Friday, July 31, 2015

Calcium Scan Can Predict Premature Death Risk

A scan of calcium deposits inside your arteries can help doctors deduce how long you’re likely to live, a new study has found.

The test, called a coronary calcium scan, uses a regular CT scan to look for calcium deposits in the three major arteries that carry blood away from the heart, said lead author Leslee Shaw, a professor of cardiology at Emory University in Atlanta.

People with the largest amounts of calcium in their arteries carry an early death risk that’s six times greater than those with no calcium deposits, researchers found in a 15-year study of nearly 10,000 patients.

“If you had no calcium or very small amounts, we were able to track over a very long time that you actually had a very outstanding survival,” Shaw said.

Calcium deposits develop as a response to plaque formation along the artery walls, Shaw said.
These plaques, which are caused by blood cholesterol, build up over time and cause arteries to narrow, leading to heart disease as the heart works harder to pump blood through the body.

If a plaque bursts, a blood clot can form on its surface, blocking blood flow and causing a heart attack, according to the U.S. National Institutes of Health. If the clot breaks free, it can flow into the brain and cause a stroke.

To prevent plaques from bursting, the body tries to harden them by depositing calcium salts over and around them, Shaw said.

In this new study, doctors referred 9,715 healthy patients in the Nashville area between 1996 and 1999 to a cardiology outreach screening program provided by the military’s Tricare Healthcare System. The patients underwent a calcium scan, and also provided a detailed history of their heart risk factors.

Wednesday, July 29, 2015

Wisdom Wednesday: Chasing Chemistry

Quintessential Applications (QA) is the format I use to evaluate all patients. It is a form of manual muscle testing based on excitation and inhibition of neural pathways. It uses the nervous system as a window to view the status of the human body.

However, the majority of the testing involves “chasing the chemistry” of the body.

The first pathways that are evaluated are all associated with inflammation. I frequently tell new patients, “If you can eliminate inflammation, 80% of your symptoms will resolve, regardless of the cause.” However, if you cannot reduce inflammation, you cannot properly evaluate or treat the underlying causes that are the ultimate goal of nutritional therapy.

Prostaglandins are the most common inflammatory pathway I find, accounting for 60% of my patient population. PG2 (prostaglandin 2) is released by damaged tissues and is magnified by the liver. While PG2 can be reduced by NSAIDS, like Advil, aspirin, or Aleve, I prefer to use omega 3 fatty acids, like fish oil or flax seed oil that form PG3 in the body. PG1 precursors (omega 6 fatty acids) like black current seed oil, borage oil, or evening primrose oil can also reduce PG2. The beauty of QA is that I can actually determine which one(s) will be most effective in reducing inflammation.

Fish oil is the most common anti-inflammatory supplement that will reduce PG2 inflammation. However, the better the patient’s diet (think fresh fruits and vegetables) the more likely that flax seed oil will work better than fish oil. Virtually all Americans are deficient in omega 3 fatty acids, unless they are supplementing their diet.

Monday, July 27, 2015

Low-Risk Prostate Cancers

A wide majority of U.S. men with low-risk prostate cancer are being treated for the disease even though “active surveillance” is an option, a new report finds.

The study data was collected in 2010 and 2011, and a lot has changed since that time in regard to the popularity of active surveillance, experts noted.

Active surveillance is “gaining acceptance among urologists and patients,” said study co-author Dr. Hui Zhu, chief of urology at the Louis Stokes Cleveland VA Medical Center in Ohio.

“Age-appropriate men should discuss the risks and benefits of screening with their physicians, and men with newly diagnosed localized prostate cancer should ask their physicians whether active surveillance is a good option for them”, he added

There’s been controversy for years about diagnosing and treating prostate cancer.  Tumors considered to be low-risk may never spread, but men have often been treated anyway.  But those treatments aren’t without risk.  Prostate cancer treatments can cause serious and lasting side effects, such as incontinence and erectile dysfunction, according to the American Cancer Society.

