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Ask Stanford Med, Complementary Medicine, Nutrition, Pain

Ask Stanford Med: Pain expert responds to questions on integrative medicine

Ask Stanford Med: Pain expert responds to questions on integrative medicine

rolfing2Sometimes the best medicine is staying healthy. As more Americans look for ways to improve their health, prevent disease and manage pain, the subject of complementary practices may enter more conversations between patients and physicians. So for this installment of Ask Stanford Med, we asked Emily Ratner, MD, clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to questions on integrative medicine. Her answers appear below.

As a reminder, these answers are meant to offer medical information, not medical advice. They’re not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and provide appropriate care.

Mary says: Please speak about the efficacy of integrative medicine to alleviate multi-point pain from a variety of causes (ITP, OA, aging). A relative has doctor fatigue as well, and is not interested in anything else.

Integrative Medicine (IM) may be defined as the combination of conventional and nonconventional modalities chosen by a patient and physician in a patient-centered decision-making process in order to achieve the best outcome for an individual. Patients often seek nonconventional modalities when conventional medicine techniques are unable to achieve a particular goal, often pain relief or pain management. As a general rule, multi- and inter-disciplinary measures are often most helpful in relieving suffering from pain. These may include five general categories of nonconventional modalities, although there is overlap amongst the different types:

  • Mind-body medicine: meditation, hypnosis, biofeedback, guided imagery, yoga
  • Biologically based practices: uses substances found in nature – herbs, foods, vitamins, supplements
  • Manipulative/Body-based practices – massage, chiropractic/osteopathic manipulation
  • Whole medical systems: Traditional Chinese Medicine (includes acupuncture), Ayurveda, naturopathy
  • Energy Medicine – Reiki, Healing/Therapeutic touch, Qi Gong, acupuncture, yoga

Depending on patient preference, available resources in the community and other factors, a decision is made where to begin. I often recommend acupuncture as a place to start, closely followed by a mind-body medicine technique, as my experience is that stress plays a large role in either pain or the perception of pain. However, it largely depends on the individual’s needs and preferences.

Scope Editor asks: A recent study of herbal products found that most of those examined contained contaminants, substitutions and unlisted fillers among their ingredients. What are the implications of these findings, and how can consumers protect themselves when buying supplements?

This is a significant issue that highlights the need for increased supplement regulation, although the study to which you refer has been criticized for some of its conclusions. While FDA regulations for supplements are a bit stricter than for foods, the regulations are far less comprehensive than those for pharmaceutical agents.

That being said, product contamination with heavy metals, undisclosed pharmaceutical agents (especially in products from outside the U.S.), and inaccurate product ingredient amounts plague this field.

Until improved regulatory procedures are instituted, I suggest looking at a reputable database that independently tests these products, such as ConsumerLab.com. This and other independent organizations add their seal of approval to product labels that have tested either the products or the manufacturing practice involved in production of the substance. Look for the Consumer Lab seal or other seals: cGMP (current Good Manufacturing Practice), USP (United States Pharmacopeia), or NSF (another independent lab).

Some experts note that specific stores have strict quality control for their products – like Sam’s Club, Costco, Whole Foods – but I typically look up each individual product on a database (I use consumerlab.com) prior to recommending it.

Another option is to consult with a trained Integrative Medicine practitioner who has access to these databases and is knowledgeable about these products.

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Ask Stanford Med, Cardiovascular Medicine, Health Policy, In the News, Technology

Stanford expert weighs in on new guidelines for statin use

statinsAs you may have read, the American Heart Association and the American College of Cardiology recently released a new set of guidelines for lowering cholesterol, along with an online risk-assessment calculator. But two independent reviewers found that the calculator’s design was flawed, overestimating many people’s risk for heart problems and potentially driving an over-prescription of statin drugs. (Their comments were posted today on The Lancet.) Controversy about the guidelines and online tool raised questions at the recent annual meeting of the American Heart Association and prompted a press briefing yesterday in which the two issuing organizations stood in support of the risk calculator.

