Honolulu Advertiser Staff
February 6, 2008
HONOLULU – More than 2,900 people in Hawai'i died from cardiovascular disease in 2005, making it the leading cause of death in the state, according to a new report titled "The Burden of Cardiovascular Disease in Hawai'i – 2007."
The report, which was released today by the Hawai'i State Department of Health Community Health Division, represents the most recent compilation of data on cardiovascular disease in the state, according to a news release.
Cardiovascular disease is a group of diseases that affect the heart and blood vessels, the two most common forms being heart disease and stroke.
The Department of Health hopes this report can be used to provide updated data to community programs that address CVD issues, educate the public on CVD health disparities, and encourage partnerships with chronic disease programs and groups that are closely linked to CVD, such as diabetes and tobacco prevention, according to the release.
"Cardiovascular disease is a serious, common and very costly disease," said health director Dr. Chiyome Fukino. "This report provides healthcare partners as well as individuals with updated data that can be used to help take tailored steps to minimize the risk and impact of cardiovascular disease."
This technical report presents data on CVD mortality, prevalence, hospitalizations and associated risk factors. The report was completed in collaboration with a number of community partners. Highlights of the report include findings that known risk factors for CVD include high blood pressure, diabetes, and smoking. Another risk factor is low socioeconomic status, which is defined as adults who have an annual household income below $15,000, less than a high school education or are unemployed.
"While Hawai'i as a whole has a relatively low rate of cardiovascular disease in relation to the rest of the country, there are widespread disparities within our population that must be addressed," said Dr. Kalani Brady, American Heart Association O'ahu Metro board member. "If we don't address those risk factors and turn the tide, we could see death rates again increase."
The "Burden of Cardiovascular Disease in Hawai'i – 2007" is available at www.hawaii.gov/health.
Thursday, July 31, 2008
Most in Isles skimp on exercise and nutrition
Honolulu Advertiser
Posted on: Wednesday, March 19, 2008
Most in Isles skimp on exercise and nutrition
By Dan Nakaso
Advertiser Staff Writer
For more tips on getting fit, quitting smoking and healthy eating, go to www.healthyhawaii.com
START WALKING
The state Department of Health's recommendations on starting a walking program to get fit:
How far and how fast you walk is not an issue in the beginning. Recommendations:
• Walk 10+ minutes 5+ days a week.
• Walk briskly, and with a purpose.
• Work your way up to 30+ minutes 5+ days a week.
Walking can be done:
• With one piece of equipment: good walking shoes.
• To music, to nature or to conversation.
• In groups or alone. You can decide each day which suits you.
Fitness level does not matter. Simply get off the couch.
Begin with the end in mind. Good health and happiness will result from placing one foot in front of the other on a regular basis.
Enlisting support has been shown to drastically increase your chances of success. Talk about the fact that you're walking. Others will ask how it's going, which keeps you motivated.
Don't let the weather stop you. Find favorite walking routes for both sunny and rainy weather.
Sign up for a walking event like a 5K walk. Just remember you don't need to walk a marathon to be healthy.
Join a walking club. Commit to at least one group workout a week.
Plan a walking or hiking vacation (and get in shape for it).
Make walking a part of your routine. Walk to work, walk during breaks, take the stairs, walk the kids to school, etc.
The first comprehensive report on Hawai'i's nutrition and physical activity covers more than a hundred pages with statistics and charts but can be summarized simply:
Most children and adults need to get more exercise every day. And everyone can benefit from increasing the amount of fruits and vegetables they eat each day.
"The changes don't have to be dramatic," Lt. Gov. James "Duke" Aiona said yesterday at the state Capitol in releasing the report. "One more fruit and vegetable improves health. ... Eliminate one cookie, one chocolate candy and one soda" per day.
And exercise can come easily, too, Aiona said. Adults can break down their 30 minutes of recommended daily exercise into three separate, simple activities like walking up the stairs at work.
"It can be as easy as flying a kite, walking the dog or walking down the street to buy a newspaper," Aiona said.
Most of the data in the Hawaii Physical Activity and Nutrition Surveillance Report 2008 has been reported before and covers information for 2005:
One in five people in Hawai'i were considered obese.
In 2005, 2,900 people in Hawai'i died of heart disease.
Most middle and high school students did not meet the daily recommendations for physical activity. And almost half of adults were not physically active enough.
An estimated $140 million in inpatient hospital charges related to heart disease, stroke and diabetes could have been prevented in 2005 if more adults were regularly physically active.
"We know that walking for at least 30 minutes per day can lower risks of obesity, heart disease and stroke and some cancers," said Dr. Chiyome Fukino, director of the state Department of Health. "This report will be our guide to improving physical activity and nutrition in our community."
Some 750 copies were published at a cost of $12,345 from Hawai'i's tobacco settlement funds. The report also is available at www.healthyhawaii.com; click on the link "Pan plan."
Reach Dan Nakaso at dnakaso@honoluluadvertiser.com.
Posted on: Wednesday, March 19, 2008
Most in Isles skimp on exercise and nutrition
By Dan Nakaso
Advertiser Staff Writer
For more tips on getting fit, quitting smoking and healthy eating, go to www.healthyhawaii.com
START WALKING
The state Department of Health's recommendations on starting a walking program to get fit:
How far and how fast you walk is not an issue in the beginning. Recommendations:
• Walk 10+ minutes 5+ days a week.
• Walk briskly, and with a purpose.
• Work your way up to 30+ minutes 5+ days a week.
Walking can be done:
• With one piece of equipment: good walking shoes.
• To music, to nature or to conversation.
• In groups or alone. You can decide each day which suits you.
Fitness level does not matter. Simply get off the couch.
