A blood test may seem like a simple thing, but it can do so much.
It can diagnose disease, reveal how well your organs work and whether a course of treatment is effective or not, experts say.
Some blood tests require patients to fast before the blood is drawn. It’s crucial that you avoid eating before such tests, which require blood that is clear of nutrients, such as fats and sugars.
Glucose and lipid testing are the most common types of fasting blood tests, said Carole Andrews of Penn State Health in Hershey, Pa., where she’s a supervisor in the department of pathology and laboratory medicine.
“The amount of fats and glucose (sugars) will increase in the blood if a person has recently eaten,” Andrews explained in a Penn State news release. “This will affect the results of these specific tests.”
You may also wonder why technicians take so many blood samples.
Vials used to collect samples may contain additives that keep blood from clotting before the lab can test it. Tubes are color-coded according to the type of test. For example, a purple-colored vial is used for a blood count and a green-colored vial may be used for a chemistry profile, Andrews said.
How much blood is collected depends on the number and type of tests ordered by your doctor.
And there’s no need for concern if multiple vials of blood are taken. Most people have between 4,500 to 5,700 milliliters of blood.
“Even if you had 10 tubes of blood taken, that’s less than 60 milliliters,” Andrews said. “It’s not going to make an impact because your body is designed to replace what is lost.”
You can make the process easier by drinking plenty of fluids beforehand, she suggested. This will make it easier for the technician to poke into a vein.
“Also, it is easier if the patient is relaxed and comes in with a good attitude,” Andrews said. “If they tense up too much, it can make the venipuncture difficult.”
Deer hunters aren’t the only ones geared up for action, however.
Michigan hospital emergency staff sees hundreds of hunting-related injuries every year.
While some injuries are minor, Spectrum Health Butterworth Hospital averages about 14 hunting-related hospitalizations a year.
The 2018-19 season landed 20 patients in the hospital due to injuries sustained from falling out of tree stands. One of those had a spinal cord injury, 11 had vertebral fractures, and one suffered a pelvic fracture.
2009-18 hunting accident statistics
Total of 128 admissions due to fall from a tree stand
No deaths
11 spinal cord injuries
Multiple vertebral, pelvic, arm and leg fractures
These stats don’t include all the people who go to the emergency room for injuries that aren’t serious enough for overnight—or much longer—stays in the hospital or in rehabilitation units.
Alistair Chapman, MD, a Spectrum Health Medical Group critical care surgeon, helped lead a study into falls from tree stands and their impact on trauma centers. He knows first-hand how dangerous the season can be for hunters, especially for those who are overweight or fall from a height of 20 feet or more.
“Tree stand falls cause significant injury,” he said.
Emergency department doctors and trauma surgeons are particularly concerned about the increase in life-changing traumas such as spine fractures, brain injuries and paralysis from these falls.
“The infrequent use of safety harnesses is alarming,” Dr. Chapman said, sharing that less than 3% of the injured hunters in their study used a harness. In a couple of cases, the harnesses broke.
What gives? In 1997, the Michigan Department of Natural Resources changed hunting rules to allow firearm hunters to hunt from raised platforms. Since that time, the accident rate has climbed.
“The majority of deer hunters in Michigan are firearm hunters, so an increase in injuries was expected,” said Bruce Murray, MD, a Spectrum Health emergency medicine specialist.
An avid hunter himself, Dr. Murray added: “What’s unfortunate is that these are injuries that, in most cases, could be prevented.”
Records show that fall victims with arm and leg fractures account for the most injuries. Spine injuries comes in at a close second. Chest wall trauma is the third-leading cause of injury.
A broken limb may not sound like a big deal—unless you experience one. And Dr. Murray also quickly pointed out that the severity of these injuries is sometimes shocking.
“We see life-altering injuries every year,” he said.
So what can hunters do to avoid injury? Drs. Murray, Chapman and other safety experts have many suggestions.
Hunting safety tips you need to know:
Tree stand safety is as important as gun safety. Follow that same approach to the tree stand as you do your gun.
Never use drugs, alcohol or sedatives while hunting.
Check permanent tree stands each time before use. Replace any worn or weak lumber before it breaks.
Always wear a safety harness or belt while checking or using a stand.
Read, understand and follow the manufacturer’s instructions when installing a ready-made tree stand.
Inspect portable stands for loose nuts and bolts before every single use.
Know what you should do if you slip while using a safety device. Make a plan.
Use a haul line to raise or lower equipment.
Keep firearms unloaded and arrows in a covered quiver when going up or down.
Choose a tree large enough to support your weight.
Never hurry to set up your stand. Take your time to check it over.
Make sure someone knows the location of your tree stand and when you will be there, every time.
Stay awake and alert. Always be aware of your position on the tree stand platform.
Use a short tether between you and the tree when attaching your fall restraint device. This is to keep you in the stand if you slip or fall, not to catch you after you have fallen.
Always carry a cell phone or other device to call for help if you need it. Keep it easily accessible.
Good medicine is about getting back to the basics and leading a healthy lifestyle. And there’s no better way to do this than to start your day with a healthy meal.
I know this can be difficult some days, especially if you are in a hurry. If you are like me, you are lucky to get out the door on time to get to work, school, exercise class, or an early-morning meeting.
I want to help you be prepared for whatever may come your way throughout the day.
Even if you make an unhealthy choice (or two) later in the day by eating or drinking something high in sugar and low in nutrition, at least you know you started your day the healthy way. Adding veggies, protein, hydration and nutrition to your breakfast can help you lean more toward a healthy lifestyle.
Smoothies are a good choice for breakfast because you can add so many different (and healthy) ingredients to help you stay full all morning.
It’s important to remember that not all smoothies are the same. Some are full of sugar and lacking in nutrition. My favorite green smoothie is full of nutrients because, remember, our bodies need vitamins (vitamin D, calcium, B vitamins), minerals (iron), protein, fat and carbohydrates every day.
The ingredients in my green smoothie help in several areas of wellness, including heart health, protection from cancer and maintaining strong bones. I have listed the ingredients separately, including an explanation of what each ingredient brings to the smoothie.
I make this smoothie for breakfast most days, not only because it tastes great but also because it can prevent colon cancer.
Colorectal cancer is the third most common cause of cancer death in the United States, and the second most common cancer in women.
This is just one more excellent reason to give this smoothie a try for breakfast tomorrow and every day thereafter.
Colorectal cancer is preventable in most cases by early detection, though you can also improve colorectal health by maintaining a healthy weight and eating a proper diet—rich in fiber and antioxidants (like the ingredients in my green smoothie), low in saturated fats and red meat, and high in vitamins.
Age-related macular degeneration, or AMD, is an incurable eye disease that affects millions of older Americans, but there are a number of things you can do to reduce your risk, a vision expert says.
AMD causes blurred central vision due to damage to the macula—a small area at the back of the eye—and it is most common after age 60, according to the U.S. National Eye Institute.
AMD is also more common in women and whites. At-risk patients should get regular eye exams, advised Dr. Julie Rosenthal, a retina specialist.
She said there are a number of things people can do to help slow or possibly prevent AMD. If you smoke, try to quit. Smoking may double the risk of AMD.
Find out if you have a family history of the disease.
People with a first-degree relative with AMD have a much greater risk of developing it. If you have a family history of the disease, watch for potential symptoms such as difficulty recognizing faces, struggling to adapt to low light and seeing straight lines that appear wavy.
Eat lots of spinach, kale, Swiss chard and other leafy greens, which are high in antioxidant vitamins that help protect against cellular damage from free radicals, which can contribute to eye disease, according to Rosenthal.
If you have a poor diet, consider taking multivitamins. People at risk of advanced AMD should ask their doctor about a specialized blend of supplements called AREDS. This is “not a treatment or cure but can decrease your risk of getting the more severe forms of AMD,” Rosenthal said in a university news release.
When outside, wear sunglasses that provide protection from UV and blue light that can cause retinal damage. Sunglasses with a “UV 400” label are recommended by the American Macular Degeneration Foundation.
Maintain healthy blood pressure and weight. Poor blood circulation due to high blood pressure can restrict blood flow to the eyes, thus contributing to AMD. Losing weight is a proven way to lower blood pressure.
Use a tool called an Amsler grid to check for vision problems related to macular damage.
When staring at the grid, if you notice that the central part of your vision in one eye has become darker or the grid lines are wavy, call your doctor, Rosenthal said. Keep the grid in a place that reminds you to use it daily.
Did you know your lifestyle choices could tip the scale for whether or not you experience cancer in your lifetime?
It’s true.
No one purposefully acts to increase their cancer risk, however, not everyone knows which lifestyle choices will make a negative—or positive—difference.
Take colon cancer, for instance. Colon cancer risk is affected by lifestyle habits and can be detected early if people are aware of their risk, get timely screenings and watch for early symptoms.
Studies show there are ways we can proactively reduce our chances of developing colorectal cancer.
People who exercise daily, eat a diet high in fiber, fruits and vegetables, take adequate vitamins B6 and D, and eat fish regularly (not deep fried) have a lower relative risk of getting colorectal cancer.
People who smoke, drink more than two alcohol drinks per day and are obese have a higher risk. Hormone replacement therapy, statins and daily aspirin are also shown to be associated with a lower risk of colorectal cancer.
Many women I have cared for never thought they would get colorectal cancer. Some women think it is an older person’s disease or that only men are at risk.
Risk factors for colorectal cancer
• 50 years or older
• HPV infection
• Family history of colorectal cancer
• History of Crohn’s or ulcerative colitis
• Diet high in saturated fats and low in fiber
• Diet low in vitamins D and B complex
• More than one alcoholic drink per day
• Lack of exercise
• Obesity
How cancer develops
Cancer happens when cells start to grow out of control either from exposure to a cancer-causing agent like cigarette smoke, or damage in the process of growth control like with BRCA gene mutations.
If there is both exposure and a gene mutation, the risk is even higher. When cells grow out of control, they group together in a lump or mass and then can break free of the organ boundaries, and spread.
The earlier a cancer is caught, the easier it is to treat. Once cancer spreads, it is much harder to cure.
A cautionary tale
A patient I’ll call Susan never thought colon cancer would affect her. In her case, there was no family history, no inflammatory bowel disease, and she lived a healthy lifestyle. She is active, rarely drinks alcohol, eats low fat and takes her vitamins.
But Susan had symptoms. She ignored those symptoms, thinking it must be a yeast infection, constipation, or simply not important. Like many of us, she was so busy caring for her family she didn’t make the time to get checked out.
Her pain worsened, the discharge worsened and her bowel habits started to change more dramatically. She finally had no choice but to pursue testing. Susan learned she had Stage 4, metastatic colorectal cancer.
Susan underwent aggressive surgery and chemotherapy with a good result. Her story is one that should make us all pause and remember to seek care when something does not seem right. Another takeaway: Get your colonoscopy.
Be proactive
Donald Kim, MD, is a Spectrum Health Medical Group colorectal surgeon and cares for patients with colorectal cancer.
“Colorectal cancer is not only treatable but preventable with proper colon cancer screening,” Dr. Kim said. “Unfortunately, most patients present without symptoms, so it’s essential that you have your recommended screening colonoscopy.”
If you have risk factors for colorectal cancer, it is important you not only get an early screening, but also follow a healthy lifestyle to reduce your chances of getting cancer.
Risk factors include being 50 or over (45 and over if African American), have a first-degree relative with colorectal cancer, have a family history of colorectal cancer or genetic syndromes such as familial polyposis syndrome or Lynch syndrome. It also matters if you have a personal history of colon polyps or inflammatory bowel disease such as Crohn’s colitis or ulcerative colitis, or if you have had abdominal radiation.
The symptoms of colorectal cancer depend on the location of the tumor. They include a change in bowel habits such as new constipation or diarrhea, consistent new bloating and gas, rectal bleeding or dark tarry stools, a feeling of incomplete emptying, or persistent cramps and pain. Another sign of cancer is iron-deficiency anemia.
The number of people living with Parkinson’s disease worldwide could double in the next two decades, experts project.
In a report warning of a possible Parkinson’s “pandemic,” researchers say the stage is set for cases to surge to 12 million or more by 2040.
What’s to blame? In large part, trends that are generally positive: Older age is a major risk factor for Parkinson’s. With life expectancy rising worldwide, more people will develop the disease. At the same time, Parkinson’s patients are surviving longer, which drives up the number of people living with the disease at any given time.
