Johns Hopkins Health Alerts Current Issue

Lupus and Heart Disease

Mon, 22 Feb 2010 06:00:00 CST

Systemic lupus erythematosus (SLE), or lupus, is an autoimmune disease, in which the immune system mistakenly attacks the body's own organs and tissues. The sites most often affected are the joints, skin, kidneys, heart, lungs, blood vessels, and brain. Now research reported in the journal Arthritis and Rheumatism (Volume 58, page 1458) looks at lupus and heart disease – a complication often overlooked by both doctors and patients.

Scientists have known for years that the risk of heart disease is greater for people with lupus than for those without the disease. But many people with lupus aren't getting that message, according to a recent study.

Researchers sent questionnaires to 226 people with lupus and found that only 31% were aware that they faced a significantly increased risk of cardiovascular disease because of lupus. In 58% of the cases, doctors had not discussed the risk or preventive measures.

The patients who had discussed heart disease with their physicians were more than twice as likely to understand that lupus was a risk factor and more than three times as likely to understand that they themselves were at risk. Lupus patients who were younger than 32 were more likely to understand that information than patients over 52, even though younger patients were less likely to have talked about heart disease with their doctors. The researchers speculate that younger patients may be more likely to be getting information from sources like the Internet.

If you have lupus, talk with your doctor about your risk of heart disease and the risk factors you can control: weight, blood pressure, cholesterol levels, and fitness.

How Often Should You Have Bone Density Testing?

Fri, 19 Mar 2010 06:00:00 CST

Bone mineral density (BMD) tests are performed in people who are at risk for osteoporosis or have experienced a suspicious fracture. These tests help doctors diagnose osteoporosis or osteopenia (low bone mass, a warning sign for osteoporosis). They can also predict a person's risk of fracture, monitor progression of bone loss over time, and observe how well osteoporosis treatments are working.

After an initial bone mineral density test, the interval until the next test may be extended up to five years for people who are not at risk for bone loss, according to a study in the Canadian Medical Association Journal (Volume 178, page 1660). Most guidelines recommend an interval of two to three years between bone mineral density tests.

Canadian researchers measured the bone mineral density in the spine and hip of 9,423 adults, age 25 to 85, at baseline and again every three and five years. They found that accelerated bone loss among the 4,443 women began between the ages of 40 and 44 and peaked between 50 and 54. Accelerated bone loss began again after age 70. The 1,935 men began steadily losing bone earlier, between ages 25 and 39. They then experienced a steep decline in BMD around age 65.

Even women who had the greatest amount of bone loss had a rate of loss of only 1.3% per year, and only one quarter lost more than 5% of bone density over any five-year period. Therefore, the investigators concluded that repeat bone mineral density measurements can be safely delayed for up to five years, unless the test is performed to monitor response to treatment or the person has additional risk factors.

The new Fracture Risk Assessment (FRAX) tool allows doctors to determine your probability of experiencing a fracture in the next 10 years. This should help them provide an individualized recommendation for repeat testing.

Chewing Gum Is Good For Your Recovery

Tue, 16 Mar 2010 06:00:00 CST

Research suggests that chewing sugarless gum after colon cancer surgery can speed recovery and shorten hospital stays by as much as a third.

The first line of treatment for colon cancer is to remove the primary tumor or tumors. If your colon cancer is confined to polyps or a small area, surgery is probably the only treatment that you need. After major surgery, you will not be able to eat and will be given intravenous fluids.

After a few days, you should be able to eat, and bowel function will resume, although it may take a few days to return to normal function. A typical hospital stay for colon cancer surgery is between four and eight days, and full recovery takes about two months.

Now a report in the Archives of Surgery (Volume 141, page 174) suggests that chewing sugarless gum after colon cancer surgery may help patients to get up and go, shortening hospital stays by a third.

After colon cancer surgery, most patients don't want food or water, and it takes a few days for bowel function to resume. If the intestinal shutdown lasts much longer, it can lead to longer hospital stays that may expose patients to infection and other complications. Chewing gum triggers the same reflex as eating, stimulating gastrointestinal hormones connected with bowel activity.

