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VITAMIN E SAFETY
Vitamin E
has recently been reported to be associated with an increased risk of death in a study which combined 19 old clinical trials. All the studies used alpha-tocopherol, an artificial preparation, generally sold in health food stores. We have been recommending the
isomers of vitamin E for about a year, since the first negative articles came out. Gamma tocopherol and the tocotrienols are part of the isomers of vitamin E found in Metagenics preparation
E1:1. The link, https://www.yafferuden.com/yronline/html/supp_vitamin_e_1_1.html
takes you to the article I wrote about this on our supplement site. I think
the isomers of vitamin E have a role in preventing prostate cancer and breast cancer, as well as Alzheimer prevention and maybe heart disease and stroke. Time will tell. In the meantime realize that the risk
of alpha tocopherol is low, but at the present time, it seems to offer no benefit! Switch to the isomers of vitamin E which much more closely resemble the vitamin content of the E in nuts and oils. We have
Vit E 1:1 in the office.
VIOXX, CELEBREX & BEXTRA
Vioxx has recently been removed from the market due to increased cardiac risk in those patients on it long term. We have had a medical bulletin posted on this website
since the original studies came out 2 years ago, and have had few patients taking this drug on an ongoing basis. We did notice a tendency towards fluid retention and blood pressure elevation on this
medication. While it may be a class effect, the original studies suggested that Celebrex, another Cox-2 inhibitor was free of these cardiovascular complications. The studies on Bextra are being looked at
now. We rarely use Bextra on a longterm basis. In conclusion, Vioxx causes a slight increased risk of cardiac complications in those with heart problems using it long-term. Until we learn more, I will
feel comfortable using Celebrex on an ongoing long term basis, and Bextra on a short term basis.
FLUMIST
Flumist supply
has been exhausted, but 2 million more doses are being manufactured. It is a live virus, intended for use in healthy people between 5 and 49, who will not be exposed to anyone with a compromised immune system in the week following administration. It could result in a transmission of the live virus. It will be available in pharmacies in the near future, and if you can find it, we can prescribe and administer this nasal preparation.
LDL CHOLESTEROL & LIPITOR/CRESTOR
Recent information suggests that lowering LDL cholesterol to 62 with high dose Lipitor was more effective than lowering it to 98 with Pravachol. There was a 25% decrease in heart
events in the lower group. If lower LDL is better, then Crestor should be better than Lipitor, as Crestor 10 mg./day lowers LDL by 50%, while Lipitor lowers it 40%. At the same time, some are accusing Crestor of having
kidney side effects. We feel that Crestor is more potent at lower doses, and does not have significant risk. 600,000 patients have used it without problems. It has fewer drug interactions, and does not interact with
grapefruit juice. We believe that Omega-3 fatty acid supplements decrease the risk of sudden heart death by 50%, and that antioxidants also reduce risk by stabilizing plaque. These include Vitamin C, especially before
meals, combination vitamin E, and resveratrol, green tea extract, and other antioxidants in food. It's all about stabilizing and reducing plaque in the coronary arteries.
WOMEN & ANTIBIOTICS
New information suggests that when women take
antibiotics, they increase their risk of breast cancer later in life. Preliminary studies suggest that women who take more than 25 antibiotic prescriptions had double the risk of developing breast cancer in a
17-year period. It is not clear whether there is a cause and effect, or that women with decreased resistance to infections, also have decreased resistance to breast cancer.
Back to Top RELIEVE PREGNANCY NAUSEA, VOMITING
Electrical stimulation of median nerve relieves nausea, vomiting of pregnancy
Noninvasive electrical stimulation of the median nerve on the
volar aspect of the wrist reduces the incidence and severity of nausea and vomiting in the first trimester of pregnancy, physicians report in the July issue of Obstetrics and Gynecology.
Electrical stimulation therapy appears to reduce symptoms related to motion sickness, chemotherapy and anesthesia, Dr. Todd Rosen, of Morristown Memorial Hospital, New Jersey, and
associates point out, and one small trial suggested that it suppresses pregnancy-induced nausea and vomiting.
In the current report, Dr. Rosen's group studied nerve stimulation therapy with the ReliefBand Model WB-R (Woodside Biochemical Inc., Carlsbad, California) in a prospective study of 230 patients.
The women had experienced nausea and vomiting for at least 3
days and were between 6 and 12 weeks pregnant. Ninety-five patients randomly assigned to nerve stimulation and 92 to a sham device identical in appearance to the study device completed the 3-week study.
The time-averaged change in Rhodes Index total experience score was significantly better in the study group than in the control group, 6.48 versus 4.65 (p = 0.02), and thus resulted in
a "consistent reduction in nausea and vomiting from baseline levels throughout the 3-week study period." However, there were no significant differences between groups in total
experience scores, total occurrence scores or total distress scores of the Rhodes Index.
Those in the nerve stimulation therapy group were more likely to
gain weight over the 3-week trial period, 77% versus 54%, and they gained significantly more weight than did the control group, 2.9 pounds versus 1.2 pounds (p = 0.003). Control group
patients were significantly more likely to report an episode of dehydration.
The "adequately powered, prospective, randomized, placebo-controlled trial...demonstrates that acustimulation at
the P6 Neiguan point is beneficial to women who suffer from symptoms of nausea and vomiting during the first trimester of pregnancy," Dr. Rosen and his colleagues conclude.
Back to Top PROSCAR
Proscar
reduces the incidence of prostate cancer, but the cancers that develop are more aggressive. On balance, this doesn't suggest that Proscar is good or bad in reloation to prostate cancer.
