What's New In Health

About This Blog

2005-08-24T11:11:00.000-07:00

Dr. Lei from the Genetics and Public Health Blog asked us to tell our readers a bit more about this blog. The following are answers to the U.S. National Institutes of Health list of 10 Things to Know about Evaluating Medical Resources on the Web.

1. Who runs this site?

What's New In Health is written by a board-certified family physician in group practice in California. I am a graduate of the UCLA School of Medicine, have a full-time medical practice, and am involved in medical education with both residents and medical students. I have written and published numerous academic medical papers and will have my third textbook published in September. I currently serve as a consultant for several large corporations and have been the recipient of several teaching awards. At present, I am the only writer for this blog.

2. Who pays for the site?

Thus far, this blog is wholly supported by me on my free time. A few dimes come in here and there from the ads on the site, but this does not cover the expenses involved with running this site. Although some of the articles written have information about pharmaceutical companies, biotechnology companies, or medical equipment manufacturers, none of the information here at What's New In Health is bought or sold. The information is presented solely for the public's benefit.

3. What is the purpose of the site?

There are countless sources of medical information available on the web, and countless more sources of medical and health news. Some of these sources are legitimate and credible, while many others are not. Furthermore, many of the articles found on the web are written by individuals with no background in the medical or health sciences. The goal of this blog is to provide credible health news and information written by a physician who has a solid understanding of the topics being presented.

4. Where does the information come from?

The information on this blog comes from dozens of sources. I review Yahoo Health News and Google Health News daily to see what new information is being presented to the public. I also subscribe to dozens of electronic and paper journals, which I review for interesting content (and to keep myself up-to-date). I also gather information from medical texts, other medical journals, and subscription services to create a well-written article that provides more information than the standard news services.

5. What is the basis of the information?

The source material comes from medical texts, medical journals, and online subscription services. I only take information from legitimate sources such as peer-reviewed articles or well-written texts. At any time, I would be happy to provide citations for my source material upon request.

6. How is the information selected?

The topics to be discussed are selected based upon what is currently appearing in the health news, issues that I think readers might find interesting, and requests from our readers. I then research the topic as needed in the same manner that I would in writing a medical journal article. There is no one to review my writing, however, so I am always open to feedback from my readers if there are any issues regarding accuracy or even new information that has become available.

7. How current is the information?

Topics are selected and reviewed on a daily basis. My articles are written as quickly as I can while still maintaining quality and accuracy. The most exciting topics in the news are usually current to within 24 hours. However, some topics may not be time-sensitive, in which case the information is up-to-date, but may not be late-breaking news.

8. How does the site choose links to other sites.

What's New In Health does not link to any site that asks or pays for a link. I provide links to sites that I believe offer quality content with relevant information for my readers. I am open to suggestions regarding links to other sites, but ultimately I will choose which sites to link.

The advertisements that appear on the site are generated randomly. I do not have any influence over the particular ads, except that I do not permit ads for things such as gambling and adult content. The Amazon.com ads have books that I personally recommend. If you do not find these recommendations to be high-quality books, please let me know.

9. What information about you does the site collect, and why?

What's New In Health never sells or rents your information to anyone. If you use the bloglet service to have our updates emailed to you, that is the only purpose that your email is used for. You may discontinue the service at any time.

10. How does the site manage interactions with visitors?

I am open and eager to receive comments from my readers. I will gladly accept your opinions, musings, or recommendations for future articles. You may post your comments publicly on the blog, or you may email them to me privately at WhatsNewInHealth@gmail.com.

I hope that the answers to these questions help you in your quest to find accurate, high-quality, and timely health information. Thank you for your readership. You are the reason that I am spending time writing these articles.

Opening Up the Forum

2005-08-23T09:51:00.000-07:00

We have decided to open up the forum and respond to our readers' request. If there is a topic that you would like us to discuss or write an article about, please let us know. We may not be able to fulfill all requests, but we will try to address the most interesting and/or helpful topics over the next week or two.

Please leave a comment with your suggestions.

Exciting Times for Macular Degeneration

2005-08-22T09:56:00.000-07:00

An offer from OSI Pharmaceuticals to buy Eyetech Pharmaceuticals has energized both the business and science communities in the world of macular degeneration research.

Age-related macular degeneration (AMD) is a degenerative disease of the central portion of the retina that results in loss of central vision in the affected eye. Central vision is required for activities such as driving, reading, and watching television, in addition to many of the tasks of daily life. Age-related macular deneration is classified as dry (atrophic type) or wet (neovascular type). Wet AMD is characterized by the growth of abnormal vessels in the retina, which can leak, leading to fluid collections or bleeding under the retina. This leaking fluid can result in retinal detachment, leading to vision loss.

Wet AMD results in a rapid distortion and loss of central vision over a period of weeks to months. Once wet AMD has developed in one eye, the other eye is at high risk of developing the disease. In a large study, wet AMD was found in 0.9 percent of all people, but in no one under the age of 55. The prevalence of the disease increased with age.

As many as 15 million people suffer from some form of AMD, with more than 1.6 million of these being the wet type of AMD. There are 500,000 new cases of wet AMD worldwide each year. Although wet AMD is not nearly as common as dry AMD, wet AMD causes significantly more severe vision loss. Wet AMD represents about 10 percent of all AMD cases but is responsible for as much as 90 percent of the severe vision loss accociated with AMD.

Why all of the new excitement? Eyetech Pharmaceuticals has the first and only product on the U.S. market for treating wet AMD. However, biotech giant Genentech is close behind with a new product of their own in clinical trials. And today, OSI Pharmaceuticals offered to buy Eyetech in a cash and stock deal.

Eyetech Pharmaceuticals, Inc., is a biopharmaceutical company specializing in therapeutics to treat diseases of the eye. In December 2004, their first product, pegaptanib sodium injection, marketed under the name Macugen, was approved by the United States Food and Drug Administration for use in the treatment of all types of wet AMD. They began selling their product on the U.S. market in January 2005. Macugen is also being tested in clinical trials for the treatment of diabetic macular edema and retinal vein occlusion, both significant causes of vision loss. Macugen was named Innovative Product of the Year in 2005 by the Pharmaceutical Achievement Awards. Macugen is the first and only FDA-approved therapy for the treatment of all subtypes of wet AMD. Macugen is being co-promoted with Pfizer.

