Staying Safe During Holiday Travel

If you’re one of the millions of people planning to travel over the holidays, we’d like you to do it safely. Whether your plans involve car, plane or train take a minute or two to study these simple steps to stay healthy while traveling.

“One health risk to consider when traveling is simply sitting for too long,” says Clayton Cowl, M.D., an expert in travel medicine at Mayo Clinic. “Concerns like blood clots in the legs from sitting too long, becoming dehydrated from lack of fluid intake or drinking too much alcohol, and not walking much when delayed in an airport or train station can be serious. Driving for hours to reach a destination after a long day at work can be as equally worrisome due to fatigue and eyestrain.”

Blood clots can be a concern when a person sits for too long because leg muscles aren’t contracting and blood can pool and stagnate in the vessels. This can lead to deep vein thrombosis and even pulmonary embolism – a potentially fatal condition, caused by clots becoming lodged in the lungs.  When travelling by car, both driver and passengers should stop every few hours to hydrate and walk. Plan ahead, and pick some good rest stops along your route. How about a park, a mall, or a place of interest?

As an added benefit, allowing children to run or play in a safe environment while traveling will often help curb their excessive energy in a confined space and may help them relax while traveling for longer periods.

When traveling by plane, check the in-flight magazine for tips on how to exercise in your seat and on trips longer than three hours, get up at least once to take a walk to the bathroom or other end of the plane.

And regardless of how you travel, try to avoid crossing your legs while sitting for long periods, because this can inhibit adequate blood circulation.

If you’re the one doing the driving, plan to get a good night’s sleep the day before the trip, to avoid drowsiness during the journey. If possible, take turns at the wheel with other passengers. Take breaks at rest stops and chose healthy low carb meal options, to avoid crashing after a sugar high. Combining meals or rest room stops with a short walk to get fresh air and stretch can make a big difference in staying more alert and refreshed.

While we all want to just get to our destination for the holidays, budgeting a little extra time to account for unexpected weather delays and adequate driving breaks is a really smart plan.

To avoid stiffness from sitting too long, if you’re a passenger try doing some simple stretches, such as extending legs out and back several times and massaging thighs and calves.

To avoid eyestrain and its associated annoying symptoms including sore or irritated eyes, dry or watery eyes, double vision or blurriness, increased sensitivity to light or unremitting shoulder and neck fatigue never drive if you are sleep deprived.

A short nap can significantly relieve these symptoms and non-medicated eye drops can help if eye irritation persists

Whatever your travel method, avoid dehydration. Drink plenty of water and minimize or eliminate alcohol consumption as alcohol dehydrates at a cellular level.

Above all, plan for the worst, and enjoy the best: When severe winter weather hits, many vehicles may become stranded and help may be hours or sometimes days away. Pack a simple emergency kit, including blankets, snacks, water, charging devices, flashlights and activities to keep kids amused.

Thank You for your attention. Now, please fasten your seat belts, place doors to manual and turn off all cellular devices. You’re ready for the holidays!

Bon Voyage.

Heads Up on i-Concussion

There is a new face at Northern Arizona University (NAU) football games this fall.  No – not a new quarterback or coach – but a robot on wheels!

Making its debut at the season kick-off game against the University of Arizona in Tucson last Friday, the robot has the ability to assess a player for symptoms and signs of a concussion and to consult with sideline medical personnel thanks to a specialized camera system, remotely operated by a Mayo Clinic neurologist.

 Mayo Clinic will be working with NAU to test the feasibility of using a telemedicine robot to assess athletes with suspected concussions during football games as part of a research study. With sophisticated robotic technology, use of a specialized remote controlled camera system allows patients to be “seen” by the neurology specialist, miles away, in real time.

“Athletes at professional and collegiate levels have lobbied for access to neurologic expertise on the sideline. As we seek new and innovative ways to provide the highest level of concussion care and expertise, we hope that teleconcussion can meet this need and give athletes at all levels immediate access to concussion experts,” said Bert Vargas, M.D., a neurologist at Mayo Clinic who is heading up the research.

