Being the first group of parents to have to have to parent an all digital generation of kids, it’s no wonder our brains go on overload trying to sort out not only how to use all things digital but keep our developing kids safe and thriving in their ever digital lives.
I talked about these issues today on Fox25 Boston and highlighted the new social media and sexting tips out from the American Academy of Pediatrics in honor of Internet safety month. Here’s the clip of the segment with all the details:
To remember the key points of the new AAP tips, I came up with the mnemonic “TECH”:
T: talk to your kids about their technology use and what they think of technology and the issues they hear about online.
E: educate yourself about the technology your kids are using, your kids about the issues, and your community about the need for youth education programs in schools as support for the issues
C: check your kids online profiles and logs often, and sometimes without warning
H: have a family tech use plan and follow-through when violations occur.
We know how to parent off line. We know how to create consequences when curfews are broken and expectations for social rules and proper behavior are not met. What we have to do now is modify our already great parenting skills to the online world. These tips are the first step!
Plus, keep in mind, you are not alone. Not only are all the parents around you in the same boat but you have experts like me here to help answer your questions about the high tech lives of kids.
I had a great chat after the segment with many FoxNews25 viewers and will post what we talked about soon so everyone can benefit. In the meantime, if you have questions about your own “Networked Family” or a story to share from your own “Networked Family” archives, email me at ideas@pediatricsnow.com.
Patient question about healthline.com/blogs/pregnancy_childbirth/2008/07/amniocentesis-is-not-without-risk.html" >“Amniocentesis is Not Without Risk”:
I am 29 years old and am 21 weeks along. I just had an ultrasound a couple of days ago and was told that the nasal bone is not showing up which puts me at higher risk for a baby with Down Syndrome. I have yet to have someone tell me how much of an increased risk. I did not have the 1st trimester screenings as I’ve always said that it wouldn’t make any difference but now that it’s staring me in the face I am seriously considering an amniocentesis. I just wonder if I can go through the next 19 weeks wondering. Can you tell me what my risk is for a Down Syndrome baby? Thank you.
Previously we published a post that discussed the role of assessment of the healthline.com/blogs/pregnancy_childbirth/2008/07/fetal-nasal-bone-assessment-in-first.html" >fetal nasal bone in first trimester screening for fetal chromosomal abnormalities and, in particular, screening for Down syndrome (trisomy 21). Confirmed absence of the fetal nasal bone in first trimester has been correlated with a detection rate for Down syndrome in the range of 70% (with false positive rates dependent on maternal ethnicity a?? 2.2% in causcasians; 5% in Asians; and 9% in Afro-Carribeans) (Cicero, et al. Ultrasound Obstet Gynecol. 2003;21:15a??18; Prefumo, et al., BJOG 2004; 111:109a??112). Although determining the presence or absence of the nasal bone can clearly contribute to the risk assessment in first trimester, unfortunately, the technical difficulty of reliably obtaining an image and accurately interpreting the findings have led to more restricted use here in the U.S., even at many major academic centers.
In contrast, in midtrimester genetic screening, often done at 18-20 weeks, the finding of an absent nasal bone and to a lesser degree a hypoplastic nasal bone, is becoming more widely recognized as a major a??markera?? for trisomy 21. In midtrimester, complete absence of the fetal nasal bone occurs in about one-third of Down syndrome babies. If a a??shorta?? nasal bone (nasal bone hypoplasia), is included in the evaluation, 60% or more fetuses with Down syndrome may be detected, again with false-positive rates depending on ethnicity and the variable cut-off values for defining a a??short nasal bonea?? in different studies (Bromley; et al., J Ultrasound Med 2002; 21:1387a??1394; Bunduki; et al., Ultrasound Obstet Gynecol 2003; 21:156a??160; Lee, et al., J Ultrasound Med 2003; 22:55a??60; Gamez, et al., Ultrasound Obstet Gynecol 2004; 23:152a??153).
One small study using 3D ultrasound found an absent nasal bone in 9 of 26 babies with Down syndrome (34.6%) and only 1 of 27 (3.4%) chromosomally normal babies, but this also meant that 9 of the 10 (90%) babies in whom complete absence of the nasal bone was found had Down syndrome (Goncalves, et al., J Ultrasound Med 2004;23:1619-27). In a recent study of 4373 babies evaluated in midtrimester, complete absence of the nasal bone was found in about 30% of Down syndrome and only 1% of chromosomally normal fetuses . (Odibo; et al., Am J Obstet Gynecol 2008;199:281.e1-281.e5). Nasal bone hypoplasia, defined in this study as <0.75 MoM, identified 47% of Down syndrome pregnancies and occurred in 6% of normal pregnancies.
So, to our reader, I cannot give a precise estimate of increased risk based on the ultrasound findings you report. However, if the ultrasound was performed by an experienced examiner and adequate images were obtained for evaluation, the complete absence of a fetal nasal bone at 21 weeks, even as an isolated finding, is disconcerting. The risk for Down syndrome could be as high as 90% and the false positive rate 5% or less. And, if you really need to know whether or not your baby is affected, an amniocentesis would be the best way to get that information. Best wishes and please let us know what you find out.
Dr T
This post, healthline.com/blogs/pregnancy_childbirth/2009/09/absence-of-fetal-nasal-bone-in.html" >Absence Of Fetal Nasal Bone Is A Marker For Down Syndrome, was originally published on healthline.com/" target="_blank">Healthine.com by Kenneth Trofatter M.D., Ph.D..
Several years ago I was urgently paged by a patient who had discovered a lump at the bottom of his chest. He came straight over to my office, fairly certain he had cancer. The lump turned out to be a normal part of his sternum (breastbone), a small piece of cartilage called the xiphoid. Now that’s the kind of diagnosis I like to make.
I’m guessing most people don’t know where their xiphoid is and, fortunately, it doesn’t come up much in conversation. But there are a few parts of the body you should be familiar with in order to recognize important symptoms and alert your doctor. Here’s my top-four list of organs whose location patients should know but often don’t:
Appendix
The appendix is a wormlike structure in the right (from the patient’s point of view) lower quadrant of the abdomen, at the very beginning of the colon - near the junction of the large intestine (colon) and small intestine. The word “itis” means inflammation; so appendicitis means inflammation of the appendix. Appendicitis can cause pain and all sorts of vague gastrointestinal symptoms such as nausea, indigestion, and lack of appetite.
Where is the appendix? Place your left index finger on your umbilicus (that’s med-speak for navel or belly button) and your right index finger on the curved bone (iliac crest) at the top of your right hip. The appendix is usually about a third of the way from your right index finger to your left index finger. But the location can vary considerably and the classic presentation of pain around the navel that migrates down to the right lower quadrant only occurs about half the time. Depending on how the appendix is pointed, the pain can appear in all sorts of places - even in the right upper quadrant.
Clinical pearl: the appendix is on the right, not the left.
