Shocking news: Overdoing ICDs

Concern about possible overuse of implantable cardioverter-defibrillator devices has led to a reevaluation of their benefits and risks. According to some critiques, ICDs might have been given too much credit for preventing deaths in key clinical trials, when other factors, such as the use of beta blockers, might have been responsible. Others have pointed out that the management of heart failure has improved because of wider use of beta blockers and ACE inhibitor drugs, so the risk of fatal ventricular arrhythmias in heart failure patients has decreased, very possibly making ICDs less useful than they once were. Confidence in ICDs has also been undercut in recent years by recalls of flawed devices. Some doctors have also called for more discussion and consideration of the various drawbacks and complications of ICDs. For example, perhaps as many as one out of every five ICD patients receives an "inappropriate shock" from the device that's triggered by something other than a serious ventricular arrhythmia. (Locked) More »

Talking of walking in three easy pieces

Studies examine various aspects of the health benefits of walking: gait speed, use of hiking poles, and type of footwear. Researchers at the University of Pittsburgh have shown that walking may also serve as something of a prognosticator. Results of their research show that after about age 65, how fast we walk, or gait speed may predict how long we have to live. Results from several studies show that using hiking poles while walking at a fairly brisk pace does seem to increase cardiovascular workload. Some studies show that people have an increased physiological response but don't feel as though any more exertion is involved. One study of people who have pain in their legs while walking because of poor circulation found that they were able to walk farther with less pain if they used hiking poles. Pain from arthritic knees makes walking difficult for many people, and shoes with thick, cushiony soles are commonly believed to help. But some research is challenging that conventional wisdom with results that suggest that thinner, more flexible soles actually put less load on the knees. More »

The shingles vaccine

For people who have had shingles, the question of whether or not to get the vaccine to prevent a recurrence is not easily answered. Some pretty good data suggests that the risk of recurrence is quite high and, particularly if you've had a bad case, getting the vaccination would seem to be a prudent precaution. But it's also possible to make a case for the evidence not being all that solid. More »

A wash worth its while?

Certain ingredients in some brands of mouthwash may help prevent bad breath, but some experts think that using a toothbrush on the tongue is more effective. Some bad breath experts say that most of the bacteria responsible for the problem reside in a small area near the back of the tongue, and that using a toothbrush to brush them away is more effective than rinsing with a mouthwash. On the other hand, a 2008 review of the existing research (only five studies passed muster) concluded that two of the antibacterial agents most commonly used in mouthwashes, cetylpyridinium chloride and chlorhexidine, may reduce the levels of halitosis-producing bacteria, and that other ingredients (zinc, chlorine dioxide) may neutralize smelly sulfur compounds. (Locked) More »

Ask the doctor: Nothing works for fullness in ears. Any suggestions?

Q. I have a feeling of fullness in my ears that won't go away. I think it has been diagnosed as something called eustachian tube dysfunction. I have been to several otolaryngologists. Nothing has worked. Suggestions? A. People with a persistent sensation of fullness in the ear should get it checked out by a physician. Occasionally, hearing loss can create such a feeling. Temporomandibular joint disorders, which affect the joint that connects the jawbone to the skull, can also create the sensation. But a diagnosis of eustachian tube dysfunction does make sense. The eustachian tube, which connects the middle ear to the nasal cavity, helps to equalize the air pressure on either side of the eardrum. If your eustachian tube is blocked or not working properly, there's less pressure on the inside of the eardrum than the outside, so the eardrum may cave in slightly, which causes that sensation of fullness. In serious cases, fluid accumulates behind the eardrum because pressure is so low that fluid from surrounding tissues and blood vessels gets pulled into the middle ear. (Locked) More »