Important Information & Medical Advice

DIVERTICULOSIS and DIVERTICULITIS

Amy E. Thompson, MD

 

Diverticulosis is a condition in which small pouches (called diverticula) form at weak spots in the wall of the colon.

Diverticulosis is common in older adults, occurring in about half of people between 60 and 80 years old. It affects men and women equally. Scientists do not know what causes diverticulosis. A low-fiber diet may play a role in developing the disease. Another cause might be abnormal contraction and spasm of the muscles in the colon wall. Obesity, lack of exercise, and some medications have been associated with diverticulosis.

Symptoms

Most people who have diverticulosis do not have any symptoms. When diverticulosis causes symptoms, it is called diverticular disease. Symptoms can include constipation, cramps, bloating, and painless bleeding from the rectum. Diverticular disease also includes diverticulitis.

Diverticulitis occurs when diverticula become inflamed or infected. Symptoms include abdominal pain (usually on the left side), fever, nausea, vomiting, cramps, and constipation. Possible complications include

  • Abscess

  • Stricture (narrowing of part of the colon)

  • Perforation (tear)

  • Peritonitis (abdominal inflammation that can occur after a perforation)

  • Fistula (abnormal connection between the colon and the bladder, small intestine, vagina, or skin)

Diagnosis

Because it does not usually cause symptoms, diverticulosis is often found when a test such as a colonoscopy is done for an unrelated reason. Diverticulosis and diverticular disease can also be diagnosed with a barium enema (x-ray scan). Diverticulitis is usually diagnosed with a computed tomography scan of the abdomen.

Prevention

Eating foods high in fiber can help prevent constipation and may decrease the risk of developing diverticulosis. High-fiber foods include whole grains and fresh fruits and vegetables.

For many years, doctors recommended that patients with diverticulosis and diverticular disease avoid eating nuts, popcorn, and seeds. Eating these foods was thought to cause symptoms and lead to diverticulitis. A study published in the August 27, 2008, issue of JAMA, however, showed that this is not the case. The study found that eating nuts, corn, and popcorn does not increase the risk of diverticulitis or diverticular bleeding.

Treatment

The goal of treatment for diverticulosis is to prevent and manage symptoms. Increasing fiber intake by eating foods high in fiber or taking a fiber supplement may help. Your doctor may also recommend medication or probiotics, which are “good bacteria” that are normally found in a healthy intestine. More research is needed to determine if probiotics are effective in treating diverticulosis.

Many cases of mild diverticulitis are treated at home with antibiotics and a few days of a liquid diet. If your symptoms are severe or you have a complication, you may need to be treated in the hospital. Treatment in the hospital might include intravenous antibiotics, bowel rest (no eating or drinking), or surgery.

Surgery may also be an option if you have diverticular bleeding that does not stop on its own or recurrent episodes of diverticulitis.

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab.

SIX RELAXATION TECHNIQUES TO REDUCE STRESS

We all face stressful situations throughout our lives, ranging from minor annoyances like traffic jams to more serious worries, such as a loved one’s grave illness. No matter what the cause, stress floods your body with hormones. Your heart pounds, your breathing speeds up, and your muscles tense.

This so-called “stress response” is a normal reaction to threatening situations, honed in our prehistory to help us survive threats like an animal attack or a flood. Today, we rarely face these physical dangers, but challenging situations in daily life can set off the stress response. We can’t avoid all sources of stress in our lives, nor would we want to. But we can develop healthier ways of responding to them.

One way is to invoke the “relaxation response,” through a technique first developed in the 1970s at Harvard Medical School by cardiologist Dr. Herbert Benson, editor of the Harvard Special Health Report Stress Management: Approaches for preventing and reducing stress. The relaxation response is the opposite of the stress response. It’s a state of profound rest that can be elicited in many ways. With regular practice, you create a well of calm to dip into as the need arises.

Following are six relaxation techniques that can help you evoke the relaxation response and reduce stress.

1. Breath focus. In this simple, powerful technique, you take long, slow, deep breaths (also known as abdominal or belly breathing). As you breathe, you gently disengage your mind from distracting thoughts and sensations. Breath focus can be especially helpful for people with eating disorders to help them focus on their bodies in a more positive way. However, this technique may not be appropriate for those with health problems that make breathing difficult, such as respiratory ailments or heart failure.

