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HEALTH – FOR THOUGHT-Update: September, 2016

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WILL YOU DIE IN THE NEXT FIVE YEARS?

Take Online Test
courtesy: SKY NEWS
4th. June, 2015

A new online tool which claims to predict an individual’s likelihood of death with 80% accuracy has been launched.
The test, for people aged between 40 and 70, uses a number of questions – including walking speed and number of cars owned – to judge their risk of dying in the next five years.
It is based on research into half a million people carried out by two Swedish scientists, using more than 600 lifestyle variables to assess what can best predict mortality risk.
They narrowed it down to 13 lifestyle questions for men and 11 for women, with the researchers claiming it is 80% accurate.
[Take the test at Ubble.co.uk]
The researchers also found that self-assessment of health proved to be the most accurate indicator of how likely men were to die, whereas previous cancer diagnoses were the most accurate for women.
A habit of smoking was found to be the best way to judge whether someone will die, once disease and serious disease or disorder were excluded.
Dr Erik Ingelsson, who was involved in the study, said: “The fact that the score can be measured online in a brief questionnaire, without any need for lab tests or physical examination, is an exciting development.
“Of course, the score has a degree of uncertainty and shouldn’t be seen as a deterministic prediction.
“For most people, a high risk of dying in the next five years can be reduced by increased physical activity, smoking cessation and a healthy diet.”
It is hoped the test will help raise awareness among the public about their health, as well as aiding doctors and being used as a guide for public health policy.
Once users have finished the questionnaire, they are presented with a so-called Ubble age based on their answers.
A lower age than their own indicates good health: a higher one, less so.
Users also receive a risk of death expressed as a percentage.
This indicates how many people out of 100 of the same age and with similar answers will die within the next five years.
Dr Ingelsson added: “In general, if your Ubble age is higher than your actual age, it could raise concerns and provide some incentive for lifestyle change.
“Each question is representative of something – the number of cars owned by someone is most likely a proxy for their social-economic group.
“Walking fast would not decrease your risk of dying, but if you are walking slowly it could be a predictor of bad health – such as heart disease.”
The data for the project came from the UK Biobank, an online database of 500,000 people and their health conditions.
A total of 498,103 participants in that database were used for the study, which began in 2007.

More than 8,500 people had died by the time a follow-up was done in 2012.

Conclusions were drawn by comparing the risk profile of those who died with those who did not.

 

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ILLUSTRATION:COPYRIGHT:DAVID BAIN

HEALTH ISSUES FOR THOUGHT

New medical breakthroughs are promising
LIFE WITHOUT PAIN

By Melanie Thernstrom (from the New York Times Magazine)

A modern chronicler of hell might look to the lives of chronic-pain patients for inspiration. Theirs is a special suffering – its dimensions materializing at the Tufts-New England Medical Center pain clinic in Boston. Here, in a small examining room, only three things exist: the doctor, the patient and pain. Of these, pain predominates.
“Some of my patients are on the border of human life,” sighs Dr. Daniel Carr, the clinic’s medical director. “Chronic pain is like water damage to a house – if it goes on long enough the house collapses. By the time most patients make their way to a pain clinic, it’s very late.”
What doctors see in a chronic-pain patient is a ruined body and a ruined life. It is Carr’s job to rescue the crushed person within, to locate the original source of pain and to rebuild psychically, psychologically, socially.
Chronic-pain – continuous pain lasting longer than three months –afflicts an estimated 50 million Americans, with costs in disability and lost productivity totaling more than $100billion annually. Only in recent years, however, has chronic pain become a focus of research. “It’s a field on the verge of an explosion,” Carr says.
Pain had always been understood as a symptom of underlying disease. Treat the illness, and the pain takes care of itself. Yet the experience of patients shows chronic pain often outlives its original causes. Worsens over time and takes on a puzzling life of its own.
Research into “neural plasticity” – the capacity of neurons to change their function-has begun to shed light on what happens. Unlike ordinary or acute pain, which is part of a healthy nervous system, chronic pain resembles a disease, a pathology of the nervous system that produces abnormal changes in the brain and spinal cord. Far from being an unpleasant experience, endured simply with a stiff upper lip, this pain harms the body, unleashing negative hormones like cortisol that adversely affect the immune system and kidney function.
Disseminating the new knowledge about pain will be difficult, however. Pain treatment resides primarily in the hands of ordinary physicians, most of whom know little about it. Less than one percent have been certified as pain specialists, and medical schools give the subject very little attention. Still, the American Board of Pain Medicine now provides a list of board-certified doctors on its website (abpm.org).

