Who Will You Ever Trust Again?
Do you remember Woody Allen's line in the movie Sleeper? Sitting in a McDonald's two hundred years in the future ("Trillions Sold"), he mentions that scientists recently discovered that hamburgers are actually very healthy for you. Well, sit down before you read this one.
95,000 patients without diabetes, without overt blockage of their arteries, and without previous cardiovascular disease were randomly given daily aspirin or not. (You can guess where this is going.) There was virtually no difference found in the frequency of heart attack or stroke between the two groups and no difference in mortality. Patients who received aspirin had fewer brain clots, but this was balanced by the number that had more brain hemorrhages. Patients who received aspirin experienced slightly more (non-brain) bleeding.
The authors of this study, which appeared in Lancet, May 30, 2009, suggest that the benefits of aspirin to most people may no longer outweigh the risks, especially if their cholesterol is controlled, they're not smoking, and are generally taking care of themselves.
If you own Bayer stock, take two of the many aspirin pills on your medicine shelf and call your broker.
Readers' Responses:
#1:
Hmmm. So what are the implications (if any) for us nonsmokers whose cholesterol and blood pressure are controlled but who have had cardiovascular disease and arterial blockages sufficient to warrant CABGs? Inquiring minds want to know.
My answer: I dunno. As I read between the lines of the article, a situation like yours might seem to shift the balance towards taking aspirin. But your question takes me way beyond my area of expertise. You might want to print out the article (reference above), send it to your doctor then discuss it with him/her. The conclusion was the author's, and recent, and I'm not sure how widely it is shared in the medical community which, as you know, is generally conservative about changing recommendations.
#2:
"Thanks" for this bad bit of news.
#3:
"That article makes me feel better. I stopped taking "an aspirin a day" a year and a half ago as I was covered in black and blue. Every time I bumped into anything , I looked like a battered wife. Much better since I stopped even though I still bruise easily.
#4:
Years ago you suggested that I take an aspirin a day for heart protection. I chose not to. From my reading then and since I have seen that aspirin has a multiplicity of effects including blood thinning and clot prevention. Some of those effects are not as desirable. Personally, I like it when a wound clots easily and I get a scab rather than continued bleeding. It is nice to be able to have procedures (like a prostate biopsy (even though that is not pleasant)) immediately without having to wait a few days for the blood thinners to clear my system.
July 19, 2009
Sweet Forgetfulness
Insulin helps the body convert glucose (sugar) to energy and, in doing so, keeps glucose blood levels moderated. Starting in people's thirties however, for unknown reasons, insulin does not work as well, and people tend to experience glucose spikes particularly after meals or sugar binges.
It has recently been found that these glucose spikes can damage the part of the brain that is responsible for recall. One thing you can do to reduce the frequency or intensity of the spikes and hopefully minimize age-related memory decline is to exercise, as this reduces blood glucose by converting it to muscle energy. Also, it probably wouldn't hurt to eat smaller meals and eschew frequent candy bar and ice-cream orgies.
Insulin helps the body convert glucose (sugar) to energy and, in doing so, keeps glucose blood levels moderated. Starting in people's thirties however, for unknown reasons, insulin does not work as well, and people tend to experience glucose spikes particularly after meals or sugar binges.
It has recently been found that these glucose spikes can damage the part of the brain that is responsible for recall. One thing you can do to reduce the frequency or intensity of the spikes and hopefully minimize age-related memory decline is to exercise, as this reduces blood glucose by converting it to muscle energy. Also, it probably wouldn't hurt to eat smaller meals and eschew frequent candy bar and ice-cream orgies.
June 2009:
* PSA Tests Are Not Always To Be Relied Upon.
* Some Antidepressants May Cause Diabetes.
PSA Test Results: Strongly Suggestive but Hardly Definitive
PSA (prostate specific antigen) blood tests are used to screen for prostate cancer. While they are often useful, the test gives so many false positive and false negative results that it must be viewed with some reservation. (False positives suggest cancer when there is none; false negatives suggest there is no cancer when cancer is in fact present.)
A number of studies have followed men who had two or more annual PSA tests. Fairly consistently, between 20%and 25% of those who tested positive one year had normal results the following year. In addition, routine biopsies have discovered prostate cancer in a substantial minority of men with normal PSA levels. In some cases these cancers have been aggressive. Hopefully a more reliable test will be developed soon.
