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For more information about heart health and to find free educational resources and tips to prevent heart disease, visit the NHLBI website at www.nhlbi.nih.gov and The Heart Truth® program at www.hearttruth.gov

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Directed by Laura Siegel

Hosted by Linda Emanuel

Edited by Matt McKenney for ProPodcastingServices.com

Special Guests: Dr. Eric Shiroma and Dr. David Schopfer

Welcome to Talking Total Farmer Health, I’m your host Linda Emanuel, and today we will be talking about heart health!

Just like you need to make sure you tune-up your tractor, or take your animals to the vet, you need to make sure to take care of your own health too! And what is more important to keep your body running well, than your heart? So, today we have two guests joining us to discuss heart health – what it you need to know, and how you can keep yourself healthy on the farm even when you’re really busy. Today I'm excited to be able to welcome two gentlemen that are working in the space of cardiovascular health. We have Doctor David Schopfer and Doctor Eric Shiroma. Thank you so much, you two, for joining us.

Thank you for having us.

Thanks for having us.

You bet. So to start us off, Doctor Schopfer, please introduce yourself and share a little bit about your everyday work.

So I am a cardiologist and a medical officer at the National Institutes of Health in the National Heart Lung Blood Institute. My day to day job, I oversee, many different, research projects and grants, spanning a pretty wide spectrum of heart disease, primarily focused around coronary artery disease. But, and this involves everything from, basic science laboratory research, trying to understand cellular mechanisms all the way up to big clinical trials with, with thousands of people that are being enrolled and being followed for many years. So, kind of a wide range of things that I'm involved with. And then, I also still see patients, regularly as, as well, in my clinic.

Nice, nice. Doctor Eric Shiroma, tell us about yourself and the work that you do on a daily.

By training, I am an epidemiologist and exercise physiologist. I work with David at the same place at the NIH. And so we have a lot of tasks that overlap. So, not trying to repeat things, but one of the main things I also do is we're creating some workshops and seminars that reach out into the public and kind of give nice overviews on some of the current updated science around heart disease. And for me, physical activity, as well as trying to figure out where some of the gaps and where we want to go next with some of this research.

I love filling in the gaps. I think that's part of my work as a nurse, is I'm always trying to fill in the gaps and let people know some of this great work that's happening out there by these strong professionals. So let's dig right in here. Why is heart health so important?

It still is the number one killer in the United States. And male farmers are actually at a higher risk of heart disease than non-farmers. So, while we know that heart disease is important for everyone, it's particularly important in this, in this population. It affects some groups, some populations, some different racial groups, more than others. And so really trying to figure out what's going on under there. And also that, it's important because we know that there are a lot of things we can do to prevent some of this heart disease. So, by living a little bit healthier and sticking to some good medical regimens, it's something that we can actually have an impact on.

Yeah, it certainly is. And that impact is important. Just helping us that are working the day to day lives on farms and ranches to understand what can we do to change our outcomes. And if heart disease is part of our, our makeup, of what we have to deal with, how do we go about that? So, let's talk about myths. Are there any common myths about heart disease that you'd like to dispel?

So, following up on that, I think where we're talking about some groups that have a higher risk of heart disease, we also tend to ignore some groups that we probably shouldn't be ignoring. For example, we always think of heart attacks and heart disease happening in older individuals. Well, that's not really true. We have heart disease starting even in our low 30s, and we can see things coming early or late, depending on a lot of different factors. But we're not immune just because we feel like we are younger than the people we think are having some of these things. So, I think that that's one of the big ones, is this is not an issue for us to take on later in life. This is an issue we need to start thinking about and preventing stuff earlier in life. And that can start really at a younger age than we probably are thinking about.

I'll add. I think, I think there's sometimes people have a concept that much of heart disease is not preventable and that, you know that it's very tightly tied to genetics or that there's nothing you can do about it. And I think sometimes you hear about that and people will say, well, you know, my father, my grandfather, Lucky, you know, he smoked till he was 100. How could it be bad? How could he have lived that long and not had a heart attack? But there's so many different factors that, that play a role and to different levels in different people. But what we definitely know is that that heart disease is certainly preventable, at least in, in some. And we can at least certainly delay the development of heart disease, or the severity of the heart disease that we develop, significantly until, until for many years, and in a perfect world, you know, so that we don't get it at all in our lifetimes. But there are definitely a number of things that, that individuals can do to, to keep their hearts, healthy for, for as long as possible.

