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 Wed, 22 Oct 2014 17:21:00 -0400 Quarantine Ends for Ebola Patient's Family Though they shared an apartment with the first Ebola patient who got sick in the United States,...                    What Is the Doctor's Reaction? We have so much to learn about the Ebola virus. This particular strain that is infecting people in West Africa seems to be especially dangerous. Yet research has shown that some people have Ebola viruses enter their bodies but do not get sick or have relatively mild symptoms. Why do people respond so differently? We have many more questions than answers. But experience with other infectious agents and some small studies of Ebola-infected patients provide a few clues. Ebola belongs to a family of viruses known as filoviruses. Ebola is not contagious until a person has symptoms. The virus is spread only through close contact with body fluids. The viral particles enter through the nose, mouth, lining over the eye or a break in the skin. Once inside the body, the Ebola virus multiplies very rapidly, producing millions and millions of viruses. The virus does damage in several ways. It can directly kill certain cells. It also can produce:
  • A substance that blocks the immune system from effectively fighting the virus
  • Another substance that latches onto cells that line the inside of blood vessels. These cells become fragile. It's the reason that bleeding often occurs with this infection.
How quickly and how vigorously the immune system revs up plays a major role in what happens next. Some people don't get sick or have only a flulike illness. That's because their bodies mounted a very quick, robust immune response to the virus. Those who develop more severe problems are most often otherwise healthy, but just don't have the same rapid, vigorous immune response. Obviously, people with known impaired immunity would have a very high risk of dying from Ebola virus infection. Other reasons (not proven) why direct exposure to the Ebola virus might not cause infection include:
  • The virus gets on normal intact skin only, without getting into the nose, mouth or eye.
  • The cells that line the nose, mouth and eye don't allow the virus to either latch on or get beyond the cell wall.
  • The virus gets inside the body. But the person has been exposed to some other strain of Ebola or another type of virus. This means that his or her immune system was already primed to fight the new Ebola virus invasion.
What Changes Can I Make Now? It's important to keep Ebola in perspective for people not living in West Africa. We have had four cases in the United States. And only one person died. Compare that to influenza. Flu viruses infect many millions of people every year and cause thousands of deaths. If you haven't had your flu vaccine yet, get it today. There are more options than ever. To help protect yourself from the flu, colds and other viral infections, wash your hands or use an alcohol-based cleanser frequently.  If you do get a viral infection, your body can fight it more effectively with a strong immune system. You can feel better faster and reduce your risk of serious illness. Following general health guidelines is the best step you can take toward keeping your immune system strong and healthy.
  • Don't smoke.
  • Eat a diet loaded with fruits and vegetables.
  • Take a multivitamin if you suspect that you may not be getting all the nutrients you need through your diet. For example, few foods naturally contain vitamin D.
  • Exercise regularly.
  • Get enough sleep.
  • Maintain a healthy weight.
  • Take steps to lessen stress.
The store shelves are loaded with herbs and supplements promoted to boost the immune system. But so far there is no evidence that they actually bolster protection against infection or disease. Showing whether an herb or supplement can enhance immunity is a complex task. For example, scientists don't know whether an herb that seems to raise the levels of one type of immune cell in the blood is actually doing anything helpful for overall immunity. What Can I Expect Looking to the Future? Ebola will be contained in the United States and in most other countries around the world. But the epidemic in West Africa will take many months to slow down. Meanwhile, vaccine studies are under way. And treatment with antibodies against Ebola has shown some early success.]]>
Wed, 22 Oct 2014 17:21:00 -0400
Study: Common Symptoms Often Not Explained At least one-third of patients who visit a doctor with common symptoms don't get a clear,...                      What Is the Doctor's Reaction? Did you ever see your doctor for something you thought might be serious? Did you leave the office with just reassurance, wondering if you needed some sort of treatment or test? You're not alone. But there are probably good reasons for your doctor's decision not to do too much right away. As this new study shows, most symptoms are not caused by  a serious condition. And most get better in a short time. In fact, an explanation often can't be found for some of the most common symptoms that bring people to their doctors. Among patients seeing a doctor, the most common physical symptoms reported are:
  • Pain. This accounts for about 50% of visits.
  • Respiratory complaints, such as congestion, colds or flu. They account for 25% to 30% of visits.
  • Other symptoms, including fatigue, sleep problems, intestinal symptoms or dizziness. They account for another 20% to 25% of visits.
The latest edition of the journal Annals of Internal Medicine published the study. Researchers reviewed previous research. They excluded respiratory symptoms, such as common colds that nearly always get better quickly on their own. Here's what they found:
  • One third or more of people with common symptoms will have no definite cause discovered, even with many tests.
  • Doctors ask about symptoms and perform a physical examination. This provides up to 94% of the information needed to establish a diagnosis or to rule out serious conditions. Tests may add little more.
  • Psychological symptoms often occur along with physical symptoms. And they can affect each other. Teasing them apart and diagnosing the cause of each may be impossible.
  • In up to 80% of cases, people with common symptoms recover within a few weeks or months. This happens even without a specific diagnosis or treatment.
  • It's rare that a serious condition not suspected at the first visit is diagnosed in follow-up.
  • Some treatments can be helpful for many different symptoms. For example, acetaminophen (Tylenol and generics) can be helpful for headaches, back pain or an achy shoulder, even if the cause of these symptoms is not clear.
  • An explanation itself can be helpful. Providing a possible cause may be more reassuring than throwing up one's hands and leaving it at "well, everything is normal."
These observations are vitally important for doctors who see patients with common physical complaints. But they are also important for patients who are worried about their symptoms. Of course, there are always exceptions. Sometimes there is a serious problem even when it was not suspected during the first visit. Such cases need follow-up and another evaluation. It's good to keep an open mind. But it's also important to know the facts. What Changes Can I Make Now? Based on the findings of this new review, perhaps the biggest change you can make now is to modify what you expect from your doctor. For example, if you have a headache, don't expect your doctor to get a CT scan right away (even if you are worried that you may have a brain tumor). Serious causes of headaches are rare. Most headaches have no obvious cause regardless of how many tests are done. But let your doctor know your concerns. Explaining why a serious condition is unlikely and why extensive testing is not necessary are important parts of your doctor's job. If you have a symptom that bothers you and won't go away, let your doctor know. After a thorough review of your symptoms and an examination, there's a good chance that your doctor can diagnose the cause. But don't be surprised if you get:
  • No diagnosis.
  • No testing.
  • No specific treatment (other than a pain reliever or other supportive treatment).
  • A recommendation to "give it some time."
  • An explanation about your symptoms that is more of a theory than proven scientific fact. For example, your doctor may tell you that stress and tension in the muscles of your neck may be causing your headaches.
If you're getting worse instead of better or the nature of your symptoms changes, it may be best to take another look. At that point, it may be time to order a test or two.  What Can I Expect Looking to the Future? Doctors often say "common things are common." That may seem obvious -- and redundant! The idea is that in most cases, it makes little sense in to go searching for rare conditions when a "garden variety" diagnosis is so much more likely.  The findings of this new review explain how true this is. Amid concerns about too many treatments and too many tests, health-care costs keep going up. We would all do well to recognize that time, not extensive testing and treatment, is often the best medicine.]]>
Tue, 21 Oct 2014 00:00:00 -0400
Seeing Film Violence May 'Desensitize' Parents As they watch more violence or sex in movies, parents may be less bothered by it and more likely...                    What Is the Doctor's Reaction? Do you check what a movie is rated before letting your child watch it? The Motion Picture Association of America (MPAA) rates movies. This system is intended to give useful information to parents about the movie content.
  • General Audiences (G): Anyone can see the movie.
  • Parental Guidance Suggested (PG): Some parts of the movie may not be right for young children to see.
  • Parents Strongly Cautioned (PG-13): Some parts of the movie may not be right for children under 13 to see.
  • Restricted (R): Children under 17 must be with an adult.
Over the years, this system appears to have changed. Rating decisions seem to be made sometimes by chance. The ratings do vary a lot. The amount of violence and sex in movies that can be seen by younger children has gone up. Parents also seem less worried about their children seeing these risky behaviors in movies. How come? A new study in the journal Pediatrics might help explain these trends. Researchers wanted to know if parents have a less emotional reaction to the violence and sex in movies when they see them more often. This is called being "desensitized" -- the more they see it, the less it bothers them. To test this idea, 1,000 parents of children and teens, ages 6 to 17, were asked to watch 6 movie clips in a row. The clips showed violence or sex from popular movies. For each clip, they were asked:
  • The youngest age they thought was OK for a child to see the movie
  • If they would let their own child watch the movie
The more clips parents watched, the more they thought the scenes were OK for children to see.
