Loud snoring doesn't just annoy your spouse. It could signal dangerous sleep apnea, yet millions go undiagnosed.
A government move may help change that: Medicare is poised to allow at-home testing for sleep apnea -- letting people snooze in their own beds instead of spending the night in a sleep laboratory.
It's a controversial proposal, but potentially a far-reaching one. Some 18 million Americans are estimated to suffer from sleep apnea, yet specialists think fewer than half know it.
"It's been awkward and inconvenient and expensive to get a sleep test, and now that should be improved," said Dr. Terence Davidson of the University of California, San Diego, a longtime proponent of home-testing.
Today, Medicare pays for sleep apnea treatment -- called CPAP, a mask that blows air through the nose while sleeping -- only for seniors diagnosed in a sleep lab. Last month, Medicare proposed covering those diagnosed with cheaper home tests, too. Final approval is expected in March.
While sleep apnea is a problem for seniors, it is most common in middle-aged men. But private insurers now reluctant to cover home apnea testing are expected to follow the government's lead, thus easing access for all ages.
Sleep apnea doesn't just deprive family members of their own zzzzs. Sufferers actually quit breathing for 30 seconds or so at a time, as their throat muscles temporarily collapse. They jerk awake to gasp in air, sometimes more than 15 times an hour. They're fatigued the next day because their brains never got enough deep sleep.
Severe apnea increases the chance of a car crash sevenfold. Research from UCSD suggests 1,400 deaths each year are caused by drivers with sleep apnea.
Worse, sleep apnea stresses the body in ways that also increase risk of high blood pressure, heart attack, stroke and diabetes.
Not every apnea patient is a bad snorer, and a low rumble may not be cause for concern. But sleep apnea's trademark is bad snoring, the snorting, choking kind. Other risk factors: Being overweight, having small airways and apnea in the family.
Yet patients don't remember the nightly breathing struggle, and often don't see a doctor unless a family member complains about snoring -- or until daytime sleepiness gets so bad they can't function.
Only then comes the test debate.
There are dozens of sleep disorders. A night slumbering in a sleep lab, hooked to monitors that measure both breathing and brain waves while health workers watch, has long been the standard for telling who has sleep apnea or another disorder.
But this lab-based polysomnography, or PSG, can cost $1,500. And while access has improved, there are swaths of the country where reaching a sleep lab can mean a few hundred miles drive.
For about $500, home tests use primarily breathing monitors to detect only sleep apnea, not other disorders. Hook it up at bedtime, and a doctor checks the recordings later.
A home test can miss apnea, because it won't signal if someone never fell into that deep REM sleep where breathing is most likely to falter, said Dr. Thomas Gravelyn of the Saint Joseph Mercy Hospital sleep center in Ann Arbor, Mich., who opposes the Medicare change.
"You have this good feeling that everything was taken care of, when in fact it wasn't," he said.
"It certainly is possible to diagnose severe apnea at home," added Dr. Joyce Walsleben, chief of New York University's sleep center. "What if it isn't severe? Are you willing to say it doesn't exist at all if you get a negative study?"
Still, a Canadian study published last year randomly assigned suspected apnea sufferers to either a sleep lab or home testing, and found they worked equally well.
Last month, the American Academy of Sleep Medicine, which represents sleep centers, changed its position to say home tests can help certain high-risk patients -- but should be administered by sleep specialists.
Medicare's proposal wouldn't limit which doctors offer home tests. The American Academy of Otolaryngology, head-and-neck surgeons, requested the change.
In fact, Medicare concluded a sleep-lab test isn't perfect, either -- and thus proposed that all patients get a 12-week trial of CPAP treatment. Only if their doctors certify they're being helped would treatment continue.
That's important, because about half of apnea patients prescribed CPAP struggle to use it, said Dr. Charles Atwood of the University of Pittsburgh Medical Center, a home-test proponent.
What he calls tricks of the trade -- trying differently shaped masks, adjusting the air pressure, adding a humidifier to moisten nostrils -- early could keep more of them in care.
Consider Raymond Miles, 57, diagnosed with a sleep-lab study a few years ago. While he felt better with CPAP treatment, Miles quit it in frustration when he couldn't get help maintaining it.
Two weeks ago, nudged by his wife, Miles underwent a home test with a different doctor to see if it's time to try care again.
