Daily Health and Medicine News

Cancer Treatment News: Making cancer treatment less onerous for patients

Making cancer treatment less onerous for patients

Questions about costs, timing and how to find the right treatment protocol can weigh heavily on patients, especially those who must travel great distances to meet with specialists or get a second opinion.

It doesn’t have to be that way, said Steve Bonner, chief executive of Cancer Treatment Centers of America (CTCA), a for-profit cancer-treatment network with hospitals in the Chicago, Tulsa, Philadelphia and Phoenix metro areas.

CTCA is launching a fixed-price product that offers a comprehensive diagnostic evaluation and treatment plan for four of the biggest cancer types that’s guaranteed to be delivered within three to five business days. Patients who still need additional testing after five days can complete the process at no additional cost.

“For the first time in oncology, we believe, you know what the services are you’re going to get, you know what the prices are going to be and you know how long it will take,” Bonner said.
More transparent pricing

The flat-price charges range from $10,000 for prostate cancer on the low end to $14,500 for lung cancer. A comprehensive work-up and treatment plan for breast cancer runs $12,200 while colorectal cancer costs $11,400 for employer health plans, health insurers or patients who pay out of pocket. At the end of the five-day process, patients are free to take the written treatment plan to a competing cancer treatment facility if they wish.

“In health care today, it’s rare that you know what the price is before you make a buying decision,” Bonner said. “This is our first step in that direction.”

Cancer Treatment Centers of America’s effort to make pricing more transparent comes at a pivotal time in U.S. medicine. The health-reform law that President Obama signed in March of 2010 and rolls out over the next few years calls for a variety of methods to raise health-care quality while holding down costs. It includes initiatives aimed at making health-care providers more accountable and health-information technology more widely used. It’s also reshaping financial incentives so doctors and hospitals that achieve the best health outcomes can share in the savings they generate.

Astronomical finding may help treat cancer patients

Astronomers studying stars and black holes have discovered that heavy metals emit low-energy electrons when exposed to X-rays at specific energies – a finding they say could lead to safer and more effective cancer treatments in the future.

The finding raises the possibility that implants made of gold or platinum can allow doctors to destroy tumours with low-energy electrons, while exposing healthy tissue to far less radiation than is possible on Friday, the researchers said.

“As astronomers, we apply basic physics and chemistry to understand what’s happening in stars. We’re very excited to apply the same knowledge to potentially treat cancer,” study author Sultana Nahar of Ohio State University was quoted as saying by LiveScience.

Computer simulations by the researchers suggested that hitting a single gold or platinum atom with a small dose of X-rays at a narrow range of frequencies produces a flood of more than 20 low-energy electrons.

These ejected electrons can kill cancer, shredding their DNA. So doctors can embed many heavy-metal nanoparticles inside and around tumours, then hit them with a tailored shot of radiation, the researchers said

The resulting electron shower can obliterate a tumour and the process would greatly reduce a patient’s radiation exposure compared to most current radiation treatment methods.

For their research, presented at the International Symposium on Molecular Spectroscopy held recently in Columbus, the scientists built a prototype device that showed that specific X-ray frequencies can free low-energy electrons from heavy-metal nanoparticles.

While the machine needs to be developed further, it’s providing a proof of principle for the potential cancer treatment technique, the astronomers said. “This could lead to a combination of radiation therapy with chemotherapy using platinum as the active agent.”

The researchers came up with the new potential cancer treatment after studying the space. Specifically, they were trying to understand what different stars are made of, based on how radiation flows through them and emanates from them.

The team constructed complex computer models to simulate these processes. The models clued them into how heavy metals such as iron behave when they absorb different types of radiation.

Iron plays the dominant role in controlling radiation flow through stars. But it is also observed in some black hole environments, which produce some types of X-rays that can be detected from Earth, the researchers said.

They said, “That’s when we realised that the implications went way beyond atomic astrophysics. X-rays are used all the time in radiation treatments and imaging, and so are heavy metals – just not in this way.

“If we could target heavy metal nanoparticles to certain sites in the body, X-ray imaging and therapy could be more powerful, reduce radiation exposure and be much more precise.”

2 Biotechs, 1 Promising Cancer Drug

It’s not often you find two companies with market caps below $350 million partnered on a drug, but such is the case for perifosine, where tiny Aeterna Zentaris (NAS: AEZS) licensed the cancer drug to only slightly larger Keryx Biopharmaceuticals (NAS: KERX) .

Yesterday, the duo announced that they had completed enrollment in a phase 3 clinical trial testing perifosine in patients with advanced colorectal cancer.

