Healthsifter by mary desmond pinkowish, since 2003

How Smart, Overweight Kids Outwitted Medical Researchers

OK, I'm glad it wasn't a medical study that I was running, but it's pretty funny anyway. As reported by the WSJ Health Blog, some overweight kids in the UK who were enrolled in an exercise study put their pedometers on their dogs! Very funny. The researchers were surprised to find how active the "kids" had become, but without losing weight. First reported at the BBC.

The 8-Way Kidney Transplant

It sounds dirty, but it's great. Really great. A snippet from the WSJ Health Blog this morning:

...imagine an eight-way kidney transplant involving surgeries with 10 women and six men in four states over the course of three weeks. It’s thought to be the longest chain of kidney donations on record, according to the Washington Post.

This is actually called a "domino transplant," and this one got started at Johns Hopkins. Here's how it works, again from Health Blog:

...a living donor wants to give a kidney to someone they know but isn’t a biological match for them. Instead, they are matched to a recipient they don’t know. Ideally, another donor then provides his or her organ to the first recipient. These types of transactions are rare because they’re difficult to arrange, even with just one donor and one recipient.

Doctors to the Stars: A Pain

Do you ever wonder about the other side of stories like those about Michael Jackson, Heath Ledger, Anna Nicole Smith? If so, read the column by Dr. Kent Sepkowitz in today's Slate. Here's an excerpt detailing his brush with celebrity patients. He goes on to describe how easily docs get sucked into the celeb cycle.

So now are we awaiting the news on poor Michael. His version of Dr. Nick, a physician named Conrad Murray, had, by report, been a member of the retinue for just a few months. Murray's entry into the news was characterized by his apparent attempt to exit the news; he is said to have high-tailed it from the scene of the dead or dying Michael even as police and others descended on the house. His exact contribution to the death will be revealed in the weeks, months, and probably years ahead but is likely to resemble that of his predecessor Dr. Feelgoods—whose pen and syringes and customer-is-always-right attitude ended up creating a corpse where once an icon stood.

In a strange way, I actually stand in awe of these guys. I have taken care of a few celebs in my career, and for me it was an awful experience. If you fuck it up, you're toast. Once I took care of a very important person, a person you have heard of and are very interested in, someone you would be shocked to know had the problem—asthma—that I treated him for. Well, almost treated him for. His complaints and his recollection of near death last time he had the identical symptoms so unnerved me that I asked a colleague to assume his care.

Vinegar the Fat-Fighter?

News from Japanese researchers via ScienceDaily that at least in rodents, vinegar (aka acetic acid) keeps the fat off. MedicalNewsToday also reported this a few weeks ago, and this is an excerpt from that article:

"...laboratory mice fed a high-fat diet and given acetic acid developed significantly less body fat (up to 10 percent less) than other mice. Importantly, the new research adds evidence to the belief that acetic acid fights fat by turning on genes for fatty acid oxidation enzymes. The genes churn out proteins involved in breaking down fats, thus suppressing body fat accumulation in the body."

I'm always eager to find a weight-loss miracle that doesn't kill you in the process. This sounds like something to try, although I have no idea how much--is two salads a day with oil and vinegar enough, or should I be doing vinegar shots? That sounds terrible. I wonder if it's dangerous. Thanks to Cecil Adams over at The Straight Dope, I got an answer to the question "Is Consuming Vinegar to Excess Dangerous?"  I won't be doing the shots--that actually could be dangerous. But a tablespoon or two before meals might be worth a try.  

Interested in the folk history of vinegar as a health tonic? Read this article from Nutrition Forum. If you're interested, this is the original journal reference: Kondo et al. Acetic Acid Upregulates the Expression of Genes for Fatty Acid Oxidation Enzymes in Liver To Suppress Body Fat Accumulation. Journal of Agricultural and Food Chemistry, 2009; 090609114939008 DOI: 10.1021/jf900470c

Darvon/Darvocet/Propoxyphene: New FDA Warnings

It's been around since 1957, but propoxyphene, aka Darvon/Darvocet, today is the subject of increased FDA warnings about the potential for fatal overdoses. Here's a Q&A from the agency, which answers most of the important questions about this pain medication. The FDA will require manufacturers to bolster the warnings on the drug label and to produce a Medication Guide that will be given to everyone who gets a prescription or refill. The Agency decided against a phased withdrawal of propoxyphene from the market, as requested by Public Citizen and the European Medicines Agency.   

Use that Trampoline (Safely): Rules for Your Next Garden Party

Trampolines are the new see-saws, with clamoring from some corners to restrict their use. As in, "I can't believe they got a trampoline for their backyard!" Trampolines are great fun and good exercise for kids. According to researchers in the U.K., there are just three things you need to remember to keep your kids out of the emergency department:

• One person at a time on the canvas. This is the most important rule.
• Use a net
• Make sure an adult supervises.

Having just one person on the trampoline at a time appears to be a pretty important factor in reducing injuries; in two major studies 74% to 80% of injuries occurred with multiple users.  And adults should pretty much never go on with a child--the weight discrepancy means that the kid is about 5 times more likely to get hurt. The original article appeared in the British Medical Journal. And don't you love that dry British wit? Here's the last line of their short article:

"We note that children have been hurt while being supervised or bouncing with adults who have been drinking at a summer garden party, for example. Adults, please note that lager, wine, and trampolines do not mix."

