Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Why preparing for a colonoscopy is a two-step process

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I was flabbergasted to learn, as part of the preparation for a colonoscopy, I would not only have to start the bowel clean-out the night before, but would have to get up in the middle of the night to finish the job. If I hadn’t eaten for a day and had dutifully drunk that horrible stuff and suffered the consequences by bedtime, why would I have to do it again in the wee hours?

As everybody of a certain age knows, a colonoscopy is no fun. The doctor inserts a long (very long) viewing tube through the rectum all the way up through the intestines looking for polyps, signs of early colon cancer.

Still, as the 50 percent of us who get the test also know, it’s a lifesaver. Nearly 150,000 of Americans are diagnosed with colon cancer every year, and 55,000 die. Nine times out of 10, colon cancer can be prevented with proper screening.

So colonoscopy is a no-brainer – at least every 10 years starting at age 50.

But why the so-called split-dosing protocol?

Even with no food intake and a good preliminary clean-out, the colon gets mucky overnight. “The other stuff is dead cells, bacterial secretions, mucus, bile, and other material that collect all through the night, even if you have been fasting,” says Dr. John Petrini, a gastroenterologist and immediate past president of the American Society for Gastrointestinal Endoscopy.

Most of this debris winds up on the right side of the colon. “With split-dosing, you get an absolutely clean colon. The right side is particularly clean, which allows you to pick up small polyps that might not otherwise be seen,” Petrini says.

“The reason we do this is not to torture people but to reduce the number of people who need to repeat their tests because of inadequate preparation,” says Dr. Joshua Korzenik, co-director of the Crohn’s and Colitis Center at Massachusetts General Hospital.

That’s why a final clean-out is now often recommended about five hours before the exam. For those who want a colonoscopy first thing in the morning, that means getting up in the middle of the night to finish the prep.

Should all newborns be screened for potential hip problems?

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Historically, this has been a controversial issue, with the American Academy of Pediatrics recommending screening and another prominent group, the United States Preventive Services Task Force, recommending against it, arguing that the evidence has been insufficient.

But a study published in July by researchers at Children’s Hospital Boston may settle things. The study recommends giving every newborn a simple physical exam, which takes about one minute, followed by ultrasound if the exam raises red flags.

The study, led by Dr. Susan T. Mahan, a pediatric orthopedic surgeon at Children’s, analyzed data from more than 70 studies dating back to 1939. It compared screening with physical exam and ultrasound, to physical exam plus ultrasound only if warranted, to no screening at all. Physical exam plus ultrasound, when warranted, proved best at picking up hip dysplasia.

Hip dysplasia, which means the baby’s hip joint is too shallow or unstable, can lead to early arthritis and lifelong pain. Hip dysplasia is the most common congenital defect in newborns, though estimates of incidence vary widely – from 1.4 per 1,000 babies to more than 35 per 1,000, depending on the age of the baby studied and the method used for detection. It is also the most common cause of osteoarthritis of the hip in North America, Europe, and Japan. The risk increases if there is a family history of the problem and if the birth is breech (the baby’s bottom delivers first).

“If you were to ultrasound all newborn hips within the first week or so of birth, as many as 20 percent may have some abnormality,” says Mahan, though 90 percent of these get better on their own. Treatment typically involves placing the child in a soft harness for six weeks or so to straighten the hips; in more severe cases, a cast or surgery may be necessary.

The goal, says Mahan, is to use screening to catch the cases that probably would not get better on their own and intervene early.

Do topical creams and gels help with muscle pain?

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Traditional muscle rubs containing salicylate – an aspirin-like compound – do not help much, according to a recent review by British researchers for the Cochrane Collaboration, an international nonprofit that provides up-to-date information on health care research. But American doctors say that newer topical NSAIDs (non-steroidal anti-inflammatory drugs) containing diclofenac may be more effective.

In the Cochrane review, researchers from the University of Oxford looked at seven randomized, controlled trials of muscle rubs containing salicylates for acute pain, and nine randomized, controlled trials for chronic pain involving a total of 1,276 people. The rubs caused irritation and reddening of the skin by stimulating blood flow, which has been theorized to relieve certain kinds of muscle pain.

