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January, 2011

Finding lung cancer early

A large study evaluating the effectiveness of using CT scans to screen for lung cancer could lead to earlier detection and treatment, and possibly fewer deaths.

Let's go nuts

Nuts contain healthy unsaturated fats, protein, and important nutrients like potassium, and there is ample evidence that eating nuts regularly helps protect against heart disease.

When the liver gets fatty

The increase in obesity among Americans has led to an increase in fatty liver disease as a consequence of insulin resistance. Some researchers believe that this condition may lead to heart disease.

On the brain: Maybe more than one way to beat cognitive decline

Physical activity and mentally challenging and engaging activities may help prevent cognitive decline.

On the brain: The brainy omega-3 fails an Alzheimer's test

A study of patients with Alzheimer's disease found that taking the omega-3 fat DHA did not affect the progression of the disease.

In Brief: Good news about new macular degeneration drugs

A study of two drugs used to treat macular degeneration found no added risk of heart disease or death compared to older treatments.

In Brief: Old noses have more room inside

Researchers found that the nasal cavities of older people were larger than those of younger people.

In Brief: Sleep helps with fat reduction

Getting a full night's sleep may help the body lose more fat.

Ask the doctor: Should I be worried about my blood pressure medication causing cancer?

I heard about a study that found that ARBs can cause cancer. I am taking one, Cozaar, because of high blood pressure. Should I stop taking it?

Ask the doctor: Should I stop taking Avandia?

Because of the recent news about Avandia, my physician has advised me to stop taking it. Is that wise?

February, 2011

The vitamin D-cision brings surprises

A panel of experts acting at the request of the Institute of Medicine has determined that most Americans are in fact getting enough vitamin D from a combination of sun exposure, diet, and supplements.

Mindful eating

Research suggests that more deliberate and thoughtful eating habits could help some people lose weight.

Update from the cold front

There is still no cure for a cold, but you may be able to prevent one, or at least cut down on its duration.

Understanding the ECG: Reading the waves

The electrocardiogram is useful in diagnosing many heart conditions, and is receiving new attention due to its role in determining whether someone has had a heart attack.

Palliative care: Sooner may be better

Palliative care, which aims to improve a person's quality of life during a serious illness, may also result in prolonging life in certain cases.

Ask the doctor: What do you think of these so-called sunless tanning products?

My teenage daughter wants to be tan when we go to Florida for our winter vacation. I have suggested one of the so-called sunless tanning products, but she says they don't look natural and wants to go to an indoor tanning salon instead. What do you think?

March, 2011

Shocking news: Overdoing ICDs

Concern about possible overuse of implantable cardioverter-defibrillator devices has led to a reevaluation of their benefits and risks.

Talking of walking in three easy pieces

Studies examine various aspects of the health benefits of walking: gait speed, use of hiking poles, and type of footwear.

The shingles vaccine

For people who have had shingles, the question of whether or not to get the vaccine to prevent a recurrence is not easily answered.

A wash worth its while?

Certain ingredients in some brands of mouthwash may help prevent bad breath, but some experts think that using a toothbrush on the tongue is more effective.

Ask the doctor: Generic vs. brand-name drugs: Any difference?

Some doctors strongly advise against the use of generic drugs with the argument that manufacturing processes are better controlled in branded medicines. What is your view?

Ask the doctor: Nothing works for fullness in ears. Any suggestions?

I have a feeling of fullness in my ears that won't go away. I think it has been diagnosed as something called eustachian tube dysfunction. I have been to several otolaryngologists. Nothing has worked. Suggestions?

April, 2011

Four sob stories

Research on crying focuses on several different areas, including the chemicals in emotional tears and their purpose, and whether or not depressed people cry more.

The 2010 Dietary Guidelines

The government has released the latest version of its dietary guidelines, but some health care professionals are disappointed, because they feel that the recommendations regarding sugar-sweetened drinks and salt consumption are not strong enough.

Proton-pump inhibitors

Proton-pump inhibitors are the strongest type of medicine available for treating stomach acid. There is some concern about their potential side effects and interactions with other medications.

Accountable care organizations

A new type of health care organization aims to improve managed care by controlling costs and rewarding efficiency while maintaining high standards of care.

In Brief: Routine screening of the carotid arteries not recommended

An ultrasound screening can detect blockage in the carotid arteries, but a government task force is discouraging such screenings due to the very small percentage of the population at risk for such a stroke.

Ask the doctor: Creatine for muscle strength

I'm 70 and exercise 30 minutes a day. I've heard that creatine supplements might help build muscle strength. Is there anything to it?

Ask the doctor: Preventing and curing sarcoidosis

A friend has sarcoidosis. How bad a disease is it? Can it be prevented and treated effectively?

May, 2011

Editor's note

The editor in chief of the Harvard Health Letter introduces the 2011 edition of a special issue comprised entirely of "Ask the doctor" letters from readers.

Ask the doctor: Is robotic surgery better?

A hospital in the area is advertising robotic surgery. Is it really any better than having a surgeon do the operation?

Ask the doctor: Alternative to warfarin

For several years, I have been taking warfarin because of atrial fibrillation. I recently suffered nosebleeds, which took two days to control. The trauma of those episodes makes me want to swear off warfarin, but I am not sure what other options I have.

Ask the doctor: Do cataracts need to be ripe for surgery?

I think I may have cataracts. I heard somewhere that they need to be ripe before I get surgery. Is that true?

Ask the doctor: Seborrheic keratoses

I have a bad case of seborrheic keratoses on my back and chest. What can you tell me about this skin problem?

Ask the doctor: Nuclear stress tests

I recently had a nuclear stress test and the contrast agent got stuck in my gut, so the image couldn't be read. Is this a common problem, and is there anything that can be done about it?

Ask the doctor: Runny nose

Why does the nose run in cold weather?

Ask the doctor: 10% brain myth

Is it true that we use only 10% of our brains?

Ask the doctor: Baggy eyes

What causes bags and puffiness around the eyes and dark circles underneath them?

Ask the doctor: Heavy bleeding, fibroids, and polyps

I am 53 and have experienced heavy menstrual bleeding. An ultrasound showed fibroids and polyps. My doctor gave me three choices: monitor with ultrasound, get a hysterectomy, or freeze the fibroids and polyps. I am not sure what to do.

Ask the doctor: Coconut oil

I have started noticing more coconut oil at the grocery store and have heard it is better for you than a lot of other oils. Is that true?

Ask the doctor: Questioning the necessity of aspirin

My doctor advised me to start taking an 81-mg aspirin once a day. I am a physically active 62-year-old and have been a vegetarian - mostly vegan - for 35 years. I'd really rather not take aspirin. Am I being foolish in questioning my doctor's advice?

June, 2011

Are full-body airport scanners safe?

There is concern about radiation exposure from x-ray machines used for airport security scans, but the added risk is so small that it is insignificant.

Health by the numbers

Statistics on statin use show a decrease in LDL cholesterol levels in those who take the medications, but for people who don't want to or who cannot handle the possible side effects, dietary changes can have similar benefits.

Breaking the fast

Research reiterates the importance of eating breakfast every day, but carefully choosing what you eat in the morning, and how much, can optimize your breakfast's nutritional content.

Drugs in the water

Chemicals from medications and personal care products are making their way into streams, lakes, and other bodies of water, but water treatment facilities are not currently equipped to filter pharmaceutical waste from our water supply.

Ask the doctor: What is the upper limit for omega-3 fats?

There's a lot of publicity about omega-3 fats being beneficial for heart, mind, joints, eyes, and so on. There are over-the-counter products of varying size. So, this is my question: is there a daily upper limit on fish oil consumption?

July, 2011

Berry good for health

Berries contain antioxidants, vitamins, and a generous amount of fiber, making them an excellent component of a more healthful diet.

Following up: Deactivating the ICDs of hospice patients

Hospice patients with implantable cardioverter-defibrillators may choose to turn off the shock function of the devices to avoid a potentially painful shock.

A Q&A with our new board member

The Harvard Health Letter has a conversation with its newest board member, a physician who is involved with geriatric care issues.

Diagnosing Alzheimer's disease

New guidelines for diagnosing Alzheimer's disease aim to identify changes in the brain that are associated with the development of the disease.

In Brief: Why do vitamins keep on failing in clinical trials?

Two researchers theorize that trials of vitamins have not yielded more positive results because the test subjects already had ample levels of the nutrient being tested in their bodies.

9 things that can affect your vitamin D level

Many factors influence the body's production of vitamin D, including age, weight, and air quality.

Bypass vs. angioplasty

Studies comparing bypass surgery to angioplasty found that, for those with more serious heart disease, there is little difference in eventual outcome between the two methods.

Ask the doctor: Oral steroids for nasal polyps

I have chronic sinusitis and nasal polyps. I switched doctors and the new specialist suggested trying oral steroids, something that my previous doctor never mentioned. What do you think?

August, 2011

Niacin trial stopped early: Now what?

A clinical trial of niacin in combination with a statin to lower cholesterol was stopped early because of concerns that the combined medication could be associated with an increased risk of stroke.

