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 Fri, 29 Aug 2014 00:00:00 -0400 Electric Brain Stimulation Improves Memory A small study has found that electrical stimulation to certain parts of the brain can improve... What Is The Doctor's Reaction? Electrical stimulation of the brain is approved by the U.S. Food and Drug Administration (FDA) to treat severe depression. The results of this study suggest it also may offer help for people with memory problems. The technique is called repetitive transcranial magnetic stimulation (rTMS). It’s a painless procedure with almost no risks. A technician places an electromagnetic coil against the person’s scalp on one side of the head. The device sends out magnetic impulses to the brain. It’s similar to the magnetic impulses used when a person has an MRI. These researchers were specifically interested in whether rTMS could enhance associative memory. Associative memory allows us to recall something from the past when we experience or think about something in the present time. For example, you might see that a particular old movie is playing on TV and it reminds you of a girlfriend you took to see that movie years before. The part of the brain called the hippocampus plays a dominant role in memory function, especially associative memory. The initial brain activity, before a memory becomes a memory, starts in another part of the brain. Usually that is the outer layer, called the cortex. The researchers aimed the electromagnetic waves to stimulate brain connections between the cortex and the hippocampus. By using a special type of MRI, called functional MRI, they could see if they were directing the magnetic impulses to the right areas. Once the right spot was located, each volunteer received 20 minutes of rTMS every day for 5 consecutive days. Associative memory was tested daily and then again 24 hours following the last session. The rTMS enhanced associative memory in these volunteers by as much as 30%. Improvements were still seen 24 hours after the last rTMS session. What Changes Can I Make Now? The researchers are not suggesting that rTMS be used by people that already have well functioning memories. In people treated with rTMS for depression, there is a very small risk of seizures. There are other healthier ways to help maintain memory and potentially boost brain function:
  • Don't smoke or use other tobacco products.
  • Exercise regularly. Make it your goal to get at least 150 minutes of moderate-intensity exercise per week.
  • Use alcohol in moderation. That means no more than one drink per day for women and no more than two per day for men.
  • Maintain a healthy body weight. In particular, try not to let your waist expand. People with more fat around the middle have a higher risk of developing dementia, even if their body weight is normal.
  • Eat a Mediterranean-style diet. Increase the amounts of fish, vegetables, legumes, olive oil and whole grains you eat.
  • Keep your blood pressure in the normal range. To do this, get regular exercise, eat lots of fruits and vegetables and cut down on salt. Your doctor can prescribe medicines if needed.
  • Stay socially engaged with family and friends.
  What Can I Expect Looking To The Future? Over the next few years, more studies will be done to test rTMS in people with brain disorders affecting memory. People with Alzheimer’s and traumatic brain injury would be excellent candidates for such studies.]]>
Fri, 29 Aug 2014 00:00:00 -0400
Polyp Removal and Future Colon-Cancer Risk People who have low-risk colon polyps removed may have a lower-than-average risk of future colon...                    What Is the Doctor's Reaction? Colon cancer is a leading cause of death among adults in the United States. Fortunately, we have good screening tests with the potential to save lives. Colonoscopy is the best screening test for colon cancer. During a colonoscopy, a doctor peers into the colon through a flexible tube with a light and camera on the tip. If a tumor is seen, a sample (biopsy) can be removed to find out whether it is cancerous. A small tumor can be removed during the procedure. Colonoscopy can prevent deaths due to colon cancer by:
  • Detecting cancer at a curable stage
  • Detecting (and removing) certain types of polyps called adenomas, which sometimes become cancerous
  • Leading to more frequent testing in the future if cancer or some kinds of polyps are found
How much of the benefit of colonoscopy is due to detection of polyps? That's the subject of a study just published in the New England Journal of Medicine. Researchers in Norway did the study. They used the nationwide health monitoring system to identify who had a polyp removed and later developed colon cancer or died.  They looked at data on nearly 41,000 people who had polyps removed. During an average follow-up of 8 years:
  • 1,273 developed colorectal cancer and 383 died of the disease.
  • People who had low-risk polyps removed were 25% less likely to die of colorectal cancer than the expected rate in the general population. A low-risk polyp was defined in this study as an adenoma that was single, small or lacked certain features when viewed under a microscope.
  • People who had high-risk polyps removed were about 16% more likely to die of colorectal cancer than the expected rate for the general population.
This last finding could be interpreted as a failure of colonoscopy. People with high-risk polyps still had a higher than expected rate of colon-cancer death even though polyps were removed. However, I think this would not be a correct interpretation. Here's why:
  • The average follow-up in the study was only eight years. It may take longer to show the protective effect of polyp removal.
  • At the time of this study, the guidelines in Norway recommended less frequent screening after polyp detection than current guidelines. More frequent screening could have produced better results.
  • The rate of colorectal cancer-related deaths might have been even higher in those with high-risk polyps if they had not had colonoscopies.
  • Removal of the low-risk polyps was linked with a reduction in colorectal cancer-related deaths. That's probably because removing the tumors alone lowers risk.
  • This study involved people with symptoms, such as bleeding. Results could have been different if the polyps had been discovered by routine screening.
  • In this study, some polyps may have been missed or incompletely removed. The solution for this is better colonoscopies, not fewer of them.
A wealth of data links screening colonoscopy with a decrease in deaths related to colorectal cancer.  This study should not discourage anyone from having a screening colonoscopy.  What Changes Can I Make Now? You can reduce your risk of colon cancer and increase the chance of detecting the disease at a curable stage. Here's what you can do:
  • Eat a diet that is high in fiber, vegetables and folate while avoiding saturated fat, processed meat and excessive alcohol or calories.
  • Exercise each day.
  • Take a daily, low-dose aspirin (but talk to your doctor first).
  • Have colonoscopies (and/or other screening) as recommended.
Current guidelines recommend a colonoscopy every 10 years for people at average risk of colon cancer. Screening should begin at age 50 and end at age 75 to 85. Earlier and more frequent screening may be recommended for some people, such as those with a history of colon cancer or a strong family history of the disease. Other screening options include: •    Rectal examinations •    Testing of the stool for blood •    Sigmoidoscopy (an internal examination of the last part of the colon) •    Barium enema •    CT scanning However, these are less effective. Don't rely on these as your only means of screening. If you have had colon cancer or an adenoma in the past, talk to your doctor about how often to have follow-up screening. What Can I Expect Looking to the Future? You can expect more studies of colonoscopy among people at average or high risk of colorectal cancer. We may discover how often to repeat screening for those at increased risk and also who can safely skip screening. For those with adenomas, the ideal study would randomly assign people to have a repeat colonoscopy at various time intervals over a decade or more. Until such studies are completed, I think it's best to follow current guidelines.]]>
Thu, 28 Aug 2014 00:00:00 -0400
Aspirin May Cut Risk of 2nd Deep-Vein Clot Aspirin may offer some long-term protection for people who have had blood clots in the legs or...                    What Is the Doctor's Reaction? Blood clots in the legs can happen after surgery, major injury or a long bed rest. But often doctors don't find a reason why a blood clot forms in a leg vein. Doctors call them unprovoked deep-vein thromboses (DVTs). Someone with an unprovoked DVT has a lifelong risk that it will happen again. But taking one of the usual medicines to prevent another clot brings its own problems and risks, especially the risk of major bleeding. The results of this study suggest a safer option after the first year -- daily low-dose aspirin. A DVT causes pain and swelling. It can limit movement. But the greatest danger is the risk that part of the clot will break away from the leg and travel to the lungs. That's called a pulmonary embolism (PE). The symptoms are shortness of breath, chest pain and lightheadedness. And if the embolism is large, it can cause sudden death. The usual treatment for an unprovoked DVT or PE is an anticoagulant ("blood thinner"), such as heparin. Injections are given for a few days. Then people take either warfarin (Coumadin) by mouth or one of the newer anticoagulant pills for at least 6 months. Most doctors recommend 12 months. But after this treatment is done, you still have a high risk of another DVT or PE. The risk is 10% in the first year and 5% per year after that. Taking a blood thinner for the rest of your life provides the greatest protection against having a second DVT or PE. But most often patients and their doctors opt to stop the drug after one year. That's because over a lifetime the risk of major bleeding caused by the blood thinner is actually higher than the risk of another DVT or PE. Low-dose aspirin is not as good, but it is much safer. It's only half as effective as warfarin or one of the newer blood thinners. But the lifetime bleeding risk is much lower. And aspirin also protects against heart attacks, strokes and potentially some cancers. What Changes Can I Make Now? If you have had a DVT or PE in the past and currently do not take warfarin or another blood thinner, talk with your doctor about low-dose aspirin to help prevent another clot. You also can take other steps to help prevent a DVT from ever happening or happening again:
  • Stay active.
