Can Your Blood Pressure Be Too Low? You bet.

You probably haven’t heard much about the dangers of low blood pressure.

In Dr. H. Gilbert Welch’s book Overdiagnosed, he tells the story of a patient of his at the Department of Veterans Affairs (VA) in Vermont. Mr. Bailey was 82 and lived alone on a farm. He worked outdoors almost all day, every day, doing everything from rebuilding stone walls to clearing brush and shoveling snow. He was a healthy man with only a few minor health issues.

But Mr. Bailey ended up on a master list of VA patients with high blood pressure. His systolic blood pressure (the top number) was 160, which is considered high, although his diastolic pressure (the bottom number) was fine, running 70-90.

Seeing that Mr. Bailey was highlighted as someone with a high systolic blood pressure spurred Dr. Welch to start Mr. Bailey on a daily 25 milligram pill of hydrochlorothiazide, a diuretic that reduces the amount of fluid in the blood vessels, and thus lowers blood pressure. It worked. Mr. Bailey’s systolic blood pressure went down.

But then one day Mr. Bailey collapsed. He was working outside on a hot, humid day, got dehydrated, and his blood pressure got too low.

It turns out that when hypertension is moderate, the value of treatment is low, says Dr. Welch. The chance of “overdiagnosis” is  high and the benefit is not worth the risk.

So Mr. Bailey decided to stop taking the pill to reduce his blood pressure.

Lower Blood Pressure May Not Work for Everyone

A study published in JAMA Internal Medicine last year found that older adults who had a systolic blood pressure of 128 or less had a higher level of mental decline than did those with a higher reading. And low blood pressure has been associated with other health issues: studies have  found that lower blood pressure in seniors can cause or be related to declining kidney function.

Scientists aren’t certain why this is true, but basic physics helps answer the question. As we age, our blood vessels  naturally stiffen and may narrow, and either or both of those features can increase blood pressure. If you don’t get enough blood pressure, your vital organs, such as the brain and kidneys, for example, may not get the oxygen they need.

Even in younger people, low blood pressure can be a problem. Anyone of any age who gets dehydrated (causing less “total fluid” in the blood vessels), may get dizzy and even faint.

Confusing Standards 

But it can be confusing to know what’s right to do. Our healthcare system tends to treat blood pressure somewhat aggressively. Just last November, a study and editorial published in the New England Journal of Medicine suggested that a target systolic blood pressure of 120 may be smart.

The study, the Systolic Blood Pressure Intervention Trial (SPRINT), involved almost 1,000 people 50 or older with a systolic blood pressure of 130 to 180. But all the participants in the study already had at least one risk factor for heart disease, such as high cholesterol  or smoking.

Half were in a group aiming for a systolic blood pressure of 120 while the others were going for a blood pressure 140 or lower. All the participants were put on common blood pressure medications. After four years, the ones seeking the 120 systolic blood pressure had a 25 percent lower risk of stroke, heart attack and related problems, including death.

But the trial also showed that people trying for the lower systolic blood pressure number had a higher risk of fainting and reduced kidney function.

Most of those who got their blood pressure down near the 120 blood pressure target had to take three to five medications to do it, while those who were  trying for 140 systolic only had to take an average of one medication. Some patients had to take several drugs to get their blood pressure down to the target, each with its own side effect.

By the way, guess how many different drugs are marketed in the U.S. to reduce high blood pressure? I took a quick look and counted 80, from Accupril to Ziac.  On the positive side, patients and physicians have a wide range of options to choose from. On the other hand, pharmaceutical companies have a big investment in blood pressure management.

Drugs Are Not the Only Way to Achieve a Healthy Blood Pressure

Are there other steps you can take? Exercise moderately for at least 30 minutes five times a week; achieve a healthy weight; cut back on processed and other salty foods; eat plenty of fish,  fresh fruits and vegetables; and limit your alcohol intake.

What Next?

