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We provide the same Preventive Executive Physical Program as received by the President of the United States.


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A Key Antibacterial Soap Ingredient Must Go

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In 1978 the Bee Gees ruled the airwaves, Grease topped the box office and the U.S. Food and Drug Administration first proposed a rule on antibacterial hand soaps—a rule that would have eliminated an unnecessary and unsafe ingredient called triclosan. Thirty-five years later many things have changed, but the FDA has not. Just recently it proposed rules on antibacterial soaps that would remove triclosan-containing soap from the shelves—for the third time. Yet because the FDA has failed to finalize any of these proposals, triclosan has proliferated in the marketplace. It is now the most common active ingredient found in antibacterial consumer hand soaps.

It’s also common in our bodies. Triclosan has been measured in amniotic fluid, breast milk, human blood and the urine of 75 percent of Americans sampled over the age of six. Although it does not discriminate by gender or racial/ethnic group, it appears to increase in concentration as income increases. Despite little evidence of their effectiveness to reduce illness, triclosan-containing antibacterial soaps have dominated the market. Soap aside, triclosan can also be found in consumer products as diverse as cutting boards, shoes, lipstick and toothpaste.

In other words, we are continually exposed to triclosan. The problem is that triclosan is not safe. In animal studies it has been shown to interfere with the regulation of thyroid hormones (affecting metabolism and brain development), testosterone synthesis (decreasing sperm counts) and estrogen action (causing early onset of puberty). Exposure to triclosan has been shown to weaken heart muscle, impairing contractions and reducing heart function, and to weaken skeletal muscle, reducing grip strength. In aquatic environments fish exposed to triclosan were unable to swim properly.

Higher urinary levels of triclosan are associated with hay fever, allergies to airborne triggers (like ragweed and cats) and food (peanut, shrimp, dairy) allergies. Triclosan has even been associated with elevated body mass index in adults. Although the mechanism driving this association is not clear, researchers suggest that it could be due to changes in the gut flora or hormones.

There are also concerns about the potential impact of triclosan use on development of antibiotic resistance. Laboratory studies on bacteria exposed to triclosan demonstrate evidence of cross-resistance to critically important antibiotics including erythromycin, ciprofloxacin, ampicillin and gentamicin. Further, there is evidence that resistance to triclosan itself exists in Salmonella enterica, Staphylococcus aureus, streptococcus, Escherichia coli and other species of bacteria. Strains of Mycobacterium tuberculosis tolerant to triclosan have also showed resistance to the drug isoniazid (INH), which is used to treat tuberculosis. Although the overuse of antibiotics in humans and livestock is a greater contributor to the public health crisis of antibiotic-resistant bacteria, the potential increased risk of antibiotic resistance from the use of antimicrobial chemicals is unnecessary.

To add insult to injury, there is no added benefit to using triclosan (or any antibacterial) soaps. Triclosan is intrinsically ineffective against some bacteria like Pseudomonas aeruginosa and fungal infections. The FDA requires that to be considered effective these soaps must do more than remove bacteria; they must “provide a clinical benefit by reducing infections.” But studies show that using soap containing triclosan does not reduce human illnesses or infections any more than using regular soap. There have even been occasional reports of fatal bacterial outbreaks in hospitals using triclosan, including bacterial contamination of triclosan soap containers in a surgical intensive care unit.

Which brings us back to the FDA. In the rule it proposed in 1978 (and again in 1994 and 2013) the FDA said it does not have sufficient information to determine whether triclosan is safe or effective. In the absence of such a determination triclosan cannot be sold in the U.S.—but the FDA’s failure to finalize these proposals allowed the products to remain on the market. Therefore, in 2010 the Natural Resources Defense Council sued the FDA to compel it to finalize its rules. As a result of the settlement, the FDA now has to finish its rules on antibacterial soaps by September 2016. If at that time the FDA still cannot say triclosan is safe and effective, then antibacterial hand soaps can no longer contain triclosan. Until then, antibacterial soaps remain on the market and consumers are left to protect themselves from this harmful chemical.

