Popular Health Supplements

Hmmm, this looks interesting.

This link is to a graphic representation of data around health supplements as a "bubble race". The higher the bubble, the stronger the evidence showing that it works. The bigger the bubble, the more popular it is (in terms of Google searches).

Hormone Replacement Therapy: better to wean slowly or stop cold turkey?

Ever since the publication of the findings of the Womens' Health Initiative earlier in the last decade,
it has generally been appreciated that hormone replacement should be reserved for alleviation of intractable menopausal symptoms and only for as long as necessary to do so.

On the other hand, it has been unclear whether stopping hormone replacement can be sudden or whether it should be done gradually.

A recent medical study suggests that there may not be much difference between the two approaches.

Women who suddenly stopped taking hormone replacement had the same number and severity of hot flashes as women who took their usual doses every other day for a month and then stopped.

Interestingly, almost half the women went back on to hormone replacement because of the severity of hot flashes within a year of going off them.

I think the take-home message is that hormone replacement is reasonable to use to alleviate significant hot flashes and menopausal symptoms. In order to establish whether you still need to be on them, it's okay to just stop them and consider restarting them if the symptoms return and are not tolerable. Remember that the earliest signs of harm from use of hormone replacement took over 5 years to manifest in the Womens' Health Initiative study, and also that there are alternatives to hormone replacement that you may prefer.

An Inspiration in Tough Economic Times

Ralph Bakshi is a cartoonist and cartoon animator (remember Fritz the Cat, Wizards, Lord of the Rings?) who in this YouTube video is responding to a question at a comics convention as to advice for young up-and-comers in a tough industry during this economic downturn.

His answer is like Babe Ruth taking it out of the park.

The answer addresses the opportunities in times of crisis for animators, but really speaks to anyone with some creative talent, a marketable idea and the drive to take the entrepreneurial bull by the horns.

This is recommended viewing for anyone considering making a go of a long cherished idea that has been on the back burner until now.

Kidney Stones

Kidney stones are a relatively common, and potentially quite painful problem.

They occur through the formation of crystals from dissolved chemicals in the urine. These form in the kidneys, and can be passed down through the ureters to the bladder. If they are small enough to get out of the bladder, but big enough to get stuck partway down (4-6 mm across) that's when the problem gets very painful. Painful as in more painful than childbirth (so says every female patient I have ever had who has a basis for comparison).

Kidney stones have a 10-15% chance of occurring in any given person's lifetime, though this varies with a number of factors:

• Stones are 2-3 times more likely to occur in men than in women.
• Whites have more stones than Hispanics, Blacks and Asians.
• Stones are uncommon in people under 20 years old, and the occurrence peaks between 50-70.
• Stones are more common in hot, dry climates. Also, heat exposure and dehydration are risks.

80% of stones are made of calcium (which happily means that they show up on plain old X-Rays), and 80% of these calcium stones are made up of a chemical called calcium oxalate.

So, for the good news- there are things you can do in order to prevent these stones. (h/t to my urology colleague Dr. Kash Desai for many of these):

• Hydration: drink 6-8 glasses of water a day, avoid sodas, salt and caffeine from your diet.
• Avoid high-protein and high-salt diets.
• Avoid excessive cheese and dairy intake.
• Lemonade is good: 8-10 ounces of lemon juice in 64 ounces of "reverse osmosis" water such as Aquafina, Dasani or Alhambra.
• Orange juice, or any other citrus juice is good. (Remember, you should not drink grapefruit juice at all if you take a statin cholesterol medication.)
• Vitamin B-6, 50 mg a day.
• Calcium supplements are OK, but should be calcium citrate with Vitamin D and magnesium (and not calcium carbonate such as Tums, Rolaids or "natural" calcium).