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July 13th, 2009
06:32 AM ET

[BLEEP!] That hurts!

By Caitlin Hagan
CNN Medical Associate Producer

OK America, I confess: Sometimes I can be a little bit of a potty mouth. (Mom, maybe this is not a great blog for you to read.) Yes, I know those dirty little words are unbecoming to some and I really should watch my language (and I really do try!) but sometimes, when I'm walking through my condo and I stub my baby pinky toe on a table leg and the pain takes my breath away and brings tears to my eyes and makes me freeze with my foot mid-air in ridiculous pain....well, I can't be held accountable for anything four-lettered I may say. (D**n it!)

Thankfully, Dr. Richard Stephens and his team at Keele University in the United Kingdom just published a study that says swearing actually has a pain-lessening effect. (See Mom? It’s healthy!) When we swear, we increase our threshold for pain, meaning we can bear it longer and don't feel it as much. Stephens is not sure why this happens, only that for some reason, "swearing appears to increase our pain tolerance."

Like those moments when I stub my toe, Stephens came up with the idea to study this after he accidentally whacked his finger with a hammer. "I swore a bit and then around the same time, our daughter was born. My wife swore throughout her labor...and the midwife said don't worry about it, we hear that language all the time." Not surprising, says clinical psychologist Paula Bloom. "From my own experience of giving birth without drugs to a 9 pound, 11 ounce child, I can imagine I had quite the little truck driver vocabulary going on."

For the study, Stephens asked the participants to submerge one hand in nearly freezing water for as long as they could while repeating a curse word. Later the participants submerged the same hand again, this time repeating a word they would use to describe a table. When people were cursing, they kept their hand in the water for 40 more seconds than they could otherwise. So what were the words that made that possible? Turns out they were different for everyone. "We decided at the outset that people would give us their own swear words," Stephens said. "Swearing is quite personal and what one person finds extremely offensive, someone else may not find offensive at all." That being said, the usual suspects topped the list: s**t, the F word and British slang – bollocks!

All joking aside, many people find swearing to be incredibly distasteful, regardless of when or why it happens. Bloom thinks this study may change that. "This removes the morality piece about language. We're so quick to judge and sometimes our judgment interferes with science. We're walking around thinking [swearing] is a bad thing...it's not really." Stephens agrees. "Swearing has gotten very bad publicity– it's a negatively construed thing. But the positive aspect of it is swearing self-regulates our emotions. It can have a beneficial effect."

What do you think? Is swearing helpful or distasteful?


July 9th, 2009
02:47 PM ET

The importance of practicing safe sun

By Caitlin Hagan
CNN Medical Associate Producer

Few things can make me as happy as a hot summer day at the beach. I'm a total sucker for sunshine but unfortunately, until recently, I had not been able to spend much time romping around in the sand. So when I packed my beach bag I made sure to bring not one, not two, but three bottles of sunscreen: plenty of protection to make sure my skin was sunkissed, not sunburned. Sounds like a great plan, right? Except all three had different SPFs, some but not all were broad spectrum, and one was just for my face. For a woman who wants to avoid a sunburn but maximize her vacation, things got a little confusing.

Apparently my dilemma is not that uncommon. Dr. Ariel Ostad is a dermatologist and assistant professor of dermatology at New York University who deals with this issue often. According to him, which SPF, or sun protection factor, you choose is not as important as what kind of radiation you're being protected from. SPF protects you from ultravoilet B, or UVB, radiation, the kind that causes sunburns. But when you are outside in the sun, your skin is also exposed to another type of damaging radiation. "Make sure your sunscreen contains an ingredient to block UVA radiation. 'Broad spectrum' is really the term that people should be looking for," advises Ostad. Since UVA rays are responsible for premature wrinkles and sun spots, it is best to keep your skin out of their reach.

