Laughter is the Best Medicine :)

The following is a post from my colleague, Dr. Benjamin Voss.  Great information-enjoy!

Is Laughter really the Best Medicine?                                                                

 

This talk was originally presented on July 29, 2010 at Washington University School of Medicine Grand Rounds. This is backed by real research. Smile, it’s true.

 

I have always been told the laughter is the best medicine and when I finished residency, I was determined to investigate if this is indeed true. The story of the The Roseto Effect peaked my interest. In the 1950s, a visiting professor named Dr. Stewart Wolf noted that he rarely found anyone from Roseto, Pennsylvania under the age of 65 with heart disease. Their diet was high in fat consisting of lard, pizza, and biscotti, they smoked heavily, and the majority of them were overweight. After years of research, he concluded that their unique Community where they recreated their Italian heritage was health protective. They had three-generation family meals, talked to each other in the street, respected elders, enjoyed the calming effect of church, and had many civic organizations. The protective social structure insulated them from the pressures of the modern world.

 

Depression is obviously bad. However, its severity is traditionally underappreciated. Depression is an independent risk factor for developing heart disease and dying regardless of one’s other medial problems. Answering yes to “During the last month have you felt so sad, discouraged, hopeless, or had so many problems that you wondered if anything was worthwhile?" more than doubled one’s risk of developing heart disease. People with a Type A personality have a 2-fold increase risk of having a heart attack. Depression after a heart attack predicts the likelihood of death as much as developing heart failure after the heart attack. There are many physiological theories and explanations for this, but the key is that one’s body has “chronic sympathetic activation,” or a stressed body and mind all the time.

 

Positive affect, defined as “the experience of pleasurable emotions such as joy, happiness, excitement, enthusiasm, and contentment,” has the opposite effect on people. Comedian Bill Cosby once said “Immortality is a long shot, I admit. But somebody has to be first.” While humor is his occupation, the research actually supports his idea. Studies have shown people with a positive affect have better immune function and a greater resistance to upper respiratory infections. People who have hope and curiosity have lower blood pressure. Agreeing with one of the following four statements:“I felt that I was just as good as other people,” “I felt hopeful about the future,” “I was happy,” and “I enjoyed life,” showed a lower risk of stroke. While depression increases the risk of death in diabetics, positive affect lowers that risk. Hospitalized patients who answered yes to “I still enjoy things I used to enjoy” lived longer than patients who disagreed. Positive affect lowers the risk of death after a heart attack and in patients with AIDS. The physiological explanation here is enhanced parasympathetic activation, meaning lower heart rate, lower blood pressure, and increased glucose tolerance.

 

“Behavioral activation interventions” have been studied and these include increasing the frequency of enjoyable hobbies and activities. Exercise has been shown to reduce depression. Nutritional counseling in order to avoid overeating when stressed is important. Stress management options include yoga, vacations, and music. Social support is critical and walking groups are a great way to exercise and build community. So while it is critically important to take your medication and listen to your doctor, try adding a laugh or two to your daily routine.

 

Thank you Dr. Fuller for this opportunity to be a guest blogger. I do my best to get him to laugh everyday. 

The Statin Scare

Many of you may have heard the recent news in regards to the FDA updating the risk profile for the common cholesterol lowering medications referred to as "statins."  As portrayed by the media, if you take this medication you are sure to end up with dementia and crippling diabetes.  Let me share my perspective on this situation.

First of all, it must be reemphasized that statin medications have unequivocally resulted in lower rates of death due to heart disease.  Even in the short time that I have been in practice I have seen far fewer patients develop heart disease, suffer heart attacks or had the need for procedures and surgery.  This certainly is not due to the population eating better and getting more exercise since obesity rates have steadily climbed higher and higher over that same time period. It is due to driving down cholesterol levels, largely from statin medications.  This has been quantified to about a 25% decrease chance of death in those who take the medication.  That is very substantial.

Now to the cautions.  I'll be the first one to say that I do not want to take one of these medications.  I put a lot of time and effort into exercising regularly and eating right so that I do not have to.  I have grandparents who had heart disease and stroke.  My father was recently put on a statin medication.  I may have to take one some day but I will do all in my power to lower my risk through non pharmaceutical means first.  If my levels raise despite my best efforts I'll have no second thoughts about trying a statin medication.

The FDA highlighted two main concerns.  The first is the "reports of memory loss."  This sounds like the medicine can cause dementia.  That is as scary a thought as having cancer.  I have dementia in my family as well and have no desire to head down that path.  What has been reported is not dementia but more of a "brain fog." Patients describe this as muddled thinking, not being as sharp.  The good news is that this is totally reversible.  It goes away when the medications is stopped.  It happens quite infrequently but I have seen it in my practice on occasion.

The second concern is for elevated blood sugar readings.  As a prescribing physician I have not seen diabetic patients have problems with their blood sugars after taking the statin medications.  I wonder if this is related to the population becoming more obese.  That would be a reason both for having elevated cholesterol levels requiring medication as well as being predisposed to developing diabetes.  It is important to understand that the lower cardiovascular risk seen in studies using statin are the most robust in the subset of patients who have diabetes.  It is currently considered to be bad practice to avoid statin drugs in diabetics whose LDL cholesterol values are over 100 mg/dl.  Dr. Amy Egan, the deputy director of safety for the FDA's metabolism and endocrinology division summed it by saying, “Clearly we think that the heart benefit of statins outweighs this small increased risk, But what this means for patients taking statins and the health care professionals prescribing them is that blood-sugar levels may need to be assessed after instituting statin therapy” (link here).


If you have concerns, by all means share those with your physician but don't stop taking your medication till you do.  These are life saving medications.  They need to be treated with care, yes.  The risks of not taking them may well be higher than the risk of stopping them.  

The Wicked Whoop

One of medicine's achievements is the near eradication of  of whooping cough.  Or so we thought.  This potentially devastating illness often attacks the very young resulting in spasm after spasm of violent coughing.  It is now also making a resurgence in adults.  The force of air through the throat results in a "whooping" noise, thus the name.  The cough is not only severe it is doggedly persistent, lasting for months in many patients.  There are antibiotics which treat the infection but even if started early, the cough may linger for months.  The disease is caused by the bacteria Bordetella Purtussis.  It is the "P" in the childhood vaccine DPT.  As children have been vaccinated, the incidence of whooping cough has dropped significantly in our society.  Given the aging population of those who have received the vaccine, there is now a sizeable number of adults who have never had whooping cough.  It was felt that the vaccine provided life long immunity until a few years ago when groups of cases started popping up.  We have now learned that adults need a booster.  A new form of the tetanus vaccine is available called the Tdap, which accomplishes just that.  It is recommended to be given immediately to anyone who has close contact with infants.  The rest of us should receive it ten years after our last tetanus shot.  It is a completely killed vaccine, not a partially live one. It is quite safe.  The most common effects are a sore arm or a headache.  Many people are not familiar with how bad whooping cough can be.  Let me assure you, it is worth having the pain of the vaccine.  Don't let the wicked whoop snatch you.  Ask your doctor about getting your vaccine.