Health A-Z

Anti-smoking efforts have saved 8 million American lives

Anti-tobacco efforts have saved 8 million lives in the 50 years since the publication of a landmark Surgeon General report, “Smoking and Health,” a new analysis shows.

The 1964 report, which concluded that tobacco causes lung cancer, led to a sea change in American attitudes toward smoking. Smoking rates have plunged 59% since then, falling from 42% of adults in 1964 to 18% in 2012, according to the Centers for Disease Control and Prevention.

By avoiding tobacco or quitting the habit, people have gained nearly two decades of life, according to the analysis, published Tuesday in the Journal of the American Medical Association.

An American man’s life expectancy at age 40 has increased by an average of nearly eight years, and a woman’s by nearly 5½ years, since 1964. About one-third of those gains come from decreased tobacco use, the analysis says.

“Tobacco control has been described, accurately, as one of the great public health successes of the 20th century,” CDC director Thomas Frieden writes in an accompanying editorial.

Twenty-six states and Washington, D.C., now ban smoking in indoor public places. As smoking rates have declined, so have the incidence rates of many cancers. About 40% of the decline in men’s overall cancer death rates, in fact, is due to the drop in tobacco use, according to the American Cancer Society.

Tobacco damages virtually every part of the body, Frieden says, causing one-third of heart attacks. Smoking increases the risk of 14 kinds of cancer, including acute myeloid leukemia and tumors of the mouth, esophagus, stomach and pancreas, according to the American Cancer Society. About 443,000 Americans die from smoking-related illnesses every year.

Nearly 18 million Americans have died from tobacco just since the Surgeon General report was published, according to the new analysis, led by Theodore Holford of the Yale University School of Public Health.

Tobacco killed 100 million people worldwide in the 20th century, according to the Campaign for Tobacco-Free Kids. If current trends continue, tobacco will kill an additional 1 billion in the 21st century, the group estimates.

Frieden notes that smoking remains a major health challenge. Nearly one-third of non-smokers are still exposed to secondhand smoke, either at home or at work. Images of smoking are still common on TV and in movies. Tobacco taxes are too low in many parts of the country, making cigarettes affordable for both adults and kids. And although most smokers say they want to quit, few of them receive proven treatment, such as counseling and medication, which together can double their odds of kicking the habit, he writes.

A spokesman for R.J. Reynolds Tobacco Company declined to comment.

David Sylvia, a spokesman for Altria, the parent company of tobacco giant Philip Morris USA, says his company’s goal today is simply to make current smokers aware of its brands, and it has no interest in attracting new smokers.

“Adults should have the ability to choose to purchase a legal product,” Sylvia says. “We want to make sure that when adult, current smokers are choosing their brand, they think about our brand.”

Source: USA Today

Hookah smoking’s dangers lead to bans

Do you smoke cigarettes? What about marijuana? Many doctors, including myself, routinely ask patients these questions. Over the years, fewer and fewer people say yes. But if you — like me — thought Canada was winning the war on smoking, look again.

New data suggests young Canadians are turning to waterpipes, also called shisha or hookah — and the fumes they’re inhaling may be even more toxic than cigarettes.

Traditionally, hookah smokers use harsh flavourless tobacco, but flavours like fruit, chocolate and even bubble gum are now popular.

Almost 10 per cent of Ontario students between Grades 7 and 12 smoked a hookah in the last year, according to the 2013 Ontario Drug Use and Health Survey performed by the Centre for Addiction and Mental Health (CAMH). That’s one and a half per cent more than reported cigarette use in this age group.

A similar trend is occurring across the country. According to a study published in Preventing Chronic Disease in May, researchers from the University of Waterloo found that the number of Grade 9 to 12 students in Canada reporting ever using a hookah increased from 9.5 per cent in 2006 to 10.1 per cent in 2010, while cigarette use declined during that time.

