Author: books

By Cara Murez 

HealthDay Reporter

TUESDAY, Oct. 25, 2022 (HealthDay News) — When a man has cancer in an area that affects sexual function, his doctor is likely to discuss it with him.

But the same is not true for a woman who has cancer in a sex organ, according to new research. Investigators found 9 in 10 men were asked about their sexual health, yet only 1 in 10 women received the same care.

“There seems to be a big disparity in the way we approach sexual dysfunction with our patients, where female patients are asked about sexual issues much less often than male patients are,” said lead author Dr. Jamie Takayesu. She is a radiation oncology resident physician at the University of Michigan Rogel Cancer Center.

“Equally importantly, we see this trend on a national level in clinical trials,” Takayesu said.

The findings were presented at the annual meeting of the American Society for Radiation Oncology, in San Antonio.

In the United States, about 13,000 women are diagnosed with cervical cancer each year, while more than 220,000 men have new cases of prostate cancer.

Radiation therapy and other treatments are often used in both cases. 
 

The potential for long-term side effects, including sexual dysfunction, is important to consider, Takayesu said. About 96% of patients with prostate cancer and 67% of those with cervical cancer survive for at least five years.

In brachytherapy for prostate or cervical cancer, doctors insert radioactive sources directly into the tumor. This can affect organs in the genital region.
 

About half of the women who receive cervical brachytherapy experience sexual side effects, among them uncomfortable and sometimes painful changes to vaginal tissue and dryness, according to the research team.

Somewhere between one-quarter and half of men who receive prostate brachytherapy end up with erectile dysfunction during, after or well after treatment.

Takayesu said the lack of openness toward women’s sexual health isn’t limited to medical offices.

“Culturally, there are differences in how we talk about sexual dysfunction that affects men versus women. We see ads on television about erectile dysfunction, for example, but there’s no equivalent to these for women,” Takayesu said in a meeting news release.

For the study, researchers combined analyses of institutional data and national clinical trials.

The authors reviewed consult notes in the records of 201 patients who were treated with brachytherapy for prostate cancer or cervical cancer between 2010 and 2021.

Doctors discussed sexual health with about 89% of men compared to 13% of women. Doctors assessed none of the women using a patient-reported outcomes tool, but did so with 81% of the men.

In analyzing the U.S. National Institutes of Health Clinical Trials Database, researchers found that prostate cancer trials, compared to cervical cancer trials, were significantly more likely to include sexual function as a primary or secondary endpoint. They also were more likely to include overall quality of life as an endpoint.

One radiation oncologist called the new findings “eye-opening.”

“While a small retrospective study, the stark disparity in sexual health assessment between men and women is indeed illuminating,” said Dr. David Byun, who practices at NYU Langone’s Perlmutter Cancer Center in New York City.

“The potential long-term quality-of-life side effects, including their impact on sexual health, must be adequately discussed during consultation, so patients are fully informed [about treatments],” said Byun. He’s also a clinical instructor in radiation oncology at NYU Grossman School of Medicine.

According to the study authors, some of the reasons for the disparities may be that for prostate cancer, patients have multiple treatment options, some of which affect sexual health. In comparison, cervical cancer doesn’t have the same variety of treatments.
 

And while men can choose between sexual dysfunction medications approved by the U.S. Food and Drug Administration, few to none exist for women.
 

“The only tools that we commonly recommend for women are lubricants and dilators, but even these are not great options,” Takayesu said.

“It’s easy for us to prescribe different medications for our male patients, but for our female patients, we don’t have that first step. I think that creates a barrier to bringing these issues up,” she said.
 

Doctors need to start asking female patients about their sexual health more frequently. “If we don’t know about problems, we can’t solve them,” Takayesu said.

Byun agreed. “Educate and communicate — ask your patients what is important to them so you can best serve them,” he advised.

Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

More information

The U.S. National Cancer Institute has more on cancer treatment and women’s sexual health.

SOURCE: American Society for Radiation Oncology, news release, Oct. 21, 2022; David Byun, MD, radiation oncologist, NYU Langone Perlmutter Cancer Center and clinical instructor in radiation oncology, NYU Grossman School of Medicine, New York City
 

Oct. 25, 2022 — In early October, respiratory syncytial virus, or RSV, tore through Victoria Thiele’s Indiana home. Her three older children had manageable symptoms. But her 8-week-old newborn ended up developing a severe case.

Thiele, whose family lives in Fort Wayne, said the baby experienced chest retractions while breathing and was taken to the emergency room at a local hospital, where she was diagnosed with RSV and bacterial pneumonia.

