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Welcome to Health Consumer

When I entered medicine as a profession, I was idealistic. I wanted to help people learn about their health and provide guidance when they needed to make important health decisions. I always believed my job was to translate complex medical information so that it made sense. Everyone deserves this. It gives people the best possible opportunity to make decisions that meet their needs.

Unfortunately, medicine as practiced today makes if difficult to do this. The typical office visit is brief, options and decisions are complicated, and there are competing distractions that consume our time and energy.

In addition, we now expect consumers to be more responsible for their health. But there is an overwhelming amount of health information they can access. And it is difficult for many to know what is accurate, meaningful, and relatively free of bias. What questions do you ask? How do you put it all together so that you can make a decision?

This blog is devoted to you – the consumer who is trying to make sense of health information. Although I will tend to focus on current topics, my main objective is to provide a framework on how to critically think about health information and how to approach health decisions.

I look forward to your comments and suggestions as we learn together.

Facts About Sildenafil You Need to Know Before You Use It

Sildenafil is the active ingredient in Viagra and it is sold under the name Sildenafil as a generic alternative. Sildenafil and Viagra do exactly the same thing and equally well. The generic version is just generally cheaper than Viagra. There are actually quite a few alternatives to Viagra on the market.

If you are suffering from erectile dysfunction and need a few quick facts to decide whether you need to ask your doctor for a Sildenafil prescription, this is what you need to know.

  • Sildenafil is the generic option for Viagra and is prescribed for erectile dysfunction or impotence in men. It has the same effect as Viagra and improves sexual performance in men that struggle to get or keep an erection.
  • Sildenafil is not safe for women to use. Some studies have been conducted on the effects of Sildenafil or Viagra in women, but no definite findings have been reported.
  • Sildenafil can only be bought on prescription. This medication is not available to buy without a doctor’s prescription. The medication can interact negatively with other drugs and it can also be dangerous to use when suffering from certain health conditions. This is why you must discuss this treatment with a doctor before you start taking Sildenafil.
  • Sildenafil comes in three different doses. It starts with Sildenafil 25mg and can be increased to 50mg or 100mg if it is ineffective and the doctor agrees to prescribe it. For most men, the 25mg is more than enough but severe ED may require a higher dose.
  • Sildenafil works by dilating the arteries in the penis. This increases blood flow to the penis and makes it possible for an erection to happen. The drug is called a vasodilator which means that it dilates the arteries and increases blood flow.
  • Sildenafil should not be used with nitrate-based medications. Nitrates are usually prescribed to help with high blood pressure. This means that it increases blood flow and also dilates arteries to reduce the pressure. If Sildenafil and these other medications are taken together, it can cause very low blood pressure and very dangerous health conditions.
  • Millions of men in the world have successfully used Sildenafil and Viagra to treat ED. In America alone, millions of men suffer from ED and make use of treatments like Sildenafil. It is an effective drug that has very few side effects and it has changed many men’s lives.
  • Few to no side effects are reported. Some men experience mild headaches and facial flushing when using Sildenafil. Others have also reported stomach problems, blurry vision, and nasal congestion. However, most men do not experience these side effects and those who do says that it is all worth it.
  • Sildenafil is not funded by the NHS. You will need a private prescription for Sildenafil or Viagra as the NHS does not fund erectile dysfunction medications. You will have to carry the full cost of the treatment and pay a prescription fee. Your insurance may reimburse you for this, but you will have to check with them.

Use these facts to determine whether Sildenafil will be the right medication for your problem.

3 essential diets that can help you to get rid of Bacterial Vaginosis

Bacterial vaginosis is a type of vaginal infection that affects many women today. In the vaginal area, there are both good and bad bacteria. People with bacterial vaginosis have more of the bad bacteria. Usually, if you have more than one sex partner then your chance of having bacterial vaginosis increases. Smoking can also put you at risk of having this disease.

