A recent study done in Australia has found that those who take frequent breaks at work to stretch and walk around have smaller waistlines and smaller waistlines translate into a lower risk of heart disease.

They studied over 2700 people 20 years or older by monitoring their activity with an accelerometer. They wore the device while awake and it measured the amount and intensity of physical activity. Those who took an average of 1258 breaks in a week were two pant sizes smaller than those who took an average of 99 breaks in a week. A marker of inflammation called the C-reactive protein was also lower in the active group. The average break time was around 4 minutes. The range of sedentary times of those in the whole group was between 1.8 up to 21.2 hours a day.

Physical activity is very important. Getting up and walking around engages the core muscles, which are generally at rest with sitting. Taking breaks and walking around has also been found to help people be more productive on the job.

If you are sedentary at work, it is time to schedule frequent breaks. Bring good walking shoes and just walk around the block or up and down the stairs or even around the halls. Your heart will thank you.

Remember how easy the resuscitation part of CPR was to learn? You just had to memorize A-B-C which stood for AIRWAY-BREATHING-COMPRESSION. (Some people taught that the “C” actually stood for CIRCULATION, but same thing in terms of the goal.) No matter how much the medications changed for the various arrhythmias in the advanced portion of life support, ACLS, you could always count on the ABCs to get you started when someone suddenly became unresponsive. And this was true for years and years.

Until now. The 2010 American Heart Association Guidelines for CPR* state that compressions should be the first step in initiating CPR, therefore changing the prior ABCs to CAB (COMPRESSION-AIRWAY-BREATHING). This isn’t really all that new; it was recommended, based on a review of the most current resuscitation literature, in the various cardiology journals over two years ago. But now it will be talked about more in the mainstream media.

Based on research that confirms the superiority of performing CPR this way, the idea behind it is that there is already oxygen present in the lungs and bloodstream within the first few minutes of an arrest. Therefore, beginning with compressions will push that lifesaving oxygen to the brain and heart immediately, rather than having the thirty second delay caused by first establishing an airway as dictated by the old way of doing CPR.  In addition, the new guidelines recommend that the speed of compressions be increased to a rate of at least 100 times per minute, and that the compressions be made more deeply, to a depth of at least 2 inches in children and adults, and 1.5 inches in infants.

Another important change is that the guidelines advocate that even bystanders untrained in CPR be instructed to perform “Hands Only” CPR, which means that they do only chest compressions for adults who are unresponsive with abnormal or no breathing. You can already hear the sighs of relief from those potential rescuers who were always at best wary, at worst terrified, of having to do mouth-to-mouth resuscitation (and potentially catching a dread disease) should someone arrest in their vicinity. Now everyone can save a life – or at least, begin the process of saving a life, without fear.

So, even though the traditional ABCs will hopefully always remain the same, there’s now a new and better way to perform CPR. Repeat after me…C-A-B (100 per minute/depth 2 inches).

* Circulation. 2010;122[suppl 3]:S640-S656.(November 2, 2010 supplement)

There is a particular area in the South that has a very high incidence of stroke. A recent study done through Emory University has found the possible reason for this phenomenon may be the increased consumption of fried fish. This area known as the stroke belt includes the states of North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas and Louisiana. The buckle of the belt includes the coastal plains of North Carolina, South Carolina and Georgia.

Researchers studied the fish consumption of over 21,000 people in this area. Although they ate a fair amount of fish, only 23% of those in the belt and 17% of those in the buckle ate non-fried fish. Consequently, those living in the belt were 20% more likely to die from stroke and those living in the buckle were 40% more likely to die from stroke.

Eating fish and/or using fish oil is commonly recommended to reduce the risk for stroke and heart attack. However, frying the fish not only seems to negate the benefit but also seems to increase the risk. My guess is it has to do with not only consuming fried food but also eating increased calories as a result of the frying. If you look at Burger King you will find that one of the foods with the highest calories is the fish sandwich at 680 calories. The fish may be healthy but all the stuff around it may not be good for you or your waistline.

America has gotten the message that fish is healthy. However, the way it is cooked is important. In order to benefit from fish and decrease your risk of stroke put away the frying pan, add some vegetables and get out there and exercise.

