T

he battle for heart health isnt easy. We need

all the help we can get. One of your primary
partners in this challenge should be your doctor,
who ideally is there not only to treat symptoms,
but also to provide a specic plan to follow, along
with continuing guidance and support along the
way.
A good doctor is not only a healer, but a
mentor, a friend, and even cheerleader as you ght
heart disease or other medical problems. At least
thats the way it used to be.
Unfortunately, that kind of care has mostly gone
the way of house calls. Changes in the medical
insurance industry have eroded a healthcare system
that was once the envy of the world.
The enactment of the Afordable Care Act, also
known as ObamaCare, will only speed this decline
by pushing millions of uninsured Americans into a
system that is already bulging at the seams. I see the
results of this growing crisis every day.
But dont give up; you can still get good medical
care. You just cant stand by and assume that it will
happen, though. Patients have to be proactive!
In this months issue of the Heart Health Report,
Ill ofer a behind-the-scenes look at what goes on in
your doctors ofce, and tell you what you need to
know to get the best care possible.
1. Prepare Before Seeing a Doctor
Thanks to healthcare reform, reimbursements
from health insurers and federal programs such as
Medicare and Medicaid have shrunken drastically
and theyre getting smaller every year.
The result is that doctors are paid less. To
compensate, they feel pressure to see patients as
quickly as possible.
It doesnt matter how compassionate your
doctor is; this is simply the harsh reality of our
current healthcare system.
In the past, I could spend an hour or more with
each new patient, establishing a relationship that I
expected to last a lifetime. Nowadays, such a thing is
unheard of.
Typically, the rst visit now lasts just 30 minutes,
and the usual half-hour follow-up is telescoped to
between ve and 15 minutes.
What this means for you, as the patient, is
that you must be fully prepared when you go to a
doctors ofce. Dont waste precious time hunting
for forms or trying to recall the names of the
prescriptions you take. That way, there will be more
time to allow the doctor to get to know you, so he
or she can better treat your medical issues.
Get to Your Appointment Early ......................... 2
Compile an Inventory of Medications .............. 2
Make a List of Your Health Concerns ............... 3
Maintain a Personal Medical File ....................... 3
Consider Paying Cash .......................................... 3
Case Study: Socialite Worried Sick .................... 4
Quick Takes: Vitamin D From Mushrooms ..... 6
Ask Dr. Crandall ................................................... 8
In This Issue . . .
9 Tips to Make the Most
Of Your Doctor Visits
Vol. 4, Issue 7 / July 2013 By Chauncey Crandall, M.D.
2 July 2013 drcrandall.newsmax.com
Here are some ways to maximize the time your
doctor has to spend with you.
2. Be on Time Or Early
Each time you see your doctor, plan to get to the
ofce at least 15 minutes early (30 minutes if youre
a new patient).
Why do you need so much advance time?
Because every time you go, you will be asked to
sign in and also probably verify your insurance
information. If you arrive late, you can throw the
doctors schedule of for the rest of the day.
Arriving early also gives you time to relax and
prepare yourself for the visit. Theres nothing like a
last-minute rush to cause a spike in blood pressure.
Another tip for new patients: Make sure you
know how to get to the doctors ofce ahead of
time, and even where to nd parking. These kinds of
unexpected delays ofen lead to patients showing up
late and throwing schedules of.
This information is usually furnished on the
doctors website. You can also get it by calling the
ofce for directions.
3. Compile an Inventory of Medications
Your doctor needs to know what medications
youre on in order to make any prescription
changes or check for interactions between drugs.
The best thing you can do is make out a list of the
medications you take, including both prescription
and over-the-counter drugs, in advance of your visit.
Be sure to note the dosage, as well as how ofen
you take them. Supplements count, too.
If you have a smart phone, you can easily put
the information on it, so youll have an updated list
when you go to the pharmacy.
For my elderly patients, I advise them to sweep
all of their meds into a bag and bring it to the ofce
along with them. Too ofen, they keep expired
medications that really should be discarded. I have
my nurse help them go through the vials so they
return home with only the drugs they really need.
4. Have Your Current Health
Insurance Card
Be sure to keep track of your most recent health
insurance card, and present it to your doctors
receptionist at every visit. You should be aware that
sometimes insurers will mail a new card with a new
number even if you havent switched carriers.
