Aetna Latest Healthy Living News http://www.planforyourhealth.com/ Latest Healthy Living News from Aetna en Aetna Latest Healthy Living News http://www.planforyourhealth.com/ http://www.planforyourhealth.com/ Latest Healthy Living News from Aetna TYPO3 - get.content.right http://blogs.law.harvard.edu/tech/rss Fri, 22 Aug 2014 05:31:00 -0400 Exercise May Deter Heart Rhythm Problem http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/news-review-from-harvard-medical-school-shots-fight-cancer-linked-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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/studies-look-at-sodiums-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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/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 Tylenol May Not Relieve New Back Pain http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/tylenol-may-not-relieve-new-back-pain/ Though it's used widely for many kinds of pain, acetaminophen (Tylenol and generics) may not help... What Is the Doctor's Reaction? When it comes to drug benefit, there is nothing quite like a randomized, placebo-controlled study for showing the facts. This week, a high-quality study has surprised doctors and patients alike. It found that acetaminophen (Tylenol and generics) is no more helpful than placebo pills for low back pain. The study had 1,643 patients and was based in Australia. The drug tested was paracetamol. That's the name in most countries for the medicine we call acetaminophen. People in the study had new back pain, not long-term (chronic) back pain. They were randomly divided into groups. Some patients got usual doses of acetaminophen and some got placebo pills. A third group had some of each. All of the groups had the same rate of recovery. Acetaminophen and placebo had the same amount of effect on:
  • Pain
  • Disability
  • Functioning
  • Sleep
  • Quality of life
Hold it. I have trusted in acetaminophen. I recommend it to my patients multiple times per day, for many different pain problems. Is this study telling us that it does not help pain? This study has convincing results. But its message is limited to back pain. For example, acetaminophen has seemed helpful in studies for dental pain, cancer pain and pain after surgery. So was this study flawed? Were the other studies flawed? Is this a huge "placebo effect," feeling better because you believe you are taking a real medicine? Or is back pain special? Maybe, in some ways, back pain is special. New back pain often involves two pain problems that we know acetaminophen can't help very well. The first is inflammation. The second is nerve pain. Inflammation happens when there is a ruptured disc in the back. It can last a couple of weeks. This is what happened in the study. For all groups, back pain went away within about 17 days. About 20% of patients had obvious nerve pain. They had burning or pain that extended down the leg, lower than the knee. I respect this study's findings. And I have to say, I feel let down by my trusted Tylenol. I would have expected to see at least a small benefit. This study reminds me that we truly don't understand the way acetaminophen works. It has very weak similarities to ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs). But experts can only guess at the way Tylenol works. Because of this study, acetaminophen is now much lower on my list of recommended treatments for back pain. It is well worth a try, though, if you are not getting relief from NSAIDs. Remember that this study was only for people with new back pain. Long-term back pain often involves deconditioned muscles. In this case, there is no inflammation or nerve pain. Perhaps acetaminophen still can offer a benefit in these cases. What Changes Can I Make Now? This study reminds us of an important fact about new back pain. It almost always goes away within a few weeks. Even though acetaminophen didn't help pain any more than placebo, three out of four patients in each study group were satisfied with their treatment. So with or without treatment, you can expect most cases of new low back pain to go away. To help low back pain, I recommend simple measures:
  • Stay active. Movement is medicine. Keeping your back in use will prevent loss of muscle tone, which can cause its own back pain problem.
  • Use NSAID medicines, such as ibuprofen (Motrin, Advil and generics) or naproxen (Naprosyn, Aleve and generics). If you can't take an NSAID or if it doesn't help, I don't see any harm in trying usual doses of acetaminophen. If it does not seem to help, just stop taking it.
  • Check your workstation. Good posture at work can be a major help for back pain.
  • Check your shoes. They should have good cushioning. Avoid high heels, which can strain  the curvature of your back.
  • Consider your mattress. It may be time to get a mattress with better back support.
  • Try applying heat. You can buy warming adhesive patches (such as the brand "ThermaCare") at pharmacies. These patches release heat for 8 hours or more. They can be very helpful.
  • Build a team of caregivers. Involve your doctor in your pain management, as well as a physical therapist and potentially other specialists.
