Archive for December, 2011

Cancer Screening in the Elderly Population on the Rise

December 29, 2011

A new study from the University of Connecticut published in this month’s issue of the Archives of Internal Medicine states that the elderly population is being more extensively screened for breast, colorectal, prostate, and cervical cancer.  The US Preventative Services Task Force, the same organization that recently spoke out decidedly against PSA in the use for prostate cancer screening, currently recommends that those 75 years or over should not be routinely screened for these diseases, and informed use of testing should be employed for this population of patients.  Although most medical screening tests are relatively cheap, easy, and accessbile, these factors do not justify using them, unless they overall make a difference in patient quality of life or survival.  To decide if a any medical screening test is necessitated should ultimately be determined by an informed patient who has communicated with his physician.

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Vitamins May Not Be All That Helpful

December 28, 2011

It is not unusual to view an advertisement for a vitamin that suggests it helps people with cardiovascular problems, cancer, diabetes, or other chronic diseases. Judging the validity of these advertisements is often difficult due to what often appears to be conflicting data, and the use of personal anecdotes.
What is the evidence? A study was conducted by the U.S. Agency for Healthcare Research and Quality and published in 2006. (The complete report, Multivitamin/Mineral Supplements and Prevention of Chronic Disease can be viewed here)
The study examined the use of vitamins for the prevention of the following:
• breast cancer, colorectal cancer, lung cancer, prostate cancer, gastric cancer, or any other malignancy (including colorectal polyps)
• myocardial infarction, stroke
• type 2 diabetes mellitus
• Parkinson’s disease, cognitive decline, memory loss, dementia
• cataracts, macular degeneration, hearing loss
• osteoporosis, osteopenia, rheumatoid arthritis, osteoarthritis
• hepatitis, non-alcoholic fatty-liver disease
• chronic renal insufficiency, chronic nephrolithiasis
• HIV infection, hepatitis C, tuberculosis
• chronic obstructive pulmonary disease

The results of the study
The authors concluded there is limited evidence to date suggesting potential benefits of multivitamin/mineral supplements in the primary prevention of cancer in individuals with poor nutritional status or suboptimal antioxidant intake.
The evidence also indicates that multivitamin/mineral supplement use does not have significant effects in the primary prevention of cardiovascular disease and cataracts.
Regular supplementation of a single nutrient or a mixture of nutrients for years has no significant benefits in the primary prevention of cancer, cardiovascular disease, cataract, age-related macular degeneration or cognitive decline.
A few exceptions, that were reported in a single reviewed study included a decreased incidence of prostate cancer with use of synthetic α-tocopherol (50 mg per day) in smokers, a decreased progression of age-related macular degeneration with high doses of zinc alone or zinc in combination with antioxidants in persons at high risk for developing advanced stages of the disease, and a decreased incidence of cancer with use of selenium (200 mcg per day).
Supplementation with calcium has short-term (particularly within one year) benefit on retaining bone mineral density in postmenopausal women, and a possible effect in preventing vertebral fractures. Combined vitamin D3 (700–800 IU/day) and calcium (1000 mg/day) may reduce the risk of hip and other non-vertebral fractures in individuals with low levels of intake. Supplementation with β-carotene increased lung cancer risk in persons with asbestos exposure or cigarette smoking.
Users of Vitamins Beware
The overall quality and quantity of the literature on the safety of multivitamin/mineral supplements is limited. Among the adverse effects reported were vitamin A supplementation may moderately increase serum triglyceride levels. Calcium supplementation may increase the risk of kidney stones. Vitamin E supplementation was associated with an increased incidence of nosebleeds but was not associated with an increased risk of more serious bleeding events.

Bottom Line: Vitamins may be helpful for a few conditions. Nothing beats a good diet with fresh fruits and vegetables, plenty of exercise, and adequate sleep. Vitamins and supplements are not the cure all for many diseases or the major source of disease prevention.

Want To Live Longer and Better? Start Walking….But Do It A Little Faster

December 26, 2011

Medical science has recognized for many years that walking 30 minutes a day improves the quality of life through the attainment of a higher level of functional capacity up to the end of life. Now we have research that walking 30 minutes at a rate of 3.5 miles per hour also improves the quantity, or how long we live.