Hookah bars in Canada aren’t required to have age restrictions because they serve tobacco-free herbal hookah — which for the most part, isn’t prohibited by anti-tobacco smoking laws. But hookah smoke can be just as dangerous as cigarette smoke because the charcoal used to heat tobacco in waterpipes emits high levels of carbon monoxide, metals, and cancer-causing chemicals. And that’s now prompting lawmakers across Canada to look at ways to curb the practice.

Alberta passed a law in November that bans hookah smoking in public places altogether. Many Ontario towns and cities like Barrie, Peterborough, Brantford, and Orillia have put similar bylaws in place, despite no province-wide action. Toronto alone has more than 80 hookah bars.

Hookah originated in the Middle East and India in the 16th century. Waterpipes burn charcoal to heat tobacco or herbs, producing smoke. The pipe then bubbles the smoke through water to cool it before inhalation.

Traditionally, hookah smokers use harsh flavourless tobacco. But mixing tobacco with flavours like fruit, chocolate and even bubble gum is now popular. Since smoking tobacco indoors is not allowed in most places in Canada — bars serve herbal hookah instead. “Herbal” tobacco-free hookah uses a mixture of flavours and herbs.

Hookah poses health hazards to smokers and those exposed to second hand smoke, says Roberta Ferrence. (CBC)

Appealing flavours are pulling in users far beyond Arab communities. In fact, the latest Canadian Youth Smoking Survey funded by Health Canada showed that young people of African, Latin American and Asian descent were the most likely to use the pipes.

Because hookah smokers share a pipe, “it’s a great way to spend time with friends,” says Anton Volov, a first-year undergraduate student at York University – adding that “my friends have told me it’s healthier than cigarettes.”Volov smokes hookah at bars twice a week and enjoys trying new flavours each time.

Hookah poses serious potential health hazards to smokers and those exposed to second hand smoke — just like cigarettes, says Dr. Roberta Ferrence, the senior scientific advisor to the Ontario Tobacco Research Unit, a lead research agency funded by the Ontario government. Hookah smokers are at increased risk for heart and lung disease and cancer, she adds.

Herbal hookah’s hazards

The United States Centers for Disease Control and Prevention explains that hookah users may absorb higher concentrations of toxins than cigarette users — because they puff more often, inhale more deeply and smoke for longer periods of time in each session. A typical 1-hour hookah session involves 200 puffs, while an average cigarette is 20 puffs.

Thus far, Alberta is the only province to take action and ban hookah smoking. “The evidence for the hazardous effects of hookah, even herbal hookah, is clear. We have to protect our youth,” says Fred Horne, Alberta’s Minister of Health.

Now, the Ontario Campaign for Action on Tobacco wants the Government of Ontario to bring “tobacco-like” products under existing Smoke-Free legislation, which would make it illegal to serve even herbal hookah in public areas.

Ontario is committed to ensuring tobacco-containing hookah is not smoked in public areas, as already prohibited by law, says David Jensen, spokesperson for the Ontario Ministry of Health and Long Term Care. But Ontario is not planning to outright ban hookah use in public areas — because research showing the harmful effects of herbal hookah is limited and smoking hookah “is a social or cultural activity for some people,” Jensen says.

Michael Perley, the director of the Ontario Campaign for Action on Tobacco, disagrees. “This is clearly not a cultural activity anymore,” he says. The hazardous health effects of herbal hookah are well known, he adds.

In a study published in Tobacco Control in September, researchers in Alberta found that smoke from herbal hookah contained levels of toxic substances equal to or in excess of cigarette smoke. Ferrence performed a similar study published in Tobacco Control in September that examined the air quality of 12 hookah bars in Toronto — where only herbal hookah was allowed. The air contained much higher levels of cancer-causing particulate matter and carbon monoxide than those found in smoking rooms of bars.

They also found high air nicotine levels in most of these hookah bars, suggesting hookah with tobacco was still being served. Many bars claim they serve herbal hookah to get around tobacco-free legislation — but we know this isn’t true, Perley says. But it doesn’t matter whether hookah contains tobacco or is herbal — the health risks are still there, Ferrence says.

