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Saturday, 28 February 2015
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Ways to Treat Depression That Aren’t Antidepressants
Reviewed by Brunilda Nazario, MD
Feb. 27, 2015 -- There may be hope for hard-to-treat depression as scientists explore novel approaches to the often crippling condition.
Recently, a number of studies have suggested the benefits of Botox, ketamine, and certain sometimes-unexpected means of treating depression.
“I’m excited in general, and I’m curious,” says Peter D. Kramer, MD, author of Listening to Prozac and Against Depression.
Each year, around 16 million U.S. adults battle major depression. Many of them benefit from antidepressants. But as many as a third get depressive symptoms despite medication. And side effects, which can include weight gain, nausea, and insomnia, are troublesome for some patients. That leaves many people with depression searching for alternatives.
But if Kramer is hopeful about the newer, novel ways to treat the condition, he’s also cautious. The studies backing those treatments aren't conclusive, and none of the approaches have been approved by the FDA to treat depression (though some, such as ketamine, have been approved for other uses).
“Things are merely hopeful until they are demonstrated [safe and effective],” Kramer says. “It’s always hard to tell what’s going on, but it’s a very interesting time, and I think some of them will come through.”
Here’s a closer look at what might be used to help treat depression in years to come.
Ketamine. Already in use in certain clinics and in some emergency departments around the country, ketamine is an anesthetic most often used during surgery. It's given through an IV, and it quickly eases symptoms of depression, often in a matter of hours. The benefit is temporary, though.
One recent study found it to be very good at helping curb suicidal thoughts in severely depressed people. But it's expensive, still experimental as a depression treatment, and can cause hallucinations and other side effects.
“Some people are very uncomfortable with the side effects,” says Alan Manevitz, MD, a psychiatrist who specializes in treatment-resistant depression at Lenox Hill Hospital in New York City.
Nitrous oxide, or laughing gas. This is an anesthetic commonly used by dentists. A small study published last December reports that nitrous oxide improved depression symptoms within less than 2.5 hours.
source : Ways to Treat Depression That Aren’t Antidepressants
Hepatitis C Infections in Hospitals Show Need for Tight Infection Control Practices
In both cases, there were breaches in safety rules, CDC reports
WebMD News from HealthDay
By Steven Reinberg
HealthDay Reporter
FRIDAY, Feb. 27, 2015 (HealthDay News) -- Two cases of hepatitis C infection that occurred during routine surgeries highlight the need for hospitals to tighten infection control to prevent more transmissions, officials said Friday.
In one case, two New Jersey patients (one of them had hepatitis C) received an injection of the anesthetic propofol from the same medication cart. In the other instance, two Wisconsin patients (one of them had hepatitis C) received kidneys that had been prepared for transplantation on the same machine, according to an article in the Feb. 27 issue of Morbidity and Mortality Weekly Report, a publication of the U.S. Centers for Disease Control and Prevention.
The source of the infection in the Wisconsin case was not pinpointed, said Gwen Borlaug, coordinator of the HAI Prevention Program at the Wisconsin Division of Public Health, but "we identified breaches in infection control practices in the operating room that likely resulted in the transmission."
In the New Jersey case, the infection was traced to contaminated equipment that was taken from one operating room to another. Dr. Barbara Montana, medical director of the communicable disease service at the New Jersey Department of Health, said, "Fortunately, these infections can be prevented when health care providers follow basic infection prevention practices."
According to the CDC, 22 outbreaks of health-care-associated hepatitis infections occurred from 2008 through 2014. Most of the outbreaks occurred in outpatient care centers and long-term care facilities.
These outbreaks typically involved unsafe injection practices, such as using medication vials on multiple patients or reusing needles or syringes, Borlaug said. Other outbreaks have occurred as a result of contaminated items, such as blood sugar testing devices, she said.
"It is imperative to always practice sound infection control measures, such as cleaning and disinfecting used medical equipment and patient care items, and observing safe injection practices," Borlaug said.
Patients can also play a part in preventing these infections, Montana said.
"Patients should ask questions about infection prevention practices, such as whether health care providers are following good infection prevention practices, including hand washing and using a new needle/syringe for each patient and cleaning equipment between patients," she said.
source : Hepatitis C Infections in Hospitals Show Need for Tight Infection Control Practices
Actor Leonard Nimoy Dies of COPD at Age 83
WebMD News from HealthDay
Feb. 27, 2015 -- Leonard Nimoy, best known for his role as Mr. Spock on "Star Trek," died Friday morning at age 83.
The actor was hospitalized earlier this week and died at his home in Los Angeles. His wife, Susan Bay Nimoy, confirmed his death and said the cause was end-stage chronic obstructive pulmonary disease (COPD), The New York Times reported.
Last year, Nimoy announced he had the disease and said it was caused by his years of smoking, which he gave up three decades ago.
Nimoy was cast as Mr. Spock -- the Vulcan first officer of the starship Enterprise -- in the original "Star Trek" series, which first aired in the mid-1960s but was canceled after three seasons. Nimoy continued to play Spock in subsequent movies and TV series, with his last appearance in the 2013 movie "Star Trek Into Darkness."
source : Actor Leonard Nimoy Dies of COPD at Age 83
Immune System Changes Tied to Chronic Fatigue Syndrome
Researchers saw evidence only in first 3 years of disease, findings could lead to early test
WebMD News from HealthDay
By Dennis Thompson
HealthDay Reporter
FRIDAY, Feb. 27, 2015 (HealthDay News) -- Chronic fatigue syndrome appears to be linked to specific changes in a person's immune system, particularly increased amounts of chemical messengers that regulate immune responses, researchers report.
The study adds to growing evidence that chronic fatigue syndrome is caused by a malfunctioning immune system, said lead author Dr. Mady Hornig. She is director of Translational Research at the Jerome L. and Dawn Greene Infectious Disease Laboratory at Columbia University's Mailman School of Public Health, in New York City.
The immune system of a new chronic fatigue syndrome patient appears unable to shut down or reduce its response to an infection that has passed, Hornig said.