"There's a different level of comfort being at home," Miles said.
Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.
Thursday, June 19, 2008
Tuesday, June 17, 2008
UV Rays can harm eyes
Most people know the harmful effects that ultraviolet rays can have on the skin. But many are not aware of the damage that they can cause to the eyes. Possibly the most frightening aspect of UV damage is that it is cumulative, meaning the negative effects may not present themselves until years later.
A recent survey, sponsored by Transitions Optical, Inc., revealed that although 82 percent of respondents knew that extended exposure to the sun could cause skin cancer, only 9 percent knew it could damage vision. Additionally, only one in six respondents said they wear sunglasses when they prepare for extended exposure to the sun and only approximately one third said they wear a hat.
"Most of us wouldn't dream of staying outside in the sun without putting on sunscreen lotion," said Daniel D. Garrett, senior vice president of Prevent Blindness America. "But we also have to remember to wear both UV-blocking lenses and a brimmed hat to protect our eyes as well."
Prevent Blindness America offers an online resource for patients and their loved ones to learn more about what they can do to protect their eyes.
Extended UV exposure has been linked to eye damage including:
* Cataracts -- a major cause of visual impairment and blindness worldwide. Cataracts are a cloudiness of the lens inside the eye that develops over a period of many years. Laboratory studies have implicated UV radiation as a cause of cataract. Furthermore, studies have shown that certain types of cataract are associated with a history of higher ocular exposure to UV and especially UV-B radiation.
* Age-related macular degeneration -- a leading cause of vision loss in the United States for people age 55 and older. Exposure to UV and intense violet/blue visible radiation is damaging to retinal tissue and scientists have speculated that chronic UV or intense violet/blue light exposure may contribute to degenerative processes in the retina.
* Pterygium -- a growth of tissue on the white of the eye that may extend onto the clear cornea where it can block vision. It can be removed surgically, but often recurs, and can cause cosmetic concerns and vision loss if untreated.
* Photokeratitis -- essentially, a reversible sunburn of the cornea resulting from excessive UV-B exposure. It can be extremely painful and can result in temporary loss of vision. There is some indication that long-term exposure to UV-B can result in corneal and conjunctival degenerative changes.
Fortunately, eye protection doesn't have to be expensive to be effective. Quality sunglasses should block out 99 to 100 percent of both UV-A and UV-B radiation and prices vary. For UV protection in everyday eyewear, there are several options like UV-blocking lens materials, coatings and photochromic lenses.
A recent survey, sponsored by Transitions Optical, Inc., revealed that although 82 percent of respondents knew that extended exposure to the sun could cause skin cancer, only 9 percent knew it could damage vision. Additionally, only one in six respondents said they wear sunglasses when they prepare for extended exposure to the sun and only approximately one third said they wear a hat.
"Most of us wouldn't dream of staying outside in the sun without putting on sunscreen lotion," said Daniel D. Garrett, senior vice president of Prevent Blindness America. "But we also have to remember to wear both UV-blocking lenses and a brimmed hat to protect our eyes as well."
Prevent Blindness America offers an online resource for patients and their loved ones to learn more about what they can do to protect their eyes.
Extended UV exposure has been linked to eye damage including:
* Cataracts -- a major cause of visual impairment and blindness worldwide. Cataracts are a cloudiness of the lens inside the eye that develops over a period of many years. Laboratory studies have implicated UV radiation as a cause of cataract. Furthermore, studies have shown that certain types of cataract are associated with a history of higher ocular exposure to UV and especially UV-B radiation.
* Age-related macular degeneration -- a leading cause of vision loss in the United States for people age 55 and older. Exposure to UV and intense violet/blue visible radiation is damaging to retinal tissue and scientists have speculated that chronic UV or intense violet/blue light exposure may contribute to degenerative processes in the retina.
* Pterygium -- a growth of tissue on the white of the eye that may extend onto the clear cornea where it can block vision. It can be removed surgically, but often recurs, and can cause cosmetic concerns and vision loss if untreated.
* Photokeratitis -- essentially, a reversible sunburn of the cornea resulting from excessive UV-B exposure. It can be extremely painful and can result in temporary loss of vision. There is some indication that long-term exposure to UV-B can result in corneal and conjunctival degenerative changes.
