Every generation needs to watch their blood pressure, researchers say
From: http://www.webmd.com/stroke/news/20161123/strokes-decline-in-older-americans-rise-in-young?src=RSS_PUBLIC
Wednesday, November 23, 2016
Strokes Decline in Older Americans, Rise in Young
From: http://www.webmd.com/stroke/news/20161123/strokes-decline-in-older-americans-rise-in-young?src=RSS_PUBLIC
Can Surgery Trigger Rare Muscle Disorder?
Still, the likelihood of developing postoperative Guillain-Barre syndrome remains slight, researchers say
From: http://www.webmd.com/brain/news/20161123/can-surgery-trigger-rare-muscle-disorder?src=RSS_PUBLIC
U.S. Kids Are Eating Healthier Now, But ...
Their salt intake has risen and veggies are still shunned, study finds
From: http://www.webmd.com/parenting/news/20161123/us-kids-are-eating-healthier-now-but---?src=RSS_PUBLIC
Anti-inflammatory medications and the risk for cardiovascular disease: A new study, a new perspective
Follow me on Twitter @RobShmerling
News last week about celecoxib shows how challenging it can be to understand the risks and benefits of newly developed drugs. This is particularly true when the findings of one study contradict those of past studies. And that’s exactly what has happened with celecoxib.
Anti-inflammatory medications: pros and cons
The FDA approved celecoxib (Celebrex) in 1999. This anti-inflammatory medication can be a highly effective treatment for arthritis and other painful conditions. It was developed with the hope that it would be at least as effective as other anti-inflammatory medications (such as ibuprofen or naproxen) but cause less stomach irritation. Developing a safer anti-inflammatory medication is a worthy goal, since stomach irritation can not only cause annoying pain or nausea, but it can also lead to ulcers, bleeding, or perforation. These medications can also increase blood pressure and cause kidney problems.
Celecoxib is known as a COX-2 inhibitor — that’s because it targets an enzyme (COX-2) involved in inflammation. Ibuprofen and naproxen (and many other anti-inflammatories) target COX-1 and COX-2. They’re called “non-selective” anti-inflammatory drugs. Because of where these enzymes are found in the body, the COX-2 selective medications seemed capable of dampening down inflammation while going easier on the stomach.
And that was true. Celecoxib — and other COX-2 inhibitors, such as rofecoxib (Vioxx) — did cause less stomach trouble. But soon after its approval, studies suggested other concerns: an increased risk of heart attack and stroke. Rofecoxib was removed from the market in 2004. And while the FDA allowed celecoxib to remain on the market, it required the manufacturer to issue additional warnings to patients. It also required additional study. And that’s why celecoxib is back in the news this week. The results of the PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen or Naproxen) trial were released. And the news is good for celecoxib.
Results suggests lower cardiovascular disease risk — and fewer side effects — than expected
The PRECISION trial is a carefully designed and powerful study that analyzed the impact of celecoxib on cardiovascular disease. The study spanned 926 medical centers in 13 countries and enrolled more than 24,000 patients with two of the most common types of arthritis (osteoarthritis and rheumatoid arthritis). Each study subject had a higher than average risk for cardiovascular disease due to a history of high blood pressure or high cholesterol.
Study subjects were divided into three groups who took anti-inflammatory medications every day: one group took celecoxib, one group took ibuprofen, and the last group took naproxen.
Study subjects taking celecoxib in moderate doses were
- no more likely than those taking ibuprofen or naproxen to have a fatal or non-fatal heart attack or stroke
- less likely than those taking ibuprofen or naproxen to have significant gastrointestinal problems, such as serious bleeding
- less likely than those taking ibuprofen to have kidney problems or hospital admission for high blood pressure.
What does this mean for you?
It’s rare that a single study provides a definitive answer or changes practice overnight. But this was a large, well-designed, and expensive study that is unlikely to be repeated any time soon. And, another study of lower-risk people came to a similar conclusion just last year.
Still, questions may yet come up regarding:
- The lack of a placebo group. As suggested by some prior research, it is possible that all three of the drugs used in this study increase the risk of cardiovascular problems; without a control group, it’s impossible to say.
- Dosing. Study subjects were allowed to take up to 400 mg/day of celecoxib if they had rheumatoid arthritis but only 200 mg/day if they had osteoarthritis. In real life doctors may prescribe a wider range of doses.
- Reason for treatment. This study only included people with rheumatoid arthritis or osteoarthritis. The results might be different if people with other conditions had been included.
- Other medical problems. The risks and benefits of celecoxib in people with other medical problems (such as significant kidney disease) are uncertain because this study excluded them.
