Why Some Patients Develop Anemia

Many Heart Patients Anemic After Too Many Blood Tests in Hospital

Researchers warn this could translate into worse outcomes.

By Amanda Gardner, HealthDay News

One in five patients who are hospitalized for heart attacks develop anemia because so much of their blood is drawn for routine diagnostic tests, researchers have found.

Often, this anemia persists for a month or more after discharge and could spell worse outcomes — even death — down the line, according to a study in the Aug. 8 online edition of the Archives of Internal Medicine.

"This is not just a lab abnormality," said study senior author Dr. Mikhail Kosiborod, a cardiologist with St. Luke's Hospital Mid-America Heart & Vascular Institute in Kansas City, Mo. "These patients actually feel worse after they leave the hospital. Mortality is higher, too."

People with anemia have too-low numbers of the red blood cells that carry critical oxygen to different parts of the body.

The researchers had previously found that about half of heart attack patients who are admitted to the hospital with normal red blood cell, or hemoglobin, counts actually leave with new anemia.

But the majority of these patients had no bleeding complications that could account for the condition.

That led Kosiborod and his colleagues to hypothesize that it was due to the amounts of blood drawn for routine diagnostic tests.

"Drawing blood in a hospital is typically a very common occurrence, particularly in the intensive care unit," said Kosiborod, who is also an associate professor of medicine at the University of Missouri in Kansas City.

The study authors looked at electronic medical records for almost 18,000 patients who'd had a heart attack at one of 57 U.S. hospitals.

While all had normal hemoglobin levels when they were admitted, 20 percent developed moderate-to-severe anemia by the time they left the hospital.

The risk of anemia rose 18 percent for each 50 milliliters (mL) drawn.

"That was probably somewhat more than what we initially expected to find," Kosiborod said.

The average patient had 173.8 mL of blood drawn for testing, or about half a unit of whole blood. That was about 100 mL higher than the blood drawn in patients who didn't develop moderate-to-severe anemia, according to the researchers.

There were also differences in the amount of blood drawn from hospital to hospital.

"Because we see such a significant variation, chances are that one of the reasons for the variation is hospital-based processes of care," Kosiborod said. "Some hospitals draw more blood than others."

Fortunately, the authors have identified a couple of seemingly simple fixes to this problem.

One option would be to use smaller pediatric tubes to draw the blood rather than adult-sized tubes.

"Pediatric tubes are perfectly adequate for most of the tests that need to be done and can drastically reduce the amount of blood lost," Kosiborod said.

Fewer blood draws also would help, and it may be possible to use blood already drawn and already in the lab for subsequent tests.

But the findings aren't enough to conclude that unnecessary tests are being done, Kosiborod said.

Less testing could also result in medical problems and this study didn't look specifically at how appropriate the tests were.

But there may be an added benefit to doing fewer blood tests.

"We're spending a lot of money on these tests that [can be unnecessary]," said Dr. Stephanie Rennke, lead author of an accompanying editorial and an assistant clinical professor of medicine at the University of California, San Francisco (UCSF). "If you put the cost together with the issue of the hazard of patients developing hospital-acquired anemia, that's pretty profound."

According to Rennke, UCSF has already tightened up its protocol for ordering blood tests. "We have to think before we order a test," she said.

What are these dry white spots on my child's face?

What are these dry white spots on my child's face?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Mondays, it's pediatrician Dr. Jennifer Shu.

Question asked by Lee of Maryland:

We just got back from the beach and I noticed that my 6-year-old daughter has some dry white spots on her face. I make sure she always wears sunscreen, and she has not had a sunburn. I've put lotion on her skin but it's not helping. She had eczema when she was younger but that always showed up on her arms and legs and not the face. What could this be?

Expert answer:

Thanks for your question. In the summer, it's common for children and young adults to develop a benign skin condition called pityriasis alba. It consists of multiple lighter round patches of skin on the face and often is a little scaly so that it looks rough or like it's peeling slightly. It is unclear exactly what causes pityriasis alba but it does seem to be more common after sun exposure and in people who have eczema.

Pityriasis alba can last for weeks to years and is more noticeable in the summer when the surrounding skin is more tan than the affected spots. The lighter areas usually occur on the face but can also show up on the neck, shoulders and arms. The majority of people with this skin condition are between 3 and 16 years of age.

