Aetna Latest Healthy Living News Latest Healthy Living News from Aetna en Aetna Latest Healthy Living News Latest Healthy Living News from Aetna TYPO3 - get.content.right Fri, 27 Mar 2015 00:00:00 -0400 Living Past 90 Closely Linked to Genes The longer you live past 90, the greater the odds that your genes are a big reason, researchers... The longer you live past 90, the greater the odds that your genes are a big reason, researchers say in a new study. The study looked at thousands of groups of siblings in New England. In all of the groups, at least one person reached age 90. For people who lived to be 90, the odds that a sibling also reached 90 were about 70% higher than for an average person born around the same time. People who lived to age 95 were 3½ times as likely as the average person to have a sibling who reached that age. And those who made it to 100 had 9 times the normal chance of having a sibling who also reached 100. The genetic connection was even stronger for those who reached 105. Their odds of having a sibling who reached that age were 35 times normal. The Journal of Gerontology: Biological Sciences published the study. HealthDay News wrote about it March 26. What Is the Doctor's Reaction?  Not that long ago, celebrating an 80th birthday was an uncommon event. I remember watching the 1950s TV show You Bet Your Life with Groucho Marx. On one of his shows, Groucho had an 81-year-old male contestant. The man received resounding applause just for being alive. Fast forward to today. Now living 80 years or more is the average life expectancy in many developed countries. It's a bit less in the United States, at 78.7 years. And then there are the people with super-long life spans of 100 years or more. Until recently, scientists attributed very long life primarily to healthy behaviors. They thought genetics played a smaller role. But newer research suggests otherwise.  Thomas Perls, M.D., of Boston University, has been a pioneer researcher in the study of why people live past 100. They are called centenarians. He and his colleagues have just published new results supporting his view that our genes have the greatest influence on our chances of reaching that milestone. For example, if you happen to have a brother or sister that lived to age 105, your chance of living that long is 35 times as high as the odds for other people born in the same year as you. Scientists have not yet identified which specific gene or genes control super-long life. But we know these genes are rare. Very few families carry them. In the United States, there are about 54,000 people age 100 and older. Worldwide, the number is about 317,000, out of 7 billion living people. For the rest of us, lifestyle choices have the greatest influence on how long we live. Sure, genetics matter. But the genes most of us inherit play a smaller role in life expectancy than genes do for people who reach 100. More importantly, it's not how long you live that counts -- it's how you live. One recent survey asked people: "Do you want to live to age 120?" Most people said no. But what if this were the question:  "Would like to live to age 120 if you could remain pain-free and able to care for yourself?" Surely many more people would say "Yes." What Changes Can I Make Now? Here is what you can do to live longer. More importantly, these steps can help you to feel healthier and more vigorous during those later years:
    • Avoid tobacco. If you are a smoker, it is never too late to quit. Your body reaps health benefits from the day you stop.
    • Eat a healthy diet with plenty of fruits and vegetables.
    • Stay physically active throughout each day. And schedule at least 30 minutes of dedicated exercise most days of the week. 
    • Make sure you get the right nutrients. With a balanced diet and 10 to 15 minutes of daily sunshine (for the vitamin D), you should be able to get all you need. For pennies a day, a generic multiple vitamin can add some insurance. 
    • Don't overeat, and keep your body weight in check. 
    • Socialize. Maintain contacts with family and friends throughout your life. 
    • Think positive. Most centenarians have a positive attitude and easily shed stress. 
    • Get routine screening exams and vaccinations.
    • Don't overuse alcohol. While a drink per day may actually help your health, clearly more is not better in this case.
What Can I Expect Looking to the Future? Life expectancy in the United States and other developed countries has been on a steady upward rise. But the dramatic rise in obesity rates, which is linked to higher rates of type 2 diabetes, threatens to lower average life expectancy in the future. Very recently there has been some relatively positive news. The number of new obesity cases seems to be leveling off. But to maintain our current average life expectancy, obesity rates must fall hard and fast.]]>
Fri, 27 Mar 2015 00:00:00 -0400
Fitness May Reduce Lung, Colon Cancer Risk Men who are fit in middle age may have lower risks of some cancers in later years, a new study... What Is the Doctor's Reaction? Exercise is good for you. You've probably heard this many times before. You may even be tired of hearing it. But it's hard to ignore the simple truth that exercise is one of the best things you can do for your health. The list of ways exercise can improve your health is long. And it's getting longer. For example, regular exercise may be helpful to treat or prevent:
  • Osteoarthritis
  • Heart and artery disease (including heart attack and stroke)
  • Dementia
  • Osteoporosis
  • Diabetes
  • Obesity
  • Depression
It's an impressive list. But did you know that exercise may also reduce the risk of certain types of cancer? And those who are physically active may survive longer once a cancer is diagnosed. For example, a 2010 study found that among women with breast cancer, those who were most active tended to live longer. A new study provides some of the best evidence to date that exercise and physical fitness during midlife can affect cancer risk and cancer-related death decades later. Researchers enrolled nearly 14,000 men with an average age of 49. Each man had a treadmill test to assess physical fitness. Then researchers kept track of the men for several decades to see who developed prostate, lung or colorectal cancer. Researchers also looked at the causes of death among men 65 and older who developed these cancers. The results suggest a dramatic benefit related to exercise. Compared with those who were the least fit, those who were most fit had:
  • A 55% lower risk of lung cancer
  • A 44% lower risk of colon cancer
  • A 32% lower risk of cancer-related death
  • A 68% lower risk of death from heart and artery disease after the diagnosis of cancer
But not all cancers studied were lower among the most fit. The risk of prostate cancer was actually 22% higher in this group. The results of this study suggest that physical fitness may reduce the risk of certain cancers. But you should not rely on exercise alone to prevent cancer. And the finding of a higher risk of prostate cancer certainly deserves more study. What Changes Can I Make Now? This study is only the latest to suggest that it's a good idea to increase your physical fitness.  Think about how much exercise you are getting and what may be keeping you from getting more. Some commonly reported barriers and changes you can make to overcome them include:
  • "I don't have enough time." You can increase your physical activity in ways that take little or no time. For example, meet with a colleague while walking instead of sitting in a conference room. Take the stairs instead of the elevator. You may even save time by not waiting for the elevator.
  • "Exercise is uncomfortable (or painful)." Certain conditions, such as arthritis or lung disease, can make it unpleasant to exercise. If discomfort is a problem for you, be sure to start slowly. With the guidance of a physical therapist or an experienced trainer, it's usually possible to get past the discomfort. For example, people with arthritis often tolerate exercise well if they do it in a pool.
  • "Exercise is boring." Use exercise to explore what's around you. For example, walking or jogging is a great way to learn about new places while traveling. Or you could exercise while watching TV or listening to music. An "exercise buddy" can transform physical activity into a social event.
  • "Exercise is expensive." This can be true if you're paying for a health club. But some of the best exercise is free (such as walking or jogging). Other types require only a modest investment, such as buying a bicycle.
Of course, exercise isn't the only thing you can do to lower your risk of cancer. Talk to your doctor about lifestyle changes (such as quitting smoking) and screening tests (such as colonoscopy). They can lower your risk of cancer or promote early detection. What Can I Expect Looking to the Future? This study is powerful evidence that being physically fit during midlife may protect against certain types of cancer. However, it also raises several important questions. They include:
  • Does physical fitness protect women or nonwhite men against cancer? This study included only men, and nearly all were white.
  • Does fitness protect against other types of cancer? This study examined the impact of exercise only on cancers of the prostate, lung and colon.
  • How does exercise protect against cancer? This study did not look at why lung and colon cancer rates were lower among those who were most fit.
