Health



April 21, 2011, 1:40 pm

Pesticide Exposure in Womb Affects I.Q.

pesticides? Pesticides on fruits, vegetables and other household products may lower a child’s I.Q.

Babies exposed to high levels of common pesticides in the womb have lower I.Q. scores than their peers by the time they reach school age, according to three new studies.

The research, based on data collected in New York and California from about 1,000 pregnant women and their babies, is certain to set off a new debate about the benefits of organic produce and the risks of chemicals found in the food supply and consumer products. The pesticides, called organophosphates, are commonly sprayed on food crops and are often used to control cockroaches and other pests in city apartments. Read more…


April 21, 2011, 8:27 am

Think Like a Doctor: A Litany of Symptoms Solved!

On Wednesday I challenged readers to solve a complicated case of a 76-year-old woman who became physically and mentally debilitated over a matter of months.

More than 500 readers weighed in with diagnoses that included porphyria, thrombotic thrombocytopenic purpura and lupus. As of late Wednesday night, 15 readers had come up with the right diagnosis. And the winning answer is:

Diagnosis: Cushing’s syndrome.

The first answer came early. At 12:54 a.m. Eastern time, Dr. Elizabeth Neary, a pediatrician in Madison, Wis., was the first reader to put all the patient’s symptoms together and reach the correct diagnosis.

The wide range of complaints that characterize Cushing’s syndrome was first described by Dr. Harvey Cushing in 1932. In this disease, the adrenal glands churn out too much cortisol, an essential hormone involved in our body’s response to stress. Cortisol helps maintain blood pressure, reduces the immune system’s inflammatory response and increases blood sugar levels — all vital processes for helping our bodies cope with biological and environmental stress.

But long-term exposure to high levels of cortisol can cause osteoporosis, diabetes, high blood pressure, muscle weakness, memory loss and psychiatric disease. It causes the skin to thin and weaken, making it susceptible to bruises that are often dark and dramatic looking. The lesions on this patient’s arms and legs were signs of this.

Cushing’s syndrome is unusual, but a milder version of the disease can be seen in patients who use steroid hormones like prednisone for the treatment of asthma, rheumatoid arthritis or other inflammatory diseases. However, in this case, the syndrome is believed to have been caused by a tiny tumor that was triggering the constant release of high doses of cortisol.

How the Diagnosis Was Made:

When the patient and her two daughters arrived at Waterbury Hospital, Dr. Rachel Lovins met them in the emergency room. She had been introduced to their mother some years earlier, but now she didn’t recognize the woman who sat before her in the wheelchair.

She had gained a lot of weight, her face was much rounder than Dr. Lovins remembered, and her hair, which had been dark and curly, was thin, gray and uncombed. Over the past year or so, Dr. Lovins had heard her friends talk about their mother’s weakness and decline. Seeing her now, it was clear that her illness had taken its toll. Dr. Lovins excused herself to allow the patient to change into her hospital gown. She would see her again once she had been evaluated in the E.R. and admitted to the hospital.

When she returned later, she stood in the doorway and watched as Dr. Chris Mikos, an E.R. physician, lifted the woman’s hospital gown to examine her abdomen. When he did that, Dr. Lovins saw that the woman had red, almost purple stretch marks on her abdomen.

Suddenly the whole case made sense. Dr. Lovins realized the patient might have Cushing’s syndrome. These stretch marks, known as striae, are the result of the thinning of the skin caused by the excess cortisol. It’s a classic finding in Cushing’s. The patient’s primary doctor may not have seen these marks because she probably didn’t have this debilitated elderly woman change into a gown for every visit.

The test used to look for Cushing’s syndrome is called the dexamethasone suppression test. In this test, you give the patient a dose of a steroid hormone, dexamethasone. If the patient has a normal stress hormone system, then the amount of cortisol in the body will drop dramatically as the body reacts to the steroid and begins to suppress its own cortisol production. A normal patient would post a reading of less than five when it’s measured several hours into the test. This patient’s cortisol was eight times that.

