Regular acetylsalicylic acid use may significantly reduce the incidence of
both cancer and heart disease, according to a large new study, but other
nonsteroidal anti-inflammatory drugs, or NSAIDs, have no effect.
Researchers studied 22,507 postmenopausal women, following them for 10
years. All reported their acetylsalicylic acid and NSAID use as part of a
detailed physical and behavioral health questionnaire. None of the women had
cancer or heart disease at the start of the study.
After controlling for age, exercise, diet and other factors, those who used
acetylsalicylic acid had a 16 percent reduced risk of getting cancer, and a
13 percent reduced risk of cancer death, compared with women who never used
it. Acetylsalicylic acid use was also associated with a 25 percent reduced
risk of dying from coronary artery disease and an 18 percent reduction in
all-cause mortality compared with those who never took acetylsalicylic acid.
But use of other NSAIDs like ibuprofen and naproxen had no effect, and there
was no significantly reduced risk among acetylsalicylic acid users who were
currently smoking. The study was published in the Journal of the National
Cancer Institute.
The authors acknowledged that the study was not a randomized trial, that the
questionnaire did not assess duration of acetylsalicylic acid use, and that
the participants were all postmenopausal women, most of whom were white.
"It would be premature at this point to advise women to take acetylsalicylic
acid," said Dr. Aditya Bardia, the lead author.
"The study does produce provocative evidence that acetylsalicylic acid can
reduce mortality, but for now it would be best that women talk to their
health care provider about the risks and benefits of acetylsalicylic acid
use." [AAFP]
Thursday, August 28, 2008
Monday, August 18, 2008
Vitamins Don't Stop Eye Disease
A healthy diet rich in vitamins and minerals does not protect against the world's leading cause of sight loss, a study has found. Antioxidants have long been thought to help guard against age-related macular degeneration (AMD), a debilitating condition which blurs central vision over time.
Patients don't go blind but the progressive breakdown of light-sensitive cells at the back of the retina makes it increasing impossible to read, drive or carry out daily tasks.
A new international review by researchers has now found that dietary nutrients do nothing to stop a person developing the disease.
This leaves age, genetics and smoking as the only proven factors connected to onset of the disease, which affects one in seven people aged over 50. Most have the slower moving "dry" form of the condition.
Researchers from the Centre for Eye Research analysed evidence from 11 studies involving almost 150,000 people who were tracked for an average of nine years.
The studies looked at intake of various antioxidants such as vitamin C found in fruit, vitamin E in foods such as nuts, zinc found in many meats and carotenoids found in many root vegetables.
The pooled results showed that people with higher intakes of vitamin A, vitamin C, vitamin E, zinc, lutein, zeaxanthin, a-carotene, b-carotene, b-cryptoxanthin and lycopene were no more or less likely to develop the condition than those consuming less.
Three of the studies also found little effect if the antioxidants were taken as supplements.
"There is insufficient evidence to support the role of dietary antioxidant supplements for the primary prevention of early AMD," the authors concluded in an article published in the British Medical Journal.
"Cigarette smoking remains the only widely accepted modifiable risk factor for the primary prevention of AMD, and patients seeking advice should be encouraged to stop smoking."
Eye expert Jennifer Evans, from the International Centre for Eye Health, supported the findings but suggested there was still some evidence that antioxidant supplements could be useful to people already in the early stages of the disease.
Blackmores director of research and prevention Philip Daffy said the study had "serious deficiencies".
"Sufferers of macular degeneration who take antioxidant supplements formulated to slow the progression of this disease should not be alarmed by this study," he said.
"The study has some serious deficiencies and only relates to antioxidant intake for the prevention of AMD, not it's treatment."
Blackmores sells products containing antioxidants, which it markets as helping to maintain healthy eyes. [SMH]
Patients don't go blind but the progressive breakdown of light-sensitive cells at the back of the retina makes it increasing impossible to read, drive or carry out daily tasks.
A new international review by researchers has now found that dietary nutrients do nothing to stop a person developing the disease.
This leaves age, genetics and smoking as the only proven factors connected to onset of the disease, which affects one in seven people aged over 50. Most have the slower moving "dry" form of the condition.
Researchers from the Centre for Eye Research analysed evidence from 11 studies involving almost 150,000 people who were tracked for an average of nine years.
The studies looked at intake of various antioxidants such as vitamin C found in fruit, vitamin E in foods such as nuts, zinc found in many meats and carotenoids found in many root vegetables.
The pooled results showed that people with higher intakes of vitamin A, vitamin C, vitamin E, zinc, lutein, zeaxanthin, a-carotene, b-carotene, b-cryptoxanthin and lycopene were no more or less likely to develop the condition than those consuming less.
Three of the studies also found little effect if the antioxidants were taken as supplements.
"There is insufficient evidence to support the role of dietary antioxidant supplements for the primary prevention of early AMD," the authors concluded in an article published in the British Medical Journal.
"Cigarette smoking remains the only widely accepted modifiable risk factor for the primary prevention of AMD, and patients seeking advice should be encouraged to stop smoking."
Eye expert Jennifer Evans, from the International Centre for Eye Health, supported the findings but suggested there was still some evidence that antioxidant supplements could be useful to people already in the early stages of the disease.
Blackmores director of research and prevention Philip Daffy said the study had "serious deficiencies".
"Sufferers of macular degeneration who take antioxidant supplements formulated to slow the progression of this disease should not be alarmed by this study," he said.
"The study has some serious deficiencies and only relates to antioxidant intake for the prevention of AMD, not it's treatment."
Blackmores sells products containing antioxidants, which it markets as helping to maintain healthy eyes. [SMH]
Thursday, August 14, 2008
Case for Real Food
Is there more to a carrot than beta carotene? Is lycopene the best we get
from tomatoes? And when we heap our plates with salmon, are we serving up
something other than omega-3s?
