Flu shot linked to lower heart attack, stroke risk

When it comes to prostate trouble, the lion’s share of attention goes to prostate cancer and an enlarged prostate. A third condition, prostatitis, flies under the radar even though it affects up to one in six men at some point in their lifetimes. It triggers more than two million visits to doctors and untold agony each year.

Prostatitis, which means inflammation of the prostate gland, is an equal opportunity disorder. Unlike prostate cancer and benign prostatic hyperplasia (BPH), which predominantly affect older men, prostatitis affects men of all ages.

Prostatitis refers to a loose assemblage of syndromes characterized by urinary problems such as burning or painful urination, the urgent need to urinate, trouble voiding, difficult or painful ejaculation, and pain in the area between the scrotum and rectum (known as the perineum) or lower back. Although it causes some of the same symptoms as BPH and can occur at the same time, prostatitis is a separate condition.

Some types of prostatitis are caused by bacterial infection. These cases are often accompanied by the classic symptoms of infection, such as fever, chills, and muscle pain along with urinary problems. As a result, they are relatively easy to diagnose and treat, and they usually respond well to antibiotics. Unfortunately, such straightforward forms of prostatitis are the minority.

Physicians aren’t sure what causes the rest. Potential culprits include difficult-to-detect bacteria, inflammation, depression and stress, and mechanical or neuromuscular problems in the pelvic muscles that irritate the general area. This uncertainty is what can make the treatment of prostatitis so maddening.
Types of prostatitis

Prostatitis is classified into four categories, each with its own treatment approach
Acute infection of the prostate

This sudden-onset infection is caused by bacteria that travel from the urethra, and perhaps from the rectum, to the prostate. It’s the least common but most dramatic form of prostatitis, beginning abruptly with high fever, chills, joint and muscle aches, and profound fatigue. In addition, you may have pain around the base of the penis and behind the scrotum, pain in the lower back, and the feeling of a full rectum. As the prostate becomes more swollen, you may find it more difficult to urinate, and the urine stream may become weak. (If you can’t urinate at all, it’s a medical emergency; this usually means the prostate is so swollen that it’s completely blocking urine flow. Depending on the severity of symptoms, hospitalization may be necessary.)

Antibiotics are the standard treatment and are highly effective for this form of prostatitis Typical choices include fluoroquinolones—such as ciprofloxacin (Cipro), levofloxacin (Levaquin), and ofloxacin (Floxin)—and trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim). It’s important to continue your medication for the entire prescribed course, even if you are feeling better. This will help prevent your infection from returning.

To help ease any discomfort, try sitting in a hot bath, take stool softeners, and use over-the-counter pain relievers, such as aspirin or ibuprofen. Drinking plenty of fluids can help flush the bacteria from your system, too.
Chronic bacterial prostatitis

This type of prostatitis is also caused by bacteria. It’s more common in older men who have BPH. It sometimes follows a bout of acute bacterial prostatitis. Unlike the acute form, however, chronic bacterial prostatitis is a subtle, low-grade infection that can begin insidiously and persist for weeks or even months.

A man with chronic bacterial prostatitis usually doesn’t have a fever, but is troubled by intermittent symptoms such as a sudden urge to urinate, frequent urination, painful urination, or the need to get up at night to urinate. Some men have low back pain, pain in the rectum, or a feeling of heaviness behind the scrotum. Others have pain after ejaculation, and the semen may be tinged with blood. These symptoms wax and wane, and they are sometimes so understated that they aren’t noticeable.

Treatment requires the same antibiotics used for the acute form, usually for one to three months, but even with the prolonged treatment, the infection often recurs. If this happens, the recurrence can usually be controlled with another course of antibiotics.
Chronic nonbacterial prostatitis

Chronic nonbacterial prostatitis, also known as chronic pelvic pain syndrome is the most common form of prostatitis. Its symptoms resemble those of chronic bacterial prostatitis. Yet no bacteria are evident, and pinpointing a cause or causes has been difficult.

Research suggests that chronic nonbacterial prostatitis may result from a cascade of interconnected events. The initiating event may be stress, an undetectable infectious agent, or a physical trauma that causes inflammation or nerve damage in the genitourinary area. Over time, this may lead to heightened sensitivity of the nervous system. In other words, CP/CPPS may be an overactive pain syndrome. What’s more, some physicians and researchers are beginning to think that the condition may affect the entire pelvic floor—all of the muscles involved with bowel, bladder, and sexual function—not just the prostate gland.

