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, 24 Apr 2015 13:04:00 -0400 Doctors Say It's Hard to Talk about End-of-Life Care Doctors often find it hard to talk with patients about end-of-life care, a new study shows. And... Doctors often find it hard to talk with patients about end-of-life care, a new study shows. And differences in culture, ethnic group and language make things even more difficult, they told researchers. The study was based on a survey. In all, 1,040 doctors in training (residents) answered the questions. They were asked if they had difficulty talking about end-of-life care with seriously ill patients and their families. Almost everyone said yes. They also were asked about the top 3 problems that came up when they had these talks with someone from a different ethnic group. They named language differences, the patient's or family's spiritual beliefs about death and dying, and the doctor's ignorance of the patient's cultural values and practices. Other problems listed were the patient's or family's limited understanding of medical information and mistrust of the health-care system. These issues also are harder to overcome if the doctor and patient don't speak the same language. Researchers urged patients to start the discussion about what care they do and don't want and what their goals are. The journal PLoS One published the study. wrote about it April 22. 
                What Is the Doctor's Reaction?  If you had a terminal illness, you'd face some important and difficult questions. 
  • Would you prefer to live as long as possible, even if it meant being in pain or unable to talk to loved ones? Or would comfort and a peaceful death matter more to you?    
  • Does your doctor know your wishes for medical care at the end of your life? 
  • Do your family members know your goals and what you prefer? 
If you haven't thought much about these questions or made your wishes known, you are not alone. Previous research has found that many people who are seriously ill have no plan in place to help with decision making. Many also have never shared their preferences with anyone. Other studies have shown that doctors are not very good at predicting what their patients want in the face of dire illness. In recent years, a lot of attention has been given to urging each person to name a health-care proxy. This is a person you choose to make health-care decisions for you if you can't. Of course, you also need to make sure that person knows what you would want. Perhaps you've heard of The Conversation Project. This organization is "dedicated to helping people talk about their wishes for end-of-life care" with their doctors and loved ones.  These efforts have made progress in overcoming the barriers to talking about end-of-life care. Now a new study focuses on the barriers that doctors face.   Researchers surveyed just over 1,000 doctors in their last year of residency about end-of-life discussions with their patients. Here's what the study found: 
  • Nearly every doctor reported barriers to talking about end-of-life decisions. Only 8 out of 1,040 (less than 1%) reported that there were no barriers.
  • About 86% described the barriers as "very challenging."
  • About 91% of Asian doctors found these discussions challenging. Fewer African-American doctors (85%), white doctors (83%) and Hispanic/Latino doctors (79%) felt that way.
  • Among the biggest challenges were:
    • Language and the need for interpreters
    • The spiritual beliefs of the patients and their families about death
    • The doctor's lack of knowledge about the patient's cultural beliefs
    • Cultural differences about sharing information or making medical decisions
    • Limited ability of patients or their family members to understand medical information
    • Patient and family mistrust of the medical system 
Each of these challenges is more likely to get in the way of an end-of-life discussion for minorities and people who speak a different language or have different cultural backgrounds from their doctors.  These findings show that it's not enough to just encourage people to name a health-care proxy or to talk with those close to them about end-of-life care. Doctors will need to be part of the solution as well. What Changes Can I Make Now? When it comes to making decisions about end-of-life care, it's never too soon to take the first steps. Here's how you can start: 
  • Think about what you would want in the face of terminal illness. It can be difficult to make decisions about something that may be decades away or may never happen. And it's OK if you aren't sure. You may change your mind over time.
  • Choose a health-care proxy. This could be a spouse, child or sibling.  But it does not have to be a family member. The most important thing is that your proxy is someone you trust to make decisions that honor your preferences.
  • Let your loved ones and your health-care proxy know your goals, values and preferences. 
  • Involve your doctor in the conversation. Let him or her know who your health-care proxy is and what you've discussed. If something your doctor says is unclear, be sure to ask for an explanation!
  • Recognize the challenges you and your doctor face. Everyone may find it hard at times to understand medical information. And cultural or language differences can add to the challenges, especially for sensitive or difficult decisions. 
You can use some very good resources to learn more about end-of-life medical decision making. They include these websites: 
  • The Conversation Project
  • National Institute on Aging
  • AARP
  • Stanford Letter Project
What Can I Expect Looking to the Future? The U.S. population is becoming older and more diverse. This means that the importance of planning for end-of-life medical issues will only increase. I hope that doctors will receive more and better training to help them have end-of-life discussions with their patients. We may also see changes in how doctors are paid for spending the time it takes to have these discussions. And it's likely we'll continue to see a rise in programs that encourage people to "have the conversation."]]>
Thu, 23 Apr 2015 19:20:00 -0400
Blue Bell Recalls All Frozen Desserts Blue Bell Creameries has removed all of its frozen dessert products from the market because of... Blue Bell Creameries has removed all of its frozen dessert products from the market because of possible listeria contamination. The Texas-based company made the announcement April 20. Blue Bell also reported results of recent tests. They found Listeria monocytogenes bacteria in some cartons of chocolate-chip cookie dough ice cream made on two dates in March. This means that listeria has been found in products made by several different plants. That's why Blue Bell decided to pull all frozen desserts. People should return any products they have for a full refund. Ten cases of listeria infection dating back to 2011 have been linked to Blue Bell ice cream products. The most recent were this year. Three people have died. Listeria symptoms include nausea, vomiting and stomachache. Symptoms can start 3 to 70 days after exposure. Severe cases are rare. But, in high-risk groups, listeria can even cause meningitis and blood infections. HealthDay News wrote about the Blue Bell announcement April 21. 
                 What Is the Doctor's Reaction?  Listeria monocytogenes bacteria are commonly found in soil and water. They can contaminate fruits and vegetables that people eat. Animals also can feed on contaminated foods. Listeria make their way from the animals' intestines into their muscles and milk.  We don't know how live listeria got into chocolate chip cookie dough ice cream made by Blue Bell Creameries. The bacteria also survived processing. As a result, 10 people have a proven listeria infection related to eating the ice cream. Three have died.  The company can't be sure its other frozen dessert products are safe. So it has pulled all of them from the market. You should return any products you  already have. You will receive a full refund.  Getting sick from listeria is extremely unusual. The infection is called listeriosis. But certain groups of people are at high risk to become sick. Anyone with a weakened immune system is at risk. Examples include people with HIV and people with active cancer.  Pregnant women are especially at risk from listeria infections. They get sick 20 times more often than other healthy adults. Infants and the elderly are also somewhat more likely to get listeriosis.  Listeriosis can cause fever, muscle pain and sometimes nausea or diarrhea. It can spread to the brain and nervous system. This can cause meningitis or seizures. In pregnant women, listeria crosses the placenta and can cause miscarriage.  What Changes Can I Make Now?  Your risk of getting sick is extremely small if you ate an ice cream product made by Blue Bell Creameries within the last couple of months. Most of the products probably are not contaminated with listeria. Also, if you are generally healthy and not pregnant, eating something contaminated by listeria probably would not make you ill.  Of course, if you do develop an unexplained fever or a bad headache, contact your doctor. Let him or her know that you ate a frozen food made by the company. Listeria infections are rare. So doctors don't consider it as a cause of illness right away unless there are special circumstances.  Once listeria is considered a possibility, you can start the right antibiotic promptly. Usually this is ampicillin.  You can take steps to lessen any risk of listeria infection. Here's what you can do: 
    • Thoroughly cook meat. 
    • Wash raw vegetables and fruits before eating them. 
    • Keep uncooked meat separate from cooked and prepared foods.
    • Don't eat or drink unpasteurized (raw) dairy products.
    • Wash your hands, utensils and cutting boards after they have touched uncooked foods. 
If you are in a high-risk group for listeria infection, then you should take other precautions as well. 
    • Avoid deli meats, luncheon meats or hot dogs unless they are cooked to steaming hot. 
    • Do not eat blue-veined cheeses or soft cheeses such as Brie or Camembert unless the label clearly says they were made from pasteurized milk. 
    • Do not eat pâtés or meat spreads. Canned meat spreads or pâtés are OK.
    • Do not eat refrigerated, smoked seafood unless it is cooked.