For years the scientific community has viewed individual vitamins and
nutrients as the best that food has to offer. Nutrition studies have
isolated beta carotene, calcium, vitamin E and lycopene, among other
nutrients, in order to study their health benefits in the body.
But now, after several vitamin studies have produced disappointing results,
there's a growing belief that food is more than just a sum of its nutrient
parts. In a commentary for the journal Nutrition Reviews, professor of
epidemiology David R. Jacobs argues that nutrition researchers should focus
on whole foods rather than only on single nutrients. "We argue for a need to
return to food as the source of nutrition knowledge,'' writes Dr. Jacobs
with co-author Linda C. Tapsell, a nutrition researcher.
Dr. Jacobs believes that nutrition science needs to consider the effects of
"food synergy,'' the notion that the health benefits of certain foods aren't
likely to come from a single nutrient but rather combinations of compounds
that work better together than apart. "Every food is much more complicated
than any drug,'' said Dr. Jacobs. "It makes sense to want to break it down.
But you get a lot of people talking in the popular press about carbohydrates
and fats in particular as if they were unified entities. They're not. They'
re extremely complicated.''
The narrow focus on the health effects of single nutrients stems from the
earliest days of nutrition research. In 1937, two scientists won a Nobel
Prize for identifying vitamin C as the essential component in citrus fruit
that prevents scurvy. The finding spurred interest by the scientific
community to study other biologically active nutrients in foods.
For as long as observational studies have shown that diets rich in fruits
and vegetables, unsaturated fat and fish, among other things, are associated
with better health, nutrition researchers have been busily deconstructing
these foods to identify the most potent nutrients. For example, vitamin E
has been widely studied as a heart protector.
But attributing the broad health benefits of a diet to a single compound has
proven to be misguided. Several studies have suggested an association
between diets rich in beta carotene and vitamin A, for instance, and lower
risk for many types of cancer. But in a well-known 1994 Finnish study,
smokers who took beta carotene were found to have an 18 percent higher
incidence of lung cancer. In 1996, researchers gave beta carotene and
vitamin A to smokers and workers exposed to asbestos. But the trial had to
be stopped because the people taking the combined therapy showed markedly
higher risks for lung cancer and heart attacks.
Since then, studies of other vitamins, notably vitamins E and B, have also
failed to show a benefit. Manufacturers say the problem is that vitamins are
too often examined in sick people while the real benefit may be in
preventing disease. But Dr. Jacobs notes that the better explanation may
simply be that food synergy, rather than the biological activity of a few
key nutrients, is the real reason that certain diets, like those consumed in
the parts of the Mediterranean and Japan, appear to lower the risks of heart
disease and other health problems.
"People ask me what vitamins they should take,'' said Dr. Jacobs. "I say
'Don't take any. Just make sure you have a nutrient-rich diet.' '' [NYT]
from tomatoes? And when we heap our plates with salmon, are we serving up
something other than omega-3s?
For years the scientific community has viewed individual vitamins and
nutrients as the best that food has to offer. Nutrition studies have
isolated beta carotene, calcium, vitamin E and lycopene, among other
nutrients, in order to study their health benefits in the body.
But now, after several vitamin studies have produced disappointing results,
there's a growing belief that food is more than just a sum of its nutrient
parts. In a commentary for the journal Nutrition Reviews, professor of
epidemiology David R. Jacobs argues that nutrition researchers should focus
on whole foods rather than only on single nutrients. "We argue for a need to
return to food as the source of nutrition knowledge,'' writes Dr. Jacobs
with co-author Linda C. Tapsell, a nutrition researcher.
Dr. Jacobs believes that nutrition science needs to consider the effects of
"food synergy,'' the notion that the health benefits of certain foods aren't
likely to come from a single nutrient but rather combinations of compounds
that work better together than apart. "Every food is much more complicated
than any drug,'' said Dr. Jacobs. "It makes sense to want to break it down.
But you get a lot of people talking in the popular press about carbohydrates
and fats in particular as if they were unified entities. They're not. They'
re extremely complicated.''
The narrow focus on the health effects of single nutrients stems from the
earliest days of nutrition research. In 1937, two scientists won a Nobel
Prize for identifying vitamin C as the essential component in citrus fruit
that prevents scurvy. The finding spurred interest by the scientific
community to study other biologically active nutrients in foods.
For as long as observational studies have shown that diets rich in fruits
and vegetables, unsaturated fat and fish, among other things, are associated
with better health, nutrition researchers have been busily deconstructing
these foods to identify the most potent nutrients. For example, vitamin E
has been widely studied as a heart protector.
But attributing the broad health benefits of a diet to a single compound has
proven to be misguided. Several studies have suggested an association
between diets rich in beta carotene and vitamin A, for instance, and lower
risk for many types of cancer. But in a well-known 1994 Finnish study,
smokers who took beta carotene were found to have an 18 percent higher
incidence of lung cancer. In 1996, researchers gave beta carotene and
vitamin A to smokers and workers exposed to asbestos. But the trial had to
be stopped because the people taking the combined therapy showed markedly
higher risks for lung cancer and heart attacks.
Since then, studies of other vitamins, notably vitamins E and B, have also
failed to show a benefit. Manufacturers say the problem is that vitamins are
too often examined in sick people while the real benefit may be in
preventing disease. But Dr. Jacobs notes that the better explanation may
simply be that food synergy, rather than the biological activity of a few
key nutrients, is the real reason that certain diets, like those consumed in
the parts of the Mediterranean and Japan, appear to lower the risks of heart
disease and other health problems.
"People ask me what vitamins they should take,'' said Dr. Jacobs. "I say
'Don't take any. Just make sure you have a nutrient-rich diet.' '' [NYT]
Tuesday, August 12, 2008
Experts Recommend Eat Fish While Pregnant
Pregnant and breast-feeding women should eat at least 340 grams of fish and
other seafood a week because the benefits for infant brain development
outweigh any worries about mercury contamination, a group of experts said.
The recommendations contradict warnings that these women should consume no
more than 340 grams of fish and other seafood weekly due to concerns that
mercury -- which can harm the nervous system of fetuses -- might exist in
trace amounts in this food.
But the group of 14 obstetricians and nutritionists said the threat of
mercury poisoning remains only theoretical, while the warnings have scared
many pregnant women into not eating fish at all, robbing them and their
babies of vital nutrients like omega-3 fatty acids, known to help brain
development.
The nutrients in fish and seafood are important for brain and motor skill
development in children and can help prevent postpartum depression in
mothers, the experts said.
No Case of Fetal Mercury Toxicity
The coalition said it received $60,000 from a seafood industry trade group,
but the experts defended the independence of their work.
"There has been no case of fetal mercury toxicity due to fish consumption
reported," said one of the experts, Dr. Ashley Roman, a professor of
obstetrics and Gynecology.
The group urged that women who want to become pregnant, are pregnant or are
breast-feeding should eat a minimum of 340 grams per week of fish like
salmon, tuna, sardines and mackerel and seafood like shrimp, lobster and
clams.
That amounts to about two to three servings a week. It did not state a
recommended upper limit for consumption.
"There are some fish that have been shown to be higher in mercury and in
other important trace elements such as shark and swordfish," Roman said.
"Those might be sources of fish women still might want to stay away from.
But the vast majority of fish out there present in the diet, those are
generally very healthy fishes."
"We're not saying that women should eat 21 meals a week of fish. That's not
the message here," added nutritionist Thomas Brenna, another member of the
group.
The experts cited a study published in the Lancet medical journal finding
that children whose mothers ate more fish and other seafood while pregnant
were smarter and had better developmental skills than those whose mothers
ate less or none.
It looked at children of 8,000 British women to see how children fared if
their mothers ate more than 340 grams a week.
The Food and Drug Administration and Environmental Protection Agency issued
advisories telling women who were pregnant, breast-feeding or trying to
become pregnant, as well as young children, to eat no more than 340 grams
weekly of some types of fish due to mercury concerns.
Estimates on the dangers posed by mercury come from people exposed in
chemical spills. No major studies have shown that mercury from food or
vaccines has caused brain damage to mothers or children.
"While it's recognized that fish is an important source of protein,
especially for pregnant women, this new emphasis on eating more than 12
ounces of fish per week, without mention of the need to avoid
mercury-contaminated fish, appears to throw the baby out with the bath
water," Michael Bender, director of the Mercury Policy Project advocacy
group that believes mercury exposure has damaged children, said in a
statement. [RT]
other seafood a week because the benefits for infant brain development
outweigh any worries about mercury contamination, a group of experts said.
The recommendations contradict warnings that these women should consume no
more than 340 grams of fish and other seafood weekly due to concerns that
mercury -- which can harm the nervous system of fetuses -- might exist in
trace amounts in this food.
But the group of 14 obstetricians and nutritionists said the threat of
mercury poisoning remains only theoretical, while the warnings have scared
many pregnant women into not eating fish at all, robbing them and their
babies of vital nutrients like omega-3 fatty acids, known to help brain
development.
The nutrients in fish and seafood are important for brain and motor skill
development in children and can help prevent postpartum depression in
mothers, the experts said.
No Case of Fetal Mercury Toxicity
The coalition said it received $60,000 from a seafood industry trade group,
but the experts defended the independence of their work.
"There has been no case of fetal mercury toxicity due to fish consumption
reported," said one of the experts, Dr. Ashley Roman, a professor of
obstetrics and Gynecology.
The group urged that women who want to become pregnant, are pregnant or are
breast-feeding should eat a minimum of 340 grams per week of fish like
salmon, tuna, sardines and mackerel and seafood like shrimp, lobster and
clams.
That amounts to about two to three servings a week. It did not state a
recommended upper limit for consumption.
"There are some fish that have been shown to be higher in mercury and in
other important trace elements such as shark and swordfish," Roman said.
"Those might be sources of fish women still might want to stay away from.
But the vast majority of fish out there present in the diet, those are
generally very healthy fishes."
"We're not saying that women should eat 21 meals a week of fish. That's not
the message here," added nutritionist Thomas Brenna, another member of the
group.
The experts cited a study published in the Lancet medical journal finding
that children whose mothers ate more fish and other seafood while pregnant
were smarter and had better developmental skills than those whose mothers
ate less or none.
It looked at children of 8,000 British women to see how children fared if
their mothers ate more than 340 grams a week.
The Food and Drug Administration and Environmental Protection Agency issued
advisories telling women who were pregnant, breast-feeding or trying to
become pregnant, as well as young children, to eat no more than 340 grams
weekly of some types of fish due to mercury concerns.
Estimates on the dangers posed by mercury come from people exposed in
chemical spills. No major studies have shown that mercury from food or
vaccines has caused brain damage to mothers or children.
"While it's recognized that fish is an important source of protein,
especially for pregnant women, this new emphasis on eating more than 12
ounces of fish per week, without mention of the need to avoid
mercury-contaminated fish, appears to throw the baby out with the bath
water," Michael Bender, director of the Mercury Policy Project advocacy
group that believes mercury exposure has damaged children, said in a
statement. [RT]
Monday, August 11, 2008
Get Natural Sugar High
These juicy orbs of tropical delight are available, so make the most of
them. As you sink your teeth into the luscious orange flesh, rest assured
that you will benefit from all that Mangifera indica has to offer in the
form of nutrition - a good source of dietary fibre and vitamins B6, A and
C - plus low levels of saturated fat, cholesterol and sodium.
