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Warning symptoms in advance of sudden cardiac arrest can save a life.

Posted in Blogfinger Medical Reports, tagged on December 26, 2015| 3 Comments »

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American Medical Association Morning Rounds prepared for Paul Goldfinger, MD.  December 22, 2015:

Warning symptoms may be common prior to sudden cardiac arrest.
The AP (12/22 ) reports that research published in Annals of Internal Medicine  suggests “a lot of people may ignore potentially life-saving warning signs hours, days, even a few weeks before they collapse” due to cardiac arrest.
On its website, CBS News (12/22,) reports that the study of 839 patients found that approximately “half of patients who have a sudden cardiac arrest first experience symptoms like intermittent chest pain and pressure, shortness of breath, palpitations, or fainting.”     However, “80 percent of them ignore their pre-arrest symptoms.”

 

Blogfinger Medical Commentary:  Paul Goldfinger, MD, FACC

This unusual research from Oregon examined over 1.000 victims of SCA (sudden cardiac arrest,)  ages 35-65. For over 800 of them, there was enough medical information to come to some conclusions about warning symptoms. We used to think that most SCA cases were sudden, with no warnings; but this trial says otherwise.

In this study, with data collected over 10 years, about half of the SCA victims had warning symptoms  (especially chest pain, shortness of breath, fainting, and palpitations) during the weeks prior to their cardiac arrest.   For those who sought help for such symptoms, they had the best chance of surviving.  For those with symptoms who waited to seek help, they did poorly.  By the time a 911 call for  cardiac arrest is made, the survival rates are poor—perhaps 10%, with about 30% survival for those who sought help.

Whether someone has a history of heart disease or not, such symptoms should be checked by going to an ER or even calling 911 if the symptoms are impressive (as described above.)   Don’t waste your time calling your doctor–you’ll probably get an appointment for next week or longer, or they’ll tell you to call 911. Don’t gamble and waste time.  Don’t be reluctant to go to the ER without delay. Better safe than sorry.

In addition to the kind of cases examined in this trial, there is certainly a significant group  “out there”  who are destined to have a cardiac arrest  (and we don’t know exactly how to identify them) who seek medical attention because of warning symptoms or because of increased cardiac risk, who get treated in one way or another, who don’t experience the SCA that was in the cards for them.

The process begins with diagnostic evaluations and then there are many interventions that have been shown to improve survival in treated patients—-everything from coronary stents/bypass surgery, implanted defibrillators, drugs including beta blockers, aspirin and statins plus a myriad of prevention modes , such at blood pressure control, diet, exercise and others.

We used to use the term “hearts too good to die” in discussing young victims of sudden cardiac arrest who have conditions where they basically have good heart function and who could have been saved if only their electrical instability or their blocked arteries had been recognized or if their high risk cardiac conditions without symptoms had been diagnosed.

Doctors need to know about prevention of cardiac death, but some physicians are not very interested in prevention.   Patients  and families must be aware!

Such diagnostic findings are especially true for middle aged males, who should be evaluated for coronary risk, even if they feel great. Paying attention to risk could prevent more SCA’s.  And this is especially true if someone has major risk factors (hypertension, smoking, diabetes, obesity, family history, inactivity, high cholesterol,etc.)

We spent years perfecting our patient education book on prevention and I beg you to get it and study it.  It’s now four years since we updated it, but the basics are valid.  Eileen and I first worked on that book and gave it away free when we had a grant from Merck. In 2011 we published the 4th edition ourselves, but we make pennies per copy, and we don’t care about that. It cost about $12.00 paperback online.

We will donate every cent to the AHA; So please get it and read it.   It was designed to be easy to understand, but also recognizing that lay people are smarter than most doctors think.  Go  Amazon or Barnes and Noble.com  and search under Paul Goldfinger MD.

So don’t ignore worrisome symptoms, and have your coronary risk profile checked.    And please don’t shovel snow.  (We will be posting our yearly article on that subject.)   Here is a link    Dangers of snow shoveling

 

Prevention does work

 

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Eating out or eating in? Blogfinger medical report:

Posted in Blogfinger Medical Reports, Medical topics by Paul Goldfinger, tagged on December 13, 2015|

Cravebits.com

Cravebits.com

 

Click to read the small print.

Click to read the small print.

From MarketWatch.com:

“Down to your last belt loop and your last penny? These seemingly unrelated phenomena may have more in common than you think, a new survey shows.

“Dining out is the No. 1 thing that Americans blow their budgets on, according to the Principal Financial Group’s annual Financial Well Being Index, which will be released Wednesday (Market Watch got an early look at the data). The company surveyed more than 1,100 employed American adults.

