7 Things Oliver Sacks Taught Us About the Brain—and Life

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Oliver Sacks, MD, the neurologist who wrote so eloquently about the many maladies of the mind and the patients affected by them, died yesterday at age 82 from a rare eye cancer that had spread to his liver. In his essays and 13 books, Dr. Sacks helped us understand the mysteries of the human condition, through compelling case histories of men and women living with glitches in their brains. (Dr. Sacks himself struggled with face blindness.) In memory of the “poet laureate” of medicine, here are a few of his most moving missives on life, death, and everything in between.

On the inner workings of the brain

“The brain is more than an assemblage of autonomous modules, each crucial for a specific mental function. Every one of these functionally specialized areas must interact with dozens or hundreds of others, their total integration creating something like a vastly complicated orchestra with thousands of instruments, an orchestra that conducts itself, with an ever-changing score and repertoire.” ―The Mind’s Eye, 2010

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On neurological disorders

“In examining disease, we gain wisdom about anatomy and physiology and biology. In examining the person with disease, we gain wisdom about life.”—The Man Who Mistook His Wife for a Hat and Other Clinical Tales, 1985

On the “norm”

“People will make a life in their own terms, whether they are deaf or colorblind or autistic or whatever. And their world will be quite as rich and interesting and full as our world.” —Interview with the Associated Press, 2008

On the healing power of music

“I have seen deeply demented patients weep or shiver as they listen to music they have never heard before, and I think that they can experience the entire range of feelings the rest of us can, and that dementia, at least at these times, is no bar to emotional depth. Once one has seen such responses, one knows that there is still a self to be called upon, even if music and only music, can do the calling.” —Musicophilia: Tales of Music and the Brain, 2007

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On aging

“One has had a long experience of life, not only one’s own life, but others’, too. One has seen triumphs and tragedies, booms and busts, revolutions and wars, great achievements and deep ambiguities, too. One has seen grand theories rise, only to be toppled by stubborn facts. One is more conscious of transience and, perhaps, of beauty. At 80, one can take a long view and have a vivid, lived sense of history not possible at an earlier age.” —The New York Times, 2013

On the transience of life

“A few weeks ago, in the country, far from the lights of the city, I saw the entire sky ‘powdered with stars’ (in Milton’s words); such a sky, I imagined, could be seen only on high, dry plateaus like that of Atacama in Chile (where some of the world’s most powerful telescopes are). It was this celestial splendor that suddenly made me realize how little time, how little life, I had left. My sense of the heavens’ beauty, of eternity, was inseparably mixed for me with a sense of transience—and death.” —The New York Times, 2015

On dying

“When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate—the genetic and neural fate —of every human to be a unique individual, to find his own path, to live his own life, to die his own death.

“I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.

“Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.” — The New York Times, 2015

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Women Who Breast-Feed Less Likely to Have MS Relapse: Study

By Kathleen Doheny
HealthDay Reporter

MONDAY, Aug. 31, 2015 (HealthDay News) — Breast-feeding exclusively for at least two months may help new mothers with multiple sclerosis (MS) lower their risk of relapse, new research suggests.

Exclusive breast-feeding, without supplementing, seems to be key, the researchers said.

“We found that women with MS who breast-fed exclusively had a significantly lower relapse risk than women who did not breast-feed at all or breast-fed some but not exclusively,” said study author Dr. Kerstin Hellwig, a researcher at Ruhr-University Bochum in Germany.

The study is published online Aug. 31 in JAMA Neurology.

In MS, the immune system attacks the central nervous system, including the myelin that surrounds nerve fibers and the nerve fibers themselves, according to the National Multiple Sclerosis Society. Symptoms vary, but can include weakness, fatigue and numbness and tingling of extremities. MS can be mild, moderate or severe and debilitating, according to the society.

