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Hopkins News for You
This is a monthly service for our friends and patients around the world from Johns Hopkins International. To receive reports e-mail, please send e-mail topatientnewsletter@jhmi.edu .
May 2002
1. Angioplasty Better than Clot Busters
2. Angry Young Men & Heart Disease
3. Don't Ignore the Snore
Protecting Angioplasty Patients from Heart Problems
Low Back Pain with Don Martin, M.D.
1. Angioplasty Better than Clot-Busters
A Johns Hopkins study of heart attack patients has concluded that they may be better off with balloon angioplasty to open blocked blood vessels than with clot-busting drugs. Angioplasty patients experienced a 40 percent lower combined incidence of death, repeat heart attacks or strokes six week and six months after the procedure. In addition, the angioplasty group had a shorter hospital stay, averaging 4.5 days compared to 6 days for the drug group.
2. Angry Young Men and Heart Disease
Young men who quickly react to stress with anger are at three times the normal risk of developing premature heart disease says a Hopkins study of more than 1,000 physicians who have been followed for the past 50 years. Such men--who said they expressed or concealed their anger, became irritable or engaged in gripe sessions--were also five times more likely than their calmer counterparts to have an early heart attack even without a family history of heart disease. "In this study, hot tempers predicted disease long before other traditional risk factors like diabetes and hypertension became apparent," says cardiologist Patricia Chang, M.D. "The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management."
3. Don't Ignore the Snore
Parents should be aware that snoring is not necessarily normal in children, and they should discuss it with their doctors. The American Academy of Pediatrics recently issued new guidelines to evaluate snoring in children. Though in some children snoring is just annoying, in many others it can signal the presence of obstructive sleep apnea, a condition associated with daytime tiredness and slow physical growth, and which may even be misdiagnosed as attention deficit disorder. The updated guidelines are available atwww.aap.org. Among the recommendations: Pediatricians should screen all children for snoring and rely on a nighttime sleep study to diagnose obstructive sleep apnea. Removal of the tonsils and adenoids is the first treatment for most children, followed by postoperative evaluation to determine if additional treatment is needed.
Protecting Angioplasty Patients from Heart Problems
Many people know that aspirin protects heart attack victims against future episodes. Now, another drug may safeguard patients who have had coronary artery surgery. A Dutch study treated 1700 angioplasty patients with an anti-cholesterol statin called Lescol. After four years of treatment, patients experienced up to a 47% reduction in serious cardiac episodes and additional surgeries. Hopkins cardiologist Roger Blumenthal says these post-operative findings are vital to long-term recovery. "When people have bypass surgery, angioplasty, or stenting they think they are cured. But in reality they have undergone only a temporary measure. Unless their risk factors are addressed, with more aggressive management of blood pressure, cholesterol and lifestyle improvements, the odds are that one or more blockages will develop."
Low Back Pain with Don Martin, M.D., Internal Medicine and Rheumatology
Question:What is low back pain and what causes it?
Dr. Martin: Low back pain is centered around the lumbar spine (low back), the muscles alongside it and the sacro-iliac joints just above the buttocks. The most common causes are mechanical, such as straining of the lumbar muscle, a herniated disc with spinal cord or nerve compression, osteoarthritis, spinal stenosis or narrowing of the spinal canal, and scoliosis or curvature of the spine.
Question: What is the natural course of low back pain?
Dr. Martin: The vast majority of people recover without medical intervention. Thirty-three percent of individuals recover within 1 week, 70% within 2 weeks, and 90-95% within 2-3 months.
Question: What type of evaluation is appropriate for these patients?
Dr. Martin: Since low back pain usually improves without intervention, most patients require nothing more than a history and examination. However, certain "red flags" suggest the possibility of more serious disease and may require additional laboratory and/or imaging studies. "Red flags" include: continuous pain that lasts more than 4-8 weeks; progressive weakness; bowel or bladder dysfunction; a history of unexplained fevers, night sweats or weight loss; a history of tuberculosis, HIV infection, alcoholism or illicit injection drug use; a history of malignancy; or a history of corticosteroid use or other causes of immunosuppression.
Question: How should "routine" low back pain be treated?
Dr. Martin: Because most low back pain improves by itself, patient education and reassurance play an important role. Bed rest, if used at all, should be no longer than 2-4 days because prolonged rest may actually slow recovery. Acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs can relieve symptoms. The usefulness of muscle relaxants, other than local heat, is debatable. Physical therapy should be considered if there is no significant improvement after 2-4 weeks of conservative treatment.
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