Let’s Talk About Knowing Your Numbers
Kate and Cami welcome back Dr. Thomas Meyer for Heart Month to talk about heart healthy numbers and why it's important to know your numbers sooner than later.
Note: Due to extra social distancing during recording for the safety of all parties, some audio may sound more muffled than normal.
Announcer:
Thanks for joining us for this episode of Centra Scripts, where we talk health and wellness and practical tips for your everyday life. And now, here's your host, Kate Justice.
Kate Justice:
Well, thanks so much for joining us on this at episode of Centra Scripts. As always, we are very excited to be with you here today, and this episode's going to be a little bit different. I'm Kate justice and I've been here with you guys for the last two years on this podcast. So I'm super excited today because I've got somebody new for you to hang out with going forward from here. Cami Smith is joining as a co-host today. Cami, thanks for being here.
Cami Smith:
Absolutely, and hello.
Kate Justice:
Cami has just joined Centra back in July of 2021, and so she is going to be stepping into the role of the podcast host going forward from here. And we're just really excited to see where this goes and to continue to have amazing conversations with our providers and community members. And speaking of that today, we are joined today by our guest, Dr. Thomas Meyer, and he is with HVI, The Heart and Vascular Institute here in town. And you may remember a few episodes back that we talked a lot about the Institute and the creation of what they're doing here and the implementation of all these things for the community. So Dr. Meyer, thank you for joining us today. Well, we want to get started because I'd like to have you explain a little bit about what you do here for HVI and how long you've been with cardiology and that sort of thing.
Dr. Thomas Meyer:
Sure, sure. Well, I've been here for about 15 years. I came straight to Lynchburg for my fellowship at Emory University in Atlanta. So I've spent my whole cardiology career here in Lynchburg. So I have a vested interest in the Lynchburg community and the health of the community. And my focus in cardiology is, one, I love preventive cardiology, and that's what we're talking about today. And then two, I specialize in cardiac imaging, so echocardiograms, CT, cardiac CTS, cardiac MRIs. So the radiology of cardiology. So a good variety of things.
Kate Justice:
Very cool. Well, and one reason we're here today, Cami, is Heart Month is here and it's on the docket. And so talk a little bit about that and what we're excited about for this month.
Cami Smith:
So the month of February is National Heart Month. And what we like to do during this entire month is to help educate people on preventative, as well as just the best ways to take care of themselves, the best ways to know, what is the best blood pressure? How do I take my blood pressure? Why is that even important? And so the more information that we can do to push out into our local community... And I love what you said. This is your community. Lynchburg is where you've had your whole practice. And so that community is so vitally important to us and helping them take care of their heart in the best way possible.
Kate Justice:
Yeah. And I think it was really evident even just when you introduced yourself there, Dr. Meyer, that you are extremely passionate about heart health. And so what drives you in your desire to make sure that the community knows these good things?
Dr. Thomas Meyer:
Well, I think preventive cardiology is so very important. Now, it may not seem is exciting as, say, treating a heart attack. When a patient has a heart attack, they're rushed in the ER, they go to immediately catheterization laboratory within 20 minutes, you open up their artery and they feel better right away. Well, wouldn't it be better to prevent that heart attack and the long term disability and decreased heart and all those things that come with it? If we can take a 30 year old with a lot of cardiac risk factors and prevent that heart attack or stroke 10, 20 years from now, I think we're providing huge benefit and saving thousands of lives, preventing many heart attacks and really adding years to people's lives. So I think that's why preventing cardiology is so important. It doesn't get all the fame or the excitement as interventional cardiology or other parts of cardiology, but it does play a huge role.
Kate Justice:
Now, HVI is a fairly large practice. We've talked about this before on the podcast, just the myriad of things that you all are able to treat here, but also the preventative care. How many preventative cardiologists are here?
Dr. Thomas Meyer:
Well, I would say that all cardiologists are in fact preventive cardiologists. In every patient we see, we're going to look at all the risk factors, try and treat those aggressively. There's probably about six or seven that really focus on prevention. But again, we all do or should be focused on prevention.
Kate Justice:
Yeah, very cool.
