Chikara Ohi writes:
      
      
      
1) I must tell Mr. O the following:
        In fact, Mr. O is not in good health, even though he thought "everything
        was back to normal, and now I'm feeling fine." Because the signs of
        a heart attack can be subtle and hard to identify, many people don't recognize
        the symptoms even when they are in the middle of a major heart attack.
        But a heart attack (or myocardial infarction) occurs when a coronary artery,
        one of the blood vessels that supply oxygen-rich blood to the heart muscle,
        becomes blocked. The area of heart muscle that does not receive blood begins
        to die. Furthermore, Mr. O now complains of sharp chest pains that sometimes
        occur right after his dinner meals. This is a clear symptom of angina pectoris.
        Angina--a feeling of pain, heaviness, tightness, burning, or squeezing
        in your chest--is an indication that you have heart disease and are at
        risk of having a heart attack. Angina occurs when the heart muscle does
        not receive enough oxygen because of a temporary narrowing of one of the
        coronary arteries that supply it with oxygen-rich blood. In addition, I
        must warn him that he has six coronary disease risk factors. They are cigarette/tobacco
        smoke, high hypertension, high levels of cholesterol, physical inactivity,
        being overweight and a family history of coronary disease. 
        
        2) Getting prompt treatment for a heart attack can be lifesaving. So, If
        Mr. O experiences one or more symptoms of a heart attack, I will advise
        him to act quickly and take the following steps:
        
        * Sit down or lie down.
        * If symptoms persist for 2 minutes, call your local emergency telephone
        number and say you may be having a heart attack. Leave the phone off the
        hook so that medical personnel can locate your address if you should become
        unconscious.
        * If you have nitroglycerin tablets, take up to three pills, one at a time
        every 5 minutes.
        * Ambulances are well equipped to provide emergency care for people who
        are having heart attacks. It is usually better to have medical personnel
        come to you than for you to start off for the hospital.
        * If you can get to the hospital faster by car than by ambulance, have
        someone drive you. Do not drive yourself--it could be dangerous.
        * Do not delay getting medical treatment, even if you are not sure you
        are having a heart attack. 
        * If your breathing or pulse stops, any person who is trained in cardiopulmonary
        resuscitation (CPR) should immediately begin the procedure. 
        * When you arrive at the emergency room, you or the person who brought
        you should announce clearly that you may be having a heart attack. Make
        sure you are seen at once.
        
        3) First of all, with regard to the short term, Mr. O should stop smoking
        because nearly one-fifth of deaths from cardiovascular diseases are attributable
        to smoking. And Mr. O must follow his doctor's instructions and stay on
        his medication. Dietary and lifestyle changes also may help control his
        high blood pressure. Some people with mild hypertension can lower their
        blood pressure by reducing sodium in their diet. (I need to find out if
        Mr. O eats too much salt.) Excessive alcohol intake (more than two ounces
        daily) raises blood pressure in some people as well, and should be restricted.
        Blood pressure also returns to normal in many obese people when they lose
        weight. Increasing physical activity can reduce blood pressure in some
        people, too. Before drugs are prescribed, these methods to control blood
        pressure are often recommended for people with only mildly elevated blood
        pressure.
        
        In sum, my advice to him is --
        
        * Stop smoking.
        * Eat a variety of foods.
        * Maintain a healthy weight.
        * Choose a diet low in fat, saturated fat and cholesterol.
        * Choose a diet with plenty of vegetables, fruits and grain products.
        * Use sugars in moderation.
        * Use salt and sodium only in moderation.
        * If he drinks alcoholic beverages, do so in moderation. 
        * Do exercise as much as possible every day.
        * Check his cholesterol level, LDL level, etc.in the blood every year.
        
        4) In addition, with regard to the long term, he should do exercise as
        much as possible every day. Because increasing physical activity can reduce
        blood pressure in some people. Maybe it's time for his workouts to go along
        with his low-fat diet. So, I want to recommend low-impact aerobic exercise
        to him. For example, I have joined a health club and use a stationary bike,
        a treadmill and a stair-climber there. These machines are designed for
        people who want low-impact aerobic exercise. If he joins a club like mine,
        he gets the same benefit he gets from jogging. But he doesn't have to go
        out in any weather to clock up the miles. 
        
        
        
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