Aetna: Latest Health News http://www.planforyourhealth.com/ Latest Health News from Aetna en Aetna: Latest Health News http://www.planforyourhealth.com/ http://www.planforyourhealth.com/ Latest Health News from Aetna TYPO3 - get.content.right http://blogs.law.harvard.edu/tech/rss Wed, 16 May 2012 12:00:00 -0400 High Blood Pressure: You Are Not Your Family History http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/high-blood-pressure-you-are-not-your-family-history/ Having a family history of high blood pressure doesn't mean you're helpless to stay heart... What Is the Doctor's Reaction? Have you ever heard someone say, "Well, it's in my genes, so I guess there's nothing I can do"? Too often, people feel that if their parents have high blood pressure or diabetes or heart disease, they are destined to have it as well. Fortunately, this is simply not true. Studies show that "bad genes" can be offset by the good effects of healthy behaviors, such as:
  • Being physically active
  • Eating well
  • Not smoking
  • Maintaining a healthy body weight
A study in the American Heart Association's journal Hypertension reinforces this. Here's what we learn from the study:
  • Having a parent with high blood pressure does increase your chances of developing high blood pressure.
  • But being physically fit lowers your risk of developing high blood pressure.
  • Even if you have a family history of high blood pressure, you can make a big difference in lowering your chances of getting it - if you stay physically fit.
High blood pressure is a major risk factor for developing a heart attack or stroke. The most common risk factors for developing high blood pressure include:
  • Age - The risk of high blood pressure increases as we get older.
  • Race/ethnicity - Although high blood pressure can develop in adults of all races and ethnicities, high blood pressure is more common in blacks.
  • Being obese or overweight
  • Too much salt in your diet
  • Stress
  • Alcohol use
  • Lack of physical activity
  • Family history
  • Other medical issues, such as kidney problems, thyroid problems or pregnancy
Lowering blood pressure or preventing high blood pressure from developing in the first place can reduce your risk of heart disease and stroke. Even if one of your parents has high blood pressure, you still have the power to change your behavior and lower your own risk. What changes can I make now? Finding time to exercise and get physically fit can be challenging, but it's easier than you think. The official guidelines from the American Heart Association and the Centers for Disease control suggest:
  • "Vigorous" physical activity for 75 minutes each week – running, jogging or biking
OR
  • "Moderate" physical activity for 150 minutes each week – walking or easy bike riding
If you can’t reach these goals yet, don’t worry. You have to start somewhere. Here are some tips:
  • Just move! Some activity is better than no activity.
  • Do an activity you love. Maybe you don't like to walk, run or do aerobics. So don't! Instead, take a dance class, ride your bike or climb the stairs at work during your lunch hour. Do you what you love and you will love what you do.
  • Book an appointment with yourself. Put an exercise appointment on your calendar. You wouldn't miss a doctor's appointment, would you? So why miss an appointment to get yourself healthy?
What can I expect looking to the future? More research is showing that family history is an important predictor of disease. Despite this, research also is showing us that you have the power to change your behavior for the good to prevent disease. Unfortunately, the health care system is set up to manage diseases after they develop. It is not designed to help you live healthy and stay healthy. But this is changing. Insurance companies are providing incentives for gym memberships. Large employers are offering wellness programs. Prevention of heart disease is becoming a greater focus as more of the population becomes obese or overweight and health care costs skyrocket. High blood pressure remains a major cause of heart attacks and stroke. But you can reduce your risk by being more physically fit, even if high blood pressure runs in your family. ]]> Tue, 15 May 2012 00:00:00 -0400 Study: More People Have Multiple Diseases http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/study-more-people-have-multiple-diseases/ Increasing numbers of adults in the United Kingdom have multiple health problems, a new study... What Is the Doctor's Reaction? I am a primary care doctor. I take care of patients, for example, who have:
  • High blood pressure
  • Diabetes
  • Heart disease
  • Asthma or other respiratory concerns
  • High cholesterol
  • Headaches
  • Muscle and joint pain
No, I don't mean my patients have one of these problems. I mean I take care of some patients who have all of these problems at once. My patients are typical American adults. Most of them have at least four or five concerns on their medical "problem list." There is a lot for us to talk about each time we meet to review their health. Maybe you have several chronic (long-lasting) health problems, too. Health policy researchers in the United Kingdom just estimated that 23% of British adults have 2 or more medical illnesses. Among people older than 65, the majority have more than one chronic illness. There are several names for this. It's called "complex medical illness" or "multimorbidity" or sometimes "polypathology." With multiple problems, you can very quickly end up with a long list of medicines. About 25% of U.S. adults take more than 5 medicines on a regular basis. For older people, this is the norm. The majority of people over 65 take more than 5 medicines. Many people take more than 10 medicines regularly. A long drug list is not surprising for people with more than one condition. To control blood sugar in diabetes, most people need two medicines. To control high blood pressure, most people need two other drugs. If you have coronary artery disease, you are best off getting treatment with aspirin, a cholesterol drug and a beta-blocker medicine to prevent heart attacks. What is not predictable about such a long drug list is how these drugs will act all together. Thanks to research, doctors know a lot about how people who have one medical problem are likely to respond to treatment with one drug. But we have almost no studies that show how people with several problems at once are going to react to treatments. Nearly two out of three clinical trials -- the kind of studies that test new drugs -- exclude people who have more than one condition. So very often doctors guess about how different medicines -- and different diseases -- will behave when they are thrown together. What Changes Can I Make Now? If you have several medical illnesses, you should have a good primary care doctor who can coordinate your care. For older adults, this may be an internal medicine doctor (internist) or a geriatrician. When you have new symptoms, one of the first things you should do with your doctor is to look at your medicine list. You might be having a side effect from a medicine or from a combination of medicines. Always check with your doctor before you make any medicine change. In most situations, if your doctor says it would be safe, it is reasonable to stop a medicine for a short time to find out if it is causing the new symptoms. Sometimes a problem caused by a drug you are taking can be serious enough to put you in a hospital. About half of these serious events happen in people who are 65 or older, or have multiple medical problems. If you are older, or take more than 10 medicines, I recommend that you schedule a visit every year that is dedicated to a review of your medicines. At the start of that visit, talk to your doctor about your priorities. Sometimes a long list of medicines is the best way to care for you and help you to live longer. But for many people, a long drug list is more of a problem than it is a help. Too long a list creates financial stress. Medicine side effects may interfere with daily comfort or function. And keeping up with all of your medicines can be frankly overwhelming. What Can I Expect Looking to the Future? Doctors need more guidance in how to choose, and sometimes combine, treatments for people with more than one condition. The American Geriatrics Society (AGS) is doing its part to try to help improve care for these patients. Last year this society put together a group of concerned doctors to try to develop some reasonable guiding principles for doctors with more complex patients. Some of the comments were presented this month at a national meeting. More detail is expected this summer. The guiding principles are scheduled to be published in the Journal of the American Geriatrics Society. ]]> Fri, 11 May 2012 14:03:00 -0400 Study Links 'Social Jetlag' to Obesity http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/study-links-social-jetlag-to-obesity/ Waking up to an alarm clock might seem like a good way to get to work on time. But researchers... What Is the Doctor's Reaction? Just last week, a cousin came to visit. His job requires him to work late hours, so he routinely goes to sleep around 3 or 4 in the morning. He tends to get up close to noon. While he was visiting us, he needed a ride in the morning before we went to work. So he had to shift to earlier hours. I told him he was going to feel "jetlagged" even though he wasn't flying anywhere. As he went about his day trying to cope with a shift in his sleep schedule, my cousin was likely surrounded by other "jetlagged" people. That's because of a newly described condition called "social jetlag." With this condition, the body's internal clock is out of synch with the actual time of day. It can develop in anyone who doesn't get enough sleep. A common example is someone who uses an alarm clock to wake up. When the body is ready to sleep, it's time to go to work. As work extends later into the day, less time is available for sleep. And so the cycle repeats. All of this leads to chronic sleep deprivation. And that can mean daytime fatigue and sleepiness. Unfortunately, you can't quickly "reset" your internal clock. It's determined by cycles of light and dark that affect brain function and several hormones. When you travel to a new time zone, it can take days or weeks to change your internal clock. That makes it a challenge for travelers. And it's also a problem for those with social jetlag. New research is under way to study this. Researchers at the University of Munich are gathering information about how people sleep and how sleep affects their health and quality of life. One of their latest findings is that social jetlag may be linked with weight gain. In fact, it's possible that we can blame at least part of the increase in obesity on social jetlag. Other recent research has linked sleep deprivation with:
  • Abnormal blood sugar and insulin levels
  • Higher rates of smoking
  • Increased alcohol consumption
  • Increased caffeine use
These studies could lead to new advice about how you can get your body's clock back in synch with your work and sleep schedule. What Changes Can I Make Now? Avoiding social jetlag could be challenging for some people, especially if their job requires erratic hours. However, the best way to avoid sleep deprivation is get 7 to 9 hours of sleep each night. If that's difficult for you, the first step is to practice good "sleep hygiene." Here's what you can do:
  • Try to go to bed and get up at the same times each day. Avoid long naps during the day.