  • Talk with your physician about how your unique combination of characteristics — age, family history, gender, any conditions such as diabetes or kidney disease, cardiac risk factors,smoking habits, stress and lifestyle — should inform your decision about aiming for a a particular target blood pressure.
  • Don’t stop taking any prescribed medications, including any blood pressure medications, without talking with your physician first.
  • If you faint or fall, are dizzy or light-headed, or feel confused or disoriented, or have any other troubling symptoms, contact your physician right away.
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Can’t Get the Right Diagnosis? How to Get Help

Some people spend years trying to get an unusual combination of distressing symptoms diagnosed and  treated. They go from doctor to doctor, test to test, hoping that someone will somehow put two and two together and name their problem.

There is hope. The National Institutes of Health (NIH) launched a research program last September called the Undiagnosed Diseases Network (UDN). It’s based on a program established in 2008 which has put 750 patients through a week of imaging, genetic testing and other tests. Up to 50 percent of those patients were diagnosed through the program.

Top Specialists, Great Resources and Collaborative Analysis

The concept is simple: put a diverse, cooperative medical team in charge of using a broad range of diagnostic resources at top medical centers to diagnosis some of medicine’s most perplexing diseases. All the blood tests, imaging, genetic testing and other data are kept in a cloud-based, secure data-hosting system that physicians and researchers at all of the sites can access.

No Cost to Patients

The UDN is  free — patients aren’t charged for examinations or testing — but they must agree to have their data shared with NIH researchers.

UDN is available at seven medical centers: Baylor College of Medicine, Duke Medicine with Columbia University Medical Center, Harvard Teaching Hospitals, the NIH, Stanford Medical Center,  UCLA Medical Center, and Vanderbilt Medical Center.

Some people will have their medical mystery will be solved: a diagnosis will be found and a treatment plan developed. Others may get a diagnosis but the treatment will not be known. And unfortunately, others may leave without answers.

How to Apply

Ask your physician to send a referral letter that summarizes your medical issues and notes when symptoms were first noticed; lists any other diagnoses you have received; provides a summary of the results of your recent relevant evaluations, tests, medications and treatments; offers his or her thoughts  about what the diagnosis may be, and, if you are applying for a child, details any potentially relevant prenatal and birth history. The letter, with an electronic application, can be sent through the UDN’s website,


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What a Skeptical Surgeon Says You Should Know

I’d like to introduce you to someone who calls himself a “skeptical surgeon,” Ian Harris, M.D., Ph.D. He is an academic orthopedic surgeon in Sydney, Australia. Dr. Harris has a point of view I thought you would find interesting and provocative. 

What are you skeptical of and how did you develop this philosophy?

Dr. Harris: I am skeptical of the degree to which medicine benefits society. It is my position that the benefits from medicine are overestimated and the harms are underestimated.

The more objectively you explore many of the claims that arise from modern medicine, the more you realize that this is the case. There are so many examples of interventions that, on the surface, sound good, but when put to the (scientific) test, turn out to be a net harm, or barely beneficial. Either that, or you find that they have never been properly tested in the first place.

The public and the medical community therefore see medicine through rose-colored glasses, which results in an over-diagnosed, over-treated society.

Conditions that are part of normal life are being medicalized (sadness, grief, social anxiety, low grades, backache, obesity, childbirth, sex, menopause, aging) and “real” diseases are being over-medicalized (high blood pressure, arthritis, cardiovascular disease, and some types of cancer). In fact, those examples show you how difficult it is to define disease.

I went into medicine straight from college, and then into surgical training soon after that. I had some exposure to surgery in Europe and in the United States. and then started as a specialist orthopedic surgeon.

I was always interested in the scientific basis for medical practice, rather than just doing what everyone else did, which is how most medicine is practiced.

While I remain a practicing surgeon, I now have higher training in clinical epidemiology and statistics, and remain a student of the scientific method. I perform research and teach evidence-based medicine.

Since I have started challenging the conventional wisdom of medicine, I have found that much of it does not stand up to scrutiny. Repeatedly, I find that what appeared effective was either naive or deliberately calculated to show an effect. The biases that drive our perception of the net benefit of medicine are numerous and all point in the same direction.

What do you see as the biggest, broadest issues patients are facing these days?

Dr. Harris: Much of our zeal over new studies, and our biases in conducting and reporting those studies, are the result of a lack of scientific rigor.

Patients face a problem because they are entrusting their doctor to be the judge of all this science and they do not realize that the doctor may be just as biased as is the general public.