  • The youngest age they thought was OK for a teen to watch violent or sex scenes dropped from 17 to 14.
  • Parents became more willing to let their own children watch each movie.
Parents also were less bothered by:
  • Violence if they had watched more movies in the last week
  • Violence and sex if they had already seen the movies from which the clips were taken
So is all PG-13 content acceptable for teens? This study suggests that movie ratings probably are not so clear or strict. Many parents may be quicker to accept these ratings if they are desensitized to violence and sex themselves. The parents hired by the MPAA to help decide movie ratings also are probably desensitized to violence and sex, the researchers say. After all, these parents watch hundreds of movies a year. What Changes Can I Make Now? Risky behaviors in movies can affect your child more than you might think. For example, a large body of research has linked watching lots of violence with more aggressive behavior in children. Or if characters engage in sex, teens may see it as exciting and something they want to try. It is your job to make sure your child is watching movies and using other media that are right for his or her age. Be sure to follow these tips:
  • Work to understand the social and emotional development of your child or teen.
  • Know all the different types of media your child uses and sees every day.
  • Insist on a good balance among your child's activities.
  • Make a family plan for movies to watch and safe ways to use all technology.
  • Limit how much time your child spends seeing movies, watching TV and surfing the Internet.
  • Talk often with your child about the dangers of violence, sex and other risky behaviors seen in movies or through technology.
  • Do not rely on movie ratings.
    • Learn more about the movie to decide what is right for your child to see.
    • Know that there may not be any difference in the amount of violence and sex shown in movies rated PG-13 rather than R.
    • Do not watch movies or TV shows you do not think are OK for your child in front of him or her.
What Can I Expect Looking to the Future? The increasing amount of violence and sex in popular movies is cause for concern. More research is needed on the effect of violence and other risky behaviors in movies on children's future behavior. Parents should make their own informed decisions on what movies their children watch. We also need to take a new look at the movie ratings system. It does not appear to be so effective in protecting youth from being exposed to problem content that could have a negative effect on their health. Future studies should explore potential improvements to the system. These could include:
  • Ways to prevent desensitization in movie raters
  • The effect of recruiting more parents to participate in the rating system
Mon, 20 Oct 2014 00:00:00 -0400
2 Nurses Get Ebola; Response under Scrutiny In a hearing October 16, members of Congress criticized mistakes that may have allowed Ebola to...                    What Is the Doctor's Reaction? Until last year, a young doctor worked alongside me in my primary care clinic in Oregon. He moved to Dallas. Today I learned that he is one of the 76 health-care workers who are being watched for signs of Ebola infection. He cared for Thomas Duncan, a Liberian who died in a Dallas hospital. Two nurses have been diagnosed with Ebola virus after caring for that same patient. When you work in health care, you feel a kinship with other health-care workers everywhere. Doctors and nurses share a language. They manage the same stresses day to day. So the news out of Dallas felt very personal to me, even before I heard that my close colleague cared for this patient. In fact, it has felt personal that more than 400 health-care workers have become infected in West Africa. Texas Presbyterian Hospital has been criticized for fumbling in its delayed diagnosis of Duncan and in its protection of health workers. The Centers for Disease Control and Prevention (CDC) has also been criticized, and not without reason. The CDC apparently advised a nurse with a low-grade fever that she could travel on a commercial airline. We are learning lessons. I have misgivings about the special risk Ebola poses to nurses and doctors. If an Ebola case came to my hospital, I hope that we could diagnose it without delay. I hope that we would take every precaution in perfectly isolating a patient and safeguarding caregivers. But my hospital is not unlike Texas Presbyterian in its level of preparedness for Ebola. My hospital just circulated a first draft of a protocol for Ebola. It is a strong protocol, but we have not practiced it. Like most American hospitals, we are not yet ready for Ebola to come through our doors. What Changes Can I Make Now? The spread of Ebola to two Texas health workers has been devastating news. Still, the events in Dallas have snapped the health-care system to attention. That, at least, is a good thing. I am glad to see changes being made by the CDC. Both of the sick nurses were moved to hospitals that have special isolation units to contain biohazards. They will receive care from experts trained to care for Ebola patients. Four hospitals have these units. They are in Georgia, Maryland, Nebraska and Montana. They have a total of only 19 isolation unit beds. Depending on the way this virus outbreak evolves, these hospitals may not be able to shoulder the full load of Ebola care in the United States. But for now they can handle Ebola safely. They can provide other hospitals with time to do detailed training and stock up on appropriate equipment. Hospitals are up to this task. Experts advise use of a "buddy plan" for Ebola care. One person works in a patient room. The other person watches. If any possible errors or contamination occur, the buddy must insist on a break for decontamination. Hospital training sessions will need to include hands-on practice in putting on and taking off protective gear in a way that does not risk spreading the virus. Ebola protocols will definitely limit the number of caregivers providing for a patient. This will limit the number of health-care workers who could be exposed. In the first days of the AIDS epidemic, doctors learned to keep themselves safe from HIV by practicing "universal precautions." They took care to wear gloves and manage needles in the same safe way for every patient, whether the patient was known to have AIDS or not. For Ebola, taking universal precautions will not be practical. We can't wear the protective suit with every patient. Instead, we need to have "universal consciousness." Everyone needs to expect that Ebola might come to his or her hospital. We need to ask all patients with fever or signs of infection whether they have traveled and to where. We need to isolate suspect cases without delay. What Can I Expect Looking to the Future? My colleague in Texas has one more anxiety-filled week to wait and watch for symptoms. I am deeply hopeful that he will remain free of fever. As we will see in Texas, the key to containing Ebola is contact surveillance. This means that people who have been in close contact with an Ebola patient must be watched for 21 days. Temperatures are taken twice daily. Symptoms are reported. Public contacts are avoided. Potentially, people with high-risk exposures may be placed on a "no-fly list" during this time. These precautions help us to keep a single case or a small cluster of cases from breaking into the open community. This low-tech strategy works, for these reasons:
  1. Ebola is not contagious until a person has symptoms.
  2. Ebola is spread only through close contact with body fluids.
  3. Ebola infection always causes symptoms. And the symptoms always occur in the first 21 days after exposure.
If any one of these things were not true about Ebola, contact surveillance and quarantines would not be able to contain infection. We are lucky that the spread of Ebola can be so easily "mapped."]]>
Fri, 17 Oct 2014 13:12:00 -0400
Psoriasis Linked to Poor Blood Pressure Control People with severe psoriasis may have more problems with controlling high blood pressure, a new...                    What Is the Doctor's Reaction? Psoriasis is a condition that causes patches of skin to become inflamed and scaly. It affects up to 4% of the U.S. population. Most people, including doctors, probably think of psoriasis as a problem confined to the skin. That's why it's surprising -- and important – to hear news that it may be linked to other serious health conditions.  For some, psoriasis is a minor annoyance. For others, it's a much bigger problem. When severe, the rash of psoriasis can cause pain, fevers and chills. People with psoriasis may develop skin infections. About one-third of people with psoriasis develop a form of arthritis called psoriatic arthritis. This disease can damage joints permanently. Previous research has linked psoriasis with an increased risk of high blood pressure (hypertension), heart attack and stroke. A new study tells us more. It shows that people with psoriasis are less likely than others to have their high blood pressure under control. The journal JAMA Dermatology published the study. Researchers enrolled more than 13,000 people with high blood pressure. About 10% also had psoriasis. Here's what the study found:
  •  Treatments for high blood pressure were similar for those with and without psoriasis.
  •  The more severe the psoriasis, the higher the blood pressure.
  •  The findings were unchanged even after accounting for psoriasis treatments that can affect blood pressure.
