The Knowledge That Harvard Medical School’s Clinical Instructor Dr. Monique Tello Thinks Everyone SHOULD Have About Heart Health

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Anyone (who has not had a double mastectomy, anyway) can get breast cancer.

Breast cancer, if diagnosed early (before it spreads), has a 98% survival rate.

That survival rate drops to 31% if diagnosed after it has spread through the body.

(The US CDC’s breast cancer “stat bite” page has more stats and interactive graphs, so click here to see those charts and get the more detailed low-down on mortality/survival rates with various different situations)

We think that the difference between 98% and 31% survival rates is more than enough reason to give ourselves a monthly self-check at the very least! You’ve probably seen how-to diagrams before, but here are instructions for your convenience:

This graphic created by the Jordan Breast Cancer Program (check them out, as they have lots of resources)

If you don’t have the opportunity to take matters into your own hands right now, rather than just promise yourself “I’ll do that later”, take this free 4-minute Breast Health Assessment from Aurora Healthcare. Again, we think the difference early diagnosis can make to your survival chances make these tests well worth it.

Lest we forget, men can also get breast cancer (the CDC has a page for men too), especially if over 50. But how do you check for breast cancer, when you don’t have breasts in the commonly-understood sense of the word?

So take a moment to do this (yes, really actually do it!), and set a reminder in your calendar to repeat it monthly—there really is no reason not to! Take care of yourself; you’re important.

Pssst! Did you scroll past the diagrams, looking for the online 4-minute test promised by the subtitle? If so, scroll back up; the link is in the middle!

Harvard Medical School’s Clinical Instructor’s Five-Point Plan for Heart Health

Dr. Monique Tello, M.D., M.P.H., is a practicing physician at Massachusetts General Hospital, director of research and academic affairs for the MGH DGM Healthy Lifestyle Program, clinical instructor at Harvard Medical School, and author of the evidence-based lifestyle change guide Healthy Habits for Your Heart.

Here are what she says are the five most important factors to help keep your ticker ticking:

5. Have (at most) a moderate alcohol intake! While there are polyphenols such as resveratrol in red wine that could boost heart health, there’s so little per glass that you may need 100–1000 glasses to get the dosage that provides benefits in mouse studies. If you’re not a mouse, it may not be as beneficial, and Dr. Tello recommends drinking no more than one glass per day of any alcohol. What constitutes a glass? It varies from one kind of drink to another, so here’s a handy guide.

4. Don’t smoke. Best of all to never start. But if you did, quit. Simple as that. There is no healthy amount of smoking. While paradoxically, quitting smoking may of course be stressful to you, the long term gains are considered more than worth it. As with all advice, do consult your own physician for guidance, as individual circumstances may vary, and that may change the best approach for you.

3. Maintain a healthy body weight. While BMI (Body Mass Index) is not a perfect system, it’s a system in popular use, and Dr. Tello recommends keeping a BMI between 18.5 and 24.9.

What’s your BMI? It takes into account your height and weight; here’s a Quick BMI Calculator for your convenience.

2. Keep a healthy level of physical activity—which ideally means at least 30 minutes per day vigorous activity, but obviously if you’re not used to this, take it slowly and build up over time. Even just small lifestyle changes (walking where possible, taking the stairs instead of the elevator where possible, etc) can add up to a big difference.

1. Enjoy a healthy diet. This is the single most important thing, and the best modern scientific consensus holds that the best diet contains plenty of vegetables, fruits and nuts, whole grains, and omega-3 fatty acids, while it avoids processed meats, sugar-sweetened beverages, trans fats (what are trans fats?), and too much sodium.

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  • Language Fluency Beats General Intelligence & Memory For Longevity

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    And no, it doesn’t have to be a second language, although that helps a lot:

    An Underrated Tool Against Alzheimer’s ← you don’t even have to learn the second language to a high level, to benefit

    Rather, what we’re talking about today is your first language fluency. So, for most of our readers, English. For the study participants it was German, because this was a German research team using data from the German population.

