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 Thu, 30 Oct 2014 00:00:00 -0400 High-Fat Diets May Help Adults with Epilepsy A high-fat, low-carbohydrate diet may help adults as well as children to control epileptic...                    What Is the Doctor's Reaction? For people with epilepsy, reducing the number of seizures -- or halting them -- is an important goal of treatment. A treatment to do just that could be as close as the kitchen. Epilepsy is a common condition. It causes sudden -- and often unpredictable -- changes in the brain's electrical activity. These changes produce seizures (also called convulsions). Someone having a seizure may lose consciousness and move the arms or legs uncontrollably for a short time. If only one part of the brain is affected, symptoms may be more subtle. They may include a brief episode of twitching, blinking or "spacing out." Treating the cause of epilepsy can be effective. For example, surgery to remove a brain tumor or an abnormal blood vessel in the brain can cure the condition. But often no cause can be found. Most people with epilepsy rely on medicines to prevent seizures.  But, according to a review of previous studies, a high-fat diet might help. The journal Neurology published the review. Researchers analyzed past research of high-fat, low-carbohydrate diets such as the Atkins diet. The studies included a total of more than 130 people with epilepsy. Here's what they found:
  • About one-third of people adopting this type of diet had at least a 50% reduction in seizures.
  • About 9% of those on the most stringent diet (called the "ketogenic diet") had a more than 90% reduction in seizures.
  • The drop in seizures occurred within days or weeks of the diet change. It lasted as long as people stayed on the diet.
  • Side effects of the diet were minor. Weight loss was one of the most common.
But the news from this study was not all good.
  • The benefit of the high-fat diet did not last when people went back to their usual diets.
  •  It was difficult to follow the high-fat diet over the long term. Up to half of those in the study stopped the high-fat diet before the study was over.
Changing the diet in this way is already common for children with seizure disorders who do not respond well to medicines. But this review is among the best evidence so far that it can also work well for adults. This could allow better seizure control for the millions of adults with epilepsy. It also could improve our understanding of how to control seizures. Further research could lead to new medicines or other diets that are even more effective or easier to stick with. What Changes Can I Make Now? If you are one of the 50 million people worldwide with epilepsy, it's important to know your options. Talk to your doctors about:
  • Treatment of the cause -- As described above, if there is a known cause of your seizures, removing the cause can stop them.
  • Medicines -- There are more anti-seizure medicines now than ever before. Taking one (or more than one) can be highly effective. Regular doctor visits and blood tests are usually recommended. It's important to let your doctors know of any side effects.
  • Surgery -- It may be reasonable to consider surgery when:
    • A cause of the seizures (such as scar tissue or a tumor) can be identified and removed.
    • Medicines don't help, especially if surgery can be done safely on the part of the brain where the seizures begin.
Unfortunately, even with these options, many people continue to have seizures. Some have unacceptable side effects from the medicines they take. And, even when they are well-tolerated, medicines don't work well for more than one-third of people with epilepsy. So we badly need more and better treatments. Could changing your diet help? This new study suggests that it could. However, before going on a high-fat, low-carb diet as a way to treat seizures, talk to your doctor. Some may find this diet appealing. For example, it includes foods such as bacon, heavy cream and butter. But it's not for everyone. And the ketogenic diet requires close monitoring by your doctor. Common side effects of these high-fat diets include:
  • Constipation
  • Nausea
  • Abnormal levels of blood lipids (such as cholesterol or triglycerides)
Rarer, but serious, side effects include kidney stones and pancreatitis (pancreas inflammation). What Can I Expect Looking to the Future? You can expect doctors and researchers to explore new ways to prevent seizures. These may include new medicines, surgical techniques or diets. I hope that this latest research will lead to a better understanding of why some people develop seizures in the first place. Perhaps that could lead to preventive approaches.  It's not clear to me why a high-fat, low-carb diet should help people with seizures. I hope future studies will determine why it works.]]>
Thu, 30 Oct 2014 00:00:00 -0400
Substance in Cocoa May Aid Aging Memories A substance found in cocoa may help to improve normal age-related memory loss, a very small study...                    What Is the Doctor's Reaction? Last night, my husband gleefully read me a headline from the New York Times:  "To Improve a Memory, Consider Chocolate." Throwing scientific caution to the wind, I said, "Sign me up!" By Monday morning, the article was the second most e-mailed on the New York Times website.  The Times was reporting on a very small study in a journal called Nature Neuroscience. The study was done at Columbia University and partially funded by the Mars candy company. It had only 37 participants. For 3 months, the study group drank a mixture that was high in an antioxidant called cocoa flavanols. Compared with a group who drank a lower-flavanol mixture, they did much better on specific memory tests. The study group did better on a kind of memory test that involves pattern recognition. They also had increased function in an area of the brain linked to this type of memory. It's important to note that they did not have a change in the part of the brain linked to early Alzheimer's disease. Flavanols are plant-based chemicals found in chocolate, tea and apples. They are a type of antioxidant. They may help to decrease other chemicals that can damage cells. No one is sure why flavanols had such a robust response in this study. Maybe they increased blood flow to the brain. Or perhaps they caused part of a nerve cell, called a dendrite, to grow and become better able to connect with other cells. Don't trade in your broccoli for a bag of dark chocolate just yet. Remember, this was a very small, early study. It's exciting in that the findings are so positive, but there are many reasons for caution:
  • Currently, to consume the amount of flavanol in the study, you’d have to eat about seven chocolate bars, with all their fat and calories.
  • This was a very, very small study. Studies like this are intended to show "proof of concept" -- that an idea is a good one. In order to really know about how this affects large groups of people, we would need to see a much larger study over a longer period of time.
  • Be aware that most chocolate is highly processed. The processing markedly decreases the amounts of flavanols in the final product.
As a doctor, I find this study really intriguing. First, it addresses a huge issue (and fear) for all of us -- memory loss as we age. Second, it offers an exciting new area for research. It doesn't give us answers, but it begs us to ask more questions.  Am I going out to buy flavanol pills? No. Will I watch with interest what larger, more comprehensive studies show? Absolutely. What Changes Can I Make Now? Age-related memory loss can be quite normal. Even some people in their 20s and 30s have an occasional moment where they can't quite find a word. As we get older, this can intensify. It's not a sign of impending Alzheimer's if you occasionally forget a word, lose your car in a parking lot, or forget someone's name and remember it later. The worrisome memory loss linked more with dementia is different. Signs of this type of memory loss include:
  • Forgetting ever having known someone
  • Losing the ability to drive a car or read a clock
  • Having significant trouble with math calculations
  • Having memory loss that causes you to be unable to do something you have done for years 
You can take other steps that might be more helpful for your memory than eating massive amounts of chocolate. Here are some ideas:
  • Be vigilant about your overall health. Get regular exercise, eat healthy foods and don't smoke!
  • Exercise your brain as well as your body. Play a game, or read and discuss a book, a movie or a sports event with someone else.    
  • Be social. Isolation can lead to depression, which can affect memory as well.
  • Sleep well.
  • Use tricks if you need them. Keep a calendar. Write notes to yourself.  Set a reminder on your phone. 
If you or someone you love has serious worries about memory, discuss it with a doctor. He or she will help you understand normal memory loss, review your medicines and perform some tests. All of this should help determine if there is a serious cause of memory loss. Some causes can be reversed. What Can I Expect Looking to the Future? These study results are really intriguing. We all want to preserve our memories and our functioning.  And, I suspect, most of us would like to see chocolate come out as a heroic contributor. I think that this study will lead to larger studies that will help us to answer important questions about the role of cocoa flavanols in memory retention.]]>
Tue, 28 Oct 2014 00:00:00 -0400
Better College Care Urged for Chronic Illness Most colleges say they can manage care for students with long-term medical conditions, a new study...
What Is the Doctor's Reaction? It's one of the triumphs of modern medicine: youth with chronic diseases are living longer and more normal lives. And more are going to college. The problem is that caring for them often falls apart there. It's no small task to give youth with chronic (long-term) disease normal lives. It often requires:
  • Daily medicines
  • Lots of appointments with doctors and other health professionals
  • Close monitoring by parents and school nurses
  • Adjustments in daily routines
Taking care of a chronic disease requires planning. It requires not only reacting to problems, but also preventing problems from happening. Pediatric practices have learned to do this. They have learned to teach parents and communities how to do it too. But colleges -- or at least most of them -- aren't set up to do it. That was the finding of a study just released in the journal Pediatrics, the official journal of the American Academy of Pediatrics. Researchers surveyed 200 colleges. They asked the colleges how they identify and care for students with chronic disease. They asked about three common chronic diseases: asthma, diabetes and depression. About 42% of the colleges did not have any system at all to identify and care for students with chronic disease.  Nearly one-third, 31%, did have a "registry," a list of students with chronic disease. They also had a system to do some outreach to them. While this is encouraging, 31% is nowhere near enough. In general, college health systems are set up to deal with infections, injuries and other emergencies. They aren't set up to do ongoing management of chronic illness. There is an assumption that parents and students will manage it. When students go to college near their homes and can continue to use their health care team, this is feasible. But when students go to college far from their homes, it's far more difficult. What Changes Can I Make Now? If you have a child with a chronic disease, you can do a lot to help him or her stay healthy at college. First and foremost, it's important to teach teens about their disease. They need to be empowered to take part in their own management. As tempting as it is to do everything for your child, it's important to remember that you won't always be at your child’s side. Taking a few steps can help your teen learn to take over management of his or her chronic illness. By high school:
  • Make sure your teen understands his disease: what it is, what causes it, what makes it worse and what makes it better. Don't assume that he knows already.
