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Heart Attack Survivors Should Avoid Certain Pain Medicines (NSAIDs)

New information published in Circulation advises against using any nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who have had a prior heart attack.  These over-the-counter drugs are commonly used  like Advil, Aleeve, Diclofenac, Ibuprofen.  Using NSAIDs for even as little as one week was associated with a 45% increase for death or recurrent myocardial infarction (MI).  The researchers could not identify a period that seemed to be safe, no matter how short.

The study used the Danish National Patient Registry and identified 83,675 patients who had a first MI between 1997 and 2006.  The average age was 68 years and 65% were men.   All the NSAIDs (except Naprosyn) used during the observation period were associated with an increased risk for death or new heart attack.  Diclofenac (brand name Voltaren) was the worst.

Readers should not go away thinking NSAIDs cause heart attacks.  This study looked at patients who had already had an MI.  But for those patients, the over-the-counter pain relievers should be avoided.  Many patients with heart disease also have arthritis or other pain syndromes.  We need to come up with safe treatments for pain or use “safer” NSAIDs like low dose Naprosyn or Ibuprofen only when the benefit is weighed with the risk.

Just because something is sold without a prescription does not mean it is without risk.  Tell your doctor every medication you take.

*This blog post was originally published at EverythingHealth*

Gender Disparities In Heart Attack Treatment: Women More Likely To Die

One-third (33.5%) of female heart attack patients receive surgery or angioplasty compared to nearly half (45.6%) of men, and among heart attack patients receiving an intervention such as coronary bypass surgery or angioplasty, women had a 30% higher death rate compared to men, reports HealthGrades.

The findings are based on an analysis of more than 5 million Medicare patient records from 2007 to 2009 and focused on 16 of the most common procedures and diagnoses among women.

The most noticeable disparities were in cardiovascular care. Heart disease is the #1 killer of women in America, surpassing all forms of cancer combined, the company said in a press release. Read more »

*This blog post was originally published at ACP Internist*

Physical Activity Versus Physical Fitness: It Could Mean The Difference Between Life And Death

My neighbor Ed was a thin man all his life. He maintained an ideal body weight by combining regular physical activity with a modest intake of calories. He was a “young” seventy year-old who looked the picture of heart health.

Ed regularly read the newspaper while walking on his treadmill, he hit a golf ball straighter and longer than his peers, and he wore the same size jeans now than he did in college 50 years ago. What’s more, he bragged about his low blood pressure, normal cholesterol level and perfect blood chemistries. He took no pills. I think he went to his primary care doctor each year just to show off his health.

The morning he woke with crushing chest pressure and shortness of air stunned him. “This couldn’t be a heart attack?” he thought. An hour later, minutes after his urgent heart catheterization showed severe blockages in all three of the main coronary arteries, a sternal saw provided a heart surgeon access to his dying heart.

Ed did well. The story had a happy ending. He still looks the picture of health, but now there’s a scar on his chest and a few pill bottles in his medicine cabinet.

How can a human who exudes heart health go to bed well and wake up with severe heart disease? What’s missing? What could Ed have done differently? Could his doctors have measured anything—over and above the traditional risk measures—that might have suggested his obviously higher cardiac risk? Read more »

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

A Nurse’s Guide To Heart Attacks

How do you know if you’re having a heart attack? Are you thinking about the classic Hollywood example?

Hollywood Loves Drama – Know the Signs of a Heart Attack

The classic example of a Hollywood heart attack is a person clutching their chest, gasping for a breath and falling to the ground.

After all, Hollywood is hot for drama, and when it comes to portraying a person having a heart attack, the exaggerated Hollywood version is far more riveting than a person sitting quietly wondering if their very slight arm discomfort is anything they should be concerned about.

The Hollywood version can be very misleading. Read more »

*This blog post was originally published at Health in 30*

Much Ado About George: My Father In Law’s Trip To The ER

georgezMy father in law is 83 years old. He has high blood pressure, high cholesterol, and occasional “senior moments.” He rarely complains about anything, and spends most of his time doing household chores, playing with grand kids, and watching TV. So it was with some degree of concern that I raised my head from my morning cereal when George announced at the breakfast table that he was having chest pain.

I looked at him with narrowed, clinical eyes and began asking the usual rule out MI type questions – did it feel like pressure? Where was the pain exactly? When did it start? Does anything make it better or worse? Does it radiate down your arm or up your jaw? Have you ever had this pain before? How severe is it on a scale of 1-10? Read more »

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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