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, 28 May 2015 00:00:00 -0400 Acetaminophen Link to Liver Failure Varies by Country In 7 European countries, overdoses of a common painkiller cause one-fifth of all cases of liver... In 7 European countries, overdoses of a common painkiller cause one-fifth of all cases of liver failure that require a transplant, a study finds. But this is much more common in some countries than others. Researchers found 600 cases of short-term (acute) liver failure that led to liver transplants in a 3-year period in these countries. Of these, 111 were caused by an overdose of paracetamol. This is the drug known as acetaminophen (Tylenol and generics) in the United States. It is safe to use in recommended doses. But it can cause liver failure in large doses, especially when combined with alcohol. In this study, two-thirds of the overdoses were suicide attempts. Overdose rates varied widely from country to country. Paracetamol overdose caused 52% of the cases of liver failure leading to transplant in Ireland, but only 1% in Italy. Overdoses caused 28% of the cases in the UK, 18% in France, 8% in the Netherlands and none in Greece or Portugal. Overall, use of paracetamol varied among the countries. But this did not explain the differences in overdose rates. The British Journal of Clinical Pharmacology published the study. Medscape and Medical Express wrote about it May 28.                      What Is the Doctor's Reaction?  Acetaminophen is among the most widely used medicines in the world. It's the active ingredient in Tylenol and many generics. More than 25 billion doses are sold each year in the United States alone. Billions of other doses are sold as paracetamol, the name used in other countries.  Its wide use is easy to understand. It can be quite effective, not only for pain but also to bring down a fever. You can buy it without a prescription. And it's considered to be quite safe when taken as directed.  So, when there is news about the safety of acetaminophen, it's worth paying attention. The new study is in the British Journal of Clinical Pharmacology. Researchers analyzed rates of liver failure caused by paracetamol that required a liver transplant. The study looked at rates in  seven European countries between 2005 and 2007.  The overall rate was low: just 1 case per 6 million people each year. However, the rates varied dramatically among the countries studied: 
  • Portugal and Greece had no cases of liver failure due to paracetamol that required a liver transplant. Of the other countries, Ireland had the highest rate (1 case for every 286,000 people). Italy had the lowest rate (1 case for every 180 million people). France, the United Kingdom and the Netherlands were in between.
  • Among all cases of liver failure requiring a transplant in these countries, 19% were blamed on paracetamol. But it accounted for 52% of cases in Ireland, 28% in the UK and just 1% in Italy.  
  • These differences were found even when researchers accounted for how often people buy paracetamol. For example, per-person use was highest in France. Yet it had one of the lowest rates of paracetamol-related liver failure that required a transplant.
  • Most cases (63%) were the result of an attempted suicide. In 28%, the intent was not certain. 
The reasons for these large differences are not clear. The authors suggest one possibility. Perhaps it's more common to attempt suicide by taking an overdose of paracetamol in the UK and Ireland than in the other countries studied.  Or perhaps some countries have more prior liver disease -- such as viral hepatitis or alcoholic liver disease -- than others. For example, fewer people may develop severe liver failure after taking paracetamol in a country with lower rates of hepatitis B, hepatitis C and alcoholism. Genetic differences between the people of different countries also could affect the risk of paracetamol-induced liver failure. This study did not examine these possibilities.  What Changes Can I Make Now?  The most important change you can make now is in how you think about acetaminophen. Standard doses are considered safe. But an overdose can cause potentially fatal liver failure within hours or days.  Keep in mind that many prescription and over-the-counter medicines for fever, colds, flu and pain contain acetaminophen. Unless you read the label, it's easy to take too much acetaminophen without realizing it.  Here are some other measures you can take to avoid an overdose of acetaminophen: 
  • Keep in mind that acetaminophen goes by several names. These include paracetamol and APAP (an abbreviation of its chemical name, acetyl-para-aminophenol).
  • Take no more than 3,000 milligrams (mg) per day. This is the maximum dose for adults who weigh at least 150 pounds. If you weigh less, check with your pharmacist or doctor.
  • Pay attention to the total number of milligrams in each pill. It's easier to exceed the maximum daily dosage when each pill is 500 or 650 mg. Regular-strength acetaminophen is 325 mg.
  • Drink only moderate amounts of alcohol. Many experts recommend that women have no more than 1 alcoholic drink per day; men can have 2 per day. This is even more important if you also take acetaminophen regularly. 
If you often take acetaminophen, check with your doctor. He or she may recommend a change in the dose. This medicine also may interact with others you take.  What Can I Expect Looking to the Future?  This new study shows that the rates of severe liver failure caused by acetaminophen vary among European countries. But it doesn't tell us why. It also doesn't tell us anything about liver damage caused by acetaminophen use that did not require a liver transplant.  Future research should identify: 
  • The factors that increase the risk of liver failure caused by acetaminophen
  • Better ways to prevent and such treat liver damage, especially for those at increased risk
  • How often liver damage and other major health problems can be blamed on acetaminophen 
In fact, there is some dispute about the overall safety of acetaminophen, even when it's taken in recommended doses. Only high-quality research can answer just how much is too much and who is at risk.]]>
Thu, 28 May 2015 00:00:00 -0400
Fewer Hospitals Give Formula to New Moms About one-third of U.S. hospitals still send formula home with new mothers even if they are... About one-third of U.S. hospitals still send formula home with new mothers even if they are breastfeeding, a new study shows. But the practice has become much less common in the last few years, the study found. The study was based on a national survey of hospitals and birth centers. In 2007, 73% of hospitals reported that they sent breastfeeding mothers home with formula for their babies. That fell to 32% in 2013. The study author said this is an encouraging trend. Doctors recommend that babies receive only breast milk for the first 6 months of life. But this happens for only 19% of babies born in the United States. Women who give their babies some formula are less likely to stick with breastfeeding. The journal Pediatrics published the study. HealthDay News wrote about it May 26.                      What Is the Doctor's Reaction?  Breast milk is the best milk for your baby. It is a natural gift from mother to baby. Not formula!  The American Academy of Pediatrics suggests babies drink only breast milk for at least the first 6 months of life. But not enough mothers end up breastfeeding for that long.  There are ways hospitals and birth centers can help mothers who want to breastfeed. 
  • Encourage mothers to start breastfeeding right from birth. Any mother who breastfeeds right from day one is more likely to continue breastfeeding.
  • Don't give formula to the baby. Giving some formula makes it harder for the mother to continue to breastfeed. Yet some hospitals still give formula to new mothers. 
A new study looks at how many hospitals and birth centers actually give formula to breastfeeding mothers. It was based on a survey. Someone at each hospital and birth center in the United States filled out the survey. This happened every 2 years from 2007 to 2013. The journal Pediatrics published the study.  The Centers for Disease Control and Prevention (CDC) did the survey. It collected information about the care given to new mothers and babies. Among other things, it asked whether the hospital or birth center gave formula to breastfeeding mothers.  The authors found an interesting trend.  Over time, hospitals and birth centers became much less likely to give away formula: 
  • 73% in 2007
  • 66% in 2009
  • 55% in 2011
  • 32% in 2013 
Numbers went down the most for hospitals and birth centers that had more than 5,000 births a year. In 2007, 63% of big hospitals gave formula to breastfeeding mothers. By 2013, this had dropped to 12%.  Hospitals and birth centers have done a good job. It appears that less formula is now given out to breastfeeding mothers. Breastfeeding goes up when formula is not given to mothers.  What Changes Can I Make Now?  Breast milk should be the major source of nutrition throughout your baby’s first 12 months of life. Many good things pass from mother to baby with breastfeeding. Breast milk has the perfect balance of nutrients for the baby.  Have an open mind about breastfeeding your baby. It can be very hard. But you can do it! Don't give up! There are experts who can help you. Having support at the hospital or birth center right from day one is very important.  More hospitals and birth centers are involved in programs that help make it easier for you to breastfeed.  Baby-Friendly Hospital Initiative (BFHI) was started by the World Health Organization (WHO) and the United Nations Children's Fund in 1991. BFHI promotes and supports breastfeeding. Hospitals and birth centers with the "Baby-Friendly" label have completed the "Ten Steps to Successful Breastfeeding." These 10 Steps are hospital practices and rules that help mothers to breastfeed. International Code of Marketing of Breast Milk Substitutes discourages hospitals and birth centers from giving breast milk substitutes (such as formula) to mothers. Hospitals and birth centers as started in 2006. This idea came from the Massachusetts Breastfeeding Coalition. It provides hospitals and birth centers with information and resources to remove formula from discharge packs. Mothers don't get formula (or coupons for it) when they leave the hospital or birth center. The Joint Commission of Hospital Accreditation Organization (JCAHO) includes breastfeeding in its perinatal quality of care measurements. These include the number of newborns who are fed only breast milk (no formula) during their entire time in the hospital after birth. Starting January 2014, all hospitals with more than 1,100 births every year had to record this information. This means big hospitals are more likely to promote breastfeeding.  If you are having trouble making enough breast milk, speak with your doctor. She can give you advice. She also may refer you to a lactation (breastfeeding) specialist.  You might also find these resources from the American Academy of Pediatrics helpful: 
  • Warning Signs of Breastfeeding Problems
  • Benefits of Breastfeeding for Mom
  • Establishing a Breastfeeding Routine
What Can I Expect Looking to the Future?  Legislative efforts will continue to try to prevent hospitals and birth centers from giving out formula. Many centers are working on their own to promote and support breastfeeding. Expect more hospitals to become "Baby-Friendly" and follow the "Ten Steps to Successful Breastfeeding." New ways will be created and studied to teach mothers to: 
  • Breastfeed
  • Be comfortable with breastfeeding
  • Make breastfeeding less of a challenge 
New moms also are likely to receive more support of breastfeeding in the workplace. You can expect efforts to help employers understand the special needs of new breastfeeding mothers.]]>
Wed, 27 May 2015 00:00:00 -0400
Hospice May Aid Some Depressed Survivors Hospice programs may help some surviving spouses deal with depression, a new study suggests. The... Hospice programs may help some surviving spouses deal with depression, a new study suggests. The study was based on a national survey of 1,016 older adults whose spouses died after a serious illness. Researchers also used Medicare records. About 30% of those who died had received hospice care for at least 3 days. Overall, 52% of surviving spouses had an increase in depression symptoms over time. This was true whether they had been involved with hospice or not. Depression symptoms improved for about 28% of hospice users' survivors and 22% of those not involved with hospice. Researchers also looked just at survivors who had been primary caregivers. Results were similar. These differences were small enough that they could have been the result of chance. Then researchers adjusted the numbers based on other information. This included education, income and health conditions of the deceased and surviving spouses. After adjustment, survivors of those who used hospice were more likely to have improved depression symptoms. The Journal of the American Medical Association published the study. HealthDay News wrote about it May 26.                    What Is the Doctor's Reaction?  When a cure is no longer possible, hospice care helps people achieve the best quality of life given the circumstances. They can live their last days in a peaceful environment, surrounded by family and friends.  Relieving symptoms such as pain, anxiety and shortness of breath are the most important goals. And hospice programs offer much more. They: 
    • Provide drugs, medical supplies and equipment as needed. 
