Category: Cardiovascular

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Treating Microcirculation Defects in Cardiovascular Diseases

Defects in microcirculation have been documented as major factors in the development of cardiovascular diseases, especially type 1 diabetes.[1] By treating microcirculation defects, thus increasing blood and oxygen flow to the heart, the risk of recurrent significant cardiovascular events can be reduced significantly, and strength and endurance can improve. 

An example of microcirculation compromise in a patient with severe cardiovascular disease can be seen in the clinical case of Leo B.

Leo was a 64-year-old male with a medical history of diabetes mellitus for 15 years, cigarette smoking, elevated cholesterol, and high LDL (harmful blood fat) levels. 

Leo had a heart attack (myocardial infarction) several years ago.

He had suffered a myocardial infarction 6 weeks earlier and also suffered from exertional angina (chest pain with exertion).

He was taking lisinopril (20 mg per day) for high blood pressure, insulin for his diabetes, and one baby aspirin a day as a blood thinner to prevent another heart attack.

Leo was put on a cardiac rehabilitation regimen[2] consisting of a low-fat diet, moderate exercise, and stress control. 

He used D’OXYVA[3]as an adjunct application, which helped increase his strength and endurance while decreasing his episodes of exertional chest pain.

What is Microcirculation? 

In general, microcirculation[4] refers to the smallest blood vessels in the body, consisting of the arterioles, venules, and capillaries. 

These tiny blood vessels supply oxygen to the organs of the body and remove waste products produced by the body’s metabolism. 

Smooth muscle cells, which are the lining cells of the arterioles and of some venules, are under the control of the sympathetic and parasympathetic nervous systems and other chemical factors. 

These influences help control the ability of the microcirculatory system to dilate and contract to increase or decrease circulation and oxygenation.

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What is Coronary Microcirculation? 

Coronary microcirculation (microvascular network) refers to the smallest arterioles and venules that supply the heart. 

These tiny branching blood vessels play crucial roles in supplying oxygen and removing waste products from the heart muscle. 

When the heart requires more oxygen, the arterioles dilate, increasing blood flow to the heart. 

This is especially important if a patient suffers from cardiovascular conditions such as angina or heart failure. 

What Causes Cardiac Microcirculation Dysfunction? 

Dysfunction of cardiac microcirculation can be caused by many factors, including:

  • Dysfunction of the endothelial (lining) cells of the arterioles, which affects the ability of arterioles to dilate and allow for increased blood flow
  • Increased alpha 2 adrenergic activity, which leads to vasoconstriction and resultant decreased cardiac perfusion
  • Sclerosing of the arterioles, causing reduced blood flow and oxygenation 
Conclusion 

Microcirculation consists of the smallest blood vessels in the body and includes cardiac microcirculation, which plays a crucial role in supplying oxygen and removing waste products from the heart. The transdermal deoxyhemoglobin vasodilator D’OXYVA plays an important role in increasing blood flow (perfusion) and resultant oxygenation to the cardiovascular system. This increase in oxygenation has been found to help increase endurance and strength and is an important adjunct solution to consider as part of cardiac rehabilitation.

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/31733651
  2. https://www.nhlbi.nih.gov/health-topics/cardiac-rehabilitation
  3. https://doxyva.com/active-lifestyle/
  4. https://academic.oup.com/eurheartj/article/38/7/478/3048614

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HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

LEARN MORE ABOUT D'OXYVA
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Diabetes, cardiovascular disease and the microcirculation

Abstract

Cardiovascular disease (CVD) is the leading cause of mortality in people with type 2 diabetes mellitus (T2DM), yet a significant proportion of the disease burden cannot be accounted for by conventional cardiovascular risk factors. Hypertension occurs in majority of people with T2DM, which is substantially more frequent than would be anticipated based on general population samples. The impact of hypertension is considerably higher in people with diabetes than it is in the general population, suggesting either an increased sensitivity to its effect or a confounding underlying aetiopathogenic mechanism of hypertension associated with CVD within diabetes. In this contribution, we aim to review the changes observed in the vascular tree in people with T2DM compared to the general population, the effects of established anti-diabetes drugs on microvascular outcomes, and explore the hypotheses to account for common causalities of the increased prevalence of CVD and hypertension in people with T2DM.

