Archive | January 2024


Folate (vitamin B-9) is important in red blood cell formation and for healthy cell growth and function. The nutrient is crucial during early pregnancy to reduce the risk of birth defects of the brain and spine. Folate is found mainly in dark green leafy vegetables, beans, peas and nuts.

Folate is found mainly in dark green leafy vegetables, beans, peas and nuts. Fruits rich in folate include oranges, lemons, bananas, melons and strawberries. The synthetic form of folate is folic acid. It’s in an essential component of prenatal vitamins and is in many fortified foods such as cereals and pastas.

A diet lacking foods rich in folate or folic acid can lead to a folate deficiency. Folate deficiency can also occur in people who have conditions, such as celiac disease, that prevent the small intestine from absorbing nutrients from foods (malabsorption syndromes).

The recommended daily amount of folate for adults is 400 micrograms (mcg). Adult women who are planning pregnancy or could become pregnant should be advised to get 400 to 1,000 mcg of folic acid a day.”


Folic Acid Awareness Month!

folicacid2  folicacid1

National Folic Acid Awareness Month, which was in the beginning of this month! January 10–16, 2016, was National Folic Acid Awareness Week but for those who may have missed the info on it don’t fret striveforgoodhealth is covering Folic acid today and its especially important to women who might become pregnant, as it can help prevent serious birth defects of the brain, neck and spine. Recent studies suggest that it can also help lower the risk of neural tube defects and orofacial clefts (cleft lip and palate). Notably, folic acid has been shown to lower the risk of anencephaly (the absence of a large part of the brain and skull) and spina bifida (an opening in the spinal column) by 50 to 70%.

Much of the baby’s growth and development happens very early in pregnancy, even before most women know they’re pregnant. Experts estimate that women need to start taking folic acid at least one month before they become pregnant for it to prevent birth defects, so it’s important to make folic acid-enriched foods and vitamins a part of your daily routine.

The benefits aren’t limited to your baby: your body needs folic acid, too. The acid helps to create healthy new cells in the body, from hair to nails to skin and blood cells. Without it, blood cells become unstable, and the body is susceptible to disease. The vitamin also protects your liver, allowing it to continue purifying your body. Folic acid is a water-soluble vitamin that your body cannot store, so it should be taken every day to replenish your body’s supply.

Many foods are now being fortified with more folic acid, such as grains, pastas and breakfast cereals. Check the nutritional facts label on your favorite products to see how much they contain. Many cereals now contain as much as 100% of the recommended daily value. Additionally, prenatal vitamins typically contain folic acid. If you’re not yet taking a prenatal vitamin, you can also look for multivitamins with added acid, or buy folic acid pills.

Birth defects are common, costly, and critical conditions that affect one in every 33 U.S. newborns annually. Women can reduce their risk of having a baby born with a birth defect by making healthy choices and adopting healthy habits before and during pregnancy.

Health care providers can encourage parents-to-be to make a PACT for birth defects prevention by taking the following steps: Planning ahead for pregnancy; Avoiding harmful substances like chemicals in the home or workplace (2); Choosing a healthy lifestyle, including eating a healthy diet (3); and Talking with their health care provider before and during pregnancy, particularly about medication use.

Centers for Disease Control and Prevention encourages health care providers to become active participants in National Birth Defects Prevention Month by joining the nationwide effort to raise awareness of birth defects, their causes, and their impact.

CDC urges all women of childbearing age who can become pregnant to get 400 µg of folic acid every day to help reduce the risk for neural tube defects. Health care providers should encourage women of childbearing age to consume folic acid in fortified foods or supplements, or a combination of the two, in addition to a diet rich in folatCDC urges all women of childbearing age who can become pregnant to get 400 µg of folic acid every day to help reduce the risk for neural tube defects. Health care providers should encourage women of childbearing age to consume folic acid in fortified foods or supplements, or a combination of the two, in addition to a diet rich in folate.

An easy way to be sure you’re getting enough folic acid is to take a daily multivitamin with folic acid in it. Most multivitamins have all the folic acid you need. If you get an upset stomach from taking a multivitamin, try taking it with meals or just before bed. If you have trouble taking pills, you can try a multivitamin that is gummy or chewable. Also be sure to take it with a full glass of water.  This medication we said earlier is a water soluble and for it to do its optimal level of action it needs water.  Just like Colace that is a water soluble it needs to be taken also with water for it to do its function in making the stool softer; if not taken with water it will do very little in resolving constipation.  So don’t forget water.