Gallbladder
The gallbladder is a small sac that stores bile in the right upper quadrant of the abdomen, nestled under the right ribcage. When the gallbladder contracts, it squirts bile down a duct and into the small intestines, where it helps digest food. Sometimes the bile precipitates into stones or sand-like sludge inside the gallbladder, often causing no symptoms. But if a stone blocks the thin tube (cystic duct) where the bile exits the gallbladder, the gallbladder can become inflamed and painful. The classic symptom of an inflamed gallbladder (cholecystitis) is sharp right upper quadrant pain that may radiate to the right shoulder or right back. There may also be nausea and vomiting.
Atypical symptoms include pain in the upper midline (epigastrium) or even chest.
Clinical pearl: if a stone leaves the gallbladder and gets stuck in the duct (common bile duct) that leads to the small intestine, it can block the flow of bile out of the liver and cause jaundice (yellow discoloration of the skin and whites of the eyes).
Pancreas
The pancreas organ secretes digestive enzymes and hormones and is located behind the upper left and upper middle parts of the abdominal cavity - in back of the stomach and in front of the spine. Pancreatitis can cause extreme pain that may bore through to the back. A common cause is “gallstone pancreatitis” - occurring when tiny gallstones, sand, or sludge leave the gallbladder, travel down a duct (common bile duct) and disrupt the normal flow of digestive enzymes as they flow from the pancreas into the small intestines. The pancreatic juices back up into the pancreas and cause inflammation. Other causes of pancreatitis include alcohol, medication, infection, and trauma.
Clinical pearl: If you develop pancreatitis from gallstones, the gallbladder usually has to be removed in order to prevent another episode.
The Kidneys
When we were first year medical students, one of my best friends thought that the kidneys were in the pelvis. Makes sense. But wrong. They’re actually fist-sized organs in the mid-upper back towards the side (the flanks). My friend became a superb psychiatrist and can tell you exactly where the superego is located. Kidney stones or infection can cause flank or abdominal pain and a variety of other symptoms, including nausea, pain on urination, or blood in the urine.
Clinical pearl: With vitamin D supplementation becoming increasingly prevalent, don’t make the mistake of taking more vitamin D than your doctor recommends. Too much can cause kidney stones.
Every year it happens: people come to me telling of what they are going to be doing different in this fresh new year. ??People are going to stop smoking, start exercising, and (especially) lose weight. ??This year, I am among the resolvers.
Every year, most people fail.
Which makes me wonder what it is about us humans that allows us to act against what we know is best. ??Why is it that educating people is rarely enough to fix a problem? ??Why should we have an obesity a??epidemica?? when very few people really want to be obese?
I wrote a post about the use of shame as a weapon in society and how it is used against obese people. ??It is one of my all-time most read posts, and the one that first got me in the NY Times (aside from that incident with the llama and Silly String in the airport). ??Our society a?? and us physicians especially a?? are very fond of telling people things they already know in patronizing ways. ??a??You need to loose some weight.a?? ??a??Smoking is very bad for you, you know.a?? ??a??You and your teenager need to communicate better.a??
These things arena??t wrong, but they are so obvious that our saying them implies ??a: the other person is really stupid, b: they are totally uneducated and out of touch, c: they are weak, or d: all of the above. ??One of the performance measures physicians will likely be measured by in the future is counseling about obesity, smoking, etc. ??The problem is, our counseling does as much good as the billion New Years resolutions done every year. ??It brings focus on a problem that the person obviously has trouble solving without giving a solution. ??Ita??s like me seeing a person with depression and telling them: a??you know, you should really stop being depressed.a??
Duh.
The problem is one of understanding the true underlying problem. ??Quitting smoking is actually quite simple; you just stop smoking. ??But the problem is not quitting, it is wanting to quit. ??The problem with the obese person is even more complex, as there are huge societal, physiological, and psychological factors that are encouraging people to eat more than their bodies need. ??To simply tell them to eat less and exercise more fails to address any of the reasons why the person is eating more and exercising less (if thata??s the reason for their obesity). ??Ironically, ita??s the person who is lecturing the obese person who has the real gap in understanding.
Come on, folks! 1/3 of our population is struggling with this! ??Shouldna??t that suggest to us that the problem is a little deeper than just a??poor self-control?a?? ??Ita??s not an epidemic of stupidity or moral weakness.
So what can we do about these obese smokers who dona??t exercise? ??The reason I feel powerless when facing people in the exam room with this because I cant make people want to change. ??Ia??ve struggled with my weight over the years, mainly because there are periods of time my want for eating overpowers my want for taking care of my health. ??During those periods, I want to want to take care of myself, and ??I want to not want to eat as much. The battle rages in the area of my wants. ??This is why people employ guilt and shame to get others to change: we hope it changes their wants. ??It usually fails.
Here are some things from personal experience that have been most effective in helping people keep their resolutions:
Dona??t make people feel inferior. One of the greatest benefits from having my own personal struggles is that I come at people already knowing that I can be a moron, so I am less likely to look down on their moronic behavior. ??I have told patients that one of the best things about doing my job is that I get to see that everyone else is just as screwed up as I am. ??Smokers, obese people, and non-exercisers are what they are for one reason: they are humans. ??Would I really be a non-smoker if I didna??t grow up in a house where nobody smoked?
Let them know you realize their struggle is hard. It is simple to stop smoking, but it is also very difficult. ??When I am helping someone overcome an issue like this, I am joining in on a very difficult task.
Dona??t promise magic fixes. It would be nice if a pill would make us thin. ??It would be great if somehow I could suddenly want to exercise more. ??I personally crave easy answers for my problems because I dona??t want to do the hard stuff. ??But my life is defined far more by the hard things I accomplish than by easy ones. ??I used to recommend the Atkina??s diet and prescribe diet pills. ??They worked only until people stopped using them, but 99% of the weight loss accomplished in this manner would be gone in a year. ??Why? ??Because changing wants is not done by magic; it is done by hard work (usually).
Keep focus small. Weight loss is not a good resolution because it is not directly in a persona??s control. ??Eating better is under control to some extent because people can choose to do it. ??But the best goal is to eat a good dinner tonight. ??Tonight is far more in our control than next week. ??Advice should focus on this as well a?? keeping things practical.
OK, it sounds like I am a real expert. ??Well, I am an expert at trying and failing. ??I am an expert on knowing what doesna??t work. ??I can communicate with others, but those donuts still hold an amazing sway over me. ??I still dona??t exercise much because getting up at 5:30 AM sounds like purgatory and I am too tired at the end of my day.
Well, I am resolving to do better. ??I am resolving to take better care of myself and to be a better person. ??But to fight and win these battles it will take a lot of time, a lot of failure, a lot of help, and a lot of resolve.
