6 Spring cleaning tips for your sinuses

If you have stubborn sinuses or sinusitis, here are six tips for tackling allergens around your home that may be causing or aggravating your symptoms, like dust, dust mites, and pet dander.

1. Encase your mattresses, box springs, and pillows in allergen-proof covers.
2. Use an air conditioner or dehumidifier to keep humidity levels in your home under 50 percent.
3. Remove carpeting from your bedroom.
4. Vacuum weekly. High-efficiency particulate (HEPA) filters are good at trapping particles, although vacs without the filters can do just as good a job.
5. Wash curtains, throw rugs, bedding, and clothes in very hot (140° F or higher) water or add an extra rinse cycle.
6. If symptoms persist after you try all these things, consider a good portable or whole-house air cleaner that will remove fine particles like dust mite droppings and pet dander from the air.

Read more on sinusitis (free), and on avoiding allergens inside—and outside the home (subscribers only).

Mother's Day: Stay healthy—heed your own advice

Mothers give their children quite good advice: eat your breakfast, go to bed, and, when needed, take your medicine. We schedule yearly visits to the pediatrician, call for appointments at the first sign of infection, and make sure that vaccinations are kept up-to-date.

But when it comes to our own health, we often toss all wisdom aside, getting too little sleep, eating on the run forgetting to schedule an annual physical. And when I ask patient-moms which regular doctor they see, most will admit they haven’t gotten around to finding one yet. We could feel lousy for weeks before we seek care, and by the time we schedule a visit, we’re at the end of our ropes.

A few years back, I ignored a minor shoulder injury. Even though the pain was severe enough to wake me up at night, I continued to carry a heavy laptop for months. When I finally saw an orthopedist, he told me I had an enormous bone spur. I could have avoided the damage if I had gone to him earlier and followed a few easy restrictions. All the sleep deprivation also took its toll—I was tired at work, and at home, too.

When we’re sick and run down, our patience runs thin, and our mothering tends to suffer along with our health. As they say before takeoff, put your own oxygen mask on first—you’ll be less help to your children if you’re not ready yourself. So, mothers, get enough rest, eat balanced meals, and don't forget to take your calcium. And for this Mother’s Day focus on health—if not for yourself, for your family’s sake.

—Orly Avitzur, M.D., medical adviser to Consumers Union

Read more on women's health at our Women's Condition Center—and take a peek at gift ideas for Mother's Day.

Women can get different heart attack symptoms than men

It seems Hollywood has been doing a disservice to women when it comes to showing what a heart attack  feels like. Although men often get the signs of a heart attack that appear on the Silver Screen, like tightening of the chest, shortness of breath, clutching the chest and dropping to one knee, a new and as yet unpublished study has found that women can get different symptoms.

Researchers conducted in-depth telephone interviews with 30 women who had had a heart attack, within seven days of their being discharged from the hospital, about what had happened to them. The average age of the women was 48—not the age you might associate with heart disease. Many of the women said they didn't realize their symptoms could be due to a heart problem, or that they were even at risk of heart disease.

The study, presented by researchers from Yale School of Medicine at a recent meeting of the American Heart Association, found that women who had a heart attack often got atypical symptoms, such as neck and shoulder pain, discomfort that was easy to mistake for indigestion, or unusual fatigue.

Researchers say they found the women were surprised to find their actual symptoms differed from the "Hollywood heart attack" that they would have expected. And because they didn't link these symptoms to heart problems, women often delayed seeking medical care. But it's not just the women who were confused. They reported that doctors also often failed to act quickly because they didn't realize women were having a heart attack.

A knowledge gap that needs filling

This study highlights the need to educate both the public and the medical profession about what symptoms women can get with a heart attack. Although heart disease is still quite uncommon in women in their late 40s and early 50s, every year 16,000 American women in this age group die from heart problems and 40,000 need to be treated in the hospital. Overall, 460,000 American women die from a heart attack annually.

—Zosia Kmietowicz, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Kids with ADHD should get a heart test before drug treatment

Children with attention deficit hyperactivity disorder should get an electrocardiogram, or ECG, before starting medication for the problem, an April American Heart Association statement recommends. The advice stems from growing evidence that the drugs commonly used to treat ADHD can elevate heart rate and blood pressure, and may increase the risk of sudden cardiac arrest. The latest estimates suggest that ADHD occurs in 5-7 percent of school-aged children in the U.S.

For most children with ADHD those effects appear to be minimal. But they can pose serious risks to children who have certain heart abnormalities. And the standard health exam most kids get from their doctor before starting the drugs may not reveal those abnormalities. Moreover, research suggests that children with ADHD may have a higher than average risk of heart problems.

For all those reasons, the new AHA recommendation calls for children and teens to have an ECG to measure the heart’s electrical activity and look for heart rhythm abnormalities before they start ADHD drugs. Those already taking the drugs should consider getting an ECG if they haven’t previously had one. Individuals with worrisome results on that test should be referred to a pediatric heart specialist before starting the drugs, and undergo frequent follow-up exams once they do.

Common ADHD drugs include dextroamphetamine (Dexedrine, Dextrostat, and generic), methylphenidate (Concerta, Ritalin, and generic), and Adderall, which is a combination of several amphetamines and is also sold as a generic.

