It's what that matters...

"Our job is not to figure out the how. The how will show up out of a commitment and belief in the what."

-- Jack Canfield

Sex Good for Men's Hearts

Guys Having It at Least Twice a Week Cut Risk of Serious Cardiac Woes Almost in Half, Research Indicates

A new study in the American Journal of Cardiology finds that men who have sex at least twice a week can almost halve their risk of developing serious heart disease.

And sex may have other health benefits, as well, notes Dr. Holly Phillips of WCBS-TV in New York.  On "The Early Show" Friday, Phillips said the research, published in the American Journal of Cardiology, tracked more than 1,000 men for 16 years, 40- to 70-years-old, with no history of heart disease. It was found that men who had sex twice a week or more were as much as 45 percent less likely to develop serious heart conditions than men having sex less than once a month. Women weren't part of the study but, Phillips notes, many experts think the results would hold true for women, too.

The researchers said the benefits of sex could stem from its physical and emotional effects on the body. Don't forget, sex can be good exercise, which might serve to protect the heart. Estimates are you burn around 60 calories during sex. So, let's say you have sex 12 times a month: Twelve times 60 is the equivalent of running seven miles!

But doctors think there is also an emotional component: Men with a desire for more sexual activity and who are able to engage in sex are likely to be healthier and might be more likely to be in a supportive intimate relationship with a regular partner, and this might improve health through stress reduction and social support. So, says Phillips, doctors should ask about their patients' sex lives and vice versa: Men should consult with their doctors if they experience any sexual difficulties, because it could be a sign of heart disease.

Phillips points out that other studies have shown other health benefits from sex: Sexual activity may ease depression and pain by releasing natural chemicals such as endorphins, possibly decrease the risk of prostate cancer, and boost the immune system by boosting immunoglobulins, which destroy invading organisms.

From CBS News

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

AED Device Recall

Note: AED devices provided by the Center for Executive Medicine are not affected by this recall.  If you have an AED not provided by our office, you should review this information carefully and verify that your device is not affected.

Cardiac Science Corporation and FDA notified healthcare professionals and consumers of a recall because the automated external defibrillator (AED) may not be able to deliver therapy during a cardiac resuscitation attempt, which may lead to serious adverse events or death. These AEDs were manufactured in a way that makes them potentially susceptible to failure under certain conditions. Each of the approximately 12,200 devices affected in this recall can be confirmed at the Cardiac Science Web site, www.cardiacscience.com/AED195. The affected AEDs were manufactured or serviced between October 19, 2009 and January 15, 2010 and include the following models - Powerheart 9300A, 9300E, 9300P, 9390A, 9390E, CardioVive 92532 and CardioLife 9200G and 9231. Each affected AED should immediately be removed from service since it may not deliver the expected therapy.

From: www.fda.gov

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Happy Valentine's Day

"You know you're in love when you can't fall asleep because reality is finally better than your dreams."
- Dr. Seuss

"Love wouldn't be blind if the Braille weren't so damned much fun."
-- Anonymous

"Love is a grave mental disease."
-- Plato

"Anything worth doing is worth doing slowly."
-- Mae West

“A life without love is like a year without summer.”
-- Swedish Proverb

“Who, being loved, is poor?”
-- Oscar Wilde

"If love is blind, why is lingerie so popular?"
-- Anonymous

Coffee May Cut Risk of Prostate Cancer

Study Shows Regular Coffee Drinkers Have 60% Lower Risk of Advanced Prostate Cancer

Drinking coffee regularly may help lower the risk of advanced prostate cancer, a study shows.

The study, presented this week at a conference of the American Association for Cancer Research in Houston, shows men who drank the most coffee were nearly 60% less likely to develop advanced prostate cancer than non-coffee drinkers.  Researchers say it's too early to start recommending that men start drinking coffee to help prevent prostate cancer, but the results are encouraging.

"Very few lifestyle factors have been consistently associated with prostate cancer risk, especially with risk of aggressive disease, so it would be very exciting if this association is confirmed in other studies," says researcher Kathryn M. Wilson, PhD, a postdoctoral fellow at the Channing Laboratory, Harvard Medical School and the Harvard School of Public Health, in a news release. "Our results do suggest there is no reason to stop drinking coffee out of any concern about prostate cancer."

Researchers say it's the first study of its kind to look prospectively at both the overall risk of prostate cancer and the risk of localized vs. advanced prostate cancer  that has spread beyond the prostate. In the study, researchers analyzed information from the Health Professionals' Follow-Up Study, which included data on the coffee-drinking habits of nearly 50,000 men from 1986 to 2006. During that time period, 4,975 of the men developed prostate cancer.  The results showed men who drank the most coffee (six or more cups per day) had a 59% lower risk of aggressive prostate cancer (fatal or advanced disease) compared to non-coffee drinkers.

