Tag Archives: Health

A Healthy Bet (18) – Palpitations (Part 2)

As it appeared in Ante Up Magazine – Apr. 2010

By Frank Toscano, M.D.

At about 6 pm on Day Two of the 2009 WSOP $2500 Razz Event, “Miami” John Cernuto seemed to be taking a little nap between hands. When one of the players nudged him, he collapsed unconscious onto the table. Play was stopped and paramedics were called. After about half an hour, John regained consciousness and was wheeled away to the hospital.

Last month we discussed arrhythmias, abnormal heart rhythms, which may, or may not, be predictors of serious illness. In my simplistic classification system, I advised that slight elevations in heart rate or an occasional skipped beat usually fit into a “no big deal” category. Think about the possible causes like caffeine, stress, stimulants or dehydration and, if the arrhythmia persists, seek medical attention to look for more serious conditions. A completely irregular rhythm or really rapid rates fall into the “call for help” category. Have the floorman cash out your chips and call for an ambulance. This would not be a good time to play one more round.

This month, we’ll cover the “OMG you’re dead!” category, but first, a little background. The heart is a pump, a lot like the one attached to your back yard pool. There are big pipes coming in and big pipes going out and some electrical connections to power the thing. Your heart also has a few smaller pipes (the coronary arteries) that supply nourishment to the pump itself, the heart muscle.

Over time, the plumbing in your house can get clogged with lime and scale. Likewise, your coronaries can get narrowed with french fries, cheeseburgers and pizza until one day a little clot forms and, bingo, a very important pipe supplying your heart muscle becomes blocked. If someone doesn’t get the clot out fairly quickly, say within an hour or two, some of your heart muscle will die and your pump will forever be less powerful. This is what a heart attack is, basically a plumbing problem.

When this happens to your home plumbing, you call a smelly overpriced guy with baggy pants to come over and snake your line. In the ER if you’re having a heart attack, we do exactly the same thing. We call in a plumber for your heart. Interventional cardiologists snake your clogged pipes, hike up their baggy scrubs and hand you a big bill, just like your plumber.

But the bad heart rhythms we’ve been talking about so far are not heart attacks, not plumbing problems at all, but actually electrical problems. More like short circuits or loose wires than clogged pipes.

The biggest danger occurs when, during a heart attack, the heart muscle becomes so irritated that the electrical circuits that run through it short out. The arrhythmia that can occur, called ventricular fibrillation, is a quick killer. The official name of this condition, “Sudden Death”, is so clearly descriptive that you don’t need me to tell you that it’s a bad thing. Now not all heart attacks develop ventricular fibrillation, but when they do, this would not be the time for a plumber. This is a job for electricity. Time to charge up the paddles and reboot – now. Restore power first, then have the pipes unclogged.

Clearly, this is not something you can do much about if it happens to you. It’s “Sudden” so you really don’t have time to call 911 before you hit the felt. And it’s “Death” so your brain will turn to mush within a few minutes if someone doesn’t kickstart your ticker. You’d better hope you haven’t been the table bully because you’ve got to rely on others to save you.

So how do you know if you might someday suffer from this delightful condition? Count your risk factors. Are you over 65? Do you have high blood pressure? High cholesterol? Diabetes? Do you smoke? Did a close family member have heart disease? Have you had heart problems in the past? Answer “yes” to too many of these questions and you are at risk for what Redd Foxx called “The Big One.”

There are some things you can do to lessen your risk. You can’t control your age or your genetics but you can put out that cigarette. Take your blood pressure medicine every day even if it makes you feel bad. Have your cholesterol checked and keep your diabetes under control.

If you are at risk, there is one other thing you can do to improve your chances of surviving “Sudden Death” and it’s so important that I’ll devote my entire column to it next month. And, by the way, Miami John survived his collapse at the Razz table and was able to return for the Main Event a few days later. Lucky for him, it wasn’t Sudden Cardiac Death, or even a heart attack. It turns out he had some internal bleeding which curiously enough is just another type of plumbing problem – leaky pipes. That’s what Razz will do to you.

A Healthy Bet (17) – Palpitations

As it appeared in Ante Up Magazine – Mar. 2010

By Frank Toscano, M.D.

