Aetna Latest Healthy Living News Latest Healthy Living News from Aetna en Aetna Latest Healthy Living News Latest Healthy Living News from Aetna TYPO3 - get.content.right Tue, 05 May 2015 14:19:00 -0400 2-Minute Walks May Offset Effects of Sitting Recent research suggests that sitting for long periods is harmful even for those who get regular... Recent research suggests that sitting for long periods is harmful even for those who get regular exercise. But a new study finds that getting up and moving for just 2 minutes each hour can help reverse those effects. The study used data from a national health survey. People wore devices that measured their movement throughout the day. Researchers kept track of people for 3 years. In that time, 137 died. Researchers found that those who had short spurts of light activity were less likely to die during the study than those who just sat for a long time. For example, people may have spent the time in walking, cleaning or gardening. Doing these things for as little as 2 minutes an hour, instead of 2 minutes of sitting, reduced the risk of early death by 33%, the study found. Experts already recommend that people get at least 2½ hours of moderate activity, such as brisk walking, each week. The study authors recommended that people add the brief bursts of activity, too. The Clinical Journal of the American Society of Nephrology published the study online. HealthDay News wrote about it April 30.  What Is the Doctor's Reaction?  Two minutes.  This study suggests that walking just 2 minutes every hour can help reverse the negative health effects of an inactive lifestyle. This is in contrast to what most doctors suggest -- moderate exercise for at least 2½ hours a week! The Clinical Journal of the American Society of Nephrology published the study online.  No one is saying that a higher level of exercise is bad. But this study found that people who did light-intensity activity -- walking, cleaning or gardening -- lived longer than people who didn't move much at all. Researchers used data from more than 3,000 people who wore devices to measure their activity.  The health risks of sitting have been well defined.  Spending a lot of time sitting can increase the risk of diabetes, heart disease and even death.  People who got up and moved for at least 2 minutes every hour had a 33% lower risk of early death than people who moved less.  Among people with chronic kidney disease, who may move less than most people, the decreased risk of death was 41%.  The authors are clear that they do not discourage people from doing the 2½  hours of moderate exercise that most doctors recommend. But they say that adding light-intensity exercise -- during the workday, for example -- can also make an important difference.  Most of us find it hard to get 2½ hours of moderate activity each week. In fact, 80% of Americans don't. This article adds an important fact -- that light exercise, done in small amounts, has distinct health benefits. Most people -- whatever their job, living situation, and lifestyle -- can achieve this amount of exercise. It is quite hopeful.  What Changes Can I Make Now?  Get up and move! If you don't exercise or if you work at a desk job, make an effort to leave your seat and walk around for two minutes every hour. It can be as simple as a trip to the bathroom, a walk to get a cup of coffee or glass of water, or a quick spin around your office. If you're at home, walk around during the commercials of your favorite TV show.  Walking has many health benefits. The American Heart Association says that walking can help you: 
  • Reduce your risk of heart disease
  • Maintain a healthy weight
  • Reduce the risk of certain cancers 
Most of these benefits are linked with more than two minutes an hour of exercise. But still, walking is easy for most of us. It's also enjoyable and doesn't cost any more than a pair of comfortable shoes. Give it a try!  What Can I Expect Looking to the Future?  This was an observational study. Researchers compared the health outcomes for people who chose on their own whether to do light-intensity activity. It would be nice to see the results confirmed by a randomized, controlled trial. A study like this would randomly assign people who were similar in other ways to do light activity or not. I would also love to see whether light activity does more to improve health.  Finally, if these benefits are proven, then I hope we will see workplaces, schools, senior centers and other places develop programs to encourage people to walk more -- even for just two minutes. ]]>
Mon, 04 May 2015 00:00:00 -0400
Low Health Literacy May Speed Heart Death Heart-failure patients who have problems understanding medical instructions may die sooner than...                      What Is the Doctor's Reaction? Heart failure is a common and serious condition. It develops when the heart is unable to pump as forcefully as it should. Fluid backs up into the lungs and legs. This makes it hard to breathe and causes leg swelling and weight gain. Coronary artery disease, high blood pressure and heart valve problems are among the most common causes. In the United States alone, heart failure affects more than 5 million people. It plays a role in nearly 300,000 deaths each year. And it's costly. By 2030, we will spend an estimated $50 billion to $70 billion each year treating heart failure. We do have new medicines and better operations (including heart transplants) to treat heart failure. But we still need better ways to prevent and treat this condition.  Low health literacy -- a poor understanding of medical information -- is also common. Past research has linked it to several health problems. For example, people with limited health literacy tend to have more trouble managing asthma or diabetes. Hospital admissions that could be prevented are more common among those with poor health literacy.  A new study is among the first to look at the impact of low health literacy on people with heart failure. Researchers published their results in the Journal of the American Heart Association. The study included nearly 1,400 people who had been admitted to the hospital for heart failure. They were interviewed about their confidence in understanding medical information. Researchers kept track of return hospital visits and deaths for an average of 21 months.  About one-quarter of the study group scored low on measures of health literacy.  Compared with those who scored the highest, those with the lowest health literacy were: 
  • Older
  • More likely to be male
  • Less likely to have completed high school
  • 34% more likely to die in the next year or two 
Emergency room visits and return trips to the hospital within 90 days did not vary by health literacy. This may be because follow-up care is more intense just after discharge than months or years later.  These results suggest that a poor understanding of health information can have dire consequences. This study did not determine whether improving health literacy will save lives. But the results suggest patients might do better if doctors: 
  • Found out which patients have low health literacy
  • Took the time to provide clearer information to them
What Changes Can I Make Now?  Heart failure can't always be prevented. But you can make changes now to reduce your chances of developing heart failure. Here's what you can do: 
  • Have your blood pressure and cholesterol checked on a regular basis.  If either is not in an ideal range, work with your doctor to improve it with diet and exercise. Your doctor can prescribe medicines if needed.
  • Don't smoke.
  • Maintain a normal body weight.
  • Exercise regularly.
  • Drink only moderate amounts of alcohol. 
If you already have heart failure, listen carefully to your doctor's instructions.  Repeat them back to your doctor to make sure you've got it right.  Ask questions about anything that is unclear. Questions you might ask include: 
  • What is the purpose of each of my medicines?
  • What should I do if I forget to take a dose of my medicines?
  • What side effects are most common with my medicines?
  • What should I keep track of, and what changes should I report right away?  For example, a rising body weight can be a sign that heart failure is getting worse. 
  • Who should I call if I notice my weight is going up or if it's harder for me to breathe? 
Your doctor also may make changes based on the findings of this new research. Your doctor may ask questions to find out how much you understand about medical information and instructions. Past research has found that doctors often think their patients understand more than they actually do. This means that doctors need to find out about their patients' health literacy. This lets them know who is at increased risk of problems in the future.  Doctors may be able to improve heart-failure care among those with low health literacy. Here are some things we can do: 
  • Contact patients regularly to check for symptoms or signs of heart failure.
  • Provide clearer instructions.
  • Prescribe fewer medicines or switch to ones that are taken only once or twice each day.
  • Schedule more frequent appointments.
  • Arrange home visits by nurses or doctors. 
However, we don't really know how useful these approaches may be. This study did not look at the best ways to address low health literacy among people with heart failure.  What Can I Expect Looking to the Future? In the future, I believe attention to health literacy will increase. Identifying those with low health literacy is an important first step. Figuring out what do may prove difficult. But finding a way to bridge gaps in patients' understanding of medical information may improve their health. It could even be life-saving.]]>
Thu, 30 Apr 2015 00:00:00 -0400
CDC: More Americans Dying from Falls Americans ages 65 and older are much more likely to die from falls than older adults were in 2000,... Americans ages 65 and older are much more likely to die from falls than older adults were in 2000, a new report shows. The report comes from the U.S. Centers for Disease Control and Prevention (CDC). It was based on death records. They showed 10,273 deaths from falls in 2000 for adults at least 65 years old. That increased to 25,464 in 2013. The average age in this group has been rising. So the CDC adjusted the numbers to account for age. The increase in age-adjusted death rates was steady throughout the 13-year span. Deaths from falls rose from 38.2 to 67.9 per 100,000 men. Among women, they rose from 24.6 to 49.1 per 100,000. The journal Morbidity and Mortality Weekly Report published the report May 1.                      What Is the Doctor's Reaction?  A report from the U.S. government says older Americans are dying from accidental falls at roughly double the rate we saw 13 years ago.  In fact, older adults are falling more in general. This January the journal JAMA Internal Medicine wrote that 36% of adults age 65 and up who were surveyed said they had fallen  within the last 2 years. This was almost a 30% increase from results of a similar survey done in 1998. If you have already fallen once, your risk of falling a second time in the next year is about 60%.  For those of us who practice medicine, this increase in falls and their consequences is devastating to see. In 2012, emergency rooms treated 2.4 million people over 65 who had fallen. In 2011, falls killed 22,900 Americans over age 65. This was almost 4 times the rate of deaths from car accidents in the same age group.  Some estimates put falls as the third most costly cause of hospital stays, right after cancer and heart disease. When my own patients need hospital care after a fall, I worry about them. Why? Because I know that roughly 60% of older adults who admitted to hospitals after a fall will be discharged to a nursing facility, not to home. Falls can be the beginning of adult frailty.  So why are we falling more often? We do have more older adults in the United States these days. We also have more people in their 80s and 90s. But the increased rate of falls is true for older adults in every age bracket.  One thing that definitely adds to our risk for falls is the fact that we take more medicines. Medicine side effects contribute to falls. Some medicines that can promote falls are used more than ever now in older adults. These medicines include: 
  • Antidepressants
  • Sleeping pills
  • Narcotic pain medicines
  • Medicines for overactive bladder
  • Gabapentin (Neurontin) used for pain
What Changes Can I Make Now?  If you sometimes feel unsteady or lightheaded, or worry about falling, talk with your doctor. The U.S. Preventive Services Task Force advises doctors to check in with patients over age 65 once a year to consider ways to improve their risk of falls.  Here are some things you can talk over with your doctor: 
  • Do you need all of your medicines? If your list is long, your doctor may be able to pick out one or more medicines that are not needed. Many medicines add to fall risk. In particular, getting off of a medicine for depression or anxiety can cut your fall risk by about 66%.
  • Is your blood pressure at a healthy level? Your doctor should check blood pressure lying and standing. If you are over 60 and don't have heart disease, kidney disease or diabetes, your blood pressure should be lower than 150/90. If your blood pressure is much lower than that and you are on blood pressure treatment, it may be best to stop one of your medicines.