  • "Wind down" at night with a low-key activity such as reading or listening to calming music.
  • Exercise regularly, but avoid strenuous activity within a few hours of bedtime.
  • Avoid caffeine late in the day.
  • Drink only moderate amounts of alcohol. Avoid alcohol just before bed.
  • Drink less fluid late in the evening (so you don't have to get up to urinate).
  • Avoid large meals or spicy foods just before bed.
  • Keep your bedroom dark and quiet. Many people like to use ear plugs or a sleep mask. Others prefer "white noise" or a fan in the background.
This new sleep research could have far-ranging impact. For example, it could affect decisions about Daylight Savings Time. Abrupt changes in the settings of your clock may not sit well with your internal clock. It could also affect the time schools open. I've long thought teenagers might be better off if they could stay up late (as they seem naturally inclined to do), sleep late in the morning and start school at noon. Work environments might also take these findings to heart. Employers could reduce the need for erratic work hours. Providing more sunlight in the workplace and encouraging breaks to go outside could also help. In fact, these efforts could lead to better rested and more productive workers. What Can I Expect Looking to the Future? Sleep quality and quantity can have a big effect on quality of life. Increasingly, we are seeing that it can also impact health. For these reasons, I think you should expect to hear much more about the results of sleep research. I hope we'll hear not only about the ways poor sleep can be harmful but also about ways to sleep better. As the impact of sleep on health garners attention in the future, I think more people will make the effort to get more shut-eye. ]]> Thu, 10 May 2012 00:00:00 -0400 Oral Bacteria May Raise Risk for Some Cancers http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/oral-bacteria-may-raise-risk-for-some-cancers/ INTELIHEALTH - Exposure to a strain of bacteria that causes periodontal (gum) disease may increase... Porphyromonas gingivalis. This is one of the types of bacteria that can cause gum disease. P. gingivalis can also occur in a healthy mouth. An immune response shows that the body is reacting to the bacteria. After the exams and tests, researchers kept track of people for up to 12 more years. The researchers wanted to see if people with periodontal disease were more likely to die from oral cancers or cancers of the digestive tract. The researchers looked at these cancers:
  • Lip
  • Oral cavity
  • Pharynx
  • Esophagus
  • Pancreas
  • Stomach
  • Liver
  • Colon and rectum
  • Anus
Researchers found that people with gum disease were at increased risk of dying from cancers of the colon, rectum and pancreas. People who had an immune response to P. gingivalis but did not have periodontal disease were more likely to die from one of these cancers. The researchers did not look at each cancer specifically, however. The study looked only at deaths from these cancers. It could not study the risk of being diagnosed with them, and how that risk might relate to oral bacteria. The survey involved more than 12,000 people. However, there were not enough data on deaths from certain types of cancer. Other studies have linked periodontal disease with oral and digestive system cancers. This is the first study to relate P. gingivalis with the risk of cancer death in people who do not have gum disease. The study appears in the May issue of the journal Carcinogenesis.]]> Wed, 09 May 2012 00:00:00 -0400 Probiotics May Help Prevent Some Diarrhea http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/probiotics-may-help-prevent-some-diarrhea/ Products known as probiotics might help to prevent diarrhea after antibiotic treatment. That's... What Is the Doctor's Reaction? Many types of bacteria and yeast normally live on our skin, in our intestines and on other body surfaces. They're known as our "normal flora." When there's a balance in the normal flora, these bacteria do not invade beneath the surface they live on. They do not disrupt our normal body functions. And they do not make or give off toxic substances that could harm us. We take antibiotics to kill the bacteria that are causing an infection. But the antibiotics also kill these "good" bacteria, too. This upsets the natural environment in the intestines. The result is often loose, watery stools. This is called antibiotic-associated diarrhea. Most often, the symptoms start on the last day or two of treatment or shortly after the antibiotics are gone. The diarrhea is usually mild. There may be two to four loose stools per day for a couple of days. In most cases, it gets better quickly without treatment. Some people get very ill from antibiotic-associated diarrhea. The most severe form, called Clostridium difficile (C. diff) colitis, can be life-threatening. Probiotics have been widely promoted as a way to keep your body in balance. Probiotics contain bacteria found in the healthy normal flora of the gut. They are sold in the form of pills, yogurts and other preparations. The idea behind probiotics is to increase the populations of bacteria that seem to be present in good health. There's no good evidence that probiotics are useful in otherwise healthy people. But prior medical studies have suggested they work in some conditions, such as:
  • Treating C. diff colitis that keeps coming back, or doesn't go away, even with repeated courses of other treatments
  • Helping prevent further problems caused by pancreatitis
  • Decreasing repeated vaginal yeast infections
Probiotics also appear to decrease the risk of antibiotic-associated diarrhea. Researchers reviewed 82 clinical trials that were relevant to this question. The studies had to meet well defined criteria. According to the analysis, people who took a probiotic with an antibiotic had a 42% lower risk of diarrhea. What Changes Can I Make Now? The results of this study sound impressive. But I won't be advising probiotics every time I write a prescription for an antibiotic. Probiotics are generally considered safe. But the authors of this article note that side effects or adverse reactions are still possible. And most often antibiotic-associated diarrhea causes mild symptoms that go away quickly. I likely will advise that some people take a probiotic along with an antibiotic. But I must admit that there is not yet clear evidence for my personal advice. People who might benefit from a probiotic include:
  • People who have had antibiotic-associated diarrhea in the past. This is especially true for those who have had C. diff infection.
  • People receiving a prolonged course of antibiotics, more than 10 days. Note: This is very arbitrary and not based on data. Other doctors might prescribe if antibiotics are used more than 5 days.
  • People who have switched from one antibiotic to a different one within a relatively short period of time.
The researchers were not able to answer these important questions:
  • Which probiotics work best in preventing and treating antibiotic-associated diarrhea?
  • Which specific antibiotics are more likely to cause diarrhea?
