Have Diabetes-Related Complications? Exercises to Avoid

Chances are, you've heard about the benefits of exercise so often, you could list them in your sleep: it can lower your bad cholesterol and raise your good cholesterol, help you lose weight, reduce body fat, reduce your stress level, and give you more energy. But if you're dealing with any diabetes-related complications, the rules are a little different.

"The benefits of exercise are enormous," says Kellie Rodriguez, RN, CDE, CPT, director of patient education at the Diabetes Research Institute. "But you need to be super-careful about doing exercise that is high impact, or that involves lifting weights and straining, when you have certain complications from diabetes."

Here are a few of the complications that should be a yellow light for you. Depending upon your doctor's recommendation, you'll be able to switch to a different form of fitness. There is an exercise program out there for nearly everyone; it's just a matter of finding one that's right for you.

● Peripheral neuropathy. When this complication occurs, an individual may not have good sensation in the feet, Rodriguez explains. And if you have no sensation, you could injure yourself while running, jogging, or skiing-or even just walking-and not even realize it. "This can be incredibly dangerous," Rodriguez says. "If you have peripheral neuropathy, after exercise you need to look at the bottoms of your feet for scratches, cuts, and blisters." Also be sure to wear cotton socks and well-fitting, comfortable shoes for exercise. One good activity for those who aren't supposed to be jogging, Rodriguez suggests, is swimming.

● Eye disease (diabetic retinopathy). If you develop this condition, you'll want to stay away from weight lifting. "It can raise the blood pressure, which can lead to bleeding in the back of the eye," Rodriguez says. Be sure to check with your eye specialist to find out what types of exercise are safe for you to do.  

 ● Autonomic neuropathy. This condition affects the nerves that control such organs as the bladder, genitals, and intestinal tract. When an individual has autonomic neuropathy, he may no longer feel the symptoms of low blood sugar or he may even have a silent heart attack, Rodriguez explains. Be sure to get medical clearance before doing exercise, and plan a fitness program carefully.

Most individuals will be able to safely do a variety of exercises, says Hope Warshaw, RD, CDE, MMSc, co-author of the "Real-Life Guide to Diabetes."  "Your doctor may want you to see an exercise physiologist or physical therapist to help you figure out what exercise is right for you," she says. "For people with type 2 diabetes, exercise has myriad benefits.  It's all about finding the right program."

When you do choose an exercise program, be safe by following some simple rules. Wear your medical identification bracelet or necklace, carry your ID in your pocket, and always travel with food or glucose tablets to treat low blood sugar. Check your blood sugar regularly if you exercise for over an hour: you may need a snack before you finish.

Sources:

"What I need to know about physical activity and diabetes." National Diabetes Information Clearinghouse (NDIC), National Institutes of Diabetes and Digestive and Kidney Diseases,  National Institutes of Health.
http://diabetes.niddk.nih.gov/dm/pubs/physical_ez/index.aspx

Colberg, Sheri R., Sigal, Ronald J., Fernall, Bo, Regensteiner, Judith G., Blissmer, Bryan J., Rubin, Richard R., Chasan-Taber, Lisa, Albright, Ann L., Braun, Barry. "Exercise and Type 2 diabetes." Diabetes Care. Volume 33, Number 12, December 2010.
http://care.diabetesjournals.org/content/33/12/e147.abstract

Considering a Cardiac Implant? What You Should Know

For some patients with serious heart conditions, a defibrillator (a device that helps the heart do its job) can be lifesaving. As with all medical interventions, however, there are benefits and risks. You may have heard about recent studies that report increased rates of infections in patients who've had one of these devices surgically implanted.

There are two main types of implanted defibrillators:  ICDs (implantable cardioverter-defibrillator) and CRT-Ds (cardiac resynchronization Therapy Defibrillator). A defibrillator monitors the electrical activity of the heart. If it detects a potentially dangerous change in the heart's rhythm, it will send small pulses of electricity to shock the heart back into its normal rhythm. Defibrillators are nicknamed "emergency rooms in the chest" because they can intervene when a patient's heart fails, potentially saving the patient's life.

The use of defibrillators doubled between 1993 and 2008. During the same time, the number of implanted device-related infections tripled. While most surgical wounds are likely to become contaminated from bacteria on the skin or in organs, some may progress and become clinical infections. Cardiologists estimate the risk of surgical site infections at five to 20 percent. Infections can prolong patients' hospital stays and may even lead to death. Patients who undergo surgery are also at risk for respiratory, urinary tract, and other bacterial infections.

Defibrillators can fail, especially CRT-Ds. In one study of 3,253 patients who received a CRT-D, 416 had a device-related event by 18 months, and of those, 390 needed surgical intervention. By four years, 50 percent needed surgery to replace the batteries. During the same time, only 10 percent of patients with an ICD needed an intervention (13 percent for dual-chambered ICDs). Furthermore, the rate of infection in patients with a CRT-D was higher. The researchers emphasized, however, that these events were not associated with worse clinical outcomes and did not change the risk of death.

Some heart specialists are also concerned that many patients who receive defibrillators don't actually need them. In one study, researchers found that nine out of 10 patients received no medical benefits from the device.

