May 4th, 2011 by Peggy Polaneczky, M.D. in Health Tips, Research
Tags: Birth Control Pills, Blood Clots, British Medical Journal, Drosperinone, DVT, Family Planning, OB/GYN, Obstetrics And Gynecology, Oral Contraceptives, Research, Risks, Women's Health, Yasmin, Yaz
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Two studies published in this weeks’ British Medical Journal, one from the US and the other from the UK, report that users of drosperinone containing oral contraceptives (Yaz, Yasmin and their generics) have increased relative risks for non-fatal blood clots compared with users of pills containing levonorgestrel.
While neither study is perfect, and indeed have some very major limitations, they add to a growing body of evidence that pills containing drosperinone may impart higher risks for blood clots than older pills. Yaz is not alone in this regard – other studies have suggested that pills containing the newer progestins gestodene and desogestrel also impart slightly high clot risks than the so-called first and second generation pills containing the older progestins norethindrone and levonorgestrel.
I won’t go into the studies’ limitations here, but will say that trying to get our hands around comparative data on clot risks between various pills is an extraordinarily difficult process given that the diagnosis of blood clots is not always straightforward (or correct), pill choices are not randomized and fraught with prescribing bias, and confounding risk factors for clotting are numerous and difficult to control for. I wish folks would stop trying to answer these questions on the quick and cheap using claims and pharmacy databases without requiring chart review and strict diagnostic criteria. But that’s the way these studies are being done, and that’s the data I am being forced to contend with in my practice, so let’s talk about it. Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
May 1st, 2011 by Jessie Gruman, Ph.D. in Health Tips, True Stories
Tags: 911, Calling 911, Dialing 911, ED, Emergency Department, Emergency Medicine, Financial Implications, LinkedIn, Patient-Centered Care, Urgent Care, When to Call 911
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Nora misjudged the height of the stair outside the restaurant, stepped down too hard, jammed her knee and tore her meniscus. Not that we knew this at the time. All we knew then was that she was howling from the pain.
There we were on a dark, empty, wet street in lower Manhattan, not a cab in sight, with a wailing, immobile woman. What to do? Call 911? Find a cab to take her home and contact her primary care doctor for advice? Take her home, put ice on her knee, feed her Advil and call her doctor in the morning?
Sometimes it is clear that the only response to a health crisis is to call 911 and head for the emergency department (ED). But in this case – and in so many others we encounter with our kids, our parents, our co-workers and on the street – the course of action is less obvious, while the demand for some action is urgent.
The question “which action?” has become more complicated of late because:
- In some communities, there are alternatives to an ambulance or a drive to the nearest ED, such as Urgent Care centers.
- Disincentives exist for going the route of the ED: in many cash-strapped municipalities we are charged for the cost of ambulance ride; we risk not having our ED visit covered by insurance if we make the wrong decision or fail to notify our health plan in a timely manner. Or we don’t have insurance and the ED care is expensive.
- Some of us have a number of clinicians who could guide us about ED versus self care on any urgent health matter, plus our health plan may have a nurse advice line that could do the same. Which among them to call? How long will it take to get an answer in the middle of a busy workday or a late night?
- Many of us have no primary care clinician to call. Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
April 30th, 2011 by admin in Health Tips
Tags: Abdominal Fat, Apples and Pears, Beer Belly, Cardiology, Cardiovascular Risk, Health, Healthy Eating, Heart Health, Men's Health, Obesity, Risk Factor, Waist Circumference, Weight Loss, Women's Health
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Extra fat that accumulates around the abdomen goes by many names: beer belly, spare tire, love handles, apple shape, middle-age spread, and the more technical “abdominal obesity.” No matter what the name, it is the shape of risk.
Abdominal obesity increases the risk of heart attack, stroke, diabetes, erectile dysfunction, and other woes. The danger zone is a waist size above 40 inches for men and 35 inches for women.
As I describe in the April 2011 issue of the Harvard Men’s Health Watch, beer is not specifically responsible for a beer belly. What, then, is to blame? Calories. Take in more calories with food and drink than you burn up with exercise, and you’ll store the excess energy in fat cells.
Many studies indicate that people who store their extra fat around the midsection (apple shape) are at greater risk for heart and other problems than people who carry it around their thighs (pear shape). An analysis of 58 earlier studies covering over 220,000 men and women suggests that excess fat is harmful no matter where it ends up. This work was published in The Lancet. Read more »
*This blog post was originally published at Harvard Health Blog*
April 29th, 2011 by Linda Burke-Galloway, M.D. in Health Tips, News
Tags: Asthma, Babies, Birth, FDA, Obstetrics And Gynecology, Off-Label Use, Pregnancy, Pregnant Moms, Pregnant Women, Preterm Labor, Terbutaline, Uncategorized
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The Federal Drug Administration (FDA) recently issued a new warning about a medication that has been used for years and it has sent shock waves throughout my specialty. Terbutaline is an FDA approved medication that is used for asthmatic patients or patients who have significant narrowing of the airways. However for years it has been used as an “off-label” medication to treat preterm labor but now that’s about to change. An off-label drug means it hasn’t been approved for that specific use by the FDA.
According to the FDA, the injectable form of Terbutaline should only be used for a maximum of 24 to 72 hours because the drugs association with heart problems and death. The FDA goes on to say that the oral version (pills) should not be prescribed to treat preterm labor because it’s ineffective and can cause similar problems. As an obstetrician, I feel utterly betrayed. The medication clearly had side effects that included shortness of breath and a racing heart. As resident physicians we were taught that the benefit outweighed the risks of having a premature baby and the patients should try to adjust to the medication. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
April 28th, 2011 by PeterWehrwein in Health Tips
Tags: Avoiding Hitting The Wall, Carb Calculator, Carbohydrates, Fitness, Hitting The Wall, Marathon, Nutrition, Running
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Recently, about 27,000 runners began the annual 26-mile, 385-yard (42.195 kilometers) mass run from suburban Hopkinton to Boston.
But if past marathons in Boston and elsewhere are any indication, perhaps up to 40% of these optimistic and determined souls will slam into a sudden sensation of overwhelming, can’t-do-this fatigue several miles (typically about five) before they get a chance to experience the glory of crossing the finish line.
It’s called “hitting the wall.”
Getting through, around, or over hitting the wall is part of the mystique of marathon running, although there’s a physiological explanation that’s not all that mysterious: when runners hit the wall, their bodies have run out of the carbohydrates needed to sustain intense physical activities like long-distance running.
Benjamin I. Rapoport believes many runners could avoid hitting the wall if they put a few key facts about themselves and their target marathon time into the online calculator he created, which can be found at www.endurancecalculator.com. The calculator will tell them how many extra calories they should get from pasta, rice, or other high-carbohydrate food or drink before (and in some cases, during) running a marathon. Read more »
*This blog post was originally published at Harvard Health Blog*
Two studies published in this weeks’ British Medical Journal, one from the US and the other from the UK, report that users of drosperinone containing oral contraceptives (Yaz, Yasmin and their generics) have increased relative risks for non-fatal blood clots compared with users of pills containing levonorgestrel.