In 2011, the U.S. Preventive Services Task Force discouraged the use of routine prostate cancer testing.  One reason why was because of the odds that low-risk tumors would be treated.  But, despite that recommendation, many doctors continue ordering the prostate-specific antigen (PSA) tests.  Supporters of the test suggest that if the PSA leads to an over diagnosis of low-risk prostate cancers, that problem can be countered with active surveillance, the study authors noted.

Friday, July 24, 2015

Many Hospital Patients Not Asked About Supplements

Most hospitalized Americans aren’t asked if they take dietary supplements, such as multivitamins, a new study suggests. Photo by ClipArtLord

“If clinicians are unaware of possible drug-[dietary supplement] reactions, they may unknowingly provide a treatment plan or prescribe medications that could have an adverse reaction or interactions with the dietary supplement,” said study author Dr. Paula Gardiner.

She is assistant director of Boston Medical Center;s program for integrative medicine and health care disparities.

“Dietary supplements also affect physiological processes in the body and could have an impact on medical procedures like surgery, chemotherapy, blood work and many other treatments or procedures,” she added in a medical center news release.

Nearly 18% percent of American adults (more than 40 million) take dietary supplements, according to the 2012 National Health Interview Survey.

The most commonly used dietary supplements are vitamins and minerals, the U.S. Centers for Disease Control and Prevention reports.  But other supplements may include herbs, amino acids or other substances, the study authors pointed out.

The study, published recently in the journal Patient Education and Counseling, looked at 558 hospital patients, more than half of whom (60%) used dietary supplements.

Of those 333 patients, only 36% had use of supplements documented at admission to the hospital.  Only 18% told a health care provider about their dietary supplements use, and only one in five were asked about dietary supplement use by a health care provider, the study found.

Wednesday, July 22, 2015

Wisdom Wednesday: Magnetic Resonance Imaging

Magnetic resonance imaging or MRI was developed from nuclear magnetic resonance (NMR) in the 1970’s by Dr. Raymond Damadian. NMR had industrial uses for evaluating structural components. Dr. Damadian used NMR to study potassium ions in the human body and proposed that tumors could be visualized with the images he was able to generate.

In simple terms, an MRI is a giant electromagnet is which the patient is placed. The entire room is shielded in copper to block out external FM radio waves. When the magnet is turned on, all the water molecules in the body line up with the magnetic field. The water molecules also absorb FM radio waves generated by the MRI.

When the magnet is turned off the water molecules resume their normal orientation. This has two measurable effects: First, the molecules emit the same FM radio waves they absorbed. Second, the molecules “wobble” slightly as they reorient, creating their own magnetic field.

This data is stored in the computer showing where all the water molecules are located throughout the human body. The computer then can generate holographic images depicting the location of the water.
There are also two sets of images. The T1 views are created from the FM signal from the water molecules. The T2 images are built from the data from the magnetic “wobble”. Comparing the T1 to T2 images yields additional insight as the images highlight tissues quite differently.

Bone, being virtually devoid of water, is imaged as an absence of any signal. So MRI is quite limited in its’ ability to “see” bone. However, tumors, infection, and even fracture involve the inclusion of water so these pathologies actually light up very well on MRI.

Monday, July 20, 2015

St. John’s Wort vs Prozac

Researchers at Adelaide University compared the reported adverse drug reactions to St. John’s wort, an herbal treatment for depression, with fluoxetine, a prescription antidepressant which includes Prozac.

It found both can cause serious side effects such as dangerous increases in body temperature and blood pressure. Both treatments also caused side effects such as anxiety, panic attacks, dizziness, vomiting, amnesia and aggression.

“There is a common belief that because something is natural and can be purchased from a health food shop without a prescription, it’s safe,” says researcher Claire Hoban.

“People need to start thinking of St. John’s wort, and other herbal medicines, as a drug and seek advice from a qualified healthcare practitioner to be sure they use it safely,” she says.

Between 2000 and 2013, there were 84 reports of adverse reactions to St. John’s wort and 447 to fluoxetine, [notes] the study published in Clinical and Experimental Pharmacology and Physiology.

Fewer people use St. John’s wort and adverse reactions for herbal medicines largely go unreported because they are not considered drugs, say Hoban.