Instead, the system continues to pump out large amounts of cytokines -- chemical messengers that coordinate the response of the immune system's many cell types.
"Their immune system is no longer resilient and able to bounce back after this cytokine surge" in response to an infection, Hornig said. "We need the system to be regulated, so it shuts off after the disease is gone, and that isn't happening here."
Doctors now can look for increased levels of these chemicals in the blood of patients who might have chronic fatigue syndrome, potentially aiding in their diagnosis, she said.
"We may be able to reduce the time it takes to get a diagnosis, and reduce the time it takes to get them some treatment," Hornig said. Treating chronic fatigue syndrome early could reduce its future impact on patients' lives, she added.
The new study, published Feb. 27 in the journal Science Advances, comes on the heels of a new Institute of Medicine report that declared chronic fatigue syndrome a "legitimate" illness that should be treated by doctors as a disease rather than an emotional problem.
Between 836,000 and 2.5 million Americans suffer from chronic fatigue syndrome, and an estimated 84 percent to 91 percent of people with the disorder are not diagnosed, according to the IOM. Chronic fatigue syndrome tends to strike people in their 40s and 50s, and occurs four times more often in women than men.
source : Immune System Changes Tied to Chronic Fatigue Syndrome
1 in 5 Preemies With Lung Disease Exposed to Secondhand Smoke
22 percent were from what parents said were nonsmoking homes, study finds
WebMD News from HealthDay
By Robert Preidt
HealthDay Reporter
FRIDAY, Feb. 27, 2015 (HealthDay News) -- High levels of nicotine were found in the hair of many children with premature birth-related lung disease whose parents claimed not to smoke, a new study finds.
The lung disease bronchopulmonary dysplasia often occurs in children who were born prematurely. Not surprisingly, exposure to tobacco smoke can be harmful for children with this condition, according to the researchers.
In this study, Johns Hopkins Children's Center researchers analyzed nicotine levels in hair samples from 117 children younger than 3. All of the children had been seen at the bronchopulmonary dysplasia clinic between January 2012 and January 2014.
During those visits, parents provided information about the children's exposure to tobacco smoke at home.
The researchers found that about 20 percent of the children were exposed to tobacco smoke at home. However, 22 percent of the babies who lived in what their parents said were nonsmoking homes had hair nicotine levels similar to children who lived in homes with smoking.
This means that parents provided inaccurate information about smoking in the home or the children were exposed to tobacco smoke somewhere else, according to the study published recently in the journal Pediatrics.
Many of the children live in multi-unit housing where smoking is permitted and may be exposed to tobacco smoke that way, the researchers suggested.
"We found that more than one-fifth of children whose caregivers report nonsmoking households have significant exposure," Dr. Sharon McGrath-Morrow, a lung specialist and professor of pediatrics, said in a Hopkins news release.
The researchers also found the effects of tobacco smoke exposure were more significant for the children who needed either supplemental oxygen or mechanical ventilation to breathe. They saw a six- to seven-fold higher risk of hospitalizations and activity limitations when these youngsters showed signs of exposure to smoke.
"Tobacco smoke is a modifiable exposure," McGrath-Morrow said. "If we could prevent [smoke exposure] in these children, they'd likely have better outcomes."
She added that she hoped that the study might lead to better ways to protect these vulnerable children.
source : 1 in 5 Preemies With Lung Disease Exposed to Secondhand Smoke
5 Things to Do After a Surprise Pregnancy
By Camille Noe Pagán
WebMD Feature
Reviewed by Traci C. Johnson, MD, FACOG
An unplanned pregnancy can be quite a shock, but there’s no reason to panic. You’re not alone. Almost half of all pregnancies in the U.S. are surprises.
Here are the first five steps you should take.
1. Call your primary care doctor or ob/gyn and make an appointment. “It’s important to see your doctor so she can figure out how far along your pregnancy is. That helps determine your care and next steps,” says Maureen Phipps, MD, chief of obstetrics and gynecology at Women & Infants Hospital of Rhode Island.
If you don’t plan on keeping the baby, now is the time to consider abortion or adoption.
If you don’t know how long it’s been since you had your last period, be sure to tell the doctor’s office that. Also let them know if you’re taking any prescription or over-the-counter medications, or if you have a health condition like diabetes or depression. If so, your doctor may want to see you right away, or may refer you to a specialist.
2. If you’re not doing so already, start taking a prenatal vitamin that has 400 mcg of folic acid right away. “Folic acid reduces the risk of brain, spine, and spinal cord defects in babies. In order for folic acid to work, you want to have it in your system before and during the first few weeks of pregnancy,” says Siobhan Dolan, MD. Dolan is a professor of obstetrics and gynecology and women’s health at Albert Einstein College of Medicine.
3. If you drink alcohol, smoke cigarettes, or use drugs, stop right away. All three can be harmful to your baby.
4. Take good care of yourself. If you weren’t expecting to get pregnant, you may feel stressed or depressed. If you do, talk to your doctor or another health professional, such as a psychologist or social worker. Eat healthy and drink lots of water to help keep your energy up.
5. Steer clear of things that can put your pregnancy at risk, including:
- Cat litter (cat feces can give you a dangerous infection called toxoplasmosis)
- Raw meat
- Unpasteurized foods
- Seafood that’s high in mercury, including tuna, swordfish, and shark
source : 5 Things to Do After a Surprise Pregnancy
Friday, 27 February 2015
5 Things To Know About The Supreme Court Case Challenging The Health Law
By Julie Rovner
Fri, Feb 27 2015
The Affordable Care Act is once again before the Supreme Court.
On March 4, the justices will hear oral arguments in King v. Burwell, a case challenging the validity of tax subsidies helping millions of Americans buy health insurance if they don’t get it through an employer or the government. If the court rules against the Obama administration, those subsidies could be cut off for everyone in the three dozen states using healthcare.gov, the federal exchange website. A decision is expected by the end of June.
Here are five things you should know about the case and its potential consequences:
1: This case does NOT challenge the constitutionality of the health law.
The Supreme Court has already found the Affordable Care Act is constitutional. That was settled in 2012’s NFIB v. Sebelius.