The new concerns shouldn't stop parents and kids from seeking treatment for ADHD. But they do underscore the importance of thorough diagnosis and careful treatment. Indeed, as we have reported previously, many children and teens labeled as ADHD either do not have it or have only mild symptoms. They may not need medication at all. So be sure to get a second opinion if you have doubts.

For more about symptoms and medications to treat ADHD, read our free Best Buy Drugs report and our treatment ratings (subscribers only) on the condition.

—Joel Keehn, senior health editor

Hands-only resuscitation replaces mouth-to-mouth

It's a disturbing fact that only a third of adults who collapse from cardiac arrest get the emergency first aid that can help them survive. Cardiopulmonary resuscitation (CPR) usually involves giving a person mouth-to-mouth while pressing hard on the center of the chest. The procedure, which can be performed by any adult, is intended to maintain a flow of blood and oxygen to the heart and brain until emergency medical help arrives, and it doubles someone's chances of surviving. Yet bystanders are often worried about making things worse, and many people don't like the idea of giving mouth-to-mouth.

Now, a round-up of the research on cardiac arrests, published by the American Heart Association (AHA), says that, in many cases, using chest compressions alone (called "hands-only CPR") is likely to work just as well as traditional CPR using mouth-to-mouth. And bystanders may also find it easier to carry out.

According to the AHA, anyone who sees an adult suddenly collapse should:

• Call 911
• Push hard and fast on the center of the person's chest.

The AHA points out that an adult who collapses and isn't responding is very sick, so there's very little chance of making things worse. It's fairly common to break a rib while doing CPR, but without urgent help, a person in cardiac arrest is almost certain to die.

You need to continue with CPR until emergency services arrive. Chest compressions are hard work, so if there's someone around who can help, swap over as you get tired. If you're on your own, just do the best you can.

There are still some instances where traditional CPR, including mouth-to-mouth, is better. Adults who are found already unconscious, children, victims of drowning or people with breathing problems may be better off getting traditional CPR. If you've been taught how to give mouth-to-mouth resuscitation, and are confident you can do it, you can still do CPR in the way you were trained. But any attempt at CPR is better than nothing.

If you see someone collapse, call 911, then start pushing hard and fast on the center of the person's chest. If you've been trained in CPR that includes mouth-to-mouth, and you're confident you can do it, add 2 breaths for every 30 chest compressions.

—Philip Wilson, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Help yourself: Learn how to rate and manage pain

Pain is the main complaint for about 40 percent of patients visiting primary-care doctors with roughly half of the people with chronic or recurrent pain failing to get adequate relief. In many ways pain remains a medical mystery, but here’s what to do for occasional, severe, and recurrent pain:

Self assess. First, assess how bad the pain is. Rate it on a scale of 0 (no pain) to 10 (the worst pain you could imagine). For pain that you rate 5 or less, start by self-treating with nondrug measures. For example, use heat to help ease back pain or cramps. You can also use over-the-counter pain relievers, which typically suffice for this level of pain.

How to choose an over-the-counter. Choose a drug based on the type of pain and your risk factors. Acetaminophen (Tylenol or generic) is often a good option. At recommended doses it's reasonably safe and effective for most people. People who drink heavily or have a liver disorder should avoid acetaminophen, since it's toxic to the organ. Ibuprofen and naproxen are often good over-the-counter choices if acetaminophen isn't enough. They not only ease pain but also quell inflammation. Both drugs are probably safer than aspirin, which poses a higher risk of bleeding. And while long-term use of any NSAID poses serious gastrointestinal and possibly coronary risks, the short-term use of recommended doses is generally safe for most people who don’t have heart, kidney, or stomach problems.

Severe-pain solutions. If you rate your pain at 6 or higher, it doesn’t improve with nondrug steps and OTC drugs, or it lasts longer than a few days, see your doctor. He or she might suggest a prescription NSAID, because a different or stronger formulation may yield additional relief. Another approach can be a prescription opioid such as oxycodone (Oxycontin and generic). You or your doctor might resist using such drugs because of addiction concerns. But physical dependence typically requires several weeks of use, and psychological dependence in patients with acute or severe pain is unlikely because they rarely experience euphoria from the drugs.

Medications that pair an opioid with acetaminophen, aspirin, or ibuprofen may be an even better choice. Those can provide greater relief, since the two ingredients work in different ways, and they reduce the risk of side effects because the combination permits smaller doses of each.

Recurrent pain. Even when the pain is relatively mild, chronic or recurrent pain from arthritis, headaches, or other sources can seriously interfere with everyday activities. Since chronic pain often ebbs and flows, rating your discomfort on the 0 to 10 pain scale can help you decide, day to day, how to manage the problem.

For more information, see Consumer Reports’ Best Buy Drug report on opioids.

Smart shopping for hospital care

Want to know which hospital is best suited to treat your medical condition? Or would you simply like to know how other patients really felt about their care while being treated at your local hospital? New data released last week can help you decide without having to rely on word-of-mouth recommendations or other biased information.

A new consumer Web site, Hospital Compare, offers data from about 2,500 hospitals that care for adult patients, which can allow you to make an informed choice about hospital care.