- Other medical treatments. All patients in this study took a medication to protect the stomach; outside of studies, that’s not always the case.
While these issues are valid, I think this study does provide a significant measure of reassurance regarding the cardiovascular risks of celecoxib. And it may encourage doctors who thought the drug was too risky to prescribe it more often.
This new research shows in a dramatic way why “more research is needed” is not just a tagline at the end of so many medical news stories. And in the case of celecoxib, the result of the additional research is good news indeed.
The post Anti-inflammatory medications and the risk for cardiovascular disease: A new study, a new perspective appeared first on Harvard Health Blog.
From: Robert H. Shmerling, MD http://www.health.harvard.edu/blog/anti-inflammatory-medications-and-the-risk-for-cardiovascular-disease-a-new-study-a-new-perspective-2016112310725
Baby sleep: Helping baby sleep through the night
From: http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/baby-sleep/art-20045014
High blood pressure dangers: Hypertension's effects on your body
High blood pressure is a risk factor for more than heart disease. Discover what complications high blood pressure can cause.
From: http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868
Breast-feeding tips: What new moms need to know
Breast-feeding might take more practice — and patience — than you ever imagined. Here's help understanding the basics.
From: http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/breast-feeding/art-20047138
Depression during pregnancy: You're not alone
From: http://www.mayoclinic.org/depression-during-pregnancy/art-20237875
Woman gives birth to her own grandson
A medical condition prevented one woman from delivering her own baby -- so her mother stepped in
From: http://www.cbsnews.com/news/grandmother-megan-barker-gives-birth-to-her-own-grandson/
From: http://www.cbsnews.com/news/grandmother-megan-barker-gives-birth-to-her-own-grandson/
U.S. abortion rate falls to lowest level in decades
Centers For Disease Control reports number of procedures has been declining since 2010
From: http://www.cbsnews.com/news/u-s-abortion-rate-falls-to-lowest-level-in-decades/
From: http://www.cbsnews.com/news/u-s-abortion-rate-falls-to-lowest-level-in-decades/
Rare thunderstorm asthma kills 4 in Australia
Hundreds of people were hospitalized in Australia’s second-largest city after a storm caused rain-sodden ryegrass pollen to explode and disperse over the city
From: http://www.cbsnews.com/news/thunderstorm-asthma-kills-4-in-melbourne-australia/
From: http://www.cbsnews.com/news/thunderstorm-asthma-kills-4-in-melbourne-australia/
These medicines often send Americans to the ER
New research from the CDC cites these medications for nearly half of adverse drug-related events
From: http://www.cbsnews.com/news/blood-thinners-diabetes-antibiotics-these-medicines-often-send-americans-to-the-emergency-rooom/
From: http://www.cbsnews.com/news/blood-thinners-diabetes-antibiotics-these-medicines-often-send-americans-to-the-emergency-rooom/
Mercury Levels Dropping in North Atlantic Tuna
Study suggests industry emission controls may lead to healthier fish
From: http://www.webmd.com/food-recipes/news/20161123/mercury-levels-dropping-in-north-atlantic-tuna?src=RSS_PUBLIC
Judge blocks new federal overtime rule
A federal judge issued a preliminary injunction Nov. 22, blocking a new rule to extend overtime pay.
From: http://www.ada.org/en/publications/ada-news/2016-archive/november/judge-blocks-new-federal-overtime-rule
From: http://www.ada.org/en/publications/ada-news/2016-archive/november/judge-blocks-new-federal-overtime-rule
Depression during pregnancy: You're not alone
From: http://www.mayoclinic.com/depression-during-pregnancy/art-20237875
Breast-feeding tips: What new moms need to know
Breast-feeding might take more practice — and patience — than you ever imagined. Here's help understanding the basics.
From: http://www.mayoclinic.com/healthy-lifestyle/infant-and-toddler-health/in-depth/breast-feeding/art-20047138
Baby sleep: Helping baby sleep through the night
From: http://www.mayoclinic.com/healthy-lifestyle/infant-and-toddler-health/in-depth/baby-sleep/art-20045014
High blood pressure dangers: Hypertension's effects on your body
High blood pressure is a risk factor for more than heart disease. Discover what complications high blood pressure can cause.
From: http://www.mayoclinic.com/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868
Failed study, dimmed hopes in hunt for Alzheimer's treatment
In a widely anticipated study, the drug failed to slow mental decline, ending hope that researchers had finally found a drug that does more to help those suffering from the disease
From: http://www.cbsnews.com/news/failed-study-dimmed-hopes-in-hunt-for-alzheimers-treatment/
From: http://www.cbsnews.com/news/failed-study-dimmed-hopes-in-hunt-for-alzheimers-treatment/
Experts: Wheat Sensitivity Is Real
Researchers are trying to find out why some people without wheat allergy or celiac disease still report sensitivity to wheat-containing foods.
