Tag Archives: Harvard Health

Medicine, Reviews, Rx

OTC Pain Relievers: Types & How To Safely Use Them

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The two main categories of commonly used pain relievers (also known as analgesics) are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

  • Acetaminophen (Tylenol) controls pain and fever but doesn’t help with inflammation. It’s an active ingredient in many drugstore headache and cold remedies.
  • NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). These ease pain and lower fever like acetaminophen, and also work as anti-inflammatories. NSAIDs are popular pain relievers for inflammation-related conditions like arthritis and injuries.

Potential side effects

Acetaminophen. High doses can damage the liver. The maximum recommended per day is usually 4,000 milligrams (mg), equivalent to 12 regular-strength or eight extra-strength Tylenol tablets. It’s also possible to develop liver problems after taking small to moderate amounts if done so over an extended period.

To be safe, take no more than 3,250 mg of acetaminophen a day. The FDA recommends using products containing no more than 325 mg per pill or capsule to avoid excessive dosages. Also, be cautious when mixing multiple products containing acetaminophen, such as a pain reliever, a cold medication, or a prescribed narcotic. “And do not take acetaminophen if you drink alcohol more than moderately on a regular basis or if you have liver disease,” says Dr. Gilligan.

NSAIDs. The most common side effect is stomach irritation which may cause pain, bloating, or heartburn. These medications also may cause ulcers, which can lead to internal bleeding. Excessive use of NSAIDs increases the risk of heart attack, stroke, and kidney failure. The most common daily limits are 1,200 mg for ibuprofen and 660 mg for naproxen.

All NSAIDs (except aspirin) tend to boost blood pressure. While the effect is most potent in people who already have high blood pressure, anyone taking an NSAID may see an increase in readings.

People who are concerned about possible side effects can try topical pain relievers, such as products containing diclofenac (Voltaren gel) or lidocaine. “They are a safe choice for pain due to soft tissue injury or osteoarthritis as smaller amounts are absorbed by the body,” says Dr. Gilligan.

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Research, Reviews, Studies, Technology

Prostate Cancer: A PSMA Scan Predicts Recurrence

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“We found that the information we could get from PSMA scanning in patients with newly-diagnosed prostate cancer before surgery was at least as reliable and useful as other information from biopsy, PSA levels, or clinical exam for predicting how patients would do after surgery or other treatment,” says Farshad Moradi, a radiologist at Stanford who co-authored the study.

In December, scientists at Stanford University reported promising findings with a new technology that lights up prostate tumors on specialized imaging scans. The approach relies on a minimally-radioactive tracer that travels the body hunting for cancer cells.

Called 68Ga-PSMA-11, and delivered intravenously, the tracer binds exclusively with a protein called prostate- specific membrane antigen (PSMA). Prostate cancer cells contain far more of this protein on their surfaces than normal prostate cells do. Tumors flagged by 68Ga-PSMA-11 show up on an imaging scan like lit matches in a dark room. Doctors are already using PSMA scans to diagnose early metastatic cancer, and the tracer can also be used to ferry drugs directly into malignant tumors.

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Medicine, Resources, Reviews

Heart Disease: Thoracic Aortic Aneurysm Risks

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A thoracic aortic aneurysm is a weak spot in the aorta, the main pipeline for blood from the heart to the body. The weak spot has the potential to dissect or rupture, cutting off the supply of life-sustaining blood to the rest of the body. Thoracic aortic aneurysms are often harder to detect and diagnose compared to the more common abdominal aortic aneurysms. 

December 14, 2022

The aorta begins deep in the heart. It emerges from the top of the powerful left ventricle, curves up and over the heart in a gentle arch, then descends into the chest and through the muscular diaphragm into the abdomen (see “Thoracic aorta”). It ends around the belly button, where it splits into two smaller arteries, one for each leg.

THORACIC AORTA

From start to end, arteries branch off to nourish the heart, brain, arms, kidneys, liver, stomach, intestines, and every other part of the body. The stretch of the aorta from its start in the heart to the top of the diaphragm is called the thoracic aorta; the section below the diaphragm is the abdominal aorta.

Some aneurysms are relatively harmless. Others can lead to the catastrophic problems known as dissection or rupture. For now, size is the best and only guide to the health threat posed by an aneurysm.

Dissection. The most common consequence of an aortic aneurysm, dissection occurs when a tear develops in the inner lining of the aortic wall. The inner and outer layers peel apart, creating an extra channel for blood inside the aorta. It may do no harm, or it may allow blood to bypass the outflow to certain organs or tissues, leaving them without a blood supply. This can cause a heart attack, stroke, kidney damage, and other problems.

Rupture. A break in all three layers of the aortic wall is termed a rupture. Blood pours from the aorta into the chest. This massive internal bleeding can quickly lead to shock and death.