  • Get up from your desk often and take short walks.
  • When sitting, move your feet up and down often to squeeze your calf muscles.
  • Maintain a healthy weight.
  • Don't smoke.
  • Drink plenty of liquids, especially when travelling long distances. Avoid alcohol during the trip, as it can dehydrate you.
  • If you are admitted to the hospital or have surgery, ask your doctor about preventive treatment with blood thinners or leg "compressors."
What Can I Expect Looking to the Future? Aspirin will likely become standard treatment for people with unprovoked DVT or PE once they stop their anticoagulant drug. Many people who have had a DVT related to surgery, injury or long-term bed rest may also decide to take daily low-dose aspirin. But aspirin should not be considered a replacement for a full course of anticoagulant drug therapy.]]>
Wed, 27 Aug 2014 14:26:00 -0400
'Sleep Drunkenness' Common, Study Finds A new survey suggests that about 15% of Americans have what's sometimes known as "sleep...                    What Is the Doctor's Reaction? I suspect all of us have had an occasional episode of brief confusion when suddenly awakening from a deep sleep. Usually it lasts 5 to 10 minutes. Doctors call it confusional arousal. It's sometimes called "sleep drunkenness." This new study gives us a real-life glimpse of just how often sleep drunkenness happens. It also suggests what might predispose a person to have these episodes. The researchers surveyed more than 19,000 adults. About 1 in 7 had an episode of confusional arousal within the last year. And half of those people had frequent episodes, one or more a week. Some people are more likely than others to have sleep drunkenness. They include those who:
  • Have a sleep disorder, such as sleep apnea
  • Have depression, anxiety or panic disorder
  • Take medicine for a mental health disorder, such as an antidepressant
  • Sleep less than six hours or more than nine hours a night
About 9% of people who experience sleep drunkenness don't recall some or all of what happened during the period of confusional arousal. Interestingly, confusional arousal happens less often as we get older. The likely reason is that older people have shorter periods of very deep sleep during the night than younger people. People are more likely to have confusional arousal if they suddenly wake up from the very deep part of sleep. What Changes Can I Make Now? It would be terrific if we could arrange our lives to wake up naturally every morning. No alarm clock, no kids jumping into your bed, no loud noises outside your window. But that's not a reality for most of us. Confusional arousals are much more common than we previously recognized. You might not realize it if you experience these episodes. So it's important to be aware that the time after you first wake up from sleep is a bad time to be making major decisions. Perhaps even minor ones. During that first 10 to 15 minutes after awakening, tell yourself you need to concentrate and focus on what you are doing. For some people, it may take longer than that to reach full brain power. Confusional arousals have the potential to be dangerous. It's possible to unknowingly inflict harm on a bed partner or on yourself during a spell. However, that's rare.
What Can I Expect Looking to the Future? There is so much more we need to learn about confusional arousals. For example, when might they be a symptom of some other problem or condition? What might be done to more quickly resume clear thinking when an episode occurs?  These are just a couple of the questions that future research will address.]]>
Tue, 26 Aug 2014 19:29:00 -0400
2 Americans Recover after Ebola Treatment Two Americans treated for Ebola infection were released from Emory University Hospital this week....
What Is the Doctor's Reaction? Two Americans involved in treatment of Ebola in Liberia became infected with the virus themselves -- and they have recovered. With celebration and speeches, Kent Brantley, M.D., and Nancy Writebol were both released from Emory University Hospital in Atlanta this week. I listened to a newscast in which Dr. Brantley addressed well-wishers. His comments were not focused on his own recovery. Rather, his mind was still on the work to be done in West Africa. According to the World Health Organization, more than 170 health-care workers have been infected. Most have been Africans. More than 80 have died. Doctors and other health-care professionals who are willing to care for Ebola patients are my heroes. They are in short supply. In pivotal times of medical history, we have needed people who can put aside fears and work on the front lines. Ebola makes me think of another time in history when people relied upon truly brave volunteer doctors to step into the midst of an epidemic. Just as West Africa is relying on "Ebola doctors" today, Europe relied on "plague doctors" during the late Middle Ages, in the time of bubonic plague. That epidemic (plague) was much more wide-scale than the current Ebola epidemic. Plague was less well understood than Ebola is, and it spread more easily. But it is interesting to me to compare the doctors and public health strategies now and then. Ebola doctors and plague doctors gown themselves for work in similar ways. We have seen news images of white and yellow disposable paper gowns worn by medical professionals in West Africa. Ebola doctors wear hoods and goggles. Many of them wear masks shaped like duck bills. This shape makes it easier to breathe through the mask. Artists' drawings show plague doctors who look strikingly similar, encumbered with protective clothing. The drawings also show a beak-shaped mask. In this case, the mask contained flowers and aromatic herbs, to help doctors cope with the terrible smells as they worked with the dying and dead. Plague doctors coated their long robes with wax or lard. Some historians think this may have kept the gowns free of body fluid stains or contamination. They wore spectacles a lot like today's goggles, as well as leather pants and boots. They carried canes that allowed them to examine patients without so often touching them. It is remarkable to consider how effectively these outfits might have protected doctors in those days, when so little was understood about exactly how illness was spread. Plague was spread by fleas that carried bacteria. Ebola is spread differently, through body fluids. But just as in times of bubonic plague, public health measures for Ebola virus include quarantines. Did you know that the word quarantine was invented during the time of bubonic plague? Ships that were thought to harbor potential plague infection were kept in harbors. They were not allowed to dock for 40 (in French, quarante) days. In some cases, quarantines in plague time overruled civil rights. This is also a worry in our own time. In the time of plague, some houses were forcibly sealed up from the outside. Sick inhabitants were trapped inside. This week in Liberia, violence erupted in West Point, a slum district under quarantine. Protesters stoned security forces who were keeping residents from fleeing. Security forces fired bullets into the crowd and released tear gas. What Changes Can I Make Now? Dr. Brantley said, "I'm glad for any attention my sickness has attracted to the plight of West Africa in the midst of this epidemic." This is a desperate time in West African nations involved in the Ebola outbreak. More than 1,300 people have died. Travel has been restricted, and it is challenging to preserve human freedoms in a time when we depend upon quarantines to prevent spread of disease. Despite our celebratory hospital releases this week for two brave Americans, the Ebola outbreak remains geographically limited to West Africa. These nations need our empathy and the support of health care volunteers and provisions. Some people who are not in West Africa are dismayed at protests against quarantines. Keep in mind that quarantines are socially complicated. Where there is uncertain trust toward government, motives behind quarantines can be confused. And if people in quarantine do not have health care and food supplies, we can't expect cooperation. What Can I Expect Looking to the Future? This is the largest outbreak of Ebola virus ever recorded. Our collective efforts to stop the spread of Ebola count even now more than they will as the epidemic enlarges. With unrest in West Africa now, we can expect to see further spread of Ebola before it is genuinely contained. Most experts closely involved with Ebola do not expect this outbreak to become worldwide. Even if Ebola does affect some American travelers or health-care workers, it is not expected to expand into an epidemic in the United States. With adequate hospital resources and an educated community, cases here can be isolated soon after they are identified to help prevent spread. As we watch this outbreak play out, let us appreciate the heroes who are willing to step into the center stage of the crisis in West Africa.]]>
Fri, 22 Aug 2014 00:00:00 -0400
Exercise May Deter Heart Rhythm Problem Exercise may help older women to avoid an abnormal heart rhythm, a new study suggests. The study... What Is the Doctor's Reaction? If you're a woman past the age of menopause, you can add a new benefit to the list of those bestowed by exercise. It appears that exercise may lower your risk of developing an abnormal heart rhythm. That's the conclusion of a study just published in the Journal of the American Heart Association. Researchers first asked more than 81,000 women (average age: 63) about their level of physical activity. Then they determined how many women developed atrial fibrillation in the next 11 years. Atrial fibrillation is an irregular heartbeat. Usually, the upper chambers of the heart (the atria) contract in a regular, coordinated way. With atrial fibrillation, they quiver randomly instead. Some people don't notice the abnormal heart rhythm. Others have palpitations, shortness of breath or other symptoms. Atrial fibrillation increases the risk that blood clots will form inside the heart. A clot can travel to the brain or other parts of the body. A clot in the brain can cause a stroke. The researchers found that:
  • The most active women had the lowest rates of atrial fibrillation.