Background

Type 2 diabetes mellitus (T2DM) and hypertension are established risk factors for cardiovascular disease (CVD), and people with T2DM and hypertension have an increased risk of cardiovascular (CV) mortality compared with those with either condition alone. This excess risk is suggested to be due to the synergistic effect on large and small blood vessels simultaneously, thereby reducing the potential for compensatory collateralization protecting organs from the adverse consequences of damage to either vascular bed. The principle role of the vasculature is to deliver oxygen and nutrients to the tissues—whether that is the heart, the brain, or the kidney. The functional changes occurring in T2DM and hypertensive conditions significantly alter the haemodynamic stress on the heart and other organs. However, the different physiology, mechanisms and changes at the microvascular level differ from those at the macrovascular level in T2DM and hypertension, which in turn have significant implications with respect to future CV risk.

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Conclusions

Over the past few decades, epidemiological studies have elucidated the role of impaired microcirculation in people with diabetes and aetiopathogenesis of CVD. This has led to the recognition of the prevalence of microvascular disease. Furthermore, the prognostic value of incidence of microvascular disease in predicting CVD is now acknowledged. The focus of present-day epidemiological studies is to understand the association between pathological mechanisms and the risk factors to ascertain whether they are targets of therapeutic value or risk markers of CVD. These studies have contributed to the evidentiary framework in favour of clinical monitoring of microvascular function, and spurred the initiation of mechanistic studies by redefining our knowledge of vascular disease, particularly in people with diabetes.

Read full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905152/

HOW D’OXYVA CAN HELP?

Over the past few decades, epidemiological studies have elucidated the role of impaired microcirculation in people with diabetes and aetiopathogenesis of CVD. D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

LEARN MORE ABOUT D'OXYVA
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Under Armour developing ‘smart’ sneaker that reads blood pressure

Under ArmourOpens a New Window. is developing a “smart” sneaker that would track the blood pressure of its wearer, according to a patent filing this week.

The sports apparel brand’s filing with the U.S. Patent and Trademark Office details two versions of a sneaker currently in development. The first version of the sneaker would link to a wearable device and transmit blood pressure that would then be used to adjust the sneaker’s fit for optimal blood flow. The second version of the sneaker contains a “blood pressure detector.”

In the patent filing, Under Armour said the sneaker is meant to help its wearer recover after a “strenuous workout.”

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“There exists a need for a device and method to effectively pump blood through the plantar venous plexus and support recovery after engaging in athletic activity,” the company wrote in its filing, dated June 25.

Under Armour representatives did not immediately respond to a request for comment. Baltimore Business Journal was first to report on the filing.

The filing comes as Under Armour and other sports apparel companies seek to integrate technology into their products.

The Baltimore-based company unveiled its first smart shoe, the “HOVR Connected Series,” in 2018. The footwear line measures a runner’s gait and other workout data.

Reference: https://www.foxbusiness.com/retail/under-armour-blood-pressure-sneaker

HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation. 

D’OXYVA promotes benefits related to significantly improved blood circulation, including significantly increased cardiac activity, physical fitness, metabolism, endurance, energy balance and a healthy weight by significantly improving Microcirculation that is detectable real-time with high quality diagnostics.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

LEARN MORE ABOUT D'OXYVA
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The Alzheimer’s-blood pressure connection

Rock legends David Bowie and Freddie Mercury must have known something that science discovered only recently. In their rock anthem “Under Pressure,” they crooned: “Pressure pushing down on me … Chipping around, kick my brains around the floor.”

Researchers wouldn’t put it quite that way, but there is a correlation between a person’s elevated blood pressure later in life and brain health, particularly Alzheimer’s disease risk. A study in Neurology recorded the blood pressure of 1,300 people ages 59 to 102 annually for a mean of eight years. Brain autopsies of deceased subjects then revealed a link between high blood pressure and the presence of neurofibrillary tangles, characteristic of Alzheimer’s disease.

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An elevated systolic, or top number, above 134 mmHG increased the odds of developing brain lesions by nearly 50%. But according to Dr. Richard Isaacson, director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, anything above 120 puts you in the “new risk zone.” The study didn’t find a correlation with an elevation of the diastolic (the bottom number) and Alzheimer’s.

