There Is No Such Thing As A Healthy Tan

Between 1970 and 2009, melanoma increased eight-fold among women ages 18-39 and four-fold in men who live in Olmstead County, Minn. These numbers mirror the trend across the country. The rising cancer rates, especially among young women, is being driven by the use of indoor tanning beds. Tanning beds can emit ten to fifteen times more UV radiation than the midday sun. Ultraviolet radiation is a known carcinogen.

Besides using tanning beds, risk factors for developing melanoma include a family history; having fair skin, light hair and eyes; and burning easily.  The greatest increase in melanoma is occurring among adolescents and young adults.

Among women, cancer was most commonly found on legs (particularly on the back of the legs), arms and back. In men, the back and arms were most frequently affected; followed by neck, shoulder and head.

To lessen the risk of melanoma, the American Academy of Dermatology recommends avoiding the mid-day sun and wearing a broad-spectrum, water-resistant sunscreen with a SPF of 30 or more. “There is no such thing as a healthy tan.”

Men Believe They Are Invincible

Robert B. Rhodes MD has come to the conclusion that men don’t think that anything bad will happen to them. Women are taught at an early age to visit a doctor annually and have certain tests, such as mammograms, at regular intervals. Even if they forget or ignore the guidelines, they all know about them. In contrast, men only go to the doctor when they feel bad enough.

With the support of the US Preventive Services Task Force, Dr. Rhodes has formulated the 2,3,4,5 Principle of Men’s Health. It’s very simple:

Men should get physicals:

            Two times in their 20s

            Three times in their 30s

            Four times in their 40s

Every year in their 50s (and beyond).

Insurance companies are often paying almost 100% of preventive services, so cost is no longer an avoidance tactic.

Good health: Do it for your family and yourself. The more a man knows about his own health, the greater the odds he will stay around to reach his goal, enjoy life and love his family.

Save Yourself - Call 911

The Wall Street Journal recently ran an article about how to survive a heart attack. There was lots of useful information, but what really struck me was that a large number of people, in the midst of a myocardial infarction, drive themselves to the emergency room!

A heart attack happens when there is a blocked blood vessel and the affected part of the heart cannot do its job. That job might be pumping blood or it might be maintaining a steady rhythm. If the patient is lucky, the surrounding heart tissue will take over for a while – just like your work colleague will cover your phone while you take a bathroom break. But like at work: how long can one expect someone else to do the job, especially without any notice?

A lot of things can go terribly wrong very quickly if there is inadequate blood flow. If the muscle part of the heart is compromised blood will not be pushed to the vital organs. Would UPS be able to make deliveries if their trucks didn’t have fuel? If the natural pacemaker is knocked out, the very inadequate backup pacemakers will try to do the job (usually not successfully). Did you every watch a local TV newscast on a holiday evening?

Even if you manage to get to the hospital without losing consciousness, potentially killing yourself and someone else, you might be polite enough to wait your turn to check in. The clock is ticking – that blood vessel is still blocked and bad things are happening.

If you think you may be having a heart attack, save yourself! Call 911 immediately. The hospital will come to you. Paramedics will start treatment in the field (emergency-speak for wherever you are) and alert the emergency department that you are on the way. If anything bad happens, someone with training and equipment will help you. If you drive yourself, or if your spouse drives you, who is going run the defibrillator? 

Rice - another grain story

It’s increasingly clear that our underlying genetics are the major factor in determining our response to health challenges. A study recently published in the British Medical Journal demonstrated that a higher consumption of white rice is more likely to lead to diabetes in persons of Chinese and Japanese descent. A dose-response analysis showed that each serving per day of white rice consumption was associated with an 11% increase in risk of diabetes in the overall population. The association of increased intake of white rice and increased risk of diabetes is less robust in persons of Western descent.

Rice was first domesticated approximately 8000 to 9000 years ago by people living in the region of the Yangtze River valley in China. Rice is now grown worldwide and provides food for more than half of the world’s population, especially those living in some of the most populous countries, such as China, India, and Japan. White rice is the predominant type of rice consumed worldwide and has a higher glycemic index than whole grains. Additionally, white rice is lower in many beneficial nutrients (insoluble fiber, magnesium and others) that have been associated with lower risk of diabetes.

In much of the world, there is less hunger than there has been in the past. Physical activity has dramatically declined in the past few decades. A higher intake of calories combined with less exercise combined with a genetic predisposition is well known to be a recipe for diabetes. Now it appears that there are population specific triggers. If rice is a trigger for the Eastern patients, it would not be surprising to learn that it could be potatoes for the Eastern Europeans and pasta for the Southern Europeans.

To read more, here is the full article in the British Medical Journal.

Avoiding Gluten

I have recently heard a lot of discussion about the health benefits of a gluten-free diet. Gluten is a protein that is found in wheat, rye, barley and many prepared foods. In patients with celiac disease, an autoimmune response to gluten results in damage to the lining of the small intestine. The small intestine is responsible for absorbing food and nutrients. Thus, damage to the lining of the small intestines can lead to difficulty absorbing important nutrients; this problem is referred to as malabsorption.

The criteria for diagnosis of celiac disease are rigorous. In additional to gastrointestinal problems, patients with celiac disease can have other health problems. Since so many conditions are associated with celiac disease (diabetes, hypothyroidism, anemia, osteoporosis, skin problems and nervous system disorders), people without celiac disease are exploring ways to improve their health by eliminating gluten.

Maintaining a gluten-free diet is a challenging task. One needs to avoid foods containing wheat, rye, barley, malt, brewer's yeast  (unless labeled gluten free). Naturally gluten free foods include rice, wild rice, corn, and potatoes. A small percentage of people with celiac disease cannot tolerate oats.

There is no good evidence that there are health benefits to maintaining a gluten-free diet in the absence of celiac disease. It’s possible that many people feel better because they have eliminated pizza, pastries, pasta, and sweetened breakfast cereal. Additionally, avoiding factory prepared food with long lists of multisyllabic additives is always a good idea! 

Sinus Infections

The Infectious Diseases Society of America (IDSA) has issued new guideline on the diagnosis and management of acute bacterial rhinosinusitis, offering ways to distinguish bacterial from viral infection and stressing that antibiotic treatment is not necessary in the latter case.

Antibiotics kill bacteria, and are not recommended for most sinus infections because 90% to 98% are caused by viruses.

An infection probably has a bacterial cause and warrants antibiotics if symptoms last for at least 10 days and are not improving; if symptoms are severe, such as a temperature of at least 102° and facial pain for three to four successive days; and if symptoms worsen, usually after a viral upper respiratory infection of five or six days' duration that seemed to be improving, according to the guideline.

In patients who do have a bacterial sinus infection, the guideline recommends amoxicillin-clavulanate (Augmentin) to cover ampicillin resistant bacteria. Common antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin) and trimethoprim-sulfamethoxazole (Septra) are not recommended as first line antibiotics because of resistance issues. The guideline also recommends that antibiotic treatment in adults last five to seven days rather than 10 days to two weeks.

Whether viral or bacterial, sinus infections can be miserable. Analgesics, such as ibuprofen or acetaminophen are excellent for pain relief. Topical steroids (Flonase, Nasonex) have been shown to be beneficial. Medications that thin mucus, such as guaifenesin (Mucinex) promote drainage.