http://www.planforyourhealth.com/ Latest Healthy Living News from Aetna en http://www.planforyourhealth.com/ http://www.planforyourhealth.com/ Latest Healthy Living News from Aetna TYPO3 - get.content.right http://blogs.law.harvard.edu/tech/rss Wed, 22 May 2013 14:05:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/stroke-care-costs-projected-to-double/ The costs of treating stroke will more than double by 2030, a new report says. The main reason... What Is the Doctor's Reaction? Stroke is the fourth leading cause of death in the United States. And it could move even higher on the list. Advancing age is a major factor that increases the risk of stroke. The aging of the baby boomer generation is expected to contribute to rising stroke rates in the coming years. So it should not be surprising to learn that experts also predict an increase in the costs of caring for people with stroke. What surprised me is how much of an increase. A new report in the medical journal Stroke predicts these changes by 2030:

• The number of people having strokes will increase by 20%.
• The costs to care for people with stroke will more than double. Compared with current spending, that's an increase from $72 billion to $183 billion. And that doesn't count $57 billion in lost productivity.
• The biggest increases in stroke are expected to affect those ages 45 to 64, Hispanics and the uninsured.

These estimates are clearly cause for concern. But I think they also represent an opportunity. There is much that can be done to reduce the number of strokes in the future. What Changes Can I Make Now? Changes you make now can reduce your chances of having a stroke. Learn about the factors that increase the risk of stroke and what you can do about them. They include:

• Inactivity -- Exercise for at least 45 minutes most days of the week.
• Smoking -- If you smoke now, make a commitment to quit. If you cannot quit on your own, ask your doctor about programs that can help. Avoid secondhand smoke as well.
• High blood pressure (hypertension) -- Have your blood pressure checked regularly. If it's high, cut back on salt and lose excess weight. If necessary, take medicines your doctor recommends.
• Diabetes -- Medicines, changes in diet and loss of excess weight may reduce your risk of diabetes-related health problems, including stroke.
• Obesity -- Excess weight increases the risk of diabetes, high blood pressure and other risk factors for stroke. Therefore, it's helpful to maintain a healthy weight.
• An unhealthy lipid profile -- If you have blood lipids (such as total and LDL cholesterol) that are not in an ideal range, talk to your doctor. Diet, exercise and medicines often can improve them.
• Atrial fibrillation -- This is a type of irregular heartbeat. Your doctor may detect it during routine medical care or while evaluating symptoms. For example, you may have palpitations or feel lightheaded. If you have atrial fibrillation, consider taking a blood thinner, such as warfarin (Coumadin), which can lower the risk of stroke.
• Narrow carotid arteries -- The carotid arteries are in the neck and supply blood to the brain. If narrowed by atherosclerosis, they can be opened up with a surgical procedure. This improves blood flow to the brain and reduces the risk of stroke.
• Depression -- Recent studies have shown a link between depression and stroke. However, we don't know whether treatment of depression lowers stroke risk.

Find out if you have a family history of heart and blood vessel disease, such as heart attack or stroke. If you have a strong family history, changing your other risk factors is even more important. Know the symptoms of stroke. Prompt treatment by experienced stroke experts gives you the best chance for a good recovery. If you have stroke symptoms, call for emergency care right away. Symptoms of stroke usually occur suddenly. They may include:

• Confusion
• Trouble speaking or understanding what is said
• Difficulty walking or loss of balance
• Vision loss
• Numbness or weakness of one side of the body or face
• Severe headache

Plan ahead. If you have risk factors for stroke, talk to your doctor about which hospitals near you are able to provide state-of-the-art stroke care. What Can I Expect Looking to the Future? Future research may help explain why some people are more likely to have a stroke than others. For example, it's not clear why Hispanics are at higher risk than other ethnic groups. If we reduce our risk factors, we can prevent many strokes. Universal health insurance coverage and a focus on preventive health measures could also help reduce strokes. These are two key goals of the 2010 Affordable Care Act. With these positive changes, we may be able to avoid a dramatic increase in stroke rates and costs of care. If so, today's estimates could prove to be a "worst case scenario" that never actually happens.]]> Wed, 22 May 2013 14:05:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/better-sunscreen-labels-still-may-mislead/ Sunscreens that Americans buy this summer should have more accurate labels. Updated rules from... What Is the Doctor's Reaction? It took more than 30 years. But finally sunscreens will need to show accurate labels. The U.S. Food and Drug Administration (FDA) released new guidelines for sunscreen labels in 2011. The agency told the manufacturers they had a year to get their products tested to comply with the new rules and make the labels accurate. The FDA gave them extra time beyond the one year. But now the sunscreens you buy must comply with the new rules. They must be tested for protection against ultraviolet A and B rays. UVA rays cause wrinkles. UVB rays cause sunburn. Both can cause skin cancer. Sunscreens carry a sun protection factor (SPF) rating to show how well they protect against sunburn. SPF is a measurement of how much longer it takes for your skin to turn red from the sun after applying the sunscreen. For example, let's say your skin turns red after 10 minutes in the sun. Sunscreen with an SPF of 15 would prevent your skin from turning red for 150 minutes under the same conditions. The SPF level must be 15 or higher for both types of rays. Products that don't meet this standard must carry a warning. The American Academy of Dermatology recommends using products with an SPF of 30, up to 50. The FDA says there's no proof that numbers above 50 provide more protection. Despite that, 1 in 7 product labels still claims an SPF higher than 50, according to a consumer group. The FDA also requires sunscreen labels to be more accurate with the use of terms. If a label says "broad spectrum," the product must pass tests proving that it truly protects against both UVA and UVB rays. Always choose broad spectrum sunscreens to decrease cancer risk. The rules ban the terms "sunblock," "waterproof" and "sweatproof." Sunscreens can be labeled as "water resistant." They should indicate how long they provide protection after water exposure or sweating, either 40 or 80 minutes. What Changes Can I Make Now? Apply sunscreen before you go out. Make sure you apply enough and apply often. Use 1 ounce of sunscreen (a shot glass full) to cover your body and face. Reapply sunscreen right away after swimming or heavy sweating. Apply every 2 hours if you don't get in the water and don't sweat. Even the best sunscreens can't protect you from all of the sun's rays. Here are some other ways to protect yourself from skin cancers, sunburn and early aging of skin:

• Wear clothing made from tightly woven fabrics or those that absorb UV light.
• Avoid the sun from 10 a.m. to 4 p.m., when its rays are most intense.
• Wear a wide-brimmed hat to keep UV rays off your face.
• Stay in the shade.
• Pay attention to reflections from water, sand and (in the winter) snow.
• Watch for news reports that give the UV index in your area. A UV index reading of 2 or less means low danger from the sun's UV rays for the average person.
• Examine your skin regularly for any new moles or changes in moles. Ask your doctor about any changes you see.

The downside of avoiding the sun and full protection is the risk of vitamin D deficiency. Buy foods and drinks fortified with vitamin D. Or consider a vitamin D supplement. I recommend a vitamin D3 supplement at a dose of 1,000 international units (IU) daily. What Can I Expect Looking to the Future? Excessive sun exposure and other sources of UV rays increase the risk of the different types of skin cancer. Of these, melanoma is the one that doctors worry about most. It's the deadliest. Current research suggests that sunburns, especially before age 19, substantially raise melanoma risk. This likely is true for burns related to indoor tanning as well.]]> Tue, 21 May 2013 13:45:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/depression-raises-midlife-womens-stroke-risk/ Women in their 40s and 50s have a very low risk of stroke, but the risk doubles if they are... What Is the Doctor's Reaction? Stroke is a major cause of long-term disability and death in the United States. Women have a higher lifetime risk of stroke than men. This is especially true for women in middle age. And the risk has been increasing. Stroke rates in midlife women have risen during the last 25 years. Some estimates suggest they might have tripled. Stroke rates in men of similar age stayed flat over this same period. Scientists don't know why stroke rates have increased for midlife women, and not for men. Depression seems to be a likely contributor. Prior studies have shown a definite link between depression and stroke in both sexes. But depression rates in women are twice as high as in men throughout the lifespan. The results of this study add more evidence to the link between depression and stroke among women. The data came from the Australian Longitudinal Study on Women's Health. The researchers enrolled women ages 47 to 52 to look at their health during early midlife. To identify depression, the researchers used a depression scale or recent use of an antidepressant drug. Of the 10,547 women, 24% were depressed. The stroke rate in the depressed women was 2.4 times as high as in non-depressed women. Women with depression were more likely to have other factors that increased the risk of stroke. They included:

