When things in your life seem almost too much to handle, when 24 hours in a day are not enough, remember the mayonnaise jar......and the coffee.
A professor stood before his philosophy class and had some items in front of him. When the class began, wordlessly he picked up a very large and empty mayonnaise jar and proceeded to fill it with golf balls. He then asked the students if the jar was full. They agreed that it was.
So the professor then picked up a box of pebbles and poured them intothe jar. He shook the jar lightly. The pebbles rolled into the open areas between the golf balls. He then asked the students again if the jar was full. They agreed it was.
The professor next picked up a box of sand and poured it into the jar. Of course, the sand filled up everything else. He asked once more if the jar was full. The students responded with a unanimous "Yes."
The professor then produced two cups of coffee from under the table and poured the entire contents into the jar, effectively filling the empty space between the sand. The students laughed.
"Now," said the professor, as the laughter subsided, "I want you to recognize that this jar represents your life.
The golf ball are the important things--your family, your children, your health, your friends, your favorite passions--things that if everything else was lost and only they remained, your life would still be full.
The pebbles are the other things that matter like your job, your house, your car.
The sand is everything else--the small stuff."
"If you put the sand into the jar first," he continued, "there is no room for the pebbles or the golf balls. The same goes for life.
If you spend all your time and energy on the small stuff, you will never have room for the things that are important to you.
Pay attention to the things that are critical to your happiness.
Play with your children.
Take time to get medical checkups.
Take your spouse out to dinner.
Play another 18 holes.
There will always be time to clean the house and fix the disposal.
"Take care of the golf balls first, the things that really matter. Set your priorities. The rest is just sand."
One of the students raised her hand and inquired what the coffee represented.
The professor smiled. "I'm glad you asked. It just goes to show you that no matter how full your life may seem,
there's always room for a cup of coffee with ur friend."
Friday, November 30, 2007
Tuesday, November 27, 2007
Good Habits to Remember to Prevent Neck Pain
• Take frequent breaks. Don't sit in one place for a long time, such as your car or at your desk. Arrange some of the items in your office so that they are inconvenient. This will force you to get up, stretch or walk around.
• Maintain good neck posture. Adjust the seat of your computer or desk chair so your hips are slightly higher than your knees — your head and neck will naturally follow in the correct position. Traveling in a car, airplane or train? Place a small pillow or rolled towel between your neck and a headrest to keep the normal curve in your neck'
• How are you sleeping? Avoid sleeping with too many pillows or falling asleep in front of the television with your head on the arm of a couch.
• On the phone a lot? Use a speakerphone or headsets — do not cradle the phone in your neck.
• Exercise. Treat your body to a consistent regimen of stretching and strengthening to balance your muscle groups. This protects your neck as well as helping your whole body. Walking at any pace is excellent exercise for your neck. The rotation of the spine provides a great natural workout for the neck muscles.
• Eat smart and drink water. Good nutrition and staying well hydrated are not only important to stay healthy, but vital in the healing process
• Maintain good neck posture. Adjust the seat of your computer or desk chair so your hips are slightly higher than your knees — your head and neck will naturally follow in the correct position. Traveling in a car, airplane or train? Place a small pillow or rolled towel between your neck and a headrest to keep the normal curve in your neck'
• How are you sleeping? Avoid sleeping with too many pillows or falling asleep in front of the television with your head on the arm of a couch.
• On the phone a lot? Use a speakerphone or headsets — do not cradle the phone in your neck.
• Exercise. Treat your body to a consistent regimen of stretching and strengthening to balance your muscle groups. This protects your neck as well as helping your whole body. Walking at any pace is excellent exercise for your neck. The rotation of the spine provides a great natural workout for the neck muscles.
• Eat smart and drink water. Good nutrition and staying well hydrated are not only important to stay healthy, but vital in the healing process
Fever. What is a fever? What to do about a fever?
There is much misinformation out there about fever and what to do about it. What is a fever, and what actually causes it? Normal body temperature is 98.6 degrees F, but this is just an average. Some people are normally higher, and some normally lower. A fever is defined as a body temperature above 100.5 degrees F. Therefore, a body temperature of 99.5 degrees or 100 degrees F is not a fever and should not be a cause for worry in otherwise normal children. While fever is a cause for concern, it is rarely a reason for panic. Fever is only a symptom, not a disease, most often scary and annoying, but in most cases not dangerous.
The body temperature is controlled by the hypothalamus, a section of the brain that acts just like your household thermostat. That is, if the body gets too cold, the thermostat sends out instructions to warm things up, and if it gets too hot, the thermostat tries to cool things down. When the body is faced with an infection, it responds in a number of ways. In addition to making antibodies that kill the offending germs, it sends various white blood cells to the location of the infection, where they act very much like soldiers at a battle.
They help the antibodies destroy the invaders. In addition, they are able to kill the offending germs directly. The number and types of these white blood cells are one of the things that your doctor measures when he does a blood count. Fever can be thought of as one of the body's normal responses to infection. Because of this fact, we may have to reconsider the need to treat fever.
The only reliable way to take a young child's fever is rectally. The new high tech ear canal thermometers are easy to use and remarkable fast, but they tend to read a little high. The under arm is also quite inaccurate.
Not all fevers need treatment. Most children with temperatures lower than 102 degrees generally do not feel all that bad, although earaches and sore throats may hurt. The increased body temperature may actually be beneficial in fighting off the infection. Children with a temperature above 102 degrees are often uncomfortable because of the fever and may need treatment - a child with a fever who is feeling and behaving well does not need to be given medication.
The old favorite remedy, aspirin, should not be used to treat fever in children under 16 years of age because of its association with Reye's Syndrome (a syndrome of rapidly worsening neurological symptoms and liver degeneration) in children with viral illness and chicken pox.
Instead of aspirin to treat fever today we have acetaminophen and ibuprofen, both of which are sold under a variety of brand names. Alcohol rubs are a bad idea as it is scary and uncomfortable, and can cause serious side effects in young infants.
Alcohol rubs make kids shiver, which is the body's way to generate large amounts of heat, the last thing you want to do if your child has a fever. Instead sponge the child down in the tub with lukewarm water for a few minutes - but careful not to allow the child to get cold enough to shiver. Also a child should not be bundled up, as it will make him hotter and can raise the temperature of young infants.
Some cautions: A temperature over 100.5 degrees F in a child under 3 months of age is always a concern. They rarely get fevers, even when they are sick, so a fever is unusual even in the presence of illness, and they can change very rapidly. One minute they are okay and a few minutes later they can become seriously ill. There is little warning. You should quickly alert your pediatrician to any abnormal temperature in an infant under three months of age.
Infants between 3 months to 3 years of age present a similar dilemma, only not such an urgent one. A pediatrician has the training and experience to distinguish medically serious conditions from minor viral illnesses in children. Make notes and call your pediatrician if concerned. Every child and every situation is different, and you and your pediatrician must work together to choose the appropriate course of action. ("My Baby's Got a Fever!" Herschel Lessin, M.D., Healthology.com - Dec. 2001)
In general, it is unwise to reduce a fever unless the person (child or adult) is absolutely miserable and if the fever is over 102 or 103. There is an exaggerated concern that many parents have regarding fever. They are unaware that there is no brain damage until the temperature gets beyond 105 or so. Now, I do get concerned when the temperature is above 102, but would hold off using aspirin or Tylenol unless the person was feeling very uncomfortable.
These drugs actually inhibit the body's immune response and actually tend to prolong the illness rather than resolving it more quickly. ("Sponging, Fans Do Little To Bring Down Fever," Dr. Joseph Mercola, mercola.com - Nov. 2001)
On average, flu symptoms lasted 5.3 days in participants who did not take aspirin or acetaminophen, compared with 8.8 days in people who took the anti-fever drugs. (Researchers at the University of Maryland schools of medicine and pharmacy in Pharmacotherapy, Dec. 2000) This report is on mercola.com. - Nov. 2001)
A basic fever, one due to minor bacterial or viral illness, can be an expression of the immune system working at its best. Some research supports the theory that when fever is blocked, survival rates from infection decline. Fever increases the amount of interferon (a natural antiviral and anticancer substance) in the blood. Fever also impairs the replication of many bacteria and viruses, so a moderate fever is a friend.
However, it makes sense to avoid suppressing moderate fevers with drugs, while continuing to monitor for dramatic increases in temperature and worsening of any other symptoms. Don't cajole or coerce your children into eating during fevers if they don't feel hungry, but encourage fluids, because dehydration alone can drive up fever. For the few children (about 3%) who have febrile seizures, pediatricians can help parents block high temperatures by giving ibuprofen or acetamiinophen when fevers start.
If you give over-the-counter medicines for reducing fever and discomfort follow the package instructions. Bundle if child feels cold, but dress lightly so the child can throw off the covers when they feel the need. ("Fever in Children - a Blessing in Disguise," Linda B. White and Sunny Mavor, originally printed in "Mothering Magazine," excerpted from"Kids, Herbs, and Health: A Parents' Guide to Natural Remedies. on mercola.com - June 2001).