But researchers say it's not just the caffeine that's responsible for the prostate cancer prevention benefits. The study showed men who drank decaffeinated coffee also had a similar reduction in aggressive prostate cancer risk. 

Researchers say coffee also contains many other potentially beneficial compounds such as antioxidants and minerals that may play a role in preventing prostate cancer and more research is needed to confirm these results. "Coffee has effects on insulin and glucose metabolism as well as sex hormone levels, all of which play a role in prostate cancer," says Wilson

By Jennifer Warner, WebMD Health News
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Organization

"Science is organized knowledge. Wisdom is organized life."



-- Immanuel Kant

Drugs May Curb Breast Cancer

A popular class of bone-building drugs known as bisphosphonates appear to significantly reduce women's  risk of breast cancer, according to research presented Thursday at the San Antonio Breast Cancer  Symposium.

In one study, researchers analyzed data from the huge National Institutes of Health-sponsored Women's Health Initiative and found that users of bisphosphonates had nearly a third fewer cases of breast cancer compared with nonusers.  A second study involving more than 4,500 postmenopausal women in Israel with and without diagnoses of breast cancer found that those who reported using bisphosphonates for at least five years were about 30% less likely to receive a breast-cancer diagnosis, even after controlling for risk factors such as family history and use of other medications.

Low bone density had been linked with lower risk of breast cancer in previous studies, prompting scientists to look at data on women being treated with bisphosphonates for bone loss. But neither study presented Thursday was a clinical trial in which women were randomly assigned to take bisphosphonates or not. As a result, it still isn't definitive whether the drugs used to treat weak bones were actually responsible for the reduced risk of cancer. And why bisphosphonates appear to reduce breast-cancer risk isn't clear.  Bisphosphonates have side effects, including bone and muscle pain as well as rare but serious cases of jaw bone death that have resulted in hundreds of lawsuits by plaintiffs alleging improper warnings about the drugs.

But the results provide the best evidence to date that the medicines  appear to reduce women's risk of breast cancer. Still, it is too early for women to seek bisphosphonate therapy for the purpose of preventing cancer, said Gad Rennert, lead investigator of the Israeli study, which was sponsored by a U.S. private research foundation and several organizations in Israel.  Bisphosphonates for treating osteoporosis include Merck & Co.'s Fosamax and Roche Holding AG's Boniva. Another bisphosphonate, Novartis AG's Zometa, is administered intravenously to prevent the spread of cancer into the bones of patients with a variety of cancers. Some 45 million prescriptions for bisphosphonates were written in the U.S. in 2008, according to data provider IMS Health.

In the analysis of the Women's Health Initiative data, researchers compared rates of breast cancer in 2,816 women who reported using oral bisphosphonates at the start of the study with 151,952 nonusers. The rate of invasive breast cancer was 3.3% in the bisphosphonate user group versus 4.4% among nonusers after an average of 7.8 years of follow-up.  Moreover, the reduction wasn't related to the fragility of women's bones.

"Bisphosphonates may have direct inhibiting effects on breast cancer," Rowan Chlebowski, lead investigator on the study and an oncologist at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, said of the results.  But because bone is often a target of metastases -- spreading cancer cells -- for different kinds of tumors, the drugs have potential to work for other types of cancer as well, according to Dr. Rennert.

"Biology is usually smart," said Dr. Rennert, who also serves as director of the National Israeli Cancer  Control Center and a professor at the Technion-Israel Institute of Technology. "If you have an agent that has anti-tumor qualities, it could be the case for other tumors, too. It has immense potential if [the result] holds."

By Shirley S. Wang, The Wall Street Journal
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Finding Time

"Those who think they have no time for bodily exercise will sooner or later have to find time for illness."

-- Edward Stanley, Earl of Derby. The Conduct of Life. Address at Liverpool College, December 20, 1873

10 Health Habits That Will Help You Live to 100

You don't need to eat yogurt and live on a mountaintop, but you do need to floss.

The biggest factor that determines how well you age is not your genes but how well you live. Not convinced? A new study published in the British Medical Journal of 20,000 British folks shows that you can cut your risk of having a stroke in half by doing the following four things: being active for 30 minutes a day, eating five daily servings of fruit and vegetables, and avoiding cigarettes and excess alcohol.