The best way to keep your normal flora in balance is to take antibiotics only when you need them. What Can I Expect Looking to the Future? Most antibiotic-associated diarrhea is a mild nuisance. But C. diff colitis can be deadly. C. diff is best prevented by limiting the use of antibiotics and preventing the spread of the infection in hospitals and nursing homes. The contact precautions used include private rooms, strict hand washing, gloves and gowns. We don't know whether a probiotic prescribed on the first day of antibiotic treatment will decrease the rising number of C. diff cases. This question needs further study. ]]> Wed, 09 May 2012 00:00:00 -0400 Study: 42% Will Be Obese by 2030 http://www.planforyourhealth.com/living-healthy/health-news/diet-fitness/diet-fitness-details/newsarticle/study-42-will-be-obese-by-2030/ A new study says 42% of U.S. adults will be obese by 2030. Just over one-third are obese now. The... What Is the Doctor's Reaction? The rate of rise in obesity is slowing. But that won't be enough to decrease the number of people with a body mass index (BMI) of 30 or greater in the future. Unless there is a zero rate of increase, the obesity epidemic will get worse. People with a BMI of at least 30 are considered obese. Obesity is a complex problem. Scientists still struggle to understand it. In some cases, genes are the biggest factor. But in most cases, it's hard to determine the exact cause of obesity. It's difficult enough for a doctor to figure out why a patient has built up excess body fat. But what accounts for the rapid rise in obesity around the world? It's hard to understand how so many humans could add so many pounds in such a short period of time. In less than 40 years, the rate of obesity in the United States has increased by more than 50%. Two of three U.S. adults are now overweight or obese. The newest prediction is that 42% of Americans will be obese by 2030. As many as 11% will weigh over 100 pounds more than they should. The cost is huge, an estimated $223 billion a year in the United States. And it's not just financial costs. One American out of 10 dies because of health problems related to excess body fat. Quality of life suffers because obesity increases the risk of so many conditions, including:
  • Diabetes
  • High blood pressure
  • Heart disease
  • Some cancers
  • Arthritis
  • Fatty liver disease, which can lead to cirrhosis
What Changes Can I Make Now? We may not fully understand this sudden rise in obesity. But we have known for years how to at least turn the tide. It's the simple formula you hear about constantly:
  • Eat healthier foods.
  • Decrease your daily intake of calories.
  • Burn more calories by being physically active every day.
Even if your genes are against you and everyone in your family is obese, diet and exercise can modify what seems like destiny. Based on studies of people able to lose weight, here are some tips that might help you eat better and be more active:
  • Eat breakfast. If possible, have yogurt. Yogurt eaters tend to maintain healthier weights.
  • Stay away from potatoes. They are not a vegetable.
  • Watch less television. TV is the enemy of exercise and the friend of snacking.
  • Get enough sleep but not too much. People who sleep too little (less than six hours a day) or too much (more than nine hours a day) are more likely to gain weight.
  • Don't overeat or skip exercise on weekends. Be consistent day to day.
  • Weigh yourself regularly. Seeing a couple of extra pounds on the scale can motivate you to get back on track.
  • Always choose the lower-calorie foods. Of course, that's unrealistic. But if that is your mindset, you have a good chance of making the healthier decision.
What Can I Expect Looking to the Future? We know what we need to do. Still, actually doing these things is harder than ever. We have easy access to lots of foods. And new inventions continue to allow us to accomplish tasks with no or very little physical exertion. We will need to find ways to give people financial incentives for maintaining a healthy weight. It's no easy task. ]]> Tue, 08 May 2012 00:00:00 -0400 Requirements Boost Middle School Shots http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/requirements-boost-middle-school-shots/ Middle school children are more likely to get recommended shots if their states require them, a... What Is the Doctor's Reaction? When schools require kids to get shots, vaccination rates rise. This sounds obvious, but researchers from the U.S. Centers for Disease Control and Prevention (CDC) wanted to know how much the rates rise. They were particularly interested in middle school children, ages roughly 12 to 14. Some shots are recommended at this age. But as children get older they often go to the doctor less. So the rates of vaccination (immunization) at this age aren't as high as for younger children. The study focused on a few vaccines given to middle school children. Two of them are Td and TdaP. Children usually receive one or the other. Both protect against tetanus and diphtheria. The second one is preferred because it also protects against pertussis. Here's what the researchers found. In the 32 states where Td or TdaP is required, 80% of the children got the shots. The rate was 70% in the states where it is not required. Why is this important? We have been seeing more outbreaks of pertussis, also known as "whooping cough." This illness can be very dangerous. For infants, it can be deadly. By preventing the illness in youth and adults, we prevent it from getting to the infants. Meningococcemia is a very dangerous, often fatal infection. It can strike quickly and unexpectedly. The study also looked at Menactra, a vaccine against this disease. In the 3 states where Menactra is required, 70% were immunized versus 53% in the other states. This difference certainly translates into saved lives. Some states don't require these shots but do require that parents be "educated" about them. Usually this is done by sending home written materials. The researchers found that education, or at least this kind of education, did not increase immunization rates. There are parents who do not wish to immunize their children. Many of them chafe at being "forced" to immunize in order to send them to public schools. States have exemptions for children who can't be immunized for medical reasons. Many of them have exemptions for people whose religious beliefs or traditions do not allow immunization. Some states have "philosophical" exemptions for families who simply do not want to immunize. Shots and other immunizations are medical treatments. Like all medical treatments, they carry risks. All vaccines are carefully tested before being licensed. Their safety is continuously monitored. The vast majority of problems that occur are minor, such as fever or pain at the site of the injection. But more serious side effects are certainly possible. This is what worries some parents. However, it's important to remember that the risks of every vaccine-preventable illness are much higher than the risks of the vaccine. Many people don't remember or understand this for the simple reason that vaccines have made the illnesses rare. And because they are rare, some parents think that vaccines aren't needed. It is true that when enough people get their shots, it creates something we call "herd immunity." That helps to protect those who aren't immunized, including the very young and those who can't get vaccines for medical reasons. But you need enough people. And that's where school immunization requirements have made such a difference. They prod people into getting them done, and help keep everyone safer. Recently, we have seen more cases of vaccine-preventable illnesses in the news. They have included not just pertussis but mumps and measles as well. Most outbreaks have been started by visitors from other countries where these illnesses are common. These cases have made it very clear that we can't rely on herd immunity; we need to raise the immunization rates. To do that, we are going to need school requirements. We also will need to have engaged, honest discussions with parents who hesitate about vaccines. As unfair as some people may feel it is to force them to immunize their children, it's really unfair to expect others to immunize so that your child can be safe. We need to find a solution that's fair to both groups. What Changes Can I Make Now?
  • If your school has immunization requirements, follow them. You help your child and the community, too.
  • Make sure you take your child for a yearly physical examination. That way, you can be sure he or she gets all the vaccines available.
  • If you have questions or concerns about vaccines, visit the Vaccines and Immunizations page of the CDC website. It's full of information about vaccines, vaccine safety and vaccine-preventable diseases.
What Can I Expect Looking to the Future? I hope that this study will encourage other states to institute or strengthen immunization rules for their students. And I hope it will encourage discussions that increase the number of children who are immunized. If we can do that, we will save lives -- and make our children, and all of us, healthier. ]]> Mon, 07 May 2012 13:42:00 -0400 New Guidelines for Lupus Kidney Disease http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/new-guidelines-for-lupus-kidney-disease/ New expert guidelines should help doctors treating people with lupus kidney disease. Systemic... What Is the Doctor's Reaction? I welcome new guidelines, especially to help doctors diagnose complex diseases. Systemic lupus erythematosus is one of those diseases. It's also called lupus or SLE. This disease affects women much more often than men. It often appears in late teens or early adulthood. Most people with lupus have fairly mild disease and a good prognosis. From time to time, they have bouts of joint pains, low-grade fever and fatigue. There are many other possible symptoms. Each person tends to have a little different set of symptoms when the lupus flares up. But lupus is very unpredictable. It can start with mild symptoms and remain relatively mild and easy to treat for many years. Or it may get worse over time. Or it can make a person very ill right from the start. The three main worries in people with lupus are:
  • Kidney disease leading to kidney failure -- Kidney failure requires dialysis or a kidney transplant.
  • Faster hardening of the arteries and coronary artery disease -- This is related to long-term inflammation.
  • Infections -- Lupus itself causes changes in the immune system. The drugs needed to control lupus also greatly increase the risk of infections.
