Johns Hopkins Health Alerts Current Issue

The Promise of Tanezumab

Mon, 09 Nov 2009 06:00:00 CST

When it comes to the pain caused by knee osteoarthritis, there is a great need for an effective drug that doesn't cause dependency, because many patients either cannot tolerate, or don't obtain sufficient pain relief from traditional nonsteroidal anti-inflammatory medication. Finally, there may be a solution: Tanezumab.

According to Nancy E. Lane, M.D., Professor of Medicine and Rheumatology at the University of California at Davis Medical Center, and Director of their Center for Healthy Aging, a Phase II clinical trial of tanezumab has shown that treatment once every eight weeks significantly reduces pain in patients with moderate to severe knee osteoarthritis

Dr. Lane and her colleagues followed 444 men and women aged 40-78 who were unable to control their pain with non-steroid anti-inflammatory medication, such as ibuprofen or naproxen, or who were candidates for more invasive treatments such as total joint replacement.

The patients enrolled in this 16-week study were treated with either tanezumab or a placebo. Tanezumab is a humanized monoclonal antibody against nerve growth factor, or NGF. NGF stimulates the growth of sensory nerve cells and increases the body's response to pain. Tanezumab appears to block the pain signals.

Tanezumab was intravenously administered at 10, 25, 50, 100, or 200 µg/kg on days 1 and 56 of the study. The researchers measured effectiveness by evaluating knee pain with walking and patient assessment of response to the treatment as well as other outcome measures, including stiffness and physical function.

The results: Tanezumab significantly improved knee pain and the patients' overall assessments of their condition by 46% to 62% compared with 22% for those patients given placebo. At weeks 12 and 16, researchers noted a significant improvement in the secondary outcome measures, including pain, physical function, and stiffness. Within three days of the first dose of tanezumab, many patients in Dr. Lane's study experienced a greater-than-50% improvement in walking knee pain. At higher doses, there was a 70 to 80% drop in knee pain that continued over the next two months.

Based on these interesting study findings from Dr. Lane, it is clear that inhibition of NGF may provide a novel type of therapy to reduce the pain of osteoarthritis and possibly other pain conditions, including fibromyalgia, metastatic cancer pain, and degenerative disease pain.

6 Simple Stretches for Pain-Free Travel

Fri, 23 Oct 2009 06:00:00 CDT

Don't let back or neck pain cramp your travel fun. Experts who treat back pain recommend that you stretch regularly while you’re in flight or when you take a driving break. Stretching can help relax tense muscles and overly tight ligaments in the back and neck.

Traveling by car or plane can be a pain in the neck, literally, as well as a pain in the back. Sitting for prolonged periods adds strain to the structures of the lower back and neck, and poor posture while sitting puts even more stress on your spine. Regular travel with back or neck pain can be a challenge, but you can take measures to reduce or avoid pain and discomfort while on the road or in the air.

Here are six simple, yet effective stretches to help you can do anywhere, without a lot of fancy equipment:

Neck and shoulder stretches :

To loosen your neck, rotate your head to the left and maintain this position for about five seconds. Turn your head forward again; then turn to the right and hold for five seconds. Repeat five times.

To loosen your shoulders and neck, shrug your shoulders up while holding your arms at your sides. Stay in this position for about five seconds, then return to a resting position. Repeat five times.

Back stretches:

Begin in an upright, seated position and gradually lower your torso toward your knees. Let your arms drop down and then wrap them around your thighs. Hold this position for about 20 seconds while breathing deeply, then return to your normal, seated position. Repeat five times.

While standing, put your hands on your lower back and slowly stretch backward from the waist. Hold for 10 seconds, then relax and straighten up. Repeat five times.

Place your hands on your hips and bend to the left. Maintain this position for five seconds. Return to an upright position, then bend to the right and hold for five seconds. Repeat five times.

Leg stretch:

While sitting, keep the balls of your feet on the floor and raise your heels. Hold for 10 seconds. Lower your heels back down, and repeat 10 times. Although this is really a calf stretch exercise, you’ll feel the stretch all the way up into your lower back.