Back to Top SARS
SARS starts with fevers greater than 100.4, with headaches and muscle aches. After 2-9 days, a dry cough develops, along with shortness of breath. Although 5% of patients worldwide die, no
one has died as of May 4th in the US! Since the virus has been identified, and the DNA of the virus has been defined, it is only a matter of time before there are accurate diagnostic tests. A
vaccine should be available in the next year. On the other hand, the virus appears to be mutating, and recurrences seem to be occurring. Usually spring brings a break to viral epidemics,
and hopefully isolation and control techniques will be god enough to slow the virus until definitive vaccines and therapies can be developed. Back to Top
FOOD & PROSTATE CANCER
Several studies are suggesting that different
foods may play a role in decreasing prostate cancer cell growth. Lycopenes in cooked tomatoes are very likely to be beneficial. Garlic and
scallions contain flavonols which have shown antitumor effects. Omega 3 fatty acids in flaxseed, high fibre, and low fat diets all seem to be protective. Back to Top RAISING SPERM COUNT
Low sperm counts
can be raised by 74% with supplements including folic acid and zinc according to an article in The New Scientist in March, 2002. Back to Top C REACTIVE PROTEIN
C reactive protein has been receiving much press lately. As you can see from prior bulletins, we have been aware of this for several years. We now know that chronic inflammation of the
plaque in the coronary arteries, leads to erosion of the fibrous cap, which can lead to plaque rupture, clot formation, vascular blockage and heart tissue damage. High CRP levels directly lead
to vascular inflammation by suppressing nitrous oxide in the vessel wall. Aspirin and statins lower inflammation, CRP levels and are protective. We will monitor CRP level in appropriate
patients, but patients should realize that very high false readings occur when there are other inflammations in the system, such as viruses, or other infections. Cardiovascular research is increasingly showing that a new predictor of heart disease risk, c-reactive protein, is just as
important as monitoring cholesterol levels to prevent and treat heart disease and other ills, including stroke, sudden death and peripheral vascular disease. Now, University of California, Davis
physicians have discovered that this protein is not just a marker for heart disease, but that it actually damages the blood vessel wall by blocking a critical "protector" protein and by
promoting plaque formation. The finding, published in the September 17 issue of the journal Circulation (available on the Web at http://www.circulationaha.org ), describes a new molecular
pathway that stimulates plaque formation. The work is important because it provides a new target for drug development efforts, explains why cholesterol screening is not enough to accurately
assess heart disease risk, and underscores the need to use c-reactive protein screening to more accurately assess at-risk populations.
In their series of experiments, UC Davis researchers found that c- reactive protein inhibits the activity of a very critical "protector" enzyme in the blood vessel wall. This protector
enzyme, called eNOS, or endothelial nitric oxide synthase, produces nitric oxide, which works to keep blood vessels healthy and heart disease at bay by preventing plaques from adhering to
blood vessel walls, keeping coronary arteries dilated and inhibiting constriction of smooth muscle cells. At the molecular level, c-reactive protein decreases the
stability of eNOS messenger RNA and prevents the activation of its second-messenger molecule, cyclic GMP. These events prevent eNOS from producing its protective biological effects. C-reactive protein
also promotes white- blood-cell binding to blood vessel walls and stimulates the release of other adhesion molecules, including intercellular adhesion molecule 1, or
1CAM-1, and vascular cell adhesion molecule, or VCAM-1, which further promote plaque build-up. "Without the protective effects of eNOS and the plaque-promoting effects of c-reactive protein,
the blood vessel wall is ripe for the development of heart disease," said Ishwarlal Jialal, professor of pathology and director of the Laboratory for Athersclerosis and Metabolic Research at UC
Davis School of Medicine and Medical Center. "The attachment of white blood cells and their entry into the vessel wall are early events that lead to fatty streaks or early plaque formation."
These novel findings at the molecular and cellular level support the work of other investigators who have shown that patients with increased levels of c-reactive protein have impaired blood
vessel function, as measured by forearm blood flow. The findings also support current efforts to develop new screening guidelines. "By using existing high-sensitive assays to measure c-reactive
protein levels, we can better identify individuals who are truly at risk for heart disease and get them started on prescription drugs, lifestyle changes or other treatments as necessary to reduce these protein
levels and to prevent disease," said Jialal, who is the Robert E. Stowell Endowed Chair in Experimental Pathology. "High risk groups include postmenopausal women and
individuals with a positive family history of premature heart disease, hypertension, smoking or metabolic syndrome, a disorder characterized by a disproportionate amount of
abdominal fat, elevated blood pressure, blood sugar and triglycerides and low levels of HDL, the "good" kind of cholesterol. Testing would be beneficial to individuals in these
groups, especially when cholesterol levels are within the normal range and other risk factors and assessment measures indicate an intermediate level of risk for heart disease."
Other investigators at UC Davis contributing to this study include Sridevi Devaraj, assistant professor of pathology, and Senthil Venugopal, research fellow. Measures of eNOS enzymatic
activity was performed in the laboratory of Philip Shaul, University of Texas Southwestern Medical Center at Dallas. ((AScribe - The Public Interest Newswire / http://www.ascribe.org )) " Back to Top
LIPOPROTEIN UPDATE
In recent years it has become clear that some patients with normal cholesterol develop severe vascular disease, whereas others with high cholesterol do not have damage. It is
important to understand that LDL cholesterol is the lipoprotein carrier of the "bad" cholesterol that gets absorbed into the vessel wall, and leads to fatty plaques in the arteries. The HDL,
"good" cholesterol, is the lipoprotein carrier of the bad cholesterol away from the vessel wall. We now know that there are dense and fluffy LDL's, and that the dense LDL
particles can penetrate the vessel wall and do damage, while the fluffy LDL's tend to bounce off the wall, and get taken back to the liver. Thus we really want to know the LDL particle count,
not the LDL cholesterol level, and also the particle size. One can have a moderately high LDL, but if the particles are large, the particle number is smaller, and the damage potential for
each particle is smaller. The HDL carrier is also more effective at being a good carrier if it is large. Until recently, testing for particle size and number was not readily available. A lab in
North Carolina, Liposciences, has patented an NMR Spectrophotometry evaluation of lipoproteins which promises to revolutionize the way we look at serum lipids. Triglycerides also
seem to take on a much bigger role in lipid related damage and is better measured by measuring VLDL, the transporting carrier, and how that is cleared by the liver. We are excited to be using
this test, which generally costs about $140, and is not offered, by any of the standard labs. Liposciences is allowing us to use this test on our patients for a few months, in an effort to help
spread the word on its importance. See their website: http://www.liposcience.com/pat_pe.htm
Back to Top
DIURETICS & BLOOD PRESSURE
Recent press about Diuretics as the first drug of choice for high blood pressure
comes from the ALLHAT study released in December in JAMA. Careful reading of the study suggests that there is no change in mortality (death) in patients on the ACE,
the Ca channel blocker, or the diuretic. There is less than '1 person in a hundred over 6 year time period' decrease in stroke on the water pill (6.3 vs. 5.6) versus the ACE. The ACE group
was not able to use water pills if the BP wasn't well-controlled by the ACE alone due to the design of the study. This led to poorer BP control in the ACE group, which is artificial. In
addition, there have been advances in ACE's since the study started in 1994, but not in diuretics. In addition, the incidence of high sugar, lipids, and low potassium and electrolyte
imbalances were worse in the diuretic group. We find that many of our patients start with ACE's, and then
get diuretics if necessary as a second drug. Since diuretics cause frequent urination, there are many patients who prefer not taking them! Long commute times or business meetings
make diuretics very inconvenient. Men with large prostates may have difficulty with diuretics. There are few side effects with ACE inhibitors, other than cough.
