Picture This: A Cartoon Anthology

By Stephen Raskin MD

Every 37 seconds an American dies of cardiovascular disease. For nearly half of its victims atherosclerotic cardiovascular disease shows up suddenly with a heart attack or sudden death – as if appearing out of a fog. This is the disease that kills most men and women in the United States and knowing about it earlier makes common sense.

Atherosclerosis starts silently in our teen years, and often tracks with poor lifestyle, and poorly controlled risk factors including poor nutrition, abnormal lipids, high BP, diabetes, tobacco use, sedentary behavior, and importantly, genetic predisposition. The development and progression of coronary atherosclerosis is a silent process and each year nearly 150,000 Americans present with fatal myocardial infarction as the one and only manifestation of this indolent disease.

It is obvious that our current methods to identify and treat atherosclerotic vascular disease fail too many.

• Language: English
• Publisher: Xlibris US
• Release date: Nov 22, 2020
• ISBN: 9781664141131

Stephen Raskin MD

Stephen Raskin, MD is currently the Director of the Sutter Eastbay Lipid Clinic in Oakland, California. He is a former Clinical Professor of Medicine, University of California, San Francisco, and mentor at the UC Berkeley-UC San Francisco Joint Medical School Program. Dr. Raskin is a graduate of Queens College of the City University of New York where in addition to premedical training he served as the political cartoonist for the school newspaper. He graduated from the Medical College of Wisconsin and was elected to the National Honor Medical Society, Alpha Omega Alpha. He is a Fellow American College of Cardiology and holds Board certifications in Internal Medicine, Cardiovascular diseases, Cardiovascular Computed Tomography and Clinical Lipidology. He enjoys travel photography and has been an avid sailor, completing two transpacific crossings. Dr. Raskin lives in Oakland with his wife Anne, and their feline, Nuzzie. Dr. Raskin is a frequent invited lecturer on preventive cardiology.

Book preview

Copyright © 2020 by STEPHEN RASKIN, MD. 802521

All rights reserved. No part of this book may

be reproduced or transmitted in any form or by

any means, electronic or mechanical, including

photocopying, recording, or by any information

storage and retrieval system, without permission

in writing from the copyright owner.

Xlibris

844-714-8691

www.Xlibris.com

ISBN:    Softcover        978-1-6641-4114-8

              Hardcover      978-1-6641-4115-5

              EBook             978-1-6641-4113-1

Library of Congress Control Number: 2020922112

Rev. date: 11/20/2020

FOR

Anne, my heart’s desire

AND

Sophie and Greg,

Putter, Ellie and Lucie,

my greatest legacy

CONTENTS

ACKNOWLEDGEMENTS

AUTHOR’S NOTE

PREFACE

CHOICES

FOG OF UNCERTAINTY

FIREMEN ARE AFRAID

ATHEROSCLEROSIS

PARTICLES

IT’S HOT HERE

DOUBLE-HEADED MONSTER

BUYER BEWARE

IT’S NOT A PIPE

OPEN-ARTERY HYPOTHESIS

SOOTHSAYER

DON’T FORGET ME

NOBEL DISCOVERY

ELEPHANT IN THE ROOM

THE DRAGON

ATHEROSCLEROTIC GUN

WAYPOINTS

POLICY

A HARD RAIN’S A-GONNA FALL

WALKING INTO THE ABYSS

THE REAL OMEGA-3

SHE LOVES ME SHE LOVES ME NOT

BLINDSIDED

JANUS-LIKE

FALSE IDOL

LEFT MY HEART IN SAN FRANCISCO

MASTERPIECE

PRIMA FACIE EVIDENCE

GAME CHANGER

YOU LOOK MAHVELOUS

TWO ROADS

RESIDUAL RISK

MEASUREMENTS

GLOBAL CRISIS

WE HAVE MET THE ENEMY

KNOCKOUT PUNCH

EPILOG

FURTHER READING

ABOUT THE AUTHOR

ACKNOWLEDGEMENTS

I would like to express my deepest appreciation to my family for their support and steadfast encouragement, as I attempted to balance family life, my cardiology practice and cartooning. I owe a huge debt of gratitude to my sister-in-law, Patricia Reilly, for her patience, stamina, and superb editorial assistance. A special thank you to Tiffany Alyssa Eatz, Roger Blumenthal, Allan Sniderman, Jim Adams, Karol Watson, Matt Ito, Susan Robinson, Mike Wegener, Joe Sky and Terry Moran, who provided feedback and encouragement throughout the development of this project. I wish also to recognize my late Dad, whose old country wisdom permeates my world-view and remains a continued source of inspiration and comfort.