X-PECTing success
I’m a sucker for a good clinical-trial acronym, and they really don’t get much better than “X-PECT” (Xeloda + Perifosine Evaluation in Colorectal cancer Treatment), especially since the companies have a good reason to expect positive results.

As the name implies, the trial is testing perifosine in combination with Roche’s Xeloda in patients who have failed other colorectal-cancer treatments — including Sanofi’s (NYS: SNY) Eloxatin, Amgen’s (NAS: AMGN) Vectibix, and/or Erbitux from Bristol-Myers Squibb (NYS: BMY) and Eli Lilly (NYS: LLY) .

In a phase 2 trial, Xeloda plus perifosine improved median overall survival over Xeloda alone by 6.8 months. This was a small trial of only 35 patients, but it’s still fairly impressive since that’s a 62% improvement on Xeloda alone. Phase 3 data is typically not as impressive as phase 2 results, but there seems to be some leeway for less impressive results to still show a statistically significant effect.

The trial was run under a Special Protocol Assessment, or SPA, with the Food and Drug Administration. Essentially, an SPA means the FDA has agreed that the trial is sufficient for approval. If the trial meets its primary endpoint and nothing new crops up, the FDA should approve the drug.

With a primary endpoint of overall survival — the gold standard in oncology — it seems like a bit of overkill to have an SPA, but there’s really no downside to having one. Just don’t expect the presence of an SPA to increase the chance of a clinical trial success.

When can we expect results?
The companies will probably give us a timeframe in the coming months for their estimate of when the trial will be completed, but we can do some back-of-the-envelope calculations to get close.

The results will be revealed after 360 patients in the study die. It took less than 16 months to enroll the 430 or so patients in the trial. If you assume the patients enrolled steadily, the 360th patient was enrolled about three months ago; the enrollment probably accelerated as we went through the trial, but this is a rough estimate. The median survival of patients in the phase 2 trial was 10.9 months and 17.9 months, depending on whether the patients received perifosine and Xeloda or just Xeloda. Let’s call it an average of a 14-month survival, which would happen approximately 11 months from now. Add in a month or two to crunch the numbers, and we should have the data this time next year.

Which one?
Both companies have drugs in development beyond perifosine, but if you’re betting on the cancer drug as the near-term catalyst, I think Keryx is probably the more appropriate choice. The royalty structure wasn’t disclosed in the licensing deal, but assuming the royalties are in the 10% or less range, Keryx will retain a majority of the financial benefit from perifosine in the U.S. market.

While I’ve focused on perifosine’s potential in colorectal cancer, I’d be remiss if I didn’t point out that it’s also being tested as a treatment for a blood cancer called multiple myeloma. The success in colorectal cancer is important, but it would really take a failure of perifosine in both indications for it to be a complete flop.

Learn to thrive once cancer treatment is complete

University of Colorado Cancer Center is looking for cancer survivors to take part in a clinical trial of a program aimed at helping them manage their condition more effectively. The program, called “Cancer: Thriving and Surviving,” is adapted from a successful effort helping people manage other chronic conditions like diabetes.

With more than 12 million cancer survivors nationwide, researchers would like to know if programs that have proven effective in helping people manage fatigue, frustration, pain and stress might also work for managing similar issues associated with cancer.

“A cancer survivor’s journey does not end after treatment. And therapies and surgeries can have long lasting physical and emotional impact. If proven effective, ‘Cancer: Thriving and Surviving’ can help improve the quality of life for cancer survivors worldwide”, said Betsy Risendal, PhD, assistant research professor in the Colorado School of Public Heath and the trial’s principal investigator.

Cancer survivors can suffer numerous long-term complications including depression, difficulty concentrating and neuropathy.

The program, the first of its kind in the country, has been adapted especially for cancer survivors. Covered topics include communication with health care providers and family members regarding a cancer diagnosis, how to improve and maintain health and problem solving. The instructors, many of whom are themselves cancer survivors, are specially trained to lead the sessions.

The class will meet weekly for about two hours and for seven weeks. Cancer survivors and their caregivers are welcome to participate. Three metro area classes begin in August, and they may be offered in northern and southern Colorado and rural communities later this year.

There are some eligibility requirements for the study, which is being conducted by CU Cancer Center and funded by the Centers for Disease Control. To find out if you are eligible to enroll, you may call the community research partner, the Consortium for Older Adult Wellness at 303-956-8908 or toll free at 888-900-2629. Two classes begin next month on the Anschutz Medical Campus in Aurora: Aug 3 from 6:00 p.m. – 8:30 p.m. and Aug. 4 from 9:30 a.m. to 11:00 a.m.

