Category Archives: Health

Men More Likely to Show Up in ER

Researchers followed 367 men and 370 women for 30 days after they were discharged from the Boston Medical Center to determine if gender played a role in the need for follow-up urgent care, including readmission to the hospital.

The study was published April 18 in the online journal BMJ Open.

Men in the study were an average of about four years younger than the women, and tended to have better-paying jobs and more access to private health insurance. Women were more likely than men to have a family doctor and to have been diagnosed with depression at some time in the past, with twice as many women taking antidepressants.

The study found that the return rate for urgent care within 30 days of discharge was 29 percent for women and 47 percent for men. Men were twice as likely to go to the emergency room, according to a journal news release.

Many key factors predicted men’s return to hospital. They were 72 percent more likely to return if they were unmarried or retired, 64 percent more likely if they had not seen their family doctor since their discharge and 53 percent more likely if they were depressed.

“Our findings raise the possibility that social isolation — as illustrated by the positive association with being retired or unmarried, and [having] symptoms of depression — may be important factors to target for intervention,” wrote Dr. Suzanne Mitchell, of the department of family medicine at the Boston University School of Medicine, and colleagues, in the release.

The researchers noted that previous studies found that men’s social isolation tends to contribute to poorer health results for them, and that women are better at using health services.

Bacteria Also Spreads Outside Hospitals

The dangerous bacteria Clostridium difficile spreads not only in hospitals but also in other health-care settings, causing infections and death rates to hit “historic highs,” U.S. health officials reported Tuesday.

C. difficile is a deadly diarrheal infection that poses a significant threat to U.S. health care patients,” Ileana Arias, principal deputy director at the U.S. Centers for Disease Control and Prevention, said during a morning news conference. “C. difficile is causing many Americans to suffer and die.”

The germ is linked to about 14,000 deaths in the United States every year. People most at risk from C. difficile are those who take antibiotics and also receive care in any medical facility.

“This failure is more difficult to accept because these are treatable, often preventable deaths,” Arias said. “We know what can be done to do a better job of protecting our patients.”

Much of the growth of this bacterial epidemic has been due to the overuse of antibiotics, the CDC noted in its March 6 report. Unlike healthy people, people in poor health are at high risk for C. difficile infection.

Almost 50 percent of infections are among people under 65, but more than 90 percent of deaths are among those aged 65 and older, according to the report.

Previous estimates found that about 337,000 people are hospitalized each year because of C. difficile infections. Those are historically high levels and add at least $1 billion in extra costs to the health care system, the CDC said.

However, these estimates might not completely reflect C. difficile’s overall impact.

According to the new report, 94 percent of C. difficile infections are related to medical care, with 25 percent among hospital patients and 75 percent among nursing home patients or people recently seen in doctors’ offices and clinics.

Although the proportion of infection is lowest in hospitals, they are at the core of prevention because many infected patients are transferred to hospitals for care, raising the risk of spreading the infection there, the CDC said.

Half of those with C. difficile infections were already infected when they were admitted to the hospital, often after getting care at another facility, the agency noted.

The other 50 percent of infections were related to care at the hospital where the infection was diagnosed.

The CDC said that these infections could be reduced if health care workers follow simple infection control precautions, such as prescribing fewer antibiotics, washing their hands more often and isolating infected patients.

These and other measures have reduced C. difficile infections by 20 percent in hospitals in Illinois, Massachusetts and New York, the CDC said.

In England, infections have been cut 50 percent in three years, the agency said.

Patients get C. difficile infections mostly after taking antibiotics, which can diminish the body’s “good” bacteria for several months.

That’s when patients can get sick from C. difficile, which can be picked up from contaminated surfaces or spread by health care providers.

The predominant sign of C. difficile infection is diarrhea, which can cause dehydration. If serious, the infection can become deadly. Other symptoms include fever, nausea and loss of appetite.

The CDC advises that if diarrhea occurs after a patient starts antibiotics, C. difficile should be suspected and treatment continued with another antibiotic.

Commenting on the report, infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University, said, “All these recommendations are fine; the problem is they are not going to work, you can’t stop these practices. This bug exists in a climate of overuse of antibiotics.”

Food Swaps to Lower Cholesterol

  • Making an effort to lower your cholesterol numbers can require some serious life changes, most drastically when it comes to your diet. For many people, the “bad for you” list looks a lot like a list of favorite foods — and that’s the biggest challenge.

