Archive for August, 2008
August 29th, 2008
Most people know that the risk of heart disease can be reduced by embracing a healthy lifestyle. However, people may be surprised to learn that many cancers can be linked to lifestyle factors as well. The good news is that many of the behaviors that reduce the risk of cardiovascular disease, such as exercise and maintaining a healthy weight, also help reduce the risk of cancer. As hard as it might be to believe, doctors are finding it difficult to discover the health positives for being overweight, sedentary, smoking and drinking to excess. While I might think that studying the benefits of a Henry the VIII lifestyle sounds appealing, it appears unlikely that the results of that study would provide any comfort to those who find it difficult to exercise, maintain a normal body weight, avoid tobacco, and limit their alcohol intake. The good news is that there is no prohibition about enjoying life and that enjoyment may be heart healthy as well. Below are some of the behaviors that can reduce the risk of cancer:
- Avoid tobacco usage and contact. The most critical, modifiable risk factor for cancer is tobacco use. For a person who smokes, quitting is the single most important action that can reduce the risk of cancer. In addition to smoking, chewing tobacco and exposure to passive smoking are cancer risk factors. While most people know that smoking increases the risk of lung cancer, it is important to know that it also increases the risk of multiple other cancers including cancer of the oral cavity, esophagus, kidney and bladder. For those who do use tobacco and are finding it difficult to quit, a family physician can help assist in finding an effective way to quit.
- Limit sun exposure. Skin cancer is increasing in prevalence and sun exposure is a risk factor. Wear protective clothing, avoid exposure during the peak UV hours of 10 a.m. to 2 p.m., and wear sunscreen with a sun-protection factor (SPF) of 15 or greater that blocks both UVA and UVB rays, to reduce the risk of skin cancer.
- Practice safe sex. The use of condoms can decrease the risk of exposure to carcinogenic viruses, including human papillomavirus (HPV), the hepatitis viruses, and HIV.
- Maintain a healthy weight throughout life. Being overweight increases the risk for some cancers, such as breast and uterine. For those who do develop cancer, obesity is also linked to a poorer prognosis at the time of diagnosis.
- Exercise regularly. While all levels of exercise can be beneficial, experts suggest trying to achieve at least a moderate level of exercise (an increase of heart rate but not to the point where one is unable to speak) for at least 30 minutes on most days of the week.
- Eat a healthy diet that is low in fat and high in fiber. Try to eat at least five servings of fruit and vegetables each day. Avoid processed red meats because of an association with gastrointestinal cancer and monitor portion control in order to maintain a healthy weight.
- Limit alcohol consumption to no more than two ounces as day for men and one ounce for women. One ounce of alcohol is equivalent to a glass of wine, a beer or a single mixed drink. This level of alcohol is not considered harmful to healthy individuals and may even be heart healthy.
- Check your body regularly for early signs of cancer by performing self-examinations.
And, of course, given my training as a doctor I would be neglectful if I didn’t advise people to follow their doctor’s recommendations for cancer screening examinations and tests.
August 25th, 2008
I meet with the Chronic Pain Support group at SwedishAmerican Hospital on the second Monday of each month at 10am. These individuals are terrific weather forecasters. Some experience pain fluctuations with slight changes in the barometric pressure. Severe weather changes, such as thunderstorms, cause the most increase in pain before and during the storm. Weather related joint pain actually has a physiologic explanation. There are sensory nerves in joints called baro-receptors. These respond to changes in atmospheric pressure, especially when there is low barometric pressure. Low barometric pressure occurs when the atmosphere changes from dry to moist. Arthritic joints have less cartilage to provide cushion, so people with arthritis are prone to feel these changes more readily. So, the next time someone with chronic pain states they can feel it is going to storm, don’t think it is “all in their head”, think it is in their joints and grab an umbrella!
August 19th, 2008
It seems likely that the rise in health care costs will be an important issue in the November elections. In preparing for a recent talk, I reviewed the usual statistics. Since the 1960’s, health care costs have increased about 10 percent each year and last year more than $2 trillion, or about 16 percent of our GNP, was spent on healthcare. Of this cost increase, about 4 percent per year is due to general inflation. Of the remaining 6 percent, about 2 percent is for inflation in medical costs over and above general inflation while the rest is due to an increase in intensity of services and changes in our population. In other words, we have more individuals at risk for problems and we do more things for them.
Staggering as these numbers sound, I came across two factoids that truly put a more meaningful face on the issue for me. The first is that if the price of gasoline rose in parallel to the price of health care, we would be paying $15 a gallon for gas. And you thought $4 a gallon was bad. Even those of us with a bit of arthritis and early morning stiffness might be dusting off our bicycles to get to work. Unlike gas, which most of us purchase directly, many of us pay for our health care indirectly though insurance, so the increase in cost may not be fully appreciated.
The second factoid is the answer to a trick question, “What is the most expensive component of an American car?” Your first inclination might be to answer steel. But, knowing that this blog is about healthcare and since I warned that I was tossing a curveball, many of you might have answered healthcare. If so, pat yourself on the back. Embedded in the cost of an average car is about $1800 which goes to pay auto workers’ health care benefits. In contrast, healthcare accounts for less than a third of the cost for a car made in Japan. This makes it challenging for US manufacturers to compete on price.
