A new study from the Internal Medicine Dept. at the University of Michigan published in the journal Gastroenterology suggests that there is currently over use of surveillance colonoscopies in low risk patients and an under use in high risk patients. The study took into consideration cost effectiveness, mortality, and the unpleasant nature of the procedure.

The results of this study don’t really address screening colonoscopies but surveillance procedures in those people with known precancerous polyps. If you fall into this category you might want to discuss with your gastroenterologist how often you have follow up procedures done. bjmdjd

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Gastroenterology (journal) · precancerous polyps · surveillance colonoscopies

A Canadian study published last week online in the Lancet listed the ten risk factors associated with 90% of the risk of stroke. They are:

1. hypertension (high blood pressure)
2. current smoking
3. waist to hip ratio (an indicator of health that compares the size of the waist to the size of the hips)
4. diet
5. alcohol intake
6. regular exercise
7. diabetes
8. stress and depression
9. heart problems
10. lipids (elevated cholesterol or other fat problems in the blood)

All ten risk factors applied to ischemic stroke (the most common kind of stroke which is caused by  the interruption of blood flow like from a clot) while the first five applied to intracerebral hemorrhagic stroke (the kind where there is bleeding in the brain).

The study suggested that specifically treating these ten risk factors could greatly decrease the number of strokes that occur. Something to think about when planning on what you need to do to overall improve your health.  bjmdjd

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ischemic stroke. hemorrhagic stroke · risks of stroke · The Lancet

I’ve heard all of my life that it was harmful to hold in your anger and that it was just better to let it out. There may be some proof for certain people that this is true.

Research published in the latest issue of the American Journal of Cardiology says that for people with coronary artery disease holding in anger is associated with a higher risk of heart attack and cardiac death.

It was noted by the authors of the study that there may be a great deal of anger in patients who outwardly appear to be well adjusted and without anger. With the increased likelihood of cardiac events these patients require recognizing and possibly treating from a mental health standpoint. bjmdjd

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American Journal of Cardiology · anger · cardiac death · heart attack

While writing one of the installments for my radio show this past weekend I came across some alarming statistics concerning tanning booth use and melanoma. I’ve known about the possible connection for some time but it really struck me as to what a serious problem this is. And unfortunately the most affected group appears to be young females who might not be making decisions based on the most reliable information. Couple this with a dose of feeling bullet proof and you’ve got a recipe for disaster.

A recent study from the University of Minnesota found that there is strong evidence that ”indoor tanning increases the risk for melanoma and should be avoided.” In 2006 the World Health Organization’s International Agency for Research on Cancer stated that there was only a weak association between indoor tanning and the risk of developing melanoma. Recently the group changed their stance and now calls tanning devices carcinogenic.

The tanning industry is a big money maker and of course they refute the findings of the latest study saying that the lead researcher was not a neutral party. One of the main concerns of the authors was the same as mine. That the main users of the indoor tanning devices are teens. The study noted that in looking at 116 American cities the average number of tanning salons surpassed the average number of Starbucks or McDonalds!

To tan or not to tan. Indoor tanning appears to be a serious public health problem. As mentioned by the authors of the study it needs to be addressed in schools much like obesity and smoking. There is talk of possibly making it unlawful for anyone below the age of 18 to use tanning salons. At least not without parental consent. Do we need more laws or just allow common sense to prevail? While I hate more laws it doesn’t appear that common sense is working very well.  bjmdjd

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indoor tanning · melanoma · tanning booths · University of Minnesota

The big story in the news today is the results of a new study published in Pediatrics journal which shows a possible connection between pesticide exposure and attention deficit hyperactivity disorder. Pesticides now join a growing list of possible causes of the popular diagnosis including too much television exposure and simply over diagnosis.

The Harvard study measured the pesticide levels in the urine of 1,139 children between the ages of 8 and 15 years old. Through caretaker interviews it was found that 150 children with positive urine tests carried the diagnosis of ADHD. The higher the pesticide level the more likely the child was to have the disorder.

It is important to note that while the study does show a possible connection it is only one study and much more work and research needs to be done to make a definite correlation. The authors of the study recommended buying organic products and washing all fruits and vegetables well before eating.  bjmdjd

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ADHD · fruits and vegetables · Harvard study · Pediatrics journal · pesticide and ADHD connection · pesticides

For many years it was felt that nuts were an unhealthy snack. More recently many kinds of nuts have been found to be better for you than originally thought.

