In my book The Guide to Optimal Health: Creating Your Personal Wellness Wheel, we present an eight step program to improve personal health for the individual and group. The eight steps focus on proactive, preventative medicine, life style behaviors modification, nutrition, exercise, hormone optimization, stress management and optimism as a path to better health.

Its amazing how many people are unaware that long standing, poorly controlled stress can cause significant harm to the body. Dont get me wrong, everyone knows that its doesnt feel good to be stressed out all of the time but its more than not feeling good thats a problem.

Just to describe some of the changes, the bodys normal response to a challenge within our environment including perceived physical or psychological threat, it to increase the production of hormones which in lay persons terms "adrenaline". This prepares us to "fight or flight" after we have evaluated the situation. The hormone results in an increased constriction of the blood vessels of the body icluding your heart. Your blood pressure increases and your heart rate increases. The hormone causes insulin resistance and elevation of your blood glucose (sugar) so that your body has plenty of energy to run or fight. The mechanisms are all protective over a short period of time. However if this process occurs and continues unabated for a long period of time, it is detrimental to the body. It can lead to diabetes hypertension, enlargement of the heart, cardiovascular disease (stroke and heart attack), high cholesterol, alzheimers disease and cancer

Now what can we do to prevent this process. The answer is nothing. Let me rephrase that. Any person who leaves their home daily will encounter stress. No one can avoid stress. But its how we deal with it thats important. We introduce more of this concept and ideas about how to decrease the response to stress over the course of your life. Why relationships are important and more

The rewarding feeling that I receive from the practice of vascular surgery is tremendous. The field is quite challenging but the rapid evolution in technology allows us to treat a greater percentage of disease in a minimally invasive fashion.

Still, my research focus is squarely on increasing awareness of cardiovascular disease with an emphasis on educating children, adolescents and adults about the lifestyle changes that we can make that would make cardiovascular disease an uncommon event.

Cardiovascular disease (including stroke and heart attack) is the number one cause of death among Americans. Greater than combined death from all cancers. But we are not born with CVD. Poor dietary behaviors, lifestyle choices like smoking, increased stress and a sendentary lifestyle all contribute to our high incidence of CVD.

For those individuals with "bad genes", new highly sensitive genetic testing and cholesterol fractionation can help doctors determine which patients are at highest risk for disease formation. In these patients, prompt alterations in diet and aggressive cholesterol treatment can decrease the risk of stroke and heart attack

My new book, Your Guide To Optimal Health: Creating Your Personal Wellness Wheel, presents an eight step program focused on dimishing the risk of developing chronic diseases such as hypertension, diabetes, cardiovascular disease and obesity. For people with chronic disease, the program can make the management of these diseases easier by decreasing or eliminating medication dosages

For people who have no obvious illness and are striving to prevent these diseases by living a life of wellness, "Your Guide To Optimal Health" program provides a strategy for achieving this lofty goal. Visit www.personalwellneswheel. to learn more about the program and how to order your book

I encourage everyone to make sure that you observe PAD awareness Month by encouraging those around you over the age of 50 to have their ABI (Ankle Brachial Index) checked. The Ankle Brachial Index is a comparison of the blood pressure at the ankle to the blood pressure at the elbow. Its very simple and anyone that is capable of measuring a regular blood pressure can perform the test, it does not necessarily require a medical professional. Lets do a sample calculation:

Mrs Smith has an ankle blood pressure of 60/20. Her brachial (elbow) pressure measures 120/80.
60 divided by 120 = .50 . Mrs Smith's ABI is .50. The Normal ABI is>1.0, mild decrease .9-.75, moderate decrease .74-.50, severe decrease <.49

At least one in fifteen people over the age of 55 have PAD which can lead to stroke, limb loss and heart attack.
Importantly more than have the people that are affected have no symptoms for various reasons including the presence of diabetes and limited activity.

Early diagnosis can permit effective treatment.

For more information, visit www.beatpad.org

My non profit organization The PAD Coalition (www.beatpad.org) kicked off the season with a visit to a local church recently. After several years of campaigning to increase public awareness about Cardiovascular disease, I am always surprised at the number of people who have a poor understanding of the process. As a healthcare system, we clearly do a very poor job of educating people about identifying the symptoms of disease. We are stuck in a "Medical Treatment Model" instead of a disease prevention model

Peripheral Arterial Disease or PAD is a subset of Cardiovascular disease. PAD is the term for blockages that occur outside of the  heart including the blood vessels of the neck (carotid) responsible for strokes; the blood vessels of the legs that are responsible for pain with ambulation (claudication) , gangrene and amputations; the blood vessels of the kidneys responsible for hypertension and kidney failure just to name a few

Of these groups, the legs are by far the most easily diagnosed by patient's complaints, physician examination and very easily performed tests like the ABI (Ankle Brachial Index). This is important for several reasons. One, if we identify developing blood vessel blockages in the legs, we can become more aggressive in treating the medical factors of blood pressure, lipids and diabetes as well as smoking cessation. If these fail to improve the symptoms, then many procedures are available to improve the situation

More importantly, if a patient has abnormal circulation in the arteries of the legs, there is an 80% chance that they will have significant blockages in the blood vessels of the heart. By identifying this process by a patient complaints of pain in the legs with ambulation or more sever symptoms of ulceration; we are alerted to be very aggressive in treating the identical risk factors for heart disease. If patients and primary care doctors were aware of this very simple premise and applied it every day, we would make a significant impact on the prevention, identification and treatment of heart disease.

The problem is that although vascular specialists are familiar with this 5-10 minute evaluation,  the familiarity of non specialist is much less. That's why it is just as important to improve awareness among PCP's, nurses, NP's as it is for patients. In fact, if one can measure their blood pressure, you can measure your ABI

photo source www.cardiovascularsystemsinc.com