Lupus kidney disease is especially hard to treat. First, about 40% of people with lupus don't get kidney problems that impact their lives. For the people who do have it, kidney disease varies in much the same way as other aspects of lupus. In some people, it can be mild and stable for years. In others, it can lead to kidney failure within weeks if not treated. Kidney damage from lupus is caused by the attack of auto-antibodies. These are proteins made by the immune system that attack our own tissues and cells. They can damage the kidneys in different ways. Treatment for lupus kidney disease must be tailored to the specific type of kidney damage. A panel appointed by the American College of Rheumatology wrote the guidelines. To do this, they first reviewed many studies and considered the opinions of experts. The panel makes it clear that these are recommendations. They are not meant to prescribe the best treatment for every person with lupus kidney disease. What Changes Can I Make Now? If you have lupus and are uncertain about whether your kidneys are involved, ask your doctor for the results of 2 standard tests:
  • A urine analysis to find out if you have one or more of the following in your urine:
    • Protein
    • Red blood cells
    • White blood cells
    • Casts (tubes of debris or cells)
  • A blood test for creatinine -- A higher than normal level indicates reduced kidney function.
If you have any signs of kidney disease, your doctor will likely suggest you take a medicine called hydroxychloroquine (Plaquenil). It also helps to limit symptoms of lupus and how often they flare up. If you have signs of kidney disease, your doctor may also suggest a kidney biopsy. The amount of protein in the urine or number of cells seen on a urine analysis does not reflect well what is actually happening to the kidneys. A biopsy is the only way to know for sure. If you have any protein in your urine, your doctor will probably prescribe another drug. This will be either an angiotensin converting enzyme (ACE) inhibitor or an angiotensin blocker (ARB). These drugs are most often used to treat high blood pressure. But for people with kidney disease and protein in the urine, they help protect the kidneys from failing. They work even if your blood pressure is normal. Other, more potent drugs may be prescribed. This will depend on the biopsy results, the rate at which kidney function is getting worse, or both. What Can I Expect Looking to the Future? These guidelines will help doctors care for people with lupus kidney disease. They also will help researchers to find even better treatments for kidney disease in the future. Any potential new and different treatment can be compared with those in the treatment guidelines.]]> Fri, 04 May 2012 12:46:00 -0400 2 Blood Thinners Equal for Heart Failure http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/2-blood-thinners-equal-for-heart-failure/ Aspirin and warfarin (Coumadin) are equally effective in preventing strokes and death for many... What Is the Doctor's Reaction? Doctors often must provide treatment advice based on incomplete information. Research studies may not have settled a particular issue. Or the ideal study may have never been done. The question of which blood thinner is best for people with heart failure is a good example. With heart failure, the heart does not pump as forcefully as it should. As a result, fluid backs up into the lungs, legs or both. Blood clots can form in the legs or in the heart itself. They are caused by sluggish blood flow and by changes in the blood. A blood clot that travels to the lungs or the brain can have devastating results. The clot can cause difficulty in breathing, stroke or even death. It's not known whether blood thinners, such as aspirin or warfarin (Coumadin), can safely fix this problem. And if they can, which blood thinner is best? A new study asks whether aspirin or warfarin is a better blood thinner for people with heart failure. The study included more than 2,300 people with severe heart failure. They were randomly assigned to receive either aspirin or warfarin. Researchers kept track of them for up to 6 years. Here's what they found out:
  • The overall rate of major problems was similar for both treatment groups. These included stroke, bleeding into the brain and death.
  • The rate of strokes caused by a blood clot was lower in the warfarin group. But they also had more episodes of serious bleeding.
While helpful, this study is unlikely to be the last word on the matter. Why?
  • It did not have a group that took only a placebo (fake pills). Some people with heart failure may have no other reason to take a blood thinner, such as a previous blood clot. It's possible they would do just as well without the pills.


  • The study included relatively few people with narrowed arteries near the heart. They might benefit more from warfarin than other patients. The study also excluded those with mild heart failure.


  • No one was treated with one of the newer blood thinners, such as dabigatran or rivaroxaban. It's easier to pick the right dose of these newer drugs than it is for warfarin. A newer blood thinner might have been safer and more effective than warfarin or aspirin.


  • The study excluded people with an abnormal heart rhythm called atrial fibrillation. Stroke risk is higher in people with atrial fibrillation than for those with a normal rhythm. For people with this condition, studies suggest that warfarin is better than aspirin.


Still, this study's results could lead to a change in practice, at least until the role of the newer blood thinners is clearer. Aspirin is easier to use and monitor than warfarin. If a blood thinner is recommended for severe heart failure, aspirin should be the preferred choice. What Changes Can I Make Now? You can make changes now that could reduce your risk of developing heart failure.
  • Adopt a heart-healthy diet. This means more fruits, vegetables and whole grains. Also limit saturated and trans fats.
  • Start an exercise program. If you're not used to exercising, ask your doctor to recommend a program. Meeting with a physical therapist or a personal trainer may be helpful.
  • Do what you can to maintain a healthy body weight. If you're overweight or obese, increase your physical activity and cut back on calories.
  • Get your blood pressure, blood sugar and cholesterol checked regularly. If they are not in an ideal range, talk to your doctor about medicines and other treatments.
  • Get your heart murmur checked out. If you've been told you have a heart murmur, ask your doctor if it could lead to heart failure or other health problems. Ask whether you need treatment.
  • Don't smoke.
  • Drink less alcohol. A reasonable guide is no more than 1 drink per day for women and no more than 2 per day for men.
If you have already been diagnosed with heart failure, see your doctor regularly. The doctor will check on how you are doing and adjust your treatments if needed. You also have an important role to play.
  • Limit your salt intake.
  • Keep an eye on your weight. A rising weight could mean you're retaining fluid because your heart failure is getting worse. This is a particular concern if you have gained pounds in just a few days. Let your doctor know about weight gain right away.
  • Take your medicines as prescribed.
  • Consider all of your treatment options. Surgery or a heart transplant may be recommended for certain types of heart failure or if other treatments aren't working.
What Can I Expect Looking to the Future? Heart failure is a common and serious condition. Therefore, I expect researchers to continue comparing treatment approaches for some of the problems it can cause, such as blood clots. For example, we need good studies of whether newer blood thinners can help people with heart failure. I hope we'll also see more studies about ways to prevent heart failure. ]]> Thu, 03 May 2012 13:26:00 -0400 Blood Test May Help Predict Breast Cancer http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/blood-test-may-help-predict-breast-cancer/ A blood test may be able to predict a woman's risk of breast cancer years ahead of time, a new... What Is the Doctor's Reaction? In the 1950s, breast cancer was considered a single disease. The standard treatment was radical mastectomy. This was followed by radiation. Even that harsh regimen didn't always cure it. The next "advance" was to add drug treatment (chemotherapy) to prevent cancer from returning. This did increase cure rates. But there was a trade-off. The side effects included increased risk of infection, nausea, hair loss and numbness from nerve damage. The one-size-fits-all approach wasn't due to medical ignorance. Researchers had long suspected that breast cancers weren't all the same. During the last 30 years, they have learned more. They have found out how to tell which breast cancers are more likely to need which treatment. For example, some women can have a lumpectomy. This removes much less of the breast than a mastectomy. Some women need chemotherapy and/or hormone therapy. Others do not. Advances in molecular biology, such as gene research, also have had an effect. This research is helping doctors treat breast cancer in a way that is more specific to each person. However, we have made less progress in preventing breast cancer or finding it early. Mammograms for all women ages 50 to 75 has been the standard approach for decades. We still debate whether women ages 40 to 49 who have an average risk of breast cancer should be screened. Small strides made in gene research do help to guide decisions about more intensive screening. For example, women with BRCA gene mutations have a very high risk of developing breast cancer. They usually start having mammograms or magnetic resonance imaging (MRI) breast exams at a young age. Some decide to have a mastectomy to prevent cancer. Finding more genes linked with increased breast cancer risk solves only one part of the puzzle. Scientists are also learning how our bodies modify genes. These changes can make genes more or less likely to stimulate cancer growth. In the May 1 issue of Cancer Research, scientists report discovery of one type of gene change. The study found that it that it doubles a woman's breast cancer risk. The study included 640 women with breast cancer and 741 without cancer. Researchers were able to analyze blood samples that were taken an average of 3 years before the start of the study. Women who developed breast cancer had the gene change present before diagnosis much more often than the women without cancer. These kinds of tests will help doctors better adapt screening to each woman. What Changes Can I Make Now? The experts continue to debate how often and at what age women should start getting mammograms. You and your doctor can decide what strategy is best for you. Consider your personal risk factors, such as:
  • Family history -- Women who have two or more first-degree relatives with breast or ovarian cancer have a greater than 50% chance of developing breast cancer. A first-degree relative is a mother, daughter or sister.