  • Exercise equal to running 2 hours a week was linked with a 9% lower risk of atrial fibrillation, compared with those who got the least exercise.
  • Exercise equal to brisk walking 3 hours a week was linked with a 10% lower risk of atrial fibrillation.
  • Exercise equal to brisk walking 1 hour a week was linked with a 6% lower risk of atrial fibrillation.
  • Atrial fibrillation was more common among obese women. But exercise reduced this tendency.
These findings are important because atrial fibrillation can be a dangerous condition.  And previous research suggested that strenuous activity might actually increase the risk of atrial fibrillation. Treatments are available to control the irregular rhythm and to prevent clots. But they don't always work, and side effects are common. That's why news that physical activity can reduce the risk of atrial fibrillation is important. And, of course, exercise has many other health benefits. What Changes Can I Make Now? The message of this study is clear: get moving. If you generally don't exercise, it's important to start slowly. Then gradually increase your activity levels. If you have heart disease or other medical problems or if you aren't sure whether you can exercise safely, talk to your doctor first. To increase your physical activity:
  • Find an activity or exercise program you like. You'll be more likely to stick with it.
  • Make exercise a routine part of your day.
  • Start slowly with low-impact aerobic exercises, such as walking or biking.
  • Get an exercise partner. This will make it more enjoyable and harder to skip.
  • Increase your "non-exercise" activity. For example, take the stairs instead of the elevator. Or choose the parking spot that's a bit farther away from where you are headed.
Know what health factors increase the risk of atrial fibrillation. These include: 
  • Rheumatic heart disease (rheumatic fever in the past that affected the heart and its valves)
  • Heart and blood vessel disease (such as angina or past heart attack)
  • High blood pressure
  • Diabetes
  • Excessive alcohol intake
  • An overactive thyroid gland
  • Advanced age
  • Lack of exercise (as suggested by this new study)
Changes you make could reduce your risk of atrial fibrillation. For example, you can exercise more or get treatment for high blood pressure. What Can I Expect Looking to the Future? I believe that the list of health benefits linked to exercise will continue to grow. Future research could show which types of exercise are best to protect against atrial fibrillation. This latest research only included women. I look forward to research that also looks at the relationship between exercise and atrial fibrillation among men.]]>
Thu, 21 Aug 2014 00:00:00 -0400
Non-Car Commuters Thinner, Study Finds Walking, biking or even riding public transit to work can help with weight control, a new study... What Is the Doctor's Reaction? We hear it over and over: Get more exercise. For many, finding the time to do it is the biggest obstacle. Try leaving the car at home. If you live close enough to work, walking or biking to get there will help to shed pounds and body fat. And if you live too far from work, here's some good news. Commuting to work by bus, train or other public transportation may do the same, according to this study.  BMJ, formerly the British Medical Journal, published the study. The study results do not actually prove that commuting by public transportation was the direct cause for lower body weight and less body fat. What the researchers found is that average-sized adults who got to work using public transit weighed 6 to7 pounds less than those driving to work. They also had about 1% to 1.5% less body fat. The researchers did try to account for differences in other exercise, as well as social and economic factors known to influence body weight. It makes sense that commuting by public transit would be linked with a healthier body. It usually requires some walking or biking to get to and from the bus stop or train station. In fact, a prior study found that U.S. adults who use public transportation walk an average of 19 minutes as part of their daily commute to work. What Changes Can I Make Now? Leaving the car at home may not be an option for you. Here are some other ways to get more exercise while at work. Get up and move often. One study compared workers who sat continuously for 5 hours with those who got up every 20 minutes to walk around briskly or perform some other exercise. The frequent movers had lower blood sugar and insulin levels. That's a good formula to keep down body fat. Count steps. Don't do this just at work. Wear a pedometer all day long. It's a low-cost way to track your progress. You might not reach the widely touted goal of 10,000 steps. The goal is to keep increasing your steps from week to week. Take longer walks at lunch time or when you are back at home. If you are a new walker, start at a comfortable level for you. Divide your walking into 3 parts:
  1. A slower pace to warm up
  2. A faster pace to get your heart pumping
  3. A slower pace to cool down
What Can I Expect Looking to the Future? Cities and suburbs have taken some baby steps toward making it safer and easier for people to walk and bike to work. Much more needs to done, which will require major financial commitments.  And reasonably priced, convenient public transportation would help encourage more people to leave the car at home.]]>
Wed, 20 Aug 2014 00:00:00 -0400
Many Get Cancer Screening at Advanced Ages Many older adults who are unlikely to live more than 10 years still are given routine screening... What Is the Doctor's Reaction? Screening for cancer has been heavily promoted as an important part of staying healthy. The public health messages never state the risks or costs of screening. So it's widely believed that cancer screening is always a good thing. Two new articles add to the growing evidence that cancer screening should not be routine for everyone. And it can be harmful, especially in older folks. The articles appear in this week's journal JAMA Internal Medicine. Guidelines from well-respected health organizations often include ages when screening should stop. Despite the evidence, that advice has often been ignored. Besides the potential risks of further tests and treatments, the costs of cancer screening can be misleading. For example, the PSA (prostate-specific antigen) blood test to detect early prostate cancer is indeed low-cost. But an abnormally high PSA often means that men have expensive biopsies. If prostate cancer is found, many may have even more costly cancer treatment. Quite often, the cancer treated would not have shortened their lives. Even the value of breast cancer screening for women at average risk of the disease is being questioned. A mammogram costs a bit more than PSA screening in men. But, similar to PSA testing, it's the large number of further tests, biopsies and surgeries that really run up the cost. One of these new studies showed that screenings for breast, cervical, prostate and colorectal cancer were often done in people with life expectancy of fewer than 10 years. Cancer screening in people with limited life expectancy rarely translates into improved survival. And those extra months or years almost never lead to better quality of life. The other study focused on the large number of colonoscopies that did not follow current guidelines. The data included:
  • Colonoscopies ordered on people over age 75
  • Repeat colonoscopies sooner than every 10 years, the recommended interval for people with a  previous normal test
What Changes Can I Make Now? Current guidelines suggest the following:
  • Stop routine Pap smears to screen for cervical cancer at age 65 if Pap smears have been negative in the past.
  • Stop routine screening mammography for women at average risk of breast cancer after age 75.
  • Stop screening colonoscopies for adults at average risk of colorectal cancer at age 75.
  • Stop all routine screening with PSA for men at average risk of prostate cancer.
Experts realize that cancer screening advice based on age alone is too arbitrary. That is why many experts suggest doctors consider a person's life expectancy. If it is less than 10 years, screening is unlikely to improve survival and quality of life. And usually the risks are greater than the benefits. But estimating life expectancy is very difficult. Therefore, doctors are reluctant to make what amounts to a guess for many patients. Instead, cancer screening should be a mutually shared decision, with the patient well informed of the risks. That includes the risks of the test. But it also should include the risks of what may happen if a test does suggest there may be a cancer -- one that won't shorten the patient's life. What Can I Expect Looking to the Future? We should focus less on cancer screening. What's more important is cancer prevention. Here's what you can do:
  • Stay physically active and spend at least 150 minutes per week on moderate-intensity exercise.
  • Maintain a healthy weight.
  • Don't smoke or use other tobacco products.
  • Either avoid alcohol or drink moderately. This means an average of no more than one alcoholic drink per day for women or no more than two per day for men.
  • Eat a diet rich in fruits, vegetables and whole grains.
Tue, 19 Aug 2014 00:00:00 -0400
Shots Fight Cervical-Cancer Virus 8 Years A vaccine appears to protect against human papillomavirus (HPV) for 8 years, a new study finds....