Source: Scientific American


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Why You Shouldn’t Eat and Run

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As a 10-mile-a-day runner, Dave McGillivray thought he could eat whatever he wanted without worrying about his heart. “I figured if the furnace was hot enough, it would burn everything,” said McGillivray, who is 59.

But a diagnosis six months ago of coronary artery disease shocked McGillivray, a finisher of 130 marathons and several Ironman-distance triathlons. Suddenly he regretted including a chocolate-chip-cookie recipe in his memoir about endurance athletics.

“My first reaction was, I was embarrassed,” he said.

As race director of the Boston Marathon, McGillivray is a high-profile exhibit in a growing medical case against the devil-may-care diets of many marathoners. Their high-mileage habit tends to lower their weight, blood pressure, heart rate and cholesterol levels, leading them (and sometimes their doctors) to assume their cardiac health is robust regardless of diet.

“‘I will run it off’—that attitude clearly prevails among the marathoners themselves, almost sometimes to an arrogance,” said Paul Thompson, a veteran marathoner who is chief of cardiology at Hartford Hospital.

A growing body of research shows the error of that thinking. A study published in the current edition of Missouri Medicine found that 50 men who had run at least one marathon a year for 25 years had higher levels of coronary-artery plaque than a control group of sedentary men. A British Medical Journal study published this year compared the carotid arteries of 42 Boston Marathon qualifiers with their much-less active spouses. “We hypothesized that the runners would have a more favorable atherosclerotic risk profile,” says the article. As it turned out, that hypothesis was wrong.

A small body of research suggests that heart problems may arise not in spite of extreme-endurance exercise but because of it. That has led some cardiologists to theorize that, beyond a certain point, exercise stops preventing and starts causing heart disease.

“Studies support a potential increased risk of coronary artery disease, myocardial fibrosis and sudden cardiac death in marathoners,” Peter McCullough, a Baylor University cardiologist, wrote as lead author of an editorial in the current Missouri Medicine.

But many cardiologists are skeptical. “The science establishing a causal link between vigorous exercise and coronary disease is shaky at best,” said Aaron Baggish, a Massachusetts General Hospital cardiologist who does triathlons and marathons. Even so, he said, “I’ve never once told a patient they need to run marathons or race triathlons to maximize health, as this is not accurate.”

Reports of heart disease in runners are prompting some marathoners to get coronary-artery scans. Ambrose Burfoot, winner of the 1968 Boston Marathon and editor-at-large of Runner’s World magazine, is 67 years old, 6 feet tall and only 147 pounds. A lifelong vegetarian, he subsists mostly on fruits, vegetables and nuts, though he eats “cookies and all dairy products—cheeses, ice creams etc.,” he wrote in an email.

“Last March I learned that I have a very high coronary calcium,” he said. “I have a condition perhaps similar to Dave McGillivray’s.”

The medical profession’s recommendation for such runners depends on which cardiologist they visit. James O’Keefe, a Kansas City cardiologist and ex-triathlete who believes sustained endurance exercise can damage the heart, said he would recommend no more than 20 miles a week at a modest pace.

Thompson and Baggish, however, believe that in many cases endurance athletes diagnosed with heart disease can safely continue doing marathons and triathlons, if their conditions are treated. Thompson argues that risk must be weighed against quality of life, an idea that Burfoot embraces.

“I subscribe to the old saw: ‘Exercise—it might not add years to your life, but it adds life to your years,'” said Burfoot.

But cardiologists are united in their campaign against the old notion that high-calorie workouts confer a free pass to eat anything.

Those who run several hours a day often dream about cookies and ice cream. When McGillivray ran from coast to coast in 1978, he tended to finish each day at a Dairy Queen. “It wasn’t just replacing calories but a mental thing—that vanilla shake was my reward,” he said.