Then there’s a less expected factor: Declining smoking rates. While the habit has many devastating effects, research suggests it protects against Parkinson’s.
Those are obviously trends that no one wants to reverse, said report author Dr. Ray Dorsey.
There are, however, other ways to slow the projected rise in Parkinson’s, said Dorsey, a professor of neurology at the University of Rochester Medical Center in New York.
“We believe there’s a lot we can do toward prevention,” he said.
At the top of the list is reducing people’s exposure to certain pesticides, solvents and other chemicals that research has linked to Parkinson’s risk.
As an example, Dorsey pointed to the weed-killer paraquat.
“It’s been strongly linked to an increased risk of Parkinson’s and it’s banned in 32 countries,” he said.
It’s still used in the United States, however. And, Dorsey noted, some countries that have banned it—such as England—continue to make and export it to other countries, including the United States
Then there is trichloroethylene, or TCE—an industrial solvent that is a known human carcinogen and can contaminate groundwater, according to the U.S. Department of Health.
TCE is also toxic to nerve cells and studies have tied it to Parkinson’s, Dorsey said.
Parkinson’s disease currently affects nearly 1 million people in the United States alone, according to the nonprofit Parkinson’s Foundation.
The cause is unclear, but as the disease progresses, the brain loses cells that produce dopamine—a chemical that regulates movement. As a result, people suffer symptoms like tremors, stiff limbs and balance and coordination problems. All gradually worsen over time.
Medications and other treatments can lessen those effects, but there is no cure.
The new report—co-authored by representatives of the Parkinson’s Foundation and Michael J. Fox Foundation—paints a potentially bleak picture.
Between 1990 and 2015, the number of people diagnosed with Parkinson’s worldwide doubled, to just over 6 million. And based on the aging population, Dorsey and his colleagues project that the number will double again by 2040, to about 12 million.
But that figure, they say, could actually be higher—up to 17 million—with declining smoking rates and growing industrialization factored into the mix.
“There is an urgent and pressing need for the world to wake up and recognize there is a coming wave of Parkinson’s disease,” said Dr. Michael Okun, medical director of the Parkinson’s Foundation and an author of the report.
In addition to broader bans on paraquat and TCE, Dorsey said other measures could help stem the tide.
For example, people with a history of head injury face a relatively higher risk of Parkinson’s. So preventing head injuries in the workplace, sports or recreation—by wearing helmets, for instance—could help, Dorsey said.
There’s also some evidence that certain healthy lifestyle habits are protective—namely, vigorous exercise and eating a Mediterranean diet.
But beyond prevention, health care systems have to prepare for a surge in Parkinson’s, according to Okun.
“The numbers of patients with Parkinson’s disease are growing a rates that will overwhelm the world’s health care systems,” he said.
One key step, Dorsey said, will be to find ways to bring health care to patients at home.
“If I’m an elderly person with Parkinson’s who can no longer drive,” he said, “I need the care to come to me.”
Of course, many patients will have family members who can help out. But that brings up another huge issue—the burden on family caregivers.
Already in the United States, more than 30 million people provide care to an adult aged 50 or older, Dorsey pointed out.
“The main reason,” he said, “is neurological conditions, like Alzheimer’s and Parkinson’s.”
The report was published recently in a supplement to the Journal of Parkinson’s Disease.
If you want to know where someone’s priorities lie, take a look at how they spend their money.
Take, for instance, the federal government.
In 2018, the National Institutes of Health spent $303 million on asthma research and $989 million on autoimmune disease studies. That same year, the agency allocated $23 million to the study of migraines.
This, despite the fact that migraines are 50 percent more prevalent than both of the other illnesses. Migraines affect more than 39 million Americans, and about 4 million of them suffer from the chronic form of the disease (15 or more migraine days a month).
There is indeed a gross inequity in funding migraine research compared to other illnesses, said Jared Pomeroy, MD, a headache specialist with Spectrum Health Medical Group Neurology.
In pointing out the federal data, Dr. Pomeroy said one of the main reasons for the lack of funding is stigmatization—migraine patients are more stigmatized than patients who suffer from more diagnosable diseases such as asthma.
Medical tests can help determine the presence and severity of diseases such as asthma. There are no such tests for migraines.
“A lot involves patients reporting their symptoms,” Dr. Pomeroy said. “If someone is missing an arm or a leg, you can see the problem. It’s obvious there’s a disability.
“But headaches are harder to see and diagnose,” he said. “Doctors must rely mostly on what a patient reports, as opposed to relying on their own observations.”
The human condition
Migraines aren’t just an American issue—they’re a human issue.
The World Health Organization lists migraines among the Top 20 illnesses that cause a disability.
The disorder has a disproportionate economic impact as well, typically affecting people in the prime of their lives.
A bout with migraines can cause an otherwise healthy person to miss work or school, and in some cases it can lead to job loss. It can also cause a person to miss out on precious family time.
It’s truly an ailment that knows no social or economic boundaries, striking the rich and famous just as often as it strikes everyday people.
People with migraines can sporadically—and temporarily—escape the battle.
When they seek treatment, however, they sometimes find it difficult to gain understanding from people who have never suffered a migraine, Dr. Pomeroy said.
“A lot of people who don’t suffer from migraines see them as a character flaw, not as a physical ailment,” the doctor said.
Society’s conventional knowledge of migraines doesn’t always mean the public, or even employees in the medical field, will understand the nature of the beast.
Generally, migraines can be accompanied by nausea, vomiting or pulsating on one side of the head. Routine activity can aggravate them.
A migraine patient is often sensitive to light and sound.
Some patients will also experience numbness in their face or body, and the headaches may cause weakness in an arm or leg. Seeing a flashing light, experiencing tunnel vision or even temporarily losing sight are also symptoms.
Treatments
While science is still pursuing a full understanding of migraines, there are treatments available.
They usually entail over-the-counter or prescription drugs. For more severe pain, doctors have used injections or other specialized drugs to provide immediate relief.
“In the 1990s, Triptan medications were developed for acute treatment of migraines,” Dr. Pomeroy said. “Since then, we haven’t had any new classes of pharmaceutical agents developed specifically for migraines.”
Researchers have developed new drugs within existing pharmaceutical classes, the doctor said, and some medicines meant for unrelated disorders have been used effectively for migraines.
Botox has become a godsend for some, although it involves 31 tiny injections that must be repeated every 12 weeks. Others may find relief simply by placing an ice pack on the back of the neck, or on the primary location of the pain.
Patients may also see symptoms improve by changing lifestyle factors such as diet and exercise, Dr. Pomeroy said. Cutting out caffeine and nicotine can be a big help.
Interestingly, the migraine sufferer’s keen intuition is often one of the best defenses.
People who frequently experience migraines can sense when a new one is approaching.
When it strikes at work or at school, they’re better prepared—even if they know their best course of action means returning home to rest in a dark, quiet room.
Some experts think migraines may be hereditary. This much is certain: There’s typically no known cause, and there is no cure.
And until there’s enough funding to help researchers develop a cure, migraine suffers must muddle through the attacks. With guidance from a good doctor, their outlook can improve.
If life looks gray and cloudy when you smoke, you might not be imagining it.
Heavy smoking may actually damage color and contrast vision, researchers report.
They looked at 71 healthy people who smoked fewer than 15 cigarettes in their lives and 63 people who smoked more than 20 cigarettes a day. The participants were aged 25 to 45 and had normal or corrected-to-normal vision.
But the heavy smokers showed significant changes in their red-green and blue-yellow color vision and also had greater difficulty discriminating contrasts and colors than nonsmokers.
“Our results indicate that excessive use of cigarettes, or chronic exposure to their compounds, affects visual discrimination, supporting the existence of overall deficits in visual processing with tobacco addiction,” said co-author Steven Silverstein, director of research at Rutgers University Behavioral Health Care.
“Cigarette smoke consists of numerous compounds that are harmful to health and it has been linked to a reduction in the thickness of layers in the brain, and to brain lesions, involving areas such as … the area of the brain that processes vision,” he added in a university news release.
He also noted, “Previous studies have pointed to long-term smoking as doubling the risk for age-related macular degeneration and as a factor causing lens yellowing and inflammation.”
Nicotine and smoking harm the body’s circulatory system. These findings indicate they also damage blood vessels and neurons in the retina, according to Silverstein.
He said the results also suggest that research into vision problems in other groups of people, such as those with schizophrenia who often smoke heavily, should take into account their smoking rate.
About 34 million adults in the United States smoke cigarettes, according to the U.S. Centers for Disease Control and Prevention, and more than 16 million have a smoking-related disease, many of which affect the cardiovascular system.
The study was published recently in the journal Psychiatry Research.
Kratom is often marketed as a safe alternative to opioid painkillers, but this unregulated substance poses a significant health risk. (Courtesy Spectrum Health Beat)
Calls to U.S. poison control centers related to the herbal drug kratom have skyrocketed, increasing more than 50-fold in a matter of six years, a new study shows.
Back in 2011, poison centers received about one call a month regarding someone who’d taken too much kratom, a plant that is purported to produce mild opioid-like effects.
These days, nearly two calls a day are received concerning kratom exposures, researchers report in a recent issue of the journal Clinical Toxicology.
“We’re now getting literally hundreds of cases a year versus 10 or 20,” said researcher Henry Spiller, director of the Central Ohio Poison Center at Nationwide Children’s Hospital in Columbus. He noted that kratom reports underwent a “relatively big spike” sometime between 2015 and 2016.
The researchers identified 11 deaths associated with kratom use, including two in which kratom was used by itself and nine where kratom was used with other drugs.
Unfortunately, kratom is being promoted as a safe alternative to opioid painkillers for people with chronic pain, Spiller said.
“Because it’s a plant and it’s natural, at this point it’s unregulated,” Spiller said. “A lot of people have been Google-searching it for use in chronic pain and other things and we’ve started to see a really significantly increased use and, in many cases, abuse of it.”
But taking too much kratom can cause some unintended health problems, including agitation, seizures, rapid heart rate and high blood pressure, Spiller said. In extreme cases, kratom overdose can put a person into a coma, stop their breathing or cause kidney failure.
“Just because it’s natural doesn’t mean it’s harmless,” Spiller said.
The U.S. Food and Drug Administration has issued a warning to consumers against using kratom and the U.S. Drug Enforcement Agency has listed it as a “drug of concern.”
Kratom has not been approved for any medical use by the FDA.
For this study, researchers analyzed calls to U.S. Poison Control Centers between 2011 and 2017, finding more than 1,800 reports related to kratom use.
The annual number of calls increased dramatically, going from 13 calls in 2011 to 682 calls in 2017, researchers found.
About two of every three of these calls occurred recently, in either 2016 or 2017.
About a third of the calls resulted in a person needing hospitalization and more than half resulted in serious medical outcomes, the researchers said.
“The belief that kratom is harmless because it is classified as an herbal supplement is directly challenged by the findings in this report—and policy efforts need to address this knowledge gap,” said Dr. Harshal Kirane, director of addiction services at Staten Island University Hospital.
Most dangerous kratom exposures occurred among males (71 percent), adults aged 20 and older (89 percent), in a home (86 percent) and involving intentional abuse or misuse (60 percent), findings show.
Although kratom appears confined to adult use for now, children and teenagers could be exposed to the herb if its popularity keeps increasing, said Kirane, who wasn’t involved with the study.
“The dramatic increase in the rate of reported kratom exposures in recent years suggests a growing demand for this substance,” Kirane said. “Increasing prevalence of kratom use may place young children in dangerous situations, particularly if regulatory measures are not in place to ensure childproof packaging and consistency in quality of kratom.”
Idaho and Oregon are the states with the most reported kratom poisonings, while Delaware and Wisconsin had the lowest rates.
Using kratom with another substance significantly raised a person’s chances of poisoning, nearly tripling the odds that they’d land in a hospital and more than doubling the risk of having a serious medical outcome.
Of the nine deaths involving a mixture of kratom with another substance, kratom was the first-ranked substance in seven, researchers said. The deaths involved kratom used alongside antihistamines, alcohol, benzodiazepines (such as Valium or Xanax), caffeine, fentanyl or cocaine.
“Though the drug claims to cure anxiety and depression, there are very few ‘cure-alls’ in the medical world and anything that claims to alter an individual’s mental state should be taken with the utmost seriousness,” said Dr. Teresa Amato. She is chair of emergency medicine at Northwell Health’s Long Island Jewish Forest Hills in New York City.