Consequently, the average patient is more likely to be screened unnecessarily, put on medication that might not work, and undergo surgery with questionable benefit/risk ratios. Simply saying something is scientific is no longer enough.

Something happened to our culture over the last 50 years or so that has made us believe just about everything can be tested and most everything can be treated. How did this happen and how can this approach be dangerous to our health?

Dr. Harris: The reason we believe in medicine is because that is what we want to believe. Who wouldn’t? In fact, there is no negative feedback on this belief.

The health industry (doctors, nurses, hospital administrators and owners, universities, pharmaceutical companies, and device inventors and manufacturers) want medicine to work in order to help people, make a profit, keep their jobs, or whatever.

Patients want medicine to work to validate their suffering, take responsibility, solve their problems, etc. There is very little that that opposes this strong medicalizing force.

We have been overestimating the benefits and underestimating the harms for a long time. It is only recently that the problem is being addressed, partly because we are being more scientific and partly because those harms are becoming so large that they are getting hard to ignore.

Dr. Harris calls himself “Doctor Skeptic” on his popular blog and you can follow him on Twitter via “@doctordoubter.”

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How To Stop Heartburn

It turns out that when it comes to heartburn,  new research is showing that taking  a pill may be  unhealthy and even unsafe.

For the millions who rely on Nexium, Prilosec, Prevacid  or other medications, this is likely exasperating and frustrating news, since living with regular heartburn is no picnic.

These drugs typically are very effective in relieving or reducing  the painful, annoying symptoms of “gastrointestinal reflux disease,” or GERD.


Serious risks

For years, physicians thought the drugs were safe. But over the last few years, research has found that  these drugs, also called “protein pump inhibitors,” or “PPIs,” alter the chemistry in the stomach, creating the risk for infections, food poisoning, pneumonia, serious nutrient deficiencies, decreased bone strength, and even the potentially fatal digestive system infection called “clostridium difficile.”

And just yesterday, a study of almost 75,000 patients published in JAMA Neurology concluded that “the avoidance of PPI medication may prevent the development of dementia.” Those taking PPI meds had a significantly higher risk of dementia as opposed to those not taking the drugs.

How Does Heartburn Happen?

Initially, there’s a trigger, maybe it’s stress, or a long night of partying, or too much acidic food. The first time it strikes you might find yourself burping a lot, or feeling intense pressure in your chest area, or sensing  burning regurgitation in throat. It can be frightening. Sometimes it’s a one-off; you take a couple of chewable anti-acid pills and you’re fine.

Frequently, it continues. That’s because the extra acid — whatever caused it — burns the tender valve of your esophagus, making it a less-effective “trap door” between your stomach and your throat. Unless the esophagus gets about two or three months of a low-acid environment, it won’t heal. So the discomfort continues.

That’s unless you find a way to reduce the stomach acid and stop irritating the stomach and esophagus. PPIs do that because they reduce the amount of acid the stomach manufactures. But as we now know, there are serious side effects from using drugs to change the natural process of the stomach.

But Take Heart: There’s Another Way

I had a bad case of heartburn a few years ago and knew I didn’t want to start taking medication.  For the vast majority of people,  research shows that a combination of lifestyle changes can stop the cycle and reduce or stop your symptoms. But it takes about two or even three months of vigilance:

  • No alcohol for two months. Honestly. Alcohol stimulates stomach acid and can itself irritate the damaged esophageal valve. Once your heartburn symptoms go away, you can gradually re-introduce a little alcohol at a time back into your life, if you wish, and see how you do. If you have more heartburn, give the alcohol a rest and try again in a few weeks.
  • Avoid fatty and/or spicy foods. Your stomach acid increases when fat and spicy food enters the stomach. You can help the healing process along by avoiding as much fat as possible. That may mean initially cutting out red meat, desserts, higher-fat salad dressings, butter and most cheese. As with alcohol, after a few months, slowly re-introduce those foods back into your diet and see how it goes. I tried  a yogurt-made dressing when I was fighting heartburn and I like it so much, I’m still using it.
  • Avoid citrus, including orange juice, lemons and lemonade.  (Oddly, even though I’ve been heartburn-free for years, a sip of lemonade still gives me a bit of discomfort).  Apple and cranberry juice may be good substitutes.
  • Eat smaller meals. When you stomach is full, it produces more acid. Eat less at a sitting. Have a half a sandwich for lunch, and then an apple a few hours later.
  • Try sleeping with your head elevated.  That’s because when your esophageal valve is injured from acid, it doesn’t close tightly. So if you’re lying flat in bed, it’s easier to have stomach acid flow toward the valve, burning it, and re-irritating it.
  • No soft drinks or coffee. Even decaffeinated coffee is usually irritating. That’s because it’s a bit acidic.  That’s the problem with soft drinks, too: they can stimulate acid production.
  • Drink plenty of water. Practically, you have to because this list has virtually eliminated every other fluid. But water also helps dilute the acid.
  • Lose weight. You probably will anyway just by reducing fat and alcohol. Extra weight can push against your stomach, increasing the chances acid will irritate your esophagus.
  • Be kind to yourself. The anti-heartburn diet is no fun. So reward yourself with other treats, whatever makes you happy. Avoid stress or find a way to talk about it with someone you love. Take a walk.

If you still are uncomfortable, be sure to talk to your physician and decide what is best for you.


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What Should You Know About Your Lab Results?

Your doctor orders lab work for you and you get your blood drawn. Do you need to do anything more?

The answer is yes. You have an important role in reviewing your test results and asking your physician questions about what the data means and what action you may need to take, says David Koch, a professor of pathology and laboratory medicine at Emory University and president of the American Association of Clinical Chemistry (AACC).

Koch says it’s important for people to learn enough about their lab results to understand whether they need to make a change in diet or lifestyle, or get some form of treatment.

The first step? Be sure to ask the laboratory for your own copy of the lab results, look them over, and be prepared to ask your physician some questions, urges Koch.

Notice whether any of the lab values have been identified as too low or too high, says Howard Andrew Selinger, M.D., chairman of family medicine at Quinnipiac University, in Hamden, Ct.

Tools You Can Use

After reviewing your data, Koch recommends visiting Lab Tests Online, a 12-year-old website produced by the AACC. It’s a popular, easy-to-understand tool with about 2.5 million visitors a month, he says.  The website features definitions of common tests (like “HDL,” “Glucose” and “eGFR”, for example) and explanations of reference ranges and why your results may vary over time.

Selinger also encourages patients to plug their lab results into reliable calculators, such as the ARIC coronary calculator  for heart disease. For example, put in your HDL (directly from your lab report), your top blood pressure reading (such as 120, for example) and answer a few short questions, and you’ll be told your estimated risk of having a heart attack or dying of heart disease in the next 10 years.

To better understand your risk of breaking a bone, enter information into the FRAX calculator for fracture risk.

Putting the Data in Perspective

Koch says people should avoid thinking it’s too complicated to learn more about their lab results. Instead, he encourages patients to study their data and talk with their physician about whether any lab value is a cause for concern.

Your goal should be to understand your lab values in terms of your overall health and any recent health issues you’ve experienced, says Selinger.

The Bottom Line

  • Scan your results looking for outliers. Ask your physician how much of a variation from the given normal range — or a change since your last test — is OK.
  • If a test is abnormal, learn more about the test and the condition it identifies or measures.
  • If you don’t get a copy of your lab results, ask your physician. The test or tests may have slipped through the cracks. Don’t assume the test was taken and reviewed.
  • Keep your own copy of all your lab results in a file at home.
  • If you’re interested in watching how your lab results change over time, you can plot them on a simple graph and see how they’re changing. Some physicians may have a system that does this automatically.


Related Blog Posts:

Preventing Communication Failures

Just Got Bad News? One Word to Get You Better Healthcare

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How to De-Frag Your Health Care

If your computer has ever slowed way down you may have been adefrag 2 2.8.16dvised to “defrag,” which puts all parts of a file together in the same place on the drive, enabling it to run faster and more efficiently.

In much the same way, your health care needs to be de-fragged. For most people, health care is extremely fragmented, creating errors, delaying diagnoses and treatment, and increasing

Even for the very healthy, the burden of keeping even two or three different doctors apprised of what you’re experiencing is typically on you. No one else is doing it.