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Aging, Medicine, Resources, Reviews

Heart Health: Function & Benefits Of Pacemakers

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“The likelihood of needing a pacemaker increases with age,” says Dr. Sunil Kapur, a cardiologist at the Heart and Vascular Center at Harvard-affiliated Brigham and Women’s Hospital. “The good news is that today’s pacemakers have evolved from fixing irregular heartbeats to helping the heart maintain its normal function, which allows many men with certain heart conditions to stay active longer.”

December 1, 2022

A pacemaker monitors the heart’s rhythm and, when necessary, generates a painless electrical impulse that triggers a heartbeat.

The most common use for a pacemaker is when the heart beats too slowly or pauses, which triggers dizziness, shortness of breath, or fainting. (You should see your doctor immediately if you have any of these symptoms.) A pacemaker also can help your heart chambers beat in sync and improve blood flow if your heart isn’t pumping enough blood. In some cases, a pacemaker may be needed to treat a heartbeat that is too fast or irregular.

These issues can stem from problems with the heart’s electrical signaling, a heart defect, an enlarged or thick heart muscle, heart failure, or a heart attack.

Several tests can help your doctor determine if you need a pacemaker: an electrocardiogram, which measures the heart’s electrical activity; Holter monitoring, in which you wear a small device to track your heart’s rhythm; or an echocardiogram, which uses sound waves to produce images showing your heart’s size, structure, and motion.

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Aging, Dr. C "Comments", Medicine, Reviews

Hearing Aids: Over-The-Counter vs Prescription

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Hearing aids are not one-size-fits all. “While OTC devices may help many people with mild or moderate hearing loss, they might not be appropriate for all types of hearing loss,” says Dr. Naples.

Harvard Health Publishing – A change in FDA regulations has cleared the way for over-the-counter (OTC) hearing aids. What does this mean for you if you’re among the approximately 48 million Americans with some degree of hearing loss? We asked Dr. James Naples, assistant professor of otolaryngology/head and neck surgery at Harvard-affiliated Beth Israel Deaconess Medical Center, to help explain potential pros and cons.

The basics: Hearing aids versus amplification products

There are various types of hearing aids that largely work in the same way. Whether the style is behind the ear or in the ear canal, they amplify sounds to make them louder. They also help filter out certain types of noise. “All hearing aids use a combination of signal processing and directional microphones to filter out some unwanted noise and to improve our ability to hear sounds,” says Dr. Naples.

Don’t confuse prescription or OTC hearing aids with personal sound amplification products (PSAPs) sold at most drug stores. Such products merely amplify nearby sounds. They’re not tailored to an individual’s hearing loss, and aren’t regulated by the FDA or intended to treat hearing loss.

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COMMENTARY:

Humans and their mammalian cousins have lost the ability to regenerate the hair cells in the inner ear. In preindustrial society(how could they know?) people apparently didn’t lose hearing as they aged. However, in the Industrial Age, the prevalence of noise has been increasing along with our power consumption,  and loss of hearing consequently occurs along with Aging.

High frequency loss is the most prominent, and this leads to inability to hear consonants, and have more difficulty with the voices of children and women which tend to be of a higher frequency. The ability of young people to hear high frequencies better than older people has led to various ringtones and songs favoring high frequencies, which the children can hear and older people cannot.

There are a number of things that can add to this hearing loss, such as chronic exposure to loud sounds (such as rock concerts), exposure to drugs that damage hearing, such as certain antibiotics and even aspirin. Otosclerosis and repeated middle ear infections can also accentuate the problem by interfering with sound conduction.

Ringing in the ears, tinnitus, is also associated with accelerated hearing loss.

I have had tinnitus for a long time, and at the age of 90, I have definite hearing loss. Even a couple of decades ago my high frequency loss was quite demonstrable by audiogram. I am resisting the temptation to get it corrected, since the louder sounds from the device would probably gradually reduce my baseline hearing ability. Also  I am now forced to pay strict attention when listening to people. This may slow down the tendency of older people to have a greater difficulty in “decoding” the  spoken word, due to decreased brain processing.

With the passage of a new law permitting people to access hearing aids without a prescription, the price of hearing aids is bound to go down, another reason for waiting.

If you are considering getting a hearing aid, an audiologist would prepare one that is tuned to your specific hearing loss.

The best is none too good.

—Dr. C.

Aging, Medicine, Studies

Vitamin D: Lower Levels Increase Dementia Risks

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Low vitamin D levels were linked with an increased risk of both dementia and stroke over the following 11 years. Based on this observational study, people with low vitamin D levels were found to have a 54% greater chance of developing dementia compared with people whose levels were normal.