The study looked at 34 people who had part of their sigmoid colon removed because of colon cancer or diverticulitis. Half chewed one stick of sugarless gum for about an hour three times a day, starting the morning after colon cancer surgery. The rest were treated as usual. In the chewing-gum group, the time to producing intestinal gas was reduced by 14.8 hours, to feeling hungry by 9.3 hours, and to the first bowel movement by more than a day. The total hospital stay for the gum group was 59.8 hours shorter than the control group, with discharge in 4.3 days instead of 6.8. Researchers noted that hospitals cost an average of $1,500 a day. Sugarless gum costs 4 cents per stick.

The Challenge of Antidepressant Medication and Intimacy

Wed, 17 Mar 2010 06:00:00 CST

Sex -- and satisfaction with your sex life -- is an important part of the lives of most adults. But having a satisfying sex life may be a challenge for those who take antidepressants.

While sexual dysfunction is a frequent symptom of depression itself (and successful treatment of depression may eliminate it), antidepressant medication can sometimes worsen or even cause sexual problems. In fact, sexual dysfunction is a potential side effect of all classes of antidepressants.

Between 30% and 70% of people who take antidepressant medications experience sexual problems, which can begin within the first week to several months after starting treatment. Antidepressant-related sexual dysfunction can affect almost any aspect of your sex life. In men, it frequently causes erectile dysfunction (the inability to achieve or sustain an erection), and in women, antidepressants may cause vaginal dryness and decreased sensation in the genitals. In both genders, antidepressants can diminish sex drive and make achieving orgasm difficult or impossible.

Sexual dysfunction due to any cause, including antidepressants, can have effects that range far beyond the bedroom, including psychological distress and a decrease in self-esteem and overall quality of life. This causes many people to stop taking their antidepressant medication. Up to 90% of people who experience antidepressant-related sexual dysfunction stop taking their medication prematurely. Fortunately, you can regain your sex life without stopping your medication and risking your symptoms worsening. For example:

Choose a medication with a low rate of sexual side effects – Wellbutrin, Remeron, or Cymbalta.

Change the time of day you take the medication.

Reduce the dosage.

Take a short break or “drug holiday.”

Add another medication to combat sexual dysfunction.

Follow a healthy lifestyle.

Are Your Feet at Risk?

Thu, 18 Mar 2010 06:00:00 CST

If you have diabetes, it’s critically important to pay attention to your feet. Shoes that rub or pinch can cause foot ulcers, a major diabetic complication. In fact, one study says that ill-fitting shoes are the most common precipitator of foot ulcers. And if not detected and treated early, foot ulcers can become infected and even lead to amputation.

Selecting the right footwear if you have diabetes and high-risk feet involves more than picking out a pair that goes well with a dress or suit. Properly fitting, comfortable shoes are essential to prevent foot ulcers and protect the health of your feet.

"The biggest mistake that people with diabetes make with regard to their feet is that they are not fit properly for a pair of shoes," says Lee Sanders, D.P.M., Chief of Podiatry Services at the Veterans Affairs Medical Center in Lebanon, Pennsylvania, and coauthor of A Practical Manual of Diabetic Foot Care (Wiley-Blackwell). "The shoe has got to fit."

Of course, not everyone with diabetes is at high risk for foot ulcers. The main problem that determines foot ulcer risk is diabetic neuropathy (nerve damage). One indication that you may have neuropathy is numbness, tingling, or burning in your feet and toes, especially if you have had diabetes for a decade or more. The reason numbness puts you at such risk is that the nerves have a purpose: to warn you of danger. If those nerves aren't functioning properly, you will not know when you are developing a foot ulcer, have shoes that don't fit, or have even stepped on a tack!

Peripheral arterial disease (PAD) is another problem that can put our feet at high risk. The poor blood flow to the legs and feet in this condition slows the healing of any foot wound and increases the chance of infections. One symptom of PAD is a cramping pain in one or both calves when you walk (called claudication) that goes away within minutes when you stop walking.

The highest risk is suffering from both neuropathy and PAD, so find out from your healthcare provider whether you have one or both. But even if you do, all is not lost. With careful foot care, you can successfully prevent problems by following some important healthcare behaviors. The key is to prevent that first break in the skin and to treat it quickly if it happens.

For more information on foot care, see:

Putting Your Feet First

If the Shoe Fits, Wear It

Restaurant Rules

Mon, 01 Mar 2010 06:00:00 CST

Sensitivity to dairy, gluten, or fructose doesn’t have to ruin your digestive tract – or your lifestyle. However, eating out at a restaurant presents special challenges for a person with a food intolerance. Here are some “restaurant rules” to help you stay healthy when you eat out.