Perhaps the most important question raised by this research is also the hardest to answer: How can we get people to improve their physical fitness? Perhaps the results of this study will help.]]>
Thu, 26 Mar 2015 00:00:00 -0400
Brain Stents May Increase Stroke Risk Propping open a narrowed artery in the brain actually may lead to more strokes than giving... What Is the Doctor's Reaction? Opening blocked arteries in the heart, legs and neck can help prevent heart attacks, leg amputation and strokes. Arteries can be opened with surgery. But today doctors more often open arteries with balloons (angioplasty). Usually they leave a wire-mesh tube (stent) in place to keep the artery open. Most strokes occur because of narrowed arteries within the brain. Doctors call this condition intracranial arterial stenosis. The underlying cause is the same as it is for artery blockages in the heart and other parts of the body. It's atherosclerosis -- fatty deposits that harden into plaques. Surgery to open brain arteries is impossible. It would cause too much damage to normal brain tissue. Balloon angioplasty has a long track record of success in opening other arteries. It seems natural to think that this procedure would also be an option to open blocked arteries inside the brain. The best candidates for angioplasty should be people with a recent mild stroke or transient ischemic attack (TIA). A TIA is also called a mini-stroke. A TIA causes stroke symptoms that last 10 minutes or more, but less than 24 hours. Most symptoms of TIA last 1 to 2 hours or less. To date, angioplasty for narrowed arteries in the brain has been a disappointment. Past studies looking at angioplasty vs. medicines have not produced better outcomes. In this particular study, the researchers used a different type of stent. They hoped they could show that past problems were just technical. However, the results of this study once again show that giving medicines alone is safer than angioplasty combined with medicines. In fact, this study was stopped early because angioplasty led to more problems than medicines, without better stroke prevention. Actually, medicines alone may be even better at preventing strokes.  What Changes Can I Make Now? Seek medical attention right away if you have symptoms of TIA. See a doctor even if the symptoms go away within a few minutes. The greatest risk of having a stroke occurs in the first few days after a TIA. Here's how you can lower your risk of ever having a TIA or stroke:
    • Keep your blood pressure in the normal range (less than 140/90).
    • Maintain a normal weight.
    • Don't smoke.
    • Eat at least 5 servings of fruits and vegetables daily.
    • Stay physically active, and schedule at least 30 minutes per day for dedicated exercise.
    • If you have atrial fibrillation (an abnormal heart rhythm), you and your doctor need to choose a drug that prevents clots from forming in the heart.
 For most people who have had a TIA or stroke, medicines should include:
    • One, and possibly two, anti-platelet agents. Aspirin is almost always one of them. In this study, people also received clopidogrel (Plavix) for 90 days after the stroke or TIA.
    • A statin. Statin drugs help prevent strokes even if your cholesterol level is normal.
This study did not include people with a narrowed or blocked artery in the neck. That's known as carotid artery stenosis. For this condition, either surgery or angioplasty remains an option to help prevent future stroke. What Can I Expect Looking to the Future? Some people with narrowed arteries in the brain may have another stroke or continue to have TIAs despite lifestyle changes and recommended medicines. It's possible that angioplasty might be helpful for them. However, it's very unlikely that there will be a study to answer this question any time soon.]]>
Wed, 25 Mar 2015 00:00:00 -0400
Study Supports Live-Donor Liver Transplants People with sudden (acute) liver failure do just as well if they receive a partial liver from a...                    What Is the Doctor's Reaction? Sudden liver failure is uncommon. But when it does happen, more than 80% of people die unless they receive a new liver. And death can come quickly. With limited time to find a liver, many patients die before one can be found. The results of this new study suggest a way that more livers could become available for transplantation. The number of people who need liver transplants is much larger than the number of livers available from donated organs. The patients include people with livers that are slowly failing and those with sudden liver failure. In the past, all of these transplants required a donation from a person who had just died. In recent years, live-donor liver transplants have become more common. This has increased the number of liver transplants that can be performed. Transplant surgeons remove part of a liver from a healthy person. Then they transplant it into the patient dying of liver failure. It sounds dramatic. But the risks to the person donating part of his or her liver are small. Live-liver donation has been reserved for planned liver transplants. They have been done on patients whose livers are failing slowly. This allows time for a complete medical evaluation to be certain they are good candidates for liver transplant. But surgeons have appropriately been reluctant to do live-donor liver transplants on an emergency basis. Even though the risk to the donor is small, it is not zero. And even with a liver transplant, there is still a substantial risk that someone with sudden liver failure will die. A new study reports on the success of transplants from living donors to patients with sudden liver failure. A team in Toronto did the transplants. They found that potential living donors can be evaluated quickly enough to help save lives. They were able to do the donor screening in about 24 hours. What Changes Can I Make Now? In the United States today, the No. 1 cause of sudden liver failure is acetaminophen (Tylenol and generics) overdose. Worldwide, viral hepatitis is the most common cause. Other developed countries, such as in Europe, use more paracetamol for pain and fever rather than acetaminophen. The two drugs are very similar. Paracetamol is linked with the same risk of sudden liver failure. Acetaminophen overdoses happen either by accident or in an attempt to commit suicide. With prompt treatment, liver failure can be prevented. Accidental overdoses happen because people don't realize how many over-the-counter products contain acetaminophen. Here's an example. You take Tylenol regularly at the standard dose for arthritis pain. You develop back pain and go to the drug store to look for a back-pain reliever. Let's say the product is called "Back Pain Gone." (The brand name is fictional.) If you don't read the ingredients, you might not realize that each tablet contains as much acetaminophen as one tablet of Extra Strength Tylenol. The above example actually happened to a friend's sister. Unfortunately, she did not receive the antidote to acetaminophen poisoning soon enough. She died. A safe dose of acetaminophen is no more 6 extra-strength (500 milligram) pills or 8 regular-strength (325 milligram) pills in a 24-hour period.  Always read the ingredients if you take more than one type of painkiller. That includes both prescription and over-the-counter pills. What Can I Expect Looking to the Future? The team in Toronto deserves our thanks for leading the way in showing that live-donor liver transplants can save patients with sudden liver failure. However, the efforts involved to make these donations happen so quickly is huge. We'll see whether similar results can occur at other transplant centers.]]> Fri, 20 Mar 2015 00:00:00 -0400 Metabolic Problems Riskier than Weight for Some In Mexican-Americans, problems with cholesterol, blood sugar and blood pressure are better...                    What Is the Doctor's Reaction? You've likely heard plenty about the rising rates of obesity. Considering the health risks linked with increased weight, you might think that losing excess weight should be a major priority. And you'd be right. But a new study suggests that, in some situations, weight loss should not be the primary focus. It appears that, for some people, blood sugar, cholesterol and blood pressure levels can be more important than weight loss. The study included more than 500 Mexican-American adults. Researchers examined the relationships among three types of health factors:
  • Body mass index (BMI, a measure of weight that accounts for height)
  • "Cardiometabolic risk factors" (including a blood sugar, cholesterol levels and blood pressure)
  • Atherosclerosis, the "hardening of the arteries" that often leads to a heart attack or stroke
In this study, no one had a history of heart and blood vessel disease. Atherosclerosis was detected by an ultrasound test of the carotid artery, a major artery in the neck. This test can detect the problem well before any symptoms develop. This study found that:
  • Nearly 80% of those in the study had unhealthy metabolic risk factors. They were more common among people who were:
    • Male
    • Older
    • Less educated
    • Eating fewer fruits and vegetables than recommended
  • About one-third of those in the study had signs of atherosclerosis, shown by the carotid ultrasound tests. 
  • Metabolic risk factors were linked with a greater likelihood of atherosclerosis. BMI was not.
These results suggest that when it comes to the risk of heart disease and stroke, it may be more important for some people to improve metabolic factors than to lose excess weight. And this might be more common among members of certain ethnic groups.  But weight loss may still be important. After all, obesity increases the risk of many metabolic problems. And those problems increase the risk of heart and blood vessel disease. Perhaps that's why only 10% of the obese individuals in this study had healthy metabolic profiles. Obesity also has harmful health effects other than atherosclerosis. For instance, it can increase the risk of arthritis, depression and certain types of cancer (to name a few).  What Changes Can I Make Now? In my view, it seems a bit artificial to emphasize metabolic risk factors over body mass index. After all, both are so tightly connected to health. Both have profound effects on several health risks, not just atherosclerosis. And we don't know which risk factor (or combination of risk factors) is the most important in any single person. So the findings of this study will not change what I say to my patients. It's important to maintain a healthy weight. And it's also important to do what you can to keep your cholesterol, blood sugar and blood pressure in healthy ranges. You can make several changes to help accomplish this:
  • Get more active. Try to exercise for 45 minutes a day at a moderate intensity most days of the week. Increase your "non-exercise" activity as well. Take the stairs. Walk more.
  • Know your blood pressure and blood lipid levels (including your total, HDL and LDL cholesterol results). If they are not in ideal ranges, talk to your doctor. Lifestyle changes and, if necessary, medicines can improve these results.
  • Ask your doctor if you should be screened for diabetes. This may be particularly important if you are obese or if you have a family history or symptoms of diabetes (such as frequent urination).
  • Know your BMI. Do what you can to avoid obesity (a BMI of 30 or higher). Considering how difficult it can be to lose weight, it's important to avoid excessive weight gain in the first place.