The body temperature is controlled by the hypothalamus, a section of the brain that acts just like your household thermostat. That is, if the body gets too cold, the thermostat sends out instructions to warm things up, and if it gets too hot, the thermostat tries to cool things down. When the body is faced with an infection, it responds in a number of ways. In addition to making antibodies that kill the offending germs, it sends various white blood cells to the location of the infection, where they act very much like soldiers at a battle.
They help the antibodies destroy the invaders. In addition, they are able to kill the offending germs directly. The number and types of these white blood cells are one of the things that your doctor measures when he does a blood count. Fever can be thought of as one of the body's normal responses to infection. Because of this fact, we may have to reconsider the need to treat fever.
The only reliable way to take a young child's fever is rectally. The new high tech ear canal thermometers are easy to use and remarkable fast, but they tend to read a little high. The under arm is also quite inaccurate.
Not all fevers need treatment. Most children with temperatures lower than 102 degrees generally do not feel all that bad, although earaches and sore throats may hurt. The increased body temperature may actually be beneficial in fighting off the infection. Children with a temperature above 102 degrees are often uncomfortable because of the fever and may need treatment - a child with a fever who is feeling and behaving well does not need to be given medication.
The old favorite remedy, aspirin, should not be used to treat fever in children under 16 years of age because of its association with Reye's Syndrome (a syndrome of rapidly worsening neurological symptoms and liver degeneration) in children with viral illness and chicken pox.
Instead of aspirin to treat fever today we have acetaminophen and ibuprofen, both of which are sold under a variety of brand names. Alcohol rubs are a bad idea as it is scary and uncomfortable, and can cause serious side effects in young infants.
Alcohol rubs make kids shiver, which is the body's way to generate large amounts of heat, the last thing you want to do if your child has a fever. Instead sponge the child down in the tub with lukewarm water for a few minutes - but careful not to allow the child to get cold enough to shiver. Also a child should not be bundled up, as it will make him hotter and can raise the temperature of young infants.
Some cautions: A temperature over 100.5 degrees F in a child under 3 months of age is always a concern. They rarely get fevers, even when they are sick, so a fever is unusual even in the presence of illness, and they can change very rapidly. One minute they are okay and a few minutes later they can become seriously ill. There is little warning. You should quickly alert your pediatrician to any abnormal temperature in an infant under three months of age.
Infants between 3 months to 3 years of age present a similar dilemma, only not such an urgent one. A pediatrician has the training and experience to distinguish medically serious conditions from minor viral illnesses in children. Make notes and call your pediatrician if concerned. Every child and every situation is different, and you and your pediatrician must work together to choose the appropriate course of action. ("My Baby's Got a Fever!" Herschel Lessin, M.D., Healthology.com - Dec. 2001)
In general, it is unwise to reduce a fever unless the person (child or adult) is absolutely miserable and if the fever is over 102 or 103. There is an exaggerated concern that many parents have regarding fever. They are unaware that there is no brain damage until the temperature gets beyond 105 or so. Now, I do get concerned when the temperature is above 102, but would hold off using aspirin or Tylenol unless the person was feeling very uncomfortable.
These drugs actually inhibit the body's immune response and actually tend to prolong the illness rather than resolving it more quickly. ("Sponging, Fans Do Little To Bring Down Fever," Dr. Joseph Mercola, mercola.com - Nov. 2001)
On average, flu symptoms lasted 5.3 days in participants who did not take aspirin or acetaminophen, compared with 8.8 days in people who took the anti-fever drugs. (Researchers at the University of Maryland schools of medicine and pharmacy in Pharmacotherapy, Dec. 2000) This report is on mercola.com. - Nov. 2001)
A basic fever, one due to minor bacterial or viral illness, can be an expression of the immune system working at its best. Some research supports the theory that when fever is blocked, survival rates from infection decline. Fever increases the amount of interferon (a natural antiviral and anticancer substance) in the blood. Fever also impairs the replication of many bacteria and viruses, so a moderate fever is a friend.
However, it makes sense to avoid suppressing moderate fevers with drugs, while continuing to monitor for dramatic increases in temperature and worsening of any other symptoms. Don't cajole or coerce your children into eating during fevers if they don't feel hungry, but encourage fluids, because dehydration alone can drive up fever. For the few children (about 3%) who have febrile seizures, pediatricians can help parents block high temperatures by giving ibuprofen or acetamiinophen when fevers start.
If you give over-the-counter medicines for reducing fever and discomfort follow the package instructions. Bundle if child feels cold, but dress lightly so the child can throw off the covers when they feel the need. ("Fever in Children - a Blessing in Disguise," Linda B. White and Sunny Mavor, originally printed in "Mothering Magazine," excerpted from"Kids, Herbs, and Health: A Parents' Guide to Natural Remedies. on mercola.com - June 2001).
Treating a Blister
Blisters are sore, swollen areas on the skin where fluid has collected beneath an outer layer of skin. Blisters are caused by friction, often from poorly fitted shoes or socks that rub against the skin.
Here are suggestions on caring for a blister, courtesy of the University of Michigan Health System:
Steps should be taken to avoid further irritating the problem area.
Large blisters can be carefully drained with a sterilized needle, then covered with antibiotic ointment and a bandage.
For extra protection, purchase a moleskin at a drugstore. Cut a hole that's larger than the blister in the moleskin, creating a moleskin "donut." Then apply the moleskin so that the hole is over the blister.
See your doctor about any blisters that don't heal in a reasonable amount of time, or look like they may be infected.
Here are suggestions on caring for a blister, courtesy of the University of Michigan Health System:
Steps should be taken to avoid further irritating the problem area.
Large blisters can be carefully drained with a sterilized needle, then covered with antibiotic ointment and a bandage.
For extra protection, purchase a moleskin at a drugstore. Cut a hole that's larger than the blister in the moleskin, creating a moleskin "donut." Then apply the moleskin so that the hole is over the blister.
See your doctor about any blisters that don't heal in a reasonable amount of time, or look like they may be infected.
How Today’s Docs Pick Their Fields_Must Read
When young whippersnappers arrive at medical school in the fall of their first year, it's not uncommon to hear them declare, in a voice giddy with idealism, that they want to cure cancer or save babies or dedicate their careers to small inner-city clinics. But check back in with them four years later—after they've racked up $200,000 in debt, contemplated having kiddies and been scared witless by the prospect of piddling reimbursements—and many of them will say they want nothing so much as good pay, flexible hours and few midnight emergencies. Your future lifesaver wants, in a word, a nice lifestyle.
This is said to be particularly true of the grade grubs, the ones with the scores to get into ultra-competitive fields, and they even have a mnemonic to help them remember which are the styliest of the lifestyle specialties: If you want to be happy in medicine, follow the ROAD—Radiology, Ophthalmology, Anesthesiology and Dermatology. ROAD!
But is that all there is to it these days? In medicine, as in love, everyone has his or her type.
Each fall, when the weather turns gusty and romantic, the city's fourth-year medical students embark on a mass professional mating ritual designed to hook them up with the residency program of their dreams. The ritual is known as the Match, and like all frenzied dating rites, it is as much about defining who the students are as about finding their medical soul mates.
Are they ultra-alpha gunners with a latent urge to slice and dice? Then perhaps they'll become surgeons, overworked but well paid. Or maybe they tend more toward the brainy-hipster type, with dog-eared copies of Dora in their pockets. Then clearly psychiatry is the field for them.
This year's match frenzy kicked off on Sept. 1, when a vast electronic database began accepting student applications. By now, most students have already dispatched their carefully crafted personal statements to 10, 20, sometimes 40 programs, but a few poor souls are still scrambling—still trying to choose a specialty, in some cases—by the Nov. 1 deadline.
Then it's on to interviewing, praying and waiting for the big day: March 15, Match Day, when a giant HAL-like computer spits out a binding verdict for each student.
Why do some choose a life of treating rashes while others opt for curing cancer or fixing fractures?
The most popular theory of the moment is the aforementioned Lifestyle Theory. A slightly less cynical theory—in fact, a downright warm-and-fuzzy one—is the "mentoring" hypothesis, which states that students, like ducklings, follow the lead of their schools or advisors.
But at the end of the day, for many students, the big choice comes down, quite simply, to personality, attraction, even musk. Indeed, one of the great old medical-school clichés is that a practiced eye can identify which students will go into which fields on the first day of class. The Match, nearly four years later, just seals the deal.
So who's going to be setting your sprains, delivering your tykes or—God forbid—changing your catheter? Whoever they are, we just hope they'll take our insurance!
INTERNAL MEDICINE
Quote:
To hear many doctors describe it, there are two distinct breeds of modern-day physician: those who "do," which is to say, pin joints, slice open patients and zap people with radiation; and those who "think," which is to say, diagnose diseases, titrate medications and monitor symptoms.
