Posts Tagged ‘doctor’

When it comes to raising vitamin D levels, anesthesiologists advise: Don’t be wimpy!

There’s already enough evidence to justify increasing vitamin D levels to improve health, according to the opinion piece by Drs Michael F. Roizen of the Cleveland Clinic and Jeffrey D. Roizen of Children’s Hospital of Philadelphia. Meanwhile, they propose a randomized trial to conclusively determine whether vitamin D can reduce complication rates after surgery.

Don’t Wait for Further Research — Act Now to Increase Vitamin D Levels

The father-and-son coauthors write in response to the latest research paper reporting linking higher vitamin D levels to better health outcomes. In that study — also published in Anesthesia & Analgesia — Dr Alparslan Turan and colleagues of the Cleveland Clinic found that surgical patients with higher vitamin D had lower rates of death and complications after surgery.

While the observational study shows significant associations, it can’t prove a cause-and-effect relationship. Dr Turan and coauthors suggest a cautious approach to further research, starting with more observational data on the relationship between preoperative vitamin D levels and postoperative outcomes.

But Drs Roizen and Roizen strongly disagree, writing: “What a wimpy conclusion.” While acknowledging the limitations of observational studies, they point out that a long series of studies has linked vitamin D to “a cornucopia of improved health outcomes.” These include “improved bone health, fewer falls, fewer bone fractures, reduced risk of heart attack and stroke, reduced risk of, and death from, colon, breast, and prostate cancer” — among others.

They believe the research warrants moving forward with a formal study evaluating the benefits of vitamin D supplementation before surgery. Citing the storied history of advances in clinical care by anesthesiologists, Drs Roizen and Roizen write, “Let’s continue to take bold steps to improve outcome….Let’s determine whether vitamin D is just a fireman (showing up at every fire, but seldom causing them), or has some real fire power in improving perioperative outcomes.

They propose a randomized trial to determine whether giving vitamin D supplements for two or three weeks before scheduled surgery can decrease complication rates. Among the questions to be answered are what vitamin D levels have the most benefit with the lowest potential for harm — recommendations range from 20 to 50 nanograms per milliliter (ng/mL). Ideally, the study would include groups with vitamin D levels or 20, 35, and 50 ng/mL.

But patients shouldn’t wait for the results of clinical trials before taking “reasonable” steps to ensure adequate vitamin D levels, Drs Roizen and Roizen believe. They recommend that patients ask their doctor what their vitamin D level is and whether they need more. For patients with vitamin D levels less than 50 ng/mL, they recommend taking supplements to get more vitamin D2 and D3. They note that it takes six weeks to achieve a steady-state vitamin D level.

The Roizens add that doctors aren’t immune to low vitamin D. They have checked their own vitamin D levels, and believe that other physicians — including anesthesiologists — should consider doing so as well. They conclude, “No matter what you decide for yourself, let us be bold (and beneficial to the rest of medicine and our patients) as a specialty.”

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Aspirin: scientists believe cancer prevention benefits outweigh harms

For the first time, scientists have reviewed all the available evidence from many studies and clinical trials assessing both the benefits and harms of preventive use of aspirin. Conclusions of the study are published in the leading cancer journal Annals of Oncology.

The researchers, led by Professor Jack Cuzick, Head of the Centre for Cancer Prevention at QMUL (London, UK), found taking aspirin for 10 years could cut bowel cancer cases by around 35% and deaths by 40%. Rates of esophageal and stomach cancers were cut by 30% and deaths from these cancers by 35-50%.

To reap the benefits of aspirin, the evidence shows people need to start taking a daily dose of 75-100 mg for at least five years and probably 10 years between the ages of 50 and 65. No benefit was seen whilst taking aspirin for the first three years, and death rates were only reduced after five years.

However, the research also warns taking aspirin long-term increases the risk of bleeding from the digestive tract, e.g. stomach bleeding. Amongst 60-year-old individuals who take daily aspirin for 10 years, the risk of digestive tract bleeds increases from 2.2% to 3.6%, and this could be life-threatening in a very small proportion (less than 5%) of people.

