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.

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.

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.

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.

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.

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.

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.