‘Those restaurant meals are also adding to our growing waistlines: On days when people dine out, they tend to consume 200 more calories than when they eat at home, according to a study of more than 12,500 people published by Public Health Nutrition last year, and government research shows that “when eating out, people either eat more or eat higher calorie foods — or both — and that this tendency appears to be increasing.” Other studies show that eating out more frequently is associated with obesity and higher body fat.”

And the problem is getting worse. While 22% of Americans blew their budgets on dining out in 2014, this year, 24% did so.

In the Huffington Post a few years ago, Mark Hyman, MD wrote a fascinating piece which is very important.  Here is an excerpt and a link:

“Research shows that children who have regular meals with their parents do better in every way, from better grades, to healthier relationships, to staying out of trouble. They are 42 percent less likely to drink, 50 percent less likely to smoke and 66 percent less like to smoke marijuana. Regular family dinners protect girls from bulimia, anorexia, and diet pills. Family dinners also reduce the incidence of childhood obesity. In a study on household routines and obesity in U.S. preschool-aged children, it was shown that kids as young as four have a lower risk of obesity if they eat regular family dinners, have enough sleep, and don’t watch TV on weekdays.”

http://www.huffingtonpost.com/dr-mark-hyman/family-dinner-how_b_806114.html

Blogfinger Medical Commentary:  By Paul Goldfinger, MD, FACC

For the first time, data reveals that Americans spend more money on eating out than they do at  grocery stores.  Processed foods and restaurant foods tend to contain more salt, fat, and sugar than you might think.  The food industry plays up the addictive properties of certain ingredients including sugar, salt and fat.     Eating at home brings more fresh fruits and vegetables as well as low fat proteins and less calories to the table.

The issue is not only calories, which goes to the obesity issue, but it also involves prevention from cardiovascular disease, strokes, high blood pressure, cancer and diabetes.  In our book Prevention Does Work: A Guide to a Healthy Heart, we go over every nutrition issue that we could think of including good/bad fats, coffee, chocolate, nuts, salt, statins and many others.

In addition, for you modern men and women who don’t know how to cook, Eileen provides 36 easy-to-prepare evidence- based original recipes with an emphasis on seafood, and it’s all about home cooking.  You young families should try to eat most  of your meals at home, for a variety of reasons.

Our book is an inexpensive way to get on a better nutritional road. Don’t rely on unsubstantiated Internet claims.  We provide the scientific evidence  in a way that you can understand.

Go to Barnes and Noble and type Paul Goldfinger, MD.  They have it for $12.95 in paperback.  It is also on Amazon.com.

Good diets, exercise, good music, low stress, and a good lifestyle will help keep you young.  Here is Frank Sinatra who would have been 100 yesterday, joining Charles Aznavour with another way to feel young:

 

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One-third of physicians unaware of HIV pre-exposure prophylaxis drug

Posted in Blogfinger Medical Reports, tagged on December 3, 2015|

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The New York Times (11/26,) reported that officials at the Centers for Disease Control and Prevention said last week that about one-third of primary care physicians and nurses in the US have not heard of Truvada (emtricitabine and tenofovir disoproxil fumarate), an HIV pre-exposure prophylaxis drug. According to Dr. Eugene McCray, director of the CDC’s division of HIV prevention, “Providers play a central role in increasing awareness and uptake of PrEP.”

AFP (11/26) reported that CDC Director Tom Frieden, MD, MPH, said, “PrEP isn’t reaching many people who could benefit from it, and many providers remain unaware of its promise.” Dr. Frieden added, “With about 40,000 HIV infections newly diagnosed each year in the US, we need to use all available prevention strategies

Blogfinger medical commentary:    By Paul Goldfinger, MD.

There are 40,000 newly diagnosed cases of HIV yearly in the US.  Some of those cases could have been prevented with a drug called Truvada, made by Gilead Pharmaceuticals, a company in California.

PrEP means pre-exposure prophylaxis. 

The idea is that certain uninfected people are particularly at risk of being infected.  High risk groups include gay or bi-sexual males and  also drug users who inject  narcotics.  A small but important at-risk group are the sexual partners of heterosexual adults with HIV.  Heterosexuals can get HIV by needle sticks, transfusions or risky sexual relations.  These individuals would benefit from daily dosing of  Truvada. 

This story interests me at several levels.  For one, I am appalled, but not surprised, that so many physicians have never heard of this important drug. Too many doctors do not keep up with the latest advances in medicine.  That is why, in the age of Google, everyone who is susceptible to certain medical conditions should learn as much about those problems and not depend totally on doctors.