Most of the time, Cushing’s syndrome is caused by a tumor in the pituitary gland in the brain, which in turn causes the adrenal gland to overproduce cortisol. In these cases, surgical removal of the tumor will cure Cushing’s.

But in this case, no tumor was found in the pituitary or elsewhere in the patient’s body. Even so, her doctors still believe that a tumor is triggering the excessive cortisol release, but the tumor is too small to locate.

This patient was started on a medication that prevents the overproduction of cortisol, but she had to stop because of side effects. She is waiting to start the next medicine. If that fails, she will have surgery to remove her adrenal glands. When I saw her last she was doing better but wondered out loud whether she would ever walk again.

Why It Was a Difficult Case:

Because cortisol is a hormone that affects every part of the body, the effects of Cushing’s syndrome are wide ranging, and there is no single symptom that announces that a patient has the disease.

Some of this patient’s complaints were pretty common for a woman her age. She’d gained weight. She was tired. She was depressed. She had high blood pressure. She had cataracts. She had swelling in her legs. All of these are symptoms of Cushing’s, but they are also common in patients without Cushing’s.

On the other hand, she had some unusual problems as well. Her muscles were weak. She had a high white blood cell count. She’d had a gastrointestinal bleed. Still, it wasn’t until you put it all together that it became clear that this woman’s many health problems were all related to Cushing’s.

The patient’s oldest daughter sent an e-mail to her friends telling the story of her mother’s ordeal and of her own frustration in pursuing this unifying diagnosis.

We were told that her psychological state, her neurological problem, her circulation issues and her excessive bleeding were an unrelated bunch of unfortunate circumstances conspiring to make this woman ill. “It happens when you are old,” we were told more than once.

With a disease like Cushing’s, our specialist approach to medicine makes us seem like the proverbial blind men examining the elephant. Each specialist can identify what he is seeing, and yet the whole picture will be missed.

Most of the time, that kind of piecemeal medicine works just fine. But the problem is that the cases in which a different approach is required often are tough to distinguish from the bread-and-butter stuff we see every day.

Readers who come to this column already know it will highlight an unusual case, and as a result, you are ready to take on all the exotic possibilities. Because of that, you are way ahead of the doctor who has to figure out which patient, out of all the patients she’s seen that day, needs something special. That recognition is the start of diagnosis.


April 20, 2011, 12:02 am

Think Like a Doctor: A Litany of Symptoms

Apr. 21 Update | Thanks for all your diagnosis submissions! To find the answer to the medical mystery, see “Think Like a Doctor: A Litany of Symptoms Solved!”

The Challenge: Can you solve a medical mystery involving a once healthy older woman who becomes physically and mentally debilitated in a matter of months?

Last month, the Diagnosis column of The New York Times Magazine asked Well readers to sift through a difficult case and solve a diagnostic riddle. Hundreds responded, and several of you succeeded in solving the mystery.

If you missed out, here’s another chance to play medical detective. Below you’ll find a summary of a new case. The first reader to solve it gets a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you could outdiagnose Gregory House. Let’s get started. Read more…


April 20, 2011, 12:01 am

Are Gawky Adolescents More Injury Prone?

Jetta Productions/Getty Images

Does the onset of puberty make a young athlete more clumsy? Many of us, particularly the parents of budding adolescents, would answer with a resounding yes. But it’s a question that has intrigued and vexed scientists and coaches for some time, and it has implications for how young athletes should be trained.

Children long have been thought to suffer through a physically gawky stage during the so-called tween years, beginning around age 11 or 12. It’s a time when most parents worry that their children are at particularly high risk of hurting themselves on the playing field, and there is some evidence, though limited, that sports injuries do spike around this time. A nationwide study from last year of running-related injuries in young people ages 6 to 18 found that 13-year-olds were the most likely to get hurt, and that typically, their injuries were caused by falls; the youngsters seemed to be tripping over their own growing feet. Similarly, epidemiological studies of knee injuries in female athletes have found that they occur far more commonly after a girl has entered puberty and undergone a growth spurt.