Preventing cancer: Are we getting closer?

A drug now used in breast cancer treatment may have the potential to prevent the disease in some women.

Conversation with a Harvard expert

The Health Letter talks to a nutrition researcher specializing in the effects of high-glycemic-load foods.

With rising, a fall in blood pressure

With age, the heart and blood vessels weaken, leading to lower blood pressure when standing up. Insufficient blood to the brain can cause dizziness and blurred vision, and an increased risk of falls.

Happy - and healthy - trails to you

Vacaion planning should include these health planning and preparedness measures.

Moderate drinking - and how to keep it that way

Moderate alcohol consumption offers some clear health benefits, but it is important not to slip from moderation into riskier drinking.

Ask the doctor: Can I replace potassium pills with foods high in potassium?

I am taking furosemide (Lasix) once a day. I was told to also take potassium pills, but I don't like pills. Can I replace the potassium pill with foods high in potassium?

Ask the doctor: What can be done about a lump in the back of the throat?

I often feel like I have a lump of mucus in my throat. In the morning I spit some of it up, but the sensation doesn't go away. What can I do about it?

September, 2011

More than the usual forgetfulness

Age-related memory loss is common, but forgetting things like significant dates or events could be a sign of mild cognitive impairment, which increases the likelihood of progression to dementia.

Conversation with a Harvard expert

The Health Letter interviews a researcher and professor whose area of expertise is medications.

Adult food allergies

Sometimes adults suddenly develop allergies to foods they have eaten since they were children. Such reactions may be caused by a cross-reaction to another allergen.

Stress and overeating

Stress hormones trigger increased appetite in general, and cravings for fatty, sugary foods in particular.

In Brief: Fiber on a winning streak

Eating high-fiber foods helps lower cholesterol, and research is now suggesting that it may also help protect against respiratory and infectious diseases.

In Brief: Avoiding kidney stones

Ways to prevent kidney stones mainly revolve around dietary choices, along with drinking plenty of water.

Wake up and use the microwave, Health Letter, say our readers

Eating oatmeal is a great way to add fiber to your diet, and using a microwave oven is a convenient way to speed up the cooking time.

Ask the doctor: Is abdominal surgery riskier if I am overweight?

I am overweight and need abdominal surgery. Does being overweight make the surgery more difficult and add to the complication rate?

Ask the doctor: Have I given up steak for nothing?

I read that Harvard researchers found no association between eating red meat and developing heart disease and diabetes. Have I been depriving myself of steak for more than 20 years for no good reason?

October, 2011

Controlling what - and how much - we eat

Because humans have evolved to crave fat, salt, and sugar, it is difficult to shift away from them and toward a healthier diet, but it is possible to learn to like vegetables, fruits, and whole-grain foods more.

Preventing delirium in the hospital

Delirium occurs frequently in older people who are hospitalized. It can manifest as a state of confusion and agitation, or one of withdrawal and lethargy.

Conversation with a Harvard expert

The Health Letter talks with an orthopedic surgeon about joint replacement.

A matter of opinion

Getting a second opinion about a medical issue is a good idea. It can confirm a previous diagnosis or offer new insights, and it may help avoid costly or unnecessary treatment.

Novel therapy for C. difficile infections

An unusual treatment may help prevent the recurrence of a bacterial infection.

Ask the doctor: Is there a connection between antidepressants and cataracts?

I read something about antidepressants causing cataracts. Is there any truth to it?

Ask the doctor: Unconscious or subconscious: Which is the correct term?

I've always used the word subconscious when talking about thoughts that are buried. But someone corrected me recently and said unconscious is the correct term. Have I been using the wrong word?

November, 2011

Feet and falling

Research indicates that older people who fall are more likely to have foot pain, bunions, or other foot problems.

Now being served, better nutrition advice

The Harvard School of Public Health and Harvard Health Publications team up to produce a more substantive alternative to the government's MyPlate dietary recommendations.

Do antidepressants work in the damaged brain?

Antidepressants have not fared well in research on patients with Alzheimer's disease, but there is some evidence that they may benefit stroke victims.

Ask the doctor: Is there a better way to treat morphea?

My wife has morphea spots on many areas of her body. We are currently treating them with Dovonex, which seems to help a little but is expensive. Do you have a better way to treat this disease? We have been told very little is known about how to treat it.

December, 2011

Editor's note

The editor in chief of the Harvard Health Letter introduces a second 2011 edition of a special issue comprised entirely of "Ask the doctor" letters from readers.

Ask the doctor: Are artificial sweeteners a good alternative to sugar?

More and more nutrition advice seems to be anti-sugar these days. So are artificial sweeteners a good alternative?

Ask the doctor: Why is poultry a protein on your Healthy Eating Plate?

I saw Harvard's Healthy Eating Plate and noticed that poultry was listed as a healthy protein. I am not surprised that you're recommending fish, nuts, or beans. But why poultry?

Ask the doctor: Is it okay to keep on taking Ambien for my sleeping problems?

I am 70, have had sleep problems, and have started to take Ambien every night. It seems to be working very well. Is it okay if I keep on taking it?

Ask the doctor: Should I worry about health effects from BPA?

Is the chemical BPA just another health scare, or is it really something we should be worried about?

Ask the doctor: Why are waits in the emergency department so long?

I sprained my ankle pretty badly a few weeks ago and was taken to the emergency room. It took three hours before I saw a doctor. Why are emergency rooms so crowded and the waits so long just to be seen?

Ask the doctor: For macular degeneration, which is better, Avastin or Lucentis?

I have wet macular degeneration. I am trying to decide between Avastin and Lucentis. Which drug is better?

Ask the doctor: What is gastroparesis and how can it be treated?

A friend has a condition called gastroparesis. Please explain what it is and how it can be treated.

Ask the doctor: Is the alternative to warfarin safe and effective?

My wife's medication to treat atrial fibrillation recently was changed from warfarin to a new drug called Pradaxa. They say that the new medicine does not require regular INR tests and is just as effective. Is that so?

January, 2010

Out in the cold

Winter can be tough on the body, with increased rates of respiratory diseases and cardiac events, but cold weather also helps stimulate the body's calorie-burning fat.

In Brief: Vitamin D may prevent falls

Research appears to support the idea that a regular dose of vitamin D helps improve strength and balance in older people, which helps reduce the incidence of falls.

In Brief: How do you know whether it's flu?

It is not always easy to tell whether an oncoming illness is a cold or the flu, but the symptoms do differ, and this chart can help.

In Brief: Aspirin as colon cancer treatment?

Researchers from Harvard found that people with certain types of colon cancer who took aspirin were less likely to die of the disease.

The aging mouth - and how to keep it younger

Age brings increased likelihood of tooth decay, gum disease, and oral cancer. Proper oral care can keep the mouth healthy longer.

The prep is worse than the procedure

Prepping for a colonoscopy is unpleasant, but the bowel needs to be clear for the procedure to be effective. Some bowel-cleaning solutions now come in better-tasting flavors, and guidelines now recommend split dosage of the laxative.

By the way, doctor: Could aspirin cause hearing loss?

I am 85 and have taken an 81-mg aspirin each day for decades for heart attack prevention. Recently, I noticed these words on the label: "Stop using if you get ringing in your ears or loss of hearing." Should I be worried?

By the way, doctor: Is 60 too old to be treated for prostate cancer?

I have heard that doctors feel men over 60 shouldn't be treated for prostate cancer because they're old enough that they are going to die anyway. Is that so?

February, 2010

The respiratory tract and its infections

Respiratory tract infections include the common cold, sinusitis, pharyngitis, bronchitis, and pneumonia. Hand washing is the most effective action people can take to prevent getting one of these infections.

In brief: Acrylamide: No longer such a hot potato

The chemical acrylamide, which forms as a byproduct of cooking many baked and fried foods, was thought to cause cancer, but subsequent research has not supported this view.

Does stroke risk begin with the stork?

Researchers looking at stroke risk found that people who were born and spent their childhood years in states in the southeastern United States have a higher risk of stroke as adults.

Choices for hipsters

Hip replacements are common procedures, and their popularity is expected to increase as baby boomers age. Some younger patients opt for hip resurfacing, but it may make them more vulnerable to needing a full replacement later.

By the way, doctor: Do I need to take bile salts after gallbladder surgery?

I have read that people who have had their gallbladders removed should take bile salts. My gallbladder was removed many years ago, and no doctor has said I should take bile salts. Should I?

By the way, doctor: Should coenzyme Q10 be taken with statins?

I take a statin. Should I be taking coenzyme Q10 to protect myself against the muscle pain that statins can cause?

March, 2010

Cultivating your inner boss

Executive function is the part of our thinking that organizes, plans, decides, and inhibits inappropriate impulses. Healthy lifestyle habits such as exercising, controlling blood pressure, and getting enough sleep also work to preserve executive function.

Understanding migraine

Questions and answers about migraine headaches: what they are and are not, what causes them, prevention, and more.

