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Heart monitor
Dr. Alan Blaker, executive medical director of McLeod Heart and Vascular Institute in Florence, listens to patient Drexell Turner’s heart during an office visit. Blaker encourages patients to get regular checkups to monitor their health.
Photo by Milton Morris
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Healthy steps
Drexell Turner Jr. committed to a healthier lifestyle after his doctors discovered blocked arteries, requiring heart surgery. He watches what he eats and exercises three days a week at McLeod Health & Fitness Center in Florence.
Photo by Milton Morris
Even though his father had a history of heart attacks, Drexell Turner Jr. never expected to have heart trouble. He wasn’t overweight. Sure, his desk job kept him sitting most of the day, but he stayed active with yard work at home. Occasionally, he got tired or short of breath; nothing that worried him.
Then medical tests revealed extensive blockages in the arteries around his heart, including one nearly 90 percent blocked. Turner learned he’d need open heart surgery—the sooner, the better. Ten years later, thanks to that intervention and some changes in his exercise and eating habits, the 68-year-old Florence man lives to tell the tale.
Cardiovascular problems like Turner’s are all too common in South Carolina, where heart disease is one of the leading causes of death. It’s also one of the most critical health issues keeping South Carolina near the bottom of the list in the 2016 America’s Health Rankings Annual Report, a state-by-state health assessment compiled by the nonprofit United Health Foundation.
On the upside, the report shows that South Carolina’s health isn’t getting any worse. For three years in a row, the Palmetto State’s rank, as compared to other states, has held steady.
On the downside, that rank is still 42nd, one of the worst. Entrenched among the country’s least healthy states, most of them clustered in the Deep South, South Carolina is not, on average, getting any healthier. We still eat poorly, exercise too little, smoke too much and avoid health checkups. As a result, many South Carolinians are battling serious challenges to their health, chiefly cardiovascular disease, diabetes, obesity, smoking and cancer.
Here’s a closer look at those five health issues, with tips on what to do to improve your own health. To read the full 2016 AHR report, visit SCLiving.coop/health.
Cardiovascular disease
The best advice for dealing with heart disease is to do everything possible to prevent yourself from getting it, interventional cardiologist Dr. Alan Blaker says.
“Once you have heart disease, you always have it,” says Blaker, executive medical director of the McLeod Heart and Vascular Institute in Florence. “From then on, you are managing it and trying to live with it.”
Though many people think of cardiovascular disease as blocked arteries and heart attacks, it also encompasses heart malfunctions such as congestive heart failure, valvular disease and arrhythmia, he says. The dangers associated with the disease include death, heart attack and debilitating illness, as well as lengthy hospitalizations, costly medications, reduced ability to work and possibly a less active lifestyle.
But most of the risk factors that lead to cardiovascular disease can be controlled, Blaker says.
One of those is smoking. “Smoking leads to more incidences of coronary artery disease and death due to heart attack,” he says.
A high-fat diet—common in the South—contributes to obesity and diabetes, two more risk factors for developing heart disease.
A fourth risk factor cannot be controlled, Blaker says—that’s a family history of heart disease. People who know heart disease runs in their family should take extra care to reduce the other risk factors by managing their weight, blood pressure and diabetes and not smoking.
“The problem is you don’t feel it until something happens,” he says of ignoring the risks. Symptoms like chest pressure or discomfort and shortness of breath can indicate artery blockages and may be precursors of heart attacks. But blockages can grow to be extensive before a person notices problems.
Having been surprised by his arterial blockages, Drexell Turner now does everything he can to stay healthy, faithfully exercising three mornings a week at McLeod Health & Fitness Center and reading nutrition labels to make sure he’s eating a healthier diet.
"I think it took the medical intervention to make me change,” Turner says.
Regular checkups with a primary-care physician help people monitor their risks, Blaker says, and community health screenings and workplace health fairs can also identify risks before problems arise.
For men over 45 and women over 55 who have at least one other risk factor, Blaker recommends a short, painless calcium-scoring test, which can detect the beginnings of even minor blockages in arteries around the heart and alert you to the need for lifestyle changes.
Diabetes
South Carolina is home to a growing epidemic of this incurable, chronic disease—the seventh leading cause of death in the state, according to the S.C. Department of Health and Environmental Control.
“A lot of it here has to do with the genetics, the ethnicity, the diet and the weight problems,” says Dr. Kathie Hermayer, chair of the Diabetes Initiative of South Carolina and director of the MUSC Diabetes Management Service in Charleston.
Family history is one risk factor for developing diabetes, a condition in which the body cannot properly process food into energy, creating excess blood sugar. African-American and Hispanic populations tend to be at higher risk, as do people who are overweight or have high blood pressure, those who are physically inactive, and women who experienced gestational diabetes during pregnancy, Hermayer says.
