What is the harm of sitting?

Have you ever stopped to think about how many hours per day that you spend sitting? Add up the time you spend sitting to have your morning breakfast, your drive to the office, sitting in an office chair for a good portion of the day, sitting to have lunch, your ride home, sitting at the dinner table, and then sitting on the couch or reclining to watch television for hours. For many, this number will total 15 or more hours per day. There have been several recent studies that have shown many negative effects of sitting for long periods. Some of the associations with prolonged sitting include increased cardiac risks, weight gain, worsening of diabetes, and even early causes of death. One study of more than 595,000 adults concluded with a 34% increased risk of death for those who sit 10 hours per day. Another study looking at adults who spent less than two hours per day watching television versus those who spend more than four hours found those who sat more had a 50% increased risk of death overall and greater than 125% increased risk of cardiovascular events including a heart attack. Some reports have suggested that even those who exercise on a regular basis, but sit for prolonged periods are at risk.

So how does sitting cause so many problems? Sitting causes the bodies metabolism to slow causing physiological changes to occur. The risk for a blot clog begins to rise as circulation slows. Sitting causes both blood glucose (blood sugars) and triglyceride levels to also increase. We also know that sitting is not good for the spine. The supporting muscles become tight or overstretched, depending on sitting postures. Sitting places twice as much stress on the spine and discs as standing does. Studies have shown continuous sitting to reduce the height of the L4-5 disc and also has the potential to cause reduced range of motion leading to back pain.

While there are many lifestyle changes that can be made to reduce the amount of time sitting, most of us do not have the option of how we work during the day. If you have to sit, here are a few recommendations to lower some of the potential risks:

1. Stand up and walk around every 30 minutes
2. Consider a standing workstation, if possible
3. Reposition computer monitors and keyboards so that you are not “hunched over” while working
4. Stand while making telephone calls
5. Sit upright with good posture to maintain the natural curve of the back.
6. Stretch on a regular daily basis
7. If sitting for prolonged periods, take a 5 minute break frequently to exercise the hips, knees, and feet.
8. Get up an walk after eating snacks/lunch

The bottom line…. Focus on ways to change your daily sitting habits to incorporate more periods of standing, walking, and exercising whenever possible.

What is Arthritis?

The term arthritis is commonly used to represent a disease process that occurs only in the elderly. In reality, it is estimated that over 52 million adults have some form of arthritis and it is the number cause of disability in the U.S. Nearly half of those who have arthritis have limitations with their normal daily activities.   With a population that is living longer, these numbers are expected to grow considerably in the next decade. When we say arthritis what does it really mean?

According to the Arthritis Foundation, arthritis is a general term referring to joint pain or joint disease.  There are approximately 200 types of arthritis which can be classified into seven groups:

• Degenerative arthritis (most common form)
• Inflammatory arthritis
• Infectious arthritis
• Metabolic arthritis
• Soft tissue musculoskeletal pain
• Connective tissue disease
• Back pain

There is no single cause of arthritis.  Most forms of arthritis are caused by a combination of contributing factors (personal, environmental, and genetic) while the cause of some forms of arthritis remains elusive.

Several risk factors for arthritis have been identified.  These can be divided into modifiable risk factors and non-modifiable risk factors.  Obesity, injuries, and occupation are all known to lead to the development of osteoarthritis.  These are risk factors that have the potential to be modified.   Age, sex, and genetics are the non-modifiable risk factors associated with various forms of arthritis.

In addition to the adult forms of arthritis, there are several known forms of childhood arthritis known as Juvenile rheumatoid arthritis, juvenile chronic arthritis, and juvenile idiopathic arthritis.  Approximately 1 in 250 children in the U.S. under the age of 18 has been diagnosed with a form of childhood arthritis.

Symptoms of arthritis vary considerably amongst the different types.  The onset can be abrupt or can develop gradually.  The most common symptoms include pain in one or more areas, swelling, and joint stiffness. Treatment is aimed at managing these symptoms to control pain, minimize structural damage, and improve quality of life.  Common treatments for arthritis include various medications, injections, therapies, splints, patient education, support groups, weight loss, and surgery.

New treatment approaches utilizing biologic agents and targeted drugs are being studied in the hopes of finding a cure for the various forms of arthritis.

Can the number of moles predict risk of Melanoma?

Rates of melanoma have been rising for over 30 years in the U.S. It is expected that nearly 9900 people will die this year from Melanoma. According to the American Cancer Society, the lifetime risk of melanoma is 1 in 40 for whites, 1 in 200 for hispanics, and 1 in 1000 for blacks. Approximately 74,000 new cases of melanoma will be diagnosed this year.

Mole or nevus as they are also known, are benign pigmented tumors. While most moles will remain benign, it is believed that a person who has many moles has an increased likelihood of developing melanoma. In fact, a prior study published in 2014 concluded that those with moles were 4.6 more times likely to develop melanoma than those without moles.

A recently published study in the British Journal of Dermatology has determined that the number of moles on a person’s right arm may predict risk of melanoma.

