07 November 2018
WEDNESDAY, Nov. 7, 2018 (HealthDay News) — Despite years of attention to the problem, U.S. hospitals have made little headway in preventing severe cases of bedsores among older Americans, a new study shows. Researchers found that across hospitals in three states, the rate of bedsores among Medicare patients dropped by 40 percent between 2009 and 2014. However, the picture looked less positive after the researchers did more digging. Nearly all of the decline was in early stage bedsores — not the deep, severe wounds that can last for years. Plus, the researchers said, it’s hard to know how much of the decrease in early stage bedsores is “real.” The figures come from Medicare billing data — which may not reflect the actual incidence of bedsores among hospital patients. “We’re hoping it’s a true decrease, but we can’t actually tell,” said senior researcher Dr. Jennifer Meddings, an associate professor at the University of Michigan Medical School. The problem is, the overall rates of bedsores in the billing records were very low — much lower than what Meddings’ team found using a different data source. That source, based on information from patients’ medical charts, suggests that billing records captured only about 1 in 20 bedsores that Medicare patients actually suffered. Bedsores — known medically as pressure ulcers, or pressure injuries — are caused by staying in one position for too long. They can affect people who are bedridden, use a wheelchair, or otherwise have difficulty moving. Early stage bedsores may appear as red patches on the skin, or a wound that looks like a cut or blister. Advanced-stage injuries are large and deep, affecting tissue under the skin. Pressure injuries are painful and can lead to serious, life-threatening infections, explained Janet Cuddigan, vice president of the National Pressure Ulcer Advisory Panel. The panel is a nonprofit dedicated to preventing the injuries. When the wounds are deep, they are also slow to heal, and leave people vulnerable to developing pressure injuries again, said Cuddigan, who was not involved in the study. She said she was not surprised by the findings, because they echo what some previous research has shown. But this study confirms the pattern in a broader population, Cuddigan noted. “This heightens our awareness that more needs to be done to prevent pressure injuries,” she said. Hospitals have been trying, Cuddigan pointed out. One way, she said, is through “early mobilization” of patients, even in the intensive care unit. Other measures include regularly cleaning and moisturizing patients’ skin and providing enough protein, vitamins and minerals to keep the skin healthy. And it’s not only bed surfaces that can cause pressure injuries, Cuddigan explained. Tubes and other medical equipment can be culprits. Meddings made the same point. If a patient needs an oxygen mask, for example, it can cause a pressure ulcer on the delicate skin behind the ear. “So every day, we need to check behind the ear,” Meddings said. In some cases, prevention is particularly tough. For example, Cuddigan said, a severely ill patient might have a drop in blood pressure each time staff members try a change in position. And moving patients is not as simple as it might sound, Meddings said. It might require a whole “repositioning team” if a patient is quite heavy, for instance. Plus, there’s skill and knowledge involved, Meddings noted. Patients are not simply “turned,” but repositioned in specific ways to limit their bedsore risk. Family members can do a lot to help, however, Meddings said. “Ask questions,” she advised. “If there’s any piece of plastic attached to the patient, you can ask, ‘Is that still needed?’ You can say, ‘When I was helping him put on his sock today, I noticed a red spot on his heel.’ “ Meddings also recommended talking not only to your family member’s doctor, but to the nursing staff, too. “They really are considered our skin care experts,” she said. Cuddigan agreed that families should feel free to speak up. “We want you to be part of the team with us,” she said. The findings are in the November issue of Health Affairs. More information The U.S. National Library of Medicine has more on bedsores.