Sex is a delicate topic, and many doctors don’t ask their patients about sexual and lifestyle issues, and they should. How many of you have ever been questioned by your doctor about your lifestyle, and, in particular, about sexual matters such as STD prevention?

And how many uninfected people are in relationships with others who are HIV positive, but don’t know that Truvada exists?   That is a tragedy at a personal level and a disgrace for the medical profession.

The profession has done well with some related issues such as quickly treating medical personnel who get stuck with an infected needle.   Or providing treatment if a risky situation occurs, such as a broken condom.

Another happy area is that this is the first year in the USA when no baby has been born with HIV, transmitted by the mother.  And, many HIV patients take medication which prolongs their lives and brings their viral counts so low that they are practically non-infectious. 

These advances are amazing especially when we still do not have a cure or a vaccine for this condition.  Prevention is so important, and doctors must pay attention.

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Lowering blood pressure target may lead to lower rates of cardiovascular events: the SPRINT Trial

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged , on November 19, 2015| 1 Comment »

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The CBS Evening News (11/9,) reported that “a new study that says sharply lower blood pressure leads to significantly longer lives.”

On ABC World News (11/9), Dr. Richard Besser reported, “The results were so startling, they stopped the study…early.”

The New York Times (11/10,) reports that investigators found that “among the 9,361 hypertension patients followed for an average of 3.2 years, there were 27 percent fewer deaths (155 compared with 210) and 38 percent fewer cases of heart failure (62 compared with 100) among patients who achieved the systolic pressure target of 120 than among those who achieved the current 140 target.”

Altogether, “there was a 25 percent reduction — 243 compared with 319 — in people who had a heart attack, heart failure or stroke or died from heart disease, Dr. Paul K. Whelton, a principal investigator for the study, said.” The findings were presented at the American Heart Association meeting and published in the New England Journal of Medicine.

Blogfinger Medical Commentary.   Paul Goldfinger, MD, FACC

One year ago, experts at the NIH were recommending that doctors back off  on their advice for patients with hypertension  (high blood pressure) saying that any systolic reading  (the top number) under 150 would be fine for patients over age 60, while 140 would suffice for younger people.  The 140 number had been the standard for many years.

In 2014, after years of waiting, the NIH put out their JNC 8 guidelines for treating high blood pressure. The result had cardiologists pulling their hair out over the wishy-washy results which had doctors cutting back on aggressive treatment,  and patients, especially older ones,  throwing away their pills.  This quote is from the NJC 8, 2014 guidelines:

There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion.

Now, in a large trial of over 9,000 people age 50 or older, it appears that a systolic reading of under 120 is best. The study did not include diabetics or  stroke victims.  In order to be in the trial, you needed a BP of 130-180 systolic.  The bottom number (diastolic) was not studied but it is nevertheless important, and 90 is the cutoff for diastolic readings.  And if you were younger than 75 you needed to have at least one risk factor such as heart disease or high cholesterol. in order to be in the trial.

So most people in the US with hypertension would not qualify for this trial, and the results can’t be applied to them.  The treatment phase consisted of one group who were shooting for a reading  under 140, while the more aggressive group achieved BP under 120.

The study considered drug therapy as the main way to get the systolic BP below 120 in the aggressively treated group, but no consideration was given to non-drug lifestyle therapies such as weight reduction, low salt diet, adequate sleep and exercise.

Interestingly although this academic study (done where the researchers often live in a bubble) was making believe that doctors can push readings down to 120 in older individuals, the reality, in real-life,  is that many patients can’t even get their BP under 140.  Doctors have often failed to achieve the old goals, despite an excellent array of drugs, and there are often errors made in how these patients are followed.

In the office, the BP reading is often taken in a hurry by a medical assistant whose technique is often sloppy using untrustworthy equipment.   In addition, a rushed measurement  is often misleading.  The patient should be allowed to sit quietly and then repeat the reading.  The doctor should double check it himself.

Office readings are particularly unreliable if one is interested in the blood pressure experienced by a patient throughout the day.  All my patients were recording home readings several times per day, keeping diaries of time and circumstances.  If they were stressed, or they had other issues,  they were to write it down.  They also would take readings standing and sitting. Almost every one of my patients were within scientific guidelines.

I discussed salt, nutrition, exercise, stress and weight with my patients as part of a comprehensive  prevention plan. It’s all in our book “Prevention Does Work: A guide to a healthy heart.” by Paul and Eileen Goldfinger.