The students who choose internal medicine—the largest residency in the Match—fall by and large into the latter category. Often hailed as the "intellectuals" of the med-student menagerie, they're the ones, according to Mount Sinai fourth-year student Bryan Mahoney, who "love thinking and thinking and thinking about diagnoses and treatment plans." They're the scrabble players and chess types, the crossword puzzlers and, in the case of oncologists, the baseball-card collectors. Why?
"Because oncologists [have to] know a lot of chemotherapy regimens in terms of scheduling, dosing, adjustments, all the minutiae," said Daniel Zandman, also from Mount Sinai, "they're masters of esoteric knowledge."
GENERAL SURGERY
Quote:
Some might call it indentured servitude: at least five years of hard, suturing labor in an environment of screaming supervisors, pressure-cooked peers and geysers of blood. But the students who choose general surgery can't seem to get enough of it. They're the kind of people who take pride at staying at the hospital far longer than they have to, who complain about the laws limiting residency hours, who elbow each other out of the way for the chance to scrub in on a 12-hour surgery. Think Tracy Flick with a scalpel.
Certainly prestige has something to do with it—surgery has long been regarded as the pinnacle of the profession—but it also goes deeper, subcutaneous.
"General surgery has people who really are passionate about doing it, because honestly, I look at them and think … 'Your lives are absolutely miserable,'" said Mr. Mahoney, who himself contemplated surgery before opting for anesthesiology. "But then I see 70-year-olds who still work 90 hours a week, and I have to admit they must sincerely love what they're doing—or hate their family. I can't tell which."
DERMATOLOGY
Quote:
Among the many accomplishments required of the would-be dermatologist are perfect skin (the pimply would never dare apply), a fine sense of fashion and a love of the well-shaped heel—high heel, that is.
"You can always spot the dermatologists among the medicine interns," said one lady student from the Columbia College of Physicians and Surgeons. "They're wearing sling-back heels with a white coat. They look like Clinique women."
"All you hear are their shoes clicking down the hallway," observed another Columbia student named Jon.
But don't be fooled by the clip-clopping of well-shod feet: The derm girls are no shuffle-lumps. Thanks to its good hours, high pay and cushy lifestyle—how many dermatological emergencies can you get a month?—dermatology has heel-clicked its way from being one of the easier fields in the medical kingdom to one of the most competitive. Said Dr. Suzanne Rose, associate dean for academic and student affairs at Mount Sinai: "You almost have to have a Ph.D." Or at least a good C.V.
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"Dermatology is for people who have the right résumé, but they're not the most intellectual," said one student. "It's the same kind of people who go into investment banking."
NEUROLOGICAL SURGERY
Quote:
For the overachievers of the overachieving set, the career of choice is, and perhaps only can be, neurosurgery.
Only a handful of students dare apply from each school, but, lucky them, should they match, their big reward is … work. At least six head-splitting, spine-slicing years of it while they scalpel their way through residency. And at the end of that, they are rewarded with yet more work—although this time, the grind is tempered by the sweet smell of fat checks, fast cars (which they park conspicuously outside the hospital) and their very own TV icon.
Still, ladies trawling the neuro-surge wards for their own Dr. McDreamies, beware! "You just can't be normal and work 100 hours a week for the rest of your life," said the Columbia lady student, adding that the neurosurgery residents' behavior was, at times, so "inappropriate" last year (think off-color jokes, for starters) that they were banned from doing rounds with med students.
Indeed, the on-call pager extension for Columbia's pediatric neuro-surge service is, reportedly, *-*-*-D-I-C-K.
ANESTHESIOLOGY
Quote:
Throughout the New York med-scape, this year's residents-to-be are lining up for a spot on the "other side" of the operating-room curtain. Once dismissed as a job for medicine's "techie" types, anesthesia has slowly been building its way up from a field that couldn't fill its slots (in 1996, Weill Cornell didn't place a single anesthesiology resident) to one of the trendy residencies-of-the-moment (in 2006, 10 Cornell students chose anesthesiology).
"Anesthesiology," said a Columbia student named Aaron, "is extremely popular this year."
The anesthesia lifestyle is certainly a big part of the appeal: You can work five days a week, rake in the ducats, and still have time to play catch with the kids. But for many people, the lure of anesthesia is also about the strange thrill of putting people under.
"The classic analogy is that it's like flying a plane," said Mr. Zandman. "There's takeoff and landing, which are really eventful, and then you sort of can put it on cruise control in the middle.
But," he added, "you have to love five minutes of fear."
FAMILY MEDICINE
Quote:
No matter how idealistic med students are when they crack the spines of their first-year anatomy books, after four years in New York's ambition mill—to say nothing of its debt-grinder—few retain enough of that early glow to go into family medicine. And if they do, it can mean only two things: They're Mother Teresa reincarnated—or they bombed their board exams.
The "poorhouse" wages are partly to blame. But the demise of the do-gooder family doc is also part of the larger trend away from the gritty grind of primary care toward the luxe appeal of the lifestyle specialties.
"People are discouraged from entering family medicine because it's just looked down upon," said the Columbia lady student.
A Mount Sinai student painted an even grimmer picture. "Even the students from Caribbean medical schools, which traditionally just take the leftovers in terms of residencies, even they don't want to go into family …. It's a suffering field."
ORTHOPEDICS
Quote:
Thirty or 40 years ago, when orthopedic surgeons were seen as the glorified carpenters of the medical trade, the word on the wards about students who opted for ortho was that they were "strong as an ox and half as smart."
These days, the "half as smart" no longer applies—students have to score top grades to get into this ultra-competitive residency—but the "strong as an ox" still resonates. Among the students who rush ortho, an impressive number are said to be "tawny and brawny," with 20-inch biceps, 18-inch necks and a mantel full of varsity trophies. One Mount Sinai senior said he was convinced one of his friends was trying to pack on 20 pounds of muscle to help guarantee an ortho placement.
Such a cult of beefiness hasn't always been friendly to lady applicants. "I think they guard their profession," said the Columbia student named Jon. But this has started to change in recent years, as a few fearless broads have begun breaking the bone-doctor barrier, determined to show they can retract with the big boys.
Still, there is room for progress. Said one woman who ultimately decided against orthopedics, "I realized I was trying to mentally prepare myself for being discriminated against."
PATHOLOGY
Quote:
In the bowels of every hospital, beneath shvitzing pipes and fluorescent lights, lurks a breed of doctor that thrills to the stench of formaldehyde and the chill of death, the company of a corpse over a live, kicking patient.
And in each med-school class, there are a handful of students—say one or two, maybe three—who can't wait to join them. These are the country's future pathologists, the quirky, mole-ish types with librarian hearts and Tim Burton minds. Some call them the mad scientists of the trade, others the "weirdos" who "like to be in the equivalent of broom closets cutting up people."
But like all true great oddballs, their day might be dawning.
"Everyone says pathology is the next derm," said Mr. Mahoney, "because the hours are great, the pay is wonderful, and right now it's not competitive …. People are starting to look at path."
EMERGENCY MEDICINE
Quote:
For the confident, the quick-thinking and the kids who grew up crushing on Dr. Doug (George Clooney) Ross, the emergency room is becoming an increasingly alluring place to hang their stethoscopes. A relatively new specialty, emergency medicine attracts the steely-nerved and intense, the students who don't shrivel up at the idea of making spot diagnoses—and then, say, jabbing a needle into a patient's chest to inflate their lungs.
"It's pretty dramatic," said Mr. Zandman.
Not everyone is so full of admiration, however. Because E.R. docs work "just" three 12-hour shifts a week, some deride it as shift-work, a flexible, well-paid way to be an M.D. But the emergency "shift workers" might have the last laugh.
"I think people would like more going into it, because there seems to be a shortage of emergency-room doctors," said Dr. Albert Kuperman, associate dean for educational affairs at Albert Einstein College of Medicine. "All the big hospitals are enlarging their emergency-medicine departments."
OBSTETRICS AND GYNECOLOGY
Quote:
Once the province of creepy, specula-wielding old guys, obstetrics and gynecology are all about estrogen these days—and, girl, can it be intense! Though it's not considered one of the "competitive" residencies, OB/GYN is nonetheless filled with hyper-competitive types—people who are determined to deliver babies, cure chlamydia and defend women's health, all while not sleeping, slaving for attendings, and facing a future of endless hours and skyrocketing insurance.
Needless to say, the effect can be traumatic.
"I definitely saw more residents cry during my OB/GYN rotation than I saw in the rest of medical school combined," said one Columbia student.
Indeed, Columbia's OB/GYN residency is somewhat notorious, at least among the med-student throng. While the reigning image of the young OB/GYN is of the feminist crusader, stridently devoted to helping her sex, the Columbia residentrix trends more towards sorority chick. Toward Mean Girls, in fact. Like Lindsay Lohan in scrubs.
"It really feels like an all-girls school, in bad ways," said the Columbia lady student, recalling the bleary mornings of her OB/GYN clerkship, when the residents would page her to do pre-rounds push-ups. "There is a lot of passive-aggressiveness."