I really enjoy playing in live multi-table tournaments. I love the challenge of trying to navigate a large field, and if I can make a deep run, the financial and psychological rewards are superb.

I didn’t always feel this way. Years ago when I entered my very first big tournament at the local Indian Casino, I was pretty nervous. I just knew I would make novice mistakes that would advertize to all my total lack of experience. As I waited for the tournament to begin, I studied the blind structure while I nursed an espresso in the food court.

My most awkward moment in the tournament came just after being moved to a new table. I was dealt a pair of Kings under the gun. As I calculated a raise I thought to myself, “This is a great opportunity. Don’t mess it up.”  As I reached for my stack, I noticed my hand was trembling slightly. I dribbled out a few chips and then tried to hide my excitement by crossing my arms and leaning on them. I could feel my heart racing against my hand. Part of my skills set as an ER Doctor is being able to estimate heart rate without looking at a watch. I’m sure mine was going at least 120.

So why does this happen? And why so fast? Is it something we can control? Is it dangerous?

First, a few definitions. An arrhythmia is secret doctor-talk for any abnormal heart rhythm. The seriousness of an arrhythmia can range anywhere from “no big deal” to “call for help” to “OMG, you’re dead!” When you can feel your own heart beating abnormally, it’s called a palpitation.

 You can usually feel your own pulse by pressing lightly on the underside of your wrist near the bone at the base of your thumb. You can also try to find it in your neck just underneath the angle of your jaw. Don’t press too hard. Count for 15 seconds and multiply by 4. A solid regular rhythm between 60 and 100 is good.

My racing heart was caused by a number of factors. I was anxious to begin with and I had just picked up a big hand that I didn’t want to screw up. My stress produced surges of adrenalin that cranked up my heart rate. A shot of espresso-strength caffeine compounded the matter.

Heart rates in the 120 range are usually not a major problem especially if you can identify and correct the cause of the extra adrenalin. Anger, stress, anxiety, caffeine, lack of sleep, dehydration, smoking, and some drugs, legal and illegal, like decongestant nasal sprays, Ritalin, speed and cocaine can all cause adrenalin surges. Drink some Gatorade, put out the cigarette and take a deep cleansing breath to see if you can make your rate go down. Resolve to get more sleep and stop using those nasty stimulants. If these easy fixes don’t work, see your doctor because a host of more serious medical problems like thyroid disease, blood clots in the lung, anemia and fever can also produce a persistently elevated heart rate.

Once you start hitting rates of 140 or more, it’s time to call for help. Commonly, rates that high are not caused by a simple gush of adrenalin, but by an actual short circuit in the heart’s electrical wiring. Your friendly paramedics carry a medication that usually works well to reset the circuit. Young healthy hearts can generally sustain rapid rates without suffering long-term damage, but older, weaker tickers can quickly get overwhelmed by rates that high. Don’t hesitate to call 911.

Irregular rhythms are a different story altogether. Usually a few “skipped beats” here and there are inconsequential. It would be wise to have them investigated but don’t panic. The usual adrenalin-producing culprits are probably at fault. But a completely irregular rhythm with no pattern whatsoever is a cause for alarm. Atrial fibrillation (more secret doctor-talk) needs to be controlled and corrected as soon as possible. Visit your kindly local ER doctor. This is not a problem you should put off until tomorrow.

So let’s summarize the “no big deal” and “call for help” groups. If it feels like your heart is thumping hard or fast, try to check your own pulse. If your rate is mildly rapid or you feel a few skipped beats, think about the various things that could stimulate an adrenalin surge. If your rate is really high or completely irregular, pull the trigger and call 911.

Next month we’ll cover the “OMG, you’re dead!” group and discuss how you can improve your chances if you get hit with “The Big One.”

In case you’re wondering, my Kings ran into an Ace on the flop, the button shoved and I ran away. I got blinded down by weak play and I eventually fizzled out. I don’t play like that anymore and I’m no longer nervous about big tournaments. I still, however, like my espresso.

A Healthy Bet (16) – Smoking

As it appeared in Ante Up Magazine – Feb. 2010

By Frank Toscano, M.D.