  • Make sure your teen knows her medicines and when to take them. Let her take them herself. As you transfer this responsibility, use pill boxes (the kind that have days written on them) or do daily checks on the counter on inhalers to make sure the medicine is being taken. But let her do it herself.
  • Let (or make) your teen do the talking at visits with health-care professionals
  • Give your teen some time alone with health-care professionals.
As your teen gets ready to go to college:
  • Talk to the college. Find out what health services it offers for students, and whether any system is in place for those with chronic disease. Make sure that the college knows your child's diagnosis. Make sure that a medical professional at the school is aware of your child's needs.
  • If your child needs specialty care, find specialists near the college that your child can see. Set up appointments, if possible. Get medical records sent to each specialist's office.
  • If your child is going to school outside of your state, talk to your insurance company. Make sure your child can get medical care in the area.  Most colleges offer a health plan for students, but it may not cover the medical care your student needs off-campus.
  • Talk with your insurance company about getting a 90-day supply of medicines.
  • Put everything in writing. This should include medicines, what to do in an emergency, numbers to call, etc. Give a copy to your child and one to the health staff at the college. For example, all students with asthma should have a written Asthma Action Plan.
What Can I Expect Looking to the Future? As the number of college students with chronic disease increases, colleges will need to work with doctors and parents to come up with systems to care for them. I hope that this study will be a wake-up call to many colleges, and will help to move that process forward.]]>
Mon, 27 Oct 2014 13:57:00 -0400
Pregnancy Diabetes May Affect Daughter's Weight Daughters of women with high blood sugar during pregnancy may be more likely to become overweight...                    What Is the Doctor's Reaction? High blood sugar in a pregnant woman greatly increases the chance that she will develop diabetes later in life. It also increases the risk of a premature (early) delivery and having a very large newborn. There's another important risk. In this study, the daughters of women who had high blood sugar during pregnancy had a much greater chance of becoming overweight or obese early in life than the daughters of women with normal blood sugar in pregnancy. This was true even for daughters whose weights were normal at birth. This is not the first study to show the risk of a higher body mass index (BMI) in children of women who had high blood sugar during pregnancy. These researchers went beyond just looking at BMI. They also looked at the percentage of body fat and the waist-to-height ratios of the daughters. A high waist-to-height ratio indicates you likely have more belly fat. Doctors call it visceral fat. It's the most dangerous type of fat. This type of fat has been linked with a greater risk of diabetes and heart disease. In this study, women's blood sugar levels during pregnancy just needed to be higher than normal to increase their daughters' risk of weight gain. The pregnant women did not need to carry a diagnosis of gestational diabetes. The researchers did identify which daughters had the greatest chance of becoming overweight or obese. They were born to women who were overweight or obese themselves before pregnancy and had gestational diabetes. Gestational diabetes is very common today. Close to 10% of pregnant women develop it. That's why pregnant women are routinely tested for gestational diabetes. The test usually is done between the 24th and 28th weeks of pregnancy. Women are tested sooner if they:
  • Have had gestational diabetes in the past
  • Have symptoms that suggest high blood sugar, such as excessive urination, thirst and dry mouth
For the gestational diabetes test, the pregnant woman drinks a sugar solution. Blood is drawn one hour later. A blood sugar level of 140 milligrams per deciliter (mg/dL) or higher suggests gestational diabetes. What Changes Can I Make Now? Compared with men, women have an extra motivation to maintain a healthy weight and exercise regularly. Excess weight may affect not only their health but also the health of their children. If you are overweight, it's best to lose the weight before you get pregnant.  But once you are pregnant, forget the old saying "eat for two." Women who have a normal body weight at the start of pregnancy should consume 300 extra calories per day. But for overweight and obese women, this is probably too much. Underweight women should eat more. The recommended amount of weight gain during pregnancy depends on your weight before you got pregnant. The Institute of Medicine and the American College of Obstetricians and Gynecologists recommend these goals:
  • For underweight women, gain 28 to 40 pounds.
  • For women of average weight, gain 25 to 35 pounds.
  • For overweight women, gain 15 to 25 pounds.
  • For obese women, gain about 15 pounds.
Ideally, weight gain during pregnancy should be gradual. Most of the gain should occur during the second half of pregnancy. Women who have diabetes or pre-diabetes before a planned pregnancy need to keep their blood sugar as close to normal as possible. If blood sugar levels rise during pregnancy, getting them under control is more important than the amount of weight gain. What Can I Expect Looking to the Future? This study was done just on daughters. It's likely that sons of pregnant women with high blood sugars would also have a greater chance of having more body fat. You can expect a future study to provide us with the answer.]]>
Fri, 24 Oct 2014 19:37:00 -0400
Rare Headaches May Be More Common after Weight-Loss Surgery Some people may develop headaches after weight-loss surgery, a small study suggests. The study...                    What Is the Doctor's Reaction? Low fluid pressure in the brain can cause headaches. It's a rare disorder, known as spontaneous intracranial hypotension. This study alerts us to the potential for these headaches to occur after weight-loss surgery. But they are still uncommon. Doctors often cannot find out the exact cause of headaches that don't go away or keep coming back. Because it is rare, spontaneous intracranial hypotension might not be considered. The brain and spinal cord are surrounded by fluid. This cerebrospinal fluid acts as buffer. It prevents the brain from bumping up against the skull and the spinal cord from pressing against the spine. The fluid is produced deep inside the brain. It fills cavities in the brain called ventricles. The fluid flows out to cover the brain and spinal cord. The brain constantly produces new spinal fluid. Special channels outside the brain absorb older fluid. Normally, new fluid is made and old fluid absorbed at a constant rate. So the pressure around the brain stays within a very narrow range. If the pressure gets too high or too low, it can cause headaches. High pressure around the brain is much more common than low pressure. Most often, high pressure happens because of some major problem such as a stroke, infection or brain tumor. But high pressure can happen without a known cause. It's called benign intracranial hypertension. Intracranial hypotension is the opposite condition. The fluid pressure around the brain and spinal cord is low. The usual cause is one or more small holes or tears in the layer of tissue that surrounds the spinal cord. The spinal fluid sits between the spinal cord and this layer. The holes let spinal fluid leak out, lowering the pressure. Most cases of intracranial hypotension occur after a spinal tap. This procedure is done to get a sample of cerebrospinal fluid for testing. The doctor needs to insert a needle through the covering tissue layer. The hole is small. It almost always seals right away after the procedure. Even with perfect technique, however, the hole might stay open. Fluid can continue to leak out. Intracranial hypotension is called "spontaneous" if low pressure develops around the brain when there was no prior spinal tap or direct trauma to the spine. In this small study, most of the patients with spontaneous intracranial hypotension were found to have leaks. Why this happened after weight-loss surgery is not clear. Of interest, the opposite problem, intracranial hypertension, also causes headaches. This happens most often in obese young women. To treat it, doctors may recommend weight-loss surgery. After surgery, there is often a dramatic fall in cerebrospinal fluid pressure and total relief of headaches. This is probably because small fluid leaks occur. What Changes Can I Make Now? The most common symptom of intracranial hypotension from low fluid pressure is a headache that gets worse if you remain standing. Lying down relieves the pain. Other symptoms may include neck pain or stiffness and nausea. Sometimes vomiting occurs. A new headache after a spinal tap is almost always caused by intracranial hypotension. The spontaneous ones can be more difficult to diagnose because not everyone has the classic symptoms. This type of headache can get better within a couple of weeks if you just spend more time lying down. But it may last for months and sometimes even years. If the pain is mild to moderate, conservative treatments are usually tried first. These include drinking plenty of fluids, adding salt to your diet and taking caffeine tablets. The usual dose of caffeine is 200 to 300 milligrams, taken 2 to 3 times a day. For headaches that are more severe or don't get better, doctors perform epidural blood patch therapy. It's a relatively simple procedure. About one teaspoon of your own blood is injected into the layer of tissue that holds in spinal fluid. The procedure is similar to the epidural injection of pain-relieving medicine used in surgery and childbirth. What Can I Expect Looking to the Future? If you are considering weight-loss surgery, the rare problem of intracranial hypotension should not be a reason to avoid it. But knowing ahead of time that the surgery could be the cause of a new headache would almost surely lead to quicker relief.]]> Thu, 23 Oct 2014 00:00:00 -0400 Quarantine Ends for Ebola Patient's Family Though they shared an apartment with the first Ebola patient who got sick in the United States,...                    What Is the Doctor's Reaction? We have so much to learn about the Ebola virus. This particular strain that is infecting people in West Africa seems to be especially dangerous. Yet research has shown that some people have Ebola viruses enter their bodies but do not get sick or have relatively mild symptoms. Why do people respond so differently? We have many more questions than answers. But experience with other infectious agents and some small studies of Ebola-infected patients provide a few clues. Ebola belongs to a family of viruses known as filoviruses. Ebola is not contagious until a person has symptoms. The virus is spread only through close contact with body fluids. The viral particles enter through the nose, mouth, lining over the eye or a break in the skin. Once inside the body, the Ebola virus multiplies very rapidly, producing millions and millions of viruses. The virus does damage in several ways. It can directly kill certain cells. It also can produce:
  • A substance that blocks the immune system from effectively fighting the virus
  • Another substance that latches onto cells that line the inside of blood vessels. These cells become fragile. It's the reason that bleeding often occurs with this infection.
