Few of us like being patients, but there are ways to take charge of the situation Medication mergers
It’s no fun being a patient.You’re sick or bringing a family member or friend along. pills, but researchers are propos- worried about being so. There’s the loss It’s helpful to them to have friends or family ing a “Polypill” of generics thateveryone over 55 would take. . 3 members of the patient who can listen care- ness (and the health care system) seems to Passing out
take over. Even normally assertive and intelli- gent people find themselves “shutting down,” calmer patients that way. And doctors often so they can’t understand new information pick up some insights into the people they’re taking care of by meeting family and friends.
sions. Others become irritable or downright Old eyes sans spectacles
hostile — not a great mind-set for making Talk to a nurse. Even if we know better,
some of us are a little too eager to be good patients, so we don’t complain or admit to more rights than ever before. Most doctors Bowel movements
today neither want nor expect patients to rassed at repeatedly asking, “What does that The color and consistency ofstool may be a tip-off to health passively follow orders. And the Internet mean?” Some find themselves clamming up problems. . . . . . . . . . . . . . . . . . 6 provides vast resources to help you under- around authority figures. If you don’t feel stand your condition and make choices.
comfortable talking to a doctor, seek out Earlier this year, Harvard Medical School one of the doctor’s nurses or some other sponsored a forum titled “Taking Charge: staff member. It’s no secret that patients con- Patient Advocacy for Yourself or a Loved One.” fide in nurses and other staff. Many doctors is best for you? . . . . . . . . . . . . . 7 Dr. Nancy Keating, an internist at Brigham and Women’s Hospital, and Dr. George De- from nurses than they’d ever find out on By the way, doctor
metri, director of the Center for Sarcoma and What do coronary stents accomplish?. . . . . . . . . . . . . . . . 8 Institute, led the discussion. Here are nine sug- Know your options. Most medical jour-
3neys have several crucial forks in the
road. If a doctor presents only one choice, Bring along a family member or close
chances are you’re not getting the full story.
friend. This is perhaps the single most
Of course doctors often do — and should — important piece of advice anyone can give.
Patients need a second pair of eyes to look immune system. Get the facts.
Harvard Health Publications out for them and a second set of ears both to must decide whether that doctor can still hear their concerns and to listen to the doc- tors and nurses. If you don’t have anybody close by who can accompany you in person, Set the terms of the relationship. A study
more information, or go towww.health.harvard.edu/YI.
ask the doctor to list someone in the medical 4 published several years ago showed that
record who should be called before crucial most patients want a collaborative relationship decisions are made or after something im- with their doctor. But people’s preferences vary. The researchers found that roughly 1 in 4 people prefer an active, take-charge role, Patient tips continued from page 1
Editor in Chief Anthony L. Komaroff, M.D.
also gives you the right to ask for chan- Board members are associated with Harvard Medical School and affiliated institutions. They review all published articles.
get copies of their medical records.
Dental Medicine R. Bruce Donoff, D.M.D., M.D.
Emergency Medicine John Tobias Nagurney, M.D. Gastroenterology Stephen E. Goldfinger, M.D.
his or her relationship with a doctor.
Gerontology Kenneth L. Minaker, M.D.
Bring a tape recorder to your
or too deferential, make that known.
8office visit.This may seem intru-
Nutrition Bruce Bistrian, M.D., Ph.D.
Ophthalmology B. Thomas Hutchinson, M.D.
Think through your priorities.
Orthopedics Donald T. Reilly, M.D., Ph.D.
5Treatments often involve trade- an audiotape after your visit may help
Preventive Medicine JoAnn E. Manson, M.D., Dr.P.H.
freshing your memory can be helpful.
Women’s Health Soheyla Gharib, M.D.
the Journal of Clinical Oncology. They Online www.health.harvard.edu/subinfoLetters Harvard Health Letter had significantly better recall of having tients who didn’t listen to a tape.
Use the Internet. Sure, the In-
Bulk Subscriptions Consumer Health Publishing Group 6ternet is full of half-baked hokum Find a doctor you like and re-
spect… This can be hard. Your
health insurer may limit your choices.
Corporate Sales & Licensing Consumer Health Publishing Group information, so much so that it’s real- 1100 Summer St., 2nd Fl.
Stamford, CT 06905 ly a missed opportunity not to get on- 888-456-1222 x102 (toll free)203-975-8854 x102 with your doctor is hard to overrate.
Published monthly by Harvard Health Publications, …and don’t feel obligated to stick
Editor in Chief Anthony L. Komaroff, M.D.
with one you don’t. It’s important to
2004 President and Fellows of Harvard College. (ISSN 1052-1577) Proceeds support the research efforts of Harvard Medical School. database of all the medical journals.
