Hold the heartburn on Thanksgiving

For many people, the Thanksgiving feast means overindulging, which can lead to a bout of indigestion and heartburn. But the easiest way to manage heartburn is to prevent it from happening in the first place. Keep your belly jolly this turkey day by trying these simple steps:

• Cut back on caffeine and alcohol
• Eat smaller meals
• Eat fewer fatty foods
• Go easy on spicy foods
• Give up smoking

If your heartburn is still bothering you, adjusting your bed may help soothe your stomach at night. Raise the head of your bed using wooden blocks, so that your head is higher than your feet. One small study found this helped ease heartburn symptoms.

A longer range strategy is losing weight if you need to, which may give you another reason to hold back on that second helping of stuffing during Thanksgiving.

If the diet changes don’t bring relief, then it may time to try a medicine. Your first and best bet is to try an inexpensive over-the-counter antacid like Maalox, Mylanta, Rolaids, Tums, or acid-reducing drugs called H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75, Zantac 150). All of those products are available without a prescription as low-cost generics.

If your heartburn persists and you experience it twice a week or more for weeks or months on end, then you should see a doctor because you may have gastroesophageal reflux disease, or GERD. This is a serious condition that can cause damage to your esophagus, if left untreated. The good news is that drugs called proton pump inhibitors, or PPIs, can help keep GERD under control. In our Best Buy Drug report, we recommend two over-the-counter proton pump inhibitors as your best first option if you have been diagnosed with GERD:

•   Prilosec OTC
•   Generic omeprazole OTC

Another option might be the nonprescription version of Prevacid, called Prevacid 24HR, which recently hit store shelves earlier this month.

All of these are just as effective and safe as more expensive PPIs but remember, if you are having an acute bout of heartburn on Thanksgiving day, a PPI should not be what you reach for first.  In most cases, an antacid or an acid-reducing H2 blocker is all you need.

—Steve Mitchell, associate editor, Consumer Reports Best Buy Drugs

Tips for staying flu-free during holiday travel

You may have heard that the swine (H1N1) flu outbreak has potentially peaked in the U.S. It’s possible—the CDC noted recently that flu-like activity has declined in every region of the country, though some areas are still seeing increases. But even at a declining rate, this year’s flu activity already outpaces a typical flu year, which generally doesn’t get going until December. “Even when a peak has occurred,” says Anne Schuchat, M.D., director of the National Center for Immunization and Respiratory Diseases, “half of the people who are going to become ill haven't gotten ill yet.” And there’s always the possibility of a second wave during a flu pandemic.

Officials also warn that holiday travel could lead to a bump in flu activity. So don’t let your guard down just yet. If you’re traveling during this Thanksgiving holiday, make sure you take some precautions. “The first step is to travel well," said Schuchat. “That means travel only when you are well.” Other precautionary measures that the CDC recommends, which should be familiar to readers of this blog, are:

• Washing hands frequently with soap and water or an alcohol-based hand sanitizer containing at least 60 percent alcohol
• Covering your coughs and sneezes with tissues or your sleeve
• And vaccination, especially if you’re in a priority group

The risk from flight
If you are flying this holiday season, crowded planes aren’t just a nuisance; they can actually increase your chances of infection. A review of studies published in 2005 in the British medical journal The Lancet called commercial airlines “a suitable environment for the spread of pathogens carried by passengers or crew.” However, they also concluded that the “perceived risk is greater than the actual risk.”

Study adds weight to case against cholesterol drug Zetia

 
Bad news continues to buffet the once-blockbuster cholesterol drug ezetimibe, which is sold under the brand name Zetia. Backing up research released last year, a new study has found that ezetimibe does not reduce fatty build-ups in the arteries, despite lowering levels of "bad" (LDL) cholesterol in the blood. On the other hand, one of the oldest treatments for high cholesterol—the B vitamin niacin—seems to help on both counts, say the researchers.

The study included 363 people with heart disease, or a high risk of the disease, who had been taking drugs called statins for several years to lower their cholesterol. Statins are the usual go-to drug when changes in diet and exercise don't reduce a person's cholesterol enough. But sometimes even statins fall short and people need additional treatment. Ezetimibe was approved by the FDA as a supplemental treatment, and for occasional use on its own, in 2002. Besides Zetia, you can also get a pill called Vytorin that combines ezetimibe with a statin (the earlier research looked at this combined form).