Because men often suffer from multiple symptoms simultaneously—such as pain and difficulty urinating—they may require several types of medication or other therapy, depending on the pattern of symptoms. These include antibiotics, Pain relievers, a medication to reduce the urge to urinate, a medication to ease urine flow by relaxing the muscles at the neck of the bladder, and even some alternative therapies such as myofascial release. (HarvardProstateKnowledge.org will explore treatments for chronic nonbacterial prostatitis/chronic pelvic pain syndrome in a future article.)
Asymptomatic inflammatory prostatitis

This is usually discovered during tests for another medical condition, such as infertility or other prostate disorders. White blood cells are present in the urine or prostate secretions, but there are no symptoms. With no symptoms and no known cause, it isn’t treated. There’s something satisfying about getting immediate feedback about exercise, sleep, and other activities. That’s why more and more people are joining the “quantified-self” movement. It involves formal tracking of health and habits, usually using apps and devices that feed data to them—from heart rate, activity, and sleep monitors to Bluetooth connected scales. I haven’t yet become a full-fledged member, partly because having so many apps and connected devices on the market makes it hard to decide which ones are worth trying.

I’m hoping that Wellocracy will help. This website, launched by the Harvard-affiliated Center for Connected Health, aims to give people like me impartial information about fitness trackers, mobile health apps, and other self-help technologies.

Wellocracy lists dozens of sleep trackers, wearable activity trackers, mobile running apps, and mobile pedometer apps, each with a mini-review and a “what we wish it had” listing. The site lets you compare apps and devices in each of the four categories. The compare feature isn’t yet as helpful as those from Consumer Health Reports, but that may be coming.

The site also provides a guide for beginners like me, and offers tips for adding activity “bursts” throughout the day.

“There are millions of people struggling to eat well, exercise, manage a chronic disease or decrease other health risks. Wellocracy will help them select and use digital health tools, understand their individual motivations, and make incremental lifestyle changes that can easily be incorporated into busy schedules,” said Wellocracy founder, Dr. Joseph C. Kvedar, an associate professor at Harvard Medical School.

One theme the site promotes is “stickiness.” That means finding motivational strategies, apps, and devices that help you stay on track to achieve your goals. You can calculate your “stickiness factor” on the website. Millions of baseball fans will tune in tonight for the opening game of the World Series. Boston Red Sox versus St. Louis Cardinals. Sportswriters are saying it will be an interesting series between two well-matched teams.

Football fans have it easy. They have to sit through just one big game to decide the year’s champion. For us baseball fans, it could take seven games spread over nine days to determine this year’s champion. (Or it could be just four games over five days, as happened in 2004 when the Red Sox swept the Cardinals.)

That means fans need to approach the series as a marathon, not a sprint. Here are a few suggestions for getting through the Series with your physical and emotional health intact.

Sleep: All seven games are scheduled to start around 8:00 pm Eastern Time. That could make for some late nights. If you have a chance to take a nap on game day, go ahead and do it.

Exercise: Physical activity—and I’m not talking about adjusting the La-Z-Boy or opening a bottle of beer—is a good way to get rid of pre-game jitters. A 20- or 30-minute walk, run, swim, or whatever can help you relax. It’s also good for blood pressure, which can climb high during a stressful game.

Food: The gluttony of Super Bowl Sunday is almost acceptable because it’s a one-day feast. But doing that night after night can give you heartburn and affect your weight. If you routinely snack while watching baseball, try some healthier alternatives to chips and sour-cream dip. Examples include whole-wheat crackers and hummus or guacamole, dried fruits and nuts, or celery and carrot sticks.

Alcohol: If you drink, keep it moderate. Being sleep deprived and hung over for up to nine days isn’t good for your health, and certainly won’t endear you to your family members or coworkers (although some of them may be in the same boat).

Emotions: Some people can watch a World Series game dispassionately. I’m not one of them. As a Red Sox fan, my mood goes up and down with the team’s success. The anxiety that fans like me have is actually rooted in evolution. The human body reacts to a threat—physical or emotional—with the “fight or flight” response. The adrenal glands pump the hormone epinephrine (also known as adrenaline) into the bloodstream. It causes the heart to beat faster than normal. Blood pressure rises. Extra oxygen is sent to the brain, increasing alertness. Sight, hearing, and other senses become sharper. Blood sugar (glucose) and fats are released into the bloodstream from storage sites in the body.

