Wishing all my blog readers, blog folllowers and subescribers a very happy, prosperous, memorable and fruitful Happy New Year 2014.
Feel free to write to me.
Email oncozene @email@example.com
The co-authors of a 20-year-old study promoting the use of prescription drugs to combat the effects of attention deficit hyperactivity disorder (ADHD) are now claiming the report may have overstated medication’s benefits.
According to a report in the New York Times, at least two co-authors of the highly influential study – called the Multimodal Treatment Study of Children With ADHD – have come forward to express concern that the original report also downplayed the benefits of behavioral therapy.
“There was lost opportunity to give kids the advantage of both and develop more resources in schools to support the child — that value was dismissed,” said co-author Dr. Gene Arnold, a child psychiatrist and professor at Ohio State University.
“I hope it didn’t do irreparable damage,” added a second co-author, Dr. Lilly Hechtman of Montreal’s McGill University. “The people who pay the price in the end is the kids. That’s the biggest tragedy in all of this.”
The report originally claimed that not only was medication like Adderall and Ritalin more effective than therapy, but also that combining the two treatments offered little to no benefit to the patient. Even a 2001 report that showed a combination of medication and therapy effectively treating ADHD symptoms by 12 percent over medication only (68 – 56 percent) labeled the results“small by conventional standards.”
Boosted by marketing from pharmaceuticals, prescriptions for ADHD drugs have skyrocketed since the early 1990s, alongside a significant rise in the diagnosis of ADHD in general.
According to new data from the Centers for Disease Control and Prevention, 15 percent of high-school-age children have been diagnosed with the disorder, with roughly 3.5 million currently taking medication. These numbers stand in stark contrast to the 600,000 or so children diagnosed with ADHD in 1990.
“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Keith Conners, a psychologist and professor emeritus at Duke University, said to the Times earlier in December.“This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
One of the reasons medication has been used so often to treat the disorder is that, at the cost of $200 a year, it’s significantly cheaper than therapy, which can run up to $1,000 a year or more and isn’t covered as comprehensively by insurance companies. While medication can be helpful, it also has its consequences – potential addiction, anxiety, depression, insomnia and, in some cases, suicidal tendencies and hallucinations.
Behavioral therapy, meanwhile, focuses on developing a child’s long-term academic and social skills. According to psychologist Ruth Hughes of the advocacy group Children and Adults With Attention-Deficit/Hyperactivity Disorder, medication may make a child ready to learn important skills, but it still requires someone to teach them.
Now, new studies are suggesting that the effects of medication begin to decrease once a child grows older, suggesting it’s extremely difficult to calculate how a child will react as they reach young adulthood. Some researchers pin the blame on the fact that many children stop taking the pills, while others say it demonstrates the inability of a medication-only approach to conclusively treat the disorder.
“My belief based on the science is that symptom reduction is a good thing, but adding skill-building is a better thing,” Stephen Hinshaw, a psychologist at the University of California, Berkeley, said to the Times. “If you don’t provide skills-based training, you’re doing the kid a disservice. I wish we had had a fairer test.”
On New Year’s Eve, Americans drink more alcohol than on any other day of the year.1 Other top contenders are Christmas, Thanksgiving, the Fourth of July, and St. Patrick’s Day… but none top New Year’s Eve, for imbibing.
What that means is that New Year’s Day, may be the day of the year when you’re most likely to suffer from a hangover, which is the conglomeration of symptoms – fatigue, nausea, stomach pain, headaches, shakiness, vomiting, dizziness, and more – that occurs when you’ve had too much to drink.
The best way to prevent a hangover, of course, is to avoid drinking, or have only one or two cocktails at the most (but be aware that even a single drink can trigger a hangover in some people).
But let’s say you tend to get caught up in your celebrations and suspect you might have a few more than you normally do. There are some natural remedies that may help you to avoid hangover symptoms altogether, but the time to take action is now, before you drink.
Alcohol, and too much of it specifically, triggers a cascade of reactions in your body that contribute to the symptoms known as a hangover. This includes:
Alcohol inhibits the secretion of vasopressin, an antidiuretic hormone that keeps you from urinating unintentionally. When this enzyme is suppressed, water is sent right to your bladder (along with electrolytes) to be excreted, causing you to urinate more often.
The increased urination can lead you to become quickly dehydrated, and as your body draws water from your brain to function, it may leave you feeling fatigued or dizzy.
3. Acetaldehyde Build-Up
When alcohol reaches your liver, an enzyme called alcohol dehydrogenase breaks it down into acetaldehyde. Acetaldehyde is far more toxic than alcohol (by up to 30-fold!2).