A longtime friend of mine died last week. She was three months short of her 98^th birthday, and had never been in the hospital until this final illness which began about a month before. She had few illnesses throughout her life and, other than vitamins, took no regular medications. Her only disability in the last five years of her life was blindness secondary to macular degeneration. And even this didn’t impact her daily activities that much.

Her good health continuing into a ripe old age is indeed remarkable. But there was something else about her that was even more remarkable – her attitude and her beliefs, and how she maintained and practiced these every day of her life. That last line would seem to be an opening to discuss her faith or religion or spirituality, and although she did in fact have a very strong faith, that’s not where I’m going with this.

What was truly remarkable about this lady was that she set daily goals for herself – not necessarily huge lifetime goals either – and actually carried them out on a day by day basis.  She strongly believed that she must accomplish something every single day; and she did. Whether she began a new drawing (she was an artist), or learned a new song (she was a musician), or went through old magazines and cut out photos that she liked for a scrapbook, she always accomplished something new each day. When she became blind, she immediately started getting books on tape; her first project was to listen to the Old Testament of the Bible from start to finish. When she had done that TWICE, she then began to learn French and practiced every single day. And, when she was 89, she wrote her memoirs.

These small accomplishments did not stop her from her activities of daily living. She got up every morning, got dressed – complete with pearls and stockings –

straightened her apartment, spoke on the phone to her sister, and went about her regular activities in addition to doing something new. We once were talking about the new year, and she could not understand why people made resolutions.  If they would just get up in the morning and do what they needed to – without fighting it, without thinking too much about it – then there would be no need for resolutions, she told me.

I will miss her. But, her friendship has left me with many gifts, one of which is that I will no longer make New Year’s resolutions. I will simply do as she told me.

A recent study conducted at Harvard gave placebo pills twice a day to patients with irritable bowel syndrome. The unique aspect of this study is that they told the patients they were getting placebo, pills with no active ingredients. They even put placebo on the pill bottle. Despite this, sixty percent improved when compared to thirty-five percent improvement in patients who got nothing.

This study is interesting for a couple of reasons. The fact that just taking something seemed to help patients improve is important. Was it the fact that a doctor gave it to them or just that they were actively doing something that made the difference? We do not know. And, thirty-five percent of patients got better without any treatment. That is also remarkable.

The placebo affect is powerful and is (in my opinion) indicative of the power we each have to improve our own health. In my own practice I see it happening all the time. I do not give my patient’s placebo pills. However, when I give them a medication and they have faith that it will work it almost always does. Conversely, I have some patients who read the side effects on the medication and get every one of them immediately even when they are unlikely to occur within minutes of taking a medication.

I was at a lecture once and the speaker said that every medication is a placebo. At that time I scoffed at the notion. However, the longer I practice the more I understand what he was saying. Our minds are incredibly powerful. We need it to be in sync with the rest of us for healing to happen. The mind, body and spirit are important aspects of each and every one of us. For health and wellness it is crucial that we recognize and attend to all three.

Weight maintenance and fitness are complicated. Recent studies looking at the effect of marital status on fitness level has shown just how complicated things can get. A study of 8900 adults over several years found that those who were married showed a drop in fitness level based on treadmill tests. Men who became divorced had improved fitness.

Another study of over 6900 men and over 1900 women followed over 3 years found that the women who remained single had an increase in their fitness. The women who married showed no increase in their fitness level. Men who remained single and those who married showed a decrease. Those who divorced during the course of the study gained fitness.

These studies point to the fact that marital status appears to have a significant impact on fitness and health. It seems that both men and women may tend to let themselves go when they are in a secure relationship.

Knowledge is power. Knowing that marriage might lead to a decrease in fitness may change behaviors and help couples to make exercise and healthy eating a priority in their relationships. It is much better to be fun and fit than fat and happy.

You can’t pick up a newspaper (if you even still do that) or look at the news online these days without hearing about Boomers starting second careers, beginning a new business, or going on adventures. And, of course, included in the adventure category are all the sports and activities we never had time to do when we were younger and overworking.  Bungee jumping, bobsledding, skydiving, etcetc are only a few of things we’re taking up. Included with these is the use of all-terrain vehicles (ATVs) for recreational use. Have you read about them and think they look interesting? Read on…

 A new study published in the October 2010 issue of the journal Neurosurgery* by researchers at the University of Utah found that accidents due to ATVs are increasing in the US, and are causing serious spinal cord and brain injuries. Focusing on ATV injuries in the state of Utah, they found that there were nearly 1500 injuries due to ATVs in just 5 years.  Of these, half had injuries to the spinal cord or brain. Most patients had injuries severe enough to require emergency transport to a hospital; there were 4 patients who were dead on arrival, and 15 who died in the hospital of injuries sustained.