It has been a while since Ia??ve had a patient with postoperative alcohol withdrawal.?? I can still recall my first exposure to this problem as a 3rd year medical student at the Veterana??s Hospital.?? It was my first clinical rotation a?? surgery service at the VA.
Browsing the CME articles on the JAMA website, I came across the article (full reference below):?? Improved Outcomes in Patients With Head and Neck Cancer Using a Standardized Care Protocol for Postoperative Alcohol Withdrawal.?? For me it was a nice review of the problem with updates on current drug use/protocol.
Their protocol is based on three distinct clusters of symptoms characterize alcohol withdrawal syndrome (AWS).??Central nervous system excitation usually occurs within 12 to 48 hours after the last drink.
Type B symptoms relate to adrenergic hyperactivity, which manifest as fever, chills, diaphoresis, hypertension, tachycardia, tremors, piloerection, mydriasis, nausea, and palpitations.
Type C symptoms include attention deficit, disorientation, hyper-alertness, short-term memory impairment, impaired reasoning, psychomotor agitation, and hallucinations signifying delirium. These symptom types may occur alone or in combination.???? Delirium typically occurs later, with a variable time course.
The older term delirium tremens may be used in this context to describe the combined symptoms of confusion (type C), hyperadrenergic state (type B), and CNS excitation (type A)
The authors present their experience from March 2003 until March 2005 with 26 consecutive patients prospectively treated for AWS using a standardized care protocol from among 652 patients admitted for head and neck surgical procedures (see the two images belowa??credit) and compared them with a retrospective comparison group of 14 patients who met the inclusion criteria but were treated from March 2000 to December 2002, prior to the use of the AWS protocol.
Outcomes (preprotocol/protocol)
Transfers from the regular inpatient unit to the ICU for AWS-related cause?? — 29%?? vs 4%.
Respiratory arrest — 14% ??vs 4%.
Mechanical restraints used?? — 57% vs 42% .
Delirium present –?? 79% vs 29%.?? When present, delirium lasted a mean (SD) of 3.2 days in the preprotocol group and 3.3?? days in the protocol group.
Violence (such as biting, scratching, kicking, verbal outbursts, and other violent manifestations) present?? — 36% vs 8%.
One or more wound complications present — 50% vs 46%.
No seizures, falls, or deaths occurred in either cohort during the inpatient stay. No patient developed delirium tremens.
The article?? is worth the review even with the small number of subjects.
REFERENCE
Improved Outcomes in Patients With Head and Neck Cancer Using a Standardized Care Protocol for Postoperative Alcohol Withdrawal; Arch Otolaryngol Head Neck Surg. 2008;134(8):865-872; Christopher D. Lansford, MD; Cathleen H. Guerriero, RN, BSN; Mary J. Kocan, MSN; Richard Turley, MD; Michael W. Groves, MD; Vinita Bahl, DMD, MPP; Paul Abrahamse, MA; Carol R. Bradford, MD; Douglas B. Chepeha, MD; Jeffrey Moyer, MD; Mark E. Prince, MD; Gregory T. Wolf, MD; Michelle L. Aebersold, RN; Theodoros N. Teknos, MD
If you want to improve the health of Americans, why not look around the world for places where people live the longest, healthiest lives and try to copy whatever it is theya??re doing? Thata??s exactly what Dan Buettner has done. He is the author of The Blue Zones: Lessons for Living Longer From the People Whoa??ve Lived the Longest.
Examples of areas he calls a??blue zonesa?? are Sardinia, Okinawa, Costa Rica (the Nicoya Peninsula), Ikaria (a Greek island), and Loma Linda, California. Things residents have in common include exercising regularly, eating more vegetables and less meat, engaging in social networking, and having a sense of purpose.
Buettner teamed up with AARP The Magazine to see if he could create a healthier environment and lifestyle for the 18,000 residents of Albert Lea, Minnesota. It was literally a town makeover involving restaurants, schools, businesses, parents, and town leaders. They created bike and walking paths, made restaurant menus more nutritious, prohibited junk food in schools, and created projects such as a community garden and workshops that helped people become more engaged with each other. When the five-month a??health/minnesota_miracle.html" >Vitality Projecta?? ended in October, 2009 a total of 3,464 residents had participated. The average projected lifespan rose by 2.9 years and residents uniformly reported feeling better physically and emotionally.
This approach makes so much sense to me. Wea??ve all heard the statistics. Two thirds of Americans are either overweight or obese, increasing their risk of medical problems like heart disease, diabetes, and even cancer. Most people cannot simply a??snap out ofa?? their unhealthy lifestyles through willpower a?? even if theya??re motivated to change. Experts like Brian Wansink, Ph.D., author of Mindless Eating: Why We Eat More Than We Think, have shown how difficult it is to eat properly and live a healthy lifestyle when wea??re surrounded by an environment that promotes lousy habits. So change the environment.
A number of colleagues recently mentioned to me that they’ve heard that new smokeless tobacco products are very dangerous because they cause a lot of poisonings to children.
When I checked the Internet, sure enough — there were plenty of news headlines along the lines of a??Tobacco mints tied to poisoning in kidsa?? and a??Tobacco candy poisoning kids, study shows.a?? I thought this looked interesting, particularly as I was unaware of any a??tobacco candy.a????
On looking into it, I found that the source article was one recently published by Professor Greg Connolly at Harvard University and colleagues. The study examined data on all accidental poisonings resulting from ingestion of tobacco products by children under 6 years old that were reported to poison control centers around the United States.
The study found that over the years 2006 to 2008 there was a total of 13,705 cases reported for all tobacco products, of which the type of tobacco used was unknown in 1,197 cases (8.7%). Of the 13,705 cases, 10,573 (77%) were caused by consuming cigarettes. 167 were caused by consuming cigars, and 1,768 (12.9%) were caused by consuming (presumably traditional forms of) smokeless tobacco.
The new varieties of snus and other novel tobacco products (Camel Orbs, Sticks and Strips) were not widely available in the United States during the period under study, but the authors mentioned that they had heard of 2 cases of mild poisoning of children aged 2 and 3 who had ingested some snus, and a single case of a 3 year old who was believed to have ingested Camel Orbs in 2009.
The paper serves a useful purpose in quantifying the number of accidental poisonings of young children (primarily less than 2 years old) by tobacco products. Clearly this points to the need for greater awareness among tobacco users to not leave these products where children can access them. It also points to the potential need for childproof containers for all tobacco products.
The thing that struck me as rather odd about this paper was that it focused so much on the harmfulness of the novel smokeless tobacco products. The paper included a photograph of Camel Orbs alongside a packet of TicTacs (candies), and certainly they are similar. One difference is that whereas TicTacs??are contained in easily opened flip-top containers, the new smokeless tobacco products are contained in containers that are not only childproof, but are psychologist-proof and actually extremely difficult to open by anyone who tries. I suspect that one reason kids may be poisoned by these products is that it is so difficult to get the product out, and almost impossible to put it back in, leading consumers to leave the loose product laying around.