So your body again attempts to break it down with the enzyme acetaldehyde dehydrogenase and glutathione, a powerful antioxidant that is crucial for liver detoxification (glutathione contains high levels of cysteine, which is why taking this in supplement form may help prevent hangovers… more on this below).
Together, this powerful detox duo can break down the acetaldehyde into harmless acetate (which is similar to vinegar).
However, when you drink too much alcohol, your stores of glutathione become depleted, which allows acetaldehyde to build up in your body, causing the toxic hangover effect.
It should be noted that women have less acetaldehyde dehydrogenase and glutathione than men, which is why women may have a more severe reaction to drinking the same amount of alcohol as a man of similar weight.
Congeners are ingredients produced as byproducts of fermentation and distillation. They include acetone, acetaldehyde, tannins, and some flavorants in different alcoholic beverages. Congeners are thought to make the effects of a hangover worse and are found in higher amounts in darker liquors (such as brandy, whiskey, and red wine) than clear liquors like vodka or gin.
5. Glutamine Rebound
Alcohol inhibits glutamine, a natural stimulant in your body. This is partly why alcohol has a depressive effect that may make you fall asleep easily… at first. After you’ve stopped drinking, your body will work overtime increasing glutamine levels, which is why you’ll ultimately wake up more often and have a more fitful night’s sleep after you drink.
This glutamine rebound may contribute to the fatigue, tremors, anxiety, restlessness, and even increased blood pressure that are often felt during a hangover.3
6. Disruptions to Your Stomach Lining, Blood Vessels, and Blood Sugar
Alcohol is irritating to your stomach lining and leads to an increased production of stomach acid. This can cause nausea, vomiting, and stomach pain. Alcohol can also lead to dips in your blood sugar level, which can lead to shakiness, mood swings, fatigue, and seizures. Also, alcohol may cause your blood vessels to expand, which may trigger headaches.
7. Inflammatory Response
Finally, alcohol also provokes an inflammatory response in your body in which your immune system may trigger agents that provoke hangover symptoms including memory problems, decreased appetite, and trouble concentrating.4
A great example confirming the validity of this approach that you might relate to is if you ever took vitamin C prior to going to the dentist who gave you a local anesthetic to numb your tooth before dental work. You would most likely have noted that the anesthetic did not work at all, took a much larger dose, or wore off quickly. This is because vitamin C accelerates your liver’s ability to detoxify it.
Alcohol is a different animal, though, and since it impacts your body on such a wide scale, the more steps you take to circumvent the ill effects, the better. If you know you’ll be having a few drinks, take this natural protocol beforehandto help ‘pre-tox’ your body:
1. N-acetyl cysteine (NAC)
NAC is a form of the amino acid cysteine. It is known to help increase glutathione and reduce the acetaldehyde toxicity5 that causes many hangover symptoms. Try taking NAC (at least 200 milligrams) 30 minutes before you drink to help lessen the alcohol’s toxic effects.
If you’re wondering just how powerful NAC can be, consider that, like alcohol, one way that Tylenol causes damage to your liver is by depleting glutathione. If you keep your glutathione levels up, the damage from the acetaminophen may be largely preventable. This is why anyone who overdoses on Tylenol receives large doses of NAC in the emergency room — to increase glutathione.
2. B Vitamins
NAC is thought to work even better when combined with thiamine, or vitamin B1.6 Vitamin B6 may also help to lessen hangover symptoms. Since alcohol depletes B vitamin in your body and they’re required to help eliminate it from your body, a B-vitamin supplement taken beforehand, as well as the next day, may help.
3. Milk Thistle
Milk thistle contains silymarin and silybin, antioxidants that are known to help protect the liver from toxins, including the effects of alcohol. Not only has silymarin been found to increase glutathione, but it also may help to regenerate liver cells.7 A milk thistle supplement may be most useful when taken throughout the entire holiday season if you know you’ll be having cocktails on more than one occasion.
4. Vitamin C
Alcohol may deplete your body of vitamin C, which is important for reducing alcohol-induced oxidative stress in your liver. Interestingly, one animal study showed that vitamin C was even more protective to the liver than silymarin (milk thistle) after exposure to alcohol.8 Just as with a dental anesthetic, vitamin C will also help detoxify alcohol, so make sure you’re getting enough vitamin C, either via supplements or food, before indulging in alcoholic beverages.