While those are some of the obvious steps you can take to age well, researchers have discovered that centenarians tend to share certain traits in how they eat, move about, and deal with stress—the sorts of things we can emulate to improve our own aging process. Of course, getting to age 100 is enormously more likely if your parents did. Still, Thomas Perls, who studies the century-plus set at Boston University School of Medicine, believes that assuming you've sidestepped genes for truly fatal diseases like Huntington's, "there's nothing stopping you from living independently well into your 90s." Heck, if your parents and grandparents were heavy smokers, they might have died prematurely without ever reaching their true potential lifespan, so go ahead and shoot for those triple digits. Follow these 10 habits, and check out Perls' lifetime risk calculator to see how long you can expect to live.

1. Don't retire. "Evidence shows that in societies where people stop working abruptly, the incidence of obesity and chronic disease skyrockets after retirement," says Luigi Ferrucci, director of the Baltimore Longitudinal Study of Aging. The Chianti region of Italy, which has a high percentage of centenarians, has a different take on leisure time. "After people retire from their jobs, they spend most of the day working on their little farm, cultivating grapes or vegetables," he says. "They're never really inactive." Farming isn't for you? Volunteer as a docent at your local art museum or join the Experience Corps, a program offered in 19 cities that places senior volunteers in urban public elementary schools for about 15 hours a week.

2. Floss every day. That may help keep your arteries healthy. A 2008 New York University study showed that daily flossing reduced the amount of gum-disease-causing bacteria in the mouth. This bacteria is thought to enter the bloodstream and trigger inflammation in the arteries, a major risk factor for heart disease. Other research has shown that those who have high amounts of bacteria in their mouth are more likely to have thickening in their arteries, another sign of heart disease. "I really do think people should floss twice a day to get the biggest life expectancy benefits," stresses Perls.

3. Move around. "Exercise is the only real fountain of youth that exists," says Jay Olshansky, a professor of medicine and aging researcher at the University of Illinois at Chicago. "It's like the oil and lube job for your car. You don't have to do it, but your car will definitely run better." Study after study has documented the benefits of exercise to improve your mood, mental acuity, balance, muscle mass, and bones. "And the benefits kick in immediately after your first workout," Olshansky adds. Don't worry if you're not a gym rat. Those who see the biggest payoffs are the ones who go from doing nothing to simply walking around the neighborhood or local mall for about 30 minutes a day. Building muscle with resistance training is also ideal, but yoga classes can give you similar strength-training effects if you're not into weight lifting.

4. Eat a fiber-rich cereal for breakfast. Getting a serving of whole-grains, especially in the morning, appears to help older folks maintain stable blood sugar levels throughout the day, according to a recent study conducted by Ferrucci and his colleagues. "Those who do this have a lower incidence of diabetes, a known accelerator of aging," he says.

5. Get at least six hours of shut-eye. Instead of skimping on sleep to add more hours to your day, get more to add years to your life. "Sleep is one of the most important functions that our body uses to regulate and heal cells," says Ferrucci. "We've calculated that the minimum amount of sleep that older people need to get those healing REM phases is about six hours." Those who reach the century mark make sleep a top priority.

6. Consume whole foods, not supplements. Strong evidence suggests that people who have high blood levels of certain nutrients—selenium, beta-carotene, vitamins C and E—age much better and have a slower rate of cognitive decline. Unfortunately, there's no evidence that taking pills with these nutrients provides those antiaging benefits. "There are more than 200 different carotenoids and 200 different flavonoids in a single tomato," points out Ferrucci, "and these chemicals can all have complex interactions that foster health beyond the single nutrients we know about like lycopene or vitamin C." Avoid nutrient-lacking white foods (breads, flour, sugar) and go for all those colorful fruits and vegetables and dark whole-grain breads and cereals with their host of hidden nutrients.

7. Be less neurotic. It may work for Woody Allen, who infuses his worries with a healthy dose of humor, but the rest of us neurotics may want to find a new way to deal with stress. "We have a new study coming out that shows that centenarians tend not to internalize things or dwell on their troubles," says Perls. "They are great at rolling with the punches." If this inborn trait is hard to overcome, find better ways to manage when you're stressed: Yoga, exercise, meditation, tai chi, or just deep breathing for a few moments are all good. Ruminating, eating chips in front of the TV, binge drinking? Bad, very bad.

8. Live like a Seventh Day Adventist. Americans who define themselves as Seventh Day Adventists have an average life expectancy of 89, about a decade longer than the average American. One of the basic tenets of the religion is that it's important to cherish the body that's on loan from God, which means no smoking, alcohol abuse, or overindulging in sweets. Followers typically stick to a vegetarian diet based on fruits, vegetables, beans, and nuts, and get plenty of exercise. They're also very focused on family and community.

