Howard LeWine, M.D.
Posts by Howard LeWine, M.D.
Blood clots can be lifesavers when they form outside the bloodstream to stop bleeding from an injury. But they can wreak havoc when they form inside the bloodstream. A blood clot in a coronary artery can cause a heart attack. One in the brain can cause a stroke. Blood clots that form in a leg vein cause a problem known as venous thromboembolism, or VTE. If the clot stays in the leg, it can cause swelling or pain. If it breaks away and travels to the lungs, it can cause a potentially deadly pulmonary embolism. In about half of people who develop a VTE, doctors can identify what caused it. In the other half, VTE is something of a mystery. These are called “unprovoked” VTEs. Such unprovoked VTEs often spark a search for hidden cancer. But a study published in The New England Journal of Medicine suggests that these searches are usually fruitless — and costly.
Young adults with even slightly above-normal blood pressure may be more likely to have heart problems later in life, according to a new study in the Journal of the American College of Cardiology. The study focused on nearly 2,500 men and women who were 18 to 30 years old when the study began and whose health was followed for 25 years. Those with slightly high blood pressure, a condition known as prehypertension, were more likely to have had signs of heart disease in middle age. Echocardiograms showed they were more likely to have developed problems with the heart’s left ventricle.
If you’re a chocoholic, the news out of England is tantalizing: middle-aged and older adults who eat up to 3.5 ounces of chocolate a day (that’s more than two standard Hershey bars) seem to have lower rates of heart disease than those who spurn chocolate. At least that was the conclusion of a study that followed the health of nearly 21,000 resident of Norfolk, England, for 11 years. Most of the previous studies on the chocolate-heart connection found that only dark chocolate offered any cardiovascular protection. In the Norfolk study, any type of chocolate, including milk chocolate, seemed to have the same beneficial effect. I routinely write my patients a prescription for exercise, and sometimes for eating more vegetables and fruits. I won’t be writing any prescriptions for chocolate in the foreseeable future. But I won’t be telling them not to eat chocolate—in moderation of course.
There are several good reasons to keep ticks off your body. One is that they are creepy and suck your blood. Others are the 14 diseases they are known to transmit. A report published online this week in the Annals of Internal Medicine describes the newest tick-borne disease in North America, which is caused by a bacterium known as Borrelia miyamotoi. This spiral-shaped bacterium is related to the one that causes Lyme disease. Like Lyme disease, Borrelia miyamotoi disease is spread by small, hard-bodied deer ticks. Infection with Borrelia miyamotoi often causes a recurring fever, as well as headache, muscle aches, and chills. It does not usually cause the “bull’s eye” rash seen in some people with Lyme disease. According to the Annals report, nearly one-quarter of people diagnosed with Borrelia miyamotoi disease are so sick they need to be hospitalized. The best therapy so far is the oral antibiotic doxycycline. Experts aren’t sure how common Borrelia miyamotoi disease is because it isn’t on doctors’ radar screens, and because some people who develop it never see a doctor.
Hospice care improves quality of life in the dire circumstances of a person’s last days. It can enable the dying to spend this time in peace, surrounded by family and friends, and in little pain. Studies confirm what many know intuitively. Family members are likely to experience major depression following the loss of a loved one. A recent study published in today’s online JAMA Internal Medicine looked at whether hospice care reduces the severity of bereavement-related depression in people who had recently lost a spouse. While the researchers saw no difference between spouses whose partners were enrolled in hospice and those how weren’t, major depression was less common in spouses who received support from a hospice program.
A strong or weak hand grip carries more than just social cues. It may also help measure an individual’s risk for having a heart attack or stroke, or dying from cardiovascular disease. As part of the international Prospective Urban and Rural Epidemiological (PURE) study, researchers measured grip strength in nearly 140,000 adults in 17 countries and followed their health for an average of four years. Each 11-pound decrease in grip strength over the course of the study was linked to a 16% higher risk of dying from any cause, a 17% higher risk of dying from heart disease, a 9% higher risk of stroke, and a 7% higher risk of heart attack. Interestingly, grip strength was a better predictor of death or cardiovascular disease than blood pressure. What’s the connection? It’s possible that grip strength measures biological age.
Switching from a “Western” diet with lots of fat and meat to a fiber-rich diet for just two weeks makes conditions in the large intestine less favorable to the development of colon cancer. The opposite switch may promote the formation of cancer. That’s the conclusion from a small but elegant study done in urban Pittsburgh and rural KwaZulu-Natal, South Africa. In the study, 20 volunteers from each area switched diets. For two weeks, the Americans ate a traditional high-fiber African diet rich in fruits, vegetables, nuts, and beans, while the Africans ate a Western diet with more fat, protein, and meat. In just two weeks, significant changes occurred in the lining of the colon and in its chemical and bacterial make-up in both groups, but in different directions. Those following the African diet showed improvements in colon health likely to protect against colon cancer, while those following the Western diet showed changes that could lead to colon cancer.
Atrial fibrillation is a heart rhythm disorder that affects millions of people. It can lead to potentially disabling or deadly strokes. Researchers from Johns Hopkins University School of Medicine adding motion-tracking software to standard MRI heart scans of 149 men and women with atrial fibrillation. The scans revealed specific changes in the muscles of the left atrium that increased stroke risk in some of the volunteers. These changes were not associated with age or other risk factors for stroke. This could help many people with this condition to avoid taking warfarin or other clot-preventing medications for life. But it is much too early to include MRI as part of the standard evaluation of people with atrial fibrillation — not to mention that such scans would significantly increase the cost of these evaluations. For now, doctors will continue to use standard tools to help determine stroke risk.
One type of lower back pain, called lumbar spinal stenosis, can be painful and potentially disabling. An operation known as laminectomy or decompression is sometimes done to ease the pain of lumbar spinal stenosis. Physical therapy can also help. Researchers compared the results of laminectomy to those of a special physical therapy program among nearly 170 Pittsburgh-area men and women with lumbar spinal stenosis. The two approaches worked equally well — pain declined and physical function improved. There were more complications in the surgery group. Since there are no hard and fast rules for choosing the right treatment for lumbar spinal stenosis, the results of this study offer some guidance — try a well-designed physical therapy program first.
Older adults with new back pain usually end up getting a CT scan or MRI. That’s often a waste of time and money and has little or no effect on the outcome, according to a new study from the University of Washington. The results of the study contradict current guidelines from the American College of Radiology. The guidelines say that it’s “appropriate” for doctors to order early MRIs for people ages 70 and older with new-onset back pain, and many doctors do just that. The study, which followed more than 5,200 men and women over the age of 65 who saw a primary care physician for a new bout of back pain, found that people who got early back scans did no better than those who didn’t have scans. The scans added about $1,400 per person to the overall cost of back pain care — with no measurable benefit.