New Findings Change Aspirin-a-Day Guidelines

Our concierge family practice doctors in Jupiter understand the temptation to pop a pill—whether a prescription medication or a supplement—to stay healthy, instead of following more difficult suggestions regarding exercise and diet.

And to be sure, the long-standing belief that taking a daily low-dose aspirin can prevent heart attacks has some scientific basis for those who’ve already suffered a heart attack. In addition, some earlier research did seem to support daily aspirin use for reducing the risk of numerous cancers as well as Alzheimer’s disease.

Latest findings

But the good thing about science in general and medical research in particular is that researchers are constantly reviewing and refining established knowledge. In the case of the aspirin-a-day approach, for example, several new studies in the last year have challenged the practice of taking a low-dose (81 mg.) aspirin to prevent cardiovascular disease (CVD). And this month the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines recommending against the use of daily low-dose aspirin, based on these studies.

One study published last month in the Journal of the American Medical Association (JAMA), for example, found that people without heart trouble who took a daily dose of aspirin had a lower risk of heart attack, stroke, and death. These benefits, however, were canceled out by the increased risk of bleeding in the intestinal tract or the brain, which can often be deadly.

Researchers in that study performed a meta-analysis of 13 studies that included 164,225 participants, none of whom had CVD when the studies began.

“For every 256 patients treated with aspirin for five years, one heart attack, stroke or death from cardiovascular disease would be prevented,” Dr. Sean Zheng, lead author of the study and and academic clinical fellow in cardiology at King’s College Hospital in London, told CNN. “On the other hand, for every 210 patients treated with an aspirin over the same period, one would have a serious bleeding event.”

“This calls into question the net benefit of taking aspirin, and whether people who have not previously had cardiovascular disease should take aspirin,” Zheng said.

Another study published last fall in the New England Journal of Medicine (NEJM) reported similar results, even finding that older patients experienced no health benefits at all from daily aspirin use. These and other recent studies are what led to this month’s revised recommendations from the AHA/ACC.

“We knew there would be an increased risk of bleeding with aspirin, because there has always been,” recommendations co-author Dr. Anne Murray told NBC News. “But not only did it not decrease risk of disability or death, it did not decrease the risk of heart attack and stroke, and there was an increase in the rate of death.” Murray is also a geriatrician and epidemiologist at the Hennepin Healthcare Research Institute and the University of Minnesota, Minneapolis.

In their statement, the AHA/ACC advised against taking a preventive aspirin a day, saying it may actually cause more harm than good.

“We’re talking about healthy people who don’t have known heart disease or stroke, who might have been considering or [are] already taking an aspirin to prevent that heart attack or stroke in the first place,” said Dr. Erin Michos, another of the authors of the new AHA/ACC guidelines.

The AHA stressed that the new recommendations do not apply to people who have already had a heart attack or stroke, or who have undergone such procedures as receiving a coronary artery stent or bypass surgery. But for the elderly (people over 70) and those with a high risk of internal bleeding, the AHA cautioned that “aspirin may do more harm than good, but there are no absolutes, so these decisions need to be tailored to individuals.”

Another co-author of the revised recommendations suggested that doctors might advise their patients who have a strong family history of heart disease to take a daily aspirin. This could also apply to those whose tests reveal considerable plaque build-up in their arteries. But for those with a low or moderate risk, lifestyle changes could have a more salient effect.

“Eat a heart-healthy diet, get regular physical activity, control blood pressure and control cholesterol,” Michos said. “If [people] need a statin, take it. Those are much more important when compared to recommending aspirin.”

As with so many other over-the-counter remedies, we always recommend you check with us before taking them. Each person is different and their needs and sensitivities are also different. We can help determine the best course for you.

new-years resolutions doctors

Easy New Year’s Resolutions for Your Health

As humans, we look to a new year for a fresh start, especially regarding our health. Toward that end, we make resolutions, which we have every intention of keeping but which are often forgotten by February.

Our concierge doctors in Jupiter, Florida at MD2.0, would like to offer you some ideas on small ways to improve your overall health that we hope you’ll find easier to stick with.

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concierge doctor jupiter headaches

Is it a Headache or a Migraine?

If you have a painful throbbing in your head, you may be very uncomfortable but think it couldn’t be a migraine because it’s not debilitating. Or you don’t have the shimmering lights in your vision or nausea and vomiting that you’ve heard usually accompanies a migraine.

Regardless, you could still be suffering from a migraine and not know it. Or you could have an ordinary headache with several of the symptoms of a migraine. The symptoms of headaches and migraines can vary so much from person to person that it can sometimes be difficult even for doctors to tell the difference.

So why does it matter, then? Can’t you just pop a couple aspirin, slap on an ice pack and say you’ve got a painful headache? No, because the treatments are different for each, and sometimes a headache is more than that. That’s why your concierge doctors at MD 2.0 in Jupiter, Florida, want to explore the different types of headache, including migraine, and help you decide when to get seek medical attention.

