Saturday, March 21, 2009

Saturday and Sunday blogs appear as a Health and Wellness Weekly. Please see http://www.healthandwellnessweekly.wordpress.com/.

Is Your Heart Failing You?

Heart failure. It doesn’t mean someone has died. But it does mean that someone’s heart is no longer working correctly. The heart is weak and not able to pump the way it should. There is no cure. Health failure is a chronic, but manageable, condition.

 

When the left side of the heart is not pumping well the individual suffers from left-sided failure. The symptoms include:

• Shortness of breath.
• Persistent cough or wheezing.

 

When the right side of the heart is not pumping well it is called right-sided failure. Right sided failure often follows left sided failure. The symptoms of right sided failure include:

• Swelling of the feet, legs and the abdomen.

 

Symptoms common to both left and right failure are:

• Fatigue.
• Loss of appetite and/or nausea.
• Confusion or impaired thinking.
• Increased heart rate.

 

Any disease that causes the heart to work harder than normal may, if it’s left untreated, lead to heart failure. Diseases that often lead to heart failure include:

• High Blood pressure.
• Coronary artery disease.
• Diabetes.
• Severe lung disease.
• Structural defects in the heart.

 

The incidence of heart failure increases with age. African Americans have a much higher rate of heart failure than other Americans.

NY Times

 

If you have one of the conditions listed above, manage your disease according to your healthcare provider’s recommendations. Prevent or postpone heart failure. Your heart is in your hands.

 

For more about heart failure see:

 

The American Heart Organization

Medline Plus

PSA In The News

Prostate-specific antigen. To get screened for prostate cancer or not to get screened.

 

The results of two large studies, one in Europe (182,000 men) and one in the US (almost 77,000 men) made the front page of the New York Times today.  The studies seem to resolve what the New England Journal of Medicine calls “The Controversy That Refuses to Die.”

 

The prostate is a gland the produces much of the fluid that carries sperm. The prostate gland is located internally at the base of the penis. It surrounds the urethra, which is the small tube leading from the urinary bladder to outside the body. The urethra is also the tube through which the sperm carrying fluid exits the body. In young men the prostate is about the size of a walnut. It normally enlarges with age. It may become infected (prostatitis) or enlarge to such an extent that it interferes with urination. The prostate may also become cancerous.

 

Most prostate cancers are slow growing, some are not. However, in the presence of any prostate cancer the PSA test is positive. That is, the test will detect it. It then becomes a matter of deciding if the individual should proceed further in the testing and have a biopsy. If the biopsy detects cancer it means that the cancer has achieved a size that can be detected surgically. The next step is to decide what to do.

 

The options are:

• Watch and wait.
• Remove the cancer surgically.
• Radiate the cancer.

 

Now, here is the problem that the studies looked at: what saves the most lives?

 

As it turned out, early detection of prostate cancer did not save lives to any significant degree. What it did is expose people to needless anxiety and surgery. Why? Because there is no way of telling which cancers are slow growing and which are not. Therefore, the researchers concluded that screening the general population for prostate cancer does no good and may do harm. All surgery carries some risk. Removal or radiation of the prostate carries the risk of incontinence and/or impotence.

 

Now the controversy – to screen or not to screen – can be put to rest.

More On Boosting Your Brain

A recent article by Julie Deardorff in The Chicago Tribune quotes Sam Wang, a neuroscientist, as saying, “If I had to pick between fitness training and brain training, I’d go with fitness,” because fitness exercises show a greater effect than computer-brain exercises. However, Wang noted that “fitness training only lasts as long as the benefit to your cardiovascular system.” Computer-brain exercise “might last longer.”

 

I’m left wondering what this is all about. Is it really an artifact of boomers reaching a certain age and, like Peter Pan (brought to boomers in the 1953 Disney movie), refusing to grow up? Have people in general always searched for eternal youth? Or was it only the adventurers and dreamers such as Ponce de Leon and an assortment of alchemists? Perhaps it’s only the advent of instant “news” that makes this such a hot topic. But it IS everywhere and not just in brain boosting exercises.

 

The list of “stay young” products and procedures runs the gamut from surgical body sculpting to anti-wrinkle creams and body sculpting exercises. Gone are the days when “dyeing” hair or wearing a wig was part of a mid-life crisis. Now younger and younger people are not only seeking to turn back the clock, they are seeking some sort of physical ideal that seems to be garnered more from fantasy and the media than from real life.