How quickly and how vigorously the immune system revs up plays a major role in what happens next. Some people don't get sick or have only a flulike illness. That's because their bodies mounted a very quick, robust immune response to the virus. Those who develop more severe problems are most often otherwise healthy, but just don't have the same rapid, vigorous immune response. Obviously, people with known impaired immunity would have a very high risk of dying from Ebola virus infection. Other reasons (not proven) why direct exposure to the Ebola virus might not cause infection include:
  • The virus gets on normal intact skin only, without getting into the nose, mouth or eye.
  • The cells that line the nose, mouth and eye don't allow the virus to either latch on or get beyond the cell wall.
  • The virus gets inside the body. But the person has been exposed to some other strain of Ebola or another type of virus. This means that his or her immune system was already primed to fight the new Ebola virus invasion.
What Changes Can I Make Now? It's important to keep Ebola in perspective for people not living in West Africa. We have had four cases in the United States. And only one person died. Compare that to influenza. Flu viruses infect many millions of people every year and cause thousands of deaths. If you haven't had your flu vaccine yet, get it today. There are more options than ever. To help protect yourself from the flu, colds and other viral infections, wash your hands or use an alcohol-based cleanser frequently.  If you do get a viral infection, your body can fight it more effectively with a strong immune system. You can feel better faster and reduce your risk of serious illness. Following general health guidelines is the best step you can take toward keeping your immune system strong and healthy.
  • Don't smoke.
  • Eat a diet loaded with fruits and vegetables.
  • Take a multivitamin if you suspect that you may not be getting all the nutrients you need through your diet. For example, few foods naturally contain vitamin D.
  • Exercise regularly.
  • Get enough sleep.
  • Maintain a healthy weight.
  • Take steps to lessen stress.
The store shelves are loaded with herbs and supplements promoted to boost the immune system. But so far there is no evidence that they actually bolster protection against infection or disease. Showing whether an herb or supplement can enhance immunity is a complex task. For example, scientists don't know whether an herb that seems to raise the levels of one type of immune cell in the blood is actually doing anything helpful for overall immunity. What Can I Expect Looking to the Future? Ebola will be contained in the United States and in most other countries around the world. But the epidemic in West Africa will take many months to slow down. Meanwhile, vaccine studies are under way. And treatment with antibodies against Ebola has shown some early success.]]>
Wed, 22 Oct 2014 17:21:00 -0400
Study: Common Symptoms Often Not Explained At least one-third of patients who visit a doctor with common symptoms don't get a clear,...                      What Is the Doctor's Reaction? Did you ever see your doctor for something you thought might be serious? Did you leave the office with just reassurance, wondering if you needed some sort of treatment or test? You're not alone. But there are probably good reasons for your doctor's decision not to do too much right away. As this new study shows, most symptoms are not caused by  a serious condition. And most get better in a short time. In fact, an explanation often can't be found for some of the most common symptoms that bring people to their doctors. Among patients seeing a doctor, the most common physical symptoms reported are:
  • Pain. This accounts for about 50% of visits.
  • Respiratory complaints, such as congestion, colds or flu. They account for 25% to 30% of visits.
  • Other symptoms, including fatigue, sleep problems, intestinal symptoms or dizziness. They account for another 20% to 25% of visits.
The latest edition of the journal Annals of Internal Medicine published the study. Researchers reviewed previous research. They excluded respiratory symptoms, such as common colds that nearly always get better quickly on their own. Here's what they found:
  • One third or more of people with common symptoms will have no definite cause discovered, even with many tests.
  • Doctors ask about symptoms and perform a physical examination. This provides up to 94% of the information needed to establish a diagnosis or to rule out serious conditions. Tests may add little more.
  • Psychological symptoms often occur along with physical symptoms. And they can affect each other. Teasing them apart and diagnosing the cause of each may be impossible.
  • In up to 80% of cases, people with common symptoms recover within a few weeks or months. This happens even without a specific diagnosis or treatment.
  • It's rare that a serious condition not suspected at the first visit is diagnosed in follow-up.
  • Some treatments can be helpful for many different symptoms. For example, acetaminophen (Tylenol and generics) can be helpful for headaches, back pain or an achy shoulder, even if the cause of these symptoms is not clear.
  • An explanation itself can be helpful. Providing a possible cause may be more reassuring than throwing up one's hands and leaving it at "well, everything is normal."
These observations are vitally important for doctors who see patients with common physical complaints. But they are also important for patients who are worried about their symptoms. Of course, there are always exceptions. Sometimes there is a serious problem even when it was not suspected during the first visit. Such cases need follow-up and another evaluation. It's good to keep an open mind. But it's also important to know the facts. What Changes Can I Make Now? Based on the findings of this new review, perhaps the biggest change you can make now is to modify what you expect from your doctor. For example, if you have a headache, don't expect your doctor to get a CT scan right away (even if you are worried that you may have a brain tumor). Serious causes of headaches are rare. Most headaches have no obvious cause regardless of how many tests are done. But let your doctor know your concerns. Explaining why a serious condition is unlikely and why extensive testing is not necessary are important parts of your doctor's job. If you have a symptom that bothers you and won't go away, let your doctor know. After a thorough review of your symptoms and an examination, there's a good chance that your doctor can diagnose the cause. But don't be surprised if you get:
  • No diagnosis.
  • No testing.
  • No specific treatment (other than a pain reliever or other supportive treatment).
  • A recommendation to "give it some time."
  • An explanation about your symptoms that is more of a theory than proven scientific fact. For example, your doctor may tell you that stress and tension in the muscles of your neck may be causing your headaches.
If you're getting worse instead of better or the nature of your symptoms changes, it may be best to take another look. At that point, it may be time to order a test or two.  What Can I Expect Looking to the Future? Doctors often say "common things are common." That may seem obvious -- and redundant! The idea is that in most cases, it makes little sense in to go searching for rare conditions when a "garden variety" diagnosis is so much more likely.  The findings of this new review explain how true this is. Amid concerns about too many treatments and too many tests, health-care costs keep going up. We would all do well to recognize that time, not extensive testing and treatment, is often the best medicine.]]>
Tue, 21 Oct 2014 00:00:00 -0400
Seeing Film Violence May 'Desensitize' Parents As they watch more violence or sex in movies, parents may be less bothered by it and more likely...                    What Is the Doctor's Reaction? Do you check what a movie is rated before letting your child watch it? The Motion Picture Association of America (MPAA) rates movies. This system is intended to give useful information to parents about the movie content.
  • General Audiences (G): Anyone can see the movie.
  • Parental Guidance Suggested (PG): Some parts of the movie may not be right for young children to see.
  • Parents Strongly Cautioned (PG-13): Some parts of the movie may not be right for children under 13 to see.
  • Restricted (R): Children under 17 must be with an adult.
Over the years, this system appears to have changed. Rating decisions seem to be made sometimes by chance. The ratings do vary a lot. The amount of violence and sex in movies that can be seen by younger children has gone up. Parents also seem less worried about their children seeing these risky behaviors in movies. How come? A new study in the journal Pediatrics might help explain these trends. Researchers wanted to know if parents have a less emotional reaction to the violence and sex in movies when they see them more often. This is called being "desensitized" -- the more they see it, the less it bothers them. To test this idea, 1,000 parents of children and teens, ages 6 to 17, were asked to watch 6 movie clips in a row. The clips showed violence or sex from popular movies. For each clip, they were asked:
  • The youngest age they thought was OK for a child to see the movie
  • If they would let their own child watch the movie
The more clips parents watched, the more they thought the scenes were OK for children to see.
