Wednesday, April 30, 2008

Natural Anti-Oxidant Provides Clues for Parkinson’s Treatment

A naturally occurring anti-oxidant in humans has lead researchers to believe there is a link between serum urate levels and the progression of Parkinson’s disease.

Urate, once believed to be a useless a by-product of metabolism, is now thought to play "an important role in keeping us healthy," according to Alberto Ascherio, MD, of the Departments of Nutrition and Epidemiology, Harvard School of Public Health in Boston, Massachusetts. The study is published in the April 14 Online First issue of the Archives of Neurology.

The authors found that patients who had the highest levels of serum urate had the slowest progression of early Parkinson’s disease. Data from the PRECEPT study was used, which involved 806 people with Parkinson’s disease; followed between April 2002 and April 2004. Baseline urate measurements were obtainable in 804 of the participants, and the study included men and women. The group was at least 30 years of age, and not receiving traditional drug therapy for Parkinson’s disease. Data from sixty five sites across the US and Canada were reviewed.

Urate levels were higher in males, those with obesity, gout, high blood pressure, and increased body mass index. Certain types of diuretics also increase uric acid levels in the body. As urate levels declined, symptoms of Parkinson’s disease progressed. The correlation was strongest among the men, and the researchers don’t exactly know why women seem to be protected.

Since the whole process is complex as it relates to anti-oxidant protection, we still don’t know exactly where this study will lead. "Urate captures the oxygen and prevents the damage to other molecules; it's a sort of scavenger of oxygen," according to Dr. Ascherio. He added that researchers do not yet fully understood the exact protective mechanism involving urate. Alcohol and sugars increase serum urate levels, while dairy products and Vitamin C decrease urate levels, but produce high levels of ascorbates which are also powerful anti-oxidants. High serum urate levels in the body increase the risk of gout, heart disease and kidney stones. Thus, for now, the authors can only speculate about the protective mechanism of urate.

Inosine is a precursor to urate. The Michael J. Fox Foundation has provided 5.6 million dollars to fund a phase 2 clinical trial to determine the safety and tolerability of Inosine, which is available as a supplement. They hope to see if Inosine can safely raise urate levels. We know that high levels can lead to gout, heart disease and kidney stones.

I can't help but be reminded of the beauty of synergy and balance. When we study a part of the whole, of course, we are lead to further mysteries.

Another thought - urine therapy (urate is excreted by the kidneys) has been advocated across many cultures, and for centuries. I’m not recommending it - I’m just saying…..

You can read more about the history urine therapy at The Skeptics Dictionary.

Archive of Neurology: Published online April 14, 2008. ◦

Saturday, April 26, 2008

Stress is a Definite Health Risk – How do You Manage?

According to the American College of Cardiology, stress is a definite predictor of heart disease. The jury is no longer out – feelings of irritability, lack of sleep, job stress, marital woes, racial prejudice, and care giving are all examples of stressors that can greatly affect heart health. The chance of developing heart disease is even stronger when stress occurs suddenly - loss of job, job promotion, the death of a loved one or close friend, and natural disasters can happen at any time.

The recognition of the link between stress and heart disease should prompt each of us to find successful ways to manage our health – we need to eliminate activities that can be controlled, and find ways to deal with chronic and acute stressors - something that is probably more easily said than done. Studies now show that our bodies undergo physiologic changes in response to anxiety. Stress wreaks havoc with the sympathetic nervous system, and doubles our risk of future heart attack. Stress doesn’t directly cause heart attack, but is thought to act as a trigger. Family physicians are being urged to consider stress as a risk factor for heart disease, much the same as smoking, obesity, diabetes, and high cholesterol. Our judicial system has been flooded with court cases challenging the notion that stress has lead to disease.

Successful techniques for stress management include meditation, exercise, progressive relaxation training and the use of medications. Many people shun medication because of undesirable side effects or expense.

How many people do you personally know who simply “put up” with stress, as though it were a fact of life? It seems to be the norm, doesn’t it? Well, now we know that we need to work harder than previously thought to manage our time and restore calm to our lives.

We know much about the positive effect of exercise, but many people are hesitant to try other forms of relaxation. In fact, a lot of people don’t engage in regular exercise. Learning to relax is different for everyone. Most of us don’t even talk about stress – we just try to move past it.

What do you do to relieve stress? Have you changed your life to facilitate your health, perhaps by giving up a good job with a long commute, or downsizing to simplify your day to day existence? I invite you to please share your personal strategy – we will all benefit.

Citation: J Am Coll Cardiol 2008; 51:1237-46.