The good news: Lifestyle changes can help you achieve a healthy blood pressure of around 120/75. The DASH, Mediterranean and “What to Eat When” diets are a smart starting point. Check out Sharecare.com for info on these nutritional approaches and to download a free phone app to keep track of your numbers. Plus, ask your doc about medications and at-home, self-measured blood pressure monitors; the cuff ones are usually reliable, but should be checked against one at your doc’s office.

Reference: https://www.arcamax.com/healthandspirit/health/youdocs/s-2212497

HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

LEARN MORE ABOUT D'OXYVA
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How does transdermal non-invasive CO2 infusion at the thumb cause improved blood circulation and cellular O2 levels in the foot?

How does transdermal non-invasive CO2 infusion at the thumb cause improved blood circulation and cellular O2 levels in the foot?

ABOUT THE AUTHOR

Judy Delp Ph.D.

Job Description

Professor of Biomedical Sciences

 

Education

B.S. Rockhurst University, Kansas City, Missouri

Ph.D. University of Missouri

 

Memberships

American Physiological Society

American Microcirculatory Society

American Heart Association

Toriyama et al.17 studied the effect of CO2 bathing in 83 limbs with critical ischemia and achieved limb salvage in 83% without surgery. They concluded that peripheral vasodilation from CO2 bathing resulted from an increased parasympathetic and decreased sympathetic activity. In the current study, treatment with transdermal CO2 in a localized area produced a sustained, remote vasodilation, and a lowering of systemic blood pressure.
 
These findings share some similarity with the hemodynamic changes that occur following an acute bout of exercise, in which both neural and vascular components contribute to a sustained decrease in vascular resistance and blood pressure that persists after cessation of exercise18. In the current study, the period of sustained vasodilation seen in response to transdermal CO2 was heightened in diabetic patients.
 
Interestingly, in hypertensive individuals, the period of post-exercise hypotension is of greater magnitude and duration as compared to that of normotensive individuals 18, 19. Paradoxically, the current findings in diabetic patients exposed to transdermal CO2 as well as previous findings in hypertensive patients post-exercise, imply that sensitivity to signals that mediate these cardiovascular responses increases in patients with pre-existing cardiovascular dysfunction19.
 
A sustained decrease in systolic blood pressure occurs post-exercise and here, following application of transdermal CO2, suggesting that neural mechanisms contribute to the observed reduction in systemic vascular resistance. The roles of efferent sympathetic nerve activity18-20, afferent nerve activity from muscle 21-24, and the baroreceptor reflex20, 23 in mediating post-exercise hypotension remain controversial.
 
Neural mechanism(s) could contribute to changes in skin SPP and systolic blood pressure induced by exposure to transdermal CO2. Future studies will need to monitor heart rate, heart rate variability, and sympathetic nerve activity during and after transdermal CO2 in order to more fully assess the role of the autonomic nervous system in mediating the sustained increases in SPP and systolic blood pressure reported in this initial study.
 
Vascular conductance increases in both active muscle and inactive vascular beds following a bout of dynamic exercise 25, 26, suggesting that circulating factors contribute to this period of sustained systemic vasodilation. Vasodilation occuring independently of neural regulation constitutes more than 50% of the increase in systemic vascular conductance that occurs post-exercise; however, the mechanisms that underlie the post-exercise vasodilation have remained elusive.
 
Studies that have employed blockade of nitric oxide or evaluation of circulating nitric oxide metabolites have shown that the post-exercise vasodilatory response does not rely on circulating nitric oxide availability27, 28. A recent study by New and colleagues28 indicates that the nadir of post-exercise hypotension coincides with the peak of appearance of lipid hydroperoxides in venous blood, suggesting that reactive oxygen species with known vasodilatory properties29-32 contribute to the exercise-induced decrease in systemic vascular resistance. In the current study, transdermal CO2 was applied to the thumb, and a significant increase in SPP was measured at the toe.
 
Thus, a similar circulating vasodilatory stimulus may contribute to the remote, sustained vasodilation created by local transdermal application of CO2. Further investigations will need to focus on the identification of the mechanisms involved in both the local and remote factors that contribute to the sustained hemodynamic changes produced by exposure of the skin to CO2.
 