However, Genentech has ranibizumab (Lucentis) in Phase III clinical trials for the potential treatment of the wet form of AMD. Lucentis is being developed in collaboration with Novartis Ophthalmics. On May 24th, 2005, Genentech released preliminary data showing that Lucentis had unprecedented efficacy against some types of AMD and may even help reverse the disease.

Up to this point, OSI Pharmaceuticals had focused on cancer and diabetes products, but appears eager to get into the ring with Genentech. Interestingly, OSI Pharmaceuticals currently is co-promoting another product, Tarceva, with Genentech.

What does this all mean? There is one exciting product already on the market for wet AMD and another one likely to be on the market soon. This is good news for the millions of people suffering from the disease and should make for interesting time for biopharmaceutical investors.

Night Work May Increase Breast Cancer Risk

2005-08-21T15:36:00.000-07:00

Researchers from Harvard University and Brigham and Women's Hospital have shown that working regular night shifts increases the risk of developing breast cancer by as much as 50 percent. The data is reported in the European Journal of Cancer.

The researchers analyzed data from more than 10,000 women and found that those who worked at night were one and a half times more likely to develop breast cancer than the daytime staff. Furthermore, the risk seemed to be associated with the amount of nighttime work performed. More night work was found to be associated with a higher risk of breast cancer.

One theory for the increased risk is that exposure to artificial light at night leads to an increased production of estrogen. Another theory is that the hormone melatonin plays a role. Melatonin is normally released in the body at night and helps regulate sleep patterns. Women with high levels of melatonin in the morning are at lower risk of breast cancer. When normal melatonin cycles are interrupted, production of estrogen is increased. Elevated estrogen levels can induce hormone-sensitive tumors in the breast.

Previous studies have demonstrated other health risks associated with night work. These other health risks include higher rates of heart disease, depression, and other types of cancer.

New Aneurysm Device Put to Use

2005-08-18T19:27:00.000-07:00

A new stent used to treat aneurysms is now being put to use nationwide. The stent was approved by the Food and Drug Administration in March 2005, and the University of Pennsylvania has just started FDA-required training for surgeons nationwide on how to use the device. The University of Pennsylvania will be one of seven training centers for the stent.

The GORE TAG Thoracic Endoprosthesis is a flexible tube that comes in a range of lengths and diameters and is used to treat aneurysms in the chest. The device is manufactured by W.L. Gore and Associates, Incorporated, the same company that makes Gore-Tex products. This stent is the first FDA-approved grafting system for treating aneurysms of the descending thoracic aorta, the large artery in the chest that connects the heart with all of the blood vessels in the abdomen, pelvis, and lower extremities.

An aneurysm is a diseased, weakened, and bulging section of an artery wall. Thoracic aortic aneurysms are diagnosed in about 15,000 people annually. Thoracic aortic aneurysms are the result of several different factors, including aging, smoking, high blood pressure, high cholesterol, infection, and genetic disorders such as Marfan syndrome. Three out of four people with thoracic aortic aneurysms are asymptomatic and are diagnosed when they are being tested or treated for other health conditions. A ruptured aortic aneurysm has a very high death rate due to massive internal bleeding.

Traditional aneurysm surgery is high-risk and requires a 12-inch incision in the chest and removal of the diseased portion of the aorta while the patient is kept alive on a heart-lung machine.

To implant the new stent device, the surgeon makes a 2 to 3 inch incision in the abdomen or groin, introduces a catheter with the compressed stent into an artery, and guides it to the diseased part of the aorta. The stent is then opened and expands to the width of the aorta, creating a new aortic lining and sealing off blood flow into the aneurysm.

Compared with traditional surgery, the stent had 66% fewer aneurysm-related deaths and less blood loss (472 mL vs 2402 mL). Using the stent resulted a faster recovery and a shorter hospital stay: 3 days with the use of the stent versus 10 days for traditional surgery. The new stent offers a particular advantage for elderly or very sick patients who might not be able to tolerate the stress of traditional surgery.

At this time, it is unclear how long the stents will last. The stents have been used in clinical trials since 1999, and the stents have held up for patients who have had them inserted in the last three to four years. W.L. Gore and Associates has stated that they have not had any aneurysm ruptures through two years of use.

Medical Disclaimer
The information contained in this online site is intended to provide accurate and helpful health information for the general public. The information is provided with the understanding that the author and publisher are not engaged in rendering medical, health, psychological, or any other kind of personal professional services on this site. The information should not be considered complete and does not cover all diseases, ailments, physical conditions, or their treatment. The information provided on this site should not be used in place of care by a competent medical professional, who should be consulted before adopting any of the suggestions in this site or drawing inferences from it.

The information about medications on this site is general in nature. It does not cover all possible uses, actions, precautions, side effects, or interactions of the drugs mentioned. The information is not intended as medical advice for individual problems or for making an evaluation as to the risks and benefits of taking a particular drug.

The operator(s) of this site and the publisher specifically disclaim all responsibility for any liability, loss or risk, personal or otherwise, which is incurred as a consequence directly or indirectly, of the use and application of any of the material on this site.

Comparison of Coronary Stents

2005-08-17T09:38:00.000-07:00

The following article provides an overview of drug-eluting stents as well an a review of the recent meta-analysis in the Journal of the American Medical Association (JAMA) comparing the two drug-eluting stents available on the U.S. market.

Coronary angioplasty, also known as percutaneous transluminal coronary angioplasty (PTCA), is a procedure performed by a cardiologist to open a clogged coronary artery in the heart. A catheter is passed through a vein in the groin or the arm, and a catheter is passed through the vein and into the heart. Once there, dye is released into the coronary arteries. Live x-rays are taken to show the cardiologist where the blockage is in the arteries. Once the blockage is identified, the cardiologist attempts to open this blockage.

