Mike Goodkind, (415) 725-5376 or 723-6911
Email: [email protected]
Health Tips from Stanford University Medical Center
January, 1997
DIAGNOSTIC 'BAD NEWS' DOESN'T ALWAYS SIGNIFY A PROBLEM, SPINE SURGEON SAYS
Backache sufferers often think they have a serious problem when scans disclose a diagnosis of a degenerative or a bulging disk, notes a Stanford spine surgeon. "But the patients, fortunately, are wrong. A diagnosis of degenerative or bulging disk is like finding gray hair: It's a sign that you're not getting any younger, but it doesn't say anything at all about your health or how you feel," explains Dr. Eugene Carragee, associate professor of functional restoration and chief of Stanford University Medical Center's Spine Center. "About 40 percent of people over 40 have some sign of degenerative or bulging disks, and this almost never causes disabling symptoms or serious disease," Carragee says. Still, the finding can cause a lot of confusion. The scenario works something like this: "A patient complains about backache and a physician orders an MRI scan or similar diagnostic test to rule out nerve compression, tumors or some other rare ailment such as a spinal infection. Not any of these complications are found, but the patient is told, usually just as an aside, that he or she has a degenerative or bulging disk," Carragee says. As we get older, Carragee says, cells may stop regenerating cartilage. Disks become more brittle, and they may, like balloons that are losing air, tend to sag a bit. "But unless the patient expects to be a world-class athlete, these normal changes will have little or no effect on daily function and don't necessarily cause pain," he says. But what about the back pain the patient sought help for initially? "In an overwhelming number of cases, the pain will go away with time. And simple aerobic and strengthening exercises, such as abdominal crunches or back- strengthening exercises, will do far more to relieve such pain in a healthy person than medications, inactivity or worry," Carragee says. "Ask your physician or physical therapist about what exercises might be best for you."
DON'T GIVE KIDS CIGARETTE PREMIUMS, EXPERT SAYS
Don't give kids those cute T-shirts, hats and other "premiums" that cigarette companies hand out free: It just might encourage them to take up the habit, says a researcher at Stanford University Medical Center. Ellen Feighery, a research associate at the Stanford Center for Research in Disease Prevention, says a recent study by her group found that seventh graders were more than twice as likely to experiment with cigarettes if they owned one of the promotional items that tobacco companies give out as premium gifts or advertising vehicles. "We're not saying that the T-shirts and gifts actually prompted the kids to take up cigarettes," Feighery explains. "What the research did show is that the kids who owned these items were 2.2 times more likely to say they had experimented with cigarettes." Feighery says it's important for older family members and friends to help kids avoid associating cigarettes with glamor, fun or friendship, "and it just makes sense not to present them with a gift that endorses a substance that has proved to be so harmful to their health. "It's a good idea to deglamorize the advertising to make kids savvy customers," she says. "Help them separate the buzz from the reality. For example, those attractive models with cigarettes in their mouths probably have yellow teeth and bad breath." (Editor's note: The study conducted by Feighery and colleagues was published in the September 1996 issue of the American Journal of Public Health.)
REDUCE INFECTION RISK BY CLEANING YOUR DISHWASHING TOOLS PROPERLY, EPIDEMIOLOGIST ADVISES
To prevent contamination of dishes and kitchen implements, your dishcloth or sponge needs proper cleaning, too, says a Stanford Health Services epidemiologist. "It's unsanitary to wash your dishes with a dirty dishcloth full of bacteria," says Brenda Bouvier, manager of infection prevention and epidemiology at Stanford Health Services. "If you don't keep your cloth clean, you run the risk of contaminating containers used to store and serve uncooked foods." The solution is simple, says Bouvier: After washing the dishes, clean the dishcloth with hot water and soap. Then rinse the cloth thoroughly with hot water and allow it to air dry. "Drying is a key part of the process, because most bacteria and viruses die in a dry environment," she says. And don't forget to clean the cutting board, which also can harbor bacteria, Bouvier adds. "But don't worry too much," Bouvier adds. "The transmission of bacteria and viruses is not normally a serious threat in your own kitchen. Friction, soap and water will usually get rid of them."