A recent study published in the Archives of Internal Medicine revealed that eating almost any kind of nut lowers total cholesterol levels and the bad kind LDL. The amount of lowering was found to be dependent on how many nuts were consumed. The authors of the study said that the risk of coronary artery disease was almost 40% lower in folks who ate at least four servings of nuts per week compared to those who rarely or never ate them.

It does seem that the benefits of eating nuts on cholesterol lowering was better in those who started with higher cholesterol levels. This study seems to support the 2003 statement by the Food and Drug Administration that the consumption of certain types of nuts might lower the risk of heart disease. The nuts mentioned at that time by the FDA included almonds, hazelnuts, pecans, pistachios, walnuts, and peanuts.  bjmdjd

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Archives of Internal Medicine · coronary artery disease · Food and Drug Administration · nuts can lower cholesterol

Two terms you have read about on this blog recently are prehypertension and prediabetes. Both are fairly new terms developed to identify patients earlier for diabetes and high blood pressure.

The terms came up again at the American Society of Hypertension 2010 Scientific Meetings held last week in NYC. Various studies identified these patients at being easy to identify and that those with both diagnoses are at an increased risk of cardiovascular disease. Several of the meeting participants stated that these patients should at least be receiving lifestyle change information.

Physicians: Nearly every patient that is seen in a primary care office has their blood pressure checked and a fasting blood sugar measured at  some point. If you believe this statement you must admit that this subset of patients is really already identified within your patient population. All you have to do is label them. Any primary care physician worth his/her salt is already addressing both of these diagnoses but this information does add some incentive for both the patient and the physician to see the importance of starting at least life style changes as an intervention. I believe that you will find that patients with both of these diagnoses also have other risk factors for cardiovascular disease  bjmdjd

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American Society of Hypertension · cardiovascular disease · prediabetes · prehypertension

As I mentioned recently on a radio program that I record, stents are usually placed after a  balloon angioplasty procedure. It’s also important to have these patients be put on anti platelet drugs immediately. Most people refer to these anti platelet medications as blood thinners (though this is not exactly correct). The most popular one available by prescription is clopidogrel (Plavix).

Research published in the April 20, 2010 online edition of Circulation: Cardiovascular Quality and Outcomes reported that patients who had a drug eluding stent placed and delayed in filling their prescription for clopidogrel had much higher rates of death/heart attack during the follow up period.

The reasons for filling the prescriptions were varied but showed how important discharge planning is for many patients after hospitalization. Money is not always the determining factor as many patients have co-morbid conditions and transportation problems that may delay their going to the pharmacy.  bjmdjd

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Circulation Journal · clopidogrel · drug eluding stents · Plavix

Sorry for being absent for the past few days but it was necessary and there hasn’t been a lot going on anyway.

I recently saw a segment on television about this story so I was glad to find some further information on it. It is also of some interest to me due to the fact that one of my family members is having fairly severe memory problems now.

Accoring to the April issue of the Journal of Alzheimer’s Disease there is now an  online screening tool that has been found to be better and more reliable that standard tests in diagnosing cognitive impairment. It not only can determine who did and did not have cognitive impairment but could also identify the stage of Alzheimer’s disease.

It was noted that 69% of people with Alzheimer’s are not diagnosed by their primary care physician which suggests that there are many missed opportunities to make this diagnosis in the early stages of the disease. This is important due to the advances in medications which can now make a big difference in functioning if started early in the disease process.

The investigators admit that the tool needs further validation but state that it appears to be very promising. A web site is provided in the article for physicians that would like further information.  bjmdjd

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Alzheimer's disease · cognitive imparment · health · Journal of Alzheimer's Disease · wellness

A new study to be published this week in the Journal of the American College of Cardiology has found that light to moderate consumption of alcohol is associated with lower rates of cardiovascular disease when compared to teetotaling. It was a large study involving  245,000 American adults.

Light alcohol intake has long thought to be heart protective mainly through increasing HDL. As with all other similar studies, there are many confounding factors and no one claims to know the ideal amount of alcohol intake. While light alcohol intake was associated with lower rates of cardiovascular disease, moderate alcohol intake showed even better results. Heavy drinking was not associated with higher or lower rates of CV disease.

When I was in active practice I had several ministers I took care of that loved the results of these types of studies.  bjmdjd

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Journal of the American College of Cardiology