We've done a great job in modern medicine of being able to take care of those with heart disease. And I just want to bring up the myth that this sometimes happens. Is it still a serious thing? Right. We all know people that have had one or multiple heart attacks, and they seem to be doing “okay.” But this is something that we really don't want to take lightly. I mean, it's not getting a cavity, right? It is a substantial thing that we want to really try to prevent or at least delay. 375,000 people die from heart disease just last year. So this is not something to take lightly. We know that it happens, but it is serious.

375,000 That is a lot of people. A lot of families affected.

Exactly. 17 million people or more have heart disease in the United States right now. So we are talking about some big numbers.

There's a number of different types of things that can go wrong with the heart. I think when people think of heart, they think of heart disease, they think heart attack, but it's so much more. There's so many other underlying things that can go on. So what are the obvious? And maybe the not so obvious signs or symptoms of heart disease or a possible heart attack? You know, really, we need to understand, help us understand what the symptoms are that may indicate that we need to take action now, immediately. Or maybe it's something we need to follow up with our doctor, our health care provider.

Yeah, yeah. So the symptoms of a heart attack… Let's, let's break this down. So coronary artery disease blockage in these arteries can lead to a heart attack. And those symptoms can be a little different than if the blockage in the arteries are building up slowly over time, but- but haven't quite caused a heart attack yet. But in in the ones where the blockage has become very severe, or it's happened suddenly and there's a sudden blockage of flow to the heart muscle. The classic symptoms are chest pain, shortness of breath, pain sometimes can extend actually all the way into the shoulder or arm or up into the neck. Patients often feel like clammy or sweaty for no reason. You know, they're not exerting themselves, but they get kind of a cold, sweaty feeling, and often feel nauseous or even, like stomach pain, essentially some stomach discomfort. So those are the, the classic ones.

When blockage develops more slowly over time too, you may just feel symptoms of significant fatigue. Also shortness of breath. You might get chest discomfort or just a kind of an achy or a tightness that occurs, when you're exerting yourself, lifting something, going up a flight of stairs, doing some strenuous activity, and then it will kind of wane and subside.

And so sometimes people will then start to do a little bit less activity because they think, oh, that that made me feel a little uncomfortable. I won't push myself next time. Those are the ones that are kind of in the textbook that are that, you know, are kind of written about and well known and well recognized, but but they're really can also be what we kind of call atypical symptoms or kind of unusual ones. I mean, someone might have dizziness or lightheadedness. Women in particular have less of those textbook symptoms. They tend to, to have more somewhat vague symptoms. It can be, again, kind of abdominal discomfort, a little nausea, maybe even just some anxiety, more fatigue. It's less common, actually, in, in women that they'll have the classic chest pain radiating to their, to their arm or to their neck as their, as their presentation.

Yeah, I agree you were bringing back some great memories of when I used to work in intensive care, and I had a cardiologist that told me, this was decades ago already. He said, “women are not easy to figure out.” I think he meant that on a couple of different levels, but in particular relationship to the heart, he said. “You really have to dig deep sometimes to find out how they've been feeling, because they may not always verbalize everything, you know, those leading up to symptoms, um, things that happen so quietly.”

It reinforces the importance, too, that we have kind of a broad approach and that and that we don't dismiss symptoms just because maybe we don't think, “oh, well, that doesn't- that's not what a heart attack is, right? So it can't possibly be that.” Um, you know, it's very important to, to be open minded and to be, be concerned if you're feeling unusual symptoms that you're not used to and that are, you know, it's worth pursuing and, and seeking care and then finding out, um, because even, even from the physician standpoint, sometimes it's not always straightforward and it's not always clear. And we have to do a little bit of investigation as well.

Exactly. And my next question was going to be about signs and symptoms differ by age or gender. Well, I think you've helped us understand the female a little bit, but how about age? Does that ever play into sometimes how those symptoms can differ?

Age can play a factor in terms of changing the dynamics, of those symptoms and how heart disease can present. When you're younger, it's more likely to be the classic symptoms. But as we get older, it starts to, to shift to, to other symptoms. And part of that, it's not entirely just by age, but it's also a combination of other diseases that are present that complicate things, if you have arthritis and joint pains already, muscle pains. And you know, sometimes these things become more complicated, more difficult, to tease out what is new versus what is old and, so certainly as you develop additional medical problems, it does become more complicated. And unfortunately that does happen with aging.

Yeah. Makes sense. Makes sense. Okay. Let's talk about risk factors. What are some risk factors for heart disease? And again thinking about our population out here as we live rural, the farmers and ranchers you know, do those risk factors look different when you live rural?