  • The youngest age they thought was OK for a teen to watch violent or sex scenes dropped from 17 to 14.
  • Parents became more willing to let their own children watch each movie.
Parents also were less bothered by:
  • Violence if they had watched more movies in the last week
  • Violence and sex if they had already seen the movies from which the clips were taken
So is all PG-13 content acceptable for teens? This study suggests that movie ratings probably are not so clear or strict. Many parents may be quicker to accept these ratings if they are desensitized to violence and sex themselves. The parents hired by the MPAA to help decide movie ratings also are probably desensitized to violence and sex, the researchers say. After all, these parents watch hundreds of movies a year. What Changes Can I Make Now? Risky behaviors in movies can affect your child more than you might think. For example, a large body of research has linked watching lots of violence with more aggressive behavior in children. Or if characters engage in sex, teens may see it as exciting and something they want to try. It is your job to make sure your child is watching movies and using other media that are right for his or her age. Be sure to follow these tips:
  • Work to understand the social and emotional development of your child or teen.
  • Know all the different types of media your child uses and sees every day.
  • Insist on a good balance among your child's activities.
  • Make a family plan for movies to watch and safe ways to use all technology.
  • Limit how much time your child spends seeing movies, watching TV and surfing the Internet.
  • Talk often with your child about the dangers of violence, sex and other risky behaviors seen in movies or through technology.
  • Do not rely on movie ratings.
    • Learn more about the movie to decide what is right for your child to see.
    • Know that there may not be any difference in the amount of violence and sex shown in movies rated PG-13 rather than R.
    • Do not watch movies or TV shows you do not think are OK for your child in front of him or her.
What Can I Expect Looking to the Future? The increasing amount of violence and sex in popular movies is cause for concern. More research is needed on the effect of violence and other risky behaviors in movies on children's future behavior. Parents should make their own informed decisions on what movies their children watch. We also need to take a new look at the movie ratings system. It does not appear to be so effective in protecting youth from being exposed to problem content that could have a negative effect on their health. Future studies should explore potential improvements to the system. These could include:
  • Ways to prevent desensitization in movie raters
  • The effect of recruiting more parents to participate in the rating system
Mon, 20 Oct 2014 00:00:00 -0400
2 Nurses Get Ebola; Response under Scrutiny In a hearing October 16, members of Congress criticized mistakes that may have allowed Ebola to...                    What Is the Doctor's Reaction? Until last year, a young doctor worked alongside me in my primary care clinic in Oregon. He moved to Dallas. Today I learned that he is one of the 76 health-care workers who are being watched for signs of Ebola infection. He cared for Thomas Duncan, a Liberian who died in a Dallas hospital. Two nurses have been diagnosed with Ebola virus after caring for that same patient. When you work in health care, you feel a kinship with other health-care workers everywhere. Doctors and nurses share a language. They manage the same stresses day to day. So the news out of Dallas felt very personal to me, even before I heard that my close colleague cared for this patient. In fact, it has felt personal that more than 400 health-care workers have become infected in West Africa. Texas Presbyterian Hospital has been criticized for fumbling in its delayed diagnosis of Duncan and in its protection of health workers. The Centers for Disease Control and Prevention (CDC) has also been criticized, and not without reason. The CDC apparently advised a nurse with a low-grade fever that she could travel on a commercial airline. We are learning lessons. I have misgivings about the special risk Ebola poses to nurses and doctors. If an Ebola case came to my hospital, I hope that we could diagnose it without delay. I hope that we would take every precaution in perfectly isolating a patient and safeguarding caregivers. But my hospital is not unlike Texas Presbyterian in its level of preparedness for Ebola. My hospital just circulated a first draft of a protocol for Ebola. It is a strong protocol, but we have not practiced it. Like most American hospitals, we are not yet ready for Ebola to come through our doors. What Changes Can I Make Now? The spread of Ebola to two Texas health workers has been devastating news. Still, the events in Dallas have snapped the health-care system to attention. That, at least, is a good thing. I am glad to see changes being made by the CDC. Both of the sick nurses were moved to hospitals that have special isolation units to contain biohazards. They will receive care from experts trained to care for Ebola patients. Four hospitals have these units. They are in Georgia, Maryland, Nebraska and Montana. They have a total of only 19 isolation unit beds. Depending on the way this virus outbreak evolves, these hospitals may not be able to shoulder the full load of Ebola care in the United States. But for now they can handle Ebola safely. They can provide other hospitals with time to do detailed training and stock up on appropriate equipment. Hospitals are up to this task. Experts advise use of a "buddy plan" for Ebola care. One person works in a patient room. The other person watches. If any possible errors or contamination occur, the buddy must insist on a break for decontamination. Hospital training sessions will need to include hands-on practice in putting on and taking off protective gear in a way that does not risk spreading the virus. Ebola protocols will definitely limit the number of caregivers providing for a patient. This will limit the number of health-care workers who could be exposed. In the first days of the AIDS epidemic, doctors learned to keep themselves safe from HIV by practicing "universal precautions." They took care to wear gloves and manage needles in the same safe way for every patient, whether the patient was known to have AIDS or not. For Ebola, taking universal precautions will not be practical. We can't wear the protective suit with every patient. Instead, we need to have "universal consciousness." Everyone needs to expect that Ebola might come to his or her hospital. We need to ask all patients with fever or signs of infection whether they have traveled and to where. We need to isolate suspect cases without delay. What Can I Expect Looking to the Future? My colleague in Texas has one more anxiety-filled week to wait and watch for symptoms. I am deeply hopeful that he will remain free of fever. As we will see in Texas, the key to containing Ebola is contact surveillance. This means that people who have been in close contact with an Ebola patient must be watched for 21 days. Temperatures are taken twice daily. Symptoms are reported. Public contacts are avoided. Potentially, people with high-risk exposures may be placed on a "no-fly list" during this time. These precautions help us to keep a single case or a small cluster of cases from breaking into the open community. This low-tech strategy works, for these reasons:
  1. Ebola is not contagious until a person has symptoms.
  2. Ebola is spread only through close contact with body fluids.
  3. Ebola infection always causes symptoms. And the symptoms always occur in the first 21 days after exposure.
If any one of these things were not true about Ebola, contact surveillance and quarantines would not be able to contain infection. We are lucky that the spread of Ebola can be so easily "mapped."]]>
Fri, 17 Oct 2014 13:12:00 -0400
Psoriasis Linked to Poor Blood Pressure Control People with severe psoriasis may have more problems with controlling high blood pressure, a new...                    What Is the Doctor's Reaction? Psoriasis is a condition that causes patches of skin to become inflamed and scaly. It affects up to 4% of the U.S. population. Most people, including doctors, probably think of psoriasis as a problem confined to the skin. That's why it's surprising -- and important – to hear news that it may be linked to other serious health conditions.  For some, psoriasis is a minor annoyance. For others, it's a much bigger problem. When severe, the rash of psoriasis can cause pain, fevers and chills. People with psoriasis may develop skin infections. About one-third of people with psoriasis develop a form of arthritis called psoriatic arthritis. This disease can damage joints permanently. Previous research has linked psoriasis with an increased risk of high blood pressure (hypertension), heart attack and stroke. A new study tells us more. It shows that people with psoriasis are less likely than others to have their high blood pressure under control. The journal JAMA Dermatology published the study. Researchers enrolled more than 13,000 people with high blood pressure. About 10% also had psoriasis. Here's what the study found:
  •  Treatments for high blood pressure were similar for those with and without psoriasis.
  •  The more severe the psoriasis, the higher the blood pressure.
  •  The findings were unchanged even after accounting for psoriasis treatments that can affect blood pressure.
