Top 10 Ways to Avoid a Heart Attack
A sad event may leave you with a "heavy" heart. If you're a cold and callous person, you're described as having either a "hard" heart or no heart at all. The 1980s music group Quarterflash tried to harden their heart, and Bruce Springsteen says that everybody's heart is hungry. There are a lot of words you can attach to "heart" to describe a wide variety of human conditions and emotions. But here's a sobering thought -- the two words most often used to describe a real cardiac event are "arrest," "attack" and "failure."
Your ticker is a pretty simple organ. It brings blood in by way of arteries and then pumps it back out to the rest of the body. A waxy substance called plaque can build up on the inside of these arteries, which makes them narrower, and it becomes more difficult for the blood to take the ride into and out of the heart. Over time, the buildup of plaque deposits can rupture and cause total blockage of the blood flow to the heart. This is called a heart attack and it's the No. 1 killer of both men and women each year in the United States.
The bad news about heart attacks is that there are many factors that play in to whether you'll have one, including your genes, what you eat and how much you exercise. The good news is that they're preventable. If you take steps now, you can greatly improve your chances of not having a heart attack. We've compiled a list of 10 things you can do to help you avoid being a heart attack statistic.
Heart Tip 10: Exercise
This one is a no-brainer. When you lift weights, your muscles get stronger and healthier. Your heart is a muscle, so the same thing holds true for it. Doctors recommend 30 minutes of cardiovascular exercise three times a week at the bare minimum. If you want to really get yourself into shape, you should try and get that 30-minute workout in five to seven days a week. Not everyone loves to jog or go to the gym. This is why the key to any exercise plan is to make it something that you enjoy.
If you hate to jog, try a team sport or play some tennis. If tennis is too hard on your joints, try swimming. If you can't swim, take your dog for a brisk daily walk. Throw the Frisbee with friends in the park. Go rollerblading. If you love golf, ditch the cart and walk the 18 holes. Exercise doesn't have to mean plodding away on a treadmill. Find something you enjoy doing and do it with regularity to establish a routine. After about a month, that routine is ingrained as a habit. Before you know it, that habit has you on your way to avoiding a heart attack.
Heart Tip 9: Sleep
This tip is one most people can probably get behind. In today's hectic world, it seems like some of our basic needs aren't often met -- sleep is one of them. Although it varies for everyone, doctors suggest that you should get about 8 hours of sleep per night. Almost 60 percent of adults have problems sleeping, and only 37 percent get that recommended amount per night. Not only does being tired all day hurt your performance, but research shows that too little or too much sleep can have some poor effects on your blood pressure and ticker, specifically.
A 10-year-long Harvard University study tracked the sleep habits and health of more than 70,000 women between the ages of 45 and 65 who had no previous heart trouble. At the end of the 10-year period, 934 of these women suffered from coronary heart disease and 271 died from it. The 5 percent of the women who slept less than five hours per night were nearly 40 percent more likely to suffer from heart disease than women who slept an average of eight hours. On the flip side, the women who slept more than nine hours per night were 37 percent more likely to have heart trouble. Studies have returned similar results in men. So the key is to try and stay within that eight hour range, and you're doing your heart a favor.
Heart Tip 8: Aspirin
In 1998, the Food and Drug Administration (FDA) advised people that have already had a heart attack to begin taking an aspirin a day to help prevent another one. The popular pain reliever, in low doses, works to help prevent clotting by thinning the blood. If your blood isn't clotting, you're less likely to have a heart attack. The American Heart Association (AHA) also suggests a daily dose of aspirin to help prevent a first and second heart attack.
However, many people haven't heeded the warning about taking too much aspirin, and nearly 250,000 adults are admitted to the hospital each year for internal bleeding as a result. The FDA and the AHA recommend that adults stick to the minimum daily dose, which is only 75 to 81 milligrams. This is the equivalent of a single baby aspirin. When you consider that a standard full dose of aspirin comes in at 325 milligrams, people who pop one of those per day are doing more harm than good. Before you start an aspirin regimen, you should consult your doctor. The requirements are different for men and women and not everyone is a good candidate for aspirin therapy. You also shouldn't drink alcohol if you're on a daily aspirin dose because it can increase your chances for internal bleeding.
