November 24th, 2010 by Toni Brayer, M.D. in Better Health Network, Health Tips, News, Research
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New clinical trials and published research are giving us information on how to improve health in elderly patients. Here are some brief points from the Cleveland Journal of Medicine that were surprising to me:
— Each year 30 percent of people age 65 or older fall and sustain serious injuries so preventing falls and fractures is important. Vitamin D prevents both falls and fractures, but mega doses of Vitamin D (50,000 mg) might cause more falls. A better dose is 1,000mg a day in people who consume a low-calcium diet.
— Exercise boosts the effect of influenza vaccine.
— The benefits of dialysis in older patients is uncertain, as it does not improve function in people over age 80. We don’t even know if it improves survival. Older patients who receive dialysis for kidney failure had a decline in function (eating, bed mobility, ambulation, toileting, hygiene, and dressing) after starting treatment.
— Colinesterase inhibitors (Aricept, Razadyne and Exelon) are commonly used to treat Alzheimer disease, but they all can have serious side effects. Syncope (fainting), hip fractures, slow heart rate, and the need for permanent pacemaker insertion were more frequent in people taking these drugs. The benefits of these drugs on cognition is modest.
— A new drug called Pradaxa (dabigatran) will likely prove to be safer than Coumadin (warfarin). Over two million adults have atrial fibrillation and the median age is 75. The blood thinner warfarin is critical for prevention of strokes but it caries a high risk of bleeding and drug levels have to be monitored frequently. Dabigatran will probably replace warfarin, but it will probably also be a lot more expensive.
As I often say, medicine and science are constantly changing and evolving. As new evidence comes forth, physicians and patients need to re-evaluate they way we do things.
*This blog post was originally published at EverythingHealth*
November 12th, 2010 by John Mandrola, M.D. in Better Health Network, Humor, Opinion, True Stories
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I loved my old status. Perhaps, reveled in it would be a better description. I was a crotchety, generic medicine-only doctor.** Sadly, my status changed today. Dabigatran (brand name Pradaxa) was the culprit.
It was a little nerve racking. I wrote the order, looked at it, thought it out again, talking to myself: “John, are you sure you don’t want to do it the old way? [pause to think] No, I am embracing the new.” And then, I closed the chart and handed it to the nurse.
“What’s that? Pradaxa?” asked the nurse. “Stop the Lovenox? You sure?” My face must have told the story.
Eight days had passed since dabigatran’s approval. “That’s plenty of time to mourn warfarin’s demise,” I thought. Enough studies, enough blogs — it was time for the rubber to hit the road. Read more »
*This blog post was originally published at Dr John M*
June 27th, 2010 by John Mandrola, M.D. in Better Health Network, Opinion, Research, True Stories
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In cancer treatment, detection of a tumor in an early stage markedly increases the chance of favorable outcomes.
Can the much-aligned blood thinner, warfarin, occasionally help in early detection of cancer?
Few pharmacologic agents receive more bad press than warfarin. Stories, which are too numerous to count, like “Did warfarin kill my father,” can be widely found on Internet forums, search engines, and are often quoted by reluctant patients — whose numerator of bad warfarin experiences is one.
It is true that warfarin has a narrow therapeutic window — a small difference between an effective dose and dangerous dose. Read more »
*This blog post was originally published at Dr John M*
June 22nd, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, News, Opinion, Research
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The New York Times reported recently on efforts by providers and payers to increase patient medication adherence through the use financial incentives paid to patients. The article cited the use of small financial payments (<$100), awarded via lotteries, to patients that take Warfarin –- an anti-blood clotting medication.
There is certainly nothing wrong with financial incentives. Incentives have been proven successful in changing selected provider (quality and safety improvement) and patient behavior (stop smoking, weight loss and taking health risk surveys). But paying patients to take their medication is different. Actually, the evidence suggests that it is a just plain stupid idea for a whole lot of reasons. Read more »
*This blog post was originally published at Mind The Gap*
December 23rd, 2009 by Shadowfax in Better Health Network, True Stories
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I’ve not been blogging much lately because of work craziness and traveling. One of my recent travels, however, was not for work but for pleasure. I’ve been studying karate (a traditional Okinawan version called Shorin-Ryu) for over fifteen years. There’s a national federation to which I belong and there are seminars three or four times a year taught by some of our more senior instructors. This was one such seminar, and it focused on joint lock and grappling techniques, some of which our style shares in common with other martial arts such as Akido and Judo.
At one point I was working with a fifth-degree black belt instructor, “Bill.” Super nice guy, and absolutely amazing in his speed and techniques. He was also very kind in teaching me a number of useful tricks and nuances of the techniques we were working on. There was a sequence which culminated in a choke-hold, and he was unhappy with the manner in which I was choking him. Read more »
*This blog post was originally published at Movin' Meat*
