What is the harm of sitting?

24th Feb 2016 Medical News

Have you ever stopped to think about how many hours per day that you spend sitting? Add up the time you spend sitting to have your morning breakfast, your drive to the office, sitting in an office chair for a good portion of the day, sitting to have lunch, your ride home, sitting at the dinner table, and then sitting on the couch or reclining to watch television for hours. For many, this number will total 15 or more hours per day. There have been several recent studies that have shown many negative effects of sitting for long periods. Some of the associations with prolonged sitting include increased cardiac risks, weight gain, worsening of diabetes, and even early causes of death. One study of more than 595,000 adults concluded with a 34% increased risk of death for those who sit 10 hours per day. Another study looking at adults who spent less than two hours per day watching television versus those who spend more than four hours found those who sat more had a 50% increased risk of death overall and greater than 125% increased risk of cardiovascular events including a heart attack. Some reports have suggested that even those who exercise on a regular basis, but sit for prolonged periods are at risk.


So how does sitting cause so many problems? Sitting causes the bodies metabolism to slow causing physiological changes to occur. The risk for a blot clog begins to rise as circulation slows. Sitting causes both blood glucose (blood sugars) and triglyceride levels to also increase. We also know that sitting is not good for the spine. The supporting muscles become tight or overstretched, depending on sitting postures. Sitting places twice as much stress on the spine and discs as standing does. Studies have shown continuous sitting to reduce the height of the L4-5 disc and also has the potential to cause reduced range of motion leading to back pain.


While there are many lifestyle changes that can be made to reduce the amount of time sitting, most of us do not have the option of how we work during the day. If you have to sit, here are a few recommendations to lower some of the potential risks:


  1. Stand up and walk around every 30 minutes
  2. Consider a standing workstation, if possible
  3. Reposition computer monitors and keyboards so that you are not “hunched over” while working
  4. Stand while making telephone calls
  5. Sit upright with good posture to maintain the natural curve of the back.
  6. Stretch on a regular daily basis
  7. If sitting for prolonged periods, take a 5 minute break frequently to exercise the hips, knees, and feet.
  8. Get up an walk after eating snacks/lunch


The bottom line…. Focus on ways to change your daily sitting habits to incorporate more periods of standing, walking, and exercising whenever possible.

Conflicting evidence for daily calcium supplementation

Evidence from a recent meta-analysis (September 2015) published in the British Medical Journal goes against the long-standing recommended daily intake of calcium. In fact, one of the lead authors concluded “Most people don’t need to worry about their calcium at all.” His reasoning behind this is that randomized control trials have shown only a slight reduction in risk for fractures with calcium supplementation. At present, the U.S. daily recommended intake for calcium is approximately 1000-1200mg per day. Other countries have different daily recommendations (mostly lower amounts).

The meta-analysis looked at the results from 26 randomized control trials. Some of the major findings include serious adverse events such as kidney stones, gastrointestinal symptoms, and cardiovascular events. It was noted that only two randomized controlled trials evaluated dietary calcium’s effect on fracture risk. Both trials lacked significant power and therefore statistical significance was unable to be achieved.

It is estimated that women lose 0.5% to 1% of bone mass per year after age 40. Calcium supplementation has been recommended for the prevention of osteoporosis.

Previous researchers have expressed concern for the risk of hypercalciuria (elevated calcium in the urine) and hypercalcemia (elevated calcium in the blood) in post-menopausal women. The end result can be the formation of kidney stones. Other meta-analysis have shown an increased for cardiovascular events such as myocardial infarction in those post-menopausal females who take excess supplemental calcium.

There are several points to consider when looking at the results of these studies. While not universally accepted, calcium obtained through a normal diet is likely superior to taking supplemental calcium. Secondly, most need to monitor how much calcium they actually obtain through their regular diet. Some may not need any additional supplementation.

In regards to the newly published meta-analysis, there are additional co-factors, including Vitamin K2 and Vitamin D deficiency which must be considered before concluding that we should not worry about calcium.

Unfortunately, these published findings make it more difficult for clinicians and patients to reach any definitive conclusion regarding daily calcium intake.

This meta-analysis was funded by pharmaceutical giants, Merck, Amgen, Lilly, and Novartis.


Tai V., Leung W., Grey A., Reid IR., Bolland MJ. Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ. 2015 Sept 29;351.

What is Arthritis?