10 Shattuck St., Suite 612, Boston, MA 02115 don’t like or trust. It may not feel like PUBLICATIONS MAIL AGREEMENT NO. 40906010RETURN UNDELIVERABLE CANADIAN ADDRESSES TO Get your medical records. Under
7the federal Health Insurance spective, either. You’d both be better
WINDSOR, ON N8X 1Z1 — E-mail: wgarcia@chpg.net 2 | Harvard Health Letter
All-in-one pills for heart diseaseA polypill may make sense, but drug companies are coming up with their own combinations. Taking your medicine these days Extrapolating from existing research re- What’s next?
sults, they estimated that their Polypill Some critics say that a Polypill is a bad may make sense for the “average” per- lar conditions (heart attack, stroke, un- might be an increase in the likelihood of in it may not be healthy for a given per- that all-in-one needn’t mean one for all.
of pills a person has to take, increase the The hypothetical Polypill
Recipe for heart attack
and stroke prevention
Poly wants a pill
sive prevention and treatment is great.
this familiar approach a step further. In an article in the British Medical Journal, tor, its best-selling statin, and Norvasc, a university’s hospital after a heart at- everyone age 55 and over should take Circulation, Mukherjee reported that, and other cardiovascular conditions.
may be a great idea. But there’s a dan- terol-lowering statin, half doses of three inhibitor, a beta blocker, and a diuretic), aspirin, and the vitamin folic acid.
Harvard Health Letter | 3
Fainting Simple maneuvers could keep you from losing consciousness if you’re feeling faint. The most common causes of syncope (SIN-co-pee) are the most blood pressure can make people vul- the heartbeat (beta blockers, nitrates) or of the blood it needs. No organ “likes” also had some success “retraining” the legs and the lower part of your body.
Cross your legs to stay on your feet
If you feel a fainting spell coming on, a more blood is pushed into the brain.
off a full loss of consciousness — pro- Fear factor
are another potential cause of fainting.
you’re getting blood into the brain.
faint. No one is sure why. The “wires” Be sure to talk to your doctor
his or her side to prevent choking. It’s temporary drops in blood pressure heart problem, they’ll usually start by 4 | Harvard Health Letter
The end of glasses? First came LASIK. Now there’s a procedure for baby boomers who don’t want to wear reading glasses.
But does it work?
Behind your pupil and iris is a ple who wore regular lenses, those Conductive keratoplasty
than twice as likely to suffer falls.
easily back and forth between seeingobjects in the distance and those right Eyes that see things differently
getting stuck in a certain position.
cornea so the eye can see things up close.
inputs into a single, clear field of vision.
eyes. Those who’ve worn glasses for see- it’s a good answer to the hassle of read- ing in the distance (they’re nearsighted tients don’t really like monovision and certain people never get used to it.
less “contrast sensitivity” — the ability to distinguish between light and dark.
them does take some getting used to.
eye is either uncorrected (because big question marks. How many people it already sees well up close) or has are going to be happy with monovision? a contact lens that boosts that near And how long before the treatment tients will need reading glasses again six half will need them after a year, accord- Monovision
glasses or contact lenses, involves using a laser to reshape the cornea, the clear, erated on if the goal is monovision.
Initially, CK is cheaper than LASIK.
New kid on the block
$1,000 less. But over the long run — if Harvard Health Letter | 5
What is a healthy bowel movement?The characteristics of feces can offer clues to health problems, digestive and otherwise. Australian colorectal surgeon from the esophagus,stomach,or small the stool is hard. One reason older called melena that has a very bad odor.
Bowel Book: A Self-Help Guide for Suf- ferers that the “human gastrointestinal berries and beets can change the color.
Frequency. In Western societies, people
agents in imaging studies lighten it.
day, but it’s an individual matter. All Fat content. Normal stool is about 1%
that fiber is really a very mild laxative.
fat. Passing stool that is 7% fat is called once a week and are perfectly healthy.
ally smelly, and stick to the side of the to flow into, rather than out of, the in- gastrocolic reflex is the reason manypeople, and especially children, need Consistency. Feces are normally about
Odor. The normal unpleasant scent
water, they’re soft; if they contain too little, they’re hard. Soft feces can lead to incontinence and passive soiling.
whenever possible because a more functions of the large intestine. A intense urge makes it easier to start healthy large intestine takes 11/2 quarts therefore, strong-smelling, feces. Sulfur like beer and bread as preservatives.