Heart Tip 7: Lower Your Cholesterol
Cholesterol gets a bad rap. There are actually two kinds of cholesterol and one of them, high-density lipoprotein (HDL), is produced in the liver and plays a vital role in the functioning of your body's cells. The easiest way to say it is that HDL makes your cells waterproof. This ensures that the biochemistry of the inside of the cell is different from the outside. HDL also serves as a guard against cancer and aging and is necessary for proper neurological functioning.
So why would you want to lower your cholesterol? Because the second kind, low-density lipoprotein (LDL), get smaller and smaller until they're tiny enough to enter the walls of your blood vessels and attach themselves like a bad houseguest. Once enough of the LDL sticks around, it's called plaque. Over time, the plaque can rupture and block the vessels altogether. Then it's heart attack time.
You can combat this in a couple of ways. There's the age-old advice to quit smoking, get on a healthy diet and exercise. Then there's a drug treatment called statins that can help lower your LDL levels. The American Heart Association recommends that fat not exceed 25 to 30 percent of your daily intake and your cholesterol from food not be more than 300 milligrams. You should also get 25 to 30 grams of fiber into your diet each day and see tip No. 1 for your exercise routine. Statins are the other option. If your doctor finds that your LDL levels are more than 130 grams per deciliter, he may decide to put you on one of the six brands of statin drugs on the market. Whether it's through diet and exercise, statins or both, lowering your cholesterol is a great way to help you avoid the dangers of a heart attack.
Heart Tip 6: Lower Your Blood Pressure
A lot of people may hear the words blood pressure and not even know what that actually means. It's pretty simple -- blood pressure is the measurement of the force of the blood against the walls of your blood vessels. When your blood pressure is measured, there are two readings -- systolic and diastolic. The systolic part refers to the pressure when your heart is expanded, and the diastolic reading is when your heart is at rest. They're given as systolic over diastolic, like a fraction.
The American Heart Association estimates that about one-third of all Americans have high blood pressure, or hypertension, and that a third of those people don't know it. This is because there really aren't any symptoms. It's called the "silent killer" because the only way to find out if your pressure is high is to check it. Some people sit down at the machines in pharmacies and grocery stores, but unless it's a new machine or you know that it's been maintained and recently recalibrated, you can't really trust those numbers.
If you get your pressure checked and it falls under 120/80, then you're doing fine. Anything between 120-139/80-89 is called prehypertension, and above this level is considered high. The first step in controlling your blood pressure is to have it checked on a regular basis. Once you find out you have high blood pressure, your doctor will ask you to eat less fatty foods, cut your salt intake, stop smoking if you're a smoker, exercise and limit the amount of alcohol you drink. If this isn't enough to get your pressure down, you may need to go on blood pressure medication like diuretics, which get rid of excess fluids and salts, and beta-blockers that actually reduce the amount of blood your heart pumps.
Heart Tip 5: Chill Out
Everyone knows that being stressed out isn't a good feeling. Turns out, it goes a little deeper than that -- stress can actually have some pretty severe effects on your body. Research scientists in Canada performed a study and found that people who had heart attacks and returned to a stressful career were twice as likely to have a second attack as those who held down reasonably stress-free jobs. University of London researchers found similar results for people who had stressful intimate relationships.
There's an area at the base of your brain called the hypothalamus that sets off an alarm whenever you get stressed. This alarm sends a signal to your adrenal glands to release a surge of stress hormones, including adrenaline and cortisol. This is also known as the fight-or-flight response. Your heart rate increases, which elevates your blood pressure and boosts energy supplies. If you're always stressed, then your body thinks it's in a constant state of threat -- not a good thing. Reducing your stress levels will lead to a reduced heart rate and ultimately help you to lower your blood pressure.
If you lead a stressful life, try to chill out by relaxing with friends after work. Take a walk or give meditation a try. Exercise and the right amount of sleep also go a long way toward combating your stress level. If none of these tricks work and you still find yourself stressed, see a professional counselor or psychotherapist. It can help your head and your heart.
Heart Tip 4: Stop Smoking
File this one under no-brainer as well. Every smoker on the planet knows that it's not good for them. The problem is that it's really difficult to quit. So difficult that nearly two-thirds of adults who want to quit aren't able to . So hard that almost half of patients that undergo surgery for lung cancer continue to smoke. That's how tough it is. It's also extremely bad for your heart.
