Patrick J. Skerrett
Posts by Patrick J. Skerrett
Tiny shock absorbers in the knee (each one is called a meniscus) provide a key cushion between the thighbone and the shinbone. They are prone to tearing, and sometimes just wear out. A torn meniscus can cause pain or other symptoms, like a knee that locks. But sometimes they don’t cause any symptoms. In a youngish person, when a knee-wrenching activity like skiing, ultimate Frisbee, or slipping on the ice tears a meniscus, the damage is often repaired surgically. But a torn meniscus is often seen in the 9 million Americans with knee osteoarthritis, and for them the best course of action hasn’t been crystal clear. Results of the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial published yesterday in the New England Journal of Medicine indicate that physical therapy may be just as good as surgery. Both therapies led to similar improvements in knee function and pain at six and 12 months.
New guidelines for recognizing and managing sports-related concussions could help protect the brains of millions of athletes at all levels of play, from professional football to youth soccer. The guidelines, released today by the American Academy of Neurology (AAN), replace a now-outdated set published in 1997. The guidelines step away from trying to “grade” concussions or diagnose them on the field or sidelines. Instead, they focus on immediately removing from play athletes who are suspected of having a concussion until they can be evaluated. “When in doubt, sit it out.” The AAN estimates that concussions cause between 1.6 million and 3.8 million mild brain injuries each year. Many athletes don’t get medical attention for these injuries, often because they or their coaches don’t recognize the warning signs or take them seriously. The new guidelines should help better identify athletes who have suffered concussions and improve how concussions are managed and treated.
Americans drive while talking on a cellphone or texting more than their counterparts in seven European countries. A report published yesterday showed that 69% of American drivers surveyed said they had talked on a cellphone while driving at least once in the previous month (31% said they did it “regularly or fairly often”), and 31% said they had read or sent text messages while driving. The least distracted drivers were in the United Kingdom. Not surprisingly, younger drivers were more likely to have reported talking on a cellphone or texting while driving. The statistics on distracted driving are chilling: In 2011 (the last year with complete statistics), 3,331 people were killed in motor vehicle crashes involving a distracted driver, and nearly 400,000 were injured. The National Highway Traffic Safety Administration estimates that distracted driving accounts for about one in five crashes in which someone was injured.
It always takes me a few days to get used to Daylight Saving Time. While I love the extra hour of light at the end of the day, I’m not so wild about the extra hour of darkness in the morning or waking up an hour earlier than I need to. And I sure miss the hour of sleep I lost yesterday. That lost hour seems to be a big deal. A report in this month’s American Journal of Cardiology details the jump in heart attacks seen in a large Michigan hospital the first week after the start of Daylight Saving Time, and the small decline after it ends in the fall. A few years back, researchers showed a similar pattern in Sweden. The number of traffic accidents are similarly affected. In a Canadian study, there were more accidents on the Monday after the start of Daylight Saving Time than there were on the Monday the week before the change. If ever there was a perfect day for a nap, today would be it. A single nap won’t fully reset your body clock or make up for a lost hour of sleep, but it can help. It’s also a good way to stay sharp, especially in the afternoon.
The toll taken by medical mistakes burst into public attention with a 1999 report called To Err Is Human from the U.S. Institute of Medicine. The report estimated that between 44,000 and 98,000 people die each year as a result of preventable medical errors. Such errors can be headline grabbers, like the death of Boston Globe columnist Betsy Lehman from an overdose during chemotherapy. The safety of hospital stays and encounters with health-care providers got a boost today with the publication of 22 evidence-based “patient safety strategies.” Although most focus on care that takes place in hospitals, they extend to almost all interactions between individuals and their doctors, nurses, and other care providers. Very few of the safety practices are expensive, high-tech interventions. Instead, they are almost old-fashioned efforts that aim to improve communication between health-care providers and their patients, and to improve the practice of medicine rather than the art of medicine. The theme of all of these interventions is to create systems that help caregivers follow every step that is known to improve patient care, and to avoid relying on fallible human memory. To err may be human, but it is also often preventable.