This study suggests that psoriasis may directly lead to increases in blood pressure.  These findings could have an important impact on the treatment of people with psoriasis. They could even lead to new insights into the cause (or causes) of high blood pressure. What Changes Can I Make Now? This latest research suggests that if you have psoriasis, it may be a good idea to get your blood pressure checked regularly. And if you have high blood pressure and psoriasis, frequent checks may help you make sure your blood pressure is in a good range. It could turn out that controlling your psoriasis will help control your blood pressure, although that's unproven. If you have psoriasis, know your treatment options.  They include:
  • Medicines applied to the skin, such as lubricants or corticosteroids
  • Phototherapy (often called "light therapy")
  • Medicines related to vitamin A, such as acitretin
  • Medicines that affect the immune system, including methotrexate or an injectable "biologic" drug (such as etanercept, infliximab, adalimumab or ustekinumab)
Each of these medicines has risks and benefits. Discuss them thoroughly with your doctor. Things to consider include how well the medicines work for you and their side effects, convenience and cost. Choosing among these options will be based on:
  • How severe your psoriasis is
  • Your own preferences
The cause of high blood pressure is usually impossible to identify in a particular person. But changing any factors that increase your risk might prevent it.  Risk factors that can be changed include:
  • Excess weight
  • Lack of regular exercise
  • Excessive drinking of alcohol
  • A diet that is high in salt (for example, more than 3,000 milligrams a day)
  • Certain medicines, such as corticosteroids
  • Smoking
High blood pressure can lead to heart attack, stroke and other health problems. So it's important to:
  • Reduce your risk of developing high blood pressure
  • Find out if you do have it
  • If necessary, take medicines to lower your blood pressure
What Can I Expect Looking to the Future? We don't understand yet why links have been found between heart disease and inflammation of:
  • The skin (as with psoriasis)
  • The joints (as with certain types of arthritis)
  • Other parts of the body
In some cases, it appears that reducing the inflammation helps to protect against potential effects of heart disease, such as heart attack. For example, future research could show that treatment of psoriasis helps control high blood pressure. Research in this area is still in its early stages. So stand by. There is much more to come regarding the links between diseases marked by inflammation (such as psoriasis) and diseases of the heart and blood vessels. I hope that studies like this one will lead to new insights into both conditions.]]>
Thu, 16 Oct 2014 00:00:00 -0400
Black Diabetics More Likely to Lose a Leg Amputation rates for Americans vary greatly depending on their race and where they live, a study...                    What Is the Doctor's Reaction? Medical care in the United States varies greatly depending on where you live and your race. Health insurance coverage explains only part of the difference. The Dartmouth Atlas Project has used Medicare data to help better understand factors other than health insurance that may be linked to variations in care. The project started more than 20 years ago. The project's most recent report highlights regional and racial differences in diabetes care related to the risk of amputation. More than 100,000 major leg amputations are performed on Medicare patients each year. More than half of them have diabetes. The other big factor that increases the risk of amputation is poor circulation in the legs. It's called peripheral artery disease (PAD). PAD is caused by buildup of fatty deposits in leg arteries. The deposits get hard and lead to decreased blood flow to the lower legs and feet. Having both diabetes and PAD puts a person at even greater risk of amputation. The researchers looked at Medicare claims data that identified people with both diabetes and peripheral artery disease. The period covered was from 2007 to 2011. Then the researchers looked at amputations in this group. They compared the rates of amputation by region and race. The differences were dramatic. The rate of amputation in blacks with diabetes and PAD was almost three times as high as the rate among non-blacks with these conditions. Amputation rates were five times as high in some regions as in others. The path from health to diabetes and PAD and then to amputation is a long one. Steps taken along the way can prevent many amputations. But this doesn't always happen. This report helps identify the many regional and racial challenges that help shed light on why care varies so much. Many issues influence prevention and treatment. They include:
  • Level of education, which affects how well people understand the complexities of care
  • Finances, which keep some people from filling prescriptions, buying special footwear or getting to the doctor's office
  • Cultural beliefs and trust in Western medicine
  • Access to primary care
  • Differences in how quickly doctors recommend surgery for PAD that can open blockages
What Changes Can I Make Now? If you have diabetes and PAD, you can do a lot to avoid ever coming close to needing amputation. It doesn't even cost much. Here's what you can do:
  • Don't smoke. Even if you need medicine to help you quit, not smoking will save you money.
  • Keep your blood sugar under control with diet and exercise so you can take less medicine. If you need medicine, work with your doctor to choose low-cost generics.
  • Lower your cholesterol. You should be taking a statin. There are several excellent generic choices today.
  • Walk several times per day to help your circulation.
  • Take great care of your feet.
Foot care is essential. Diabetes damages the nerves, so you may not feel an injury. A small break in the skin can lead to an ulcer that is likely to get infected. Once this happens, the risk of amputation goes way up, even with the best wound care and antibiotics. Here's how to take care of your feet:
  • Examine your feet every day. Look for any sores, cuts, scratches, breaks in the skin or swollen areas. Don't forget to check between your toes.
  • Wash your feet with warm water and soap every day. Dry them carefully. Don't soak your feet. This can lead to dry, cracked skin.
  • Massage feet with a moisturizing cream to prevent dryness. This reduces the chance of cracking, which can lead to skin infection. But don't moisturize between the toes.
  • Keep toenails well cared for to avoid ingrown nails. But if this problem develops, don't try to remove the nail yourself. See your doctor instead.
  • Have all calluses, corns, warts and other common foot ailments treated by a health professional.
  • Don't use anything that’s too hot or too cold on your feet.
  • Put on clean socks or stockings each day.
  • Wear well-fitting, comfortable shoes. If neuropathy makes it hard to tell how a shoe feels, consult an expert in fitting footwear for people with diabetes.
  • To reduce the chances of injuring your feet, avoid going barefoot.
What Can I Expect Looking to the Future? The results of this study can actually help Medicare save money. Complex medical care and surgeries are expensive. This study points toward some of the factors that affect amputation risk. With better understanding of these factors, doctors and public health officials will be able to take steps to improve care and lower costs.]]>
Wed, 15 Oct 2014 14:04:00 -0400
Gender May Affect Heart's Reaction to Stress Stress may affect women and men with heart disease in different ways, a new study suggests. The...                    What Is the Doctor's Reaction? Our bodies often encounter the effects of stress. Occasional short-term stress raises heart rate and blood pressure. It also can cause blood vessels to tighten and send signals that could increase blood clot activity. These changes usually don't last long. In healthy people, this response does not appear to affect health. But for someone with coronary artery disease, these responses can lead to chest pain and even a heart attack. The results of this study provide more insight into why this happens. It's now well known that women and men differ in how they experience coronary artery disease. Women often do not have the typical squeezing pain in the middle of the chest with exertion. They might just sweat heavily or feel short of breath or extremely weak. Women with coronary artery disease also do worse than men with the disease.  This cannot be explained simply by the traditional risk factors such as family history, smoking and high cholesterol. This new research offers some plausible explanations for the difference. The researchers recruited people with stable coronary artery disease. This means they had known blockages of the coronary arteries. But they had no symptoms or very predictable symptoms with exertion. The study participants were given mental tasks to induce stress. Men tended to show a rise in blood pressure and heart rate. But this often did not cause areas of the heart to show impaired function. Women tended to have a different response. They showed less increase in heart rate and blood pressure. But they were more likely than men to show impaired heart function as a result of reduced oxygen supply to heart muscle cells. This might have occurred because of blood clots or tightening of coronary arteries. The study included 82% men and only 18% women. Higher than average percentages of the women were African-American, lived alone or were unmarried. These factors could definitely influence the study results. What Changes Can I Make Now? Frequent or persistent stress is common. Surveys done by the American Psychological Association have found that about 25% of Americans have high levels of stress. How we react to stress also matters -- and not just for women with heart disease. Repeated activation of the stress response takes a toll on the body. Stress contributes to high blood pressure. It promotes the formation of artery-clogging deposits that can lead to heart disease. And it can cause brain changes that may contribute to anxiety, depression and addiction. Here's how to help counter the stress response:
  • Use the relaxation response. Every day, plan to spend some time at rest (not asleep). Sit somewhere comfortable. Close your eyes and relax your muscles. Focus on breathing regularly. Continuously repeat one word. Repeat it aloud or in your mind. It should be a simple word, such as "relax" or "easy," a religious word or phrase, or a syllable such as "om," used in many forms of meditation. Continue regular breathing with your muscles relaxed.
  • Unwind with physical activity. For example, taking a brisk walk shortly after feeling stressed deepens breathing and helps relieve muscle tension. Movement therapies such as yoga, tai chi and qi gong combine fluid movements with deep breathing and mental focus. All of these can induce calm.
  • Reach out for social support. Family members, friends and companions all provide a life-enhancing social net. Close relationships can offer emotional support that helps to sustain you at times of stress.