    The Berlin Aging Study

    Previous research has linked intelligence to longevity, but intelligence comprises multiple traits. So, what’s most important? Memory? General intelligence? Nope. Language fluency!

    Let’s clarify something before we continue: “fluency” does not, in linguistics, mean what most people use it to mean. It’s not about the size of one’s overall knowledge of the language (e.g. vocabulary size), but rather, it is about one’s ability to speak and/or write fluently—literally, fluently means “flowingly”, i.e. without undue hesitation or difficulty.

    The study used data from the Berlin Aging Study, which tracked 516 people aged 70–105 from 1989 onwards.

    Researchers assessed four cognitive abilities, with two kinds of tests for each of:

    • Verbal fluency (detailed description below)
    • Perceptual speed (pattern-recognition speed)
    • Verbal knowledge (vocabulary size)
    • Episodic memory (personal memory recall)

    General intelligence, meanwhile, was assessed as “the average of those 8 scores”.

    The two tests for the cognitive ability of “verbal fluency” were:

    Categories

    Participants had to name as many different animals as possible within 90 seconds. Their answers were subsequently rated for correctness by two independent research assistants, to assure that noticed or unnoticed repetitions, wrong categories, and morphological variants were not coded as correct.

    Word beginnings

    Participants were asked to name as many different real words starting with the letter s as possible within 90 seconds. The named words were rated for correctness by two independent research assistants to avoid considering repetitions, morphological variants, and wrong words as correct.

    You can read about these and the other tests for the other cognitive abilities, in the paper itself:

    Verbal Fluency Selectively Predicts Survival in Old and Very Old Age ← if you’re looking for the test descriptions, scroll to “Method” and then scroll past the table, and you’ll see the test descriptions

    They found that of all these metrics, only the two verbal fluency tests (and none of the other tests) showed a significant link to longevity.

    Why this is important

    Although the study does not prove causality (it could be that people who are predisposed to live longer for other reasons are more verbally fluent because of some common factor that influences both language fluency and longevity), it seems as good a reason as any to develop and maintain language fluency.

    This builds on what was found in “The Nun Study“, that followed a convent of nuns (because they are a very homogenous sample in terms of occupation, location, diet, routine, etc, so a lot of confounding factors were already controlled-for) and made numerous major discoveries about things that impact aging (including the relevance of the APOE4 gene! That was The Nun Study).

    When it came to nuns and language…

    Based on the autobiographies written by the nuns in their youth upon taking their vows, there were two factors that were later correlated with not getting dementia:

    • Longer sentences
    • Positive outlook
    • “Idea density”

    That latter item means the relative linguistic density of ideas and complexity thereof, and the fluency and vivacity with which they were expressed (this was not a wishy-washy assessment; there was a hard-science analysis to determine numbers).

    Want to spruce up yours? You might like to check out:

    Reading, Better: Reading As A Cognitive Exercise

    …for specific, evidence-based ways to tweak your reading to fight cognitive decline.

    Take care!

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  • In This Oklahoma Town, Most Everyone Knows Someone Who’s Been Sued by the Hospital

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    McALESTER, Okla. — It took little more than an hour for Deborah Hackler to dispense with the tall stack of debt collection lawsuits that McAlester Regional Medical Center recently brought to small-claims court in this Oklahoma farm community.

    Hackler, a lawyer who sues patients on behalf of the hospital, buzzed through 51 cases, all but a handful uncontested, as is often the case. She bantered with the judge as she secured nearly $40,000 in judgments, plus 10% in fees for herself, according to court records.

    It’s a payday the hospital and Hackler have shared frequently over the past three decades, records show. The records indicate McAlester Regional Medical Center and an affiliated clinic have filed close to 5,000 debt collection cases since the early 1990s, most often represented by the father-daughter law firm of Hackler & Hackler.

    Some of McAlester’s 18,000 residents have been taken to court multiple times. A deputy at the county jail and her adult son were each sued recently, court records show. New mothers said they compare stories of their legal run-ins with the medical center.