What Can I Expect Looking to the Future?  More people will be reported ill from listeria related to eating Blue Bell ice cream. Now that the link between the two is established, cases can be identified soon. And the right antibiotic can be started, improving the chance of a full recovery.]]>
Wed, 22 Apr 2015 00:00:00 -0400
New Guidance on Treatment after First Seizure New guidelines may help decide who should take medicine after a first seizure. About 10% of people... New guidelines may help decide who should take medicine after a first seizure. About 10% of people in the world have at least 1 seizure in a lifetime. But the risk of having more seizures varies. The updated guidelines come from the American Academy of Neurology and the American Epilepsy Society. They outline how to estimate the risk that someone will have another seizure. Taking anti-epileptic drugs can help prevent seizures, but they have side effects. After a first seizure, the chance of having another one is highest in the next 2 years. The chance is 21% to 45%, the guidelines say. Risk varies based on each person's medical history and test results. Two groups have the highest risk of another seizure, the guidelines say. They include people who have had another brain problem, such as a stroke or head injury, and those whose test results show signs of epilepsy. People with epilepsy have multiple seizures. The risk of a repeat seizure also may be high for someone whose brain scan shows a significant abnormality and for someone who had a seizure during sleep. The journal Neurology published the guidelines. HealthDay News wrote about them April 20. 
               What Is the Doctor's Reaction?  About 1 person in every 10 has at least one seizure in a lifetime. When that first seizure happens, you won't know right away if it will happen again. Even the best seizure specialist in the world can't tell for sure.  But doctors do have guidelines to help them advise patients about their chances of having more seizures. The guidelines can help patients decide whether to start taking a drug right away to prevent more seizures. The American Academy of Neurology published updated guidelines online April 21.  The guidelines are based on a series of tests each patient with a first-time seizure should have: 
  • A brain wave test called an electroencephalogram (EEG)
  • A picture of the brain, preferably an MRI, though a CT scan may be enough
  • Routine blood tests to look for a chemical imbalance, such as:
    • A very low or very high blood sugar level
    • A low blood sodium, magnesium or calcium level 
Some people who have a first seizure might also need a spinal tap (lumbar puncture). This test takes a sample of the fluid that surrounds the brain and spinal cord. In some cases, the situation and medical history may suggest the seizure was drug-related. In that case, doctors would order urine and blood drug tests.  What Changes Can I Make Now? Here is how the guidelines help you and your doctor decide what to do after a first seizure.  If the seizure was the result of something that just happened or a medical problem that can be fixed, it's called a provoked first seizure. Causes of provoked seizure include: 
  • Head trauma (if the brain scan or MRI is normal)
  • An abnormality (shown on a blood test) that can be fixed to eliminate seizure risk
  • A brain infection
  • Drug use  
For a provoked first seizure, medicine rarely is prescribed to prevent future seizures.  An unprovoked first seizure means that doctors can't find out the cause right away. The person could have no prior history of any neurologic problem. Or the person could have a known brain disorder or a prior abnormal brain imaging test. But the seizure still would be unprovoked if it was not expected.  Your chances of having another seizure after an unprovoked seizure are highest if: 
  • You have either a new or old abnormality on your brain CT scan or MRI
  • Your EEG results show a pattern consistent with a seizure disorder
  • You had the seizure while asleep
For any of these situations, most often you would start an anti-epileptic drug right away.  If you didn't fall into any of these high-risk groups, you still would have at least a 20% risk of another seizure within the next 2 years. Starting an anti-epileptic drug right away lowers the risk of another seizure during that time. But in the long term, there is no difference in the risk of having another seizure whether you start the medicine now or wait.  If these medicines had no potential side effects, the decision would be a lot easier for most people. But that is not the case for any of the drugs.  Factors that might influence your decision to start medicine now or wait: 
  • You can't drive right after a first seizure. But in some states you might be able to drive sooner if you are taking an anti-epileptic drug.
  • You hate taking medicine.
  • You don't mind starting a new medicine because you know you can stop or switch to a different one if you have side effects.
What Can I Expect Looking to the Future?  You always have the choice to accept or decline any treatment your doctor recommends.   Sometimes the decision is easy. If you have strep throat, taking an antibiotic makes you feel better sooner, prevents further problems and helps stop the spread of infection to your family.  Other times, the decision is not straightforward. Whether or not to take an anti-epileptic drug after a first seizure is a good example. But it helps to have guidelines like these that are based on solid medical evidence. Then you and your doctor can work together to make the choice that feels right for you.]]>
Tue, 21 Apr 2015 00:00:00 -0400
Weight Tied to Risk of Worst Prostate Cancers Obesity appears to increase the risk of aggressive prostate cancer, especially in black men, a new... Obesity appears to increase the risk of aggressive prostate cancer, especially in black men, a new study finds. The study included nearly 3,400 black men and almost 22,700 white men. When the study began, they were at least 55 years old and did not have prostate cancer. In the next 5½ years, blacks were 58% more likely to develop prostate cancer than whites. The increase in risk was greatly affected by weight. Among men of normal weight, blacks had a 28% higher risk of prostate cancer than white men. For very obese black men, the risk was 103% higher. And very obese black men were 81% more likely to have aggressive prostate cancer than black men of normal weight. This type of prostate cancer grows quickly. The link between obesity and prostate cancer was not as strong for white men. Very obese white men were 33% more likely to develop aggressive disease than white men of normal weight. The risk of developing a slower-moving prostate cancer was 122% higher for very obese blacks and 20% lower for very obese whites, compared with men of normal weight. The journal JAMA Oncology published the study. HealthDay News wrote about it April 16.                What Is the Doctor's Reaction? Prostate cancer affects African-American men very differently than it affects non-Hispanic white men. Black men have a higher risk of: 
  • Developing prostate cancer during their lives
  • Getting prostate cancer at a younger age
  • Dying from prostate cancer (because the disease is more aggressive from the start)
And the differences between blacks and whites become even more dramatic when you add in the effects of body weight, according to results of this study.  The researchers used information gathered from a clinical trial. It included 3,398 African-American men and 22,673 non-Hispanic white men. The trial was originally designed to see if selenium, vitamin E or both could prevent prostate cancer.  The researchers compared how often prostate cancer occurred in men of normal weight vs. very obese men. Normal weight was defined as a body mass index (BMI) of less than 25. Very obese meant a BMI of 35 or higher.  For white men, being very obese was actually linked with a slightly decreased risk of developing low-grade prostate cancer. This type of cancer is less likely to grow and invade other parts of the body. However, obesity increased the risk that prostate cancer in white men would be high-grade, or likely to grow rapidly.  Obese black men were more likely to develop both low-grade and high-grade prostate cancer than black men of normal weight. And obesity increased the risk of high-grade prostate cancer for black men even more than for white men.  This study could only show links between body weight and prostate-cancer risk. It doesn't prove that obesity causes prostate cancer. Note, for example, that obese white men were less likely to develop low-grade prostate cancer.  What Changes Can I Make Now?  These study results raise the possibility that obese men, especially obese black men, should get routine screening for prostate cancer with a prostate-specific antigen (PSA) blood test. But right now we don't have evidence that screening would lead to better outcomes for these men.  Men of any race and body weight should be informed about the pros and cons of prostate cancer screening. I suggest that men follow several steps in making  a decision about screening.  First, ask yourself these questions before having your blood drawn for a PSA test. 
  1. Am I willing to proceed with a prostate biopsy if PSA testing indicates that I might have prostate cancer?
  2. Would I want to get treatment right away if the biopsy shows any cancer cells, even very low-grade cancer cells? 
If you answer "yes" to both of those questions, then getting a PSA test is a reasonable choice.  What if you answer "yes" to question 1 and "no" or "not sure" to question 2? In that case, it's important to think about what happens next if the biopsy does show cancer. 
  • If the biopsy shows more aggressive prostate cancer, cancer treatment would almost surely be recommended.
  • If the biopsy shows only low-grade prostate cancer, frequent repeat tests would likely be recommended. This would include regular PSA blood tests and perhaps repeat prostate biopsies. Would you be comfortable with that approach? 