When I had a small skin cancer removed from my back by my dermatologist, no one told my primary physician or sent a copy of the pathology report to that office. So I did.

If you break a bone snowboarding, no one automatically tells your physician back home. If your ophthalmologist sees signs of cardiovascular disease during an eye exam, he or she is unlikely to ask if it’s OK to send the information to your physician.

Chief Health Communicator? That Would Be You

The more complicated your problems, the more fragmented your care will be. The average Medicare patient sees two physicians and five specialists a year (according to The Fragmentation of American Health Care: Cases and Solutions, edited by Einer Elhage). Those with a chronic illness see an average of 13 physicians a year. A Medicare patient with coronary artery disease sees 10 physicians in six distinct practices annually. Indeed, the more physicians following someone after a heart attack, the lower the survival rates.

It’s important you know that there is no little Tinkerbell picking up your medical records and automatically delivering them to the physicians in your life who should know what’s happening with you. Consider yourself the the person most responsible to collect written updates, copies of test results and lists of new and changed medications and get them to all your other healthcare providers.

When you get a test result, procedure or have surgery,  get the summary in writing, keep a copy, and send or bring copies to all your other healthcare providers. Attach a simple note: “Wanted to keep you up- to-date on my health status. Please put this in my chart.” If it’s an important healthcare issue, be sure to bring up the data or  problem at your next visit and mention that you sent a written summary for inclusion in your medical record. Keep a master list of all your medications and update it any time a healthcare provider adds or deletes a drug or changes a dosage.

Bring a copy of that list to your medical appointments and to the emergency room if you end up there. Don’t leave your dentist or your optometrist/ophthalmologist out of the loop. They need to know the details of your general health status. It will help them diagnose and treat any issues they may identify with you. Be sure they know if you have any infections, immune issues, heart problems, chronic conditions or are taking blood thinners or antibiotics, as well as other medications.

Call the healthcare provider who ordered the test and ask the office staff to email or send you a written copy of the test summary. Keep a copy in your own “medical updates” file. If the test was indeed OK, you still should have copy for reference at a later time, if needed.

If you or someone you love ends up in the hospital, your role of communicator will be even more vital. Often specialists are called in to evaluate problems that are detected or develop while you’re in the hospital. Specialists don’t always talk to each other, or to a hospitalist, or even realize who has changed or added a medication, who has ordered a test, or what results are in. The more you can communicate, the better. If you are being asked to go back for a test you already had or if you have questions about what is happening, don’t assume someone has it all managed. Ask questions and be sure you understand what tests you’re getting and why. If you are being discharged from the hospital, it is an especially important time to ask for the results of any tests or procedures you had in the hospital.

De-fragging your health care may sound overwhelming. Just remember: get written copies of every test, procedure and surgery, keep a copy of each for yourself (you’ll be the only person on earth with a complete copy of your own medical record, by the way), and give copies to your healthcare providers. Ask questions when you don’t understand why someone wants to order a test for you. Bring a knowledgeable person along with you to healthcare appointments, if you like.

Be the hub of the wheel. Of everyone involved in your health care, you’re the one with the most at stake.

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How Telephone Tag with a Doctor Affected the Metropolitan Opera

There’s a fascinating health story on the front page of the New York Times today. But it isn’t billed as something about healthcare. It’s a story about the possible need for the conductor of the Metropolitan Opera to retire.

James Levine 

James Levine, 72, the Opera’s music director for almost 40 years, has been struggling with a combination of Parkinson’s disease, back problems and a severe spinal injury from a fall. This season Levine has seemed more frail, showing difficulty controlling his left arm and sometimes unavoidably leaning to the right of his wheelchair while conducting.

Levine was thinking it was time to retire. He was worried that his Parkinson’s was worsening. He had called his neurologist, but had played “telephone tag” with his doctor and never got an appointment.

Sound familiar? You have a health concern, try getting a chance to talk with your doctor, but can’t connect, so you move on.

It turns out that the delay in getting the attention Levine needed was indeed unfortunate. Not only did it almost cause Levine to retire, but Levine’s weakness could most likely have been resolved far sooner.