• Smoking
• High blood pressure
• Heart disease
• Diabetes
• Lack of exercise
• Overweight and obesity

When the researchers took out the impact of these risk factors, depressed women still had 1.9 times the stroke rate of non-depressed women. Other studies have also found somewhat higher stroke rates for depressed women, primarily women in later stages of midlife. But depression made an even bigger difference in stroke rates for the younger midlife women in this new study. This is not proof that depression causes stroke. But many experts do think there is a biological connection. We just haven't discovered it yet. What Changes Can I Make Now? Depression isn't the same in everyone. And feeling sad might not be the major symptom. Here are some of the other symptoms:

• Feeling helpless or hopeless
• Loss of interest in activities you used to enjoy
• Trouble concentrating or remembering things
• Sleep changes (can't sleep or sleep too much)
• Anger or irritability
• Appetite or weight changes (can be either more or less)
• Reckless behavior, such as excessive alcohol use or reckless driving
• Feeling worthless

There may be reasons other than depression for these symptoms. But depression is one of the most common causes. Obviously, you should seek treatment if you have depression. But also recognize the link between depression and other medical problems such as heart disease, diabetes and obesity. Taking positive action to improve your health can also lessen your symptoms of depression. What Can I Expect Looking to the Future? Depression not only increases stroke risk, it also means you are more likely to have a heart attack or develop other types of heart disease. We don't yet know if and what types of depression treatment will help lower these risks. This is an area of active research. My prediction is that scientists will discover a biological or genetic reason that puts a person at risk for all three -- depression, heart disease and stroke.]]> Fri, 17 May 2013 13:53:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/pelvic-surgery-failure-increases-with-time/ Surgery to repair pelvic organ prolapse fails over time for many women, a new study concludes.... What Is the Doctor's Reaction? It's a common problem that few women want to talk about: pelvic organ prolapse. It develops when the tissues in the pelvis loosen. This may allow the cervix, uterus and bladder to enter the vaginal canal near the entrance to the vagina. This problem also goes by other names. They include pelvic relaxation, cervical prolapse and uterine prolapse. Pelvic organ prolapse is more common as women get older. The risk of prolapse is also greater for women who are obese or have had several vaginal births. Symptoms include:

• Discomfort in the pelvis, lower abdomen or back
• A bulging of pink tissue into the vagina
• Bleeding from the vagina
• Urinary problems, such as:
  
  • Frequent urination
  • Urinary tract infections
  • Leakage of urine during heavy lifting, coughing or sneezing (called stress urinary incontinence)
• Pain or urine leakage during sex

Surgery is often needed to treat this condition. During the operation, surgeons often insert a firm, synthetic material called "surgical mesh." The purpose is to hold the vagina and pelvic organs in place. (You may have heard about problems with surgical mesh from advertisements by malpractice attorneys. Problems linked to some types of surgical mesh have led to recalls and lawsuits.) Surgeons sometimes perform another procedure at the same time. It's called urethropexy. The purpose is to help prevent stress urinary incontinence. More than 225,000 operations for pelvic organ prolapse are done each year in the United States. Still, much about these procedures is uncertain. For example:

• How effective is the standard operation (called abdominal sacrocolpopexy)?
• How long do the benefits of surgery last?
• How effective is urethropexy in preventing urinary incontinence?

A new study attempts to answer these questions. Study results appear this week in the Journal of the American Medical Association. Researchers analyzed the long-term results of surgery for women with pelvic organ prolapse. They found that after 7 years:

• Pelvic organ prolapse had returned in up to 27%.
• Up to 29% of the women had a return of the symptoms that led to their surgery.
• Most of the women had stress urinary leakage. This included 62% of the women who had urethropexy to prevent the problem and 77% of those who did not have this surgery.
• For about 10% of the women, the mesh used in the surgery fell to pieces over time.

These findings are disappointing. The failure rate is unacceptably high. It also appears to increase over time. The results suggest it's better to have urethropexy as part of the operation for pelvic organ prolapse. But even those who added this procedure had a high rate of urinary leakage after seven years. What Changes Can I Make Now? You may be able to reduce the chances you'll have symptoms of pelvic organ prolapse. Here's what you can do:

• Avoid heavy lifting.
• Maintain a healthy weight.
• Don't smoke. The chronic cough of many smokers is thought to contribute to some cases of pelvic organ prolapse.

These measures may be particularly important if you are obese or have had several vaginal births. If so, your risk of pelvic organ prolapse is higher than average. If you already have pelvic organ prolapse, know your treatment options. Keep in mind that if you have no symptoms, you may not need treatment. Other options include:

• Exercises to strengthen muscles of the pelvis -- These are often called Kegel exercises.
• Insertion of a pessary into the vagina -- This ring-shaped device provides support to the cervix and uterus and helps keep them in place.
• Surgery -- This includes the type of operation described in this latest research. However, other procedures also are done. They include hysterectomy (removal of the uterus). The choice depends on your goals and preferences. Things to consider include your symptoms, your age and whether you want to have children in the future.

Talk with your surgeon if you've had surgery for pelvic organ prolapse and have concerns about the success of your surgery or about a surgical mesh recall. What Can I Expect Looking to the Future? I hope that in the future we will have more effective procedures to offer women with pelvic organ prolapse. This might include a new type of surgical mesh, or it may be a completely different type of operation. Effective ways to prevent the problem would be even better. Regardless of how the treatment of pelvic organ prolapse changes in the future, we'll need to study it. This research shows how important it is to conduct long-term research on standard treatments, especially for conditions that are as common and important as pelvic organ prolapse.]]> Thu, 16 May 2013 14:14:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/processed-restaurant-foods-still-high-sodium/ The high sodium level of processed and restaurant foods is not getting much better, two new... What Is the Doctor's Reaction? Eat less sodium. Eat less sodium. Eat less sodium. The message is loud and clear. You do need some sodium for your body to work properly. But Americans, on average, eat about 3,400 milligrams (mg) of sodium per day. That's more than double the recommended amounts for some adults. For most adults, the recommended daily sodium intake is less than 2,300 mg per day (about 1 teaspoon of salt). The U.S. government recommends less than 1,500 mg per day for adults over age 50 or those with certain medical problems. The problems include high blood pressure and diabetes. Why does sodium matter? There is a clear link between too much sodium intake and high blood pressure. And high blood pressure greatly increases the risk of heart disease and stroke. Nearly 75 million Americans have high blood pressure. Many more are at risk of developing it. People develop high blood pressure for many reasons. But eating too much sodium is a major contributor. Some of that sodium comes from the salt we add to our foods. But by far the greater problem is the amount of sodium already in the processed foods we commonly eat. We do have control over the foods we choose to eat. However, we do not have control over the amount of sodium in processed foods. Companies and restaurants have been urged to reduce the sodium in their foods. But how good a job have they done? It appears that not much has changed. A pair of research studies, out this week, remind us just how much sodium is in processed foods and restaurant meals. One study showed that the average single meal at a sit-down restaurant contains 2,269 mg of sodium. That's almost as much as the recommended sodium limit for an entire day for an average adult. A second study looked at whether there have been any changes in how much sodium is in processed foods we buy or in the restaurant foods we order. The study looked at 402 processed foods and 78 fast-food restaurant items. Some foods had lower sodium content. But overall there had been no significant change when comparing average sodium content in foods in 2005 to foods in 2011. What Changes Can I Make Now? The first step is to try to limit how much sodium you are eating. You have the power to choose what you eat. Here are some tips:

1. Pay attention to how much sodium is in the food you buy. Check the labels. Make note of how many servings are in the package. Most labels indicate how much sodium is in one serving. If you eat the whole package, you need to multiply the amount of sodium by the number of servings you have. It's much harder to know how much sodium is in a restaurant meal. But many chain restaurants are now making the nutrition information for their foods available. Take a look. You might be shocked at what you find.


2. Cook your own food. Much of the sodium in our diets comes from processed and pre-prepared foods. If you make your food yourself, from fresh ingredients, you will automatically cut down your sodium intake. Of course, this is hard, especially in our fast-paced lives, but it's well worth the effort.


3. Don't be fooled by "low fat" or "low cholesterol" on the labels. Some packages say "low fat," some say "low cholesterol" and some say "low salt." But most foods don't have all of these in one. Remember that a food that's good for you in one way may not be good for you in another. Even those foods that are labeled as "low salt" may still have more sodium than you need. Read the labels carefully.