Cami Smith:
So we want to talk to you today about knowing your numbers, like we mentioned before. Can you explain what that means when you say that it's important to know your numbers? So the average person, like you said, we want to be on the front end and not on the treatment side of things we want to get on the preventative side of it. So if someone's wanting to prevent and wanting to take care of themselves and you say that it's important to know your numbers, can you explain to us what that means?
Dr. Thomas Meyer:
Yeah. So the numbers that we typically think about when we say, know your numbers, it's an American Heart Association campaign, the numbers that we look at would be blood pressure, and we'll talk about each one of these more details shortly, so blood pressure, cholesterol, body mass index, or weight, and then finally glucose level or sugar level and risk for diabetes. So those are the numbers that we focus on. And the reason all these numbers are important is because they're all what we call modifiable risk factors. All of these numbers we can treat either with lifestyle or medication. And so these numbers are so important because we can modify those. And that's as opposed to non-modifiable risk factors would be like age and sex and things like that you can't treat.
Kate Justice:
Yeah. So when we talk about knowing your numbers, I think that a lot of times, maybe people don't think that this is something that's important maybe earlier on in life. I think there's a lot of people that think, "Well, of course, when you get to an elderly state or that sort of thing, I'll need to know my numbers then." But why is this important for even in a younger population and how young should you start knowing these numbers?
Dr. Thomas Meyer:
Yeah. Well, I think even pediatrics should be checking cholesterol levels every few years at certain ages, because there are cases of genetic elevated cholesterol levels where the kids develop high cholesterol very early on. But then in adults, it should be starting at age 20, you should check your cholesterol and then every five years thereafter, and same thing with blood pressure. And the reason it's important, a lot of times when we're young, we're invincible, you feel fine and you don't think about 10, 20 years down the line when these risk factors add up. But we know that plaque build up in the arteries start very early on, even in teenagers and young adults. And so as that plaque builds up, it's over years and years, and that eventually leads to a heart attack. The heart attack is something that the risk doesn't start when you're 50, it starts very early on. So that's why you have to know early.
Kate Justice:
Yeah.
Cami Smith:
So you mentioned that it is important to come in before you've had signs of any kind of issues, and obviously before heart attacks. So what is something that people should be aware of that would lead them to come into a facility versus just making sure they're aware of their numbers in their normal day to day routine?
Dr. Thomas Meyer:
Yeah. I think the biggest red flag would be if you have a family history of heart disease. If your parents or uncles, aunts, siblings have heart attacks at an early age, that would be a big red flag where you need to really get treated early on and get established with a provider that can look at your risk fractures and treat those.
Kate Justice:
Awesome. Well, let's talk very specifically about some of these numbers then, some of these things that you mentioned just a few minutes ago in your description there of knowing your numbers. Let's start with blood pressure. So first of all, what is blood pressure? Because I feel like people might not understand what those numbers are and there's systolic and diastolic, and what does that even mean? So talk about what blood pressure is and then what a good range of numbers would be for people.
Dr. Thomas Meyer:
Yeah. So blood pressure, you hear two numbers, you hear the top number, the bottom number. The top number is called the systolic number, and that's the pressure in the arteries when the heart beats. And then the bottom number is the diastolic number. That's the pressure in the arteries when the heart relaxes. So you have a systolic and diastolic number. And the reason why blood pressure is important is I think many people have heard it's called the silent killer. You can walk around with blood pressure of 160, 170, 180 and not even know it. And high blood pressure is the leading cause of strokes and heart attacks of all the risk factors. So it's the most important thing we need to know.
Dr. Thomas Meyer:
And what are the good numbers? What should your blood pressure be? Ideally, it should be less than 120/80. That's considered normal blood pressure. What we call pre-hypertension or elevated blood pressure would be 120 to 129. Now, most people would consider that a normal blood pressure, but it's been shown that over time, that anything over 120 can lead to increased risk for heart disease. And so the elevated blood pressure is 120 to 129. High blood pressure or stage one hypertension is 130 to 139, and then stage two hypertension is over 140, 140/90. So really, you want your blood pressure less than 120/80 in the long run.
Kate Justice:
So let's talk a little bit about that for a minute. So if you've got numbers that are consistently running higher, let's say even above that 129 marker, what are some things that you can do just naturally in your life to start to bring those down? And when would they have a conversation with you or another provider and that sort of thing?
