20 Medical Advances to Be Thankful For

From the Wall Street Journal,

Life expectancy in the U.S. reached an all-time high of 77.9 years in 2007

Death rates dropped significantly for eight of the 15 leading causes of death in the U.S.,

The death rate from coronary heart disease dropped 34% from 1995 to 2005

The death rate from cancer, the second-biggest killer, dropped 16% from 1990 to 2006

Nearly 40% of U.S. adults have never had a permanent tooth extracted

Continue reading here for the full 20 medical advances and the details behind the advances here
http://online.wsj.com/article/SB10001424052748703819904574553930012357104.html

Don't give your kidneys to heaven, we need them here

From the Philippine Star It might seem to border on the macabre — this subject of harvesting the organs of the dead so that these may be transplanted and prolong the lives of needy patients. But with a growing population requiring transplants, deceased organ donation is the most feasible alternative to address the problem of lack of organs for transplantation.

Consider these figures: The Philippine Renal Disease Registry said that in 2007, 10,000 to 12,000 individuals developed end-stage renal disease. Of these, half or 5,000 required kidney transplants. However, less than 10 percent (or less than 500) were able to undergo transplant surgery because of insufficient organ supply. With 95.5 percent of the kidneys transplanted coming from living donors in the Philippines, only 15 deceased donor organs are transplanted each year. This means that otherwise usable kidneys are buried and in effect, wasted. Continue reading by clicking the title below

Don't give your kidneys to heaven, we need them here

10 surprising facts about cholesterol

When examining labels, look at fat content as well as cholesterol numbers.

STORY HIGHLIGHTS

• Signs of high cholesterol can show up on your skin as reddish-yellowish bumps
  
• Low cholesterol can be bad too
  
• A food low is cholesterol can still raise your cholesterol level depending on the fat content
  
• Cholesterol numbers are improving, in part thanks to better diets, drugs

(from Health.com) -- Like most people, you probably think of cholesterol -- if you think of it at all -- and picture fatty foods and heart trouble.

Yes, elevated blood cholesterol is bad news, and 34 million Americans have levels that can increase their risk of all sorts of health problems, including a heart attack.

But if you think you've heard everything you need to know about this waxy fat, there may be a few surprises in store.

For one, cholesterol can be so high that it shows up in fatty deposits in the skin. On the other end of the spectrum, cholesterol can even be too low.

High cholesterol inevitable for some

If you have sky-high cholesterol, it may be partly genetic. But for some families, it's inevitable that LDL, or bad cholesterol, will be in the unhealthy zone. The disease, known as familial hypercholesterolemia, affects about 1 in 500 people and can cause total cholesterol levels from 300 mg/dL to 600 mg/dL, as well as heart attacks early in life.

Some people with familial hypercholesterolemia inherit two defective genes (one from each parent)­, a much rarer condition that affects 1 in 1 million people; they can have total cholesterol over 1000 mg/dL. Such high cholesterol can cause early death, often before age 20.

Health.com: 7 causes of high cholesterol

Clogged arteries look like butter

Even if you can't see xanthomas on the skin, high cholesterol can still build up in the body.

LDL slowly builds up in artery walls, causing a thick plaque that can narrow arteries, restrict blood flow, and lead to blood clots.

Arteries thicken, become more rigid, and start to take on the yellow color of cholesterol. If you were able to take a look at the inside of cholesterol-clogged arteries, they would look as if they were lined with a thick layer of frozen butter!

You can see high cholesterol

Normally, you only know you have high cholesterol levels if a doctor tells you so. But it is possible for high cholesterol to be as plain as the nose on your face, showing up on the skin as reddish-yellowish bumps known as xanthomas.

The patches vary in size and can be found all over the body, including on the joints, hands, and eyelids (though not all eyelid xanthomas are caused by high cholesterol). They tend to occur in older people and in those with diabetes or other health problems.

Xanthomas are also more likely to be seen in people with familial hypercholesterolemia, who can even have them in infancy.

Health.com: Myths about your cholesterol number

Cholesterol can be too low

Everyone knows that high cholesterol is bad, but very low cholesterol can be unhealthy too.

Experts recommend that you keep your total cholesterol under 200 mg/dL, which is about the average for adults. However, below a certain level -- generally 160 mg/dL -- low cholesterol is associated with health risks, including cancer. Do the health problems cause low cholesterol, or vice versa? Are they even unrelated? It's not clear.

Research shows that some pregnant women with low total cholesterol are more likely to give birth prematurely. Low total cholesterol and LDL levels have even been linked to anxiety and depression.

Our cholesterol is dropping

Finally some good news! While you may assume that cholesterol levels have blossomed along with the obesity epidemic, cholesterol has in fact dropped.

For example, 33 percent of people ages 20 to 74 had high cholesterol (defined as above 240 mg/dL) in the early 1960s, and the average was 222 mg/dL; in 2003 to 2006, about 16 percent of people in that age group had high cholesterol and the average was 200 mg/dL.

Elevated cholesterol, which was unrecognized as a serious health problem 50 years ago, is dropping mainly because of more awareness of its dangers, which has resulted in healthier diets, more cholesterol screening, and the widespread use of statin medications.

Health.com: Are you cholesterol smart? Take our quiz

Exercise boosts good cholesterol

Doctors generally recommend exercise as a lifestyle change that can help lower cholesterol naturally.