What Is the Doctor's Reaction? The human papillomavirus (HPV) is an infection easily passed during sex. More than half of sexually active people get it at some point in their lives. For most people, the infection goes away on its own. But in some cases, HPV causes cancer. For example, about 11,800 U.S. women were diagnosed with cervical cancer in 2010. About 3,900 died of the disease. The HPV vaccine helps prevent serious health problems caused by HPV infection, such as:
  • Cervical and anal cancer in females
  • Head, neck, penile and anal cancer in males
  • Genital warts in females and males
  • Warts in the airways of babies and children
A study in the journal Pediatrics looked to see if the HPV vaccine is still helpful as much as 8 years after the first dose. The researchers kept track of more than 1,600 boys and girls who got a 3-dose series of the HPV vaccine. They received the shots between ages 9 and 15. The study checked how well the vaccine offered them:
  • Immunity (amount of protection)
  • Effectiveness (cases of HPV infection or disease prevented)
  • Safety (cases of serious side effects from getting vaccine)
One group  got the vaccine at an average age of 12 years. For the "catch-up" group, the average age was 15. Researchers found that:
  • Children and teens were protected from HPV as long as 8 years after vaccination.
  • Not one teen in the early-vaccination group developed a serious HPV-related infection or disease.
  • Three serious health events occurred during the study period. One was related to the vaccine.
  • The only cases of serious HPV infection that occurred were found in the catch-up vaccination group. In one case,  abnormal cervical cells were found. This could be because this group was vaccinated three years later than the other group. They might have been exposed to HPV sometime in those years before getting the vaccine.
The authors believe that HPV vaccine has an important role in preventing HPV-related cancers. This study's long-term data on effectiveness and safety should be very reassuring to teens, families and health care professionals. I hope that more teens and families now will accept the HPV vaccine. What Changes Can I Make Now? It's important to get your sons and daughters vaccinated to protect them against HPV. The American Academy of Pediatrics and Centers for Disease Control and Prevention recommend HPV vaccine for all males and females at ages 11 to 12. The vaccine is licensed for children as young as age 9. There are 2 HPV vaccines. Gardasil (HPV4) is recommended for both females and males. Cervarix (HPV2) is recommended only for females. Both are given as 3 shots over a 6-month period. The HPV vaccine prevents cancer. Yet some parents hesitate to have their young children vaccinated against a virus that is spread through sex. Your child should not wait until he or she is sexually active to get the HPV vaccine. The vaccine works best when it is given before someone has sex for the first time. Plus, this study shows us that the HPV vaccine keeps working as much as eight years after the vaccine series was received. What Can I Expect Looking to the Future? Expect doctors to routinely recommend the HPV vaccine for your children by age 11. Do not delay getting the vaccine for your children. If you have any concerns about the HPV vaccine, talk with the pediatrician. I hope that, with better education, more parents will get all their children vaccinated against HPV. The best timing for the vaccine to protect against cancer is before your child begins having sex. I expect that more children will get the HPV vaccine when they are younger. This will lead to less cancer. Many more lives will be saved.]]>
Mon, 18 Aug 2014 00:00:00 -0400
Studies Look at Sodium's World Health Impact Two new studies add to the discussion about salt and its role in high blood pressure and heart...
What Is the Doctor's Reaction? Do you regularly add salt to your food? Do you worry about people who do? Perhaps you're on a low-sodium diet on the advice of your doctor or because of something you read in the news.  My guess is that most people think little about sodium on a daily basis. There's a salt shaker in most kitchens, and salt is a staple of many recipes. It's a simple and essential part of our diet. Yet there is a lot of confusion about how much is too much, how much is too little and how much difference it makes. There's even confusion about the terms, "salt" and "sodium." What we think of as table salt consists of sodium chloride. It accounts for about 90% of sodium we consume. So when we talk about sodium in our food and its impact on health and disease, we can use the terms "salt" and "sodium" interchangeably. Guidelines suggest that the average adult consume no more than 2,300 milligrams (mg) of sodium daily. That's the amount in just one teaspoon of salt. Guidelines suggest that many people limit salt intake even more. Yet the average American currently consumes more than 3,400 mg each day. Too much sodium can cause your body to hold on to (retain) fluid. This can increase blood pressure. Two new studies in the New England Journal of Medicine come to somewhat different conclusions about salt intake. In one, researchers conclude that eating too much sodium may contribute to millions of preventable deaths. Researchers combined data from more than 100 prior studies regarding sodium intake in 66 countries. They estimated the impact of sodium intake on blood pressure and on deaths from heart and blood vessel disease. The researchers estimated that:
  • Worldwide, average sodium intake was nearly 4,000 mg daily
  • There would be 1.65 million fewer deaths per year worldwide if average sodium intake was closer to 2,000 milligrams daily
  • About 40% of deaths attributed to excess sodium intake occur in people younger than age 70
  • Reducing sodium intake to recommended levels would prevent about 10% of deaths related to heart and blood vessel disease
Although these are only estimates, the numbers are impressive. High blood pressure (hypertension) can be treated. It is among the most modifiable factors that increase the risk of heart and blood vessel disease. And these diseases are among the leading causes of early death worldwide. So it's hard to ignore these findings. But another study in the same journal found that the picture may be more complicated. It suggested that there may also be risks linked with too little sodium. The study included more than 100,000 people from 17 countries. Those with the middle range of sodium intake consumed an estimated 3,000 to 6,000 mg each day. People in this group had lower rates of death and heart attack, heart failure or stroke than those with higher or lower intake. The American Heart Association and other experts recommend that most Americans eat less salt than the middle range in this study. So how can lower amounts of sodium be riskier than the higher amounts that most people now consume? One reason could be that people with high blood pressure or other reasons for a high risk of heart disease are usually advised to eat less salt. Their higher-than-average rates of heart disease and related deaths may then be erroneously linked to their lower salt intake. So I think it's too soon to throw out current advice to eat less salt.  What Changes Can I Make Now? Most U.S. adults fall into a group that should limit sodium intake to 1,500 mg daily, according to current guidelines. You should restrict your sodium intake to this low level if you:
  • Are older than age 50
  • Are African-American
  • Have high blood pressure
  • Have chronic kidney disease
  • Have diabetes
  • Have heart failure
Limiting sodium intake can help people in these risk groups prevent or control high blood pressure. Consuming less sodium can help avoid "fluid overload." This means that the body is unable to remove some fluid and therefore holds on to it. Most sodium in the U.S. diet comes from added salt. So preparing or choosing low-salt foods can make a big difference in how much sodium you consume. There are many ways to reduce sodium in your diet. Consider these ideas:
  • Read labels. Choose foods marked as "low sodium," "reduced sodium" or "no salt added."
  • Avoid processed foods. Most fresh fruits and vegetables are naturally low in sodium.
  • Season your food with less salt. Choose low-salt or no-salt seasonings and spices.