At issue in this case is a line in the law stipulating that subsidies are available to those who sign up for coverage “through an exchange established by the state.” In issuing regulations to implement the subsidies in 2012, however, the IRS said that subsidies would also be available to those enrolling through the federal health insurance exchange. The agency noted Congress had never discussed limiting the subsidies to state-run exchanges and that making subsidies available to all “is consistent with the language, purpose and structure” of the law as a whole.
Last summer, the U.S. Court of Appeals for the Fourth Circuit in Richmond ruled that the regulations were a permissible interpretation of the law. While the three-judge panel agreed that the language in the law is “ambiguous,” they relied on so-called “Chevron deference,” a legal principle that takes its name from a 1984 Supreme Court ruling that held that courts must defer to a federal agency’s interpretation as long as that interpretation is not unreasonable.
Those challenging the law, however, insist that Congress intended to limit the subsidies to state exchanges. “As an inducement to state officials, the Act authorizes tax credits and subsidies for certain households that purchase health insurance through an Exchange, but restricts those entitlements to Exchanges created by states,” wrote Michael Cannon and Jonathan Adler, two of the fiercest critics of the IRS interpretation, in an article in the Health Matrix: Journal of Law-Medicine.
source : 5 Things To Know About The Supreme Court Case Challenging The Health Law
Rear End Takes a Front Seat in Plastic Surgery Offices
By Robert Preidt
HealthDay Reporter
THURSDAY, Feb. 26, 2015 (HealthDay News) -- Butt enhancement helped boost cosmetic procedures in the United States by 3 percent last year, according to a new report.
Americans saddled with sagging, small or otherwise run-of-the-mill fannies underwent 11,505 buttock augmentations with fat grafting (up 15 percent from 2013), the American Society of Plastic Surgeons reported.
More than 3,500 buttocks were lifted (up 44 percent from the year before), according to a society news release.
And buttock implants -- chosen by over 1,800 Americans -- rocketed 98 percent over the previous year.
Plastic surgery among men also grew in popularity, the 2014 report noted.
"Male plastic surgery rates have significantly increased since 2000, and the notion that cosmetic procedures are just for women no longer exists," society president Dr. Scot Glasberg said in the news release.
Some men wanted bigger chests: Plastic surgeons performed 1,054 pectoral implants (208 percent more than in 2013).
And more than 26,000 men underwent breast reductions (29 percent more than in 2000).
"Men are seeking to regain a more youthful look, improve their self-image and feel better about their appearance," Glasberg added.
Overall, 15.6 million minimally invasive and surgical cosmetic procedures were performed in the United States in 2014. There were also 5.8 million reconstructive surgeries performed -- a 1 percent increase from 2013.
Demand for minimally invasive and cosmetic procedures continued. The top five procedures were: botulinum toxin type A, or Botox (6.7 million); soft-tissue fillers (2.3 million); chemical peels (1.2 million); laser hair removal (1.1 million); and microdermabrasion (nearly 882,000). All except microdermabrasion racked up increases from 2013.
America's favorite surgical procedures had their ups and downs, the study found. Breast augmentations fell 1 percent compared to 2013. Nose reshaping dropped 2 percent, eyelid surgery declined 4 percent and facelifts fell off 4 percent.
Liposuction, however, jumped up 5 percent in the year-to-year figures.
Breast cancer patients underwent over 102,000 breast reconstructions, a 7 percent increase from 2013.
"It's encouraging to see a significant rise in breast reconstruction rates, because studies show that reconstruction can greatly improve a patient's quality of life and self-image," Glasberg said. "But, not all breast cancer patients undergo breast reconstruction, in some cases because they are not informed of all of their reconstructive options."
source : Rear End Takes a Front Seat in Plastic Surgery Offices
Could Coffee Lower Risk of Multiple Sclerosis?
Studies link several cups daily with reduced odds for the disease
WebMD News from HealthDay
By Amy Norton
HealthDay Reporter
THURSDAY, Feb. 26, 2015 (HealthDay News) -- People who down several cups of coffee every day may have a decreased risk of developing multiple sclerosis, a new study suggests.
The study, of 5,600 Swedish and U.S. adults, found that those who drank four to six cups of coffee a day were about one-third less likely to develop multiple sclerosis (MS), compared with people who did not drink coffee.
Researchers stressed that the findings do not prove that coffee fights MS -- a disease in which the immune system mistakenly attacks the protective sheath around nerve fibers in the brain and spine. Symptoms can include muscle weakness, numbness, vision problems and difficulty with balance and coordination.
"This doesn't mean we should be recommending rampant coffee drinking," said lead researcher Dr. Ellen Mowry, an assistant professor of neurology at Johns Hopkins University in Baltimore.
There could, for instance, be something else about coffee drinkers -- such as a diet or lifestyle habit -- that is the real explanation behind their lower MS risk, Mowry explained.
"Until we are able to prove that coffee -- or some component of coffee, like caffeine -- is actually helpful, we can't make any recommendations," she cautioned.
And that is partly because all that caffeine could have negative effects, too, she said.
Still, the findings do build on evidence that coffee and possibly caffeine specifically are "neuroprotective," Mowry said. Higher coffee intake has been linked to lower risks of other diseases that involve degeneration in brain cells, including Parkinson's disease and Alzheimer's, she noted.
And, Mowry added, scientists have found that high caffeine intake can protect lab mice from developing an MS-like condition -- by blocking part of the inflammatory process that damages nerves in the brain and spine.
"So it's plausible that coffee has some protective effect, with the caveat that a lot of things seen in lab animals do not pan out in humans," Mowry said.
She is scheduled to present the findings -- which are considered preliminary until published in a peer-reviewed medical journal -- in April, at the annual meeting of the American Academy of Neurology in Washington, D.C. The academy released the results Thursday, ahead of the conference.
source : Could Coffee Lower Risk of Multiple Sclerosis?
