Saturday, June 6, 2009

Cost-Effective Steps to Fight Insomnia -

How much would you pay for a good night's sleep?

If the sleep peddlers have their way, quite a bit. Sleep is a $23.9 billion industry — if you count things as diverse as mattresses, white noise machines and prescription pills — and it has more than doubled in the last decade, according to Marketdata Enterprises, a research firm in Tampa, Fla.

The market for insomnia drugs alone is expected to grow 78 percent, to nearly $3.9 billion, by 2012, as drug makers scramble to bring more pills to market to compete with name brands like Lunesta, Sonata and Ambien CR.

There is even a new event, the National Sleep Foundation's Big Sleep Show, to promote sleep-inducing products and services to the tired masses. It occurs several times a year, and the next one is set for August in Dallas.

Sleeping is a serious problem for millions of people. The National Sleep Foundation (which receives financial support from pharmaceutical companies) estimates that 20 percent of Americans, up from 13 percent eight years ago, sleep fewer than six hours a night. The lucky few who sleep a full eight hours or more dropped to 28 percent, from 38 percent, the foundation said.

Being chronically sleep-deprived is more than just tiring. It can lead to depression, high blood pressure and lower productivity, both on and off the job.

If the problem is pure insomnia — rather than sleep apnea or another medical issue — there are smart and affordable options. Here are some of the most cost-effective ways to get the sleep you need, and a few things you should avoid altogether.

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Tuesday, June 2, 2009

For Athletes, a Road to Success Paved With Bad Advice -

The talk, at the Expo Center at the Boston Marathon this year, had an intriguing title: Using Biomechanics to Predict Running Injuries. And the lecturer, Dr. Thomas W. Vorderer, a podiatrist at the division of sports medicine at Children's Hospital, one of the Harvard hospitals, spoke with great conviction.

You can prevent injuries, Dr. Vorderer said, or, if you get them, can make them heal if you learn the right way to stretch and if you stretch regularly. And you should also learn the right way to run; in general, he said, runners should strike the ground with their heels first. If they strike with their midfoot or forefoot, he said, they are just asking for injuries.

Dr. Vorderer speaks from experience: he was a competitive runner for years and said he trained with fantastic coaches. And he says he has helped countless runners rid themselves of chronic injuries by figuring out why they were getting injured and teaching them, for example, the right way to stretch. He has e-mail messages from grateful patients, thanking him for solving problems that threatened to end their running altogether.

But exercise physiologists say none of what he espouses has been established by rigorous studies. Stretching evidence is so inconclusive that two large studies are now under way that randomize people to stretch or not and ask whether it prevents injuries, does nothing or increases injury rates. No one knows what the answer will be.

As for running styles, a credible study in 2007 showed that running form often depended on running speed. The slower people run, the study found, the more likely they are to strike the ground with their heel first. The same runners, going more slowly, run differently from when they run fast.

There is no right or wrong way to run, said Peter R. Cavanagh, a professor in the department of orthopedics and sports medicine at the University of Washington. And even if there is, he said, it is not clear that people can permanently change their natural stride.

Dr. Vorderer says that he knows experts often disagree but that the art of sports medicine is to understand individuals.

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Monday, June 1, 2009

A Doctor's Opinion: Why I Started Microblogging on Twitter

It wasn't until Joshua Schwimmer launched his combined feed of physicians-twitters that I started to think about using Twitter again. Checking the mini posts was not only fun but also potentially useful. Doctors and medical librarians (my other favorite group of bloggers) are busy and often do not have time for long posts. The 140 characters on Twitter are enough to share some interesting bits of information that otherwise would have gone unpublished.

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Talking Frankly at the End of Life -

I’ve spent a lot of time over the last few years thinking, writing and speaking about end-of-life care, but this issue recently became quite personal for me. My mother-in-law died two weeks ago.

A ringer in her youth for Donna Reed, with Rita Hayworth legs, my mother-in-law possessed a dazzling memory and a designer’s flair, and she loved to surround herself with family and friends (“where the action is,” she used to say). She spent most of her 86 years following her husband across the country, teaching art in the schools where he taught. But wherever they landed, she managed always to make new friends. Lots of friends. When one of her sons passed away, she and my father-in-law received more than six hundred letters of condolence.

But by the time my mother-in-law died 14 days ago, her social circle had shrunk considerably. She had been battling rheumatoid arthritis for almost 50 years, a series of debilitating strokes for 10, and the ulcers on her legs that would not heal would, in the final year of her life, necessitate an above-the-knee amputation. Over the last few months, unable to hold a pen to write and too weak to speak into a phone, my mother-in-law saw her social life whither away. Her once expansive world was reduced to the square footage accessible by wheelchair and amenable to the trappings of all the medical equipment she needed.

In the days since her death, I have often thought about the many conversations my mother-in-law and the family had with the doctors and nurses about the dying process. There was the initial discussion over two months ago that she was likely to die soon and would benefit from hospice, and then there were also the many daily conversations about her comfort, about what she wanted and what she did not.

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