What Can I Expect Looking to the Future? For the near future, prevention and treatment of heart disease will be similar for women and men. But studies such as this one will promote further research into the important differences related to the mind-heart connection in the two sexes]]>
Tue, 14 Oct 2014 00:00:00 -0400
Cold Temperatures Change Fat Behavior Body fat can burn more calories in colder temperatures, a study has found. The study examined... What Is the Doctor's Reaction? All fat is not created equal. It turns out there is good fat and bad fat. The typical fat we think about is called white fat. It's the kind that isn't good for you. It stores calories and adds inches to waist lines. The other kind of fat called brown fat does the opposite. It creates heat and burns calories, which can lead to weight loss. Newborn babies have a relatively high amount of brown fat. As we age, we lose much of our brown fat and white fat increases. Most adults have more than 1,000 times more white fat than brown fat. We can't naturally make our bodies produce more brown fat. But this study and other research shows that white fat can be stimulated to act more like brown fat. Cooling white fat turns on a couple of genes that increase the metabolic activity of fat cells. The fat cells begin to burn more calories. Scientists have coined the term "beige fat" for this transformed white fat. But not everyone has the same potential to make white fat behave more like brown fat. People that are obese don't have the same response to fat cooling. Their white fat doesn't become beige. What Changes Can I Make Now? Right now you still need to rely on the basic weight loss formula. You need to burn more calories with physical activity than you take in. Most recently I have been recommending a reduced-calorie, Mediterranean-style diet:
  • Five or more servings of vegetables a day. A serving is ½ cup of raw or cooked vegetables, 1 cup of raw leafy greens or ½ cup of vegetable juice.
  • Four servings of fruit a day. A serving is ½ cup of fresh, frozen or canned fruit; ¼ cup of dried fruit; one medium-sized piece of fruit; or ½ cup of fruit juice.
  • About 3 tablespoons of olive oil a day.
  • One handful (about 1½ ounces) of nuts, 3 times per week.
  • Three to five servings of legumes (beans, peas and lentils) per week. A serving is ½ cup.
  • Five servings of whole grains a day. A serving is 1 cup of dry breakfast cereal; ½ cup of cooked cereal, brown rice or whole-grain pasta; or one slice of whole-grain or multi-grain bread.
  • Three or more servings of fish (especially fatty fish) a week. A serving is 4 ounces.
  • One serving of yogurt or cheese a day.
  • If you enjoy alcohol, limit yourself to an average of one drink a day. One drink is 5 ounces of wine, 12 ounces of beer or 1½ ounces of liquor.
Specifically avoid:
  • Soda and sugary drinks
  • Sweets, pastries and commercial bakery goods
  • Red and processed meats (eat white meats instead)
  • Margarines and most tub spreads
What Can I Expect Looking to the Future? Keeping your house cooler won't become the new trend to lose weight. Our bodies adjust to lower temperatures in other ways. So at most you might shed a pound or two by turning down your thermostat. It's still a good idea if you want to save money on heating bills. But scientists are likely to get excited about this study. If cool temperatures can alter white fat to act more like brown fat, it raises the possibility that there are other ways to create more beige fat.]]>
Fri, 10 Oct 2014 11:58:00 -0400
Lifestyle Factors Affect Stroke Risk Women with a healthy lifestyle are half as likely to have a stroke, says research from Sweden. The...
What Is The Doctor's Reaction? Sometimes it seems as though every other health-related news story has the same conclusion: Exercise more, eat better, give up bad habits and your health will improve. Well, here's another one. In a large study of Swedish women, researchers showed that just five healthy lifestyle factors can dramatically reduce the risk of stroke. Stroke is a leading cause of death worldwide. In the study, more than 31,000 women with an average age of 60 completed a survey with 350 questions. (That's right, 350 questions!) Researchers assessed these five lifestyle factors:
  • Being a lifelong nonsmoker
  • Having a healthy diet – This was defined by how often fruits, vegetables and other healthy foods were consumed.
  • Drinking alcohol in moderation (3 to 9 drinks per week)
  • Being physically active – Research subjects could meet this goal by walking or biking at least 40 minutes daily and exercising more intensely at least an hour each week.
  • Having a healthy body mass index (BMI), an assessment of body weight that takes height into account – This was defined as a BMI below 25.
The researchers found that:
  • Less than 2% of the women reported "yes" for all of these factors. Most said "yes" to 2 or 3 of them.
  • These factors affected the women's risk of stroke. For example, comparing women with and without each healthy lifestyle factor, the risk of having a stroke over the 10 years of the study was:
    • 15% lower for those with a healthier diet
    • 20% lower for nonsmokers
    • 23% lower if 1 of the 5 factors was present (compared with none)
    • 35% lower if 3 factors were present (compared with none)
    • 54% lower if all 5 factors were present (compared with none)
Strokes can cause devastating brain damage or death. Treatment for stroke is not reliably effective. So prevention is crucial. This new research shows how these lifestyle factors can contribute to protection from stroke. For these reasons, this study is noteworthy.

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

What Can I Expect Looking To The Future? In the future, it's likely you will hear more about the value of a healthy lifestyle. While it may seem redundant, repetition may be the best way to make it happen.]]>
Thu, 09 Oct 2014 00:00:00 -0400
Diabetes: Screen all Adults 45 and Older Adults age 45 and older should be screened for type 2 diabetes and prediabetes, says new advice...
What Is The Doctor's Reaction? In the United States, 29 million people are living with diabetes. But 8 million of them don't know they have it. And estimates from 2012 put the number of people with pre-diabetes at 86 million. If nothing changes, as many as 1 in 3 American adults will have diabetes by the year 2050. Both major types of diabetes, type 1 and type 2, are rising. But it’s type 2 diabetes that is increasing so dramatically. It used to be called adult onset diabetes. But now the condition is also affecting children. To help address the rapid rise in type 2 diabetes, the United States Preventive Services Task Force (USPSTF) has just expanded its recommendations on screening. The task force now recommends blood sugar testing for:
  • All adults age 45 and older
  • Younger adults who are overweight or obese
  • Younger adults who have a mother, father, sister or brother with diabetes
  • Women with a history of gestational (pregnancy related) diabetes or polycystic ovary syndrome
  • Certain ethnic groups, including African Americans, American Indians/Alaska Natives, Asian Americans, Hispanics/Latinos, and Native Hawaiians/Pacific Islanders
The two most common tests to screen for diabetes and pre-diabetes are the fasting blood sugar and the hemoglobin A1c (HbA1c) blood test. For the fasting blood sugar test, you don’t eat or drink anything other than plain water for 8 hours prior to the blood draw. You don’t need to fast for the HbA1c blood test. It can be done any time of the day. Fasting blood sugar levels:
  • Normal: Less than 100 mg/dL
  • Pre-diabetes: 100mg/dl – 125 mg/dL
  • Diabetes: Greater than 125 mg/dL
Hemoglobin A1c is measured as a percent of blood sugar that binds to hemoglobin in red blood cells. It reflects the average blood sugar over the prior 2 -3 months. HbA1c levels:
  • Normal: Less than 5.7%
  • Pre-diabetes: 5.7 – 6.4%
  • Diabetes: 6.5% or higher (on 2 separate blood tests)
What Changes Can I Make Now? You can't prevent type 1 diabetes. But type 2 diabetes can be prevented. And even if already present, life style changes can often help control it with little or no medication. That’s why the USPSTF has expanded recommendations for blood sugar screening. The major problem in type 2 diabetes is insulin resistance. Insulin normally helps the sugar in our blood get into the liver and muscles to provide energy. In type 2 diabetes, the liver and muscle cells don't respond well to the insulin. The cells are "insulin resistant." When blood sugar can't move into the cells, sugar in the blood starts to rise. The pancreas puts out more insulin to try to push the sugar into cells. This starts a cycle of higher blood sugar and blood insulin levels. Eventually, the pancreas can't keep up with the rising blood sugar. The way to help prevent and treat type 2 diabetes is to ask your pancreas to make as little insulin as possible to keep blood sugar in the normal range. Of course, you can't command your pancreas to do that. But you can help make it happen.
  • Maintain a healthy body weight.
  • Keep your waistline trim. There is no consensus on an ideal waistline. I suggest less than 30 inches for women and less than 35 inches for men.
  • Stay as physically active as you can throughout the day.
  • Dedicate a minimum of 30 minutes a day, most days of the week, to moderate-intensity exercise. If you need to lose weight, strive for 60 minutes daily.
  • Eat and drink fewer products that contain simple sugars.