Overall, the researchers found, there’s not enough evidence to support the use of gels or creams containing salicylates.

In the last several years topical NSAIDs have entered the US market. These prescription drugs (the Flector Patch and Voltaren Gel, both of which contain diclofenac) are “somewhat effective for treating the chronic pain of osteoarthritis,” says Dr. James P. Rathmell, chief of the Division of Pain Medicine at Massachusetts General Hospital. “But only one in three patients will get more than 50 percent pain relief.”

There are also over-the-counter rubs such as BenGay, Icy Hot, and Zostrix. The first two contain menthol and Zostrix contains capsaicin. Menthol and capsaicin activate a class of receptors called TRP (Transient Receptor Potential), found on sensory neurons, says Rathmell.

In general, a major problem with any of the topical treatments is that they don’t get deeply enough into muscle tissue to provide much relief, says Dr. Robert Simms, chief of rheumatology at the Boston University School of Medicine.

“It is reasonable to try this stuff,” says Rathmell, “but don’t expect miracles. The pain relief is modest and more than half of people will not get any significant relief.”

Does resistance – strength – training benefit older adults?

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It certainly does. In fact, the benefits of strength training – weight lifting, exercise machines, pulling on wide elastic bands color coded for resistance – are among the strongest findings in medical research.

A new meta-analysis, which involved pooling data on 6,700 people over age 60 from 121 randomized, controlled studies, shows that resistance training makes muscles substantially stronger and helps people do better at everyday activities such as walking, climbing steps, and standing up from chairs. The analysis was published online July 8 by the Cochrane Collaboration, an international not-for-profit organization that provides up-to-date information about the effects of health care.

The take-home message, says Chiung-Ju Liu, an occupational therapist and gerontologist at Indiana University in Indianapolis who led the review, is that people, even into their 80s and even if they have some health problems, should do resistance exercises two to three times a week. Each exercise session should be hard enough so that you can only do three sets of 8 to 12 repetitions of the weight being lifted.

“Once you feel the resistance is not enough of a challenge, then you can increase to the next level,” heavier weights or a more difficult elastic band, says Liu. If you have a special medical condition such as heart disease or arthritis, check with your health care provider and monitor any pain associated with the exercise.

The evidence in favor of strength training – at any age – “is nothing short of astonishing,” says William J. Evans, an exercise physiologist at the University of Arkansas for Medical Sciences. And it is “remarkably safe. There are no reports that I have seen to indicate that there are any safety issues. . . . Resistance exercise is actually safer than regular aerobic exercise as far as risks of a cardiac event.”

Can anything be done for female pattern hair loss?

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Yes – treatments similar to those for men.

As in men, there are many causes of hair loss in women – including scalp infections and inflammation, and auto-immune attacks on the follicles in the skin that make hair.

But the most common problem for women, especially after menopause, is “female pattern hair loss,” or androgenetic alopecia. High levels of the male hormone testosterone can trigger this, but “most women with androgenetic alopecia have normal levels of testosterone,” says Dr. Lynne Goldberg, a dermatologist and director of the hair clinic at Boston Medical Center.

These women may have hair follicles that are genetically programmed to be extra sensitive to testosterone, which causes them to produce thinner – and eventually, no – hair, says Dr. Deborah Scott, a dermatologist at Brigham and Women’s Hospital.

The first treatment, Scott says, is Rogaine (minoxidil), which must be used continuously to sustain any benefit. If it does not make new hair grow, it can help slow hair loss.

Propecia (finasteride) is used to treat hair loss in women in Europe, but is not government-approved here for that purpose. Studies suggest it does not work well in women, Scott says, though some doctors prescribe it, which they are allowed to do. Another option, though it, too, isn’t approved for this use, is Aldactone (spironolactone), a diuretic whose side effect is to block testosterone receptors.

Hair transplants are a good, but expensive, option, and not covered by insurance. The latest technique uses “micrografts,” meaning that hair follicles are surgically removed from one spot on the head – usually the back of the scalp – and inserted one or two hairs at a time in the bald area. While hair follicles in the crown of the head are often destroyed by testosterone, those at the back are not.

However, if your underlying problem is inflammation or infection, transplantation won’t help.

