The story is told about a patient scheduled for shoulder surgery who receives a letter from the orthopedic surgeon that he is one of the designers of the artificial shoulder the patient is about to receive and that he is paid royalties from the implant manufacturer.

This doctor is unusual because most physicians do not reveal their business connections with equipment or pharmaceutical companies. Read the rest of this entry

When your head is pounding, your eyes light-sensitive, every sound is a roar and you feel nauseated, the chances are good you are having a migraine headache.

A headache that comes and goes over the years and long-lasting is most likely a migraine or a vascular headache related to blood vessels. Symptoms include recurrent pain, throbbing, and pressure all of which can last for days.

There are many causes for migraines including stress, insomnia, barometric pressure, altitude changes and some foods. It is no longer unusual these days to find that children and teens also suffer from migraines along with adults.

Recently a new association for migraine has come to light, the patent foramen ovale (PFO) or a hole in the heart. Usually this congenital defect closes on its own, but many people live their whole lives with it open and without negative effects. However, for some it can be the cause for a stroke or migraines.

There is no proof of this yet and research is ongoing, but one out of every four to five patients with migraines have holes in their hearts. Apparently closing the PFO provides relief from the migraines and people who have their PFO closed feel more energetic, and their hands and feet feel warmer.

Preventive therapy usually includes an anti-inflammatory, seizure medication, or an anti-depressant heart medication.  A physician may also order a migraine-specific drug that turns off the pain center in the brain.

Whatever the treatment, the advice is to see your physician first.

Heart failure is a confusing and frightening term for many people.

I bring up this topic because a neighbor’s husband was diagnosed with heart failure. During a conversation about his condition, his wife thought that her husband’s heart had stopped beating when the doctor told her the diagnosis was heart failure.

At that moment I took a deep breath not knowing whether or not it was my place to help her understand the term, but I did explain that heart failure really means that the heart isn’t working as effectively as it should.

In other words the pump is broken. Either the heart isn’t able to fill up with enough blood or pump with enough force, or both. If the heart is not pumping as efficiently as it should, then your need for oxygen and nutrients is also not being met. When the heart does not pump powerfully as it should, fluid backs up into the lungs and builds up in the feet, ankles and legs. That means the organs are also not getting enough blood and oxygen.

On the other hand, heart failure does not mean the situation is hopeless. It is true that heart failure cannot be cured, but patients can take steps to manage their heart failure so it does not get worse.

Medications such as diuretics, ACE inhibitors to lower blood pressure, beta-blockers to slow heart rate, and Digoxin to strengthen the heart beat may be prescribed to help alleviate the symptoms and make the heart function more efficiently. When patients experience severe heart failure they may have a pacemaker, heart pump or even a heart transplant.

There are warning signs that you or someone you know may be experiencing heart failure. They include:

• Feeling unusually tired especially during an activity.

• Shortness of breath

• Difficult breathing when lying down

• Swelling in the feet, ankles and legs

• Coughing while exercising or when lying down

• Abdominal pain and loss of appetite

• Weight gain from fluid buildup

• Frequent urination

All of the above are possible signs that fluid is building up in your body. Contact your doctor if you are experiencing any of these symptoms. Remember early detection, regardless of the disease or condition, means early treatment, which is likely to equate to a more quality lifestyle.

To your healthy aging.

Ruthan Brodsky

According to recent research published in Neurology high blood pressure is linked to memory problems in people over age 45.

We have been told repeatedly that our blood pressure should be at least normal which is something less than 120 (systolic) over 80 (diastolic) – often written as 120/80mm Hg and read as 120 over 80 millimeters of mercury.  High blood pressure or hypertension is when your blood pressure is higher than normal for an extended period of time.

We have this general idea that high blood pressure puts us at greater risk for heart attacks and strokes. We also now know that we could have normal blood pressure as young adults and even thru those hectic times of raising kids and creating some kind of life for ourselves and family, but as we age our arteries and veins lose their elasticity and it’s more likely our pressure will raise above normal.

Those of us who are wise enough to realize the serious risks of hypertension will take our meds to control the pressure. For those who haven’t made up their mind just yet, your risk of growing old without a quality life has just increased with this new research. For every 10-point increase in the blood pressure reading, the odds of a person having cognitive problems were 7% higher.

The study involved over 20,000 participants, age 45 and older. Close to 50 percent were already taking medication for high blood pressure but another almost 8 percent of them already had memory and cognitive problems. The thinking is that by preventing or treating high blood pressure, we could potentially prevent cognitive impairment which is a precursor to dementia. Research already shows us that high diastolic blood pressure leads to the weakening of small arteries in the brain which can cause small areas of brain damage.

It seems to me that you don’t have to be a genius to figure out that you need to do what you need to do – diet, exercise, meds – to control your blood pressure.

To your healthy aging.

Ruthan Brodsky

You and I know that exercise is good for us.  I admit to being very good about doing aerobic exercise on a regular basis but not so good about strength training. I need to set aside time for longer workouts at least a few times a week. Read the rest of this entry

Keeping your bones and muscles strong will give you a better quality of life as you get older. There is no doubt about the results of the research on this topic. Read the rest of this entry

As far as I can figure out Botox is approved for four non-cosmetic uses:

• Strabismus or misaligned eyes

• Blepharospasm or eyelid twitching

• Cervical dystonia or neck spasm and pain

• Hyperhidrosis or excessive sweating

One approved areas in which Botox has achieved success is for dystonia, a neurological disorder characterized by involuntary muscle contractions which result in uncontrollable movements. The toxin injections show beneficial effects on specific groups of muscles that don’t respond well to physical therapy, medications and surgery.