In the new study, half the people took ezetimibe and half took an extended-release version of niacin, in addition to their statin. All had regular ultrasound scans to check the narrowness of the arteries in their necks. The level of build-up in these blood vessels can help predict a person's risk of having a heart attack or stroke.

Q&A: Is an irregular heartbeat dangerous?

I seem to have an irregular heartbeat. Could that be dangerous? —D.S., Lady Lake, Fla. 

It could be. Minor, short-lived variations in heart rate or an occasional "skipped" beat are relatively common and usually completely harmless. But more frequent or sustained irregularities— like a recurrent racing heartbeat, or erratic rhythms that last for more than a few seconds—could indicate several serious problems, including heart disease, an overactive thyroid, or a reaction to certain drugs or dietary supplements. And the irregular rhythms themselves can cause dizziness, fainting, stroke, heart attack, or even sudden death in susceptible people. You should see your doctor right away to determine the cause of the perceived irregularity. If an electrocardiogram doesn’t turn up anything, your doctor will likely have you wear a continuous-recording monitor for at least 24 hours to provide a more complete picture.

Simple, cheap remedy for toenail fungus

I used to cringe when my yoga instructor told us to “take off your socks.” The big toenail on my right foot was an ugly flakey brownish gray, a condition I’ve had for years. It may have started when I was taking Tae Kwon Do and kept landing on my big toe while trying to do roundhouse kicking.

I don’t know which is more embarrassing, having a discolored toenail or being the only one in yoga class with socks on. I was also unhappy at the beach and the community pool in the summer. Yeah, I could paint my toenails, but I was hoping that if I let that big toe breathe, it would eventually get better.

The toe was not only discolored but sometimes uncomfortable, so I went to a podiatrist who said he thought I had a nail fungus and gave me a liquid topical with a brush (much like nail polish) to apply daily.  This I did for months and months without any noticeable change. I returned to the podiatrist and he clipped a piece of the nail to be analyzed, and it was confirmed, I had a fungus. He sent me for blood tests because the next form of treatment would be Sporanox (itraconazole), a prescription antifungal pill that carries serious health warnings and precautions. At first, it seemed as though the Sporanox was going to work and then the fungus returned. I was then given another liquid topical and another antifungal medicine.

Q&A: Co-Q10 supplements for statin safety?

I’ve heard that people on cholesterol-lowering statin drugs should take coenzyme Q10 (Co-Q10) pills to prevent muscle damage. Does any evidence support that? —M.R.V., by e-mail 

Not enough to recommend taking the pills for that purpose. Muscle pain or, rarely, muscle damage is a known side effect of statins, and several studies have found that some of those drugs can reduce natural blood levels of Co-Q10. And extreme deficiencies of the compound can cause similar muscle problems, which then respond to Co-Q10 supplements. But no study has determined whether Co-Q10 reductions actually cause the side effect in statin users. And to our knowledge, only one small, unpublished study has indicated that the pills can relieve that adverse effect. More important, people who experience muscle discomfort while on a statin should talk to their doctor about stopping the drug, reducing the dosage, or switching to a different one rather than taking a supplement to try relieving the symptom, which might signal a more serious problem.

Routine mammograms and the importance of rating preventive services

This week’s news from the U.S. Preventive Services Task Force (USPSTF) on routine breast cancer screening has caused quite the stir. The USPSTF shared their new ratings of preventive services for breast cancer: Mammograms work really well in women in their 60s, pretty well in women in their 50s and not so well in their 40s. If you want to have mammograms in your 40s prepare for more confusing results including additional imaging to clarify and in some cases, a biopsy to be certain. And their recommendations included a couple of small but important points: breast self exam doesn’t lead to early detection of breast cancer nor do breast exams by doctors (remember we are only talking about women who have NO symptoms). The big news: Doctors and patients in their 40s should talk to each other about what to do rather than just do the same thing all the time out of pure routine. What’s wrong with that?

We seem to have developed the view that more prevention is always better, more testing is better than less, and that more information is always helpful. But this week’s news challenges that notion…and that is what it was meant to do. Making decisions is hard, especially when we have a health problem. But it’s also true when there are health issues we may not have yet. Surprise, life isn’t simple.

The focus in the media has been on the USPSTF recommendations without sufficient attention to some important context issues. These include:

1) Breast cancer (and for that matter almost all cancers) is not one disease. They afflict us in multiple forms each with a different natural history. Some breast cancers are very aggressive and respond slowly if at all to our treatment options. Others are slower growing and very responsive to treatment.