Replacing thousands of calories with purely nutritious foods can be challenging. Since receiving his diagnosis last October—and radically changing his diet—the 5-foot-4 McGillivray has dropped to 128 pounds from 155, an improvement he celebrates.

Far from cutting back his workout regimen, McGillivray has amped it up, boosting his weekly mileage to 70 from about 60. As race director of the Boston Marathon, which is April 21, he plans to continue his tradition of running that course after the last runner has crossed the finish line. And to celebrate turning 60 in August, he plans to complete an Ironman-distance triathlon.

Although McGillivray says that his cardiologist, Baggish, gave him “the green light” for such challenges, Baggish said in an email that, “I do not give patients (Dave included) green or red lights. We engage in an open discussion about known and uncertain risks and benefits and come up with a collective and very individualized plan about what is reasonable.

“In Dave’s case,” he added, “we did just this and he is leaning toward doing the (Ironman) with full knowledge of the fact this his risk is elevated compared to the general field.”

Some critics say that continuing to engage in endurance athletics despite cardiac disease is evidence of addiction. “I’m not afraid to call myself an exercise addict,” said Burfoot. “I have always been afraid of dying on a run. But the way I look at it now, it’s not that running will have killed me. Running has enhanced my life immeasurably, but it could also ‘trigger’ a life-ending event that probably would have happened even sooner except for my running.”

Source: Wall Street Journal


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Women are at the ‘epicenter of Alzheimer’s disease,’ says new report

Report: Alzheimer's far more likely than breast cancer in women over 60

Women are at a much higher risk for developing Alzheimer’s disease than men, and the condition poses an even greater risk for elderly women than breast cancer, a new report finds.

According to the latest Alzheimer’s Association 2014 Alzheimer’s Disease Facts and Figures report, women have a 1 in 6 estimated lifetime risk of developing the disease at age 65, while the risk for men is nearly 1 in 11. Additionally, women in their 60s are about twice as likely to develop Alzheimer’s as they are to develop breast cancer.
These differences in gender are further reflected by the fact that there are 2.5 times as many women than men providing 24-hour care for someone living with Alzheimer’s.
Acting as an “on-duty” caregiver for someone living with Alzheimer’s creates a strain that leads to feelings of isolation and depression, as well as the need to take a leave of absence or give up working entirely. While performing caregiving duties, 20 percent of women went from working full-time to working part-time, compared to 3 percent of men.

“[W]e know that women are the epicenter of Alzheimer’s disease, representing majority of both people with the disease and Alzheimer’s caregivers. Alzheimer’s Association Facts and Figures examines the impact of this unbalanced burden,” said Angela Geiger, chief strategy officer of the Alzheimer’s Association.
Alzheimer’s disease is currently the sixth leading cause of death in the United States and affects more than 5 million Americans – including 3.2 million women. Adding to that, 15.5 million caregivers provide 17.7 billion hours of unpaid care. Dementia caregiving resulted in an estimated $9.3 billion in increased health care costs for caregivers in 2013.

Given these statistics, the Alzheimer’s Association is calling for a greater investment in research of the disease.
“Well-deserved investments in breast cancer and other leading causes of death such as heart disease, stroke and HIV/AIDS have resulted in substantial decreases in death. Comparable investments are now needed to realize the same success with Alzheimer’s in preventing and treating the disease,” Geiger said.

The Alzheimer’s Association points out that there is still a lack of understanding about the disease – a form of dementia that causes problems with memory, thinking and behavior.

“Despite being the nation’s biggest health threat, Alzheimer’s disease is still largely misunderstood. Everyone with a brain — male or female, family history or not — is at risk for Alzheimer’s,” Geiger said. “Age is the greatest risk factor for Alzheimer’s, and America is aging. As a nation, we must band together to protect our greatest asset, our brains.”

Source: Fox News


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March is National Colorectal Cancer Awareness Month

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Your risk of colorectal cancer increases as you age; more than 90% of all cases occur in individuals who are 50 and older. Colorectal cancer screening helps find precancerous polyps so they can be removed before they turn into cancer.