But why isn't SPF the top priority? According to Ostad, the higher and higher SPFs for sale now are more about marketing than actual increased protection. It turns out that a sunscreen with a high SPF such as SPF 80 does not offer exponentially more protection, as most people think it does. According to the American Academy of Dermatology, there are diminishing returns the higher the SPF reaches. Sunscreen with SPF 30 lets in about 3 percent of the sun's harmful rays and a sunscreen with SPF 85 does not do much better, letting in more than one percent. "Anything above an SPF 30 makes absolutely no difference," says Ostad.

Keep in mind though, not all sunscreens are equal, even if they are broad spectrum. People worried about breaking out after slathering on sunscreen should opt for non-comedogenic products, which means that they won’t block pores. Sunscreens with an active ingredient of zinc oxide or titanium dioxide are good bets for people with sensitive skin who worry about too many chemicals in their products.

Now I know that the next time I head out for a day in the sun, there's no need for confusion (or three bottles).

How do you keep your skin protected?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


July 9th, 2009
06:00 AM ET

What pain relief options does a recovering addict have?

As a regular feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta:

From Jolene: 
"I have a friend who needs to have his wisdom teeth pulled and will need pain medication. The problem is, he is a recovering addict. Any suggestions?"

Answer:

Jolene, first of all, congratulations to your friend for making it to and staying in recovery. More than 23 million Americans struggle with substance abuse problems every day, according to a recent government survey, but only about 4 million of them actually receive some kind of treatment for their addiction to alcohol or illicit drugs.

That being said, it’s true that since he’s a recovering addict, your friend faces a greater challenge than many when it comes to any type of surgical procedure that’s going to require pain management.

But his pain definitely needs to be treated, regardless. The reason: Studies have shown that if a patient does not receive adequate pain treatment in surgical recovery, his tissues don’t tend to heal as well. Pain that goes untreated can also lead to what pain experts refer to as “wind-up,” meaning the spinal cord gets so bombarded with continuous pain signals that it can lead to a longer, more chronic pain situation. So it’s important to “quiet” the spinal cord by bringing the pain under control.

While the vast majority of patients who undergo oral surgery do take some type of narcotic drug afterward for relief, some people are able to successfully treat their pain with anti-inflammatory drugs such as prescription-strength ibuprofen. These non-habit-forming drugs might be the first step for your friend to try. He will need to discuss this option with his doctor, because there is a greater concern about bleeding with this class of drugs, although usually they are safe especially if taken only for a few days.

If the anti-inflammatory drugs don’t work, however, there are some narcotic drugs that are thought to be less addictive than others. Tramadol is one option. It’s a chemical that works as an antidepressant but also has a weak effect on your brain’s opiate receptors, meaning it can provide pain relief but it doesn’t work as assertively on the brain’s reward system (which can lead to addiction). It’s thought to be safer for people who struggle with addiction. Your friend will need to work with his physician to weigh the risks and benefits of trying a narcotic drug before going down this path.

The critical part of keeping a recovering addict from falling back into a cycle of substance abuse with painkillers is making sure that both the doctor and patient vigilantly monitor the course of pain management. For a procedure like wisdom teeth removal, a patient should start feeling better after a few days, maybe a week max. The doctor should follow up with the patient so that if he still complains of pain, the doctor can re-evaluate what could be causing the pain to continue.


July 7th, 2009
10:14 AM ET

CDC launches environmental health site

By David S. Martin
CNN Medical Senior Producer

If you’re like me, you try to exercise and eat a diet with lots of fruits and vegetables. The hope, of course, is that a healthy lifestyle leads to good health. It doesn’t always work out that way.

There are two things we don’t control when we sit down at the table or head to the gym. The first is our genes. We may have a family history of heart disease or Alzheimer’s. The second is the environment: The air we breathe, the water we drink, chemicals we ingest, all can have a subtle but profound affect on our long-term health.

This year, perhaps as never before, the federal government is recognizing this link between health and the environment.

The Centers for Disease Control and Prevention today launched the Web-based Environmental Public Health Tracking Network. The site is designed to track links between air and water pollutants and such chronic conditions as asthma, heart disease, cancer and childhood lead poisoning.