When angioplasties first started being performed, a ballon was used to dilate the artery. However, the wall of the coronary artery can become weakened following balloon dilatation. In a small percentage of cases, the artery would be successfully opened only to have the artery collapse after the balloon was deflated. This often required emergency open-heart bypass surgery.

Experience showed that over time, 30 percent of coronary arteries eventually closed after balloon angioplasty. Stents were then developed to help hold the arteries open, and the first one was approved for use in the United States in 1994. Starting then, a metal tube or scaffold structure was often placed in the artery after balloon dilatation to help keep the artery open.

However, it was found that the arteries often closed over a period of time, a process called restenosis. Restenosis occurred by six months in 25 percent of cases, requiring a repeat angioplasty. Physicians and companies began testing drugs that were known to interrupt the biological process that caused restenosis. They began coating the stents with these drugs to prevent restenosis.

There are three factors involved in these drug-coated stents. The first is the type of stent that carries the drug coating. The second factor is the method by which the drug is delivered (eluted) to the arterial wall. The final factor is the drug itself.

In addition to aspirin, patients who receive drug-eluting stents must take an anti-clotting drug such as clopidogrel (Plavix) or ticlopidine (Ticlid) for up to six months after stenting to prevent blood from reacting to the stent and clogging up the artery. Ideally, a smooth layer of cells lining the artery grows over the stent, incorporating the stent into the wall of the artery.

Drug-eluting stents current have a world market of $2.5 billion annually. There are two drug-eluting stents currently approved by the Food and Drug Administration (FDA) for use in the United States. The Cordis CYPHER sirolimus-eluting stent was approved April 2003, and the Boston Scientific TAXUS paclitaxel-eluting stent was approved March 2004. Medtronic and Guidant have stent programs in clinical trials and are hoping for FDA approval late 2005 or 2006.

Both stents have shown significant reductions of restenosis in clinical trials, which brings us to present day research.

A European meta-analysis from six randomized trials was reviewed in the current issue of the Journal of the American Medical Association (JAMA). The researchers found six randomized trials to compare the sirolimus-eluting stents to the paclitaxel-eluting stents. The six trials incorporated a total of 3,669 patients.

The results of their meta-analysis showed that patients receiving sirolimus-eluting stents had a lower risk of restenosis (reblocking of the artery) and a lower need for revascularization of the artery (re-opening of the affected artery) compared with those receiving a paclitaxel-eluting stent. The rates of death, heart attack, or stent thrombosis (blood clot in the stent) were similar with the two drug-eluting stents.

For more information on angioplasty and drug-eluting stents, please visit www.angioplasty.org or www.PTCA.org.

Medical Disclaimer
The information contained in this online site is intended to provide accurate and helpful health information for the general public. The information is provided with the understanding that the author and publisher are not engaged in rendering medical, health, psychological, or any other kind of personal professional services on this site. The information should not be considered complete and does not cover all diseases, ailments, physical conditions, or their treatment. The information provided on this site should not be used in place of care by a competent medical professional, who should be consulted before adopting any of the suggestions in this site or drawing inferences from it.

The information about medications on this site is general in nature. It does not cover all possible uses, actions, precautions, side effects, or interactions of the drugs mentioned. The information is not intended as medical advice for individual problems or for making an evaluation as to the risks and benefits of taking a particular drug.

The operator(s) of this site and the publisher specifically disclaim all responsibility for any liability, loss or risk, personal or otherwise, which is incurred as a consequence directly or indirectly, of the use and application of any of the material on this site.

2005-08-16T13:53:00.000-07:00

Gene Therapy Advancing for Muscular Dystrophy

A new report from researchers at the University of Pittsburgh has raised hopes that gene therapy might become a possibility for muscular dystrophy.

The researchers were able to deliver a miniature gene throughout the bodies of mice, showing that systemic therapy is possible.

Previous attempts to treat muscular dystrophy were limited to localized injections. In 2002, researchers at the University of Washington reported successful treatment of muscular dystrophyin mice using a virus which contained a gene that produces a crucial protein lacking in individuals with muscular dystrophy. Their success was tempered by the need to inject the virus into each affected muscle.

The Pittsburgh research team utilized a miniature gene because the gene used to replace the defective gene is too large to fit inside the virus used to deliver it. They showed that the miniature gene, which functions similarly to the defective one, could be delivered throughout the body. More importantly, the animals exhibited some improvement in their symptoms.

Muscular dystrophy is a group of genetic diseases resulting in progressive muscle weakness and muscle degeneration, affecting movement. Muscular dystrophy affects more than 50,000 Americans. The most common muscular dystrophies appear to be due to a genetic deficiency of a muscle protein called dystrophin.

The research will be published in this week's issue of Proceedings of the National Academy of Sciences.

For more information on this topic, visit the Muscular Dystrophy Association or the National Institutes of Health.

2005-08-15T18:07:00.000-07:00

Painkillers Linked to Hypertension in Women

A new study from the American Heart Association has shown that women taking daily doses of non-aspirin pain medications are more likely to develop high blood pressure than those who don't take the medications.

The study involved 5,123 women participating in the long-running Nurses Health Study at Harvard Medical School and Brigham and Women's Hospital in Boston, Massachusetts. Results of the study were published today in the American Heart Association journal Hypertension.

The study found that women taking acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) were more likely to develop blood pressure problems than women not taking these medications.

Although many over-the-counter pain medications had previously been linked to hypertension, acetaminophen had been considered a safe alternative. NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve) have previously been linked to blood pressure problems and have recently been required by the food and drug administration to carry stricter warning labels due to possible hear-related problems associated with their use.

The research found that aspirin did not cause significant blood pressure problems, though researchers do not know exactly why this is. Although aspirin appears safer with regard to blood pressure issues, aspirin still has health risks such as the risk of gastrointestinal bleeding.

In this study, the risk of developing hypertension for women not taking painkillers was about 1 to 3 percent per year. Women ages 34 to 53 who took an average of more than 500 milligrams of acetaminophen per day (one extra-strength Tylenol is 500 milligrams) had twice the risk of developing high blood pressure. Those who took more than 400 milligrams of NSAIDs per day (two tablets of ibuprofen are 400 milligrams) had a 60 percent increased risk of developing high blood pressure.