What Can I Expect Looking To The Future? We definitely have the potential to slow the rise of diabetes and even reverse the trend by helping people take the steps we already know can work.]]>
Wed, 08 Oct 2014 00:00:00 -0400
Liberian in U.S. Has Ebola; 100 Being Watched A Liberian man visiting the United States has been diagnosed with the Ebola virus. The Centers for...                    What Is the Doctor's Reaction? Ebola virus has come to the United States. In Dallas, a Liberian man with the illness has been placed in a private and isolated hospital room. About 100 people in the community are lying low and watching for symptoms. They were either exposed to the patient or exposed to people who were exposed to him. Needless to say, this Texas community and the rest of America are fearful there may be more cases. In West Africa, the number of Ebola cases seems to be racing out of control. A prediction has been made that there might be 1.4 million cases by January, if something is not done to stop the epidemic. So we know this is a highly contagious disease. But experts all seem to agree: Ebola can be contained in a developed country like the United States.  We have heard this reassurance from leaders at the Centers for Disease Control and Prevention (CDC). We also have heard it from the top infectious disease official at the National Institutes of Health. Can they be right? Can we be confident that Ebola will be contained (kept from spreading) where we have cases in the United States? One protesting doctor who is not an Ebola expert has made his doubts clear. He traveled through Atlanta's airport wearing a showy protective suit with the words "CDC IS LYING" on his back! I am a primary care doctor, and as a health care worker I have some legitimate worry about Ebola. When I first heard loud and clear reassurance from the CDC, I was surprised. But these experts are smart people. So I thought about this question a lot. And I believe our experts. Ebola can be contained. Ebola is spread by contact with body fluids, especially vomit, diarrhea, sweat and saliva. There are two key reasons that Ebola can be contained: 1. Ebola is only contagious to people who are in close contact with a patient who has symptoms. Unlike measles and other diseases that can be spread through a cough or sneeze, Ebola does not spread through the air. This helps us. It means we can name everyone who might have a risk for infection. It also means we can limit the number of people who are exposed. We can do this by quickly isolating the patient and limiting the number of caregivers. The key to containing Ebola is "contact surveillance." This means that people who have been in close contact with an Ebola patient must be watched for 21 days, to see if they have symptoms. Each person's temperature is taken twice daily. Symptoms are reported. Public contacts are avoided. Contact surveillance helps us to keep one case or a small cluster of cases from breaking into the open community. 2. Ebola always causes symptoms. And this always occurs in the first three weeks after exposure. The fact that Ebola is so good at making people ill sounds sinister, but it is actually a tremendous advantage. It is the reason we can contain Ebola. In this way, Ebola is very different from another terrible infection that was much harder to contain: polio. Polio also spreads through direct contact with body fluids. But for every 10 people who got infected with polio, only one would show symptoms. This made it impossible to stop the epidemic by putting people in quarantine. Quarantine could only identify a small fraction of the cases. Many active cases were released from quarantine because they were not known to be infected. So polio was not contained in the United States until a vaccine was available. Ebola will be different. What Changes Can I Make Now? Franklin D. Roosevelt said, "The only thing we have to fear is fear itself." In West Africa, fear and mistrust of government have led to delays in patients seeking medical care. This has worsened the spread of disease. In order to contain Ebola, we need perfect cooperation with contact surveillance efforts. Public health officials will help us through to the end of each case or case cluster. We are up to this task. Go ahead and trust the experts at the CDC. I do and so can you.  What Can I Expect Looking to the Future? In West Africa, Ebola has stretched the capacity of local communities to cooperate with containment efforts. It may take years to contain the Ebola outbreak in West Africa. There is some chance that this outbreak may not be contained until we can develop an effective vaccine. America can mobilize resources effectively at home. Ebola will look very different in the United States than it does in Africa. As Africa's outbreak continues, we will certainly see cases in the United States. We will also see some small clusters of cases. U.S. health care professionals will need to be vigilant to quickly recognize cases. This will allow them to be isolated right away, so that contact surveillance can remain manageable.]]> Fri, 03 Oct 2014 13:02:00 -0400 Study: Social Ties Help Heart Attack Recovery Social support may help younger as well as older adults avoid depression and poor quality of life...                    What Is the Doctor's Reaction? Having friends and family around you can improve the quality of your life. But could it actually improve your health?  It could, according to a new study of more than 3,400 adults under age 55 who survived a heart attack. People were asked about their social supports. They included friends, family and others who:
  • Provided companionship
  • Served as confidants
  • Offered advice
  • Provided emotional, financial or other support
Here's what the researchers found out:
  • About 1 in 5 people had low levels of social support.
  • Those who had low social support were more likely than those with more support to:
    • Drink too much
    • Smoke
    • Be unmarried or live alone
    • Be unemployed
    • Have health factors that increased their risk of heart and blood vessel disease (such as high blood pressure)
A year after a heart attack, those with low social support had:
  • More symptoms of depression
  • More psychological distress
  • Lower quality of life
Findings were similar for women and men. Why is this study important? Heart and blood vessel disease, including heart attacks and stroke, is the leading cause of death in the United States. It is essential that we understand how it develops, how to prevent it, and how to improve survival. And we've seen remarkable advances in all of these areas. The role of social supports in heart disease has only recently been considered. The results of this study suggest that it may be a powerful one. Establishing and encouraging social connections could improve the health of younger adults after a heart attack just as much as some medicines or procedures. What Changes Can I Make Now? You can make several changes to reduce the odds that you will have heart disease, including a heart attack. 
  • Don't smoke.
  • Get regular exercise.
  • Maintain a healthy weight.
  • Get your blood pressure and cholesterol checked, and get treatment if they are not in ideal ranges.
  • Take medicines to control your blood sugar if you have diabetes.
  • Take aspirin, a statin medicine or both if you are at high risk for heart disease.
Should improving your social supports be on this list? Perhaps. But it may not be that simple. This study found a link between low social supports and worse outcomes from a heart attack a year later. However, this doesn't prove that better social support will actually improve outcomes. And even if it could, recommending better social support is much easier than making it happen. What Can I Expect Looking to the Future? We need more research on the connection between social support and better recovery from heart attack among adults of all ages. If this link is confirmed, encouraging improved social support could become a routine part of care after a heart attack, especially for those who have few social contacts. For example, doctors might refer patients to a support group. This is already happening to some extent. Many doctors and groups, such as the American Heart Association, encourage people with heart disease to share information and experiences and provide support to one another. You can also expect to hear about research that may help us to understand why social supports affect outcomes after a heart attack. The results of such research could lead to dramatic changes in the care of people who have had heart attacks.]]>
Wed, 01 Oct 2014 13:48:00 -0400
Neurology Group Backs Less Use of Narcotics Narcotic pain relievers are usually too risky for long-term treatment of headaches, low back pain...                    What Is the Doctor's Reaction? Narcotic painkillers have been around for a long time. When used properly for short periods of time, they can be very effective and safe.  However, long-term use leads to tolerance. That means you need higher and higher doses to get pain relief. This can lead to addiction. And high doses can cause accidental death. The American Academy of Neurology has joined the chorus of other medical groups to say that we need to make changes. The excess use of narcotic painkillers is a recent phenomenon. Before the late 1990s, doctors were strongly discouraged from prescribing narcotics. The exceptions were for pain related to cancer and terminal diseases. Use of these drugs for chronic (long-lasting) pain not related to cancer began to grow at the end of the last century. Advocacy groups pushed to make pain relief a priority for all patients. They said the cause of the lasting pain did not matter. The push was so strong that pain assessment became the "fifth vital sign." Patients now are routinely asked to rank their pain level from 1 to 10. The four traditional vital signs are blood pressure, heart rate, temperature and breathing rate. Prior guidelines focused on the amount of painkiller patients were taking. Doctors were advised to consult a specialist for patients using a high dose of narcotics regularly. Specifically, referral was recommended for patients who took a narcotic dose equivalent to 120 milligrams per day of morphine (or more) and did not have good pain control and improved function. Doctors could refer patients to any specialist who might offer help. But most often this meant referral to a pain specialist. A dose of 120 milligrams of morphine equals about:
  • 800 milligrams (mg) of codeine
  • 50 mg of fentanyl (Duragesic), in a patch
  • 120 mg of hydrocodone (Vicodin)
  • 30 mg of hydromorphone (Dilaudid)
  • 80 mg of oxycodone (Percocet, Oxycontin)
The older guidelines did not stop the growth in prescriptions written for narcotics. And there is no evidence that narcotics are effective treatment for non-cancer pain that lasts more than three months. So these new guidelines from the American Academy of Neurology recommend that doctors avoid long-term narcotics for:
  • Headaches
  • Low back pain
  • Fibromyalgia and similar pain syndromes
What Changes Can I Make Now? For short-term pain relief after an injury or surgery, narcotic painkillers are an excellent choice. But for long-lasting, non-cancer pain, there are many better choices. Before starting treatment, it's important to understand why you have persistent pain. That's not always possible. People can have lasting pain without a definite diagnosis. But it still helps to have some theory as to what is causing your pain. This theory can help provide a focus for non-drug therapies, such as physical therapy and relaxation techniques. When drugs are needed, the type of pain matters. For example, nerve pain does not respond very well to narcotics. Other drugs are designed specifically for nerve pain. They include:
  • Gabapentin (Neurontin)
  • Duloxetine (Cymbalta)
  • Low-dose amitriptyline (Elavil)
Sometimes pain is related to inflammation. In that case, a nonsteroidal anti-inflammatory drug (NSAID) can be very effective. NSAIDs include:
  • Ibuprofen (Motrin, Advil, generic versions)
  • Naproxen (Naprosyn, Aleve, generic versions)
Even if a narcotic needs to be added to the NSAID from time to time, the dose required is often smaller. What Can I Expect Looking to the Future? In the next few years, changes in narcotic prescribing patterns will surely lead to tensions between doctors and some of their patients. Government agencies will be more closely following the narcotic prescribing practices of doctors. But helping patients to get pain relief will continue to be an important priority, as it should be.]]>
Tue, 30 Sep 2014 13:56:00 -0400
Pediatricians Back Long-Acting Birth Control Long-acting birth control methods should be the first choice for teenagers who have sex, the...                    What Is the Doctor's Reaction? Teenage pregnancy happens way too often. About 750,000 U.S. teens become pregnant each year. Most of these pregnancies are unplanned. The teens are not ready to become parents. There are many ways for teens who are having sex to prevent pregnancy. This is called birth control or contraception. Each form has pros and cons. Some types of birth control use female hormones to prevent pregnancy (most effective). Others block sperm from entering the body (less effective). The American Academy of Pediatrics (AAP) just released its updated policy statement on birth control for teenagers in the journal Pediatrics. The statement recommends that pediatricians:
  • Protect the privacy of all teenagers.