Donald Martin, a consultant lobbyist with Safe Shisha — a group that promotes safe and responsible hookah use on behalf of bar owners in Alberta — argues against banning hookah. Instead, he wants hookah bar regulations like age restrictions, special licenses, and ventilation standards. “Anybody can just set up shop, why not introduce some regulations to ensure hookah is smoked safely,” Martin says. “How is this different than licensing alcohol?” he asks.

Simply regulating hookah bars would leave Canada behind Lebanon, Turkey, and parts of Saudi Arabia and India — where governments have banned the indoor smoking of hookah, Perley says. “Even countries where hookah is traditionally used are banning it,” he says.

People need to know how harmful hookah can be, Ferrence says. In Beijing, people are told to stay in their homes when particulate matter levels in the air due to smog exceed 500 micrograms per cubic meter. “We consistently measured levels of 1500 in hookah bars, that’s three times the amount,” she says. “In one bar, levels were as high as 17,000,” she adds.

Source: CBC news

Reduction in hospital medical errors with improved handoff communication

A new study from Boston Children’s Hospital’s division of general paediatrics — published by the Journal of the American Medical Association (JAMA) — indicates that improving verbal and written communication during patient handoffs can reduce medical errors substantially without burdening existing workflows.

Medical errors are a leading cause of death and injury in the US, with an estimated 80 per cent of serious medical errors involving some form of miscommunication, particularly when care is transferred in a hospital setting from one provider to the next.

“By introducing more standardized communication during patient handoffs for this study, Boston Children’s saw a substantial drop in the overall number of medical errors,” says the study’s principal investigator Dr Christopher Landrigan.

“We believe if other medical centres adopted similar protocols it could have a positive and significant impact on patient safety.”

Error types included those with little or no potential for harm, intercepted potential adverse events, non-intercepted potential adverse events and preventable adverse events. Preventable adverse events decreased from 3.3 per 100 admissions to 1.5 per 100 admissions following intervention.

With the goal of improving provider-to-provider communication, Dr Landrigan and Dr Amy Starmer, lead author of the study, designed a multi-faceted, bundled handoff system consisting of three key components: standardized communication and handoff training, a verbal mnemonic and a new team handoff structure.

“Traditionally, doctors are trained in medical school to interview a patient and write daily summaries of the care plan, but though vital to patient care, rarely receive communication or handoff training,” says Dr Starmer. “We sought to rectify that omission with this study.”

The researchers examined 1,255 patient admissions that occurred during the implementation of the handoff bundle to measure how it impacted patient care and clinician workflow across two separate inpatient units at Boston Children’s.

Implementation of the new system began with an interactive workshop for all participating clinicians, during which they practiced giving and receiving handoffs under different clinical and real-world scenarios. The workshop was based on best practices for handoffs using elements of the TeamSTEPPS communication programme, developed by the military and the US Agency for Healthcare Research and Quality.

Secondly, participants adopted an easy-to-remember mnemonic to ensure all relevant information was verbally communicated during the handoff. Face-to-face handoffs were also restructured to involve all team members and minimize interruptions and distractions.

Finally, in conjunction with Boston Children’s informatics team, the researchers created a structured handoff tool within the electronic medical record (EMR) to standardize the documentation of patient information that is transmitted at change of shift. The electronic handoff tool self-populates with standard patient information. This replaced the previous method of information exchange that required clinicians to manually enter and re-enter information in a word processing document, increasing the potential for human error.

After implementation of the communication bundle there were fewer omissions or miscommunications about important data during handoffs, which led to positive results. Of the 1,255 patient admissions studied, medical errors decreased 45.8 per cent. In addition, following the intervention, providers spent more time communicating face-to-face in quiet areas conducive to conversation, and spent more time at the bedside with patients.