Psychs on Twitter: Tweeps

What a cool column over at Psych Central. Sandra Kiume has assembled a list of her favorite psychs and other mental health pros who are active at Twitter. Have a look. These are the criteria she used to include/exclude people:          

• NO marketing (including “free” e-books, how-to guides, etc.)
• not just “broadcasting” or re-feeding, follows others and reads their feeds
• interacts with friends and followers, replies to people
• shares more than just factoids, quotes, or pop psych aphorisms
• active but not overactive
• not too off-topic, talks mostly about psychology, psychotherapy and/or mental health
• humour, taste, talent, good writing and personality

A Vote to Ban Vicodin, Percocet; Lower Doses for Acetaminophen

A panel convened by the FDA yesterday voted to recommend banning the prescription pain killers Vicodin and Percocet because of concerns about liver toxicity when these drugs are taken with acetaminophen, the active ingredient in many over-the-counter pain and cold products. Then panel also recommended that the maximum daily dose of acetamophen be reduced. Here's part of the story from Physician's First Watch:

The FDA does not have to heed the advice of its expert panels, but it frequently does, according to the New York Times. If the FDA follows the panel's recommendation, seven other prescription drugs combining acetaminophen and narcotics could also be banned.

In addition, the panel voted to reduce the maximum daily dose of acetaminophen to less than 4000 mg and the maximum dose in over-the-counter formulations to 325 mg (down from 500 mg).

According to the Washington Post, 124 million prescriptions for Vicodin or its generic equivalents were written in the U.S. last year.  The New York Times also covers this story today and closes with some good advice:

Consumers need to be better educated about the risks of popular medicines, most panel members agreed.“If you keep track of what you’re taking, none of this is an issue for you,” Dr. Jan Engle, a panel member and head of the Department of Pharmacy Practice at the University of Illinois in Chicago, said in an interview after the meeting.

Find more on acetaminophen from the FDA here.

Drug-Induced Celebrity Deaths: Isn't There a Better Way to Learn These Lessons?

Drugs.com says that Michael Jackson's death drove a huge increase (really huge) in Internet queries about the drug Demerol (meperidine hydrochloride), which has been implicated in his death (pending the rest of the toxicology reports). Similar spikes of interest about drugs like Xanax (alprazolam), Valium (diazepam), OxyContin (oxycodone), Ativan (lorazepam), and Restoril (temazepam) followed the deaths of Heath Ledger and Anna Nicole Smith, according to Drugs.com. Here's an excerpt from that article:

Drugs.com reported a massive 20,900% increase (yes, you read that correctly – twenty thousand, nine hundred percent) in interest for information on the prescription medication Demerol – allegedly prescribed for the legendary entertainer Michael Jackson. More than 135,000 page views were logged on the Drugs.com web site by people researching Demerol this past Friday – the single biggest spike in daily interest for a medication since the similarly tragic and untimely death of Heath Ledger.

Demerol (meperidine) is a narcotic pain relieving medication. It works by dulling the pain perception center in the brain. Interest in the medication exploded from around 650 page views per day on average to 135,164 page views on Friday, June 26.

So some people may now know more about the dangers of these meds. Will lives be saved? Who's actually doing the reading?

Adios NyQuil?

Even she reads the label, and she wears a stethoscope to work!

As reported at the Wall Street Journal Health Blog today, the FDA has convened a panel of experts to recommend ways of reducing the risk of acetaminophen overdoses. Acetaminophen is the active ingredient in medications like Tylenol. It's also used widely in products, like NyQuil, that contain other ingredients, usually to manage head colds and flu symptoms. According to eMedicine, about 100  products include acetaminophen. That's a lot of acetaminophen. Close to 500 people die of acetaminophen toxicity every year in the U.S., and about 25,000 people require hospitalization for treatment of overdoses. Acetaminophen kills livers, and it is  now a more common cause of acute liver failure in the U.S. than viral hepatitis. It's the second most common reason Americans need liver transplants.

How do people get into jams with this stuff? It's pretty easy, especially if you don't read drug labels. Some make the common mistake of assuming that if you can buy a drug without a prescription, it must be safe. Not so. In fact, as they point out in the Health Blog, the maximum daily dose is uncomfortably close to not-much-higher doses that can cause injury. Other people, also non-drug-label readers, may not realize that they're doubling or tripling up on acetaminophen if they are visited by, say, a head cold and sprained ankle on the same day and take two different medications for two different problems, not realizing that both products have acetaminophen.

And here's a really bad one: Did you tie one on last night and wake up with a killer hangover this morning? If so, stay clear of acetaminophen--which can be dangerous if you've been drinking that other popular liver toxin--booze. According to the Hepatitis C Support Project, people who routinely have 2-3 alcohol-containing drinks a day should not take more than half of the usual recommended dose of acetaminophen--that's no more than 2 grams (2,000 milligrams) in 24 hours. But hey--this is all on the label.

If you have no idea what a drug label is or how to read it, check out the Tylenol site, which has a pretty good tutorial on how to read a drug label.

Tomorrow, the FDA panel will vote on the best way to reduce the risk of acetaminophen toxicity. They may reduce the maximum dose--or goes so far as to pull combo products like Nyquil, according to the WSJ. 

This would all be a lot easier if we all just read the label.

Read this Book: The Mirror Effect: How Celebrity Narcissism is Seducing America

Don't go there, baby!

I don't plug books often in posts (although I have a typelist of good health books over there...to the left), but I want to recommend this one, which I've just finished: The Mirror Effect: How Celebrity Narcissism is Seducing America, by Dr. Drew Pinsky. You'll find mostly positive reviews over at Amazon. As the mother of two teens (ok, buddy, I know you're actually 20 now...) I urge parents of younger kids to read this too, before they become inculcated with celebrity-itis and all its attendant nonsense. Don't wait to learn about this till they're in 6th or 7th grade and you find yourself doing more explaining about celebrity behavior and misbehavior than you ever dreamed you'd need to do.

One example: My daughter and her friends became insanely brand-conscious starting in late elementary school. I was denied very little in the material department when I was a kid, but only rarely did my friends and I crave particular brands of shoes or jeans. We had a rough few years with our daughter on that score. I call it the Battle of the Brands--so many confrontations about what we would and would not purchase for her. The problem wasn't necessarily the thing she wanted so much as the source of the brand-itch: Britney was carrying a particular bag or Paris (OMG--NO!) had a certain breed of dog.