Earlier this year, Mark Hlatky, MD, professor of health research policy and of cardiovascular medicine at Stanford, released a different sort of heart-related calculator, comparing five-year outcomes for two heart-disease interventions. I posed some questions to Hlatky about the the new online tool and guidelines; his answers appear below.

What are your thoughts on the design of the online risk calculator released with the new guidelines?

I’ve tested the spreadsheet in the guideline and agree that the risk estimates appear to be high. There are several possible reasons for this, but a key change is that the current version is to predict the risk of heart attack AND stroke, not just heart attack. So by design all the numbers are higher than prior calculators.

The other issue is that they have used different data than the prior “Framingham risk calculator” to produce these numbers, so there may be additional differences in the estimates from the ones everyone has been using.

New York Times piece includes comments from Johns Hopkins’ Michael Blaha, MD, who notes that the data sets used, from the 1990s, were too old to be accurate in determining how risk factors such as cholesterol level and blood pressure could lead to heart attacks and strokes in today’s population. Do you agree?

The overall risk of coronary disease in the population has been decreasing over time, so using older data to predict current risk might over-estimate the risk.  This is only a problem if the lower risk is due to factors OTHER than improvements in the traditional cardiac risk factors. For example, rates of smoking have gone down, so overall population risk is going down too. But that’s not necessarily a problem for the risk calculator because smoking is included in the calculator. But if all smokers have been smoking less, the risk attached to being a smoker today might be lower than the risk of being a smoker years ago.

What do you think are the implications of this controversy – for doctors, patients, and the medical research review process?

The controversy might confuse the public, so it’s a shame it couldn’t have been avoided. The review process appears to have been flawed, since this criticism was leveled earlier in the development of the guideline.

On a more substantive level, the risk level is now set so low (7.5 percent over 10 years) that many people in the population who have “optimal risk factor levels” (systolic blood pressure 110 or below, total cholesterol 170 or below, HDL cholesterol of 50 or above, no diabetes and non-smoker) would targeted for statin treatment simply on the basis of their age.  The calculator puts men age 63 and older with “optimal risk factor levels” at elevated risk, and all women age 71 and above with “optimal risk factor levels” at elevated risk. It’s a little hard for many to accept that everyone above a certain age should be on a statin, and there’s no direct evidence to back up this pretty sweeping recommendation.

Previously: Heart bypass or angioplasty? There’s an app for that, Exploring the cost-effectiveness of statin use among kidney patientsWider statin use may be cost-effective way to prevent heart attack, strokeNew test for heart disease associated with higher rates of procedures, increased spending and Stanford researcher cautions against widespread use of statins
Photo by AJC1

Ask Stanford Med, Complementary Medicine

Ask Stanford Med: Pain expert taking questions on integrative medicine

organic produce and Whole FoodsIntegrative medicine – the combination of traditional Western medicine with evidence-based, complementary approaches to health improvement, symptom management and disease prevention – encompasses many disciplines. The National Center for Complementary and Alternative Medicine (NCCAM), one of the 27 members of the National Institutes of Health, oversees scientific research and informs decision-making in the area. NCCAM’s mission “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care” is upheld by a number of academic medical centers, including Stanford’s Center for Integrative Medicine.

If you’ve downed a spoonful of fish oil, taken vitamins or probiotics, visited a chiropractor, or engaged in deep breathing to manage pain, you’ve experienced a practice of integrative medicine. But for many, there’s a shroud of mystery around the subject, and while peer-reviewed research studies have been conducted on some aspects of the discipline, other practices require further study.

So for this edition of Ask Stanford Med, we’ve asked Emily Ratner, MD, a clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to your questions on integrative medicine.

Ratner’s research interests include the use of acupuncture to manage medical conditions and to address pain and side effects from surgery and cancer. She also studies physician and trainee burnout and resilience.