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Here, in a small examining room, only three things exist: the doctor, the patient and pain. Of these, pain predominates.
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EXPERIENCING PAIN
Daniel Carr is one of the nation’s leading pain specialists. A day spent in his clinic demonstrates the dangers of the wait-it-out approach to pain. A typical patient is Lee Burke, 56, who learned eight years ago that she had an acoustic neuroma, a survivable brain tumor, behind her left ear. The recovery after surgery to remove the growth was supposed to be a mere seven weeks. Instead, Burke awoke with headaches-lancinating, lightning-hot pain-that knocked her out for periods ranging from four hours to four days. She never returned to her job as an executive at a real estate company. When pain came between her and her husband, she left him-and her home. “It was easier to be alone with the pain” Burke explains.
Asked to describe the headaches, Burke says. “It’s like being slammed into a wall and totally destroyed” she looks at Carr with the peculiar stricken bewilderment – why? and why me?- seen on faces of many pain patients.
“It’s like knives are going through my eyes” she says, starting to weep.
While Burke blots her face, Carr sits calmly, hands in his lap, his concentration fixed. He asks Burke to close her eyes and taps her head with the corner of an unopened alcohol wipe. Within a few minutes, he has found a clear pattern of numbness, suggesting the occipital nerve in her face was severed or damaged during her surgery. Carr regards this as revelation-the demystification of her pain.
Pain makes a child of everyone. Burke’s voice is small as she asks “If the nerve was cut, why does it cause pain?
It’s a question researchers have only recently been able to answer. Doctors used to be so confident that severed nerves could not transmit pain-they’re severed!-that nerve cutting was commonly prescribed as treatment. But while these nerves may stay dead, sometimes they grow back or fire spontaneously to produce stabbing, electrical or shooting sensations.

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A typical patient is Lee Burke, 56, who learned eight years ago that she had an acoustic neuroma, a survivable brain tumor, behind her left ear. The recovery after surgery to remove the growth was supposed to be a mere seven weeks. Instead, Burke awoke with headaches-lancinating, lightning-hot pain-that knocked her out for periods ranging from four hours to four days.
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WHEN NERVES MISFIRE
Picture the pain wiring of the nervous system as a warning device that protects the body from tissue injury or disease. Acute pain is like a properly working alarm system: the pain matches the damage, and it disappears when the problem does. Chronic pain is like a broken alarm: a wire is cut or hurt, and the entire system goes haywire. “The repair doesn’t occur because the system itself is damaged”, explains Dr. Clifford Woolf, a pain researcher at Massachusetts General Hospital in Boston. It is called neuropathic pain because it is a pathology of the nervous system.
Why does chronic pain often worsen? Woolf’s research demonstrated that physical pain changes the body in the same way emotional loss watermarks the soul. The body’s pain system is plastic, meaning it can be molded by pain to cause- yes, more pain. Nerves recruit others in a “chronic-pain windup”. The nervous system revs up and undergoes what Woolf calls “central sensitization”
As for Lee Burke’s neuropathic pain, Carr prescribes Neurontin, a new antiseizure drug that also acts as a nerve stabilizer and can quiet misfiring nerves. Within four months, Burke feels 50 percent better. She can move her head side to side and sit up to watch TV instead of lying prone in agony. She says, “Dr. Carr is my savior”

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Asked to describe the headaches, Burke says. “It’s like being slammed into a wall and totally destroyed” she looks at Carr with the peculiar stricken bewilderment – why? and why me? – seen on faces of many pain patients. “It’s like knives are going through my eyes” she says, starting to weep.
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HEALING FROM INSIDE.