    • Teach family members how to take care of their loved one. 
    • Help the dying person with emotional and spiritual aspects of death. 
    • Provide support and counseling to family and friends to ease the grief after the loss of their loved one. This is known as bereavement counseling. 
Prior studies have shown that family members have a greater than usual risk of developing major depression after the loss of a loved one. This is especially the case if the person stayed in the hospital and continued to get aggressive care.  This study was designed to find out whether hospice care decreases symptoms of depression in surviving spouses.  There was no difference during the bereavement period between spouses whose partners were enrolled in hospice and those who weren't. However, major depression occurred less often in spouses who got support from a hospice program.  What Changes Can I Make Now?  Hospice services shouldn't end when the patient dies. Medicare requires agencies to provide bereavement services to families for up to a year after the death.  There's little oversight of the bereavement requirement. You may need to follow up with the hospice agency to make sure it provides the services you need.  Here are some other questions to ask when evaluating a hospice program: 
    • What services are available to the patient and family members? 
    • How involved are family members in providing care? 
    • What are the roles of doctors, nurses and other health professionals? 
    • Who will be on the hospice care team? How are they trained, screened and managed? 
    • How will pain and other symptoms be managed? 
    • If there's a change in the person's condition or circumstances, can services be moved to another setting (hospital, home or nursing facility, for example)? 
    • How is the program accredited, reviewed and licensed? Is it certified by Medicare?
    • How does the hospice handle payment and billing? Be sure to get all financial arrangements -- costs, payment procedures and billing -- in writing. 
What Can I Expect Looking to the Future?  If you have major depression after the death of a loved one, hospice care should not be considered a treatment option. Even if the hospice provides excellent bereavement counseling, major depression requires standard treatment. Usually that means a combination of medicine and talk therapy. However, regular contact with a hospice nurse after death of the loved one can be helpful. The nurse can make sure you get the mental health services you need.]]>
Tue, 26 May 2015 00:00:00 -0400
Pregnant Women Skip Whooping-Cough Shot Many pregnant women are not getting recommended shots to protect themselves and their babies... Many pregnant women are not getting recommended shots to protect themselves and their babies against whooping cough, a new study shows. The study comes from the U.S. Centers for Disease Control and Prevention (CDC). It includes data from New York City and 16 states for the last 4 months of 2011. In all, nearly 56% of pregnant women got the Tdap vaccine. This vaccine protects against tetanus, diphtheria and pertussis bacteria. Pertussis causes whooping cough. About 14% of the women got the shot before pregnancy. Another 10% got it during pregnancy and 31% after the birth. U.S. health officials urge all pregnant women to get the Tdap booster shot. Getting it just before or during pregnancy can pass some immunity to the infant. Vaccination after the birth for the mother and other contacts also helps to protect the baby. Infants can't get a shot to protect against pertussis until they are at least 6 weeks old. The journal Morbidity and Mortality Weekly Report published the study May 21.                     What Is the Doctor's Reaction?  Pregnant women want to do everything they can to keep their babies healthy. Knowing this about moms, I was surprised to see this week's report by the Centers for Disease Control and Prevention (CDC). The report was about a vaccination that prevents pertussis (whooping cough). The vaccine is known as Tdap.  This shot is recommended for every pregnant woman, with a booster for every pregnancy. But the CDC report showed that only 14% of women got the right shot against whooping cough before they became pregnant. Another 10% were vaccinated during pregnancy and 31% soon after delivery. Altogether, this still leaves 44% of pregnant women and new mothers who did not get vaccinated. This tells me that we have been slow to spread word about our vaccine advice.  So let me shout about it: "Calling all new moms!"  Whooping cough is caused by a kind of bacteria. In toddlers and older children, it can cause a "whoop" noise from coughing. It sounds like a barking seal. In toddlers and adults, whooping cough is almost never fatal. Babies are a different story. Babies are too young to have immunity against pertussis. Most people who die from pertussis are 3 months old or younger. Infant deaths from pertussis happen in the United States every year. Recently, whooping cough has been creating an epidemic in parts of the United States. Last year, there were 28,660 cases. In 2012, we had a particularly bad year, with 48,277 cases of pertussis. I live in Oregon, where we had more than 800 pertussis cases in 2012. In Washington state, there were more than 4,900 cases. I remember that 22 infants were hospitalized in the Pacific Northwest. Twenty of them were 3 months old or younger. Across the United States, 15 babies died.  This might sound to you like a large number of cases. It does to me. But before there was a vaccine against pertussis, there were more than 200,000 cases in the United States each year. This vaccine works pretty well.  Babies under 6 weeks of age are too young to get a vaccine that protects against pertussis. So their only protection is that their mothers are in good health. Mothers are thought to be the source for 30% to 40% of infant infections with pertussis. Grandparents are another common source, if they have not had a Tdap shot in adulthood. This is not a happy gift to give a baby.  What Changes Can I Make Now?  The Tdap vaccine prevents tetanus, diphtheria, and pertussis (Tdap). As of October 2012, the Advisory Committee on Immunization Practices has recommended: 
  • One Tdap shot in every pregnancy. The best time to get the vaccine is when you are between 27 and 35 weeks into your pregnancy.
  • A one-time vaccine for everyone age 11 or older who has not been vaccinated before.  
It is especially important to have the vaccine if you have frequent contact with an infant. Grandparents need this vaccine to protect themselves and their infant grandchildren. Many cases of infant pertussis have been traced back to infected grandparents. Older adults who are protected only by long-ago childhood vaccines don't have much immunity to whooping cough.  Even if you don't spend time with an infant, you should be vaccinated with Tdap as an adult. Whooping cough is a miserable thing. The infection causes clusters of 10 or more coughs at a time. This can be exhausting. Some people cough so hard that they vomit at the end of a cough series. The coughing can last for 12 weeks or longer.  Because the Tdap shot also protects against tetanus, many people wait until they are due for a tetanus booster to have this vaccine. A tetanus booster, also given in a shot called Td, is recommended every 10 years. However, in a year of epidemic, it is safe and acceptable to have the Tdap vaccine even if you are not yet due for your next tetanus shot.  What Can I Expect Looking to the Future?  People need shots against whooping cough in both childhood and adulthood because the immunity from this vaccine fades over decades. Except for pregnant women, most people are advised to get the shot one time in adulthood. This may change in the future. I won't be surprised if experts someday recommend a Tdap once every few years. I will happily get one again.]]>
Fri, 22 May 2015 18:44:00 -0400
Home Walking May Help Leg Arteries Support groups that encourage people to walk may help people with clogged leg arteries, a new... Support groups that encourage people to walk may help people with clogged leg arteries, a new study suggests. The study included 194 people age 65 or older. All of them had peripheral artery disease. This is a narrowing of leg arteries. It causes pain when people walk even short distances. People in the study were randomly divided into 2 groups. One group attended weekly sessions that encouraged them to walk. This part of the study lasted 6 months. Then, for another 6 months, they got weekly phone calls from the group leader. The leader encouraged them to walk at least 5 days a week. People in the other group also went to weekly meetings on health topics. But they did not get any messages about exercise. After 12 months, 80% of those in the exercise group were able to climb a flight of stairs or walk one-quarter of a mile without help. Only 36% of those in the other group were able to do this. People in the exercise group also improved in walking speed, ability to rise from a chair and standing balance. The Journal of the American Heart Association published the study. HealthDay News wrote about it May 20.                      What Is the Doctor's Reaction?  For people with peripheral artery disease (PAD), just walking one block can be impossible.  PAD is a narrowing of arteries that supply blood to the leg muscles. When those muscles contract during normal walking, they need more blood than they can get. If your arteries are narrow enough, the cramp-like pain becomes severe. You have to stop walking. After a while, you can start again. But having to stop every half-block (or even more often) because of the pain is more than just uncomfortable. It's frustrating and drains your energy.  Unfortunately, treatment options for PAD have long been limited. You can control some of the factors that increase your risk of this condition. You can take medicines that thin the blood or widen (dilate) blood vessels. But many people need surgery or other procedures because the other options do not work well enough.  Past research has found that exercise can be quite helpful for people with PAD. However, these studies have used closely supervised exercise programs. For example, people walked on a treadmill at a hospital or exercise facility. These programs may not translate well outside of research settings. That's why this new study is so important. The Journal of the American Heart Association published the results.  Researchers enrolled nearly 200 adults who were at least 65 years old and had PAD. Half were assigned to attend a weekly meeting. During the meeting, they were encouraged to walk at least 5 days a week. After 6 months of meetings, they received weekly phone calls encouraging them to keep walking. The remaining study subjects (the control group) also had weekly meetings. But they discussed health topics that were not related to walking. After 12 months, here's what happened: 
  • Those assigned to the exercise program were much more likely to be walking better than those who got the general health messages. More than 80% were able to climb a flight of stairs or walk a quarter of a mile on their own. Only 36% of the control group were able to do so.
  • The exercise group also improved more on other measures of function. This was defined as a combination of walking speed, balance and the ability to get up from a chair.
  • Those who exercised were less likely to lose mobility. Less than 9% of those in the exercise group lost some of their ability to move at any point during the study. Nearly 34% of the control group lost mobility. 
