October 9th, 2007 by Dr. Val Jones in News
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I was intrigued by a news story all over the wires today and yesterday – that blood transfusions may do more harm than good. Over 4.5 million Americans receive blood transfusions for one reason or another each year in the US. Two new studies have been published in the Proceedings of the National Academy of Sciences, suggesting that blood can get “stale” much sooner than we think. Although we’ve known for a while that blood transfusions should be given only when critically needed, this news is interesting in that it may explain why blood transfusions are not a panacea.
Blood contains nitric oxide – a gas that is used as a signaling molecule in humans. It can trigger the relaxation of blood vessel walls, which is important in getting blood flow and oxygen to areas of the body that need it. Nitric oxide exists in small amounts in the bloodstream, but it can evaporate rapidly once outside the body (such as in a transfusion bag). So the question is: how critical is it to have nitric oxide dissolved in the blood given via transfusion?
The Red Cross keeps blood for up to 42 days after it is donated (though nitric oxide depletion may occur within hours) and will continue to do so until it is clearly shown that the expiration dates should be shortened. Further research is underway to test whether or not infusing nitric oxide back into blood is a viable option to improve its ability to oxygenate the recipient. It’s not easy to do this, since nitric oxide is a very tricky gas that can become a free radical or an acid in the presence of certain oxygen species. So the exact proportion of nitric oxide is critical – a little does just the right thing, but too much can be harmful or even fatal – which is probably why we haven’t tested this in humans yet, only dogs.
Still, many have high hopes for adding nitric oxide to the blood supply – Dr. Jonathan Stamler of Duke University appears to have applied for more than 50 nitric oxide associated patents and, not surprisingly, is taking the lead on various research studies, including the two new ones mentioned in my first paragraph.
My personal take on this? Blood transfusions are a serious treatment that can save lives, but should not be given willy nilly to “boost” people’s hematocrits. I’ve witnessed physicians giving their patients an extra unit of blood “just to perk them up a bit” prior to discharge from the hospital. That behavior is not safe or appropriate. So before you undergo a blood transfusion, make sure you really need one. Until we figure out how to replace nitric oxide safely in the blood supply, the life-saving potential benefits of a transfusion must outweigh the risks of stroke and heart attack from nitric oxide-depleted blood.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 8th, 2007 by Dr. Val Jones in Health Tips
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You’d think that all my friends were participating in breast cancer awareness month – first the abnormal mammogram scare, now a new email from a young, worried friend: “I found a lump in my breast. What should I do?”
My friend is 28 years old, with no family history of breast cancer. However, I take all lumps seriously because my husband’s sister was diagnosed in her early 30’s, after complaining of some hip pain followed by an x-ray which revealed diffuse metastases. Nonetheless, it bears repeating that a breast lump in a woman in her 20’s is highly unlikely to be cancer. For those of you out there who have found a lump in your breast, here are the statistics:
- An estimated 90% of breast lumps are benign (and that includes lumps in significantly older women).
- The number one risk factor for breast cancer is age. The risk of a woman in her 30’s having breast cancer is <0.43%. The National Cancer Institute doesn’t have per cent risks for women in their 20’s but I’m sure it’s even lower.
- Fibrocystic breast tissue occurs in up to 60% of all women, and has a lumpy texture.
- Breast cysts are fairly common, up to 7% of western females have a breast cyst at some point in their lifetimes.
- Breast lumps often occur in response to normal hormonal fluctuations in the menstrual cycle
So if you find a breast lump, you should have it evaluated, but please keep in mind that there’s a 60% chance that it’s due to harmless fibrocystic changes, and (if you’re in your 30’s) a 0.43% chance that you’ll develop cancer. Indeed, most lumps are benign at all ages.
The next step in a lump evaluation is to have an ultrasound and if you’re over 35 to also have a mammogram, and then if the clinical images warrant it, a biopsy to confirm the contents of the lump. Also keep in mind that once you’ve had a biopsy, you can expect some scarring which could be read as “abnormal” in future mammograms. So don’t be surprised if you get an abnormal mammogram later on after the biopsy.