But a recent study in the Journal of Lipid Research suggests that exercise may affect cholesterol differently, depending on the patient's race and gender.

Among the study participants, who were followed over nine years, physical activity equivalent to an extra hour of mild exercise or half hour of moderate exercise per week was associated with an increase in high-density lipoprotein (HDL), or good cholesterol, in each of the groups the researchers studied.

But LDL, the bad cholesterol, dropped only in women, and total cholesterol dropped only in African-American women.

Cholesterol-free food can still raise cholesterol

Watch out for cholesterol-free food. Cholesterol is made by the liver of animals, and it will only be found in animal-based foods, such as meat, milk, and eggs. Certain products can honestly state that they have little or no cholesterol -- however, that doesn't mean they are good for your cholesterol levels.

Many fried foods and commercial baked goods contain cholesterol-raising trans fats, most commonly in the form of partially hydrogenated vegetable oils. Trans fats, along with saturated fats, are the main culprits of high cholesterol from food, but they won't be listed as cholesterol on packaging.

Read ingredient lists and nutrition labels carefully, looking at fat content as well as the cholesterol content, before deeming a purchase a healthy choice.

Health.com: 5 heart-healthy recipes

High cholesterol may cause erectile dysfunction

Sure, it's bad for your heart. But high cholesterol can cause a host of other health problems.

A 2005 Swedish study found that men with total cholesterol of about 270 mg/dL and above were 4.5 times more likely to develop testicular cancer than men with cholesterol levels of 220 or below (though the authors cautioned that the link between the two conditions was probably complicated by other factors).

What's more, high cholesterol has been linked to a greater risk of erectile dysfunction, kidney failure, and even Alzheimer's disease.

And a 2009 study found that diets high in dietary cholesterol are associated with an increased risk of developing liver cirrhosis or liver cancer. Continue reading here http://www.cnn.com/2009/HEALTH/11/24/moh.healthmag.cholesterol.surprises/index.html

Read more about cholesterol at these links

http://en.wikipedia.org/wiki/Cholesterol

http://www.pdnhf.org/detail.asp?dt=topics&arch=yes&fr=s&id=181

20 Health Advances to Be Thankful For

Life Is Getting Measurably Better for Many People Here and Abroad
News about health often focuses on the negative: scary new flu viruses,
incurable diseases, dashed hopes for miracle drugs. Maybe that's because we
have such high expectations that doctors and scientists can fix anything.

But amid all that bad news-not to mention the acrimony over health-care
reform-it's easy to overlook how much progress has been made in recent
years. Here are 20 health-care advances to give thanks for:

Nearly 62% of U.S. adults said they were in excellent or very good health,
along with 82% of their children, according to families sampled by the
federal government for the National Health Interview Survey, which was
conducted in 2007 and released this year. Continue reading here
http://online.wsj.com/article/SB10001424052748703819904574553930012357104.html

Panel says mammogram should start at age 50

Panel says mammogram should start at age 50

NEW YORK — In a recommendation sure to generate confusion, most women don't need a mammogram in their 40s and should get one every two years starting at 50, a government task force said Monday. It marked a major reversal from the American Cancer Society's position Read the complete article here http://www.buffalonews.com/180/story/864209.html

A mammogram is a special type of X-ray of the breasts. Mammograms can show tumors long before they are big enough for you or your health care provider to feel. Mammograms are recommended every year or two for women older than 40. They are also recommended for younger women who have symptoms of breast cancer or who have a high risk of the disease.

Mammograms are quick and easy. You stand in front of an X-ray machine. The person who takes the X-rays places your breast between two plastic plates. The plates press your breast and make it flat. This may be uncomfortable, but it helps get a clear picture. You will have an X-ray of each breast. A mammogram takes only a few seconds and it can help save your life.

Read more

Mammography

What is Mammography? What are some common uses of the procedure? How should I prepare? What does the equipment look like? How does the procedure work? How is the procedure performed? What will I experience during and after the procedure? Who interprets the results and how do I get them? What are the benefits vs. risks? What are the limitations of Mammography?

http://en.wikipedia.org/wiki/Mammography

http://www.radiologyinfo.org/en/info.cfm?pg=mammo

http://www.medicinenet.com/mammogram/article.htm

http://www.nlm.nih.gov/medlineplus/mammography.html

A Breathing Technique Offers Help for People With Asthma

I don’t often write about alternative remedies for serious medical conditions. Most have little more than anecdotal support, and few have been found effective in well-designed clinical trials. Such trials randomly assign patients to one of two or more treatments and, wherever possible, assess the results without telling either the patients or evaluators who received which treatment.

Now, however, in describing an alternative treatment for asthma that does not yet have top clinical ratings in this country (although it is taught in Russian medical schools and covered by insurance in Australia), I am going beyond my usually stringent research criteria for three reasons:

¶The treatment, a breathing technique discovered half a century ago, is harmless if practiced as directed with a well-trained therapist.
¶It has the potential to improve the health and quality of life of many people with asthma, while saving health care dollars.
¶I’ve seen it work miraculously well for a friend who had little choice but to stop using the steroid medications that were keeping him alive.

My friend, David Wiebe, 58, of Woodstock, N.Y., is a well-known maker of violins and cellos, with a 48-year history of severe asthma that was treated with bronchodilators and steroids for two decades. Ten years ago, Mr. Wiebe noticed gradually worsening vision problems, eventually diagnosed as a form of macular degeneration caused by the steroids. Two leading retina specialists told him to stop using the drugs if he wanted to preserve his sight.