2. Body scan. This technique blends breath focus with progressive muscle relaxation. After a few minutes of deep breathing, you focus on one part of the body or group of muscles at a time and mentally releasing any physical tension you feel there. A body scan can help boost your awareness of the mind-body connection. If you have had a recent surgery that affects your body image or other difficulties with body image, this technique may be less helpful for you.

3. Guided imagery. For this technique, you conjure up soothing scenes, places, or experiences in your mind to help you relax and focus. You can find free apps and online recordings of calming scenes—just make sure to choose imagery you find soothing and that has personal significance. Guided imagery may help you reinforce a positive vision of yourself, but it can be difficult for those who have intrusive thoughts or find it hard to conjure up mental images.

4. Mindfulness meditation. This practice involves sitting comfortably, focusing on your breathing, and bringing your mind’s attention to the present moment without drifting into concerns about the past or the future. This form of meditation has enjoyed increasing popularity in recent years. Research suggests it may be helpful for people with anxiety, depression, and pain.

5. Yoga, tai chi, and qigong. These three ancient arts combine rhythmic breathing with a series of postures or flowing movements. The physical aspects of these practices offer a mental focus that can help distract you from racing thoughts. They can also enhance your flexibility and balance. But if you are not normally active, have health problems, or a painful or disabling condition, these relaxation techniques might be too challenging. Check with your doctor before starting them.

6. Repetitive prayer. For this technique, you silently repeat a short prayer or phrase from a prayer while practicing breath focus. This method may be especially appealing if religion or spirituality is meaningful to you.

Rather than choosing just one technique, experts recommend sampling several to see which one works best for you. Try to practice for at least 20 minutes a day, although even just a few minutes can help. But the longer and the more often you practice these relaxation techniques, the greater the benefits and the more you can reduce stress.

HOW TO LOWER YOUR CHOLESTEROL WITHOUT DRUGS from Harvard Medical School

You can begin to reduce your “bad” LDL cholesterol by making a few simple changes in your diet.

If your cholesterol is creeping upward, your doctor has probably told you that diet and exercise — the traditional cornerstones of heart health — could help to bring it down. And if you’d prefer to make just one change at a time, you might want to begin with your diet. A major 2012 analysis of several controlled trials involving hundreds of men and women found that dietary changes reduced LDL and total cholesterol while exercise alone had no effect on either. (However, adding aerobic exercise did enhance the lipid-lowering effects of a heart-healthy diet.)

The people in the studies followed a variety of diets, from Mediterranean to low-fat to low-calorie. However, the most effective diets substituted foods with cholesterol-lowering power for those that boost cholesterol. According to Kathy McManus, director of the Department of Nutrition at Brigham and Women’s Hospital, eating with your LDL in mind doesn’t have to be an exercise in self-deprivation. While you may have to say goodbye to a few snacks and fast foods, you can replace them with others that are equally satisfying. “You don’t have to follow an all-or-nothing approach. It’s really a matter of common sense,” she says. She suggests a few ways to start getting your cholesterol under control.
There is so much evidence implicating trans fats in heart disease that the FDA has proposed removing the “generally recognized as safe” designation from them. “The first thing we do when I’m counseling patients is to go over all the sources of trans fats in their diet and make substitutions,” McManus says.Weed out the worst fats

Trans fats are created by adding hydrogen to a liquid fat to help it solidify. Food manufacturers started using trans fats because they extend the shelf life of packaged baked goods. Fast-food purveyors took to them because they can be reused again and again. Although public pressure has forced the food industry to phase out trans fats, they haven’t disappeared entirely. To avoid eating them inadvertently, scrutinize the labels on food packages before you put them in your shopping cart. If you see “partially hydrogenated” in the list of ingredients, pass that product by. If trans fats aren’t banned from restaurants in your area, ask if the cook uses partially hydrogenated oil before you order.

Saturated fats and dietary cholesterol, which are derived primarily from animal products, aren’t exactly heart-healthy, but it’s all right to eat them in small amounts. McManus says that because eggs are such a good source of nutrients, it’s okay to have as many as four yolks a week and whites as often as you like. She also gives a nod to red meat, shrimp, lobster, high-fat cheeses, butter and organ meats — but only to small portions of each one every couple of weeks or so.

