Friday, April 28, 2017

Chemicals Found in Many U.S. Streams

The mixture of pollutants in many U.S. streams are more complicated and potentially more dangerous than previously thought, a new study suggests.

Researchers checked for 719 organic chemicals in water samples from 38 streams across the United States and found more than half of those chemicals in the different samples.

Every stream – even those in wild and uninhabited areas – had at least one of the chemicals and some had as many as 162, the study found. It was led by scientists from the U.S. Geological Survey and the Environmental Protection Agency.

The detected chemicals included: insecticides and herbicides, along with byproducts from their degradation; antibacterials such as triclosan; and medications such as antihistamines and the diabetes drug metformin.

Some of the chemicals were often detected together in streams. Further research is needed to determine the potential for complex interactions between these chemicals, to assess if they pose a threat to aquatic life, the food chain and human health the researchers said.

Wednesday, April 26, 2017

Wisdom Wednesday: Don’t Bank on Heart-Rate Accuracy from Your Activity Tracker

Wrist-worn activity trackers such as Fitbit don’t reliably assess heart rate, a new study finds.

While the devices may have some legitimate benefits, they shouldn’t be used for medical purposes, researchers suggest.

Evaluating four wearable activity trackers for Fitbit, Basis, and Mio, the investigators compared results to those from an electrocardiograph (EKG). The researchers found results varied among the different models, and were much less accurate during exercise than at rest.

“These devices are probably good enough to inform consumers of general trends in their heart rate – high or low – [but] it’s important to have more accurate information when physicians are relying on this data to make decisions on medications or other tests and treatments,” said Dr. Mitesh Patel.

Patel is an assistant professor of medicine and health care management at the University of Pennsylvania. He wasn’t involved in the study.

However, the study’s lead author cautions against making too much of the discrepancies. “At any moment, the tracker could be off by a fair bit. But at most moments, it won’t be,” said Lisa Cadmus-Bertram, an assistant professor of kinesiology at the University of Wisconsin at Madison. “The heart-rate feature performed better at rest,” she said. “They’re not as precise during exercise.”

A 2014 survey by PricewaterhouseCoopers found that 20% of American adults owned a wearable activity tracker.

Monday, April 24, 2017

Kidney Disease a Big Contributor to Heart-Related Deaths

Based on data from 188 countries at six time points between 1990 and 2013, the researchers estimated that in 2013, reduced kidney function was associated with 4% of deaths worldwide, or 2.2 million deaths.

More than half of these deaths (1.2 million) were heart-related, while nearly 1 million were caused by kidney failure, according to the report.

The findings provide new insight into the significant impact of kidney disease, also called “renal” disease, and highlight the importance of screening for kidney problems, the study authors said. “Understanding the true health impact of kidney disease on society necessitates considering cardiovascular as well as end-stage renal disease deaths and disability,” said Dr. Bernadette Thomas, of the University of Washington in Seattle. She made her remarks in a news release from the American Society of Nephrology.

The investigators also found that reduced kidney function ranked below high blood pressure, high blood sugar and overweight/obesity, but was similar to high cholesterol, as a risk factor for disability-adjusted life years (the number of years lost due to ill health, disability or early death).

Friday, April 21, 2017

Prolonged Antibiotic Use Tied to Precancerous Colon Growths

Taking antibiotics for an extended period in early to middle adulthood might increase your risk for precancerous growths in your colon, a large study suggests.

Women who took antibiotics for two weeks or more in their 20s through their 50s were more likely to have colon lesions in their 60s than women who didn’t take the drugs for an extended period, researchers found. If not removed, these lesions, called polyps or adenomas, can lead to colon cancer.

“This suggests that alterations in the naturally occurring bacteria that live in one’s intestines caused by antibiotics might predispose individuals to colorectal cancer,” said lead researcher Dr. Andrew Chan.

Through the study was limited to women, the link likely also holds true for men, Chan said. “More research needs to be done to understand the interaction between alterations in one’s gut bacteria and future risk of colorectal cancer,” he said.