“We believed these systems would lead to a reduction in medical errors, but did not expect to see a change of this magnitude,” Dr Starmer says. “And even more surprising was that the systems were introduced so easily. Participants embraced the new systems, became more productive, and could then focus more energy to the job at hand.”

Based on the results of this study, Dr Landrigan and team developed I-PASS, a handoff bundle rolling out to 10 teaching hospitals across North America.

“Our ultimate goal,” says Dr Landrigan, “is to develop a robust handoff programme that can be broadly disseminated across hospitals and specialties to reduce medical errors and optimize patient safety.”

Source: India Medical Times

Hepatitis E Outbreak in Uganda

Health Minister Christine Ondoa has expressed concern over the rising prevalence of Hepatitis B in eastern Uganda, despite efforts to contain the deadly disease.

“Ministry and district health officers are working tirelessly to see that we solve this problem; we call upon all people to embrace preventive measures because it is better than cure,” Ondoa said in Soroti last week,

Like HIV, Hepatitis B spreads through sex, mother-to-child transmission, sharing of sharp objects and blood transfusion. But it is 15 times more infectious than HIV/Aids.

The disease is incurable and difficult to detect, and causes liver cancer and chronic liver failure.

“The government has already introduced medicine for children below one year,” Ondoa said, as the government launched a programme to distribute 21 million nets. “This is the vaccine they get below the left thigh when they are six weeks; parents immunize your children against Hepatitis B.”

Hepatitis B virus infection is highly endemic in Uganda, with transmission occurring in childhood and adulthood. Some 1.4 million adults are chronically infected and some communities disproportionately affected.

Source: All Africa

Red light, green labels: Food choice made easier

In March 2010, Massachusetts General Hospital’s cafeteria got an overhaul. Healthy items were labeled with a “green light,” less healthy items were labeled with a “yellow light,” and unhealthy items were labeled with a “red light.” Healthier items were also placed in prime locations throughout the cafeteria, while unhealthy items were pushed below eye level.

The “Green Light, Red Light, Eat Right” method is a favorite among experts fighting childhood obesity. But doctors at Massachusetts General wanted to know if the colors could really inspire healthier eating habits among adults long-term.

The results of their study were published Tuesday in the American Journal of Preventive Medicine.

The study

A cash register system tracked all purchases from the hospital’s large cafeteria between December 2009 and February 2012. The first three months of data were used as a baseline for comparison purposes. In March 2010, all food and beverages were labeled with a visible green, yellow or red sticker. Those with a green sticker were put at eye level and in easier-to-reach places.

Signs, menu boards and other promotions were used to explain the changes around the hospital.

The cafeteria had an average of 6,511 transactions daily. Approximately 2,200 of those were from hospital employees who used the cafeteria regularly. Twelve months into the study, researchers analyzed the number of purchases from each color group, and compared them to the baseline totals. They did the same at the end of the 24-month period.

The results

The number of red items purchased during the study period decreased from 24% at the baseline to 21% at both the 12 and 24-month follow-ups. The biggest decrease was seen in red-labeled beverages (such as regular soda) – from 27% at baseline to 18% at 24 months.

Sales of green items increased from 41% to 46%.

In other words, cafeteria-goers bought more water and purchased healthier food items during the study period than they did before the traffic light system went into place.

Employees showed the biggest improvement; their purchases of red items decreased by about 20%.

Takeaway

“These results suggest that simple food environment interventions can play a major role in public health policies to reduce obesity,” the study authors write.

Lead study author Dr. Anne Thorndike wasn’t sure that the changes seen early in the study would last over the two-year period. The consistent results at 24 months suggest people won’t grow tired of or immune to helpful food labels, she says.

Thorndike does not believe the color coding system can replace more detailed nutrition information, but says the labels “convey some basic nutrition information in a format that can be quickly interpreted and understood by individuals from diverse backgrounds.”

It’s unclear if the traffic light system produced the change in consumers’ behavior or if it was the rearrangement of items in the cafeteria.