Apparently, you may not have any health issues if you have bacterial vaginosis. But if you are pregnant then there is a high chance of miscarriage. Also, if you are going to have a surgery and you have bacterial vaginosis then there is a high chance of infection. The chance of having sexually transmitted diseases also increases if you suffer from bacterial vaginosis. There are some essential diets that can relieve you from such problem.

1. Yogurt

It is a natural probiotic which means that there are lots of bacteria in it. If you eat yogurt more good bacteria will be added to your body. So, your vaginal environment will be balanced. These good bacteria will also help to lessen the number of bad bacteria. You should make yogurt a part of your everyday diet.

2. Increase your intake of vitamin E

Vitamin can improve your immune system. According to a research, people who have more vitamin E in their diet have less chance of having bacterial vaginosis. You should include almonds, sunflower seeds, hazelnuts, etc. in your daily diet. Fruits and vegetables like kiwi, broccoli, spinach, and avocado are rich in vitamin E. If you don’t find the time to accommodate all these in your diet every day then you can take vitamin E supplements instead. You will find these in the local health food stores or pharmacies.

3. Have food containing folic acid

Breakfast cereals contain lots of folic acids. It strengthens the immune system. Other sources of folic acid include spinach, asparagus, broccoli, beef liver, etc. You can take folic acid tablets as well. Folic acid reduces your chance of having bacterial vaginosis. You can consult a dietician to know the correct amount of folic acid intake every day.

Make these three essential items a part of your regular diet. You will decrease the chance of having bacterial vaginosis. As a result, your chance of having any sexually transmitted diseases will also decrease. You should also maintain good hygiene so that you don’t have any type of infection in your vaginal area. Please read more about bacterial vaginosis on the site

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Asthma – Is It Letting You Down?

Asthma is a serious medical condition that affects our respiratory system. It constricts the airways, so you will find it hard to breathe. Those who have experienced asthma attacks know how difficult life can be for them. The attacks can trigger for a number of reasons. It can occur due to pollen, dust, pollution, etc. Asthma can affect our day-to-day lives if we don’t know how to control it.

Many people having asthma stays depressed most of the time because of their health condition. They often refrain themselves from social gatherings and outdoor activities. But this shouldn’t be the case. You can easily lead a normal life just by knowing how to control your asthma symptoms. You should be glad to know that celebrities like David Beckham, Roland Schoeman, and others have asthma; yet they have achieved great things in life. If they can do it, then so can you. Here are some tips that can help you to lead a comfortable life, despite having asthma.

Breathe properly

Most asthma patients find it hard to breathe sometimes. You should practice breathing exercises so that the function of your lungs improves. Take a deep breath, hold it there for sometimes and then exhale slowly. Practice this a few times and you will see that you feel much better. You can do this breathing exercise every day in the morning before starting your day.

Take preventive medication

Visit a doctor, and he or she will prescribe you preventive medicines. You must keep these medications and inhaler with you always. So, if you see any symptom of an asthma attack, you can use your inhaler or take medicine right away.

Do exercise regularly

Though exercise can induce asthma attacks, so can obesity. So, you must exercise to be fit and healthy. There are some asthma-friendly exercises that you can try. These include swimming, walking, bicycling, playing golf and weightlifting. You can easily control your breathing in all these exercises. If the weather is bad, you should try exercising indoors.

Though it is not possible to cure asthma completely, by learning how to manage the condition, you will be able to lead a perfectly healthy life. It is a misconception that asthma will slow you down. You can do everything just by knowing what triggers your asthma attack and how to prevent it. Go to a doctor and diagnose your condition to get a treatment plan for your asthma.

Perfect Depression Care: Reducing Suicides to Zero

New evidence suggests we can provide mental health care in a way that would completely eliminate suicides among people with depression.

A unique program for patients with depression dropped suicide rates from 89 per 100,000 patients per year to zero.  And the absence of a single suicide in this population has remained at zero for two and a half years.  This program, called the Perfect Depression Care Initiative, was created in 2001 by the Behavioral Health Services division of the Henry Ford System, in Detroit, Michigan.  The program was funded by the Robert Wood Johnson Foundation as a healthcare redesign demonstration project.

