Archive for February, 2011

No Need to Stress Out Over Fertility

Does stress affect fertility?

A body of evidence continues to build about the effects of chronic stress on a woman’s ovulation and a man’s sperm production. Stress may lead to a cascade of hormonal events that led to inhibition of the body’s central reproductive hormone signal, and subsequently disturb ovulation or sperm production and sexual activity, write Weill Cornell fertility doctors Drs. Zev Rosenwaks and Marc Goldstein in A Baby at Last!

Humans are designed to endure acute stress. That’s a part of life. But the significant amount of stress couples endure, cycle after cycle, as they attempt to conceive may disrupt reproductive function. Normal fitness and diet routines may fall by the wayside, leading to a more frazzled, stressed lifestyle. Putting this into Eastern philosophic terms, if you are not in harmony with yourself and your culture, you are stressed.

However in studies attempting to make a direct connection between stress and lower in vitro fertilization success rates, the results are mixed.

A new meta-analysis of 14 studies and more than 3,500 infertile women undergoing assisted reproductive treatment found emotional distress did not affect their chances of becoming pregnant. In the Feb. 24, 2011 online edition of the British Medical Journal, Cardiff University psychologists conclude: “The findings of this meta-analysis should reassure women and doctors that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise the chance of becoming pregnant.”

We still need more information to determine the exact relationship between stress and its effects. It may be helpful for couples to know that anxiety and depression won’t necessarily ruin their chances of having a baby.

The Sweetness of Doing Nothing

I recently watched the hit movie Eat, Pray, Love starring Julia Roberts, based on the best-selling book by Elizabeth Gilbert, and learned the Italian phrase “il dolce far niente,” literally “sweet doing nothing.”

Gilbert learned the phrase from new friends in Italy on her year-long journey of self-discovery. In Italy, “il dolce far niente” means sitting in a café talking with friends, perhaps enjoying a bite to eat along with a bottle of wine, or just watching the world pass by.

This type of mindfulness reminded me of meditation guru Jon Kabat-Zinn, who in this YouTube lecture calls it “much to do about almost nothing.”

I decided to explore the pleasure of relaxation in carefree idleness over the long Presidents’ Day weekend. To get out of the mind set of being totally plugged in, 24/7, I purposely did not check my e-mail for 3 days. We took a family trip to East Hampton, where we walked on the sparkling, snowy beach, played board games (Apples to Apples, Risk), went bowling, and ate comfort food (meat loaf for dinner, pancakes for breakfast).

I felt refreshed, recharged, and reconnected.

How do you experience “il dolce far niente”?

8 Active Ingredients of Tai Chi

How does a mind-body therapy like Tai Chi work?

In modern medicine, drugs are prescribed because of their active ingredients. Well-defined, laboratory-synthesized chemical compounds, such as ibuprofen, the active ingredient in Advil or Motrin, are specifically designed to impact physiological pathways to elicit a predictable, desired effect—in the case of ibuprofen, blocking the sensation of pain and reducing inflammation and fever.

Tai Chi is obviously different than drug therapy. It has no well-defined, single chemical ingredient, and is more a mixture of exercise, meditative, and psychosocial components.

A writer-colleague, Dan Ferber, addresses this issue in a new article in Kung Fu magazine in his fascinating interview with Tai Chi Master Yang Yang, Director of the Center for Taiji Studies in Champaign, Illinois, who spoke last October at the First International Symposium on Exercise Therapy, which took place at the Mayo Clinic in Rochester, Minnesota.

Yang Yang notes that mind-body treatments are considerably more complex than treatment with pharmaceuticals: “The effectiveness of a new drug is typically tested in a trial that is double-blinded, which means that the subjects themselves do not know which treatment they received. In a trial of taiji and other mind-body modalities, the subjects will know which treatment they have received. Gold-standard pharmaceutical trials are also placebo-controlled, meaning that patients receive either drug or a sugar-pill that they can’t distinguish from the drug. Placebo controls are difficult to achieve for trials of mind-body interventions. Unlike a drug, which acts via a single cellular mechanism, mind-body interventions like taiji exert their effects in multiple ways simultaneously.”

