Happiness In Life: Carrying The “H Card”

The most moving speaker at the American Academy of Family Physicians (AAFP) convention I went to in Denver a few months ago was a doctor with Stage 4 cancer who had survived well past all expectations for his disease. While talking about achieving happiness through balance in life, he pulled out of his wallet a card made for him by his daughter, a preschool teacher.

a??This is the C card,a?? he told us. a??It says: a??I have cancer. I can do whatever I want.a??a??

What a great idea, I thought. As much as it resonated with me, though, I couldna??t help but feel there was more to it than that.

Recently I was comforting a dear friend who had lost her mother. Remembering this handout from the AAFP, I held her close and said: a??Youa??re a mourner now. You can do whatever you want.a?? I might as well said: a??You have the M card.a??

Therea??s this crotchety old guy in his eighties whom Ia??ve known for years. He does whatever he wants. I dona??t think he actually carries a card in his wallet that says: a??This is the O card. I am old. I can do whatever I want,a?? but he might as well. He is indeed old, and so he is entitled.

Please understand that I am not speaking about total abandon: Freedom to rape, murder, pillage, stay home in bed all day, refuse to pay taxes, and so forth. Within the broad context of fulfilling onea??s obligations to society — caring for onea??s family, body, and finances — I think the secret of true happiness is discovering sooner rather than later the freedom to do whatever you want.

Call it the “H card.” Just being human ought to be enough to do whatever we want. We can wear purple. We can paint our fingernails black (and any other parts of our bodies as well). We can eat cake for dinner. We can ride shopping carts through the parking lot. I dona??t think we should wait until we have cancer, or lose a loved one, or blow out some arbitrary number of birthday candles, to do whatever we want — and to be happy.

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How Good Is Your Doctor At Diagnosing You?

We’ve all been there. It often starts with some kind of recurring pain or dull ache. We dona??t know whata??s causing the pain or ache. During the light of day we tell ourselves that it’s nothing. But at 3:00am when the pain wakes you, worry sets in: “Maybe I have cancer or heart disease or some other life-ending ailment.” The next day you make an appointment to see your doctor.

So now you’re sitting in the exam room explaining this scenario to your doctor. Based on your previous experience, whata??s the first thing your doctor would do?

A. Order a battery of tests and schedule a follow-up appointment.

B. Put you in a patient gown and conduct a thorough physical examination, including asking you detailed questions about your complaint??before ordering any tests.

If you answered “A,”??you have a lot of company. A recent post by Robert Centor, M.D., reminded me of yet another disturbing trend in the doctor-patient interaction.??The post, entitled a??Many doctors order tests rather than do a history and physical,a?? talks about how physicians today rely more on technology for diagnosing patients than their own “hands-on” diagnostic skills — a good patient history and physical exam, for example.

Prior to the technology revolution in medicine over the last 20 years, physician training taught doctors how to diagnose patients using with a comprehensive history and physical exam. More physicians today are practicing a??test-centered medicine rather than patient-centered medicine.” Medical schools focus on teaching doctors to a??click as many buttons on the computer order set as we possibly can in order to cover every life-threatening diagnosis.a?? The problem is that medicine is still an imperfect science, and technology is not a good substitute for an experienced, hands-on diagnostician.

The results of this move to a??test-centered medicine” include more unnecessary tests ordered, patients exposed to unnecessary risks (radiation, anxiety, etc.), and healthcare costs going up.

Get Your Physician To Listen Or Find A Physician Who Knows How To Listen

Sir William Osler (1849-1919), who’s considered the a??most influential physician in history,a?? believed that the best diagnosticians were those who listened to their patients. The following quote attributed to Osler says it best: a??Listen to the patient — he (or she) is telling you the diagnosis.a??

So the next time you’re sitting on the exam table, before your doctor can interrupt you, present an organized history of your complaint. Ask your doctor to examine you before referring you for X-rays or lab tests. If your doctor can make the case for tests after he or she has heard you out — fine.??This way you can be more likely of getting the correct diagnosis.

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Big Breakfast, Big Calories: Rethink Your Morning “Fuel Up”

Haven’t we all learned that breakfast should be our biggest meal???”Start the day with ‘fuel’ and you can burn it off as the day goes on.” “Eat a big breakfast and you’ll eat fewer calories all day long.”

This advice is probably not true, and in fact a new study published in the??January 17th issue??Nutrition Journal shows that people ate the same at lunch and dinner regardless of what they had at breakfast.??If a person ate 1,000 calories at breakfast??(which is easy to do with bacon, eggs, toast, hashbrowns, and??juice),??he or she??had a total increase in calories eaten throughout the day by 1,000 calories.

This doesn’t mean we should be skipping breakfast.??The problem may be what we historically think of as an “American” breakfast.??It might have worked for the farmer in the past or the laborer hauling lumber, but it’s just too many calories for our current level of activity.

But there’s nothing wrong with a “European” breakfast of whole-grain cereal and fruit.??Or yogurt and fruit.??Or one egg and toast.??Or cheese and bread (whole grain, of course) like the French do it.

What about coffee and a muffin from Starbucks??? The blueberry muffin carries 470 calories, with almost half of them coming??from fat.??The Starbucks coffeecake is a whopping 630 calories. A??tall latte adds another 204 calories (or 90 to 126 calories for a non-fat latte).

If you’re happy with your weight, you can ignore this article because you’ve probably already learned the appropriate caloric intake for your level of activity. But if yor’re one of the millions of readers who are trying to lose weight, this study shows that overweight??people should pay attention to breakfast calories, eating less as a way to reduce total calories for the day.

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End-Of-Life Planning Makes It Easier To Say Goodbye

This is a guest post by Dr. Barbara Okun and Dr. Joseph Nowinski.

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End-Of-Life Planning Makes It Easier To Say Goodbye

Saying goodbye as the end of life approaches can be difficult, even for those with a gift for words. In a moving account in a recent issue of The New Yorker, writer Joyce Carol Oates describes the last week of her 49-year marriage, as her husband was dying from complications of pneumonia. Like A Year of Magical Thinking, Joan Didiona??s poignant memoir of her husbanda??s sudden death and its aftermath, Oatesa?? essay highlights the need for each of us to think about death and dying — and discuss them with loved ones — long before they become a likelihood.

In our work with individuals and families facing death, we have seen too many people miss the opportunity to say goodbye because they avoid what feels like a scary or taboo topic: What do I want to happen when I die? Beginning this discussion early, preferably while you are in good health, can help pave the way for a a??good death.a?? In our new book, Saying Goodbye: How Families Can Find Renewal Through Loss, we offer a guide to help individuals facing a terminal illness and their families navigate the realities of death and dying. Planning ahead is essential. Here are some suggestions for doing that:

Choose your team. Identify support people and specialists (legal, medical, financial, religious) you can count on to advocate for you and help you make decisions. Designate these people to act for you by signing advance medical directives.

