Archive for July, 2013

Back pain often overdiagnosed and overtreated

What doctors call “routine” back pain can really, really hurt. Surprisingly, the best treatment is usually quite conservative—over-the-counter pain relievers, ice and heat, and gentle exercise. Yet for decades, many doctors have been ordering more and more unnecessary tests, narcotics, and referrals to surgery. A new study of 24,000 people treated for back pain from 1999 through 2010 shows that many were not treated according to established guidelines, which promote treatment with over-the-counter pain relievers and physical therapy when appropriate, and advise against early referral for MRI or CT scans, the use of narcotics, or early referral to other physicians for injections or surgery. For a first-time bout with low back pain, or another go-round with it, try cold and heat, rest followed by gentle exercise, and over-the-counter pain relievers, such as acetaminophen or an NSAID like aspirin, ibuprofen, or naproxen.

Expert panel proposes annual lung cancer test for some

Howard LeWine, M.D.

Chief Medical Editor, Harvard Health Publishing

Proposed recommendations from the influential U.S. Preventive Services Task Force call for annual CT scans for some current and former smokers. Implementing these recommendations could prevent an estimated 20,000 deaths per year from lung cancer. The task force suggests annual testing for men and women between the ages of 55 and 79 years who smoked a pack of cigarettes a day for 30 years or the equivalent, such as two packs a day for 15 years or three packs a day for 10 years. This includes current smokers and those who quit within the previous 15 years. According to the draft recommendations, which were published today in the Annals of Internal Medicine, the benefits of annual checks in this group outweighs the risks. According to the Task Force recommendations, not all smokers or former smokers should undergo yearly CT scans. This group includes smokers or former smokers who are younger than 55 or older than 79, who smoked less or less often than a pack of cigarettes a day for 30 years or the equivalent, who quit smoking 15 or more years ago, or who are too sick or frail to undergo treatment for lung cancer. These draft recommendations have been posted for public comment until August 26, 2013.

Go with the flow: engagement and concentration are key

Edward Phillips, M.D.

Assistant Professor, Harvard Medical School

Have you ever been so immersed in what you were doing that all distractions and background chatter just fell away? Nothing existed except the brush and your painting, your skis and the slope, your car and the road. Mihaly Csikszentmihalyi, a renowned professor of psychology at Claremont Graduate University in Claremont, Calif., calls that state of intense absorption “flow.” Flow experiences lead to positive emotions in the short term, and over the long term people who more frequently experience flow are generally happier. Flow experiences have several common characteristics. These include losing awareness of time, not thinking about yourself, working effortlessly, and wanting to repeat the experience. They are more likely to occur when there is a balance between the challenge of an activity and the skill you have in performing it.

Women often fear sex after a heart attack

A heart attack can be a frightening wake-up call with long-lasting aftereffects. It’s no surprise that women often tread gently after having a heart attack—and many don’t tread back into the bedroom for sex. Up to 60% of women are less sexually active after a heart attack, often due to worries that sex could trigger a repeat heart attack. A new study suggests that although women believe sex is important for resuming a sense of normalcy and intimacy with their partners, many are fearful that it would be too much for their hearts to take. Reassurance from a doctor is sometimes all that’s needed to ease those fears. How does a woman know if she’s physically ready for sex after a heart attack? It’s safe to have sex if you can work up a light sweat without triggering symptoms like chest pain or shortness of breath.

Falling TVs injure 17,000 kids a year


Former Executive Editor, Harvard Health

More than 17,000 American youths end up in emergency departments each year with injuries from a falling television set. Two-thirds of them are under age 5, according to a report published online today in the journal Pediatrics. From 1996 to 2011, nearly 400,000 children under 18 years old were treated in emergency departments for TV-related injuries. In 1996, most of the injuries occurred when kids ran into television sets. By 2011, injuries from falling TVs dominated. The rate of TVs falling from dressers, bureaus, chests of drawers, and armoires nearly quadrupled. The authors of the study suggest that adding TVs to the list of furniture types that come with anti-tip devices “would be an important step in decreasing the number of injuries resulting from falling TVs.”

6 self-help tips for hemorrhoid flare-ups

Hemorrhoids are swollen blood vessels on the outer rectum and anus. They can turn bowel movements into intensely painful experiences. Classic symptoms include rectal pain, itching, bleeding, and possibly prolapse (protrusion of hemorrhoids into the anal canal). Although hemorrhoids are rarely dangerous, they can be a painful recurrent bother. Simple self-help measures can ease the ordeal of most hemorrhoids and allow healing. These include: Step up the fiber. Lubricate the process. Don’t delay having bowel movements. Try over-the-counter remedies. And sit in a sitz.

New treatment option for prostate cancer that has spread to the bones

Nancy Ferrari

Senior editor, Harvard Health

The radioactive element radium has been used to treat cancer since soon after its discovery in 1898 by Marie Curie and her husband, Pierre. And it’s still finding new uses—a recently approved form of radium, radium-223 (Xofigo), is now being used to treat prostate cancer that has spread to the bones. Researchers say that Xofigo addresses “an unmet need” in men with this type of prostate cancer, since current therapies don’t work very well against it.

Straight talk needed to choose health care at the end of life

Birth, childhood, adulthood, and death span the book of life. Unfortunately, many people tend to avoid thinking or talking about how they want the final chapter to read. For the seriously ill or elderly—and even those who aren’t—not expressing wishes and desires about health care at the end of life can lead to getting care you wouldn’t have chosen for yourself. Families often bear the brunt of delaying or avoiding a discussion about a loved one’s end-of-life preferences. That often leaves family members making decisions without knowing what their loved one would have wanted. Doctors in Canada just published recommendations for starting the end-of-life conversation. The Conversation Project offers a “starter kit” to help people prepare to discuss their end-of-life wishes. Another resource is Five Wishes, a planning document distributed by the Aging with Dignity Foundation.

Taking aspirin linked to lower risk of colorectal cancer

Howard LeWine, M.D.

Chief Medical Editor, Harvard Health Publishing

Aspirin has many uses, from easing a headache or cooling a fever to preventing heart attacks and the most common kind of stroke. It may be time to add “preventing colorectal cancer” to the list. New results from the Women’s Health Study, a clinical trial that evaluated the benefits and risks of low-dose aspirin and vitamin E among nearly 40,000 women, show that aspirin reduces the risk of developing colorectal cancer by 20%. The effect isn’t immediate, but instead takes ten to 20 years to be seen. Aspirin isn’t without its drawbacks, including gastrointestinal bleeding and ulcer formation. Both occurred slightly more often among women taking aspirin. Although the Women’s Health Study results sound promising, don’t go reaching for the aspirin bottle just yet. Taking aspirin—and any other drug—is really a balancing act between benefits and risks.

Genetic testing to guide prostate removal: too soon to know if it helps

Is it possible for a gene test to identify whether a prostate that’s healthy today is sure to develop cancer down the road? And should results of such a test be the basis for removing a seemingly healthy prostate gland? Those are questions raised by recent press reports of a British man who had his prostate gland removed because he carried a faulty gene called BRCA2.