  • If you do need to lose excess weight, talk to your doctor about a diet and exercise program. An organized weight loss program (such as Weight Watchers) can be helpful. Medicines and surgery are occasionally recommended.
Take all your medicines as prescribed. For people who already have heart and blood vessel disease, preventing further problems is possible with lifestyle changes and medicines. What Can I Expect Looking to the Future? The impact of excess weight will continue to impose an enormous public health challenge for decades to come. But I hope that the attention given to the epidemic of obesity will lead us to make changes. If we improve our diets and get more active, we may be able to live at healthier weights. These changes should reverse the rise in obesity rates. But they are also the cornerstones of better metabolic health.]]>
Thu, 19 Mar 2015 00:00:00 -0400
Early Tests May Not Aid Elders' Back Pain Early imaging tests don't help older adults with new back pain feel better any faster, a new study...                    What Is the Doctor's Reaction? Back pain, especially low back pain, is very common. Most people will have back pain at some point in their lives. For those who have new back pain at an older age, guidelines have recommended early use of imaging tests. This study suggests that the strategy for everyone with new back pain should be the same. More often than not, the exact reason for back pain cannot be found. But in more than 90% of cases, the pain will get better without any specific treatment. In the other 10%, pain tends to last a long time or keep coming back. And an exact cause is not usually found, even with extensive testing. So guidelines have generally recommended that doctors wait before doing any tests to find a cause of new back pain. The exception is when a person has symptoms or signs that could represent a more serious problem, such as a fracture, cancer or infection. Only then is it necessary to do an imaging test, such as a spine X-ray, CT scan or MRI. The reasons for ordering early tests are called "red flags." They include:
  • Back pain with a fever
  • Back pain in someone who has cancer
  • Back pain that wakes you from sleep (not just waking up and realizing your back still hurts, but pain that wakes you up)
  • Back pain after severe trauma
  • Back pain with loss of control of urine or stool
Today, most guidelines also recommend early imaging for new back pain among older adults. Other symptoms or signs don't need to be present. Some guidelines recommend tests for someone 55 and older. Others say 70 or older.   The results of this study refute that advice. That really should come as no surprise. In fact, there never has been medical evidence to support using older age as the only reason to do imaging soon after back pain starts. What Changes Can I Make Now? Back pain can be very severe. If you haven't had it before, it can be frightening. It's also natural to want to know why this has happened. Just hearing that the doctor didn't find anything worrisome in the back exam still might leave you feeling uneasy. Wouldn't a CT scan or MRI, or even a plain X-ray of the back, help make a diagnosis? The answer is NO in 99% percent of people with new back pain, unless there are "red flag" symptoms or signs. The imaging test might show a bulging disc or some other changes. But these findings rarely are the reason for your back pain. And there is the risk that you will get treatments directed at what is seen on the CT scan or MRI. The treatments could cause more problems. The results of this study did not show that imaging tests led to more problems. But they did add substantially to cost without resulting in faster healing. There is no best remedy for new back pain. A long bed rest makes it worse. Right away, you should try to get up and slowly move around every few hours. Stand and sit until you become too uncomfortable. Then lie down again. Try to do more each time you get up. What Can I Expect Looking to the Future? You can expect that future guidelines for new back pain will no longer offer different advice based on older age.]]>
Wed, 18 Mar 2015 15:15:00 -0400
New Drugs Lower LDL, May Protect Heart A new type of drug lowers cholesterol and may also reduce heart attack and stroke rates, study...                    What Is the Doctor's Reaction? Statins are the first-line drugs to lower blood cholesterol levels. They decrease the risk of heart attack and stroke. They are especially effective for people who have artery disease or are at high risk of developing it. For about one in five people, though, a statin doesn't lower cholesterol enough. Adding a second drug often does not succeed in reaching the goal. And some people can't take a statin because of side effects such as muscle pain or liver damage. A new type of cholesterol-lowering drug may completely change how we treat high cholesterol. The new drugs are called PCSK9 inhibitors. They are antibodies, which are proteins that attack a substance or cell in the body. PCSK9 inhibitors target and shut down a specific protein in the liver. Knocking out this protein dramatically reduces the amount of harmful LDL cholesterol in the bloodstream. Lower LDL translates into healthier arteries. This means fewer heart attacks, strokes and related problems. The New England Journal of Medicine has just published results of studies on 2 different PCSK9 inhibitors. These studies showed the cholesterol-lowering power of these antibodies. Taking either of these new drugs, plus regular treatment, reduced LDL cholesterol 60% more than regular treatment alone. For most people in both groups, regular treatment included taking a statin. Just lowering a cholesterol number does not translate to better health. The main objective must be a lower risk of heart problems, heart attacks and strokes. The 2 studies were not designed to prove the drugs would lead to better health. However, the results strongly suggested that they will. People taking the PCSK9 inhibitors were 50% less likely to have a heart attack or stroke or develop heart failure than those on standard treatment. As with all drugs, there are downsides. At least for now, PCSK9 inhibitors must be given by injection every 2 to 4 weeks. Some people taking the new drugs had mental confusion or trouble paying attention. Cost will almost surely be an issue. These drugs may cost as much as $10,000 a year. What Changes Can I Make Now? If you have high cholesterol, it's best to try to lower it with exercise and a healthy diet, such as the Mediterranean diet. This does the trick for some people. When medicine is needed, a statin will almost always be the best choice. Some people should take a statin even if they eat well and exercise regularly. That includes people with:
  • Artery disease, including angina (chest pain with exercise or stress), a previous heart attack or stroke, or other related conditions
  • A very high level of harmful LDL cholesterol, generally at or above 190 milligrams per deciliter (mg/dL)
  • Diabetes, for those age 40 or older
If you are not in one of these groups, the decision to take a statin depends on how many factors you have that increase your risk of heart disease. Risk factors include:
  • A parent, brother or sister who had coronary artery disease or stroke at an early age (a man before age 55 or a woman before age 65)
  • Tobacco use
  • High blood pressure
  • A low HDL ("good cholesterol") level (under 40 mg/dL)
What Can I Expect Looking to the Future? PCSK9 inhibitors are still experimental drugs. The Food and Drug Administration may approve one of them later this year. If approved, these drugs probably would be used first in people who don't respond to statins or who develop side effects from them. It's very likely that future studies will prove that PCSK9 inhibitors lower the risk of heart attack and stroke in people already taking a full dose of a statin. So combining a statin with one of these new drugs may be a good option for those at especially high risk for heart problems and stroke.]]>
Mon, 16 Mar 2015 00:00:00 -0400
Cochlear Implants May Help More than Seniors' Hearing Seniors with severe hearing loss who received a cochlear implant to restore hearing also had... . HealthDay news wrote about it March 12.
What Is the Doctor's Reaction?
My father-in-law didn't show up to his grandson's wedding rehearsal. He is hard of hearing. "I told Dad three times," said my sister-in-law, Marcia. "Do you think he just didn't hear me, or do you think he is losing his mind?" It could be both, I thought. And maybe the problems are related to each other. We are starting to learn that hearing loss can have a domino effect. It can lead to depression. Hearing loss can create frustration, so a person might not pay attention. As a doctor, I see my older patients become more isolated as they become hard-of-hearing. People with hearing loss can't have meaningful conversations with their families. This can be a problem for social functioning and quality of life. Over time, for some people, hearing loss can slow thinking in a way that looks a lot like the beginning of dementia. The people who seem to be at highest risk for depression from poor hearing are people who have lost part of their hearing, but not all of it. People who are completely deaf seem to do a better job at adapting — perhaps because they are forced to. If a person has cognitive decline (such as dementia) after losing hearing, is it reversible? Maybe, if you can give a person back their hearing. A really interesting study was just done in 94 people with hearing loss. The people in the study were all between the ages of 65 and 85. In this study, people who got a treatment that improved hearing also got improved cognitive function. The treatment led to better quality of life and less depression. Before the treatment, 41% of the patients had depression. After the treatment, only 24% of patients had depression. What was the treatment? It is called a cochlear implant device. Cochlear implant doesn't give you normal hearing, but it detects sound and gives your ear signals that you can learn to interpret as speech. It used to be used only in kids. Now, older adults who have very severe hearing loss can also get this device. Some people have a cochlear implant on one side, and wear a hearing aid on the other. Some people get a cochlear implant on both sides. For this surgery, a cut is made behind the ear, and one end of an insulated wire is threaded into the spiral-shaped structure inside the ear, called the cochlea. Inside the cochlea, the wire has electrodes on it. The other end of the wire comes through the skin behind the ear. After the surgical wound heals, this end of the wire is connected to a small transmitter. The transmitter looks a lot like a hearing aid because a piece of the device rests above and behind the ear. In the year following surgery, the device allows patients to understand voices and sounds again.
