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December 9th, 2008
12:04 PM ET

What supplement does Dr. Gupta take?

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

Question asked by J. Mizer, San Diego, California

"As part of CNN's programming, Dr. Gupta named the one daily vitamin supplement he takes, however, I can't remember what it was.  Can you  please advise?"

Answer:

Hi J,

First off, thanks for tuning in to CNN!  Your question is one I get often — the dilemma of whether to take a daily supplement can be confusing. The truth of it is Americans spend billions of dollars a year on a products that have no scientific proof they work.

In fact, 20 percent of Americans take some kind of an herbal supplement, but in about 2/3 of those cases the supplement isn’t clinically proven to provide benefit.

To answer your initial question, the one supplement I take everyday is fish-oil/omega 3. I have a family history of heart disease and there is evidence fish-oil, can help reduce my risk.    But this doesn’t mean, fish-oil is the only supplement that has benefits. 

Studies show calcium and vitamin D supplements can reduce your risk for osteoporosis. And folic acid supplements are beneficial for expecting mothers as they help prevent birth defects.

Here are a couple best-selling herbal supplements  that studies have proved have no benefit. Gingko biloba does not help your improve your memory or to ward of Alzheimer’s disease.  Studies say echinacea does not help fight off a cold and there is no evidence that St. John’s Wart works to treat depression.

I know it is harder than it sounds but the best way to get nutrients is through a well balanced diet.  Loading up on lots of vegetables, fish and leafy greens will provide you with a wide range of essential vitamins to keep your immune system up and your brain working at full speed.

 If you do chose to go with any type of vitamin or supplement, be sure to tell your doctor about it. Some herbal supplements can also cause harmful drug interactions with pharmaceutical drugs you might also be taking.


December 9th, 2008
12:03 PM ET

How can I work diet, fitness into my busy life?

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

Asked by Lillian, Washington, D.C.

"I go to school and work and never seem to have time to cook healthy meals or fit in a workout routine.  Can you give me some advice on how to get a program started?"

Answer:

Lillian, I can vouch firsthand that with a busy schedule, healthy eating habits and exercise routines are often the hardest to keep up 
with. 

One thing we know is that vegetables are one of the best foods for us to eat. They are filling, and packed with vitamins and nutrients. 

Look for vegetables at the store that are easy to prepare: pre-washed salads, carrots, grape tomatoes, celery. 

 One thing my family does is create vegetable snack-packs.  We get zip-lock bags and mix up the vegetables so they are easy to grab and eat on the road or bring for lunch.   Also, give grilling a try! It is an easy way to add a healthy, gourmet touch to dinner. Season vegetables-like asparagus, mushrooms, green peppers-with low-sodium seasonings and grill for about 5 to 10 minutes.

As for exercising, since your time is limited, try to find an activity that you can do socially while gaining health benefits.   One example is joining a dance group.  You can burn up to 500 calories dancing an hour.   Have a dog? Look for dog-walking group in your area.  It’s a great way to meet people, and help you..and Rover get in shape. 

The bottom line is you have to make health a priority.  Even if you have just 30 minutes a day of free time to exercise -make it happen! You will end up having more energy for your daily tasks at work and school.  Good luck, Lillian!


December 9th, 2008
12:02 PM ET

How common are peanut allergies?

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

Question asked by Jennifer, Ellijay, Georgia

"Our 17-month-old son was recently given peanut butter during snack time and he had a very severe allergic reaction. How common are peanut allergies, what causes them and what steps can we take to ensure we avoid peanuts?"
 
Answer:
 

Jennifer, food allergies are quite common among children. About 8 percent of kids have some sort of food allergies, the most common allergen being peanuts.   Peanut reactions can cause dizziness, constricted breathing and in some cases loss of consciousness.  What’s happening is your child’s immune system can’t process the protein found in peanuts.  As a defense mechanism, it identifies it as harmful and causes the reaction. 

