impotant playe inimpoving health cae fo people all ove the wold. Oumodel - doctos teating the whole peson, not just the

disease - should become the standad of cae foeveyone. Ou philosophy is to ecommend altenatives toinvasive, costly pocedues unless absolutely necessay,and that makes us a bit of a maveick in the cuent health

cae climate. We believe wee in the vanguad, and withthe help of the philanthopic community, wee able topomulgate ou style of cae.

Outcomes eseach and a planned confeence onoveteatment in health cae ae two cuent pojectsAndi is woking on, and she has seveal moe exciting newactivities in the woks.

Andi looks fowad to woking with donos, long-time andnew alike, to ensue the Lown Foundations continuedvitality and leadeship position in patient-focused heathealth.

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4 L O W N F O R U M

High blood pessue: A common poblem, but often a difficult solution

Chales M. Blatt, MD

(continued from page 1) This infomation is key tomanagement but may be challenging to intepet andepesents one of the most difficult aspects of this veycommon condition.

A lage study caied out in Pais, Fance nealy 10 yeasago involving 11,000 patients detemined that nomalblood pessue eadings at home on multiple occasionsdefined a patient who did not equie blood pessueloweing medication. The supising finding in thisimpotant study was that a substantial numbe (11%) hadnomal blood pessue at the doctos office, but higheadings at home. This goup suffeed most fom theseious consequences of unteated hypetension.

The patients esponseAt fist, he esponded as most patients do - with a

degee of disbelief and denial followed by epeatedlychecking blood pessue measuements. He found thathis blood pessue was elevated, often above 155/90,and clealy within the ange deseving teatment. Evenafte modest weight loss, salt eduction, and execisingthee days pe week, his blood pessue emained toohigh.

The initial appoach to teating high blood pessue canvay. His physician tied a low dose of a geneic diueticfollowed in seveal weeks by a low dose of a geneicACE-inhibito. The combination woked well fo thispatient. The physician had othe options to conside.

Fequently a thid dug, such as a calcium channelblocking dug, is added to a diuetic and an ACE-inhibito. Calcium channel blocking dugs aecommonly-used and well-toleated. One has ecentlybecome geneic, making it affodable with a low co-payon most insuance plans.

Physicians often use a combination of two o moemedications to lowe blood pessue because it keepsindividual dug doses low and avoids the possibility ofside effects that esult fom an inceased dosage of asingle dug. Most physicians aim to lowe blood pessueto less than 130/80. Lowe pessues ae welcome as

long as side effects attibuted to lowe pessue do notintevene.

The impotance of teatmentWhy do doctos make such a big deal about teating highblood pessue? Sustained high pessues in the bloodvessels that seve the bain, heat, and kidneys - thethee ogans that we cannot do without - can causepogessive and potentially sevee damage to the innelining of these ateies. This sets the stage fothickening, uptue, clot fomation, and disuption ofblood flow to these ogans, which can esult in stoke,heat attack, and decline in kidney function o even

kidney failue that could possibly equie dialysis.When you conside how common and how seious thiscondition is, it is supising that so many people efuse tobelieve they have high blood pessue when fistdiscoveed at the doctos office. Many factos maycontibute to high blood pessue including: familyhistoy of high blood pessue, excess body weight, ahigh salt diet, stess (family, wok, financial), a sedentaylifestyle, and even living in a city. Although it can occufo many yeas without symptoms, high blood pessueequies caeful management by both the physician andthe patient ove the long tem.

Managing high blood pessueSuccessfully teating high blood pessue often equiesa multi-faceted appoach, and the patient can make a lotof pogess by adopting appoaches that educe saltintake and body weight, and incease execise.

1) Weight loss will help lowe blood pessue damaticallyin most people. In geneal, evey pound of body masscontains mile of blood vessels though which the heatmust pump blood to sustain the health of the tissues.Weight loss tanslates to a apid eduction in the stainplaced upon the heat and helps lowe blood pessue.

2) Avoiding estauant and cafeteia food as much aspossible educes the oveall intake of sodium chloide(table salt). Anything pepaed in quantity is pesevedwith salt; many easily-identified items such as cannedsoups, pocessed deli meats, pickles, chips, Chinese food,pizza, and fast food have enomous concentations ofsalt. Salt causes the body to etain fluid which tanslatesto a highe pessue within the blood vessels.

