Grooming Essentials For Women / Educational Video

I just found this health related video on YouTube … and thought you might enjoy it!

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Excerpt from the public domain video, “Good Grooming For Girls (1956)”, courtesy of Prelinger Archives.

Tell us what you think about this video in the comments below, or in the Battling For Health Community Forum!
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Can people with heart disease fly?

It is holiday or vacation time in many parts of the world and many people are travelling by car, boat, train or plane, with the mode of transport mainly determined by distance. Summer school break is definitely the peak season for flying as people have more time for longer and farther trips. But how safe is air travel for those who have heart problems and other chronic conditions?

The British Cardiovascular Society recently issued a guidance on the safety of travelling on a commercial aircraft that will help both primary health care clinicians and their patients.

But first of all, how does air travel affect our health? The authors explain:

“…the main impact of air travel is the inhalation of air with reduced oxygen content in a pressurized environment, resulting in lower circulating oxygen levels in the blood, known as hypobaric hypoxia. Passengers already at high risk of angina, MI, heart failure, or abnormal heart rhythms might be adversely affected by hypoxia.”

Recent studies have shown however that the blood oxygen levels have little or no adverse effects on the circulatory system, certainly not in short-haul flights.

Based o these new findings, here is what the new guidelines has to say:

Patients after heart surgery

What are the travelling restrictions for those who had just a heart surgery? The guidance states it depends on the type of procedure and the risk profile of the patient.

“For post-STEMI and NSTEMI, those at low risk are advised that they can fly three days after their event and those at medium risk can fly after 10 days.”

Those with high-risk profiles should wait a little longer for stabilization. At any rate, the decision to fly should be discussed with the doctor.

Heart patients with pacemakers and other implants

People are wondering how flying can affect their implantable cardioverter defibrillators (ICDs), pacemakers and stents. The guidance states that  in most cases, flying is safe for people wearing these implants.

“After uncomplicated elective PCI, the guidelines state that patients can fly “after two days.” Likewise, patients with pacemakers implanted are advised they can fly after two days, unless they have suffered pneumothorax, in which case they should wait until two weeks after it has fully healed. The same advice applies to those with ICDs, with the added recommendation that they should not fly after the ICD has delivered a shock until the condition is considered stable.applies to those with ICDs, with the added recommendation that they should not fly after the ICD has delivered a shock until the condition is considered stable.

Deep vein thrombosis (DVT) and venous thromboembolism (VTE)

Many studies have shown that the risk for DVT and VTE increase when flying for long periods of time such as during a long-haul flight. However, the same increased risk applies when travelling by car, bus, or train. The absolute risk for DVT among healthy individuals is 1 in 6000 for a long-haul flight (e.g. more than 4 hours).

“Even those at high risk—those who have already had a DVT, recent surgery lasting more than 30 minutes, or known thrombophilia or are pregnant or obese (BMI>30 kg/m2)—can still fly, provided they consume plenty of fluids, exclude caffeine and alcohol, wear compression stockings, and take a low-molecular-weight heparin.[as blood thinner]..”

Warning: Aspirin as a blood thinner during flying is not recommended!

The mammogram debate: the two sides

Mammogram guidelines questioned

Mammogram, the gold standard for breast cancer, is currently questioned just like what happened to prostate-specific antigen (PSA) s for prostate cancer. This was brought about by inconclusive research evidence that screening starting at 40 and beyond increases survival rates.

Last week, a heated debate started when the US Preventive Services Task Force (USPSTF) issued new federal guidelines on mammography which recommends that the starting age for mammograms to be raised to 50.

The previous US guidelines, with full backing from the American Cancer Society recommend that women should have the mammograms every 2 years starting at age 40. The recommendations applied to women with no family history of breast cancer and are therefore not considered to be high-risk. Those who have high risk profiles still need to continue regular screening tests.

The pros

The reasons for these new recommendations are quite similar in some ways to the reasons why many medical professionals (including the American Cancer Society) do not support routine prostate cancer screening with the PSA tests. Some of these reasons are:

• Too many false positives that result in unnecessary but invasive biopsy
• Overdiagnosis and overtreatment of a disease that is not necessarily fatal and may go away by itself.
• Too many false alarms that lead into mental pressure, unnecessary fears and worries. Why worry 10 years earlier?
• Mammograms present health risks, such as exposure to radiation
• Upgrade to international standards.
• Unnecessary healthcare costs

Indeed some of these points sound familiar in connection with the PSA test in 2008 and it was the same task force USPSTF that recommended the PSA 2008 guidelines. However, those guidelines were widely accepted, even embraced by the health community.

Regarding international standards, guidelines vary from country to country. Many developed countries, including the UK, Canada, set the age limit at age 50. I had my first mammogram 4 years ago in Germany. During my last gynecological check up here in Switzerland, I asked my doctor whether it’s time for the next one. But you are not yet 50, she told me.

Health care cost is another sore issue. Countries with universal health care system tend to cut down on screening methods that do not show conclusive benefits in order to allocate limited resources for what is necessary without compromising health care quality. Americans may dismiss this as “rationing” but it does have the upside of giving access to affordable health care to everybody.

The fact remains that there is no significant differences in breast cancer mortality between countries who start screening at 40 and those who start 10 years later.