    But smart food choices are essential for lowering cholesterol and lowering your risk of heart attack. Watching your diet can reduce your cholesterol levels without medication, or enhance the effects of the cholesterol-lowering drug you take. “Your genetics play a big role in your cholesterol level, but so do other factors — including diet — and the foods you eat can help to lower it,” says Harvey Kramer, MD, a cardiologist at Danbury Hospital in Danbury, Connecticut.

    If your new diet rules seem daunting, here are some simple food swaps for an easier transition.

    Scallops Instead of Red Meat

    Swapping out red meat for fish — especially fattier varieties, like salmon — may contribute to lower cholesterol numbers overall, says Sue Gebo, RD, MPH, a nutrition expert and assistant professor of family medicine at the University of Connecticut Medical School in Hartford.

    Scallops are a particularly healthy substitute because they’re among the lowest in fat of all fish choices, so you’ll save on calories, too. Plus, Gebo adds, “they have a rich texture and a very satisfying flavor, especially when they’re grilled.”

    Crushed Walnuts Instead of Croutons on Salad

    High-fiber vegetables are great for lowering cholesterol, so salads are a go — that is, until you top them off with high-carb croutons, which may also be high in unhealthy fats. Enter heart-healthy nuts; walnuts in particular are a great healthy food swap for garnishing a salad. A study published in March 2014 in the journal Metabolism showed that when people added 43 grams (g) of walnuts (about 6 tablespoons) to their diet every day for two months, their bad cholesterol levels went down significantly — by about 7 milligrams per deciliter (mg/dL) more than a control diet. And when it comes to nuts, walnuts are a particularly heart-healthy food for low cholesterol because they’re rich in polyunsaturated fatty acids, a healthier type of fat.

    Canadian Bacon Instead of Regular Bacon

    Bacon lovers, rejoice! While 1 ounce (about 3 slices) of regular bacon contain a whopping 12 g of fat, 3 ounces of Canadian bacon have less than half of that amount — 5 g of fat. “I don’t know why they call it bacon, because Canadian bacon is really just round slices of really lean ham,” says Gebo. No matter what you call it, it’s by far a better, healthier option.

    An English Muffin Instead of a Croissant

    Those flaky, perfectly shaped croissants look delicate and delicious at the bakery, but the layers of flour and butter equal a big mistake if you’re watching your cholesterol. Butter is high in cholesterol-raising saturated fat, while a whole grain English muffin not only has less saturated fat, but also adds around 4 g of heart-healthy fiber. Making this swap will put you well on your way to the American Heart Association’s recommended 25 g of fiber a day to help lower your cholesterol.

    Dark Chocolate Instead of Milk Chocolate

    If you’re a chocoholic trying to stick to a heart-healthy diet, opt for the dark stuff. While milk chocolate contains saturated fat that can raise your LDL (“bad”) cholesterol, you can choose dark chocolate and skip most of the fat. Studies have shown that dark chocolate may actually boost your HDL (“good”) cholesterol, too. Cocoa butter contains oleic acid, a healthier monounsaturated fat like that in olive oil. Additionally, cocoa may lower LDL cholesterol in people at risk for heart disease. Just make sure the dark chocolate you choose has 70 to 80 percent cacao, suggests Chauncey Crandall, MD, cardiologist at the Palm Beach Gardens Medical Center and the Good Samaritan Medical Center in West Palm Beach, Florida.

     

    Hummus Instead of French Onion Dip

    You probably already know to skip potato chips in favor of vegetables such as celery and carrot sticks, but what’s the best choice for dipping? Hint: It’s not the favorite high-calorie French onion dip. Hummus, made from mashed chickpeas and heart-healthy olive oil, is just as tasty and has both fiber and protein, unlike saturated fat-rich cream-based dips. You can also pair it with whole grain pita chips, which aren’t fried like potato chips.

     

    Ground Turkey Chili Instead of Beef Chili

    If you’re a purist, you may not favor ground turkey itself; even in burgers, it can taste like, well, turkey. But lean ground turkey, which usually contains 7 percent fat compared with the 20 percent fat content of that “80 percent lean” ground beef at the market, is a cinch to disguise. The lower the saturated fat, the less detrimental it is to your cholesterol level. Even better, “no one can tell the difference,” says Gebo, who uses ground turkey all the time to make chili. One more diet tip for lower cholesterol: Ground turkey makes a great substitute for ground beef in dishes like meatballs or meatloaf.