Research Update on Colorectal Cancer

Tue, 10 Nov 2009 06:00:00 CST

Doctors who treat colorectal cancer and urological cancer have observed that patients who have had one of these cancers appear to be more likely than the average person to be diagnosed with the other.

To see if this observation reflected a true association, investigators reviewed information from more than 500,000 people with colorectal cancer or a urological cancer using data collected by the U.S. Surveillance Epidemiology and End Results (SEER) program.

They found that people with colorectal cancer had a 59% increased risk of developing cancer of the renal pelvis (a type of kidney cancer) compared with the general population and a 100% increased risk of developing cancer of the ureters (the tubes that connect the kidneys to the bladder). Similarly, people with renal pelvis or ureteral cancers were at increased risk for developing colorectal cancer.

While both of these cancers are rare, the findings from this study suggest that if you have been diagnosed with colorectal cancer, especially before age 60, you should be considered at increased risk.

If you notice symptoms of renal pelvis or ureteral cancer -- blood in your urine, pain when urinating, or frequent urination -- report it to your doctor right away. When these cancers are identified and treated early, the likelihood of cure is greater than 90%.

Reported in the Archives of Internal Medicine (Volume 168, page 1003).

Antidepressant Medication "Poop Out"

Wed, 11 Nov 2009 06:00:00 CST

A reader from Roswell, Georgia asks: “I have been taking 20 mg/day of Celexa (citalopram) for about a year and a half for depression. It was the first medication I tried, and it worked great. For the past two months or so, however, I haven't been feeling great. I have been sleeping a lot, crying a lot, and feeling antisocial. Is it possible for Celexa to "poop out" and just stop working over time? Should I talk to my doctor about increasing my dosage or changing medications? Or maybe this bout with depression is just extra bad and I should tough it out?” Here’s our advice.

Antidepressant tachyphylaxis -- known less formally as the "poop out" effect -- was first described in 1984 when researchers observed that some patients experienced relapse of mood symptoms on antidepressants that had previously been effective therapies. There is some suggestion that serotonin reuptake inhibitors, or SSRIs, such as Celexa, are more prone to tachyphylaxis than other antidepressants, such as tricyclic medications like nortriptyline and serotonin norepinephrine reuptake inhibitors (SNRIs) like Effexor.

When antidepressants appear to "poop out," there are four options available to the physician and patient. The first is to increase the medication dosage in an effort to boost the antidepressant effect, assuming the maximum dose is not already prescribed. For example, the maximum dose of Celexa is 60 mg daily. A common pattern with SSRIs is for there to be an initial response to a lower dose that is not sustained, requiring titration over time to higher doses. Increasing the dosage alone may be sufficient to jumpstart recovery.

The second option is to switch antidepressant medications, either to another medication within the same class or to a different class. This method has the benefit of simplicity, in that it continues to be a single medication regimen.

The third and fourth options involve augmentation of the current antidepressant, either with the addition of a second antidepressant or a non-antidepressant augmentation drug. If a second antidepressant is chosen, it is common to add a medication with a different mechanism of action. For example, if someone is already taking an SSRI, the physician might add a tricyclic antidepressant. Non-antidepressant augmentation strategies include lithium, low-dose atypical neuroleptics such as Zyprexa or Risperdal, thyroid hormone, the blood pressure medication Pindolol, or the anti-anxiety drug Buspar (buspirone).

Bottom line: In most cases like yours, the simplest intervention is to increase the dosage of the antidepressant medication you're already taking, particularly because it has been effective in the past and you're not currently taking the maximum dosage. The key to successful treatment of depression is ongoing communication between you and your physician and not settling for partial recovery or resigning oneself to "toughing it out."

New Approach to Slow Diabetic Kidney Disease

Thu, 12 Nov 2009 06:00:00 CST

A study reported in The New England Journal of Medicine (volume 358, page 2433) sheds light on a promising new approach that is effective for treating diabetic nephropathy (kidney disease) -- a complication of long-term diabetes.

About 30 to 40% of people with type 1 diabetes and 20% of those with type 2 diabetes eventually develop some kidney damage, though by no means do all of them go on to kidney failure. The damage occurs in tiny blood vessels throughout the kidneys, which act as filters to remove waste products from the bloodstream.