It’s important to get tested according to national guidelines, which include colonoscopies and occult blood tests. At Presidential Healthcare Center, we track your CEA levels as part of our executive physical program; this is a cancer marker that can help us catch the disease in its earliest stages. Celebrate this March by scheduling your personalized executive physical!


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13 Million More Could Get Statin Therapy in U.S.

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A new study published in the New England Journal of Medicine reports that the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) guidelines for the treatment of cholesterol would increase the number of U.S. adults eligible for statin therapy by nearly 13 million. Older adults without cardiovascular disease would comprise the majority of the increase.

The previous Third Adult Treatment Panel (ATP III) guidelines of the National Cholesterol Education Program (ATP-III) recommended statin therapy for patients with cardiovascular disease or diabetes and low-density lipoprotein (LDL) cholesterol levels of >100mg/dl. For primary prevention, LDL cholesterol level plus the Framingham risk score (10-year cardiovascular disease risk calculator) were used to determine whether statin therapy was warranted.

The new ACA/AHA guidelines recommend the following:

  • Statin      therapy to all adults with known cardiovascular disease regardless of LDL      cholesterol level;
  • Statin      therapy for patients with an LDL cholesterol level of ≥190mg/dL      (4.91mmol/L);
  • Statin      therapy for patients 40–75 years of age with diabetes or a 10-year risk of      cardiovascular disease of >7.5% with an LDL cholesterol level of      ≥70mg/dL (1.81mmol/L) or higher.

Michael J. Pencina, PhD, from the Duke Clinical Research Institute, and colleagues analyzed fasting sample data from 3,773 individuals ages 40–75 in the National Health and Nutrition Examination Surveys (NHANES) collected from 2005–2010. Of the total patients,1,583 (42.0%) were receiving or would be eligible for statin therapy based on the ATP III guidelines, vs. 2,135 participants (56.6%) who would be eligible based on the 2013 ACA/AHA recommendation. Using these statistics, the authors estimate that nearly half of the adult U.S. population between the ages of 40–75 with triglyceride level of <400mg/dL would be eligible for statin therapy (56 million, 48.6%). This is a net increase of 12.8 million potential new statin users and an increase of 11.1 percentage points over those eligible under the ATP III guidelines.

With the increase in adults eligible for statin therapy, the authors suggest that there will be higher treatment rates among both those who are and are not expected to have future cardiovascular events, particularly in men. The effect would be seen in older (ages 60–75) vs. younger (ages 40–59) cohorts, as 77% in the older age group would be eligible compared to 30% in the younger group.

Read more in the New England Journal of Medicine here.


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Risks to Bone Health in Treating Chronic Disease in Younger Patients

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Osteoporosis, a loss of bone strength that raises the risk of fractures, is one of the most common and crippling ailments associated with aging in women. Increasingly, it is striking younger patients who have a host of other medical problems.

Researchers call it secondary osteoporosis. They are identifying a growing list of factors that contribute to bone deterioration, including chronic diseases and some of the powerful drugs used to treat them. Alone or in combination, disease and medication can interfere with the way the body naturally breaks down and rebuilds bone tissue, and how well it absorbs bone-building nutrients like calcium and Vitamin D.

Because there often are no symptoms as bone weakens, osteoporosis often hasn’t been diagnosed until a patient suffers a fractured bone.

Now, bone health experts are calling for greater efforts to identify patients earlier who are at risk for secondary osteoporosis, before their bones become more fragile and further raise their risk of injury and disability.

Recommended measures include bone mineral density scans for patients who wouldn’t ordinarily get routine screening, treatment of underlying diseases that contribute to bone loss, lifestyle changes and calcium and vitamin D supplements. Doctors also are prescribing osteoporosis medicines shown to slow bone loss or build new bone.

