Category Archives: Health

Food Handling: Don’t Trust Trial and Error to Prevent Illness

Dr.JaccarinoDr. Frederick Jaccarino, M.D.
Ever since the evolution of early hunter-gatherers there has been a need and desire to preserve food supplies. Those earlier Homo sapiens recognized that stockpiling some roots and berries would come in handy when the ready supply of fresh meat was unavailable.
And so, just as our collective wisdom arose from lore passed orally from generation to generation, so too food acquisition, preparation, and safe handling certainly arose through trial and error. Perhaps only a few cavemen had to get severe belly pain after eating a three-day old elk carcass before the whole tribe for generations to come would shun the grisly leftovers.
However, the tribes who killed their elk in winter might also note that after three days in the snow, the elk still tasted ok, and there were no consequences for their intestines. Back then, the tribes were still migratory enough that knowledge and lore could be topics worth discussing over the campfire. They didn’t really have a lot of issues other than survival to discuss; there were no taxes, Obamacare, or Miley Cyruses to captivate their attention.
Entering this century, we benefit from the refined knowledge of food production and food safety developed from those many centuries of trial and error, careful observation, and scientific experimentation. Yet still, people continue to become ill due to the food they consume! The classic example is staph bacteria growth on the food item; it produces a toxin that causes nausea about one to six hours after the meal – most victims recover within a day. Prevention involves sanitary handling (clean hands, no contact with the food by people with skin infections, keeping hot food hot and cold food cold, and avoiding that three-day old elk meat. Other bacteria and parasites cause illness through directly infecting you, rather than by indirect toxins.
Middle Eastern cultures grew to shun pork meat; a serious illness called trichinosis results from eating undercooked pork.
Shellfish from warm waters may transfer a cholera-causing bacteria; the resulting diarrhea is massive and shellfish from our colder waters are more likely to cause hepatitis A, which is no picnic either.
The takeaway lessons are that food can make you sick. Decrease your own risks by focusing on sanitation in both preparation and storage. Get any leftovers into refrigeration ASAP, and heed expiration and use-by dates, and don’t rely on the “smell test” to assess the safety of a food.
Even dogs make that mistake!

Awareness: The Right First Step

Dr.JaccarinoDr. Frederick Jaccarino, M.D.

September is “Women’s gynecology awareness month.” Though it may seem that men would be disinterested in the topic, it would truly be a mitzvah (good deed) for a son or nephew to remind their loved ones that gynecological awareness doesn’t end when reproduction is no longer an option.
The changes of menopause are every bit as challenging to an adult woman as the difficulties of a teen experiencing the changes of puberty. The first time a female should be discussing their gynecologic concerns with a nurse or doctor will vary due to variability in physical maturation as well as cultural mores. A pediatrician who knows her or his patient will decide the appropriate time for such discussions and exams.
Sometimes the subject comes up quite early for girls prone to urinary infections, though the usual ages for opening Ob-Gyn conversations are for girls between ten and 12 years of age. A doctor visit may include several minutes discussing bodily functions, hygiene, and the changes wrought by the impending onset of puberty. Certainly many girls have gotten most of the info from their moms already; the M.D.’s role is to give a stamp of approval to the right way to prevent illnesses, and to dispel various urban myths propagated by the preteen grapevine.
The healthcare provider will likely also convey new and current information that mom may not be aware of. The highlights of the preteen gynecologic education should include handling the symptoms of menstruation and ovulation, prevention of infections such as UTI’s, and some coaching about setting healthy boundaries in one’s social life.
Once a girl starts having more intimate relationships, sex education should include open and thorough discussions with the doctor. Pregnancy and sexually transmitted illnesses can be life changers, and cervical-cancer deaths have declined in incidence only because the Pap test works for early detection. Unless the cervix itself has been removed, cervical cancer remains a risk into menopause; why not remember to get checked routinely?
While you are there the doctor will ask about other gender-specific health concerns such as irregular bleeding, breast health, and possible screening for ovarian or uterine diseases. As menopause imposes itself on the adult woman, the question of hormone-replacement therapy usually arises. Because the consensus regarding safety seems to change every few years, the decision often falls to a personal mind-meld between the patient and her healthcare provider. Awareness is your best first step.
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Bops on the Head Can Mean Serious Business for Brain


Dr. Frederick Jaccarino, M.D.