The contras

Many health experts however, do not agree with the new guidelines

• For one thing, women without family history of breast cancer can have the disease before the age 40. For these women, forewarned is forearmed. They’d rather take unnecessary anxiety than miss the chance of an early diagnosis and therefore early treatment.
• Although the recommendations are not binding, there is danger that insurance companies might not cover mammogram expenses before the age of 50.

Some high profile health experts explicitly expressed their disagreement with the new guidelines.

American Cancer Society (ACS)

According to Dr. Otis W. Brawley Chief Medical Officer of ACS

“The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.”

Health and Human Services Secretary Kathleen Sebelius

Secretary Kathleen Sebelius in an interview advises women to “keep doing what they have been doing” with regards to breast cancer screening.

“The task force has presented some new evidence for consideration but our policies remain unchanged.Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action. ..My message to women is simple. Mammograms have always been an important lifesaving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions and make the decision that is right for you.”

Former head of the National Institute for Health Dr. Bernadine Healy

Ex-NIH director Dr. Bernadine Healy’s take is to ignore the new guidelines, which he believes, could save money but not lives.

Other resources:

Mammogram advice accurate but not ‘right’

Five Reasons to Welcome the New Mammogram Guidelines‎

Experts: routine depression screening for teenagers

It is a problem that many parents face: clinical depression among teenagers.

As many as two million American teenagers suffer from depression and most go undiagnosed, thus untreated according to the United States Preventive Services Task Force. The task force has recently came up with guidelines recommending primary health care practitioners to routinely screen teenage patients for clinical depression. The new recommendations have been published in the April issue of the journal Pediatrics.

The guidelines apply to adolescents aged 12 to 18 years old. However, the task force found there is insufficient evidence to show the benefits of screening younger children for clinical depression

Depression in young people can lead to

• poor health outcomes
• difficulties in school
• disruptions of family and social relationships
• lowerquality of life
• self-destructive behavior/suicide
• depression in adulhood

It is therefore necessary that clinical depression be diagnosed as early as possible.

“Depression in adolescents has a significant impact on both mental and physical health, and adolescents with depression have more hospitalizations for psychiatric and medical issues than adolescents who are not depressed,” said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. “It is important that adolescents are diagnosed and treated for clinical depression in order to improve their health and quality of life, especially if they have a family history of depression.”

However, screening for clinical depression should only be done “when appropriate systems are in place to ensure accurate diagnosis, treatment and follow-up care.” Treatment of clinical depression among teenagers can be through by psychotherapy or by pharmacological means using selective serotonin reuptake inhibitors (SSRIs), or combined therapy (SSRIs plus psychotherapy). However, the prescription of anitdepressants SSRIs should be done with care as this class of drugs is associated with an increased risk of suicidality.

The new guidelines go further than the previous guideline issued by the Academy of Pediatrics which recommended pediatricians to ask their young patients questions about depression.

The new recommendarions cited using “two questionnaires that focus on depression tip-offs, like mood, anxiety, appetite and substance abuse.” The screening should be done by the family doctor or pediatrician who is known to the family and the patient.

Almost 6% of Amrican teenagers aged 13 to 18 are clinically depressed. A lot of cases do not show over symptoms and are therefore easily overlooked by parents and teachers. Suicide due to clinical depression is the 3^rd leading cause of death in US adolescents in the age range 15 to 24 years old.

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The STITCH study: hypertension management made simple

“Less is better” might be the new strategy in treating high blood pressure, according a study by Canadian researchers. The study called “Simplified Treatment Intervention to Control Hypertension” (STITCH) was conducted by researchers at the Robarts Research Institute of the University of Western Ontario. The study followed up 2,104 participants with high hypertension, basically patients from 45 family practices in southwestern Ontario, Canada.

There are many different guidelines of the management of hypertension depending on the country and the medical group you are talking to. They can be complicated and confusing and can be challenging to both patients and doctors alike. Furthermore, they are frequently updated and amended.

The objective of the STITCH study is “to see if there are simpler ways to help patients (and their doctors) reduce their blood pressure to goal levels than by following national guidelines which can be complicated.”

The STITCH study came up with the following simplified treatment regime:

(1) initial therapy with a low-dose angiotensin-converting enzyme (ACE) inhibitor/diuretic or angiotensin receptor blocker/diuretic combination;

(2) up-titration of combination therapy to the highest dose;

(3) addition of a calcium channel blocker and up-titration; and

(4) addition of a non-first-line antihypertensive agent.

The results of the study suggest that starting with low doses of combination drug, then gradually increasing may actually be better for recently diagnosed hypertensive patients. “A half tablet of a single pill combination drug (e.g. an ACE-inhibitor/diuretic or angiotensin receptor blocker/diuretic combination) than the regular starting dose of a single drug” may actually be more effective. The results of the study will be published in the April edition of the journal Hypertension.

High blood pressure is a risk factor for heart disease and stroke. According to the most recent estimates (source: American Heart Association), one in three Americans have high blood pressure.

Aside from pharmacological therapy, lifestyle changes are necessary to prevent, manage and control high blood pressure. Some of these lifestyle changes are (Source: American Heart Association Scientiific Advisory):

• Weight Loss
• Dietary Salt Restriction
• Moderation of Alcohol Intake
• Increased Physical Activity
• Ingestion of a High-Fiber, Low-Fat Diet

Honestly, even the “simplified” treatment regime of the STITCH study doesn’t look that simple to me. I’d rather go for the lifestyle changes and got for prevention.

Photo credit: stock.xchng