PEDIATRICS
Quote:
Farewell, crusty old pediatricians with the icy stethoscopes, old-grandpa smell and bedside manner inspired by Dr. Spock. The lasses who want to become kiddie doctors today—and they are quite often lasses—are widely considered the "nicest" and "most compassionate" kids in the class, if not the most aggressive go-getters.
With its low pay and limited prestige value—these folks are "just" keeping our future generations healthy, after all—pediatrics tends to rank low on the competitive scale (the median pediatrician board score is the fifth lowest in the Match). But what the future peds might lack in cutthroat drive, they make up for in stubborn determination.
"Everyone understands that pediatricians go into pediatrics because they're passionate about taking care of children, and not because they want to make money," said pediatrician-to-be Celia Quinn. "So it's really hard to talk someone out of doing pediatrics."
PLASTIC SURGERY
Quote:
It's one of the strange laws of medicine that perhaps the most competitive field in the residency game is plastic surgery. And the students who set their sights on this prize—who go "straight to plastics," as they say—are of necessity among the most ambitious, driven and grindy students in the class. In 2005, they had the highest median board scores of all the students in the National Resident Matching Program (NRMP).
But don't worry, the leading lights of medicine aren't sinking their talents into tummy tucks and boob jobs—exclusively. As Jon, the Columbia student, explained, "To have done that well to match straight into plastics, you're going to have enough competitive spirit to want to be recognized as [a leader in your field]. So they're going to do a lot of reconstructive work, burn work, grafting."
At least at first. There is always time for face-lifts
PSYCHIATRY
Quote:
Funky glasses alert! More than 100 years after Freud unlocked the secrets of the unconscious, psychiatry remains the unquestioned realm of the bookish and bespectacled. Often mistaken for their neuro-peers, the psych folks are nonetheless their own individuated breed: a little dreamy, kinda cool, maybe with a background in the humanities or their own near-crazy experience. "They are people that are almost too empathic for medicine," said Ms. Quinn, "because they can't handle dealing with people's physical illness—or not being able to deal with [it]."
This hasn't always won them plaudits in the macho world of medicine, where doctors like to fancy themselves stiff-lipped doers rather than sensitive dreamers. "They're not real doctors," some physicians sneer—a fact that may explain psychiatry's relative unpopularity in large parts of the country. In 2005, according to data from the NRMP, psychiatry filled less than 64 percent of its slots with U.S. students and attracted applicants with the second-lowest median board scores.
But fear not, New Yorkers: Your addled nerves will still be well taken care of. Here, in Therapyville, psychiatry is a pretty good draw, thanks in part to several top psychiatric programs. "At Columbia," said the student named Jon, "it's really popular."
This is said to be particularly true of the grade grubs, the ones with the scores to get into ultra-competitive fields, and they even have a mnemonic to help them remember which are the styliest of the lifestyle specialties: If you want to be happy in medicine, follow the ROAD—Radiology, Ophthalmology, Anesthesiology and Dermatology. ROAD!
But is that all there is to it these days? In medicine, as in love, everyone has his or her type.
Each fall, when the weather turns gusty and romantic, the city's fourth-year medical students embark on a mass professional mating ritual designed to hook them up with the residency program of their dreams. The ritual is known as the Match, and like all frenzied dating rites, it is as much about defining who the students are as about finding their medical soul mates.
Are they ultra-alpha gunners with a latent urge to slice and dice? Then perhaps they'll become surgeons, overworked but well paid. Or maybe they tend more toward the brainy-hipster type, with dog-eared copies of Dora in their pockets. Then clearly psychiatry is the field for them.
This year's match frenzy kicked off on Sept. 1, when a vast electronic database began accepting student applications. By now, most students have already dispatched their carefully crafted personal statements to 10, 20, sometimes 40 programs, but a few poor souls are still scrambling—still trying to choose a specialty, in some cases—by the Nov. 1 deadline.
Then it's on to interviewing, praying and waiting for the big day: March 15, Match Day, when a giant HAL-like computer spits out a binding verdict for each student.
Why do some choose a life of treating rashes while others opt for curing cancer or fixing fractures?
The most popular theory of the moment is the aforementioned Lifestyle Theory. A slightly less cynical theory—in fact, a downright warm-and-fuzzy one—is the "mentoring" hypothesis, which states that students, like ducklings, follow the lead of their schools or advisors.
But at the end of the day, for many students, the big choice comes down, quite simply, to personality, attraction, even musk. Indeed, one of the great old medical-school clichés is that a practiced eye can identify which students will go into which fields on the first day of class. The Match, nearly four years later, just seals the deal.
So who's going to be setting your sprains, delivering your tykes or—God forbid—changing your catheter? Whoever they are, we just hope they'll take our insurance!
INTERNAL MEDICINE
Quote:
To hear many doctors describe it, there are two distinct breeds of modern-day physician: those who "do," which is to say, pin joints, slice open patients and zap people with radiation; and those who "think," which is to say, diagnose diseases, titrate medications and monitor symptoms.
The students who choose internal medicine—the largest residency in the Match—fall by and large into the latter category. Often hailed as the "intellectuals" of the med-student menagerie, they're the ones, according to Mount Sinai fourth-year student Bryan Mahoney, who "love thinking and thinking and thinking about diagnoses and treatment plans." They're the scrabble players and chess types, the crossword puzzlers and, in the case of oncologists, the baseball-card collectors. Why?
"Because oncologists [have to] know a lot of chemotherapy regimens in terms of scheduling, dosing, adjustments, all the minutiae," said Daniel Zandman, also from Mount Sinai, "they're masters of esoteric knowledge."
GENERAL SURGERY
Quote:
Some might call it indentured servitude: at least five years of hard, suturing labor in an environment of screaming supervisors, pressure-cooked peers and geysers of blood. But the students who choose general surgery can't seem to get enough of it. They're the kind of people who take pride at staying at the hospital far longer than they have to, who complain about the laws limiting residency hours, who elbow each other out of the way for the chance to scrub in on a 12-hour surgery. Think Tracy Flick with a scalpel.
Certainly prestige has something to do with it—surgery has long been regarded as the pinnacle of the profession—but it also goes deeper, subcutaneous.
"General surgery has people who really are passionate about doing it, because honestly, I look at them and think … 'Your lives are absolutely miserable,'" said Mr. Mahoney, who himself contemplated surgery before opting for anesthesiology. "But then I see 70-year-olds who still work 90 hours a week, and I have to admit they must sincerely love what they're doing—or hate their family. I can't tell which."
DERMATOLOGY
Quote:
Among the many accomplishments required of the would-be dermatologist are perfect skin (the pimply would never dare apply), a fine sense of fashion and a love of the well-shaped heel—high heel, that is.
"You can always spot the dermatologists among the medicine interns," said one lady student from the Columbia College of Physicians and Surgeons. "They're wearing sling-back heels with a white coat. They look like Clinique women."
"All you hear are their shoes clicking down the hallway," observed another Columbia student named Jon.
But don't be fooled by the clip-clopping of well-shod feet: The derm girls are no shuffle-lumps. Thanks to its good hours, high pay and cushy lifestyle—how many dermatological emergencies can you get a month?—dermatology has heel-clicked its way from being one of the easier fields in the medical kingdom to one of the most competitive. Said Dr. Suzanne Rose, associate dean for academic and student affairs at Mount Sinai: "You almost have to have a Ph.D." Or at least a good C.V.
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"Dermatology is for people who have the right résumé, but they're not the most intellectual," said one student. "It's the same kind of people who go into investment banking."
NEUROLOGICAL SURGERY
Quote:
For the overachievers of the overachieving set, the career of choice is, and perhaps only can be, neurosurgery.
Only a handful of students dare apply from each school, but, lucky them, should they match, their big reward is … work. At least six head-splitting, spine-slicing years of it while they scalpel their way through residency. And at the end of that, they are rewarded with yet more work—although this time, the grind is tempered by the sweet smell of fat checks, fast cars (which they park conspicuously outside the hospital) and their very own TV icon.
Still, ladies trawling the neuro-surge wards for their own Dr. McDreamies, beware! "You just can't be normal and work 100 hours a week for the rest of your life," said the Columbia lady student, adding that the neurosurgery residents' behavior was, at times, so "inappropriate" last year (think off-color jokes, for starters) that they were banned from doing rounds with med students.
Indeed, the on-call pager extension for Columbia's pediatric neuro-surge service is, reportedly, *-*-*-D-I-C-K.
ANESTHESIOLOGY
Quote:
Throughout the New York med-scape, this year's residents-to-be are lining up for a spot on the "other side" of the operating-room curtain. Once dismissed as a job for medicine's "techie" types, anesthesia has slowly been building its way up from a field that couldn't fill its slots (in 1996, Weill Cornell didn't place a single anesthesiology resident) to one of the trendy residencies-of-the-moment (in 2006, 10 Cornell students chose anesthesiology).