    “There’s a lot that’s not right,” Sherry McKee, a dorm monitor at a tribal boarding school outside McAlester, said on the courthouse steps after the hearing. The hospital has sued her three times, most recently over a $3,375 bill for what she said turned out to be vertigo.

    In recent years, major health systems in Virginia, North Carolina, and elsewhere have stopped suing patients following news reports about lawsuits. And several states, such as Maryland and New York, have restricted the legal actions hospitals can take against patients.

    But with some 100 million people in the U.S. burdened by health care debt, medical collection cases still clog courtrooms across the country, researchers have found. In places like McAlester, a hospital’s debt collection machine can hum away quietly for years, helped along by powerful people in town. An effort to limit hospital lawsuits failed in the Oklahoma Legislature in 2021.

    In McAlester, the lawsuits have provided business for some, such as the Adjustment Bureau, a local collection agency run out of a squat concrete building down the street from the courthouse, and for Hackler, a former president of the McAlester Area Chamber of Commerce. But for many patients and their families, the lawsuits can take a devastating toll, sapping wages, emptying retirement accounts, and upending lives.

    McKee said she wasn’t sure how long it would take to pay off the recent judgment. Her $3,375 debt exceeds her monthly salary, she said.

    “This affects a large number of people in a small community,” said Janet Roloff, an attorney who has spent years assisting low-income clients with legal issues such as evictions in and around McAlester. “The impact is great.”

    Settled more than a century ago by fortune seekers who secured land from the Choctaw Nation to mine coal in the nearby hills, McAlester was once a boom town. Vestiges of that era remain, including a mammoth, 140-foot-tall Masonic temple that looms over the city.

    Recent times have been tougher for McAlester, now home by one count to 12 marijuana dispensaries and the state’s death row. The downtown is pockmarked by empty storefronts, including the OKLA theater, which has been dark for decades. Nearly 1 in 5 residents in McAlester and the surrounding county live below the federal poverty line.

    The hospital, operated by a public trust under the city’s authority, faces its own struggles. Paint is peeling off the front portico, and weeds poke up through the parking lots. The hospital has operated in the red for years, according to independent audit reports available on the state auditor’s website.

    “I’m trying to find ways to get the entire community better care and more care,” said Shawn Howard, the hospital’s chief executive. Howard grew up in McAlester and proudly noted he started his career as a receptionist in the hospital’s physical therapy department. “This is my hometown,” he said. “I am not trying to keep people out of getting care.”

    The hospital operates a clinic for low-income patients, whose webpage notes it has “limited appointments” at no cost for patients who are approved for aid. But data from the audits shows the hospital offers very little financial assistance, despite its purported mission to serve the community.

    In the 2022 fiscal year, it provided just $114,000 in charity care, out of a total operating budget of more than $100 million, hospital records show. Charity care totaling $2 million or $3 million out of a $100 million budget would be more in line with other U.S. hospitals.

    While audits show few McAlester patients get financial aid, many get taken to court.

    Renee Montgomery, the city treasurer in an adjoining town and mother of a local police officer, said she dipped into savings she’d reserved for her children and grandchildren after the hospital sued her last year for more than $5,500. She’d gone to the emergency room for chest pain.

    Dusty Powell, a truck driver, said he lost his pickup and motorcycle when his wages were garnished after the hospital sued him for almost $9,000. He’d gone to the emergency department for what turned out to be gastritis and didn’t have insurance, he said.

    “Everyone in this town probably has a story about McAlester Regional,” said another former patient who spoke on the condition she not be named, fearful to publicly criticize the hospital in such a small city. “It’s not even a secret.”

    The woman, who works at an Army munitions plant outside town, was sued twice over bills she incurred giving birth. Her sister-in-law has been sued as well.

    “It’s a good-old-boy system,” said the woman, who lowered her voice when the mayor walked into the coffee shop where she was meeting with KFF Health News. Now, she said, she avoids the hospital if her children need care.