Questions can be submitted to Ratner by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Sunday, November 10 at 5 p.m.

When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses
  • Ratner will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Director of Stanford Headache Clinic answers your questions on migraines and headache disordersStudy shows complementary medicine use high among children with chronic health conditions,Ask Stanford Med: David Spiegel answers your questions on holiday stress and depressionReport highlights how integrative medicine is used in the U.S. and Americans’ use of complementary medicine on the rise
Photo by ASSOCIATED PRESS

Ask Stanford Med, Fertility, Men's Health, Pregnancy, Stanford News, Women's Health

Ask Stanford Med: Expert in reproductive medicine responds to questions on infertility

Ask Stanford Med: Expert in reproductive medicine responds to questions on infertility

couple sitting2Infertility is a reality faced by 10 to 15 percent of U.S. couples. For some, the topic is emotionally charged. And while many may have questions related to reproductive endocrinology, research and treatment options may not be favorite table topics for a night out with friends. So for this edition of Ask Stanford Med, we’ve asked Valerie Baker, MD, the division chief of reproductive endocrinology and infertility and director of Stanford’s Program for Primary Ovarian Insufficiency, to respond to such questions about infertility. Her answers appear below.

@giasison asks: Can you name the 3 top causes of #infertility in your current practice?

Age-related decline in fertility (particularly decline in egg quantity and egg quality with age), sperm problems, and lack of ovulation.

Charmaine asks: Is it true that infertility could be a side effect of vaccination? Why?

No, vaccinations do not cause infertility.

Michelle asks: How have treatments for infertility evolved over the last 10 years? And what might treatments look like 10 years from now?

The biggest advance since the mid-90s has been our ability to help couples with extremely poor sperm quality to conceive. I hope that 10 years from now we will have treatments that help couples where a woman is suffering from premature loss of her egg supply to conceive with her own eggs. Right now, the main choice for women with extremely low egg supply and low egg quality is oocyte donation, where the egg comes from a donor.

Shabba92 asks: What are the most common treatments in your clinic? What percentage of patients wind up undergoing IVF?

The most common treatments are intrauterine insemination (IUI) and in vitro fertilization (IVF). We also do ovulation induction for women who are not ovulating on their own and surgery if needed to correct certain problems. Many couples are able to conceive with simpler treatments and do not need IVF. Fewer than half need IVF.

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Ask Stanford Med, Fertility, Pregnancy, Stanford News, Women's Health

Five million babies and counting: Stanford expert offers conversation on reproductive medicine

Five million babies and counting: Stanford expert offers conversation on reproductive medicine

newbornEarlier this week, an international group announced that reproductive medicine techniques, such as in vitro fertilization, have led to the birth of 5 million babies since 1978. “This is a great medical success story,” a member of the International Committee for the Monitoring of Assisted Reproductive Technology said in a statement, pointing out that the number of these babies equals the population of the state of Colorado.

At Stanford, Valerie Baker, MD, heads up the academic division that focuses on reproductive medicine. From now until Monday evening, she’s taking questions on the topic, as well as on infertility in general. Readers can share what’s on their mind with her in the comments section of this blog entry or by sending a tweet that includes the hashtag #AskSUMed.

Previously: Ask Stanford Med: Expert in reproductive medicine taking questions on infertility, Oh, baby! Infertile woman gives birth through Stanford-developed technique, Stanford researchers work to increase the odds of in vitro fertilization success, Sex without babies, and vice versa: Stanford panel explores issues surrounding reproductive technologies and New test predicts the success of IVF treatment
Photo by Emery Co Photo

Ask Stanford Med, Fertility, Men's Health, Pregnancy, Stanford News, Women's Health

Ask Stanford Med: Expert in reproductive medicine taking questions on infertility

Ask Stanford Med: Expert in reproductive medicine taking questions on infertility

4223909842_e028c12f28An estimated 10 to 15 percent of couples in the United States are infertile. One or a number of factors may render a couple unable to conceive, including hormone imbalances or blockages of sperm movement in men, and ovulation problems arising from a variety of causes in women. Those who turn to fertility treatments, a recent study showed, can expect to pay more than $5,000 out of pocket on average, or upwards of $19,000 for in vitro fertilization (IVF).