A recent article in the Journal of the American Medical Association studied thousands of seniors over age 65 and found that those who walked at a faster speed lived longer and with a better quality of life. The paper pointed out that walking is a reliable tool for measuring well-being and predicting longevity because walking requires body support, timing, and power, and it places demands on the brain, spinal cord, muscle, joints, heart, and lungs. Significant to this study was the finding that the greatest gains in longevity correlated with gait speed and were realized after age 75.

What is most surprising about this new research was the dramatic correlation that was found between gait speed and life expectancy. Figure 1 compared the probability that an 80 year old male or female will live to 90, based on waling one mile per hour versus 3.5 miles per hour, and the predicted differences in medial life expectancies for these two groups. The analysis demonstrated that the median life expectancy of an 80 year old of either sex increases an additional 10 years, simply if the gait speed of that individual is 3.5 mph versus 1 mph.

Bottom Line: We all know that exercise is good for us and performing some activity such as walking 30 minutes a day is going to be good for us. Now we know that if we pick up the pace a little bit we will have a better quality of life and will probably live longer. So if an apple a day keeps the doctor away, walking at brisk pace will increase the distance between the doctor and the patient.

Gait speed and longevity

Speed of Walking Improves Longevity

Does Your Wi-Fi Wipe Out your Sperm?

December 22, 2011

If you are a man and if you are worried about infertility, don’t try to Google the term “infertility” with a computer on your lap. A new experiment suggests that heat and\or radiation from a single Wi-Fi enabled laptop may be strong enough to cause cell damage in sperm. Researchers took samples of ejaculated semen and left them directly under a computer-stimulating holding a laptop directly above the male genitals. Within 4 hours, 25% of the sperm stop swimming, and 9% showed signs of DNA damage. A control group of sperm stored at the same temperature, but away from a computer, showed much less degradation. It is suspected that electromagnetic radiation in wireless devices positioned near the male reproductive organs may decrease human sperm quality.

 

Bottom Line:  So, if you are trying to have a baby, use your desktop and not your laptop.

Don’t Let Your Bladder Drain Your Travel Plans

December 21, 2011

Travel today can make anyone anxious and nervous. But traveling and worrying about urinary incontinence can make even the most seasoned traveler think twice about making plans for a trip. This article will provide ideas that can help allay those apprehensions about traveling if you have urinary incontinence.

First, if fears about having an incontinence episode are causing you to consider skipping your trip entirely, check in with your doctor. There are medications that can be taken once a day that will help with bladder frequency, urgency of urination and urinary incontinence. You may need to start taking medications a few days or a week in advance of traveling for them to work most effectively, so don’t delay.
Here are other things to discuss with your doctor:

A Kegel a day may keep you dry and comfortable. Kegel exercises are used to strengthen the muscles in the pelvis. However, it may take weeks or months to train these muscles to help control your urination. You can do the exercises at any time even while reading this article or while waiting for the lavatory sign to read “vacant.”

Some medications have side effects that can contribute to urinary incontinence. Check to make sure other drugs you take aren’t undermining bladder control. For example, people who take diuretics to manage blood pressure or swelling might need to switch medications to fight incontinence .
Creating Your Flight Plan

Here’s how to plan for flying or driving “dry”:
Book tickets carefully. If you’re flying, try to get an aisle seat and, if possible, one close to the toilet. Many booking sites let you choose the seat you want on a map of the plane.

Plan your route. If you’re driving, take a careful look at your map and consider stopping for bathroom breaks every 90 minutes or so (based on your typical time between urges or leaks).

Buy supplies. Even with good planning, you could experience a leak. Adult absorbent pads can help you feel more confident. For long trips, talk with your doctor about urethral plugs or portable catheters. Some patients may have a catheter or tube inserted into the bladder before a trip which will drain urine from the bladder to a leg bag which can be easily concealed under your clothing. The catheter can then be removed when you reach your destination. And if you’re flying, check ahead with your airline to find out what you can take in a carry-on. Generally, all prescription assistive products can go on the plane with you.