  • Ask about each teen's sexual history in a caring and non-judgmental way.
  • Explain that not having sex (abstinence) is the best way to prevent pregnancy (works all the time).
  • Discuss the pros and cons of each method of birth control.
  • Encourage the correct use of condoms every time the teen has sex. Hormones prevent pregnancy. But the condom protects against spreading sexually transmitted infections (STIs).
This report also highlights what pediatricians should know about the different ways to prevent pregnancy. These methods of birth control are listed below in the order of how well they prevent pregnancy. Those that work the best are listed first. Those at the end do not work nearly as well.   The AAP says that the first two, which are long-acting, should be the top choices for teen patients.
  • Progestin implant. A small rod that releases a hormone into the body is placed under the skin of the upper arm.
  • Intrauterine device (IUD). This small T-shaped object is placed inside the womb (uterus). Some IUDs use hormones. Others, coated in copper, work as a barrier.
  • Progestin-only injectable contraception. A hormone shot is given every three months.
  • Combined oral contraceptives ("the pill"). These pills contain two different hormones, progestin and estrogen. A pill must be taken every day.
  • Vaginal ring. This ring is placed into the vagina to release hormones into the body.
  • Transdermal patch. The patch is placed on the skin to give off hormones into the body.
  • Progestin-only pills ("the mini pill"). A pill with only one hormone (progestin) is taken every day.
  • Diaphragm (cervical cap). This cup-shaped piece blocks sperm from getting into the cervix. It is used with a chemical to kill the sperm.
  • Male condom. The male partner wears this barrier over the penis to prevent sperm from getting into the vagina. It also helps prevent the spread of STIs.
  • Female condom. A barrier is placed into the vagina to keep sperm out. It also helps prevent the spread of STIs.
  • Withdrawal. The male pulls out his penis before releasing sperm into his partner (ejaculation). This does not work well at all to prevent pregnancy.
  • Fertility awareness ("rhythm method").  The female partner knows when to avoid sex during her monthly menstrual cycles in order to not get pregnant. This does not work well at all to prevent pregnancy.
  • Vaginal spermicides. Chemicals that kill sperm are placed into the vagina.
What Changes Can I Make Now? The AAP supports sex education as the most effective way to prevent teenage pregnancy and STIs. Sex education always should include information about abstinence and the many forms of birth control. As a parent, you play a big role in your teen's sex education. Talking with your teen about sex can be difficult. Be sure to follow these tips:
  • Be prepared. Look at reliable sources on sex before talking with your teen. For example, check out the website of the Centers for Disease Control and Prevention (CDC).
  • Talk about sex like any other health topic. Sex is not something dirty or embarrassing. This lets teens know that they can feel comfortable coming to you with any questions or problems.
  • Listen to teens. Make sure to give them a chance to talk. Let them ask questions.
  • Be honest. It might feel awkward, but answer your teen's questions with the truth. It is OK if you do not have all the answers. You can find the answer and share it later.
  • Ask for help. If you are having trouble talking with your teen about sex, ask your teen's doctor for advice.
Some parents are afraid that if they talk about sex, their teen will want to try it. Don't worry! Studies show that teens who have received sex education:
  • Are not more likely to have sex
  • Are more likely to delay having sex
  • Are more likely to use birth control
What Can I Expect Looking to the Future? Expect the pediatrician to talk with your teen about safe sex and birth control.  They can work together to choose a birth-control method that works best for your teen, when needed. More and better ways to educate teens, parents and child health professionals about preventing pregnancy and STIs will be created. The AAP and CDC will continue to study and update their guidance on birth control as methods change or as new options become available.]]>
Mon, 29 Sep 2014 00:00:00 -0400
Similar Results for Varicose-Vein Treatments Three common treatments for varicose veins all help to improve symptoms, a new study finds....                    What Is the Doctor's Reaction? Chances are good that you or someone you know has varicose veins. Fortunately, for most, they are more of an annoyance than a health threat. Varicose veins are thought to develop because the tiny valves in the veins aren't working well. This prevents blood from flowing freely. Instead, blood "backs up" in the vein. This causes the vein to swell just beneath the skin. Varicose veins are typically blue or purple. For many, the main issue is one of appearance. They just don't like how the veins look. But sometimes varicose veins become inflamed or painful. The legs also may become swollen or achy. Some people have skin ulcers. Most people with varicose veins require no treatment at all. For mild symptoms, compression stockings and leg elevation can help. Despite these measures, some people are bothered enough by varicose veins to warrant more treatment. Common options include:
  • Surgery -- The operation removes the abnormal veins.
  • Thermal ablation -- Concentrated energy (using a laser or radio waves) is applied into the abnormal veins. This treatment damages the vein and causes it to collapse.
  • Foam sclerotherapy -- Doctors inject an irritating chemical foam into the vein. This scars the abnormal veins so they can no longer swell.
Which of these treatments is best? That's the topic of a study in this week's edition of the New England Journal of Medicine. Researchers compared three methods of treating varicose veins:  surgery, laser or foam sclerotherapy. Here's what they found: 
  • All three treatments were effective. Overall quality of life was improved by about the same amount for each treatment.
  • Surgery was slightly better for improving appearance and other symptoms. Foam sclerotherapy was slightly worse.
  • Problems that sometimes occurred after treatment included a lumpy appearance or numbness. These were somewhat rarer after laser surgery than the other treatments.
For anyone considering treatment for varicose veins, these results suggest that all three approaches are acceptable. There are only minor differences among them. The surgeon's experience, preference and success rates are probably much more important than the small differences noted in this study. What Changes Can I Make Now? Unfortunately, there are no clearly effective ways to prevent varicose veins. Regular exercise and avoiding excess weight might help. Factors that increase risk include family history, pregnancy, aging and obesity. Varicose veins are more common in women than in men. If you already have varicose veins, you may be able to relieve symptoms. Taking these steps may help: 
  • Don't stand or sit for long periods without getting up and moving around.
  • Keep your legs raised above the level of the chest when you sit or lie down.
  • Exercise regularly.
  • Maintain a healthy weight.
  • Wear compression stockings.