10th Feb 2016 Medical News

The term arthritis is commonly used to represent a disease process that occurs only in the elderly. In reality, it is estimated that over 52 million adults have some form of arthritis and it is the number cause of disability in the U.S. Nearly half of those who have arthritis have limitations with their normal daily activities.   With a population that is living longer, these numbers are expected to grow considerably in the next decade. When we say arthritis what does it really mean?

According to the Arthritis Foundation, arthritis is a general term referring to joint pain or joint disease.  There are approximately 200 types of arthritis which can be classified into seven groups:

  • Degenerative arthritis (most common form)
  • Inflammatory arthritis
  • Infectious arthritis
  • Metabolic arthritis
  • Soft tissue musculoskeletal pain
  • Connective tissue disease
  • Back pain

There is no single cause of arthritis.  Most forms of arthritis are caused by a combination of contributing factors (personal, environmental, and genetic) while the cause of some forms of arthritis remains elusive.


Several risk factors for arthritis have been identified.  These can be divided into modifiable risk factors and non-modifiable risk factors.  Obesity, injuries, and occupation are all known to lead to the development of osteoarthritis.  These are risk factors that have the potential to be modified.   Age, sex, and genetics are the non-modifiable risk factors associated with various forms of arthritis.

In addition to the adult forms of arthritis, there are several known forms of childhood arthritis known as Juvenile rheumatoid arthritis, juvenile chronic arthritis, and juvenile idiopathic arthritis.  Approximately 1 in 250 children in the U.S. under the age of 18 has been diagnosed with a form of childhood arthritis.

Symptoms of arthritis vary considerably amongst the different types.  The onset can be abrupt or can develop gradually.  The most common symptoms include pain in one or more areas, swelling, and joint stiffness. Treatment is aimed at managing these symptoms to control pain, minimize structural damage, and improve quality of life.  Common treatments for arthritis include various medications, injections, therapies, splints, patient education, support groups, weight loss, and surgery.

New treatment approaches utilizing biologic agents and targeted drugs are being studied in the hopes of finding a cure for the various forms of arthritis.


Can the number of moles predict risk of Melanoma?

10th Feb 2016 Medical News

Rates of melanoma have been rising for over 30 years in the U.S. It is expected that nearly 9900 people will die this year from Melanoma. According to the American Cancer Society, the lifetime risk of melanoma is 1 in 40 for whites, 1 in 200 for hispanics, and 1 in 1000 for blacks. Approximately 74,000 new cases of melanoma will be diagnosed this year.

Mole or nevus as they are also known, are benign pigmented tumors. While most moles will remain benign, it is believed that a person who has many moles has an increased likelihood of developing melanoma. In fact, a prior study published in 2014 concluded that those with moles were 4.6 more times likely to develop melanoma than those without moles.

A recently published study in the British Journal of Dermatology has determined that the number of moles on a person’s right arm may predict risk of melanoma.

A team of researchers from the Department of Twin Research and Genetic Epidemiology at King’s College, analyzed data from over 3500 caucasian twins during an eight year period. Specially trained nurses counted freckles and moles on 17 body areas of each subject. The findings of the study indicate that the number of moles located just above the right elbow was the strongest predictor of mole count over the whole body. More specifically, women with at least 11 moles on their right arm were more likely to have over 100 moles on their entire body. This equates to a 5 times greater risk for developing melanoma, according to the study.

A smaller study of 400 subjects was also conducted which did replicate the major findings.

If this finding were to hold up, this could have important implications for primary care medicine. This could allow earlier detection of those at risk for melanoma.



Ribero S et al. Prediction of high naevus count in a healthy uk population to estimate melanoma risk . British Journal of Dermatology. 2015.


Should I be taking a daily Aspirin?

05th Feb 2016 Medical News

Data from ongoing research has suggested that the daily use of aspirin is beneficial for protecting against heart attacks, strokes, certain cancers, and possibly treatment for neurodegenerative diseases such as Parkinson’s and Alzheimer’s. With this in mind, should all adults be taking a daily aspirin.  

In September 2015, the U.S. Preventative Services Task Force released new guidelines recommending aspirin to protect against heart disease and colorectal cancer. However, the guidelines are intended for those ages 50 to 69 with an increased risk of heart attacks or strokes and are not at increased risk for bleeding.