Experts know that about 20 percent to 30 percent of women with MS have a relapse within the first three or four months after giving birth, according to background information in the study. However, studies about whether breast-feeding reduces that risk have produced conflicting results, with some finding a benefit and others not, the current study authors noted.

Hellwig and her team followed just over 200 pregnant women in the period after pregnancy. Data was collected from 2008 to 2012.

All of the women had the relapsing-remitting form of MS, in which the disease waxes and wanes. About 85 percent of those diagnosed with MS are initially diagnosed as having this form of the disease, according to the NMSS.

The researchers followed the women for a year after giving birth. About 60 percent intended to breast-feed only for at least two months; the others breast-fed partially or not at all.

About 38 percent of those who didn’t breast-feed exclusively or at all had a relapse within six months of childbirth. But just 24 percent of those who did breast-feed exclusively for two months had a relapse in the six months after giving birth, the study found.

After the women who breast-fed exclusively added supplemental feedings to their baby’s diet, the relapse rates between groups became similar, Hellwig said.

While the study found a link between breast-feeding and MS relapse rates, it did not prove a causal connection.

“Clearly breast-feeding is not harmful and therefore most women with MS should be supported if they choose to breast-feed exclusively since it clearly does not increase the risk of postpartum relapse,” she said.

As to why it may reduce risk, the researchers speculated that hormonal changes during breast-feeding leading to a lack of ovulation may be key. It’s known that women with MS are less likely to get a diagnosis during non-ovulating times, such as childhood or after menopause, the researchers said.

The study findings appear to be good news for women with MS who want to breast-feed, said Kathleen Costello, vice president of healthcare access for the National Multiple Sclerosis Society.

“The decision to breast-feed is one made by the individual and her family based upon numerous considerations,” Costello said. “One [consideration] that I’ve typically noted is the worry that breast-feeding could negatively impact the MS disease process. This study suggests that exclusive breast-feeding does not appear to increase the risk of having a postpartum MS relapse and may have a modest benefit in reducing that risk.”

More information

To learn more about relapsing-remitting MS, see National Multiple Sclerosis Society.

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Could Lots of Coffee Up Heart Risks for Young Adults With High Blood Pressure?

MONDAY, Aug. 31, 2015 (HealthDay News) — Bad news for young coffee lovers: Gulping down lots of your favorite pick-me-up might raise your risk of heart attack if you’ve already got high blood pressure, a new study suggests.

Italian investigators looked at 12 years of heart health data for a group of about 1,200 adults ages 18 to 45. This type of study design means the research could only point to an association, not cause and effect.

But experts said the findings might be worth bearing in mind.

“Although some limitations exist with this type of study, this association — especially in heavier coffee drinkers — cannot be totally discounted,” said one U.S. expert, cardiologist Dr. David Friedman.

“Patients with known heart disease who are at elevated risk should limit their intake of daily caffeine products,” said Friedman, who is chief of heart failure services at North Shore-LIJ’s Franklin Hospital in Valley Stream, N.Y.

The new research was presented Saturday in London at the annual meeting of the European Society of Cardiology. Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

The new study was led by Dr. Lucio Mos, a cardiologist at Hospital of San Daniele del Friuli in Udine, Italy. His team tracked about 1,200 young adults with untreated stage 1 high blood pressure. That means they had systolic blood pressure (the top number of a reading) between 140 and 159 mm Hg and/or diastolic blood pressure (the bottom number) between 90 and 99 mm Hg.

Over 12 years, there were 60 heart or circulation-related events — incidents such as heart attacks or strokes — among the participants. About 80 percent were heart attacks, while the others included strokes, peripheral artery disease (poor circulation in the legs) and kidney failure.

Compared to those who didn’t drink coffee, the risk of these events was four times higher among the heavy coffee drinkers and three times higher in moderate coffee drinkers.

Moderate coffee drinking was defined as one to three cups of the caffeinated beverage per day, while “heavy” consumption was defined as four or more cups daily.

