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.
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.
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.
The ability of today’s electronic books to display videos, images explained by a spoken voice, animations, interactive tools, and quizzes gives doctors new ways of explaining things. Harvard Health Publications and Orca Health have created a series of ten interactive iBooks focused on heart disease. Currently, these are available only as iBooks. Need to know what happens in the heart when a heart attack is underway, how doctors open up cholesterol-clogged arteries, or how to cope with the irregular heart rhythm known as atrial fibrillation? The answers are in these iBooks. They let users view the heart in ways and detail they’ve never seen before to learn about common heart conditions and procedures.
A slowdown in the output of the thyroid gland can cause many problems, ranging from extreme fatigue and depression to intolerance to cold, weight gain, dry skin, and dry hair. Millions of Americans have an underactive thyroid, a condition known as hypothyroidism. The symptoms can usually be controlled with a daily dose of synthetic thyroid hormone called levothyroxine. Who actually benefits from taking levothyroxine is being called into question. New evidence suggests that many people with borderline hypothyroidism may be taking this medication unnecessarily.
If you’ve ever had a kidney stone, you surely remember it. The pain can be unbearable, coming in waves until the tiny stone passes through your urinary plumbing and out of the body. For many, kidney stones aren’t a one-time thing: in about half of people who have had one, another appears within seven years without preventive measures. Preventing kidney stones isn’t complicated but it does take some determination. Prevention efforts include drinking plenty of water, getting enough calcium from food, cutting back on salt (sodium), limiting animal protein, and avoiding stone-forming foods like beets, chocolate, spinach, rhubarb, tea, and others.
Having obstructive sleep apnea puts you at risk for a number of conditions, including high blood pressure and stroke. New guidelines from the American College of Physicians (ACP) emphasize lifestyle modifications for treating obstructive sleep apnea to prevent those conditions. The guidelines don’t offer any radical treatment updates, but they do reinforce the effectiveness of tried and true therapies. The first recommendation is weight loss for people who are overweight and obese. The link between excess weight and sleep apnea is well established. The second recommendation is using continuous positive airway pressure, or CPAP. This is typically the first-line treatment because weight loss can be so hard to achieve.
Women with early-stage HER-2 positive breast cancer may benefit by taking a drug called pertuzumab (Perjeta) before undergoing breast surgery. By shrinking breast tumors before surgery, the drug is expected to lead to less invasive operations and a greater chance of a cure. Perjeta was initially approved in 2012 to treat late-stage breast cancer that had spread to other parts of the body. Yesterday the FDA approved it for pre-surgery use. Keep in mind that the use of Perjeta before surgery has only been approved for women with HER-2 positive breast cancer. In this form of the disease, which affects accounts for one in five cases of breast cancer, the malignant cells overproduce something called human epidermal growth factor receptor-2. Such tumor cells tend to be more aggressive than other types of breast cancer cells.
One key instruction in the operating manual for healthy aging is remaining ever vigilant about osteoporosis. The quest to identify osteoporosis early has led to widespread testing of bone mineral density (BMD), the key measure of bone strength. Medicare pays for the gold-standard test, dual-energy X-ray absorptiometry (DEXA), every two years, regardless of whether their previous scan was normal or not. A study published today found that repeat bone-density testing after four years improved the ability to identify those at higher risk by only 4%. This study raises the fundamental question: Is repeating testing of older people with normal bone strength every two years too much?
Carrying too many pounds is a solid signal of current or future health problems. But not for everyone. Some people who are overweight or obese mange to escape the usual hazards, at least temporarily. This weight subgroup has even earned its own moniker—metabolically healthy obesity. Most people who are overweight or obese show potentially unhealthy changes in metabolism, like high blood pressure, high cholesterol, and insulin resistance. But some people who are overweight or obese manage to avoid these changes and, at least metabolically, look like individuals with healthy weights. Such individuals have near-normal waist sizes, blood pressure, cholesterol, and blood sugar, as well as good physical fitness. Metabolically healthy obesity isn’t common. And it may not be permanent.