Eat more of the better fats

Both polyunsaturated and monounsaturated fatty acids help lower LDL. Most plant-derived oils, including canola, safflower, sunflower, olive, grapeseed, and peanut oils, contain both. Fatty fish (such as salmon, tuna, trout, herring, and mackerel), seeds, nuts, avocados and soybeans are also great sources.

Go crazy with color

Fruits and vegetables have scads of ingredients that lower cholesterol — including fiber, cholesterol-blocking molecules called sterols and stanols, and eye-appealing pigments. The heart-healthy list spans the color spectrum — leafy greens, yellow squashes, carrots, tomatoes, strawberries, plums, blueberries. As a rule, the richer the hue, the better the food is for you.

Don’t be too refined

Whole grains are another good source of fiber. Instead of refined flour and white rice, try whole-wheat flour and brown or wild rice. Old-fashioned oatmeal is also a good choice, but not the quick-cooking versions, which have had much of the fiber processed out.

And don’t substitute sugar for fat. “It’s one of the worst choices you can make,” McManus warns. Food manufacturers may boost the sugar content of low-fat salad dressings and sauces to add flavor. If you see sugar, corn syrup, or any word ending in “ose” near the top of the list of ingredients, choose a higher-fat version without trans fats instead.

Remember: Calories still count

All fats, whether good or bad, have nine calories per gram — about 100 calories a tablespoon. While you switch to a heart-healthy diet you may need to keep tabs on your calorie intake for a while.

END OF LIFE ISSUES: 5 commonly held myths

Some people don’t have a health care power of attorney or living will because they don’t realize how important these documents are. Others worry that such documents mean they are signing their lives away. Not so.

These powerful documents make sure that you get the treatment you would want for yourself if you couldn’t communicate your wishes. Here are a few myths that shouldn’t get in the way of creating a health care power of attorney or living will:

Myth: More care is always better.

Truth: Not necessarily. Sometimes more care prolongs the dying process without respect for quality of life or comfort. It’s important to know what interventions are truly important. It’s often impossible to know that in advance. That’s where the advice of a health care team is invaluable.

Myth: Refusing life support invalidates your life insurance, because you are committing suicide.

Truth: Refusing life support does not mean that you are committing suicide. Instead, the underlying medical problem is considered to be the cause of death.

Myth: If medical treatment is started, it cannot be stopped.

Truth: Not starting a medical treatment and stopping a treatment are the same in the eyes of the law. So you or your health care agent can approve a treatment for a trial period that you think may be helpful, without any fear that you can’t change your mind later. However, be aware that stopping treatment can be more emotionally difficult than not starting it in the first place.

Myth: If you refuse life-extending treatments, you’re refusing all treatments.

Truth: No matter what treatments you refuse, you should still expect to receive any other care you need or want — especially the pain and symptom management sometimes called intensive comfort care.

Myth: Stopping or refusing artificial nutrition and hydration causes pain for someone who is dying.

Truth: Unlike keeping food or water from a healthy person, for someone who is dying, declining artificial nutrition or intravenous hydration does not cause pain.

From Harvard Medical School

HUMAN PAPILLOMA VIRUS

In a typical year in the United States about 150 people die from meningococcus, four from tetanus, none from diphtheria, 20 from pertussis, and roughly 4,000 from cancers caused by human papilloma virus (HPV). People are more than 20 times more likely to die from HPV than from the other four diseases combined.

The Centers for Disease Control and Prevention (CDC) estimates that every year a cancer caused by HPV is diagnosed in an estimated 17,600 women and 9,300 men.

There is a safe and effective vaccine which protects against HPV. This vaccine is best given at age 11 to 12, but can be given from ages 9-26. To read more about the HPV vaccine go here:  http://well.blogs.nytimes.com/2016/08/22/the-underused-hpv-vaccine/

For those with a deeper quest for scientific knowledge, check out the nonfiction book The Immortal Life of Henrietta Lacks, by Rebecca Skloot. This book chronicles the discovery of the human papilloma virus as the cause of cervical cancer.