Concussions, also known as head injuries, have been a major topic in the sports pages in recent years. The number of affected athletes really hasn’t risen; what’s increased is the recognition by the trainers and medical community of the serious, long- term consequences of even fairly innocuous hits to the head. The angst and concern emerge from high-profile examples such as Muhammad Ali and Sidney Crosby, though Little League coaches should be just as aware of the dangers of concussions as professional-team doctors.
Head injury can occur to anyone not living in bubble-wrap. The threat starts with infants who may slip out of an adult’s hands and hit the floor, to toddlers (the very definition of “toddle” is to walk unsteadily), to hard-hitting athletes, to slip-prone elderly adults. When the head is struck with more than a minor amount of force, the brain inside gets shaken and may also bang into the hard shell surrounding it—the bony skull. It may hit hard enough to cause a bruise on the brain, which may in severe cases even result in blood leaking into the skull cavity…where it does not belong.
There is limited space in the skull; the blood tends to crush the brain tissue, leading to headaches, seizures, and possibly death. Patients with these injuries usually have signs and symptoms which lead to prompt diagnosis and prompt treatment.
By far, most everyday concussions are much less severe. Recognition of these milder concussions is more challenging because the symptoms are more subtle and the diagnostic tests less readily available, yet the consequences of nonrecognition remain significant.
As best as the public knows, athletes Ali and Crosby never had blood or any visible—on CAT or MRI scan—abnormalities. But Crosby has missed dozens of games while Ali is left with the degeneration of his brain to the point of incapacity. Each is an example of the deleterious effects of multiple bangs to the head.
Most amateur athletes, from weekend warriors to school-team competitors, face similar risks as the pros. Brain injuries, even when not severe, need a lot of time to recover; if the victim does not rest the brain, it heals more slowly; if reinjury happens the effects multiply—so a normal CAT scan is not a ticket back into the game.
An astute healthcare provider will convince the gung-ho competitor that it is better to walk away and live to compete another day, even if it’s weeks later. Take concussions seriously—for your long-term health and brain function!
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Turning the Tide on Childhood Obesity

Submitted by: Dr. Janey Thornton, USDA Deputy Under Secretary for Food, Nutrition and Consumer Services
As the Department of Agriculture’s Deputy Under Secretary for Food, Nutrition and Consumer Services, I am on a mission to make sure all of our nation’s children have the best possible chance at a healthy life and a bright future. So, I’m very encouraged by some recent news from the Centers for Disease Control and Prevention (CDC):  the rate of obesity among low-income pre-school children appears to be declining for the first time in decades.
The declining rates show that our collective efforts—at the Federal, State and community level—are helping to gain ground on childhood obesity, particularly among some of the more vulnerable populations in our country.  Low-income children are often at a big disadvantage when it comes to getting the food they need to grow up healthy and strong, which is why the nutrition programs and resources available through USDA are so vital.
Programs like WIC—with its new, healthier food package offerings for pregnant women, breastfeeding mothers and young children, including more fruits and vegetables and more whole grains—and the Child and Adult Care Food Program—with its increasing emphasis on nutrition and physical activity for young children—are making a difference in the lives of millions of children.
Our efforts don’t stop there. School-aged children are now getting healthier and more nutritious school meals and snacks, thanks to the support of First Lady Michelle Obama’s Let’s Move! initiative and historic changes implemented under the historic Healthy, Hunger-Free Kids Act.  We’re supporting healthy, local foods in schools through our Farm to School grant program, and we’re improving access to fresh produce and healthy foods for children and families that receive Supplemental Nutrition Assistance Program benefits.
So what can you do to make a change in your home and community? Parents and caregivers can use educational materials like Healthy Eating for Preschoolers and Nutrition and Wellness Tips for Young Children to help teach young children healthy habits from the start. Teachers, principals and school food service professionals can use nutrition education materials like the Great Garden Detective curriculum provided through Team Nutrition to motivate older children to eat healthy and try new foods. Kids can explore MyPlate Kids Place and take the MyPlate Pledge to commit to making healthy food choices at school and at home. And parents, teachers, and kids alike can get active and learn about healthy foods with Let’s Move! in school, at home and in their communities.
Don’t get me wrong—we still have a long way to go before America’s childhood obesity epidemic is a thing of the past.  Far too many—1 out of every 8—preschoolers are still obese.  Unfortunately, obesity in these early childhood years sets the perfect stage for serious health problems throughout the entire lifespan.

We at USDA are proud of our ongoing efforts to ensure the health of America’s next generation, and we know that, combined with your efforts at home, we are beginning to see real results in thefight against early childhood obesity.

