Archive for October, 2013

Howard LeWine, M.D.

Balance training seems to prevent falls, injuries in seniors

Most people take balance for granted. They navigate without thinking, effort, or fear. For millions of others, though, poor balance is a problem. Some struggle with long-term dizziness or imbalance. Others suffer balance-related falls and injuries. A new study concludes that exercise can reduce not only the odds of falling but the odds of sustaining fall-related injuries. In many urban areas, there’s no shortage of classes aimed at improving balance. You can find them at senior centers, Y’s and Jewish Community Centers, health clubs, and the like. There’s also a lot you can do at home. The American College of Sports Medicine Standing recommends standing with one foot in front of another, lifting a foot off the floor, and shifting weight in various directions as three examples of home exercises.

Stephanie Watson

Radiation for breast cancer can increase heart risks

Radiation, on its own or coupled with other treatments, has helped many women survive breast cancer. Yet radiation therapy can cause the appearance of heart disease years later. New research published in JAMA Internal Medicine estimates that the increased lifetime risk for a heart attack or other major heart event in women who’ve had breast cancer radiation is between 0.5% and 3.5%. The risk is highest among women who get radiation to the left breast—understandable, since that’s where the heart is located. The heart effects of radiation begin emerging as soon as five years after treatment. However, future heart risk should not be the reason to abandon this important component of treatment. Cancer experts are doing more and more to minimize the amount of radiation the heart receives.

Howard LeWine, M.D.

World Stroke Day: stroke is common, disabling, and often preventable

Today is World Stroke Day. It offers a good reminder of the profound impact that stroke has on individuals and communities. Nearly 800,000 Americans have strokes each year. Worldwide, one in six adults will have a stroke during their lifetime. Although most survive, stroke is a leading cause of disability in the United States and many other countries. A report published last week in The Lancet documents a troubling trend: more and more young people are experiencing strokes. Between 1990 and 2010, the number of strokes among people aged 20 to 64 years increased 25%. This age group now accounts for one-third of strokes worldwide. Some stroke survivors recover fully and regain their previous levels of function. Others don’t. Keys to full recovery include rapid identification of stroke symptoms, immediate evaluation and treatment, early rehabilitation, and support

Patrick J. Skerrett

Wellocracy aims to help trackers choose and use health apps and devices

There’s something satisfying about getting immediate feedback about exercise, sleep, and other activities. That’s why more and more people are joining the “quantified-self” movement. It involves formal tracking of health and habits, usually using apps and devices that feed data to them—from heart rate, activity, and sleep monitors to Bluetooth connected scales. But with so many apps and connected devices on the market, it can be hard to decide which ones are worth trying. Wellocracy, a website launched by the Harvard-affiliated Center for Connected Health, aims to give people impartial information about fitness trackers, mobile health apps, and other self-help technologies. It reviews dozens of sleep trackers, wearable activity trackers, mobile running apps, and mobile pedometer apps, lets you compare apps and devices in each category, provides a guide for beginners and offers tips for adding activity “bursts” throughout the day.

Michael Craig Miller, M.D.

For fans, World Series is a marathon, not a sprint

Millions of baseball fans will tune in tonight for the opening game of the World Series. Boston Red Sox versus St. Louis Cardinals. Sportswriters are saying it will be an interesting series between two well-matched teams. Football fans have it easy. They have to sit through just one big game to decide the year’s champion. For us baseball fans, it could take seven games spread over nine days to determine this year’s champion. That means fans need to approach the series as a marathon, not a sprint. Pay attention to sleep, exercise, food, alcohol, and emotions. The Red Sox and Cardinals are two very likable teams. Commentators point out that these guys play the game the “right way.” The players themselves say it’s going to be fun. Let’s see if we fans can remember that baseball is a game. This World Series should be fun to watch. Whoever you’re rooting for, have fun watching.

Julie Corliss

Flu shot linked to lower heart attack, stroke risk

Getting the flu shot may do more than protect against the flu and its lingering aftermath. It also lowers a person’s odds of a having heart attack, stroke, heart failure, or other major cardiac event—including death—by about a third over the following year. What’s the connection between flu and cardiovascular problems? The body mounts an impressive immune response against the flu. That causes a lot of inflammation, which destabilizes cholesterol-filled plaque inside blood vessels. Plaque rupture can cause a heart attack or stroke. Experts recommend a flu shot for everyone six months of age and older. It is especially important for those who face the highest risk of complications: young children; adults over age 50; those of all ages with serious health conditions such as cardiovascular disease, asthma or other lung disease, liver or kidney disease, or diabetes; and those who care for young children or other individuals at high risk of flu complications.

Howard LeWine, M.D.

Doctors often don’t reveal cancer test overtreatment and harms

There’s no question that tests to detect cancer before it causes any problems can save lives. But such tests can also cause harm through overdiagnosis and overtreatment. A study published yesterday in JAMA Internal Medicine indicates that the majority of people aren’t informed by their doctors that early warning cancer tests may detect slow-growing, or no-growing, cancers that will never cause symptoms or affect health. Undergoing surgery, chemotherapy, or radiation for such cancers provides no benefits and definite harms. The researchers found that only 9.5% of people were informed by their doctors of the risk of overdiagnosis and possible overtreatment. Compare that to 80% who said they wanted to be informed of the possible harms of screening before having a screening test. Informing patients about the risks of screening isn’t easy to do in a brief office visit. It’s complicated information. And the researchers suggest that many doctors don’t have a good grip on relative benefits and harms of screening.

Patrick J. Skerrett

Stopping nosebleeds: a pinch will usually do the trick

Most nosebleeds (the medical term is epistaxis) stop quickly. Some, though, need medical attention. An article posted online yesterday in JAMA Otolaryngology-Head & Neck Surgery looks at treatment options for serious nosebleeds. The bottom line: Conservative options, like packing the nose with gauze, work just as well as more invasive efforts, have negative fewer side effects, and cost less. It makes sense to treat every nosebleed as if it is one that can be fixed at home. A good, strong pinch in the right place will often do the trick.

Daniel Pendick

PET scans peer into the heart of dementia

What’s bad for the heart is often bad for the brain. High cholesterol, high blood pressure, diabetes, and unhealthy “hardening” of the arteries increase the risk of mental decline or dementia later in life. A study published online today in Neurology shows that older people with the stiffest arteries are more likely to show the kinds of damage to brain tissue often seen in people with dementia. The study adds support to the “two hit” theory of dementia. It suggests that the accumulation of Alzheimer’s-linked amyloid protein in the brain may not pose problems until damage to small blood vessels that nourish the brain nudges them over into dementia. There may be a silver lining to this line of research: Efforts to improve cardiovascular health can also protect the brain.

Howard LeWine, M.D.

Letters from an obese president tell a familiar story of struggling with weight

William Howard Taft was America’s heaviest president. He would have preferred being seen and remembered for something else, and took steps to lose weight. Taft’s story of weight loss and regain, described in today’s Annals of Internal Medicine, sounds completely familiar today, more than 100 years later. Using correspondence and archival sources, Deborah Levine, an assistant professor at Providence College in Rhode Island, tells the story of Taft’s struggles with his weight. In 1905, with the help of a British physician, Taft went from 314 pounds to 255. He was pleased with his accomplishment. But three years later, when Taft was inaugurated as the nation’s 27th President, he tipped the scales at 354 pounds. His story and struggle with weight are no different than what many people experience today.