Journal Watch December 2017

CHRONIC PAIN

• Popular Shoulder Surgery to Ease Chronic Pain Questionable: A placebo-controlled study found that arthroscopic procedure, subacromial decompression, proved no difference in relieving shoulder pain than the sham surgery. The Lancet

• Hip steroid injections associated with risky bone changes: Osteoarthritis patients who received a steroid injection in the hip had a significantly greater incidence of bone death and collapse compared with control groups, according to new research. Radiological Society of North America

• Noninvasive, nonpharmacological Treatmentof Chronic Pain: A Systematic Review: A number of nonpharmacological interventions can provide beneficial effects on function and/or pain that are durable 1 month to 1 year after the completion of therapy. Exercise, multidisciplinary rehabilitation, acupuncture, and mind-body and mindfulness practices may slightly to moderately improve function and pain across multiple chronic pain conditions. Our findings provide some support for clinical strategies that focus on use of nonpharmacological therapies as preferred interventions for chronic pain. Additional comparative research on sustainability of effects beyond the immediate post-treatment period is needed, particularly for conditions other than low back pain. Agency for Healthcare Research and Quality

COMPLEMENTARY & ALTERNATIVE MEDICINE

• Acupuncture May Ease Pain Tied to Breast Cancer Care: Some common breast cancer medications can trigger joint pain, but new research suggests acupuncture may ease that side effect. San Antonio Breast Cancer Symposium

• Does Alternative Treatment for Cancer Increase Risk of Death?: The survival rates of the 281 selected patients who chose the alternative medicine route were compared with 560 conventional treatment patients, matched for demographic and clinical factors. After statistic analyses were completed, the results showed that, overall, patients who pursued alternative treatment for cancer had markedly worse five-year survival rates than those who underwent conventional therapy. Even after controlling for clinical and demographic factors, choosing alternative medicine over traditional treatment was an independent predictor of an increased risk of death. NCI: Journal of the National Cancer Institute

FDA ACTION

• Approved Juluca, the first complete treatment regimen containing only two drugs to treat certain adults with human immunodeficiency virus type 1 (HIV-1)

• Approved Ozempic for Type 2 Diabetes

• Approved insulin lispro injection (Admelog), a short-acting insulin indicated to improve glycaemic control

• Approved “biosimilar’ Ogivri for breast, stomach cancers

• Approved once monthly injection buprenorphine to treat opiod use disorder

• Approved first use of mepolizumab (Nucala) to treat adult patients with eosinophilic granulomatosis with polyangiitis (EGPA)

PREVENTION

• Dog Owners Have Lower Risk of Cardiovascular Disease: Dogs shower their owners with affection and demand walks on a regular basis. And according to medical researchers, a corresponding link between dog ownership and heart health — previously called "probable" by experts — is supported by Swedish data. An examination of Sweden's national records — spanning more than 3.4 million people and 12 years — found that registered dog owners had a lower rate of cardiovascular disease and a lower risk of death. Nature’s Scientific Reports

'Brain Training' Program Helps Prevent Dementia In what is being billed as a first, researchers report that healthy seniors who tried a new brain-training program were less likely to develop dementia down the road. In essence, the program, called BrainHQ, tries to speed thinking by giving seniors the task of distinguishing between a series of ever-changing objects on a computer screen -- both in the center and periphery of their vision. Over time, the objects appear more quickly, and look more similar to one another. This makes the task increasingly difficult, with the aim being to boost the individual's ability to rapidly and accurately identify the objects at hand. Over a 10-year period, the speed-of-thought-processing program lowered dementia risk by nearly 30 percent, the study team said, when compared with seniors who didn't have such training. Alzheimer's & Dementia: Translational Research & Clinical Interventions

• Any physical activity in elderly better than none at all for reducing cardiovascular risk: Any physical activity in the elderly is better than none at all for reducing cardiovascular risk, according to an 18-year study in more than 24,000 adults published today in the European Journal of Preventive Cardiology.