Migraine

A migraine is not technically a headache, but a neurological disorder that includes a constellation of symptoms, with a painful, long-lasting headache at the center. Its main symptom is a severe throbbing pain or pulsing sensation in the head, which feels like a very bad headache, usually on one side of the head, but in a third of migraine attacks, both sides are affected. It is often—but not always—preceded by what is known as an “aura,” strange tricks of vision that can encompass anything from a blind spot in the vision to flashing or shimmering lights to wavy or zigzagging lines. Migraines are also usually, but not always, associated with such symptoms as nausea, vomiting, and extreme sensitivity to lights and noises, and can also include a pins-and-needles sensation in the arms and legs or a weakness or numbness on one side of the face or body.

One or two days before the onset of a migraine, patients often experience subtle body signals (called “prodrome”) that can alert them to an upcoming migraine. These changes can include neck stiffness, constipation, increased thirst and urination, food cravings, frequent yawning, and mood swings from depression to euphoria. To complicate the issue even further, it’s possible to have many of the migraine symptoms, especially the aura, without the headache. The primary signature of a migraine, however, is the extreme incapacitation associated with the headache pain involved.

Other headache types

Just because a headache isn’t officially classified as a migraine doesn’t mean it can’t be painful or even somewhat debilitating. And there are several types:

• Tension headache, the most common, is usually felt around the head and scalp and the back of the head or neck. Often called “stress” headaches, they are further divided into episodic and chronic, depending on how often they occur, and can be uncomfortable but don’t normally restrict regular activities.

• Cluster headaches, most often experienced by men, are called that because they tend to occur in clusters or groups, sometimes several in a day over a period of weeks or months, then they disappear, often for years. Because they can be quite painful and occur on one side of the head, they are sometimes difficult to distinguish from migraines.

• Sinus headaches are frequently misdiagnosed, but in general, they must be accompanied by nasal congestion, watery eyes, and fever, due to the infection in the sinuses that causes them.

There are a number of other types of headaches, categorized by their causes, such as menstrual headaches, ice cream headaches, and caffeine headaches, among others. The most serious (i.e. dangerous) is the so-called “thunderclap” headache which occurs suddenly like a clap of thunder and causes extreme pain. This is a medical emergency that must be investigated immediately.

Treatment

For common headaches, many people find relief with over-the-counter (OTC) pain-relief-med.com, ice packs, and rest. Others swear by less conventional treatments such as caffeine, ginger, hot showers, acupuncture, or even massaging the temples with lavender or peppermint oil. It’s helpful to determine the cause of frequent headaches, so keeping a diary of symptoms can help pinpoint triggers.

Because symptoms and treatments of the different headache types overlap, if these typical home remedies don’t work, it’s best that you come and see us for an evaluation. There are numerous new prescription drugs available to treat migraines, as well as other more stubborn headaches.

Sometimes a headache isn’t “just a headache,” so if your headaches are debilitating, let us know. We can help.

concierge doctors exercise effects

Exercise Is the Best Medicine

Your concierge family practice doctors at MD 2.0 in Jupiter, Florida, realize that to some people “exercise” is a chore. But study after study demonstrates the health benefits of regular movement, as well as the dangers of little-to-no exercise.

 

The danger of not exercising

Here’s another study that underscores the dangers of the sedentary lifestyle. Published last month in the Journal of the American Medical Association (JAMA), this one found that a lack of regular exercise is as detrimental to health as smoking, diabetes, and heart disease.

“Being unfit on a treadmill or in an exercise stress test has a worse prognosis, as far as death, than being hypertensive, being diabetic or being a current smoker,” Dr. Wael Jaber, a cardiologist at the Cleveland Clinic, told CNN. The senior author of  the study, he called the results “extremely surprising.”

“We’ve never seen something as pronounced as this and as objective as this,” he added. “[Being unfit] should be treated almost as a disease that has a prescription, which is called exercise.”

Researchers investigated 122,007 former patients at Cleveland Clinic who were tested on a treadmill between January 1, 1991 and December 31, 2014. They found those with the lowest level of fitness, i.e., a sedentary lifestyle, had a risk of death almost 500 percent higher than those who were the most physically fit.

This is only the latest study to document the danger of the sedentary lifestyle. Here are just a few others:

  • A Texas study published in January found that for people over 50, regular exercise reversed the effects of aging, including hardening of the arteries and less efficient heart muscle action.
  • Another showed a 40 percent decrease in cancer deaths among those who were more active than their sedentary counterparts.
  • In the famous Nurses’ Health Study, those who exercised for a half-hour or more a day halved their risk of heart attack and stroke.
  • Another Texas study found that men who were considered physically active lowered their stroke risk by two-thirds.

