As I have previously blogged many times, most
vitamins and supplements have not been shown to have any benefits and
are over utilized. Eat fresh fruits and vegetables!
I a recent study,
researchers found that about 10% of women who took Vitamin D and
Calcium supplements developed high levels of calcium in the blood and
urine. This is associated with an increased risk of kidney stones and
possible hardening of the arteries.
The women who took low dose calcium (600 mg or less) did not develop these abnormalities.
Unless your doctor says you need supplements or vitamins, please just eat a well balanced diet!
When sewage and waste water is treated before
being released into local waterways or used as fertilizer, the vast
majority of bacteria are removed; but not all.
Hospitals are natural repositories of multiple
antibiotic resistant bacteria. Researchers in France discovered that
treated hospital waste water contained significant levels of drug
resistant bacteria; the treatment only removed 94% of these (while
removing 98% of others).
Swimming in these waters and possible
contamination of foods with more toxic bacteria may result if this is
not monitored properly. On the other hand this has not yet happened so
it may just be an interesting finding.
The hospital pictured here is the one where I was born at!
Lipitor and other "statins" are in common use for lowering of cholesterol and preventing heart disease.
Thus it is somewhat troubling when we find that the strongest of these medications - high dose lipitor and
zocor, and crestor, seem to be associated with higher rates of diabetes
- about 20%. This seemed to occur in the first 4 months of treatment;
suggesting it was not just that these patients ate more and became
obese.
This does not mean we should stop using these drugs -
they are very useful. You should ensure that you are getting the lowest
dose appropriate and that you conti ue to get monitored for diabetes.
The FDA finally updated regulations on tanning
beds, where they are now classified as moderate risk and not
recommended for children under 18.
They should not be used by anyone. I still cannot understand why people have them in Florida!
Researchers have estimated that tanning beds are responsible for a 56%
increase in malignant melanoma, a very dangerous skin cancer. It also
causes melanoma in the eye and other skin cancers.
Medical science has begun to advance
dramatically in the field of DNA sequencing. This is the ability to
analyze the blood of a sick patient for foreign DNA and then comparing
it with a database to determine what infection the patient has.
In a case report, there was a patient with an immune deficiency who had
been ill for two weeks. His blood was sent for the experimental DNA
sequencing, and the infectious agent was identified.
This will eventually become inexpensive and commonplace, so that diagnosis of unusual infections will become easy.
The CDC reports that 10% of Americans now
have diabetes; a result of our obesity epidemic. Do you know 10 people?
Chances are one has diabetes.
Diabetes can cause heart disease, kidney failure, Alzheimer's disease, strokes, neuropathy, peripheral vascular disease and amputations.
If you read my blog and facebook you know how important diet and exercise are if you want to be healthy as you age.
I exercise at least 4 times a week and eat fresh fruit and vegetables
daily. Even when I was working full time I managed to cycle on weekends
and evenings (in summer), and found time to go to the gym, play tennis
and softball. You should too if you don't yet.
More
evidence is piling up that excess red meat is unhealthy. We all know
about heart disease, but now a recent review suggests more dangers.
Among 90,000 women surveyed for red meat intake, those in the highest
group had a 22% increase over those in the lowest. Substituting chicken
or legumes for even one meal a day had a substantial decrease.
Personally my wife and I have been eating much less red meat for many
years; and our daughter was vegan even while married to an Argentinean!
The manufacturer of Cialis (for those of you
without TV, newspaper, or magazines Cialis is a drug used to help
maintain erections) have applied for over-the-counter status.
If this is approved, it would hit the shelves in 2017 once the generic version comes out
As we continue to use antibiotics, many
bacteria develop resistance to them. Since these germs reproduce in
hours, much of this is driven by evolutionary pressure. But how do these
genes form in the first place?
Researchers discovered that nearly 3000 different antibiotic-resistance
genes representing all major resistance mechanisms were detected in
bacteria from grassland and agricultural soil, which have never infected
humans or animals or have been exposed to antibiotics.
Although most of these genes were inactive, they seem to be present in
many different organisms. The researchers do not know why this occurs,
but, since most antibiotics have developed from natural sources such as
fungus (e.g. penicillin) it makes sense that the germs have evolved
these mechanisms.
Next time your doctor tells you that he or
she prefers not to give you antibiotics for a minor infection, you can
understand that we are trying to prevent evolution of super-bugs. .
Due to the unstable nature of many countries, polio virus infections have begun to spread in these areas.
The CDC now recommends that travelers to these regions get the inactivated polio vaccine (this is not a live
virus) even if they were vaccinated as a child. We now know that some
childhood vaccine levels can wane as we get older (like whooping cough).
Its better to be safe.
In its declaration, the WHO noted that 10 countries have ongoing poliovirus transmission:
Cameroon, Pakistan, and Syria have recently exported wild
poliovirus. Residents and people traveling to these countries for more
than 4 weeks are required to receive IPV or oral polio vaccine 4 to 52
weeks before departing these countries.
Afghanistan, Equatorial
Guinea, Ethiopia, Iraq, Israel, Somalia, and Nigeria are infected with
poliovirus but have not yet exported it. Residents and long-term
travelers to these countries are encouraged to get boosters.
Anytime you travel you can go to the CDC web site to see ongoing recommendations.
http://emergency.cdc.gov/han/han00362.asp
http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/poliomyelitis
Most of you know that I strongly support
universal health care. Personally I feel most of the rhetoric about
Obamacare is political propaganda; instead of complaining if you think
it doesn't work offer an alternative not a repeal. There is no way we should go backwards.
