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Monday, March 29, 2010

More Hospitals Offering Therapeutic Hypothermia For Comatose Survivors Of Cardiac Arrest

We've been doing this at Stamford Hospital for at least two years now with truly amazing results.

USA Today (3/29, Marcus) reports that since the "American Heart Association issued recommendations and guidelines for inducing mild hypothermia in comatose survivors of cardiac arrest" in 2005, the "number of hospitals offering the treatment has climbed." Nearly "500 of about 5,000 hospitals across the country are doing it," and one expert calls therapeutic hypothermia "one of the most exciting and promising interventions for the treatment of cardiac arrest over the past 50 years." Still, "most proponents of cooling say they're surprised that the therapy hasn't caught on faster."
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Friday, March 26, 2010

NPR: Warding Off Muscle Cramps As We Age

I found the following story on NPR

Many patients complain about nighttime leg cramps. It is a very painful and disrupts sleep. It is very difficult to treat. Here's a great article discussing this condition:

http://www.npr.org/templates/story/story.php?storyId=124888051&amp;sc=17&amp;f=1128 <http://www.npr.org/templates/story/story.php?storyId=124888051&amp;sc=17&amp;f=1128>

Warding Off Muscle Cramps As We Age

by Patti Neighmond

NPR - March 22, 2010

If you're over 65, you probably know what a "charley horse" is. You may have gotten them during strenuous exercise as a younger person. But in older age, muscle cramps can be unlike any you've ever had before. That's because like so many other things in our bodies, our muscles and nerves wear out and function less effectively as we age.
"A cramp is a sudden painful contraction of a muscle that becomes rock hard," says Dr. Robert Miller, a neurologist who specializes in muscle cramps at the California Pacific Medical Center and teaches at University of California, San Francisco. "The muscle goes into a spasm and squeezes all the little nerve endings inside the muscle, and creates pain, and definitely ... gets your attention until you do something about it."
Uncontrollable Muscle Spasms
For Ken Holladay, 71, his muscle cramps started off mild and irregular. At first, he got them once every few weeks, but then they started to get more frequent. Eventually, they occurred every single night — often twice, between 2 a.m. and 6 a.m. It was a painful version of a charley horse, only it was in his feet and toes: "The big toe was at 90 degrees to the bottom of the foot; put your foot on the floor, and this big toe would be pointing straight up toward the ceiling; and I don't believe you can voluntarily pull a big toe that high."
But as it turns out, your muscles can, all on their own. Holladay says that one time his toe actually curled down, "and I leapt out of bed to try and get rid of the pain and landed on that toe and broke the toe, broke the bone underneath that big toe, broke the toenail off." It was terrible, he says.
And since the cramps typically occurred twice every night, it was impossible to get a good night's sleep or feel well-rested during the day. But that's not what drove Holladay to seek treatment. What really scared him, he says, was the possibility that, as he got older, he might become bedridden due to disease or injury. If that happened, Holladay says, he wouldn't be able to get out of bed and walk, stretch and flex his muscles. He would just have to lie there, in terrible pain.
It was too scary a thought.
Searching For Treatment
So, Holladay went searching for help and treatment. First his doctor had to determine whether the spasms were an indicator of any other muscle or nerve degenerative disease, like ALS. With that established, Holladay tried a number of potential treatments: acupuncture, and then prescription quinine, which has since been taken off the market as a treatment for muscle cramps due to concerns about side effects. Neither one worked.
Finally he drove over an hour to see Dr. Yuen So, director of the neurology clinic at Stanford University. As it turned out, So and colleagues had just finished an evidence-based review of treatments for muscle cramps. Unfortunately, they turned up little. There were hundreds of studies but no conclusive or compelling evidence that any particular treatment would work for all or even most patients.
Dr. Hans Katzberg headed the review. Katzberg says some treatments held promise, including a certain type of calcium channel blocker used to treat blood pressure, as well as Vitamin B complex. Even with them, however, results were not convincing. "We were surprised to find out how little is documented in the treatment of cramps," says So. "A lot we do in medicine is based on anecdotal experience, and in this case, a lot of the treatments we use fall into the unproven category."
For Holladay, So ended up prescribing an anti-seizure medication. The meds worked.
"After a week or two, no cramps. After a month or two, no cramps," Holladay says. It was miraculous, he says, and he can't speak highly enough of the neurology department at Stanford or of Dr. So.
Keeping Spasms At Bay
Even though things eventually worked out for Holladay, that's not the case for many patients who suffer severe nighttime muscle cramps. According to UCSF neurologist Miller, older people are at greater risk for cramps simply because of their age. Nerves control muscles, and nerves just wear out.
"As we age, there are changes in both nerves and muscles. Muscles get more weak and small. And nerves undergo some decay, with the tissue becoming thin. And when that happens, the connections that the nerves make to the muscle become less secure."
And cramps occur at the place where nerves meet muscle, says Miller. When the brain sends the signal for the muscle to move, "the signal does have to cross through tiny nerve twigs, or nerve terminals." Excessive signaling, excessive irritability — which may result from thinning and weakened nerves — seems to be the generator for cramping.
At 68, Miller is a candidate for cramps himself. But he keeps them at bay, he says, by eating a banana a day and drinking lots of water. The banana provides electrolytes with its magnesium, potassium and calcium. The water provides fluid. Fluid and electrolytes, says Miller, while not proved to decrease muscle cramps, do seem to help by keeping nerve pathways healthy.
And Miller also benefits from stretching, doing weekly yoga and daily bike riding. Every day, he traverses San Francisco's hills for a total of two hours back and forth to work, "stretching my calf muscles and hamstring muscles by standing up on the pedals and stretching first one and then the other." Stretching is a tried-and-true cure for muscle cramps by pretty much any sufferer's description, says Miller, despite the lack of scientific evidence. Copyright 2010 National Public Radio
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Wednesday, March 10, 2010

