The
information in this column is intended for informational
purposes only, and does not constitute medical advice or
recommendations by the author. Please consult with your
physician before making any lifestyle or medication changes, or if you
have any other concerns regarding your health.
ACUTE
CORONARY SYNDROME- DO
YOU KNOW THE SYMPTOMS?
The
acute
coronary syndrome (ACS) describes patients who are experiencing
symptoms of
inadequate blood flow to the heart (myocardial ischemia), or who are
experiencing
an actual heart attack (myocardial infarction).
Patients who are experiencing ACS should see a qualified
emergency room
or cardiology physician immediately, as there is abundant research
evidence showing
that the early diagnosis and treatment of ACS leads to improved
survival, and
improved heart function in survivors.
Most
of us know
the classic g and symptoms of ACS, including the acute onset of
crushing chest
pain, which sometimes radiates to the left arm or the left jaw. However, for many patients
with heart disease,
ACS can present without these classic “textbook” symptoms. These atypical ACS
symptoms can include any
of the following: isolated pain (i.e., without chest pain) in the right
or left
arm, upper back, neck, jaw or upper abdomen (the latter is often
perceived as “indigestion”);
shortness of breath; the new onset of weakness or extreme fatigue;
fainting or
the feeling that one is about to faint; nausea or vomiting; and
palpitations or
other abnormal heart rhythms (patients with diabetes and elderly
patients are
more likely to experience these atypical signs and symptoms, rather
than the
classic signs and symptoms associated with ACS).
Certainly,
it is
understandable that many lay people who have no personal history of
coronary
artery disease might not be aware of the atypical signs and symptoms of
ACS,
but one would think that patients with a known history of myocardial
ischemia
or prior myocardial infarction would have a pretty fair idea regarding
both the
typical and atypical signs and symptoms of ACS.
However, a clinical study, just published in the journal Archives of Internal Medicine, suggests
that almost half of patients with a history of ischemic heart disease
were
ill-informed about the signs and symptoms of ACS.
This
multi-institutional
study was conducted by researchers at the University
of California
(the San Francisco
and Los Angeles
campuses),
the University
of Pennsylvania,
the University
of Washington,
the University
of Kentucky,
the University
of Nevada (Reno), and
other institutions in the United
States
and Australia. In this clinical study,
3,522 patients with a
history of either heart attack or a prior medical intervention for
coronary
artery disease participated in a survey designed to assess their
knowledge about
the symptoms of ACS, as well as the appropriate steps that should be
taken by
patients experiencing the symptoms of ACS. The
average age of these patients was 67, and
68% of these study volunteers were men.
The
researchers
defined a score of less than 70% on the survey as being representative
of a low
level of knowledge. The
average score
among all of these adults with a history of significant coronary artery
disease
was only 71%. Moreover,
the scores of
46% of the participating patients, or nearly half of the patients, fell
within
the “low knowledge” range! When
the
researchers analyzed factors that were associated with higher
knowledge scores on the survey, they found that the
following factors were statistically significant predictors of adequate
or excellent
knowledge about the symptoms of ACS:
female gender, younger age, higher levels of education,
previous
participation in a cardiac rehabilitation program, and receiving care
by a
cardiologist rather than an internist or general practitioner. A prior history of heart
attack or coronary
artery bypass surgery (ABG) was not associated with a higher level of
knowledge
as tested by the survey, however.
The
results of
this clinical study are rather provocative, and suggest that more needs
to be
done to educate patients at high risk of experiencing ACS, including
those who
have already experienced episodes of ACS in the past.
When ACS occurs, delays in diagnosis and
treatment can truly become a matter of life-and-death.
If you believe that you are experiencing the
symptoms of ACS, then please do not ignore them.
Instead, you should seek appropriate medical
assistance, and without delay!
GREEN
TEA & LUNG
CANCER
Lung
cancer
remains the most common cause of cancer-associated death in the United
States
more than 40 years after the link between smoking and lung cancer was
first publicly
disclosed by the US Surgeon General.
In
2008, the American Cancer Society estimates that approximately 215,000
new
cases of lung cancer will be diagnosed (almost evenly split between men
and
women), and about 166,000 Americans will die of this highly lethal
cancer. The
greatest tragedy surrounding this
greatest of cancer killers is that more than 95% of lung cancer cases
could be
preventing simply by eliminating smoking.
When I hear people complain that the war on cancer has not
delivered
dramatic reductions in the incidence of most cancers, I immediately
think about
lung cancer. In
2008, and there will be
an estimated 566,000 deaths due to cancer in the United States, and
more than
166,000 of these deaths, or 29% of all
cancer deaths, will be due to a cancer that is almost completely
preventable
(i.e., simply by leading a reasonably healthy lifestyle)…. For these reasons, and
because the available
treatments for most cases of lung cancer are rarely successful in
eradicating
all traces of cancer, I rarely include reviews of lung cancer research
clinical
studies in this column. However,
an
intriguing research paper, just published in the journal Carcinogenesis,
looks at the effects of an extract of green tea
upon lung cancers induced in laboratory mice.
This study was conducted by researchers from the University
of Cincinnati,
the University
of Minnesota,
and Washington
University.