Friday, April 25, 2008

Massage, Aromatherapy and Alzheimer's Disease

Massage and aromatherapy have known benefits. Most people, especially family caregivers, may not be aware that aromatherapy, massage, therapeutic touch, light and pet therapy may help subdue aggressive behaviors, especially those associated with Alzheimer’s disease and other forms of dementia.

Anyone who has cared for a family member with dementia is well aware of the challenges. Oftentime, cognitive decline results in the need to place a family member within an institution, as management problems with behaviors escalate. Behavioral problems are very distressing when you’re caring for a loved one.

Using non medical approaches to help someone remain at home has many advantages. There are no side effects, and alternative approaches to care often address a more specific patient need, such as sensory deprivation.

Therapeutic touch and aromatherapy may provide a solution. Hand massage can be very calming. Music and pet therapy may cure boredom that can lead to periods of agitation and aggression.

The presence of a therapy dog for 30 minutes on two occasions during sundown hours reduced the number of agitated behaviors in 28 older adults with dementia in another study.

Multisensory stimulation provokes the senses of sight, hearing, touch, taste, and smell - through the use of effects such as meditative music, lighting, tactile surfaces, and aroma. Examples include moving shapes beamed around the room, bubble tubes, fiber-optic sprays, music, and aromatherapy oil diffusers. Studies have shown that these interventions can provide calm, though the effects were not long lasting, and took four weeks to see the effects.

Hand massage has also been studied, and showed that physical aggression can be calmed with the use of slow stroke hand massage. In the study, verbal aggression was not decreased, but physical signs of agitation responded well to hand massage.

Aromatherapy, using lavender oil, was placed in a resident facility, and diffused for a two hour period. There was a sixty percent “modest” improvement in agitated behavior among the residents when compared to placebo(water).

The use of Melissa oil showed a 60% decrease in agitation when it was applied to the face and arms of a group of severely demented, agitated patients. Melissa oil was compared with sunflower oil, and found to be more effective.

These studies are encouraging, and provide insight on how to help manage a loved one when trying to care for them in the home or in a healthcare setting. No one thing will work for each individual. Perhaps combinations of therapies are worth exploring.

You can search for Melissa oil online. It is expensive, but is said to decrease respirations, and slow heart rate. It has a distinctive lemon scent. Aromatherapy diffusers, calming music, as well as natural lighting may also be beneficial. You can purchase pure lavender oil from any natural health store and there are many online merchants from which to choose.

Source: Geriatrics Aging. 2005; 8(4):26-30. ©2005 1453987 Ontario, Ltd. ◦

Thursday, April 24, 2008

Advice to Government from the NRC – “Smog Probably Kills”

The National Research Council (NRC) of the National Academies, a private agency that advises the US government, has recently provided suggestive evidence that smog “"is likely to contribute to premature deaths." The thirteen member panel is asking that our government consider ozone reduction life saving, though they don’t thoroughly know the health effects of current regulatory standards. The report notes: "The health-benefits estimates should be accompanied by a broad array of analyses of uncertainty but should give little or no weight to the assumption that there is no causal association between estimated reductions in premature mortality and reduced ozone exposure."

The report also states "the effect of acute ozone exposure on mortality is likely to be larger than average in persons with preexisting disease, especially lung and heart diseases."

Unfortunately, the panel is under fire from the API - “The findings contradict arguments made by some White House officials that the connection between smog and premature death has not been shown sufficiently and that the number of saved lives should not be calculated in determining clean-air benefits.” The report seems to be viewed as a reproach to President Bush’s environmental policies.

The analysis was commissioned by the EPA, and is built on studies that find much plausibility in their conclusions. They have found much research that provided them with “insights to suggest the potential for a number of events by which ozone exposure could lead to increased mortality”, including inflammation of the lungs, worsening of heart disease, and damage to the airways and autonomic nervous system.

What is astounding to me as a healthcare professional is that the recommendations are being questioned. We have seen a steady increase in the incidence of adult onset asthma. Most of those cases are preceded by allergic reactions and eczema. Even in areas with cleaner air, the incidence of asthma in children has been found to be greater near freeways.

Rather than call the report a political reproach, why not advocate for studies that would completely define the issue? To me, it’s an extremely important and worthwhile investment. You can view the entire report at
What do you think?

Related: Induction of Asthma and the Environment: What We Know and Need to Know

Wednesday, April 23, 2008

Heart Protective Gene Found in Some Blacks

According to a study published online April 20, 2008 in Nature Medicine, approximately 40% of blacks may be naturally protected after heart failure. Researchers have uncovered a gene variant that appears to act like a beta blocker (a heart protective drug), adding years to the lifespan of blacks with heart failure; possibly negating the need for drug therapy. Dr Stephen B Liggett (University of Maryland, Baltimore) and colleagues surmise: “The findings may help explain why beta blockers don't appear to benefit some African Americans.”