What Can I Expect Looking to the Future? There is no debate that Americans have too much sodium in their diets. It is well-recognized that higher levels of dietary sodium intake are linked to higher rates of heart disease and stroke. Yes, people do need to take responsibility for the foods they eat. But the food industry also needs to take responsibility by reducing the sodium in processed foods. It seems that allowing food manufacturers and restaurants to voluntarily reduce sodium has not been successful. In the future, the government may require companies and restaurants to lower sodium levels in foods. In the meantime, there is much we can do to reduce the sodium we consume. We can pay attention to labels, focus on eating fresh fruits and vegetables, and cook our own food. Otherwise, we will see the consequences of our high-sodium diets in the next decades with an increase in the rates of high blood pressure, heart disease and stroke.]]> Wed, 15 May 2013 14:09:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/doctors-urged-to-screen-for-alcohol-problems/ An influential group of experts is recommending that primary care doctors screen all adults for... What Is the Doctor's Reaction? There's so much to accomplish during a routine visit to your primary care doctor. So having a simple screening tool to determine if a person is misusing alcohol is terrific. The one question: "How many times in the past year have you had X or more drinks in a day?" X is 5 for men and 4 for women and all adults older than 65. If the answer is at least once, then the doctor should do further questioning. The person may be misusing alcohol. The U.S. Preventive Services Task Force identifies the following levels of misuse:

• Risky alcohol use: For men, more than 14 drinks per week or more than 4 drinks in one day. For women, more than 7 drinks per week or more than 3 drinks in one day. Risky means you are more likely to develop social or medical problems related to alcohol.
• Harmful alcohol use: Alcohol misuse has already impacted your physical or mental health or harmed your social relationships.
• Alcohol abuse includes one or more of the following:
  
  • Multiple times you have not met your responsibilities at home, work or school
  • Excessive alcohol use, followed by droving a vehicle, operating machinery or doing something else that put you or others in harm's way
  • Legal problems related to alcohol use
• Alcohol dependence: Physical craving for alcohol and/or symptoms of alcohol withdrawal if you try to stop drinking

Similar to all screening tests, this one-question test is not perfect. It can identify about 85% of adults who misuse alcohol. So it is a sensitive test. But about 30% of people who say that they have had more than 4 or 5 drinks at least once in the last year do not have a problem with alcohol. What Changes Can I Make Now? The U.S. Preventive Services Task Force wants primary care doctors to screen patients for alcohol misuse. Here's why:

• The question appears to do no harm. It might make someone feel uncomfortable, but not much else.
• Screening might identify a much more serious problem than the doctor has recognized or the patient has mentioned.
• Early, simple interventions may prevent risky alcohol use from becoming harmful use or abuse.

A little advice and encouragement may help you figure out if your drinking follows a risky pattern and what to do about it. The source of advice could be your primary care doctor. Or the doctor might refer you to an alcoholism counselor. Often a non-professional person who is knowledgeable about alcohol or had an alcohol problem can be very effective. This is not long-term therapy. It's perhaps two or three discussions. The helper can ask you how much you are drinking and let you know how it compares with the norm. He or she might:

• Talk briefly about the consequences of more serious alcohol use
• Provide a self-help manual or workbook
• Suggest that you keep records of your drinking and choose a goal of cutting back or stopping completely

What Can I Expect Looking to the Future? You may see increased publicity about risky alcohol use. This has been shown to be effective. In one study, people misusing alcohol were helped by little more than responding to a public appeal. The advertisement was placed in newspapers, on television, on radio and in leaflets and posters distributed in Toronto, Canada. The ad contained a telephone number, along with the following message: "Thinking of a change in your drinking? Do you know that 75% of people change their drinking on their own? Call us for materials that can be completed at home."]]> Tue, 14 May 2013 14:10:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/survey-many-teens-text-while-driving/ Almost half of older U.S. teens text while driving, a new survey shows. And those who text while... What Is the Doctor's Reaction? OMG! LOL! G2G! TTYL! Look familiar? If you have a teenage son or daughter, you've probably seen this texting shorthand before. Sometimes it seems as if teens have their very own texting language. Texting can be a fun way for teens to keep in touch with their friends. But they should never be texting while driving! Car crashes are the No. 1 killer of teenagers in the United States. About 3,000 young lives are lost every year because of car accidents. Most of these crashes are caused by driver inexperience. When you add in distractions (such as texting), the result can be especially deadly. A new study published in the journal Pediatrics looked at the rates of texting and driving among teens aged 16 years and older. The researchers used results from the Youth Risk Behavior Survey. High school students across the country take this survey. It asks them questions about their lifestyle, such as whether or not they smoke cigarettes, drink alcohol or use drugs. As part of the survey, teens were also asked whether they had sent a text or e-mail while driving during the last 30 days. In all, 8,505 students answered this question. Almost half (45%) reported texting while driving in the last month. That is a lot of distracted drivers on the road! The students who had sent texts while driving were also more likely to:

• Not always wear a seatbelt
• Ride with a driver who had been drinking alcohol
• Drink alcohol and drive

These findings suggest that a large group of teens may act in unsafe ways while driving. This is putting the teens themselves, their passengers and other drivers at risk for crash-related injuries or even death. What Changes Can I Make Now? Experts are brainstorming ways to decrease the number of teens who are texting and driving. Here are some of their proposed strategies:

• Bans on cell phone use (including texting) for new drivers. Currently, 36 states and the District of Columbia have laws making it illegal for new drivers to use their cell phones while behind the wheel. Forty-five states, and Washington, D.C., have specifically banned texting while driving for new drivers. Find out more about the laws in your state.



• New technology. Some experts have recommended installing devices that block cell phone use in teens' cars. Others have recommended devices that monitor the teen's driving behaviors (such as cell phone use). These devices provide feedback to parents.



• Parental supervision. Setting rules against cell phone use for your child is critically important. Make sure they are following these rules, too. This may be the best way to decrease texting and driving.

Teen car crashes can be prevented. Proven strategies can improve the safety of young drivers on the road. Here are more things you can do to keep your teen driver safe:

• Practice driving with your teen as much as you can. The more experience he has behind the wheel, the safer he'll drive.



• Set rules for the road. Make sure that your new driver (and her passengers) always wear seat belts. Limit the hours when she is allowed to drive. Don't allow driving at night or with teen passengers. Crashes are more likely to occur in these situations.



• Limit distractions. Sending texts, making phone calls, using a GPS or MP3 player all take a driver's focus off the road. Instead, suggest other options to these bad habits. For example, encourage your teen to pull into a parking lot to answer or make phone calls.



• Write a parent-teen driving agreement. Work with your teen to write the agreement. Have him or her sign it!
  
  • Discuss your rules of the road with your teen.
  • Talk about why the rules must be followed.
  • Explain what the consequences are for breaking them.


• Lead by example. Be a role model of good driving behaviors. Always do this, even when your children are too young to drive. Young children can pick up on your dangerous behaviors. If you talk on the phone, text, speed or drive without your seat belt, teens will do what they see you do.

The government's "Parents are the Key" campaign offers parents tools and proven steps for reducing teen driving injuries and deaths. What Can I Expect Looking to the Future? You can expect serious efforts to keep young drivers safe on the road. Laws against cell phone use and texting will be strictly enforced. States that do not have such laws may begin to pass them. You also can expect your child's pediatrician to stress the importance of practicing safe driving behaviors. The doctor is very likely to encourage you to set road safety rules for your teen. This should include no cell phone use at all while driving.]]> Mon, 13 May 2013 13:07:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/study-finds-no-benefit-from-fish-oil-pills/ Fish oil pills don't reduce the risk of heart attack and stroke in people at high risk of heart... What Is the Doctor's Reaction? Fish oil has been flying high as a health-boosting supplement. It has garnered a reputation as an easy way to protect the heart, improve brain function and lengthen life. Such claims are one reason that Americans spend more than $1 billion a year on over-the-counter fish oil. Food companies also are adding it to milk, yogurt, cereal, chocolate, cookies, juice and many other foods. Fish oil is loaded with omega-3 (or n-3) fatty acids. There are three main types:

• Eicosapentaenoic acid (EPA)
• Docosahexaenoic acid (DHA)
• Alpha-linolenic acid (ALA)

EPA and DHA are found mainly in fish. For that reason, they are sometimes called marine omega-3s. ALA is found in plant-based foods, such as flaxseed, walnuts, and canola and soybean oils. It's true that healthy people tend to have high levels of EPA and DHA in their blood. People with heart failure, stroke and heart attack often have lower levels of these omega-3 fatty acids. However, this does not necessarily mean that taking fish oil pills will prevent heart disease. In fact, there is now good evidence that you do not decrease your chance of heart attack, stroke or death by taking fish oil pills. Based on the results of a new study, even people at high risk of heart attack, stroke or premature death showed no benefit. Study results appear in today's New England Journal of Medicine. All of the people enrolled in the study had known blood vessel disease or had multiple factors that put them at high risk. They had at least four of the following risk factors, or they had diabetes and at least one of these factors:

• Age 65 or older
• Male sex
• High blood pressure
• High cholesterol
• Current smoker
• Obesity
• A family history of coronary artery disease at a younger age (father or brother younger than 55, mother or sister younger than 65)

People in the study were randomly assigned to take capsules containing either olive oil or omega-3 fatty acids. Results for the two groups were the same. The omega-3 capsules did not prevent death or hospital stays for heart attack or stroke. Side effects were also measured during the study. Minor side effects were similar in both groups. People reported no major side effects. What Changes Can I Make Now? To help prevent heart disease and lower your risk of heart attack and stroke, don't rely on omega-3 fatty acid pills. But do keep eating fish, especially fatty fish that are rich in omega-3 fatty acids. Examples of fatty fish include salmon, sardines, mackerel, char and halibut. Why the fish but not fish oil pills? Multiple well-done studies have shown that fish eaters have lower rates of heart disease and stroke. True, that doesn't prove that the fish directly causes the lower risk. But fish is one of the healthiest sources of protein. Also, stick to the proven ways to lower your chance of heart attack and stroke:

• Quit smoking.
• Exercise more.
• Eat smaller portions of food and decrease saturated fat.
• Keep your blood pressure in the normal range, with medicines if needed.
• Know your LDL cholesterol level. Lower it with a statin or other medicine if needed.
• Talk with your doctor about whether you should take a baby aspirin.

You might still decide to take fish oil pills or another type of omega-3 supplement. At low to moderate doses, this appears to be quite safe. I suggest taking no more than 1,000 milligrams (one gram) of fish-oil based omega-3s per day. For people with very high blood triglyceride levels, high-dose omega-3 pills are an effective treatment. These pills (known as Lovaza) are available by prescription. The usual dose is 4 grams per day. What Can I Expect Looking to the Future? As we have seen with other supplements, such as vitamin E, the scientific evidence supporting health benefits from fish oil does not live up to the hype. Is this the final word on omega-3s? Probably not.]]> Thu, 09 May 2013 14:12:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/diet-fitness/diet-fitness-details/newsarticle/christie-gets-surgery-to-aid-weight-loss/ New Jersey Gov. Chris Christie, who has endured both jokes and doubts about his political future... What Is the Doctor's Reaction? Weight-loss surgery has been hailed as a potential lifesaver for people who are severely overweight. It can dramatically:

• Reduce blood sugar levels
• Lower blood pressure and cholesterol
• Improve sleep apnea (a dangerous pattern of breath holding during sleep)
• Improve heart function

In general, weight-loss surgery is intended for people with a body mass index (BMI) of 40 or higher. They are considered to be very obese. People with a BMI of 35 to 39.9 also may qualify for surgery. They must also have a severe, treatment-resistant medical condition. Such conditions include diabetes, heart problems and sleep apnea. Some experts suggest that some people with type 2 diabetes and even lower BMI levels (between 30 and 34.9) be considered for surgery. Whether Governor Christie had weight loss surgery for political reasons or for concerns about his future health, he clearly fits the profile of a good candidate. We don't know his exact weight before surgery. However, the estimate is 300 pounds plus. He is just under 6 feet tall. This gives him a body mass index of at least 41. Christie also admits to multiple trials in weight-loss programs. He has lost and regained substantial amounts of weight at least a couple of times. But, like more than 95% of obese people, he has regained all the lost pounds and more. The governor has said he was otherwise in good health. Even if that was correct, his risk of developing problems directly related to obesity was high. At a BMI of greater than 40 and knowing that the surgery appeared uncomplicated for him, Christie surely chose the best and perhaps only treatment option for obesity. What Changes Can I Make Now? Today, surgeons generally suggest one of three weight-loss procedures:

• Laparoscopic adjustable gastric banding -- This is the simplest of the three procedures. It is done through small holes in the abdomen. The surgeon wraps an adjustable band around the upper stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach. The person feels full much sooner than before.
• Open Roux-en-Y gastric bypass -- The surgeon cuts into the abdomen and creates a small pouch in the stomach. This bypasses the rest of the stomach. The pouch is hooked to a loop of small intestine beyond the first section of intestine.
• Laparoscopic Roux-en-Y gastric bypass -- There's no large surgical cut. Small holes are made in the abdomen. Cameras are used to guide the instruments. The technique is otherwise similar to the open Roux-en-Y.

Governor Christie opted for the simplest procedure, the stomach banding. For most, this is same-day surgery. Christie's surgery was reported to take only 40 minutes, and he was home later the same day. Recovery moves along quickly. Christie will check in with his weight-loss surgeon regularly to see if the stomach band needs adjusting. The band can be easily tightened or loosened as needed depending on his rate of desired weight loss and how he feels. Usually weight loss should be slow and steady. He must be sure to get enough vitamins and minerals through diet, supplements or both. Roux-en-Y surgery leads to greater average weight loss than gastric banding. However, it is a more complicated operation. It also has greater short-term and long-term risks. What Can I Expect Looking to the Future? If you are considering weight-loss surgery, realize that you must commit to a lifelong change in the way you eat. Without lifestyle change, surgery will either make you miserable or not result in weight loss. And likely both. This is why people are required to go through at least one structured weight-loss program before they are eligible for surgery.]]> Wed, 08 May 2013 14:23:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/seeking-a-better-way-to-fight-eye-disease/ Adding components found in fish oil doesn't improve a pill that may help to slow down a blinding... What Is the Doctor's Reaction? Macular degeneration runs in my family. One of my elderly aunts was blind before she died. My grandfather struggled with his vision. It was harder for him to be unable to see well than it was for him to be terribly limited by a heart condition. He couldn't move easily, and his vision restricted him further from exploring the world through reading, watching TV or driving. Macular degeneration is an eye condition that affects our central visual area, called the macula. It's also called age-related macular degeneration or AMD. People with macular degeneration gradually lose their vision right in the middle of their eyes. They find that they cannot see well straight ahead and cannot see fine details. Severely affected people can't drive, read or do crafts. AMD is the cause of half of the blindness in the United States. It is the leading cause of blindness in the developed world. Wet and dry macular degeneration are the two types of this disease. The wet kind gets worse faster than the dry kind does. The dry kind is more common. There are some experimental treatments for wet AMD, but no good treatments for dry AMD. However, a specific combination of vitamins, discussed below, may help to slow down the disease. This latest news relates to a study called the Age Related Eye Disease Study, or AREDS. Previous research based on this study has found that certain vitamins and minerals may help prevent macular degeneration from developing or getting worse. They include vitamins C and E, beta-carotene, zinc and copper. The new study added different combinations of supplements to the original formula of proven vitamins. Researchers wanted to see if other supplements would be of further benefit. They tested four groups. All four received the original formula.

• One group also got lutein and zeaxanthin. These are plant-derived antioxidants. Lutein is found in leafy green vegetables like kale and spinach. Zeaxanthin is related to vitamin A. It is responsible for the colors of paprika, corn and saffron.
• A second group also got DHA and EPA, omega-3 fatty acids found in fish oils.
• A third group also got lutein, zeaxanthin, DHA and EPA.
• People in the fourth group got no extra supplements. They took placebo (fake) pills.