2) Mammography is a better test in some people and for some cancers than it is for others, especially when screening at an early stage is what we want from it.

3) The USPSTF focuses on recommendations for primary care doctors for patients with no symptoms getting routine care.

Q&A: Preventing shingles?

A friend recently had a painful outbreak of shingles. How can I avoid that condition? —F.J.S., Franklin, N.C.

If you’re age 60 or older, you can get the shingles vaccine. About one in four adults who’ve had chicken pox will eventually experience shingles, a painful, blistering rash that occurs when the herpes zoster virus—which lies dormant in the body after a case of the pox—is reactivated by weakened immunity from age, disease, or another factor. The vaccine cuts your risk of a first outbreak in half, and reduces discomfort by about two-thirds in the event you do get shingles. (The odds of a second outbreak are much smaller, only about 1 in 20.) Your doctor should be able to provide the shot, which costs about $150 and is partly covered by most forms of insurance.

Partners in crime: Diabetes and obesity

The number of Americans with type 2 diabetes has almost doubled in the past decade, to an estimated 24 million. That includes the one in four who don’t even know they have the disease. And some experts believe it won't be long before that number exceeds 30 million.

Why the explosion? Obesity. Up to a third of us are now clinically obese. And since the vast majority of people with type 2 diabetes are also overweight, it's no wonder those two disorders are often referred to as twin epidemics. Indeed, three out of four respondents to a Consumer Reports survey of 5,012 people with type 2 diabetes said they were overweight. And overweight respondents were more than twice as likely to say that they were unsuccessful at managing their diabetes.

The good news is that efforts to rein in excess weight can help prevent and control the condition. For example, a three-year study published in the New England Journal of Medicine showed that for people at high risk for type 2 diabetes, a 7 percent weight loss through diet and 30 minutes of exercise, five days per week, resulted in a 58 percent drop in the expected incidence of the disease. And our survey found that efforts to control weight, by improving diet and increasing activity, were effective strategies for helping people successfully manage their diabetes. Diabetes educators and dietitians were rated as being more helpful than primary-care physicians and endocrinologists in educating patients about nutrition.

The bottom line: The solution to tackling obesity and diabetes is simple. You can't choose your parents, but there are no barriers to eating right and exercising.

—Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser

Quit smoking today—and start looking better tomorrow

Fewer wrinkles. Better-smelling breath, hair, and clothing. Healthier teeth and gums. More money in your pocket. An improved sense of taste and smell. A reduced risk of heart disease, stroke, chronic obstructive pulmonary diseases, and cancer of the lungs, cervix, pancreas, throat, intestine, kidneys, and bladder. Most important, up to 10 years added to your life span. Despite these convincing reasons to quit smoking, Americans are not getting the message that smoking can not only shorten your life, but also increase the risk of death in those who come into contact with your secondhand smoke—including your children.

According to a recent study by the Centers for Disease Control, the rate of U.S. smokers in 2008 (20.6 percent) has remained virtually unchanged since 2004, when 20.9 adults reported being smokers. And 20.6 percent translates to 46 million U.S. smokers, 443,000 preventable deaths each year, and $96 billion in annual health-care costs. Hardest hit by the tobacco epidemic are vulnerable populations, including people with lower levels of education.

If you smoke cigarettes, choose to quit today as part of the 34th Great American Smokeout. It’s true that quitting is no simple task—and you may have made several honest attempts before. But considering the damage cigarette smoke does to your looks, on top of your health and the health of those around you, it’s worth another try. Consider these practical ways to help you get started:

Lasting legacy of breast cancer

Surgery for breast cancer undoubtedly saves lives—but for some women, it also leaves a legacy of long-term pain. Now doctors are being urged to identify the women most at risk, so they can treat pain quickly after surgery.

A recent study showed that almost one half of all women who had surgery for breast cancer in Denmark over a two-year period still had pain two to three years later. The pain was mostly in their breast area, although it extended to the armpit, arm, and side of the body for some women.

Half of these women classed their pain as moderate or severe, and many had pain every day. So it’s clearly a major issue that needs to be tackled.

Surprisingly, the main factor that predicted whether a woman had pain was how old she was. Under-40s were the most likely to have pain, with 64 in 100 women saying they still had pain on average of 26 months after surgery. By comparison, only 40 in 100 women aged 60 to 69 said they had pain.