• Some video games are good for older adults' brains: Playing 3D-platform video games on a regular basis may improve cognitive functions in seniors and increase grey matter in a brain structure called the hippocampus, a new study suggests. If you're between 55 and 75 years old, you may want to try playing 3D platform games like Super Mario 64 to stave off mild cognitive impairment and perhaps even prevent Alzheimer's disease. Plos One

• Vigorous Exercise May Help Slow Parkinson’s Disease: People with early stage Parkinson's may be able to delay a worsening of the disease through a regimen of intense exercise, new research found. "If you have Parkinson's disease and you want to delay the progression of your symptoms, you should exercise three times a week with your heart rate between 80 to 85 percent maximum. JAMA Neurology 

NUTRITION/SUPPLEMENTS/VITAMINS

• Low-salt, heart-healthy dash diet as effective as drugs for some adults with high blood pressure: A study of more than 400 adults with prehypertension, or stage 1 high blood pressure, found that combining a low-salt diet with the heart-healthy DASH diet substantially lowers systolic blood pressure -- the top number in a blood pressure test -- especially in people with higher baseline systolic readings. Journal of the American College of Cardiology

• Maintaining sufficient vitamin D levels may help to prevent rheumatoid arthritis: Maintaining sufficient vitamin D levels may help to prevent the onset of inflammatory diseases like rheumatoid arthritis, research has discovered. Journal of Autoimmunity

• Can diet help reduce disability, symptoms of MS?: For people with multiple sclerosis (MS), eating a healthy diet of fruits, vegetables and whole grains may be linked to having less disability and fewer symptoms than people whose diet is less healthy, according to a study. Neurology 

• Drinking tea protects vision?: The study of U.S. adults found that people who drank hot tea on a daily basis were 74 percent less likely to have glaucoma, compared to those who were not tea fans. Experts were quick to stress that it may not be tea, itself, that wards off the eye disease. There could be something else about tea lovers that lowers their risk. British Journal of Opthamology

TREATMENT

• Hormone therapy in the menopause transition does not increase risk of stroke: Postmenopausal hormone therapy is not associated with increased risk of stroke, provided that it is started early, according to a new report. PLOS Medicine

• Four simple tests could help GPs spot pneumonia and reduce unnecessary antibiotics: Testing for fever, high pulse rate, crackly breath sounds, and low oxygen levels could be key to helping GPs distinguish pneumonia from less serious infections, according to a large study. European Respiratory Journal

• Clot-busting drugs not recommended for most patients with blood clots: Large clinical trial concludes such treatment does not prevent long-term complications About half of people with blood clots in the deep veins of their legs develop a complication that involves chronic limb pain and swelling, making it difficult to walk and perform daily activities. A large-scale clinical trial has shown that a risky, costly procedure to remove such clot fails to reduce the likelihood that patients will develop the debilitating complication. NEJM

• Bleach Baths for Eczema Not Needed: Bathing in water is just as effective for the treatment of eczema as bathing in a bleach solution, a new review of previous research indicates. Annals of Allergy, Asthma and Immunology

• Birth Control Pill Tied to Slight Rise in Cancer Risk: Newer versions of the birth control pill carry a similar increased risk of breast cancer as earlier ones that were abandoned in the 1990s, a new study reveals.Women taking modern formulations of the pill have a 20 percent increased risk of breast cancer compared with those who've never been on hormonal contraception, the study of almost 2 million Danish women found. NEJM

• Self-Taught Breathing Retraining Improves Quality of Life for Patients With Asthma: Self-taught breathing retraining improves quality of life just as much as training by a physiotherapist, according to a randomised controlled trial published in The Lancet Respiratory Medicine.

• No Association Between Statin Use and Reduced Risk of Breast Cancer Recurrence: While other studies have reported that statins may be associated with decreased odds of breast cancer recurrence, a multivariable analyses presented hat the 2017 Annual San Antonio Breast Cancer Symposium (SABCS) do not support those results. “While OR estimates were not statistically significant, the associations between statin use and breast cancer recurrence were in the direction of increased risk of recurrence.”

• Postmenopausal Women Should Still Steer Clear of HRT: Task Force: et again, the nation's leading authority on preventive medicine says postmenopausal women should avoid hormone replacement therapy (HRT). The U.S. Preventive Services Task Force is standing by its original recommendation that women who have already gone through menopause should avoid using female hormones to guard against osteoporosis or diabetes. JAMA 

• Hyperbaric oxygen therapy may alleviate symptoms of Alzheimer's Disease: A new study reveals that hyperbaric oxygen treatments may alleviate symptoms experienced by patients with Alzheimer's disease. Neurobiology of Aging

CAREGIVING

• Are Women with Parkinson’s Disease at a Disadvantage: Women with Parkinson's disease appear to face a disadvantage: They're much less likely than men to have caregivers, a new study finds. That's probably because women often outlive their most likely potential caregiver. "Care provided by family and friends to people with Parkinson's disease is an important source of support, and our findings show that women living with Parkinson's are less likely to receive this support than men," Neurology

OTHER

• Cancer Survivors Can Develop PTSD:  A study of 469 adults with different types of cancer found that nearly 22 percent had symptoms of PTSD six months after their cancer diagnosis. And about 6 percent still had the condition four years after diagnosis. Cancer