Dr. Thomas Meyer:
Yeah. So if you're consistently running with a blood pressure of over 130, then the first thing that providers would recommend would be lifestyle changes, and that would include increase your exercise as that can decrease blood pressure, decreasing salt intake, and improving your diet and weight loss would also be beneficial. Usually, you try lifestyle changes for several months and bring somebody back in six months and reassess their blood pressure. And if it's consistently running high, at that point, you may want to consider treatment with medication. And it's important to also have patients who have high blood pressure in the office get a blood pressure machine at home and check that at home, because there is what we call white coat hypertension, where every time somebody goes to the doctor's office elevated because they're nervous-
Kate Justice:
That's my poor mother.
Dr. Thomas Meyer:
Exactly.
Kate Justice:
My dad is a provider, and so she's very used to the medical world. And every time she goes to the doctor, they're always like, "Are you okay?"
Dr. Thomas Meyer:
Right, right. And then you go home and it's normal. So tracking at home is very useful, especially if it's always high in the doctor's office. Because this is a real thing. So I recommend patients get a good mantra at home, write it down, write down their blood pressure. A lot of times there's apps that connect to your blood pressure machine, and so it gives the doctor a good graph of what your blood pressure readings are running. And it's very useful for us to see the home readings too.
Kate Justice:
Very good. How long after maybe implementing some of... You said about six months is when you would bring a patient back to the office. Is that about the normal window when you can expect to see some changes for those?
Dr. Thomas Meyer:
For lifestyle changes, I would say about six months. Now, somebody with high risk for heart disease, I'd probably bring them back sooner within a few months. Or if the blood pressure's running much above 140, then I would bring back sooner. But if it's in the 130 range, low 140s, I would probably give them six months to really try diet, try exercise, lose some weight, stop smoking if they smoke, and all those things would be very beneficial. You can see a substantial improvement.
Dr. Thomas Meyer:
I also always ask about other medications they might be taking. If somebody comes in the office with a blood pressure of 160, I ask, "Are you taking ibuprofen?" Any sort of NSAIDs, Motrin, all those things will raise blood pressure. Decongestants, so if they're taking a decongestion over the counter, that'll raise the blood pressure too. So I always ask about that because that can be a key factor in causing somebody's high blood pressure at the moment.
Kate Justice:
Interesting. I didn't know about the decongestants. Good to know.
Dr. Thomas Meyer:
Yeah. Yeah.
Cami Smith:
So what would a good cholesterol number look like? We're going to jump slightly different.
Dr. Thomas Meyer:
Yeah. Yeah. Cholesterol numbers, there's different components of cholesterol, so we like to look at the breakdown. So first of all, we look at the total cholesterol. Less than 200 is what we'd like it to be. But then importantly, it's a breakdown of what the particles are, and those particles include the HGL, which is a good cholesterol. HGL is good because it helps remove cholesterol from the bloodstream and takes it back to the liver to be metabolized. So HGL is a good cholesterol, and a higher level is correlated with decreased cardiovascular risk. A good HGL number for both males and females would be over 60. Okay. It's considered low in males if it's less than 40 and females less than 50. Now, HGL is difficult to raise, but exercise helps raise that and the diet helps raise it also.
Dr. Thomas Meyer:
And then looking at other particles, the LDL is probably the most important one. That's considered the bad cholesterol that's directly linked to cardiovascular disease. There's a direct correlation between LDL and risk for heart attack and strokes at linear risk. So we want the LDL, for the most part, less than 100. Now, that's going to vary whether or not the patient has a history of heart disease or not. If they have a history of heart disease, you want that much lower, less than 70. If they don't have history for heart disease and very few risk factors, probably less than 130 is fine. So it really depends on your risk, and we look a lot at risk factors and other things that would affect our decision to treat that cholesterol levels. And then finally, the triglycerides are a fatty substance in the blood. The diet has huge role in triglycerides, and that should be less than 150.
Cami Smith:
Okay. Now, you mentioned that there is a way to take your blood pressure readings at home. Is there a way you would recommend to be more aware of cholesterol numbers at home?