As of now, the tracking network only covers 16 states (California, Connecticut, Florida, Maine, Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Utah, Washington, Wisconsin) and New York City.

The CDC plans to add five more sites this summer and hopes to eventually include all 50 states.

The tracking network will help the government respond more quickly to environmental health problems and also improve our understanding of the connection between environment and health, said Dr. Howard Frumkin, director of the CDC’s National Center for Environmental Health, in a news release.

That’s also what prompted the National Institute of Child Health and Human Development to embark on a 21-year study that will follow 100,000 children from the womb to adulthood. The agency began signing up study participants in January.

All this focus on the environment and health is a reminder that while we inhabit a globe, we don’t live in a bubble.

Has the environment ever made you sick?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


July 6th, 2009
10:54 AM ET

Should Diprivan (propofol) be a controlled substance?

By Elizabeth Landau
CNN.com Health Writer/Producer

The general anesthetic Diprivan (propofol) has been making headlines as questions about Michael Jackson's death abound. A nurse who had worked for the singer told CNN that Jackson requested the drug because he had trouble sleeping, and The Associated Press reported that it had been found in his home. Diprivan is not approved as a sleep aid by the Food and Drug Administration. Read more about propofol.

It turns out that propofol, used routinely for surgeries and procedures such as colonoscopies, has been a point of concern among some anesthesiologists because of the potential for abuse by health care workers. A 2007 study published by the International Anesthesia Research Society found that about 18 percent of the 126 academic anesthesia programs in the United States had at least one reported instance of propofol abuse within the previous 10 years.

Researchers also found that six out of 16 residents (about 38 percent) who abused propofol died from it. While these are small numbers, lead author Dr. Paul Wischmeyer, professor of anesthesiology at the University of Colorado, believes this is indicative of a larger problem.

People who abuse propofol tend to have had trauma earlier in life, and take the drug to escape it, Wischmeyer said. These people also tend to be impulsive and risk-taking, he said.

Wischmeyer became passionate about the issue because one of his classmates in residency died from using the drug.

"I know physicians that have reached their hands into sharps boxes, where all of the needles are disposed of, to pull out old, used syringes of this stuff that have been used in other patients, and then use it on themselves," he said.

The drug affects two important brain receptors, one of which is associated with marijuana, and the other is targeted by anti-anxiety drugs such as Valium, he said.

"Once someone has tried this drug in a way that they remember it, they very much always choose to try it again," he said.

Some people may die from propofol abuse because the drug itself becomes contaminated when it sits out for too long, like "spoiled milk," he said. There is also a risk of overdose.

"The difference between being high and being dead is a cc or two," Wischmeyer said.

If propofol is the direct cause of death, it should show up in an autopsy in urine, blood, and possibly hair, he said. But it does depend on how long before death the drug was injected.

Should propofol be considered a controlled substance that needs to be "scheduled," with tight distribution and strict accounting of its use? Anesthesiologists are still debating this.

On the down side, stricter pharmacy control of Diprivan would involve increased costs and administrative oversight, the study authors noted. Although there have been documented cases of propofol abuse, it is still much less frequent than abuse of opioids and benzodiazepines, which are governed by strict federal laws and local pharmacy control, they wrote.

But Wischmeyer advocates that it should be a controlled substance because of how lethal it is. He argues that having an extra layer of accounting, as there is with many painkillers and sedatives in hospitals, would not delay the supply of drug for the patients who need them. It was only with Wischmeyer's group's study that the anesthesiology community became more aware of the growing abuse problem, he said.

Most anesthesia programs do not keep track or control of propofol stocks, the authors wrote.

The drug does not produce a "high" per se, but does give the person who takes it a euphoric feeling upon waking up, said Dr. Hector Vila, chairman of the Ambulatory Surgery Committee for the American Society of Anesthesiologists.