This study suggests that psoriasis may directly lead to increases in blood pressure.  These findings could have an important impact on the treatment of people with psoriasis. They could even lead to new insights into the cause (or causes) of high blood pressure. What Changes Can I Make Now? This latest research suggests that if you have psoriasis, it may be a good idea to get your blood pressure checked regularly. And if you have high blood pressure and psoriasis, frequent checks may help you make sure your blood pressure is in a good range. It could turn out that controlling your psoriasis will help control your blood pressure, although that's unproven. If you have psoriasis, know your treatment options.  They include:
  • Medicines applied to the skin, such as lubricants or corticosteroids
  • Phototherapy (often called "light therapy")
  • Medicines related to vitamin A, such as acitretin
  • Medicines that affect the immune system, including methotrexate or an injectable "biologic" drug (such as etanercept, infliximab, adalimumab or ustekinumab)
Each of these medicines has risks and benefits. Discuss them thoroughly with your doctor. Things to consider include how well the medicines work for you and their side effects, convenience and cost. Choosing among these options will be based on:
  • How severe your psoriasis is
  • Your own preferences
The cause of high blood pressure is usually impossible to identify in a particular person. But changing any factors that increase your risk might prevent it.  Risk factors that can be changed include:
  • Excess weight
  • Lack of regular exercise
  • Excessive drinking of alcohol
  • A diet that is high in salt (for example, more than 3,000 milligrams a day)
  • Certain medicines, such as corticosteroids
  • Smoking
High blood pressure can lead to heart attack, stroke and other health problems. So it's important to:
  • Reduce your risk of developing high blood pressure
  • Find out if you do have it
  • If necessary, take medicines to lower your blood pressure
What Can I Expect Looking to the Future? We don't understand yet why links have been found between heart disease and inflammation of:
  • The skin (as with psoriasis)
  • The joints (as with certain types of arthritis)
  • Other parts of the body
In some cases, it appears that reducing the inflammation helps to protect against potential effects of heart disease, such as heart attack. For example, future research could show that treatment of psoriasis helps control high blood pressure. Research in this area is still in its early stages. So stand by. There is much more to come regarding the links between diseases marked by inflammation (such as psoriasis) and diseases of the heart and blood vessels. I hope that studies like this one will lead to new insights into both conditions.]]>
Thu, 16 Oct 2014 00:00:00 -0400
Black Diabetics More Likely to Lose a Leg Amputation rates for Americans vary greatly depending on their race and where they live, a study...                    What Is the Doctor's Reaction? Medical care in the United States varies greatly depending on where you live and your race. Health insurance coverage explains only part of the difference. The Dartmouth Atlas Project has used Medicare data to help better understand factors other than health insurance that may be linked to variations in care. The project started more than 20 years ago. The project's most recent report highlights regional and racial differences in diabetes care related to the risk of amputation. More than 100,000 major leg amputations are performed on Medicare patients each year. More than half of them have diabetes. The other big factor that increases the risk of amputation is poor circulation in the legs. It's called peripheral artery disease (PAD). PAD is caused by buildup of fatty deposits in leg arteries. The deposits get hard and lead to decreased blood flow to the lower legs and feet. Having both diabetes and PAD puts a person at even greater risk of amputation. The researchers looked at Medicare claims data that identified people with both diabetes and peripheral artery disease. The period covered was from 2007 to 2011. Then the researchers looked at amputations in this group. They compared the rates of amputation by region and race. The differences were dramatic. The rate of amputation in blacks with diabetes and PAD was almost three times as high as the rate among non-blacks with these conditions. Amputation rates were five times as high in some regions as in others. The path from health to diabetes and PAD and then to amputation is a long one. Steps taken along the way can prevent many amputations. But this doesn't always happen. This report helps identify the many regional and racial challenges that help shed light on why care varies so much. Many issues influence prevention and treatment. They include:
  • Level of education, which affects how well people understand the complexities of care
  • Finances, which keep some people from filling prescriptions, buying special footwear or getting to the doctor's office
  • Cultural beliefs and trust in Western medicine
  • Access to primary care
  • Differences in how quickly doctors recommend surgery for PAD that can open blockages
What Changes Can I Make Now? If you have diabetes and PAD, you can do a lot to avoid ever coming close to needing amputation. It doesn't even cost much. Here's what you can do:
  • Don't smoke. Even if you need medicine to help you quit, not smoking will save you money.
  • Keep your blood sugar under control with diet and exercise so you can take less medicine. If you need medicine, work with your doctor to choose low-cost generics.
  • Lower your cholesterol. You should be taking a statin. There are several excellent generic choices today.
  • Walk several times per day to help your circulation.
  • Take great care of your feet.
Foot care is essential. Diabetes damages the nerves, so you may not feel an injury. A small break in the skin can lead to an ulcer that is likely to get infected. Once this happens, the risk of amputation goes way up, even with the best wound care and antibiotics. Here's how to take care of your feet:
  • Examine your feet every day. Look for any sores, cuts, scratches, breaks in the skin or swollen areas. Don't forget to check between your toes.
  • Wash your feet with warm water and soap every day. Dry them carefully. Don't soak your feet. This can lead to dry, cracked skin.
  • Massage feet with a moisturizing cream to prevent dryness. This reduces the chance of cracking, which can lead to skin infection. But don't moisturize between the toes.
  • Keep toenails well cared for to avoid ingrown nails. But if this problem develops, don't try to remove the nail yourself. See your doctor instead.
  • Have all calluses, corns, warts and other common foot ailments treated by a health professional.
  • Don't use anything that’s too hot or too cold on your feet.
  • Put on clean socks or stockings each day.
  • Wear well-fitting, comfortable shoes. If neuropathy makes it hard to tell how a shoe feels, consult an expert in fitting footwear for people with diabetes.
  • To reduce the chances of injuring your feet, avoid going barefoot.
What Can I Expect Looking to the Future? The results of this study can actually help Medicare save money. Complex medical care and surgeries are expensive. This study points toward some of the factors that affect amputation risk. With better understanding of these factors, doctors and public health officials will be able to take steps to improve care and lower costs.]]>
Wed, 15 Oct 2014 14:04:00 -0400
Gender May Affect Heart's Reaction to Stress Stress may affect women and men with heart disease in different ways, a new study suggests. The...                    What Is the Doctor's Reaction? Our bodies often encounter the effects of stress. Occasional short-term stress raises heart rate and blood pressure. It also can cause blood vessels to tighten and send signals that could increase blood clot activity. These changes usually don't last long. In healthy people, this response does not appear to affect health. But for someone with coronary artery disease, these responses can lead to chest pain and even a heart attack. The results of this study provide more insight into why this happens. It's now well known that women and men differ in how they experience coronary artery disease. Women often do not have the typical squeezing pain in the middle of the chest with exertion. They might just sweat heavily or feel short of breath or extremely weak. Women with coronary artery disease also do worse than men with the disease.  This cannot be explained simply by the traditional risk factors such as family history, smoking and high cholesterol. This new research offers some plausible explanations for the difference. The researchers recruited people with stable coronary artery disease. This means they had known blockages of the coronary arteries. But they had no symptoms or very predictable symptoms with exertion. The study participants were given mental tasks to induce stress. Men tended to show a rise in blood pressure and heart rate. But this often did not cause areas of the heart to show impaired function. Women tended to have a different response. They showed less increase in heart rate and blood pressure. But they were more likely than men to show impaired heart function as a result of reduced oxygen supply to heart muscle cells. This might have occurred because of blood clots or tightening of coronary arteries. The study included 82% men and only 18% women. Higher than average percentages of the women were African-American, lived alone or were unmarried. These factors could definitely influence the study results. What Changes Can I Make Now? Frequent or persistent stress is common. Surveys done by the American Psychological Association have found that about 25% of Americans have high levels of stress. How we react to stress also matters -- and not just for women with heart disease. Repeated activation of the stress response takes a toll on the body. Stress contributes to high blood pressure. It promotes the formation of artery-clogging deposits that can lead to heart disease. And it can cause brain changes that may contribute to anxiety, depression and addiction. Here's how to help counter the stress response:
  • Use the relaxation response. Every day, plan to spend some time at rest (not asleep). Sit somewhere comfortable. Close your eyes and relax your muscles. Focus on breathing regularly. Continuously repeat one word. Repeat it aloud or in your mind. It should be a simple word, such as "relax" or "easy," a religious word or phrase, or a syllable such as "om," used in many forms of meditation. Continue regular breathing with your muscles relaxed.
  • Unwind with physical activity. For example, taking a brisk walk shortly after feeling stressed deepens breathing and helps relieve muscle tension. Movement therapies such as yoga, tai chi and qi gong combine fluid movements with deep breathing and mental focus. All of these can induce calm.
  • Reach out for social support. Family members, friends and companions all provide a life-enhancing social net. Close relationships can offer emotional support that helps to sustain you at times of stress.
What Can I Expect Looking to the Future? For the near future, prevention and treatment of heart disease will be similar for women and men. But studies such as this one will promote further research into the important differences related to the mind-heart connection in the two sexes]]>
Tue, 14 Oct 2014 00:00:00 -0400
Cold Temperatures Change Fat Behavior Body fat can burn more calories in colder temperatures, a study has found. The study examined... What Is the Doctor's Reaction? All fat is not created equal. It turns out there is good fat and bad fat. The typical fat we think about is called white fat. It's the kind that isn't good for you. It stores calories and adds inches to waist lines. The other kind of fat called brown fat does the opposite. It creates heat and burns calories, which can lead to weight loss. Newborn babies have a relatively high amount of brown fat. As we age, we lose much of our brown fat and white fat increases. Most adults have more than 1,000 times more white fat than brown fat. We can't naturally make our bodies produce more brown fat. But this study and other research shows that white fat can be stimulated to act more like brown fat. Cooling white fat turns on a couple of genes that increase the metabolic activity of fat cells. The fat cells begin to burn more calories. Scientists have coined the term "beige fat" for this transformed white fat. But not everyone has the same potential to make white fat behave more like brown fat. People that are obese don't have the same response to fat cooling. Their white fat doesn't become beige. What Changes Can I Make Now? Right now you still need to rely on the basic weight loss formula. You need to burn more calories with physical activity than you take in. Most recently I have been recommending a reduced-calorie, Mediterranean-style diet:
  • Five or more servings of vegetables a day. A serving is ½ cup of raw or cooked vegetables, 1 cup of raw leafy greens or ½ cup of vegetable juice.
