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Do Statins Reduce Cholesterol Deposits in Arteries?
Tweet Share on Facebook May 15, 2009 Comment (7)
There is evidence that statins can reduce the amount of cholesterol plaque in the arteries in some patients. In 2006, we published a study showing that high doses of a powerful statin could reduce plaques in about two thirds of patients. In this study, we treated people to reach very low levels of LDL, the "bad" cholesterol, and were able to increase HDL, "good" cholesterol, by 14.7 percent. However, such an aggressive regimen is not for everybody, so please talk to your doctor. -
Is Exercise Possible if I'm in Chronic Pain?
Tweet Share on Facebook May 5, 2009 Comment (3)
One of my colleagues at Duke Integrative Medicine, Sam Moon, M.D., M.P.H., in the Department of Community and Family Medicine, Division of Occupational and Environmental Medicine, is an expert in integrative approaches to pain and healthful lifestyles. Here is what he has to say:Chronic pain frequently produces 'collateral' harm, including the many adverse effects of physical inactivity, such as decreased vigor, muscle weakness, worsening obesity, low mood, and so on. It is human and natural to withdraw a bit and 'nurse' one's pain with rest. This is good early on. Chronically, this natural instinct becomes part of the problem. Exercise (physical activity) is but one small slice of a full, long-term pain management plan, and that 'slice' is as crucial as it is highly individual, complex, and tricky. Success is finding combinations of activity that are safe, beneficial, fun, sustainable over seasons, and 'elastic' (i.e., their intensity and duration can be scaled up and down easily). If this goal becomes a struggle, you should seek a professional 'integrative exercise prescription.'
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Is PSA Screening for Prostate Cancer Worthwhile?
Tweet Share on Facebook March 25, 2009 Comment (3)How should men interpret the conflicting news over the value of the PSA test? Is that prostate cancer screening test worthwhile?
Two clinical studies (one in the United States and one in Europe), both dealing with prostate-specific antigen screening, were recently published in the online version of the New England Journal of Medicine and have caused considerable discussion. These represent the first reports from two large, randomized trials, which many doctors and patients alike had hoped would resolve important questions about the upside and downside of PSA screening in "healthy" men, i.e., men who are being screened for primary prevention. In the United States, a very substantial proportion of men over the age of 50 undergo such screening on a routine basis. Some physicians have critiqued the publication of these studies now, as opposed to allowing the studies to unfold for a longer time span, precisely because of the uncertainty and lack of closure likely to arise among patients, doctors, and health policy experts. It is possible that some of the issues can be resolved as more time elapses in both trials. That said, the studies have been published, and the public needs to absorb the results.
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Is the Hormone Estrogen Good or Bad for the Brain?
Tweet Share on Facebook March 25, 2009 Comment (1)
The best data on the role of estrogen come from a study of women who were ages 65 and older when they started taking estrogen, which clearly showed that it was not good for the brain. The data on younger women are less clear, but the evidence suggesting that it might be good for cognitive function is weak. Given what we know today, estrogen should not be initiated to prevent dementia. -
Should Children Get Heart Evaluations Before Taking Stimulant Medications for ADHD?
Tweet Share on Facebook March 25, 2009 Comment (11)There have been reports that children taking Ritalin and other stimulants for attention deficit hyperactivity disorder can develop dangerous heart complications. Should a child have a heart evaluation before starting a stimulant?
This is a very actively debated controversy. The American Heart Association suggested that at a minimum, children should see their pediatrician. And you know, anytime people—whether adults or children—start a medication, they should be seen by a doctor and carefully evaluated with a physical examination, listening to the heart, and so on, for any murmurs or any other evidence of abnormality. The American Heart Association also recommended that an electrocardiogram, an EKG, be performed. The American Academy of Pediatrics issued a separate guideline saying that that was not necessary. In the final analysis, speak to your pediatrician, who best knows your own child.I served on a Food and Drug Administration advisory panel that reviewed these drugs, and, in fact, I suggested that they needed a black-box warning, a strong warning, because of the heart risks. And I do support careful evaluation of the potential for heart-related adverse events in children, like sudden death, from heart arrhythmias. These are very rare, and no parent should be excessively concerned, but anything we can do to reduce the risk makes sense to me, and I feel an EKG is a very reasonable thing to do before taking these medications. What you're looking for is to see if there are any abnormalities that might make them higher risk to developing complications. And of course, if they have heart-related symptoms when they're already on the medication, they need to be evaluated.