To avoid trouble, you need to read food labels very carefully. If you are at a restaurant, be sure to alert the server of your peanut allergy.  There are often hidden sources of peanuts in certain foods. For example, arachis oil is actually peanut oil.  And it's common for sunflower seeds to be sorted on machines shared with peanuts.  Also, many ethnic foods, including Thai, African and Chinese dishes contain peanuts. 

 As your child gets older, inform him of the allergy and the risks. Discourage him from sharing foods with other children or at school, which will help limit any surprise attacks.  Also, inform all the key people in your child’s life about the allergy.  Never assume an aunt, a family friend, a baby sitter, or the day care or school knows about his allergy.

 Finally, be prepared: Carry and epinephrine shot on you at all times.  You can also leave a dose with the school or day care in case of emergency.  Epinephrine will increase blood pressure and the open airways in the lungs.

I know it seems like a lot to process but know you aren’t alone! There are many resources on the Web and as well as food allergy support groups to offer more tips to make the transition in diet easier.


December 9th, 2008
12:00 PM ET

What's this wartime brain injury?

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

Asked by Elizabeth,  Lawrence, Massachusetts

"My cousin is a marine that fought in Iraq.  Just recently, he was told he had an injury that caused his brain to actually "rattle" around in his head! What is the name of this condition and could you tell me more about it?"

 Answer:

 First of all, thanks to your cousin for his brave service. As someone who has reported from the frontlines in Iraq, I have witnessed, firsthand the dangers and the unimaginable sacrifices servicemen and servicewomen face on a daily basis. I’ve also met, and even operated on,  soldiers who suffer from your cousin’s condition. 

 It’s called “traumatic brain injury” or TBI. It’s a blow, jolt or penetration to the head that can disrupt the normal functioning of the brain.  It can happen anywhere and at anytime – during a fall, car crash or even rough sports. Concussions are a milder form of TBI.  

We now know, though, that traumatic brain injury has become one of the signature injuries of the wars in Iraq and Afghanistan. One of  the biggest causes are unexpected blasts from improvised explosive devices or IED’s.  Their sheer force can literally rock the brain, even when wearing a helmet.  The skull strikes a hard surface and the brain goes back and forth, like jello wiggling, and then begins to bruise from the swelling. 

It’s important to remember that there’s a broad range of severity for TBI. Common symptoms include headaches, dizziness, sleep disorders, nausea or memory problems. In mild cases, a traumatic brain injury may present as headaches or occasional dizziness. More severe cases can involve complete memory loss, personality changes or even persistent vegetative state.

Today, the Army checks soldiers before and after deployment to identify TBI cases. But unlike an obviously severed limb, traumatic brain injuries are difficult to diagnose, sometimes only noticeable years after leaving the battlefield. 

Unfortunately, there is no one way to treat TBI. Recovery depends on the severity of the case and varies from person to person. 

Everything from talk therapy to rehabilitation to the use of drugs to reduce symptoms of depression and anxiety are used.  The good news is that mild cases often require little more than rest and over-the counter pain reliever.


December 8th, 2008
08:55 AM ET

A question of consent

By Caleb Hellerman
CNN Medical Senior Producer

I’ve been working on a project called “Another Day: Cheating Death” that you’ll hear more about in 2009. It’s about medical innovations, especially in the realm of emergency medicine.

When it comes to emergencies, doctors face a dilemma: how do you test a new treatment?  Take cardiac arrest: for decades, emergency responders have given victims a shot of epinephrine – adrenaline – to help re-start the heart.  But there’s a new study, from Norway, which says the drug actually doesn’t make a difference. How do they know? The only way you can: by testing it.  About half the patients, who suffered out-of-hospital cardiac arrest over the five-year study period, got a shot of epinephrine along with CPR and defibrillation.  The other half got no epinephrine.  

None of the patients gave consent to be part of the study.  They couldn’t; they were unconscious, and resuscitation efforts had to start right away. The study was approved by an independent oversight board – but when Norwegian reporters found out about this in January, there was a scandal. The doctors were accused of withholding lifesaving treatment. The study had to be cut short, although by that point, it was nearly finished, anyway.

Dr. Kjetil Sunde, one of the lead authors, is still upset.  He told me, “People only think you’re a good practitioner if you give a lot of drugs. If you just cure him with traditional doctor’s wisdom, they think you’re bad.”