Surprised? It gets worse.  Since children as young as 8 years old are allowed to operate ATVs, and since there is no legal helmet requirement, many of the injured were kids with head injuries. A different study showed that injuries in kids nearly tripled over a 10 year period. Another surprising finding (or maybe not so surprising) was that helmets were worn only sporadically – in both kids and adults. And, the estimated national costs of ATV-related injuries are $3.24 billion annually.

Since ATVs are by their very nature unstable, mandating requirements for their safe use  – short of banning them – is a problem.  Three-wheeled vehicles have been banned in some states, but there is no national legislation regarding ATVs. The authors suggest that the following might help to decrease injuries due to ATVs:  requiring helmet use, increasing the supervision of children on ATVs, educating the public and maybe even requiring rider training.

After reading this, are you SURE you want that ATV for Xmas? Before you answer that, remember that you’re a role model for not only your kids but others as well. So, think again…

*Finn,MA, MacDonald JD, A Population-Based Study of All-Terrain Vehicle-Related Head and Spinal Injuries; Neurosurgery,October 2010, vol 67, issue 4, pp 993-997.

I thought I knew what I was writing about in my blog this week. Then I realized that I had written about the same thing last year at this time. Although I’m not sure I learned that I needed to slow down last year… you can bet I’ll try again this year. Here is that blog:

It dawned on me the other day – after a specific incident I’ll mention in a moment – that despite all the joy and exhilaration of this season, it’s also one that can be loaded with danger if we’re not careful. And that’s exactly what we’re NOT during this month because there’s too much to do and too much rushing. 

Let me backtrack first. We had a huge snowstorm over the weekend; in fact, it set a record for December snowfalls in Baltimore (a bit over 20 inches).  It left the ground and the world pristine and gorgeous, and we were able to get out and about easily fairly soon. After lots of digging and plowing of course. 

I’m terrified of falling. You already know that if you’ve read our book or have seen prior blogs (http://www.smartwomanshealth.com/horn_miller_blog/?p=282). Because of this, I am extra cautious about watching where and how I walk when doing stairs, and of course, when there’s been rain or snow or ice. Despite thinking I was being careful yesterday on the first day out after the snowstorm, I missed seeing a patch of ice as I was coming out of the grocery store, and the next thing I knew, I was flat on the ground with the hot tea from my cup spilled all over me. The only thing good about it was that it happened so fast that I didn’t have time to get that awful feeling you get AS you are falling.

It started me thinking that perhaps I had NOT been as cautious as I usually am, or that I had been in such a hurry because of all the things I had to do, that I was distracted. And this led me to the realization that distraction due to rushing and being more overprogrammed than usual is the cause of many potential dangers lying in wait for us during this busy and harried season.  So, I made a list of the potential dangers that may occur because we are too busy, rushing too much, or overtired now.

·        Falling or having an accident (car or other)

·        Overeating

·        Eating too much sugar

·        Drinking too much alcohol

·        Smoking

·        Spending too much money

·        Not getting enough sleep

·        Not getting enough exercise

·        Being emotionally raw

·        Getting depressed

·        Completely missing the joy of the season

Now, doing any of the above for a short period of time may not be harmful, but the Holiday Season generally lasts at least one month or more for all of us. Doing any or all of the above for that period of time can be devastating to your health, especially since it can lead you to break all your good habits from the prior ten or eleven months.

The simple remedy? SLOW DOWN and FOCUS.  Be aware that rushing and being distracted and trying to do too many things can put you at risk for an accident or worse.  Tell yourself that it’s ok if: 1) you don’t get your Holiday cards out until after Christmas or 2) you’re late to a holiday party or 3) you give someone on your list a gift card to Amazon instead of picking out the perfect present or 4) you send store-bought cookies to the school party instead of baking them yourself , and so forth. You get the picture.  Remember that all the perfectly-chosen gifts and home baked cookies in the world are not worth anything if they  cost you your good health and health habits.

Wishing a joyful and slow Holiday season – Merry Christmas and Happy Kwanzaa! And hope your Chanukah was wonderful.