That makes sense when the threat is short-lived. But when it lasts for several hours, or several days, this stress response can be harmful. If you find yourself getting stressed, breathing deeply and slowly for a minute or two while saying a relaxing word like “win” can help.

Who knows why we get so caught up in our teams’ fortunes? Evolutionary biologists would tell us that the impulse to identify strongly with a group evolved because our survival depended on it. “Defend your tribe” has morphed into being true to your team. This can sometimes drive us to watch games anxiously, even angrily. Once you’re in that frame of mind, it’s hard to find the pleasure in it.

I have come to recognize that I enjoy watching games more when one of my teams is not on the field. I appreciate the talent and the spectacle. And I am sometimes rewarded with a satisfying, live drama.

Maybe we fans can approach this series with that kind of appreciation. The Red Sox and Cardinals are two very likable teams. Commentators point out that these guys play the game the “right way.” The players themselves say it’s going to be fun.

Let’s see if we can remember that baseball is a game. This World Series should be fun to watch. So whoever you’re rooting for, have fun watching. Ever since the winter of 2003, when my husband came down with nasty case of the flu that led to a three-week bout of walking pneumonia, he’s been religious about getting a flu shot each fall. But the benefits he gains may go beyond warding off respiratory-related problems.

A study published in today’s Journal of the American Medical Association finds that getting the influenza vaccine lowers a person’s odds of a having heart attack, stroke, heart failure, or other major cardiac event—including death—by about a third over the following year.

What’s the connection between flu and cardiovascular problems? “When you get the flu, your body mounts an impressive immune response, which causes a lot of inflammation. As a result, the plaque inside your blood vessels can become unstable, which can lead to blockage and a possible heart attack or stroke,” says study leader Jacob Udell, MD, a cardiologist at Women’s College Hospital in Toronto and a clinician-scientist at the University of Toronto.

Changes in the lungs wrought by the flu virus can lower blood oxygen levels, which makes the heart work harder. The virus can also directly injure heart muscle cells, leading to heart failure or making it worse.

Udell and colleagues pooled data from six clinical trials involving more than 6,700 people. Their average age was 67. About one-third had heart disease; the rest did not. Overall, those who had been vaccinated against the flu had a 36% lower risk of a having major cardiac event during the following year. And for those who had recently had a heart attack, a flu shot cut the risk of heart attack or stroke even further.

Dr. Udell cautions that the safety and effectiveness of an influenza vaccine to lower the risk of heart attack or stroke still needs to be confirmed with a large clinic trial, which he’s currently planning. If the findings hold true, “we may be able to tell patients that by getting your flu shot, it might save your life—what a simple and significant way to reduce deaths and the burden on our healthcare system,” says Dr. Udell.

Experts recommend a flu shot for everyone six months of age and older. It is especially important for those who face the highest risk of complications: young children; adults over age 50; those of all ages with serious health conditions such as cardiovascular disease, asthma or other lung disease, liver or kidney disease, or diabetes; and those who care for young children or other individuals at high risk of flu complications.

Yet more than half of people younger than 65 with serious health conditions skip an annual flu shot, as do about a third of all people older than 65.

Compared to other heart-healthy habits like exercise and healthy eating, getting a yearly flu shot is pretty low effort. Even if you’re young and at low risk of heart disease, why not do what you can to avoid the aches, fever, and fatigue of the flu?

Supercharge your cold and flu defenses!

27 surprising secrets, smart strategies, and simple steps to keep your immune system at its cold-and-flu-fighting best

In addition to protecting yourself from an infectious disease, immunization also helps protect those who aren’t through what is known as herd immunity. The more people who are immunized, the fewer who will be carrying the infectious agent, and the smaller the odds that someone who isn’t immunized or resistant will come into contact with it. Check out this video of how herd immunity works.

My husband is fortunate: His workplace offers free, on-site flu shots. I’ll be taking my daughter to her pediatrician next week for a dose of the nasal spray version of the vaccine—a good option for the needle-phobic, but only if you’re under 50, as some research suggests it’s less effective in older people than the shot. As for me, I’ll be rolling up my sleeve at my local CVS. To find out where you can get a flu shot, see this handy map from the Centers for Disease Control and Prevention.

If you haven’t gotten yours yet, do it soon: Outbreaks have happened as early as October in some years, although the season typically peaks in January or later.


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