by Specialdocs Consultants, LLC | Nov 20, 2017 | Medical Conditions, Patient News
If you’ve ever wondered why a blood pressure check is part of almost every visit to a doctor’s office, consider what is communicated through the familiar black cuff in just a few seconds. The force of blood pushing against the walls of the arteries as the heart pumps is a critical measure of how well your heart muscle works – systolic blood pressure (SBP, or the top number of a reading) measures the pressure in the arteries when the heart beats; diastolic blood pressure (DBP, or the bottom number) refers to the pressure in the arteries when the heart muscle is resting between beats and refilling with blood.
Readings that exceed the norm, hypertension or high blood pressure, indicate an increased risk of heart attack, stroke and kidney failure. However, exactly what constitutes ‘normal’ blood pressure for optimal health has been debated and tested for decades, and recommendations have fluctuated over time. While the gold standard is under 120 mm Hg/80 mm Hg, the targets for treating hypertension have varied over the years – less than 140/90 in the 1990s, down to 130/80 in 2003, raised to a controversial 150 or less in 2014, and retreating to less than 140 in 2015.
At the end of 2015, a landmark study of more than 9,300 patients, the Systolic Blood Pressure Intervention Trial (SPRINT), moved the needle down even further. Those who were treated most aggressively to drive down blood pressure to 120/80 experienced a significantly lower risk of cardiovascular events, chronic kidney disease, and death. In fact, the outcomes were so convincing that the trial was actually halted after just three years, much sooner than planned, leading the American Society of Hypertension to state: “The early termination of this trial represents an exciting moment in the history of hypertension treatment.” Still, notes of caution were sounded because multiple medications were required, sometimes causing adverse side effects, and experts
agreed more study was needed to justify changes in clinical practice. Additional evidence followed this year, with an analysis of adults aged 75 years and older who participated in the SPRINT study. The benefits of lowering blood pressure to 120 were even more pronounced, resulting in a one third reduction in risk of cardiovascular events and death, even among the frailest older patients. This finding could benefit almost six million seniors over 75 with elevated blood pressure, according to the Journal of the American College of Cardiology.
While the outcomes are promising, and point in an even more downward direction, experts have not yet reached a consensus on optimal blood pressure targets. For now, hypertension patients should consult with their doctor to determine whether this lower goal is best for their individual care.
Who’s at risk? Virtually everyone
Even those who don’t have high blood pressure by age 55 face a 90 percent chance of developing it during their lifetime, so learning how to identify, prevent and control hypertension can benefit us all. Consider these best practices:
Identify.
- Regular checkups are key, as people can live with high blood pressure for years without experiencing any symptoms while internal damage to other parts of the body may be silently occurring.
Prevent.
- Keep a healthy weight: in an overweight person, every 2 pounds of weight lost can reduce SBP by 1 mm Hg.
- Eat well: a diet rich in fruits, vegetables, and lowfat dairy products can reduce SBP by 8 to 14 mm Hg.
- Limit sodium: (see Nutrition Corner, below)
- Keep active: 30 minutes of aerobic activity most days of the week can reduce SBP by 4 to 9 mm Hg.
- Moderate alcohol consumption: for women, a single drink a day may lower SBP by 2 to 4 mm Hg.
- Quit smoking: not only does smoking raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls.
Control.
- If lifestyle measures alone are insufficient, your physician will determine the appropriate medication, which may include diuretics, beta-blockers or ACE inhibitors.
The post Bring It Down: Healthy Blood Pressure Numbers May Go Even Lower appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Medications, Patient News
Nothing erodes the quality of life faster than pain and unfortunately more than half of American adults report they live with it on a chronic, recurring basis. That makes it easy to understand why, when seemingly safe, effective opioid drugs became widely available in the 1990s, they were quickly embraced by physicians and patients. Considered one of the most promising developments in pain management in decades, opioids such as oxycodone (OxyContin, for example), hydrocodone (Vicodin) or meperidine (Demerol) had already proved highly effective on a short-term basis to treat acute pain. The mechanisms were clear: opioid molecules travel through the bloodstream into the brain, attach to receptors on the surface of certain brain cells and trigger the release of dopamine in the brain’s reward and pleasure center.