     

    Roasted Potatoes Instead of French Fries

    French fries are, well, fried and usually doused in fat, so they’re a good food to skip when you’re watching your cholesterol levels. Avoid ordering fries at restaurants whenever possible. Instead, make them at home, where you can control the preparation (it’s easy to roast them rather than fry them). Gebo’s recipe: Cut a potato into sections, brush with olive oil, and bake in the oven — 20 minutes at 450 degrees should be enough to render them nice and crispy. Sprinkle them with pepper for more flavor.

    Swapping out red meat for fish — especially fattier varieties, like salmon — may contribute to lower cholesterol numbers overall, says Sue Gebo, RD, MPH, a nutrition expert and assistant professor of family medicine at the University of Connecticut Medical School in Hartford.

    Scallops are a particularly healthy substitute because they’re among the lowest in fat of all fish choices, so you’ll save on calories, too. Plus, Gebo adds, “they have a rich texture and a very satisfying flavor, especially when they’re grilled.”

Why Checkups Are Vital

When you were little, your parents probably made sure you had an annual checkup with your doctor. But as you’ve grown older, you may have gotten out of this habit.

Health professionals stress that these regular exams are important to help identify risk factors and problems before they become serious. If diseases are caught early, treatments are usually much more effective. Ultimately, having a regular doctor’s visit will help you live a long and healthy life.

Doctor’s Visit: The Prevention Checkup

Depending on your age, sex, and family medical history, a checkup with your doctor may include:

  • Blood, urine, vision, and hearing tests to evaluate your overall health
  • Assessments of your blood pressure, cholesterol level, and weight
  • A discussion about your diet and exercise habits and any tobacco, drug, and alcohol use
  • Immunizations and booster shots
  • Screenings to assess your risk of developing certain diseases, including diabetes (if you already have high blood pressure or high cholesterol) and cancer
  • Depending on your age and sexual lifestyle, testing for STDs and possibly HIV
  • Starting at age 50, or younger if you have a family history, a screening test for colorectal cancer
  • A discussion about depression and stress to evaluate your mental health

Doctor’s Visit: Concerns for Men

For men, in addition to checking weight, high blood pressure, and other basics, your doctor’s visit may specifically include:

  • Starting at age 50, or younger if you have a family history, a rectal exam to check for abnormal bumps in the prostate and a prostate specific antigen (PSA) blood test to screen for prostate cancer
  • Between the ages of 65 and 75 if you have ever smoked cigarettes, an abdominal exam to check for an enlargement in your aorta; an abdominal aortic aneurysm, a weakness in the lining of the aorta (a large blood vessel in your chest and abdomen), can develop with age and become a life-threatening problem.

Doctor’s Visit: Concerns for Women

For women, in addition to checking weight, high blood pressure, and other basics, your doctor’s visit may specifically include:

  • A test for cervical cancer, called a Pap smear, every one to three years
  • A clinical breast exam to check for any unusual lumps or bumps in your breasts
  • Starting at age 40 (or younger if you have a strong family history for breast cancer), a breast cancer screening with a mammogram every one to two years
  • Starting at age 65, a referral for a bone density test to screen for osteoporosis, the disease that causes brittle, fragile bones and typically affects older women; women with more than one risk factor for osteoporosis may start earlier

Doctor’s Visit: Preparation

It’s important for you to play an active role to get the most out of your doctor’s visit. Before your exam, review and update your family health history, be prepared to ask if you’re due for any general screenings or vaccinations, and come up with a list of questions if you have particular health concerns.

Related Recall of Medicines

A recall of certain medicines due to odor problems has been expanded by Johnson & Johnson’s McNeil Consumer Healthcare unit.

On Jan. 15, the company recalled a number of over-the-counter medicines due to consumer complaints about a moldy smell that caused nausea and sickness in some people, the Associated Press reported.

The expanded recall covers four lots of Benadryl Allergy Ultratablets and one lot of Extra Strength Tylenol that were distributed in the United States, Puerto Rico, Bermuda and Tobago.

The odor is from a chemical treatment on wooden pallets used to store and transport packaging materials for medications, the AP reported.

Kidney stones are small chunks of solid material that can form in your kidneys, a pair of organs that filter your blood.

The “stones,” which are usually yellow and brown, vary in size and shape.