From: http://www.webmd.com/digestive-disorders/celiac-disease/news/20161123/experts-wheat-sensitivity-is-real?src=RSS_PUBLIC
What is "Heart Healthy Nutrition" and Why is it So Hard to Define?
From: Mayo Clinic http://www.youtube.com/watch?v=j2wKOYPSPu0
No Aloe Vera in Some Aloe Gel Products
No Aloe Vera in Some Aloe Gel Products
From: http://www.webmd.com/skin-problems-and-treatments/news/20161123/aloe-vera-gel-products?src=RSS_PUBLIC
Mayo Clinic Minute: Mannheim Steamroller and ambient therapy
From: Mayo Clinic http://www.youtube.com/watch?v=J2qjZY5u7Uc
Anti-inflammatory medications and the risk for cardiovascular disease: A new study, a new perspective
Follow me on Twitter @RobShmerling
News last week about celecoxib shows how challenging it can be to understand the risks and benefits of newly developed drugs. This is particularly true when the findings of one study contradict those of past studies. And that’s exactly what has happened with celecoxib.
Anti-inflammatory medications: pros and cons
The FDA approved celecoxib (Celebrex) in 1999. This anti-inflammatory medication can be a highly effective treatment for arthritis and other painful conditions. It was developed with the hope that it would be at least as effective as other anti-inflammatory medications (such as ibuprofen or naproxen) but cause less stomach irritation. Developing a safer anti-inflammatory medication is a worthy goal, since stomach irritation can not only cause annoying pain or nausea, but it can also lead to ulcers, bleeding, or perforation. These medications can also increase blood pressure and cause kidney problems.
Celecoxib is known as a COX-2 inhibitor — that’s because it targets an enzyme (COX-2) involved in inflammation. Ibuprofen and naproxen (and many other anti-inflammatories) target COX-1 and COX-2. They’re called “non-selective” anti-inflammatory drugs. Because of where these enzymes are found in the body, the COX-2 selective medications seemed capable of dampening down inflammation while going easier on the stomach.
And that was true. Celecoxib — and other COX-2 inhibitors, such as rofecoxib (Vioxx) — did cause less stomach trouble. But soon after its approval, studies suggested other concerns: an increased risk of heart attack and stroke. Rofecoxib was removed from the market in 2004. And while the FDA allowed celecoxib to remain on the market, it required the manufacturer to issue additional warnings to patients. It also required additional study. And that’s why celecoxib is back in the news this week. The results of the PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen or Naproxen) trial were released. And the news is good for celecoxib.
Results suggests lower cardiovascular disease risk — and fewer side effects — than expected
The PRECISION trial is a carefully designed and powerful study that analyzed the impact of celecoxib on cardiovascular disease. The study spanned 926 medical centers in 13 countries and enrolled more than 24,000 patients with two of the most common types of arthritis (osteoarthritis and rheumatoid arthritis). Each study subject had a higher than average risk for cardiovascular disease due to a history of high blood pressure or high cholesterol.
Study subjects were divided into three groups who took anti-inflammatory medications every day: one group took celecoxib, one group took ibuprofen, and the last group took naproxen.
Study subjects taking celecoxib in moderate doses were
- no more likely than those taking ibuprofen or naproxen to have a fatal or non-fatal heart attack or stroke
- less likely than those taking ibuprofen or naproxen to have significant gastrointestinal problems, such as serious bleeding
- less likely than those taking ibuprofen to have kidney problems or hospital admission for high blood pressure.
What does this mean for you?
It’s rare that a single study provides a definitive answer or changes practice overnight. But this was a large, well-designed, and expensive study that is unlikely to be repeated any time soon. And, another study of lower-risk people came to a similar conclusion just last year.
Still, questions may yet come up regarding:
- The lack of a placebo group. As suggested by some prior research, it is possible that all three of the drugs used in this study increase the risk of cardiovascular problems; without a control group, it’s impossible to say.
- Dosing. Study subjects were allowed to take up to 400 mg/day of celecoxib if they had rheumatoid arthritis but only 200 mg/day if they had osteoarthritis. In real life doctors may prescribe a wider range of doses.
- Reason for treatment. This study only included people with rheumatoid arthritis or osteoarthritis. The results might be different if people with other conditions had been included.
- Other medical problems. The risks and benefits of celecoxib in people with other medical problems (such as significant kidney disease) are uncertain because this study excluded them.