An Unprecedented Surge in RSV 

Thiel’s experience mirrors what’s happening across the country. On Oct. 21,  the CDC director tweeted that respiratory viruses, including the flu and RSV, are surging. Data from the CDC shows the percentage of those testing positive for RSV has more than doubled over the past month – straining the capacity of children’s’ hospitals as they try to care for the sickest patients. 

“Nobody has enough beds,”  says Renee Higgerson, MD, pediatric intensivist and medical director at Pediatrix Critical Care of Texas and St. David’s Children’s Hospital. “We’re taking care of patients in every possible location we can in the hospital.”

Yvonne Giunta, MD, director of pediatric emergency medicine at Staten Island University Hospital, part of Northwell Health in New York, said the pediatric emergency department at her facility is seeing a high volume of RSV cases, along with other respiratory infections. 

“It’s not uncommon for a surge in pediatric volume in the late fall and early winter,” Giunta says. “But this surge seems to have started earlier than in previous years.”

What’s Behind the Surge? 

RSV usually has a predictable seasonal pattern, peaking in late December to mid February, according to the CDC. The virus hits young children hardest, causing about 58,000 hospitalizations of kids under the age of 5, and 100 to 300 deaths per year in that age group. But as the CDC noted, RSV was almost nonexistent in 2020, when pandemic prevention methods nearly knocked the virus out of circulation.

Christopher J. Harrison MD, professor of pediatrics at the University of Missouri-Kansas City, said children get RSV by the time they are 2, and these first exposures make children less susceptible to the virus. 

But the COVID pandemic means that some children born over the past couple of years were never exposed to RSV. 

“Since the hiatus where we lost regular viruses, we ended up really shaking up the whole epidemiology thing,” Harrison says. 

The loosening of pandemic control measures coupled with a much more susceptible younger population is a “perfect storm” for this outbreak, he notes. 

Hospitals Pitching In 

Higgerson says she has been heartened by how hospitals in her area have come together, inviting patients to take free hospital beds on the rare occasions they become available. 

“Everybody is working cooperatively,” she says. 

But the biggest hurdles are nursing and staffing shortages. 

“We’re opening some sections of the adult hospital, creating pediatric beds,” she says. “But what’s limiting us is the availability of nurses. We just need more nurses.”

Giunta says she is already strategizing ways to accommodate staffing needs. 

“We are encouraging the swing shift, which typically would cover mainly the adult emergency department, to cross-cover the pediatric area in the later afternoon and evening hours,” she says. 

Educating Parents 

Michael Chang, MD, a pediatric infectious disease specialist at UT Health Houston and Children’s Memorial Hermann Hospital, whose facility is also operating at or near capacity due to a high volume of RSV, stresses the importance of parent education when it comes to managing this outbreak.

Many parents have resumed normal pre-pandemic activities and are burned out by pandemic protocols, Chang says.

“People are so tired of thinking about the pandemic that we have really returned to our prior behavior of shrugging off mild illnesses, runny noses, etc.,” he says. 

Hospitals and pediatric offices should emphasize the ABCs of disease prevention when it comes to RSV, such as avoiding crowds, staying home when sick, and hand washing, Chang says. Teaching parents to recognize when symptoms can be managed at home, and when to take a child to the ER, could also help decrease the number of patients overwhelming emergency rooms. 

What Parents Need to Know 

In most children, RSV causes mild cold symptoms like sore throat, congestion, and coughing. But for children under the age of 2, children with weak immune systems, or those with asthma, RSV can be more serious.

In vulnerable children, RSV can cause bronchiolitis, an inflammation of the small airways, making it difficult to breathe. It can also cause pneumonia.

Most cases of RSV can be treated at home with extra fluids, cool-mist humidifiers, and nasal suctioning. But some children may need emergency medical care.

Theile’s baby was put on high-flow oxygen, but her oxygen levels remained below normal. 

“At that point, they told me she would need to be put on a ventilator,” Theile says. 

After 4 days of ventilation, antibiotics, and treatment with steroids, the infant was able to breathe on her own. Thiele says she’s grateful for the compassionate care her daughter received, but that the atmosphere at the hospital was chaotic and frightening.

“When we went into the ER, they had to take her stats in a hallway because all rooms were full of children with RSV,” Thiele says. “The PICU was filled with the sounds of children coughing and monitors going off due to their stats going down. It was truly heartbreaking.”