If you continue to have pain, aching or other symptoms related to varicose veins, let your doctor know. He or she may refer you to a vascular surgeon to discuss the types of treatments analyzed in this latest research. Ask the surgeon why he or she favors one approach over another and the success rate with that treatment. Understand that each of these treatments has potential problems. They may include pain, bleeding or a blood clot. But, if your symptoms are significant, the risk may be worth accepting. What Can I Expect Looking to the Future? When there are multiple treatment options for a common condition, high-quality research is essential to identify the best option. Sometimes the studies show that one approach is clearly better. Medical practice often changes as a result. Other times, as in this latest study, the effectiveness and safety of different treatments turn out to be similar. Either way, the results are useful. And they provide a measure of reassurance when considering the options your doctor recommends. You can expect to hear much more about other studies comparing common treatments in the future.]]>
Thu, 25 Sep 2014 14:16:00 -0400
Diabetes Growth May Be Slowing Down After nearly 20 years of rapid increases, U.S. diabetes rates may be rising more slowly. That's...                      What Is the Doctor's Reaction? This is welcome news. Earlier predictions suggested that 1 in 3 people in the United States would be living with diabetes by 2050. In this study, researchers provide us with newer data. The number of people living with diabetes is still increasing each year. But the rate of rise from 2008 to 2012 is markedly less than from 1990 to 2008. And the number of people per 1,000 with diabetes fell in 2012, compared with 2008. The researchers used information from a 1980-2012 survey of nearly 665,000 adults. One of the many questions was "Do you have diabetes?" It did not matter what type of diabetes the person had. In the United States, almost 95% of people have type 2 diabetes. Several factors contributed to the rapid rise during the 1990s and the first part of the new century:
  • People with diabetes are living longer.
  • A lower blood sugar level for a diagnosis of diabetes was adopted during the 1990s.
  • Average weight gain and the number of people with obesity rose dramatically during the same period. Weight gain, leading to obesity, is a major cause of type 2 diabetes.
The good news is not equally shared by all ethnic and racial groups. During the last five years of the survey, the number of new cases of diabetes reported was significantly higher for blacks and Hispanic adults than for non-Hispanic white adults. This hardly means the diabetes epidemic is over. As the U.S. population grows, so will the number of people diagnosed each year with both type 1 and type 2 diabetes. What Changes Can I Make Now? Type 1 diabetes cannot be prevented. Almost all cases are caused by the immune system misbehaving. It's called autoimmunity. The body's immune system attacks the pancreas and destroys the cells that make insulin. Type 2 diabetes is very preventable. The major problem in type 2 diabetes is insulin resistance. Insulin normally helps the sugar in our blood get into the liver and muscles to provide energy. In type 2 diabetes, the liver and muscle cells don't respond well to the insulin. The cells are "insulin resistant." When blood sugar can't move into the cells, sugar in the blood starts to rise. The pancreas puts out more insulin to try to push the sugar into cells. This starts a cycle of higher blood sugar and blood insulin levels. Eventually, the pancreas can't keep up with the rising blood sugar. The way to help prevent type 2 diabetes is to ask your pancreas to make as little insulin as possible to keep blood sugar in the normal range. Of course, you can't command your pancreas to do that. But you can help make it happen.
  • Maintain a healthy body weight.
  • Keep your waistline trim. There is no consensus on an ideal waistline. I suggest less than 30 inches for women and less than 35 inches for men.
  • Stay as physically active as you can throughout the day.
  • Dedicate a minimum of 30 minutes a day, most days of the week, to moderate-intensity exercise. If you need to lose weight, strive for 60 minutes daily.
  • Eat and drink fewer products that contain simple sugars.
I you have a parent or sibling with type 2 diabetes, you have a much higher risk of developing the condition. However, you and your children have the potential to prevent it with diet and exercise by starting right now. What Can I Expect Looking to the Future? It's too early to predict if the number of new cases of diabetes will continue to slow. When analyzing the data, researchers will need to be careful not to over interpret any results. For example, today an estimated 1 in 4 people with diabetes don't know they have it. If many more cases are detected and diagnosed, the number of new cases of diabetes would appear to rise. But the real number of truly new cases could actually be falling.]]>
Wed, 24 Sep 2014 18:51:00 -0400
Doctors Urged to Watch Out for Chikungunya Doctors in the United States need to be on the lookout for patients with chikungunya virus, a...                    What Is the Doctor's Reaction? Four months ago, I'd never heard of the chikungunya virus. Today, I'm able to pronounce this word (chik-en-gun-ye), which means "to be contorted" in the African Kimakonde language. More importantly, I know how to:
  • Look for it in sick patients
  • Diagnose it
  • Teach my colleagues about it
  • Support patients through it 
What is it? Chikungunya is a virus in the same family as German measles, and both Eastern and Western equine encephalitis. It is transmitted from mosquitoes to humans. First described in the 1950s, outbreaks of the virus mainly occurred in West Africa, India and Southeast Asia. The current outbreak was first detected in 2013. It occurred halfway around the world from where the virus was first seen, on the island of Saint Martin in the Caribbean. By the first half of 2014, reports of the disease were widespread in most of the Caribbean islands. Fortunately, this is not a lethal virus. People who get the infection feel terrible. They have fever, headaches, muscle aches, swollen joints and sometimes a rash. Most people get better in 7 to 10 days. But some people have lasting joint pain for a longer time. There is no specific medicine to treat it. We use anti-inflammatory medicines and support people through the worst of the illness.  Why the Caribbean? Well, it provided a good home for this virus. There are lots of insects, including the two types of mosquitoes that transmit the virus best. People travel often between Caribbean Islands and their homes in North and South America. Most humans on this side of the globe have no immunity to this virus. All of this is a set-up for a very active virus -- more than 30,000 cases so far -- that can be easily spread by infected mosquitoes.  The majority of Americans with the virus in the United States have brought it back from the Caribbean. But nine cases reported from Florida were most likely acquired within the United States. National boundaries don't mean much to infections. The authors of this article say there is a high likelihood that the disease will take hold locally. This is most likely in the Southeastern United States. Data from the Centers for Disease Control and Prevention suggest that it already has a foothold. The chikungunya virus is an excellent example of how infections travel in our very mobile world. They are assisted by travelers and insects that can be found anywhere. In this amazing world of global travel and communication, the spread of this virus reminds us that we need to work globally to understand, control and wipe out diseases of all types. What Changes Can I Make Now? If you get sick after a visit to the Caribbean, whether you were at a resort or visiting Aunt Mabel, let your doctor know where you've been. People usually get sick about three to seven days after infection. The most common symptoms are fever and severe joint pains. About half of people infected by this virus have a rash. Don't worry. You won't be contagious to your family or other close contacts. Your doctor may order a blood test to confirm the cause. Then you'll likely be treated with anti-inflammatory medicines and rest. Most people improve within a week to 10 days. It's important to try to prevent transmission of the virus from mosquitoes to humans. Travelers to areas at risk should use bug repellent, especially during the day, when mosquitoes that carry chikungunya usually bite. On a public health level, communities should work on helping to get rid of mosquito breeding areas. Insecticides should be used appropriately to decrease the mosquito population. Finally, scientists and public health officials can work together to develop a safe, effective vaccine for chikungunya. What Can I Expect Looking to the Future? The rapid and efficient spread of chikungunya should serve as a cautionary tale about how fast viruses can change and have an impact all over the world. We are fortunate that this is not a lethal virus. Our response to this new virus will be important, not only for itself, but to develop responses for other viruses that are sure to come along.]]>
Tue, 23 Sep 2014 19:44:00 -0400