07 November 2018
WEDNESDAY, Nov. 7, 2018 (HealthDay News) — Although the herbal supplement kratom is still legal and widely available, its opioid-like effects have caused significant withdrawal symptoms in at least two newborns in the United States and that should raise concerns, researchers say. A case study of a baby boy exposed to kratom during his mother’s pregnancy — only the second American case reported — likely signifies a broader trend among pregnant women toward seeking alternatives to opioid painkillers such as morphine, heroin and oxycodone (OxyContin), said study author Dr. Whitney Eldridge. “I think mothers are becoming increasingly aware of the dangers of using prescription and non-prescription opioids during pregnancy,” said Eldridge, a neonatologist at Morton Plant Hospital and St. Joseph Women’s Hospital, both in Florida. “As opioid use among pregnant women has increased, I fear they may see kratom as a potentially safe, legal, non-opioid alternative aid for opioid withdrawal, as its opioid-like properties are not well-advertised,” Eldridge added. In February, the U.S. Food and Drug Administration classified compounds in kratom as opioids, basing its findings on a computer analysis showing it activates receptors in the brain that also respond to opioids. But controversy over kratom — which is sold as a dietary supplement, typically to manage pain and boost energy — remains, as it continues to be sold as a non-opioid remedy for opioid withdrawal. Non-opioid alternatives to treat opioid dependence continue to be researched and scrutinized, experts said. The case study, published online Nov. 7 in the journal Pediatrics, centered on a newborn boy whose mother had a seven-year history of oxycodone use, but who had successfully completed drug rehabilitation. She had last used oxycodone two years before her baby was born, and her urine test was negative for drug use. Kratom — which grows naturally in the Southeast Asian countries of Indonesia, Malaysia, Papua New Guinea and Thailand — is less potent than morphine and doesn’t slow breathing. But 33 hours after his birth, the baby boy in this case study began showing symptoms consistent with opioid withdrawal, including sneezing, jitteriness, excessive suck, scratching at the skin around his face, and irritability. His mother denied using prescription medications, supplements or illegal drugs during her pregnancy, but the baby’s father reported that the mother drank kratom tea daily during pregnancy. She had bought the tea to help with sleep and her own opioid withdrawal symptoms. Treated with morphine and a common blood pressure drug over the next several days, the boy’s condition improved and he was discharged from the hospital at 8 days old. “Prior to this case, I was unfamiliar with kratom and unaware of its potential to be a source of withdrawal for [newborn babies],” Eldridge said. “After caring for this infant, I started to pay attention to how heavily kratom is advertised and realized pediatricians and obstetricians need to be familiarized with its potential to affect our patients.” Further research is needed to “make an educated decision as to how to classify kratom,” she suggested. “It may have a role to play in opioid dependency, [but] currently there is too little data to say what role it should be,” Eldridge added. “Meanwhile, pregnant women should disclose kratom use to their physicians just as they would alcohol or tobacco, and physicians have a responsibility to educate pregnant women about the potential impact of kratom for their newborn.” Eldridge’s sentiments were echoed by Dr. Martin Chavez, chief of maternal-fetal medicine at NYU Winthrop Hospital in Mineola, N.Y. “I think what hit home most with this case study … is that we really have to do a thorough job inquiring what type of alternate medications — whether over-the-counter, holistic or something being provided by a family member — a pregnant woman may be taking,” said Chavez. “The most important thing is, just because it’s not being prescribed doesn’t mean it’s not having a potential impact [on the baby],” he added. “When in doubt, when you’re pregnant or have a newborn, be totally open with your clinician not only about prescription medications, but any other type of medication you may be taking to alleviate symptoms you’re having.” More information The U.S. National Institute on Drug Abuse has more on kratom.
05 November 2018
MONDAY, Nov. 5, 2018 (HealthDay News) — More than 17 million cosmetic procedures are performed in the United States each year. Most of these are minimally invasive, designed to improve your appearance in subtle ways without the surgery, stitches and long healing time of early facelifts, once the only rejuvenating option available. Today’s most popular procedures are: Botox injections to soften lines, with more than 7 million done annually. Injectable fillers to plump folds, 2 million of which involve hyaluronic acid products. Chemical peels and micro-dermabrasion, both of which resurface skin. Laser hair removal. Keep in mind that “minimally invasive” doesn’t always mean zero healing time. It can take weeks for the redness and crusting to disappear following strong re-surfacing procedures that remove damaged top layers of skin. But they don’t involve the surgery and lengthier recovery of facelifts and eyelifts, for instance. And in fact, fewer and fewer of those procedures are being done. With the easy accessibility of peels and injections, people at younger and younger ages are starting to avail themselves of these treatments, even before they have a real need for them. Experts warn not to start too soon — overly plumped lips and a frozen forehead can actually make you look older than you are. They recommend more emphasis on caring for skin from an early age to prevent or delay the need for procedures in the future. If you’re considering having some work done, have a candid conversation with a dermatologist or plastic surgeon to determine which, if any, procedures are right for you, along with realistic expectations of what can be achieved. Remember that these are all true medical procedures that should be performed in a controlled environment by highly trained healthcare providers. Some minimally invasive procedures can be done by a skilled dermatologist while others require a plastic surgeon. More information The American Society of Plastic Surgeons has details on all cosmetic procedures, from peels to surgical options.