To understand why someone should or should not take daily aspiring requires a good understanding of how this drug truly works.  Aspirin is a synthetic compound derived from an ingredient found within the bark of a willow tree.  Aspirin helps reduce fever, pain, and inflammation in the body and stops platelets from sticking together and forming clots. When blood platelets are able to clump together, a clot can form a block an artery causing decreased blood flow to the heart or brain leading to a heart attack or a stroke. The obvious benefit of aspirin is that is minimizes these potential risks. However, there is a downside to this. Normally when we cut ourselves the platelets clump together at the site and form a plug to prevent blood loss. This can lead to increased bleeding amongst those who use aspirin. Aspirin also carries the risk of increased stomach ulcers and gastrointestinal bleeding especially in older patients. While aspirin can help prevent against an ischemic stroke, the risk of a hemorrhagic stroke (bleeding) that may occur from a fall and hitting your head is increased.  Tinnitus (ringing in the ears) and asthma can also occur in some who take aspiring.


A survey of over 2500 adults in the U.S. aged 45 to 75 years old published in the American Journal of Preventative Medicine (2015) showed that over 52% of respondents were taking aspirin. Of those surveyed without a history of cardiovascular disease, 47% were taking aspiring daily.

In considering risks and benefits, the daily use of aspirin for those who have had a prior heart attack, stroke, or TIA is often recommended by physicians to prevent a second episode.  Others middle aged adults who have not had aheart attack or stroke may still benefit from daily aspirin use if they have personal risk factors for or a strong family history of cardiovascular disease, stroke, or diabetes.

So where does the rest of the population fit in with regards to taking aspirin? The evidence for primary prevention of a first heart attack or stroke is still not clear cut. Research appears to be pointing to including daily aspirin use in some disease prevention and treatment guidelines, but caution still remains.  The risks of use may outweigh the potential benefits in healthy individuals with little or no risk factors.

Aspirin should not be taken unless directed by a physician.


Williams CD, Chan AT, Elman MR et al. Aspirin use among adults in the U.S.: results of a national survey. American Journal of Preventative Medicine. 2015 May; 48(5): 501-508.


Preventative Task Force Aspirin for the prevention of cardiovascular disease http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/aspirin-for-the-prevention-of-cardiovascular-disease-preventive-medication




Predicting the trends in medical care for 2016

03rd Feb 2016 Medical News

As most of us have experienced, healthcare has gone through some dynamic changes in the last few years.  There is intense focus on improving health outcomes, making access tocare easier, and utilizing technology to expand treatment. At the same time, increasing costs for patients, medical providers and health organizations along with an upcoming Presidential election later this year also will certainly affect this year’s trends in healthcare but how and to what degree is unknown.

Perhaps the biggest area of innovation that is expected to continue with tremendous growth in 2016  is the development of consumer medical applications and wireless health technology.  This includes the long list of activity wrist bands that track everything from blood pressure to heart rate to sleep patterns.  A recent study by Frost and Sullivan found that approximately 16% of those surveyed already are using this type of technology and 24% utilize some type of medical app.   These type of activity sensors combined with mobile apps allow users to maintain a better sense of control over their own health and are able to do so with real-time information and convenience.   This should help drive preventative care.

Speaking of convenience, more and more care clinics are popping up in local neighborhoods, grocery stores, and pharmacies.  This adds more options for patients and consumers who are looking to remove the burden of making an appointment with their usual office based medical care provider.  Many hospital systems are expanding their services with networks of  convenient care clinics. 

Telemedicine is here to stay!  Medical care is offered 24 hours per day 365 days through the use of a computer, tablet or smartphone.   E-visits take place over a secure internet connection and these virtual visits are offered by an increasing number of providers for simple health concerns such as colds, back pain, and headaches.  Many of the practice sites offer credit card payment options, although some insurers are now beginning to pay for E-visits.  This offers patients another avenue of access to medical care without having to make an appointment  while offering the utmost in conveience. The big concern with this is cybersecurity.  2015 saw an unprecedented number of major cyber attacks, compromising data and in some cases patients confidential medical history.  Many app companies, insurers, physician practices, and health systems are taking a proactive approach to cybersecurity to make it a priority.

Going deeper in 2016 we are likely to see the continued trend of mergers taking place. We began to see some of the large insurance carriers merge in the last year or so and this will create a handful of powerful players. The same holds true for medical practices and health system consolidation.

