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Simple Test Reveals Health Problems (May 31, 2004)

(Ivanhoe Newswire)

It’s common to get your blood pressure checked when you visit a doctor, but keeping track of those readings could be a good predictor of future problems. A new study shows this simple blood pressure check reveals important information about the five-year risk for stroke and heart and kidney disease.

For the research, study authors looked at electronic medical records from 5,825 patients. They focused on vital signs, diagnoses, test results, and drug therapy. Then they looked at predictors of subsequent vascular complications over the next five years.

Researchers report vital signs, especially systolic blood pressure, have significant prognostic value for future health problems. Specifically, the researchers found an elevation of 10 millimeters of mercury in blood pressure was associated with an increase in risk ranging from 6 percent for stroke or heart attack to 13 percent for chronic renal insufficiency, or loss of function in the kidneys.

Study authors say too often physicians ignore a single elevated blood pressure reading, opting to wait and reassess the patient during the next visit. Instead, researchers say blood pressure and heart rate are truly vital signs, and elevations should be taken seriously and treated.

SOURCE: Annals of Family Medicine, 2004;2:209-217

 

Latest on the Risk of Osteoporosis (May 31, 2004)

(Ivanhoe Newswire)

Two new research studies may help doctors identify which postmenopausal women are at an increased risk for a future fracture. The studies show some women may be overlooked for therapy even though they are at the risk for a fracture.

Study authors say the most important predictor of bone fracture in postmenopausal women without a previous fracture is bone mineral density. Bone mineral density is measured by a T-score. As the T-score decreases, the risk for fracture increases. The question has been what level of a T-score indicates an increased risk.

In the first study, authors from Columbia-Presbyterian Medical Center in New York looked at different levels of T-scores and fracture incidence within one year of bone mineral density testing. According to the World Health Organization, a T-score of -2.5 or lower indicates osteoporosis. The study showed that of 2,259 women who had fractures, only 6.4 percent of the women had a T-score of -2.5 or less. If treatment is only given to women with a T-score of -2.5 or less, many women who had fractures will miss the opportunity for treatment. Researchers say in order to reduce osteoporotic fractures doctors cannot just rely on T-scores.

The second study from the Colorado Center for Bone Research in Lakewood focused on identifying women with osteopenia at potential risk for fracture within one year of bone mineral testing. Osteopenia is indicated by a T-score of -2.5 to -1.0. The study looked at data on 57,421 women. Researchers looked at 32 risk factors for a fracture.

Study authors report the most important predictors of fracture include: women who had a previous fracture; a T-score at a peripheral site, such as the forearm, of -1.8 or less; self-rated poor health status and poor mobility. The classification system developed by the study authors correctly identified 74 percent of women who suffered from a future fracture. Researchers hope the guidelines will be useful for physicians in evaluating the risk of fracture in postmenopausal women.

SOURCE: Archives of Internal Medicine, 2004;164:1108-1112, 1113-1120

 

Another Thumbs up for Soy (May 31, 2004)

(Ivanhoe Newswire)

Another study uncovers more evidence that soy plays a part in cancer prevention. The latest research focuses on women and the risk of endometrial cancer. Endometrial cancer is cancer affecting the lining of the uterus.

Since soy has been found to be beneficial for breast cancer and prostate cancer, researchers from Vanderbilt University in Nashville, Tenn., conducted a study to determine if soy is beneficial for endometrial cancer.

The study included Chinese women in Shanghai. Researchers interviewed 832 women who were diagnosed with endometrial cancer and 846 healthy women. The amount of soy intake over five years was measured as well as current body measurements.

Researchers found regular consumption of soy foods is associated with a reduced risk of endometrial cancer, particularly among overweight women. Soy foods are a rich source of isoflavones and also may contain high amounts of fiber.

Researchers say the rates of endometrial cancer vary widely in different countries. Asian women have a lower rate of the cancer than their Western counterparts. They say diet, including the intake of soy, may play an important role in this difference.

SOURCE: British Medical Journal, 2004;328:1285-1288

 

A Chocolate a day Keeps Heart Disease Away? (May 31, 2004)

(Ivanhoe Newswire)

Not much of a red wine drinker? A new study finds small, daily doses of dark chocolate may have the same effects on health.

Researchers say when healthy people ate small amounts of flavonoid-rich chocolate every day for two weeks, they boosted the functions of their blood vessels. The chocolate improved the blood vessels’ ability to dilate, and at the same time, epicatechin -- a flavonoid thought to be beneficial for blood vessel function -- was absorbed at higher levels in the blood.

Researchers suggest that the higher levels of epicatechin triggered the release of substances that increase blood flow in the artery. “Better blood flow is good for your heart,” says lead author Mary Engler, Ph.D., R.N., a professor of physiological nursing at the University of California-San Francisco School of Nursing.

She says arteries that are able to dilate more have increased blood flow, an important step in lowering the risk of heart disease. Plus, the daily snacks of chocolate did not increase the cholesterol levels of the study’s participants.

Flavonoids are chemical compounds that are found in plants. Past studies have shown flavonoids have antioxidant properties and are particularly helpful to the cardiovascular system by decreasing the body’s inflammatory immune responses, regulating blood platelets, and decreasing oxidation of LDL cholesterol -- a process that allows cholesterol to accumulate in the vessels.

Several years ago, scientists discovered that dark chocolate contains more flavonoids than any other foods that have been tested so far, including green and black tea, red wine, and blueberries. The authors say standard manufacturing of chocolate removes about a quarter to half of its flavonoids, but now some companies are using different processing methods to preserve as much as 70 percent to 95 percent of the flavonoids.

“There’s little doubt that in moderation and in conjunction with a healthy, balanced diet and exercise we can enjoy -- and even benefit from -- moderate amounts of high-flavonoid dark chocolate,” says Engler.

SOURCE: Journal of the American College of Nutrition, 2004;23:197-204

 

Who Takes Better Care of Themselves: Men or Women? (May 30, 2004)

(Ivanhoe Newswire)

New research shows men and women have different approaches when it comes to staying healthy.

Researchers from the University of Michigan Health System in Ann Arbor and the Centers for Disease Control and Prevention analyzed data on more than 97,000 men and women who answered questions about their health habits.

Results show women are less likely than men to take a daily aspirin as a preventative measure. Researchers say women at risk for heart disease were even less likely to take aspirin regularly. About 45 percent of high-risk women reported taking aspirin regularly, compared to nearly 60 percent of high-risk men.

Researchers say both genders reported getting their cholesterol and blood pressure checked at similar times.

However, researchers also found women were more likely than men to remember or follow advice about diet and exercise. However, only about two-thirds of both men and women reported exercising and dieting.

Authors of the study conclude, “This just reinforces how hard it is to change people’s behavior, even among high-risk people ... There are many people who should be modifying their behavior and who know they should be dieting and exercising, but they don’t do it. We need to find ways to help them.”

SOURCE: To be published in an upcoming issue of the American Journal of Preventative Medicine

 

Pipe Smoking Dangers (May 30, 2004)

(Ivanhoe Newswire)

New research shows pipe smoking may be just as harmful as cigar smoking.

Researchers from the American Cancer Society in Atlanta studied data on about 15,000 men who smoked pipes and about 123,000 men who never smoked.

They found pipe smoking was associated with cancers of the colon and rectum, esophagus, larynx, lung, oropharynx, pancreas and stomach. Pipe smokers were at an especially high risk for developing cancers of the larynx, lung and oropharynx.

Researchers say although pipe smoking poses fewer risks than cigarette smoking, it seems to carry the same risks as cigar smoking.

Authors of the study write, “All tobacco products cause excessive morbidity and mortality.”

Pipes are the least commonly used tobacco products in the United States, but their popularity is increasing among middle school and high school students. Researchers say pipe smoking is also common among the Native American population.

Authors conclude, “Comprehensively documenting the deleterious health effects of pipe smoking is important in countering efforts by the tobacco industry to promote pipes as desirable alternatives to cigarettes or cigars.”

SOURCE: Journal of the National Cancer Institute, 2004;96:853-861

 

Fish, Pregnancy and Asthma (May 26, 2004)

(Ivanhoe Newswire)

A new study shows pregnant women with asthma can reduce their risk of having asthmatic children by eating oily fish. However, that same study also shows pregnant women who consume other types of fish may have an increased risk of having asthmatic children.

Researchers from the University of Southern California in Los Angeles presented their study at the American Thoracic Society International Conference in Orlando, Fla.

Results show asthmatic mothers who ate oily fish, such as salmon and trout, during pregnancy were about 70-percent less likely to have children with asthma. In fact, researchers say the more oily fish a woman consumed, the less likely her child was to develop asthma. Children with non-asthmatic mothers did not benefit from having their mothers eat oily fish during pregnancy.