High blood pressure (hypertension) worsens kidney disease (nephropathy), so controlling hypertension is an essential part of managing diabetic nephropathy. For many people, existing antihypertensive drugs fail to slow kidney damage, but the new drug aliskiren (Tekturna) may offer much-needed additional protection.

Researchers randomized a group of 599 people with diabetes, hypertension, and kidney disease: Half took 150 mg of Tekturna daily for three months, then 300 mg a day for the next three months; the other half received placebos. All took the antihypertensive drug losartan (Cozaar) in addition to drugs to lower blood pressure.

Participants taking Tekturna had reduced proteinuria (loss of protein in the urine) -- a sign of failing kidneys -- by 20%, on average. In addition, almost 25% of the Tekturna takers had a 50% reduction in protein loss in urine, compared with 13% of the placebo group. Little difference in blood pressure was seen between the two groups.

Many common antihypertensive drugs work by interfering with angiotensin, a chemical that raises blood pressure by constricting blood vessels. Tekturna also blocks renin, the enzyme that produces angiotensin.

What Works for Chronic Constipation

Mon, 16 Nov 2009 06:00:00 CST

According to the American College of Gastroenterology, Americans make at least 2.5 million visits to the doctor for constipation each year. Because constipation is so ubiquitous and has been noted since ancient times, there are many widely held beliefs and myths about its treatments and consequences -- beliefs that have persisted, despite the absence of medical evidence to prove they are true.

In an article published in the American Journal of Gastroenterology, digestive disease experts reviewed these long-held beliefs and revealed the current evidence for and against them.

They note that there is no data to show that when stools remain in the body for a long time, which occurs when you’re constipated, that they poison the colon. Likewise, there’s no evidence to prove that cleansing the colon regularly can reverse the symptoms. (For a discussion of colon cleansing, see the article: Colonics: How Risky Are They?)

The reviewers also state that although increasing fiber intake undoubtedly makes stools bulkier and easier to pass, and increases the frequency of bowel movements, the role of fiber in the treatment of constipation has been exaggerated. Indeed, there are no studies to show that a lack of dietary fiber is responsible for chronic constipation. And too much fiber may actually make symptoms worse for some people with constipation.

Likewise, it’s been suggested that a low intake of fluids may lead to constipation, and that drinking more fluids may soften and enlarge hard, small stools, making them easier to expel. But there’s no scientific evidence for this either, and it appears that increasing fluid intake won’t help constipation unless you’re severely dehydrated.

One idea that does hold scientific weight is the link between physical activity and constipation. In elderly and sedentary people, increasing exercise may relieve some of the symptoms of mild constipation. Still, it is unlikely that stepping up activity will have much effect on severe cases of constipation.

Finally, the reviewers note that a number of misconceptions exist about the use of laxatives to relieve constipation. Urban legend says that you can get addicted to laxatives and that frequent use increases the risk of colorectal cancer and nerve damage, but the data show otherwise. When used at recommended doses, laxatives are safe and nonaddicting. Still, if you need to take laxatives for more than a week at a time, you should see your doctor for further advice.

Alternative Treatment for Chronic Prostatitis May Help

Tue, 17 Nov 2009 10:00:00 CST

Should you try acupuncture to relieve the pain of chronic prostatitis? Results from a recent study provide the answer.

Like other forms of chronic pain, chronic prostatitis is a complex condition with no simple solutions. Successful management depends on treating the original source of the pain as well as the neurological and psychosocial problems that often accompany it.

As a result, your doctor may prescribe several different types of medication. Some men also benefit from cognitive behavioral therapy, which can help improve coping strategies and psychological well-being.

But what if you’ve tried medications and they haven’t helped? Should you give acupuncture a try?

Results from a small study in The American Journal of Medicine suggest that acupuncture may provide relief to men with chronic prostatitis. The study compared the potential benefits of acupuncture versus sham (inactive) treatments in 89 men who had symptoms of chronic prostatitis for three or more of the past six months and who had a score of 15 or higher on the National Institutes of Health Chronic Prostatitis Symptom Index.

