Holidays bring the heart attack season
Tue, 04 Dec 2007 02:17:37 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Those lords-a-leaping and ladies dancing may want to consider the downside of the holidays: Heart attack season has arrived. December and January are the deadliest months for heart disease, and many of the things that make the season merry are culprits: Rich meals, more alcohol — and all that extra stress.
But what may make the Christmas coronary more deadly than the same-size heart attack in, say, August, is a double dose of denial. It's not uncommon for people to initially shrug off chest pain as indigestion. Research suggests they're even more reluctant for a run to the emergency room when it means disrupting a holiday gathering, or if they've traveled to a strange city — meaning they arrive sicker.
Minutes matter.
"You have only a short window of opportunity to save heart muscle," warns Dr. William Suddath of Washington Hospital Center in the nation's capital — where a cardiac team on-duty 24 hours a day aims to start clearing victims' clogged arteries within 15 minutes of their arrival in the emergency room.
How bad each year is varies widely, but some hospitals say they saw an upswing in heart attacks start on Thanksgiving weekend. At Suddath's hospital, it started with a surprise spike the weekend before Thanksgiving — with so many critically ill patients that doctors ran out of a key heart-pumping machine and had to rent two extras.
Doctors have long braced for the seasonal upswing. A 2004 study confirmed it was a nationwide phenomenon, with peaks in death coinciding around the Christmas and New Year's holidays.
Why is harder to pin down. Vanderbilt University cardiologist Dr. Keith Churchwell says a "hurricane of factors" can tip someone at risk of a heart attack over the edge during this busy time of year.
"You can't be too busy to ignore your cardiovascular health," he says — but that's a key excuse he hears from his own patients.
Consider:
_Busy revelers tend to skip their medications, forget them when traveling or be unable to get refills far from home.
_What dieter can resist holiday goodies? The few extra pounds so many people gain will haunt you long-term. Right away, a particularly heavy meal, especially a high-fat one, stresses the heart as it is digested. Blood pressure and heart rate increase. There's even evidence that the lining of arteries becomes temporarily more clot-prone.
_Too much salt has an even more immediate effect, causing fluid retention that in turn makes the heart have to pump harder.
_Alcohol in moderation is considered heart-healthy. But if a round of holiday parties leaves you tipsy, that, too, makes your heart pump harder to get blood to peripheral arteries.
_Worse is something called "holiday heart syndrome," where alcohol literally irritates the heart muscle to trigger an irregular heartbeat called atrial fibrillation. If a-fib goes unchecked for too long, it in turn can cause a stroke.
_People say they're too busy to exercise, especially as it gets cold and darkness falls earlier. It can take months to build back up to pre-holiday exercise habits.
As for cold weather, it can constrict blood vessels, and the extra exertion of snow shoveling can cause a heart attack. The usual winter rise in respiratory diseases is another risk, adding further burden to a stressed heart — another reason to get a flu shot.
But the holiday spike happens even in warm climates.
And delay in treatment plays a role.
Hospitals may be short-staffed during the holidays, slowing the time it takes to diagnose a heart attack and start clearing the blocked artery, says Dr. Alice Jacobs of Boston University, past president of the American Heart Association.
The good news: The nation's hospitals are undergoing a major shift to speed care to heart attack sufferers. It's called "door to balloon time," and the aim is to reopen blocked arteries with angioplasties or other procedures within 90 minutes of arrival.
Only about a third of people suffering major heart attacks get such fast care now. But more than 900 hospitals have signed on to meet that challenge — sites that either are forming 24-hour cardiac catheterization teams like Suddath's, or making sure on-call doctors arrive within minutes, or ferrying patients to those angioplasty centers.
But for the hospital overhaul to work, patients can't hesitate when symptoms strike.
"If you have symptoms, don't ignore them, wherever you are," Jacobs stresses.
Yet realizing you're having a heart attack can be hard. Terry Bieber was just 50 when she woke up two days after Thanksgiving 2006 feeling what she thought was indigestion, got some Tums and returned to bed. Sometime later her husband realized she was sweating heavily while her skin was cold to the touch. Still, she argued when he went to call 911.
Like many women, Bieber didn't feel classic chest pain or pain radiating down her arm. She had to be helicoptered from the hospital near her Prince Frederick, Md., home to Washington Hospital Center for emergency angioplasty of two arteries.