Flu Vaccine Just 18% Effective This Year
Reviewed by Brunilda Nazario, MD
Feb. 26, 2015 -- It’s no secret this year’s flu shots didn’t work as well as doctors had hoped. But the news got worse Thursday when the CDC revised its estimates of the flu vaccine’s effectiveness downward even further, from 23% to 18%.
That means for all ages, getting vaccinated cut the risk of needing medical treatment for flu symptoms by just 18%.
“That’s crummy, at best. This year was a bum year,” says William Schaffner, MD, an infectious disease expert and a professor at the Vanderbilt University School of Medicine in Nashville, TN.
And there’s more bad news: Early numbers show that for the second flu season in a row, the FluMist nasal spray, aimed mainly at children, didn’t work at all for kids ages 2 through 8.
That was a bit awkward for the CDC, which had just advised doctors that they choose the nasal spray over the shot for younger kids. Previous studies had suggested that FluMist was more protective than injections for kids in this age group.
Today the agency's advisory committee changed its position, telling doctors to use either kind of vaccine in children, with no particular preference for the nasal spray.
The vaccine-effectiveness percentage is just an average. The real effectiveness probably sits in a range between 6% and 29%, says Brendan Flannery, PhD, of the Center for Immunization and Respiratory Diseases at the CDC.
When the vaccine is a good match to the strains of flu making people sick, vaccine effectiveness has been as high as 60%.
This season’s dominant flu strain, H3N2, is different from the strains included in the flu vaccine, though.
So far this season, 86 children have died of the flu, and more than 13,000 people have been hospitalized with it, according to the CDC. The highest rate of hospitalizations is in adults older than 65. Most adults who've had to go to the hospital have had at least one underlying medical condition.
Experts say even though this flu season’s vaccine wasn’t up to par, people shouldn’t give up on getting their annual flu shots.
source : Flu Vaccine Just 18% Effective This Year
Surprises in Proposed New Dietary Guidelines
Feb. 26, 2015 -- Eggs are no longer bad guys. Coffee with those eggs? Go ahead, have a cup, maybe even three.
Those are among the latest recommendations an expert advisory panel has made for the upcoming "2015 Dietary Guidelines for Americans" -- and the group's report is turning some conventional thinking on its head.
The panel's advice is under review by the Department of Health and Human Services and the USDA, which will issue the guidelines jointly later this year. The guidelines are published every 5 years, and they reflect the latest science-based evidence about what we eat. They can help people make healthy food choices through the USDA’s MyPlate program.
The advisory committee's new report puts an emphasis on eating a plant-based diet, including vegetables, fruits, whole grains, legumes, nuts, and seeds. But some so-called “bad” foods are back on the menu, too.
"The 2015 report reinforced much of what we saw in 2010,” such as the need for people to eat more plant-based meals, says Connie Diekman, RD, director of university nutrition at Washington University in St. Louis. But there are notable additions, such as the goal of eating without depleting environmental resources. "The mention of sustainability is new. No previous guidelines addressed it," she says.
Other unexpected recommendations include:
Caffeine is OK (within reason). For healthy adults, it’s all right to have up to 400 milligrams a day, or about three to five cups of coffee. This doesn’t apply to children and teens.
Coffee lovers still need to be aware of what they add to their java, says Sonya Angelone, RDN, a registered dietician in the San Francisco Bay area. Coffee with sugar and creamer added, or designer coffee drinks, can be loaded with calories and fat, she says.
Cholesterol is no longer a villain. The 2010 guidelines suggested we should limit cholesterol from foods to no more than 300 milligrams daily. (A large egg has about 186 mg of cholesterol.) Experts now say cholesterol is ''not a nutrient of concern," because cholesterol from foods doesn't cause higher blood cholesterol levels.
source : Surprises in Proposed New Dietary Guidelines
Surprises in Proposed New Dietary Guidelines
Feb. 26, 2015 -- Eggs are no longer bad guys. Coffee with those eggs? Go ahead, have a cup, maybe even three.
Those are among the latest recommendations an expert advisory panel has made for the upcoming "2015 Dietary Guidelines for Americans" -- and the group's report is turning some conventional thinking on its head.
The panel's advice is under review by the Department of Health and Human Services and the USDA, which will issue the guidelines jointly later this year. The guidelines are published every 5 years, and they reflect the latest science-based evidence about what we eat. They can help people make healthy food choices through the USDA’s MyPlate program.
The advisory committee's new report puts an emphasis on eating a plant-based diet, including vegetables, fruits, whole grains, legumes, nuts, and seeds. But some so-called “bad” foods are back on the menu, too.
"The 2015 report reinforced much of what we saw in 2010,” such as the need for people to eat more plant-based meals, says Connie Diekman, RD, director of university nutrition at Washington University in St. Louis. But there are notable additions, such as the goal of eating without depleting environmental resources. "The mention of sustainability is new. No previous guidelines addressed it," she says.
Other unexpected recommendations include:
Caffeine is OK (within reason). For healthy adults, it’s all right to have up to 400 milligrams a day, or about three to five cups of coffee. This doesn’t apply to children and teens.
Coffee lovers still need to be aware of what they add to their java, says Sonya Angelone, RDN, a registered dietician in the San Francisco Bay area. Coffee with sugar and creamer added, or designer coffee drinks, can be loaded with calories and fat, she says.
Cholesterol is no longer a villain. The 2010 guidelines suggested we should limit cholesterol from foods to no more than 300 milligrams daily. (A large egg has about 186 mg of cholesterol.) Experts now say cholesterol is ''not a nutrient of concern," because cholesterol from foods doesn't cause higher blood cholesterol levels.
source : Surprises in Proposed New Dietary Guidelines
U.S. Ebola Survivor Dr. Craig Spencer Gives His Side of the Story
Former volunteer in fight against West African outbreak felt vilified by media, politicians
WebMD News from HealthDay
By Dennis Thompson
HealthDay Reporter
THURSDAY, Feb. 26, 2015 (HealthDay News) -- Many U.S. politicians and media outlets hyped the threat of U.S. cases of Ebola last year, according to a newly written personal account by Dr. Craig Spencer, the last American Ebola patient treated in the United States.