But other recent exercise science, somewhat surprisingly, has not been able to confirm the existence of an adolescent awkward stage. Read more…


April 18, 2011, 7:06 pm

New Lessons to Pave a Road to Safety

Stuart Bradford

Teenagers are notoriously bad drivers, accounting for 10 times as many crashes as middle-aged ones. But short of keeping them off the road entirely, is there a way to make their driving safer — for them and for the rest of us?

New research suggests that there is. A nationally representative sample of more than 800 crashes involving teenage drivers shows that almost two-thirds were due not to reckless behavior like speeding or joyriding but to three novice driving mistakes: failing to scan the road, misjudging driving conditions and becoming distracted.

Focusing on these three common mistakes could go a long way in improving teenage driving and reducing fatalities, said an author of the report, Dr. Dennis Durbin, co-director of the Center for Injury Research and Prevention at Children’s Hospital of Philadelphia. (The findings, from the children’s hospital and State Farm Insurance, were published in the journal Accident Analysis and Prevention.)

“The question is, What should we be doing with teens during that learning phase that can produce a better driver?” Dr. Durbin said in an interview. “We want to create programs that can help parents more intentionally teach these kinds of skills.”

Read more…


April 18, 2011, 4:08 pm

Side Sleeping to Reduce Snoring

Christoph Niemann

Today’s “Really?” column explores the claim that sleeping on your side can reduce snoring.

Scientists say there are two types of snorers: those who snore only when they sleep on their backs, and those who do it regardless of their position. After sleep researchers in Israel examined more than 2,000 sleep apnea patients, for example, they found that 54 percent were “positional,” meaning they snored only when asleep on their backs. The rest were “nonpositional.”

Other studies have shown that weight plays a major role. In one large study, published in 1997, patients who snored or had breathing abnormalities only while sleeping on their backs were typically thinner, while their nonpositional counterparts usually were heavier. The latter group, wrote the authors, consequently suffered worse sleep and more daytime fatigue.

To learn more, read the full report, “To Reduce Snoring, Try Sleeping On Your Side,” and then join the discussion.


April 18, 2011, 4:04 pm

New Mothers Have Worse Health Habits

New motherhood apparently takes a toll on a woman’s health. Young mothers of small children exercise less than other women their age and don’t eat as well, according to a new report.

The young mothers consumed more calories — eating more saturated fat and drinking more sweetened beverages — and got about an hour less of moderate to vigorous physical activity each week than similar childless women, who were active for three hours a week on average, the researchers found.

While it’s no surprise that a mother of a small child might have less time to exercise, there is no explanation for the poor quality of her diet. New fathers also had less time to exercise, but their diets didn’t change, nor did they gain weight.

Read the full report, “Fewer Healthy Habits for Young Mothers,” and then join the discussion.


April 15, 2011, 3:21 pm

Cooking With Sprouted Brown Rice

Andrew Scrivani for The New York Times

If you’ve never heard of sprouted brown rice, you’re not alone, writes Martha Rose Shulman in this week’s Recipes for Health.

Until recently I’d never heard of sprouted brown rice. These sprouts aren’t like the ones you put on a sandwich. Sprouted brown rice looks and feels like regular brown rice, and it must be cooked for the same amount of time. But once cooked, it’s sweeter and more delicate than ordinary brown rice, and a little less chewy.

Sprouting any grain increases its nutritional value by making its nutrients more bio-available, among them calcium. But it’s the flavor and texture of this new sprout that have gotten me hooked. If you’ve been hard pressed to get your family to embrace brown rice, this may be the way to go.

Here are five ways to cook with sprouted brown rice:

Sprouted Brown Rice Bowl With Carrot and Hijiki: Julienne carrots with hijiki seaweed is a traditional Japanese combination. Tofu is added to bulk up the protein.