Use it at home

“Families could utilize this concept by categorizing foods in the household as ‘green’ or red,'” Thorndike says. “For example, you could have a ‘green’ snack drawer or shelf on the refrigerator that the kids could freely choose from, and you could designate a ‘red’ drawer in which the kids would need to ask permission before taking a snack.”

Parents can also rearrange their cupboards to put healthier snacks front and center. Sorry, cookies – it’s the dark corner up top for you.

Source: the chart

New technique enables patient with ‘Word Blindness’ to read again

In the journal Neurology, researchers report a novel technique that enables a patient with “word blindness” to read again.

Word blindness is a rare neurological condition. (The medical term is “alexia without agraphia.”) Although a patient can write and understand the spoken word, the patient is unable to read.

The article is written by Jason Cuomo, Dr Murray Flaster and Dr Jose Biller of Loyola University Medical Centre.

Here’s how the technique works: When shown a word, the patient looks at the first letter. Although she clearly sees it, she cannot recognize it. So beginning with the letter A, she traces each letter of the alphabet over the unknown letter until she gets a match. For example, when shown the word Mother, she will trace the letters of the alphabet, one at a time, until she comes to M and finds a match. Three letters later, she guesses correctly that the word is Mother.

“To see this curious adaption in practice is to witness the very unique and focal nature” of the deficit, the authors write.

The authors describe how word blindness came on suddenly to a 40-year-old kindergarten teacher and reading specialist. She couldn’t make sense of her lesson plan, and her attendance sheet was as incomprehensible as hieroglyphs. She also couldn’t tell time.

The condition was due to a stroke that probably was caused by an unusual type of blood vessel inflammation within the brain called primary central nervous system angiitis.

Once a passionate reader, she was determined to learn how to read again. But none of the techniques that she had taught her students — phonics, sight words, flash cards, writing exercises, etc — worked. So she taught herself a remarkable new technique that employed tactile skills that she still possessed.

The woman can have an emotional reaction to a word, even if she can’t read it. Shown the word “dessert,” she says, “Oooh, I like that.” But when shown “asparagus,” she says, “Something’s upsetting me about this word.”

Shown two personal letters that came in the mail, she correctly determined which was sent by a friend of her mother’s and which was sent by one of her own friends. “When asked who these friends were, she could not say, but their names nevertheless provoked an emotional response that served as a powerful contextual clue,” the authors write.

What she most misses is reading books to children. She teared up as she told the authors: “One day my mom was with the kids in the family, and they were all curled up next to each other, and they were reading. And I started to cry, because that was something I couldn’t do.”

Source: India medical times

‘Sticky balls’ may stop cancer spreading

Cancer-killing “sticky balls” can destroy tumour cells in the blood and may prevent cancers spreading, early research suggests.

The most dangerous and deadly stage of a tumour is when it spreads around the body.

Scientists at Cornell University, in the US, have designed nanoparticles that stay in the bloodstream and kill migrating cancer cells on contact.

They said the impact was “dramatic” but there was “a lot more work to be done”.

One of the biggest factors in life expectancy after being diagnosed with cancer is whether the tumour has spread to become a metastatic cancer.

“About 90% of cancer deaths are related to metastases,” said lead researcher Prof Michael King.

They attached a cancer-killing protein called Trail, which has already been used in cancer trials, and other sticky proteins to tiny spheres or nanoparticles.

When these sticky spheres were injected into the blood, they latched on to white blood cells.

Tests showed that in the rough and tumble of the bloodstream, the white blood cells would bump into any tumour cells which had broken off the main tumour and were trying to spread.

The report in Proceedings of the National Academy of Sciences showed the resulting contact with the Trail protein then triggered the death of the tumour cells.

Prof King told the BBC: “The data shows a dramatic effect: it’s not a slight change in the number of cancer cells.