But the data contained in the report found at least 10,573 cases of children poisoned by cigarettes, as compared with one poisoned by Orbs. It seemed rather strange, given that data, for all the focus and media coverage to be on Orbs. Why no call for all cigarettes to be packaged in childproof containers rather than flimsy cardboard boxes?
The core message here should be that tobacco is a poison and should never be left accessible to the hands of children.
REFERENCE:
Connolly G., et al. “Unintentional child poisonings through ingestion of conventional and novel tobacco products.” Pediatrics, April 2010.
This post, healthline.com/blogs/smoking_cessation/2010/04/10753-young-children-poisoned-by.html" >Why Tobacco Should Be Childproof, was originally published on healthline.com/" target="_blank">Healthine.com by Jonathan Foulds M.A., M.App.Sci., Ph.D..
A??patient apologized to me for asking so many questions. “There’s no need to apologize,” I said to the patient, “Ita??s wonderful that you have so many questions concerning your healthcare.” I mentioned to her that she is an a??empowered and engaged patient,a?? and that’s a good thing.
Ita??s no secret that health consumers are turning to the Internet for health information.
In a recent article from MediaPost News, Gavin Oa??Malley writes that, according to new a study by Epsilon Strategic & Analytic Consulting Group, a??40% of online consumers use social media for health information a?? reading or posting content a?? while the frequency of engagement varies widely. According to the study, individuals who use healthcare social media fall into two broad groups: the 80% who are highly engaged patients, and take active roles in health management; and the 20% who lack confidence to play an active role in their own health.a??
Highly-engaged patients are proactive in their healthcare
The reasons health consumers engage in healthcare social media are simple.
They are looking for emotional and informational support. By engaging in online health communities many people find that emotional support they are looking for. They find reassurance from other people going through the same experience. They can collaborate and share information. They gather health information from various sites to help them gain knowledge.
Therea??s no question that todaya??s patients are savvy healthcare consumers
Todaya??s patients are e-patients.??Surrounded by technology, researching health information on the Internet has never been easier. Patients are engaging in communities and healthin30.com/2009/10/how-to-engage-your-e-patients-like-a-rock-star/" >social networking sites and the exchange of information between patients has proven invaluable to some, thanks to the e-patient and healthcareblog.com/" >Health 2.0 movement.
Dave deBronkart, diagnosed with advanced kidney cancer quickly became engaged in the internet searching desperately for health information and support. He became an empowered and engaged patient surrounding himself with invaluable information and support.
I asked Dave about his experience as an e-patient. a??I joined the online health communities and found affirmation that I was indeed at the right hospital, and I obtained firsthand experiences from other patients learning what they went through.a?? Enthusiastically and adamantly he said, a??People search for information about everything else, why wouldna??t they search for health information to try to help themselves in a crisis.a??
He added, a??The Internet doesna??t replace doctors. Ita??s an additional valuable resource.a??
Still, doctors, nurses and other healthcare providers question the social media value
So while many health consumers are searching the web for support, reassurance and specific health information and health news, doctors and even nurses continue to question the value of the Internet for patients.
Therea??s a plethora of health information on circulating the Web and some healthcare providers feel that patients may be obtaining inaccurate information.
Will health information online make doctors obsolete?
In KevinMD.coma??s recent post, a??health-information-online-doctors-obsolete.html" >Health information online wona??t make doctors obsolete,a?? he asks the following:
But are doctors in danger of being a??phased outa?? by Google and other search engines? a?| In an interesting perspective piece by Pamela Hartzband and Jerome Groopman in the New England Journal of Medicine, the answer appears to be no a?| Doctors have to get used to the fact they are no longer the sole source of a patienta??s health information. Instead, they need to serve more as interpreters of data, and be willing to separate the tangible information from the increasing amount of noise patients find online.
In that NEJM perspective piece, Hartzband and Groopman provide spot on information when they write about the relationship between doctors and patients:
a?| sending e-mail is quite different from speaking with a patient face to face, and doctors must consider carefully what they say and how they say it. Ita??s impossible to judge the effect on patients of information transmitted through cyberspace: we cana??t observe grimaces, tears, or looks of uncertainty. And written dialogue is quite different from spoken conversation: replies may be delayed, phrases may be more stilted, tone of voice is absent. We should pay close attention to any unintentional fraying of the physiciana??patient bond.
healthin30.com/2009/05/after-40-years-patients-still-crave-attention-and-respect/" >Face-to-face communication remains critical for the doctor-patient relationship.
Bottom line
Ita??s important for doctors, nurses and other healthcare professionals to understand that Google, social media sites, health news and information sites and online patient community sites will not replace them. Ita??s simply a tool that offers additional information, and it allows the conversation to get started between health provider and patient. Doctors, nurses and other health providers need to engage in the Internet and social media platforms to help educate the health consumer.?? They have the power to provide accurate, reliable and truthful information. They should not shun away from the Internet, but embrace it and join forces with the health consumer. Partnering together is a very useful and empowering.
Additionally, the Internet will not change the underlying need for face-to-face interaction and engagement between doctor and patient. That personal interaction will always be paramount.
The European Heart Journal studied 6,000 British civil servants and followed them for 11 years.??They found that working an extra 3 to 4 hours a day is associated with increased coronary??heart disease.
The researchers controlled and adjusted for lifestyle, cardiac risk factors, and other factors that would skew the results, and still found that people who worked 3 to 4 extra hours a day had a 60 percent??increase in risk for heart disease.
These results were for both women and men (ages 39 to 61) and the outcome measure was fatal myocardial infarction (MI) — commonly known as heart attack –??and non-fatal MI and proven angina.??Other risk factors like smoking, elevated lipids, diabetes made no difference in the results.
The conclusion:??”Overtime work is related to increased risk of incident coronary heart disease independently of conventional risk factors. These findings suggest that overtime work adversely affects coronary health.”
A new survey in the journal healthaffairs.org/cgi/content/abstract/hlthaff.2009.0296v1" >Health Affairs synthesizes nearly everything I believe is wrong with the U.S. healthcare system. The survey found that patients believe that more care is better, that the latest and most expensive treatments are the best, that none of their doctors provide substandard care, and that evidence-based guidelines are a pretext for denying them the care they need and deserve.
Sigh.
Until we can retrain consumers (that would be all of us) to understand that in medicine more is NOT better, that evidence-based guidelines may translate in some instances into less but better care, that doctors are falliable and should be questioned, and that the cost of a treatment has nothing to do with the quality, we will never get out of the healthcare quagmire in which we find ourselves.
healthline.com/blogs/outdoor_health/uploaded_images/tickapp-708357.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}">Dr. Jeremy Joslin is a wilderness medicine aficionado and has without question posted the greatest number of intelligent and useful comments to posts at this blog. So, I’m pleased to learn that he has created a very useful iPhone application named TickDoctor.