The sodium content of many foods may surprise you. For example, high sodium levels are often found in:
  • Soy sauce
  • Ketchup
  • Breads
  • Cold cuts and many other meats
  • Pizza
  • Cheese
  • Snacks such as pretzels or chips
The impact of lowering dietary salt is significant -- and fast. When salt intake is reduced, blood pressure can begin to fall within a few days. What Can I Expect Looking to the Future? These new studies are likely to fuel debate about advice to eat less salt. Already, media outlets are presenting opposing opinions from heart disease experts. I think the scientific evidence showing the hazards of high salt intake is difficult to ignore. I believe that in the future salt consumption will fall in the United States and in other places where it is high. To understand just how much salt is too much, and too little, we need long-term clinical trials. These studies would compare people placed on diets containing varying amounts of sodium. It's likely that the ideal amount will vary for different groups of people. Craving salty foods is learned. And it can be "un-learned." It takes time to get used to foods that are less salty -- but for many, I think it's worth the effort.]]>
Thu, 14 Aug 2014 00:00:00 -0400
New Home Test Finds Most Colon Cancers U.S. regulators have approved a new home test that detects more than 90% of colorectal cancers.... What Is the Doctor's Reaction? In March, a panel of advisers to the U.S. Food and Drug Administration (FDA) weighed the risks and benefits of a more sensitive home stool test to screen for colorectal cancer. All of the panel members voted to recommend approval. As expected, the full FDA now has followed the panel's advice. The test goes by the trade name Cologuard. It is approved for people age 50 and over who are at average risk of colon cancer. It should not be used as a substitute for colonoscopy in people with greater than an average risk. This includes people with:
  • A history of polyps or prior colorectal cancer
  • A strong family history of colorectal cancer
  • Ulcerative colitis or Crohn's disease
Until now, approved stool testing for cancer screening only checked for microscopic amounts of blood. This method misses a lot of polyps and small cancers. Cologuard detects abnormal DNA as well as blood. A very large study concluded that with the DNA detection the test misses only 8% of people with colorectal cancer. This compares with 26% missed by testing only for blood in the stool. Both tests missed many pre-cancers. But Cologuard missed fewer of them than the stool tests that detect blood only. However, the Cologuard test produced more false positives than just testing stool for blood. A false positive stool test suggests that you have a polyp or cancer when none actually exists. The only way to prove that a stool test is a false positive is to perform a colonoscopy to directly look at the whole colon. That's why anyone with a positive stool test done for cancer screening needs a colonoscopy. What Changes Can I Make Now? Cologuard stool testing offers another option for colorectal cancer screening. But right now, colonoscopy remains the best screening method. It is recommended once every 10 years for people age 50 and over who have an average risk of colorectal cancer. The doctor uses a flexible, lighted instrument called a colonoscope. You receive medicine to help you relax and avoid discomfort. The doctor looks through the colonoscope and inspects the inside of the colon. The great advantage of colonoscopy is that it does more than detect early cancers and pre-cancers. It finds polyps. If the doctor finds a polyp, a device on the end of the colonoscope can remove it. Removing polyps helps prevent them from turning into cancers. Colonoscopy does have risks. It's possible that the instrument can puncture the colon and cause an infection. It's also possible to have excessive bleeding if the doctor removes a polyp or snips a bit of tissue for a biopsy. Fortunately, these risks are small. Other options available to screen for colorectal cancer are:
  • Sigmoidoscopy every five years -- This test is similar to colonoscopy, but it looks at only the lower part of the colon. No sedation is needed. The preparation is much simpler than it is for a colonoscopy.
  • Virtual colonoscopy -- This test uses a CT scan instead of a scope to check the colon for cancers and polyps. It is not covered by Medicare.
As with stool testing, if something abnormal is found on one of these tests you would need a full colonoscopy. What Can I Expect Looking to the Future? While the FDA was reviewing the expert panel's advice, the U.S. Centers for Medicare & Medicaid Services was doing the same. It is very likely that Medicare will approve the Cologuard test to screen people ages 50 to 85 at average risk for colorectal cancer. Future studies will determine how often the test should be done if no cancer is detected. Some experts suggest the interval might be once every 3 years.]]>
Wed, 13 Aug 2014 14:47:00 -0400
Robin Williams Dies; Suicide Suspected Comedian and actor Robin Williams, who had fought substance abuse and depression, was found dead...
What Is the Doctor's Reaction? Based on what has been reported, Robin Williams was depressed and committed suicide. It might seem paradoxical that someone with such success and so much humor to share could be depressed. But that is often the reality. A person can hide the sadness behind jokes and smiles. But he or she is hurting terribly inside. Symptoms of depression might be triggered by unfortunate events. Most often, though, depression happens for reasons we are just beginning to understand. Clearly, genetics plays a major role. I want to believe that if he had sought treatment for depression, Robin Williams would not have taken his own life. Without treatment, a severely depressed person can feel so awful and hopeless that he or she believes the only solution is dying. This suicide, like any suicide, raises many questions. Did Mr. Williams convince his family that his depression was not that bad? Did he resist getting professional treatment despite urging from family and close friends? Did he start to use alcohol, cocaine or other drugs again to self-treat the depression? Did he actually start depression treatment, but too quickly concluded that it wasn't helping? What Changes Can I Make Now? Today depression remains a clinical diagnosis. That means it's based on symptoms. There is no blood test, genetic test or scan to diagnose depression. A good screening tool for depression is to ask yourself these two questions:
  • During the last two weeks, have you felt depressed or hopeless?
  • In the same period, have you felt little interest or pleasure in your usual activities?
But if you are depressed, you may not even recognize these symptoms. So a family member or friend may need to be asking the questions. If the answer to either of these is yes, seek help. Start with your primary care doctor, or reach out to a mental health professional. Depression isn't the same in everyone. And feeling sad might not be the main symptom. Here are some of the other symptoms:
  • Trouble concentrating or remembering things
  • Sleep changes (can't sleep or sleep too much)
  • Anger or irritability
  • Appetite or weight changes (can be either more or less)
  • Reckless behavior, such as excessive alcohol use or reckless driving
  • A feeling of worthlessness
  • Thoughts about harming yourself
There may be reasons other than depression for these symptoms. But depression is a common cause. If you do start an antidepressant, realize that it may take a few weeks to work. And the first drug chosen is successful only 40% of the time. Stay in touch with your doctor often. Report it right away if you feel worse or consider hurting yourself. What Can I Expect Looking to the Future? Of course, we need to respect the Williams family's privacy. But perhaps in the future family members or close friends would be willing to share what was going on the days before his death. These details might help others facing similar challenges in trying to help a loved one who doesn't acknowledge depression or resists getting professional help.]]>
Tue, 12 Aug 2014 14:33:00 -0400
Tool Helps Predict Risk of 2nd Kidney Stone Answers to a set of questions can help doctors predict whether someone who has one kidney stone... What Is the Doctor's Reaction? About 10% of Americans will have a kidney stone that causes symptoms at some point in their lives. The symptoms almost always include severe pain. Other symptoms can include bloody urine, nausea and vomiting. A first stone often leads to a second one. The risk of having a second stone has been estimated as high as 50% to 80% within 10 years of the first stone. This study gives us a more accurate risk of a second kidney stone. But the special value these researchers offer is a new tool to predict who is likely to have a second stone. Their results are based on examination of 2,239 records of people with a first-time painful kidney stone. All lived in Olmstead County, Minn. The information about these patients was tracked for 30 years. The average risk of a second kidney stone from the time of the first stone was:
  • 11% within 2 years
  • 20% within 5 years
  • 31% within 10 years
  • 39% within 15 years
But these are just averages. It doesn't give you a personal risk of having a second stone after your first. To help answer that question, the researchers looked at more than 30 different factors that might affect the risk of developing a second symptom-causing kidney stone. They found that 11 factors identified people who had the greatest risk of a second painful stone. Based on their analysis, researchers developed a tool called The Recurrence of Kidney Stone nomogram. The 11 risk factors included:
    1. Younger age (20s and 30s)
    2. Male sex
    3. White race
    4. Family history of kidney stones
    5. A prior episode of pain that suggested a kidney stone, but no stone seen on imaging tests
    6. Stone seen on imaging done in the past for reasons other than kidney stone symptoms
    7. Bloody urine along with kidney stone pain
    8. Other stones seen within the kidney, but not the stone causing pain
    9. A painful stone at the bottom of the kidney
    10.  A painful stone at the bottom of the ureter (duct) where it enters the bladder
    11.  A stone that was analyzed in the lab and found to contain uric acid
What Changes Can I Make Now? If you have had one painful kidney stone, you can estimate your risk of a second stone using the tool that researchers developed. Share your risk score with your doctor, especially if it is high. If you have already had two or more stones, then your risk of having more painful episodes is very high. This tool does not apply to you. See your doctor for further evaluation and specific preventive treatment for you. Even if your risk of a second kidney stone is low, take these easy and generally healthful steps:
  • Drink plenty of liquids to avoid dehydration.
  • Eat more fruits and vegetables, whole grains and calcium-rich foods.
  • Limit animal protein in your diet.