Sleep apnea: Keeping up the positive pressure

Sleep apnea has been linked to many health problems. Obstructive sleep apnea can be treated effectively with a continuous positive airway pressure (CPAP) machine, though getting used to using it can be challenging.

From our follow-up files

Further information about recently published articles on bowel prep before colon surgery, Kegel exercises to strengthen pelvic muscles, and the results of a study on platelet-rich plasma therapy.

By the way, doctor: Can I go back to eating wheat once my celiac disease is under control?

I have a mild case of celiac disease. Do the villi ever recover after wheat gluten is given up? I am really tired of gluten-free food!

By the way, doctor: Are MRI contrast agents harmful?

Do the contrast agents used with MRI scans have side effects? I have had several MRIs and am wondering if there's reason to be worried.

April, 2010

All about gout

Many people think of gout as an archaic and uncommon affliction, but it is becoming more common, mainly among older men who eat a lot of meat and seafood and drink a lot of alcohol, particularly beer.

It's time to really get the ticks off

Deer tick nymphs are most active in the warmer spring and summer months. A tick bite can lead to Lyme disease or other illnesses.

Is hefty the new healthy?

Some studies have suggested that a little extra weight may be beneficial to older people, but increasing weight and fat around the waist in older age still mean a greater risk of a number of diseases.

From our follow-up files

Additional information about recently published articles on a possible alternative treatment for migraines, avoiding the need for hip replacement, and the effect of high blood pressure on executive function.

By the way, doctor: Is there a solution for watery eyes?

I am 63 and have tears running down my face at odd times. Most of the information I've found on the Internet is about infants with blocked tear ducts. Can you provide some information about tearing in adults?

May, 2010

Editor's note

The editor in chief of the Harvard Health Letter introduces this year's edition of a special issue comprised entirely of "By the way, doctor" letters from readers.

By the way, doctor: Is not washing your face good for your skin?

I wash my face very little because I have heard soaps, no matter how mild, dry out the skin. What do you think - what should I wash my face with?

By the way, doctor: Should I stop taking these vitamins?

In addition to a multivitamin, I have been taking vitamin B12 supplements (1,000 mcg) for a few years, hoping to increase my energy. My recent blood profile showed a high level of B12 (1,826 pg/ml). Should I stop taking B12? My energy is about the same.

By the way, doctor: When is the best time to check your own blood pressure?

I'm starting to check my blood pressure at home. When during the day should I do it?

By the way, doctor: Will a fiber supplement interfere with my medications?

I take a fiber supplement, but have heard that I shouldn't be taking it at the same time as medication. How far apart should I take fiber and medicines such as Plavix and Crestor?

By the way, doctor: Should boys be getting the HPV vaccine?

Why are parents not being urged to get their sons vaccinated for HPV?

By the way, doctor: How can caffeine help migraines?

If coffee constricts blood vessels, why would it help migraine sufferers, since the constriction curtails blood flow, which would seem to cause more pain?

By the way, doctor: Could swimming in cool water give me a heart attack?

When I attempt to go into the outdoor pool at my beach club, I gasp for breath, get dizzy and light-headed. I read that some people who are very sensitive to cold water may sustain a heart attack from submersion in cold water. Is this a possibility?

By the way, doctor: Will thiazide diuretics increase my chances of getting diabetes?

Thiazide diuretics are often recommended as the first medication to use to control blood pressure, but I've heard that a large study called ALLHAT found an association between thiazide diuretics and diabetes. Is this something to be concerned about?

By the way, doctor: Are gourmet salts better for you?

Do you know anything about the various fancy salts? I've heard that they deliver salty flavor but have a smaller dose of harmful sodium.

By the way, doctor: Is Avastin for macular degeneration a good choice?

My 78-year-old husband has wet macular degeneration. He is being treated with a drug called Avastin. Is that a good choice?

By the way, doctor: What can I do about excessive belching and feeling full?

I belch a lot and get a feeling of fullness in the upper abdomen. Is this a common condition? What are the causes and cures? I would prefer natural remedies.

By the way, doctor: Does an H. pylori infection without symptoms need to be treated?

I'm in my mid-80s and am infected with H. pylori, the "ulcer bacteria." I don't have any symptoms and have heard that half of everyone over age 60 tests positive for H. pylori and that many people never develop ulcers. Do I need to be treated?

By the way, doctor: Can even one fatty meal cause heart problems?

I'm in good health and have a good lipid profile but occasionally have a yearning for brisket or corned beef. I recently read that even one meal heavy in fat could cause atherosclerosis. What do you think?

June, 2010

An update on soy: It's just so-so

Soy's earlier promise as a health food has been dimmed somewhat by the results of more recent research.

War on cancer won't be won in the produce aisle

Results of the EPIC study show that consumption of fruits and vegetables has a much smaller effect on cancer risk than was previously believed, but including them in one's diet is still important for cardiovascular health.

Colon cancer risk: A refresher course

Colon cancer is highly preventable, and many factors influence a person's risk. Diet and exercise, unsurprisingly, factor heavily.

New (still proposed) rules for sunscreen

The FDA's proposed revisions to sunscreen labeling would provide more information to consumers and emphasize safety.

In Brief: Depression research: An objective view of gloomy outlook

Researchers are examining the possibility that at some point, depression may be objectively measureable through a retinal test.

In Brief: Looking for a panacea? Just keep on moving

Results of studies show that exercise or other physical activity has a beneficial effect on conditions ranging from mild cognitive impairment to Parkinson's disease.

By the way, doctor: Colonoscopy: Is it time to go virtual?

I read that President Obama had a virtual colonoscopy. Is this the colon cancer screening test that everybody should be getting instead of a regular colonoscopy? I thought it was kind of experimental.

July, 2010

A prescription for better health: go alfresco

Spending time outdoors is likely to improve your mood and concentration, encourage activity and fitness, and fuel your body's production of vitamin D.

Can aspirin do that, too?

In light of its success in reducing the risk of heart attack or stroke, researchers are investigating whether aspirin may offer protection against cancer.

When nerves get damaged

People with peripheral neuropathy may experience pain, numbness, tingling, and other unpleasant sensations. Often the cause cannot be determined, so the condition must be managed by attempting to treat the symptoms.

Elevating your HDL game

Taking niacin is an effective way to boost HDL cholesterol, but there are side effects to consider.

By the way, doctor: Is it okay to take ibuprofen p.m.?

I take ibuprofen p.m. on occasion - maybe once a month or so - to help me get to sleep. It seems to work. Is that okay?

By the way, doctor: Can you give me some advice about omega-3s?

I am confused about omega-3 fats. Are the different types equally good for you?

August, 2010

Storm's a-comin'

The dangers of lightning are generally well understood, but thunderstorms can also trigger asthma attacks, and they may be linked to other conditions as well.

Getting back on the bike

Bicycling is a great way to get to work while getting the benefits of aerobic exercise. Riding safely and comfortably will make bike excursions more enjoyable.

Is the heart attack going out of style?

Two studies show a decline in the number of hospitalizations for heart attacks, suggesting that efforts at prevention are effective.

From our follow-up files

Additional information about recently published articles on gout and migraine headaches.

By the way, doctor: Does removing blood increase the amount of iron in the body?

My brother has been told he has too much iron in his body. I've heard the treatment is removing blood every so often, but his doctor says that will just produce more iron in his blood. Can that be true?

By the way, doctor: Can I stop getting colonoscopies?

At age 60 I was treated for colon cancer. Since then I've had regular colonoscopies with no further sign of colon cancer. I'm now 84 and healthy. Does it make sense to get another colonoscopy?

September, 2010

The smoldering epidemic

Hepatitis C is caused by a virus, but it can go undetected for years or even decades because there are often no symptoms. If left untreated, the virus can cause inflammation of liver tissue that can lead to cirrhosis.

Tiny specks may add up to heaps of trouble

The dust in a typical house is likely to contain allrergens like pet hair and dander, or chemicals and poisons like lead or arsenic that make their way in from outdoors.

The aging face

People who want to look younger have a number of options for nonsurgical treatments for the face, such as injections of dermal fillers or laser treatments.

By the way, doctor: Should my mother get an angiogram?

My mother is having angina when she exerts herself. She is scheduled for an angiogram and maybe angioplasty. I've heard that women's heart disease is different from men's and that angioplasty may not be as effective in women. Should she get the angiogram?

By the way, doctor: Isn't quinoa a supplier of complete proteins?

I read in your June 2010 issue that soybeans are the only plant food that could serve as a person's sole source of protein because they contain all eight essential amino acids. I thought quinoa does too.

October, 2010

The simplification of CPR

Guidelines for CPR have eliminated the giving of mouth-to-mouth breaths, partly so people will be more likely to give CPR, and partly because blood flow slows during the time compressions are stopped to give breaths.

Keeping cancer from coming back

The question of whether or not cancer survivors should take vitamin or mineral supplements to prevent recurrence cannot be answered conclusively, because there have not been any studies in this area.

When eyes get dry and what you can try

Dry, irritated eyes can be caused by a number of conditions, such as certain autoimmune diseases, and are a side effect of certain medications. They are more common in women and older people.

