Wednesday, November 23, 2011

Talkin' Turkey Safety

Untold thousands of turkeys will be prepared for Thanksgiving dinner this year. Safe turkey preparation requires special knowledge since it is a large item that is typically frozen prior to cooking and, with the exception of holidays, is not commonly prepared.

Which is best fresh or frozen? This appears primarily to be personal preference. Prepared properly, either will provide a delicious main course. While it seems that fresh birds would automatically have the advantage, tasters from Cook’s Illustrated found that those labeled as "fresh" could actually be tougher than some that were frozen. Apparently "fresh" turkeys can be chilled to as low as 26 degrees causing the formation of ice crystals in the meat. If the temperature of the turkey fluctuates from freezing to above freezing repeatedly, damage to the meat causing dryness can occur. It is best to buy a fresh turkey just a day or two before cooking. Avoid buying a fresh pre-stuffed turkey since harmful bacteria can multiply in the bird’s cavity if it has not been properly processed. Keep frozen turkeys frozen until ready to thaw and prepare.

What’s the best way to thaw frozen turkey? There are three ways to thaw turkey safely - in the refrigerator, in cold water, or in the microwave oven. In order to get your turkey out of the freezer in time to thaw in the refrigerator, you should allow approximately 24 hours for every 4 to 5 pounds. For example, a 12 to 16 pound turkey would take 3 to 4 days to thaw and a 20 to 24 pound turkey would take 5 to 6 days to thaw. Keep the refrigerator at 40 degrees or lower while thawing with a pan or tray under the turkey to catch any leaking juices. If thawing the turkey in cold water, you should allow approximately 30 minutes per pound. This can shorten thawing times considerably with a 12 to 16 pound turkey requiring only 6 to 8 hours and a 20 to 24 pound turkey requiring 10-12 hours. A turkey thawed in cold water should be wrapped securely so that water is not able to leak through the wrapping and be kept completely submerged. Change the water every 30 minutes while thawing. Thawing in a microwave may be limited by the size of the oven. Since energy levels of various microwave ovens vary, it is best to check the owner’s manual for the minutes per pound and power level to use for thawing. Remove all outside wrapping prior to thawing in a microwave. Once thawed, the turkey should be cooked immediately and not refrigerated or refrozen. Always wash hands, utensils, the sink, and anything else that comes in contact with raw turkey or its juices with soap and water.

How do you know when a turkey is thoroughly cooked? Most cookbooks offer a guide for time required to roast turkeys of various weights. You can also find this information in the
Consumer Guide to Safely Roasting a Turkey from the U.S. Department of Agriculture. At an oven temperature of 325 degrees, the lowest safe level for roasting, an unstuffed 18 to 20 pound bird will take from 4 ¼ hours to 4 ½ hours to cook thoroughly. A whole turkey is safe when cooked to a minimum internal temperature of 165 °F. It is always best to use a meat thermometer to confirm this. Check the temperature in the innermost portion of the thigh and at the thickest part of the breast. You should not depend on a "pop-up" temperature indicator alone since these are not as accurate as food thermometers. The turkey will carve more easily if allowed to stand for 20 minutes after roasting.

What about leftovers? There is nothing better than turkey sandwiches made from leftover turkey. However, numerous cases of food poisoning have resulted from improper handling of leftovers. Avoid leaving turkey dinner on the counter for family or guests for "grazing" after dinner. Discard any turkey, stuffing, or gravy left out at room temperature longer than 2 hours. Even refrigerated, these items should be eaten within 3 to 4 days after the Thanksgiving meal.

Have a Healthy and Happy Thanksgiving!

Friday, November 18, 2011

The Great American Smokeout, November 17

Recent statistics indicate that over 46 million Americans still smoke despite widespread knowledge that tobacco use is a leading cause of disease and premature death. However, of these, almost four out of every five would like to quit. Why don't they? Most smokers find smoking to be pleasurable. In addition, nicotine is one of the most addicting drugs around. Being addicted does not mean that it is impossible to stop smoking, but it does mean that there are powerful urges and needs that have to be overcome in order to do so. Many ex-smokers say quitting was the hardest thing they ever had to do. If they were able to do it, so can you, your friend, or family member. Let's look at some of the reasons to quit smoking. In regular or heavy smokers, stopping smoking can produce almost immediate beneficial effects.