Make your wishes known. Think about, and then begin to share with your closest loved ones, your wishes about:

• End-of-life treatments if you are incapable of making that decision for yourself


• Ending treatment, for example chemotherapy, if your prognosis for improvement was nil.


• Where you want to spend your final weeks if it becomes clear that you have only that long to live.


• Who you want to be with you in your final weeks, and what you would like them to do for you.


• What you would want in terms of a funeral ceremony and burial.

Make plans for the living. Provide clear instructions for the guardianship of your children, if needed, or financial support for your survivors.

It isna??t easy to initiate a discussion about what you want to happen, or hope will happen, when your life ends. The purpose of this discussion is to ensure that your wishes are carried out and to save your loved ones the panic of not knowing what you would want and having to make these decisions without previous discussion or planning. One way to open the conversation is by saying something like, a??Ia??ve been thinking what I would want if I were to become ill or die suddenly, and I want to share my thinking with you.a?? A colleague of ours, Samuel Bojar, M.D., has another approach. He has written a a??Just in Casea?? booklet that includes his ideal end-of-life plan. He updates it periodically and makes it available on his computer to all his family members.

Things left unsaid is one of the themes that run though Oatesa?? essay. Dona??t wait for a crisis or the specter of death to say a??I love youa?? or a??This is what I want to happen when my time has come.a??

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Barbara Okun, Ph.D., is a professor of counseling psychology at Northeastern University, a clinical instructor at Harvard Medical School, and a clinical psychologist and family therapist. Joseph Nowinski, Ph.D., is a nationally known psychologist with more than 20 years experience working with individuals and families. Their new book, Saying Goodbye: How Families Can Find Renewal Through Loss, has just been published.

                       

Prevention Magazine Pushes Non-Evidence-Based Heart Screening

The February issue of Prevention magazine has an article entitled “Surprising Faces of Heart Attack” profiling “three women (who) didn’t think they were at high risk. Their stories are proof that you could be in danger without even knowing it.” No, their stories are not proof of that.

The story is about three women in their 40s. The story varyingly states that the three should have had the following screening tests:

– Advanced cholesterol test, carotid intimal medial thickness test ( CIMT)

– Advanced cholesterol test??and stress echocardiography

– Cardiac calcium scoring and CIMT

??There’s an accompanying piece:??”7 Tests You’re Not Having That Could Save Your Life.”

I asked one of our HealthNewsReview.org medical editors, Harold Demonaco, director of the Innovation Support Center at the Massachusetts General Hospital, to review the two pieces. As his day-job title suggests, he deals??with review of the evidence for new and emerging healthcare technologies. He wrote:??

The section “7 Tests you are not having that could save your life” states: “If you have not had these cutting edge screenings, put this magazine down and call your doctor. Now.”

Wow. While much of the information is correct, it is the context that is disturbing. Suggesting that these tests are essential in everyone is a bit over the top. Some of the information provided for each test is basically correct. However in some cases the recommendations go well beyond national guidelines.

The major issue here is the tacit assumption that tests are infallible, without any downsides and are always a good thing. That is simply not the case. So who should get these tests?

Here’s what national guidelines suggest:

1. Cardiac calcium scoring. The most recent recommendations in 2007 states:

“….it may be reasonable to consider the use of Coronary Artery Calcium scoring measurement in asymptomatic patients with intermediate coronary heart disease…” Intermediate risk implies a 10 to 20 percent??risk of a coronary event in the next 10 years.

“The committee does not recommend use of Coronary Artery Calcium measurement in people with low risk (below a 10 percent??risk of a coronary event in the next 10 years. This patient group is similar to the ‘population screening’ scenario, and the committee does not recommend screening of the general population using CAC measurement.”

A far cry from what is being suggested in the article.

2. Carotid intimal medial thickness. The article suggest the test is needed if you are over age 40 or if you are under 40 and a close relative had a heart attack or stroke before age 55. Here’s what the U.S. Preventive Services Task Force said in 2009:

“Carotid intima-media thickness (CIMT) measurement is a noninvasive test that serves as a surrogate marker for coronary atherosclerosis. There is a correlation between CIMT and traditional coronary risk factors. The clinical utility of measuring IMT for the purpose of predicting risk of coronary or cerebral events has not been established. It is not evident from the literature that CIMT is able to improve on risk prediction above what is provided by utilization of traditional risk factors or the effect of these measurements on patient outcomes.”

3. Advanced lipid profile and lipoprotein test. The article notes: “Get Them If: You have a family history of heart disease.”

But, the 2010 guidelines from the American College of Cardiology and the American Heart Association suggests that lipid parameters beyond standard fasting lipid profile are not recommended in asymptomatic adults.

4. DNA detection

Anyone over age 40 should have genetic testing according to the article. A published meta analysis from the Journal of the American College of Cardiology found, “..no significant relationship between development of clinical coronary artery disease and the gene variant…” Hardly an endorsement for use of the test in anyone over the age of 40.

The article is basically within standard guidelines with regard to testing with A1C and stress echocardiography.

Surprising faces of heart attack

Each of the women’s stories represents a teaching moment that is lost. The histories are incomplete and little can be said other than generalities. Having said that, each story is interesting in what is said. One woman is said to have hypersomnia requiring her to have 10 to 12 hours sleep each night. Hypersomnia is a condition that results in excessive sleepiness during the day. There is also a suggestion that??five hours of sleep nightly increases risk of a cardiac event. That is perhaps true if the person is sleep deprived. It is probably not true if, like many people,??five hours sleep is sufficient. Suggesting that all of us need 10 to 12 hours sleep is not supported by any literature.

Another woman is described as a 47-year-old woman who at the time of her heart attack was morbidly obese (her height of 5 ft 4 inches and a weight of 245 pounds gives her a body mass index of 42, well into a range defined as morbidly obese.) This single element in her history places her in a high risk category.

Ms. Younger had borderline obesity when she had her heart attack. Perhaps the tests suggested are appropriate but other more mainstream tests should be done prior to these high tech options according to standards of care. Rather than focusing on high tech and in some case rather controversial tests as being necessary, where is the recommendation on primary care, an annual physical and most importantly on lifestyle modification?

For a magazine named “Prevention” there seems to be a good deal of emphasis on high-tech testing and not on preventive medicine.

                       

Stress In Life: Respond Differently And Live Longer?

a??This job is killing mea?? is not a statement of jest. It is a desperate plea of outright sincerity.