It makes me uneasy to think I might not get the “standard of care” in such a crucial situation. At the same time, how else are we going to find a better way of doing things?

Would you be upset if you found a hospital had tested a new emergency treatment on you or a loved one, without getting consent?

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. 


December 5th, 2008
12:02 PM ET

Kids struggle with diabetes

Volunteering at Tides

Volunteering at Tides

By Alani Gregory
CNN Medical Intern

Just imagine going to a restaurant and ordering a plate of food. Before you even take a bite, you must estimate the serving size of each food on the plate. Then, you must correctly estimate the amount of carbohydrates in that food, add it all up, and then give yourself insulin. Now imagine doing this every time you eat! That’s the harsh reality of living with diabetes.

When I entered my freshman year of college, like every overachieving-“Grey’s Anatomy”-watching- pre-med student, I began my quest to rid the world of all its health maladies. I was immediately drawn to an organization called T1DES (Type 1 Diabetes Education and Support), a student-run organization that provides access to diabetes education and support for children in inner-city New York. One application, a background check and an interview later and I was in. My first day, I sat in disbelief during training, when the facts and figures were spelled out. According to the CDC, 23.6 million children and adults in the United States suffer from type1 or type 2 diabetes. Every year, 15,000 children learn they have type 1 diabetes. That’s 40 children each day, according to the Juvenile Diabetes Research Foundation International.

Much of the focus on diabetes has been on reducing type 2 diabetes – the form of the disease in which the body either becomes resistant to insulin or doesn’t produce the necessary amount. In most cases, type 2 diabetes can be prevented with exercise, healthier eating, and regular doctor visits. With the great diabetes initiatives under way, I rarely hear any projects geared towards type 1 diabetics.

The cause of type 1 diabetes is unknown, but scientists believe genetics and the environment contribute to the body’s own immune system attacking and destroying insulin-producing cells in the pancreas. It can’t be prevented by a simple prescription of more exercise and healthier eating. Organizations including JDRF are currently looking into possible cures such as, pancreatic islet cell transplantation. But, until there is a cure, it is important that programs are created that teach children – the population most affected by the disease – how to manage their diabetes and provide a stigma-free atmosphere.

Once, we had a participant who refused to test her blood sugar in front of anyone. Her mother pleaded with us to help her test in public because not testing could have tremendous implications. Initially, we could not understand why she would not test in public, but quickly realized that she was uncomfortable about having the disease. By the end of the semester, she was testing in front of the other kids. Unfortunately, many children just like her, who feel embarrassed and isolated, don’t have access to programs geared towards their specific needs.

The kids find comfort in meeting people just like them, often showing off their cool insulin-pump cases or sharing stories of when their blood sugar dropped so low they had to be rushed to hospital. If we begin to provide educational venues for children with this chronic disease, then the $58 billion dollars the nation spends annually on type 1 and type 2 diabetes related complications could be significantly reduced. Type 1 diabetes may not be preventable, but its long-term complications such as nerve damage, heart disease, blindness, and kidney disease can be prevented. These educated diabetic children will grow into well-informed adults who are armed with the knowledge to be guardians of their health.
Do you know anyone with type I diabetes? Are there any programs in your area that target children with type 1 diabetes? What else can be done to educate children with the condition?

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.


December 4th, 2008
04:16 PM ET

Extreme Challenges: How Obama should address health care

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

There is no doubt health care will be an extreme challenge, especially with the economy in the tank. A bigger challenge may be a perception one. To remind people the economy and health care reforms are truly linked. After all, we have the most expensive health system in the world, and Americans spend more on health care than housing or food. Here is a number to ponder. The United States spends nearly 500 billion more than peer nations on health care, and we don’t get nearly enough for it.

As a doctor and a parent, I can’t believe we have let ourselves get to this point. Too many people are uninsured, and even more have insurance that is simply inadequate. According to the American Cancer Society, 100,000 Americans will end up in bankruptcy because of a cancer diagnosis. Can you believe that? You are diagnosed with the most devastating medical illness of your lifetime only to be hit with the most devastating financial crisis you will suffer. Yes, the economy and health care are truly linked.

Last month, nearly half of all Americans surveyed reported skipping pills, postponing or canceling medical appointments and generally cutting back on medical care simply due to cost. The uninsured who are injured or who developed a chronic illness were less likely to receive follow up care, which worsened the severity of their condition. So, here is another number: Roughly 22,000 people die each year due to lack of coverage. For sake of reference, the number of people who die annually from homicide in the United States is around 17,000. It would seem being uninsured is a different sort of homicide.

The next administration will be faced with extreme challenges and health care reform has to be front and center. As you may infer, you can’t really fix the economy without addressing health care. Still, this reporter is optimistic we will see some changes over the next few years. Heck, the next administration might even deal with stem cells and obesity to boot.

Programming note: Tune in tonight at 11 pm ET for the program, “Extreme Challenges: President Obama”, to hear Anderson Cooper and the CNN team lay out the challenges facing America’s 44th President and offer some advice.

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.


December 2nd, 2008
04:20 PM ET

Are your doctors awake?

By Jennifer Pifer-Bixler
CNN Medical Senior Producer

When I was in college, I had emergency surgery.  The whole incident was a blur. One moment I was being poked, the next, I was being wheeled off to the OR.  When I woke up after surgery, I was groggy and feeling NO pain.  For the next few days, morphine was my best friend.  Granted, my memories from that week are pretty limited, but one thing I do remember is a young doctor stopping by my room to check on me.  I have no idea what he said, but I do remember vividly that he tried to stifle a yawn while he was talking to me.  That made ME yawn and in turn, he yawned AGAIN.  Perhaps it was the pain meds, but boy I thought that was hilarious.

The “dueling yawns incident” pops in my mind whenever I hear about the long hours doctors work while they are in residency.  To succeed, not only do these new doctors have to be smart, they must have endurance.  For a long time, there was no limit to how many hours a resident was expected to be on duty.  But in 2003, the Accreditation Council for Graduate Medical Education, the council that evaluates and accredits medical residency programs in the United States, set up new rules limiting the maximum resident work week to an average of 80 hours and the maximum shift length to 30 hours.  However, according to some researchers, even with the 30-hour limit on shifts, there can be a whole host of serious problems.  I recently spoke with Dr. Charles Czeisler at the Harvard Medical School Department of Sleep Medicine.  He studies lack of sleep and its impact on doctors.  Czeisler's research shows that one in five residents admit making a fatigue-related mistake that hurt a patient.  One in 20 admits making a fatigue-related mistake that resulted in death.  In other words, says Czeisler, working 24 hours straight without sleep is comparable to being legally drunk.

That's sobering news.  And it makes me wonder about the doctor who treated me in college.  I wonder now how many hours he had been working.  Now the Institute of Medicine says it it's time to talk about residents’ hours and workloads.  "Fatigue, spotty supervision, and excessive workloads all create conditions that can put patients' safety at risk and undermine residents' ability to learn," said committee chair Dr. Michael M.E. Johns, chancellor of Emory University in Atlanta, Georgia.

Among the recommendations from the IOM:

           * Limit shifts to 16 consecutive hours

           * Give residents more days off

           * Provide transportation home after a long shift.

The IOM acknowledges that there is no easy solution.  In fact, it says there are very valid reasons for some residents to work long hours.  Keep in mind that this is a training time for doctors.  And getting the most experience possible ultimately benefits patients.  Also, the work flow varies from specialty to specialty and experts say 'one size’ doesn't fit all when it comes to schedules. For example, the time a surgeon needs to spend with a patient is different than a dermatologist.

The committee stresses that limiting resident hours is not a “silver bullet.”  It also recommends greater supervision of residents by experienced physicians and limits on patient caseloads based on residents levels of specialty and experience. 

Reaction to the report has been mixed.  Public Citizen http://www.citizen.org says the IOM has missed “a golden opportunity” and doesn't go far enough to protect patients.   Czeisler, however, says it is an important first step.  But he worries that nothing will change unless the federal government gets involved and enacts new laws.

I want to know what you think.  Do you think these recommendations are needed?  Have you ever been treated by a “drowsy doctor?"  And if you are a doctor, do you think working long hours helped or hurt your residency?

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.


December 1st, 2008
03:39 PM ET

Will antibiotics help the ache?

By Shahreen Abedin
CNN Medical Senior Producer

I'm typing this blog entry while sitting on an airplane.  Haha, just kidding.  I'm a mom of a now 1-year old who got off a plane a few days ago when I flew home to Dallas for Thanksgiving.  I couldn't imagine tap-tapping on a laptop while also trying to feed and keep the little one calm and happy in that a cramped little airplane seat! 

Along with being near-impossible, it would've been one more thing to push me towards the edge of losing it altogether.  There is just SO much to worry about when flying with baby – are his bottles ready? How do I time lunch and what's he going to eat? Did I bring enough toys that are entertaining enough but won’t disturb others? And oh yeah this is a fun one: Is he going to get sick this time too? 

See, the last two times we flew with the munchkin, he ended up getting an ear infection.  I don’t know if it’s because, like many adults, the re-circulated air in the cabin during cold and flu season, along with the close quarters with so many sniffly, coughing people allowing the virus to cling to trays and seats– just makes him more susceptible to getting a cold?  That stuffiness from his cold (a viral infection) can lead to fluid backing up in a child’s ears, thereby setting the scene for an ear infection, which is bacterial (those infections are usually only treated with antibiotics if they last a few months).

Or is it something else about the experience of flying to a different house, surrounded by different people, sleeping in an unfamiliar bed, etc., that makes his immune system go wonky? 

Nevertheless, I know my kid isn’t alone in his bouts with ear infections.  It’s the most common bacterial illness in children, according to the American Academy of Pediatrics.  Young children are more likely to get these pesky infections because their Eustachian tubes are shorter, narrower, and more horizontal than for the rest of us, so they don’t drain as well.  Every year, over 5 million kids get ear infections, leading to over 30 million doctors’ visits, according to the American Academy of Pediatrics. 

The first time it happened, I saw the telltale ear tugging, usually a sign of pain or discomfort, and then took him to a drug store clinic while I was still in Dallas, where he was prescribed antibiotics by a nurse practitioner.  The second time, we came home and his pediatrician said we could put him on antibiotics or just wait it out and see how he does.  See, the AAP (and I) are both concerned about antibiotic resistance.  Which is why the organization actually now recommends that doctors give parents the option of letting the kid fight the infection on his own for the first two or three days, observing how he does, and then prescribing antibiotics only if the symptoms don’t improve.  The academy says that about 80 percent of cases actually get better even without antibiotics.

On top of that, a study from this February, published in the Archives of Otolaryngology-Head & Neck Surgery, found that antibiotics don't really work to get rid of the fluid that accumulates in the ear due to infections.  When I asked her about this, Dr. Laura Jana, spokesperson for the American Academy of Pediatrics and author of “Heading Home with Your Newborn,” said that yes, for 2 or 3 year olds, the trend is now for doctors to hold off on the antibiotics and let the child fight off the infection naturally.  But for babies under age 1 like mine, because their ability to hear is so intrinsically tied to the critical language skills that they develop during this period, doctors will still give them the amoxicillin to fight off the underlying bacterial infection if there's fluid buildup and inflammation, even if the drugs don’t work for fluid reduction.

For the pain, though, the academy still recommends ibuprofen or acetaminophen.  Dr. Jana also stresses the importance of follow up visits for the little tykes, to make sure that the fluid has indeed finally drained from the ears.

So I’m wondering – how many of you out there have chosen to wait it out and let your baby’s body duke it out alone, and how did that go for you? How many of you, like I was the first time, are more willing to put the baby on antibiotics if it could help, when they're in their first year?  Did you have any problems with antibiotic resistance later on?  And do you also deal with ear infections related to when you travel?  What was your experience?  And what are your most useful tricks for getting your small child to stay healthy and sane on a plane?

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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