For instance, some may be jagged and as small as a grain of sand, while others may be lumpy and the size of golf balls.

A stone may stay in the kidney or travel down the urinary tract — the body’s waste and excess-water drainage system — and get stuck, causing severe pain in the belly or side of the back.

Other symptoms may include nausea, chills, and blood in the urine.

Prevalence and Demographics of Kidney Stones

Kidney stones are one of the most common disorders of the urinary tract, resulting in more than a million visits to health care providers and 300,000 emergency room visits each year in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

About one in 11 people in the United States, or 8.8 percent of the population, have had a kidney stone, according to a 2012 report in the journal European Urology.

Kidney stones affect both men and women, though struvite stones are more common in women and uric acid stones are more common in men.

Overall, however, the prevalence of kidney stones is higher in men than women.

Kidney stones are also more common in obese people than non-obese people, and less common in non-Hispanic African and Mexican-Americans than in non-Hispanic Caucasians, according to the European Urology study.

What Are the Kidneys?

Part of the urinary system, your two kidneys are fist-sized, bean-shaped organs, located just below the rib cage, one on each side of the spine.

They have a number of important functions, mainly filtering the blood to remove waste and excess water, resulting in the formation of urine, which is stored in the bladder and emptied from the body through the urethra.

What You Need to Know

images-23Most people think of rheumatoid arthritis as a joint disease, but like other autoimmune disorders, it can impact different areas of the body as well. One of the more common complications for people with rheumatoid arthritis is eye problems, which can lead to corneal damage and ultimately impact vision if left untreated.

Some common eye conditions, like the ones described below, may affect people with rheumatoid arthritis (RA). But there are steps to take to safeguard eye health and avoid permanent damage.

Dry Eyes

“RA can be associated with extra-articular [meaning outside the joint] manifestations, and dry eyes are one of the most common problems,” says Ana-Maria Orbai, MD, instructor of medicine in the division of rheumatology at the Johns Hopkins University School of Medicine in Baltimore. “A person with dry eyes might experience itching, a sand-like sensation in the eyes, and redness.” They may also notice a lack of moisture or tears in the eyes, as well as blurred vision.

Although many people turn to over-the-counter eye drops for relief, the best treatment for dry eyes is prescription drops, which you can get from your ophthalmologist, Dr. Orbai says. A doctor who specializes in medical care of eyes, whereas an optometrist focuses primarily on vision problems, this eye MD can prescribe the right kind of eye medication for different uses (day versus night, for instance).

If you decide to go the over-the-counter route, avoid eye-drop products that have preservatives or vasoconstrictive agents, such as some from Visine and Clear Eyes, which often promise to relieve redness or “take the red out,” Orbai explains.

If your dry eyes are severe, your doctor might discuss the option of punctal plugs, a minor procedure that entails having a small plug inserted into the tear duct to keep the eye from draining. Your doctor may also prescribe Restasis (cyclosporine) drops.

Scleritis

Scleritis is an inflammation of the sclera, the white outer layer of the eye. Symptoms can include pain (sometimes severe), swelling, redness, blurred vision, tearing, and sensitivity to light. If you experience any of these issues, you should be evaluated by your ophthalmologist, Orbai says. And don’t delay seeking treatment. “Time is of the essence to prevent eye damage and vision loss,” she says. If it ends up being scleritis, your ophthalmologist may prescribe corticosteroid eye drops and possibly immunomodulator medications, she says.

Iritis and Uveitis

A quick anatomy lesson: The uvea is the middle part of the eye between the sclera and retina, which is in the back of the eye. The iris is the colored part of the eye that helps control how much light enters.

Uveitis is an inflammation of the uvea; iritis, a form of uveitis, is an inflammation of the iris. Symptoms include blurred vision; dark, floating spots in your vision; eye pain; redness; and sensitivity to light.

Treatment for either condition depends on the symptoms, Orbai explains. “Some options include corticosteroids, Trexall (methotrexate), Humira (adalimumab), and Remicade (infliximab). Your ophthalmologist will determine the right course of treatment for you based on your symptoms.

Medication Complications

Some of the medications used to treat rheumatoid arthritis, such as prednisone (a corticosteroid) and Plaquenil (hydroxychloroquine), can actually trigger eye problems. “Plaquenil, on rare occasions, can cause retinopathy,” says Orbai — an inflammatory disease of the retina that can lead to impairment or loss of vision. And prednisone can cause cataracts or glaucoma, or worsen these conditions if you already have them.