There are many others, and they all reach similar conclusions: A lifestyle that includes little physical exercise is deadly.

 

Too late to start?

But what if you’re no longer in the so-called “prime of life”? It’s a little late to bother with exercise, isn’t it? The answer is a resounding no. One study published in the Journal of the American College of Cardiology tracked the progress of 33,000 Swedish men from 1998 to 2012 who began exercising at an average of age 60. They reduced their risk of heart failure by 21 percent.

The important thing to remember when starting an exercise routine later in life is to start slowly, don’t push yourself, and work your way up to maximum fitness level. You may never compete in the Olympics, but you’ll notice improvements in every area of your life.

 

Benefits of exercise

Whatever age you begin regular exercise, you’ll begin to notice the positive effects within days. According to the Mayo Clinic, here just 10 of the many benefits of regular aerobic exercise:

  1. Losing weight and keeping it off
  2. Increased stamina
  3. Warding off viral illnesses like colds and flu
  4. Reduced risk of obesity, heart disease, high blood pressure, type 2 diabetes, stroke and certain types of cancer
  5. Control of chronic conditions including coronary artery disease
  6. Strengthening the heart muscle to slow the pulse, pump blood more efficiently, and improve blood flow to the entire body
  7. Boost the “good” cholesterol (high-density lipoproteins or HDL) while lowering “bad” cholesterol (low-density lipoproteins or LDL) helping to reduce plaque buildup in the arteries
  8. Reducing tension, anxiety, and depression
  9. Helping maintain mobility and brain function in older age
  10. Living longer.

We cannot stress this enough: Regular exercise is vital to your overall health and well-being. If you’re tired of feeling tired and dealing with various aches and pains, pick an exercise and go for it. Just be sure to check with us first.

rare disease afm

Mysterious Illness Spreading, But Still Very Rare

Your concierge family practice doctors in Jupiter, Florida, at MD 2.0., have been hearing concerns from our patients about the recent publicized increases of a rare polio-like disease occurring mainly in children. The Centers for Disease Control and Prevention (CDC) is investigating as many as 127 cases of acute flaccid myelitis (AFM) in at least 22 states this year. Some news outlets place the number of states affected closer to 30, because reporting cases to the CDC is voluntary, and this information may not have reached the CDC yet.

The symptoms of AFM are very similar to polio, a disease that was eradicated in the U.S. through the use of universal immunization. AFM affects a person’s nervous system, specifically the spinal cord, causing weakness in one or more limbs. It tends to begin about a week after a slight fever or respiratory illness, but can suddenly appear as weakness in the arms and legs. Other symptoms can include slurred speech or difficulty swallowing, or a “drooping” appearance in the face. Many patients recover quickly, while others continue to have paralysis requiring ongoing care.

More than 90 percent of the cases the CDC has confirmed have occurred in children under age 18; the average age is four. Although one death from AFM was reported last year, no deaths have been associated with the illness so far this year.

Cause still unknown

AFM was even rarer prior to its first major U.S. outbreak in 2014 when 120 cases were confirmed. The illness seemed to slack off in 2015 with only 22 confirmed cases, then spiked again in 2016 (149 cases), dropped in 2017 (33 cases), and now in 2018, we have 62 confirmed cases so far with an additional 65 suspected cases being investigated by the CDC. So not only do the cases seem to be rising then declining from year to year for reasons that are still unclear, but they also seem to cluster in the fall months. There are no state clusters, however, suggesting the illness is not spread from person to person but arises spontaneously.

The most frightening thing about AFM is that scientists have been unable to pinpoint a cause. All the confirmed AFM patients have been tested for poliovirus, and have definitively tested negative. The CDC has also tested every case for evidence of a wide range of known pathogens (germs) or viruses and has been unable to detect a consistent pattern among those affected.

What is known

Scientists continue to look for a common thread. Given the persistent controversy over vaccinations, it should be noted that those affected have differing histories on vaccinations: Some of the patients were vaccinated, some were not. (Incidentally, in October an unvaccinated child in Florida became the first person to die from this year’s flu.)

Unless it can be found that all those who contracted the illness share a common trait, such as being or not being vaccinated or contracting the same type of cold or flu, or having traveled to a certain place or having come in contact with some pollutant, the cause of the syndrome will remain a mystery.

What is also known is that the chances of developing AFM is less than one in a million, according to the CDC.

Should you worry?

The likelihood of you or your child developing this distressing illness is miniscule, but there is a chance, especially since this is a year in which the cases are spiking. But we believe there is little cause for concern. As a parent, you should take the typical precautions you always do to ensure your child stays healthy: obtaining the recommended vaccinations, ensuring they wash their hands regularly and practice accepted hygiene methods, eating well, exercising, and getting enough sleep.

Just be aware that AMF strikes with little warning, and watch your child for any signs of the symptoms described above. If you have any concerns or questions, please don’t hesitate to contact us immediately.

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