Secondary osteoporosis is increasingly being diagnosed in younger patients with cancer, celiac disease, rheumatoid arthritis and inflammatory bowel disease, as well as in people taking reflux medications, blood thinners and some depression drugs, researchers say. Patients are at risk of secondary osteoporosis after bariatric surgery for weight loss, as are those receiving hormonal treatments to prevent the recurrence of breast or prostate cancer.

Adverse effects of diabetes on bone health are starting to be recognized. Smoking, excessive alcohol use, eating disorders like anorexia nervosa and inactivity are also linked to declining bone mass.

Anyone taking corticosteroids, such as prednisone, is at risk, according to the American College of Rheumatology. The drugs, prescribed to suppress inflammation in a wide range of illnesses and to prevent organ rejection after transplants, have a direct negative effect on bone cells and can interfere with the body’s handling of calcium.

According to the National Osteoporosis Foundation, nine million adults in the U.S. have osteoporosis and an additional 43 million have low bone mass, or osteopenia, which increases their risk of osteoporosis and broken bones. The foundation projects that by 2030, the number of adults over age 50 with osteoporosis and low bone mass will grow by more than 30% to 68 million.

Primary osteoporosis is most commonly caused by women’s loss of estrogen after menopause. Age-related bone loss affects men starting in their 70s.

Last year, a review by researchers at Loyola University Medical Center in Maywood, Ill., found secondary causes of bone loss are reported in up to 60% of men, more than 50% of premenopausal women and some 30% of postmenopausal women who are diagnosed with osteoporosis.

“When I find a younger patient with osteoporosis, there is likely to be a secondary cause, and if that cause isn’t treated, they will continue to lose bone even if they are on osteoporosis medications,” says Pauline M. Camacho, an endocrinologist at Loyola and co-author of the study.

Source: Wall Street Journal


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Prostate Surgery Ups Survival For Some

Men with early-stage prostate cancer who had their prostates surgically removed were significantly more likely to be alive nearly two decades later than men who went without surgery and were monitored through so-called “watchful waiting,” the latest findings from a long-running Swedish study show.

The 700-patient study, which found similar results at earlier stages, is likely to heighten debate about the value of surgery versus observation or watchful waiting, which generally involves no immediate treatment. In recent years, doctors increasingly have embraced watchful waiting, in part because other large studies have shown that surgery provides no benefit yet has potentially undesirable side effects.

The Swedish study, published Wednesday in the New England Journal of Medicine, showed that after 18 years, there were 13% fewer deaths from any cause, and 11% fewer deaths from prostate cancer specifically, in the group that had surgery versus the watchful-waiting group. By the 18-year mark, 200 of 347 men in the surgery group had died from any cause, versus 247 of 348 monitored men.

The benefits of surgery were most pronounced in men who were under 65 when diagnosed. In these patients, there were 25.5% fewer deaths from any cause and 15.8% fewer deaths from prostate cancer in the surgery group. Among men 65 and older at diagnosis, there was no significant reduction in death in the surgery group, according to the study, which was led by Swedish physicians and funded by the Swedish Cancer Society.

Moreover, men whose cancers had an intermediate risk of growing or spreading were more likely to benefit from surgery than men whose cancer had a low or high risk of spreading. Among intermediate-risk patients, there were 24.2% fewer deaths from prostate cancer in the surgery group than in the watchful-waiting group. Among low-risk patients, there were 3.8% fewer deaths from prostate cancer in the surgery group, a slim enough difference that the researchers said it could have been due to chance. In high-risk patients, there was no significant difference in prostate-cancer death between the groups.

James McKiernan, director of urologic oncology at New York-Presbyterian Hospital and Columbia University Medical Center, said the results should help doctors better target patients for surgery. “On first pass, this looks like a green light to go operating on everyone, but what it really does is shed a lot of light on the subset of patients who will benefit from surgery,” he said. “The younger patient with relatively aggressive cancer is the patient who will benefit most from treatment.”

Source: Wall Street Journal