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May 24, 2011  In This Issue... - Harvard Scientists Discover Missing Link Behind Frequent Memory Lapses, and How to Reverse Years of Mental Decline
- Blood Thinners: Too Risky?
- Arthritis Abolished in Minutes by Doctor's Astonishing Speed Cure
- Better Odds Against Breast Cancer
- How Bottom Line Changed My Life
Harvard Scientists Discover Missing Link Behind Frequent Memory Lapses, and How to Reverse Years of Mental Decline Why decades of toxic exposure are taking a toll on your brain, and what you can do about it. Find out what you can do here
Blood Thinners: Too Risky? A good friend of mind had a serious heart attack several years ago. He survived but was left with congestive heart failure. His heart was not pumping adequately, and there was a risk of it throwing off clots -- clots that could lodge in his heart or brain. As a protective measure, he began taking blood thinners. Thinners, however, are a double-edged sword. They keep the blood from clotting, but as they do, they allow for the possibility of blood leaking into places it shouldn’t. If all goes well, you count yourself lucky. In my friend’s case, the drugs kept him in reasonably good health until, out of nowhere, the thin blood leaked and he ended up in the hospital with a hematoma -- bleeding in the brain. Fortunately it was a minor head bleed, not a stroke. A study from Vanderbilt University Medical Center in Nashville, published last spring in the Archives of Surgery, underscored the dangers blood thinners carry, when it found that people on the popular anticoagulant warfarin (Coumadin) who sustained a traumatic injury (and this can be something as simple as falling in your bathtub and hitting your head) were twice as likely to die as those not on the drug. DIFFERENT MEDS, DIFFERENT RISKS What can you do to best protect yourself? To discuss the dilemma, I called Emile Mohler, MD, director of vascular medicine at the Penn Heart and Vascular Center in Philadelphia. Dr. Mohler said that even people who take these drugs can get confused about the exact nature of the medicine they are on. In fact, calling the drugs "blood thinners" is technically incorrect -- the drugs do not thin blood but rather act on clots that can form in the blood. And, while the group of drugs overall is referred to as "anticoagulants," this too is actually not quite correct since different drugs act in different ways. Here is an explanation of the drug categories and how they differ... - Anticoagulants -- e.g., warfarin (Coumadin). These do not dissolve clots but inhibit clot production and prevent clots from enlarging. They are used for atrial fibrillation, an erratic heartbeat that can create clots that travel to the brain, triggering stroke, as well as for other situations in which clots may form in the heart, such as during heart-valve replacement. These drugs treat blood clots in a deep vein, usually in the legs. This condition is known as deep vein thrombosis (DVT). Anticoagulants also help prevent second strokes or heart attacks.
- Antiplatelets -- e.g., aspirin, clopidogrel (Plavix). Platelets are cells in the blood that form clots to repair damaged blood vessels. Unfortunately platelets also can create harmful clots -- and so antiplatelet drugs are used to prevent the kind of platelet "clumping" that starts a clot. Antiplatelets are used for heart attacks caused by a clot (myocardial infarction), for angioplasty/stent patients and to prevent future heart attacks in patients who have already suffered one.
- Thrombin inhibitors -- e.g., heparin. These are fast-acting drugs that are used, usually on a short-term basis, right after many types of surgery to prevent clot formation or to treat patients with vein clots.
Your Safety on Anticoagulants Dr. Mohler describes these drugs as "incredibly lifesaving," noting that most of the time the drugs’ benefits outweigh their risks. Nevertheless, he says it is indeed a tough balance between clot protection and bleeding. "There is always going to be a risk of bleeding whatever the specific drug, because otherwise it would mean the drug isn’t effective," he explains. To maximize your safety, Dr. Mohler offered the following information and advice... - Although Coumadin is the most widely used anticoagulant, it is a difficult drug for both patients and doctors, says Dr. Mohler, because "however carefully blood levels are monitored, they can change quickly, and the foods you eat impact your blood levels as well." For your safety: Strictly adhere to a schedule of monitoring with International Normalized Ratio (INR) blood tests (through a Coumadin clinic) to be sure that your blood levels remain in the proper range. Diet is critical -- Coumadin blocks the clotting action of vitamin K, but if you eat foods that are high in K (leafy greens, especially spinach and kale), it can negate the effect of the Coumadin. Limit yourself to the number of servings per week that your doctor advises.