Antibiotics disrupt the diversity and number of bacteria in the gut, or “microbiome.” They also reduce resistance to toxic bacteria. All of this might play a role in the development of precancerous growths, Chan said.

For the report, Chan and his colleagues collected data on the more than 16,600 women 60 and older who took part in the Nurses Health Study.

The women provided a history of antibiotic use between ages 20 and 59. They also had had at least one colonoscopy between 2004 and 2010. Nearly 1,200 precancerous polyps in the colon were found during that time.

Wednesday, April 19, 2017

Wisdom Wednesday: What You Need to Know About Cholesterol

Cholesterol plays a vital role in your health, so it’s important to understand the different types of cholesterol and how to influence their levels, a heart specialist says.

‘Good cholesterol – high density lipoprotein (HDL) – recycles cholesterol and fat in the body,” said Dr. Alex Garton. He’s a noninvasive cardiologist from Pinnacle Health Cardiovascular Institute, based in central Pennsylvania.

“What we call bad cholesterol, low-density lipoprotein (LDL), is ‘bad’ because any leftover LDL is deposited into the blood vessels, increasing the risk of vascular disease. HDL can help prevent this by ‘recycling’ excess amounts of bad cholesterol,” Garton explained in an institute news release.

Total cholesterol can be deceiving, so it’s important to know the levels of both your bad cholesterol and good cholesterol.

LDL levels should generally be kept below 130 mg/dL of blood. But a level of 100 mg/dL is considered “optimal.” The U.S. National Heart, Lung, and Blood Institute says.

HDL levels should be above 40 mg/dL, the NHLBI says. And, levels above 60 mg/dL are even better.

But cholesterol levels are only part of the overall picture, Garton said.

“Smoking cigarettes, having high blood pressure or having a family history of early heart disease can also increase a patient’s cholesterol-related risks. These factors actually lower the LDL cholesterol number that signifies a patient is at risk for heart disease,” he said.

Monday, April 17, 2017

A Surprising Culprit Behind Celiac Disease?

A typically harmless type of virus might sometimes trigger celiac disease, a new study suggests.

Celiac disease is caused by an abnormal immune response to the protein gluten, which is found in wheat, rye and barley. The condition damages the lining of the small intestine, and the only effective treatment is a gluten-free diet.

The new study found that when mice were infected with particular strains of a common human intestinal reovirus, their immune system could not tolerate gluten.

Patients with celiac disease also had much higher levels of antibodies against reoviruses than those without the autoimmune disease, the researchers said.

“This study clearly shows that a virus that is not clinically symptomatic can still do bad things to the immune system and set the stage for an autoimmune disorder, and for celiac disease in particular,” said senior study author Dr. Bana Jabri. She is director of research at the University of Chicago’s Celiac Disease Center.

“However, the specific virus and its genes, the interaction between the microbe and the host, and the health status of the host are all going to matter as well,” Jabri added in a university news release.

The findings were published April 7 in the journal Science.

My Take:
The trigger for the immune system response in autoimmune disease can be a protein or carbohydrate. Viruses are nothing more than a simple protein. They have a specific amino acid sequence and as little as five linked amino acids will trigger and immune response. The small size of viruses makes it easier for them to slip through the gut lining to stimulate that immune response.

Friday, April 14, 2017

Is Surgery Always Necessary for Gallstones?

Gallstone pancreatitis occurs when one on more gallstones gets stuck in a duct in the pancreas. This blocks pancreatic enzymes from leaving the pancreas and traveling to the small intestine to aid in digestion. When those enzymes back up into the pancreas, it causes inflammation and pain according to the American College of Gastroenterology.

The standard treatment is to remove the gallbladder within 30 days to prevent a recurrence, researchers said.

The study included information on more than 17,000 cases of gallstone pancreatitis in the United States. All occurred between 2010 and 2011. The patients all had private insurance and were under the age of 65.

Seventy-eight percent of the patients had their gallbladders removed within the recommended 30 days of their initial hospitalization. Less than 10% of those patients returned to the hospital with pancreatitis, the study found.