 

Don’t get me wrong. I firmly believe in keeping both the mind and the body at its peak performance for as long as possible. I also believe in reconstructive surgery for major physical defects. But come on, ladies and gents! Do you really need a model’s derriere or a body builder’s abs? Do you really need (or want) to cut back 30% on your food intake in order to improve your memory?

 

Yes, play computer-brain games (unless your money would be better spent on Sudoku and word-find magazines). Exercise for cardio-vascular health. Eat moderately and wisely. Stay as healthy and as fit in mind and body as you can for along as you can. But you are more than your mind and your body. You are also wisdom and spirit. These can not be enhanced with a scalpel or a drug or an obsession with things physical.

 

And – remember – no one really gets out of here alive.

Another Thing To Think About

Yesterday I blogged about falls. In that blog I mentioned a little known condition of the elderly, normal pressure hydrocephalus. I thought I’d follow-up on that today.

 

Normal pressure hydrocephalus is a neurological condition that affects the brain. Hydrocephalus means water on the brain. It would be more accurate to say water in the brain. In this case, too much water – the water being cerebrospinal fluid.

 

Cerebrospinal fluid (CSF) is a straw colored fluid that surrounds the brain and spinal cord. It is filtered from blood that circulates through very small blood vessels within four spaces in the brain. The spaces are called ventricles. The CSF flows from the ventricles into the subarachnoid space which surrounds the spinal cord and the brain. It is eventually re-absorbed. This process is the CSF circulation.

 

Hydrocephalus occurs when the normal flow of the CSF is blocked so that there is a back up of CSF in the ventricles. This causes the ventricles to enlarge and exert pressure on the brain from the inside. Hydrocephalus can occur from an obstruction to the circulation of CSF, from overproduction of CSF or from poor re-absorption of CSF. Sometimes the cause of normal pressure hydrocephalus is unknown.

 

Abnormal pressure on the brain results in symptoms that can vary greatly. Some of these symptoms may be related to changes in walking: weakness in the legs, sudden unexplained falls or unsteadiness when walking. As the pressure on the brain continues the symptoms become more severe and may include: memory loss, difficulty with speech, lack of interest in surroundings and episodes of urine or bowel incontinence. Normal pressure hydrocephalus may accounts for 5% of all dementias.

 

The treatment for hydrocephalus is surgery to shunt the excess CSF from the ventricles to another part of the body where it can be re-absorbed. The extent of recovery depends on the cause of the hydrocephalus and how much damage it has done to the brain.

 

Normal pressure hydrocephalus is another thing to think about when someone, especially someone over 65, has unexplained falls or changes in behavior.

 

NIH

What Increases The Risk of Death In Those over 65?

Among people over 65, low-trauma falls that result in a fracture increase the risk of death for at least five years after the fall. For a hip fracture, the risk of death persists for ten years.

 

The results of a study published in the Journal of the American Medical Association produced some interesting facts about low-trauma fractures in those over 65. But what is more interesting is that the study population all had osteoporosis, in many cases unrecognized.

 

In one of my previous blogs I wrote about osteoporosis, so I won’t repeat that information here. But let me just re-emphasize that osteoporosis is a growing problem and one that should be taken seriously. It can be prevented or at least postponed.

 

This blog is about falls in older individuals.

 

Every fall by an older individual should be taken seriously, even if it doesn’t result in injury. A fall may be the first sign of an underlying medical or psychological condition. Some of these include: diabetes, arthritis, normal pressure hydrocephalus, dementia, postural hypotension, and Parkinson’s disease.

 

A fall may also indicate that the individual needs a review of the medications being taken, even the over-the-counter ones. Finally, a fall may indicate that the individual is not getting sufficient exercise and, as a result, has developed weak muscles.

 

Falls are not a normal part of aging. Yet, every year more that a third of people over 65 experience a fall. Many of these could have been prevented by lifestyle or environmental changes.

 

Every fall requires investigation to determine its cause. It’s not the fact of the fall that counts, it’s the why.

 

Read what Senior Health has to say about falls at http://nihseniorhealth.gov/falls/toc.html

Saturday, March 14, 2009

Saturday and Sunday blogs appear as a Health and Wellness Weekly. Please see http://www.healthandwellnessweekly.wordpress.com/.