So, I think some of the traditional ones that probably most people listening can guess are, you know, high cholesterol, high blood pressure, diabetes, overabundance of stress, for example, smoking being a very big one that, you know, we really can modify. So, I don't think it's, you know, a lot of things that people aren't used to hearing. But I think it's worth always reminding that these things aren't really happening by themselves, that they're working as a, as a unit to really give that additional risk. And I think that most people will know that, you know, these are things we want to look out for and try to prevent and treat these things. So, we can, for most of these traditional risk factors, address those. Now, of course, there are some that, you know, we were given and don't have a lot of say over. So, age is a big risk factor, you know, our genetics, our parents, you know, if we have heart disease in our family, that should give us a little bit of a red flag to pay a little bit more of attention. And we can't do very much about that. But there are a lot of things and including small things we can do to try to make our risk a little bit lower and, you know, sit there and just be a little bit healthier. And these things that we do aren't just for heart disease. They affect a lot of other diseases as well. So we're getting a really good, buy for our buck here when we start to do some of these small changes.

Right, right. Small shifts, small changes. And I was just going to talk about that. So what can a farmer and their family do to lower their risk? And really preventative measures, if you will, those small shift steps that they can easily incorporate into their daily life.

So I think one of them that we don't really think of is first getting in for that annual checkup in physical. I know that the world is very busy. I am so what I've done, just because I had a couple of years where I was struggling to manage that is, I do it right around my birthday. So I now have it built into my system that when my birthday comes up to make sure I schedule that appointment. It's, you know. Yes, we don't always want to give up our time to be able to go do these things, but it's nice to be able to think through that because they will, you know, take a look at all of these different risk factors so you don't have to forget about any of them. They'll take your blood pressure. They'll take a look at your cholesterol. They'll take a look at your blood sugar as well. So they kind of can give you an overall picture and really see how things are also changing over time. And most importantly, when you're looking at these things on a regular basis, we don't have to wait till it's a problem. The doctors are able to sort of see things as they're progressing and kind of head them off a lot of times in different directions, so we don't have to wait till it's something that you have to address in a very serious manner. And of course, David can jump in as the person in the hospital who's done more of these. And I don't work in a hospital, but these are some of the things, I think where you start is kind of doing that way.

And of course, there are some behaviors that we can do to keep these things down when we're not worrying about going into a physical. And I think that a lot of these, you know, are ingrained in people from what we think of. But I will say, and I always say the first one really is smoking. That's the one we got to kick to the curb if we can. We can just leave it at that. We all know that answer, but really, that's the first one. And then I think the other thing is, is just thinking about being a little healthier in small steps. One of the things we see in research is the people who are healthy in one aspect, all the other kind of habits trail along with them because you start feeling better and they just kind of build on each other. So you're not really taking on this mountain. You're really doing it in a, pardon the pun, but one step at a time, right? So as an exercise person, encouraging you to add small amounts of steps in, every step counts. That's kind of some of the small things. And I think particularly with farmers, with it being an active job and being a going and lifting things up and other things, people may assume that that's enough activity. And actually we find out that that's not always true, right? So we know that it's active, but are we really hitting enough that's going to kind of give us these health benefits. And one of the other things that we're learning a lot in research is, and maybe you've heard this, is that sitting is the new smoking.

And so just being up and about during the day isn't really addressing some of this sitting down for hours and hours. And of course, as somebody who works at a desk, it's a little bit of a more higher priority for me. But finding ways to kind of break that up and that can be as small as when the commercial on the TV comes up, just walking around a little bit, getting up and standing and stretching. Probably not going to the fridge for a snack, but thinking through some of these small things, I think that that's really a great place to start. And then lastly, of course, is and second important to smoking is we have to watch kind of what we're eating. And I don't think I need to tell farmers the importance of quality food, but I think I also need to reinforce that, you know, we're living in a diet where we're eating multiple things, and what they say now is eating multiple colors. So that'll help us get some of our fruits and vegetables. And so also teaching the eating habits, as much as you guys are providing all the food for us as well. So just really small nudges that are going to kind of build on each other. And when you do it, the rest of the family also learns and starts to do it as a group. And so it really does reinforce each other that way. So first it's, you know, just a little bit of a mindset shift. And so I think that those are some of the small steps. And I think David has more.