Of the more than 3,700 patients who didn’t have their gallbladder removed within 30 days, about 1,200 had their gallbladder removed within six months. But nearly 2,500 patients who didn’t have their gallbladder removed within 30 days had still not undergone the surgery four years later.

It’s not clear why some patients who didn’t initially undergo gallbladder removal had pancreatitis recurrences while others did not. More research is needed to find the answers, according to the study authors.

Wednesday, April 12, 2017

Wisdom Wednesday: Disconnecting

Last week my wife took me to Cartagena to celebrate my 65th birthday. It was my first visit to South America and hopefully not my last. We rented a large house in the old city with three other couples. The house was magnificent – fully staffed, 5 bedrooms, 6 baths and 3 pools. It overlooked the bastille wall and ocean.

We did typical tourist things – toured the city, went scuba diving and charted a boat for a day to visit a private club on a nearby island. A couple of days were reserved for just hanging around the house to unwind. Each evening we all met on the roof to watch the sunset over the ocean.

It was, to date, my best vacation and certainly my best birthday.

My gauge was my ability to disconnect from the pressures of everyday life. A good friend of mine, who works harder than anyone I know, has started taking off a month each summer. He claims it takes him about ten days to really disconnect.

I’ve never taken off more than a week, so I have no real frame of reference for his claim. However, this vacation I seemed to disconnect immediately. Maybe it was the exotic nature of the vacation or being in a Spanish speaking country where English is rarely spoken. I’ve never studied Spanish but I really tried to use the language to communicate as much as possible.

Although several televisions were available, I never turned one on. In fact, the thought never occurred to me. For a whole week, I was unaware of the latest world events. I only knew about the mud slides in Columbia (they were 300 miles away) when friends from the U.S. called with concern.

Monday, April 10, 2017

Physical Therapy as Good as Surgery for Carpal Tunnel Syndrome

Surgery is a common approach to treat carpal tunnel syndrome. But physical therapy may work just as well, a new study indicates.

Researchers found that physical therapy – particularity so-called manual therapy – improved hand and wrist function and reduced pain as effectively as a standard operation for the condition. Moreover, after one month, physical therapy patients reported better results than those who underwent surgery.

“We believe that physical therapy should be the first therapeutic option for almost all patients with this condition,” said lead study author Cesar Fernandez de las Penas. “If conservative treatment fails, then surgery would be the next option,” said de las Penas, a professor of physical therapy at King Juan Carlos University in Alcorcon, Spain. Also, one extra benefit of therapy over surgery may be cost savings, he noted.

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes squeezed at the wrist. It often arises from repetitive motions required for work, such as computer use of assembly line work. Symptoms usually start gradually, with patients noticing numbness and weakness in the hand and wrist.

Surgery for the condition generally involves cutting a ligament around the wrist to reduce pressure on the median nerve, according the U.S. National Institutes of Health.

For this study, de las Penas and his colleagues followed 100 women from Madrid who had carpal tunnel syndrome. Half were treated with physical therapy and half underwent surgery.

For three weeks, the therapy patients received weekly half-hour manual therapy sessions – meaning therapists used only their hands. The therapists focused on the neck and median nerve. They also applied manual physical therapy to the shoulder, elbow, forearm, wrist and fingers. On their own, patients performed neck-stretching exercises at home.

Friday, April 7, 2017

Are Blood Thinners Overused in Patients with Irregular Heartbeat?

Many people living with the heart rhythm disorder known as atrial fibrillation may be taking unneeded blood thinners, a new study suggests.

These blood thinners, which include aspirin, Plavix and warfarin, are believed to reduce the risk of stroke that can come with atrial fibrillation. But for many atrial fibrillation patients with a low stroke risk, the medications might actually increase both bleeding and stroke risk, researchers reported.

The way most doctors decide whether a patient needs a blood thinner is by using a simple score called CHADS2, which assigns points to patients based on age and other medical risks. A score of 2 is usually needed to recommend a blood thinner, the researchers explained.