Begin with the end in mind. Good health and happiness will result from placing one foot in front of the other on a regular basis.
Enlisting support has been shown to drastically increase your chances of success. Talk about the fact that you're walking. Others will ask how it's going, which keeps you motivated.
Don't let the weather stop you. Find favorite walking routes for both sunny and rainy weather.
Sign up for a walking event like a 5K walk. Just remember you don't need to walk a marathon to be healthy.
Join a walking club. Commit to at least one group workout a week.
Plan a walking or hiking vacation (and get in shape for it).
Make walking a part of your routine. Walk to work, walk during breaks, take the stairs, walk the kids to school, etc.
The first comprehensive report on Hawai'i's nutrition and physical activity covers more than a hundred pages with statistics and charts but can be summarized simply:
Most children and adults need to get more exercise every day. And everyone can benefit from increasing the amount of fruits and vegetables they eat each day.
"The changes don't have to be dramatic," Lt. Gov. James "Duke" Aiona said yesterday at the state Capitol in releasing the report. "One more fruit and vegetable improves health. ... Eliminate one cookie, one chocolate candy and one soda" per day.
And exercise can come easily, too, Aiona said. Adults can break down their 30 minutes of recommended daily exercise into three separate, simple activities like walking up the stairs at work.
"It can be as easy as flying a kite, walking the dog or walking down the street to buy a newspaper," Aiona said.
Most of the data in the Hawaii Physical Activity and Nutrition Surveillance Report 2008 has been reported before and covers information for 2005:
One in five people in Hawai'i were considered obese.
In 2005, 2,900 people in Hawai'i died of heart disease.
Most middle and high school students did not meet the daily recommendations for physical activity. And almost half of adults were not physically active enough.
An estimated $140 million in inpatient hospital charges related to heart disease, stroke and diabetes could have been prevented in 2005 if more adults were regularly physically active.
"We know that walking for at least 30 minutes per day can lower risks of obesity, heart disease and stroke and some cancers," said Dr. Chiyome Fukino, director of the state Department of Health. "This report will be our guide to improving physical activity and nutrition in our community."
Some 750 copies were published at a cost of $12,345 from Hawai'i's tobacco settlement funds. The report also is available at www.healthyhawaii.com; click on the link "Pan plan."
Reach Dan Nakaso at dnakaso@honoluluadvertiser.com.
Tuesday, July 29, 2008
The Doctor’s World
By LAWRENCE K. ALTMAN, M.D
Published: July 29, 2008
New York Times
When Senator Edward M. Kennedy disclosed on May 20 that he had brain cancer, three days after suffering a seizure, doctors did not list surgery as a possibility. A news release from Massachusetts General Hospital in Boston left the impression that radiation and chemotherapy were the main options for his pernicious type of cancer.
Two weeks later, Mr. Kennedy, 76, flew to Durham, N.C. There, at Duke University on June 2, neurosurgeons operated for three and a half hours and declared the procedure “successful,” though they did not specify their criteria.
Precisely why Mr. Kennedy’s treatment course changed is not known; he and his doctors are not talking to reporters.
What is known is that a few days after Mr. Kennedy learned he had a malignant brain tumor in the left parietal lobe, he invited a group of national experts to discuss his case.
The meeting on May 30 was extraordinary in at least two ways.
One was the ability of a powerful patient — in this case, a scion of a legendary political family and the chairman of the Senate’s health committee — to summon noted consultants to learn about the latest therapy and research findings.
The second was his efficiency in quickly convening more than a dozen experts from at least six academic centers. Some flew to Boston. Others participated by telephone after receiving pertinent test results and other medical records.
Except for the circumstances, telephone participation and the number of invited experts, the meeting resembled the tumor board meetings that specialists regularly hold in their hospitals.
For Mr. Kennedy, the scene was all too familiar. It resembled those he had convened to map the care for two of his children when they had cancer years earlier.
A son, Edward Jr., who is now 46, had part of his right leg amputated in 1973 for bone cancer. Mr. Kennedy invited a group of experts to his home to discuss follow-up care for the boy, who then received radiation and two years of an experimental form of chemotherapy.
A daughter, Kara Kennedy Allen, had lung cancer in 2003. After some surgeons deemed the cancer inoperable, bolder surgeons operated. Ms. Allen is doing well five years later.
Mr. Kennedy is hoping for similar success as he completes about six weeks of radiation, with chemotherapy expected to continue for a year.
The initial news release about his brain tumor called it a glioma without specifying the type. A meeting participant described it as a glioblastoma, the deadliest form of brain cancer. Patients live, on average, about a year after it is detected.
In the meeting, experts spoke about surgery, radiation and chemotherapy, said the participant, Dr. Raymond Sawaya, chairman of neurosurgery at Baylor College of Medicine and the M. D. Anderson Cancer Center in Houston.
Opinion about the benefit of surgery for Mr. Kennedy was divided. Some neurosurgeons strongly favored it; two did not, Dr. Sawaya said, including himself, largely because the cancer was not a discrete nodule, but was spread over a large area, making it unlikely that most of it could be removed.
Chances for success are somewhat proportional to the amount of tumor removed, although experts disagree about precisely how much visible tumor must be removed for the best chances.
Whether the surgery was justified or not, that Mr. Kennedy had it at Duke embarrassed the Massachusetts General Hospital, a Harvard teaching institution. The change in venue strongly suggests that the meeting somehow led to the more aggressive surgical approach.
The urgency of the operation forced Mr. Kennedy, the third-longest-serving senator in history, to cancel his receiving an honorary doctorate from his alma mater, Harvard.