However, mothers who ate fish sticks during pregnancy were twice as likely to have children with asthma, regardless of whether they had asthma themselves.

Frank Gilliland, M.D., Ph.D., from USC, says, “Fish sticks are deep-fried, and they contain omega-6 fatty acids, which encourage inflammation of the airways. Oily fish contain omega-3 fatty acids, which appear to be anti-inflammatory and lead to the reduced potential for developing asthma and allergies.”

SOURCE: The American Thoracic Society International Conference in Orlando, Fla., May 21-26, 2004

 

Can Daughters Make Your Asthma Worse? (May 26, 2004)

(Ivanhoe Newswire)

Moms-to-be who are carrying girls are more likely to experience a worsening of their asthma than pregnant asthmatic women carrying boys, according to a new study.

Doctors speculate female fetuses may produce a substance in response to the inflammation of the mother’s airways that somehow worsens the woman’s pre-existing asthma.

Australian researchers found 60 percent of asthmatic women who were pregnant with boys were symptom-free throughout their pregnancy and did not report nighttime breathing problems from the 18th week to the 30th week of pregnancy. On the other hand, 61 percent of women carrying girls were symptom-free at 18 weeks but by the 30th week only 28 percent remained symptom-free. Also, these women said their nighttime symptoms increased significantly from 18 weeks to 30 weeks.

Lead researcher Peter G. Gibson, M.D., says there is bright spot. “The good news is that the vast majority of pregnant women with asthma can control their asthma with treatment,” says Dr. Gibson, a professor at John Hunter Hospital in Newcastle, Australia.

Most of the study’s asthmatic participants reported using inhaled steroids every day. Doctors say inhaled steroids are generally considered safer for the fetus than oral steroids, and they can effectively control the inflammation in the airways caused by asthma. The use of inhaled steroids increased significantly in women carrying girls but did not change in women carrying boys.

Dr. Gibson stresses the importance of controlling asthma during pregnancy. He says, “If a mother has a severe asthma attack, it can result in reduced oxygen to the baby, which is needed for normal growth and development.”

SOURCE: Presented at The American Thoracic Society International Conference in Orlando, Fla., May 21-26, 2004

 

Why we Need Folic Acid (May 25, 2004)

(Ivanhoe Newswire)

New research shows about half of the population carries a gene that puts them at risk for passing on neural tube defects like spina bifida to their offspring.

Researchers publishing in this week’s British Medical Journal explain doctors already know one form of the gene responsible for processing folate in the body is linked to neural tube defects. They speculated another form of the gene might also be associated with the birth defects.

To find out, researchers studied about 400 people with neural tube defects, comparing their folate-processing genes with those of about 850 people without neural tube defects. Results showed the second form of the gene led to just as many cases of neural tube defects as the first form, mainly because the second form is much more prevalent in the general population. About 10 percent of people carry the first form the gene, called the “TT” variation. Nearly 40 percent carry the second form, called “CT.”

People who have the variant forms of the gene are not able to process folate as easily as those with the normal form, called “wild CC.” The inability to process folate leads to spinal cord problems in the developing fetus. Correcting the problem, however, is easily accomplished by folic acid supplementation.

The researchers say these results reinforce the importance of supplementing the diets of all women of childbearing age with folic acid.

SOURCE: BMJ, May 2004; 10.1136/bmj.38036.646030.EE.

 

Good job Plus Good Marriage Equals low Blood Pressure (May 24, 2004)

(Ivanhoe Newswire)

Too much stress may put your health in jeopardy. A new study shows job strain and marital stress factors increase a person’s risk of having high blood pressure.

Researchers from Toronto presented the results of the Double Exposure study at the American Society of Hypertension’s 19th Annual Scientific Meeting in New York City. They examined nearly 250 participants who worked fulltime and lived with a spouse or partner.

About 20 percent of participants reported experiencing job-related stress, and about 28 percent of participants said they were not in a satisfactory relationship.

Researchers say job stress was significantly associated with higher blood pressure readings. Patients who reported more job stress had an average blood pressure reading that was five points higher than those who reported little stress at work.

Researchers say that rise in blood pressure was not as significant when participants were in the company of a spouse. However, when participants were in the company of a spouse and consumed more than 10 drinks of alcohol a week, they had blood pressure readings that were 3.68 points higher.

Researchers conclude, “Excessive alcohol consumption was related to higher blood pressure during spousal contact. The impact of marital factors as well as job strain on blood pressure will be further examined in the one-year follow up of the Double Exposure study.”

SOURCE: American Society of Hypertension 19th Annual Scientific Meeting and Exposition in New York, May 18-22, 2004

 

Preemies Need More Breast Milk (May 24, 2004)

(Ivanhoe Newswire)

Premature infants born in multiple births aren’t getting their fair share of breast milk, say researchers publishing in the May/June issue of Ambulatory Pediatrics.

That’s important because these babies are often at the greatest risk for medical problems and need to have the optimal nutrition that only breast milk can provide.

Researchers compared the breastfeeding behaviors of mothers who had full-term multiple births, full-term singleton births, pre-term singleton births, and pre-term multiple births. They were encouraged when they found full-term multiples -- twins or triplets -- were just about as likely to receive breast milk as full or pre-term singleton births.

However, pre-term multiples were at a significant disadvantage. Investigators found just 57 percent of mothers were providing breast milk to their infants three days after delivery. By six months, only 14 percent of the infants were receiving breast milk. These figures compare to 66 percent and 29 percent, respectively, for pre-term singletons; 69 percent and 35 percent for full-term singletons; and 73 percent and 38 percent for full-term multiples.

Study author Sheela R. Geraghty, M.D., a pediatrician at Cincinnati Children’s Hospital Medical Center, says it’s up to physicians to provide more help and guidance to mothers of pre-term multiples. “Mothers of pre-term multiple gestation infants are as motivated as any other mothers. It is the obligation of the health care community to support these mothers so they can provide optimal nutrition of breast milk to their infants as well.”

SOURCE: Ambulatory Pediatrics, 2004;4;226-231

 

New Approach to Crohn's (May 24, 2004)

CHICAGO (Ivanhoe Newswire)

Crohn's disease is a debilitating gastrointestinal disorder. It happens when the immune system malfunctions and attacks the intestines. There is no known cause of the disease and no cure. While treatments available provide relief to some patients, many remain searching for a successful answer. Now, doctors may have another one to offer.

Every week, Kristen Smith treks three-and-a-half hours from Indianapolis to Chicago. But with all the Windy City has to offer, Smith has more than sightseeing and shopping on her mind. She's here for a study of a new drug for Crohn's disease.

"They're kind of at the end of the road with normal treatment. I'm either on it, or it hasn't worked," Smith tells Ivanhoe.

Nearly four years ago, Smith thought she had the flu. Then, her symptoms got worse. Today, Smith says: "[I have] a lot of abdominal pain. I can't eat. I have no desire to eat, basically." She had to take a break from school. She is on 30 pills a day and still is in a constant battle with her body. "There is always the fight with depression or good days and bad days, or I want to do something and can't."

Alan Buchman, M.D., a gastroenterologist at Northwestern University Feinberg School of Medicine in Chicago, says "We're searching for drugs that are not only better or work better than other drugs that are commercially available, but are safer."

In Crohn's disease, white blood cells produce too much of the chemical TNF (tumor necrosis factor) and cause inflammation. A new drug called CNI-1493 blocks the message to make TNF. "The idea is that we can block this inflammatory cascade and stop the inflammation from occurring," explains Dr. Buchman.

Smith says, "I'm very much an overachiever and don't like being told, 'You can't do something,' or, 'You have limits.'" If the study continues like doctors expect, she will be able to get back to normal life.

Dr. Buchman says another benefit of the new drug is that because the target is so specific, it's unlikely to cause extreme side effects like currently available drugs do. The treatment is given by infusion three times a week for two weeks in a row.

If you would like more information, please contact:
Tamara Kerrill
Senior Broadcast Editor
Northwestern University

 

Cooking for Diabetes (May 24, 2004)

ORLANDO, Fla. (Ivanhoe Newswire)

In our fast-paced world, too many Americans choose convenience over nutrition when it comes to eating. One chef who wants to change that mindset.

You can learn a lot about healthy cooking by watching Chris Smith cook chicken. It's a four-ounce breast he marinates in olive oil, poultry seasoning, red pepper flakes, lemon pepper, dried rosemary, and fresh garlic. He sears each side about 10 seconds in a Teflon pan coated with cooking spray, then he bakes it until the meat reaches 160 degrees.