Recently, studies have documented that episodes of brief, non-damaging ischemia occurring in a tissue can induce systemic protection against ischemia-reperfusion injury in a remote organ. This phenomenon, termed remote ischemic conditioning, has been demonstrated to confer protection against ischemic events in the myocardium33-35, brain36, and kidney37, 38.
 
Although shown to be effective in various clinical and pre-clinical models 34, 35, 38-40, the mechanism(s) of remote protection have not been clearly identified. Both neural and humoral mechanisms have been proposed to contribute to the protection against ischemic damage afforded by remote ischemic conditioning38, 39, 41-43.
 
Basalay et al.41 have shown that when remote ischemic conditioning is applied before induction of myocardial ischemia, sensory nerves and recruitment of a parasympathetic neural pathway are involved in reduction of infarct size. In contrast, application of remote ischemic conditioning after myocardial ischemia also afforded protection against infarction, but was not altered by vagotomy or peripheral denervation41.
 
Remote ischemic conditioning has also been demonstrated to improve perfusion of transplanted kidneys, suggesting that remote conditioning confers protection that does not rely on intact neural circuitry38. Recently, Michelsen and colleagues42 have demonstrated that dialysate of human plasma from subjects who underwent either ischemic preconditioning or exercise preconditioning reduced infarct size in rabbit hearts, indicating that release of a humoral factor, possibly acting on opioid receptors, contributes to the cardioprotective effects of ischemic and exercise preconditioning.
 
Other reports in the literature have also shown evidence of a humoral substances that mediate protection against ischemia when remote ischemic conditioning is applied; however, these substance(s) remain to be identified. Application of transdermal CO2 produces a remote vasodilation that may be mediated through release of a circulating humoral agent.
 
Future investigations will need to focus on assessment of plasma samples during and following transdermal CO2 application.
This pilot study demonstrated an increase in measures of remote skin microvascular function with D’OXYVA, a simple commercially-available device to deliver transdermal CO2. The effects of the treatment were evident at all periods up to and including the last test period, 240 minutes post-exposure.
 
Although the sample size was small in this study, a clear increase in SPP and SPP/SBP ratio and a decrease in SBP and DBP continued for 4 hours post-treatment. The differences in skin perfusion and blood pressure responses detected between diabetic and non-diabetic subjects will require further examination in larger studies.
 
Click below to access Prof. Judy Delp’s Presentation on Transdermal Delivery of Carbon Dioxide Boosts Microcirculation.
 
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HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

LEARN MORE ABOUT D'OXYVA
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Impaired Tissue Perfusion

What is Impaired Tissue Perfusion?

Ineffective tissue perfusion is a state in which an individual has a decrease in oxygen resulting in failure to nourish the tissues at the capillary level.

Tissue perfusion is a critical parameter for tissue survival and function, and both relative and absolute perfusion assessments are highly relevant for both diagnosis and evaluation of the therapy response.

Sometimes situations occur where this exchange of gases between the blood and the cells is disrupted, meaning the cells (and ultimately the tissues and organs) stop getting adequate oxygen supply. The body can’t function without oxygen, so obviously this is a problem. When tissues don’t receive enough oxygen through the capillaries, this is called ineffective tissue perfusion.

Many conditions can disrupt the exchange of oxygen and carbon dioxide, but diabetes, obesity, anemia, high blood pressure, and coronary artery disease are some of the more common risk factors that can cause ineffective tissue perfusion. We can further classify the type of ineffective tissue perfusion based on the part of the body affected. For example, there’s renal (meaning kidney), cerebral (meaning brain), cardiopulmonary (meaning heart and lungs), gastrointestinal (meaning digestive tract), and peripheral (meaning affecting the extremities) ineffective tissue perfusion.

Common Risk Factors

Small arteries in diabetic subjects, whether hypertensive or normotensive, exhibit severe hypertrophic remodeling, and histological analysis of skeletal muscle biopsy samples reveals capillary rarefaction in subjects with type 2 diabetes. Histological capillary density is inversely related to fasting plasma glucose and fasting insulin levels and positively related to insulin sensitivity in nondiabetic individuals. Microvascular permeability to large molecules such as albumin is increased in diabetes, a process that is linked to hyperglycemia and ROS

In humans, coronary flow reserve is significantly lower in obese than in nonobese subjects, and capillary recruitment is reduced in nondiabetic obese individuals compared with lean control subjects. Even in a sample of healthy children (11 to 14 years of age), microvascular function was negatively correlated with adiposity. Thus, obesity appears to have an independent effect on microvascular function.