He did, and endured several terrifying trips to the emergency room when asthma attacks raged out of control and forced him to resume steroids temporarily to stay alive.
Nothing else he tried seemed to work. “After having a really poor couple of years with significantly reduced quality of life and performance at work,” he told me, “I was ready to give up my eyesight and go back on steroids just so I could breathe better.”

Treatment From the ’50s
Then, last spring, someone told him about the Buteyko method, a shallow-breathing technique developed in 1952 by a Russian doctor, Konstantin Buteyko. Mr. Wiebe watched a video demonstration on YouTube and mimicked the instructions shown.

“I could actually feel my airways relax and open,” he recalled. “This was impressive. Two of the participants on the video were basically incapacitated by their asthma and on disability leave from their jobs. They each admitted that keeping up with the exercises was difficult but said they had been able to cut back on their medications by about 75 percent and their quality of life was gradually returning.”

A further search uncovered the Buteyko Center USA in his hometown, newly established as the official North American representative of the Buteyko Clinic in Moscow.

“When I came to the center, I was without hope,” Mr. Wiebe said. “I was using my rescue inhaler 20 or more times in a 24-hour period. If I was exposed to any kind of irritant or allergen, I could easily get a reaction that jeopardized my existence and forced me to go back on steroids to save my life. I was a mess.”
But three months later, after a series of lessons and refresher sessions in shallow breathing, he said, “I am using less than one puff of the inhaler each day — no drugs, just breathing exercises.”

Mr. Wiebe doesn’t claim to be cured, though he believes this could eventually happen if he remains diligent about the exercises. But he said: “My quality of life has improved beyond my expectations. It’s very exciting and amazing. More people should know about this.”

Ordinarily, during an asthma attack, people panic and breathe quickly and as deeply as they can, blowing off more and more carbon dioxide. Breathing rate is controlled not by the amount of oxygen in the blood but by the amount of carbon dioxide, the gas that regulates the acid-base level of the blood.
Dr. Buteyko concluded that hyperventilation — breathing too fast and too deeply — could be the underlying cause of asthma, making it worse by lowering the level of carbon dioxide in the blood so much that the airways constrict to conserve it.

This technique may seem counterintuitive: when short of breath or overly stressed, instead of taking a deep breath, the Buteyko method instructs people to breathe shallowly and slowly through the nose, breaking the vicious cycle of rapid, gasping breaths, airway constriction and increased wheezing.

The shallow breathing aspect intrigued me because I had discovered its benefits during my daily lap swims. I noticed that swimmers who had to stop to catch their breath after a few lengths of the pool were taking deep breaths every other stroke, whereas I take in small puffs of air after several strokes and can go indefinitely without becoming winded.

The Buteyko practitioners in Woodstock, Sasha and Thomas Yakovlev-Fredricksen, were trained in Moscow by Dr. Andrey Novozhilov, a Buteyko disciple. Their treatment involves two courses of five sessions each: one in breathing technique and the other in lifestyle management. The breathing exercises gradually enable clients to lengthen the time between breaths. Mr. Wiebe, for example, can now take a breath after more than 10 seconds instead of just 2 while at rest.

Responses May Vary
His board-certified pulmonologist, Dr. Marie C. Lingat, told me: “Based on objective data, his breathing has improved since April even without steroids. The goal now is to make sure he maintains the improvement. The Buteyko method works for him, but that doesn’t mean everyone who has asthma would respond in the same way.”
In an interview, Mrs. Yakovlev-Fredricksen said: “People don’t realize that too much air can be harmful to health. Almost every asthmatic breathes through his mouth and takes deep, forceful inhalations that trigger a bronchospasm,” the hallmark of asthma.

“We teach them to inhale through the nose, even when they speak and when they sleep, so they don’t lose too much carbon dioxide,” she added.

At the Woodstock center, clients are also taught how to deal with stress and how to exercise without hyperventilating and to avoid foods that in some people can provoke an asthma attack.

The practitioners emphasize that Buteyko clients are never told to stop their medications, though in controlled clinical trials in Australia and elsewhere, most have been able to reduce their dependence on drugs significantly. The various trials, including a British study of 384 patients, have found that, on average, those who are diligent about practicing Buteyko breathing can expect a 90 percent reduction in the use of rescue inhalers and a 50 percent reduction in the need for steroids within three to six months.

The British Thoracic Society has given the technique a “B” rating, meaning that positive results of the trials are likely to have come from the Buteyko method and not some other factor. Now, perhaps, it is time for the pharmaceutically supported American medical community to explore this nondrug technique as well.

Read the complete original article here http://www.nytimes.com/2009/11/03/health/03brod.html?em=&pagewanted=print

More on Asthma

http://en.wikipedia.org/wiki/Asthma

http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html

http://asthma.about.com/

http://www.doh.gov.ph/faq/show/487

http://www.nlm.nih.gov/medlineplus/asthma.html

Medical Apps for the iPhone

My assignment was to speak for 18 minutes (the standard talk length) about medical apps for the Apple iPhone. Sounds easy, right? Only one problem: there are about 7,000 medical apps.

