Video Course Evaluation Form. Atty ID number for Pennsylvania: Name of Course You Just Watched

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Garden State CLE 21 Winthrop Road Lawrenceville, New Jersey 08648 (609) 895-0046 fax- 609-895-1899 Atty2starz@aol.com Video Course Evaluation Form Attorney Name Atty ID number for Pennsylvania: Name of Course You Just Watched Please Circle the Appropriate Answer Instructors: Poor Satisfactory Good Excellent Materials: Poor Satisfactory Good Excellent CLE Rating: Poor Satisfactory Good Excellent Required: When you hear the bell sound, write down the secret word that appears on your screen on this form. Word #1 was: Word #2 was: Word #3 was: Word #4 was: What did you like most about the seminar? What criticisms, if any, do you have? I Certify that I watched, in its entirety, the above-listed CLE Course Signature Date Garden State CLE, 21 Winthrop Rd., Lawrenceville, NJ 08648 609-895-0046 fax 609-895-1899

GARDEN STATE CLE LESSON PLAN A 1.5 CLE CREDIT COURSE FREE DOWNLOAD LESSON PLAN AND EVALUTION Heart Disease & the Stressed-Out-of-Your-Mind Middle-Aged Lawyer WITH Steven Lederman, M.D. AND FEATURING ROBERT RAMSEY, SENIOR INSTRUCTOR Program Description Nothing kills more attorneys each year than heart disease. You don t have to be a victim. This 1.0 credit CLE may literally save your life. Garden State recommends this CLE for every lawyer in private practice.

I. INTRODUCTION Garden State CLE Panelists [Steven Lederman, M.D. and Robert Ramsey, Esq.] Scope of Topic [1:07 duration and 8 pages of materials] II. WHY CARDIOLOGY? Doctor Dan the Bandage Man III. THE PREVENTION OF HEART DISEASE in Attorneys Stress elevated blood pressure Makes it more difficult to take care of yourself Lifestyle changes could prevent much of the type of problem he treats

IV. STRESS in the Lives of Attorneys Most importantly: stress prevents you from doing the things you know that you need to do in terms of lifestyle changes, etc. Prolonged stress may be a significant risk factor for other items related to the disease V. HIGH BLOOD PRESSURE VI. VII. VIII. IX. WEIGHT & SEDENTARY LIFESTYLE SMOKING & ALCOHOL DIABETES THE ROLE OF GENDER Women lag behind men UNTIL menopause arrives X. FAMILY HISTORY HUGE risk factor

XI. ALCOHOL Has an indirect effect XII. LIPID PROFILES OF LDL/HDL Higher LDL increases your risk Lower HDL increases your risk Very high HDL may be a risk XIII. XIV. INSULIN RESISTANCE AND MILDLY ELEVATED BLOOD SUGARS ARE SIGNIFICANT RISK FACTORS DENIAL OF SYMPTOMOLOGY Chest discomfort (not necessarily pain): tightness, heaviness, pressure fullness and burning in the chest and many other factors Back pain and jaw pain Left arm, across back Usually comes on with activity and subsides with rest. Call your Doctor Physical cause: Blockage in artery leading to heart Angina is pain

Significant impairment is 70% or more Heart attack pathophsyiology: Clot at plaque site, blocks artery and you have a heart attack XV. DENIAL CAN BE DEADLY Better safe than sorry Go to your ER and hope to find out it was acid reflux XVI. SURGICAL OPTIONS Bypass is the restoration of blood flow through a blocked pipe, in essence Angioplasty is the first line of treatment to help avoid bypass Internal mammary artery is the most resilient of all and reserved for the most important blockages. The Docs today are talented at diagnosis and treatment with stents and angioplasty. Coated stents make lesser the issue of buildup of amino acids etc on the stents of today. Can you get non-invasive bypass surgery? Yes, of course. Small incisions are capable of

being given, but it depends on location, size, seriousness, etc. XVII. WORD ASSOCIATION Arrhythmias are electrical problems in the chambers of the heart Tachycardia is an abnormal rhythm, the seriousness is related to the source/mechanism of the problem. Aortic aneurism: outpouching of the wall of the aorta and can involve any portion of it and weakness in the aortic wall. Hypertension is often in the family history for aneurism victims. Ascending and descending aorta, abdominal aorta too. Abdominal aorta is involved most often in aneurysm. You are likely to remain asymptomatic until death. Heart valve problems: There are four valves. Generally, left side of the heart is the problem, they can be leaky or blocked, regurgitent or stenotic. Aortic stenosis is the most common valve problem.

XVIII. XIX. HEART ENLARGEMENT TRANSPLANTS They are life savers There are alternatives like mechanical hearts like the former vicepresident had---before his transplant Age cut off for transplants could be a medical cutoff date due to Co-morbidities etc. (e.g. Lung and liver) Statins may help reduce cholesterol metabolism in the liver Damage to other organs IS possible Muscle side effects too HDL/LDL drugs XX. CORONARY HEART DISEASE REVERSAL Dead muscle can t be reversed, but the heart s reserve capacity is great Ejection fraction: amount/volume of blood ejected with each beat XXI. THE PLANT-BASED DIET OPINION

Minimize meat intake and maximize vegetables and plant based foods Vegetables are zero cholesterol foods Some Veggies are high fat, and other non meat foods have fats and oils Vegan diets are less calorie dense than the typical Western diet High fiber Not in favor of eggs Calories are not something that you need to worry about XXII. FATALITES IN HEART ATTACKS 13% to 15% of all heart attacks result in death in the FIRST instance Take care of yourself: if you are a stressed out attorney, you DO NOT have to DIE