Stress, anxiety, depression — all have been associated with an increased risk of cardiovascular disease and mortality. But can interventions to help people cope with stress positively affect longevity and decrease risk of dying? The results of a new study in the Archives of Internal Medicine would imply the answer is an encouraging a??yes.a??

Constructively dealing with stress is easier said than done, but it would seem logical that if we can reduce our psychological and social stressors we might live longer and delay the inevitable wear and tear on our vessels. This study proved that one such intervention, cognitive behavioral therapy (CBT) for patients who suffered a first heart attack, lowered the risk of fatal and nonfatal recurrent cardiovascular disease events by 41 percent??over eight years. Nonfatal heart attacks were almost cut in half. Excitement may be dampened by the fact that all-cause mortality did not statistically differ between the intervention and control groups, but did trend towards an improvement in the eight years of follow up.

Definitely less suffering. Maybe less deaths.

The authors state that psychosocial stressors have been shown to account for an astounding 30 percent??of the attributable risk of having a heart attack. Chronic stressors include low socioeconomic status, low social support, marital problems, and work distress. Emotional factors also correlated with cardiovascular disease include major depression, hostility, anger, and anxiety.

An experienced and specifically trained psychologist usually directs cognitive behavioral therapy for patients. It has been proven to help conditions ranging from social anxiety to borderline personality disorder. While such therapy is by definition supervised and directed by a professional, perhaps we can benefit from a crude understanding of its methods.

In this study, the CBT focused on??five key components: Education, self-monitoring, skills training, cognitive restructuring, and spiritual development. It emphasized stress management, coping with stress, and reducing the experience of daily stress, time urgency, and hostility. The program was highly structured, performed over 20 two-hour sessions during the course of a year.

Education. The goal was for participants to learn more about cardiovascular disease, specifically about anatomy, physiology, symptoms, consequences, the relationship between stress and heart disease, and the symptoms and signs of stress.

Self-monitoring. This goal encompassed becoming more alert to body signals of stress such as heart rate, muscular tension, and pain, with greater attention to behavioral and cognitive clues. This was accomplished in part by the use of diaries to observe, monitor, and reflect upon reactions and behaviors, as well as the use of group processes to enhance observational skills and understanding.

Skills training. This goal was to reduce negative thinking, and to learn to act constructively rather than simply reacting to everyday problems. Ia??ve heard this method described elsewhere as the imperative to a??respond, not react.a?? A drill book was used for daily behavioral exercises, practicing alternatives to anger, frustration, and depressive reactions. Problem solving and communication skills were rehearsed in the group setting as well.

Cognitive restructuring. This goal involved recognizing negative, hostile, and stress-triggered thoughts and attitudes. Efforts were made to change the participants a??internal dialoguea?? through constructive self-talk, focusing on hostility, worries, and self-defeating attitudes. This component seems to have relied the most on the specialized training of the psychologists to deliver a restructuring of maladaptive thinking styles, again through individual and group efforts

Spiritual development. The goal was to encourage a spiritual reflection upon life, and what is desired for the future. Individual goals, quality of life, and the importance of significant others were discussed. The social and emotional support of the group helped foster self-esteem, optimism, trust and emotional intimacy.

The structure of each session was similar to most CBT programs. This included a weekly specific theme, starting each session with progressive muscular relaxation, followed by reflection and discussion of homework assignments. The current theme was discussed and tied in with previous and new themes, ending with a new homework assignment, often individually tailored. A variety of educational media and materials were used.

Specific skills and themes were tailored to the participants, and the authors noted a predictable (if not clich??d) pattern. Women more often needed focus on self-confidence and self-assertion skills, while men were more often in need of ways to cope with aggressive and hostile behavior.

Another gender difference centered around social networks. Women were often over-involved with social ties, subduing their own self-interests, while mena??s social networks tended to provide more unconditional support. (I would also insert another clich?? here that men I see in my own practice often suffer from poor tending to social ties, and consequent isolation).

Limitations of this study include the population of patients studied — over 90 percent??were white and of Swedish ancestry, and over 75 percent??were male. There was an overall all-cause decrease in mortality for those attending the CBT program, but this tendency did not meet statistical significance. Prior similar studies have shown conflicting results of stress reduction programs, some concluding that stress management does not affect cardiovascular mortality.

However, the authors also reference??two meta-analyses of health education and stress management programs for patients with coronary artery disease that found a pooled 34 percent??reduction in cardiac mortality and a 29 percent??reduction in recurrent heart attacks. Meta-analyses are generally considered to be of higher authority than individual trials since the evidence they collect is from multiple independent trials.

So what does this study mean?

Perhaps in a broad sense we can confirm our intuitive sense that stress is harmful to us. A stressful job, aggressive people, a bad relationship, depression, and anxiety all place undue wear and tear not only upon the health of our psyche, but also upon the health of our very substance. More importantly, our hearts and minds can benefit from everyday measures to reduce stress, and to deal constructively and optimistically with the internal and external battles we face.

Participation in a supervised cognitive behavioral therapy group, especially after one suffers a first heart attack, seems like a good idea, and might just prevent or delay a significant burden of recurrent cardiovascular disease.

At the very least, studies like this reaffirm our collective need to step back, to reflect upon the pace and tenor of our strident lives, and to methodically work on a less-reactive response to our daily conflicts. It is almost as if an empathic approach to ourselves is needed, one that genuinely considers our woes with some healthy distance, perspective, and practiced coping skills.

Respond, dona??t react.

REFERENCE:

“Randomized Controlled Trial of Cognitive Behavioral Therapy vs. Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients with Coronary Heart Disease: Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM).” Arch Intern Med. 2011; 171(2): 134-140.

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About White-Coat Hypertension

“But doc, my blood pressure is always normal at home.”??I wish I had a dollar for every time I have heard that line and I know it is true.??When some patients come to see me, their blood pressure is abnormally high (above 130/90). This is known as “white-coat hypertension.”??Although it has been thought to be from anxiety about seeing the doctor, even long-established patients who have no conscious anxiety can exhibit elevated blood pressure in the office.

Because blood pressure naturally fluctuates and the office visit is not a “normal” setting,??it is important for patients who have high blood pressure (hypertension)??to have their own??blood pressure??cuff at home. Now that devices are automated and easy to use, everyone with hypertension should be monitoring their??blood pressure??in the comfort of their own home.??I advise multiple readings over a week at different times of day.??Get a reading when resting and when rushing around.??Take??your blood pressure??after you exercise and after a meal.??It is important to keep a log and write it down.??Only then can we see patterns and know if the blood pressure is controlled or not.