When you “set mine”, you try to see a flop cheaply with a medium or small pair. If you hit your set, you then try to get maximum value from your disguised monster. In a recent game, a mid-position player raised 4X and I was in the small blind with 66. If I called, maybe the big blind would come along too, maybe not. I knew that the odds of flopping a set were about 8–1 against. That’s about a 12% chance of success – not great. Clearly there’s not enough in the pot right now to justify a call. Are my implied odds large enough to make this play worthwhile? What critical piece of information have I left out? More on this hand later.

Now, I’m going to make a serious confession: I used to smoke. I haven’t used any tobacco products in many years, but I know deep within the center of my brain that if I lit up today, I’d enjoy it.

When I started smoking in the late 60s, no one talked about the dangers. Heck doctors, professional golfers, even Santa Claus smoked. My own father smoked. JFK smoked for gosh sakes! In my high school, the smoking area behind the gym was where parties were planned, where the cheerleaders hung out, where the major social interaction of our school took place. And if you didn’t light up while you were out there, you stood out like a geek at a football game.

It took me years to decide I wanted to quit and years more to actually succeed. I truly understand first hand the allure, the psychological pleasures and the biochemical cravings of nicotine addiction. I understand the crackle of the cellophane as you open a new pack, the click-whoosh of a hefty Zippo and the little surge of calm enjoyment that comes when the nicotine receptors in the brain’s pleasure-center release tiny packets of dopamine.

I understand it but I also hate it. I hate it that smokers use the streets as their ashtray. I hate it that my grandfather died from lung cancer, that my father could hardly breath during his last years on earth, that my step father-in-law is getting radiation treatments on his tongue. I also hate the smell. I hate it on the clothes of an asthmatic child who rode to the E.R. in a car with a smoker, or in the hair of a cougher who can’t understand why his bronchitis won’t go away. Or on my brethren poker players who rush outside for a quick smoke during every tournament break.

I really don’t make any value judgments about smokers because I understand that, although no one will ever quit without the will to do so, the success rate of quitting is not an issue of will power alone. It’s an issue of biochemistry, of overcoming a constant barrage of psychological and biochemical messages that reinforce the feeling that lighting up is comfortable, it relieves stress, it is pleasurable. Smoking may be the most difficult addiction of all to conquer.

The success rate of trying to quit without  some sort of medication is pretty abysmal, in some studies as low as 8%. Nicotine replacement (patches and gum) help a little. Zyban, which calms the nerves and reduces the cravings, is a little better but still not great. Chantix by Pfizer uses a novel approach and seems to actually be making a serious difference for smokers determined to quit.

Chantix blocks and, at the same time, stimulates nicotine receptors. That means that the pleasure-producing effects of nicotine are blocked (That puff doesn’t feel quite as good.) yet Chantix also stimulates the receptors a little so that a small amount of dopamine is still released.  For some, that small amount is just enough to reduce the nicotine cravings that cause so many to fail.

Time now for full disclosure: I’ve owned a small amount of Pfizer stock for decades. They have never sent me on a junket, bought me dinner, or even given me a coffee cup with their logo on it. The stock has dropped like a rock. I wish I had never bought it.

Chantix is not magic. There are side effects like nausea and sleep disturbance, and some big risks including suicidal thoughts, so if you are considering trying it, you should discuss the risks in detail with your doctor. The success rate using Chantix is about 22% to 44% depending upon the study, better than trying on your own or using gum, patches or Zyban. If those numbers seem low, consider the payoff. If you’ve tried to quit before and failed, it just might be the trick to help you succeed.

Now back to the poker hand. You can’t estimate implied pot odds without knowing how much you might win – the stack sizes. This is Florida. Buy-ins are limited and the stacks at my table were too short to justify a 12% chance of flopping another 6. The implied pot odds were low so I folded.

With Chantix, your chances of success are at least double what my chance was of hitting my set. And the implied pot odds are enormous – decreased risk of cancer, stroke and heart disease, and more money in your pocket to play poker. Plus you’ll smell better at the table. It’s a bet you should consider very seriously.

A Healthy Bet (15) – New Years Resolutions

As it appeared in Ante Up Magazine – Jan. 2010

By Frank Toscano, M.D.