There were more severe reactions to St. John’s wort, 11.9% of reports compared to 6.7% for Prozac.
The big concern is using St. John’s wort and prescription antidepressants together because this can lead to serotonin syndrome inducing gastrointestinal upsets, hemorrhage, confusion, inattention and even death, she said.

Friday, July 17, 2015

Severe Burns May Trigger Dangerous Shifts in Gut Germs

People who suffer severe burns may experience potentially dangerous changes in the 100 trillion bacteria inside their gastrointestinal (GI) tract, a small study suggests.

At issue is the breakdown of good and bad bacteria typically found inside a healthy person’s GI tract.

Researchers from the health sciences division of Loyola University Chicago observed that after a severe burn, four patients experienced a big increase in the number of potentially harmful bacteria and a corresponding drop in relatively beneficial bacteria.

The potentially harmful bacteria are part of a family that includes E. coli and salmonella.

Such an imbalance, known as “dysbiosis” has been linked to many conditions, including inflammatory bowel disease, obesity, rheumatoid arthritis and diabetes, study lead author Dr. Mashkoor Choudhry, a professor of surgical research, microbiology and immunology, said in a Loyola news release. He added that the imbalances might lead to complications responsible for most deaths in severe burn patients.

The findings, published in the July 8 issue of PLOS ONE, suggest that treating patients with live beneficial bacteria known as probiotics may help restore their microbiotic health. The findings might also apply to other trauma patients, including those with traumatic brain injuries, Choudhry said.

Wednesday, July 15, 2015

Computerized Tomography

Computerized Tomography or CT scan is a marriage between x-ray and a computer. This has several advantages over x-ray. First the images have much more detail than plain film.

Second, the data can be manipulated to depict various planes through the body – frontal, sagittal, coronal, etc. - much like MRI. They can even be viewed in 3D. Finally, the level of x-ray exposure (ionizing radiation) is much reduced.

CT scan, just like plain x-ray, differentiates tissue based on density. The more dense the tissue, the more x-ray is absorbed, the less strikes the computer receptors, the lighter the shade. So bone (very dense) shows up as white and air shows up as black. All the other tissues are in between, showing up as varying shades of gray.

Again, just like x-ray, CT scan sees bone extremely well and the absence of bone (think bone tumor or fracture) is readily seen in contrast. By comparison, MRI sees soft tissue very well, but does not image bone readily. I’ll review MRI in detail next week.

Motion is a real issue for all imaging studies. X-ray solves this issue by taking single exposures in a tenth of a second. CT scan and MRI have issues in this regard as they collect data over a long period of time. So tissues that move, like the heart, lungs, and the digestive tract cannot easily be captured. Blood will appear black as it courses through the arteries and veins of the body.

High speed CT scans eliminates motion allowing clear images of moving tissue. This study can visualize calcium deposits in the artery walls of the heart. The radiologist rates the amount of calcification as the “calcium score”. High calcium scores have led some physicians and many patients to fear calcium intake as a cause of heart disease. However, that fear is misplaced.

Monday, July 13, 2015

Common Antidepressants Linked to Higher Fracture Odds in Menopausal Women

Women prescribed a common class of antidepressants to ease menopausal symptoms may face a long-term rise in theirs for bone fracture, a new study suggests.

The antidepressants in question are selective serotonin eruptive inhibitors (SSRI) medications such as Celexa, Paxil, Prozac and Zoloft.

Besides being used to treat depression, these drugs are often prescribed as an alternative to hormone replacement therapy (HRT) to tackle hot flashes, night sweats and other problems that can accompany menopause.

However, “SSRIs appear to increase fracture risk among middle aged women without psychiatric disorders,” wrote a team led by Dr. Matthew Miller of Northeastern University in Boston.

The team added that the effect seems to be “sustained over time, suggesting that shorter duration of treatment may decrease [this effect].”

Findings from the study were published June 25 in the journal Injury Prevention.