3) As sodium is educed in the diet, potassium intakeshould be encouaged. These two essential elementswok in opposite diections with espect to bloodpessue. A diet low in sodium but high in potassium willset the stage fo lowe blood pessue. This elationshiphas been noted acoss many societies and continentswhen food and wate have been analyzed.

4) regula aeobic o dynamic execise - that ismovement of the ams, legs, o both to geneate a lightsweat ove a sustained peiod (30 to 45 minutes daily) -helps with weight loss AND educes the psychologicalstess that has become pat of the fabic of ou daily,hectic lives. This is especially tue fo people living andwoking in uban aeas.

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Magaet saw this as an oppotunity to finally pioitizehe health. The key is letting go, she advises. It can behad to let go, but you health equies it.

Letting go has given he a healthypespective. You have to let go of thosethings that pevent you fom beinghealthy. Its impotant to know when itstime to let go, and you dont want tolean that when its too late.

Siste Magaets new outlook haschanged the way she takes cae of heself. Im moecaeful now I take my blood pessue and I execiseevey day, and Im moe caeful with what I eat.Howeve, she doesnt believe that changing he dailyoutine to fulfill he health needs was budensome. Itgives me peace of mind, and its all pat of accepting thesituation.

Siste Magaet also cedits the cae she eceives at theLown Cente to he success living with high bloodpessue. D. Blatt and the Lown Cente have made a bigdiffeence in my life. The cae Ive eceived and theiattention to my health has made me much moe awae.

L O W N F O R U M 5

believe you can delive bette quality cae by doing moefo the patient and less to the patient. The challenge wehave is to suppot ou expeience with data that othepovides can use to make valid compaisons of thestategies we have used fo ou patients and theoutcomes, including both motality and complications, aswell as the quality of life that esults. Once you canmeasue and povide data to suppot this, people willtake a pause and say the Lown model has demonstatedove a peiod of seveal decades that cost and quality cango hand and hand if you do ight by the patient.

What is the broader significance of this tool for thehealth care industry?

Eveybody will be held accountable fo the quality andoutcomes they delive. Ou health cae model istansaction-based, but going fowad, eveyone is sayingwe cant affod to be tansaction based so wee going tostat paying fo the value that povides delive. Butbecause its not easy to qualify value, we need a modelthat answes the question: Did the couse of action Ipescibe my patient make a diffeence? This tool allowseveyone to eplicate the numbes, look at thei data, andcompae it to thei pees.

Nassib Chamoun, Chaiman of the Boad of the LownFoundation, led a team that ecently published a simpleand fee tool to compae the pefomance betweendiffeent hospitals. By measuing clinical outcomes, suchas motality and length-of-stay, the new tool seeks tomeasue the value of cae using publicly available data. Aneditoial in the jounalAnesthesiology, which highlightedthei epot on its cove, descibed thei technique as anaccuate way to compae apples to oanges.

Nassib, who will benefit most from this model?

I think patients will benefit the most. Unfotunately ightnow thees this big debate in health cae efom, and alot of fighting between the constituents involved. A lothas been done fo payment efom but little has beendone in tems of the quality of cae we delive in thissystem. Wee lacking a value model to guide this pocess.But the minute you bing epoducible, tanspaent datato the table, then the convesation between theconstituents takes a diffeent diection.

How is this tool relevant to the Lown Center's work?

The position we have taken histoically at the LownCente is that cost and quality ae not in conflict. We

PATIENT PrOFILE

Letting go fo you health

Sister Margaret

Siste Magaet Devine loved he wok. Despite the stessand long hous, he job helped people and took he allove the wold. Howeve, he job kept he so busy she

had little time fo he health. I neve thought that what Iwas doing was detimental to my health because Ienjoyed what I was doing.

Eight yeas ago, Siste Magaet found out she had highblood pessue while at a chuch health fai. Despiteknowing the isk, she neve thought about slowing downand eevaluating he health needs. My mind was caughtup on othe things - I was woking a lot and wasnt takingany time off. I was eally going nonstop.