This seems like the perfect time for some Poker New Year’s Resolutions. I’m not referring to the strategy kind. There are plenty of pros who are qualified to give you wise one-liners worth remembering next year. Papa Brunson says “Never go broke with a Queen in your hand.” Son Todd says “The third raise is always Aces.” Kid Poker warns not to overvalue tens. “After all, they’re just tens.” And our friend, Lee Childs advises simply, “Decide to win.”

I’m also not going to focus on any of my personal poker goals. I have a few like “always try to keep count of the pot” and “play more Razz” but those are really of no concern to anyone but me.

No, I’m supposed to be the medical guy so I thought I’d review the most important nuggets of healthy advice I’ve given you in my columns over the past year or so and ask you to consider taking some of these good health habits into the New Year. What follows is my Top Ten List of Healthy Poker Resolutions for 2010.

            Number 10:  Get a swine flu shot. You’ve gotten one already haven’t you? I sure have. Regular poker players are at a particularly high risk because they sit at a table with nine other people and pass things like cards and chips back and forth. The swine flu has gotten a lot of press this year because it’s so darn contagious, but even standard old seasonal flu kills 35,000 Americans every year. If you play a lot of poker you should get a flu shot EVERY year, especially this one. And if you do get sick, do everyone a favor and stay home. Have some soup.

            Number 9:  Wash your hands, a lot. After a bathroom break, before eating, and at the end of your session, wash up. If you can’t find soap and water, use hand sanitizer. Avoid touching your nose or mouth during play. Sneeze or cough into the crook of your elbow, not your hand. If someone at your table is sneezing or coughing, cover your own mouth.

            Number 8:  Get enough sleep. If you are planning to play late, catch a nap earlier in the day or sleep late the next morning. Don’t replay hands in your head while you are trying to get to sleep, especially those bad beats. Let them go.

            Number 7:  Limit your caffeine. And not just coffee or Red Bull. Colas, Mountain Dew and even Green Tea “Energy” drinks are loaded with the stuff.

            Number 6:  Don’t hold your bladder too long. Limit your fluids during the latter stages of a tournament when the blinds escalate and take advantage of breaks in the action to take care of business. Did I mention washing your hands? See Number 9 above.

            Number 5:  Don’t let a blood clot sideline your game. Sitting at the table for hours can cause blood to sludge in your legs. Point your toes and contract your calf muscles every time you get the button. Get up frequently and walk; do deep knee bends; exercise your legs; wear elastic socks.

            Number 4:  Don’t lean on your elbows. This goes for on-line as well as live play. That little watery blob at the tip of your elbow is a bursa. If you traumatize it enough by leaning on it, it can swell up or even get infected. For gosh sakes, don’t stick a needle in it. If it’s hot and red, see a doctor. If it’s not, leave it alone.

            Number 3:  Exercise your mind and your memory. Pay attention to the play especially when you are not involved in a hand. Look for patterns. Resolve to remember them. Challenge yourself. Learn other games (like Razz!).

            Number 2:  Don’t use drugs to improve your game. The slight and temporary performance improvement you might experience by using speed or coke isn’t worth the enormous danger to your health. If you don’t have ADD, forget Ritalin and Adderall. They are just as risky. Pharmaceutical quality speed is, after all, still speed.

            And my Number 1 Healthy Poker Resolution for 2010:  Don’t smoke at the table – cigars, cigarettes, anything. And don’t let others smoke at your table either. Clearly you’ll have more control over this resolution if it’s your own home game, but you can voice your objections and refuse to attend games where smoking is allowed. And, if you have a choice, choose a non-smoking card room. No matter how good a game might be, it’s not worth breathing carcinogens.

I’d like to take this opportunity to thank all of the readers of this column and especially those who have taken the time to send in questions or comments (favorable or not). I encourage your questions, your comments and particularly any ideas you may have for future columns. You can write me at: info@antemumagazine.com. Have a Healthy New Year!

A Healthy Bet (14) – Better Poker Through Chemistry

As it appeared in Ante Up Magazine – Dec. 2009

By Frank Toscano, M.D.

World Champion, Peter Eastgate has a tell and I can fix it. I didn’t notice it during last year’s November Nine broadcast but ESPN edits those shows so much that facial expressions you see on the screen might not occur in even the same hour as the hand you are watching. Instead, it was a few months later on High Stakes Poker, that I first saw it.