Shingles: Prevention is the way to go

As the immune system weakens with age, the risk of shingles increases. Many doctors recommend that people over 60 get the shingles vaccine.

By the way, doctor: What is body dysmorphic disorder?

My niece has been diagnosed with body dysmorphic disorder. I've heard of it, but I'm not sure what it is exactly.

November, 2010

Smartphoning it in

There are a number of apps available for smartphones to help people with topics like dieting and fitness, blood pressure monitoring, stress management and reduction, first aid, and more.

You've torn your ACL. Now what?

People with ACL injuries in the knee may want to consider physical therapy to see how well the knee heals before deciding on difficult and expensive reconstruction surgery.

New caution about opioids

Abuse of prescription opioid medications has increased, resulting in overdoses and deaths. There is also evidence that long-term use of an opioid can affect the nervous system and cause other side effects.

By the way, doctor: Why don't statins damage the heart muscle?

I've heard that statin drugs can cause muscle damage. Since the heart is a muscle, why don't statins cause heart damage?

By the way, doctor: Is there an environmentally friendly way to get omega-3s?

Omega-3 fats may be good for you, but I worry about overfishing. Is there a way of getting omega-3s without contributing to this problem?

December, 2010

H1N1 and this flu season

The H1Ni flu pandemic was not as serious as had been expected, but children and pregnant women were disproportionately affected, and those groups are still at higher risk of getting the H1N1 flu this winter.

Rules to eat by

The federal government's dietary guidelines are likely to Include recommendations to reduce sodium intake, take vitamin D, avoid solid fats, and more.

Sex in the second half

Older Americans are remaining sexually active in greater numbers, due in part to continued good health and the prevalence of erectile dysfunction drugs.

Creative thinking and the brain

Excerpts from an interview with the author of a book on the psychology and neuroscience of creativity.

By the way, doctor: Is anterior hip replacement better?

I have a severely arthritic hip. It's pretty clear that I'm a candidate for hip replacement. When I looked on the Internet, there were a lot of Web sites promoting "anterior hip replacement." What is it, and is it any better than the traditional approach?

By the way, doctor: Will wearing glasses make my eyesight worse?

I am starting to have trouble reading. But I have heard that wearing glasses to help me read will make my eyesight worse. Is that true?

January, 2009

Measuring how fat we are

Body mass index is the most well-known way of measuring fat stored in the body, but waist circumference and waist-to-hip ratio measure different types of fat that may increase the risk of certain health problems.

Do PPIs have long-term side effects?

Proton-pump inhibitors relieve acid reflux, but people who take them long-term may be more susceptible to certain bacterial infections, pneumonia, and bone fractures.

Changing the cardiovascular prevention game

Results of the JUPITER trial showed that people with low LDL cholesterol but with a high C-reactive protein level who took the statin rosuvastatin had a dramatic decrease in risk of serious cardiovascular events.

What's up… and what's not

Results of drug trials and studies: selenium does not lower prostate cancer risk, lifestyle factors have a definite effect on longevity, and a possible correlation between physical warmth and opinion of warmth of personality.

By the way, doctor: What should an exam for skin cancer include?

Since having a carcinoma removed, I've gotten a full-body examination by a dermatologist every six months. I recently went to a new dermatologist, who just took a quick look at my back, arms, and legs. I wonder what the standard is for a full-body exam.

February, 2009

Learning to walk: A graduate course

Aging, or a condition such as arthritis, can negatively affect your gait. Focusing on the mechanics of walking can improve your stride, making it healthier.

A new way for TMJ

In the past, dentists and doctors were quick to treat temporomandibular joint (TMJ) problems with dental work and surgery. Now it is understood that TMJ pain may have many different causes, and surgery is not always the best course of action.

Getting a leg up on sciatica

The pain of sciatica can be relieved through surgery, but evidence suggests that over time, conservative treatment (NSAIDs, physical therapy, perhaps a steroid injection) provides equivalent relief.

By the way, doctor: Why two anti-inflammatories?

I read about statins having anti-inflammatory effects and lowering CRP levels. So why are we now being told that some people need to take two anti-inflammatories - aspirin and a statin?

By the way, doctor: Is there any drawback to hyaluronic acid capsules?

I have been taking capsules containing hyaluronic acid for my knees. Is there any downside to this medication?

March, 2009

12 ways to cut health care costs

Individuals can reduce their health care costs by following these suggestions, which include developing a consistent relationship with a primary care physician, taking generic medications when possible, and discussing end-of-life issues ahead of time.

In brief: The shoulds - and the shouldn'ts - of getting your shots

The immunization schedule for adults has changed, and many people may not be up to date on their vaccinations. Talk with your doctor about what shots you may need.

All the pretty pictures

The prevalence of CT scanning has had a marked impact on medical diagnosis, but the radiation from a CT scan is much higher than from a traditional x-ray, and people who undergo repeated scans may be at increased risk for cancer.

Weighing on our minds

It was previously believed that heavier people were less likely to develop dementia than thinner people, but recent evidence has shown that people with more abdominal fat in middle age are more likely to develop dementia later in life.

By the way, doctor: What might have caused my sister and brother-in-law's pulmonary embolisms?

Within a three-month period, both my sister and her husband (both in their 40s) were hospitalized with pulmonary embolisms. Any thoughts on the cause? Could it be something in the air?

April, 2009

Putting the joie de vivre back into health

Following the now-established benefits of moderate alcohol consumption, research now shows that chocolate and coffee also provide some measure of benefit to health, as do sleep, sex, and a strong social network.

The Whipple procedure

About 20 percent of people with pancreatic cancer are candidates for a surgery called the Whipple procedure that removes the part of the organ where most of this type of cancer originates.

Vitamins: Benefit of the doubt vs. doubts about benefit

The argument for taking a daily multivitamin is not as strong as it used to be. Research continues to accumulate showing that vitamins do not provide the benefits they were once believed to, and sometimes can be harmful.

By the way, doctor: Can cutting calories help my memory?

I'm 65, and I don't think my memory is as good as it once was. I read about a study that says you can improve your memory by eating less. Is there any truth to it? It sounds too good to be true.

By the way, doctor: Should I be concerned about omega-3 fats and bleeding?

I've been taking omega-3 fats and have two big bruises. Even small doses of aspirin cause me to bruise. My doctor is not concerned, but should I be?

May, 2009

Editor's note

The editor in chief of the Harvard Health Letter introduces this year's edition of a special issue comprised entirely of "By the way, doctor" letters from readers.

By the way, doctor: Children and soy milk

Is it safe for children to drink soy milk?

By the way, doctor: Screening for pancreatic cancer

We have screening tests for other cancers. How about pancreatic cancer?

By the way, doctor: PET-CT scans for finding breast cancer

I've been having PET-CT scans to look for any growth or spread of previously removed tumors. Are they as reliable in detecting breast cancer as a regular mammogram?

By the way, doctor: Diabetes treatment

I've had type 2 diabetes for 12 years; I'm now 81. I take metformin plus Januvia. My doctor has never suggested that I monitor myself with a meter. My hemoglobin A1c has been creeping up and is now 7. Should I be getting more aggressive in my treatment?

By the way, doctor: A very fishy diet

I read in the Health Letter that one of the nutrition experts eats five servings of fish a week. Why so much? And isn't there a risk from the contaminants?

By the way, doctor: Hammertoe woes

I have been told by a podiatrist that because of hammertoes, the fat pads on the ball of my foot have dissipated, causing pain when I walk or stand for long periods. I like to walk for exercise so this is a real bother.

By the way, doctor: Plugged-up feeling in an ear

I have a plugged left ear problem. It usually starts about 4 p.m. and lasts about three to four hours. I cough, clear my throat, yawn, close my nostrils and blow - nothing seems to help.

By the way, doctor: Tremors

I am curious about tremors in adults. I know that people with Parkinson's disease get them, but I am not sure about other conditions.

By the way, doctor: Ginkgo biloba and dementia

You published an article saying that ginkgo biloba might slow down dementia. I was 59, and I started taking it. I think it has helped me and know others who think likewise. But I read that a recent study says it doesn't help. Your thoughts?

June, 2009

Getting out the gluten

Doctors are diagnosing more cases of celiac disease, leading to an increased interest in gluten-free foods, although not everyone who has difficulty digesting gluten has celiac disease.

Calcium curious

Concerns about calcium are addressed by answering some commonly asked questions about this nutrient.

The principles of conservative prescribing

A patient-safety research organization has compiled a list of principles intended as guidelines for conservative prescribing of medications.

By the way, doctor: Will Levitra overcome the problems caused by finasteride?

Finasteride has been prescribed for my BPH. I think that the most frequent side effect is erectile dysfunction or loss of sexual desire. Would Levitra or a similar drug (like Viagra or Cialis) overcome the side effects of finasteride?

July, 2009

Angina

Angina is pain that radiates from the chest, caused by blockage of a coronary artery. Stable angina is not immediately life-threatening and can be treated effectively with medication, but unstable angina is a medical emergency.