He notes recent research by Drs. Peter Wayne and Ted Kaptchuk of Harvard Medical School into the effects of Tai Chi on musculoskeletal strength and flexibility training, deep breathing, mindfulness, visualization and intention, and massage or gentle touch, psychosocial interaction, ritual and spirituality.

“Which are the effective ingredients? Do they work together? Is it possible to create a placebo, or ‘sham’ taiji intervention to assess the efficacy of taiji versus a placebo? Is it necessary? All these questions remain to be answered,” says Yang Yang.

In a recent conversation, Wayne told me “for a variety of reasons, I have found it useful to think of and teach Tai Chi within a framework of active ingredients. My colleagues and I have come to call the ‘8 Active Ingredients’ of Tai Chi. They are: Awareness, Mindfulness, and Focused Attention; Intention, Belief and Expectation; Dynamic and Structural Integration, Form and Function; Moderate Effort and Relax Actively; Natural, Freer Breathing; Psychosocial Support; Alternative Health Paradigm; and Ritual and Repetition of Practice. We use this conceptual framework to evaluate the clinical benefits of Tai Chi, to explore its underlying mechanisms of action, and to shape the way we teach Tai Chi in our trials.”

In practice, each of these active ingredients is interdependent and interwoven with the others. For example, you can not substantially change your breathing without altering your posture, neuromuscular dynamics, inner awareness, intention, and mood. As Wayne says “just as white light shining through a prism leads to a rainbow of colors, the 8 Active Ingredients allow you to appreciate the multiple components that make up the whole of Tai Chi.”

Senators Urge Major Leagues to Ban Smokeless Tobacco

Chewing (aka spit/smokeless) tobacco has been part of American baseball since the 1900s, when players stuck wads of it in their cheeks to keep their mouths from getting dry in the dusty parks.

“Smokeless tobacco is not only bad for the players themselves, but also sends the wrong message to young boys who look up to players as role models,” said Bobby Brown, former President of Major League Baseball’s American League, in a Heart Insight magazine article I wrote in May 2010.

As a cardiologist, Brown knew that tobacco increased the risk of heart problems, but he struck out when he broached the idea of banning smokeless tobacco in the Majors because it would have required altering the collective bargaining agreement between the players and owners, and the players union wanted no part of it.

However, he was instrumental in getting Minor League baseball to ban the use of smokeless tobacco, and then the use of all tobacco products, in the 1990s.

Brown took an indirect approach to attack smokeless tobacco use among Major League players. He helped launch a full-scale educational campaign teaching professional baseball players and team personnel about the long-term hazards of using smokeless tobacco, and worked to develop a guide tailored to help baseball players break the habit.

In April 2010, House Energy and Commerce Committee chairman Rep. Henry Waxman (D-CA) and Health Subcommittee chairman Frank Pallone (D-NJ) held a hearing on chewing tobacco use by young people and the bad example set by professional baseball players who use the stuff. A Major League Baseball official and the chief labor counsel of the Players’ Association agreed to put the issue on the table when the players’ labor contract expires in December 2011.

Two days ago, two Senate Democrats, Frank R. Lautenberg of New Jersey and Dick Durbin of Illinois, sent a letter urging Baseball Commissioner Bud Selig and union chief Michael Weiner to agree to a ban in their next collective bargaining agreement.

Whether the players agree to a ban during collective bargaining remains to be seen, notes Brown, adding, “anything they do to stop the use of smokeless tobacco is a step in the right direction.”

Going Pro for Ronny Turiaf Was No Slam Dunk

My latest cover story for Heart Insight (February 2011 issue) is about Ronny Turiaf, the veteran basketball player who had a serious heart problem that nearly benched his pro career. Here’s an excerpt from the article:

Anyone who watches Ronny Turiaf play basketball can plainly see he puts his heart and soul into each game. But fans may not realize that a life-threatening heart condition nearly ended his professional career before it began. His own health scare and successful open-heart surgery inspired the New York Knicks center to become a passionate advocate for heart-health awareness.

After a stellar college career at Gonzaga University in Spokane, WA, Ronny was selected by the Los Angeles Lakers in the second round of the 2005 National Basketball Association Draft. A routine physical examination turned up a heart abnormality, and an echocardiogram confirmed there was a bulge in his aorta right at the root, where the artery connects to the left ventricle of the heart. The condition was deemed serious enough to require surgery.