This study is the first to explore whether a remote neurological assessment is as accurate as a face-to-face evaluation in identifying concussion symptoms and making return to play decisions. Mayo Clinic physicians will not provide medical consultations during the study, they will only assess the feasibility of using the technology.

But, if it appears feasible, this may open the door for countless schools, athletic teams, and organizations without access to specialized care to use similar portable technology for sideline assessments.

“As nearly 60% of U.S. high schools do not have access to an athletic trainer, youth athletes, who are more susceptible to concussion and its after-effects, have the fewest safeguards in place to identify possible concussion signs and symptoms at the time of injury. Teleconcussion is one way to bridge this gap regardless of when or where they may be playing.” Says Dr Vargas.

Others involved collegiate sports agree.

“At NAU, our primary goal is to provide an outstanding student-athlete experience culminating in graduation,” says Dr. Lisa Campos, vice president for Intercollegiate Athletics at Northern Arizona University. “We charge our staff to research the most current and best practices to ensure the safety and care of our students. Partnering with the Mayo Clinic in its telemedicine study will further this research and potentially improve diagnosis for rural areas that may not have access to team doctors or neurologists. The study allows the NAU Sports Medicine Staff and team doctors to continue to make all diagnoses and return to play decisions for our students, while investigating the effectiveness and efficiencies of telemedicine. We are excited to have the teleconcussion robot on our sideline this fall.”

“There were a number of examples last football season where college football players clearly demonstrating concussion-like symptoms were quickly thrown back in games or weren’t even taken out of the game for an evaluation,” said Ramogi Huma, executive director of the National College Players Association. “College football players are in desperate need for independent concussion experts on the sidelines, and this study could help make that safeguard a reality.”

Telemedicine is not new to the Mayo Clinic in Arizona.  They first used the technology with the telestroke program in 2007, when statistics revealed that 40% of residents in Arizona did not live in an area where they were availed of stroke expertise. Since the telestroke program began nearly 3,000 emergency consultations for neurological emergencies have taken place.

We’ll be following the results of this study and will let you know the results as soon as they’re in.

An Unexpected Exercise in Exercise

Despite the fact that numerous studies have shown the powerful effect that exercise can have on recovery from cancer, including reducing tumor recurrence rates by up to 50%, a new study has shown that many cancer patients are reluctant to exercise, and fewer still discuss it with their oncologists.

According to the Mayo Clinic study published in the Journal of Pain and Symptom Management, patients took exercise advice most seriously when it came directly from their oncologists, but none of those studied had discussed it with them.

The study was part of a series of investigations looking at exercise habits among 20 adult lung cancer patients. Researchers found that patients who exercised regularly before their diagnosis were more likely to exercise than those who had not. Many patients considered daily activities, such as gardening, sufficient exercise.

“There was a real sense of what I do every day, that’s my exercise,” said lead author Andrea Cheville, MD.

Most of the patients thought that their daily activities equated to exercise, whereas in reality, most of these activities required minimal effort.  Such inactivity can contribute to weakening of the body and greater vulnerability to problems, including cancer recurrence.

“Generally, patients are not being given concrete advice about exercise to help them maintain functionality and to improve their outcomes,” added Dr. Cheville.

Exercise can improve patients’ mobility, enable them to enjoy activities and keep them from becoming isolated in their homes. It can contribute to overall feelings of strength and physical safety, ease cancer-related fatigue and improve sleep.

The researchers now plan to investigate how to make the message about exercise meaningful to cancer patients so that they can optimize symptom relief and enhance their own recovery.

Is Your Doctor Burned Out?

Is life / work stressing you out?  Thinking about going to see your doctor for help?  Before making that appointment you may want to think again.

According to a national survey of physicians, released this week nearly 1 in 2 US doctors are themselves suffering from burnout.  That’s more than any other US workers.

Overtaxed doctors are not only at risk for personal problems, like relationship issues and alcohol misuse, but their job-related fatigue can also erode professionalism, compromise quality of care, increase medical errors and encourage early retirement – a potentially critical problem as an aging population demands more medical care.