The men were randomly assigned to receive two acupuncture treatments or two sham treatments a week for 10 weeks. The sham treatments were nearly identical to genuine acupuncture needle insertions except for the location and depth of placement.

True acupuncture was nearly twice as effective as the sham procedure in relieving chronic prostatitis symptoms. Moreover, patients treated with acupuncture were more than twice as likely as the men given the inactive treatment to experience long-term prostatitis relief. Few of the men experienced complete resolution of their symptoms.

This study supports findings from other trials showing a benefit from acupuncture for chronic prostatitis. More study is needed before the treatment can definitively be recommended, but if nothing else has worked for you, a trial of acupuncture might be worth considering.

Urgent Care or the ER – Which is the Right Choice?

Wed, 18 Nov 2009 06:00:00 CST

You've got a sore throat or a deep cut that needs medical attention now, but you don't think it warrants a trip to the emergency room (ER). Is going to an urgent care center a sound alternative?

"In these cases, call your primary care provider first," says Michele Bellantoni, M.D., Associate Professor of Medicine and Medical Director of Johns Hopkins Bayview Care Center. "This is particularly important for patients with chronic conditions, because a healthcare provider familiar with your medical history will be able to tell you whether a problem that appears small actually requires complex care. No matter where you seek medical attention, it's also necessary to keep your primary provider informed about any medical problems you're facing."

Urgent care centers are staffed with licensed physicians (and are not to be confused with retail clinics in pharmacies and chain stores, which are typically run by nurse practitioners and physician assistants who perform screenings and treat minor illnesses).

Many urgent care facilities offer services your doctor's office likely does not provide, including x-rays, on-site lab work, and suturing. Other major advantages of urgent care are speed and cost. In some states, the average wait time in the ER for a patient with a non-emergency ailment is more than four hours, and services typically cost $1,000-plus.

At an urgent care center, the bill may be five times less than the ER, and patients generally wait no more than an hour. That's why thousands of these facilities are springing up throughout the country. In fact, many are affiliated with hospitals (including Johns Hopkins), which have started offering urgent care to expand business and relieve busy ERs.

If you're not sure whether you or a companion is experiencing an emergency, play it safe and go to the ER -- particularly for symptoms of a heart attack (like chest pain) or a stroke (like sudden vision changes, slurred speech, one-sided weakness, or mental confusion).

Practicalities. Research urgent care facilities in your area so if you face a non-emergency problem, you'll know where to go. The website www.findurgentcare.com will give you a list of centers in and near your zip code. Find out which accept your insurance and when they're open. While urgent care centers have expanded evening and weekend hours, most aren't open 24 hours a day like ERs.

Info To Bring Along. Whether you're visiting an urgent care center or the ER, always bring a copy of your essential medical information. Make a list with the following items and keep it in an accessible place (like on the refrigerator), so you can grab it quickly before you seek medical attention:

The name, address, phone number, and fax number of your primary care provider

Your current medical conditions

Your current medications, along with dosages

Drug allergies

Flu shot a MUST for People with Heart Disease

Fri, 30 Oct 2009 06:00:00 CDT

Have you had your annual flu shot? Between 10% and 20% of people catch the flu each year, and a bad case can be deadly for individuals with coronary heart disease. Yet only one in three adults with cardiovascular disease get an annual flu shot. Read what the AHA advises.

People with heart disease are not only at higher risk for the flu than the general population but also more likely to have a severe case and to develop complications, such as viral or bacterial pneumonia. What's more, the flu can worsen coronary heart disease and trigger a heart attack.

No one knows for sure how the flu increases the risk of a heart attack. One possibility: Inflammation associated with the flu can trigger the rupture of unstable plaque, leading to the formation of a blood clot that could cause a heart attack.

Heart Benefits of the Flu Shot -- The strongest evidence for protection from a flu shot in people with heart disease comes from the Flu Vaccination in Acute Coronary Syndromes (FLUVACS) study. In that study, about 300 individuals who had been hospitalized for either a heart attack or a planned angioplasty were randomly assigned to receive a flu vaccine or remain unvaccinated. Over the next year, twice as many of the unvaccinated group (23%) died of heart disease, had a nonfatal heart attack, or developed severe ischemia (insufficient blood supply to the heart tissue), compared with those who were vaccinated (11%).