Dr. Janey Thornton serves as USDA’s Food, Nutrition and Consumer Services Deputy Under Secretary.  Before coming to USDA, Dr. Thornton served as School Nutrition Director for Hardin County Schools in Elizabethtown, Kentucky and served as president of the 55,000-member School Nutrition Association during the 2006-2007 school year. Learn more about USDA’s efforts to improve child nutrition and visit for quick, easy nutrition and diet tips for families.


Childhood Obesity Starts at Home

by Frederick Jaccarino, MD

Frederick Jaccarino, M.D.

Frederick Jaccarino, M.D.

America’s leaders set national priorities, assign elected and appointed officials to solve specific problems, and work on solutions in order to secure the future of our nation.   The current administration is working on dozens of important issues, and one more which is being spearheaded by the First Lady, Michelle Obama: childhood obesity.

The causes of the childhood obesity epidemic in America today are well known. Diets include “essential nutrients” like chips, tacos, pizzas, burgers, and a rare green item like mint ice cream or avocado dip. Add all these mostly empty calories to an increasingly sedentary lifestyle, and the unsurprising result is obesity and an accelerated aging process in our youth, who often enter their twenties already seriously overweight.

What isn’t visible – but looms as the actual consequence of this trend – is the premature artery clogging, hypertension, and diabetes that is leading to an ever  rising demand for medical treatments and will be a costly burden for society.

Just as when the government joined the medical establishment in the war on tobacco, so too the government has a big stake in the battle against childhood obesity.  And, as with tobacco, the battle is being waged via information and education.

The first lady’s voice reaches beyond America’s shores. However, she will need the aid of other members of government,  like Congress, to levy taxes and fines that will prod us to offer better nutrition for our children.

New York’s Mayor Bloomberg, for one, has taken aim at the obesity problem by making laws discouraging large portions, and other laws to inform customers how many calories are in that bacon-cheeseburger.  Standards defining acceptable limits on fat or sugar content seem to be just what our National Institutes of Health scientists have been working on for years, and the taxes will be “virtuous” since they promote better health and primarily punish only those who choose to ignore the warnings of Michelle Obama and others.

Is it fair or democratic for our government to use fines and taxes to encourage one food choice over another?  The answer is yes, it is fair because society as a whole absorbs the costs of caring for the ill and ailing.  Statistically speaking, the overweight children (not unlike smokers) will use healthcare earlier and more often than their healthier counterparts.

Living a balanced life

“Self-acceptance must come from within.”

By Roger Zotti

Psychotherapist and motivational speaker Diane Lang says what she learned from writing her book, Creating Balance & Finding Happiness (Kendall Hunt Publishing), was “to re-use my own tips and tools when I had a major illness. Sometimes you write about something—even teach it—but it’s harder to follow your own advice. When I got very sick last year, I had to take my own advice, which was tough.” In fact, the reason Diane wrote her book because “the information, tips, and tools I write about really helped me. I wanted to share what really worked.”
Diane says writing her first book, “The Path from Motherhood to Career,” and her latest weren’t overly challenging. “I had the basic information I used to help myself and others, so I found writing the books therapeutic,” she explains. Her third book, which she’s now writing, “is more challenging because it’s a process I’m still working on, which is releasing my addiction to fear and living a life of trust and faith.”
One concept Diane kept in mind while writing “Creating Balance & Finding Happiness” was gratitude. “I talk about it in my book and in my workshops. I can’t stress how important it is to live a life full of gratitude. I’m constantly saying thanks for everything.” She suggests a daily “gratitude check,” which for her takes “2-5 minutes.” Then she begins her day by asking herself, “What I am grateful for in my life?” Then at night she asks herself, “What am I grateful for that happened today?”
A recurring point in “Creating Balance & Happiness” is that in our fast-paced world most of us seek instant gratification: “Society has come to a point where everyone wants a quick fix…but that doesn’t happen and sets us up for failure,” Diane asserts. Positive changes in a person’s life “will take time,” patience, and “trial and error.”
Diane’s views about being selfish may surprise readers: “The selfish you….is good because it means a better, healthy you for everyone around you.” She recommends making “a verbal or nonverbal commitment—whatever it takes. Just make ‘you’ the most important person in this world. Now, you can go out and give the world your all….Don’t ever hesitate to be selfish if it means a better you!”
Another standout point is self-acceptance. “I have caught myself many times looking for approval from others, but once you become aware that you can see the pattern…stop it dead in its tracks by knowing it doesn’t work,” she writes. “Self-acceptance must come from within. Looking for acceptance and approval from others is a sign of low self-esteem.”
In straightforward and unpretentious language, Diane’s book offers common sense suggestions—which some people may have forgotten and about which they need reminding—about how to live a balanced, happy life. She considers “Creating Balance & Happiness” “a journey” for herself, for her daughter, and “for everyone who reads it. Also, its goal is to help herself and “others to be the best people they can be by using the tips in the book.”