The information, known as HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), allows consumers to see how frequently hospitals offer treatments for heart attack, heart failure, pneumonia and surgical patients. The HCAHPS information was collected through surveys given to patients after they received hospital care. Among the 27 survey topics patients responded to were:

• Communication with doctors and nurses
• Cleanliness of the hospital
• Pain management
• Information received when being discharged from the hospital
• Willingness to recommend the facility to others

Information is to be updated quarterly and data from most of the nation’s hospitals is to be appear on the site by year’s end.

Hospital Compare is the result of a cooperative effort among members of the Hospital Quality Alliance (HQA), the Centers for Medicare and Medicaid Services, which is a part of the U.S. Department of Health and Human Services.

In presenting the site to members of the media, Michael O. Leavitt, U.S. Health and Human Services secretary said, “This is not about eliminating anyone. This is about improving everyone.” And it’s also about informing everyone.

Check it out for yourself at www.HospitalCompare.hhs.gov.

—Gayle T. Williams, deputy editor

Are adults snoozing while kids are "snusing?"

I recently wrote a blog about hookah smoking—prompted by my sixteen-year-old son—about the practice among teenagers. When he read it online, his blasé response was that it was "so yesterday's news." The preferred method of tobacco in school these days, he said, is smokeless tobacco. In addition to chewing tobacco which comes in the form of loose leaf, plug or twist, the current rage is a less conspicuous product called "Snus", a non-chew, no-spit oral tobacco that's stuffed between the lip and gum.

One of the more popular brands, Camel Snus, manufactured by tobacco giant RJ Reynolds, is sold in tea-bag like pouches about the size of a lozenge. Teachers can't easily detect the pouches, so kids can fly under the radar when they use it in school. Even so, the habit has become so prevalent that there have been recent announcements on the loudspeaker at my son’s high school reminding students that smokeless tobacco is a code of conduct violation. When I asked my son how common it was, he guessed that about 10 percent of the boys in his class were using it.

Although teens have been known to exaggerate, his estimate is actually under the national average. A Morbidity and Mortality Weekly Report released in June 2006, revealed that the prevalence of smokeless tobacco use is closer to 14 percent among high school-aged boys and a little over 2 percent among girls. The rate varied widely across states with 4.4% usage among male students in Maryland and 26.5% in West Virginia. Overall, the percentage was highest among white male students (17.6%) and rose each year from 9^th to 12^th grade among male students.

According to the CDC, smokeless tobacco carries four dangerous health effects:

• It contains 28 cancer-causing agents (carcinogens).
• It’s a well- known cause of cancer, increasing the risk of cancer of the mouth.
• Oral health problems strongly associated with smokeless tobacco use are leukoplakia (a lesion of the soft tissue that consists of a white patch or plaque that cannot be scraped off) and recession of the gums.
• Smokeless tobacco use can lead to nicotine addiction and dependence and adolescents who use smokeless tobacco are more likely to become cigarette smokers.

It’s quite possible that kids are unaware of these warnings. But last week, a 24-year old patient told me that he wished he had known more about the risks when he was using chewing tobacco in high school. When he tried to quit after six years, he found it impossible. He said that coaches and teachers had turned a blind eye to the habit, and that no one warned him that it could be harmful.

Several tobacco companies have banked on the lack of attention paid to smokeless tobacco—the five largest smokeless tobacco manufacturers spent a new record of $250.79 million on smokeless tobacco advertising and promotion during 2005 alone. Despite the 1998 Smokeless Tobacco Master Settlement Agreement—a legal settlement between the states and the tobacco companies prohibiting tobacco companies from taking "any action, directly or indirectly, to target Youth... in the advertising, promotion or marketing of tobacco products."—smokeless tobacco companies have continued to advertise in magazines with high youth readership. According to a new report published in the March 2008 issue of the American Journal of Public Health, magazines with high youth readership accounted for roughly 47 percent of all smokeless tobacco expenditures.

Tobacco-free kids, a non-profit organization dedicated to reducing tobacco use, advises that smokeless tobacco companies in the United States have a long history of creating new products that appeal to kids and marketing them aggressively. The U.S. Smokeless Tobacco Company markets candy-flavored spit tobacco including berry blend, mint, wintergreen, apple blend, vanilla blend and cherry. Indeed, it has been alleged that manufacturers have developed flavored products with lower nicotine concentrations to get users early so that they become dependent and seek out products with a higher nicotine concentration.

This so-called "graduation strategy" worked with my patient. By the time he had graduated from college, he had graduated to cigarettes.

Read our free facts about smoking and our complete Treatment Ratings and Natural Medicine Ratings (subscribers only) on how to quit .

—Orly Avitzur, M.D., medical adviser to Consumers Union

Tracking down migraine triggers

If you can pinpoint exactly what’s causing your migraines, you might be able to better treat them—or even prevent them from occurring in the first place.

Migraines affect 18 percent of women and 6 percent of men in the U.S. and are a leading cause of absenteeism and decreased productivity at work. The overall cost burden of migraines to society exceeds that of other chronic conditions, including asthma, depression, diabetes, and heart disease. Although medications called triptans, such as rizatriptan (Maxalt) or sumatriptan (Imitrex), can often halt a migraine in progress, nearly half of migraine sufferers who take those or other pain-relieving drugs are still dissatisfied with their ability to function or work afterward. And when used on a regular basis, over-the-counter and prescription pain relievers can even cause headaches. Quite a few commonly used preventive medications, such as amitriptyline or divalproex (Depakote), might have unwelcome side effects, including weight gain and/or sedation. That might be why only 12 percent of migraine patients take them.