Long Term Use of Some Antidepressants May Bring on Diabetes
Depression seems to increase the risk of diabetes, but it has been unclear what the role of antidepressants are in this phenomenon. 2,243 adults who developed diabetes after starting anti-depressant therapy were compared to 8,962 age and sex matched patients without diabetes for a three year period. Factors found to increase the risk of diabetes were:
1) taking certain antidepressants (Paxil (paroxetine), Luvox (fluvoxamine), Effexor (venlafaxine), and Elavil (amitriptyline)) but not others (Prozac (fluoxetine), Celexa (citalpram) or Zoloft (sertraline))
2) taking above the median dose of the medication
3) taking the medication for a longer period of time.
But the strongest predictor of new onset diabetes was being overweight at the time the medication was started. In addition, in my experience, the diabetes inducing antidepressants are more likely than the others to cause weight gain. Patients taking them might want to consult their physicians about been monitored for pre-diabetic or diabetic blood levels or consider a change in anti-depressant medication if that is feasible.
* Some Antidepressants May Cause Diabetes.
PSA Test Results: Strongly Suggestive but Hardly Definitive
PSA (prostate specific antigen) blood tests are used to screen for prostate cancer. While they are often useful, the test gives so many false positive and false negative results that it must be viewed with some reservation. (False positives suggest cancer when there is none; false negatives suggest there is no cancer when cancer is in fact present.)
A number of studies have followed men who had two or more annual PSA tests. Fairly consistently, between 20%and 25% of those who tested positive one year had normal results the following year. In addition, routine biopsies have discovered prostate cancer in a substantial minority of men with normal PSA levels. In some cases these cancers have been aggressive. Hopefully a more reliable test will be developed soon.
Long Term Use of Some Antidepressants May Bring on Diabetes
Depression seems to increase the risk of diabetes, but it has been unclear what the role of antidepressants are in this phenomenon. 2,243 adults who developed diabetes after starting anti-depressant therapy were compared to 8,962 age and sex matched patients without diabetes for a three year period. Factors found to increase the risk of diabetes were:
1) taking certain antidepressants (Paxil (paroxetine), Luvox (fluvoxamine), Effexor (venlafaxine), and Elavil (amitriptyline)) but not others (Prozac (fluoxetine), Celexa (citalpram) or Zoloft (sertraline))
2) taking above the median dose of the medication
3) taking the medication for a longer period of time.
But the strongest predictor of new onset diabetes was being overweight at the time the medication was started. In addition, in my experience, the diabetes inducing antidepressants are more likely than the others to cause weight gain. Patients taking them might want to consult their physicians about been monitored for pre-diabetic or diabetic blood levels or consider a change in anti-depressant medication if that is feasible.
May 2009 (2)
Vitamin D Deficiency Increases the Risk of Fractures, Infection, Tumors. Really.
The current poster child of vitamin deficiencies is D. Unlike some others, this one is not uncommon and has actual scientific evidence to supporting the value of supplements for some people. Symptoms of Vitamin D deficiency in its milder forms are barely distinguishable from hypochondiasis: muscle aches, frequent colds, and "immune system problems". But studies of large numbers of people have shown that those with D deficiency in fact suffer more often from a variety of problems including softening of the bones, immune diseases, cardiovascular disease, cancer, and infections.
For example, a study of 6,000 men over 65 years of age found that low Vitamin D blood levels are associated with low bone density, which predisposes to hip fractures, which predispose to nothing good, I assure you. The Journal of Nutrition recently reported that a study of over 400 pregnant women found that vaginal infections were 26% more common in those with D levels lower than 50 and 65% more common in those with levels lower than 20. Black women were more likely to have lower levels because darker skin (and aging) interferes with synthesis of the vitamin.
The normal level of Vitamin D in the blood is 80 nanamoles per liter. If you want to know whether yours is lower, it is unfortunately very unlikely that your medical insurance will cover the cost of a blood test unless your doctor states there is clinical evidence that you have a deficiency. If the test is done, and the level is low (or if you are a vitamin hypochondriac and this article has made you worry that it might be low), you can increase the level by taking inexpensive, over the counter vitamin D3 supplements. These raise the level slowly over time. Engaging in outdoor activities also helps. Other things you can do to increase your D levels are be thin, be Caucasian, live in the South, and be younger. If a blood test shows that you have a severe deficiency, you can get an injection of D from your health care provider that will raise it more rapidly.