Survey participants completed a 22-item Burnout Inventory questionnaire, which measured emotional exhaustion, depersonalization (treating patients as objects rather than human beings) and low sense of personal accomplishment. Of the 27,276 physicians asked to participate, 26.7% responded. They had to report only one symptom to be included among those reporting burnout.

Differences in burnout rate varied by specialty: While most people assume that the surgical or cancer specialties would be at highest risk, the researchers from the Mayo Clinic found that emergency medicine, internal medicine, neurology and family medicine reported the highest rates.

“Nearly 60% of physicians in those specialties had high levels of burnout,” says says lead author Tait Shanafelt MD. “This is concerning since many elements critical to the success of health care reform are built upon increasing the role of the primary care providers.”

On the other hand, doctors practicing pathology, dermatology, general pediatrics and preventive medicine had the lowest rates of burnout.

In other words, it’s the physicians on the front line of care who are most likely to burn out.

And that’s not all. When asked about emotional exhaustion, 37.9% of physicians reported signs, compared with 27.8% reported by other workers surveyed.

“The rates are higher than expected,”. Commented Shanafelt “We expected maybe 1 out of 3.

Being asked to see more patients and not having enough time to spend with them creates an atmosphere of being on a hamster wheel, says physician Jeff Cain, president-elect of the American Academy of Family Physicians.

While the current prevalence of burnout is alarming many predict it could get worse as health care reform takes hold and the medical profession has to take on the additional workload associated with the millions of patients who will be newly insured under the health care law.

While the Affordable Care Act will put more pressure on the front lines, this new study could be an important wake-up call. The country needs to hear to build multidisciplinary health care teams to meet the need and help unburden our poor put-upon physicians, so they in turn can help us.

Bad day for your bowels?

Having one of those days…weeks…months?  If so, you should consider getting help before you end up with toilet troubles.

Seriously?   According to the results of a study unveiled this week at the American College of Gastroenterology’s (ACG) 76th Annual Scientific Meeting, the psychological and emotional traumas experienced over a lifetime, such as the death of a loved one, divorce, natural disaster, house fire or car accident, physical or mental abuse, all may contribute to adults with irritable bowel syndrome (IBS).

Researchers from the Mayo Clinic in Rochester, MN, found that adults with IBS reported more traumas over a lifetime than matched controls .

“While stress has been linked to IBS, and childhood abuse has been reported to be present in up to 50 percent of patients with IBS, most studies of abuse have focused on sexual abuse with sparse detail and also have not looked at other forms of psychological trauma,” said Yuri Saito-Loftus, MD. “This is the first study that looks at multiple forms of trauma, the timing of those traumas, and traumas in a family setting.”

IBS is a chronic gastrointestinal disorder marked by abdominal discomfort, bloating, constipation and/or diarrhea and may be caused by changes in the nerves and muscles that control sensation and motility of the bowel. Trauma may sensitize the brain and the gut, according to Dr. Saito-Loftus, who said that the results of this study indicate that patients with IBS experience or report traumas at a level higher than patients without IBS.

In the United States, it is estimated that 10-15% of the adult population suffers from IBS. The burden of illness for IBS is significant and can have such a severe impact on Health-Related Quality of Life that it has been linked to an increase in suicidal behavior.

“Patients and their families frequently wonder, ‘why me?’, ‘why did this happen?,’” said Dr. Saito Loftus. “This will help them understand why IBS happened to them.”

Our advice?  Do not “underplay” the role of stress. Even if you think you can cope with life’s little traumatic experiences on your own, your bowels may not agree.

Do DIY “spit kits” stress you out?

One of the fastest growing health care trends in “individualized medicine” is home genetic testing. The over-the-counter mail-in kits, with price tags as high as $2,500, use a saliva specimen to identify small variations in the human genome  associated with heightened risk for diseases such as diabetes and prostate cancer.