“People who need to take medications that have side effects that impact the eye should see an ophthalmologist who can monitor for adverse effects,” says Orbai. “For example, patients using Plaquenil should be seen yearly to rule out retinopathy.” If they do develop the condition, the doctor may decrease the dosage or stop the medication. “The most important precaution is to minimize duration of treatment: Take the least amount for the shortest time,” Orbai says.

Weight Loss Plan

If you have rheumatoid arthritis (RA), it’s important to maintain a healthy weight.

The reason: Obesity can worsen RA and make its treatments less effective, according to a 2014 review published in Autoimmunity Reviews. As for people who don’t have RA, obesity can increase their risk for developing both this condition and other autoimmune diseases, the researchers found.

Another review, published in May 2016 in Arthritis Care & Research, found that people with RA who were obese were less likely to reach remission than those who were at a normal weight.

Losing weight can lower the levels of inflammation in the body — the cause of RA-related joint pain and swelling. That’s because fat cells produce hormones called leptins, which aggravate inflammation, says Nathan Wei, MD, director of the Arthritis Treatment Center in Frederick, Maryland. “Regardless of what kind of arthritis you have, losing weight is a good thing for lowering inflammation,” he says.

A lower body weight can also help relieve pressure on your joints, which can reduce pain. In addition, losing weight can help reduce the risk of complications from RA, such as heart attack and stroke, Dr. Wei says.

Weight loss also generally helps improve your self-image, which can encourage you to make more healthy lifestyle choices. “It becomes a self-fulfilling prophecy,” Wei says.

Create Your RA Weight Loss Plan

Ready to get started? Follow these steps.

Reach out to professionals. A good starting place is to talk with your doctor — but don’t stop there. Seek out a nutritionist to help you plan meals and set a daily calorie intake goal. You can also see a physical therapist or personal trainer to help get your exercise routine on track.

Set specific goals. Weight-loss goals should be SMART — specific, measurable, attainable, relevant, and timely, says April Miller, RD, CPT, a clinical dietitian at the Healthy Living Center at the University of Rochester Medical Center in New York. For instance, a good goal might be to lose 5 pounds in a month by keeping a food journal and working out three times a week.

Start a journal. Before you even begin to make any changes to your diet, you should keep track of the foods you eat. This can help you see how you’re currently eating and look for places you can make improvements. A food journal can also help you meet your calorie goals and see which foods may cause inflammation and worsen your RA symptoms, Miller says. You can use a pen and paper or an electronic food tracker to keep track of what you’re eating, and also record the times of the day when your symptoms are worse.

Stock up on RA-friendly foods. The same foods that can help you lose weight may also help minimize symptoms of RA. Fruits and vegetables are high in fiber, which helps you feel fuller and may help reduce inflammation. Aim for 25 to 30 grams of fiber a day, Miller says. Other foods to include in your RA-friendly diet are cold-water fatty fish like salmon, tuna, trout, herring, and mackerel — aim for two weekly servings — and extra-virgin olive oil, which you can use for salad dressings, marinades, and roasting vegetables. “The easiest way to make healthy food choices is to look at your plate,” Miller says. “If half of it is filled with fruits and vegetables, you’re in good shape.” The rest should be split between lean protein and whole grains.

Choose an exercise to try. If you’re out of shape, start by slowly incorporating exerciseinto your routine and be gentle on your joints. Try low- or no-impact activities like swimming, water exercises, and cycling. Also be sure to do a mix of cardiovascular exercise, resistance training, and stretching, says Wei.

Put it on your calendar. Physically allotting time for exercise, grocery shopping, and cooking can help you achieve your goals. Miller says some of her clients add in exercise as a private appointment on their work calendars. It helps them commit to it and communicates to co-workers that they’ll be unavailable during that time, she explains.

Reward yourself for progress. Being able to move with less pain and stiffness might be reward enough. But for extra motivation, try planning a spa day or another healthy indulgence after reaching weight-loss milestones.

Overcome weight-loss plateaus. When you find yourself hitting a roadblock, it may be time to lower your daily calorie goal or change up your workout routine. Incorporating more strength training is a good way to mix up your level of physical activity. “It’s one of the last things people try,” Miller says. And it might be just the thing you need to get over a hump.