Strides in research to overcome barriers to conception have included a recent Stanford-developed technique to promote egg growth in infertile women who have experienced early menopause. Senior author Aaron Hsueh, PhD, professor of obstetrics and gynecology at Stanford, collaborated with scientists here and at the St. Marianna University School of Medicine in Kawasaki, Japan on a procedure known as “in virto activation,” in which a portion of a woman’s ovary is removed, treated outside the body, and then returned near her fallopian tubes. Through this specialized structure, a participant in the study recently gave birth.

For this edition of Ask Stanford Med, we’ve asked Valerie Baker, MD, to respond to your questions about infertility. Baker, who offered insights on Hsueh’s study and its possible implications for patients in a video and article last month, is division chief of reproductive endocrinology and infertility and director of Stanford’s Program for Primary Ovarian Insufficiency. Her research and clinical interests include primary ovarian insufficiency, and assisted reproductive technology and hormone therapy for fertility and reproduction.

Questions can be submitted to Baker by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Monday, October 21 at 5 PM.

When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses
  • Baker will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Researchers describe procedure that induces egg growth in infertile womenOh, baby! Infertile woman gives birth through Stanford-developed technique and Sex without babies, and vice versa: Stanford panel explores issues surrounding reproductive technologies
Photo by Dylan Luder

Ask Stanford Med, Sleep, Sports, Stanford News

Ask Stanford Med: Cheri Mah responds to questions on sleep and athletic performance

Ask Stanford Med: Cheri Mah responds to questions on sleep and athletic performance

US Open TennisWhether you’re a student-athlete superstar or the mayor of your local gym, chances are your performance on the field, court or treadmill could be influenced by the way you sleep. So for this installment of Ask Stanford Med, we’ve asked Cheri Mah, a researcher with the Stanford Sleep Disorders Clinic and Research Laboratory, to respond to questions on sleep and athletic performance. Below are her answers, along with some tips to help you get the most out of your nightly slumber. We hope this will help you consider which of your own sleep practices are working, and what you might want to reconsider.

Michelle asks: Can you give a summary of your  research to date showing that sleep might help athletes? And what kind of studies are you working on now?

For past few years, William Dement, MD, PhD, and I have been studying the impact of sleep extension on the athletic performance in elite athletes. My interest in specifically studying sleep duration and sleep quality in athletes stems from a study in 2002. By chance, several Stanford swimmers were in our study, and although we weren’t investigating athletic performance, they mentioned that they had set several personal records in their last swim meet!

Over subsequent years, we’ve examined the impact of sleep extension across many sports at Stanford including basketball, football, tennis, and swimming to compare similarities and differences across sports. Our findings from men’s basketball published in 2011 indicate that several weeks of sleep extension improves reaction time, mood, levels of daytime sleepiness, and specific indicators of athletic performance including free throws, 3 point field goals, and sprint time. These findings suggest that sleep duration is likely an important component of peak performance.

Additionally, our study suggests that significantly reducing an accumulated sleep debt from chronic sleep loss may require more than one night or weekend of recovery sleep. Although sleep is frequently overlooked and often the first to be sacrificed, sleep duration and sleep quality should be important daily considerations for athletes aiming to perform at their best.

Currently, we’re continuing our research on sleep extension and examining the impact on different aspects of performance in various sports. We’re  also investigating the habitual sleep habits and patterns of elite athletes. Since each sport has it’s own unique culture and training, we’re  interested in examining the similarities as well as differences across sports among the Stanford student-athlete population.

Emily asks: What sort of sleep-related work have you done with Stanford athletes over the years? What kind of feedback have you gotten from the students?