Dr. Thomas Meyer:
There's really no home tests for cholesterol. That's something your doctor needs to check. So for people that don't have history of heart disease or high cholesterol, every five years, it's recommended they get it checked, once they reach the age of 20. For people with known heart disease or on cholesterol medicines, it should be checked every year.
Cami Smith:
Okay. Good to know.
Kate Justice:
All right. So moving on to another very important number here, a blood sugar level, and I feel like this is one of those that people talk about all the time, "Oh, I've got low blood sugar, or I feel like maybe my sugar just dropped," ...that sort of thing. And I know there's some discussion for people who are maybe more aware of their blood sugar levels, their glucose levels because of diabetes and that sort of thing. But for somebody who doesn't deal with something where they're having to check their blood sugar regularly, what does that look like for just the everyday life?
Dr. Thomas Meyer:
If you get labs at your doctor's office, so they're fasting labs, the fasting glucose or blood sugars should be less than 100. If it's 100 to 125, it's considered what we call pre-diabetes, and then over 125, if you get that checked on a consistent basis, it continues to be over 125, then it's probably diabetes. And then clearly if you have a blood sugar anytime over 200, non fasting or fasting, that's probably diabetes. So really less than a hundred is what your fasting sugar should be.
Cami Smith:
Okay. And how important are blood sugar levels with the overall cardiac health of what you're looking? You know, we talk about blood pressure being the silent killer and then cholesterol's right up there. Is this sort of in a nuanced direction that we're talking about these numbers or how does that fit into the overall look?
Dr. Thomas Meyer:
Yeah. Diabetes is definitely a cardiovascular risk factor and risk for many other things, too. Kidney failure, neuropathy, all those things. Diabetes affects multiple organs and control of that is similar to how you control your blood pressure and cholesterol and things like that. You know, lifestyle changes first and foremost.
Cami Smith:
It's the thing that people never want to hear either because they're like, I don't want to change how I'm living.
Dr. Thomas Meyer:
A hard thing to go.
Kate Justice:
Absolutely.
Dr. Thomas Meyer:
Just give me a medicine.
Cami Smith:
Yeah. Just snap your fingers and make it better.
Cami Smith:
Well, especially I think that some of the ages that people are coming in and they're starting to have to face some of these issues, you're very well established in your ways and you've created routines. And so I'm sure that is a part of what you do on a daily basis. As you're helping educate is helping people change some really deep grooves that they've created with habits over time.
Dr. Thomas Meyer:
You know, you can't ... it’s hard to make drastic changes a lot at once, so a lot of times you encourage small changes. If somebody comes in and sugar's elevated or they're 30 pounds overweight, I'll look for easiest things they can change. For example, I'll ask if they drink soda or sugar drinks and a lot of times they'll say I drink three Pepsis a day and that's a huge amount of sugar. If they just stop that, they could lose 20 pounds probably pretty easily and decrease risk for diabetes substantially. So look for those small changes, start with that and then gradually work your way to other things, but one thing at a time. It's hard to say, "Okay, quit smoking, stop your sodas, lose 50 pounds and exercise 45 minutes a day."
Kate Justice:
Right. That's a very overwhelming conversation.
Dr. Thomas Meyer:
Exactly.
Kate Justice:
And the other thing is just water intake, as well, can really help equal out a lot of this as well. And I think most of us are probably not drinking what we should be a day.
Dr. Thomas Meyer:
Definitely substitute water or non-sugar drinks with any sugar drinks that you might have, juices, whatever.
Kate Justice:
Yeah, for sure.
Dr. Thomas Meyer:
It's funny, a lot of people think that drinking orange juice every day or drinking three glasses of orange juice is healthy, but there's a lot of sugar in there. And other people think, it's funny what conceptions people have. I asked somebody if they drink much soda and they said, "Well, I switched from Coke to 7UP," because they didn't think 7UP had any sugar. I said, "Well," so you really look at the sugar content in things and you realize how much there is in things.
Kate Justice:
Yeah. Label reading is something that we've talked about. When you're in the grocery store, really getting to know your labels on things, because there's probably a lot more sugar content, even in bread, in certain breads and things like that. So yeah, be aware of your labels and definitely start to reeducate yourself on some of those things.
Cami Smith:
Let's talk a little bit about body mass index. So your BMI, how does one first calculate your BMI? Why is it important? And then how does it tie in to all of this that we've talked about?
