For The Love of The Game: A Tribute to Mickey Foxwell

I was very saddened to learn of the passing of my friend and colleague, Dr. Mickey Foxwell. He was the Associate Dean of Admissions at the University of Maryland School of Medicine for nearly 3 decades, during which time more than 4000 medical students were accepted, enrolled and eventually earned their M.D. degrees. As the face of the medical school admissions committee, he cared very much about each student’s welfare and their progress over the 4-year program. He knew every student in the medical school, and he even made himself available to meet with candidates who did not gain admission on the first go-around in order to make their application more competitive for subsequent tries. He was also a kind and caring physician whom his patients adored- I knew this first hand because we shared a number of patients and I was always humbled by their gratitude and admiration for him.

But it was his love of the game of baseball that connected so many of us, including myself. Mickey was a walking baseball encyclopedia and when it came to the Eastern Shore of Maryland, where he was raised, no one knew more about the national pastime. He would regale stories about some of baseball’s greatest players including, John “Home Run” Baker, Walter “The Big Train” Johnson and Jimmy Foxx (“there’s no crying in baseball”) who were raised or have family currently living on the Eastern Shore. When I begged him to write a book on Eastern Shore’s impact on Major League Baseball, he smiled and said, maybe someday…

Of course, Maryland’s most renowned ball player is Babe Ruth, whose birthplace (and museum) is directly across the street from our medical center. In fact, two of my fondest memories of Mickey involved the Babe. The first occurred when we both attended the 100th Anniversary of Babe Ruth’s birth on a cold February day when the U.S. postal service issued commemorative collectibles. The 2nd was also in the mid-90s when he beamed with delight as he showed me the autographed Babe Ruth baseball he had just purchased in pristine condition, similar to the ball pictured above, but this one was signed in green, a true collector’s rarity!

Mickey was well loved and respected throughout our medical community. But I was lucky to share a special friendship not only based on the love of medicine but also for the love of the game. Mickey, rest peacefully… in your field of dreams…

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.

Protecting the Aging Heart

Advanced age is a well-established risk factor for heart disease and its complications. This occurs in large part because 3 out of every 4 men and women aged 65 years and older have at least 1 major risk factor for heart disease. They are as follows: a history of cigarette smoking, diabetes mellitus, hypertension and elevated LDL cholesterol levels. And while death rates from heart disease have been significantly reduced since the 1960s, the one age group where less progress has been made are in men and women 65 years and older. In fact, rates of cardiovascular disease (heart attacks and strokes) with advanced age is expected to double over the next 2-3 decades, unless risk factors are better controlled. The good news is that older hearts can age gracefully as demonstrated in societies such as in Okinawa, Japan where rates of heart attack and stroke have traditionally been low due to healthy lifestyle and excellent social engagement.

This blog will explore ways that older men and women can protect their aging hearts by taking better control of their risk factors. Even if you have multiple risk factors or have experienced a cardiovascular event, it is never too late to intervene in this process and improve your cardiovascular health. You can also check out the recent interviews that my colleagues and I did for Medscape where this topic is discussed in greater detail.

Cigarette Smoking: Because a history of cigarette smoking can shave 10 years off of your life, efforts directed at complete smoking cessation (without switching to vaping) may help to offset risk. Some useful non-pharmacologic tools include hypnotherapy, acupuncture and behavioral counseling. The Nicotrol® inhaler has been the most successful tool in my practice as it most closely simulates the act of cigarette smoking (as compared to nicotine gum or nicotine patches). Other smoking cessation aids that have been effective in my practice are Zyban® and Chantix.®. Always check with your physician to determine what smoking cessation strategies might work best for you.

Diabetes Mellitus: A normal fasting glucose is less than 100 mg/dL with “prediabetes” defined by fasting glucose levels between 100-125 mg/dL and diabetes defined as at least 2 fasting levels exceeding 125 mg/dL. If you have prediabetes, you may be able to reduce conversion to diabetes by losing 5-10% of your body weight. Similarly, if you have early stage diabetes, you may also be able to move your metabolic clock back to the prediabetes stage when a similar proportion of weight reduction has been achieved. This can be accomplished through reducing caloric intake and increasing physical activity. A simple rule of thumb is that if you just remove the equivalent of 1 bagel (300 calories) and add 2 miles of walking (200 calories) each day, you are on your way to losing 10 pounds over a 2-3 month period!

High Blood Pressure: Hypertension is defined as a systolic blood pressure (top number) of 140 mmHg and diastolic blood pressure (lower number) of 90 mmHg. The goal is to gradually lower blood pressure in older men and women. While an ideal blood pressure is less than 120/80, older men and women with long-standing hypertension typically have stiff blood vessels (arteries) and therefore lowering blood pressure too drastically and quickly (e.g., reducing systolic blood pressure from 160 mmHg down to 120 mmHg) may compromise blood flow to the brain and cause a stroke. Therefore the goal in older men and women is to more gradually lower blood pressure. This can be accomplished safely through dietary measures (less than the equivalent of 1/2 teaspoon of salt daily) and medication that is titrated over weeks to months (rather than hours to days).