What Can I Expect Looking to the Future? If we believe the findings in the study, acetaminophen should be used less often as a first treatment for low back pain. The study authors are cautious. They say we should repeat a similar study, to see if we get similar results. Meanwhile, they advise us not to discard acetaminophen as a treatment for back pain. That seems like a prudent idea. In prior studies, acetaminophen and NSAIDs have seemed to offer similar benefit. I guess this means that neither type of drug can really knock the socks off back pain. NSAIDs deserve a similar placebo-controlled trial. That will help us update our expectations about how well those medicines work for back pain, too.]]>
Fri, 25 Jul 2014 18:01:00 -0400
Taking Pulse May Help Track Stroke Risk http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/taking-pulse-may-help-track-stroke-risk/ People who have had strokes and their family members can help detect an increased risk of a second... What Is the Doctor's Reaction? Imagine a free, painless test you can do yourself in 30 seconds, a test that can tell you whether you're at risk for stroke. There is such a test. It's called checking your pulse. And it's the subject of a study just published in the medical journal Neurology. In this study, 256 people who had suffered a stroke were taught how to monitor their own pulse for an irregular (abnormal) rhythm. Some family members were also trained. Why is it important to detect an irregular rhythm? The rhythm of your pulse reflects the rhythm of your heart. And a common abnormal heart rhythm, called atrial fibrillation, is a major, treatable factor that increases the risk of stroke.  This new study compared patients or their relatives with health-care professionals. The goal was to see how well each group could detect an irregular pulse. EKG recordings confirmed whether an abnormal heart rhythm was occurring. After receiving training:
  • Patients were able to detect an abnormal pulse in 54% of cases when an abnormal rhythm was present. Relatives detected 77% of cases. This compares with 97% of health-care professionals.
  • Patients accurately identified a normal pulse in 96% of cases. The rate was 93% for family members and 94% for health-care professionals.
Checking for an irregular heart rhythm after stroke is nothing new. It's a routine part of the evaluation of any stroke patient. This usually includes recordings of the heart's electrical activity by EKG or by monitoring over many hours or days. One recent study found that an implantable recording device was better than standard methods for detecting atrial fibrillation in people with recent stroke.  But training people who have had strokes or their family members to monitor the pulse is a novel, low-tech approach. Based on this study, it also seems reasonably accurate. What Changes Can I Make Now? If you have had a stroke in the past, talk to your doctor about the results of this research. Together, you can decide whether you should learn to monitor your pulse. Know the factors that increase the risk of stroke. You can take action to reduce some of these risks. Here's what you can do:
  • Smoking -- Make quitting a priority.
  • A "high risk" cholesterol profile, such as high total and LDL cholesterol -- Reduce high numbers through diet, exercise and, when necessary, medicines. These steps can reduce your risk of heart and blood vessel disease, including stroke.
  • High blood pressure (hypertension) -- Medicines to lower blood pressure can reduce stroke risk.
  • Diabetes -- Treatments to control blood sugar and combat blood vessel  complications may lessen stroke risk.
  • Atrial fibrillation -- When the heart is beating irregularly, blood clots can form. Clots can travel from the heart to the brain, causing a stroke. A blood thinner, such as warfarin (Coumadin), can reduce stroke risk by preventing clots from forming.
  • A diseased carotid artery -- Plaque deposits (atherosclerosis) involving this major artery in the neck can lead to stroke. Surgery to open it up can lessen stroke risk.