These results are important for two reasons. They confirm the benefit of walking for people with PAD. They also show that a home-based, "real world" exercise program can have a major and long-lasting positive impact. These findings should lead doctors to routinely recommend that people with PAD begin a regular exercise program. And it need not be directly supervised.  What Changes Can I Make Now?  Know the factors that increase your risk of developing peripheral artery disease. They include: 
  • Advanced age
  • Smoking
  • High blood pressure (hypertension)
  • High cholesterol
  • Diabetes 
These factors also increase the risk of heart attack and stroke. So any changes you make now to reduce your risk of PAD could have other health benefits.  If you already have PAD, talk to your doctor about how you can improve your symptoms (and prevent them from getting worse). Here's what you can do: 
  • Don't smoke.
  • Improve your cholesterol levels.
  • Keep your blood pressure in a good range.
  • If you have diabetes, keep your blood sugar well-controlled.
  • Exercise at least 30 minutes each day. As this latest research shows, walking can be quite helpful. But you may prefer swimming, biking or other activities instead. 
  • Work with a physical therapist who can design a safe exercise program that you can tolerate.
  • Take a medicine. Some of the more commonly recommended drugs for PAD are:
    • Aspirin
    • Clopidogrel (Plavix)
    • Cilostazol (Pletal)
    • Pentoxifylline (Trental)
  • Consider having a procedure (called angioplasty). A tiny balloon is inflated inside the narrowed artery to open it up.
  • Consider having vascular surgery to bypass the narrowed part of the artery. 
It may not be easy to give up an addiction such as smoking or to begin exercising. But considering the other options and the results of this new study, these treatments that don't involve procedures are worth the effort.  What Can I Expect Looking to the Future?  I hope that people with PAD will embrace the findings of this latest research and become able to move better and with less pain in the future. Perhaps the need for angioplasty and surgery for PAD will decline. I also hope that prevention measures will lead to fewer cases of PAD in the future.]]>
Thu, 21 May 2015 00:00:00 -0400
Study Tracks Amyloid Links to Dementia Risk Deposits called amyloid plaques may appear in the brain 20 years or more before people develop... Deposits called amyloid plaques may appear in the brain 20 years or more before people develop signs of dementia, a research review finds. These plaques are more often found in older adults. But they also are seen more often in younger adults with a high risk of developing Alzheimer's disease, the study showed. The study was based on previous research. It included 1,359 people with diagnosed Alzheimer's disease, 538 people with other types of dementia and autopsy results for 1,369 others with Alzheimer's. The living subjects all had PET scans to look for amyloid plaques in the brain. Among those with normal memory and thinking skills, these plaques were more common with age. About 10% of 50-year-olds had them. That increased to 33% at age 80 and 44% at age 90. Some people carried the APOE4 gene variant, which is linked with a higher risk of Alzheimer's. People in this group were 2 to 3 times more likely to have amyloid plaques than those without the gene. People who already had mild memory issues were more likely to have plaques, and at earlier ages. The Journal of the American Medical Association published the study. HealthDay News wrote about it May 19.                  What Is the Doctor's Reaction?  Alzheimer's disease continues to be more difficult to understand than we hoped. Alzheimer's disease is the most common type of dementia. The risk of developing it increases with age. As people live longer than ever, the numbers of those affected will increase dramatically during the next couple of decades.  The main features of Alzheimer's disease are problems with memory and thinking. The symptoms come on gradually and get worse over time. But changes in the brain that eventually lead to the disease appear to begin long before symptoms arise. Perhaps 25 years before.  One of the changes linked with a higher risk of developing Alzheimer's disease is a build-up of a protein called beta amyloid. However, about 12% of people with diagnosed Alzheimer's disease don't show amyloid deposits on brain scans. And about 30% of older people who continue to maintain excellent thinking and memory have heavy deposits of amyloid on a brain scan.  These two reports provide us with some more details that will help with diagnosing Alzheimer's and finding new prevention and treatment strategies.  Here are some highlights of the researchers' findings: 
  • Brain scans to look for beta amyloid are most helpful in younger adults with symptoms of dementia. Scans that show amyloid deposits in these people make a diagnosis of early-onset Alzheimer's disease extremely likely.
  • However, in older people with dementia, amyloid deposits can be seen just as often with other types of dementia as with Alzheimer's. Those other types include dementia caused by blood vessel disease (called vascular dementia), frontotemporal dementia and dementia with Lewy bodies. So the presence of brain amyloid in older people can't be used to diagnose the type of dementia.
  • The factors that are linked with a greater risk of developing Alzheimer's disease are also linked with having larger amyloid deposits. This applies even in older people with normal brain function. 
This new research found that highly educated people develop thinking and memory problems at an older age than those with less formal education. However, the highly educated people had more brain amyloid than those with less education. The researchers suggest that more education creates pathways in the brain to help preserve thinking and memory despite these amyloid deposits. What Changes Can I Make Now?  While these findings are interesting, they don't suggest any new treatments yet to help prevent dementia or stretch out the time it takes to get worse. But here is what you can do now: 
  • Don't smoke or use other tobacco products. 
  • Use alcohol in moderation. That means no more than 1 drink per day for women, and no more than 2 per day for men. 
  • Maintain a healthy body weight. And 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. 
  • Exercise regularly. Make it your goal to get at least 30 minutes of moderate-intensity exercise 5 days of the week. 
  • Keep your blood pressure in the normal range. 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.  
  • Keep your mind active. The scientific benefit is a bit uncertain. But even if it doesn't help, you can have fun using your brain in activities you enjoy. For example, you could try number games like Sudoku and word games like Scrabble and Words with Friends. 
There is some evidence that a Mediterranean-style diet may be especially good for the brain.  These lifestyle suggestions should look familiar. They are the same ones that will help keep your heart healthy and decrease your risk of stroke. What Can I Expect Looking to the Future?  The complex relationship between brain amyloid and Alzheimer's disease makes it very challenging to study anti-amyloid drugs. But it is probably our best shot at finding a treatment to reduce risk or at least slow the disease. Recent studies of anti-amyloid drugs have been disappointing. However, it may be that they are being given after the damage is done. New studies are underway to start anti-amyloid drugs much earlier. People in these studies have deposits showing on brain scans but don't show signs of problems with thinking or memory.]]>
Wed, 20 May 2015 00:00:00 -0400
Steroid Pills May Not Help Disk Pain Taking corticosteroid pills for 2 weeks may help people with sciatica move better, a new study... Taking corticosteroid pills for 2 weeks may help people with sciatica move better, a new study finds. But the pills did not reduce pain any more than a placebo did. The study included 269 people who had endured back pain caused by a herniated disk for 3 months or less. The average was 4 weeks. They were randomly assigned to receive either prednisone pills or placebo pills. People took the pills for 3 weeks. Researchers assessed their pain and function before and after the treatment. Function improved more for the prednisone group than for the placebo group. But there was no difference between groups in measurements of pain. The Journal of the American Medical Association published the study. MedPage Today wrote about it May 19. 
What Is the Doctor's Reaction?  Do steroid pills help the nerve pain caused by a herniated ("slipped") disk?  I know a few patients (and a couple of friends) who would say yes. The severe, shooting pain that runs from the lower back down the back of the leg seems to improve right away after they take the steroid pills. This condition is often called sciatica.  And steroid pills are a common treatment. Doctors often prescribe these pills, such as prednisone, for disk-related pain. Some back-pain guidelines include them as an appropriate treatment.  Even so, this remedy has not been well studied. And that means it's hard for the person with a disk problem to know if the risk of steroid side effects is worth taking.  A new study seeks to address this gap in our knowledge. Researchers published their results in the Journal of the American Medical Association. The study randomly assigned 269 adults with nerve pain caused by a herniated disk to receive 2 weeks of steroid pills or a placebo. Patients were assessed after they finished treatment and again a year later. The results were mixed: 
  • Pain was similar in both the steroid-treated and placebo-treated groups.
  • Physical function was slightly better in the steroid-treated group.
  • The number of people requiring surgery for their disk-related symptoms was similar in both groups. 
Steroids are generally prescribed to relieve the sudden, severe pain of disk-related nerve compression. So the lack of a difference in reported pain between the steroid and placebo groups is disappointing. Naturally, this makes me wonder: if this study found that steroids were no better than placebo for sciatica pain, why do they seem to work so well for some people?  Does the placebo effect make them feel better? Or is it possible that steroids actually do work very well for some people, but not at all for others? Unfortunately, this new research cannot answer these questions. What Changes Can I Make Now? If you suffer from sciatica or other disk-related symptoms, know the available treatments and ways to prevent pain from returning.  Talk to your doctor about the risks and benefits of these treatments:
  • Rest (balanced with limited activity). Keep in mind that prolonged bed rest can make matters worse.
  • Gentle exercise. This can help you move better and begin to strengthen back muscles. A physical therapist can be helpful to design an exercise program with you.
  • Hot or cold compresses.
  • Medicines for pain, such as acetaminophen (Tylenol and generics) or ibuprofen (Motrin, Advil and generics).
  • Medicines for nerve pain, such as amitriptyline (Elavil) or gabapentin (Neurontin).
  • Chiropractic care, acupuncture or massage.
  • Injections of steroids with an anesthetic.
  • Surgery. (This is rarely needed.) 
This new research calls into question the role of steroid pills in treating sciatica pain. However, if it has worked for you before, your doctor may recommend it again.  Once you've recovered from a bout of sciatica, you may be able to prevent its return. Here are some things you can do: 
  • Strengthen your abdominal muscles. Exercises, such as abdominal "crunches," can improve core strength and support the lower back.
  • Swim or walk regularly.
  • Lift objects from the squatting position (rather than bending over an object to lift it).
  • Don't sit or stand for long periods.
  • Stretch regularly.
  • Don't wear high heels. 