Drinking coffee also increased the risk of “prediabetes” — a precursor to type 2 diabetes — in some of the participants. This risk is linked to factors such as genetics and being overweight and obese, according to the study.

In a meeting news release, Mos acknowledged that “there is controversy surrounding the long-term cardiovascular and metabolic effects of coffee consumption in patients with hypertension.”

He believes the new findings point to a “linear” relationship between coffee drinking and heart risks in younger adults with high blood pressure, meaning that the risks rise along with the amount of coffee consumed.

As to why that might be so, Mos said that it could be linked to coffee’s effects on blood pressure and/or blood sugar.

For his part, Friedman said that differences in each person’s processing of caffeine might play a role, too. “There was an association [in the study] with those patients having higher risk of development of heart problems who were also seen to be so-called ‘slow caffeine metabolizers,'” he said.

Dr. Kevin Marzo is chief of cardiology at Winthrop-University Hospital in Mineola, N.Y. He said that “the health effects of coffee have been controversial, with some studies suggesting benefit, and some, like the most recent in young hypertensive adults, showing potential harm by raising blood pressure.”

He believes that, based on the findings, “physicians may want to encourage a healthy lifestyle with regular exercise, good nutrition and keeping the coffee consumption to less than three cups per day” in younger adults with high blood pressure.

More information

The U.S. National Institutes of Health explains how to reduce heart risks.

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Too Little Sleep May Quadruple Your Risk for Colds: Study

By Alan Mozes
HealthDay Reporter

MONDAY, Aug. 31, 2015 (HealthDay News) — When you’re run down from lack of sleep, you really are more apt to catch a cold, a new study finds.

Investigators exposed 164 adults to a cold virus, and found better-rested folks more likely to resist infection.

Those who slept fewer than six hours a night were more than four times as likely to catch a cold as those who got more than seven hours’ shuteye.

“The role that sleep has on the immune system is well-established, though not completely understood,” said study lead author Aric Prather, an assistant professor of psychiatry at the University of California, San Francisco.

The study doesn’t prove that insufficient sleep actually causes you to catch a cold. But it builds on prior investigations that have linked bad sleep habits to a weakened immune system and a potentially higher risk for developing an array of chronic illnesses.

Prather noted that animal and patient investigations have shown that “when an otherwise healthy person is (temporarily) deprived of an entire night of sleep, we see fairly robust changes in things like which types of immune cells are circulating in the blood and what types of chemical messengers are released from cells that aid in immune system communication.”

The U.S. Centers for Disease Control and Prevention has expressed concern about an “epidemic” of insufficient sleep, the study authors noted. They also point to a recent National Sleep Foundation survey indicating that, on average, 20 percent of Americans get less than six hours of sleep a day.

Participants in this study were healthy Pittsburgh residents ages 18 to 55. All took part in a two-month health screening process between 2007 and 2011.

In the week leading up to their exposure to the cold virus, researchers monitored participants’ usual sleep patterns. Afterward, all were quarantined in a hotel for five days and given nasal drops containing a cold virus.

The result: Cold risk was 4.2 times greater for those who slept fewer than six hours a night, and 4.5 times greater for anyone grabbing five hours or less of slumber a night, when compared with those getting more than seven hours a night.

The findings held up even after accounting for factors such as time of year, weight and obesity status, income, education background, self-declared stress levels, smoking status, exercise routines and drinking habits, the researchers said.

They added that their findings, published in the September issue of Sleep, are based on strong science, given that they tracked existing bedtime patterns, rather than artificially withheld sleep.

Mary Carskadon, a professor of psychiatry and human behavior with Brown University Alpert Medical School in Providence, R.I., expressed little surprise with the findings.

“This is a confirmatory study of other studies that have been moving our thinking in this direction,” she said. “Short sleep has been linked to a greater risk for cancer and other more chronic conditions, and consistently shorter sleep has clearly been associated with a higher likelihood of illness.”