The U.S. Food and Drug Administration (FDA) has raised concerns about whether the tests are clinically beneficial and has advocated they be conducted under medical supervision, but few studies, to date, have investigated the emotional effects that direct-to-consumer genetic screens have on patients.

Now that’s all changed.  A group of Mayo Clinic physicians and bioethicists have analyzed whether these genetic tests cause patients to experience excessive worry about developing diseases. “We looked for evidence of increased concern about disease based solely on genetic risk, and then whether the concern resulted in changes in health habits,” said co-author Clayton Cowl, M.D.

The randomized study found patients’ worry tended to be modestly elevated one week after the genetic testing, and that people worried more about unfamiliar diseases, for instance the thyroid condition Graves’ disease than those commonly known, such as diabetes.

One year later, however, patients who had undergone testing were no more stressed than those who hadn’t. One surprising result was that men whose genetic risk for prostate cancer was found to be lower than that of the general population, and who also had normal laboratory and physical screening results for the disease, were significantly less stressed about the disease than the control group.

The researchers concluded that the tests may be useful if they prompt patients to make health-conscious changes, such as losing weight or being vigilant about cancer screening.

However, some doctors are concerned that patients who learn they have less-than-average genetic risk for a disease might skip steps to promote good health. Others just think it’s a bad idea – period.  “Genetic testing is a complex, difficult and emotionally laden medical process which requires extensive counseling, contextualization and interpretation,” says Dr. Michael Grodin, professor of bioethics, human rights, family medicine and psychiatry at Boston University.

It’s also worth noting that the current study only assessed the emotional effects of do-it-yourself genetic testing. Nobody yet knows whether a calculation of genetic risk accurately predicts disease.

Have you bought one of these kits?  How did you feel while you waited for the results. SRxA’s Word on Health would love to know.

On Your Knees!

Regular readers of SRxA’s Word on Health have heard from time to time about my knee problems. For those of you just joining us, it’s a long sorry tale of injuries that originated during my Olga Korbut wannabe days as a pre-teen gymnast, that were exacerbated by years of marathon running and more recently resulted in surgery following a dog-induced injury!

As I write, I’m recovering from having just had my knee drained and preparing to undergo a series of rooster comb injections to alleviate the pain and swelling of the latest flare-up.

Naturally then, I was interested to hear about a new US – Canadian study which intends to explore whether the nagging knee pain and inflammation experienced by women is different from what men encounter and whether biological differences between men and women affect the incidence and severity of knee osteoarthritis.

Mary I. O’Connor, M.D., chair of the Department of Orthopedic Surgery at Mayo Clinic’s campus in Florida, will be the study’s principal investigator.

Osteoarthritis, characterized by the breakdown of cartilage in the joint resulting in stiffness and pain, is the most common form of arthritis. It affects approximately 27 million Americans and is more common in women than men.

According to Dr. O’Connor, “Knee osteoarthritis is a leading cause of disability in the U.S. and women have greater pain and reductions in function and quality of life from this condition than do men.”

While the underlying mechanisms for differences in knee osteoarthritis between men and women are not yet known, recent studies have indicated sex differences at the cellular and molecular levels may influence development of the disease. This study will examine a variety of human tissues normally discarded during total knee replacement surgery performed for severe osteoarthritis. The tissues will be analyzed for possible differences in pain fibers and hormone and vitamin D receptors between female and male patients.

The team hopes that the results will provide valuable clues for more effective treatment and possible prevention. Hopefully this will benefit not only yours truly, but also the multitudes of women who suffer from the constant pain and inflammation of osteoarthritis of the knee.

Patients are from Mars, Physicians are from Venus!

Or so it would seem.  According to a study just published in the Annals of Internal Medicine there is a huge disparity between patients’ expectations of angioplasty versus those of their cardiologists.  While the majority of heart patients harbor the notion that angioplasty, a procedure performed to unblock clogged arteries, will cut their risk of heart attacks and death, cardiologists believe that its value is limited to reducing chest pain.

The research involved 27 cardiologists and 153 patients who consented to elective coronary catheterization and possible angioplasty, from Baystate Medical Center, Springfield, and Tufts University School of Medicine, Boston.