It's possible that these same measures can prevent you from ever having sciatica in the first place.  What Can I Expect Looking to the Future?  This latest research could lead doctors to stop recommending steroid pills for disk-related nerve pain, including sciatica. However, we'll need more research to know whether some people will improve with steroid treatment. For example, this study included people with symptoms that lasted an average of four weeks. Perhaps that's too long. Steroid pills might work better if started sooner.  This new study makes steroid pills a questionable treatment for sciatica caused by a herniated disk. But, for those who have taken oral steroids and felt immediate relief, there is no question: they can work quite well. I hope that researchers will soon figure out which people with disk trouble will improve with steroids and which people should forgo them.]]>
Tue, 19 May 2015 00:00:00 -0400
Grip Strength Linked to Early-Death Risk How's your hand grip? A new study suggests that answering this question could help assess your... How's your hand grip? A new study suggests that answering this question could help assess your risk of heart attack, stroke and early death. Grip strength has been shown to be a good indicator of overall muscle strength. In this study, researchers looked at results of grip-strength tests on nearly 140,000 adults. They were 35 to 70 years old and came from 17 countries. In the next 4 years, nearly 3,400 died. People with low grip strength were more likely to die or have a heart attack or stroke than those who were stronger. This was true even after researchers accounted for other factors that affect death and heart disease risk. These factors included age, education level and whether people smoked, drank alcohol or exercised. Every 11-pound drop in grip strength was linked with a 17% increased risk of heart-related death and a 16% increased risk of death from any cause. Each strength decrease of this size also was linked to a 9% higher risk of stroke and a 7% higher risk of heart attack. The journal Lancet published the study. HealthDay News wrote about it May 13.                 
What Is the Doctor's Reaction?  Our age in years (chronological age) can be very different from our biological age. Biological age has no exact definition. Rather it refers to whether our body is functioning better or worse than our chronological age.  Many factors influence biological age. The most important include your overall physical fitness and any medical conditions you may have.  Muscle strength also figures into the equation. And perhaps it's the best way to assess our biological age, as this new study suggests.  Hand-grip strength has been shown to reflect overall muscle strength. It's easy to measure, and the test doesn't cost much.  Previous studies have linked weak hand-grip strength with a higher risk of death compared with those who have a stronger hand grip. Most of the studies have been done on older people living in North America or Europe.  The results of this study support those previous reports. What's different is the huge number of people in the study, nearly 140,000. They come from 17 countries around the world. And they include younger as well as older people.  In this study, weak hand grip was linked with an increased risk of heart disease, death from heart disease and also death from all other causes. However, a weak hand grip did not increase the risk of any specific disease other than heart disease. It was not linked with a greater chance of falling, breaking a bone or developing diabetes or cancer.  So if a weaker hand grip doesn't increase the risk of most medical conditions, why should it be linked with greater mortality? The researchers suggest that a person with weaker muscles is likely to die sooner if medical problems develop than someone with more muscle strength will. Muscle strength could therefore predict survival.  What Changes Can I Make Now?  To build muscle strength, do resistance training 2 or 3 times per week. You can do it more often. But don't do strength exercises on the same muscles 2 days in a row. When you strengthen your muscles, they need 48 hours to rebuild after a workout.  You will likely think about dumbbells and weight machines to build muscles. Resistance bands work just as well. These flat or tube-shaped rubber bands provide resistance as you move your arms and legs through different positions.  You don't have to limit muscle building to workouts. Take advantage of daily activities to challenge your muscles. For example: 
  • Lift that carton of milk a few times before you put it back in the refrigerator, to build your arm muscle.
  • Use the stairs when possible. This helps to build the muscles in your legs, hips, buttocks and abdomen.
  • Get active while you talk on the phone or stand in line. Do leg lifts and heel raises to strengthen the muscles in your legs and buttocks. 
Be sure to get enough sleep. It's critical to allow for muscle recovery and proper healing of stressed tissues. Aim for seven to eight hours per night. That will give your body time to repair muscle tissue and replenish your muscles' energy stores.  Your muscles need healthy nutrients to get stronger. You don't need protein supplements or lots of meat. Plant-based proteins and fish will provide more than you need. Get your carbs from whole-grain products. To get your vitamins and minerals, eat lots of fruits and vegetables. What Can I Expect Looking to the Future? In the future, visits to the doctor may start with a medical assistant measuring your hand grip strength after taking your blood pressure and pulse.]]>
Fri, 15 May 2015 14:38:00 -0400
THC Pill No Help for Dementia Behaviors In a small study, a "medical marijuana" pill did not help behavior problems caused by... In a small study, a "medical marijuana" pill did not help behavior problems caused by dementia any more than a placebo, researchers report. The study included 50 people. They were having behavior problems linked with their dementia. They showed aggression, acted agitated or wandered. People were randomly assigned to take either the "medical marijuana" pill or a placebo (fake) pill 3 times a day. The marijuana pill contained synthetic THC, the active ingredient in marijuana. In the next 3 weeks, most people improved. But the THC group did not improve any more than the placebo group. Researchers said maybe just the extra attention of being in the study helped to soothe behavior problems. Side effects also were similar between the two groups. None were serious. Researchers said they will do another study using a larger dose of THC. The journal Neurology published the study. HealthDay News wrote about it May 13.                   What Is the Doctor's Reaction?  Medical marijuana now is legal in nearly half of U.S. states. So it is vitally important that we answer this question: for which conditions is it effective?  Without knowing the answer, it is impossible to know whether the use of medical marijuana is a good idea. If it's unlikely to help, you may decide to forgo even trying it, especially given its price and the risk of side effects. These are same sorts of calculations that apply to using any medicine.  For a few conditions, there is good evidence to support the use of marijuana or its active ingredient, tetrahydrocannabinol (THC). For example, drugs containing synthetic THC are already approved to: 
  • Treat nausea caused by cancer chemotherapy
  • Increase appetite for people with AIDS who have severe weight loss 
A new study looks at the potential for THC to help people with dementia.  It might seem odd to treat a disease that impairs brain function with a drug that affects the brain in the way that marijuana does. But small studies have suggested that marijuana might help with these symptoms in people with dementia: 
  • Restlessness
  • Wandering
  • Aggression 
These are serious problems for people with dementia -- and for those who provide their care.  The medical journal Neurology published results of the new study. It included 50 older adults with dementia and challenging behaviors, including pacing, aggression or wandering. Here's what researchers found: 
  • Over 2 to 3 weeks, the behavior of those receiving THC and those taking a placebo improved. There was no significant difference between the two groups.
  • Quality of life, function and measures of pain were also similar between those receiving a placebo or THC.
  • The two groups had similar rates of side effects. No serious side effects were seen. 
These results suggest that any benefits were not related to THC. So why did both groups improve? It could have been the added attention people received by being in the study.  Some behaviors linked with dementia have been challenging to treat. For those who hoped medical marijuana might be the answer, these results are disappointing. But this may not be the last word on the subject. This study was quite small. And it may turn out that THC might help those with other symptoms (such as poor appetite or insomnia) more than those who are aggressive or restless. Or a different dose of THC might have been more helpful.  For me, the most important thing is that researchers were able to do a high-quality research study on this topic. Of course, we want to know which drugs work well. But it's also quite helpful to know which ones don't.  What Changes Can I Make Now?  If you have considered medical marijuana to treat symptoms or a condition you have, talk to your doctor about the pros and cons. But don't be surprised if your doctor isn't sure how to answer your questions. There is much we don't know about when marijuana may be helpful.  Even if you learn that marijuana may help your condition, know the risks. Potential effects include: 
  • Sedation or euphoria
  • Fear, anxiety or panic
  • Increased appetite and weight gain
  • Poor judgment
  • Impaired memory or concentration
  • Decreased motivation 
Some studies have linked marijuana use with an increased risk of schizophrenia. However, it's not clear whether marijuana actually causes schizophrenia.  As with any other drug, the risks and benefits of medical marijuana may vary from person to person. So learn what you can from reliable sources and talk to your doctor. Medical centers and government-sponsored websites (such as Medline Plus) tend to provide the most accurate information. They should be more reliable than sites that promote or discourage marijuana use or those that sell marijuana-related products. What Can I Expect Looking to the Future?  Researchers are hard at work studying the impact of marijuana (or THC) on human health and disease. So you can expect to hear much more about its potential as a treatment for a host of conditions. According to, more than 500 clinical trials of marijuana are planned, underway or completed.  The only way we'll know if medical marijuana is worthwhile is to study it well. And, as this study shows, that's happening.  You can also expect to hear more about research on the prevention and treatment of dementia. Some studies certainly will focus on challenging symptoms such as aggression, wandering or pacing. As more Americans join the oldest age groups, we are expecting to see more cases of dementia. So better approaches to treatment can't come too soon.]]>
Thu, 14 May 2015 00:00:00 -0400
Study Backs 'Slow Metabolism' Link to Weight A small new study suggests that some people really may have a harder time losing weight because of... A small new study suggests that some people really may have a harder time losing weight because of a "slow" metabolism. The study of 12 obese men and women took place in a laboratory. For the first 3 weeks, people were given enough calories to maintain weight. During this time, however, each person spent a total of 4 days either fasting or getting fed twice the normal amount. They spent these days in a chamber that measured their use of energy (metabolism). When fasting, some people had a bigger decrease in energy use than others did. They also had a smaller increase in energy use when overfed. Overall, their bodies conserved energy. This is called a thrifty metabolism. Others had a "spendthrift" metabolism, burning more energy overall. After the steady-weight phase, everyone went on a low-calorie diet for 6 weeks. In the last 2 weeks of the study, they went back to the steady-weight diet. During the calorie-cutting phase, people in the "thrifty metabolism" group lost less weight than others. People with a spendthrift metabolism lost more weight. The journal Diabetes published the study. HealthDay News wrote about it May 11.                     What Is the Doctor's Reaction? I often hear this from patients. "No matter how much I cut calories, I can't lose weight." Some of them wonder:  "Could I have a slow metabolism?"  These patients were not just looking for an excuse. People's bodies do indeed respond very differently when they cut calories. This report helps us better understand why some obese people hold on to weight when they eat less, while others shed the pounds easily.  The researchers recruited 12 obese adults. They were otherwise in good health and willing to go through intensive study.  The researchers first did baseline studies to find out how many calories each person needed to stay at the same body weight for 3 weeks. Each of them was then placed on 50% calorie reduction for 6 weeks.  As part of the study, each person fasted for 24 hours. During the fast, the researchers calculated how much energy each of them spent. At a different time, each of them was overfed. Again, researchers calculated energy use.  The researchers looked at how weight loss after the 6-week diet compared to energy spent during fasting and overeating.  As expected, all of the obese adults spent less energy during the fast. All of them spent more energy when they were overfed.  But those who lost the least amount of weight during the 6-week diet also spent the least amount of energy while fasting. Instead of slow metabolism, the better description for these folks is thrifty metabolism. They also had smaller increases in energy spent while overeating, compared with those who lost the most weight.  The opposite was true for the obese adults who lost the most weight on the reduced-calorie diet. They spent the most energy during the fast and also when they were overfed. What Changes Can I Make Now?  Even if you have a thrifty metabolism, you will lose weight if you reduce calories enough and get more exercise.  I prefer a modified Mediterranean-style diet. Not only can you lose weight, but this diet also has the best evidence that it helps decrease the risk of heart disease and stroke. Here are the basics of a Mediterranean-style diet for weight loss: 
  • As many vegetables daily as you want. 