Smith learned to cook at The Culinary Institute of America in Hyde Park, N.Y. While he was there, he learned he had type 1 diabetes. "And I'll be honest with you, with all the diseases out there, I'd much rather have a disease that I can control, rather it controlling me," he tells Ivanhoe.

Smith had to eat healthier. It was then he decided to preach what he practiced. "We have become a fast food nation, and what I want to do is to challenge people to get back into their kitchen and enjoy cooking again," Smith says.

He developed a template for healthy cooking he calls MVP, for moderation, variety and portion control. This chicken is a good example.

Smith has dubbed himself "the diabetic chef," and has a book by the same name. He's spreading the art of healthy cooking through a book, lectures and classes. After all, he says he wanted to be a chef not only to cook, but also to serve. "And this is a way I can really do that. I can do that and make an impact, and that's powerful to me."

Smith stresses that his recipes are not only for diabetics but can be adopted by anyone who wants to eat healthier.

If you would like more information, please contact:
http://www.thediabeticchef.com

 

Uncontrolled Blood Pressure Among Elderly (May 24, 2004)

(Ivanhoe Newswire)

The current rates of blood pressure control in the elderly are unacceptably low due in part to an inadequate number of medications and, perhaps, to poor selection of drugs, say researchers presenting at the American Society of Hypertension's 19th Annual Scientific Meeting in New York City.

"The elderly are the fastest-growing segment of the U.S. population, and they have the highest prevalence of hypertension. Yet, clinicians seem to be reluctant to treat older patients aggressively, perhaps because of perceived lower benefits or possible increased risk of side effects," says Donald Lloyd-Jones, M.D., contributing author from Northwestern University Feinberg School of Medicine in Chicago.

Researchers classified participants by age, and as expected, the prevalence of hypertension increased markedly with advancing age. In the younger-than-60 age group, around 27 percent had high blood pressure (higher than 140 systolic/90 diastolic); in the 60-to-79 age group, about 59 percent had high blood pressure; and 70 percent had high blood pressure in the 80-and-older group. Control rates of the blood pressure declined with advancing age, especially among women. Among those 80 and older, only 32 percent of men and 24 percent of women had their blood pressure under control.

Sixty-six percent of participants were being treated with medication. The majority, however, were only being treated with one medication, and even though thiazide diuretics have been shown to be extremely effective, only 22 percent of men and 32 percent of women 80 and older were using thiazides.

Recommendations to combat this problem are for initial lower doses of medications to avoid side effects in older patients and add more medications as necessary to help patients reach their blood pressure goals.

Risks associated with hypertension include cardiovascular disease, heart attacks, and congestive heart failure. The authors say improved blood pressure control of people 80 years and older, especially women, must be made a national priority.

SOURCE: American Society of Hypertension's 19th Annual Scientific Meeting in New York, May 18-22, 2004

 

Yoga for Cancer (May 20, 2004)

(Ivanhoe Newswire)

The ancient Eastern tradition of yoga may have a modern medical application.

According to researchers from The University of Texas M.D. Anderson Cancer Center in Houston and elsewhere, lymphoma patients who took part in yoga classes reported better sleep quality than those in a control group.

The study was conducted among 39 lymphoma patients who were either undergoing treatment or who had concluded treatment within the last year. About half the patients were assigned to the yoga classes while the other half were put on a waiting list and served as the control group.

The yoga classes consisted of controlled breathing and visualization exercises, along with mindfulness techniques and low-impact postures.

Researchers compared the yoga group with the control group, looking at quality of sleep and other factors. Results show those in the yoga group had fewer sleep disturbances and better sleep quality. Patients also slept longer and needed fewer medications to help them sleep.

The authors believe these findings are encouraging and suggest the need for more study on the medical benefits of yoga. They write, “The benefits that have been documented and potential impact of these benefits ... are important enough to warrant the further study of developing such programs for cancer patients.”

SOURCE: Cancer, 2004;100:2253-2260

 

At-Home Anesthesia (May 19, 2004)

TAMPA, Fla. (Ivanhoe Newswire)

While surgery is not easy, it's the recovery afterwards that can really take its toll on a patient. In the past, patients have been sent home with narcotics to relieve pain, but the drugs can have negative side effects. There's now an option that makes recovery at home easier.

Mary Young and her husband, Frank, are relaxing at home today, just one day after Mary had shoulder surgery. "It was hurting bad enough that I said, 'I want it fixed,'" Mary says.

Surgery made Mary nervous, but the recovery worried her more. Pain pills and Mary are old enemies. "I was nauseated, very sick, sleep for two or three days and just felt really bad," she says.

This time around, Mary is free from those strong narcotics. Instead, she's hooked to a pump that delivers a local anesthetic to keep her shoulder numb. She says, "I don't have any pain at all."

Anesthesiologist Ward Longbottom from University Community Hospital in Tampa, Fla., says at-home anesthesia is a huge step forward for patients. "A lot of the operations that did have to stay in house in the past are now going home," he tells Ivanhoe.

Doctors use a stimulator to find the nerve that needs to be blocked. A catheter is inserted in the skin and is hooked to the pump. "When the patient goes home, they have 24-hour-a-day access to an anesthesiologist," adds Dr. Longbottom. He also says the anesthetics used are less toxic and safer for the patient.

Mary gets a continuous dose of pain relief. And with a simple push of a button, she can get more medication and more relief. But the programmed pump will not go above the amount set by the doctor.

"I have felt so much better," Mary comments. She hopes her road to recovery will be as smooth as the first 24 hours.

The at-home anesthesia is available to patients who have surgery on their arms or legs. For example, it's used for shoulder, elbow, wrist, knee, hip or ankle surgeries. Doctors say another benefit is patients who are in less pain often have better rehabilitation.

If you would like more information, please contact:
Health Source at
University Community Hospital
Tampa, FL
(800) 326-4325

 

Is Back Pain in the Head? (May 19, 2004)

(Ivanhoe Newswire)

It turns out psychological factors may be a strong predictor for back pain in some patients.

Researchers from the Stanford University School of Medicine in California studied nearly 100 patients for four years. None of the patients experienced back pain at the start of the study. Researchers examined patients’ spines through the use of disc injections and magnetic resonance imaging (MRI). Patients were also given psychological tests.

Results show those who fared poorly on the psychological exam were nearly three-times more likely to report back pain. Patients with a history of disputed workers’ compensation claims were also more likely to develop back pain.

Even patients who had fluid injected into their spines reported experiencing less pain than those who scored poorly on the psychological test. The fluid injection procedure -- called discography -- is thought to induce back pain.

“It was thought that discography could separate the wheat from the chaff. But the bottom line is that it didn’t predict who would go on to develop back pain,” says Eugene Carragee, M.D., lead author of the study.

Researchers say only a quarter of the 300,000 spinal fusion operations that are performed each year are done for obvious reasons, such as removing tumors or deformities.

Dr. Carragee concludes, “The structural problems were really overwhelmed by the psychosocial factors. The question is, can we better identify groups that have a greater chance of being helped by surgery?”

Researchers from Stanford are now working on a five-year study aimed to examine a higher-risk group of people -- those who already have lower back pain.

SOURCE: Spine, 2004;29:1112-1117

 

Breast Milk Good for the Heart (May 19, 2004)

(Ivanhoe Newswire)

The saying, “breast is best” is commonly heard when talking about formula vs. breastfeeding an infant. Now, new research suggests another reason women may want to breastfeed. The study shows breastfed infants have less cardiovascular risks later in life.

Previous research indicated breastfeeding reduced cardiovascular disease, but the studies all had major weaknesses. This newest research was done over 20 years by investigators in London.

The study included 216 teenagers who were randomly given breastmilk or formula during infancy in the early 1980s. The teens underwent cholesterol screenings to compare their good and bad cholesterol. Their C-reactive protein was also tested. Higher concentrations of CRP are associated with the development of atherosclerosis.

Researchers report the adolescents who were fed breast milk during infancy had a 14-percent lower ratio of LDL to HDL cholesterol and lower concentrations of CRP than adolescents who had been given formula during infancy. Study authors say these findings suggest that infant nutrition permanently affects the lipoprotein profile later in life and that breast feeding has a beneficial effect.

SOURCE: The Lancet, 2004;363:1571-1578

 

Low-carb Better than Low-fat? (May 19, 2004)

(Ivanhoe Newswire)

New research brings good news for all the low-carb dieters out there. Restricting carbs may be a better way to lose weight than restricting fat.

Two studies published in this month’s issue of the Annals of Internal Medicine compared low-fat and low-carb diets.