TickDoctor provides a stunning visual atlas of the most common ticks encountered in North America. Although not yet comprehensive, most common ticks are represented. For each tick species, the user is able to identify males, females, and nymphs. In many instances, there are included images of the engorged female, which often looks very different from its non-fed state.
More than just a beautiful atlas, TickDoctor provides instructions for prevention of tick bites and how to remove them if bites should occur. If a bite has occurred, or if you’re just plain curious, Dr. Joslin has included medically relevant data on each species, describing which diseases have been associated with it.
While this application should never substitute for the advice of a physician, it will help guide you to the identification of the tick in question and provide a framework of reference for dealing with “what to do next.”
I’ve been informed by Jeremy that, “if you have a great photo of a tick and want it considered for the next application update, let me know. You can do this by posting a comment and I’ll follow up with you. We’re always interested in making the atlas better.”
This post, healthline.com/blogs/outdoor_health/2009/08/tickdoctor.html" >The iPhone TickDoctor, was originally published on healthline.com/" target="_blank">Healthine.com by Paul S Auerbach M.D., M.S..
I ran into an old friend this past week and, as all of us over 60 do, we began talking about our health and the various ailments afflicting us as we age.
He shared with me that he was currently dealing with a bad case of the a??shinglesa?? (known as Herpes Zoster in medical circles) at age 65 and how terribly painful they were. He said that he wouldna??t wish them on his worst enemy.
As many of you may know because youa??ve suffered a similar problem, shingles is caused by the Varicella Zoster virus, the same virus that causes chickenpox.
Only someone who has had a case of chickenpox a?? or gotten chickenpox vaccine a?? can get shingles. The virus stays in your body and it can reappear many years later to cause a case of shingles.
Always being the doctor, I asked my friend whether or not hea??d gotten the vaccine to help reduce his risk of getting shingles.
He acted shocked and was quite angry as he explained that hea??d never been told by his doctor about that there was a vaccine available that might prevent shingles.
The vaccine available for adults 60 and over to prevent shingles is called Zostavax. In clinical trials, the vaccine prevented shingles in about half of people 60 years of age and older. Even if you do get shingles after being vaccinated, it may help reduce the pain associated with shingles but it cannot be used to treat shingles once you have it.
Ia??m really not pushing the Zostavax vaccine because ita??s not recommended for everyone but rather am reminding everyone that prevention is much better than treating after someone has a disease.
Talk to your doctor at your yearly visit to see what preventive steps you should be taking.
Check the CDC website for more information about vaccines that might be right for you especially if you are traveling to other countries.
Frankly, if your doctor is not talking to you about preventing disease, then it just might be time to find another doctor.
About Kevin Soden, MD
Dr. Kevin Soden has been a medical journalist for over 20 years appearing on CBS, NBC and most recently on NBCa??s Today Show. He now serves as the host for Healthline, the national award-winning daily medical television show seen on the Retirement Living Network. He also serves as the worldwide Medical Director for Texas Instruments and Cardinal Health and teaches as a courtesy Professor at the Univ. of Florida College of Medicine.
His awards include 3 Tellya??s, the 2008 CableFax award for best cable health show, the 2008 and 2001 National Award for Excellence in Medical Reporting from the National Association of Medical Communicators, a finalist for the International Freddie Awards in 2001, and as the Executive Producer for Rush of the Palms received the 2003 International Film Critics award for short films.
Kevin published The Art of Medicine: What Every Doctor and Patient Should Knowa?|a critically acclaimed book focusing on improving doctor-patient communications. He is also the primary author of a consumer medical book Special Treatment: How to Get the High-Quality Care Your Doctor Gets. He is also a contributing author to the recently published A Practical Approach to Occupational and Environmental Medicine and to Physician Leaders: Who, How and Why Now? He has just finished his third book Think Like a Man: Male Behaviors that Can Help Woman Lighten the Load, Loosen Up and Find Happiness in a Stress-Filled World. He also is a regular contributor to numerous popular magazines.
Soden graduated with honors from the University of Florida College of Medicine and is one of the original inductees into the UF Medical Wall of Fame. He also has a Masters in Public Health from the Medical College of Wisconsin and a Masters in Personnel Administration from Florida State University.
There’s a disease that Americandoctors are absolutely terrible at diagnosing. It’s estimated that three million Americans have celiac disease and only a small percentage of them know it. In celiac disease, a component of wheat, rye, and barley called gluten sets off an immune reaction that attacks the intestine and can affect the entire body.
Patients are unable to properly absorb essential nutrients because the absorptive fingers (villi) in the small intestine have been damaged or destroyed. Doctors usually miss the diagnosis because they don’t realize how variable the disease can be. Here is a list of associated symptoms and problems:
Diarrhea, abdominal pain, bloating, gas, distention, weight loss, constipation, irritable bowel syndrome, failure to thrive in infancy, vomiting, short stature, iron deficiency with or without anemia, poor performance in school, delayed puberty, infertility, recurrent miscarriage, osteoporosis, vitamin deficiencies, fatigue, tooth discoloration and dental enamel defects, skin disorders, elevated liver enzymes, Down syndrome, Sjogren’s syndrome, aphthous ulcers (canker sores), arthritis, depression, nerve and ??balance problems (peripheral neuropathy and cerebellar ataxia), irritability in children, seizures, and migraines. Patients with other autoimmune diseases such as type 1 diabetes and thyroiditis are at increased risk for celiac disease.
Click here for the National Institute of Health’s information on celiac disease.
There appears to be a slight increase in the risk of lymphomas and gastrointestinal cancers that, in one study, returned to normal after five years of a gluten-free diet.
The diagnosis is usually missed because doctors don’t think of it. ??I was taught in medical school thirty years ago that patients always have dramatic symptoms such as diarrhea and weight loss. Wrong. We now know that about half of patients have atypical symptoms that are included in the long laundry list above. Although doctors are??becoming more aware of the illness, it takes an average of more than four years for the correct diagnosis to be made in the small percentage of patients in whom the diagnosis is not missed altogether.
New England Journal of Medicine on Celiac Disease.
There are simple blood tests that can detect celiac disease over 90 percent of the time and that only rarely give false positives. The diagnosis is then confirmed by an upper endoscopy. With the patient sedated, a small, flexible tube is slipped into the mouth, down the esophagus and stomach and into the first part of the small intestine (duodenum), where biopsies are taken and subsequently examined for changes seen in celiac disease.
Treatment is a gluten-free diet - easier said than done, especially for a child who wants to be like everybody else and eat pizza, cookies, and cake at birthday parties. Patients have to be extremely vigilant because gluten is in many unexpected foods, such as soy sauce, candy, and malt flavoring.
