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Considering A Non-Fatal Patient’s Quality Of Life

Why is it easier to talk about quality of life with patients who are dying? Why don’t we factor these considerations into the decision-making for patients with conditions that aren’t fatal?

The presence of a terminal illness serves to focus everyone’s attentions. Widespread cancer metastases? Concerns about tight blood glucose control fade away. End-stage liver disease? Blood pressure control doesn’t matter so much any more. Bony pain from prostate cancer? Narcotic and sleeping pill addiction doesn’t even occur to anyone. I find it far more problematic to deal with patients with debilitating but non-fatal conditions when treatment options are perceived as limited because of co-existing diseases that produce so-called contraindications to certain medications.

I have a patient in his mid-70s with severe pain from osteoarthritis. Several fractures and a couple of unsuccessful joint replacement surgeries haven’t helped matters. Several years ago he found that a little drug called Vioxx worked extremely well for him, reducing his pain considerably and allowing him to do pretty much watever he wanted. As we all know, however, that drug was pulled from the market because of an unacceptable increased risk of heart attacks and other untoward cardiovascular events. Interestingly, Read more »

*This blog post was originally published at Musings of a Dinosaur*

Use Of Prescription NSAIDS During Early Pregnancy Linked To Miscarriage?

A new study of more than 52,000 pregnant women in Canada shows that miscarriage rates were more than twice as high for women who took a nonsteroidal anti-inflammatory drug (NSAID) compared to women who did not.  The study, published in the Canadian Medical Association Journal reported that women who used prescription NSAIDS for just 4 days during early pregnancy had an increased risk for miscarriage.

These medications are commonly prescribed for pain, cramps, headaches and fever and can be bought over the counter as Advil, Aleeve or Ibuprofen.  We have thought they were safe in early pregnancy but this study shows that may not be the case. Read more »

*This blog post was originally published at EverythingHealth*

Article Reviews The Effectiveness Of NSAIDs For Arthritis Pain

Recently I gave in and went to see a rheumatologist after more than 3 months of intense morning stiffness and swelling of my hands (especially around the PIPs and MCPs) and wrists which improved during the day but never went away.  It had gotten to the point where I could no longer open small lid jars (decreased strength), do my push-ups or pull ups (pain and limited wrist motion), and OTC products (Tylenol, Advil, etc) weren’t working.  I can’t take Aleve due to the severe esophagitis it induces.  I didn’t want to write a prescription for my self-diagnosed (without) lab arthritis.

BTW, all the lab work came back negative with the exception of a slightly elevated sed rate and very weakly positive ANA.  The rheumatologist was impressed with the swelling, pain, and stiffness and was as surprised as I by the normal lab work.  He thinks (and I agree) that I am in the early presentation of rheumatoid arthritis.  He wrote a prescription for Celebrex and told me to continue with the Zantac I was already taking (thanks to the Aleve).  The Celebrex is helping.

So I was happy to see this article (full reference below) come across by twitter feed.  H/T to @marcuspainmd: Useful review of NSAIDs effects & side effects for arthritis pain: Read more »

*This blog post was originally published at Suture for a Living*

NSAIDs Might Be Risky For People With Heart Problems

As if people with the combination of high blood pressure and heart disease don’t already have enough to worry about, a new study suggests that common painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) pose special problems for them.

Among participants of an international trial called INVEST, those who often used NSAIDs such as ibuprofen (Advil, Motrin and others), naproxen (Aleve, Naprosyn, and others), or celecoxib (Celebrex) were 47% more likely to have had a heart attack or stroke or to have died for any reason over three years of follow-up than those who used the drugs less, or not at all. The results were published in the July issue of the American Journal of Medicine.

Millions of people take NSAIDs to relieve pain and inflammation. They are generally safe and effective. The main worry with NSAIDs has always been upset stomach or gastrointestinal bleeding. During the last few years, researchers have raised concerns that Read more »

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

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

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

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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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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