Folic acid has been added to foods such as enriched breads, pastas, rice and cereals. Check the Nutrition Facts label on the food packaging. A serving of some cereals has 100% of the folic acid that you need each day.

In addition to getting 400 mcg of folic acid from supplements and fortified foods, you can eat a diet rich in folate. You can get food folate from beans, peas and lentils, oranges and orange juice, asparagus and broccoli, and dark leafy green vegetables such as spinach, and mustard greens.

Nutritional habits

Although all enriched cereals and grain products in the U.S. are fortified with the B-vitamin folic acid, only one-third of U.S. women of childbearing age consume the recommended amount from their diet. Taking a multivitamin with folic acid every day is a key way that women can get the recommended amount of 400 mcg.

Remember be prepared before pregnancy

Women need folic acid, even if not planning to become pregnant, since 50% of all pregnancies are unplanned. Taking folic acid before pregnancy reduces the risk of birth defects of the brain and spine, called neural tube defects (NTDs), by up to 70%.

Message to the Hispanic community

Hispanic babies are 1.5 to 2 times more likely than others in the U.S. to be born with an NTD. The Centers for Disease Control and Prevention (CDC) report that Latinas in the U.S. consume the least amount of folic acid and have the least knowledge about folic acid among racial or ethnic groups.


“Influenza (flu) and the common cold are both contagious respiratory illnesses, but they are caused by different viruses. Flu is caused by influenza viruses only, whereas the common cold can be caused by a number of different viruses, including rhinoviruses, parainfluenza, and seasonal coronaviruses.”

Centers for Disease Control and Prevention CDC (

Knowing the facts and treatment on the cold and Influenza!

-flu-transmission2  flu



-Both colds and flu usually last the same seven to 10 days, but flu can go three to four weeks; the flu virus may not still be there, but you have symptoms long after it has left. Allergy can last weeks or months.  The CDC states regarding the rise of the flu since the past 40 years from the date provided in this sentence with updating this article from Sept 20, 2022 the following: “During this 40-year period, flu activity most often peaked in February (17 seasons), followed by December (7 seasons), January (6 seasons) and March (6 seasons).”

-The winter flu epidemic will be coming around us again and in a given locality it reaches its peak in 2 to 3 weeks and lasts 5 to 6 weeks. Then is disappears as quickly as it arrived. The reason for this is not completely clear. The usual pattern is for a rise in the incidence of flu in children, which precedes an increase in the adult population.  Know this it repeats again certain seasons as listed above by the CDC.

-The flu virus can lead to serious complications, including bronchitis, viral or bacterial pneumonia and even death in elderly and chronically ill patients. Twenty thousand or more people die of the flu in the America each year. Know this that the frequency of human contact across the world and the highly infectious nature of the virus make this explanation difficult to accept. Moreover there is no evidence of persistent or latent infection with influenza viruses. In any case, this idea is not really very difficult from the notion that the virus circulates at a low level throughout the year and seizes its opportunity to cause an outbreak when conditions allow.

-Even harder to explain is why the flu disappears from a community when there are still a large number of people susceptible to infection. Than even harder than that is why flu is a winter disease, which is not fully understood or known. However, flu is spread largely by droplet (aerosol) infection from individuals with high viral level in their nasal and throat secretions, sneezing, and coughing on anyone close at hand. The aerosol droplets of the right size (thought to be about 1.5 micrometers in diameter) remain airborne and are breathed into the nose or lungs of the next victim.

-Situations in which people are crowded together are more commonly in cold or wet weather and so perhaps this contributes to spreading the flu at these times. It is interesting that in equatorial countries, flu occurs throughout the year, but is highest in the monsoon or rainy season. Enough about facts but onto logical thinking for when we or someone we know has it and what questions we might be asking ourselves.  


Are the treatments for these illnesses the cold or the flu different?

For any of these things, if it affects the nose or sinus, just rinsing with saline that gets the mucus and virus out is a first-line defense. It’s not the most pleasant thing to do, but it works very well.

There are classes of medicines that can help the flu — Tamiflu and Relenza — antivirals that block viruses’ ability to reproduce and shorten the length and severity of the illness. But they have to be taken within 48 hours or the cat is proverbially out of the bag [because by then] the virus has done the most of its reproduction.

For a cold or flu, rest and use decongestants and antihistamines, ibuprofen, acetaminophen, chicken soup and fluids. Zinc supposedly helps the body’s natural defenses work to their natural capacity and decrease the severity and length of a cold. Cells need zinc as a catalyst in their protective processes, so if you supply them with zinc, it helps them work more efficiently.