Anyway, read the book.

Fibromuscular Dysplasia: A Not-So-Rare Cause of Strokes, Aneurysms, and Sudden Death

According to this article in the Wall Street Journal, doctors learn in medical school that fibromuscular dysplasia (FMD) is a rare disease. But physicians who specialize in vascular medicine think that as many as 3% to 5% of Americans have this strange condition that causes the walls of arteries to grow inward, toward the center of the vessel, blocking blood flow. This can happen in any artery--including those that feed the brain, heart, and kidneys. The first sympton is sometimes the last one--sudden death. FMD was first described in 1938, but it was listed as a cause of stroke by the National Stroke Association only in 2005. Apparently, not everyone who has FMD will run into trouble, but doctors have a lot to learn about this condition. A good first step would be for them to start unlearning some of the things they were taught about FMD in med school. Here's an excerpt from Thomas Burton's excellent article (Dr. Olin, a professor at Mt. Sinai Medical School in NYC, is one of the world's few authorities on the condition):

Dr. Olin has prepared a top-10 list of doctors' misconceptions and missteps. They include, "Telling patients that the symptoms are all in their head. Telling patients that FMD is a rare disease. Telling patients with severe headaches with FMD that there is nothing that you can do for them."

The signs of FMD are frequently the same: young patients with high blood pressure, or who have had a stroke or temporary symptoms of a stroke; patients whose blood makes a swishing sound indicating turbulent flow; or patients with brain aneurysms.

You can find more information at the Fibromuscular Dysplasia Society of America and MayoClinic.com. Dr. Olin co-authored a review article about the condition in the New England Journal of Medicine in 2004; it's written for doctors, but you can get something out of it even if you don't wear a stethoscope to work.

Music and Your Heart

In 1638, Claudio Monteverdi, the granddaddy of opera, said that the purpose of all music was to move the soul.  Modern cardiovascular research is confirming his assertion--if you substitute "heart" for "soul." It's a stretch, but stick with me on this. Researchers present data about the effect of music on the heart in the current issue of Circulation, a journal published by the American Heart Association. Here is a segment of the press release about the study:

Five random tracks of classical music were played — including selections from Beethoven’s Ninth Symphony; an aria from Puccini’s Turandot; a Bach cantata (BMW 169); Va Pensiero from Nabucco; Libiam Nei Lieti Calici from La Traviata — as well as two minutes of silence.

Researchers found:

• Every crescendo led to increased narrowing of blood vessels under the skin, increased blood pressure and heart rate and increased respiration amplitude. In each music track the extent of the effect was proportional to the change in music profile.
• During the silent pause, changes decreased, with blood vessels under the skin dilating and marked reductions in heart rate and blood pressure. Unlike with music, silence reduced heart rate and other variables, indicating relaxation.
• Music phrases around 10 seconds long, like those used in “Va Pensiero” and “Libiam Nei Lieti Calici,” synchronized inherent cardiovascular rhythm, thus modulating cardiovascular control.

Music can induce physiologic changes that may precede the psychological appreciation. Such autonomic modulations could be of practical use to induce body sensation which might reach the level of consciousness, or at least create a continuous stimulus to the upper brain; moreover, the inter-individual synchronization of body physiology mediated by music could aid in strengthening the sense of sharing within the human relationship.

The researchers think that these and other, earlier findings may lead to the inclusion of music in stroke rehab, for example. At the very least, rehab sessions will be more fun. Music makes everything better, right?

Obesity Linked to Cancer Again, and Teens are in Special Danger

From the Health Blog at WSJ:

Studies have tied obesity to increased risk of pancreatic cancer, but new findings suggest that weight control early in life is especially important. Obesity in early adulthood is associated with both increased risk and earlier onset of pancreatic cancer, a study in the Journal of the American Medical Association shows. In fact, overweight teens are twice as likely to develop pancreatic cancer later in life than similar adults who had never been overweight.

Have Low-Fat Diets and Products Made Us Fat?

Read the cover story in the latest issue of Ode magazine. You owe it to yourself to read the story carefully and with an open mind. Think about it: We started to get fat when we started losing our minds about dietary fat....Here are a few excerpts from the article:

For more than three decades, we’ve been told that fatty foods are deadly, to blame for a full menu of health hazards, from heart disease to obesity to cancer. Regularly described as the nutritional equivalent of cigarettes, fat has been the target of public-service campaigns and municipal bans aimed at keeping us slender and healthy. But a growing body of international research suggests our obsessive fear of fat may be misplaced. A high-fat diet won’t necessarily make us sick or fat; a low-fat diet may not make us healthy or slim.

Even the American Heart Association (AHA), a leader in the campaign against dietary fat, recently revised its nutritional guidelines, increasing the daily recommendations for fat. "The science just wasn’t there," acknowledges Robert Eckel, president of the AHA and a professor of endocrinology, metabolism and diabetes at the University of Colorado Health Sciences Center.

And...

So given the blanket condemnation of fat, what did we eat instead? If we cut fat out of our diets, we have to get calories from somewhere. When food companies offer reduced-fat versions of cookies, salad dressings and sauces, sugar and carbohydrates generally make up the difference. When we consciously reduce the fat in our diets, we don’t typically eat fewer calories; we eat more rice and pasta, according to a survey by the U.S. Department of Agriculture. And low-fat products have their own problems. "If you reduce the fat, you have to replace it with something," says Samuel Klein, a professor of medicine and nutrition in the medical school at Washington University in St. Louis, Missouri. "So it’s sugar." It’s true: Either for taste, or to replace fat’s richness and moistness, the food industry began using sugar.

