No matter how diligent I try to be about applying sunscreen I always seem to end up with a burnt patch. I miss a spot, wash it off (the back of my hands and forearms are common causalities), or get caught up in the activities of the day and forget to reapply. Though new labeling guidelines starting next year will help us form a better understanding of what our sunscreen is and isn’t doing for us, sometimes the best option to protect our skin is to keep it covered up. But not all clothing is created equal.

The degree of protection clothing offers you is designated by a UPF rating, or Ultraviolet Protection Factor, a measurement of the amount of UV radiation the fabric prevents from reaching your skin. A UPF of 30-49 is considered very good protection, 50 and above is considered excellent by the Skin Cancer Foundation. Tightly-woven dark-colored fabric offers the most protection from the sun. Light colors, tight fitting items where the fibers are stretched, and wet clothes offer less protection. A white T shirt has an average UPF of 7, this goes down to only 3 when it is wet. If you can see through a fabric when you can hold it up to the light, then UV rays can get though to your skin. A good choice for a beach cover up would be a long-sleeved, dark denim shirt which has an average UPF of 1,700. You can also buy clothing specially treated with a chemical sun block to provide more protection, look for UPF labeling on these garments.

If dark denim is not the beach look you are going for this year, a wide-brimmed hat can offer protection roughly equivalent to an SPF of 5 for your face, ears, and neck and looks very chic paired with dark over-sized sunglasses. Look for a brim 3 inches or wider.

Clothing and accessories should be used to augment, not replace, the protection provided by sunscreen. You should still regularly use a sunscreen with SPF of 15 or higher and try to remember to reapply often.

For more information on new sunscreen labeling guidelines that will take affect summer 2012 visit www.fda.gov/sunscreen.

Whether you have been relatively healthy your whole life or have been juggling a few chronic medical conditions, everyone can benefit from keeping a home record of their medical history. Though our office Electronic Medical Record system is able to keep an up to date account of your medical history, you want to be prepared for when medical emergencies happen on vacation or if you find yourself moving out of town or out of state. After all, you are your first and best healthcare advocate. Whether you want to store your information in a computer file or Google document or prefer to write things down in a dedicated notebook, every home medical record should contain the following:

• Current and previous medical conditions and any past surgeries, including when and why they were done.
• A current account of your family medical history including your siblings, parents, and grandparents.
• Allergies you have to any medications or foods.
• A list of current medications, don’t forget to include any vitamins or supplements.  You should also keep a separate list of medications you have taken and did not like or did not find helpful so that these can be avoided in the future.
• Dates of any adult vaccinations – you need a tetanus booster every ten years so this is one that people often lose track of.
• Dates and results of screening tests like PAP smears, mammograms, and colonoscopies. This will help ensure you do not fall behind on important cancer screening tests. Also, some insurance plans will not cover these tests if they are done too soon so knowing the dates can keep you from having to foot the bill.
• Any blood work and imaging tests (X-rays, CT scans, MRIs, etc) and when, where, and why they were done (i.e. what symptoms you were having that prompted the testing).
• Names of previous doctors you have seen and the practice address and phone number in case records need to be obtained at a later time

It can be useful to obtain and keep a copy of blood work or imaging studies for your own records but keep in mind lab and radiology reports are written by health care professionals for health care professionals. Many times the significance of results needs to be interpreted in the context why the tests were ordered. Variation from the range of normal does not necessarily indicate a serious problem and there are many things that may be incidentally discovered on CT scans and MRIs that don’t mean anything negative to your health. Please be judicious with what and how you Google and if you ever have questions about previous blood work or imaging results please let us know! We would be happy to answer any questions you have.

I am often concerned that patients are drinking too much, yet find the conversation about alcohol difficult. Many women are unaware that the maximum per day that a women should drink is one drink a day (one beer, glass of wine or one shot) The safe amount for men is two drinks per day. The reasons for this gender differences include women’s lower body size, percentage of body weight composed of water, and differences in metabolism.

I often get the impression that when women think of alcohol abuse or alcoholism they think of the homeless person on the street who is drinking at 10 am. They don’t think of women who drink a half bottle of wine each night or a few martinis as having a problem.

Women suffer from the health consequences of excess alcohol at much lower levels of alcohol consumption. We all know that excess alcohol affects the liver and can lead to permanent liver damage. Alcohol is also associated with a linear increase in breast cancer incidence, so the more you drink the higher your risk.Alcohol is also associated with cardiomyopathy (a degenerative disease of the heart muscle), brain shrinkage, pancreatits, colon cancer and other gastrointestinal cancers.

If you think you may be drinking to much, start with this survey http://www.alcoholscreening.org/Home.aspx. If you want to cut back on your drinking, the first thing is to remove alcohol from your home. If you are having problems cutting back, they are many programs and private counselors that we can recommend.

An important part of keeping your immune system strong during this winter’s cold and flu season is making sure you get enough sleep. Adults need around seven to eight hours of sleep a night, but many fall short of that. If you are having trouble sleeping there are a few adjustments you can make at home that just might help you get the sleep you need.