The study is largely an attempt to answer the question 'are the more expensive new BP drugs more effective than the old water pills'. There are unquestionably cost issues here, and issues
involving medical marketing. But the real answer is that both water pills and ACE's get the job done, but water pills may be less convenient for many of our patients. Back to Top
METABOLIC SYNDROME
The
metabolic syndrome is an insulin-resistance overweight syndrome estimated to occur in a third of all adults, and 40% of all American adults over 60. It is characterized by abdominal obesity
, (male 40' waist, female 35'), hypertension, high triglycerides, low HDL, high uric acid levels (gout), and fasting glucose of 110 or greater. Basically it is a prelude to
adult onset diabetes, and cardiovascular disease. It is a wake-up call to change diet and exercise patterns, as well as smoking, stress reduction, good lipid level control, etc. Back to Top
EBCT OF HEART
Coronary artery calcification score
measures the amount of calcified coronary artery plaque. It is a 10 minute CT scan that costs about $350 and is available at Park Avenue Radiology
(888-1000). It is not covered by insurance. The test measures only calcified plaque, which tends to be mature plaque, and cannot at this time show uncalcified plaque. As a screening
tool, if there is no calcified plaque, one can be reasonably assured that there will be no coronary issues in the near term. On the other hand, much plaque suggests the need for
aggressive stress testing and lipid lowering. Future generations of Electron Beam CT will enable visualization of uncalcified plaque also. Back to Top
SMALLPOX & ECZEMA
Individuals who have a history of eczema or other rashes have a slight risk of developing a life-threatening rash if exposed to the smallpox vaccine. At the present time, those with a
history of eczema, or those living with individuals with eczema
are not candidates for vaccination!
(Background) Of the 6.5 million people vaccinated during the 1962 English campaign (approximately one half of whom were primary vaccinees), 185 developed Eczema Vaccinatum and 11
(6%) died. Rash histories (active or past) indicated that 80% of those with EV had "atopic eczema," whereas 4% had "seborrheic eczema" and 16% were "not definitely classified." Two thirds of the patients with atopic eczema
did not have active disease (some for up to 10 years) at the time of exposure. Accidental (contact) primary vaccination accounted for more cases of EV
(65%) than did intentional vaccination for the first time. EV was more common in the 1- to 5-year-old age group and in males, though the mortality rates for the sexes were the same. Back to Top
EV was more common in younger children (infants were not immunized) and in those who acquired vaccinia by accidental
contact. Rates of EV were 123 per million primary vaccinees, with case fatality rates of approximately 1%. Although little information was available on the specific dermatologic conditions
of the victims of EV, the authors commented that those patients with "obvious and severe eczema" were rarely
vaccinated.
Current Advisory Committee on Immunization Practices guidelines for administering the smallpox vaccine state that neither those individuals with a history of active or quiescent eczema (eczema
being another term frequently used to refer to AD, though it can refer to other inflammatory skin diseases as well) nor those with close contacts who have a history of active or quiescent eczema should be vaccinated under routine circumstances (ie, no clear exposure to smallpox) because of the higher risk of developing EV. Given that the lifetime prevalence of AD is ~10%
to 15%,
26 that perhaps this many people (or even more) have a "history of eczema" (which includes patients with AD), and that
likely twice this many people have a contact who has active or quiescent AD, it is conceivable that up to half of the population currently would not be eligible to routinely receive smallpox vaccination.
Back to Top
THE ADKINS DIET
The Adkins Diet
is being re-evaluated for weight loss and diabetes prevention. We have felt that many diets, including this one, works for weight loss. Many people try a diet, get
bored with that diet, and proceed to the next diet. Adkins, being high fat and low carb, is particularly difficult to maintain for any length of time. It causes weight loss and cholesterol
lowering, in spite of the high grease intake. Very few people adhere to it longer than a few months in our experience. Recent studies suggest tat there may be merit to the diet. But on a
long term basis, there may well be an increased risk of prostate, breast, colon, and pancreatic cancers associated with a high fat diet. Bottom line: works okay on a short term basis. Back to
Top
HRT
HRT (hormonal replacement therapy) has recently been
associated with an increased risk of heart disease and breast cancer after a few years of treatment. We believe that estrogen replacement is good for a few years, to get a woman
through the hot flash stage of menopause, but that a prescription drug, Evista, should be prescribed after a few years. It is wise to address this issue directly with your GYN.
Back to Top
APPETITE AND OBESITY
A newly discovered hormone, ghrelin, has been linked to appetite and obesity. When an individuals diets and loses
weight, the ghrelin level goes up, increasing appetite. Historically, the hormone is thought to make people "fatten up" during plentiful times, in preparation for times of famine. Recent
studies with gastric bypass surgery, show sustained weight loss, possibly related to decrease ghrelin levels, after the procedure! Back to Top
MAMMOGRAPHY UPDATE
A recent article states that mammography has not been proven to save lives from breast cancer. The argument is that in young women, breast cancer is often very aggressive and finding it
early is often not helpful, In older patients, it is often not aggressive, and finding it early often doesn't make a difference. Hence, it has not been proven that mammography alone affects
mortality. We feel that even if the statistics can't yet "prove" benefit in a universal setting, the benefit of finding a breast cancer earlier, rather than later, in an individual patient
has to be beneficial for that patient. We will enthusiastically continue to encourage mammography, as well as self-exam in our practice until more reliable techniques come along.
