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 Tue, 30 Sep 2014 13:56:00 -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
Diabetes Growth May Be Slowing Down After nearly 20 years of rapid increases, U.S. diabetes rates may be rising more slowly. That's...                      What Is the Doctor's Reaction? This is welcome news. Earlier predictions suggested that 1 in 3 people in the United States would be living with diabetes by 2050. In this study, researchers provide us with newer data. The number of people living with diabetes is still increasing each year. But the rate of rise from 2008 to 2012 is markedly less than from 1990 to 2008. And the number of people per 1,000 with diabetes fell in 2012, compared with 2008. The researchers used information from a 1980-2012 survey of nearly 665,000 adults. One of the many questions was "Do you have diabetes?" It did not matter what type of diabetes the person had. In the United States, almost 95% of people have type 2 diabetes. Several factors contributed to the rapid rise during the 1990s and the first part of the new century:
  • People with diabetes are living longer.
  • A lower blood sugar level for a diagnosis of diabetes was adopted during the 1990s.
  • Average weight gain and the number of people with obesity rose dramatically during the same period. Weight gain, leading to obesity, is a major cause of type 2 diabetes.
The good news is not equally shared by all ethnic and racial groups. During the last five years of the survey, the number of new cases of diabetes reported was significantly higher for blacks and Hispanic adults than for non-Hispanic white adults. This hardly means the diabetes epidemic is over. As the U.S. population grows, so will the number of people diagnosed each year with both type 1 and type 2 diabetes. What Changes Can I Make Now? Type 1 diabetes cannot be prevented. Almost all cases are caused by the immune system misbehaving. It's called autoimmunity. The body's immune system attacks the pancreas and destroys the cells that make insulin. Type 2 diabetes is very preventable. 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 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.
I you have a parent or sibling with type 2 diabetes, you have a much higher risk of developing the condition. However, you and your children have the potential to prevent it with diet and exercise by starting right now. What Can I Expect Looking to the Future? It's too early to predict if the number of new cases of diabetes will continue to slow. When analyzing the data, researchers will need to be careful not to over interpret any results. For example, today an estimated 1 in 4 people with diabetes don't know they have it. If many more cases are detected and diagnosed, the number of new cases of diabetes would appear to rise. But the real number of truly new cases could actually be falling.]]>
Wed, 24 Sep 2014 18:51:00 -0400
Doctors Urged to Watch Out for Chikungunya Doctors in the United States need to be on the lookout for patients with chikungunya virus, a...                    What Is the Doctor's Reaction? Four months ago, I'd never heard of the chikungunya virus. Today, I'm able to pronounce this word (chik-en-gun-ye), which means "to be contorted" in the African Kimakonde language. More importantly, I know how to:
  • Look for it in sick patients
  • Diagnose it
  • Teach my colleagues about it
  • Support patients through it 
What is it? Chikungunya is a virus in the same family as German measles, and both Eastern and Western equine encephalitis. It is transmitted from mosquitoes to humans. First described in the 1950s, outbreaks of the virus mainly occurred in West Africa, India and Southeast Asia. The current outbreak was first detected in 2013. It occurred halfway around the world from where the virus was first seen, on the island of Saint Martin in the Caribbean. By the first half of 2014, reports of the disease were widespread in most of the Caribbean islands. Fortunately, this is not a lethal virus. People who get the infection feel terrible. They have fever, headaches, muscle aches, swollen joints and sometimes a rash. Most people get better in 7 to 10 days. But some people have lasting joint pain for a longer time. There is no specific medicine to treat it. We use anti-inflammatory medicines and support people through the worst of the illness.  Why the Caribbean? Well, it provided a good home for this virus. There are lots of insects, including the two types of mosquitoes that transmit the virus best. People travel often between Caribbean Islands and their homes in North and South America. Most humans on this side of the globe have no immunity to this virus. All of this is a set-up for a very active virus -- more than 30,000 cases so far -- that can be easily spread by infected mosquitoes.  The majority of Americans with the virus in the United States have brought it back from the Caribbean. But nine cases reported from Florida were most likely acquired within the United States. National boundaries don't mean much to infections. The authors of this article say there is a high likelihood that the disease will take hold locally. This is most likely in the Southeastern United States. Data from the Centers for Disease Control and Prevention suggest that it already has a foothold. The chikungunya virus is an excellent example of how infections travel in our very mobile world. They are assisted by travelers and insects that can be found anywhere. In this amazing world of global travel and communication, the spread of this virus reminds us that we need to work globally to understand, control and wipe out diseases of all types. What Changes Can I Make Now? If you get sick after a visit to the Caribbean, whether you were at a resort or visiting Aunt Mabel, let your doctor know where you've been. People usually get sick about three to seven days after infection. The most common symptoms are fever and severe joint pains. About half of people infected by this virus have a rash. Don't worry. You won't be contagious to your family or other close contacts. Your doctor may order a blood test to confirm the cause. Then you'll likely be treated with anti-inflammatory medicines and rest. Most people improve within a week to 10 days. It's important to try to prevent transmission of the virus from mosquitoes to humans. Travelers to areas at risk should use bug repellent, especially during the day, when mosquitoes that carry chikungunya usually bite. On a public health level, communities should work on helping to get rid of mosquito breeding areas. Insecticides should be used appropriately to decrease the mosquito population. Finally, scientists and public health officials can work together to develop a safe, effective vaccine for chikungunya. What Can I Expect Looking to the Future? The rapid and efficient spread of chikungunya should serve as a cautionary tale about how fast viruses can change and have an impact all over the world. We are fortunate that this is not a lethal virus. Our response to this new virus will be important, not only for itself, but to develop responses for other viruses that are sure to come along.]]>
Tue, 23 Sep 2014 19:44:00 -0400
Outbreak of Severe Virus Now in 22 States At least 160 cases of a sometimes severe virus have been confirmed in 22 states, U.S. health...                    What Is the Doctor's Reaction? If you haven't started taking hand-washing really seriously, now's the time to start -- especially if you have children with asthma. It's been all over the news: a bad virus sweeping the country that is landing hundreds of children in the hospital. The virus that is being blamed is called enterovirus D68. Enteroviruses are very common. Every year, especially in the summer and fall, they cause 10 million to 15 million infections. The vast majority of these illnesses are mild -- colds, rashes, vomiting, low-grade fever, mouth sores. But sometimes, as is the case with this particular strain, they can be more serious. We don't entirely understand why this strain is causing so much trouble -- or why it is particularly affecting children. It may be simply that children haven't lived as long as adults. This means they have had less time to build up immunity to enteroviruses in general. Whatever the reason, it's clear that enterovirus D68 does cause more trouble for children, especially those with asthma. This illness can cause cold symptoms that then lead to trouble breathing. Sometimes affected children need oxygen. Many of the children who get sick enough to end up in the hospital have asthma. Not only do they get sick from the virus, it causes their asthma to act up. As of the end of last week, there were 160 confirmed cases in 22 states. There are almost certainly many more than 160 cases, and the virus is likely in more than 22 states. Special tests need to be done to know for sure what exact virus is making children sick. These are tests that doctors don't always do on sick children. The tests that confirm it is enterovirus D68, as opposed to another kind of enterovirus, can be done in only a small number of laboratories. This can take a long time. What Changes Can I Make Now? As I said above, the best thing you can do is wash your hands. Enterovirus D68 doesn't get spread through the air. It's spread through contact with body fluids like saliva and nasal secretions (snot). Washing your hands regularly can help decrease the chance of catching all sorts of illnesses, including this one. It's also a good idea to:
  • Stay away from sick people to the extent possible
  • Stay home if you are sick
  • Regularly wipe down common surfaces, such as doorknobs
  • Avoid sharing cups and utensils
  • Teach children to cover coughs and sneezes with the inside of the elbow instead of the hand
Since we are in flu season, these are great things to do anyway. If you have a child with asthma, it's really important that he or she take all medicines as prescribed, especially "controller" medicines. These are the ones that are meant to prevent symptoms. Very often, families get a bit lax with those over the summer, when many children with asthma get better. Families figure the controller medicines aren't needed, and they stop them. If that was the case in your family, start those medicines up again. They could make all the difference if your child catches this virus. It's also important to be watchful of any child who gets a cold. Chances are it's just a cold, and nothing serious. But look out for any trouble breathing. Children who have trouble breathing may:
  • Cough very often
  • Breathe fast or heavy
  • Have trouble talking
  • Look pale
If you notice any of this, bring your child to get medical attention right away. What Can I Expect Looking to the Future? I hope that this virus will pass as we move out of fall. I also hope that, with increased awareness, people will take the best steps to prevent this illness and get children the care they need quickly.  But when we move out of fall, we will still be in flu season. So even if the news says that enterovirus D68 isn't as big a threat anymore, keep up with the hand-washing and other suggestions.  Get your flu shot, too. Winter is a bad time for viruses. The habits you learn for preventing enterovirus D68 can go a long waytoward keeping you and your family as healthy as possible.]]>
Mon, 22 Sep 2014 14:19:00 -0400
CDC Backs 2nd Pneumonia Vaccine for Seniors Adults age 65 and older should get 2 vaccines to prevent pneumonia, U.S. health officials say. The... Streptococcus pneumonia (pneumococcus) bacteria. These bacteria also can cause bloodstream infections and meningitis. The PCV13 vaccine already is recommended for children and certain high-risk adults. An expert panel that advises the CDC on vaccines voted in August to recommend this vaccine for older adults, too.  The new advice calls for everyone age 65 and older to receive both vaccines, but not at the same time. The CDC has detailed advice on when to give each vaccine to get the best protection. The journal Morbidity and Mortality Weekly Report published the new advice.                    What Is the Doctor's Reaction? If you are over 65, a new vaccine is recommended for you. It is the PCV13 (Prevnar 13). Like its cousin, the PPSV23 (Pneumovax), this is a vaccination to protect you against bacterial pneumonia. People who have stayed up to date with vaccinations already received a dose of Pneumovax when they turned 65. The U.S. Centers for Disease Control and Prevention (CDC) announced yesterday that it now recommends older adults get both kinds of vaccine. Pneumonia caused by the bacteria Streptococcus pneumoniae (also called pneumococcus) can make people very sick, very fast. These bacteria are one reason that doctors try to give anyone with pneumonia a dose of antibiotics within one hour of diagnosis. Without treatment, pneumonia can become severe. The bacteria can also spread into the bloodstream or can cause meningitis. Nowadays, hospital labs test for this infection. When I was a younger doctor, labs were smaller. It was my job to test for this infection, at the bedside. Patients would cough out brown sputum, and I would spread this onto a glass slide and rinse the slide with colorful ink. Then I would study it under a microscope. The bacteria have a very distinct look -- two small lobes joined together. I never found a slide with just a few pneumococci on it; there were always either none or millions. What Changes Can I Make Now? The PCV13 is not exactly "new." It has been included in childhood vaccinations for several years. But it is new for adults. In 2012, the CDC recommended PCV13 for adults 19 or older who have:
  • Impaired immune systems
  • Organ transplants
  • Leukemia or any other blood cancer
  • Kidney failure (on dialysis)
  • A cerebrospinal fluid leak
  • Cochlear implants
  • No spleen
Now the CDC also recommends a single dose of PCV13 for anyone who is older than 65. If you have the option, it is best to get the PCV13 before the PPSV23. This way you get the largest vaccine response. If you are getting the PCV13 first, wait a year between the 2 vaccines. If you have already received the PPSV23 vaccine, you can still get the PCV13 vaccine. In this case, wait 8 weeks between the 2 vaccines. What Can I Expect Looking to the Future? Some health economics experts criticize this decision. They say it is too costly for the amount of extra prevention it provides. But I think this is good new advice. Adding this second vaccine is a way of boosting immunity for older adults who have already received the PPSV23. Adding the PCV13 vaccine is expected to prevent as many as 12,000 cases of pneumonia during the lifetime of those Americans who are now over 65. But I am not sure how many of my patients over 65 will follow the new advice right away. Why? At this time, Medicare pays for only one dose of pneumococcal vaccine for an adult over age 65. It is unlikely that we will see this policy change during the next year. For many patients, a vaccine price tag of $150 or so is too high, unless insurance is paying for most of it.]]>
Fri, 19 Sep 2014 21:44:00 -0400
Healthy Habits Urged to Help Prevent Dementia A healthy lifestyle may help to prevent dementia as well as problems such as heart disease and...                    What Is the Doctor's Reaction? The numbers are staggering. The current cost of caring for people with dementia in the United States is greater than $600 billion. Within 15 years, the cost is expected to rise to $1 trillion. Worldwide, experts predict that 135 million people will be living with dementia by 2050. To bring increased public awareness of the looming epidemic, Alzheimer's Disease International has declared September 21 World Alzheimer's Day. Each year a status report is issued around the same date. This year's report focuses on health factors that we can change to help prevent dementia. This past year we have heard about multiple disappointing trial results for drugs to treat Alzheimer's disease. But the authors of this report do not just review the status of new drug research. They should be applauded for emphasizing what we can do now to help lower our risk of Alzheimer's and other dementias. More than 90% of dementias are caused by 2 diseases. Alzheimer's disease is responsible for 65% to 70% of cases. Vascular dementia accounts for about 20% to 25%. People with dementia often have features of both types. And ways to help prevent them are similar. What Changes Can I Make Now? A higher risk of dementia is linked to several factors. The ones with the strongest links include:
  • Low levels of exercise and physical activity
  • Diabetes
  • Smoking, current and past
  • High blood pressure
  • Fewer educational opportunities early in life
This year's report lists the best ways to help prevent, or at least delay, Alzheimer's disease and other types of dementia. Here's what you can do:
  • Exercise regularly. Make it your goal to get at least 150 minutes of moderate-intensity exercise per week. Then strive to become even more fit.
  • Don't smoke or use other tobacco products.  
  • Use alcohol in moderation. That means no more than one drink per day for women, and no more than two per day for men.
  • Maintain a healthy body weight. In particular, try not to let your waist expand. People with more fat in the middle have a higher risk of developing dementia, even if their body weight is normal.
  • Keep your blood pressure in the normal range. To do this, get regular exercise, eat lots of fruits and vegetables, and cut down on salt. Your doctor can prescribe medicines if needed.