Weight is a significant factor—four of five adults with diabetes are overweight or obese. Losing even 5 to 7 percent of your body weight can reduce the risk of developing diabetes, Hermayer says.
People with prediabetes—a higher-than-normal level of blood sugar, not yet high enough for a diabetes diagnosis—are also at higher risk of developing Type 2 diabetes, which can lead to heart attack, stroke, blindness, kidney failure, or loss of toes, feet or legs.
“Start testing at age 45, or sooner if you are overweight or have other risk factors,” Hermayer says. Anyone with a family history of diabetes or a diagnosis of prediabetes should meet regularly with a primary-care physician for blood tests that monitor any progression into diabetes.
“You are the director over your own health,” says Florene Linnen, 74, a longtime community advocate for diabetes education who has lived with diabetes for three decades. She helped establish Georgetown County Diabetes CORE Group to teach others how to manage the disease.
After learning how to read grocery labels, cook healthier, exercise and monitor their blood sugar, “people are managing it better here now,” the Santee Electric Cooperative member says.
Prevention is the best defense against diabetes. The National Diabetes Prevention Program, online at cdc.gov/diabetes/prevention, offers links to lifestyle-change programs in your area that teach ways to reduce risks by eating healthier, incorporating more activity into your schedule and improving overall health.
Obesity
It’s not unusual to find South Carolina scoring poorly in obesity assessments, since it’s often ranked among the 10 most obese states, says Kelsey Allen, community coordinator for Eat Smart Move More SC, a statewide nonprofit that works to decrease obesity.
More alarming, Allen says, is that we are second in the country for childhood obesity.
“The fact that we are seeing childhood obesity trends getting worse and worse means that we have a lot more work to do,” she says. “As your weight increases, your risk of developing other health problems increases.”
Obesity is linked to multiple life-threatening health problems, including diabetes, some cancers, high blood pressure, strokes and heart disease. As the AHR report notes, obesity is the second-leading cause of preventable death; smoking is number one.
Two key behaviors contribute to the state’s obesity numbers, Allen says. One is a sedentary lifestyle, common for people who sit behind desks at work or in front of TVs and electronic devices at home. To combat that, people need to incorporate more activity into their daily lives.
“There are data that show spending a lot of time sitting is as bad for your health as smoking,” Allen says.
Another factor is frequent consumption of sugar-sweetened beverages, like sweet tea and soda, which offer no nutritional value but contribute to weight gain, she says. Cutting back starts as simply as substituting one sugary drink a day with water, then steadily decreasing those drinks in your diet.
“You don’t wake up one morning and you’re obese; it’s a series of small decisions,” Allen says. “Reversing that process is all about small steps leading to a healthy lifestyle.”
For those looking to make small changes toward getting the weight off, Allen recommends two online guides:
letsgosc.org: Type in your ZIP code to find a map to walking trails, public parks, farmers markets and other healthy resources near you.
choosemyplate.gov: This interactive website from the U.S. Department of Agriculture is packed with online tools for choosing and tracking healthy eating and exercise options.
Smoking
One bad habit South Carolinians seem to be dropping is smoking. The percentage of adults in the state who smoke decreased in the past year, from 21.5 to 19.7 percent.
Before you start cheering, keep in mind that this mimics a nationwide downward trend in smoking. Every state has decreased its rate over the past four years. The problem for South Carolina is we’re decreasing at a slower rate than the national average. That’s why we still rank 37th for that health risk.
And there are good reasons to work harder on quitting.
“Smoking is the number-one cause of preventable disease and death in South Carolina,” says Megan Hicks, executive director of the S.C. Tobacco-Free Collaborative (SCTFC). Smoking and secondhand smoke contribute to a long list of other health issues, she notes—among them, cancer, diabetes, heart disease, stroke, respiratory problems and low-birthweight babies.
Together, smoking and secondhand smoke cause one in five deaths every year, according to the Centers for Disease Control.
A nonprofit that works in partnership with organizations statewide, SCTFC promotes efforts such as smoke-free communities and tobacco-cessation programs “to eliminate the toll of tobacco use” on South Carolina. In everything they do, Hicks says, they emphasize prevention—especially among youth.
“The younger you try it, the easier it is for you to become addicted,” she says. “There is no safe level of tobacco use or exposure to secondhand smoke.”
Just this year, she says, DHEC launched a new, socialmedia-heavy program called BackFireSC, targeting teens with messages about prevention and quitting. Links to teen-friendly memes, videos and social media sites are at backfiresc.com.