A team of researchers from the Department of Twin Research and Genetic Epidemiology at King’s College, analyzed data from over 3500 caucasian twins during an eight year period. Specially trained nurses counted freckles and moles on 17 body areas of each subject. The findings of the study indicate that the number of moles located just above the right elbow was the strongest predictor of mole count over the whole body. More specifically, women with at least 11 moles on their right arm were more likely to have over 100 moles on their entire body. This equates to a 5 times greater risk for developing melanoma, according to the study.

A smaller study of 400 subjects was also conducted which did replicate the major findings.

If this finding were to hold up, this could have important implications for primary care medicine. This could allow earlier detection of those at risk for melanoma.

References:

Ribero S et al. Prediction of high naevus count in a healthy uk population to estimate melanoma risk . British Journal of Dermatology. 2015.

https://www.epworth.org.au/About-Us/News/Pages/Moles-and-the-risk-of-skin-cancer.aspx

Should I be taking a daily Aspirin?

Data from ongoing research has suggested that the daily use of aspirin is beneficial for protecting against heart attacks, strokes, certain cancers, and possibly treatment for neurodegenerative diseases such as Parkinson’s and Alzheimer’s. With this in mind, should all adults be taking a daily aspirin.  

In September 2015, the U.S. Preventative Services Task Force released new guidelines recommending aspirin to protect against heart disease and colorectal cancer. However, the guidelines are intended for those ages 50 to 69 with an increased risk of heart attacks or strokes and are not at increased risk for bleeding.

To understand why someone should or should not take daily aspiring requires a good understanding of how this drug truly works.  Aspirin is a synthetic compound derived from an ingredient found within the bark of a willow tree.  Aspirin helps reduce fever, pain, and inflammation in the body and stops platelets from sticking together and forming clots. When blood platelets are able to clump together, a clot can form a block an artery causing decreased blood flow to the heart or brain leading to a heart attack or a stroke. The obvious benefit of aspirin is that is minimizes these potential risks. However, there is a downside to this. Normally when we cut ourselves the platelets clump together at the site and form a plug to prevent blood loss. This can lead to increased bleeding amongst those who use aspirin. Aspirin also carries the risk of increased stomach ulcers and gastrointestinal bleeding especially in older patients. While aspirin can help prevent against an ischemic stroke, the risk of a hemorrhagic stroke (bleeding) that may occur from a fall and hitting your head is increased.  Tinnitus (ringing in the ears) and asthma can also occur in some who take aspiring.

A survey of over 2500 adults in the U.S. aged 45 to 75 years old published in the American Journal of Preventative Medicine (2015) showed that over 52% of respondents were taking aspirin. Of those surveyed without a history of cardiovascular disease, 47% were taking aspiring daily.

In considering risks and benefits, the daily use of aspirin for those who have had a prior heart attack, stroke, or TIA is often recommended by physicians to prevent a second episode.  Others middle aged adults who have not had aheart attack or stroke may still benefit from daily aspirin use if they have personal risk factors for or a strong family history of cardiovascular disease, stroke, or diabetes.

So where does the rest of the population fit in with regards to taking aspirin? The evidence for primary prevention of a first heart attack or stroke is still not clear cut. Research appears to be pointing to including daily aspirin use in some disease prevention and treatment guidelines, but caution still remains.  The risks of use may outweigh the potential benefits in healthy individuals with little or no risk factors.

Aspirin should not be taken unless directed by a physician.

References:

Williams CD, Chan AT, Elman MR et al. Aspirin use among adults in the U.S.: results of a national survey. American Journal of Preventative Medicine. 2015 May; 48(5): 501-508.

U.S

Preventative Task Force Aspirin for the prevention of cardiovascular disease http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/aspirin-for-the-prevention-of-cardiovascular-disease-preventive-medication

Predicting the trends in medical care for 2016

As most of us have experienced, healthcare has gone through some dynamic changes in the last few years.  There is intense focus on improving health outcomes, making access tocare easier, and utilizing technology to expand treatment. At the same time, increasing costs for patients, medical providers and health organizations along with an upcoming Presidential election later this year also will certainly affect this year’s trends in healthcare but how and to what degree is unknown.

Perhaps the biggest area of innovation that is expected to continue with tremendous growth in 2016  is the development of consumer medical applications and wireless health technology.  This includes the long list of activity wrist bands that track everything from blood pressure to heart rate to sleep patterns.  A recent study by Frost and Sullivan found that approximately 16% of those surveyed already are using this type of technology and 24% utilize some type of medical app.   These type of activity sensors combined with mobile apps allow users to maintain a better sense of control over their own health and are able to do so with real-time information and convenience.   This should help drive preventative care.

Speaking of convenience, more and more care clinics are popping up in local neighborhoods, grocery stores, and pharmacies.  This adds more options for patients and consumers who are looking to remove the burden of making an appointment with their usual office based medical care provider.  Many hospital systems are expanding their services with networks of  convenient care clinics. 