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Is Virtual Colonoscopy as Good as Standard Colonoscopy?
Tweet Share on Facebook March 23, 2009 Comment (2)I have heard that a virtual colonoscopy is a simple X-ray procedure. What would you advise someone who is dreading getting a colonoscopy?
Most studies compare polyp detection rates, which are equivalent [between the two types of tests]. But I think visual inspection through [standard] optical colonoscopy should provide higher detection of "flat lesions" while also allowing the gastroenterologist to remove polyps and biopsy other lesions. Plus, the radiation from a virtual colonoscopy is the equivalent of several hundred chest X-rays, [and] many radiologists will fill the colon with air, a process which can be uncomfortable.On the other hand, virtual colonoscopy can be enormously helpful if a gastroenterologist hasn't been able to successfully perform colonoscopy because of a large, redundant colon that has multiple twists and turns or because a patient has old scars binding loops of bowel together. I have had one patient with a strong family history of pancreatic cancer and another patient with a family history of lymphoma who elected to have virtual colonoscopy at age 50 because the procedure allows us to look at the pancreas and lymph nodes outside the colon, and they were young enough to be unlikely to have polyps that would require a follow-up colonoscopy anyhow.
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What's the Best Way to Catch Breast Cancer Early?
Tweet Share on Facebook March 17, 2009 Comment (1)
Without a doubt, the best way to detect breast cancer early is to have regular screening mammograms beginning at age 40. While it is not clear how much breast self-exam adds to early detection, it is free and is recommended monthly for women beginning in their 20s. Women should also have a clinical breast exam as part of their annual health checkup. -
Can Insomnia Point to a Medical or Psychiatric Problem?
Tweet Share on Facebook March 3, 2009 Comment (2)The ability to fall asleep easily and awaken refreshed is a sign of good overall health. People who have arthritic pains, restless legs, itching skin, anxiety, depression, and many other problems may have difficulty falling asleep. When doctors hear that a patient has been awakened by a symptom, it carries special significance that it relates to an underlying medical problem. Depression, for example, can be associated with early awakening.As we age, the elastic tissues of our bladder are replaced by fibrous tissue, so we need to urinate more frequently both during the day and at night. Limiting fluid intake between dinner and bedtime decreases the fluid volume in our body. Between dinner and bedtime, try to lie down on a sofa with your feet on the armrest so they're higher than your head and read a newspaper or book with your arms elevated for 10 to 15 minutes. Blood flows from your extremities into your chest, thereby stretching the heart muscles and causing them to release natural diuretics. This will result in one or two urinations before bedtime, decreasing the need to urinate during the night.
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Why Are Chronic Sleep Problems So Common?
Tweet Share on Facebook March 3, 2009 CommentMany patients have problems falling asleep or staying asleep. In our stressful world, people rush from putting children to bed or completing projects and then either want time for themselves or worry about yesterday or tomorrow. They eat and exercise too late at night and are involved in stimulating activities that make falling asleep more difficult. Alcohol before bedtime can be a problem. While it can help people fall asleep, they are likely to awake in the middle of the night as the alcohol level drops in their brain tissues; they become hyperalert and cannot fall back asleep.Melatonin, a brain hormone, can help some people fall asleep, but only if they are in a totally dark room or wearing black eye cover. That's because light striking the retina blocks much of melatonin's effect. Benadryl, a wonderful old antihistamine you can buy over the counter, has sedating side effects. Although it is not addicting, some people feel groggy the next day and don't eliminate the Benadryl until noon.
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If My Child Has a Sleep Problem, What Might Help?
Tweet Share on Facebook March 3, 2009 Comment (4)Do children develop insomnia? If so, why? How is insomnia in children usually tackled?
Sleep disturbances are common but transient in infants and children and usually can be handled by small adjustments in bedtime routines. Parents should rest assured that most infants and toddlers will get enough sleep, though some babies do develop patterns of waking that are problematic to their parents. Dr. Richard Ferber and his group at Children's Hospital in Boston have developed useful advice for the parents of young children to help establish good sleep routines. Their suggestions can be found in the book Solve Your Child's Sleep Problems.Dr. Ron Becker of Children's Hospital's Center for Pediatric Sleep Disorders shared his thoughts with me about older children:
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