However, the benefits derived from long-term cessation have the greatest positive impact on health:
  • Within twenty minutes of quitting, your heart rate and blood pressure drop to a more normal level.

  • Twelve hours after quitting, carbon monoxide and nicotine related to smoking is eliminated from the body.

  • A few months after quitting, the senses of taste and smell improve and breathing comes more easily with less coughing.

  • By one year of quitting, the additional risk imposed by cigarette smoking on the development of heart disease is cut in half.

  • Five years after quitting the risk of stroke reverts to that of a person who
    has never smoked. The risk of developing cancer of the mouth, throat, esophagus, and bladder is cut in half.

  • Ten years after quitting the risk of dying from lung cancer is about half that of a person who is still smoking.

  • Fifteen years after quitting the risk of coronary heart disease is that of a non-smoker.
Along with the health benefits, wouldn't it be nice not to worry about where and when you can light up legally or if you are offending someone? Wouldn't it be nice to have the money spent on cigarettes to use for something else?

Those are a few of the personal reasons for quitting. But what about the impact of smoking on others? It is now well known that even a little second-hand smoke is dangerous. Second-hand smoke is linked to the development of certain cancers, breathing problems, and heart disease in non-smokers. People who breathe second-hand smoke get colds and flu more easily. Children who breathe second-hand smoke are much more likely to develop asthma and are more likely to have ear and lung infections, including pneumonia. It is now recognized that pregnant women who smoke or breathe second-hand smoke are more likely to have stillbirths, low birth weight babies, and babies who die of Sudden Infant Death Syndrome (SIDS). If that's not enough rationale to convince you to quit smoking, consider that there are more than 4,000 chemicals in cigarette smoke. Some of them are also in wood varnish, the insect poison DDT, nail polish remover, and rat poison.

Setting a quit date and choosing a quitting plan. Many tobacco users choose the day designated as the Great American Smokeout to quit smoking. This year, the American Cancer Society has designated it to be November 17. Click on this link to the American Cancer Society for tips and tools to help you quit or log into your account and send us your question for more suggestions.

Thursday, November 10, 2011

Coping with the "Winter Blues"

Seasonal affective disorder (SAD) is a type of depression triggered by the changing of the seasons. In most cases, it occurs along with the shortening of daylight hours in the fall and continues into the winter months. SAD typically resolves with the longer days of spring and stays in remission through the summer months. Other names for SAD include "winter blues" and seasonal depression.

Who gets SAD? In the U.S., approximately 5% of the population meets the diagnostic criteria for this disorder, although up to 20% of people develop some of the symptoms. The risk of developing SAD increases with aging and affects women more commonly than men. Those living in the more northerly latitudes with longer, colder winters are also at greater risk.

What are the symptoms of SAD? Symptoms of depression, such as sadness, feeling "empty", and loss of energy are most typical of SAD. Other SAD symptoms include:
  • Feelings of hopelessness and/or helplessness

  • Irritability, restlessness

  • Loss of interest in activities that had previously been enjoyable

  • Difficulty sleeping or oversleeping

  • Overeating and weight gain

  • Trouble with concentration or memory

  • Withdrawal from social situations
In severe instances, SAD can be associated with thoughts of suicide.
How Does SAD Develop? SAD is thought to be caused by a chemical imbalance in the brain prompted by shorter daylight hours and a lack of sunlight in the winter. Melatonin, which plays a role in sleep patterns, and serotonin, a brain chemical that affects mood, are two of the brain chemicals involved in its development. With shorter daylight hours, more melatonin and less serotonin is produced which affects the body's internal alarm clock as well as its mood.

How is SAD diagnosed? With the overlap of symptoms of SAD and certain medical disorders, such as hypothyroidism or viral infections, a medical evaluation is recommended for those who develop features of SAD. There is no specific test for SAD but the doctor may want to perform a physical exam and blood tests to rule out possible medical disorders. When the following are present: 1) seasonal symptoms of depression for at least two consecutive years, 2) periods of depression following by improvement when the season changes, and 3) no other life events or circumstances can be found to explain the mood changes, the diagnosis can be made on history alone.