"Anesthesiology," said a Columbia student named Aaron, "is extremely popular this year."
The anesthesia lifestyle is certainly a big part of the appeal: You can work five days a week, rake in the ducats, and still have time to play catch with the kids. But for many people, the lure of anesthesia is also about the strange thrill of putting people under.
"The classic analogy is that it's like flying a plane," said Mr. Zandman. "There's takeoff and landing, which are really eventful, and then you sort of can put it on cruise control in the middle.
But," he added, "you have to love five minutes of fear."
FAMILY MEDICINE
Quote:
No matter how idealistic med students are when they crack the spines of their first-year anatomy books, after four years in New York's ambition mill—to say nothing of its debt-grinder—few retain enough of that early glow to go into family medicine. And if they do, it can mean only two things: They're Mother Teresa reincarnated—or they bombed their board exams.
The "poorhouse" wages are partly to blame. But the demise of the do-gooder family doc is also part of the larger trend away from the gritty grind of primary care toward the luxe appeal of the lifestyle specialties.
"People are discouraged from entering family medicine because it's just looked down upon," said the Columbia lady student.
A Mount Sinai student painted an even grimmer picture. "Even the students from Caribbean medical schools, which traditionally just take the leftovers in terms of residencies, even they don't want to go into family …. It's a suffering field."
ORTHOPEDICS
Quote:
Thirty or 40 years ago, when orthopedic surgeons were seen as the glorified carpenters of the medical trade, the word on the wards about students who opted for ortho was that they were "strong as an ox and half as smart."
These days, the "half as smart" no longer applies—students have to score top grades to get into this ultra-competitive residency—but the "strong as an ox" still resonates. Among the students who rush ortho, an impressive number are said to be "tawny and brawny," with 20-inch biceps, 18-inch necks and a mantel full of varsity trophies. One Mount Sinai senior said he was convinced one of his friends was trying to pack on 20 pounds of muscle to help guarantee an ortho placement.
Such a cult of beefiness hasn't always been friendly to lady applicants. "I think they guard their profession," said the Columbia student named Jon. But this has started to change in recent years, as a few fearless broads have begun breaking the bone-doctor barrier, determined to show they can retract with the big boys.
Still, there is room for progress. Said one woman who ultimately decided against orthopedics, "I realized I was trying to mentally prepare myself for being discriminated against."
PATHOLOGY
Quote:
In the bowels of every hospital, beneath shvitzing pipes and fluorescent lights, lurks a breed of doctor that thrills to the stench of formaldehyde and the chill of death, the company of a corpse over a live, kicking patient.
And in each med-school class, there are a handful of students—say one or two, maybe three—who can't wait to join them. These are the country's future pathologists, the quirky, mole-ish types with librarian hearts and Tim Burton minds. Some call them the mad scientists of the trade, others the "weirdos" who "like to be in the equivalent of broom closets cutting up people."
But like all true great oddballs, their day might be dawning.
"Everyone says pathology is the next derm," said Mr. Mahoney, "because the hours are great, the pay is wonderful, and right now it's not competitive …. People are starting to look at path."
EMERGENCY MEDICINE
Quote:
For the confident, the quick-thinking and the kids who grew up crushing on Dr. Doug (George Clooney) Ross, the emergency room is becoming an increasingly alluring place to hang their stethoscopes. A relatively new specialty, emergency medicine attracts the steely-nerved and intense, the students who don't shrivel up at the idea of making spot diagnoses—and then, say, jabbing a needle into a patient's chest to inflate their lungs.
"It's pretty dramatic," said Mr. Zandman.
Not everyone is so full of admiration, however. Because E.R. docs work "just" three 12-hour shifts a week, some deride it as shift-work, a flexible, well-paid way to be an M.D. But the emergency "shift workers" might have the last laugh.
"I think people would like more going into it, because there seems to be a shortage of emergency-room doctors," said Dr. Albert Kuperman, associate dean for educational affairs at Albert Einstein College of Medicine. "All the big hospitals are enlarging their emergency-medicine departments."
OBSTETRICS AND GYNECOLOGY
Quote:
Once the province of creepy, specula-wielding old guys, obstetrics and gynecology are all about estrogen these days—and, girl, can it be intense! Though it's not considered one of the "competitive" residencies, OB/GYN is nonetheless filled with hyper-competitive types—people who are determined to deliver babies, cure chlamydia and defend women's health, all while not sleeping, slaving for attendings, and facing a future of endless hours and skyrocketing insurance.
Needless to say, the effect can be traumatic.
"I definitely saw more residents cry during my OB/GYN rotation than I saw in the rest of medical school combined," said one Columbia student.
Indeed, Columbia's OB/GYN residency is somewhat notorious, at least among the med-student throng. While the reigning image of the young OB/GYN is of the feminist crusader, stridently devoted to helping her sex, the Columbia residentrix trends more towards sorority chick. Toward Mean Girls, in fact. Like Lindsay Lohan in scrubs.
"It really feels like an all-girls school, in bad ways," said the Columbia lady student, recalling the bleary mornings of her OB/GYN clerkship, when the residents would page her to do pre-rounds push-ups. "There is a lot of passive-aggressiveness."
PEDIATRICS
Quote:
Farewell, crusty old pediatricians with the icy stethoscopes, old-grandpa smell and bedside manner inspired by Dr. Spock. The lasses who want to become kiddie doctors today—and they are quite often lasses—are widely considered the "nicest" and "most compassionate" kids in the class, if not the most aggressive go-getters.
With its low pay and limited prestige value—these folks are "just" keeping our future generations healthy, after all—pediatrics tends to rank low on the competitive scale (the median pediatrician board score is the fifth lowest in the Match). But what the future peds might lack in cutthroat drive, they make up for in stubborn determination.
"Everyone understands that pediatricians go into pediatrics because they're passionate about taking care of children, and not because they want to make money," said pediatrician-to-be Celia Quinn. "So it's really hard to talk someone out of doing pediatrics."
PLASTIC SURGERY
Quote:
It's one of the strange laws of medicine that perhaps the most competitive field in the residency game is plastic surgery. And the students who set their sights on this prize—who go "straight to plastics," as they say—are of necessity among the most ambitious, driven and grindy students in the class. In 2005, they had the highest median board scores of all the students in the National Resident Matching Program (NRMP).
But don't worry, the leading lights of medicine aren't sinking their talents into tummy tucks and boob jobs—exclusively. As Jon, the Columbia student, explained, "To have done that well to match straight into plastics, you're going to have enough competitive spirit to want to be recognized as [a leader in your field]. So they're going to do a lot of reconstructive work, burn work, grafting."
At least at first. There is always time for face-lifts
PSYCHIATRY
Quote:
Funky glasses alert! More than 100 years after Freud unlocked the secrets of the unconscious, psychiatry remains the unquestioned realm of the bookish and bespectacled. Often mistaken for their neuro-peers, the psych folks are nonetheless their own individuated breed: a little dreamy, kinda cool, maybe with a background in the humanities or their own near-crazy experience. "They are people that are almost too empathic for medicine," said Ms. Quinn, "because they can't handle dealing with people's physical illness—or not being able to deal with [it]."
This hasn't always won them plaudits in the macho world of medicine, where doctors like to fancy themselves stiff-lipped doers rather than sensitive dreamers. "They're not real doctors," some physicians sneer—a fact that may explain psychiatry's relative unpopularity in large parts of the country. In 2005, according to data from the NRMP, psychiatry filled less than 64 percent of its slots with U.S. students and attracted applicants with the second-lowest median board scores.
But fear not, New Yorkers: Your addled nerves will still be well taken care of. Here, in Therapyville, psychiatry is a pretty good draw, thanks in part to several top psychiatric programs. "At Columbia," said the student named Jon, "it's really popular."
High Body Mass Index Increases Risk of Developing Cancer
An increasing body mass index (BMI) is associated with a significant increase in the risk for certain types of cancer, report researchers conducting the Million Women Study, a cohort study of women in the United Kingdom. Among postmenopausal women residing in the United Kingdom, 5% of all cancers are associated with excess body weight, according to a study published in the November 7 Online First issue of the BMJ. This is particularly true for endometrial cancer and adenocarcinoma of the esophagus, as approximately half of all cases within this population are attributed to being overweight or obese.
In an accompanying editorial, Eugenia E. Calle, PhD, from the American Cancer Society in Atlanta, Georgia, notes that there is already substantial observational evidence suggesting that increasing adiposity, both overall and central, is associated with an increasing risk for a number of cancers.
"The strongest empirical support for mechanisms to link obesity and cancer risk involves the metabolic and endocrine effects of obesity, and the alterations they induce in the production of peptide and steroid hormones," Dr. Calle writes. "The worldwide obesity epidemic shows no signs of abating, so insight into the mechanisms by which obesity contributes to the formation and progression of tumours is urgently needed, as are new approaches to intervene in this process."