Blood pressure readings in the doctors office are not necessarily the most accurate.??Patients are often rushed trying to get parked and in on time.??Medical assistants can use the wrong size cuff or not position the arm correctly.??Listening (auscultation) is not very accurate due to human error.??It is the multiple readings over time that give a more accurate picture of blood pressure control.

High blood pressure in the office can be true hypertension or it can be white-coat hypertension that is usually controlled at home.??If a patient is on blood pressure medication and has controlled??blood pressure??at home, I will not add more medication just because they are elevated in the office.??If a patient has not been diagnosed with hypertension and??his or her blood pressure??is elevated in the office,??he or she??is advised to get their own blood pressure cuff for at home and return with readings for us to review. This way we can minimize unnecessary and expensive medication and make sure we are protecting the patient as well.

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Cough And Cold Meds: The Good And The Bad

Want to try to avoid a visit to the doctor for that cough or cold? Why not go to the pharmacy to get an over-the-counter (OTC) medicine? In this video from local TV news, I talk about the good and bad of OTC cough and cold meds. Will that medicine from the pharmacy actually help you get better faster?

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Dental Fillings And Birth Defects: What Moms-To-Be Should Know

Although the first trimester of pregnancy is sacred, there will be patients who will encounter problems at that time. During the first trimester, the brain and the central nervous system develops from 6 to 10 weeks, a time period commonly known as organogenesis. To minimize the risk of developing birth defects, medications and invasive procedures are usually postponed until the arrival of the second trimester.

A recent article in the October 2010 issue of Ob.Gyn. News reported some disturbing findings: Dental fillings in the first trimester were linked to the development of a cleft palate. A cleft palate is a birth defect that has a slit in the roof of the mouth because it failed to close during the??first trimester.

The article by Susan London described a study in Norway where pregnant women had dental filings in the first trimester and their babies subsequently developed cleft palates. Ideally, dental problems should be addressed prior to becoming pregnant, however that is not always an option. Dental problems can occur during pregnancy because of the increased calcium requirements of the fetus as well as hormonal changes of the pregnancy.

The Norway medical study identified 573 infants that have facial clefts. It was thought that the fetal exposure to mercury from maternal fillings during a critical period in the development of its face may increase the risk of deformities. Amalgam fillings continuously give off small amounts of vaporized mercury that cross the placenta and accumulate in the fetus. Silver dental fillings contain 52 percent??mercury.

About 27 women had fillings placed in the first month of their pregnancy and quadrupled their risk of having a baby with cleft palate. Women who had fillings placed in multiple months of their pregnancy fared even worse. London suggests that further studies needs to be done, especially since the American Dental Association declined to comment regarding this matter.

Given the results of the Norway study, pregnant women should postpone dental work until the second trimester if at all possible, and should discuss the matter with??their obstetrician or midwife.

                       

Patient-Centered Outcomes Research: Will Patients Be Involved?

A year ago Gangadhar Sulkunte shared his story here about how he and his wife became e-patients of necessity, and succeeded, resolving a significant issue through empowered, engaged research. As todaya??s guest post shows, hea??s now actively engaged in thinking about healthcare at the level of national policy, as well a?? and he calls for all patients to speak up about this new issue. a?? Dave

I recently came across a Pauline Chen piece in the New York Times, “Listening to Patients Living With Illness.” It refers to a paper by Dr. Wu et al,??”Adding The Patient Perspective To Comparative Effectiveness Research.” According to the paper and the NY Times article, Dr. Wu and his co-authors propose:

1. Making patient-reported outcomes a more routine part of clinical studies and practice and administrative data collection.


2. In some cases requiring the information for reimbursement.

Patient-Centered Outcomes is outcomes from medical care that are important to patients. The medical community/research focuses on the standard metrics related to survival and physiological outcomes (how well is the part of the body being treated?). In the patient-centered outcomes research, they will also focus on outcomes important to patients such as quality of life. In other words, the care experience will be viewed through the eyes of the patients and their support groups to ensure that their concerns are also addressed.

Dr. Wu and his colleagues hope that eventually all doctors will be able to order patient surveys that measure experiences like levels of pain, physical functioning or depression, proactively identifying results that are high or low, then reviewing those results with patients. Despite initial concerns that patients might feel overburdened by the questionnaires, most have been enthusiastic.

The article also refers to the Patient-Centered Outcomes Research Institute, which was established by the healthcare reform bill. The authors of the paper feel that the potential of such an enterprise will be fully realized only if the institute supports initiatives and strategies that place the patient experience not only front and center in research, but also smack in the middle of the medical mainstream.

The charter of the institute provides for transparency. We patients should demand that they go a step ahead and include patients in every step. ??They should include ways for patients to participate and see the results of the research they are conducting. They can have a portal where the patients can add their data to the data being provided by their patient panels.

I have not seen these items in their agenda, so we should start by seeking more transparency.

__________

Due to a production error, the first release of this post had the wrong ending. The last two paragraphs were changed shortly after.

                       

Alcohol And Cancer: A Beverage Guide For The Holidays

Guest post submitted by MD Anderson Cancer Center*

When you raise your glass at this yeara??s holiday toast, choose your beverage wisely. Research shows that drinking even a small amount of alcohol increases your chances of developing cancer, including oral cancer, breast cancer and liver cancer.

Yet, other research shows that drinking small amounts of alcohol may protect the body against coronary heart disease and type 2 diabetes. Some evidence even suggests that red wine may help prevent cancer.

Researchers are still trying to learn more about how alcohol links to cancer. But, convincing evidence does support the fact that heavy drinking damages cells and contributes to cancer development.

Confused? Use our beverage guide to choose a drink with the lowest health risk, and learn your recommended drink limit and what alcoholic drinks to avoid.

Stick to the recommended serving size

Alcoholic drinks come in three choices: beer, wine and liquor. A drink is defined as 12 ounces of beer, five ounces of wine or 1.5 ounces of liquor.

The National Cancer Institute recommends that women have no more than one drink per day and men have no more than two drinks per day.

Women shouldna??t drink as much as men because they have less total body water to dilute the effects of alcohol. This means alcohol stays in a womana??s body longer than in a mana??s.?? And, the longer large amounts of alcohol stay in the body, the higher the risk for brain and organ damage, motor vehicle crashes, high blood pressure, stroke, violence, suicide and other injury.

Select low-calorie options

Many of us get way too many calories from drinks a?? about 460 calories a day, according to a recent study. That can increase your chance for becoming overweight or obese, which ups your cancer risk and leads to other health concerns.

Before taking a sip of alcohol, check the bottle label and look at the calories per serving if listed. Many popular drinks are loaded with empty calories a?? especially drinks mixed with soda, fruit juice or cream. Eggnog is one of the biggest holiday offenders with about 340 calories per one-cup serving.