Create a routine to help prepare your mind and body for sleep

• Establish a relaxing bedtime routine such as taking a warm bath and reading for 10 minutes before going to bed. By doing the same thing every night before going to sleep eventually these activities will help you feel sleepy.
• If you find that your mind races when you try to go to sleep, putting your thoughts down on paper can help get them out of your head. Try writing in a journal an hour or so before you go to bed. You want to avoid doing any activities that may be mentally or emotionally stimulating right before you try to go to sleep.
• Resist the temptation to ‘sleep in’ on weekends or days you don’t have to work. It is better to have a regular bedtime and waking time.

Create a calming sleep environment

• Your bedroom should be dark, quiet, cool, and tidy. Visible clutter can keep your mind active and add to stress. If noise is a problem, a humidifier this time of year can provide soothing white noise as well as some much-needed moisture into the air.
• Use your bed only for sleeping or for having sex. Avoid watching TV, talking on the phone, or eating in bed.
• Keep all bedroom clocks out of sight. Clock watching can add to stress and makes it harder to fall asleep.

Pay attention to the timing of activities

• Try not to consume caffeine after lunch; it can take from 6-8 hours to eliminate just half of the caffeine you ingest. Even if you are able to fall asleep shortly after consuming caffeine, its stimulant effects still prevent your body from reaching the deeper, more restorative levels of sleep.
• Limit or stop using nicotine and alcohol close to bedtime. Though alcohol may initially make you feel sleepy, it often causes you to wake up in the middle of the night.
• Exercise daily in the morning or afternoon. Exercising at night can make you too alert to fall asleep.
• Don’t eat a large meal close to your bedtime.
• Avoid daytime naps, they can be disruptive to your efforts to have a set bedtime and may lead to fewer hours of sleep in a 24 hour period.

Consistent use of these techniques and reestablishing routines takes time and effort, but a good night’s sleep is well worth it!

The current dispute over mammograms gives many people who’ve been around since the 1980s a sense of déjà vu. Like archeologists arguing endlessly over the same set of bones, cancer specialists, it can seem, have been arguing endlessly over pretty much the same set of data.

New information recommends against routine mammograms for women under 50.

Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement

Description: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population.

Methods: The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals.

Recommendations: The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms. (Grade C recommendation)

The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation)

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement)

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement)

The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation)

The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement)

The U.S. Preventive Services Task Force (USPSTF) makes recommendations about preventive care services for patients without recognized signs or symptoms of the target condition.

It bases its recommendations on a systematic review of the evidence of the benefits and harms and an assessment of the net benefit of the service.

The USPSTF recognizes that clinical or policy decisions involve more considerations than this body of evidence alone. Clinicians and policymakers should understand the evidence but individualize decision making to the specific patient or situation.

Summary of Recommendations and Evidence

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms. This is a C recommendation.

The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. This is a B recommendation.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. This is an I statement.

The USPSTF recommends against teaching breast self-examination (BSE). This is a D recommendation.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. This is an I statement.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer. This is an I statement.

A study published in the August 10/24th issue of the Archives of Internal Medicine supports that healthy living reduces disease. Over 23,000 people aged 35-65 were studied for an average of 7.8 years. Participants who never smoked, were not obese (BMI<30), performed at least 3.5 hours of physical activity per week and followed a healthy diet had a strong impact on preventing chronic diseases. Participants with all 4 factors at base line had a 78% lower risk of developing a chronic disease including diabetes, heart attack, stroke and cancer than participants without a healthy factor.

A study published in the July 9th issue of the New England Journal of Medicine reveals a way to make medical abortions (not surgical) safer. The data comes from Planned Parenthood Centers throughout the country. By switching medication administration from the vagina to the mouth the rate of infections after medical abortions declined 73%. Subsequent addition of routine antibiotics further reduced the rate of infections by 76%. Women seeking medical abortions should insist on only oral medications and a prescription for antibiotics or testing for sexually transmitted diseases to reduce their risk of infection.

There was a great article in today’s WSJ about a medical condition called Fibromuscular Dysplasia. This condition is more common in women then men and is thought to occur in up to 5% of the population. It can cause high blood pressure, headaches, abdominal pain and even heart attacks, stokes, aneurysms, and sudden death.

What is Fibromuscular Dysplasia (FMD)?

The word “dysplasia” simply means abnormal cellular development or growth. In people with FMD, the dysplasia involves the walls of one or more arteries in the body. Areas of narrowing, called stenosis, may occur as a result of abnormal cell development. If enough narrowing causes a decrease in blood flow through the artery, symptoms may result. Many people with FMD do not have any symptoms or signs on physical examination and are diagnosed by accident during a radiology scan for another problem.