The commencement was scheduled for six days after the consultants’ meeting, and doctors said that was too long to wait, Mr. Kennedy told the Harvard president, Drew Gilpin Faust, in a telephone call, according to a friend who did not want to be identified. When Dr. Faust said Mr. Kennedy would receive the degree in person in the future, the announcement received a standing ovation.
In declaring his operation successful, Duke doctors did not define their criteria, like whether they had removed all visible cancer or spared him complications like loss of speech.
A week later, Mr. Kennedy returned to the Boston hospital for continuing outpatient care and has released sparse information about his cancer and progress. Although he is learning to cope with fatigue, “the news is really all positive and encouraging,” his wife, Victoria, told friends in an e-mail message this month.
On July 9, he flew in virtual secrecy to Washington to make a surprising and dramatic appearance in the Senate, stirring the normally staid chamber to a rousing ovation and moving many colleagues to tears. He looked steady. But his cheeks were puffy, a telltale sign of heavy steroid treatment, as he voted, delivering Democrats a decisive victory on a signature health care issue.
Mr. Kennedy can tap leading doctors for answers in a way few patients could. His celebrity status aside, he has spent a career promoting insurance and other ways to improve the health of Americans. And he has had a track record of being thorough and diligent in researching medical options when relatives or friends have fallen ill.
His colleague John Kerry, also a Massachusetts Democrat, said in an interview that when his first wife, Julia Thorne, was waging what turned out to be a losing battle with bladder cancer two years ago, “Teddy recommended specifically getting a group of doctors together from different places and different approaches and get them all on a call so that you can force different theories to be tested by the others who are there.
“He actually helped me find the right people to put on the call,” Mr. Kerry said. “The process was unbelievably effective.”
Occasionally, some patients, including prominent scientists, have asked doctors to organize a number of independent experts to advise about their illnesses.
Yet powerful and wealthy people who could have convened such a group have delegated the consulting to their doctors.
Several doctors not connected with Mr. Kennedy’s case said in interviews that they admired his resourcefulness in getting more opinions simultaneously. At the same time, these doctors said many average patients gained competent advice, without a command performance, by sending pertinent records to experts for their opinions.
Many patients search the Internet for medical information and ask that their scans and other data be sent electronically or by overnight services.
Then such patients visit, call or write the consultant.
Second opinions have their downsides as well as benefits. One downside is that people inexperienced in reading medical papers “tend to editorialize and pick out what they want to be the answer, and many of us may not agree with their interpretation,” said Dr. Eugene S. Flamm, a neurosurgeon at Montefiore Medical Center in the Bronx.
Just sending images and records is far less preferable than meeting with a patient before rendering an opinion. “I do not operate on films,” Dr. Flamm said. “I operate on people.”
Meeting with patients “is an important factor in terms of their expectations and concerns,” he continued, adding: “I can see a white ball on a scan and say yes, that is a tumor, I agree. Beyond that it is rather difficult to come up with a treatment plan based on that, other than saying, yes I would operate or I won’t.”
Outcomes of surgery for glioblastomas have not improved significantly in recent decades, several doctors say, so they tend to recommend a wait-and-see approach — reserving surgery for palliation if it is needed later in the course of therapy.
These doctors said that the concept of reducing the amount of cancer so radiation and chemotherapy can interact more effectively made a lot of sense theoretically, but in a practical sense, had not panned out.
Some experts said they favored a more aggressive surgical approach, when it can be performed safely because it offers the best chance of longer survival, particularly when combined with various forms of radiation and chemotherapy. The experts say that even if surgery cannot prolong life many years, it can offer more quality for the time that is left.
The experts also contend that newer techniques like functional brain imaging and mapping are improving the safety and outcomes of brain surgery for glioblastomas. Neurosurgeons can test tiny areas of the brain to map functions controlled by the specific areas. Because these areas vary in anatomic location with the individual, mapping helps the surgeon avoid cutting into vital areas and damaging areas that control vital motor and cognitive functions.
Even when neurosurgeons do sophisticated imaging testing before surgery, they enter the operating room somewhat uncertainly.
Long-term survival, an uncommon outcome, is considered to be three years or longer, and most such survivors have had aggressive brain surgery to remove the tumor, experts say. Long-term success also depends in part on a patient’s age and other ailments.
The uncertainty of what to do in each glioblastoma case shows that doctors have much to learn about brain cancers. That knowledge gap makes philosophy an important part of the decision process for patients and doctors.
Many patients willingly take the risks of aggressive brain surgery because they understand that their chances of longer survival are reduced without an attempt to remove as much of the visible tumor as possible.
Surgeons realize that while they can operate on virtually every patient, some patients are not surgical candidates.
But some patients insist on surgery even when doctors say the risk is too great because the cancer is dangerously close to vital areas of the brain.
“It is human nature for patients, in saying they want to save their lives, say I am willing to lose my speech or be completely paralyzed,” said Dr. Sawaya, the Houston expert. But most neurosurgeons are unwilling to take such risks, he said, “because patients paralyzed after surgery are miserable, and also everybody around them is miserable.”
Dr. Mitchel S. Berger, chairman of the department of neurosurgery at the University of California, San Francisco, flew to Boston to participate in Mr. Kennedy’s meeting and care. He spoke only about his experience in other cases, including the recent one of a woman who at 80 is four years older than Mr. Kennedy. She has a glioblastoma that Dr. Berger judged likely to cause her death in about two months.
If he could remove all visible brain cancer, the operation, combined with chemotherapy and radiation, could provide 3 to 15 months of good-quality life with her family, Dr. Berger said. He added: “While that may not be a huge amount of time — one-eightieth of her lifetime — it is a lot of time to say and do many things. When people look at it in that context, it becomes a big and significant piece of time.”