Back to Top
ASPIRIN & VASCULAR DISEASE
A big, new study of 200,00 people suggests that 75 to 150 mg.
of aspirin prevents heart disease and stroke in individuals with known vascular disease, and in high risk patients. Thus, 1 or 2 baby aspirin lowers the risk of vascular events by 25% without
increasing the risk of significant bleeding. Even slightly elevated BP, systolic 135, and diastolic 85-90, was associated with
2.5 times the heart risk in women, and 1.5 times the risk in men, worse in patients over 65. Back to Top
KIDNEY STONES & DIET
New studies suggest that people with kidney stones should have a normal amount of calcium in the diet. Instead they should have low-protein, low salt diets to prevent further
stones. Back to Top
ANTIOXIDANTS & STATIN DRUGS
Antioxidants, such as vitamin E and Vitamin C have recently been accused of interfering with the benefits of statin drugs,
such as Lipitor and Zocor. In fact the study suggests that that antioxidants may blunt the effect of Niacin on raising the HDL. At this time we will continue to emphasize the benefit of vitamin
E naturally in nuts and oils, and vitamin C in citrus fruits. If an individual is on Niacin, and has low HDL, we would stop the use of Vitamin E and C supplements. Back to Top
OSTEOARTHRITIS DRUGS
Recent studies suggest that
glucosamine and chondroitin sulfate actually work to reduce inflammation and rebuild joints in patients with osteoarthritis. Consumer's Union studied the
different products and suggests that all are similar. Should be fifty cents per day. Back to Top
WTC TRAGEDY
We are all saddened by the loss of many patients, friends, and
relatives of patients. The post-traumatic stress syndrome is a very real condition and can be helped with counseling and medications. None of us have ever been through anything like
this before, and it is natural to have anxiety, depression, and physical manifestations of adrenaline release. There are several links under Emergency, and Mental Health site links which may
be helpful. Do not hesitate to call in if you need assistance!! Back to Top
COX-2 AND HEART RISK
Celebrex and Vioxx are anti-inflammatory drugs and pain-relievers in the COX-2 inhibitor family which have been
shown to have a decreased incidence of stomach-related side effects. The medications have been used by about 100 million people worldwide. Recent analyses suggest that patients
on these pills, compared to patients in other studies who were not on these pills, had a higher incidence of cardiovascular incidents. At the present time, the data is preliminary,
comparing very different groups of patients, and only suggests that further studies are needed. We feel that these medications are of value in selected patients, and unless someone is in a
greatly increased risk group, we will be very comfortable using these medications at this time. If an individual is a high risk group (i.e. an elderly male, a smoker, an individual with high
cholesterol, or a diabetic), we have to weigh the risks versus the benefits. Back to Top INJECTION SNOREPLASY
is a new technique where a sclerosing agent is injected into the
soft palate in the doctor's office which prevents fluttering of the palate, and reduces snoring. Most patients require one or two injections. It is cheap, easy, and there were no significant
complications. It is presently experimental., and the work is being done at Walter Reed Medical Center by Eric Mair, M.D. (EricMair@aol.com).
Back to Top SEVERE PHARYNGITIS PAIN
is best treated by a 10mg. pill or im injection of dexamethasone,
in conjunction with penicillin or erythromycin. Patients were completely pain free in 12 to 24 hours and there were no complications. Back to Top
VITAMIN C - DAMAGING?
Recent studies suggest that Vitamin C supplements may
produce DNA damaging compounds, and that might explain why these supplements have not been shown to decrease the risk of cancer. It was felt that since fresh fruits rich in vitamin
C do reduce cancer risk, supplements should also be beneficial. This is now brought into question. Back to Top
BAYCOL WITHDRAWN
Baycol has recently been withdrawn from the market because of muscle injury
leading to death in 31 patients. This has long been recognized a potential complication, especially when used with Lopid or niacin. There is no reason to believe that the
incidence of the severe muscle damage is significant with Lipitor, Pravachol, or Zocor. We will continue to use these.
Back to Top
HOME SLEEP APNEA DETECTOR
A moustache-like device has been approved by the FDA for
home monitoring of sleep apnea syndrome. A four-inch long strip with three temperature sensors is worn overnight, and is brought back to the physician the next morning. It detects the
frequency of apnea events, and is safe and simple.
Back to Top
EXTERNAL LIPOSUCTION!
Angiosonics, of Morrisville, North Carolina is developing a
technique for external lipolysis. When this new device is available, an externally applied ultrasound will melt the underlying fat, enabling safe body contouring without an incision. Back to Top
TOPICAL RX OF SKIN CANCER
Basal cell skin cancer is presently treated with local surgery, often Moh's surgery. A new technique using phototherapy was 90% effective in treating basal cells. Metvix' PDT therapy is
being developed by Photocure ASA in London. Back to Top
GLUCOSAMINE HELPS ARTHRITIS
A large study shows Glucosamine, 1500mg. daily, improves
osteoarthritis symptoms by 25% over three years, along with improvement in cartilage thickness. Back to Top
SLEEP DISORDER GENE
A gene has been identified which causes sleep disorders! A
single mutation leads to a protein with one abnormal amino acid which changes the way phosphate groups are connected to the proteins that regulate the sleep-wake cycle. The point is that
many sleep disorders are chemically induced, including the need for less sleep as we age. Understanding the genetic and biochemical abnormalities can lead to the development of new
treatments that are more specific. Dr. Kingman Strohl, of Case Western Reserve, and
'Talk about Sleep', is excited about the potential practical benefits of this research. Back to Top
PMS TREATMENT
PMS has been successfully treated with 'agnus castus fruit' extract. One tablet daily, available in health food stores, decreased symptoms by 52% over 3 cycles. Symptoms included
irritability, breast fullness, and bloating. Back to Top
45 Y/O & EYE SURGERY
By cutting 8 slits in the sclera, close-up vision loss related to
aging may be corrected. This is a 20 minute outpatient procedure which is being evaluated now to give the eye more room to expand so that lens can adapt to close-up objects.
Studies in Latin America showed no adverse effects. Alfred Jolson, of Winter Park, Fla. is participating in the studies. Lasik surgery does not correct presbyopia (aging vision).