- Other medical treatments. All patients in this study took a medication to protect the stomach; outside of studies, that’s not always the case.
While these issues are valid, I think this study does provide a significant measure of reassurance regarding the cardiovascular risks of celecoxib. And it may encourage doctors who thought the drug was too risky to prescribe it more often.
This new research shows in a dramatic way why “more research is needed” is not just a tagline at the end of so many medical news stories. And in the case of celecoxib, the result of the additional research is good news indeed.
The post Anti-inflammatory medications and the risk for cardiovascular disease: A new study, a new perspective appeared first on Harvard Health Blog.
From: Robert H. Shmerling, MD http://www.health.harvard.edu/blog/anti-inflammatory-medications-and-the-risk-for-cardiovascular-disease-a-new-study-a-new-perspective-2016112310725
Revised I-9 forms now available
Citizenship and Immigration Services on Nov. 14 published a revised version of Form I-9, the form used for verifying the identity and employment authorization of individuals hired for employment in the United States
From: http://www.ada.org/en/publications/ada-news/2016-archive/november/revised-i-9-forms-now-available
From: http://www.ada.org/en/publications/ada-news/2016-archive/november/revised-i-9-forms-now-available
Enthusiastic Dads May Mean Happier Kids
A man's enjoyment, confidence in his role as father seemed even more important than time spent
From: http://www.webmd.com/parenting/news/20161122/enthusiastic-dads-may-mean-less-troubled-kids-study?src=RSS_PUBLIC
High blood pressure dangers: Hypertension's effects on your body
High blood pressure is a risk factor for more than heart disease. Discover what complications high blood pressure can cause.
From: http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868
Baby sleep: Helping baby sleep through the night
From: http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/baby-sleep/art-20045014
Breast-feeding tips: What new moms need to know
Breast-feeding might take more practice — and patience — than you ever imagined. Here's help understanding the basics.
From: http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/breast-feeding/art-20047138
Depression during pregnancy: You're not alone
From: http://www.mayoclinic.org/depression-during-pregnancy/art-20237875
Lilly Alzheimer's drug fails in latest study
Drugmaker's shares slide after testing shows that once promising treatment doesn't slow cognitive decline
From: http://www.cbsnews.com/news/lilly-alzheimers-drug-fails-in-latest-study/
From: http://www.cbsnews.com/news/lilly-alzheimers-drug-fails-in-latest-study/
Baby sleep: Helping baby sleep through the night
From: http://www.mayoclinic.com/healthy-lifestyle/infant-and-toddler-health/in-depth/baby-sleep/art-20045014
Depression during pregnancy: You're not alone
From: http://www.mayoclinic.com/depression-during-pregnancy/art-20237875
Breast-feeding tips: What new moms need to know
Breast-feeding might take more practice — and patience — than you ever imagined. Here's help understanding the basics.
From: http://www.mayoclinic.com/healthy-lifestyle/infant-and-toddler-health/in-depth/breast-feeding/art-20047138
High blood pressure dangers: Hypertension's effects on your body
High blood pressure is a risk factor for more than heart disease. Discover what complications high blood pressure can cause.
From: http://www.mayoclinic.com/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868
How to avoid holiday travel health emergencies
Thanksgiving week is one of the busiest travel periods of the year; here are some expert tips to have a safe and healthy holiday
From: http://www.cbsnews.com/news/thanksgiving-travel-how-to-avoid-holiday-health-emergencies/
From: http://www.cbsnews.com/news/thanksgiving-travel-how-to-avoid-holiday-health-emergencies/
Depression during pregnancy: You're not alone
From: http://www.mayoclinic.org/depression-during-pregnancy/art-20237875
Breast-feeding tips: What new moms need to know
Breast-feeding might take more practice — and patience — than you ever imagined. Here's help understanding the basics.
From: http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/breast-feeding/art-20047138
Baby sleep: Helping baby sleep through the night
From: http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/baby-sleep/art-20045014
High blood pressure dangers: Hypertension's effects on your body
High blood pressure is a risk factor for more than heart disease. Discover what complications high blood pressure can cause.
From: http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868
Movember: Stashing prostate and testicular cancer awareness into the limelight
Since 2003, the Movember movement has been raising public awareness of testicular and prostate cancer. The common theme that links cancers of all types is that early detection tends to lead to better outcomes. Because cancer often has no symptoms in its early stages, screening for cancer has been an integral part of primary care routine visits.
I go for an annual physical every year. Do I really need to do self-examinations?