  • Do you have enough vitamin D? Vitamin D helps to keep your muscles in good health. A blood test can show if you need a supplement.
  • Where can you sign up for a balance class? Exercise classes that emphasize balance and improve your thigh and buttock muscle strength have been proven to reduce fall risk. Examples of these classes are Tai Chi Moving for Better Balance, Matter of Balance, Stepping On and Otago. These classes and programs are available in many cities and neighborhoods.
  • Have you had your vision checked? Treat cataracts and other eye problems. If you wear glasses, avoid bifocals. Use one pair for near vision and another pair for far vision, especially when you are outdoors. This allows you to see obstacles on the ground in front of you, which can be blurry with bifocals.
  • Do you need a cane?  Use one if it will help keep you steady. A physical therapist may help you to plan out a safe way to support your walking.  
  • Can you make your home safer? Here's what you can do:
    • Remove clutter you might trip over.
    • Get rid of small, loose rugs.
    • Install grab bars in the bathroom.
    • Make sure stairs have a rail and a good light, and use nightlights.
    • Wear shoes both inside and out of the house. Bare feet and slippers are both more likely to slip.
    • Keep frequently used items in low cupboards, so you rarely use a step stool.
What Can I Expect Looking to the Future? If you talk with your doctor, you will almost certainly find a few ways you can lessen your risk of falls right away. When I have these discussions with my patients, the best thing that happens is that they have less fear of falling than they did before. This makes a big difference. With less fear of falling, you can have more confidence, increase your activity and get out of the house more often.]]>
Thu, 30 Apr 2015 00:00:00 -0400
Study: Brief Diet Switch Cuts Colon Cancer Risk Switching diets may make a big difference in African Americans' risk of colon cancer, a small... Switching diets may make a big difference in African Americans' risk of colon cancer, a small study suggests. African Americans have a higher risk of colorectal cancer than whites. But rural African blacks have an extremely low risk. The new study included 20 African Americans and 20 blacks from rural South Africa. Researchers gave everyone colonoscopies. They removed polyps that could develop into cancers from 9 Americans. None of the Africans had polyps. Researchers also looked at inflammation, chemical activity and bacteria in the colon. What they found was different between the 2 groups. The Americans' results have been linked in other research with a higher risk of colon cancer. The Africans showed lower risk. Researchers had the groups switch diets for 2 weeks. The African Americans ate the Africans' normal high-fiber, low-fat diet. The black Africans switched to an American-style diet. It had 2 to 3 times the levels of protein and fat they usually ate. The researchers then repeated the colonoscopies to look for changes. The African Americans had big reductions in inflammation and other factors linked with colon cancer risk. The Africans had big increases. Nature Communications published the study. HealthDay News wrote about it April 28.                     What Is the Doctor's Reaction?  Colorectal cancer is the third most common cancer in the United States. It's also the third most common cause of cancer death. Rates differ based on race and ethnic group. Compared with other races, African Americans have the greatest risk of developing and dying from colon cancer.  However, the picture is completely different in native Africans. Fewer than 5 of every 100,000 blacks who live in rural Africa develop colorectal cancer. In the United States, 65 out of every 100,000 blacks are diagnosed with the disease. That's 13 times the risk of rural Africans. A gap that large is unlikely to be explained by genetic differences.  This elegant study is small. Only 40 people were enrolled -- 20 African Americans and 20 blacks from rural South Africa. At the start of the study, they all had colonoscopies.  Nine of the 20 Americans had polyps. Some polyps may develop into cancer. No polyps were found in any of the 20 South Africans. Stool samples were also taken. These allowed researchers to look at chemical and bacterial patterns known to be linked with an increased risk of colorectal cancer.  As expected, the usual diets of the two groups were extremely different. The Americans ate two to three times as much animal fat and protein as the Africans. The Africans ate much more fiber.  The two groups switched diets for two weeks. Researchers repeated the colonoscopies and once again examined stool samples. In just that very short period of time, changes occurred in the lining of the colon and the chemicals and bacteria in the gut. The Americans now had a "healthier" colon profile. The opposite was true for the Africans. What Changes Can I Make Now?  Many studies suggest that people who eat more fruits and vegetables and fewer animal products are less likely to develop colorectal cancer. But these types of studies are observational. They compare the health of groups that choose different types of diets. They can't prove that one diet over another definitely decreases the risk of getting this type of cancer.  This study adds strong support for the influence of diet on colorectal cancer risk. It compares how different diets affected exactly the same people. It provides very plausible biological reasons for how diet can change the chemical reactions and the bacteria in our colon that lead to cancer.  These are the dietary changes that may help prevent colorectal cancer: 
    • Eat a diet rich in fruits and vegetables. 
    • Limit red and processed meats. 
    • Get enough vitamin D through sunlight, diet, pills or all of these. 
    • Choose whole-grain products that provide more fiber. 
You can also take other steps to reduce your risk: 
    • Stay physically active and dedicate time to exercise each day. 
    • Don't smoke. 
    • Use alcohol in moderate amounts or not at all. 
    • Maintain a healthy body weight. 
    • Get screened with colonoscopy. 
For people at average risk of colorectal cancer, screening begins at age 50. Colonoscopy is the preferred method. That's because it allows the doctor to remove polyps that could turn into cancer.  What Can I Expect Looking to the Future?  People have different amounts and types of bacteria that normally live in the intestines. It's called our microbiome. This is a hot area of research. Studies such as this one will help us learn how our microbiome affects our risk of colorectal cancer. But the potential goes way beyond cancer risk. Overall health and risk of many diseases may be closely related to our microbiome.]]>
Wed, 29 Apr 2015 00:00:00 -0400
MRI May Help Gauge Stroke Risk in Atrial Fibrillation People with an abnormal heart rhythm may have a higher risk of stroke if they also have certain... People with an abnormal heart rhythm may have a higher risk of stroke if they also have certain changes in part of the heart, a new study suggests. The study looked at 169 people with atrial fibrillation. This condition causes part of the heart to quiver rather than beat normally. People in the study received a type of MRI before having a procedure to treat the abnormal rhythm. This type of MRI shows heart muscle movement, among other things. Researchers looked at the MRI results. They compared people who did or did not have a history of stroke or transient ischemic attack (TIA). They saw differences in the heart between these two groups. The function of the upper left chamber (atrium) was different in those who had a history of stroke or TIA. Researchers said that seeing these features on an MRI may show a higher risk of stroke. Knowing which people with atrial fibrillation have a higher risk of stroke could help guide treatment. People with a higher risk may have a greater need for blood thinners to help prevent stroke. The Journal of the American Heart Association published the study. HealthDay News wrote about it April 27.                      What Is the Doctor's Reaction?  Doctors may have a new way to help determine stroke risk in people with an abnormal heart rhythm. That's what the results of this new study suggest.  A normal heartbeat starts in a cluster of cells in the right upper heart chamber (right atrium). This is a natural pacemaker. These special cells send out a pulse of electricity.  The electrical current flows into the rest of the heart. It stimulates the heart muscle cells in the lower heart chambers (the ventricles). This causes them to squeeze (contract) in a regular, organized way. Each time the left ventricle contracts, the heart pumps blood out to the rest of the body.  Atrial fibrillation disrupts this natural process. Areas outside of the natural pacemaker also send out signals. The signals are fast. They don't follow a steady beat. So the atria don't squeeze and relax. Instead, they quiver. This causes blood to pool rather than flow smoothly through the heart.  In general, atrial fibrillation is not a dangerous rhythm. But it is linked with an increased risk of stroke. Blood that doesn't flow easily can form small clots. They can break away from the heart and go to the brain.  To reduce stroke risk, people with atrial fibrillation are often advised to take a blood thinner. But blood thinners can cause severe bleeding. Sometimes it can be life threatening.  Doctors use different methods to help decide whether a person should be on a blood thinner. Factors such as age and prior history of stroke need to be balanced against the chance that the blood thinner will cause serious bleeding.  In this study, researchers used a special type of heart MRI to look at the left upper chamber (left atrium) of the heart. They found that specific changes in the muscles of the left atrium increased stroke risk. And these changes were not linked with age or other factors that increase the risk of stroke. What Changes Can I Make Now?  This is an interesting study. But it is much too early and costs too much to use MRI to help evaluate atrial fibrillation. Doctors will continue to use standard tools to determine stroke risk.  If you have atrial fibrillation, your stroke risk is higher if you: 
  • Are age 65 or older -- and even higher if you are 75 or older.
  • Have had a stroke or a TIA in the past. A TIA stands for transient ischemic stroke. It means you had stroke symptoms but they completely went away over minutes to hours.
  • Have heart failure.
  • Have blood vessels narrowed by atherosclerosis in any part of your body.
  • Have diabetes.
  • Are a woman. 