The following colleagues, and mentors who over the years provided freely of their expertise, support and encouragement and individually enriched my journey as a preventive cardiologist deserve special mention. These gentlemen include: Doctors: John Kane, Ron Krauss, John Rumberger, Matt Budoff, and Robert Superko. A special recognition to my many patients, who remain at the center of my medical universe and also to the late Mr. Dave King, the founding father of coronary calcium imaging who encouraged me, and many others, in the early days to persevere and follow the science for the benefit of our patients.

AUTHOR’S NOTE

About half of Americans have some form of cardiovascular disease. A working knowledge of important science-based concepts about maintaining health and avoiding the too-often sudden complications of this disease makes common sense. After all, cardiovascular disease is responsible for most of the deaths in the U.S. and as a practicing cardiologist it is something I think about.

Knowledge underwrites the process of shared decision-making, a vital piece of the doctor-patient relationship and something particularly important when it comes to heart disease. Dr. Paul Dudley White, one of six founding members of the American Heart Association in 1924 said, We were living in a time of almost unbelievable ignorance about heart disease. Now, nearly a century later cardiometabolic diseases are soaring and ignorance about the benefits of a healthy lifestyle and particularly, healthy nutrition is commonplace.

When patients are sick healthcare teams make efforts to educate, but when it comes to heart health, the process must start much earlier, before patients get sick.

The American Heart Association (AHA)’s 2020 Impact Goals considers health literacy (the degree to which individuals access and process health information in health-related decisions) an unmet goal to improve cardiovascular health for Americans. When words alone fail to educate, images often assume a greater role, especially when it comes to science-based education. The PICTURE THIS is a cartoon anthology based on that premise. The reader is introduced to the broad topics of atherosclerosis and cholesterol, and why atherosclerotic vascular disease is often missed by traditional approaches of care. New insights in early detection of atherosclerosis and the confusion about cholesterol are explored in hope of translating the hieroglyphics of the science into understandable action plans.

The importance of lifestyle and healthy nutrition are recurrent themes. The reader is also introduced to many of the thought leaders whose contributions to the science have led to remarkable innovations that have improved the lives of millions. My cartoons and commentaries are based on many hours of patient interaction, as we worked together to formulate patient-specific preventive cardiology plans. Impromptu sketches often accompanied those visits, as they still do today, in an effort to clarify those important take-home messages.

Cartooning began for me during the turbulent 1960’s as a pre-med student at Queens College of the City of New York. It was there I was lucky enough to land a job as an editorial cartoonist for the school paper, the Phoenix. There was much to comment about then, with student unrest widespread against the backdrop of the first televised war in Vietnam. Many of us found our voice and were inspired to speak truth to power.

Now nearly 50 years later, cardiovascular disease is omnipresent and remains a silent threat to the wellbeing of millions across the globe. As COVID-19 dominates our lives and redefines normalcy my hope is to leverage cartoons to highlight the other deadly pandemic, of atherosclerotic vascular disease, and why its early diagnosis and treatment remain vital. When it comes to our cardiovascular health, a proactive stance against this formidable adversary is only possible with more knowledge. This is even more important today, since good vascular health and prevention of chronic cardiometabolic disease can be protective and lessen the ravages of COVID-19.

Science assumes a much greater relevance in today’s world with implications that are particularly important for the environment, society and our health. Unfortunately, in the post-truth era, objective facts seem less influential in shaping public opinion compared to personal beliefs. The value of knowledge based on science compared to beliefs cannot be understated. When it comes to our heart health, beliefs too often supersede the science. The key thing that differentiates modern medicine is its embrace of science. Sadly, a recent Institute of Medicine report concluded that nearly half of American adults have difficulty understanding and acting upon health information.

Healthcare providers are assuming much more responsibility as health educators. For many of us the important job to educate individuals about the science of atherosclerosis and the importance of lifestyle, fundamental for wellness, remain daily challenges.

What follows are the musings of a preventive cardiologist that can make a difference. The reader is presented with science-based concepts about cardiovascular disease, cholesterol, nutrition and health policy from the perspective of a practicing cardiologist, father and grandfather.

Oakland

September, 2020

A9RA590.jpg

How the hell do you spell ennui?

From the World of Steve Raskin

Published in the Phoenix, 1968

In memory of my cousin, SP5 Gerald Levy

173rd Airborne Brigade, 2nd Battalion,

503rd Infantry, C Company.

PREFACE

I have been privileged to see many remarkable advances in the treatment of cardiovascular diseases from surgical procedures, once thought impossible, to life-saving medicines. These advances are responsible for longer and more productive lives for countless individuals. Unfortunately, the undeniable truth is most Americans will die of atherosclerotic cardiovascular disease.

I write these words in September 2020 in the midst of