One of the unapproved treatments for Botox is using it for migraine headaches. Scientists speculated that for cosmetic surgery, not only does the toxin suppress muscle contractions but it also suppresses pain signals. Now the data shows that the toxin isn’t much better than a placebo for most headaches. That’s not to say it may work for some individuals or larger doses work better than the ones used for the clinical trial. However, because there isn’t absolute proof and the side effects could be a drooping eyelid and temporary weakness of the neck muscles, it doesn’t make sense to spend from $250 to $1,000 per treatment.

On the other hand there is good evidence that says Botox is effective for chronic facial muscle contractions, excessive sweating, and hand tremors.

Some of the unapproved, off-label uses of Botox include treatments for cerebral palsy, drooling, tension headache, ringing in the ear, constipation, incontinence, hair loss, tennis elbow and a dozen or so more conditions.

Following the reporting of some serious health problems and a number of deaths from the unapproved use of Botox, the FDA now has a black box label for all Botox and similar products, which is the highest packaging warning the agency requires. The label states that the toxin can spread beyond its injection site to other parts of the body and cause symptoms of botulism, including muscle weakness and trouble breathing and swallowing.  The FDA also warns that the potency level may vary from product to product.
Good enough warning for me to think twice before having a Botox treatment, especially if not approved.

What about you? Would you use Botox? Under what circumstance?

To your healthy aging.

Ruthan Brodsky

Today we know botulinum toxin as Botox. I recall when I only knew of botulism as a lethal food poisoning that paralyzed your muscles including those that control breathing. Now we know that a regulated dosage of Botox can be helpful. For instance, injected into muscle tissue, botulinum toxin can reduce spasms and pain.

Today I usually think of Botox as an injection that gets rid of wrinkles, at least temporarily.  Most of the cosmetic injections are on the vertical furrows between the eyebrows that become deeper as we age. By preventing muscle contractions that cause facial lines, Botox smooths the skin and makes the skin look younger.

Today it is also used to treat a range of facial wrinkles including those on the neck, commonly called turkey neck, and at the corners of the eye called crow’s feet.

However, Botox has a longer medical history. In the late 1980s it was approved for the treatment of misaligned eyes (strabismus) and abnormal squinting and eyelid twitching. Since then it’s been approved for the treatment of muscle spasm affecting the neck and shoulders called cervical dystonia as well as for severe sweating.

Botox and some of its cousins such as Myobloc, have the approval for just a few medical conditions. However, once a drug is approved it can be prescribed at a clinician’s discretion. As a result, Botox is being used for many conditions including reducing migraine headaches.

The effects of using Botox for cosmetic or medical conditions are temporary which means doses must be repeated. The dose depends on the patient’s weight, the condition being treated, which muscle is being injected, and how much of that muscle is being treated. With repeat injections, muscles may atrophy and lose some function. That is usually when injections stop.  Some patients who receive large doses become resistant to the drug but now they have developed antibodies to deal with that problem.

More on Botox and medical conditions in my next post.
If you receive Botox injections, let us know what your condition is or is it cosmetic? It will be interesting to see which areas are treated more. Our own clinical survey.

To you healthy aging.

Ruthan Brodsky

Ads for over-the-counter products and prescription medications to help you fall asleep and stay asleep are in all the media including TV, radio, online, and on the backs of buses. Most of us, however, prefer to find a way in which we do not have to take any more medications even if they just come from the drugstore shelf. We would be much happier if we could figure out how to deal with our sleeping problems more naturally.

One of the problems is that as we age we tend to have more medical problems, many of which are chronic. In general, people with poor health or chronic medical conditions do have more sleep problems. For instance, hypertension is associated with snoring, obstructive sleep apnea (OSA) and heart failure because OSA is associated with heart failure.

Then there is menopause and all the hot flashes that go with it plus the changes in breathing. Of course the decreasing hormone levels are also a factor for many sleepless nights. Gastroesophageal reflux disease (GERD), or what we commonly call acid reflux is another common cause of sleep problems because the pain makes it difficult to sleep. Diabetes and asthma are other sources of sleep problems.

Here are a few changes you can make to help you get a good night’s sleep:

• Exercise in the afternoon.
• Avoid stimulants such as caffeine for at least 4 hours before bed.
• Establish a schedule for your sleep going to bed at the same time and waking up at the same time.
• Use your bedroom for sleep and sex only.
• Avoid alcohol later in the evening because it increases your chances of waking up in the middle of the night.

Try taking naps but remember that sleep during the day affects sleep at night. For instance, a 30-minute nap may give you more energy in the afternoon but it may take you longer to fall asleep at night.

If you are still experiencing difficulty sleeping, first think whether a particular event or problem may be the cause of your sleep problem. If so, sleeping well will return when the problem is resolved or managed. If not, then it is time to talk to your doctor. You may want to keep a record of your sleep and fatigue levels during the day and a list of any other symptoms to give to your doctor to help with the diagnosis.

In the meantime if you cannot fall asleep after 20 minutes, do as the National Sleep Foundation suggests: Get out of bed and do something quiet and relaxing like reading a book or listening to music. Do not turn on old war movie on TV. When you feel sleepy, get back in bed and try again. If not successful in 20 minutes, repeat.

Try some of these lifestyle changes before you start taking meds even if they are non prescription. They may help you get the sleep you want and with no side effects.

To your healthy aging,

Ruthan Brodsky

Sleep patterns to change as you get older along with all the other physical changes.  Most people tend to have a tougher time falling asleep and then more trouble staying asleep than they did when they were younger. The problem is, no matter what the common thinking is all about, your need for sleep doesn’t decline as you get older. In fact your sleep needs remain fairly constant. Read the rest of this entry