Is sleep deprivation linked to negative emotions?

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It certainly is. In fact, after being deprived of just one full night’s sleep, people not only have stronger negative emotions the next day, they are much more likely to remember bad experiences than good.

One key study showing the strength of negative emotions after sleep deprivation was conducted by radiologist Seung-Schik Yoo of Brigham and Women’s Hospital and others. Twenty-six healthy young men and women (ages 18 to 30) with no history of psychiatric problems were divided into two groups, one that was deprived of sleep for 35 hours and one that was not. Both groups were then tested in functional magnetic resonance imaging scanners and were shown pictures that ranged from neutral to extremely upsetting, such as images of mutilated animals.

When viewing the upsetting pictures, those who were sleep-deprived showed much more activation of the amygdala, a primitive part of the brain that governs emotional arousal, especially responses to fear. At the same time, the sleep-deprived folks showed less activation of the medial-prefrontal cortex, the front part of the brain that puts a brake on amygdala activity, than the control group.

The reasons for these changes are not known, says Yoo, whose study was published in 2007 in Current Biology, but it’s clear that sleep deprivation is linked to “negative feedback all over the place.” And that may be true even if you don’t miss an entire night’s sleep.

Sleep doesn’t immediately chase away the negativity, according to a 2006 review published in the Annual Review of Psychology. Robert Stickgold, associate professor of psychiatry at Beth Israel Deaconess Medical Center, says data suggest that even after sleep-deprived people get a couple of nights of good sleep, there is still a “horrible bias shift” in their memories of events from the day after their lost sleep.

They “remember twice as much of the bad stuff as the good stuff. If you were living a life of four to five hours’ sleep a night, you might after a while only remember the bad things that happen. If that’s not a route to depression, I don’t know what is.”

Moral of the story: If you want to be happy, don’t skimp on sleep.

Is the growing use of hand sanitizers changing the normal ecology of our hands, making it easier for the MRSA bacteria to grow?

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Probably not. MRSA, or methicillin-resistant staphylococcus aureus, normally lives in the nose and throat, the armpits and the perineum (the area near the anus), said Dr. J. Owen Hendley, professor of pediatric infectious diseases at the University of Virginia School of Medicine. It’s not commonly carried on the hands.

Using a hand sanitizer, or washing with soap and water, kills the “transient flora,” or bacteria, including MRSA, that is temporarily on the skin. These cleaning methods do not get rid of permanent, or “resident,” bacteria, but this is not a problem because these bacteria do not cause disease, he said. In fact, these good bacteria help keep disease-causing germs away.

Dr. Stuart Levy, a professor of microbiology at Tufts University School of Medicine and president of the Alliance for the Prudent Use of Antibiotics, agrees.

“There’s no reason to worry,” he said. Hand sanitizers have revolutionized how doctors and nurses treat patients in hospitals. “These alcohol dispensers are in front of every door, all over. It’s fabulous,” he said. “They’re gentle to the hands because they contain a lubricant, they work immediately, they dry, and you kill the bacteria on your hands.”

Should women undergoing treatment for breast cancer take antioxidants?

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There is a glaring lack of evidence that antioxidants either help or hinder, yet many women undergoing chemotherapy, radiation, and hormonal therapy do take these supplements.

A study led by Columbia University epidemiologists Heather Greenlee and Judith Jacobson and published online June 8 in the journal Cancer looked at 663 women, originally part of the large Long Island Breast Cancer Study Project. These women all received chemotherapy, radiation, or hormonal therapy, and 60 percent of them reported in interviews that they had taken antioxidants such as vitamin C, vitamin E, beta-carotene, and selenium during treatment. Most were taking high doses, defined as more than the dose of each supplement in a Centrum multivitamin.

The trouble, says Jacobson, is that nobody knows whether taking antioxidants is safe or effective for breast cancer patients. Her study did not look at outcomes between women who took supplements and those who didn’t. “We have no evidence in this study either way – that there’s any benefit or any harm,” she says, adding that breast cancer patients should tell their oncologists that they are taking the supplements.

