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Fighting your way back to good health

[Times photo: Dirk Shadd]
Bob and Agnes Kissling walk the beach at Pass-a-Grille.

By RANDOLPH FILLMORE, Times Correspondent

© St. Petersburg Times, published May 10, 2000

Careful record-keeping and discipline are the keys to keeping cholesterol and blood pressure levels down permanently.

Two routine tests -- blood pressure and total cholesterol -- may have saved Bob Kissling's life. For years, the 14-year Pass-a-Grille resident has walked miles on the beach daily. But in his 67th year he started coming up short. Of breath, that is.

"I walked on the beach every day, at a brisk pace," says the retired electrical engineer, now 70. "But suddenly I started getting out of breath very easily."

Kissling went to the Bay Area Heart Center in St. Petersburg for a checkup.

"First they found my blood pressure was too high. Then found my cholesterol was too high," recalls Kissling, who was born in Switzerland and claims with a laugh that an in-born Germanic sense of rigor helped him do what was dietarily necessary to get his cholesterol down. Not only did he get on a medication to lower his cholesterol, he turned on his computer and started meticulously charting his daily intake of fats and salt. His daily documentation included adding up the cholesterol and fat in whatever he ate and, of course, making an effort to select lower fat and lowest cholesterol foods.

"I keep a record of every meal," says Kissling, who started his efforts at 198 pounds and now tips the scales at just over 140. "I watched the tables that said just how much fat or cholesterol were in all the food I ate. I took much smaller quantities of food and closely watched the fat intake and sodium. After two months the doctor took me off the cholesterol medication."

Kissling says he eats pretty much what he did before, but just less of it. His wife, Agnes, helps.

"In beginning we were very careful with cholesterol and saturated fat," recalls Mrs. Kissling. "Even now he eats no butter. Recipes had to be modified. If I baked cookies I replaced egg yolks with egg whites. I'm a good cook, I enjoy cooking, but never before looked at what went in. That was a switch for me. That's why we needed to write it down and keep a close record. Now I have a good feel for it."

Although he is off the cholesterol-lowering drug, Kissling does not neglect taking his other medications, those aimed at helping him lower his risk of heart attack or stroke. He takes a blood thinner to ease the work load of his heart and a diuretic to prevent fluid retention. He keeps up the daily walking but stays away from alcohol and caffeine.

"My advice is to believe in your doctor and believe in yourself," says Kissling, adding that he is living proof that adherence to the heart-healthy behaviors that health care providers preach can actually work. "I often hear that people lose weight and keep it off for nine months or a year, then gain it back. You should do what the doctor tells you to do."

Researchers at the University of South Florida's Lipid Clinic are also concerned with controlling cholesterol and keeping folks with high cholesterol healthier longer. They have several clinical trials going on to help provide what Dr. Stephen Glasser, the clinic's director, calls "primary" and "secondary" prevention.

"Primary prevention means preventing a cardiac event," Glasser says. "Secondary prevention means preventing a second event in those who have already had a cardiac event."

Either kind of prevention adds up to closely monitoring your lipid levels and limiting your dietary fat intake. "Lipids describe the fatty substances found in the blood and body," says Mary Anne Knipp, USF Lipid Clinic nurse manager. "We are talking about three values that make up the Lipid Panel -- triglycerides, high density lipoprotein (HDL), and low-density lipoprotein (LDL).

Knipp calls the LDLs "bad" cholesterol and the HDL "good cholesterol" because LDLs can blend with other cells in the blood and clog up your arteries. HDL cholesterol carries LDL away from the arteries.

"Your LDLs should be 130 or less," Knipp says. "If you have a history of heart disease it should be around 100. Normal for HDLs is around 35. If you have low HDLs you are at risk for coronary artery disease."

Two heart bypass surgeries and a stroke landed Jack Clow, a retired 30-year U.S. Marine with four tours of duty in Vietnam and three Purple Hearts, at the USF Lipid Clinic. He was referred by his doctors at the James A. Haley Veterans Administration Medical Center just across the street from the USF Lipids Clinic. Now, Clow is in the gym three days a week and, with the help of Lipid Clinic dietitian Grace Lau, has radically change his diet. What is his new diet? "Everything I hate," Clow says with a chuckle. "Fish, vegetables, chicken breast."

But he uses his well-honed Semper Fi attitude to adhere to the exercise regimen and diet drill. "Even in the Marine Corps I didn't particularly like exercise," says the 66-year-old Clow, who in addition to eating a low-fat diet works out on the cross-country ski machine and does aerobics and weightlifting.

"You need to have the inner discipline to stick to it," says Clow, like the warrant officer he was. He adds that it may have been three decades of a typically high-fat military diet that helped clog his arteries.

"I've had a lot of good friends die of high cholesterol," he says.

You need not have lived on a military diet to end up with high cholesterol, however. The standard American diet will do it for anyone. The damage LDL cholesterol does to your veins and arteries does not discriminate between men or women, the middle-age or elderly. "It's an equal opportunity disease," Knipp says.

Knipp says that their patients are generally referred to them by primary care physicians but that anyone with a concern about high cholesterol or high blood pressure can contact them. Testing means getting a full lipid panel. Liver function and glucose tests will follow as hyperlipidemia can also be associated with diabetes.

Education from Knipp and the dietitian, plus regular lipid screening and adherence to the diet usually bring down the high numbers. "It's a team approach between the patient and the staff," says Knipp. Medications are part of the "team," however. Diet and exercise generally does not accomplish everything.

"Even with exercise and diet, levels may only be reduced by 10 percent, on average," says Glasser, who adds that most hyperlipidemia research is in new drugs aimed at lowering cholesterol counts.

There are also not so high-tech drug therapies. Glasser encourages his patients to take a low-dose aspirin as part of their secondary prevention ritual. Major studies have shown aspirin to be beneficial to those with circulatory diseases because aspirin helps blood flow past the blockages rather than stick to them. The American Heart Association has recently recommended the simple headache drug as standard therapy. Glasser suggests that aspirin might also be beneficial for primary prevention as well, but studies are ongoing and inconclusive.

Several clinical trials in hyperlipidemia, hypertension and angina are being conducted at the USF Lipids Clinic. Anyone interested in participating in a clinical trial may contact research nurses Mary Ann Knipp, (813) 974-5606 or Kim Roberts at (813) 974-5604.

Randolph Fillmore is a Tampa freelance writer who specializes in science and medicine. He is a regular contributor to Health Times and the Baltimore Sun.

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