Back to Top CALCIUM CHANNEL BLOCKERS & HIGH BLOOD PRESSURE
Two recent major studies draw differing conclusions about calcium channel blockers (CCB's) as the first line of treatment
for high blood pressure. One suggests equivalent benefit to ACE inhibitors, and one study suggests that the CCB's do not reduce hypertension related side effects well when used as first-line
therapy. It was concluded that diuretics, beta-blockers, and then ACE inhibitors were better single agent first drugs. There was agreement that CCB's were good with fewer side effects
when combined with other drugs. We have many patients on CCB's, including Norvasc, and we are comfortable with the benefits of these drugs. If a patient is only on a CCB for high
blood pressure, and has any question, please do not hesitate to call. Back to Top
ALLERGIES AND CO-WORKERS
Many people are allergic to dust mites and cat allergens. A
recent study suggests that one can get significant exposure from proximity to co-workers wearing cat and dust-bearing woolen sweaters that have not been recently washed. An
individual working in an environment causing allergic symptoms must first consider "sick building syndrome", and environmental issues, but also the clothing of co-workers! Back to Top ANTIOXIDANTS IN TOMATOS
Lycopenes are powerful antioxidants found in tomatoes. They have been shown to decrease prostate cancers in heavy tomato eaters. A new study suggests that 30 mgs. of daily lycopene
reduces exercise-induced asthma in 55% of patients within one week of starting the supplement. Presently bronchodilator sprays, antihistamine sprays, and a medication called Singulaire
have all been found to be effective, but this is the first non-medical approach of potential merit.
Back to Top SKIN CANCER
Skin cancer is very common in the US. Nonmelanoma skin
cancers have been found to respond remarkably well to a compound in an Australian plant, Radium weed. This has been an urban folk remedy , and a study now shows that with just
three days of local treatment, 88% of sunspots, basal cell and squamous cell carcinomas responded completely. Peplin Biotech has patented this ingredient, and trials continue. This would
represent a major breakthrough in the treatment of skin cancer, if further studies bear out the initial results.
Back to Top HOT FLASHES
Hot flashes are a problem for post-menopausal women,
particularly if they can not take estrogens. Patients with breast cancer are not able to take estrogen, and in addition, they have increased hot flashes when placed on tamoxifen. A new study
from the Mayo Clinic finds that Effexor, an antidepressant, reduces flashes by 61%. After a week of 37.5 mgs. per day, the dose is doubled. There are few side effects. Megace, a
progesterone derivative has also been used with success, but because it is a hormone, there are many patients who need to avoid it. Trials of vitamin E and clonidine have been much less successful. Back to Top NEW TREATMENT FOR CORONARY ARTERY DISEASE
A recent study presented at the American Heart Association meeting showed that a combination of a statin to lower the LDL cholesterol, plus niacin,
2 to 4 grams daily, to raise the HDL cholesterol "halted coronary artery disease to a standstill". In patients with known coronary disease, the incidence of further
events at 3 years was 70% less than placebo, while statins alone had 35% fewer cardiac events. Niacin dosages need to be gradually increased over 8 weeks, and patients with diabetes
need to be aware that niacin will increase glucose levels. Back to Top
ANGER & HEART ATTACKS
A person who is prone to anger is about 3 times more likely to
have a heart attack or sudden death than someone who is least anger-prone. This is especially true in middle-aged men and women with normal blood pressure. It is medically important to
learn how to control the anger response. Sudden releases of adrenaline can be catastrophic. Yoga, meditation, massage, or just re-adjusting priorities can be beneficial to your health. Back to Top
HAIR LOSS & BACTERIA
Hair loss may be caused by a bacterial infection and may benefit by antibiotics. Dr. Arnold Schroeter of the Mayo Clinic found
that bacteria in the hair follicle secretes a chemical when activated by ultraviolet light which causes inflammation leading to hair loss in men and women. When treated with minocycline
100mg twice daily, 60% of men and 80% of women had no further hair loss. Preventing uv exposure with a hat is a more practical treatment, although topical antibiotic shampoos are
being investigated. Stay tuned. Back to Top
OSTEOPOROSIS & VERTEBRAL COLLAPSES
Men and women with osteoporosis suffer vertebral collapses
which are very painful. Once one occurs, the spine becomes curved, and a second fracture becomes more likely. Traditional treatment is bed rest, pain meds, and back braces, as well as
treating bone loss with osteoporosis medicines. A new procedure injects cement into the disc, after a baloon ramp is inserted to 'jack up' the deformed disc. Kyphoplasty was
performed by Dr. Joseph Lane at the Hospital for Special Surgery in NYC. He reported 311 procedures, taking 50 minutes on average, and reported 96% pain relief after 2 days.
Back to Top
NEW HERPES TREATMENT
A new study suggests that herpes cold sores are more effectively treated by a combination of anti-herpes pills (zovirax), plus a high potency cortisone gel applied topically.
The lesions were smaller, with less pain and faster healing when the steroid was added. Back to Top
ALZHEIMER'S & DIET
Recent studies suggest that alzheimer's syndrome can be
prevented with a diet high in antioxidants. The effect was seen with foods high in beta-carotene, vitamin E, and vegetables, but not with fruits or flavonoids. Another diet
emphasizing veggies, nuts, oils. Back to Top
VITILIGO & PSORIASIS
A new type of excimer laser has been demonstrated to be effective in the treatment of psoriasis
and in vitiligo (a de-pigmenting disease). Current light therapy involves uv light treatment which subsequently increases the risk of skin cancer
and must be given three times weekly for months. James Spencer M.D. of Mt. Sinai in NYC is experimenting with this promising approach. It delivers very concentrated light, and
works very quickly, sometimes in just three sessions.