You should also withhold iron supplements. Viruses use iron as part of their reproductive cycle, so depriving them of it blocks their dissemination. The majority of these infections are not bacterial and do not require [nor will they respond to] antibiotics. My rule of thumb is that a viral infection should go away in seven to 10 days. If symptoms persist after that, you’d consider if it’s bacteria like Strep or Haemophilus.  Those bacteria cause illnesses that are longer lasting and need antibiotics for ranging 3 to 14 days, depending on the med used.

Is that treatment approach the same for kids versus adults? In general, the same rules apply: Most children will have six to eight colds a year in their first three years of life, and most are viral. Adults have 3 or more a year. It’s very easy to test for strep and for that you should have a [positive] culture [before treating with antibiotics]. The principle behind that is knowing the organism the doctor will know what antibiotic to use to fight off the bacterial infection and you won’t build up antibodies from the antibiotic that you didn’t need in the first place if you are given the wrong antibiotic in the beginning.

Are there strategies for avoiding cold and flu different? Avoidance is very similar for both: Strict hand washing, not sharing drinking cups or utensils, and avoiding direct contact with people who are sneezing. Their transmission is similar. As long as someone has a fever, they have the possibility to transmit infection. After they’ve had no fever for 24 hours, they’re not infectious anymore.

The U.S. Centers for Disease Control and Prevention (CDC) now recommends that just about everyone get the flu shot: kids 6 months to 19 years of age, pregnant women, people 50 and up, and people of any age with compromised immune systems. Is the shot beneficial to anyone who gets it? Unless you have a contraindication, there’s no reason not to get it=PREVENTION. Contraindications include egg allergy (because the vaccine is grown from egg products), any vaccines within a last week or two, and active illness at the time of your vaccine.

The best to do is PREVENTION so you can avoid the cold or flu in its active phase or post phase, so doing the following will help prevent it:

Get vaccinated yearly if your a candidate and live a healthy lifestyle overall=Good dieting, living good healthy habits and maintaining exercise with rest daily or 2 to 3 times a week including get a vaccine yearly for the flu with maintaining good clean anti-infection habits like as simply as washing the hands as directed above.

****Recommended is to check with your MD on any changes with diet or exercise especially if diagnosed already with disease or  and on medications especially; for your safety.****

References on The FLU and The COLD:

1-Wikipedia “the free encyclopedia” 2013 website under the topic Influenza.

2-Kimberly Clark Professional website under the influenza.

3-Web MD under “COLD, FLU, COUGH CENTER” “Flu or cold symptoms?” Reviewed by Laura J. Martin MD November 01, 2011

4-2013 Novartis Consumer Health Inc. Triaminic “Fend off the Flu”

5-Scientific American “Why do we get the flu most often in the winter? Are viruses virulent in cold weather? December 15, 1997






“Pacemakers are devices that can be placed in your body, usually by surgery, to support the electrical system in your heart. They can stabilize abnormal heart rhythms and prevent problems that can disrupt or endanger your life.  Your heart has its own electrical system, which tells your heart’s chambers when it’s their turn to squeeze. When your heart’s electrical system malfunctions, your heart’s chambers may squeeze in the wrong order or squeeze too weakly to provide enough blood to your body. Pacemakers use electrical impulses to correct these kinds of malfunctions. 

While it depends on the specific model of pacemaker and how often it has to assist your heart, pacemakers are now available that can last as long as 10 or 15 years. Your healthcare provider can tell you the average lifespan of the device you’ll receive, and will also schedule follow-up appointments to check your pacemaker’s battery level. It’s also usually a simpler process to replace a pacemaker battery than it was to implant the device in the first place.”

Cleveland Clinic

What to know about Pacemaker Insertion for those with AFib with pauses or rhythm arrest and more!


Pacemakers are sometimes recommended for people with conditions that cause the heart to beat abnormally.

Each time the heart beats, the heart muscle contracts (pulls inwards) in preparation for pumping blood around the body.

The contractions are triggered by electrical pulses. These are generated by a group of specialised cells known as the sinoatrial node (SA node).

The SA node is often referred to as a natural pacemaker because it generates a series of electrical pulses at regular intervals.

The pulse is then sent to a group of cells known as the atrioventricular node (AV node). The AV node relays the pulse to the 2 lower chambers of the heart (the ventricles).

A pacemaker or implantable cardioverter defibrillator (ICD) is needed when something disrupts this process and causes an abnormal heartbeat.