For a lot of people, nutrition guidelines and taste preferences are the only factors steering food choices. But the simple act of eating is more complex if you have what's known as a food intolerance, or difficulty digesting any of a number of common dietary staples.

Lactose (dairy) intolerance, celiac disease (inability to digest gluten, found in wheat), and fructose (fruit sugar) malabsorption can cause a crop of unpleasant digestive woes -- so if you have any of these conditions, avoiding the offending edible becomes of prime importance.

Once you've figured out how to avoid the foods that upset your digestive system, eating at home can be a relatively easy task. But trying to eat a meal at a restaurant -- where you're not in total control of every ingredient and cooking utensil -- can be challenging.

Here's how to make sure your next restaurant meal includes only the foods you want:

Preview the menu online. Many restaurants have websites with full menus, so you can make sure there's something acceptable for you to eat.

Call ahead and make sure they will be able to accommodate your special needs.

Choose your reservation time carefully. Avoid peak dining hours, when the wait and kitchen staff may be too busy to remember your requests.

Tell your server about your particular food intolerance. He or she may be able to help you identify menu items that are safe for you to eat.

Ask how the food is prepared. Inquire, for example, if the salad includes croutons or the meat is marinated in soy sauce. And don't be afraid to ask that your food be prepared in whatever way you need.

Be pleasant and keep your requests simple. The restaurant staff has other tables and customers, and you're more likely to get what you've asked for if you're not overly demanding.

When in doubt, don't eat it. If you can't verify that a food or ingredient is safe, avoid it.

Overactive Bladder Concerns

Tue, 02 Mar 2010 06:00:00 CST

In this Grand Rounds column from a recent Prostate Bulletin, a reader writes: Early this year I had the TURP surgery (transurethral prostatectomy) for BPH (benign prostatic hyperplasia). Before the surgery, I would take one 5 mg tablet of Ditropan XL or oxybutynin each evening and I did not have to get up to urinate during the night. Now, after the TURP procedure, I am back to getting up to go to the bathroom. I tried taking Ditropan XL and oxybutynin, but they no longer worked. I tried taking one pill in the morning and another at night, and that didn't work either. In addition, I am careful not to drink anything after 6 P.M. ...

At my urologist's suggestion, I tried a new prescription drug, VesiCare, and when that didn't work, I tried Detrol LA. I still have to get up four, sometimes five times a night to urinate. I've now noticed that during the daytime I have to urinate more often before, sometimes in a panic.

Do you have any idea why this is happening? Any recommendations about what I can do to get a better night's sleep? It seems like my bladder is just not functioning properly anymore. Novato, CA

Dr. Jacek L. Mostwin answers: A few things that can be considered as possible causes of your symptoms could be easily treated. Is there a urinary tract infection? A urinalysis and a urine culture would answer that question. Is there a bladder stone? An ultrasound or a cystoscopic examination would answer that question. Is there a scar or a bladder neck contracture in the area where the prostatic surgery was performed? Cystoscopic examination or a flow rate would help to answer that question.

If the suggestions described above don't lead to a diagnosis, your overactive bladder symptoms may be due to changes in spinal reflexes that took place over the many years during which the prostate was blocking your bladder. These reflexes improve partially after prostatectomy, but in some cases they do not improve completely. We generally expect about 15% of patients to continue to have significant overactive bladder symptoms, and some of them may get worse.

Again, if none of the suggestions made in the previous paragraph provide an answer, and there is no other explanation for your severe overactive bladder symptoms, you may require more decisive intervention. It all depends on how bothersome your symptoms are.

A device called the Interstim is approved for the treatment of your problem. It is more commonly described as a spinal cord stimulator, although the electrodes used to stimulate the bladder nerves do not actually enter the spinal cord at all. It is a safe device and has been used in many thousands of patients with good results. This would be one possible solution to consider if your symptoms are very disruptive and they have not responded to any other medications or conservative fluid management.

Are Your Ears Ringing?

Wed, 03 Mar 2010 06:00:00 CST

Tinnitus is often described as “ringing in the ears” (the term is derived from tinnire, Latin for “to ring”). But tinnitus can take many different forms, including humming, whistling, hissing, machinelike noises, and even roaring. While there is no cure for tinnitus, many treatments are available, and new ones are being developed.

The cause of tinnitus is frequently in the inner ear. Lloyd Minor, M.D., Director of Otolaryngology -- Head and Neck Surgery at Johns Hopkins, explains, “Tinnitus often accompanies age-associated hearing loss, so we presume that it’s caused by damage to inner ear structures and hair cells in the cochlea, especially if the person is or was routinely exposed to loud noises. However, when a patient has tinnitus without hearing loss, we think it may have a central cause -- that the tinnitus is coming from the brain.”

An audiogram (hearing test) indicates the extent of hearing loss and helps determine if centrally located tinnitus is the more likely cause. A careful medical history also is important to find out if a coexisting medical condition or medication could be at work. Thyroid disorders and high blood pressure, for instance, and at least 200 medications, including common pain relievers, may cause tinnitus.

The search for tinnitus relief: A good first step is to cut out caffeine. “Many people who give up caffeinated beverages like coffee, tea, and soda and foods like chocolate find that their tinnitus symptoms improve,” says Dr. Minor. Giving up smoking and alcohol also may help.

Probably the most common treatment is to mask the internal noise with external noise. Dr. Minor notes, “Oftentimes people are only bothered by tinnitus when it’s quiet -- at bedtime, for instance. No masking device has been shown to help a large number of patients better manage their tinnitus. But people’s experiences with tinnitus and its treatment can vary widely. If a patient finds that a masking device helps, I wouldn’t discourage its use.”

The latest efforts: Early studies of a new therapy called transcranial magnetic stimulation (TMS), which sends an electric current into the brain, are encouraging, and clinical trials are under way. Some tinnitus patients have benefited from electrical cortical stimulation (ECS), which makes use of pacemaker-like implants to deliver electric impulses. Electric neurostimulation is noninvasive and also has few side effects. But more research is needed, and currently TMS and ECS aren’t available outside clinical trials.

Genetic Testing for Heart Disease: Is It a Good Idea?

Fri, 12 Feb 2010 06:00:00 CST

Having a family history of premature heart disease (heart disease in a father or brother younger than age 55 or in a mother or sister younger than age 65) is considered a risk factor for heart attacks.

Today, many investigators are searching for genes that might be associated with premature heart disease. A few have been identified, such as that for familial hypercholesterolemia (see below), and some companies already market tests that purport to assess risk. However, genetic research is still in its early stages. In addition, many of the genes involved in heart disease have not yet been identified, and having a particular gene mutation does not mean that you are destined to have a heart attack.

So for now, we advise against genetic testing for the vast majority of people with a family history of premature heart disease, because the results are unlikely to change your doctor's treatment advice.

What is inherited high cholesterol? -- Familial hypercholesterolemia is an inherited form of high cholesterol that results from a mutation in the gene for the low-density lipoprotein (LDL) receptor. About 1 in 500 people inherits a single copy of the mutated gene from either their father or mother.

In people with familial hypercholesterolemia total cholesterol levels are usually above 300 mg/dL and LDL cholesterols are above 200 mg/dL. In addition, men with the condition often have heart attacks in their 40s and 50s; women, in their 60s.

Because people with familial hypercholesterolemia have a one in two chance of passing the mutation on to their children, family members can benefit from a blood cholesterol test at an early age. High total and LDL cholesterol levels indicate the need to start treatment.

Treatment involves the same measures used for other forms of high cholesterol. Dietary changes are especially important, and medication is always needed. However, even with treatment, very few people with familial hypercholesterolemia are able to lower their cholesterol to normal levels.

People who inherit high cholesterol levels and have a positive family history should make an appointment with a doctor who specializes in lipids if they are unable to lower their LDL cholesterol substantially after six months to one year of treatment. For a referral to a physician in your area, call MEDPED (Make Early Diagnosis to Prevent Early Death) at 888-244-2465 or visit www.medped.org.

Why You Should Monitor Your Blood Pressure at Home

Tue, 09 Mar 2010 06:00:00 CST

A home blood pressure monitor is not a substitute for regular visits to your doctor's office. However, experts now recommend that all people with high blood pressure purchase a home monitor to follow their blood pressure between office visits. Two types of home monitors are available: aneroid and electronic. Aneroid monitors consist of a cuff, stethoscope, and dial gauge; electronic monitors, a cuff and monitor with a digital screen.

Experts are now calling for people to do more monitoring of their blood pressure at home. Research reported in the journal Hypertension (volume 52, page 10) shows that home measurements, compared with those taken at a doctor's office, provide a more complete picture of average blood pressure levels and better predict the risk of a heart attack or stroke. They also offer instant feedback as to whether or not your efforts to lower blood pressure are working.

For these reasons, experts recommend that all people with known or suspected high blood pressure purchase a home blood pressure monitor and also receive instruction on its use from a healthcare professional.

The average of two to three readings taken in the morning and evening for a week provides a reliable estimate of blood pressure. Cutoffs for diagnosing high blood pressure from home readings are lower: A home blood pressure reading above 135/85 mm Hg is considered hypertension. However, for those with coronary heart disease, diabetes, or kidney disease, the cutoff is still 130/80 mm Hg.

The experts also advised that a home monitor should have a cuff that wraps around the upper arm (not the wrist) and that you should take the monitor to your doctor's office once a year to check its accuracy. Monitors typically cost less than $100.

Should You Be Screened for Lung Cancer?

Thu, 04 Mar 2010 06:00:00 CST

Are you a smoker who's thinking about getting a computed tomography (CT) scan to check for lung cancer? If your answer is yes, you might want to reconsider. Here’s why …

It's well known that screening for certain cancers, like cervical or colon cancer, can identify the disease early and save lives. But the value of screening for other types of cancer continues to be controversial in some circles. Screening for lung cancer falls into the latter group.

On the surface, screening for any cancer that has the potential to kill thousands of people seems like a reasonable idea. With screening, the disease is usually found at its earliest stage before it grows or spreads -- the time when treatment is most likely to result in a cure. In the case of lung cancer, both chest x-rays and CT scans can identify small nodules on the lung, with CT able to identify those as small as a grain of rice.

But not all nodules are cancerous, and to determine whether a nodule is requires a biopsy, which is invasive. This additional testing is not risk free and can cause needless emotional stress if the nodule turns out to be benign. In addition, even when a biopsy does identify cancer, it's not clear whether removing the growth lengthens life expectancy.

That's because the tiny tumors commonly identified by CT screening might never grow to an advanced stage that could cause significant illness or death. In contrast, despite routine screening, aggressive, late-stage cancers seldom show up on CT early enough to be cured -- even in smokers, according to a recent study in the Journal of the American Medical Association.

So are there any benefits to screening for lung cancer? The experts say "maybe not." But we could have a definitive answer soon, when results from the National Lung Screening Trial (NLST) are reported. The study, which began in 2002, enrolled 50,000 current or former smokers who were randomly assigned to receive a spiral CT scan or chest x-ray and had the test repeated annually for three years. At the end of the study the investigators will try to determine whether screening saved lives and, if so, whether one method was better than the other.

Our advice. Skip the screening tests for lung cancer -- at least until results from the NLST are available. This recommendation holds true even if you are a smoker. But see your doctor and ask about screening if you develop symptoms that could be signs of lung cancer.

Living With Alzheimer's: Two Stories From the Front

Mon, 08 Mar 2010 06:00:00 CST

Caring for a loved one with Alzheimer’s is challenging. Here are answers to two questions, asked by Alzheimer’s caregivers to the editors of our Johns Hopkins Memory Bulletin. The subjects: Confusion about place … and symptoms of aphasia.

Q. What do you recommend that I do for my grandfather, who doesn't realize that he is actually home? Gramps worked for the railroad for 48 years and did a lot of traveling during his career. Now that he is 90 and was diagnosed with Alzheimer’s a year ago, he suddenly says that someone should pick him up, along with his luggage, and help him get home. This has been going on for a month, and I don't know how I can convince him and ease his concerns that he is already safe at home. Westport, CT

A. You are describing what doctors refer to as an agnosia, an inability to recognize a familiar object, person, or place despite intact eye function. This symptom can be seen in other brain diseases that affect the parietal lobes of the brain, so it is not only a symptom of Alzheimer's disease but does become common in Alzheimer’s as the illness progresses. This is not merely "forgetting" where one lives; many individuals with this problem can accurately describe the home they live it. Rather, it is an inability of the brain to merge the memory of a place with the perception the person is seeing at that time.

Advice: In my experience, there is no benefit and sometimes harm in repeatedly trying to convince the patient that "this is your house." I think it would be best to distract him by changing the subject, reminiscing about his home, or empathizing with his distress.

Q. My wife was originally diagnosed with early Alzheimer's disease but now the diagnosis has been switched to primary progressive aphasia. I would appreciate your views on diagnosis, prognosis, and treatment possibilities. Via e-mail

A. Primary progressive aphasia, or "PPA," is a condition in which a person has a slowly progressive loss of the ability to communicate through speech. Most individuals who have this condition are found to have fronto-temporal dementia at autopsy but some individuals have the pathology of Alzheimer's disease located only or primarily in the brain's language center.

Advice: Individuals with PPA have marked difficulty finding words and may eventually become unable to generate language through speech. They can often comprehend more than they can express, so if a person gives them 'yes' or 'no' choices for responses, , communication is easier.

Many but not all individuals with PPA are frustrated by their difficulty with language expression; when this is the case, it is often helpful to them to let them know you recognize their frustration.

How Much Calcium Is Really in Your Supplement?

Wed, 10 Mar 2010 06:00:00 CST

Many people take calcium supplements to help stave off bone loss, but how much calcium you actually get from a supplement isn't as straightforward as it may seem. Johns Hopkins explains …

In nature, calcium exists only as a compound (such as calcium carbonate or calcium citrate). Each compound contains a different amount of "elemental" calcium, the important ingredient needed for bone health.

When you take a calcium supplement, it's the amount of elemental calcium that's key. If the amount of elemental calcium isn't clearly stated on the bottle, check the Nutrition Facts label, which will include how much elemental calcium -- often listed simply as "calcium" -- is in a "serving size."

For example, Tums Ultra 1000 contains 1,000 mg of calcium carbonate per tablet, but only 40% of calcium carbonate is elemental calcium -- meaning, one Tums Ultra 1000 tablet has 400 mg of the essential mineral.

Often, the recommended serving size on the supplement label does not meet your daily calcium requirement. Tums Ultra 1000 lists a serving size as two tablets, adding up to 800 mg of calcium -- not enough for adults over 50, who should get 1,200–1,500 mg a day.

Bottom Line Advice: If you have questions about the right dosage, ask your doctor how many pills you should take each day. Also, it's best to spread out your daily dosage of calcium so you don' t take more than 600 mg of elemental calcium at one time; the body absorbs larger amounts less efficiently. Finally, take calcium carbonate with meals, because this type of calcium is absorbed better in the presence of stomach acid.

Protecting Yourself From a Serious Fall

Tue, 02 Mar 2010 06:00:00 CST

Of all the potential side effects from prescription medications, accidental falls are a particular concern for older people. At a younger age, a fall usually results in nothing more than a bruised ego -- we get up, rub the affected area, and get on with the day.

Not so for many older adults, for whom falls can be a serious or even fatal event. In 2005 nearly 1.8 million Americans age 65 and older were treated in emergency rooms for nonfatal injuries from a fall -- according to the Centers for Disease Control and Prevention (CDC). Injuries range from mild (bruises and abrasions) to moderate (hairline fractures) to life-threatening problems, such as a broken hip or bleeding in the brain.

The good news is that you can prevent injurious falls due to prescription medications by working with your pharmacist and your doctor(s). They can assess whether you are at a higher risk for falls and need to take extra precautions with your medications.

What Are the Risk Factors? Among older people, various risk factors strongly indicate a higher fall risk. The CDC and a 2008 review article in Neurology cite the following factors:

Age. Fall risk continues to rise with increasing age. In 2001, adults age 85 and older had four to five times more fall injuries than those ages 65 to 74.

Diseases and conditions. Dementia, stroke, or illnesses that create an abnormal walk raise the risk of a fall. An increased risk also is likely among people with Parkinson's disease, peripheral neuropathy, weakness or sensory loss in the lower limbs, and substantial loss of vision.

History of falls. An individual who suffered a fall during the previous year has a 55% higher risk of having another fall. Geriatricians strongly recommend routine fall-risk assessments. If you or your loved one has not been assessed for fall risk, ask your doctor about it. If you have taken a fall in the past year, insist on such an assessment.