Hyper-vitaminosis D is extremely rare in people taking vitamins at recommended levels. When it does occur, it is usually caused by taking a form of vitamin D that requires a doctor's prescription.
The current poster child of vitamin deficiencies is D. Unlike some others, this one is not uncommon and has actual scientific evidence to supporting the value of supplements for some people. Symptoms of Vitamin D deficiency in its milder forms are barely distinguishable from hypochondiasis: muscle aches, frequent colds, and "immune system problems". But studies of large numbers of people have shown that those with D deficiency in fact suffer more often from a variety of problems including softening of the bones, immune diseases, cardiovascular disease, cancer, and infections.
For example, a study of 6,000 men over 65 years of age found that low Vitamin D blood levels are associated with low bone density, which predisposes to hip fractures, which predispose to nothing good, I assure you. The Journal of Nutrition recently reported that a study of over 400 pregnant women found that vaginal infections were 26% more common in those with D levels lower than 50 and 65% more common in those with levels lower than 20. Black women were more likely to have lower levels because darker skin (and aging) interferes with synthesis of the vitamin.
The normal level of Vitamin D in the blood is 80 nanamoles per liter. If you want to know whether yours is lower, it is unfortunately very unlikely that your medical insurance will cover the cost of a blood test unless your doctor states there is clinical evidence that you have a deficiency. If the test is done, and the level is low (or if you are a vitamin hypochondriac and this article has made you worry that it might be low), you can increase the level by taking inexpensive, over the counter vitamin D3 supplements. These raise the level slowly over time. Engaging in outdoor activities also helps. Other things you can do to increase your D levels are be thin, be Caucasian, live in the South, and be younger. If a blood test shows that you have a severe deficiency, you can get an injection of D from your health care provider that will raise it more rapidly.
Hyper-vitaminosis D is extremely rare in people taking vitamins at recommended levels. When it does occur, it is usually caused by taking a form of vitamin D that requires a doctor's prescription.
May 2009
Avoiding Kidney Stones
A kidney stone can be extremely painful to pass. In a recent study, 503 people who had recurrent stones, including ones from calcium and from gout, were treated with potassium citrate for about three and a half years. Prior to the treatment, subjects had had averaged about 2 stones per year. During the treatment period they averaged fewer than half a stone per yer.
The potassium citrate works by making the urine more acid, which tends to dissolve stones. It is available without a prescription and is found in many soft drinks. If you can't get it from your pharmacy, Vitamin C pills may also be used to acidify the urine. You may want to check with your doctor before trying either.
A kidney stone can be extremely painful to pass. In a recent study, 503 people who had recurrent stones, including ones from calcium and from gout, were treated with potassium citrate for about three and a half years. Prior to the treatment, subjects had had averaged about 2 stones per year. During the treatment period they averaged fewer than half a stone per yer.
The potassium citrate works by making the urine more acid, which tends to dissolve stones. It is available without a prescription and is found in many soft drinks. If you can't get it from your pharmacy, Vitamin C pills may also be used to acidify the urine. You may want to check with your doctor before trying either.
April 2009
Why Not Take Vitamins Containing Folic Acid.
It Can't Hurt. Or Can It??
Supplemental vitamins are marketed to the public as risk-free aids for improving health and extending life. A series of randomized research trials have called this assumption into question.
For example, regular doses of folic acid (folate) to have been used, with no research support, as a way to prevent recurrence of colo-rectal cancers. A recent study found this practice to be associated, in fact, with a slightly higher risk of more aggressive recurrence of the cancer.
Many men take high dose folic acid supplements to avoid a heart attack or stroke. The same study found no support for this practice either. Worse, it found that folic acid taken in daily doses commonly used in vitamin pills actually increases the ten year probability of prostate cancer in men over 57 years of age. The probability was only 3% among those taking placebo compared to almost 10% among those taking folic acid.
There may be a clue here why, compared to other countries, health care costs are higher in the US than in other first world countries, while life expectancy is shorter. More health care does not necessarily equate with better health care.
It Can't Hurt. Or Can It??
Supplemental vitamins are marketed to the public as risk-free aids for improving health and extending life. A series of randomized research trials have called this assumption into question.
For example, regular doses of folic acid (folate) to have been used, with no research support, as a way to prevent recurrence of colo-rectal cancers. A recent study found this practice to be associated, in fact, with a slightly higher risk of more aggressive recurrence of the cancer.