• Checking Prices for Medical Procedures Online? Good Luck: A new study has found that people searching online to figure out how much they'll pay for a medical procedure will come away disappointed most of the time. "Fewer than 1 in 5 websites actually yielded a local price estimate that was relevant to the health care procedure in question." JAMA Internal Medicine

• Man Flu: Doctors and women alike have long noticed that men tend to bemoan those symptoms more than women. The phenomenon even has a name: the "man flu." So, are men just whiny wimps? No, a new analysis out of Canada suggests, because respiratory illnesses may indeed hit men harder than women. BMJ

Take a Break: Make a Polish Star

I like the video below, but if you prefer written instructions check out Homemade OrnamentsPolish Star

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Life With Chronic Conditions: Keep the December Blahs at Bay

Low serotonin levels in the brain increase risk of depression. December seems to be the “perfect storm”-the least sunlight of the year and our over compensation for it by eating and drinking all sorts of simple carbs, spending hours sitting inside and using the cold as an excuse not to go out and exercise – well who has time between the shopping and parties? In short, the December blahs, have begun to descend along with serotonin levels. 

Interestingly, I started writing this post and a Christmas package arrived from my brother. On the accompanying card, John, who is a doctor of the most scientific sort, said he was including a book by a neurosurgeon he had come in contact with regarding a patient with Parkinson’s Disease.

The book “Into the Magic Shop,” was authored by Dr. James Doty, whom I had heard on the podcast “On Being.” I relate this because it’s an insightful book that arrived at the perfect time, reminding me that it can be truly a magical time of  year. In fact, among the “things to consider” sections below are some exercises from the book.

 

 The good news is that there are things you can do to change that, and in turn, improve other aspects of your life.

One of my favorite comments about how to cope with the holidays, comes from the comedian Patton Oswalt, whose wife died unexpectedly a few years ago, Go see an early matinee and sip coffee from the only sandwich place open on the block. Pretend you’re the survivor of a weird plague that’s wiped out the population yet still leaves TV stations broadcasting, fast food joints cooking you delicious food and empty buses crawling up abandoned streets. When you look at a holiday spent alone at the right angle, it becomes a sun-lit film noir wonderland... People’s loneliness isn’t alleviated by tit-for-tat joy. That’s too easy. It’s other people being alive and present which spawns true joy, and makes the dead air particles shimmer and vibrate and warm the world. So go out and invade, in any way you can. If you have kids, make them part of your crew, let them join your mission. Be alive and aware and in motion on the Lonely Planet. It won’t stay lonely for long.

Things to consider & Try

• Increasing serotonin naturally: On going research shows that increasing serotonin in the brain decreases feelings of depression. There are a number of ways to do this without drugs including: exercise, sunlight, massage, and thinking happy thoughts. Check out Boosting Your Serotonin Activity. Be aware that before taking vitamins, which is often recommended to increase serotonin, check with your medical provider.

• Ruth’s Tricks: Mindfulness Exercises-These are from the book Into the Magic Shop mentioned above.

• Get moving: Not surprising a clear link has been established between lack of physical activity and depression. You don’t have to be a gym rat to enjoy the benefits of getting plenty of exercise. Build it into your life. Check out Take a Stand to Better Health.

• Get outside and enjoy nature. Take a walk, sit in the park, ride a bike, feed the birds

• Get plenty of sleep.

• Cut back on sugar and simple carbs: Given that the “eating season” has already started, this can be a bit of a challenge but there are lots of ways to do this, such as drinking seltzer with a twist of lime instead of having an alcoholic beverage or soda.  Out of site out of mind-don’t have a sugar bowl, syrup, honey or other sweeteners sitting out where you will be tempted to use them. Reduce the amount of sugar you use-instead of two packets of sugar for coffee, use one. Eat half a cookie instead of a whole one. Substitute the simple carbs pastries, pretzels, and pasta, with more complex ones such as sweet potatoes, apples, blueberries, carrots, and garbanzo beans. Brain serotonin levels can also be raised by eating foods rich in L-tryptophan, such as chicken, turkey, salmon, beef, nut butter, eggs, and green peas.

• Cut back on social media. Have face-to-face conversations. Power down too much texting, messaging, and scrolling through Facebook adds to anxiety and depression.

• Declare Your Holiday Bill of Rights. You deserve to honor the holidays in a way that works best for you—and to take care of yourself in the process. Use this bill of rights to give yourself permission to make the holidays what you need them to be. Share it with loved ones so they can help support you.

• Straighten Up hunching had a negative impact on mood vs. walking with back straight, chin up, and shoulders back put liveliness in steps and overall mood

• Eliminate negative people from your life, or if you can’t eliminate them, reduce the amount of time you interact with them.