For years, efforts to ease post-operative pain have lagged. Morphine, the drug of choice, leaves people groggy and confused. Its side effects of nausea and fever can extend hospital stays-and boost infection risk. So heart surgeon Rob Dowling and colleagues at Jewish Hospital in Louisville., Ky., looked into an alternative, the ON-Q pain relief system. This balloon-like pump sends painkillers that lack the sedating effects of morphine through catheters directly into the stitched-up wound.
In Dowling’s study of 35 heart-by-pass patients, those who got the continuous drip felt less pain and left the hospital almost three days sooner than a placebo group. (The ON-Q group still got morphine, but only half as much.) The technique also works for colon, C-section and orthopedic surgery.
END OF B OX ARTICLE
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THE CASE FOR TOUGH TREATMENT
Why did it take seven years for Burke to get relief? ”There’s tremendous ignorance about neuropathic pain,” Woolf says. “Most doctors don’t know to look for it”. One confusing factor: Not all patients with similar conditions develop chronic pain. Physicians might look at a patient’s MRI scan and say, “the bone’s all healed” and conclude there is no reason for pain. But the pain is not in the muscles or bones; it is in the invisible hydra of the nerves.
Such confusion is what caused the delay in successfully treating Burke. Before coming to the clinic, she had consulted Dr. Martin Acquadro, a caring, competent physician and the director of cancer pain at Mass General. Observing that she had severe muscle spasms in her head, neck and shoulders, Acquadro diagnosed tension headaches and treated Burke with Botox injections, tricyclic antidepressants and migraine medications. She tried range-of-motion physical therapy, stress-reduction courses, psychiatric treatment, yoga, meditation. She took 1,600 milligrams of ibuprofen a day, along with 12 cups of coffee (caffeine is a treatment for migraines). Acquadro hadn’t thought of Neurontin, and he feared opiates. “When a patient is depressed or anxious, you’re leery about narcotics,” he says. “I was being cautious”
Though only an estimated five percent of chronic pain patients using opiates such as morphine are considered at risk for developing addictive behavior, the drugs have a reputation for being dangerous, and social biases-class, race and sex-influence who they are prescribed for. One study shows that patients at centers that predominately treat minorities are three times more likely than others to receive inadequate pain relief. Their requests for medication are more likely interpreted as bad “drug-seeking behavior”
Women tend to be less aggressive in demanding pain treatment or may behave in ways misinterpreted as hysteria. The longer pain goes untreated, the more desperate the patient becomes-until those behaviours look like the problem. Whenever Acquadro sent Burke to specialists, she’s break down in pain. “They figured I was a basket case,” she says. “And I was.”

LINK TO DEPRESSION
In fact, almost everyone who has chronic pain eventually develops anxiety and depression. Surprisingly, pain and depression both share the same neural circuitry. The neurotransmitters and hormones modulating a healthy brain-like serotonin and endorphins – are the same ones that control depression. “Chronic pain uses up serotonin in the brain like a car running out of gas” says Dr William Breitbart, chief of psychiatry at Sloan-Kettering. “If the pain persists long enough, everybody runs out of gas.”
Medications that treat depression also treat pain. Depression or stressful events can in turn enhance pain. But to make stress reduction a primary treatment is like trying to repaint walls in a crumbling house. “Chronic pain is not just a sensory or affective or cognitive state,” says Woolf. “It‘s a biologic disease afflicting millions of people. Soon, I believe, there will be effective treatment because the tools are coming together to understand and treat it.”

THE FUTURE
The most important tool in Woolf’s lab is the new “gene chip” technology that identifies which genes become active when neurons respond to pain. “In the past 30 years of pain research, we’ve looked for pain-related genes one at a time, and come up with 60. In the past year, using gene-chip technology, we’ve confirmed hundreds more” Woolf says happily. “All we have to do is find the key genes, the master switches that drive the others”
Woolf is particularly interested in certain abnormal sodium ion channels seen only in damaged sensory neurons. He believes he’s close –perhaps a year away-from identifying which of these channels are most important. Then, if the animal data applies to humans, pharmaceutical companies could design blockers for these channels, and develop new drugs.
The biggest question of pain research now is: Will a blocker for neuropathic pain help all the people who already have it?
Woolf hesitates. “We don’t really know” he says. But he’s confident that doctors will be able to stop pain before it becomes so debilitating. A genetic component may well put people at a higher risk for developing such pain. “And within a decade,” says Woolf, “we’ll be able to predict that susceptibility, and prevent the pain early on”
Do you live with chronic pain? Get more expert advice at rd.com/pain relief

***Culled from Reader’s Digest December 2003; page 128

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