Back to Top
CHOLESTEROL PLAQUE BLOCKAGE
A recent study of transplant hearts taken from healthy young donors killed in accidents found that significant
cholesterol plaque blockage was found in 17% of hearts in kids under 20 years old. 37% from 20 to 30 years old; 60% from 30 to 40 years old, 71% from 40 to 50 years old, and 85% over 50 years
old had significant blockages with plaque! The implication is that everyone starting in childhood should exercise, eat well, avoid tobacco, etc. If we can retard plaque development early,
the results will be accentuated longterm. Keep in mind that these same plaques form in the brain, in the penis, in the kidneys, etc! Back to Top
GRAPEFRUIT JUICE INTERACTIONS
Grapefruit juice
can cause increased absorption of many medications. Blood pressure pills can reach concentrations of three or four times normal when taken with grapefruit juice over
a five day period. This is particularly troublesome in elderly patients who may be more susceptible to the side effects of certain drugs. Back to Top
GREEN TEA & CANCER
Drinking four cups of green tea probably prevents skin cancers. Polyphenols found in green tea have been shown to be powerful antioxidants which lead to the death of tumor cells
and the blood vessels surrounding them. Fish oils, fruits, vegetables, herbs, soy, olive oil and green tea have all been attributed with cancer killing effects. Tea has been shown to
decrease the risk of oral cancers, and has decreased lung and colon cancers in mice. Back to Top RINGING IN THE EAR
Tinnitus, ringing in the ear, is a chronic, common untreatable
problem. Dr. John Shea, of the Shea Ear Clinic in Memphis, reported that injecting lidocaine into the inner ear , and then receiving intravenous lidocaine for two hours, for three
consecutive days was very effective in most patients in stopping the tinnitus! This is only a preliminary study, and the treatment is not likely to be widely available for a couple of
years if proven effective in other studies,, but this represents the possibility of the first real tinnitus breakthrough. We have many patients with this condition, and it may be worth
contacting the Shea Clinic if the condition warrants it. Phone (901) 763-1234. Back to Top ASPRIN & HEART DISEASE
Aspirin has been shown to lower the risk of heart disease
by 44 percent in men over the age of 50. Only 81 mg. of aspirin is necessary, but there is an increased risk of stroke on aspirin, because of decreased blood clotting. A new study shows that men with
blood pressure over 140 had more stroke risk than heart benefit. So aspirin is not indicated if the blood pressure is borderline high. Back to Top
WAIT TEN MINUTES BEFORE DESERT
It takes ten minutes for the brain to register that a person is no longer hungry. The satiety center, as mapped by functional MRI testing, doesn't respond for these ten minutes,
during which time most individuals continue to eat. This results in many extra calories, and increased obesity. Recognizing this, an individual who eats slowly, pauses between courses, and
waits for the satiety response to occur, may walk away from the table feeling full, not stuffed, and may have a significantly lower caloric intake. Wait at least ten minutes before ordering dessert!! Back to Top THE MAGIC OF RED WINE
The
French Paradox, which states that the French had a low rate of heart disease despite a high cholesterol diet, may be explained by the discovery of a compound in red wine called
trans-Resveratrol, "Res". This is a natural dietary compound that effects the immune system, preventing arterial plaque formation, and interfering with the development of certain cancers.
It is found in many fruits and nuts, especially in red grapes, mulberries, raspberries, and peanuts. A glass or two of red wine may well be a good thing. Back to Top
HUMAN GENOME
The announcement that the rough draft of the human genome
has been mapped, has lead to a very enthusiastic public reaction. The truth is that there may still be up to 100,000 more human genes to map out, and then there is the need to
understand how each gene controls what protein involved in what bodily function. Once this information is better understood, we may begin to understand how each individual
differs. We can then design drugs which block certain genes so that we can target medications to work very specifically in certain individuals. Back to Top This may be decades away and would significantly change the way we view pharmaceuticals. We will in a shorter period of
time be able to predict accurately which individuals are susceptible to which conditions. This may allow pre-emptive approaches to certain conditions, diabetes, lung cancer, etc.,
but it is also fraught with emotional and legal consequences. Lots of other unimaginable consequences may result from the exact understanding of how certain proteins work in the body,
and how certain traits are inter-related. What is the relationship between a biochemical problem, and a psychological problem, such as alcoholism? Stay tuned, but don't expect
much specific intervention for a number of years.
Back to Top GERD - GI REFLUX
GERD, GI reflux, has recently had two new therapies approved by the FDA. Through the endoscope, a radiofrequency device
can zap the inner lining of the esophagus, thickening the walls of the esophagus, and destroy nerves that allow the muscle at the base of the esophagus to relax inappropriately.
The other device involves lowering a miniature sewing machine through the endoscope to stitch the tissue around the opening of the stomach tighter. Both of these procedures tighten the
lower esophageal sphincter and prevent reflux from occurring. They are both done as outpatient procedures, and are as effective as laparoscopic surgery to tighten the sphincter. Dr.
Stephen Edmundowicz, of the Barnes-Jewish Hospital in St. Louis, is a pioneer in these procedures, which are just beginning to be rolled out nationally. Back to Top
HIGH NORMAL BLOOD PRESSURE
High normal blood pressure doubles the risk of a woman
developing cardiac problems. Systolic blood pressure of 130-139, or diastolic pressure of 85-89, were identified as doubling vascular damage in women! In an unrelated study,
white coat syndrome, BP being elevated only in the doctor's office, was also found to cause more heart damage, than BP which was normal all the time. We tend now to overlook white
coat syndrome, but studies are beginning to show that there are many other times that the individual responds to stress by elevating BP, and the long-term effect of this is cumulative! For
those of us who want to be around and healthy many years from now, it looks like we should do everything possible to protect the pump and hoses now!!! Back to Top
PROSTATE RADIOACTIVE SEEDING
New studies suggest that ultrasound guided prostate
radioactive seeding may be the procedure of choice for localized prostate cancer. In one major study there was 82% disease-free survival , and 98% survival from prostate cancer
death at 12 years. Of patients at high risk for extraprostatic disease, there was still 79% disease free survival, compared to 40% disease free in similar patients treated with radical
prostatectomy. High doses of radiation can be delivered very locally with the radioactive seeds when placed under ultrasonic guidance. In the early 1970's, this procedure was done blindly,
and the results were poor. This is the first longterm study of this revised procedure, and the results are very exciting. It was directed by Dr. Haakon Ragde at Northwest Hospital in Seattle.