An abnormal heartbeat is called an arrhythmia. Here are some of the most common causes of arrhythmias:

Sick sinus syndrome

In sick sinus syndrome, the SA node doesn’t work as it should. This can lead to an abnormally slow heartbeat (bradycardia), an abnormally fast heartbeat (tachycardia), or a combination of both.

Symptoms of sick sinus syndrome can include:

  • a slower pulse than normal (bradycardia)
  • extreme tiredness (fatigue)
  • fainting (or nearly fainting)
  • dizziness or lightheadedness
  • shortness of breath
  • chest pain
  • irregular or fluttering heartbeats (palpitations)

Most cases of sick sinus syndrome are thought to be related to age.

Over time, the SA node tissue can become hardened and scarred. This can disrupt the normal pattern of electrical pulses released by the SA node.

Some types of medication can also trigger sick sinus syndrome as a side effect. These include calcium channel blockers and beta blockers.

Atrial fibrillation

Atrial fibrillation is a condition that causes the heart to beat abnormally fast.

This is usually considerably higher than 100 beats a minute (often 140 beats a minute or more).

Atrial fibrillation can usually be treated with medication, but some people don’t respond to treatment, so a pacemaker may be recommended.

Sometimes people with atrial fibrillation can have a much slower pulse rate than normal, which can also be intermittent (not continuous).

In these cases, a pacemaker will usually be recommended.

Heart block

In people with heart block, the pulse that needs to be sent from the SA node to the AV node is either delayed or absent.

Heart block can be caused when the heart is damaged (acquired heart block), or it can occur if a baby is born with 1 or more defects that affect their heart (congenital heart block).

If you have heart block and it’s causing troublesome symptoms, a pacemaker will usually be recommended.

Cardiac arrest

An implantable cardioverter defibrillator (ICD), which is a device similar to a pacemaker, is mainly used to prevent cardiac arrest.

A cardiac arrest is a potentially fatal condition where the electrical activity that controls the heart becomes so disrupted that the heart stops beating.

Unless it’s treated quickly, a cardiac arrest will be fatal.

An ICD can detect abnormal electrical signals that could indicate that a cardiac arrest is about to happen.

If the ICD detects these type of signals, it sends a powerful electrical shock to the heart.

This basically “reboots” the heart. After the shock, the heart should start beating normally again.

An ICD implantation may be recommended if you have had a cardiac arrest in the past or it’s thought you have a significant risk of having one in the future.

What are pacemakers?

Pacemakers are electronic devices that stimulate the heart with electrical impulses to maintain or restore a functional heartbeat. Pacemakers were initially external and involved the placement of subcutaneous electrodes for patients with inappropriate intrinsic cardiac pacemaker activity and-or abnormal conducting tissue. The complete heart block was treated using electrodes directly attached to the heart. Ultimately, the pacemaker evolved and an entirely implantable pacemaker was developed. Since then, there have been several advancements in pacemakers, and the modern-day permanent pacemaker is placed subcutaneously. This activity reviews the indications, contraindications of pacemakers and highlights the role of the interprofessional team in the management of patients requiring them.

Pacemakers are electronic devices that stimulate the heart with electrical impulses to maintain or restore a normal heartbeat. In 1952, Zoll described an effective means of supporting the patients with intrinsic cardiac pacemaker activity and/or conducting tissue by an artificial, electric, external pacemaker. The pacing of the heart was accomplished by subcutaneous electrodes but could be maintained only for a short period. In 1957, complete heart block was treated using electrodes directly attached to the heart. These early observations instilled the idea that cardiac electrical failure can be controlled. It ultimately led to the development of totally implantable pacemaker by Chardack, Gage, and Greatbatch. Since then, there have been several advancements in the pacemakers, and the modern-day permanent pacemaker is subcutaneously placed device.

There are several different types of pacemakers.

The main types are:

  • single-chamber pacemaker – this has 1 wire, which is connected to either the right atrium (upper heart chamber) or right ventricle (lower heart chamber)
  • dual-chamber pacemaker – this has 2 wires, which are connected to the right atrium and right ventricle
  • biventricular pacemaker – this has 3 wires, which are connected to the right atrium, right ventricle and left ventricle

There are 4 types of artificial pacemakers:

  1. Implantable pulse generators with endocardial or myocardial electrodes
  2. External, miniaturized, patient portable, battery-powered, pulse generators with exteriorized electrodes for temporary transvenous endocardial or transthoracic myocardial pacing
  3. Console battery or AC-powered cardioverters or monitors with high-current external transcutaneous or low-current endocardial or myocardial circuits for temporary pacing in asynchronous or demand modes, with manual or triggered initiation of pacing

All cardiac pacemakers consist of 2 components: a pulse generator which provides the electrical impulse for myocardial stimulation and 1 or more electrodes or leads which deliver the electrical impulse from the generator to the myocardium. This discussion focuses on the indications of pacemaker placement.