Q&A: H1N1 vaccine and Guillain-Barré risks?

Should I get the swine flu (H1N1) vaccine if I’ve had Guillain-Barré syndrome? —J.M., Irvington, N.Y.

That depends in part on your risk of getting swine flu and becoming seriously ill if you do. It’s true that some studies have associated flu vaccines with a slight increase (about one person per million) in the risk of developing Guillain-Barré syndrome (GBS), a neurological disorder. And some evidence suggests that a previous case of GBS increases your risk of getting it again. But the flu itself can also cause GBS as well as such complications as pneumonia and in rare cases, death. If you’re among the priority groups for H1N1 vaccination—including pregnant women, health-care workers, and people ages 25 to 64 with underlying conditions such as diabetes and heart or lung disease—the shot’s benefits probably outweigh its risks.

Q&A: Viagra and eye problems?

I take sildenafil (Viagra), which temporarily gives a blue tint to my vision. Recently I was also diagnosed with macular degeneration. Will taking sildenafil worsen that? —Name and address withheld

Probably not, but few studies have looked into it. Sildenafil affects vision by blocking an enzyme that helps the eyes process color. But the limited studies available, mostly funded by drug manufacturers, show that effect is transient and appears to have no long-term effect on eye function. A few small studies of patients with macular degeneration or glaucoma taking sildenafil have shown the drug doesn’t worsen either condition within up to five hours of taking it. 

The only eye condition that’s been associated with sildenafil use is a rare blockage of blood flow to the optic nerve that causes a sudden, permanent decrease in vision in one eye—though it’s not clear what role the drug plays, if any, in the condition. If you experience such an impairment, contact your eye doctor right away.

Read more on the side effects of sildenafil, find out if women should take Viagra, and see our Treatment Ratings for macular degeneration (subscribers only).

Avoid dangerous combination: Blood thinner Plavix with some heartburn drugs

The Food and Drug Administration warned today that people who take the blood thinner clopidogrel (Plavix) should not take the heartburn drugs omeprazole (Prilosec, Prilosec OTC, and generics) and esomeprazole (Nexium) because two new studies confirm that the combination could have dangerous consequences. The studies show that omeprazole and esomeprazole—both members of a class of stomach acid-reducing drugs called proton pump inhibitors, or PPIs—can lower the effectiveness of Plavix , putting people at risk of heart attacks or strokes.

Plavix is given to people after a heart attack to help reduce the risk of blood clots that can trigger another attack. The drug can be hard on the stomach and cause gastrointestinal bleeding, so people are often prescribed a PPI treatment, which reduces the amount of acid in the stomach and lowers the risk of stomach bleeding. But previous studies suggested this drug combination may actually increase the risk of having another heart attack. The FDA’s warning is based on two new studies from the makers of Plavix that show that both omeprazole and esomeprazole reduce the drug’s effectiveness because they block an enzyme in the body called CYP 2C19.

The agency said it does not have enough information to draw a conclusion about whether any other PPIs can be safely used with Plavix, but studies into this issue are being conducted. However, a different type of acid-reducing drug called cimetidine (Tagamet, Tagamet HB, and generics) also inhibits the CYP 2C19 enzyme and should not be taken with Plavix.

What your walking speed can tell your doctor

Doctors are trained fortune-tellers of sorts. But instead of divining the future through tea leaves or Tarot cards, they look to our bodies for clues. If our blood pressure is high, they may warn of heart and circulation problems that could be down the road. Ditto for high cholesterol. But doctors can also draw upon subtler signs — even, for example, our walking speed.

As odd as it may sound, studies show that healthy older adults who walk slowly are at higher risk of falls, disabilities, frequent hospital visits, and other health problems. And, according to a new study, slow walkers also have triple the chance of dying from heart disease, although the reasons aren't yet clear.

The study included 3,208 seniors ages 65 to 85 in France. Each person's walking speed was clocked over 6 meters (almost 20 feet). The researchers then checked on the participants every couple of years. All were in reasonably good health at the start of the study, and didn't have any conditions that could have substantially affected how fast they walked, such as Parkinson disease, dementia, or a disabling stroke.

After five years, 209 people had died, including 99 from cancer, 59 from heart disease, and 51 from other causes (such as infections and respiratory failure). The researchers found that the slowest walkers were three times more likely to have died of heart disease than those who walked at a faster clip. However, they didn't find a link between slow walking and other causes of death, including cancer.