Eric, I think you've touched on a lot of great stuff there. Yeah, I just will reinforce that, right we have, we have non-modifiable risk factors that as this, as said, you know, we can't change and that's, that's our family. That's how old we are. That's, you know, our genetic makeup. But, but a lot of things are fall into the modifiable bucket and we can change. And so you know diet and physical activity are, are really important. And what we're seeing, you know, in society unfortunately in America is that obesity is just, you know, becoming astronomical in terms of its rise and, and, and its prevalence. And so it's just so important- just reinforces that, you know, overall, as a society, we're just not eating as healthy as we should be. We're not being as active as we should be. And so, trying to maintain a healthy weight is, is really important. Some of the classic risk factors is, as Eric noted, things like having high cholesterol or, watching your blood sugar, having high blood pressure. I mean, these are modifiable. But as you said, you have to go to the doctor often to both be diagnosed and then often get medication to treat them. So although some of these things we can do ourselves, cooking healthy food, you know, getting physical activity. We can do those ourselves. There are things that it is. That's why it is so important to go see that doctor once a year, at least check in, see, see how those things look. And see if there's anything that might need a little bit of, of additional help with, with medication, potentially, so.

And in today's farming world, we have great GPS lighting. We've got comfortable seats in our tractors now to sit, so you can sit for long hours. And I push our guys on the farm quite often. I said, you take your water jugs with you to hydrate. Well of course, then that means they have to answer to biology. But you know what? I think that's okay, because then they get out of that seat, they get out of the tractor, go walk around for a little bit, stretch the legs and get in just a little bit of exercise.

I’m just going to reinforce that, that's actually important. That actually has been studied uh, in terms of looking at heart health among, among farmers - that the modern farmer, as you said, is different than maybe the one that the non-farming community kind of thinks of in that traditional sense of, you know, of, of 40 or 50 years ago, like you said, with all the technology and GPS and, and all the automation now that's occurring on the farm. Right. There's a lot less actual physical activity occurring than decades ago. And so it's important that just because you're up and maybe walking around or getting up and down, that doesn't necessarily kind of qualify as really getting physical activity. I mean, when we talk about getting physical activity, recommendations are that you're doing something strenuous enough to break a sweat and breathe heavy for 30 minutes at a time, multiple times a week. So, if you didn't do something that was making you making you, physically that tired then, then it's probably not quite enough. And we should be thinking about doing some more.

Exactly. And when you live rural, you don't have that gym that you can go to. So what do you do? Well, we can walk.

And I think one more point is, is that with physical activity, we really know that you have to build it into your life, right? So if you're busy on the Monday to Friday and you can only do the weekends, we've actually seen some research about this trend there called the Weekend Warrior, right? Where they can't exercise every day, but they can get it in the same number, the same miles, whatever it be, same lifting on the weekend. And they still get significant benefit. In fact, it looks like they're getting almost the same benefit. So it really is trying to do it in a way that you can do it and not really worrying if, oh, if I can't do it today, just again, this healthy lifestyle and doing it when you can really does seem to be providing some health. And so some is, some is still good even if you can't make that high mark.

Like you said, start small and eventually it just builds on itself, which is, is really exciting. Okay, so a question I get quite often from the people in my area about home blood pressure monitoring devices, I'd like your thoughts about them and some of the best practices to self-monitor your blood pressure, and then the importance that that information plays when you go in to talk to your health care provider.

So there is a wide range of, of blood pressure monitors available on the market. I'm not going to make any specific recommendations about a brand or anything of that nature. But I would say that the classic blood pressure cuff that you think about on your, on your upper arm is, is still the, the way to go. Sometimes these machines do need to get recalibrated. After a few years they, they do lose a little bit of their, their sensitivity. But checking blood pressure at home is fantastic. It's, it's a great way to, to make sure that you're getting the effect hopefully either from the medication or from your, from your change in your lifestyle that you want. One thing I do recommend to people is that it's important to check your blood pressure at different times during the day.

Blood pressure naturally fluctuates throughout the day, so if you only check it in the morning when you wake up, you'll essentially only have a time, you’ll only have a snapshot of what your blood pressure looks like in the morning. You'll have no idea what your blood pressure is like throughout the day. And so it could be normal when you wake up. And you may be having high blood pressure all day long and you never know it. So it's actually important to check it at different times throughout the day. It could be very burdensome to have to check it multiple times in a single day. So, you know, maybe morning one day and then the next time you check it, check it in the afternoon, check it before bed one night, you know, etc. just kind of mix it up and then over time, you'll get a nice spread and a kind of nice sense of kind of where your blood pressure tends to be.

Yeah. Good deal. So, you know, they log this information, and I would suggest that they put the time of day, they took their blood pressure and then just bring that in and sit down with your health care provider. That is a key part of their daily home care. Right?

Absolutely.