Diane’s book may be purchased at, Barnes and,, and

Painchronicity: Help Chronic Pain

Frederick Jaccarino, M.D.

Frederick Jaccarino, M.D.

In an earlier column acute pain was discussed.  “Acute” pain is the sensation which tells you the stove is hot, or maybe that you’ll remember the contraceptives from now till menopause.  These are examples of acute pain; acute means that the pain arrived fairly recently, and there good chance it will be relieved in the near future, like when you move your finger away from the hot stove, or when the beautiful baby is finally laying on your chest.  The conversation today is about a different kind of pain called chronic pain, which is a vast subject at the center of much of the demand for medical care.

“Chronic” pain must be understood to be conquered. Chronic means the discomfort has been around for a while, and it is likely to outlast its welcome way too long.  It’s that ache or stab in your lower back that can flare up after a car ride or routine housework. Sometimes it’s that achy elbow which has supplanted your need for a barometer.  Some syndromes or conditions are notable for the chronic pain associated with them; consider the daily morning joint pains of the rheumatoid arthritis patients, or the abdominal cramps experienced daily by people with colitis or malabsorption syndromes.  The pharma and medical communities offer resources that can tame the inevitably recurring symptoms.

The chronic pain sufferer is well served by having a skilled health care provider as an ally and advisor.  Lifestyle and dietary changes may be important to treating the pain symptoms.  Alternative approaches such as massage, acupuncture, yoga, etc have helped many deal with their chronic pain.  Mainstream medical treatments have been miraculously improving the lives (by lessening the discomfort) through advances such as titanium hips, neurosurgical interventions like deep brain stimulators and implantable pumps, and even bioengineered inflammation fighters.  There are therapies specifically targeting causes of pain, such as antidepressants and corticosteroids.  Finally, there are the non-specific analgesics such as acetaminophen and opiate narcotics.

The most predictably problematic side effects accompany the use of opiates.  Itchy skin and constipation affect almost everyone who takes in opiates.  Cloudy alertness is bad for any age, awful in the elderly. Increasing tolerance and addiction is also common, even in household members who have access to the pill bottles of the chronic pain patient.  For chronic pain, the patient should shun narcotic pain relievers, unless there is no other solution for relief.  Too many individuals’ and families’ drierms have drifted away in the daze of a drug’ allure.

Accidents Happen to the Best of Us

Frederick Jaccarino, M.D.

Frederick Jaccarino, M.D.

As winter’s winds whirl and water turns to ice, the health care system braces for the seasonably predictable rash of weather-related traumatic injuries.  Snow, ice, and freezing temperatures lead inevitably to car crashes, falls, and thermal injuries.  Trauma care has evolved into a distinct field of medicine ever since pioneering doctors in the 1950’s and ’60’s started a system from the first responders to the definitive care centers.

Most of modern trauma care arose directly from wartime military experience, especially Vietnam and Korea.  There we learned that the first hour after a serious injury, the so-called Golden Hour, will determine the likelihood of survival.  So today the prehospital rescuers, not unlike field medics in combat, are expected to quickly carry out a list of actions and assessments which maximize the first part of the golden hour.  They are expected to evaluate the ABCDEs of resuscitation.  They will protect the spine from movement, they will stanch any active bleeding, and closely monitor the vital signs.  And importantly, they must triage correctly.

Triage is a way of matching resources to needs.  When managing an accident scene, the EMT must quickly go through the abc’s with each victim, initiate spinal immobilizations, and then determine if the injuries should be managed by the closest available site, the most appropriately qualified hospital, or the most convenient. The rapid, confident performance of the EMT, including triage decisions, results daily in hundreds of trauma victims getting the most appropriate treatment of their injuries. Though a nearby average ER may save a trauma victim’s life by being the quickest option, seriously traumatized persons  who can be safely delivered to a trauma center will be well served by the comprehensive care such centers represent.   For a hospital to be designated as a trauma center, it must meet the stringent requirements of the American College of Surgeons, including the requirement of having immediately available at all times doctors in anesthesia, neurosurgery, orthopedics, etc., and certain services such as CT scan and ultrasound.

