You snooze, you lose?

I've always wondered at my patients who get up early--really early--to go exercise. Losing sleep to lose weight may be a losing proposition. Multiple studies suggest that short sleep duration is associated with obesity. So sleep in and skip the pumpkin latte--that's a better strategy for health.

I tell people to think of this like a marble in a
bowl of Jello-- you can compress the Jello, but the
marble won't compress or change size.
Richard G. Barr, MD

Elasticity breast imaging. Doesn't sound like a test at which aging women would excel.

Elasticty ultrasound, however, may be an up and coming way to evaluate suspicious breast lesions. If the results of a study of 80 women are confirmed in larger samples, this test may some day significantly reduce the number of unnecessary biopsies.

The new technology measures the movement of tissue, and malignant tissue just doesn't wiggle like a bra-ful of jelly. In the small series of 80 women with suspect breast lesions, the elasticity ultrasound correctly identified 100% of the cancerous tumors and was 99% specific in identifying only cancers and not benign growths.

Slouch not

But neither should you sit at the computer in a bolt upright postion. Scientists have confirmed that book-on-head perfect posture is as hard on the backbone as schlumping in our chairs like vultures feeding on prey.

The Scottish radiologists used MRI imaging to watch the effects of various seated postures on the back dynamics of young adult volunteers. The first scans were done while the subjects were lying on their backs, a position which stresses the discs between vertebrae not at all. Subsequently, the group was positioned for follow-up imaging while sitting upright in a "90% position" with the spine at a right angle to the thighs, again while slouching forward as if hunkered over a keyboard, and finally while reclining slightly with knees below the level of the hips "much the way a Formula One race car driver sits in the cockpit of the car."

Turns out that race car drivers have the formula one should use while seated through the workday. When the angle of the trunk to the thighs is 135 degrees, the MRI's demonstrated the least amount of squash to the intervertebral disc and the central nucleus pulposus (the part of the disc that gooshes out with ruptures) remained well-centered.

For those of us who do not work out of racing cockpits, the doctors recommended sitting on a well-inflated exercise ball high enough to allow our knees to drop below the level of our hips. Try scooting forward in your chair right now so your knees drop down and your feet hook back behind the front legs of your chair. My lower back feels better already!

Brush and dab bests scoop and smear

Those of you of a 'certain age' are trying to come to grips with colon cancer screening. If you are like me (she says smugly), you've signed up for your colonoscopy or already have had it. If you're like me in 2005, you're fretting endlessly over whether or not to have a colonoscopy at all.

In the a-little-is-better-than-none-at-all world of colon cancer screening, perhaps you have agreed to have your stool analyzed for occult blood. The rationale behind stool testing is that precancerous polyps or early colon cancers tend to bleed in a microscopic sort of way. So even though you can't see it, special tests can detect even small amounts of blood in your solid waste.

A recent study out of Australia suggests that scraping at your stool and smearing it on a card is yesterday's news, and thank heavens for that. Instead, a tidy little test called InSure which allows you to swish a brush over your production as it sits in the toilet and then dab the results onto a mailing card is not only more agreeable to perform but more accurate.

The InSure test was half again more likely to detect a cancer and nearly twice as likely to detect a complex polyp called an adenoma--a colonic goomba with cancerous potential. So until you get up the nerve to go for the scope, request the InSure test for your annual close encounter of the turd kind.

Falling often, and falling fatally

People are living longer as frailer adults, more prone to falling. As a result, the rate of falls resulting in disability or death is significantly higher than it was a decade ago.

My frail old mom just started using a Soloflex Whole Body Vibration system (www.soloflex.com) in the last few weeks. This device--a sleek black bench low to the floor--is supposed to enhance muscle and blood vessel tone, balance, and bone strength in just 10 minutes per day.

Unfortunately, one small step up on a shaking platform is one small step too much for a shakey old lady. So she sits on the side of her bed with only her feet on the bench for her daily 'work-out.'

Interestingly, just this little shake-up has resulted in increased feeling in her numbish feet. I am hopeful that more sensitive feet means surer footing as she navigates around her apartment.

The British Medical Journal studied smokers and their deteriorating lung function over a lifetime of inhaling.

By the time the study subjects first became symptomatically short of breath around age 58, they had lost 50% of their lung function. They were severely disabled by age 65 when their lung function was 75% gone, and by age 70 they were dead of COPD (chronic obstructive lung disease).