Magnesium is another nutrient depleted by alcohol, and it’s one that many are already deficient in. Plus, magnesium has anti-inflammatory properties that may help to reduce some hangover symptoms. If you don’t eat a lot of magnesium-rich foods, taking a magnesium supplement before an evening involving drinking may be helpful.
The pre-tox measures above are important for supplying your body with the vitamins, antioxidants, and other nutrients to protect your liver and assist in the breakdown and removal of alcohol from your system. Other practical measures that may help include:
- Stay Hydrated: Drink a glass of water along with each alcoholic beverage to help prevent dehydration. At bedtime, drink another large glass of water or two to help stave off hangover symptoms in the morning.
- Eat Beforehand and During: If your stomach is empty, it will speed the alcohol’s rate of absorption into your body. It may also cause more severe stomach irritation. Make it a point to eat a meal before you drink alcohol and nibble on satisfying snacks (such as cheese) while you drink. At the very least, try this old piece of wisdom from the Mediterranean region — take a spoonful of olive oil before drinking alcohol to help prevent a hangover.9
- Replenish Electrolytes: Try drinking coconut water before you go to bed to help reduce hangover symptoms in the morning.
- Stick with Clear Alcohol: Generally, clear liquors (vodka, gin, white wine) will contain fewer congeners than darker varieties (brandy, whiskey).
- Stop Drinking When You’re Buzzed: When you feel buzzed, it’s a sign that your body’s detoxification pathways are becoming overwhelmed. Take a break from drinking, or quit for the day entirely, to allow your body to metabolize the alcohol effectively.
Ideally, the steps above will help you to avoid a hangover, but keep in mind that if you drink excessively, there is virtually no foolproof way to prevent all the ill effects. If you find yourself feeling hung over after too many drinks, don’t try the “hair of the dog” remedy of drinking more alcohol – this will only prolong your reaction. Also avoid taking acetaminophen (Tylenol), which will only further tax your liver. Instead, try these hangover remedies to feel better faster:10
- Exercise: If you can manage it, a short bout of high-intensity exercise may help you to sweat out some of the toxins. Be sure to drink plenty of water to avoid becoming even more dehydrated.
- Replenish your body: Try bone broth for minerals, coconut water for electrolytes, eggs for natural cysteine, and coconut for potassium.
- Ginger: If you’re feeling nauseated, steep a piece of fresh ginger root in hot water for a natural stomach-settling tea.
- Try a cup of black coffee: It may reduce swelling in your blood vessels, helping to relieve headache.
If you’re using the hangover pre-tox or remedies above, hopefully it is only for the very occasional use. While an infrequent drink here and there is not likely to cause too much damage, especially in combination with a healthful lifestyle, it’s important to realize that alcohol is a neurotoxin that can poison your brain and disrupt your hormonal balance.
When it comes to alcohol, remember that using it in moderation is key and excessive use is virtually guaranteed to damage your health. I generally define “moderate” alcohol intake (which is allowed in the beginner phase of my nutrition plan) as a 5-ounce glass of wine, a 12-ounce beer, or 1 ounce of hard liquor with a meal, per day. As you progress further into reaching higher levels of health, I do recommend eliminating all forms of alcohol.
The family of a US teenager declared brain dead after a routine operation went wrong has won an extension to the court order keeping her alive.
The court order keeping her on life support in California had been due to expire on Monday evening.
Jahi McMath, 13, had a tonsillectomy this month to treat a sleep disorder but she began bleeding heavily after surgery and went into cardiac arrest.
Her family says there is still hope for recovery.
However, the Children’s Hospital & Research Center, which carried out the procedure, wants to turn off her ventilator.
On Monday, Alameda County Superior Court Judge Evelio Grillo ordered the hospital to maintain Jahi on a ventilator until 7 January.
Jahi’s mother, Nailah Winkfield, said she wept when she heard about the ruling.
She said the delay was an answer to a prayer and a sign that she was right to keep fighting.
“Who wants to know the date and the time their child would die?” she said. “I don’t care what anyone has to say about what I’m doing… I have to do what is right for me and for Jahi.”
Jahi’s family believes she is still alive but the hospital in Oakland, California, has argued in court papers that there is no medical treatment they can give to the teenager because she is “practically and legally” dead.
An independent paediatric neurologist from Stanford University supported that view.
We believe a parent has the right to make decisions concerning the existence of their child”
Jahi McMath’s family statement
In an earlier ruling, a judge at Alameda County Superior Court agreed and issued an order allowing Children’s Hospital to remove Jahi from a breathing machine at 17:00 local time on Monday (01:00 GMT on Tuesday).