The type of pacemaker you need will depend on your specific heart problem.


The most common indications for permanent pacemaker implantation are sinus node dysfunction (SND) and high-grade atrioventricular (AV) block. Guidelines for implantation of cardiac pacemakers have been established by a task force formed jointly by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS). The European Society of Cardiology has established similar guidelines.

ACC/AHA/HRS divides indications of pacemaker implantation into 3 specific classes:

  • Class I: These are conditions where implantation of a pacemaker is considered necessary and beneficial (benefits much greater than risks).
  • Class II: These are conditions where placement is indicated, but there is conflicting evidence or divergence of opinion. In Class IIa weight of evidence is in favor of efficacy (benefits greater than risk), while in class IIb, the efficacy is less well established (benefits ­greater than or equal to the risks).
  • Class III: These are conditions in which permanent pacing is not recommended, and in some cases, it may be harmful (risks greater than the benefits).


The pacing and CRT are associated with complications. The majority of complications occur in the hospital or during first 6 months. Lead complications are the main reason for the re-implantation of the pacemaker and CRT devices. Other complications include, but are not limited to infections, hematoma formation, pericardial effusion or tamponade, pneumothorax, coronary sinus dissection, or perforation. Some old pacemakers are not MRI safe.

Pacemaker procedures tend to have few complications, which you can discuss with your healthcare provider. In general, the following complications that are possible:

  • Allergic reactions: These may happen because of a medication you’re given or you may be allergic to one of the materials used in the pacemaker itself.
  • Blood clots: Your healthcare provider may prescribe blood-thinning medications to reduce the risk of developing a blood clot.
  • Malfunctions of the pacemaker or its leads: In some cases, a pacemaker lead may get jostled out of position or might break free. Your healthcare provider will recommend limiting your activity for a while after your procedure to avoid this.
  • Malfunctions caused by sources outside of your body: Your healthcare provider will give you instructions on devices or machines to avoid so you don’t have pacemaker problems caused by outside electrical interference. Fortunately, advancements in pacemaker technology mean these situations aren’t common.
  • Unexpected heart rhythm problems: Some people develop heart rhythm problems — in rare instances — because of the pacemaker. Your healthcare provider can talk to you about these risks and help you avoid them.

Pacemaker implantation has shown a mortality benefit overall.

There are some areas where the indications for a pacemaker are clear, but there are few areas where clinical judgment and expertise plays a greater role. Although the guidelines attempt to define practices that meet the needs of most patients, the ultimate decision for the patient should be based on particular patient presenting scenario, clinician judgment, and discussion with the patient about risks and benefits of the procedure. There are specific pacemaker generators that are used for patients with AV block and sinus node dysfunction depending upon presentation. The different types of generators include a single chamber, dual chamber, and biventricular. A cardiology consult is highly recommended prior to the insertion of a pacemaker.


“Atrial fibrillation (AFib) is an irregular and often very rapid heart rhythm but it can also be a in slow rate for some. An irregular heart rhythm is called an arrhythmia and that is all AFIB patients who are diagnosed with it. AFib can lead to blood clots in the heart. The condition also increases the risk of stroke, heart failure and other heart-related complications.

During atrial fibrillation, the heart’s upper chambers — called the atria — beat chaotically and irregularly. They beat out of sync with the lower heart chambers, called the ventricles. For many people, AFib may have no symptoms. But AFib may cause a fast, pounding heartbeat, shortness of breath or light-headedness due to the rapid heart rate.

AFib can also be bradycardia (a slow heart beat rhythm).

You could have pauses  in that AFIB bradycardia that are called sick sinus syndrome or a longer pauses causing sinus arrest.  Each pt’s heart is unique on how it operates.”


Heart Rhythms, like A FIb, with a pause in it called Sick Sinus Syndrome-What it is, S/S, causes, tests, and treatment!

   TopBox-Normal Sinus Rhythm

Normally, the heartbeat starts in an area in the top chambers of the heart (atria). This area is the heart’s pacemaker. It is called the sinoatrial node, sinus node or SA node. Its role is to keep the heart beat steady and regular. This creates the normal rhythm of the human body call Normal Sinus Rhythm (listed above in pictures in 2nd box call NSR).