He also believes that officials and the media unnecessarily maligned those who were risking their lives to combat the West African epidemic.
Spencer contracted the virus while performing aid work at an Ebola treatment center in Guinea, and fell ill days after his return to New York City. He entered Bellevue Hospital on Oct. 23 as New York's first Ebola patient, and spent 19 days there recovering from his infection.
"Though I didn't know it then -- I had no television and was too weak to read the news -- during the first few days of my hospitalization, I was being vilified in the media even as my liver was failing and my fiancee was quarantined in our apartment," Spencer wrote in a letter in the Feb. 26 New England Journal of Medicine.
While he was in the hospital, media outlets hyped the potential threat of Ebola and criticized Spencer for going out into the city after his return, he wrote. At the same time, politicians used the virus seemingly to score election-season points with voters by enacting poorly considered quarantines.
"After my diagnosis, the media and politicians could have educated the public about Ebola," Spencer wrote. "Instead, they spent hours retracing my steps through New York and debating whether Ebola can be transmitted through a bowling ball."
Fear motivated these decisions, and Spencer said as an American aid worker he well understands that fear, "because I felt it on a personal level."
He often woke up in the middle of the night during his work in Guinea, sweating and heart racing, convinced that he'd contracted Ebola even though his temperature was normal.
"Ebola is frightening not just because of its high fatality rate, but also because of how little we know about it," he wrote. "We cannot explain exactly what it does to our bodies, nor tell patients who survive it how it may affect them in the future."
source : U.S. Ebola Survivor Dr. Craig Spencer Gives His Side of the Story
Thursday, 26 February 2015
Women's Heart Attack Symptoms: 6 Possible Signs
Reviewed by James Beckerman, MD, FACC
When a heart attack strikes, it doesn’t always feel the same in women as it does in men.
Women don't always get the same classic heart attack symptoms as men, such as crushing chest pain that radiates down one arm. Those heart attack symptoms can certainly happen to women, but many experience vague or even “silent” symptoms that they may miss.
Do You Really Need Bypass Surgery?
It's the news you don't want to hear from your cardiologist: One or more of your coronary arteries -- the blood vessels that supply blood to your heart -- is blocked. You have coronary artery disease, the No. 1 killer of U.S. adults. So does this mean you're headed for bypass surgery? Maybe not, if your situation isn't an emergency. You might have other options -- including less drastic procedures to reopen those arteries, medication alone, or even radical lifestyle change. What's your best option?...
These six heart attack symptoms are common in women:
- Chest pain or discomfort. Chest pain is the most common heart attack symptom, but some women may experience it differently than men. It may feel like a squeezing or fullness, and the pain can be anywhere in the chest, not just on the left side. It's usually "truly uncomfortable" during a heart attack, says cardiologist Rita Redberg, MD, director of Women’s Cardiovascular Services at the University of California, San Francisco. "It feels like a vise being tightened."
- Pain in your arm(s), back, neck, or jaw. This type of pain is more common in women than in men. It may confuse women who expect their pain to be focused on their chest and left arm, not their back or jaw. The pain can be gradual or sudden, and it may wax and wane before becoming intense. If you're asleep, it may wake you up. You should report any "not typical or unexplained" symptoms in any part of your body above your waist to your doctor or other health care provider, says cardiologist C. Noel Bairey Merz, MD, director of the Barbra Streisand Women's Heart Center at Cedars-Sinai Medical Center in Los Angeles.
- Stomach pain. Sometimes people mistake stomach pain that signals a heart attack with heartburn, the flu, or a stomach ulcer. Other times, women experience severe abdominal pressure that feels like an elephant sitting on your stomach, says cardiologist Nieca Goldberg, MD, medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center in New York.
- Shortness of breath, nausea, or lightheadedness. If you're having trouble breathing for no apparent reason, you could be having a heart attack, especially if you're also having one or more other symptoms. "It can feel like you have run a marathon, but you didn't make a move," Goldberg says.
- Sweating. Breaking out in a nervous, cold sweat is common among women who are having a heart attack. It will feel more like stress-related sweating than perspiration from exercising or spending time outside in the heat. "Get it checked out" if you don't typically sweat like that and there is no other reason for it, such as heat or hot flashes, Bairey Merz says.
- Fatigue. Some women who have heart attacks feel extremely tired, even if they've been sitting still for a while or haven't moved much. "Patients often complain of a tiredness in the chest," Goldberg says. "They say that they can't do simple activities, like walk to the bathroom."
Not everyone gets all of those symptoms. If you have chest discomfort, especially if you also have one or more of the other signs, call 911 immediately.
source : Women's Heart Attack Symptoms: 6 Possible Signs
For Many Middle-Class Taxpayers On Obamacare, It’s Payback Time
By Anna Gorman
Thu, Feb 26 2015
Roberta and Curtis Campbell typically look forward to tax time. Most years, they receive a refund – a little extra cash to pay off credit card bills.
But this year the California couple got a shock: According to their tax preparer, they owe the IRS more than $6,000.
That’s the money the Campbells received from the federal government last year to make their Obamacare health coverage more affordable. Roberta, unemployed when she signed up for the plan, got a job halfway through the year and Curtis found full-time work. The couple’s total yearly income became too high to qualify for federal subsidies. Now they have to pay all the money all back.
“Oh my goodness, this is just not right,” said Roberta Campbell, who lives in the Sacramento suburb of Roseville. “This is supposed to be a safety net health care and I am getting burned left and right by having used it.”
As tax day approaches, hundreds of thousands of families who enrolled in plans through the insurance marketplaces could be stuck with unexpected tax bills, according to researchers. Those payments could be as high as $11,000, although most would be several hundred dollars, one study found.
The result is frustration and confusion among some working and middle-class taxpayers, whom the Affordable Care Act was specifically intended to help. The repayment obligations could dissuade people from re-enrolling and provide more fuel to Republicans’ continuing push for a repeal of the law.
The problem is that many consumers didn’t realize that the subsidies were based on their total year-end income and couldn’t reliably project what would happen over the course of the year, said Alyene Senger, research associate at The Heritage Foundation, a conservative think tank.