Heres what they wont tell you, but I will:
Insurance carriers thrive on creating confusion. If
your medical form has the wrong number on it,
your insurer may very well refuse to pay, and refer
the bill back to you.
Sometimes, these claims are never paid. In that
case, the insurance company wins and you may be
lef holding the bag for the charge. Worse yet, you
might not even nd out about it until the debt is
turned over to a collection agency and damages
your credit rating.
health
Please note: All informaton presented in Dr. Crandalls
Heart Health Report (including answers to reader ques-
tons) is for informatonal purposes only, and is not spe-
cifcally applicable to any individuals medical problem(s),
concerns, and/or needs. No content is intended to be a
substtute for professional medical advice, diagnosis,
or treatment. All informaton presented in Dr. Crandalls
Heart Health Report should not be construed as medi-
cal consultaton or instructon. You should take no acton
solely on the basis of this publicatons contents. Readers
are advised to consult a health professional about any is-
sue regarding their health and well-being. Any acton you
take on the basis of the informaton provided is solely at
your own risk and expense. The opinions expressed in Dr.
Crandalls Heart Health Report do not necessarily refect
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For rights and permissions, please contact the publisher
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Fill Out Forms Ahead of Time
Some doctors provide new patents with website
pages where they can sign in and fll out such forms
as their medical history and insurance informaton
which you can then take to your frst ofce visit. Take
advantage of this tmesaver if it is available.
You may also be ofered a form to fax to your
previous doctor so that your records can be
transferred to your new doctor. This is not foolproof,
however.
Ill tell you how to assemble your own portable
medical fle on page 3.
July 2013 3 newsmaxhealth.com
5. Bring a List of Your Concerns
And Your Spouse
Dont rely on your memory alone during your
visit. Write down all the questions you have for
your doctor before going to the ofce. Remember,
the days of frequent, unhurried follow-up visits or
phone calls are gone. So make the time you spend
with your doctor count by knowing what you are
going to ask ahead of time.
That doesnt mean taking an endless list of
concerns, however. You want to prioritize so the
majority of the time is spent talking about the
things that concern you the most.
In addition, its ofen better to have two sets of
ears. Many people become nervous when they see
a doctor, and might forget what they are told. A
spouse, adult child, or a trusted friend can take notes
and remind you of important points aferward.
Make sure that one person is the designated
speaker and one is the listener in order to avoid
confusion and keep the visit from dragging on too
long.
6. Maintain a Personal Medical File
Have you ever asked a specialist doctor to send
a lab report to your primary care physician, or vice
versa, and it just never happened? Or your doctors
ofce is supposed to call with test results, but youre
lef waiting by the phone?
Let me to tell you a secret. In many ofces, the
staf member who used to handle those kinds of
tasks isnt there anymore. Healthcare cutbacks are
not only afecting hospitals, theyre afecting doctors
ofces too. Many have been forced to downsize their
stafs.
The result is that you can no longer rely on your
medical records being faxed from doctor to doctor.
Years ago, patients were not allowed access to
their own medical les or test results. But this is no
longer true.
Whenever you undergo a test, you should
request a copy and keep it on le in your home. This
not only helps you keep better track of your blood
pressure, cholesterol, and blood glucose numbers
for example but also allows you to take your
own les to the doctors ofce, particularly if you are
seeing a new doctor.
Look at this as a proactive way of putting your
health in your own hands literally.
This also holds true if youre having tests done
at a Veterans Administration (VA) hospital. Dont
assume there is any connection between that facility
and your doctors ofce; get a copy of your records
and bring them to your personal doctor.
In these days of Internet access, you would
think this would not be necessary. But in spite of
the technological advances, medical record-keeping
remains cumbersome.
7. Consider Paying Cash
If youre self-employed, you may decide to
change insurance carriers if your premiums go up.
But if youre covered through your employer, this
change may be made for you. In fact, because of the
About Chauncey Crandall
Chauncey W. Crandall, M.D.,
F.A.C.C., is chief of the cardiac
transplant program at the
world-renowned Palm Beach
Cardiovascular Clinic in Palm
Beach Gardens, Fla., where
he practices interventional,
vascular, and transplant
cardiology. Dr. Crandall
received his post-graduate training at Yale University
School of Medicine, where he also completed three
years of research in the cardiovascular surgery
division. He lectures nationally and internationally on
preventive cardiology, cardiological healthcare of the
elderly, healing, interventional cardiology, and heart
transplants. Known as the Christian physician, Dr.
