Diseases & Conditions Archive

An international team of researchers has pored over scores of studies of bone density, osteoporosis, and hip fracture and has concluded that the number of hip fractures that have been prevented by bone-building drugs called bisphosphonates since 1995 doesn't justify the expense and potential side effects of the medication. Their findings were published online by the journal BMJ on May 26, 2015.

In their report, the researchers cited earlier studies to support their conclusion, including

Findings from a major clinical trial show that a new type of vaccine for shingles is much more effective than the existing vaccine in older people, although the new shot comes with more side effects.

Q. I heard that there is a new stool test for colon cancer screening. Can this test replace colonoscopy for me? I am 68 years old with no history of colon problems, and my last colonoscopy was normal.

A. Among screening tests for hidden colorectal cancer, colonoscopy remains the "gold standard" because it's the most effective technique for detecting colon cancers and simultaneously provides an opportunity to remove any precancerous growths (polyps). The new DNA-based stool test (Cologuard) is less invasive and inconvenient than colonoscopy and finds more cancers and polyps than older stool tests, but it does not entirely eliminate the need for colonoscopies.

Q. I have been struggling with persistent athlete's foot. I have tried several over-the-counter medications for several weeks without improvement. How can I rid myself of this rash.

A. Athlete's foot, a common rash on the soles of the feet and in between toes, is caused by a skin fungus (Tinea pedis). The rash usually improves with use of antifungal creams and sprays for two to four weeks. If not, you have several options.

Early detection and proper use of eye drops are essential to preventing vision loss.

Glaucoma is a leading cause of irreversible blindness and is more common with aging. The condition affects peripheral vision at first, but eventually becomes more widespread. Treatment with daily eye drops helps to slow the process, but it's best to start early. "Glaucoma tends to be like a snowball," says Dr. Brian Song, a glaucoma specialist at Harvard-affiliated Massachusetts Eye and Ear Infirmary. "It's easier to control it early than if you wait for it to build momentum."

Q. I've been taking dabigatran (Pradaxa) for atrial fibrillation for a few years and haven't had any problems. But I've seen ads on television suggesting that this drug and others like it aren't safe. What's your advice?

A. Known as novel oral anticoagulants, these drugs make the blood less likely to clot, which helps prevent strokes. Others in the class include rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). They work as well as the older anti-clotting drug warfarin (Coumadin) but don't require frequent testing for clotting function and are less likely to interact with food and other drugs.

By Anne Fabiny, M.D., Editor in Chief

Every so often, medical professional organizations issue new guidelines for treating diseases, based on an accumulation of new evidence. In 2013 the American College of Cardiology and American Heart Association issued a guideline on treating blood cholesterol to reduce atherosclerotic cardiovascular disease (ASCVD) risk, using a new risk calculator (online at health.harvard.edu/heartrisk) to estimate a person's risk of developing ASCVD over the next 10 years. The guideline created a controversy because using the new risk calculator gives everyone over 75 a risk score of at least 7.5%—the threshold for prescribing statins to prevent heart disease in younger people. By that measure, everyone over the age of 75 should be on a statin!

Q. I experienced a minute of blurred vision during a headache today. Is that cause for concern?

A. While temporary blurred vision usually does not indicate a serious underlying health problem, on occasion it can. In people over age 60, I am more concerned about that symptom, because it can be sign of a transient ischemic attack (TIA), also called a ministroke. The fact that your vision problem accompanied a headache could well indicate that you are suffering from a common type of headache—migraine. Migraines don't threaten permanent damage to your brain, whereas a TIA is a sign that a person is at risk for an impending stroke. Strokes can cause permanent brain damage. If you are younger than 60, if you have had headaches accompanied by visual problems multiple times in the past, or if you have been diagnosed as having migraine headaches, I'd feel even more confident that your symptoms are caused by this condition.

Daily aspirin use has increased among U.S. adults, according to a survey published May 2015 in the American Journal of Preventive Medicine. The survey asked more than 2,500 people ages 45 to 75 about their current aspirin use. The overall use was 52%, up from 41% in a similar survey in 2004. The most common reasons for taking daily aspirin were prevention of heart attack and stroke. Eighteen percent of aspirin users cited cancer prevention as their reason for taking aspirin. And while most users said they'd talked to their doctor before starting aspirin therapy, 25% of the respondents had not. That finding is troubling, since aspirin is a blood thinner. "Aspirin can increase the risk of bleeding in the brain or elsewhere in the body. This risk might be justified if there is a good reason for aspirin use, but might be entirely unjustifiable if not. That is why I always recommend discussing any medication or supplement use with one's primary care provider," says Dr. Natalia Rost, associate professor of neurology at Harvard Medical School. 

Image: Thinkstock

As we reported in March, sleep apnea and other sleep breathing problems are associated with the development of dementia. Now a study published online April 15, 2015, by Neurology finds that sleep breathing problems are associated with an earlier onset of the decline in thinking skills.

Researchers analyzed the medical histories of about 2,500 people ages 55 to 90 and found that people with sleep breathing problems were diagnosed with mild cognitive impairment (a decline in thinking skills) an average of 10 years earlier than people who didn't have those problems. The encouraging news: people who treated their sleep breathing problems with a continuous positive airway pressure (CPAP) machine were diagnosed with mild cognitive impairment about 10 years later than people whose problems were not treated. The study doesn't prove a cause-and-effect relationship, but it does offer hope. "CPAP improves the quality of sleep in people with sleep-disordered breathing. Healthy sleep is an important time for our brains to accomplish critical 'housekeeping' tasks. One of these tasks is clearing beta-amyloid, one of the main proteins associated with Alzheimer's disease," says Dr. Scott McGinnis, an instructor in neurology at Harvard Medical School.