Key components of this program included:

  • Risk assessment: At each visit, patients were assigned to one of three levels of suicide risk, with specific acions for each level of risk.
  • Improved patient access: Patients had three ways to access care and support – this included drop in group appointments, same day appointments with providers, and email access to providers.
  • Weapon assessment:  Consistently, patients were asked if they had weapons at home, and if they did, patients were encouraged to get rid of these weapons.

In addition, staff completed a suicide prevention course, staff called patients to check in on them, a web site was established for patient education, and family members received suicide prevention education. 

This program demonstrates that suicide prevention can work.

Be aware of suicide warning signs.  Take suicide threats seriously.  And if someone is suicidal, help them get the care they need.

Direct to consumer advertising: As drug sales climb, are we smarter or healthier?

Direct to consumer advertising is the promotion of prescription drugs through newspaper, magazine, television, or internet marketing.

Proponents of this advertising, including the drug industry, argue that direct to consumer advertising educates consumers about certain conditions and encourages consumers to see their healthcare provider for diagnosis and treatment. Although these ads clearly increase sales, evidence is lacking that it improves consumer knowledge or health.

Meanwhile, opponents believe that these promotional ads may overstate the health benefits of a medication while down-playing serious side-effects. This can result in ads that are misleading or just plain wrong.

Cost is another concern. Direct to consumer advertising has contributed to an overall increase in spending on both the advertised drug as well as other drugs used to treat that condition, according to a 2006 report by the U.S. Accountability Office. If these ads resulted in more appropriate, cost-effective prescribing, then the money might be well spent. But there’s no evidence that this is the case. Instead, these ads may lead to over diagnosis, overtreatment, and inappropriate use of medications when generic medications or non-drug treatments are just as good or better.

These ads are required to meet certain regulatory requirements, including the following:
o They must provide a fair balance of the risks and benefits of the medication.
o They cannot be false or misleading.
o They must state at least one approved use of the drug.
o They must provide the generic name of the drug.
o They must include all risks associated with the drug. However, they can meet this requirement by giving only the more important risks while providing sources where consumers can get the complete risk profile, such a 1-800 number, website address, referencing a print add that lists all the side effects, stating “ask your healthcare provider”.

If you think a prescription drug ad has violated a law e.g., it’s false, misleading, or lacks fair balance), then contact the FDA’s Division of Drug Advertising and Communications (DDMAC). Consumers can call DDMAC at 301-796-1200. Alternatively, a written complaint can be mailed to DDMAC at:
Food and Drug Administration
Center for Drug Evaluation and Research
Division of Drug Marketing, Advertising, and Communications
5901-B Ammendale Road
Beltsville, MD 20705-1266

Remember that direct to consumer advertisements are a blend of information and promotion. As such, view the information with a healthy dose of skepticism. If you think the information might apply to you, seek out other sources that are more balanced.

There are many good sources out there, but here are a few to consider:
o Talk to your healthcare provider.
o Check out your health plan’s website or Web MD.
o If you only want information about prescription medications, try the Drugs@FDA section of the Food and Drug Administration (FDA) website ). At Drugs@FDA, you can search for a medication, select the drug label icon, and get detailed information about the drug.
o If you’re willing to spend a little money, I like two commercial newsletters that are evidence-based and free of pharmaceutical company influence – Prescriber’s Letter and The Medical Letter. Prescriber’s Letter is more consumer friendly.

Overtreatment of back pain: A nagging problem

Back pain is a common problem that affects at least 80 percent of us at some point in our lives.  It’s the second most common reason for see a doctor.  And when it comes to overtreatment, it may be number one.

We have a problem in this country when it comes to taking care of people with back pain.  Years of data show us that we over-scan, over-xray, and overtreat with medications and procedures. Not only is this costly, but it can harm people rather than help them.