According to the Academy of American Pediatrics, signs your child may need immediate medical attention include:

• Labored breathing
• Flared nostrils while breathing
• Retractions at the belly or ribs
• Sucking in at the collarbone while breathing
• Wheezing
• Gray or blue skin or lips
• Extreme lethargy
• Dehydration symptoms, such as decreased wet diapers

Being older has never been so popular. More than 55 million Americans are 65 and up and make up a higher percentage of the U.S. population than ever before.

Baby boomers are a huge part of it: Every day, 10,000 of them turn 65 until 2030, causing a “silver tsunami” of changes in the senior living industry.

Food plays an important role: Many of today’s prospective residents have traveled more and eaten better than earlier generations. The three-meals-a-day concept is giving way to all-hours availability. Upscale and organic options like roasted apple and brie grilled cheese and gourmet burgers are replacing senior communities’ menu mainstays like split pea soup and meatloaf.

That may sound like an upgrade, but a lot of people might appreciate a more diverse menu. More than 13% of today’s U.S. seniors were born in other countries. Many moved to America decades ago – and people from all over the world enjoy eating a wide variety of dishes. And yet, the traditional foods of your culture often remain staples of what you cook and eat. So what are the options if you might want to change where you live — by moving to an independent or assisted living community —  but not what you eat?

More Roti, Less Mashed Potatoes

Many senior communities offer a weekly international food theme, like Taco Tuesday or Italian night. But the majority of the menu is still traditionally Western. That works for most, but not everyone.

“Indian food is so important to our residents that, when they reach the assisted living stage, nobody moves out because they’d have to contend with mashed potatoes and green bean casserole,” says Iggy Ignatius, chairman and founder of ShantiNiketan Retirement Communities in Tavares, FL. “It wouldn’t be spiced up the Indian way.”

While scoping out a second career in social work, Ignatius noticed that many fellow Indians who’d moved to America in the ’70s and ’80s didn’t want to retire to India and leave their children and grandchildren behind.

“There were a lot of retirement communities in America, but no Indian retirement communities. They served food, but not Indian food,” Ignatius says. “I saw that as a niche and thought, if I started something like that, maybe it’d be my social work.”

Though it’s not marketed as an exclusively Indian community, 100% of the residents in the 300-home community are Indian. Of those, many are vegetarians for religious or cultural reasons. As an optional add-on to housing, ShantiNiketan offers a food club. A board of advisors creates the menu and two cooks prepare the dishes. Lunch might be mixed dal (lentil stew) with cabbage, potatoes, green beans, salad, roti (a type of flatbread), rice, yogurt, and pickles. Dinner options include uttapam (pancake made with fermented lentil rice batter), chole puri (a chickpea dish) and radga (potato, white peas, and cilantro) patties.

ShantiNiketan’s Food Club was a major factor in the decision-making process for Leela Shah, who came to America from central India in the early 1960s for college and built a life and family here with her husband, Atul.

“When we first came to America and adjusted to Western cuisine, our weekly diet included American food, but mostly we eat Indian,” she says. “I worked very hard all those years and wanted the option to cook or not cook if I wanted to in our later years.”

With backgrounds in pharmaceutical chemistry, the Shahs were also concerned about nutrition.

“There’s fancier food in other communities, but nutrition is important to us and here we can eat everyday Indian food that’s balanced, healthy, and affordable,” she says. “If it’s not spiced the way we like it, we bring our own black or red pepper to make it hot.”

Keeping It Spicy

Diversity is always on the menu at Priya Living, an Indian-inspired independent living community with four locations near Indian communities in California, and two more planned in Michigan and Texas.

Where many senior communities have a central clubhouse for dining, Priya Living has a “marketplace” that’s open from 8 a.m. to 8 p.m. and offers a chai bar, hot bar, refrigerated grab-and-go section, and provisions you can purchase and cook in your room. It’s mostly, but not exclusively, vegetarian Indian food, with some chicken, lamb, and goat options and themed international days that include Italian, Mexican, Chinese, and Indo-Chinese cuisines.

“Besides the price and layout, the number one question we get is, ‘What kind of food do you serve?” says Anjan Mitra, Priya Living’s head of innovation and former founder and CEO of Dosa, a family popular Indian restaurant in San Francisco. “The Indian style of cooking is very different. It’s not uncommon for us to use 15 different spices in a dish, but they have to work with each other. People are invested in the food — they want it to be familiar — but they’re not invested in cooking it anymore.”