For men at average risk who choose screening, the advice is to start at age 50. For men at higher risk, the age to begin screening probably would be younger. However, there is no consensus advice.  What Can I Expect Looking to the Future? Preventing obesity is already the No. 1 public health effort. Lowering prostate cancer risk adds to the long list of reasons for maintaining a healthy body weight.]]>
Fri, 17 Apr 2015 00:00:00 -0400
Sleep Apnea May Speed Up Memory Problems Loud snorers and people with sleep apnea may develop memory problems much earlier than those with... Loud snorers and people with sleep apnea may develop memory problems much earlier than those with normal breathing during sleep, a new study suggests. But getting treatment for sleep apnea may restore normal risk levels. The study was based on a review of medical records for about 2,500 people. They ranged in age from 55 to 90. Researchers divided people into 3 groups. One group had normal brain function. One group had mild memory and thinking problems (mild cognitive impairment). The third group had Alzheimer's disease. Researchers also looked at when people developed these problems. Diagnosis with mild memory problems occurred about 10 years earlier for people who had sleep-disordered breathing (sleep apnea or heavy snoring) than for those without sleep issues. Alzheimer's disease was diagnosed about 5 years earlier. Researchers also looked at a smaller group that received treatment for sleep apnea. Their treatment was using a continuous positive airway pressure machine during sleep. Those who developed mild memory problems were diagnosed about 10 years later than people who had untreated sleep apnea. The journal Neurology published the study. HealthDay News wrote about it April 15.             What Is the Doctor's Reaction? Sleep disorders are common. For example, sleep apnea affects an estimated 18 million Americans. People with sleep apnea have poor-quality sleep and long pauses in breathing during sleep.  Sleep apnea can cause headaches, fatigue and daytime sleepiness. But for a long time it was considered bothersome rather than dangerous. We now know it's more serious than that. Sleep apnea can increase the risk of motor-vehicle accidents (from falling asleep at the wheel), heart failure and lung disease. A new study suggests that sleep apnea might contribute to yet another serious problem: dementia. Results appear in the medical journal Neurology. Researchers analyzed the medical records of nearly 2,500 people (aged 55 to 90) who reported: 
  • Untreated sleep apnea
  • Sleep apnea that was being treated
  • No history of sleep apnea 
Some people had normal brain function. Others had Alzheimer's disease or a condition called mild cognitive impairment. People with this condition have declines in memory and thinking. Symptoms are not as severe as they are in Alzheimer's disease. But many people with these milder memory problems do eventually develop Alzheimer's disease.  These findings of the study suggest that sleep apnea may contribute to a decline in brain function. 
  • Of those who developed mild cognitive impairment, people with sleep apnea developed it at an average age of 77. Those without sleep apnea developed it later, at an average age of 90.
  • Of those diagnosed with Alzheimer's disease, people with sleep apnea developed dementia at an average age of 83. Those without sleep apnea developed it at an average age of 88.
  • Some people with sleep apnea received a common treatment called continuous positive airway pressure (CPAP). Among those who got this treatment, mild cognitive impairment developed 10 years later than for those who were untreated. In other words, treatment seemed to return the risk of memory problems to the same level as that of people without sleep apnea. 
This study is important because it points to sleep apnea as a potential risk factor for decreased brain function. It also suggests that treating sleep apnea may protect the brain.  If confirmed by future research, this study could lead to advances in our knowledge about how problems with thinking and memory develop. This could lead to a way to prevent these conditions. Such insights could have a profound impact. The average age of our population is increasing, so these conditions are likely to become even more common.  What Changes Can I Make Now? If you have symptoms of sleep apnea, see your doctor for evaluation.  Symptoms include: 
  • Daytime sleepiness and fatigue
  • Loud snoring
  • Headache, especially in the morning 
Obesity increases the risk of sleep apnea, so staying at a healthy weight may help to prevent it. Alcohol and medicines that make you drowsy can make fatigue and daytime sleepiness worse. People with sleep apnea should limit alcohol and avoid sedatives. While sleep apnea is treatable, many people have difficulty wearing the CPAP mask. The mask makes a tight seal around the mouth and nose. It can be hard to tolerate the rush of air flowing through the mask. Some people may remove it by accident during sleep. For many, it can be a challenge to find a mask that maintains the tight seal. If you have sleep apnea, work with your doctor to find the CPAP settings and mask that are right for you.  Not everyone who snores heavily has sleep apnea. A sleep study is recommended to confirm the diagnosis. During a sleep study, technicians monitor your breathing pattern, oxygen levels and brain waves (among other measures) while you sleep.  What Can I Expect Looking to the Future?  This study found a link between sleep apnea and brain disease. However, this does not prove that such sleep problems actually cause brain disease. We will need more studies to confirm the findings of this latest research. More research also may show whether sleep apnea actually causes a decline of thinking and memory. If that's confirmed, you can expect to hear much more about how to prevent and treat sleep apnea and how sleep problems affect brain function over time.]]>
Thu, 16 Apr 2015 00:00:00 -0400
Pharmacists May Help People Stick to Pills Pharmacists may have a role to play in helping people on blood thinners take their pills on... Pharmacists may have a role to play in helping people on blood thinners take their pills on schedule, a new study finds. The study used information on outpatients in the Department of Veterans Affairs (VA) health system. The 5,400 people in the study group got prescriptions for the drug dabigatran (Pradaxa). This blood thinner is prescribed for many people with an abnormal heart beat called atrial fibrillation. It helps to prevent clots that can cause strokes. Researchers interviewed pharmacists at 41 VA centers. They asked the pharmacists about how the VA center educated people about the drug and kept track of them. Practices varied. About 28% of those in the study did not take the medicine as directed. Patients were more likely to take their medicines correctly if pharmacists, rather than doctors' offices, did the follow-up. They also were less likely to miss doses. The journal JAMA Internal Medicine published the study. HealthDay News wrote about it April 14.                   What Is the Doctor's Reaction? Not taking prescribed medicines properly is a huge problem. And it happens often. Three out of four Americans say they don't always take medicine as instructed. They might not even pick up the prescription. Doctors call it medicine non-adherence. Some estimates say it causes up to one-third of unplanned hospital stays and more than 100,000 deaths each year. Studies have found several reasons that people don't always take their medicine as prescribed. They include: 
  • Problems with paying for the drug
  • Not being able to read and understand the instructions on the label
  • Forgetting to take the drug, especially if it needs to be taken more than once a day
  • Not understanding why the doctor prescribed the drug and how it helps their health
  • Having symptoms that they believe are side effects of the drug
  • Not realizing that, for some drugs, missing even one dose can be dangerous
The results of this new study show how a pharmacist can be part of the solution. The study focused on a blood thinner called dabigatran (Pradaxa). It's prescribed to people with an irregular heart beat known as atrial fibrillation. Many people with atrial fibrillation have an increased stroke risk. Taking a blood thinner reduces the risk of blood clots that can cause a stroke. But it must be taken properly. Skipping doses makes a stroke more likely. Taking too much can cause bleeding. This can be serious and sometimes life-threatening. Before dabigatran, warfarin (Coumadin) was the best and really the only blood thinner that could be taken as a pill. But with warfarin, you need regular blood tests to adjust dosing. On the other hand, warfarin has two advantages that can help people to take the right dose every day: 
  1. You take it only once a day. And being late or even skipping one day on a rare occasion will not increase stroke risk.
  2. After each blood test, you get a call from a nurse. The nurse tells you whether you need to take a different dose. During the call, the nurse can also review whether you are taking the medicine properly. If not, the nurse can find out why and help solve any problems.
If you take dabigatran, you don't need blood tests. The dose is always the same. But this also means you don't have regular contact with a nurse. Your doctor's office won't know if you are not taking the medicine properly.  You also have to remember to take dabigitran twice a day. And, unlike warfarin, it must be taken right on schedule. Skipping a few doses does increase stroke risk. In this study, pharmacists were able to improve dabigatran adherence. They did this by:
  • Educating people about why they should take every dose and what to do if they miss a dose
  • Calling people who are late picking up refills to find out why
What Changes Can I Make Now?  Here's what you can do to help take medicines correctly:
  • If cost is an issue, be sure to discuss this before your doctor writes the prescription. A generic version could save you a lot of money. A generic drug must contain the same active ingredient in the correct dose as the brand-name drug.
  • If there is no generic version, ask if another medicine might be just as good for you. For example, warfarin and dabigatran thin the blood in different ways. They both prevent stroke in people with atrial fibrillation. But warfarin is much cheaper than dabigatran.
  • Make sure you understand why you need the drug and how it helps you.
  • If the directions on the label are not clear, review them with the pharmacist until you know what to do. At home, ask for help from family or a friend if you still are uncertain.
  • If you take a lot of pills, ask your doctor how you can simplify your drug program.
  • Take advantage of techniques and technology to help you remember to take your drugs on schedule. 
Here are some simple techniques that may help you keep track of medicines: 
  • Use a seven-day pillbox.
  • Set an alarm on your watch, phone or clock.
  • Make a chart that shows when to take your pills.
  • Use a journal to record when you take your pills.
  • Take a dose at the same time each day.
  • Take your medicines at the same time as another daily activity, such as brushing your teeth. 