Beta blockers are prescribed to patients as the result of evidence based practice. They are routinely used for the treatment of heart failure, arrhythmias, and following heart attacks. Past studies have shown that African Americans don’t respond to Beta blockers as well as whites. Sharon Cresci (Washington University, St Louis, MO) says: "I think this is so exciting. I believe this gene has significantly contributed to the discrepancies that have been found in such studies. If researchers were able to go back and genotype patients from their studies, it would probably help clarify some of their findings." Dr. Cresci is the second author of the study, and her comment was provided during an interview with Heartwire.

The researchers sequenced the DNA of 96 people of European American, African American, or Chinese descent to look for differences in two specific heart genes - GRK2 and GRK5. They found that everyone had the same gene with the exception of African Americans. Forty one percent were found to possess a variant, known as GRK5-Leu41. Next, they compared survival rates of those with and without the variant in 375 African Americans with heart failure. Not all were taking beta blockers during the study. Those who were not taking the drug, and had the gene variant, lived twice as long as those with the more common gene sequence, and did not take beta blockers. For those taking beta blockers, survival rates were the same, showing that beta-blockers provided no added benefit when the gene variant is present.

Dr. Cresci feels it is too soon to advocate gene testing to decide if blacks with heart failure should or should not take beta blockers, but the group is planning more research. The potential also exists for using GRK5-Leu41 as an actual treatment for heart failure. The study results may add to the growing use of genetic testing for individualized delivery of healthcare.

"This is a step toward individualized therapy. "Medical research is working to identify many genetic variants that someday can ensure that patients receive the medications that are most appropriate for them. Right now, we know one variant that influences beta blocker efficacy, and we are continuing our research into this and other relevant genetic variants”, says Dr. Cresci.

Nature Medicine April 20, 2008

To learn more about heart failure, visit the American Heart Association. ◦

Tuesday, April 22, 2008

Commonly Used Prescriptions May Hasten Cognitive Decline in Elders

Jack Tsao, MD, DPhil, associate professor of neurology at Uniformed Services University, in Bethesda, Maryland, recently studied the effect of medications with anticholinergic properties on cognitive decline. The study was prompted by an elderly patient who presented with memory loss, yet did not fall within the normal parameters used to diagnose dementia or Alzheimer's disease. Kenneth Heilman, MD, from the University of Florida at Gainesville, who co-authored the study, noticed that this was his second patient who had begun treatment for overactive bladder and complained of memory loss.

According to Dr. Tsao: "Because Dr. Heilman had seen a previous case of another woman who had memory complaints that reversed after stopping her bladder medicine, we did the same for this lady, and her memory improved. This prompted us to ask the question of whether anticholinergic medicines or medicines that have anticholinergic properties actually can impair thinking in normal individuals".

Medications that contain strong anticholinergic properties include those used to treat Parkinson's disease, and drugs used to treat overactive bladder, such as Detrol, Warfarin, furosemide (Lasix), and Zantac have weak anticholinergic properties, in addition to the antihypertensive/fluid pill, HCTZ. Even medications, such Dramamine and Benadryl have an anticholinergic effect. Per Dr. Tsao: "When we actually looked through the literature, a lot of medicines that are not advertised as anticholinergic in nature actually have anticholinergic properties in vitro. He concluded that anticholinergic medications contribute to an increase in elderly cognitive decline.

Plans to further the study include involving patients who already have mild cognitive impairment to see if anticholinergic drugs make it worse. They also intend to investigate the link between cognitive decline and drug potency.

The results come from the American Academy of Neurology 60th Annual Meeting. Dr. Tsao suggests that physicians consider cognitive performance when prescribing medications with anticholinergic properties.

A 2006 study, published in the British Medical Journal also showed that elders who take anticholinergics fared more poorly on memory tests. Dr. Tsao suggests… “if someone is having what they feel is a noticeable problem with their ability to remember things, they need to go see their doctor. And they need to mention if they are on one of these drugs."

In addition, make certain that you understand all of your medications, including the side effects. Accept counseling from your pharmacist when new medications are prescribed. You should always carry a list of your medications, and keep it updated to show each of your healthcare providers. Never assume that communication between healthcare providers is current. If you are over age 65, you need to be especially cautious when taking any medication. Never be afraid to ask questions.

Source: American Academy of Neurology 60th Annual Meeting: Abstract S51.001. Presented April 17, 2008.

Wednesday, April 16, 2008

Healthy Women Faced with Breast Removal Option Based on Gene Testing

Women,who carry the gene mutation BRCA, may be faced with the decision of having mastectomy to avoid developing breast cancer. According to Dutch researchers, presenting at the 6th European Breast Cancer Conference in Berlin, Germany, women who carry the BRCA gene mutation have an estimated 85% lifetime risk of developing breast cancer. Surgical breast removal, or mastectomy, reportedly reduces that risk to less than 1%. Previous studies have shown that the risk of cancer could be reduced by 3%.