However, no study to date “has yet spoken to the mechanism behind this,” said Carskadon, who is also a sleep researcher at E.P. Bradley Hospital in East Providence, R.I.

“So even though we know good sleep is part of a healthy lifestyle, we don’t know if it’s actually protective,” she added. “In other words, is longer sleep protective or is shorter sleep just exposing vulnerabilities? It’s a chicken-and-egg thing that we just can’t answer yet.”

More information

There’s more on good sleep at the U.S. National Heart, Lung, and Blood Institute.

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Too Much TV Time Tied to Higher Odds for Blood Clot in Lung: Study

MONDAY, Aug. 31, 2015 (HealthDay News) — People who sit around watching TV for hours on end may raise their risk for a sudden and deadly blockage of a lung artery, new research reveals.

Called a pulmonary embolism, the condition is described by study author Toru Shirakawa as “a serious, sometimes fatal, lung-related vascular disease characterized by sudden onset of symptoms such as chest pain or difficulty breathing.

“[And] the disease is caused by obstruction of the pulmonary arteries by blood clots, generally formed in the leg vessels,” he explained in a news release by the European Society of Cardiology. Shirakawa is a public health research fellow in the department of social medicine at Osaka University in Japan.

Researchers have long noticed that a clot risk appears to be higher among cancer patients and among those taking oral contraceptives. But increased risk has perhaps most often been associated with those who have to lie down or sit for long periods, such as those on cramped, long-haul flights. This particular risk has given rise to a nickname for the condition: “economy class syndrome.”

But now an 18-year-long study involving more than 86,000 people suggests that folks who watch TV for five hours or more a day may also face a significantly elevated risk.

Investigators saw that habitual and prolonged TV viewing doubles the risk for a fatal pulmonary embolism, compared to someone who watches less than 2.5 hours of TV per day.

Shirakawa was to present the findings Monday in London at the annual meeting of the European Society of Cardiology. Research presented at medical meetings is considered preliminary because it is has not gone through a peer-review process.

Study participants ranged in age from 40 to 79. Between 1988 and 1990, they completed questionnaires regarding their TV-viewing habits, and all fatalities were subsequently tracked until 2009.

After accounting for age, gender, blood pressure, diabetes status, smoking and drinking history, height and weight, and exercise routines, the investigators saw that extended TV viewing was linked to higher embolism risk.

When the study team focused solely on those under age 60, the risk went up exponentially, with five hours of TV a day linked to a six times greater risk, compared with those watching 2.5 hours daily. Those under 60 who watched between 2.5 and five hours daily saw their risk triple.

While the researchers found a link between TV watching and embolism risk, the study didn’t prove a cause-and-effect relationship.

“Leg immobility during television viewing may in part explain the finding,” Shirakawa said. “To prevent the occurrence of pulmonary embolism, we recommend the same preventive behavior used against economy class syndrome. That is, take a break, stand up and walk around during the television viewing. Drinking water for preventing dehydration is also important.”

More information

There’s more on pulmonary embolism at the U.S. National Heart, Lung, and Blood Institute.

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Many Teens With Chronic Illnesses Use Alcohol, Pot

By Emily Willingham
HealthDay Reporter

MONDAY, Aug. 31, 2015 (HealthDay News) — Teens with chronic diseases such as asthma and juvenile arthritis have to manage their health carefully, yet many of them have had alcohol or smoked marijuana in the last year, a new study shows.

“That was surprising to us,” said study first author Elissa Weitzman, assistant professor of pediatrics at Boston Children’s Hospital, about the findings. “We thought having a chronic illness might be protective, to some extent, given the potential for near-term serious health harm and the high value youth place on staying healthy.”

But, she added, “While it’s tempting to think that these youth are somehow immune from typical adolescent risk behaviors, they are not. They are exposed to marketing, promotion, peer behaviors, and like their peers, [they] are looking to have fun, fit in and ‘escape.’ “

The study was published online Aug. 31 in the journal Pediatrics.