“My surgeon gave me two choices — not play basketball again and do limited physical activities, or have surgery. It was impossible for me to stop playing basketball and not continue to help my family,” says Ronny, who had left his home on the French island of Martinique at the age of 14 to play high school basketball in France. He chose the surgery without hesitation.

Meditation vs Medication – One Letter Apart

There is a rich body of research showing that meditative exercises like Tai Chi can change the structure and function of the brain, and that focused concentration and non-judgmental moment-to-moment awareness in and of itself (without overt exercise) may modulate multiple aspects of health, including pain, immune function, and mood.

A new look at ongoing studies at Harvard in today’s Huffington Post suggests meditation may help to physically train the brain. Just as pumping iron trains muscles, meditation trains the brain by pumping neurons, writes Aditi Nerurkar, MD, Integrative Medicine Fellow at Harvard Medical School. She notes that studies show meditation can benefit patients with hypertension, chronic pain, rheumatoid arthritis, fibromyalgia, cancer, anxiety, depression, and substance abuse.

Tai Chi is commonly referred to as “meditation in motion.” One of the key features that distinguishes Tai Chi from simple movements using only your body weight for resistance is its rich, integrated set of meditative movements.

One of Tai Chi’s active ingredients relates to becoming more aware of, and at greater ease with, what is going on within your body and mind at any given moment. “Inner focus on moment-to-moment sensations allows you to train and hold your attention or mental focus, providing you with a tool to manage distracting thoughts and incessant mental chatter,” says Peter Wayne, PhD, Director, Tai Chi and Mind-Body Research Programs at Harvard Medical School. “As a result, you are more fully engaged and therefore more efficient with the physical tasks at hand and more in the moment.”

Unlike other Eastern practices, Tai Chi training does not teach meditation within the context of sitting on a pillow but through practical body-centered exercise. This may make what you learn more translatable to practical, everyday activities of daily living. One of the grand masters of Tai Chi, Wolfe Lowenthal, quoted Cheng Man Ch’ing in his book There Are No Secrets: Professor Cheng Man Ch’ing and His T’ai Chi Chuan: “The difference between yoga and Tai Chi is that even if you get it (meditative relaxation) studying yoga, there is nothing you can do if someone tries to knock you off your cushion.”

Other meditative traditions encourage the complete clearing or emptying of one’s mind of all thoughts. In contrast, Tai Chi is more of an active focused meditation. “During practice, when the mind wanders, you gently refocus it back to noticing practical and functional bodily sensations in the present moment,” says Wayne.

“One metaphor I commonly use during resting meditations is to think of the fabric of the body as a paper towel. Just as a paper towel naturally absorbs and holds water in its highly absorbent pores without effort, let the mind rest into and be held in or cradled by the body,” he says. “The spirit of this active ingredient is nicely captured in a clever phrase I saw on a bumper sticker and that I commonly cite in Tai Chi class: ‘Meditation—it’s not what you think.’”

Genetic Testing of Embryos Leads to Births

With momentum building to transfer just one or two embryos, fertility clinics have begun to focus on choosing the one embryo that is most likely to succeed.

Traditionally, embryos have been selected for transfer based on a visual examination of their morphology, that is, their shape, the number of divisions, and other physical factors. But many embryos that look great under the microscope have undetected chromosomal abnormalities, such as missing or extra chromosomes.

The first IVF baby born in Britain using a new chromosome counting technique was reported this week, following on the footsteps of two babies born using the same screening tool, which is called microarray comparative genomic hybridisation (CGH), last October in Italy and Germany.

CGH is a genetic test that analyzes the chromosomes in an egg or embryo before the transfer stage of an IVF cycle. Healthy humans carry 46 chromosomes, 23 chromosomes contributed by the egg and 23 chromosomes contributed by the sperm. Eggs begin their development process with the full complement of 46 chromosomes, but half of them are shed into a small genetic bundle known as the polar body.

CGH can screen the chromosomes from up to five cells taken from an early embryo, called a blastocyst, or analyze the genetic quality of eggs by examining DNA in the polar body.