EYE HEALTH

From Harvard Medical School:

Of your five senses, which one are you most afraid of losing? If you’re like most people, your answer is your ability to see. Because our eyesight is so precious, it’s no wonder that myths abound about what can damage our eyes — and what can protect them. Here, we debunk five common myths — and tell you how to truly keep your eyes healthy.

Myth: Doing eye exercises will delay the need for glasses.

Fact: Eye exercises will not improve or preserve vision or reduce the need for glasses. Your vision depends on many factors, including the shape of your eyeball and the health of the eye tissues, neither of which can be significantly altered with eye exercises.

Myth: Reading in dim light will worsen your vision.

Fact: Dim lighting will not damage your eyesight. However, it will tire your eyes out more quickly. The best way to position a reading light is to have it shine directly onto the page, not over your shoulder. A desk lamp with an opaque shade pointing directly at the reading material is ideal.

Myth: Carrots are the best food for the eyes.

Fact: Carrots, which contain vitamin A, are indeed good for the eyes. But fresh fruits and dark green leafy vegetables, which contain more antioxidant vitamins such as C and E, are even better. Antioxidants may even help protect the eyes against cataracts and age-related macular degeneration. Just don’t expect them to prevent or correct basic vision problems such as nearsightedness or farsightedness.

Myth: It’s best not to wear glasses or contact lenses all the time. Taking a break from them allows your eyes to rest.

Fact: If you need glasses or contacts for distance or reading, use them. Not wearing your glasses will strain your eyes and tire them out instead of resting them. However, it will not worsen your vision or lead to eye disease.

Myth: Staring at a computer screen all day is bad for the eyes.

Fact: Using a computer does not damage your eyes. However, staring at a computer screen all day can contribute to eyestrain or tired eyes. People who stare at a computer screen for long periods tend not to blink as often as usual, which can cause the eyes to feel dry and uncomfortable.  To help prevent eyestrain, adjust the lighting so it doesn’t create a glare or harsh reflection on the screen, rest your eyes briefly every 20 minutes, and make a conscious effort to blink regularly so that your eyes stay well lubricated.

 

Harmful Dietary Supplements

 

Top view pov of adult man taking blue pills selective focus

With the help of an expert panel of independent doctors and dietary-supplement researchers, Consumer Reports identified 15 supplement ingredients that are potentially harmful. The risks include organ damage, cancer, and cardiac arrest. The severity of these threats often depends on such factors as pre-existing medical conditions as well as the quantity of the ingredient taken and the length of time a person has been exposed to the substance. You can read more about this at:

http://www.consumerreports.org/vitamins-supplements/15-supplement-ingredients-to-always-avoid/

Advanced Directives

This is a written statement of a person’s wishes regarding medical treatment, made to ensure those wishes are carried out should the person be unable to communicate them to their doctors or family. If you would like Advance Directive forms, please ask. This does not require a lawyer. The state of Vermont also maintains an online registry of Advance Directives. You may choose to register your medical Advance Directives online, allowing medical facilities throughout the state access to your wishes should the need arise.

Antibiotics

Antibiotics are a large group of medications which treat bacterial infections. Antibiotics play an important role in modern medicine, however their overuse is well documented and associated with a host of secondary problems. Health care professionals are trained to err on the side of caution, trying to avoid antibiotic overuse, unless deemed necessary. Typical infections such as the flu, common colds, pink eye, and “stomach bugs” are caused by viruses and will not respond to antibiotics.

Bone Density Screening

For average risk women, screening bone density exams are recommended at age 65. If you are younger than 65 and believe you are at increased risk, you can calculate your risk at www.shef.ac.uk/FRAX

Aortic Aneurysm Screening

If you are male and a current or former smoker, a one-time screening with ultrasound is recommended between the ages of 65-75. Please also let us know if aneurysms of any sort run in your immediate family.

Breast Cancer Screening

The current guidelines of the United States Preventive Services Task Force recommend mammograms for average risk women every two years from ages 50 – 74. Mammography for women in their 40’s and for age 75 and older should be a result of shared decision making, as there is not definitive science to guide our recommendations for these age groups.

Cholesterol Screening

We recommend routine screening for cholesterol every five years for healthy adults. Unless your practitioner has instructed you to fast, you do not need to be fasting for cholesterol screening. Children and teens are screened for cholesterol based on individual circumstances and family history.