  • Breast density -- A mammogram will show if you have dense breast tissue. Women with dense breasts have a higher risk of breast cancer than women whose breasts contain more fat. The greater the proportion of dense breast tissue on a mammogram, the higher the risk.


  • Exposure to radiation -- Women who have had high-dose radiation to the chest have an increased risk of developing breast cancer. Radiation usually was done as part of treatment for another cancer (such as Hodgkin disease). The risk is especially high if a woman had radiation treatment as a teenager.


  • Diethylstilbestrol (DES) exposure -- This drug was used from the 1940s through the 1960s to prevent miscarriage. It has since been banned. Women who took DES have a slightly higher risk of developing breast cancer. Their daughters may also.


  • Weight -- Being overweight or obese has been linked to breast cancer risk, especially for women after menopause. However, the relationship is complicated.


  • Alcohol -- Women who drink alcohol have a higher risk of breast cancer than women who don't drink. The risk rises with the number of drinks consumed.


  • Other cancers -- Breast cancer risk is higher in women who have been diagnosed with cancers of the ovary, colon or endometrium.
What Can I Expect Looking to the Future? You can expect to see many discoveries in molecular biology. Some of these eventually will lead to a better understanding of your risk of cancer and other diseases. But we are years away from knowing which will actually be useful. ]]> Wed, 02 May 2012 13:54:00 -0400 Oral Health May Affect Fertility http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/oral-health-may-affect-fertility/ INTELIHEALTH - Non-white women with periodontal disease may have more problems becoming pregnant,... ]]> Wed, 02 May 2012 00:00:00 -0400 Painkiller Withdrawal Triples in Newborns http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/painkiller-withdrawal-triples-in-newborns/ The growth of painkiller use and abuse has led to another surge in drug dependence, this one... What Is the Doctor's Reaction? Treating pain is the duty of all doctors. Powerful medicines can help us. Sounds easy, right? Yet the downsides are also powerful. The medicines don't work for everyone. Some people become addicted or use the medicines inappropriately. During the last 10 years, use of prescription pain medicines called opiates has increased dramatically. These medicines include oxycodone (Oxycontin), morphine and others. Overdoses have increased dramatically as well. This is a national problem. It is particularly evident among teens and young adults in rural areas. Young women are among the abusers of these drugs. So there is a second concern -- babies born with opiate dependence. This new article addresses something called neonatal abstinence syndrome (NAS). Between 60% and 80% of babies newly born to mothers who are taking these drugs -- legitimately or not -- have withdrawal symptoms. They include tremors, poor ability to feed, diarrhea, seizures and trouble breathing. Such babies require time in intensive care. Many of them stay in the hospital for more than 2 weeks after birth. This costs the health care system up to $50,000 per baby. The authors of this study looked at a large database of information on children admitted to U.S. hospitals. They found that the risk of NAS tripled between 2000 and 2009. At the same time, the use of opiates by mothers increased five-fold. State programs paid the majority of costs for treating the babies. Why is this important? The authors bring up several issues that are key to all of us as we think about health and health policy. In Florida, for example, the risk of dying from a prescription drug overdose is four times higher than the risk of dying from an illegal drug overdose. The number of addicted babies in the state has increased five-fold. Money we spend caring for these sick babies is money that can't be spent on everything from repairing roads and bridges to education to maintaining green spaces. It impacts all of us in different ways. Most importantly, it impacts two generations -- babies and mothers -- who are the future of our country. This article suggests that we need to do more to prevent the problem. We also need to provide more efficient care for its adult and child victims. What Changes Can I Make Now? If you live with chronic (long-term) pain, explore options with your doctor. In many cases, opiate pain medicines are perfectly appropriate. But consider alternatives, too. These include various kinds of pills as well as other treatments, such as steroid injections. Some people really benefit from exercise, physical therapy, acupuncture or even massage. It's unlikely that any one treatment will make pain disappear completely. The goal is to manage pain and gain function in your life. Some people have a higher risk of addiction, or using powerful medicines incorrectly. They include people who have:
  • A personal or family history of addiction, especially to prescription medicines
  • Certain mental health problems
  • A history of being abused in childhood
If you have a history of addiction, tell your doctor. Work with him or her to treat your pain safely. If you know or are concerned about a young person who is abusing prescription medicines, be honest with them. Don't ignore the problem or make excuses for them. Try to get them help. A drug-using woman who is pregnant needs help right away! Your doctor may be a good place to start. So is this U.S. government website. It includes resources to help people find treatment for addiction. What Can I Expect Looking to the Future? This is an important, well-done study that outlines a growing public health issue for the United States. It answers many questions, but brings up many more. I expect that the information in this report will help to focus attention on the use and abuse of prescription opiates in young people. I think we will see more attempts to decrease addiction and find better ways to care for newborns with NAS. ]]> Tue, 01 May 2012 00:00:00 -0400 Early Menopause May Increase Fractures http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/early-menopause-may-increase-fractures/ Women who go through menopause early may be more likely to have osteoporosis and broken bones, a... What Is the Doctor's Reaction? Early menopause increases the risk of osteoporosis, fractures and a shorter life, a new study finds. The research was published online in the journal BJOG. Prior studies often suggested similar results. But not all of them did. Some showed no link between early menopause and greater fracture risk or shorter lifespan. The researchers in the new study defined early menopause as no menstrual periods for 12 months before age 47. Late menopause was defined as occurring at age 47 or older. The study, done in Sweden, began in 1977. All 390 women were 48 years old when the study began. Of these, 61 had early menopause and 329 had late menopause. By age 77, 198 of the women were alive and still in the study. Researchers were able to interview them and do bone mineral density studies. Women with early menopause were almost twice as likely to have osteoporosis as women with late menopause. This disease causes brittle bones. Early menopause increased the rate of broken bones related to osteoporosis by 68%. Only 48% of the women with early menopause were alive at age 77. Of the women with late menopause, 65% were still living. The researchers were not able to find out why there was a greater risk of osteoporosis, fractures and early death in women with early menopause. But estrogen is well known to help strengthen bones. The average age of menopause for the early group was 42. The researchers did not have the average age of menopause for the late group. The average age of menopause in Western countries is 51. A woman who reaches menopause at 51 has had 9 more years of estrogen than a woman who reached menopause at 42. So she is starting the rest of her life with a much higher bone density than a 51-year-old woman with early menopause. What Changes Can I Make Now? The current advice is to use estrogen after menopause only to decrease symptoms. These symptoms include hot flashes, especially those that interrupt sleep, and dryness in the vagina. The estrogen dose should be the lowest effective amount for the shortest period of time. New research suggests that the scare about estrogen treatment for some women after menopause may be overblown. Some studies have found that women taking estrogen-only treatment soon after menopause may actually have a lower risk of heart disease and breast cancer. Estrogen-only treatment means no progesterone. Taking estrogen along with progesterone increases breast cancer risk. Women take progesterone with estrogen mainly to decrease the risk of cancer of the uterus. This is also called endometrial cancer. If a woman has had a hysterectomy to remove the uterus, progesterone is not needed. For women who have a uterus, there are ways to screen for early-stage endometrial cancer with ultrasound and biopsy. This provides an option for estrogen-only