A better and more satisfying approach to preventing migraines is to find and avoid the triggers that set them off. Surprisingly, research has shown that more than three quarters of sufferers are ultimately able to identify triggers, such as:

• Beer, red wine, chocolate, and cheeses
• Hunger
• Odors, including perfume
• Bright or fluorescent lights, the sun, or glare from TV or computer screens, particularly if flickering
• Insomnia (regular, but not too much, sleep is known to protect against attacks.)
• Tension, irritability, and stress

But it’s not a precise exercise. Not all culprits cause migraines each time, and sometimes migraines result only when factors occur simultaneously—so-called “stacked triggers.” For instance, while perfume alone might not cause a problem, drinking a glass of red wine might change those odds for the worse. To further complicate matters, some sufferers have a delayed response to stimuli, and triggers can even change over time.

Some doctors recommend keeping a headache diary —a log detailing your attacks and the medication responses that can help patients and doctors identify possible triggers and assess treatment effectiveness. You should document each headache episode, describe its connection to meals and beverages, and note situational factors such as fatigue, sleep patterns, or stress. You should also list the medications you took, and write down how you felt afterward. Women should note their menstrual cycle as well.

If a trigger is a food or fragrance, simply avoiding the offending substance will do the trick. For light-related triggers, sunglasses or tinted glasses can be helpful. Behavioral therapies, such as biofeedback and meditation, are recommended when stress is a factor. Keeping to a regular sleep schedule can help with sleep-related headaches. Alas, some triggers, such as weather and time zone changes, can’t be easily manipulated.

Visit our conditions section for more details about migraines, our detailed Treatment Ratings (for subscribers), and our free CR Best Buy Drugs report on triptans.

—Orly Avitzur, M.D., medical adviser to Consumers Union

See Dr. Avitzur talking about migraine triggers and treatments on ABC news.

Heart attack? Get to the ER on time

If you suddenly felt faint and developed shoulder discomfort, would you call 911? You should. Those are two of the five most important heart-attack warning signs. And more than half of cardiac deaths may occur within an hour of developing the first symptom.

But according to an article in the February 22, 2008 issue of Morbidity and Mortality Weekly Report, published by the federal Centers for Disease Control and Prevention, less than a third of adults recognize all five warning signs of a heart attack:

1. Pain and discomfort in the jaw, neck or back
2. Feeling weak, lightheaded or faint
3. Chest pain or discomfort
4. Pain or discomfort in the arms or shoulder
5. Shortness of breath

Even more disturbing, the CDC study found that many people who did suspect a heart attack would delay calling 911. That hesitation can be fatal: Your odds of surviving an attack are much higher if you get to the emergency room within an hour of the onset of symptoms. After you call 911, chew and swallow one 325-mg (regular) aspirin or four 81-mg (baby) aspirins, since that can help prevent artery-clogging blood clots from forming.

The CDC data revealed striking variability across the country.  In Washington, D.C., for example, only 34 percent of respondents recognized pain or discomfort in the jaw, neck, or back as a sign.  Joel Rosenberg, M.D., Clinical Director of Cardiology at the George Washington University Hospital, said, “We’ve done a very poor job of educating people on how heart attacks present.” Rosenberg is not surprised by the poor results in D.C. given a financially devastated healthcare infrastructure, substantial numbers of low income residents, and poor access to care. “We have to start investing more time, money and effort into prevention of disease as opposed to just focusing on treatment” said Rosenberg, adding, “This includes teaching the public about the warning signs of heart attacks.”

Minnesota—which ranked number one in residents’ ability to identify chest pain as a heart-attack symptom and in calling for emergency assistance—may provide some clues as to how to accomplish that goal.  Thomas Behrenbeck, M.D., Ph.D., Associate Professor of Cardiology at the Mayo Clinic in Rochester, Minn., attributes these stats to focused public service campaigns and grass roots efforts, such as CardioVision 2020, dedicated to improving heart health. “As a result, Minnesota folks are probably more in tune with the warning signs and get medical attention faster than most,” Behrenbeck said. And efforts to improve the care chest pain patients receive once they get to the ER has improved the heart-attack survival rate at Mayo’s emergency room to between 94 and 97 percent, proving, said Behrenbeck that “time is life.” 

—Orly Avitzur, M.D., medical adviser to Consumers Union

It’s not too late for you—and now all your children—to get the flu vaccine

I got the flu shot for the first time this past fall, soon after I started working at Consumers Union, thanks to my new employer’s policy of offering free flu immunization to all of its employees. And, possibly no coincidence, I didn’t get the flu this year—though my wife and youngest daughter did. The federal Centers for Disease Control and Prevention says that my wife, as a health-care professional, should have gotten the vaccine. But, like a lot of people, for one reason or another she just didn’t. My healthy 11-year-old daughter, on the other hand, wasn’t a candidate for the shot—until now.

Previously, the recommendation was for children from 6 months through 4 years old to be vaccinated. However, a panel of immunization experts voted on Feb. 27 to expand the recommended ages for annual flu shots for kids to include all children from age 6 months through 18 years old. The panel said that the recommendation should start “as soon as feasible,” and no later than the 2009-2010 flu season.