Experts have devised an online tool to calculate a stroke risk score for people with atrial fibrillation. This tool can help you and your doctor decide the best stroke risk strategy for you.  What Can I Expect Looking to the Future?  I do suspect that MRI or some other technique to image the heart will be important in the evaluation of atrial fibrillation in the future. But not any time soon.]]>
Tue, 28 Apr 2015 00:00:00 -0400
Ovary Removal Cuts Breast-Cancer Deaths Women with breast cancer who carry a high-risk gene can lower their risk of death from the disease... Women with breast cancer who carry a high-risk gene can lower their risk of death from the disease 62% by having their ovaries removed, a new study finds. They can reduce their risk even more by not delaying that surgery for more than a year or two, researchers said. The study included  676 women who had early-stage breast cancer. All of them were carriers of a BRCA1 or BRCA2 gene mutation. Women with these genes have a much higher than average risk of breast cancer and ovarian cancer. About half of the women in the study decided to have their ovaries removed. Those with a BRCA1 gene who had their ovaries removed were 62% less likely to die of breast cancer in the next 20 years. Death rates were up to 73% lower for women who had the surgery within 2 years of their breast cancer diagnosis. Breast cancer death rates were only slightly lower for those with BRCA2 genes who had their ovaries removed. The difference was small enough that it could have been the result of chance. The journal JAMA Oncology published the study this week. HealthDay News wrote about it.                    What Is the Doctor's Reaction? A new study shows that removing the ovaries can dramatically lower the risk of dying from breast cancer in women who carry the BRCA1 gene mutation. The journal JAMA Oncology published the results. The study was done in women who had a diagnosis of breast cancer and who had a BRCA1 or BRCA2 gene. The risk of breast cancer death over a span of 20 years fell 62% for those with a BRCA1 gene who had their ovaries removed, compared with those who did not. Women who had their ovaries removed quickly -- within a year of BRCA diagnosis -- had the lowest risk. Their risk of breast cancer death dropped 77%.  Ovaries produce estrogen, which is known to stimulate breast cancer. The results of ovary removal were impressive for women with a BRCA1 gene. But the study did not show as clear a benefit for women with the BRCA2 mutation.  One in every 300 to 500 women carries a BRCA1 or BRCA2 gene. These are commonly known as the breast cancer genes. The genes are more common among Jewish women of Ashkenazi (East European) descent. About 1 in every 50 of these women carries a BRCA gene.  I care for several women who are aware that they carry a BRCA gene. All of these women are fearful of cancer. They have all watched relatives grapple with breast or ovarian cancer. They know their lifetime risk is, as one patient said to me,  "almost inevitable." She said, "I am waiting for the other shoe to drop." Estimates of lifetime risk for breast cancer in women with a BRCA gene range from 65% to 85%.  If you have a BRCA gene, surgery can reduce your cancer risk to almost zero. Complete preventive surgery includes removing the breasts and removing the ovaries (after childbearing is complete). But my patients have not all made the same decisions. Not all have chosen to have preventive surgery.  My patients are typical. According to a 2011 study, a majority of women with a BRCA gene feel certain that surgery is the best way to prevent cancer. But: 
  • Only 37% have both breasts removed
  • 65% have ovaries removed  
These surgeries change a woman's body image and sense of sexuality. Removal of the ovaries causes infertility and can cause early symptoms of menopause. What Changes Can I Make Now?  If you don't know, learn whether you are at risk.  Have any of your relatives ever been diagnosed with breast or ovarian cancer? If so, discuss your family history with your doctor.  If you have these cancers in the family, you may benefit from seeing a genetic counselor. You may want to be tested for the BRCA genes. This is especially true if: 
  • Your relative was diagnosed when young (under age 50)
  • Breast cancer occurred in a male relative or multiple relatives
  • You are Jewish (of East European heritage) 
Roughly 20% of people with a family history of breast cancer and one of these family features are carriers of a BRCA gene.  Women with BRCA can lower their risk in several ways: 
  • Have earlier and more frequent screening, such as:
    • Breast self-exams every month
    • Breast exams by your doctor every 6 months
    • Yearly mammograms beginning at age 25 or 30
    • Yearly breast MRI
    • Checks of the ovaries using ultrasound and blood tests
  • Take risk-reducing medicine (tamoxifen, raloxifene or exemestane). Five years of use lowers cancer risk by 40% to 50% during the treatment years.
  • Take birth control pills. They can lower ovarian cancer risk by about 50%. Taken at a young age, modern birth control pills do not seem to increase breast cancer risk by a worrisome amount.
  • Have surgery. This is the most certain way to lower your risk. This can include breast removal, ovary removal or both.
What Can I Expect Looking to the Future?  Decisions about preventive surgeries in BRCA families are difficult and very personal. It helps to have more information about ovary removal and how much it improves cancer risk.  This surgery study is compelling. I think it will cause more women with BRCA1 to have their ovaries removed. Many more may seek out the surgery with less delay.  More study is needed to better understand the effect of ovary removal on breast cancer risk in women with the BRCA2 gene.]]>
Fri, 24 Apr 2015 13:04:00 -0400
Doctors Say It's Hard to Talk about End-of-Life Care Doctors often find it hard to talk with patients about end-of-life care, a new study shows. And... Doctors often find it hard to talk with patients about end-of-life care, a new study shows. And differences in culture, ethnic group and language make things even more difficult, they told researchers. The study was based on a survey. In all, 1,040 doctors in training (residents) answered the questions. They were asked if they had difficulty talking about end-of-life care with seriously ill patients and their families. Almost everyone said yes. They also were asked about the top 3 problems that came up when they had these talks with someone from a different ethnic group. They named language differences, the patient's or family's spiritual beliefs about death and dying, and the doctor's ignorance of the patient's cultural values and practices. Other problems listed were the patient's or family's limited understanding of medical information and mistrust of the health-care system. These issues also are harder to overcome if the doctor and patient don't speak the same language. Researchers urged patients to start the discussion about what care they do and don't want and what their goals are. The journal PLoS One published the study. wrote about it April 22. 
                What Is the Doctor's Reaction?  If you had a terminal illness, you'd face some important and difficult questions. 
  • Would you prefer to live as long as possible, even if it meant being in pain or unable to talk to loved ones? Or would comfort and a peaceful death matter more to you?    
  • Does your doctor know your wishes for medical care at the end of your life? 
  • Do your family members know your goals and what you prefer? 
If you haven't thought much about these questions or made your wishes known, you are not alone. Previous research has found that many people who are seriously ill have no plan in place to help with decision making. Many also have never shared their preferences with anyone. Other studies have shown that doctors are not very good at predicting what their patients want in the face of dire illness. In recent years, a lot of attention has been given to urging each person to name a health-care proxy. This is a person you choose to make health-care decisions for you if you can't. Of course, you also need to make sure that person knows what you would want. Perhaps you've heard of The Conversation Project. This organization is "dedicated to helping people talk about their wishes for end-of-life care" with their doctors and loved ones.  These efforts have made progress in overcoming the barriers to talking about end-of-life care. Now a new study focuses on the barriers that doctors face.   Researchers surveyed just over 1,000 doctors in their last year of residency about end-of-life discussions with their patients. Here's what the study found: 
  • Nearly every doctor reported barriers to talking about end-of-life decisions. Only 8 out of 1,040 (less than 1%) reported that there were no barriers.
  • About 86% described the barriers as "very challenging."
  • About 91% of Asian doctors found these discussions challenging. Fewer African-American doctors (85%), white doctors (83%) and Hispanic/Latino doctors (79%) felt that way.
  • Among the biggest challenges were:
    • Language and the need for interpreters
    • The spiritual beliefs of the patients and their families about death
    • The doctor's lack of knowledge about the patient's cultural beliefs
    • Cultural differences about sharing information or making medical decisions
    • Limited ability of patients or their family members to understand medical information
    • Patient and family mistrust of the medical system 
Each of these challenges is more likely to get in the way of an end-of-life discussion for minorities and people who speak a different language or have different cultural backgrounds from their doctors.  These findings show that it's not enough to just encourage people to name a health-care proxy or to talk with those close to them about end-of-life care. Doctors will need to be part of the solution as well. What Changes Can I Make Now? When it comes to making decisions about end-of-life care, it's never too soon to take the first steps. Here's how you can start: 
  • Think about what you would want in the face of terminal illness. It can be difficult to make decisions about something that may be decades away or may never happen. And it's OK if you aren't sure. You may change your mind over time.
  • Choose a health-care proxy. This could be a spouse, child or sibling.  But it does not have to be a family member. The most important thing is that your proxy is someone you trust to make decisions that honor your preferences.
  • Let your loved ones and your health-care proxy know your goals, values and preferences. 
  • Involve your doctor in the conversation. Let him or her know who your health-care proxy is and what you've discussed. If something your doctor says is unclear, be sure to ask for an explanation!
  • Recognize the challenges you and your doctor face. Everyone may find it hard at times to understand medical information. And cultural or language differences can add to the challenges, especially for sensitive or difficult decisions. 
You can use some very good resources to learn more about end-of-life medical decision making. They include these websites: 
  • The Conversation Project
  • National Institute on Aging
  • AARP
  • Stanford Letter Project
What Can I Expect Looking to the Future? The U.S. population is becoming older and more diverse. This means that the importance of planning for end-of-life medical issues will only increase. I hope that doctors will receive more and better training to help them have end-of-life discussions with their patients. We may also see changes in how doctors are paid for spending the time it takes to have these discussions. And it's likely we'll continue to see a rise in programs that encourage people to "have the conversation."]]>
Thu, 23 Apr 2015 19:20:00 -0400
Blue Bell Recalls All Frozen Desserts Blue Bell Creameries has removed all of its frozen dessert products from the market because of... Blue Bell Creameries has removed all of its frozen dessert products from the market because of possible listeria contamination. The Texas-based company made the announcement April 20. Blue Bell also reported results of recent tests. They found Listeria monocytogenes bacteria in some cartons of chocolate-chip cookie dough ice cream made on two dates in March. This means that listeria has been found in products made by several different plants. That's why Blue Bell decided to pull all frozen desserts. People should return any products they have for a full refund. Ten cases of listeria infection dating back to 2011 have been linked to Blue Bell ice cream products. The most recent were this year. Three people have died. Listeria symptoms include nausea, vomiting and stomachache. Symptoms can start 3 to 70 days after exposure. Severe cases are rare. But, in high-risk groups, listeria can even cause meningitis and blood infections. HealthDay News wrote about the Blue Bell announcement April 21. 
                 What Is the Doctor's Reaction?  Listeria monocytogenes bacteria are commonly found in soil and water. They can contaminate fruits and vegetables that people eat. Animals also can feed on contaminated foods. Listeria make their way from the animals' intestines into their muscles and milk.  We don't know how live listeria got into chocolate chip cookie dough ice cream made by Blue Bell Creameries. The bacteria also survived processing. As a result, 10 people have a proven listeria infection related to eating the ice cream. Three have died.  The company can't be sure its other frozen dessert products are safe. So it has pulled all of them from the market. You should return any products you  already have. You will receive a full refund.  Getting sick from listeria is extremely unusual. The infection is called listeriosis. But certain groups of people are at high risk to become sick. Anyone with a weakened immune system is at risk. Examples include people with HIV and people with active cancer.  Pregnant women are especially at risk from listeria infections. They get sick 20 times more often than other healthy adults. Infants and the elderly are also somewhat more likely to get listeriosis.  Listeriosis can cause fever, muscle pain and sometimes nausea or diarrhea. It can spread to the brain and nervous system. This can cause meningitis or seizures. In pregnant women, listeria crosses the placenta and can cause miscarriage.  What Changes Can I Make Now?  Your risk of getting sick is extremely small if you ate an ice cream product made by Blue Bell Creameries within the last couple of months. Most of the products probably are not contaminated with listeria. Also, if you are generally healthy and not pregnant, eating something contaminated by listeria probably would not make you ill.  Of course, if you do develop an unexplained fever or a bad headache, contact your doctor. Let him or her know that you ate a frozen food made by the company. Listeria infections are rare. So doctors don't consider it as a cause of illness right away unless there are special circumstances.  Once listeria is considered a possibility, you can start the right antibiotic promptly. Usually this is ampicillin.  You can take steps to lessen any risk of listeria infection. Here's what you can do: 
    • Thoroughly cook meat. 