Fortunately, eye protection doesn't have to be expensive to be effective. Quality sunglasses should block out 99 to 100 percent of both UV-A and UV-B radiation and prices vary. For UV protection in everyday eyewear, there are several options like UV-blocking lens materials, coatings and photochromic lenses.
Sunday, June 15, 2008
Recognizing Anaphylaxis
An anaphylactic reaction may start off innocently enough, with a tingling or itching sensation or a strange metallic taste. Other common symptoms include hives, a sensation of warmth, trouble breathing or swelling of the mouth and throat. Symptoms may develop within minutes or as long as two hours after exposure, but life-threatening reactions may take up to several hours to appear.
Because exposure to any offending substance can quickly progress to severe anaphylaxis and even death, persons experiencing a combination of the following symptoms are advised to seek emergency care right away:
* Difficulty breathing due to narrowing of airways and swelling of the throat
* Wheezing, coughing or unusual (high-pitched) breathing sounds
* Confusion, slurred speech or anxiety
* Difficulty swallowing
* Swelling of the tongue, throat and nasal passages
* Localized edema or swelling, especially involving the face
* Itchiness and redness on the skin, lips, eyelids or other areas of the body
* Skin eruptions and large welts or hives
* Skin redness, at the site of a bee sting, for example
* Bluish skin color, especially the lips or nail beds, or grayish in darker complexions
* Nausea, stomach cramping, vomiting/diarrhea
* Heart palpitations (feeling the heart beating)
* Weak and rapid pulse
* Dizziness, a drop in blood pressure, fainting or unconsciousness, which can lead to shock and heart failure
Because exposure to any offending substance can quickly progress to severe anaphylaxis and even death, persons experiencing a combination of the following symptoms are advised to seek emergency care right away:
* Difficulty breathing due to narrowing of airways and swelling of the throat
* Wheezing, coughing or unusual (high-pitched) breathing sounds
* Confusion, slurred speech or anxiety
* Difficulty swallowing
* Swelling of the tongue, throat and nasal passages
* Localized edema or swelling, especially involving the face
* Itchiness and redness on the skin, lips, eyelids or other areas of the body
* Skin eruptions and large welts or hives
* Skin redness, at the site of a bee sting, for example
* Bluish skin color, especially the lips or nail beds, or grayish in darker complexions
* Nausea, stomach cramping, vomiting/diarrhea
* Heart palpitations (feeling the heart beating)
* Weak and rapid pulse
* Dizziness, a drop in blood pressure, fainting or unconsciousness, which can lead to shock and heart failure
Friday, June 13, 2008
115-year-old's brain worked perfectly
A Dutch woman who was the oldest person in the world when she died at age 115 in 2005 appeared sharp right up to the end, joking that pickled herring was the secret to her longevity.
Scientists say that Henrikje van Andel-Schipper's mind was probably as good as it seemed: a post-mortem analysis of her brain revealed few signs of Alzheimer's or other diseases commonly associated with a decline in mental ability in old age.
That came as something of a surprise, said Gert Holstege, a professor at Groningen University, whose findings will be published in the August edition of Neurobiology of Aging.
"Everybody was thinking that when you have a brain over 100 years, you have a lot of problems," he said in a telephone interview with The Associated Press on Friday.
He cited a common hardening of arteries and the build up of proteins associated with Alzheimer's disease as examples.
"This is the first (extremely old) brain that did not have these problems."
Van Andel was the oldest living person in the world at the time of her death in 2005 in the Dutch city of Hoogeveen, according to the Guinness Book of World Records.
In 1972, the then 82-year-old Van Andel called the University of Groningen in order to donate her body to science. She called again at age 111 because she worried she might no longer be of interest. At that time Holstege began to interview her, testing her cognitive abilities at ages 112 and 113. Though she had problems with her eyesight, she was alert and performing better than the average 60- to 75-year-old.
Dr. Murali Doraiswamy of the Center for Aging at Duke University, not associated with the study, said it is unusual and valuable.
In the first place there are few "super-centenarians" - people 110 and older - alive at any one time, a slim proportion of the world's population and a scant number even compared to those who reach 100 years.
As a result, he said, there are few chances to study brains as old as hers.