therapy. However, most gynecologists still recommend progesterone. If you have early menopause, it's surely reasonable to consider estrogen treatment until age 50 or perhaps a bit longer to help protect your bones. That's an easy decision if you don't have a uterus. You can take estrogen without progesterone. If you do have a uterus, things get more complicated. You will need to weigh the added risk of breast cancer with estrogen plus progesterone vs. the increased risk of endometrial cancer with estrogen only. Discuss the risks and benefits with your doctor. What Can I Expect Looking to the Future? Based on newer evidence, I think women who have recently reached menopause will start taking estrogen more often than they do now. I suspect that five years of estrogen treatment will become more accepted. But I hesitate to make any prediction, especially about the future of estrogen treatment. ]]> Mon, 30 Apr 2012 00:00:00 -0400 Exercise, Healthy Diet Urged after Cancer http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/exercise-healthy-diet-urged-after-cancer/ Exercise and healthier eating may help to keep cancer from returning after treatment, the... What Is the Doctor's Reaction? About 1 in every 25 Americans is a cancer survivor. The total number is 12 million. And it's growing rapidly. A cancer survivor is a living person diagnosed in the past with cancer. This does not include anyone who had basal cell or squamous cell skin cancer that did not spread. Today most cancer survivors are living more than five years. Almost half of them die from another disease or a cancer that started in a different organ. Heart disease, stroke and other blood vessel diseases are still the most common cause of death in the United States. So it's not surprising that these diseases cause the majority of deaths in long-term cancer survivors. Receiving a new diagnosis of cancer begins an intense period, usually lasting many months. Most often the focus is on the cancer treatment. Patients and their families also have to deal with the emotional impact. And patients must cope with the side effects of therapy and the big question of survival. When your treatment finishes, you begin cancer survivorship. There is a new set of questions. Do you go back to the routine you had before you were diagnosed with cancer? Or do you need to change how much and what you eat? Should you exercise more or less? Until recently, diet and exercise have received little attention for cancer survivors. The American Cancer Society (ACS) has published new guidelines to help patients and their doctors get some answers to these questions. The society has based the guidelines on observational studies. Observational studies can show a link between lifestyle choices and outcomes. Results from studies like these cannot be considered proof of cause and effect. But they do provide useful information to help guide cancer survivors and their doctors. What Changes Can I Make Now? Advice about diet and exercise for the cancer survivor is very personal. Some people become weak and lose a lot of weight during treatment. For them, the main goals will be to get enough calories, protein, vitamins and minerals. Any physical activity should be followed by a period of rest. Other survivors have a good appetite and a reasonable energy level. For them, diet and exercise goals will be similar to what is recommended for healthy people. Maintaining a healthy weight helps to decrease the risk of multiple cancers. These include cancers of the breast, uterus and colon. And obese men are more likely to develop an aggressive type of prostate cancer. Whether a normal weight improves prognosis once cancer is diagnosed is unclear. Here's what the cancer society recommends about exercise for cancer survivors:
  • Return to your normal level of physical activity as soon as possible.
  • Increase your amount of physical activity beyond this level over time.
  • Do moderate-intensity aerobic exercise for at least 30 minutes at a time, 5 times per week. (I recommend trying to increase this to 60 minutes most days of the week.)
  • Do strength training at least twice per week, but not more than every other day.
Here are the basic components of a healthy diet:
  • Eat plenty of fruits and vegetables.
  • Use vegetable oils, not butter or shortening, for cooking and salads.
  • Limit saturated fats.
  • Get carbohydrates from whole-grain products.
  • Avoid simple sugars.
What Can I Expect Looking to the Future? Publishing guidelines for healthy lifestyle choices in cancer survivors was a much needed move. But the cancer society admits that this is only a first step. Further research will provide us with more personalized advice in the future. ]]> Fri, 27 Apr 2012 13:15:00 -0400 Less Radiation to Find Appendicitis http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/less-radiation-to-find-appendicitis/ Doctors may be able to diagnose appendicitis with a scan that uses a much lower dose of... What Is the Doctor's Reaction? Some things I learned in medical school surprised me. One of the most surprising was about appendicitis. I learned that it was common for doctors to strongly suspect appendicitis, then to find a normal appendix during surgery. When I was training, the estimate was that about 10% of these operations removed a normal appendix. To me, that seemed like a lot of surgery that was not needed. Yet it was considered acceptable. That's because, in those days, you couldn't be sure before going to surgery. And, if you weren't sure, it was better to operate on a person who didn't have appendicitis than to not operate on someone who did. The word "appendicitis" means inflammation of the appendix. The appendix is found in the lower right portion of the abdomen. It's near where the small and large intestines meet. Treatment usually requires emergency surgery to remove the appendix. Delayed surgery can lead to problems such as infection, perforation (a hole in the intestine) or death. While it's still not perfect, the diagnosis of appendicitis is much more accurate now than it was 30 years ago. That's largely because of imaging tests such as ultrasound and CT scanning. They have helped doctors confirm an inflamed appendix and avoid operations on people who don't have it. That's good news. But the increased use of CT scanning means that many people are exposed to radiation. This is particularly worrisome because children and young adults are most likely to develop appendicitis. They also have the largest risk from radiation. A new study addresses this concern. It included nearly 900 people with suspected appendicitis. They were randomly assigned to have a CT scan with either standard or low-dose radiation. The researchers compared the number of people who went to surgery for "false-positive" scans. These are scans that seem to show appendicitis when the appendix is actually normal. This study found that:
  • The false-positive rate was low, and similar for both types of scans. It was 3.5% for low-dose and 3.2% for standard-dose scans.
  • The rates of perforation and the need for more imaging tests were also similar.
In recent years, studies have shown a dramatic increase in the radiation people get from medical tests. Some have suggested this could increase cancer risk and other problems. So limiting radiation during medical tests is a worthy goal. This study could help. If confirmed by others, this study could lead to lower radiation use during CT scanning for people who might have appendicitis. What Changes Can I Make Now? It may seem impossible for you, as a patient, to limit the amount of medical radiation you receive. After all, doctors recommend which tests to have. You may feel you have little say. Still, I think it is possible to take an active role in limiting your exposure:
  • Ask questions about the tests you are having, such as:
    • Is there an alternative test (such as ultrasound) that provides less or no radiation?
    • How accurate is this test? Are the results likely to change my treatment?
    • Have I had this test before? If so, is it important to repeat it?
  • Tell your doctor about tests you've had that he or she may not know about. For example, if your gynecologist orders a CT scan and the facility is separate from your other doctors, let all of them know.
  • Make sure you wear the protective covering offered by the technician; if you aren't offered one, ask about it
  • Keep a record of any testing you've had. Make it available to your doctors.
Increasingly, systems are being put into place to keep track of how much radiation each patient has received. That can be helpful. But it may not work well if you have tests done in more than one place and each place has a different system. We don't know the cause of appendicitis, so there is no way to prevent it. But it's a common condition. About 1 person in 500 has appendicitis in the United States each year. About 1 child out of 250 requires an appendectomy by age 14. So it pays to know the symptoms of appendicitis. They include:
  • Pain -- It often starts as a pain throughout the abdomen (belly), but later focuses on the right lower part.