Aside from research,  I’ve worked over the years with various teams and athletes at Stanford to help improve and optimize their sleep and recovery.

For many athletes, it’s their first time diving deep into the impact of sleep on performance – they had never before focused on their sleep as an important component of their daily training beyond being told to “get a good night of sleep” before a game or competition. Many of the athletes I work with are surprised at the difference sleep can have on their training, performance, and even schoolwork! For many, it’s their first experience having a strategic approach to optimizing sleep and tracking their progress through a season. It’s often only in hindsight – after they’ve significantly reduced their sleep debt over several weeks – that many athletes realize they were operating at a sub-optimal level. Additionally, athletes often realize after extending their sleep that they need more hours of sleep than they previously thought to perform at their best. Some athletes have gone on to play at the professional level and have even been advocates of the importance of sleep on sports performance.

Several coaches have been quite interested in improving sleep and recovery in their team. They’re often aware that their athletes aren’t  properly rested and thus have been interested in both educating their athletes and implementing strategies to improve their team’s recovery. Some coaches have also consulted me on their travel schedules to minimize jet lag and optimize performance on the road.

Dr. Dement and I are also part of the Stanford Performance Enhancement Alliance, which serves Stanford athletes through a multidisciplinary approach to sports performance.

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Ask Stanford Med, Sleep, Sports, Stanford News

Last day to submit questions on sleep and athletic performance to Stanford expert

CARTERAs a reminder, today is the final day to submit questions for our Ask Stanford Med installment spotlighting sleep and athletic performance. Questions related to research on the subject and to sleep patterns or exercise habits can be submitted to Cheri Mah either by sending a tweet with the hashtag #AskSUMed or by posting a comment here. We’ll accept questions until 5 p.m. Pacific time.

In our earlier post, we included details on Mah’s research:

Sleep and sports are the focus of Mah’s work, dating back to a 2002 study during which collegiate swimmers reported they had beaten personal swim records after getting extra hours of sleep as part of their participation in the trial. A light bulb went off in Mah’s head, who decided then to investigate whether sleep extension could have an impact on physical performance. Since then she has researched the effects of sleep on numerous groups of athletes, including elite college-level basketball players (as detailed in a 2011 study), and she has two soon-to-be-published papers measuring the impact of sleep on Stanford football players and on NFL players. Over the last several years, Mah has also worked with many of the Stanford sports teams and coaches to integrate optimal sleep and travel scheduling into their seasons, and she consults on sleep issues with professional hockey, football and basketball teams.

Previously: Ask Stanford Med: Cheri Mah taking questions on sleep and athletic performanceStanford expert: Students shouldn’t sacrifice sleepA slam dunk for sleep: Study shows benefits of slumber on athletic performanceCould game time affect a baseball player’s at-bat success? and Want to be like Mike? Take a nap on game day
Photo by ASSOCIATED PRESS

Ask Stanford Med, Health Costs, Research, Stanford News

What’s the going rate? Examining variations in private payments to physicians

What's the going rate? Examining variations in private payments to physicians

In this photo taken Tuesday, Sept. 2, 2009, University Muslim Medical Association Community Clinic family medicine physician Linh Vuong, right, checks vital signs of high school student Ericka Millan,15, at the UMMA Community Clinic in Los Angeles.  American Muslims want to ensure that they can fulfill "zakat," or obligatory charitable religious giving, following zakat pledge by President Barack Obama. (AP Photo/Damian Dovarganes)When a U.S. physician sees a patient – either for a routine visit or to administer some sort of treatment – there’s a good chance she’ll be paid a different amount for her work than another doctor doing the same thing one state, or perhaps even one county, away. Variation in the amounts that private insurers pay physicians is a known phenomenon, but extensive research on the practice – and the factors that account for such variation - has been lacking.