"It's very rare to be able to do not only a post-mortem, but also be able to have tested her two, three years before she died," said Doraiswamy.
"For a scientist, getting the opportunity to study someone like that is like winning the lottery."
Doraiswamy, an Alzheimer's expert, said that the proportion of brains with some buildup of proteins associated with the disease increases with age. As a result, experts theorize anybody who lives long enough will get them eventually.
When Van Andel died, the director of the elderly home where she was living declined to give a cause of death, pointing to her extremely advanced years.
Holstege said she died of cancer.
"She died from stomach cancer, and you and I can also die from stomach cancer," he said, adding that her case demonstrates that very old people die of diseases, not simply old age.
"It is very important to treat the elderly as normal people, as if they are 50 or 60."
He noted that Van Andel was operated on at age 100 for breast cancer and survived 15 more years.
When she was born in 1890, she weighed only 3.5 pounds, and her mother expected her to die in infancy. Van Andel's husband died in 1959. She had no children.
Longevity was in her genes, as all her siblings lived past 70, and her mother died at the age of 100.
Asked what advice she would give to people who want to live a long time, she once quipped: "Keep breathing."
Scientists say that Henrikje van Andel-Schipper's mind was probably as good as it seemed: a post-mortem analysis of her brain revealed few signs of Alzheimer's or other diseases commonly associated with a decline in mental ability in old age.
That came as something of a surprise, said Gert Holstege, a professor at Groningen University, whose findings will be published in the August edition of Neurobiology of Aging.
"Everybody was thinking that when you have a brain over 100 years, you have a lot of problems," he said in a telephone interview with The Associated Press on Friday.
He cited a common hardening of arteries and the build up of proteins associated with Alzheimer's disease as examples.
"This is the first (extremely old) brain that did not have these problems."
Van Andel was the oldest living person in the world at the time of her death in 2005 in the Dutch city of Hoogeveen, according to the Guinness Book of World Records.
In 1972, the then 82-year-old Van Andel called the University of Groningen in order to donate her body to science. She called again at age 111 because she worried she might no longer be of interest. At that time Holstege began to interview her, testing her cognitive abilities at ages 112 and 113. Though she had problems with her eyesight, she was alert and performing better than the average 60- to 75-year-old.
Dr. Murali Doraiswamy of the Center for Aging at Duke University, not associated with the study, said it is unusual and valuable.
In the first place there are few "super-centenarians" - people 110 and older - alive at any one time, a slim proportion of the world's population and a scant number even compared to those who reach 100 years.
As a result, he said, there are few chances to study brains as old as hers.
"It's very rare to be able to do not only a post-mortem, but also be able to have tested her two, three years before she died," said Doraiswamy.
"For a scientist, getting the opportunity to study someone like that is like winning the lottery."
Doraiswamy, an Alzheimer's expert, said that the proportion of brains with some buildup of proteins associated with the disease increases with age. As a result, experts theorize anybody who lives long enough will get them eventually.
When Van Andel died, the director of the elderly home where she was living declined to give a cause of death, pointing to her extremely advanced years.
Holstege said she died of cancer.
"She died from stomach cancer, and you and I can also die from stomach cancer," he said, adding that her case demonstrates that very old people die of diseases, not simply old age.
"It is very important to treat the elderly as normal people, as if they are 50 or 60."
He noted that Van Andel was operated on at age 100 for breast cancer and survived 15 more years.
When she was born in 1890, she weighed only 3.5 pounds, and her mother expected her to die in infancy. Van Andel's husband died in 1959. She had no children.
Longevity was in her genes, as all her siblings lived past 70, and her mother died at the age of 100.
Asked what advice she would give to people who want to live a long time, she once quipped: "Keep breathing."
Tuesday, June 10, 2008
Can drinking flat soda ease an upset stomach?
THE BELIEF:
Drinking flat soda can ease an upset stomach.
THE FACTS:
It is not often that a soft drink is seen as medicinal. But when it comes to stomach distress, many people view a cup of flat soda as just what the doctor ordered.
The quick and popular remedy -- usually in the form of cola, ginger ale or clear sodas -- is said to help settle the stomach with its slight fizz and replenish fluids and glucose lost by vomiting and diarrhea. Parents also find that children who are verging on dehydration but reluctant to consume any liquids are more amenable to soda.