Women ages 51 to 77 years of age who took an average daily dose of more than 500 milligrams of acetaminophen also had double the risk of developing high blood pressure within 3 years. Women in this age group who took more than 400 milligrams of NSAIDs had a 78 percent increased risk of developing high blood pressure.

The bottom line? There are several issues that this study brings up. First, acetaminophen (Tylenol) may not as safe as most physicians believed. Second, daily use of all types of over-the-counter painkillers except those containing aspirin appears to increase the risk of high blood pressure in women.

There are, however, a few other points to consider. Taking these medications intermittently such that your daily dose is lower than the threshold used in the study may not increase the risk of high blood pressure. The other point to consider is that many people need to take these medications on a daily basis to relieve chronic pain syndromes and live their lives fully. If you do need to take painkillers frequently, we recommend that you discuss this issue with your doctor and watch your blood pressure carefully.

2005-08-15T09:35:00.000-07:00

Update

We're sorry for the lack of posts the last few days which was due to an out-of-town wedding. Check back this evening for an all new post. Thank you for your continued loyalty and readership.

2005-08-10T08:52:00.000-07:00

New Meningitis Vaccine Guidelines

Recent developments in the world of vaccines have led to new and broader guidelines regarding meningitis vaccinations. A new meningitis vaccine marketed under the name Menactra by the pharmaceutical company Sanofi Pasteur was licensed by the United States Food and Drug Administration January 14, 2005. In May, the U.S. Centers for Disease Control and Prevention (CDC) released new guidelines for those who should be vaccinated.

The CDC now recommends routine vaccination of young adolescents with the new vaccine at the 11-12 year-old doctor's visit. For those who have not previously received the vaccine, vaccination is now recommended at about age 15 before entry into high school. Vaccination is still recommended for college freshman who live in dormitories because they are at higher risk for meningococcal disease compared with other people of the same age. The vaccine is given as an injection into the muscle in the arm as just one dose.

Meningococcal disease is caused by bacteria that infect the bloodstream and the linings of the brain and spinal cord, causing serious illness and death. There are 2500 to 3000 cases of meningococcal disease in the United States each year. 10 to 14 percent of those who get meningococcal disease die and up to 20 percent have permanent disabilities such as mental retardation, hearing loss, or the loss of limbs.

Meningococcal disease often begins with nonspecific flu-like symptoms or migraine-type headache. However, the disease spreads quickly and within hours can cause organ failure, brain damage, severe limb disease requiring amputation, or death.

Teenagers and young adults are particularly vulnerable to the disease, accounting for nearly 30 percent of all cases in the United States. Freshmen living in dormitories are up to six times more likely to get the disease than other people. This is believed to be due to crowded living conditions as well as lifestyle factors.

Meningococcal disease is spread through air droplets as well as though direct contact with someone who is infected. The disease can be spread through coughing, kissing, and sharing cigarettes, utensils, cups, or lip balm. Meningococcal disease is most common in the late winter and early spring.

The new CDC guidelines for meningitis vaccines has been endorsed by the American Academy of Pediatrics, which issued a policy statement agreeing with the guidelines.

Additional information about meningococcal disease and the meningitis vaccine can be found at the websites for the following organizations:
National Immunization Program
National Meningitis Association
Centers for Disease Control and Prevention
Meningitis Foundation of America
American College Health Association

2005-08-09T13:42:00.000-07:00

Research Links Arsenic to Tumor Growth

A study from the University of Oklahoma Health Sciences Center indicates that environmental arsenic found in drinking water can stimulate the growth of cancerous tumors and cause them to spread faster.

What the study did not indicate is whether arsenic in drinking water actually causes cancer. The study showed that arsenic increases the growth rate of tumors that are already present.

The researchers used mice which were fed water with elevated levels of arsenic. The mice were then implanted with cancerous tumors. The mice continued to receive arsenic water, and tumor growth was monitored. The researchers found that arsenic increased the growth rate of the tumors and also caused the tumors to spread to the lungs.

The study showed that arsenic levels as low as 4 parts per billion (ppb) stimulated blood vessel growth, which may help tumors grow. Levels as low as 10 ppb caused tumors to increase in size.

The current federal arsenic standard is 50 ppb, and this standard is being lowered to 10 ppb on January 23, 2006. The Environmental Protection Agency will present this study to a congressional subcommittee this coming November.

Although this study did not link arsenic to the development of cancer, arsenic previously has been linked to skin cancer, bladder cancer, lung cancer, liver cancer, kidney cancer, and prostate cancer. The World Health Organization, the Department of Health and Human Services, and the Environmental Protection Agency have determined that inorganic arsenic is a human carcinogen (a cause of cancer). Further studies are being performed by the same group of researchers to determine if elevated arsenic levels increase the risk of developing tumors.

Arsenic is a naturally occurring element widely found in the earth's crust. Inorganic arsenic compounds are mainly used to preserve wood. Organic arsenic compounds are used as pesticides, primarily on cotton plants.

Arsenic exposure can come from many sources. Arsenic exposure may come from eating food, drinking water, or breathing air containing arsenic. Breathing sawdust or burning smoke from wood treated with arsenic can also result in arsenic exposure. Another concerning source of arsenic exposure is living near uncontrolled waste sites containing arsenic or living in areas with unusually high levels of arsenic in the rock. For more information on arsenic, visit The Agency for Toxic Substances and Disease Registry.

2005-08-08T14:54:00.000-07:00

Louisville Considering Smoking Ban

The city of Louisville, Kentucky, is considering a smoking ban in restaurants and day care centers. More than 4,800 municipalities across the country are covered by smoking bans in the workplace, restaurants, or bars. Some have bans in all three places. What makes the upcoming vote in Louisville interesting is that Louisville has the highest smoking rate in the nation and is the largest city in a tobacco-growing state.

Kentucky's adult smoking rate was 27.5 percent in 2004, which made it the top in the nation. Kentucky's governor, Ernie Fletcher, said last month that smoking was the cause for about 7,700 deaths each year in his state. Smoking-related health care costs Kentucky an estimated $1.4 billion per year.