Two hundred fifty one women who carried the BRCA mutation were studied. Two types of BRCA mutation pre-dispose a woman to breast cancer, BRCA 1 and BRCA 2. Two thirds of the women in the study carried the BRCA 1 mutation, the rest BRCA 2. The women had either one, or both breasts removed. One woman developed cancer in the incompletely removed breast tissue that extends under the armpit, but is disease free six years later.

The benefits, according to Reinie Kaas, MD, from the surgical department of the Netherlands Cancer Institute, in Amsterdam: We can safely state that continued follow-up, which can be costly and stressful for the patient, is not warranted in patients who have had prophylactic mastectomy.” She emphasizes that “"healthcare services should not press women to make this choice simply to reduce costs."

It is estimated that half of women who carry the gene mutation have opted for mastectomy. Those who do not opt for surgery receive annual mammograms, perform monthly self-exams, see their doctor twice a year and undergo MRI’s for surveillance. Even with the increased screening, most tumors develop so fast that 25% -35% of women already have tumors that are more than 2cm. in diameter.

The surgery involves removal of breast tissue, while sparing the overlying skin. Breast impantation is performed immediately, making the procedure at least cosmetically appealing.

The decision for gene testing alone is bound to be a difficult one for many women, but in reality, knowledge of your risk factors is only the beginning. If you do have the gene variant that puts you at high risk, you will be faced with another difficult decision.

If you have a first-degree relative who has had breast cancer, you are at greater risk. Other factors that increase your risk, according to the National Cancer Institute, include:

Age—The risk of breast and ovarian cancers increases with age. Most breast and ovarian cancers occur in women over the age of 50. Women with an altered BRCA1 or BRCA2 gene often develop breast or ovarian cancer before age 50.

History — Women who have already had breast cancer are at increased risk of developing breast cancer again, or of developing ovarian cancer. Women who have had colon cancer also have an increased risk of developing ovarian cancer.

Hormonal Influences — Estrogen is naturally produced by the body and stimulates the normal growth of breast tissue. It is suspected that excess estrogen may contribute to breast cancer risk because of its natural role in stimulating breast cell growth. Women who had their first menstrual period before the age of 12 or experienced menopause after age 55 have a slightly increased risk of breast cancer, as do women who had their first child after age 30. Each of these factors increases the amount of time a woman’s body is exposed to estrogen. Removal of a woman’s ovaries, which produce estrogen, reduces the risk of breast cancer.

Birth Control Pills (Oral Contraceptives) - Most studies show a slight increase or no change in breast cancer risk in women taking birth control pills. Some studies suggest that a woman who has taken birth control pills for a long period of time, and began taking them at an early age or before her first pregnancy, has a small increase in her risk for developing breast cancer. In contrast, taking birth control pills may decrease a woman’s risk of ovarian cancer.

Hormone Replacement Therapy - A woman’s risk for developing breast cancer may be increased by hormone replacement therapy (HRT), especially when it is used for a long period of time. Doctors may prescribe HRT to reduce the discomfort from symptoms of menopause, such as hot flashes. Some evidence suggests that women who use HRT after menopause may also have a slightly increased risk of developing ovarian cancer. HRT may have positive health effects as well, such as lowering a woman’s risk of heart disease and osteoporosis. These protective effects diminish after a woman discontinues therapy. The risks and benefits of HRT should be carefully considered by a woman and her health care provider.

Dietary Fat - Although early studies suggested a possible association between a high-fat diet and increased breast cancer risk, more recent studies have been inconclusive. It is not yet known whether a diet low in fat will lower breast cancer risk.

Physical Activity - Studies of the relationship between physical activity and breast cancer have had mixed results. However, some studies suggest that regular exercise, particularly in women age 40 and younger, may decrease breast cancer risk.

Alcohol - Alcohol use may increase breast cancer risk, but no biological mechanism for the relationship between alcohol and breast cancer risk has been established.

Environmental Factors - Exposure of the breast to ionizing radiation, such as radiation therapy for Hodgkin’s disease or other disorders, is associated with an increased risk of breast cancer, especially when the exposure occurred at a young age. Evidence for the effect of occupational, environmental, or chemical exposures on breast cancer risk is limited. For example, there is some evidence to suggest that organochlorine residues in the environment, such as those from insecticides, might be associated with an increase in breast cancer risk. However, the significance of this evidence has been debated. Scientific research is currently in progress to study the effects of various environmental factors on breast cancer risk.