Learn to thrive once cancer treatment is complete

The University of Colorado Cancer Center is Colorado’s only National Cancer Institute-designated comprehensive cancer center. Headquartered on the University of Colorado Denver Anschutz Medical Campus, the center is a consortium of three state universities (Colorado State University, University of Colorado at Boulder and University of Colorado Denver) and six institutions (The Children’s Hospital, Denver Health, Denver VA Medical Center, Kaiser Permanente Colorado, National Jewish Health and University of Colorado Hospital).

Arthritis Treatment News: FDA Nixes Expanded Golimumab Use

FDA Nixes Expanded Golimumab Use

July 27, 2011 — The US Food and Drug Administration (FDA) did not approve an application for a proposed label expansion for golimumab (Simponi, Janssen Biotech, Inc.), which would include stopping the progression of joint damage. Janssen Biotech, Inc., which is part of Johnson & Johnson, announced Friday that it received a “complete response” letter from the agency.

The “complete response” letter signifies that the FDA has completed its initial review of the application but that changes must be made before the application can be approved.

Brian Kenney, a company spokesperson, would not reveal what additional information the FDA has requested. He also declined to comment on the FDA’s safety concerns.

FDA spokesperson Morgan Liscinsky told Medscape Medical News that federal regulations prevent the FDA from disclosing any information from a new drug application that has not been approved by the agency.

“We look forward to collaborating with the FDA to fully understand the requirements needed to support this proposed label expansion,” Jerome A. Boscia, MD, vice president and head of immunology development at Centocor Research & Development, a division of Johnson & Johnson Pharmaceutical Research & Development, LLC, said in a statement.

Janssen Biotech, Inc., plans to request an end-of-review meeting with the FDA to thoroughly understand the details of the complete response letter and discuss future steps to achieve approval, according to a statement.

The expanded approval application for Simponi sought to expand the physician label to include inhibiting the progression of structural damage, such as joint damage; inducing major clinical response and maintenance of reduction of signs and symptoms; and maintenance of improved physical function in the treatment of moderately to severely active rheumatoid arthritis.

Simponi is a human monoclonal antibody that targets and neutralizes excess anti-tumor necrosis factor (TNF)-α, a protein that can cause inflammation and damage to bones, cartilage, and tissue. It is an FDA-approved treatment for reducing signs and symptoms of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. It is 1 of 5 TNF blockers on the market.

According to David S. Pisetsky, MD, PhD, professor of medicine and immunology in the Division of Rheumatology and Immunology at Duke University Medical Center and director of Duke University Arthritis Center in Chapel Hill, North Carolina, TNF blockers generally do everything listed under Simponi’s proposed label expansion.

“TNF blockers in general fulfill all those criteria,” he told Medscape Medical News after hearing about the application. “But did they have enough data in those particular studies to support those claims?”

The FDA’s initial thumbs down probably relates to a shortage of data from clinical trials to support the claims, he said. It usually relates to the number of patients and duration of the study. “That’s my guess,” he said.

Psoriatic Arthritis

Psoriatic arthritis affects about 25 percent of those with psoriasis and early diagnosis is critical to reduce the risk for joint destruction. Researchers are trying to identify potential markers that may be useful for determining which patients are at greatest risk for the condition.

Psoriatic Arthritis
Psoriasis is a chronic skin condition characterized by red, scaly patches on the skin, typically over the scalp, knees, elbows, and torso. According to the National Psoriasis Foundation, the condition affects about 7.5 million Americans.

Psoriatic arthritis is an inflammatory condition that is sometimes associated with psoriasis. It occurs when the body’s immune system mistakenly attacks the joints. This leads to a breakdown of joint cartilage and bone damage. Christopher Ritchlin, M.D., Rheumatologist with the University of Rochester Medical Center in Rochester, NY, says in addition to bone destruction, psoriatic arthritis patients can have abnormal bone growth, which can cause the joints to fuse and become immobile.

Roughly 25 percent of psoriasis patients develop psoriatic arthritis. Some signs include: painful and swollen joints, back pain, morning stiffness, fatigue, loss of range of motion in the joints, nail changes and redness and pain around the eyes. Most patients develop the condition about ten years after the first signs of psoriasis. However, Ritchlin says about 15 percent of patients develop joint symptoms before the onset of the skin disease and another 15 percent develop the skin and joint symptoms at about the same time.

Getting Treatment
Initial treatment for psoriatic arthritis tends to be conservative. Doctors may start with nonsteroidal anti-inflammatory medications to reduce pain, swelling and inflammation. If these drugs cause too many side effects or fail to reduce symptoms, the next step is to use disease modifying antirheumatic medications, then biologic response modifiers. Exercise is important to keep joints strong and flexible. Patients may also use heat and cold treatments to soothe joint pain.