Telemedicine is here to stay!  Medical care is offered 24 hours per day 365 days through the use of a computer, tablet or smartphone.   E-visits take place over a secure internet connection and these virtual visits are offered by an increasing number of providers for simple health concerns such as colds, back pain, and headaches.  Many of the practice sites offer credit card payment options, although some insurers are now beginning to pay for E-visits.  This offers patients another avenue of access to medical care without having to make an appointment  while offering the utmost in conveience. The big concern with this is cybersecurity.  2015 saw an unprecedented number of major cyber attacks, compromising data and in some cases patients confidential medical history.  Many app companies, insurers, physician practices, and health systems are taking a proactive approach to cybersecurity to make it a priority.

Going deeper in 2016 we are likely to see the continued trend of mergers taking place. We began to see some of the large insurance carriers merge in the last year or so and this will create a handful of powerful players. The same holds true for medical practices and health system consolidation.

Regenerative medicine which incorporates stem cells and cellular therapies is poised to grow with an increasing number of new products coming online, further clinical developments, and a more favorable regulation.

Lastly, the Affordable Health Act (ACA) has been at the center of debate since its inception. Now with the looming Presidental election upcoming, there is the possibility that we can see another major overhaul of our healthcare system take place with ACA being repealed.

Are Annual Physicals Really Necessary?

It is estimated that over 45 million Americans will get a routine physical examination this year. Certain aspects of the annual physical are now covered under preventative care without cost to the patient.

Interestingly, an article written by Dr. Ezekiel Emanuel, who is one of the experts that helped develop President Obama’s health care law feel that for most, an annual physical is “worthless”. He further contends that the cost of annual exams outweighs any potential benefits. This has sparked a great debate over whether the routine annual physical is really necessary.

There has been a greater push for evidence-based medicine. Taken from a 2012 review conducted by an international group of researchers, 14 randomized clinical trials that included over 182,000 people found that annual physical exams do not lower the overall cost of medical care, future appointment, disease-related deaths or even hospitalizations. Some such as Dr. Emanuel further contend that annual exams may lead to further screenings or tests with abnormal findings which have no specific meaning.

While some argue that annual physicals are geared primarily toward insurance companies and billing, many physicians feel that waiting until you are sick to establish with a physician is not the best practice. A one-on-one interaction with the physician in a non-stressed time that may allow a better physician-patient connection and thereby giving the physician a greater overall understanding of the patient. Perhaps a restructuring of the annual physical would be more beneficial? This point has been brought up by some physicians.

Based on the results of large longitudinal population study (Aerobic Longitudinal Study) of over 12,000 people, 99.8% of middle age adults do not manage the 7 primary risk factors in cardiovascular (and other) diseases:

1. Avoid smoking
2. 30 minutes of moderate physical activity daily
3. Control cholesterol levels
4. Manage blood pressure
5. Manage weight
6. Control blood sugar
7. Eat healthy foods

Only 0.2% of the study participants managed all 7 habits in their lifestyle! Fewer than 10% met 5 more of the habits described above. No cardiovascular related events occurred in any of the participants who met ideal levels of the 7 habits during the 20 year period of the study.

Taking this information into account, perhaps risk stratification (presence of medical comorbidities, disease risk factors and medications taken) should dictate frequency of check-ups while those who are asymptomatic may not need an “annual” physical but rather a periodic visit to review preventative and lifestyle factors such as those mentioned in the Aerobic Longitudinal Study.

References:

Emanuel, Ezekiel. Skip Your Annual Physical. New York Times op-ed. January 9, 2015

Drug-Resistant Head Lice

Every year, millions of school aged children get head lice. Typically this has been more of a nuisance problem than a serious illness.

Lice are considered ectoparasites that live exclusively on the human scalp and feed off of human blood. Head lice are wingless insects that spread by close contact between people such as with sharing headwear, combs, brushes, towels and clothes. Head lice live approximately 28 – 30 days and multiply quickly. Female lice can lay as many as 90 eggs and within 15-20 days mature into adult lice. Itching is the number one symptom of lice infestation and may take up to several weeks before this starts. Head lice do not transmit communicable diseases.

It is estimated that as many as 12 million children, most commonly pre and elementary school aged, are treated in the U.S. annually for this disease. Treatment is usually by medication containing the active ingredient, permethrin.

Unfortunately, treatment of head lice is becoming a complex issue. A research team from Southern Illinois University collected lice samples from individuals in over 30 states. Of the samples collected, 104 out of 109 lice populations had gene mutations leading to treatment resistence. To date, more than 25 states have reported resistant head lice. It is believed that resistance to standard medications developed just as antibiotic resistance has. The overuse and misuse of permethrin in this case has led to the development of super lice which make them immune to standard treatments.

Fortunately, several pharmaceutical companies have developed other products that are effective against head lice. Many of these require a doctor’s prescription. The use of home remedies including olive oil, coconut oil, clove oil, and essential oils such as tea tree have also been reported treatments for head lice. While many of these are considered “natural”, the safety and efficacy is unknown.

Keys to treating head lice include using an effective treatment (prescription medication, OTC medication, or natural home remedy), combining the hair carefully to remove nits, vacuuming the home and washing suspected clothing and linens, and daily head checks until infestation is gone. Management of head lice is easier the earlier infestation is identified.

References:

Yook KS et al. In Vitro and In Vivo Evaluation of Infestation Deterrents Against Lice. J. Med Entomology. 2015 2015: 52(5):970-978.