Changes in what you eat also may reduce stroke risk. Aim for a diet that is high in fruits and vegetables and low in saturated and trans fats. Try to include several servings of fish per week. Low-dose aspirin also may be recommended for those with prior stroke or multiple risk factors for stroke, such as those above. A strong family history of heart and blood vessel disease also increases the risk of stroke. Of course, it can't be changed, but a family history of stroke makes it even more important to take steps to modify the other risk factors. What Can I Expect Looking to the Future? If other researchers confirm the findings of this study, taking your pulse on a regular basis after stroke could become routine. It could even become commonplace for people who haven't yet had a stroke, especially for those with multiple risk factors for stroke. At a time when expensive and invasive medical testing is increasingly common, it's important not to overlook simpler options that may be effective. Involving patients in their own monitoring is one such approach. And when patients are unable to monitor themselves, family members may be recruited to do so.  Self-monitoring may take advantage of technology, such as the use of an activity-tracking bracelet. Or patients may simply be taught to check the rhythm of their own pulses. You can expect both approaches to become more common in the future.]]>
Thu, 24 Jul 2014 13:55:00 -0400
Study Tallies Cancer-Spread Risk of Procedure http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/study-tallies-cancer-spread-risk-of-procedure/ A study has provided new estimates of the risk that one surgical technique to remove the uterus... What Is the Doctor's Reaction? Minimally invasive surgery has improved outcomes for many surgical procedures. But a new report suggests that one minimally invasive technique may spread previously undetected cancer. This technique is used to perform a hysterectomy (removal of the uterus). With minimally invasive surgery, the surgeon can make much smaller incisions (cuts). He or she inserts an instrument called a laparoscope into one small incision. Tools are inserted into the others. The doctor looks through the laparoscope to perform the procedure. This type of surgery has dramatically reduced length of stay in the hospital compared with traditional surgery. If minimally invasive surgery occurs in the morning, the patient can often go home the same day. People can get out of bed sooner and often have less pain than with traditional surgery.  And that decreases the risk of problems such as blood clots in the legs and pneumonia. Hysterectomy (removal of the uterus) is one of the procedures that can be done using a laparoscope. The uterus is a muscular organ, normally the size of a small lemon. Many women have a hysterectomy because of benign (non-cancerous) growths called fibroids. These growths can make the uterus much larger. Removing the uterus through a small incision usually requires cutting it into small pieces. A popular method used is called power morcellation. The morcellator is an electric power tool. It can easily cut up the uterus into small pieces. The pieces are removed through the small incisions. The U.S. Food and Drug Administration (FDA) issued a safety alert about morcellation on its website on April 17. If the uterus being removed has cancer cells, morcellation can cause these cells to spread into the abdomen and pelvis. A surgeon who suspected that the uterus or nearby organs contained cancer cells would never use morcellation. But it's not always possible to know for sure. This research paper gives us some idea of the risk that morcellation of the uterus will spread cancer. In this study, for every 10,000 women who had the procedure, 27 were found to have cancer. At first, this may sound scary. But, in fact, a woman who has morcellation of the uterus has a greater than 99.7% risk of not having cancer.  Unsuspected cancers in younger women were extremely rare. The risk increased with age. What Changes Can I Make Now? There are several reasons why a woman may need to consider a hysterectomy.  Fibroids are a very common condition. These benign tumors can become very large or there may be many of them. The result may be discomfort and irregular vaginal bleeding. Some women have very heavy periods that cause iron-deficiency anemia. Multiple or very large fibroids may require a hysterectomy. But methods that don't involve surgery can be used to shrink fibroids. If surgery is needed, there are other options besides morcellation. If you do need a surgical procedure for a problem with your uterus, be sure you understand why it needs to be done. Review the pros and cons of the different approaches with your doctor. This is the best way to arrive at the best treatment for you. What Can I Expect Looking to the Future? For the near future, I suspect that surgeons will rarely use power morcellation for hysterectomies. That's because there will almost always be another option.  But we should keep in mind that the risk of spreading cancer by power morcellation truly is extremely small.]]> Wed, 23 Jul 2014 18:57:00 -0400 No Heart-Attack Drop for Younger Adults http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/no-heart-attack-drop-for-younger-adults/ Though heart attacks have declined among older adults, a new study finds that rates have stayed... What Is the Doctor's Reaction? Hospital stays and deaths resulting from heart attacks have declined dramatically for older people. But for adults under the age of 55, the decrease is much less impressive. During the last 10 years, doctors have become more aware of the differences in coronary artery disease between men and women. This is important because most of the studies done to help determine the best way to diagnose heart attacks and other heart problems were done on men. The lessons learned were applied to women. At the time, doctors thought that the symptoms and outcomes would be very similar. They clearly are not. In fact, the differences are quite striking. Many women do not have the classic squeezing chest pain of heart attack. Instead, they might have extreme fatigue, profuse sweating, shortness of breath or all of these. And women of all ages have a greater risk of dying from a heart attack than men. This particular study was designed to look at trends in hospital stays and deaths from heart attacks in men and women younger than 55. For men, there was little change during the 10 years covered by the study. Younger women were just as likely to have a hospital stay after a heart attack in 2010 as in 2001. But there were fewer deaths. Even with the decrease, women's risk of dying in the hospital from a heart attack was consistently higher than the risk for men. The authors did not look at why heart attacks rates and deaths were not falling as much for younger adults as for older ones. Perhaps it is related to less active lifestyles and rising rates of obesity and diabetes. What Changes Can I Make Now? Heart and blood vessel diseases still cause the most deaths in the United States and most developed countries. Prevention must start early in life. The symptoms and outcomes for women with heart disease may be different than those for men. But the way to prevent a heart attack is similar for both sexes.