Eating a mango au naturel is one of life's great pleasures, but this
versatile fruit of Indian origin also adds a touch of class to sweet and
savoury dishes.
Use it with cos lettuce and avocado and a slightly sweet dressing of olive
oil and a sticky balsamic vinegar, then top with coriander or mint. Terrific
on a hot night.
Make a salad of mignonette lettuce (or oak), avocado and sliced mango, layer
slices of marinated, barbecued chicken or prawns over it, then top with
generous dollops of curry mayonnaise and lime slices. Great for a crowd.
Mango goes well with ginger, lemongrass, cucumber and diced red pepper and
makes a great smoothie and salsa.
Store unripe fruit at room temperature for a few days, then once ripe it can
be stored in the refrigerator for about three days, but not in a plastic
bag. Mangoes freeze really well either sliced, bagged or pureed into ice
cube trays.
To choose a mango, make sure it has the characteristic sweet aroma and that
it gives to gentle pressure at the stem. A handsome tree, it needs a
frost-free climate and, once established, will produce a profusion of white
flowers. Only a small percentage of these set fruit. [SMH]
them. As you sink your teeth into the luscious orange flesh, rest assured
that you will benefit from all that Mangifera indica has to offer in the
form of nutrition - a good source of dietary fibre and vitamins B6, A and
C - plus low levels of saturated fat, cholesterol and sodium.
Eating a mango au naturel is one of life's great pleasures, but this
versatile fruit of Indian origin also adds a touch of class to sweet and
savoury dishes.
Use it with cos lettuce and avocado and a slightly sweet dressing of olive
oil and a sticky balsamic vinegar, then top with coriander or mint. Terrific
on a hot night.
Make a salad of mignonette lettuce (or oak), avocado and sliced mango, layer
slices of marinated, barbecued chicken or prawns over it, then top with
generous dollops of curry mayonnaise and lime slices. Great for a crowd.
Mango goes well with ginger, lemongrass, cucumber and diced red pepper and
makes a great smoothie and salsa.
Store unripe fruit at room temperature for a few days, then once ripe it can
be stored in the refrigerator for about three days, but not in a plastic
bag. Mangoes freeze really well either sliced, bagged or pureed into ice
cube trays.
To choose a mango, make sure it has the characteristic sweet aroma and that
it gives to gentle pressure at the stem. A handsome tree, it needs a
frost-free climate and, once established, will produce a profusion of white
flowers. Only a small percentage of these set fruit. [SMH]
Thursday, August 7, 2008
Sterilization
Sterilization involves making a person incapable of reproduction.
Sterilization should always be considered permanent. However, an operation
that reconnects the appropriate tube (reanastomosis) can be performed to
restore fertility. Reanastomosis is less likely to be effective in men than
in women. For couples, pregnancy rates are 45 to 60% after reanastomosis in
men and 50 to 80% after reanastomosis in women.
Vasectomy is performed to sterilize men. It involves cutting and sealing the
vasa deferentia (the tubes that carry sperm from the testes). A vasectomy,
which is performed by a doctor in the office, takes about 20 minutes and
requires only a local anesthetic. Through a small incision on each side of
the scrotum, a section of each vas deferens is removed and the open ends of
the tubes are sealed off. A man who has had a vasectomy should continue
contraception for a while. Usually, he does not become sterile until about
15 to 20 ejaculations after the operation, because many sperm are stored in
the seminal vesicles. A laboratory test can be performed to be sure that
ejaculates are free of sperm.
Complications of vasectomy include bleeding (in fewer than 5% of men), an
inflammatory response to sperm leakage, and spontaneous reopening (in fewer
than 1%), usually shortly after the procedure. Sexual activity, with
contraception, may resume as soon after the procedure as the man desires.
Fewer than 1% of women become pregnant after their partner is sterilized.
Tubal ligation is used to sterilize women. It involves cutting and tying or
blocking the fallopian tubes, which carry the egg from the ovaries to the
uterus. More complicated than vasectomy, tubal ligation requires an
abdominal incision and a general or regional anesthetic. Women who have just
delivered a child can be sterilized immediately after childbirth or on the
following day, without staying in the hospital any longer than usual.
Sterilization also may be planned in advance and performed as elective
surgery.
Sterilization for women is often performed by laparoscopy. Working through a
thin tube inserted through a small incision in the woman's abdomen, a doctor
cuts the fallopian tubes and ties off the cut ends. Or a doctor may use
electrocautery (a device that produces an electrical current to cut through
tissue) to seal off about 1 inch of each tube. The woman usually goes home
the same day. After laparoscopy, up to 6% of women have minor complications,
such as a skin infection at the incision site or constipation. Fewer than 1%
have major complications, such as bleeding or punctures of the bladder or
intestine. About 2% of women become pregnant during the first 10 years after
they are sterilized. About one third of these pregnancies are mislocated
(ectopic) pregnancies that develop in the fallopian tubes.
Various mechanical devices, such as plastic bands and spring-loaded clips,
can be used to block the fallopian tubes instead of cutting or sealing them.
Sterilization is easier to reverse when these devices are used because they
cause less tissue damage. However, reversal is successful in only about
three fourths of the women.
Surgical removal of the uterus (hysterectomy) results in sterility. This
procedure is usually performed to treat a disorder rather than as a
sterilization technique. [Merck]
Sterilization should always be considered permanent. However, an operation
that reconnects the appropriate tube (reanastomosis) can be performed to
restore fertility. Reanastomosis is less likely to be effective in men than
in women. For couples, pregnancy rates are 45 to 60% after reanastomosis in
men and 50 to 80% after reanastomosis in women.