After a lot of time reading "best medical apps" stories online, asking Twitter users for their suggestions and reading online reviews, I finally boiled the list down to about 50 promising apps. I tried them out and further winnowed the list to a bunch that I ultimately demo'ed in my talk. Eventually, the video of the talk will be posted at ted.com/talks, but in the meantime, here's what I covered.

(I haven't really given them full-blown testing, so read the online reviews before you spend good money on them. Except for the free ones—you've got nothing to lose!)

FOR PATIENTS:
* JetLag RX. You input your travel destination, your usual bedtime and so on. The app recommends a schedule for eating, sleeping and exposure to light in order to land in the new time zone with a minimum of jet lag, based on modern jet-lag research. (Not yet available in the iTunes app store; $10)
* Uhear. Clever, self-administered test for hearing loss. (Free)
* SoundAMP. Turns the iPhone into a hearing aid. Amplifies and processes voices to make them clearer. Even has a 30-second replay button that can save you from having to say "What?" so often. ($9.99)
* ProLoQuo2Go. I read about this one in The Times. It's a speech synthesizer for patients who have trouble speaking; you tap big fat icons to put sentences together. You can also save common phrases into a special Quick Set. For an app, the price is shockingly high. But its competition is an $8,000 PC-based system that's decidedly not mobile. ($190)

* Period Tracker, Period Tracker Companion. The title says it all. This little app helps women predict the onset of each month's period, and wirelessly syncs with the man's app (Companion) so that he can know exactly when "to be a little extra nice and special." (Lite version, free; Companion, $1)

* Lose It! This beautifully designed weight-loss app has an astounding number of followers, if the outpouring of enthusiasm on Twitter is any indication. You tap to record everything you eat. It's actually kind of fun, because the program contains every food item you can imagine, including brand-name packaged food and restaurant-chain menus. For each one, the app lists the complete nutritional information.

You also indicate what exercise you get each day, using a similarly complete list of activities. Finally, you tap in your weight each day. Probably because the app focuses you so well on staying true to your goals, its fans say it truly works. (Free)

* Eyeglasses. As an over-40-year-old, I've become addicted to this app. It simply turns the iPhone 3GS into a magnifying glass. Hold it in front of some tiny type—on a menu, a receipt, a ticket, a medicine bottle—and Eyeglasses, after a moment of autofocusing, shows you a magnified version of it on the screen. Keeping your hand steady is tough, and the 6X and 8X images sort of fall apart—but the 2X and 4X views have saved me more than once. ($3)

* Retina. It's for color-blind people like me. You hold it in front of something—clothes in your closet, for example—and it tells you by name what color you're seeing. I love this one more for the concept than the execution; it says black is "too dark" and white is "too bright," for example, and it really needs more differentiation between various *degrees* of red or whatever. Tinted room light (of the sort that requires white-balance adjustments on a camera) can flummox it. But as an early example of an "augmented reality" app, it's very exciting. (Free)

FOR DOCTORS:

* OsiriX. An amazing viewer of medical images (X-rays, scans of all sort). Drag with one finger to adjust brightness or contrast. Zoom in, rotate. Special modes let you measure some element (tumor, fracture, etc.) with either a circle or a line that you draw with two fingers. Syncs with a special image server at the hospital. ($20)
* Anatomy Lab. A virtual cadaver. Drag up or down with two fingers to peel away (or restore) another thin layer of the photo, down to the organs and beyond. Or choose from a list of body parts and jump directly, revealing that exposed part. Grisly and amazing. ($10)
* Epocrates. Another Twitter favorite. Like an electronic version of the huge Physicians' Desk Reference book. Tap in two or more medications, and it warns you of cross side effects. Tap in the description of a pill (hexagonal, yellow, inscription), and it tells you what the medicine is, and all about it. This much, plus a medical calculator (body mass, etc.) is free; paid versions offer even more instant information for the physician. (Free)
* AirStrip OB. Lets an obstetrician monitor a patient's status, right down to the baby's heartbeat, from elsewhere in the hospital (or the town). Requires that the AirStrip fetal software suite be installed at the hospital. A good hint at the kind of remote monitoring that may be possible. (Free)

Read the full original article here http://www.nytimes.com/2009/11/05/technology/personaltech/05pogue-email.html?_r=1&em=&pagewanted=print

Watch the Walk and Prevent a Fall

FALLS are so harmful to the elderly and so costly to society that if falling were a disease, it would be deemed an epidemic.

.Enlarge This Image

Julie Keefe for The New York Times

Philip and Dorothy Martin are participating in research intended to help prevent falls.

More than one-third of people ages 65 or older fall each year. About one fall in 10 results in a serious injury, like a hip fracture. Roughly 20 percent of older people who suffer a hip fracture die within a year.

The estimated economic cost of falls ranges widely, up to $75 billion a year in the United States, if fall-related home care and assisted-living costs are added to medical expenses.

For years, a small group of geriatric experts has studied falls and suggested preventive programs. Most of the work has relied on visits to doctors and self-reported surveys of volunteers.

But now, researchers are beginning to apply the digital tools of low-cost wireless sensors in carpets, clothing and rooms to monitor an older person’s walking and activity. The continuous measurement and greater precision afforded by simple computing devices, researchers say, promise to deliver new insights on risk factors and tailored prevention measures.