    • Wash raw vegetables and fruits before eating them. 
    • Keep uncooked meat separate from cooked and prepared foods.
    • Don't eat or drink unpasteurized (raw) dairy products.
    • Wash your hands, utensils and cutting boards after they have touched uncooked foods. 
If you are in a high-risk group for listeria infection, then you should take other precautions as well. 
    • Avoid deli meats, luncheon meats or hot dogs unless they are cooked to steaming hot. 
    • Do not eat blue-veined cheeses or soft cheeses such as Brie or Camembert unless the label clearly says they were made from pasteurized milk. 
    • Do not eat pâtés or meat spreads. Canned meat spreads or pâtés are OK.
    • Do not eat refrigerated, smoked seafood unless it is cooked.
What Can I Expect Looking to the Future?  More people will be reported ill from listeria related to eating Blue Bell ice cream. Now that the link between the two is established, cases can be identified soon. And the right antibiotic can be started, improving the chance of a full recovery.]]>
Wed, 22 Apr 2015 00:00:00 -0400
New Guidance on Treatment after First Seizure New guidelines may help decide who should take medicine after a first seizure. About 10% of people... New guidelines may help decide who should take medicine after a first seizure. About 10% of people in the world have at least 1 seizure in a lifetime. But the risk of having more seizures varies. The updated guidelines come from the American Academy of Neurology and the American Epilepsy Society. They outline how to estimate the risk that someone will have another seizure. Taking anti-epileptic drugs can help prevent seizures, but they have side effects. After a first seizure, the chance of having another one is highest in the next 2 years. The chance is 21% to 45%, the guidelines say. Risk varies based on each person's medical history and test results. Two groups have the highest risk of another seizure, the guidelines say. They include people who have had another brain problem, such as a stroke or head injury, and those whose test results show signs of epilepsy. People with epilepsy have multiple seizures. The risk of a repeat seizure also may be high for someone whose brain scan shows a significant abnormality and for someone who had a seizure during sleep. The journal Neurology published the guidelines. HealthDay News wrote about them April 20. 
               What Is the Doctor's Reaction?  About 1 person in every 10 has at least one seizure in a lifetime. When that first seizure happens, you won't know right away if it will happen again. Even the best seizure specialist in the world can't tell for sure.  But doctors do have guidelines to help them advise patients about their chances of having more seizures. The guidelines can help patients decide whether to start taking a drug right away to prevent more seizures. The American Academy of Neurology published updated guidelines online April 21.  The guidelines are based on a series of tests each patient with a first-time seizure should have: 
  • A brain wave test called an electroencephalogram (EEG)
  • A picture of the brain, preferably an MRI, though a CT scan may be enough
  • Routine blood tests to look for a chemical imbalance, such as:
    • A very low or very high blood sugar level
    • A low blood sodium, magnesium or calcium level 
Some people who have a first seizure might also need a spinal tap (lumbar puncture). This test takes a sample of the fluid that surrounds the brain and spinal cord. In some cases, the situation and medical history may suggest the seizure was drug-related. In that case, doctors would order urine and blood drug tests.  What Changes Can I Make Now? Here is how the guidelines help you and your doctor decide what to do after a first seizure.  If the seizure was the result of something that just happened or a medical problem that can be fixed, it's called a provoked first seizure. Causes of provoked seizure include: 
  • Head trauma (if the brain scan or MRI is normal)
  • An abnormality (shown on a blood test) that can be fixed to eliminate seizure risk
  • A brain infection
  • Drug use  
For a provoked first seizure, medicine rarely is prescribed to prevent future seizures.  An unprovoked first seizure means that doctors can't find out the cause right away. The person could have no prior history of any neurologic problem. Or the person could have a known brain disorder or a prior abnormal brain imaging test. But the seizure still would be unprovoked if it was not expected.  Your chances of having another seizure after an unprovoked seizure are highest if: 
  • You have either a new or old abnormality on your brain CT scan or MRI
  • Your EEG results show a pattern consistent with a seizure disorder
  • You had the seizure while asleep
For any of these situations, most often you would start an anti-epileptic drug right away.  If you didn't fall into any of these high-risk groups, you still would have at least a 20% risk of another seizure within the next 2 years. Starting an anti-epileptic drug right away lowers the risk of another seizure during that time. But in the long term, there is no difference in the risk of having another seizure whether you start the medicine now or wait.  If these medicines had no potential side effects, the decision would be a lot easier for most people. But that is not the case for any of the drugs.  Factors that might influence your decision to start medicine now or wait: 
  • You can't drive right after a first seizure. But in some states you might be able to drive sooner if you are taking an anti-epileptic drug.
  • You hate taking medicine.
  • You don't mind starting a new medicine because you know you can stop or switch to a different one if you have side effects.
What Can I Expect Looking to the Future?  You always have the choice to accept or decline any treatment your doctor recommends.   Sometimes the decision is easy. If you have strep throat, taking an antibiotic makes you feel better sooner, prevents further problems and helps stop the spread of infection to your family.  Other times, the decision is not straightforward. Whether or not to take an anti-epileptic drug after a first seizure is a good example. But it helps to have guidelines like these that are based on solid medical evidence. Then you and your doctor can work together to make the choice that feels right for you.]]>
Tue, 21 Apr 2015 00:00:00 -0400
Sleep Apnea May Speed Up Memory Problems Loud snorers and people with sleep apnea may develop memory problems much earlier than those with... Loud snorers and people with sleep apnea may develop memory problems much earlier than those with normal breathing during sleep, a new study suggests. But getting treatment for sleep apnea may restore normal risk levels. The study was based on a review of medical records for about 2,500 people. They ranged in age from 55 to 90. Researchers divided people into 3 groups. One group had normal brain function. One group had mild memory and thinking problems (mild cognitive impairment). The third group had Alzheimer's disease. Researchers also looked at when people developed these problems. Diagnosis with mild memory problems occurred about 10 years earlier for people who had sleep-disordered breathing (sleep apnea or heavy snoring) than for those without sleep issues. Alzheimer's disease was diagnosed about 5 years earlier. Researchers also looked at a smaller group that received treatment for sleep apnea. Their treatment was using a continuous positive airway pressure machine during sleep. Those who developed mild memory problems were diagnosed about 10 years later than people who had untreated sleep apnea. The journal Neurology published the study. HealthDay News wrote about it April 15.             What Is the Doctor's Reaction? Sleep disorders are common. For example, sleep apnea affects an estimated 18 million Americans. People with sleep apnea have poor-quality sleep and long pauses in breathing during sleep.  Sleep apnea can cause headaches, fatigue and daytime sleepiness. But for a long time it was considered bothersome rather than dangerous. We now know it's more serious than that. Sleep apnea can increase the risk of motor-vehicle accidents (from falling asleep at the wheel), heart failure and lung disease. A new study suggests that sleep apnea might contribute to yet another serious problem: dementia. Results appear in the medical journal Neurology. Researchers analyzed the medical records of nearly 2,500 people (aged 55 to 90) who reported: 
  • Untreated sleep apnea
  • Sleep apnea that was being treated
  • No history of sleep apnea 
Some people had normal brain function. Others had Alzheimer's disease or a condition called mild cognitive impairment. People with this condition have declines in memory and thinking. Symptoms are not as severe as they are in Alzheimer's disease. But many people with these milder memory problems do eventually develop Alzheimer's disease.  These findings of the study suggest that sleep apnea may contribute to a decline in brain function. 
  • Of those who developed mild cognitive impairment, people with sleep apnea developed it at an average age of 77. Those without sleep apnea developed it later, at an average age of 90.
  • Of those diagnosed with Alzheimer's disease, people with sleep apnea developed dementia at an average age of 83. Those without sleep apnea developed it at an average age of 88.
  • Some people with sleep apnea received a common treatment called continuous positive airway pressure (CPAP). Among those who got this treatment, mild cognitive impairment developed 10 years later than for those who were untreated. In other words, treatment seemed to return the risk of memory problems to the same level as that of people without sleep apnea. 
This study is important because it points to sleep apnea as a potential risk factor for decreased brain function. It also suggests that treating sleep apnea may protect the brain.  If confirmed by future research, this study could lead to advances in our knowledge about how problems with thinking and memory develop. This could lead to a way to prevent these conditions. Such insights could have a profound impact. The average age of our population is increasing, so these conditions are likely to become even more common.  What Changes Can I Make Now? If you have symptoms of sleep apnea, see your doctor for evaluation.  Symptoms include: 
  • Daytime sleepiness and fatigue
  • Loud snoring
  • Headache, especially in the morning 
Obesity increases the risk of sleep apnea, so staying at a healthy weight may help to prevent it. Alcohol and medicines that make you drowsy can make fatigue and daytime sleepiness worse. People with sleep apnea should limit alcohol and avoid sedatives. While sleep apnea is treatable, many people have difficulty wearing the CPAP mask. The mask makes a tight seal around the mouth and nose. It can be hard to tolerate the rush of air flowing through the mask. Some people may remove it by accident during sleep. For many, it can be a challenge to find a mask that maintains the tight seal. If you have sleep apnea, work with your doctor to find the CPAP settings and mask that are right for you.  Not everyone who snores heavily has sleep apnea. A sleep study is recommended to confirm the diagnosis. During a sleep study, technicians monitor your breathing pattern, oxygen levels and brain waves (among other measures) while you sleep.  What Can I Expect Looking to the Future?  This study found a link between sleep apnea and brain disease. However, this does not prove that such sleep problems actually cause brain disease. We will need more studies to confirm the findings of this latest research. More research also may show whether sleep apnea actually causes a decline of thinking and memory. If that's confirmed, you can expect to hear much more about how to prevent and treat sleep apnea and how sleep problems affect brain function over time.]]>
Thu, 16 Apr 2015 00:00:00 -0400
Pharmacists May Help People Stick to Pills Pharmacists may have a role to play in helping people on blood thinners take their pills on... Pharmacists may have a role to play in helping people on blood thinners take their pills on schedule, a new study finds. The study used information on outpatients in the Department of Veterans Affairs (VA) health system. The 5,400 people in the study group got prescriptions for the drug dabigatran (Pradaxa). This blood thinner is prescribed for many people with an abnormal heart beat called atrial fibrillation. It helps to prevent clots that can cause strokes. Researchers interviewed pharmacists at 41 VA centers. They asked the pharmacists about how the VA center educated people about the drug and kept track of them. Practices varied. About 28% of those in the study did not take the medicine as directed. Patients were more likely to take their medicines correctly if pharmacists, rather than doctors' offices, did the follow-up. They also were less likely to miss doses. The journal JAMA Internal Medicine published the study. HealthDay News wrote about it April 14.                   What Is the Doctor's Reaction? Not taking prescribed medicines properly is a huge problem. And it happens often. Three out of four Americans say they don't always take medicine as instructed. They might not even pick up the prescription. Doctors call it medicine non-adherence. Some estimates say it causes up to one-third of unplanned hospital stays and more than 100,000 deaths each year. Studies have found several reasons that people don't always take their medicine as prescribed. They include: 
  • Problems with paying for the drug
  • Not being able to read and understand the instructions on the label
  • Forgetting to take the drug, especially if it needs to be taken more than once a day
  • Not understanding why the doctor prescribed the drug and how it helps their health
  • Having symptoms that they believe are side effects of the drug
  • Not realizing that, for some drugs, missing even one dose can be dangerous
The results of this new study show how a pharmacist can be part of the solution. The study focused on a blood thinner called dabigatran (Pradaxa). It's prescribed to people with an irregular heart beat known as atrial fibrillation. Many people with atrial fibrillation have an increased stroke risk. Taking a blood thinner reduces the risk of blood clots that can cause a stroke. But it must be taken properly. Skipping doses makes a stroke more likely. Taking too much can cause bleeding. This can be serious and sometimes life-threatening. Before dabigatran, warfarin (Coumadin) was the best and really the only blood thinner that could be taken as a pill. But with warfarin, you need regular blood tests to adjust dosing. On the other hand, warfarin has two advantages that can help people to take the right dose every day: 
  1. You take it only once a day. And being late or even skipping one day on a rare occasion will not increase stroke risk.