When you smoke, the burning of the cigarette creates something called carbon monoxide (CO) -- the same stuff that's created when your car burns gasoline. The CO you inhale takes the place of the oxygen that's carried to and from your heart by your red blood cells. This basically poisons those cells and keeps them from carrying oxygen to the heart and from the heart to the rest of the body. This happens because CO is a master of disguise -- it's able to pass itself off as oxygen. So when you smoke, you're basically starving your heart of oxygen, the one thing it needs to function properly. If you smoke a pack of smokes a day, the CO level in your bloodstream will stay between 4 and 8 percent. A normal amount of CO in your blood is extremely low -- zero to eight parts per million.
Whether or not you're at risk for a heart attack, you should probably try to quit smoking. It's tough, but people do it every day all over the world, so you can too. Try cutting down first. A review of smoking studies for people that had no desire to quit showed that cutting down often led to complete cessation . It's also been proven that it's much easier to quit if you partner up with a fellow smoker who's kicking the habit. Nicotine replacement therapy can be effective for some, and there are other new drugs on the market like Chantix that are effective for some smokers.
Heart Tip 3: Undergo Preventive Screenings
Here's a novel idea -- preventive medicine. In other words, trying to stop a problem before it becomes one. Preventive health screenings can give you and your doctor a lot of information about how at risk you are for cardiovascular disease. The Department of Health and Human Services recommends that you start getting your blood pressure checked every two years starting at the age of 18. It also recommends having your cholesterol levels checked at age 18, and from then on, as often as your doctor thinks is necessary.
The great thing about preventive screenings is that they don't take very long and are basically painless. Blood pressure checks involve a stethoscope and an aneroid monitor. You may not recognize the aneroid by its fancy name, but it's the arm cuff system that you've likely seen before. Your cholesterol levels are determined through a simple blood test, so you'll need to get your arm tapped for the red stuff. Aside from these standard checks, there are ultrasound tests that can detect arterial blockage, and you'll also likely have your body mass index (BMI) calculated so you'll know exactly how out of shape you are. Your BMI is your weight divided by the square of your height, and multiplied by 732.You may not want to hear some of these numbers, but getting information early on about your risk level can help you avoid a heart attack down the road.
Heart Tip 2: Know Your Family Medical History
This one isn't as easy as you might think. Some families never suffer through a divorce and are open and honest about everything that goes on. Other families are fractured and distant, with medical goings on swept under the rug for the sake of not worrying children. Because of divorce, death and parents giving their children up for adoption, many adults may not even be acquainted with one or both of their parents at all, much less their medical histories. Some people have genetic predispositions to certain diseases and illnesses -- heart disease is no exception. If your father died from a heart attack at the age of 50, then chances are you may be headed down that same road. Even the healthiest of individuals can't do anything about the genes they inherited.
The first thing you should do to get your information is to interview your siblings and parents and record the information they give you. Your doctor will ask you these questions anyway, so you may as well have the information. From there, go on to interview other family members. Find out about chronic illnesses, disease and any major surgeries they've undergone. Ask your grandparents about their siblings and parents. Take down all the information in detailed notes, no matter how limited it is. Even knowing how and at what age your great-grandmother passed away can be important to your risk level. The last thing you should ask in your interviews is what kind of lifestyle your relatives lived. If your grandfather who died from a heart attack at 50 drank like a fish and smoked like a chimney while he stuffed his face with salt pork, then you should take that into consideration.
Heart Tip 1: Adopt a Heart-healthy Diet
You really are what you eat. If you dine on a steady flow of bacon and eggs, cheeseburgers, French fries and Twinkies, then you and your heart aren't going to be in the best condition. Adopting a heart-healthy diet is the most important thing you can do to benefit your ticker. It will help you to lower your blood pressure and cholesterol and limit the amount of bad fat you take in.
As far as a broad approach goes, try to get as far away from processed foods as possible. The closer your four food groups are to their original, unprocessed form the better. It's called a whole foods lifestyle. Include plenty of fresh fruits and vegetables and eat fish at least twice a week. Salmon is your best bet for supplying your heart with healthy omega-3 fatty acids that will help you reduce arterial plaque. Whole grains like oatmeal and whole wheat bread are a must as well.