Overall, rates of serious or fatal gastrointestinal bleeding are very low under the age of 70, but increased sharply after that age. Another side effect of aspirin use is peptic ulcer, the risk of which is increased by 30-60%.

The study also uncovers uncertainty over the most appropriate dose of aspirin required to maximize the benefit / harm ratio, with doses varying between 75 mg to 325mg a day in different clinical trials and studies. It is also not clear whether taking aspirin for longer than 10 years will result in greater benefits.

Professor Jack Cuzick commented: “It has long been known that aspirin — one of the cheapest and most common drugs on the market — can protect against certain types of cancer. But until our study, where we analysed all the available evidence, it was unclear whether the pros of taking aspirin outweighed the cons.

“Whilst there are some serious side effects that can’t be ignored, taking aspirin daily looks to be the most important thing we can do to reduce cancer after stopping smoking and reducing obesity, and will probably be much easier to implement.”

“Our study shows that if everyone aged between 50-65 started taking aspirin daily for at least 10 years, there would be a 9% reduction in the number of cancers, strokes and heart attacks overall in men and around 7% in women. The total number of deaths from any cause would also be lower, by about 4% over a 20-year period. The benefits of aspirin use would be most visible in the reduction in deaths due to cancer.

“The risk of bleeding depends on a number of known factors which people need to be aware of before starting regular aspirin and it would be advisable to consult with a doctor before embarking on daily medication.”

Further research is needed to define more clearly who will benefit most greatly from taking aspirin and who is most at risk of the bleeding side effects.

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Lacking trust in one’s doctor affects health of emotionally vulnerable cancer patients

Patients who feel anxious and uneasy with their doctor may be impacted the most. “Anxiously attached patients may experience and report more physical and emotional problems when the relationship with their physician is perceived as less trusting,” said Chris Hinnen, Ph.D., lead author and clinical psychologist at Slotervaart Hospital in Amsterdam, The Netherlands.

The researchers acknowledge that the issue of trust between patients and their doctors can be complicated, but observe that it’s important to understand fears of rejection and abandonment that often exist in anxiously attached patients.

Hinnen and his colleagues analyzed questionnaire responses from 119 participants with breast, cervical, intestinal or prostate cancers at 3, 9 and 15 months after their diagnosis. Seventy-one percent of those surveyed were female and had an average age of 59 years old. Researchers used a shortened version of the Wake Forest Physician Trust Scale and the Revised Experiences in Close Relationships scale to determine 1) participants’ trust in the physician most involved in treatment and 2) participants’ attachment anxiety or avoidance at the 3 month mark and assessed their distress and physical limitations at three sequential time intervals. Lower levels of trust were associated with more distress at all periods and more physical limitations at three and nine months for anxiously-attached patients.

“In some people, early childhood experiences coupled with constitutional factors have led to an exaggerated desire for closeness and intimacy together with a high fear of rejection and abandonment,” Hinnen noted. “Consequently, the feeling of not being able to rely on one’s physician may be especially frightening and stressful for anxiously attached patients.” People with less attachment anxiety may have better ways of coping with a less trusting physician relationship.

Michelle B. Riba, M.D., professor and associate chair for Integrated Medical and Psychiatric Services at the University of Michigan, noted doctor-patient relationships are very important, especially when the patient is confronted with cancer. “However, this study was not free from bias because it was primarily comprised of women who liked their doctors, and these women were already in a personal relationship which portended an attachment to a relationship with their physician.”

Riba also noted the three-month time line when cancer patients in the study were asked about doctor-patient trust levels. “The problem is at three-months patients may be seeing a variety of physicians such as a surgeon, oncologist, medical oncologist or radiologist, not just one doctor,” she said.

The study notes that it is important to take into account the fact that some patients don’t feel connected to their doctor. These patients may be more at risk for emotional and physical adjustment problems associated with cancer diagnosis and treatment.

Riba added, “As physicians we try to place patients with doctors that match a patient’s style, but that doesn’t always happen. Instead, patients may move and look for other relationships on their own.”

“Since the patient-physician relationship has such an impact on patient well-being,” Hinnen said, “especially for those who are most vulnerable, limiting free choice of a [cancer] physician seems foolish.”

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