For their analysis, Weitzman and her colleagues conducted a survey of just over 400 students. They were 9 to 18 years old, and the average age was about 15. All had a chronic disease, including asthma, cystic fibrosis, type 1 diabetes, juvenile arthritis, or inflammatory bowel disease. The participants completed the electronic survey during a visit to one of their specialist physicians.

A large portion of the children in the study, 75 percent, were white. Almost three quarters reported having a parent with a college degree.

Most of the children — 82 percent — were in high school. The researchers found that more than a third of the high school students with chronic disease had consumed alcohol in the past year. A fifth of the high schoolers had used marijuana in the last 12 months, the study found.

The teens who consumed alcohol were more likely than the nondrinkers to have missed or skipped taking their medications for their condition, the researchers said.

Alcohol has the potential to affect lab test results, and can interact negatively with medications, the researchers said. But nearly two-thirds of the children reported not knowing whether alcohol use can interfere with the effectiveness of lab test results. Almost half didn’t know if alcohol could interfere with the effects of their medications.

“I think that the big take-home is if we can help educate them, we may be able to improve their compliance with their meds,” said Dr. Ruchi Gupta, an associate professor of pediatrics at Northwestern University Feinberg School of Medicine in Chicago. “There needs to be an open, honest discussion about what they need to do to manage their disease, and the role that alcohol or marijuana or any substance can play in the effectiveness of their medication or how it’s helping them,” she added.

Weitzman echoed that advice. “We have found that youth really want to understand these risks and are looking for information to be delivered to them as part of their care,” she said. “They are specifically interested in how alcohol and other substances can affect them and their disease.”

The study authors wrote that these rates of alcohol and marijuana use are similar to those in the general population of healthy teens. One difference is that boys in the general population usually have a higher risk than girls for alcohol consumption, the study found. The new study found no effect of gender or ethnicity on the risk of alcohol or marijuana use.

When the authors looked at mental health status and substance use, they found that binge drinking was associated with a positive mental health status. That’s possibly because students who binge drink are enjoying social time with peers, the researchers suggested.

In other words, chronic illnesses don’t keep teens from acting like teens. “I think in general, in the populations of teens they’re looking at, this is a huge time for risk-taking,” said Gupta. “So this is a time when they are experimenting, thinking that they’re indestructible.”

Weitzman said the study authors also “are investigating whether this group of youth is also using substances to address symptoms of their conditions, side effects of their medications, or to ‘treat’ anxiety or depression, all factors that could play a role” in their behaviors. “Understanding these issues is vital to supporting these youth who face unique hurdles.”

More information

For prevention tips, see the National Council on Alcoholism and Drug Dependence.

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Cold Weather May Up Risk of Stroke, Severe Heart Attack for Some

MONDAY, Aug. 31, 2015 (HealthDay News) — The onset of cold weather is clearly a bummer for beach lovers, but two new studies suggest that it may actually pose health risks for some.

One investigation, out of Taiwan, has identified a link between cold weather and a heightened risk of stroke for patients with atrial fibrillation, a common problem where the heart beats irregularly.

The finding is based on comparisons of daily temperature records in six regions of Taiwan between 2000 and 2011 and the incidence of ischemic stroke among almost 290,000 patients. Ischemic stroke, the most common type, occurs when blood flow to the brain is interrupted.

“Our study shows a clear association between temperature and risk of ischaemic stroke in patients with AF,” said Dr. Tze-Fan Chao in a news release from the European Society of Cardiology. Chao is a cardiologist at Taipei Veterans General Hospital and National Yang-Ming University in Taiwan.

The concern: cold weather might promote blood clot formation in the left atrium of the heart, thereby boosting stroke risk among these patients.

The analysis revealed stroke risk rose by 10 percent in spring and nearly 20 percent in winter, as compared with summertime risk.

But the study did not prove that cold weather causes stroke risk to rise.

