Category Archives: Other Medical

NINDS Know Stroke Campaign – Know Stroke Home

Posted on by MaryO

Each year in the United States, there are more than 795,000 strokes. Stroke is the fourth leading cause of death in the country and causes more serious long-term disabilities than any other disease. Nearly three-quarters of all strokes occur in people over the age of 65 and the risk of having a stroke more than doubles each decade after the age of 55.

The National Institutes of Health through the National Institute of Neurological Disorders and Stroke (NINDS) developed the Know Stroke. Know the Signs. Act in Time. campaign to help educate the public about the symptoms of stroke and the importance of getting to the hospital quickly.

Read the entire article at NINDS Know Stroke Campaign – Know Stroke Home.

A New Surgery Risk – NYTimes.com

Posted on by MaryO

Thousands of Americans every year develop an abnormal heart rhythm after having major surgery. These episodes have long been considered a fleeting phenomenon that is generally not a cause for concern.

But a large new study suggests that doctors should take these abnormal heart rhythms, known as atrial fibrillation, or A-fib, more seriously. It found that patients who experienced one or more episodes after surgery had a striking increase in their risk of having a future stroke. The findings are likely to encourage doctors to potentially monitor and in some cases treat the patients who experience them.

“This is telling us that once you see atrial fibrillation in the hospital, that’s a marker of potential trouble to come,” said Dr. Donald Easton, a clinical professor of neurology at the University of California, San Francisco medical school.

Read more at  A New Surgery Risk – NYTimes.com.

44 Ways to Make the Day of Someone With Cancer | Elana Miller, MD

Posted on by MaryO

These would work for Cushing’s, as well.

“…Over the following months I experienced a whirlwind of physical and emotional changes. The treatment became increasingly arduous, and I lost the ability to perform even simple functions, including working, driving, preparing food, and running errands. At 31 years old, I thought anyone taking away my independence would be prying it from my cold, dead hands. Unfortunately, that was almost the case.

Thankfully, I had a community of supporters — family, coworkers, friends — who stepped up and took care of me when I needed it most.

When a person first gets a cancer diagnosis, they’re often so overwhelmed they have no idea how to ask for help or what to ask for — but they sure need it. If you have a friend or family member with cancer you want to help, don’t make the mistake of making a vague, questionably-sincere offer “Well, call me when you need me!” (they won’t).

Instead, make your friend’s life easier by anticipating his or her needs and giving tangible, much-needed support. Here is a list of the top favors people did for me that made my day (and made my life much easier!) after my cancer diagnosis…”

From 44 Ways to Make the Day of Someone With Cancer | Elana Miller, MD.

Why 6 Seconds of Exercise Can Be as Worthwhile as 90 Minutes – ABC News

Posted on by MaryO

HOW MUCH EXERCISE YOU REALLY NEED

6 Seconds

For seniors, every second of exercise counts.

In a new Scottish study, retirement-age subjects were asked to do six six-second sprints on a stationary bicycle with one minute of rest in between. After six weeks, their blood pressure dropped by a respectable 9 percent.

It’s possible these results might translate to younger folks, said Michele Olson, an exercise science professor and researcher at Auburn University in Alabama.

“Even a little activity can increase the efficiency of your heart and lead to more energy overall, no matter what your age,” she said.

Read the entire article at  Why 6 Seconds of Exercise Can Be as Worthwhile as 90 Minutes – ABC News.

 

maryO butterfly script

Heart Of The Matter: Treating The Disease Instead Of The Person : Shots – Health News : NPR

Posted on by MaryO

Many times patients and doctors see the same hospital visit through different eyes.

This NPR article discusses the importance of seeing things from both sides…

 

Heart Of The Matter: Treating The Disease Instead Of The Person : Shots – Health News : NPR.

Evaluation and Management of the Premenopausal Woman with Low BMD

Posted on by MaryO

Current Osteoporosis Reports, 10/31/2013  Review Article  Clinical Article

bone density machine

bone density machine (Photo credit: x1987x)

Cohen A et al. – Interpretation of bone mineral density (BMD) results in premenopausal women is particularly challenging, since the relationship between BMD and fracture risk is not the same as for postmenopausal women. Assessment of markers of bone turnover and follow–up bone density measurements can help to identify those with an ongoing process of bone loss that may indicate a higher risk for fracture, and possible need for pharmacologic intervention.