Want a mixed drink? Try creating a low-calorie blend by adding diet soda or water.

Stay away from 100-proof liquor

Ita??s the ethanol in beer, wine and liquor that researchers believe increases cancer risk.

So while youa??re checking the bottle label, check the ethanol percentage or number as well. Youa??ll find either an alcohol by volume (ABV) percentage or an alcohol proof number.

ABV and alcohol proof are standard measures used worldwide to show how much alcohol or ethanol is in a beverage. In the United States, the alcohol proof number is twice the ABV percentage.

Beer, wine and liquor should contain the same amount of ethanol per serving a?? about half an ounce. That equals to about:

• 40% ABV or 80-proof in liquor


• 2 a?? 12% ABV in beer


• 9 a?? 18% ABV in wine

Avoid anything with more, like 100-proof liquor. Also, how much you drink over time matters more than what you drink.

Non-alcoholic drinks are probably best

Your end-of-year celebrations may come with fully stocked bars. But avoiding them is your best bet to ringing in a healthy New Year.

If youa??re looking for a non-alcoholic drink with a a??cocktail-likea?? feel, try club soda and lime. It has minimal calories and health risks. Or, try a low-calorie festive holiday punch.

Remember, alcoholic beverages offer few nutritional benefits. Look for healthier sources to get your holiday calories.

*This article originally appeared on MD Anderson Cancer Centera??s Focused on Health e-newsletter. To read the full newsletter, click here. To subscribe to future issues, click here.

                       

7 + 3 = 10 Foods To Avoid In 2011

A patient reading a copy of Prevention in the waiting room brought to my attention an interesting article entitled a??7 Foods That Should Never Cross Your Plate.a?? I would have to agree that these seven commonly eaten foods should be avoided, so Ia??ll rehash them here, along with??three more of my own choosing to flesh out a New Yeara??s 7 + 3 = Top 10 list.

The lead into the article implores the reader to recognize that a??clean eating means choosing fruits, vegetables, and meats that are raised, grown, and sold with minimal processing.a?? Michael Pollan, the regarded author of The Omnivores Dilemma and In Defense of Food, puts it even more simply: a??Eat food. Not too much. Mostly plants.a??

So here are the food items to avoid, in no particular order:

1) Canned Tomatoes a?? The resin that lines the corners of tin cans usually contains bisphenol-A, a compound found to produce estrogenic effects in the body, linked to heart disease, diabetes, obesity, and possibly neuro-developmental problems like ADHD. Tomatoes get picked on because their acidity increases the leaching of BPA into the food. Perhaps citrus foods and other acidic canned goods would have the same concerns.

2) Corn-Fed Beef a?? If youa??ve ever watched the documentary Food Inc., youa??ve probably been disgusted and appalled by the supply chain that brings meat to our tables and fast food restaurants. Bloated cows are being fed corn and soybeans, heavily subsidized crops controlled by Monsanto, to the detriment of their health. Eating their meat passes on the lower nutritional value to us, and perpetuates an immoral system of CAFOa??s and cow concentration camps. Grass-fed beef, especially free range, is higher in vitamins, minerals, and has a healthier fat profile (better omega-3 to omega-6 fatty acid ratios). Bison tends to be grass fed, free-range, and of a superior nutritional quality. Eat Wild can help you find local farms that raise animals properly and often need your support. Think of the higher cost returning dividends on your health and as a charitable support of a good cause.

3) Microwave Popcorn a?? There are chemicals lining the bags which are linked to infertility and liver/testicular/pancreatic cancer. These chemicals, including perflourooctanoic acid, vaporize while the bag is being cooked and then migrate into the popcorn, ultimately accumulating in your body. Some of the chemicals will be phased out by 2015, but why not pop kernels the old-fashioned way in a skillet on the stovetop? (Mmm, butter.)

4) Nonorganic Potatoes a?? Most root vegetables, including the highly consumed potato, absorb pesticides, fungicides, and herbicides from conventionally grown soils. Organic potatoes should absorb fewer of these types of chemicals as none are added to the soil or in processing steps between farm and market. Whole Foods has several varieties, and perhaps your local farmer can vouch for her methods.

5) Farm-Raised Salmon a?? Or any other similarly-raised fish, are often crammed into pens and consume a frankenfood diet of soy, chicken litter and hydrolyzed feathers, pesticides, and antibiotics. Such Fish-in-Water-Belt-Buckle-246.html' target='_blank'>fish meat consequently has been found to be less nutritional and higher in contaminants, carcinogens, and other chemicals. The Blue Ocean Institute has compiled a free guide on how to choose seafood that is sustainably caught by evaluating speciesa?? life history, abundance in the wild, habitat concerns, and catch method or farming system. It is a must-read.

6) Milk Produced with Artificial Hormones a?? It seems like there are more and more a??rBGH-freea?? milk options on the shelves, so this message is even getting through to Wal-Mart. Milk producers who still treat their cattle with recombinant bovine growth hormone (rBGH or rBST) increase problems for the health of their cows and milk consumers alike. Insulin-like growth factor is found in higher levels in such milk, and can increase risk of breast, prostate, and colon cancers.

7) Conventional Apples a?? Apple trees are propagated through grafting, reducing their genetic variation and ability to acquire adaptations against pests. As such they are among the most highly sprayed fruits, and while the pesticide residues are claimed to be not harmful by the industry, it makes sense to avoid them if possible. Some studies are suggesting a link between total accumulations of pesticides from all sources and Parkinsona??s Disease. Organically grown apples and fruits will have lower burdens of these chemicals, and the processes used to bring them to market are more sustainable.

And here are three more to round out an even 10:

8. Hmmm. How about Scrutinizing Foods Promoted by Coupons? a?? In tough economic times, or with tight financial budgets, the appeal of saving money is obvious and understandable. The problem is that most items available for purchase with a coupon from your grocery store are highly processed and chock full of preservatives to extend shelf life. Hot dogs, Entenmanna??s pastries, and Carvel Ice Cream come to mind. Read through the ingredients. A sale on fresh produce, or a coupon for some household cleaning item not withstanding, beware the allure of saving money as it may cost more in long term health. Coupons may be best applied to inedible things.

9. Peanut Butter a?? Get the kind with a slick of oil on the top. The hydrogenated oils of the conventional Jiffy and Skippy and other brands that sound like embarassing nicknames render the peanut butter less healthy. If the sole ingredient is a??peanuts,a?? youa??ve found a better option. Or try almond butter, or even walnut butter. If you have a food processor, you can easily grind up your own homemade variety.

