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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.
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Should Heart Failure Patients Avoid Exercise?
Tweet Share on Facebook February 4, 2010 Comment (3)I've heard that it's not a good idea to exercise if you have heart failure. Is that true?
Regular brisk exercise is a key component of managing heart failure. We recommend that people get a good-quality pedometer and try to achieve 10,000 steps of walking (roughly 4 miles) each and every day. This will improve their quality of life and help to optimize their blood pressure, glucose, and lipid values. There are increasing data that regular brisk exercise significantly reduces cardiovascular morbidity and mortality in people with normal and reduced heart muscle function. -
Help! What Can I Do for My Vertigo?
Tweet Share on Facebook February 2, 2010 Comment (3)I've been suffering from vertigo for the past three or four years. Lately, ear pain, dizziness, light sensitivity, and headache have become a regular occurrence. What should I do?
If your vertigo is becoming increasingly frequent and severe, you should definitely see an ear, nose, and throat specialist to look for wax, infections, or tumors that could be seen in the external or middle ear. A formal audiogram should be obtained, and even if you do not have more hearing loss in that ear than your other ear, I would recommend an MRI of the brain (with and without gadolinium contrast) with special sections of the internal acoustic canals to look for a benign and typically slow-growing tumor known as a vestibular schwannoma, popularly called an acoustic neuroma. Meclizine (Antivert) is an antihistamine medicine that can lessen vertigo symptoms, but it can also make one more drowsy and fuzzy-headed. This is also true for baclofen and diazepam. Until your evaluation is complete, it would be prudent to go on a low-salt diet and to drive defensively and be cautious about biking and other activities that might put you at risk for injury should you suddenly experience neurologic symptoms.