So should a slip on the ice result in a slide followed by a snap and a crack, rest assured that your 911 call will result in a magical mystery tour of the trauma system.  Somehow the system works; from the EMT’s putting you in a splint and on a board, to the morphine for the pain, to the ER for x-rays, to the operating room for the orthopedist to pin the broken bone back together, to physical therapy and rehabilitation.

Moustaches and Prostates: A Team

Frederick Jaccarino, M.D.

When considering issues affecting the health of men, the second most vexatious foe, after cardiovascular diseases, is the all-too-common prostate cancer.  Not only does it strike often; it is also the second most frequent cause of cancer death in men. Despite its prominence, and despite millions of dollars spent on prostate research, there remains a lot of controversy about how to screen for the illness, how to diagnose it, and when and how to treat prostate cancer.

September is prostate cancer awareness, for when the lay press reported  some of the new perspectives we now entertain on the subject.  The prehospital professionals serving the Westerly/Stonington region are currently raising donations for prostate research thru their Movember @ Sons moustache campaign. Consider supporting both worthy causes; the ambulance teams and prostate cancer research.

Why would a man NOT want or need to know if he has prostate cancer? A generation ago the answer was simple; early detection and early intervention seemed to make sense. Most prostate cancers grow and spread so slowly that if you did nothing about them they would never result in symptoms or affect longevity.  So a 50-year-old with a typical prostate cancer would be better off worrying about his blood pressure and other cardiovascular risk factors than his cancer; the cancer won’t hurt him. He probably would be better off not even knowing he was carrying this cancer.  Less worry and stress; sign me up!

Consequently, current trends consider the possibility that a man’s life journey may be measurably better if he is unburdened by the awareness he is letting cancer coexist with him, unchallenged.

Radiation, surgery, or hormone therapy each carry risk of complications such as incontinence, impotence, or worse.
The reality is there are different types of prostate cancer (called grades). High grade cancers are aggressive and nasty, so early detection of these ones might save lives.  Unfortunately, to tell if you have a slow lazy tumor or a terrifying killer
requires a piece of the tumor under a microscope.

The experts have decided to recommend screening to begin at an age dictated by the age and genetic risk of the individual patient. Of course, each of us may decide for ourselves when to be screened (a needle and a digit).  Do not count on symptoms to guide you, as most symptoms develop late, so they become the albatross heralding a lost gamble.

So, if you’re an adult male, go discuss the issue with your doctor.

Hospital Horrors: Infections

by Frederick Jaccarino, M.D.

A hot topic in hospital based healthcare circles is the rising incidence of dangerous infections which may come your way during a visit to the hospital even if you arrived at the hospital in a completely healthy state.  There are hazards lurking in, or on, the hallowed hospital hallways.  It’s not that germs haven’t always been around.  Bacteria were here to oversee humans’ evolution arising from the sludgy sediment. But now we’ve returned the evolutionary favor by helping the bacteria and viruses learn new and more destructive qualities.  There are a few examples of multi-resistant germs who are IN-VINCe-IBLE!  So the more you know about who these guys are and how to avoid them, the less likely your “routine” knee replacement surgery ends up with a trip to the ICU, or worse.

Handwashing is the number one preventive measure. That’s why cleanser dispensers outnumber the total number of humans in most hospitals.  Handshaking has become a quaint reminder of our days of innocence.  And you really should stand up straight; leaning on a counter or wall might transfer an unwanted guest to you or your family.  The hepatitis virus could infect you two days after it got left on that wall. Doctors used to be taught to sit on the patient’s bed when trying to calm or comfort a distressed patient; now they are discouraged from even wearing a tie, due to the risk of spreading germs.

Before any planned visit to a hospital for a procedure, preparation should include getting your immune system as healthy as possible.  That includes optimal nutrition, cardiovascular conditioning, and for diabetics, careful blood sugar control.  If you are taking medications that weaken the immune system (many do, such as steroids, cancer treatments, and arthritis medications) talk with your doctor about if  they should be stopped because of the heightened risks. If you have any open wounds or sores, use antiseptics and sterile gauze to cover them before entering the hospital. Most germs get into your body through places where your skin is not, like through a sore, nose, eye, mouth, or other openings.

Speaking of openings, when the nurse or doctor puts something into you (like a tube or needle) that too crosses the skin barrier.  It wouldn’t be considered unreasonable to request a second opinion if she picks up a tube she dropped on the floor and points it at you.  I’d probably make a run for it, bad knee and all!