It is important to point out that striving for a BP of 120 especially in the elderly, creates a risk of dizziness, fainting, falling, kidney failure and cognitive failure.   The benefits in this trial, in absolute numbers,  are not huge, despite the 24% reduction in end points such as death rates, and many experienced doctors are skeptical.  My own cardiologist is sticking to the old guidelines, and I agree, but I am inclined to want to be closer to 120 than to 140. The new guidelines are not even out yet, so don’t be too quick to play the low number game.

In 2014, I wrote a series of 4 articles “Confessions of a high blood pressure doctor.”  Part III deals with this topic of targets as of 2014. It is a good orientation piece.      Confessions Part III treatment goals 2014

Quote of the day.  In the New York Times (11/10) “Well” blog, Harlan M. Krumholz, MD, from Yale Med School, points out that this trial does not offer an absolute conclusion for clinical use at this time.

He writes, “The study opens a new option for treatment, but it is not a slam dunk that everyone who fits the eligibility criteria of the study ought to be treated.” Rather, Dr. Krumholz argues, “it is a choice that is worthy of thought and reflection.”   

And we can sure use more doctors who take the time for “thought and reflection.”

You can also search the Times for Gina Kolata’s recent essay on this subject.

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Casual smoking is increasing among young American women, study shows.

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged on July 18, 2015| 2 Comments »

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It's still considered cool and sexy. The Telegraph.co

It’s still considered cool and sexy. The Telegraph.co

TIME link on women smokers

TIME (7/16, Furman) reports a new study indicates that “for a large swath of young American women, light smoking is growing in popularity.” The study, published in Preventing Chronic Disease, “analyzed a sample of 9,789 women between ages 18 and 25 from the 2011 National Survey on Drug Use and Health,” who were then asked “if they had smoked part or all of a cigarette in the past 30 days; those who said they had were classified as current smokers, while those who hadn’t, but had smoked previously, were considered ‘former’ smokers.” The results showed that “while heavy smoking—a pack a day—has decreased in the U.S….27% of all people in the study—and 62% of the current smokers—identified as very light smokers, a habit of five or fewer cigarettes a day.”

Blogfinger Medical Commentary:    Paul Goldfinger, MD, FACC.

In medical school in the mid-1960’s, I saw people smoking all over the hospitals and even in patient rooms.  When we had “chart rounds” at Mt. Sinai Hospital in New York, the door was shut, and the room was filled with smoke due to cigarettes and pipes.  In fact, a survey at that time showed that “more doctors smoke Camels than any other cigarette.”  In 1964, the Surgeon General issued his first report on “Smoking and Health.”

When we were preparing our prevention book, I was interested in all cardiac risk factors, but smoking was very high on the list of risky behaviors.  We wrote that the risk correlated with the amount smoked.  I always included in my lectures that even one cigarette per day carried an increased risk compared to none.

This study from the University of Texas  looks at nearly 10,000 young women, 18-25,  and their habit of “light” or “casual” smoking.  Some call it “smoking while drunk.”   27% of the study population smoked “lightly,”  and many think that light smoking is safe.    The authors say that “even a very light habit isn’t safe.”

This evaluation doesn’t look at risk, but you can connect the dots between these findings and known risk from light smoking.

It’s been long known that stopping smoking reduces risk, although it never goes down to zero.  Chronic smoking, light or heavy, takes a long term toll, but a smoker will be safer if he/she stops.

Over the years many smokers, including most physicians, gave up the habit.  But the current report raises some concerns regarding increased cigarette smoking among young women. I recommend that you click on the link above to read the TIME article.     It is brief but has some very interesting practical information as well as an old video.

NIKKI LONEY  has some advice for young women.  She says that love can’t be trusted, so don’t let smoke get in your eyes.

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Study: Increased use of mammograms to screen for breast cancer has not saved lives

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged on July 7, 2015| 1 Comment »

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The Los Angeles Times (7/7, Kaplan) “Science Now” blog reports that research published in JAMA Internal Medicine suggests that “the increased use of mammograms to screen for breast cancer has subjected more women to invasive medical treatments but has not saved lives.” Investigators “examined data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results registry.”

The Washington Post (7/7, Cha) “To Your Health” blog reports that the investigators “found that the number of breast cancer diagnoses rose with more aggressive screenings,” but “the number of deaths remained the same.”

On its website, NBC News (7/7, Fox) reports that the researchers “also found more screening did not reduce the rate of larger breast tumors, defined as those 2 cm or larger.”