When Levine finally got in to see his doctor, Stanley Fahn, M.D., it seemed that his involuntary movements (dyskinesia) were most likely caused by an overdose of his medication for Parkinson’s, L-dopa.  Lowering the dose would have solved the problem.

Now on a new dose of the medication, Levine is set to conduct the Philadelphia Orchestra later in February and will begin rehearsals for a production of Verdi’s “Simon Boccanegra” with Placido Domingo in March. That’s music to our ears.

The healthcare lesson from Levine’s experience?

  • If you notice a change in your health, power through telephone tag and get an appointment with your physician. Don’t ignore the issue. Don’t get discouraged by the front desk.
  • Always question whether your medication may be causing undesirable side effects or whether you might benefit from an adjustment in the dose.
  • Don’t make big life decisions until you fully understand any health problems you’re experiencing. Your issues may be more manageable than you think.



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Preventing Communication Failures

Assume nothing. Honestly.

That can be challenging when you’re a patient or a family member, and you just want to trust the system to get you the care you or your loved one needs.

But, unfortunately, you have to treat virtually every interaction with health care as if it were a moon shot. Ready, set, check, check, triple check, feedback, lift off!

This goes for everything from getting the results from a simple blood test to making sure the dentist is doing the root canal in the tooth that actually needs it, to ensuring that the pathology report that was read to you over the phone was indeed yours.

A report released today by CRICO Strategies suggests that lack of effective communication involving physicians and hospitals caused  almost 2,000 patient deaths between 2009 and 2013. The analysts also found 7,000 cases in which communication failures between healthcare staff and patients or among physicians had seriously harmed patients.

The data in the report came from approximately a third of all malpractice claims in the U.S., representing a broad cross section of hospitals and medical offices, according to the report’s authors.

In one case, a nurse failed to tell a surgeon that her patient’s hematocrit, a sign of the amount of red blood cells detected in a blood test, had precipitously fallen, signaling hemorrhage.

Another case: someone with diabetes left a message for the doctor, but never got called back. Later, the patient collapsed and died from lack of insulin.

Yet another example: a woman’s diagnosis of cancer was not communicated to the patient for an entire year because her lab result wasn’t sent to her primary care provider.

The report says everything from reliance on electronic medical records to frequent interruptions in work flow, intense workloads, and top-down leadership cultures contribute to the problem.

But perhaps you’re thinking that there’s nothing you can possibly do about these mistakes. After all, how can you  prevent errors from occurring  when you don’t know much about medicine or hospitals, especially when you’re not feeling well? And if you ask too many questions, won’t the staff think you don’t trust them?

The vast majority of nurses and doctors would tell you: don’t be intimidated. Ask questions. The system isn’t perfect. And if you’re too sick to do it, ask your loved ones to speak up on your behalf.

Here are six things you can do to improve communication and health outcomes for you and for those you love, starting today:

  1. Get your own copy of every lab result and test report sent directly to you. Read it over carefully. If you have any questions, call your physician. Phone the office and make sure the physician has seen the same report you received. If you have any questions at all, make an appointment and discuss the the report in person. Ask for the results when you’re in the hospital, too.
  2. If you don’t get a call back from your physician within a reasonable time, keep calling. Do not assume that the doctor thought your health issue was unimportant. It is very likely your doctor has not gotten your message.
  3. Never be afraid to question anything. If you’re a hospital patient and someone comes with a stretcher to take you for  a test or procedure, ask about the test, who ordered it, and why. If that doesn’t make sense to you, ask to talk with the physician.
  4. Repeat to the staff why you’re there for an operation or procedure…all the way until you’re getting anesthesia. Remind the oral surgeon that “I’m here to have my very back lower right molar removed,” for example. Or, “It is my right knee they will be working on.”
  5. Any time someone would like you to swallow a pill or receive an injection or treatment, ask them what you are getting and why. If their answer doesn’t make sense, ask them to double check, or wait until you can talk with your physician.
  6. Talk directly with your physician any time you want to know about your diagnosis and treatment plan.  “What did the tests tell you and what does that suggest we should do next?”  That question should not be communicated to anyone but the person directly responsible for your healthcare outcomes.

Yes, on the one hand, it’s too bad you have to be alert to these issues. But, there’s no downside to being actively involved in your own care. The more you know, the better. And the more you communicate, the safer you’ll be.