Another paper did suggest that there were more complications with this therapy including 15% with moderate to severe bowel dysfunction, and urinary burning. Sexual dysfunction was
comparable to the surgical group. Back to Top ALCOHOL MAY BE GOOD
Alcohol consumption in moderation has been getting a lot of good press recently. Moderate drinkers have a lower rate of
first heart attacks compared to teetotalers, and now patients who have had a heart attack, have as much decreased incidence of a second if there is a drink or two daily. 22% of
abstainers died at four year follow-up, compared to 9% of the seven to fourteen drinks per week group. In this study the type of alcohol did not matter. Alcohol has also been shown to
increase the good cholesterol, HDL, more than exercise, in women! 25% increase in HDL with one to two drinks daily! Lastly, alcohol was found to boost sensitivity to insulin, thereby
reducing oversecretion of insulin, thus preventing diabetes, and vascular disease. Back to Top FOLLOWUP AFTER LUMPECTOMY
It is important to realize that in early stage breast cancer,
breast conserving surgery, lumpectomy, is considered treatment of choice. This should almost always be accompanied by adjuvant therapy—radiation, hormones, or multidrug
chemotherapy. Even in women over 65. As many as 15% of patients fail to have proper followup therapy after their surgeries. Always consult with an oncologist whenever there is
breast cancer surgery! Back to Top DAIRY PRODUCTS CONTROVERSY
There is new controversy regarding dairy products. We recommend four servings of dairy daily in premeopausal women
to prevent osteoporosis. After menopause, that goes up to six. New studies suggest that even one serving of dairy daily significantly increases the risk of ovarian cancer in women. In
a large prominent long term study the group with the most lactose had 44% greater risk for ovarian cancer than the low lactose group. Given that the difference was one in two
hundred versus one in 130 women with a 16 year follow-up, this suggests that unless one is in a high risk for ovarian cancer group, the protective benefits of milk products in preventing
osteoporosis, which affects a huge percentage of the female population, far outweighs the potential risk! Soy products, high in calcium, have an estrogen-like protective effect, and may be
the perfect answer. Along with low-fat, and lots of fruit and veggies. Back to Top SLEEP APNEA
Sleep apnea seems to increase significantly with menopause and may lead to all kinds of secondary effects, including poor
quality sleep, fatigue, hypertension, and irregular heartbeats. The risk for sleep apnea increases eightfold! HRT tended to prevent sleep apnea. Interestingly snoring was not always
prominent, and trouble falling asleep and staying asleep predominated. Overnight sleep studies are probably underutilized in menopausal women. In another study, obese
women, and women with polycystic ovaries also had an increased risk of sleep apnea. Finally, in patients treated with a CPAP breathing machines for sleep apnea, if a partner can
change the pressure by remote control, one can maximize the therapy by establishing what minimal level of pressure inhibits the snoring and breathing problems. Back to Top
ASTHMA & SEXUAL FUNCTION
Asthma has been shown to interfere with
sexual function. Asthma is often worse at night, and breathing is easiest when sitting, worse when lying down. We often ask about shortness of breath with exercise, but many people are not able to enjoy
sexual activity because of breathing difficulties. This could be dealt with by using preventative inhalers, or by using other
forms of asthma therapy. Please bring this up if this is an issue. Back to Top
BEE STING IMMUNIZATION
Bee stings can cause severe immune reactions, and can even
lead to anaphylactic shock and death. 'Epipens' are available which enable an individual to self-inject epinephrine, giving extra time to get to the hospital. These are prescriptions which last
for up to two years before losing effectiveness. Immunotherapy has recently been shown to be good for long-term prevention. When shots are given over a period of
two years, and there is no more evidence of a positive skin test, there is a very good chance that the patient is immunized for life.
Back to Top PERSISTENT THIGH PAIN
Persistent thigh pain in exercisers often goes undiagnosed. A normal x-ray does not rule out the diagnosis of femoral shaft stress fractures
. MRI consistently makes the diagnosis, and should be considered in heavy exercisers and in patients who may have osteoporosis. Back to Top
CELL PHONE EXPOSURE
Recent information suggests that the radiation from cell phone exposure may affect short-term memory. Mobile phones in England will now carry health warnings. Even though there is no
proof that they are in any way dangerous, safety cannot be assured. Guidelines concerning frequency and duration of use are being developed. A recent article suggests that hands-free
kits, designed for protection, actually channeled three times as much radiation to the brain!
Back to TopSYSTOLIC BLOOD PRESSURE
Recent announcements from the National Heart and Lung Institute suggest that
systolic blood pressure (top number) is more important to control than the diastolic (bottom number). Strokes and heart failure occur more often with lack of systolic
control. Top number should be kept to 140, and bottom should be below 90. Back to TopERECTILE DYSFUNCTION
Erectile dysfunction occurs more commonly in overweight men
. Men with a waistline of 42 inches, were twice as likely as their thinner counterparts to have moderate to severe erectile dysfunction. Inactive men also were more likely to suffer. Back to TopVITAMIN B6 IN BEER
Vitamin B6 in beer
seems to decrease the risk for heart disease more than wine or other alcoholic beverages. Interestingly, homocysteine, a risk factor for heart disease,
rises with red wine and gin, whereas it is lowered by beer.
Back to TopMONOSATURATED FATS
Individuals fed monunsaturated (olive oil) fats with mashed potatoes, remained filled much longer than if polyunsaturated
fats were used. Rice was associated with less duration of satiety than potatoes. Different foods and oils can definitely satisfy hunger needs for longer periods of time than others. Monosaturated fats, which are good for the heart and blood vessels, have been found to better control appetite for longer
periods of time. Monounsaturated oils include canola (rapeseed), peanut, and olive oil. Back to Top
ASTHMA STEROID INHALERS
Asthma steroid inhalers have been shown to decrease bone
density when used in high doses over a long period. Inhaled steroids have been shown to reduce long-term lung damage, and chronic scarring in asthma, and are an important therapy for
asthmatics. But the least amount that can control the symptoms, the less effect on bones. By using other drugs like Singulair, Accolate. Or Tilade, one can reduce steroid needs. In
addition, Serevent spray reduces dosage need. Allergy-proofing the environment is important, as is using a spacer with the inhalant, and rinsing the mouth after use. A spacer captures
the big particles, which have the most side effects, while allowing the smaller steroid particles to get into the lungs. If one is on high-dose, long-term inhaled steroids, we should
consider doing a bone density, which is done in the office. We would encourage 1500 mg. of calcium, about 5 servings of calcium-containing food or supplements, as well as 400u of
vitamin D, as well as weight-bearing exercise. Do not be afraid to use the inhaled steroids. Respect them, and protect your bones. Women at high risk for osteoporosis should pay
particular attention to this new information!
Back to Top
CHOLESTEROL & PLANT STEROLS
Low-fat diets containing plant sterols were found to be twice
as effective as those without plant sterols in lowering cholesterol. Margarines including Take Control, and Benecol are commercially available in the US, and are high in plant sterols.