Blogfinger Medical Commentary:   By Paul  Goldfinger, MD, FACC.

We have been trying to temper rigidity with flexibility on BF regarding this topic.  But some of you have gotten angry over my comments targeting  pink banners all over town.  As you can see, the subject is controversial, and the Meridian mammogram industry needs to take another look at their in-your-face pink advertising campaign, particularly as it is done in OG.

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Study: Thirty-three million US adults may be affected by problem drinking. Blogfinger medical report.

Posted in American Medical Association reports, Blogfinger Medical Reports, tagged on June 6, 2015|

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From the American Medical  Association:  (Note the links below)

The AP (6/4, Tanner) reports, “Alcohol problems affect almost 33 million adults and most have never sought treatment,” according to a study published online June 3 in JAMA Psychiatry. The research conducted by investigators at the National Institute on Alcohol Abuse and Alcoholism also suggests that “rates have increased in recent years.”

NIAAA director George Koob, PhD, “said it’s unclear why problem drinking has increased but that many people underestimate the dangers of excessive alcohol.” Koob also pointed out that effective behavioral treatments and medications exist to help people overcome problem drinking. He said, “There’s a lore that there’s only Alcoholics Anonymous out there and that’s not true.”

TIME (6/4, Sifferlin) reports that the study examined “the prevalence of drinking issues based on a new definition for alcohol use disorders in the” American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). That “definition classifies problem drinkers as those who have two of 11 symptoms including continuing to drink even if it harms relationships, drinking harming performance at work of school, or inability to quit,” with problem severity being “classified by the number of symptoms a person has.”

Newsweek (6/4, Main) reports that “researchers surveyed more than 36,000 Americans and asked them about their drinking habits,” also finding that “binge drinking is becoming more common and intense.” Koob said, “There has been this cultural shift – people are drinking more when they drink.”

Yahoo! News (6/4, Chan) quotes Koob, who said, “These findings underscore that alcohol problems are deeply entrenched and significantly under-treated in our society.”

The NPR (6/4, Hurt, Shute) “Shots” blog points out that “Native Americans face the greatest risk overall” for problem drinking, “and men are still drinking more than women, with 36 percent of men reporting alcohol use disorder at some point in their lives, compared to 22.7 percent of women.” Among young people, “drinking problems were worst…with 26.7 percent of young adults under 30 saying they’d had trouble in the past year, compared to 16 percent of 30- to 44-year-olds.”

Blogfinger Medical C0mmentary:    Paul Goldfinger MD, FACC, Editor @ Blogfinger.net

The 5th edition of the DSM of the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders) was released in 2013.  This is the “bible” for mental health workers to use for diagnostic nomenclature.  The alcohol data was gathered in 2012 and 2013 by the National Institutes of Health, looking at adults 18 and older.   The 18-29 year old group is particularly affected, and not only do many have drinking problems, but the amount of drinking has been going  up.    DSM-5_Cover

The section on “alcohol use disorders:” —AUD is very important because it recognizes that 14% of adults in the US currently have a drinking problem  (33 million) and that 30% of the population has had an AUD at some time in their lives. They now recognize that most people with AUD have not sought treatment and that AA is not the only treatment option.   There are medications and there are behavioral therapy methods.

The devastation caused by AUD is huge:  It is disabling to individuals, and its effects harm families, work places, and, overall, the national interest.  And don’t forget the physical issues:   acute alcohol intoxication during binge drinking can cause death; even mild impairment (with alcohol level below illegal) can  cause auto accidents; and long term use can cause cancer, heart disease, brain damage, and liver disease.

A big concern is that many won’t admit that they have a problem, and those around them may not recognize a problem either.  The new criteria help define the diagnosis and the degrees of involvement—spelled out in the handbook.

You can buy a copy of the DSM-5 Handbook on line  (eg Amazon.com)

DANISH NATIONAL CHAMBER ORCHESTRA.   Drinking songs often glamorize alcohol intake—-eg all those Irish drinking songs. Here is  Verdi’s “Drinking Song—Libiamo” from the film The Quartet   (and here is ourBF  2013 movie review:  Quartet movie  )

 

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Advisory panel considers changing recommendations on cholesterol

Posted in Blogfinger Medical Reports, Blogfinger Presents, Medical opinions by a physician, Medical topics, Medical topics by Paul Goldfinger, tagged on February 16, 2015|

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The Blond Pharmacist

The Blond Pharmacist

Scott Pelley reported in the CBS Evening News (2/10) that according to the Dietary Guidelines Advisory Committee, a government advisory panel, “we don’t have to worry so much after all about cholesterol in our diets.”