“We, as doctors, are unable to tell patients how this ‘medication’ might affect them and cannot in good conscience advise the use of this medicine without a thorough FDA investigation,” said Amato, who had no part in the study.
People should be aware that kratom can interact with medications or illicit drugs in harmful ways and could exacerbate existing health problems, Spiller said.
There’s also a concern that because it’s unregulated, people may be getting kratom that either varies in potency or is mixed with other substances, he added.
“I’d be cautious,” Spiller said. “At this point, we’re not sure of everything kratom does.”
Pregnant women in particular should be careful with kratom.
The researchers identified seven babies who had been exposed to kratom in the womb, three of whom required admission to a critical care unit after birth.
Five of the babies experienced withdrawal symptoms from their mothers’ kratom use and four of those had been exposed to kratom alone.
“I would very much caution pregnant women,” Spiller said. “You can have a real impact on your child.”
For the first time in decades, doctors have a new weapon to fight serious cases of depression.
Of the 16 million Americans adults living with depression, as many as four million have treatment-resistant depression, which means current treatments such as talk therapy, anti-depressants and electro-convulsive therapy have given them little or no relief.
But recently, the Food and Drug Administration approved ketamine, a fast-acting drug that differs significantly from Prozac, Paxil and other anti-depressants that have been on the market since the 1990s.
Even when antidepressants work, it often takes four to six weeks to kick in, while ketamine only takes several hours to begin showing positive effects, drug trials have shown. The approval is “welcomed news,” said David Franzblau, MD, a psychiatrist with Spectrum Health Medical Group.
“The prospects for ketamine as a long-term treatment remains to be seen,” said Dr. Franzblau, the site chief of the Spectrum Health Integrated Care Campus at East Beltline.
“Trials have shown that the duration of time before symptom-relief is generally much shorter compared to current antidepressants so it at least represents a promising bridge, if not a long-term treatment.”
A stubborn illness
Depression is a mood disorder that affects the way people feel and
interferes with their ability to function at home and at work.
It can be associated with the loss of appetite, sleep disturbance, difficulty concentrating, memory impairment, and a loss of motivation and productivity, Dr. Franzblau said.
“Everybody experiences sadness and anxiety,” he said. “It’s the length of time and number of episodes, along with a constellation of other symptoms, that determine whether somebody has clinical depression.”
About one in 16 American adults suffer from clinical depression at any given moment.
“Depression is the most prevalent mental health disorder in the population,” Dr. Franzblau said. “I believe the adverse impacts of even the treatment-resistant variants can be substantially decreased, and thereby improve the quality of life (of all patients), with enough time and a systematic approach.”
The first step in combating depression is consulting with your primary care physician. First-line interventions that a mental health professional might recommend include counseling and medication.
Antidepressants regulate neurotransmitters like dopamine, serotonin and norepinephrine. But the results have been mixed, especially for the up to 33 percent of patients who have treatment-resistant depression.
One current intervention for treatment-resistant depression is electro-convulsive therapy. The benefits of electro-convulsive therapy “were observed accidentally,” Dr. Franzblau said, “like many scientific discoveries.”
The symptoms of depression among patients with epilepsy improved after a seizure.
“The brain is an electrical apparatus: brain activity, thinking, memory and mood regulation like arousal or anxiety, those are all electrical or electro-chemical events,” he said. “So ECT is basically inducing a seizure” in a controlled environment (often in an outpatient setting), helping severely depressed people who haven’t responded to medication.
There are misconceptions about the procedure, and suitable patients have to be chosen, but it can be effective in bringing about a recovery, Dr. Franzblau said. Sometimes one course of this treatment will suffice, or a patient may require periodic maintenance treatment.
From the club to the doctor’s office
Despite $12 billion a year spent on antidepressants globally, suicide rates have increased 25 percent nationally in the last two decades, and are rising in 49 of 50 states.
That’s why any new treatment is welcomed news.
Interest in ketamine—an anesthetic used frequently in hospitals and the battlefield—has grown steadily since the early 2000s.
In 2000, researches at Yale reported that doses of ketamine provided quick relief to seven people with depression.
In 2006, the National Institute of Mental Health documented 18 people with treatment-resistant depression who received the drug intravenously and reported their issues had disappeared almost immediately.
“What seems remarkable is that the drug also seems to help domains other than depression, like anxiety, suicidal thinking, and anhedonia”—the inability to feel pleasure, noted Dr. Carlos Zarate Jr, chief of the National Institute of Mental Health’s experimental therapeutics branch who led the 2006 study.
“It seems to have more broad effects, on many areas of mood,” shared in a New York Times article about ketamine.
Ketamine does have side effects. Ketamine was once a popular drug in the 1980s and 1990s known as Special K, and can cause hallucinations and psychotic episodes in people who are high risk for them. The drug also was less effective in drug trials for people over 65.
The drug maker, Janssen Pharmaceuticals, said the non-generic medication form esketamine, which will be marketed as Spravato, would have less dramatic side effects. Like with all new drugs, Dr. Franzblau said he’ll proceed cautiously because the benefits and costs become clear only after a medication has been used for some time.
“I anticipate I will use it,” he said. “I want to make sure that the benefits outweigh any complications and side effects.”
Esketamine will be administered as a nasal spray. Patients who receive it will have to be monitored for at least two hours, and won’t be allowed to drive on days they receive the drug.
The recommended course will be two days per week for four weeks.
In one drug trial, Janssen reported that those taking esketamine only relapsed into depression 25 percent of the time, as opposed to 45 percent with a placebo. All the people in the study had previously been diagnosed as having treatment-resistant depression, and had failed with other types of treatment.
“Clinical depression represents considerable suffering for the patient and their families,” Dr. Franzblau said. “At worse, it’s a lethal condition, as demonstrated by the rising suicides in our country. New treatments are needed and offer hope.”
Researchers say new drug therapies can target certain genes that play a role in the growth and spread of prostate cancer. (Courtesy Spectrum Health Beat)
A drug that targets faulty gene repair may buy more time for some men with advanced prostate cancer, a new clinical trial finds.
Experts called the study “landmark,” because it zeroed in on men with particular gene mutations that can be targeted with newer drug therapies.
It’s an approach that is already used in treating breast, ovarian and lung cancers.
Specifically, the trial tested a drug called Lynparza (olaparib), which is currently approved to treat certain patients with breast or ovarian cancers linked to mutations in the BRCA genes.
When BRCA is working properly, it helps repair damaged DNA in body cells that can lead to cancer. When the gene is altered, those repair mechanisms go awry.
BRCA mutations do not only lead to breast and ovarian cancers, though. They also help drive some cases of prostate cancer.
In the new trial, researchers recruited men with advanced prostate cancer who had alterations in BRCA or certain other genes involved in DNA repair.
The investigators found that, compared with standard hormonal therapy, Lynparza delayed patients’ cancer progression for a median of about three months. That means half the patients saw a longer delay and half a shorter one.
Along with that delay, the drug slowed down patients’ pain progression.
“Delaying the cancer from growing is meaningful,” said Dr. Maha Hussain, who led the trial, which was funded by drug makers Astra Zeneca and Merck.
“At the end of the day, patients want to live longer—and also better,” added Hussain, a professor at Northwestern University Feinberg School of Medicine, in Chicago.
She was to present the findings at the annual meeting of the European Society for Medical Oncology, in Barcelona. Studies reported at meetings are generally considered preliminary until they are published in a peer-reviewed journal.
Lynparza is one of a newer class of drugs called PARP inhibitors, which block a protein that cancer cells need to keep their DNA healthy. Without it, those cells may die. Cancer cells with defects in DNA-repair genes are especially vulnerable to PARP inhibitors.
The drug class is part of a wider trend in cancer treatment, toward “targeted therapies”—where medications are tailored to target certain molecules in cancer cells that help them grow and spread.
A range of targeted drugs are available for common cancers, such as breast and lung, but prostate cancer has “lagged behind,” Hussain said.
Dr. Eleni Efstathiou, of MD Anderson Cancer Center in Houston, described the new trial as landmark.
“Overall, these data show that, like breast and lung cancers, prostate cancer is not one but many different diseases,” Efstathiou said. “We need to start identifying different groups of patients and treating them with targeted therapy.”
She noted that only a fairly small percentage of prostate cancer patients would have alterations in DNA-repair genes—which can be inherited or arise as the cancer progresses.
And doctors do not routinely screen cancers for all those gene flaws.
Screening for inherited mutations is “becoming part of guidelines,” Efstathiou noted, but screening for non-inherited alternations is not yet done.
For the latest trial, the researchers screened 4,425 men with advanced prostate cancer that had spread to distant sites in the body and was not responding to standard hormonal therapy.
The investigators ended up with 245 patients with alterations in either BRCA or another gene called ATM. A second group of 142 patients had alterations in any of 12 other genes tied to flawed DNA repair.
Patients in both groups were randomly assigned to either take Lynparza tablets or start one of two newer hormonal therapies.
Overall, Lynparza patients saw their cancer advance more slowly, with the difference being clearer in the group with BRCA or ATM defects.
For those men, cancer progression was delayed by a median of 7.4 months, versus 3.5 months among patients on hormonal therapy. A preliminary analysis suggested their overall survival was also better—a median of 18.5 months, versus 15 months.
Lynparza does have side effects, including anemia and nausea, Efstathiou pointed out, which can make it difficult to stick with the drug. Just over 16% of Lynparza patients in the trial stopped treatment due to side effects.
The drug is not yet approved for prostate cancer, though some doctors use it “off-label” for certain patients, Hussain noted.
At this point, Efstathiou said, doctors may want to screen for DNA-repair mutations in the tumors of men with advanced prostate cancer, since “we now have evidence it can be successfully targeted.”
Like other targeted drugs, Lynparza carries a hefty price tag: Researchers have estimated that it costs more than $234,000 to extend a patient’s life by one year.
The old saying, “TV rots your brain,” could have some validity for folks as they age.
In a new study, middle-aged people who watched television for more than 3.5 hours a day experienced a decline in their ability to remember words and language over the next six years, British researchers found.
What’s worse, it appears that the more TV you watch, the more your verbal memory will deteriorate, researchers said.
“Overall, our results suggests that adults over the age of 50 should try and ensure television viewing is balanced with other contrasting activities,” said lead researcher Daisy Fancourt. She’s a senior research fellow at University College London.
For the study, researchers relied on data from a long-term study of aging involving more than 3,600 residents of England.
Participants reported the amount of hours of TV they watched daily. They also had their thinking and reasoning skills regularly tested as part of the study.
People who watched less than 3.5 hours of TV a day didn’t seem to suffer any deterioration in their brain power, Fancourt said.
But more than that amount, people became increasingly apt to struggle with words or language in tests conducted six years later.
The decline in language skills is similar to that experienced by the poor as they age, Fancourt said.
“We already know from a number of studies that being of low socio-economic status is a risk factor for cognitive decline,” Fancourt said. “If we compare the size of association for watching television for greater than 3.5 hours a day, it has a similar-sized association with verbal memory as being in the lowest 20 percent of wealth in the country.”
The worst deficits occurred in those people who watched more than seven hours of television daily, researchers found.
While only an association was seen in the study, there are a couple of potential reasons why this might happen.
“Due to the fast-paced changes in images, sounds and action, yet the passive nature of receiving these—i.e., television does not involve interaction as gaming or using the internet does—watching television has been shown in laboratory studies to lead to a more alert, but less focused, brain,” Fancourt explained.
Some TV viewing is also stressful and stress has been associated with a decline in brain power, she added.
The specific effect on verbal skills indicates that avid TV viewing could be replacing other activities that would be better for the brain, said Rebecca Edelmayer, director of scientific engagement at the U.S.-based Alzheimer’s Association.
“You’re spending more time not engaging with your family, your friends and having social conversations, because they’re specifically reporting a decrease in verbal recall,” Edelmayer said. “We know engagement with others in conversation is something that supports and protects verbal recall.”
People who want to protect their thinking skills need to socialize often and engage in other activities that “stretch” their brain, Edelmayer said.
In fact, a long-term study published just last week in the journal Neurology found that exercising both the brain and body during middle age may guard against dementia. Such mental exercise includes reading, playing music, sewing or painting, according to the report.