Tuning a blind eye to he health, Siste Magaets highblood pessue stated to affect he slowly at fist. Itwasnt until my second time back in the Philippines, whenI was woking with poo people in slum aeas, that Iealized I wasnt able to wok as had as I used to. Ineeded to slow down and take time fo my health.

She didnt. A little ove a yea ago Siste Magaet had astoke and was hospitalized fo fou days. It was awakeup call fo me. I didnt want to give up my wok, but Ihad to give most of it up. Accepting he situation, Siste

QUESTION & ANSWEr

Assessing the value of cae among health povides

Vikas Saini, MD

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A heo to manyJohn Bogle, founde and etied CEO ofthe Vanguad Goup, ecently publisheda collection of essays that eflect on oucuent financial system. The book,entitled Dont Count On It, devotes fouchaptes to his heoes and mentos. Inone of these chaptes he highlights D.Lown, whom M. Bogle descibes as

The paadigm of the healingphysicians, ceative, innovative, and wold enownedcadiologist. His cae caied me though the cucialmiddle yeas of my 34-yea stuggle with heat disease.M. Bogle continues, By dint of his poweful chaacteand billiant mind, D. Lown has lengthened and enichedthe lives of countless patients...I owe my life to him. M.Bogle ends the chapte, Speaking fo the wold, fo hispatients, and fo myself, Benad Lown made thingsbette fo us all.

pevailing motality among those admitted with an acuteheat attack and subjected to bed est. Although the chaiteatment was initially questioned and even deided by

the medical pofession, igoous bed est was soonunivesally abandoned. Within a few yeas the peiod ofhospitalization was educed by half, ehabilitation washastened, and patients etun to wok acceleated.

In eflecting on this expeience many yeas late, I amtoubled by the ways in which doctos ationalized ateatment that not only had little o no value, but exacteda daconian punishment to boot. Why subject heat attackvictims to igid bed est that could only incease theimisey and that led to majo complications in those whoaleady had a life theatening condition? This was not justa small eo; it was a colossal misjudgment, yet anothe

of the numeous examples of medical tadition deailinghealthy skepticism and impeding a commonsenseappoach.

A majo eason that the detimental effects of polongedbed est wee not discoveed ealie had to do with thephysicians lack of attentiveness to thei patients and evena failue to appeciate that chuning emotions deangethe functioning of evey ogan in the body, be it heat ointestine. That one can die fom an aching heat is widelyacknowledged. Even in this age of magical technology andmiaculous scientific discoveies, the medical pofession isemiss when not being attentive to the heatache that

each and evey human being expeiences.

6 L O W N F O R U M

It has been 60 yeas since the publication of The chaiteatment of acute coonay thombosis. I co-authoedthis oddly-titled aticle with my mento, D. Samuel A.

Levine. Few studies have made as lage an impact on theteatment of heat attack victims. I ecall this seeminglyancient expeience because of the lessons it holds fopesent-day health cae.

The study involved getting patients into a chai. This maysound bizae. What is so novel about sitting? Howeve,when I aived at the Pete Bent Bigham Hospital (nowBigham and Womens Hospital) in 1950, patientsexpeiencing an acute heat attack had taditionally beenkept at stict bed est fo fou to six weeks. Sitting in achai was fobidden. They wee not allowed to tun fomside to side without assistance. Duing the fist week,

patients wee fed by a nuse. Fo the constipated, whichincluded nealy evey patient, pecaiously balancing on abedpan was agonizing as well as embaassing.

The motality was awesome. Moe than one in theepatients died. Not supisingly, many died fom bloodclots migating to thei lungs. Psychological depessionwas the ule. Othe complications included intactablechest pain, postatitis, sevee constipation, bedsoes,fozen shouldes, bone thinning, and collapsed lungs.

Medical insistence on igoous bed est was based on asacosanct theapeutic pinciple, the need to est a

diseased body pat, be it a factued limb o atubeculosis-infected lung. Unlike a boken bone, whichcould be immobilized in a cast, o a lung lobe, which couldbe collapsed by inflating a chest cavity with ai, the heatcould not be ested so eadily. The only appoximation tothe pinciple of est fo the diseased heat was to diminishits wokload. Thus, bed est was equated with heat est.