A second study, out of Canada, found that cold weather increased the risk for the most severe type of heart attack.

Led by researchers from the University of Manitoba in Winnipeg, that investigation found that with every 20-degree Fahrenheit drop in temperature, the risk for experiencing a very severe type of heart attack known as an ST-elevation myocardial infarction (STEMI) went up by 7 percent.

“We demonstrated that there is a clear relationship between daily temperature and the risk of STEMI,” study author Dr. Shuangbo Liu, an adult cardiology resident, noted in a university news release. However, the study did not prove that drops in temperature caused heart attack risk to increase.

STEMI heart attacks, the study authors noted, usually result when plaques rupture within coronary arteries. As heart attacks go, they pose the highest risk of death.

“Daily temperature can predict STEMI risk one or two days before it happens,” Liu said. “These findings create an opportunity for future research studies to examine whether there are treatment strategies that can temper the effects of climate on the risk of heart attacks.”

Both Liu and Chao presented their respective findings Saturday at the European Society of Cardiology annual meeting in London. Studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed medical journal.

More information

There’s more on STEMI risk at the American Heart Association.

There’s more on atrial fibrillation at the American Heart Association.

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Wireless Pacemaker Shows Promise in Early Trial

MONDAY, Aug. 31, 2015 (HealthDay News) –A tiny, wireless heart pacemaker showed promise in early tests and could offer an alternative to conventional, wired pacemakers, researchers report.

Experts say, however, there are still some safety concerns with the new device.

The wireless pacemaker is attached to the heart using a catheter inserted through a leg. Traditional pacemakers use a generator and wires, and they require surgery to be implanted.

The study included 526 patients, average age nearly 76, in the United States, Canada and Australia. During the first six months of use, the wireless pacemaker showed “good safety and reliable function,” according to lead investigator Dr. Vivek Reddy, of the Icahn School of Medicine at Mount Sinai Hospital in New York City, and colleagues.

The study, presented Sunday at the European Society of Cardiology annual meeting in London and published simultaneously in the New England Journal of Medicine, was funded by device maker St. Jude Medical Inc., and Reddy has received consulting fees from the company.

After six months, nearly 7 percent of patients in the study had complications connected to the device. About 10 percent of patients with conventional pacemakers have complications, according to the Associated Press.

However, a clinical trial of the wireless pacemaker in Europe was stopped two times last year and again earlier this year after a number of complications occurred. In one case, the pacemaker came loose and lodged in the artery leading to the patient’s lungs, the AP reported.

The wireless pacemaker is approved in Europe, and the results of this new study will likely be submitted to the U.S. Food and Drug Administration. Medtronic makes a similar pacemaker that is also available in Europe, the news service reported.

The new device costs at least twice as much as a conventional pacemaker and lacks some functions that are standard on conventional devices, according to the AP reported.

“It can’t monitor patients remotely, so they have to go to the hospital for checks,” Dr. Jagmeet Singh, a spokesman for the American College of Cardiology, explained to the AP.

More information

The U.S. National Heart, Lung, and Blood Institute has more about pacemakers.

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I Tried an Ultrasound Wand for My Face

Photo: Courtesy of MIMI/Instagram @jenu_biosciences

Let’s face it; we’ll try anything to up our skin care routine. Whether it’s the latest serum, trending ingredient, or mask—we’re there. So when I heard about JeNu, an ultrasound wand you can use at home that increases the absorption of your skin care by threefold, I knew I had to try.

As a 20-something, anti-aging isn’t a concern of mine yet. But if you’re looking to take your retinol or eye cream to the next level without resorting to Botox, this is it. So how exactly does it work? The wand sends 365,000 pulses of ultrasound energy per second through your skin, essentially vibrating your products into your skin more effectively than your fingers ever could.

To use, simply place a pearl-sized amount of conducting gel ($28, jenu.com) onto the wand, turn it on, and move the wand in small, circular motions on one area of your face. Because it really is magic, the wand automatically shuts off after one minute, making timing truly effortless.

