Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Should marathon runners take a baby aspirin before a big race?

by

Probably, according to emerging scientific evidence. But not all doctors agree.

Marathon running can cause muscle injury that triggers production of inflammatory chemicals called cytokines. Cytokines boost activation of blood clotting agents called platelets, potentially raising the risk of clot-induced heart attacks, says Dr. Arthur Siegel, director of internal medicine at McLean Hospital in Belmont and a volunteer in the Boston Marathon medical tent.

In 2006, Siegel and colleagues reported in the journal of the American Society for Clinical Pathology that “during a race, a runner goes from the low risk to the high risk category for having an arterial thrombus [clot in an artery].” (The study used a blood test made by Bayer HealthCare, which makes aspirin.)

“Aspirin is potentially an antidote to this platelet activity,” Siegel said – thus, it makes sense for marathoners to take a baby aspirin before a race.

The idea of taking a baby aspirin – 81 milligrams – before a marathon was also strongly endorsed this month by Dr. Lewis Maharam, medical director of the New York City Marathon and author of the “Ask the Running Doc” column in “Runner’s World.”

In March, the US Preventive Services Task Force, an independent panel of private-sector experts convened by the government, endorsed daily use of 75 milligrams of aspirin – roughly the amount in a baby aspirin – to prevent acute cardiovascular disease in men aged 45 to 79 and to prevent stroke in women aged 50 to 79, whether they are runners or not.

Aspirin was not recommended for people at low risk for cardiovascular disease. It cautioned that the recommendations apply only when the potential reduction of stroke or heart attack risk outweighs the increased risk of gastrointestinal bleeding due to aspirin.

Some doctors remain cautious. Dr. Malissa J. Wood, a cardiologist, co-director of the women’s heart program at Massachusetts General Hospital and marathon researcher, cautioned that while muscle injury can increase platelet activity, it’s not clear that this translates to heart problems in runners.

Do electronic medical records make hospitals safer?

by

A study from Johns Hopkins University supports the argument that they do.

In theory, electronic records are more accessible, readable, and complete, and thus translate into faster, more appropriate treatment, which could save money and lives. With that in mind, researchers led by Dr. Neil R. Powe, director of the school’s Welch Center, looked at 167,233 patients in 41 Texas hospitals.

They found that for all medical conditions studied (heart attacks, congestive heart failure, coronary bypass surgery, and pneumonia), a 10 percent increase in use of computerized records corresponded with a 15 percent decrease in death rates. Hospitals in which doctors wrote medication orders online also had 9 percent fewer complications, such as adverse drug reactions, for people with heart attacks, and 55 percent fewer for people undergoing bypass surgery.

Powe estimates that if the results from Texas hold up nationwide, there would be 100,000 fewer hospital deaths per year, with cost savings of $500 to $1,000 per hospitalization.

Not everyone is so positive. The Congressional Budget Office has said some analyses of health informative technology – or HIT, as it is known – may have overstated the financial benefits by focusing on potential, rather than likely, savings.

An editorial accompanying the Johns Hopkins study, published in the Archives of Internal Medicine, said it provides important additional information on the advisability of health information technology, with “impressive” relationships between the technology and better health and cost outcomes. But, cautioned author Dr. David Bates of Brigham and Women’s Hospital, the work by the Johns Hopkins team “should be considered circumstantial; there is no way to be certain that the HIT is responsible for the changes observed.”

But Bates goes on to say that, at least for large and medium-sized hospitals, “the time is now” for more computerization.

A recent survey published in the New England Journal of Medicine showed that so far only 1.5 percent of US hospitals have a comprehensive electronic-records system. In part, that’s because it’s expensive to install such systems and train technical support staff.

But once in place, electronic medical records may hold promise for better care.

I’ve heard of surgery to repair hips and knees riddled with arthritis. Is there anything similar for hands and wrists?

by

Yes. Although many hand and wrist problems associated with rheumatoid arthritis respond relatively well to medication alone, others – especially those linked to osteoarthritis – are increasingly being treated with surgery.

