Harvard Health Blog

Most people take balance for granted. They navigate without thinking, effort, or fear. For millions of others, though, poor balance is a problem. Some struggle with long-term dizziness or imbalance. Others suffer balance-related falls and injuries. A new study concludes that exercise can reduce not only the odds of falling but the odds of sustaining fall-related injuries. In many urban areas, there’s no shortage of classes aimed at improving balance. You can find them at senior centers, Y’s and Jewish Community Centers, health clubs, and the like. There’s also a lot you can do at home. The American College of Sports Medicine Standing recommends standing with one foot in front of another, lifting a foot off the floor, and shifting weight in various directions as three examples of home exercises.

Radiation, on its own or coupled with other treatments, has helped many women survive breast cancer. Yet radiation therapy can cause the appearance of heart disease years later. New research published in JAMA Internal Medicine estimates that the increased lifetime risk for a heart attack or other major heart event in women who’ve had breast cancer radiation is between 0.5% and 3.5%. The risk is highest among women who get radiation to the left breast—understandable, since that’s where the heart is located. The heart effects of radiation begin emerging as soon as five years after treatment. However, future heart risk should not be the reason to abandon this important component of treatment. Cancer experts are doing more and more to minimize the amount of radiation the heart receives.

Today is World Stroke Day. It offers a good reminder of the profound impact that stroke has on individuals and communities. Nearly 800,000 Americans have strokes each year. Worldwide, one in six adults will have a stroke during their lifetime. Although most survive, stroke is a leading cause of disability in the United States and many other countries. A report published last week in The Lancet documents a troubling trend: more and more young people are experiencing strokes. Between 1990 and 2010, the number of strokes among people aged 20 to 64 years increased 25%. This age group now accounts for one-third of strokes worldwide. Some stroke survivors recover fully and regain their previous levels of function. Others don’t. Keys to full recovery include rapid identification of stroke symptoms, immediate evaluation and treatment, early rehabilitation, and support

Prostatitis (infection or inflammation of the prostate gland) flies under the radar even though it affects up to one in six men at some point in their lifetimes. It triggers more than two million visits to doctors and untold agony each year.

There’s something satisfying about getting immediate feedback about exercise, sleep, and other activities. That’s why more and more people are joining the “quantified-self” movement. It involves formal tracking of health and habits, usually using apps and devices that feed data to them—from heart rate, activity, and sleep monitors to Bluetooth connected scales. But with so many apps and connected devices on the market, it can be hard to decide which ones are worth trying. Wellocracy, a website launched by the Harvard-affiliated Center for Connected Health, aims to give people impartial information about fitness trackers, mobile health apps, and other self-help technologies. It reviews dozens of sleep trackers, wearable activity trackers, mobile running apps, and mobile pedometer apps, lets you compare apps and devices in each category, provides a guide for beginners and offers tips for adding activity “bursts” throughout the day.

Millions of baseball fans will tune in tonight for the opening game of the World Series. Boston Red Sox versus St. Louis Cardinals. Sportswriters are saying it will be an interesting series between two well-matched teams. Football fans have it easy. They have to sit through just one big game to decide the year’s champion. For us baseball fans, it could take seven games spread over nine days to determine this year’s champion. That means fans need to approach the series as a marathon, not a sprint. Pay attention to sleep, exercise, food, alcohol, and emotions. The Red Sox and Cardinals are two very likable teams. Commentators point out that these guys play the game the “right way.” The players themselves say it’s going to be fun. Let’s see if we fans can remember that baseball is a game. This World Series should be fun to watch. Whoever you’re rooting for, have fun watching.

Getting the flu shot may do more than protect against the flu and its lingering aftermath. It also lowers a person’s odds of a having heart attack, stroke, heart failure, or other major cardiac event—including death—by about a third over the following year. What’s the connection between flu and cardiovascular problems? The body mounts an impressive immune response against the flu. That causes a lot of inflammation, which destabilizes cholesterol-filled plaque inside blood vessels. Plaque rupture can cause a heart attack or stroke. Experts recommend a flu shot for everyone six months of age and older. It is especially important for those who face the highest risk of complications: young children; adults over age 50; those of all ages with serious health conditions such as cardiovascular disease, asthma or other lung disease, liver or kidney disease, or diabetes; and those who care for young children or other individuals at high risk of flu complications.

There’s no question that tests to detect cancer before it causes any problems can save lives. But such tests can also cause harm through overdiagnosis and overtreatment. A study published yesterday in JAMA Internal Medicine indicates that the majority of people aren’t informed by their doctors that early warning cancer tests may detect slow-growing, or no-growing, cancers that will never cause symptoms or affect health. Undergoing surgery, chemotherapy, or radiation for such cancers provides no benefits and definite harms. The researchers found that only 9.5% of people were informed by their doctors of the risk of overdiagnosis and possible overtreatment. Compare that to 80% who said they wanted to be informed of the possible harms of screening before having a screening test. Informing patients about the risks of screening isn’t easy to do in a brief office visit. It’s complicated information. And the researchers suggest that many doctors don’t have a good grip on relative benefits and harms of screening.

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.

Radical prostatectomy changes the experience of orgasm. But it doesn’t need to be any less pleasurable or satisfying, says Dr. Ravi Kacker, a urologist and fellow in male sexual medicine at Harvard-affiliated Beth Israel Deaconess Medical Center.

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 Publishing 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.

Drinking water and changing your diet are just some ways to avoid kidney stones. See the full list here.

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.

Checking seemingly healthy people for cancer—what doctors call screening—seems like a simple process: Perform a test and either find cancer early and cure it or don’t find it and breathe easy. It works for colon, breast, and cervical cancers, but not for others. For colon cancer, there are several effective screening tests: colonoscopy, sigmoidoscopy, and stool testing. Two new studies in yesterday’s New England Journal of Medicine help further quantify their benefits. In the studies, all three types of test reduced the risk of developing or dying from colon cancer. Colonoscopy worked best, followed by sigmoidoscopy and then stool testing. The biggest challenge for colon cancer screening is getting people to have the available tests. About 50,000 Americans die of colon cancer each year—many of these can be prevented with early screening.

Antibiotic-resistant bacteria sicken more than two million Americans each year and account for at least 23,000 deaths. The main cause? Overuse of antibiotics. A new report from the Centers for Disease Control and Prevention, Antibiotic Resistance Threats in the United States, 2013, details the health and financial costs of antibiotic resistance in the United States. In terms of health, antibiotic resistance should be in the CDC’s top 15 causes of death. It also adds as much as $20 billion in direct health-care costs. And the problem could get worse before it gets better. Antibiotic resistance is a problem because commonly used antibiotics will become less able to treat common infections. The CDC identified three types of bacteria as urgent hazards: Clostridium difficile, Enterobacteriaceae, and Neisseria gonorrhoeae. Decreasing the use of antibiotics and preventing infection in the first place are two key steps to halting the problem.

No time in your busy schedule for a long workout? No problem. Combining brief bouts (less than 10 minutes long) of moderate to vigorous exercise over the course of the day also add up to good health, an interesting new study suggests. The findings reinforce suggestions that people should look for simple ways to get short bouts of moderate to vigorous exercise: for example, by parking at the far end of the lot and walking briskly to the entrance, by taking the stairs quickly instead of riding the elevator, or by plugging in your earbuds and dancing energetically to a favorite song. If you are a professional working a desk job at a computer, set a timer and every half hour get up and do a minute or two of something energetic.