Time to put some muscle into it

Aerobic exercise has clear cardiovascular benefits, but with aging, strength training is equally important. Building and maintaining muscle helps with balance and mobility, and helps older people stay healthy.

Nutrition's dynamic duos

Certain nutrients, such as calcium and vitamin D or potassium and sodium, work better in pairs, which is useful information when making nutritional choices.

By the way, doctor: Emergency care for chest pain

If you have chest pain or discomfort, how do you know if it is serious enough to warrant emergency medical attention?

August, 2009

Editor's note

The editor in chief of the Harvard Health Letter introduces a special section in this month's issue focusing on feet.

Coming out of its shell

Concerns about shrinking fish populations may move health-conscious eaters to choose more shellfish. Informed shoppers should be aware of the differences in nutritional value and potential toxins among various types of shellfish.

Overdoing acetaminophen

Accidental overdoses and potential liver damage have raised concerns about the safety of acetaminophen. As a result, the FDA is considering lowering the recommended safe daily limit.

Special section: Feet: How your feet work - and three steps for keeping them healthy

Our feet are marvels of anatomical engineering, but they can also cause problems. Common sense when choosing footwear can ease the pain and pressure on feet.

Special section: Feet: Agonies of the feet: Four common foot problems

Some people have a tendency to develop certain foot conditions, while others can occur because of poor shoe choices or excess weight.

Special section: Feet: A guided tour down the foot aisle

Guest editor Dr. James Ioli evaluates the effectiveness of some of the foot care products available in drugstores.

By the way, doctor: Flip-flops - how bad are they?

I read your article about hammertoes. Are flip-flops really that bad for your feet?

By the way, doctor: A second bunion operation?

I had bunion surgery five years ago. I thought it would fix the problem. Now the bunion has come back. Should I get bunion surgery again?

By the way, doctor: Switching from heels to flats

I know high heels are bad for the feet, but when I switched to flats, my feet started to hurt. Why?

September, 2009

His and hers heart disease

It is now understood that heart disease affects men and women differently, so doctors should consider these gender differences in diagnosis and treatment.

Counting every step you take

A pedometer is an inexpensive tool that can be an effective motivator to encourage walking more.

Whiplash

The abrupt movement of the neck during a whiplash injury can cause strains or sprains that do not show on standard imaging tests.

By the way, doctor: Cinnamon as treatment for diabetes?

I've heard that you can treat diabetes by taking an extract from cinnamon. I suspect this is snake oil, but is there anything to it?

By the way, doctor: Should I have seen a doctor sooner for a dog bite?

Recently, my dog bit me on the hand. When I showed up at my doctor's office several days later, he told me I had waited too long. Should I have gone to the doctor sooner?

October, 2009

H1N1 and its descendents

The H1N1 flu outbreak is linked to earlier versions of the virus. So far the 2009 pandemic has not been as severe as some health officials expected, but it is still a good idea to take basic precautions.

Game on

Research into how video games affect children is complicated by other factors that influence a child's behavior, such as personality and home life. Parents should consider limiting the type of games played or the amount of time spent playing.

Platelet-rich plasma therapy

Platelet-rich plasma therapy is a procedure used to treat joint pain, but even though the technique has been approved by the FDA, little research has been done on its effectiveness in people.

By the way, doctor: Cut off from toenail fungus medicine too soon?

Penlac didn't work to cure my toenail fungus. I took an oral medication, terbinafine, and saw some improvement, but my insurance company won't approve more than a few months of treatment. It's frustrating to finally have a solution and then be cut off.

By the way, doctor: Why three blood thinners at once?

I am currently on Coumadin because I had atrial fibrillation after my bypass, Plavix because of my stent, and a baby aspirin. Why do I need to take three blood thinners?

November, 2009

Napping may not be such a no-no

A nap in the afternoon can help a person regain mental focus and retain information better, and may help people who work night shifts remain alert.

The male face of osteoporosis

As death rates from heart disease and other conditions decline, more men are living long enough to lose bone mass, making osteoporosis more of a male problem than it had been considered in the past.

A sport for all seasons

Swimming is an excellent form of exercise for almost anyone. It tones larger muscles, eases arthritis pain, and lowers blood pressure, while the cushion of the water greatly reduces the risk of injury.

Side effects: Minor can add up to major

Many medications have anticholinergic side effects, meaning they block the action of a key nervous system chemical. If a person takes a number of these medications for a period of time, the effects can build up and cause problems with thinking and memory.

By the way, doctor: Why did my doctor prescribe steroids?

I have been diagnosed with temporal arteritis and am being treated with prednisone, which the doctor says is a steroid. I know athletes use steroids to bulk up, and I can't see how that would have anything to do with temporal arteritis. Can you explain?

By the way, doctor: Can the brain grow new neurons?

A recent Health Letter urged us seniors to stay mentally active because that causes the growth of new neurons (brain cells). When my husband had a stroke 40 years ago, the doctors told me the brain cannot make new cells in later life. What's the truth?

December, 2009

The top 10 health stories of 2009

The Health Letter reviews the major health news of the year, including health care reform, the H1N1 flu pandemic, a possible alternative to warfarin that has fewer side effects, and questions about the need for testing for certain cancers.

Regaining control of your bladder

Urinary incontinence can be treated with medication or, if necessary, surgery, but people with this problem should first try pelvic floor exercises, moderation of fluid intake, and bladder retraining.

Vitamin's value to be D-termined

A five-year study funded by the National Institutes of Health hopes to determine whether vitamin D and omega-3 fats have an effect on rates of cardiovascular disease or cancer.

By the way, doctor: Is the difference between the two blood pressure numbers important?

I'm 72 and my systolic blood pressure has been steady between 115 and 125. The diastolic number is low (55-65) and seems to be falling. Is the difference between these two numbers important, and is the falling diastolic number something to worry about?

More on toenail fungus

After Dr. Kenneth Arndt answered a question about toenail fungus, a number of readers sent us their favorite remedies. We asked Dr. Arndt to comment on several of them.

January, 2008

Cold comfort

There is still no cure for a cold, and cold medications have come under scrutiny and criticism. Some people may get better results taking separate medications for fever, cough, and congestion, rather than a combination product.

Human growth hormone

Used by athletes to build muscle, human growth hormone may in fact make muscles bigger, but not necessarily stronger. HGH is also marketed as an anti-aging treatment, but there are no data about possible side effects from long-term use.

A SAD story: Seasonal affective disorder

Seasonal affective disorder is thought to be caused by decreased exposure to sunlight during the winter months. Light therapy helps some people, and the FDA has approved the antidepressant bupropion for treatment as well.

Vitamin E: Separate and unequal?

Expectations for vitamin E's ability to protect the body against illness and disease have not been met, but certain types of vitamin E may have more effective antioxidant properties than others.

In Brief: Getting well after Bell's

Bell's palsy is the paralysis of one side of the face caused by inflammation of the facial nerve. Treatment with a steroidal anti-inflammatory medication usually eliminates the condition.

In Brief: Low-carb dieting: Slimmer but sadder?

Research suggests that a diet low in carbohydrates could lead to lower levels of serotonin in the body, which in turn may cause an increase in bad moods.

By the way, doctor: Should my father go back to taking Coumadin?

My father caught a bad case of pneumonia. He's recovered, but it seems to have left him confused, and he uses a walker now. Before the pneumonia he was taking Coumadin for atrial fibrillation. Now that he's feeling better, should he start taking it again?

February, 2008

Moisturizers: Do they work?

Moisturizers work by trapping and holding water in the skin, in combination with some oily substance that binds the moisture to the skin. While ingredients vary, almost any moisturizer will help with dry skin.

Too much of a good thing

Researchers have compiled data regarding patterns and variations of medical care throughout the US. They found that differences in standards of care tend to be due to doctors' personal preferences more than any other reason.

Nutrition: Conversation with an expert

Dr. Walter Willett, the head of the nutrition department at the Harvard School of Public Health, discusses nutrition-related questions and issues.

HDL: Good and brainy

HDL, the "good" cholesterol, helps prevent heart disease, but there is some evidence that suggests it may also help protect against strokes, and possibly dementia as well.

Heads in the game

Research has found links between incidences of concussions among professional football players and depression. Players who experienced more than one concussion had a higher likelihood of being diagnosed with depression.

By the way, doctor: Should I continue to take Fosamax?

I've taken Fosamax for 11 years. My bone density has improved. One doctor I consulted told me to continue taking it, but another said it would be dangerous to do so. What should I do?

By the way, doctor: Will Boniva make my bones weaker?

I am taking Boniva for osteoporosis. I read that an alleged women's health expert said that osteoporosis drugs like the one I'm taking actually make bones weaker by stopping the body from breaking down old bone, and causing jaw disease. Is this true?

March, 2008

Pain relief, opioids, and constipation

Opioid drugs like morphine are the most effective pain relievers, but constipation is a typical side effect. it is therefore advisable to take a stool softener and a laxative when taking an opioid.