Even though our health care costs exceed those of any other country, it’s not clear that the dollars are well spent. Several things point to the quality of health care. Most of us, including me, feel that for complicated care or an acute emergency, few others can match the quality of our healthcare system. However, global statistics would suggest we are not getting the best value for our dollar. For example, our country ranks 19th in the world for life expectancy and 24th for infant mortality. Despite our national price tag, we still have almost 50 million Americans who do not have any health insurance.
So, come November I predict that health care will reemerge with energy as one of the key discussion points for candidates. Several states have tried innovative strategies to increase the numbers of individuals covered and to control costs. I look forward to seeing how the current candidates will flesh out their proposals and hope that the creativity and energy that have solved so many of our nation’s problems will once again defuse this crisis.
August 13th, 2008
Minimally Invasive Hysterectomy and Hysterectomy Alternatives
The most recent information published indicates that approximately 600,000 hysterectomies are performed each year in the
United States. More than 90% of these surgeries are performed for benign (non-cancerous) reasons. This means that by age 60 one in three women will have had a hysterectomy.
The majority of these hysterectomies are performed for the following reasons: fibroids, endometriosis, uterine prolapse, vaginal bleeding, chronic pelvic pain. In spite of improvements in surgical techniques, the majority of these surgeries are still performed as conventional open surgeries requiring large abdominal incisions. Newer procedures such as Laparoscopic Hysterectomy and Laparoscopic Supracervical Hysterectomy can be an option for many patients. Other minimally invasive techniques include vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy. It is certainly worth asking your surgeon about these options if a hysterectomy is one of your current considerations.
Hysterectomy is not the only answer anymore for many of the conditions listed above. A number of these conditions can be managed with medications. If medications are not successful fibroids can often be managed with Uterine Artery Embolization or Myomectomy (removal of fibroid only). Both of these techniques can be minimally invasive and preserve the uterus. In the case of uterine prolapse, pessaries have been use for decades and continue to be a good option for many patients. This device is essentially a crutch that helps to reduce symptoms of pelvic pressure and allows the patient to continue with her daily activities. Finally, endometrial ablation is a techniques that is used to treat heavy or abnormal uterine bleeding. This procedure is not new but continues to become less invasive. Developed twenty years ago it has now evolved into a procedure that can be done in the office with success rates of 85%.
Not everyone is a candidate for these newer techniques. Most patients, however, have many more options than the routine Total Abdominal Hysterectomy. Asked your physician about some of these options and see what they can offer you.
August 12th, 2008
Getting a good nights sleep may not be on the list for back to school items, but should not be forgotten. Did you know that preschoolers (3 to 5 years old) need 11-13 hours of sleep while children up to 12 years of age need approximately 10-11 hours of sleep? Teenagers should get at least 9 hours of sleep every night. A child who doesn’t sleep well may not function well during the day. They may experience development or behavior problems, irritability, headaches or falling asleep in school. The first step in getting them a good nights sleep is to follow a consistant routine of bedtime and waking up. Establish a relaxing bedtime ritual. Do not substitute television watching for personal interaction at bedtime. Screen television programs, videos and games for age-appropriate material. Avoid letting your child fall sleep with a bottle, being held or rocked. Avoid giving your child food and drinks with caffeine or other stimulants (cough medicines and decongestants) at bedtime. It is also important to make sure your child does not have disruptions in their sleep caused by snoring or pauses in their breathing, called sleep apnea. If your child has problems sleeping, snoring or sleep apnea, talk to your doctor or contact a sleep specialist at SwedishAmerican Sleep Disorders Center.
August 9th, 2008
Can hearing instruments really help in background noise? Yes, hearing instruments with directional microphones have been proven to reduce background noise. Difficulty understanding speech in the presence of noise was the most commonly-reported problem by hearing impaired individuals. Clinical studies show even mild amounts of hearing loss can affect one’s ability to communicate in background noise. Digital noise reduction makes hearing aids more comfortable to wear but directional microphones emphasize speech to the front of the wearer.
Traditional microphones are used in almost all conventional hearing aids. They pick up sounds from all around equally well regardless of origin. With directional microphones sound is selectively amplified. Sound waves coming from the front are enhanced, while sounds from behind are reduced. This makes conversational speech is easier to hearand background noise is reduced.
A clinical study conducted at Washington University in St. Louis, Missouri, and Mayo Clinic in Rochester, Minnesota, showed that every patient who wore hearing instruments with directional microphones could hear better in noise. A MarkeTrak independent survey of hearing aid wearers: more than double satisfaction when listening in noise with directional microphones over conventional hearing systems. It showed 9 out of 10 hearing aid wearers were satisfied or very satisfied with Directional Microphones. At Professional Hearing & Audiology clinics we always include a no charge directional microphone demonstration with our complementary hearing tests to show the amazing difference directional microphones can make in your life.