  • In most cases, Z scores rather than T scores should be used to define “low BMD” in premenopausal women.
  • The finding of low BMD in a premenopausal woman should prompt thorough evaluation for secondary causes of bone loss.
  • If a secondary cause is found, management should focus on treatment of this condition.
  • In a few cases where the secondary cause cannot be eliminated, treatment with a bone active agent to prevent bone loss should be considered.
  • In women with no fractures and no known secondary cause, low BMD is associated with microarchitectural defects similar to young women with fractures; however, no longitudinal data are available to allow use of BMD to predict fracture risk.
  • BMD is likely to be stable in these women with isolated low BMD, and pharmacologic therapy is rarely necessary.

From MDLinx

Menopausal Hormone Therapy

Posted on by MaryO

PS-main-logo

Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women’s Health Initiative Randomized Trials

JAMA, 10/02/2013  Evidence Based Medicine  Clinical Article

Manson JE et al. – Menopausal hormone therapy continues in clinical use but questions remain regarding its risks and benefits for chronic disease prevention. To report a comprehensive, integrated overview of findings from the 2 Women’s Health Initiative (WHI) hormone therapy trials with extended postintervention follow–up. Menopausal hormone therapy has a complex pattern of risks and benefits. Findings from the intervention and extended postintervention follow–up of the 2 WHI hormone therapy trials do not support use of this therapy for chronic disease prevention, although it is appropriate for symptom management in some women.

Methods

  • A total of 27 347 postmenopausal women aged 50 to 79 years were enrolled at 40 US centers.
  • Women with an intact uterus received conjugated equine estrogens (CEE; 0.625 mg/d) plus medroxyprogesterone acetate (MPA; 2.5 mg/d) (n = 8506) or placebo (n = 8102).
  • Women with prior hysterectomy received CEE alone (0.625 mg/d) (n = 5310) or placebo (n = 5429).
  • The intervention lasted a median of 5.6 years in CEE plus MPA trial and 7.2 years in CEE alone trial with 13 years of cumulative follow–up until September 30, 2010.
  • Primary efficacy and safety outcomes were coronary heart disease (CHD) and invasive breast cancer, respectively.
  • A global index also included stroke, pulmonary embolism, colorectal cancer, endometrial cancer, hip fracture, and death.

Results

  • During the CEE plus MPA intervention phase, the numbers of CHD cases were 196 for CEE plus MPA vs 159 for placebo (hazard ratio [HR], 1.18; 95% CI, 0.95–1.45) and 206 vs 155, respectively, for invasive breast cancer (HR, 1.24; 95% CI, 1.01–1.53).
  • Other risks included increased stroke, pulmonary embolism, dementia (in women aged >=65 years), gallbladder disease, and urinary incontinence; benefits included decreased hip fractures, diabetes, and vasomotor symptoms.
  • Most risks and benefits dissipated postintervention, although some elevation in breast cancer risk persisted during cumulative follow–up (434 cases for CEE plus MPA vs 323 for placebo; HR, 1.28 [95% CI, 1.11–1.48]).
  • The risks and benefits were more balanced during the CEE alone intervention with 204 CHD cases for CEE alone vs 222 cases for placebo (HR, 0.94; 95% CI, 0.78–1.14) and 104 vs 135, respectively, for invasive breast cancer (HR, 0.79; 95% CI, 0.61–1.02); cumulatively, there were 168 vs 216, respectively, cases of breast cancer diagnosed (HR, 0.79; 95% CI, 0.65–0.97).
  • Results for other outcomes were similar to CEE plus MPA.
  • Neither regimen affected all–cause mortality.
  • For CEE alone, younger women (aged 50–59 years) had more favorable results for all–cause mortality, myocardial infarction, and the global index (nominal P < .05 for trend by age).
  • Absolute risks of adverse events (measured by the global index) per 10 000 women annually taking CEE plus MPA ranged from 12 excess cases for ages of 50–59 years to 38 for ages of 70–79 years; for women taking CEE alone, from 19 fewer cases for ages of 50–59 years to 51 excess cases for ages of 70–79 years.
  • Quality–of–life outcomes had mixed results in both trials.