If you are considering genetic testing, it’s recommended that you speak with a professional genetic testing counselor, doctor or other health care worker. To find a professional, you can contact the National Cancer Institute’s Cancer Information Service (CIS) at 1–800–4–CANCER (1–800–422–6237).

6th European Breast Cancer Conference (EBCC): Abstracts 18 and 109. Presented April 16, 2008.

Related: - The Deepest Cut. The author of a new memoir talks about her decision to have her breasts removed to lower her cancer risk, and her desire to be a mother.

Tuesday, April 15, 2008

Testosterone Spray for Female Libido – Forget About It

The proof is now in the pudding. The female libido really must be complex. According to a new study, testosterone spray works as well as using nothing for the treatment of sexual dissatisfaction in premenopausal women. Testosterone seems to help women who are postmenopausal, but the effect before menopause has not been established.

Susan Davis, MD, of Monash University in Victoria, Australia, studied the response of 261 women aged 35 to 46 who reported sexual dissatisfaction and had low testosterone levels. They all received either one of three different doses of testosterone sprayed on the abdomen, or a spray that contained nothing (placebo). All of the women reported an increase in sexual satisfaction. In an accompanying editorial regarding the outcome, Rosemary Basson, MD, of the University of British Columbia, suggests that hormone replacement with testosterone may not be the best choice of therapy for women who want to boost their sex drive. She suggests that doctors explore mental health and relationship issues to address reports of sexual dissatisfaction.

Testosterone peaks in women at age 20, and then begins to decline. It is an important hormone for women as well as men. Past studies have shown that combination estrogen/testosterone replacement improves both the psychological and physiologic well being of women who have had their ovaries and uterus removed, and has been taken by many women who were postmenopausal.

The conclusion is that there is no reason to support the use of testosterone in women prior to menopause.

Hormonal balance is best maintained in women who are physically active and eat foods rich in magnesium, potassium and other minerals. Consider adding soy to your diet. Fresh fruits and vegetables should also be consumed throughout the day. The combination of good health and professional counseling appear to be the best solution - at least until we know more.

Annals of Internal Medicine, April 14 ◦

Sunday, April 13, 2008

Study - Half of All Childhood Cases of Cardiomyopathy are Genetic

According to a study published online, April 10, 2008 in the New England Journal of Medicine, childhood cases of hypertrophic cardiomyopathy (enlarged heart muscle), are the result of genetic predisposition. The findings have prompted recommendations that all first-degree relatives of children affected with cardiomyopathy receive prompt genetic analysis.

According to senior author, Dr Jon Seidman (Harvard Medical School), approximately half of the children who present with childhood cardiomyopathy have exactly the same gene mutations as those seen in adults. He points out that a large number of those children have no family history of the disease. He explains: The answer is that in about one-third of cases, the mutation has arisen for the first time in the child (de novo), he explains, and in the other two-thirds, "their parents just haven't shown any sign of the disease yet." This makes testing especially important for siblings in order to provide early prevention and treatment if they also possess the same heart damaging genes.

One problem is the cost of testing - $2500 to $3000. The initial test must explore over 30,000 bases of DNA. Once the familial genes are targeted, other family members would test less expensively, looking for the already targeted gene.

Cardiomyopathy in children causes the same health problems, regardless of the cause. The importance of the study lies in the opportunity for prevention and screening of family members who are also at risk - "While there is no cure for hypertrophic cardiomyopathy, there are both preventive and therapeutic interventions that cardiologists can employ that can prolong life and improve quality of life, according to Dr. Seidman. ◦

Saturday, April 12, 2008

Lead in Marijuana Causes Poisoning

Twenty patients were recently admitted to University Hospital Leipzig, Germany for the treatment of lead poisoning after smoking marijuana. Admissions occurred over a period of 3-4 months, and all of the patients were 16 to 33 years of age.

One of the patient required abdominal surgery, one had severe mental changes as the result of encephalopathy (brain disease); accompanied by hallucinations. Primary symptoms included abdominal cramps, nausea, anemia, and fatigue. Another patient experienced permanent paralysis of the forearm.

Investigation uncovered a common pattern among those treated – all were young, unemployed, or were students, and they all provided a history of smoking. Additionally, they all had body piercings; eventually admitting to smoking marijuana with a water pipe, or rolled into a joint.

It took eight weeks to find the source of the problem - it seems that lead was deliberately added to the marijuana to increase the weight and street value by an estimated 10%. The lead, grayish in appearance, was not noticeable to the consumers.

The patients were treated with chelation therapy after a quick diagnosis, but it took some time to track down the cause of the poisonings. A full criminal investigation was then launched, as well as an anonymous screening program for marijuana users. Of the 145 persons who used the service, 95 were found to require treatment for dangerous levels of lead in the blood stream. Lead is effectively absorbed by the respiratory tract.