“The recommendation would always be to stretch yourself and stay as engaged as you can be, whatever the connection is,” Edelmayer said. “We’re asking you for best brain health to go outside your normal passive box.”
The new study was published recently in the journal Scientific Reports.
If you find yourself struggling to stay alert, it could hint at an underlying medical problem—or the need for changes to your nighttime sleep routine. (Courtesy Spectrum Health Beat)
Napping isn’t just for infants and children. Adults can get in on the action, too—they need only recognize the right time, place and circumstance.
Feeling fatigued or groggy during the day? That’s a good place to start. But you first need to determine why you’re feeling that way.
A nap can be refreshing and invigorating, helping you reenergize for a trip or for the workday, or whatever activity you’re undertaking, said Mary Barr, adult nurse practitioner in sleep medicine at Spectrum Health.
But the circumstances allowing for a nap will vary.
Generally speaking, you should only be napping during the day if you’re ill or if you’re trying to relieve pain. You could also nap amid abnormal circumstances—when you’re recovering from an acute injury, for example, or managing chronic illness.
Sometimes your schedule might deprive you of some much-needed sleep. If you find there’s no way to make it through the day without stealing a few quick moments of rest—or if you’re engaged in an activity that is simply wearing you down—a short nap is entirely acceptable.
Just be sure it’s a temporary solution. You should change your activities so you can keep to your regular schedule.
If you feel sleepy while driving, pull over in a safe place and catch a few Zzzs, Barr said. Likewise, when performing tasks that require high levels of attention, consider a nap to ward off fatigue.
If you’re at work, your nap needs to happen while on break or during your lunch hour.
“A 15-minute nap—often called a power nap—can refresh you when you are feeling sluggish or inattentive, groggy or not focused,” Barr said.
Generally, a 15- to 30-minute nap is enough. You can tell if you’ve slept too long because you’ll wake up feeling more groggy than before, she said.
There’s no ideal nap time, just whenever you feel sleepy during the day. Generally, this is after lunch for most people.
Falling asleep when napping is good, although you may not necessarily fall into any deep sleep stages.
Not all naps are equal
A word of caution: Don’t nap too late in the day or too close to your typical bedtime. Such naps can interfere with normal nighttime sleep routines, Barr said.
And make no mistake—you need a good night’s sleep every single night. Usually, if your sleep routine is good, you won’t need additional napping.
Barr offered a good rule of thumb: Make sure your nap is at least six to eight hours before your normal bedtime.
She also said that napping every day could be an indication you’re not getting enough rest at night. Bad sleep habits could cause this, but there could also be a medical problem. Sleep apnea or restless legs syndrome, for example, can make people feel sleepy during the day.
One American Academy of Sleep Medicine study that found frequent napping is associated with an increased risk of Type 2 diabetes in older adults.
Adults who don’t sleep well at night should analyze their sleep habits to see what might be interrupting their sleep. Stimulants such as caffeine or nicotine could be to blame, but bad sleep habits could also be the culprit.
Some other napping tips from Barr:
Keep the nap short—ideally about 30 minutes.
Make sure the nap is in a safe, comfortable place where you won’t be disturbed.
Avoid long weekend naps, especially if you don’t nap during the week.
Don’t resort to napping to make up for sleepless nights.
If sleepless nights are a recurring problem, you may need to seek help from a sleep professional to determine if there is an underlying medical cause.
Too little sleep. Not enough exercise. Far too much “screen time.”
That is the unhealthy lifestyle of nearly all U.S. high school students, new research finds.
The study, of almost 60,000 teenagers nationwide, found that only 5 percent were meeting experts’ recommendations on three critical health habits—sleep, exercise and time spent gazing at digital media and television.
It’s no secret that many teenagers are attached to their cellphones, or stay up late, or spend a lot of time being sedentary. But even researchers were struck by how extensive those issues are among high school students.
“Five percent is a really low proportion,” said study leader Gregory Knell, a research fellow at University of Texas School of Public Health, in Dallas. “We were a bit surprised by that.”
In general, medical experts say teenagers should get eight to 10 hours of sleep at night and at least one hour of moderate to vigorous exercise every day. They should also limit their screen time—TV and digital media—to less than two hours per day.
The new findings show how few kids manage to meet all three recommendations, Knell said.
It’s easy to see how sleep, exercise and screen time are intertwined, he pointed out.
“Here’s one example: If kids are viewing a screen at night—staring at that blue light—that may affect their ability to sleep,” Knell said.
“And if you’re not getting enough sleep at night, you’re going to be more tired during the day,” he added, “and you’re not going to be as physically active.”
Ariella Silver is an assistant professor of pediatrics and adolescent medicine at Icahn School of Medicine at Mount Sinai, in New York City. She agreed there’s a lot of overlap in the three behaviors.
Silver, who was not involved in the study, also made this point: The two-hour limit on screen time may be tough for high school students, since their homework may demand a lot of computer time.
It’s not clear how much that may have played into the findings, Silver said.
Still, she sees screen time as possibly the “biggest factor” here. Silver agreed that it may hinder teenagers’ sleep. But another issue comes up when social media “replaces” face-to-face social interaction.
When kids do not go out with friends, they miss out on many experiences—including chances for physical activity, Silver said.
While no group of kids in the study was doing well, some were faring worse than others. Only 3 percent of girls met all three recommendations, versus 7 percent of boys.
Similarly, the rate was 2 percent to 4 percent among black, Hispanic and Asian American students, versus just over 6 percent of white kids, the findings showed.
The report was published online recently in the journal JAMA Pediatrics.
Silver offered some advice for parents:
Instead of telling kids to “get off the phone,” steer them toward alternatives, like extracurricular activities, community programs or family time. “Their screen time will go down by default,” she noted.
Be a good role model. Get off your phone and demonstrate healthy habits, including spending time being physically active with your kids.
Talk to teenagers about the importance of healthy habits. “Ask them, ‘How do you feel when you don’t get enough sleep?’” Silver suggested. “Ask, ‘How do you feel when you don’t get outside in the sun and get some exercise?’” It’s important, she said, that kids notice how their bodies feel when they do or don’t engage in healthy habits.
Set some clear rules around screen time, such as no devices in the two hours before bedtime. “Make sure your kids realize these devices are a privilege, and not a necessity to living,” Silver said.
The good news, Knell said, is that since sleep, exercise and screen time are interrelated, changing one habit could affect the others, too.
“There are certainly small changes you can make that may have a big impact,” he said.
In people with buildup of amyloid brain protein, regular aerobic activity might slow degeneration in the brain region tied to memory. (Courtesy Spectrum Health Beat)
For people at risk of Alzheimer’s disease, working out a couple of times a week might at least slow the onset of the illness, new research suggests.
Regular exercise over a year slowed the degeneration of the part of the brain tied to memory among people who had a buildup of amyloid beta protein in their brain.
These protein “plaques” are a hallmark of Alzheimer’s, noted researchers at the University of Texas Southwestern Medical Center in Dallas.
Aerobic exercise didn’t stop plaques from spreading, but it might slow down the effects of amyloid on the brain, especially if started at an early stage, the research team suggested.
“What are you supposed to do if you have amyloid clumping together in the brain? Right now doctors can’t prescribe anything,” lead researcher Dr. Rong Zhang said in a university news release.
However, “if these findings can be replicated in a larger trial, then maybe one day doctors will be telling high-risk patients to start an exercise plan,” he said. “In fact, there’s no harm in doing so now.”
One expert who wasn’t involved in the study agreed with that advice.
“Exercise is an excellent way to both prevent Alzheimer’s and to help patients with Alzheimer’s disease stay stable for longer periods of time,” said Dr. Gayatri Devi, a neurologist specializing in memory disorders at Lenox Hill Hospital in New York City.
“Aerobic exercise, three to four times a week, has been shown to help grow brain cells in the part of the brain called the hippocampus, the key area for both laying down new memories and for retrieving old ones,” she explained.
In the new study, Zhang and colleagues randomly assigned 70 people aged 55 and older to either half-hour workouts of aerobic exercise four to five days a week, or less strenuous flexibility training.
All of the patients had some amyloid plaque buildup in their brains at the beginning of the study and were classed as having “mild cognitive impairment,” often a precursor to Alzheimer’s.
Followed over one year, people in both groups maintained similar mental abilities in memory and problem solving, the researchers noted.
However, those in the aerobic exercise group showed less shrinkage of the brain’s hippocampus as seen on scans.
The hippocampus is an area of the brain important to memory and one of the first areas usually affected by Alzheimer’s, Zhang’s group explained.
“It’s interesting that the brains of participants with amyloid responded more to the aerobic exercise than the others,” Zhang said. “Although the interventions didn’t stop the hippocampus from getting smaller, even slowing down the rate of atrophy through exercise could be an exciting revelation.”
To further test the effect of exercise, Zhang is heading up a five-year trial that includes more than 600 older adults, aged 60 to 85, who are at risk for Alzheimer’s.
“Understanding the molecular basis for Alzheimer’s disease is important,” Zhang said. “But the burning question in my field is, ‘Can we translate our growing knowledge of molecular biology into an effective treatment?’ We need to keep looking for answers.”
Dr. Jeremy Koppel is associate professor of psychiatry and molecular medicine at the Litwin-Zucker Center for Alzheimer’s Disease & Memory Disorders, at Feinstein Institutes for Medical Research in Manhasset, N.Y.
Reading over the new findings, he said that, on the whole, the study was “disappointing” because exercise “did not have any specific effect on tests of memory, mental flexibility or amyloid deposition in patients with mild cognitive impairment.”
While the finding regarding hippocampus size was interesting, “this was not the primary outcome measure of the study,” Koppel noted.
So, “it may be that aerobic exercise interventions are best targeted at those not suffering already from cognitive impairment,” he said.
The report was published recently in the Journal of Alzheimer’s Disease.
Sleeping in on Saturday and Sunday mornings may feel like a reboot from a harried week, but it’s unlikely to compensate for what your body really needs: consistently good sleep. (Courtesy Spectrum Health Beat)
People who are sleep-deprived during the week often try to make up for it on weekends. But a new study suggests the tactic may backfire.
Researchers found that weekday sleep loss had negative effects on people’s metabolism—and “catch-up” sleep on the weekend did not reverse it.
In fact, there were signs that the extra weekend shut-eye could make matters worse, said senior study author Kenneth Wright, a professor at the University of Colorado, Boulder.
The bottom line, according to Wright, is that people need to consistently get sufficient sleep.
“If you want to lead a healthy lifestyle,” he said, “that has to include good sleep habits.”
The study, published online recently in the journal Current Biology, included 36 healthy young adults. They were randomly assigned to one of three groups that all spent nine nights in the sleep lab.
One group was allowed to sleep for up to nine hours each night. A second could sleep only five hours. The third group was allowed five hours of sleep for five days, then a weekend “recovery” period where they could sleep in as late as they wanted. After that, they returned to five hours of sleep for two nights.
Wright’s team found that in both sleep-deprived groups, people lost some of their sensitivity to insulin, a hormone that regulates blood sugar. They also began to eat more at night and gained some weight, on average.
The group that was allowed to sleep in on the weekend saw one benefit: There was less late-night eating on those days.
However, they went right back to post-dinner munching once they returned to five-hour nights. And their insulin sensitivity remained impaired.
In addition, Wright said, they showed decreased insulin sensitivity in the liver and muscles, specifically—which was not seen in the group that got no catch-up sleep over the weekend.
Over time, decreased insulin sensitivity can be a precursor to Type 2 diabetes. And a number of studies have linked chronic sleep loss to heightened risks of diabetes and obesity, Wright noted.
In general, experts recommend that adults get seven or more hours of sleep each night for the sake of their overall health. Yet, studies show that more than one-third of U.S. adults fall short of that goal.
Dr. Phyllis Zee, a sleep specialist and professor at Northwestern University School of Medicine, in Chicago, said, “We tend to buy into the myth that by ‘catching up’ on sleep on weekends, we’ll (reverse) the adverse effects of repeated sleep loss.”
But, according to Zee, who was not involved in the new research, “the results of this study support that it is indeed a myth. In fact, even the muscle and liver ‘remember’ the adverse and persistent effects of sleep loss.”
It’s true, Wright said, that real life can get in the way of optimal sleep. But he added that people should take an honest look at their habits and see if they can make time for a good night’s sleep.
“What are the ‘sleep stealers’ in your life?” Wright said. “Are you up late watching TV or on your computer?”
Late-night “screen” use is a problem not only because it takes time away from sleep, he pointed out. Staring at a blue light before bedtime can actually disrupt your ability to fall asleep.
Sleep is vital for a range of body processes, not only metabolism. And Zee said there’s evidence that other effects of chronic sleep loss—including dampened alertness and mental performance—cannot be erased with a couple of nights of catch-up sleep.
“Regularity in both timing and duration of sleep is key to brain and body health” she said.
Early studies of an experimental contraceptive have shown it can safely reduce hormones that are key to sperm production. (Courtesy Spectrum Health Beat)
A male contraceptive pill, long a goal of men—and women—everywhere, may be one step closer to reality, U.S. researchers report.
They say their experimental pill appears to be safe while reducing levels of hormones key to sperm production.
“Our results suggest that this pill, which combines two hormonal activities in one, will decrease sperm production while preserving libido,” said study co-senior investigator Dr. Christina Wang. She’s professor of medicine at Los Angeles Biomed Research Institute at Harbor-UCLA Medical Center in Torrance, Calif.
But no one should hold their breath while waiting for the pill to reach the market: “Safe, reversible hormonal male contraception should be available in about 10 years,” Wang said in a news release from the Endocrine Society.
Her team presented the findings at the society’s annual meeting in New Orleans.
The study “shows promise for a future reversible male contraceptive,” agreed Dr. Tomer Singer, who directs reproductive endocrinology and infertility at Lenox Hill Hospital in New York City. He wasn’t involved in the new research and stressed that “more studies, including prospective randomized trials, are needed in order to confirm these initial findings.”
The new research involved 40 healthy men who received either a placebo or the experimental birth control pill, which is for now called 11-beta-MNTDC.
As Wang’s group explained, the pill is a modified form of testosterone that delivers the combined actions of both a male hormone and a female hormone (progesterone).
The men took the placebo or drug once a day for 28 days.
Among the men who took the birth control pill, average circulating testosterone levels dropped as low as that which occurs in a state of androgen (male hormone) deficiency.
However, the men did not experience any severe side effects, such as major loss of libido, as can occur in a typical state of androgen deficiency.
Any side effects that did occur were few and mild and included fatigue, acne or headache, Wang’s group reported.
Five of the men who took the birth control pill reported slight declines in their sex drive, while two reported mild erectile dysfunction. However, none of this affected their sexual activity, which did not decrease. None of the men stopped taking the drug because of side effects, and they all passed safety tests.
In men who took the birth control pill, levels of two hormones required for sperm production dropped greatly compared to those who took the placebo. And the drug’s effects were reversible after the men stopped taking the pill.
Wang stressed that the drug would take at least three 60- to 90-day regimens to begin to affect sperm production, so the 28 days of treatment in the study was too short to achieve maximum sperm suppression.
However, her team plans longer studies and—if they show that the drug is effective—the next phases will be larger studies.
Finally, the pill would be tested in sexually active couples, Wang said.
Singer agreed that longer trials are key to knowing if this pill will be successful.
“We know that in order to produce a healthy sperm—which has a life cycle for approximately 3 months—there has to be secretion of both FSH and LH, which are two hormones secreted by the pituitary gland,” he explained. Those two hormones “act on the testicular cells to produce sperm in one (type of cell) and secrete testosterone in the other,” Singer added.
However, “the main challenge is that suppressing the hormones—testosterone, LH and FSH—by taking hormonal treatment may result in a decease in libido, erection and ejaculation,” Singer said. This early, phase 1 clinical trial shows promise, he said, but only larger, longer trials will prove if 11-beta-MNTDC is both safe and effective.
Because the findings were presented at a media meeting, they should also be considered preliminary until published in a peer-reviewed journal.
Taking medication for high blood pressure or high cholesterol can reduce the odds of stroke. Researchers also suspect improvements in diet, exercise and lifestyle are contributing to better outcomes. (Courtesy Spectrum Health Beat)
Starting in the late 1980s, stroke rates among older Americans began to fall—and the decline shows no signs of stopping, a new study finds.
The researchers found that between 1987 and 2017, the rate of stroke incidence among Americans aged 65 and older dropped by one-third per decade.
The pattern has been steady, with no leveling off in recent years.
It’s not completely clear why, according to researcher Dr. Josef Coresh, a professor at Johns Hopkins School of Public Health, in Baltimore.
Over time, fewer older adults in the study were smokers, which is a major risk factor for stroke. On the other hand, some other risk factors—such as high blood pressure and Type 2 diabetes—became more common.
Of course, those conditions can be treated. And it’s known that for any one person, getting high blood pressure, high cholesterol and diabetes under control can cut the risk of stroke, Coresh said.
“However,” he added, “at the population level, we found that the decline (in strokes) was larger than what would be predicted from risk factor control alone.”
That suggests something else is going on, Coresh said.
The findings are based on data from a long-running heart health study that began in 1987. At the outset, it recruited almost 15,800 adults aged 45 to 64 from communities in four U.S. states.
A previous study found that the stroke rate among the participants fell between 1987 and 2011—a decline seen only among people aged 65 and older.
The new analysis, published online recently in JAMA Neurology, shows that the trend continued between 2011 and 2017.
Over 30 years, Coresh’s team found, there were 1,028 strokes among participants aged 65 and older. The incidence dropped by 32% over time.
In more recent years, many more older adults were on medication for high blood pressure or high cholesterol, versus the late 1980s. But risk factor control did not fully explain why the stroke rate dropped so much, according to Coresh.
He said that other factors not measured in the study—including exercise, salt intake and overall diet—might be involved.
Dr. Larry Goldstein, a spokesperson for the American Heart Association/American Stroke Association, made another point: The study could not account for exactly how well-controlled people’s blood pressure and other risk factors were.
That could go a long way toward explaining the decline in stroke incidence, according to Goldstein, who is also a professor of neurology at the University of Kentucky.
But while the latest findings are good news, there are also more sobering stroke statistics, Goldstein said. Although strokes are most common among people aged 65 and older, they strike younger adults, too, and the incidence of stroke among younger people has been inching up in recent years.
Plus, Goldstein said, the death rate from stroke—which had been declining—has recently “stalled” and is starting to reverse course.
“It might be because folks are now having more severe strokes,” Goldstein noted.
It’s critical, he added, that people be aware of the signs of stroke and get help quickly if they think they, or a family member, is having one.
Some of the warning signs include a drooping or numbness on one side of the face; arm weakness or numbness; slurred speech; sudden confusion or difficulty seeing or walking; or, as Goldstein described it, “the worst headache of your life.”
His advice: “Don’t delay getting help. Time saved is brain saved.”
Tramell Louis Jr. has diabetes, and his friends all know it.
So when he collapsed at lunch while waiting to place his order, his buddy thought Tramell was having a diabetic attack.
He helped him out to his car and called LaGenda, Tramell’s wife, who drove to meet them outside the restaurant.
It didn’t take her long to figure out that this was no low-blood-sugar attack, so she followed her instincts and called 911.
“I’m asking him questions and he’s looking at me, but he won’t respond. So at that point I knew something was grotesquely wrong,” she said. “I just knew it wasn’t related to the diabetes.”
As she watched “his mouth go crooked,” she wondered whether he was having a stroke.
Clot retrieval
An ambulance took Tramell to the emergency department at Spectrum Health Butterworth Hospital, where doctors confirmed LaGenda’s suspicions: At age 37, her husband had suffered an acute ischemic stroke.
The doctors quickly got him hooked up to an intravenous drip and administered a clot-busting medicine known as IV tPA. As the only drug approved by the Food and Drug Administration for treating acute ischemic stroke, this is the standard of care in a case like Tramell’s.
At the same time, emergency room staff called one of the hospital’s stroke specialists, who ordered a CT angiogram to pinpoint the source of the stroke. Tramell was rushed to the interventional radiology suite for imaging.
With the images on screen, the Spectrum Health Medical Group neurointerventionalist could see that Tramell was a perfect candidate for an advanced intervention called a mechanical thrombectomy, or clot retrieval.
Tramell’s brain scans showed two blood clots—one in the carotid artery in his neck and the other lodged in the left-middle cerebral artery, a major artery supplying the brain.
This second clot had shut down the blood flow to the left side of his brain, like a dam blocking a river.
“When the doctor showed me the CT scan of his brain, you could clearly see that (one) side of his brain had no blood flow to it at all,” LaGenda recalled.
Time is brain
With stroke, speed is everything. The longer the brain is deprived of blood, the more damage the brain suffers.
Studies have shown that for every minute blood supply is blocked, approximately 2 million neurons die.
So if a patient fits the criteria for intervention, “the sooner you start the procedure, the sooner you take out the blood clot, the sooner you restore the blood flow, the better the outcomes at three months.” That’s the standard measurement in the United States today.
Thankfully, Tramell beat the clock. From the moment he arrived at the hospital to the time he underwent surgery, less than an hour had passed.
Because there were two clots, the doctor used a two-step process to retrieve them. First he inserted a catheter into a blood vessel in the patient’s groin and fed it up to the carotid artery. Using a tool called the Solitaire device, he trapped the first clot in a tiny mesh stent and pulled it out.
Photo by Taylor Ballek, Spectrum Health Beat
Then he repeated the technique, fishing out the clot in the central brain. Immediately the blood began to flow again, in what doctors call complete recanalization—the channel was open again.
The results for Tramell proved to be dramatic.
His symptoms—loss of language function and right-side weakness—improved literally overnight, said Vivek Rai, MD, a neurologist with Spectrum Health Medical Group who specializes in stroke and vascular neurology. He took over Tramell’s care after his release from intensive care.
“After the procedure, the next morning when he woke up, he was night and day,” Dr. Rai said. “And he continued to do so well.”
Now that Tramell is in the clear, Dr. Rai will see him annually in the neurovascular program’s stroke clinic, keeping tabs on his carotid artery disease, which was the cause of the stroke, and monitoring his general health. To prevent a future stroke, Tramell will need to take aspirin and cholesterol medication, and carefully control his diabetes and blood pressure.
Driven to change
At five months post stroke, Tramell is feeling better than ever.
“I feel great. I really do,” he said. “I feel healthier than I have in a long time.”
He looks and sounds healthy, too, with no lingering effects. At least, none that a bystander would notice.
“The only problem I have is my speech,” he said. “When I speak, if it’s a word I haven’t used after I had my stroke, it takes—it’s like a pause and then I have to remember the word and then it jogs it, and then I start using it fluently.”
The stroke served as a major wake-up call for the father of two. Realizing his life could be snatched from him—separating him from his wife and children—brought out strong emotions.
“I felt anger, extreme anger—with myself. I just knew I had to change. I had the worst—the worst—eating habits in the world,” he said, noting that before he started taking insulin, he weighed over 300 pounds.
Today Tramell is eating better, faithfully taking his medications, drinking more water, kicking his soda habit and “running on a treadmill like crazy”—even when his job as a shipping and receiving clerk keeps him at work late.
“My wife—she’s the one that motivates me to do all the things I do,” he said.
Making a conscious decision to let go of anger and resentment rooted in the past will help you focus on what’s important today. (Courtesy Spectrum Health Beat)
It’s surprisingly easy to hold a grudge, but whether it involves a friend, a co-worker or a loved one, it can fill you with bitterness, keep you stuck in the past and even lead to anxiety or depression.
That means you’re the one suffering from the situation—and not necessarily the subject of your anger and irritation.
Besides the emotional toll, researchers from Glasgow Caledonian University and Edinburgh Napier University, in Scotland, found that holding a grudge can also heighten feelings of physical pain, even if that pain has nothing to do with the incident in question.
So if your lower back is bothering you or you have the achiness of arthritis, your pain can feel worse if you’re stewing over the grudge.
Letting go of a grudge starts with forgiveness. That doesn’t mean you’re excusing the behavior the other person exhibited—and you may never forget it—but if you can forgive the person for their mistake, you can break free of the hold he or she has had on your life.
The benefits are wide-ranging and immediate.
Making a conscious decision to let go of the anger and resentment that keeps you rooted in the past will allow you to focus on your present and what’s important to you today.
Letting go of grudges frees you to focus on the positive relationships in your life—the ones that bring you true happiness and contentment. It also lessens feelings of anxiety and hostility while improving self-esteem and your health in general.
As you let go of grudges, they will no longer define you and you’ll feel like a burden has been lifted from your shoulders.
So many women come into the office and share now familiar symptoms.
“Why am I gaining weight?”
“I do not feel like myself!”
“How do I avoid a heart attack so I do not suffer like my mom?!”
“I am afraid to go out in the winter because I do not want to break a hip.”
“How do I deal with all of my stress?!”
Women’s health is different than men’s health and the topic deserves research and attention to better recognize and offer the best prevention and treatment options to women.
Menopause symptoms are important to understand and treat as these symptoms can be a sign more is going on under the surface.
Low estrogen causes hot flashes, night sweats and vaginal dryness. It also accelerates development of heart disease, bone loss, diabetes and obesity.
Emotional changes can be a sign of the existence of a high level of stress from handling kids and aging parents. Or this can be a red flag symptom of changing levels of brain chemicals, less sleep and a need for improved coping tools.
Women who cope well with life and body changes have three things in common:
1. They believe they deserve to be happy.
2. They keep a support network around them.
3. They ask for help when they need it.
A patient I’ll call Katie came to us because she was facing the perfect storm of menopause and felt like it was a hurricane.
She had all the symptoms—hot flashes, night sweats, irritability, insomnia, bladder urgency and low sex drive.
She no longer felt motivated to get up early to exercise and ate cookies at 3 p.m. to stay awake.
She and her husband argued about minor things, especially about how to deal with their son who was failing his class. Her mom, who’d suffered a stroke, fell and broke her hip in the assisted living center.
Work seemed crazy as her boss had left and she had to do both their jobs until a replacement could be found.
Katie came to us because she heard we could help with hot flashes. We certainly could offer meds and call it a day, but we see such a situation as an opportunity to become her partner in her health and consider all options.
This included a practical plan for a healthy lifestyle using the SEEDS, tracking and treating her symptoms, and assessing her health risks for bone loss, stroke and heart attack.
We also know emotional health is a big part of healthy aging. We support this facet of wellness by listening, discussing how the SEEDS can support the body and mind, and also having a team that includes a psychotherapist who can help our patients cope with strong emotions.
Three months later, Katie had improved sleep, better moods, only a rare hot flash, and she and her husband had a plan worked out with their son. Her mom had started to heal and feel better, and she was excelling in her new role at work.
Further, she ate better, took her vitamin D and calcium, and made time for small bursts of exercise. She no longer needing cookies to stay awake.
Best of all, she had a plan to reduce her risk of stroke, heart attack and bone loss.
Her hurricane of menopause had passed and life returned to smooth sailing.
Exercise is a great way to stay youthful and even turn back the clock on aging.
If you’re new to exercise or simply want a fitness reboot, here are ideas by the decade.
In your 20s
Experiment with different workouts to find what you enjoy. Make exercise a regular habit that you won’t want to give up, even when career and family make heavy demands on you.
In your 30s
Short on time? Try three 15-minute walks spread throughout the day. To stay fit and retain muscle, do cardio just about every day and strength training two or three times a week. If you’re new to exercise, take classes or have a personal trainer create a program for you.
In your 40s
Enhance your weekly routine by doing both low-intensity exercise, like yoga for stress relief and flexibility, and high-intensity workouts, like interval training or a spin or kettlebell class, to boost calorie burn and muscle elasticity. Expect longer recovery times after high-intensity workouts, so make sure to get enough sleep.
In your 50s
Regular exercise remains a must, but ask your doctor for modifications if you have any chronic conditions. Varying your workouts or taking up a new sport will engage your brain as well as different muscles. Get in at least one or two high-intensity workouts a week and try to take active vacations that include favorite pastimes like biking, hiking or even walking tours.
In your 60s and beyond
Stay fit and strong to stay independent longer, and stay socially engaged by taking group classes. Stick with strength training, but consider using machines rather than free weights for more control. Water workouts may be easier on joints, too, especially if you have arthritis. But always keep moving. Try tai chi for flexibility and balance, and go dancing for fun and fitness.
It’s not always possible to lower cholesterol through diet alone—sometimes there’s no way to override your DNA. Sometimes medication becomes a must.
But certain foods can be part of the plan to improve your numbers, to both lower low-density lipoprotein (LDL) cholesterol, the bad one, and raise your high-density lipoprotein (HDL), the good one.
First, choose foods with soluble fiber.
Think of this type of fiber as a magnet, drawing cholesterol out of your body. Good sources are oats, oat bran and barley, along with beans, eggplant and okra. When used in recipes, these foods tend to take on the flavors of other ingredients, so be adventurous with recipe planning—and generous with herbs and spices.
Apples, grapes, strawberries and citrus fruits are good choices because of their pectin, a type of soluble fiber.
Next, go for foods with polyunsaturated fats. These include vegetable oils like canola, sunflower and safflower, as well as fatty fish like salmon, rich with omega-3 fatty acids, and most types of seeds and nuts.
Plant-based foods also contain substances called plant sterols and stanols, which help keep the body from absorbing cholesterol.
Particularly good sources are Brussel sprouts, wheat germ and wheat bran, peanuts and almonds, and olive, sesame and canola oils.
In terms of foods to limit, talk to your doctor about your unique needs. High-cholesterol foods like shellfish and eggs aren’t as dangerous as once thought. The verdict is still out on the saturated fat found in meat, but some research has found that full-fat yogurt, milk and even cheese may be good for you.
The one type of fat to completely avoid is trans fat.
The U.S. Food and Drug Administration banned its addition to foods in 2018, but because of extensions granted to some manufacturers, certain items could be on store shelves until January 2021. So keep checking the ingredients on any packaged foods you’re considering.
On any given day, 1 in 5 American youngsters don’t drink any water at all, a new survey shows.
And those who don’t end up consuming almost twice as many calories from sugar-sweetened beverages.
That, investigators warn, translates into an extra 100 calories per day, which over time can raise the risk for becoming overweight or obese.
“Drinking water is the healthiest beverage to drink,” said study author Asher Rosinger, director of the Water, Health and Nutrition Laboratory at Pennsylvania State University. “Water is an essential nutrient that is critical to proper physiological and cognitive functioning.”
By contrast, sugary drinks “are problematic because they have been linked to many negative health conditions, such as weight gain, dental caries (cavities), and type 2 diabetes,” said Rosinger. He noted that current guidelines recommend limiting daily intake of added sugars to less than 10% of all calories consumed.
“Kids should drink water every day and it should be the first option (parents) go to when their kids are thirsty,” Rosinger said.
In the study, data was collected from the U.S. National Health and Nutrition Examination Surveys between 2011 and 2012 and between 2015 and 2016.
About 8,400 children, aged 2 to 19, reported whether they drank water each day—although amounts were not quantified—and how much of sugar-sweetened beverages they routinely consumed.
The latter included all non-diet sodas, sweetened fruit juices, sports drinks, energy drinks, and/or presweetened tea and coffee drinks. Zero-calorie diet sodas and drinks, 100% fruit juices and unsweetened coffee and teas were excluded.
Among the 1 in 5 who didn’t drink any water daily, sugared-drink calories totaled 200, on average, compared with 100 calories a day among water drinkers.
Sugared-drink habits varied somewhat by race, however. For example, white non-water drinkers were found to consume more additional calories from sugared drinks than Hispanic non-water drinkers (123 extra calories per day versus 61 extra calories per day).
Regardless, are such relatively low amounts of excess calories really a big deal? Yes, say investigators, who point out that taking in an extra 3,500 calories means packing on an extra pound.
That breaks down to just a little more than a month of 100 extra calories per day.
Rosinger did note that sugary drink consumption among American children has dropped over the last 15 years.
But he added that “there are still pockets and sub-populations that have high consumption levels. (So) it’s critical to identify which kids are particularly at risk for high sugar-sweetened beverage intake, since this can lead to these negative health effects.”
On that front, Rosinger noted that water insecurity due to contamination “is a growing problem in the U.S., so we need to keep that in mind as important context, especially when it comes to parents who may be giving their kids soda or juice because they distrust the water. Therefore, it’s critical to ensure that everyone has access to safe, clean water.”
The findings were published recently in the journal JAMA Pediatrics.
Lona Sandon is program director in the department of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas. She said the findings “confirm what I have seen in practice: If someone is not drinking water, they are drinking something else, likely soft drinks or other sugary drinks.” She was not involved with the study.
Sandon’s advice to parents? “Provide water and low-fat plain milk at the table. Keep flavored milk only for special occasions. Avoid purchasing soft drinks or other fruit juice-type drinks that are laden with added sugar.
“Try no-calorie, flavored seltzer water instead. Make a no-soft drink or other sugary drinks rule in the household. Save them for special occasions. Keep 100% fruit juice to 1 cup per day. Keep sports drinks for sports, not with meals, and only if the child will be exercising for more than an hour.”
Not a creature was stirring—except for Myra Moritz, 61, a Hudsonville, Michigan, business supervisor who had no plans of missing work.
But something felt a little odd that day. A sluggish left arm. And a heavy hip.
“It got worse over the day,” Moritz remembers. “I told my husband the next morning that I was having a stroke.”
Her husband, Dennis Moritz, took her to Spectrum Health Butterworth Hospital, where doctors soon confirmed what she suspected: She had suffered a stroke.
Lifestyle change
Not all strokes move quickly.
While minutes and seconds certainly matter when treating the victims, the type that hit Moritz had been slow-moving.
“I was too late for that magic pill that turns a stroke around,” she said. “But the staff immediately started tests and treatment and they found I had 95 percent blockage in my right artery and 75 percent in my left.”
In the years leading up to the stroke, Moritz underwent treatment for high blood pressure and high cholesterol. She also had five successful bypasses eight years prior, with surgery performed at Spectrum Health Fred and Lena Meijer Heart Center.
Photo by Chris Clark, Spectrum Health Beat
She knew enough about stroke to recognize her condition, even though she didn’t experience the more classic FAST symptoms associated with stroke:
F—Facial drooping
A—Arm weakness
S—Speech difficulties
T—Time to call emergency services
“I did not have any facial drooping or slurred speech,” Moritz said. “But as the day went on, I felt more weakness in my arm. And my brain was getting foggy. I was having trouble comprehending.”
Justin Singer, MD, Spectrum Health Medical Group neurosurgeon, served on the stroke team that treated Moritz.
“Myra had severe bilateral carotid stenosis, or carotid artery disease,” Dr. Singer said. “Lifestyle habits that contribute to this are high blood pressure, cholesterol, smoking, but also genetics. She had these high risk factors.”
To reduce Moritz’s chances of having another stroke, Dr. Singer performed carotid endarterectomy on her right artery. This surgical procedure removes blockages in the carotid arteries of the neck.
Carotid endarterectomy is not a cure, Dr. Singer said. Arteries can become blocked again if conditions such as high blood pressure and cholesterol are not controlled. This causes new plaque buildup.
“So I quit smoking,” Moritz said. “That was the last day I smoked.”
Moritz immediately began to exhibit mild seizures during rehab.
Photo by Chris Clark, Spectrum Health Beat
“That’s not uncommon after a stroke,” Dr. Rector said.
But the seizures were enough to set Moritz back in her recovery.
“After the seizures, my memory seemed to be more affected,” Moritz said. “I was very tired. And about six days later I started to have hallucinations—probably a side effect from some of the meds I was taking to control the seizures.”
Moritz remembers seeing pirate ships sailing across the lake outside her window at Blodgett Hospital. Dogs she had owned in the past, now dead, suddenly trotted into the room to greet her. When she reached out to pet them, there was nothing there.
“I learned to check with my husband before trusting anything I was seeing,” she said. “And then I also realized that if I blinked, if it was a vision, it would go away.”
The good news: Moritz wasn’t bedridden during recovery.
Under Dr. Rector’s guidance, the rehab team gave her a proper workout to strengthen her left leg and left arm.
She practiced ascending and descending the stairs. She’d get in and out of a pretend car, use the bathroom independently and improve her balance with a walker.
“All the things I needed to be able to do when I go home,” Moritz said.
A return to normal
Before the stroke, Moritz would swim 60 laps twice a week at an indoor pool.
It may be a while before she achieves that level again, but her prognosis is excellent.
Photo by Chris Clark, Spectrum Health Beat
On leaving the hospital a little more than a month after her stroke, she felt optimistic and strong.
“A physical therapist comes out to the house three times a week to work with me,” she said. “That will go down to twice a week soon. My brain doesn’t feel foggy anymore and my appetite is better.
“Although, maybe that’s not so great,” she laughed.
Her doctors have recommended a Mediterranean diet, heavy on fruits and vegetables. She expects to drive again in about six months, when the risk of seizure has passed.
“Myra has made a remarkable recovery,” Dr. Rector said. “By the time she was discharged, we scored her 4 out of 5. We expect her to eventually return to normal or near normal.”
The directive from her doctors: control blood pressure, screen for hypothyroidism, stay active, maintain a healthy diet and keep watch on any reoccurring stroke symptoms.
And don’t smoke.
“An amazing group of doctors and nurses and rehab people have worked with me,” Moritz said. “Everyone has been so kind and supportive throughout every step of my recovery. My rehab people always ask me during my exercises: ‘Can you do one more?’”
Late last summer, Tricia Johnson experienced subtle stomachaches.
Job stress, she thought. Or maybe tight muscles from starting a new workout routine.
“It was kind of constant, but not like pain,” Johnson said. “More like pressure would be the word for it. I kind of blew it off.”
But then, her stools started to change color. And change consistency.
She visited her primary care doctor, who ordered blood work.
“Everything came back pretty OK,” Johnson said. “My white blood count was a little down, but nothing she was concerned about. She chalked it up to my having irritable bowel syndrome. She gave me some anti-cramping pills. I took those for 10 days, but didn’t see any change.”
She returned for a CT scan on Aug. 30.
“I was barely home and I was getting a phone call from the physician,” Johnson said. “He said ‘I have bad news for you.’ My instinct was I thought it was my gall bladder. So when he said, ‘I have bad news for you,’ I thought, ‘Yeah, it’s my gall bladder, I’m going to need surgery.’”
Soul shock
That would have been welcome news.
Instead of hearing about gallbladder issues, she heard unthinkable words spill from her telephone earpiece: “You have pancreatic cancer.”
Johnson sat down on her bed. Shock flooded her soul.
“He must have set me up with an oncologist,” she said. “I just don’t remember much of that day. My husband (Shane) was working in Detroit. I had to call him. He couldn’t believe it. We stayed on the phone with each other that whole three-hour drive home. He even called the doctor to make sure I wasn’t hearing things wrong.”
She had Stage 4 cancer in her pancreas, liver, lymph nodes and some of her vessels. And the cancer was too advanced for surgery.
“She told me it was the worst kind,” Johnson said.
Johnson underwent aggressive chemotherapy with four different medicines twice a month. Each session would take between five and six hours. She would return home with a pump that would continue to deliver chemo drugs.
“They told me it was going to be like dropping a hand grenade in my body,” she said. “They only gave me 6 to 9 months to live, depending on how I handled treatment.”
Johnson wasn’t about to let cancer rule her future. She started researching and studying, trying to learn everything she could to combat the criminal in her cells, the one trying to steal her health and life as she knew it.
“I learned we needed to do our part to take care of the rest of me and we changed my diet,” Johnson said. “We were typical Western Americans that ate processed foods, sugars and red meat.
“After reading a lot of different things, we changed to whole foods,” she said. “We still do some chicken and fish and learned about the top 10 cancer-fighting foods. I really do attribute that to helping me get through chemotherapy and keeping me healthy. If people don’t know I have cancer, they wouldn’t know. I don’t look like a cancer patient at all.”
Johnson concluded chemotherapy at the end of January. Scans showed the tumor had shrunk.
Reason for hope
Then, came the most encouraging news of all.
Spectrum Health surgical oncologist G. Paul Wright, MD, was starting a new clinical trial for hepatic artery infusional chemotherapy to the liver. The trial is the first of its kind in the United States and only a few places around the country have an HAI pump program.
Photo credit: Chris Clark, Spectrum Health Beat
He inserted the pump in late February. During this surgery, he and his partner, fellow surgical oncologist Mathew Chung, MD, performed nanoknife ablation of the tumor in the pancreas. This uses high voltage electrical pulses to shock the tumor while preserving the surrounding structures.
“It’s pumping chemo directly to my liver,” Johnson said. “So far so good with the pump. I haven’t had any side effects. Before with a port, by the time the chemo got to my liver, it was only 25 percent effective. Now, it’s 400 times the amount I would be getting through regular chemo.”
Dr. Wright said the hope is to increase longevity for patients who respond to what he called a “very aggressive” treatment.
“One of my primary career interests is the delivery of regional chemotherapy to isolated areas of the body,” Dr. Wright said. “This targets affected areas while minimizing toxicity that the rest of the body experiences.”
The pump in her abdomen, about the size of a hockey puck, slowly delivers high-dose chemotherapy to the liver over the course of two weeks.
“We then empty the chemotherapy out and take a two-week break before the next pump chemotherapy treatment,” Dr. Wright said. “These treatments are combined with regular chemotherapy through the standard port.”
So far, the results are astounding.
“As part of the trial we track tumor response using a blood test that is specific to pancreatic cancer,” Dr. Wright said. “So far, early into her treatment, those numbers have already improved by 90% from when she was first diagnosed.”
Photo credit: Chris Clark, Spectrum Health Beat
Johnson and her husband recently visited Lemmen-Holton to have the chemotherapy removed and heparin placed in the pump, as a two-week placeholder before the next treatment.
Clinical research nurse Marianne Morrissey told Johnson she’s looking great.
“We’re very hopeful,” Morrissey said. “And so far, you’ve been a model first patient, so we like it. The tumor shrank. Whatever you’re doing, keep doing it because it’s working.”
Johnson announced that she’s ready to go back to work in her role as a restaurant manager at Brann’s in Grandville.
“Your asking is a good sign that you’re ready,” Morrissey told her.
Shane, a martial arts instructor, said his wife works out three days a week.
“I help people with health and fitness and training,” Shane said. “I’ve taken and applied all of that to Tricia, as if she’s one of my fighters. Every day we work at this. Realistically, she didn’t have six months. It was that bad. That white flag is pretty easy to throw in the air. That’s not an option now. Everything is very positive.”
Including Johnson’s attitude.
Although she felt scared at first to trial the “direct-to-the-liver” chemotherapy pump, she remained hopeful.
“It made me feel so comfortable because Dr. Wright was so passionate about it,” Johnson said. “I look at it like, ‘What do I have to lose?’ I’ll do anything I can to be around longer.”
The plan is for Johnson to undergo the clinical trial pump treatments for six months, with a CT scan after three months.
Photo credit: Chris Clark, Spectrum Health Beat
“I think that’s why I’m still here,” she said. “There’s a reason I was chosen to do this.
“Number one, it’s to help with medical research. Number two, I want to give back,” she said. “I can’t wait until I can volunteer at the hospital. Eventually, this disease is going to get me, but if I can help others have better quality of life, that makes me feel wonderful. There are so many people who have touched me, prayed for me, and done amazing things including my family members.”
About two dozen genetic variations help determine if a person is prone to carrying weight around the belly, according to new research. (Courtesy Spectrum Health Beat)
A large, new study has uncovered 24 genetic variations that help separate the apple-shaped people from the pear-shaped ones.
Researchers said the findings help explain why some people are prone to carrying any excess weight around the belly. But more importantly, they could eventually shed light on the biology of diseases linked to obesity—particularly abdominal obesity.
While obesity is linked to a range of health conditions, excess fat around the middle seems to be a particular risk factor for certain diseases—like Type 2 diabetes and heart disease.
“But we haven’t really known why,” said lead researcher Ruth Loos, a professor at Mount Sinai’s Icahn School of Medicine, in New York City.
Her team dug into the genetics underlying body fat distribution. If researchers can learn about the important gene variants, Loos explained, they can better understand why some people develop diabetes or heart disease when they gain weight, while others do not.
The findings, published online recently in Nature Genetics, come from a huge international research effort, looking at over 476,000 people at 70 research centers around the world.
Loos and her colleagues focused on hunting down so-called coding variations—differences within genes that have the potential to alter the way that genes and their proteins function.
In the end, the scientists discovered two dozen coding variations that were associated with body fat distribution. Some of those variations have already been linked to processes such as blood sugar control and fat metabolism.
In general, Loos said, genes linked to obesity can be separated into two broad groups. One group acts on the brain, influencing how much you eat by regulating hunger and satiety.
“The gene variations we identified in this study don’t act in the brain,” Loos said. “They work at the cellular level, determining where fat will be stored in the body.”
It all raises the possibility of developing medications that can “tweak” those genetic pathways so that body fat is redistributed in a healthier way, according to Loos.
But that’s a long way off, she stressed.
The next step, Loos said, is to learn more about how these gene variations function in the body.
No one, however, is saying that body weight and shape are genetically set in stone.
Dr. Carl Lavie is medical director of cardiac rehabilitation and preventive cardiology at the Ochsner Heart and Vascular Institute, in New Orleans.
“Genes are involved in the development of obesity and where the fat is distributed,” Lavie said. “However, the evidence is much stronger for environmental causes.”
Those causes are no surprise: Lavie pointed to sedentary lifestyles and sugary, high-calorie diets.
“Regardless of a person’s genetic profile,” he said, “physical activity and reducing calorie intake can prevent obesity and abdominal obesity—and prevent it from progressing.”
Plus, Lavie noted, exercise boosts a person’s cardiovascular fitness level—which is a critical factor in the risk of developing or dying from heart disease.
Loos agreed that genes are not destiny.
“Obesity is partly genetic,” she said. “We should not forget that diet and exercise are very important.”
However, she added, people with a genetic predisposition toward storing belly fat will have a harder time keeping a trim, heart-healthy waistline.
When summer fruits and vegetables start to disappear from grocery stores and the action shifts indoors to watching sports and munching on unhealthy snacks, it helps to have a diet plan in place to avoid weight gain.
First, remember that farmers’ markets are still open across the country. You can buy local as long as you make the shift from summer crops to fall ones.
That means tomatoes and cucumbers give way to offerings like root vegetables, including carrots, parsnips and turnips and the wide variety of squashes such as acorn, butternut, Hubbard and kabocha.
These are all great for hearty, cook-ahead soups and stews for dinners and brown bag lunches.
Vegetables in the orange family, including sweet potatoes, are rich in vitamin A.
But don’t overlook nutrient-dense dark, leafy greens like varieties of chard and bok choy.
Brussels sprouts, cauliflower, broccoli and other cruciferous vegetables may be abundant in your area and they taste great roasted with a slight drizzle of olive oil and finished with a splash of balsamic vinegar—hearty enough for a vegetarian meal.
Though local melons, stone fruits and many berries may be gone, explore sweet fall fruits like apples, pears and grapes, as well as the more exotic pomegranates, persimmons and quince, the season’s first cranberries and even fall raspberries.
Have fruit salads ready to snack on instead of greasy chips and crackers, or make a batch of baked apples or poached pears to satisfy a sweet tooth.
If you’re a runner who wants to make sure you are eating right before, during and after a race, Spectrum Health dietitian Kristi Veltkamp has two words for you: whole foods.
“You don’t need to buy pricey supplements,” she said. “Whole foods are the best way.”
They focused on protein and carbohydrates and how they are readily available in the form of whole foods.
Complex carbohydrates—plentiful in whole grains, fruits and vegetables—are great for athletes, Veltkamp said. But don’t confuse them with the simple carbs like those found in a white bread, sodas and French fries.
And don’t think that all your protein must come from meat, Veltkamp added. Edamame, beans, chickpeas and nuts are great options. Keep in mind that one cup of edamame contains a whopping 18 grams of protein.
Here are a few other options for a nutrient-rich diet:
The nitrates found in celery, leafy greens and beets convert to nitric oxide in the body, which increases blood flow and improves aerobic endurance.
Vitamin D regulates the way your body responds to inflammation. Foods high in Vitamin D are fatty fish, egg yolks and fortified dairy products.
Foods high in omega 3, including salmon, tuna, walnuts and chia seeds, support brain health and reduce inflammation.
Consuming fruits and vegetables that are high in vitamins C, E and A reduce the imbalances in the body caused by exhaustive exercise. These include dark leafy greens, nuts, seeds, avocado, broccoli, berries, citrus, tomatoes, carrots and sweet potatoes.
Herbs and spices such as ginger, turmeric, garlic, cinnamon and rosemary contain antioxidants, minerals and vitamins.