Learn foreign customs. If you’re traveling internationally, learn how to ask for a bathroom in the local language. Also check in advance to find out whether you will need change for public restrooms and tips for attendants.
Bladder Control While on Your Trip

Choose beverages carefully. Caffeine, soda, beer, and wine are all diuretics and increase the production of urine and can aggravate an already overactive bladder. You should skip these while flying or driving. Sip on water if you’re thirsty.

Ask for privacy. Should you find yourself in the awkward situation of needing a pat-down or other security screening, and you’re feeling embarrassed about your incontinence or related supplies, know that you can ask security officers for privacy. You may want to ask your doctor in advance for a note to confirm your situation.

Avoid constipation as constipation actually makes bladder control more difficult, so make sure you eat a varied diet and have regular bowel movements.

Void early and often. Instead of waiting for a leak, be proactive and seize your opportunities. Make sure you go to the bathroom before you get on the plane, during a layover, and when you have opportunities between meal and beverage cart service times. When driving, stick to your planned stops, even if you don’t feel the urge to go.

Pack a change of clothes. You want to travel light, but you should have easy access to a spare set (or two) of underwear and easy-to-wash travel pants.

Pack toilet supplies. Because you never know how well bathrooms will be maintained, you may want to carry your own flushable wipes, spare toilet tissue, sanitizing hand gel, plastic bags for disposing of trash or for storing soiled clothes, and any other supplies you think you might need.

Plan for special events. You may occasionally have to attend a gala dinner or other social engagement that could require sitting for hours while people speak or make presentations. Try to find out whether these will be on your itinerary and whether you can be seated close to a door.

Bottom Line: With proactive incontinence management, your trip should be as pleasurable and comfortable as you want and you won’t have to depend on Depends!

Article modified from Taking Incontinence on the Road, By Madeline Vann, MPHMedically reviewed by Farrokh Sohrabi, MD

Health check ups for men

December 21, 2011

Health check ups for men

I am often asked about what tests or procedures men should have even if they are enjoying good health.  I am providing you with a suggested health checkups for men beginning at age 20-70. 

 Age 20

Blood pressure every 2 years or annually if elevated

Cholesterol every 5 years

Dental exam annually

Vision examination every 2 years

Immunization (tetanus-diphtheria at age 19)

Sexually transmitted diseases

Skin cancer (look for marks or changes on your skin)

Testicular cancer-testicle self-examination

 

Age 30

Blood pressure every 2 years or annually if elevated

Cholesterol every 5 years

Dental health annually

Eye examination every 2 years

Immunizations (tetanus-diphtheria every 10 years)

Sexually transmitted diseases

Skin cancer (look for marks or changes on your skin)

Testicular cancer-testicle self examination

 

Age 40

Blood pressure every 2 years or annually if elevated

Cholesterol annually

Dental health annually

Diabetes (blood sugar test at age 45, or earlier if overweight or other risk factors are present)

Heart health (EKG every 4 years to screen for abnormalities)

Immunizations (tetanus-diphtheria every 10 years)

Prostate cancer (baseline PSA test if African American or there is a family history, age 50 otherwise)

Skin cancer (look for marks or changes on your skin)

 

Age 50

Blood pressure every 2 years or annually if elevated

Cholesterol annually

Colorectal cancer or annually

Dental health annually

Eye health every 2 years if you have vision problems

Heart health (EKG every 3 years to screen for abnormalities)

Immunizations (tetanus-diphtheria every 10 years, annual flu vaccine)

Osteoporosis (if risks factors are present)

Prostate cancer annually

Skin cancer (look for marks or changes on your skin)

 

Age 60

Abdominal ultrasound (if you have smoked over 100 cigarettes in your lifetime)

Blood pressure annually

Colorectal cancer annually

Dental health annually

Diabetes (every 3 years or as doctor recommends)

Eye health every 2 years if you have vision problems

Hearing annually

Heart health (EKG every 3 years to screen for abnormalities)

Immunizations (tetanus-diphtheria every 10 years, annual flu vaccine, shingles/herpes zoster vaccine once after age 60)

Osteoporosis if risks factors are present

Prostate cancer annually

Skin cancer (look for marks or changes on your skin)

 

Age 70+

Abdominal ultrasound (if you have smoked over 100 cigarettes in your lifetime)