Source: NEJM

Friday, April 11, 2008

Elderly Patients with Heart Failure Require Special Treatment

Older adults with heart failure require frequent hospitalization, accounting for significant burden on the patient, families, and our healthcare system. As more people reach age 65, elder care will escalate. Most people in the senior population have multiple health issues, which require clinical trials to meet increasing demands for healthcare delivery. However, few clinical trials target elderly patients with heart failure. Co-morbidities such as kidney failure and urinary incontinence, which may inhibit therapy with diuretics, cognitive impairment, arthritis, lung disease, and heart rhythm disturbances, require special approaches for heart failure in the presence of advanced age.

Many factors have an indirect impact on treating elders with heart failure, though medication standards are the same whether a patient is young or old. Targeted treatment should address specific issues that are unique to our increasingly older population.

As we age, kidney function declines, as does the ability to eliminate sodium and water. The result leads to disturbances in electrolyte (sodium, potassium, chloride) balance. Urinary tract abnormalities, resulting in incontinence (inability to hold urine in the bladder) may not be reported to physicians due to embarrassment. Many patients avoid taking their medications as a result.

Heart failure causes shortness of breath and decreased exercise tolerance, yet elderly patients with chronic lung disease should not be withheld from receiving beta-blockers, medications that are shown to improve symptoms of heart failure.

Low blood pressure can result from standard heart failure treatment, causing falls and additional hospitalizations. Evaluation is needed to replace medications that may contribute to worsening problems, making it necessary to choose different medications for treatment.

Arthritis requires the use of pain medications, such as anti-inflammatories, that are known to impair kidney function and promote bleeding, providing yet another challenge to physicians.

Recommendations also include screening for coronary artery disease via cardiac catheterization, much the same as in younger patients. Evidence shows that treatment with cholesterol lowering drugs and medications to treat angina improve prognosis. Surgery can also be considered to repair heart valve disease and bypass coronary artery disease, depending on other health risks.

Short-term treatment for depression is also shown to improve survival of elderly patients with heart failure, but it is recommended that they be used with caution.
It is estimated that elderly patients with heart failure have a survival rate of less than three years, making the prognosis worse than those who have cancer. Many patients are at a disadvantage because they have less understanding of their disease process.

If you or a family member has a diagnosis of heart failure, make it a priority to become educated about treatment options. Report medication problems and new symptoms to your doctor. Recognize that multiple approaches may be necessary to improve survival and quality of life. A look at the special needs required to treat elders with heart failure makes it apparent that the problem is challenging for patients as well as physicians.

There are many other treatment options, such as pacemakers, implantable cardiac defibrillators, and daily exercises, and this article highlights a few of the special treatments needed to treat heart failure in elders.

The best approach for the management of heart failure includes risk factor reduction, patient and family education, and the proper use of medication. The benefits include fewer hospitalizations, improved quality of life and increased survival.

From International Journal of Clinical Practice

Tuesday, April 8, 2008

Patients Who See Multiple Physicians Have Lengthier Hospital Stays

An analysis of more than 10,000 hospitalized patient reveals that seeing different physicians (Hospitalists) prolongs patient hospital stays. The practice of acquiring hospital-based physicians to evaluate and treat patients may not be as beneficial for patients as it is for doctors.

Obtaining follow up appointments has also been identified as a quality of care issue. Study author, Kenneth R. Epstein, MD, from IPC The Hospitalist Company Inc, North Hollywood, California has defined the dilemma as fragmentation of care, or FOC, explaining: ...”if a patient who was hospitalized for 5 days saw 1 doctor for 3 days and other doctors the other 2 days, FOC would be 2 of 5, or 40%."

Dr. Epstein analyzed the medical records of patients across 16 states - 1724 patients admitted with pneumonia and complications, and 8509 patients admitted with heart failure and shock. Hospital admissions were between December 2006 and November 2007. The patients stayed at 223 hospitals. He concluded that greater fragmentation of care resulted in longer hospital stays for all patients with pneumonia and heart failure.

The exact reason for the extra days in the hospital is only speculative. Bryan Huang, MD, assistant clinical professor of medicine at the University of California, San Diego, says it is "anyone's guess, but there's no way to convey 100% of the information each time you hand off a patient to someone else. Dr. Huang says, “You don't know what the previous day was like, admitting that he is always reluctant to discharge a patient on the first day he has assumed care.

The use of Hospitalists has had a positive impact on clinicians by promoting a healthy work-life balance, " but much less focus has been given to the impact of discontinuity of care on patient length of stay and other utilization and quality metrics,according to Dr. Epstein.

If you find yourself or a family member in the hospital, you may want to discuss discharge plans before the “hand off”.