Those smokers, however, who quit at age 45 added 10 additional years on to the point at which they were first symptomatic, and did not experience severely disabling symptoms until age 75. And finally, those smokers who quit at last with the onset of severe disability at age 65 added 5 addtional years to their life.

If it's not one cancer...

Then it's another. As if getting successfully through one cancer diagnosis is not triumph enough, Danish investigators sorting through a half million records found that women who survived breast cancer had a 25% increased risk of contracting a new primary nonbreast cancer in 57 years of follow-up compared with women cancer-free from the outset.

The scientists suggested several reasons why this might be so including: a genetic susceptability to cancer, shared environmental risk factors, the result of previous cancer treatment, and increased surveillance.

Flu shots

We will finally have flu shots available next week. If you have not yet gotten one, consider making an appointment to get vaccinated soon. While most people survive the flu, it can certainly take a week or two out of your life.

Coughing it up in the waiting room

My waiting room, not necessarily a pleasant place to sit through the cold and flu season. Two things to consider before you join the hackers and wheezers out front:

1. This from the latest issue of the NEJM:

Cough after acute bronchitis typically persists for 10 to 20 days but occasionally may last for 4 or more weeks.

If you're no longer feeling ill but still coughing, join the crowd. Especially in Denver's dry, dusty, cold winter air, coughs go on and on and on.

2. If you need a prompt appointment, consider Thursdays. For some reason, this is a quieter day at the office, and you may be less likely to share air space with someone who's got an illness that you don't want.

Wrinkled old knees

Or rather, a new wrinkle in treating old knees.

Maren Mahowald, a Minneapolis MD, found that botox injections into the aching knees of patients with severe pain from osteoarthritis caused a significant drop in discomfort. These patients were not candidates for knee replacements. Interestingly, the worse the pain, the better the response.

Here's strong praise for the possibilities:

One of the most provocative things that have come down the pike for the treatment of osteoarthritis in a long time.
--Robert Wortmann, MD, University of Oklahoma College of Medicine

Depression is bad for your heart

Well, no kidding. But now investigators are uncovering the specifics as to why depression increases the risk of cardiovascular disease.

In a study published in the Archives of Internal Medicine, Maryland researchers checked out C-reactive protein (CRP) levels in nearly 7,000 people. They found a significant association between depression and CRP which is a measure of inflammation in the body and known to predict cardiovascular risk.

Treatment with antidepressants has been linked to a decreased risk of heart attack in depressed persons, in part scientists theorize because some of these medications have anti-platelet effects. This study suggests, however, a direct link between depression and low level inflammation in the body which in turn is detrimental to blood vessel health.

Bye bye B's

Women who are taking them solely for that purpose [to slow the development of cardiovascular disease] may want to discontinue.
--Christine Albert, Brigham and Women’s Hospital, Boston, Massachusetts

5,000+ women participating in the Women’s Antioxidant and Folic Acid Cardiovascular Study were randomized to folic acid/B12/B6 supplements or not to see if lowering their homocysteine levels with the B vitamins would lower their risk of cardiovascular disease.

Over 7 years of being B-less or B-ful, no differences were noted in the rates of heart attacks or strokes. Dr. Albert noted that these findings "provide support for homocysteine as a marker of pre-existing CVD rather than a risk factor."

Brains vs. Breast

This is not a commentary on the merits of beauty pageants, but rather additional information for those of us who dither endlessly about the best therapeutic course through menopause and beyond.

Finnish researchers took samples of normal breast tissue obtained at the time of tumor surgery from otherwise healthy women. When these breasts cells were nurtured in the laboratory along with estradiol and/or medroxyprogesterone (aka Provera), all hormonally-exposed cells demonstrated increased growth, decreased apoptosis (the normal death of breast cells that occurs on a regular basis throughout our reproductive lives), and a loss of differentiation. In other words, the cells increased in number causing them to become more susceptible to potential carcinogenic mutations while losing characteristics of normal breast tissue. Arggh! Time to flush the estrogen down the toilet?

Up the road a ways at the brain, however, the news was better. Noted neuroscientist Roberta Diaz Brinton and colleagues cultured cells in the lab as well, checking for the effects of estradiol on neurons. Hippocampal cells (the little darlings in charge of memory function) ducked destruction from beta-amyloid protein--the Alzheimer's villain--when they were pretreated with estradiol prior to amyloid exposure.