FMD is most commonly found in the arteries that supply the kidneys with blood (renal arteries). Up to 75% of all patients with FMD will have disease in the renal arteries. The second most common artery affected is the carotid artery, which is found in the neck and supplies the brain with blood. Less commonly, FMD affects the arteries in the abdomen (supplying the liver, spleen and intestines) and extremities (legs and arms). More than one artery may have evidence of FMD in 28% of people with this disease.

What causes FMD?

The cause of FMD is not yet known, but several theories have been suggested. A number of case reports in the literature have identified the disease in multiple members of the same family including twins. There is a very strong likelihood that there is a genetic basis for the development of FMD. However, a relative may have different artery involvement, different disease severity, or not develop FMD at all. In fact, not all individuals with FMD have a family member with the disease. In a series from France, about 11% of family members had FMD.

FMD is also more commonly seen in women than in men resulting in the theory that hormones may play an important role in disease development. This theory is further supported by the fact that most women are premenopausal at the time of diagnosis. However, with better imaging available, an increasing number of patients are now being diagnosed later in life. In small population studies, one’s reproductive history (the number of pregnancies and when they occurred) as well as the use of birth control pills did not correlate with the development of FMD.

Other possible causes of FMD include abnormal development of the arteries that supply the vessel wall with blood resulting in inadequate oxygen supply; the anatomic position of the artery within the body; and tobacco use. It is likely that many factors are involved in the development of FMD. This area requires further research.

What are the signs and/or symptoms of FMD?

Many people with this disease do not have symptoms or findings on a physical examination. The signs and/or symptoms that a person with FMD may experience depend on the arteries affected and the degree of narrowing within them. The two most common areas affected by FMD are the renal arteries (arteries carrying blood to the kidneys) and the carotid arteries (arteries carrying blood to the brain). Common manifestations related to the artery involved are shown below.

FMD of Renal Arteries (Kidney):

• High blood pressure [>140/90 mmHg]
• Abnormal kidney function as detected on blood tests
• Flank pain from dissection or infarction of the kidney
• Kidney failure (rare)
• Shrinkage (atrophy) of the kidney

FMD of Carotid Arteries:

• Bruit (noise) heard in neck with stethoscope
• Swooshing sound in ear
• Ringing of the ears
• Vertigo (room spinning)
• Dizzyness
• Headache
• Transient ischemic attack
• Stroke
• Neck pain
• Horner’s syndrome
• Dissection

People with carotid FMD have a higher risk for intracranial aneurysms (abnormal dilations of the arteries in the brain). An intracranial hemorrhage (bleeding in the brain) may occur if an aneurysm ruptures. FMD involving the mesenteric arteries (arteries that supply the intestines, liver and spleen with blood) can result in abdominal pain after eating and unintended weight loss. FMD in the arms and legs can cause limb discomfort with walking or arm use (intermittent claudication), cold limbs, weakness, numbness or pain.

Who has FMD?

Anyone can have FMD. However, it is much more common in women. Most women are typically diagnosed between the ages of 25-50. Some types of FMD are more common in children or teenagers (See Pediatric FMD). And there are an increasing number of individuals who are being diagnosed later in life (after age 60).

How common is FMD?

It is difficult to determine how common FMD is in the general population. This is due to several reasons. Individuals with mild disease are often asymptomatic and so the disease often goes undetected. Most studies examining the prevalence of FMD have looked at specific patient populations in whom individuals may have already suffered from serious consequences of the disease. Since the disease is often not diagnosed, it is likely that FMD is more common than previously thought.

How can FMD be diagnosed?

There are a number of methods that can be used to detect FMD. These include computed tomographic angiography (CTA) and magnetic resonance angiography (MRA), ultrasound, and catheter based angiogram. The experience and expertise available at your medical institution will play an important role in what diagnostic options are available to you.

In the most common form of FMD (medial fibroplasia), a characteristic “string of beads” appearance is seen in the affected artery. This appearance is due to changes in the cellular tissue of the artery wall that causes the arteries to alternatively become narrow and dilated. A less common, but more aggressive form of FMD may cause an area of severe concentric narrowing of the blood vessel (intimal fibroplasia) or long smooth narrowing.

Michael Jackson died suddenly today. It is known that he hadn’t been feeling well and his personal physican was at his home this morning and tried to resuscitate him. Michael apparently had a sudden cardiac arrest. This simply means that his heart stopped beating. SCA (sudden cardiac arrest) is a common cause of death accounting for more than 325,000 deaths each year in the United States. The most common cause is underlying coronary heart disease, which often goes undiagnosed. Other causes can be underlying structural heart disease, drug overdoses, airway obstruction, drowning and pulmonary emboli. These medical conditions commonly cause an irregular heart beat called ventricular fibulation where blood is not pumped effectively. This causes a rapid loss of conscienceness. This rhythm can be reversed with a defibulator which delivers an electrical current to the heart. However, it must be done quickly, basic cpr is not typically effective. Stress, and drugs such as alcohol, amphetamines or cocaine can also contribute to the problem. A definitive answer is not likely until toxicology and autopsy reports are released.