What Changes Can I Make Now?
Most people with hearing loss do not need a cochlear implant surgery. It makes sense to start simple — with a hearing aid. In the United States, according to the U.S. National Health and Nutritional Examination Surveys (NHANES), only 1 out of every 7 people who are over 50 and have hearing loss own a hearing aid. Also, many people who do own a hearing aid don't use them as often as would be helpful. For hearing loss that is caused by old age, these things can help:
  • Hearing aids. These are expensive (sometimes more than $1000), but most patients can test the device before buying and get a refund if they aren't satisfied. Cosmetically appealing hearing aids that are miniature or hidden inside the ear canal tend to amplify less well than standard hearing aids. Some modern hearing aids are programmed to cancel out noise such as wind.
  • Other amplification devices. These include amplified telephones and headsets that broadcast from a television or a church microphone. Another device is the inexpensive wireless "Pocketalker" (a headset with a portable microphone). To use the Pocketalker, you place a small pager-sized portable microphone close to the person you are listening to. You can then listen to this voice through a headset.
  • Lessons in sign language or lip reading. This can be helpful even for people who have only lost part of their hearing.
  • Cochlear implant. This is only offered to patients who can't benefit from hearing aids because their hearing is so poor.
What Can I Expect Looking to the Future?
New hearing devices are being tested that are not visible outside of the ear. One device that recently got approval from the U.S. Food and Drug Administration is the "Esteem." This is a battery-powered device that is surgically implanted in the middle ear. It senses movement of the eardrum and translates this movement into stronger signals for the inner ear. Another device ("Lyric") is placed onto the eardrum by a surgeon and is replaced several times per year. Devices for hearing loss are also being improved. One change is to have hearing aids amplify sounds differently depending on what direction the sounds are coming from. This technology is called directional amplification. It can make noise from a person who is in front of you and facing you sound louder, as well as make noise from a person behind you or to your side sound quieter. This can make it a lot easier to have a conversation.]]>
Fri, 13 Mar 2015 14:16:00 -0400
Colon Cancer Risk Lower for Vegetarians Vegetarians may have a lower risk of colorectal cancer than meat-eaters, a new study concludes....                    What Is the Doctor's Reaction? There are lots of health benefits from a vegetarian diet. It can help:
  • You live longer
  • Lower your blood pressure
  • Reduce body weight
  • Decrease your risk of developing type 2 diabetes
  • Reduce your chance of heart problems
You may also lower your cancer risk. According to results of this study, vegetarians may have a 20% lower risk of developing colorectal cancer. Vegetarians come in different flavors:
  • Semi-vegetarians still eat animal products, but more selectively. Many of them eat chicken and fish but not red meat.
  • Pescatarians (or pescavegetarians) avoid meat and poultry. They still eat fish and seafood.
  • Lacto-ovo vegetarians skip all meat, fish, and poultry. But they do eat dairy products and eggs.  
  • Vegans eat only a plant-based diet. It's the strictest form of vegetarianism. They eat no animal products at all -- not even eggs or dairy products.
The people in the study did not assign themselves to one of these categories.  Instead, the researchers put them into groups based on detailed dietary histories. That's one of the strengths of this study. People who did not belong to one of the four vegetarian types were classified as non-vegetarians. Other strengths of this study include the large number (77,000) and diversity of those who were studied. However, this study only shows a link between eating a vegetarian diet and having a lower rate of colorectal cancer. It does not prove that a vegetarian diet itself was the reason for the reduced risk. Some other factor that researchers did not identify could be the reason vegetarians were diagnosed with colorectal cancer less often. In fact, it was the pescatarians (the vegetarians who ate fish and other seafood) that had the lowest colorectal cancer rate. What Changes Can I Make Now? If you do opt for a vegetarian diet, you need to be sure you get enough of certain nutrients. That's especially true if you go vegan. Pay special  attention to these nutrients: protein, calcium, vitamin B12 and iron. Here are some plant-based sources for each of them:
  • Protein: Lentils, beans, quinoa, oatmeal, nuts
  • Calcium: Fortified soy milk or rice milk, fortified orange juice, broccoli, beans, leafy green vegetables, almonds, almond butter, sesame seeds, soybeans
  • Vitamin B12: Fortified soy milk or orange juice, fortified cereals
  • Iron: Soy nuts, tofu, kale, spinach, beans, peanut butter
However, to make sure you get enough B12, iron and other micronutrients, I advise a daily multiple vitamin with iron. What Can I Expect Looking to the Future? If going vegetarian is not for you, a Mediterranean-style diet is also linked with a lower risk of colorectal cancer. With the Mediterranean diet, some red meat is allowed. But it should be limited. Most importantly, you want to avoid processed meats.]]>
Tue, 10 Mar 2015 15:00:00 -0400
Study: Statins May Increase Men's Diabetes Risk Men who take statin drugs to lower cholesterol may be more likely to develop diabetes than men who...                    What Is the Doctor's Reaction? Statin drugs are great for lowering cholesterol. This makes them great for preventing heart disease. They make that risk almost 30% lower. But they are not perfect. Why? Like almost every medicine, they can cause side effects. The most common side effects of statin drugs are muscle symptoms, such as aches and cramps. This doesn't happen for most people who take the drugs. And it can be reversed. But it is worth talking over another risk from statin drugs. They make you somewhat more likely to be diagnosed with diabetes. Doctors who specialize in diabetes don't worry about this much. Those who are affected are people who are very likely to get diabetes sooner or later anyway. For some people, taking a statin seems to make diabetes begin a bit earlier (perhaps some years earlier) than it otherwise would start. That is not good. But let's give statin drugs credit where credit is due. It might be a good trade-off to have a few people get diabetes earlier, if we are preventing enough heart attacks and strokes. Over and over, studies have shown that statin drugs do prevent heart attacks and strokes. A study this week says the number of people who get diabetes by taking a statin may be higher than we think. The study was done in Finland. For this study, researchers watched what happened to 8,749 people. When the study began, none of these people had diabetes. About 1 out of every 4 people in the study was taking a statin drug. About 11% of those who took statins got a diagnosis of diabetes during the next 6 years. Only 6% of the people who were not taking a statin got diabetes. This suggests that 5% (or 5 people out of 100) might have had their diabetes triggered by taking a statin during 6 years of use. Before this study, we thought the risk was lower. In earlier studies, the risk looked like about 3 cases per 1,000 per year, for high-dose statins. This translates to about 1 in every 330 statin-takers having an early start to diabetes per year. This new study says diabetes might occur in as many as 1 of every 100 statin-takers per year. The real risk is probably somewhere in the middle. What Changes Can I Make Now? It is important for us to get accurate information about side effects from drugs like statins. We only want to use drugs for prevention if they give us more benefits than harms. A big cholesterol treatment guideline was published in 2013. This guideline was approved by the American Heart Association (AHA) and the American College of Cardiology (ACC). In this guideline, experts said the benefits from statin pills were bigger than the risks, if we give statins to people who have a high risk of heart attack or stroke. Who has a high enough risk to benefit from statins? Probably most people ages 60 to 75. Experts from the AHA and ACC said the predicted benefits of a statin outweigh the risks for anyone with more than a 7.5% chance of having a heart attack or stroke in the next 10 years. If the diabetes risk is as high as this new study suggests, it might be better to limit statins to people who have a 10% or 15% risk of heart attack or stroke in the next 10 years. This would help ensure we are getting more benefit than burden from these medicines. If you already have diabetes, should you take a statin? Probably. The AHA/ACC guideline says that anyone age 40 to 75 who has diabetes should be on a statin to prevent heart disease. The guidelines prefer a high dose of statin, too. But we do know statins can make diabetes just a bit harder to control, particularly at a high dose. If you have diabetes, you can get most of the benefit from statin drugs if you take a moderate dose. What Can I Expect Looking to the Future? Cholesterol guidelines are leading us to treat more people with statins than ever before. And we are more often choosing a high dose. Certainly, this will prevent many heart attacks and many strokes. It is appropriate to use this powerful tool for prevention. But we will also learn new things about side effects as we use these drugs.]]> Fri, 06 Mar 2015 00:00:00 -0500 Hepatitis E Shots Protect at Least 4½ Years A new vaccine protects against hepatitis E infection for at least 4½ years, a new study shows....                    What Is the Doctor's Reaction? "Hepatitis" is a general term that means "inflammation of the liver." And while there are several causes, viral infections are among the most common.  Some viruses that cause hepatitis have been named by letters. You may have heard of hepatitis A, B and C. They are the most common ones in the United States. Hepatitis A is commonly spread by contaminated food. It tends to cause mild symptoms without long-lasting liver injury. Hepatitis B and C are most commonly spread through blood transfusions, sex or shared needles. And they can cause chronic (long-lasting) liver disease. You may have never heard of hepatitis E. It's most often spread by contaminated water. Outbreaks usually occur in places where there is crowding and poor sanitation. For example, it may occur in refugee camps created during war or after natural disasters in developing countries. Less commonly, it is spread by infected people or animals (including deer, boars and pigs). Each year, hepatitis E infections cause thousands of deaths.  But there is some good news to report about efforts to prevent this infection. Researchers have developed and tested a new vaccine against this virus. They published their findings in this week's New England Journal of Medicine. More than 100,000 adults (aged 16 to 65) in China took part in the study. Half of them received a series of 3 vaccinations against hepatitis E. The others received hepatitis B vaccine. Here's what researchers reported:
  • The vaccine against hepatitis E was highly effective. People who received it had 87% fewer cases of hepatitis E than those who got the other vaccine. Nearly 90% of those who got the vaccine still had protective antibodies triggered by the vaccine at least 4½ years later.