Gillian Reeves, PhD, a statistical epidemiologist at the Cancer Epidemiology Unit, University of Oxford in the United Kingdom, and colleagues, evaluated the relationship between BMI and cancer in 1.2 million British women between the ages of 50 and 64 years, who participated in the Million Women Study. The researchers note that according to national statistics, currently 23% of all women in the United Kingdom are obese and 34% are overweight.
For their study, Dr. Reeves and her team assessed the relative risks (RRs) for incidence and mortality for all cancers, and for 17 specific types of cancer, according to BMI. The data were then adjusted for numerous confounders including age, geographic region, socioeconomic status, age at first birth, parity, smoking status, alcohol intake, physical activity, years since menopause, and use of hormone replacement therapy.
The follow-up period for cancer incidence averaged 5.4 years, during which time 45,037 incident cancers occurred. Average follow-up time for cancer-related mortality was 7.0 years, and 17,203 cancer-related deaths occurred during this time.
The researchers observed that women with a higher BMI tended to come from a lower socioeconomic class; had more children vs those with a lower BMI; and were also less likely to smoke, drink, and use hormone replacement therapy. But after adjusting the data for confounders, they found that increasing BMI was associated with an increased incidence of endometrial cancer, adenocarcinoma of the esophagus, kidney cancer, leukemia, multiple myeloma, pancreatic cancer, non-Hodgkin's lymphoma, ovarian cancer, and breast cancer in postmenopausal women and colorectal cancer in premenopausal women.
They note that there were also substantial differences in cancer risk based on menopausal status. For endometrial cancer, both premenopausal and postmenopausal women had a significantly increased risk with increasing BMI, but the risk was far greater for the latter. Positive trends in risk with BMI were seen in premenopausal women for colorectal cancer and malignant melanoma, and although an increased BMI was associated with a lower risk for breast cancer in premenopausal women, it raised the risk in postmenopausal women.
The results of their analysis also showed a significant inverse association between BMI and squamous cell carcinoma of the esophagus and lung cancer. In general, the relationship between BMI and cancer-related mortality was similar to that for incidence.
"Overall, these findings imply that 6000 new cancers annually in postmenopausal women in the UK are due to being overweight or obese, of which 4800 are due to obesity," the study authors conclude.
The Million Women Study is supported by Cancer Research United Kingdom, the UK Medical Research Council, and the UK National Health Service Breast Screening Programme. The study authors have disclosed no relevant financial relationships.
Clinical Context
Obesity is known to be an important cause of type 2 diabetes mellitus, hypertension, and dyslipidemia. In addition, the adverse metabolic effects of excess body fat accelerate the development of atheroma and increase the risk for coronary heart disease, stroke, and early death. Currently, there is substantial evidence that supports the link between increasing adiposity and a higher risk for many cancers. These cancers include adenocarcinoma of the esophagus, endometrial cancer, kidney cancer, and postmenopausal breast cancer.
The aim of this study was to examine the relationship between BMI and cancer incidence and mortality.
Study Highlights
* In this prospective cohort study, 1.2 million women aged 50 to 64 years from the United Kingdom were recruited into the Million Women Study between 1996 and 2001.
* On average, they were followed up for 5.4 years for cancer incidence and 7.0 years for cancer mortality.
* Women with a BMI of 25 to 29.9 kg/m2 were defined as overweight, and women with a BMI of 30 kg/m2 or more were obese, in accordance with the World Health Organization.
* The main outcome measures included RRs for incidence and mortality for all cancers and for 17 specific types of cancer according to BMI.
* Data were adjusted for several confounders including age, geographic region, socioeconomic status, age at first birth, parity, smoking status, alcohol intake, physical activity, years since menopause, and use of hormone replacement therapy.
* Results revealed that 45,037 incident cancers and 17,203 deaths from cancer occurred in the follow-up period.
* Increasing BMI was associated with an increased incidence of endometrial cancer (trend in RR per 10 units, 2.89; 95% confidence interval [CI], 2.62 - 3.18), adenocarcinoma of the esophagus (RR, 2.38; 95% CI, 1.59 - 3.56), kidney cancer (RR, 1.53; 95% CI, 1.27 - 1.84), leukemia (RR, 1.50; 95% CI, 1.23 - 1.83), multiple myeloma (RR, 1.31; 95% CI, 1.04 - 1.65), pancreatic cancer (RR, 1.24; 95% CI, 1.03 - 1.48), non-Hodgkin's lymphoma (RR, 1.17; 95% CI, 1.03 - 1.34), ovarian cancer (RR, 1.14; 95% CI, 1.03 - 1.27), all cancers combined (RR, 1.12; 95% CI, 1.09 - 1.14), breast cancer in postmenopausal women (RR, 1.40; 95% CI, 1.31 - 1.49), and colorectal cancer in premenopausal women (RR, 1.61; 95% CI, 1.05 - 2.48).
* In general, the relationship between BMI and mortality was similar to that for incidence.
* For colorectal cancer, malignant melanoma, and breast and endometrial cancers, the effect of BMI on risk differed significantly according to menopausal status.
* The estimated proportion of all cancers attributable to being overweight or obese among postmenopausal women was 5%.
* For endometrial cancer and adenocarcinoma of the esophagus, approximately half of cases (51% and 48%, respectively) were attributable to being overweight or obese.
Pearls for Practice
* There is evidence to support that obesity is linked to adenocarcinoma of the esophagus, endometrial cancer, kidney cancer, and postmenopausal breast cancer.
* Among postmenopausal women in this study, 5% of all cancers are attributable to women being overweight or obese. Increasing BMI is associated with a significant increase in the risk for cancer for 10 of 17 specific types examined.
In an accompanying editorial, Eugenia E. Calle, PhD, from the American Cancer Society in Atlanta, Georgia, notes that there is already substantial observational evidence suggesting that increasing adiposity, both overall and central, is associated with an increasing risk for a number of cancers.
"The strongest empirical support for mechanisms to link obesity and cancer risk involves the metabolic and endocrine effects of obesity, and the alterations they induce in the production of peptide and steroid hormones," Dr. Calle writes. "The worldwide obesity epidemic shows no signs of abating, so insight into the mechanisms by which obesity contributes to the formation and progression of tumours is urgently needed, as are new approaches to intervene in this process."
Gillian Reeves, PhD, a statistical epidemiologist at the Cancer Epidemiology Unit, University of Oxford in the United Kingdom, and colleagues, evaluated the relationship between BMI and cancer in 1.2 million British women between the ages of 50 and 64 years, who participated in the Million Women Study. The researchers note that according to national statistics, currently 23% of all women in the United Kingdom are obese and 34% are overweight.
For their study, Dr. Reeves and her team assessed the relative risks (RRs) for incidence and mortality for all cancers, and for 17 specific types of cancer, according to BMI. The data were then adjusted for numerous confounders including age, geographic region, socioeconomic status, age at first birth, parity, smoking status, alcohol intake, physical activity, years since menopause, and use of hormone replacement therapy.
The follow-up period for cancer incidence averaged 5.4 years, during which time 45,037 incident cancers occurred. Average follow-up time for cancer-related mortality was 7.0 years, and 17,203 cancer-related deaths occurred during this time.
The researchers observed that women with a higher BMI tended to come from a lower socioeconomic class; had more children vs those with a lower BMI; and were also less likely to smoke, drink, and use hormone replacement therapy. But after adjusting the data for confounders, they found that increasing BMI was associated with an increased incidence of endometrial cancer, adenocarcinoma of the esophagus, kidney cancer, leukemia, multiple myeloma, pancreatic cancer, non-Hodgkin's lymphoma, ovarian cancer, and breast cancer in postmenopausal women and colorectal cancer in premenopausal women.
They note that there were also substantial differences in cancer risk based on menopausal status. For endometrial cancer, both premenopausal and postmenopausal women had a significantly increased risk with increasing BMI, but the risk was far greater for the latter. Positive trends in risk with BMI were seen in premenopausal women for colorectal cancer and malignant melanoma, and although an increased BMI was associated with a lower risk for breast cancer in premenopausal women, it raised the risk in postmenopausal women.
The results of their analysis also showed a significant inverse association between BMI and squamous cell carcinoma of the esophagus and lung cancer. In general, the relationship between BMI and cancer-related mortality was similar to that for incidence.
"Overall, these findings imply that 6000 new cancers annually in postmenopausal women in the UK are due to being overweight or obese, of which 4800 are due to obesity," the study authors conclude.
The Million Women Study is supported by Cancer Research United Kingdom, the UK Medical Research Council, and the UK National Health Service Breast Screening Programme. The study authors have disclosed no relevant financial relationships.
Clinical Context
Obesity is known to be an important cause of type 2 diabetes mellitus, hypertension, and dyslipidemia. In addition, the adverse metabolic effects of excess body fat accelerate the development of atheroma and increase the risk for coronary heart disease, stroke, and early death. Currently, there is substantial evidence that supports the link between increasing adiposity and a higher risk for many cancers. These cancers include adenocarcinoma of the esophagus, endometrial cancer, kidney cancer, and postmenopausal breast cancer.