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A Great Cancer Resource

The phone rings. Or your doctor’s office calls and want you to come in right away. Or perhaps someone you know tells you what they’ve just learned. 

All of a sudden, you or someone you know or love has cancer. You need to know more. But where to go?

Check out the National Cancer Institute’s PDQ Information Summaries. It provides timely, thorough but very clear summaries of important information for patients and families, and for health professionals, too.

Just click on the type of cancer involved; the alphabetical list ranges from acute lymphoblastic leukemia to vulvar cancer.  If you click on the “patient” version, you get what they call a “treatment summary.” It is a clear and yet fairly comprehensive description of key points, description of the cancer, anatomical drawings, causes, signs and symptoms, tests, factors affecting the prognosis or likely outcomes, stages of the disease, and ways to determine whether the cancer has metastasized, or spread.

If you click on the “health professional” link (which I suggest you also do), you’ll get a more technical and detailed version of the patient information, with links to the research supporting the information.

The website provides information for both pediatric and adult cancers, and also has sections on supportive and palliative care, cancer screening and prevention, and cancer genetics. There are fact sheets, dictionaries, blogs and newsletters.  Everything is at no cost to the user.

If you have an interest in the latest research and have a bit of a technical bent, you might also want to check out “Cancer Currents,” a National Cancer Institute (NCI) cancer research blog.

If you want to know more about cancer treatment, there is a section that discusses types of treatment, side effects, clinical trials, cancer drugs, and complementary and alternative medicine options.

And, there’s an excellent list of questions to ask your doctor.  It’s so complete, I’d recommend you print it out and bring it with you to your next visit.




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Going on a Long Flight? Avoid Window Seats

I love window seats on a long flight. There’s nothing like getting a big-picture perspective on planet Earth when you’re looking out at big, billowing clouds and the tiny ground below from 30,000 feet. But it turns out, sitting next to the window couldview from a plane 1.5.16 actually be bad for your health.

That’s because people who sit next to the window tend to get up less often during a flight. You can’t blame them. After all, who wants to climb over two strangers in the middle and aisle seats, especially if they’re sound asleep or have their seat-back trays piled high with food or a laptop?

And the risk isn’t due entirely to shrinking leg room; this isn’t just a problem for people traveling in coach. Even those in business and first class tend to avoid getting up if they’re by the window.

These clots can develop when parts of your body, most typically your legs, are dependent, or lower, than the rest of you, and not moving much. Blood clots can cause swelling and pain locally, and if they travel through your veins to your lungs, they can cause a pulmonary embolism, which can be life threatening.

The American College of Chest Physicians has  published guidelines about the risks of getting blood clots in your legs, also called deep venous thrombosis (DVT), published in the journal Chest.

What Puts You at Risk

Those who are flying long distance who have the greatest risk are sitting in a window seat, on birth control pills or supplementary estrogen, have had a previous clot, have a disability that restricts their mobility, have problems with blood coagulation, are obese, have recently had surgery or trauma, or have cancer. Others at risk include people who are are pregnant and seniors. The longer the trip, the greater your risk. If you’re healthy, your risk is still relatively low.

You may be pleased to hear that the guidelines suggest there is no definitive evidence to support that dehydration, alcohol intake, or sitting in economy class increases a patient’s risk for developing blood clot resulting from long-distance flights.

Things You Can Do to Prevent DVT

There are some things you can do to reduce your risk of DVT:

  • Walk up and down the aisle every hour or two.
  • Wear below-the-knee graduated compression socks.
  • Don’t take a sleeping pill. You’ll find you sit virtually immobilized when you’re snoozing.
  • Don’t take aspirin or anticoagulants with the intention of cutting your risk of DVT.  If you’re at high risk for DVT, talk with your healthcare provider before your trip.
  • If you’re in a bus or a train for more than an hour or two, these tips also apply. If you’re in a car, pull over and get out to stretch and walk around a bit every couple of hours, too.
  • While you’re seated, do occasional leg exercises (to the extent there’s room), flexing your feet (lifting them up) and stretching.

Learn more from the Centers for Disease Control and Prevention (CDC).

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