Legumes like beans and lentils are loaded with protein, fiber, iron and calcium and are free of fat and cholesterol. Nuts are packed with antioxidants, omega-3s, fiber and vitamin E, among other things. The important thing is to not think of it as a diet, but as a lifestyle change. Stay away from boxed food, head for the fruit and veggie aisle, and you're on your way to making sure there are no ambulances in your future.
Your ticker is a pretty simple organ. It brings blood in by way of arteries and then pumps it back out to the rest of the body. A waxy substance called plaque can build up on the inside of these arteries, which makes them narrower, and it becomes more difficult for the blood to take the ride into and out of the heart. Over time, the buildup of plaque deposits can rupture and cause total blockage of the blood flow to the heart. This is called a heart attack and it's the No. 1 killer of both men and women each year in the United States.
The bad news about heart attacks is that there are many factors that play in to whether you'll have one, including your genes, what you eat and how much you exercise. The good news is that they're preventable. If you take steps now, you can greatly improve your chances of not having a heart attack. We've compiled a list of 10 things you can do to help you avoid being a heart attack statistic.
Heart Tip 10: Exercise
This one is a no-brainer. When you lift weights, your muscles get stronger and healthier. Your heart is a muscle, so the same thing holds true for it. Doctors recommend 30 minutes of cardiovascular exercise three times a week at the bare minimum. If you want to really get yourself into shape, you should try and get that 30-minute workout in five to seven days a week. Not everyone loves to jog or go to the gym. This is why the key to any exercise plan is to make it something that you enjoy.
If you hate to jog, try a team sport or play some tennis. If tennis is too hard on your joints, try swimming. If you can't swim, take your dog for a brisk daily walk. Throw the Frisbee with friends in the park. Go rollerblading. If you love golf, ditch the cart and walk the 18 holes. Exercise doesn't have to mean plodding away on a treadmill. Find something you enjoy doing and do it with regularity to establish a routine. After about a month, that routine is ingrained as a habit. Before you know it, that habit has you on your way to avoiding a heart attack.
Heart Tip 9: Sleep
This tip is one most people can probably get behind. In today's hectic world, it seems like some of our basic needs aren't often met -- sleep is one of them. Although it varies for everyone, doctors suggest that you should get about 8 hours of sleep per night. Almost 60 percent of adults have problems sleeping, and only 37 percent get that recommended amount per night. Not only does being tired all day hurt your performance, but research shows that too little or too much sleep can have some poor effects on your blood pressure and ticker, specifically.
A 10-year-long Harvard University study tracked the sleep habits and health of more than 70,000 women between the ages of 45 and 65 who had no previous heart trouble. At the end of the 10-year period, 934 of these women suffered from coronary heart disease and 271 died from it. The 5 percent of the women who slept less than five hours per night were nearly 40 percent more likely to suffer from heart disease than women who slept an average of eight hours. On the flip side, the women who slept more than nine hours per night were 37 percent more likely to have heart trouble. Studies have returned similar results in men. So the key is to try and stay within that eight hour range, and you're doing your heart a favor.
Heart Tip 8: Aspirin
In 1998, the Food and Drug Administration (FDA) advised people that have already had a heart attack to begin taking an aspirin a day to help prevent another one. The popular pain reliever, in low doses, works to help prevent clotting by thinning the blood. If your blood isn't clotting, you're less likely to have a heart attack. The American Heart Association (AHA) also suggests a daily dose of aspirin to help prevent a first and second heart attack.
However, many people haven't heeded the warning about taking too much aspirin, and nearly 250,000 adults are admitted to the hospital each year for internal bleeding as a result. The FDA and the AHA recommend that adults stick to the minimum daily dose, which is only 75 to 81 milligrams. This is the equivalent of a single baby aspirin. When you consider that a standard full dose of aspirin comes in at 325 milligrams, people who pop one of those per day are doing more harm than good. Before you start an aspirin regimen, you should consult your doctor. The requirements are different for men and women and not everyone is a good candidate for aspirin therapy. You also shouldn't drink alcohol if you're on a daily aspirin dose because it can increase your chances for internal bleeding.
Heart Tip 7: Lower Your Cholesterol
Cholesterol gets a bad rap. There are actually two kinds of cholesterol and one of them, high-density lipoprotein (HDL), is produced in the liver and plays a vital role in the functioning of your body's cells. The easiest way to say it is that HDL makes your cells waterproof. This ensures that the biochemistry of the inside of the cell is different from the outside. HDL also serves as a guard against cancer and aging and is necessary for proper neurological functioning.