“How do you know if you are going to get that promotion?” she said. “How do you know what your Christmas bonus is going to be?”
In addition, Senger said the government didn’t go out of its way to publicize the tax consequences of receiving too much in federal subsidies. “It isn’t really something the administration focused on heavily,” she said. “It’s not exactly popular.”
source : For Many Middle-Class Taxpayers On Obamacare, It’s Payback Time
Supreme Court Insurance Subsidies Decision Could Trigger Price Spikes
By Julie Appleby
Thu, Feb 26 2015
Making health insurance available and affordable to millions of people who buy their own coverage was a key goal for backers of the federal health law known as Obamacare.
But if the Supreme Court strikes down the insurance subsidies of millions of Americans who rely on the federal insurance marketplace, it could leave many worse off than they were before the law took effect, say experts.
“The doomsday scenario could materialize and it does impact everyone” — those getting subsidies, as well as those paying the full cost of their plans on the individual market in states using the federal exchange, said Christopher Condeluci, an attorney who worked for Iowa Republican Sen. Charles Grassley on the Senate Finance Committee staff during the drafting of the law.
That’s because millions of consumers likely would drop their policies, which they could no longer afford without subsidies.
Most insurers could not drop plans without giving one-to-three months’ notice. But the companies remaining in the market would likely seek sharp increases in premiums for the following year, anticipating that the consumers most likely to hold onto their plans would be those needing medical care.
One Rand analysis projects that unsubsidized premiums could increase by almost half — an average annual increase of $1,600 for a 40-year-old — and that 70 percent of consumers would cancel their policies.
Those price increases, in turn, would drive more people to drop coverage, spurring further price hikes and potentially leading to what insurance experts call “a market death spiral.”
“It’s not the subsidy market that will fall apart, it’s the whole market” for everyone who doesn’t get job-based insurance coverage, said Robert Laszewski, a consultant for the insurance industry who is no fan of the health law. “There will be millions of Republicans who are not subsidy-eligible who are also going to get screwed.”
Legal Arguments
At issue in King v. Burwell — slated to be argued before the Supreme Court March 4 — is the basis of subsidies that go to millions of low- and moderate-income Americans in the approximately three dozen states that rely on the federal marketplace. More than 85 percent of the 8.6 million people who purchased plans in those states qualified for subsidies, administration officials say.
source : Supreme Court Insurance Subsidies Decision Could Trigger Price Spikes
Q&A With Mariel Hemingway
The actress and author opens up about her family and how she stays happy and healthy.
Reviewed by Michael W. Smith, MD
1. Your new book, Out Came the Sun, and the 2013 documentary about your life, Running From Crazy, bring home the personal demons and mental illness that run deep within your family. How have you been able to face and overcome your challenges?
I think there's always a person in a family who says, "I don't want to do this anymore." Maybe not in one generation, maybe it takes two generations. But someone says, "I don't want to keep passing this on." I don't know if my kids are going to be perfect, but they're not going to have secrets between themselves and me.
By Stacy WeinerYou don't have to change much. Here, surprising ways to feel better every day I'm a nonstop happiness seeker. On long drives, I don't ask my husband, "Are we there yet?" I meditate on life and ask myself, "Am I happy yet?" Here's my happiness inventory: I have a great house, but the toilets gurgle incessantly. My 9-year-old son is adorable, but has nerve-shredding sleep habits. My husband of 21 years is worth at least his weight in Godiva, but I'm pretty sure I see my dry...
2. Was it painful bringing up all those memories as you wrote the book?
To be perfectly honest, I had help finding structure. I would write the story itself, each thing as I would remember it. It was really therapeutic. It was actually kind of fabulous, like journaling. I had to get it out.
3. You write that you stayed in an unfulfilling first marriage for 25 years. Why?
My marriage seemed OK because it was better than what I was brought up in. It took 25 years to realize I didn't have to settle and that I could be truly happy.
4. In your book, you said that one of the deepest relationships is with nature. Why is that?
I found peace, joy, and happiness by going outside. Being around rocks and mountains and horses, being outside in wind. Those things kept me alive. I felt more myself when I was climbing up a mountain and feeling everything about my body. That's how I survived my childhood.
5. Your daughter Dree is a model and actor, and your daughter Langley is an artist. How did you feel about them going into the business?
When Dree was born, she was a very showy girl. She's been the same ever since. But I didn't want to let her model until she was 17.
6. Do you worry about the genetic risk of mental illness for your girls?
I used to think about that a lot. Now, because of the things I've done, I know that I can help. It makes me sad that as a society we still fear talking about mental illness when it's far more prevalent than cancer and other diseases. Mental illness is not untenable. You can get to the bottom of this.
source : Q&A With Mariel Hemingway
Zac Posen's Designer Dogs
The fashion designer may rule the runways, but his 3 dogs rule the roost.
By Melanie D. G. Kaplan
WebMD Magazine - Feature
Reviewed by William Draper, DVM
After 11 years with his black miniature poodle, Tina Turner, fashion designer Zac Posen doesn't hear much about resembling his dog (since he, too, has dark, curly hair). By now, he says, it's simply stating the obvious.
As usual, his company House of Z juggles numerous projects. In 2014, he launched new eyewear and fine jewelry collections and a wedding collection at David's Bridal. He was also named creative director for Brooks Brothers' signature women's collection.
My WebMD: How Our Adopted Dog Changed Our Lives
My husband, Bill, and I became friends because our former spouses were brother and sister. We used to spend a lot of time together -- going skiing, celebrating holidays, that sort of thing. We were all very close. But then first his wife died (in 1998) and then my husband died (in 2003) -- both of cancer. Bill and I supported each other. We gave each other shoulders to lean on. Eventually we fell in love. After we got married, it took us four years to find a nice home that we could afford (our spouses'...
Read the My WebMD: How Our Adopted Dog Changed Our Lives article > >
Posen is especially excited about returning as a judge on Lifetime's Project Runway. He says the show now has a "whole different caliber of taste and talent." He and his partner, House of Z creative director Christopher Niquet, and their three handbag-sized dogs live in New York City.