Technology also can help: 
  • Automatic pill dispensers pop out the right pills at the right times.
  • Some pillboxes have timers and alarms.
  • Electronic caps fit on your prescription bottles and beep when it's time to take a pill. Then they record when the cap was removed to show that you took the pill.
  • Smartphone apps can organize pill information and remind you when to take them. 
What Can I Expect Looking to the Future?  New tech gadgets will be invented to make medicine adherence even easier. For example, new methods of packaging pills already are being developed. For example, one type of package can send out signals automatically to a family member when you take your pills. And some companies are working on putting that technology into the pills themselves.]]>
Wed, 15 Apr 2015 00:00:00 -0400
Listeria Reported in Ice Cream, Hummus Two popular food brands have recalled products contaminated by listeria. Blue Bell brand ice cream... Two popular food brands have recalled products contaminated by listeria. Blue Bell brand ice cream has been linked with 8 illnesses and 3 deaths. The U.S. Centers for Disease Control and Prevention (CDC) announced the outbreaks April 9. Also last week, Sabra said it had recalled 30,000 cases of classic hummus. The bacteria were found in several tubs of hummus in Michigan. No infections have been linked to hummus, state health officials said. The CDC said 3 people in Texas became ill after eating Blue Bell ice cream between 2011 and 2014. Five cases in Kansas occurred from January 2014 to January 2015. Three of the Kansas patients died. Blue Bell Creameries has closed a plant and recalled several products. An expert interviewed by HealthDay News said people can get sick 3 to 70 days after being exposed to listeria. The typical time for symptoms to develop is 2 to 4 weeks after exposure. Listeria bacteria cause about 1,600 U.S. illnesses and 3 to 4 outbreaks each year, the expert said. But severe cases are rare, the CDC said. Listeria kills about 260 Americans each year. HealthDay wrote about the outbreaks April 10.                  What Is the Doctor's Reaction? It was a lovely weekend in the Northeast. My husband and I took a long walk. We saw kids (with helmets) on scooters and bicycles. People took the time to stop and chat with each other. Picnics and ice cream can't be far away! That, of course, made it all the more distressing to read about listeria in 2 products. Outbreaks linked to Blue Bell ice cream have been reported in Texas and Kansas. And a routine inspection found listeria in Sabra hummus, leading to a recall of 30,000 units.  What is listeria? Listeria monocytogenes is a bacterium that can contaminate food. In nature, it lives in soil and water. Listeria can lurk for years in food-processing factories. It is most commonly found in: 
  • Uncooked meats and vegetables
  • Unpasteurized (raw) milk
  • Cooked and processed foods such as cheese, meat and some smoked seafood 
Our refrigeration systems kill most bacteria, but listeria can live in your refrigerator.  Listeria infection is called listeriosis. For most healthy people, it is similar to so-called stomach flu. You might have fever, aches and some diarrhea. But generally it gets better without treatment.  Some groups, however, are at much higher risk of serious illness from listeria infection. For these groups, there is a much higher rate of illness and death. People in higher-risk groups are also likely to have neurological symptoms of infection, such as seizure, headache or a stiff neck. These are the main high-risk groups: 
  • Pregnant women. They are about 10 times more likely than most people to get listeria infection. Hispanic pregnant women have an even higher risk. These infections can cause miscarriage or illness, even death, in a newborn.
  • Older adults. More than half of listeria infections occur among adults over 65. 
  • People with immune systems weakened from cancer, HIV, liver or kidney disease. 
Listeria can be slow to appear. People can become sick up to two months after eating foods contaminated with these bacteria. Fortunately, they can be treated with antibiotics. The U.S. Centers for Disease Control and Prevention (CDC) does not recommend treatment or testing for exposed people -- even in higher-risk groups -- unless they become sick.  Despite the multiple reports of listeria in recent weeks, it is still a pretty rare disease. Based on CDC data, outbreaks and cases do not appear to be increasing. Furthermore, it is a win for food safety that the hummus products were found on routine inspection. This means they can be pulled from supermarket shelves, hopefully before anyone becomes ill.  What Changes Can I Make Now?  If you were affected by either the ice cream or the hummus outbreak, you should talk with your doctor. He or she can monitor you and your symptoms for the next few months. Most people won't get sick, but if you do, the illness can be serious. You should be diagnosed and treated right away. Preventing listeria is important for everyone, particularly so for those in higher-risk groups. The CDC has some excellent suggestions about preventing listeria. Here's what you can do: 
  • Avoid foods at risk.
  • Don't drink raw (unpasteurized) milk.  
  • Make sure that you heat deli meats, such as hot dogs, to steaming before you eat them.
  • Refrigerate leftovers and use them quickly.   
If you are pregnant or in another high-risk group, talk with your doctor about foods to avoid or eat with special caution.  What Can I Expect Looking to the Future? It's hard to know. Are outbreaks becoming more common? Less common? I would like to see more protection (and inspection) of our food supply to make sure that people are safe from listeria and other foodborne illnesses. We are lucky in this country to have an excellent surveillance and inspection system. I hope that we protect it.]]>
Tue, 14 Apr 2015 00:00:00 -0400
Being Short May Be Hard on the Heart Short people may be more likely to have heart disease, and that could be linked to their genes, a... What Is the Doctor's Reaction? The main factors that increase your risk of developing coronary artery disease are well known. They include family history, smoking, diabetes, high blood pressure and high cholesterol. But there are some odd risk factors, such as shorter height in adulthood. Shorter adults tend to have higher blood pressure and cholesterol. They are also more likely to develop diabetes than taller adults. Some studies have adjusted their numbers to account for those risk factors. And they still have shown that being short, all by itself, is linked with a greater chance of having heart disease.  We don't know why adult height and heart disease risk are linked. The results of this study provide strong evidence that the reason may be related to genes.  Some diseases are caused by an abnormal change (mutation) in a single gene. Sickle cell disease and Huntington's chorea are examples. But the genetics of coronary artery disease is more complex. Only some of the genes that make a person more likely to get heart disease have been discovered.  It's easier to predict whether a child will become a short adult. Similar to heart-disease risk, height is also determined by multiple genes. But unlike heart-disease genes, the major "height" genes have been found.  The researchers in this study looked at genetic information from more than 18,000 people. The researchers looked for links among: 
  • Usual coronary-artery risk assessment
  • Some of the genes known to influence heart disease
  • The genes known to predict maximum adult height
In the past, several studies have shown a link between short height in adulthood and heart disease. But the height an adult actually reaches is greatly influenced by nutrition and illness in childhood. And nutrition and illness in childhood could be a reason for heart disease later in life. This study was designed to look at the relationship between "height" genes and the risk of coronary artery (heart) disease. The researchers found that the more genes people had that are linked with reduced height in adulthood, the higher their risk of heart disease.  By their calculations, someone who is 2½ inches shorter than average has an increase of 13.5% in heart-disease risk. By looking at genes, the researchers were able to take away the effects of diet or illness on height (and heart-disease risk).  What Changes Can I Make Now?  Right now, these study results do not change what all of us should do to help prevent heart disease. However, if you are short, it may be even more important for you.  Other odd factors also have been linked with heart disease risk: 
  • Ear lobe creases. People with a diagonal crease or dent on one or both earlobes have a higher-than-average chance of developing heart disease.
  • Baldness. Heart disease is somewhat more common in men who begin losing their hair early.
  • Gray hair. Early graying has been linked with heart disease.
  • Leg length. The longer your legs, the lower your risk of heart disease. Of course, this also means you are less likely to be short. 