Blood pressure annually

Cholesterol annually colorectal cancer annually dental health annually diabetes (every 3 years)

Immunizations (tetanus-diphtheria every 10 years, annual flu vaccine, pneumococcal vaccine after age 65)

Osteoporosis if risks factors are present

Prostate cancer annually

Skin cancer (look for marks or changes on your skin)

Advice About Ordering Your Medications From Online Pharmacies In Other Countries

December 20, 2011

Drugs for most medical conditions are very costly. Today the cost spent on pharmaceutical agents is $307 billion per year or $728 for every American is spent each year on medications. (I am sure this is much higher for seniors who take much more medication than younger individuals.) The Medicare “donut hole”, or the failure of Medicare to pay for prescription drugs after the government has paid several thousand dollars, leaves many seniors without coverage for expensive medications for weeks or months at a time. Consequently, many seniors are going without medications or are looking to online foreign sources, i.e., Canada, Mexico, India, and China for their prescription medications. This article will discuss the caveats and pitfalls for buying prescription medications online.

I am frequently asked by patients how to buy less expensive medications including is it safe to buy medications online from another country.
The U.S. Food and Drug Administration (FDA) opposes foreign drug purchases, warning that these sales pose serious safety problems. While importing Canadian medications is against U.S. policy, the FDA has said that it will not prosecute individuals who import small amounts (three months or less) for personal use. If you are considering ordering medications from Canada, remember that the FDA cannot guarantee the safety of those medications. The FDA’s concerns include:

Medications that have not been approved for sale in the United States may not have been manufactured under quality assurance procedures designed to produce a safe and effective product.

Some imported medications — even those that have the name of a product approved in the United States — may, in fact, be counterfeit versions that are unsafe or ineffective.

Some imported medications and their ingredients, although legal in foreign countries, may not have been evaluated for safety and effectiveness in the United States. These medications may be addictive or contain other dangerous substances.

Some medications are unsafe when taken without adequate medical supervision. You may need a medical evaluation to ensure that the medication is appropriate for you and your condition. Or you may require medical checkups to make sure that you are taking the medication properly, to assess whether it is working for you, and to check for unexpected or life-threatening side effects.

The medication’s label, including instructions for use and possible side effects, may be in a language you do not understand and may make medical claims or suggest specific uses that have not been adequately evaluated for safety and effectiveness.

An imported medication may not have information that would allow you to be treated promptly and correctly for a dangerous side effect caused by the medications.

The American Association for Retired Persons (AARP), the leading non-profit, non-partisan membership organization for people aged 50 years and over in the United States, does not encourage Americans to break the present drug importation law. But with an estimated two million Americans already buying prescription medications from Canada and other countries, AARP has come up with guidelines to help consumers minimize their risk and ensure that the medications they receive are the ones their doctors have prescribed. AARP recommends that you pick an online pharmacy that:

If you are buying drugs from Canada, look for the displays the seals of the Canadian International Pharmacy Association (CIPA; see http://www.ciparx.ca/) or Internet and Mail-Order Pharmacy Accreditation Commission (IMPAC; see http://www.impacsurvey.org/). These organizations set standards for safety and service among Canadian mail-order pharmacies that sell to Americans. Those that meet the standards receive accreditation.

Requires a prescription for medication from your doctor. Reputable pharmacies may allow you to fax in a prescription but will then either confirm the prescription by a phone call to your doctor’s office or wait until they receive the original prescription in the mail before filling your order.

Expect that the pharmacy requires you to submit details of your medical history and clearly states the pharmacy’s policies for ensuring medical and personal privacy.

It is probably best to have taken a medication for at least one month before you order by mail so that you and your doctor know the medication is working and is safe for you.

Provides a full mailing address and a toll-free phone number on its website so that you can call and speak to a pharmacist to ask any questions you may have.

Displays on its website full information about shipping fees, payment policies, and refunds. Reputable pharmacies offer secure (encrypted) online payment for credit cards, alternative options for payment (such as electronic fund transfers and regular checks), and do not charge any separate fees except for shipping.

Charges the cost of the medications to your credit card only when the drugs are shipped, not when the order is first placed. An honest pharmacy refunds your money or reships medications immediately if your order does not arrive.