Internet wunderkid Tom “Durr” Dwan had rags but that didn’t stop him from betting enough chips to buy a Mercedes. Don’t you just hate the way he does that? I know I do. Anyway, Eastgate had trips but he began to agonize that maybe, just maybe, this time Durr held a monster. That’s when it happened.

Usually Peter’s 22 year-old forehead is as smooth as butter, but as he struggled with the idea of giving up this juicy pot, his brow furrowed. His eyebrows moved downward and closer together and two deep vertical creases appeared between them in the area called the glabella. He was clearly very uncomfortable. He had a good hand, a very good hand, but you could see that he had lost confidence. Durr saw it too. Even if Eastgate called, Durr knew he could take it away from him on the next street. Eastgate eventually laid it down but the hand was lost with the furrow, not the fold.

I saw him do it again twice at this year’s WSOP. Similar situations – good hand for Peter, big bet from an opponent, loss of confidence, furrow, fold. Normally I’d keep this kind of valuable poker strategy information to myself but I doubt that Eastgate is going to be furrowing his brow at my home game anytime soon. The key thing is that this tell can easily be fixed with a little chemistry.

Some of you may know that, like Superman, I have two identities. At night, I don my super-powered E.R. white jacket and stamp out disease in one of our nation’s healthcare safety-nets. If you get drunk and beat up, I can hold your hand and say, “there, there.” If your dog ate your Vicodin, I can call a vet. (Sorry, sir, no refills.) And if you get swine flu, I’ll heat up some soup.

But during the day, I assume my secret identity. I become a mild-mannered Medical Spa doctor who makes beautiful women just a tiny bit more beautiful. My Medical Spa alter ego purchases Botox by the truckload just to keep up with demand. I know Botox well and I know it can help Peter Eastgate’s forehead.

Botox is an interesting molecule. It’s made by bacteria that grow in improperly canned foods. It blocks the part of muscle fibers that recognize messages coming from nerves. If the message is blocked, the muscle doesn’t contract. Wrinkles disappear; furrows go away; Peter looks relaxed; Durr backs down; Peter wins a car. Peter’s furrows are pretty deep so he’ll probably need a lot of Botox, maybe 35 or 40 units which, by the way, costs less than what he would have tipped the dealer if he had won that pot.

The late John Bonetti, a three-time bracelet winner, also had a tell that Botox could have fixed. Watch reruns of Poker After Dark, and you will see his bushy eyebrows shoot up to the ceiling whenever he had great hole cards. Forty or fifty units in the forehead and those eyebrows would have stayed put.

Now I’m not suggesting that Botox is the answer for poker tells – far from it. Behavioral experts will tell you that hands and feet and shoulders broadcast many more tells than foreheads. But you should be aware that Botox certainly can be used to hide furrowing, wrinkling, crinkling and even frowning.

Be especially wary of those sly ladies who secretly use Botox to look a little younger but nevertheless enjoy the benefits of hiding some facial expressions at the tables. I won’t name any names but take a real close look at any of the lovely female poker pros over 40. Do they have clear, smooth foreheads, classically arched eyebrows, curiously absent crows’ feet? Some of them just don’t seem to age much from year to year. They look well rested, even perky. Could it be good genes? Or is it skillful use of chemistry? I know which side of that bet, my money is on. My “secret-identity self” can sniff out Botox from across the poker table.

That’s not to say that all Botoxed foreheads look good at the table. To see a really bad Botox job, check out the shockingly dreadful 2003 poker movie Shade. Skip all the painful pot-splashing and string bets and fast-forward to the showdown when Sly Stallone and Melanie Griffith appear. Sly’s glabella never moves. That’s okay, but check out his “Spock brows”, a result of too much Botox in the wrong place. Probably done by the same doc that did Melanie’s lips.

So, if you want to look a little younger, a little more refreshed or if you would just like to soften your pensive frown, erase your crow’s feet or smooth your forehead, Botox works pretty well. Seek out a doc who’s a real Botox pro. But if you really want to hide your excitement over flopping the nuts, pay close attention to what your hands, feet and torso are doing.

And, Peter, if you really can’t control that furrow, I can fix it.  Give me a call.