A pacemaker-like device that stimulates the brain can help control some of the muscular problems brought on by Parkinson’s disease, the second most common neurodegenerative problem in America. A report in tomorrow’s New England Journal of Medicine may prompt doctors to recommend its use sooner rather than later. For more than a decade, deep-brain stimulation has been used to help control Parkinson’s symptoms. It involves placing a tiny wire called a lead (pronounced leed) in the part of the brain that controls movement and a matchbook-sized stimulator under the skin below the collarbone. The lead and stimulator are connected to each other by a second wire that runs under the skin of the shoulder, neck, and head. The device emits small pulses of electricity that help coordinate movement. Deep-brain stimulation traditionally isn’t used until a person has lived with Parkinson’s for a decade or more. The new report in the NEJM will give doctors more leeway to use this therapy earlier in people with Parkinson’s.
To get or stay healthy, many people focus on exercising more, eating better, or quitting smoking. Getting recommended vaccinations is another relatively simple strategy for health that an alarming number of Americans overlook. Vaccination isn’t just for kids. Adults should get immunized against infectious agents that cause the flu, pneumonia, whooping cough (pertussis), shingles (herpes zoster), and more. The latest schedule for adult immunization has been published in the Annals of Internal Medicine. It now recommends adding a second anti-pneumonia vaccine for people with compromised immune systems. It also says that all adults age 65 and older should get the tetanus, diphtheria, and pertussis (Tdap) vaccine, as should pregnant women with each pregnancy. When it comes to adult immunization, Americans aren’t doing very well. One-third of older Americans don’t get the pneumococcal vaccine, 84% don’t get the shingles vaccine, and 87% don’t get the tetanus, diphtheria, and pertussis vaccine. In addition to protecting yourself from an infectious disease, immunization also protects others.
As a huge, snowy Nor’easter barrels into New England, I’m thinking about all the shoveling I’ll be doing over the next couple days. Luckily I have three teenagers to help. But now that I’m of an AARP age, I have to be more mindful of the cardiovascular effects of shoveling. Snow shoveling is a known trigger for heart attacks. Emergency rooms in the snowbelt gear up for extra cases during significant snow storms. What’s the connection? Many people who shovel snow rarely exercise. Picking up a shovel and moving hundreds of pounds of snow, particularly after doing nothing physical for several months, can put a big strain on the heart. Pushing a heavy snow blower can do the same thing. Cold weather also contributes. Tips for protecting the heart include shoveling many light loads instead of fewer heavy ones, taking frequent breaks, and hiring a teenager.
File this under “if a little bit is good, a lot isn’t necessarily better:” taking high-dose vitamin C appears to double a man’s risk of developing painful kidney stones. In an article published yesterday in JAMA Internal Medicine, Swedish researchers detail a connection between kidney stone formation and vitamin C supplements among more than 23,000 Swedish men. Over an 11-year period, about 2% of the men developed kidney stones. Men who reported taking vitamin C supplements were twice as likely to have experienced the misery of kidney stones. Use of a standard multivitamin didn’t seem to up the risk. Many people believe that extra vitamin C can prevent colds, supercharge the immune system, detoxify the body, protect the heart, fight cancer, and more. To date, though, the evidence doesn’t support claims that extra vitamin C is helpful. If high-dose vitamin C doesn’t improve health, then any hazard from it, even a small one, is too much.
“Whole grain” has become a healthy eating buzzphrase, and food companies aren’t shy about using it to entice us to buy products. Browse the bread, cereal, or chip aisle of your favorite grocery store and you’ll see what I mean. Last year, nearly 3,400 new whole-grain products were launched, compared with just 264 in 2001. And a poll by the International Food Information Council showed that 75% of those surveyed said they were trying to eat more whole grains, while 67% said the presence of whole grains was important when buying packaged foods. But some of the products we buy may not deliver all the healthful whole-grain goodness we’re expecting. Identifying a healthful whole-grain food can be tricky. A new study from the Harvard School of Public Health says the best way is to choose foods that have at least one gram of fiber for every 10 grams of carbohydrate. Fiber and carbs are both listed on the nutrition label.