Regenerative medicine which incorporates stem cells and cellular therapies is poised to grow with an increasing number of new products coming online, further clinical developments, and a more favorable regulation.

Lastly, the Affordable Health Act (ACA) has been at the center of debate since its inception. Now with the looming Presidental election upcoming, there is the possibility that we can see another major overhaul of our healthcare system take place with ACA being repealed.





Gene mapping of the inner ear: Effects on hearing and balance

Hearing loss associated with aging or other disorders is a significant public health problem.

Within the inner ear are specialized sensory cells that include hair cells. Additional supporting cells also contained in the cochlea, provide structural and functional support to the hair cells. Collectively, these specialized cells help detect sound and enable us to hear. Similar specialized cells located in the utricle (pouch near the cochlea) help us maintain balance. This is part of the vestibular system.

These specialized cells are not able to repair themselves or regenerate. Aging along with certain medications, injuries, disease processes, and infections can lead to a loss of hearing and balance problems.

Research scientists from the University of Maryland School of Medicine and scientists from Tel Aviv University Sackler School of Medicine have collaborated in identifying a technique to help isolate a family of proteins that are essential for inner ear cell development.

Historical methods of analyzing gene activity have usually required thousands of cells. In contrast, the research teams, supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) utilized a new technique for analyzing gene activity within one cell. This has allowed the researchers to better understand developmental patterns associated with the inner ear and vestibular system. This new knowledge may help lead to identifying ways to promote regeneration within the inner ear.

In a second study, the researchers used RNA sequencing technology to search for common regulatory regions within the genes expressed in specialized hair cells. They found a group of gene regulators known as Regulatory Factor Xs (RFX) are particularly active in the hair cells. This is believed to play a large part in hearing. In mice who lacked two RFX proteins, loss of hair cells and hearing occurred within 2 weeks after birth. Deafness occurred at approximately 3 months.



National Institute on Deafness and Other Communication Disorders (NIDCD)


Are Annual Physicals Really Necessary?

27th Jan 2016 Medical News

It is estimated that over 45 million Americans will get a routine physical examination this year. Certain aspects of the annual physical are now covered under preventative care without cost to the patient.

Interestingly, an article written by Dr. Ezekiel Emanuel, who is one of the experts that helped develop President Obama’s health care law feel that for most, an annual physical is “worthless”. He further contends that the cost of annual exams outweighs any potential benefits. This has sparked a great debate over whether the routine annual physical is really necessary.

There has been a greater push for evidence-based medicine. Taken from a 2012 review conducted by an international group of researchers, 14 randomized clinical trials that included over 182,000 people found that annual physical exams do not lower the overall cost of medical care, future appointment, disease-related deaths or even hospitalizations. Some such as Dr. Emanuel further contend that annual exams may lead to further screenings or tests with abnormal findings which have no specific meaning.

While some argue that annual physicals are geared primarily toward insurance companies and billing, many physicians feel that waiting until you are sick to establish with a physician is not the best practice. A one-on-one interaction with the physician in a non-stressed time that may allow a better physician-patient connection and thereby giving the physician a greater overall understanding of the patient. Perhaps a restructuring of the annual physical would be more beneficial? This point has been brought up by some physicians.

Based on the results of large longitudinal population study (Aerobic Longitudinal Study) of over 12,000 people, 99.8% of middle age adults do not manage the 7 primary risk factors in cardiovascular (and other) diseases:

  1. Avoid smoking
  2. 30 minutes of moderate physical activity daily
  3. Control cholesterol levels
  4. Manage blood pressure
  5. Manage weight
  6. Control blood sugar
  7. Eat healthy foods

Only 0.2% of the study participants managed all 7 habits in their lifestyle! Fewer than 10% met 5 more of the habits described above. No cardiovascular related events occurred in any of the participants who met ideal levels of the 7 habits during the 20 year period of the study.

Taking this information into account, perhaps risk stratification (presence of medical comorbidities, disease risk factors and medications taken) should dictate frequency of check-ups while those who are asymptomatic may not need an “annual” physical but rather a periodic visit to review preventative and lifestyle factors such as those mentioned in the Aerobic Longitudinal Study.



Emanuel, Ezekiel. Skip Your Annual Physical. New York Times op-ed. January 9, 2015

Zika Outbreak in the Amercas and now in Florida

20th Jan 2016 Diseases

A recent outbreak of a mosquito borne virus known as Zika has been the source of great public health concern in Brazil. It is estimated that 1.3 million cases of Zika have been identified since May of 2015.