Photo: Courtesy of MIMIchatter.com

The first time I tried the product, I checked my imagination at the door and sheepishly went for my cheeks, but the sky is the limit. You can use the JeNu Ultrasonic Infuser basically anywhere. If you’re concerned about fine lines and wrinkles, concentrate on your under eyes, lips, and forehead. After just a few uses, I can honestly say my skin feels smoother and more hydrated.

If you do the math, adding three to five minutes to your nightly routine is well worth tripling the absorption and effectiveness of your favorite products you already rely on. And if I’m being completely honest, I not only feel legit—like I’m giving myself my very own at-home spa treatment—but I know I’m doing good when I use it.

The JeNu Ultrasonic Infuser retails for $249 and is available at Jenu.com.

This article originally appeared on MIMIchatter.com.

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Why I Finally Started Washing my Face… at Age 23

Here’s Every Moisturizer You Need to Be Using Based on Your Age

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Knee, Hip Replacement Surgeries Linked to Heart Risks

By Steven Reinberg
HealthDay Reporter

MONDAY, Aug. 31, 2015 (HealthDay News) — People who have total hip or knee replacement surgery face a greater risk for a heart attack during the first month following the procedure, a new study finds.

The chances of a heart attack were more than eight times greater in the first 30 days after total knee replacement surgery compared to people who didn’t have the procedure. The risk of a heart attack was four times greater during the month following total hip replacement surgery, the study revealed.

But the researchers noted that the findings shouldn’t deter people from having these surgeries.

“Overall, neither knee or hip replacement increases the risk of heart attack over the entire follow-up period in our study, even though the risk was substantially increased shortly after surgery,” he said. “This risk should not keep a patient from having either surgery.”

Indeed, the odds of a heart attack dissipated over time in these patients, the study found. However, the odds of blood clots in veins and lungs increased in the month following surgery and lasted for years after knee or hip replacement was performed, the researchers said.

“Contrary to recently published findings, our study indicates that total joint replacement procedures do not provide an overall protective effect on the risk of heart attack,” said lead researcher Yuqing Zhang, a professor of medicine and epidemiology at Boston University School of Medicine.

These findings suggest that the risk for heart attack immediately after surgery may have been underestimated, he said.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said, “It is well documented that during and early after a variety of surgical procedures that the risk of a heart attack is elevated.”

An earlier study of patients with osteoarthritis comparing those who did or did not undergo knee or hip replacement suggested that there was lower risk for heart attacks among those having surgery, according to background information in the study. However, heart attacks in the month after surgery were excluded from that study, skewing the results, Fonarow said.

“The reasons for increased risk of heart attack for these and other types of surgery are many, and to date approaches such as use of heart medications, such as aspirin, beta blockers and alpha blockers, have generally not been successful in lowering the risk,” he said.

Zhang said that measures may need to be taken to reduce the risk of a heart attack after surgery.

The findings were published Aug. 31 in the journal Arthritis & Rheumatology.

For the study, Zhang and colleagues collected data on nearly 14,000 people over the age of 50 with osteoarthritis who had a total knee replacement. They compared these patients with a similar number of people who didn’t have the procedure. They also collected data on more than 6,000 people over the age of 50 with osteoarthritis who had a total hip replacement and compared them with a similar number of people who didn’t have one.

Osteoarthritis is the most common type of arthritis; it affects 27 million Americans over 25, according to the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The disorder causes joint pain and stiffness.

In some cases, hip or knee replacement may be a good option for patients with osteoarthritis to relieve pain and stiffness and restore mobility, NIAMS said. As many as 1.8 million hip or knee replacements are performed each year worldwide, background information from the study noted.

Fonarow said that following a heart-healthy lifestyle is the best way to reduce the risk of a heart attack during and after an operation.