Researchers sifted through data from the PharMetrics Claims Database, which collects information on drug treatments involving roughly 61 million patients nationally. They focused on more than 137,000 women between the ages of 40 and 64, all of whom began SSRI treatment at some point between 1998 and 2010.

They found that women in the SSRI group faced a 76% higher risk for fracture after a single year of SSRI use, compared with the non-SSRI group.

Friday, July 10, 2015

Are Too Many Young Americans Getting Antipsychotics for ADHD?

A growing number of teens and young adults are being prescribed powerful antipsychotics, even though the medications aren’t approved to treat two disorders – ADHD and depression – they are commonly used for, a new study shows.

Researchers found that antipsychotic use rose among children aged 13 and older from 1.1% in 2006 to nearly 1.2% in 2010. And among young adults – people aged 19 to 24 – antipsychotic use increased from 0.69% in 2006 to 0.84% in 2010.

Of concern to some experts are the conditions for which many of these antipsychotic prescriptions are being written, namely attention-deficit hyperactivity disorder (ADHD) and depression. Currently, the U.S. Food and Drug Administration approves this class of drugs for psychiatric conditions such as psychosis, bipolar disorder, schizophrenia or impulsive aggression tied to autism.

But the new report finds that by 2009, 52.5% of younger children (aged 1 to 6), 60% of older children (aged 7 to 12) and about 35% of teens who got an antipsychotics were diagnosed with ADHD.

“ADHD is the main diagnosis being targeted by antipsychotic treatment in children and adolescents – this is not an adequate diagnostic indication,” said Dr. Vilma Gabbay, chief of the Pediatric Mood and Anxiety Disorders Program at the Icahn School of Medicine at Mount Sinai in New York City.

The study was funded by the U.S. National Institute of Mental Health (NIMH) and led by Dr. Mark Olfson, from the department of psychiatry at Columbia University in New York City.

In their study, Olfson’s team tracked data on antipsychotic prescriptions from a database that includes roughly 60% of all retain pharmacies in the United States. The database includes prescription information on approximately 1.3 million children, teens, and young adults, the researchers said.

Wednesday, July 8, 2015

Wisdom Wednesday: X-ray Imaging

Imaging studies are an integral aspect of practice. However, they are not to be used as a screening tool with the possible exception of trauma. Today, most hospitals do not x-ray the spine of automobile accident victims, unless there is evidence of fracture on physical examination.

The best example of using x-ray as a screening procedure is the traditional chest x-ray taken whenever you are admitted to the hospital. There is no good reason to do so, it’s just convention. Chest x-rays are the most difficult x-rays to read. Statistically, the damage we cause through ionizing radiation far out weights the diagnostic value of the routine chest x-ray. However, reduced lung sounds, rales, chest pain and other exam findings may warrant a chest x-ray.

In the 1970’s, when I was in Chiropractic College, we were taught to x-ray every new patient. I started out doing just that. However, my first new patient that was an infant challenged my thinking. I did not x-ray that little baby and began to use discernment rather than just following the rule.

This was reinforced by my postgraduate studies in radiology. Radiologist are taught that the need for x-ray is based on history and physical examination. Was there trauma? Are there symptoms of pathology that might be revealed on x-ray? Are some of the orthopedic and neurological tests indicative of the need for x-ray? Can this patient be adjusted safely without the aid of an x-ray?

The more I used these analytical tools, the less often I took x-rays. Eventually, I sold my x-ray equipment. Now, when I feel x-rays are needed, I send the patient to a local radiologist who will take digital films of very high quality and give me an interpretation of their findings, at a very reasonable fee. It’s always nice to have another physician, with somewhat different training and experience, give you their findings to augment your own.

Monday, July 6, 2015

FDA Tells Food Industry to Stop Using Artificial Trans Fats

In a move that it says is designed to protect the heart health of Americans, the U.S. Food and Drug Administration said Tuesday that food manufactures have three years to remove artificial trans fats from the nation’s food supply.

The FDA ruled that partially hydrogenated oils - the major source of trans fats in the American diet - are no longer “generally recognized as safe,” the designation that for decades has allowed companies to use the oils in a wide variety of food products.