The test results take up to a week, so blastocysts are frozen and then thawed for implantation in a later IVF cycle. This allows the selection of a gestationally normal embryo. However, the polar body mirrors the chromosomes of the egg only, so CGH tests for chromosomal abnormalities derived from the egg, not the sperm.

The British researchers note that a randomized trial is necessary to be able to say exactly how much benefit CGH provides in improving IVF success rates, and further clinical studies are needed to reveal which patients will benefit the most.

At Weill Cornell Medical Center in New York, the IVF team led by Zev Rosenwaks, MD, uses preimplantation genetic diagnosis (PGD) to select healthy embryos in couples who may have missing or extra chromosomes or who may be at risk of having a child with a genetic disease.

For PGD, one or two cells is removed from the developing embryo for analysis. This allows the IVF team to identify embryos that do not carry the gene for certain inherited diseases, such as cystic fibrosis and sickle cell anemia. This capability greatly reduces the risk that these diseases will be passed on to children, and without lowering pregnancy rates.

The One Best Site to Search for Medical Information

My good friend and fellow medical writer Lois Wingerson has been telling me for years about SearchMedica, a great free search engine for medical information that was established in late 2006. It wasn’t until she asked me to write a short news item for one of its weekly blogs that I checked out SearchMedica, and I can’t tell you how glad I am.

SearchMedica was built to help doctors research unanswered questions because “our research shows that every day a doctor sees 3 or 4 patients with a problem he or she doesn’t know exactly how to resolve. Many searches in the long tail are for specific conditions, clearly looking for the way to address a particular problem in a particular patient,” says Wingerson, who is Content Manager at SearchMedica.

An analysis of the 200 most common search terms from the 2010 annual report shows “clinical condition” is the most popular term used. In the All of Medicine tab of SearchMedica, “cardiovascular” is a very popular disease category, which is not surprising given the prevalence of heart disease. Overall, Google Analytics shows people spend about 4 minutes per visit and look at about 3 pages.

Sometimes there are searches on medical jargon that seems funny but may mean something to medical professionals.

“There was a search a few days ago on the term ‘banana bag’ which brought up no results in SearchMedica, but a Google search found it on Wikipedia,” says Wingerson. “As I suspected, it’s a kind of intravenous bag. You wouldn’t find it on SearchMedica because SearchMedica doesn’t view Wikipedia as an authoritative source, and I guess nobody in the authoritative medical literature has used the term often enough in any article so that it even ranks on SearchMedica searches.”

SearchMedica is as useful for medical writers as it is for doctors in finding background information on a particular topic, both in locating previous studies or related information on a medical news subject, or in finding reliable general information.

“For a medical writer, it’s a terrific way to get instant perspective and make sure that you’re not ‘going off half cocked,’ calling something news that isn’t really that new, because it’s very easy to follow the course of debate or research on a topic over the past year or two,” says Wingerson. “The article categories listed immediately above the first item in any results list (Research/Reviews, Evidence-based Articles, Practice Guidelines, Practical Articles/News, Patient Education, Clinical Trials, CME, Complementary Medicine) are a good way to target a search to particular kinds of resources.

“We like to say that SearchMedica is more targeted than Google, but broader than PubMed, because it indexes many of the controlled circulation publications that PubMed won’t catalogue. There’s debate in these less-authoritative sources that can be really useful for a reporter. Importantly, SearchMedica (unlike the major search engines) is constructed to use publication date as a very important factor in default ranking. The most recent item won’t necessarily appear at the very top of the list; an item more relevant to your search term but slightly less recent may appear higher. But in general latest comes first.”

Google, with its immense brainpower, is still a good place to start general medical searches for consumers. “I often go to Google myself when I draw a blank on SearchMedica, as in the ‘banana bag’ example,” she says. Also, SearchMedica is not optimized for searching by article, so if you know the exact reference, then PubMed is the way to go.

But if I want one website that I know has both medical perspective, easily understood background information, plus the latest journal references, my new first choice is now SearchMedica.

Double Your Sperm Count?