Lexington, Kentucky's second-largest city, passed a ban on most public indoor smoking in 2003. The ban did not take effect until 2004 due to a failed court challenge.

2005-08-07T12:44:00.000-07:00

Questions About LASIK Eye Surgery

I frequently get questions from both patients and friends about LASIK eye surgery. While LASIK surgery can be almost miraculous, it is not always perfect and is not without risks. There is a ton of information available on the internet about LASIK eye surgery, some of which is accurate and some which is not so accurate.

Essentially, LASIK is a surgical procedure intended to reduce a person's dependency on glasses or contact lenses. LASIK stands for Laser-Assisted In Situ Keratomileusis. The procedure changes the shape of the the cornea, the clear covering of the front of the eye, using an excimer laser.

Think of the eye as a camera. The cornea is the lens and the retina is the film. Light passes through the lens and is focused on the retina, where it is interpreted as an image. If the light is not focused properly, the image (and your vision), will not be crisp and accurate. By changing the shape of the cornea, LASIK surgery helps focus light on the retina correctly.

During the procedure, a knife called a microkeratome is used to cut a flap in the cornea. The flap is folded back and pulses from a computer-controlled laser vaporize a portion of the stroma, the middlesection of the cornea. The flap is then replaced.

I could go on and on about risks and benefits, more details about the procedure, the different types of lasers used, questions to ask your doctor, which patients are the best candidates for LASIK, and how to choose a good doctor for this procedure. Fortunately, the FDA has already done the work and has an excellent website dedicated to this very topic. The website can be found at http://www.fda.gov/cdrh/lasik/.

If you are considering LASIK surgery, I recommend that you read this website and understand the procedure well so that you can be a knowledgeable consumer and get the very best eye care.

Medical Disclaimer
The information contained in this online site is intended to provide accurate and helpful health information for the general public. The information is provided with the understanding that the author and publisher are not engaged in rendering medical, health, psychological, or any other kind of personal professional services on this site. The information should not be considered complete and does not cover all diseases, ailments, physical conditions, or their treatment. The information provided on this site should not be used in place of care by a competent medical professional, who should be consulted before adopting any of the suggestions in this site or drawing inferences from it.

The information about medications on this site is general in nature. It does not cover all possible uses, actions, precautions, side effects, or interactions of the drugs mentioned. The information is not intended as medical advice for individual problems or for making an evaluation as to the risks and benefits of taking a particular drug.

The operator(s) of this site and the publisher specifically disclaim all responsibility for any liability, loss or risk, personal or otherwise, which is incurred as a consequence directly or indirectly, of the use and application of any of the material on this site.

2005-08-06T13:46:00.000-07:00

Two Oklahoma Boys Die of Rare Brain Infection

Two Oklahoma boys died Friday after being infected with a rare parasite which is associated with swimming in stagnant water.

The two boys, ages 7 and 9, contracted Naegleria fowleri, an ameba that enters the body through the nose and can cause a deadly inflammation of the brain, spinal cord, and meninges, the membrane covering the brain and spinal cord. The inflammation, called amebic meningoencephalitis, is almost always fatal. Of the 200 cases that have been reported in the last 40 years, there have been only 2 survivors.

The boys are believed to have contracted the parasite from swimming in stagnant ponds. The boys presented to their doctors with symptoms of fever, headache, and hallucinations. After the deaths, three public pools in Tulsa were closed for testing, although health officials do not believe the parasite was contracted there.

Naegleria fowleri is an ameba which is found worldwide. The ameba is found most commonly in warm bodies of fresh water such as lakes, ponds, rivers, and hot springs. The ameba is also found in warm water discharge from industrial plants, under-chlorinated swimming pools, as well as the soil. Although the parasite is found commonly in the environment, infection is rare. there have been only 24 infections reported in the United States from 1989 to 2000.

Naegleria is most common during the dry summer months when the temperature is above 80 degrees Fahrenheit and when the water is warm and water levels are low. For more information on Naegleria, see the CDC Naegleria factsheet.

For more information on swimming safely, visit www.healthyswimming.org.

2005-08-05T09:55:00.000-07:00

Question of the Day

As a service to our loyal readers, we will periodically answer medically-related questions that are emailed to us. Today's question comes from R.M. who asks:

"I am a 56 year old male who had high cholesterol. By watching my saturated fats, exercising, and taking niacin I lowered it. Recently, about an hour or so after eating and taking my vitamins and niacin, twice I have gotten odd tingling feelings and felt like I had a fever. It lasted about 20 minutes. I have taken the niacin and vitamins for several years and have never had this happen before. What could be causing thisto happen now?"

Dr. Ryan responds:

This is an excellent and not uncommon question. The symptoms that you felt were likely due to the niacin that you are taking. Niacin is a member of the B complex family of vitamins and is available in both over-the-counter and prescription forms. At higher doses, niacin is used to treated elevated blood triglyceride levels and may also help with low HDL (good cholesterol) levels.

As with any attempt to treat elevated cholesterol or triglyceride levels, a modification of lifestyle using diet, exercise, and weight reduction should be attempted. It sounds like you have been a model patient in this regard. The use of niacin can reduce total cholesterol 10-25%, reduce triglycerides 20-50%, and increase HDL levels 15-30%.

Patients who have a known allergy to niacin should avoid it. In addition, those with significant liver dysfunction, peptic ulcer disease, or arterial bleeding should not take niacin.

Niacin is typically started at 50 to 100mg two or three times daily. The dose is gradually increased over 6 to 8 weeks to reach a goal dose of 500-1000mg three times daily. Liver function tests should be monitored every 6 to 12 weeks during the first year of therapy and then every 6 months while the medication is continued.

The most common side effect of niacin, which you experienced, is flushing. This flushing can be mild to severe and may make you feel like you have a fever. Other common side effects of niacin include itching, dry skin, headache, nausea, vomiting, diarrhea, and attacks of gout. Flushing can be decreased by first taking 325mg of aspirin. Avoiding hot liquids or alcohol also may decrease the flushing. Flushing, itching, and gastrointestinal symptoms may be decreased by slowly increasing the dose of niacin and avoiding taking niacin on an empty stomach. The good news is that the body develops tolerance to niacin and the flushing usually occurs less frequently, though it may occur now and again.