- Patients on low-dose aspirin therapy must be careful when taking additional aspirin for painkilling purposes, as it can jeopardize the antiplatelet effect. For your safety: Never take additional aspirin. If you need a painkiller, take acetaminophen instead -- or if you take ibuprofen, which is more similar to aspirin, always take the additional painkiller at least 30 minutes after taking the daily aspirin to be sure that the other drug will not interfere with the antiplatelet action of the aspirin.
- Surgery patients need to clot in order to heal, but when taking blood thinners it is tricky, Dr. Mohler says. Depending on the level of clot risk, there are a variety of ways for doctors to handle this problem, including using heparin in place of warfarin for a few days. For your safety: Before surgery, discuss with your doctor how this will be handled to best protect you.
- Accidents that healthy people are likely to recover from quickly can cause deep bruises and bleeding when a patient is on these drugs. For your safety: Avoid situations with a high risk for injury -- even minor injury -- such as rough sports, difficult hiking, etc. Always carry a card or wear a medical ID bracelet that lets emergency medical professionals know you are on an anticoagulant or antiplatelet... be sure to inform all of your health-care professionals, including pharmacists, about your drug.
Brighter Days Ahead There are hopeful developments in the world of anticoagulants with new drugs in development. One called dabigatran (Pradaxa) is already available and may one day replace Coumadin. It is easier to monitor, and diet does not interfere with it. However, you need to take it twice a day, and the drug is very expensive. Another group of anticoagulants called factor Xa inhibitors is in development, and Dr. Mohler says these too may replace Coumadin in some instances, especially for DVT. Perhaps most intriguing of all, there is a new study underway at The University of Pennsylvania that should make treatment easier and safer. Researchers are investigating patients’ DNA for mutations that affect blood clotting. The hope is that with information specific to individuals, doctors will be able to adjust drug dosages to create optimal levels in each person’s blood. Source(s):
Emile Mohler, MD, associate professor of medicine, Hospital of the University of Pennsylvania, Presbyterian Medical Center of Philadelphia, and director of vascular medicine, Penn Heart and Vascular Center, Penn Medical, Philadelphia. 
Arthritis Abolished in Minutes by Doctor's Astonishing Speed Cure People fly in from all over the world to visit the famed California clinic of Dr. Mark Stengler. His naturopathic speed cures are the stuff of medical legend -- sought after by film actors, sports stars and mega-millionaire CEOs. Legions of patients can attest to the power of this amazing new botanical "nano-cure." An NFL hero was stunned by its speed, as it eased his chronic hip pain in minutes! Better still, the relief "held" for days.
Read on...