A study published online April 22, 2022, by The American Journal of Clinical Nutrition suggests vitamin D deficiency may raise risk for dementia and stroke.

The study analyzed more than 294,000 people (most of them women over 60) living in the United Kingdom. Using blood tests on all participants and neuroimaging tools on about 34,000, researchers looked for associations between vitamin D levels and risks of dementia and stroke. A normal blood vitamin D level was defined as at least 50 nanomoles per liter (nmol/L); a deficiency was defined as less than 25 nmol/L.

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Medicine, Reviews, Rx

Heart Disease: The Best Ways To Lower High LDL Cholesterol Levels

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November 1, 2022

What is a healthy target for LDL cholesterol?

Target LDL depends on many factors, including your age, family history, and personal history of cardiovascular disease. For people at intermediate risk, LDL should be lowered by 30% to 50%. For those who have already had a heart attack, target LDL is no more than 70 mg/dl (note: automatic download).

Which non-statin therapies are recommended first?

Five non-statin therapies described in this post aim to help people achieve target LDL goals while minimizing side effects. They may be combined with a statin or given instead of statins.

Each helps lower LDL cholesterol when diet and statins are not sufficient, such as when there is a family history of high cholesterol (familial hypercholesterolemia). But so far, only two options are proven to reduce cardiovascular risk — the risk for heart attack, stroke, heart failure, and other issues affecting the heart and blood vessels.

Ezetimibe (Zetia)

What it does: Lowers LDL and cardiovascular risk by reducing cholesterol absorption.

How it’s given: A daily pill

Relatively inexpensive and often given with statins.

PCSK9 inhibitors, alirocumab (Praluent) and evolocumab (Repatha)

What it does: A protein called PCSK9 controls the number of LDL receptors on cells. These medicines are monoclonal antibodies against PCSK9 that increase LDL receptors on the liver, helping to clear circulating LDL from the bloodstream.

How it’s given: A shot every two to four weeks

Highly effective for lowering LDL, but expensive and may not be covered by insurance.

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Medicine, Studies

Glaucoma: The Risks Of Ocular Hypertension

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Often described as the silent thief of sight, glaucoma is the most common cause of irreversible blindness in the world. High pressure in the eye damages the optic nerve, first stealing peripheral vision (what you see at the corners of your eyes) and later harming central vision (what you see when looking straight ahead). Usually, people notice no symptoms until vision loss occurs.

Close up photo of a brown eye; black pupil in the center, irish is many shades of brown, white of eye shows tiny veins

Lowering high eye pressure is the only known treatment to prevent or interrupt glaucoma. But does everyone with higher-than-normal eye pressure need to be treated? A major long-term study provides some clues, though not yet a complete answer.

Does everyone with high eye pressure develop glaucoma?

In the US, glaucoma affects an estimated three million people, half of whom do not know that they have it. An ophthalmologist can perform a comprehensive eye exam to determine if someone has glaucoma, or is at risk for developing it in the future due to high eye pressure (ocular hypertension). Research from the long-running Ocular Hypertension Treatment Study (OHTS) shows that some people with high eye pressure may never develop glaucoma, while others will.

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Diet Health, NUTRITION, Studies

Diet: Consuming Olive Oil Daily Lowers Heart Risks

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Consuming just a half-tablespoon or more of olive oil a day is linked to a lower risk of dying from heart disease and other chronic health conditions, new research suggests.

photo of a hand holding a bottle of olive oil and drizzling it on a dish of quinoa

The study included more than 92,000 women and men from the Nurses’ Health Study and the Health Professionals Follow-up Study, who filled out diet questionnaires every four years for 28 years. Olive oil intake was calculated from how much they reported using in salad dressings, on bread and other food, and in baking or frying.

Compared with participants who rarely or never consumed olive oil, those who consumed the most (about a half-tablespoon or more daily) had a 19% lower risk of dying from heart disease during the study. Researchers also noted lower death rates over all among people who substituted olive oil for a similar amount of margarine, butter, mayonnaise, or dairy fat. The findings, published Jan.18, 2022, in the Journal of the American College of Cardiology, lend further support for choosing olive oil — a key component of the heart-friendly Mediterranean diet.

Read more at Harvard Health

Medicine, Research, Studies

Stroke: Long Periods Of Sitting Increases Risks

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The study involved 7,607 adults who wore a hip-mounted accelerometer (a device that records how fast you move) for a week. Their average age was 63. During a follow-up period averaging 7.4 years, 246 of the participants experienced a stroke.

People who sat for 13 or more hours per day during the initial week of motion tracking were 44% more likely to have a stroke compared with those who’d spent less than 11 hours per day sitting still. In addition, longer bouts of sitting (more than 17 minutes at a time) were linked to a higher risk than shorter bouts (less than eight minutes).