High LDL Cholesterol: Lowering LDL (bad cholesterol) levels is an important component to reducing cardiovascular risk with benefits persisting well beyond age 65. A healthy LDL level is less than 100 mg/dL but if you have cardiovascular disease, your LDL target goal should be less than 70 mg/dL. Natural ways to lower LDL include foods that are high in soluble fiber (such as oats, beans and psyllium- see “Heal Your Heart” for a list of the Top 50 Foods) as well as safe and effective cholesterol lowering medications that are proven to reduce the risk of a heart attack and stroke.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland  and author of “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” published by Penguin Random House.

Happy Birthday “Buddy”

 

While vacationing a number of years ago, I heard an older gentleman grimace when he heard a younger father say to his boy, “come here buddy”. “A father should not call his son his buddy” he remarked angrily. Soon after, when I made a similar pronouncement to my son, the old man got up from the pool and left in disappointment and dismay. While I understood his belief that a father calling his son “buddy” might signal development of a collegial relationship and contradict the “older-school”, authoritarian parenting style, I didn’t quite grasp why the former could not be incorporated if parents instilled a solid value system. That is, why can’t a parent also be a friend to their age appropriate child(ren)?

In fact, over the years, our parental-son relationship has been built on a solid foundation of empathy, kindness to strangers and respect for all. And yes, my son and I enjoy each other’s company and friendship. These days his common interchange is “watch it fella”, when he’s sinking basketball 3-pointers behind the top of the key or reminding me not to challenge his 6’3″ frame when driving down the lane for a layup. Recently, I’ve been able to provide the satisfactory retort “gotcha fella” at the billiard table after he gifted me a cool pool cue stick on my b-day that has indeed vastly improved my game.

All told, our family is very fortunate to have such a thoughtful, kind, appreciative and considerate young man in our lives. We hope that his lucky number “17”, will ring true throughout his 17th year-

Happy Birthday “Buddy”!

 

 

 

COVID-19 and Common Sense: A Tale of 2 States

Governor Larry Hogan continues to be Maryland’s most popular Governor in recent years because of his deep seated commitment to the health and well being of the people he serves. Earlier this year and months before the COVID-19 crisis struck Maryland, Governor Hogan’s popularity rating was 75%! This is astonishingly high considering that he is a Republican in a very blue state. But what has distinguished this Governor has been a common sense approach in managing the COVID-19 crisis. First, he directly purchased 500,000 test kits from South Korea when it became abundantly clear that an insufficient testing supply would hamper U.S. efforts during the early weeks of the pandemic. Second, he assembled a task force of highly qualified experts to help guide the reopening of Maryland. Third, (and most importantly) he listened to them! He used a common sense approach that consisted of meeting specific milestones over a designated 14-day period (i.e., reduction/stabilization in hospitalization & ICU rates). Only when these milestones were met, would progression to the next phased reopening be permitted. As a result of this thoughtful, common sense approach, new COVID-19 cases have dropped (see 1st Figure) as the phased reopening continues. The percentage of positive tests (positivity rate) has declined from high levels (over 25%) to the recommended level of less than 5%, meaning that we have better control over the virus and can institute safeguards such as contact tracing to keep transmission rates low.

But progress will only be maintained if we follow recommendations to stay home when ill, practice social distancing and wear a face mask. While face masks are required on public transportation, inside retail shops/malls, restaurants and bars (currently limited to 50% capacity), the “Masks on Maryland!” initiative is making a strong case for masks to be worn until an effective vaccine is available.

By contrast, states that have not mandated the wearing of masks, such as Florida, are suffering dearly. As illustrated in the 2nd Figure, cases have been rising at an alarming rate. The high positivity rate (~18%) is deeply concerning and consistent with the virus being well out of control. When Governors of Florida (and other states) minimize the importance of wearing masks, this potentially deadly virus is simply not taken seriously. Rather, the message is perceived as: “if I don’t need to wear a mask, then what’s the problem?” AKA “if I don’t need to wear a mask, then why do I need to socially distance?” This is precisely what has been observed when outrageously high numbers of (predominantly young) people congregate in bars, nightclubs and other social gatherings without any regard to the welfare of others. Consequently, bars/nightclubs have now been forced to temporarily re-close in some states.

My healthcare colleagues agree that wearing a mask over upcoming months is a very small price to pay for some small degree of normalcy. But make no mistake, life will not return to normal until COVID-19 is no longer a health issue. In other words, until an effective vaccine becomes available or more tragically, herd immunity develops (due to continued disregard to wear masks/socially distance, with the inevitable consequence of continued countless and unnecessary deaths), why don’t other states adopt the common sense approach that Governor Hogan has used to lead Maryland …and reduce spread of this viral beast?

Michael Miller, MD is Professor of Medicine, Epidemiology & Public Health and a cardiologist at the University of Maryland School of Medicine in Baltimore, Maryland.  His recent book,  “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” is published by Penguin Random House, USA.