The genetics of these features have not been studied. What Can I Expect Looking to the Future? Just being short is surely not the direct cause of developing heart disease. But the link between the genes linked with both height and heart disease suggests that these genes somehow drive similar processes in the body. Those processes may lead to both shorter height and heart disease. Finding this link could be a first step in developing precision therapy for someone with a particular set of genes.]]>
Fri, 10 Apr 2015 00:00:00 -0400
Arts, Computers, Social Life May Support Brain People who engage in arts and crafts, use computers or have an active social life may stay... People who engage in arts and crafts, use computers or have an active social life may stay mentally sharp longer as older adults, a new study suggests. The study included 256 adults, ages 85 or older. They had normal brain function when the study began. Researchers asked them about their activities, both current and earlier, during middle age. During the next 4 years, nearly half developed mild cognitive impairment. This is a problem with memory or thinking that can lead to dementia. Researchers adjusted their numbers to account for differences in sex and education. They found that people who were involved in artistic pursuits during midlife and later life were 73% less likely to develop brain problems than others. Those who did crafts, used computers or had an active social life had half the risk of brain problems of those who did not do these things. Those who developed high blood pressure in midlife were more than twice as likely as others to develop brain problems. The journal Neurology published the study. HealthDay News wrote about it April 8.                What Is the Doctor's Reaction? Have you ever wondered what you can do to keep your brain sharp into advanced age?   If you are a baby boomer, you are not alone in pondering this question. And it has the attention of researchers who study the aging brain. It's also the focus of companies that promote "brain games" and other products intended to "exercise" the brain to keep it functioning well. We don't know how well these products work, but several studies have shown a link between good brain function and keeping busy with hobbies and social connections. A new study is the latest to examine the link between what you do in your leisure time and brain function in advanced age. And the results suggest there is something you can do to keep your brain working well.  The journal Neurology published the study. Researchers surveyed 256 elderly men and women. Their average age was 87. They were asked about a variety of activities during middle and advanced age, including:  
  • Arts, such as painting, drawing and sculpting
  • Crafts, such as woodworking, pottery, quilting and sewing
  • Social activities, such as going to the movies or concerts and visiting with friends
  • Computer use , such as shopping online or searching the web 
At the start of the study, each person had normal brain function and no prior problems with memory or thinking.  During the next four years, nearly half developed mild cognitive impairment. This form of brain dysfunction causes problems with memory or language. It may lead to dementia. Mild cognitive impairment was: 
  • 73% less likely to develop among those who were active in the arts activities during middle and advanced age than among those who were not
  • 45% less likely to develop among those engaged in crafts
  • 55% less likely to develop among those with an active social life
  • 53% less likely to develop among computer users 
People who were more likely to develop mild cognitive impairment included those who had: 
  • An above-average risk of heart disease
  • Depression
  • A gene (called APOE) that has been linked with Alzheimer's disease 
As interesting as these results are, we cannot conclude from this study that any of these activities will protect your brain in advanced age. We only know that among people who made it to advanced age with normal brain function, people who did these activities were more likely to stay sharp.  We'll need more research to prove that these activities actually caused better brain health.  What Changes Can I Make Now?  Keeping your brain healthy is a lifelong job. It's never too soon to start. You can make changes now to increase your chances of having good brain health in advanced age. Here's what you can do: 
  • Don't smoke.
  • Get your blood pressure, blood sugar and cholesterol checked. If they are not in an ideal range, changes in your diet, increased exercise, and, if necessary, medicines can improve them.
  • Take a blood thinner (such as aspirin or warfarin) to lower your risk of stroke if you have an irregular heart beat (called atrial fibrillation).
  • Have surgery if you have a severely narrowed carotid artery (a major source of blood flow to the brain).
If you enjoy arts, crafts or working with computers, this new study suggests you might be helping your brain. Filling in your social calendar could be helpful as well.   It's fascinating that leisure-time activities could be helpful to future brain function. My question is this: How do these activities protect the brain?  What Can I Expect Looking to the Future?  You can expect the aging population of this country to embrace studies like this one that suggest ways to avoid dementia. I hope that future research will confirm the findings of this new study. If that happens, you can also expect details to emerge, including: 
  • How do these activities protect the brain?
  • Which activities are best?
  • How much activity is the minimum to protect the brain? 
We continue to learn more about how to prevent dementia. Maybe the day will come when your doctor, instead of prescribing a medicine, will recommend that you join a book club and start your own blog.]]>
Thu, 09 Apr 2015 13:24:00 -0400
Physical Therapy or Surgery for Back Pain? Physical therapy may relieve one type of back pain as well as surgery does, a new study finds. The... Physical therapy may relieve one type of back pain as well as surgery does, a new study finds. The study included 170 people in their late 60s. All of them had lumbar spinal stenosis. This is a narrowing of the channel inside one or more bones of the spine. People had severe back pain and problems with movement. They were randomly assigned to receive either surgery or physical therapy. The surgery removed areas of bone that were narrowing the spine and pressing on nerves. The physical therapy program lasted 6 weeks. But people in the physical therapy group were allowed to get surgery instead. More than half of them did so. People in both groups had tests of movement 10 weeks, 6 months and a year after surgery or physical therapy. They also were asked about pain. After 2 years, they filled out a survey to assess overall results. In the long term, both groups had equal reductions in pain. Both groups also had similar changes in movement and quality of life. Not everyone showed improvement. The journal Annals of Internal Medicine published the study. HealthDay News wrote about it April 7. What Is the Doctor's Reaction? Lumbar (low back) spinal stenosis is a common problem in the aging spine. It causes pain and limits movement. For most people, there are no hard and fast rules about treatment, especially when to have back surgery. The results of this study offer guidance for doctors and their patients. Low-back stenosis means that the space inside the lowest part of the spinal canal has narrowed. The causes include bulging discs and overgrowth of bone and ligaments. The result is pressure on the nerves, which causes pain. Typical symptoms of spinal stenosis are:
  • Pain in the groin, buttocks and upper thigh. But it does not move down the leg like the pain of sciatica.
  • Pain with standing or walking that gets better if you sit or squat.
  • Pain that feels worse when you lean back and feels better if you lean forward.
At first, most people with low-back spinal stenosis are treated with what doctors call conservative measures. These include pain relievers, anti-inflammatory medicines and physical therapy. Some people also get corticosteroid injections into the spine. If symptoms don't improve, doctors often recommend surgery. Prior studies have compared conservative measures, including physical therapy, with surgery. They consistently have shown quicker pain relief and better movement after surgery for severe spinal stenosis. However, these studies were mostly observational. This means they looked at differences between people who simply decided to get one treatment or another. They could not actually prove surgery is the better treatment option for spinal stenosis.   Some clinical trials also have compared surgery to conservative treatments. Clinical trials are studies that usually offer the most reliable type of evidence. They randomly assign similar patients to get one treatment or another. However, the results of the spinal stenosis studies were hard to interpret. That's because many of the people assigned to conservative therapy changed their mind and went for surgery.  Symptom relief may happen faster with back surgery. But the studies show that's not the case long-term. After 6 to 10 years, symptoms related to spinal stenosis were similar for those who got conservative therapy only and those who got surgery. About 20% of people who chose surgery had 1 or more repeat operations.  This new study is unique because everyone was a good candidate for back surgery and agreed to have surgery. But they understood that each of them would be randomly assigned to get surgery right away or take part in a physical therapy program designed for the study. Both groups had similar short-term and long-term outcomes in these areas:
  • Pain relief
  • Better movement
  • Improved quality of life 
What Changes Can I Make Now?  In the past, a person with severe symptoms from lumbar spinal stenosis might opt to have surgery right away. Given the results of prior studies, it would have been very reasonable not to wait and see if conservative therapy helped.  The results of this study suggest that a well-designed physical therapy program can relieve symptoms just as quickly as back surgery.  Some people may need to get surgery right away.  For example, severe pressure on the nerves might cause: 
  • Weak muscles around the pelvis or upper legs
  • Loss of bladder or bowel control
  • Pain that can't be controlled with strong medicine
If you need surgery, the operation performed is almost always a laminectomy. The surgeon removes the bony plate (lamina) on the back of the vertebra that is narrowed.  This opens up more space for the spinal nerves. The procedure usually means one to three days in the hospital. Sometimes it is done through a tiny incision and guided by video from a miniature camera.  Sometimes there is so much narrowing that a simple laminectomy won't be enough. In that case, you may need a laminectomy with spinal fusion. The surgeon removes disks and other tissues as well as one or more bony plates.  Special cement or hardware is used to make the spine stable. You will have to spend more days in the hospital than you would after a laminectomy. Recovery also is longer.  Laminectomy alone is just as effective as spinal fusion. Therefore, it's always the preferred option when possible.  What Can I Expect Looking to the Future?  Given the results of this study, most people with spinal stenosis should try physical therapy before surgery. But if symptoms don't quickly improve, your preference will guide the decision of how long to wait to have surgery.]]>
Wed, 08 Apr 2015 12:33:00 -0400
More Intense Exercise May Extend Life Working up more of a sweat when you exercise may help you live longer, two new studies find. And... Working up more of a sweat when you exercise may help you live longer, two new studies find. And for most people more vigorous exercise appears to be safe, a third study suggests. All of the studies focused on middle-aged or older adults. One included more than 204,000 people. Researchers kept track of them for more than 6 years. They were divided into groups based on how much of their exercise was vigorous, such as running, compared with moderate activity, such as brisk walking. Those who said up to 30% of their exercise was vigorous were 9% less likely to die during the study than those who did no vigorous activity. The death rate was 13% lower for those who did more than 30% vigorous exercise. A second study had similar results. The journal JAMA Internal Medicine published both of them. The journal Circulation published the third study, which looked at cardiac arrest risk. Researchers reviewed more than 1,200 cardiac arrests among adults age 35 to 65. Only 5% occurred during vigorous exercise. People who were exercising were more likely to get help quickly and to survive. The journal Circulation published the study. HealthDay News wrote about the first JAMA study and the Circulation study April 6. What Is the Doctor's Reaction? We know that some exercise is better than none. But how much more health benefit do we get if we exercise longer or harder or both? Is vigorous exercise better than moderate-intensity exercise? And what's the risk of dropping dead from vigorous exercise in middle age and beyond?  Three articles published online yesterday provide data to help us answer these questions.   People who don't exercise now get the greatest health benefits if they do the recommended minimum of: 
  • 150 minutes per week of moderate-intensity exercise OR
  • 75 minutes per week of vigorous exercise
Regularly getting this much exercise can lower the risk of death by 20% over a period of 14 years. That is the conclusion of a study done by Hannah Arem, Ph.D., and her colleagues. JAMA Internal Medicine published the study.  Exercising for up to 3 times the minimum continues to lower your risk of dying. Increasing the amount or intensity of exercise even more may have other health benefits. But this study measured only the risk of dying. So you may not gain any further years of life if you go beyond 7½ hours of moderate-intensity exercise or 3 hours and 45 minutes of vigorous exercise each week.  The researchers also looked at whether too much exercise might be harmful. The answer appears to be no. At least, it appears that a lot of exercise does not increase the risk of dying.  People who exercised 10 times the minimum amount had similar death rates as those who did 3 to 5 times the minimum. Ten times the minimum means more than 3 hours per day of moderate-intensity exercise or more than 1½  hours per day of vigorous exercise. JAMA Internal Medicine also published a second related article online. Researchers in Australia looked at the potential extra benefits of vigorous exercise in adults 45 to 75 years of age. This study also looked at death risk. Results of their study showed a reduced risk of death for people who did more vigorous exercise compared with those who did only moderate exercise.  The journal Circulation published the third article. It provides some reassurance about the very low risk of middle-aged adults suddenly dropping dead while exercising. The study also showed that the chance of surviving a cardiac arrest (when the heart stops beating) is much greater during exercise than at other times. The likely reasons: 
  • People tend to exercise with or around other people.
