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to your Address Book or Safe List. Learn how here. | September 18, 2011 | |  |  | The Deadly Clot-Buster Filter | | | Arthritis Vanishes in Minutes | | | Portly People at Risk for Cognitive Decline | | | Are You or Your Loved Ones Taking Any of These Highly Prescribed Medicines? | | | Men’s Hair Thickener OK for Women? | | | |  |  | |  | |
 | | The Deadly Clot-Buster Filter My friend Frances feels like a ticking time bomb. Six years ago, during cancer surgery, her surgeon implanted a special metal filter in her inferior vena cava (IVC), the large vein in the abdomen that returns blood from the lower body to the heart in order to guard against postoperative blood clots. Frances was told that if a clot formed, it could become a pulmonary embolism, a potentially deadly condition in which a clot travels to the lungs. But ironically, the filter that was supposed to protect Frances has itself become a grave concern—because it is breaking apart. Bits of the device have snapped off, moved through her circulatory system and lodged in her lungs... and the rest of the filter has embedded itself so firmly in the blood vessel wall that her surgeon failed in his attempt to remove it. Frances is far from alone. The FDA has received more than 900 reports of problems, including filter fractures... migration of filters or detached pieces to other parts of the body, such as the heart, lungs and intestines... perforation of the inferior vena cava... and, ironically, increased risk for the formation of the very clots that the device is meant to guard against. Those cases may represent just the tip of the iceberg, given that about 167,000 patients received IVC filters in 2007 and 259,000 are expected to get them in 2012. Meanwhile, new reports of complications continue to emerge. You may have one of these filters now—or your doctor may someday recommend one. Either way, you need to know about the risks and how to protect yourself. For information, I contacted Peter L. Faries, MD, chief of the division of vascular surgery at Mount Sinai School of Medicine. What I learned... WHAT’S GOING ON? Many different types of surgery (including orthopedic surgeries, cancer operations, even outpatient procedures) increase a person’s odds of developing a blood clot. An IVC filter may be implanted when a patient is deemed to be at particular risk for postsurgical clotting. The filter, a metal device several inches long with multiple spidery legs, resembles the metal ribs of an umbrella. It is inserted into the patient’s IVC via a catheter threaded through a vein in the groin or neck. Once in place, the filter opens like an umbrella. If a clot forms, breaks off and gets carried into the IVC, the filter’s job is to catch it and hang on to it (while the body’s own clot-dissolving mechanisms and/or blood-thinning medications encourage it to dissolve) so it never reaches the lungs. Retrievable IVC filters generally are intended to be removed after a few months, when the risk for postsurgical clotting subsides... permanent filters are specifically designed to be left in place. Concerns about IVC filters came to light when a study by cardiologist William Nicholson, MD, was published in Archives of Internal Medicine. After a patient complained of chest pains, Dr. Nicholson discovered that a leg of his IVC filter had migrated to his heart, necessitating open-heart surgery. Then the doctor contacted all patients at his institution who had received this particular type of device (the Bard Recovery filter) and discovered that 25% had broken filters! Among patients who had a newer version, the Bard G2, 12% had broken filters. If retrievable filters are left in long after the risk for postsurgical clotting has passed, breakage can occur when metal fatigue sets in. Some doctors may be lax about recommending follow-up care, as Frances said that her doctor was. In other cases, patients neglect to return to the doctor as scheduled to have the filter removed. Dr. Faries explained, "Often a person has a removable filter inserted before a big surgery, then afterward, there’s recovery and rehab. The patient thinks, 'I’ve been through a lot already, I don’t want to go back to the doctor just now'—and then never gets around to the follow-up." IF YOUR DOCTOR RECOMMENDS AN IVC FILTER Some patients truly are at increased risk for a postsurgical pulmonary embolism—for instance, because they have a history of clots or cannot take blood-thinning medication. In such cases, an IVC filter can be lifesaving, Dr. Faries said—and so its benefits far outweigh its risks. But in other cases, doctors seem to be too quick to jump on the IVC filter bandwagon. Evidence: In a recent study in Archives of Internal Medicine, 26% of filter placements were deemed inappropriate and another 23% were considered debatable. Clearly, when a patient doesn’t really need the filter, getting one "just in case" creates unnecessary risks. Suppose that your doctor someday suggests that you need an IVC filter. Here’s what to discuss before you say OK... - Why is a filter advisable for you personally? The doctor should explain which factors in your individual health history tip the balance of benefits versus risks.
- Are there other options? Many at-risk patients can be treated with blood-thinning medication, such as warfarin (Coumadin), rather than a filter.
- What information is there on the long-term safety of the particular product to be used? Your doctor should be able to discuss the specific brand.
- Will the filter be implanted temporarily or permanently? Though the best answer depends on your individual needs, the doctor ought to explain his or her recommendation to you.
- If the filter is to be permanent, will you receive a product specifically designed for permanent placement? The answer must be yes—these filters have had fewer reports of breakages, Dr. Faries noted.
- If the filter is temporary, when will it be removed? Again, the answer varies from patient to patient—but the FDA recommends that physicians consider removing retrievable IVC filters as soon as protection from pulmonary embolism is no longer needed. Remember, what’s important is to follow up in a timely manner. You can’t just leave the thing in and forget about it! As Dr. Faries emphasized, care of the filter must remain a priority.