Crandall has been heralded for his values and message
of hope to all his heart patients.
Continued on page 5
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IMPORTANT
4 July 2013 drcrandall.newsmax.com
Heart Disease Worries a Socialite Sick
Heart Health Case History of the Month
In each issue, I will share with you the story
of one of my patients, detailing how making
changes to your life can radically improve your
heart health. Names and some details have been
changed for privacys sake, but the problems and
their resolutions are real.
Dr. Chauncey Crandall
These days, one of the patients that I see most
frequently is Pamela, a dress designer who is
responsible for clothing some of the chicest women
in Palm Beach.
Now in her 50s, Pamela is meticulous about her
appearance. She also appears to be the picture of
health. Shes slender and rarely indulges the hors
doeuvres that are always circulating at the classiest
society parties in Florida.
Unfortunately, appearances can sometimes be
deceiving. Pamela has heart disease and it is worrying
her sick.
Trauma Leaves the Door Open to Stress
Some years ago, Pamela almost died in a car
accident. Surgeons managed to patch her up, and
today Pamela bears no outward sign of her injuries.
But inside is another story. The car accident lef her
riddled with fear and anxiety.
Three years ago, Pamela sufered a heart attack.
Shed been admitted on a Sunday, following one of
Palm Beachs biggest social events. She was having
nausea, which she at rst attributed to eating a little
too much at the party, but her husband insisted she go
to the emergency room.
Although nausea isnt ofen a symptom of heart
disease in men, its not uncommon in women, so the
emergency room doctor decided to administer an
EKG. The cardiac test showed borderline changes,
and a follow-up blood test came back positive for
troponin, which is a heart attack indicator.
Pamela underwent a cardiac catheterization to
check the blood ow in her coronary arteries. Her lef
anterior descending artery had blockages. We inserted
a stent to restore the blood ow.
Pamela set out to become healthier. She lost weight,
began an exercise program, and quit smoking.
She did everything right, but she was still troubled
by chest pain that made her anxious. I couldnt
convince her that she was okay. She insisted on more
tests, but they always came out normal.
Having feelings of anxiety afer a heart attack is not
unusual. A heart attack is a very traumatic event that
brings people in touch with their mortality. Some
become conscious of or even xated on every
single heartbeat.
In addition, normal aches and pains and twinges
feel magnied, as though another heart attack might
be right around the corner.
This can occur with just about anyone who has
sufered a heart attack. But for someone like Pamela,
who was terried of losing control, the situation was
even worse.
Pamelas anxiety was compounded because the
heart attack had caused her to revisit the trauma from
the car accident.
When a traumatic event is not resolved, it leaves the
door open for anxiety to occur afer a second event
which can cause just as much distress as the rst.
Eventually, a potentially lethal pattern sets in.
The Dangers of Anxiety
Anxiety is not a harmless problem. In fact, studies
have found that heart disease patients who have
anxiety are almost twice as likely to die than patients
without anxiety.
When youre anxious, your body is under chronic,
low-level stress. This causes your body to function in
a hyper-alert state, and causes the release of harmful
hormones, like adrenaline, which raises blood
pressure, and cortisol, which causes the accumulation
of unhealthy belly fat and raises cholesterol levels.
Pamelas constant anxiety surely played a role in
her rst heart attack, and I was concerned that it
could do it again.
A patient like Pamela requires frequent ofce visits
and almost constant attention. But in our current
healthcare climate, it is growing more difcult to
provide her with the reassurance she requires.
Therefore, I enlisted the help of Pamelas family.
Her son, David, promised to talk to her about seeing
a therapist, and see if she could be helped with
medication.
Pamela has already done so much to help herself
that I feel condent this added level of emotional
support will turn out to be what she needs to conquer
heart disease and prevent that second and potentially
fatal heart attack. o
July 2013 5 newsmaxhealth.com
rise in healthcare premiums, this is occurring more
and more ofen.
It happens because many employers put their
healthcare contracts up for bidding annually,
in order to nd the lowest price they can. This
can result not only in changing your healthcare
coverage, it can also force you to end your
relationship with your current doctor.