In the first study, researchers from the Veterans Affairs Medical Center in Philadelphia examined more than 130 obese adults. Participants were divided into two groups. The first group restricted their carbohydrate intake to less than 30 grams a day. The second restricted their calorie intake by 500 calories a day, with only 30 percent of their calories coming from fat.

Researchers found participants in the low-carb group had lower triglyceride levels than those on the low-fat diets. High levels of triglycerides, or fat in the blood, are associated with an increased risk of heart disease. Those in the low-carb group also had better HDL (good) cholesterol levels than those in the low-fat group. Diabetics who followed the low-carb diet had better control over their blood sugar.

After six months, the low-carb group lost more weight than the low-fat group. However, after a year, both groups had lost about the same amount of weight.

The second study, out of Duke University in Durham, N.C., included 120 overweight people. After six months, participants on the low-carb diet lost an average of 26 pounds, whereas those on the low-fat diet lost an average of 14 pounds. Participants in the low-carb group received vitamin and nutritional supplements.

In this study, the low-carb group also had better triglyceride and HDL cholesterol levels than the low-fat group.

Linda Stern, M.D., from the Philadelphia VA Medical Center, concludes, “I think a low-carbohydrate diet is a good choice because much of our overeating has to do with consumption of too many carbohydrates ... More research is needed to see if a low-carbohydrate diet remains safe and effective in the long-term.”

SOURCE: Annals of Internal Medicine, 2004;140:769-777, 778-785

 

Lung Test Questioned (May 19, 2004)

(Ivanhoe Newswire)

A popular lung function test may not be as accurate as some think. New research brings to light some common problems with a spirometry test.

Spirometry is one of the most common pulmonary lung function tests. It is used to test for a variety of lung problems and to determine the effectiveness of treatment. The patient takes a deep breath and breathes out with force into a spirometer to the best of their ability. The spirometer measures both the amount of air expelled and how quickly the air was expelled from the lungs.

It is widely assumed that accuracy is guaranteed by frequent calibrations. However, researchers in Pittsburgh say errors frequently occur during the test that can lead to inaccurate results. They say one common error happens when the machine measures the zero level or no airflow incorrectly. Another common error can occur when the sensor is obstructed by condensation of water vapor, mucus, or the subject’s fingers.

Researchers say these two problems are especially dangerous because the high values they produce replace accurate but lower values recorded during testing, leading the technician to believe the patient’s lung function is better than it actually is.

Study authors say those who conduct spirometry need to be aware of these possible errors and question if a patient has a dramatic improvement in their lung function in a short time period.

SOURCE: Chest, 2004;125:1902-1909

 

Women not Getting Tested (May 18, 2004)

(Ivanhoe Newswire)

Women are heading to the doctor for a Pap smear and mammogram, but they are missing out on getting the screening for the number three cancer killer in women. New research shows many women, even health-conscious women, are not getting a colonoscopy.

“Women have internalized the public health message that they should go for regular mammograms and that they should have Pap smears, because that’s what normal women do for themselves,” says Ruth Carlos, M.D., M.S., from the University of Michigan Health System in Ann Arbor. “Now they need to add colorectal screenings to the list.”

To compare cancer-screening tests, researchers looked at the Centers for Disease Control and Prevention’s 2001 Behavioral Risk Factors Surveillance Survey. It asked more than 54,000 women over the age of 50 what cancer checks they’ve had. Study authors then compared this data to the American Cancer Society’s guidelines.

While nearly 70 percent of women had a Pap smear, and 82 percent reported having a mammogram, researchers report only 46 percent had been checked for colon cancer. However, women who had both a Pap smear and mammogram were more than five-times as likely to have a colonoscopy.

Study authors comment that perhaps when women have a Pap smear or mammogram, doctors should prompt them to have a colon cancer screening. Researchers say this would be a great opportunity to increase a woman’s awareness about the need for a colonoscopy.

SOURCE: American Roentgen Ray Society Annual Meeting in New Orleans, May 15-20, 2004

 

Fish may Boost Fetal Growth (May 17, 2004)

(Ivanhoe Newswire)

Regular fish consumption during the final stages of pregnancy seems to increase the size of the infant, according to a new study.

British researchers say a diet rich in fish may boost the fetal growth rate during pregnancy. They found the more fish a woman ate, the less likely she was to deliver a low birth weight baby. However, they did not find that a diet rich in fish extended the length of pregnancy, something earlier studies had suggested.

The authors note that low birth weight normally occurs in one in 10 pregnancies. In women who ate no fish, that rate increased to one in eight, or 13 percent.

Nearly 12,000 women were asked to report their levels of fish consumption at 32 weeks of pregnancy. The women’s average intake amounted to only about a third of a small can of tuna per day. They conclude that if women were to boost those numbers some, they may increase fetal growth rate.

The Food and Drug Administration advises pregnant women to avoid larger fish like shark and swordfish because of their high levels of mercury. The FDA says women can safely eat up to 12 ounces of fish a week and still enjoy the healthy benefits of it. Some of the most commonly eaten fish that are low in mercury include shrimp, canned light tuna, salmon and catfish. Albacore, or “white,” tuna actually contains more mercury than canned light tuna, so the government suggests pregnant women limit their intake of it to six ounces per week.

SOURCE: Journal of Epidemiology and Community Health, 2004;58:486-492

 

Women Take Heart (May 17, 2004)

PITTSBURGH (Ivanhoe Newswire)

Heart disease claims nearly 500,000 women's lives each year. Researchers say the risk of developing heart disease increases after menopause. Technology is now helping women monitor their risk of disease, while simple steps may help eliminate that risk altogether.

This is not how Judy Beigi expected to spend her retirement. But when she found out she had high cholesterol, Beigi knew she had some changes to make. "I had to agree to start exercising." She also follows a strict diet. It's all part of an effort to lower her risk of heart disease.

Lewis Kuller, M.D., an epidemiologist at University of Pittsburgh, says women Beigi's age are at an especially high risk for heart problems. "Women gain a lot of weight through menopause, and we showed that this was a very detrimental factor."

In fact, Dr. Kuller says when waist circumference gets over 34, their risk for heart disease, diabetes and breast cancer rises substantially. But there is good news. Technology, like an EBCT (electron beam computed tomography) scan, now helps women monitor their risk of disease. "With this we can actually tell a woman, at age 50 or 55, you have this much calcium deposits in your arteries, you've got to be fairly aggressive in changing your risk factors," explains Dr. Kuller.

But even the best technology can't prevent heart disease. Dr. Kuller says, "In spite of all the efforts over the last 10, 15 or 20 years, it's still basically don't smoke, keep your weight down, exercise, and a low saturated-fat and cholesterol diet."

This is advice Beigi takes to heart. Since participating in Dr. Kuller's study, she's lost more than 30 pounds. "I have a new pattern of eating. This is the best way to prevent heart disease," says Beigi. And she's taking the right steps to do just that.

Dr. Kuller says it's never too late for women to reduce their risk factors for heart disease. He says it's the excess fat in the abdomen that causes insulin resistance, which contributes to the risk of heart disease and diabetes.

If you would like more information, please contact:
Monica Love
Research Specialist
University of Pittsburgh Department of Epidemiology
(412) 383-1895
lovem@edc.pitt.edu

 

Freezing Breast Tumors (May 17, 2004)

BALTIMORE (Ivanhoe Newswire)

Each year, more than 1 million women in the United States undergo breast biopsies. In about 80 percent of these cases, the lumps are benign, or non-cancerous. But that benign lump still causes anxiety in many women. Now, one technique is making it easier for women to get rid of the lumps without surgery.

Elizabeth Fletcher knows fear is not an option when she is shooting hoops on the court. But when doctors found a lump in her breast last year, fear became her toughest opponent. "It is scary," Fletcher says. "It's probably the scariest thing because when you hear breast cancer or lump, you automatically think it's cancer."

Luckily, Fletcher's tumor was not cancerous, but like many women she still wanted to get rid of it.

"It's quite amazing how many women, even though they know that the lump that they have is benign, want it out," Gauri Bedi, M.D., a breast surgeon at Mercy Medical Center in Baltimore, tells Ivanhoe.

Dr. Bedi says in most cases, benign breast tumors can be left alone. "We can be 99 percent sure that it is completely benign, but there is still that 1 percent to 2 percent. People don't want that uncertainty."

In the past, doctors had to perform invasive surgery to remove the lump. But now, they can freeze it with a procedure called cryoablation. Doctors insert a probe into the tumor. Argon gas is passed through the probe to form an ice ball, which destroys the tumor. The body eventually absorbs it.