  • Stay socially engaged with family and friends.
Some studies suggest that a Mediterranean-style diet may be especially good for the brain. These suggestions should look familiar. They are the same ones that will help keep your heart healthy, decrease your risk of stroke and lower the chance of developing some types of cancer. What Can I Expect Looking to the Future? Most past studies of new potential drugs to treat Alzheimer's disease include people who already have symptoms of the disease. This is likely too late. The brain changes seen in Alzheimer's disease begin many years before we see symptoms. Some exciting studies have been launched this year. For example, researchers in one study identified older adults with brain changes that looked like those in Alzheimer's. But they didn't have any symptoms. These changes can be seen on special brain scans. People enrolled in the study are being given a drug that can attack these changes. Researchers want to see if it prevents dementia symptoms from happening later on.]]>
Thu, 18 Sep 2014 00:00:00 -0400
2 Drugs Slightly Better for COPD, Study Says Giving patients with chronic lung disease 2 drugs provides slightly better results than a single...                    What Is the Doctor's Reaction? Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world. Doctors treat COPD with a several types of medicines. But there is limited information to help doctors choose the best drugs with the fewest side effects for individual patients. This "real world" study offers doctors and their COPD patients some guidance. COPD includes chronic bronchitis and emphysema. More than 80% of people with COPD are current or former smokers. Most are over age 40. Women are more likely to develop it than men. The main features of COPD are:
  • Less flow of air into and out of the lungs
  • Permanent damage to the lungs and bronchial tubes
  • Symptoms that usually get worse over time, such as cough, shortness of breath and fatigue
People with COPD get symptoms and flare-ups because of inflammation in the airways and tight bronchial tubes. This is especially true for those with chronic bronchitis. Treatment is aimed at minimizing these effects. The most commonly prescribed treatments for COPD are inhaled drugs. They include:
  • A long-acting beta-agonist bronchodilator to open tight airways, such as salmeterol (Serevent) or formoterol (Foradil)
  • A corticosteroid to reduce airway inflammation, such as beclomethasone (QVAR), budesonide (Pulmicort) and fluticasone (Flovent)
  • A product that combines these two, such as Advair or Symbicort
  • A long-acting anticholinergic to keep lung airways open, such as tiotropium (Spiriva)
Prior studies had shown that all of the inhalers could decrease symptoms and reduce the number of COPD flare-ups. However, these studies mostly included younger COPD patients. They also tended to exclude those with other diseases. This study is "real world" in that it looked at what happened to older COPD patients and did not exclude those with other medical problems. All of the patients in this study were age 66 or older. What Changes Can I Make Now? If you still smoke and have COPD, you must quit now. It's the only way to possibly prevent the disease from getting worse. Here are some key findings from this study that can help guide doctors and their COPD patients:
  • Combination inhalers that contain both a long-acting beta-agonist bronchodilator and a corticosteroid are slightly better at reducing hospital stays and decreasing the risk of death than using only the beta-agonist.
  • Combination inhalers are especially helpful for COPD patients who also have asthma.
  • There was not enough data to determine the extra benefit of a long-acting anticholinergic drug for people who already use a combination inhaler
Inhaled corticosteroids did not appear to increase the risk of fracture or pneumonia. (Prior studies had suggested that they did increase these risks.) What Can I Expect Looking to the Future? Future drug discoveries may offer even more relief for COPD symptoms and perhaps decrease flare-ups. However, those gains are likely to be small. The big gain will come from preventing COPD by never smoking and finding better ways to help smokers quit.]]>
Wed, 17 Sep 2014 13:10:00 -0400
FDA Approves Contrave, New Diet Drug The Food and Drug Administration (FDA) has announced approval for the third new diet drug since...                    What Is the Doctor's Reaction? Obese people now have another option to help them with weight loss. It's a drug called Contrave. It was just approved by the U.S. Food and Drug Administration (FDA). Pharmacies will likely have it in stock within a few months. The drug also is approved for those who are overweight and have certain health conditions. Contrave is a combination of two drugs that were FDA approved many years ago for other conditions. The two drugs are naltrexone and bupropion. Doctors prescribe naltrexone to help people with alcoholism and narcotic addiction. Bupropion is used to treat depression and seasonal affective disorder. It is also prescribed to help people stop smoking. Neither drug alone is approved for weight loss. The FDA approved Contrave based on results of studies that included 4,500 obese and overweight people. They followed a program of calorie reduction and exercise. Among those who also took Contrave, 36% to 42% lost 5% or more of their body weight. Some people lost a lot more. But more than 50% had little or no weight loss. Why should a combination of a drug for addiction and one for depression help with weight loss? It's likely that the drugs act on impulse, reward and/or hunger centers in the brain. This may decrease appetite and dampen the reflex to seek food for comfort.  What Changes Can I Make Now? Contrave should not be prescribed just to help you lose a few pounds. It is approved for long-term weight reduction if you are:
  • Obese (body mass index, or BMI, of at least 30)
  • Overweight with a BMI of 27 to 29.9 and a weight-related condition such as high blood pressure or diabetes
This drug has some potential serious side effects. They include possible suicidal thoughts and seizures. You should NOT take Contrave if you:
  • Have a seizure disorder
  • Have uncontrolled high blood pressure
  • Have an eating disorder
  • Take narcotics or another drug to treat narcotic addiction
There are other side effects as well, including:
  • Nausea and vomiting
  • Dizziness
  • Headache
  • Insomnia
Perhaps the best candidate for Contrave is an obese smoker. The drug might help with weight reduction and also make it easier to quit smoking. Once Contrave is started, it's important to monitor blood pressure. The first 3 months should be viewed as a trial period. If you have not lost at least 5% of body weight by then, the drug is not likely to be a successful treatment for you. In that case, it should be stopped. What Can I Expect Looking to the Future? Contrave is the third drug to be FDA approved for weight loss in the last couple of years. The other two are Qsymia and Belviq. It would be great to see a head-to-head study of these three drugs to see which is most effective. But that is unlikely to happen.]]>
Fri, 12 Sep 2014 00:00:00 -0400
Blood Type May Influence Dementia Risk People with the least common blood type may have a higher risk of dementia than those with other...                    What Is the Doctor's Reaction? Do you know your blood type? Do you know why it matters? Blood types are proteins (called A, B or O) on your red blood cells. Which ones you have are determined by your genes. You may have learned how your blood type is important in case you need a blood transfusion or want to donate blood.  That's because your blood type plays a major role in determining whether your blood is "compatible" with the blood of others. For example, someone with type A blood has antibodies that see type B as an invader. Someone with type A can receive blood from others with type A but may have a severe reaction to type B blood. The reverse is true for type B. People with type AB have antibodies to neither. They can receive blood from anyone. Those with type O have antibodies to both. They can receive only type O blood, but can donate to anyone. But blood type may be important for other reasons. Past research has found that people with type O blood type have a lower than expected rate of heart disease and stroke. A new study suggests that blood type could also play a role in how likely it is that you'll develop memory loss in the future. The medical journal Neurology published the study. Researchers enrolled more than 30,000 people to study predictors of memory or thinking problems. After 3½ years, nearly 500 had developed these problems. Their blood types were then compared with nearly 600 people with normal brain function. The researchers found that:
  • About 6% of the group with memory or thinking problems had AB blood.  That's more than expected, since this blood type is found in about 4% of the population.
  • People with type AB blood were 82% more likely to develop problems with brain function than those with type O.
  • Those with AB blood had higher levels of factor VIII than other people in the study. This could be important because higher levels of factor VIII have been linked to brain dysfunction and dementia. Factor VIII is a protein involved in the formation of blood clots.
Although these findings are interesting, it's not clear to me how important they may be. Here's why:
  • Only a small proportion of the population has type AB blood.  Yet dementia is quite common. Therefore, other factors are probably much more important.
  • There doesn't seem to be any immediate impact of these findings on preventing or treating memory loss. After all, you cannot change your blood type.
  • We don't know why blood type might affect memory and thinking.
Still, if these findings are confirmed, they could lead to discoveries about how memory loss develops and who is at highest risk. These insights could lead to new preventive approaches and treatments. What Changes Can I Make Now? If your blood type is AB, this study is no reason to panic. A "link" or "association" between the AB blood type and memory problems is not proof that the blood type actually causes brain problems. But you can make changes to reduce the chances you'll have memory or thinking problems in the future. Here's what you can do:
  • Exercise regularly.
  • Maintain a healthy weight.
  • Choose a diet that's high in fiber, fruits, vegetables and omega-3 fatty acids (found mainly in fish).
  • Keep your blood pressure and blood lipids (such as cholesterol) in a healthy range.
  • Don't smoke.
  • Drink only moderate amounts of alcohol.
  • Keep your mind active. This can include having a busy social life and hobbies and doing activities that challenge your mind.
These measures are recommended for everyone, regardless of blood type. For most people, it is not essential even to know your blood type. However, that could change as we learn more about the impact of blood type on health and disease. What Can I Expect Looking to the Future? This new study suggests that blood type may be a predictor of problems with memory and thinking in the future.  But it raises other questions. For example, is the memory loss linked to type AB blood a good predictor of future dementia? Can the influence of blood type on brain function be altered?  The answers could lead to advances in the prevention and treatment of dementia. And that would make this new study big news indeed.]]>
Thu, 11 Sep 2014 14:17:00 -0400
Statins May Reduce Diabetes-Related Damage Taking statin drugs to lower cholesterol can raise blood sugar in some people. But these drugs may...                    What Is the Doctor's Reaction? The relationship between statins and type 2 diabetes is complex. Statins can raise blood sugar. And it's possible that taking a statin drug can raise it enough for you to be diagnosed with type 2 diabetes. But people with any type of diabetes need a statin more than people without this disease. They are at higher risk of heart disease, heart attack and stroke. This is true even if they have relatively normal cholesterol levels. Beyond reduced risk of heart disease and stroke, this new study suggests other benefits of taking a statin for people with diabetes. In people with type 1 diabetes, the body stops making insulin. People with type 2 make plenty of insulin. But their cells don't respond normally to insulin. Insulin should make it easy for sugar to move from the bloodstream into cells. But people with type 2 diabetes have insulin resistance. New cholesterol guidelines from the American Heart Association recommend that anyone with a higher than average risk of heart disease and stroke take a statin. This will likely lead to many more people taking a statin. Whether or not they are at high risk to develop diabetes should not affect that decision. Someone who does have diabetes should definitely take a statin if the LDL (bad) cholesterol level is 70 milligrams per deciliter (mg/dL) of blood or higher. Because statins raise blood sugar in some people, doctors have been concerned that statins might also cause more diabetes-related damage to nerves, eyes and kidneys. A new study looks at this question. The researchers first identified thousands of people diagnosed with diabetes. Then they reviewed pharmacy records to see which ones were taking a statin drug regularly before they were diagnosed with diabetes. Their findings were a surprise. Researchers found just the opposite of what they expected to see. People who were regularly taking a statin before they were diagnosed with diabetes were less likely to have nerve or eye damage than people who had not been taking a statin before diagnosis. The statins also appeared to provide some protection against gangrene of the foot, another dreaded diabetes complication. Taking a statin neither helped nor harmed the kidneys. But this also was a better-than-expected result.  What Changes Can I Make Now? This type of study is called an observational study. It can only show a connection between statin users and a possible lower risk of nerve and eye damage. It does not prove that statins prevent these problems. But it is reassuring that taking a statin does not increase your risk of these problems if you develop diabetes. Earlier guidelines recommended treatment of high cholesterol to reach a specific goal number. Doctors aimed for this goal even if it meant prescribing a statin plus other drugs to lower cholesterol.. But the reason for taking a statin is not to boast about your cholesterol number. Statins do much more. They lower the risk of developing hardening of the arteries. And they help prevent heart attack and stroke. That's what matters! Taking another cholesterol-lowering drug just to reach a certain number doesn't make you healthier. The new guidelines recommend a statin based on heart disease and stroke risk. A statin is recommended for:
  • Anyone who has heart and blood vessel (cardiovascular) disease, including angina (chest pain with exercise or stress), a previous heart attack or stroke, or other related conditions
  • Anyone with a very high level of harmful LDL cholesterol (generally greater than 190 mg/dL)
  • Anyone with diabetes between the ages of 40 and 75
  • Anyone with a greater than 7.5% chance of having a heart attack or stroke, or developing other forms of heart and blood vessel disease in the next 10 years
What Can I Expect Looking to the Future? Diabetic nerve damage can be extremely painful. And avoiding vision loss is always a high priority for anyone. Wouldn't it be terrific if future studies prove that statins do help to prevent these problems?]]>
Wed, 10 Sep 2014 00:00:00 -0400
No Clear Winner among Osteoporosis Drugs Osteoporosis drugs do reduce the risk of fractures. But there's no evidence that one drug is...                    What Is the Doctor's Reaction? As we age, our risk of bone fracture as a result of thin bones (osteoporosis) keeps increasing. This is especially true for women. The most disabling fractures are those of the hip and spine. To help prevent a first fracture in people with osteoporosis and further fractures in those who have already had one, doctors prescribe drugs to strengthen bone. Doctors have many choices. Lots of advertisements, directed at both consumers and doctors, suggest that this or that drug is best. But which ones are really most effective? The authors of this study tried to answer the question. The authors did an extensive review of existing well-done studies. According to their analysis, most of the drugs were very similar. The most commonly prescribed drugs reduced:
  • Fractures of vertebrae by 40% to 60%
  • Fractures of the hip and other non-vertebral fractures by 60% to 80%