Stir-Fried Bean Sprouts With Sprouted Brown Rice: Shorten the time spent stir-frying by substituting pea sprouts for the bean sprouts in this dish.

Rice Bowl With Spinach and Smoked Trout: Make an excellent meal for one by mixing cooked rice with just a few handy ingredients.

Shrimp and Brown Rice Soup: This irresistible soup is inspired by a Southeast Asian dish traditionally made with Thai jasmine rice.

Thai-Style Sprouted Rice and Herb Salad: The dressing for this Thai salad is made with far less fish sauce, and therefore sodium, than is used in the traditional version.


April 15, 2011, 1:38 pm

What’s the Best Exercise?

Jonathan De Villiers for The New York Times

Looking for the best exercise for your body? Maybe it’s walking, running, squats or even the butterfly stroke.

The Phys Ed columnist Gretchen Reynolds has the answers (sort of) in this week’s New York Times Magazine. She writes:

Ask a dozen physiologists which exercise is best, and you’ll get a dozen wildly divergent replies. “Trying to choose” a single best exercise is “like trying to condense the entire field” of exercise science, said Martin Gibala, the chairman of the department of kinesiology at McMaster University in Hamilton, Ontario.”

One option explored by Ms. Reynolds is the burpee.

But when pressed, Dr. Gibala suggested one of the foundations of old-fashioned calisthenics: the burpee, in which you drop to the ground, kick your feet out behind you, pull your feet back in and leap up as high as you can. “It builds muscles. It builds endurance.” He paused. “But it’s hard to imagine most people enjoying” an all-burpees program, “or sticking with it for long.”

To learn more about the burpee and other “best” exercises, read the full report, “What’s the Single Best Exercise?” and then please join the discussion below.


April 15, 2011, 12:55 pm

Hypnosis as a Health Option

Dr. David Spiegel, director of the Center on Stress and Health at  Stanford University School of Medicine, said hypnosis can be an  “effective and inexpensive way to manage medical care.”Peter DaSilva for The New York Times Dr. David Spiegel of Stanford University School of Medicine calls hypnosis an “effective and inexpensive way to manage medical care.”

Today’s Patient Money column looks into the costs and potential benefits of hypnosis for dealing with anxiety, pain management and other health issues.

Some critics find the research into mind-body therapies unconvincing, but their skepticism has not deterred patients. And there are researchers who say they believe that by helping patients feel in better control of their symptoms, hypnosis can reduce the need for medication and lower costs.

“It is an effective and inexpensive way to manage medical care,” said Dr. David Spiegel, director of the Center on Stress and Health at Stanford University School of Medicine and a leading authority on hypnosis.

A study by radiologists at Harvard Medical School, published in 2000, found that patients who received hypnosis during surgery required less medication, had fewer complications and shorter procedures than patients who did not have hypnosis. In a follow-up study in 2002, the radiologists concluded that if every patient undergoing catheterization were to receive hypnosis, the cost savings would amount to $338 per patient.

To learn more, read the full column, “Using Hypnosis to Take Control of Your Symptoms,” and then join the discussion below.


April 15, 2011, 10:16 am

Sexism Charges Divide Surgeons’ Group

A Valentine’s Day editorial in the official newspaper of the American College of Surgeons has set off a firestorm of controversy that has divided the largest professional organization of surgeons in the country and raised questions about the current leadership and its attitudes toward women and gay and lesbian members.

The editorial, written by Dr. Lazar J. Greenfield, an emeritus professor of surgery at the University of Michigan School of Medicine and president-elect of the American College of Surgeons, extols the mood-enhancing effects of semen on women. It begins with a reference to the mating behaviors of fruit flies, then goes on to discuss studies on the menstrual cycles of heterosexual and lesbian women who live together. Citing the research of evolutionary psychologists at the State University of New York, it describes how female college students who had been exposed to semen were less depressed than their peers who had not, concluding: “So there’s a deeper bond between men and women than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates.”