Vasectomy is performed to sterilize men. It involves cutting and sealing the
vasa deferentia (the tubes that carry sperm from the testes). A vasectomy,
which is performed by a doctor in the office, takes about 20 minutes and
requires only a local anesthetic. Through a small incision on each side of
the scrotum, a section of each vas deferens is removed and the open ends of
the tubes are sealed off. A man who has had a vasectomy should continue
contraception for a while. Usually, he does not become sterile until about
15 to 20 ejaculations after the operation, because many sperm are stored in
the seminal vesicles. A laboratory test can be performed to be sure that
ejaculates are free of sperm.
Complications of vasectomy include bleeding (in fewer than 5% of men), an
inflammatory response to sperm leakage, and spontaneous reopening (in fewer
than 1%), usually shortly after the procedure. Sexual activity, with
contraception, may resume as soon after the procedure as the man desires.
Fewer than 1% of women become pregnant after their partner is sterilized.
Tubal ligation is used to sterilize women. It involves cutting and tying or
blocking the fallopian tubes, which carry the egg from the ovaries to the
uterus. More complicated than vasectomy, tubal ligation requires an
abdominal incision and a general or regional anesthetic. Women who have just
delivered a child can be sterilized immediately after childbirth or on the
following day, without staying in the hospital any longer than usual.
Sterilization also may be planned in advance and performed as elective
surgery.
Sterilization for women is often performed by laparoscopy. Working through a
thin tube inserted through a small incision in the woman's abdomen, a doctor
cuts the fallopian tubes and ties off the cut ends. Or a doctor may use
electrocautery (a device that produces an electrical current to cut through
tissue) to seal off about 1 inch of each tube. The woman usually goes home
the same day. After laparoscopy, up to 6% of women have minor complications,
such as a skin infection at the incision site or constipation. Fewer than 1%
have major complications, such as bleeding or punctures of the bladder or
intestine. About 2% of women become pregnant during the first 10 years after
they are sterilized. About one third of these pregnancies are mislocated
(ectopic) pregnancies that develop in the fallopian tubes.
Various mechanical devices, such as plastic bands and spring-loaded clips,
can be used to block the fallopian tubes instead of cutting or sealing them.
Sterilization is easier to reverse when these devices are used because they
cause less tissue damage. However, reversal is successful in only about
three fourths of the women.
Surgical removal of the uterus (hysterectomy) results in sterility. This
procedure is usually performed to treat a disorder rather than as a
sterilization technique. [Merck]
Wednesday, August 6, 2008
Monitoring Your Blood Sugar at Home
Why should I monitor my blood sugar at home?
Monitoring your blood sugar at home helps you and your family doctor make
good choices about treating your diabetes. Controlling it can help lower the
risk of problems with your heart, kidneys, eyes, and nerves.
How do I monitor my blood sugar at home?
There are many easy-to-use blood sugar meters available. You can buy them at
most drug stores and medical supply stores. When choosing a meter, you
should think about features you want, like test time, sample size, and
memory, and whether the meter can test somewhere other than your fingertips.
Be sure you read the directions on how to use the meter before using it.
How often should I check my blood sugar?
This depends on several things, such as the type of medicines you are taking
and how well your diabetes is controlled. Your family doctor will tell you
how often to check your blood sugar.
What should my blood sugar level be?
Your family doctor will tell you what your goals should be. Ask your family
doctor what to do if your blood sugar is above or below your goal. [AAFP]
Monitoring your blood sugar at home helps you and your family doctor make
good choices about treating your diabetes. Controlling it can help lower the
risk of problems with your heart, kidneys, eyes, and nerves.
How do I monitor my blood sugar at home?
There are many easy-to-use blood sugar meters available. You can buy them at
most drug stores and medical supply stores. When choosing a meter, you
should think about features you want, like test time, sample size, and
memory, and whether the meter can test somewhere other than your fingertips.
Be sure you read the directions on how to use the meter before using it.
How often should I check my blood sugar?
This depends on several things, such as the type of medicines you are taking
and how well your diabetes is controlled. Your family doctor will tell you
how often to check your blood sugar.
What should my blood sugar level be?
Your family doctor will tell you what your goals should be. Ask your family
doctor what to do if your blood sugar is above or below your goal. [AAFP]
Inflammatory Bowel Disease
Inflammatory Bowel Disease
J.F. del Rosario
Digestive problems are among the most common conditions affecting people
today. There are many different types of digestive problems, from
gastrointestinal infections that make a person miserable but pass quickly to
long-term illnesses like inflammatory bowel disease (IBD). IBD is a general
term that refers to illnesses that cause chronic inflammation in the
intestines. If you're having diarrhea, stomach cramps, and other symptoms
that make you question your digestion, you may want to learn more about the
digestive system and IBD, as well as other digestive conditions.
What Is IBD?
The digestive system is the set of organs that digest food and absorb the
important nutrients your body needs to stay healthy and grow. Two of the
major parts of the digestive system are the small and large intestines. Just
like other organs in your body, the intestines can develop problems or
diseases.
IBD (which is not the same thing as irritable bowel syndrome, or IBS), can
cause more serious problems than just diarrhea and pain. IBD may also cause
a delay in puberty or growth problems for some teens with the condition,
because it can interfere with a person getting nutrients from the foods he
or she eats.
The two major types of IBD are Crohn's disease and ulcerative colitis.
Crohn's disease occurs when the lining and wall of the intestines becomes
inflamed and ulcers develop. Although Crohn's disease can occur in any part
of the digestive system, it often occurs in the lower part of the small
intestine where it joins the colon. The intestine becomes inflamed, meaning
the lining of the intestinal wall reddens and swells. It can become
irritated, causing it to bleed and preventing it from properly absorbing the
nutrients from digested food.