  2. After each blood test, you get a call from a nurse. The nurse tells you whether you need to take a different dose. During the call, the nurse can also review whether you are taking the medicine properly. If not, the nurse can find out why and help solve any problems.
If you take dabigatran, you don't need blood tests. The dose is always the same. But this also means you don't have regular contact with a nurse. Your doctor's office won't know if you are not taking the medicine properly.  You also have to remember to take dabigitran twice a day. And, unlike warfarin, it must be taken right on schedule. Skipping a few doses does increase stroke risk. In this study, pharmacists were able to improve dabigatran adherence. They did this by:
  • Educating people about why they should take every dose and what to do if they miss a dose
  • Calling people who are late picking up refills to find out why
What Changes Can I Make Now?  Here's what you can do to help take medicines correctly:
  • If cost is an issue, be sure to discuss this before your doctor writes the prescription. A generic version could save you a lot of money. A generic drug must contain the same active ingredient in the correct dose as the brand-name drug.
  • If there is no generic version, ask if another medicine might be just as good for you. For example, warfarin and dabigatran thin the blood in different ways. They both prevent stroke in people with atrial fibrillation. But warfarin is much cheaper than dabigatran.
  • Make sure you understand why you need the drug and how it helps you.
  • If the directions on the label are not clear, review them with the pharmacist until you know what to do. At home, ask for help from family or a friend if you still are uncertain.
  • If you take a lot of pills, ask your doctor how you can simplify your drug program.
  • Take advantage of techniques and technology to help you remember to take your drugs on schedule. 
Here are some simple techniques that may help you keep track of medicines: 
  • Use a seven-day pillbox.
  • Set an alarm on your watch, phone or clock.
  • Make a chart that shows when to take your pills.
  • Use a journal to record when you take your pills.
  • Take a dose at the same time each day.
  • Take your medicines at the same time as another daily activity, such as brushing your teeth. 
Technology also can help: 
  • Automatic pill dispensers pop out the right pills at the right times.
  • Some pillboxes have timers and alarms.
  • Electronic caps fit on your prescription bottles and beep when it's time to take a pill. Then they record when the cap was removed to show that you took the pill.
  • Smartphone apps can organize pill information and remind you when to take them. 
What Can I Expect Looking to the Future?  New tech gadgets will be invented to make medicine adherence even easier. For example, new methods of packaging pills already are being developed. For example, one type of package can send out signals automatically to a family member when you take your pills. And some companies are working on putting that technology into the pills themselves.]]>
Wed, 15 Apr 2015 00:00:00 -0400
Listeria Reported in Ice Cream, Hummus Two popular food brands have recalled products contaminated by listeria. Blue Bell brand ice cream... Two popular food brands have recalled products contaminated by listeria. Blue Bell brand ice cream has been linked with 8 illnesses and 3 deaths. The U.S. Centers for Disease Control and Prevention (CDC) announced the outbreaks April 9. Also last week, Sabra said it had recalled 30,000 cases of classic hummus. The bacteria were found in several tubs of hummus in Michigan. No infections have been linked to hummus, state health officials said. The CDC said 3 people in Texas became ill after eating Blue Bell ice cream between 2011 and 2014. Five cases in Kansas occurred from January 2014 to January 2015. Three of the Kansas patients died. Blue Bell Creameries has closed a plant and recalled several products. An expert interviewed by HealthDay News said people can get sick 3 to 70 days after being exposed to listeria. The typical time for symptoms to develop is 2 to 4 weeks after exposure. Listeria bacteria cause about 1,600 U.S. illnesses and 3 to 4 outbreaks each year, the expert said. But severe cases are rare, the CDC said. Listeria kills about 260 Americans each year. HealthDay wrote about the outbreaks April 10.                  What Is the Doctor's Reaction? It was a lovely weekend in the Northeast. My husband and I took a long walk. We saw kids (with helmets) on scooters and bicycles. People took the time to stop and chat with each other. Picnics and ice cream can't be far away! That, of course, made it all the more distressing to read about listeria in 2 products. Outbreaks linked to Blue Bell ice cream have been reported in Texas and Kansas. And a routine inspection found listeria in Sabra hummus, leading to a recall of 30,000 units.  What is listeria? Listeria monocytogenes is a bacterium that can contaminate food. In nature, it lives in soil and water. Listeria can lurk for years in food-processing factories. It is most commonly found in: 
  • Uncooked meats and vegetables
  • Unpasteurized (raw) milk
  • Cooked and processed foods such as cheese, meat and some smoked seafood 
Our refrigeration systems kill most bacteria, but listeria can live in your refrigerator.  Listeria infection is called listeriosis. For most healthy people, it is similar to so-called stomach flu. You might have fever, aches and some diarrhea. But generally it gets better without treatment.  Some groups, however, are at much higher risk of serious illness from listeria infection. For these groups, there is a much higher rate of illness and death. People in higher-risk groups are also likely to have neurological symptoms of infection, such as seizure, headache or a stiff neck. These are the main high-risk groups: 
  • Pregnant women. They are about 10 times more likely than most people to get listeria infection. Hispanic pregnant women have an even higher risk. These infections can cause miscarriage or illness, even death, in a newborn.
  • Older adults. More than half of listeria infections occur among adults over 65. 
  • People with immune systems weakened from cancer, HIV, liver or kidney disease. 
Listeria can be slow to appear. People can become sick up to two months after eating foods contaminated with these bacteria. Fortunately, they can be treated with antibiotics. The U.S. Centers for Disease Control and Prevention (CDC) does not recommend treatment or testing for exposed people -- even in higher-risk groups -- unless they become sick.  Despite the multiple reports of listeria in recent weeks, it is still a pretty rare disease. Based on CDC data, outbreaks and cases do not appear to be increasing. Furthermore, it is a win for food safety that the hummus products were found on routine inspection. This means they can be pulled from supermarket shelves, hopefully before anyone becomes ill.  What Changes Can I Make Now?  If you were affected by either the ice cream or the hummus outbreak, you should talk with your doctor. He or she can monitor you and your symptoms for the next few months. Most people won't get sick, but if you do, the illness can be serious. You should be diagnosed and treated right away. Preventing listeria is important for everyone, particularly so for those in higher-risk groups. The CDC has some excellent suggestions about preventing listeria. Here's what you can do: 
  • Avoid foods at risk.
  • Don't drink raw (unpasteurized) milk.  
  • Make sure that you heat deli meats, such as hot dogs, to steaming before you eat them.
  • Refrigerate leftovers and use them quickly.   
If you are pregnant or in another high-risk group, talk with your doctor about foods to avoid or eat with special caution.  What Can I Expect Looking to the Future? It's hard to know. Are outbreaks becoming more common? Less common? I would like to see more protection (and inspection) of our food supply to make sure that people are safe from listeria and other foodborne illnesses. We are lucky in this country to have an excellent surveillance and inspection system. I hope that we protect it.]]>
Tue, 14 Apr 2015 00:00:00 -0400
Being Short May Be Hard on the Heart Short people may be more likely to have heart disease, and that could be linked to their genes, a... What Is the Doctor's Reaction? The main factors that increase your risk of developing coronary artery disease are well known. They include family history, smoking, diabetes, high blood pressure and high cholesterol. But there are some odd risk factors, such as shorter height in adulthood. Shorter adults tend to have higher blood pressure and cholesterol. They are also more likely to develop diabetes than taller adults. Some studies have adjusted their numbers to account for those risk factors. And they still have shown that being short, all by itself, is linked with a greater chance of having heart disease.  We don't know why adult height and heart disease risk are linked. The results of this study provide strong evidence that the reason may be related to genes.  Some diseases are caused by an abnormal change (mutation) in a single gene. Sickle cell disease and Huntington's chorea are examples. But the genetics of coronary artery disease is more complex. Only some of the genes that make a person more likely to get heart disease have been discovered.  It's easier to predict whether a child will become a short adult. Similar to heart-disease risk, height is also determined by multiple genes. But unlike heart-disease genes, the major "height" genes have been found.  The researchers in this study looked at genetic information from more than 18,000 people. The researchers looked for links among: 
  • Usual coronary-artery risk assessment
  • Some of the genes known to influence heart disease
  • The genes known to predict maximum adult height
In the past, several studies have shown a link between short height in adulthood and heart disease. But the height an adult actually reaches is greatly influenced by nutrition and illness in childhood. And nutrition and illness in childhood could be a reason for heart disease later in life. This study was designed to look at the relationship between "height" genes and the risk of coronary artery (heart) disease. The researchers found that the more genes people had that are linked with reduced height in adulthood, the higher their risk of heart disease.  By their calculations, someone who is 2½ inches shorter than average has an increase of 13.5% in heart-disease risk. By looking at genes, the researchers were able to take away the effects of diet or illness on height (and heart-disease risk).  What Changes Can I Make Now?  Right now, these study results do not change what all of us should do to help prevent heart disease. However, if you are short, it may be even more important for you.  Other odd factors also have been linked with heart disease risk: 
  • Ear lobe creases. People with a diagonal crease or dent on one or both earlobes have a higher-than-average chance of developing heart disease.