However, what was not known was how patients reacted to these medications when taken daily for weeks, months and years to treat chronic conditions ranging from headaches and stubborn lower back pain to neuropathy, fibromyalgia and severe degenerative joint disease. As use of opioids for chronic pain (defined as lasting longer than three months) became widespread, reports of unwanted side effects emerged, along with doubts about long-term efficacy and optimal outcomes. Most alarmingly, the potential for abuse and addiction materialized into a full-blown crisis, evidenced by stark statistics like these:
- Opioid prescriptions increased 7.3% from 2007-2012; by 2013, 1.9 million people were reported to be abusing or dependent on opioids. As many as 25% of people prescribed opioids on a long-term basis struggle with addiction.
- 165,000 Americans died from overdosing on prescription opioids from 1999-2014, climbing from 3 deaths per 100,000 people to 9; the highest rates were seen among 25 to 54-year-old white Americans.
Clearly, sweeping changes were needed, and in response, new recommended guidelines for safer pain management were issued by the Centers for Disease Control (CDC) last spring, and received
strong endorsement from well-respected organizations including the American Academy of Pain Medicine and the American College of Physicians (ACP). According to ACP, the recommendations are “reasonable, based on the best available evidence, and find the right balance between educating about the hazards of opioids while recognizing special circumstances where such medications may be an important part of a treatment plan.” The recommendations specify best practices for dosage levels and usage, and raise awareness of the risks posed to all patients by the drugs. Please note that these are recommendations only and may be altered at the discretion of the physician treating you to fit your unique needs. These include:
- Non-pharmacologic and non-opioid therapy are preferred for chronic pain. Opioid therapy should be used only if expected benefits for both pain and function are anticipated to outweigh risks.
- If opioids are used, they should be combined with non-pharmacologic and non-opioid pharmacologic therapy, as appropriate.
- Physicians should establish treatment goals with their patients before starting opioid therapy, including realistic and clinically meaningful goals for pain and function, and an ‘exit strategy’
should the therapy need to be discontinued.
- Use immediate-release opioids instead of extended-release/long-acting opioids.
- Use the lowest effective dosage, and carefully reassess individual risks and benefits when increasing dosage to ≥50 morphine milligram equivalents per day.
- Prescribe immediate-release opioids for acute pain in no greater quantity than needed for the expected duration of pain – three days or less will often be sufficient, more than seven days will
rarely be needed.
- A frank physician-patient discussion regarding the risks and benefits of opioids should take place before starting therapy. An evaluation of benefits and harms should be scheduled within one to four weeks of starting opioid therapy, and repeated at least every three months. If benefits do not outweigh harms of continued therapy, physicians should explore alternatives (see sidebar) with patients and work with them to gradually taper off to lower doses and ultimately discontinue use.
The post The Painful New Reality of Opioid Prescriptions appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Nutrition, Patient News
While the evidence is not yet in on the enhanced nutritional value of organic or natural foods, consumers appear to have made their own decision. The latest research shows more than 62 percent of Americans now regularly shop for these types of products and pay premium prices for ‘farm to table’ dishes when dining out. Many questions remain, however, chief among them: what exactly is promised by these terms…and do they deliver?
The lack of official guidelines can make it difficult to identify the difference between ‘organic’ and ‘natural’ or ‘cage-free’ versus ‘free-range.’ The Food and Drug Administration (FDA) does not formally define ‘natural,’ but refers to a longstanding policy that interprets it to mean nothing artificial or synthetic has been added to a food that wouldn’t normally be expected, without addressing production, processing or manufacturing methods. Realizing the term is vague, even misleading, the FDA is solicitingpublic input until May and plans to issue more meaningful standards later this year.
For now, “’all-natural’ is more of a marketing ploy,” according to Mick Bessire, agricultural educator at Cornell Cooperative Extension. “Antibiotics can be used in production, or chickens can be raised in battery cages and have their beaks trimmed and still be called natural.”