One of the drugs, raloxifene (Evista), helped prevent fractures of vertebrae. But it did not appear to prevent hip and other fractures. These are relative reduction rates. This means that compared with taking no drug at all to prevent fracture, you reduce your risk by this amount. If you look at the risk this way, it sounds like everyone with osteoporosis or a prior fracture related to thin bones should take one of the drugs. But looking at the risk in a different way paints a different picture. About 75 patients need to be treated with one of the drugs to prevent a single fracture of vertebrae over a period of 1 to 3 years. And 55 patients need to be treated to prevent other types of fracture. The researchers conclude that not enough head-to-head studies comparing drugs have been done to find an advantage of one drug over another. Authors of an editorial published with the study agree with this conclusion. But the editorial writers say that the researchers' conclusions overstate the effectiveness of osteoporosis drugs in fracture prevention. Their main concern is that not enough people ages 75 and over are included in the analysis. These are the folks at greatest risk of fracture from thin bones. What Changes Can I Make Now? If all of the drugs were low-cost and none had any side effects, then choosing one of them to prevent a fracture for someone at risk would always be easy. But that is not reality. Osteoporosis drugs have huge differences in costs, and their side effects vary. In general, the oral bisphosphonate drugs are the most cost-effective. They also have a long track record. Some people can't take them because of heartburn or other digestive problems. Examples of generic bisphosphonates include:
  • Alendronate
  • Ibandronate
  • Risedronate
For people who prefer to take pills less often, there are formulations that can be taken just once a week or even monthly. There are also intravenous drugs that treat osteoporosis and prevent fractures. They are given once or twice a year in the doctor's office. You want to prevent or at least delay the onset of osteoporosis and fractures related to thin bones. It's best to take these steps at a young age, but it is good advice no matter how old you are. Here's what you can do:
  • Don't smoke.
  • Use alcohol in moderate amounts or not at all.
  • Stay physically active. It's especially important to do weight-bearing exercises such as walking, jogging and resistance training with free weights or machines.
  • Make sure you get enough calcium in your diet.
  • If you don't get frequent sun exposure, you likely need to take a vitamin D supplement. The Institute of Medicine recommends:
    • 600 international units (IU) of vitamin D a day for everyone ages 1 to 70
    • 800 IU of vitamin D a day for those 71 and older
What Can I Expect Looking to the Future? A clinical trial that compared the different drugs to treat osteoporosis and prevent fractures would need to be funded by the government. It's too risky for a drug company to sponsor one. And the cost to do such a study is likely beyond the budget of a government agency. The logical solution: We need much more emphasis on preventing osteoporosis and fractures.]]>
Tue, 09 Sep 2014 14:06:00 -0400
New Drug May Further Shorten Flu Symptoms A new drug may reduce flu symptoms faster than current treatments, two studies suggest. The new...                    What Is the Doctor's Reaction? A new flu drug appears to be more effective than the most commonly prescribed treatment, oseltamivir (Tamiflu). The new drug is called peramivir. Tamiflu shortens symptoms by about 12 hours. According to these study results, peramivir shortened symptoms, including fever, by almost 24 hours. Peramivir needs to be given by injection. Only a single dose is needed. Tamiflu is taken by mouth, a single pill twice a day for 5 days. Both drugs need to be given within 48 hours of when your symptoms begin. Peramivir is not yet approved for use in the United States. It has been approved in some other countries. Doctors had hoped that Tamiflu, if given early enough, could decrease hospital stays, serious illness and deaths from influenza. It also seemed logical to expect earlier treatment of flu to lower the chance of spread to others. However, a recent review of 20 clinical trials found no solid evidence to support these claims. It's terrific that we may have a new drug to treat flu. However, the 2 studies on peramivir included only 427 adults. For an illness that affects millions of people every year, this is an extremely small sample. The makers of peramivir have asked the U.S. Food and Drug Administration (FDA) to approve it for use here. But even if the FDA approves the drug soon, we need to avoid getting too excited about peramivir. The early studies of Tamiflu suggested it would be much more effective than it really is. The adult volunteers enrolled in studies like these are generally healthy except for their flu symptoms. It's nice to have people feel better faster from peramivir. But what we really need to know is how well it works on people who need the drug the most. The ones at greatest risk of serious illness caused by flu are children, pregnant women, people with long-term illnesses and the elderly. Peramivir appears to be safe for otherwise healthy adults. But, again, they are the least likely to get major side effects from a drug. What Changes Can I Make Now? With some rare exceptions, everyone 6 months and older should get a yearly flu vaccine. There is even a safe flu shot for people with egg allergy. The flu shot contains inactivated (killed) virus particles. This season, special attention is being given to women who are pregnant or expect to be pregnant. It doesn't matter whether you just found out you're pregnant or due for delivery within a few days. Any time is the right time for a flu shot. Pregnant women should get only the shot, not the nasal spray vaccine (FluMist). For adults ages 65 years and older, the high-dose flu shot (Fluzone) provides more protection than the standard dose. But it costs more and appears to more often cause the same side effects as the standard vaccine. These include short-term, low-grade fever, soreness at the injection site and muscle aches. Live, attenuated (weakened) influenza vaccine (FluMist) is the preferred vaccine for children 2 to 8 years old. This vaccine is squirted into the nose. It provides better protection than the flu shot in this age group. The flu shot contains no live virus. So some types of vaccine may be better for you than others. But unless you have an egg allergy, it is more important to get the standard flu shot if that is the only one available. What Can I Expect Looking to the Future? I suspect peramivir will get FDA approval. But that's unlikely to happen before next flu season.]]> Mon, 08 Sep 2014 00:00:00 -0400 Potassium May Lower Stroke Risk in Women Women who consume more potassium have a lower risk of stroke, a study has found. The study... What is the Doctor's Reaction? More than half of the 800,000 Americans who have strokes each year are women. Nearly 4 million American women are living with the aftermath of a stroke. And because women live longer than men, their lifetime risk of having a stroke is higher. Those numbers are why stroke prevention is especially important for women. Eating more foods rich in potassium may be one more way to reduce stroke risk in older women. That’s the finding in this study published online in the journal Stroke. Getting more dietary potassium helps lower blood pressure. And keeping blood pressure in the normal range is your best way to prevent stroke. However, in this study, women with normal blood pressure actually had greater stroke prevention from a potassium-rich diet than woman with high blood pressure did. The authors suggest that higher dietary potassium could keep arteries from becoming stiff with age. Stiff arteries are strongly linked with stroke risk, even before high blood pressure develops. This study only shows a link between lower stroke risk and eating more potassium rich foods. It does not prove that diet was the direct reason. People that get more potassium from their diet tend to eat less sodium. High-sodium diets can also increase stroke risk. But even if you don’t eat less salt, you still lower your chance of stroke by eating potassium-rich foods. Thousands of years ago, when humans roamed the earth gathering and hunting, potassium was abundant. Sodium was scarce. The diets of these early humans contained about 11,000 milligrams of potassium a day. Much of it came from fruits, vegetables, leaves, flowers, roots and other plant sources. The amount of sodium was much less. It was probably not much more than the 200 milligrams per day that a body needs. Today, sodium is easy to come by. It is cheap and abundant. The average American consumes about 2 teaspoons of salt per day. That's about 5,000 milligrams of sodium. Much of it is hidden in processed and prepared foods. It's a different story for potassium. We average 2,500 milligrams a day. That's only about half of the 4,700 milligram minimum recommended for adults. What Changes Can I Make Now?  The simplest way to start getting more dietary potassium is to eat more fruits and vegetables. But if you like to know specifics, here are the potassium totals in some common foods: A word of caution for people with kidney disease — you may need to limit your potassium intake.