• Take a break: Hundreds of different ways are included at the Take a Break Pinterest site.

• Try the Emotional Freedom Technique (EFT)

• Try Hygge: Pronounced “hue-gah,” the Danish (the Danes are considered the happiest people in the world) term “hygge” means creating a nice, warm atmosphere and enjoying the good things in life with people you most enjoy. It is an absence of anything annoying or emotionally overwhelming and the presence of comforting, gentle and soothing things. Originating in Norway, where it meant well being, the high season of hygge is Christmas. Candles, mulled wine, fire places, blankets and scarves make this long and cold winter season bearable and for many, quite enjoyable. 

• Be nice to someone if for no other reason it will give you a boost. Same goes for volunteering

• Learn something new: Check out “The Best Thing for Being Sad is to Learn Something”

Take a Break: Celebrate Polish Christmas

 The theme for this December’s “take  a breaks” are Polish Christmas customs.

The Polish believe it is good luck to have a spider on your Christmas Tree. There are a variety of legends associated with it, such as the spider wove the blanket for the Christ child; the spiders, who had been chased out in an effort to clean the house, returned on Christmas Eve to enjoy the splendor and crept into the tree leaving behind the lace of their webs.

One popular custom is the pajaki (pie yanki), which some refer to as a deluxe spider condo. Paper chandeliers, or pajaki, are a traditional Polish folk craft designed to brighten up the home with bold spring blooms during the long winter. Traditionally made from reeds, tissue paper, and foil, these ornate decorations can be made from many different items and can be made large or small.

Try some of these links to create your own pajaki:

How to Make a Pajaki Chandelier

Pajaki Chandelier DIY

The Pajaki Has Landed

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

How much do you excuse someone’s behavior because of their “condition/”

How often do you accept inappropriate behavior because you “understand” that the person is sick, dealing with a crisis, addiction or for some other reason? Is it healthy to do this? Is this the compassionate thing to do? Where do you draw the line?

We humans need to be liked, loved, accepted, wanted and needed to one degree or another. To that end, we often put up with a lot to have those needs met. But how helpful is it over looking inappropriate behavior particularly if it’s having a negative impact on you?

Different scenarios call for different things to consider. However, it is important to recognize that it’s not okay to be abused, be it physical, verbal or emotional. Secondly, put your needs first. It isn’t being selfish, but rather a tool to help you come from a place of strength to be compassionate and caring. Allowing yourself to be someone’s “whipping boy,” no matter how you rationalize it, takes a terrible toll on your mind, body and spirit. Finally, mental illness is not an excuse for seriously inappropriate behavior but it’s one very commonly used. If this is an underlying issue, read When Someone Close to You Has a Mental Health Issue .

Bottom line-Accepting unacceptable behavior makes it acceptable.

Below are some scenarios and ways to deal with them

Scenario I: The person has a dementing illness, e.g. Alzheimer’s, a brain tumor, or some other major illness that is negatively impacting cognition. Verbal abuse is very common with dementia patients, posing significant challenges for caregivers. The reason the person is acting out can be rooted in various triggers, which can be hard to determine, particularly if the person has lost the ability to communicate effectively. Remember you didn’t cause the disease so don’t blame yourself for something out of your control.

• Try to remember that this is not abuse or aggression toward you.

• Remain calm and don’t respond with anger, fear, alarm or anxiety if at all possible.

• Be clear about the person’s diagnosis and talk to their medical provider about what you are experiencing

• Try to determine what the triggers are and eliminate them

• Try various approaches to avoid the inappropriate behavior including: regular physical activity (short walk); social interaction; giving them an activity they can do such as caring for plants, washing dishes; music, art and pet therapy

• Don’t go it alone. Get help. If this is too damaging a situation, you are not a bad person if you need to stop being a caregiver.

Resources

• How to address anger and aggression from a loved one with dementia from AARP 

• Verbal Abuse from Elderly Parents is Really Responsive Behavior 

Scenario II: A provider abused by a patient. Provider abuse is so common, particularly among nurses, it’s considered to be part of the job description. It’s not okay.

• Know what type of policies and procedures your medical facility has put in place to protect staff, If they have an “acceptable behavior agreement” contract, or a provider “bill of rights,” which the patient is required to sign, use it. These agreements outline inappropriate patient behaviors, how this impacts staff as well as delivery of care, and consequences if behavior continues. Patients often don’t understand how their negative behavior impacts those around them let alone their care. If your facility does not offer such an agreement, work with them to put one in place.