It's best to continue using sunscreen when outside to avoid sunburns and try to keep the skin color on the face about the same shade throughout. Moisturizers can help, and sometimes using a mild steroid cream such as hydrocortisone may improve the appearance of the skin as well as any itching that might accompany the spots.

Other skin conditions may also look like what you describe so it's always best to get confirmation from your child's doctor. Good luck.

Getting to the Root of Bad Breath

Good dental hygiene should help you clear up a bad case of halitosis. But what's causing your stinky breath in the first place?

By Lynn Yoffee

Medically reviewed by Cynthia Haines, MD

If you're constantly popping mints or chewing gum to cover up bad breath, you're not alone. One in four Americans has halitosis and is cursed with smelly breath.

Why? Most cases of halitosis are caused by improper dental hygiene. If you don't brush and floss your teeth after every meal, bits of food that get stuck in your teeth and gums and on your tongue will begin to decay and emit foul odors.

An unclean mouth also means that bacteria can grow, potentially leading to gum disease, which is also one of the causes of bad breath. In addition, certain foods and drink are more likely to cause bad breath, including:

• Garlic
• Onions
• Cheese
• Orange juice
• Soda, including diet varieties

After these foods or drinks are digested, their oils make their way into your bloodstream and are then carried into your lungs. The odor is then released through your breath.

Other Causes of Bad Breath

Aside from what you eat and drink, bad breath can also be linked to:

• A dry mouth. Saliva is your mouth's natural cleanser, so when your mouth is dry, dead cells can build up, which is what causes morning breath. This is an even bigger problem if you sleep with your mouth open. Smoking and certain medications can also cause dry mouth. In more extreme cases, you could have a problem with your salivary glands that leaves your mouth unusually dry.
• Chronic diseases. Sometimes underlying health conditions can cause bad breath. Lung infections, cancers, kidney or liver failure, diabetes, and gastroesophageal reflux disease (GERD), for example, are all associated with halitosis.
• Respiratory, mouth, throat, and nose conditions. These conditions are also often associated with bad breath. For example, discharge from a sinus infection is known to cause bad breath. If you have an upper respiratory infection such as bronchitis, the sputum coughed up can also cause halitosis.
• Tobacco products, particularly smoking. Tobacco products can dry your mouth and result in bad breath. People who use tobacco are also at greater risk of developing gum disease, poor general oral health, and oral cancers.
• Malnutrition. Starvation or intense dieting can result in bad breath due to ketoacidosis, which is a breakdown of chemicals that occurs during fasting.

Beating Bad Breath

To combat bad breath, try the following:

• Avoid foods and beverages that you know cause bad breath; this may also mean minimizing your intake of alcohol.
• Brush for two to three minutes after every meal and floss your teeth at least once a day.
• Brush your tongue gently to remove dead cells, including the back of your tongue, because that's where bacteria often collect.
• Drink lots of water to keep your mouth moist and clean. And water really is what's best here: Other beverages, particularly caffeinated beverages, don't work as well as water for halitosis treatment and prevention.
• Eat less meat and more vegetables and fruits each day.
• Get dental checkups at least twice a year that include an exam and cleaning.
• If you wear dentures, bridges, or removable braces, clean them thoroughly at least once a day.
• Suck candy or chew gum (preferably sugarless) to stimulate saliva production, which helps wash away food particles and bacteria.

When to See Your Dentist About Bad Breath

If you still feel like you have bad breath after trying these tips, ask someone who is close to you for confirmation. Sometimes, you really are your own worst critic. If it is indeed an issue, make an appointment with your dentist to try to uncover what could be causing your bad breath.

Avoid drinking, eating, chewing gum, or brushing your teeth before your dental appointment. Skip the perfume or other scented products too, so that your dentist can truly assess your halitosis. Your dentist will likely ask you a number of questions, ranging from your dental hygiene habits to your general health.

In some cases, halitosis may be due to a buildup of plaque, which is a layer of bacteria on your teeth. If this is the case, the dentist may have you use a special antimicrobial mouth rinse.

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If your dentist determines that the bad breath is due to gum disease, you'll be treated or referred to a gum disease doctor, called a periodontist. Also called periodontal disease, gum disease causes your gums to recede from the teeth and leaves pockets that gather bacteria and plaque. A periodontal cleaning, or more extensive treatment, may be needed.