Many men take high dose folic acid supplements to avoid a heart attack or stroke. The same study found no support for this practice either. Worse, it found that folic acid taken in daily doses commonly used in vitamin pills actually increases the ten year probability of prostate cancer in men over 57 years of age. The probability was only 3% among those taking placebo compared to almost 10% among those taking folic acid.
There may be a clue here why, compared to other countries, health care costs are higher in the US than in other first world countries, while life expectancy is shorter. More health care does not necessarily equate with better health care.
March 2009
Medical-Intelligence
A Periodic Review of Selected Medical Research
by Marc D. Schwartz, MD
MarcDSchwartzMD@GMail.com
by Marc D. Schwartz, MD
MarcDSchwartzMD@GMail.com
Table of Contents
I Hear $400. Do I Hear $600?
Having a Hip Fracture Increases a Person's Chance of Dying for Up to Ten Years
Avoid NSAID's Following Hospitalization for Heart Failure
On the Brighter Side
New Standard for Treating Locally Advanced Prostatic Cancer
-------------------------------------------------------------------------------------------------------
I Hear $400. Do I Hear $600?
Fifteen percent of people who were paid $400 to stop smoking for six months did so. This is over twice the cessation rate of those not paid. A year later eleven percent were still not smoking.
This cure rate is good (for those who stopped) and no so good (for the almost 90% who didn't).
Since the annual smoking-related cost of smoking (including medical care and lost productivity) is $3,400 per person per year, I'm sure another researcher will up the bid shortly.
Having a Hip Fracture Increases a Person's Chance of Dying for Up to Ten Years
Four thousand Australians over 60 years of age were followed for 18 years. During that time, over a quarter had a fracture of some kind, most commonly of the hip. The mortality rate of those who had a fracture was almost twice that of those who did not. A second or third fracture doubled or tripled that rate.
The increased risk of dying persisted for five years for any fracture and for ten years for a hip fracture. The controllable risk factors associated with fractures are weak quadriceps (thigh) muscles, smoking, and low physical activity. If this does not get you to the gym, I don't know what will!
Avoid NSAID's Following Hospitalization for Heart Failure
Over 100,000 Danish patients who were hospitalized for heart failure were followed over a ten year period. Risks for death, hospitalization, and heart attack were all higher with any use of a non-steroidal anti-inflammatory drug. The greater the dose taken over time, the greater the risk.
On the Brighter Side
Over a three month period, women who reduced their calorie intake by 30% had a dramatic increase in memory. Don't even think about it. Most people, including you, just can't sustain this level of calorie reduction over time. The good news: new drugs are actually being developed that mimic the consequences of calorie restriction.
New Standard for Treating Locally Advanced Prostatic Cancer
A study was carried out of the effects of two cancer treatments on 875 men under 75 of age who had prostate cancer that did not involve the nodes and did not have known metastases. The study was restricted to men in otherwise good health.
Men were randomly treated with either anti-androgen hormones or anti-androgen treatment plus maximum dose radiation. Mortality was significantly lower in the combined therapy group. The authors of the editorial in Lancet, where the study was published, believe that long term combined therapy should be the new standard of care for such patients.
ADHD Stimulants and Genetic Damage
Do stimulants cause genetic damage?
A study of white blood cells of 47 children taking either methylphenidate or mixed amphetamine salts for a period of three months showed no more chromosome damage than did the white cells of children not taking these medications. While somewhat reassuring, longer term studies, now under way, are warranted. J Amer Acad Child Adolescent Psychiat December 2008
A study of white blood cells of 47 children taking either methylphenidate or mixed amphetamine salts for a period of three months showed no more chromosome damage than did the white cells of children not taking these medications. While somewhat reassuring, longer term studies, now under way, are warranted. J Amer Acad Child Adolescent Psychiat December 2008
Ginkgo and Dementia
Does Ginkgo Prevent Dementia?
Over 3000 volunteers at least 75 years of age took either ginkgo or placebo for a period of six years. There was no difference in the rate of dementia of any cause between the two groups although the rate of strokes was non-significantly higher in the ginkgo group.
Over 3000 volunteers at least 75 years of age took either ginkgo or placebo for a period of six years. There was no difference in the rate of dementia of any cause between the two groups although the rate of strokes was non-significantly higher in the ginkgo group.