Food (serving)

Potassium (milligrams)

Potato with skin, baked (1 medium)


Halibut, baked (4 ounces)


Raisins (1/2 cup)


Banana (medium)


Acorn squash, cooked (1/2 cup)


Spinach, cooked (1/2 cup)


Tomato sauce (1/2 cup)


Lentils, cooked (1/2 cup)


Cantaloupe (1/4 medium)


Kidney beans, cooked (1/2 cup)


Orange juice (6 ounces)


Bran breakfast cereal (1/2 cup)


Milk, low-fat 1% (1 cup)


Orange (1 whole)


If you have kidney disease or take a drug that causes you to retain potassium, you may need to limit total potassium intake. Examples of drugs that can cause high potassium include:
  • ACE inhibitors, such as captopril and lisinopril
  • Angiotensin receptor blockers, such as losartan and valsartan
  • Potassium-sparing diuretics, such as spironolactone and triamterene
What Can I Expect in the Future? Recently, some experts have questioned whether the recommendations on sodium have become too strict. But there is no debate about the health benefits of eating more potassium-rich foods.]]>
Fri, 05 Sep 2014 13:14:00 -0400
Poor Sleep Linked with Shrinking Brain Volume A small study has found an association between poor sleep patterns and a reduction in brain volume...
What Is The Doctor's Reaction? Is there a connection between lack of sleep and the size of your brain? It’s possible. At least that’s the conclusion of a new study in the latest edition of Neurology. Researchers enrolled 147 adults of various ages. Each had 2 brain MRI scans several years apart and each completed questionnaires about their sleep.  The study found that:
  • About one-third of subjects had significant sleep problems
  • Those with sleep difficulties tended to lose brain volume more rapidly than those who slept well
  • The link between loss of brain volume and sleep trouble was most substantial among those over age 60
When news breaks of this research, I can imagine headlines that could terrify insomniacs everywhere:  Poor sleep shrinks your brain Sleep loss causes dementia Startling new findings of sleep research: it’s enough to keep you up at night  But each of these would be inaccurate and unnecessarily provocative. In fact, the importance of this study’s findings is far from clear. Here’s why: 
  • It’s not known whether poor sleep causes loss of brain volume or whether these changes in the brain contribute to poor sleep
  • Variation in brain volume is common among adults. Smaller (or decreasing) brain size does not necessarily mean the person will become demented or lose their mental capacities.
  • Brain volume changes linked with sleep problems were limited to certain parts of the brain. Even among those with poor sleep, many parts of the brain seemed unaffected.
  • The link between sleep problems and decreasing brain volume was observed primarily among older adults. Sleep problems and brain atrophy are common in older adults, so the link might be coincidental.
  • The study was small.
I think we need to know much more about the relationship between brain size and sleep before we can come to any conclusions. This study could be onto something. Or, it might just be reporting on a coincidence that is part of normal aging.

What Changes Can I Make Now? If you have trouble sleeping, you aren’t alone.  About 1 in 3 adults reports trouble getting to sleep or staying asleep.  We spent $32 billion in 2012 on getting a better night’s sleep. Much of that was spent on drugs to improve sleep. But medications aren’t the only option for dealing with sleep problems.  In fact, most doctors try non-drug options first or combine drug and non-drug treatments. Common non-drug approaches to poor sleep include:
  • Changes in your sleep environment – For example, eliminate annoying or disturbing noise.  A “white noise” machine or fan can help mask outside noises.
  • Changes in your habits – Don’t drink fluids before bed, as you may have to get up to urinate a few hours later.  Avoid napping during the day and go to bed at the same time each night.
  • Limit (or eliminate) stimulants – Drinking coffee or smoking a cigarette close to bedtime can disrupt sleep. Alcohol is sedating, but when its effects wear off, people often awaken and find it difficult to get back to sleep.
  • Relaxation techniques – Progressive relaxation, imagery and meditation can reduce stress and allow you to transition to a more rested state in preparation for sleep. 
  • Seeing a counselor or therapist – Stress, anxiety and depression are common contributors to poor sleep.  Professional counseling can help.
  • Get regular exercise – But avoid exercising just before bed.
  • Don’t “work” to get to sleep – If you don’t fall asleep within 15 to 20 minutes, get up, do something else (such as reading) and try again later.
A number of medications are available to help with sleep.  But it’s important to recognize their side effects and limitations and to use them only occasionally.  Discuss the pros and cons of sleep medications with your doctor, including over-the-counter and “natural” remedies. Insomnia can be due to certain medical conditions, such as sleep apnea or restless legs syndrome.  With treatment, sleep quality can improve dramatically. That’s another reason to see your doctor if you have significant sleep problems.

