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Dealing With The Problem Of Hospital Readmissions For Heart Failure

“How are you feeling, Ms. Jones?”


“Have you been more short of breath lately?”

“Not really, just when I exercise.”

“How much exercise?”

“I dunno. But after I go to the mailbox and walk back up to the house, I’ve got to stop now where before I didn’t.”

Exertional dyspnea. It conjures up a large differential of potential cardiovascular or pulmonary causes. And as the above commonly-encountered doctor-patient conversation demonstrates, the problem is a dynamic one: at rest things are often fine, on exertion or with recumbency less so.

Now imagine that the doctor then sees elevated neck veins, hears rales in the lower lung fields, and sees swollen ankles on their patient. Heart failure, right? Read more »

*This blog post was originally published at Dr. Wes*

Which Is More Important: To Be Thin Or To Be Fit?

These days, most adults are overweight, not active, or both. If you could change just one—become active or lose weight—which would be better?

At least for men, being more fit may have a bigger health payoff than losing weight, according to a new study of more than 14,000 well-off middle-aged men who are participating in the Aerobics Center Longitudinal Study. Researchers followed their health, weight, and exercise habits for 11 years. They estimated how physically fit the men were by calculating their metabolic equivalents (METs) from a treadmill test.

Compared with men whose fitness declined over the course of the study, those who maintained their fitness levels reduced their odds of dying from cardiovascular disease or any other cause by about 30%, even if they didn’t lose any excess weight. Those who improved their fitness levels saw a 40% reduction.

Body-mass index (BMI), a measurement that takes weight and height into account, was not associated with mortality. The results were published in the journal Circulation.

What is “fitness”

Fitness is a measure of Read more »

*This blog post was originally published at Harvard Health Blog*

Cancer Patients: How Will Treatment Affect Other Aspects Of Health?

The death of Kara Kennedy, the only daughter of the late Senator Edward M. Kennedy, at age 51 from an apparent heart attack while exercising, was yet another tragedy for one of the country’s most prominent political families. It also offers a reminder of the possible long-term effects of cancer and its treatment.

In 2002, Kennedy was diagnosed with lung cancer that her doctors initially said was inoperable. Her father refused to accept that diagnosis, according to an article in the Boston Globe. He found doctors at Brigham and Women’s Hospital in Boston who thought they could treat the cancer. They removed a portion of Ms. Kennedy’s right lung and then administered radiation and chemotherapy. She lived for another nine years, in apparently good health.

While the cause of Kennedy’s death has not yet been confirmed, the long-term effects of her lung cancer treatment could have played a role. Cancer survivors are often at increased risk of heart disease. That’s because the treatments used to fight cancer—drugs, radiation, and hormones—can damage the heart and arteries. (These are detailed in a Harvard Heart Letter article on cancer therapy and heart disease.)

If life were completely fair, cancer survivors would be exempt from future health problems. Sadly, that isn’t the case. Read more »

*This blog post was originally published at Harvard Health Blog*

Diet Soda And Your Risk For Heart Attack Or Stroke

It tastes sweet. It’s pleasurably fizzy. And free of calories. What’s more, the FDA says NutraSweet (aspartame) is safe. So what’s not to like about diet soft drinks?

A bunch. The ongoing debate about the healthiness of diet soft drinks reminds me of the old adage, “If something sounds to be true, it probably is.”

Artificially-sweetened “diet” drinks get touted as healthy alternatives to sugary drinks because they contain no calories or carbohydrates. On paper it seems plausible to think they are inert, no more dangerous than water. The Coca-Cola Company sublimely strengthens this assertion by putting a big red heart on Diet Coke cans.

But diet-cola news (Los Angeles Times) presented at the International Stroke Conference 2011 suggests otherwise. This widely-publicized observational study of 2,500 older patients (average age=69) from New York showed that drinking diet soda on a daily basis increased the risk of having a heart attack or stroke by 61 percent. The abstract — not a peer-reviewed study — stated that this association persisted after controlling for other pertinent variables.

Sure, this is only a look back at 559 patients who had a vascular event. The study asserts only an association, not that diet colas cause heart attacks and strokes. That’s a big difference.

That said, however, I don’t view these results as trivial either. This trial builds on the results of prior studies of diet drinks which strongly suggest that despite their lack of calories, diet drinks don’t prevent obesity. Read more »

*This blog post was originally published at Dr John M*

The Forecast For Heart Disease: Gloomy With A Chance Of “Boomers”

As a youngster, I loved being part of the baby boom — it meant there were dozens of kids on my block who were ready to play hide-and-seek or join mysterious clubs. Now that I’m of an AARP age, there’s one club I don’t want to join: The one whose members have bypass scars, pacemakers, or other trappings of cardiovascular disease. The American Heart Association’s (AHA) gloomy new forecast on cardiovascular disease tells me it won’t be easy to avoid.

The AHA foresees sizeable increases in all forms of cardiovascular disease (see table) between now and 2030, the year all of the boomers are age 65 and older. Those increases will translate into an additional 27 million people with high blood pressure, eight million with coronary heart disease, four million with stroke, and three million with heart failure. That will push the number of adult Americans with some form of heart disease to 110 million.

AHA cardiovascular disease forecast

(Percentages refer to the percentage of Americans aged 18 years and older.)

If the AHA’s projections are accurate, the cost of treating cardiovascular disease would balloon from $272 billion today to $818 billion in 2030. Add in the cost of lost productivity, and it jumps to more than $1 trillion. Yikes!

Although obesity and inactivity are part of the problem, much of the increase comes from the graying of the baby boom. We can’t stop boomers from aging, but we can fight cardiovascular disease, a condition the AHA calls “largely preventable.” Read more »

*This blog post was originally published at Harvard Health Blog*

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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