While the flu season is already in full swing, and there are concerns that this year’s flu shot isn’t as effective as some, there are still lots of good reasons for you, and your kids, to get vaccinated:

• As we reported in October 2007, the disease can peak in April or May, so even a late, and less-than-perfect, shot is better than none
• We think that all adults should consider getting an annual flu shot, not just those at highest risk
• Though some parents avoid the shot because of safety concerns, our analysis of the research suggests those fears are unfounded
• Children are prime transmitters of the flu. The illness causes a lot of children to miss school, and parents to miss work—as I know all too well.

Read more about:
Flu prevention and our Treatment Ratings (for subscribers)
CDC flu recommendations
Our recommendations on other adult vaccines and a childhood vaccine checklist

—Joel Keehn, senior health editor

Prevent medical identity theft

Financial identity theft can leave your wallet hurting and your credit history in chaos. Medical identify theft—someone using your personal information to get medical care—can do that and more. “Not only may you get bills for services you didn’t receive, but incorrect information can appear in your medical records, with devastating consequences,” says Pam Dixon, executive director of the World Privacy Forum.

The crime, which affects an estimated 250,000 Americans each year,may be on the rise. “There’s a huge demand, not only among criminals who sell prescription drugs on the black market or submit false health insurance claims, but also people who just can’t afford health care,”Dixon says.

Medical identity theft often starts with an employee in a hospital or doctor’s office who sells stolen information to organized crime rings. People might not find out that they’ve been victimized until they get a bill for care they never received or are denied health insurance coverage because of a medical problem they don’t have. To protect your medical identity:

• Share health insurance information only with trusted providers.
• Monitor the explanation of benefits you receive from insurers, and get a summary each year of all the benefits paid in your name. Contact the insurer and provider about charges for care you didn’t receive, even if you don’t owe any money.
• Keep copies of your health-care records in case of a dispute.
• Check your credit history for medical liens.
• Demand that your providers and insurance company correct errors or remove false information in your medical records.
• If you think you’ve been a victim, file a police report and send copies to insurers, providers, and credit bureaus.

Visit the World Privacy Forum for more information.

More treatment isn’t always the best option

Our health care system sometimes seems like a runaway train. We all know it’s out of control, but no one can figure out how to stop it.  Here’s one example:

A man in his mid-80s, quite frail, had managed to survive two surgeries for lung cancer but the disease had now spread elsewhere in his body. His oncologist was pressing him to start chemotherapy, and he was seeking a second opinion from me. Now, understand that there was zero chance the chemo would cure him. At best, it had about a 10 percent chance of extending his life for six months beyond what would be expected without it – but he would be sick most of that time with nausea, vomiting, and weakness, and would be unable to travel away from home. After weighing the tradeoffs, he decided to skip the chemo. I have since left my position at the hospital where this conversation took place, but the last time I saw him, about six months later, he was still alive and feeling reasonably well. He had spent quality time with his family and even traveled over the holidays.

Conversations like this don’t take place often enough.  Too few consumers and doctors challenge the belief that “more treatment is always better.”  There are many reasons that we have come to believe this. Medical breakthroughs and heroic treatments are always news, whereas failures and horrible side effects are often not. Drug and device manufacturers spend billions to promote the idea that the shiniest, costliest new treatments are better than the old ones, even when there’s no solid evidence for this. High-tech treatments are moneymakers for doctors and hospitals.

I don’t see the situation getting better without some significant changes in the way we deliver and pay for health care. We need more doctors to do what I did with that man—talk through the risks and benefits of treatments, especially expensive, invasive ones. We need better research comparing old and new treatments. Right now, the incentives are in the wrong direction. Doctors earn very little for sitting down and talking to patients, but a lot for delivering costly interventions, whether they’re needed or not.

If you or someone you care about is facing decisions about treatment for a serious illness, keep the following in mind:

• You don’t have to accept the first recommendations you receive
• Insist on a meaningful conversation with your doctor, spelling out the risks and benefits of tretament
• Make sure you understand the side effects and success rates of the treatments you’re offered
• Balance those side effects and success rates against your own quality of life preferences
• Seek a second or even third opinion if necessary

—John Santa, MD, MPH

We are interested in hearing from you about your experiences. Have you ever received high-tech treatment that you later regretted because of side effects or lack of effectiveness? Have you ever turned down treatments that your doctor recommended? Did you have a tough time navigating the complexities of our system when deciding on treatment options? What and who helped you the most? What information was most useful to you? 

Share your story with us.

Q&A:Will Chantix help me quit smoking?

I want to quit smoking. Is it true that the new drug varenicline (Chantix) is more effective than other treatments? —A.G., Seattle

Possibly. Varenicline eases cigarette cravings by providing mild nicotine-like effects, while potentially blocking some of the satisfaction cigarettes provide when you do smoke. Several manufacturer-funded studies have shown that it may work a little better than the antidepressant bupropion (Zyban and generic), often used for smoking cessation. (Research hasn’t compared varenicline with counseling or nicotine-replacement products, both of which appear comparable in efficacy to bupropion.) While the side effects reported for varenicline are relatively mild, the drug is too new to judge its safety definitively. So try the more-established treatments first and consider varenicline if they don’t work.