Bottom Line: If you’re wondering where to start looking for pharmacies online, visit http://www.pharmacychecker.com, a website run by an independent American consumer research group that provides ratings and price comparisons for more than 40 online pharmacies based mainly in the United States and Canada. This site rates them on a scale of 1–5 and notes whether a pharmacy is licensed, requires a prescription, provides its address and phone number, and offers personal privacy and payment security. The site compares prices for more than 1,000 drugs at these pharmacies and gives details on shipping fees and delivery times. Buying medication online is slight risk. However, if you follow these guidelines, you may be able to achieve considerable savings for those expensive medications.

Premature Ejaculation-Consider Icing Down The Penis

December 20, 2011

Premature ejaculation affects 20% to 38% of men, making it among the most common forms of male sexual dysfunction worldwide. Overactivity of these nerves has been implicated as a cause of premature ejaculation.
Treatment options include certain antidepressants such as Celexa (citalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline), as well as anesthetic ointments and cream, and behavioral therapies. Unfortunately, many men aren’t helped by the treatments.
A new technique involves inserting a tiny, hollow needle into the skin near the belly button. The doctor snakes the hollow needle down to one of the penile nerves, which is knocked out by freezing the nerves. It’s not painful, though some men feel a cold sensation.
Researchers tested the technique on 24 men who hadn’t been helped by standard treatments. They lasted an average of 110 seconds before ejaculation, or nearly two minutes, over the three months they were followed, compared with 36 seconds before treatment.
These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.
SOURCES:
Radiological Society of North America 97th Scientific Assembly and Annual Meeting, Chicago, Nov. 27-Dec. 2, 2011.
J. David Prologo, MD, assistant professor, interventional radiology, Case Western Reserve University School of Medicine, Cleveland.

Facts on Fiber

December 11, 2011

Most of us haven’t a clue how many grams of fiber we get from our diets in on a typical day. Yet for many Americans, this number should be doubled.
Most of us don’t even come close to the recommended intake of 20 grams to 35 grams of fiber a day. Americans’ mean fiber intake is about half that –14-15 grams a day.
That’s not surprising when you consider that we get fiber from ‘roughage’ like fruits, vegetables, whole grains, nuts/seeds, and beans. The typical American isn’t exactly loading his or her plate with these foods (you’d be hard-pressed to find a fruit, vegetable, whole grain, or bean in your average fast-food value meal).
Why Is Fiber so Good for Us?
Eating a higher-fiber diet has been shown to lower blood cholesterol levels, improve and prevent constipation, slow digestion and can help us eat less — and lose weight.
Simply doubling the amount of fiber you eat from the average of 15 grams per day to around 30 grams helps reduce calorie intake. Fiber has been shown to increase satiety, not only by lowering the energy density of foods (that is, how many calories they have per serving) but also by slowing the rate that foods pass through the digestive systems.
When you increase dietary fiber, do it gradually to avoid gastric distress, and to drink plenty of fluid to avoid constipation.
Dietary fiber not only makes us feel fuller, but reduces digestibility. Some studies have shown that large amounts of fiber in the diet can help regulate blood glucose and insulin. These may be reasons why people who eat higher-fiber diets tend to weigh less and are less prone to gain weight as they age.
The research findings on fiber’s benefits keep pouring in. Some recent studies have shown that:
• Eating a higher-fiber diet, as part of an overall healthful lifestyle, may play a role in a healthful BMI ( body mass index). One study found that women who ate more whole grains and total fiber consistently gained less weight over 12 years than those who ate less fiber and whole grains. Another study found that women with low-fiber, high-fat diets were more likely to be overweight than those following high-fiber, low-fat diets. Weight control advice for American women should place greater emphasis on consumption of fiber.
• A high-fiber diet may reduce your risk of colon cancer. If populations with a low average fiber intake suddenly doubled their fiber by making wiser food choices, they could lower their risk of colon cancer by 40%, according to a study involving data collected from 10 European countries. A recent National Cancer Institute study also linked high fiber intakes to a lower risk of colorectal cancer. This was especially true for fiber from grains, cereals, and fruits.
Fiber may reduce the risk of type 2 diabetes. Those who ate a diet high in refined carbohydrates and low in cereal fiber were more likely to increase their risk of type 2 diabetes, according to a recent study. And a recent Finnish study showed that as whole grain and cereal fiber intake increased, the risk of type 2 diabetes seemed to decrease. But it may not just be all about the fiber in this case; high-fiber foods are also rich in important micronutrients. That’s why it’s better to concentrate on including whole plant foods in your diet than to take a fiber pill or supplement.