Wheezy Windbags Signal Asthma

by Frederick Jaccarino, M.D.

Onomatopoeia is a term describing a word’s characteristic of sounding like its action or meaning, as in fizz, swish, and whoop.  Medical jargon is replete with onomatopoeic words  such as borborygmi and, I think, asthma. The former word describes the sounds of  grumbly, burbling, intestines, while the latter is a condition associated with challenged, whistling respirations.  Whisper the word asthma and you can hear the wheezy sounds  stethoscopes deliver to the doctors’ ears.  Those wheezes announce the struggle of the air flowing through narrowed bronchial air passages in asthmatic lungs.
Asthma is becoming a growing epidemic among American children living in the 21st century. The struggle to breathe for an asthmatic is caused by inflammation of the lungs which leads to narrowed air passages.  The inflammation might be started by exposure to  allergens or irritants in the environment.  There are hundreds of potential allergens and irritants; consider dust, pet dandruff, mold, smoke, acid reflux, exercise, cold air, foods, viruses, and many more.  Each asthma sufferer is likely sensitive to their own individual list of triggers. One strategy for managing  asthma  involves finding all of the individual’s triggers, and carefully avoiding them.
Susceptibility to asthma is usually genetically acquired, while attacks get triggered by environmental exposures. Families with asthma issues often also must deal with skin conditions like eczema and hives. Ironically, recent studies suggest the growing numbers of asthmatics might be attributed to the increased vigilance of modern parents, shielding their children from any exposures to germs and “dirt.”   The theory is that the immune system learns to handle its business properly by seeing the allergens and other threats while the child is developing.  If the child matures without those early interactions with germs and dirt, his or her inexperienced immune system will overreact when challenged later in childhood or young adulthood.  Mom’s adage to “eat a peck of dirt” before you die may be lore worth remembering.
Managing asthma requires an understanding by the asthmatic of how to avoid attacks, what medications are needed to prevent attacks, and how to respond when things get worse.  There are still thousands of asthma deaths which could be avoided if those three factors were understood and practiced.

Cardiac Gambling

by Frederick Jaccarino, M.D.

A recent cocktail party conversation turned to the subject of chest pain. After stating that everyone gets chest pain, most people nodded agreement, while one woman firmly disagreed, saying she’s never had chest pain. Probably true, but my intended point was that there are many different cause of pain in the chest which are not heart related, and often not even worthy of worry. Indeed, most people will have to deal with chest pain at times. Heart attacks however, usually leave survivors a memory of a pain which heralded that attack’s presence.
The heart beats sixty to one hundred times a minute in the middle of the chest. Our very survival depends on the circulation of blood powered by the powerful heart muscles which contract with each beat. Each contraction squeezes out a volume of blood to the body, then relaxes to receive a new volume ready for the next beat. Also in the chest are the lungs, which expand and contract to bring oxygen and other gasses into and out of the body. Likewise, food and fluids get into the body by passing through a hollow tube, the esophagus, which is in the chest. The esophagus does some squeezing itself, to keep things moving in the right (or sometimes wrong!) direction. All these activities occur efficiently and continuously without any conscious effort or awareness. Any malfunction of these vital functions will be urgently brought to our conscious awareness by some uncomfortable sensation such as pain, nausea, or suffocation sensations. That these feelings are hard to ignore is a good thing for survival. Other structures that may cause pains in the chest are ribs, muscles, the gallbladder, liver and pancreas, to name a few.
So, back to the original premise; there are many possible causes of chest pain, making it a common phenomenon. The patient, and often a doctor, must try to differentiate the characteristics of the pain in order to assess the risk it poses, and the best path to relief. That is a taller order than it appears on first glance. Even highly competent physicians, with the assist of testing and technology, will miss some heart attacks, while over-testing patients with pains unlikely to be due to a diseased heart. Your best bet is to know your own risk factors, pay attention to the circumstances and characteristics of your discomfort, and let common ( too often uncommon ) sense dictate your own plan of action.
A brief word on risk factors. Smoking, obesity, cholesterol, stress, and hypertension are all manageable; choosing to not manage them is merely the choice of higher risk. Age and genetics are inevitable, but nevertheless important to risk assessment. Life makes us all gamblers; when it comes to health both the patient and the doctors gamble. A wise patient will win and walk away more often than the reckless, but may still be felled by lady luck. A prudent doctor tries to improve the odds of his bets by evaluating every available clue so that he may help the patient’s quest to avoid their bad bets.