Breast cancer awareness is very important and can save lives, but on the flip side it can also make us paranoid about our breasts. My advice would be to take any lumps seriously, but also know that it’s not cancer until proven so – and that most women have breasts with a somewhat lumpy texture, so if you don’t have any lumps, you’re technically in the minority.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 8th, 2007 by Dr. Val Jones in Humor, Medblogger Shout Outs
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If you haven’t seen this before, you must check out TBTAM’s photo of a man’s message to his wife (taped on the refrigerator). He had answered the phone and taken down this message for her…
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“Someone from the Gyna Colleges called. They said the Pabst beer is normal. I didn’t even know you liked beer.”
— Rick
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 7th, 2007 by Dr. Val Jones in Book Reviews
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I’ve been reading Mindy Roberts’ hilarious book: Mommy Confidential: Adventures From The Wonderbelly of Motherhood. I particularly enjoy the moments she captures about her son, Will. I thought I’d share some excerpts with you to give you a good chuckle:
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Today at Jake’s 6th birthday party, Will rushed up to me saying, “Mommy! There’s a dead squirrel over there! Hurry mommy, before he goes to heaven!”
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Will is obsessed with size differentials among animals and the relative strengths and weaknesses of each as they relate to other predators. He wants to know exactly how big everything is so that he can determine how many predators it takes to bring down each type of prey. Among the factors are: height, weight, speed, habitat, how far it can jump, whether it can rear up, whether it can swim, and how sharp the teeth are. Usually he wants to know if, say, 20 wolves can take on 10 tigers, but this morning’s question took the cake. “Daddy, can 10 monkeys take down a zebra?”
You can find Mindy’s book at her website.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 6th, 2007 by Dr. Val Jones in News
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Have you ever been singled out in a lecture and picked on? Or maybe at a comedy club? It’s somehow awkward when everyone is looking at you, and you can’t really defend yourself. That happened to me yesterday in a lecture about how email can transform medical practices. My friend Joe Scherger was talking about the beauty of asynchronous communication, and how much time it saves – when out of the blue, he said that Blackberries defeated the whole purpose of emailing, and that people who used them lead unbalanced lives. He then pointed at me and said, “See my friend Val Jones, there? She uses a Blackberry all the time!”
All eyes fixed on me with a sort of half pity, half “tisk, tisk” expression.
“She answers all her emails within minutes… She never unplugs.”
I shrugged and smiled sheepishly. Soon the conversation turned to other subjects, and I resisted the urge to pull my Blackberry out of my bag to check my emails.
Today I heard that Intel instituted email-free Fridays as a means to force their engineers to talk to others face-to-face. Apparently, the company was worried that interpersonal skills were being lost, and that people were not developing normal working relationships because of the artificial distance created by email-only communication.
“Well, at least I’m not alone,” I thought as I read the news story. “This is a serious problem across the country.”
There has been recent debate in the psychiatric community about whether or not video games could be considered an addiction (just as drugs and alcohol can be). Some have proposed that it be added to the DSM-V due out in 2012, others have said that compulsive video game playing is a sign of other underlying pathology (such as depression or social anxiety) but not a true addiction.
But the bottom line is that overuse of the Internet can disrupt a person’s time available for meaningful interpersonal relationships, be they with a spouse, a parent, a relative, or a friend. When your husband is sitting in the same room with you and has to get your attention by IM-ing or emailing you, you know there’s a problem.
And there doesn’t seem to be much of a break in sight – with Facebook, MySpace, Linked-In, YouTube, Pownce, Twitter, GTalk, blogs, podcasts, discussion boards, chat rooms, forums, etc. available as 24-7 forms of entertainment and communication, and companies like Intel trying to forbid this kind of stuff at least 1 day per week, Blackberries are the least of our worries. I wonder if these programs are like junk food for the brain? Will we soon suffer from cerebral obesity?
I’m afraid that I recognize that there is a problem, but I’m not sure what the solution is. “Just say no” to email doesn’t work for me… I like the fast-paced interactivity and connection I get from these activities. Maybe there’s a positive feedback loop at work, though – we spend a lot of time involved in online activities and become more isolated and lonely in our personal lives. In the end we become more and more engaged with the Internet to fill the emotional gap that we’re actually creating by overusing it.
I’ll ask my husband what he thinks… perhaps I’ll send him an email about it tonight.
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