"Don't take any chances," she now advises. "I had no clue at all that's what it was. ... If I had been by myself, I probably would not have called 911."
_____
EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Cops More smoke toad venom to get high
Mon, 03 Dec 2007 23:18:43 GMTKANSAS CITY, Mo. - Law enforcement authorities have discovered that people are willing to go to great lengths to get high, including a troubling new method that features a frightened toad.
"Toad smoking," which is a substitute for "toad licking," is done by extracting venom from the Sonoran Desert toad of the Colorado River. The toad's venom — which is secreted when the toad gets angry or scared — contains a hallucinogen called bufotenine that can be dried and smoked to produce a buzz.
In October, a Kansas City man was charged with possessing a controlled substance after Clay County authorities determined he possessed a toad with the intent to use its venom to get high.
Clay County Prosecutor Daniel White said possessing the toad is not illegal, but using it to get high off its venom is.
"It is easier to get it, and law enforcement might not immediately know you use it to get high," White said. "It's sort of a New Age way to get high. You convince yourself it is OK because it is something you get naturally from our environment.
"There are a lot of things that are created naturally but they are still not legal," he said.
White said that for years people experimented with "toad licking," and now toad smoking is considered a substitute. To do so, a person heats up the frog's venom to break down its toxins and preserve the hallucinogen, which is dried.
He said some Internet sites feature an instructional video on how to extract the toad's venom.
Police found the toad when they went to a northern Kansas City home to investigate a suspected meth lab. They later arrested David S. Theiss, 21, and charged him with three counts of possession of a controlled substance and one count of possessing drug paraphernalia — the toad.
Theiss also is accused of possessing mescaline, a controlled substance extracted from a cactus.
While smoking toad venom might sound extreme, an even more disturbing method to get high possibly includes sniffing fermented human waste. Vicky Ward, manager of prevention services at Tri-County Mental Health Services in Kansas City, said she has read e-mail warnings about a drug called jenkem.
The drug is made from fermented feces and urine.
"We work with a lot of youths and we ask them whether anyone has tried it and they said no," Ward said. "They have heard about it because of the Internet."
But whether people actually use of jenkem has not been determined, Ward said, noting that a Web site that investigates urban legends isn't clear on the matter.
"Kids get ideas that later turn out to be unfounded, but you will get some idiots who will try anything," she said.
___
Information from: The Kansas City Star, http://www.kcstar.com
Docs dont always turn in bad colleagues
Mon, 03 Dec 2007 23:12:03 GMTWASHINGTON - Do doctors rat out incompetent colleagues? A new survey suggests nearly half don't — showing some disconnects between what doctors say is the right thing to do, and what they actually do.
Researchers at Massachusetts General Hospital mailed a survey, and a $20 incentive check, to more than 3,000 doctors. About half answered — and some of the responses renew longstanding questions about the medical profession's ability to regulate itself.
More than 90 percent of those surveyed said physicians should always report an impaired or incompetent colleague, or when they witness a significant medical mistake, to the proper authorities. But 45 percent said they hadn't always done so, researchers reported Monday in the journal Annals of Internal Medicine.
Other findings:
_A third of surveyed doctors said they would order an unnecessary and expensive MRI scan just to get rid of a complaining patient.
_A quarter said they would refer patients to an imaging center in which they had a financial interest without revealing the conflict of interest, which could violate certain laws.
_Two-thirds of the doctors said they accepted patients who are unable to pay, and three-fourths said they had volunteered without pay at least once in the last three years. Overall, 28 percent of the responding doctors' patients were uninsured or on Medicaid.
_Fewer than 1 percent said they had lied to patients, and 3 percent reported withholding information from patients or family that those people should have known. Eleven percent reported breaching patient confidentiality.
And that $20 check? Twenty-one doctors who didn't answer the survey cashed it anyway.
FDA Studies behind cold meds are weak
Mon, 03 Dec 2007 22:56:02 GMTBy MATTHEW PERRONE, AP Business Writer
WASHINGTON - There is limited evidence that new formulations of over-the-counter cold medications actually relieve nasal congestion, federal health officials said Monday.