  • Baldness. Heart disease is somewhat more common in men who begin losing their hair early.
  • Gray hair. Early graying has been linked with heart disease.
  • Leg length. The longer your legs, the lower your risk of heart disease. Of course, this also means you are less likely to be short. 
The genetics of these features have not been studied. What Can I Expect Looking to the Future? Just being short is surely not the direct cause of developing heart disease. But the link between the genes linked with both height and heart disease suggests that these genes somehow drive similar processes in the body. Those processes may lead to both shorter height and heart disease. Finding this link could be a first step in developing precision therapy for someone with a particular set of genes.]]>
Fri, 10 Apr 2015 00:00:00 -0400
Arts, Computers, Social Life May Support Brain People who engage in arts and crafts, use computers or have an active social life may stay... People who engage in arts and crafts, use computers or have an active social life may stay mentally sharp longer as older adults, a new study suggests. The study included 256 adults, ages 85 or older. They had normal brain function when the study began. Researchers asked them about their activities, both current and earlier, during middle age. During the next 4 years, nearly half developed mild cognitive impairment. This is a problem with memory or thinking that can lead to dementia. Researchers adjusted their numbers to account for differences in sex and education. They found that people who were involved in artistic pursuits during midlife and later life were 73% less likely to develop brain problems than others. Those who did crafts, used computers or had an active social life had half the risk of brain problems of those who did not do these things. Those who developed high blood pressure in midlife were more than twice as likely as others to develop brain problems. The journal Neurology published the study. HealthDay News wrote about it April 8.                What Is the Doctor's Reaction? Have you ever wondered what you can do to keep your brain sharp into advanced age?   If you are a baby boomer, you are not alone in pondering this question. And it has the attention of researchers who study the aging brain. It's also the focus of companies that promote "brain games" and other products intended to "exercise" the brain to keep it functioning well. We don't know how well these products work, but several studies have shown a link between good brain function and keeping busy with hobbies and social connections. A new study is the latest to examine the link between what you do in your leisure time and brain function in advanced age. And the results suggest there is something you can do to keep your brain working well.  The journal Neurology published the study. Researchers surveyed 256 elderly men and women. Their average age was 87. They were asked about a variety of activities during middle and advanced age, including:  
  • Arts, such as painting, drawing and sculpting
  • Crafts, such as woodworking, pottery, quilting and sewing
  • Social activities, such as going to the movies or concerts and visiting with friends
  • Computer use , such as shopping online or searching the web 
At the start of the study, each person had normal brain function and no prior problems with memory or thinking.  During the next four years, nearly half developed mild cognitive impairment. This form of brain dysfunction causes problems with memory or language. It may lead to dementia. Mild cognitive impairment was: 
  • 73% less likely to develop among those who were active in the arts activities during middle and advanced age than among those who were not
  • 45% less likely to develop among those engaged in crafts
  • 55% less likely to develop among those with an active social life
  • 53% less likely to develop among computer users 
People who were more likely to develop mild cognitive impairment included those who had: 
  • An above-average risk of heart disease
  • Depression
  • A gene (called APOE) that has been linked with Alzheimer's disease 
As interesting as these results are, we cannot conclude from this study that any of these activities will protect your brain in advanced age. We only know that among people who made it to advanced age with normal brain function, people who did these activities were more likely to stay sharp.  We'll need more research to prove that these activities actually caused better brain health.  What Changes Can I Make Now?  Keeping your brain healthy is a lifelong job. It's never too soon to start. You can make changes now to increase your chances of having good brain health in advanced age. Here's what you can do: 
  • Don't smoke.
  • Get your blood pressure, blood sugar and cholesterol checked. If they are not in an ideal range, changes in your diet, increased exercise, and, if necessary, medicines can improve them.
  • Take a blood thinner (such as aspirin or warfarin) to lower your risk of stroke if you have an irregular heart beat (called atrial fibrillation).
  • Have surgery if you have a severely narrowed carotid artery (a major source of blood flow to the brain).
If you enjoy arts, crafts or working with computers, this new study suggests you might be helping your brain. Filling in your social calendar could be helpful as well.   It's fascinating that leisure-time activities could be helpful to future brain function. My question is this: How do these activities protect the brain?  What Can I Expect Looking to the Future?  You can expect the aging population of this country to embrace studies like this one that suggest ways to avoid dementia. I hope that future research will confirm the findings of this new study. If that happens, you can also expect details to emerge, including: 
  • How do these activities protect the brain?
  • Which activities are best?
  • How much activity is the minimum to protect the brain? 
We continue to learn more about how to prevent dementia. Maybe the day will come when your doctor, instead of prescribing a medicine, will recommend that you join a book club and start your own blog.]]>
Thu, 09 Apr 2015 13:24:00 -0400
Physical Therapy or Surgery for Back Pain? Physical therapy may relieve one type of back pain as well as surgery does, a new study finds. The... Physical therapy may relieve one type of back pain as well as surgery does, a new study finds. The study included 170 people in their late 60s. All of them had lumbar spinal stenosis. This is a narrowing of the channel inside one or more bones of the spine. People had severe back pain and problems with movement. They were randomly assigned to receive either surgery or physical therapy. The surgery removed areas of bone that were narrowing the spine and pressing on nerves. The physical therapy program lasted 6 weeks. But people in the physical therapy group were allowed to get surgery instead. More than half of them did so. People in both groups had tests of movement 10 weeks, 6 months and a year after surgery or physical therapy. They also were asked about pain. After 2 years, they filled out a survey to assess overall results. In the long term, both groups had equal reductions in pain. Both groups also had similar changes in movement and quality of life. Not everyone showed improvement. The journal Annals of Internal Medicine published the study. HealthDay News wrote about it April 7. What Is the Doctor's Reaction? Lumbar (low back) spinal stenosis is a common problem in the aging spine. It causes pain and limits movement. For most people, there are no hard and fast rules about treatment, especially when to have back surgery. The results of this study offer guidance for doctors and their patients. Low-back stenosis means that the space inside the lowest part of the spinal canal has narrowed. The causes include bulging discs and overgrowth of bone and ligaments. The result is pressure on the nerves, which causes pain. Typical symptoms of spinal stenosis are:
  • Pain in the groin, buttocks and upper thigh. But it does not move down the leg like the pain of sciatica.
  • Pain with standing or walking that gets better if you sit or squat.
  • Pain that feels worse when you lean back and feels better if you lean forward.
At first, most people with low-back spinal stenosis are treated with what doctors call conservative measures. These include pain relievers, anti-inflammatory medicines and physical therapy. Some people also get corticosteroid injections into the spine. If symptoms don't improve, doctors often recommend surgery. Prior studies have compared conservative measures, including physical therapy, with surgery. They consistently have shown quicker pain relief and better movement after surgery for severe spinal stenosis. However, these studies were mostly observational. This means they looked at differences between people who simply decided to get one treatment or another. They could not actually prove surgery is the better treatment option for spinal stenosis.   Some clinical trials also have compared surgery to conservative treatments. Clinical trials are studies that usually offer the most reliable type of evidence. They randomly assign similar patients to get one treatment or another. However, the results of the spinal stenosis studies were hard to interpret. That's because many of the people assigned to conservative therapy changed their mind and went for surgery.  Symptom relief may happen faster with back surgery. But the studies show that's not the case long-term. After 6 to 10 years, symptoms related to spinal stenosis were similar for those who got conservative therapy only and those who got surgery. About 20% of people who chose surgery had 1 or more repeat operations.  This new study is unique because everyone was a good candidate for back surgery and agreed to have surgery. But they understood that each of them would be randomly assigned to get surgery right away or take part in a physical therapy program designed for the study. Both groups had similar short-term and long-term outcomes in these areas:
  • Pain relief
  • Better movement
  • Improved quality of life 
What Changes Can I Make Now?  In the past, a person with severe symptoms from lumbar spinal stenosis might opt to have surgery right away. Given the results of prior studies, it would have been very reasonable not to wait and see if conservative therapy helped.  The results of this study suggest that a well-designed physical therapy program can relieve symptoms just as quickly as back surgery.  Some people may need to get surgery right away.  For example, severe pressure on the nerves might cause: 
  • Weak muscles around the pelvis or upper legs
  • Loss of bladder or bowel control
  • Pain that can't be controlled with strong medicine
If you need surgery, the operation performed is almost always a laminectomy. The surgeon removes the bony plate (lamina) on the back of the vertebra that is narrowed.  This opens up more space for the spinal nerves. The procedure usually means one to three days in the hospital. Sometimes it is done through a tiny incision and guided by video from a miniature camera.  Sometimes there is so much narrowing that a simple laminectomy won't be enough. In that case, you may need a laminectomy with spinal fusion. The surgeon removes disks and other tissues as well as one or more bony plates.  Special cement or hardware is used to make the spine stable. You will have to spend more days in the hospital than you would after a laminectomy. Recovery also is longer.  Laminectomy alone is just as effective as spinal fusion. Therefore, it's always the preferred option when possible.  What Can I Expect Looking to the Future?  Given the results of this study, most people with spinal stenosis should try physical therapy before surgery. But if symptoms don't quickly improve, your preference will guide the decision of how long to wait to have surgery.]]>
Wed, 08 Apr 2015 12:33:00 -0400
More Intense Exercise May Extend Life Working up more of a sweat when you exercise may help you live longer, two new studies find. And... Working up more of a sweat when you exercise may help you live longer, two new studies find. And for most people more vigorous exercise appears to be safe, a third study suggests. All of the studies focused on middle-aged or older adults. One included more than 204,000 people. Researchers kept track of them for more than 6 years. They were divided into groups based on how much of their exercise was vigorous, such as running, compared with moderate activity, such as brisk walking. Those who said up to 30% of their exercise was vigorous were 9% less likely to die during the study than those who did no vigorous activity. The death rate was 13% lower for those who did more than 30% vigorous exercise. A second study had similar results. The journal JAMA Internal Medicine published both of them. The journal Circulation published the third study, which looked at cardiac arrest risk. Researchers reviewed more than 1,200 cardiac arrests among adults age 35 to 65. Only 5% occurred during vigorous exercise. People who were exercising were more likely to get help quickly and to survive. The journal Circulation published the study. HealthDay News wrote about the first JAMA study and the Circulation study April 6. What Is the Doctor's Reaction? We know that some exercise is better than none. But how much more health benefit do we get if we exercise longer or harder or both? Is vigorous exercise better than moderate-intensity exercise? And what's the risk of dropping dead from vigorous exercise in middle age and beyond?  Three articles published online yesterday provide data to help us answer these questions.   People who don't exercise now get the greatest health benefits if they do the recommended minimum of: 
  • 150 minutes per week of moderate-intensity exercise OR
  • 75 minutes per week of vigorous exercise
Regularly getting this much exercise can lower the risk of death by 20% over a period of 14 years. That is the conclusion of a study done by Hannah Arem, Ph.D., and her colleagues. JAMA Internal Medicine published the study.  Exercising for up to 3 times the minimum continues to lower your risk of dying. Increasing the amount or intensity of exercise even more may have other health benefits. But this study measured only the risk of dying. So you may not gain any further years of life if you go beyond 7½ hours of moderate-intensity exercise or 3 hours and 45 minutes of vigorous exercise each week.  The researchers also looked at whether too much exercise might be harmful. The answer appears to be no. At least, it appears that a lot of exercise does not increase the risk of dying.  People who exercised 10 times the minimum amount had similar death rates as those who did 3 to 5 times the minimum. Ten times the minimum means more than 3 hours per day of moderate-intensity exercise or more than 1½  hours per day of vigorous exercise. JAMA Internal Medicine also published a second related article online. Researchers in Australia looked at the potential extra benefits of vigorous exercise in adults 45 to 75 years of age. This study also looked at death risk. Results of their study showed a reduced risk of death for people who did more vigorous exercise compared with those who did only moderate exercise.  The journal Circulation published the third article. It provides some reassurance about the very low risk of middle-aged adults suddenly dropping dead while exercising. The study also showed that the chance of surviving a cardiac arrest (when the heart stops beating) is much greater during exercise than at other times. The likely reasons: 
  • People tend to exercise with or around other people.