Is there a treatment for SAD? The most common treatments for SAD are light therapy, anti-depressant medications, and psychotherapy.
  • Light therapy, also called phototherapy, is a safe and simple treatment for SAD. Phototherapy involves the use of a light box containing special fluorescent lights with a color spectrum similar to outdoor light. Sitting in front of this artificial light source for approximately 30 minutes each day is usually adequate to modify chemicals in the brain that are responsible for the development of SAD. This is usually done in the early morning to mimic sunrise. Studies have shown that between 50% and 80% of users improve markedly with this type of treatment. It is important, however, that treatment is continued throughout the difficult season. Another type of light therapy involves a light placed in the bedroom that gradually increases in brightness to simulate a natural sunrise. Side effects of light therapy are uncommon with irritability, eyestrain, headaches, and nausea being reported most commonly.

  • Antidepressant medications are also effective for treating SAD and can be used along with light therapy. The most commonly used anti-depressants are in serotonin selective reuptake inhibitor family (SSRI) family, which includes fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

  • Psychotherapy is another option for treating SAD, particularly if light therapy and/or medications have not helped. Psychotherapy appears to help by addressing negative thoughts and behaviors that are contributing to the depression rather than changing brain chemistry.
Are lifestyle or alternative treatments effective? For those with mild symptoms of SAD, or to compliment standard treatment, a number of lifestyle measures may be considered. Whenever possible, get outside during the day for a walk. At home, open blinds or add skylights to let in sunshine. Exercise regularly for stress and anxiety relief. Remain socially active even if it requires some effort. Supplements used in treating depression, such as St. John's wort, melatonin, and fish oil (omega-3 fatty acids), may help with SAD symptoms also.

Friday, November 4, 2011

The PSA Controversy - Why do cancer screening recommendations change?

Cancer screening is used to detect the disease in its earlier stages when treatment is more successful. But even more importantly, screening is used to reduce cancer deaths. The Pap test is an example of a screening test that has been highly successful in reducing death from cervical cancer. Other tests, such as chest x-rays to screen for lung cancer have not been shown to reduce deaths, even when the x-rays are performed in smokers. Additional reasons that some screening tests are not performed routinely are that they look for cancers that are so rare that only a few individuals would benefit, or that the screening test is so expensive that its widespread use is cost-prohibitive.

After many years of use, why is the PSA test now falling out of favor and why do other cancer screening recommendations change from time to time?

The U.S. Preventive Services Task Force (USPSTF) recently released a preliminary report advising against the use the Prostate Specific Antigen (PSA) blood test to screen for prostate cancer. In brief, the PSA test is incapable of telling the difference between prostate cancer that will and will not affect a man during his natural lifetime. This is because the great majority of asymptomatic men who have their prostate cancer detected by PSA screening have a tumor that is so slow growing that they will probably die of some other cause, such as heart disease, rather than from prostate cancer. Furthermore, the USPSTF found that PSA testing results in a high rate of false positive tests, leading to persistent worry about the possibility of having prostate cancer, unnecessary biopsies with associated complications, and worse yet, unnecessary surgery.

In supporting their position, the Task Force noted that in the U.S., approximately 90% of men with PSA-detected prostate cancer end up being treated, primarily with surgery or radiation therapy. Very few of these men's lives, however, will be prolonged by this treatment, with many suffering from treatment complications. Five out of every 1,000 men undergoing prostate cancer surgery will die within one month of the surgery. Radiotherapy along with surgery causes urinary incontinence and erectile dysfunction in 20 to 30% of men treated.

A great deal of opposition, coming from medical organizations and pharmaceutical companies, as well as from prostate cancer advocacy groups, has been expressed toward this recommendation. Some opponents even consider it a politically motivated effort to reduce health care costs. It should be pointed out, however, that the cost of screening or treatment was not a factor in the expert panel's position, and furthermore, their recommendation relates only to men that do not have symptoms suspicious for prostate cancer. As for now, the use of PSA testing in men with symptoms suggestive of prostate cancer, or for surveillance after diagnosis and/or treatment of prostate cancer should continue.

Medicine is an evolving science. Changes in the cancer screening guidelines come about after better or more compelling research becomes available. Another recent example of this is the Task Forces' position on the optimal interval for performing screening mammograms, which was also met with a great deal of opposition. In both instances, however, the goal was to provide the most objective and reasonable recommendations for a large population of people given the scientific evidence at hand.

While the rationale for abandoning the use of the PSA test will continue to be debated, clearly, a better test is needed. Ideally, this test would be positive primarily in those individuals who actually had prostate cancer, and would be able to distinguish between indolent and aggressive forms of prostate cancer. Go here, to read a summary of the USPSTF recommendations regarding PSA testing.