The Food and Drug Administration said studies of phenylephrine, an ingredient recently added to many cold medicines, are small, poorly designed and decades-old. The agency reviewed data ahead of a meeting later this month on phenylephrine in widely used nasal decongestants, such as Pfizer's Sudafed.
Manufacturers, including Pfizer Inc., Procter & Gamble Co. and Wyeth, switched to phenylephrine after Congress enacted a law in 2006 that pseudoephedrine products be kept locked behind the counter and sold on request at pharmacies. The law is aimed at prohibiting the illegal processing of drug-store cold medications into the highly addictive stimulant methamphetamine.
FDA said seven of 14 studies of phenylephrine did not show a significant improvement in nasal airflow at the currently used dosage. FDA only requires two large, comprehensive studies to support effectiveness of a drug, however agency scientists said nearly all the phenylephrine studies were inadequate.
"The studies are small and lacking many details necessary to provide a convincing demonstration of effectiveness," the FDA said.
University of Florida Professor, Leslie Hendeles, said the findings support his view that the new formulations "aren't any better than taking nothing," and he supports upping the dosage to achieve effectiveness.
Researchers at the University of Florida had requested the government examine phenylephrine's effectiveness and said there is scant evidence they work better than a placebo at the 10-milligram dose in formulas available without a prescription.
Georgetown University Professor, Kenneth Dretchen, disagreed, saying at least five of the studies reviewed by FDA are robust and show "without question" that phenylephrine works.
Dretchen chairs Georgetown's department of pharmacology and was hired by the Consumer Healthcare Products Association to review data on the ingredient. The group's members include Procter & Gamble, Wyeth and most companies that make over-the-counter medicines.
Several studies that showed poor results for phenylephrine "were not designed to be able to pick up subtle differences," in nasal airflow, Dretchen added. He is scheduled to present CHPA's case at an FDA meeting set for Dec. 14. A panel of experts will hear presentations from regulators, industry and academia and make recommendations to FDA.
"FDA may decide through its advisory panel that it wants to run one more trial just to be sure of these results," Dretchen said. "But from my own vantage point, I'm satisfied."
Researchers from the University of Florida are expected to counter at the meeting that more research is needed to find an effective phenylephrine dose.
"What we need is a large-scale scientific study in modern times looking at different doses to determine which will actually let you breath through your nose," Hendeles said. He pointed out that most of the studies of phenylephrine were performed in the 1960s and 1970s.
His group recommends increasing the dosage available without a prescription to 25 milligrams. But FDA review documents suggest there is mixed evidence the increased dose would improve effectiveness.
Obesity behind over half of maternal birth deaths
Tue, 04 Dec 2007 00:03:42 GMTBy Andrew Hough
LONDON - More than half of mothers who died during child birth were overweight, a report found on Tuesday.
The Confidential Enquiry into Maternal and Child Health said maternal-related deaths in the UK are at a two decade high.
In its annual report, &;Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer,&; it found that of the almost 300 women who died during childbirth between 2003 and 2005 from pregnancy-related conditions, more than half were obese. The deaths left 520 children motherless, it added.
Obese pregnant women are more at risk of dying, suffering heart disease, miscarriage, diabetes, infections and blood clots.
Although the death rate has not changed significantly since 2000, it has risen by around 40% since 1985/87, the study showed.
It also found that women from poorer backgrounds were up to seven times more likely to die from pregnancy-related complications.
About 40 percent of deaths were preventable, it added.
Tuesday's report criticized doctors for failing to identify and manage common medical conditions or potential emergencies outside their immediate area of expertise.
It comes just a few days after the Healthcare Commission found that one in four women giving birth in NHS hospitals were left alone during labor, in clear contravention of official guidelines.
The report said that maternal obesity was now a &;major and growing risk factor for maternal death.&;
It called for more pre-conception counseling and advice for obese woman to help tackle the problem.
CEMACH director, Gwyneth Lewis, said the report &;clearly shows the impact that a mother's overall health has on the outcome of her pregnancy.&;
President of the Royal College of Obstetricians and Gynaecologists, Professor Sabaratnam Arulkumaran, said maternal obesity puts more pressure on resources.
&;Obesity is fast emerging as the public health issue of our generation and its impact on maternity must be taken seriously,&; he said in a statement.
&;Maternity services are already struggling to cope with the increasing birth rate.&;