Consultation with an experienced dietitian is crucial because some older materials distributed by doctors, dietitians, and nutritionists are out of date and cause patients to avoid certain foods unnecessarily. There are many Web sites that provide excellent information about diet (see below). There’s research into developing a pill that would help people with celiac disease, but it’s not ready for prime time yet.
The key to improving our dismal rate of picking up celiac disease is to increase awareness both in physicians and patients. One study found that general practitioners actively looking for the disease increased their rate of diagnosis by 43 fold.
Anybody with any of the long list of symptoms or problems listed above should consult a doctor and discuss whether testing for celiac disease is appropriate.
There are many ways that celiac disease can disguise itself. Here are four to especially look out for:
a?￠ A child with behavior or learning problems
Celiac disease can cause cognitive difficulty that has been called “brain fog.” The causes are unclear but may include nutritional problems, inflammation, or immunologic damage in the brain. It’s well known that children with iron deficiency - with or without anemia - do worse in school. ??Researchers suspect celiac disease may be linked to developmental delay and ADHD.
a?￠ Irritable bowel syndrome
There is an increased risk of celiac disease in the 10-15 percent of adults who carry the diagnosis of “irritable bowel syndrome” (IBS). Many of the symptoms of IBS such as diarrhea, constipation, bloating, and abdominal pain also occur in celiac disease.
a?￠ Iron deficiency
A simple blood test will detect low iron, a relatively common condition that is usually not from celiac disease. However, low iron may be the only clue to celiac disease, so it’s important to maintain a high index of suspicion. Remember that some patients can have both a relatively innocent cause of iron deficiency (such as poor dietary intake or menstrual blood loss) AND malabsorption of iron due to celiac disease.
a?￠ Osteoporosis
Untreated celiac disease - with its associated low vitamin D and decreased calcium absorption - increases the risk of osteoporosis. Although there is disagreement among experts, some researchers have advocated that all patients with osteoporosis be tested for celiac disease.
Others say to reserve routine testing for men and pre-menopausal women with osteoporosis because osteoporosis is less frequent in these groups compared to postmenopausal women and therefore it’s important to look for unusual causes such as celiac disease. In any case, all patients with osteoporosis should be considered for celiac testing on an individual basis.
It is unacceptable that millions of people are suffering from a disease that can usually be easily treated with diet. Patient and physician education is crucial. If you send this blog to one hundred of your friends, the odds are that one of them will have celiac disease and not know it. You could change somebody’s life.
For this weeka??s CBS Doc Dot Com, I discuss celiac disease with a world expert, Dr. Peter Green, Professor of Clinical Medicine and Director of the Celiac Disease Center at Columbia University Medical Center.
For online celiac disease resources:
The Celiac Disease Center at Columbia University
healthtopics.html" >National Library of Medicine
Celiac Disease Foundation
Celiac Sprue Association
For more information on gluten-free diets for celiac disease:
I took this photo when my mom was in the hospital earlier this year. My hand looks like I wash dishes for a living. Her hand shows many of the spots that come with age and sun exposure: actinic keratosis, liver spots, etc.
There is a decent article that gives an overview of hand rejuvenation in the Sept/October issue of the Aesthetic Surgery Journal.
The epidermis thins as we age. Lentigines, actinic keratoses and seborrheic keratoses, general dyschromia, and textural roughness appear. Capillary fragility may make bruising common. Fat atrophy may make tendons and bony prominences more noticeable and the veins appear to bulge.
The article goes through the available treatments: chemical peels, vein sclerotherapy, fillers, laser therapy, intense pulsed light (IPL) therapy, fractional skin therapy, and Thermage.
It also reminds us that caution must be exercised as hand skin has relatively few adnexal structures and therefore has less capacity to replace the epidermis.
All of the procedures discussed are on an out-patient basis and some may be performed with local anesthesia.
Prescription-strength skin care like Retin-A can help repair sun-damaged skin, cause spots to fade, improve transparent skin, and stimulate the production of collagen. As with the face, use of sun protection is extremely important to protect the improvements gained and to prevent further sun-damage.
Chemical peels are available in a variety of forms: glycolic acid, Jessnera??s solution and trichloroacetic acid (TCA). These are useful in addressing the mild pigmentary and texture changes of the skin. Dr Shamban likes to use pre-formulated peels to avoid worrying about acid concentration changes that can occur due to evaporation when bottles are opened and re-stored. Mentioned is SkinMedica peel which is a combination of tretinoin and glycolic acid.
Fractional skin resurfacing, IPL treatments, and Laser treatments can be used to treat spots, spider veins (IPL), and improve the texture of the skin.
Soft tissue augmentation can be performed with fat cells taken from other parts of your body and transplanted to your hands. Synthetic fillers can also be used (Sculptra, Restylane, Juvederm, Radiesse). Results are immediate. The duration of improvement depends on the size and location of the area treated, as well as on the material used.
Sclerotherapy can be used to address the veins, but Dr Shamban states that often the veins do not need treatment if appropriate soft-tissue volume is replaced.
Microdermabrasion is a superficial skin polishing that improves the appearance of aging skin and spots. The results are immediate. Maintenance treatments are required.
Thermage is a non-surgical procedure that uses a radio frequency (RF) system to gently cause the collagen in your skin to contract and tighten. The result is smoother, softer looking hands.
Use of sun protection before and after is important, but difficult as the hands are washed frequently during each day.
REFERENCE
Combination Hand Rejuvenation Procedures; Aesthetic Surgery Journal, Vol 29 (5), pp 409-413, Sept/Oct 2009; Shamban, Ava T. MD
Empowered health consumers know how to take charge of their health and are proactive in their care.
Whether theya??re surfing the web for health information, visiting their doctor or health care professional, or a patient in the hospital; empowered health consumers know how to question and communicate.
This blog is a continuation of the healthin30.com/2009/10/hand-washing-and-swine-flu-h1n1-still-important/" >a??He Said, She Saida?? post where I promised to give you tips about how to be an empowered health consumer.
Sabriya Rice, CNN Medical Producer had a similar idea.
Here are my 3 tips to help you become an empowered health consumer:
1.?? Ask tough questions when it comes to the web and on-air health reports
Dona??t believe everything you read or hear without questioning it.?? Listen to a health report with ears wide open and dona??t be afraid to question it.?? When searching for health information on the web, check out sites such as cdc.gov, fda.gov, clevelandclinic.org, and mayoclinic.org, but dona??t stop there.?? There are some other great sites that are not so well known, and offer exceptional information.
a??Always read an article with a critical eye. Does what the author say make sense??? Check the facts and get the facts from more than one sourcea??, says Kevin Soden, MD, medical journalist and author.
If news shows arena??t asking the tough questions; go ahead and ask your own questions.?? Ask questions when youa??re searching for health information on the web or listening to a health report.
When health consumers surf the web for health information, Matthew Holt, founder ofhealthcareblog.com" > thehealthcareblog says, health consumers should, a??Check multiple sources. Ask questions in consumer forums and look for multiple answers.a??