  • Lots of fruits, but more vegetables than fruits. 
  • Olive oil for salads and cooking. 
  • One handful (about 1½ ounces) of nuts, 2 to 3 times a week. Nuts are healthy, but the calories add up quickly. 
  • Plenty of legumes (beans, peas and lentils), at least 3 times per week.
  • Whole grains as your main carbohydrate source. But again, not too much. 
  • Three or more servings of fish (especially fatty fish) a week. A serving is 4 ounces. 
  • A cup of low-calorie yogurt daily. 
  • 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 
What Can I Expect Looking to the Future?  It's unclear how this new information might help make it easier for obese people with thrifty metabolism to shed pounds. But at least it does provide some scientific reason for why weight loss can be so challenging.]]>
Wed, 13 May 2015 00:00:00 -0400
Study: Resistant Typhoid More Widespread A drug-resistant strain of the bacteria that cause typhoid fever is spreading through Asia and... A drug-resistant strain of the bacteria that cause typhoid fever is spreading through Asia and Africa, a new study warns. The strain is known as H58. It is now one of the most common forms of the bacteria Salmonella typhi, the study says. H58 resists several antibiotics that are used to treat the disease. It is still changing and becoming resistant to other drugs. The study looked at data on more than 1,800 S. typhi samples. They were collected from 63 countries in the last 20 years. Nearly half included the H58 strain. This strain has reached epidemic levels in Africa, the study found. Symptoms of typhoid fever include a high, long-lasting fever, belly pain and weakness. Up to 20% of those who are infected die. Typhoid fever is not a threat in developed countries. That's because clean water and sewage treatment prevent spread of the bacteria. Travelers to Asia and Africa can get a vaccine to prevent typhoid. The vaccine reduces the risk of infection by 50% to 80% for all strains, an expert told HealthDay News. The journal Nature Genetics published the study. HealthDay wrote about it May 11.                    What Is the Doctor's Reaction?  We often hear about salmonella infections. The types of salmonella commonly seen in the United States and other developed countries cause diarrhea. Often this comes along with fever and belly pain. Infected people usually get better within several days on their own. Most of them don't need antibiotics.  There are many other types of salmonella. Salmonella typhi and Salmonella paratyphi cause a different illness. They cause typhoid fever. Salmonella infections almost always come from contaminated food or water.  Between 1 and 3 weeks after swallowing the bacteria, the person develops fever and chills. Belly pain comes next, and the fever continues. There also may be classic pink spots on the skin (called rose spots) that come and go quickly.  If not treated with the correct antibiotics, typhoid can be deadly.  The types of salmonella seen in the United States infect animals as well as humans. S. typhi and S. paratyphi infect only humans. The bacteria that cause typhoid fever, therefore, are spread only between humans, usually through human waste.  Worldwide, typhoid fever affects millions of people. It's rarely seen in the United States and developed countries. The difference is sanitation. Developed countries have higher standards for water and food safety, flush toilets and sewage systems. When typhoid cases are seen in developed countries, almost always the affected person has travelled to a part of the world with a high infection rate.  In the past, a variety of antibiotics easily killed S. typhi. However, during the last 20 years a strain of the bacteria known as H58 has become more widespread. It is resistant to all of the most commonly used and most effective antibiotics. H58 is now the most common strain in Asia and Africa.  What Changes Can I Make Now?  If you are travelling to Asia, Africa or other areas where typhoid fever is common, get vaccinated before you go. Plan to finish two weeks before you travel. There are two types of vaccines. One is taken by mouth. The other is injected.  Once you are there, the U.S. Centers for Disease Control and Prevention (CDC) recommends the following ways to help prevent typhoid fever: 
  • If you drink water, buy it bottled. Bottled carbonated water is safer than un-carbonated water. Or bring water to a full boil for at least one full minute before you cool and drink it.
  • Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.
  • Eat foods that have been thoroughly cooked and are still hot and steaming.
  • Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
  • When you eat raw fruit or vegetables that can be peeled, wash the outsides thoroughly. Use soap. If you can, use boiled or bottled water. Peel them yourself. If possible, wash your hands one more time before eating.
  • Avoid foods and drinks from street vendors. It is difficult to keep food clean on the street. Many travelers get sick from food they bought from street vendors. 
These tips can also help prevent other foodborne and waterborne infections. That's true at home as well as when you travel.  What Can I Expect Looking to the Future? S. typhi will not become more common in the United States and other developed countries. Again, the reason is sanitation. If you do have persistent fever after traveling to Asia or Africa, tell your doctor where you have been. It’s possible that you have typhoid fever. It could even be a multi-drug-resistant strain.]]>
Tue, 12 May 2015 00:00:00 -0400
Experts Push Pertussis Shots in Pregnancy Vaccinating pregnant women offers the best way to protect newborns against whooping cough, a panel... Vaccinating pregnant women offers the best way to protect newborns against whooping cough, a panel of experts says. If that doesn't happen, everyone having close contact with the baby should get the vaccine as soon as possible, the panel says. The new advice comes from an expert group called the Global Pertussis Initiative. Pertussis bacteria cause whooping cough. The new report is based on a close look at previous research. Several studies show that whooping cough rates among babies less than 3 months old have dropped in recent years. This drop occurred after increased promotions of pertussis booster shots for pregnant women. Women who get the shots while pregnant can pass on some of their immunity to their babies before birth. Babies can't get their own shots until age 2 months. That's when they get their first dose of the vaccine against diphtheria, pertussis and tetanus. The panel's review found that "cocooning" also helps protect babies. This means surrounding the newborn with people who have been vaccinated against pertussis. But there were fewer studies of this approach. The journal Pediatrics published the panel's advice May 11.                     What Is the Doctor's Reaction? Cough-cough-cough-cough-cough-whoop! This sounds just like whooping cough (also known as pertussis). It makes breathing really hard for children. They turn red in the face trying to catch their breath. Sometimes they may vomit after a coughing spell. They can stop breathing briefly. Pertussis can even lead to death in very young babies.  All infants must be protected against whooping cough. But infants 0 to 6 weeks old are too young to get the pertussis vaccine themselves. Mothers (and fathers) have been shown to be the major source of spread of pertussis to infants. This is because they spend the most time with them. So parents of infants need to get vaccinated.  Older children, teens and adults also are at risk for getting whooping cough. Everyone must be up to date with the recommended doses of pertussis vaccine. 
  • DTaP is the pertussis vaccine is for children under 7 years of age.
  • Tdap is the pertussis vaccine is for anyone 7 years of age and older. 
A new article in the journal Pediatricsreviews all that is known about two important ways to stop the spread of pertussis to infants. 
  1. Vaccinate all pregnant women in the third trimester (last three months).
  2. Vaccinate everyone who takes care of (or is in close contact with) an infant. This is called cocooning. 
The authors found that vaccinating all pregnant women works better than cocooning to protect the most infants from whooping cough. Giving the Tdap pertussis vaccine during pregnancy is known to be safe. Women who get the vaccine show no increase in problems with the birth or the newborn.  Pertussis is a serious global health issue. It is being diagnosed more around the world. Three common reasons are: 
  • The amount of protection (immunity) goes down over time.
  • Doctors are more aware of the disease when treating patients who are coughing.
  • It is easier than ever before to make the right diagnosis in the lab. 
