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Emergency Resuscitation

You are in a room where a person suddenly drops to the floor unconscious. You put your ear over his heart and hear no heartbeats. That person is dead unless you pump on his chest immediately to circulate blood to bring enough oxygen to keep his brain alive, and then shock his heart with an electrical defibrillator to make it start beating again.

He passed out because *his brain suffered from lack of oxygen, *caused by lack of blood circulating to his brain, *caused by his heart fibrillating (shaking rather than pumping) or having a heart beat too weak to pump blood. His brain will die in a minute or two if you don't circulate blood by compressing his chest, and his heart will not start beating again unless you shock it as soon as possible, within about ten minutes.

Recent studies show that:

• Compressing the chest first is just as successful as using the electrical defibrillator first (BMC Journal, September 2010). A study of 1,503 patients showed that survival rates were the same for immediate defribrillation and after at least 90 seconds of chest compressions before electrical defibrillation.

• Interrupting chest compressions during resuscitation reduces the chances of heartbeat return to normal after electrical shocking (defibrillation). For every second of a pause in compressions there is a one percent reduction in the likelihood of success (BMC Medicine, February 6, 2009; Circulation, October 2009).

• Mouth-to-mouth resuscitation is no better than just pressing on the chest (NEJM, July 29, 2010). You may not need to do mouth-to-mouth resuscitation in adults. However, this may not apply to children because of their small lungs.

• Place the heel of one hand between the nipples and the other hand on top of that.

• Keep elbows straight with your shoulders directly over your hands.

• With your upper body weight, push down on the chest two inches deep at 100 compressions a minute.

• Continue until signs of movement or until emergency help arrives.

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Dear Dr. Mirkin: How can I use strength training to make me a better racer in endurance sports such as cycling, running or rowing?

Do strength training along with your endurance training, but do not go to failure! A study from Spain divided highly trained, competitive rowers into four groups:

1) four arm exercises leading to repetition failure,
2) four exercises not leading to failure,
3) two exercises not to failure, and
4) no resistance training.

All four groups did the same endurance training (Medicine and Science in Sports and Exercise, June 2010). Those who did the four exercises not to failure improved the most in *rowing performance, *lifting the heaviest weight that they could lift once, and *the highest muscle power output.

Athletes who train primarily for strength must train to muscle failure. That means that they lift weights repeatedly until they can barely lift that weight another time. This causes muscle damage that is necessary for maximum muscle growth and strength. The next-day muscles soreness tells them that their muscles are damaged and when thy heal, their muscles will be stronger. Then they take easier workouts until the soreness goes away and repeat their muscle-damaging workouts.

However, athletes in endurance sports must take long hard workouts lasting many hours. If lifting weights causes so much muscle damage that they cannot do their endurance workouts, they cannot compete in their sports. This study shows that athletes in endurance sports can benefit from lifting weights, but they should not go to failure so often that it reduces their workouts that are specific for their sports.

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Dear Dr. Mirkin: How can I reduce my risk for breast cancer?

One American women in eight can expect to develop breast cancer. This rate is double that of women in Brazil and triple those in China (American Institute for Cancer Research). Since the majority of breast cancer cases are caused by factors in the environment and not by genes (Lancet, June 19 2010), women (and men) need to change some habits.

A major risk factor for breast cancer is having higher and longer exposure to the female hormone, estrogen, caused by:

• being overweight (fat cells are the principal source of estrogen after menopause);
• taking estrogen-containing birth control pills;
• taking estrogen after menopause;
• starting menstruation early (before age 13);
• starting menopause late (after age 52);
• drinking alcohol (alcohol reduces the liver's ability to remove estrogen from the bloodstream).

Other risk factors include:
• not having children;
• not exercising;
• having your first child after age 35;
• not breast feeding;
• having dense breast tissue;
• diabetes;
• storing fat in the belly, rather than the hips;
• gaining body fat in later life;
• smoking;
• eating red meat;
• not eating enough fruits and vegetables.

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Recipe of the Week:

Gabe's Famous Bean-Eggplant-Tomato Casserole (quick version!)

You'll find lots of recipes and helpful tips in The Good Food Book - it's FREE

June 21st, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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