  • If you exercise regularly, your body can survive longer without your heart beating than if you don't exercise. 
What Changes Can I Make Now?  If you don't exercise now, the best thing you can do is to get started. Exercise improves multiple body functions: 
  • The heart becomes more efficient at pumping blood.
  • The lungs move oxygen into the blood stream faster.
  • Blood vessels deliver the oxygen to tissues throughout the body with ease.
  • Muscles get stronger.
  • The body's cells respond better to insulin. This helps to keep blood sugar levels from rising.
Do you have any health factors that increase your risk of heart disease? If you do, take action to improve them. In the study in Circulation, most of the people who had a cardiac arrest during exercise had a higher than average risk of heart attack. They had one or more of these risk factors: 
  • A family history of heart disease at an early age, younger than 55 for men or younger than 65 for women 
  • Smoking
  • High LDL cholesterol
  • High blood pressure
  • Diabetes 
Once you start exercising, don't ignore symptoms that might be caused by heart disease. Chest pain is just one of the symptoms. Sometimes you might have little or no chest pain. You might just: 
  • Feel faint
  • Break out in a cold sweat
  • Get unexpectedly short of breath
  • Feel pain in the jaw or arm 
If this happens, stop exercising right away. Call your doctor for advice. And don't test yourself to see if it will happen again.  What Can I Expect Looking to the Future?  Recent studies suggest that vigorous exercise might offer the greatest health benefits. For most people, though, it's difficult and exhausting to exercise at high intensity for more than a few minutes.  Instead, consider interval training. You can start with bursts of high-intensity exercise for 10 to 15 seconds only. Then go back to moderate intensity. For example, if you walk or jog, speed up for short bursts every few minutes. Then resume your prior pace.]]>
Tue, 07 Apr 2015 00:00:00 -0400
Report: Poor Americans Lose the Most Sleep Many Americans are sleep-deprived, and those with lower incomes are losing the most sleep. That's... Many Americans are sleep-deprived, and those with lower incomes are losing the most sleep. That's the main message of a brief report issued April 2 by the Centers for Disease Control and Prevention (CDC). The report was based on a national health survey from 2013. People were asked how many hours of sleep they get per night, on average. Lower-income people were more likely to report being sleep deprived. This was defined as less than 6 hours of sleep a night. About 35% of those with family incomes below poverty level were sleep deprived, compared with 28% of those with incomes at least 4 times the poverty level. All of these numbers are higher than some earlier surveys show. A study published in the journal Sleep in 2010 looked at past surveys that asked Americans about sleep habits. It found that about 7.6% of U.S. adults reported getting less than 6 hours of sleep a night in 1975. This rose to 9.3% in 2006. Full-time workers were the only group reporting an increase in sleep deprivation, the study found. The journal Morbidity and Mortality Weekly Report published the results of the 2013 survey. What Is the Doctor's Reaction? Researchers just shared results from a huge 2013 survey by the U.S. Census Bureau. It was called the National Health Interview Survey. Among other things, this survey asked Americans about their sleep. Most health experts think a typical adult needs about eight hours of sleep each day. Six hours is considered a "short sleep." But Americans seem to be getting less sleep than ever. Look how we compare to past years: 
  • In 1975, 7.6% of Americans said they slept less than 6 hours a night.
  • In 2006, 9.3% of Americans said they slept less than 6 hours a night.
  • In 2013, depending on income level, between 27.7% and 35.2% of Americans said they slept less than 6 hours each night. 
In the survey, people from low-income families were most likely to have short sleeping hours. Most of the time, activity logs suggested that hours of work took the place of sleep.  I think people who manage on a small amount of sleep underrate the impact that has on them every day. Sleep deprivation isn't good for your health. We know that getting too little sleep can lead to these problems: 
  • Slower thinking
  • Slower reaction times
  • Less ability to pay attention
  • More car accidents and other accidents
  • Depressed mood
  • Poor sexual function or lower interest in sex (low libido)
  • Weight gain
  • High blood pressure
  • Blood test results that show signs of inflammation
  • A smaller immune response after getting a flu shot
  • A higher likelihood you will catch a cold
  • Higher rates of heart attack and stroke
  • Weight gain
  • Aches and pain (such as the condition fibromyalgia)
It appears that we are becoming a sleep-deprived nation. We should worry about this trend. Let's make some changes if we can. What Changes Can I Make Now?  Figure out how much sleep you need each day. Do you know the answer? Shouldn't you?  The amount of sleep you need is not something that a doctor can predict for you. Most adults probably need about 8 hours. But for some people, 6 hours is probably just right. For others, 8 hours or even 10 hours is right.  Pay attention to how long you sleep when you don't set an alarm clock. Also pay attention to how much sleep you have had on days when you feel well, and on days when you feel sleepy or have trouble paying attention. You will have to use clues like this, and trial and error, to truly know how much sleep is right for you. Plan a bedtime. For most Americans who wake up to an alarm clock, the best way to increase sleep hours is to go to bed earlier. But if you press the "snooze button" on your alarm clock multiple times every day, maybe you don't need to get up as early as you have planned. Consider setting your wake-up time for a later hour. Shorten your morning routine by planning and packing (lunch, work clothes) the evening before.  Trade some low-value wakeful time for more sleep. Every day has obligations. But every day also has some flexible time. Try to trade an hour of activity that you don't value highly (for example, TV watching) for an hour of sleep. It is best for health if your sleep happens all at once, but naps help, too. Help yourself to get high-quality sleep. 
  • Have a dark, quiet room, with a comfortable mattress.
  • Remove TVs from the bedroom.
  • Cut back on caffeine, tobacco and alcohol.
  • Exercise on most days, but don't exercise right before bed.
  • Avoid sleeping pills. They don't lead to high-quality sleep.
  • Talk with your doctor if your sleep has frequent interruptions (especially if you wake because of medical symptoms). There may be a way to help.
What Can I Expect Looking to the Future?  Getting enough sleep is one of the best things you can do for your health and your work efficiency. Quit smoking, get exercise, eat well and get your sleep. Adding more sleep is one of the fastest ways to feel at your best, too. For most people who are sleep deprived, it only takes a few days of unrestricted sleep to restore energy and function. But for working Americans, this still may be one of the hardest habits to change. Economic changes, such as a higher minimum wage, might help people who lose sleep in order to work longer hours. But cultural perceptions also need to change. First we need to value our sleep. Then we can safeguard our sleeping hours.]]>
Fri, 03 Apr 2015 00:00:00 -0400
Test May Show Return of Lymphoma Sooner Measuring a type of DNA found in tumors can help detect whether the most common type of lymphoma... Measuring a type of DNA found in tumors can help detect whether the most common type of lymphoma has returned after treatment, a study finds. The study focused on diffuse large B-cell lymphoma, known as DLBCL. It often can be cured. But people need to come back for CT or PET scans to look for a return of the cancer. The new study looked at another possible test. The study enrolled 126 people with DLBCL. They had been treated with chemotherapy between 1993 and 2013. Researchers took blood samples before and after treatment and during follow-up. They tested the samples for a type of DNA comes from the tumor. People also received follow-up CT scans. In all, 107 people had all signs of their cancer disappear with treatment. Those who had detectable tumor DNA in their blood during follow-up were 200 times more likely to have a return of the cancer than those with no detectable levels. Measuring tumor DNA showed the return of cancer 3 months earlier than the CT scans. People with higher levels of tumor DNA in blood also were less likely to respond to treatment. The journal Lancet Oncology published the study April 1. What Is the Doctor's Reaction? For many survivors of cancer treatment, there is always the possibility that the cancer will come back. That's why it is routine to do regular tests on cancer survivors to confirm that the cancer is gone. Frequent tests may detect a return of the cancer sooner, when the cancer is at a more treatable stage. These tests often include:
  • Blood tests: Some tumors make proteins that can't normally be detected in healthy people. 
  • CT scans: The return of cancer may show clearly if the tumors are large enough.
  • PET scan: This test uses an injected radioactive substance to show how parts of the body are working. Some tumors tend to "light up" on a PET scan.
While these tests can be helpful, they have major limits. For example, CT and PET scans cost a lot. Repeated scans expose people to radiation that can possibly be harmful. These scans also may miss small tumors. They may suggest that you have cancer even though you don't. And most cancers do not make abnormal proteins that can be detected in the blood.  We need better ways to show when cancer has come back. And researchers publishing in the latest edition of the journal Lancet Oncology may have found one for lymphoma. Lymphoma is a cancer of the lymphatic system. This includes the lymph nodes and spleen. In this study, researchers analyzed the blood of 126 people who had the most common type of lymphoma. This type is called diffuse large B-cell lymphoma, or DLBCL. Each person had received chemotherapy and then repeated CT scans over a period of about 11 years. Researchers in this study took blood samples and tested them for tiny amounts of DNA that came from the tumor. Having this DNA in your blood was closely linked with a return of lymphoma.
