NBC Anchor, Tim Russert, Died of Heart Disease Dispite A Normal Exercise Stress Test? ~ Dr. B. Interview

Doc B. returns with comments on heart disease, pharmacological stress tests and the recent unexpected death of Tim Russert.

L.P.: What is the latest on NBC anchor, Tim Russert's sudden death from heart disease?
Doc B: His heart doctor, Dr. Oz was on Larry King. Dr. Oz explained that with heart disease, you can never really tell in advance how to prevent it. What are the odds that Tim could have done something different? Dr. Oz explained that "Of the 450,000 people a year who die of heart attacks in this country, probably half of them never knew they were at risk of a heart attack. It's because the heart doesn't really have pain fibers. In fact, the only reason you ever feel any pain when you're having a heart attack is because the nerves in the heart cross other nerves -- from your chin, your arm or from the chest and the spinal column. And they short-circuit each other out. And that creates this referred pain that in cardiology and cardiosurgery we recognize to be angina."

L.P.: If the plaque is not limiting blood flow is that really such a big problem?
Dr. B: Dr. Oz also explained this issue pretty clearly, "... this is a big wake-up call for a lot of Americans, as well -- is that a lot of the plaques that we have are not flow limiting. And by that I mean they don't cause a limitation on the amount of blood that courses through the veins that go to our heart.... "

L.P. : How did that cause the death of Tim Russert?
Dr. B.: Based on what I have read, Tim had a cardiac arrest. It was probably an acute dissection, rupturing plaque that's causing a blockage of a coronary artery. The temporary blockage caused a heart attack -- a fatal arrhythmia.

L.P. Did they try to save Russert?
Dr. B. Dr. Michael Newman told Larry King that a defibrillator, a heart-shocking device, was unsuccessful in saving Russert. "
L.P.: Can't stress tests determine the condition of a patient's heart?
Dr. B.: After releasing autopsy results, Dr. Michael Newman said Russert had passed a stress test on April 29. He had even worked out on a treadmill the morning of his death.
"Russert, age 58, was known to have asymptomatic coronaryartery disease (atherosclerosis), which resulted in hardening of his coronary arteries," Newman said. "The autopsy revealed an enlarged heart and significant atherosclerosis of the left anterior descending coronary artery with (a) fresh clot which caused a heart attack resulting in a fatal ventricular arrhythmia."

L.P.: Did Russert have any symptoms?
Dr. B.: As I understand it, Russert's stress test on April 29 was "normal." Dr. Newman said. "At a high level of exercise he had no symptoms." Newman said Russert's blood pressure and cholesterol were "well-controlled." see http://www.people.com/people/article/0,,...

L.P. : Which is better, pharmacological stress testing or exercise stress testing?
Dr. B.: Imaging tests are more sensitive than the exercise ECG in the detection of severe (three vessel and left main) disease . . . the sensitivity for severe disease was 93 to 98 percent with planar thallium imaging, stress echocardiography, and SPECT perfusion imaging compared with 86 percent for exercise ECG testing. Furthermore, it you have arthritis or are in poor physical condition, you may not be able to exercise at a high enough level to adequately stress your heart without the pharmacological agent.

L.P.: What is the best nuclear pharmacological stress test?
Dr. B.: The modern nuclear pharmacological testing of choice is rapidly becoming the Adenosine stress test. The test can help determine if there is adequate blood flow to the heart during activity versus at rest. Adenosine does not increase your heart rate. Adenosine dilates blood vessels leading into the heart, increasing blood flow, therefore simulating exercise for patients unable to exercise on a treadmill. It is the fastest acting pharmacological agent and while it may produce symptoms of shortness of breath, within seconds of discontinuing the Adenosine, the symptoms almost always stop.

L.P.: Are there any contraindications to using Adenosine.
Dr. B.: The only major restriction is not to use Adenosine if a patient is actively wheezing with Bronchial Asthma. If the patient is not actively wheezing, most facilities such as the Cleveland Clinic will go ahead and proceed with an adenosine stress test despite the patient having a history of asthma. Some will opt to use a Dobutamine stress test instead if the patient does not have tachycardia (fast heart rate) or hypertension (high blood pressure.) The Journal of Nuclear Cardiology 2007 14:827-34 has reported a new study that 6 minute Adenosine infusion can be safe in patients with mild asthma or COPD. In my opinion, it really is a judgment call for the physician based on his training and experience with no wrong answer.