An Issue of Identity

As a teenager, Yuji Ishikata cared for his aging grandmother. Once a wonderful cook, she spent her final years eating prepared homestyle Japanese meals similar to what Ishikata now makes for other seniors as the chef of the nutrition program at J-Sei, a Nikkei cultural organization in San Francisco’s East Bay area.

In addition to Japanese meals served at their 14-bed residence facility, J-Sei offers home-delivered lunches Monday through Friday to people 60 or older in their delivery area who can’t shop for or prepare their own meals.

“Losing touch with the Japanese food they’ve eaten their entire lives would be like losing their identity,” Ishikata says. “Whatever else is changing around them, food offers comfort, nostalgia, and familiarity.”

Ishikata sends out around 150 meals every weekday from a set monthly menu that includes chicken teriyaki with broccoli and unagi donburi, or eel over rice, Kazue Nakahara’s favorite dish.

For Nakahara, 76, who’s third-generation Japanese-American, J-Sei’s meal delivery eliminates the large amount of preparation and “fuss” she says Japanese food requires above Western dishes like spaghetti and meatballs.

But her real motivation is comfort: Nakahara’s Japanese-born husband, Hidetaka, 80, has gravitated more to the food of his childhood as he’s aged.

“Before he’d make a fried egg and bacon for breakfast. Now he prefers onigiri, or rice balls, and some miso,” she says. “The older he gets, the more Japanese he gets.”

Oct. 25, 2022 — Including more foods rich in an omega-3 called alpha-linolenic acid (ALA) could help people with heart failure, a new study suggests.

ALA is an omega-3 fatty acid found mainly in plants. Higher blood levels of ALA were tied to fewer deaths and fewer first trips to the hospital for heart failure compared to lower levels in the study, published in the Journal of the American College of Cardiology.  Some of the best sources of plant-based omega-3s include flax, which can be purchased as seeds or oil and is often found in cereals, baked goods, and other products. Chia seeds, pumpkin seeds, walnuts, soy foods, canola oil, seaweed, edamame, and kidney beans are also good sources.  

“The most striking finding to us is the clear difference between patients in the bottom 25% — the lowest ALA levels — compared to the other 75%,” says Aleix Sala-Vila, PHD, of the Hospital del Mar Medical Research Institute in Barcelona, Spain.

The researchers studied blood samples from 905 heart failure patients. The average age was 67, and about a third were women. After a follow-up of about 2 years, 140 people died of any cause, 85 died from cardiovascular disease, and 141 people were hospitalized for the first time with heart failure.

Patients with higher blood levels of ALA were significantly less likely to die or have a first heart failure hospitalization than those with lower levels, according to the analysis. 

More research is needed to show definitively whether increasing dietary ALA can improve heart failure outcomes, Sala-Vila says. But for now, “including some ALA-rich foods such as walnuts in the diet might translate into cardiovascular benefits for anyone, whether they have heart failure or not. There is no evidence of any harmful effect of one daily serving of walnuts, not even on weight gain.”

Diet Often “Overlooked”

JoAnn E. Manson, MD, DrPH, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston, called the study findings “promising.”

“Diet is often overlooked as an important factor in maintaining good health and good heart health,” she says. “This study gives further support that a dietary factor may influence heart health, including heart failure. Until recently, most of the dietary emphasis has been on salt intake, which is very important, but not as much as some of these other dietary factors.” 

However, the study doesn’t prove that increasing ALA blood levels will definitely improve heart failure prognosis, she says. 

“It may be that the foods that are leading to this higher blood level of ALA make up the type of plant-based diet that’s been linked to a lower risk of cardiovascular disease, such as the Mediterranean diet. The findings also could be the result of other factors that aren’t fully controlled for in the analysis, or the study participants may be more compliant with their medications.”

Nevertheless, she says, “It’s reasonable to recommend that people with a history of heart failure or who are at high risk increase their intake of ALA-enriched foods.” 

It’s also good advice for everyone to follow a heart-healthy diet, including plenty of ALA, she adds. 

“Have a large salad or a couple of smaller salads every day, add canola or flaxseed oil, and sprinkle on some walnuts,” she advises. “This will give you a high intake of ALA every day.” 

Whether you’re newly diagnosed or have known for a while, telling people that you’re HIV-positive can be hard. You may worry about how others will react or if they’ll treat you differently.

But sharing your HIV status is important. Your friends and family members provide the support you need, says Marguerita Lightfoot, PhD, director of the Center for AIDS Prevention Studies at the University of California San Francisco School of Medicine. They relieve the burden of keeping a secret and give you a shoulder to lean on. Or they can help with physical tasks, like giving you a ride to the doctor’s office.