Other frequently used terms:
Organic: A USDA Organic seal signifies that the product is made without synthetic fertilizers, irradiation, and has not been genetically modified in any way; no antibiotics or growth hormones are used in meats; 100 percent organic feed is used for livestock. The use of food additives and fortifying agents such as preservatives, artificial sweeteners and colors is severely restricted. Usually pesticide-free, too.
Hormone-Free: The best choice for hormone-free meat is products with the USDA Organic label. Hormones are already banned in egg-laying hens.
Grass-Fed: Look for an American Grass-fed Association or Animal Welfare Approved stamp, which guarantee the animal was raised on a family-owned pasture or range. Beyond the humane
benefits, some studies have found that grass-fed beef contains higher levels of healthy fatty acids and antioxidants.
Cage-Free: A voluntary label recognized by the USDA’s Agricultural Marketing Service (AMS) as birds permitted to roam, but generally without access to the outdoors.
Free-Range or Free-Roaming: Another voluntary label that indicates animals have access to the outdoors but type and duration is undefined.
Pasture-raised: Means animals roam freely and eat vegetation in their natural environment.
Certified Humane: Offers more specific guidelines for cage-free, free-range and pasture-raised labels.
White/brown eggs: Does not indicate quality or nutrition levels, but is based on the breed of the egg-laying hen.
Farm-raised fish: Frequently bred to be heavier, grow faster and can contain chemicals versus wild-caught fish. Diner beware though: according to advocacy organization Oceana’s recent study, restaurant customers were misled about salmon 43 percent of the time – ordering sustainable wild salmon as labeled on the menu, but receiving farmed salmon on their plates.
Is it worth the effort? Probably. For example, wild salmon contains far more healthy omega 3 fatty acids than farm-raised salmon. While a recent study from Mayo Clinic showed that many organically and conventionally produced foodstuffs were similar nutritionally, organic foods are inarguably less processed and more sustainable choices – good for our bodies and the environment.
The post Is What You’re Reading What You’re Eating? appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Medical Conditions, Patient News
The aching, swollen, stiff joints associated with osteoarthritis (OA) have long been considered an inexorable result of aging. According to conventional wisdom, cartilage, the smooth connective tissue on the end of bones that cushion the joints, simply breaks down over a lifetime of walking, exercising and moving, allowing the bones to rub together. When medications and physical therapy no longer provide relief, a costly and time-intensive mechanical joint replacement may be the only solution. However, advances in research and a focus on prevention are providing
a new outlook on an ageold problem…we bring you the latest insights, below.
Prevention
The connection between overweight and OA is even stronger than previously thought. Recent studies show that up to 65 percent of cases of OA of the knee could be avoided if weight was reduced. Consider that your knees bear a force equivalent to three to six times your body weight with each step, so a lighter weight relieves the burden considerably. For women, extra weight is even more of a risk factor than men. In addition, fat tissue produces proteins called cytokines that cause inflammation, and in the joints, this can alter the function of cartilage cells. Gaining weight results in your body releasing more of these harmful proteins. However, losing even a few pounds can reduce joint stress and inflammation and decrease by half the risk of OA.
Avoid practicing a sport in an intensive and prolonged way. An injured joint is nearly seven times more likely to develop arthritis than one that was never injured. The condition is now seen more frequently among 30 to 50-year-olds than previously because young athletes or middle-aged ‘weekend warriors’ who tear their anterior cruciate ligament (ACL) or menisci of the knee have a much higher risk of osteoarthritis 10 to 20 years after their injury. Take steps to manage or prevent diabetes, which may be a significant risk factor for OA. Some studies suggest high glucose levels trigger the formation of molecules that make cartilage stiffer and less resistant to stress, and cause inflammation that leads to cartilage loss.
Management
Low impact exercise is key to living well with osteoarthritis. While resting aching joints can bring temporary relief, lack of movement will ultimately lead to more discomfort.