• Get help, particularly if the person becomes violent

Resources

• How Medical Providers are Treated by Patients Impacts Their Care 

• A Tool to Handle Verbally Abusive, Difficult Patients 

• Why Violence Against Nurses Has Spiked in the Last Decade 

• 10 Terrific Tips for New Nurses Dealing with Difficult Patients 

Scenario III: Domestic Abuse- Chronic conditions are linked with domestic violence. Even while they are still in an abusive relationship, many do not make the connection between their health conditions and their past relationships, and even more alarmingly, neither do health professionals.

This type of abuse knows no gender but women are more apt to report it while men are far more ashamed about it and are less likely to do so. It’s important to understand that abusive behavior and violence is a deliberate choice made by the abuser. It’s about power and control and they will use a wide array of means to get or exert it-humiliation, violence, isolation, threats, intimidation, denial, blame etc. This is not a sign of love or respect and the sooner one is out of such a relationship the better for all.

It’s also important to recognize that many assume that domestic abuse and violence is associated with a mental illness. As it turns out, there are a few mental illnesses or disorders that can increase the risk of abusive patterns. Overall though, abuse and mental illness are very separate. Even if they do have a mental health issue, abuse is never okay.

• Learn more about Domestic Violence and Abuse and what can be done about it.

• Call or log onto the National Domestic Violence Hotline  at 1-800-799-7233

• Check out other resources: Domestic or Intimate Partner Violence from Women’s Health  Does Mental Illness Cause Abuse

Scenario IV: The person is using drugs/alcohol Abusive behavior is very common by those who are addicted. The spouse of an addict very often bears the brunt of both the blame and the abuse. It’s hard to do anything right. He or she is not supportive. Mental and emotional abuse may be directed at the spouse to completely shut down any ability to effectively fight the real problem—the addiction. It’s very common for spouses and significant others to be browbeaten into submission, often for years. Of course, physical violence is a very real possibility, especially toward spouses, children, elderly parents—particularly those people who can’t fight back. Narcon 

Don’t be an enabler and put up with inappropriate behavior,  Check out the

14 Rules for Dealing with Addiction

Related posts

• The Difference Between Helping and Enabling

• When Your Tired of Being Taken Advantage Of

• When Someone Close to You Has a Mental Health Issue 

• Those You Help May Reject You and How to Avoid It 

• They Ask for Help, You Try, But Nothing is Right 

7 Ways to Protect Yourself from Outrageous Medical Bills

7 Ways You Can Protect Yourself From Outrageous Medical Bills

November 29, 20172:27 PM ET

Marshall Allen

From

Eva Bee/Ikon Images/Getty Images

A doctor offers a surgical add-on that leads to a $1,877 bill for a young girl's ear piercing. A patient protests unnecessary scans to identify and treat her breast cysts. A study shows intensive care-level treatment is overused.
ProPublica has been documenting the myriad ways the health system wastes money on unnecessary services, often shifting the costs to consumers. But there are ways patients can protect themselves.
We consulted the bill-wrangling professionals at Medliminal, one of a number of companies that negotiate to reduce charges for a share of the savings. After years of jousting with hospitals, medical providers and insurers, their key advice for patients and their families is to be assertive and proactive.

Here are seven steps patients can take to protect themselves:

1. Make sure the proposed test or treatment is necessary. Ask what might happen if you don't get the service right away.
2. Ask the price before the test or treatment. (Prices may not be negotiable if they're set by an insurance company contract.)
3. Write on your financial agreement that you agree to pay for all treatment by providers who are in-network, which means they have set rates with your insurance company. (The medical providers may not accept the altered form.)
4. If possible, get the billing codes the medical provider will use to charge you and contact your insurance provider to make sure that each code is covered.
5. If you are having a procedure, try to get the National Provider Identifier and/or Tax ID number of the surgeons, anesthesiologists and their assistants. Contact your insurance company to see whether the providers are in-network, which results in the negotiated rates.
6. Demand an itemized bill and then look at each specific charge. Medical bills are often riddled with errors.
7. Ask whether the provider has a financial assistance policy, which could result in a sliding scale discount. Many people qualify, and discounts can range from 20 percent to 70 percent.

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ProPublica is a nonprofit newsroom based in New York. You can follow Marshall Allen on Twitter:@marshall_allen. Have you seen examples of wasted health care spending? Share them with Marshallhere.

Take a Break: Try Processing Speed Training

New research indicates that a type of brain exercise-processing speed training-could reduce the risk of dementia risk by 30%.  While a lot more research is going to be needed to confirm that, in the mean have some fun by trying some processing speed training.

Queendom Mental Speed Test

On The Brain

Let the Brain Games Begin from AARP

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.