When the going gets tough: Constipation causes and treatments

Remember summer camp? Carefree days of new friend-ships, arts and crafts, swimming and boating, noisy mess halls, sing-along campfires, and the quiet time at the end of the day, followed by “Taps” and lights out. But not before the camp nurse, in her starched white uniform, made her appearance, clipboard and pencil in hand, and directed the question of the day to each, in turn: “Soft, medium, hard, or none?”—and she wasn’t taking egg orders for breakfast. A teaspoon of castor oil was the unwary respondent’s reward. Although that barbaric ritual has gone the way of public hangings, America’s obsession with daily bowel movements has persisted, largely due to persistent misconceptions. One myth is that waste products can accumulate and contaminate the rest of the body. Another is the belief that constipation can cause colon cancer. Patients have varying ideas about what constitutes constipation. One survey of nearly 600 constipated patients found that the main complaint of 79 percent was straining to pass the stool. Hard stools were a problem for 71 percent, while 57 percent complained of infrequent bowel movements. (Some had more than one complaint.)

The standard medical definition of constipation includes both of the following: 1. Infrequency (less than three bowel movements per week); and 2. Difficult passage of hard, dry stools. Most everyone agrees that anything between three times a week to three times a day can be considered normal. Constipation, as defined above, affects as many as one of every four Americans at one time or another, occurs more than twice as often in women as in men, and is more frequent among older people. Laxative sales in the U.S. are projected to exceed $850 million annually by 2010.

The cause may vary
Most of the time constipation is transient and related to changes in diet or schedule. Going on vacation, starting the Atkins diet, cutting out your usual exercise routine, or ignoring the morning urge in order to catch a train can play havoc with your bowels. A host of medications can cause constipation, including iron and calcium supplements, antidepressants, painkillers, and some blood-pressure drugs. Constipation can occur in pregnancy or be caused by serious conditions, such as an underactive thyroid, elevated blood-calcium levels, Parkinson’s disease, multiple sclerosis, irritable bowel syndrome, and actual blockages of the intestine by colon cancer. All can cause difficulty in moving one’s bowels.

Loosening up
Although a lack of fiber in the diet and dehydration can cause constipation, treating the problem by increasing dietary fiber and drinking eight glasses of water a day lacks the certainty of evidence-based medicine and often results in bloating, flatulence, abdominal distention, and increased urinary frequency. As long as you’re consuming adequate amounts of fiber (at least 25 grams per day) and drinking enough fluids to keep your urine a pale yellow, increases are not likely to help. Resuming your usual lifestyle after a vacation or switching the medication that was the cause usually does the trick. You won’t suffer permanent harm from a few days of constipation, but there’s nothing wrong with the temporary use of a laxative if you’re truly uncomfortable. But how to choose from the myriad products that line the shelves of your pharmacy?

The trick is to select a single-ingredient product that matches your particular complaint. If your main symptom is straining to pass hard, dry stools, try docusate (Colace and generic), an emollient type of laxative better known as a stool softener. If your problem is infrequency, choose a bulk laxative such as methylcellulose (Citrucel and generic), polycarbophil (Equalactin, FiberCon, and generic), or psyllium (Fiberall, Metamucil, and generic). If you have both complaints, take both kinds. Despite lore to the contrary, both types of laxatives are relatively safe for long-term use, but check with your physician. For more stubborn cases, as can occur in seniors with aging bowels, the occasional use of a stimulant laxative such as bisacodyl (Correctol, Dulcolax, and generic) may be necessary. Drawbacks are painful cramping and diarrhea with urgency. As with any symptom treated with an over-the-counter medication, if constipation persists longer than a week or two or recurs after treatment, it’s time to see your physician to find out if something more serious is going on.—Marvin M. Lipman, M.D.

Dr. Lipman has been Consumers Union's chief medical advisor since 1967. He is a diplomate of the American Board of Internal Medicine (certified in endocrinology and metabolism) and is clinical professor of medicine emeritus at New York medical College.

Holiday help for heartburn

It's that time of year when food and wine merchants thrive, tons of hors d'ouevres are consumed at office parties, families convene for feasts, glasses are raised to "Auld Lang Syne," and heartburn remedies fly off pharmacy shelves.

About 20 percent of people in the U.S. suffer at least once a week from symptoms of acid reflux, or heartburn (also known as dyspepsia, indigestion, sour stomach, or agita), and another 20 percent have it less frequently. A smaller but substantial percentage of the population has heartburn often enough (two or more times a week) to have earned the diagnosis of GERD (gastroesophageal reflux disease). No wonder the sales of heartburn remedies add up to billions of dollars a year.

Causes and complications
The food and drink you swallow are transported by strong, involuntary contractions of the muscular esophagus into your stomach through an opening guarded by a powerful muscle called the lower esophageal sphincter. The closure of that sphincter prevents stomach acid from backing up, or refluxing, into the esophagus. Those involuntary mechanisms are so powerful that you can swallow quite well while doing a headstand.

But when the sphincter doesn't close properly, whether because of a genetic weakness, excessive fat ingestion, obesity, or reasons unknown, acid reflux can wreak havoc on the relatively delicate esophageal lining, causing inflammation, irritation, and, sometimes, ulceration. Victims feel it as a distinctive burning sensation located under the breastbone, which may or may not be related to meals and commonly occurs at night.

