February 21st, 2011 by Toni Brayer, M.D. in Health Tips, Opinion
Tags: Abnormally High Blood Pressure, Accurate Blood Pressure Readings, Blood Pressure At Home, Blood Pressure Control, Cardiovascular Risk, Dr. Toni Brayer, Elevated Blood Pressure, Everything Health, Family Medicine, General Medicine, Heart Health, High Blood Pressure, Internal Medicine, Nervous About Seeing The Doctor, Office Visit Anxiety, Patients' Anxiety, Primary Care, Stress and Anxiety, Test Anxiety, White-Coat Hypertension
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“But doc, my blood pressure is always normal at home.” I wish I had a dollar for every time I have heard that line and I know it is true. When some patients come to see me, their blood pressure is abnormally high (above 130/90). This is known as “white-coat hypertension.” Although it has been thought to be from anxiety about seeing the doctor, even long-established patients who have no conscious anxiety can exhibit elevated blood pressure in the office.
Because blood pressure naturally fluctuates and the office visit is not a “normal” setting, it is important for patients who have high blood pressure (hypertension) to have their own blood pressure cuff at home. Now that devices are automated and easy to use, everyone with hypertension should be monitoring their blood pressure in the comfort of their own home. I advise multiple readings over a week at different times of day. Get a reading when resting and when rushing around. Take your blood pressure after you exercise and after a meal. It is important to keep a log and write it down. Only then can we see patterns and know if the blood pressure is controlled or not.
Blood pressure readings in the doctors office are not necessarily the most accurate. Patients are often rushed trying to get parked and in on time. Medical assistants can use the wrong size cuff or not position the arm correctly. Listening (auscultation) is not very accurate due to human error. It is the multiple readings over time that give a more accurate picture of blood pressure control.
High blood pressure in the office can be true hypertension or it can be white-coat hypertension that is usually controlled at home. If a patient is on blood pressure medication and has controlled blood pressure at home, I will not add more medication just because they are elevated in the office. If a patient has not been diagnosed with hypertension and his or her blood pressure is elevated in the office, he or she is advised to get their own blood pressure cuff for at home and return with readings for us to review. This way we can minimize unnecessary and expensive medication and make sure we are protecting the patient as well.
*This blog post was originally published at EverythingHealth*
February 19th, 2011 by AnnMacDonald in Health Tips, Research
Tags: Ann MacDonald, Brain Signals, Cognitive Behavioral Therapy, DBS, Deep Brain Stimulation, Drug Treatment, Electrical Stimulation, Electrodes in the Brain, FDA, Food and Drug Administration, Harvard Health Blog, Harvard Health Publications, Harvard Medical School, Harvard Mental Health Letter, Harvard University, Health Affairs, Humanitarian Device Exemption, Medical Device Safety, Medical Manufacturers, Medical Marketing, Mental Health, National Institute of Mental Health, Neuroscience, New York Times, Obsessive Compulsive Disorder, OCD, Pacemaker for the Brain, Psychiatry and Psychology, Regulating Medical Devices
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A paper published in the February issue of Health Affairs — discussed at length in an article in the New York Times — contains the sort of blunt, plain-spoken language you seldom read in academic journals. The authors, who include some of the most prominent neuroscientists and ethicists in the world, warn that manufacturers are misusing the FDA’s humanitarian device exemption to promote deep brain stimulation as a “treatment” for obsessive compulsive disorder (OCD).
In fact, they make clear that deep brain stimulation is very much an experimental procedure. Research is still at an early stage, and the risks to patients are not well defined. When suffering is severe and no other treatment has provided relief, there is value in making available an intervention like deep brain stimulation. But misleading or biased information, no matter where it comes from, certainly undermines patients’ ability to calculate benefits and risks.
To enable deep brain stimulation, a surgeon must first implant electrodes in the brain and connect them to a pair of small electrical generators underneath the collarbone. Deep brain stimulation uses electricity to affect how brain signals are transmitted in particular areas of the brain. The image to the left, from the National Institute of Mental Health, shows how deep brain stimulation depends on the implantation of pulse generators below the collarbone and electrodes in the brain.
Specific concerns are raised by the article in Health Affairs (and in our own article on this topic last year in the Harvard Mental Health Letter). Read more »
*This blog post was originally published at Harvard Health Blog*
February 18th, 2011 by Berci in Better Health Network, Health Tips
Tags: Active Cold and Flu Reports, Berci, Dr. Bertalan Mesko, Google Flu Trends, Health 2.0, Infectious Disease, Influenza, Medicine 2.0, mHealth, Mobile Health Apps, Mobile Health Technology, Novartis WheresFlu, Respiratory Tracking Program, Respiratory Tract Infections, Science Roll, SDI FAN, Sickness Incidence Levels, Tracking Disease Activity, U.S. Flu Outbreaks
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As a part of the TheraFlu campaign, Novartis has developed free Android, Blackberry and iPhone applications for tracking flu outbreaks in the U.S. These days it’s become inevitable to develop free apps on all platforms in order to promote your product. From Novartis:
Keep up-to-date on the most active cold and flu reports around the country. The WheresFlu™ app follows sickness incidence levels from week to week and keeps track of the current top 5 affected cities in the nation. The WheresFlu™ app will find your current location and provide you with results for that area. Or you can enter a ZIP code to get information for that area.
