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Executive Health: A 194-Year-Old Lesson

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Maybe you do not have it on your calendar but I have it on mine. Today is an important day in Michigan and U.S. medical history. In fairness, I just returned from a trip to Mackinac Island to speak to the Michigan Policy Conference on executive health (http://www.youtube.com/watch?v=ZzhZx1lDaqo&sns=em). On June 6, 1822 a young fur trader, Alexis St. Martin, was shot in the stomach when a musket accidentally discharged. He was cared for by an Army surgeon, Dr. William Beaumont. St. Martin survived albeit with a hole in his stomach providing a window into the digestive process (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1921378/).

At the time, a debate on whether digestion was mechanical or chemical (acid) was ongoing. Beaumont was able to study the issue by observing and testing the process in St. Martin, proving acid was the key agent. Beaumont went to be known as the father of American gastric physiology. The hospital system I work at is named after him and the cafeteria is the Mackinac Room (www.beaumont.org).

A less well known aspect of the long relationship between Beaumont and St. Martin was the end of their days. St. Martin lived for 58 years after the accident, dying in 1880 (http://www.mysteriesofcanada.com/quebec/alexis-st-martin-bidagan/). Unfortunately Dr. Beaumont did not fare as well, dying in 1853. In addition to my hospital system, his scientific contributions were honored with the naming of an Army medical center after him as well as other institutions.

How is it that the Army executive surgeon Dr. Beaumont died decades before St. Martin, who had to deal with a fistula in his stomach all those years? Their different lifespans are a springboard to highlight the toll that "executives" may experience in terms of health. One need only search executive health on the internet to identify programs at almost every major medical center catering to the health assessment of executives. While this may be in part economically motivated, there is at least some evidence that executives do suffer from unique health risks and outcomes (http://www.ncbi.nlm.nih.gov/pubmed/27206130). Special testing if often incorporated into the "executive physical" even when not supported by medical evidence (http://www.ncbi.nlm.nih.gov/pubmed/27098425). I have written before about the need to replace the executive stress test with more accurate means of detecting silent and potentially lethal vascular disease (http://www.huffingtonpost.com/joel-kahn-md/rip-the-executive-physical-exercise-test_b_6903350.html).

June 6 can serve to remind executives that they are at risk for early disease and death due to stress, poor diet, sitting, sleep and lack of time to exercise. The solution has to be focusing on a multifaceted lifestyle, something I call Vitamin L, or "Lifestyle." This is supported by studies that demonstrate an 80% reduction in chronic diseases like heart disease and adult diabetes by simple lifestyle steps crucial for the executive, and others, to adhere to.

Research indicates the lifestyle that executives should pattern their lives after. For example, in 2013, researchers in the Netherlands studied almost 18,000 men and women without heart disease (http://www.ncbi.nlm.nih.gov/pubmed/23823570). They followed them for up to 14 years, and in that time more than 600 of the group had heart attacks, including fatal ones. They found that if people followed four steps they were able to lower their risk of heart attacks by 67%: averaging 30 minutes a day of physical activity, eating a healthy diet in the Mediterranean style rich in fruits, vegetables and whole grains, not smoking, and enjoying more than one alcoholic beverage a month. People who added a fifth health habit -- sleeping seven or more hours at night on average -- lowered their risk of heart attacks by 83%.

After the ideal of preventing chronic disease in executives, the next imperative is to detect silent disease, particularly silent heart disease. In most communities a direct examination of heart arteries using a coronary artery calcium scan (CACS) with a fast multi-slice CT scanner. No contrast or IV injection is used and the test takes about 1 minute. The amount of radiation exposure is certainly higher than a chest X-ray, but it is 1/10th or less than that of a cardiac catheterization or a stress nuclear perfusion scan. The American College of Cardiology has given a high endorsement (IIA) to the use of coronary artery calcium scans in persons with known risk factors for silent coronary disease (http://www.acc.org/about-acc/press-releases/2014/03/30/17/22/cac-pr).

Heart disease remains the number one killer for men and women alike in the US, and it is time to perform direct arterial examinations like CACS for at-risk or older patients, roughly every 7-10 years as part of a routine wellness exam. In this regard, we can think of CACS as the "mammogram" of the heart. Combining it with recent studies showing that half a dozen or so lifestyle habits prevent 80-90 percent of heart attacks should leave our CCUs empty and extend the lives of so many who erroneously think their hearts are healthy. We can use the anniversary of the meeting of Dr. Beaumont and Alexis St. Martin, and their strangely different lifespans, to be certain we are focusing on health and prevention, in executives, entrepreneurs, and those at excessive stress.