The reality is that two people who listen to a doctor spell out the risk-benefit profile can come to different decisions. One may say surgery is not worth the risk, while the other says, “That is one way I want to say goodbye.”
Published: July 29, 2008
New York Times
When Senator Edward M. Kennedy disclosed on May 20 that he had brain cancer, three days after suffering a seizure, doctors did not list surgery as a possibility. A news release from Massachusetts General Hospital in Boston left the impression that radiation and chemotherapy were the main options for his pernicious type of cancer.
Two weeks later, Mr. Kennedy, 76, flew to Durham, N.C. There, at Duke University on June 2, neurosurgeons operated for three and a half hours and declared the procedure “successful,” though they did not specify their criteria.
Precisely why Mr. Kennedy’s treatment course changed is not known; he and his doctors are not talking to reporters.
What is known is that a few days after Mr. Kennedy learned he had a malignant brain tumor in the left parietal lobe, he invited a group of national experts to discuss his case.
The meeting on May 30 was extraordinary in at least two ways.
One was the ability of a powerful patient — in this case, a scion of a legendary political family and the chairman of the Senate’s health committee — to summon noted consultants to learn about the latest therapy and research findings.
The second was his efficiency in quickly convening more than a dozen experts from at least six academic centers. Some flew to Boston. Others participated by telephone after receiving pertinent test results and other medical records.
Except for the circumstances, telephone participation and the number of invited experts, the meeting resembled the tumor board meetings that specialists regularly hold in their hospitals.
For Mr. Kennedy, the scene was all too familiar. It resembled those he had convened to map the care for two of his children when they had cancer years earlier.
A son, Edward Jr., who is now 46, had part of his right leg amputated in 1973 for bone cancer. Mr. Kennedy invited a group of experts to his home to discuss follow-up care for the boy, who then received radiation and two years of an experimental form of chemotherapy.
A daughter, Kara Kennedy Allen, had lung cancer in 2003. After some surgeons deemed the cancer inoperable, bolder surgeons operated. Ms. Allen is doing well five years later.
Mr. Kennedy is hoping for similar success as he completes about six weeks of radiation, with chemotherapy expected to continue for a year.
The initial news release about his brain tumor called it a glioma without specifying the type. A meeting participant described it as a glioblastoma, the deadliest form of brain cancer. Patients live, on average, about a year after it is detected.
In the meeting, experts spoke about surgery, radiation and chemotherapy, said the participant, Dr. Raymond Sawaya, chairman of neurosurgery at Baylor College of Medicine and the M. D. Anderson Cancer Center in Houston.
Opinion about the benefit of surgery for Mr. Kennedy was divided. Some neurosurgeons strongly favored it; two did not, Dr. Sawaya said, including himself, largely because the cancer was not a discrete nodule, but was spread over a large area, making it unlikely that most of it could be removed.
Chances for success are somewhat proportional to the amount of tumor removed, although experts disagree about precisely how much visible tumor must be removed for the best chances.
Whether the surgery was justified or not, that Mr. Kennedy had it at Duke embarrassed the Massachusetts General Hospital, a Harvard teaching institution. The change in venue strongly suggests that the meeting somehow led to the more aggressive surgical approach.
The urgency of the operation forced Mr. Kennedy, the third-longest-serving senator in history, to cancel his receiving an honorary doctorate from his alma mater, Harvard.
The commencement was scheduled for six days after the consultants’ meeting, and doctors said that was too long to wait, Mr. Kennedy told the Harvard president, Drew Gilpin Faust, in a telephone call, according to a friend who did not want to be identified. When Dr. Faust said Mr. Kennedy would receive the degree in person in the future, the announcement received a standing ovation.
In declaring his operation successful, Duke doctors did not define their criteria, like whether they had removed all visible cancer or spared him complications like loss of speech.
A week later, Mr. Kennedy returned to the Boston hospital for continuing outpatient care and has released sparse information about his cancer and progress. Although he is learning to cope with fatigue, “the news is really all positive and encouraging,” his wife, Victoria, told friends in an e-mail message this month.
On July 9, he flew in virtual secrecy to Washington to make a surprising and dramatic appearance in the Senate, stirring the normally staid chamber to a rousing ovation and moving many colleagues to tears. He looked steady. But his cheeks were puffy, a telltale sign of heavy steroid treatment, as he voted, delivering Democrats a decisive victory on a signature health care issue.
Mr. Kennedy can tap leading doctors for answers in a way few patients could. His celebrity status aside, he has spent a career promoting insurance and other ways to improve the health of Americans. And he has had a track record of being thorough and diligent in researching medical options when relatives or friends have fallen ill.
His colleague John Kerry, also a Massachusetts Democrat, said in an interview that when his first wife, Julia Thorne, was waging what turned out to be a losing battle with bladder cancer two years ago, “Teddy recommended specifically getting a group of doctors together from different places and different approaches and get them all on a call so that you can force different theories to be tested by the others who are there.
“He actually helped me find the right people to put on the call,” Mr. Kerry said. “The process was unbelievably effective.”
Occasionally, some patients, including prominent scientists, have asked doctors to organize a number of independent experts to advise about their illnesses.
Yet powerful and wealthy people who could have convened such a group have delegated the consulting to their doctors.
Several doctors not connected with Mr. Kennedy’s case said in interviews that they admired his resourcefulness in getting more opinions simultaneously. At the same time, these doctors said many average patients gained competent advice, without a command performance, by sending pertinent records to experts for their opinions.
Many patients search the Internet for medical information and ask that their scans and other data be sent electronically or by overnight services.
Then such patients visit, call or write the consultant.