Coronary flow reserve decreases progressively with age in subjects without coronary artery disease, from approximately 4 at 30 years to 3 at 65 years of age, largely due to increased basal myocardial blood flow.

Tobacco smoking acutely impairs capillary recruitment, and thus hyperemic blood flow increases in skin and coronary flow reserve is reduced in established smokers. Coronary flow reserve in smokers can be improved by administration of antioxidant vitamin C, which suggests that smoking-related oxidative stress is an important mechanism.

Individuals with hypercholesterolemia without coronary artery disease have reduced coronary flow reserve, and coronary flow reserve is inversely correlated with LDL cholesterol. A reduction in coronary flow reserve can be detected in healthy young men (mean age 31 years) with familial hypercholesterolemia, which suggests that microvascular abnormality is detectable early in the atherosclerotic process.

Given the relationships between individual cardiovascular risk factors with measures of microvascular status, it is not surprising that the overall Framingham risk score is inversely correlated with skin capillary recruitment, maximal skin capillary density, and coronary flow reserve.

Defining Characteristics

Ineffective Tissue Perfusion is characterized by the following signs and symptoms:

  • Abnormal arterial blood gases
  • Altered respiratory rate outside of acceptable parameters
  • Bronchospasms
  • Capillary refill >3 seconds
  • Chest pain
  • Chest retraction
  • Dyspnea
  • Dysrhythmias
  • Nasal flaring
  • Sense of “impending doom”
  • Use of accessory muscles
  • Altered mental status
  • Behavioral changes
  • Changes in motor response
  • Changes in pupillary reactions
  • Difficult in swallowing
  • Extremity weakness or paralysis
  • Speech abnormalities
  • Abdominal distention
  • Abdominal pain or tenderness
  • Hypoactive or absent bowel sounds
  • Nausea
  • Altered sensations
  • Altered skin characteristics (hair, nails, moisture)
  • Cold extremities
  • Dependent, blue, or purple skin color
  • Diminished arterial pulsations
  • Edema
  • Positive Homan’s sign
  • Skin discolorations
  • Skin temperature changes
  • Skin color pale on elevation, color does not return on lowering the leg
  • Slow healing of lesions
  • Weak or absent pulses
  • Altered blood pressure outside of acceptable parameters
  • Elevation in BUN/creatinine ratio
  • Hematuria
  • Oliguria or anuria

Damage, Complications, and Prognosis

Microvascular abnormalities that lead to impaired tissue perfusion appear to represent a generalized condition that affects multiple tissues and organs. For example, in hypertension, coronary flow reserve is correlated with the media:lumen ratios of small arteries in biopsies of subcutaneous fat. Dilatation of venules in the retina independently predicts progression of cerebral small-vessel disease, and in diabetes, reduced coronary flow reserve predicts the occurrence of retinopathy.

Impaired tissue perfusion may be involved in target-organ damage and complications that involve several vascular beds. For the coronary microcirculation, an obvious example associated with both hypertension and diabetes is the occurrence of myocardial ischemia and angina in the presence of angioscopically normal epicardial coronary arteries, also known as cardiac syndrome X. Impaired myocardial perfusion may also be an important factor in the development of hypertensive heart failure and may lead to localized ischemia and disturbed patterns of electrical activity that constitute a substrate for serious arrhythmias. In the case of renal disease, glomerular and peritubular capillary rarefaction has been noted in different animal models and in human progressive renal disease, and it precedes the development of impaired perfusion and chronic hypoxia. It has been suggested that hypoxia may be the common factor linking many forms of progressive renal disease.

Microvascular abnormality is also a predictor of prognosis. In hypertensive patients, the media:lumen ratio of peripheral small arteries is a strong independent predictor of cardiovascular events. Among individuals with normal or minimally diseased coronary arteries, reduced coronary flow reserve is an independent predictor of cardiovascular events within the next decade. Finally, in patients with chest pain and angiographically normal arteries, coronary flow reserve <3 is associated with a 6-fold increase in all-cause mortality risk compared with coronary flow reserve >3 during 8.5 years of follow-up.