10. Dona??t Eat Fast Food or Highly Processed Foods a?? What kind of hamburger costs 99 cents? What kind of a??inputsa?? go into such a thing? Cast behind each happy meal is a long shadow of animal misery, petroleum fuel, and heavy processing. The stuff will not harbor life as mold will not grow on it, so how can it sustain you? [addendum: perhaps this lack of mold is due to natural dessication common to all burgers left out in the open] Similarly, foods that sit on the shelves in the middle aisles of the supermarket may contain a zoo of chemicals and preservatives, and whenever the label reads a??high-fructose corn syrupa?? or a??mono and diglyceridesa?? I usually put it back. Might be fun to see how long you can avoid the middle aisles all together. The best packaging ever designed for conveying nutrients to our bodies is in the inherent beauty of a vegetable or fruit, the subjects of countless still life paintings and recipes.

Eating healthy is expensive, but so is not eating healthy. And I am not saying that we should eat amanita muscaria mushrooms because they are a??natural.a??

Thanks to the writers at Prevention for this list to spur a conversation. Any other thoughts? Ia??m off to eat an air-sandwich with flax seeds and celery butter.

                       

What Everyone Should Know About Plastics

Information circulating about the dangers of plastic containers has created fear and confusion. Are plastic containers toxic? Do harmful chemicals leach out into its contents? Do we need to discard all plastic containers?

Recently, I interacted in a live health chat on MedHelp about the safety of plastics. Scientist, Joe Schwarcz, Ph.D., Director of McGill Universitya??s Office for Science and Society, talked about a??The Real Truth About Plastics: What You Should And Shouldna??t Worry About.a??

While Dr. Schwarcz states that some plastics like those made by Tupperware and Rubbermaid are safe to use, there are other plastics made of Bisphenol A (BPA) that may cause some concern, however he did not become alarmed.

There is extensive information on the safety of plastics, and reading some of it can easily cause panic and confusion, but the smartest step health consumers can do for themselves is to remain calm and dona??t become alarmed.??Gather the facts and determine whata??s best for you.

The Facts About Bisphenol A (BPA)

Bisphenol A (BPA) is used to manufacture polycarbonate plastics. This type of plastic is used to make some types of beverage containers, compact disks, plastic dinnerware, impact-resistant safety equipment, automobile parts, and toys. BPA epoxy resins are used in the protective linings of food cans, in dental sealants, and in other products.

General exposure to BPA at low levels comes from eating food or drinking water stored in containers that have BPA. Small children may be exposed by hand-to-mouth and direct oral (mouth) contact with materials containing BPA. Dental treatment with BPA-containing sealants also results in short-term exposure. In addition, workers who manufacture products that contain BPA can be exposed.

How Does BPA Get Into The Body?

BPA can leach into food from the epoxy resin lining of cans and from consumer products such as polycarbonate tableware, food storage containers, water bottles, and baby bottles. Additional traces of BPA can leach out of these products when they are heated at high temperatures.

During The Live Chat

An audience member during the live chat asked about the safety of plastics that contain chemicals that mimic estrogen that may result in developing breast, uterine, or ovarian cancers. Dr. Schwarcz replied that these plastics contain BPA and phthalates and that they are estrogenic. He states, however that we are a??exposed to estrogenic compounds all over the place. Soy contains isoflavones which are estrogenic, so do chickpeas, and of course milk!?? Natural estrogens in milk are thousands of time more potent estrogens than BPA.a??

Dr. Schwarcz writes about BPA in his blog “Chemically Speaking”:

a??The more bisphenol A is in the news, the more acrimonious and self-serving the debates seem to get.?? On one side we have some scientists stirring the pot with statements like a??The science is clear and the findings are not just scary, they are horrific.?? When you feed a baby out of a clear, hard plastic bottle, ita??s like giving the baby a birth control pill.a???? This is absurd.?? The science isna??t clear, ita??s quite murky.?? If it were all clear, we wouldna??t be having such bitter debates.a??

On the other hand, the BPA defenders, mostly with industrial connections, claim that BPA has been safely used for fifty years and presents no risk to humans.?? This is a hollow claim.?? True, nobody has ever experienced an acute reaction from traces of BPA leached out of a polycarbonate bottle, but that is not the kind of risk wea??re worried about.?? The concern is over the possibility of subtle effects that may turn up after long term exposure to minute amounts of BPA, or health problems that may be manifested in the distant future if exposure occurs at a crucial stage of development.?? Such concerns are legitimate and are based upon suggestive, but certainly not conclusive, evidence.a??

American Chemistry Council

a??An international panel of experts concluded that food is by far the main source of bisphenol A (BPA) exposure and that other sources are of minor relevance. The experts were also able to model circulating levels of BPA in the human body, which are very low, indicating that BPA is not accumulated in the body and is rapidly eliminated.a?? [Source: The World Health Organization (WHO), 2010.]

U.S. Food And Drug Administration (FDA)

But according to the U.S. Food and Drug Administration (FDA), in January 2010 the FDA announced it shares the perspective of the National Toxicology Program (NTP) that recent studies provide reason for some concern about the potential effects of BPA on the brain, behavior, and prostate gland of fetuses, infants, and children.??a??The NTP has minimal concern for effects on the mammary gland and an earlier age for puberty for females in fetuses, infants, and children at current human exposures to bisphenol A.a??

a??FDA also recognizes substantial uncertainties with respect to the overall interpretation of these studies and their potential implications for human health effects of BPA exposure.?? These uncertainties relate to issues such as the routes of exposure employed, the lack of consistency among some of the measured endpoints or results between studies, the relevance of some animal models to human health, differences in the metabolism (and detoxification) of and responses to BPA both at different ages and in different species, and limited or absent dose response information for some studies.

FDA is pursuing additional studies to address the uncertainties in the findings, seeking public input and input from other expert agencies, and supporting a shift to a more robust regulatory framework for oversight of BPA to be able to respond quickly, if necessary, to protect the public.a??

Information from the live chat provided by Dr. Schwarcz and audience questions appear below. You can read the full health chat on the safety of plastics on MedHelp.

The Real Truth About Plastics: What You Should And Shouldna??t Worry About

Q:?? Barbara

Are plastics safe to store food???Is there a difference between the containers bought in a dollar store as opposed to higher price plastic containers?

A: Dr. Schwarcz

There are many types of plastic containers.??The ones sold for storage like Tupperware and Rubbermaid (I have no association with either of those companies) are great, they are made of polyethylene or polypropylene.??I wouldna??t, however, heat up tomato sauce in an old margarine tub because that has only been tested for margarine storage.??As a general rule though for use in the microwave, oven glass or ceramic are the best.

Q:?? Katscan

Some vegetables come in those microwave bags. Are they safe to use? What about storing food in Ziploc bags? I do that all the time. Am I exposing myself to BPA?