Hospital spokesman Sam Singer said they would comply with the judge’s new order.
The McMaths are hoping that a New York facility will care for their daughter. Two California care homes have already withdrawn offers to accept Jahi.
It is unclear how the girl’s operation on 9 December went so badly awry. She was having her tonsils removed to treat her apnoea, a condition that causes sleepers to experience irregular breathing.
Jahi was declared brain dead three days after surgery.
The family said in a statement at the weekend: “We have our strong religious convictions and set of beliefs and we believe that, in this country, a parent has the right to make decisions concerning the existence of their child: not a doctor… and definitely not a doctor who runs the facility that caused the brain death in the first place.”
Children’s Hospital says it is willing to work with the family to transfer Jahi to another facility, as long as it can legally do so.
“We need to be able to talk to the other facility to understand what it is they are capable of doing,” Cynthia Chiarappa, a hospital spokeswoman, said.
“This is not transferring an individual in a vegetative state, but a dead body.”
Jahi’s family has launched an online fundraising drive, which had collected more than $22,000 (£13,000) by Monday morning, to transfer their daughter to another facility.
The McMaths’ lawyer, Chris Dolan, said he was waiting to hear from a hospital in New York, where officials have been considering the case.
“The family is together, and today everybody is praying and being together,” Mr Dolan told the Associated Press news agency on Sunday.
Although frequently overlooked, emotional health is critical for your physical health and healing. No matter how devoted you are to the proper diet and lifestyle, you’re unlikely to achieve optimal health if emotional barriers stand in your way.
Energy psychology uses a psychological acupressure technique based on the same energy meridians used in traditional acupuncture (which has been used to treat physical and emotional ailments for over 5,000 years) but without the invasiveness of needles.
The Emotional Freedom Techniques (EFT) is the most popular form of energy psychology and was developed in the 1990s by Gary Craig, a Stanford engineering graduate specializing in healing and self-improvement. I routinely used EFT in my practice, and highly recommend it to optimize your emotional health.
The method involves tapping specific points on your head and chest with your fingertips while thinking about your specific problem—be it a traumatic event, an addiction, pain, etc.—and voicing positive affirmations. This can be done alone or under the supervision of a qualified therapist.1
The combination of tapping the energy meridians and voicing positive affirmation works to clear the emotional block from your body’s bioenergy system, thus restoring your mind and body’s balance.
Clinical trials have shown that EFT is able to rapidly reduce the emotional impact of memories and incidents that trigger emotional distress. Once the distress is reduced or removed, your body can often rebalance itself, and accelerate healing.
While some still view energy psychology with suspicion, EFT has actually met the criteria for evidence-based treatments set by the American Psychological Association for a number of conditions, including post-traumatic distress syndrome (PTSD).2
In a critical review published in the American Psychological Association’s (APA) journal Review of General Psychology3 last year, researchers found that EFT “consistently demonstrated strong effect sizes and other positive statistical results that far exceed chance after relatively few treatment sessions.”
Other recent studies demonstrate how EFT can accomplish remarkable progress in a very short amount of time for people with a history of trauma. For example:
1. A 2009 study4 of 16 institutionalized adolescent boys with histories of physical or psychological abuse showed substantially decreased intensity of traumatic memories after just ONE session of EFT.
2. An EFT study5 involving 30 moderately to severely depressed college students was conducted. The depressed students were given four 90-minute EFT sessions. Students who received EFT showed significantly less depression than the control group when evaluated three weeks later.
Most recently, a study published in the Energy Psychology Journal6 confirmed that the benefits from EFT are the result of the tapping process and not a placebo effect. The study included 20 college students who were divided into two groups. One group did EFT while the control group received mindfulness training. Before and after the sessions, positive and negative emotions were assessed.
This included enjoyment, hope, pride, anger, anxiety, shame, hopelessness, boredom, and mindfulness. Overall, the EFT group experienced significantly greater increases in positive emotions, such as hope and enjoyment, along with greater decreases in negative emotional states like anger and shame. The study concluded that:
“No significant change was found for mindfulness. Tapping on acupoints, combined with the vocalization of self-affirming statements, appears to be an active ingredient in EFT rather than an inert placebo. The results were consistent with other published reports demonstrating EFTs efficacy for addressing psychological conditions in students.”
Such findings come as no great surprise to other researchers in the field, such as Dr. Dawson Church, Ph.D., founder of the National Institute for Integrative Healthcare. Dr. Church told the Examiner:
“We learn early on to disassociate from our emotions. EFT is a way that people can feel safe and empowered to process their emotions. When we tap and use affirmative statements, we can actually change our old conditioned responses.”