  • Side effects were similar (and mild) in both groups.
Clearly, this is welcome news for the millions of people at risk for hepatitis E.  A vaccine against hepatitis E possibly could prevent 20 million infections and 70,000 deaths in the world each year. You might think that would be a lead story in the papers or on TV. It should be. Yet this research may attract less coverage than it deserves for at least two reasons:
  • Many people have never heard of hepatitis E.
  • Health problems that mostly affect developing countries tend to get less news coverage than diseases that occur elsewhere.
We still need to know more about this vaccine. For example, there are at least 4 different strains of hepatitis E. We need to know if the vaccine protects against them all or only the ones included in this study. What Changes Can I Make Now? You can make changes now to reduce your risk of hepatitis. Here are some things you can do:
  • Make it a habit to always wash your hands well.
  • Ask your doctor about hepatitis vaccines. For example, a hepatitis A shot is recommended before traveling to certain countries. Hepatitis B vaccine is now routinely recommended for children between the ages of 1 to 2 and for some adults. The adult groups include people with liver disease or HIV infection.
  • Drink bottled water when you travel to places where the water supply isn't always safe.
  • If you eat shellfish, choose reputable restaurants or food markets.
  • If you've been exposed to someone with hepatitis, talk to your doctor about vaccination and other treatments.
  • Don't use intravenous drugs, share needles or snort cocaine.
  • Don't have unprotected sex (unless you're in a long-term relationship and have sex only with each other).
  • If you get a tattoo or body piercing, make sure the equipment is clean.
  • Don't drink excess amounts of alcohol. For example, don't have more than 7 alcoholic drinks per week if you're a woman or more than 14 per week if you're a man.
  • Be careful about your use of acetaminophen (Tylenol and generics). Since it's in many over-the-counter and prescription medicines, it is easy to take too much.  Avoid taking more than 3,000 milligrams a day.
People in China can get this new vaccine for hepatitis E.  It may soon be available elsewhere as well. What Can I Expect Looking to the Future? You can expect to hear about more research to assess how well this vaccine protects against hepatitis E. Important questions include:
  • Will repeat shots or "boosters" be required? If so, how often?
  • Is the vaccine safe and effective among children or older adults?
  • Is the vaccine safe for pregnant women? This is important because pregnant women with hepatitis E infection have a much higher death rate than others with this infection. Hepatitis E also increases the risk of stillbirth.
We still have much to learn about the hepatitis E vaccine. But this new research provides reason to hope we can prevent this troublesome infection.]]>
Thu, 05 Mar 2015 00:00:00 -0500
Study: Few Thyroid Lumps Turn Cancerous A new study suggests that people with non-cancerous lumps on the thyroid may not need the close...                    What Is the Doctor's Reaction? The discovery of a lump on the neck can shake up the coolest and most collected among us. If you're like most people, you immediately fear the threat of cancer. If the lump is on your thyroid, it's called a nodule. The results of this study suggest that the chance of cancer developing in thyroid nodules is even lower than we thought. Thyroid nodules are very common. In some autopsy series, 50% of people are found to have one or more nodules. Most of them are small. More people than ever are being diagnosed with thyroid nodules. It's not because they are any more common than they were 50 years ago. They are just being found more often. In the past, someone might have noticed a lump in the neck. Or the doctor may have felt it during an exam. Today, doctors frequently order imaging tests, such as chest CT scans and ultrasound exams of the carotid arteries. Even though the tests are done for other reasons, they may also show thyroid nodules. The discovery of a thyroid nodule almost always leads to a blood test and a thyroid ultrasound. The blood test is called TSH. It shows whether your thyroid is normally active, underactive or overactive. Most of the nodules seen on ultrasound are less than one centimeter across and look benign (not cancerous). If a nodule is larger than that or looks unusual, the standard advice is to do a fine-needle biopsy. This test uses a thin needle to remove some cells. They are examined under a microscope to look for signs of cancer. Nodules that appear benign on ultrasound or don't have any cancer cells on biopsy may still need follow-up. The American Thyroid Association has published guidelines about how this should be done. The guidelines recommend repeat thyroid ultrasounds to look for changes in the nodule and for new nodules. If the nodule grows or a new one appears, the guidelines say to repeat the fine-needle biopsy. However, in this new study researchers found that growth of thyroid nodules is common. And nodules that grow are not more likely than others to be cancerous. The researchers also found that the chance of cancer developing in a thyroid with benign nodules is extremely small. Of the 992 patients in the study, only 5 developed cancer within 5 years. And of all the nodules found on the first thyroid ultrasound, only 0.3% later showed cancer. That means 99.7% remained benign! What Changes Can I Make Now? Thyroid nodules usually can't be prevented. However, some people are more prone to developing them, such as:
  • People who don't get enough iodine
  • Obese people
  • People with insulin resistance, such as those with pre-diabetes and diabetes
  • Smokers
However, these people are NOT at any higher risk of thyroid cancer. The great majority of thyroid nodules are benign. But there is a higher risk of a new nodule being cancerous in:
  • Children
  • People under 30
  • People over 60
  • People with a family history of thyroid cancer
  • People who received radiation therapy or radiation exposure to the face, head, neck or upper chest
What Can I Expect Looking to the Future? The American Thyroid Association last updated its advice on diagnosis and treatment of thyroid nodules in 2009. New guidelines are expected either later this year or early next year. These study results add important new information. They will surely influence changes to current guidelines.]]>
Wed, 04 Mar 2015 13:36:00 -0500
Study Links Nuts with Lower Death Rates Eating tree nuts, peanuts and peanut butter may help people live longer, a new study suggests. The...                    What Is the Doctor's Reaction? This study finds health benefits from eating nuts. That's nothing new. Many studies have shown that regular consumption of tree nuts decreases risk of heart disease. Tree nuts that have been studied often include walnuts and almonds. But it's likely many other nuts have the same effect. Most of the prior studies looked at selected groups. This study included a wider range of people. It included more African Americans, Asians and people of lower income and education than older research findings. The researchers found that eating tree nuts, peanuts or both regularly was linked with a lower risk of death than little or no nut consumption. The risk of death from heart disease was especially reduced. The results held for all the different racial and ethnic groups, as well as for people with lower incomes. The other big plus for this study was the inclusion of peanuts. Peanuts are much cheaper than tree nuts. That's why mixed nuts contain a high percentage of peanuts. Peanuts are technically not nuts because they don't grow on trees. They grow in the ground. They are in the same family, called legumes, as peas and beans. Legumes are plants with seeds inside a pod (shell).  