First performed in the 1950s this surgery involves cutting the hyperactive nerves that control sweating and blushing at the second and third thoracic level. Sensory nerve cell bodies are collected in ganglion that exit the spinal cord at different levels along the spine.  Those that exit at T2 and T3 are involved in excessive facial sweating and are also implicated in excessive blushing.

 Previously the procedure was quite invasive but new techniques limit the amount of cutting. One study reported on in the Journal of Cosmetic Dermatology by Drott et al, sent questionnaires to 1314 patients who had undergone the procedure for excessive blushing after a mean of 29 months. Only 831 patients responded to the questionnaires but those who responded reported a significant reduction in blushing. As with hyperhidrosis, the most common side effect of the surgery is compensatory sweating on the trunk and legs.

If you are unfortunate enough to suffer from excessive blushing or sweating, consult your medical provider for more information on treatment options.

Athletic trainers, chiropractors, physical therapists and practitioners of alternative medicine have been using LLLT since it was FDA approved in 2002. Because LLLT produces no heat, sound or vibration it is felt that it causes photochemical reaction in the cells and tissues that may lead to reduced inflammation and improve circulation to the affected area. 

Some studies done on carpal tunnel syndrome showed that LLLT is effective in treating mild to moderate CTS. A smaller study involving 23 patients (involving 30 hands) showed a 77% achieved complete resolution of symptoms. Overall results remain controversial with wavelength, dosage, site application and treatment duration all affecting the outcome.

Interstingly, the Department of Labor and Industries published a paper about LLLT. Click on this link for further information about the use of LLLT in treating various disorders.

As a filter, it only allows substances with a molecular weight  of up to 40,000 to pass through it. This prevents larger molecules such as proteins from being excreted. We can tell a lot about the health of the kidney from a single specimen of urine.

So just how much fluid do the kidneys filter each day? An astonishing 47.5 gallons – and of this, we excrete approximately 1.5 quarts of urine a day!

Statistics vary but about 5-20% of patients will regain weight despite having gastric bypass surgery. This indicates that we still don’t fully understand the psychopathology of binge eating and its impact on gastric bypass surgery as one 2002 study of binge eating in gastric bypass patients concluded.

The two most common types of weight loss surgery are laparoscopic gastric banding and gastric bypass surgery with weight loss expected to be between 45-75% and 50-75% respectively. Gastric bypass surgery should be done by an experienced surgeon.

For more information about these types of surgery, UpToDate has an excellent patient handout on weight loss surgical options.

The study results were published in the British medical journal Lancet. The study followed for 10 years, people who had been diagnosed with impaired fasting glucose, otherwise known as “pre-diabetes”. The purpose of the DPPO was to study the long term effect of diet and exercise and the diabetes medication, metformin, on the delay of type 2 diabetes.

One group took metformin, a well known anti-diabetic medication, while the other group focused on life-style changes that included modest weight loss and increased physicial activity. A third group received a placebo instead of metformin.

Those in the life-style changes group delayed the onset of type 2 diabetes by 4 years compared with placebo, while those in the metformin group delayed the onset by 2 years according to Dr. David M. Nathan, one of the principal investigators of the study. He went on to say in a statement from the National Institue of Diabetes and Digestive and Kidney Diseases which funded the program, that “…people age 60 and older lowered their rate of developing type 2 diabetes in the next 10 years by about half.”

This is good news for anyone diagnosed with pre-diabetes showing that simple changes in your activity level to promote weight loss really does work.

Interval training increases endurance, increases fat burn, and as Gibala et al concluded in their study at McGill University, decreases the amount of  work out time. “Given the markedly lower training volume in the SIT group, our results suggest that intense interval training is indeed a time-efficient strategy to induce rapid muscle and performance adaptations comparable to traditional endurance training.”

Interval training is quite easy. If you normally work out on the treadmill for 50 minutes at 4 mph, try shortening your work out to 25 minutes. Every 5 minutes, spend 30 seconds going as fast as you can, then resume your previous pace of 4 mph. This will give you 5 intense work out sessions lasting 30 seconds each – in other words 2 1/2 minutes of intense work out time. (Be sure to include a 5 minute warm-down period. Abruptly stopping  your work out can cause dizziness and blood pooling in the lower extremities.)

As always, consult your health care provider if you are new to any exercise program. Once you’re cleared, give interval training a try. You’ll be surprised by how quickly you can lose weight.

In the November 2009 newsletter, the “right stuff” column featured broccolini. According to the newsletter, broccolini is rich in Vitamin C (130% of a day’s worth) and Vitamin A (30%). Eight stalks are only 35 calories. I like to add a bunch, trimmed (including the stalks) in soup.

Nutrition Action also suggests tossing them with a little olive oil and roasting them in the oven on 450 degrees for 12-15 seconds then sprinkling them with a little Parmesan cheese.

Feel free to submit your own favorite way of preparing broccolini.