For more information about the propofol issue among anesthesiologists, read the study and check out Anesthesiology News.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


July 3rd, 2009
02:18 PM ET

Heady advice on lice

By Andrea Kane
CNNhealth.com Producer

Pssst: Come here… A bit closer. I have a confession to make: One of my daughters has L-I-C-E. And it is driving me crazy, because it just will not go away, no matter how much I cut, comb and nitpick her hair. And I’ve been doing a lot of nitpicking lately – at times, I feel like a mama chimp grooming her child (minus popping the “prize” into my mouth). My daughter gets cranky having to sit there for an hour (especially when I pull an individual hair strand to remove an egg - aka: nit - that is cemented on) and I get cranky, too.

According to the CDC, there are an estimated 6 million to 12 million head lice infestations each year in the U.S. among children 3 to 11 years old. Lice are usually transmitted through direct head-to-head contact. Less commonly, they can be passed on via a hat, comb, pillow or other personal object (contrary to our worst fears, lice don’t dive-bomb from one person’s head to another’s). Cleanliness and socioeconomic status have little to do with getting head lice, although race may have an impact; African-Americans are less likely to get them.

Aside from being icky and itchy, head lice are not known to transmit disease (although hard scratching can cause a secondary infection). That said, you don’t want them hanging around.

Our “ordeal” started in mid-May when I stopped by the school nurse’s office for her to have a look-see because her two best friends had it (that, and she was scratching an awful lot). “You see right there - those are nits,” she said, pointing to what looked like a bitty grain of salt on the hair shaft.

The nurse instructed me to shampoo my daughter’s with an over-the-counter pediculicide (lice-killing) shampoo, then comb out all the nits because OTC shampoos do not kill all the eggs (only the heavy-duty, super-toxic, prescription shampoo does). The third step (after shampooing and nitpicking) is to delouse personal objects.

At the drug store, the choices were many: popular OTC shampoos (with either pyrethrins – derived from chrysanthemums - or their synthetic cousin permethrin), homeopathic treatments (that promise to kill lice without harsh chemicals), gels to help with the nitpicking– even an electric comb that electrocutes the lice.

I ended up buying the store brand, partially because it offered the most shampoo at the cheapest price (the shampoos are expensive and we are - except for my husband - a household of long, curly-haired females, so we needed quantity, especially since we didn’t want to skimp). I slathered it on my daughter’s hair, waited 10 minutes, then rinsed and, with a fine-toothed comb, I combed… and combed… and combed, trying to get all of the nits out. Have I mentioned that she has long curly hair? A lot of it? A thick underbrush of it? Well, it took a long time to through it all. Except that I didn’t get it all: We both grew impatient before I was done.

Then, I threw all of her bedding into the wash, boiled all the combs and hairclips, and quarantined her stuffed animals and brushes. And for good measure, my husband and I shampooed our hair and washed our linens (as luck would have it, there had been a thunderstorm the night before and we played musical beds). I also checked her sister’s hair: Nothing! Mom 1, lice 1.

The next day, the lice were gone. And for a few glorious days, I thought we had dodged a bullet.

With most of the OTC shampoos, you have to retreat between seven and 10 days after the initial treatment, when the eggs that the shampoo failed to kill the first time finally hatch and repopulate the hair - but before the nymphs can grow into adults capable of reproducing. The life cycle of lice is about three weeks.

But before we could get halfway to retreatment time, they were back. So I cut off six inches of my daughter’s hair and we tried another brand of OTC shampoo; this one did not work at all (lice can become resistant to a particular pediculicide). So I went back to the first shampoo and I bought the electric comb (which was pretty cool and did electrocute some lice, but apparently not all). When that failed, I tried the homeopathic shampoo that works by dehydrating the lice and their eggs (this one you have to leave on for at least an hour, instead of 10 minutes). At the time of each treatment, we washed linens, boiled hair accessories all over again. The stuffed animals never made it out of quarantine.

But still the lice returned.