As this process happens more frequently and to
more people, patients are losing their loyalties to
their doctors and, unfortunately, vice versa.
If your insurance changes and you have a doctor
you trust, you may want to consider paying your
doctor in cash for ofce visits. You can still use your
insurance if you need hospitalization. In that case,
your doctor will be able to continue to see you in
the hospital.
This is probably the time when you will want
your own doctor the most anyway, and you can have
the continuity of care you seek.
8. Make the Most of Medical Tests
Not long ago, it was standard practice to have
patients take multiple tests on a single day. For
instance, I would prescribe a cardiac stress test to
check for heart disease and an echocardiogram to
view the structures of the heart would be scheduled
for the same day.
While this used to be a very efcient use of both
doctors and patients time, it is less likely to occur
these days, as insurers and Medicare administrators
are ordering bundled tests to be taken on diferent
days.
There are two reasons for the increased
inconvenience and neither of them has to do
with medical care. For one thing, it is expected that
patients will protest the inconvenience by canceling
the additional tests, which means a savings for
payers. If that doesnt occur, additional visits can
mean more money in the form of additional co-
payments.
The best thing you can do is to educate yourself
about which tests are truly necessary to diagnose
and help treat your health problem. Fortunately, as
a Heart Health Report subscriber, you will nd a
wealth of information about proper testing in the
archives of this newsletter.
Other reputable sources include the Cleveland
Clinic and Mayo Clinic websites. Once you read up
on the tests, you will have far fewer questions than
before.
9. Be Smart About Taking Medications
Of course, the cost increases that are taking
place throughout the healthcare system have hit
medications as well. As new prescription drug costs
climb, healthcare insurers and pharmacy chains are
putting their medication contracts out to bid and
looking only at the bottom line.
One result is the reliance on generic drugs,
which now comprise 80 percent of the nations
Continued on page 7
Continued from page 3
Not Enough Doctors
There is a doctor shortage coming that will cut
across all specialtes, including my feld of cardiology.
In fact, 43 percent of the natons cardiologists are
currently over the age of 55. As they retre, there are
simply not enough doctors and med students coming
up the ranks to replace them, especially with the
natons rapidly aging populaton.
There are some things you can do to deal with the
impending shortage and contnue to get the care you
need:
Dont wait untl you get sick to fnd a new doctor.
Find one immediately. Asking a trusted friend for a
recommendaton is stll the best way.
If your insurance company forces you to change
doctors, ask your doctor if another physician within
the same practce takes your insurance, or if he or
she can give a referral.
Choose a doctor from a large academic medical
center where there is stll a large pool of staf to
provide the doctors ofce with support.
Current subscribers have instant access to any and every
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Dr. Crandalls Heart Health Report.
Simply go here: drcrandall.newsmax.com
Check your e-mail inbox for this months password.
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Exclusive to Current Subscribers
6 July 2013 drcrandall.newsmax.com
Quick Takes: Tips for Better Heart Health Now
Exercise Survey Ofers
Mixed News
While Americans overall
levels of activity are getting
better, the majority of us still
dont get enough exercise to meet
the governments tness goals,
according to a new survey from the
Centers for Disease Control and
Prevention (CDC).
The CDC recommendations
call for a minimum
of 150 minutes of
moderate activity
or 75 minutes of
vigorous activity,
along with muscle-
strengthening
activities such as
push-ups, sit-ups,
or exercise using
resistance bands
or weights two or
more days a week.
The most recent federal health
data shows steady progress has
been made since 2007, with nearly
50 percent of those surveyed either
meeting or exceeding exercise
goals.
However, only 21 percent said
they meet the muscle-building
recommendations, .
While this was the highest
tness level ever recorded by the
CDC, the report is mixed news
overall.
On one hand, the increase in
aerobic exercise is to be applauded.
But strength-training and exibility
are also needed for good overall
health.
Get More Vitamin D
With Mushrooms
Were learning more about
how important vitamin D is to
heart health. Unfortunately, age
diminishes the bodys ability to
synthesize this nutrient from
sunshine. Supplements are one
solution, but mushrooms are a rich
source of it as well.