We hope this helps.
Sincerely,
Dr. Ryan

Sources:
Noble: Textbook of Primary Care Medicine, 3rd ed, Mosby 2001.
Mosby's Drug Consult online, Elsevier 2005.

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2005-08-04T09:43:00.000-07:00

New Exercise Guidelines Just for Women

A new study released today in the New England Journal of Medicine has established age-specific exercise guidelines just for women. Until this study was released, the only exercise guidelines that were available were based on studies on men. This new study increases the knowledge about gender differences in disease processes as well as physiology.

The new study, led by a cardiologist from Northwestern University in Chicago, showed that women's exercise capacity is slightly lower than men's and that it declines a bit faster than men's as they age. The study found that women lose about 1 percent of their exercise capacity per year. For example, a 50-year-old woman should be able to reach 8.2 METs while a 50-year-old man should be able to reach 9.2 METs.

The data was taken from 5,721 exercise stress tests performed on women over the age of 35 and were compared to known fitness levels for men. The women in were given a standard exercise stress test in which they walk on a treadmill while the speed and incline are increased every three minutes until they became tired or developed other problems. The exercise capacity is then measured in metabolic equivalents, or METs, based upon the speed and incline of the treadmill.

One MET is the amount of energy required to sit quietly for one minute. Walking at a moderate pace requires 3 to 6 METs per minute. Running requires 6 to 10 or more METs per minute, depending upon the speed and incline.

Perhaps the most important finding of this study is that women whose exercise capacity was less than 85 percent of what it should be were twice as likely to die within eight years. The study tested the fitness equation to see how well it predicted survival during eight years the volunteers were followed and also looked at another group of 4,471 women with heart disease symptoms who were followed for five years. Surprisingly, women in both groups who did under 85 percent of their expected MET level had twice the risk of death compared to those who did more than 85 percent.

The bottom line? This study emphasizes the point that exercise is critical to good cardiovascular health and that measurements of good exercise tolerance are different between the sexes. Perhaps most importantly, this study showed that your risk of death is higher if you are not able to reach your expected METs, regardless of whether you have symptoms of heart disease.

There is no need for fancy physiologic testing to measure your fitness level. Most treadmill and bicycle machines at health clubs will calculate METs for you. As always, consult with your personal physician prior to initiating any exercise regimen. If you are at risk for heart disease, your doctor may prescribe an exercise stress test for you in a doctor's office so that your fitness level may be tested in a safe environment.

The entire study report as well as the exercise guidelines are available online at www.nejm.org.

2005-08-03T10:25:00.000-07:00

Brain-Dead Cancer Patient Gives Birth

In a remarkable story of human suffering and new life, a brain-dead cancer patient has given birth to a baby girl. Susan Torres, a 26-year-old researcher at the National Institutes of Health had metastatic melanoma which had spread to her brain. Susan collapsed on May 7th, the day before Mother's day, as a result of a stroke, which was found to be due to a previously undiagnosed melanoma. The stroke left her unconscious and brain-dead. Susan's husband, Jason Torres, was told by doctors that his wife's brain functions had ceased and there was no hope for survival.

After the stroke, Susan was kept on life support for three months to give her fetus time to develop to the point that a successful delivery might be possible. The baby girl was delivered on Tuesday by Caesarean section, at which time Susan was about seven months pregnant. The surgical delivery reportedly went smoothly. The baby girl, named Susan Anne Catherine Torres, weighs 1 pound, 13 ounces and is 13 1/2 inches long. She is being cared for in the neonatal intensive care unit at the Virginia Hospital Center in Arlington.

Jason Torres, Susan's husband, had quit his job to be at his wife's side at the hospital, spending each night sleeping in a chair next to her bed. The couple have one other child, 2-year-old Peter, who has been living with his grandparents while the family waited for the delivery. A website has been set up to help raise money for the family's medical bills, which reportedly are tens of thousands of dollars per week. The website can be found at www.SusanTorresFund.org.

The hospital declined to release information regarding Susan's condition or whether she was still connected to the life support machines. According to Dr. Winston Campbell, director of maternal-fetal medicine at the University of Connecticut Health Center, the English medical literature has reported at least 12 other cases since 1979 of a woman being kept alive on life support to deliver a baby.

2005-08-02T19:23:00.000-07:00

Uninsured Children Often Go Without Medical Care

A new study released by the Robert Wood Johnson Foundation shows that one-third of the 8.4 million American children without health insurance go without any medical care for an entire year. The study, titled Going Without: America's Uninsured Children, also showed that uninsured children in virtually every state do not receive all the medical care they need. In comparison, nearly 88 percent of insured children received care during the same period.

The report noted that more than 7 out of 10 uninsured children are eligible for Medicaid or coverage through the State Children's Health Insurance Program (SCHIP). Though there are many children being left uninsured, these two government programs have significantly reduced the number of uninsured children. The number of uninsured children in America has decreased by nearly 2 million since 1998, while the number of uninsured parents has increased by 1 million in the same time span.

Part of the reason that so many children are being left uninsured is because many parents are unaware of the programs or unable to apply for them, according to the foundation releasing this report.

The study also noted that uninsured children are less likely to receive all of their needed medical care and that the problem exists in nearly every state. The five states with the highest levels of uninsured children not receiving any care included Arizona, Nevada, New Mexico, Oklahoma, and Texas.

As might be expected, uninsured children often do not have a personal doctor or nurse who can provide continuity of medical care. Conversely, almost 9 out of 10 insured children have an individual whom they are able to identify as their regular doctor or nurse.

The Robert Wood Johnson Foundation currently is sponsoring "Covering Kids and Families," its sixth annual back-to-school campaign aimed to get more children enrolled in health insurance. Parents of uninsured children can call toll-free at (877) KIDS-NOW to find out if their children are eligible for low-cost or free health care coverage.