Fiber intake has also been linked to the metabolic syndrome, a cluster of risk factors that increase the chances of developing heart disease and diabetes:
• Higher intakes of fiber (from cereal and whole-grain products) were linked with a slower build up of cholesterol filled plaque of the arteries in postmenopausal women with coronary artery disease. In another study, in men and women aged 40-60 and free of heart disease, viscous fiber (especially pectin, the type of soluble fiber found in apples) appeared to protect against the progression of atherosclerosis in neck arteries.
• High intakes of oat fiber appeared to have a protective effect on the heart, by lowering LDL “bad” cholesterol without decreasing HDL “good” cholesterol.

The 2 Types of Fiber
Though both have health benefits, there’s a difference between the insoluble, type of fiber found in whole grains, carrots, tomatoes, and lettuce, and the softer, water-soluble type found in oatmeal, pears, strawberries, and apples.
Soluble or viscous fiber is the softer type that dissolves in water.
When digested, it helps prevent cholesterol from being absorbed in the intestines. This type of fiber is also thought to help minimize the rise in blood sugar levels after a meal, which is particularly helpful for people with diabetes.
This type of fiber comes from: beans (they have both types of fiber), oatmeal and oat bran, some fruits (apples, mangoes, plums, kiwi, pears, blackberries, strawberries, raspberries, peaches, citrus fruits, dried apricots, prunes, and figs), and some vegetables (dried peas, beans, and lentils).
Insoluble fiber doesn’t dissolve in water.
It helps keep bowel movements regular, and may reduce the risk of colon problems. It may also reduce the risk of hemorrhoids, varicose veins, and obesity (by making us feel full).
Insoluble fiber is found in: Whole-wheat grain and wheat bran, brown rice, bulgur, seeds, and vegetables (carrots, cucumbers, zucchini, celery, and tomatoes).
The bottom line: All dietary fiber is good for you. Just get more of it. So feast on fiber!
This was modified by an article from WebMd High-fiber foods boost health and help control your weight by Elaine Magee, MPH, RD

Are You Inspired by Failure?

December 11, 2011

Another wonderful article by my colleague Dr. Neil Neimark

“Failure inspires winners. And failure defeats losers.”
Robert T. Kiyosaki, author of Rich Dad, Poor Dad

The above quote makes us realize that in order to be happy in life, we must make a vital distinction between “success and failure” and “winners and losers.”

Being a winner or a loser is not really determined by success or failure at any particular event in life; it is rather a state of mind that is affected by — but not determined by — our successes or failures in life.

If we are inspired by our “failures” to try harder, learn new distinctions and reinforce our efforts, we are a winner.

If we are defeated by our failures, we are a loser.

So being a winner or a loser is a state of mind. Success and failure only provide feedback as to how we are doing.

We may not always win (succeed) in life, but we can always choose to be a winner.

This is the power of mindset.

Life may not always bring us peace and happiness, but we can always choose to be peaceful or happy. It is a choice. In fact, it is a key to lifelong happiness, fulfillment and peace of mind.

Whether the external world grants us our goals and desires or not, a winner is one who always finds and/or creates greater goodness, love, fulfillment, happiness, contribution and peace in life.

In other words, choosing to be a winner, i.e. to have the mindset of a winner, is choosing to make happiness a habit.

If we learn to be happy inside no matter what is happening outside, we have a lifelong treasure that can enrich and empower us.

Does this mean we will never feel despair, hurt, frustration or disappointment?

Of course not, these feelings are a real part of life and honestly acknowledging them is essential to true and lasting happiness. But what we choose to do with these feelings determines whether we will be a winner or a loser in life.

In his book Happiness is a Serious Issue, Dennis Prager teaches that “though things do not always turn out for the best, you can always make the best of how things turn out.”

It is this attitude, this belief, this value that will bring you the mindset of a true winner in life.