About three months ago I was asked to do research for an online article regarding illnesses that come from pets. I was really busy at the time and almost turned down the assignment, but for some reason I decided to do it. One of the things I learned about was a worm called ascaris. It is actually a round worm that has infected a large number of people worldwide. It is transmitted by eating food that is contaminated with animal feces containing the eggs of the worm. Once consumed the eggs hatch in the gut and they multiply and can migrate into the lungs where they cause a respiratory infection that allows them to be coughed up and swallowed and start all over again. Many people never have symptoms but others can go on to become quite ill. Now I know you are wondering why I am writing about this and what it has to do with synchronicity. Here goes.

I have many patients who travel all over the world in an effort to make it a better place. One of my patients who traveled to South Africa came in with belly pain. After a series of blood tests I ordered an abdominal ultrasound to see if she had gallstones. There were no gallstones but the radiologist noted a little density in her bile duct that looked like a worm. Fortunately, I had just learned about ascariasis and sure enough that is what she had. Once treated, the little worm was gone in the follow-up ultrasound. I thought that was pretty cool (not to mention slightly gross) and then another patient came in with a different complaint.

Just about a month later a young patient of mine who had been to China over a year ago had continued problems of abdominal pain followed by cold and flu symptoms. She had been all over the country looking for answers as to why she felt so sick. She had a zillion tests including two colonoscopies and two upper endoscopies. She had me perplexed until I realized there was a cycle to her symptoms. She would get abdominal pain and cramping and nausea and then when that subsided she would get a cough and flu like symptoms. Going back to the life cycle of the worm I thought maybe that is what she had and sure enough she did! We gave her the de-worming medicine and she is back to good health.

How funny that I learned about ascaris just in time to recognize it in both of these patients and that first patient made it so much easier to find when the second patient came in. I think that is one of the reasons I love medicine so much. Things like this happen all of the time. I wonder what the next adventure will be?

Ever since mobile phones became available in the early 1980s, there has been some concern about their use causing negative health effects.  The thought behind this was that low level exposure to radiofrequency electromagnetic fields, such as that emitted when using cellular phones, could lead to the development of brain tumors. A review of this possibility in the late 1990s led to the initiation of an international study on the relationship between cell phone use and brain tumors.

Known as the “INTERPHONE” study, its results were posted on June 17, 2010 – prior to the publication of the paper in the International Journal of Epidemiology.* This study is the largest case-control study done to date on cell phones and brain tumors and  included the largest number of cell phone users with at least 10 years of exposure. Also, it included the greatest cumulative hours of cell phone use of any prior study.

The study looked specifically at the occurrence of two types of brain tumors: gliomas and meningiomas. You may already know that gliomas are malignant and can be highly aggressive. Meningiomas, on the other hand, are not malignant, but can cause bad effects by virtue of growing and impinging on structures in the brain. 

The study found that there was no increased occurrence of meningiomas associated with regular cell phone use. For gliomas, the study found that there was no overall risk either, but also found was that there might be an increased risk only in those people who: 1) had the highest amount of time of cell phone usage; and 2)had gliomas located in the temporal lobe of their brain (located on either side of the head); and 3) reported regular cell phone usage on the same side as the glioma was found.  However, the researchers believe this finding about gliomas to be inconclusive since there were possible sources of error in the study that still needed to be analyzed.

Bottom line: the researchers believe that the possible causation of gliomas by longterm use of mobile phones requires further study.

What does all this mean for you? That the jury is still out on whether cell phones are definitely unsafe.  However, the fact that the study showed that those people who seemed to be at greatest risk for a glioma were those who had the highest level of exposure to the electromagnetic fields makes sense.

Could this study be an early warning? Medical literature is loaded with early studies, such as this, that showed a trend, but that were not statistically significant – or definitive – that a behavior caused a negative health outcome. Like cigarette smoking and lung cancer.  And we know how that turned out.

What should or shouldn’t you do? Well, you shouldn’t worry. But to be absolutely safe, you should consider either limiting the time you spend on your cell phone (that’s a tough one) OR start using an ear piece, at least until further studies are out. I’m headed out now to get my “Blue Tooth”.

*Posted: 06/17/2010; International Journal of Epidemiology. 2010;39(3):675-694. © 2010 Oxford University Press