The aim of this study was to examine the relationship between BMI and cancer incidence and mortality.
Study Highlights
* In this prospective cohort study, 1.2 million women aged 50 to 64 years from the United Kingdom were recruited into the Million Women Study between 1996 and 2001.
* On average, they were followed up for 5.4 years for cancer incidence and 7.0 years for cancer mortality.
* Women with a BMI of 25 to 29.9 kg/m2 were defined as overweight, and women with a BMI of 30 kg/m2 or more were obese, in accordance with the World Health Organization.
* The main outcome measures included RRs for incidence and mortality for all cancers and for 17 specific types of cancer according to BMI.
* Data were adjusted for several confounders including age, geographic region, socioeconomic status, age at first birth, parity, smoking status, alcohol intake, physical activity, years since menopause, and use of hormone replacement therapy.
* Results revealed that 45,037 incident cancers and 17,203 deaths from cancer occurred in the follow-up period.
* Increasing BMI was associated with an increased incidence of endometrial cancer (trend in RR per 10 units, 2.89; 95% confidence interval [CI], 2.62 - 3.18), adenocarcinoma of the esophagus (RR, 2.38; 95% CI, 1.59 - 3.56), kidney cancer (RR, 1.53; 95% CI, 1.27 - 1.84), leukemia (RR, 1.50; 95% CI, 1.23 - 1.83), multiple myeloma (RR, 1.31; 95% CI, 1.04 - 1.65), pancreatic cancer (RR, 1.24; 95% CI, 1.03 - 1.48), non-Hodgkin's lymphoma (RR, 1.17; 95% CI, 1.03 - 1.34), ovarian cancer (RR, 1.14; 95% CI, 1.03 - 1.27), all cancers combined (RR, 1.12; 95% CI, 1.09 - 1.14), breast cancer in postmenopausal women (RR, 1.40; 95% CI, 1.31 - 1.49), and colorectal cancer in premenopausal women (RR, 1.61; 95% CI, 1.05 - 2.48).
* In general, the relationship between BMI and mortality was similar to that for incidence.
* For colorectal cancer, malignant melanoma, and breast and endometrial cancers, the effect of BMI on risk differed significantly according to menopausal status.
* The estimated proportion of all cancers attributable to being overweight or obese among postmenopausal women was 5%.
* For endometrial cancer and adenocarcinoma of the esophagus, approximately half of cases (51% and 48%, respectively) were attributable to being overweight or obese.
Pearls for Practice
* There is evidence to support that obesity is linked to adenocarcinoma of the esophagus, endometrial cancer, kidney cancer, and postmenopausal breast cancer.
* Among postmenopausal women in this study, 5% of all cancers are attributable to women being overweight or obese. Increasing BMI is associated with a significant increase in the risk for cancer for 10 of 17 specific types examined.
STROKE: Remember The 1st Three Steps
STROKE IDENTIFICATION:
During a party, a friend stumbled and took a little fall - she assured everyone that she was fine (they offered to call paramedics) and just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm , Ingrid passed away.) She had suffered a stroke at the party. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some ?don't die. They end up in a helpless, hopeless condition instead. It only takes a minute to read this...A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke... totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.
RECOGNIZING A STROKE
Thank God for the sense to remember the "3" steps, STR . Read and Learn! Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke. Now doctors say a bystander can recognize a stroke by asking three simple questions:
S *Ask the individual to SMILE .
T *Ask the person to TALK , to SPEAK A SIMPLE SENTENCE (Coherently: It is sunny out today.)
R *Ask him or her to RAISE BOTH ARMS.
{NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out their tongue... if the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke} If he or she has trouble with ANY ONE of these tasks, call emergency services immediately and describe the symptoms.
This is URGENT A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved.
During a party, a friend stumbled and took a little fall - she assured everyone that she was fine (they offered to call paramedics) and just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm , Ingrid passed away.) She had suffered a stroke at the party. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some ?don't die. They end up in a helpless, hopeless condition instead. It only takes a minute to read this...A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke... totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.
RECOGNIZING A STROKE
Thank God for the sense to remember the "3" steps, STR . Read and Learn! Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke. Now doctors say a bystander can recognize a stroke by asking three simple questions:
S *Ask the individual to SMILE .
T *Ask the person to TALK , to SPEAK A SIMPLE SENTENCE (Coherently: It is sunny out today.)
R *Ask him or her to RAISE BOTH ARMS.
{NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out their tongue... if the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke} If he or she has trouble with ANY ONE of these tasks, call emergency services immediately and describe the symptoms.
This is URGENT A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved.
Believe it or not
I cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was rdanieg The phaonmneal pweor of the hmuan mnid Aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it deosn't mttaer inwaht oredr the ltteers in a wrod are, the olny iprmoatnt tihng is taht the frist and lsat ltteer be in the rghit pclae. The rset can be a taotl mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Amzanig huh? yaeh and I awlyas thought slpeling was ipmorantt ..
Monday, November 26, 2007
What’s happiness?
It is not easy to define happiness. Individual preferences overtake each other’s description of the same.
People often ask: “where do we find happiness?” money,richness, beauty, coloures, scents, nature etc. all give us immense pleasure. God has created this beautiful world only to enchant the occupants. There is some pleasure, which we can drive without directing our efforts towards it.
The case of nature is the best example. The only thing we need is the inclination.
Like the ways to God, the roads to happiness are also many. To derive pleasure out of one’s life is not something that comes directly from god. It lies within us. What we need to rekindle this state of mind is willingness to think wisely and positively.
The mind is a hotbed of emotions. To have the right mix of emotions, we need a better actor in us. How to emote to get the right mix of the mindset is what
matters. Simple things can add colour to our disenchanted life if we have the time to pause and think.
Plenty of anything cannot make one happy. But having this plenty disbursed to the have-nots make us feel the joy of others.
There were two neighbours. One was rich and the other the poor. Both were preparing for Diwali. The rich man decorated his house elaborately and illuminated it with lights. The poor man only lit a diya at the entrance of his house.
They were both intimated by god that he would visit them on New year. The rich man was happy that he had outdone his neighbour. The poor man was happy that his diya was glowing in the darkness and that its light had a divine touch.
Finally, God came to settle their claims. His attention was first drawn to the single
diya that had lit up an entire dark patch. God was attracted to this and did not even look at the brightly-lit house on the other side.
The verdict was clear. We all yearn for happiness. Having plenty does not mecessarily guarantee happiness. So don’t wait for heaven to come to you. Make efforts to steer your mind to a state of happiness by sharing the little you
have. Even a single lamp can cheer up a completely dark area. Light it and you will find happiness shining there in your inner self.
People often ask: “where do we find happiness?” money,richness, beauty, coloures, scents, nature etc. all give us immense pleasure. God has created this beautiful world only to enchant the occupants. There is some pleasure, which we can drive without directing our efforts towards it.
The case of nature is the best example. The only thing we need is the inclination.
Like the ways to God, the roads to happiness are also many. To derive pleasure out of one’s life is not something that comes directly from god. It lies within us. What we need to rekindle this state of mind is willingness to think wisely and positively.
The mind is a hotbed of emotions. To have the right mix of emotions, we need a better actor in us. How to emote to get the right mix of the mindset is what
matters. Simple things can add colour to our disenchanted life if we have the time to pause and think.
Plenty of anything cannot make one happy. But having this plenty disbursed to the have-nots make us feel the joy of others.
There were two neighbours. One was rich and the other the poor. Both were preparing for Diwali. The rich man decorated his house elaborately and illuminated it with lights. The poor man only lit a diya at the entrance of his house.
They were both intimated by god that he would visit them on New year. The rich man was happy that he had outdone his neighbour. The poor man was happy that his diya was glowing in the darkness and that its light had a divine touch.
Finally, God came to settle their claims. His attention was first drawn to the single
diya that had lit up an entire dark patch. God was attracted to this and did not even look at the brightly-lit house on the other side.
The verdict was clear. We all yearn for happiness. Having plenty does not mecessarily guarantee happiness. So don’t wait for heaven to come to you. Make efforts to steer your mind to a state of happiness by sharing the little you
have. Even a single lamp can cheer up a completely dark area. Light it and you will find happiness shining there in your inner self.
iPods Could Kill: Study
If the world wasn’t already worried enough about electromagnetic radiation from cell phones, Apple now provides us with another source from which to fuel our anxieties, particularly if we’re old.
According to a study presented by a 17-year-old high school student to a meeting of heart specialists on Thursday, iPods can cause pacemakers to malfunction and even fail by interfering with the electromagnetic equipment monitoring the heart.
If you believe that animal testing is cruel, try waving iPods in front of 100 old folk with a mean age of 77, all fitted with Pacemakers.