Second opinions have their downsides as well as benefits. One downside is that people inexperienced in reading medical papers “tend to editorialize and pick out what they want to be the answer, and many of us may not agree with their interpretation,” said Dr. Eugene S. Flamm, a neurosurgeon at Montefiore Medical Center in the Bronx.
Just sending images and records is far less preferable than meeting with a patient before rendering an opinion. “I do not operate on films,” Dr. Flamm said. “I operate on people.”
Meeting with patients “is an important factor in terms of their expectations and concerns,” he continued, adding: “I can see a white ball on a scan and say yes, that is a tumor, I agree. Beyond that it is rather difficult to come up with a treatment plan based on that, other than saying, yes I would operate or I won’t.”
Outcomes of surgery for glioblastomas have not improved significantly in recent decades, several doctors say, so they tend to recommend a wait-and-see approach — reserving surgery for palliation if it is needed later in the course of therapy.
These doctors said that the concept of reducing the amount of cancer so radiation and chemotherapy can interact more effectively made a lot of sense theoretically, but in a practical sense, had not panned out.
Some experts said they favored a more aggressive surgical approach, when it can be performed safely because it offers the best chance of longer survival, particularly when combined with various forms of radiation and chemotherapy. The experts say that even if surgery cannot prolong life many years, it can offer more quality for the time that is left.
The experts also contend that newer techniques like functional brain imaging and mapping are improving the safety and outcomes of brain surgery for glioblastomas. Neurosurgeons can test tiny areas of the brain to map functions controlled by the specific areas. Because these areas vary in anatomic location with the individual, mapping helps the surgeon avoid cutting into vital areas and damaging areas that control vital motor and cognitive functions.
Even when neurosurgeons do sophisticated imaging testing before surgery, they enter the operating room somewhat uncertainly.
Long-term survival, an uncommon outcome, is considered to be three years or longer, and most such survivors have had aggressive brain surgery to remove the tumor, experts say. Long-term success also depends in part on a patient’s age and other ailments.
The uncertainty of what to do in each glioblastoma case shows that doctors have much to learn about brain cancers. That knowledge gap makes philosophy an important part of the decision process for patients and doctors.
Many patients willingly take the risks of aggressive brain surgery because they understand that their chances of longer survival are reduced without an attempt to remove as much of the visible tumor as possible.
Surgeons realize that while they can operate on virtually every patient, some patients are not surgical candidates.
But some patients insist on surgery even when doctors say the risk is too great because the cancer is dangerously close to vital areas of the brain.
“It is human nature for patients, in saying they want to save their lives, say I am willing to lose my speech or be completely paralyzed,” said Dr. Sawaya, the Houston expert. But most neurosurgeons are unwilling to take such risks, he said, “because patients paralyzed after surgery are miserable, and also everybody around them is miserable.”
Dr. Mitchel S. Berger, chairman of the department of neurosurgery at the University of California, San Francisco, flew to Boston to participate in Mr. Kennedy’s meeting and care. He spoke only about his experience in other cases, including the recent one of a woman who at 80 is four years older than Mr. Kennedy. She has a glioblastoma that Dr. Berger judged likely to cause her death in about two months.
If he could remove all visible brain cancer, the operation, combined with chemotherapy and radiation, could provide 3 to 15 months of good-quality life with her family, Dr. Berger said. He added: “While that may not be a huge amount of time — one-eightieth of her lifetime — it is a lot of time to say and do many things. When people look at it in that context, it becomes a big and significant piece of time.”
The reality is that two people who listen to a doctor spell out the risk-benefit profile can come to different decisions. One may say surgery is not worth the risk, while the other says, “That is one way I want to say goodbye.”
Tuesday, July 22, 2008
Power Naps Can Be Sign Of Productivity
Long Naps May Cause Sluggishness
Barbara A. Besteni, Staff writer
It's about 2 p.m. in Miramar, Fla. At the far end of a parking lot serving several office buildings, Jorge Hernandez opens the back door of his 2004 Honda Accord and disappears inside.
Twenty minutes later, he climbs out and heads back to his office, alert and ready to battle whatever the rest of the day has in store.
It's a ritual Hernandez follows religiously Monday through Friday.
"I don't know what I'd do without my daily power nap," he says.
Leonardo da Vinci, Albert Einstein and Thomas Edison -- all champion power nappers -- would have agreed. It could be argued that Edison was the first person to turn off the lights for the sole purpose of catching some midday Zs.
Research shows that a 20-minute nap in the afternoon may be just what the doctor ordered to recharge your battery and increase productivity for the rest of the day.
Long And Short Of Naps
The term "power nap" was originated by Dr. James B. Maas, author of "Power Sleep: The Revolutionary Program That Prepares Your Mind for Peak Performance." Maas defines a power nap as a short period of sleep that ends before deep, or slow-wave, sleep kicks in.
Dr. Sara Mednick, a researcher from the Salk Institute for Biological Studies, lists on her Web site improved heart function, hormonal maintenance and cell repair as some of the benefits of power napping. Her research also indicates that power naps can lift your moods, lower stress and improve memory and learning.
But in order to be effective, a power nap must not go on too long.
"I'm a nap junkie,"says Peter Castellanos, a sales and marketing consultant who credits naps for helping him stay focused during workdays that often go beyond 12 hours. "But if I'm asleep longer than 15 to 20 minutes, I get cranky and moody and am worthless the rest of the day."
That's what happens when someone goes beyond stages I and II of the sleep cycle, Maas said in his book. Sleep comes in five stages that repeat every 90 minutes throughout the night. Once you enter stage III, you are in slow-wave sleep and are entering deep sleep. Waking during this stage or later produces what's called sleep inertia.