"It's an office-based procedure," Dr. Bedi says. "They don't have a surgical scar. They don't have to go to the operating room. It's tolerated very well." Fletcher can vouch for that. "I recovered within a day. I was back at work. It's a much better option than surgery." It is an option she considers a slam dunk.

The procedure takes about 30 minutes to 45 minutes and can be performed a few weeks after a biopsy. Dr. Bedi says it is especially popular among younger women who tend to have more benign lumps. This technique is also used to freeze liver, prostate and kidney tumors, and researchers are now testing its feasibility on breast tumors that are cancerous.

If you would like more information, please contact:
Dan Collins
Media Relations Director
Mercy Medical Center
(410) 332-9714

 

Eye Disorders can Shorten Lifespan (May 17, 2004)

(Ivanhoe Newswire)

People with age-related eye problems, such as age-related macular degeneration and cataracts, may not live as long as those without them, perhaps because the conditions signal declining health, says a new study.

Frederick L. Ferris, III, M.D., of the National Eye Institute, and colleagues say various eye disorders have been reported to be significant predictors of a shorter life span. Cataract, in particular, may be a sign of physiological processes that are associated with aging and death. A cataract involves the lens of the eye becoming cloudy and can cause partial blindness.

In a study of 4,753 people aged 55 to 81, people with macular degeneration, a progressive condition that causes gradual vision loss, had a 41-percent higher risk of death during the 6.5-year follow up than people without signs associated with the disorder.

The research also found people who had cataract surgery had a 55-percent higher risk of death than those with good vision, while those with vision worse than 20/40 in one eye had a 36-percent higher risk.

However, a subgroup of participants was randomly assigned to take zinc, and these patients had a 27-percent lower mortality rate than those not taking zinc. "The beneficial effects of zinc on mortality in this study may be related to an improved immune response, which is known to decrease with aging," the authors write.

While the exact mechanisms are unclear, the study showed the decreased survival rates for people with either cataracts or macular degeneration, suggests that these conditions may reflect systemic rather than only local processes. For instance, advanced AMD was associated with cardiovascular deaths.

The authors conclude, "The improved survival in individuals randomly assigned to receive zinc requires further study."

SOURCE: The Archives of Ophthalmology, 2004:122:716-726

 

The Lowdown on Low Carbs (May 13, 2004)

By Shanida Smith, Ivanhoe Health Correspondent
ORLANDO, Fla. (Ivanhoe Newswire)

Last October, I reconnected with my best friend Chantel Hall who lost several pounds on the Atkins diet. She explained how carb counting works and what she could and couldn't eat. It sounded simple enough, I didn't have to give up cheese, and some of the restaurants I frequent, including Ruby Tuesday's and TGI Friday's, had low-carb menus. Four months later, after following the Atkins plan I read online, I was 21 pounds lighter.

Stories of weight loss success like mine have propelled Atkins and other low carbohydrate diets such as the South Beach and Zone diets into the national spotlight. Research giant ACNielsen found more than 17 percent of the 10,000 U.S. households surveyed reported that someone in their home is currently on a low-carb diet. Opinion Dynamics Corp., another research company, surveyed 1,800 people and found 11 percent of U.S. adults follow a low-carb diet, 20 percent have tried one and 19 percent (about 24 million Americans) may try one in the next two years. Low-carb popularity continues to soar amid a growing debate on whether low-carb diets are healthy long term and for whom they are healthy.

One in 12 Americans has diabetes, a common complication of weight problems. In addition, two-thirds of U.S. adults are overweight, and a third are clinically obese. Though there's a large need for effective weight loss plans, low-carb diets may not be best for particular groups.

Low-carb regimes may trigger birth defects and childhood cancers, according to Gideon Koren, director of the Motherisk program at the Toronto Hospital for Sick Children. Bread, pasta, breakfast cereals and orange juice, restricted on low-carb diets, are key sources of folic acid essential to the development of fetuses.

Researchers at the Massachusetts Institute of Technology say complex carbs, such as potatoes, rice, whole grain breads, lentils, beans and pasta, are best for stabilizing mood. So if you are already prone to mood changes, a low-carb diet may make you cranky. Judith Wurtman, Ph.D., a research scientist in MIT's Department of Brain and Cognitive Science, says low-carb diets can inhibit the synthesis of brain serotonin, which is made after the consumption of carbohydrate foods. "Many people eat carbs as a form of self medication because, as we discovered years ago, the resulting increase in brain serotonin improves mood. We call these people carbohydrate cravers and without carbs, they tend to feel very grumpy, angry and even anxious. They experience symptoms similar to PMS," she says. This means double the trouble for women especially because they generally have lower serotonin levels than men.

The growing number of overweight U.S. children has especially thrust their weight loss into the debate. The American Dietetic Association does not recommend low-carb diets for children at all. Julie Upton, R.D., an ADA spokesperson, says, "Children should be getting half of the daily calories from carbohydrates." Several scientists caution that low-carb diets lack critical nutrients children need for their physical and intellectual development, which comes from fruits, vegetables and whole grains.

In contrast, Mary Vernon, M.D., a member of the Atkins Physicians Council, says children can successfully go on low-carb diets under supervision. "There are many more nutrients in chicken and salad than in fries and coke," she adds. Jonny Bowden, C.N., C.N.S., author of "Living the Low Carb Life: Choosing the Diet that's Right for You: from Atkins to the Zone," says, "Children eat way, way too many processed foods and high sugar junk: fruit juice drinks, sodas, fries, snack foods, cereals, pastas, breads, cakes, etc. A lower carb diet, one rich in vegetables, fruits, protein fat and fiber and lighter on the processed carbs, is a huge improvement over their usual diet."

Some thin adults who want to lose a few pounds may want to proceed with caution, too. Marion Nestle, chair of the Department of Nutrition, Food Studies, and Public Health at New York University, says, "Low carb diets work if -- and only if -- they reduce calorie intake. Diets are about calories. Skinny people are best off eating a balanced diet." On the contrary, Dr. Vernon says skinny people can tailor their low-carb diet to their individual needs. She adds, "Everybody needs different levels of carbs. If you follow the Atkins Nutritional Approach, you will find your body's nutritional balance." The American Dietetic Association recommends thin people steer clear of low-carb diets altogether.

Many experts agree that the most effective weight loss occurs with an individualized diet plan tailored for you by a health professional. In a recent study led by Dena Bravata, M.D., from Stanford University, researchers found no evidence that low-carb diets were more effective than others. The only factors they found that led to success were less calories overall and a long-term commitment. Back-to-back studies in the New England Journal of Medicine show participants on the Atkins-style low-carb diets lost the most weight out of others on traditional low-fat diets but investigators conclude more research needs to be done before giving low-carb diets the thumbs up. Studies released continue to make a case for both sides of the debate.

If you would like more information, please contact:
The American Dietetic Association
120 South Riverside Plaza, Suite 2000
Chicago, Illinois 60606-6995
(800) 877-1600

 

The Secret to Staying Awake (May 13, 2004)

(Ivanhoe Newswire)

Already going for that second cup of coffee? Researchers from Rush University Medical Center, Brigham Women's Hospital and Harvard Medical School suggest you pace yourself.

According to their research, taking smaller doses of caffeine throughout the day are a more effective way to help you stay awake.

James Wyatt, Ph.D., lead author of the study, from Rush University Medical Center in Chicago, says, "I hate to say it, but most of the population is using caffeine the wrong way by drinking a few mugs of coffee or tea in the morning, or three cups from their Starbucks' grande on the way to work. This means that caffeine levels in the brain will be falling as the day goes on."

Nearly 20 male participants were given either a placebo or a caffeine pill every hour after they woke up. The pill contained .3 milligrams per kilogram of body weight, equivalent to two ounces of coffee, for every 2.2 pounds of body weight.

By progressively building up their caffeine levels, the subjects had fewer accidental sleep incidents and were able to perform better on cognitive tests.

However, those on caffeine did report feeling more tired than the placebo group proving that caffeine should not be a substitute for sleep when trying to rejuvenate the body.

SOURCE: Sleep, 2004;27

 

Blood Holds Clue to Osteoporosis (May 13, 2004)

(Ivanhoe Newswire)

A person’s blood may reveal answers about their risk for osteoporosis and hip fractures. Two new studies show high levels of amino acid are associated with an increased risk of fracture.

High levels of homocysteine have long been associated with an increased risk of heart disease and stroke. Very high levels are also known to be associated with homocystinuria, a rare disease characterized by early onset osteoporosis. Now, in two separate studies, high levels have also been found to be associated with an increased risk for a fracture.

One study out of the Netherlands looked at the circulating homocysteine level and the risk of incident osteoporotic fractures in 2,406 participants. The men and women in the study were 55 years or older. Researchers found in all of the different groups they studied there was an association between a high level of homocysteine and the risk of fracture.