In his new best-selling book, The 4-Hour Body: An Uncommon Guide to Rapid Fat-loss, Incredible Sex, and Becoming Superhuman, Tim Ferriss sets out to rewrite the rules on how to reshape your body. He describes how he developed a minimalist approach to fitness and health, using himself as a human guinea pig to test every fad, diet, supplement, and workout he could find to identify the things that really work.

The back cover boasts about a dozen things you will learn (in less than 30 minutes), including how to double your sperm count. Ferriss has some interesting ideas here, which I ran by Marc Goldstein, MD, who is the Director of the Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical Center, and one of my co-authors of A Baby at Last!.

Ferriss had his sperm tested in his early 30s after a friend developed testicular cancer. Even though he was in top physical shape, his sperm count was borderline normal. After researching the medical literature, he hit upon the effects of cell phone radiation on sperm. So the first thing Ferris did was to remove the cell phone from his pants pocket and carry it either in an armband or in the front pocket of a backpack.

Good idea says, Dr. Goldstein: “I agree with that. Rat studies were randomized controlled studies and indicate live cell phones near testicles might have a negative effect. I give that advice to my patients. I include this in my updated list of lifestyle changes to preserve a man’s fertility.”

In addition, Ferriss started cold treatments, taking short ice baths and/or cold showers 10 minutes upon waking and before bed, even though he admits that the effects on sex hormones are largely untested. And he began eating Brazil nuts, which contain selenium, a mineral Dr. Goldstein says has been shown to increase sperm production and sperm quality.

After 11 weeks, Ferriss had his sperm tested again, and says he nearly tripled his motile sperm (the number of good swimmers) per ejaculate. His ejaculate volume increase by 44%, motile sperm per millimeter by 100%, and motile sperm per ejaculate by 185%.

“The increases in his numbers are well within the large range of variability seen in multiple semen analysis in the same man,” says Dr. Goldstein. “They could have nothing to do with the changes he made unless he didn’t mention that he also stopped drinking heavily and using drugs.” Ferriss doesn’t say anything about limiting alcohol or drug use.

Ferriss also recommends that men over age 30 highly consider storing their sperm because, in general, men are becoming more infertile, many medical conditions and procedures can render men infertile, and men may change their minds about wanting kids, so why not do it?

Dr. Goldstein’s advice is not so liberal: “Only store your sperm if you are going to be treated for cancer, or already have a critically low sperm count.”

Ferriss has other intriguing ideas in The 4-Hour Body I’ll comment about in the future.

Use the Right Painkillers to Kill Pain

Here are the highlights of this month’s (actually January’s) feature from the Sports Injury Handbook website:

Use the Right Painkillers to Kill Pain

Early, aggressive use of simple over-the-counter (OTC) painkillers can allow you to rehabilitate sports injuries without the risk of addiction to prescription painkillers, such as Vicodin.

OTC painkillers usually are enough to calm the aches and pains of most sports injuries. Three types of painkillers are the most valuable: aspirin, acetaminophen, and non-steroidal anti-inflammatory agents.

Aspirin is the oldest drug. It not only kills pain but also reduces inflammation. The major side effects of aspirin are stomach upset and even bleeding from the lining of the stomach. If you have problems with regular aspirin, use buffered or enteric coated aspirin instead. Aspirin also interferes with blood clotting and should not be used in large doses during contact sports.

Acetaminophen pills, such as Tylenol, have the same painkilling effects as aspirin in most people but do not have as much of an anti-inflammatory effect. They are less irritating to the stomach and have no anti-clotting effect.

Ibuprofen is the active ingredient in non-steroidal anti-inflammatory agents. The various OTC preparations are half-strength versions of the prescription medication Motrin. They all have a very strong anti-inflammatory effect and also have pain-relieving properties.

Choose whichever painkiller you like the best. Most often you know from previous experience which drug works well for you. One caveat: do not take aspirin along with anti-inflammatory agents. Since these two are chemically similar, adding one to the other could lead to a toxic reaction. So, for example, if you are taking ibuprofen for sore muscles and you get a headache, take acetaminophen instead of aspirin.

Also, anyone with a history of gastrointestinal problems should not take anti-inflammatory agents, including those sold in drug stores, except under a doctor’s direction. The doctor may prescribe accompanying medication to ameliorate the side effects.