L.P. What is the best advice to reduce your chance of heart disease?
Dr. B: Exercise. Eat a low fat diet. Keep your cholesterol level low. Keep your blood pressure low. If you have diabetes, keep your sugar levels under control! Have regular check up with your doctor. And, last but not least, do not smoke!

L.P. Thanks, Dr. B.

Disclaimer: This article should not be used as a substitute for medical advise or treatment. As always, if you need medical treatment or advice, immediately consult your physician.

Want to Marry a Rich Man? Dye Your Hair Brown ~ by Blond Bombshell

Men must think women sit around just dreaming of marrying a rich man. Why else would they do research and write stories revealing that 62 percent of billionaires have wives with brown hair. Who cares? Certainly not me! So, am I supposed to dye my hair brown because Microsoft head honcho Bill Gates' wife, Melinda French Gates is a brunette? Sorry, Melinda, you can keep him.

The study goes on to say that only 22% of billionaires wives were blond and only 16% were raven-colored hair. No billionaire was married to a redhead. Like we should panic. Hey girls, before running down to the salon to dye your red roots, why not just accept the fact that you may be stuck with a multi millionaire instead of a billionaire? Believe it or not, this is not the first totally worthless study on the subject. In 2004, Florida State University determined that men prefer long, thick and brown hair on women. Why? Sexist egg heads claim it's biological. Men are "programmed to find a fertile mate"according to Dr. Kelley Kline. (Kline would be more enlightened to state that men are programmed to have sex. Men typically take the path of least Resistance which is the quickest way to satisfy their own selfish desires.)

Kline opines that long, thick hair is a signal that a woman is strong, young and healthy. (Dr. Kline, perhaps by your way of thinking I should neglect to shave my arm pits and legs. Let me give you a hint: the way to attract a man is to show cleavage and interest in him.) This expensive study also thought it prudent to study hair length. Both men and women found long hair to be "overwhelmingly" more attractive than the short or medium-length hair. (Kind of refutes the theory of biological programming to breed when it comes to other women, don't you think doc...) The FSU study concludes that neanderthal pigs consistently prefer brunettes over blondes. "At least in our study, gentlemen do not prefer blondes. They prefer brunettes," Kline told Reuters.

Dr. Kline, who cares? A woman's appearance should be based on her own preference and not based on how to best attract a man. Otherwise, all a woman needs to do to attract a man is to hold up a sign that she is ready, willing and able.

Ms. Calabaza Makes A Guest Appearance to Supply An Urban Myth of A Legendary Cross Examination

Urban myths exist in every profession. Ms. Calabaza supplies us with a classic attorney police officer cross examination which has probably been told at each police academy for several decades. While the whit is worth reading, like Surfer Dudes story of the lawyer who smoked cigars and then filed an insurance claim for fire loss (LINK) it is an urban myth that likely never happened.
Q: "Officer -- did you see my client fleeing the scene?"

A: "No sir. But I subsequently observed a person matching the description of the offender, running several blocks away."

Q: "Officer -- who provided this description?"
A: "The officer who responded to the scene."

Q: "A fellow officer provided the description of this so-called offender. Do you trust
your fellow officers?"
A: "Yes, sir. With my life."

Q: "With your life? Let me ask you this then officer. Do you have a room where you change your clothes in preparation for your daily duties?"
A: "Yes sir, we do!"

Q: "And do you have a locker in the room?"
A: "Yes sir, I do."

Q: "And do you have a lock on your locker?"
A: "Yes sir."

Q: "Now why is it, officer, if you trust your fellow officers with your life, you find it necessary to lock your locker in a room you share with these same officers?"
A: "You see, sir -- we share the building with the court complex, and sometimes lawyers have been known to walk through that room." The courtroom EXPLODED with laughter, and a prompt recess was called.


