May 2007

In This Edition

Choosing How To Treat a Blocked Coronary Artery
.....Why and How to Have a Medical Team on Your Side
A Cause for Anxiety
.....Why Cognitive-Behavioral Treatment Doesn't Help Some People's Anxiety
The Attack May Be Transient But The Risk May Not Be
.....Know Beforehand What To Do About a Possible TIA
Make the Baby’s First Car Ride a Safe One
.....Breathing Difficulties are Common in Preemies. Avoiding Them Is Easy
Good News! Grandpa Can’t Get His Blood Pressure Under Control
.....High Blood Pressure May Not Be A Risk in Those Over 80

Choosing How To Treat a Blocked Coronary Artery
Sometime soon, someone you know may be found to have coronary artery disease. Soon thereafter, sometimes very soon thereafter, they may have to decide whether to have a coronary artery by-pass graft (CABG, or cabbage as they say on the wards) or to have stent (a tiny tube inserted to hold open a coronary artery). A number of studies have compared the value of these two treatments, and while neither has been found to be clearly better than the other, two recent studies found CABG was less likely to lead to complications, was at least as likely to reduce mortality, and was more cost effective. (The stents studied were not the "drug eluting" type.) Still, many patients may do better with a stent. Until the indications are more definite, if you are choosing between the two, it is a good idea to ask your doctor to arrange a consultation for you with a cardiac surgeon who does stents, another who does CABGs, and a non-surgical cardiologist.

A Cause for Anxiety
Cognitive-behavioral therapy (CBT) helps with general anxiety in about half of cases. Why not the other half? Anxious people in committed relationships were treated with CBT. 62% got better. Those who those who experienced hostility from their partners failed to improve while those who experienced non-hostile criticism had significant reductions in anxiety.

The Attack May Be Transient But The Risk May Not Be
In a Transient Ischemic Attack (TIA), there is a temporary decrease in blood flow (ischemia) to part of the brain. It is usually caused by a spasm of a vessel or a partial blockage due to a tiny clot. The person experiencing a TIA suddenly feels faint, dizzy, off-balance, and may have a speech impediment, poor balance, numbness, and/or headache. Most often the effects disappear within a few days. Recent studies have led the National Stroke Association to upgrade its guidelines for assessing a TIA. The Association is now calling it a condition that requires emergency evaluation and treatment to avoid the possibility of permanent damage. It was found that found 10% of TIA’s were followed by a stroke within three months, with half of these occurred within two days. As I reported in the April issue of Medical-Intelligence, some very effective treatment works only within the first three hours after a stroke and is only available at emergency stoke centers. So know where your nearest "emergency stroke unit" is (use this phrase when asking about it) so you can get there quickly. When you arrive in the ER, immediately tell the admissions clerk that the person you are with may be having a stroke. Insist on being seen by a clinician ASAP. Minutes may count.

Make the Baby’s First Car Ride a Safe One
Almost one of five premature babies has breathing difficulties during the ride home from the hospital. (It does not seem to make a difference whether a car seat or car bed is used.) To avoid problems, be sure to place the baby’s head so the baby it can breathe freely; observe the baby carefully during the trip to make sure it is breathing well and has not vomited; and, if the trip is a long one, stop periodically to pick the baby up and change its position.

Good News! Grandpa Can’t Get His Blood Pressure Under Control
Four thousand hypertensive patients age 80 and older were studied. Most were taking anti-hypertensive medication and had an average blood pressure (148/72), normal for this age group. Surprisingly, during a five year period, a greater portion of those with blood pressure below 140/90 died than did those above 140/90. In fact, among these 80-plus year olds, how much higher than140/90 blood pressure was had no effect on mortality. More studies are underway to help understand these findings. But don’t any of you kids throw away your hypertension medication yet. Research continues to show clearly that uncontrolled high pressure is still bad for those younger than 80.