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Sunday, May 31, 2009

May 29, 2009

Guys who play football professionally are probably in great shape, right? They work out all the time, pay close attention to what they eat and get regular physical exams. Turns out though, that the majority of professional football players have either high blood pressure or the condition that precedes it known as prehypertension. That's in this week's JAMA, Prevalence of Cardiovascular Disease Risk Factors Among National Football League Players
We've known about an association between a lot of weight lifting and high blood pressure for a while, and that's what I suspect is the driver here. Rick points out that other factors may also be involved: use of that class of pain relievers known as nonsteroidal antiinflammatory medications (NSAIDs) such as ibuprofen, or perhaps use of supplemental salt, ostensibly to replace that lost via sweat. Probably not necessary, Rick opines. In any case, the NFL is planning to start screening players for high blood pressure, and for those of you weight lifting fans out there, having your blood pressure measured is a good idea. As is adding a significant cardiovascular component to your workout.

Speaking of good ideas, turns out that what everyone thought was a good idea isn't. That's the use of compression stockings, which almost everyone complains about, in people who've had a stroke. The study is in this week's Lancet, Thigh-length compression stockings and DVT after strokeThe Lancet, In Press, Corrected Proof, Available online 26 May 2009. Not only didn't these stockings prevent blood clots, but people who used them had skin problems. So here's something to safely give a miss.

Not to miss, however, is balance assessment. A Johns Hopkins study published in Archives of Internal Medicine,, shows that about 30% of US adults over the age of 40 have a balance problem. This is especially bad because it can lead to falls, broken bones, nursing home stays, and death, a trajectory that is well established in older folks. Lloyd Minor, one of the study's authors, points out that while most of us can identify problems with hearing or sight, balance issues are much sneakier in their onset and may worsen so slowly over time that people may not come to their doctor with a specific complaint. Screening is easy, and there are specific things people can do to reduce their risk of falls, like removing throw rugs, using a cane or other aid for walking, and 'vestibular retraining,' which sounds kind of scary but isn't. So it may be worthwhile to talk with your primary care doc about balance screening.

Our final study this week is from the New England Journal of Medicine. This study describes a technique called radiofrequency ablation for a precancerous condition in the esophagus called Barrett's. This is important because here's the relationship: chronic heartburn ( in medicalese, gastroesophageal reflux disease or GERD) goes to changes in the esophagus called Barrett's esophagitis, goes to esophageal cancer, with a dismal prognosis and often death. Previous to the development of this technique, surgery to remove part of the esophagus was attempted, with a host of problems and mortality. This technique is much less problematic and seems to help a lot at one year of follow up.

Rick and I both agree, however, that the best medicine for GERD is prevention. That means weight loss (!), not eating within several hours of sleeping, reducing consumption of red wine and foods known to cause heartburn, and perhaps use of antacid medications, starting with the lowest tech ones. Wonder if Rick will follow his own advice this week as he is in France on vacation, where the great food and red wine flow?

Until next week, then, Y'all live well.

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