To better understand these differences in payments, Stanford health-policy experts Laurence Baker, PhD, and M. Kate Bundorf, MBA, MPH, PhD, teamed up with an Indiana University–Purdue University researcher to comb through more than 41 million insurance claims for four kinds of services: office visits with established patients, office visits with new patients, office consultations, and preventive visits with established patients. What they found was that physicians at the high-end of payments received were generally paid more than twice than what physicians at the low end were paid for the same service. They also found that the variation couldn’t be explained by patients’ and physicians’ characteristics – things like the age and sex of the patient, the physician’s specialty, and whether the doctor was a “network provider” – but that about one third of the variation was associated with the geographic area of the practice.

To find out more about the study, which was published online yesterday in Health Affairs, I contacted Baker. He answers my questions below.

Were you surprised by what you found?

Sort of. Some news reports have highlighted variations in health-care bills, so we were ready for some variations. But since we were looking at services that are quite common and pretty consistent from place to place, we weren’t expecting to find very big variations, which is what we got.

The other thing that’s interesting is the amount of variation that isn’t explainable by the things we looked at. I had expected a lot of it would be explainable, but most of it isn’t. This is another indication of the complexity of the health care system and the lack of understanding we have of the factors that determine prices.

Did you expect geography to be more of or less of a factor?

I had expected more. Geography is a proxy for many things – such as the costs in different areas, the competitiveness of areas, the preferences of the population and doctors. These could all influence prices. I had thought these would play a bigger role than what we found. But there’s a chance that these things still do, but in ways that are specific to individual doctors or groups, so that we need to do more work to fully measure them.

Why is a better understanding of price variation important?

Price variations could signal important problems with the functioning of health-care markets. Large price variations for similar services normally only exist where someone in a market has a lot of power to dictate prices, which is often a problem for consumers. Price variations can also exist for reasons we’d be less concerned about – for example, if some providers are much higher in quality than others. But knowing about the existence and patterns of price variations can guide us to examine areas that we may need to work on to improve the system.

Informing patients about price variations can also be important. Some patients – for example, the uninsured – can end up paying widely different prices for the same services. If they have more information, they’ll perhaps be better able to manage their health-care experiences and bills.

Continue Reading »

Ask Stanford Med, Sleep, Sports, Stanford News

Ask Stanford Med: Cheri Mah taking questions on sleep and athletic performance

football kidIt’s football season and back-to-school time, which means evening routines in households across the country may be changing to accommodate homework, practice, dinner, and perhaps Monday Night Football-watching. For athletes of all ages and stripes, conversations may also be focused on optimizing performance and reducing the risk of injury, with such topics as conditioning technique and nutrition getting playing time in the discussions. But one thing that may not be getting enough attention is sleep, and its role in sports.

To boost the conversation of sleep’s part in athletic performance, we’ve asked Cheri Mah, a researcher with the Stanford Sleep Disorders Clinic and Research Laboratory, to respond to your questions on the topic. Sleep and sports are the focus of Mah’s work, dating back to a 2002 study during which collegiate swimmers reported they had beaten personal swim records after getting extra hours of sleep as part of their participation in the trial. A light bulb went off in Mah’s head, who decided then to investigate whether sleep extension could have an impact on physical performance. Since then she has researched the effects of sleep on numerous groups of athletes, including elite college-level basketball players (as detailed in a 2011 study), and she has two soon-to-be-published papers measuring the impact of sleep on Stanford football players and on NFL players. Over the last several years, Mah has also worked with many of the Stanford sports teams and coaches to integrate optimal sleep and travel scheduling into their seasons, and she consults on sleep issues with professional hockey, football and basketball teams.

Questions can be submitted to Mah by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Tuesday, September 17 at 5 p.m.

When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses
  • Mah will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Stanford expert: Students shouldn’t sacrifice sleep, A slam dunk for sleep: Study shows benefits of slumber on athletic performance, Could game time affect a baseball player’s at-bat success? and Want to be like Mike? Take a nap on game day
Photo by Nick Weiler

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