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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*

Thyroid Cancer: A Hazard From Radioactive Iodine Emitted By Japan’s Failing Nuclear Power Plants

One of the most abundant substances in the cloud of radioactive steam released by a failing nuclear power plant is iodine-131 — a radioactive form of the element iodine that is found throughout nature. Iodine-131 poses a special health risk because of its cancer-causing effect on the thyroid gland.

The small, butterfly-shaped thyroid sits just below the voice box. From this perch, it controls how fast every cell in the body changes food into energy. The gland’s main product, thyroid hormone, governs the function of the digestive tract, brain, heart, nerves, muscles, bones, skin, and more.

Iodine is a key ingredient that goes into making thyroid hormone. We get this element from ocean-caught or ocean-farmed fish and shellfish, milk, cheese, yogurt, eggs, and fruits and vegetables grown in iodine-rich soil.

The human body is surprisingly good at absorbing iodine and storing it in the thyroid gland. That’s a problem when iodine-131 is released into the atmosphere. The thyroid stores it as readily as natural, non-radioactive iodine. As iodine-131 builds up in the thyroid gland, it emits bursts of radiation that can damage DNA and other genetic material. Such damage can remove the normal limits to cell growth and division. Unchecked growth of thyroid tissue is thyroid cancer.

Iodine-131 gets into the body several ways. A person can breathe in radioactive steam released by a nuclear power plant. Fallout — radioactive particles that fall out of the atmosphere and settle onto plants, soil, and water — further adds to the burden when a person eats iodine-131 enriched fruits and vegetables or drinks water containing the isotope. Milk is another vehicle — cows that eat grass sprinkled with iodine-131 make milk that contains it. Read more »

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

Does “I Know CPR” Mean You Can Do CPR?

While I was browsing the produce section of my grocery store the other day, the sound of a panicked voice coming over the store’s loudspeaker made me jump. “Does anyone in the store know CPR? Anyone? CPR? We need you in baked goods!”

I froze. In theory, I know how to perform CPR — cardiopulmonary resuscitation. I took a two-hour course on it nearly 25 years ago. But I hadn’t given it much thought since then and I certainly hadn’t practiced what I learned.

My mind started whirling as I tried to remember the sequence of steps. They’d changed the rules a few years back — I knew that much — so I wouldn’t have to do mouth-to-mouth resuscitation. But where exactly on the chest was I supposed to push? Should I form a fist and push down with my knuckles, or use the ball of my hand?

Suddenly, sirens wailed outside the store. The rescue squad had arrived. Too late, as I learned afterward, for this man, who was a victim of a sudden cardiac arrest. This type of heart attack strikes so fast that there usually aren’t any warning signs. You might see someone grasp his or her chest, collapse, twitch and gasp a few times, and then lie deathly still.

At that point, every minute counts. Enough oxygen remains in the person’s bloodstream to nourish the brain for several minutes — but a bystander has to circulate oxygenated blood to the brain and other organs by pushing down on the chest hard and fast, mimicking the heartbeat.

I’m a health writer. I knew this intellectually. But until those agonizing moments in the grocery store, I never really understood on a gut level just how important every minute is. Read more »

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

Does Cell Phone Use Stimulate Brain Activity?

We all know that using a cell phone can stimulate the brain to work a bit harder. “Mr. Skerrett? This is Dr. LeWine’s office. Do you have a minute to talk about your test results?” or “Dad, a bunch of kids are going to Casey’s house after the dance. Can I go?” But a new study published in JAMA is making me wonder what the energy emitted by the phone itself — not just the information it delivers — is doing to my brain.

Here’s the study in a nutshell. Dr. Nora Volkow and her colleagues recruited 47 volunteers to have their brain activity measured twice by a PET scanner. Both times the volunteer had a cell phone strapped to each ear. During one measurement, both phones were turned off. During the other, one phone was turned on but muted so the volunteer didn’t know it was on; the other was left off. Each session lasted about an hour. The scans showed a small increase in the brain’s use of glucose (blood sugar) when the phone was on, but only in parts of the brain close to the antenna.

It was an elegant study. The researchers took pains to anticipate sources of error. They used a control (both phones off) against which to compare the effect of a “live” cell phone. They used cell phones on each ear, one on and one off, to see if the effect was localized. They muted the phone that was on to eliminate the possibility that any brain activation was due to listening to the sound of a voice coming through the phone’s speaker. So the result is probably a real one, not an artifact or measurement error.

What does this brain activation mean? No one really knows. As Dr. Volkow told NPR, “I cannot say if it is bad that they [cell phones] are increasing glucose metabolism, or if it could be good.” Read more »

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

Think Zinc For A Cold? Not Me

Media channels are a-twitter with the news that zinc can beat the common cold. CBS News, the LA Times, the Huffington Post, and hundreds of others are treating a quiet research report as big news that will have a life-changing effect. After reading the report and doing a little digging into the dark side of zinc, I’m not rushing out to stock up on zinc lozenges or syrup.

The latest hubbub about zinc was sparked by a report from the Cochrane Collaboration. This global network of scientists, patients, and others evaluates the evidence on hundreds of different treatments. In the latest review, on zinc for the common cold, researchers Meenu Singh and Rashmi R. Das pooled the results of 13 studies that tested zinc for treating colds. By their analysis, taking zinc within 24 hours of first noticing the signs of a cold could shorten the cold by one day. They also found that taking zinc made colds a bit less severe.

Sounds good so far. But instead of saying, “Hey, take zinc if you have a cold,” the researchers concluded like this:

“People taking zinc lozenges (not syrup or tablet form) are more likely to experience adverse events, including bad taste and nausea. As there are no studies in participants in whom common cold symptoms might be troublesome (for example, those with underlying chronic illness, immunodeficiency, asthma, etc.), the use of zinc currently cannot be recommended for them. Given the variability in the populations studied (no studies from low- or middle-income countries), dose, formulation and duration of zinc used in the included studies, more research is needed to address these variabilities and determine the optimal duration of treatment as well as the dosage and formulations of zinc that will produce clinical benefits without increasing adverse effects [bold is mine], before making a general recommendation for zinc in treatment of the common cold.”

Not exactly a ringing endorsement. 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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