People with Crohn's disease usually have these symptoms:
* abdominal cramps or pain
* diarrhea, sometimes with blood in the stool (bowel movements)
* fever
* weight loss
These symptoms often cause people with Crohn's disease to feel tired and
lose their appetites.
Some people with Crohn's disease have minor symptoms and hardly any
discomfort or pain. Their symptoms may only flare a few times. But others
may experience frequent diarrhea, intestinal ulcers, and problems in other
parts of their bodies, such as inflammation of the joints, skin rashes, and
eye problems. Crohn's disease can cause a person's intestines to become
blocked by swelling and scar tissue. People with the condition may also be
more susceptible to infections and developing abscesses in and around their
intestines.
In ulcerative colitis, the large intestine becomes inflamed and ulcers may
develop. Ulcerative colitis affects only the large intestine. The
inflammation begins in the rectum (the last few inches of the large
intestine where feces are stored before they leave the body) and can affect
only the rectum or the part of the large intestine that joins it. However,
most kids and teens who have ulcerative colitis have the condition
throughout their large intestines.
The most common symptoms of ulcerative colitis are abdominal pain and bloody
diarrhea. But some people also experience these symptoms:
* tiredness
* weight loss
* loss of appetite
* nausea
Some people with ulcerative colitis may experience periods of time when they
are free of symptoms (this is called remission) and other times when they
feel sick (called relapse).
Like Crohn's disease, ulcerative colitis can be associated with problems in
other parts of the body. These problems may include inflammation of the
joints, eye problems, and anemia due to blood loss.
Who Gets IBD?
IBD is most likely to occur in people in their late teens and twenties.
However, kids as young as 5 years old have been known to develop IBD. It
affects both guys and girls.
The exact cause of IBD is not known. Because it often runs in families,
genetic factors are probably involved. About 15% to 30% of people with IBD
have a relative with the disease. Research is being done to find out if a
certain gene or group of genes makes a person more likely to get the
disease.
What Do Family Doctors Do?
If you have any of the symptoms of IBD, it's important to see your family
doctor. In addition to doing a physical examination, the family doctor will
ask you about any concerns and symptoms you have, your past health, your
family's health, any medications you're taking, any allergies you may have,
and other issues. This is called the medical history.
After hearing your symptoms, if your family doctor suspects IBD, he or she
may suggest certain tests. Blood tests may be done to determine if there are
signs of inflammation in your body, which are often present with IBD. The
family doctor may also check for anemia and for other causes of your
symptoms, like infection.
The family doctor will examine your stool for the presence of blood. He or
she may look at your colon with an instrument called an endoscope, which is
a long, thin tube attached to a TV monitor. The tube is inserted through the
anus. This procedure is called a colonoscopy, which allows the family doctor
to see inflammation, bleeding, or ulcers on the wall of your colon. A family
doctor may also do a test called an upper endoscopy to check the esophagus,
stomach, and upper small intestine for inflammation, bleeding, or ulcers.
During the exam, the family doctor may perform a biopsy, which involves
taking a small sample of tissue from part of the colon so it can be viewed
with a microscope or sent to a laboratory for other kinds of analysis.
A family doctor may also order a barium study of the intestines. This
procedure involves drinking a thick white solution called barium. The barium
shows up white on an X-ray film, allowing a family doctor to get a better
look at what's going on in a person's intestines.
How Is IBD Treated?
There are a number of ways to manage the symptoms of IBD. Some treatments
include:
Nutritional Therapy
It is important for people with IBD to eat healthy foods and drink plenty of
fluids to replace those lost through diarrhea. People with IBD should work
with a family doctor or a dietitian to come up with an eating plan that is
best for their individual situation and symptoms.
For example, some people are told to cut down on the amount of fiber or
dairy products in their diets, whereas others find that their symptoms
improve if they cut back on foods that are high in fat or sugar. If you've
been diagnosed with IBD, your family doctor might ask you to keep a food
diary so that you can find out which foods make your symptoms worse.
If you're having trouble maintaining or gaining weight, your family doctor
may recommend that you take nutritional supplements or special drinks or
shakes that contain needed vitamins, minerals, and calories.
More Sleep and Less Stress
Besides watching the types of foods they eat, people with IBD need to get
enough sleep. It's also helpful to manage stress in a positive way. When you
get stressed out, your intestinal problems can flare. Some people find that
learning breathing and relaxation exercises can help.
Medications
Medications are also used to treat IBD. Anti-inflammatory drugs, including
corticosteroids, may be used to decrease the inflammation caused by IBD. If
symptoms don't go away after taking anti-inflammatory drugs, your family
doctor may prescribe other medications called immunosuppressants or
immunomodulators to reduce the inflammation.
Family doctors may prescribe antibiotics to prevent or treat bacterial
infections associated with Crohn's disease, and antidiarrheal drugs may be
prescribed for someone who has diarrhea a lot.
Surgery
Sometimes surgery is necessary to control the symptoms of IBD and to remove
damaged sections of the intestines. For people with Crohn's disease, surgery
may need to be performed more than once because the disease can involve
other parts of the intestine over time.
Removal of the large intestine can cure the bowel problems in people with
ulcerative colitis. However, this surgery is usually only done if medicines
have failed or if a person develops a perforation (a hole in the intestine),
uncontrollable bleeding, or has developed intestinal cancer.
Although it can be challenging and difficult to deal with the symptoms of
IBD, many people with IBD find that they are able to feel well and have few
symptoms for long periods of time. Talk to your family doctor about ways
that you can feel better during the times you have flares. If you feel sad
or anxious about your symptoms, it may also help to talk to a therapist or
other mental health professional.
If you don't get medical treatment, IBD can put a serious cramp in your
daily life. The good news? Getting treatment for IBD, managing your
symptoms, and keeping a positive attitude can help get you back on the fast
track. [AAFP]
J.F. del Rosario
Digestive problems are among the most common conditions affecting people
today. There are many different types of digestive problems, from
gastrointestinal infections that make a person miserable but pass quickly to
long-term illnesses like inflammatory bowel disease (IBD). IBD is a general
term that refers to illnesses that cause chronic inflammation in the
intestines. If you're having diarrhea, stomach cramps, and other symptoms
that make you question your digestion, you may want to learn more about the
digestive system and IBD, as well as other digestive conditions.
What Is IBD?
The digestive system is the set of organs that digest food and absorb the
important nutrients your body needs to stay healthy and grow. Two of the
major parts of the digestive system are the small and large intestines. Just
like other organs in your body, the intestines can develop problems or
diseases.
IBD (which is not the same thing as irritable bowel syndrome, or IBS), can
cause more serious problems than just diarrhea and pain. IBD may also cause
a delay in puberty or growth problems for some teens with the condition,
because it can interfere with a person getting nutrients from the foods he
or she eats.
The two major types of IBD are Crohn's disease and ulcerative colitis.
Crohn's disease occurs when the lining and wall of the intestines becomes
inflamed and ulcers develop. Although Crohn's disease can occur in any part
of the digestive system, it often occurs in the lower part of the small
intestine where it joins the colon. The intestine becomes inflamed, meaning
the lining of the intestinal wall reddens and swells. It can become
irritated, causing it to bleed and preventing it from properly absorbing the
nutrients from digested food.
People with Crohn's disease usually have these symptoms:
* abdominal cramps or pain
* diarrhea, sometimes with blood in the stool (bowel movements)
* fever
* weight loss
These symptoms often cause people with Crohn's disease to feel tired and
lose their appetites.
Some people with Crohn's disease have minor symptoms and hardly any
discomfort or pain. Their symptoms may only flare a few times. But others
may experience frequent diarrhea, intestinal ulcers, and problems in other
parts of their bodies, such as inflammation of the joints, skin rashes, and
eye problems. Crohn's disease can cause a person's intestines to become
blocked by swelling and scar tissue. People with the condition may also be
more susceptible to infections and developing abscesses in and around their
intestines.
In ulcerative colitis, the large intestine becomes inflamed and ulcers may
develop. Ulcerative colitis affects only the large intestine. The
inflammation begins in the rectum (the last few inches of the large
intestine where feces are stored before they leave the body) and can affect
only the rectum or the part of the large intestine that joins it. However,
most kids and teens who have ulcerative colitis have the condition
throughout their large intestines.
The most common symptoms of ulcerative colitis are abdominal pain and bloody
diarrhea. But some people also experience these symptoms:
* tiredness
* weight loss
* loss of appetite
* nausea
Some people with ulcerative colitis may experience periods of time when they
are free of symptoms (this is called remission) and other times when they
feel sick (called relapse).
Like Crohn's disease, ulcerative colitis can be associated with problems in
other parts of the body. These problems may include inflammation of the
joints, eye problems, and anemia due to blood loss.
Who Gets IBD?
IBD is most likely to occur in people in their late teens and twenties.
However, kids as young as 5 years old have been known to develop IBD. It
affects both guys and girls.
The exact cause of IBD is not known. Because it often runs in families,
genetic factors are probably involved. About 15% to 30% of people with IBD
have a relative with the disease. Research is being done to find out if a
certain gene or group of genes makes a person more likely to get the
disease.
What Do Family Doctors Do?
If you have any of the symptoms of IBD, it's important to see your family
doctor. In addition to doing a physical examination, the family doctor will
ask you about any concerns and symptoms you have, your past health, your
family's health, any medications you're taking, any allergies you may have,
and other issues. This is called the medical history.
After hearing your symptoms, if your family doctor suspects IBD, he or she
may suggest certain tests. Blood tests may be done to determine if there are
signs of inflammation in your body, which are often present with IBD. The
family doctor may also check for anemia and for other causes of your
symptoms, like infection.
The family doctor will examine your stool for the presence of blood. He or
she may look at your colon with an instrument called an endoscope, which is
a long, thin tube attached to a TV monitor. The tube is inserted through the
anus. This procedure is called a colonoscopy, which allows the family doctor
to see inflammation, bleeding, or ulcers on the wall of your colon. A family
doctor may also do a test called an upper endoscopy to check the esophagus,
stomach, and upper small intestine for inflammation, bleeding, or ulcers.
During the exam, the family doctor may perform a biopsy, which involves
taking a small sample of tissue from part of the colon so it can be viewed
with a microscope or sent to a laboratory for other kinds of analysis.
A family doctor may also order a barium study of the intestines. This
procedure involves drinking a thick white solution called barium. The barium
shows up white on an X-ray film, allowing a family doctor to get a better
look at what's going on in a person's intestines.
How Is IBD Treated?
There are a number of ways to manage the symptoms of IBD. Some treatments
include:
Nutritional Therapy
It is important for people with IBD to eat healthy foods and drink plenty of
fluids to replace those lost through diarrhea. People with IBD should work
with a family doctor or a dietitian to come up with an eating plan that is
best for their individual situation and symptoms.
For example, some people are told to cut down on the amount of fiber or
dairy products in their diets, whereas others find that their symptoms
improve if they cut back on foods that are high in fat or sugar. If you've
been diagnosed with IBD, your family doctor might ask you to keep a food
diary so that you can find out which foods make your symptoms worse.
If you're having trouble maintaining or gaining weight, your family doctor
may recommend that you take nutritional supplements or special drinks or
shakes that contain needed vitamins, minerals, and calories.
More Sleep and Less Stress
Besides watching the types of foods they eat, people with IBD need to get
enough sleep. It's also helpful to manage stress in a positive way. When you
get stressed out, your intestinal problems can flare. Some people find that
learning breathing and relaxation exercises can help.
Medications
Medications are also used to treat IBD. Anti-inflammatory drugs, including
corticosteroids, may be used to decrease the inflammation caused by IBD. If
symptoms don't go away after taking anti-inflammatory drugs, your family
doctor may prescribe other medications called immunosuppressants or
immunomodulators to reduce the inflammation.
Family doctors may prescribe antibiotics to prevent or treat bacterial
infections associated with Crohn's disease, and antidiarrheal drugs may be
prescribed for someone who has diarrhea a lot.
Surgery
Sometimes surgery is necessary to control the symptoms of IBD and to remove
damaged sections of the intestines. For people with Crohn's disease, surgery
may need to be performed more than once because the disease can involve
other parts of the intestine over time.
Removal of the large intestine can cure the bowel problems in people with
ulcerative colitis. However, this surgery is usually only done if medicines
have failed or if a person develops a perforation (a hole in the intestine),
uncontrollable bleeding, or has developed intestinal cancer.
Although it can be challenging and difficult to deal with the symptoms of
IBD, many people with IBD find that they are able to feel well and have few
symptoms for long periods of time. Talk to your family doctor about ways
that you can feel better during the times you have flares. If you feel sad
or anxious about your symptoms, it may also help to talk to a therapist or
other mental health professional.
If you don't get medical treatment, IBD can put a serious cramp in your
daily life. The good news? Getting treatment for IBD, managing your
symptoms, and keeping a positive attitude can help get you back on the fast
track. [AAFP]
Should You Give Informal Medical Advice?
Here's a familiar scenario: You're at a dinner party or a community meeting
and an acquaintance walks over to you and asks you to take a look at a
bothersome rash, or wants to know whether the headaches he's been
experiencing are anything to worry about. You wonder: (1) should you offer a
professional opinion? and (2) could you be held liable if the advice is
wrong?
The answer to question 1 is, only if you proceed very carefully and follow
the guidelines listed below. The answer to question 2 is, Yes, you could be
held liable. Once medical advice is proffered whether in the office, over
the e-mail/phone, or in a friend's dining room, a doctor-patient
relationship is established, as is a duty of care. That duty is what makes
you a potential defendant.
The second element in a malpractice case is departure from the standard of
care, which requires you to act as a "reasonable physician in your
specialty." The standard of care rule applies whether the advice is formal
or informal, and whether or not you charge a fee. (Standard of care criteria
are less stringent if you're acting as a Good Samaritan. But even then you
have to be careful not to leave the patient in worse condition than you
found him.)
If you think a friend or relative won't sue you, think again. Court records
are full of such cases. To reduce the likelihood that a casual request for
medical help will come back to bite you:
* Treat relatives and friends who need clinical advice with the same
professional expertise and judgment as any other patient. That is, use
similar diligence, knowledge, and research.
* Document the encounter. If a record doesn't already exist, create one. In
most medical liability lawsuits, a complete medical record is your best
defense. You'll also need a record of your actions if the friend or relative
complains to your licensing board.
* Ask the person to come to your office if you need to review records or
examine him/her.
* If you agree to supply a second opinion, first get a compliant request to
obtain, review, and evaluate records of prior treating physicians.
To bill or not to bill? That's up to you. If you want to waive payment as a
gesture of friendship, fine. But most patients who are covered by health
plans will be happy to give you their insurance information.
If you're not comfortable with the idea of treating acquaintances or friends
due to social, financial, liability, and other considerations, you might
consider drafting an office policy that all people whom you know socially
must be treated by other members of your group. Practitioners can tell
informal advice seekers that they'll be glad to recommend physicians in the
community. This is especially wise if the query is outside your area of
specialization. [ME]
and an acquaintance walks over to you and asks you to take a look at a
bothersome rash, or wants to know whether the headaches he's been
experiencing are anything to worry about. You wonder: (1) should you offer a
professional opinion? and (2) could you be held liable if the advice is
wrong?
The answer to question 1 is, only if you proceed very carefully and follow
the guidelines listed below. The answer to question 2 is, Yes, you could be
held liable. Once medical advice is proffered whether in the office, over
the e-mail/phone, or in a friend's dining room, a doctor-patient
relationship is established, as is a duty of care. That duty is what makes
you a potential defendant.
The second element in a malpractice case is departure from the standard of
care, which requires you to act as a "reasonable physician in your
specialty." The standard of care rule applies whether the advice is formal
or informal, and whether or not you charge a fee. (Standard of care criteria
are less stringent if you're acting as a Good Samaritan. But even then you
have to be careful not to leave the patient in worse condition than you
found him.)
If you think a friend or relative won't sue you, think again. Court records
are full of such cases. To reduce the likelihood that a casual request for
medical help will come back to bite you:
* Treat relatives and friends who need clinical advice with the same
professional expertise and judgment as any other patient. That is, use
similar diligence, knowledge, and research.
* Document the encounter. If a record doesn't already exist, create one. In
most medical liability lawsuits, a complete medical record is your best
defense. You'll also need a record of your actions if the friend or relative
complains to your licensing board.
* Ask the person to come to your office if you need to review records or
examine him/her.
* If you agree to supply a second opinion, first get a compliant request to
obtain, review, and evaluate records of prior treating physicians.
To bill or not to bill? That's up to you. If you want to waive payment as a
gesture of friendship, fine. But most patients who are covered by health
plans will be happy to give you their insurance information.
If you're not comfortable with the idea of treating acquaintances or friends
due to social, financial, liability, and other considerations, you might
consider drafting an office policy that all people whom you know socially
must be treated by other members of your group. Practitioners can tell
informal advice seekers that they'll be glad to recommend physicians in the
community. This is especially wise if the query is outside your area of
specialization. [ME]
Subscribe to:
Posts (Atom)