Gary Schwitzer, Associate Professor, University of Minnesota School of Journalism & Mass Communication and is the Publisher of healthnewsreview.org/" >HealthNewsReviewa??s mission is to review health news coverage every day to make sure news stories are accurate.
There is plethora of health information circulating the web, and network news broadcast serious health information in only a couple of minutes or less.?? Since some news health segments may only be a few minutes long, viewers may not be getting all the information they need.
Herea??s an example where critical information is missing.
In a recent healthnewsreview.org/blog/" >blog by Gary Schwitzer, a??CBS Early Show should read us the health news right out of the papera??, Schwitzer questions the validity of this health report.
a??Did it come from a study? Or straight out of the Wall Street Journal? Last week the CBS early show brought on another physician-correspondent to talk about the benefits of coffee drinking. Anchor Harry Smith referred to a??this new study.a?? What new study? None was referenced.
What the segment was apparently based on was a Wall Street Journal story that same day that had ALL of the same information. No attribution was given.a?? [source: healthnewsreview.org/blog/" >Healthnewsreview Blog]
Take a look.?? What do you think when you hear a report that refers to a a??new study?a???? Perhaps at the end of this segment a??New Research on Javaa??s Health Perksa?? Harry Smith or Dr. Alana Levine?? (Primary Care Physician) perhaps could have said, a??For more detailed information on this topic, visit our websitea?|a???? Unfortunately, there isna??t any detailed information on CBSa??s website.?? Herea??s what youa??ll find, health/main6037574.shtml?tag=contentMain;contentBody" >a??Coffee: New Health Benefits.a??
a??Primary care physician Dr. Alanna Levine spoke to Harry Smith about new research on the health perks of drinking coffee including lowering the risk of heart disease and depression.a??
To be an empowered health consumer you need to question what you read and hear.?? Ita??s important to know the source.?? What study and who funded the study?
Watch now
Watch CBS News VideosOnline
2.?? Ask a lot of questions, dona??t sit quietly in the doctora??s office or hospital
Before your appointment write down any questions you may have.?? Ask questions about your diagnosis, medications, tests, and follow-ups.?? Be in charge and know whata??s going on.?? Ask for a copy of your test results. And write down your questions.
Here are some questions that you may want to ask your doctor:
What are the causes of my symptoms?
Will the symptoms go away??? How long will they last?
What tests are needed to determine this condition?
How is this condition diagnosed??? What are the criteria for diagnosis?
What is the treatment?
Are there alternative therapies??? Over-the-counter medications? Prescriptions??? What are they??? Will my present medications interfere with any of these new medications?
Should my diet change??? Are there certain foods that I should be eating?
What lifestyle changes should be made?
3.?? Be Prepared a?? Carry your personal medical history & medication form with you and give your childa??s care-giver a consent-to-treat form
Medical History & Medication Form
Dona??t leave home without your list of medications and current healthin30.com/downloads/" >medical history & medication form.
Know your medications and keep a personal medical history form with you
Understanding your medications and keeping track of them is critical.?? Ita??s a great idea to have these listed on your personal medical history form that you carry with you at all times.?? Just in case you end up in the ER or are directly admitted to the hospital, you will be asked multiple times by multiple staff for a list of your medications, past hospitalizations, if you have any allergies and emergency contact numbers.
healthin30.com/downloads/" >Where can you find a medical history form?
There are some sites where you can create a small information card; however some people are on many medications that the small size isna??t sufficient.?? For a healthin30.com/downloads/" >6??4 size that you can simply carry in a photo style wallet, Ia??ve created one for you.?? You can download it for free by clicking this healthin30.com/downloads/" >link.?? Simply print, complete and carry.?? Moms, this form will fit nicely into the popular 6??4 photo wallets.?? Keep a list for you, your kids and spouse or significant other, parents and grandparents. Ita??s great for college students as well.?? Men, simply fold to carry in your small wallet.
(As an healthin30.com/2009/02/real-simple-magazine-taps-experts-for-emergency-care-advice/" >expert medical contributor to Real Simple Magazine, a??In an Emergency,a?? this was my number one tip).
Consent to Treat Form
Give your childa??s care-giver a consent to treat form
It can be found at Emergencycareforyou.org.
In case of an emergency, having a notarized consent-to-treat form signed by the childa??s caregiver will prevent treatment from being delayed.?? Of course any life-threatening illnesses or injuries are always top priority, but for a non-critical case having the proper forms will help expedite the process. Find the consent-to-treat form at Emergencycareforyou.org, the American College of Emergency Physicians (ACEP) website.
Question what you read and hear, communicate with your health care professionals and be prepared in case of an emergency or for your next doctora??s visit.?? By following these simple tips you can be an empowered health consumer.
We would love to hear from you.?? Do you think you are an empowered health consumer??? What are your tips?
My daughter really wants an iTouch. Shea??s 12a?|a tween. We heard nothing about this until recently when a friend was over who happened to have been given one for a holiday gift. It turns out that many of her friends have them now so she feels like iPods are suddenly passe.
Instead of asking us for one or concocting a plan to put it on her next birthday list, she came up with the idea to earn enough money for it by doing chores around the house. Pointing out the amount of chores and likely time frame to sock away $200-300 bucks was not a deterrent, at least not out of the gate.
If the truth be known, wea??re not for this at all. ??Did I mention shea??s only 12? The iTouch, in case you are not familiar with it, is essentially an iPhone without the phone. Kids use it to watch videos via itunes, ??play music, because it has a built in iPod, and play games they can download, some free and some paid. This thing can also connect to the Internet if you enable that feature and get email if you set up that feature. In my mind and my husbanda??s it simply does much more than a 12 year old needs.
In terms of her current technology, she is really doing more than fine. She has a phone shea??s happy with that texts and does everything she wants it to and an iPod. In fact, this isna??t about upgrading either of those gadgets but about wanting to keep pace with her friends and just having something to add to the mix because thata??s what kids do, of all ages in fact.
In the end, though, they always fall back on the tried and true, dona??t they?
How many times have you run out to the store battling crowds to find the toy or gadget of the season only to find it sitting in the corner a month later?
When your older kids were small, how often did you get them the latest whatever of the holiday season or birthday only to have the box or bow be more interesting?
Of both of my girls, this daughter follows that pattern most of all. Shea??s incredibly creative and simplicity rules. She always thinks she wants the latest and greatest but in the end, shea??s rather really just have what she already has.
My daughter is in good company, as Nancy Gibbs of Time Magazine points out in her essay The Power of Play-Doha?|In Tough Times, classic toys still hold their town.
Gibbs recalls that the best present of her childhood was a stuffed grey elephant that went everywhere with her and created ours of amazing play. She notes:
a??Friends tell me how to this day, the smell of new plastic evokes Baby Tender Love. They recall the gust of freedom a new bike blew in, and the endless architectural possibilities provided by a tub of Legos: six bricks fit together in 102,981,500 ways. Will any of this seasona??s hot toys leave marks so deep? Or would strapped parents do better to remember the toys that changed them and go looking elsewhere?a??