While we wait for Dr. Brinton and others to identify an estrogen-like molecule that neurons love but breast cells ignore, which will it be, brains or breasts?

No more delicious, crispy, french fries for me

Trans fats, can live without them. These manufactured fats start life as a perfectly worthy vegetable-derived fatty acid molecule that's bent in at least one position on its long carbon chain--called a cis unsaturated fat. As a result of a partial hydrogenation process, the newly straightened out trans fat molecules are: 1) solid at room temperature, 2) resistant to aging in a rancid sort of way, and 3) full of that great fatty mouth feel found in foods we love to eat but should avoid.

Trans fats are known to elevate levels of cholesterol and triglycerides which, in turn, is known to increase risk of coronary heart disease (CHD). The elevated incidence of gummed up arteries, however, attributable to trans fat intake exceeds that which would be predicted by cholesterol levels alone. Trans fats actually upset endothelial cells--the worthy little cells that line blood vessels--causing them to produce cellular alarm signals as if they were under attack by bacteria or traumatized from a bagel knife.

Food manufacturers are now required to post trans fat content on food labels. Be aware that manufacturers of foods that contain less than 500 mg of trans fatty acids per serving are allowed to list their trans fat content as zero.

For those of you who take comfort in the fact--and I hear this a lot--that "there is no breast cancer in my family:

We don't know why most women get breast cancer. Only one out of 10 or one out of 20 has inherited a germline mutation from her parents, so that means that 19 out of 20 women who get breast cancer get it because of something that happened after they were born.

--Devra Davis, PhD, MPH, University of Pittsburgh

Signs of sinusitis

So what's it take to get an antibiotic prescription these days? It's not just the arbitrary whim of a doctor too harried to argue nor a pharmocological sympathy vote for the best hard luck story of the day. I'd like to banish your bug before your long-planned trip to Ireland too, but there is a bit of science to discerning that which responds to antibiotics and a lot to lose if these medications are too freely prescribed.

Researchers at the University of Oslo set out to answer that age-old riddle, how do you tell a Norwegian with bacterial sinusitis from one with just a cold? They identified four clinical factors that separated CT scan proven sinusitis (as in responds to antibiotics) from the great viral pretenders: 1) A history of purulent--as in nasty, colored--drainage from the nose, 2) tooth pain, 3) seeing that yucko stuff in the nose on exam, and 4) an elevation of a blood test called the erythrocyte sedimentation rate which is an indication of inflammation and infection. Sickly Norwegians with three out of four of these miserable signs had an 86% chance of having sinusitis, and the diagnosis could be made quickly and without costly imaging studies.

An additonal important clue noted by Dr. Morten Lindbaek was a history of a two-phase illness that's lasted at least 7 days. In other words, a patient begins with a common cold that abruptly gets worse and lasts longer than average, presumably due to a secondary bacterial sinus infection. Dr. Lindbaek found that the majority of patients with CT-confirmed sinusitis had symptoms for a week or more while those with shorter illnesses generally had clear-headed scans.

Chemobrain

Chemotherapy, especially in women undergoing treatment for breast cancer, can be associated with confusion and memory problems. For several of my patients, the mental fall-out from treatment has been far more distressing than the cancer diagnosis.

Several studies of note have appeared recently in the medical literature regarding chemobrain--including its causes, longterm outlook, and treatment:

1. An imaging study done at UCLA utilized PET scan technology to measure changes in blood flow and brain cell metabolism after chemotherapy. They found that key regions in the frontal cortex in charge of memory and 'executive functioning' demonstrated functional changes as much as 10 years after treatment. Lead investigator, Dr. Daniel Silverman, noted: "We found that the lower the patient's resting brain metabolism rate was, the more difficulty she had performing the memory test."

2. Ohio researchers improved focus and memory function in a group of 'chemobrainers,' 94% of whom were women post-therapy for breast or ovarian cancer, with the use of a purified form of methylphenidate (Ritalin) called Focalin. This medication is used for treatment of ADD. Focalin is known to improve function in brain pathways utilizing the neurotransmitter norepinephrine which enhances attention and focus, and chemotherapy is believed to alter neurotransmitter levels.

3. A large study of cancer survivors age 65 and older did not show an increase in dementia diagnoses within the first 2 years after chemotherapy treatment. The authors theorized that chemobrain may cause more short-term changes in memory rather than the permanent and profound disruptions that lead to Alzheimer-like diseases.