Sick sinus syndrome is a group of heart rhythm problems due to problems with the sinus node, such as:

  • The heartbeat rate is too slow, called sinus bradycardia
  • The heartbeat pauses or stops, called sinus pauses or sinus arrest
  • Episodes of a fast heart rate
  • Slow heart rhythms that alternate with fast heart rhythms, called bradycardia-tachycardia or “tachy-brady syndrome”  Tachy meaning fast and Brady meaning slow.

Alternative Names

Bradycardia-tachycardia syndrome; Sinus node dysfunction; Slow heart rate – sick sinus; Tachy-brady syndrome; Sinus pause – sick sinus; Sinus arrest – sick sinus


Sick sinus syndrome most often occurs in people older than age 50. It is often due to scar-like damage to electrical pathways in the heart muscle tissue.

In children, heart surgery on the upper chambers is a common cause of sick sinus syndrome.

Coronary heart disease, high blood pressure, and aortic and mitral valve diseases may occur with sick sinus syndrome. However, these diseases may have nothing to do with the syndrome.

Sick sinus syndrome is uncommon, but not rare. It is the most common reason people need to have an artificial pacemaker implanted. Sinus bradycardia occurs more often than the other types of the condition.

Tachycardias (rapid heart rhythms) that start in the upper chambers, when the SA node can’t work to intiate the person’s rhythm,  atrial rhythms start to take over as the pacemaker of the heart that may be part of the sick sinus syndrome for people who have it. These atrial rhythms include atrial fibrillation, atrial flutter, atrial tachycardia-all are types of upper chamber heart rhythms, where they intiate from. A period of fast heart rates is often followed by very slow heart rates. When there are periods of both slow and fast heart rates (rhythms) the condition often will be called tachy-brady syndrome; this is what makes up atrial fibrillation (a fib) irregular rhythm/slow and fast heart beats and due to this allows pooling of blood in the heart chamber putting it at a potential to clot and could be passed on from the heart into circulation if the clot breaks off and if it reaches the brain puts the patient at risk for stroke.  Or A Fib can cause heart failure or other cardiac problems.

Some medicines can make abnormal heart rhythms worse, especially when doses are high. These include digitalis, calcium channel blockers, beta-blockers, and antiarrhythmics.


Most of the time, there are no symptoms.

Symptoms that do occur may mimic those of other disorders.

Symptoms may include:

  • Chest pain or angina
  • Confusion or other changes in mental status
  • Fainting or near-fainting
  • Fatigue
  • Dizziness or lightheadedness
  • Sensation of feeling the heart beat (palpitations)
  • Shortness of breath, possibly only with physical activity like walking

Exams and Tests

The heart rate may be very slow at any time. Blood pressure may be normal or low.

Sick sinus syndrome may cause symptoms of heart failure to start or get worse. Sick sinus syndrome is diagnosed when the symptoms occur only during episodes of arrhythmia. However, the link is often hard to prove.

An ECG may show abnormal heart rhythms related to this syndrome.

Holter or longer term rhythm monitors are effective tools for diagnosing sick sinus syndrome. They may pick up very slow heart rates and long pauses, along with episodes of atrial tachycardias. Types of monitors include event monitors, loop recorders, and mobile telemetry.

An intracardiac electrophysiology study (EPS) is a very specific test for this disorder. However, it is not often needed and may not confirm the diagnosis.

In some cases, a person’s heart rate is observed when walking or exercising to see if it increases enough; a stress test.


You may not need treatment if you do not have any symptoms. Your health care provider will review the medicines you take to make sure they are not making your condition worse. Do not stop taking any of your medicines unless your provider tells you to do so.

You may need a permanent implanted pacemaker if your symptoms are related to bradycardia (slow heart rate or with long pauses or rhythm arrest (completely stops).

Part II Total Brain Injury (TBI) in regards to Winter Sports.

  xte head tackle CTE5

CTE 5 cte hockey




Part II reviews Concussion-The symptoms/grade levels/diagnostic tooling with treatment and  CTE=Chronic Traumatic Encephalopathy

 The signs and symptoms you may see indicating a concussion aren’t immediately present where in other situations observed immediately; it depends on the impact of the hit to the brain and location. Concussions are fairly common. Some estimates say a mild brain trauma is sustained every 21 seconds in the U.S. But it’s important to recognize the signs of a concussion so you can take the proper steps to treat the injury.