However, research shows that may not be a great idea. In a recent study, British researchers conducted a review of the medical literature going back to the 1950s in search of scientific evidence supporting the claim. They found none. Then, after a biochemical analysis, they compared the contents of colas and other sodas with over-the-counter oral rehydration solutions containing electrolytes and small amounts of sugar.
The soft drinks, the authors found, not only contained very low amounts of potassium, sodium and other electrolytes, but also in some cases as much as seven times the glucose recommended by the World Health Organization for rehydration. "Carbonated drinks, flat or otherwise, including cola, provide inadequate fluid and electrolyte replacement and cannot be recommended," they said.
THE BOTTOM LINE:
Flat soda, a popular remedy for upset stomach, may do more harm than good.
Drinking flat soda can ease an upset stomach.
THE FACTS:
It is not often that a soft drink is seen as medicinal. But when it comes to stomach distress, many people view a cup of flat soda as just what the doctor ordered.
The quick and popular remedy -- usually in the form of cola, ginger ale or clear sodas -- is said to help settle the stomach with its slight fizz and replenish fluids and glucose lost by vomiting and diarrhea. Parents also find that children who are verging on dehydration but reluctant to consume any liquids are more amenable to soda.
However, research shows that may not be a great idea. In a recent study, British researchers conducted a review of the medical literature going back to the 1950s in search of scientific evidence supporting the claim. They found none. Then, after a biochemical analysis, they compared the contents of colas and other sodas with over-the-counter oral rehydration solutions containing electrolytes and small amounts of sugar.
The soft drinks, the authors found, not only contained very low amounts of potassium, sodium and other electrolytes, but also in some cases as much as seven times the glucose recommended by the World Health Organization for rehydration. "Carbonated drinks, flat or otherwise, including cola, provide inadequate fluid and electrolyte replacement and cannot be recommended," they said.
THE BOTTOM LINE:
Flat soda, a popular remedy for upset stomach, may do more harm than good.
Monday, June 9, 2008
No belly full of laughs: Bigger waistlines and stroke linked
The connection between belly fat and the brain intensified last week. Many Americans have obsessed about abdominal fat for, oh, decades. A new study from the Oakland, Calif.-based Kaiser Permanente Division of Research revealed that people who have large waistlines in their 40s are more likely to develop Alzheimer's disease and other dementia conditions in their 70s.
Individuals in the study with the biggest bellies had a risk factor two times that of the leanest people. And belly fat was deemed a more significant risk factor than family history, even if both parents suffered from Alzheimer's.
"If (baby boomers) are not frightened enough about heart disease, maybe they will worry about losing their mental function," said Dr. Sam Gandy, a spokesman for the Alzheimer's Association, in a wire service story.
Well, there's more than heart disease and Alzheimer's/dementia for the belly-fat worry list. In one of those findings covered by media outlets but not getting large headlines or much air time, a University of Southern California study presented at a medical conference in February connected excess abdominal fat among women 35 to 54 to a fast-rising rate of stroke among females in that age group. The rate has tripled in recent years, said USC neurologist Dr. Amytis Towfighi at the International Stroke Conference in New Orleans.
Female waistlines, on average, are two inches bigger than they were a decade ago. Plus, the USC study showed the percentage of women with "abdominal obesity" rose from 47 to 59 percent. Towfighi and other researchers commenting on the study generally agree that this abdominal fat and a continuing rise in obesity are at the root cause of causing more strokes.
A couple of points that got the attention of scientists and public health officials if not the media:
The stroke rate among middle-age men stayed about the same during the time period of federal data examined, which was 1999 to 2004.
While stroke generally is considered to be a disease among the elderly, the sudden spike in middle-age female stroke and belly-fat numbers (men's statistics stayed the same in both categories) alarms health care professionals.
There's more. Doctors have long considered men to be more susceptible to strokes in middle age, with women having strokes at more equal rates once they are five to 10 years into menopause.
It's clearly time to rethink the probabilities -- and maybe even consider that women with excess abdominal fat are even more at risk for stroke than men with expanded waistlines.
Women and stroke incidence were a topic at medical student rounds last week at Swedish Medical Center. Third-year University of Washington med student Corinne Taraska updated the group about the strong link between stroke and women with migraines who also take birth control medication and smoke cigarettes.