The study involved getting patients into a comfotablechai fo inceasing duations on succeeding days. By theend of the fist week, they sat up fo seveal hous twicedaily. Initially the house staff was vehemently opposedand esisted getting patients out of bed. They even

accused me of committing cimes not unlike those of theNazi expeimentations. Howeve, they apidly becameenthusiastic adheents.

Patients equied fewe nacotics fo chest pain and lesssedation fo anxiety, and they could do without sleepingmedications entiely. Nuses commented that thepatients demeano changed fom anxious and depessedto moe upbeat.

The outcome of the study was impessive. Duing anaveage of fou weeks of hospitalization, only eight of the81 patients died. This was less than a thid of the

A chai as teatment

Benad Lown, MD

John Bogle

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Thank you fo you suppotThe Lown Cadiovascula reseach Foundation pomotes cacae that advocates pevention ove costly, invasive teatmeand estoes the elationship between docto and patient.

You financial suppot allows us to continue ou wok and ca

ou heat health message to local, national, and global audieWe geatly appeciate any donation you ae able to make.

You can donate online at ou website (lownfoundation.og) you donation to 21 Longwood Avenue, Bookline, MA 02446Please make checks payable to the Lown Cadiovascula resFoundation. Fo moe infomation about suppoting theFoundation, please contact Andi Bown, Diecto of Developat abown1@patnes.og o 617-732-1318 (x3350)

Educational oppotunitiesInteested in hosting a lectue on a heat health topic by oneou physicians at you woksite o community oganization? contact Jessica Gottsegen at jgottsegen@patnes.og o 611318 (x3805).

receiving the FoumIf you would pefe to eceive the Lown Foum by email, senfull name and email addess to info@lownfoundation.og.

New patient appointments availableNew patient appointments ae cuently available. If you wolike to make an appointment with one of the Lown Goupcadiologists, please call 617-732-1318 and select option 1.

LOWN CArDIOVASCULAr CENTEr

N e w s B e a t

Benn Grover, Edito of PoCo,paticipated in the United Health/NationalHeat, Lung and Blood Institutes Chonic

Disease Centes of Excellence semi-annualsteeing committee meeting inWashington DC on Octobe 7-8, 2010.

Dr. Barbara Roberts, Diecto of the Womens CadiacCente at the Miiam Hospital and LCrF Boad Membe,was inteviewed by Providence Business News onNovembe 29, 2010 whee she discussed the impotanceof pevention in the fight against heat disease.

On Decembe 9, 2010 Dr. Tom Graboys gave a talk at BethIsael Deaconess Medical Cente as pat of thei quatelyconfeence seies. Duing his talk he discussed his

pespective on the cuent state of the docto-patientelationship.

At the equest of D. AndewWeil, Dr. Graboys contibuted achapte on cadiac ahythmias toa ecently published book titled,Integrative Cardiology. D. Weil isan Ameican autho and physician, best known foestablishing and populaizing the field of integativemedicine.

The Lown Cente physicians egulaly give lectues tocommunity goups and oganizations on heat healthtopics such as nutition, execise, coping with stess,second opinions, and altenatives to sugey. Dr. VikasSaini spoke at the Goddad House in Bookline on Januay24, 2011 and at the Watetown Mall on Febuay 4, 2011.Dr. Brian Bilchik was a guest speake duing the BooklineAdult & Community Education winte semeste. He alsoaddessed the Bookline rotay Club on Febuay 10, 2011.

In Januay, the Foundation welcomedgaduate consultant, Mychal Voorhees.She is a gaduate student in the HealthCommunication pogam at EmesonCollege. Since moving to Boston in August2009, Mychal has seved as acommunications inten with the EPA and

Health resouces in Action. Befoe moving to Boston topusue he gaduate degee, Mychal woked in the pessoffice at The Cate Cente, a non-pofit oganizationfounded by Pesident Cate, in Atlanta.

Mychal will eseach successful communication stategiesand ceate an outeach and maketing campaign foPoCo that tagets medical school students andpofessos in developing counties.