The second study by researchers at Tufts University in Boston included men and women who had blood samples drawn almost 20 years ago. Researchers compared their homocysteine levels with the incidence of hip fracture. They also found the men and women with the highest homocysteine levels had the greatest risk of fracture.

Researchers say this finding could have important implications for the development of interventions to prevent fractures. Study authors say total homocysteine concentrations can effectively and easily be modified through dietary intake of folic acid and vitamins B6 and B12. They feel if further research confirms this finding, nationwide folic acid fortification of food could help reduce fracture rates in the United States.


SOURCE: The New England Journal of Medicine, 2004;350:2033-2041, 2042-2049

 

Sun to Blame for eye Disease (May 12, 2004)

(Ivanhoe Newswire)

This summer you may want to stay out of the sun to protect your vision. New research shows extended exposure to sunlight may lead to age-related maculopathy, also called age-related macular degeneration -- an eye disorder that can cause blindness.

Researchers from the University of Wisconsin Medical School in Madison followed more than 3,600 patients for five years and more than 2,700 patients for 10 years. Patients were between 43 and 86 years old.

Participants who reported being in the sun for more than five hours a day during their teens, 30s, and at the beginning of the study were three-times as likely to develop increased retinal pigment -- a characteristic of age-related maculopathy. These patients were also twice as likely to develop early age-related maculopathy over 10 years, compared to patients who reported spending less than two hours a day in the sun.

Results also show participants who reported being in the sun the most had about a 50-percent lower risk of developing characteristics of age-related macular degeneration when they used hats and sunglasses at least half the time.

On the other hand, those who reported experiencing more than 10 severe sunburns during their childhood were 2.5-times more likely to develop abnormal blood vessels in their retinas, which is associated with age-related maculopathy.

However, researchers say there were no relationships between UV-B exposure, time spent outdoors during the winter, or skin sensitivity.

SOURCE: Archives of Ophthalmology, 2004;122:750-757

 

New Attempt at Solving HRT Controversy (May 7, 2004)

(Ivanhoe Newswire)

One week a medical group announces the benefits of hormone replacement therapy, and the next week another group of experts shun it. But they all seem to agree the need for a balanced discourse on both the pros and cons of the issue has never been greater.

“Before the first [Women’s Health Initiative] report was released in 2002, there was an overstatement of the benefits of hormone therapy in the medical community. Since that time, however, public opinion has probably shifted too far in the other direction -- overstating the risks of HT without acknowledging its benefits in relieving menopausal symptoms,” said Isaac Schiff, M.D., from Massachusetts General Hospital in Boston, speaking at The American College of Obstetricians and Gynecologists Annual Clinical Meeting in Philadelphia.

Dr. Schiff says experts and doctors need to formulate recommendations for women, especially now that new data was released in March by WHI on estrogen-only HT. This data comes just two years after their initial report on combined hormone therapy (estrogen and progestin).

Estrogen-only is solely given to women who have had hysterectomies because estrogen by itself can raise the risk of uterine cancer. WHI found that estrogen-only therapy showed no benefit in reducing heart disease and did not increase the risk of breast cancer in a six-year period. It did show a benefit in the prevention of osteoporosis. Like combination therapy, estrogen alone increased the risk for stroke in eight of 10,000 women.

Dr. Schiff reminds us that the 2002 studies on combined HT therapy showed increased risk for heart attacks, breast cancer, stroke, and blood clot.

But HT will not go away as it remains the most effective treatment for menopausal symptoms, especially for women who experience severe symptoms after hysterectomies, he says.

Now, ACOG recommends HT can still be used for treatment of hot flashes, but should be accompanied with medical consultations at least once a year, regular mammograms, and the smallest effective dose of HT for the shortest possible time.

SOURCE: The American College of Obstetricians and Gynecologists Annual Clinical Meeting in Philadelphia, April 30-May 5, 2004

 

Total Body Lift (May 7, 2004)

PITTSBURGH (Ivanhoe Newswire)

This year, more than 140,000 people will have gastric bypass surgery to lose weight. But with the massive weight loss comes an often unexpected and unwelcome change.

Maria Beal has been heavy for as long as she can remember. "I was a pretty confident 340 pound woman," she tells Ivanhoe.

But Maria knew she had to lose weight for her health, so she had gastric bypass surgery. She says: "By August, I was down 65 to 70 pounds. By October, I was down 100, 105." But with the weight loss came another problem -- excess skin. And more than the cosmetic, it brings medical problems.

"Infections that can be troublesome to dangerous," says Dennis Hurwitz, M.D., a plastic surgeon at The Hurwitz Center for Plastic Surgery in Pittsburgh. "They lead to cellulitis and abscess."

Typically patients undergo multiple surgeries to remove all the skin, but Dr. Hurwitz performs a procedure he calls "a total body lift." "In our fast-paced life today, with people wanting to get back to work and avoiding long post-operative convalescence, repeatedly going to surgery, this is working for them," he tells Ivanhoe.

He cuts around the hips and buttocks and removes the excess skin then does the same around the back and below the arms. A new study found this large operation is no more risky than several small ones -- just maybe a little more painful.

"There was not a spot on me that didn't hurt," Maria says. Her husband, Greg, says, "When you see the final picture, and you see the results that have become from all this, she will tell you herself that it is worth it."

Dr. Hurwitz points out the patient must be in good general health and must not be a smoker in order to undergo total body lift. Also, people who are still massively obese are not good candidates. He says the eight- to 10-hour procedure costs between $25,000 and $40,000 in surgeons fees and is generally not covered by insurance.

If you would like more information, please contact:
Dennis Hurwitz, M.D.
The Hurwitz Center for Surgery
http://www.usalipo.com
http://www.hurwitzcenter.com

 

Good use for Umbilical Cords (May 6, 2004)

(Ivanhoe Newswire)

The umbilical cord used to keep a baby alive in the womb may also keep children with a potentially fatal condition alive after birth. A new study shows cord-blood transplantation may halt the progression of Hurler’s syndrome and prolong life.

Hurler’s syndrome causes progressive deterioration of the central nervous system, cardiac disease, and death in childhood. It is characterized by skeletal abnormalities such as hip dysplasia, carpal tunnel syndrome, and clouding in the eye.

Doctors have known a bone marrow transplant can stop the progression of the disease and prolong life, but many children lack a suitable bone marrow donor. Now, a new study in The New England Journal of Medicine shows transplantation with stem cells supplied by cord blood from unrelated donors can have the same impact. Researchers found this procedure changed the natural history of the condition in young children.

Investigators found 17 of the 20 children who participated in the study at Duke University in Durham, N.C., survived event-free for more than two-and-a-half years after transplantation. Five patients had acute graft-versus-host disease, or serious short-term side effects, but none had long-lasting problems.

Researchers conclude cord blood from unrelated donors is an excellent source of stem cells for transplantation in Hurler’s syndrome patients. One advantage of umbilical-cord blood is that donor and recipient matching does not have to be as close as that necessary for bone marrow grafts. However, no suitable adult stem-cell donor was identified in a timely fashion in more than 50 percent of patients, according to the article.

In a related article, the scientists from the University of North Carolina at Chapel Hill point out that stem-cell transplantation is now the treatment of choice for children younger than age 2 with Hurler’s syndrome who have minimal or no central nervous system disease. The authors suggest, “The screening of newborns may be essential for timely diagnosis and the initiation of treatment before the onset of irreversible damage.”

SOURCE: The New England Journal of Medicine, 2004;350:1960-1969, 1932

 

Ugly Side of Beauty: If the Shoe Doesn't Fit -- Full-Length Doctor's Interview (May 6, 2004)

In this full-length doctor's interview, Sharon Dreeben, M.D., explains possible complications of cosmetic foot surgery.

What are the latest trends in foot surgery?

Dr. Dreeben: About five years ago we started seeing advertisements for cosmetic foot surgery. These advertised patients could have a better life and fit into their shoes. Then we started realizing that patients were having surgery not because they were having pain but so their foot would be prettier. They wanted to put in more padding so they could wear their high-heeled shoes without any discomfort, so they were told. As the trends started to grow, we realized that this is a problem. Then we started seeing patients that were having complications from these surgeries, and we felt we really needed to investigate this and let the public know what was happening. We saw patients that didn't have appropriate medical information before they went into these. There are times when you should have surgery and when you shouldn't.

What sorts of things are people getting done to their feet cosmetically?