Countries need to: 
  • Teach their public and medical communities all about pertussis
  • Monitor the impact of pertussis
  • Use these strategies to protect all young babies from pertussis
What Changes Can I Make Now?  Every mother should receive the Tdap pertussis vaccine each time she is pregnant. Be open to getting vaccinated during your pregnancy. The last three months of pregnancy is the best time to get it. This will help protect your new baby against whooping cough.  When a pregnant woman gets the Tdap vaccine, it tells her immune system to make antibodies that protect her from getting whooping cough. She passes on these antibodies to her baby at birth. This gives her newborn protection against whooping cough.  The idea of cocooning helps, too. Parents, caregivers and all close contacts of the baby should get one dose of the Tdap vaccine when the mother is pregnant. If that doesn't happen, then get the vaccine right after the baby is born.  This cocooning approach surrounds the infant with people who all have been vaccinated. This limits how much and how often the baby is exposed to pertussis. The infant is then protected from getting whooping cough from any of these people.  You also can protect your older infant against pertussis by giving him the DTaP vaccine. Infants and children need 5 doses of this vaccine. The doses are given at these ages: 
  • 2 months
  • 4 months
  • 6 months
  • 12 to 18 months
  • 4 to 6 years 
These shots help your child's immune system to develop her own protection. Children 7 to 10 years of age who did not complete the full DTaP vaccine series should receive a single dose of Tdap.  What Can I Expect Looking to the Future?  Your obstetrician should routinely recommend the Tdap vaccine to you each time you are pregnant. This provides the greatest protection for your infant.  Expect all family members and caregivers to receive the Tdap vaccine, too. If they don't know they need it or don't remember, then remind them. They should get the vaccine during the pregnancy or right after the infant is born.  Researchers will continue to study the different ways to protect as many infants as possible from pertussis. New information from studies done around the world will be used to update advice for doctors.]]>
Mon, 11 May 2015 00:00:00 -0400
Healthier Diets Linked to Less Mental Decline People who eat healthier diets may also be less likely to lose mental sharpness as they get older,... People who eat healthier diets may also be less likely to lose mental sharpness as they get older, a new study finds. The study included nearly 28,000 older adults from 40 countries. Researchers gave them tests of mental sharpness and asked them questions about diet. Then they kept track of people for about 5 years. In that time, tests showed that 14% of those with the healthiest diets had a decline in thinking and memory. Among people with the least healthy diets, 18% suffered declines. Better diets were those that included more fruits, vegetables, fish, nuts, whole grains and soy. Diets classified as poorer in quality included those with more red meat, deep-fried foods, alcohol and sweets. The study was not able to show whether diet actually caused the difference between the 2 groups. But researchers did try to account for other factors that can affect the risk of mental decline with age. But even among people who were better educated, thinner or got more exercise, those who ate better diets had a lower risk of mental decline. The journal Neurology published the study. HealthDay News wrote about it May 6.                      What Is the Doctor's Reaction? Previous studies have shown a link between healthier eating and an improved chance of keeping your mind sharp as you age. So the results of this study are not surprising. What makes this study special is its size and breadth. The researchers enrolled 27,860 people ages 55 and over. The study included both men and women from 40 different countries. People in the study also had above-average risk of heart disease, stroke and decline in brain function.  The researchers rated each person's diet using the modified Alternative Health Eating Index. The index provides an overall score of diet quality. It's based on seven components:
  • Vegetables
  • Fruits
  • Nuts and soy proteins
  • Whole grains
  • Deep-fried foods
  • Ratio of fish to meat and eggs
  • Alcohol 
If you eat the most vegetables, fruits, whole grains and fish and little if any meat or deep-fried foods, you will get an excellent diet-quality score. High alcohol intake lowers the quality score.  The researchers used a standard test for brain function called the Mini-Mental State Exam (MMSE). They compared results of each person's MMSE at the beginning of the study with the results of the exam at the end of the study. On average, the study lasted nearly five years.  Those who ate the healthiest diets had the least brain-function loss over five years. This was true no matter what MMSE score the person had on the first mental exam.  What Changes Can I Make Now?  Since the start of this study, the Alternative Health Eating Index has been updated. In the newer version of the index, a Mediterranean-style diet very closely matches a high-quality diet.  These are the main components of a Mediterranean style of eating: 
  • 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 3 to 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 drink a day for women or 2 drinks a day for men. 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?  Scientists are not sure why a healthier diet improves your chances of keeping your brain sharp. Sure, people who follow a healthier diet tend to be thinner and exercise more. But it appears that diet affects the brain even if you account for the effect of these other factors.  Researchers are actively pursuing the answers. That will be interesting. But it won't change the way you should eat now to stay as healthy as you can.]]>
Thu, 07 May 2015 00:00:00 -0400
2-Minute Walks May Offset Effects of Sitting Recent research suggests that sitting for long periods is harmful even for those who get regular... Recent research suggests that sitting for long periods is harmful even for those who get regular exercise. But a new study finds that getting up and moving for just 2 minutes each hour can help reverse those effects. The study used data from a national health survey. People wore devices that measured their movement throughout the day. Researchers kept track of people for 3 years. In that time, 137 died. Researchers found that those who had short spurts of light activity were less likely to die during the study than those who just sat for a long time. For example, people may have spent the time in walking, cleaning or gardening. Doing these things for as little as 2 minutes an hour, instead of 2 minutes of sitting, reduced the risk of early death by 33%, the study found. Experts already recommend that people get at least 2½ hours of moderate activity, such as brisk walking, each week. The study authors recommended that people add the brief bursts of activity, too. The Clinical Journal of the American Society of Nephrology published the study online. HealthDay News wrote about it April 30.  What Is the Doctor's Reaction?  Two minutes.  This study suggests that walking just 2 minutes every hour can help reverse the negative health effects of an inactive lifestyle. This is in contrast to what most doctors suggest -- moderate exercise for at least 2½ hours a week! The Clinical Journal of the American Society of Nephrology published the study online.  No one is saying that a higher level of exercise is bad. But this study found that people who did light-intensity activity -- walking, cleaning or gardening -- lived longer than people who didn't move much at all. Researchers used data from more than 3,000 people who wore devices to measure their activity.  The health risks of sitting have been well defined.  Spending a lot of time sitting can increase the risk of diabetes, heart disease and even death.  People who got up and moved for at least 2 minutes every hour had a 33% lower risk of early death than people who moved less.  Among people with chronic kidney disease, who may move less than most people, the decreased risk of death was 41%.  The authors are clear that they do not discourage people from doing the 2½  hours of moderate exercise that most doctors recommend. But they say that adding light-intensity exercise -- during the workday, for example -- can also make an important difference.  Most of us find it hard to get 2½ hours of moderate activity each week. In fact, 80% of Americans don't. This article adds an important fact -- that light exercise, done in small amounts, has distinct health benefits. Most people -- whatever their job, living situation, and lifestyle -- can achieve this amount of exercise. It is quite hopeful.  What Changes Can I Make Now?  Get up and move! If you don't exercise or if you work at a desk job, make an effort to leave your seat and walk around for two minutes every hour. It can be as simple as a trip to the bathroom, a walk to get a cup of coffee or glass of water, or a quick spin around your office. If you're at home, walk around during the commercials of your favorite TV show.  Walking has many health benefits. The American Heart Association says that walking can help you: 
  • Reduce your risk of heart disease
  • Maintain a healthy weight
  • Reduce the risk of certain cancers 
Most of these benefits are linked with more than two minutes an hour of exercise. But still, walking is easy for most of us. It's also enjoyable and doesn't cost any more than a pair of comfortable shoes. Give it a try!  What Can I Expect Looking to the Future?  This was an observational study. Researchers compared the health outcomes for people who chose on their own whether to do light-intensity activity. It would be nice to see the results confirmed by a randomized, controlled trial. A study like this would randomly assign people who were similar in other ways to do light activity or not. I would also love to see whether light activity does more to improve health.  Finally, if these benefits are proven, then I hope we will see workplaces, schools, senior centers and other places develop programs to encourage people to walk more -- even for just two minutes. ]]>
Mon, 04 May 2015 00:00:00 -0400
Low Health Literacy May Speed Heart Death Heart-failure patients who have problems understanding medical instructions may die sooner than...                      What Is the Doctor's Reaction? Heart failure is a common and serious condition. It develops when the heart is unable to pump as forcefully as it should. Fluid backs up into the lungs and legs. This makes it hard to breathe and causes leg swelling and weight gain. Coronary artery disease, high blood pressure and heart valve problems are among the most common causes. In the United States alone, heart failure affects more than 5 million people. It plays a role in nearly 300,000 deaths each year. And it's costly. By 2030, we will spend an estimated $50 billion to $70 billion each year treating heart failure. We do have new medicines and better operations (including heart transplants) to treat heart failure. But we still need better ways to prevent and treat this condition.  Low health literacy -- a poor understanding of medical information -- is also common. Past research has linked it to several health problems. For example, people with limited health literacy tend to have more trouble managing asthma or diabetes. Hospital admissions that could be prevented are more common among those with poor health literacy.  A new study is among the first to look at the impact of low health literacy on people with heart failure. Researchers published their results in the Journal of the American Heart Association. The study included nearly 1,400 people who had been admitted to the hospital for heart failure. They were interviewed about their confidence in understanding medical information. Researchers kept track of return hospital visits and deaths for an average of 21 months.  About one-quarter of the study group scored low on measures of health literacy.  Compared with those who scored the highest, those with the lowest health literacy were: 
  • Older
  • More likely to be male
  • Less likely to have completed high school
  • 34% more likely to die in the next year or two 
Emergency room visits and return trips to the hospital within 90 days did not vary by health literacy. This may be because follow-up care is more intense just after discharge than months or years later.  These results suggest that a poor understanding of health information can have dire consequences. This study did not determine whether improving health literacy will save lives. But the results suggest patients might do better if doctors: 
  • Found out which patients have low health literacy
  • Took the time to provide clearer information to them
What Changes Can I Make Now?  Heart failure can't always be prevented. But you can make changes now to reduce your chances of developing heart failure. Here's what you can do: 
  • Have your blood pressure and cholesterol checked on a regular basis.  If either is not in an ideal range, work with your doctor to improve it with diet and exercise. Your doctor can prescribe medicines if needed.
  • Don't smoke.
  • Maintain a normal body weight.
  • Exercise regularly.
  • Drink only moderate amounts of alcohol. 
If you already have heart failure, listen carefully to your doctor's instructions.  Repeat them back to your doctor to make sure you've got it right.  Ask questions about anything that is unclear. Questions you might ask include: 
  • What is the purpose of each of my medicines?
  • What should I do if I forget to take a dose of my medicines?
  • What side effects are most common with my medicines?
  • What should I keep track of, and what changes should I report right away?  For example, a rising body weight can be a sign that heart failure is getting worse. 
  • Who should I call if I notice my weight is going up or if it's harder for me to breathe? 
Your doctor also may make changes based on the findings of this new research. Your doctor may ask questions to find out how much you understand about medical information and instructions. Past research has found that doctors often think their patients understand more than they actually do. This means that doctors need to find out about their patients' health literacy. This lets them know who is at increased risk of problems in the future.  Doctors may be able to improve heart-failure care among those with low health literacy. Here are some things we can do: 
  • Contact patients regularly to check for symptoms or signs of heart failure.
  • Provide clearer instructions.
  • Prescribe fewer medicines or switch to ones that are taken only once or twice each day.
  • Schedule more frequent appointments.
  • Arrange home visits by nurses or doctors. 