For an older person, a fall is often a byproduct of some other health problem: cardiovascular weakness, changes in medication, the beginnings of dementia, gradual muscle degeneration. Motion analysis aided by inexpensive sensors and computing, researchers say, may well become a new “vital sign,” like ablood pressure reading, that can yield all sorts of clues about health.

“For the last 100 years, clinical research and medical practice have been based on appointments, examinations and asking patients questions — tiny biopsies of time in a person’s life,” said Dr. Jeffrey Kaye, a professor of neurology and biomedical engineering at the Oregon Health and Science University. “But technology now gives us the ability to get behavioral activity data all the time for a much more fine-grained, real-world picture of what is happening with a person’s health.”
The National Institute on Aging is intrigued, and sponsoring some initial research. Richard M. Suzman, the institute’s director of behavioral and social research, said studies of older people’s activity patterns, including early detection of risks, would “increasingly use sensors to deliver this higher fidelity of data.”

“It’s extremely promising,” he added.
Fall prevention also promises to be part of an emerging — and potentially large — worldwide industry of helping older people live independently in their homes longer. The European Union, for example, has committed 1 billion euros, or nearly $1.5 billion, to study and finance technologies and services for the aged. Big corporations, including Intel and General Electric, are investing in the field.
“The independent-living industry could have a huge payoff in innovation, jobs and competitiveness,” said Eric Dishman, an Intel research fellow and director of strategy for the company’s digital health group.

In clinical settings, wearable sensors and wireless sensors embedded in carpets are used to measure precisely a person’s walking speed, stride length, step width and body sway — all variables in assessing the risk of falling.

In Ireland, a research group, Technology Research for Independent Living, recently completed a two-year study of 600 people, ages 60 to 94. The subjects came in for detailed walking assessments, using the sensor technology. The exact measurements, said Dr. Chie Wei Fan, a medical gerontologist at Trinity College Dublin, help in devising more customized exercise programs for specific muscles or changes in medication to eliminate dizziness.

The technology-aided “targeted interventions,” Dr. Fan said, reduced falls by 30 percent in the study group, compared with a similarly aged sampling of the population. But she thinks it should be possible to reach 50 or 60 percent.
“We’re still catching the fallers too late,” Dr. Fan said.
Earlier detection is the goal of an at-home sensor and data study being conducted by the Oregon Center for Aging and Technology, whose sponsors include the Oregon Health and Science University and Intel.

The initial five-year study, begun in 2006 and financed by the National Institute on Aging, involves 230 volunteers, whose mean age is 84. In each home, wireless sensors are placed in rooms and hallways linked to a personal computer connected to the Internet, allowing a person’s activity to be monitored steadily. The cost of the sensors is $200 or less.

Activity patterns from the data, said Dr. Kaye, director of the aging and technology center, can help identify ways to prevent falls. The motion sensors may show that a person with congestive heart failure, for example, is getting up from bed often at night to go to the bathroom. If the heart problem is under control, Dr. Kaye said, it may well be a good idea to reduce the dose of the person’s diuretic, trading a little bit of ankle swelling for a good night’s sleep — and far less risk of falling.

Dorothy Martin, 81, and her husband Philip, 83, joined the study two years ago. They live in a two-bedroom apartment in a retirement community in Lake Oswego, Ore., and as part of the study they fill out weekly self-assessments of their activities and health. Once a year, they undergo detailed, in-person physical and cognitive evaluations. They say the sensor monitoring is unobtrusive because the sensors track only motion, not what they are doing.

Both of the Martins are in good health. Still, they have watched friends grow increasingly frail over the years.

“We did this to participate in research that would be helpful to other people, and possibly to us,” Mr. Martin said. Read the complete orginal article here http://www.nytimes.com/2009/11/08/business/08unboxed.html?hpw=&pagewanted=print

Surgery at a Spa? Buyer Beware.

THERE is little to suggest that the TriBeCa MedSpa in Manhattan is a medical facility, at least in the traditional sense. In the waiting area, called the Tranquillity Room, a waterfall cascades down one wall. A client may have a pedicure or facial before entering a softly lighted space where a plastic surgeon performs laser Fraxel treatment or some other minimally invasive procedure that would cost twice as much in a harried doctor’s office.

TriBeCa MedSpa is one of 1,800 medical spas in the United States, hybrid facilities that offer treatments like laser hair removal and liposuction alongside massages and other traditional spa fare. In recent years, the business has become a growth industry: from July 2007 to December 2008, the number of medical spas increased 85 percent, according to the International Spa Association, far outpacing the growth of day, destination and resort spas.

The kinds of procedures performed in medical spas has also increased. At the Park Avenue Medical Spa in Armonk, N.Y., for instance, clients who have undergone chemosurgery for skin cancer, which may leave the skin pitted, can receive reconstructive surgery, a treatment that falls outside the strictly aesthetic category and may point in the direction the industry is evolving.
“It certainly seems like the wave of the future,” said Dr. Gerald Ginsberg, a cosmetic surgeon and medical director of the TriBeCa MedSpa, who noted that, increasingly, patients are becoming “customers” searching for the best deal in what he calls “today’s medical emporia.” All the more reason, in his mind, that it is important to enforce regulations “to ensure we’re offering the best care for the best price.”