  • Don't smoke. Quitting reduces your heart attack risk within weeks.
  • Stick to a heart-healthy diet, such as a Mediterranean-style diet.
  • Stay physically active and exercise regularly.
  • Maintain a healthy weight.
  • Keep your blood pressure under control.
  • Work to keep your LDL cholesterol and triglyceride levels down and HDL cholesterol up. Start with diet changes and increased exercise. Add medicines prescribed by your doctor if needed.
What Can I Expect Looking to the Future? Most people know what to do to help prevent heart disease. But far too few are actually doing it. What we need most are new ways to motivate people to reduce heart disease risk and the research to prove that those ways are effective.]]>
Tue, 22 Jul 2014 14:28:00 -0400
Deaths Drop Sharply in HIV Population http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/deaths-drop-sharply-in-hiv-population/ People infected with HIV in wealthier countries are 28% less likely to die early than they... What Is the Doctor's Reaction? Advances in treatments have made HIV into a different disease than it was in the early years. In the 1990s, the life expectancy for a person with HIV was about 10 years. Now HIV infection doesn't reduce your life expectancy, if you get recommended treatment and you take your medicine reliably. I vividly remember a conversation with a patient from almost 20 years ago. I was having an office visit with a man who had HIV. When he was diagnosed, there was no treatment for HIV or its more advanced stage, AIDS. He watched his close friends die with AIDS. Then he resolved to live well in what he expected to be his final days. What I remember from our conversation was his desperate life planning. "HIV was my death sentence," he said. "Death was a certainty for me. I quit my good job, and I spent my careful savings. I don't have children to leave my money to. Because I knew I would die from HIV, I traveled and splurged, and have done things that I have always wanted to do. I have given away my prized possessions. I timed my spending so that my life savings would run out right now -- but doctor, I am supposed to be dying!" We looked at each other knowingly. A few months before, I had put him on treatment with a drug that was new for HIV back then, AZT. It was a game changer. People were no longer dying quite so "reliably" from HIV. On AZT, my patient's infection was improving beautifully. The idea that he might live for years -- even decades, or perhaps a normal life span -- was startling for both of us. "So what do I do now, doctor?" he asked me. "I have to start over. How can I do that when I spent everything and I don't have a job?" Some years later I lost track of this patient. As treatments improved, my patient and many others became people living with HIV, instead of people dying with HIV. Doctors now think of HIV as a chronic illness, not a "death sentence," as my patient called it. To punctuate the changes in HIV, this week we have updated information about the causes of death for HIV-positive adults. It applies to high-income countries, where treatment is broadly available. The study included almost 50,000 patients with HIV. It found that cancers unrelated to HIV, liver disease and heart disease are now the leading causes of death in HIV patients. Only 29% of HIV-positive adults appear to be dying of AIDS-related causes. For those of us who have cared for HIV patients across several different decades, this is an astonishing statistic. Another article, published in December in the journal PLoS One, estimated these life expectancies for HIV in the United States and Canada:
  • A young adult appropriately taking combination antiviral treatment for HIV would be expected to live into the early 70s (essentially, a normal life span)
  • Some people with HIV don't take their medicines. So average life expectancy for people with HIV overall is lower, in the early 60s.
  • For a young adult injection drug user with HIV, average life expectancy is slightly less than 50 years old.
What Changes Can I Make Now?
If you have HIV, taking medicine to suppress the virus is highly effective, long-term treatment. Most people who die from HIV-linked infections now are people who do not take medicines to treat it. If you have HIV, make a plan with your doctor about appropriate treatment. For most people with HIV, it is helpful to be seen by a specialist in HIV care. This type of doctor is familiar with HIV medicines and will be able to monitor your virus for signs of resistance to drugs. Since treatment is so effective, knowing who has HIV infection is really important. Many people infected with HIV don't know it. Some experts estimate that about 17% of those with HIV do not know that they have the infection. But at least one study (in Boston) estimated that the number was closer to 25%. It is recommended that everyone get tested for HIV once. This way we can find some of these hidden HIV infections. What Can I Expect Looking to the Future? We are still not able to cure HIV. Research is focused on work to produce a vaccine, and methods that might someday completely cure the virus. Even stem cell transplants are being explored. For now, it is wonderful to be able to offer patients treatment for HIV that makes it a less threatening disease.]]>
Fri, 18 Jul 2014 13:17:00 -0400