IF YOU ALREADY HAVE AN IVC FILTER Did you receive an IVC filter in the past? What to do... - If you are overdue for a filter follow-up visit, contact your doctor without delay. An X-ray can check for breakage... additional testing can determine where broken pieces have gone and whether they can be surgically removed.
- Ask your doctor whether the filter itself—intact or not—should and could be removed. In many cases, removal is a relatively simple procedure similar to the insertion method, Dr. Faries said.
- If your doctor says that your filter is not retrievable, get a second or even a third opinion. If it turns out that you must live with the filter, follow your doctor’s recommendations regarding ongoing follow-up and surveillance.
- Be on the lookout for possible warning signs—unexplained shortness of breath, chest pain, abdominal pain—that could signal filter breakage, migration or clotting. If you experience any such symptoms, call your doctor immediately.
Source: Peter L. Faries, MD, is the Franz W. Sichel Professor of Surgery, chief of the division of vascular surgery and a professor of radiology at Mount Sinai School of Medicine in New York City. Winner of numerous professional awards, he is listed among Castle Connolly’s Top Doctors and New York magazine’s Best Doctors.
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 | | Portly People at Risk for Cognitive Decline It’s bad enough that a person is more likely to develop heart disease and/or diabetes if he or she has metabolic syndrome—but now a study from France links this condition to problems with memory and cognitive function, too. The study included 7,087 men and women age 65 or older. At the start of the study, 16% of them had metabolic syndrome, defined as having three or more of the following—high blood pressure, large waist circumference (a sign of excess abdominal fat), high triglycerides (a type of blood fat), low HDL "good" cholesterol and high blood sugar. All participants took standard tests of cognitive function and memory at the start of the study and then again two years and four years later. Over the course of the study: Compared with people who did not have metabolic syndrome, those with metabolic syndrome had a 22% higher risk for cognitive decline and a 13% higher risk for memory problems related to retaining visual information. If you have any of the symptoms of metabolic syndrome, talk to your doctor about getting them under control. Doing so may help protect your memory and your mind. Source: Christelle Raffaitin, MD, is a medical researcher at the French National Institute of Health Research in Bordeaux, France, and lead author of a recent study published in Neurology.
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 | | Are You or Your Loved Ones Taking Any of These Highly Prescribed Medicines? Cholesterol Drugs... Heart Medications... Bronchodilators... Zantac®, Pepcid® or Tagamet®... Antidepressants like Prozac®... Aspirin, Tylenol® or Advil®... Antihistamines... Decongestants... Corticosteroids... Antibiotics... Propecia®... Estrogen or HRT Drugs... Blood Thinners. Or any of the following best-selling natural remedies? Calcium... St. John’s Wort... Glucosamine... Echinacea... Coenzyme Q10... Saponin... Vitamin B-6... Vitamins C or E... Melatonin... Vitamins A or D... Epigallocatechin Gallate... Chondroitin Sulfate... Diallyl Disulfide... Ginkgo Biloba. | |
Read on...  | |  | | |
| | | Men’s Hair Thickener OK for Women?
Q: I read that nonprescription 5% minoxidil (Rogaine) works better than a 2% formula for regrowing women’s thinning hair. But the package label says that the 5% product is only for men. Should I stick with the 2% strength labeled for women?
A: Despite the label, it is fine for women to use the stronger formula. Minoxidil products are labeled based on how the manufacturer of the Rogaine brand originally received the FDA approvals. When the 5% solution was later found to be superior for women’s hair regrowth, those study results were published in the Journal of the American Academy of Dermatology. The manufacturer didn’t bother to change the label at that point because doing so would have required going through the FDA, which would be very costly. Instead, doctors now recommend the 5% formula for women "off label" (for a use other than what is indicated on the package label) because they believe it is safe and more effective. It also is OK to use generic minoxidil, which is essentially the same as the brand-name product but cheaper by about $30 for the two-ounce pack (a three-month supply). For best results... - Apply the medication twice per day, making sure that it reaches your scalp rather than just sitting on top of your hair.
- Use the foam rather than the liquid formulation—this makes it easier to keep the medication off your face (and anyplace else that you do not want hair to grow). Exception: If you have relatively thick hair and you find that the foam gets caught in it, try the liquid formulation instead.
- If the 5% solution feels too greasy to you, use the 5% product at bedtime and the less greasy 2% product in the morning.
If you experience any side effects, such as scalp irritation and itching or facial hair growth, check in with your dermatologist. Though these side effects are reversible, you may need to adjust your minoxidil usage—for instance, by going back to the 2% formula (which is less likely to cause side effects) or by using the 5% solution every other day instead of daily. Source: Eric Schweiger, MD, is an assistant clinical professor of dermatology at The Mount Sinai Medical Center, a board-certified dermatologist and hair transplant surgeon at Bernstein Medical–Center for Hair Restoration and a private practitioner at Schweiger Dermatology, all in New York City. He also is the coauthor of Hair Loss & Replacement for Dummies. www.BernsteinMedical.com
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 | |  Tamara Eberlein, the editor of HealthyWoman from Bottom Line, has been a health journalist for nearly three decades. An award-winning author or coauthor of four books, she is committed to helping other women in midlife and beyond live healthy, fulfilling lives. Her latest book is the updated, third edition of When You’re Expecting Twins, Triplets, or Quads (HarperCollins). She is also the "chief health adviser" to her husband of 26 years and three college-age children. | |  | | Bottom Line Publications | 281 Tresser Boulevard, 8th Floor | Stamford, CT 06901
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