Naps Don't Replace Long Sleep
While a 20-minute nap is a good refresher, it won't make up for hours lost at night.
Studies show that those if you lose sleep one night, your body makes up for it by increasing the amount of deep sleep you get the next night. But you can't catch up on sleep lost over a long period of time.
If you are often sleepy, or you find that your naps last longer than 30 minutes, it may be that you're not getting enough quality sleep at night.
Despite the benefits of a power nap, you still need an adequate amount of sleep every night to perform at your best, sa Maas. For some people, six hours might be adequate. Others may need eight hours or more. It's up to you to determine what amount is right for you.
The combination of quality nighttime sleep and consistent power naps will keep you alert and consistent throughout your waking hours.
"The return on investment of those 20 minutes a day is amazing," Castellanos says. "Power naps have added hours to my day by increasing the quality of the hours I'm awake."
Nap Tips
While there is no right or wrong way to take a nap, here are some tips for reaping the benefits of this midday ritual.
1. Try to schedule power naps after lunch. Experts say 2 or 3 p.m. is best. If you nap any later, you risk falling into slow-wave sleep or interfering with your regular night sleep.
2. Eat foods that are high in calcium and protein an hour or two before your nap. These foods help induce sleep. Avoid high-fat foods and foods that are high in sugar.
3. Use caffeine wisely. A Japanese study found that a cup of coffee 20 to 30 minutes before your nap may help avoid post-nap grogginess. It takes that long for your body to feel the effects of caffeine. The researchers concluded that by taking a power nap right after drinking a cup of coffee, you enjoy the benefits of the nap and wake up as the caffeine is kicking in.
4. Find a quiet place where you won't be disturbed. If you're not lucky enough to have a private office and a comfy couch, your parked car can work just as well. Remember to turn off your cell phone and, if you nap in your car, crack open a window.
5. Make the area as dark as possible. If necessary, wear an eyeshade. Darkness stimulates melatonin, a hormone that helps induce sleep.
6. Keep the temperature at a comfortable level. Body temperature drops when you fall asleep. Keep a light blanket handy just in case.
7. Relax. Turn off the to-do list in your mind and let yourself go.
8. Set an alarm. This insures you will wake before you enter deep sleep and won't miss an important meeting or appointment.
9. Be consistent. Experts suggest that working a 20-minute nap into your routine will help your body expect it. The more naps become part of your routine, the more you will reap the benefits.
10. Get rid of guilt. Researchers agree that power naps are great for your health and productivity. Taking a nap doesn't mean you're being lazy. So, stop feeling guilty.
Tips based on information from RirianProject.com and Powersleep.org.
Copyright 2008, Internet Broadcasting.
Barbara A. Besteni, Staff writer
It's about 2 p.m. in Miramar, Fla. At the far end of a parking lot serving several office buildings, Jorge Hernandez opens the back door of his 2004 Honda Accord and disappears inside.
Twenty minutes later, he climbs out and heads back to his office, alert and ready to battle whatever the rest of the day has in store.
It's a ritual Hernandez follows religiously Monday through Friday.
"I don't know what I'd do without my daily power nap," he says.
Leonardo da Vinci, Albert Einstein and Thomas Edison -- all champion power nappers -- would have agreed. It could be argued that Edison was the first person to turn off the lights for the sole purpose of catching some midday Zs.
Research shows that a 20-minute nap in the afternoon may be just what the doctor ordered to recharge your battery and increase productivity for the rest of the day.
Long And Short Of Naps
The term "power nap" was originated by Dr. James B. Maas, author of "Power Sleep: The Revolutionary Program That Prepares Your Mind for Peak Performance." Maas defines a power nap as a short period of sleep that ends before deep, or slow-wave, sleep kicks in.
Dr. Sara Mednick, a researcher from the Salk Institute for Biological Studies, lists on her Web site improved heart function, hormonal maintenance and cell repair as some of the benefits of power napping. Her research also indicates that power naps can lift your moods, lower stress and improve memory and learning.
But in order to be effective, a power nap must not go on too long.
"I'm a nap junkie,"says Peter Castellanos, a sales and marketing consultant who credits naps for helping him stay focused during workdays that often go beyond 12 hours. "But if I'm asleep longer than 15 to 20 minutes, I get cranky and moody and am worthless the rest of the day."
That's what happens when someone goes beyond stages I and II of the sleep cycle, Maas said in his book. Sleep comes in five stages that repeat every 90 minutes throughout the night. Once you enter stage III, you are in slow-wave sleep and are entering deep sleep. Waking during this stage or later produces what's called sleep inertia.
Naps Don't Replace Long Sleep
While a 20-minute nap is a good refresher, it won't make up for hours lost at night.
Studies show that those if you lose sleep one night, your body makes up for it by increasing the amount of deep sleep you get the next night. But you can't catch up on sleep lost over a long period of time.
If you are often sleepy, or you find that your naps last longer than 30 minutes, it may be that you're not getting enough quality sleep at night.
Despite the benefits of a power nap, you still need an adequate amount of sleep every night to perform at your best, sa Maas. For some people, six hours might be adequate. Others may need eight hours or more. It's up to you to determine what amount is right for you.
The combination of quality nighttime sleep and consistent power naps will keep you alert and consistent throughout your waking hours.
"The return on investment of those 20 minutes a day is amazing," Castellanos says. "Power naps have added hours to my day by increasing the quality of the hours I'm awake."
Nap Tips
While there is no right or wrong way to take a nap, here are some tips for reaping the benefits of this midday ritual.
1. Try to schedule power naps after lunch. Experts say 2 or 3 p.m. is best. If you nap any later, you risk falling into slow-wave sleep or interfering with your regular night sleep.