Stronger Evidence Links Psoriasis and Vascular Disease

This has been kicking around for awhile, but the evidence is building to the point that it really can't be ignored. People with psoriasis have roughly double the risk of vascular disease as people without this autoimmune disease. The results of a new study conducted at the Miami VA hospital were just published in the Archives of Dermatology and reported at Medscape (WebMD). Here's a snippet:

"There are two messages from the research, Kirsner [one of the investigators] says. "First, psoriasis patients and their physicians need to be aware that they are at higher risk, and because of this they need to be aggressively screened and treated for vascular disease." Second, he said, there is some evidence that treating psoriasis might lower this risk: "Ten years ago, we used to tell patients who had psoriasis who didn't want to be treated, 'that's fine, it's your decision,' but now that may not be true, and if you don't treat psoriasis, it could be like not treating high blood pressure or diabetes."

Why Do Doctors Wear White Coats? Should They Stop?

Aaaah, just seeing those white coats makes me feel better...

An interesting story here from Slate. The American Medical Association just voted to ban this ubiquitous doctor-costume because they apparently carry germs from one patient to the next. Well that sounds like a decision we can all live with. But will we miss the symbol that screams "doctor?" Does the white coat help healing via a placebo effect? I wonder what Stacy and Clinton recommend?

We're All Doing Our Core Exercises Wrong! We're Killing Our Spines!

Seriously--that's according to an alarming article in today's magazine section of the New York Times. Here's an excerpt:

The “core” remains a somewhat nebulous concept; but most researchers consider it the corset of muscles and connective tissue that encircle and hold the spine in place. If your core is stable, your spine remains upright while your body swivels around it. But, McGill says, the muscles forming the core must be balanced to allow the spine to bear large loads. If you concentrate on strengthening only one set of muscles within the core, you can destabilize your spine by pulling it out of alignment. Think of the spine as a fishing rod supported by muscular guy wires. If all of the wires are tensed equally, the rod stays straight. “If you pull the wires closer to the spine,” McGill says, as you do when you pull in your stomach while trying to isolate the transversus abdominis, “what happens?” The rod buckles. So, too, he said, can your spine if you overly focus on the deep abdominal muscles. “In research at our lab,” he went on to say, “the amount of load that the spine can bear without injury was greatly reduced when subjects pulled in their belly buttons” during crunches and other exercises.

Based on this, I'm modifying my regimen as follows, again from the Times:

Instead, he suggests, a core exercise program should emphasize all of the major muscles that girdle the spine, including but not concentrating on the abs. Side plank (lie on your side and raise your upper body) and the “bird dog” (in which, from all fours, you raise an alternate arm and leg) exercise the important muscles embedded along the back and sides of the core. As for the abdominals, no sit-ups, McGill said; they place devastating loads on the disks. An approved crunch begins with you lying down, one knee bent, and hands positioned beneath your lower back for support. “Do not hollow your stomach or press your back against the floor,” McGill says. Gently lift your head and shoulders, hold briefly and relax back down. These three exercises, done regularly, McGill said, can provide well-rounded, thorough core stability. And they avoid the pitfalls of the all-abs core routine. “I see too many people,” McGill told me with a sigh, “who have six-pack abs and a ruined back.”

Does Obesity Surgery Break Your Bones?

It's a small, retrospective (backwards-looking) study, but it suggests that people who've had obesity, or bariatric surgery may have a higher risk of fractures in the years following the surgery. People who are obese are actually at a lower risk of osteoporosis than people of a normal weight, but other studies have shown that obesity surgery may alter the way the body absorbs or uses nutrients that preserve or strengthen bone. In this study, conducted at the Mayo Clinic in Rochester, Minnesota, people who had obesity surgery were about three times as likely as other people to have a fracture, usually of the hand or foot.  For a more detailed write-up, see MedPageToday. The study was presented this week at ENDO, the annual meeting of the Endocrine Society. Overall, the benefits of surgery probably way outweigh any risk associated with foot or hand fractures. Bones heal. But it would be interesting to know more about the ways in which this type of surgery alters metabolism. But hey--this is probably not a deal-breaker. If your doctors recommend this surgery, you should think hard about it. You likely have more to gain than lose (except lb-wise, of course!).

Flu Pandemic: Hold the Drama, There's Plenty of Time to Panic

The World Health Organization (WHO) has declared the first flu pandemic in 41 years. Here's how they define Phases 5 and 6:

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

As Lawrence Altman, MD, explained in the New York Times Science Times earlier this week, the word pandemic has had various definitions and connotations over the years:

The word implies the rapid spread of an infectious disease to many countries in different regions, hitting each with more or less the same severity. But in fact, severity varies — not all people are infected at the same time, and not every country need be affected.

And there can be many other factors, including the numbers and percentages of people falling ill and dying; a population’s vulnerability to the disease, based on previous rates of infection; and the quality of health care facilities and disease monitoring systems.

Not least is that scientists do not know precisely how pandemics arise, what fuels them, why they vary in their lethality, why some occur in waves and why they stop.

Daniel Henninger puts things in perspective in today's Wall Street Journal:

The WHO reports 141 deaths globally from swine flu, with 106 of those (75%) in Mexico and 27 in the U.S. Seasonal influenza kills 35,000 to 50,000 Americans each year. It is now evident that the current strain of the H1N1 swine-flu virus is a "mild" version rather than a pathogenic killer like the 1918 Spanish flu. In fact, seasonal flu kills 500,000 people annually world-wide, a staggering death toll that occurs with hardly any of the public losing a moment's sleep over it.

Sleep Apnea? Learn to Play the Bassoon. Or Oboe. Or English Horn

Talk about news you can use: In a study of almost 1000 professional musicians, investigators found that those who played so-called high-resistance (double-reed) woodwinds were much less likely to suffer from sleep apnea than conductors or vocalists. You can read the full report at MedpageToday. Here's an excerpt (Dr. Ward was one of the investigators):

Based on results of this study, Dr. Ward theorized that training sleep apnea patients to play double-reed instruments could be therapeutic.