Bottom line advice: The American Heart Association (AHA) recommends a flu shot with the same enthusiasm as it does the control of cholesterol, blood pressure, and other modifiable risk factors for heart attacks. In a scientific advisory issued by the AHA and the American College of Cardiology heart doctors were asked to do something they may not normally do -- give their patients flu shots.

The Centers for Disease Control and Prevention also recommends an annual flu shot for individuals age 50 and older as well as anyone with a chronic health problem such as heart disease or diabetes. Besides getting a flu shot, two other simple measures -- frequent hand washing and, if possible, avoiding close contact with a flu sufferer -- can help reduce the risk of catching the flu.

Transcendental Meditation and Your Blood Pressure

Tue, 03 Nov 2009 06:00:00 CST

A reader with high blood pressure asks: Will relieving stress help control high blood pressure? Which stress reduction technique has the most evidence backing it up? Here’s the reply from Johns Hopkins.

In stressful situations, your body releases hormones like epinephrine that cause your blood pressure to rise and your heart rate to accelerate. Whether chronic stress contributes to high blood pressure is less clear. Still, reducing stress may help you follow other lifestyle recommendations and maintain other healthy habits.

Stress reduction techniques include exercising regularly; practicing relaxation techniques such as deep breathing, guided imagery, or meditation; lightening your work or personal schedule; and having a strong social network of friends and family. Some activities that people believe lower stress -- drinking too much alcohol and smoking -- actually increase blood pressure.

The effects of stress on blood pressure are controversial. Likewise, it is unclear if stress-reduction techniques, such as biofeedback, yoga, and tai chi, help lower blood pressure.

But one method of reducing stress called transcendental meditation (TM) has the most evidence. Developed more than 50 years ago, TM involves sitting quietly for 20-minute periods, twice a day, and repeating a one-syllable word called a mantra to relax the mind.

The effects of TM on blood pressure were recently evaluated in a meta-analysis published in the American Journal of Hypertension. When the researchers considered three high-quality, randomized, controlled trials of TM in people with high blood pressure, they found that this form of meditation reduced systolic blood pressure by 6 mm Hg and diastolic blood pressure by 3 mm Hg. TM likely lowers blood pressure because of its effects on the nervous system, slowing heart rate and reducing tension in the muscles.

If you are interested in trying TM, you can learn how to do it through books, audiotapes, and DVDs. You may also find a certified instructor giving classes in your area. Keep in mind, however, that TM is not a substitute for the lifestyle measures or medications proven to lower blood pressure. But trying it will cause you no harm.

Got Asthma? Get a Flu Shot

Thu, 19 Nov 2009 06:00:00 CST

Outbreaks of the flu occur each winter and last for two to three months, leading to infection in 10 to 20% of the population. Influenza can worsen the symptoms experienced by people who have chronic obstructive pulmonary disease (COPD) or asthma. It can also make a person more prone to a bacterial infection that causes pneumonia, or the flu virus itself can cause pneumonia.

Despite this risk, many people with asthma aren't heeding the message from experts to protect themselves against flu-related complications by getting a flu shot. A report published by the U.S. Centers for Disease Control and Prevention in Morbidity and Mortality Weekly Report (Volume 57, page 653) found that during the 2005-2006 flu season, only 36% of people with asthma responding to a national health survey said they were vaccinated against the flu.

The flu vaccination rate was best among older adults with asthma: Those aged 50 to 64 years and 65 or older had the highest flu vaccination rate (49% and 76%, respectively). Flu vaccination is recommended for both age groups, whether or not a person has asthma, because the risk of flu death increases sharply among older adults.

Bottom line advice: Everyone with asthma should get a flu shot because they are at high risk for complications from the flu. Influenza is more serious in people with asthma and can often lead to pneumonia. If you're 50 or older, get your flu shot every year -- even if you don't have asthma. Although it's best to get your flu shot as soon as it becomes available in the fall, you may still benefit from being vaccinated as late as January, since influenza might not appear in some areas until February or March.

Another Reason to Nap

Mon, 02 Nov 2009 06:00:00 CST

If you enjoy an afternoon nap, here’s good news. A study published in the Journal of Sleep Research suggests that napping may improve your memory. Here’s what the researchers found.

Although memory impairment is common as we age and usually is not a sign of a serious neurological disorder, it can be frustrating and socially embarrassing. The minor memory lapses that occur with age-associated memory impairment can’t be eliminated completely; however, a number of strategies can improve overall memory at any age.

For example, a good night’s sleep has been shown to boost your memory, and now a small study reported in the Journal of Sleep Research (Volume 17, page 3) suggests that even a short daytime nap can help, too.

German researchers conducted two experiments involving 26 university students ages 20 to 29. In the first experiment, the volunteers were asked to memorize 30 adjectives within two minutes and then to recall as many as possible after either a one-hour nap or one hour of waking activities. Each participant was tested in both the napping and waking conditions, and the experiments were repeated one week after the first testing sessions.

The results showed that the students performed significantly better after napping, and their performance was not affected by the time spent in slow-wave sleep (deep sleep). The second experiment tested participants for word recall after no nap, a long nap (35 minutes), and a short nap (six minutes).

Bottom line: The students performed the best after the long nap, but even the very brief nap significantly boosted memory processing compared with no nap at all. It may be that sleep onset itself activates memory consolidation and once the process is triggered it remains effective, even when sleep time is cut short.

Testing Your Vitamin D Levels

Wed, 04 Nov 2009 06:00:00 CST

This question comes from our popular Health After 50 newsletter. A reader asks: Should I have my vitamin D levels tested? Johns Hopkins professor, Dr. Michele Bellantoni answers.

Yes, if you're over 65. Vitamin D deficiency increases your chance of fractures, muscle loss, and bone pain, explains geriatrician Michele Bellantoni, M.D., Medical Director of Hopkins Bayview Care Center and Health After 50 Board Member.

Two blood tests are used to measure vitamin D levels. Most people only need the 25-hydroxy vitamin D test, says Dr. Bellantoni . The other test, referred to as the 1,25-dihydroxy vitamin D test, is used for people with high calcium levels, kidney disease, or certain cancers. Both tests cost around $50 and are covered by Medicare.

If your levels are low, consider taking a vitamin D supplement. Aim to get 800 units of the vitamin daily, says Dr. Bellantoni. Or, if you have no history of skin cancer, you can head outdoors to catch a little sun instead of taking a supplement. "Get out and walk for a few minutes," says Dr. Bellantoni. "It's good for your heart, it's good for your bones, and it's good for your vitamin D." Ten minutes of sunshine a day without any protection (including cosmetics or moisturizers with sunscreen) is probably enough to safely boost vitamin D. Sitting by a window won't work, because the glass blocks the sun's rays, says Dr. Bellantoni.

There are no established guidelines for how often a person should have his or her vitamin D levels checked. Dr. Bellantoni recommends rechecking levels if there has been a considerable reduction in sun exposure or if you have changed your daily intake of supplements over a two-month period.

When Your Health Insurance Company Asks You to Switch Medications

Tue, 17 Nov 2009 06:00:00 CST

Has your health insurance company ever urged you to switch medications? Johns Hopkins explains the risks of "drug flipping," and offers advice.

People sometimes encounter problems with their medications when they switch insurance companies. A brand of drug that is covered with a small co-pay on their former plan may not be on the formulary (the list of drugs approved by a health insurer for use by its beneficiaries) of the new one. In these cases, the company may create financial pressure to switch from one drug to another, or from a brand-name drug to a generic -- a practice sometimes referred to as "drug flipping".

If this happens to you, start by asking your doctor or pharmacist if the new drug is as safe and effective as the one you were using before. Certain classes of drugs are interchangeable at equivalent doses, meaning you may have to take a different dose of the new drug for the same effect you got from the former medication. When this happens, drug flipping can lead to confusion and can thereby increase the chance of medication errors.

It is also possible that your individual response to the “equivalent” dose of a different drug actually may not be equivalent, in which case flipping your brand might not be in your best interest. For instance, if you are getting a good result from a certain drug for high blood pressure, switching brands could be risky.