2. Eat foods that are high in calcium and protein an hour or two before your nap. These foods help induce sleep. Avoid high-fat foods and foods that are high in sugar.
3. Use caffeine wisely. A Japanese study found that a cup of coffee 20 to 30 minutes before your nap may help avoid post-nap grogginess. It takes that long for your body to feel the effects of caffeine. The researchers concluded that by taking a power nap right after drinking a cup of coffee, you enjoy the benefits of the nap and wake up as the caffeine is kicking in.
4. Find a quiet place where you won't be disturbed. If you're not lucky enough to have a private office and a comfy couch, your parked car can work just as well. Remember to turn off your cell phone and, if you nap in your car, crack open a window.
5. Make the area as dark as possible. If necessary, wear an eyeshade. Darkness stimulates melatonin, a hormone that helps induce sleep.
6. Keep the temperature at a comfortable level. Body temperature drops when you fall asleep. Keep a light blanket handy just in case.
7. Relax. Turn off the to-do list in your mind and let yourself go.
8. Set an alarm. This insures you will wake before you enter deep sleep and won't miss an important meeting or appointment.
9. Be consistent. Experts suggest that working a 20-minute nap into your routine will help your body expect it. The more naps become part of your routine, the more you will reap the benefits.
10. Get rid of guilt. Researchers agree that power naps are great for your health and productivity. Taking a nap doesn't mean you're being lazy. So, stop feeling guilty.
Tips based on information from RirianProject.com and Powersleep.org.
Copyright 2008, Internet Broadcasting.
Tools Can Save Cardiac Arrest Victims At Work
Tools Can Save Cardiac Arrest Victims At Work
Experts: More CPR Training Would Save Lives
Jessica Schaeffer, Contributing Writer
UPDATED: 7:49 am HST July 22, 2008
With more and more tools available for cardiac arrest victims, health organizations are pushing companies to make more of an effort to train their employees to save lives.
It is estimated that more than 95 percent of victims of cardiac arrest, or the sudden loss of heart function, die before reaching the hospital, and many attacks occur in the workplace, according to the American Heart Association.
This grim statistic and the recent death of NBC News executive Tim Russert have left many wondering if the level of business preparedness, including knowledge of CPR, automated external defibrillators (AEDs), and the fairly new device called the ResQPOD, could have saved Russert and the hundreds of other cardiac arrest victims each day.
"Getting certified in CPR is strongly recommended for everyone, no matter who you are," reports the Emergency Preparedness Tips Web site. "Being certified to perform CPR can actually save a life."
No Workplace Policy
On Nov. 13, 2000, President Bill Clinton signed into law the Cardiac Arrest Survival Act, designed to expand the availability of AEDs in buildings owned or leased by the federal government.
However, there is no such policy for the common workplace.
Although it is highly recommended by the American Heart Association to place AEDs in all public areas and train employees in CPR, it is ultimately the employer's choice in private workplaces.
CPR is an emergency medical procedure that is a combination of chest compressions and lung ventilation used to keep a flow of oxygenated blood to the heart and brain.
Although it is unlikely that CPR will restart the heart, it will delay tissue death and permanent brain damage, which occurs within four to six minutes after a cardiac arrest.
The combination of CPR and an AED, a computerized medical device that administers a shock to restore a natural heart rhythm, within five to seven minutes of the cardiac arrest will increase the survival rate to 30 to 45 percent, according to the American Heart Association.
Another Survival Device
Unbeknown to many, the ResQPOD, an Impedance Threshold Device, is a tool that further increases the chance of survival by noninvasively doubling the blood flow to the heart and brain during CPR.
It is a mouthpiece used on the victim during the mouth-to-mouth portion of CPR and serves as a one-way valve that regulates when air enters the lungs. It has a timer that blinks when the patient should receive a breath, said Dr. Keith Lurie, who specializes in cardiology and internal medicine in Minneapolis and St. Cloud, Minn.
Advanced Circulatory Systems, Inc
This ResQPOD device doubles the blood flow to the heart and brain during CPR.
"ResQPOD is definitely an advance, and we are excited about it," said Lurie, a member of the Take Heart America program.
The device was first produced in Eden Prairie, Minn., in 1996, but began to be manufactured in its current form in 2003 after receiving approval from the Food and Drug Administration, Jim Flom, sales manager for Advance Circulatory, told the St. Cloud Times.
The ResQPOD is now the most recommended device in cardiac arrest survival by the American Heart Association and has almost doubled the survival rates in cardiac arrest victims when used.
However, not every city is choosing to use this device, including Washington, D.C.
The outcome could have been different in the case of Tim Russert if the building where he had the attack was prepared with trained people and they had a ResQPOD, said Lurie.
"Unfortunately, people are slow to change," he said.
Anyone interested in having a ResQPOD can ask any health professional to prescribe one.
Although Lurie emphasizes the significance of the ResQPOD, the importance of basic CPR and AEDs are not overlooked.
"You can't just use one type of medicine on a cancer patient. You need 10. The same goes for a cardiac arrest victim," he said. "You need good CPR, you need the ResQPOD put on right away, and you need people willing to do CPR for 30 minutes until a medical professional can arrive."
'It Is Absolutely Essential To Make Progress'
Organizations are joining together to spread the word about cardiac arrest and the importance of being trained in CPR and AED use.
The American Red Cross has gotten involved by starting the first annual CPR and AED Awareness Week this past June.
They encouraged "states, cities and towns to establish organized programs that provide CPR and AED trainings and increase public access to AEDs."
There have also been trials to demonstrate the importance of these devices, including the Public Access Defibrillation Trial conducted between July 2000 and January 2002.