However, Dr. Ward acknowledged that novices were unlikely to rapidly develop the needed embouchure -- the movement of facial muscles and placement of lip and tongue that allow music to be played on a wind instrument -- to sustain at least three hours of practice every day.

Dennis Nicholson, M.D., of the Sleep Disorders Center of Pomona Valley Hospital in Pomona, Calif., said it was possible that the embouchure specific to the double-reed instrument has characteristics that would help sleep apnea patients.

"This is a continuation of some previous literature that suggested that muscle training can improve sleep apnea, at least in some patients," said Dr. Nicholson, who was not involved in the study.

According to Dr. Nicholson, previous studies of musicians and obstructive sleep apnea revealed varying results among those who played wind instruments.

Dr. Nicholson suggested that a useful target for study would be identification of the specific muscle groups that are involved in playing a double-reed instrument so that patients could be trained in exercises using those muscles.

That, he said, would be a more practical application than attempting to teach patients to play double-reed instruments.

I think Dr. Nicholson has a point there. I'm sure the neighbors will be grateful, too. There's nothing like a novice woodwind player in the next apartment to enliven your domestic scene. Not sure why you fell asleep reading this post? What the hell is sleep apnea and why should you care? Read more here, at the web site for the American Sleep Apnea Association.

Travel Medicine and Vaccines: It's Not Just About Swine Flu

A bit overwrought...

In her column in today's Wall Street Journal, Laura Landro reminds us that Swine flu is the least of the health problems that travelers may encounter this summer. Here's an excerpt:

While swine flu has dominated the news as a concern for travelers, experts say other infectious diseases pose a far greater threat as the summer travel season gets under way. Especially worrisome are mosquito-borne diseases, including malaria, dengue fever, Japanese encephalitis, chikungunya fever and yellow fever, which are now spreading in areas where they weren't previously a danger. Travelers are also at increased risk for intestinal and skin-burrowing parasites, tick-borne diseases, sexually transmitted diseases, typhoid fever and the age-old scourge, traveler's diarrhea.

The CDC's Yellow Book is the bible of travel medicine. You can find the online version here. A new edition comes out online shortly.

Test Yourself for Alzheimer's Disease

She's helping him cheat?

As reported in the current issue of the British Medical Journal, researchers in Cambridge, England have developed something they call the TYM, or Test Your Memory test that helps self-diagnose Alzheimer's disease. This is what Physicians' First Watch had to say about it:

A 10-task test ("Test Your Memory," or TYM) that takes about 5 minutes to perform can detect over 90% of Alzheimer cases, BMJ reports.

Researchers evaluated the test, which is mostly self-administered, in about 100 patients with Alzheimer disease (diagnosed by a consultant neurologist) and 550 normal controls. The tasks are simple and include orientation, copying a sentence, and verbal fluency.

Controls scored an average of 47 on a 50-point scale, while patients with Alzheimer disease scored an average of 33. The authors say TYM's negative predictive value, if the cutoff point is set at 42 or under, is 99%.

The TYM tests 10 cognitive areas, as described by the researchers in the BMJ article:

"The tasks are orientation (10 points), ability to copy a sentence (2 points), semantic knowledge (3 points), calculation (4 points), verbal fluency (4 points), similarities (4 points), naming (5 points), visuospatial abilities ( 2 tasks, total 7 points), and recall of a copied sentence (6 points). The ability to do the test is also scored (5 points), giving a possible total of 50 points."

It's not clear to me that lots of people with actual dementia will take this test themselves. I suspect that more worried healthy people will do so. But it's interesting.

Breast Cancer Research: The Army of Women Program

This is an interesting find. Breast cancer expert Susan Love, MD, has partnered with Avon to form the Army of Women. Here's their stated goal:

• To recruit one million healthy women of every age and ethnicity, including breast cancer survivors and women at high-risk for the disease, to partner with breast cancer researchers and directly participate in the research that will eradicate breast cancer once and for all.
• To challenge the scientific community to expand its current focus to include breast cancer prevention research conducted on healthy women.

If you sign up, they'll send you information about studies that are recruiting participants. These might be breast cancer treatment studies, or long-term studies on prevention. So regardless of whether you've had breast cancer or not, you can help. Why not?

Sex and the (Slightly) Older Woman

Barbara Kantrowitz and Pat Wingert have an interesting column at the Newsweek web site.  Here's an excerpt:

What's needed is a reasonable balance between old-fashioned stereotypes and modern hype, combined with a new understanding of what sex means to women of "a certain age." By the time they reach their late 40s or early 50s, women should be savvy enough to know that feeling sexy is a state of mind, and that a good man doesn't need a partner to look perfect in lingerie in order for her to be desirable.

But there are certainly very real challenges. Women's bodies change as they get older—no matter how much yoga or liposuction they can afford. A slower metabolism makes staying slim a struggle. That's why the vast majority of American women over 45 are either overweight or obese. In order to enjoy sex, you have to feel that you're sexy. That's not easy if your self-esteem is tied to unrealistic images of eternal youth.

A New Class of Migraine Drugs On the Way in 2009

This is a free article from Journal Watch that includes information on a new type of migraine drug. The manufacturer may file a new drug application this year (2009). Here's an excerpt from Journal Watch:

Telcagepant is a new calcitonin gene-related peptide antagonist that lacks the vasoconstrictor effects of triptans. In a randomized, controlled, double-blind, parallel-treatment trial funded by the maker of telcagepant, 1380 adult patients (mean age, 42; 85% female) with acute migraine received one of four oral treatments: telcagepant (160 mg or 300 mg), zolmitriptan (5 mg), or placebo. The study was conducted at 81 outpatient primary care and headache centers in Europe and the U.S.

This drug and others like it may be an alternative to the triptans, which cause side effects in some people and can't be used in people with heart disease. You can read more about this new agent, which is a Merck product, here and at Medscape. 