Outbreak of Severe Virus Now in 22 States At least 160 cases of a sometimes severe virus have been confirmed in 22 states, U.S. health...                    What Is the Doctor's Reaction? If you haven't started taking hand-washing really seriously, now's the time to start -- especially if you have children with asthma. It's been all over the news: a bad virus sweeping the country that is landing hundreds of children in the hospital. The virus that is being blamed is called enterovirus D68. Enteroviruses are very common. Every year, especially in the summer and fall, they cause 10 million to 15 million infections. The vast majority of these illnesses are mild -- colds, rashes, vomiting, low-grade fever, mouth sores. But sometimes, as is the case with this particular strain, they can be more serious. We don't entirely understand why this strain is causing so much trouble -- or why it is particularly affecting children. It may be simply that children haven't lived as long as adults. This means they have had less time to build up immunity to enteroviruses in general. Whatever the reason, it's clear that enterovirus D68 does cause more trouble for children, especially those with asthma. This illness can cause cold symptoms that then lead to trouble breathing. Sometimes affected children need oxygen. Many of the children who get sick enough to end up in the hospital have asthma. Not only do they get sick from the virus, it causes their asthma to act up. As of the end of last week, there were 160 confirmed cases in 22 states. There are almost certainly many more than 160 cases, and the virus is likely in more than 22 states. Special tests need to be done to know for sure what exact virus is making children sick. These are tests that doctors don't always do on sick children. The tests that confirm it is enterovirus D68, as opposed to another kind of enterovirus, can be done in only a small number of laboratories. This can take a long time. What Changes Can I Make Now? As I said above, the best thing you can do is wash your hands. Enterovirus D68 doesn't get spread through the air. It's spread through contact with body fluids like saliva and nasal secretions (snot). Washing your hands regularly can help decrease the chance of catching all sorts of illnesses, including this one. It's also a good idea to:
  • Stay away from sick people to the extent possible
  • Stay home if you are sick
  • Regularly wipe down common surfaces, such as doorknobs
  • Avoid sharing cups and utensils
  • Teach children to cover coughs and sneezes with the inside of the elbow instead of the hand
Since we are in flu season, these are great things to do anyway. If you have a child with asthma, it's really important that he or she take all medicines as prescribed, especially "controller" medicines. These are the ones that are meant to prevent symptoms. Very often, families get a bit lax with those over the summer, when many children with asthma get better. Families figure the controller medicines aren't needed, and they stop them. If that was the case in your family, start those medicines up again. They could make all the difference if your child catches this virus. It's also important to be watchful of any child who gets a cold. Chances are it's just a cold, and nothing serious. But look out for any trouble breathing. Children who have trouble breathing may:
  • Cough very often
  • Breathe fast or heavy
  • Have trouble talking
  • Look pale
If you notice any of this, bring your child to get medical attention right away. What Can I Expect Looking to the Future? I hope that this virus will pass as we move out of fall. I also hope that, with increased awareness, people will take the best steps to prevent this illness and get children the care they need quickly.  But when we move out of fall, we will still be in flu season. So even if the news says that enterovirus D68 isn't as big a threat anymore, keep up with the hand-washing and other suggestions.  Get your flu shot, too. Winter is a bad time for viruses. The habits you learn for preventing enterovirus D68 can go a long waytoward keeping you and your family as healthy as possible.]]>
Mon, 22 Sep 2014 14:19:00 -0400
CDC Backs 2nd Pneumonia Vaccine for Seniors Adults age 65 and older should get 2 vaccines to prevent pneumonia, U.S. health officials say. The... Streptococcus pneumonia (pneumococcus) bacteria. These bacteria also can cause bloodstream infections and meningitis. The PCV13 vaccine already is recommended for children and certain high-risk adults. An expert panel that advises the CDC on vaccines voted in August to recommend this vaccine for older adults, too.  The new advice calls for everyone age 65 and older to receive both vaccines, but not at the same time. The CDC has detailed advice on when to give each vaccine to get the best protection. The journal Morbidity and Mortality Weekly Report published the new advice.                    What Is the Doctor's Reaction? If you are over 65, a new vaccine is recommended for you. It is the PCV13 (Prevnar 13). Like its cousin, the PPSV23 (Pneumovax), this is a vaccination to protect you against bacterial pneumonia. People who have stayed up to date with vaccinations already received a dose of Pneumovax when they turned 65. The U.S. Centers for Disease Control and Prevention (CDC) announced yesterday that it now recommends older adults get both kinds of vaccine. Pneumonia caused by the bacteria Streptococcus pneumoniae (also called pneumococcus) can make people very sick, very fast. These bacteria are one reason that doctors try to give anyone with pneumonia a dose of antibiotics within one hour of diagnosis. Without treatment, pneumonia can become severe. The bacteria can also spread into the bloodstream or can cause meningitis. Nowadays, hospital labs test for this infection. When I was a younger doctor, labs were smaller. It was my job to test for this infection, at the bedside. Patients would cough out brown sputum, and I would spread this onto a glass slide and rinse the slide with colorful ink. Then I would study it under a microscope. The bacteria have a very distinct look -- two small lobes joined together. I never found a slide with just a few pneumococci on it; there were always either none or millions. What Changes Can I Make Now? The PCV13 is not exactly "new." It has been included in childhood vaccinations for several years. But it is new for adults. In 2012, the CDC recommended PCV13 for adults 19 or older who have:
  • Impaired immune systems
  • Organ transplants
  • Leukemia or any other blood cancer
  • Kidney failure (on dialysis)
  • A cerebrospinal fluid leak
  • Cochlear implants
  • No spleen
Now the CDC also recommends a single dose of PCV13 for anyone who is older than 65. If you have the option, it is best to get the PCV13 before the PPSV23. This way you get the largest vaccine response. If you are getting the PCV13 first, wait a year between the 2 vaccines. If you have already received the PPSV23 vaccine, you can still get the PCV13 vaccine. In this case, wait 8 weeks between the 2 vaccines. What Can I Expect Looking to the Future? Some health economics experts criticize this decision. They say it is too costly for the amount of extra prevention it provides. But I think this is good new advice. Adding this second vaccine is a way of boosting immunity for older adults who have already received the PPSV23. Adding the PCV13 vaccine is expected to prevent as many as 12,000 cases of pneumonia during the lifetime of those Americans who are now over 65. But I am not sure how many of my patients over 65 will follow the new advice right away. Why? At this time, Medicare pays for only one dose of pneumococcal vaccine for an adult over age 65. It is unlikely that we will see this policy change during the next year. For many patients, a vaccine price tag of $150 or so is too high, unless insurance is paying for most of it.]]>
Fri, 19 Sep 2014 21:44:00 -0400
Healthy Habits Urged to Help Prevent Dementia A healthy lifestyle may help to prevent dementia as well as problems such as heart disease and...                    What Is the Doctor's Reaction? The numbers are staggering. The current cost of caring for people with dementia in the United States is greater than $600 billion. Within 15 years, the cost is expected to rise to $1 trillion. Worldwide, experts predict that 135 million people will be living with dementia by 2050. To bring increased public awareness of the looming epidemic, Alzheimer's Disease International has declared September 21 World Alzheimer's Day. Each year a status report is issued around the same date. This year's report focuses on health factors that we can change to help prevent dementia. This past year we have heard about multiple disappointing trial results for drugs to treat Alzheimer's disease. But the authors of this report do not just review the status of new drug research. They should be applauded for emphasizing what we can do now to help lower our risk of Alzheimer's and other dementias. More than 90% of dementias are caused by 2 diseases. Alzheimer's disease is responsible for 65% to 70% of cases. Vascular dementia accounts for about 20% to 25%. People with dementia often have features of both types. And ways to help prevent them are similar. What Changes Can I Make Now? A higher risk of dementia is linked to several factors. The ones with the strongest links include:
  • Low levels of exercise and physical activity
  • Diabetes
  • Smoking, current and past
  • High blood pressure
  • Fewer educational opportunities early in life
This year's report lists the best ways to help prevent, or at least delay, Alzheimer's disease and other types of dementia. Here's what you can do:
  • Exercise regularly. Make it your goal to get at least 150 minutes of moderate-intensity exercise per week. Then strive to become even more fit.
  • Don't smoke or use other tobacco products.  
  • Use alcohol in moderation. That means no more than one drink per day for women, and no more than two per day for men.
  • Maintain a healthy body weight. In particular, try not to let your waist expand. People with more fat in the middle have a higher risk of developing dementia, even if their body weight is normal.
  • Keep your blood pressure in the normal range. To do this, get regular exercise, eat lots of fruits and vegetables, and cut down on salt. Your doctor can prescribe medicines if needed.
  • Stay socially engaged with family and friends.
Some studies suggest that a Mediterranean-style diet may be especially good for the brain. These suggestions should look familiar. They are the same ones that will help keep your heart healthy, decrease your risk of stroke and lower the chance of developing some types of cancer. What Can I Expect Looking to the Future? Most past studies of new potential drugs to treat Alzheimer's disease include people who already have symptoms of the disease. This is likely too late. The brain changes seen in Alzheimer's disease begin many years before we see symptoms. Some exciting studies have been launched this year. For example, researchers in one study identified older adults with brain changes that looked like those in Alzheimer's. But they didn't have any symptoms. These changes can be seen on special brain scans. People enrolled in the study are being given a drug that can attack these changes. Researchers want to see if it prevents dementia symptoms from happening later on.]]>
Thu, 18 Sep 2014 00:00:00 -0400