Exercise strengthens the muscles around the joint, acting like a shock absorber, helping to reduce pain. In addition, exercise helps with weight control and is a natural mood elevator. Experts recommend low-impact activities like swimming, walking, biking, and moderate weight lifting. The Arthritis Foundation developed a form of tai chi specifically for people with arthritis,
featuring agile steps and a high stance, that helps increase flexibility and improve muscle strength inthe lower body.
Some new approaches to pain management show promise, but beware of unsubstantiated claims. Platelet-rich plasma (PRP) injections, which involve withdrawing blood, spinning
it to separate the platelets and then injecting the concentrated platelets into a joint, are being studied for long-term effectiveness. Experts advise against costly supplements such as glucosamine, chondroitin and shark cartilage, all of which have proven of little benefit for people with OA. Some elements of Chinese medicine, including herbs and acupuncture, may help control OA symptoms in some people, but these therapies have not yet been confirmed in large, well-designed clinical studies. Also unproven are low-power laser light, copper bracelets or magnets, chiropractic manipulation and acupressure. The most effective over the counter medication are NSAIDs (non-steroidal anti-inflammatory drugs such as Advil). While Tylenol helps reduce pain and is the safest medicine for older people or those with kidney disease, it does not lower inflammation.
Finally, if you do need an orthopedic implant in the future, take comfort in the fact that development of the next generation of devices is well underway. They will likely be biologic, composed of protein and cells instead of metal and plastic,…functioning as well as a normal joint and created to last a lifetime.
The post Joint Assets appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Healthy Aging, Patient News, Wellness
HealthWise presents an ongoing look at research that provides valuable insights to help today’s seniors – and the generations set to follow – create a vibrant next chapter. We have looked at strategies to keep the aging brain healthy and to protect the aging senses. In this issue, we get under your skin to learn how to keep it supple and resilient over the years. Wrinkles. Dry skin. Crow’s feet. Undereye circles. Sagging. Is there a way to stave off these very natural signs of aging? The answer is yes…and no. The thickening of the stratum corneum (the outer layer of the epidermis) which causes drier and flakier skin, is inevitable, as is the thinning of the dermis (underneath the epidermis), resulting in loss of elasticity. Genetics plays a pivotal role in determining when this starts to occur. However, there are a number of preventive steps you can take – some well-known and a few unexpected – which may help mature skin keep its youthful glow at 50, 60 and beyond.
Experts advise:
- Cut your sun exposure in half, at a minimum. UV exposure damages elastin and causes a loss of collagen, which results in sagging, fine lines and wrinkles. Think of sunscreen as the only truly magic elixir to improve skin appearance and health, and most importantly, prevent skin cancer…and choose one with SPF 30 or above and broad-spectrum UVA/UVB protection and use daily. In addition, wear a hat and UV-protective clothing outside, and try and avoid being in the sun when UV rays are strongest, between 11 am and 1 pm.
- Exercise. Another benefit to engaging in at least three hours of physical activity weekly is the positive impact on keeping skin younger, with the potential to reverse skin aging even for those
who start exercising late in life. New research showed that men and women over age 65 who exercised frequently had skin composition similar to 20 to 40-year-olds, with markedly thinner,
healthier stratum corneums and thicker dermis layers. Participants’ skin “looked like that of a much younger person, and all they had done differently was exercise.” Researchers surmised
that myokines, substances created by working muscles, may be responsible for the results, jump starting changes in cells far from the muscles themselves. They also noted that it was
unlikely that any pill or salve would replicate the skin benefits of a workout.
- Take short, lukewarm showers. Long, hot showers strip your skin of its natural oils.
- Protect in winter with a humidifier to add moisture to the home, and gloves to protect your hands from drying out.
- Focus on the right foods and beverages. Include omega-3 and omega-6 fatty acids in your diet, preferably from natural sources such as olive oil and fish, to help protect your skin’s
moisture barrier. Cut back on sugars which promote inflammation and can potentially damage normal production of dermal cells. Avoid high glycemic foods such as white bread and pretzels, which may also be responsible for prematurely aging skin. Drink plenty of water, but moderate alcohol intake – red wine can dilate blood vessels and contribute to rosacea, a skin irritation.