Dr. Dreeben: I think most patients that want cosmetic surgery want their feet to look prettier. They want all the toes to be the same size, and they want to fit into their shoes. In order to do that, they shorten toes. Usually it's the second toe, which oftentimes is too long. Sometimes they'll narrow the foot to be able to wear narrow and fashionable shoes. They'll also notice they have a bump called a bunion, and they don't like the look of it.

The most important thing is to define what cosmetic surgery is. Cosmetic surgery is not surgery because you have a painful bunion or a painful hammertoe. Cosmetic surgery is having surgery on the foot when there is no anatomic deformity and no pain. The patients just want to make the foot look better and because they may have a variant of the normal, aesthetically pleasing foot.

Is it like Chinese foot binding?

Dr. Dreeben: I think that's where we started years and years ago with Chinese foot binding, and now we've come full circle. The Chinese were able to deform the foot by manipulating it while it was growing, now we just wait until it's fully-grown and then start cutting pieces out.

What is toe cleavage?

Dr. Dreeben: Toe cleavage is just like breast cleavage. It's when you can see the very base of the the big toe and second toe. You see where the toes start to indent. It's just a funny expression for the new shoes that don't cover the toes completely.

I have other phrases that I use for these foot surgeries; for silicone implants, I call them toe jobs. Just like a boob job, you get a toe job. The patients can have silicone complications from these, which is the same type of problems that can develop from breast surgery. But even worse, the toes are a weight-baring surface. They don't just sit there. In the toes, you can have biomechanical problems as a result of the surgery that can halt normal daily activities.

What are the dangers or potential complications from these cosmetic surgeries?

Dr. Dreeben: Cosmetic surgery is, for the most part, the same as any other surgery. It has the same risks and complications, except it has very little upside to it. All surgeries have a 1-percent incidence of developing an infection. Secondly, you can change the biomechanical alignment of the foot, and therefore, you can't walk at all. You can have transfer lesions where all the weight is placed on the third or fourth metatarsal head instead of the second toe that you operated on. If you correct the bump on a bunion, the big toe can move in a certain direction. Or you can get arthritis in the big toe. If you inject silicone into the base of the foot in order to increase the padding -- and let me say right now, that there is no documentation that increasing the padding will change the symptoms or make you feel better in high heels -- you can injure to the nerves. You can also develop abnormalities from the collagen or silicone.

What advice would you give to somebody considering cosmetic foot surgery?

Dr. Dreeben: It's the same advice that I give to all my patients. If you have pain on a daily basis and have tried reasonable alternatives -- like changing your shoes, not wearing your stilettos, changing from a four-inch heels to two-inch heels, padding your shoes, taking your shoes to the shoemaker, adjusting your shoes to your foot -- and you're still having problems, have the surgery. But don't have surgery to change the shape of your foot, especially if you're not having any pain.

What do you think of the fact that over half the surgeons say their patients are asking for such surgery?

Dr. Dreeben: There is definitely a trend going on. I am in the American Orthopedic Foot and Ankle Society (AOFAS), and we specialize in orthopedic surgery, specifically that of the foot and ankle. All of the experience from the rest of the body is going to help us learn what we can do in the foot. We surveyed our members just to find out how many doctors have been seeing an increase in patients coming to them saying they want cosmetic foot surgery. Fifty percent of our orthopedists say somebody has come to their office and asked them to do a cosmetic foot surgery. Most of them have said that they won't do it. A few of them have said, "You know, what do you do but perform the surgery?"

The hardest part is that there is always a gray line of what's cosmetic surgery and what's not. For example, a gentleman comes into your office, has a small hammertoe, and he can't find a pair of shoes to fit. Is that cosmetic surgery? Not really. He has a deformity. That's not the same as somebody who has a longer toe that has no problem, but just doesn't like the way it looks and wants to chop it off.

Would you perform purely cosmetic surgery?

Dr. Dreeben: No. Again, there are always the gray areas, but I would not perform purely cosmetic surgery.

What do you think if someone gets foot surgery just for fashion's sake?

Dr. Dreeben: I think they're unaware of the potential complications. If they spoke with a lot of women that have had disaster stories, they might not be as anxious for the surgery. Some women can't work anymore, can't walk anymore, their activities are changed, and their shoe wear has changed along with their entire life. They can't do simple things like stand at the sink and cook. I don't think that after talking to people and listening to the risks, benefits and complications, most reasonable people would consider the surgery. However, having said that, there is so much pressure on a woman today to be beautiful, to be perfect, to have a perfect figure, and a perfect foot. This is why I think that they do it, and so in a certain extent the fault is ultimately our own. The media also has a lot to do with it. It's all in the packaging.

What do you think about doctors that will perform purely cosmetic surgery where there is no medical necessity?

Dr. Dreeben: I think that they're doing their patients a disservice. They may get away with a few that have good results, but the ones that don't have good results have a real problems. It's truly, I think, irresponsible.

However, to be fair I have to restate there's always the gray line. It's sometimes very subtle and very difficult when a patient comes into your office and says, "Hey doc, you've got to do something to help me." Sometimes you know deep in your heart that if you don't do it, somebody else is going to do it. That may be somebody with less capability, and then you're stuck in a bad spot.

What kind of shoes do you wear?

Dr. Dreeben: For the most part, I wear flat shoes when I'm in the office. Then I'll wear a little heel during the day if I want to go out or look nicer, and once in a while I'll wear a stiletto. I like them as much as the next woman. If I buy a shoe that has a pointy toe, I get it a half size longer. I used to be an eight and a half, and I've gone on to a nine and a half. As embarrassing as it is, I'll take a size 10 to allow myself a lot of room in the toe box. I take the shoe to an orthotist and ask them to pad the bottom so that I am more comfortable. If there is an area of stitching that's bothering me, I'll have it released. Unfortunately, it's an expense to buy the shoes, and then it's an additional expense to have them adjust it to fit your foot. But it's a lot cheaper than having a surgery and a whole lot cheaper than having a surgery that incapacitates you.

***

 

Breast Milk Does a Baby Good (May 4, 2004)

(Ivanhoe Newswire)

Breastfeeding is associated with reducing the risk of all-cause death in infants, say scientists at the National Institute of Environmental Health Sciences in Research Triangle Park, N.C.

Researchers concluded that promoting breastfeeding could potentially prevent up to 720 postneonatal deaths in the United States.

They compared records of about 9,000 babies between 28 days and 1 year of age. Children who were breastfed had 20-percent lower risk of dying than children who were not breastfed, and longer breastfeeding was associated with lower risk. The effect was the same in black and white children.

Author Walter J. Rogan, M.D., says, “Although we knew that breastfeeding in the developing world was lifesaving, since it prevented diarrhea and pneumonia, we had no nationally representative data from the United States on this very basic outcome. These data show that, even in the United States, there is a modest decrease in mortality for breastfed children.”

Breastfeeding has been shown to boost the immune system of babies. The authors also hypothesize that breastfeeding may represent a package of skills, abilities and emotional attachments characteristic of families whose infants survive, and that it may not be the breast milk entirely that produces the benefit.

The authors conclude that the case for breastfeeding is already very strong in the United States, and these findings represent another reason to encourage more women to breastfeed. In 2001, 70 percent of mothers left the hospital breastfeeding, and 33 percent were still breastfeeding at 6 months.

SOURCE: Pediatrics, 2004;113:435-439

 

Botox for Cerebral Palsy (May 3, 2004)

(Ivanhoe Newswire)

The same toxin used to fight wrinkles may also help children with cerebral palsy.

In a study of more than 70 patients with cerebral palsy, researchers from Wake Forest University Baptist Medical Center in Winston-Salem, N.C., found patients injected with Botox experienced three-times the improvement in functional ability compared to those on placebo.

Cerebral palsy is caused by an injury to the developing nervous system that occurs during or shortly after birth. The disease causes arms and legs to stiffen and contract. Botox helps relax those muscles and appears to improve a patient’s ability to perform daily tasks.

L. Andrew Koman, M.D., from Brenner Children’s Hospital at Wake Forest, says, “This non-surgical intervention is one way to improve functional outcomes for these patients, decrease pain, and facilitate care.”

Dr. Koman says patients experienced the most benefit one to two days after receiving the injection. The injections can be repeated every three to six months. Dr. Koman says: “Many of our patients come back into the office asking for additional injections because they are thrilled with the results. Once the muscles have relaxed, patients can undergo therapy to strengthen weak muscles.”

Dr. Koman says the only side effect is soreness at the sight of the injection. He says Botox injections work well when combined with other treatments.

SOURCE: American Academy of Pediatrics’ annual meeting in San Francisco, May 1-4, 2004

 

Danger at the Dentist for Pregnant Women? (May 3, 2004)

(Ivanhoe Newswire)

Women who have dental X-rays during pregnancy are three-times more likely to have a low-birth weight infant, according to a new study.