The study, unfortunately, found that none of the extra supplements further delayed or decreased vision loss. Some people received the original formula without beta-carotene, which has been linked with higher lung cancer risk in smokers. The formula appeared to be just as effective without it. Based on their analysis, the authors hope that looking further at the lutein and zeaxanthin groups will lead to a role for these supplements. In these small groups, people who received the original formula without beta-carotene did better than those whose pills included it. People who had very low levels of lutein and zeaxanthin in their diets also did better with these supplements than those who got more from their diets. What Changes Can I Make Now? Macular degeneration is more common in smokers, whites and people who have a family history of the condition. If you are over 50 and in a high-risk group, it's reasonable to see an eye doctor for an exam. At this age, it is also a good idea to be checked for other eye diseases, such as glaucoma or cataracts. If you have diabetes, you should see an eye doctor every year. Don't wait until you have trouble with your vision. At this point, we cannot restore vision, so preventing any loss is key to maintaining your eyesight. If your doctor recommends it, you might consider taking the AREDS vitamin preparation. It works best for certain groups of people, so definitely talk to a doctor before deciding to take these supplements. Also, be sure to eat your leafy green veggies. If you are already having problems with your vision, don't despair and don't delay. Your eye doctor can help you find a low-vision specialist and some visual rehabilitation. These steps can help you make the best of what you have and continue to enjoy a rich, full life. What Can I Expect Looking to the Future? This work really shows the benefit of large research studies. These studies are able to answer complicated questions and point us in good directions for future learning. Great strides have been made in macular degeneration during the last several years. I hope they will continue in both treatment and prevention.]]> Tue, 07 May 2013 00:00:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/most-parents-report-distracted-driving/ In a new survey, nearly 90% of parents admitted to being distracted by technology in the last... What Is the Doctor's Reaction? When we think of distracted drivers, we tend to think about teenagers, or those erratic drivers in front of us who don't use their turn signals because they are holding their phones. We don't necessarily think about … parents. But, it turns out, parents can be very distracted drivers. In a study just released, researchers from Michigan did a survey of more than 600 adults. All were parents and caregivers of children ages 1 through 12 who were seen in an emergency room for any reason. Researchers asked the parents how often in the last month they had performed certain distracting activities while driving with their child in the car. Here are the rough percentages that reported doing each of these activities:

• Phone calls (handheld or hands-free): 75%
• Child care (feeding, picking up a dropped toy): 70%
• Self-care (grooming, eating): 70%
• Directions (checking navigation system or map): 50%
• Entertainment (changing CD or DVD): 50%
• Texting: 15%

Almost 90% said they had engaged in at least one technology-based distraction in the last month. These activities are not all equally dangerous. Munching on a pretzel or listening to your GPS system tell you to turn right is absolutely not as dangerous as texting or leaning back to grab a dropped toy. But we know that distractions can lead to accidents. Among these parents, people who used a phone or did self-care while driving were more than twice as likely to have ever been in a motor vehicle crash. Those who did child care or got directions were just under twice as likely. Drivers who had ever been in a crash were more likely to report some sort of distracted driving than drivers never involved in a crash. Another interesting finding was that parents whose children were not restrained in the car properly (according to Michigan law) more often reported child care distractions or texting. What Changes Can I Make Now? All passengers are precious cargo, but children are especially precious. They count on parents and caregivers to keep them safe. Distractions cause accidents. We talk a lot about cell phones, but anything can do it. You could be changing a radio station, or just turning to talk to the person next to you. Anything that takes your eyes and concentration off the road can lead to a crash. It's crucial that parents and caregivers understand this. It's hard not to have any distractions. But you can limit them. Here are a few things you can do:

• It's best to pull over to make a phone call. If you have to make a call while driving, use a hands-free device.
• If snacks or toys are needed for a ride, do some planning to make sure they are within your children's reach.
• Make rules for the car. Let your kids know that you simply aren't going to fix the DVD or change the music or reach back to get something while you are driving. Then they'll be less likely to get upset and you'll be less likely to be tempted to break your rules. Don't try to explain it to them while you're in the car. Talk about it ahead of time.
• Whenever possible, have another adult (or at least an older child) with you when taking long car trips with children.
• Resist the temptation to do a drive-thru for meals. Stop and eat. Between eating yourself and reaching back to grab or give food, you are putting everyone at risk.
• Know where you are going ahead of time. This helps avoid the distraction of figuring it out on a map or your smart phone while driving. If you need to use a GPS system, use one that tells you what to do, as opposed to one that you need to look at. If you do need to look at it, mount it on the dashboard to minimize the amount of time your eyes are off the road.

What Can I Expect Looking to the Future? If we don't work to limit distractions, what we can expect is more motor vehicle accidents. I hope that this study will be a wake-up call -- and will help save lives.]]> Mon, 06 May 2013 00:00:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/fda-probes-wider-caffeine-use-in-food/ Caffeine has been showing up recently in snack foods, candy and gum. Now U.S. food regulators are... What Is the Doctor's Reaction? Hi doctor,

I'll make it short. Could you please let me know if anything in this supplement might be harmful to me? I don't use it for weight loss but just something to help me with more energy.

Thanks for your advice in this matter. I am a primary care doctor. I get questions from patients all the time about supplements, energy drinks, diet pills and herbal mixtures that have been advertised. This was a message I got last week. Many of these "energy boosters" have caffeine as their active ingredient. That was true for the supplement my patient was asking me about in this message. Each pill had the amount of caffeine that you would get from two cups of coffee. Caffeine boosters and snacks are in the news right now. This week, Wrigley started selling a caffeinated gum, calling it "the right energy, right now." Food manufacturers have also recently put caffeine into candy, chocolates, jelly beans, trail mix, chips and other snack foods. Some people are getting more caffeine through these energy snacks than they ever got from coffee. They are being marketed as a wellness product -- for more energy, better athletic performance. So are caffeinated snacks safe? In moderation, they are probably not going to do harm. However, the Food and Drug Administration (FDA) received 92 reports in 4 years about illnesses, hospital stays and deaths that came after people drank an energy drink named 5-Hour Energy. The FDA has also received reports of several deaths possibly linked to Monster Energy Drink. These reports do not prove that the caffeinated drinks actually caused the deaths. Caffeine has its effect in the body by triggering the brain to make extra adrenaline-type hormones. This can stress the heart and raise blood pressure. What Changes Can I Make Now? Caffeine is not a problem in the early part of the day, and in small amounts. But it is good for you to know the side effects of regular, heavy use of caffeine. If you want more energy, the healthiest way to get that is by exercising and by getting enough sleep, not by using caffeine:

• Caffeine may be linked to an increased heart attack risk. Researchers focused on people with slow caffeine metabolism. This means that caffeine stays in their bodies for a long time. Among this subgroup, heart attacks were more likely to occur in heavy coffee drinkers. Drinking 2 to 3 cups of coffee each day seemed to be linked with a 36% increase in heart attack risk. With 4 or more cups each day, the increase appeared to be 64%. This study was not designed in a way that would tell us for sure that there is risk from caffeine.



• Unfiltered coffee might ever-so-slightly increase your total cholesterol levels. Drinking 6 cups of unfiltered coffee (such as espresso) daily appears to increase total cholesterol by about 12 milligrams per deciliter. This small change is not much to be concerned about.



• Heavy coffee intake might change your blood level of homocysteine. This is a substance that has been linked with heart risk. In one study, people who drank 6 cups of coffee daily had a higher level of homocysteine than people who drank no coffee.



• Drinking 3 or more cups per day is linked with a higher risk of miscarriage in early pregnancy.



• Caffeine can thin your bones. It causes some calcium to filter out of the body through your kidneys.



• For some people, caffeine causes headaches. This is a common symptom of caffeine withdrawal. Other withdrawal symptoms are fatigue, foggy thinking and an irritated mood.



• Caffeine reliably causes insomnia. This is true for caffeine consumed as early in the day as noon.



• Coffee or tea with meals can make you absorb less iron from the foods you eat.



• Caffeine can cause anxiety symptoms.

But there is good news, too.

• Some cancers seem to grow less if you consume caffeine.
• Caffeine can stimulate a bowel movement. Morning coffee helps people to stay "regular."
• Sometimes, caffeine can take away a migraine headache.
• Caffeine is linked with a slightly lower diabetes risk.