"Women who have regular migraine headaches with an aura, plus use birth control and smoke, are seven times more at risk for stroke than women who have regular migraines with an aura but don't smoke or use birth control," said Taraska, who will earn her medical degree this spring and spend a postgraduate year researching melanoma. "It's 10 times the risk if compared to women who don't have migraines."
About a third of all women suffer migraine headaches. The ratio is one in 10 among men.
"We have known for a long time that migraines are associated with higher risk for stroke," said Dr. Bill Likosky, director of the stroke program at Swedish. "What's new is the heightened adverse effect if you choose to use birth control medication or use tobacco."
Likosky acknowledged birth control is a personal decision, but emphasized not smoking "is within everyone's grasp" as a positive step to protect against stroke.
A stroke affects the brain and not the heart. It occurs when there is a loss of sufficient blood flow to the brain, typically caused by a blocked or ruptured artery in the neck region. Likosky said migraines, birth control medicine and smoking even one cigarette can have a clotting or clogging effect on the arteries. Putting two or all three together exacerbates the risk.
In the past decade there have been successful campaigns to raise awareness about the dangers of heart attacks and cardiovascular disease among women. Likosky said stroke awareness "cuts across gender lines" in that women just as much as men are reluctant to go to an emergency room with stroke symptoms -- either because those symptoms are not as jarring as crushing chest pain (which women typically don't feel during heart attack as well) or because people don't know the symptoms, period.
"We talk to people about the acronym FAST," said Likosky. "F is for face (numbness or weakness), A is for arms, S is for speech (or slurring) and T is for 'time is brain.' When in doubt, don't hesitate to call 911. There is a lot that can be done in the early hours of stroke treatment."
KNOW THE FIVE MAJOR SIGNS SIGNS OF STROKE
Here are the five major signs of stroke, as outlined by the National Institute of Neurological Disorders and Stroke:
Individuals in the study with the biggest bellies had a risk factor two times that of the leanest people. And belly fat was deemed a more significant risk factor than family history, even if both parents suffered from Alzheimer's.
"If (baby boomers) are not frightened enough about heart disease, maybe they will worry about losing their mental function," said Dr. Sam Gandy, a spokesman for the Alzheimer's Association, in a wire service story.
Well, there's more than heart disease and Alzheimer's/dementia for the belly-fat worry list. In one of those findings covered by media outlets but not getting large headlines or much air time, a University of Southern California study presented at a medical conference in February connected excess abdominal fat among women 35 to 54 to a fast-rising rate of stroke among females in that age group. The rate has tripled in recent years, said USC neurologist Dr. Amytis Towfighi at the International Stroke Conference in New Orleans.
Female waistlines, on average, are two inches bigger than they were a decade ago. Plus, the USC study showed the percentage of women with "abdominal obesity" rose from 47 to 59 percent. Towfighi and other researchers commenting on the study generally agree that this abdominal fat and a continuing rise in obesity are at the root cause of causing more strokes.
A couple of points that got the attention of scientists and public health officials if not the media:
The stroke rate among middle-age men stayed about the same during the time period of federal data examined, which was 1999 to 2004.
While stroke generally is considered to be a disease among the elderly, the sudden spike in middle-age female stroke and belly-fat numbers (men's statistics stayed the same in both categories) alarms health care professionals.
There's more. Doctors have long considered men to be more susceptible to strokes in middle age, with women having strokes at more equal rates once they are five to 10 years into menopause.
It's clearly time to rethink the probabilities -- and maybe even consider that women with excess abdominal fat are even more at risk for stroke than men with expanded waistlines.
Women and stroke incidence were a topic at medical student rounds last week at Swedish Medical Center. Third-year University of Washington med student Corinne Taraska updated the group about the strong link between stroke and women with migraines who also take birth control medication and smoke cigarettes.
"Women who have regular migraine headaches with an aura, plus use birth control and smoke, are seven times more at risk for stroke than women who have regular migraines with an aura but don't smoke or use birth control," said Taraska, who will earn her medical degree this spring and spend a postgraduate year researching melanoma. "It's 10 times the risk if compared to women who don't have migraines."
About a third of all women suffer migraine headaches. The ratio is one in 10 among men.