9. Be a creature of habit. Centenarians tend to live by strict routines, says Olshansky, eating the same kind of diet and doing the same kinds of activities their whole lives. Going to bed and waking up at the same time each day is another good habit to keep your body in the steady equilibrium that can be easily disrupted as you get on in years. "Your physiology becomes frailer when you get older," explains Ferrucci, "and it's harder for your body to bounce back if you, say, miss a few hours of sleep one night or drink too much alcohol." This can weaken immune defenses, leaving you more susceptible to circulating flu viruses or bacterial infections.

10. Stay connected. Having regular social contacts with friends and loved ones is key to avoiding depression, which can lead to premature death, something that's particularly prevalent in elderly widows and widowers. Some psychologists even think that one of the biggest benefits elderly folks get from exercise the strong social interactions that come from walking with a buddy or taking a group exercise class. Having a daily connection with a close friend or family member gives older folks the added benefit of having someone watch their back. "They'll tell you if they think your memory is going or if you seem more withdrawn," says Perls, "and they might push you to see a doctor before you recognize that you need to see one yourself."

By Deborah Kotz, U. S. News & World Report

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Warren Buffet Speaks

"You never know who is swimming naked until the tide goes out."

-- Warren Buffett

NEJM: "Worrisome" Radiation Doses With Imaging

Medical imaging procedures expose many nonelderly patients to substantial doses of ionizing radiation, according to the results of a new study.  Myocardial perfusion imaging alone accounts for 22% of the radiation dose from all study procedures, while computed-tomography (CT) scans of the abdomen, pelvis, and chest account for nearly 38%, report investigators.

"Our findings that in some patients worrisome radiation doses from imaging procedures can accumulate over time underscores the need to improve their use," write lead investigator Dr Reza Fazel (Emory University School of Medicine, Atlanta, GA) and colleagues. "Unlike the exposure of workers in healthcare and the nuclear industry, which can be regulated, the exposure of patients cannot be restricted, largely because of the inherent difficulty in balancing the immediate clinical need for these procedures, which is frequently substantial, against the stochastic risks of cancer that would not be evident for years, if at all."

The analysis, which studied 952 420 adults aged 18 to 64 years in five US cities, is published in the August 27, 2009 issue of the New England Journal of Medicine.

During the study period, which ran from 2005 to 2007, 655 613 adults underwent at least one imaging procedure associated with radiation exposure. The mean effective dose was 2.4 mSv per person per year, although a wide distribution was noted. Moreover, the proportion of subjects undergoing procedures and their mean doses varied according to age, sex, and city. For example, approximately 50% of adults aged 18 to 34 years underwent a medical imaging procedure requiring radiation, whereas 86% of adults 60 to 64 years of age were sent for similar testing. Women also underwent imaging procedures significantly more often than men.

In terms of rates of exposure to moderate and high doses of radiation, 193.8 per 1000 enrollees were exposed to moderate levels of radiation and 18.6 per 1000 enrollees were exposed to high levels. The researchers point out that although most subjects received less than 3 mSv per year, "effective doses of moderate, high, and very high intensity were observed in a sizable minority."

The element of risk

In an editorial accompanying the published study, Dr Michael Lauer (National Heart, Lung, and Blood Institute, Bethesda, MD) writes that the number of CT scans obtained has quadrupled since 1992 and that between 1993 and 2001 the number of myocardial perfusion scans increased more than 6% each year, "with no justification for their use based on disease rates, healthcare disparities, or newly published, definitive randomized trials." Moreover, despite abnormalities on myocardial perfusion scans being powerful predictors of future events, no study has shown that aggressive therapy in these high-risk patients can improve future outcomes, notes Lauer.

Because the use of radiation carries an element of risk, "we need to adopt a new paradigm for our approach to imaging," writes Lauer. "Instead of investing so many resources in performing so many procedures, we should step back and design and execute desperately needed large-scale, randomized trials to figure out which procedures yield net benefits."

Lauer argues that with few exceptions, such as mammography, most radiologic testing offers net negative results, because there is little high-level evidence and cumulative exposure can produce real harm, namely radiation-induced cancer.

He contends that physicians should approach imaging with the same "humility" others approached experimental treatments for acute coronary syndromes and that these tests should be subjected to rigorous randomized, controlled, clinical trials. Second, physicians should take a careful history of the patient to determine the cumulative dose of radiation a patient has already received and provide clear, personalized information about the risks of iatrogenic cancer.

"If we began a national conversation about the dangers of ionizing radiation, it might cause enough discomfort to stimulate demand for high-quality evidence our patients deserve," writes Lauer.

Sources

Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009; 361:849-857.

Lauer MS. Elements of danger—the case of medical imaging. N Engl J Med 2009; 361:841-843.

From theHeart.org

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP