Wednesday, October 31, 2012

Q&A Session at Avvo.com

Do I have a yeast infection?



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Q&A Session at Avvo.com

I'm a 12 year old boy and I get hot flashes every day all the time,including one now!



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Q&A Session at Avvo.com

Will testosterone supplementation cause any permanent harm to fertility?



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Q&A Session at Avvo.com

I have a lump on my elbow for iver a month now, it hurts and I get fatigued.



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Q&A Session at Avvo.com

What health risks may I encounter from cycling 6 weeks of 50mg a day of Anavar? And how high are these health risks for 6 weeks?



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Q&A Session at Avvo.com

I am trying to fiure out why I got a blood clot in my leg when I have not done anything to promote it being very active



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British Views on Mammography Similar to American

Remember the controversy that the United States Preventive Services Task Force (USPSTF) stirred up 3 years ago with its then latest recommendations on screening for breast cancer?  Remember the prospective cohort study published in the Annals of Internal Medicine last October in which the authors concluded that annual mammograms increased the risk of false positive interpretations?  Remember the retrospective study published earlier this past April in the Annals of Internal Medicine in which the authors concluded that breast cancer was overdiagnosed in 15-25% of women who were screened?  

If so, then you might not be so surprised to hear that the Independent UK Panel on Breast Cancer Screening concluded in a review published yesterday in Lancet that every 3rd year screening from 50-70yo decreased breast cancer mortality but also increased overdiagnosis, similar to conclusions from the other side of the pond.  In fact, for every 10,000 50yo British women screened for 2 decades, mammography would prevent 43 breast cancer deaths while 129 cases of breast cancer would be overdiagnosed.  By overdiagnosis, we conclude that it's unlikely that cancer would've led to that person's demise.  In other words, for every death prevented, 3 women were treated who would never have needed treatment and thus needlessly suffered from the side effects of treatment.

Am I anti-mammogram?  Of course not!  Just like I'm not anti-PSA either.  Instead, rather than paint with a broad brush, we need to start wielding a very fine paintbrush and personalize testing & treatment options to the individual.  So don't blindly order a mammogram but rather have a conversation with your patient and discuss both the benefits and the potential negative consequences, too.



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Tuesday, October 30, 2012

Q&A Session at HealthTap.com

i had unprotected sex a couple of weeks ago and got my period two days later. a week in a half later i got a very light period. could i be pregnant?



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Q&A Session at HealthTap.com

I took a z pack of antibiotics on 9/24/12 have had mood swings head aches and unprotected sex since first week of antibiotics could I be pregnant?



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Q&A Session at HealthTap.com

What is the life expectancy for a 42 yr old man with stage 4 signer ring cell with metastasis of the lung and how and with what would you treat him?



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Q&A Session at HealthTap.com

safe vitamins can I get to boost metabolism?I don't eat healthy but walk for 20minutes five days a week I weigh 169 want to weigh 120 no diet work 4me



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Q&A Session at HealthTap.com

Hi can u help me . I feel tired and when going up stairs I feel out of breath and my arms and legs are very weak no strength . This happens at anytime?



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Q&A Session at HealthTap.com

What's the lowest someone's blood pressure can get that's still considered safe while on blood pressure meds for high blood press?



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Don't Just Sit There, Do Something! Part 13 Life Expectancy

It's deja vu all over again. Yogi Berra

I had a strong sense of deja vu as I reviewed a population-based cross-sectional observational study of 11,247 Australians, New Zealanders, and British, published this month in the British Journal of Sports Medicine in which the authors concluded that television watching was associated with a reduction in life expectancy, so I kept digging (albeit nicely).

And then I found my August 18, 2011 post regarding an advance online copy of the exact same article.  The good news is that I still interpret data in the same fashion as I did over a year ago.  The bad news is that it takes over a year to go from an advance online copy to the real deal.

Bottom line: watching TV is bad for you.  So get out there and do something.



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Monday, October 29, 2012

Q&A Session at Avvo.com

Why did i have this kind of headache 15 years ago when i was working in a stressful situation?



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Q&A Session at Avvo.com

What kind of headache was this when i was working in a stressful situation 15 years ago?



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Q&A Session at Avvo.com

What has been happening? i am 70 yrs old. since i was a teenager, i have been able to hold my hands up to curl my hair a very



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Q&A Session at Avvo.com

Always in pain and still no answer, whats wrong with me?



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Q&A Session at Avvo.com

Is it unhealthy to breath your mouth daily?



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Q&A Session at Avvo.com

Why do sometimes I have trouble saying some words?



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Lifestyles & Risk Factors for Heart Disease

We are forever looking for the next big thing.  In the world of high definition television, we'll soon be bombarded by advertisements for 4K Ultra High Definition.  In heart disease, every company is pushing its test as the being capable of more accurately predicting risk of future events.  But as I informed a patient over the weekend who asked about this test and that, do it if the result will change your decision.  In other words, if the outcome of the test will convince you to take a medication, change your diet, and/or get physically active on a regular basis, sure, by all means, go get the test.

But what if you haven't reached 150 minutes/week of moderate intensity or 75 minutes/week of vigorous intensity exercise?  What if your body mass index is greater than 25kg/m2?  What if you still smoke?

What if you consume less than 4 cups/d of fruits & vegetables, less than 2 servings/week of oily fish, less than 3 servings/d of fiber-rich whole grains, greater than 1,500mg/d of sodium (salt), and/or greater than 35 ounces/week of sugar-sweetened beverages?  (You need to meet at least 4 of these nutritional guidelines to have this point count in your favor).

What if your total cholesterol is greater than 200mg/dL?  What if your blood pressure is greater than 120/80mm Hg?  And what if your fasting blood glucose is greater than 100mg/dL?  

In a prospective observational study published in this month's Mayo Clinic Proceedings, the authors followed for over 11 years 11,993 participants (almost 1 out of 4 who were female) with an average age of 45yo.  Those who met 5 to 7 of the above ideal lifestyle metrics had a 63% lower risk of heart disease associated death compared to those who met 2 or less while those who met 3 to 4 had 55% lower risk.

But you already knew this, right?  Want to know what's really sad?  Of the almost 12K individuals, only 29 (yeah, just over 2 dozen) met all 7 criteria for lowest risk of heart disease.  As for the rest, why bother to spend money on the newest, latest tests when they've got their work already cut out for them.



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