The overtreatment of back pain includes excessive tests and treatments.  Some common issues include the following:

  • We do too many tests (e.g., back xrays, computerized tomography or CT scans and magnetic resonance imaging or MRI scans) particularly in people with back pain for less than six weeks. For about 90 percent of people, the back pain will go away within six weeks.
  • We over-prescribe expensive medications, like muscle relaxants and narcotics.  These medications are rarely necessary and may cause significant side-effects.
  • We do too many back surgeries and spinal injections on people with chronic back pain.

Meanwhile, the potential harm of overtreatment is very real.

With unnecessary tests, the greatest concerns are additional costs and false positive test results (that is, the test is “abnormal” but that abnormal result is wrong).  False positive results can cause needless anxiety.  In addition, they can lead to other tests or procedures that are unnecessary, expensive, and possibly risky.

With unnecessary back surgery and spinal injections, concerns include added cost and potential complications, which can be life threatening.

Consumers can take steps to protect themselves from becoming victims of overtreatment.  Here are some suggestions:

  • Ask questions.  For example, if your provider recommends an xray or scan, ask how they plan to use the test results.  If results won’t change the treatment plan, then why do the test?
  • Read and learn about back pain.  By doing your homework in advance, you know what to expect and are more prepared to ask questions.
  • If you have chronic back pain and surgery has been recommended, get a 2ndopinion.

Perhaps the best way to avoid overtreatment, is to have a healthy back.  And maintaining core muscle (back and abdomen) strength and flexibility is one way to go about this.  Strengthening the core muscles can prevent back pain.  It can also help people with chronic back pain.  So, embrace the health benefits of strengthening.

Hang up and drive!

Driving and talking on a cell phone is just as risky as driving while drunk.  When I realized this a few years ago, I stopped the habit.  I would never drive drunk?  So, why would I drive while talking on a cell phone?

More than 275 million Americans own cell phones; about 80 percent talk on a cell phone while driving.  A recent survey suggested that, at any given time, about 10 percent of drivers are talking on a cell phone while driving.

Meanwhile, we know that cell phone users have slower reaction times than a driver who’s drunk; their risk of a car crash is four times greater than a driver who’s not using their cell phone. And each year, nearly 30 percent of car crashes in the U.S. are caused by drivers talking on cell phones or texting.

Why would so many people engage in a behavior we know is so dangerous?  Here are some explanations:

  • Some people are unaware of the risk.  Although the data is out there, many don’t know how impaired they are when they drive and phone. Most people get it, it’s not safe to drive drunk.  And most people understand that texting and driving is a bad idea.  But many people don’t know that driving while talking on a cell phone is equivalent to driving drunk.
  • Some are in denial.  They’ve convinced themselves that they, unlike others, are good drivers.  So, they won’t get in an accident talking on their cell phone.
  • Some people get bored when they’re driving. So they talk on the phone to stay busy.
  • Finally, many people like to multitask.  They think they’re being efficient. They’re saving time.  Instead, they should be focused on saving lives.

When I talk with others about driving and phoning, common topics come up.

Many people think that hand-free phones are safer than hand-held phones.  But data clearly show that hands-free devices are no safer.  Drivers are just as distracted and just as impaired.

Many think that driving and texting is the real problem, not driving and talking on a cell phone.  And although the driving and texting is more dangerous than driving and phoning (the risk of a crash for someone driving and texting is 23 times greater than driving while not distracted), talking on a cell phone causes more accidents than texting.  This is because millions more talk than text.

Many question why driving and talking on a phone is more dangerous than talking to a passenger in the car.  First, when driving and phoning, you’re often manipulating a phone.  Second, studies have shown that brain cells or neurons work differently depending on whether drivers are talking on a phone or talking to a passenger. Finally, passengers in the car, unlike cell phone conversations, can make the driver more aware of changing road conditions and can stop the conversation if needed

There are several steps we must take to eliminate driving and phoning. As we approach this problem as a society, we can learn from the successes of the stop drunk driving campaign.