For painful or damaged wrists, the best solution is often old-fashioned fusion, says Dr. Andrew Jawa, a hand, elbow, and shoulder surgeon at Boston Medical Center. Fusion means surgically merging one of the bones of the arm (the radius) and the tiny bones of the wrist ( the carpal component), according to Jawa. Because the bones are fused, the person loses mobility in the wrist, but pain is often dramatically reduced.

With full joint replacement, like that done for hips and knees, more sophisticated technology is now making it possible to fix damaged knuckles and fingers, says Dr. Jesse Jupiter, chief of the upper hand extremity service at Massachusetts General Hospital. The most commonly replaced joint is the base of the thumb, called the basal joint – a joint that doesn’t exist in other primates.

Historically, doctors used Silastic, a kind of rubber, to replace this joint, but now they increasingly use various combinations of ceramics and metals (typically cobalt and chrome), which can be shaped to more precisely mirror the shape of the joint itself.

Finger and wrist joint replacements have lagged behind knee and hip replacements mostly because hand pain is not as disabling.

But “we use our hands for everything,” says Jupiter, adding that joint replacement for fingers and knuckles is growing steadily.

Newer prostheses and new materials mean that surgery is now an increasing option for people whose hands and wrists are damaged from osteoarthritis, he said

Which are safer to live with, dogs or cats?

by

Maybe dogs – but only by a hair. The message from experts in zoonotic diseases – infections spread between animals and people – is that both dogs and cats are not only safe to live with, but actually enhance human health.

Many of the germs carried by pets are far more likely to be transmitted through contaminated food or water than from a pet, according to the federal Centers for Disease Control and Prevention. And the benefits of pet ownership are legion – lower blood pressure, reduced stress, even better social lives, says Dr. Lisa Moses, a veterinary internal medicine specialist at MSPCA Angell Animal Medical Center in Boston.

“The reality, fortunately, is that transmission of infectious diseases from pets to people is a relatively rare event,” agrees Dr. Ed Dubovi, a virologist at Cornell University College of Veterinary Medicine.

Dogs may have a slight safety advantage because they have no part in the zoonotic disease experts worry about most: toxoplasmosis, a parasite that pregnant women can pick up from cleaning cat boxes. The parasite can cause birth defects, but can also lie dormant for years; if it then becomes activated in the brain, it can cause blindness.

On the other hand, the bigger risk of “toxo” comes from contaminated meat or soil, which makes gardening while pregnant more risky than cleaning cat boxes.

Dogs are not entirely risk-free. The salmonella bacterium – present in some dog biscuits made with tainted peanut butter – can wind up in dog feces, just as it can with cats. So can campylobacter (a bacterium that causes diarrhea). Giardia in humans usually comes through exposure to contaminated water, but it does exist in dog and cat feces; and dog urine can contain leptospirosis (a bacterium that causes high fever and, potentially, kidney damage and meningitis).

As for bites, dogs are seen as the more frequent offender. But cat bites cause worse infections because cats have sharper teeth and their saliva contains more bacteria.

Bottom line? Pets are great. Just wash your hands after cleaning up.

Is gregariousness a genetic trait?

by

Yes, at least in part. The latest evidence is in a study published in the Journal of Neuroscience.

Stanford University researchers looked at 14 young adults with a genetic condition called Williams syndrome and 13 without the syndrome. People with Williams syndrome generally have poor visual-spatial skills – they would have trouble, for example, drawing a bike – but are abnormally good at recognizing faces and are often far more extroverted than normal.

The syndrome is caused by the deletion of genes on one chromosome and is not inherited, says Dr. Barbara Pober, a Massachusetts General Hospital geneticist who studies the condition.

In the Stanford study, researchers asked all participants to look at pictures of happy and of fearful faces while their brains were being scanned by MRI machines and while they had electrodes on their scalps to detect bursts of brain activity, particularly in a small area called the amygdala. The amygdala provides instant emotional reactions to stimuli, before the higher brain centers more carefully assess danger or safety, friend or foe.

When shown pictures of happy faces, the people with Williams syndrome showed greater amygdala activity than those without, which fits with the longstanding observation of abnormally vigorous sociability, says Brian Haas, the lead author of the paper. The amygdalas of people with Williams syndrome also responded less vigorously to fearful faces, which also may account for their greater extroversion and less fear of people.

