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Heart Bypass Surgery or Stenting—Which Is Best for Me?
Tweet Share on Facebook April 23, 2010 Comment (6)I see from a recent study published in Circulation that about half of the patients who would be better off having heart bypass surgery wind up getting a stent instead. Can I keep that from happening to me?
The decision regarding who should receive a stent and who should receive bypass surgery is complex and must be individualized for each patient. There are some general principles, though. For patients having a heart attack or otherwise unstable chest pain, urgent heart catheterization and stenting have been shown to save lives. For patients with a stable chest pain syndrome (pain only with exertion), both stenting and bypass surgery have been shown to reduce symptoms. If catheterization shows only one or two readily treatable blockages, stenting may make good sense because it relieves the symptoms without the need for open heart surgery. If there are more than a couple blockages, however, most experts believe that bypass surgery is preferable, particularly if the surgeon uses the internal mammary artery to perform one or more bypasses. Internal mammary bypasses have more durability in the years following surgery than bypasses using the veins harvested from the legs. -
Does Stress Hinder Wound Healing?
Tweet Share on Facebook April 16, 2010 Comment (2)
Psychological stress can extend the time required to heal wounds by 25 percent or more. Studies in which we and other researchers have created small wounds about the size of a pencil eraser, and then measured the rate of healing, show that stress slows closure. For example, dental students took an average of 40 percent longer to heal a small, standardized wound made prior to exams, compared to an identical wound made during their summer vacation.In contrast to the relatively mild and predictable stress of academic examinations, surgery is a high-stakes stressor, and people's anxiety levels before surgery are often very high. After surgery, anxiety and depression can make pain worse—and pain is certainly another stressor that can slow your healing.
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Should I Start a Strength-Training or Interval-Training Routine?
Tweet Share on Facebook April 14, 2010 Comment (11)Rather than steady aerobic exercise, I see many fitness pros extolling the virtues of strength training and interval training routines. Wouldn't going for an easy jog be just as good a workout?
It depends upon your goals. If you are involved in competitive running, interval training is necessary to improve your performance. That type of intense exercise is not advised for anyone having a diagnosis of heart problems or musculoskeletal abnormalities. My recommendation for the masses, particularly older Americans, is "long, slow is always better than fast, short."I do feel that a total fitness program consists of a cardiovascular base coupled with musculoskeletal conditioning. You can be too muscular just as you can be overweight, and the heart is going to suffer either way. But if you do both, then you can become "totally fit." The combination of aerobic conditioning and strength training should be as follows:
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Are Digital Mammograms Better Than the Conventional Kind?
Tweet Share on Facebook April 9, 2010 Comment (1)Are digital mammograms superior to the regular kind for women of every age?
In digital mammography, the X-ray is converted into an electrical signal that can be displayed on a computer screen or printed as an image that looks like a regular mammogram. The patient's experience is no different from having a traditional mammogram. Digital mammograms can sometimes use a lower overall dose of radiation to the breast.The differences between traditional and digital mammography are similar to the differences between traditional and digital photography. Some benefits of digital mammography are that the radiologist can manipulate the digital mammogram electronically to magnify an area, change contrast, or alter the brightness. In addition, the images are available immediately, without waiting for film to develop, and the images can be transmitted electronically from remote locations for centralized reading.
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One Fifth of Adolescents Have High Cholesterol. What's Your Take?
Tweet Share on Facebook April 6, 2010 Comment (2)Government health officials recently reported that 20 percent of American adolescents have abnormal cholesterol levels. What's your reaction?
This is very alarming. Although some adolescents are genetically predisposed to have high cholesterol levels, most authorities think that environmental causes are to blame. The diet of adolescents often includes more "fast food" than a generation ago, including burgers, pizza, french fries, and soft drinks sweetened with high-fructose corn syrup. Astonishingly, 15 percent of young people are now considered obese, which definitely increases cholesterol levels. Obese children and those with high cholesterol levels face a shortened life span and high risk of developing coronary heart disease at an early age. However, most authorities are reluctant to treat younger teenagers with cholesterol-lowering drugs, so diet, exercise, and weight loss are the most important interventions.Nonetheless, some children with an inherited disorder known as heterozygous familial hyperlipidemia will require statin drugs to reduce bad cholesterol (LDL-C), because their LDL can be very high (200 or more). There is controversy regarding when to start treatment, but most authorities recommend starting at about age 13. If your teenager is overweight or you have family history of high cholesterol, it may be prudent to have his or her cholesterol checked. If levels are very high, consult an expert in the treatment of cholesterol disorders.
[Statins for Prevention? Taking a Cholesterol-Lowering Drug When Cholesterol Is Normal]
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How Much Vitamin D Is Enough?
Tweet Share on Facebook March 26, 2010 Comment (24)I've been hearing a lot about vitamin D lately. My multivitamin has 400 IU, but I've heard reports that the recommended daily allowance is not actually high enough. What do you think?