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Did you know when used in a regimen, D`OXYVA users have reported a number of health and beauty benefits?

doxyva benefits

OPTIMIZE BLOOD CIRCULATION FOR A WIDE VARIETY OF SIGNIFICANT OUTCOMES

D’OXYVA® (deoxyhemoglobin vasodilator) in various clinical trials has validated leading independent research results and demonstrated above-average results in improving a host of physiological functions at the same time.

People using D’OXYVA® have recorded significant improvements in cardiovascular activity leading to much improved physical activity. As part of a healthy lifestyle, D’OXYVA may help significantly reduce the risk of high blood pressure, hypertension, cholesterol, and diabetes in just two or three months, with an average use of 5 minutes a day and 5 times a week.

Poor circulation is a gateway for a litany of ailments: slow healing, depression, poor complexion, sores, slow metabolism, and more.

D’OXYVA significantly improves sustained oxygen-rich microcirculatory blood flow locally and throughout the body. Its patented method of fully non-invasive, painless, and harmless transdermal delivery is unique only to D’OXYVA.

When used daily, D’OXYVA users have reported a number of health and beauty benefits, including but not limited to:

  • Relief from symptoms of microvascular complications
  • Significantly increased cardiac function, physical fitness, endurance and strength, muscle size, body tone, faster recovery from sports injuries and surgical trauma
  • Improved self-esteem via promoting healthy and radiant skin, complexion, dry skin relief, and acne reduction
  • Significant reduction in downtime from other skin treatments and cosmetic procedures when used in combination, reduction in the appearance of scars, cellulite, fat, spider veins and stretch marks
  • Promoting and maintaining a healthy weight, improving general mobility, deeper, more restful sleep
  • Significant improvement of mental acuity; concentration, problem solving, multitasking, eye-hand coordination, heightened stamina, energy, and focus while managing stress
  • Improved vitals across the board during checkups with zero adverse event reports after years of regular use by people with various health, demographic, and ethnic backgrounds

HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

LEARN MORE ABOUT D'OXYVA
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Can Oxygen Therapy Improve Brain Blood Vessel Function in COPD Patients?

By Allison Inserro

Breathing in additional oxygen improves the function of blood vessels in the brains of people with chronic obstructive pulmonary disease (COPD), according to research published in Experimental Physiology.

The study revealed that patients with COPD are at higher risk of dementia, possibly because of lower brain oxygen levels as a result of problems with blood supply from brain blood vessels. According to other research cited in the study, giving patients with COPD additional oxygen reduced their risk of developing dementia, but the mechanisms underlying this effect had not been explored.

The latest research aimed to establish the effect of supplying additional oxygen in blood flow to the brain and blood vessel function in patients with COPD. Fourteen hypoxemia patients were included in the study, which tracked cerebral blood flow (CBF), oxygen delivery (CDO2), and neurovascular coupling (NVC), which is the relationship between local neuron activity and changes in CBF.

The researchers used ultrasound to view and measure blood flow in the brain in these patients at rest as well as before and during delivery of the additional oxygen. Ultrasound was used to measure the extent to which brain blood flow increased.

Participants began this test with their eyes shut, then opened them and read a piece of text. This test was designed to increase activity in the brain, and brain blood flow was expected to increase to provide an adequate oxygen supply.

Pairing these ultrasound measures with a measurement of blood oxygen levels allowed authors to estimate how much oxygen delivery to the brain increased during the eyes-open reading test.

Measurements were assessed, and the authors found that blood flow and oxygen delivery to the brain significantly increased during reading because blood vessels in the brain dilated in response to the greater oxygen demand when the brain was active.

Specifically, peripheral oxyhemoglobin saturation increased from 91 ± 3.3 to 97.4 ± 3% (P <.01). CBF was unaltered (593.0 ± 162.8 vs 590.1 ± 138.5 mL min−1; P = .91) with supplemental O2.

However, CDO22 (98.1 ± 25.7 versus 108.7 ± 28.4 ml dl−1; P = 0.02) and NVC improved.