Earlier this year, Dr. Church published a review7 of more than 40 different EFT studies evaluating the effectiveness of the method. In his paper, he cites studies demonstrating the method’s effectiveness for a wide range of emotional problems, including:
Post-traumatic stress disorder (PTSD)
Weight loss and food cravings
Athletic and academic performance
Dr. Church’s website, ResearchEFTUniverse.com,8 is a great resource if you want to learn more about EFT and the research that has been done on each of these ailments, as well as other problems. According to Dr. Church:
“EFT has been researched in more than 10 countries, by more than 60 investigators, whose results have been published in more than 20 different peer-reviewed journals… EFT research includes investigators affiliated with many different institutions.”
It’s worth noting that as a general rule, the research being done on EFT is done using the techniques originally developed by Gary Craig.9 An expanding list of similar techniques has sprung up since then, and while they might provide similar benefits, EFT is the only empirically validated treatment version. (The APA defines an empirically validated treatment as one for which there are two different controlled trials conducted by independent research teams.)
EFT has shown particular promise in the treatment of war veterans with post-traumatic stress.10 I want to highlight this aspect of its use as PTSD is hard to treat, and studies have shown drugs like antidepressants and antipsychotics to be on par with placebo for the treatment of this condition.
The documentary film entitled Operation: Emotional Freedom,11 directed by Eric Huurre, follows a number of veterans and their families who went through intensive therapy using EFT. Gary Craig, along with other EFT practitioners worked very closely with veterans who were all suffering from PTSD, depression, anxiety and a few were suicidal. The results were truly astounding. At the end of treatment, each one of them describes a new feeling of peace and hope that there is help and they were able to overcome emotional traumas experienced in combat.
The film offers a close look at the current state of health care for combat veterans diagnosed with PTSD, and examines the myths and misconceptions surrounding the chemical approach to treating emotional conditions and why drugs are not “the answer” that pharmaceuticals promise. (You can learn more about the efforts to assist veterans and their families through energy psychology on the film’s website, operation-emotionalfreedom.com.12)
Research performed by the Iraq Vets Stress Project13 also demonstrates the effectiveness of EFT. In a study that included 100 veterans with severe PTSD,14 90 percent of the veterans had such a reduction in symptoms that they no longer met the clinical criteria for PTSD after six one-hour EFT sessions! Sixty percent no longer met PTSD criteria after just three EFT sessions. At the three-month follow-up, the gains remained stable, suggesting lasting and potentially permanent resolution of the problem.
For a demonstration of how to perform EFT, please view the video below featuring EFT practitioner Julie Schiffman. This is a general demonstration that can be tailored to just about any problem. You can also find text instructions and photographs of where to tap on my EFT page. For when you’re on the go, there are at least four different EFT applications available in the iTunes store. The apps range from a simple recap of the EFTs Basic Recipe to a sophisticated virtual coaching app for specific mental health problems like anxiety and depression.
Bear in mind that while EFT is quite easy to learn and perform, I strongly encourage you to seek out a qualified therapist for more serious or complex issues. It is an art, and tapping for deep-seated issues typically require the kind of skill that only a well-seasoned practitioner will have. If you try to self-treat, you may end up falsely concluding that EFT doesn’t work, when nothing could be further from the truth… This is particularly pertinent if you’re trying to address trauma-based stress such as PTSD or grief following the loss of a loved one.
Hopefully you have never spent much time in a hospital, but if you have you likely experienced frequent disruptions to your sleep.
Aside from the beeping machines and nightly checks from hospital staff, your room was probably dimly lit with artificial light both day and night — a major impediment to proper sleep and well-being.
The study found that, on average, hospital patients in the study were exposed to about 105 lux (a measure of light emission) daily. This is a very low level of light; for comparison, an office would generally provide about 500 lux and being outdoors on a sunny day could provide 100,000 lux.2
The rooms were so dimly lit that many hospital patients had trouble sleeping. Your body requires a minimum of 1,500 lux for 15 minutes a day just to maintain a normal sleep-wake cycle, but ideally it should be closer to 4,000 for healthful sleep.3
Not surprisingly, the researchers found that the patients’ sleep time was “fragmented and low,” with most averaging just four hours of sleep a night.
Those with the lowest exposures to light during the day also reported more depressed mood and fatigue than those exposed to more light. The researchers noted:4 “Low light exposure significantly predicted fatigue and total mood disturbance.”