Ms. C., thanks for the contribution. Actually, Abraham Lincoln's story of not ever asking a question that you don't know the answer to is equally funny and actually true. Lincoln was cross examining a witness and asked questions similar to the following:

Q: It was dark and you were actually 500 feet away from the victim when the alleged attack occurred, correct?

A: Yes.

Q: Now you did not actually see the defendant bite off the victim's nose, did you?

A: No sir. ( He should have stopped here!)

Q: Then how can you come into the court room so confident that the defendant did it?
A: Because I saw him spit it out!

Growing old has now been set to video music: LINK

Shock Art Judge Alex Kozinski Pauses the Ira Isaacs Obscenity Trial While the Judge's Website is Reviewed ~ by Legal Pub

When does art constitute pornography? Judge Alex Kozinski may not be the one to decide since he has granted a joint motion to suspend the Ira Isaacs "shock-art" trial after the prosecution requested time to look at the judge's Web site. The jury is to return on Monday. (Judge Kozinski is in the first photo.)

So far the jury has seen several hours of videos depicting bestiality and extreme fetishes.
Judge Kozinski is chief justice of the 9th Circuit but is serving as a trial judge in the obscenity case of Ira Isaacs. Isaacs allegedly produced and sold movies depicting bestiality and sexual activity involving feces and urine. His own attorney, Roger Jon Diamond, finds it disgusting but argues that it is a constitutionally protected form of art.

Information on the judges site can be found at: LA Times: Judge has sex site?
Additional coverage of the trial can be found at: " Watch more on the art vs. porn debate »

Isaacs is 57. He is a Los Angeles advertising agency owner. He calls himself a "shock artist." He claims that he is, "...fighting for art." He plans to testify as his own expert witness. One can expect a rehash of previous obscenity battles involving authors James Joyce and D.H. Lawrence.
Isaacs argues that his art has therapeutic value for people with fetishes depicted onscreen.

At times, Isaacs sold as many as 1,000 videos a month at $30 apiece. The FBI then shut him down. An indictment was issued against Isaacs on a variety of obscenity charges, including importation or transportation of obscene material for sale. Such prosecutions have become more common since the U.S. Department of Justice Obscenity Prosecution Task Force was created.

The test of obscenity still hinges on a 1973 U.S. Supreme Court ruling that held that a work is not legally obscene if it has "literary, artistic, political or scientific value."
Each of the four counts against Isaacs carries a five-year maximum prison sentence. Isaacs could also be ordered to forfeit assets obtained through his video sales. Similar cases are likely to be brought against others if Isaacs is convicted.

It seems that if people did not purchase the porn, there would not be a market for its production. A market place of moral consumers would greatly reduce the perceived problem. However, one can not help but observe that under the 1973 definition, much of what our politicians say and do could be declared obscene since it lacks "literary, artistic, political and scientific value." In this day and age of scrutiny, jokes that may once have been considered humor no longer produce as many laughs...

Taylor Paschal-Placker and Skyla Whitaker Executed in Rural Oklahoma ~ by Legal Pub

Taylor Paschal-Placker, 13, and Skyla Whitaker, 11, lives were needlessly taken this week. Both girls were found shot to death in their rural community, along a dirt road. These two friends often used this road to play and to walk to sleepovers. Peter Placker, Taylor's grandfather, found their bodies after Taylor did not answer her cell phone.

The girls were sleeping over at Taylor's house. They decided to walk down the road Sunday afternoon. Peter Placker found the girls' bodies about a quarter of a mile from his house near Weleetka. The girls were each apparently shot multiple times in the head and chest. A $14,000 reward was being offered for information about the killings. Please help authorities bring their killer to justice.

Update 8-14-08: Skyla's autopsy indicates that she was shot eight times in the neck, arms, shoulders, chest and abdomen. There were two different caliber bullets.
"There is one damaged copper coated bullet appearing to be small in size (gunshot wound #8, neck) and [a] damaged copper jacketed bullet appearing to be medium in size (gunshot wound #5, [chest]), recovered," according to the autopsy.
Taylor's autopsy details five separate gunshot wounds to the face, groin and hand.
"The two gunshot wounds of the left side of the face are individually potentially fatal... The gunshot wound of the right cheek may not be fatal with prompt medical intervention. The gunshot wound over the left groin is potentially fatal. There is entrance gunshot wound perforating the right third knuckle and finger with compound fracture."