Link Seen Between Obesity and Flu Severity

A report published in the Washington Post says that scientists have noticed that many of the people with severe swine flu, ooops, H1N1 flu are obese. Here's a portion of that article:

"We were surprised by the frequency of obesity among the severe cases that we've been tracking," said Anne Schuchat, one of the CDC epidemiologists managing the outbreak. She said scientists are "looking into" the possibility that obese people should be at the head of the line along with other high-risk groups if a swine flu vaccine becomes available.

Other studies have shown that pregnant women are also at higher risk for serious influenza infection, especially in the third trimester, when the fetus and womb compress the lower parts of the lungs. This makes it harder to breathe deeply and cough forcefully; it may also alter blood flow in the chest. A similar thing may be occurring in severely overweight people, some experts speculated.

What Do You Want to Know About Vaccines?

Here's a link to information sheets for all vaccines currently available in the United States. The sheets are categorized for parents/patients and for physicians. You should be able to access all.

Jillian Michaels on Exercise When You Need to Lose Less than 50 lb

Time.com interviews Jillian Michaels about her new book, of course, and her advice for people who want to lose weight. I'm interested to hear her say that people who need to lose less than 50 lb should exercise about 8 hours a week, and certainly not more than 10 hours. Not that most of us have even 8 hours to carve out of our schedules, but this is reassuring. I wonder what she base this recommendation on. Experience, perhaps.

Psoriasis Linked to High Blood Pressure and Diabetes: What's Up with That?

Psoriasis causes lots of misery for the people who have it--and it's a bit of a mystery, too. Several studies have suggested that people with this condition are more likely that people without it to have heart disease, diabetes, lymphoma, osteoporosis, and metabolic syndrome (a precursor of diabetes).  A new report from the massive Nurses Health Study II that included data on more than 78,000 women strengthens the association between psoriasis and two disorders--high blood pressure and diabetes. The women were followed for 14 years. Those who had psoriasis during that time were significantly more likely to get diabetes and hypertension, as well, and these findings could not be accounted for by age, smoking status, or body mass index.
Here's a primer on psoriasis from WebMD and additional information from the MedlinePlus. The National Psoriasis Foundation has an interesting page on immune system involvement in psoriasis, and Clinical Trials.gov lists active clinical trials of psoriasis treatments, some of which are enrolling participants.

How to Wash Your Hands

Really....as Melinda Beck describes in the WSJ today in a column and in a nice little video...there's more to washing your hands that you think there is. You'll learn something.

Tired? Could Lack of Sleep Kill You?

I've heard that you'll die of sleep deprivation sooner than you'll die of hunger, but according to Brian Palmer writing in Slate, no human death has been attributed to lack of sleep directly (plenty of people have died as a result of falling asleep behind the wheel, however). As Palmer explains, though, the rat-experiment evidence is alarming:

In the 1980s, a University of Chicago researcher named Allan Rechtschaffen conducted a series of groundbreaking experiments on rats. After 32 days of total sleep deprivation, all the rats were dead. Curiously, researchers still do not agree on the cause of death. It's possible that the rats' body temperature dropped so much that they succumbed to hypothermia. Another theory posits that the rats' immune systems became so depressed that bacteria normally sequestered in their intestines spread throughout their bodies—though Rechtschaffen counters that his rats perished even when they were administered antibiotics. A third explanation points to some evidence of brain damage among the sleep-deprived rats. It's also possible that extreme levels of stress contributed to the rats' demise.

Kirstie Alley Says that Vegetarianism Cause her Weight Gain

In some respects, vegetarians do tend to be healthier than the rest of us, possibly because in addition to not eating meat they do lots of other healthy things--exercising, not smoking, staying fairly sober, and so forth. But there's a pitfall, as Kirstie Alley admits in her interview in this week's People. The interviewer asked her how she gained back 75-80 lb after leaving Jenny Craig:

"For seven months I was a vegetarian, and I can’t tell you how much weight I gained being a vegetarian! A vegetarian would probably be eating vegetables. But to me being a vegetarian meant I’m going to eat enchiladas with no meat, and I’m going to eat lots of bread, lots of carbs."

See what Lou Aronne, MD, said about weight problems in vegetarians in my article about vegarianism in Westchester magazine last fall.

Will Your Flu Shot Protect You from Swine Flu?

I've been wondering about this myself. Here's a segment from short article from Science magazine:

"The U.S. Centers for Disease Control and Prevention strongly doubts that this year's flu vaccine will offer people any protection from the swine flu. "We don't think that any of the existing vaccines are effective," acting CDC Director Richard Besser said yesterday at a press conference.

But some flu vaccine researchers and public health experts say the jury is still out. "If I hadn't already had the vaccine, I'd take it," says Robert Webster, a flu guru and vaccinemaker at St. Jude Children's Research Hospital in Memphis, Tennessee."