If your dentist isn't able to uncover the reason for your bad breath, a trip to your primary care doctor for a physical exam would be the next step to determine the underlying causes of your bad breath.

Learn to crave healthy foods

Train your brain to crave healthy foods
By Elizabeth Cohen

Looking back on it, Wendy Fox thinks it was the M&M's that did her in.

They sat in a glass bowl on her living room table, taunting her every time she walked by, seemingly calling out for her to scoop up a few and eat them. Eat them she did, as well as anything else chocolaty that crossed her path, such as a brownie at her favorite restaurant or a mocha drink at Starbucks.

Fox's chocolate cravings (and three pregnancies) helped her gain 40 pounds in her 30s.

"It wasn't pretty," says Fox, 41, a real estate agent in Weston, Massachusetts.

Unhappy with her growing figure -- she'd gone from a size 4 to a size 10 -- Fox watched as her mother lost 30 pounds. Her mother, who also craves sweets, had attended a program with nutritionist Susan Roberts at Tufts University to curb cravings and suggested Fox do the same.

"At my first meeting with Sue, I told her, 'You've met your challenge,' " Fox remembers with a laugh.

Roberts, author of "The Instinct Diet," explained to Fox that there's a biological reason most of us crave ice cream and not broccoli, but we can unlearn our instincts. It worked. After 14 months, Fox now craves salads instead of M&M's, has lost 36 pounds and is back down to a size 4.

The caveman's instinct

"For most of human history, people didn't have enough to eat, so fat was something you really needed to seek out," says Marcia Pelchat, a food psychologist at the Monell Chemical Senses Center in Philadelphia.

To avoid dying in a famine, the brain is wired to pick up on signs that calorie-rich foods are nearby, which helps explain why that piece of cake on the plate in front of you is so irresistible, or why seeing a sign for a doughnut shop draws you in even when you know you need to watch your diet.

"It's analogous to a drug addict who's gone through rehab, but when he walks by that abandoned crack house he suddenly thinks about going in again," Pelchat says.

Pelchat adds, however, that while we're born with certain cravings, there's also evidence we start to crave whatever we eat in large quantities. She found this when she put study subjects on a vanilla-flavored drink low in saturated fat. After consuming it every day for two weeks, about a third of the subjects reported craving the drink, even though she says, "It was chalky and not very yummy."

Research in Japan also shows that cravings are influenced by our environment. A study at Tohoku University found that many Japanese women crave sushi. "These findings suggested that the craving for some kind of food is influenced by the tradition of food products and cultures," the authors concluded.

'Chocolate makes me nauseous!'

It was tough at first, but Fox, once a chocoholic, now hardly ever craves chocolate.

"I couldn't believe it, but last night we were at a friend's house for dinner and when they served dessert, I thought, 'I can't wait to go home and have a bowl of high-fiber cereal.' "

Her biggest craving now is for salad.

"I make one every night for dinner -- leafy greens and chopped up cucumbers. I don't use dressing -- just a little bit of olive oil and salt and pepper, because I crave a natural taste," she says. "This is such a huge difference for me."

Every so often, Fox says she gets a "ping" for chocolate. But then when she eats it, it makes her feel sick.

"I can just taste the butter in the first bite. It makes me nauseous, which is so weird, because I'm the M&M girl!" she says. "I think a lot of it is psychological. I worked so hard to get where I am that I don't want to go back there. A brownie's not going to take me down!"

Judith Beck, a psychologist and president of the Beck Institute for Cognitive Behavior Therapy in Pennsylvania, says she has noticed the same phenomenon when her patients have given up foods they used to crave.

"They didn't like the sensation of greasy foods in their mouths, and sometimes foods high in sugar started to taste too sweet," she says.

Learning to crave salad

Here are three steps toward switching your cravings from fatty foods to healthy foods.

1. Clean out your cupboards

Fox removed all signs of chocolate from her home. She replaced the M&M's in the glass bowl with pretty marbles, and if she buys chocolate for a special occasion, she gets rid of it immediately.

"I just had a party for my kids and we made ice cream sundaes. As soon as it was over, I gave the leftover hot fudge to my neighbors," she says.

2. Carry around healthy foods

Fox carries apples in her purse and keeps a box of high-fiber cereal in her car so she can dig in whenever a chocolate craving hits.