The posterior cerebral artery cerebrovascular conductance increased after O2 normalization (+40%, from 20.4 ± 9.9 to 28 ± 10.4% increase in conductance; P = .04). The posterior cerebral artery cerebrovascular resistance decreased to a greater extent during O2 normalization (+22%, from −16.7 ± 7.3 to −21.4 ± 6.6% decrease in resistance; P = .04).

The cerebral vasculature of patients with COPD appears insensitive to oxygen because CBF was unaltered in response to O2 supplementation, leading to improved CDO2.

Providing extra oxygen to patients with COPD improved the function of blood vessels in the brain by increasing blood supply to meet the demands of the brain’s activity during this short test.

Other research is needed to see how long-term oxygen use would impact the function of brain blood vessels.

These improvements might provide a physiological link between oxygen therapy and a reduced risk of cerebrovascular diseases such as stroke, mild cognitive impairment, and dementia.

Ref: https://www.ajmc.com/newsroom/can-oxygen-therapy-…

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Why post-menopausal women are prone to heart attack

Why post-menopausal women are prone to heart attack Read more: https://lifestyle.inquirer.net/296431/post-menopausal-women-prone-heart-attack/#ixzz5lzYlOezl Follow us: @inquirerdotnet on Twitter | inquirerdotnet on Facebook

Recently we had a female patient in her early 60s who suffered a heart attack and fortunately survived it.

All the time, she had been accompanying her husband to regular check-ups on his heart problem, without realizing she herself was a walking time bomb.

She has been a smoker most of her adult life. She has a strong family history of cardiovascular disease (CVD), with two male siblings undergoing heart bypass surgery in their early 50s.

Her blood pressure (BP) went on upward trend after menopause, with high cholesterol levels.

She showed no symptoms so she thought she was just fine, until she woke up in the middle of the night with severe chest tightness and shortness of breath.

She was rushed to the hospital, had an immediate declogging of the heart artery through angioplasty, and a small scaffolding-like metal called stent was inserted to keep the culprit coronary artery patent.

The same story happens so many times. Wife is so concerned about her husband with a heart problem and she neglects to have herself checked, or make sure that her lifestyle is not conducive to develop CVD.

Before menopause, women are protected by estrogen, the female reproductive hormone. This hormone has been shown to have a beneficial or cardioprotective effect on the inner layer of artery wall called endothelium.

After age 50

Endothelial dysfunction triggers the start of the atherosclerosis, which is the progressive narrowing of the artery. Estrogen prevents endothelial dysfunction, and helps maintain the flexibility of the blood vessels.

Flexible arteries can relax and expand to accommodate more blood and enhance the blood flow or circulation.

The onset of menopause is usually after the age of 50 (52 to 54 years of age on average). There are some who experience early menopause, signaled by the cessation of the monthly period at a much earlier age, even before age 40.

After menopause, estrogen decreases significantly and the heart protection is almost completely gone around eight to 10 years after menopause. This is usually when women are in their late 50s or early 60s.

Hence, the risk of developing a stroke, or heart attack, may increase and become higher in women compared to men at this age.

For those who have menopause at an early age, the increase in cardiovascular risk may occur at a much earlier age, when the women are just in their late 40s or early 50s.

Ovarian failure

The common cause is premature ovarian failure, but it may also be caused by damage to the ovaries as a result of cancer therapy and/or radiation treatments.

Another cause could be surgical removal of the ovaries if tumors in the female reproductive organs are diagnosed at a younger age.

The symptoms of premature menopause are pretty much the same as regular menopause, and include hot flashes, emotional instability or mood swing, vaginal dryness, decreased memory or comprehension, decreased libido or sex drive, and insomnia.

We have to clarify that menopause, by itself, does not cause CVD. It’s just that the levels of the heart-protective female hormones, particularly estrogen, decrease, and risk factors increase around the time of menopause.

These are increasing BP, high LDL (bad cholesterol) level, and low HDL (good cholesterol level. The triglyceride level, another bad type of fat, also increases after menopause.

A reckless lifestyle in the form of a high-carb and high-fat diet, being sedentary, smoking, and other unhealthy practices —which women could have earlier in life—starts to take its toll after menopause.

Guidelines from various heart associations remind women to really take stock of their health when they’re reaching menopause, so they can avert serious complications.