So why would you want to lower your cholesterol? Because the second kind, low-density lipoprotein (LDL), get smaller and smaller until they're tiny enough to enter the walls of your blood vessels and attach themselves like a bad houseguest. Once enough of the LDL sticks around, it's called plaque. Over time, the plaque can rupture and block the vessels altogether. Then it's heart attack time.
You can combat this in a couple of ways. There's the age-old advice to quit smoking, get on a healthy diet and exercise. Then there's a drug treatment called statins that can help lower your LDL levels. The American Heart Association recommends that fat not exceed 25 to 30 percent of your daily intake and your cholesterol from food not be more than 300 milligrams. You should also get 25 to 30 grams of fiber into your diet each day and see tip No. 1 for your exercise routine. Statins are the other option. If your doctor finds that your LDL levels are more than 130 grams per deciliter, he may decide to put you on one of the six brands of statin drugs on the market. Whether it's through diet and exercise, statins or both, lowering your cholesterol is a great way to help you avoid the dangers of a heart attack.
Heart Tip 6: Lower Your Blood Pressure
A lot of people may hear the words blood pressure and not even know what that actually means. It's pretty simple -- blood pressure is the measurement of the force of the blood against the walls of your blood vessels. When your blood pressure is measured, there are two readings -- systolic and diastolic. The systolic part refers to the pressure when your heart is expanded, and the diastolic reading is when your heart is at rest. They're given as systolic over diastolic, like a fraction.
The American Heart Association estimates that about one-third of all Americans have high blood pressure, or hypertension, and that a third of those people don't know it. This is because there really aren't any symptoms. It's called the "silent killer" because the only way to find out if your pressure is high is to check it. Some people sit down at the machines in pharmacies and grocery stores, but unless it's a new machine or you know that it's been maintained and recently recalibrated, you can't really trust those numbers.
If you get your pressure checked and it falls under 120/80, then you're doing fine. Anything between 120-139/80-89 is called prehypertension, and above this level is considered high. The first step in controlling your blood pressure is to have it checked on a regular basis. Once you find out you have high blood pressure, your doctor will ask you to eat less fatty foods, cut your salt intake, stop smoking if you're a smoker, exercise and limit the amount of alcohol you drink. If this isn't enough to get your pressure down, you may need to go on blood pressure medication like diuretics, which get rid of excess fluids and salts, and beta-blockers that actually reduce the amount of blood your heart pumps.
Heart Tip 5: Chill Out
Everyone knows that being stressed out isn't a good feeling. Turns out, it goes a little deeper than that -- stress can actually have some pretty severe effects on your body. Research scientists in Canada performed a study and found that people who had heart attacks and returned to a stressful career were twice as likely to have a second attack as those who held down reasonably stress-free jobs. University of London researchers found similar results for people who had stressful intimate relationships.
There's an area at the base of your brain called the hypothalamus that sets off an alarm whenever you get stressed. This alarm sends a signal to your adrenal glands to release a surge of stress hormones, including adrenaline and cortisol. This is also known as the fight-or-flight response. Your heart rate increases, which elevates your blood pressure and boosts energy supplies. If you're always stressed, then your body thinks it's in a constant state of threat -- not a good thing. Reducing your stress levels will lead to a reduced heart rate and ultimately help you to lower your blood pressure.
If you lead a stressful life, try to chill out by relaxing with friends after work. Take a walk or give meditation a try. Exercise and the right amount of sleep also go a long way toward combating your stress level. If none of these tricks work and you still find yourself stressed, see a professional counselor or psychotherapist. It can help your head and your heart.
Heart Tip 4: Stop Smoking
File this one under no-brainer as well. Every smoker on the planet knows that it's not good for them. The problem is that it's really difficult to quit. So difficult that nearly two-thirds of adults who want to quit aren't able to . So hard that almost half of patients that undergo surgery for lung cancer continue to smoke. That's how tough it is. It's also extremely bad for your heart.