"We have known for a long time that migraines are associated with higher risk for stroke," said Dr. Bill Likosky, director of the stroke program at Swedish. "What's new is the heightened adverse effect if you choose to use birth control medication or use tobacco."
Likosky acknowledged birth control is a personal decision, but emphasized not smoking "is within everyone's grasp" as a positive step to protect against stroke.
A stroke affects the brain and not the heart. It occurs when there is a loss of sufficient blood flow to the brain, typically caused by a blocked or ruptured artery in the neck region. Likosky said migraines, birth control medicine and smoking even one cigarette can have a clotting or clogging effect on the arteries. Putting two or all three together exacerbates the risk.
In the past decade there have been successful campaigns to raise awareness about the dangers of heart attacks and cardiovascular disease among women. Likosky said stroke awareness "cuts across gender lines" in that women just as much as men are reluctant to go to an emergency room with stroke symptoms -- either because those symptoms are not as jarring as crushing chest pain (which women typically don't feel during heart attack as well) or because people don't know the symptoms, period.
"We talk to people about the acronym FAST," said Likosky. "F is for face (numbness or weakness), A is for arms, S is for speech (or slurring) and T is for 'time is brain.' When in doubt, don't hesitate to call 911. There is a lot that can be done in the early hours of stroke treatment."
KNOW THE FIVE MAJOR SIGNS SIGNS OF STROKE
Here are the five major signs of stroke, as outlined by the National Institute of Neurological Disorders and Stroke:
- Sudden numbness or weakness in the face, arm or leg, especially on one side.
- Sudden confusion or trouble speaking or understanding.
- Sudden trouble seeing in one or both eyes.
- Sudden trouble walking, dizziness or loss of balance.
- Sudden, severe headache with no known cause.
Sunday, June 8, 2008
Fake patients test Vermont medical students
The patient talked a mile a minute, hopped off the exam table, paced around and poked through the cupboards when the medical students entered the exam room.
The "patient" had spent hours training how to fake it - in the interest of science. It was "Mania Day" at the University of Vermont's medical school.
One part drama, two parts science as doctors-in-training test their diagnostic skills and bedside manner by assessing the ailments of patients played by real people in a program that's growing in popularity at U.S. medical schools.
"This environment allows them to practice and make mistakes in an environment conducive to learning before they go to the patient," said Tamara Owens, president of the Association of Standardized Patient Educators.
Most health care institutions now have some sort of standardized patient program or simulation center, practicing everything performing exams to suturing mannequins. Medical students now also are required to take a national exam involving standardized patients.
But the training does much more than prepare them for the test.
"The idea is that if we want every student to handle or work with a patient with a migraine, schizophrenia, bipolar, knee pain, back pain, we can't assume or hope that patients with those problems are going to present in the hospital or in the office," said Nicholas.
"So what we can do here is to create any kind of scenario that our clinical faculty want to teach."
Dr. Howard Barrows came up with the idea in the 1960s at the University of California at San Diego.
UVM, which Owens said considers to be one of the pioneers in the methodology, along with San Diego and University of Texas Medical Branch at Galveston, started doing it the 1970s to teach doctors how to perform pelvic exams in women. The school expanded the practice to other areas in the mid-1990s as it considered changing its curriculum and became clearer about the skills that students needed, said Cate Nicholas, director of the program.
"We really needed to spend more time on some real, basic clinical exam skills, professionalism - how do you present yourself to a patient - communication-interpersonal skills, history taking skills, physical exam skills, clinical reasoning," she said.
That's when the concept of practicing on fake patients was introduced.
The "patients" at UVM come from all backgrounds - nurses, dancers, actors, teachers, a boat maker - and need to have some level of acting ability to be effective.
They meet with doctors to learn how to act out their symptoms the same way others do, so that students get the same experience and can be assessed uniformly.
"It might take up to 8 to 12 hours of training to prepare them for a project," Owens said. "So it requires them to have the ability to recall at a 90 percent or better rate in order to be included in the project."
For $20 an hour, they not only act, they also instruct students and offer feedback.
"You can see them grow," said Jim Conan, a retired state trooper and sometime actor.
At first, Ben Higgins, 24, of Mount Desert, Maine, had a hard time interrupting his manic patient - Morris - with questions.