Sleep Habits Vary by Ethnicity

From WebMD:

Sleep problems and sleep habits vary among different ethnic groups, according to a new national survey. But among all ethnicities, there remains a common denominator: Many of us simply don't get enough sleep.


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A Conversation With Dr. Peter J. Pronovost: Doctor Leads Quest for Safer Ways to Care for Patients

Dr Pronovost is brilliant in his ability to find ways to simply yet innovatively improve safety in our hospitals. I was fascinated to read about his projects in Atul Gawande's "A Checklist Manifesto".

I'm currently working with my local hospital on many safety measures. My focus is to examine the processes in place and work to simplify and standardize to improve safety.

Here's an article from the New York Times I hope you find interesting.

"Dr. Peter J. Pronovost, medical director of the Quality and Safety Research Group at Johns Hopkins Hospital in Baltimore, travels the country advising hospitals on innovative safety measures."


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Sunday, March 7, 2010

Controlling salt intake would saves lives and cut costs

A regulatory intervention that reduced the salt intake of US adults by 3 g a day would save between $10 billion and $24billionn a year in healthcare costs, through reductions in blood pressure and knock-on reductions in rates of coronary heart disease (including heart attacks) and strokes, according to recent projections. It would also save between 44,000 and 92,000 lives a year, with benefits across all age groups and in both sexes.

These estimates come from a computer simulation that made key assumptions about the link between salt intake and blood pressure, and about the cardiovascular benefits of lower blood pressure, informed by randomized trials and other published data. The assumptions were tested in a series of sensitivity analyses that confirmed the main findings: even modest reductions in salt intake achieved over the next decade or so would prevent morbidity from cardiovascular disease, prolong lives, and save money.

The simulations suggest that controlling dietary salt would be as good for public health as controlling obesity, reducing smoking, and giving antihypertensive drugs to everyone with hypertension.

Adults in the US eat a lot of processed foods packed with salt. The average daily intake for men was 10.4 g in 2006—almost twice the recommended allowance (maximum of 5.8 g), and well over twice the intake recommended for adults over 40, black people, and anyone with hypertension (3.7 g).

N Engl J Med 2010 [PubMed Abstract] <http://imageb.epocrates.com/mailbot/links?EdID=43240751&LinkID=57439>
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Friday, March 5, 2010

Message from Polar Electro service center regarding your case

We have some good news and some bad news! Good news is your monitor has
been serviced and has been shipped back to you today. Bad news is that you
no longer have an excuse for not exercising! =)

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Wednesday, March 3, 2010

Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults

From New England Journal of Medicine

This community-based study of nondiabetic adults compared the prognostic value of glycated hemoglobin and fasting glucose for identifying persons at risk for clinical outcomes such as diabetes. As compared with fasting glucose, glycated hemoglobin was similarly associated with the risk of diabetes and more strongly associated with the risks of cardiovascular disease and death from any cause, adding to data about the use of glycated hemoglobin as a diagnostic measure.


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Tuesday, March 2, 2010

In Obesity Epidemic, What's One Cookie?

From The New York Times:

In Obesity Epidemic, What's One Cookie?

Small caloric changes have almost no long-term effect on weight,
studies show.


NYTimes: Awareness: Report Calls for Spotlight on Hypertension

From The New York Times:

VITAL SIGNS: Awareness: Report Calls for Spotlight on Hypertension

Though high blood pressure is prevalent in the United States, many
Americans don't know they have it and doctors are lax about treating
it, a new report found.


Screening May Save Athletes

From The New York Times:

Screening May Save Athletes

Preventive EKGs for athletes are cost-effective, a study has
suggested, but a screening program in the United States would be


Monday, March 1, 2010

Low-Fat Diet Tops Low-Carb in Long Run

A low-carb diet may offer quick results, but a new study suggests that a low-fat diet may be best for long-term weight loss and maintaining a healthy weight.

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