Researchers from Boston
University School of Medicine
studied 30 healthy adults who were
given either 2,000 IU of vitamin D
or 2,000 IU of mushroom powder,
which contains vitamin D2. They
took the capsules daily for 12 weeks
during the winter. Researchers
used blood tests to measure their
levels of vitamin
D. Afer 12 weeks,
all the participants
levels of vitamin
D were similar,
including those who
had ingested the
mushroom powder.
In a separate
report, the research
team was able
to determine
that mushrooms
produce vitamin D through a
similar process to what occurs in
human skin afer sun exposure.
Vitamin D is crucial not only
for good heart health, but it also
bolsters bone health and muscle
strength, in addition to reducing
the risk of other common diseases
including cancer, depression, and
diabetes. Orange juice fortied
with vitamin D, and supplements
are also good sources, the
researchers said.
Eatng Out Boosts
Calorie Intake
If youre trying to control your
weight but youre still eating out at
restaurants, youre ghting a losing
battle.
The average single restaurant
meal from one of the nations
independent or small chains
contains two to three times
the estimated calorie needs of
an individual adult at a single
meal, and 66 percent of typical
daily calorie requirements, say
researchers who analyzed 157
meals selected randomly from 33
Boston area restaurants.
On average, the meals studied
contained 1,327 calories. Nearly
three-quarters (73 percent) of
the meals contained more than
half of the FDAs daily energy
recommendation of 2,000 calories.
Twelve meals contained more than
the entire recommended daily
energy intake.
Among the meal categories
studied, Italian (1,755 calories),
American (1,494 calories), and
Chinese (1,474 calories) meals had
the highest average calorie levels.
Vietnamese meals had the lowest
calorie levels with an average of 922
calories. The Japanese meals had
the second lowest calories with an
average of 1,027 calories.
The researchers, from Tufs
University, chose independent and
small-chain restaurants because
these categories will be exempt
when the federal rules on posting
calorie counts on menus eventually
become law.
However, they also examined a
subset of the independent or small-
chain restaurant meals and found
that their average calorie content
was 6 percent higher than the
stated energy content of equivalent
meals in the largest national chain
restaurants.
This diference was not
statistically signicant and clearly
shows that whenever you eat out,
you are consuming excess calories.
To control your weight, its best
to eat at home. If you must eat out,
share the meal with a friend, or ask
the server to pack up half of it to
take home.
Do this when you order, so you
dont have to face the temptation of
having it in front of you. o

Mushrooms
produce vitamin
D through a
process similar
to what occurs
in the skin.

July 2013 7 newsmaxhealth.com

prescription drug supply.
Last years incident with glass-tainted Lipitor
brought this problem to national attention, and
provided additional evidence that the nations drug
supply is contaminated with counterfeits and/or
poorly manufactured drugs.
Although the FDA claims that generic drugs
contain the same active ingredients as branded
drugs, small variations are permitted, such as the use
of llers and other nonactive ingredients.
These ingredients can cause problems in people
who are sensitive to them. For instance, llers may
be wheat-based, resulting in symptoms for those
who are allergic.
Such problems may be misconstrued as side
efects from the drug.
Indeed, I have seen cases where people who are
sufering from serious medical conditions, such
as congestive heart failure, have had their lives
endangered because of inferior drugs.
And the situation is only going to get worse as
the huge discount chains, like Wal-Mart, Walgreens,
Costco, and others, are put under increasing pressure
from the healthcare industry to nd cheaper and
cheaper drug suppliers.
Dont bow to pressure. If your doctor prescribes
a drug, request the brand-name version. Even more
importantly, dont put yourself at risk by picking
up drugs when you travel abroad, or ordering
medications from unknown suppliers on the
Internet.
Should you decide to order drugs online, here
are the FDAs tips to keep your medication supply
safe:
Use only prescriptions from your doctor or other
trusted healthcare professionals
Deal with pharmacies that are licensed in the U.S.
Make sure you can speak to a licensed
pharmacist about the medication
Avoid foreign websites selling drugs at deeply
discounted prices.
Of course, the best way to avoid all the
complications of our healthcare system is simply to
stay healthy.
The vast majority of patients I see are people
who could have avoided coronary heart disease as
well as the host of problems that come along with
it, like high blood pressure, diabetes, and high
cholesterol, if only they have adopted a healthy
lifestyle.
