Monthly Archive
Many of my patients are frequent business travelers. Travel presents its own set of health challenges, from the risk of prolonged immobility in small airline seats, to the risk of acquiring respiratory infections on a plane. One painful consequence of travel that we’ve all experienced is jet lag. Especially when crossing several time zones, jet lag can make the first day or two at your destination very unproductive.
In last Saturday’s Los Angeles Times business section, James Gilden has a very helpful article: Shedding Some Light – or Not – on Fighting Jet Lag. He discusses a recent study for British Airlines by Chris Idzikowski, a founder of the British Sleep Society. The study attempted to discover the most important factors that effect jet lag, and how to modify these factors to get the greatest relief.
What really works in influencing the body’s biological clock and consequently combating jet lag, he said, are six factors: exposure to light, sleep, exercise, eating, drinking and social interaction. It is in timing a traveler’s exposure to light that Idzikowski has found the most promise for combating jet lag.
One result of the study is the British Airways Jet Lag Advisor. Take a look at it. It’s very easy to use and gives advice about the hours that you should avoid light and seek light in the first two days of travel to minimize jet lag. Please try it during your next trip and let me know how well it goes.
Now I just need to figure out how to keep you from getting colds when you fly.
An interesting study in the July 6 issue of The New England Journal of Medicine confirms what many physicians and patients have suspected: experience leads to quality. The study looked at over 20,000 patients with respiratory failure (inadequate or stopped breathing) in 37 different hospitals. The patients all required mechanical ventilation, meaning they were connected to a machine (a ventilator) that assisted their breathing until their respiratory problem improved. The study compared the number of these patients who survived their hospitalization to each hospital’s patient volume (the number of patients admitted to the hospital). The study took into account differences in illness severity and other differences between patients.
The patients admitted to the largest hospitals survived most frequently. A patient admitted to a hospital that was in the bottom 25% of hospital volume had a 34.2% chance of dying during the hospitalization. In the busiest 25% of hospitals, the average in-hospital mortality was 25.2%. That suggests that for every 11 patients with respiratory failure, one additional in-hospital death will occur in the least busy hospitals compared to in the busiest hospitals. That’s a surprisingly big difference.
Since this wasn’t a randomized study (meaning patients weren’t told which hospital to go to) the results may be potentially biased, so we should be cautious. The authors speculate about why busier hospitals may have better outcomes:
High-volume hospitals may improve outcomes by implementing a broad range of best practices, including higher nurse-to-patient ratios, multidisciplinary care teams… Clinicians at high-volume hospitals may also gain experience in the care of the critically ill, which could translate into improved rates of survival. More experienced as opposed to less experienced clinicians may be better at recognizing and treating the complications of critical illness or may be better at translating evidence into practice.
The bottom line is that experience translates to quality.
The Beverly Hills area is served by several hospitals, and I am frequently asked what I think about specific medical centers. This study further informs my initial opinion. Larger hospitals, like Cedars-Sinai Medical Center, have the care protocols, the information infrastructure, and the experienced specialists to provide better outcomes than small hospitals.
(Thanks to my patient J.R. for pointing me to this story.)
A little over a month ago a Seattle TV station broadcast a news story about inflammatory breast cancer. You can read the story or watch the video on the station’s website. Since then, interested viewers have emailed the story to friends and acquaintances and the video has been viewed over ten million times. This has drawn welcomed attention to inflammatory breast cancer, a very aggressive form of breast cancer.
The Mayo Clinic website has a very comprehensive review of inflammatory breast cancer. What makes inflammatory breast cancer different than other breast cancer, and frequently leads to late diagnosis, is the absence of a lump. Inflammatory breast cancer is frequently misperceived as an irritation or infection of the skin. According to the Mayo Clinic overview, signs and symptoms of inflammatory breast cancer include:
Early correct diagnosis can make a big difference in inflammatory breast cancer, so keep this in mind when you do your monthly breast self-exams and pass it along to someone you care about.
I wrote in March about the controversies regarding prostate cancer screening, and I made the point that, unfortunately, it is still not clear whether or not diagnosing prostate cancer early saves lives.
This week’s Los Angeles Times Health Section features a fascinating article by Susan Brink that highlights the limited scientific evidence, and therefore the many reasonable options, available to prostate cancer patients. She discusses several healthy men diagnosed with early prostate cancer who have researched their options and have chosen active surveillance. Active surveillance involves frequent monitoring of the cancer through blood tests, ultrasound, and even biopsies, but with no intervention to treat the cancer.
Given the lack of evidence that current treatments like surgery or radiation prolong survival in early prostate cancer, the option of active surveillance is entirely rational.
“Most of the time, I tell men that they may need treatment, but they’re not going to die,” says Mark Scholz, a Marina del Rey oncologist, specializing in prostate cancer. “A lot of men with low-grade cancer may not need treatment for five to 10 years.”
Some may never need it.
I recommend reading the article, especially the excellent summary at the end of the different available treatments.
The important thing to remember is that prostate cancer is very common and grows very slowly. A new diagnosis is not an emergency. There is plenty of time to collect opinions from oncologists, urologists, and radiation specialists, collect your thoughts, and then decide what to do. Even if it’s nothing.