In
this
laboratory study, a decaffeinated extract of green tea leaves was added
to the
diet of mice after they were injected with a mutagenic chemical known
to cause
lung cancer in mice. A control group of additional mice received
injections of
the cancer-causing chemical, but did not receive the green tea extract
in their
diet. While green
tea extract
supplementation did not appear to reduce the overall number of lung
cancer
tumors that developed in the mice, it did appear to significantly
reduce the
maximum size of the lung tumors when compared to the tumors that
developed in
the control group of mice. Using
both
MRI scans of the lung tumors and microscopic evaluation of lung tumors
after
the mice were euthanized, the researchers confirmed that the mice that
had
received green tea extract supplementation had significantly smaller
tumors
than the untreated control group mice.
While
green tea
extract did not appear to prevent the development of lung cancer in
mice
treated with a chemical (benzo[a]pyrene,
which is also present in cigarette smoke) known to
induce this type of cancer in laboratory mice, dietary
green tea did
appear to reduce the progression of the resulting lung tumors. As with all animal-based
research studies,
however, extrapolating the effects of various treatments on laboratory
animals
to humans requires a big leap of faith.
In some cases, humans do respond in similar ways as has
been observed in
laboratory animals. In
many other cases,
what appears to work in mice turns out not to work (at least to any
clinically
significant degree) in people. However,
this research article joins hundreds of others that suggest a
modest-to-moderate
anti-tumor effect associated with green tea polyphenols for at least
some types
of cancer. Currently,
there are 25 registered
clinical research trials underway in the United States that are looking
at the
effects of green tea supplements on the development and progression of
various
types of cancer, including lung cancer.
Hopefully, at least some of these trials will confirm a
beneficial
effect of green tea supplementation in humans, as has previously been
observed
in cell cultures and animal studies.
Meanwhile, please do your part in the war against cancer. If you don’t currently
smoke, then please
don’t start. If you
already smoke, then
please quit, now.
EPISIOTOMY
&
SUBSEQUENT DELIVERIES- AN UNKIND CUT
Increasingly,
obstetricians, and their patients, are questioning the traditional
wisdom about
routinely performing episiotomies in the delivery room.
An episiotomy involves making an incision on
the edge of the vaginal wall and perineum as the baby’s head descends
within
the vaginal birth canal. In
theory, the
episiotomy is a “controlled” laceration of the highly sensitive
perineal
tissues between the vagina and rectum, and was originally thought to
reduce the
incidence of deep tears of these tissues, including the sphincter
muscles of
the anus and rectum. (After
the baby is
born, the episiotomy is then repaired by the obstetrician with sutures.) However, in recent years,
the beneficial effects
of episiotomy, if any, have increasingly been called into question. In fact, recent clinical
research studies
have confirmed what many new mothers, their husbands, and even many
obstetricians, have long suspected, and that is that episiotomies often
appear
to cause the very same injuries and long-term complications that they
are
intended to prevent. These
complications
can leave women incontinent, and with chronic perineal pain that often
interferes with their ability to comfortably have intercourse for
months, and
sometimes for years. Ask
any new mother
(or her husband) who has delivered children both with and without an
episiotomy
which delivery left her with the greatest amount of perineal pain, and
for the longest
amount of time….
If,
as it is
becoming apparent, episiotomies do not prevent perineal and anal
sphincter
complications during most routine deliveries, then what might the
effects of
episiotomies be during subsequent births?
A new research paper in the journal Obstetrics
& Gynecology provides some answers to this question. The researchers reviewed
the medical records
of more than 6,000 women who underwent at least two consecutive vaginal
deliveries at the University of Pittsburgh. They found that 48% of
these women underwent
episiotomy with their first delivery.
The researchers then compared the incidence of
complications among these
women who had received episiotomies with the remaining 52% of women who
did not
undergo episiotomy during their first delivery.
The results were both striking and concerning.
Among
the women
who had previously received an episiotomy, 51% experienced moderately
severe
perineal lacerations during their subsequent second vaginal delivery,
while
only 27% of the mothers who had not
undergone a previously episiotomy suffered similar perineal lacerations. Severe lacerations that
involved the anal
sphincter muscle (and which can lead to painful bowel movements and
incontinence) occurred in almost 5% of the women who had previously
undergone
an episiotomy versus just under 2% of the women who had not received a
previous
episiotomy.
In
summary, this
retrospective clinical study adds to a growing body of research
suggesting that
episiotomy almost certainly does more harm than good, at least for
relatively
routine deliveries. In
fact, the very
birth-associated complications that episiotomy is supposed to prevent
are
actually more common in women who
have been subjected to this procedure than in those who have not
received an
episiotomy. While
there may still be an
occasional indication for episiotomy if the vaginal canal cannot safely
accommodate and deliver a large or malpositioned baby, in the vast
majority of
cases of otherwise normal and spontaneous vaginal delivery, there
appears to be
no clinically valid reason, any longer, for episiotomy.
If
you are
pregnant, it might be wise to raise this issue with your obstetrician,
as many
obstetricians who continue to routinely perform episiotomy consider the
procedure to be an integral part of their obstetric care, and some
obstetric
physicians may, therefore, plan to perform this generally unnecessary,
and
potentially harmful, surgical procedure without first discussing it in
detail
with their patients.
Disclaimer:
As always, my advice to readers is to seek the advice of your physician
before making any significant changes in
medications, diet, or level of physical activity.