Reducing the Risks of Taking Anti-clotting Medications
Advice for those taking anti-platelet or blood thinning medications
Blood platelets help clot blood. Anti-platelet medications are often prescribed to reduce the platelet levels in people for whom blood clots present a risk, like those who are susceptible to heart attacks or stroke.
This treatment, however, carries a risk for people who may develop bleeding gastro-intestinal (G.I.) ulcers, like those who have had GI bleeding in the past and those taking medications known to occasionally induce it, for example non-steriodal anti-inflammatory medications (Motrin, etc), aspirin, the anti-depressant sertraline (Zoloft), anti-platelet medications, and blood thinners like Heparin.
The American College of Gastroenterology and the American Heart Association have recently made a series of suggestions to minimize the risk of bleeding:
1) patients with a history of ulcers or GI bleeding or who take more than one anti-clotting medication should be considered for treatment with medication that reduces stomach acid, specifically a proton pump inhibitor (PPI) like Nexium, Prevacid, Prilosec and others.
2) patients without such a history who are taking only one anti-clotting medication should be considered for PPI treatment if they are over 60, using steroids, or have GI discomfort or reflux.
3) patients who have a history of ulcers should be tested for Heliobacter and, if positive, treated for it before starting anti-platelet therapy.
Bhatt et all Report of American College of Cardiology Clinical Expert Task Force: Reducing GI risks of anti-platelet therapy. Circulation:2008 Oct 28, 118:1894
Blood platelets help clot blood. Anti-platelet medications are often prescribed to reduce the platelet levels in people for whom blood clots present a risk, like those who are susceptible to heart attacks or stroke.
This treatment, however, carries a risk for people who may develop bleeding gastro-intestinal (G.I.) ulcers, like those who have had GI bleeding in the past and those taking medications known to occasionally induce it, for example non-steriodal anti-inflammatory medications (Motrin, etc), aspirin, the anti-depressant sertraline (Zoloft), anti-platelet medications, and blood thinners like Heparin.
The American College of Gastroenterology and the American Heart Association have recently made a series of suggestions to minimize the risk of bleeding:
1) patients with a history of ulcers or GI bleeding or who take more than one anti-clotting medication should be considered for treatment with medication that reduces stomach acid, specifically a proton pump inhibitor (PPI) like Nexium, Prevacid, Prilosec and others.
2) patients without such a history who are taking only one anti-clotting medication should be considered for PPI treatment if they are over 60, using steroids, or have GI discomfort or reflux.
3) patients who have a history of ulcers should be tested for Heliobacter and, if positive, treated for it before starting anti-platelet therapy.
Bhatt et all Report of American College of Cardiology Clinical Expert Task Force: Reducing GI risks of anti-platelet therapy. Circulation:2008 Oct 28, 118:1894
July 2008
Medical-Intelligence
A Monthly Review of Recent Articles of Interest
July 2008
All back issues are available at Medical-Intelligence.Blogspot.com
A Monthly Review of Recent Articles of Interest
July 2008
All back issues are available at Medical-Intelligence.Blogspot.com
Heart Attack Symptoms in Women
Women often do not have the same dramatic symptoms that men have when experiencing a heart attack ...the sudden stabbing pain in the chest, the cold sweat, grabbing the chest and dropping to the floor that we see in the movies. Here is the story of one woman's experience.
I had a completely unexpected heart attack at about 10:30 PM with NO prior exertion, NO prior emotional trauma that one would suspect might've brought it on. I was sitting all snugly and warm on a cold evening, with my purring cat in my lap, reading an interesting story my friend had sent me, and actually thinking, 'A-A-h, this is the life, all cozy and warm in my soft, cushy Lazy Boy with my feet propped up.
A moment later, I felt an awful sensation of indigestion, like when you've been in a hurry and grabbed a bite of sandwich and washed it down with a dash of water. That hurried bite seems to feel like you've swallowed a golf ball which is now going down your esophagus in slow motion and is most uncomfortable. You realize you shouldn't have gulped it down so fast and needed to chew it more thoroughly and then drink a glass of water to hasten its progress down to the stomach. This was my initial sensation---the only trouble was that I hadn't taken a bite of anything since about 5:00 p.m.
After that had seemed to subside, the next sensation was like little squeezing motions that seemed to be racing up my SPINE gaining speed as they continued racing up and under my sternum (breast bone). This fascinating process continued on into my throat and branched out into both jaws.