When full-spectrum light enters your eyes, it not only goes to your visual centers enabling you to see, it also goes to your brain’s hypothalamus where it affects your entire body.
Your hypothalamus controls body temperature, hunger and thirst, water balance and blood pressure. Additionally, it controls your body’s master gland, the pituitary, which secretes many essential hormones, including those that influence your mood.
Exposure to full-spectrum lighting is actually one effective therapy used for treating depression, infection, and much more – so it’s not surprising that hospital patients deprived of such exposures had poorer moods and fatigue.
Studies have also shown that poor lighting in the workplace triggers headaches, stress, fatigue and strained watery eyes, not to mention inferior work production.
Conversely, companies that have switched to full-spectrum lights report improved employee morale, greater productivity, reduced errors and decreased absenteeism. Some experts even believe that “malillumination” is to light what malnutrition is to food.
In a hospital setting, this has serious ramifications, as patients are already under profound stress due to illness and may be further stressed by a lack of natural bright light.
Your ‘body clock’ is also housed in tiny centers located in your hypothalamus, controlling your body’s circadian rhythm. This light-sensitive rhythm is dependent on Mother Nature, with its natural cycles of light and darkness, to function optimally.
Consequently, anything that disrupts these rhythms, like inadequate sunlight exposure to your body (including your eyes), has a far-reaching impact on your body’s ability to function and, certainly, also on its ability to heal.
While the featured study didn’t focus specifically on hospital patients’ nighttime light exposures, they’re likely to be significant. Most hospital room doors remain ajar all night, allowing artificial light from the hall to flood the room. There are also lights on medical equipment and monitors, and if your room is not private you may also be exposed to light from a roommates’ television or bathroom trips.
This is important because just as your body requires bright-light exposure during the day, it requires pitch-blackness at night to function optimally – which is all the more critical in the case of a hospital stay when bodily self-healing is most needed.
When you turn on a light at night, you immediately send your brain misinformation about the light-dark cycle. The only thing your brain interprets light to be is day. Believing daytime has arrived, your biological clock instructs your pineal gland to immediately cease its production of the hormone melatonin – a significant blow to your health, especially if you’re ill, as melatonin produces a number of health benefits in terms of your immune system. It’s a powerful antioxidant and free radical scavenger that helps combat inflammation.
In fact, melatonin is so integral to your immune system that a lack of it causes your thymus gland, a critically important part of your immune system, to atrophy.5 In addition, melatonin helps you fall asleep and bestows a feeling of overall comfort and well being, and it has proven to have an impressive array of anti-cancer benefits.6 So unnaturally suppressing this essential hormone is the last thing that a recovering hospital patient needs.
The best way to get exposure to healthy full-spectrum light is to do it the way nature intended, by going out in the sun with your bare skin – and ‘bare’ eyes — exposed on a regular basis. If you or a loved one is confined to a hospital room, however, the next best option is to move to areas with brighter natural light as much as possible, or alternatively bring in some full-spectrum light bulbs.
At night, the opposite holds true. You should turn off lights as much as possible, keep the door closed and close the blinds on the window. Wearing an eye mask is another simple trick that can help to keep unwanted light exposures to a minimum if you’re spending the night in a hospital. Taken together, these are simple ways to boost mood and improve sleep and fatigue levels among hospitalized patients.
No matter how important it is, poor lighting may be the least of your worries if you find yourself hospitalized, as once you’re hospitalized you’re immediately at risk for medical errors, which is actually a leading cause of death in the US. According to the most recent research7 into the cost of medical mistakes in terms of lives lost, 210,000 Americans are killed by preventable hospital errors each year.
When deaths related to diagnostic errors, errors of omission, and failure to follow guidelines are included, the number skyrockets to an estimated 440,000 preventable hospital deaths each year!
One of the best safeguards is to have someone there with you. Dr. Andrew Saul has written an entire book on the issue of safeguarding your health while hospitalized. Frequently, you’re going to be relatively debilitated, especially post-op when you’re under the influence of anesthesia, and you won’t have the opportunity to see clearly the types of processes that are going on.
For every medication given in the hospital, ask, “What is this medication? What is it for? What’s the dose?” Take notes. Ask questions. Building a relationship with the nurses can go a long way. Also, when they realize they’re going to be questioned, they’re more likely to go through that extra step of due diligence to make sure they’re getting it right—that’s human nature. Of course, knowing how to prevent disease so you can avoid hospitals in the first place is clearly your best bet. One of the best strategies on that end is to optimize your diet. You can get up to speed on that by reviewing my comprehensive Nutrition Plan.