Okay, so let's say you're working on the farm and someone that you're working with is starting to show signs or symptoms or start complaining of maybe there's a heart attack, some kind of related event going on, what should that coworker do or be prepared to do?

Yeah, I think the number one thing, if you think someone's having a heart related emergency, first thing is just call 911. So immediately just seek medical care, let somebody know where you are and let the paramedics get on their way to you. It's important, you know, because time is, is critically important in, in many of these emergencies. And so you want you want them there as soon as possible. Paramedics bring ways to detect what's going on with you. They bring medications with them that they can start before you get to a hospital. So, so that's why the, having the paramedics are so important. What I can't stress enough is that do not, even if you're at home or sitting in your car when it happens, do not, drive yourself or a family member to the hospital. It's just not recommended. First of all, something could happen in route that could be tragic, and you don't want something to happen.

But like I said, it's really just- it's really just losing time. Because if you show up at the hospital, you think, “Oh, well, I'm just going to go very quickly.” The hospital is really not prepared. Doesn't know you're coming. They're not prepared for you. And so you have to go through all the, the typical check in procedures at the hospital. It can be, it can be slow. Whereas if those paramedics, not only have they evaluated you and potentially started treatment for you as soon as they get to you, and then on the way, they're communicating with the hospital and they can let them know. For example, if you are having a heart attack, let the hospital know and so that they're ready and ready to receive you immediately and transition and transition your care. So overall, things actually happen much faster. If you're having an emergency, if you arrive by the paramedics than if you show up yourself or bring in a family member who's, who's having that emergency.

I think one thing on the less medical side, and especially that I dealt with my father on what I called more of a petting zoo farm. It was definitely a non-producing farm, was to take it seriously. This is not something you want to shake off. This is not an ego thing. This is. “Oh, it's just a little indigestion.” You are much better off going and being told, “Oh, this wasn't what you thought it was,” then the other way around. Because that's kind of a much more, you know, a worse outcome, especially depending on how it goes. So take it seriously. Believe people. And then really just say, okay, this is worth checking out. Like, “I am worth this time and energy,” to step back and to check it out. And that took a little bit of convincing even for my father, but I think he finally figured it out at some point. So that would just be my recommendation from a less medical side, obviously.

Oh, there's truth in that one… I'm curious as to your physician's thoughts on community CPR classes and the importance of taking those.

I think of CPR is really just, I mean, it's, it's essentially just an extension of first aid. It's a, it's a basic skill, like doing the Heimlich as well and things like this that we would like everybody to know and to be able to do… Because, in those situations where no CPR is provided, there's just very little chance at all of any, any meaningful outcome. And so CPR is really the just the, the only chance we have, uh, at giving people, giving people a chance… And again, it's just buying that time, until the paramedics can, can arrive. But all the help we can give people that when that happens, it will be appreciated.

All right. Is there anything else that you two would like to add to the conversation?

Well, I think the last one is this was not meant to scare anybody. This was kind of just a way of bringing it to our attention, so we don't just put it off here to the side. And to remember that we often think of heart disease as only affecting us. Right? It's our medical condition. But to remember that it's really affecting our family, our friends, those around us, we know that when we have parents or friends who have heart disease, how that's affecting us. And not to forget that this stuff and taking care of yourself is taking care of your family and friends as well.

If something isn't, doesn't feel right, like we said, go seek a physician and medical care, and, and find out what it is. The sooner, the sooner something is diagnosed, usually the, the better outcome we can have in terms of, of, of treating it. So, if we wait until late and things get much more, much more far along and more severe becomes a very difficult, if impossible sometimes to, to reverse or correct things. So.

Exactly, exactly. Well said, both of you. Thank you, thank you, Doctor Eric and Doctor David for your time today and all of your work that you're doing to help us to have healthy hearts and, and really healthy lives. Thank you.

Thank you for having me.

Thanks for having us.

Okay folks, that’s it for today. Thank you again for tuning in to another episode. Be sure to subscribe to this podcast to hear more from AgriSafe on the health and safety issues impacting agricultural workers. If you’d like to suggest topics, or have a story you’d like to share, contact us by email at info@agrisafe.org, and title your email “TTFH Podcast.” You can also get our attention by using the hashtag "TTFHpod" on Twitter! To see more from AgriSafe, including webinars and our newsletter, visit www.agrisafe.org.

This episode was created by AgriSafe Network, directed by Laura Siegel, hosted by me, Linda Emanuel, edited by Matt McKenney for ProPodcastingServices.com, with special guests Dr. David Schopfer and Dr. Eric Shiroma.