This month, in response to complaints, the editorial was retracted and pulled from the group’s Web site, and Dr. Greenfield was asked to step down from his position as editor in chief of the surgeon’s newspaper. But criticisms continue to mount.

“I was aghast,” said Dr. Colleen Brophy, a professor of surgery at Vanderbilt University School of Medicine in Nashville, and a member of the organization for over 20 years. Read more…


April 14, 2011, 2:35 pm

Medication-Related Injuries on the Rise

The number of people treated in hospitals in the United States for problems related to medication errors has surged more than 50 percent in recent years.

In 2008, 1.9 million people became ill or injured from medication side effects or because they took or were given the wrong type or dose of medication, compared with 1.2 million injured in 2004, according to the Agency for Healthcare Research and Quality.

Although several national reports in recent years have sounded the alarm about the toll of medication errors, the latest data show the problem continues to persist. The A.H.R.Q. data measure only patients treated in the hospital or emergency department as a result of a medication error. The data don’t distinguish between prescribing, dispensing or consumer errors. Some of the errors resulted from a physician prescribing the wrong drug or dose; others occurred because a pharmacist or nurse gave the wrong drug, or because a patient at home used the wrong type or dose of medication. Read more…


April 14, 2011, 12:42 pm

What’s in Your Belly Button?

Scientists at North Carolina State University have launched the Belly Button Biodiversity project, tracking a variety of microorganisms lurking in human navels, reports MSNBC.

To get a sample, researchers hand each subject a sterile long cotton swab. You’re asked to turn it around in your navel three times and place the swab in a vial. Scientists grow the bacteria in a culture and once they become “big and chunky enough” they’re photographed. Participants are given a sample number to view their bacteria online….

“People are always surprised at how much stuff grows from even this superficial sample,” Hulcr says, adding that a moderately disgusting discovery their project has made was that “very few people wash their belly button with soap.”

The researchers report finding copious amounts of Staphylococcus epidermidis, the most common skin bacteria, as well as other forms of bacteria, molds, fungi and yeast.

To learn more, read the full article on MSNBC.com, “New Meaning to Navel Gazing,” and then join the discussion below.


April 14, 2011, 6:00 am

What ‘Big Medicine’ Means for Doctors and Patients

A colleague described a recent meeting at his hospital by saying that five years ago, most of the physicians in the room had been like him, independent owners of small group practices. Now a majority were employees of the hospital.

“I’m a dying breed,” he said, “and it’s getting harder to survive.” The doctors in his own group had just spent months wrangling over their hospital contract, installing an electronic medical record system and scrambling to fill the void in their on-call schedule left by a colleague who went to work for another hospital.

“What’s not to like about working for a hospital,” he asked wearily, “when you can have better hours, a guaranteed salary and no practice management hassles?” Read more…


April 13, 2011, 7:00 am

Talk to Gary Taubes About Sugar

Kenji Aoki for The New York Times

In this week’s New York Times Magazine, Gary Taubes, author most recently of “Why We Get Fat: And What to Do About It,” takes on sugar. Among other things, he writes about the views of Robert Lustig, an obesity expert at the University of California, San Francisco, School of Medicine.

If Lustig is right, then our excessive consumption of sugar is the primary reason that the numbers of obese and diabetic Americans have skyrocketed in the past 30 years. But his argument implies more than that. If Lustig is right, it would mean that sugar is also the likely dietary cause of several other chronic ailments widely considered to be diseases of Western lifestyles — heart disease, hypertension and many common cancers among them.

Read the full article, “Is Sugar Toxic?” and then join a conversation with Mr. Taubes, who will be answering selected reader questions during the coming days.


About Well

Tara Parker-Pope on HealthHealthy living doesn’t happen at the doctor’s office. The road to better health is paved with the small decisions we make every day. It’s about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day.

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