The study tested the effect of the iPod on each pacemaker patient. Electrical interference was detected half of the time when the iPod was held just 2 inches from the patient’s chest for 5 to 10 seconds. In some cases, the iPods caused interference when held 18 inches from the chest.
Interfering with the telemetry equipment caused the pacemakers to misread the heart’s pacing and in one case caused the pacemaker to stop functioning altogether.
The study was held at the Thoracic and Cardiovascular Institute at Michigan State University. The results were presented at the Heart Rhythm Society annual meeting in Denver.
Fake Steve Jobs, always quick to put the flame out on any negative press for Apple, writes that Apple has known about the issue for quite some time. “And we’re happy about it. We even cranked up the voltage on our new models. Thing is, we really don’t want old people using iPods”. Given this study it’s probably wise that they didn’t.
According to a study presented by a 17-year-old high school student to a meeting of heart specialists on Thursday, iPods can cause pacemakers to malfunction and even fail by interfering with the electromagnetic equipment monitoring the heart.
If you believe that animal testing is cruel, try waving iPods in front of 100 old folk with a mean age of 77, all fitted with Pacemakers.
The study tested the effect of the iPod on each pacemaker patient. Electrical interference was detected half of the time when the iPod was held just 2 inches from the patient’s chest for 5 to 10 seconds. In some cases, the iPods caused interference when held 18 inches from the chest.
Interfering with the telemetry equipment caused the pacemakers to misread the heart’s pacing and in one case caused the pacemaker to stop functioning altogether.
The study was held at the Thoracic and Cardiovascular Institute at Michigan State University. The results were presented at the Heart Rhythm Society annual meeting in Denver.
Fake Steve Jobs, always quick to put the flame out on any negative press for Apple, writes that Apple has known about the issue for quite some time. “And we’re happy about it. We even cranked up the voltage on our new models. Thing is, we really don’t want old people using iPods”. Given this study it’s probably wise that they didn’t.
Good Night's Sleep Key to Strong Memories
Scientists are finding new evidence that a good night's rest plays a crucial role in cementing memories formed during the day.
One new study has identified a brain region involved, along with the hippocampus, in creating memories of the day's activities during sleep. Another study suggests melatonin, a hormone involved in regulating our day-night cycle, or "circadian rhythm," acts to suppress the formation of new memories as bedtime nears, perhaps in an effort to give memories made earlier in the day a chance to be prepared for long-term storage.
Both studies are detailed in the Nov. 16 issue of the journal Science.
Prepping for storage
In 1993, scientists learned that the hippocampus "replays" the day's events during sleep. The process appears to be important for consolidating new memories and preparing them for long-term storage in other brain areas.
In one of the two latest studies, David Euston of the University of Arizona and his colleagues found that the medial prefrontal cortex, a brain region implicated in the retrieval of memories from the distant past, was also active during learning and replayed the day's events during sleep. And similar to memory replay in the hippocampus, events were speeded up when reviewed.
Euston's team recorded activity in the medial prefrontal cortices of rats as they ran on a track and afterward while they slept. When the rats were running, brain cells in the medial prefrontal cortex fired off electrical signals in specific patterns over time. The patterns of electrical firing corresponded to memories.
"You see a series of these patterns," Euston said. "You can imagine at point A there'd be one pattern of cells firing, and at point B there's another pattern."
The rats' brains were scanned again as they rested after performing the task. "When the rats go to sleep, we can continue to monitor the activity of the cells, and we look for a re-expression of those same activity patterns," Euston told LiveScience.
Memory fast forward
The researchers found the patterns, but discovered they were being replayed about seven times faster than when the rats were actually performing their tasks.
"In the maze, the rat might take 1.5 seconds to get from point A to point B," Euston said. "When the rat goes to sleep, you see those patterns replaying, and the entire thing takes only 200 milliseconds."
The researchers say the medial prefrontal cortex's fast-forward replay of the day's events could be evidence that our brains can process information much faster when not busy with real-world tasks.
"When you're awake and performing things, the brain has to go at the pace at which your behavior is unfolding," Euston said. "If you're reaching for a cup, the cells in your motor cortex have to be expressing the patterns of activity that will guide your hand to the cup. When you go to sleep you don't have that constraint anymore."
Brain-imaging studies involving people have also shown the medial prefrontal cortex to be active during learning, so the same processes could apply to humans as well, Euston said.
Melatonin memories
In order to ensure that memory consolidation proceeds smoothly, our brains might have a built-in mechanism that inhibits the formation of new memories as we get closer to bedtime, the second new study finds.
Gregg Roman at the University of Houston in Texas and his colleagues linked the hormone melatonin to the quality of memories formed in zebrafish . They showed that zebrafish trained to perform a task during the day, when melatonin levels are typically low, remembered what they were supposed to do better than if they were trained at night, when levels of the hormone peak.
As further support for melatonin's role in memory, the team found that fish administered with melatonin during the day had trouble forming new memories, and that night training which occurred in the presence of constant lights (which inhibits melatonin secretion) yielded strong memories.
Roman speculates melatonin blocks new memory formation so that older experiences accumulated during the day have a chance to solidify.
Melatonin is an important hormone in every creature from cockroaches to humans, so it's likely the zebrafish findings also apply to humans, Roman said.
So does that mean learning is best done during the day and not at night?
Maybe, Roman said, but he points out that the human memory system is much more complex than that of the zebrafish, and while melatonin should inhibit memory formation at night in us, its effects will be buffered by other hormones and other brain components.
"I would presuppose that learning could occur at night in humans," Roman said. "We have a much higher capacity for learning than zebrafish."
One new study has identified a brain region involved, along with the hippocampus, in creating memories of the day's activities during sleep. Another study suggests melatonin, a hormone involved in regulating our day-night cycle, or "circadian rhythm," acts to suppress the formation of new memories as bedtime nears, perhaps in an effort to give memories made earlier in the day a chance to be prepared for long-term storage.
Both studies are detailed in the Nov. 16 issue of the journal Science.
Prepping for storage
In 1993, scientists learned that the hippocampus "replays" the day's events during sleep. The process appears to be important for consolidating new memories and preparing them for long-term storage in other brain areas.
In one of the two latest studies, David Euston of the University of Arizona and his colleagues found that the medial prefrontal cortex, a brain region implicated in the retrieval of memories from the distant past, was also active during learning and replayed the day's events during sleep. And similar to memory replay in the hippocampus, events were speeded up when reviewed.
Euston's team recorded activity in the medial prefrontal cortices of rats as they ran on a track and afterward while they slept. When the rats were running, brain cells in the medial prefrontal cortex fired off electrical signals in specific patterns over time. The patterns of electrical firing corresponded to memories.
"You see a series of these patterns," Euston said. "You can imagine at point A there'd be one pattern of cells firing, and at point B there's another pattern."
The rats' brains were scanned again as they rested after performing the task. "When the rats go to sleep, we can continue to monitor the activity of the cells, and we look for a re-expression of those same activity patterns," Euston told LiveScience.
Memory fast forward
The researchers found the patterns, but discovered they were being replayed about seven times faster than when the rats were actually performing their tasks.
"In the maze, the rat might take 1.5 seconds to get from point A to point B," Euston said. "When the rat goes to sleep, you see those patterns replaying, and the entire thing takes only 200 milliseconds."
The researchers say the medial prefrontal cortex's fast-forward replay of the day's events could be evidence that our brains can process information much faster when not busy with real-world tasks.
"When you're awake and performing things, the brain has to go at the pace at which your behavior is unfolding," Euston said. "If you're reaching for a cup, the cells in your motor cortex have to be expressing the patterns of activity that will guide your hand to the cup. When you go to sleep you don't have that constraint anymore."
Brain-imaging studies involving people have also shown the medial prefrontal cortex to be active during learning, so the same processes could apply to humans as well, Euston said.
Melatonin memories
In order to ensure that memory consolidation proceeds smoothly, our brains might have a built-in mechanism that inhibits the formation of new memories as we get closer to bedtime, the second new study finds.
Gregg Roman at the University of Houston in Texas and his colleagues linked the hormone melatonin to the quality of memories formed in zebrafish . They showed that zebrafish trained to perform a task during the day, when melatonin levels are typically low, remembered what they were supposed to do better than if they were trained at night, when levels of the hormone peak.
As further support for melatonin's role in memory, the team found that fish administered with melatonin during the day had trouble forming new memories, and that night training which occurred in the presence of constant lights (which inhibits melatonin secretion) yielded strong memories.
Roman speculates melatonin blocks new memory formation so that older experiences accumulated during the day have a chance to solidify.
Melatonin is an important hormone in every creature from cockroaches to humans, so it's likely the zebrafish findings also apply to humans, Roman said.
So does that mean learning is best done during the day and not at night?
Maybe, Roman said, but he points out that the human memory system is much more complex than that of the zebrafish, and while melatonin should inhibit memory formation at night in us, its effects will be buffered by other hormones and other brain components.
"I would presuppose that learning could occur at night in humans," Roman said. "We have a much higher capacity for learning than zebrafish."
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