Your dogs are Tina Turner, Betty Blue, and Candy Darling. What's behind the names?
Tina Turner -- I'm a big fan. And this miniature poodle has very long legs and likes to dance. Christopher had Betty Blue, a dapple miniature long-haired dachshund, named after the movie character. She's more shy, but she's been photographed by all the great photographers. Christopher worked with Karl Lagerfeld for a few years, and Lagerfeld really fell in love with animals through Betty. He named her the Linda Evangelista of dogs. And Candy Darling, an English cream miniature dachshund, is the blond baby that we adopted. Not to be cliché.
What is your home life like with Christopher and the three "kids”?
All of the dogs except Betty Blue were meant to be uptown dogs. They love walking down Sutton Place and seeing all the other fancy dogs. Tina at moments is eerily humanistic -- watching TV, watching me cook. Sometimes I have to give them chomps of carrots when I'm cooking. It's hard to resist having these three dogs in bed, but they don't sleep with us. They have their own little bed on my side. Tina is a superstar poodle-gymnast, and they all curl into one big dog ball together. They're pretty patient until we're up and dressed and ready to walk them.
source : Zac Posen's Designer Dogs
Michael Strahan Tackles Life After the NFL
The 'Live With Kelly and Michael' co-host says he learns something new every day.
Reviewed by Michael W. Smith, MD
These days, 6-foot-5-inch, 240-pound Michael Strahan scares few people, and he likes it that way.
"They go, ‘Oh, he's such a big, jolly fellow,'" says the co-host of ABC's syndicated morning talk show Live With Kelly and Michael. "They don't understand that I used to take people's heads off for a living."
My father lived with me and my family during the last two years of his life while he sank ever deeper into Alzheimer’s disease. His behavior was frequently bizarre. He might emerge from his bedroom with three of my son’s baseball caps piled on top of his head but wearing no pants. When trying to participate in a conversation, he might blurt out passionate pronouncements that made no sense at all. “Ya see, the individualism is something that’s not already formed,” he would bellow. “You gotta...
For 15 seasons, Strahan, 43, played defensive end for the New York Giants, and he terrified quarterbacks. He still holds the NFL record for most sacks in a single season. But the Michael Strahan that sportswriter Jay Glazer described as nastier and tougher than everybody else on the field? His new fans don't know that guy.
"I like that they have no idea what I used to do," says Strahan, who lives in New York City. "I think it's really cool that I've been able to make the transition to where people say, ‘He used to play football?'"
After retiring in 2008, he joined the Emmy Award-winning Fox NFL Sunday team. His celebrity and obvious ease in front of the camera got him his first guest-host spot on Live in 2010. Strahan settled in for good on Sept. 4, 2012. A year and a half later, he also joined Good Morning America as a part-time host.
Was this all part of his master plan for success? Hardly.
"TV is just like football for me, in that I kind of got into it blindly," says Strahan, who was inducted into the NFL Hall of Fame in August 2014. "Back when I started playing football, I was just happy to have a job so that I didn't have to move back home."
Giant Success
As a high school senior in Houston, Strahan had little experience with football. What he had was the faith in himself that he'd gotten from his father, Gene Strahan, an officer in the U.S. Army. As for a plan, Strahan's was simply to live up to his father's expectations.
"As a football player, I was driven by failure," he says. "I wasn't driven to be successful, per se. Failure meant disappointing my parents, not giving my best, having them look at an effort that they knew was not my best."
source : Michael Strahan Tackles Life After the NFL
Weight-Loss Surgery May Lower Some Pregnancy Complications, Raise Others
By Maureen Salamon
HealthDay Reporter
WEDNESDAY, Feb. 25, 2015 (HealthDay News) -- After undergoing weight-loss surgery, women are significantly less prone to diabetes during pregnancy but twice as likely to deliver smaller-than-normal infants, a new study suggests.
Swedish scientists found that weight-loss (or "bariatric") surgery before pregnancy lowers the chances of certain complications for mothers and babies but raises the odds for others. They recommended any pregnancy after weight-loss surgery be considered high-risk and receive stricter monitoring.
"The number of women who are obese in early pregnancy has increased dramatically over the last decades," said study author Kari Johansson, a postdoctoral researcher and nutritionist at Karolinska Institute in Stockholm. "Consequently, there has been a dramatic rise in the number of women becoming pregnant after bariatric surgery," she added.
"The positive effects of bariatric surgery on health outcomes -- such as diabetes and cardiovascular disease -- are reasonably well-studied, but less is known about the effects on pregnancy and [post-delivery] outcomes," Johansson pointed out.
The study was published online Feb. 26 in the New England Journal of Medicine.
U.S. health officials say more than one-third of American adults are obese, with a body mass index (BMI, a height-weight calculation) of 30 or higher.
Nearly 179,000 obese people underwent weight-loss surgery in the United States in 2013, according to the American Society for Metabolic and Bariatric Surgery. While various techniques may be used, the surgery restricts the amount of food the stomach can hold and/or reduces the intestines' absorption of calories and nutrients from food.
Johansson and her colleagues used data from nationwide Swedish health registries to compare pregnancies between nearly 600 women who had given birth after bariatric surgery and more than 2,300 women who hadn't had the surgery but had the same BMI.
Only 2 percent of women who had weight-loss surgery developed gestational diabetes, compared to 7 percent of the other group, the researchers said. The surgical group was also much less likely to give birth to larger-than-normal babies.
However, the weight-loss surgery group was twice as likely to give birth to babies considered small for their gestational age, and their pregnancies were also of slightly shorter duration. Additionally, the surgical group experienced a slight bump in the rate of stillbirths, the study found.
source : Weight-Loss Surgery May Lower Some Pregnancy Complications, Raise Others
Dangerous C. Difficile Germ Infects 500,000 Americans a Year: CDC
Overuse of antibiotics tied to rise in serious infections
WebMD News from HealthDay
By Steven Reinberg
HealthDay Reporter
WEDNESDAY, Feb. 25, 2015 (HealthDay News) -- Almost half a million Americans were infected with the bacteria Clostridium difficilein 2011, and 29,000 died within a month of diagnosis, U.S. health officials report.