What Can I Expect Looking to the Future? The Nurses' Health Study and the Physicians' Health Study each included tens of thousands of people. These studies showed no difference in diabetes or heart risk even for people drinking five cups of coffee per day. That is very reassuring about caffeine as a safe product. But now caffeine is being packaged in a way it can be just popped into your mouth. So it is possible to get a much bigger dose of caffeine at one time. The FDA is talking about restricting whether ads for caffeinated products may target children. Mostly, caffeine seems safe in moderate quantities. But we don't yet understand a "latte" about the full spectrum of risks or hazards of caffeine. ]]> Fri, 03 May 2013 00:00:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/study-no-z-pak-heart-risk-for-most-adults/ A common antibiotic does not increase the risk of heart-related death for young and middle-aged... A common antibiotic does not increase the risk of heart-related death for young and middle-aged adults without heart problems, a new study finds. Earlier research found an increased risk among people with heart disease who took azithromycin. This drug is also known by the brand names Zithromax or Z-Pak. The new study looked at 1.1 million people who took azithromycin for infections. They were compared with 1.1 million who did not take antibiotics and 7 million who took penicillin V. Patients were ages 18 through 64. People were 3 times as likely to die of heart disease or stroke while taking either antibiotic. Death rates were similar for both drugs. Researchers said the higher risk appeared to be related to the infection rather than to the treatment. The U.S. label for azithromycin and antibiotics similar to it carries a warning. It says they could increase the risk of a heart rhythm problem that can lead to death. The warning says this is more likely in people with existing heart problems. The New England Journal of Medicine published the study. HealthDay News wrote about it May 1. What Is the Doctor's Reaction? Did you ever take a "Z-Pak"? It's a common and convenient antibiotic treatment. The drug is most commonly prescribed for respiratory infections. Z-Paks contain azithromycin. The brand name is Zithromax, which is where the "Z" comes from. This is an antibiotic in the same family as erythromycin. In recent years, you may have seen news stories suggesting that taking azithromycin comes with a serious risk: sudden cardiac (heart-related) death. It's true. A study published last year found a small but real increased risk of sudden cardiac death among those taking azithromycin. They were compared with people taking a penicillin-type antibiotic. But before you swear off azithromycin forever, consider this: The study analyzed adults insured by Medicaid. That's important because this population includes people who tend to have multiple medical problems (including heart disease) and a high death rate in the first place. What about people whose hearts are healthy? Does the risk of sudden death after taking azithromycin apply to them as well? That's where a new study comes in. The New England Journal of Medicine published the new study. Researchers looked at the rate of heart- and stroke-related death among more than a million people from the general population who took azithromycin. Their ages were 18 through 64. They were compared with a similar number who took no antibiotic. Azithromycin users also were compared with more than 7 million people who took penicillin. The results were reassuring:

• The risk of heart- and stroke-related death among people taking azithromycin was similar to that among people taking penicillin.
• Compared with people taking no antibiotic, the risk of heart- and stroke-related death was nearly 3 times higher among people taking azithromycin. However, after statistical analysis, this increase appeared to be related to the infection or other health problems. It was not linked with the antibiotic.
• The number of heart- and stroke-related deaths occurring during azithromycin use in this study was quite low. The researchers estimate that, at most, 11 extra deaths might occur for every 1 million courses of treatment.

This study should provide a measure of comfort to the average person who gets a prescription for azithromycin. Of course, no medicine is completely risk-free. Allergic reactions and side effects (such as diarrhea) are relatively common with azithromycin use. People with heart problems might be better off taking a different antibiotic, if they need one. Still, this new study suggests that azithromycin seems to be safe for the heart for most people. What Changes Can I Make Now? Azithromycin can cause serious side effects. That risk is quite small, but it serves as yet another reminder that we should take antibiotics only when we truly need them. Remember that respiratory infections are often caused by viruses, not bacteria. This is especially likely for infections that cause sore throats, runny nose or cough. Antibiotics don't kill viruses. If you have heart disease, think twice before taking azithromycin. If your doctor prescribes it, ask whether you're at increased risk for heart rhythm problems. The doctor may decide to prescribe a different antibiotic. But, if you don't have heart problems, azithromycin is probably as safe as (or even safer than) other antibiotics. Perhaps the most important changes to make are those that lower your risk of respiratory infection. That means there's less chance you would even need azithromycin in the first place. For example:

• Avoid contact with people who are sick.
• Wash your hands often, especially if you're around someone with an infection. Remind infected people to wash their hands as well and to cover the nose and mouth when coughing or sneezing.
• Don't smoke.
• Get the flu shot each year. You'll be less likely to get the flu. That also means you'll reduce your chances of receiving an antibiotic. Sometimes that happens if there's concern that a bacterial infection might be causing your flu symptoms.
• Get the pneumococcus vaccination (often called "the pneumonia vaccine").

What Can I Expect Looking to the Future? In the future, we are likely to have new antibiotics. Then we won't need to rely on azithromycin as much as we do now. New antibiotics are likely to have side effects of their own. But I hope that sudden cardiac death won't be among them! More research should provide a better understanding of who is at risk of heart and blood vessel problems while taking azithromycin. Fortunately, it appears the average young or middle-aged adult is not among them. ]]> Thu, 02 May 2013 14:05:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/not-calling-911-slows-stroke-treatment/ More than one-third of people having a stroke in the United States don't call 911, a study shows.... What Is the Doctor's Reaction? Many people don't realize that stroke is the fourth largest cause of death in the United States. A stroke occurs when a part of the brain does not receive enough oxygen or nutrients. The cause is either a blocked blood vessel or a burst blood vessel in the brain. People who survive a stroke can be left with major physical and mental limitations that can be life-changing. Early treatment of stroke can be life-saving and can limit the chance of having long-term disability. Unfortunately, many people do not get to the hospital quickly. Calling an ambulance is the first step to getting the fastest treatment. A new research study reminds us that too few people having a stroke call an ambulance. Researchers studied more than 200,000 stroke patients from more than 1,500 U.S. hospitals. These hospitals were evaluating a program called "Get With The Guidelines." This is an effort by the American Heart Association and the American Stroke Association to improve stroke and heart attack care. The program promotes use of set treatment plans that are based on the latest research. Hospitals record certain measurements of care. For stroke care, they include:

• Time it takes from the start of stroke symptoms to hospital arrival and the start of treatment
• Number of people treated with clot-busting medicines
• The severity of stroke
• Number of patients who get education about stopping smoking and controlling blood pressure and cholesterol levels

These are just a few examples of the many measures that are included. The researchers in this study found that one measure in particular was worrisome. Too few people called an ambulance when they were having a stroke. In fact, one-third of those who had stroke symptoms did not call emergency medical services. Instead, they got to the hospital on their own. This was more likely in rural areas and for minorities. Here's why this matters. Clot-busting medicines can save lives and reduce disability. But they can only be given within a three-hour window from the start of symptoms. The longer it takes to get to the hospital, the less likely you are to get these life-saving medicines. Taking an ambulance gets your treatment started much faster. Why? Emergency medical teams can give you medicines you need right away in the ambulance. They also know which hospitals are set up to take care of people who are having a stroke. This means you will get to the right hospital right away. You'll also be more likely to get the most appropriate treatments. What Changes Can I Make Now? First, you have to know the symptoms of a stroke and remember to get help fast. A good way to remember these tips is the mnemonic F-A-S-T. F -- Face drooping or face numbness. If your smile is not equal on both sides, that may be a sign of a problem. A -- Arm or leg weakness. Does one arm not work as well as the other? S -- Speech problems. Are you having trouble speaking, or finding the right words, or even speaking gibberish? T -- Time is of the essence. Call 9-1-1. As mentioned above, an ambulance can get someone to hospital and to life-saving treatments fast. Other symptoms might signal a stroke as well. They include:

• Sudden confusion
• Sudden vision loss
• Sudden balance troubles

It's also important to remember the factors that increase your risk of stroke. They include:

• High blood pressure
• Atrial fibrillation (an abnormal heart rhythm)
• Diabetes
• Smoking
• High cholesterol
• Obesity
• Lack of exercise

What Can I Expect Looking to the Future? About 800,000 people have strokes each year in the United States. It is clear that the faster you get the treated for stroke, the better off you will be. I hope that better awareness about stroke symptoms of stroke and the need to get treated quickly will reduce the number of people with major limitations after having a stroke. Programs like "Get With The Guidelines" will continue to help us understand the things we do well and the things we could do better with stroke care. Picking up the phone and calling 9-1-1 with any possible stroke symptoms is one way that we could all do better.]]> Wed, 01 May 2013 14:09:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/antidepressants-and-surgical-bleeding/ People who take medicines for depression may have an increased risk of bleeding with major... What Is the Doctor's Reaction? About 10% of Americans take an antidepressant drug. For the great majority of them, that drug is an SSRI. SSRI stands for selective serotonin reuptake inhibitor. These drugs act by increasing brain levels of serotonin. Serotonin affects more than just our mood. It also plays a role in how we react to stress and anxiety. More recently, serotonin action in the brain has gained attention related to how we perceive pain. Some SSRIs are prescribed to treat chronic (long-lasting) pain. SSRIs are generally safe drugs. Like all medicines, they can produce side effects in some people. Nausea, loose stools and headaches are most common. They also can reduce sexual interest, desire, performance, satisfaction or all four. One of the more worrisome side effects of SSRIs is an increased risk of bleeding. The drugs affect serotonin levels in platelets as well as in the brain. Platelets are the sticky cell fragments that play a crucial role in blood clotting. Doctors routinely consider bleeding risk when people are scheduled for major surgery. The goal of this study was to find out if SSRI use around the time of surgery might cause more unwanted bleeding. The researchers also looked at the number of SSRI users having major surgery who died in the hospital or were admitted again within 30 days. These outcomes of surgery were worse in SSRI users. However, this type of study can only show a link between outcomes and SSRI use. It does not prove that taking an SSRI before or right after surgery was the reason for excess bleeding or directly increased risk of death. People who take an SSRI are more likely to have other medical problems than non-users. What Changes Can I Make Now? If you do need major surgery and take an SSRI, talk with your doctor about the best approach for you. Even if there is a risk of excess bleeding from an SSRI, that extra risk is extremely small. However, if you also take a drug to prevent blood clots, such as aspirin or warfarin (Coumadin), the bleeding risk could be significant. Nonsteroidal anti-inflammatory drugs (NSAIDs) on their own can cause internal bleeding. These types of drugs include ibuprofen, naproxen and many others. NSAIDs make platelets less sticky and irritate the lining of the stomach and upper intestine. So, if you combine an NSAID with an SSRI, the bleeding risk during and after surgery likely increases even more. In these circumstances, your doctor will advise you about reducing doses and/or not taking some of your medicines in the weeks before surgery. You should not stop taking an SSRI without getting advice from your doctor first. If you take it for depression, your symptoms could return. And untreated depression increases your risk of a poor outcome from surgery. Stopping an SSRI also means you might have more pain after surgery. Most importantly, suddenly stopping some SSRIs can cause "SSRI discontinuation syndrome." Symptoms include:

• Dizziness
• Nausea
• Insomnia
• Anxiety
• Irritability
• Aches and pains

This problem occurs most often when people taking high doses of a short-acting SSRI stop without slowly lowering the dose. Paroxetine (Paxil) is an example. What Can I Expect Looking to the Future? Based on this study and other evidence we have so far, no broad guidelines regarding SSRIs and major surgery will be available any time soon. As with all your medicines, you and your doctor will decide what medicines to take and how to take them based on your own situation.]]> Tue, 30 Apr 2013 14:05:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/excess-weight-drinking-boost-liver-damage/ Overweight women who drink too much alcohol greatly increase their risk of liver damage, a new... What Is the Doctor's Reaction? Fatty liver disease has become extremely common. Some estimates suggest as many as 20% of Americans have too much liver fat. Not that long ago, fatty liver was linked mainly with overuse of alcohol. Now the main reasons for fatty liver are the epidemics of obesity and type 2 diabetes. Fatty liver affects 70% to 90% of people with those conditions. It's not surprising that, as obesity and diabetes have become more common, so has fatty liver disease. Fatty liver disease occurs when abnormal amounts of fat make their way into liver cells. Having those fattened cells can lead to inflammation in the liver. The inflammation damages surrounding liver tissue. If alcohol is the culprit, doctors call it alcoholic hepatitis. If excess alcohol is not involved, it's called nonalcoholic steatohepatitis. "Steato" refers to fat. "Hepatitis" means that the liver is inflamed. The short name for nonalcoholic steatohepatitis is NASH. About 5% to 10% of people with fatty liver disease go on to develop NASH. Alcoholic hepatitis can get better if people stop drinking soon enough. NASH is often a relatively stable, low-grade condition. People generally have no symptoms. But the fat build-up from either problem can start a cascade of serious damage to the liver. This can lead to cirrhosis and liver cancer. These two studies confirm what experts have expected for some time. People who drink too much alcohol and have obesity or type 2 diabetes have a much higher risk of developing liver failure from cirrhosis and liver cancer. What Changes Can I Make Now? The best ways to help avoid and treat fatty liver are similar to the recommendations that keep your heart healthy and prevent type 2 diabetes:

• Maintain a healthy weight and lose weight if necessary.
• Stay as physically active as possible all day long. If you have a desk job, consider setting up your work station to stand most of the time.
• Schedule dedicated exercise time of at least 30 minutes per day.

In people who already have nonalcoholic fatty liver, weight loss seems to have a very direct effect. As people lose weight, the fatty liver becomes less fatty. Crash dieting is a bad idea. Rapid weight loss (four pounds a week or more) can wind up damaging the liver. Ideally, anyone who has fatty liver should avoid alcohol. Based on these studies, having more than one drink per day for women or two per day for men adds to the risk of liver failure and liver cancer. However, it's not as clear whether an occasional drink (no more than one per day, on average) increases the risk. What Can I Expect Looking to the Future? Alcohol and liver problems are well known. But liver damage related to excess weight or diabetes has received less attention. The heart has been the greater worry for people with these problems. And a little alcohol is said to be good for the heart. Perhaps we need to acknowledge that even a little alcohol might not be best for people at risk of fatty liver.]]> Mon, 29 Apr 2013 13:33:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/survey-most-dont-plan-for-long-term-care/ About 2 out of 3 Americans over age 40 have done little or no planning for long-term care, a new... What Is the Doctor's Reaction? When I am an old woman, I shall wear purple. I have always loved the poem by Jenny Joseph that starts with those words. I love that the woman in this poem is unafraid to grow old, and I love her plans: I shall … go out in my slippers in the rain,
And pick the flowers in other people’s gardens,
And learn to spit. Despite being so full of plans, nowhere does she anticipate how she might pay for long-term care. A survey released this week found that two-thirds of Americans over age 40 have done "little or no planning" for how they might pay for long-term care as an older adult. As a primary care doctor, I see my patients struggle with the major impact of age-related care needs on their lives and their financial realities. Long-term care costs are huge. Really, we can't afford not to think about it. The U.S. Census Bureau estimates that $217 billion will be spent in 2015 on nursing home and residential care. This includes assisted living facilities and board and care homes. Currently, about 25% of these costs are paid out-of-pocket by older adults and their families. Almost two-thirds of the cost is paid by Medicaid and Medicare combined. Medicare pays for only a short term when illness causes disability -- 20 days in a nursing home. After that, patients must meet these costs out-of-pocket. Most older adults with chronic needs then "spend down" their funds to pay for long-term care until the money runs out. At that point, at poverty level, Medicaid support may be available. The vast majority of older adults live in their own home or apartment, or with family. This includes more than 3 out of 4 people ages 85 and older. But most people will need help, at least for a short time, as they age. They may need help with personal care, such as bathing and dressing, or more intense support in a nursing home. What Changes Can I Make Now? There is no perfect way to plan for long-term care, in the event you will need it. But you can begin to make a plan, even if it's not perfect. 1. Talk with your family. Nearly 60% of elderly people who need help with personal care rely fully on unpaid caregivers, usually their children or spouses. Sometimes this is an obvious arrangement. But your family must be flexible and committed. If a caregiver must stay at home, some family income will be lost. This is rarely a comfortable situation if everyone did not agree ahead of time. 2. Consider long-term-care insurance. Fewer than 3% of American adults have purchased a long-term care insurance policy. The average cost is high. A typical plan might cost $3,300 a year for a healthy 60-year-old husband and wife. And it might pay only a $150 a day for up to 3 years. For a person who buys this insurance at age 65, there is a 45% chance of making a claim. If you never need long-term care, the payments you made to the plan are lost. 3. An "age in place" retirement arrangement might be right for you. Some campus-like retirement communities are designed to permit an older adult to "age in place." This means you can go from a relatively independent life to a more dependent life while staying in the same community. Services often include recreation for the active elderly and 24-hour skilled nursing or rehabilitation services for the frail elderly. These organizations are called continuing care retirement communities. They are always expensive. Usually, they charge an up-front fee of $25,000 to $500,000. Then you pay a membership fee or rent each month. 4. Build up your savings. Making ends meet is a challenge. But in your working years, don't underestimate how much you need to save. "After we no longer have our mortgage, we should be able to live on that," we all think. But plan for some money to stay in your savings. If disability strikes, you will need it. 5. Write an advance directive ("living will"). Some people receive intensive medical care after they become profoundly disabled. By then, they are no longer able to let their family and doctor know what care they want. If you know that you would not want life-sustaining treatments in this condition, it is wise to record your wishes in a legal "advance directive." What Can I Expect Looking to the Future? By 2030, 20% of the U.S. population is predicted to be over the age of 65. It is not clear that Medicare and Medicaid will be able to sustain the contributions that they make now toward long-term care. This is a good reason for Americans to plan ahead. ]]> Fri, 26 Apr 2013 13:54:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/surgery-lag-harms-young-with-breast-cancer/ Young women with breast cancer don't live as long if they delay treatment 6 weeks or more, a new... What Is the Doctor's Reaction? It may surprise you to learn that up to 6% of breast cancers occur in women between the ages of 15 and 39. That's about one in 17 cases. It certainly surprised me. Breast cancers diagnosed in these young women tend to grow and spread faster than in older women. As a result, they are more difficult to treat and survival rates may be lower. Rapid diagnosis and early treatment are particularly important. A new study shows just how important. Researchers analyzed more than 8,800 cases of breast cancers occurring in young women. They wanted to understand the impact of rapid treatment or treatment delay. For these young women, a delay in surgery of more than 6 weeks after the diagnosis was linked with a 5-year survival of 80%. Survival was 90% for those treated sooner. Treatment delay was nearly twice as common among Hispanic and African-American women (15%) as among white women (8%). Delays also occurred more often among women who were poor or had public or no health insurance. This new research emphasizes that:

• Although the condition is more common with advancing age, young women can and do develop breast cancer.
• Prompt treatment can be life-saving.
• Access to health care and good insurance coverage can have a big impact on the outcome of this condition.