3. Bury craved foods in the middle of a meal

For the first two weeks, Roberts tells dieters to avoid eating unhealthy craved foods altogether, in the hopes of helping them unlearn the craving. After two weeks, she tells them they can have 100 calories of that food in the middle of the meal.

"I call it the sandwich technique," she says. "If you eat chocolate at the beginning of a meal when you're really hungry, your brain will think -- associate chocolate with feeling satiated and happy. If you put it at the end of the meal, your brain will remember it as the last delicious thing you tasted."

Get Some Sleep: Avoid frequent leg cramping

Get Some Sleep: Avoid frequent leg cramping

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs regularly on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

It is frustrating, to both patients and doctors, that modern medical science often lacks understanding of or treatment for common, everyday ailments.

One such ailment, leg cramps, is very common and yet poorly understood. It often plagues people at night, and therefore “sleep-related leg cramps” is recognized as a bona fide sleep disorder by the International Classification of Sleep Disorders.

Most people have had a “charley horse” and know that leg cramps can be quite painful. Leg cramps result from the sudden, intense and involuntary contraction of a muscle or muscle group. They usually occur in the calf muscle or the small muscles of the feet.

If this happens once a year, few people think of this as a medical condition, but there are people who have leg cramps every night, sometimes several times a night. The cramps can prevent people from falling asleep or can awaken them many times during the night, and therefore leg cramps can lead to chronic sleep deprivation.

The painful sensation is usually relieved by strenuous stretching of the affected muscle. Often, people jump out of bed in their attempt to stop the searing pain. Both the prevalence and frequency increase as people age. There is research showing that approximately one-third of all people over the age of 60 and one-half of those over the age of 80 reported having sleep-related leg cramps once in the previous two months. Six percent of adults over the age of 60 have reported having leg cramps that disturb them every night.

Leg cramps are sometimes confused with restless legs syndrome (now known as Willis-Ekbom disease), but the two disorders are quite different, although patients can have both problems.

RLS is not commonly described as a sudden, intense pain. Also, people who suffer from RLS usually have a steady, uncomfortable feeling in the legs that lasts for hours, and this maddening feeling is only temporarily relieved for a few minutes while they move or rub their legs.

There are some medical conditions that seem to predispose people to leg cramps such as diabetes, peripheral vascular disease and neuromuscular disorders. Medications such as oral contraceptives have been associated with leg cramps. They occur in approximately 40% of pregnant women and usually resolve after birth.

If leg cramping is frequent and intense, people should not assume that they have benign, idiopathic (of unknown cause) leg cramps. It is advised to consult a physician in order to differentiate leg cramps from more serious medical conditions such as akathisia, myelopathy, peripheral neuropathy and disorders of calcium imbalance.

There are numerous theories about the cause of leg cramps but little evidence supporting the veracity of any given theory. One common notion is that they result from dehydration, but the little research done does not support this.

Also common is the idea that there is a relative electrolyte imbalance. Magnesium and potassium are popular culprits. Again, there is little research on this. One study attempted to treat leg cramps in a group of pregnant women and found that magnesium was no better than a placebo.

The same is true for potassium deficiency; there is no research showing that low potassium causes leg cramps or that taking extra potassium prevents them. That said, I have patients who swear that a banana before bed takes care of the leg cramping problem. I also know people who report that sitting in a bath of Epsom salts right before bed helps ward off  nocturnal leg cramps.

I have patients who think that the leg cramps come upon them only when they exercise strenuously, and then there are those who associate the cramps with lack of exercise. The best theory is the “squatting hypothesis,” which speculates that leg cramping is associated with the modern habit of sitting on chairs and on the toilet instead of squatting as our forebears would have done.

I believe that is just another way of saying that leg cramps could be caused by a lack of strengthening and stretching of the calf and feet muscles.

Study: Crying Won't Make You Feel Better

Study: Crying Won't Make You Feel Better

By MEREDITH MELNICK


There's something cathartic about having a good cry and "letting it all out," even if you don't have anything in particular that's bringing you down.


Or maybe not. Research published in the Journal of Research in Personality found that shedding some tears had no effect on the mood for nearly two-thirds of a group of women who kept daily emotion journals.

"Crying is not nearly as beneficial as people think it is," Jonathan Rottenberg, lead author of the study and an associate professor of psychology at the University of South Florida told MSNBC's Body Odd. "Only a minority of crying episodes were associated with mood improvement -- against conventional wisdom."