Dr. Thomas Meyer:
Okay, well. I'll touch on this shortly, but BMI is controversial for one, but to calculate it or what it is. BMI is your body weight divided by your height squared. So the units are kilograms per meter squared. So symmetric appropriately. So you'd have to take your weight and then divide it by your height and squared. But you can do an online calculator to figure it out.
Kate Justice:
That's way easier.
Cami Smith:
Yeah. Yes.
Dr. Thomas Meyer:
Exactly.
Cami Smith:
The math.
Dr. Thomas Meyer:
Yeah, switching the inches to meters. The problem with BMI. Well, first of all, I'll tell you what the quoted numbers for normal BMIs are. The quoted numbers are 19 to 25 is considered normal. Over 25, 25 to 30 is considered overweight. Then over 30 is considered obese. Now the problem with BMI is it doesn't take into account one, the amount of muscle somebody has, the amount of bone mass somebody has. So you could take an Olympic sprinter who weighs 200 pounds and is five 10 and all muscle and their BMI, they could be considered obese or overweight, so it makes no sense at all, basically. So BMI I really have a lot of problems with, and I don't think it's that useful. I think it's maybe good to track your BMI. So say if your BMI increases over time and you aren't doing anything to increase your muscle mass, then that could be an important thing to note.
Dr. Thomas Meyer:
I think it's more important to look at your lifestyle, your diet, your exercise, things like that. If you're leading a healthy lifestyle, the BMI or the weight will take care of itself. You know, some people are ... everybody's made differently. There's going to be people that are shorter statue, but a little bit stockier and by BMI they could be considered obese, but they're healthy. I'm not a big fan of BMI. It's one of those know your number things, but I don't take too much credence in it.
Kate Justice:
What would you say for ... there's a lot of home scales now that do a lot of these measurements when you step on the scale and you're not only just getting your weight measurement, but it'll give you a percentage of body fat that it's taking into account. How accurate are those measurements? Is that accurate?
Dr. Thomas Meyer:
I don't think it is…to calculate body facts a lot of times you have to do some sort of x-ray measures or these water measures where you submerge somebody in water and calculate their fat that way. So I don't put a whole lot of credence in those scales. I don't know how ... I don't personally know how accurate they are, but I'd put some doubt into it.
Cami Smith:
You know, we just got my husband one for Christmas because he is trying to take better care of himself. He just turned 40, and I remember back in elementary school, we would have the pinch test and we had to do that every year. They would, you know, take all of our readings and pinch tests. And so when I saw that there is a scale that can do the same, I was skeptical as well. And so I think that right there is important. That can be the difference between someone completely relying on something that the general culture tells us, this is going to tell you what you need to know. That's why I think some of this can be so important.
Kate Justice:
For sure. I think, and that, that brings up a really good point, Cami, is that what we really want people to hear and understand in all of this is that this is an ongoing overall conversation about your holistic health, of what you're doing with your lifestyle and making sure that you not only know these numbers, but that you are playing an active part in your own healthcare. So make the appointments with your primary care physicians regularly to get checked out. And yeah, don't just take the word of some of the newest gadgets for, "Oh, well this says that I'm whatever," you know, because it's not the same as being able to interact with a person to person in clinic interaction and that sort of thing.
Dr. Thomas Meyer:
I agree. You talk about fads and things like that. And same thing with diets. There's a lot of fad diets out there and trends and you know, do the Whole 30 for 30 days and I'm going to be healthy. But then what do I do after those 30 days. So, you know, I think it's more about lifestyle and your everyday activity and not something you're going to do, you're going to binge on this for a month and lose 30 pounds and then go back to what I did before. I think it's just try and make small changes in your lifestyle, move more, exercise more, try and incorporate some more fruits and vegetables, all those things. But don't go on these fad diets and then stop them.
Kate Justice:
Yeah. And with any of these health conversations that we’re having, it’s always important to remember that life is a marathon and not a sprint, and so you were talking earlier about the length of time that it takes to see some of these changes and the times you would have a patient back in your office. I think people want that quick fix. They want to know that well, a month from now, I’m going to be so much better and that, well, sometimes it takes more than a month. Sometimes it’s going to take a lot longer. So think of it in the long term, the goal instead of that sprint mentality.