Colon Cancer Screening

Colon cancer is one of the few cancers which can be prevented by screening. Starting at age 50, colonoscopy is recommended every 10 years. An alternative to colonoscopy is yearly stool testing for blood (with referral for colonoscopy if positive). Discontinue screening at age 75.

Diabetic Care

Diabetes is a chronic condition characterized by abnormal blood sugar metabolism. The mainstays of treatment include proper diet, regular exercise, medications, and monitoring for and preventing long-term complications of the condition. Special emphasis is placed on preserving the health of the eyes, heart, kidneys, feet and nervous system. If you are diabetic, we generally would like to see you every three to six months.

Erectile Dysfunction

This is a common problem with varying causes, usually amenable to treatment. Please feel free to discuss if this is a concern.

Flu Season

“Flu” refers to influenza, a highly contagious infectious disease caused by the virus Haemophilus influenza. Flu season runs from Winter into early Spring and can best be prevented by handwashing and flu vaccines given in the Fall. Symptoms include high fever, muscle aches, cough, feeling tired, headache, runny nose, and sore throat. If you have the flu, it is best to stay home, rest, drink fluids, and avoid contact with others. If influenza is diagnosed early in its course, treatment with antiviral medication may reduce the severity of the symptoms and shorten the course of the illness by a day or two.

Hepatitis C Screening

Hepatitis C is a virus which infects the liver and can have serious health consequences including liver failure and liver cancer. The hepatitis C virus is spread from person to person through blood and body fluid contact. The Center for Disease Control (CDC) recommends a one-time screening blood test for all persons born between 1945 and 1965. If you have donated blood through the Red Cross since 1990, you have already been screened for Hepatitis C.

Lung Cancer Screening

Yearly low-dose CAT scan of lungs is recommended for adults between the ages of 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. We are also here to support your efforts to reduce and quit tobacco. Please let us know when you are ready to make a change.

Lyme Disease

Lyme disease is a bacterial infectious disease transmitted by bites from infected deer ticks. An infected deer tick must be attached to a host for at least 36 hours in order to spread Lyme disease. Lyme disease initially causes a flu-like illness, often accompanied by an enlarging circular red rash. More information about Lyme disease may be found at the Vermont Department of Health website.

Medication Expiration Dates

Most prescription medications come with an expiration date one year from the date they were filled. This does not necessarily mean the medication is no longer effective. If you have questions about your particular medication(s), please ask us. If you do need to discard old or unused medications, please bring them to your pharmacy or to our office. Do not discard medications in the trash or in the water supply.

PAP Smears

Begin gynecologic exams at age 21. If testing normal, every three years until age 30 and every 5 years from ages 30 – 65.

Pertussis

Also known as whooping cough, pertussis is a very contagious bacterial infection which causes typical cold symptoms as well as a severe and prolonged (often as long as six weeks) cough. The incidence of pertussis can be markedly reduced by routine preventive vaccination. Please contact our office if you believe you have pertussis or have been exposed to an individual with pertussis. More information can be found at the Vermont Department of Health website.

Prostate Cancer Screening

The United States Preventive Services Task Force recommends against prostate cancer screening with the PSA blood test. The American Urological Association recommends against routine PSA screening for average risk men through age 54, and does not recommend for or against screening in ages 55-69 (shared decision making). Please let your practitioner know if prostate cancer runs in your family.

Sexually Transmitted Infections

Yearly screening for chlamydia is recommended through age 25, and for any adult believed to be at risk for an STI older than age 25. Screening can be performed from a urine sample for both men and women, or from a PAP smear sample for women. Our office can also perform testing for all other sexually transmitted infections as needed.

Skin Cancer

There are three types of skin cancers: basal cell carcinoma, squamous cell carcinoma, and melanoma. Using sunscreen and avoiding burns can lower the risk of skin cancer. Please let your practitioner know if skin cancer runs in your family.

Strep Throat

This is an infection of the back of the throat and tonsils caused by a bacteria called group A streptococcus. The common symptoms of strep throat are fever, sore throat, and enlarged lymph nodes in the front of the neck. Treatment with antibiotics is recommended for those with a confirmed strep diagnosis.

Vaccinations

Your health team at Evergreen strongly recommends routine immunizations for infants, children, and adults. We would be happy to discuss this with you should you have questions about vaccines.