Better Odds Against Breast Cancer However vigilant women are in watching for early signs of breast cancer, there are always those heart-stopping moments when everything goes awry. A dear friend of mine in her 40s who had gone with great discipline for a mammogram each year, who had no family history of the disease, and who kept herself astonishingly healthy and fit just called to tell me she’s been diagnosed with a malignant breast tumor that will have to be removed. Lumpectomy or mastectomy, it’s not clear yet, but the doctors have said she will need radiation and chemotherapy, as well as follow-up scans over the years. Two things are true -- her prognosis is fairly good, and her life is forever changed. Every time I hear a story like this, any of us hear a story like this, the question is asked, Why isn’t there some way to detect the presence of cancer earlier? Well, however frustrating the timing is given my friend’s diagnosis, it seems that there finally is some new and better technology on its way. If you’re a health-conscious woman age 40 or over, chances are you, like my friend, make a yearly pilgrimage to your doctor’s office to have your breasts squashed between two plastic plates. It’s not fun, it’s a little uncomfortable, but it only takes a few minutes, and 40 million of these mammograms are performed in the US each year -- resulting in the detection of 80% to 90% of all breast cancers. Now, there is promising new technology that was approved by the FDA in February of this year called breast tomosynthesis -- or, more commonly, "3D" mammography, and while there are still questions to be resolved, there is also great hope that this new development will help physicians diagnose breast cancer with even greater accuracy. I’ll explain how they hope to do that. 7% Greater Improvement in Detection FDA approval was based on two studies that asked radiologists to review more than 300 mammograms using traditional 2D mammography alone or a combination of 2D and 3D imaging. The radiologists who viewed both 2D and 3D images were 7% more accurate in their diagnoses than those who viewed only 2D. Doctors get a greater sense of depth with 3D mammography, explains Ellen B. Mendelson, MD, a professor of radiology at Northwestern University Feinberg School of Medicine and section chief of breast imaging at Northwestern Memorial Hospital in Chicago. Regular 2D technology captures a compressed image of the breast. In contrast, 3D mammography images a series of thin "slices" of the breast from different angles, which a computer processes into a 3D image that the radiologist can manipulate. 3D mammography is performed along with regular mammograms, at the same time on the same scanning machine. Resulting advantages are... - Better detection. 3D mammograms can help radiologists pin down the size, shape and precise location of abnormalities... compressed 2D images tend to obscure these details.
- Increased accuracy. There are fewer false-positive diagnoses with 3D mammography. The technology can help distinguish harmless growths from cancerous tumors by revealing more detail about irregularities. Some subtle changes are more easily observed in the thin slices that comprise the tomosynthesis exam.
- Reduced recalls and less anxiety. Improved accuracy spares many women the anxiety of being called back for further testing (for more scans or biopsies) when results are uncertain. The test still requires the flattening of the breasts so many women object to, but what a small price to pay for your health and your life!
A Lingering Concern: Radiation Exposure On the negative side, 3D mammograms expose women to additional radiation due to the dual 2D and 3D test. The amount is low, but all radiation exposure is cumulative, and we should always be aware of it, notes Dr. Mendelson. That said, the dose of the combined imaging is under the FDA limit for mammography, and the agency ruled that the benefits of the additional diagnostic information to radiologists outweigh the potential health risks from additional radiation exposure. Dr. Mendelson says that 3D mammography is currently most useful for women with dense breast tissue and for those who have already had breast cancer, but eventually it may be used by all women. At present, 3D mammography is available at a limited number of medical centers -- Mass General in Boston, which spearheaded the research, is one, and more hospitals will be offering the procedure soon. Right now, many of the sites offering the procedure are doing so only in clinical trials... and pricing and insurance coverage is being worked out at this moment also. While questions remain, Dr. Mendelson believes that when 3D mammograms are available in your area and your doctor recommends one, you should go ahead and have it. Keep in mind, however, that at this time 3D mammography is meant to complement -- not replace -- standard 2D digital mammography. Anything that improves chances of detecting breast cancer by another 7% is reason for hope. That 7% might have given my friend the edge she needed to catch her tumor while it was still tiny and much more easily removed. Source(s):
Ellen B. Mendelson, MD, FACR, chief, section of breast imaging, Northwestern Memorial Hospital, and professor of radiology, Northwestern University Feinberg School of Medicine, Chicago.
How Bottom Line Changed My Life I met a man at a conference a few weeks ago who was very eager to meet me because he's been such a loyal fan of our Bottom Line/Personal newsletter. Twenty years ago, Bob (now COO at a heart-health web site) told me, he was eager to go back to school to earn an MBA degree. He applied to a number of schools, and was rejected from every one of them. Not long after, he read an article in Bottom Line/Personal... Click here to read more...
Be well, 
Carole Jackson
Bottom Line's Daily Health News
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