J Hosp Med. 2008;3(suppl 1):11.

Fight Obesity with "Average" Night's Sleep

A new study, prompted by the current obesity epidemic, has researchers examining sleep duration and the impact on weight gain. According to the authors, Jean-Philippe Chaput, MSc, from Laval University in Quebec City, Quebec, Canada, and colleagues:. "Current treatments for obesity have been largely unsuccessful in maintaining long-term weight loss, suggesting the need for new insight into the mechanisms that result in altered metabolism and behavior and may lead to obesity."

It seems that as sleep times have diminished, we have gotten heavier. Past studies have shown that obesity is linked to lack of sleep. The results of the current study show that short duration sleep (5-6 hrs) or long duration (9-10 hrs) sleep may both contribute to weight gain.

Adults, age 21 to 64, who enrolled in the Quebec Family Study, were questioned about their sleep habits. Body composition was measured at baseline. Over half of the participants had at least one parent and one offspring with inccreased body mass index (BMI 32 or greater). The group was divided into short, average and long duration sleep times, and was followed for six years. Resting metabolic rates and energy intake was similar in each of the participants. Those who slept less were more physically active. Self reported variables also included gender, smoking habits, shift work, age, employment, total income, menopausal status, and coffee intake.

The group that got an average amount of sleep (7-8 hrs) stayed the slimmest, while the short and long duration sleepers experienced an 88% and 71% increase in body weight respectively. Body fat increased 58% for short sleepers and 94% for long sleepers.

The study is possibly limited by factors that include self-reporting and small study samples. Underlying problems such as sleep disturbed breathing and insomnia should be considered, as well as the role of genetics and obesity.

The authors conclude…” these results, emphasize the need to add sleep duration to the panel of determinants that contribute to weight gain and obesity."
Sleep. 2008;31:517-523. ◦

Monday, April 7, 2008

Pharmacogenetic Testing Companies under Fire

Individualized testing for medication response should improve medical care, but according to a critique from the Johns Hopkins University Genetics and Public Policy Center, pharmacogenetic testing (the study of genes that determine drug behavior) may be misleading physicians and health care consumers.

Currently, more than 15 companies offer CYP450 testing to guide physicians in prescribing SSRI’s (antidepressants), yet the Centers for Disease Control and Prevention uncovered "no evidence...that the results of CYP450 testing influenced SSRI choice or dose and improved patient outcomes.". Biomarkers that identify individual response to medication and treatment may sound good, but only a few are actually proven, leading to the criticism.

The viewpoint from John Hopkins stems from the fact that the physician is left out of the picture. Pharmacogenetic testing is available directly to consumers, a problem that may lead patients to request certain medications, again bypassing the function of the doctor. In addition, marketing claims vary with each company and are currently unregulated.

The authors of the critique feel that the FDA should intervene to protect the public from these companies. They also suggest that a public registry be maintained for tracking purposes regarding test usage. Further recommendations include intervention from the Federal Trade Commission to prevent false advertising.

Pharmacogenetic testing is offered to identify the metabolism of medications such as warfarin, opiates, beta-blockers and antiarrhythmic medications. Testing companies claim that pharmagogenetic analysis is a better option than “trial and error”, minimizing the liability of the physician and patient risk of medication side effects. Other claims for “individualized care”, and “practice building” are seen in the marketing ads, all of which sound appealing.

The conclusions are that genetic testing may not improve medical care or encourage public trust in genomic medicine in the absence of supportive clinical data.

Science. 2008;320:53–54. ◦

Sunday, April 6, 2008

Cholesterol Lowering Medication May Help with Heart Failure Treatment and Prevention

According to experts, heart failure patients may benefit from taking cholesterol medications. Statins (cholesterol medications) help prevent heart disease by delaying the progression of atherosclerosis (plaque in the arteries); preventing heart attack. Newer studies show that patients with heart failure, or those at risk for heart failure, may experience overall health benefit from taking statins.

Patients who develop heart failure are 8 times more likely to die from heart disease when compared to those who have actually had heart attacks without heart failure. Heart failure may occur post heart attack, as the result of heart valve disease, high blood pressure, infection, congenital abnormalities, or cardiomyopathy(enlarged heart from heart muscle disease).

Research also shows that patients with heart failure experience fewer hospitalizations when statins are prescribed. For patients who are at risk for heart failure, taking cholesterol medication seems to decrease the chance of developing congestive heart failure by 45% - 50%, even when blood flow to the heart is good (non-ischemic heart disease). Several studies have also shown improvement in heart function (ejection fraction) when statins are prescribed to heart failure patients, though studies are ongoing.