  • Nausea and vomiting
  • Fever
  • A change in bowel habits, including an inability to pass gas
If you have major abdominal pain, seek medical attention right away. Especially seek care if you have any of these other symptoms, too. What Can I Expect Looking to the Future? You can expect that in the future much more attention will be paid to radiation exposure during medical testing. This study looked at appendicitis. But it's likely that many other conditions could be evaluated with less radiation. You can also expect to hear more about hospitals and medical imaging centers developing ways to track radiation exposure for their patients. Eventually, such systems will be able to "talk" to one another. This should make it much easier to track each person's radiation exposure. ]]> Thu, 26 Apr 2012 00:00:00 -0400 Only 13% in U.S. Have High Cholesterol http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/only-13-in-us-have-high-cholesterol/ Though Americans have high levels of obesity, only 13% have high total cholesterol. That's the... What Is the Doctor's Reaction? About 25% of Americans ages 45 and older took a statin drug in the years 2005-08. That's up from just 2% in 1988-94. These numbers come from the National Center for Health Statistics. There are roughly 127 million Americans over age 45.So that means there are almost 32 million statin users. That's equal to the entire populations of Florida and Georgia combined. Are too many people taking a statin or not enough? Before we tackle that thorny question, here's the good news. Just over 13% of Americans have high total cholesterol levels. This is much better than the government's 17%. The results are based on a survey done in 2009 and 2010 by the U.S. Centers for Disease Control and Prevention (CDC). The CDC defined high total cholesterol as 240 milligrams per deciliter (mg/dL) or greater. The CDC did not find out why cholesterol levels continue to fall. It would be great to attribute this to healthier eating and more exercise. But the more likely reason is the huge increase in the number of people taking statins or other drugs to lower cholesterol. Let's go back to the question of too much or too little statin use. People who would say "too much" believe that many of those who take statins for slightly high cholesterol are at low risk of heart disease and stroke. They therefore are not really getting any benefits. The main reason for taking a statin is to reduce risk. Simply lowering a number does not make you feel better, have better health or live longer. So, this group says, why take a medicine that might have side effects? Those in the "too little" camp say that what we call a normal cholesterol level is really much too high. They say a normal cholesterol level should be under 150 mg/dL. And they say high cholesterol is not just a number. Coronary artery disease, stroke and other blood vessel diseases are the No. 1 U.S. cause of death. Many people who develop these conditions have cholesterol levels well within the so-called normal range. What Changes Can I Make Now? You should be on a statin if you have:
  • Coronary artery disease
  • Chronic (long-term) kidney disease
  • A prior heart attack or stroke
Statin treatment also is usually needed if you have a high LDL cholesterol level and diabetes or other factors that increase your risk of heart attack or stroke. An extremely high LDL almost always requires a statin or other drug to lower cholesterol. Otherwise, diet and exercise are the best treatment to try first. Different foods lower cholesterol in various ways. Some deliver soluble fiber. This type of fiber binds cholesterol in the digestive system and drags it out of the body before it can get into circulation. Some foods give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols. They help to block the body from absorbing cholesterol. Here are 10 specific foods you can eat to lower your cholesterol level.
  1. Oats -- Start your day with a bowl of oatmeal or a cold, oat-based cereal such as Cheerios for breakfast.
  2. Barley and other whole grains -- Like oats and oat bran, barley and other whole grains can help lower the risk of heart disease. They do this mainly by supplying soluble fiber.
  3. Beans are especially rich in soluble fiber. They also take a while for the body to digest. You feel full longer after a meal. That can help you lose weight.
  4. Eggplant and okra -- These two low-calorie vegetables are good sources of soluble fiber.
  5. Nuts -- Almonds, walnuts, peanuts and other nuts lower LDL. They have additional nutrients that protect the heart in other ways.
  6. Vegetable oils -- Use liquid vegetable oils such as olive, canola, sunflower, safflower and others. Using these oils in place of butter, lard or shortening helps lower LDL.
  7. Apples, grapes, strawberries and citrus fruits -- These fruits are rich in pectin, a type of soluble fiber that lowers LDL.
  8. Foods fortified with sterols and stanols – The foods include margarines and some others. Sterols and stanols extracted from plants gum up the body's ability to absorb cholesterol from food.
  9. Soy -- Eating soybeans and foods made from them, such as tofu and soy milk, can lower LDL by 5% to 6%.
  10. Fatty fish -- Eating fish two or three times a week can lower LDL in two ways. Fish replaces meat, which has LDL-boosting saturated fats. It also provides omega-3 fats that help to lower LDL.
While exercise won't lower LDL, it will raise your HDL (the good cholesterol). Even if these numbers don't change, exercise reduces your risk of heart attack and stroke later in life. What Can I Expect Looking to the Future? The total cholesterol goal needs to be lower than 240 mg/dL. And rather than looking at total cholesterol, the government should use either LDL cholesterol or non-HDL cholesterol to track our progress in the future. Non-HDL cholesterol is the total cholesterol minus the HDL cholesterol. These numbers are better predictors of heart attack risk. (For reference, an excellent LDL level is less than 100 mg/dL. An excellent level of non-HDL cholesterol is less than 130 mg/dL.) ]]> Wed, 25 Apr 2012 13:50:00 -0400 Periodontal Disease and Heart Disease: What Is the Connection? http://www.planforyourhealth.com/living-healthy/health-news/healthy-living/healthy-living-details/newsarticle/periodontal-disease-and-heart-disease-what-is-the-connection/ INTELIHEALTH - Current published research supports a link between periodontal disease and heart...
  • Body-wide inflammation may increase a person's risk of both conditions. This inflammation could begin as early as childhood and slowly get worse.
  • Antibodies to the bacteria that cause periodontal disease may also react to proteins found in blood vessels. This could cause damage that could lead to heart disease.
  • The bacteria that cause periodontal disease could enter the blood stream. From there, they could grow on plaque found in the arteries. These bacteria also could cause inflammation in the blood vessels.
    • The authors encourage more study. They suggest that future research include:
    • Standard definitions and criteria for who has periodontal disease and how extensive and severe the disease is
    • Standardized treatment for periodontal disease
    • A closer look at the effects of periodontal treatment on inflammation throughout the body, over a longer time period
    • Long-term studies, since heart disease develops over time and periodontal disease can come back after treatment
    "Treating periodontal disease improves the health of the mouth," Dr. Albert said. "It is important for patients with periodontal disease to receive treatment. We will await future research studies to determine if periodontal treatment can improve cardiovascular health as well." The statement appears in the April 18 issue of the journal Circulation.]]>     Wed, 25 Apr 2012 00:00:00 -0400     A Guide to Migraine-Prevention Drugs http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/a-guide-to-migraine-prevention-drugs/ Most people who can be helped by medicines to prevent migraines don't take them, a new report... What Is the Doctor's Reaction? People often use the term migraine to describe any severe headache. But not all severe headaches are migraines. And a mild headache can still be a migraine. That's not to minimize how awful migraines can be. Besides the headache, a migraine can bring nausea and vomiting. You also can have a sensitivity to light and sound so extreme that it puts you to bed. The migraine headache tends to produce pain that begins on one side of the head. The pain often has a pulsating quality. People with so-called classic migraine have an aura before the pain starts. The aura is usually flashing lights or zigzagging lines. Sometimes there's a temporary vision loss. But many people with migraine have pain all over their heads and never have an aura. In the past, headaches without the typical migraine symptoms were usually called tension headaches. Today, we realize that many these headaches are actually migraines. Migraine is very common. People with frequent migraines worry every day if today will be a bad one. An estimated 38% of people with migraines may be helped by treatments to prevent them. Preventive migraine therapy usually has two parts:
    • Avoiding known migraine triggers
    • Taking medicine every day to decrease the number of migraines and how severe they are
    But most people with migraine don't take advantage of the multiple treatments shown to help. That's the focus of 2 articles published in today's issue of the journal Neurology. The researchers looked at 284 migraine studies. They picked out 29 studies that met their strict criteria. Based on this information, they wrote guidelines to help in choosing treatments. What Changes Can I Make Now? It's your choice whether to take something every day to prevent migraines. When deciding this with your doctor, consider:
    • The number of headaches you have per month
    • How severe they are -- For example, do you need to miss a lot of work or school?