Acanthamoeba Keratitis From Contact Lens Solution? FDA To Intensify Investigation While Lawyers Prepare Class Action Suits? ~by Legal Pub

Contacts are suppose to help improve one's ability to see. Multipurpose contact solution is suppose to make it more convenient for 34 million Americans to enjoy clearer vision. However, federal regulators are likely to mandate stricter testing requirements for contact lens solutions because two popular formulas have been linked to eye infections. The Food and Drug Administration is considering proposals aimed at improving the safety of solutions. But will the FDA go far enough?

New testing standards for contacts and updated labeling are likely to include instructions to gently rub lenses during the cleaning process. (Will Optometrists also be sued for not instructing their patients to do so?)

Multipurpose solutions effectiveness has been questioned since Bausch & Lomb and American Medical Optics removed their products from the market in 2006 and 2007 after an outbreak of eye infections. The Centers for Disease Control and Prevention concluded that Bausch & Lomb's MoistureLoc solution played a key role in 180 Fusarium keratitis fungal infections. (This infection can cause blindness.) Bausch and Lomb and the FDA want to ensure that the current product, Renu Multiplus, remains safe. Renu's labeling does not currently advise patients to rub their contacts. The FDA will decide if such labelling should be mandated. The FDA will also decide whether solutions should be tested against a wider range of bacteria. (Acanthamoeba keratitis is not currently among the bacteria and fungi FDA requires products be tested against.)

Dr. Elmer Tu, professor of clinical ophthalmology at the University of Illinois at Chicago, reports that infections have continued despite AMO pulling its product off the market. He believes that competing products may also be susceptible to the same type of infection. "If the outbreak is continuing and the current solutions are not working than there needs to be more research into how to reduce that risk," explains Dr. Tu.

In the mean time, T.V. ads encouraging contact wearers to contact the advertising law firm to join in possible class action lawsuits. What do optometrists have to say about potential litigation? So far, most have remained silent...

Peering Through Obama's Window of Opportunity Reveaks That The Electoral College Will Determine Our Next President- by Legal Pub

During an electrifying speech to a fifth grade class last year, the process of how our President is elected became a focal point of heated discussion. "Popular vote does not necessarily win the Presidential election," I tried to explain. "Electoral college? My dad says that is a bunch of nonsense," said one fiery eyed young Democrat in training. But the fact is, the magic number for Obama is 18. Obama needs to add 18 electoral votes to the 252 won by John Kerry four years ago. If he does, he will be enjoying one heck of an inauguration.

How likely is it that Obama picks up 18 electoral votes? Peering through Obama's window of opportunity, the answer is apparent. If Obama wins Iowa (7) and Missouri (11) without losing any Kerry states, Democrats are dancing on the White House Lawn. Even more likely states for Obama may be Florida, Ohio, New Mexico, Nevada, and Colorado. Another strong possibility is winning Virginia, which Democrats typically do not win.

On the other hand, McCain will try to target Pennsylvania, Michigan, Wisconsin, Minnesota, Oregon, and New Hampshire which voted Democratic in the last election. If McCain loses Nevada, New Mexico and Iowa (all Republican states in 2004), then McCain and Obama would tie at 269 electoral votes. In the case of a tie what happens? The House of Representatives votes, with each state delegation having one vote. Since Democrats control more state delegations than Republicans, Obama wins. Will we have a President elected who does not win the majority of the popular vote? It may all depend on who each candidate selects as their Vice Presidential running mate. So far, neither side has contacted Legal Pub...

Update 11-6-08: Barack Obama wins in a near electoral landslide!

U.S. President - Electoral College
Obama (D) - 349
McCain (R) - 147 270 votes needed for presidency

Popular vote - 48 states reporting

McCain (R) 46% 55,386,310
Obama (D) 52% 62,443,218
Barr (I) 0% 480,180
Nader (I) 1% 641,044