However, peanuts have similar nutrients as tree nuts. They are an excellent protein source and contain unsaturated ("good") fats. And they have a high content of some nutrients, especially magnesium. What Changes Can I Make Now? Unless you are allergic to tree nuts or peanuts, they should be part of any well-balanced diet. But, according to this study and most others, you don't have to "go nuts" eating them. There do not appear to be any extra health benefits from eating more than a handful per day. Dieters often stay away from nuts. They worry about the fat content. That's understandable. Tree nuts and peanuts are high-calorie foods. For example, an ounce of peanuts packs 160 calories. Most tree nuts have more. But some studies have shown that eating nuts in moderate amounts can help avoid weight gain. Nuts eaten as part of a meal, or as a small snack between meals, can provide a sense of fullness that leads to eating less later on. Ultimately, maintaining or losing weight is about watching your total calories and increasing your physical activity. But if a few nuts make you feel full, perhaps you can lower calorie counts overall. Here's an easy way to get your nuts: Scoop out a spoonful of natural peanut butter. It's just ground-up peanuts, sometimes with a bit of salt. What Can I Expect Looking to the Future? Eating nuts two to three times per week is a staple of the popular Mediterranean-style diet and other plant-based diets. Tree nuts have been promoted the most. It's time for peanuts to join the party, with a lower entry fee.]]> Tue, 03 Mar 2015 00:00:00 -0500 CDC: Flu Vaccine Only 18% Effective The flu vaccine is even less effective than health officials thought against the strain of...                    What Is the Doctor's Reaction? Flu viruses change (mutate) constantly. To create an effective flu vaccine, experts must predict which of the many flu strains will cause the most illness six months in advance. They also take into account which strains might cause the most serious symptoms and deaths. But in recent years this job has been even more difficult. A new report from the Centers for Disease Control and Prevention (CDC) suggests that this year's vaccine is even less effective than first reported. In 2009, an H1N1 influenza A strain (so-called swine flu) appeared that was very different from anything seen in decades. There was no chance to include it in the 2009 strain. This "new" H1N1 flu caused a worldwide epidemic. Vaccine makers ramped up production of a new vaccine that was an excellent match against this new H1N1. In the next flu season, that vaccine offered excellent protection against that strain. And it continues to do so. In fact, it's part of this year's vaccine. However, during the last few years, the vaccine has been less effective. The problem has not been H1N1. The problem is the H3N2 influenza A virus. H3N2 has mutated faster than expected. New strains of H3N2 are appearing more rapidly than ever. The virus has changed faster than the vaccine. Each February, experts selected by the World Health Organization (WHO) meet to finalize their advice about what should be included in next season's Northern Hemisphere flu vaccine. The experts met earlier this week to make decisions about the 2015-6 vaccine. Another expert panel will meet later in the year to decide what to recommend for the 2016 Southern Hemisphere vaccine. The experts base their advice on:
  • Which flu strains are present now around the world
  • The patterns of spread and how quickly it occurs
  • Scientific evidence showing how well the current vaccine protects against newly identified strains
What Changes Can I Make Now? Don't give up on the flu vaccine. It's true that this year's vaccine is a disappointing match for H3N2. But there are good reasons that you should get the flu vaccine this year and very year.
  • The vaccine contains more than just a strain of H3N2. It will help protect you against other types of flu, such as H1N1 influenza A and influenza B.
  • If you do get sick with H3N2, your symptoms probably will be less severe than they would have been if you had not received the vaccine.
  • There is some evidence to suggest that the flu vaccine boosts your general immunity. This helps you fend off other viral infections.
What Can I Expect Looking to the Future? Vaccine regulators in each country follow WHO's advice for the annual vaccine. But each country makes its own decisions about which strains should be included in influenza vaccines licensed in that country. The U.S. Food and Drug Administration (FDA) determines which virus strains will be used in U.S. vaccines. The committee that advises the FDA is meeting next week to finalize what will be in the vaccines licensed in the United States for 2015-6.]]>
Fri, 27 Feb 2015 00:00:00 -0500
Wider Spread for Hospital-Linked Infections In a recent year, more than 450,000 Americans had a type of severe diarrhea that most often occurs... Clostridium difficile (C. diff) bacteria. These infections are hard to cure. Researchers used information from 2011. They looked at C. diff infections in 10 states. Two-thirds of them occurred in hospitals and nursing homes. The other one-third occurred in the community. But 80% of the community patients had been to see a doctor or dentist recently. Most of them received antibiotics. C. diff bacteria are most likely to grow and produce toxins when antibiotics kill the normal, harmless bacteria in the intestine. The New England Journal of Medicine published the study. HealthDay News wrote about it February 25.                    What Is the Doctor's Reaction? Clostridium difficile (C. diff) is the No. 1 cause of death from intestinal infection in the United States. The number of new cases of C. diff continues to rise. And that means the number of deaths will also increase unless we can reverse the upward trend. C. diff bacteria, and the spores they produce, are found widely in the environment. The spores can hang around on your hands and all kinds of surfaces. The spores are not active until they get inside your intestine. If you swallow the spores, they might come to life. In healthy people, this is rarely a problem. But in some cases, C. diff can cause trouble. It most often happens after you take antibiotics. The stronger the antibiotics and the longer you take them, the greater the risk that C. diff will get active. When you take an antibiotic, it doesn't kill just the bacteria that are causing an infection, such as pneumonia. It also can wipe out the good bacteria that always live in the large intestine. These good bacteria crowd out any C. diff bacteria that may exist there. They don't allow C. diff to become active. When antibiotics wipe out the good bacteria, C. diff can take over and make lots of toxins. C. diff might not get active enough or produce enough toxins to cause any symptoms. But, in large amounts, C. diff toxins can injure the lining of the lower intestine (colon). When symptoms do occur, they can range from mild to severe. Sometimes the condition can be life-threatening. In the past, almost all cases of C. diff developed in hospital patients. These are still the people at highest risk. But now more cases are being diagnosed outside the hospital. Some occur in people who have recently been in the hospital. This study estimated that 82% of the C. diff patients who are not in the hospital visited a doctor or dentist within the last 3 months. It's likely that the majority of people with C. diff received a prescription for an antibiotic. What Changes Can I Make Now? Your personal risk of getting C. diff diarrhea is low, even if you have taken antibiotics. But here are some ways that you can help combat this rising health problem:
  • Wash hands thoroughly with soap and water for at least 15 seconds. This is the best way to stop the spread of C. diff (and many other dangerous organisms). It's especially important to wash your hands after visiting a hospital or any health-care facility. Alcohol-based cleansers do not get rid of the C. diff spores.
  • Take antibiotics only if you really need them. Common colds and most sore throats and sinus infections are caused by viruses. Antibiotics only kill bacteria.
  • Sometimes you need to be in the hospital. But as soon as you feel well enough, find out if home health care is an option for you. The shorter your hospital stay, the lower your risk of coming in contact with C. diff spores.