A:?? Dr. Schwarcz

Not a molecule of BPA in sight.??These are made of polyethylene, the same as the shopping bags, hula hoops, etc.

Q:?? SixUntilMe

Is it safer to use plastic or glass bottles for a newborn???I hear conflicting reports, and as a new mom Ia??m paranoid.

A:?? Dr. Schwarcz

As you may have heard, Canada as well as some European countries and several states in the U.S.??have banned polycarbonate #7 baby bottles because of developmental problem concerns.??This is based on the a??precautionary principlea?? which suggests that if there is any risk we should avoid the substance, but one also has to exercise the precautionary principle in exercising the precautionary principle meaning that you have to make sure that the replacement is less risky than what you are replacing.??I think in the baby bottle business, we have glass which is certainly a good replacement.

Bottom Line

Dr. Schwarcz talks about the a??precautionary principlea?? where using a replacement that is less risky is good option like in the case of baby bottles.??Glass bottles are available and it is a good alternative to plastic ones.??He also says that using a??glass or ceramica?? are the best in the microwave.??He did not say to stop drinking out of water bottles and buy only BPA-free products either.??He did say in his live chat that plastics that mimic estrogen contain BPA.??He further adds that we are a??exposed to estrogenic compounds all over the place,a?? milk, soy, chickpeas are some examples of these compounds. a??Natural estrogens in milk are thousands of time more potent estrogens than BPA,a?? he stated during the live chat.

While there is no clear conclusive evidence that BPA is 100 percent detrimental to your health, there is a report from the FDA in conjunction with the National Toxicology Program (NTP) that recent studies provide reason for some concern about the potential effects of BPA on the brain, behavior, and prostate gland of fetuses, infants, and children.??The NTP has minimal concern for effects on the mammary gland and an earlier age for puberty for females in fetuses, infants, and children at current human exposures to bisphenol A.

What Can You Do To Prevent Exposure To BPA?

If you’re concerned, you can make personal choices to reduce exposure:

• Dona??t microwave polycarbonate plastic food containers. Polycarbonate is strong and durable, but over time it may break down from repeated use at high temperatures.


• Avoid plastic containers with the #7 on the bottom.


• Dona??t wash polycarbonate plastic containers in the dishwasher with harsh detergents.


• Reduce your use of canned foods. Eat fresh or frozen foods.


• When possible, opt for glass, porcelain, or stainless steel containers, particularly for hot food or liquids.


• Use infant formula bottles that are BPA-free and look for toys that are labeled BPA-free.

You are smart health consumers. You can decide whata??s best for you.

Additional Resources

U.S. Food and Drug Administration (FDA)

National Toxicology Program Bisphenol A (BPA) Fact Sheet

National Toxicology Program (BPA)

National Toxicology Program??(headquartered at the National Institute of Environmental Health Sciences, NIH-HHS)

Chemically Speaking

The Harvard Medical School Family Health Guide

U.S. Department of Health and Human Services

U.S. Food and Drug Administration (Homepage)

Centers for Disease Control and Prevention

U.S. Environmental Protection Agency

Consumer Product Safety Commission

National Institute of Environmental Health Sciences

Your Turn

We would love to hear your insightful thoughts.??Are you concerned about the safety of plastics???Do you use plastic containers???Do you use only glass containers???Are you concerned about the BPA? Do you buy BPA free products???What type of containers do you use to microwave your foods?

As always, thank you for your time.

                        u

Drug Safety In Preventing Acute Mountain Sickness

This is a guest post by Dr. Jeremy Windsor.

**********

Steroids and Acute Mountain Sickness

In recent years, many attempts have been made to identify safe and effective medications to prevent acute mountain sickness (AMS). Acetazolamide (Diamox), currently the “drug of choice” for this purpose,??is not perfect and occasionally causes objectionable side effects.??Dexamethasone (Decadron), a powerful steroid medication, has become increasingly popular for prevention and treatment in certain circles. While there is ample evidence to suggest that dexamethasone is effective, a recent case report highlights that this drug is not without risk.

In the latest issue of the journal Wilderness??& Environmental Medicine [WEM 21(4):345-348, 2010]??in an article entitled??”Complications of steroid use on Mt. Everest,” Bishnu Subedi and colleagues working for the Himalayan Rescue Association (HRA) described the case of a 27 year-old man who was prescribed a course of three drugs, including dexamethasone, intended to support him during his attempt to climb Mt. Everest. After more than three weeks of taking the medications, the mountaineer noticed the appearance of a rash and decided to stop taking them. Rather than wait for the rash to subside, he chose to continue his acclimatization program and ascend to Camp 3 at 7010m altitude. The patient arrived exhausted and confused; onlookers quickly recognized that something was seriously wrong and so a rescue party was organized to help him back to safety.

Back at Base Camp, the??HRA doctors??noted little improvement in his condition.??Close examination revealed low blood pressure and high heart rate, as well as the presence of blood in his stool. A helicopter evacuation was arranged and he was taken to the Nepal International Clinic (NIC) in Kathmandu. During his stay in and evaluation at the clinic it became clear that the use of dexamethasone had played a key part in his deterioration. Steroids taken for long periods of time??suppress the bodya??s normal steroid production??via a negative feedback loop. When supplemental steroids are suddenly discontinued, the “deconditioned” steroid-forming glands cannot rapidly respond with normal steroid production.

Without adequate steroids, the body is unable to cope even with everyday stresses, let alone the extra stress associated with mountaineering. In some persons who suddenly stop taking steroids, there develops a condition characterized by confusion, fatigue, lightheadedness, sweating, headache, diarrhea, and vomiting. To prevent this from happening, anyone who takes??steroids for more than a few weeks needs to be weaned off them over a period of weeks to months under proper medical supervision.

Blood tests in this victim also??revealed low hemoglobin concentration. Hemoglobin is an essential??oxygen-carrying pigment within red blood cells. At sea level, the normal??measured hemoglobin level??in men is between 14 and 18??grams per deciliter (g/dl) of blood.??During ascent, this may increase as part of the normal acclimatization process.??In this??case the??measured hemoglobin level??had fallen to 8.5 g/dl. The reason for this low concentration??was traced back to the blood in the stool. Following prolonged use, steroids interfere with the protective lining of the esophagus, stomach, and duodenum, causing ulceration and bleeding. Using a flexible fibre-optic endoscope, the team at the NIC identified multiple ulcers in the esophagus and injected them with adrenaline to prevent further bleeding. Left untreated, these ulcers might have proved fatal.