In support of this we once again go back to Massachusetts, where
universal coverage was introduced by the Republican governor Mitt
Romney. Since its introduction in 2006 there has been a 4.5% decrease in
mortality related to medical conditions, not explained by medical
advances. That is a lot of lives saved!
As we continue to use antibiotics, many
bacteria develop resistance to them. Since these germs reproduce in
hours, much of this is driven by evolutionary pressure. But how do these
genes form in the first place?
Researchers discovered that nearly 3000 different antibiotic-resistance
genes representing all major resistance mechanisms were detected in
bacteria from grassland and agricultural soil, which have never infected
humans or animals or have been exposed to antibiotics.
Although most of these genes were inactive, they seem to be present in
many different organisms. The researchers do not know why this occurs,
but, since most antibiotics have developed from natural sources such as
fungus (e.g. penicillin) it makes sense that the germs have evolved
these mechanisms.
Next time your doctor tells you that he or
she prefers not to give you antibiotics for a minor infection, you can
understand that we are trying to prevent evolution of
super-bugs.
The manufacturer of Cialis (for those of you
without TV, newspaper, or magazines Cialis is a drug used to help
maintain erections) have applied for over-the-counter status.
If this is approved, it would hit the shelves in 2017 once the generic version comes out.
It is recommended that everyone get screened
for colon cancer beginning at age 50, and every 10 years thereafter (if
normal). For those with a strong family history or bowel disease
screening usually begins earlier.
In the past few years many sources have suggested that screening should
stop at age 75 if normal. This has evolved to say that screening should
stop when life expectancy is less than 10 years. But many have stopped
colonoscopy at this age.
In a recent study, researchers found
that compared with no screening, colonoscopy at age 80 prevented 10
cancer deaths for every 1000 people screened.
Screening was
cost-effective in those without significant medical conditions until
ages 83. In elders with severe illnesses, screening was cost-effective
until age 77.
Nearly a quarter of people older than 75 have never undergone colorectal cancer screening. Most of these should be checked.
In addition they found that other modalities, such as stool screening
for blood or sigmoidoscopy were also useful, though less accurate.
I would recommend colonoscopy until at least 80, maybe older if you are
healthy. After that, at least until age 85 stool testing for blood
should be performed.
I will be available to see patients in consultation on July 15, Tuesday in the Weston Florida office. Please call 954.349.3030 for an appointment
Vaginal Dryness is one of the common complaints of post-menopausal women who cannot take hormones. And in some women it can actually lead to irritation and vaginitis.
Many physicians prescribe estrogen creams, but unfortunately a significant amount is absorbed and we really don't know whether this will increase the risk of uterine cancer; and is contra-indicated in breast cancer patients.
It was always thought that the dryness was caused by lack of hormone sensitive lubrication. Now some researchers have discovered that menopause is associated with a change in the bacterial population of the vagina. Is this the cause of dryness; or is it the result of the lack of estrogen.
For now there is more research needed. The commentators do not yet recommend using probiotics until more studies are done; but since they are so innocuous I say why not try? It would be great if it works!
Billions of dollars are spent on trying to look, feel and act younger, while living longer.
I have always said that a proper diet, regular exercise and keeping your mind healthy are the best way to achieve this. Many studies have shown that there are no magic vitamins or supplements which can help. And I have posted many of these.
Now I can report on three recent studies.
Having a Purpose in life Prolongs Life
In a study of over 6,000 individuals researchers found that those with a"purpose", a reason to live, and a positive attitude decreased mortality over the study by 15-20%. Evidence that positive psychological factors have a definite influence on longevity.
Are you Older than You Look?
There is a huge industry in plastic surgery and cosmetics aimed at making you look "younger". Personally, although some surgeries do seem to work, there are times that the HD television reveals a little too much about the surgery many older celebrities have put themselves through. And its not only Joan Rivers!
But has anyone actually looked at what makes us look older? Many think it is wrinkles and crows feet. But in a study of over 6,000 women, researchers found that the two most important factors in determining age were the nasolabial fold (see photo) and skin redness or pigmentation.
Its pretty simple to use sunscreen to prevent skin damage and redness. The fold may be harder to fix; but maybe plastic surgeons would be well aware to do a simpler repair than an extensive face lift.
What did I do? Easy - I grew a beard!
Women experience hot flashes after menopause. Although many may find resolution after a year or two, some continue to be distressed for many years.
Initially we treated with a combination estrogen/progesterone pill which simulated the hormonal state before menopause. Unfortunately studies showed this increased the risk of breast cancer and has been mostly abandoned.
In most women the combination is necessary since estrogen alone increases the risk of uterine cancer. If a woman has had a hysterectomy, however, they can take estrogen alone without excess risk of breast cancer. And the reported risks of increased clotting can be avoided by using the estrogen patch. This is what I use for those women.
But is there something for the rest? Some people have recommended an antidepressant, Effexor (Venlaflaxine) for these symptoms. And it works. In a recent study it was found to be equally effective to estrogen in the prevention of hot flashes. And it has no hormonal effects. I have seen it work in my patients and would use it if needed. This would be an especially useful alternative in women with a history of breast cancer who should not take any hormones under any circumstances.
Most of the drugs we use for insomnia have a rebound effect; so that when you stop using them you really can't sleep. Although we try to prescribe these drugs to be used intermittently, many patients end up taking them every night.
This is unfortunate, since not only do they become addicted, but the pills don't work as well in the long run. Most of the drugs we use have a similar mode of effect to valium, one of the original sedatives.
Now, a new medication has been developed which is a orexin
receptor antagonist. The orexin receptor is thought o be the body's way of putting us to sleep.
In preliminary studies it seems to work well, without rebound or addictive potential. Only time will tell. The generic name is Suvorexant. If it is effective it may be a new step in the treatment of insomnia.