The Zika virus is named after the Zika Forest in Uganda, where in 1947 the virus was isolated from a Rhesus monkey. It was not until 2007, that the first major outbreak of the Zika virus took place in Micronesia. Since that time additional large outbreaks have occurred in French Polynesia with over 10,000 cases identified in late 2013. The current outbreak in Brazil, is the largest ever in the Americas.

The virus is transmitted to humans by the Aedes aegypti mosquito. Once bitten by an infected mosquito, symptoms usually begin after an incubation period of three to twelve days. The CDC estimates that one in five who are bitten by an infected mosquito will develop clinical symptoms. Symptoms of the disease include the onset of a headache, rash, fever, joint pain(s), conjunctivitis and malaise. Clinically, the disease can appear very similar to dengue. For most, the disease process is mild and can last up to a week. Until recent, no deaths have been reported, Brazilian health officials and doctors are recommending that women avoid getting pregnant until after mosquito season. The virus has been linked to babies born with a rare neurological disorder in which there is incomplete brain development, known as microcephaly. The number of cases identified during this recent outbreak is over 10 times the amount from 2014. A number of recent infant deaths are being investigated to identify if there is a link.

The first case of Zika was identified in Puerto Rico last month. Public Health experts anticipated the spread of the virus into the southern United States by the spring, but we already have had 3 cases in Florida and one in Hillsborough county..

At present, there is no specific antiviral treatment for the Zika virus. Treatment is focused around supportive care including rest, consumption of fluids to prevent dehydration, and the use of acetaminophen.

Minimizing exposure to mosquitos is the only way to prevent the spread of the virus. The use of appropriate repellents, protective clothing covering the extremities, and the use of mosquito nets and screens are recommended to minimize the potential for infection.


Information accessed from www.cdc.gov/zika/index.html

What is MRSA and why is it a growing problem?

14th Dec 2015 Diseases, Medical News

MRSA infections have generated extensive public concern as the problem of antimicrobial resistance continues to grow. MRSA or Methicillin-resistant staphyloccus aureus, is a complex bacterial infection that is resistant to many antibiotics. Infections with MRSA often begin as a simple skin sore and progress to something that is very harmful. The staphylococcus aureus bacterium is commonly found in the nose and skin. In fact, it is estimated that as many as 1/3 of the population is known to be colonized with staph without having a known infection.

Bacteria can enter the body through cuts or damaged skin leading to an infection that can often be life threatening. MRSA is spread from person to person through skin contact and from object to person when someone has an active case of MRSA. Staph aureus has been found to survive for more than 6-7 weeks on various materials and surfaces. Infections are often differentiated into two types: community acquired and healthcare acquired.

Symptoms of MRSA often arise from a small bump or an irritated area of skin. As infection develops and progresses, the area can become inflamed, painful, hot to the touch, and accompanied by a fever. As MRSA gets into the bloodstream further serious symptoms including dizziness, chills, confusion, swelling, chest pain, cough, difficulty breathing, and headaches may develop.

In the last few weeks, a well documented case of MRSA in a professional athlete has been widely reported in the media. New York Giants tight end, Daniel Fells, was diagnosed with MRSA several weeks ago after suffering an ankle injury. Since then, he has undergone six surgeries as antibiotic regimens have failed to improve his condition. Amputation of his foot was being considered.

Fells case is not the only one in professional sports. In fact, this has become a growing problem in sports such as football, baseball and MMA fighting. Statistics show that these trends are also increasing at the high school and collegiate levels as well.

In regards to risk factors, there are 5 “Cs” that are known to make it easier for MRSA to be transmitted:

  1. Crowding
  2. Contact – Skin to Skin Contact
  3. Compromised Skin – Open wounds
  4. Contaminated – Objects and surfaces
  5. Cleanliness – Lack of


Treatment of MRSA infections is highly dependent on the type of infection, location, severity of overall symptoms, and whether the specific strain of MRSA responds to antibiotics.

Preventative measures include keeping your hands clean by proper hand washing with soap and water. All skin cuts and open wounds should be kept covered with a bandage. Avoid sharing clothing, linens, and other personal items.



Methicillin-resistant Staphylococcus aureus (MRSA) Infections, CDC. Updated 20 May 2014.