After about a month, at wits end, I called my pediatrician’s office. The nurse on call told me I could try the prescription shampoo (did I detect hesitation in her voice or was that me projecting?) or I could try one more “weird” treatment. Since I wasn’t particularly excited about the prospect of using poison so close to my child’s growing brain, I chose the latter. She recommended “Dippity-do.” Yup: The pink or green hair gel popular in the ’50s and ’60s. (It now comes in other colors too.)

But, she warned, I’d have to wrap my daughter’s hair in plastic wrap and a shower cap and leave it on for 12 hours. Similar to other home remedies - like mayonnaise and olive oil - the idea is to smother the lice in a thick coat of glop. The advantage of Dippity-do over the oily foodstuff is that it is much easier to wash out of hair (and doesn’t stink like unrefrigerated mayonnaise).

If this doesn’t work, I’ll be tempted to pull out the big guns: No, not the prescription shampoo but the electric razor – and give my daughter a buzz cut.

Have you or a family member had lice? How did you finally defeat it? Did using harsh chemicals on a small child worry you?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


Filed under: Caregiving • Children's Health • Parenting

July 1st, 2009
02:13 PM ET

Will reform stop people from working the system?

By Caleb Hellerman
CNN Medical Senior Producer

Tuesday afternoon, I was hanging out in Harlem, working on a story we’ll be running later this month. A few blocks away, the barricades were up and police were directing traffic around the Michael Jackson tribute at the Apollo Theater.

Donald Childs, a bicycle repairman, was holding court on the north side of Marcus Garvey Park. Looks like Jackson was working the system, he told me, finding doctors all too willing to give him whatever he asked: “Yes-man health care.”

People in poor neighborhoods work the system, too, Childs said. “You go to a clinic and wait for hours to be see anyone. Poor people, people around here, just expect that. It’s the norm. [But] they know what to do if you really need a doctor. You go to the emergency room and you tell ‘em it’s asthma, or a heart problem."

“My wife has pancreatic cancer,” Childs confided. “But when she goes to the emergency room, and she needs to be seen right away, she tells them it’s her heart.” It was painful to hear, but sad to say, not surprising. I’ve talked to a lot of people who struggle to find decent care for cancer.

A few yards away, I heard more about gaming the system. “There’s a dentist’s office at ____; they’re paying homeless people $10 for their Medicaid number,” Heidi Flores was saying. “There’s another one pays $15.” [With a Medicaid number, a doctor or dentist can file claims for reimbursement – in this case, presumably, for nonexistent services.] Her friend, George Cabassa, chimed in. “There’s another one where they give you a cleaning but they tell Medicaid they did everything and the kitchen sink.” He told me to check it out, handed me a phone number and strolled off.

No surprise here, the health care system we have is maddeningly complex. It’s full of rules, full of odd financial arrangements and full of loopholes.

Monday evening, I found myself relaxing in the office of the Rev. Dr. Joe Bush at Walker Memorial Church in the South Bronx, listening as he argued that we need something simpler: a government-run health system like the ones in Canada or Western Europe. The air conditioning felt good with the sidewalk still sweltering outside, but the pastor was getting agitated.

“The first thing they ask when you step up to the counter: ‘Where’s your card?’ It’s all about the almighty dollar.”

I asked about his own health coverage and learned something new: According to Bush, insurance companies consider pastoral work to be a high-risk profession – high-stress, with associated health problems. To cover himself and his wife, Bush pays $27,000 a year for a policy with a $2,000 deductible.

When I asked what he thinks of the argument that a “public option,” or government-run insurance plan, might drive private companies out of business, his answer came as no surprise: “That would be a wonderful thing,” he said, a smile lighting up his face. “It would be the best thing that could happen to America.”

That might be a dramatic point of view, but riding home on the plane I found myself wondering if a government-run system would make a cancer patient lie about a heart condition, just to get a doctor to take her condition seriously.

Did you ever lie or shade the truth, talking to a doctor, hospital or health insurer?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.

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