Many people who take antibiotics have mild diarrhea. C. diff is rarely the cause. However, if you have abdominal pain, fever or very frequent loose stools, contact your doctor right away. What Can I Expect Looking to the Future? Preventing C. diff is a national priority. Until a vaccine becomes available, we need to slow the number of cases. This will require:
  • Maintaining isolation of infected patients in the hospital and nursing home
  • Strict hand washing by hospital staff after leaving the patient's room
  • Decreasing the use of antibiotics when they are not needed
On the treatment front, "poop pills" will become a more standard therapy. The pills contain feces from a donor that are processed so there's nothing left but the bacteria. These are the good bacteria that can crowd out the C. diff bacteria and halt the symptoms.]]>
Thu, 26 Feb 2015 00:00:00 -0500
Study Tallies Painkiller Risk after Heart Attack Some common painkillers may increase the risk of second heart attacks when taken along with drugs...                    What Is the Doctor's Reaction? We take NSAIDs so often that we forget they have the potential to be dangerous. That's especially true after a heart attack, according to results of this study. NSAID stands for nonsteroidal anti-inflammatory drug. These drugs include over-the-counter ibuprofen (Advil, Motrin and others) and naproxen (Aleve and others). They also include prescription drugs such as celecoxib (Celebrex). Patients who have had a heart attack are told to take a daily aspirin to help prevent a second heart attack. Aspirin attaches to blood cells called platelets to make them less sticky. This decreases the risk of blood clots forming in heart arteries. Sometimes, doctors also prescribe a second anti-platelet drug, such as clopidogrel (Plavix). This is standard care if you have had a procedure called angioplasty and stenting. A balloon is inflated inside an artery to open it. Then the stent, a wire mesh tube, is placed inside to keep it open. Some people may need a third so-called blood thinner if they also have an abnormal heart beat known as atrial fibrillation. The use of any anti-platelet drug, even a baby aspirin, increases the risk of bleeding inside your body. When you add a second or third blood-thinner, the risk rises even more. NSAIDs are well known to also increase bleeding risk. Taking one of them when you also need to take aspirin, another blood thinner or both further raises the risk. The results of this study show this combination can be especially dangerous for people who have had a heart attack. If they bleed, their chances of dying are much higher if they are taking an NSAID as well as a blood thinner. The researchers also found that people who use NSAIDs after a heart attack are more likely to have another heart attack or stroke. This might seem odd, given that most heart attacks and strokes are caused by blood clots. After all, NSAIDs generally make it harder for blood clots to form. Taking them along with an anti-platelet drug should further reduce the risk of clots. The exact reason for the higher chance of heart attack and stroke with NSAID use is not clear. But many other studies have found a similar link. What Changes Can I Make Now? Getting safe pain relief can be a challenge if you are taking an anti-platelet drug or another type of blood thinner. Here are some ideas: Start with a non-drug approach. Try a heating pad, ice or physical therapy, if appropriate. Even if these approaches don't take away your pain, they may let you take a lower dose of a painkiller. Use acetaminophen. Acetaminophen (Tylenol, generic versions) may be an alternative to an NSAID. However, you must limit your use of this drug if you have a liver problem or some other conditions. A safe amount is 3,250 milligrams per day. That's no more than 10 regular-strength or 6 extra-strength tablets spread out over 24 hours. Acetaminophen reduces fever and pain. It does not reduce inflammation. For people with arthritis, reducing inflammation is usually important, so this option won't work for everyone. Consider other NSAID alternatives. Non-acetylated salicylates are cousins to aspirin. They include salsalate (Disalcid) and choline magnesium trisalicylate (Trilisate). These drugs may provide pain relief and reduce inflammation somewhat. Use the safest NSAID. Some NSAIDs may be less risky than others. The prescription NSAID diclofenac (Voltaren) appears to have the highest risk for a second heart attack. Some studies suggest that naproxen (Aleve, Naprosyn) has the lowest risk. Take your aspirin first. Aspirin prevents clotting that can lead to a heart attack. Some studies suggest NSAIDs may interfere with aspirin's protective effect. So, if you have heart disease and must use an NSAID, take the aspirin first. Wait an hour. Then take your required dose of the NSAID drug. Use only what you need. Take the lowest effective dose of an NSAID for the shortest period of time. However, in this study, even three days of use increased the chance of bleeding. What Can I Expect Looking to the Future? Sometimes there's no good alternative to an NSAID for treating pain in someone who has had a heart attack. In this case, many heart specialists recommend naproxen. Most studies suggest that naproxen is safer for the heart than other NSAIDs. But this is not proven. For now, the U.S. Food and Drug Administration requires that naproxen carry the same warning as other NSAIDs do.]]> Wed, 25 Feb 2015 00:00:00 -0500 Fewer Heart Deaths for Finnish Sauna Users Men who use a traditional Finnish sauna may be less likely than others to die from heart disease,...                    What Is the Doctor's Reaction? Doctors usually tell people with heart disease or at risk of a heart attack to steer clear of saunas. Heating up the body, so the thinking goes, puts too much stress on the heart. But this study suggests that using a Finnish sauna may actually decrease the chance of dying from a heart attack or stroke. Sauna can refer to any hot room used for relaxation. Today a modern sauna refers to a dry room with wooden walls and benches. The room is heated by a rock-filled electric device. Finnish saunas are extremely dry -- less than 20% humidity. Other "hot" rooms, such as Turkish baths and steam rooms, have very high humidity. This is not the first study to show potential health benefits from regular visits to a modern sauna. Prior studies have looked at sauna use by people with heart failure. They showed that not only can many people with heart failure safely sit in a sauna, but it can also decrease their symptoms. The heat helps their arteries relax. This allows the heart to pump more efficiently. Most of the older studies directed people to sit in saunas that were rather cool compared with the traditional Finnish saunas described by these researchers. For example, the study of heart failure patients used sauna temperatures set at 60 degrees Centigrade (140 degrees Fahrenheit). The new study looked at the effects of sauna bathing in 2,315 middle-aged men from Eastern Finland. They were enrolled in a heart disease risk study during the 1980s. The men were randomly selected to represent a population with the typical range of factors that affect heart disease risk. The researchers collected detailed information from the men. It included how many times per week and how many minutes on average they sat in a sauna. Finnish saunas are very hot -- between 80 degrees C (175 degrees F) and 100 degrees C (212 degrees F). The researchers kept track of these men for 20 years. Those who sat in the sauna 4 to 7 times each week had a lower rate of death, especially from heart attack or stroke, than those who used a sauna only once a week or not at all. A longer time spent in the sauna also was linked with lower death rates. These positive results for sauna bathing must be interpreted with caution. The results only show a link between sauna bathing and lower death rates. The study does not prove that saunas were the direct reason. In fact, it's likely that people who can sit in a very hot sauna for up to 20 minutes are healthier in the first place. What Changes Can I Make Now? Sauna bathing may be great for Finlanders. They are accustomed to sitting in the very hot, dry conditions of a Finnish sauna. If you are not a regular sauna user, you need to approach this practice with some caution. Talk with your doctor before starting sauna bathing if you have health problems such as high blood pressure or heart disease. Begin by sitting in a sauna that is cooler than those used by the people in Finland. It should be no hotter than 150 degrees F. Keep your initial sessions short -- perhaps 7 to 10 minutes. Other safety tips:
  • Even after you become accustomed to a hotter sauna, it's best to spend no more than 20 minutes per session.
  • Be sure you are well hydrated before you get into the sauna.
  • Listen to your body. If you feel lightheaded, dizzy or have palpitations, step out of the sauna.
  • After your sauna, cool down gradually.
  • Drink at least 16 ounces of cool water once you are out of the sauna.
  • Don't drink alcohol before or right after using a sauna.
  • Don't take a sauna when you are ill.
What Can I Expect Looking to the Future? Sitting in a sauna does some of the same things that exercise does. But it's no substitute. In the sauna, the blood vessels in your skin get wider (dilate). This allows your body to get rid of heat. The amount of blood your heart pumps each minute increases to fill those wider blood vessels. When you exercise, these same processes occur, but your blood vessels dilate where it really counts. They dilate not just in your skin but also in your muscles, which need the extra oxygen and nutrients carried by the blood. Compared with doing nothing at all, sitting in a sauna puts your heart and arteries through a little more exercise. But it is no substitute for the real thing.]]>
Tue, 24 Feb 2015 00:00:00 -0500