FEELING DOWN? SOME SIMPLE TESTS COULD POINT TO EASILY TREATABLE THYROID DISEASE
Thyroid disorders can affect healthy persons at any age, and almost anyone who experiences an otherwise unexplained change in well-being that lasts a month or more is a candidate to be tested for this common ailment, says a Stanford University expert. "The symptoms of thyroid disease can be nonspecific, so it's important to keep thyroid disease in mind when symptoms, ranging from fatigue to depression, are long- standing and have no apparent cause," says Dr. I. Ross McDougall, professor of radiology and of medicine. "Thyroid diseases are easy to diagnose using blood tests that can be ordered by a patient's personal physician," notes McDougall. "And treatment, while often long-term or lifelong, usually results in total elimination of symptoms." The thyroid gland, which releases hormones that play an important role in growth and metabolism, sits in the front of the neck. "When the thyroid produces too much thyroid hormone, the condition is called hyperthyroidism. Too little hormone, and you have hypothyroidism," explains McDougall. "Symptoms of hypothyroidism can include fatigue, dry skin, hair loss, weight gain, sensitivity to cold, weakness and mental changes such as depression," he says. "In hyperthyroidism, weight loss, nervousness, palpitations, heat intolerance, looseness of bowels and weakness are common." Changes in thyroid function are somewhat more common at puberty, after pregnancy and at menopause. While both forms can strike at any age, underproduction of thyroid hormone most commonly affects women over age 60. Hypothyroidism is caused by an autoimmune disorder in which the body perceives the thyroid as foreign and produces antibodies that destroy the gland. Both hyperthyroidism and hypothyroidism are much more common in women and tend to run in families. "So if you are being examined for any reason, be sure to tell your doctor if family members have had thyroid problems," says McDougall. "That may help speed up diagnosis." Diagnosis of either condition is simple, thanks to blood tests, and treatment usually returns patients to full function, says McDougall. Some other thyroid problems, such as nodules or tumors, might produce no symptoms and are most often characterized by a growth or lump in the thyroid gland, which would be found during examination of the thyroid. For hypothyroidism, thyroid tablets usually bring quick relief. When too much thyroid hormone is being made, various approaches are available, including pills, radioactive iodine or surgery. "The specific treatment plan is best developed with the help of a specialist," McDougall says. "There doesn't appear to be anything people can do to prevent hypo- or hyperthyroidism," says McDougall, "so there certainly is no reason to feel any pangs of guilt or blame if the diagnosis is thyroid dysfunction."
CALL FOR AN AMBULANCE WHEN A 'BRAIN ATTACK' IS SUSPECTED, THEN PREPARE TO ANSWER SOME SIMPLE QUESTIONS
Stroke or "brain attack" patients may save millions of brain cells and avoid long and imperfect rehabilitation if they get to the right emergency room in time, armed with the right information to help doctors start treatment, says the director of Stanford University's Stroke Center. "Immediately call for an ambulance any time you suspect someone has suffered a stroke or 'brain attack,' " says Dr. Gregory W. Albers, associate professor of neurology. "Signs to look for include sudden weakness, slurred speech, inability to speak, loss of vision, numbness or unsteady gait," he says. Once the patient reaches the emergency room, the medical team will need certain information. "Before doctors can use the latest medications to treat stroke, they have to know that the stroke occurred within three hours of treatment and that the patient doesn't have a bleeding disorder or a recent hemorrhage," says Albers. About 80 percent of stroke patients suffer from ischemic strokes, which are caused when a blocked or narrowed blood vessel prevents blood flow to the brain. For these patients, a recently approved clot-dissolving drug called tissue plasminogen activator, or TPA, has been shown to substantially guard against the common long-term effects of stroke, including loss of speech or motor function. This genetically engineered drug is now widely -- but not universally -- available to treat strokes in emergency rooms, Albers notes. But TPA may be dangerous if administered more than a few hours after a "brain attack" or given to patients with certain other medical conditions. The drug is also dangerous when given for a hemorrhagic stroke, which occurs when blood vessels rupture near or within the brain.
"In the emergency department a CT imaging scan will urgently be performed to make sure the stroke is appropriate for treatment with TPA," Albers said. But friends or family can be help, he says, by making sure two critical questions are answered: * Who was the last person to talk to the patient before the "brain attack," and when did that discussion occur? If the medical team can determine that the patient was symptom free, able to talk normally, less than three hours earlier, they will be more confident in starting treatment. * Does the patient have any medical conditions that might influence treatment decisions? Call the patient's primary care physician after you call 911, since he or she can be invaluable in answering general questions that can affect the choice of treatment. For example, persons who have certain blood disorders or who have hemorrhaged recently aren't safe candidates for TPA.
January 1997 -- 30 -- HT01/97
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