“The results are quite remarkable actually, in human blood and in mice. After two hours of blood flow, they [the tumour cells] have literally disintegrated.”

He believes the nanoparticles could be used used before surgery or radiotherapy, which can result in tumour cells being shed from the main tumour.

It could also be used in patients with very aggressive tumours to prevent them spreading.

However, much more safety testing in mice and larger animals will be needed before any attempt at a human trial is made.

So far the evidence suggests the system has no knock-on effect for the immune system and does not damage other blood cells or the lining of blood vessels.

But Prof King cautioned: “There’s a lot of work to be done. Various breakthroughs are needed before this could be a benefit to patients.”

Source: BBC news

New lung cancer screening guidelines approved for older smokers

Guidelines recommending annual low-dose CT lung cancer screening for older smokers have been approved by the US Preventive Services Task Force. The recommendations apply to individuals aged between 55 and 80 who are at high risk for lung cancer as a result of heavy smoking.

The guidelines are published in the journal Annals of Internal Medicine.

According to the American Cancer Society, approximately 228,190 new cases of lung cancer will have been diagnosed during 2013, with 159,480 deaths from the disease. This accounts for around 27% of all cancer deaths.

Background information from the guidelines states that around 85% of all cases of lung cancer are caused by smoking, and the risk of lung cancer increases with age, particularly for those aged over 55.

Dr. Michael LeFevre, co-vice chair of the US Preventive Services Task Force (USPSTF), says these factors suggest that the longer a person smokes, the higher their risk is for developing lung cancer.

Guidelines recommending annual low-dose CT lung cancer screening for older smokers have been approved by the US Preventive Services Task Force. The recommendations apply to individuals aged between 55 and 80 who are at high risk for lung cancer as a result of heavy smoking.

The guidelines are published in the journal Annals of Internal Medicine.

According to the American Cancer Society, approximately 228,190 new cases of lung cancer will have been diagnosed during 2013, with 159,480 deaths from the disease. This accounts for around 27% of all cancer deaths.

Background information from the guidelines states that around 85% of all cases of lung cancer are caused by smoking, and the risk of lung cancer increases with age, particularly for those aged over 55.

Dr. Michael LeFevre, co-vice chair of the US Preventive Services Task Force (USPSTF), says these factors suggest that the longer a person smokes, the higher their risk is for developing lung cancer.

He adds:

“When clinicians are determining who would most benefit from screening, they need to look at a person’s age, overall health, how much the person has smoked, and whether the person is still smoking or how many years it has been since the person quit.”

Low-dose CT scanning ‘more accurate’
The 2004 lung cancer screening recommendation from the USPSTF stated that the “evidence was insufficient to recommend for or against screening for lung cancer in asymptomatic persons with LDCT (low-dose computed tomography), chest radiography, sputum cytologic evaluation or a combination of these tests.”

With the aim of updating these recommendations, a panel from the USPSTF reviewed more than 33 studies involving current or former smokers who were at average or high risk for developing lung cancer.

The analysis included a study of more than 50,000 people who were a part of the National Lung Screening Trial.

From their research, the panel found that low-dose computed tomography (CT) lung cancer screening was more accurate in identifying the disease in its early stages, compared with alternative screening tests.

Their findings have led the USPSTF to “recommend annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.”

A 30-pack year is the equivalent to one pack a day for 30 years, or two packs a day for 15 years.

Screening not recommended when smoking ceased for 15 years
However, they note that screening should be stopped once a person has not smoked for 15 years or develops a health problem that shortens life expectancy or the willingness or ability to undergo potential lung surgery.

Dr. Virginia Moyer, chair of USPSTF emphasizes that it is important to assess a patient’s overall health to determine whether screening is appropriate.

“The benefit of screening may be significantly less in people with serious medical problems and there is no benefit in screening someone for whom treatment is not an option,” she says.

“In these people, screening may lead to unintended harms such as unnecessary tests and invasive procedures.”