MORE: The Crying Game: Women's Tears Dial Down Testosterone

As part of the study, 97 Dutch women between the ages of 18 and 48 logged a total 1,004 crying episodes as part of daily mood journals they kept over a three month period. For 61% of the women, crying didn't improve mood at all, although the tears didn't make them feel worse: only 9% of respondents reported feeling more sad after a crying jag, while 30% reported feeling better.

Rottenberg suspects that crying isn't the physically cleansing act that many have assumed it is, and instead suggests that those who felt better after a waterworks session may not have benefited from the actual tears so much as the social support and showings of affection they elicited.

MORE: Why Adults Cry So Easily in Animated Kids Movies

The study also offered a peak into the private act of crying—when, how long and why the women experienced their outbursts. The participants reported crying sessions lasting an average eight minutes, either alone or in the presence of one other person. The majority of crying occurred in the living room and women reported the main reason for their tears were conflict, loss and empathy over another's suffering.

Are colon cleanses good for you?

Colon cleansing: Not so healthy, analysis says

It has been touted as a natural way to improve your heath and cleanse the soul. But doctors are now finding the procedure known as colon cleansing can cause dangerous side effects.

Colon cleansing, technically known as colonic hydrotherapy or colonic irrigation, is a popular treatment, usually performed at spas. It often involves the use of chemicals in the body and in hydrotherapy, the colon is flushed with water through a tube inserted in the rectum.

But oral home remedies are also available and have become popular, especially over the Internet. Now researchers from Georgetown University in Washington, D.C. say there's no evidence any of these colon cleansing treatments work and, in fact, when used improperly can cause cramping, kidney failure and in some extreme cases, death.

"There can be serious consequences for those who engage in colon cleansing whether they have the procedure done at a spa or perform it at home," says the lead author, Dr. Ranit Mishori, a family medicine physician at Georgetown University School of Medicine. "Colon cleansing products in the form of laxatives, teas, powders and capsules... tout benefits that don't exist."

Mayo doctor is no fan of cleanses

Although colon cleansing has been around for centuries as a way to rid the body of unwanted toxins, the American Medical Association determined in the early 1900s that the procedure was invalid; there was no evidence to show the methods worked. And even though there still remains no solid evidence these products do what they claim, colon cleansing has been making a comeback, mainly because manufacturers claim it also helps people lose weight.

"If this method were the key to weight loss, it would be amazing. But there is no evidence that this helps people lose weight,” says Mishori. "Manufacturers don't describe how it works. The statements are a little empty. They say it will enhance your immune system, up your metabolism, give you energy. It’s all pretty vague. Some people swear by it, but it could be a placebo effect. And companies can make these claims, because the federal government doesn't regulate their products."

Not expecting miracles, but I love my cleanses

According to the report released this week in the Journal of Family Practice, Mishori and her colleagues examined 20 studies published in medical literature over the last 10 years.

Investigators noted while these reports showed little evidence of colon cleansing benefits, there were a number of side effects reported following the use of these cleansing methods. Those effects included cramping, bloating, nausea, vomiting, electrolyte imbalance and renal failure. And in some cases, ingredients in these remedies were toxic.

"Some herbal preparations have also been associated with aplastic anemia and liver toxicity," Mishori said.

Researchers also noted that many of the "spas" that offer colon cleansing have no trained clinicians and even organizations such as the National Board for Colon Hydrotherapy and others who promote colon cleansing require technicians who perform professional colon cleansing to have little more than a high school diploma.

"When you flush your colon out with a hose, it's like giving yourself an enema on steroids. You shouldn't put things up there that really don't belong there," stressed Mishori. "Imagine 60 liters of water going through your colon. The stress it puts on the system, and the hose, if not used correctly, could puncture the organ."

As for the home remedies, Mishori says there's no need for them. "We poop and pee for a reason. If you are a healthy person, the body does it for you."

When asked what was the best way to cleanse the body, Mishori was quick to respond.

"Eat a balanced diet, exercise regularly," she stressed, "Get six to eight hours of sleep and see a doctor regularly. But no one wants to do that," she said with exasperation. "But they'll use a hose to flush themselves out! The use of these methods are unhealthy. And what's scary is we only examined the cases that were reported to hospitals and doctors. Imagine all the people who are using these products and methods and have side effects and never go to the hospital. We don't know about them. The numbers could be staggering."