  • If you exercise regularly, your body can survive longer without your heart beating than if you don't exercise. 
What Changes Can I Make Now?  If you don't exercise now, the best thing you can do is to get started. Exercise improves multiple body functions: 
  • The heart becomes more efficient at pumping blood.
  • The lungs move oxygen into the blood stream faster.
  • Blood vessels deliver the oxygen to tissues throughout the body with ease.
  • Muscles get stronger.
  • The body's cells respond better to insulin. This helps to keep blood sugar levels from rising.
Do you have any health factors that increase your risk of heart disease? If you do, take action to improve them. In the study in Circulation, most of the people who had a cardiac arrest during exercise had a higher than average risk of heart attack. They had one or more of these risk factors: 
  • A family history of heart disease at an early age, younger than 55 for men or younger than 65 for women 
  • Smoking
  • High LDL cholesterol
  • High blood pressure
  • Diabetes 
Once you start exercising, don't ignore symptoms that might be caused by heart disease. Chest pain is just one of the symptoms. Sometimes you might have little or no chest pain. You might just: 
  • Feel faint
  • Break out in a cold sweat
  • Get unexpectedly short of breath
  • Feel pain in the jaw or arm 
If this happens, stop exercising right away. Call your doctor for advice. And don't test yourself to see if it will happen again.  What Can I Expect Looking to the Future?  Recent studies suggest that vigorous exercise might offer the greatest health benefits. For most people, though, it's difficult and exhausting to exercise at high intensity for more than a few minutes.  Instead, consider interval training. You can start with bursts of high-intensity exercise for 10 to 15 seconds only. Then go back to moderate intensity. For example, if you walk or jog, speed up for short bursts every few minutes. Then resume your prior pace.]]>
Tue, 07 Apr 2015 00:00:00 -0400
Report: Poor Americans Lose the Most Sleep Many Americans are sleep-deprived, and those with lower incomes are losing the most sleep. That's... Many Americans are sleep-deprived, and those with lower incomes are losing the most sleep. That's the main message of a brief report issued April 2 by the Centers for Disease Control and Prevention (CDC). The report was based on a national health survey from 2013. People were asked how many hours of sleep they get per night, on average. Lower-income people were more likely to report being sleep deprived. This was defined as less than 6 hours of sleep a night. About 35% of those with family incomes below poverty level were sleep deprived, compared with 28% of those with incomes at least 4 times the poverty level. All of these numbers are higher than some earlier surveys show. A study published in the journal Sleep in 2010 looked at past surveys that asked Americans about sleep habits. It found that about 7.6% of U.S. adults reported getting less than 6 hours of sleep a night in 1975. This rose to 9.3% in 2006. Full-time workers were the only group reporting an increase in sleep deprivation, the study found. The journal Morbidity and Mortality Weekly Report published the results of the 2013 survey. What Is the Doctor's Reaction? Researchers just shared results from a huge 2013 survey by the U.S. Census Bureau. It was called the National Health Interview Survey. Among other things, this survey asked Americans about their sleep. Most health experts think a typical adult needs about eight hours of sleep each day. Six hours is considered a "short sleep." But Americans seem to be getting less sleep than ever. Look how we compare to past years: 
  • In 1975, 7.6% of Americans said they slept less than 6 hours a night.
  • In 2006, 9.3% of Americans said they slept less than 6 hours a night.
  • In 2013, depending on income level, between 27.7% and 35.2% of Americans said they slept less than 6 hours each night. 
In the survey, people from low-income families were most likely to have short sleeping hours. Most of the time, activity logs suggested that hours of work took the place of sleep.  I think people who manage on a small amount of sleep underrate the impact that has on them every day. Sleep deprivation isn't good for your health. We know that getting too little sleep can lead to these problems: 
  • Slower thinking
  • Slower reaction times
  • Less ability to pay attention
  • More car accidents and other accidents
  • Depressed mood
  • Poor sexual function or lower interest in sex (low libido)
  • Weight gain
  • High blood pressure
  • Blood test results that show signs of inflammation
  • A smaller immune response after getting a flu shot
  • A higher likelihood you will catch a cold
  • Higher rates of heart attack and stroke
  • Weight gain
  • Aches and pain (such as the condition fibromyalgia)
It appears that we are becoming a sleep-deprived nation. We should worry about this trend. Let's make some changes if we can. What Changes Can I Make Now?  Figure out how much sleep you need each day. Do you know the answer? Shouldn't you?  The amount of sleep you need is not something that a doctor can predict for you. Most adults probably need about 8 hours. But for some people, 6 hours is probably just right. For others, 8 hours or even 10 hours is right.  Pay attention to how long you sleep when you don't set an alarm clock. Also pay attention to how much sleep you have had on days when you feel well, and on days when you feel sleepy or have trouble paying attention. You will have to use clues like this, and trial and error, to truly know how much sleep is right for you. Plan a bedtime. For most Americans who wake up to an alarm clock, the best way to increase sleep hours is to go to bed earlier. But if you press the "snooze button" on your alarm clock multiple times every day, maybe you don't need to get up as early as you have planned. Consider setting your wake-up time for a later hour. Shorten your morning routine by planning and packing (lunch, work clothes) the evening before.  Trade some low-value wakeful time for more sleep. Every day has obligations. But every day also has some flexible time. Try to trade an hour of activity that you don't value highly (for example, TV watching) for an hour of sleep. It is best for health if your sleep happens all at once, but naps help, too. Help yourself to get high-quality sleep. 
  • Have a dark, quiet room, with a comfortable mattress.
  • Remove TVs from the bedroom.
  • Cut back on caffeine, tobacco and alcohol.
  • Exercise on most days, but don't exercise right before bed.
  • Avoid sleeping pills. They don't lead to high-quality sleep.
  • Talk with your doctor if your sleep has frequent interruptions (especially if you wake because of medical symptoms). There may be a way to help.