Researchers from the University of Washington School of Dentistry in Seattle studied about 4,500 women. They found women who had dental X-rays were more likely to have babies weighing less than five pounds.

Philippe Hujoel, Ph.D., lead author of the study, says he was surprised at the results. He says, “The findings are surprising because the amount of radiation pregnant women were exposed to was very low and generally thought to be incapable of inducing observable health effects.”

Currently, care guidelines allow for women who are pregnant to receive very low-dose radiography to the head and neck.

Hujoel says, “We don’t know whether radiation affects neurohormonal mechanisms in the head and neck region, such as thyroid function, or whether factors unrelated to the X-rays are to blame.”

Previous studies show young women who are exposed to radiation for spine problems before getting pregnant also have an increased risk of having a low-birth weight baby.

Hujoel says his results should not discourage pregnant women from having dental X-rays if they suffer from a dental problem, as long as their doctor knows they are pregnant. He says most dentists are cautious about taking X-rays during pregnancy.

Hujoel says more research needs to be conducted to confirm his findings.

SOURCE: The Journal of the American Medical Association, 2004;291:1987-1993

 

Estrogen and Raloxifene Face Off (May 3, 2004)

(Ivanhoe Newswire)

When it comes to stopping the bone loss common in osteoporosis, estrogen gets the job done better than raloxifene (Evista), report researchers publishing in the Archives of Internal Medicine.

A study was conducted with about 600 women who had a previous hysterectomy. Those taking estrogen increased their bone mineral density by 4.6 percent. Bone density remained stable in those taking raloxifene. Women given a placebo drug for comparison purposes actually saw their bone density decline by about 2 percent.

The findings for raloxifene were similar for two different doses -- 60 milligrams or 150 milligrams.

The study also gauged the impact of the treatments on cholesterol levels. Results showed no difference in total cholesterol levels over three years among women in the raloxifene or placebo groups. However, triglyceride concentrations rose by about 25 percent among those on estrogen. Their HDL levels (the “good” cholesterol) also rose by about 13 percent.

Interestingly, say researchers, more women on estrogen reported problems with urinary incontinence -- 11 compared to just 1 or 2 in the raloxifene groups.

The investigators conclude both estrogen and raloxifene are effective in treating osteoporosis, but estrogen appears to have the edge. They write, “This head-to-head comparison allows the relative strengths and weaknesses of these two treatment options to be more clearly delineated, providing additional information to patients and their physicians when selecting the agent that offers the most advantages with the fewest problems.”

SOURCE: Archives of Internal Medicine, 2004;164:871-8

 

Childhood Time Bombs: Step Away From the Couch (May 2, 2004)

NAPERVILLE, Ill. (Ivanhoe Newswire)

Only 22 states currently require schools to offer physical education class, and only one -- Illinois -- requires it daily through high school. Many blame school budget cuts in at least 39 states in the past two years and more than a $70 billion shortfall this year. Here's what some are doing to make sure kids get the exercise they need.

Welcome to third period P.E. class at Naperville Central High School in suburban Chicago.

"When we looked at the health care crisis across the country, and the obesity crisis, we felt that we better re-evaluate whether we need physical education in schools or not," says Phil Lawler, who is director of P.E.4LIFE Institute in Naperville, Ill.

One look at the statistics proves they did need it. The average child spends almost three hours a day watching television. One in four adolescents reports doing zero physical activity. And experts now say obesity -- caused in part by sedentary behavior -- will bypass smoking as the leading cause of early death.

Lawler tells Ivanhoe, "Our country attacked the smoking issue very, very strongly, and yet, we've neglected this issue with physical inactivity."

He refused to neglect it. Instead, he launched P.E.4LIFE Institute. "Retraining adults to change lifestyle just doesn't work," Lawler says. "We need to start training children at a young age to get into the habit of physical activity on a daily basis, so we can make a difference in their health."

His approach seems to have worked. Lawler says nationwide 30 percent of kids are overweight. In Naperville, it's 3 percent.

The results intrigued Tim McCord of Titusville, Penn., who is now director of the small town's P.E.4LIFE Institute. He says: "How much is your child's health worth? Is it not worth putting extra money into a school system to help develop the health of the child?"

Titusville decided it was worth even more. They extended the school day to include daily PE and brought in new equipment and monitoring technology that refined their grading system.

"By grading on effort, it has made it so that everybody can be successful," McCord tells Ivanhoe -- including non-athletes and video game junkies.

Penn State researcher George Graham is studying how much energy kids use playing games like Dance, Dance Revolution -- DDR for short -- and Sony Eye Toy. He says, "For some kids, we think this may be a way to keep them active through the teenage years and then into adulthood."

Ten-year-old Micah Cattell says, "You don't feel like you're exercising on this, but then you feel your heart, and you can feel it beating really hard."

And how do these new games stand up to older ones?

Alex Frieden, who is 14, says, "I like shooter games too, but DDR is pretty much just as fun as any shooter game."

Fun and fitness in one.

Want more advice on what you can do to improve your child's fitness or take action in your community? Log onto http://www.ivanhoe.com/kidshealth.

If you would like more information, please contact:
P.E.4LIFE
http://www.PE4life.org
George Graham, Ph.D.
ggraham@psu.edu

 

Relax the Stomach With Botox (May 2, 2004)

PHILADELPHIA (Ivanhoe Newswire)

We've all heard about what Botox can do for cosmetic uses, wiping away the years by getting rid of wrinkles. Now, doctors in Philadelphia are using it for medical reasons. It's helping bring relief to people who live with a chronic stomach condition.

Botox. You know it can erase the signs of aging. Now, the toxin is being used to treat a chronic condition known as gastroparesis.

"Gastroparesis is where there is delayed emptying of the stomach after a meal. It may be for solid food or for liquids, which have been taken in by the patient," says gastroenterologist Frank Friedenberg, M.D., of Temple University Hospital in Philadelphia.

The condition causes a person to feel full after just a small meal. It also causes bouts of nausea, upset stomach and bloating.

Ashley Sterling knows how debilitating it can be. She says, "I go to bed at night scared to death that I'm going to wake up feeling so sick that I can't control my vomiting, which has been happening a lot lately."

Medications offer relief but often with side effects like restlessness and fatigue. Some doctors are now turning to Botox as an alternative to drug therapy.

Dr. Friedenberg says, "The idea behind Botox is that it's a very local treatment, so you do not get side effects related to it, and it works right in the area that is involved with gastroparesis."

Botox is injected into the muscle that sits at the end of the stomach. There, it goes to work. "The muscle relaxes and then there is more rapid emptying of the stomach for solids and for liquids," Dr. Friedenberg says.

There's good reason to believe Botox will mean success. Up to half of study participants showed improvement after the procedure. And there's more good news. Doctors say the treatment is not painful, and a sedative is given before the 15-minute procedure begins. The benefits usually last between three months and six months, so repeat treatments are necessary.

If you would like more information, please contact:
Jordan Reese
Public Relations Manager
Temple University Health System
Philadelphia, PA
(215) 707-4839

 

Simple Strategies may not Lower Blood Pressure (May 1, 2004)

(Ivanhoe Newswire)

Simple strategies to improve lifestyle habits may not lower blood pressure in patients with a single high blood pressure reading, according to a new study in this week’s British Medical Journal.

Researchers investigated whether simple interventions, such as providing patients with an information booklet, encouraging lower sodium intake, and advice for a healthier diet, had more or less of an effect as standard care.

They discovered these inventions had no effect on blood pressure, but they did prompt changes in the patients’ diets, which is likely to reduce the long-term risks of stroke.

Nearly 300 patients without an established history of high blood pressure were randomized into one of eight groups defined by three factors: an information booklet; low sodium, high potassium salt; prompt sheets for high fruit, vegetable, fiber and low fat. Some patients were given a booklet while others were not. Some patients were advised to use a low sodium, high potassium salt while others did not receive advice on this. Finally, some patients received prompt sheets for high fruit, vegetable, fiber and low fat, while others did not receive any of these prompt sheets.

According to the study, none of the interventions altered blood pressure. In fact, one of them had an adverse effect -- advice to use a low sodium, high potassium salt actually increased anxiety.

The one bright spot was the diet changes. Brief advice and careful follow-up resulted in 10 percent to 20 percent changes in diet, and the patients were still eating healthier after six months, the authors write. Although the changes weren’t significant enough to immediately lower the blood pressure, the researchers say those patients will have a lower risk of stroke in the future.

SOURCE: British Medical Journal, 2004;328:1054, doi:10.1136/bmj.38037.435972.EE