Color. Feces are normally brown be-
digestive system from the liver. Bleeding 6 | Harvard Health Letter
Almonds, oh joy! But peanuts better?They’re good for us, but which nut is the best? Health-conscious people are enough of the mineral,with average amount ofalpha-linolenic acid,the only lead in the folate category. Cashews have they lag behind in vitamin E. If it’s sele- some protection against diabetes, too.
in 12 ounces of many brands of soda.
If it’s clear that nuts are nutritionally into regular meals as a protein source.
hard to beat: They’re almost buttery.
fat. Much of the fat, though, is “good” ed fat, not the “bad” saturated variety are a major selling point. So the associ- terol-lowering effect of nuts. But citing individual studies, the authors of an al- mond study published in Circulation that sheds a little light on the subject.
noncompetitive approach: mixed nuts.
Folate (micrograms)
Vitamin E (milligrams)
Omega-3 fats (grams)**
Macadamia nuts
* Values are for the Virginia peanut, the variety used most often for roasted and in-the-shell peanuts. ** Amounts may include a small amount of omega-6 fats. Source: United States Department of Agriculture National Nutrient Database Harvard Health Letter | 7
Lp(a) levels, but we still don’t know whether that Q I’m 70 and recently heard about a new blood test for something called lipoprotein(a) that reduction actually translates into a lower risk for might help determine if I’ll get heart disease.
Testing for Lp(a) might be warranted if you have diseased arteries (atherosclerosis) and none A Lipoprotein(a),which is often abbreviated as of the conventional risk factors.I might also con- Lp(a), is a molecule of “bad” LDL cholesterol sider ordering this test for a patient whose high with an extra protein attached. High levels may be cholesterol level isn’t responding to a statin (Lipi- harmful because Lp(a) interferes with the blood’s tor, Mevacor, other brands) or to one of the bile- natural clot busters. Over the past several years, acid binders (LoCholest, Colestid, other brands).
some studies have shown that people with high Talk to your doctor about the value of Lp(a) Lp(a) levels are more likely to have a stroke or suf- testing for you. Don’t be disappointed if he or she fer a heart attack. The risk seems to be more pro- says, “I’m not sure.” I’m afraid this is an area where doctors need to know more before they can But that doesn’t mean you should get an Lp(a) test. Conventional risk factors like high blood pres-sure, high cholesterol, and smoking are far morereliable predictors of future cardiovascular risk.
And we know that lowering high blood pressureand cholesterol levels — and, of course, quittingsmoking — pays off by lowering cardiovascular risk. There is medicine that reduces elevated Harvard Health Letter Editor in Chief Q I read in the newspaper that angioplasty and people in this situation is no. Why? Because stents don’t do any good because narrowed crushing a big, scary-looking atherosclerotic arteries aren’t the cause of most heart attacks. Is plaque won’t do anything about all the smaller, less obvious plaques in the artery. Yes, people withsignificant coronary narrowing are at higher risk A Before patients get angioplasty or stents,they of dying from a heart attack than others are, but (and their doctors) need to be clear about it’s not so much because of obvious plaque — it’s their goals. Are they trying to relieve symptoms the many smaller ones that go along with it.
When these small plaques rupture, they can cause Patients who feel fine and have no symptoms just as much trouble as the larger ones, and there of coronary disease will not feel any better after are plenty of them left after an angioplasty has an angioplasty. If, on the other hand, their lives are being limited by angina from relatively mild The good news is that the small plaques can activity, then opening up a coronary artery could be stabilized with cholesterol-lowering therapy, really help because angina is caused by low blood good blood pressure control, and other risk factor flow to the heart. Angioplasty and stents restore interventions. And those treatments can help you But let’s turn to people who have some evi- dence of coronary disease — say, a positive stresstest — but no symptoms. For them, the questionis not relief from angina but whether angioplasty will help them live longer. The answer for most Harvard Health Letter Editorial Board Letters By the Way, Doctor
we receive, we can’t answer every letter. Nor can we provide personal 8 | Harvard Health Letter

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CURRICULUM FORMATIVO E PROFESSIONALE del Dottor VINCENZO BRANCA Nato a Rosolini (SR) il 28 agosto 1957 1. TITOLI DI STUDIO Laurea in Medicina e Chirurgia, Università degli Studi di CATANIA il 6 APRILE 1982 con voti 110/110, Lode e Premio Barbagallo Specializzazione in Neurologia, Università degli Studi di CATANIA Specializzazione in Radiodiagnostica, Università degli Studi di CAT


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