There are some common physical, mental, and emotional symptoms a person may display following a concussion. Any of these could be a sign of traumatic brain injury: confusion or feeling dazed/clumsiness/slurred speech/nausea or vomiting /headache /balance problems or dizziness /blurred vision/sensitivity to light/sensitivity to noise/sluggishness/Tinnitis – ringing in the ears/behavior or personality changes/concentration difficulties/memory loss.

Concussions are graded as mild (grade 1), moderate (grade 2), or severe (grade 3), depending on such factors as loss of consciousness, amnesia, and loss of equilibrium.

-Grade 1 concussion symptoms last for less than 15 minutes. There is no loss of consciousness.

-Grade 2 concussion there is no loss of consciousness but symptoms last longer than 15 minutes.

-Grade 3 concussion the person loses consciousness, sometimes just for a few seconds.

The seriousness of a concussion dictates what kind of treatment you should get. Most people with concussions fully recover with appropriate treatment. But because a concussion can be serious, safeguarding the person who got the concussion is important.   Seek medical attention. A health care professional can decide how serious the concussion is and whether you require treatment or not.

If you have suffered a grade 1 or grade 2 concussion, wait until symptoms are gone before returning to normal activities. That could take several minutes, hours, days, or even a week but still see a MD to know the level for sure.

If you have sustained a grade 1,2, or 3 concussion, see a doctor immediately for observation and treatment since most people don’t know the different levels or what level they have had. A doctor will be able to tell all through diagnostic tooling.  The M.D. will need to know details about how the concussion even happened including the symptoms you or the patient is having.   The doctor asks simple common questions to evaluate memory and concentration skills (your name, the present year, where you are, etc…).


The doctor may test coordination and reflexes, which are both functions of the central nervous system. The doctor may also order a CT scan or an MRI to rule out bleeding or other serious brain injury especially if he feels it was a grade 3 concussion.

If hospitalization is not required, the doctor will provide instructions for recovery. Aspirin-free medications may be prescribed and you will be advised to take it easy. Experts recommend follow-up medical attention within 24 to 72 hours if symptoms worsen.

  • Take a break. If your concussion was sustained during athletic activity, stop play and sit it out. Your brain needs time to properly heal, so rest is key. Definitely do not resume play the same day. Athletes and children should be closely monitored by coaches upon resuming play. If you resume play too soon, you risk a greater chance of having a second concussion, which can compound the damage. The American Academy of Neurology has issued guidelines about resuming activities after a concussion.
  • Guard against repeat concussions. Repeat concussions cause cumulative effects on the brain. Successive concussions can have devastating consequences, including brain swelling, permanent brain damage, long-term disabilities, or even death. Don’t return to normal activities if you still have symptoms. Get a doctor’s clearance so you can return to work or play with confidence.

Can I Prevent a Concussion?

NO, since normally a concussion is unexpected, so it is tough to prevent. But there are several common-sense precautions you can take to lessen the possibility of traumatic brain injury.  What you can do is PREVENTION by wearing proper protective equipment in high contact sports from football to hockey to boxing and even soccer (all increase the chance of a concussion).  Bicycling, skateboarding, horseback riding to roller blading all can be a threat of a concussion due to a fall to the head.  Wear head gear, padded guards for knees/elbows and even mouth gear or eye guards especially in racquet ball.  Believe it or not a bike helmet can lower the risk of traumatic head injury by 85%. Ensure that the equipment is properly fitted, well maintained, and worn consistently.

For athletes and non athletes, always wear a seatbelt, obey posted speed limits, and don’t use drugs or alcohol, don’t be foolish texting or using the cell phone while driving because they can impair reaction time. Obviously, don’t fight to cause a blow to your head from occuring, and more males than females report traumatic head injuries.

Look what can happen after repeated blows done to the head over a long time – Chronic traumatic encephalopathy (CTE) is a form of encephalopathy that is a progressive degenerative disease, which can currently only be definitively diagnosed postmortem.  Let us look at the meaning of the word actually in medical terminology=Chronic (meaning over a period of a long time) Traumatic (meaning the blows to the head) Encephalopathy (swelling of the brain definitely is a part of what happens but in all types of encephalopathy there is a brain malfunction.  Know there are over 150 different terms that modify or precede “encephalopathy” in the medical literature.

In March 2014, researchers announced the discovery of an exosome particle created by the brain which has been shown to contain trace proteins indicating the presence of the disease  Baseline testing has been created to assess potential cognitive impairment in athletes in contact sports, but a test to determine the presence of CTE while the person is alive and a conventional postmortem diagnosis is not yet available.

