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April 24th, 2009
05:37 PM ET

How jet lag affects our brains

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

It’s funny sometimes how our work content crosses over into our real lives. A case of art imitating life? For the last several weeks, I have been jet lagged, big time. It started when I was in India a few weeks ago. The trip there wasn’t bad and I managed to get on a schedule pretty quickly once I hit the ground. Once I got back, though, I had a very hard time shaking it. About a week later, I was still lying awake at 3 a.m. feeling as if I had been run over by a Mack truck. Right when I getting back on track, I flew to the West Coast and started the whole process all over again. And, I just got in from LA late last night. No question, I do travel a lot, but I was always curious: What is really happening in my brain when I am jet lagged?

The area of the brain that is most crucial to all of this is the hypothalamus. It is a key area of the brain, and most specifically the suprachiasmatic nucleus (that’s a name to remember…) contains tens of thousands of neurons whose main function is to regulate our circadian rhythms, our body clocks. (read jet lag study) In neurosurgical terms, this area is completely “out of whack” when we travel. But, it is more than that.

There are two types of neurons that individually represent our deep sleep and REM sleep. The deep sleep neurons do synch up within a day, even after a significant overseas trip but it is those neurons overseeing REM sleep that take much longer. Without REM sleep, which is the type of sleep that allows you to dream, you are going to feel more fatigued, have lapses in memory and general decreased performance.

Now, as you might imagine, researchers who figured this out in rats have already told us they are looking into the possibility of a “jet lag” drug to target the suprachiasmatic neurons in the hypothalamus regulating REM sleep patterns (I feel smart just writing that). Yes, I am convinced that one day there will be a pill for everything, but I am not a big fan of pills, so here are some techniques I have learned over the years. (watch Sanjay's personal tips)

I immediately change my clock to the new time zone when getting on the plane. If possible, I will try to go to bed an hour earlier each night for a couple of nights prior to the trip. As you might imagine, starting off sleep deprived is not a good idea. I take eye blinders and a heavy sweater on all flights, so I can sleep even during daylight. As I mentioned, sleeping pills aren’t really my thing, though I have a few frequent traveler friends who swear by melatonin. In case you can’t remember how to take this supplement, think of it as the “darkness hormone.” It is made when it is dark outside and suppressed by light. You take it about an hour before bedtime – of your new location.

Please excuse all typos – I was jet lagged when I wrote this. And, I was wondering if you had any more tips to ward off jet lag to help me and other travelers?

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.


April 23rd, 2009
10:24 AM ET

How can I avoid injury during my dancing workouts?

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

From Suzy, Raleigh North Carolina

“Dr. Gupta, I saw you on “Dancing with the Stars” this week and it was great! I started dancing about three months ago and have lost about 10 pounds. I am having fun on the program but do worry about getting injured! What can I do to lower my risk?”

Answer:

Hi Suzy, thanks for writing in. It’s great to hear you started dancing as a way to get fit. It’s a great way to burn calories without it feeling like a chore. The key for anyone looking to get in shape is to find a fitness routine you enjoy! You’ll stick with it longer and may even inspire a friend or two to join you.

Many dancers say they feel longer and leaner from just a few months of classes. Exercises like dancing, or even Pilates for example, impact the density of your muscle versus the size of the muscle. The muscle fibers are engaged differently from the way they would be in a person lifting weights. It is a great body-shaping activity, keeping the core engaged the entire time and toning and strengthening your muscles.

Of course dancing burns a lot of calories too! Fast-paced dancing (swing, ballroom, or party dancing) can burn about 360 calories per hour. Slow-paced dancing (slow ballroom or a mambo) can burn about 240 calories per hour for the average person.

But for any fan of the hit TV show, “Dancing with the Stars,”you are well aware of the injuries that can develop. Just this season, five contestants have been hurt. Nancy O’Dell had a torn meniscus; Jewel suffered a leg fracture to name a couple. Their injuries are typical – majority of dancing injures develop in the lower extremities: hip, knee, leg, ankle, foot.

To avoid injury, be careful of overuse. Overuse injuries, the most common seen among dancers, occur when a person consistently does the same movement over and over again. The muscles begin to tire, bone begins to weaken, and an injury occurs.

Studies show that during a 90-minute organized dance class, a person lands on the same leg about 200 times! Each impact is about 10 times your body weight. Imagine doing that every night? Overtime, your muscles will break down and an overuse injury will result.

So let your body rest after dancing (or any other high-intensity workout) by spacing out your workouts. For example: Avoid doing two days in a row of the same activity. Remember, it’s the repetitive motions that often cause overuse injuries. And remember that a good workout makes you alert, energizes you for the day ahead. If you are feeling sluggish, you are most likely not getting enough sleep. Sleep deprivation impacts your reaction times and overall performance, which could lead to injuries as well.

The best bet for someone looking to start dance-for-fitness regime (and avoid injury) is to cross train versus solely dancing. By making dancing ONE of the activities you do to stay in shape – not the only one – you will have fun, tone up and avoid sitting on the sidelines. Keep up the great work, Suzy!


April 22nd, 2009
06:53 PM ET

All for a sash and a crown

By Jessica Silvaggio
CNN Medical Intern

When I was a freshman at the University of South Carolina, I became a peer health educator. The health topics we promoted on campus included body image and eating disorders. This hit home for me.

Since I was 13 I have been competing in beauty pageants. One pageant director told me I would never win if I didn’t lose 20 pounds. I obsessed about my weight, cut my 1,200-calorie diet in half, and worked out twice a day. All of this just to be the girl who walked down the runway, waving, with the bouquet in my arms and the crown on my head. When I came to college I compared myself with other girls on campus, continued to count calories and wore oversized clothes to hide what I thought was a heavy body, which, in fact, was far from true. I just didn’t like the way I looked.

According to the University of California Davis, approximately 15 percent of college women and a rising number of men suffer from eating disorders. A distorted body image and dieting can contribute to eating disorders. Two ruling passions in my life were too little food and too much exercise. This had to stop.  Surely there was a way to build confidence and feel good about my body. I had to strive to value myself for other strengths such as intelligence, my outgoing personality and dancing abilities.

While training as a peer health educator, I learned to cope with my unattainable pursuit of perfection. I realized I had to learn to praise myself and have a positive attitude to boost my self-esteem. Exercise was good for me but not for weight loss – instead to reduce stress, promote strength, balance, and flexibility. I learned that eating well-balanced meals was healthier than cutting calories. And support from friends and family members was vital.

After seeking counseling on campus and realizing that God had blessed me with a healthy body, I was able to educate my peers on an issue that was personal. I have overcome my body image battle. Through the process, I learned that I have to be comfortable in my own genes or should I say jeans?

Do you have an issue with your body image? We’d like to hear about it.

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.


April 20th, 2009
01:51 PM ET

What’s the truth behind all those food expiration labels?

By Karen Denice
CNN Medical Senior Producer

What does the “Sell-by” date really mean?

Is the sell by date really a “consume-by” date? Everyone seems to have an opinion, but what are the facts? I was raised to never waste food. My grandfather used to cut the mold off my bread and hand it back to me. So, I have a rather liberal view of food safety – more of a sniffer than a by-the-book, go-by-the-date kind of gal.

But recently I was having friends over for dinner and wondered if I could be putting them at risk. The meat I was using had only a sell-by date and had been frozen every minute since then. Granted that sell-by date was in September and I was cooking for them in March. Don’t flinch!

For the dinner I used my personal sniff, color and texture test and decided it looked good, but that just made me wonder what do those dates on packages really mean? So I did some research.

Surprisingly food dating is not generally required by the federal government although 20 states do require it. There are multiple “dates” that may end up on your food; the one in question for me was the purchase or sell-by date. These dates are not an expiration date, but they do reflect when the food is at its highest quality. Depending on the food, it will stay good anywhere from one to two days [poultry] to five weeks [eggs] after the sell-by date if handled properly. (Check out this chart)  

There are also “Best if used by” or “Use-by” date stamps. These sound like your food might go bad, but again the U.S. Department of Agriculture says this refers only to the quality of the food – not safety.

If you freeze food the dates and advice gets murkier. Experts say freezing prevents the germs that cause food to spoil, but that doesn’t mean you’ll like the taste when it’s defrosted. Anything from freezer burn to how long it was frozen and the quality of the food will impact how good, or not good, it will taste.

Lucky for me, my friends enjoyed the meal and as it turns out it was unlikely they would have gotten sick anyway.

So are you a sniffer or a by-the-date person? Have you ever gotten sick taking a risk?

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.


April 17th, 2009
01:00 PM ET

Is a pill really the right answer for all addicts?

By Caleb Hellerman
CNN Medical Senior Producer

We’ve spent close to a year exploring the twists and turns of addiction and rehab. It stirs up strong emotions – a lot of us have friends or family members who have wrestled with addictions, so it touches close to home. I think that’s why many people see addiction as an issue of morality or basic decency – who are these people to wreak havoc in our lives?

That said, on at least some level addiction is a disease of the brain. I was fascinated to learn about anti-addiction medications and what they might mean for the future of treatment. It was the most e-mailed story on CNN for two days running, and we got hundreds of comments on this report. What many people wanted to know is why these medications are not widely known.

This isn’t an answer, but I’ll lay out a theory: Medications like naltrexone or topiramate don’t fit the current models for treating addiction. This is true, for different reasons, on the high end and the low end, too. The issue in high-end rehabilitation centers is obvious: Why would people or insurers pay tens of thousands of dollars a month, when they could stay home, see their family doctor or therapist and pick up a monthly prescription at the pharmacy? Of course it’s not that simple; even the biggest advocates of medication say that inpatient treatment can be helpful for some addicts, and most inpatient centers do sometimes prescribe these drugs. Still, the business angle can’t be overlooked.

Less obvious but probably bigger is the impact medication could have on outpatient therapy. That’s because a lot more people get treatment in small community centers, or clinics, than go to hospitals like Betty Ford. Even more just go to AA or another 12-step program. In all these settings, many counselors have little or no medical training. Sometimes they just have whatever wisdom they’ve gleaned from their own addiction.

If “medical” outpatient treatment is a lot less expensive than spending a month in rehab, it’s a lot more expensive than hiring lay counselors and organizing AA meetings. Dr. Robert Swift of Brown University and the Providence Veterans Affairs Medical Center, who helped run the federally funded COMBINE study that compared medication with other types of therapy, told me “A lot of these programs go to the lowest bidder. If you can provide, quote, ‘services,’ and one program uses the lowest level of acceptable counselors, and the other provides medical treatment and pharmacotherapy, one of those is going to be substantially more expensive.”

There’s no doubt the struggle over the best addiction treatment has a big component of philosophy: is this a brain disease, or a character flaw? But the issue of cost makes it that much easier to stick with the status quo. In a country of 23 million addicts, where close to 20 million don’t get treatment, that’s not really acceptable.

Has addiction touched your life? What treatment(s) have you seen work?

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.


April 15th, 2009
01:32 PM ET

The cost of addiction

By David S. Martin
CNN Medical Senior Producer

Planted along the wooded road leading to Hazelden’s main campus in Center City, Minnesota, are three wooden signs, each bearing a single word: Easy. Does. It. Treating addiction is seldom easy, though.

Angela Puckett came here after an overdose of alcohol and painkillers nearly killed her. She had spent her life as a self-proclaimed party girl. She arrived at Hazelden hoping 28 days there would begin her road to recovery.

In “Addiction: Life on the Edge”, which airs Saturday and Sunday, April 18 and 19 at 8 p.m. ET and 11 p.m. ET, CNN Chief Medical Correspondent Dr. Sanjay Gupta profiles Puckett and three other addicts trying to rebuild their lives. During the year CNN followed them, one relapsed, showing just how difficult recovery can be.

On a campus that resembles a small college, patients at Hazelden go to individual and group therapy, attend lectures, and reflect. Puckett was lucky. Her insurance covered Hazelden, where the typical stay costs $26,000. Only half of insurance plans pay for residential rehab.

Four years after she arrived at Hazelden, Puckett is back at work and back as a devoted mother to her son. “I know I’d be dead if it wasn’t for Hazelden,” Puckett told CNN. “Hazelden gave me my life back.”

“Addiction: Life on the Edge” also profiles:

* Lucy Gross, a 17-year-old who attends one of a growing number of high schools specially designed for addicts in recovery.

* Walter Kent, a retiree who ended four decades of addiction to alcohol by taking a pill.

* Nic Sheff, a young writer who chronicled his addiction to methamphetamine and other drugs and the toll it took on his family in the book, “Tweak.”

The federal government estimates there are 23 million Americans who abuse drugs or alcohol, costing more than $500 billion in healthcare, criminal justice and lost productivity.

Do you think insurance companies should be required to cover drug or alcohol treatment? How about residential treatment like Puckett’s?

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.


April 13th, 2009
12:28 PM ET

Banning or taxing bad health habits to cut health care costs

By Andrea Kane
CNNhealth.com Producer

Two articles have recently come out tackling the twin pink elephants in the room: one is an editorial in the New England Journal of Medicine in favor of taxing sugary drinks (to reduce consumption and possibly raise revenue for anti-obesity programs), the other is a story in Time magazine making the case for an outright ban on cigarettes.

The views in each make plain old sense: Ban or tax that which we KNOW is bad for our health to improve health and cut runaway health care costs.

In the case of cigarettes, the writer notes that cigarette smoking costs an “estimated $100 billion in health-care costs… annually.” In the case of sugary beverages, the authors write, they “may be the single largest driver of the obesity epidemic” (pointing out that the only studies that found no link between sugary-drink consumption and obesity are – surprise! – those funded by the beverage industry).They estimate obesity-related problems cost about $79 billion annually – about half of which is footed by the American taxpayer (you and me).

On the one hand, their arguments make me morally uncomfortable: Who are we to tell other people what to do? Isn’t it too “Big Brother”? Too paternalistic - especially when we are talking about taking steps that will affect the so-called underclass (aka: “the poor”) most? But in both cases, the writers note that poor people have the most to benefit from cutting back on sugary soft drinks and quitting smoking. This is especially true in the case of smoking since “[c]igarettes, to an extent, have become an indicator of lower socioeconomic status.” Yet, nobody likes to be told how to live or wants to feel coerced into any course of action – however “good for you” it might be.

But on the other hand, why can’t we just admit that advocates for taxing and banning these vices have a point? Banning smoking WILL reduce cancer and cardiovascular (and a whole host of other) deaths. Making soda expensive WILL force people (especially poor people, who presumably also can’t afford all the lifelong medications they’ll have to take for diabetes, high blood pressure, etc.) to drink water and thus cut out 250 to 300 empty calories a day, which over the course of a year – not to mention a lifetime - really do add up.

What also adds up are the costs: the costs associated with caring for the sick and the costs associated with lost productivity due to illness. Make no mistake, the American taxpayer (you and I) will have to pay one way or another - via higher health-care costs, the inability to get affordable insurance, or perhaps through cuts to programs such as Social Security, public education, work training programs (or the arts, national parks, etc.) in order to fund the ballooning costs associated with Medicaid/Medicare.

So what is the right answer? Where do your rights (to smoke, to drink liquid calories, to do what you want with your own body) end and my rights (to breathe clean air, to not have to pay for someone else’s problems) begin? I want to hear what you think.

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.


April 9th, 2009
10:19 AM ET

Who should take a daily aspirin?

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 Sharon, Mays Landing, New Jersey

“My husband’s doctor told him to take an aspirin a day. Should I be taking one too?”

Answer:

Thanks for the question Sharon. Aspirin is a medication we often get questions about, probably because an estimated one-third of Americans take it every day. The popular pain reliever is easily accessible, inexpensive, and available at your local pharmacy. It is commonly used to treat arthritis, headaches and fever among other minor pains. But what is often confusing is whether taking it every day can help prevent ailments– a heart attack or stroke.

Most daily users were most likely prescribed aspirin to lower their risk of cardiovascular disease. But it is important to note that not all people will benefit from this treatment, and in some cases, it can be dangerous.

The U.S. Preventive Services Task Force is a group of independent health experts who review effectiveness and offer usage guidelines for medical treatments and drugs. Last month, the USPSTF updated its 2002 recommendations of who could benefit from a daily aspirin regime.

Men aged 45 to 79, and women aged 55 to 79 who are at high risk of heart attack may benefit from a daily aspirin as a prevention tool. The USPSTF concluded that aspirin is most effective in this group of men to prevent heart attack and for women to prevent stroke.

Being overweight, having high blood pressure, high cholesterol, and smoking cigarettes are all factors that put you at high risk for heart attack. The group added that even if you fit this age and risk factor category, aspirin is not recommended if you have a history of gastrointestinal bleeding.

Women under the age of 55, or men under the age of 45 who have never had a stroke or heart attack should not take daily dose of aspirin as a preventive measure. Additionally, USPSTF did not find a clear benefit or risk of a daily aspirin in adults over the age of 80.

Aspirin works by suppressing your body’s natural production of substances and blood cells that can cause swelling, pain and blood clots. It’s a type of drug known as salicylate. It is critical to discuss the risks with your doctor before beginning an aspirin regime. It can be dangerous for people with a history of ulcers and GI bleeds among others ailments. It can also interfere with certain prescription and over-the-counter drugs, so disclose to your doctor what meds you take.

The FDA warns that women who are pregnant or breastfeeding should not take aspirin (unless specifically prescribed by a doctor). Up to 8 percent of each aspirin dose can be transferred to the baby and may cause birth defects or complications with pregnancy.

So Sharon – you can see there is no clear answer to your question because many variables come into play. You and your husband can be the same age but have different health histories and risk factors that would impact the effectiveness of a daily dose of aspirin. Talk to your doctor, who can determine the potential risk vs. benefit specific to your health history.

One thing I know for sure is if you're concerned about your risk of heart disease, eating a balanced diet and 45 minutes of moderate cardiovascular exercise a day is one of the best “medicines.”


April 8th, 2009
12:34 PM ET

Calculating the risks of skiing in Quebec

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

I just returned from Mont Tremblant, Quebec. It is one of the more beautiful ski resorts in eastern  Canada, and it is also the place where actress Natasha Richardson fell and suffered a fatal brain injury. What caused her death is now well known, but there were some other details that struck me while I was there. Let me try and work through this with you.

[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/images/04/08/gupta.mont.tremblant.jpg caption="Dr. Sanjay Gupta on assignment in Mont Tremblant, Quebec."]What no one knew at the time was that she had hit her head hard enough to cause a fracture in her skull. Just underneath that fracture is a small blood vessel that runs just on top of the brain, and it was that blood vessel that started to bleed. By many reports, Richardson got up after her fall and felt well enough to go back to her room and wave off paramedics who had been called. In neurosurgery, we refer to this as a lucid interval. She may have lost consciousness briefly, but now felt fine. The problem for Natasha or anyone with an epidural hematoma is that the pressure continues to build up in the brain. (See what an epidural hematoma looks like).

A little while later, now in her room, Natasha started to feel sick. The most likely symptoms were headache, nausea, disorientation and lethargy. 911 was called again, and now the clock was definitely ticking. If you ask a dozen neurosurgeons, how much time someone has after starting to develop the symptoms Natasha had, you will get varied answers. Anywhere from a few minutes to 90 minutes, but the message is the same: Speed matters. The problem for Natasha was she was nearly two hours away from a trauma hospital by ambulance, and there was no helicopter available to take her more quickly.

By the time she got to the hospital, too much pressure had built up on her brain and we know she died 24 hours later. The medical care in Canada is world class and the neurosurgeons there could have performed a lifesaving operation, if only she had arrived sooner.

There are doctors in Canada who have been calling for more air ambulances, long before we learned about Natasha Richardson. Others argue that the cost-benefit analysis comes down on the side of not having them. (Read more here) Based on our research, helicopters typically cost around $6,000 per hour to operate, not including other associated costs. So, here is something to ponder: Should ski resorts have access to helicopter services at all times or is there a certain amount of risk you accept if you ski in a remote location? Is it worth the cost to have this benefit?

Watch my full report Thursday on AC 360 at 10 p.m. ET.


April 7th, 2009
09:56 AM ET

Take someone you love to the doctor - today

By Caleb Hellerman
CNN Medical Senior Producer

Last fall, I started getting worried about my father - just a vague sense something wasn’t right. He’d tell the same story, gripe about the same thing, one too many times. Plus, he’s 82 years old. My mother and brother said he was fine, but then something tipped me over the edge: After more than 50 years running his own small company, my father had decided to sell the business, and I was helping with paperwork. He’d been moaning and groaning about it forever, but when I sat down to put together a few spreadsheets – well, it was easy. I thought: he couldn’t handle this?

Maybe it was a medication. Maybe stress, or a touch of depression – all things that can mimic the early stages of dementia. Or maybe my mom and brother were right. I wasn’t sure where to start, so I called Dr. Thomas Perls, a gerontologist – a specialist in treating older people. I’d interviewed him before, and said I needed a favor. Where should I take my dad? What questions should I ask?

Dr. Perls told me I really ought to take him to a gerontologist, who wouldn’t focus on an aching hip, or a memory problem, or incipient diabetes – but all of it, together. And because I was worried about memory loss, someone who could order a detailed neuropsychological exam. And then I took a big step: I told my dad I was worried about him…. and he said sure, he’d see a new doctor as long as I set it up.

But that was January, and now it’s April. Something always came up. Or maybe I didn’t want to go, myself. But then I noticed that today is something called “Take a Loved One to the Doctor Day.” It’s organized by radio superstar Tom Joyner, to encourage African-Americans to get regular checkups. We’re not African-American – but when I got the flier and saw the headline, how could I ignore what’s going on in my own family?

So today, I’m calling about that appointment. Maybe – I hope – it won’t be any big deal. But it’s my dad, and I owe it to him.

Have any advice about finding the right help for an aging parent?

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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About this blog

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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