Played by Conan, Morris talked rapidly about a home office he was building, his inability to install the dropped ceiling, and asked Higgins to help. He repeated himself, lost focus and changed the subject. He mentioned that his girlfriend was going to kick him out and urged the doctor to call and reassure her he was fine.
Midway through the half-hour session, Higgins and fellow student Elizabeth Cipolla, of New York City, took time out to discuss his case. They decided to ask Morris about medication and sleep. A doctor who stepped into the room to observe advised them to ask about his work, his level of functioning, to determine his concentration level.
The students learned Morris had been taking Zoloft and had felt euphoric ever since, sleeping only several hours a night.
The students then presented a list of findings - from the patient's neat appearance to his rapid speech, energy level, euphoric mood, and warped sense of reality - to the doctor.
"When they're in role like that, it feels very real," Higgins said. "It's fun to have real situations like that, so you can practice and know how to try and work on skills to interact with someone who might be in a manic state or a really depressed state."
The "patient" had spent hours training how to fake it - in the interest of science. It was "Mania Day" at the University of Vermont's medical school.
One part drama, two parts science as doctors-in-training test their diagnostic skills and bedside manner by assessing the ailments of patients played by real people in a program that's growing in popularity at U.S. medical schools.
"This environment allows them to practice and make mistakes in an environment conducive to learning before they go to the patient," said Tamara Owens, president of the Association of Standardized Patient Educators.
Most health care institutions now have some sort of standardized patient program or simulation center, practicing everything performing exams to suturing mannequins. Medical students now also are required to take a national exam involving standardized patients.
But the training does much more than prepare them for the test.
"The idea is that if we want every student to handle or work with a patient with a migraine, schizophrenia, bipolar, knee pain, back pain, we can't assume or hope that patients with those problems are going to present in the hospital or in the office," said Nicholas.
"So what we can do here is to create any kind of scenario that our clinical faculty want to teach."
Dr. Howard Barrows came up with the idea in the 1960s at the University of California at San Diego.
UVM, which Owens said considers to be one of the pioneers in the methodology, along with San Diego and University of Texas Medical Branch at Galveston, started doing it the 1970s to teach doctors how to perform pelvic exams in women. The school expanded the practice to other areas in the mid-1990s as it considered changing its curriculum and became clearer about the skills that students needed, said Cate Nicholas, director of the program.
"We really needed to spend more time on some real, basic clinical exam skills, professionalism - how do you present yourself to a patient - communication-interpersonal skills, history taking skills, physical exam skills, clinical reasoning," she said.
That's when the concept of practicing on fake patients was introduced.
The "patients" at UVM come from all backgrounds - nurses, dancers, actors, teachers, a boat maker - and need to have some level of acting ability to be effective.
They meet with doctors to learn how to act out their symptoms the same way others do, so that students get the same experience and can be assessed uniformly.
"It might take up to 8 to 12 hours of training to prepare them for a project," Owens said. "So it requires them to have the ability to recall at a 90 percent or better rate in order to be included in the project."
For $20 an hour, they not only act, they also instruct students and offer feedback.
"You can see them grow," said Jim Conan, a retired state trooper and sometime actor.
At first, Ben Higgins, 24, of Mount Desert, Maine, had a hard time interrupting his manic patient - Morris - with questions.
Played by Conan, Morris talked rapidly about a home office he was building, his inability to install the dropped ceiling, and asked Higgins to help. He repeated himself, lost focus and changed the subject. He mentioned that his girlfriend was going to kick him out and urged the doctor to call and reassure her he was fine.
Midway through the half-hour session, Higgins and fellow student Elizabeth Cipolla, of New York City, took time out to discuss his case. They decided to ask Morris about medication and sleep. A doctor who stepped into the room to observe advised them to ask about his work, his level of functioning, to determine his concentration level.
The students learned Morris had been taking Zoloft and had felt euphoric ever since, sleeping only several hours a night.
The students then presented a list of findings - from the patient's neat appearance to his rapid speech, energy level, euphoric mood, and warped sense of reality - to the doctor.
"When they're in role like that, it feels very real," Higgins said. "It's fun to have real situations like that, so you can practice and know how to try and work on skills to interact with someone who might be in a manic state or a really depressed state."
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