 

Dr. Jon Lapook noted that while “the amount of cholesterol in your blood is still important,” the panel found that “the amount of cholesterol in your food doesn’t necessarily translate to a higher level of cholesterol in your blood.”

 

While the current recommendations “say people should have less than 300 milligrams of cholesterol in their diet a day,” that number is “likely to change when the recommendations come out later this year.” Linsey Davis noted on ABC World News (2/10, ) that while the panel said that “eating some foods that are high in cholesterol like eggs and seafood may not be so bad after all,” foods like “meats and cheeses, because they contain saturated fats, are still on the list.”

 

The Washington Post (2/11)  reported in its “Wonkblog” blog that this “does not reverse warnings about high levels of ‘bad’ cholesterol in the blood, which have been linked to heart disease,” adding that “some experts warned that people with particular health problems, such as diabetes, should continue to avoid cholesterol-rich diets.”

 

The blog stated that “a group from the American Heart Association and the American College of Cardiology who looked at the issue in 2013 said there is simply not enough evidence of danger to call for limiting cholesterol in diets.”
USA Today (2/11, ) reports that “the committee will send its final recommendations to the Department of Health and Human Services and the U.S. Department of Agriculture, which issue the dietary advice.” HHS and the USDA “are expected to issue Dietary Guidelines for Americans, 2015 later this year.”

 

The AP (2/11, Jalonick) reports, however, that “it’s unclear if the recommendation will make it into the final guidelines.”

 

Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC

The cholesterol story began in the 1960’s when it was found that high blood cholesterol levels were associated with heart disease. But we also found out that dietary cholesterol does not increase blood levels of “bad” cholesterol, unlike lab models where heavy intake of cholesterol leads to plaque formation.

When it came to dietary advice, early on in the cholesterol era, most experts favored diets low in saturated fats without stressing cholesterol so much.  In our book, in the chapter called “Concepts: Cholesterol Risks and Treatment,” we did not even mention dietary cholesterol. As it turns out, many foods that are high in fats, such as red meats, are also high in cholesterol. But eggs, rich in yolk cholesterol, contain no fats and do not raise blood cholesterol.

What hasn’t changed is the fact that lowering bad blood cholesterol levels does save lives, but restricting dietary cholesterol is not the way to do it.

As time went by, we learned that even severe dietary fat restriction often doesn’t lower bad cholesterol levels enough to produce a clinical benefit, and that has led the prevention community to stress Mediterranean style diets which we discuss in depth in Prevention Does Work: A Guide to a Healthy Heart by Eileen and myself.

If the guidelines change, as described above, I don’t think it will make much of a difference in what people do or doctors advise. Maybe there will be a loosening of restrictions on eggs, lobsters or shrimp, but otherwise, not much change.

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CDC: Flu sending US seniors to the hospital in highest rate in a decade.

Posted in American Medical Association reports, Blogfinger Medical Reports, Paul Goldfinger MD FACC medical reports, tagged , on February 2, 2015|

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The CBS Evening News (1/30, lead story) reported on Friday that “the CDC said that the flu season in much of the country appears to have peaked.” However, “the flu is now widespread in all but six states and it’s sending Americans 65 and older to the hospital at the highest rate in at least a decade.”

NBC Nightly News (1/31, story 3, 0:25, Williams) reported that the high number of hospitalizations is “being blamed on this particularly nasty strain of flu this year and a vaccine that, sadly, has proven only about 23 percent effective.”

Bloomberg News (1/31, Cortez) reported, “The annual outbreak, already in its 10th week, has extended beyond the lower bound of a normal flu season and isn’t showing signs of easing, said Lyn Finelli, chief of surveillance and outbreak response at the” CDC. In a telephone interview, she explained, “‘While the flu may have peaked in many areas of the country, there is a surge in other areas,’ including New England, the Northeast and the West Coast.”

 

Blogfinger Medical Commentary:  Paul Goldfinger, MD, FACC

The influenza pandemic 1918-1919 killed 20-40 million people worldwide.  This gives you an idea of the potential virulence of this viral illness.  During the last ten years, the CDC has been recording hospitalization rates for citizens over age 65 in the US.  The elderly are the most vulnerable group to having serious consequences after catching the “flu.”  This season, which began in the fall, is the worst in ten years.  The A(H3N2) strain is dangerous, and “genetic drift” has made it resistant to the current vaccine.   There is no cure for this illness.