Q&A on a Vaccine for the Swine (A:H1N1) Flu Virus

This Q&A about swine flu vaccines was just released by WHO. Is an effective vaccine already available against the new Influenza A(H1N1) virus? No, but work is already underway to develop such a vaccine. Influenza vaccines generally contain a dead or weakened form of a circulating virus. The vaccine prepares the body’s immune system to defend against a true infection. For the vaccine to protect as well as possible, the virus in it should match the circulating “wild-type” virus relatively closely. Since this H1N1 virus is new, there is no vaccine currently available made with this particular virus. Making a completely new influenza vaccine can take five to six months. What implications does the declaration of a pandemic have on influenza vaccine production? Declaration by WHO of phase 6 of pandemic alert does not by itself automatically translate into a request for vaccine manufacturers to immediately stop production of seasonal influenza vaccine and to start production of a pandemic vaccine. Since seasonal influenza can also cause severe disease, WHO will take several important considerations such as the epidemiology and the severity of the disease when deciding when to formally make recommendations on this matter. In the meantime, WHO will continue to interact very closely with regulatory and other agencies and influenza vaccine manufacturers. How important will Influenza A(H1N1) vaccines be for reducing pandemic disease? Vaccines are one of the most valuable ways to protect people during influenza epidemics and pandemics. Other measures include anti-viral drugs, social distancing and personal hygiene. Will currently available seasonal vaccine confer protection against Influenza A(H1N1)? The best scientific evidence available today is incomplete but suggests that seasonal vaccines will confer little or no protection against Influenza A(H1N1). What is WHO doing to facilitate production of Influenza A(H1N1) vaccines? As soon as the first human cases of new Influenza A(H1N1) infection became known to WHO, the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America) took immediate action and began the work to develop candidate vaccine viruses. WHO also initiated consultations with vaccine manufacturers worldwide to facilitate the availability of all necessary material to start production of Influenza A(H1N1) vaccine. In parallel, WHO is working with national regulatory authorities to ensure that the new Influenza A(H1N1) vaccine will meet all safety criteria and be made available as soon as possible. Why is WHO not asking vaccine manufacturers to switch production from seasonal vaccine to a Influenza A(H1N1) vaccine yet? WHO has not recommended stopping production of seasonal influenza vaccine because this seasonal influenza causes 3 million to 5 million cases of severe illness each year, and kills from 250,000 to 500,000 people. Continued immunization against seasonal influenza is therefore important. Moreover, stopping seasonal vaccine production immediately would not allow a pandemic vaccine to be made quicker. At this time, WHO is liaising closely with vaccine manufacturers so large-scale vaccine production can start as soon as indicated.

Swine Flu: Way to Connect the Dots

Based on this article in today's WSJ, it seems like physicians, other health officials, and viral scientists in Mexico, the US, and Canada really nailed the early detection and identification of the swine flu, ooops, apologies, porcines, the A:H1N1 flu outbreak. Here's an excerpt:

On Saturday morning, April 18, Eduardo Sada, a respected epidemiologist, was playing tennis when he was interrupted by a phone call from a colleague at Mexico's health ministry summoning him to the office for an emergency. Dr. Sada said he needed to go home first to take a shower. "Forget the shower, come right away," the ministry official responded.

One hour later, Dr. Sada was at the epidemiology center in the south of the city with 60 grim-faced colleagues, grappling with the surge of pneumonia cases. The symptoms were strikingly similar: a high fever, bone-rattling body aches and pounding headaches. Acute respiratory problems, and death, could follow quickly.

Dr. Sada and his colleagues worked into the night to create a questionnaire to determine the scope of the problem. On Sunday morning, they fanned out, questionnaires in hand, to visit the city's largest hospitals.

By 6 p.m., they had the data in hand: In the previous 24 hours, 120 people had been admitted with A-type influenza. Six had died.

"We knew then we were in the middle of an influenza outbreak," says Dr. Sada.

Aporkalypse Now: Gawker on the Swine Flu

Aporkalypse Now, at Gawker is funny. You need to laugh...here's a taste:

"The World Health Organization just raised the pandemic alert to Level 5! That is is the second-highest level! We will literally all be dead by the end of the year, it is now 100% certain."

Read more.

Swine Flu: The More Optimistic View

The LA Times has a reasoned, balanced, and well-reported view of the situation by Karen Kaplan and Alan Zarembo. Here are some excerpts:

"Let's not lose track of the fact that the normal seasonal influenza is a huge public health problem that kills tens of thousands of people in the U.S. alone and hundreds of thousands around the world," said Dr. Christopher Olsen, a molecular virologist who studies swine flu at the University of Wisconsin School of Veterinary Medicine in Madison...

"This virus doesn't have anywhere near the capacity to kill like the 1918 virus," which claimed an estimated 50 million victims worldwide, said Richard Webby, a leading influenza virologist at St. Jude Children's Research Hospital in Memphis, Tenn...

When the current virus was first identified, the similarities between it and the 1918 flu seemed ominous.

"There are certain characteristics, molecular signatures, which this virus lacks," said Peter Palese, a microbiologist and influenza expert at Mt. Sinai Medical Center in New York. In particular, the swine flu lacks an amino acid that appears to increase the number of virus particles in the lungs and make the disease more deadly.

Scientists have identified several other differences between the current virus and its 1918 predecessor, but the significance of those differences is still unclear, said Dr. Scott Layne, an epidemiologist at the UCLA School of Public Health.

Ralph Tripp, an influenza expert at the University of Georgia, said that his early analysis of the virus' protein-making instructions suggested that people exposed to the 1957 flu pandemic -- which killed up to 2 million people worldwide -- may have some immunity to the new strain.

That could explain why older people have been spared in Mexico, where the swine flu has been most deadly.

Take a deep breath.

Dr. Chan Raises Pandemic Alert Level to 5

She must read Forbes.com (see below).
See the video here.

Groan: "WHO Boss Has SARS Baggage: Margaret Chan's leadership in the swine flu pandemic is questionable after the way she handled SARS"

This just in from Forbes.com:

"Swine flu is still far away from Hong Kong, but the memory of SARS is close. One other thing Hong Kongers haven't forgotten is the slow reaction by their former health minister Margaret Chan to that epidemic which killed 299 people in Hong Kong six years ago. Today she is tackling the swine flu outbreak as director general of the World Health Organization...

That calm response will be familiar to Hong Kong's citizens. Six years ago, when Severe Acute Respiratory Syndrome (SARS) broke out in Guangzhou, Chan, who was health director of Hong Kong at that time, was widely thought to have failed to recognize the urgency of infectious disease surveillance and control on the China-Hong Kong border, despite heavy passenger flow between Guangdong Province and Hong Kong.

She was criticized for not seriously considering a request by her former deputy to discuss whether the health department should send officials to Guangdong to learn more about the epidemic.