Although the patient was discharged after nearly two weeks in hospital, his problems were far from over. Psychological and physical problems related to the use of dexamethasone persisted and treatment was still ongoing a year later.??Persons who use steroids for AMS prevention must be aware of the problems they might encounter. While an approach that uses small doses of steroids for short periods of time reduces the risk of adverse effects attributable to the medication, it does not entirely eliminate them. As they should for any medication, individuals must weigh the benefits of these drugs against the potential drug-induced problems.

**********

Jeremy Windsor,??MD??is currently a Specialist Registrar in Anaesthetics rotating through hospitals in north London. He is Editor of the??High Altitude section??of Wilderness??& Environmental Medicine and one of two UK representatives on the UIAA Medical Commission.

As a member of the Caudwell Xtreme Group he climbed Cho Oyu (8201m) in 2005 and Everest (8850m) in 2007. In his spare time he works as a guide for the UK company Jagged Globe and has recently led successful expeditions to Kilimanjaro (2008 and 2009), Aconcagua (2010) and Mera Peak (2010). Over the last two years he completed two exploratory expeditions to areas in Sikkim and Himachal Pradesh. He is currently completing an MD at the University of Sheffield that looks at the electrocardiographic changes that occur in individuals who ascend to altitude.

Despite his base in London, he can often be found climbing, swimming, and running throughout the UK, especially in the Peak District of Derbyshire.

                       
                       

This post, Drug Safety In Preventing Acute Mountain Sickness, was originally published on
                        Healthine.com by Paul Auerbach, MD, MS.

Diabetes Bingo

Recently, I reconnected with a long-lost local PWD (person with diabetes) named Ryan.??Last time Ryan and I saw one another we were talking about diabetes goal-setting and dealing with wicked bouts of burnout.??And this week I received an email from him with a brilliant idea about how to stay motivated towards setting — and reaching — diabetes-related goals.

“I’ve had this ‘pyramid’ for about three months now.??Just something that I keep near my desk to keep me focused on my diabetes.??After completion of the pyramid, I have no clue what I will do but some kind of celebration will be in order,” he wrote, and attached a slide to his image.??And when I opened it, I was like “whoa.”

He had created a pyramid of his diabetes goals.??Tangible goals — real-life goals — that are both achievable and ambitious, all at once.??I thought this was so clever because it is a constant but non-threatening reminder of what diabetes goals are most top-of-mind for him.??(Also, having a celebration at the end of that pyramid completion sounds like a quality idea.??Perhaps a Fudgy the Whale?)

I’ve been working towards gaining better control of my diabetes (and overall health) lately, and I love the idea of something I can print out, stick to my fridge, and remain inspired by.??I liked the idea of a pyramid, but I kept picturing a huge bingo hall in my mind, with a whole bunch of PWDs sitting at the tables with glucose tabs and bingo markers at the ready.??But the trick wasn’t getting four in a row, it was filing the whole card.

I thought about my own personal goals and created this:

There are a few not-necessarily-diabetes-related goals on there (like “lose??6 pounds,” which is because I’m still trying to de-flump), but there are a lot of diabetes goals that aren’t unique to my particular circumstances.??Since I’m trying to emerge from some diabetes burnout, my goals aren’t as tight as they were a few months ago (i.e. the slow progression from an A1C over 8 to one under 7.5).??But these are real, and I’m hoping to fill the card within six months. Thanks for the fun idea, Ryan!

What would be on your bingo card?

                       

Meditation: How It May Change The Brain

Meditation sounds like a great idea from the perspective of a psychiatrist: Anything that calms and focuses the mind is a good thing (and without pharmaceuticals, even better).

Personally, I tried transcendental meditation as a kid (more to do with my mother than with me) and found it to be boring. I have trouble keeping my thoughts still. They wander to what I want for dinner, and should I write about this on Shrink Rap, and will Clink and Victor ever eat crabcakes with me again, and did I remember to give my last patient informed consent, and a zillion other things. Holding my thoughts still is work.

The New York Times Well blog has an article on meditation and brain changes. In “How Meditation May Change the Brain,” Sindya N. Bhanoo writes:

The researchers report that those who meditated for about 30 minutes a day for eight weeks had measurable changes in gray-matter density in parts of the brain associated with memory, sense of self, empathy and stress. The findings will appear in the Jan. 30 issue of Psychiatry Research: Neuroimaging.

M.R.I. brain scans taken before and after the participantsa?? meditation regimen found increased gray matter in the hippocampus, an area important for learning and memory. The images also showed a reduction of gray matter in the amygdala, a region connected to anxiety and stress. A control group that did not practice meditation showed no such changes.

Lower stress, lower blood pressure, higher empathy. I may have to give meditation another try.

                        e

The Importance Of Diagnosing Birth Defects

Birth defects,??particularly those of the blood vessels, account for the majority of infant deaths, especially after the first week of life. Congenital heart disease (CHD) — meaning defects of the heart –??is responsible for one-third of deaths between birth and the first year of life. Therefore, the diagnosis of CHD is critical in order to plan life-saving treatments, such as the proper place for the delivery, the type of delivery, and its timing. If it’s known in advance that an unborn baby has a heart problem and is delivered in a hospital that provides special care, its survival and future health will increase dramatically.

Who’s at risk for having CHD and which expectant moms should have further evaluation? Families who have a history of CHD — especially mothers, fathers, and siblings — should receive genetic counseling. Multiple medical studies over the past fifteen years have demonstrated the significance of genetics as a main culprit of CHD. Parents of a child with CHD have a??two percent to??three percent??chance of having another affected child. If a mother or father has CHD, a fetal cardiac echo (an ultrasound of the heart) is definitely warranted.

Because the treatment of CHD in many cases is surgical, there’s an increasing number of patients who have survived into adulthood and have ultimately become parents. Research has documented that 4.1 percent??of their children will have CHD. Children with mothers who have CHD are at a greater risk of inheriting the disease than if they have fathers with CHD. Mothers with cyanotic heart disease — that is, blood that is without oxygen that bypasses the lungs and goes directly to the blood vessels — also have a greater risk of having a baby with CHD.

Women at risk for having a baby with CHD include those who take medicine for seizures, lithium, drink alcohol, and use isotretinoin. Prenatal risk factors for CHD include abnormal fetal heart tones (especially bradycardia or a heart rate less than 100 beats per minute), a nuchal translucency fold of greater than 3.5 mm (this is a test done in the first trimester for Down syndrome), monochorionic (or identical) twins, and women who have had in-vitro fertilization. In fact, medical studies reveal that children conceived through IVF were three to 12 times more likely to have CHD then the general population.

By knowing your family history and risk factors you will be better prepared to determine if your baby has a cardiac defect. Remember, a healthy pregnancy doesna??t just happen — it takes a smart mother who knows what to do.