- Establish a smart night routine. Remove all makeup and wash your face before bed to eliminate the pollutants that break down your skin’s collagen all day. Then apply a retinoid followed
by a moisturizer.
- Get a good night’s sleep. During the deepest stage of sleep, your body releases growth hormones for cell repair, helping your skin rejuvenate on a daily basis.
- Minimize dark undereye circles with an extra nighttime pillow. As the delicate skin and muscle around the eyes weaken with time, the fat under the lower-lid skin can pool beneath your eye. Sleeping on two pillows can help prevent fluid accumulation.
If you want to explore other remedies, consider peels that exfoliate, and fractional resurfacing, a laser process that increases collagen production.
The post Aging Well, Aging Healthy…a continuing series appeared first on Specialdocs Consultants.
by Specialdocs Consultants, LLC | Nov 20, 2017 | Nutrition, Patient News
While they may not have the crisp appeal of sugar snap peas or the sleek appearance of a summer tomato, winter’s bounty of root vegetables and greens brings some of the year’s most nutrient-rich dishes to the table. Serve up as chips or gratins, roasted or braised, mashed or raw, in soups or salads…see our recommendations for a taste of the season below.
If you like kale, try collard greens, a super-green that can be thinly sliced and used in salads, or braised with mushrooms for satisfying flavor without meat. Anti-inflammatory, antioxidant (cancer preventive) and cholesterol-lowing nutrients are on the long list of benefits.
Looking for low-carb substitutes for mashed or fried potatoes? Pureed cauliflower makes a delightful stand-in for mashed potatoes, especially when blended with Greek yogurt. Less common are Romanesco, an excellent source of vitamins C and K, fiber and carotenoids; Kohlrabi, with edible roots, leaves and stems packed with potassium and Vitamin C; and Celeriac, also known as root-celery, containing antioxidants, Vitamin K and phosphorus. For a healthy alternative to French fries, consider Jerusalem artichokes, or sunchokes, with a mellow taste and flaky texture, and plenty of energy-boosting iron and cholesterol-lowering soluble fiber. Slice matchstick-thin, mix in a sprinkle of vegetable oil, rosemary, cayenne, salt and pepper and bake for 15 minutes. Or enjoy a baked sweet potato, skin and all, for a winter treat that’s high in Vitamin A and fiber, with a minimum of calories.
Beets, high in folic acids, offer crunch, color and taste. Sautee with garlic and some olive oil or use in soups for a nutritional boost.
Change up onions with leeks, which have a milder, sweeter flavor, and compounds such as allicin that fight free radicals in your body and flavonols that may help fight cancer and lower the risk of heart disease.
Carrots are always a sturdy choice, rich in beta carotene, a compound that may reduce heart disease and certain types of cancer (although supplements are not recommended, especially for smokers), and Vitamin A, which bolsters vision and bone growth. Parsnips offer a change of pace, with a sweet flavor, double the fiber of carrots, potassium and folate for cardiovascular benefits, and almost 40 percent of the daily requirement of Vitamin K, a nutrient associated with bone health.
Winter squash, in a variety of shapes, colors and flavors, are rich in Vitamins C and A, and can be boiled, baked, roasted, simmered, steamed, microwaved or sautéed. For a low-calorie alternative to pasta, try spaghetti squash which yields long yellow strands when cooked. Sweet potato fans will enjoy butternut squash, with a similar sweet nuttiness and an even silkier texture.
Broccoli contains calcium, folate, iron, protein, Vitamins A and C and fiber, and is versatile enough to steam, roast, stir fry, puree for soups or eat raw.
Give winter salads a spin with a bowl of curly endive, radicchio, beets, fennel, kohlrabi and turnip greens. Roast or boil until tender and dress while still warm to allow the flavors to be completely absorbed.
There are many more choices in the produce aisle…go browse your local grocery store and try something new this winter!
The post Find Your Roots with Winter’s Best Veggies appeared first on Specialdocs Consultants.
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