The FDA collects information about defibrillators, but it's not easy to analyze the data and not all device problems are reported. Furthermore, it's hard to calculate the costs and benefits of cardiac implants and to determine who is actually going to benefit most. If your cardiologist recommends an implanted cardiac device, have a frank discussion with him about all the potential benefits and risks.

Sources:

Bakalar, Nicholas. "Risks: Infections Follow Rise in Cardiac Implants." New York Times. Web. 29 August 2011. http://www.nytimes.com/2011/08/30/health/30risks.html?_r=2

HealthGrades. "Defibrillator Implant." Web.
http://www.healthgrades.com/procedures/profile/Defibrillator_Implant

Feder, Barnaby J. "Defibrillators Are Lifesaver, but Risks Give Pause."New York Times. Web. 12 September 2008. http://www.nytimes.com/2008/09/13/business/13defib.html

Douglas, David. "Complex Cardioverter Defibrillators More Problem Prone." Medscape Medical News. Web. 7 June 2011. http://www.medscape.com/viewarticle/744136

Grens, Kerry. "Reports of Defibrillator Failures Incomplete." Medscape Medical News.Web.13 September 2011. http://www.medscape.com/viewarticle/749585

Gifford, C.,BA (Oxon) BMBCh, Christelis, N., MBBCH FRCA FFPMRCA FANZCA, and Cheng, A., MBBS FRACP MPH PhD. "Preventing Postoperative Infection." Continuing Education Anaesthia, Critical Care & Pain 11(5) (2011): 151-156. Medscape Medical News. Web. 27 September 2011. http://www.medscape.com/viewarticle/750224

How to Decode Cancer Statistics

Trying to make sense of cancer statistics can be overwhelming. Adding to the confusion, many media reports lack context, and even reputable journals can promote misleading and overblown claims about cancer treatment. Understanding statistics, however, can help you evaluate treatment options and assess the reliability of the information you obtain.

Survival rates
When you learn you have cancer, you want to know what your chances are for a cure and how long you can expect to live. Survival rates give you a general idea about prognosis for people who have the same disease as you, but they don't tell you your chances for a cure or remission and they don't consider extenuating circumstances that may affect your outcomes.

Progression-free survival rate describes the length of time during and after treatment in which patients live with a disease that does not get worse. Disease-free survival rate is the percent of people who experience complete remission after finishing treatment.

The 5-year survival rate is probably the most common cancer statistic. It describes the percent of people in a study or treatment who are still alive five years after diagnosis or treatment for a disease, regardless if they still have the disease. For example, of 100 people who have bladder cancer, 80 were living five years after diagnosis. Scientists and oncologists often tout 5-year survival rates as evidence of success of treatment.

However, while 5-year survival rates are a valid measure for comparing cancer therapies in randomized trials, they can be misleading for describing how well cancer patients fare. Physicians are diagnosing cancers earlier and earlier, so they're finding more and more cases of cancer. They're also diagnosing benign cancers that never would have progressed (or progressed too slowly to cause problems). Both can make the 5-year survival rate look better than it actually is and does not consider patients' quality of life.

Mortality rates
The statistic cancer patients should be most interested in is mortality rate: the number of deaths with cancer as an underlying cause occurring in a specific population in a year.

We would expect mortality rates to decline with improvements in cancer control, but according to H. Gilbert Welch, MD, author of Should I Be Tested for Cancer?, screening has not reduced mortality and in fact, in some instances, mortality rates have increased.

"Mortality rates for thyroid, prostate, and breast cancers have hardly budged since 1973, yet 5-year statistics have skyrocketed," he said in an interview. "Since 1950, the 5-year survival rate for prostate cancer has risen from 40 to 98 percent, yet the death rate remained stable."

Sources:

Fischhoff, Baruch, Brewer, Noel T., and Downs, Julie S. "Communicating Risks and Benefits: An Evidence-Based User's Guide." Food and Drug Administration. Web. August 2011.http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Reports/UCM268069.pdf
http://www.healthnewsreview.org/toolkit/tips-for-understanding-studies/

Evans, Imogen, Thornton, Hazel, Chalmers, Iain, and Glasziou, Paul. "Testing Treatments." Web.
http://www.testingtreatments.org/

National Cancer Institute. "Glossary of Statistical Terms." Web. 8 December 2009.
http://cancer.gov/statistics/glossary

Mayo Clinic. "Cancer survival rate: What it means for your prognosis." Web. 6 April 2011.http://www.mayoclinic.com/health/cancer/CA00049

Welch, H. Gilbert, Schwartz, Lisa M., and Woloshin, Steven. "Are increasing 5-year survival rates evidence of success against cancer?" JAMA 283(22) 2000: 2975-2978. Web.
http://www.vaoutcomes.org/papers/JAMA2975.pdf

National Cancer Institute. "Cancer Mortality Rate." Web. 4 December 2009.
http://cancer.gov/statistics/glossary/mortality

Cancer.net. "Understanding Statistics Used to Guide Prognosis and Evaluate Treatment." Web. 27 July 2011.http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Understanding+Survival+Statistics

Lowe, Rachel Myers. "Cancer Screening Questioned." Cancerpage.com. Web. 14 December 2005.
http://www.cancerpage.com/news/article.asp?id=9164