The articles specifically write about the human side of drug trials by following five patients who entered the trial as the last resort, chronicling their miraculous remissions and the struggles involved in bringing these kinds of drugs to market. PLX 4032, developed by Roche for treating melanoma, was in the first phase. New drugs must undergo 4 stages in testing which are outlined below:

Dr. Keith Flaherty, the lead oncologist from the University of Pennsylvania, in charge of the Phase 1 trials, was investigating ways in which certain genetic mutations that cause melanoma could be turned off. To qualify for entry into the trial, patients had to have the genetic mutation that stimulated the cancer. And the results for PLX 4032 were nothing short of astonishing: tumors disappeared.

The articles detail the frustrations dealt with by patients, families and doctors when trying to push for combination drug therapy or when trying to speed up drug approval by the Food and Drug Administration (FDA). In addition, drug companies do not necessarily cooperate with each other as Dr. Flaherty finds out when he urges several companies to combine their drugs in one trial in order to target several different pathways in much the same way that HIV patients receive a “cocktail” of medications that slow replication of the HIV virus.

The articles make compelling reading. Here are the links:

Target Cancer: A Roller Coaster Chase for a Cure

Target Cancer: After Long Fight, Drug Gives Sudden Reprieve

Target Cancer: Recovery, Relapse, Reinvention

If you or someone you know is interested in participating in clinical trials (not necessarily this one) you can research all the trials available by going to clincialtrials.gov . There you can search a large database of federally and privately funded trials available in the U.S. and around the world.

Anthem mainly provides health insurance for people who are unable to get it through their employer. This means that the full burden of the rate increase is paid for by the individual.  Families already stretched thin will be forced to drop their health care coverage (and end up in Emergency Rooms when there’s a problem).

I checked the rates for family coverage using the following scenario: Male 39 yo, Female 37 with one 9 year old boy and 7 year old girl. The most expensive monthly rate was $299 BUT there was a $10,000 annual deductible plus an annual out-of-pocket expense not to exceed an additional $5,000. On some plans, the deductible is waived for certain services such as Well-Child and adult office visits. Ummmm, it’s not clear to me why someone would opt to pay an additional $116/month more for such poor coverage anyway. A $10,000 annual family deductible amounts to $833/month in medical expenses that would be incurred by the family for a year before their health care expenses would be paid for. Essentially, this policy is for catastrophic coverage only.

Whether or not the coverage provided by Anthem is adequate, this rate increase is being reviewed by the State Department of Insurance to see if it is justified by law. The president of Anthem, Leslie Margolin, argues that the anger directed against Anthem is misplaced. “This debate and this inquiry cannot and should not be just about the insurance industry or the delivery system or regulators or legislators or customers or brokers,” Margolin said.

“We have wasted precious time and precious resources doing battle with each other,” she added. “We must come together collaboratively and strategically to address the distressing symptoms of our troubled system — rising premiums, for example — and to address the fundamental underlying causes of our collective failure.”

The rate hikes are on hold until an outside actuary board can verify that Anthem spends 70% of its premiums on medical expenses, as mandated by California law. Anthem officials are confident that the rate increase will go ahead. Anthem officials say that their profit margin is on par with other health insurers and amounts to no more than 5%.

Sounds reasonable until it was declared during the Senate hearings 2/24/10 that Anthem made over $2.5 billion in profit last year (that excludes the profit it made on the sale of one of its businesses for another $2+ billion dollars). Anthem’s CEO testified yesterday that she made about $1.7 million dollars in salary, over $8 million in stock-options and another $74,000+ in bonus incentive pay last year.

By the way, Anthem last year (August 8, 2009) blasted the proposed health care reform bill and urged customers to help fight the bill. Clearly,  they are not urging customers to fight against this rate increase but while they continue to make profits, customers are forced to pay for it.

Regardless of whether Anthem is making excessive profits (it claims otherwise but you decide) the cost of health care is breaking employers and individuals alike. It’s time for a single-payer system.

There are some classic symptoms associated with appendicitis but that being said, the symptoms are fairly vague at first. The pain starts generally around the umbilicus (belly button) which then tends to radiate down to the right side of the abdomen. Loss of appetite (anorexia) and nausea almost always accompany the pain.

Now, many people complain of abdominal pain or discomfort with loss of appetite and nausea so the clinician looks for other symptoms that may help confirm the diagnosis. These are:

• guarding the abdomen voluntarily or involuntarily during the exam
• heart rate over 100
• slight temperature increase
• pain that is relieved with bending the right lower leg

Sometimes however, the symptoms are not so clear cut and can include:

• diarrhea, gas or indigestion
• general  malaise

Because symptoms can be vague especially at the onset, there is no one specific test used to diagnose appendicitis. Labs can be ordered to see if the white blood count is elevated or to rule out other causes of abdominal pain. CT scans and ultrasound testing can be useful when appendicitis is suspected but not clear. 

Even then, these radiologic exams can be less than clear. Case in point involved one patient of mine whose CT results were equivocal. The surgeon wanted to monitor her overnight to see if her symptoms worsened but she had had enough and decided she wanted to proceed with the surgery. Sure enough, the pathology report showed inflammation of the appendix.

Hopefully, a thorough history, physical and lab data can cinch the diagnosis - if not there are the radiologic tests previously mentioned. Otherwise, careful observation in a hospital setting may be required.