Medications and treatments Archive

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Q. What is the significance of mild narrowing of the carotid artery detected by an ultrasound? I have never had any symptoms of stroke.

A. "Mild" narrowing ranges from 15% to 49% blockage of the artery. Over time, this narrowing can progress and lead to a stroke. Even if it doesn't progress, mild narrowing is a sign of early blood vessel disease and calls for preventive measures.

Benzodiazepines and drugs with strong anticholinergic effects have been linked to Alzheimer's disease in people who take them. There are alternatives to both types.

Research we're watching

Reliable blood pressure readings are vital for diagnosing high blood pressure and estimating a person's risk of heart disease. New research suggests that using a home blood pressure monitor may be more dependable than other methods.

Doctors have long relied on office visits to check people's blood pressure. But growing evidence shows that readings done outside a doctor's office are more closely linked to a person's risk of heart-related problems. Ambulatory blood pressure monitoring (ABPM) involves wearing a device that automatically records blood pressure every 30 to 60 minutes for 24 hours, but it's not widely available.

They're not yet FDA-approved, but the devices are available and safe — if you know what to look for.

When Congress passed the Over-the-Counter (OTC) Hearing Aid Act in 2017, it opened up a new world of possibility for people with hearing loss. Instead of paying $5,000 for a pair of FDA-approved hearing aids and follow-up service, you could pay hundreds of dollars for an OTC pair from any seller — no doctor appointments, hearing tests, or fittings needed. The devices would have the same fundamental technology as traditional hearing aids, they'd be targeted to people with perceived mild-to-moderate hearing loss, and the FDA would ensure quality by regulating and approving the OTC devices.

But almost four years later, the OTC hearing aid category and its safety and labeling rules are still tied up in red tape.

Research we're watching

There are a number of different approaches to treating a condition called adhesive capsulitis, better known as frozen shoulder. This common condition causes significant shoulder pain and reduced mobility. While it generally goes away on its own over time, it can take up to a year or longer to heal. But there hasn't been consensus on whether any particular therapy leads to more rapid pain relief and full range of motion.

A study published online Dec. 16, 2020, by JAMA Network Open looked at various treatment options for frozen shoulder to determine which was the most effective. Researchers analyzed 65 different studies with more than 4,000 total participants and found that the first line of therapy should be to inject a steroid directly into the joint to reduce inflammation. This treatment helped to reduce pain and led to the fastest recovery. The study authors said the steroid injection should be accompanied by a home exercise program that includes stretches and exercises to improve range of movement in the shoulder.

News briefs

Hold off before you follow new recommendations to treat mild, persistent asthma — or at least consult your doctor first. The updated guidelines from the National Institutes of Health, published online in the December 2020 issue of The Journal of Allergy and Clinical Immunology, say it's okay for people with mild, persistent asthma to stop daily use of inhaled corticosteroids and instead use them only as needed, along with short-acting beta agonists ("rescue" medications). That's considered a major shift in guidance. But that may not be a good idea for some older adults, notes Dr. Anna Wolfson, an allergist and immunologist at Harvard-affiliated Massachusetts General Hospital. "A lot of people have a harder time with the occasional use of medications than a routine practice of daily use," she says. "And you may not want to decrease your asthma regimen during the pandemic. Poorly controlled asthma could lead to a flare or an ER visit, and perhaps an increased risk for complications if you develop COVID-19." Dr. Wolfson says there are some people who might benefit from using inhaled corticosteroids only as needed, but she urges you to speak with your doctor before changing your medication regimen.

Image: Branimir/Getty Images

These drugs actually help stop dangerous blood clots from forming. Here's when you may need them.

Nearly everyone has heard of "blood thinners." Maybe you or someone you know takes one. But these drugs don't "thin" blood at all.

"They are actually anti-clotting drugs," says Dr. Gregory Piazza, a cardiologist with Harvard-affiliated Brigham and Women's Hospital. "They prevent potentially dangerous blood clots from developing in people at high risk, like those who have atrial fibrillation or a stent in a blood vessel, or who are immobile after surgery."