This new finding on gregariousness fits with recently published research on twins conducted by researchers from Harvard University and the University of California, San Diego, on the genetic underpinnings of the propensity to form social networks. Identical twins, whose genes are the same, were more likely to show the same pattern of social networks than fraternal twins, who share only 50 percent of genes.

“Most people think that personality style and preferences are totally under our control, but that’s not true,” says Pober. “Findings from Williams syndrome show us that changes in genes can have dramatic effects on personality traits.”

Is there a quick way for doctors to tell if a person is allergic to penicillin?

by

No, although at least one is in the works and may be reviewed soon by the US Food and Drug Administration.

Developing a quick penicillin allergy test for emergency room use is seen as long overdue, partly because many people who think they are allergic to penicillin turn out not to be. They could safely take penicillin, an old but highly effective antibiotic, instead of more expensive drugs that are more likely to trigger drug resistance.

In a recent study published in the Annals of Emergency Medicine, researchers from the University of Cincinnati College of Medicine studied 150 emergency room patients and discovered that 90 percent of those who thought they were allergic to penicillin were not.

That determination was made by making a small skin prick and then injecting some penicillin under the skin. Within 30 minutes it was clear whether the person was allergic. This shows that, at the very least, it is feasible for emergency room physicians to test patients for penicillin allergies, says Dr. Joseph Moellman, an emergency department physician who is one of the study’s authors.

The researchers are now trying to determine how much money could be saved by testing patients and using penicillin more often. They estimated that the difference between penicillin-based antibiotics and non-penicillin based antibiotics is roughly $80 per patient.

Dr. Alasdair Conn, chief of emergency services at Massachusetts General Hospital, welcomed the new results, though he cautioned that the findings should be replicated before practices are changed in all emergency departments. Compared to new, more “broad spectrum” drugs, penicillin is “incredibly cheap,” he noted, and as more hospitals switch to computerized systems that examine doctors’ prescription orders, the push to use cheaper drugs will intensify.

Should a suspicious mammogram prompt an “open” biopsy?

by

No, not usually.

The first step in determining the reason for a troubling mammogram should be a minimally invasive “core needle” biopsy, according to guidelines issued in 2005 by the American College of Surgeons Consensus Conference and a 2006 statement by the American Society of Breast Surgeons.

In this procedure, the woman is given a local anesthetic and a small amount of tissue is extracted through a needle, often under ultrasound or MRI guidance, for analysis. Needle biopsies cost about $1,000, are very accurate, and allow a woman to return to work within a day.

But in 40 percent of cases, surgeons do “open” or “excisional” biopsies, according to Columbia University research published recently in the Journal of the American College of Surgeons. These procedures cost $5,000, plus anesthesia fees.

Open biopsies are no more accurate, and they often leave women with scars that can impede a subsequent operation if she turns out to have cancer. These more invasive biopsies can also lead to infection or bruising.

By either method, biopsies show that 80 percent of the time, women with suspicious mammograms turn out not to have cancer.

“Needle biopsy is the preferred method of diagnosis. Needle biopsy should happen 98 percent of the time,” says Dr. Melvin Silverstein, director of the breast program at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif., who wrote an editorial accompanying the recent research.

It is “outrageous and ridiculous” that so many women are still getting open biopsies, he said, adding, “Once women know this, they will not tolerate it.”

To be sure, there are times when a woman does need an open biopsy, such as when the breast is very small, when the suspicious area is close to the skin or the chest wall, when she has breast implants or is extremely “needle phobic.”

But overall, says Dr. Michelle Specht, a breast surgeon at Massachusetts General Hospital, “the more that women push for core biopsies, the better.”

Should some people avoid anesthesia containing epinephrine during dental procedures?

by

Yes, and fortunately most dentists now offer epinephrine-free anesthesia if you need it.