What Can I Expect Looking To The Future? Sleep is a mysterious thing. It’s a universal part of life.  Yet, there is much we don’t know about what goes on during sleep.  In the future, I believe we will have a much better understanding about why we sleep, how we can improve sleep and the consequences of getting too little sleep. If poor sleep is proven to cause brain atrophy and impaired brain function, it will be important for researchers to determine whether brain health can be maintained by improving sleep.
Thu, 04 Sep 2014 00:00:00 -0400
No Clear Winner Among Diets When it comes to weight loss, there is no "magic" diet, says a review of published... What is the Doctor's Reaction? High carb, low fat vs. low carb, high fat. We have a winner of the long debate about which style of weight loss diet is most effective. They both win. After 6 months, average weight loss was nearly equal, about 8 kilograms (about 17.5 pounds). However, neither diet was successful at keeping the weight off. People gained back 1 to 2 kilograms (2.2 to 4.4 pounds) on average by 12 months. And after several years, most people regained all of the weight and more. Rather than thinking about diet as your first goal in weight loss, focus on getting more exercise first. You want to get at least 30 minutes of dedicated exercise daily. Once exercise becomes part of your daily routine, you are much more likely to eat healthier. Don't worry about how many carbs or how much fat is in your diet. Pick foods that contain the healthy carbohydrates, fats and proteins. But you must keep track of your total calories. If you are not losing weight, you need to both increase your physical activity and reduce your daily caloric intake. Calories out spent to create energy must be greater than calories in by mouth. This study of the most popular diets did not include Mediterranean style diets. Many experts now recommend this style of eating as the healthiest. The health benefits were first recognized after a study done 50 years ago. Researchers looked at the eating patterns in the United States and six European countries. They compared how long people lived and rates of heart disease in the different countries. People living in the southern parts of Greece and Italy lived longer and had less heart disease than people from other parts of the world. Their diets were loaded with plant-based foods and unsaturated fats (mainly from olive oil), lots of fish, and relatively little red meat and few sweets. What Changes Can I Make Now? Although it might be nice to live close to the Mediterranean Sea, this diet works anywhere in the world. These are the basics of a Mediterranean-style diet:
  • Four 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 or more 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.
  •  At least 4 tablespoons of olive oil a day.
  • One handful (about 1½ ounces) of nuts, 3 or more times per week.
  • Three or more servings of legumes (beans, peas and lentils) per week. A serving is ½ cup.
  • Six or more 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 1 (for women) or 2 (for men) drinks 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
You also have a good chance to lose some weight with a Mediterranean-style diet. But you still need to pay attention to your total calories. What Can I Expect in the Future? We don’t need more studies comparing weight loss diets. Starting a diet is easy. Sticking with it and maintaining weight loss is the bigger challenge. The menu we need is a list of ways to make that a reality.]]>
Wed, 03 Sep 2014 00:00:00 -0400
Electric Brain Stimulation Improves Memory A small study has found that electrical stimulation to certain parts of the brain can improve... What Is The Doctor's Reaction? Electrical stimulation of the brain is approved by the U.S. Food and Drug Administration (FDA) to treat severe depression. The results of this study suggest it also may offer help for people with memory problems. The technique is called repetitive transcranial magnetic stimulation (rTMS). It’s a painless procedure with almost no risks. A technician places an electromagnetic coil against the person’s scalp on one side of the head. The device sends out magnetic impulses to the brain. It’s similar to the magnetic impulses used when a person has an MRI. These researchers were specifically interested in whether rTMS could enhance associative memory. Associative memory allows us to recall something from the past when we experience or think about something in the present time. For example, you might see that a particular old movie is playing on TV and it reminds you of a girlfriend you took to see that movie years before. The part of the brain called the hippocampus plays a dominant role in memory function, especially associative memory. The initial brain activity, before a memory becomes a memory, starts in another part of the brain. Usually that is the outer layer, called the cortex. The researchers aimed the electromagnetic waves to stimulate brain connections between the cortex and the hippocampus. By using a special type of MRI, called functional MRI, they could see if they were directing the magnetic impulses to the right areas. Once the right spot was located, each volunteer received 20 minutes of rTMS every day for 5 consecutive days. Associative memory was tested daily and then again 24 hours following the last session. The rTMS enhanced associative memory in these volunteers by as much as 30%. Improvements were still seen 24 hours after the last rTMS session. What Changes Can I Make Now? The researchers are not suggesting that rTMS be used by people that already have well functioning memories. In people treated with rTMS for depression, there is a very small risk of seizures. There are other healthier ways to help maintain memory and potentially boost brain function:
  • Don't smoke or use other tobacco products.
  • Exercise regularly. Make it your goal to get at least 150 minutes of moderate-intensity exercise per week.
  • Use alcohol in moderation. That means no more than one drink per day for women and no more than two per day for men.
  • Maintain a healthy body weight. In particular, try not to let your waist expand. People with more fat around the middle have a higher risk of developing dementia, even if their body weight is normal.
  • Eat a Mediterranean-style diet. Increase the amounts of fish, vegetables, legumes, olive oil and whole grains you eat.
  • Keep your blood pressure in the normal range. To do this, get regular exercise, eat lots of fruits and vegetables and cut down on salt. Your doctor can prescribe medicines if needed.
  • Stay socially engaged with family and friends.
  What Can I Expect Looking To The Future? Over the next few years, more studies will be done to test rTMS in people with brain disorders affecting memory. People with Alzheimer’s and traumatic brain injury would be excellent candidates for such studies.]]>
Fri, 29 Aug 2014 00:00:00 -0400
Polyp Removal and Future Colon-Cancer Risk People who have low-risk colon polyps removed may have a lower-than-average risk of future colon...                    What Is the Doctor's Reaction? Colon cancer is a leading cause of death among adults in the United States. Fortunately, we have good screening tests with the potential to save lives. Colonoscopy is the best screening test for colon cancer. During a colonoscopy, a doctor peers into the colon through a flexible tube with a light and camera on the tip. If a tumor is seen, a sample (biopsy) can be removed to find out whether it is cancerous. A small tumor can be removed during the procedure. Colonoscopy can prevent deaths due to colon cancer by:
  • Detecting cancer at a curable stage
  • Detecting (and removing) certain types of polyps called adenomas, which sometimes become cancerous
  • Leading to more frequent testing in the future if cancer or some kinds of polyps are found
How much of the benefit of colonoscopy is due to detection of polyps? That's the subject of a study just published in the New England Journal of Medicine. Researchers in Norway did the study. They used the nationwide health monitoring system to identify who had a polyp removed and later developed colon cancer or died.  They looked at data on nearly 41,000 people who had polyps removed. During an average follow-up of 8 years:
  • 1,273 developed colorectal cancer and 383 died of the disease.
  • People who had low-risk polyps removed were 25% less likely to die of colorectal cancer than the expected rate in the general population. A low-risk polyp was defined in this study as an adenoma that was single, small or lacked certain features when viewed under a microscope.
  • People who had high-risk polyps removed were about 16% more likely to die of colorectal cancer than the expected rate for the general population.
This last finding could be interpreted as a failure of colonoscopy. People with high-risk polyps still had a higher than expected rate of colon-cancer death even though polyps were removed. However, I think this would not be a correct interpretation. Here's why:
  • The average follow-up in the study was only eight years. It may take longer to show the protective effect of polyp removal.
  • At the time of this study, the guidelines in Norway recommended less frequent screening after polyp detection than current guidelines. More frequent screening could have produced better results.
  • The rate of colorectal cancer-related deaths might have been even higher in those with high-risk polyps if they had not had colonoscopies.
  • Removal of the low-risk polyps was linked with a reduction in colorectal cancer-related deaths. That's probably because removing the tumors alone lowers risk.
  • This study involved people with symptoms, such as bleeding. Results could have been different if the polyps had been discovered by routine screening.
  • In this study, some polyps may have been missed or incompletely removed. The solution for this is better colonoscopies, not fewer of them.
A wealth of data links screening colonoscopy with a decrease in deaths related to colorectal cancer.  This study should not discourage anyone from having a screening colonoscopy.  What Changes Can I Make Now? You can reduce your risk of colon cancer and increase the chance of detecting the disease at a curable stage. Here's what you can do:
  • Eat a diet that is high in fiber, vegetables and folate while avoiding saturated fat, processed meat and excessive alcohol or calories.
  • Exercise each day.
  • Take a daily, low-dose aspirin (but talk to your doctor first).
  • Have colonoscopies (and/or other screening) as recommended.
Current guidelines recommend a colonoscopy every 10 years for people at average risk of colon cancer. Screening should begin at age 50 and end at age 75 to 85. Earlier and more frequent screening may be recommended for some people, such as those with a history of colon cancer or a strong family history of the disease. Other screening options include: •    Rectal examinations •    Testing of the stool for blood •    Sigmoidoscopy (an internal examination of the last part of the colon) •    Barium enema •    CT scanning However, these are less effective. Don't rely on these as your only means of screening. If you have had colon cancer or an adenoma in the past, talk to your doctor about how often to have follow-up screening. What Can I Expect Looking to the Future? You can expect more studies of colonoscopy among people at average or high risk of colorectal cancer. We may discover how often to repeat screening for those at increased risk and also who can safely skip screening. For those with adenomas, the ideal study would randomly assign people to have a repeat colonoscopy at various time intervals over a decade or more. Until such studies are completed, I think it's best to follow current guidelines.]]>
Thu, 28 Aug 2014 00:00:00 -0400
Aspirin May Cut Risk of 2nd Deep-Vein Clot Aspirin may offer some long-term protection for people who have had blood clots in the legs or...                    What Is the Doctor's Reaction? Blood clots in the legs can happen after surgery, major injury or a long bed rest. But often doctors don't find a reason why a blood clot forms in a leg vein. Doctors call them unprovoked deep-vein thromboses (DVTs). Someone with an unprovoked DVT has a lifelong risk that it will happen again. But taking one of the usual medicines to prevent another clot brings its own problems and risks, especially the risk of major bleeding. The results of this study suggest a safer option after the first year -- daily low-dose aspirin. A DVT causes pain and swelling. It can limit movement. But the greatest danger is the risk that part of the clot will break away from the leg and travel to the lungs. That's called a pulmonary embolism (PE). The symptoms are shortness of breath, chest pain and lightheadedness. And if the embolism is large, it can cause sudden death. The usual treatment for an unprovoked DVT or PE is an anticoagulant ("blood thinner"), such as heparin. Injections are given for a few days. Then people take either warfarin (Coumadin) by mouth or one of the newer anticoagulant pills for at least 6 months. Most doctors recommend 12 months. But after this treatment is done, you still have a high risk of another DVT or PE. The risk is 10% in the first year and 5% per year after that. Taking a blood thinner for the rest of your life provides the greatest protection against having a second DVT or PE. But most often patients and their doctors opt to stop the drug after one year. That's because over a lifetime the risk of major bleeding caused by the blood thinner is actually higher than the risk of another DVT or PE. Low-dose aspirin is not as good, but it is much safer. It's only half as effective as warfarin or one of the newer blood thinners. But the lifetime bleeding risk is much lower. And aspirin also protects against heart attacks, strokes and potentially some cancers. What Changes Can I Make Now? If you have had a DVT or PE in the past and currently do not take warfarin or another blood thinner, talk with your doctor about low-dose aspirin to help prevent another clot. You also can take other steps to help prevent a DVT from ever happening or happening again:
  • Stay active.
  • Get up from your desk often and take short walks.
  • When sitting, move your feet up and down often to squeeze your calf muscles.
  • Maintain a healthy weight.
  • Don't smoke.
  • Drink plenty of liquids, especially when travelling long distances. Avoid alcohol during the trip, as it can dehydrate you.
  • If you are admitted to the hospital or have surgery, ask your doctor about preventive treatment with blood thinners or leg "compressors."
What Can I Expect Looking to the Future? Aspirin will likely become standard treatment for people with unprovoked DVT or PE once they stop their anticoagulant drug. Many people who have had a DVT related to surgery, injury or long-term bed rest may also decide to take daily low-dose aspirin. But aspirin should not be considered a replacement for a full course of anticoagulant drug therapy.]]>
Wed, 27 Aug 2014 14:26:00 -0400