She also adds that although screening for lung cancer is beneficial, it should not be seen as an alternative to giving up smoking.

Source: medical news today

Kidney stones: this pain is ‘Worse than childbirth’

One of the most common presentations is the flank pain on one side. It sometimes radiates down into the stomach, and it can actually radiate down into the genital area. That type of pain is pretty commonly seen in stone patients.

Sometimes there’s nausea and vomiting. Those type of symptoms are something that gives us a clue that this may be a stone.

The CAT scan is the gold standard for imaging for kidney stones. That’s usually the way to diagnose it. You can’t do it from a blood test or anything else.

Why do people say that they are so painful?
It blocks the flow of urine in the kidney, and it causes backup. And it’s an excruciating pain. A lot of people do describe it as worse than childbirth.

When the system is trying to push urine out, what happens is: your kidney and your ureter — they have this muscle propagation that goes down the kidney into the ureter — when it’s trying to push and the stone is blocking it, you get these intense pains. That’s why we call it colicky, it comes and goes and it’s extremely painful and the main reason for the pain is the backup of urine.

What’s happening exactly?
Usually, if they have two kidneys, they urinate fine, because you’re getting urine on the other side. The problem is, that kidney is producing urine but it can’t get pushed down.

If you take a pipe and you clog it off and somehow you’re still getting fluid into the other end … if it’s a pipe that can expand, it starts expanding.

The backup is like that. It causes a great deal of pain because you’re expanding your system. You don’t have any pop-off valve. Once it starts expanding, it’s expanding unnaturally.

It’s called hydronephrosis, and it’s basically backup of urine into the kidney.
What to do for kidney stones

Are there particular risk factors?
There are certain diseases associated with kidney stones, things like hypoparathyroidism, or some bowel diseases where your absorption isn’t normal.

Things like obesity and diabetes are associated with kidney stones. The main dietary factors are low water intake and high salt intake and animal protein — anything you killed to eat. If you have high amounts of those intakes, it causes your urine to acidify and then it becomes more prone to having stones.

It just depends on the person. If you have a family history, you’re more apt to get a stone.

What is the treatment?
If the stones are small enough, they usually pass on their own. Sometimes it can be an uneventful passage, or sometimes it’s just an excruciating passage, but we can help them out with pain medicine and some other medicines.
We say greater than 5 mm we start watching them closely. They have a higher chance of requiring surgery to pass the stone.
So it’s possible that with pain medicine, it could go away on its own?

Yep, they can pass it. As long as it’s small enough, and there’s nothing abnormal in their system that prevents it from moving through, if it’s small enough people can pass the stones by themselves.

How long does that take?
It can take a few days. Depending on where the stone is and how small it is. Sometimes we monitor up to six weeks, but if the stone isn’t progressing, we’ll go ahead and take care of it.

If the pain is so much that they can’t endure it, then we will go ahead and treat. If their pain is coming and going, and well-controlled with things like ibuprofen or other pain medicine, sometimes we just wait and let them try and pass it.

Source: CNN

The art of yoga

It’s practiced by millions of Americans who credit it with bringing them better health, physical fitness, and serenity.

And then there are those who see it differently . . .

“How many of you would like to stay here for an hour and twist yourself into agonizing positions, ultimately wrapping your leg around your head?” Alec Baldwin asked a crowd. “How many of you would rather come with me to the movies and eat a pizza?”

Yes, that’s Alec Baldwin, the famously un-serene bad boy, who not long ago made headlines, again, when he got into an ugly scuffle with a photographer staking out his family.

When he spoke with Braver, just before that incident, he made no secret of the fact that his main interest in yoga isn’t anger management; it’s that his wife Hilaria is an instructor.

“When I came to her class the first time and watched her teach her class, all I wanted to do was, like, pour a glass of scotch and light a cigarette and just say, ‘This is never happening,'” Baldwin said.

But Baldwin was there — at least in body — when his wife taught an unusual class right in the Smithsonian’s Sackler Gallery in Washington, amid priceless works of art.