2005-08-01T16:47:00.000-07:00

Study Shows Smoking Linked to Belly Fat

A study published today in the American Heart Association's online journal Circulation showed that exposure to cigarette smoke among teenagers raises the risk of developing metabolic syndrome. Metabolic syndrome is associated with excess belly fat and increases the risk of developing diabetes, heart disease, and stroke.

The researchers studied 2,273 teenagers, using data from the Centers for Disease Control and Prevention Survey. Results of the study found that 6 percent of 12- to 19-year-olds had metabolic syndrome, with the prevalence of the syndrome increasing with exposure to tobacco smoke. Only 1 percent of teens not exposed to tobacco smoke had metabolic syndrome. However, 5 percent of those exposed to secondhand smoke had metabolic syndrome, and 9 percent of active smokers had the disorder.

The risk of developing metabolic disorder was even greater among teens who were overweight or at risk of being overweight. Overweight or at-risk teenagers who were exposed to secondhand smoke had a 20 percent risk of developing metabolic syndrome. The risk rose to 24 percent for overweight teenagers who were active smokers.

According to the study design, metabolic syndrome was defined as having at least three of five characteristics that help define metabolic syndrome. These characteristics are high blood pressure, high triglyceride levels, low levels of good cholesterol, a large waist, and evidence of insulin resistance. Triglycerides are fats that are transported in the bloodstream. Insulin resistance is a sign that the body cannot efficiently use insulin and handle glucose. Those with insulin resistance are at higher risk of developing diabetes.

No one is sure exactly what it is about smoking that makes teenagers susceptible to metabolic syndrome. However, we do know that smoking has been linked to insulin resistance in adults. In addition, smoking can lower levels of good cholesterol and can raise blood pressure.

The bottom line? Numerous studies have shown the risks associated with cigarette smoking and secondhand smoke exposure. Likewise, studies have also demonstrated the health effects of obesity and a sedentary lifestyle. Now it appears that the two may be linked and that smoking adds to the risk of developing metabolic syndrome, which can have serious health consequences.

2005-07-31T10:23:00.000-07:00

West Nile Virus Update

West Nile Virus is most commonly transmitted to humans from the bite of an infected mosquito. However, West Nile Virus may also be transmitted by organ transplantation, blood transfusion, mother-to-fetus infection, and possibly by breast milk. Infection may also occur in laboratories and among farm workers.

Most human West Nile Virus infections cause either no symptoms or a mild flu-like illness. The most severely affected patients may develop encephalitis or meningitis, an inflammation of the brain or membranes of the brain and spinal cord. Persons over age 50 are at higher risk of severe illness following infection, and severe cases may be fatal. Most deaths occur in individuals over the age of 50 years, and in 2002, one-half of all deaths occurred in people over the age of 77.

The symptoms of milder infections with West Nile Virus may include fever, headache, fatigue, skin rash, swollen lymph glands, and occasionally pain in the eyes. More severe illness may cause headache with fever, vomiting, and altered mental status such as lethargy, seizures, and coma. Other symptoms of severe West Nile Virus illness include a stiff neck and focal neurologic symptoms such as paralysis or the development of tremors. If you or anyone you know has symptoms of West Nile Virus, immediate evaluation by a physician should be obtained.

West Nile Virus is commonly found in Africa, West Asia, and the Middle East. The virus was first reported in the United States in New York State in the summer of 1999. Since the first report of disease in the United States in 1999, West Nile Virus has caused more than 16,000 cases of human illness, including 650 deaths.

In 2004, the most recent year when full data are available, there were 25398 cases of West Nile Virus reported in the United States, including 100 deaths. Data for 2005 is still being tracked, but as of July 26, 2005, human cases of West Nile Virus had been reported in Arizona, Arkansas, California, Colorado, Georgia, Indiana, Kansas, Louisiana, Minnesota, Mississippi, Missouri, New Mexico, Ohio, Pennsylvania, South Dakota, and Texas.

In the temperate zone of the world, West Nile encephalitis cases occur primarily in the late summer and early fall. In the southern climates, West Nile Virus can be transmitted year round.

There are a number of strategies that you can use to protect yourself from West Nile Virus infection. Reduce the number of mosquito bites you get. Use insect repellent with DEET when outdoors and cover as much of your body as possible with clothing. Prime mosquito-biting hours are usually dusk to dawn. Pay special attention to protection during these hours. Make sure that window and door screens in your home are in good condition.

Eliminate standing water around your home in order to reduce mosquito breeding. If your neighbors have standing water such as dirty swimming pools, encourage them to eliminate these sources of infection. If they do not comply, contact your local health department who will come out and make sure the standing water is eliminated.

2005-07-30T18:26:00.000-07:00

Botox Injections Help With Excessive Sweating

The results of a study to be presented this week show that Botox, the trade name for botulinum toxin, may help reduce excessive underarm sweating. The three year study from Saint Louis University examined 193 people suffering from primary axillary hyperhidrosis, or excessive underarm sweating. The study will be presented this week at the American Academy of Dermatology meeting in Chicago.

Individuals with hyperhidrosis may sweat up to four times as much as the average person, regardless of the temperature. This excessive perspiration may result in significant social embarrassment and difficulties in performing work activities.

Experts believe that hyperhidrosis results from a dysfunction of the sympathetic nervous system, which is responsible for various bodily functions, including regulation of the body's temperature through sweating. Individuals with hyperhidrosis may produce too much of a certain neurotransmitter or may have sweat glands that respond excessively to normal levels of neurotransmitter.

Results of the study showed that those treated with Botox were less dissatisfied with their ability to perform work activities due to sweating, were less "emotionally damaged or injured" due to excessive sweating, and were more satisfied with their abilities in social settings.

The bottom line? It appears that the use of botulinum toxin, or Botox, is a significant advance in the treatment of excessive underarm sweating. The disadvantages are mild to moderate pain associated with the injections, the potential for infection, and the necessity of repeat injections at regular intervals. One potential alternative to Botox injections is a surgical procedure in which a group of nerve cells in the chest wall are cut or clipped to block the same neurotransmitter that Botox targets.