Dr. Eric Winer, director of breast cancer oncology at Dana-Farber Cancer Institute, goes further. Laboratory experiments and studies in animals have suggested that taking antioxidants could interfere with the benefits from chemotherapy and radiation, he says. In theory, these treatments work in part by increasing the levels of “free radicals” – highly reactive forms of oxygen. Antioxidants might combat these free radicals, though no one has shown this in human studies. The effects antioxidants might have on hormonal therapy are unknown.

“The evidence is thin to zero that these agents are particularly beneficial,” adds Winer, so patients may be taking substances that do them no good and may do harm. To be on the safe side, Winer suggests, women getting treatment for breast cancer should wait to take antioxidants until the treatment is over.

Do men and women react differently to babies with abnormal facial features?

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Yes, according to preliminary research published last month by researchers from McLean Hospital in Belmont. In fact, women seem to be more likely than men to reject babies with abnormal facial features, such as cleft palates, Down syndrome, crossed eyes, or skin disorders. Perhaps, the authors suggest, there’s an evolutionary reason – to make sure maternal resources go toward what they call “facial attractiveness,” which might be a sign of health and viability.

The study, published in PLoS One, was conducted by Dr. Igor Elman, a psychiatrist and director of the clinical psychopathology laboratory, and experimental psychologist Rinah Yamamoto. They asked 13 men and 14 women, few of them parents, to look at 80 baby pictures – 50 normal faces, 30 with abnormal features – on a computer. By hitting different keys, the subjects could make the pictures stay longer or disappear from the screen.

Gender played a huge role in whether the subjects accepted or rejected the pictures, said Elman. Women “worked” much harder – they made many more keystrokes – to delete pictures of babies with facial abnormalities.

This evidence fits with longstanding psychological theory that the “babyishness” of infant features – like the cuteness of baby animals – seems linked to nurturing feelings and behavior in adults, said Yamamoto.

Massachusetts General Hospital psychologist Nancy Etcoff, author of “Survival of the Prettiest,” said that “beauty has survival value. Beauty is a biological advertisement for health.”

Dr. Michael C. Miller, a psychiatrist at Beth Israel Deaconess Medical Center, agreed, but cautioned that “it’s important not to equate the responses people have to pictures of other people’s children with the reaction of mothers who give birth to a child with significant, visible defects.” Many mothers, he said, love and bond well to their babies despite visible flaws.

And for what it’s worth, babies notice beauty, too, said Etcoff. Even days-old babies, she said, prefer to stare longer at faces (not their mothers’) deemed beautiful by adults.

Does stretching before or after exercise prevent injuries and soreness?

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No, despite what many coaches still say. A review of more than 350 studies published over the last 40 years concludes that stretching prior to exercise doesn’t prevent injury in competitive or recreational athletes.

The study, published in March in “Medicine & Science in Sports and Exercise,” the journal of the American College of Sports Medicine, was led by Dr. Stephen B. Thacker, an epidemiologist at the federal Centers for Disease Control and Prevention. Promotion of stretching “has been based on intuition and observation rather than scientific evidence,” said Thacker. Stretching can increase muscle and joint flexibility, he noted, but there is “little to no relationship between stretching before a workout and injuries or post-exercise pain.”

Most injuries, he said, occur during muscle contractions within the normal range of joint motion, which raises doubts about how increasing range of motion could lower the risk of injury. Stretching helps maintain normal range of motion, which is important, especially as people get older, Thacker said.

Exercise physiologist William J. Evans of the University of Arkansas for Medical Sciences said that “few studies have demonstrated the benefits of stretching.” Most people who do stretch, he said, do so incorrectly, typically bouncing and lunging, which do not increase flexibility. To stretch properly, you should stretch slowly and hold it for at least 30 seconds.

Dr. Edward Phillips, director of outpatient medical services at the Spaulding Rehabilitation Hospital Network, cautioned that stretching can be harmful for weight lifters, particularly if they do it just before or in between sets of resistance training.

Stretching reduces the tensile strength of the muscle and is at odds with the need to contract it forcefully to overcome the resistance and thereby strengthen the muscle, said Phillips, who is also co-author of the “ACSM’s Exercise is Medicine: A Clinician’s Guide to Exercise Prescription.”

Bottom line: If you still want to stretch, do so gently and after you’re well warmed up.