    Nationwide, most people sued in debt collection cases never challenge them, a response experts say reflects widespread misunderstanding of the legal process and anxiety about coming to court.

    At the center of the McAlester hospital’s collection efforts for decades has been Hackler & Hackler.

    Donald Hackler was city attorney in McAlester for 13 years in the ’70s and ’80s and a longtime member of the local Lions Club and the Scottish Rite Freemasons.

    Daughter Deborah Hackler, who joined the family firm 30 years ago, has been a deacon at the First Presbyterian Church of McAlester and served on the board of the local Girl Scouts chapter, according to the McAlester News-Capital newspaper, which named her “Woman of the Year” in 2007. Since 2001, she also has been a municipal judge in McAlester, hearing traffic cases, including some involving people she has sued on behalf of the hospital, municipal and county court records show.

    For years, the Hacklers’ debt collection cases were often heard by Judge James Bland, who has retired from the bench and now sits on the hospital board. Bland didn’t respond to an inquiry for interview.

    Hackler declined to speak with KFF Health News after her recent court appearance. “I’m not going to visit with you about a current client,” she said before leaving the courthouse.

    Howard, the hospital CEO, said he couldn’t discuss the lawsuits either. He said he didn’t know the hospital took its patients to court. “I had to call and ask if we sue people,” he said.

    Howard also said he didn’t know Deborah Hackler. “I never heard her name before,” he said.

    Despite repeated public records requests from KFF Health News since September, the hospital did not provide detailed information about its financial arrangement with Hackler.

    McAlester Mayor John Browne, who appoints the hospital’s board of trustees, said he, too, didn’t know about the lawsuits. “I hadn’t heard anything about them suing,” he said.

    At the century-old courthouse in downtown McAlester, it’s not hard to find the lawsuits, though. Every month or two, another batch fills the docket in the small-claims court, now presided over by Judge Brian McLaughlin.

    After court recently, McLaughlin, who is not from McAlester, shook his head at the stream of cases and patients who almost never show up to defend themselves, leaving him to issue judgment after judgment in the hospital’s favor.

    “All I can do is follow the law,” said McLaughlin. “It doesn’t mean I like it.”

    About This Project

    “Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

    The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

    Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

    The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

    KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

    Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • Dried Apricots vs Dried Prunes – Which is Healthier?

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    Our Verdict

    When comparing dried apricots to dried prunes, we picked the prunes.

    Why?

    First, let’s talk hydration. We’ve described both of these as “dried”, but prunes are by default dried plums, usually partially rehydrated. So, for fairness, on the other side of things we’re also looking at dried apricots, partially rehydrated. Otherwise, it would look (mass for mass or volume for volume) like one is seriously outstripping the other even if some metric were actually equal, just because of water-weight in one and not the other.

    Illustrative example: consider, for example, that the sugar in a bunch of grapes or a handful of raisins can be the same, not because they magically got more sugary, but because the water was dried out, so per mass and per volume, there’s more sugar, proportionally.

    Back to dried apricots and dried prunes…

    You’ll often see these two next to each other in the heath food store, which is why we’re comparing them here.

    Of course, if it is practical, please by all means enjoy fresh apricots and fresh plums. But we know that life is not always convenient, fruits are not in season growing in abundance in our gardens all year round, and sometimes we’re stood in the aisle of a grocery store, weighing up the dried fruit options. 

    • Apricots are well-known for their zinc, potassium, and vitamin A.
    • Prunes are well-known for their fiber.

    But that’s not the whole story…

    • Apricots outperform prunes for vitamin A, and also vitamins C and E.
    • Prunes take first place for vitamins B1, B2, B3, B5, B6, and K, and also for minerals calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc.
    • Prunes also have about 3x the fiber, which at the very least offsets the fact that they have 3x the sugar.

    Once again, sugar in fruit is healthy (sugar in fruit juices is not*, though, so enjoy prunes rather than just prune juice, if you can) and can take its rightful place as providing a significant portion of our daily energy needs, if we let it.

    *It’s the same sugar, just the manner of delivery changes what it does to our liver and our pancreas; see:

    Which Sugars Are Healthier, And Which Are Just The Same?

    In summary…

    Dried apricots are great (fresh are even better), and yet prunes outperform them by most metrics on a like-for-like basis.

    Prunes have, on balance, a lot more vitamins and minerals, as well as more fiber and energy.

    Want to get some?

    Your local supermarket probably has them, and if you prefer having them delivered to your door, then here’s an example product on Amazon

    Enjoy!

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  • Burned Out By Tuesday?
  • What Your Doctor May Not Tell You About Fibromyalgia – by Dr. R. Paul St Amand

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The core claim of the book is that guaifenesin, an over-the-counter expectorant (with a good safety profile) usually taken to treat a chesty cough, is absorbed from the gastrointestinal tract, and is rapidly metabolized and excreted into the urine—and on the way, it lowers uric acid levels, which is a big deal for fibromyalgia sufferers.

    He goes on to explain how the guaifenesin, by a similar biochemical mechanism, additionally facilitates the removal of other excess secretions that are associated with fibromyalgia.

    The science for all this is… Compelling and logical, while not being nearly so well-established yet as his confidence would have us believe.

    In other words, he could be completely wrong, because adequate testing has not yet been done. However, he also could be right; scientific knowledge is, by the very reality of scientific method, always a step behind hypothesis and theory (in that order).

    Meanwhile, there are certainly many glowing testimonials from fibromyalgia sufferers, saying that this helped a lot.

    Bottom line: if you have fibromyalgia and do not mind trying a relatively clinically untested (yet logical and anecdotally successful) protocol to lessen then symptoms (allegedly, to zero), then this book will guide you through that and tell you everything to watch out for.

    Click here to check out What Your Doctor May Not Tell You About Fibromyalgia, and [check with your doctor/pharmacist and] try it out!

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  • Wasting Your Vitamins?

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    Are you flushing away your vitamins?

    Most likely…but you don’t have to.

    We all know what a wasteful expense supplements can sometimes be, but you can optimise your intake to get more bang for your buck!

    Top Tips for Getting Your Money’s Worth:

    1. Liquids are better than tablets—the body can’t absorb nutrients from tablets anywhere as easily as it can from liquids, with some saying as low as a 50% absorption rate for tablets, so if your supplement can come in drinkable form, take it that way!
    2. Capsules are better than tablets—capsules, depending on the kind, contain either a powder (true capsules) or a liquid (softgels). Once the capsule/softgel is broken down in the stomach, it releases its contents, which will now be absorbed as though you took it as a drink.
    3. Stay hydrated—on that note, your body can only make use of nutrients that it can easily transport, and if you’re dehydrated, the process is sluggish! Having a big glass of water with your supplements will go a long way to helping your body get them where they’re needed.
    4. Take with black pepper—studies disagree on exactly how much black pepper improves absorption of nutrients. Some say it improves it by 50%, others say as much as 7x better. The truth is probably that it varies from one nutrient to the next, but what is (almost) universally accepted is that black pepper helps you absorb many nutrients you take orally.
    5. Take with a meal—bonus if you seasoned it with black pepper! But also: many nutrients are best absorbed alongside food, and many are specifically fat-soluble (so you want to take a little fat around the same time for maximum absorption)
    6. Consider split doses—a lot of nutrients are best absorbed when spread out a bit. Why? Your body can often only absorb so much at once, and what it couldn’t absorb can, depending on the nutrient, pass right through you. So better to space out the doses—breakfast and dinner make for great times to take them.
    7. Consider cycling—no, not the two-wheeled kind, though feel free to do that too! What cycling means when it comes to supplements is to understand that your body can build a tolerance to some supplements, so you’ll get gradually less effect for the same dose. Combat this by scheduling a break—five days on, two days off is a common schedule—allowing your body to optimise itself in the process!
    8. Check Medications—and, as is always safe, make sure you check whether any medications you take can interrupt your supplement absorption!

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  • How To Stay A Step Ahead Of Peripheral Artery Disease

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    Far less well-known than Coronary Artery Disease, it can still result in loss of life and limb (not in that order). Fortunately, there are ways to be on your guard:

    What it is

    Peripheral Artery Disease (PAD) is the same thing as Coronary Artery Disease (CAD), just, in the periphery—which by definition means “outside of the heart and brain”, but in practice, it starts with the extremities. And of the extremities, it tends to start with the feet and legs, for the simple reason that if someone’s circulation is sluggish, then because of gravity, that’s where’s going to get blocked first.

    In both CAD and PAD, the usual root cause is atherosclerosis, that is to say, the build-up of fatty material inside the arteries, usually commensurate to LDL (“bad”) cholesterol, especially in men (high LDL is still a predictor of cardiovascular disease in women though, just more modestly so, at least pre-menopause or in cases of treated menopause whereby HRT has returned hormones to pre-menopause levels).

    See also: Demystifying Cholesterol

    And for that about sex differences: His & Hers: The Hidden Complexities of Statins and Cardiovascular Disease (CVD)

    Why it is

    This one’s straightforward, as it’s the same things as any kind of cardiovascular disease: high blood pressure, high cholesterol, older age, obesity, smoking, drinking, diabetes, and genetic factors (so, a risk factor is: family history of heart disease).

    However, while those are the main causes and/or risk factors, it absolutely can still strike other people, so it’s as well to be watch out for…

    What to look out for

    Many people first notice signs and symptoms that turn out to be PAD when they experience pain or numbness in the foot or feet, and/or a discoloration of the feet (especially toes), and slow wound healing.

    At that stage, chances are you will need to go urgently to a specialist, and surgery is a likely necessity. With a little luck, it’ll be a minimally-invasive surgery to unblock an artery; failing that, an amputation will be in order.

    At that stage, under 50% will be alive 5 years from diagnosis:

    Cardiovascular and all-cause mortality in patients with intermittent claudication and critical limb ischaemia

    You probably want to avoid those. Good news is, you can, by catching it earlier!

    What to look out for before that

    The most common test for PAD is one you can do at home, but enlisting a nurse to do it for you will help ensure accurate readings. It’s called the Ankle-Brachial Index (ABI) test, and it involves comparing the blood pressure in your ankle with the blood pressure in your arm, and expressing them as a ratio.

    Here’s how to do it (instructions and a video demonstration if you want it):

    Do Try This At Home: ABI Test For Clogged Arteries

    If you need a blood pressure monitor, by the way, here’s an example product on Amazon.

    • A healthy ABI score is between 1.0 and 1.4; anything outside this range may indicate arterial problems.
    • Low ABI scores (below 0.8) suggest plaque is likely obstructing blood flow
    • High ABI scores (above 1.4) may indicate artery hardening

    Do note also that yes, if you have plaque obstructing blood flow and hardened arteries, your scores may cancel out and give you a “healthy” score, despite your arteries being very much not healthy.

    For this reason, this test can be used to raise the alarm, but not to give the “all clear”.

    There are other tests that clinicians can do for you, but you can’t do at home unless you have an MRI machine, a CT scanner, an x-ray machine, a doppler-and-ultrasound machine, etc. We’ll not go into those in detail here, but ask your doctor about them if you’re concerned.

    What to do about it

    In the mid-to-late stages of the disease, the options are medication and surgery, respectively, but your doctor will advise about those in that eventuality.

    In the early stages of the disease, the first-line recommend treatment is exercise, of which, especially walking:

    Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment

    Given that this more often happens when someone hasn’t been walking so much, it can be a walk-rest-walk approach at first (a treadmill on a low setting can be very useful for this):

    See also: Exercise Comparison Head-to-Head: Treadmill vs Road

    Take care!

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