  • Four servings of fruit a day. A serving is ½ cup of fresh, frozen or canned fruit; ¼ cup of dried fruit; one medium-sized piece of fruit; or ½ cup of fruit juice.
  • About 3 tablespoons of olive oil a day.
  • One handful (about 1½ ounces) of nuts, 3 times per week.
  • Three to five servings of legumes (beans, peas and lentils) per week. A serving is ½ cup.
  • Five servings of whole grains a day. A serving is 1 cup of dry breakfast cereal; ½ cup of cooked cereal, brown rice or whole-grain pasta; or one slice of whole-grain or multi-grain bread.
  • Three or more servings of fish (especially fatty fish) a week. A serving is 4 ounces.
  • One serving of yogurt or cheese a day.
  • If you enjoy alcohol, limit yourself to an average of one drink a day. One drink is 5 ounces of wine, 12 ounces of beer or 1½ ounces of liquor.
Specifically avoid:
  • Soda and sugary drinks
  • Sweets, pastries and commercial bakery goods
  • Red and processed meats (eat white meats instead)
  • Margarines and most tub spreads
What Can I Expect Looking to the Future? Keeping your house cooler won't become the new trend to lose weight. Our bodies adjust to lower temperatures in other ways. So at most you might shed a pound or two by turning down your thermostat. It's still a good idea if you want to save money on heating bills. But scientists are likely to get excited about this study. If cool temperatures can alter white fat to act more like brown fat, it raises the possibility that there are other ways to create more beige fat.]]>
Fri, 10 Oct 2014 11:58:00 -0400
Lifestyle Factors Affect Stroke Risk Women with a healthy lifestyle are half as likely to have a stroke, says research from Sweden. The...
What Is The Doctor's Reaction? Sometimes it seems as though every other health-related news story has the same conclusion: Exercise more, eat better, give up bad habits and your health will improve. Well, here's another one. In a large study of Swedish women, researchers showed that just five healthy lifestyle factors can dramatically reduce the risk of stroke. Stroke is a leading cause of death worldwide. In the study, more than 31,000 women with an average age of 60 completed a survey with 350 questions. (That's right, 350 questions!) Researchers assessed these five lifestyle factors:
  • Being a lifelong nonsmoker
  • Having a healthy diet – This was defined by how often fruits, vegetables and other healthy foods were consumed.
  • Drinking alcohol in moderation (3 to 9 drinks per week)
  • Being physically active – Research subjects could meet this goal by walking or biking at least 40 minutes daily and exercising more intensely at least an hour each week.
  • Having a healthy body mass index (BMI), an assessment of body weight that takes height into account – This was defined as a BMI below 25.
The researchers found that:
  • Less than 2% of the women reported "yes" for all of these factors. Most said "yes" to 2 or 3 of them.
  • These factors affected the women's risk of stroke. For example, comparing women with and without each healthy lifestyle factor, the risk of having a stroke over the 10 years of the study was:
    • 15% lower for those with a healthier diet
    • 20% lower for nonsmokers
    • 23% lower if 1 of the 5 factors was present (compared with none)
    • 35% lower if 3 factors were present (compared with none)
    • 54% lower if all 5 factors were present (compared with none)
Strokes can cause devastating brain damage or death. Treatment for stroke is not reliably effective. So prevention is crucial. This new research shows how these lifestyle factors can contribute to protection from stroke. For these reasons, this study is noteworthy.

What Changes Can I Make Now? The findings of this latest research make it clear the changes you can make to reduce your risk of stroke: Don't smoke. If you smoke now, commit to quitting. And if you are unable quit on your own, talk to your doctor about medications and programs that can help. Choose a healthy diet. A good starting point is a diet that is rich in vegetables, fruits and whole grains and limited in saturated fat and trans fat. Moderate your intakes of sugar and salt. For healthy sources of fat and protein, go with seafood, poultry, beans, lentils, nuts and tofu, rather than red meat. Moderate your alcohol consumption. A good rule of thumb is up to 1 drink a day for women and up to 2 drinks a day for men. Be physically active. Aim for moderate to vigorous physical exertion for at least 30 minutes daily, most days of the week. Watch your weight. Check your BMI. For most people, a BMI between 18.5 and 25 is ideal. Try to balance your calories consumed with calories burned. Reducing the portion size of foods and increasing your exercise are important ways to achieve this balance. You've probably heard these recommendations before. And they may seem easy to make. But an epidemic of obesity and obesity-related health complications suggest that despite widespread awareness, these changes are, in fact, not easy to make. So, speak to your doctor about your risk factors for cardiovascular disease (including heart attack and stroke) and make a plan to reduce your risk. Then stick with it.

What Can I Expect Looking To The Future? In the future, it's likely you will hear more about the value of a healthy lifestyle. While it may seem redundant, repetition may be the best way to make it happen.]]>
Thu, 09 Oct 2014 00:00:00 -0400
Diabetes: Screen all Adults 45 and Older Adults age 45 and older should be screened for type 2 diabetes and prediabetes, says new advice...
What Is The Doctor's Reaction? In the United States, 29 million people are living with diabetes. But 8 million of them don't know they have it. And estimates from 2012 put the number of people with pre-diabetes at 86 million. If nothing changes, as many as 1 in 3 American adults will have diabetes by the year 2050. Both major types of diabetes, type 1 and type 2, are rising. But it’s type 2 diabetes that is increasing so dramatically. It used to be called adult onset diabetes. But now the condition is also affecting children. To help address the rapid rise in type 2 diabetes, the United States Preventive Services Task Force (USPSTF) has just expanded its recommendations on screening. The task force now recommends blood sugar testing for:
  • All adults age 45 and older
  • Younger adults who are overweight or obese
  • Younger adults who have a mother, father, sister or brother with diabetes
  • Women with a history of gestational (pregnancy related) diabetes or polycystic ovary syndrome
  • Certain ethnic groups, including African Americans, American Indians/Alaska Natives, Asian Americans, Hispanics/Latinos, and Native Hawaiians/Pacific Islanders
The two most common tests to screen for diabetes and pre-diabetes are the fasting blood sugar and the hemoglobin A1c (HbA1c) blood test. For the fasting blood sugar test, you don’t eat or drink anything other than plain water for 8 hours prior to the blood draw. You don’t need to fast for the HbA1c blood test. It can be done any time of the day. Fasting blood sugar levels:
  • Normal: Less than 100 mg/dL
  • Pre-diabetes: 100mg/dl – 125 mg/dL
  • Diabetes: Greater than 125 mg/dL
Hemoglobin A1c is measured as a percent of blood sugar that binds to hemoglobin in red blood cells. It reflects the average blood sugar over the prior 2 -3 months. HbA1c levels:
  • Normal: Less than 5.7%
  • Pre-diabetes: 5.7 – 6.4%
  • Diabetes: 6.5% or higher (on 2 separate blood tests)
What Changes Can I Make Now? You can't prevent type 1 diabetes. But type 2 diabetes can be prevented. And even if already present, life style changes can often help control it with little or no medication. That’s why the USPSTF has expanded recommendations for blood sugar screening. The major problem in type 2 diabetes is insulin resistance. Insulin normally helps the sugar in our blood get into the liver and muscles to provide energy. In type 2 diabetes, the liver and muscle cells don't respond well to the insulin. The cells are "insulin resistant." When blood sugar can't move into the cells, sugar in the blood starts to rise. The pancreas puts out more insulin to try to push the sugar into cells. This starts a cycle of higher blood sugar and blood insulin levels. Eventually, the pancreas can't keep up with the rising blood sugar. The way to help prevent and treat type 2 diabetes is to ask your pancreas to make as little insulin as possible to keep blood sugar in the normal range. Of course, you can't command your pancreas to do that. But you can help make it happen.
  • Maintain a healthy body weight.
  • Keep your waistline trim. There is no consensus on an ideal waistline. I suggest less than 30 inches for women and less than 35 inches for men.
  • Stay as physically active as you can throughout the day.
  • Dedicate a minimum of 30 minutes a day, most days of the week, to moderate-intensity exercise. If you need to lose weight, strive for 60 minutes daily.
  • Eat and drink fewer products that contain simple sugars.