What Can I Expect Looking to the Future?  Getting enough sleep is one of the best things you can do for your health and your work efficiency. Quit smoking, get exercise, eat well and get your sleep. Adding more sleep is one of the fastest ways to feel at your best, too. For most people who are sleep deprived, it only takes a few days of unrestricted sleep to restore energy and function. But for working Americans, this still may be one of the hardest habits to change. Economic changes, such as a higher minimum wage, might help people who lose sleep in order to work longer hours. But cultural perceptions also need to change. First we need to value our sleep. Then we can safeguard our sleeping hours.]]>
Fri, 03 Apr 2015 00:00:00 -0400
Test May Show Return of Lymphoma Sooner Measuring a type of DNA found in tumors can help detect whether the most common type of lymphoma... Measuring a type of DNA found in tumors can help detect whether the most common type of lymphoma has returned after treatment, a study finds. The study focused on diffuse large B-cell lymphoma, known as DLBCL. It often can be cured. But people need to come back for CT or PET scans to look for a return of the cancer. The new study looked at another possible test. The study enrolled 126 people with DLBCL. They had been treated with chemotherapy between 1993 and 2013. Researchers took blood samples before and after treatment and during follow-up. They tested the samples for a type of DNA comes from the tumor. People also received follow-up CT scans. In all, 107 people had all signs of their cancer disappear with treatment. Those who had detectable tumor DNA in their blood during follow-up were 200 times more likely to have a return of the cancer than those with no detectable levels. Measuring tumor DNA showed the return of cancer 3 months earlier than the CT scans. People with higher levels of tumor DNA in blood also were less likely to respond to treatment. The journal Lancet Oncology published the study April 1. What Is the Doctor's Reaction? For many survivors of cancer treatment, there is always the possibility that the cancer will come back. That's why it is routine to do regular tests on cancer survivors to confirm that the cancer is gone. Frequent tests may detect a return of the cancer sooner, when the cancer is at a more treatable stage. These tests often include:
  • Blood tests: Some tumors make proteins that can't normally be detected in healthy people. 
  • CT scans: The return of cancer may show clearly if the tumors are large enough.
  • PET scan: This test uses an injected radioactive substance to show how parts of the body are working. Some tumors tend to "light up" on a PET scan.
While these tests can be helpful, they have major limits. For example, CT and PET scans cost a lot. Repeated scans expose people to radiation that can possibly be harmful. These scans also may miss small tumors. They may suggest that you have cancer even though you don't. And most cancers do not make abnormal proteins that can be detected in the blood.  We need better ways to show when cancer has come back. And researchers publishing in the latest edition of the journal Lancet Oncology may have found one for lymphoma. Lymphoma is a cancer of the lymphatic system. This includes the lymph nodes and spleen. In this study, researchers analyzed the blood of 126 people who had the most common type of lymphoma. This type is called diffuse large B-cell lymphoma, or DLBCL. Each person had received chemotherapy and then repeated CT scans over a period of about 11 years. Researchers in this study took blood samples and tested them for tiny amounts of DNA that came from the tumor. Having this DNA in your blood was closely linked with a return of lymphoma.
  • People with detectable tumor-related DNA were 200 times more likely to have their disease get worse over time than those with none of this DNA.
  • Measuring tumor-related DNA allowed doctors to detect a return of lymphoma recurrence more than 3 months before the cancer caused any symptoms or signs.
  • Measuring tumor-related DNA could predict which people with lymphoma would not respond to future chemotherapy.
If results are confirmed by more research, this new test could revolutionize how doctors test patients for a return of lymphoma. And that could mean earlier detection, fewer CT and PET scans, and better prediction of response to treatment. This technique also could turn out to be useful for other types of cancer. What Changes Can I Make Now?  If you have been diagnosed with lymphoma, talk to your doctors about this new study.  Testing for tumor-related DNA in the blood is not yet widely available. But there may be a research study near you that offers it.  Lymphoma is not considered a highly preventable type of cancer. People with HIV do have an increased risk of developing lymphoma. So avoiding HIV infection may help you to avoid lymphoma. Here's what you can do to reduce your risk of becoming infected with HIV. 
  • Always use condoms during sexual intercourse.
  • Have sex with only one person who is committed to having sex only with you.
  • Suggest that any sexual partners get tested for HIV.
  • Never share needles.
Unfortunately, there is no accurate screening test for lymphoma. If you have symptoms of lymphoma, let your doctor know. Symptoms include:
  • Persistent swelling or enlargement of lymph nodes, which can be felt in the groin, under the arms or in the neck
  • Unexplained weight loss
  • Unexplained fevers
  • Night sweats
  • Severe fatigue
Not everyone with these symptoms has lymphoma. For example, mononucleosis can cause many of these same symptoms. So, if you have one or more of these symptoms, don't panic -- but do get checked out. What Can I Expect Looking to the Future? This new research on tumor-related DNA was small and only looked at one type of lymphoma. You can expect larger studies to be done using this type of testing to detect a return of DLBCL and other types of lymphoma. If confirmed, this new technique could become a standard follow-up test for people with lymphoma.  Future studies should answer whether testing the blood for tumor-related DNA can:
  • Improve doctors' ability to choose treatments for lymphoma or other types of cancer
  • Detect a return of other types of cancer
  • Serve as an accurate screening test for lymphoma and other types of cancer (for people who have not been diagnosed with cancer)
  • Help researchers study whether new treatments are working
Better ways to find out when cancer has come back could have yet another benefit:  more reliable reassurance that cancer has not returned.]]>
Thu, 02 Apr 2015 00:00:00 -0400
Blood-Pressure Advice Targets Heart Patients Three expert groups have released blood-pressure treatment guidelines for people who already have... Three expert groups have released blood-pressure treatment guidelines for people who already have heart problems. The guidelines focus on people with coronary artery disease. This is a narrowing of arteries to the heart because of plaque buildup. The guidelines say most people in this group should aim for a blood-pressure level of less than 140/90 millimeters of mercury (mmHg). The goal is 130/80 mmHg for those who already have had a heart attack, stroke or mini-stroke. This lower goal also applies to those who have had a narrowing of leg arteries or an abdominal aortic aneurysm. The guidelines come from a committee of experts. They represent many groups involved with the treatment of heart disease. In an interview with HealthDay News, the committee chairman said the guidelines are intended to be flexible. For example, older frail patients may need to set a higher blood pressure goal with their doctors. Setting the goal too low could lead to dizziness if blood pressure drops too much. The guidelines also include advice on which types of drugs doctors should use to lower blood pressure in people with artery disease. The journal Hypertension published the guidelines. HealthDay wrote about them March 31.
     What Is the Doctor's Reaction?  For decades, high blood pressure (hypertension) was defined as a reading of 140/90 millimeters of mercury (mmHg) or higher. In December 2013, the Joint National Committee on High Blood Pressure released new guidelines. This group included members from major doctor, hospital and nonprofit groups.  The new guidelines suggested raising the blood pressure target for adults ages 60 and over. The new target for these older adults would be 150/90 mmHg.   Many experts, as well as practicing doctors, disagreed with this change. A great amount of energy was spent arguing about the pros and cons of the change. Meanwhile, the more important message in the new guidelines got lost.  The key message: Blood pressure goals should be set for each person. They should be based on: 
  • Age
  • Overall health
  • Risk of heart problems and stroke
  • Side effects from blood pressure medicines
  • Preferences and goals of care 
Now three highly respected medical groups have issued new advice for one group of patients. Their guidelines address the treatment of high blood pressure for someone with coronary artery disease. The groups are the American Heart Association, the American College of Cardiology and the American Society of Hypertension. Their guidelines were published online March 31 in the journal Hypertension.  The guidelines use the best available evidence to support their advice: 
  • For people of any age with coronary artery disease and high blood pressure, the goal should be less than 140/90 mmHg.
  • For many, maintaining a blood pressure of less than 130/80 mmHg would likely further reduce the risks of heart attack, stroke and heart failure.
What Changes Can I Make Now?  The guidelines suggest the best drugs to lower blood pressure in people with high blood pressure and coronary artery disease. They are a combination of: 
  • A thiazide diuretic (water pill) such as chlorthalidone or hydrochlorothiazide.
  • An angiotensin-converting enzyme inhibitor (ACE inhibitor) or angiotensin receptor blocker (ARB). Many of these medicines are sold as generics. 
People with high blood pressure who have had a heart attack also should take a beta-blocker. Examples include metoprolol, carvedilol or bisoprolol.  That may sound like a lot of pills. But low doses of two or three different drugs keep blood pressure better controlled than a higher dose of just one drug.  The guidelines focused on target numbers and medicines. But healthy lifestyle choices are a must for people with heart disease. This is especially important if you also have high blood pressure. Here are some changes you can make:
  • If you smoke, quit now.