Long-standing reflux into the lower part of the esophagus can cause changes in the appearance of the lining cells, a condition called Barrett's esophagus that can turn into esophageal cancer in about 1 of every 200 cases. If the reflux reaches the upper portions of the esophagus, it can irritate adjacent structures and cause wheezing, coughing, hoarseness, or chronic sore throat, which often leads to misdiagnoses, especially when the usual reflux symptoms are minimal or absent.

What to take
Since heartburn is an easily recognizable symptom (although at times it can be confused with angina pectoris, or heart pain), it is a natural for self-medication. And there are many over-the-counter products to treat it. Those products can be divided into three categories--antacids, histamine-2 receptor blockers (H2 blockers), and proton-pump inhibitors (PPIs)--that vary in how they work, how quickly they work, how long they work, and how well they work.

If your heartburn occurs occasionally and unexpectedly, as is apt to happen to many of us once or twice this holiday season, your best bet is a simple antacid such as generic or store-brand versions of Maalox, Mylanta, Rolaids, or Tums. They come in various dosage forms--liquid suspensions, tablets that you chew or swallow, effervescent solutions, and chewing gum--from which you can choose. They all work in a few minutes by neutralizing the acidity in the esophagus. Their effect lasts up to a few hours, plenty long enough for reflux symptoms to have ceased.

If you know from bitter experience to expect heartburn in certain situations ("I love pizza, but it always gives me agita"), take an H2 blocker beforehand, which stops histamine from stimulating stomach acid production. There are four available, formerly only by prescription but now over the counter as well as generically: cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75, Zantac 150). They all start working in 30 minutes to 1 hour and one dose can last up to 12 hours. One product, Pepcid Complete, combines famotidine with an antacid for both immediate and longer-term relief.

When heartburn happens more than once or twice a week, taking antacids several times a day is much too labor-intensive, and even continuous twice-daily use of H2 blockers may not be very effective. At that point, more complete blockage of stomach acid production is called for. Enter PPIs, which actually block the mechanism in the stomach cells that releases acid into the stomach. The first of those to be approved, omeprazole, is available over the counter as Prilosec OTC. It may take days for these medications to provide complete relief, so they are not appropriate for occasional or intermittent heartburn. If there is no improvement from Prilosec OTC or your symptoms recur after a 14-day course, medical evaluation is mandatory.
—Marvin M. Lipman, M.D.

Dr. Lipman has been Consumers Union's chief medical advisor since 1967. He is a diplomate of the American Board of Internal Medicine (certified in endocrinology and metabolism) and is clinical professor of medicine emeritus at New York medical College.

SAD: Treating the winter blues

Bupropion (Wellbutrin XL) is the first drug approved by the Food and Drug Administration for the prevention of seasonal affective disorder, or winter depression. About 5 percent of Americans, three-quarters of them women, experience SAD each year. But do you need medication to prevent or treat it? Here are answers to five questions about this type of depression.

How do I know it's winter depression?
Some symptoms are similar to those associated with other types of depression: sadness, fatigue, excessive sleepiness, social withdrawal, and trouble concentrating. But people with SAD also tend to move slowly, crave carbohydrates, and gain weight. And they're less likely than people with conventional depression to have feelings of worthlessness or thoughts of suicide. The nonprofit Center for Environmental Therapeutics has an online questionnaire that can help you determine whether you have the disorder.

Can I get SAD if I live in a warm and sunny climate?
Yes, but it's less likely. It occurs most often in people who live in northern latitudes, where winter days are shorter and darker. For example, about 10 percent of the people living in Alaska experience symptoms of SAD, compared with only 1 percent of those in Florida, where the sun shines for more hours in the winter.

If I've had the disorder, will I get it every year?
Not necessarily. People who have experienced winter depression might have a year where the symptoms are less severe or don't show up at all. The best strategy is to watch for early warning signs, including fatigue, oversleeping, carbohydrate cravings, and weight gain. They tend to creep up weeks before your mood actually plummets, says Michael Terman, Ph.D., director of the Center for Light Treatment and Biological Rhythms at the Columbia University Medical Center in New York. This gives you time to start medication if you need it.

What nondrug treatments work?
For mild cases, doing 60 minutes of outdoor aerobic exercise in the morning might bring some relief. It makes sense to try that before medication or other treatments.

For more persistent cases, there's strong evidence that spending 30 minutes a morning in front of a lamp that simulates bright white daylight—ideally within 10 minutes of waking—can help. In a May 2006 study of 96 people, Canadian researchers found that light therapy was as effective as the antidepressant fluoxetine (Prozac and generic) in reducing symptoms of winter depression. And it works faster, usually within four to seven days, compared with four to six weeks for antidepressants. For more information on light therapy, go to the Center for Environmental Therapeutics.

Other treatment options include cognitive-behavioral therapy, in which you learn to ward off negative thoughts about the season and work on finding enjoyable activities. That kind of therapy might also help prevent a recurrence.

Is Wellbutrin XL better than other drugs for the disorder?
GlaxoSmithKline, the manufacturer of Wellbutrin, was the first to undertake the expense of conducting a clinical trial specifically on preventing SAD. In the study, which involved 1,000 people prone to winter depression, 16 percent of those who took bupropion every day through the winter developed the disorder, compared with 28 percent of the group that took a placebo.