What Can I Expect Looking To The Future? We definitely have the potential to slow the rise of diabetes and even reverse the trend by helping people take the steps we already know can work.]]>
Wed, 08 Oct 2014 00:00:00 -0400
Liberian in U.S. Has Ebola; 100 Being Watched A Liberian man visiting the United States has been diagnosed with the Ebola virus. The Centers for...                    What Is the Doctor's Reaction? Ebola virus has come to the United States. In Dallas, a Liberian man with the illness has been placed in a private and isolated hospital room. About 100 people in the community are lying low and watching for symptoms. They were either exposed to the patient or exposed to people who were exposed to him. Needless to say, this Texas community and the rest of America are fearful there may be more cases. In West Africa, the number of Ebola cases seems to be racing out of control. A prediction has been made that there might be 1.4 million cases by January, if something is not done to stop the epidemic. So we know this is a highly contagious disease. But experts all seem to agree: Ebola can be contained in a developed country like the United States.  We have heard this reassurance from leaders at the Centers for Disease Control and Prevention (CDC). We also have heard it from the top infectious disease official at the National Institutes of Health. Can they be right? Can we be confident that Ebola will be contained (kept from spreading) where we have cases in the United States? One protesting doctor who is not an Ebola expert has made his doubts clear. He traveled through Atlanta's airport wearing a showy protective suit with the words "CDC IS LYING" on his back! I am a primary care doctor, and as a health care worker I have some legitimate worry about Ebola. When I first heard loud and clear reassurance from the CDC, I was surprised. But these experts are smart people. So I thought about this question a lot. And I believe our experts. Ebola can be contained. Ebola is spread by contact with body fluids, especially vomit, diarrhea, sweat and saliva. There are two key reasons that Ebola can be contained: 1. Ebola is only contagious to people who are in close contact with a patient who has symptoms. Unlike measles and other diseases that can be spread through a cough or sneeze, Ebola does not spread through the air. This helps us. It means we can name everyone who might have a risk for infection. It also means we can limit the number of people who are exposed. We can do this by quickly isolating the patient and limiting the number of caregivers. The key to containing Ebola is "contact surveillance." This means that people who have been in close contact with an Ebola patient must be watched for 21 days, to see if they have symptoms. Each person's temperature is taken twice daily. Symptoms are reported. Public contacts are avoided. Contact surveillance helps us to keep one case or a small cluster of cases from breaking into the open community. 2. Ebola always causes symptoms. And this always occurs in the first three weeks after exposure. The fact that Ebola is so good at making people ill sounds sinister, but it is actually a tremendous advantage. It is the reason we can contain Ebola. In this way, Ebola is very different from another terrible infection that was much harder to contain: polio. Polio also spreads through direct contact with body fluids. But for every 10 people who got infected with polio, only one would show symptoms. This made it impossible to stop the epidemic by putting people in quarantine. Quarantine could only identify a small fraction of the cases. Many active cases were released from quarantine because they were not known to be infected. So polio was not contained in the United States until a vaccine was available. Ebola will be different. What Changes Can I Make Now? Franklin D. Roosevelt said, "The only thing we have to fear is fear itself." In West Africa, fear and mistrust of government have led to delays in patients seeking medical care. This has worsened the spread of disease. In order to contain Ebola, we need perfect cooperation with contact surveillance efforts. Public health officials will help us through to the end of each case or case cluster. We are up to this task. Go ahead and trust the experts at the CDC. I do and so can you.  What Can I Expect Looking to the Future? In West Africa, Ebola has stretched the capacity of local communities to cooperate with containment efforts. It may take years to contain the Ebola outbreak in West Africa. There is some chance that this outbreak may not be contained until we can develop an effective vaccine. America can mobilize resources effectively at home. Ebola will look very different in the United States than it does in Africa. As Africa's outbreak continues, we will certainly see cases in the United States. We will also see some small clusters of cases. U.S. health care professionals will need to be vigilant to quickly recognize cases. This will allow them to be isolated right away, so that contact surveillance can remain manageable.]]> Fri, 03 Oct 2014 13:02:00 -0400 Study: Social Ties Help Heart Attack Recovery Social support may help younger as well as older adults avoid depression and poor quality of life...                    What Is the Doctor's Reaction? Having friends and family around you can improve the quality of your life. But could it actually improve your health?  It could, according to a new study of more than 3,400 adults under age 55 who survived a heart attack. People were asked about their social supports. They included friends, family and others who:
  • Provided companionship
  • Served as confidants
  • Offered advice
  • Provided emotional, financial or other support
Here's what the researchers found out:
  • About 1 in 5 people had low levels of social support.
  • Those who had low social support were more likely than those with more support to:
    • Drink too much
    • Smoke
    • Be unmarried or live alone
    • Be unemployed
    • Have health factors that increased their risk of heart and blood vessel disease (such as high blood pressure)
A year after a heart attack, those with low social support had:
  • More symptoms of depression
  • More psychological distress
  • Lower quality of life
Findings were similar for women and men. Why is this study important? Heart and blood vessel disease, including heart attacks and stroke, is the leading cause of death in the United States. It is essential that we understand how it develops, how to prevent it, and how to improve survival. And we've seen remarkable advances in all of these areas. The role of social supports in heart disease has only recently been considered. The results of this study suggest that it may be a powerful one. Establishing and encouraging social connections could improve the health of younger adults after a heart attack just as much as some medicines or procedures. What Changes Can I Make Now? You can make several changes to reduce the odds that you will have heart disease, including a heart attack. 
  • Don't smoke.
  • Get regular exercise.
  • Maintain a healthy weight.
  • Get your blood pressure and cholesterol checked, and get treatment if they are not in ideal ranges.
  • Take medicines to control your blood sugar if you have diabetes.
  • Take aspirin, a statin medicine or both if you are at high risk for heart disease.
Should improving your social supports be on this list? Perhaps. But it may not be that simple. This study found a link between low social supports and worse outcomes from a heart attack a year later. However, this doesn't prove that better social support will actually improve outcomes. And even if it could, recommending better social support is much easier than making it happen. What Can I Expect Looking to the Future? We need more research on the connection between social support and better recovery from heart attack among adults of all ages. If this link is confirmed, encouraging improved social support could become a routine part of care after a heart attack, especially for those who have few social contacts. For example, doctors might refer patients to a support group. This is already happening to some extent. Many doctors and groups, such as the American Heart Association, encourage people with heart disease to share information and experiences and provide support to one another. You can also expect to hear about research that may help us to understand why social supports affect outcomes after a heart attack. The results of such research could lead to dramatic changes in the care of people who have had heart attacks.]]>
Wed, 01 Oct 2014 13:48:00 -0400
Neurology Group Backs Less Use of Narcotics Narcotic pain relievers are usually too risky for long-term treatment of headaches, low back pain...                    What Is the Doctor's Reaction? Narcotic painkillers have been around for a long time. When used properly for short periods of time, they can be very effective and safe.  However, long-term use leads to tolerance. That means you need higher and higher doses to get pain relief. This can lead to addiction. And high doses can cause accidental death. The American Academy of Neurology has joined the chorus of other medical groups to say that we need to make changes. The excess use of narcotic painkillers is a recent phenomenon. Before the late 1990s, doctors were strongly discouraged from prescribing narcotics. The exceptions were for pain related to cancer and terminal diseases. Use of these drugs for chronic (long-lasting) pain not related to cancer began to grow at the end of the last century. Advocacy groups pushed to make pain relief a priority for all patients. They said the cause of the lasting pain did not matter. The push was so strong that pain assessment became the "fifth vital sign." Patients now are routinely asked to rank their pain level from 1 to 10. The four traditional vital signs are blood pressure, heart rate, temperature and breathing rate. Prior guidelines focused on the amount of painkiller patients were taking. Doctors were advised to consult a specialist for patients using a high dose of narcotics regularly. Specifically, referral was recommended for patients who took a narcotic dose equivalent to 120 milligrams per day of morphine (or more) and did not have good pain control and improved function. Doctors could refer patients to any specialist who might offer help. But most often this meant referral to a pain specialist. A dose of 120 milligrams of morphine equals about:
  • 800 milligrams (mg) of codeine
  • 50 mg of fentanyl (Duragesic), in a patch
  • 120 mg of hydrocodone (Vicodin)
  • 30 mg of hydromorphone (Dilaudid)
  • 80 mg of oxycodone (Percocet, Oxycontin)
The older guidelines did not stop the growth in prescriptions written for narcotics. And there is no evidence that narcotics are effective treatment for non-cancer pain that lasts more than three months. So these new guidelines from the American Academy of Neurology recommend that doctors avoid long-term narcotics for:
  • Headaches
  • Low back pain
  • Fibromyalgia and similar pain syndromes
What Changes Can I Make Now? For short-term pain relief after an injury or surgery, narcotic painkillers are an excellent choice. But for long-lasting, non-cancer pain, there are many better choices. Before starting treatment, it's important to understand why you have persistent pain. That's not always possible. People can have lasting pain without a definite diagnosis. But it still helps to have some theory as to what is causing your pain. This theory can help provide a focus for non-drug therapies, such as physical therapy and relaxation techniques. When drugs are needed, the type of pain matters. For example, nerve pain does not respond very well to narcotics. Other drugs are designed specifically for nerve pain. They include:
  • Gabapentin (Neurontin)
  • Duloxetine (Cymbalta)
  • Low-dose amitriptyline (Elavil)
Sometimes pain is related to inflammation. In that case, a nonsteroidal anti-inflammatory drug (NSAID) can be very effective. NSAIDs include:
  • Ibuprofen (Motrin, Advil, generic versions)
  • Naproxen (Naprosyn, Aleve, generic versions)
Even if a narcotic needs to be added to the NSAID from time to time, the dose required is often smaller. What Can I Expect Looking to the Future? In the next few years, changes in narcotic prescribing patterns will surely lead to tensions between doctors and some of their patients. Government agencies will be more closely following the narcotic prescribing practices of doctors. But helping patients to get pain relief will continue to be an important priority, as it should be.]]>
Tue, 30 Sep 2014 13:56:00 -0400
Pediatricians Back Long-Acting Birth Control Long-acting birth control methods should be the first choice for teenagers who have sex, the...                    What Is the Doctor's Reaction? Teenage pregnancy happens way too often. About 750,000 U.S. teens become pregnant each year. Most of these pregnancies are unplanned. The teens are not ready to become parents. There are many ways for teens who are having sex to prevent pregnancy. This is called birth control or contraception. Each form has pros and cons. Some types of birth control use female hormones to prevent pregnancy (most effective). Others block sperm from entering the body (less effective). The American Academy of Pediatrics (AAP) just released its updated policy statement on birth control for teenagers in the journal Pediatrics. The statement recommends that pediatricians:
  • Protect the privacy of all teenagers.