In fact, despite the many well-regarded facilities like TriBeCa MedSpa, the rapidly growing industry is coming under increased scrutiny. Proposed legislation to tighten controls over the credentials of those who can own a medical spa; what procedures can be performed in such places; and how much training someone must have to perform particular procedures is making its way through several state medical boards, including those in Massachusetts, New York, Utah and Florida, where the death last month of a patient, Rohie Kah-Orukotan, is generating renewed concern.

On Sept. 25, Mrs. Kah-Orukotan, a 37-year-old nurse, entered the Weston MedSpa in Weston, Fla., for a minimally invasive liposuction procedure to remove fat from her abdomen and thighs. During the treatment, she suffered seizures and never regained consciousness.

Michael Freedland, the family’s lawyer, said she was given Lidocaine and propofol, a drug that induces sedation and is believed to have contributed to the death of Michael Jackson.
The case, which is still under investigation, raises several issues that concern experts around the country. First, should the treatment — which may actually have been, by the state’s classification, a more advanced, or Level II, liposuction procedure — have been performed at Weston MedSpa, which is licensed as an electrolysis facility, not a medical facility?

“We believe Mrs. Kah-Orukotan received more than a minimally invasive Level I liposuction procedure in a setting that was inappropriate,” Mr. Freedland said. In fact, a new rule before the state’s board of medicine would not allow any surgical procedure that requires sedation to occur outside of a registered Level II surgery facility.

And then there is the question of the experience of the doctor who performed the procedure on Mrs. Kah-Orukotan. Dr. Omar Brito Marin, a medical doctor with a specialty in occupational medicine, learned liposuction in a three-day intensive course, according to his lawyer, Brian Bieber, who said he believes no malpractice was committed in the case.

For some industry observers, the issue of training and experience is the cause for perhaps the greatest concern. Dr. Darrick Antell, a plastic surgeon in Manhattan, noted that all too frequently someone who starts out performing one procedure migrates to another with only minimal experience. “Someone may start out doing laser hair removal, and next thing you know they’re doing treatments for cellulite,” said Dr. Antell, who said that personnel in medical spas are pushing the boundaries of what is allowed.

Wendy Lewis, an aesthetic surgery consultant and author of “Plastic Makes Perfect,” said: “The incident in Florida is nothing short of tragic, and I feel for that woman’s children and family. But I say, buyer beware.”

Such sentiment applies to another popular medical spa procedure: laser hair removal. For years, complaints of second- and even third-degree burns from laser hair removal procedures have been reported. Yet in places like New York State, it is still not considered a medical procedure, despite vigorous protests from many in the medical community.

“In New York, legally, even a barber could do it, not that he would,” said Dr. David Goldberg, a cosmetic dermatologist in New Jersey, New York and Florida, as well as a law professor at Fordham University and a legal counsel to the Medical Spa Society.

In Massachusetts a medical spa task force has been set up to advise the state legislature on how best to regulate the facilities. “We are trying to set some standards here, yet make it flexible enough to accommodate rapid changes in the industry,” said Russell Aims, chief of staff of the Massachusetts Board of Registration in Medicine.

“We don’t want to say to the consumer, ‘Don’t go get these procedures done,’ or to a physician that he or she can’t profit from this potentially lucrative business, but I think it’s around the time I saw a place offering walk-in Botox shots at a mall that I became concerned,” Mr. Aims said.

“To me it’s a lot like the mortgage industry,” said Dr. Ranella Hirsch, a dermatologist in Cambridge, Mass., and an advocate for more stringent regulations of medical spas. “While it may allow more accessibility to treatments and procedures, it’s also brought a much higher level of permanent injury,” she said. Dr. Hirsch added that she thinks a system of federal regulations of medical spas would be more cohesive than the current state-by-state model but believes that is unlikely to happen, since medical and other professional boards, like nursing, electrology and aestheticians boards, are regulated and licensed by individual states.

“What is likelier to happen (and currently under way) is that national organizations like the American Society for Dermatologic Surgery, which represents member dermatologists nationwide, provide guidelines for legislative guidance state by state,” she said in an e-mail message.

Despite all the safety and regulatory controversies concerning medical spas, there are thousands of satisfied medical spa customers. Among them is Gail Fox of Palm Beach Gardens, Fla., who went to the Anushka Cosmedical Center Spa and Salon in West Palm Beach, for facial fillers that were administered by a nurse practitioner and found the experience “a pleasure.” “The service was on sale so the price was right. That’s what drew me in. The pace was slower than at my dermatologist’s office. All my questions were answered, and I didn’t feel pressured,” Ms. Fox said.

“These places can offer a wonderful opportunity for a consumer to reduce stress and get treatment for the whole body,” said Lynne McNees, president of the International Spa Association. But, she added, “just because someone is in a white coat, it doesn’t mean he or she is a qualified to perform a procedure on you.”

Both Ms. McNees and Hannelore Leavy, executive director of the International Medical Spa Association, emphasized the efforts their associations are making to educate the medical spa consumer. For instance, Ms. Leavy’s organization has a section on its Web site that pertains to current legislation affecting medical spas.

“If someone is cutting you open or injecting something into you it’s not a spa service, it’s a medical one,” Ms. McNees said. “You’re going to need to know who is performing that procedure, know their credentials and accreditations and really do your homework,” she said. “I tell everyone, ‘If you don’t know, don’t go.’ ” Read the complete original article here http://www.nytimes.com/2009/11/05/fashion/05skin.html?hp=&pagewanted=print

Older Bypass Method Is Best, a Study Shows

For decades, bypass surgery, in which surgeons improve blood flow to the heart by sewing new blood vessels to get around blocked ones, was done the same way. The heart was stopped while blood was pumped through a heart-lung machine to do the heart’s work.But doctors increasingly worried that the machine, the “pump,” might sometimes lead to strokes or memory problems or personality changes.

Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). The perfusionist and heart-lung machine (HLM) are on the upper right. The patient's head (not seen) is at the bottom.

Some privately called patients with those difficulties “pumpheads.”And so, in the last seven years, many surgeons began offering and patients increasingly demanded an alternative: off-pump surgery in which the machine was not used and doctors operated on a still-beating heart.Now, a large and rigorous study finds the old way is best.In the study, published Thursday in the New England Journal of Medicine, 2,203 patients were randomly assigned to have their bypass surgery on pump or off. Because the study was sponsored by the Department of Veterans Affairs, the patients were mostly men.A year later, those who had had off-pump surgery had poorer outcomes. Fewer bypasses stayed open and patients were more likely to have needed a repeat operation or to have had a heart attack or to have died. They were no less likely to have had strokes or difficulty thinking.“This is a big one,” said Dr. Eric Peterson, a Duke cardiologist who wrote an editorial accompanying the paper.

“It’s a good study and the fact that it did not find superiority was key,” he added.Dr. Peterson added that he, like many cardiologists, expected off-pump procedures to be superior.Dr. Michael Lauer, director of cardiovascular sciences at the National Heart, Lung and Blood Institute, said he anticipated and hoped that the new study would dampen enthusiasm for off-pump surgery.“Bypass surgery is one of the most common operations in the world,” Dr. Lauer said. “As many as 20 percent of bypasses in the U.S. are being done off pump. This affects a lot of people.”Dr. Frederick L. Grover, the principal investigator for the study and a heart surgeon at the University of Colorado at Denver and the Denver V.A., said his group was analyzing the costs of the two types of operations. He said if there was a difference, it was slight.Patients who had their surgery off pump had fewer blood transfusions but spent slightly longer in the operating room.

There were no significant differences between the two groups of patients in the time they spent in intensive care after their surgery or how long they spent on a ventilator or how long they spent in the hospital.Some surgeons who made off-pump surgery their specialty said they were not going to change. The results do not apply to them, they say, because they have extraordinary expertise.But others less invested in the technique said they would be doing less off-pump surgery. And that includes Dr. Grover.About 20 percent of the 225,000 to 250,000 people who have bypass surgery each year have it off pump.Off-pump surgery began to take off around 2002 when instrument makers began selling devices making the surgery seem feasible and animal studies indicated that heart-lung machines had the potential to cause problems.When they use a heart-lung machine, doctors clamp blood vessels closed, draining the heart of blood. They inject a near-freezing fluid into the heart.

They redirect blood through tubes that can create tiny bubbles or small fragments of debris that might get into the brain.At first, it was not easy to do heart surgery without the pump. How, for example, do you hold part of a beating heart still while you work on it? Some surgeons improvised, using modified kitchen spoons and forks to hold the heart steady. And how do you sew blood vessels onto the back of the heart? Surgeons had to lift the heart to get to the back and then blood pressure would drop.Instrument makers soon provided special tools that made it easier to steady specific parts of the heart while surgeons worked.

Some, like Dr. Aubrey C. Galloway, who is chairman of the department of cardiothoracic surgery at New York University Langone Medical Center, said he felt compelled to learn off-pump surgery and to do it primarily in high-risk patients.“There was a lot of market pressure and momentum behind this off-pump stuff,”

Dr. Galloway said. “A lot of surgeons were pressured to do it in everyone. Patients were coming in and saying, ‘I’m worried about cognitive dysfunction.’ ”Now, he said, “the idea that people should go somewhere to get off-pump surgery is pretty much killed by this publication.”But Dr. Nirav Patel, a heart surgeon at Lenox Hill Hospital in New York, said he does off-pump surgery in 95 percent of his patients and he is not going to change.He said that even with the new equipment, off-pump surgery was difficult and that it had taken 100 cases before he got really good at it.

He estimated that he had now done more than 1,400 off-pump operations and questioned whether the surgeons in the study had the necessary expertise.“I am an off-pump surgeon,” Dr. Patel said. “I am a big proponent of it.”

It may be, Dr. Lauer said, that surgeons like Dr. Patel are so expert at the procedure that their results are different from those reported in the study.But, he adds, “from a policy point of view, what we really care about is how well will the procedure work in the hands of a typical surgeon.” The study involved typical patients and typical surgeons. Very few surgeons, Dr. Lauer said, “have achieved exceedingly high levels of expertise.”And, he added, the study shows that for all the reasoning about why off pump is generally better, “just because something makes sense doesn’t necessarily make it so.”This article "Older Bypass Method Is Best, a Study Shows" originally appeared at The New York Times. Read the complete article here http://bulletin.aarp.org/yourhealth/diseases/articles/older_bypass_method_is_best_a_study_shows.html

Read more here

What is a heart bypass operation?
http://health.howstuffworks.com/question120.htm

Bypass Surgery, Coronary Artery
http://www.americanheart.org/presenter.jhtml?identifier=4484

Coronary artery bypass surgery
http://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery

Heart bypass surgery
http://www.nlm.nih.gov/medlineplus/ency/article/002946.htm

Is too much sleep making you tired?