During angioplasty, a tube is inserted at the groin and snaked up to the affected artery, where a balloon opens the blockage. A stent is often left in place to help prop open the artery and maintain blood flow. Angioplasty involves some risk but the rate of death during the procedure is less than 1 percent, experts note.

Although 63% of cardiologists believed that the benefits of angioplasty were limited to angina symptom relief:

• 88% of patients believe that angioplasty would prevent heart attacks or fatal heart attacks

• 74% of patients thought that without the procedure  they would probably have a heart attack within 5 years

Furthermore, most patients stuck to their beliefs even after spending time with a cardiologist who explained the risks and benefits to them, and had them sign an informed consent form prior to the angioplasty.

The authors of the study noted that the benefits obtained by angioplasty can often be achieved with medication alone, and only patients who are actually having a heart attack or coronary event can expect a reduced risk of future heart attacks and death from angioplasty.

The number of angioplasties done for stable heart patients has decreased lately.  According to the American Heart Association, about 1.3 million such procedures are done in the United States each year.

Once again, this study highlights the “disconnect” between what doctors know and what patients understand. In order to have real informed consent, patients have to understand not just the risks, but also the benefits of whatever treatment is proposed.

One reason for patients’ misunderstanding is the common belief, that if a treatment is offered, it must have curative benefits.

However, the problem of patient understanding isn’t limited to angioplasty but is common in many areas of medicine. According to a previous study from the Mayo Clinic, doctors don’t always do a good job of knowledge transfer in a way that patients and family members can understand. Graphs and charts are not going to work for many patients.

SRxA and our team of problem based learning expert Advisors can help physicians, institutions and device manufacturers produce patient-centric materials to assist with informed consent. Contact us today to find out more.

Barking your way to better health

Yes, we admit it!  We’ve watched the cute YouTube videos of cheetahs raising baboons and dogs feeding kittens. But so far we’ve resisted posting warm and fuzzy animal stories. However, when we heard that the world famous Mayo Clinic has just released its first children’s book featuring “Dr. Jack,” a miniature pinscher, we just had to share.

The 9 year old pooch is Mayo’s first facility-based service dog.  Escorted by his owner, Jack is part of the health care team that helps patients with physical activity, rehabilitation, and speech therapy. Mayo physicians place an order in a patient’s medical record when requesting a visit by Dr. Jack, who sees approximately eight to 10 patients per day. During his tenure at Mayo, Jack has helped more than 2,000 patients.

“In looking for ways to convey the Mayo Clinic model of care, we found a truly remarkable ambassador: a little dog named Jack,” says the book’s author Matt Dacy. “This book is the story of Mayo as told through the experience of Jack in a way that children can understand and adults and readers of all ages can appreciate.”

In the book, Dr. Jack wears an identification tag with the Mayo Clinics three shields -signifying clinical practice, education and research. When a young boy at Mayo Clinic meets Dr. Jack, he rubs his tag and the two go on an amazing tour of Mayo Clinic, including a helicopter ride on Mayo One.

“Why do we offer animal-assisted therapy? Because it works!” says Brent Bauer, M.D., Mayo Clinic Department of Complementary and Integrative Medicine. “Of course, almost every patient ‘feels’ better after a visit by a dog like Jack.  But scientific studies have shown this type of therapy can reduce pain in children, improve outcomes in adults hospitalized with heart failure, and reduce medication use in elderly patients.”

Your very own Word on Health blogger witnessed the miracle of pet power several years ago when visited by friends who brought along their mute, severely autistic 8 year old son. While the adults were enjoying dinner and adult beverages we suddenly heard a noise in the hallway. To his parents utter astonishment “Pedro” was lying on the floor telling elaborate stories to my 200lb Newfoundland dog. They were the first words they’d ever heard from him.

For those who’d like to learn more, there are numerous books on pet therapy.  In the meantime we’d love to hear your stories on how an animal has helped you, or someone you know, with illness.