  • Ask about each teen's sexual history in a caring and non-judgmental way.
  • Explain that not having sex (abstinence) is the best way to prevent pregnancy (works all the time).
  • Discuss the pros and cons of each method of birth control.
  • Encourage the correct use of condoms every time the teen has sex. Hormones prevent pregnancy. But the condom protects against spreading sexually transmitted infections (STIs).
This report also highlights what pediatricians should know about the different ways to prevent pregnancy. These methods of birth control are listed below in the order of how well they prevent pregnancy. Those that work the best are listed first. Those at the end do not work nearly as well.   The AAP says that the first two, which are long-acting, should be the top choices for teen patients.
  • Progestin implant. A small rod that releases a hormone into the body is placed under the skin of the upper arm.
  • Intrauterine device (IUD). This small T-shaped object is placed inside the womb (uterus). Some IUDs use hormones. Others, coated in copper, work as a barrier.
  • Progestin-only injectable contraception. A hormone shot is given every three months.
  • Combined oral contraceptives ("the pill"). These pills contain two different hormones, progestin and estrogen. A pill must be taken every day.
  • Vaginal ring. This ring is placed into the vagina to release hormones into the body.
  • Transdermal patch. The patch is placed on the skin to give off hormones into the body.
  • Progestin-only pills ("the mini pill"). A pill with only one hormone (progestin) is taken every day.
  • Diaphragm (cervical cap). This cup-shaped piece blocks sperm from getting into the cervix. It is used with a chemical to kill the sperm.
  • Male condom. The male partner wears this barrier over the penis to prevent sperm from getting into the vagina. It also helps prevent the spread of STIs.
  • Female condom. A barrier is placed into the vagina to keep sperm out. It also helps prevent the spread of STIs.
  • Withdrawal. The male pulls out his penis before releasing sperm into his partner (ejaculation). This does not work well at all to prevent pregnancy.
  • Fertility awareness ("rhythm method").  The female partner knows when to avoid sex during her monthly menstrual cycles in order to not get pregnant. This does not work well at all to prevent pregnancy.
  • Vaginal spermicides. Chemicals that kill sperm are placed into the vagina.
What Changes Can I Make Now? The AAP supports sex education as the most effective way to prevent teenage pregnancy and STIs. Sex education always should include information about abstinence and the many forms of birth control. As a parent, you play a big role in your teen's sex education. Talking with your teen about sex can be difficult. Be sure to follow these tips:
  • Be prepared. Look at reliable sources on sex before talking with your teen. For example, check out the website of the Centers for Disease Control and Prevention (CDC).
  • Talk about sex like any other health topic. Sex is not something dirty or embarrassing. This lets teens know that they can feel comfortable coming to you with any questions or problems.
  • Listen to teens. Make sure to give them a chance to talk. Let them ask questions.
  • Be honest. It might feel awkward, but answer your teen's questions with the truth. It is OK if you do not have all the answers. You can find the answer and share it later.
  • Ask for help. If you are having trouble talking with your teen about sex, ask your teen's doctor for advice.
Some parents are afraid that if they talk about sex, their teen will want to try it. Don't worry! Studies show that teens who have received sex education:
  • Are not more likely to have sex
  • Are more likely to delay having sex
  • Are more likely to use birth control
What Can I Expect Looking to the Future? Expect the pediatrician to talk with your teen about safe sex and birth control.  They can work together to choose a birth-control method that works best for your teen, when needed. More and better ways to educate teens, parents and child health professionals about preventing pregnancy and STIs will be created. The AAP and CDC will continue to study and update their guidance on birth control as methods change or as new options become available.]]>
Mon, 29 Sep 2014 00:00:00 -0400
Similar Results for Varicose-Vein Treatments Three common treatments for varicose veins all help to improve symptoms, a new study finds....                    What Is the Doctor's Reaction? Chances are good that you or someone you know has varicose veins. Fortunately, for most, they are more of an annoyance than a health threat. Varicose veins are thought to develop because the tiny valves in the veins aren't working well. This prevents blood from flowing freely. Instead, blood "backs up" in the vein. This causes the vein to swell just beneath the skin. Varicose veins are typically blue or purple. For many, the main issue is one of appearance. They just don't like how the veins look. But sometimes varicose veins become inflamed or painful. The legs also may become swollen or achy. Some people have skin ulcers. Most people with varicose veins require no treatment at all. For mild symptoms, compression stockings and leg elevation can help. Despite these measures, some people are bothered enough by varicose veins to warrant more treatment. Common options include:
  • Surgery -- The operation removes the abnormal veins.
  • Thermal ablation -- Concentrated energy (using a laser or radio waves) is applied into the abnormal veins. This treatment damages the vein and causes it to collapse.
  • Foam sclerotherapy -- Doctors inject an irritating chemical foam into the vein. This scars the abnormal veins so they can no longer swell.
Which of these treatments is best? That's the topic of a study in this week's edition of the New England Journal of Medicine. Researchers compared three methods of treating varicose veins:  surgery, laser or foam sclerotherapy. Here's what they found: 
  • All three treatments were effective. Overall quality of life was improved by about the same amount for each treatment.
  • Surgery was slightly better for improving appearance and other symptoms. Foam sclerotherapy was slightly worse.
  • Problems that sometimes occurred after treatment included a lumpy appearance or numbness. These were somewhat rarer after laser surgery than the other treatments.
For anyone considering treatment for varicose veins, these results suggest that all three approaches are acceptable. There are only minor differences among them. The surgeon's experience, preference and success rates are probably much more important than the small differences noted in this study. What Changes Can I Make Now? Unfortunately, there are no clearly effective ways to prevent varicose veins. Regular exercise and avoiding excess weight might help. Factors that increase risk include family history, pregnancy, aging and obesity. Varicose veins are more common in women than in men. If you already have varicose veins, you may be able to relieve symptoms. Taking these steps may help: 
  • Don't stand or sit for long periods without getting up and moving around.
  • Keep your legs raised above the level of the chest when you sit or lie down.
  • Exercise regularly.
  • Maintain a healthy weight.
  • Wear compression stockings.
If you continue to have pain, aching or other symptoms related to varicose veins, let your doctor know. He or she may refer you to a vascular surgeon to discuss the types of treatments analyzed in this latest research. Ask the surgeon why he or she favors one approach over another and the success rate with that treatment. Understand that each of these treatments has potential problems. They may include pain, bleeding or a blood clot. But, if your symptoms are significant, the risk may be worth accepting. What Can I Expect Looking to the Future? When there are multiple treatment options for a common condition, high-quality research is essential to identify the best option. Sometimes the studies show that one approach is clearly better. Medical practice often changes as a result. Other times, as in this latest study, the effectiveness and safety of different treatments turn out to be similar. Either way, the results are useful. And they provide a measure of reassurance when considering the options your doctor recommends. You can expect to hear much more about other studies comparing common treatments in the future.]]>
Thu, 25 Sep 2014 14:16:00 -0400