'AHA!! Now I stopped puzzling about what was happening -- we all have read and/or heard about pain in the jaws being one of the signals of an MI happening, haven't we? I said aloud to myself and to the cat, '”Dear God, I think I'm having a heart attack.” I lowered the foot rest, dumping the cat from my lap, started to take a step, and fell on the floor instead.
I thought to myself, 'If this is a heart attack, I shouldn't be walking into the next room where the phone is or anywhere else ... but, on the other hand, if I don't, nobody will know that I need help, and if I wait any longer I may not be able to get up in a moment.'' I pulled myself up with the arms of the chair, walked slowly into the next room and dialed the Paramedics.
I told the woman who answered my call her I thought I was having a heart attack with pressure building under my sternum and radiating into my jaws. I didn't feel hysterical or afraid, just stating the facts. She said she was sending the Paramedics over immediately, asked if the front door was near to me, and if so, to unbolt it and then lie down on the floor where they could see me when they came in. I then lay down on the floor as instructed and lost consciousness, as I don't remember the medics coming in, their examination, lifting me onto a gurney or getting me into their ambulance, or hearing the call they made to the hospital ER on the way, but I did briefly awaken when we arrived and saw that the cardiologist was already there in his surgical blues and cap, helping the medics pull my stretcher out of the ambulance.
He was bending over me asking questions(probably something like 'Have you taken any medications?') but I couldn't make my mind interpret what he was saying, or form an answer, and nodded off again, not waking up until the cardiologist and partner had already threaded the teeny angiogram balloon up my femoral artery into the aorta and into my heart where they installed 2 side by side stents to hold open my right coronary artery.
I know it sounds like all my thinking and actions at home must have taken at least 20-30 minutes before calling the Paramedics, but actually it took perhaps 4-5 minutes before the call, and luckily both the fire station and the ER are only minutes away from my home, and, by the time I got there, a cardiologist was all ready to go to the OR in his scrubs and get going on restarting my heart (which had stopped somewhere between my arrival and the procedure) and installing the stents.
Why have I written this to you with so much detail? Because I want you to know what I learned first hand:
1. Be aware that something very different is happening in your body not the usual men's symptoms but inexplicable things. It is said that many more women than men die of their first (and last) MI because they didn’t know they were having one and commonly mistake it as indigestion, take some Maalox or other anti-heartburn preparation and go to bed, hoping they'll feel better in the morning when they wake up ... which doesn't happen. My female friends, your symptoms might not be exactly like mine, so I advise you to call the Paramedics if ANYTHING seriously unpleasant is happening that you've not felt before. It is better to have a 'false alarm' visitation than to risk your life guessing what it might be!
2. Note that I said, “Call the Paramedics.” Ladies, TIME IS OF THE ESSENCE! Do NOT try to drive yourself to the hospital -- you're a hazard to others on the road. Do NOT call your doctor – if it's at night you won't reach him anyway, and if it's daytime, his assistants (or answering service) will tell you to call the Paramedics. He doesn't carry the equipment in his car that you need to be saved! The Paramedics do, principally OXYGEN that you need ASAP. Your doctor will be notified later. If someone other than a paramedic takes you to the hospital, when they arrive, have them go immediately to the ER desk (don’t wait on line), and tell them that you are having a heart attack.
3. Don't assume it couldn't be a heart attack because you have a normal cholesterol count. Research has discovered that a cholesterol elevated reading is rarely the cause of an MI (unless it's unbelievably high and/or accompanied by high blood pressure).
March 2008
Medical-Intelligence
A Monthly Review of Recent Articles of Interest
by Marc D. Schwartz, MD
by Marc D. Schwartz, MD
Table of Contents
Avoid In-Hospital Lung Clots
Survive an In-Hospital Cardiac Arrest
Medical Progress in In-Hospital Treatment
Oral Contraceptives Reduce Ovarian Cancer Risk
All That Glitters...
I’m Tired and I Wanna Go Home...from Tanzania
Quick Takes
Avoid In-Hospital Lung Clots
Survive an In-Hospital Cardiac Arrest
Medical Progress in In-Hospital Treatment
Oral Contraceptives Reduce Ovarian Cancer Risk
All That Glitters...