What Can I Expect Looking to the Future? Other researchers will test how well the tool works for people who live in other parts of the world. For example, people who live in climates warmer than Minnesota tend to have a higher kidney-stone risk. Their risk factors for a second stone might be slightly different than those found in this study.]]>
Fri, 08 Aug 2014 14:15:00 -0400
Study Links Low Vitamin D, Dementia Risk Older adults who have low blood levels of vitamin D may be more likely to develop dementia, a... What Is the Doctor's Reaction? Not long ago, vitamin D was thought to be good for your bones -- and little else. That's changed. Now you can find claims that vitamin D is good for just about everything. Most remain unproven. Deficiency of vitamin D has been linked to:
  • Cancer
  • Poor immune function
  • Dementia
  • Arthritis
Past studies have linked lower intake or lower blood levels of vitamin D with dementia. But the lower vitamin D levels in people with brain disease could be the result of the disease rather than a cause of it. We need studies that examine people with normal brain function who develop dementia over time. Prior studies have not reached clear conclusions.    That's where a new study comes in. It included more than 1,600 elderly men and women (average age: 74) with normal brain function. They were assessed for dementia over time and had tests of their blood vitamin D levels. Over 6 years:
  • Those with a low vitamin D level had a 53% higher risk of developing dementia than those with normal levels.
  • Among those with the lowest vitamin D levels, the risk of developing dementia was 125% higher than for those with normal levels.
  • The results were similar for Alzheimer's disease: a 70% higher risk with low vitamin D and 120% higher risk with very low levels.
These findings held up even after accounting for other factors that might contribute to dementia risk, such as smoking or drinking a lot of alcohol. But this type of study cannot determine whether the low vitamin D levels actually caused dementia. We also don't know from this study whether increasing vitamin D levels (through diet or supplements) might have prevented dementia. Still, the findings would fit with the idea that vitamin D may help the brain to function normally and that getting enough vitamin D is one way to reduce the risk of dementia. Why should vitamin D affect brain function? The answer isn't clear. But here are some findings of related research:
  • A protein that grabs onto vitamin D (called a receptor) and an enzyme that creates the active form of the vitamin are found in the brain.
  • Stroke seems to be more likely among those who are deficient in vitamin D.
  • In the lab, vitamin D encourages white blood cells to remove a protein (called amyloid) considered important in the development of Alzheimer's disease. The vitamin also protects brain cells from amyloid-related damage.
  • In rats, vitamin D can slow age-related declines in learning and memory.
Taken together, this research suggests that vitamin D is doing something vital in the brain. That makes this new study's findings even more intriguing. What Changes Can I Make Now? The role of vitamin D in conditions other than bone health remains a matter of some debate. Still, there seems to be little harm linked with keeping your vitamin D in the normal range. You may be at particular risk of vitamin D deficiency if you:
  • Are elderly
  • Are obese
  • Have chronic (long-term) disease of the digestive system (such as Crohn's disease or celiac disease) or kidneys
  • Have low vitamin D in your diet
  • Have dark skin
  • Don't get much sun exposure
You can take steps to avoid vitamin D deficiency:
    • Check food labels and choose foods that are high in vitamin D. These include:
      • Fish (especially fatty fish, such as tuna, salmon and mackerel)
      • Eggs
      • Milk, cheese and other dairy products
      • Fortified cereals
    • Consider taking a supplement. A common amount recommended for adults is 1,000 International Units (IU) per day. But guidelines vary depending on age, diet, medicines taken and other health problems. Check with your doctor first. 
    • Get some sun. The UV rays of the sun convert an inactive form of vitamin D in the skin to an active form. This means that sun exposure can help maintain vitamin D levels. About 10 to 15 minutes a day may be enough. Be careful, though. Too much sun can damage skin and increase the risk of skin cancer.
    • Have your blood tested. Doctors do not routinely check vitamin D levels. However, it's important to do so if a person has osteoporosis, unexplained bone fractures or symptoms (such as bone pain) that might be related to low levels of vitamin D.
It is unusual to get too much vitamin D from the sun or from dietary sources. However, it can happen if you get too much in supplements. Avoid a dose higher than 4,000 units per day. That's the "tolerable upper intake level," according to the Institute of Medicine. What Can I Expect Looking to the Future? We need more research that compares large groups of people at risk for dementia who do or don't take vitamin D pills. Such research would need to include blood vitamin D levels before and after the study. If vitamin D treatment and avoiding vitamin D deficiency are linked to lower rates of dementia, we would have further evidence that low vitamin D might actually cause dementia and that increasing blood levels may be protective. There is currently no known cause for most cases of dementia and no highly effective treatment. So the impact of such research findings could be enormous.]]>
Thu, 07 Aug 2014 00:00:00 -0400
Doctors Say Home Test Fine for Sleep Apnea Home testing can help to diagnose sleep apnea just as well as an overnight stay in a sleep lab,... What Is the Doctor's Reaction? Sleep apnea is extremely common. Some estimates suggest it may affect up to 15% of middle-aged and older adults. However, the great majority of people with this ailment don't know they have it. Diagnosing sleep apnea traditionally requires you to spend a night in a hospital's sleep center, hooked up to various recorders. Portable devices that can detect sleep apnea in the comfort of your own bed offer a convenient alternative. But do they work as well as sleep lab studies? This review suggests the portable home devices work just as well for diagnosing most people. People with sleep apnea briefly stop breathing dozens or even hundreds of times a night. After each pause, oxygen levels in the bloodstream plummet. This prompts the brain to send out a "breathe now!" signal. The sleeper briefly wakes and gasps for air. This pattern -- sleep, breath holding and waking to breathe again -- causes daytime sleepiness. Behind the wheel of a car, this can be deadly. Sleep apnea also has the potential to:
  • Boost blood pressure
  • Contribute to heart failure or make it worse
  • Impair memory
  • Dull thinking skills
And the loud snoring disrupts sleep for bed partners as well. The American College of Physicians guideline still recommends the overnight stay in a sleep lab as the "best" test for sleep apnea. But, with some exceptions, the guideline supports offering a home test as a good alternative. Up to 90% of people with the condition don't get diagnosed. Portable home testing could make the diagnosis easier and less costly. And that could lead to many more people getting the treatment they need. What Changes Can I Make Now? If you have excessive daytime drowsiness and think you get enough hours of sleep, you likely have sleep apnea. Other symptoms include:
  • Loud snoring four or more times per week
  • Someone telling you that you sometimes stop breathing or gasp for air during your sleep
  • Unrefreshing sleep despite being in bed for 8 or more hours
  • Morning headaches
  • A large neck (collar size); 17 inches or more in men, 16 inches or more in women
Check with your doctor about which test might be best for you. Some people probably should get tested overnight in a sleep lab. They include people with:
  • Chronic lung disease
  • A neurological disorder
  • Heart failure
Otherwise, home testing with a portable device probably would be adequate. Portable sleep apnea devices come in many makes and models. The device should be able to monitor:
  • The amount of oxygen in the bloodstream
  • Air flow through your nose
  • Chest movement to detect breathing patterns
  • Heart rate, ideally with an electrocardiogram to record your heart's electrical activity
What Can I Expect Looking to the Future? Home testing offers a cheaper and easier diagnostic test than overnight sleep studies. Because of these study results, I expect that doctors now will order home testing more often.]]>
Wed, 06 Aug 2014 14:10:00 -0400
Doctors Condemn Fla. Gun-Law Ruling Medical groups have denounced a court decision upholding a Florida law that forbids doctors from... th Circuit Court of Appeals reversed that decision July 25. The court said that "inquiring about a private matter irrelevant to medical care isn't part of the practice of good medicine." Several doctors' groups disagreed. The American Academy of Pediatrics called the decision "an egregious violation of the First Amendment rights of pediatricians." Many children's doctors ask about guns in the home. They offer advice on safe storage to help keep guns away from children. On August 1, a new coalition of 20 medical groups also decried the ruling. The coalition said the issue is "much bigger than gun safety." Doctors talk to patients about things that could affect their health and safety. "Government intrusion" in this process could put patients' health at risk, the group said. Med Page Today wrote about the reactions. What Is the Doctor's Reaction? On Friday morning, a newly formed group called the Coalition to Protect the Patient-Provider Relationship released a strongly worded statement in opposition to Florida's gun-safety counseling law. The coalition is a nonpartisan, nonprofit group of health-care professionals. It includes doctors, students, nurses and lawyers from 20 different organizations. Briefly, the Florida Legislature passed a law in 2011 that forbade doctors from asking their patients whether they owned a gun unless it was directly relevant to patient care. The law was overturned by a U.S. district court. The court said it violated the doctors' rights under the First Amendment of the U.S. Constitution -- the right to free speech. Last week, however, a U.S. appeals court said that the law could stand. The court said that the practice of good medicine does not require questions about irrelevant, private matters.    