The disease was previously called dementia pugilistica (DP), i.e. “punch-drunk”, as it was initially found in those with a history of boxing. CTE has been most commonly found in professional athletes participating in American football, Association football, ice hockey, professional wrestling and other contact sports who have experienced repetitive brain trauma. It has also been found in soldiers exposed to a blast or a concussive injury, in both cases resulting in characteristic degeneration of brain tissue and the accumulation of tau protein. Individuals with CTE may show symptoms of dementia, such as memory loss, aggression, confusion and depression, which generally appear years or many decades after the trauma.

CTE is a progressive degenerative disease of the brain found in people with a history of repetitive brain trauma, including symptomatic concussions as well as sub-concussive hits to the head that do not cause symptoms. In the case of blast injury, a single exposure to a blast and the subsequent violent movement of the head in the blast wind can cause the condition.  Look at the perfect example of who this happened to that most of Americans know or heard about what the famous boxer Muhammed Ali.

Unfortunately chronic traumatic encephalopathy (CTE) at this time can only be diagnosed 100% after death. Below is a list of confirmed cases of CTE and the breakdown by sport. It should be noted that this is a small list compared to doctors understanding of the problem of CTE and the many undiagnosed cases. Through the work of the Center of the Study of Traumatic Encephalopathy researchers have been successful in securing donations of professional athletes brains after death for further study so researchers can better understand CTE and how to better prevent it. Many on this list were identified this way.

Professional Football Players:

  • John Grimsley – Houston Oilers, Miami Dolphins – February 2008 (45) – Case Study
  • Chris Henry – Cincinnati Bengals – December 2009
  • Dave Duerson – Chicago Bears – Suicide – February 17th, 2011 (50)
  • Lew Carpenter – Detroit Lions, Clevelend Browns, Green Bay Packers – November 14th, 2010 (78)
  • Lou Creekmur – Detroit Lions (NFL Hall of Fame) – July 5th, 2009 (82) – Case Study
  • Shane Dronett – Denver Broncos, Detroit Lions, Atlanta Falcons – January 12, 1971 Floyd Patterson

Professional Boxers:

Bobby Chacon/Jerry Quarry/Mike Quarry/Wilfred Benitez/Emile Griffith/Willie Pep/Sugar Ray Robinson/Billy Conn/Joe Frazier/Muhammad Ali (suspected)

How many non professionals have been injured due to TBI’s  with not any better.  We know now and are taking action in awareness to the public to decrease the occurrences of these brain injuries from happening!  Help the community with awareness too!!

If you notice in most of my articles there is a key to prevention in getting a illness or disease.  Start taking the step towards prevention and not waiting till it happens especially CTE since the symptoms tell the M.D. the patient has high probability of the disease but can’t be actually 100% diagnosed till death in the morgue.

SO TAKE THE STEP IN MAKING A CONCUSSION NOT HAPPEN=PREVENTION, it is so simple.  Which decreases the chance of dementia, memory loss, depression from repeated blows to the head. PROTECT YOURSELF!


You may not be happy with the results especially if the cause of death was hemmorage in the brain!





“A direct blow to the head, or a blow to the body that suddenly rotates the head, can lead to a concussion, causing the brain to rapidly move back and forth inside the skull. “You don’t need impact to the head to have a concussion,” Dr. Sethi notes. For example, a football tackle or a fender bender may involve no head contact but could cause the head to whip around fast enough to cause a concussion.

Concussions typically do not damage the brain. “In the majority of cases, CAT-scans of concussion come back negative,” Dr. Sethi says. Yet, a concussion can temporarily stop the brain from working properly.

The danger is in not recognizing the signs of a concussion, especially since they are not always obvious, Dr. Sethi stresses. “Parents should know that concussion symptoms—a headache, dizziness, difficulty tolerating light or noise–could be very subtle,” he says. Athletes who have sustained a knock to the head commonly insist that they’re fine so that they can keep playing. “If you’re a coach on the sideline you may not notice anything wrong until you see that a player is off balance, looks confused or disoriented, or has a glassy look in his eyes,” he says.

Even severe head injuries, like hematomas, do not always produce immediate symptoms, Dr. Sethi says, recounting the late actor Natasha Richardson, who fell off her skis and hit the back of her head, insisted she felt fine, and refused medical care. “We call these injuries walking, talking, and dying. By the time she got to the hospital, her brain was hemorrhaging.”

Weill Cornell Medicine (