Our bodies make vitamin D3 when we're exposed to sunlight. (This substance is more appropriately considered a hormone because it's synthesized in one location for use in other parts of the body.)We know that vitamin D increases absorption of calcium from the intestinal tract. It also stimulates osteoblasts that remodel bone, making good healthy bone. Newer evidence suggests that vitamin D plays a regulatory role in controlling panels of genes that affect our immune systems. Higher vitamin D levels are associated with a lower risk of adult onset type 2 diabetes and autoimmune inflammatory responses against one's own thyroid gland, resulting in an underactive thyroid. D3 deficiency may be related to a number of other autoimmune disorders in which we attack a number of our own cells and glands. Vitamin D may play some role in preventing infection and in warding off cancer.
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How Much Calcium Do Americans Need?
Tweet Share on Facebook March 16, 2010 Comment (5)Are Americans getting enough calcium? I've heard that health officials here may recommend more calcium than is necessary. How much do people really need?
Calcium is an essential nutrient, but the optimal intake is an unsettled issue. For adults over 50, the definition of adequate intake in the United States is 1,200 milligrams per day; in the United Kingdom, this is 700 milligrams per day; and the World Health Organization, looking at the same data, concluded that 500 milligrams per day is adequate. The primary justification for high consumption of calcium has been prevention of osteoporosis and fractures, and much of the disagreement is due to the use in the United States of short-term studies of calcium deposition in bones to set the value for adequate calcium intake. Long-term studies do not support benefits of high intake of calcium or milk in preventing fracture risk. The WHO conclusions were influenced by the observation that most adults worldwide consume little or no dairy products, have calcium intakes below 500 milligrams per day, and tend to have lower rates of fractures than we do in America and Europe, where calcium and milk intake are relatively high. -
Does Aromatherapy Offer Health Benefits? Unlikely
Tweet Share on Facebook March 16, 2010 Comment (9)Aromatherapy may make you feel better, but there's no good evidence of any solid health benefits to date. Our laboratory conducted a very elaborate and detailed study to look at the effects of lavender and lemon oils on mood, heart rate and blood pressure, stress hormones, and immune function. Lemon did in fact enhance positive moods, but neither lemon nor lavender had any positive effects on the participants' physiology or biochemical markers over a period of several hours. In one part of the study, participants had their foot immersed in ice water for a minute; their pain ratings when they were smelling distilled water were no different from when they were inhaling the lavender or lemon scents. A group of British researchers reported that men and women who placed their hand and forearm in ice water for up to 15 minutes reported more pain when the ambient odor was either pleasant (lemon) or unpleasant (machine oil) compared to a no-odor condition. And Florida researchers who used heat and pressure pain found that none of their odors (lavender, rosemary, and distilled water) were related to how much pain participants reported. The absence of any analgesic benefits across all three studies is notable, because pain reduction is a primary reason for aromatherapy's widespread use in health-related applications ranging from labor pain to post-surgical discomfort.
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What’s Your Guidance for People Taking Avandia?
Tweet Share on Facebook February 26, 2010 Comment (3)The Food and Drug Administration is scrutinizing the safety of diabetes drug Avandia, as concerns about its heart risks are swirling anew. What do you think?
The controversy over Avandia was initiated by an article I wrote in May 2007 that appeared in the New England Journal of Medicine, suggesting that the drug increased the risk of heart attack.The drug Avandia remains controversial. Many physicians have stopped prescribing Avandia, but others remain unconvinced about the risk. A recent study suggested that Avandia might be safe, but the study had many flaws and did not completely rule out the possibility that Avandia may increase the risk of heart attack. In July, the FDA will convene an advisory panel to consider what action to take, including the possibility of removing the drug from the market. Currently, American Diabetes Association guidelines do not recommend taking Avandia. Fortunately, there is a safe alternative, pioglitazone (Actos), which appears not to have the same heart attack risk as Avandia. Both Avandia and Actos carry warnings about fluid retention and heart failure, so don't use either drug if you carry the diagnosis of heart failure. Both drugs can also increase the risk of fracture, particularly in women.
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Is It Safe to Get Pap Smears Less Often?
Tweet Share on Facebook February 8, 2010 Comment (4)My doctor told me I don't need a Pap smear as often. Is it really safe to go a few years without one?
The good news is that cervical cancer screening recommendations are changing because of progress in combating the disease. As we've developed a better understanding of the role of the human papillomavirus in cervical cancer, the Pap test has evolved. We can now test not only for abnormal cells that develop in response to HPV infection but also for the virus that causes the disease. The ongoing development of vaccines against HPV means that future generations are less likely to develop HPV-related diseases, and we need to adjust screening recommendations to reflect lower risk. We also recognize that the disease develops slowly, so low-risk women don't need a Pap test every year; testing every two to three years is sufficient.The current guidelines recommend that we reduce the intensity of cervical cancer screening for lower-risk women and focus more intensive screening on women at higher risk. Women below the age of 21, women who have had three sequential normal Pap smears, and women who have had a hysterectomy are all considered low risk and don't benefit from intensive screening. It is important to recognize that most women who die from cervical cancer have never had cervical cancer screening or have not been screened for at least five years.