However, we don't really know how useful these approaches may be. This study did not look at the best ways to address low health literacy among people with heart failure.  What Can I Expect Looking to the Future? In the future, I believe attention to health literacy will increase. Identifying those with low health literacy is an important first step. Figuring out what do may prove difficult. But finding a way to bridge gaps in patients' understanding of medical information may improve their health. It could even be life-saving.]]>
Thu, 30 Apr 2015 00:00:00 -0400
CDC: More Americans Dying from Falls Americans ages 65 and older are much more likely to die from falls than older adults were in 2000,... Americans ages 65 and older are much more likely to die from falls than older adults were in 2000, a new report shows. The report comes from the U.S. Centers for Disease Control and Prevention (CDC). It was based on death records. They showed 10,273 deaths from falls in 2000 for adults at least 65 years old. That increased to 25,464 in 2013. The average age in this group has been rising. So the CDC adjusted the numbers to account for age. The increase in age-adjusted death rates was steady throughout the 13-year span. Deaths from falls rose from 38.2 to 67.9 per 100,000 men. Among women, they rose from 24.6 to 49.1 per 100,000. The journal Morbidity and Mortality Weekly Report published the report May 1.                      What Is the Doctor's Reaction?  A report from the U.S. government says older Americans are dying from accidental falls at roughly double the rate we saw 13 years ago.  In fact, older adults are falling more in general. This January the journal JAMA Internal Medicine wrote that 36% of adults age 65 and up who were surveyed said they had fallen  within the last 2 years. This was almost a 30% increase from results of a similar survey done in 1998. If you have already fallen once, your risk of falling a second time in the next year is about 60%.  For those of us who practice medicine, this increase in falls and their consequences is devastating to see. In 2012, emergency rooms treated 2.4 million people over 65 who had fallen. In 2011, falls killed 22,900 Americans over age 65. This was almost 4 times the rate of deaths from car accidents in the same age group.  Some estimates put falls as the third most costly cause of hospital stays, right after cancer and heart disease. When my own patients need hospital care after a fall, I worry about them. Why? Because I know that roughly 60% of older adults who admitted to hospitals after a fall will be discharged to a nursing facility, not to home. Falls can be the beginning of adult frailty.  So why are we falling more often? We do have more older adults in the United States these days. We also have more people in their 80s and 90s. But the increased rate of falls is true for older adults in every age bracket.  One thing that definitely adds to our risk for falls is the fact that we take more medicines. Medicine side effects contribute to falls. Some medicines that can promote falls are used more than ever now in older adults. These medicines include: 
  • Antidepressants
  • Sleeping pills
  • Narcotic pain medicines
  • Medicines for overactive bladder
  • Gabapentin (Neurontin) used for pain
What Changes Can I Make Now?  If you sometimes feel unsteady or lightheaded, or worry about falling, talk with your doctor. The U.S. Preventive Services Task Force advises doctors to check in with patients over age 65 once a year to consider ways to improve their risk of falls.  Here are some things you can talk over with your doctor: 
  • Do you need all of your medicines? If your list is long, your doctor may be able to pick out one or more medicines that are not needed. Many medicines add to fall risk. In particular, getting off of a medicine for depression or anxiety can cut your fall risk by about 66%.
  • Is your blood pressure at a healthy level? Your doctor should check blood pressure lying and standing. If you are over 60 and don't have heart disease, kidney disease or diabetes, your blood pressure should be lower than 150/90. If your blood pressure is much lower than that and you are on blood pressure treatment, it may be best to stop one of your medicines.
  • Do you have enough vitamin D? Vitamin D helps to keep your muscles in good health. A blood test can show if you need a supplement.
  • Where can you sign up for a balance class? Exercise classes that emphasize balance and improve your thigh and buttock muscle strength have been proven to reduce fall risk. Examples of these classes are Tai Chi Moving for Better Balance, Matter of Balance, Stepping On and Otago. These classes and programs are available in many cities and neighborhoods.
  • Have you had your vision checked? Treat cataracts and other eye problems. If you wear glasses, avoid bifocals. Use one pair for near vision and another pair for far vision, especially when you are outdoors. This allows you to see obstacles on the ground in front of you, which can be blurry with bifocals.
  • Do you need a cane?  Use one if it will help keep you steady. A physical therapist may help you to plan out a safe way to support your walking.  
  • Can you make your home safer? Here's what you can do:
    • Remove clutter you might trip over.
    • Get rid of small, loose rugs.
    • Install grab bars in the bathroom.
    • Make sure stairs have a rail and a good light, and use nightlights.
    • Wear shoes both inside and out of the house. Bare feet and slippers are both more likely to slip.
    • Keep frequently used items in low cupboards, so you rarely use a step stool.
What Can I Expect Looking to the Future? If you talk with your doctor, you will almost certainly find a few ways you can lessen your risk of falls right away. When I have these discussions with my patients, the best thing that happens is that they have less fear of falling than they did before. This makes a big difference. With less fear of falling, you can have more confidence, increase your activity and get out of the house more often.]]>
Thu, 30 Apr 2015 00:00:00 -0400
Study: Brief Diet Switch Cuts Colon Cancer Risk Switching diets may make a big difference in African Americans' risk of colon cancer, a small... Switching diets may make a big difference in African Americans' risk of colon cancer, a small study suggests. African Americans have a higher risk of colorectal cancer than whites. But rural African blacks have an extremely low risk. The new study included 20 African Americans and 20 blacks from rural South Africa. Researchers gave everyone colonoscopies. They removed polyps that could develop into cancers from 9 Americans. None of the Africans had polyps. Researchers also looked at inflammation, chemical activity and bacteria in the colon. What they found was different between the 2 groups. The Americans' results have been linked in other research with a higher risk of colon cancer. The Africans showed lower risk. Researchers had the groups switch diets for 2 weeks. The African Americans ate the Africans' normal high-fiber, low-fat diet. The black Africans switched to an American-style diet. It had 2 to 3 times the levels of protein and fat they usually ate. The researchers then repeated the colonoscopies to look for changes. The African Americans had big reductions in inflammation and other factors linked with colon cancer risk. The Africans had big increases. Nature Communications published the study. HealthDay News wrote about it April 28.                     What Is the Doctor's Reaction?  Colorectal cancer is the third most common cancer in the United States. It's also the third most common cause of cancer death. Rates differ based on race and ethnic group. Compared with other races, African Americans have the greatest risk of developing and dying from colon cancer.  However, the picture is completely different in native Africans. Fewer than 5 of every 100,000 blacks who live in rural Africa develop colorectal cancer. In the United States, 65 out of every 100,000 blacks are diagnosed with the disease. That's 13 times the risk of rural Africans. A gap that large is unlikely to be explained by genetic differences.  This elegant study is small. Only 40 people were enrolled -- 20 African Americans and 20 blacks from rural South Africa. At the start of the study, they all had colonoscopies.  Nine of the 20 Americans had polyps. Some polyps may develop into cancer. No polyps were found in any of the 20 South Africans. Stool samples were also taken. These allowed researchers to look at chemical and bacterial patterns known to be linked with an increased risk of colorectal cancer.  As expected, the usual diets of the two groups were extremely different. The Americans ate two to three times as much animal fat and protein as the Africans. The Africans ate much more fiber.  The two groups switched diets for two weeks. Researchers repeated the colonoscopies and once again examined stool samples. In just that very short period of time, changes occurred in the lining of the colon and the chemicals and bacteria in the gut. The Americans now had a "healthier" colon profile. The opposite was true for the Africans. What Changes Can I Make Now?  Many studies suggest that people who eat more fruits and vegetables and fewer animal products are less likely to develop colorectal cancer. But these types of studies are observational. They compare the health of groups that choose different types of diets. They can't prove that one diet over another definitely decreases the risk of getting this type of cancer.  This study adds strong support for the influence of diet on colorectal cancer risk. It compares how different diets affected exactly the same people. It provides very plausible biological reasons for how diet can change the chemical reactions and the bacteria in our colon that lead to cancer.  These are the dietary changes that may help prevent colorectal cancer: 
    • Eat a diet rich in fruits and vegetables. 
    • Limit red and processed meats. 
    • Get enough vitamin D through sunlight, diet, pills or all of these. 
    • Choose whole-grain products that provide more fiber. 
You can also take other steps to reduce your risk: 
    • Stay physically active and dedicate time to exercise each day. 
    • Don't smoke. 
    • Use alcohol in moderate amounts or not at all. 
    • Maintain a healthy body weight. 
    • Get screened with colonoscopy. 
For people at average risk of colorectal cancer, screening begins at age 50. Colonoscopy is the preferred method. That's because it allows the doctor to remove polyps that could turn into cancer.  What Can I Expect Looking to the Future?  People have different amounts and types of bacteria that normally live in the intestines. It's called our microbiome. This is a hot area of research. Studies such as this one will help us learn how our microbiome affects our risk of colorectal cancer. But the potential goes way beyond cancer risk. Overall health and risk of many diseases may be closely related to our microbiome.]]>
Wed, 29 Apr 2015 00:00:00 -0400
MRI May Help Gauge Stroke Risk in Atrial Fibrillation People with an abnormal heart rhythm may have a higher risk of stroke if they also have certain... People with an abnormal heart rhythm may have a higher risk of stroke if they also have certain changes in part of the heart, a new study suggests. The study looked at 169 people with atrial fibrillation. This condition causes part of the heart to quiver rather than beat normally. People in the study received a type of MRI before having a procedure to treat the abnormal rhythm. This type of MRI shows heart muscle movement, among other things. Researchers looked at the MRI results. They compared people who did or did not have a history of stroke or transient ischemic attack (TIA). They saw differences in the heart between these two groups. The function of the upper left chamber (atrium) was different in those who had a history of stroke or TIA. Researchers said that seeing these features on an MRI may show a higher risk of stroke. Knowing which people with atrial fibrillation have a higher risk of stroke could help guide treatment. People with a higher risk may have a greater need for blood thinners to help prevent stroke. The Journal of the American Heart Association published the study. HealthDay News wrote about it April 27.                      What Is the Doctor's Reaction?  Doctors may have a new way to help determine stroke risk in people with an abnormal heart rhythm. That's what the results of this new study suggest.  A normal heartbeat starts in a cluster of cells in the right upper heart chamber (right atrium). This is a natural pacemaker. These special cells send out a pulse of electricity.  The electrical current flows into the rest of the heart. It stimulates the heart muscle cells in the lower heart chambers (the ventricles). This causes them to squeeze (contract) in a regular, organized way. Each time the left ventricle contracts, the heart pumps blood out to the rest of the body.  Atrial fibrillation disrupts this natural process. Areas outside of the natural pacemaker also send out signals. The signals are fast. They don't follow a steady beat. So the atria don't squeeze and relax. Instead, they quiver. This causes blood to pool rather than flow smoothly through the heart.  In general, atrial fibrillation is not a dangerous rhythm. But it is linked with an increased risk of stroke. Blood that doesn't flow easily can form small clots. They can break away from the heart and go to the brain.  To reduce stroke risk, people with atrial fibrillation are often advised to take a blood thinner. But blood thinners can cause severe bleeding. Sometimes it can be life threatening.  Doctors use different methods to help decide whether a person should be on a blood thinner. Factors such as age and prior history of stroke need to be balanced against the chance that the blood thinner will cause serious bleeding.  In this study, researchers used a special type of heart MRI to look at the left upper chamber (left atrium) of the heart. They found that specific changes in the muscles of the left atrium increased stroke risk. And these changes were not linked with age or other factors that increase the risk of stroke. What Changes Can I Make Now?  This is an interesting study. But it is much too early and costs too much to use MRI to help evaluate atrial fibrillation. Doctors will continue to use standard tools to determine stroke risk.  If you have atrial fibrillation, your stroke risk is higher if you: 
  • Are age 65 or older -- and even higher if you are 75 or older.