What Changes Can I Make Now? First, learn about the risk factors for breast cancer. Then, do what you can to reduce your risk. Risk factors include:

• Age -- Risk rises as women get older.
• Gender --Risk is much higher in women than men. But men can develop breast cancer.
• A personal or family history of breast cancer
• A history of radiation to the chest, as in treatment for lymphoma or other types of cancer
• Excessive exposure to estrogen -- This can be due to:
  
  • Menstruation starting before age 13
  • Menopause after age 51
  • Use of estrogen replacement for more than 5 years
• No pregnancies
• First pregnancy after age 30
• Excess weight
• Excessive alcohol consumption (3 or more drinks per day)
• Lack of exercise

Of course, some of these risk factors (such as age, gender and family history) cannot be changed. For others, however, you can take steps to reduce your risk of breast cancer (or its complications).

• Don't smoke.
• Keep your weight in a healthy range.
• Exercise regularly.
• Drink only moderate amounts of alcohol.
• Have regular screenings, including breast examinations and mammograms. The best time to start and how often to repeat these is uncertain. Discuss a screening plan with your doctor. Bring your prior mammograms with you or have all of your mammograms done at the same place. Then the radiologists can compare current with past results.
• Consider genetic testing if you're at high risk. But before having a genetic test, talk with your doctor about how this information could be useful.
• Be sure to see your doctor if you discover a lump. Fortunately, many lumps will turn out to be harmless. But if a lump is cancerous, waiting could reduce the success of treatment.

This new research shows that prompt treatment for newly diagnosed breast cancer is particularly important for young women. Regardless of age, however, it makes little sense to delay needed treatment. What Can I Expect Looking to the Future? In the future, I think we will know more about the causes of breast cancer and how to prevent it. For example, as more genes are linked with breast cancer, genetic testing may become routine. In addition, as we learn more about the genetic makeup of breast tumors, doctors may use this information to guide treatment. In the meantime, there seems little doubt that early diagnosis and treatment of breast cancer can make a big difference. This new study demonstrates this point among younger women, who tend to have more aggressive disease. But it's likely that the same is true for some other types of cancer. Some treatments can wait. But, for young women with breast cancer, the sooner treatment begins, the better. This new research clearly shows why. ]]> Thu, 25 Apr 2013 14:21:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/beta-blockers-may-trim-deaths-after-surgery/ Taking a common heart drug before surgery may reduce death rates for some patients, a new study... What Is the Doctor's Reaction? Protecting the heart has always been a big concern for anyone having major surgery. But better techniques for surgery and anesthesia have improved results. The risk of a heart attack and heart-related death has greatly decreased during the last few decades. Taking a beta-blocker before and after major surgery may be another way to help protect the heart. Examples of commonly prescribed beta-blockers include atenolol, metoprolol and carvedilol. Early studies suggested that anyone at risk of heart trouble could benefit from taking a beta-blocker before and after major surgery. These drugs slow the heart rate and decrease the heart's work load. But results of later studies were less clear for people having non-vascular surgery. Usually doctors advise a beta-blocker for patients having vascular surgery. (Vascular surgery is surgery on blood vessels. Examples include as fixing an abdominal aortic aneurysm or a bypassing blockage in a leg artery). Now doctors have a little more guidance from the results of a study published today. The study focused on six factors to find out who is most likely to benefit from taking a beta-blocker before major surgery and at least 30 days afterward. The factors were:

• High-risk surgery, such as surgery on blood vessels or an operation that typically involves a lot of bleeding
• History of stroke or narrow arteries in the neck that increase stroke risk
• Known coronary artery disease
• Heart failure
• Diabetes
• Kidney disease with decreased kidney function

For people with two or more of these risk factors, taking a beta-blocker before surgery and during the next month improved outcomes. They had a significant decrease in their risk of heart attack, cardiac arrest (heart stopping) and death during that time period. The results of the study were published in the April 24 issue of the Journal of the American Medical Association. What Changes Can I Make Now? Are you scheduled for surgery? If you have even one of the risk factors mentioned in the study, ask your doctor whether you should start a beta-blocker. Anyone over age 50 with multiple heart-disease risk factors might also benefit from treatment with a beta-blocker before surgery. It depends on how many risk factors you have and the type of surgery. As a reminder, those heart-disease risk factors include:

• Smoking or other regular tobacco use
• Family history of coronary artery disease under age 60
• High LDL cholesterol
• High blood pressure

Ideally, people who are not already taking a beta-blocker but need one should start taking it at least one week before surgery. I prefer to start it two or more weeks before surgery when possible. I start at a low dose and increase the dose gradually. Beta-blockers slow the heart rate. So this can guide the dosing. The heart-rate goal depends on the individual patient. What Can I Expect Looking to the Future? During the last few years, doctors have become less likely to prescribe beta-blockers before surgery for people not already taking them. The evidence was not conclusive. But this new study helps define which patients are likely to get the most benefit. Beta-blocker therapy for this purpose will almost surely increase.]]> Wed, 24 Apr 2013 14:32:00 -0400 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/some-alternatives-may-cut-blood-pressure/ Some alternative treatments may slightly lower blood pressure, a new report says. But the only... What Is the Doctor's Reaction? Sixty million Americans know they have high blood pressure (hypertension). But fewer than half have it under control. Why is that? High blood pressure alone rarely causes symptoms. And taking pills for something that doesn't make you feel bad can be hard to swallow. So many people with high blood pressure seek alternative means to help lower their blood pressure. Methods include relaxation exercises, meditation, biofeedback, yoga and acupuncture. How much can any of these lower your blood pressure readings? A large group of researchers has tried to answer that question. They did an exhaustive review of studies that looked at alternative therapies. They also included studies that looked at the impact of regular exercise on blood pressure. Many studies have looked at exercise and high blood pressure. Of the different types of exercise, the researchers found that regular aerobic exercise lowered blood pressure the most. And aerobic exercise was better than any of the alternative therapies. Interestingly, dynamic resistance training also helped lower blood pressure. You can do dynamic resistance exercises with free weights or resistance machines. Your muscles and joints are moving during these exercises. On the other hand, isometric exercises do not appear to improve blood pressure. These exercises put stress on your muscles without any movement. Using a hand grip is one example. The authors found fewer well-done studies on alternative therapies. Their analysis suggests that deep meditation, biofeedback and some relaxation techniques lowered blood pressure a little. The few studies available on yoga and acupuncture suggested no benefit. What Changes Can I Make Now? Most importantly, get your blood pressure checked. Normal blood pressure is a reading of no higher than 120/80. Readings between 120/80 and 139/89 show pre-hypertension. And high blood pressure is defined as multiple readings of 140/90 and higher. Lifestyle changes might help prevent you from needing medicines. And even if you need to take drugs to lower blood pressure, you likely will need fewer pills and lower doses. Regular aerobic exercise has been a standard recommendation to help lower blood pressure. Your goal is to work up to moderate-intensity exercise most days of the week. Ideally, strive for 45 to 60 minutes at each session. But even 20 to 30 minutes makes a difference. In addition:

• Maintain a healthy weight.
• Eat more fruits, vegetables and whole grains. Choose low-fat dairy foods.
• Eat less salt.
• Include foods rich in potassium in your diet, unless you have kidney disease.
• If you are a man who drinks alcohol, have no more than two drinks per day. Women should have no more than one drink per day.
• Don't smoke.

What Can I Expect Looking to the Future? Similar to most medical studies, this one looked at average benefits for each alternative therapy. Many people did not see lower blood pressures from one or more of these methods. But some did. So you might find that stress reduction, meditation or some other technique works for you. ]]> Tue, 23 Apr 2013 14:23:00 -0400