"Infections with C. difficile have become increasingly common over the last few decades, and are seen in patients in health-care facilities as well as people in their communities," Dr. Michael Bell said at a U.S. Centers for Disease Control and Prevention press conference Wednesday.
C. difficile, which causes inflammation of the colon and deadly diarrhea, is often linked to antibiotic use, said Bell, deputy director of healthcare quality promotion at the CDC's National Center for Emerging and Zoonotic Infectious Diseases.
Antibiotics can destroy the natural bacterial balance in the colon, allowing C. difficile to take over, he explained.
These infections can be prevented by controlling use of antibiotics, and making sure health-care facilities use infection-control procedures when treating patients infected with C. difficile, Bell said. Such measures have resulted in a 10 percent drop in C. difficile infections since 2011, he added.
"If we can improve antibiotic prescribing, we expect to see rates of C. difficile infection improve dramatically," Bell said. This means taking antibiotics only when necessary and for as long as necessary, he explained.
Treatment of C. difficile involves antibiotics. However, even when the infection is cured, it is difficult to restore the colon's normal bacteria, which enables C. difficile to recur, Bell explained.
"One in five patients has at least one relapse that requires treatment," he said.
Although anyone can get C. difficile, the elderly are especially vulnerable.
"About 55 percent of health care-associated C. difficile infections and 80 percent of the deaths that occur because of it happen in people 65 years of age and older," Bell said.
Moreover, he added, "one out of nine patients over 65 years old with C. difficile infection dies within 30 days of diagnosis."
The report was published Feb. 26 in the New England Journal of Medicine.
Severe C. difficile infection can damage the colon, requiring surgery, Bell added.
source : Dangerous C. Difficile Germ Infects 500,000 Americans a Year: CDC
ADHD May Raise Odds for Premature Death
Risk is small, but a sign the disorder is a serious problem, experts say
WebMD News from HealthDay
By Steven Reinberg
HealthDay Reporter
WEDNESDAY, Feb. 25, 2015 (HealthDay News) -- People with attention-deficit hyperactivity disorder (ADHD) are more than twice as likely to die prematurely as those without the common disorder, a new study finds.
The risk is small, but it's a clear indication that the disorder is a serious problem, the researchers said.
In a study of more than 2 million people, Danish researchers found that accidents were the most common cause of premature death among people with ADHD. And the risk was significantly higher for women and those diagnosed in adulthood, the researchers added.
"Our results add to the overwhelming existing evidence that ADHD is a true disorder and should not be taken lightly," said lead researcher Dr. Soren Dalsgaard, a senior researcher at Aarhus University.
Still, Dalsgaard stressed that the actual number of premature deaths among those with ADHD was small. "Although ADHD doubles the risk, it is important to note that the absolute risk is very low," he said. Out of more than 32,000 people with ADHD, 107 died early, he noted.
ADHD is a neurodevelopmental disorder that affects at least 11 percent of American children aged 4 to 17, according to the U.S. Centers for Disease Control and Prevention. They tend to be inattentive, impulsive and hyperactive, which can cause them to struggle academically and socially. The disorder often lingers in adulthood.
The new study was published online Feb. 26 in The Lancet.
"It's common for people with ADHD to be impulsive and act without thinking, which can lead to accidents," said Stephen Faraone, author of an accompanying journal editorial.
Faraone agreed with Dalsgaard that the risk of premature death related to ADHD is small. "But the increase is another sign that this is a serious disorder that needs to be taken seriously," he said.
Treating ADHD is the best way to reduce the risk of dying early, added Faraone, director of child and adolescent psychiatry research at SUNY Upstate Medical University in Syracuse, N.Y.
Treatments can include medication, psychotherapy, training or a combination of treatments, according to the U.S. National Institute of Mental Health.
source : ADHD May Raise Odds for Premature Death
Viruses Increasingly Behind Child Pneumonia Cases
Bug that causes common cold, other infections often to blame, study finds
WebMD News from HealthDay
By Amy Norton
HealthDay Reporter
WEDNESDAY, Feb. 25, 2015 (HealthDay News) -- Young children are at increased risk of becoming seriously ill with pneumonia -- but unlike in years past, the cause is usually a respiratory virus, a large U.S. study finds.
The researchers found that 66 percent of pneumonia cases in the more than 2,000 children in the study were caused by viruses alone. Just 8 percent had solely bacterial causes, and 7 percent were known to be caused by both bacteria and viruses. And, those infections can end up being serious, the study authors said.
"Pneumonia is one of the most common causes of hospitalizations among children," said the study's lead author, Dr. Seema Jain, a researcher at the U.S. Centers for Disease Control and Prevention (CDC).
Pneumonia is a general term for an infection of the lungs, and it can be caused by a range of viruses, bacteria or even fungi. The disease is often thought of as a problem affecting elderly adults -- especially when it's severe enough to warrant a hospital stay.
However, children -- especially younger children -- are also at increased risk, according to Jain. About 16 children out of every 10,000 get pneumonia every year. In youngsters under 2 years old, that number jumps to 62, according to the study published in the Feb. 26 issue of the New England Journal of Medicine.
But while it's well known that childhood pneumonia is a public health concern, these latest findings help to better "quantify" the problem, Jain said.
For the study, her team tested body fluid samples from over 2,200 children treated for pneumonia at three U.S. children's hospitals. The investigators found that nearly three-quarters of the children had viral infections -- either alone or in combination with a bacterial infection. The infections included a range of viruses that often cause congestion and other cold symptoms, but can also lead to more-severe infections such as pneumonia.
The most commonly detected virus was respiratory syncytial virus, or RSV. According to the CDC, almost all children contract an RSV infection by their second birthday. Anywhere from 25 percent to 40 percent develop either bronchiolitis (inflammation in the small airways of the lungs) or pneumonia the first time they're exposed to the virus.
source : Viruses Increasingly Behind Child Pneumonia Cases
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