Finding ovarian cancer early

Ovarian cancer is highly treatable if diagnosed early enough, but it is often difficult to detect. Women who experience unusual abdominal pain, bloating, or digestive problems over a period of two or three weeks should see a doctor.

A recipe for long life and good health: Mediterranean eating

An accumulation of research shows that following a Mediterranean diet, by eating vegetables, fruits, whole grains, fish, poultry, small amounts of meat and dairy, and moderate amounts of wine, lowers the risk of heart disease and cancer.

Do we really need all that calcium?

While calcium is essential for bone strength, some experts believe that Americans are getting too much calcium, which can actually lead to an increased risk of a hip fracture.

Tattoos: Leaving their mark

As tattoos become more common, the desire to have them removed has also increased. Lasers are generally safe and can be effective, but often cannot remove the entire tattoo.

By the way, doctor: Is Vytorin safe?

I'm taking Vytorin. After the news about a negative study a couple of months ago, I am wondering if it's safe.

By the way, doctor: Can I get a pill to help me quit smoking?

Is there a prescription medication to help me stop smoking? My doctor says no.

April, 2008

You don't have to take a pill

It is often easier to treat a condition with medication rather than making lifestyle changes, and some people cannot or do not want to take drugs. But there are ways to manage certain conditions without drugs.

Olfaction subtraction

Temporary loss of smell, which affects the ability to taste, can be caused by a cold, allergies, head injury, or viral respiratory infection. A short course of an anti-inflammatory corticosteroid medication can sometimes resolve the problem.

Our pet causes

Household pets can carry bacteria on their fur or in their waste that can transfer to humans, but the overall risk of infection is small, and can be further mitigated by getting in the habit of washing your hands after touching your pet or its waste.

By the way, doctor: Is that too much vitamin D?

My doctor gave me a prescription for 50,000 units of vitamin D to be taken every two weeks. But I've read that the recommended dose is more like 1,000 IU a day, and that more than 2,000 IU a day is unsafe. I don't want to do more harm than good!

By the way, doctor: Why is my mitral valve leaking?

I had cardiac bypass surgery three years ago. I didn't have a heart attack none of my heart muscle was killed. But two months ago, a stress test showed that the mitral valve in my heart is leaking. What could have caused it, and what can I do about it?

May, 2008

Editor's note

The editor in chief of the Harvard Health Letter introduces a special issue comprised entirely of "By the way, doctor" letters from readers.

By the way, doctor: Microwave cooking and nutrition

Does cooking with a microwave take nutrients out of food?

By the way, doctor: What is burning mouth syndrome?

My husband was diagnosed with burning mouth syndrome. This seems to be a mystery syndrome. What can you tell us about it?

By the way, doctor: How much Imitrex is too much?

My doctor suggested switching to a low-dose antidepressant like Elavil to take prophylactically rather than taking too much Imitrex, but I don't remember what the "too much" cutoff amount is.

By the way, doctor: Should I get the cervical cancer vaccine?

I am in a monogamous relationship and get Pap smears. Do I need to get the cervical cancer vaccine?

By the way, doctor: Do birth control pills disguise menopause?

How do I know whether I'm approaching menopause if I'm taking birth control pills?

By the way, doctor: Are the guidelines for taking statins different for women?

I've heard that men are supposed to take a statin if they're at high risk of getting heart disease, but that women are only supposed to after they actually get it. Is that true?

By the way, doctor: Why does skin wrinkle after being underwater?

Why do our hands and feet wrinkle up when immersed in water? Your article about moisturizers said they work by trapping water in the skin, so why don't we wrinkle up after applying moisturizer?

By the way, doctor: Is it okay to take a stool softener long-term?

I have been taking a stool softener daily for two months. It's helped with my constipation. Are there any risks to taking a stool softener on a long-term basis?

By the way, doctor: HGH after surgery

I heard that human growth hormone can help people after surgery. Is that true?

By the way, doctor: Minimally invasive knee replacement

I need a knee replacement and am trying to decide between a minimally invasive operation and a traditional one. What do you think?

By the way, doctor: Do I need to go to the ER after fainting?

I tend to faint when I get sick. Do I need to go to the emergency department (or call 911) when I faint? My doctor said I should, but that seems so unnecessary.

By the way, doctor: Cancer of the small intestine

We hear a lot about colon cancer, and sometimes about stomach cancer, but hardly ever anything about cancer of the small intestine. Why? Is it rare?

By the way, doctor: Tamoxifen versus aromatase inhibitors

I've had an ER-positive breast cancer tumor removed. Now I am getting ready for follow-up therapy. I've heard that the aromatase inhibitors are better than tamoxifen. What is your opinion?

By the way, doctor: Calcium supplements and heart attack risk

I read in the newspapers about a study that said older women taking calcium supplements are at increased risk for experiencing a heart attack, stroke, or sudden death. Should I be concerned?

By the way, doctor: Celebrex and bleeding

I take Celebrex for arthritis. I learned that it and the other NSAID medicines increase the risk of bleeding. If that's true, is my risk for hemorrhagic stroke higher?

June, 2008

When walking makes your legs hurt

There are other conditions besides arthritis that can make walking difficult and even painful, such as peripheral artery disease, chronic venous insufficiency, lumbar spinal stenosis, and diabetic neuropathy.

A good old age

Two books examine the health issues around aging and caregiving from different points of view, and offer advice and suggestions on how the United States health care system could be improved.

Masculinity and men's health

Men are more likely than women to engage in unhealthy behavior, and less likely than women to seek or heed medical advice. This may be due to masculine notions about how men are supposed to behave.

Brushing up on brushing

Many people think their toothbrushing skills are better than they really are. Tooth brushing tips include brushing for at least two minutes, using a soft brush with bristles of varying heights, and replacing your brush at least every three months.

By the way, doctor: Should I back off from getting my blood sugar down?

I read about the study suggesting that tight control of diabetes led to more deaths. My hemoglobin A1c level has been right around 7 to 7.5 for years. Should I back off? Or keep pushing for even lower glucose levels?

July, 2008

Cancer screening as we age

There is some controversy about whether or not people should continue to get screening tests for certain cancers after age 75. Variables include the person's overall health and whether or not additional life expectancy can be achieved.

Hospice care

Hospice care for terminally ill patients is increasing in popularity. This type of care is primarily a service, rather than a place, and may be administered in a hospital setting, at a patient's home, or in a nursing home.

Egg-cellent news for most, but not those with diabetes

Long criticized for their high cholesterol content, eggs have once again earned consideration as a healthy food, due primarily to their protein. But people with diabetes should still limit their egg consumption.

In Brief: Smokers: The formers versus the nevers

People who quit smoking can expect their risk of related illness to decrease to about the same level as that of people who have never smoked, although it can take several years for this to happen.

In Brief: Trans fat, au naturel

Meat and dairy products contain naturally occurring trans fat, and studies are suggesting that the small amounts of this fat in animal products may actually be good for us.

By the way, doctor: Should I stop taking a stomach acid blocker?

I was treated for two weeks with antibiotics and a proton pump inhibitor when I had an H. pylori infection. I've continued with the proton pump inhibitor to cut down on stomach acid. Could that be harmful?

By the way, doctor: Is it okay to switch from Avodart to finasteride for BPH?

I have been taking Avodart for my BPH, along with Flomax, but finasteride may be less expensive. Should I switch?

August, 2008

Hair today, more hair tomorrow?

Progress has been made in the field of hair regrowth, but the treatments, whether medication or surgery, are expensive, and there is no guarantee of success.

Surviving the Medicare maze

Negotiating the complications of Medicare insurance requires patience and a good deal of research, but the effort is necessary in order to have adequate coverage when it's needed.

The sunshine D-lemma

Ultraviolet light causes skin cancer, but it also triggers the body's production of vitamin D, which seems to counteract it. Limited sun exposure can boost levels of vitamin D, or it can be obtained through a vitamin supplement.

By the way, doctor: Should my daughter get a breast cancer gene test?

Both of my father's sisters died of breast cancer years ago, one before menopause, the other just after. I have an 18-year-old daughter. I've been wondering if I should talk to her about getting tested for the breast cancer gene. I'm the dad.

September, 2008

Editor's note

Anthony L. Komaroff, M.D., editor in chief of the Harvard Health Letter, introduces a special issue focused on exercise.

Why we should exercise - and why we don't

It's easy to find reasons not to exercise, but it's also relatively easy to meet the recommended guidelines for physical activity. Here are 27 suggestions for ways to be more physically active.

Can a gadget get you going?

The Heart Letter evaluates three devices that provide information and feedback about physical activity: a pedometer, a heart rate monitor, and an activity monitor.

Meet the METs

A MET is a metabolic equivalent, a measure of how much energy is expended doing a given exercise or activity. Researchers gauge levels of physical activity in METs. A chart shows various activities and how many METs they expend.

Good for the mind, but how about the body?

Whether mild or strenuous, a youg workout provides fitness benefits to almost anyone, even older people and those who have physical limitations.