"Clinically, there's nothing special about the efficacy of Wellbutrin relative to other common antidepressants for the treatment of SAD," says Terman. But it might carry less risk of sexual side effects than SSRIs, including fluoxetine and sertraline (Zoloft and generic).

Flu shot and flu treatment FAQs

Three years ago a flu-vaccine shortage kept many people from getting the shots. Now you’re more likely to be confused by the multiple vaccine options available, including the nasal spray recently approved even for use in toddlers, and which drugs to take if you do come down with the flu. Possible health concerns have added to the uncertainty. Here’s our advice.

Who should get vaccinated?
All adults should get a flu shot every year, especially if they’re age 50 or older, live in a long-term-care facility, are pregnant, have weakened immunity or a chronic illness, or live with or care for people in any of those groups.

Should I get the shot or the newer nasal spray?
Most people, including kids, should opt for the shot. It works as well as the spray (FluMist) and costs less. Moreover, the spray is not approved for children under age 2 or adults over 49, and its live vaccine poses unacceptable risks to pregnant women and people with weakened immunity. But consider the spray if you’re overweight, since excess fat can make it hard for the needle to reach the necessary depth, or if excessive fear of shots keeps you from getting vaccinated.

Are mercury-free shots better?
There is no convincing evidence linking the mercury-containing preservative thimerosal with autism or other health problems, though research continues. If you’re concerned, ask for a preservative-free vaccine, such as Fluzone. What about the risk of Guillain-Barré syndrome? Roughly one out of every 1 million people vaccinated may develop that neurological disorder. But the shot’s protection against illness, hospitalization, and death far outweighs the risk. Still, if you’ve had Guillain-Barré syndrome, avoid the spray vaccine and discuss with your doctor whether to get a shot.

Does it matter when you are vaccinated?
Try to get your shot by December, when the flu virus usually arrives. But the disease can peak as late as April or May, so even a January shot can help.Don’t get vaccinated while you have a moderate or severe fever, and don’t take the nasalspray vaccine if you have a cold.

What should I do if I already have the flu?
Over-the-counter pain relievers can ease the fever, chills,muscle aches, sore throat, and other symptoms associated with the flu. And if your doctor diagnoses the illness within two days of the onset of symptoms, the antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) can shorten its duration and possibly prevent complications.

Should I keep a supply of antiviral drugs on hand?
No. Stockpiling depletes the antiviral supply that health officials count on in case of a pandemic, and encourages needless use. Experts worry that excessive antiviral use may fuel the emergence of drug-resistant flu strains, much as the misuse of antibiotics leads to antibiotic-resistant bacteria. Research suggests that up to 18 percent of children treated with oseltamivir now harbor drug-resistant variants. And a 2006 study found that certain resistant flu strains could be passed from person to person, something researchers had considered unlikely. So get a prescription for antivirals only when you have the flu, and take the full course, since stopping early can allow germs to survive and adapt.

Q&A: An easy fix for back pain?

After taking my wallet out of my back pocket, my persistent lower-back pain seems to have gone away. Could something so simple really have cured me? —C.H., Branford, Fla.

Yes. Sitting on your wallet can cause low-back pain by throwing your spine out of alignment and exerting pressure against the back muscles. Back specialists often suggest carrying your wallet in a front pocket for that very reason. But it’s wise to see your doctor if the pain returns, persists for more than a week or two, or is particularly intense. That could possibly indicate a more serious condition, including arthritis, kidney stones, an infection, or a tumor.

This item first appeared in the November 2007 issue of Consumer Reports on Health.

Evidence-based medicine and your health

In a conversation with Beth Nash, M.D. of the BMJ Publishing Group, publishers of the British Medical Journal, she outlines evidence-based medicine and how it could fit into your health care decision making.

We hear a lot about “evidence-based medicine” these days. Haven’t doctors’ decisions always been based on science?

Not always. Several cases in which research overturned longstanding practices that were just assumed to work pointed to the need for a formal, evidence-based approach. For example, for years it was believed that kids should have their tonsils removed to prevent recurrent sore throats.

But when it was properly studied, it turned out that it hurt more than it helped. A newer example is the use of estrogen replacement therapy to prevent heart disease in women after menopause. It made good sense in theory. Then the clinical trials came out and showed that it did more harm than good.

Isn’t it “cookbook medicine” to base decisions solely on research?

A treatment decision is like a three-legged stool. The first leg is the clinical evidence, the second is the doctor’s expertise, and the third is the patient’s values and preferences. Doctors need to integrate their clinical expertise and their years of experience treating patients, and you in particular, into their treatment recommendations. But at the same time, they should be receptive to questions about what the research shows.

Where do the patient’s values and preferences factor in?

Values could include religious beliefs, ethics, thoughts about living wills and advance directives, and so on. Preferences involve individual sensitivities. Some people are keen to avoid drug therapy, while others find it difficult to make lifestyle changes. Some prefer not to undergo surgery because of the potential risks. A good example of a condition where patient preference comes into play is prostate cancer, where the evidence provides no clear-cut idea of what intervention is best; surgery, radiation, and watchful waiting are all reasonable options. Women with breast cancer have similar decisions to make about mastectomy vs. lumpectomy or in some cases whether to have additional radiation or chemotherapy. You learn as much as you can about the available options, then follow your gut.