STORY HIGHLIGHTS
Instead of feeling better, sometimes people feel worse after long hours asleep
Grogginess after waking is known as sleep drunkenness
People often sleep more to make up for poor quality, light sleep

Instead of feeling crisp and refreshed, Jesse Wu wakes up sluggish after 12 hours of sleep.

"If I sleep the right amount, I feel really good," said the 25-year-old who lives in a suburb of Chicago, Illinois. "If I sleep too long, I feel groggy throughout the whole day."

Like Wu, some feel exhausted after long hours of rest.

"Many people will tell you, they sleep a little worse when they sleep a long time on weekends," said Dr. Daniel Kripke, co-director of Scripps Clinic Sleep Center in La Jolla, California."Too much long sleep on weekends does not seem to make people feel better." But he acknowledged that the reasons haven't been determined.

For years, doctors have warned about the dangers of not getting enough shuteye -- traffic accidents, weight gain, decreased productivity and immune protection, but the effects of oversleeping are not well-understood. There isn't medical evidence to recommend that people who sleep long hours should change their habits, Kripke said.

Daylight saving time ends this Sunday, giving sleepers a bonus hour of sleep.

Wu savors his sleep. "I really enjoy it," he said. In the morning, he needs five alarms -- each with a different sound -- that he smacks as he lumbers out of bed.

Like many professionals, Wu sleeps little on the weekdays (about five hours) and makes up for it on weekends, spending eight to 12 hours blissfully hibernating. Sometimes, after a long stretch, he wakes up too tired to function.

"After I've gotten so much sleep, the first situation is I fall asleep at 10 p.m., even though I've gotten 12 hours of sleep, because I feel so groggy," said Wu, who works as a membership coordinator for a professional association.

This is known as sleep drunkenness, when a person hovers between sleep and wakefulness, said Dr. Lisa Shives, medical director at Northshore Sleep Medicine in Evanston, Illinois. In one case, a patient who had sleep drunkenness came to the emergency room because his wife thought he had a stroke.

"They'll wake up and be in this weird state of sleep drunkenness," Shives said. "If it's really severe, you're not going to be in any state to make decisions. If it's just regular [case], a lot of us feel 'blah,' and most of us have to carry on and get going on a shower and cups of coffee."

Oversleeping once in a while doesn't present serious health risks, experts say.

But if you habitually sleep excessively, it could be the result of an underlying health problem. And it could be cutting into your life span.

"There's been at least two epidemiological studies to show that if people get less than five hours, or more than 10 hours of sleep, it increases their mortality," said Michael Breus, the clinical director of the sleep division at Southwest Spine and Sports in Scottsdale, Arizona.

A 2007 Finnish study found that the mortality risks increased by about 20 percent for people who slept more than eight hours. That same year, a British study found that people who slept five hours or less and those who slept more than eight hours also faced increased risks. Another study showed that people who routinely slept more than eight hours a night had a greater chance of stroke than others with less sleep.

Scientists say sleep and longevity are somehow associated, but there might be confounding factors.
"We don't know if it's the long sleep. It could be something else causing illness and the long sleep," said Kripke, who has researched the topic for 35 years.

Here are possible factors for habitually excessive sleep, known as hypersomnia:

• Problem: Poor-quality sleep
A person could sleep the recommended amount, but still feel tired because he or she got poor quality sleep.
"Oftentimes, we only think of sleep in terms of minutes -- but that's really the quantity of sleep. In fact, there's a quality of sleep," said Breus, author of the book "Beauty Sleep."
The average sleep cycle takes 90 minutes to complete. It starts from stage 1, the lightest sleep, and progresses to deeper levels through stage 4. Then, it continues to rapid eye movement (REM) sleep when the person dreams.
"When you have poor quality sleep, you spend a lot of time in stage 1 sleep," said Shives, a spokesperson for the American Academy of Sleep Medicine. "You will tend to want to sleep longer to make up for the quality and increasing quantity."

• Problem: Other medical conditions
"If you find you're sleeping a lot -- like more than nine hours on a regular basis, you need to talk to your physician, because that probably means you got poor quality sleep and that could be sleep apnea, narcolepsy or restless legs form of sleep disorder," said Breus.
Sleep apnea is a major cause of problems, when breathing stops during sleep.
"If you have sleep apnea and you stop breathing through the night, you might feel really tired in the morning even though you've gotten eight hours. Those eight hours were horrible, light, crappy sleep," Breus said.
Another possibility is periodic limb movement disorder, which causes a person to jerk and twitch during sleep, causing disruptions. Depression has also been associated with excessive sleep.

• Problems: Genetics
Some people naturally thrive on little sleep. And then, there are others who flourish after nine hours.
"It's only when you go less than six and a half hours of sleep, we call you a short sleeper; more than 9.5 hours, we call you a long sleeper," Shives said. "We think there's something genetic."
A study published this year in the journal Science identified a mutated gene in a mother-daughter pair that allowed them to function on six hours of sleep. The research conducted by University of California, San Francisco scientists is believed to be the first to discover a gene, hDEC2 involved in regulating sleep length. This finding could someday lead to a better understanding of why some people require more sleep.

Find this article at:
http://www.cnn.com/2009/HEALTH/10/30/oversleeping.health.effects/index.html