Spectrum Health Culinary Medicine chef Elizabeth Suvedi teaches people about the power of whole food dishes. (Photo by Taylor Ballek, Spectrum Health Beat)
“I hope people leave here inspired and wanting to cook,” Suvedi said as the group prepared Moroccan-spiced salmon, chicken salad with apples and raisins, coconut pecan date rolls, purple cabbage and edamame salad and several other dishes. Then they sat down to enjoy them.
As Suvedi prepped the dishes, she queried runners about their training leading up to race day, sharing that she’ll be running the 5K with her husband and sons. It will be her first-ever race.
“After I run I feel so good,” Suvedi said. “I feel like I have accomplished something big.”
Seasonal allergies are nearly a year-long affair these days—from spring tree pollen to fall weeds. Learn how to battle back. (Courtesy Spectrum Health Beat)
They can travel 130 miles per hour, packing enough force to break blood vessels, and shooting as many as 100,000 germs up to 30 feet away.
No, these aren’t sledgehammers of slime; they’re the common, everyday, ordinary sneezes, brought on this time of year by some sinister seasonal allergies.
But while fall brings with it a powder keg of pollen and an all-star lineup of other allergy instigators, there are ways to fight back from a firestorm of seasonal sneezing.
“I had a patient yesterday that said, ‘I sneezed 300 times in a row,’” said allergist Karyn Gell, MD. “They get these sneezing fits, from everything in the air right now. But that’s the problem with allergies, it’s always more than one thing.”
Here are Dr. Gell’s 4 keys to fighting seasonal sneezing:
Allergy avoidance. “Keep your windows in your car and your home closed,” Dr. Gell said. “However, you’re going to want to go outside, so if you’re doing a big job like mowing the grass, wear a mask and perhaps glasses or goggles.”
Medication. “Wonderfully, they’ve all gone over the counter, so you don’t need to see a provider or get a prescription anymore,” she said. “There are several over the counter: Allegra, Claritin, Zyrtec and Benadryl. Or generics are just fine, too. That’s the antihistamines. Decongestants, now those can help beautifully to decongest all that mucus and plugging. They are behind the counter for safety as side effects may occur. And then we have eye drops, like Zaditor. You don’t want the ones that say ‘Get the red out,’ it’s addictive, and you don’t want to use that for four to six weeks of allergy season. If you drop decongestants in the eye, or spray it in the nose, it’s addictive. That’s the caution on anything decongestant.”
Irrigation. Dr. Gell says products like SinuNeb and others can help clean you out by flushing your sinuses.
Prescriptions. “When your symptoms require medication you would like to avoid, or begin adding up to 30% of days a year, we can identify exactly what you’re allergic to, how to avoid it, and how to treat it,” Dr. Gell said. “Prescription therapy is associated with an 80% success rate for your allergies.”
One strategy Dr. Gell says won’t work is waiting for allergy season to end. That’s because there really is no end to allergy season.
“Each person’s immune system is so unique, and often with allergies there are multiple,” she said. “Early spring allergens come from mostly trees, but still to come: grasses. …When rain hits, you’ll have mold, which is present whenever there is no blanket of snow on the ground, and peaks summer through fall. Pretty soon, the weeds come! And all season we have dust mite and animal dander.
“That’s the nice thing about finding out what you’re allergic to, the more you learn, the more you can make good choices about what you do.”
Researchers suspect there may be a social stigma with snoring among women, leading some to withhold information about their snoring habits. (Courtesy Spectrum Health Beat)
New research shows that snoring is not the sole domain of men.
“We found that although no difference in snoring intensity was found between genders, women tend to underreport the fact that they snore and to underestimate the loudness of their snoring,” said lead investigator Dr. Nimrod Maimon. He is head of internal medicine at Soroka University Medical Center in Be’er Sheva, Israel.
“Women reported snoring less often and described it as milder,” Maimon said in a news release from the American Academy of Sleep Medicine.
The study included more than 1,900 people, average age 49, who were referred to a sleep disorders center.
Snoring was found in 88% of the women, but only 72% reported that they snore. Both rates were about 93% in men in the study group.
Among people who snored, the average maximum loudness was 50 decibels among women and 51.7 decibels among men. While 49% of the women had severe or very severe snoring, only 40% rated their snoring at this level, the researchers found.
The study authors noted that there is a social stigma associated with snoring among women, so women may not be truthful when asked about snoring. More troubling, this may contribute to the underdiagnosis of obstructive sleep apnea in women.
Snoring is a common warning sign for obstructive sleep apnea, in which the upper airway repeatedly collapses during sleep. Left untreated, sleep apnea can lead to high blood pressure, stroke, heart disease and other health issues.
“The fact that women reported snoring less often and described it as milder may be one of the barriers preventing women from reaching sleep clinics for a sleep study,” Maimon said.
When screening women for obstructive sleep apnea, health care providers should consider other factors in addition to self-reported snoring, he suggested.
For example, women with sleep apnea may be more likely than men to report other symptoms, such as daytime fatigue or tiredness.
The study was published online recently in the Journal of Clinical Sleep Medicine.
Exposure to bright light in the hour before bedtime can make it difficult for kids to fall asleep, family health experts warn.
As day changes to night, the body increases production of a sleep-inducing hormone called melatonin. But exposure to artificial light from light bulbs or electronic devices can disrupt melatonin production, according to a news release from the Family Institute at Northwestern University in Chicago.
Recent research into the effects of light on preschool-age children found that youngsters are particularly sensitive to light exposure in the hour prior to bedtime.
“According to some researchers, evening light exposure, with its melatonin-suppressing effect, may increase the likelihood of sleep disturbances in preschool-age children,” the institute explained.
Reading bedtime stories in a brightly lit room can make it difficult for a child to fall asleep, the organization pointed out. And kids who walk into a brightly lit area to get a drink of water or tell their parents they heard a strange noise may also have trouble getting back to sleep.
Parents can help induce sleep by dimming lights in the child’s room and any areas they might walk into if they wake up, the institute suggested.
In addition, mobile electronic devices are a significant source of light exposure. As many as 90 percent of preschool-age youngsters use such devices, often during the hour before bedtime.
Research shows that melatonin remains suppressed for nearly an hour after the lights go off. The investigators suggested making the hour before their child’s bedtime a device-free period, or having the brightness on their handheld electronics set to the lowest level.
The study, by Lameese Akacem and colleagues at the University of Colorado, Boulder, was published online recently in Physiological Reports.
You can often lose weight by making small yet strategic calorie cuts at every meal, rather than eliminating entire meals or cutting portions so severely that you never feel satisfied.
You probably already know that a cup of blueberries with a dollop of creamy yogurt has a fraction of the calories of a slice of blueberry pie.
But there are many other ways you can trim the calories in favorite meals without diminishing their satisfying taste.
Here are 5 ideas that each shave off about 200 calories:
Eggs
If your idea of a big breakfast is a fatty sausage, egg and cheese sandwich, have a veggie-filled omelet instead. Make it with one whole egg and two extra whites for more protein and “overload” it with tomatoes, peppers and onions.
Romaine
Ditch the bread and high-calorie sandwich condiments at lunch by wrapping up lean protein, such as slices of roasted chicken, in large leaves of romaine lettuce with a touch of balsamic vinegar or hot sauce.
Cauliflower
To get the toothy appeal of steak, make your main course grilled portabello mushrooms and serve them with a side of mashed cauliflower instead of potatoes. With some no-salt seasoning, you won’t taste any difference.
Squash
There’s no need to give up your favorite red sauce if you use it to top spaghetti squash (or zucchini ribbons) rather than spaghetti, plus you can eat twice as much. Want healthier meatballs? Try making them with a blend of ground turkey and a whole grain like kasha or farro.
Salsa
Love Mexican food? You can still enjoy the taste—and get the fiber and protein goodness of beans—by simply skipping the tortilla or taco shell. And you don’t need sour cream if you have a dab of guacamole. Just go easy on the cheese and rice but double up on low-cal zesty salsa.
Job stress, high blood pressure and poor sleep may be a recipe for an early death, German researchers report.
In a study of nearly 2,000 workers with high blood pressure who were followed for almost 18 years, those who reported having both a stressful job and poor sleep were three times more likely to die from heart disease than those who slept well and didn’t have a trying job, the investigators found.
“As many as 50% of adults have high blood pressure,” said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles.
It’s a major risk factor for heart attack, stroke, heart failure, kidney disease and premature cardiovascular death, said Fonarow, who had no role in the new study.
“A number of studies have found associations between greater work stress and subsequent risk of cardiovascular events. Impairment in sleep has also been associated with increased risk,” he said. However, these associations did not prove a cause-and-effect relationship.
In the new study, the researchers reported that among people with high blood pressure (“hypertension”), those who had work stress alone had a twofold higher risk of dying from cardiovascular disease, as did those who reported having poor sleep alone.
According to lead researcher Dr. Karl-Heinz Ladwig, “Sleep should be a time for recreation, unwinding and restoring energy levels. If you have stress at work, sleep helps you recover.” Ladwig is a professor at the German Research Centre for Environmental Health and also with the Technical University of Munich.
“Unfortunately, poor sleep and job stress often go hand in hand, and when combined with hypertension, the effect is even more toxic,” he added in a statement.
According to the study authors, a stressful job is one where employees have many demands but little control over their work. For example, an employer demands results but denies authority to make decisions.
“If you have high demands but also high control, in other words you can make decisions, this may even be positive for health,” Ladwig said. “But being entrapped in a pressured situation that you have no power to change is harmful.”
Poor sleep was defined as having difficulty falling asleep and staying asleep. “Maintaining sleep is the most common problem in people with stressful jobs,” Ladwig said.
These problems combine over time to sap your energy and “may lead to an early grave,” he added.
Ladwig suggested that to lower the risk of an early death, people have to keep their blood pressure low, develop good sleep habits and find ways to cope with stress.
Mika Kivimaki, a professor of social epidemiology at University College London, thinks this study provides a unique look at workplace risk.
Most previous research on work stress has targeted the general working population, he said.
“The effects on health have been relatively modest. However, recent findings suggest stress might be a much bigger problem for those with pre-existing disease. This new study supports this notion,” said Kivimaki, who had no part in the study.
Focusing on people with high blood pressure was a good choice, he noted.
“In this group, atherosclerosis (hardening of the arteries) is common,” Kivimaki said. And for these patients, “stress response could increase cardiac electrical instability, plaque disruption and thrombus (clot) formation,” which can contribute to an irregular heartbeat (arrhythmia), heart attack or stroke.
The researchers think that employers can help by implementing programs that teach employees how to relax.
Employers should provide stress management and sleep treatment in the workplace, Ladwig added, especially for staff with chronic conditions like high blood pressure. Such programs should also include helping employees to quit smoking.
It is well known that people with high blood pressure can substantially lower their risk of heart attack and stroke by achieving and maintaining healthy blood pressure levels, Fonarow said. Whether or not workplace programs designed to reduce stress and improve sleep will pay off remains to be seen, he said.
The report was published recently in the European Journal of Preventive Cardiology.
But it’s essential for the making of nerve and red blood cells, as well as DNA along with many other body processes.
Adults and teens need just 2.4 micrograms a day, but you can fall short even on this small amount.
You’re at particular risk of a B12 deficiency if you’re a vegetarian because animal foods, like meat and dairy, are the only foods that deliver it.
If you have a health problem that affects nutrient absorption, like Crohn’s disease, have had bariatric surgery or take certain medications, you also run the risk.
So do people over 50 because of changes in stomach acids.
Common medications that can affect your body’s B12 levels:
PPIs such as omeprazole (Prilosec) and lansoprazole (Prevacid), used for treating heartburn or GERD.
H2 receptor antagonists such as famotidine (Pepcid) and ranitidine (Zantac), also used for treating those and other conditions.
Metformin, the diabetes drug.
A deficiency can develop slowly over time or come on rather fast.
Possible warning signs include emotional or thinking problems, fatigue, weakness, weight loss, constipation and numbness or tingling in hands and feet. These can also be symptoms of many other conditions, but it takes only a blood test to diagnose a B12 deficiency.
If you don’t eat animal-based foods, you can boost B12 with fortified soy foods or grain products like cereal.
And unless the deficiency is severe, you’ll get enough through a multivitamin supplement. When the deficiency is more serious, your doctor might give you a B12 shot to bring your level up to normal.
Be certain that the doctor who prescribes B12 supplementation for you is aware of any medications you’re taking to avoid negative interactions.
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