I’m Tired and I Wanna Go Home...from Tanzania
Quick Takes
Live Long and Prosper - Chapter One
Avoid In-Hospital Lung Clots
Blood clots of the lung are the most common preventable cause of in-hospital death. Medication and other measures to prevent it lower the risk by over half in medical patients and three quarters in general surgical patients. A recent study found that, among at-risk patients in the United States, only half of medical patients and three quarters of surgical patients received preventative medical and other treatment recommended by the American College of Chest Physicians. If you are hospitalized, check with your doctor to find out if you are “at risk for pulmonary embolism” and if you are getting the prophylactic treatment recommended
Live Long and Prosper - Chapter Two
Survive an In-Hospital Cardiac Arrest
In a study of outcomes of patients who had a pulseless cardiac arrest while in the hospital, it was found that all major outcomes, including survival and neurological damage, were less positive for those whose arrest occurred at night, between 11 PM and 7 AM. Some of the many known characteristics of nights in hospitals are lower staffing levels, less expertise of personnel on duty, less staff oversight, and less stringent patient monitoring practices. You can’t choose when to have a cardiac arrest, but it may be helpful to prepare a family member or friend to come to the hospital ASAP if you have do one at night. If your hospital allows it, they can camp out at your bedside and do their best to make sure you’re getting all the care you need. JAMA Feb 20, 2008 299:785
Medical Progress in In-Hospital Treatment
And while we’re discussing things in-hospital, let me introduce the Hospitalist, the new medical specialist who focuses only on treating in-patients. You may be disappointed to learn that substituting hospitalists for patients’ own doctors does not reduce the death rate or readmission rate. So far, studies suggest that its main benefit is reducing the length of stay.
Oral Contraceptives Reduce Ovarian Cancer Risk
Women who used oral contraceptives (OC’s) were found to have 25% less risk of ovarian cancer than those who did not take them. The longer a woman used them, the greater the protection, and benefits were observed up to 29 years after cessation. The editorialist of Lancet, where this study was published, argues that the decline in ovarian cancer resulting from the use of OC’s outweighs the small increase in risk for other cancers.
All That Glitters...
It appears that a quarter of patients taking aspirin do not get its anti-clotting benefit. In a group of 3,000 patients with established cardiovascular disease, adverse cardiovascular events occurred more often in aspirin resistant patients (40%) than in aspirin sensitive patients (15%). At the present time, it is not known which commercial laboratory test is best for determining aspirin resistance nor which anti-clotting drug to take instead of aspirin. (Herbals and vitamins are of little help.) You may want to ask your doctor to keep you up to date on progress with this issue. I’ll let you know if I hear of any news about this.
I’m Tired and I Wanna Go Home...from Tanzania
While many private health insurance plans reimburse for emergency medical expenses overseas, and some cover “medical evacuation” — moving sick or injured travelers to the nearest adequate hospital — almost no health insurance policies pay to bring travelers back home to the United States. And that can be the most expensive part of a health crisis abroad. An air ambulance from London to New York can cost $40,000; from Hong Kong, it can cost up to $100,000.
When shopping for overseas hospitalization insurance, it is important to understand the terminology. Typically, ‘evacuation’ means getting to the nearest medically appropriate hospital; ‘medical repatriation’ means getting you from there back home. Medical repatriation and can be bought for three months ($190 a person), six months ($290) or 12 months ($490).
The details of plans vary. Some cover additional expenses that might be incurred in a medical emergency overseas, like the cost of flying a relative to your bedside or the return home of your children or traveling companion. American Express Platinum members already have medical repatriation benefits. In June, AARP will begin offering the service to its members.
If you’re abroad, need hospitalization, haven’t planned ahead for a medical emergency, and don’t have the cash on hand to pay for it, there may still be a way home. The United States government may lend you the money. In 2006, the Overseas Citizens Services of the State Department issued 843 repatriation loans totaling a little over $1 million. (Once you get home, your passport is no longer valid until you pay the loan.) The office can also provide logistical support, translation services and medical referrals. To reach the office from overseas, call 202-501-4444, or contact the nearest embassy or consulate.
Quick Takes
People regularly taking anti-inflammatories like Motrin, Advil, etc. can cut their chances of having upper GI bleeding or ulcers in half by taking a proton-pump inhibitor like Prevacid or Prilosec (or generics).
A web based calculator for predicting the risk of hip fracture is available at hipcalculator.fhcrc.org.
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