Further Steps -- In addition, some basic lifestyle measures can help you to decrease the risk of a fall. Studies show that regular exercise improves strength and balance, which help to prevent falls. Even a weekly tai chi class or light strength training several times per week can make a difference.

Also look around your home and remove any physical hazards that could cause a fall, such as unsecured throw rugs or clutter in walkways. Proper lighting, particularly on your path to the bathroom at night, is another good idea. Installing handrails on stairways and grab bars in bathrooms can be helpful, too.

Linking Obesity and Aggressive Prostate Cancer

Tue, 16 Mar 2010 06:00:00 CST

Research suggests that being overweight may not increase your risk of developing prostate cancer. But obese men who do develop the prostate cancer tend to have more aggressive, higher-grade cancers at the time of diagnosis and a greater risk of dying.

In a study reported in the journal Cancer, obese men with a BMI of 35 or higher were somewhat less likely to be diagnosed with prostate cancer than were normal-weight men (BMI of less than 25). But if prostate cancer developed in these men, it was more likely to be fatal. During the five years of the study, men with a BMI of 35 or higher were twice as likely to die of their prostate cancer as were normal-weight men.

Results of another study reported in Cancer showed that obese men (BMI greater than 30) who had prostate cancer confined to the prostate or to areas surrounding it were three times more likely to develop metastatic cancer than were normal-weight men with a similar diagnosis. In this 10-year study, being obese more than doubled the risk of dying of prostate cancer.

Factors Affecting Outcome. Prostate cancer specialists suggest several possible explanations for the worse prognosis of obese men. For example, being obese alters estrogen and testosterone levels and increases insulin-related substances that spur the growth of cancer such as insulin-like growth factor-1 (IGF-1).

Another possibility is that men who are obese may be less health conscious and visit their physicians less often than they should, resulting in fewer prostate-specific antigen (PSA) tests and a delayed diagnosis. Obese men also tend to have lower PSA concentrations, possibly because the PSA is diluted in a larger volume of blood. These lower levels delay diagnosis as well.

Last, but not least, excess weight also makes it more difficult for a physician to examine the prostate via a digital rectal exam or biopsy and for a surgeon to perform a successful radical prostatectomy.

Eye on the Eyedrops

Tue, 02 Mar 2010 06:00:00 CST

If you have glaucoma, you probably use eyedrops at least once a day to lower the pressure within your eye. Although using eyedrops may sound simple enough, in reality, it's not always easy to get them in your eye or to remember to take them. This guide offers tips on the best ways to get your eyedrops exactly where they're supposed to be.

The first barrier for many people is remembering to use their eyedrops. If you find that you're forgetting your eyedrops, try using these strategies.

Develop a routine. Associate using eyedrops with another activity that you do each day, such as brushing your teeth.

Use reminders. Stick a note on your bathroom mirror or refrigerator or ask your spouse or other family members to remind you to use your eyedrops.

Simplify your regimen. Ask your doctor to simplify your eyedrop regimen; for example, you may be able to switch to once-a-day drops or a combination product that contains two types of eyedrops in one bottle.

Following these simple tips can help you get your eyedrops into your eye.

Lie down. The more horizontal your face, the better the chances that the eyedrop will go in your eye and stay there. Even if you only hit the eyelids, by staying horizontal and blinking after the drops hit the corner of your eyelids, enough will get in your eye.

Position the bottle and your eyelid. Hold the bottle vertically between your thumb and index finger and about an inch above your eye. With your other hand, carefully pull down your lower eyelid with your index finger, creating a small pocket, which increases the amount of eye surface available to catch the eyedrop.

Carefully close your eye. After the eyedrop gets in your eye, close it, but don't squeeze or close it too tightly. Gently press the inside corner of your eyelid at your tear duct, for at least one minute. This will allow your eye to absorb the medicine.

Wait before using other drops. If you use several kinds of eyedrops or more than one drop of a single medication, wait at least one minute before applying the next drop.

Troubleshooting: Shaky hands? If your hands are too shaky, try resting your palm on your cheek as you apply the eyedrops. Eyedrops still not going in? Lie down, turn your head to the side and gently close your eyes. Place a drop on the inside corner of your eyelid, then open your eyes slowly. The drop should go in. If it's unclear whether a drop went in, try another. Your eye can only hold about one eyedrop, so any excess will roll away.