From http://www.mdlinx.com/internal-medicine/newsl-article.cfm/4870253/ZZ4747461521296427210947/?news_id=466&newsdt=100213&utm_source=Newsletter&utm_medium=DailyNL&utm_content=General-Article&utm_campaign=Article-Section

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Prevent heart attack and stroke

Posted on by MaryO
Generic regular strength enteric coated 325mg ...

Generic regular strength enteric coated 325mg aspirin tablets. The orange tablets are imprinted in black with “L429”. (Photo credit: Wikipedia)

This brief article will provide information and links to where additional information can be found to help you recognize and hopefully prevent a heart attack or stroke.

According to cardiologists, most heart attacks occur in the day, generally between 6 a.m. and noon. If you take an aspirin or a baby aspirin once a day, take it at night. Aspirin has a 24-hour “half-life” therefore, the aspirin would be strongest in your system when most heart attacks happen, in the wee hours of the morning.

A 2012 RetiredBrains survey of cardiologists provides the following information on the symptoms, warning signs and treatment for heart attack and stroke.

How to recognize heart attack symptoms

Chest discomfort that feels like pressure, or seems like a squeezing pain in the center of your chest. This pain generally lasts for more than a few minutes, but sometimes goes away and returns.

Pain and/or discomfort that extends beyond your chest to other parts of your upper body, such as one or both arms, back, neck, stomach, teeth, and even your jaw; shortness of breath, with or without chest discomfort. Other symptoms include: cold sweats, nausea or vomiting, lightheadedness, indigestion, and fatigue.

What should I do when heart attack symptoms occur

If you or someone you are with experiences chest discomfort or other heart attack symptoms the first thing you should do is call 9-1-1.

Don’t wait to make the call. Don’t drive yourself to the hospital. Don’t drive the person having a heart attack to the hospital. Immediate treatment lessens heart damage and can save your life. Emergency medical services personnel can begin treatment in the ambulance on the way to the hospital and are trained to revive a person if his/her heart stops. Some people delay treatment because they are not sure they are really having a heart attack. Remember call 911 immediately as treatment given within an hour of the first heart attack symptoms saves lives and damage to the heart and substantially increases the chances of survival.

What should I do before paramedics arrive

If 911 has been called:

1. Try to keep the person calm, and have them sit or lie down.

2. If the person isn’t allergic to aspirin, have them chew and swallow an aspirin (It works faster when chewed than swallowed whole.)

3. If the person stops breathing, you or someone else who is qualified should perform CPR immediately. If you don’t know CPR, the 9-1-1 operator can assist you until the EMS personnel arrive.

For more information, check out the heart disease section on Mayo Clinic’s site and the warning signs of heart attack, stroke and cardiac arrest, compiled by the American Heart Association.

The information contained in this article should not be substituted for the advice of your physician. If you experience any symptoms or are concerned about your health in any way, you should immediately seek the advice of your physician.

From MarketWatch

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Blood Pressure Infographic

Posted on by MaryO

A Snapshot: Blood Pressure in the U.S. Make Control Your Goal. High blood pressure is a major risk factor for heart disease and stroke, the first and fourth leading causes of death for all Americans. High Blood Pressure Basics. 67 million American adults—1 in 3—have high blood pressure. High blood pressure contributes to ~1,000 deaths/day. When your blood pressure is high, you are 4 times more likely to die from a stroke, and you are 3 times more likely to die from heart disease. 69% of people who have a first heart attack, 77% of people who have a first stroke, and 74% of people with chronic heart failure have high blood pressure. Annual estimated costs associated with high blood pressure: $51 billion, including $47.5 billion in direct medical expenses. Blood Pressure Control. Only about half of people with high blood pressure have their condition under control. Reducing average population systolic blood pressure by only 12–13 mmHg could reduce stroke by 37%, coronary heart disease by 21%, deaths from cardiovascular disease by 25%, and deaths from all causes by 13%. Make Control Your Goal, Every Day. Check your blood pressure regularly—at home, at a doctor’s office, or at a pharmacy. Eat a healthy diet with more fruits, vegetables, potassium, and whole grains and less sodium, saturated fat, trans fat, and cholesterol . Read nutrition labels and lower your sodium intake. Most of the sodium we eat comes from processed and restaurant foods. About 90% of Americans eat too much sodium. Quit smoking—or don’t start. 1-800-QUIT-NOW or Smokefree.gov. Adults should limit alcohol to no more than 1 drink per day for women and 2 drinks per day for men. Get active and maintain a healthy weight. Aim for 2 hours and 30 minutes of moderate physical activity every week. This infographic was developed by the Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention in support of achieving the Million Hearts® initiative goal to prevent 1 million heart attacks and strokes by 2017.