Getting back to the issue of lighting, this isn’t only an issue for hospital patients. Virtually everyone requires exposure to bright light during the day and darkness at night for optimal health. Toward that end, here are my top tips to optimize your light exposure on a daily (and nightly) basis:
1. Get some sun in the morning, if possible. Your circadian system needs bright light to reset itself. Ten to 15 minutes of morning sunlight will send a strong message to your internal clock that day has arrived, making it less likely to be confused by weaker light signals during the night. More sunlight exposure is required as you age.
2. Make sure you get BRIGHT sun exposure regularly. Remember, your pineal gland produces melatonin roughly in approximation to the contrast of bright sun exposure in the day and complete darkness at night. If you work indoors, make a point to get outdoors during your breaks.
3. Avoid watching TV or using your computer in the evening, at least an hour or so before going to bed.These devices emit blue light, which tricks your brain into thinking it’s still daytime. Normally your brain starts secreting melatonin between 9 and 10 pm, and these devices emit light that may stifle that process.
4. Sleep in complete darkness, or as close to it as possible. Even the slightest bit of light in your bedroom can disrupt your biological clock and your pineal gland’s melatonin production. This means that even the tiny glow from your clock radio could be interfering with your sleep, so cover your alarm clock up at night or get rid of it altogether. You may want to cover your windows with drapes or blackout shades, or wear an eye mask while you sleep.
5. Install a low-wattage yellow, orange or red light bulb if you need a source of light for navigation at night.Light in these bandwidths does not shut down melatonin production in the way that white and blue bandwidth light does. Salt lamps are handy for this purpose.
This is an update of the original Cochrane review entitled Lamotrigine for acute and chronic pain published in Issue 2, 2007, and updated in Issue 2, 2011. Some antiepileptic medicines have a place in the treatment of neuropathic pain (pain due to nerve damage). This updated review adds no new additional studies looking at evidence for lamotrigine as an effective treatment for chronic neuropathic pain or fibromyalgia. The update uses higher standards of evidence than previously.
OBJECTIVES: To assess the analgesic efficacy of lamotrigine in the treatment of chronic neuropathic pain and fibromyalgia, and to evaluate adverse effects reported in the studies. SEARCH
METHODS: We identified randomised controlled trials (RCTs) of lamotrigine for chronic neuropathic pain and fibromyalgia (including cancer pain) from MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). We ran searches for the original review in 2006, in 2011 for the first update, and subsequent searches in August 2013 for this update. We sought additional studies from the reference lists of the retrieved papers. The original review and first update included acute pain, but no acute pain studies were identified.
SELECTION CRITERIA: RCTs investigating the use of lamotrigine (any dose, by any route, and for any study duration) for the treatment of chronic neuropathic pain or fibromyalgia. Assessment of pain intensity or pain relief, or both, using validated scales. Participants were adults aged 18 and over. We included only full journal publication articles.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted efficacy and adverse event data, and examined issues of study quality. We performed analysis using three tiers of evidence. The first tier used data where studies reported the outcome of at least 50% pain reduction from baseline, lasted at least eight weeks, had a parallel group design, included 200 or more participants in the comparison, and reported an intention-to-treat analysis. First-tier studies did not use last observation carried forward (LOCF) or other imputational methods for dropouts. The second tier used data that failed to meet this standard and second-tier results were therefore subject to potential bias.
MAIN RESULTS: Twelve included studies in 11 publications (1511 participants), all with chronic neuropathic pain: central post-stroke pain (1), chemotherapy-induced neuropathic pain (1), diabetic neuropathy (4), HIV-related neuropathy (2), mixed neuropathic pain (2), spinal cord injury-related pain (1), and trigeminal neuralgia (1). We did not identify any additional studies. Participants were aged between 26 and 77 years. Study duration was two weeks in one study and at least six weeks in the remainder; eight were of eight-week duration or longer.No study provided first-tier evidence for an efficacy outcome. There was no convincing evidence that lamotrigine is effective in treating neuropathic pain and fibromyalgia at doses of 200 mg to 400 mg daily. Almost 10% of participants taking lamotrigine reported a skin rash.
AUTHORS’ CONCLUSIONS: Large, high-quality, long-duration studies reporting clinically useful levels of pain relief for individual participants provided no convincing evidence that lamotrigine is effective in treating neuropathic pain and fibromyalgia at doses of about 200 to 400 mg daily. Given the availability of more effective treatments including antiepileptics and antidepressant medicines, lamotrigine does not have a significant place in therapy based on the available evidence. The adverse effect profile of lamotrigine is also of concern.