The gender divide

Women are at higher risk than men of tearing the anterior cruciate ligament of the knee. Part of this disparity may be due to anatomical differences, and hormones may play a role as well.

Let's talk to an expert

Dr. I-Min Lee, a member of the government committee that helped establish new guidelines for recommended amounts of physical activity, discusses fitness and exercise.

October, 2008

Virtual hitchhiker's guide to the medical universe

The health Web sites of various other countries offer an intriguing glimpse of how governments present health information to their citizens in other parts of the world.

The election-year physical

Americans have become accustomed to the practice of presidential candidates releasing their health records to prove their fitness for holding office.

Drug-herb interactions

The American Academy of Family Physicians has published a summary of some of the potential risks of interaction between certain herbal supplements and mainstream medications.

Should you get the shingles vaccine?

An immunization committee recommends that adults 60 and over should get the shingles vaccine. It should prevent about half those who receive it from getting shingles, and about two-thirds of those who have already had shingles from getting it again.

By the way, doctor: Does a colonoscopy reach the ileum?

I am scheduled to have a colonoscopy soon. Does the examination reach the ileum?

By the way, doctor: Can I take a pill instead of B12 injections?

I have pernicious anemia, and I get a monthly injection of vitamin B12. I have heard that there may be a pill that I could take instead. Is that true?

November, 2008

What is normal?

For tests such as blood pressure, cholesterol, and blood sugar, the range that is defined as normal may change over time, as more information becomes known about the health of people whose results were considered to be in the normal range.

Got an ear full? Here's some advice.

Earwax helps keep the ear canal clean, but if it dries out it can clump together and cause a blockage. A few drops of water held in the ear canal for a minute or so will usually dislodge the wax.

Rubbing it in

Topical pain-relief products provide quick relief for sore muscles and joints, but they vary in effectiveness. People whose stomachs are sensitive to oral pain relief medications may prefer to use a cream or ointment.

Fishing out some answers

Eating fish has clear health benefits, but not all kinds of fish are healthy. Broiled or baked fish is better than breaded, fried fish. And fish is not a healthy choice for everyone. Pregnant women and some heart patients should watch their fish intake.

By the way, doctor: How can a stress test be wrong?

How is it possible for someone with significant coronary artery disease to perform well on a cardiac stress test? Wouldn't there be some signs of trouble?

By the way, doctor: What is the healthiest amount of sleep?

I heard about a study that found people who sleep six and a half to seven hours a night will live longer than those sleeping eight to nine. What is the right amount of sleep?

December, 2008

The top 10 health stories of 2008

A review of the major health news of the year, including: the ongoing debate over blood sugar level in type 2 diabetics, a new source of stem cells, genetic testing marketed to the general public, a new type of CT scanning, and health care reform.

What's up…and what's down

Studies reinforce the benefits of hand washing in preventing illness, and suggest that red wine may provide protection from lung cancer in some people, but B vitamins do not appear to offer any help against Alzheimer's disease.

The no-name cancer

Non-Hodgkin's lymphoma is a cancer of the immune system. There are several varieties, some more aggressive than others. Depending on the type, if detected early enough it is often treatable, and sometimes curable.

By the way, doctor: Is ankle fusion my only option?

I have injury-related osteoarthritis in my right ankle. My orthopedic surgeon said, in essence, that it's ankle fusion or nothing for me - and that there are no means of surgically restoring cartilage. What do you think?

February, 2007

Back surgery: to have or not to have

Some back pain cannot be relieved by surgery, but even if it is an option it should be weighed carefully. A prudent course of action is to wait several weeks after symptoms begin to see if they improve on their own.

12 things you should know about pain relievers

A collection of information and advice on pain relievers, including watching the dosage of acetaminophen to avoid liver damage, heart risk from NSAID use, and warnings about blood pressure and kidneys.

The dish on fish

Research affirms that the health benefits of eating seafood are much more significant than any risk due to the presence of toxins such as mercury and PCBs.

By the way, doctor: B vitamins and homocysteine

How do B vitamins lower your homocysteine level, and how important is it to have a normal level?

By the way, doctor: Celiac disease and thin bones

I have celiac disease, and the disease has weakened my bones. But I'm male. I thought thin bones were primarily a problem for women? And why should a disease of my intestines affect my bones? Finally, what can be done about it?

March, 2007

Air ambulance services take off

Air ambulance services are growing in popularity, but because the industry is new, it is relatively unregulated. Those considering using such a service should do research, ask questions, and look for certification.

Reaching for the anti-salt

Potassium helps balance the sodium in our diets. It is relatively easy to get the necessary amount by eating a varied diet with plenty of plant-based foods.

Pancreatic cancer: An update on a 'stealth' cancer

Pancreatic cancer is difficult to diagnose because there are few outward symptoms, and it does not show in traditional imaging tests. It is hoped that ongoing research may reveal a mutated gene or some other sort of genetic marker.

Toenail fungus: Drill to kill

Toenail fungus is difficult to treat, but two new types of treatment in testing may make it easier. One uses short-wavelength light, and the other requires drilling tiny holes in the affected nail.

In Brief: Sing along for health

Research finds that group singing can boost the mood, relieve stress, promote relaxation, and enhance the immune system. Singing along with a group may also be beneficial for people with certain speech disorders.

In Brief: Of pets and pounds

Researchers looked at overweight people who also had overweight dogs. Those who exercised with their pets lost a small amount of weight, but the dogs lost a bigger percentage of their body weight.

By the way, doctor: Can you tell me about the tests for liver and muscle side effects from statins?

I am 80 and am taking a 40-milligram Crestor pill every day. Recently I saw a Crestor ad that said blood tests should be done to monitor for the possible side effects of liver or muscle injury. Can you tell me something about these tests?

April, 2007

9 tips for your health and the planet's

A selection of health advice that is also good for the environment, including biking or walking to work, using less energy by going to bed earlier, setting the thermostat a little higher, and buying locally grown produce when possible.

'Never been the same since'

Delirium is usually temporary, but older people who experience delirium may suffer permanent damage. It is believed that delirium is linked to dementia, but more research must be done before any conclusions can be made.

Protecting hearts, saving minds?

Researchers are exploring the possibility of a connection between cardiovascular disease and Alzheimer's disease and dememtia. The general advice for keeping the heart healthy may prove to keep the mind healthy as well.

Niacin into the void

There is evidence to suggest that niacin, a B vitamin, can help raise HDL cholesterol when taken in larger doses, but there are side effects to be considered.

In Brief: Could estrogen help colon cancer patients?

While estrogen therapy after menopause has been criticized for its negative side effects, some research is suggesting that the hormone may help reduce the risk of colon cancer in women.

In Brief: Patient, manage thyself (but coaching may be available)

Patient self-management programs may encourage patients to take more initiative regarding their health and medical care, but even if it only makes them feel more in control of their course of treatment, that is still beneficial.

By the way, doctor: What can be done for sudden hearing loss in one ear?

My 47-year-old son suddenly lost hearing in one ear. They did some blood tests and he was given steroids and a medication called Valtrex. Now they are saying nothing can be done. Can you please address this issue?

May, 2007

A better hearing aid?

An open-fit hearing aid, which leaves the ear canal open instead of covering the opening, helps eliminate distortion caused by sound waves, and may be more comfortable for wearers.

Is fructose bad for you?

A diet heavy in high-fructose corn syrup may cause people to overeat, but the real problem is more likely the high amount of sugar that people consume in their everyday diets overall, rather than one specific kind of sugar.

Tests for breast cancer

Digital mammography is poised to replace the standard version, but studies show them to be about equal in effectiveness at detecting cancers, depending on age and breast density. Ultrasound and MRI are also useful tools for detection in some women.

Protein is a problem…

OTC disorder, a genetic anomaly that affects the body's ability to properly metabolize protein, is most commonly seen in children, where it can be fatal, but less severe forms of it can affect adults as well.

…but it does help some people lose weight.

A study comparing popular diet programs found that women lost the most weight with a high-protein diet that also had the benefits of helping to raise HDL cholesterol and lower triglycerides. But whatever the diet, consuming less fat is still a key.

By the way, doctor: Can exercise and diet cure diabetes?

I read about a study at UCLA in which men with type 2 diabetes were in a program combining aerobic exercise, low-fat diets, and relatively high amounts of "good" carbohydrates. Half of them cured their diabetes. Is this possible?

By the way, doctor: Does asthma go away?

I was diagnosed with asthma five years ago, and my doctor prescribed an inhaler to use daily. I haven't had any symptoms for a year now, even though I stopped using my inhaler. Can asthma go away?

June, 2007

Meat in the hot seat

There is evidence that grilling meat releases potentially cancer-causing substances. Meat lovers can take steps to reduce their risk, such as cooking smaller pieces at a lower temperature, or precooking the meat for two minutes in a mictowave oven.

A more D-manding diet

Vitamin D is crucial to bone growth, but studies are finding that it may help protect against other diseases such as diabetes and colon cancer. Most adults do not get enough vitamin D, but a daily multivitamin and limited sun exposure can help.