Test your blood pressure IQ using our new infographic! How many facts about blood pressure did you already know?

Hypercortisolism Is Associated With Increased Coronary Arterial Atherosclerosis

Posted on by MaryO

Hypercortisolism Is Associated With Increased Coronary Arterial Atherosclerosis: Analysis of Noninvasive Coronary Angiography Using Multidetector Computerized Tomography

Journal of Clinical Endocrinology and Metabolism, 05/21/2013  Clinical Article

  1. Nicola M. Neary*,
  2. O. Julian Booker*,
  3. Brent S. Abel,
  4. Jatin R. Matta,
  5. Nancy Muldoon,
  6. Ninet Sinaii,
  7. Roderic I. Pettigrew,
  8. Lynnette K. Nieman and
  9. Ahmed M. Gharib

–Author Affiliations


  1. Program in Reproductive and Adult Endocrinology (N.M.N., L.K.N., B.S.A.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; Laboratory of Cardiac Energetics (O.J.B.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892; Integrative Cardiovascular Imaging Laboratory (J.R.M., R.I.P., A.M.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Critical Care Medicine (N.M.), Clinical Center, National Institutes of Health, Bethesda, Maryland 20892; and Biostatistics and Clinical Epidemiology Service (N.S.), Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
  1. Address all correspondence and requests for reprints to: Ahmed M. Gharib, MB, ChB, National Institutes of Health, Building 10, Room 3-5340, Mail Stop Code 1263, 10 Center Drive, Bethesda, MD 20892. E-mail: agharib@mail.nih.gov.

  1. ↵* N.M.N. and O.J.B. contributed equally to this work.

Abstract

Background: Observational studies show that glucocorticoid therapy and the endogenous hypercortisolism of Cushing’s syndrome (CS) are associated with increased rates of cardiovascular morbidity and mortality. However, the causes of these findings remain largely unknown.

Objective: To determine whether CS patients have increased coronary atherosclerosis.

Design: A prospective case-control study was performed.

Setting: Subjects were evaulated in a clinical research center.

Subjects: Fifteen consecutive patients with ACTH-dependent CS, 14 due to an ectopic source and 1 due to pituitary Cushing’s disease were recruited. Eleven patients were studied when hypercortisolemic; 4 patients were eucortisolemic due to medication (3) or cyclic hypercortisolism (1). Fifteen control subjects with at least one risk factor for cardiac disease were matched 1:1 for age, sex, and body mass index.

Primary outcome variables: Agatston score a measure of calcified plaque and non-calcified coronary plaque volume were quantified using a multidetector CT (MDCT) coronary angiogram scan. Additional variables included fasting lipids, blood pressure, history of hypertension or diabetes, and 24-hour urine free cortisol excretion.

Results: CS patients had significantly greater noncalcified plaque volume and Agatston score (noncalcified plaque volume [mm3] median [interquartile ranges]: CS 49.5 [31.4, 102.5], controls 17.9 [2.6, 25.3], P < .001; Agatston score: CS 70.6 [0, 253.1], controls 0 [0, 7.6]; P < .05). CS patients had higher systolic and diastolic blood pressures than controls (systolic: CS 143 mm Hg [135, 173]; controls, 134 [123, 136], P < .02; diastolic CS: 86 [80, 99], controls, 76 [72, 84], P < .05).

Conclusions: Increased coronary calcifications and noncalcified coronary plaque volumes are present in patients with active or previous hypercortisolism. Increased atherosclerosis may contribute to the increased rates of cardiovascular morbidity and mortality in patients with glucocorticoid excess.

  • Received October 29, 2012.
  • Accepted March 7, 2013.

From JCEM

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