The new coalition issued a strongly worded statement that addressed two issues. The first is firearms safety. The second, and larger, issue is about government intrusion on patients' relationships with their health-care professionals.  Under the Florida law, medical caregivers are not protected by the First Amendment when they ask whether people have guns in their homes.  Doctors, particularly those who care for children and families, often ask about guns in the home. They do this in order to counsel families about gun safety.  Research shows that this kind of counseling and education can decrease the likelihood of injury and death.  Intrusive questions are part of a comprehensive health assessment! I ask a patient about gun safety to help prevent injuries and accidents. For most doctors, this doesn't feel very different than asking people about using alcohol or drugs, about smoking, about exercise and diet. I ask young people about birth control or what they might do if they or their partner had an unplanned pregnancy. I ask older people about things that might increase their risk of falling. I ask depressed people about whether they have plans to harm themselves. I ask men and women if they are safe in their relationships. Part of my job is to help people to consider their health and safety risks and to think about ways to reduce those risks.  As important as the specifics of the ruling are, the issue of government intrusion on the doctor-patient relationship is particularly worrisome to me and to members of the coalition. The relationships between health professionals and patients need to be based on privacy, trust, and respect.  In order to really take good care of you, your doctor needs to be able to ask some difficult questions. You need to be able to trust that your doctor is trying to help you, not judge you. You need to know that your doctor will keep what you say confidential. When the government gets involved in this type of private conversation, it's bad medicine -- for everyone. Your doctors might be afraid to ask an important question. You might be afraid to tell your doctor the truth. When secrets, lies and fear dominate a medical conversation, everyone gets hurt.  I strongly believe that medical caregivers should be able to ask about factors that affect patients' risk of harm -- including firearms. I also fear the slippery slope of involving a third party -- the law -- into what should be a private and personal dialogue, based on trust. What Changes Can I Make Now? If you have firearms or other weapons in your home, be sure to store them in a locked cabinet. Children should not be able to get the keys. Ideally, lock up the gun's ammunition, too -- in a different and separate place. If you have questions, talk to your health-care professional about the best way to keep your family safe. Even in Florida, the law does not prevent a patient from asking his or her doctor a question! If you share the new coalition's concerns about the Florida law, then make your voice heard. If you are a resident of Florida, write to your state legislators. Let them know if you don't think this is a good or safe law. Urge them to craft better legislation. If you live in another state and have concerns about the Florida law, reach out to your own elected officials. Let them know that you feel that doctors should not be limited in the questions they can ask patients. Let them know that you want your doctor to be able to address issues of health and safety in a private, confidential, nonpolitical setting. What Can I Expect Looking to the Future? I doubt that we've heard the last about this law. I would expect further appeals. The decisions made about this law could truly impact all of us.]]> Mon, 04 Aug 2014 14:34:00 -0400 Ebola Outbreak Grows; Americans Urged to Avoid Area As the major Ebola outbreak in West Africa grew worse, officials advised Americans July 31 to... What Is the Doctor's Reaction? Two days, ago, the Peace Corps announced that it was pulling out its 340 volunteers in Liberia, Sierra Leone and Guinea. These West African nations have been stricken with an epidemic of Ebola virus. People leaving these countries have been questioned about symptoms as they exited through the airports. Liberia closed its borders this week in an effort to contain spread of infection. Liberia also has closed its schools and asked residents to stay away from public parks. All offices in Liberia have been asked to close today to allow community workers to sanitize all public areas.  The current epidemic is the deadliest Ebola outbreak in history. There is no cure for Ebola. In this outbreak of 1,300 suspected cases (about 900 of which have been confirmed cases), there have been 729 deaths. Ebola causes an illness known as hemorrhagic fever. Symptoms include aches, fever, abdominal pain and internal bleeding. A person who has Ebola symptoms is contagious for up to 21 days. Spread of the infection occurs by direct contact with body fluids. As an American and a doctor, I am bracing myself for the possibility that Ebola may spread to other regions. We live in an interconnected world. Air travel can spread contagious infection in a day. What Changes Can I Make Now? For those of us outside of West Africa, there is no immediate action we need to take. But you may choose to follow the news. This epidemic has grown worse in the last couple of weeks. Experts from the World Health Organization and Centers for Disease Control and Prevention continue to reassure us that spread can be contained with appropriate care. This is true. But appropriate care is difficult. It requires a long stretch of quarantine for anyone who has come into contact with an Ebola patient. Appropriate work is being done to control spread. There is a "Level 3" travel advisory for countries involved in the outbreak. This means that U.S. health officials have asked people to avoid non-essential travel to the region. Surveillance procedures are being introduced at airports to screen people leaving the affected countries. Officials want to make sure that nobody travels while having symptoms that might turn out to be Ebola virus. People without symptoms are not contagious, even if they have been exposed to the virus. These strategies are very important to containment of the disease:
  • Identify new cases early. This means that health systems in the area of the epidemic need financial support so that they can do appropriate lab testing. They also need the trust of their communities. Trust requires collaboration with local traditional healers. 
  • Isolate (quarantine) patients during the 21 days they are known to be potentially contagious.
  • Identify people who have been in contact with cases of the disease. Then begin a careful watch for symptoms.
  • Use safe burial practices and protective clothing. (Medical professionals use hoods, goggles, boots and multiple layers of gowns when caring for an Ebola patient.)
  • Continue research about what might be a non-human source ("reservoir") of the virus. Currently, we don't know how epidemics of Ebola begin. Spread from a mammal, possibly a fruit bat, is suspected but not proven.
  • Conduct research to develop a vaccine or treatment.
What Can I Expect Looking to the Future? The U.S. government says it will work with other countries to try to end the Ebola epidemic. Our president’s budget proposal for fiscal year 2015 asks for $45 million to fund a "Global Health Security Agenda." Work on Ebola would fall within this request. I hope that Ebola can be contained before it spreads to other countries. Could one of those countries even be our own? Yes, I think it is realistic. But if it does spread, containing the epidemic will take a level of cooperation by the American public that we have not required in the past.]]>
Fri, 01 Aug 2014 00:00:00 -0400
Nuts May Help Lower Blood Sugar Eating more tree nuts may help with diabetes control, a new review of research suggests. The study... What Is the Doctor's Reaction? It's not often that medical science discovers new health benefits for something you already like to do. A new study that links eating nuts with positive effects on blood sugar is one example. Before you rush out to buy nuts, it's important to note the details of the research. The studies were limited to people with type 2 diabetes. The improvements were linked with eating more tree nuts, such as:
  •  Cashews
  •  Almonds
  •  Pecans
  •  Walnuts
  •  Pistachio nuts
Peanuts are not on the list. That's because they are legumes, not tree nuts. The new research is called a meta-analysis. That means it analyzed the results of previous studies. It included 450 people with type 2 diabetes. After about 8 weeks of eating more tree nuts:
  • Those who ate about 2 servings (about one-half cup) each day had lower fasting blood sugar results and lower HbA1c levels than those who ate fewer tree nuts. Fasting blood sugar and HbA1c levels are common measures of diabetes control. In general, lower is better.
  • Those who ate more tree nuts had lower insulin levels than those who ate fewer. They also had less insulin resistance. This means their bodies were better able to use insulin to move sugar out of the blood so it can be used for energy. The differences between groups were small enough that they could have been caused by chance. But these changes were positive ones because insulin levels tend to rise as insulin resistance increases in type 2 diabetes.
  • The biggest improvements were noted when people ate tree nuts instead of carbohydrates.
This study is important because it provides people with type 2 diabetes a way to improve blood sugar and the body's use of insulin without adding a medicine. Given the rising number of people with type 2 diabetes, the impact of these findings could be big. However, other questions remain. For example:
  • How much of the improved blood sugar control was due to eating tree nuts, and how much was due to eating fewer carbohydrates?
  • Which nuts provide the most benefit?
  • Does a long-term increase in tree nut consumption come with any "side effects," such as weight gain?
  • Will larger and longer-term studies confirm the findings of this new research?