Take charge of your hearts health now, and you
will dramatically reduce those doctors visits, and
live a longer and healthier life as well. o
The New Model: Concierge Medicine
There is a new way to avoid a lot
of the problems involved with the
healthcare system, but it comes with
a hitch you have to be able to
aford it!
This new medical model,
sometmes called concierge
medicine, ofers coverage for a
monthly or an annual fee. One
large groups fee is $2,500 per year,
although some practces charge
more. Essentally, the fee is a
retainer, which enables doctors to
bypass insurance companies and
government programs altogether.
This model is proving so atractve
that the American Academy of Private
Physicians, which represents these
doctors, says its membership grew by
30 percent last year.
What do you get for your money?
Generally, you get a package of
services that includes comprehensive
annual physicals, guaranteed same-
day appointments, round-the-clock
cell phone access, home or work-
site visits, and some doctors even
accompany patents to see specialists.
Some doctors will bill third-party
payers for services their patents
policies reimburse, others charge a
higher annual cost for all-inclusive
services, others look to patents to
pay additonal out-of-pocket costs.
If your doctor is transitoning to
such a plan and you cant aford or
dont wish to pay the additonal fee,
here are tps from the American
Academy of Family Physicians
on what to look for in such a
combinaton practce.
If your doctors ofce is now using
a team approach, make sure the
members roles are clearly defned.
Do the team members
communicate well with each other
and do they have a good system to
communicate with you, whether
by email, an Internet portal, or a
good phone system?
All the team members should be
compassionate. No mater what
system your doctor uses, you
should feel welcome and cared for.
Continued from page 5
8 July 2013 drcrandall.newsmax.com
I know that you recommend raw almonds, but I
prefer them dry-roasted. My doctor suggested using
unsweetened almond milk instead of soy milk,
because soy contains plant estrogens. What do you
recommend?
Fred B., Bloomeld, Mich.
First, congratulations on your decision to eat
heart-healthy.
I always recommend raw almonds because the
dry-roasted ones generally contain salt.
As for soy milk, I am in agreement with your
doctor. I recommend unsweetened almond milk.
Some years ago, a doctor noticed a blood mark
under my ngernail. It occurs when I have heart
palpitations. I havent experienced any cardiac
problems, but do you think I should be concerned?
Tricia D., Riverside, Calif.
These marks are known as splinter
hemorrhages. They can occur for a number of
reasons, including being a classic sign of bacterial
endocarditis, which is an infection in one of the
hearts lef-side valves.
Because youve been well for so long, I dont
think its likely that you have such an infection.
To be on the safe side, however, you should see
your family doctor and ask to be checked for an
aortic or mitral valve infection.
I am 66, exercise regularly, and do yoga. My doctor
is pleased with my cholesterol and blood glucose
levels, but I have high blood pressure. Im on four
medications and my blood pressure is still elevated.
What can I do?
Virginia K., Brick, N.J.
It is most likely that you have what is called
essential high blood pressure, which is the
most common type. Also known as idiopathic
hypertension, this type of blood pressure occurs for
no known cause.
Considering your absence of risk factors, I
recommend that you ask your doctor to rule out any
underlying causes such as kidney disease by
performing lab tests to make sure your electrolyte,
BUN, and creatinine levels are normal.
You should also consider getting a renal
ultrasound to rule out a condition called renal artery
stenosis.
If you nd you dont have kidney disease, look
to new medications for treatment. My rst choice
for controlling hypertension is an ACE inhibitor
medication followed by a diuretic.
If that doesnt work, try a beta blocker followed
by a calcium-channel blocker.
When I have a patient with your condition, I
undertake this type of treatment in steps.
I also have the patient record their blood
pressure in the morning and evening. I ask them to
bring this chart into my ofce to be checked every
two weeks.
By following this procedure, I can usually bring
their blood pressure under control within three
months.
To your heart health,


Chauncey W. Crandall, M.D.
Ask Dr. Crandall
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The Secret to
Digestive Health?
PROBI OT I CS
Next time youre at the grocery store,
take a few seconds to appreciate the hef
of a one-pound package of butter . . .
Because some researchers now
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weighing two or three times that
amount in your gut an organ
composed entirely of bacteria!
This structure, which scientists refer
to as the microbial organ, contains
about 100 trillion bacteria. Under
optimal circumstances, most of these
are considered friendly or probiotic
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Unfortunately, and particularly with
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