When you smoke, the burning of the cigarette creates something called carbon monoxide (CO) -- the same stuff that's created when your car burns gasoline. The CO you inhale takes the place of the oxygen that's carried to and from your heart by your red blood cells. This basically poisons those cells and keeps them from carrying oxygen to the heart and from the heart to the rest of the body. This happens because CO is a master of disguise -- it's able to pass itself off as oxygen. So when you smoke, you're basically starving your heart of oxygen, the one thing it needs to function properly. If you smoke a pack of smokes a day, the CO level in your bloodstream will stay between 4 and 8 percent. A normal amount of CO in your blood is extremely low -- zero to eight parts per million.
Whether or not you're at risk for a heart attack, you should probably try to quit smoking. It's tough, but people do it every day all over the world, so you can too. Try cutting down first. A review of smoking studies for people that had no desire to quit showed that cutting down often led to complete cessation . It's also been proven that it's much easier to quit if you partner up with a fellow smoker who's kicking the habit. Nicotine replacement therapy can be effective for some, and there are other new drugs on the market like Chantix that are effective for some smokers.
Heart Tip 3: Undergo Preventive Screenings
Here's a novel idea -- preventive medicine. In other words, trying to stop a problem before it becomes one. Preventive health screenings can give you and your doctor a lot of information about how at risk you are for cardiovascular disease. The Department of Health and Human Services recommends that you start getting your blood pressure checked every two years starting at the age of 18. It also recommends having your cholesterol levels checked at age 18, and from then on, as often as your doctor thinks is necessary.
The great thing about preventive screenings is that they don't take very long and are basically painless. Blood pressure checks involve a stethoscope and an aneroid monitor. You may not recognize the aneroid by its fancy name, but it's the arm cuff system that you've likely seen before. Your cholesterol levels are determined through a simple blood test, so you'll need to get your arm tapped for the red stuff. Aside from these standard checks, there are ultrasound tests that can detect arterial blockage, and you'll also likely have your body mass index (BMI) calculated so you'll know exactly how out of shape you are. Your BMI is your weight divided by the square of your height, and multiplied by 732.You may not want to hear some of these numbers, but getting information early on about your risk level can help you avoid a heart attack down the road.
Heart Tip 2: Know Your Family Medical History
This one isn't as easy as you might think. Some families never suffer through a divorce and are open and honest about everything that goes on. Other families are fractured and distant, with medical goings on swept under the rug for the sake of not worrying children. Because of divorce, death and parents giving their children up for adoption, many adults may not even be acquainted with one or both of their parents at all, much less their medical histories. Some people have genetic predispositions to certain diseases and illnesses -- heart disease is no exception. If your father died from a heart attack at the age of 50, then chances are you may be headed down that same road. Even the healthiest of individuals can't do anything about the genes they inherited.
The first thing you should do to get your information is to interview your siblings and parents and record the information they give you. Your doctor will ask you these questions anyway, so you may as well have the information. From there, go on to interview other family members. Find out about chronic illnesses, disease and any major surgeries they've undergone. Ask your grandparents about their siblings and parents. Take down all the information in detailed notes, no matter how limited it is. Even knowing how and at what age your great-grandmother passed away can be important to your risk level. The last thing you should ask in your interviews is what kind of lifestyle your relatives lived. If your grandfather who died from a heart attack at 50 drank like a fish and smoked like a chimney while he stuffed his face with salt pork, then you should take that into consideration.
Heart Tip 1: Adopt a Heart-healthy Diet
You really are what you eat. If you dine on a steady flow of bacon and eggs, cheeseburgers, French fries and Twinkies, then you and your heart aren't going to be in the best condition. Adopting a heart-healthy diet is the most important thing you can do to benefit your ticker. It will help you to lower your blood pressure and cholesterol and limit the amount of bad fat you take in.
As far as a broad approach goes, try to get as far away from processed foods as possible. The closer your four food groups are to their original, unprocessed form the better. It's called a whole foods lifestyle. Include plenty of fresh fruits and vegetables and eat fish at least twice a week. Salmon is your best bet for supplying your heart with healthy omega-3 fatty acids that will help you reduce arterial plaque. Whole grains like oatmeal and whole wheat bread are a must as well.
Legumes like beans and lentils are loaded with protein, fiber, iron and calcium and are free of fat and cholesterol. Nuts are packed with antioxidants, omega-3s, fiber and vitamin E, among other things. The important thing is to not think of it as a diet, but as a lifestyle change. Stay away from boxed food, head for the fruit and veggie aisle, and you're on your way to making sure there are no ambulances in your future.
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