05 November 2018
MONDAY, Nov. 5, 2018 (HealthDay News) — Melanoma skin cancer death rates in men are on the rise in most countries, but are stable or declining for women in some, according to a new study. Researchers analyzed World Health Organization data from 33 countries between 1985 and 2015. Melanoma death rates in men were increasing in all but one nation. In all 33 countries, melanoma death rates were higher for men than for women, the study found. Between 2013 and 2015, the highest three-year averages were in Australia (5.72 melanoma deaths for every 100,000 men and 2.53 per 100,000 in women) and in Slovenia (3.86 per 100,000 for men and 2.58 in women). Japan had the lowest rate of melanoma deaths, 0.24 per 100,000 for men and 0.18 for women, researchers reported. The Czech Republic was the only country with a decrease in men’s melanoma death rate, with an estimated annual drop of 0.7 percent between 1985 and 2015. Israel and the Czech Republic had the largest decreases among women, 23.4 percent and 15.5 percent respectively, over the period, according to the study. The findings are being presented at the United Kingdom’s National Cancer Research Institute (NCRI) annual conference, in Glasgow, Scotland, Nov. 4-6. More research is needed to understand factors underlying the trends, according to study author Dr. Dorothy Yang, a doctor at the Royal Free London NHS Foundation Trust. “There is evidence that suggests men are less likely to protect themselves from the sun or engage with melanoma awareness and prevention campaigns. There is also ongoing work looking for any biological factors underlying the difference in mortality rates between men and women,” Yang said in a meeting news release. “The major risk factor for melanoma is overexposure to ultraviolet radiation, either from sun exposure or from using sunbeds. Despite public health efforts to promote awareness of melanoma and encourage sun-smart behaviors, melanoma incidence has been increasing in recent decades,” she said. Poulam Patel, chairman of the NCRI Skin Cancer Clinical Studies group, said effective strategies are needed to accurately diagnose and successfully treat patients. The study results suggest melanoma will continue to be a health issue, he said. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal. More information The U.S. National Cancer Institute has more on melanoma.
02 November 2018
FRIDAY, Nov. 2, 2018 (American Heart Association) — Creating art and tackling do-it-yourself projects are soothing pastimes for many people, and 37-year-old Amy Cavaliere is one of them. The mother of three from Royersford, Pennsylvania — about a half hour from Philadelphia — enjoys making pallet wall art that combines hand-stenciled words and imagery on stained wood. In fact, she was planning to franchise a popular workshop that offers classes devoted to the activity. “You go in with friends, drink wine and make a custom piece of wooden pallet art for your home decor,” she said. “It’s fun.” Unfortunately, fate had other plans. One morning in February 2017, while getting her children ready for school, Amy felt a heavy sensation in her chest. Her arms began to ache so badly that she couldn’t finish brushing her daughter’s hair. Within minutes, her skin turned pale and she started to hyperventilate. Although Amy had never experienced a panic attack, that was her best guess about what was happening. “What else could it be?” she said. After all, she was young, healthy and active, regularly participating in spinning classes and playing competitive tennis matches against her husband, John Paul. Admittedly stubborn by nature, Amy was adamant that John Paul not dial 911. He did it anyway. Her stubborn streak continued when the paramedics arrived. She insisted upon walking to the ambulance. As paramedics checked her vital signs, she tried to convince them that she was fine. Then her heart stopped. As the ambulance sped to the hospital, paramedic Dave Sauls performed CPR. “I kept expecting her to come out of it,” he said, “but it wasn’t happening.” At the emergency room, the nurses took over chest compressions and continued to perform CPR and AED shocks for nearly 45 minutes. An angiogram revealed a 100 percent blockage of her left anterior descending artery. This type of heart attack is commonly known as the widow maker. Worse yet, the blockage was caused by spontaneous coronary artery dissection (SCAD), meaning a tear in the artery wall. SCAD is a rare event that occurs mostly in women (about 80 percent), with an average age younger than 50. Other disorders are believed to make people more likely to suffer SCAD. One of them is a disease of the blood vessels called fibromuscular dysplasia, which Amy was later diagnosed with having. At her local hospital, doctors decided she needed more specialized help than they could provide. Amy spent nine days in a medically induced coma. Once she awoke, she saw John Paul sitting at the foot of her hospital bed. She had no idea of what had happened. After the sedatives and other medications left her system, Amy felt so wired she couldn’t sleep a wink for two straight days (“my eyes were like saucers,” she said). Watching the clock tick away hour by hour, she was terrified she could experience another heart attack at any moment. Any sort of chest pain causes her anxiety to this day. “Since I don’t remember what it felt like, I don’t have a frame of reference,” she said. “It’s terrifying — the inner turmoil of a cardiac patient.” After 21 days in the hospital, and surviving bouts of double pneumonia and a narrowing of her trachea, Amy was released. It took more than a year for her to start feeling like herself again. Although her heart function is permanently compromised, she is working to build strength and stamina. In the past, Amy didn’t consider it a workout unless she was drenched in sweat. But that’s no longer possible. Nor are the competitive tennis matches with John Paul. “It’s been a hard adjustment,” Amy said. “I had to shift my mentality a bit. It’s about how much I can get done before my heart rate hits 160 bpm.” One day, Dave Sauls, the paramedic, received a Facebook message from John Paul. Dave had heard Amy died. So, of course, he was “flabbergasted” by the message that said she was recovering at home. “It was a gift from God in my life and something I needed at the time,” he said. “I sat there and cried.” Since then, Dave and Amy have become close friends. He has trained many of her friends in CPR. Eager to raise awareness about women’s heart health in general and SCAD specifically, Amy has recorded local public service announcements and attended fundraising walks. “I look at it as my responsibility to warn other women that this can happen to anybody,” Amy said. “I didn’t believe that it could happen to me, and my stubbornness almost cost my kids their mother.” While it still stings that somebody else bought the home decor and art-making franchise that Amy wanted to buy into, she continues to make and sell her own pieces. She uses the name Heartwood, which her children suggested. “This,” she said, “is my therapy.”