Instead of a drop of cholesterol of 10%, the results were almost 20%! Back to Top
HIGH CALCIUM AND LOSS
High-calcium, low fat diets in mice have been shown to lose weight at DOUBLE the rate
of mice on an identical low-fat diet with normal calcium. In a study of men, dairy intake of calcium was much more effective than supplements. Eat yogurt, low-fat
cheeses, and skim milk—three or four servings daily. Back to Top VARICOSE VEINS
Varicose veins have been treated with a stripping procedure which involves cutting the vein at both ends, and "stripping it
out". A new procedure, Iclosure, has been reported that involves the insertion into the vein of a catheter. This then provides radiofrequency energy to clot the vein. It is a brand
new procedure, but it appears to be a safe and effective advance. Hold off on varicose vein surgery until Iclosure is readily available. Back to Top HIGH FIBRE DIET
Many have noted a front-page article in the NYTimes stating that fiber does not prevent colon polyps. The studies quoted are disappointing, but are almost irrelevant. First, a high
fiber diet is still good to lower cholesterol, to promote good bowel function, to provide good nutrition—lots of fruits, grains, and vegetables. If this does not reduce the formation of colon
polyps, it is not relevant because a low-fat diet reduces polyps, as does an aspirin daily. With increasing awareness of colon cancer screening, especially in high-risk individuals, most colon
cancers should be preventable. Since it takes five to ten years to go from normal to polyp, to cancer, there is plenty of time to interrupt this development. These studies may not be relevant
as they were only a few years long, and it may be that the resulting lower incidence of polyps may not appear for ten years. Continue to eat a high fibre diet! Back to Top C REACTIVE PROTEIN
C reactive protein has been found to be an important predictor of heart attack. Individuals with high crp's were at greater risk than those with high ldl -cholesterol. Treatment consists of
more aggressive exercise, dieting, and use of statin drugs. NEJM, Mar., 2000 Back to Top GENITAL HERPES
Genital herpes is now found in 25% of sexually active adults.
Only 20% of those with herpes are aware that they have it. It has been found that about 1 day per month, in both men and women, they can shed the virus without symptoms. This had
not been studied before. It is suggested that people with herpes should use condoms, which can often, but not always, prevent spread. It is not yet studied as to whether use of
acyclovir, Valtrex, or Famvir preventatively will reduce the risk of transmission. Anyone interested in being tested for herpesvirus type II, can come in for an evaluation, and the
question of preventative acyclovir can be addressed.
Back to Top PROPULSID
Recent studies have shown that people using Propulsid for reflux disease (GERD) can have fatal arrhythmias in the face of heart
disease or electrolye (potassium, etc) imbalances. We tend to use it in low doses, and have never had any problems and it has been a very helpful drug in some patients with reflux. In late
March, 2000 it was taken off the market. Any of our patients on the medicine should call, and we will have to re-evaluate the treatment options. Back to Top
COLONOSCOPY SCREENING
There has been a lot of talk about colonoscopy lately. Katie Couric had an on air colonoscopy, and gave a lot of attention to colon cancer after the death of her husband at a young age.
The New York Times recently wrote an article on the benefits of screening colonoscopy. Jane Brody in the Times also suggested screening colonoscopy. A number of studies suggest that a
screening colonoscopy at age 50 could prevent many colon cancers that are not within the reach of the flexible sigmoidoscope, 60 cm. The colon is about 5 feet long, and
historically, colonoscopy is only indicated in patients with polyps on sigmoidoscopy, in patients with a family history of colon polyps or cancer, or in a few other conditions, like ulcerative colitis.
As you probably know Dr. Yaffe performs colonoscopies daily in the office. He has been a media spokesman for the American Cancer Society, discussing colon cancer prevention in local and national media.
It is obvious that there is increased attention to colon cancer prevention, and it is up to the insurance companies to decide that at least one screening colonoscopy at age 50 for men and
women is clinically indicated. Please contact Dr. Yaffe or Dr. Ruden to discuss this issue if it seems pertinent.
Back to Top VITAMIN C
Recently an article suggested that vitamin c can increase
vascular wall thickness, leading to vascular disease causing strokes and heart attacks. While the article seems legitimate, there have been many studies which suggest that vitamin c
exerts many beneficial effects. Several responsible groups have taken a wait and see attitude, to see if anyone else can reproduce these results. It seems prudent to try to get vitamin
c naturally in citrus. Until we see articles which reproduce the results in the recent study, we feel that if you can't get two servings of fresh citrus daily, then 500 mg. of vitamin c probably
outweighs the downsides of that moderate dosage. Stay tuned. Back to Top HOMOCYSTEINE
Homocysteine has gotten a lot of attention lately. It is an amino acid that has been found to be a risk factor for heart
disease, much like cholesterol. We can test homocysteine levels in the blood, and if elevated, there are strategies for lowering it. At the present it is not clear that intervention makes a
difference, but most clinicians are of the belief that it should be controlled.Some believe that 10micromol/l is the goal, others accept 15. It goes up in many conditions, including psoriasis, rheumatoid
arthritis, and with advancing age. Medications including glucophage, dilantin, the vitamin niacin, and possibly others that interact with folate metabolism, elevate homocysteine.
Smoking, poor quality eating, excessive coffee and heavy alcohol elevate homocysteine. Many ongoing studies are attempting to determine the optimal supplements to lower homocysteine level. It seems that 2 mg.
daily of folic acid is a food maximal dose of that vitamin. 1000 mcg of vit B12 may be helpful, as well as 500mg of vit B6. Right now we suggest about 1000 of folic acid, and a follow up
in 6 weeks. We can go to 2000, and add B12 1000, and B6 500 if necessary. A good b-complex may have all these B vitamins. Of course diet, exercise, etc. are part of the package, and
realize that homocysteine probably has about a tenth of the total risk for heart disease and other vascular problems.
Back to Top LYMERIX
Lymerix has been available for one year. It is a three part
vaccine, given once, than a month later, than a year later. Studies suggest that the one year booster dose may be given earlier. In an effort to maximize summer protection, we recommend the third dose
in early June. Assuming it takes two weeks to develop antibodies, by mid-June individuals would be maximally protected against tic bites leading to Lyme's disease. Back to Top |