Since the cardiovascular risk in women peaks around eight to 10 years after the onset of menopause, women who are at high risk could be identified so that they could be treated more aggressively and monitored closely, preventing the complications which could occur years later.

A recently published study suggests that a relatively higher level of the male hormone called androgen or testosterone in postmenopausal women is associated with increased risks of cardiovascular complications.

The study, published in the Journal of the American College of Cardiology, followed up 2,800 postmenopausal women initially free of CVD. The women had their sex hormone levels measured at baseline.

The researchers reported that during an average of 12- year follow-up, CVD was diagnosed in 283 participants, plus clogging of the heart arteries (coronary heart disease or CHD) in 171, and heart failure in 103.

Adjustments were made to discount the effect of conventional risk factors and hormone therapy. The following findings were reported:

Male hormone

Higher total testosterone (male hormone)/estradiol ratio was linked with significantly increased risks for all cardiovascular outcomes.

Higher total testosterone appeared to significantly increase risks for CVD and CHD.
Higher estradiol (female hormone) was associated with significantly lower CHD risk, reaffirming its heart protective effect.

Does this study suggest that we should give post-menopausal women estrogen hormone therapy to prevent CVD or CHD?

I don’t think there’s good data to support that recommendation. There are also potential complications of aggressive hormone therapy which doctors are wary about.

The importance of this study is that we could identify the post-menopausal women who are at risk of suffering potentially serious cardiovascular complications, and implement risk-reducing strategies such as end to smoking, regular exercise and balanced diet.

Which type of diet is really good remains a big issue, in view of various fad diets claiming cardiovascular benefits.

The American Heart Association and Philippine Heart Association recommend eating a balanced diet consisting of: fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts, with less red meat and minimal sugary foods and beverages.

Aside from a healthy diet and lifestyle, adequate control of elevated BP is recommended; as well as the use of cardioprotective drugs like statins even if the cholesterol levels are not that high.

The important thing, too, is to get rid of the misconception that only men are vulnerable to heart disease, and women are spared from them.

A change of this wrong mindset is necessary so that the beloved women in our lives are not deprived of the medical care and attention they need to prevent heart attack, stroke and other cardiovascular complications.

Reference: https://lifestyle.inquirer.net/296431/post-menopausal-women-prone-heart-attack/#ixzz5lzYtfKJx 

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Being mindful of symptoms

LEWISTOWN–Dr. Maya Lichtenstein, neurologist at Geisinger-Lewistown Hospital, said that there are a myriad of potential symptoms that could be signs of a stroke. “Any sudden changes,” said Lichtenstein, “go the E.R.”

A stroke, according to Liechtenstein, is either the result of not enough blood flow to the brain, plaque in the blood vessels or heart, each resulting in a clot, or a hemorragic bleed, resulting in a bursted blood vessel in the brain. Classic symptoms of a stroke include numbness, tingling, weakness on one side of the body and changes in speech, but other sudden changes in in understanding language, vision, vertigo or clumsiness can also be symptomatic.

“It depends on what part of the brain is damaged,” said Lichtenstein.

Treatment options for a stroke vary, depending on the type of stroke.

“If you get seen fast enough,” said Lichtenstein, for a clot, a “clot-busting medication, a form of blood thinner” can be administered via I.V. A thrombectomy, a procedure, not an operation, said Lichtenstein, is another treatment option, similar to a cardiac catheterization. A bleeding stroke often leads to lowering the patient’s blood pressure and surgically relieving pressure on the brain. Taking aspirin can also treat a stroke.

Post-stroke, Liechtenstein said that rehabilitation is important, including physical, occupational, speech, and cognitive therapies. “Aggressive therapy can continue to improve people’s symptoms,” said Lichtenstein. “Everyone thinks they’re better if they can move their arms and legs.” Lichtenstein also encourages stroke patients to be aware of their mood and possible depression, encouraging them to accept all the help available.

To avoid a stroke, Liechtenstein said patients should see their doctors regularly for preventive care and that leading a healthy lifestyle is the key, including regular exercise to keep up the heart rate and eating a diet rich in fresh fruit and vegetables, lean proteins and whole grains. Lichtenstein also encourages patients to keep control of their vascular issues, such as high blood pressure and diabetes, as well as to quit smoking, if they smoke.