Hypothetically, statins may treat small blood vessel, or microvascular disease, accounting for better outcomes. In addition, we all have some form of atherosclerosis (artery plaque), making prevention of heart attack more important for those who already have diagnosed heart disease.

According to experts, 50% of the population is likely to die from blockage of the coronary arteries; most of them will not have a prior diagnosis of atherosclerotic heart disease. There are ongoing studies designed to support the use of statins in heart failure, but the preliminary evidence is positive that management of risk factors can provide benefit for patients with heart failure and possibly provide improvement of heart function.

Unanswered questions include why and how this all works. Long before science knew how Aspirin worked, they knew that it was valuable to prevent heart attacks.
In spite of unanswered questions, we do know that it’s important to maintain healthy blood vessels. Heredity, diet, and lifestyle all play a role in prevention of inflammatory response in large and small blood vessels.

Many people balk at the proposition of taking cholesterol medication due to side effects, cost and the need for ongoing blood work. If you have a family history of heart disease, are at risk for heart failure from hypertension, or have damage to the heart muscle, consider speaking with your doctor about what you can do to prevent heart attack or stroke.

Continue to follow dietary guidelines for a healthy heart. Eat foods that are high in antioxidant properties and can help reduce inflammation. Food and exercise can promote much of the same effect as cholesterol medication. It's important to take an active role in managing your own health, in addition to following your doctor's recommendations.

Source: Cardiosource Video Network

Friday, April 4, 2008

Noni, Super Fruit!

This is a guest article from my friend "Seacoral" (Coralie). Coralie feels good as the result of drinking Noni juice, and I've asked her to share her health story here.
Personally, I've done no research on the benefits of Noni juice, but Coralie consumes Noni and will tell you first hand of the benefits.


Surely, the ancestors of the Polynesian people thought it was! However, the name Super Fruit is a marketing term that refers to a common or rare exotic fruit having exceptional nutrient richness, antioxidant quality or appealing taste. The noni shrub or small tree also referred to as Morinda Citrifolia, which is the correct scientific name, comes from the family Rubiaceae.

A man´s wife claimed he stopped snoring after 35 years!

A dog owner claimed that her dog enjoyed healthy senior years right up to 171/2 without pain or medications!

In its purest form, the Noni fruit is praised by many as an excellent source of antioxidants, including more than 150 nutrients claimed to have a positive effect on our own physiology.

The noni fruit is very versatile, but it has only recently been documented as having effects on certain conditions. Research is ongoing and more and more results are being published. Like other natural health alternatives, it takes time and many clinical tests before conclusive evidence is accepted by the traditional medical fraternity. However, some Doctors have discovered that there are benefits from noni

The liquid form (Noni Juice) is proven to contain the greatest amount of nutrients and is a pleasant and nourishing supplement that boosts the immune system. Noni can help you stay fit and reduce the effects of toxins. Noni Juice provides a well-balanced supplementation when taking quite a small maintenance dose. Many people have found this easier than taking a variety of health supplementations and they also claim good effects with Noni.

The fact is that millions of people worldwide drink noni juice and are finding it beneficial; others are not impressed! There are many reasons why experiences vary. The quality of the products, how well we keep our bodies hydrated our lifestyle and many other factors. Noni Juice that is tested and verified as completely harmless is well worth testing*. The fact that noni is so versatile is also a reason why people experience it in different ways. Not everyone is exactly the same and noni is NOT a medicine!

If you have good health, congratulations! But even so, it is important to support your immune system to keep it that way. Some everyday causes of toxins in our bodies are pollution, stress, eating habits, sleeping problems and radiation from among other things computer screens, mobile telephones and the environment. Health problems that have already arisen naturally cause an extra strain on our immune system. We are not always aware of these factors until the problems develop into an ailment or disease.

Personally, I have been drinking a brand of noni juice for 4 years. Both my husband and I have noted extensive improvements in our health, which even the good results of our medical check-ups, and clinical tests support. We have had our fair share of medical problems, some as serious as cancer and a heart attack, (before drinking noni juice). Noni has not cured these health issues that have been treated with standard medical procedures. However keeping the immune system at peak performance on a regular basis gives us many health benefits.

I am very thankful for testing noni 4 years ago and have been drinking it every day since then! During this time, we have noticed many interesting improvements in our wellbeing. Just a few examples of our personal experiences - Better sleep, we seldom get contagious ailments such as coughs, colds, or flu and if so, these pass quickly without medications, increased energy levels and endurance, and an overall sense of wellbeing. Our personal experience is that these factors are improving all the time we are drinking the Juice.

I recommend reading before you buy .. An interesting and educational article on Noni products.

* Some noni products come with a 30-day money back guarantee.

Be well and talk to you soon, Coralie (alias Seacoral) . Please feel free to contact me at