The epidemic has peaked now, and although hospitalizations are still very high, outpatient visits are falling off.   Hopefully we will see a marked drop in a few weeks.  Meanwhile, if you have early symptoms  (cough, fever and sore throat,) call your doctor to see if you are eligible for an anti-viral drug such as Tamiflu  (oseltamivir). This drug should shorten the length of the illness by a day or two and may reduce serious complications. There is some controversy about the use of Tamiflu  (or the two others on the market), but the CDC has advised doctors to use the drug as needed.  I remember one recent flu season where the drug was sold out because individuals were stocking up on it, and even this season there have been spotty shortages.

 

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Survey: Only 54 percent of women get mammograms.

Posted in Blogfinger Medical Reports, tagged on October 31, 2014|

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Fox News (10/30, Cappon) reports that “a survey conducted by the Society for Women’s Health Research…revealed that although four out of five women  agree mammograms are important, only 54 percent actually get them.”

“Of the barriers to scheduling a mammogram, the majority of women cited high cost and lack of insurance as the most significant.”

“Additionally, women reported that they must consider non‐medical costs, including travel, time off work, and childcare.”

 

Blogfinger Medical Commentary:  By Paul Goldfinger, MD, FACC

October was National Breast Cancer Awareness Month.  The organizer’s web site explains their aims:   official link

The survey described above is very interesting because it provides specific guidance as to how to help improve the fight against breast cancer.  The study suggests that we need to take these steps to help reduce breast cancer mortality rates:

1. Try to identify those 20% of women who don’t know about mammograms and then educate them.

2. For women who don’t have health insurance that covers the test, they need to be informed about the special provisions of the ACA regarding mammograms and how to find insurance policies that will cover them.  Also those women can be educated about programs that offer free tests for those who can’t afford them.

3.  In areas where women don’t go for mammograms because of child care, time off from work and travel issues, breast cancer awareness groups can strive to help them with those concerns.

4.  If the oncology community decides that 3-D mammograms are superior in diagnostic accuracy, then the availability and cost of those imaging tests can be be targeted by interested cancer and public health organizations.

5. Since African-American women have substantially higher breast cancer death rates than whites,  groups such as the pink campaigns need to go into black communities to educate and  help that population.

These ideas are substantial and worthy of support.  Just hanging pink ribbons and banners in our more affluent towns is not nearly enough.

Click on “Fox News”above to read their complete article on this subject.

 

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Aging population raises issues for outpatient procedures.

Posted in Blogfinger Medical Reports, Medical topics by Paul Goldfinger, tagged , on September 12, 2014| 1 Comment »

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Bloomberg News (9/12, Langreth, Gilblom) reports that the death of Joan Rivers during an undisclosed procedure has centered attention on aging population seeking care at ambulatory care facilities. Anesthesiology experts say such “centers generally need to go out of their way to identify pre-existing conditions in patients because some facilities may not have all of the emergency equipment a hospital would.” Beverly Philip, professor at Harvard Medical School said that since older people are generally more frail and there is a need to re-evaluate “the suitability” of these individuals “for minor outpatient procedures at centers” that lack full array of equipment for responding to medical emergencies

BLOGFINGER MEDICAL COMMENTARY:  Paul Goldfinger, MD, FACC

There is not enough information out there about the Joan Rivers case to draw any specific conclusions now, but a death during an outpatient”minor” procedure is very rare.  The Rivers case is being investigated—not because it is she, but because any such incident would be investigated.

We don’t know if there were any unusual  specific problems in this one case.  We do know that this particular outpatient center had anesthesiologists present. The Bloomberg News article  (link above)  is quite good, but it emphasizes the importance of having certain “equipment” on hand for emergencies. Surely any facility that would give anesthesia to a person over 80, especially with a history of medical issues, must have had appropriate emergency equipment.

So the investigation would have to look at the check list results for this patient during the pre-op assessment. Were there any warning signs in her history or physical exam and/or were any corners cut or mistakes made during  her assessment and during the procedure?

If she had laryngospasm, (larynx spasm)  then an anesthesiologist should be able to solve that problem.

I think that anyone with a cardiac history should be carefully considered for having their procedure done at the hospital, even if it is a more annoying preop. assessment.  To say that the equipment is the same at both kinds of facilities  does not mean that the safety is the same.  If someone has a cardiac arrest in the hospital, the cavalry  arrives in less than one minute including cardiologists.  That won’t happen at an outpatient center where only the EMT unit arrives.

Also, the article says that there is a 4 minute window without oxygen before brain damage occurs, but that window is actually much smaller in an elderly person.

 

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FDA says there is little evidence testosterone treatment works.