For tobacco users who are ready to quit, Hicks recommends these resources:
S.C. Tobacco Quitline: Available 24 hours a day, seven days a week, at 1-800-QUIT-NOW (1-800-784‑8669), Quitline offers free telephone counseling. Free nicotine-replacement therapy (NRT) may be available for uninsured or underinsured callers. By combining NRT and phone counseling, smokers increase their chances of successfully quitting, Hicks says. To reach the online-support arm of this service, visit quitnow.net/southcarolina.
smokefree.gov: This website offers multiple resources for quitting, including free smartphone apps called QuitGuide and quitSTART that provide skill building and support for tobacco users trying to quit. The site also offers links to free text-messaging support programs tailored more specifically to teens, moms, veterans and Spanish speakers.
Local hospitals: Many hospitals across the state offer in-person tobacco-cessation sessions. Contact the hospital in your area.
Cancer
About 24,000 South Carolinians a year develop some type of cancer. While modes of treatment and cure rates keep improving, there are still things people can do to both minimize their risks of developing certain cancers and maximize their chances for successful treatment when the threat arises.
The most common forms of cancer—breast, lung, prostate, colon—are impacted by behaviors people can control, says Dr. David Mahvi, chief of surgical oncology and director of the Oncology Integrated Center of Clinical Excellence at the MUSC Hollings Cancer Center in Charleston.
Tobacco use, alcohol abuse and obesity are all contributing factors for some cancers, Mahvi says, so making lifestyle changes to reduce those behaviors is a step toward reducing risk. Lung cancer rates have decreased, for example, as the number of people smoking has dropped, he says.
Making the choice to get regular health screenings, such as a mammogram, pap smear or colonoscopy, can reduce risks by identifying “things that are preventable, if we catch them early,” before a patient becomes symptomatic, Mahvi says.
One form of cancer that continues to increase is melanoma, despite the known risks from sun exposure. Although it’s preventable, he says, many people do not make the choice to protect themselves from the severe sunburns that can lead to skin cancer years later. He recommends getting full-body skin exams from a primary-care physician to detect any melanoma in its early stages, when treatment involves minor surgery and before the condition grows more serious.
The best resource for prevention or early detection of cancer is regular care from your physician, Mahvi says. Knowing your individual and family medical history, your doctor can better tailor screenings and recommend lifestyle changes for your health.
Symptoms that could indicate a cancer-related threat and that should prompt someone to seek medical attention include:
- detecting a mass in the breast
- finding a mole that looks unusual
- finding blood in the urine or stools
- a persistent cough, especially for smokers
“Having a good advocate in your primary-care doctor is the best way to deal with it,” Mahvi says.
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The health outlook for seniors
Senior citizens in South Carolina seem to be a bit healthier than the general population, compared to the rest of the nation. Looking at health measures geared to seniors, the 2016 America’s Health Rankings Senior Report gave South Carolina a rank of 34th for senior health, compared to the state’s general rank of 42nd.
But over the next 15 years, that may change. The state’s senior population is projected to grow by 53 percent by 2030, as more baby boomers age into senior status. And those currently middle-aged South Carolinians will bring into their senior years higher rates of obesity and diabetes, straining the health-care system, since people 65 and older tend to have more healthcare needs, AHR notes.
“As a geriatrician, I see certain health conditions ‘snowball’ as people age—that is, smaller problems in middle age can get much larger and more complicated, affecting overall health more as we age,” says Rhonda Randall, senior advisor to United Health Foundation, which produces the AHR report, and chief medical officer and executive vice president at UnitedHealthCare Retiree Solutions.
Positive notes for S.C. seniors include the state’s high marks for seniors living in less-restrictive environments, relying on community-based meal-delivery and transportation programs, as well as in-home visits from health aides for the assistance they need.
But challenges remain, many related to nutrition. Our state is among the worst for food insecurity, often due to limited mobility or lack of community access to food, poor food-management skills and poverty. Hunger, poor nutrition and health complications are the results. South Carolina also ranks poorly for underweight seniors, whose frailty requires more care-giving and puts them at greater risk of illness and death.
“We must work together—across states, communities and the public health sector—to find ways to continue improving delivery of care to seniors and encourage wellness and health among both current and future seniors,” Randall says.
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Related stories
Health grades – Download the full 2016 America’s Health Rankings Annual Report at SCLiving.coop/health.
8 steps to better health – Healthier eating and more exercise are the keys to combating our state’s deadliest health conditions. Even small steps can help. Learn how to get started at SCLiving.coop/steps.
Directory of free medical clinics – Low-income residents can find affordable medical care at donor-supported clinics across the state. Find one near you at SCLiving.coop/directory-of-free-medical-clinics/.