  • Have had a stroke or a TIA in the past. A TIA stands for transient ischemic stroke. It means you had stroke symptoms but they completely went away over minutes to hours.
  • Have heart failure.
  • Have blood vessels narrowed by atherosclerosis in any part of your body.
  • Have diabetes.
  • Are a woman. 
Experts have devised an online tool to calculate a stroke risk score for people with atrial fibrillation. This tool can help you and your doctor decide the best stroke risk strategy for you.  What Can I Expect Looking to the Future?  I do suspect that MRI or some other technique to image the heart will be important in the evaluation of atrial fibrillation in the future. But not any time soon.]]>
Tue, 28 Apr 2015 00:00:00 -0400
Ovary Removal Cuts Breast-Cancer Deaths Women with breast cancer who carry a high-risk gene can lower their risk of death from the disease... Women with breast cancer who carry a high-risk gene can lower their risk of death from the disease 62% by having their ovaries removed, a new study finds. They can reduce their risk even more by not delaying that surgery for more than a year or two, researchers said. The study included  676 women who had early-stage breast cancer. All of them were carriers of a BRCA1 or BRCA2 gene mutation. Women with these genes have a much higher than average risk of breast cancer and ovarian cancer. About half of the women in the study decided to have their ovaries removed. Those with a BRCA1 gene who had their ovaries removed were 62% less likely to die of breast cancer in the next 20 years. Death rates were up to 73% lower for women who had the surgery within 2 years of their breast cancer diagnosis. Breast cancer death rates were only slightly lower for those with BRCA2 genes who had their ovaries removed. The difference was small enough that it could have been the result of chance. The journal JAMA Oncology published the study this week. HealthDay News wrote about it.                    What Is the Doctor's Reaction? A new study shows that removing the ovaries can dramatically lower the risk of dying from breast cancer in women who carry the BRCA1 gene mutation. The journal JAMA Oncology published the results. The study was done in women who had a diagnosis of breast cancer and who had a BRCA1 or BRCA2 gene. The risk of breast cancer death over a span of 20 years fell 62% for those with a BRCA1 gene who had their ovaries removed, compared with those who did not. Women who had their ovaries removed quickly -- within a year of BRCA diagnosis -- had the lowest risk. Their risk of breast cancer death dropped 77%.  Ovaries produce estrogen, which is known to stimulate breast cancer. The results of ovary removal were impressive for women with a BRCA1 gene. But the study did not show as clear a benefit for women with the BRCA2 mutation.  One in every 300 to 500 women carries a BRCA1 or BRCA2 gene. These are commonly known as the breast cancer genes. The genes are more common among Jewish women of Ashkenazi (East European) descent. About 1 in every 50 of these women carries a BRCA gene.  I care for several women who are aware that they carry a BRCA gene. All of these women are fearful of cancer. They have all watched relatives grapple with breast or ovarian cancer. They know their lifetime risk is, as one patient said to me,  "almost inevitable." She said, "I am waiting for the other shoe to drop." Estimates of lifetime risk for breast cancer in women with a BRCA gene range from 65% to 85%.  If you have a BRCA gene, surgery can reduce your cancer risk to almost zero. Complete preventive surgery includes removing the breasts and removing the ovaries (after childbearing is complete). But my patients have not all made the same decisions. Not all have chosen to have preventive surgery.  My patients are typical. According to a 2011 study, a majority of women with a BRCA gene feel certain that surgery is the best way to prevent cancer. But: 
  • Only 37% have both breasts removed
  • 65% have ovaries removed  
These surgeries change a woman's body image and sense of sexuality. Removal of the ovaries causes infertility and can cause early symptoms of menopause. What Changes Can I Make Now?  If you don't know, learn whether you are at risk.  Have any of your relatives ever been diagnosed with breast or ovarian cancer? If so, discuss your family history with your doctor.  If you have these cancers in the family, you may benefit from seeing a genetic counselor. You may want to be tested for the BRCA genes. This is especially true if: 
  • Your relative was diagnosed when young (under age 50)
  • Breast cancer occurred in a male relative or multiple relatives
  • You are Jewish (of East European heritage) 
Roughly 20% of people with a family history of breast cancer and one of these family features are carriers of a BRCA gene.  Women with BRCA can lower their risk in several ways: 
  • Have earlier and more frequent screening, such as:
    • Breast self-exams every month
    • Breast exams by your doctor every 6 months
    • Yearly mammograms beginning at age 25 or 30
    • Yearly breast MRI
    • Checks of the ovaries using ultrasound and blood tests
  • Take risk-reducing medicine (tamoxifen, raloxifene or exemestane). Five years of use lowers cancer risk by 40% to 50% during the treatment years.
  • Take birth control pills. They can lower ovarian cancer risk by about 50%. Taken at a young age, modern birth control pills do not seem to increase breast cancer risk by a worrisome amount.
  • Have surgery. This is the most certain way to lower your risk. This can include breast removal, ovary removal or both.
What Can I Expect Looking to the Future?  Decisions about preventive surgeries in BRCA families are difficult and very personal. It helps to have more information about ovary removal and how much it improves cancer risk.  This surgery study is compelling. I think it will cause more women with BRCA1 to have their ovaries removed. Many more may seek out the surgery with less delay.  More study is needed to better understand the effect of ovary removal on breast cancer risk in women with the BRCA2 gene.]]>
Fri, 24 Apr 2015 13:04:00 -0400
Doctors Say It's Hard to Talk about End-of-Life Care Doctors often find it hard to talk with patients about end-of-life care, a new study shows. And... Doctors often find it hard to talk with patients about end-of-life care, a new study shows. And differences in culture, ethnic group and language make things even more difficult, they told researchers. The study was based on a survey. In all, 1,040 doctors in training (residents) answered the questions. They were asked if they had difficulty talking about end-of-life care with seriously ill patients and their families. Almost everyone said yes. They also were asked about the top 3 problems that came up when they had these talks with someone from a different ethnic group. They named language differences, the patient's or family's spiritual beliefs about death and dying, and the doctor's ignorance of the patient's cultural values and practices. Other problems listed were the patient's or family's limited understanding of medical information and mistrust of the health-care system. These issues also are harder to overcome if the doctor and patient don't speak the same language. Researchers urged patients to start the discussion about what care they do and don't want and what their goals are. The journal PLoS One published the study. wrote about it April 22. 
                What Is the Doctor's Reaction?  If you had a terminal illness, you'd face some important and difficult questions. 
  • Would you prefer to live as long as possible, even if it meant being in pain or unable to talk to loved ones? Or would comfort and a peaceful death matter more to you?    
  • Does your doctor know your wishes for medical care at the end of your life? 
  • Do your family members know your goals and what you prefer? 
If you haven't thought much about these questions or made your wishes known, you are not alone. Previous research has found that many people who are seriously ill have no plan in place to help with decision making. Many also have never shared their preferences with anyone. Other studies have shown that doctors are not very good at predicting what their patients want in the face of dire illness. In recent years, a lot of attention has been given to urging each person to name a health-care proxy. This is a person you choose to make health-care decisions for you if you can't. Of course, you also need to make sure that person knows what you would want. Perhaps you've heard of The Conversation Project. This organization is "dedicated to helping people talk about their wishes for end-of-life care" with their doctors and loved ones.  These efforts have made progress in overcoming the barriers to talking about end-of-life care. Now a new study focuses on the barriers that doctors face.   Researchers surveyed just over 1,000 doctors in their last year of residency about end-of-life discussions with their patients. Here's what the study found: 
  • Nearly every doctor reported barriers to talking about end-of-life decisions. Only 8 out of 1,040 (less than 1%) reported that there were no barriers.
  • About 86% described the barriers as "very challenging."
  • About 91% of Asian doctors found these discussions challenging. Fewer African-American doctors (85%), white doctors (83%) and Hispanic/Latino doctors (79%) felt that way.
  • Among the biggest challenges were:
    • Language and the need for interpreters
    • The spiritual beliefs of the patients and their families about death
    • The doctor's lack of knowledge about the patient's cultural beliefs
    • Cultural differences about sharing information or making medical decisions
    • Limited ability of patients or their family members to understand medical information
    • Patient and family mistrust of the medical system 
Each of these challenges is more likely to get in the way of an end-of-life discussion for minorities and people who speak a different language or have different cultural backgrounds from their doctors.  These findings show that it's not enough to just encourage people to name a health-care proxy or to talk with those close to them about end-of-life care. Doctors will need to be part of the solution as well. What Changes Can I Make Now? When it comes to making decisions about end-of-life care, it's never too soon to take the first steps. Here's how you can start: 
  • Think about what you would want in the face of terminal illness. It can be difficult to make decisions about something that may be decades away or may never happen. And it's OK if you aren't sure. You may change your mind over time.
  • Choose a health-care proxy. This could be a spouse, child or sibling.  But it does not have to be a family member. The most important thing is that your proxy is someone you trust to make decisions that honor your preferences.
  • Let your loved ones and your health-care proxy know your goals, values and preferences. 
  • Involve your doctor in the conversation. Let him or her know who your health-care proxy is and what you've discussed. If something your doctor says is unclear, be sure to ask for an explanation!
  • Recognize the challenges you and your doctor face. Everyone may find it hard at times to understand medical information. And cultural or language differences can add to the challenges, especially for sensitive or difficult decisions. 
You can use some very good resources to learn more about end-of-life medical decision making. They include these websites: 
  • The Conversation Project
  • National Institute on Aging
  • AARP
  • Stanford Letter Project
What Can I Expect Looking to the Future? The U.S. population is becoming older and more diverse. This means that the importance of planning for end-of-life medical issues will only increase. I hope that doctors will receive more and better training to help them have end-of-life discussions with their patients. We may also see changes in how doctors are paid for spending the time it takes to have these discussions. And it's likely we'll continue to see a rise in programs that encourage people to "have the conversation."]]>
Thu, 23 Apr 2015 19:20:00 -0400