It’s the first major exhibit about yoga ever mounted in the U.S.
The Baldwins chaired the opening gala and helped sponsor the show, which Hilaria Baldwin says calls attention to the ancient origins of a practice that began in India some 2,500 years ago.

“By looking at the history, you see how deep the roots are,” Hilaria said, “and how important it has been through centuries. Now it kind of brings it full circle.”

Curator Debra Diamond, who began working on the exhibition in 2009, said the various depictions of yoga masters, known as yogis and yoginis, show that there was never one set tradition for yoga.

Some forms have links to Hinduism, Buddhism, and other religions.

One fragment of sculpture is from the 2nd century. Its gaunt figures, said Diamond represented renouncers — “those who gave up society, who began fasting and meditating in order to attain enlightenment and omniscience.”

But yoga practice was often completely secular. Kings and maharajas who believed that yoga could help them achieve supernatural powers, like levitation, commissioned a wealth of sculptures, paintings, and manuscripts.

So what does the word “yoga” mean?

“The Sanskrit root of yoga, which is yug, means to hold, to join, to unite,” said Diamond. “But the term yoga itself has probably more meanings than any other Sanskrit word. These range from the yolk, the harness of an ox, to the union between opposites.”

Americans, including Henry David Thoreau of Walden Pond fame, became interested in yoga as early as the mid-19th century.

But yoga later developed a somewhat less noble image.

Howard Thurston, a famous magician of the late 1800s, traveled the country claiming to have supernatural yoga-style powers, performing illusions like the suspended rope trick.

Diamond said many American first came to know of yogi through the conjuring of exotic stereotypes about India that were rather dubious. “Yogis became an embarrassment for Indians as well as for the rest of the world,” said Diamond.

But yoga’s image began to change after a 1938 film showing an athletic series of poses and postures to promote physical and mental fitness, developed by a 5-foot, 2-inch yogi named Krishnamacharya.

And today a lot of us are striking poses: A 2012 survey by Yoga Journal found that some 20 million adult Americans say they do yoga, up from 15.8 million in 2008.

But how real are the health benefits?

Dr. Lorenzo Cohen is the director of integrative medicine at M.D. Anderson Cancer Center in Houston, which offers yoga classes for patients and employees alike.

Dr. Cohen says, of the clinical trials that have been conducted, including some at M.D. Anderson, “We see that yoga can help improve fatigue, help improve sleep dysfunction in cancer survivors, as well as improve physical functioning.

“You’re engaging your mind, you’re engaging your breath, your lungs,” explained Dr. Cohen. “And in some sense, simplistically, a bio-behavioral change is happening within the body. By and large, you’re going to be decreasing stress hormones. Heart rate and blood pressure are going to reduce.”

And yoga is a booming business! According to one study, Americans spend nearly $6 billion a year on yoga classes and products.

Yoga studios are found in more and more towns. There was even a yoga garden at last April’s White House Easter Egg Roll.

And instructors like Hilaria Baldwin can teach even a yoga-phobic reporter (left) a move or two.

She persuaded her husband Alec to appear in her video for pregnant women. [They now have a four-month-old.] And Hillaria says yoga helped her become more relaxed:

“I just stopped taking things so seriously, which was really the key to being much happier,” she said.

“Has this rubbed off on you?” Braver asked Alec Baldwin.

“Only where the paparazzi aren’t involved,” he laughed.

In fact by any stretch of the imagination, yoga takes dedication and discipline, which a lot of us know we should have, but like Alec Baldwin, we may not be able to achieve, despite our best New Year’s resolutions.

“You know, I’m somebody who I think I have, like, half-wisdom,” he told Braver. “I know what I need to do. I just don’t do it! But I’m pretty certain what I need to do. I know exactly what I need to do.”

But never fear: Yoga has always been about the quest, as well as the accomplishment.

Source: cbs news