Bottom line advice. Nobody enjoys these bureaucratic problems, but they are part of the complex American healthcare system. By becoming familiar with your insurer’s formulary and drug-benefit policies, you can avoid inconvenience and unnecessary out-of-pocket expenses. Many insurers provide a condensed “pocket formulary” you can take with you when you visit your doctor. When the doctor reaches for the prescription pad, reach for your formulary and check your coverage. It may save you aggravation and expense at the pharmacy.

How Old Is Too Old For an Annual PSA Test?

Thu, 15 Oct 2009 06:00:00 CDT

If you are an elderly man, you may wonder if you should continue to have an annual PSA test to screen for prostate cancer. Here are the latest guidelines.

The U. S. Preventive Services Task Force recently recommended that doctors not screen men age 75 and older for prostate cancer. The panel weighed the potential benefits and harms of PSA testing in this population and concluded that the screening was more likely to have a negative impact on these men than a positive one.

The rationale: Prostate cancer is a slow-growing malignancy that may take 10 or more years to produce significant symptoms. Many elderly men will die of another condition before their prostate cancer becomes life threatening. Thus, an abnormal PSA test would lead to the pain and discomfort of a prostate biopsy and unnecessary worry if no cancer is found. If cancer is found and treated, the man will have to contend with side effects, such as sexual dysfunction and incontinence.

Other medical organizations recommend annual screening for men at average risk for prostate cancer beginning at age 50, but they do not address when screening is no longer necessary. And still others recommend screening for all men with a life expectancy of at least 10 years.

Bottom line advice: If you are age 75 or older, discuss the risks and benefits of PSA testing with your doctor. If you get tested and are diagnosed with a low-grade cancer, keep in mind that active surveillance is an option that allows you to be closely monitored but treated only if your disease progresses.

Practical Advice to Help You See Better When You Drive

Fri, 06 Nov 2009 06:00:00 CST

Do you sometimes have trouble seeing clearly when you drive? The American Academy of Opthalmology recommends that everyone between ages 40 and 65 have an eye exam every two to four years. If you're over age 65, you should see your eye doctor every one to two years, particularly to check for conditions such as cataracts, glaucoma, and age-related macular degeneration. Between check ups, if your vision changes or you have trouble driving at night, let your eye doctor know right away. What else can you do? In this Health Alert, Johns Hopkins provides practical advice to help you see better when you drive …

Upgrade Your Eyewear -- You may also want to investigate antireflective lenses for your eyeglasses. These lenses minimize glare and allow more light to enter the eye than regular plastic lenses, which let only 91% of available light enter. Antireflective lenses are especially helpful at night, cutting the reflections on your lenses from streetlamps and headlights.

Polarized sunglasses also may be helpful especially for reducing glare. Polarized lenses have a laminated surface that contains vertical stripes, which allows the light to enter a lens vertically, blocking the horizontal bright light.

Prepare Your Car and Know Your Limits -- There are a number of steps you can take for a safer driving experience.

Keep your headlights, taillights, mirrors, and windshields clean. These may sound like housekeeping details, but they can improve your road vision. Give your eyeglasses a shine before you set out as well.

Keep a spare pair of eyeglasses and sunglasses in your glove compartment so that you never find yourself driving without a pair handy.

If you're buying a car, skip the darkened or tinted windows. Also, pick a model with easy-to-read symbols, large dials, and an instrument panel that brightens well at night. In addition, ask for a rearview mirror that automatically filters out glare.

When you have your car serviced, make sure the lights are at full power and properly aligned so they don't affect the vision of drivers coming toward you.

Plan long road trips with your eyes in mind, stopping every few hours to rest your body and your eyes.

Avoid traveling at night, dawn, and dusk, especially in places you don't know well. And skip the crowded highways for quieter routes.

If you know you're uncomfortable driving, consider taking a refresher class. Refresher classes are offered by the AARP, The Automobile Association of America (AAA), and the National Safety Council. Another option is to work on improving your driving skills with a driving instructor or vision rehabilitation specialist.

If you take prescription medicines, such as antihistamines or blood pressure medication, check with your doctor about whether they may affect your vision.