    • Whether or not the headaches stop quickly if you take a medicine as soon as an aura or headache starts
    You might want to start with a daily herbal or over-the-counter product as preventive therapy. According to this study, the one herbal with the best evidence for effectiveness is Petasites (butterbur). Some other products that have a good chance of helping include:
    • Ibuprofen (Motrin, Advil, generic versions)
    • Naproxen (Aleve, generic versions)
    • Riboflavin (vitamin B2)
    • MIG-99 (an extract of feverfew)
    The researchers found these prescription medicines have the best evidence for preventing migraines:
    • Anti-seizure medicines:
      • Divalproex sodium (Depakote)
      • Sodium valproate
      • Topiramate (Topamax)
    • Beta-blockers:
      • Propranolol (Inderal, generic versions)
      • Metoprolol (Lopressor, generic versions)
      • Timolol
    • Frovatriptan (Frova) for migraine around the time of the menstrual period
    There is no definite first choice for any of the above. Your choice should depend upon whether you have another condition that might also be helped by the same medicine. For example, someone with arthritis and migraines might start with daily naproxen. Be patient if the first or even second medicine you and your doctor choose doesn't help. There are even more medicines not listed above that might be right for you. What Can I Expect Looking to the Future? When there are so many possible treatment options, it often means we don't understand the exact cause of a symptom or disease. This is true for migraine. The brain itself doesn't have pain receptors like skin does. It processes brain signals from other parts of the body. But why do the brain's pain centers trigger a head pain reaction? When scientists put this puzzle together, we will have better migraine therapies. ]]>     Tue, 24 Apr 2012 14:25:00 -0400     Doubts about Use of Medicines in Autism http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/doubts-about-use-of-medicines-in-autism/ A type of antidepressant sometimes used to treat autism may not help much at all, a new analysis... What Is the Doctor's Reaction? We all want to find the answers for autism. New numbers estimate that 1 in 88 U.S. children under the age of 8 has this diagnosis. So it's understandable that we would be eager to find anything that explains or helps it. But we need to be careful not to let that need to find answers cloud our judgment. That's one of the many messages in a study published today in the journal Pediatrics. Researchers from Yale and the University of Michigan at Ann Arbor did the study. They looked at prior studies that used a certain kind of medicine, serotonin receptor inhibitors (SRIs), to treat the repetitive (repeated) behaviors of autism. These drugs include fluoxetine, escitalopram and others. What they found was worrisome. Repeated behaviors, such as hand-flapping or head-banging, are very common in autism. In fact, they are one of the criteria used to make the diagnosis. These behaviors can be really disruptive. They can make things hard for children both at school and at home. They can also be very difficult for caregivers to manage. Many people with obsessive-compulsive disorder (OCD) also have repeated behaviors. In fact, there is lots of evidence to suggest that OCD and autism are related. SRIs help the repeated behaviors of OCD. Therefore, it makes sense that using them in autism might be a good idea. Indeed, published studies of SRIs and autism do suggest that they help, with minimal side effects. But when you add in the unpublished studies and look again, it seems that SRIs don't help so much after all. And the side effects aren't so minimal, either. They can help some children, especially those who have anxiety along with autism. The study had some real limitations. The authors were able to look at only 10 studies total, 5 published and 5 unpublished. And those studies were different in terms of how they described and measured repeated behaviors. But what is really clear is that the information given to doctors and the public about using SRIs in autism has not been the whole story. What Changes Can I Make Now? There are two things that all of us need to do. They are especially important for those of us who have, work with, or study children with autism. First, we need to be savvy and critical about information. Just because a study says something doesn't mean it's true, let alone the answer. It generally takes lots of studies before we can begin to have answers. That can be incredibly frustrating. But it can send us down the wrong road, or even be dangerous, if we believe things without looking very critically and asking lots of questions. Second, we need to push for changes in the way all studies, not just those on children, are done and published. All researchers are supposed to "register" their studies with ClinicalTrials.gov before they start collecting any data. Some journals, including Pediatrics, won't publish the results of a study unless it was registered. That way there is a record of the study, no matter how the results turn out. But many researchers don't register their studies. And many don't bother to write up or submit their studies if the result isn't what they expected or wanted. Also, some journals aren't interested in publishing studies that show that, well, nothing happened. But we need those results to be made public. Even if they don't grab headlines, they add to what we know and are important. What Can I Expect Looking to the Future? I hope that this study and others like it will get us all to talk more about how to make more information about research available to those who need it. And I hope it will persuade more researchers to register with ClinicalTrials.gov as they begin their studies. We desperately need more information about autism. The lives and futures of so many children depend on it. But if that information isn't reliable and true, it does more harm than good. ]]> Mon, 23 Apr 2012 14:39:00 -0400 Guidelines Back More Personal Diabetes Care http://www.planforyourhealth.com/living-healthy/health-news/conditions/health-conditions-details/newsarticle/guidelines-back-more-personal-diabetes-care/ Diabetes treatment plans and goals should be tailored to each person, new guidelines for doctors... What Is the Doctor's Reaction? Doctors are flooded with guidelines on best medical practices. The guidelines are for specific diseases. However, people often have more than one disease. They also may have factors that increase their risk of developing other conditions. In the past, the American Diabetes Association (ADA) recommended a specific goal for blood sugar control in people with type 2 diabetes. This goal was set for everyone with the disease. This week the association changed course from the "one size fits all" approach. The ADA is not backing away from what optimal blood sugars should be if you have type 2 diabetes. But the new guidelines reflect the fact that blood sugar control is only one part of dealing with a complex illness. Type 2 diabetes, previously called adult-onset diabetes, is by far the most common type of diabetes. The ADA now advocates that the doctor and patient decide together the best plan to:
    • Feel well
    • Help prevent bad events such as heart attack and stroke
    • Avoid further health problems from diabetes, such as kidney and nerve damage
    This is known as patient-centered care. It is defined as providing care that:
    • Is mindful of what you prefer and your values
    • Respects your preferences even if they are not the same as your doctor's
    • Addresses your overall needs, which includes your social situation and ability to pay for the plan of care
    • Seeks to provide the best outcome and limit side effects from treatment, rather than hitting specific targets
    In the past, the ADA has recommended that people with diabetes achieve a hemoglobin A1C (HbA1C) blood level of less than 7%. Doctors call this tight control. A1C reflects a person's average blood sugar during the prior 2 to 3 months. A normal A1C is less than 5.7%. Hemoglobin A1C levels between 5.7% and 6.4% are used to identify people with pre-diabetes. If your level is 6.5% or higher, you have diabetes. For some people, achieving an A1C of less than 7% has meant lots of episodes of low blood sugar (hypoglycemia). Hypoglycemia can cause blackouts, seizures and strokes. Frequent low blood sugars can damage brain function in older people. Recent studies also have shown that tight control does not improve quality of life for people who have had diabetes for many years. It also does not help them live longer. What Changes Can I Make Now? The ADA now says that you and your doctor should decide together your goal for blood sugar control. The ADA still suggests trying tight control for someone newly diagnosed with type 2 diabetes who is otherwise in good health. A goal A1C of 6.0% to 6.4% is ideal. This is an especially good goal if you can achieve it with lifestyle changes only, or with lifestyle plus metformin as your only diabetes drug. For people who have had diabetes for many years, a goal of 7.5% to 8.0% or even higher may be more appropriate. Reasons for "looser" blood sugar control include:
    • Older age
    • Frequent low blood sugars
    • Other medical conditions that require multiple medicines, plus a need for more than 2 drugs to lower blood sugar
    • Limited financial resources
    Controlling blood sugar is only one part of type 2 diabetes treatment. It's just as important to:
    • Control weight
    • Reduce blood pressure to normal levels
    • Preventing heart and kidney disease and stroke
      • s
    For each of these, there are guidelines that set goals. For example, someone with diabetes should aim for blood pressure lower than 130/80 and LDL cholesterol no higher than 100 milligrams per deciliter (mg/dL). Ideally, LDL should be less than 70 mg/dL. What Can I Expect Looking to the Future? It's refreshing to see this new advice from the ADA. Patient-centered care should be the main theme of all guidelines. ]]>     Fri, 20 Apr 2012 13:21:00 -0400