Dr. Thomas Meyer:
That’s definitely true.
Cami Smith:
So that’s a lot of it information. It’s a lot of information both for you to be mindful of in your day to day, but then also to be in regular conversation, regular communication with your doctor, and so I know we’ve talked about why these numbers are important, but what do we do then if you’re seeing anomalies, if you’re seeing things, it’s raising concern, how would you instruct someone? What’s the first step?
Dr. Thomas Meyer:
Yeah. So whatever we’re looking at, whatever structure we’re looking at, be it cholesterol, blood pressure, elevated glucose level, as we mentioned, the first thing is let’s work on things we can fix easily, or maybe not so easily, but fix without medication. Let’s try and move more, exercise more, back off on the sodas, back off on the processed foods, all those things. Let’s try the lifestyle changes first and then reassess in a few months, and then if we need to initiate medication at that point, we will, but most importantly, change the lifestyle, do the things we can fix without medication and then moving on from there.
Kate Justice:
Yeah. Again, that proactive style of living that healthy life. You want to be proactive and not reactive, but the things that you do have to react to, you can also still maintain from a proactive level of getting in there right away.
Dr. Thomas Meyer:
Exactly. And I think always emphasize to patients, especially if they smoke or have other high risk features that if you make these changes, you can add years to your life. You could add 10, 20 years to your life if you make these changes now. Instead of dying at age 65, you could live till 85 or 90. It’s that substantial in terms of lifestyle changes, especially the things like smoking, blood pressure and things like that.
Kate Justice:
Yeah. Very good. All right. So we’re almost out of time today, but before we go, I want to mention one very specific kind of proactive thing that maybe our listeners can take care of today even. We have something called an HRA, which is a health risk assessment that’s available on Centra’s website. There’s a number of them that you can take, but we want to talk specifically today about the HeartAware because it’s national heart month, and can you just talk a little bit about what that type of risk assessment is and why maybe that would be a good idea for people to look into?
Dr. Thomas Meyer:
Yeah. Well, I think the HeartAware is important or any sort of risk assessment is important because as we mentioned, you may have these risk factors that you may not know about. So the HeartAware will look at various symptoms that you may be having, maybe a little shortness of breath or chest pain, and really key in on things that may be abnormal that you may not realize, and also looking at your blood pressure, family history, all those things can put you at significant risk for heart disease, and so unless you think about it, then you may not seek treatment.
Kate Justice:
Yeah. And this is a really easy tool that we have available right on the front of the web page. If you go to hvi.centrahealth.com, right there on the bottom of that homepage is a link to take that health risk assessment, and the really cool thing about this is that if it comes back after your assessment with, okay, you might have some markers that might be some concern here, you can actually come in for free for an in-person assessment with one of our cardiologists and get plugged in right away to kind of that next step of care. So a huge benefit that costs you nothing to look into, which is great because I feel like everything costs something these days sometimes.
Cami Smith:
It’s true, and I think that the easiest we can possibly make it for people to just see something that maybe right under their nose can be beneficial for long term.
Kate Justice:
Yeah. And it’s not a painful assessment to take. It’s not going to take you hours to take. It’s a real quick assessment. It’s going to ask you very simple questions about your life and your lifestyle and maybe family history and that sort of thing. So no test anxiety required to take the assessment on the webpage, but Dr. Meyer, thank you so much for being here with us today and just taking time out of your day to sit down and talk about why it’s important to know these numbers and what they are. Is there anything else that you would like to tell everybody today before you go?
Dr. Thomas Meyer:
No, I appreciate you having me and just remember that prevention is key and can add years to the life.
Kate Justice:
And Cami, thanks for hopping in here with us and you guys are going to get a lot more opportunities to hang out with Cami in the future.
Cami Smith:
Aw yes, I'm excited.
Kate Justice:
She is. She's smiling really big, guys. So she's ready to hang out with everyone. So once again, thank you for joining us. Thanks for taking the time out of your day to listen to Centra scripts and to hang out with us for a little bit health information and ways to improve your healthy lifestyle. As always, you can find more information at centrahealth.com or at centratoday.com and we look forward to hanging out with you next time.