Gibbs notes that a?? (t)he best toys transcend, their survival a testament to their purpose and powera?? and gives the examples of the yo-yo, kite, legos, crayons, and slinky.
At the same time, according to Gibbs, ??a??(t)he worst toys are the opposite: overdesigned, overengineered, the product of so much imagination on the part of the toymaker that they require none from the child.a?? These are all the fad toys that come and go each season. She gives the example of this yeara??s Zhu Zhu hamster.
The bells and whistles of some toys and gadgets, like the iTouch, can be alluring but are not what keep our kids interests long term. What they need more than anything is time to have a childhood and simple things to use when their imaginations kick in.
BTW, whata??s your favorite memory from your childhood? I have two. One is taking all the blankets and sheets from my moma??s linen closet and making a fantastic tent village in the basement with some friends and the other is taking some basic blocks, and I mean basic, and building an enormous village with the same friends. We had hours of fun with those blocksa?|and were in middle school when that village was built!
So, wea??re planning on helping our daughter get off the iTouch path so she can have fun doing what we know shea??d rather be doinga?|dancing and singing with her friends with her current ipod plugged into some speakers and rewriting the lyrics in thousands of different ways. Thata??s where her heart isa?|and our job as parents is to help her see that and help her understand that some things may look cool but are just a waste of money in the end.
At a??[recent] session on caring for adult survivors of pediatric diseases, Bradley J. Benson, FACP, and Niraj Sharma, FACP, had some interesting statistics to share.
For example, more than 90%??of children with a chronic or disabling health condition are expected to live more than 20 years, meaning theya??ll eventually need an internista??s care, and every year more than 500,000 children with special healthcare needs turn 18.
As Dr. Sharma noted, a??Wea??re not talking about a handful of folks.a????
Some other statistics:
–Approximately 50% of patients with cystic fibrosis are 21 or older.
–More than 80% of children with spina bifida reach adulthood.
–80% of children who get cancer will become long-term survivors.
–20% of female Hodgkina??s survivors develop breast cancer by age 40.
Dr. Benson and Dr. Sharma stressed the importance of developing a comprehensive plan to transition survivors of childhood diseases from pediatricians to internists, something the patient-centered medical home concept could help accomplish.
Our busy lifestyles often aren’t conducive to getting the recommended amount of sleep at night. According to the National Sleep Foundation, adults need between seven and nine hours of sleep every night.
health/how-many-hours-of-sleep-are-enough/an01487" >Dr. Kenneth Berg??of the Mayo Clinic states that people who get less than seven hours of sleep per night have a higher mortality than those who have adequate sleeping habits.
Inadequate sleep has been linked to increased risk of motor vehicle accidents, an increase in body mass index and??a greater likelihood of obesity due to an increased appetite caused by sleep deprivation, increased risk of diabetes and heart problems, increased risk for psychiatric conditions including depression and substance abuse, and decreased ability to pay attention, react to signals or remember new information.
If??you are currently getting less than??seven good hours of sleep at night, consider making a change to try to increase that to a minimum of??seven or??eight hours. Here are some other suggestions to consider to improve your quality or quantity of sleep:
1. Establish regular sleep and wake schedules.
2. Have regular, relaxing bedtime routines such as taking a hot bath or playing quiet music.
3. Create a dark, quiet, comfortable and cool environment.
4. Make sure you have a comfortable mattress and pillow.
5. Avoid watching TV, using a computer or reading in bed.
6. Avoid eating 2 to 3 hours before your regular bedtime.
7. Exercise regularly during the day, but avoid exercise at least a few hours before bedtime.
8. Avoid caffeine and alcohol products close to bedtime.
In a development that may have you undergo your next medical procedure the old-fashioned way, two researchers from the University of California-San Francisco and the University of Oslo are reporting that inhaled anesthetics significantly contribute to the destruction of the ozone layer and add to the overall global warming gas content in the atmosphere.
Moreover, the study’s authors conclude with some valuable advice for your own practice: “From our calculations, avoiding N2O and unnecessarily high fresh gas flow rates can reduce the environmental impact of inhaled anesthetics.”
We’d like to venture even further. Not only would we recommend closed-circuit, low-flow anesthesia even with sevoflurane (damn those kidneys!), we’d also suggest that patients arrive by bicycle or, if absolutely necessary, a biodiesel-powered ambulance.
Press release: Study Shows Global Warming Impact of Anesthetics …
Abstract in Anesthesia & Analgesia: Global Warming Potential of Inhaled Anesthetics: Application to Clinical Use
A trained observer is what most electrophysiologists are. And being a trained observer carries over into real life, as would the handiness of??a plumber, or the strength of??a brick layer, or the wordsmithing of??a journalist.
Will and I drive??past our house.
“Whereare we going now,” he asks in the exasperated tone of a 13 year old.
I need to take a picture.
Why?
Because middle-aged patients who’ve recently realized that their life is half over often seek clues to longevity.
Let’s take stressed-out, middle-aged patients who’ve??somehow been rendered free of AF (maybe by a skillful ablation, or more likely just happenstance). Let’s also say they don’t smoke, drink excessively, have normal blood pressure, normal blood sugar, and aren’t obese. Is there anything else they can do to live longer, they often ask? Yes, I believe there is.
It’s pictured here:
If the final common pathway of successful aging lies in soothing the effects of life’s inflammation, this picture speaks volumes. These two neighbors have been happily married for nearly 65 years. They walk by our house hand-in-hand nearly every day. They talk to each other and they like each other. Trained observer or not, this is obvious.
He’s had significant heart disease for a very long time, but miraculously it has remained strikingly dormant.
There are oodles of websites proclaiming that healthy relationships are a key component of longevity. This I believe. The anti-inflammatory effect of real companionship cannot be mathematically measured as yet, but it’s likely as equally potent as statins or beta blockers, and surely greater than stents.
You can stomp through life like Philip Roth’s??”Everyman” (who perhaps is not-so-ironically ravaged by vascular disease) or you can choose the picture above. Choices. Always, there are choices.
The European Heart Journal studied 6,000 British civil servants and followed them for 11 years.??They found that working an extra 3 to 4 hours a day is associated with increased coronary??heart disease.
Dr. Jeremy Joslin is a wilderness 
If the truth be known, wea??re not for this at all. ??Did I mention shea??s only 12? The iTouch, in case you are not familiar with it, is essentially an iPhone without the 
In a development that may have you undergo your next medical procedure the old-fashioned way, two researchers from the University of California-San Francisco and the University of Oslo are reporting that inhaled anesthetics significantly contribute to the destruction of the ozone layer and add to the overall global warming gas content in the atmosphere.