  • People with detectable tumor-related DNA were 200 times more likely to have their disease get worse over time than those with none of this DNA.
  • Measuring tumor-related DNA allowed doctors to detect a return of lymphoma recurrence more than 3 months before the cancer caused any symptoms or signs.
  • Measuring tumor-related DNA could predict which people with lymphoma would not respond to future chemotherapy.
If results are confirmed by more research, this new test could revolutionize how doctors test patients for a return of lymphoma. And that could mean earlier detection, fewer CT and PET scans, and better prediction of response to treatment. This technique also could turn out to be useful for other types of cancer. What Changes Can I Make Now?  If you have been diagnosed with lymphoma, talk to your doctors about this new study.  Testing for tumor-related DNA in the blood is not yet widely available. But there may be a research study near you that offers it.  Lymphoma is not considered a highly preventable type of cancer. People with HIV do have an increased risk of developing lymphoma. So avoiding HIV infection may help you to avoid lymphoma. Here's what you can do to reduce your risk of becoming infected with HIV. 
  • Always use condoms during sexual intercourse.
  • Have sex with only one person who is committed to having sex only with you.
  • Suggest that any sexual partners get tested for HIV.
  • Never share needles.
Unfortunately, there is no accurate screening test for lymphoma. If you have symptoms of lymphoma, let your doctor know. Symptoms include:
  • Persistent swelling or enlargement of lymph nodes, which can be felt in the groin, under the arms or in the neck
  • Unexplained weight loss
  • Unexplained fevers
  • Night sweats
  • Severe fatigue
Not everyone with these symptoms has lymphoma. For example, mononucleosis can cause many of these same symptoms. So, if you have one or more of these symptoms, don't panic -- but do get checked out. What Can I Expect Looking to the Future? This new research on tumor-related DNA was small and only looked at one type of lymphoma. You can expect larger studies to be done using this type of testing to detect a return of DLBCL and other types of lymphoma. If confirmed, this new technique could become a standard follow-up test for people with lymphoma.  Future studies should answer whether testing the blood for tumor-related DNA can:
  • Improve doctors' ability to choose treatments for lymphoma or other types of cancer
  • Detect a return of other types of cancer
  • Serve as an accurate screening test for lymphoma and other types of cancer (for people who have not been diagnosed with cancer)
  • Help researchers study whether new treatments are working
Better ways to find out when cancer has come back could have yet another benefit:  more reliable reassurance that cancer has not returned.]]>
Thu, 02 Apr 2015 00:00:00 -0400
Blood-Pressure Advice Targets Heart Patients Three expert groups have released blood-pressure treatment guidelines for people who already have... Three expert groups have released blood-pressure treatment guidelines for people who already have heart problems. The guidelines focus on people with coronary artery disease. This is a narrowing of arteries to the heart because of plaque buildup. The guidelines say most people in this group should aim for a blood-pressure level of less than 140/90 millimeters of mercury (mmHg). The goal is 130/80 mmHg for those who already have had a heart attack, stroke or mini-stroke. This lower goal also applies to those who have had a narrowing of leg arteries or an abdominal aortic aneurysm. The guidelines come from a committee of experts. They represent many groups involved with the treatment of heart disease. In an interview with HealthDay News, the committee chairman said the guidelines are intended to be flexible. For example, older frail patients may need to set a higher blood pressure goal with their doctors. Setting the goal too low could lead to dizziness if blood pressure drops too much. The guidelines also include advice on which types of drugs doctors should use to lower blood pressure in people with artery disease. The journal Hypertension published the guidelines. HealthDay wrote about them March 31.
     What Is the Doctor's Reaction?  For decades, high blood pressure (hypertension) was defined as a reading of 140/90 millimeters of mercury (mmHg) or higher. In December 2013, the Joint National Committee on High Blood Pressure released new guidelines. This group included members from major doctor, hospital and nonprofit groups.  The new guidelines suggested raising the blood pressure target for adults ages 60 and over. The new target for these older adults would be 150/90 mmHg.   Many experts, as well as practicing doctors, disagreed with this change. A great amount of energy was spent arguing about the pros and cons of the change. Meanwhile, the more important message in the new guidelines got lost.  The key message: Blood pressure goals should be set for each person. They should be based on: 
  • Age
  • Overall health
  • Risk of heart problems and stroke
  • Side effects from blood pressure medicines
  • Preferences and goals of care 
Now three highly respected medical groups have issued new advice for one group of patients. Their guidelines address the treatment of high blood pressure for someone with coronary artery disease. The groups are the American Heart Association, the American College of Cardiology and the American Society of Hypertension. Their guidelines were published online March 31 in the journal Hypertension.  The guidelines use the best available evidence to support their advice: 
  • For people of any age with coronary artery disease and high blood pressure, the goal should be less than 140/90 mmHg.
  • For many, maintaining a blood pressure of less than 130/80 mmHg would likely further reduce the risks of heart attack, stroke and heart failure.
What Changes Can I Make Now?  The guidelines suggest the best drugs to lower blood pressure in people with high blood pressure and coronary artery disease. They are a combination of: 
  • A thiazide diuretic (water pill) such as chlorthalidone or hydrochlorothiazide.
  • An angiotensin-converting enzyme inhibitor (ACE inhibitor) or angiotensin receptor blocker (ARB). Many of these medicines are sold as generics. 
People with high blood pressure who have had a heart attack also should take a beta-blocker. Examples include metoprolol, carvedilol or bisoprolol.  That may sound like a lot of pills. But low doses of two or three different drugs keep blood pressure better controlled than a higher dose of just one drug.  The guidelines focused on target numbers and medicines. But healthy lifestyle choices are a must for people with heart disease. This is especially important if you also have high blood pressure. Here are some changes you can make:
  • If you smoke, quit now.
  • Eat a Mediterranean-style diet loaded with fruits, vegetables and whole grains.
  • Cut back on salt.
  • Stay physically active, with at least 30 minutes a day of dedicated exercise.
  • Maintain a healthy weight. 
What Can I Expect Looking to the Future?  More guidelines regarding treatment of high blood pressure will follow. For example, you can expect specific advice for people with high blood pressure and kidney disease.]]>
Wed, 01 Apr 2015 00:00:00 -0400
U.S. Cancer Deaths Still Dropping Slowly U.S. cancer deaths continue to decline, a new report says. The overall cancer death rate dropped... U.S. cancer deaths continue to decline, a new report says. The overall cancer death rate dropped an average of 1.5% a year between 2002 and 2011. New cancer cases fell more slowly, an average of 0.5% per year, the report says. The declines in cancer deaths each year were 1.8% for men, 1.4% for women and 2% for children. The report was written by experts from the North American Association of Central Cancer Registries, the American Cancer Society, the U.S. Centers for Disease Control and Prevention, and the U.S. National Cancer Institute. The authors said the declines reflect earlier detection, prevention and improved treatments. Lung cancer rates are falling because fewer people smoke. Declines in breast and colon cancer deaths also are related to screening and prevention efforts. Prostate cancer deaths also are down, but experts are not sure why. But several much less common cancers are on the increase. They include liver, mouth, throat, thyroid and kidney cancers. The Journal of the National Cancer Institute published the report March 30. HealthDay News wrote about it.            What Is the Doctor's Reaction? The U.S. "War on Cancer" became official in 1971. Congress passed the National Cancer Act. President Richard Nixon signed it. The law was politically popular. But, more importantly, the new federal law greatly increased cancer research funding by the government and strengthened the National Cancer Institute (NCI).  Since 1998, the NCI and other prominent health organizations have published the Annual Report to the Nation on Status of Cancer. This year's report continues to show a steady decline in the rate of yearly cancer deaths.  Does this mean we are winning the war on cancer? The answer is yes if the goal is to extend survival and also provide quality of life. For example, acute leukemia used to be incurable. Death often occurred within weeks to months. Now some forms of acute leukemia have very high survival rates and many people live normal lives.  But we need to be cautious when interpreting the decline in deaths. Newer cancer treatments have clearly played a major role. And early detection surely has saved some lives. But early detection also means more cases of cancer are being diagnosed that never would have caused death.   When more people are diagnosed with non-deadly cancers, the death rate will appear lower than it has in previous years. For example, the prostate-specific antigen (PSA) blood test led to a huge increase in the number of prostate cancer diagnoses. The number of prostate cancer deaths in the United States each year also decreased, but not by much. This means that the percentage of deaths from prostate cancer can fall even though about the same number of men die from the disease.  Where we are losing the war is cancer prevention. The number of new cases of cancer in men declined only slightly from 2002 to 2011. And the number of new cancer cases in women remained the same.  Some cancers are actually on the rise in the United States. They include: 
  • Liver cancer, primarily related to hepatitis C.
  • Cancer of the uterus, perhaps related to the rise in obesity.
  • Mouth and throat cancer in men, increasingly caused by human papilloma virus (HPV) infection. Smoking was the No. 1 cause in the past. But now fewer U.S. men are smoking.
  • Kidney cancer, reason unknown.
  • Thyroid cancer, reason unknown.
What Changes Can I Make Now? Healthy lifestyle choices provide the best way to prevent cancer. Here's what you can do:
  • Don't smoke or use other tobacco products. 
  • Maintain a healthy weight. 
  • Stay physically active and schedule daily dedicated exercise time. 
  • Either avoid alcohol or have an average of no more than one alcoholic drink per day. 
  • Avoid binge drinking, even if the average amount of alcohol you drink is moderate. 
  • Eat a diet rich in vegetables, especially the green leafy ones. They are rich in folic acid. For women, folic acid may offset any increased risk of breast cancer if you drink alcohol. 
  • Practice safe sex. 
Vaccinations also can help to prevent some cancers. They include: 
  • Hepatitis B to prevent some cases of liver cancer
  • Human papilloma virus (HPV) to prevent cervical cancer, anal cancer and probably oral cancer
Getting screened also can prevent some cancers. The two screening tests that can prevent cancer, not just detect it early, are:
  • HPV or Pap samples of the cervix in women
  • Colonoscopy to remove benign polyps before they become cancerous
What Can I Expect Looking to the Future? The number of people surviving cancer with good quality of life will continue to rise. Already, cancer cells are being tested for markers and genetic changes. This knowledge can help to provide more personalized treatments. For example, this year's cancer status report highlights how advances in breast cancer classification help women get the treatments that are most likely to be successful.
Tue, 31 Mar 2015 00:00:00 -0400