“Doctors and patients can take steps to substantially lower the risk of heart attacks by maintaining a healthy blood pressure, cholesterol level, body weight, and by exercising and not smoking,” Fonarow said. “In addition, statins are one of the most effective therapies to minimize risk.”

More information

For more information on joint replacement, visit the American Academy of Orthopedic Surgeons.

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Doctors Rarely Discuss Religion With Critically Ill, Study Says

By Emily Willingham
HealthDay Reporter

MONDAY, Aug. 31, 2015 (HealthDay News) — Whatever your religious beliefs, they’re unlikely to get addressed in the intensive care unit, a new study finds.

Religion or spirituality is important to many people nearing the end of life, but intensive care clinicians rarely talk to patients or their families about those beliefs, the study authors said.

“We found that religious or spiritual considerations were discussed in only 16 percent of family meetings in ICUs and when such concerns arose,” said study author Dr. Douglas White, an associate professor of critical care medicine at the University of Pittsburgh Medical Center. “Health care professionals only rarely asked questions to better understand the patient or family’s religious or spiritual ideas.”

That omission leaves a need unfulfilled, experts said.

“The findings regarding the silence surrounding religion and/or spirituality in ICU conversations are loud and clear,” Dr. Tracy Balboni, associate professor at Harvard Medical School, and her co-authors wrote in an editorial accompanying the study. “The question remains whether we who care for dying persons and their families will learn how to be present and listen.”

The study and editorial were published Aug. 31 in JAMA Internal Medicine.

The study authors found that almost 78 percent of people acting on behalf of patients in intensive care said that religion or spirituality was fairly or very important to them.

Yet their beliefs came up in only 40 out of nearly 250 family conferences with medical professionals. In 26 of those 40 cases, the patient’s family member brought up the subject first.

White’s team established their findings by recording these meetings, with permission from everyone involved, and analyzing the conversations.

The study authors found that medical staff tended to respond to expressions of spiritual need in one of four ways. Most often, the response focused on a medical care plan or treatment goal, as in the case of one family member who said she was praying that the patient wouldn’t have to have a tube inserted to breathe.

The physician’s response was highly clinical and did not address the prayer reference: “The long-term question is how to prevent the pancreatitis from happening again. It’s not a question, but it’s gonna be a question pretty soon, I think.”

In 13 of those 40 meetings where spirituality came up, the clinician responded with empathy. One doctor said, “Hang in there. I know it’s hard. I know,” to a loved one who observed “prayer’s not gonna work.”

But in one-quarter of meetings where beliefs were mentioned, the doctor simply responded with a curt “OK” or “Mhmm.”

A handful of physicians, in four of 40 meetings, still didn’t respond directly to the religious need but promised high-quality health care. For instance, one doctor replied, “We’ll do the best with what we’ve got” to the patient surrogate who said, “I know my God’s a big God. And I know He can even guide your guys’ hands to do the right thing.”

White said clinicians might avoid directly addressing these belief expressions for different reasons.

“It may be that clinicians, on average, are less religious than their patients,” he said. “It may be that clinicians do not know how to navigate these conversations or that they were taught to avoid discussion of such topics in favor of prioritizing discussion of medical facts.”

Patients and their family members can take these matters into their own hands, as many did in the study, by bringing up beliefs that are important to them.

“If religious or spiritual considerations are important to patients or their families, it may be important for families to inform clinicians of this and to request the involvement of spiritual care providers,” White said.

And when patients and their loved ones bring up belief needs, the clinicians should pay attention, said White.

“Physicians should take an interest in respectfully understanding more about the patients’ beliefs, such as by asking questions and listening carefully,” he said.

“For example,” White added, “a physician might say, ‘You mentioned you are trusting God. Tell me more about that.’ Then stop and listen.”

More information

The U.S. National Cancer Institute talks about other end-of-life concerns.

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from Health News / Tips & Trends / Celebrity Health http://ift.tt/1Kzbzqq