  • Educate
  • Legislate
  • Create a new safety culture and message using peer pressure – it’s not okay to drive and phone
  • Share personal stories about people harmed by distracted drivers

Remember – driving and phoning is equivalent to driving drunk. It’s not okay to drive drunk.  It’s also not okay to drive and phone.  So, my best advice: hang up and drive.

If you’re interested in learning more about this topic, check out:

Cholesterol lowering medications: do they help you if you’re healthy?

Pharmaceutical companies successfully advertise and sell cholesterol lowering medications.  Healthcare providers do what they’re trained to do – prescribe drugs.  And consumers are caught in the middle.

A new study has reignited the controversy about the value of statins, a popular cholesterol lowering medication, in people without known heart disease.

People with known cardiovascular disease benefit from these medications.  But only a quarter of people taking statins, take it for this reason.

The majority of people take statins for primary prevention – that is, they’re free of cardiovascular disease and are taking the medication to prevent a first event. And the evidence is weak that these medications work for primary prevention, suggesting we may be prescribing a medication that for most people, does more harm than good.

The new study, published last month in the Archives of Internal Medicine, was a meta-analysis of 11 studies that asked the question – do statins prevent heart disease when used for primary prevention?   The people in this study were at high risk for heart disease – for example, they had diabetes or high blood pressure.

This study was the cleanest, most complete look at the use of statins for primary prevention in a high-risk population.  Other studies that looked at this question included a mix of patients with and without heart disease, potentially biasing the results.

This analysis of over 65,000 people demonstrated that statins had no impact on all cause mortality or death.

But this isn’t the first time that the use of statins for primary prevention has been questioned.  For years, many researchers have questioned whether or not we need to drive down the cholesterol, particularly the LDL cholesterol, in people without known heart disease.

For example, you may remember the TV ad for Lipitor a few years ago that starred Dr. Robert Jarvik, the inventor of the artificial heart.  That ad proclaimed that “Lipitor reduces the risk of a heart attack by 36 percent…in patients with multiple risk factors for heart disease.”

But that ad overstated the benefits. In the study where the 36 percent benefit was reported, 3 percent of people taking a placebo or sugar pill had a heart attack compared to 2 percent of people taking Lipitor.  So, for every 100 people in the study, which lasted over three years, there was one less heart attack in the Lipitor group.  In other words, you needed to treat 100 people at high risk for heart disease with Lipitor for more than three years, in order to prevent one person from having a heart attack.  Meanwhile, the other 99 people had no benefit from taking Lipitor.

The meta-analysis did have a major limitation – the studies reviewed followed people for short periods of time, typically 5 to 7 years.  And those who promote statins for primary prevention believe that you need to take them for a longer period of time before you see the benefit.

So what about the about the value of statins for primary prevention in people who are at low risk for heart disease.  Well, here we know even less.  Yet millions of people who are at low risk for heart disease are taking these medications every day.

If you are taking a statin or other cholesterol lowering medication, what should you do?

Go in and talk to your provider.  Ask if you really need to be on that medication.  Although cholesterol lowering medications can benefit patients with know heart disease, the benefits for others is less clear.

Also, focus on other ways to improve your heart health.  Don’t smoke.  Maintain a normal body weight.  Exercise, eat a well balanced diet, and find healthy ways to reduce or deal with your stress.

Stopping health care-associated blood stream infections

Every year, 30,000 to 62,000 Americans die from what many believe is preventable – a bloodstream infection caused by a central line, a catheter placed in a vessel that ends at or near the heart.  We call these infections central line-associated blood stream infections, or CLABSI.

A national initiative, funded by the Agency for Healthcare Research and Quality and supported by the Secretary of Health and Human Services is trying to address this problem.

This national project, called On the CUSP: STOP blood stream infections (BSI) was lauched about a year ago. And although this project is using a prevention model that nearly elimated CLABSI in more than 100 intensive care units in Michigan, many U.S. hospitals, including most in Minnesota, are not participating.