What Changes Can I Make Now? Preventing diabetes is the best way to prevent the further health problems it can cause. Maintaining a healthy weight and avoiding obesity are crucial first steps. If you already have type 2 diabetes, this study suggests that eating 2 servings of tree nuts each day might help to improve your blood sugar.  However, keep in mind that nuts are high in calories. Eating too many (for example, 3 or more servings per day) without adjustments in other foods could lead to weight gain.  And weight gain can make diabetic control worse. If you have diabetes, you can take other measures to control your disease and reduce the risk of further health problems.
  • Exercise regularly.
  • Meet with a nutritionist, and stick with a heart-healthy, diabetic diet
  • Keep track of your blood sugar. Take medicines to lower it as prescribed.
  • Take an aspirin each day. This helps to prevent stroke and heart attack, especially for those who have had these problems in the past.
  • If you have high blood pressure, take a medicine to reduce it.
  • Take a statin medicine. The goal cholesterol level for people with diabetes should be lower than for people without diabetes. 
  • Don't smoke.
Play an active role in your own care. For example, if you have kidney disease, make sure every doctor you see knows about it. Some medicines are dangerous when taken by a person with kidney disease. Doses of many medicines may need adjustment. Speaking up can prevent these kinds of problems. What Can I Expect Looking to the Future? In recent years, nuts have been featured more prominently in what is considered a "healthy diet." They are part of the Mediterranean Diet and the U.S. government's Dietary Guidelines. However, these diets do not distinguish between tree nuts and other nuts. And they don't recommend more nuts if you have diabetes. That could change in the future, especially if more research:
  • Confirms the findings of this latest study.
  • Identifies how tree nuts lower blood sugar. The authors speculate that the reduction in carbohydrates, the high magnesium content of nuts or the monounsaturated fats in nuts may be what improves blood sugar levels.
  • Shows that eating tree nuts can actually prevent diabetes in those at risk.
If you like nuts as much as I do, you may want to eat more even before further studies have been completed. I know I will.]]>
Thu, 31 Jul 2014 00:00:00 -0400
Study: Early Hormone Therapy OK for Heart Short-term hormone therapy for menopause symptoms is unlikely to harm the heart, a new study... What Is the Doctor's Reaction? Until 12 years ago, doctors often prescribed hormone therapy for women after menopause. This treatment included estrogen. It was sometimes combined with progesterone. Hormone therapy was, and still is, the most effective treatment for symptoms of menopause, such as hot flashes and vaginal dryness. We also believed that it decreased the risk of heart disease, stroke, dementia and osteoporosis. That was before results of the landmark Women's Health Initiative study were released in 2002. They showed that taking estrogen and progesterone after menopause may increase women's risk of stroke, heart disease, blood clots and breast cancer. Hormone therapy does slow bone thinning. It decreases the risk of osteoporosis. The average age of the women in this major study was 63. This is many years past the age women go through menopause. So experts began to question whether hormone therapy had the same risks for younger women. More recent studies have looked at hormone therapy started at or shortly after menopause. Study results suggested that it did not increase the risk of heart disease and stroke. In fact, some studies showed that hormone therapy started right after menopause might actually decrease risk. However, they were observational studies. They compared health results in women who did or did not choose to take hormone therapy prescribed by their doctors. These types of studies can only suggest a link between early hormone therapy and lower risk of heart disease and stroke. They don't prove cause and effect. The new study is a randomized controlled trial. This is considered the "gold standard" type of study. The study group consisted of women aged 42 to 58. All of them had their last period no more than 3 years before the study began. They were randomly assigned to 1 of 3 groups:
  • Estrogen with oral progesterone 12 days per month
  • Estrogen skin patch plus progesterone pills 12 days per month
  • Placebo -- patch and pills with no active ingredients
The researchers gave all the women tests that looked at thickness of the carotid arteries in the neck and calcium deposits in the heart arteries. These tests are excellent ways to assess the amount of fatty deposits in arteries. These deposits are the cause of most heart attacks and strokes. The researchers looked at how much change occurred in the arteries over four years. Women in all three groups showed similar small increases in fatty deposits. Based on this study, hormone therapy started shortly after menopause did not increase or decrease the risk of stroke or heart attack compared with no hormone therapy. What Changes Can I Make Now? These results add more reassurance for women considering hormone therapy to treat symptoms of menopause. Short-term therapy does not increase your risk of heart attack or stroke. Short-term hormone therapy also does not increase breast cancer risk in most women. But even limited hormone therapy can increase your chance of developing a blood clot in the leg. Estrogen is the hormone that relieves symptoms such as hot flashes and vaginal dryness. If you still have a uterus, most doctors recommend taking progesterone or another type of progestin with the estrogen. This reduces the risk of uterine cancer. Which estrogen to take? Estradiol pills or patches appear to have a lower risk of blood clots than conjugated estrogen. Symptom relief is similar. You may still be reluctant to use hormone therapy. Or you may have a medical reason that you shouldn't use estrogen pills or patches. Here are a few other options for treating menopause symptoms.
  • Vaginal estrogen -- A tablet, ring or cream delivers a low dose of estrogen into the vagina. This treatment can help relieve dryness, discomfort during sex and some urinary symptoms.
  • Relaxation therapy -- There is some evidence that techniques that help you attain a state of calmness and relieve stress may help with hot flashes. Examples include deep breathing, yoga and meditation.
  • Low-dose antidepressants -- Some antidepressant drugs may reduce hot flashes. They include venlafaxine (Effexor), fluoxetine (Prozac), citalopram (Celexa) and escitalopram (Lexapro).
  • Gabapentin -- This anti-seizure drug can also help with hot flashes.
What Can I Expect Looking to the Future? Experts will not change their current advice to women. Hormone therapy should not be taken as a way to prevent chronic medical conditions, such as heart disease. Avoid long-term use of hormone therapy unless symptoms of menopause are severe and other treatments don't help.]]>
Wed, 30 Jul 2014 16:20:00 -0400
Study: Bump Beats Shake for Germ Control To reduce the spread of germs, at least in hospitals, a new article argues for bumping fists... What Is the Doctor's Reaction? The handshake may be the most important nonverbal way that we communicate. It is a standard gesture when we say hello, goodbye and make an agreement. We don't know exactly when it began. Apparently, it became accepted practice before written history. But is it time to consider changing this centuries-old tradition? Hands carry germs that can spread infections to others. Some of these infections can be very serious, including those that can't be killed by standard antibiotics. Authors of a recent article suggest that handshaking be banned in hospitals. That's because, despite the daily efforts of infection-control teams, hospital workers only get hand cleansing right 40% of the time. The Journal of the American Medical Association published the article. It's a bold opinion piece. The handshake is a traditional way doctors and all health-care professionals convey warmth and empathy to patients, family members and colleagues. This article takes a scientific look at one potential alternative to the handshake -- the "fist bump." Two people touch only the outsides of each other's closed hands. This can be embellished with some flair as you quickly pull away your fist, then open your hand toward the other person. The authors' experiment was simple. Two people at a time were paired up. Each person put a sterile glove on the right hand. One person dipped the gloved hand into a solution filled with E. coli bacteria. The other kept the glove sterile. They shook hands. Then they took off the gloves, washed their hands and put on new sterile gloves. Again, one of them dipped into the bacterial solution. The other kept the glove sterile. This time they did a fist bump. The process was repeated many times. The gloves that were sterile before the handshakes and fist bumps were tested for the amount of bacteria on them. The handshake transmitted 10 times as many  bacteria to the sterile hand as the fist bump. What Changes Can I Make Now? The fist bump will take a lot of getting used to. For many, it just won't be a good substitute for the handshake. So frequent hand cleaning remains an important way to prevent infection and avoid spreading germs to others. It's especially important if you are a hospital patient or visiting a patient. Alcohol-based hand cleansers usually work just as well as washing with soap and water. The important exception is Clostridium difficile ("C. diff"). This bacterial infection causes diarrhea. Alcohol does not kill it. Hand washing with soap and water is a must when visiting a patient with this infection. What Can I Expect Looking to the Future? The authors of this opinion piece suggest that hospitals begin the movement to seek alternatives to handshaking. Perhaps we could place signs everywhere, saying: "Handshake-free zone. To protect your health and the health of those around you, please refrain from shaking hands while on these premises."]]> Tue, 29 Jul 2014 14:25:00 -0400