The FDA has estimated that removing partially hydrogenated oils from food could prevent as many as 20,000 heart attacks and 7,000 deaths from heart disease every year.

Partially hydrogenated oils are most often found in processed foods such as baked goods like cakes, cookies, and pies; non-dairy creamers; microwave popcorn; frozen pizza; margarine and other spreads; vegetable shortenings; and refrigerated dough products like biscuits and cinnamon rolls.

Companies have until June 18, 2018, to either reformulate their products and remove all partially hydrogenated oils, or petition the FDA to permit specific uses of the oils, the agency said Tuesday.

Food manufacturers have voluntarily lowered the amounts of partially hydrogenated oils in food products by 86% since 2003, and continue to remove them from products, according to the Grocery Manufacturers Association.

Despite this, even savvy consumers still are being exposed to minute levels of trans fats from partially hydrogenated oils, added Susan Mayne, director of the FDA’s Center for Food Safety and Applied Nutrition.

Friday, July 3, 2015

Surgery May Help Teens with Frequent Migraines

Migraine surgery may be an effective choice for teens who haven’t gotten relief from standard treatment, a small study suggests.

In the study, researchers at Case Western Reserve University School of Medicine in Cleveland reviewed the medical records of 14 patients, with an average age of 16.

In teens with migraine who haven’t responded well to other treatments, “migraine surgery may offer symptomatic improvement of migraine headache frequency, duration and severity in patients with identifiable anatomical trigger sites,” wrote the study’s authors.

However, at least one headache expert questioned the value of the procedure, citing a possible placebo effect.
Results of the study were published in the June issue of Plastic and Reconstructive Surgery.

Migraines are recurring bouts of moderate to severe head pain, according to the U.S. National Institutes of Health. As many as 8% of children and teens experience migraines, according to background information in the study.

Options for treating migraine in teens include over-the-counter pain relievers, the nasal medication sumatriptan (Imitrex), and a preventive medication called topiramate, according to the study authors. A previous study found that nearly one-quarter of teens treated still had migraines after treatment.

The current study looked at whether or not surgery might be an effective option for these teens.

The surgery involved is actually a plastic surgery procedure that decompresses a nerve or releases a trigger point that is believed to cause the migraine. The surgery was developed after doctors noticed that migraine patients who underwent certain cosmetic procedures, such as a forehead lift, had fewer headaches afterward.

Wednesday, July 1, 2015

Wisdom Wednesday: Fitbit

My family got me a Fitbit Surge for my birthday in April. So this is a personal review after using this product for almost two months.

If you remember, I wrote a blog “Apple Watch Takes Tech Giant into New Territory” posted on September 19, 2014. The medical slant on this piece was that if the watch was not disease specific, few people would take advantage of the technology. Of course, I disagreed. General health is the goal and the parameters for this endeavor are not disease specific.

My Surge is designed to be worn 24/7, but needs to be recharged every 5 days or so. If I wear it at night, it will track my sleep habits. Good quality sleep is huge. It is a primary factor in AF and a host of other health issues. However, I find wearing a watch, or even my wedding band uncomfortable while sleeping. I have done it a couple of times and the data is very interesting. I seemed to have solved my sleep issues with my current nutritional/exercise regime so for the time being, no sleep data for me.

Activities of daily living (ADL) are also recorded. It will track how many steps you take, how many miles you walk, and how many flights of stairs you climb each day. It sends you a congratulatory email when you reach particular milestones. On our recent trip to the Outer Banks of North Carolina, we stayed in a three story house for a week. I got the “hiker’s award” for climbing stairs that week and have exceeded 10,000 steps per day on several occasions.

My primary use for the Fitbit is tracking my exercise activity. It is great for cycling and running as it has a GPS link that accurately tracks your movement. It displays heart rate, mph, distance and time. When you link it to your computer it can display a map depicting your course, including elevation, speed, heart rate and caloric burn.

I can’t use it for swimming as the Surge is not waterproof. However, I can enter any exercise activity into the “dashboard” on the computer link and it will calculate caloric burn based on the activity and time entered.