Chan was also blamed for having reservations about isolating a residential building in Kowloon Bay where a total of 321 SARS cases were eventually reported."

They go on to discuss the chicken dinner debacle.

Covering ALL the Bases: If You're Pregnant and Concerned About Swine Flu

The CDC has released guidelines for dealing with SwF in pregnant women. OMG. Here's an excerpt:

"Evidence that influenza can be more severe in pregnant women comes from observations during previous pandemics and from studies among pregnant women who had seasonal influenza. An excess of influenza-associated deaths among pregnant women were reported during the pandemics of 1918–1919 and 1957–1958. Adverse pregnancy outcomes have been reported following previous influenza pandemics, with increased rates of spontaneous abortion and preterm birth reported, especially among women with pneumonia. Case reports and several epidemiologic studies conducted during interpandemic periods also indicate that pregnancy increases the risk for influenza complications for the mother and might increase the risk for adverse perinatal outcomes or delivery complications."

How to Take Care of a Person with Swine Flu at Home

Right now there are apparently a handful of people in the United States who need this information, and with any luck it will stay that way. Just in case...here's information from the CDC on home care of somebody with SwF. There is a load of detailed stuff here, and it probably applies to dorms, barracks, apartments, etc.

Swine Flu Outbreak: Excellent Questions, Answered

In today's Wall Street Journal, the always-excellent Melinda Beck answers excellent questions about the links between this flu and the 1918 and 1976* flu strains, the preventive use of drugs like Tamiflu, and the possibility that this flu may have been around for awhile already (not likely). 

*aka disco flu

Everything You Could Possibly Need or Want to Know about Swine Flu

Do you have a question about swine flu that you haven't seen answered elsewhere on the web? Try here: NatureNews.com.

Swine Flu: Updates from People Who Actually Know Something

Should you be freaking out? David Whelan at Forbes.com says no. (I hope we're as lucky as he thinks we'll be. Ditto Marc Siegel, MD, of the New York Post.) Over at Slate.com, Daniel Politi quotes John Barry, author of an excellent book about previous flu outbreaks and author of an op-ed in today's New York Times:

In an interesting op-ed piece, John Barry, author of The Great Influenza, writes that it's impossible to know what will happen next since that "is chiefly up to the virus." There is a "strong possibility" that if the cases begin to diminish soon that could just be a sign that the virus has gone underground and could reemerge in a few months, stronger than ever. Barry notes that in all of the four well-known pandemics—in 1889, 1918, 1957, and 1968—"the gap between the time the virus was first recognized and a second, more dangerous wave swelled was about six months." That is why it's important to start working on a vaccine as soon as possible.

And finally, read what physician, molecular biologist, and flu expert Henry I. Miller writes in today's Wall Street Journal.

The extent and impact of the swine flu epidemic, which appears to have originated in Mexico and spread rapidly to a dozen countries and parts of the U.S., is still unknown. The epidemiology of such disease outbreaks is rather like a jigsaw puzzle, and we are now at the stage where the picture is intriguing even if we're not sure what we're seeing.

Looking For and Finding Swine Flu Cases

"Seek and ye shall find."

That's just one reason it will be difficult for scientists to determine what's really going on with this bug for some time. Swine flu (SwF) looks pretty much garden-variety flu in many people. A person in the United States who might have gotten SwF a month ago but didn't get terribly ill would have flown under the radar--and gone uncounted. No one was testing for this a month ago. Testing is more aggressive today in people who seek medical help for flu symptoms, and so it's no surprise that clusters of swine flu are turning up around the world today. To make things more complicated, people are more likely to rush to the doctor for an illness they think could be SwF, further increasing the chances of detection. It will be awhile before they sort this out.

More detailed information on self-care for Swine flu from the NYC Department of Health

This is quite detailed. Click here.

Swine Flu FAQ

From WebMD.
Tips on prevention from the CDC:

There are everyday actions people can take to stay healthy.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way.

Try to avoid close contact with sick people.

• Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
• If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

How to Deliver a Baby, Faster

I wish I'd known this a few years ago....from today's New York Times:

Lying down during the first stage of labor may slow the process, a new review of studies has found, but if the expectant mother sits, stands or walks around she may safely bring matters to a quicker conclusion. 

The analysis, published April 14 in The Cochrane Collaboration, combined data from 21 studies with a total of 3,706 women.

They go on to describe that remaining active could shorten the first stage of labor by 1 hour. If you think that's not much, you haven't been there.

...

Are Kids Truly "Addicted" To Video Games?

A study that was initiated by an Iowa State scientist who was skeptical of parental claims that teens were "addicted" to video games has concluded that he was wrong. Kids can become addicted to video games, he says. In fact, the findings suggest that an extraordinary 8.5% of American teens are addicted to video games. The study is reported in today's Washington Post and was published in the journal Psychological Science. The investigators apparently adapted diagnostic guidelines for gambling addiction to create questions about video games, and the questions were incorporated into a 2007 Harris Poll of more than 1,100 American adolescents. Kids were considered addicted if they demonstrated at least 6 of 11 symptoms, as reported in the Post:

 
"Symptoms included spending increasing amounts of time and money on video games to feel the same level of excitement; irritability or restlessness when play is scaled back; escaping problems through play; skipping chores or homework to spend more time at the controller; lying about the length of playing time; and stealing games or money to play more."

Kids who met the diagnostic criteria were categorized as "pathological gamers." No surprise: four times as many boys as girls fit the description. I'm guessing that few people disagree with the concept of gaming addiction, especially those who've watched kids, especially boys, get grabbed by these programs. But even other addiction specialists find the 8.5% figure astounding, according to the Post: 

Mark Griffiths, director of the International Gaming Research Unit at Nottingham Trent University in the United Kingdom, contended that game addiction exists but in smaller numbers than the study suggests.

"In all honesty, if there really were 8.5 percent of children who were genuinely addicted, there would be treatment clinics all over America."