  • Eat a Mediterranean-style diet loaded with fruits, vegetables and whole grains.
  • Cut back on salt.
  • Stay physically active, with at least 30 minutes a day of dedicated exercise.
  • Maintain a healthy weight. 
What Can I Expect Looking to the Future?  More guidelines regarding treatment of high blood pressure will follow. For example, you can expect specific advice for people with high blood pressure and kidney disease.]]>
Wed, 01 Apr 2015 00:00:00 -0400
U.S. Cancer Deaths Still Dropping Slowly U.S. cancer deaths continue to decline, a new report says. The overall cancer death rate dropped... U.S. cancer deaths continue to decline, a new report says. The overall cancer death rate dropped an average of 1.5% a year between 2002 and 2011. New cancer cases fell more slowly, an average of 0.5% per year, the report says. The declines in cancer deaths each year were 1.8% for men, 1.4% for women and 2% for children. The report was written by experts from the North American Association of Central Cancer Registries, the American Cancer Society, the U.S. Centers for Disease Control and Prevention, and the U.S. National Cancer Institute. The authors said the declines reflect earlier detection, prevention and improved treatments. Lung cancer rates are falling because fewer people smoke. Declines in breast and colon cancer deaths also are related to screening and prevention efforts. Prostate cancer deaths also are down, but experts are not sure why. But several much less common cancers are on the increase. They include liver, mouth, throat, thyroid and kidney cancers. The Journal of the National Cancer Institute published the report March 30. HealthDay News wrote about it.            What Is the Doctor's Reaction? The U.S. "War on Cancer" became official in 1971. Congress passed the National Cancer Act. President Richard Nixon signed it. The law was politically popular. But, more importantly, the new federal law greatly increased cancer research funding by the government and strengthened the National Cancer Institute (NCI).  Since 1998, the NCI and other prominent health organizations have published the Annual Report to the Nation on Status of Cancer. This year's report continues to show a steady decline in the rate of yearly cancer deaths.  Does this mean we are winning the war on cancer? The answer is yes if the goal is to extend survival and also provide quality of life. For example, acute leukemia used to be incurable. Death often occurred within weeks to months. Now some forms of acute leukemia have very high survival rates and many people live normal lives.  But we need to be cautious when interpreting the decline in deaths. Newer cancer treatments have clearly played a major role. And early detection surely has saved some lives. But early detection also means more cases of cancer are being diagnosed that never would have caused death.   When more people are diagnosed with non-deadly cancers, the death rate will appear lower than it has in previous years. For example, the prostate-specific antigen (PSA) blood test led to a huge increase in the number of prostate cancer diagnoses. The number of prostate cancer deaths in the United States each year also decreased, but not by much. This means that the percentage of deaths from prostate cancer can fall even though about the same number of men die from the disease.  Where we are losing the war is cancer prevention. The number of new cases of cancer in men declined only slightly from 2002 to 2011. And the number of new cancer cases in women remained the same.  Some cancers are actually on the rise in the United States. They include: 
  • Liver cancer, primarily related to hepatitis C.
  • Cancer of the uterus, perhaps related to the rise in obesity.
  • Mouth and throat cancer in men, increasingly caused by human papilloma virus (HPV) infection. Smoking was the No. 1 cause in the past. But now fewer U.S. men are smoking.
  • Kidney cancer, reason unknown.
  • Thyroid cancer, reason unknown.
What Changes Can I Make Now? Healthy lifestyle choices provide the best way to prevent cancer. Here's what you can do:
  • Don't smoke or use other tobacco products. 
  • Maintain a healthy weight. 
  • Stay physically active and schedule daily dedicated exercise time. 
  • Either avoid alcohol or have an average of no more than one alcoholic drink per day. 
  • Avoid binge drinking, even if the average amount of alcohol you drink is moderate. 
  • Eat a diet rich in vegetables, especially the green leafy ones. They are rich in folic acid. For women, folic acid may offset any increased risk of breast cancer if you drink alcohol. 
  • Practice safe sex. 
Vaccinations also can help to prevent some cancers. They include: 
  • Hepatitis B to prevent some cases of liver cancer
  • Human papilloma virus (HPV) to prevent cervical cancer, anal cancer and probably oral cancer
Getting screened also can prevent some cancers. The two screening tests that can prevent cancer, not just detect it early, are:
  • HPV or Pap samples of the cervix in women
  • Colonoscopy to remove benign polyps before they become cancerous
What Can I Expect Looking to the Future? The number of people surviving cancer with good quality of life will continue to rise. Already, cancer cells are being tested for markers and genetic changes. This knowledge can help to provide more personalized treatments. For example, this year's cancer status report highlights how advances in breast cancer classification help women get the treatments that are most likely to be successful.
Tue, 31 Mar 2015 00:00:00 -0400
CDC Steps Up Efforts vs. Resistant Bacteria The Centers for Disease Control and Prevention (CDC) will increase its efforts to reduce excess... The Centers for Disease Control and Prevention (CDC) will increase its efforts to reduce excess use of antibiotics and the spread of bacteria that resist these drugs. The White House announced the effort March 27. The goal is to reduce infections with some of the most dangerous drug-resistant bacteria by 50% to 60% by 2020. The Medicare and Medicaid programs already have told hospitals to reduce excess use of antibiotics. They must develop these programs within 3 years or lose funding. The CDC will provide funds to help more states collect data on antibiotic-resistant infections. It also will encourage hospitals and health systems to send data on patterns of antibiotic use. The CDC now is supporting hospital pilot programs to improve prevention of infections with antibiotic-resistant bacteria. A program in Chicago cut one type of infection in half. The CDC will expand these efforts. Reuters news service wrote about the new program. What Is the Doctor's Reaction? Hospitals have lots of rules to help prevent the spread of bacteria between patients. These efforts are very costly. Do they work?  The best we can say is that it would be worse if hospitals weren't doing it. All bacterial infections are dangerous in hospital patients. They can even be deadly. That's true even when we have routine antibiotics that can kill them. But more and more bacteria have become able to resist the usual antibiotics. That makes these infections still more dangerous. The Centers for Disease Control and Prevention (CDC) has made it a top priority to halt the threat of drug-resistant bacteria and their spread. Today, most hospitals use three methods to prevent the spread of bacteria. Patients are routinely screened to see if they are colonized with certain types of bacteria. Being colonized means you carry the bug on your skin or inside your nose. But you don't have any symptoms related to the bacteria. An infection implies that you have symptoms. For example, these might include fever, chills, cough or problems with urinating. Patients known to be infected or colonized with certain types of bacteria are placed in isolation rooms. The types of bacteria include the ones that spread easily from patients to staff and back to patients. They also include the antibiotic-resistant bacteria. All staff members going into an isolation room must take certain precautions. These are listed on a sign outside the door. They differ depending on the type of bacteria. Of course, the precautions include cleansing hands before and after entering the room. Staff also must wear gowns and gloves that they throw away after the visit. If there is concern about influenza or other airborne germs, staff members put on masks.  It's not realistic to perform multiple scientific studies to find out what methods beyond the ones above would make hospitals safer. Instead, the CDC is encouraging hospitals to design new ways to prevent the spread of bacteria. Funding is available to support these ideas. By looking at what progress these hospitals have made, the CDC can find and promote the best practices that have a reasonable cost. What Changes Can I Make Now? If you are in the hospital, or a loved one is, hand cleansing is the No. 1 way to help prevent the spread of infection.
  • Make sure members of the hospital staff perform appropriate hand cleansing before they enter your room. Most often that means either washing their hands or using an alcohol-based hand cleaner. But if the person is infected with Clostridium difficile (C. diff), alcohol-based cleansers are not effective. Hand washing for at least 15 seconds is required.
  • Clean your own hands often.
  • Ask visitors to do the same type of hand cleansing required of hospital staff.
Right after you are admitted to the hospital, work with your medical team to keep your time there as short as safely possible. 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 personal risk of developing a hospital-related infection. Outside the hospital, you can help prevent more strains of bacteria from becoming antibiotic resistant. Take antibiotics only if you really need them. Common colds and most sore throats and sinus infections are caused by viruses. Antibiotics kill only bacteria. What Can I Expect Looking to the Future? You can expect the CDC to identify better ways to help slow the growth of bacterial resistance to antibiotics. But there won't be any easy solutions. All of us, medical care providers and patients, will need to take part in these efforts.]]>
Mon, 30 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