But, “people are realizing that the CHADS2 scores are putting too many people above the threshold – it’s pretty easy to get a 2,” explained study author Benjamin Horne, an adjunct assistant professor of biomedical informatics at Intermountain Medical Center Heart Institute in Utah. “It’s better than flipping a coin, but there are many other scores out there that are more predictive,” Horne said. “The problem with those scores is that it is difficult and time-consuming to use.”

For the study, Horne and his colleagues collected data on nearly 57,000 patients with atrial fibrillation and a CHADS2 score of 0-2. Patients were divided into groups receiving aspirin, Plavix or warfarin or no blood thinner.

Wednesday, April 5, 2017

Wisdom Wednesday: Health Self Advocate

I had a patient contact me by phone two weeks ago with complaints of severe left knee pain and swelling. It was after office hours so he sent me pictures of the leg. One look and I sent him to the emergency room at the local hospital. The leg was twice normal size with edema extending from above the knee to the ankle.

My immediate concern with the possibility of a DVT (deep vein thrombosis). These clots frequently occur in the legs resulting in significant pain, swelling, and will often be warm or hot to the touch.

Despite having all those classic symptoms, an ultrasound at the hospital ruled out DVT. An MRI was performed which was also read as negative. Laboratory testing lead to a diagnosis of “reactive arthritis”. The patient was prescribed an antibiotic and an anti-inflammatory medication and sent home. No advice for follow-up care was given.

I spoke to the patient, again by telephone, over the weekend. I asked what and where was the infection? His response was what infection? I then asked if the test for RA (rheumatoid arthritis) was positive. He responded that he didn’t know any of his lab results. He just knew the ultrasound and MRI were negative.

Reactive arthritis is an autoimmune response to an infection someplace in the body. The immune system overreacts, attacking some joint. In this case, supposedly, the left knee. Testing for RA will be positive and in fact, reactive arthritis is considered a form of rheumatoid arthritis even though it is transient.

I advised him to get his hospital records and see his PCP the first of week. His PCP agreed with both medications but failed to comment on the diagnosis.

Over the course of the week, this patient’s condition gradually improved. However, the symptoms all returned the following week. Another phone call to me and I sent him back to his PCP and asked him to get the diagnosis while he was there.

The PCP gave him a diagnosis of pseudogout and added a steroid pack to the antibiotics and anti-inflammatory meds. Pseudogout is caused by deposition of calcium pyrophosphate crystals and the knee is the most commonly affected joint.

Monday, April 3, 2017

Vitamin E, Selenium Supplements Won’t Curb Dementia Risk

A daily dose of vitamin E or selenium supplements won’t keep dementia at bay in older men, new research reveals.

“After an average of five years of supplementation, and up to 11 years of follow-up, we did not observe fewer new cases of dementia among men who took any of the supplements compared to neither supplement,” said study co-author Frederick Schmitt. He’s a professor with the Sanders-Brown Center on Aging and the department of neurology at the University of Kentucky in Lexington.

“Based on these results, we do not recommend vitamin E or selenium supplements to prevent dementia at these doses,” he added. Approximately 5 million American Seniors are now living with Alzheimer’s, the study authors noted.

Between 2002 and 2008, the study enrolled slightly more than 7,500 males across the United States and Canada. All were aged 60 or older. None had a history of neurological problems, dementia, serious head injury or substance abuse.

Participants were divided into four groups: a vitamin E group; a selenium group; a combination group; and a placebo group. The supplement doses were 400 IUs of vitamin E and 200 mcg of selenium per day. The men took the supplements or the placebo for an average of about five years, the study authors said.

In the end, 325 men developed dementia at some point during the study. Of these, 71 had been in the vitamin E group, 78 in the selenium group, 91 in the combination group, and 85 in the control group.

“For consumers specifically concerned about brain health and cognition, they should beware that no scientifically rigorous studies have identified any supplement as an effective treatment or prevention for dementia,” Schmitt said.