Source: Cochrane Database
There has been renewal of interest in the use of prophylactic antibiotics to reduce the frequency of exacerbations and improve quality of life in chronic obstructive pulmonary disease (COPD).
To determine whether or not regular treatment of COPD patients with prophylactic antibiotics reduces exacerbations or affects quality of life.
We searched the Cochrane Airways Group Trials Register and bibliographies of relevant studies. The latest literature search was August 2013.
Randomised controlled trials (RCTs) that compared prophylactic antibiotics with placebo in patients with COPD.
We used the standard methods of The Cochrane Collaboration. Data were extracted and analysed by two independent review authors.
Seven RCTs involving 3170 patients were included in this systematic review. All studies were published between 2001 and 2011. Five studies were of continuous antibiotics and two studies were of intermittent antibiotic prophylaxis (termed ‘pulsed’ for this review). The antibiotics investigated were azithromycin, erythromycin, clarithromycin and moxifloxacin. Azithromycin, erythromycin and clarithromycin are macrolides while moxifloxacin is a fourth-generation synthetic fluoroquinolone antibacterial agent. The study duration varied from three months to 36 months and all used intention-to-treat analysis. Most of the results were of moderate quality. The risk of bias of the included studies was generally low, and we did not downgrade the quality of evidence for risk of bias.The trials recruited participants with a mean age of 66 years and with at least a moderate severity of COPD. Three trials included participants with frequent exacerbations and two trials recruited participants requiring systemic steroids or antibiotics, or both, or who were at the end stage of their disease and required oxygen.The primary outcomes for this review were the number of exacerbations and quality of life.With use of continuous prophylactic antibiotics the number of patients experiencing an exacerbation was reduced (odds ratio (OR) 0.55; 95% confidence interval (CI) 0.39 to 0.77, 3 studies, 1262 participants, high quality). This represented a reduction from 69% of participants in the control group compared to 54% in the treatment group (95% CI 46% to 63%) and the number needed to treat to prevent one exacerbation (NNTb) was therefore 8 (95% CI 5 to 18). The frequency of exacerbations was also reduced with continuous prophylactic antibiotic treatment (rate ratio 0.73; 95% CI 0.58 to 0.91).Use of pulsed antibiotic treatment showed a non-significant reduction in the number of people with exacerbations (OR 0.87; 95% CI 0.69 to 1.09, 1 study, 1149 participants, moderate quality) and the test for interaction showed that this result was significantly different from the effect on exacerbations with continuous antibiotics.There was a statistically significant improvement in quality of life with both continuous and pulsed antibiotic treatment but this was smaller than the four unit improvement that is regarded as being clinically significant (MD -1.78; 95% CI -2.95 to -0.61, 2 studies, 1962 participants, moderate quality).Neither pulsed nor continuous antibiotics showed a significant effect on the secondary outcomes of frequency of hospital admissions, change in lung function, serious adverse events or all-cause mortality (moderate quality evidence).The adverse events that were recorded varied among the trials depending on the different antibiotics used. Azithromycin was associated with a significant hearing loss in the treatment group. The moxifloxacin pulsed study reported a significantly higher number of adverse events in the treatment arm due to the marked increase in gastrointestinal adverse events (P < 0.001). Some adverse events that led to drug discontinuation, such as development of long QTc or tinnitus, were not significantly more frequent in the treatment group than the placebo group but pose important considerations in clinical practice.The development of antibiotic resistance in the community is of major concern. One study found newly colonised patients to have higher rates of antibiotic resistance. Patients colonised with moxifloxacin-sensitive pseudomonas at initiation of therapy rapidly became resistant with the quinolone treatment.
Use of continuous prophylactic antibiotics results in a clinically significant benefit in reducing exacerbations in COPD patients. All trials of continuous antibiotics used macrolides hence the noted benefit applies only to the use of continuous macrolide antibiotics. The impact of pulsed antibiotics remains uncertain and requires further research.The trials in this review included patients who were frequent exacerbators and needed treatment with antibiotics or systemic steroids, or who were on supplemental oxygen. There were also older individuals with a mean age of 66 years. The results of these trials apply only to the group of patients who were studied in these trials and may not be generalisable to other groups.Because of concerns about antibiotic resistance and specific adverse effects, consideration of prophylactic antibiotic use should be mindful of the balance between benefits to individual patients and the potential harms to society created by antibiotic overuse.