Although routine screening by a health care provider is critical, it does not alleviate the need for self-examinations. In terms of gender-specific cancers, breast cancer is one that receives a great deal of attention due to its prevalence, as one in eight women will develop breast cancer during their lifetime. It is the most commonly diagnosed form of cancer in women, and the second leading cause of cancer death in women. As with any form of cancer, early detection is critical, and the importance of routine breast self-examinations cannot be stressed highly enough. For these reasons, multiple foundations and even the National Football League promote awareness.
What is the deal with men’s health?
Far fewer people know the facts about prostate and testicular cancer. Regarding prostate cancer, about one in seven men will be diagnosed during their lifetime. It most often affects men over the age of 65, and it is the second leading cause of cancer death in men. Although there is no proven way to do self-exams, a digital rectal examination (DRE) performed by a health care provider is a useful screening tool in the detection of prostate cancer. During a DRE, a healthcare provider uses a gloved, lubricated finger inserted into the rectum to feel the prostate gland.
Testicular cancer is fortunately much less common than prostate cancer, as about one in 263 men will be diagnosed during their lifetime. Unlike prostate cancer, testicular cancer is a disease of young and middle-aged men, with about 7% of cases occurring in teens and young boys. Although the number of deaths from testicular cancer is far lower than breast or prostate cancer, it is estimated that about 380 men will die of testicular cancer in the U.S. in 2016. Early detection is critical, and we must stress the importance of routine testicular self-examinations.
Prostate and testicular cancers, especially when not detected early, can lead to difficult treatment, sterility, and potentially a lifetime of hormone replacement therapy. Men tend to be less likely in general to access the health care system, particularly for routine care, which further punctuates the need for awareness. Many men find the thought of a DRE or a testicular examination embarrassing, but such embarrassment can be lifesaving.
Why is a neurologist so interested in prostate and testicular cancer?
A few years ago, I met a colleague who was similar to me in many ways, a relatively young physician and father of two with no health problems. That is, until he discovered a small nodule on one of his testicles during a self-exam. Follow-up tests confirmed testicular cancer. Fortunately, with early intervention, he was cured after the surgical removal of one of his testicles.
So when I heard about the Movember movement, I felt compelled to do my part to raise awareness.
So here are some of my Movember experiences…
For the past few years, I have grown out a full beard in October, and then shaved it down to a mustache on November 1. For a man who never wears a mustache to suddenly have one is very much an attention grabber. I fondly recall my daughter who is now 4 saying, “Papa, you look like Super Mario with that mustache.” Fortunately, some of the comments I received have been a little more flattering. After sharing the story of Movember with some coworkers, one of the nurses said, “That mustache reminds me of Tom Selleck’s mustache. The only difference is, he is Magnum P.I., which I guess makes you Magnum P.M. (my initials).” During Movember, I begin every patient encounter explaining why I have a mustache, the importance of prostate and testicular cancer awareness, and how early detection can be lifesaving. It has always amazed me how many patients reply with a personal story of their own about a brother, uncle, coworker, etc. who was diagnosed with prostate or testicular cancer.
I fondly recall one such patient, a woman in her 70s, later changing the subject by saying, “Dr. Mathew, do you know that it tickles very much to kiss a man with a mustache?” I replied with a big smile while shrugging my shoulders, “I wouldn’t know (implying that as a heterosexual married man, I have never tried to kiss a man with a mustache),” One of my most rewarding Movember experiences occurred when I had a female patient in the medical field ask me how to perform a testicular exam. I was initially shocked by the question, but then later elated that my mustache served its purpose and then some. Not only did I raise awareness of testicular cancer, but this woman may actually help detect a case, and save someone’s life.
Then came the difficult part … showing this woman how to perform a testicular exam. My mind quickly scrambled, and after scanning the room, I noticed an Angry Bird toy from a Happy Meal that my daughter did not want. As I picked up the rotund bird, and used it as a teaching prop, she seemed to grasp the concept perfectly. I then put the Angry Bird down, and I could not help but feel that one just flew over the cuckoo’s nest…
The post Movember: Stashing prostate and testicular cancer awareness into the limelight appeared first on Harvard Health Blog.
From: Paul G. Mathew, MD, FAAN, FAHS http://www.health.harvard.edu/blog/movember-stashing-prostate-and-testicular-cancer-awareness-into-the-limelight-2016112210740
Black bean burgers with chipotle ketchup
From: http://www.mayoclinic.com/healthy-lifestyle/recipes/black-bean-burgers-with-chipotle-ketchup/rcp-20049605
Baked apples with cherries and almonds
From: http://www.mayoclinic.com/healthy-lifestyle/recipes/baked-apples-with-cherries-and-almonds/rcp-20049603
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