Board of DirectorsNassib Chamoun

Chairman of the BoardVikas Saini, MD

President

Benad Lown, MD

Chairman Emeritus

Thomas B. Gaboys, MD

President Emeritus

Paticia Aslanis

Chales M. Blatt, MDJoseph Bain, SD

Janet Johnson Bullad

J. Beckenidge EagleCaole Anne McLeod

C. Buce Metzle

Babaa H. robets, MDronald Shaichrobet F. Weis

Advisory BoardMatha Cowninshield

Hebet Engelhadt

Edwad FinkelsteinWilliam E. Fod

renee Gelman, MD

Babaa GeenbegMilton Lown

John r. Monsky

Jeffey I. SussmanDavid L. Weltman

CONTACT US

Lown Cardiovascular Researc

Foundation21 Longwood AvenueBookline, MA 02446 USA

(617) 732-1318

info@lownfoundation.ogwww.lownfoundation.og

www.lowncente.og

www.poco.og

Lown Cardiovascular GroupBian Z. Bilchik, MD

Chales M. Blatt, MDWilfed Mamuya, MD, PhD

Shmuel ravid, MD, MPH

Vikas Saini, MD

Lown Forum Editorial StaffAndi BownJessica Gottsegen

Benn Gove

Claudia Kenney

2011 Lown Foundation

Printed on recycled paper with soy

based ink.

L O W N F O R U M

8/3/2019 2011 Lown Forum 1

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Lown Cadiovascula reseach Foundation21 Longwood AvenueBookline, Massachusetts 02446-5239

What are we ordering fortake-out tonight?

Most of us believe that we do nothave the time to pepae and sit downfo an unhuied, home-cooked meal

at the end of the day. And so we endup elying on eady-made and take-out

meals, as I did duing my taining yeas. When peusingthe collection of take-out menus o eady-made meals atou local supemaket, we ty to make healthy choices -salads, oasted chicken, fish, and so on. What could bewong with those choices?

Fo states, we usually end up consuming moe caloiesthan we think, and thee is a diect coelation betweencaloies consumed, weight gain, and high blood pessue.If you have to ode out, ty splitting an ente and a salad(with dessing on the side) which will help contol you

caloie intake. Avoid dishes with ceams o cuies, andskip vegetaian fae loaded with cheese and avocado.

Moeove, most of these healthy choices have asignificant amount of sodium, which is associated withelevated blood pessue levels. The daily ecommendedsodium intake fo anyone with elevated blood pessue is1700 mg. Unfotunately, it is impossible fo us to know theexact amount of sodium in any pepaed meal. Foexample, a single taco salad, a seemingly healthy choice,has an aveage 1800 mg of sodium!

I would advise that you skip most soups, since they aeusually laden with sodium. Fo efeence, a single cup of

miso soup usually contains about 2500 mg of sodium.request no MSG when odeing Asian fae. Avoidcondiments such as mustad, pickles, olives, o fetacheese. Soy o teiyaki sauce-based items should also beavoided fo the same eason.

Taking the time to enjoy a home-cookedmeal at the end of the day has theadditional benefit of encouraging healthiereating patterns to our loved ones.

Since pepaed meals save time, but come at anunhealthy pice, what is one to do? We should stat bytying to minimize odeing out o buying pepaed mealsas much as we can. Inceasing ou dietay potassium ishelpful in loweing blood pessue, and a DASH diet whichemphasizes fuits, vegetables, low-fat food, and non-fatdaiy poducts is ecommended by most health

pofessional oganizations. If you ae unable to locateappopiate educational mateials, ask you physicianduing you next visit.

Caefully thought-out meals cooked duing the weekendcan be ecycled thoughout the week. Meals pepaed ina slow cooke can be cooked duing the day whileeveyone is at wok o school, and enjoyed togethe as afamily at the end of the day. Taking the time to enjoy ahome-cooked meal at the end of the day has theadditional benefit of teaching and encouaging healthieeating pattens to ou loved ones.

8 L O W N F O R U M

Eating healthyFed Mamuya, MD, PhD

NON-PROFIT ORG.

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PAID

THE PRINT HOUSE