As with any procedure, we recommend that you seek care from a medical professional well-trained in this procedure. Using Botox to treat axillary hyperhidrosis requires more training and experience than using Botox to treat facial wrinkles.

2005-07-29T08:20:00.000-07:00

Controversial Silicone Implants May Get Approval

The U.S. Food and Drug Administration has indicated that it probably will lift a 13-year ban on silicone breast implants. Mentor Corporation has been told that its silicone breast implants could be approved if certain questions can be resolved.

The Food and Drug Admininstration pulled silicone breast implants off the market in 1992 over safety concerns. Since that time, the implants have been available only in clinical trials to women who were born with a deformity, have had a mastectomy, or needed to replace other implants.

Currently, U.S. women who desire breast augmentation can only get saline implants, which many experts consider cosmetically inferior to silicone implants. The most significant questions relating to the safety of silicone implants have to do with when and why they tear, and what effects they may have on a woman's health if they do tear.

Silicone breat implants have both passionate supporters and vocal critics. At this time, it is unclear how long it may take Mentor to respond to the FDA and how long it may take the FDA to approve the silicone implants. There is also a possibility that the FDA may not approve Mentor's silicone implants.

2005-07-27T16:05:00.000-07:00

Echinacea May Not Help Treat Colds

A new study released by the National Center for Complementary and Alternative Medicine shows that echinacea does not help to prevent or treat the common cold. Echinacea, also known as purple cornflower, is one of the most popular herbal remedies used to treat the common cold.

Several previous animal studies and smaller human trials have suggested a benefit from echinacea in treating respiratory infections. However, a larger study released in 2003 found that echinacea did not help relieve cold symptoms.

This latest study, funded by the National Institutes of Health, adds to the evidence against echinacea as a cold remedy. The study enrolled 399 healthy patients who were given one of three echinacea preparations or a placebo. The subjects were then exposed to cold virus and their symptons were evaluated. No differences were found between the groups given echinacea or placebo. Typical cold symptoms such as sore throat, runny nose, and sneezing were about the same in the different study groups.

What does this mean for natural cold remedies such as echinacea? Don't dismiss them just yet. This was a relatively small study by scientific standards, and the echinacea used in this study was from laboratory-made plant extracts, not necessarily the kind you might buy over-the-counter. In addition, higher doses of echinacea than was used in the study might in fact help treat the common cold. Also, don't forget about other cold remedies such as zinc and vitamin C that just might help treat some cold symptoms.

2005-07-26T16:58:00.000-07:00

Breast Cancer Prevention Drug Being Studied

Exemestane, a cancer-treatment drug used to prevent recurrence of breast cancer, is being studied as a new way to help prevent breast cancer. Postmenopausal women at higher risk for breast cancer will be given exemestane to determine whether it prevents breast cancer.

Exemestane, which works by preventing the body from producing estrogen, belongs to a class of medications called aromatase inhibitors. The results of an international study released in March 2004 demonstrated that exemestane significantly lengthened survival in breast cancer patients. Now the question is whether exemestane can help prevent breast cancer in women at higher risk for the disease.

One in eight American women will be diagnosed with breast cancer in her lifetime. The exemestane trial, called the ExCel study, will last five years and will enlist 4,500 women from the United States, Canada, and Spain. The women being studied have increased risks of breast cancer such as being 60 or older or having a family history of breast cancer.

However, exemestane is not without potential risks of its own. Exemestane may increase the risk of osteoporosis and may cause joint pains, muscle pains, or nausea. Tamoxifen, another drug used to treat breast cancer, has also been shown to decrease the risk of breast cancer in women older than 35 who are at high risk for the disease. However, its use has been limited by health risks such as stroke, uterine cancer, blood clots, and hot flashes.

The ExCel study also will examine the impact of exercise on preventing breast cancer. Initial results of the research should be available in about 4 years. Exemestane is produced by Pfizer and sold under the trade name Aromasin.

What does this mean for you and your family? We'll have to wait and see. In the meantime, continue to perform breast self-examinations, see your doctor on a yearly basis, and get regular mammograms. If you are at increased risk for breast cancer, speak with your doctor regarding the screening program that is right for you.

2005-07-25T20:09:00.000-07:00

Evidence Mounting Against Vitamin E

Vitamin E is best known as an antioxidant that was reported to reduce free radical production associated with the development of coronary heart disease. In addition to this use, physicians have been recommending vitamin E supplements to their patients for years to help prevent a variety of other diseases.

Besides preventing or delaying heart disease, vitamin E has been reported to decrease the incidence of breast and prostate cancer, help reduce the risk of developing Parkinson's disease, reduce memory loss associated with aging, and help prevent the development of cataracts. However, mounting evidence suggests that vitamin E supplements may not provide as many benefits as we once thought, and may even contribute to health problems.

A recent meta-analysis of 19 clinical trials suggests that doses of vitamin E of 400 international units (IU) per day taken for at least a year might actually increase the risk of death. This risk is particularly evident in older adults and in those with chronic health problems such as heart disease, one of the diseases that vitamin E is supposed to help. According to the meta-analysis, the risks associated with vitamin E seemed to increase with doses higher than 150 IU per day.

Results of the HOPE-TOO (Heart Outcomes Prevention Evaluation-The Ongoing Outcomes) trial suggested that long-term supplementation with vitamin E at 400 IU per day failed to reduce the risk of cardiovascular disease and cancer. This same dose of vitamin E appeared to increase the risk of heart failure in patients with diabetes or vascular disease.

A recent study in the New England Journal of Medicine showed that 2000 IU of vitamin E daily was no better than placebo in helping to delay the progression of Alzheimer's disease in patients with mild memory loss.

What does all of this mean for us? While vitamin E may provide some health benefits, a number of recent studies have suggested that there may also be risks associated with this vitamin. We suggest that you limit your intake to 150 IU per day or less of vitamin E and discuss this topic with your physician.

References:
Miller, et al. Ann Intern Med 2005 Jan 4;142(1):37-46.
The HOPE and HOPE-TOO Trial Investigators. JAMA 2005;293:1338-1347.
Petersen, et al. N Eng J Med 2005;352(23):1-10.