02 November 2018
FRIDAY, Nov. 2, 2018 (HealthDay News) — The hour you “lost” with daylight savings time in the spring you “gain back” on Sunday, when clocks are set an hour back. And every time shift takes a subtle toll on the human mind and body, experts say. Still, “for most people, it is easier to stay up an hour later than to go to bed an hour earlier,” said Dr. Steven Feinsilver, who directs sleep medicine at Lenox Hill Hospital in New York City. “This is thought to be because for most of us our ‘internal clock’ is closer to a 25-hour cycle than a 24-hour cycle.” He said the furthest you can comfortably shift your internal clock is about an hour a day, and “what sets [your] clock is the wake time more than the bedtime.” Feinsilver said that to get back to a normal sleep rhythm, “set the alarm for your target time and get out of bed when it goes off, even if your night sleep was not perfect. “For the time change, set the alarm for Monday — for most of us the Sunday morning wake-up is less critical — and enjoy the extra hour,” Feinsilver said. A single night of imperfect sleep is easily gotten over — “it is when bad sleep becomes a habit we get into trouble,” he said. Feinsilver’s advice is to try to sleep a regular seven to eight hours — and “stick to a constant wake time.” Triggers such as light, food and exercise are the cues that tell your body what time it is. “Getting exposed to light early in the day wakes us up,” Feinsilver said. “This is harder in the winter when there is less and later light, but the autumn time shift helps a bit.” Dr. Daniel Barone is a neurologist and sleep medicine expert at the Center for Sleep Medicine at New York-Presbyterian/Weill Cornell Medical Center in New York City. He said that people shouldn’t expect that the extra hour of sleep they’ll get on Sunday will erase any accumulated “sleep debt.” “We as a society sleep one hour less than we did 100 years ago, so we are still ‘behind the clock’ so to speak when it comes to being sleep-deprived,” Barone said. He said the body’s sleep clock can be directly affected as autumn days grow shorter and people spend more time indoors. The body manufactures vitamin D via sunlight’s action on the skin, and too little vitamin D can affect sleep and emotions. “When you’re not getting as much sunlight, it has an effect on your mood,” Barone said. For some people, this can even mean the onset of a kind of depression known as seasonal affective disorder (SAD). Barone offered these tips for better sleep: Switch to LED lightbulbs. They’re made to simulate sunlight and can help you maintain a healthy circadian rhythm as seasons change. Cut out the evening nap. Dozing off after dinner sends confusing signals to your brain that can make bedtime later more challenging. Try mindful meditation. It can cut stress and encourage healthy sleep. Ban TVs, smartphones and laptops from the bedroom. The backlight display can disrupt sleep if used before lights-out. Keep bedrooms dark. Light creeping in can send a wake-up signal to the brain. If you’re still having trouble sleeping, consult a sleep specialist for testing, Barone said. “If you’re continually waking up in the night or you’re constantly waking up tired, a sleep test is definitely warranted,” he said. “We should view sleep as something that’s sacred,” Barone said. “Our bodies are designed to get seven to nine hours. In this 24-hour society, a lot of times the amount of sleep we get suffers. We should focus on getting good-quality sleep and dealing with any problems that exist.” More information There’s more on getting good sleep at the National Sleep Foundation.