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged on September 4, 2014|

Paul after eating raw fish, head and all.

Paul after eating raw fish, head and all. If you knew sushi like I knew sushi,  oh, oh, oh  what a girl.

 

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The NBC Nightly News (9/3, Williams) reported in its broadcast that the FDA “says there’s little evidence that testosterone boosting drugs taken by millions of American men are actually effective.” NBC notes that the agency also pointed out that it’s not convinced they carry serious risk either. “The condition has been marketed as low ‘T’ and the medications are offered to help with low sex drive and fatigue among some men,” notes NBC.

The FDA’s comments come ahead of a public meeting “to discuss the benefits and risks of treatments that raise levels of the male hormone” on Sept. 17, according to the AP (9/4, Perrone). The meeting comes after two federally funded studies “found links between testosterone therapy and heart problems in men.” The AP also testosterone boosting treatments have come under the spotlight “amid an industry marketing blitz for new pills, patches and formulations that has transformed testosterone a multibillion-dollar market.”

 

BLOGFINGER MEDICAL COMMENTARY by Paul Goldfinger, MD, FACC:

It’s not clear  how testosterone therapy leads to increased stroke or heart attacks, but, regardless, there is some evidence that it is true, so I don’t think doctors ought to be encouraging this treatment when the benefits of therapy are not clear.  Surprisingly, about 20% of men who take testosterone never had a blood level measured before starting the hormone.  The forthcoming public meeting sponsored by the Food and Drug Administration should  result in a drop in prescribing this unproven drug.

Don’t forget possible side effects of testosterone.  Just because it is a naturally occurring substance doesn’t mean that its use as a supplement will be safe.  This drug can cause the prostate gland to enlarge and it can cause harmful blood clotting.

Be aware that your insurance company may not be willing to pay for testosterone blood testing in otherwise healthy older men.

If you are going to research medical issues on line, try to use sources that you can trust, such as this one from Mayo:      Mayo Clinic staff discusses testosterone

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Osteopathic schools turning out 28% of US medical school graduates.

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged on August 9, 2014| 3 Comments »

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Rod-of-Asclepius

In a 2,100-word story, the New York Times (7/30, Berger) focuses on osteopathic medical schools, noting that “today, osteopathic schools turn out 28 percent of the nation’s medical school graduates.” Osteopathic medicine offers a “more personal, hands-on approach and its emphasis on community medicine and preventive care.” But, “whatever the reasons for choosing a DO over an MD, osteopathic medicine has, for decades now and increasingly so, been accepted as authoritative training by the medical establishment, including the residency programs that lead to licensure.” The article also notes that about 60% of graduates from osteopathic medical schools choose primary care, compared to about 30% of graduates from traditional medical schools.

Blogfinger Medical Commentary.  By Paul Goldfinger, MD, FACC

When I was in my residency at a large NYC teaching hospital, none of the residents were DO’s.  There was a stigma attached to that degree, and just about everyone who attended osteopathy schools were those who could not get into MD degree conferring medical schools, although there were exceptions.     I met osteopaths when I entered practice, and most of them did not relish publicizing their DO degrees.  Their “shingles” usually said Dr. Bob Smith, not Bob Smith, DO.  They always referred to their DO school as “medical school,”  which is sort of accurate, but they almost never would mention that they were osteopaths.

But as time went by, more and more DO’s were being accepted into conventional MD residency programs.   There were some DO postgraduate programs, but not among the best..  Perhaps that has changed now—I don’t know.   After training, often DO’s would join together to start group practices or would join other DO practices.  I suspected that their DO degrees would be a handicap in their job search.

When my group was looking for new docs, we always looked for MD’s because we wanted the best people from the most prestigious programs.    However, now there are DO’s scattered among the doctors in the most desired group practices. The stigma appears to have evaporated.  If we were looking now, I don’t think the DO degree would be a game changer for a good doctor with fine training.

My personal observation was that once a DO finished a quality MD residency, he usually could not be distinguished from others with the same MD residency training in terms of quality.  There are certain parts of the country where DO’s are more common than MD’s such as parts of the mid-West. At this time, the DO degree is widely accepted by patients and professionals alike.  It is true that many DO’s wind up practicing general medicine, and that is, of course a good thing for our healthcare system.

There is a good chance now that patients will be treated by DO’s because of the major increase in their numbers.  If you are doctor shopping, look up the doctor’s credentials—-especially where he went to medical school and where he did his postgraduate training.  He must be board certified.  My own personal pulmonologist is a superb doctor with excellent training and  DO after his name.  I would not trade him for anybody.

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