Hospital 'Superbug' Outbreak Linked to Scopes About 100 patients at a Los Angeles hospital may have been exposed to dangerous drug-resistant...                    What Is the Doctor's Reaction? Newspapers are describing an infection that has appeared in a Los Angeles hospital as "nightmare bacteria" and a "superbug." Two of the seven patients have died. The hospital has contacted other recent patients in a search for more cases. The outbreak is an infection known as CRE, which stands for carbapenem-resistant Enterobacteriaceae. CRE bacteria make a digestive enzyme of sorts that can break apart one of our strongest antibiotics. Where I work, the antibiotic carbapenem has been compared to an "atomic bomb" because it can kill almost any infection. But carbapenem doesn't kill CRE. Neither do the other antibiotics in the same class.  In fact, most of the antibiotics we reach for to treat infections are useless against CRE. Infections like this are sometimes called multi-drug resistant. Are we out of options? No, we still have a plan for patients with CRE. But treating it does present challenges. We have some antibiotics that can still work against CRE infection. The hospital lab needs to run some tests to see which ones might work well. Doctors usually use at least two antibiotics at the same time to fight this infection. In most cases, we use three or more. CRE is a dangerous family of infections. Some people who are infected die. But it is not extremely contagious. This helps a lot.  The "E" in "CRE" is actually a family of bacteria. Some members of the family you might recognize are salmonella and E. coli. Another common one is named Klebsiella. Only a few strains of salmonella, E. coli, and Klebsiella are CRE. Most of them are easily treated with antibiotics. A couple of bacteria types outside of the "E" family are also multi-drug resistant in the same way. Doctors often call them close relatives of the CRE family. These include a few strains of Pseudomonas and Acenetobacter. What Changes Can I Make Now? CRE has been around for some years now. This is not the first time we have had a hospital outbreak of it. And we know what to do to stop an outbreak like the one in Los Angeles. Doctors need to isolate patients who have CRE diagnosed, so it does not spread through the hospital. You don't need to do anything special to avoid CRE infection. Just take good care of your health. Most people who get CRE have been sick, and have needed to take frequent antibiotics. In a study of almost 100 people who had a CRE infection, 86% had been treated with a powerful antibiotic called a cephalosporin in the previous 3 months. Other factors that increase the risk of this infection include:
  • Having a serious illness
  • Needing to wear a urinary catheter
  • Having a long-term intravenous (IV) line
  • Getting breathing support from a ventilator
  • Having traveled to India or Pakistan
What Can I Expect Looking to the Future? This outbreak of CRE in Los Angeles is bad news. But it is not likely to become a more widespread problem, now that doctors know what they are dealing with. We have seen other hospitals go through larger outbreaks, and those outbreaks ended. For example, a hospital in Colombia had 54 cases of CRE. That outbreak was stopped after intensive cleaning of the hospital, replacement of several sinks and decontamination of stethoscopes. The larger lesson in CRE is that we need to be careful to use antibiotics in just the right way. We should take antibiotics when we need them, and avoid them at all other times. Otherwise, we allow resistant bacteria types to develop. Doctors have only a small number of strong antibiotics in our "back pocket" for infections like CRE. Researchers are working to develop new antibiotics that can kill resistant bacteria. But that takes time, and drug-resistant bacteria keep popping up. We are in a close race.]]>
Fri, 20 Feb 2015 16:55:00 -0500
Study Links Virus to Giant Cell Arteritis A new study links the shingles virus to another painful condition in the elderly, giant cell...                    What Is the Doctor's Reaction? It's not often that researchers discover a new cause of an old disease. But that could be exactly what's happened with a disease called giant cell arteritis. It's a potentially serious disease. It can cause vision loss, unexplained fevers and other health problems. The condition affects adults over the age of 50.  It develops in 1 in 500 people in this age group. The cause of giant cell arteritis is unknown. It is considered an autoimmune disease. That means it develops when a person's immune system mistakenly attacks normal parts of the body. One theory suggests that the immune system is genetically wired to misfire and then something in the environment triggers the attack.  Prior research has searched without success to find an infection-related cause of giant cell arteritis. But a new study may be on to something. Doctors diagnose giant cell arteritis by examining samples from the temporal arteries. These are small blood vessels in the face, just under the skin of the temples. In the new study, researchers looked for signs of varicella-zoster virus (VZV) in these arteries. This is the virus that causes shingles. After a person recovers from chickenpox (varicella), the virus can lie dormant in nerve fibers. It can reactivate later in life to cause shingles (zoster). Results of the study appear in the medical journal Neurology. Researchers found evidence linking VZV infection to giant cell arteritis:
  • Among 82 people who developed giant cell arteritis, 61 (74%) had signs of VZV in the temporal artery.
  • Of the 61 temporal arteries that showed signs of VZV, 32 had nearby muscle tissue available for analysis. Nearly 40% of them also showed signs of VZV.
  • Of 13 people of similar age who died without a history of giant cell arteritis, only 1 (8%) had evidence of VZV infection in the temporal arteries.
Does this mean varicella-zoster virus is the cause of giant cell arteritis? Not quite. It's possible that something about this disease (or its treatment) could allow the virus to appear even if it had nothing to do with the disease. This study did not look for other possible causes, such as other infections. So it's also possible that some other condition alters the immune system of people with giant cell arteritis. In this case, VZV would be just "along for the ride." We need more research to confirm these results. Still, this study raises the exciting prospect that:
  • VZV may be a cause of giant cell arteritis
  • Antiviral medicines, such as acyclovir, may help to treat it
  • Vaccinations already available may reduce the risk of giant cell arteritis
What Changes Can I Make Now? In my view, it's too soon to make any changes based on this research. For example, it is too early to recommend treatment with antiviral medicines. We already can treat giant cell arteritis with corticosteroid drugs. It's also possible to prevent some further problems caused by this condition. If you are over the age of 50 and have symptoms that suggest giant cell arteritis, contact your doctor right away. This condition can cause sudden vision loss. Once lost, vision is rarely recovered.  Symptoms of giant cell arteritis include the sudden development of:
  • Headache
  • Jaw pain after chewing
  • Scalp pain
  • Unexplained fever
  • Changes in vision
  • Aches in the shoulders and hips
Having these symptoms doesn't mean you have giant cell arteritis. Each of them can also be explained by other conditions. But it's a good idea to get checked out if one or more of these problems arise. You may be able to reduce your risk of infection with varicella-zoster virus and any illness it may cause. Here's what you can do:
  • Get vaccinated against chickenpox. The vaccine, usually given in childhood, is likely to reduce the risk of shingles in adulthood.
  • Get vaccinated against shingles. The Zostavax vaccine is approved for people age 50 or older. Current guidelines recommend getting the shot at age 60 or older. However, some people should not get this vaccine. They include people with suppressed or impaired immune function.
  • If you develop shingles, take an antiviral medicine. These medicines include acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex). If taken within 72 hours of when a rash appears, the medicines may speed recovery a bit. They also may reduce the risk of post-herpetic neuralgia. This is a long-lasting pain condition that can follow a shingles infection.
What Can I Expect Looking to the Future? The prospect of finding a cause for a mysterious condition is exciting. To identify a cause that we can prevent and treat is even better. In the near future, look for reports of more research that confirms (or disproves) the findings of this latest study.]]>
Thu, 19 Feb 2015 18:42:00 -0500
Tools May Calculate Heart Risk Too High Calculators used to assess people's risk of heart problems may put those odds too high, a new...                    What Is the Doctor's Reaction? For anyone who's had a heart attack or stroke, taking a statin makes a lot of sense. That's also true for anyone who has arteries narrowed by fatty build-up. Statins lower LDL ("bad cholesterol"). They slash the risk of future problems and deaths for these groups by more than 20%. But what about everyone else? New guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) suggest using a risk calculator to determine who should take a statin. It is intended to be used for healthy adults ages 40 to 75. The calculation is based on:
  • Age
  • Gender
  • Race
  • Cholesterol levels
  • Blood pressure
  • Known diagnosis of diabetes
  • Smoker vs. nonsmoker
The calculator estimates your risk of having a heart attack, stroke or other forms of blood vessel disease in the next 10 years. If the chance is greater than 7.5%, the advice is to take a statin. Not so fast, a group of researchers says. Their new study finds that this and other calculators can overestimate risk of heart problems or stroke by a lot. The estimates can be as much as 67% too high for women and 154% too high for men. The researchers also looked at an alternative risk calculator called the Reynolds Risk Score. This one calculated the risk for men only about 9% too high. However, it estimated the risk for women 21% too low. How could the risk calculators be so inaccurate? One problem is that age matters the most in the equation. Once you hit age 64, everyone meets the criteria based on age. But we know that many 64-year-olds have normal blood pressure, excellent cholesterol levels and a very low risk of heart disease. The AHA-ACC risk calculator also does not take into account family history. This could lead to a risk estimate that is too low. Your numbers might be excellent. But if one of your parents was diagnosed with heart disease before age 50, that puts you at higher-than-average risk. You might benefit from taking a statin. What Changes Can I Make Now? You don't need a calculator if you are at least 40 years old and have diabetes. You should take a statin. Your risk of heart disease is 2 to 4 times higher than the risk for people without diabetes. A very high LDL level, at least 190 milligrams per deciliter (mg/dL), is another solid reason for taking a statin to lower heart disease and stroke risk. A very high risk score makes it easy to advise statin treatment. But what if your score puts your 10-year risk at 7.5% or just slightly above it? Should you take a statin? I plan to still use my patients' LDL cholesterol level as a guide. For my patients who have a high LDL, but one that is less than 190 mg/dL, I will recommend a Mediterranean-style diet and exercise. Both of these may help to lower LDL. Lifestyle changes should always be a priority, even if you need a statin. If the LDL is still greater than 160 mg/dL, I will likely suggest taking a statin drug. At lower LDL levels, I still may advise statin therapy for someone with a family history of heart disease at an early age. What Can I Expect Looking to the Future? Despite its limitations, the AHA-ACC risk calculator is an easy way to start thinking about your heart health and stroke risk. Bring your score next time you visit your doctor. It's an excellent tool to help you and your doctor devise a personal wellness plan. Even if your risk score is low, a healthy diet and exercise can do more than just protect you from heart disease. They also help decrease your risk of dementia and some types of cancer.]]>
Wed, 18 Feb 2015 00:00:00 -0500