Nearly 1,000 public facilities, including apartment or office buildings, sports facilities, senior centers, and shopping malls, were selected and 20,000 volunteers were trained to either provide CPR alone or CPR and an AED. These volunteers and businesses were also equipped with around 1,500 installed AEDs throughout the buildings, according to the American College of Occupational and Environmental Medicine.
In the 292 attempted resuscitations, there were 44 cardiac arrest survivors as a result of simple training and access to the correct tools.
But Lurie emphasized that simply learning CPR is the first step to saving lives.
"Since the vast majority of people are treated by a bystander, it is absolutely essential if we want to make progress in this No. 1 killer that everyone should learn to do basic CPR," said Lurie. "You can learn it in 20 minutes, and you can learn it in confidence so if a loved one falls down, you know what to do and you can act appropriately."
Experts: More CPR Training Would Save Lives
Jessica Schaeffer, Contributing Writer
UPDATED: 7:49 am HST July 22, 2008
With more and more tools available for cardiac arrest victims, health organizations are pushing companies to make more of an effort to train their employees to save lives.
It is estimated that more than 95 percent of victims of cardiac arrest, or the sudden loss of heart function, die before reaching the hospital, and many attacks occur in the workplace, according to the American Heart Association.
This grim statistic and the recent death of NBC News executive Tim Russert have left many wondering if the level of business preparedness, including knowledge of CPR, automated external defibrillators (AEDs), and the fairly new device called the ResQPOD, could have saved Russert and the hundreds of other cardiac arrest victims each day.
"Getting certified in CPR is strongly recommended for everyone, no matter who you are," reports the Emergency Preparedness Tips Web site. "Being certified to perform CPR can actually save a life."
No Workplace Policy
On Nov. 13, 2000, President Bill Clinton signed into law the Cardiac Arrest Survival Act, designed to expand the availability of AEDs in buildings owned or leased by the federal government.
However, there is no such policy for the common workplace.
Although it is highly recommended by the American Heart Association to place AEDs in all public areas and train employees in CPR, it is ultimately the employer's choice in private workplaces.
CPR is an emergency medical procedure that is a combination of chest compressions and lung ventilation used to keep a flow of oxygenated blood to the heart and brain.
Although it is unlikely that CPR will restart the heart, it will delay tissue death and permanent brain damage, which occurs within four to six minutes after a cardiac arrest.
The combination of CPR and an AED, a computerized medical device that administers a shock to restore a natural heart rhythm, within five to seven minutes of the cardiac arrest will increase the survival rate to 30 to 45 percent, according to the American Heart Association.
Another Survival Device
Unbeknown to many, the ResQPOD, an Impedance Threshold Device, is a tool that further increases the chance of survival by noninvasively doubling the blood flow to the heart and brain during CPR.
It is a mouthpiece used on the victim during the mouth-to-mouth portion of CPR and serves as a one-way valve that regulates when air enters the lungs. It has a timer that blinks when the patient should receive a breath, said Dr. Keith Lurie, who specializes in cardiology and internal medicine in Minneapolis and St. Cloud, Minn.
Advanced Circulatory Systems, Inc
This ResQPOD device doubles the blood flow to the heart and brain during CPR.
"ResQPOD is definitely an advance, and we are excited about it," said Lurie, a member of the Take Heart America program.
The device was first produced in Eden Prairie, Minn., in 1996, but began to be manufactured in its current form in 2003 after receiving approval from the Food and Drug Administration, Jim Flom, sales manager for Advance Circulatory, told the St. Cloud Times.
The ResQPOD is now the most recommended device in cardiac arrest survival by the American Heart Association and has almost doubled the survival rates in cardiac arrest victims when used.
However, not every city is choosing to use this device, including Washington, D.C.
The outcome could have been different in the case of Tim Russert if the building where he had the attack was prepared with trained people and they had a ResQPOD, said Lurie.
"Unfortunately, people are slow to change," he said.
Anyone interested in having a ResQPOD can ask any health professional to prescribe one.
Although Lurie emphasizes the significance of the ResQPOD, the importance of basic CPR and AEDs are not overlooked.
"You can't just use one type of medicine on a cancer patient. You need 10. The same goes for a cardiac arrest victim," he said. "You need good CPR, you need the ResQPOD put on right away, and you need people willing to do CPR for 30 minutes until a medical professional can arrive."
'It Is Absolutely Essential To Make Progress'
Organizations are joining together to spread the word about cardiac arrest and the importance of being trained in CPR and AED use.
The American Red Cross has gotten involved by starting the first annual CPR and AED Awareness Week this past June.
They encouraged "states, cities and towns to establish organized programs that provide CPR and AED trainings and increase public access to AEDs."
There have also been trials to demonstrate the importance of these devices, including the Public Access Defibrillation Trial conducted between July 2000 and January 2002.
Nearly 1,000 public facilities, including apartment or office buildings, sports facilities, senior centers, and shopping malls, were selected and 20,000 volunteers were trained to either provide CPR alone or CPR and an AED. These volunteers and businesses were also equipped with around 1,500 installed AEDs throughout the buildings, according to the American College of Occupational and Environmental Medicine.
In the 292 attempted resuscitations, there were 44 cardiac arrest survivors as a result of simple training and access to the correct tools.
But Lurie emphasized that simply learning CPR is the first step to saving lives.
"Since the vast majority of people are treated by a bystander, it is absolutely essential if we want to make progress in this No. 1 killer that everyone should learn to do basic CPR," said Lurie. "You can learn it in 20 minutes, and you can learn it in confidence so if a loved one falls down, you know what to do and you can act appropriately."
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