If you’re wondering how it actually works and how it differs from Google Flu Trends, here it is:
WheresFlu™ measures weekly activity for cold and flu based upon real-time reports of symptoms from SDI FAN® (a source used by the Centers for Disease Control and Prevention). As the longest-running respiratory tracking program in the US, SDI FAN® covers illness levels in 135 regions across the country utilizing panel-member reporting along with patient-specific data. Advanced tracking uses illness status levels to predict change in the affected population for the nine US Census Regions.
*This blog post was originally published at ScienceRoll*
February 17th, 2011 by Peggy Polaneczky, M.D. in Health Tips, Research
Tags: Allergic Reaction, Bioadhesives, Biologic Adhesives, Dermabond, Dermatology, Dr. Peggy Polaneczky, Emergency Medicine, Episiotomy, Hadassah Hebrew University Medical Center, Incision, Midwives, Natural Childbirth, Non-Suture Wound Closure, OB/GYN, Obstetrics And Gynecology, Perineal Lacerations, Perineal Tears, Pregnancy and Childbirth, Skin Irritation, SMFM, Society for Maternal-Fetal Medicine, Super Glue, Superficial Skin Closure, Surgical Practices, TBTAM, The Blog That Ate Manhattan, Women's Health, Wound Care, Wound Infection
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Bioadhesives are a reasonable alternative to sutures for repair of perineal lacerations sustained during childbirth, according to a poster presentation at last week’s annual meeting of the Society for Maternal-Fetal Medicine.
Researchers at the Hadassah Hebrew University Medical Center in Jerusalem randomized women with first degree perineal tears to either 2-octyl cyanoacrylate (Dermabond) adhesive glue or suture for wound closure. While healing and incisional pain was similar, women who received the adhesive closure were more satisfied than those who were sutured.
In Portugal, bioadhesives have been studied for closure of the top skin layer of an episiotomy repair, and found to shorten the duration of the procedure with similar outcomes to suture in terms of pain, healing, and infection.
Biologic adhesives are chemically related to Super Glue, which is ethyl-cyanoacrylate. Midwives have been using Super Glue for perineal wound repair for some time, according to Anne Frye, who has authored a book on wound closure for midwives, and who gives instructions for its use in repair of perineal lacerations. Apparently Super Glue was also used by the military during Vietnam for wound closure.
A PubMed search on Dermabond finds multiple studies of its use, from plastic surgery to mastectomy, surgical wound closure, retinal surgery, lung and gastric leak closure, and even on esophageal varices. RL Bates mentions Dermabond as an option to repair skin tears in elderly patients. This stuff is turning into the duct tape of the medical profession.
It’s important to remember that adhesives are only for superficial skin closure, as use in deeper layers can cause irritation and burning of tissues. Side effects of their use include irritation and allergic reactions and of course wound infections, and pain can always occur no matter how one closes a wound.
*This blog post was originally published at The Blog That Ate Manhattan*
February 17th, 2011 by Steve Novella, M.D. in Health Tips, Research
Tags: Alternative Medicine, Antihistamines, Cold and Flu Season, cold medicines, Cold Remedies, Cold Virus, Common Cold, Decongestants, Dr. Steve Novella, Echinacea, Folk Remedies, Herbal Remedies, Homeopathic Treatments, Homeopathy, Infectious Disease, Nonsteroidal Anti-Inflammatory Drugs, NSAIDs, OTC, Over-The-Counter Medications, Pseudoscience, Respiratory Tract Infections, SBM, Science Based Medicine, Supplements, Treating Colds, Vitamin C, Zinc
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For the last week I have had a cold. I usually get one each winter. I have two kids in school and they bring home a lot of viruses. I also work in a hospital, which tends (for some reason) to have lots of sick people. Although this year I think I caught my cold while traveling. I’m almost over it now, but it’s certainly a miserable interlude to my normal routine.
One thing we can say for certain about the common cold — it’s common. It is therefore no surprise that there are lots of cold remedies, folk remedies, pharmaceuticals, and “alternative” treatments. Finding a “cure for the common cold” has also become a journalistic cliche — reporters will jump on any chance to claim that some new research may one day lead to a cure for the common cold. Just about any research into viruses, no matter how basic or preliminary, seems to get tagged with this headline. (It’s right up there with every fossil being a “missing link.”)
But despite the commonality of the cold, the overall success of modern medicine, and the many attempts to treat or prevent the cold — there are very few treatments that are actually of any benefit. The only certain treatment is tincture of time. Most colds will get better on their own in about a week. This also creates the impression that any treatment works — no matter what you do, your symptoms are likely to improve. It is also very common to get a mild cold that lasts just a day or so. Many people my feel a cold “coming on” but then it never manifests. This is likely because there was already some partial immunity, so the infection was wiped out quickly by the immune system. But this can also create the impression that whatever treatment was taken at the onset of symptoms worked really well, and even prevented the cold altogether.
What Works
There is a short list of treatments that do seem to have some benefit. Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen, and naproxen, can reduce many of the symptoms of a cold — sore throat, inflamed mucosa, aches, and fever. Acetaminophen may help with the pain and fever, but it is not anti-inflammatory and so will not work as well. NSAIDs basically take the edge off, and may make it easier to sleep. Read more »
*This blog post was originally published at Science-Based Medicine*