Epinephrine (adrenaline) is often added to anesthesia injections for dentistry because it constricts blood vessels. This reduces bleeding and helps the pain-dampening effects of the anesthesia stay where it’s needed. But people with uncontrolled high blood pressure – or those taking tricyclic antidepressants such as Elavil, MAO inhibitors, or non-specific beta-blockers – should avoid epinephrine-containing anesthesia because it can raise blood pressure too much, says Dr. David Cottrell, chairman of the department of oral and maxillofacial surgery at the Boston University School of Dental Medicine.

People with atrial fibrillation, a type of heart arrhythmia, may also want to stay away from epinephrine-containing anesthesia because it could make an already “irritable” heart even more prone to arrhythmia, adds Dr. Thomas Kilgore, also an oral and maxillofacial surgeon at BU.

Alternatives to epinephrine-containing anesthesia include Prilocaine and Carbocaine, or even nitrous oxide (“laughing gas”). Plain old Lidocaine is also a decent choice.

Bottom line: Although the small amount of epinephrine in most dental anesthetics probably won’t cause trouble (as long as your dentist injects it into your gums, not mistakenly into blood vessels), to be on the safe side, tell your dentist about your medical conditions and medications you’re taking. Then discuss your options.

What is burning mouth syndrome? Can it be treated?

by

Burning mouth syndrome is a relatively common but mysterious ailment that chiefly affects women around and after menopause. The good news is that although the condition is painful – the mouth feels as though it has been scalded, even though it looks normal – it is treatable and not contagious.

In what are called “secondary” cases, burning mouth is linked to problems such as diabetes, vitamin deficiencies, fungal infections, and medications such as ACE inhibitors, used to treat hypertension, says Dr. Vikki Noonan, an associate professor of oral and maxillofacial pathology at the Boston University School of Dental Medicine. Treating the underlying problem often gets rid of this type of “burning mouth” syndrome.

In other “primary” cases, burning mouth syndrome occurs by itself and is a type of neuropathic pain, caused by injury or malfunction of pain nerves. It is most common in older women who also have psychological distress – anxiety, depression, post-traumatic stress, or obsessive-compulsive disorder, says Dr. Sook-Bin Woo, an associate professor at the Harvard School of Dental Medicine.

“These women are usually very sad or anxious,” she says. “We always acknowledge that the pain is real, but that it is a symptom of a deeper problem.”

Treatment usually begins with over-the-counter supplements of alpha lipoic acid, an antioxidant. If this doesn’t help, try mixing a few drops of Tabasco sauce and water and sloshing it around your mouth. (Alternatively, you can use capsaicin, another hot pepper-based substance, available by prescription.) The idea is to deplete the body’s supplies of the pain molecule, substance P.

If that’s not enough, medications such as Klonopin or Elavil, taken in lower doses than for anxiety or depression, are sometimes prescribed. Stress management and psychotherapy can also be helpful.

Can sagging eyelids be tightened by laser surgery?

by

Yes, but the results vary, depending on the kind of laser used.

One approach, discovered in a small study of 31 patients, is to use a “nonablative,” or nondamaging, laser. Doctors found that patients who were getting a full-face treatment emerged with somewhat tighter upper and lower eyelids, although that was not the purpose of the treatment.

The procedure seemed to stimulate new collagen formation, which in turn tightens up eyelid skin, although in many cases only slightly, reported Dr. Roy G. Geronemus of the Laser & Skin Surgery Center of New York. He led the study and owns stock in the laser company (formerly called Reliant, now Solta Medical Inc.). The procedure, not covered by insurance, costs “a few hundred dollars,” he said.

A follow-up study used a more aggressive, or “ablative,” laser procedure that Geronemus said penetrates deeper into the skin and does injure tissue. It produced more dramatic eyelid-tightening results – closer to those of blepharoplasty, or surgical removal of excess eyelid tissue.

Dr. Daihung Do, director of dermatologic surgery at Beth Israel Deaconess Medical Center, said that for patients who don’t want surgery, the nonablative laser option may offer modest benefit. The more aggressive ablative laser method may be more promising, he said, but study results are not yet published.

Bottom line? Stayed tuned. There still haven’t been enough patients undergoing these treatments to tell for sure how effective they are.