Most of the time, choosing who to tell is a personal decision, Lightfoot says. You have control over how and when you share the news.

Who Do I Have to Tell?

In many states, you’re legally required to tell those with whom you may exchange bodily fluids, such as sexual partners. The rules vary by state and, in some cases, there’s federal regulation (such as if you want to donate blood). So you may want to check with your doctor or social worker.

• Sexual partners. You should tell any sexual partner before you have oral, vaginal, or anal sex. You should also inform past partners within a reasonable time fame, says Jeffrey T. Kirchner, DO, chief medical officer for the American Academy of HIV Medicine. “Your doctor can guesstimate roughly how long you’ve had HIV.”
• Needle-sharing partners. If you’re a drug user, you should disclose to anyone you share needles with.
• Blood, tissue, organ, or semen donation staff. You should share your HIV status before you donate. In some cases, it may not be allowed. For example, anyone who has ever tested positive for HIV can’t donate blood.
• Doctors and dentists. Informing your health care providers allows them to give you the best care. For instance, they won’t prescribe medications that could interact with your HIV drugs. Health care professionals are bound by privacy rules. They aren’t allowed to share your HIV status unless not doing so would result in harm to another person. Some states require you to tell a doctor or dentist before they treat you, so you should find out what the laws are in your state before you get any health care service.

You don’t have to tell your boss or co-workers, Kirchner says. The exception is if you have a job that may expose others to the virus, such as a surgeon.

Along with your doctor, you should tell also your mental health care providers, such as a therapist, Lightfoot says. They can help you deal with the emotional impact of an HIV diagnosis.

Who Should I Consider Telling?

The next step is to decide who else you want to share your HIV status with, such as trusted family members and friends. Write down a list of people you’re thinking about telling, Lightfoot says. “Each person has their own set of circumstances,” she says.

Ask yourself these questions about each person:

• Why do I want to tell this person? You may not want to keep a secret from someone. Or you may worry that they’ll find out about your HIV status from someone else.
• What do I hope to get from this person? Think of what you might want from them, whether that’s emotional support or a helping hand.
• What do I want to share about my HIV status? Decide what details you want to reveal and how you’ll answer potential questions.
• How do I expect this person to react? Some people won’t respond the way you think, but it’s a good idea to prepare yourself.

What Resources Do I Have?

You may decide to tell people on your own. But there are also resources that can help.

State and local health departments offer partner services free of charge. They’ll tell your sexual or needle-sharing partners that they’ve been exposed and need to get tested. Your doctor or social worker can put you in touch with a partner services health counselor.

Usually, you’ll decide how you want to disclose the information.

• Anonymous third-party notification. A health counselor reaches out to your partners. Your name and identity aren’t shared with them.
• Dual disclosure. You’ll talk to partners with a counselor.
• Self-disclosure. A counselor helps you prepare and practice, but you’ll tell partners on your own. The health department follows up so that they can get tested.

You can also work with your doctor. “I have patients bring in their loved ones to my office to disclose their status,” Kirchner says. “It’s helpful because I can share medical information face-to-face and answer any questions.”

What’s the Best Way to Share the News?

It’s often difficult to tell people about your HIV-positive status. But there are some steps you can take to make the conversation go more smoothly.

• Find a safe space. Plan on speaking in a quiet area where you can have a private conversation. If there’s a chance of a bad reaction, talk in a place where you have space but other people are nearby, such as a park.
• Be straightforward and specific. Tell the person that you have HIV instead of saying that you have a chronic disease or virus, Lightfoot says. Then spell out what you want from the person, such as, “I need someone that I can talk to and loves me no matter what, and I hope that person is you. I need your support right now.”
• Know the facts and have information ready. Sometimes people’s reactions to HIV is driven by fear and misconceptions. “Some people think that HIV is a fatal disease, when we know that it’s not,” Kirchner says. “Most patients do very well on treatment. It’s controllable.” You should be able to explain the basics about HIV and offer resources where they can get more information.
• Be prepared for any reaction. You don’t know for sure how someone will respond. “It’s going to hurt emotionally if someone you love reacts badly,” Lightfoot says. Think about how you’ll cope with those feelings. “Know who you’re going to talk to about it, whether that’s a therapist, counselor, or another friend,” she says.
• Consider taking a step back. You may have to give the other person time to process the news. “You can check back in with them,” Lightfoot says. “Or they can come to you when they’re ready.” In some cases, you may need to reconsider your relationship, she says. “Think about what you wanted to get from that person, and if it’s worth it.”