Who needs to be taking aspirin for cardiovascular protection?

The benefits of aspirin for those at risk for heart disease are clear, but for women under 65 who are not at risk, there is no benefit to a daily aspirin. There is evidence that taking aspirin regularly may reduce the risk of stroke, regardless of age.

The not-soy-good results

Once soy was believed to have many health benefits, but studies found that it was not the wonder food some claimed. But other research finds that soy can in fact be beneficial, particularly in place of red meat.

In Brief: Tai chi gives immune system a boost

The body's ability to fight off illness declines with age. A study found that participating in regular tai chi sessions boosted the immune system responses of older people.

In Brief: Cocoa beats tea

A comparison of studies found that drinking cocoa lowered blood pressure approximately as much as blood pressure medication did, while drinking tea did not produce any change.

In Brief: Prescription fish oil

A prescription fish oil product is intended to be used in combination with a special diet for people with very high triglyceride levels.

By the way, doctor: Does grapefruit juice affect aspirin?

I am 78, and for about 10 years, I have been taking an 81-mg aspirin every morning with a glass of grapefruit juice. I heard that it's not a good idea to drink grapefruit juice with some blood-thinning drugs. Is that true of aspirin too?

By the way, doctor: Should I worry about this irregular heartbeat?

At 86, I'm still competitively racing frostbite dinghies. I've noticed that my heartbeat becomes irregular during the races and for hours afterward. It feels like a weak beat after every two normal heartbeats. Is this a normal exercise reaction?

July, 2007

In search of the safe suntan

Research has found that having a tan may provide some protection from skin cancer, but tanning is not safe, so you should not try to tan just to gain this protection.

In Brief: Blood pressure checks at the barbershop

To address the serious problem of high blood pressure among African-American men, researchers gave out information and held screenings at community barbershops.

In Brief: Mint conditions

Some studies have found that peppermint oil may help relieve the symptoms of irritable bowel syndrome, and could help with other conditions as well.

Hormone therapy: The risk-benefit tightrope

The risks and benefits of hormone use in postmenopausal women vary depending on when a woman starts taking the drugs. The risk of heart disease seems to be lower in women who begin taking hormones close to the onset of menopause.

Duct tape, warts and all

A study found that duct tape could help get rid of warts, but subsequent studies have not been able to replicate the results. There are other treatments that are more effective, and sometimes warts go away on their own.

An update on the "old man's friend"

While pneumonia is still a serious illness, flu shots and the pneumococcal vaccine may help protect against it, particularly for older people or those at high risk of infection.

More on niacin: No flush, no good

No-flush niacin may eliminate the flushing that is a typical side effect of the drug, but at the expense of its ability to lower cholesterol and triglyceride levels, thereby making it ineffective.

By the way, doctor: Must I take aspirin?

I have ulcerative colitis and diabetes. My new doctor has been pushing aspirin therapy. My gastroenterologist feels that I should consider aspirin if and when there are signs that I would benefit from it and not to risk having problems with my colitis.

August, 2007

The shingles vaccine: Why hasn't it caught on?

The shingles vaccine Zostavax has not turned out to be as popular as was expected, due in part to its high cost and questions about its effectiveness.

Betting on beta blockers

Beta blockers are used to treat a variety of conditions, but some studies have questioned their effectiveness. Those already taking a bta blocker for high blood pressure do not necessarily need to switch to a different medication.

Migraine as a withdrawal symptom

Women get more migraine headaches than men, possibly because migraines have been linked to the fluctuation of estrogen levels related to the menstrual cycle.

Taking silver could give you the blues

Silver is sometimes used as an antibacterial agent, but products containing silver are being sold as supplements meant to be taken internally. This can cause stomach problems, kidney damage, or argyria (blue spots on the skin).

In Brief: Exercise without losing weight

Exercise that does not result in weight loss is probably just as beneficial to the body in other ways.

By the way, doctor: Why aren't drugs safe when they are approved?

First it was Vioxx and now Avandia. Why can't doctors and the government screen out unsafe medicines?

By the way, doctor: Should I get the prostate cancer test I've heard about?

I heard about a new test for prostate cancer that's better than the PSA test. Should I get this test?

September, 2007

Time to fatten up our diets

Doctors and nutritionists have long warned of the dangers of saturated and trans fats. But unsaturated fats are beneficial, particularly if eaten in place of carbohydrates.

Cataract surgery update: Taking a look at the lenses

People who undergo cataract surgery now have different types of replacement lenses to choose from, including ones that can change focus with the eye's muscles, but these are much more expensive than standard lenses.

Thyroid hormone: Slim fast, but will it last?

Doctors sometimes prescribe thyroid hormone for weight loss, but the increase in metabolism caused by the hormone leads to an increased appetite, which can cause weight gain after all.

Music to their ears it is not

People who are tone deaf, or amusic, are unable to distinguish differences in pitch, and may have a similar difficulty with rhythm. Research suggests this may be due to weak connections between the parts of the brain responsible for processing music.

By the way, doctor: I quit, so why am I coughing?

I stopped smoking several weeks ago, and now I find that I'm coughing a lot. Is that normal?

By the way, doctor: Can you tell me more about cellulitis?

I developed cellulitis in my arm and didn't realize it was such a serious infection. It took three months to heal without treatment. Can you tell me more about cellulitis?

October, 2007

Prescriptions for confusion

Many people have difficulty understanding the instructions for taking their medications. Some retailers have redesigned their pill bottles to make the directions clearer.

How you can limit your gas production

These suggestions may help reduce your production of flatulence.

Radon revisited

Prolonged exposure to radon gas may lead to an increased risk of lung cancer. Combined with smoking, the risk is much higher. Testing can reveal if there is an unsafe level of radon in a home's air.

In Brief: Cranberry juice and warfarin: Okay together?

According to researchers, concerns about cranberry juice interfering with the anticoagulant medication warfarin are unfounded.

In Brief: Selenium: Maybe this mineral isn't such a gem after all

The mineral selenium may halp reduce a man's risk of prostate cancer, but it may also slightly increase his risk for diabetes.

In Brief: Something to sink your teeth into: Sugarless gum

Chewing sugarless gum is a good way to neutralize the cavity-causing bacteria that live on teeth, but all sugarless gum is not created equal.

In Brief: Seat belts: A crash course in staying healthy

Seat belts protect those wearing them in the event of an accident, but they also protect others in the vehicle, as unrestrained riders can be thrown in a crash.

By the way, doctor: What can I do about my snoring?

My wife says I snore a lot. I don't think I have sleep apnea, but I'm not sure. Is there anything I can do for a serious snoring problem?

November, 2007

How to lower your risk for colon cancer

To reduce the risk of colon cancer, people should cut back on red meat, get regular exercise, maintain a healthy weight, and get a first colonoscopy at age 50.

Bipolar disorder

Bipolar disorder is difficult to diagnose because its cycles of mania and depression may be mistaken for other psychological conditions. Medications can treat the symptoms, but finding the proper combination for each patient can be a lengthy process.

In Brief: Great expectations

Statistics on life expectancy among Americans show an overall trend of increasing longevity, due to better screening for and treatment of diseases such as cancer and heart disease. But death rates from some other causes are increasing.

In Brief: You don't smoke it, but it's still tobacco

While some believe smokeless tobacco is a safer alternative to cigarettes, research found that smokeless users had higher levels than smokers of a cancer-causing substance found in tobacco.

In Brief: Giving pneumonia the brush-off

There is growing evidence of a link between gum disease and heart disease and pneumonia. Hospital patients on ventilators seem particularly vulnerable to pneumonia infections.

In Brief: Cholesterol: Beyond good and bad, there's big

Lipoproteins come in different sizes. Larger HDL particles remove cholesterol from the body more effectively. A researcher contends that the larger particles are an indicator of longevity, and that this trait can be passed to offspring.

By the way, doctor: Should I worry about giant platelets?

My platelet count has always been on the low side - 110,000. I don't have any symptoms. But a recent lab report mentioned "giant platelets." Is this something to worry about?

By the way, doctor: Is it okay for me to take L-arginine?

I am 92 and have poor blood circulation and an irregular heartbeat. Is it okay for me to take 500 milligrams of L-arginine a day?

December, 2007

The top 10 health stories of 2007

A summary of the major health news of the year, including: more evidence of the hazards of not getting enough sleep, inexpensive genome sequencing, new avenues for treating inflammation, improving health insurance coverage, and breast MRI scans.

To catch a thief may stop a heart

Security devices used for inventory control in stores may interfere with the operation of pacemakers or implantable cardioverter-defibrillators (ICDs).

Screening to prevent stroke

Ultrasound carotid screening for stroke risk is being promoted as a simple detection tool, but the test does not always identify those at risk, and some doctors feel that treating the factors that contribute to risk is more beneficial to overall health.

By the way, doctor: Should I get a partial knee replacement?

I am 55 and have a bad right knee from playing lots of sports. I am interested in getting a partial knee replacement. I've heard that the recovery is shorter and the result is better than a total replacement. What do you think?