Ritchlin says patients with psoriatic arthritis often see a dermatologist, rheumatologist and family health care provider. It’s important for all physicians involved in the patient’s care to work together to provide the safest and simplest forms of treatment.

Early diagnosis of psoriatic arthritis is critical to reduce the risk for joint destruction. However, in patients who develop the joint symptoms before the skin disease, Ritchlin says the diagnosis can be tricky because the joint signs may be mistaken for rheumatoid arthritis. Since there are no specific diagnostic tests for psoriatic arthritis, doctors must rely on medical and family history, physical exams, diagnostic X-rays and blood tests (that rule out rheumatoid arthritis). Ritchlin is also looking at potential markers that may be useful for identifying patients at greatest risk for developing psoriatic arthritis.

Shock Wave Therapy and PSGAGs: Effects on Arthritis

We know osteoarthritis (OA) is a painful, degenerative condition that can result in lost training days, poor performance, and early retirement in equine athletes. We also know that there are many different treatments for OA. What we don’t know, and what a team of researchers recently investigated, is how certain arthritic joint tissues–such as the subchondral bone (the layer of bone that lies directly underneath the layer of articular cartilage that lines the ends of the bones and lends support to the joint)–respond to treatments such as extracorporeal shock wave therapy (ESWT) and polysulfated glycosaminoglycans (PSGAGs, a common joint therapy).

“Previous studies have shown that both extracorporeal shock wave therapy and intramuscular administration of polysulfated glycosaminoglycans have a beneficial effect in some horses with OA, and these therapies are widely used in equine practice,” said Chris Kawcak, DVM, PhD, Dipl. ACVS, professor and equine surgeon at the Gail Holmes Equine Orthopaedic Research Center at Colorado State University.

“The subchondral bone is commonly involved in joint disease and is therefore a potential site of action for ESWT and PSGAGs,” relayed Kawcak.

To determine if ESWT or PSGAGs “targeted” the subchondral bone, Kawcak and colleagues created a chip in the middle carpal joint (the lower joint in the knee) in one knee of 24 healthy horses. Three groups of horses were then either treated with ESWT, PSGAGs, or neither. The team evaluated the treatment results by measuring the levels of various markers of cartilage and bone turnover (i.e., synthesis and degradation) in blood and synovial (joint) fluid samples; evaluating bone density; and assessing the structure and composition of the bone.

Key findings of the study were:
PSGAG had no significant effect on any bone variables; and
ESWT also did not affect the subchondral bone itself, but increased levels of the bone marker called osteocalcin in the blood were significantly higher in horses treated with ESWT than in the control group.

“Unlike other published studies, we did not find any physical evidence of subchondral bone remodeling, and, thus, healing following either ESWT or PSGAG administration,” relayed Kawcak.

Back Pain Treatment Today: 10 things you might not know about low back pain

10 things you might not know about low back pain

1. One-half of all working Americans admit to having back pain symptoms each year; 80 percent of the population will experience a back problem at some point in their lives.

2. Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.

3. Most cases of back pain are mechanical or non-organic — meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture, or cancer.

4. Americans spend at least $50 billion each year on back pain — and that’s just for the more easily identified costs.

5. Fifty to 70 percent of individuals without back pain will have positive MRI’s for disc bulges or herniations. In most cases, the disc is not the cause of pain.

6. Spinal manipulation and other hands-on treatments (active release, myofascial release, trigger point therapy, Graston technique) are better treatments then anti-inflammatory drugs or muscle relaxers for acute low back pain.

Visit www.mishockpt.com/videos to see Dr. John utilizing myofascial release as well as the Graston technique.

7. Spinal stabilizer muscle strength, endurance and motor control essential in limiting the debilitating effects of low back pain and preventing chronicity. There are specific physical therapy exercises that can be done to enhance these muscle groups.

8. The sacroiliac joint and the muscles around the spine and pelvis are the most common cause of low back pain.

Visit www.mishockpt.com/videos to see Dr. John perform hand-on therapy to the sacroiliac joint.

9. Chiropractic and physical therapy care are more cost-effective in the treatment of low back pain versus medical care (drugs, injections, surgery, MRI, X-rays).

10. There is hope for your low back pain. You can improve your condition today. Mishock Physical Therapy & Associates can help.

If pain is limiting you from doing the activities you enjoy, give Mishock Physical Therapy a call for a free phone consultation at 610-327-2600 or e-mail your questions to mishockpt@comcast.net . Also, visit us online to learn more about our treatment philosophy, our physical therapy staff, and our four convenient locations in Gilbertsville, Skippack, Phoenixville, and Barto at mishockpt.com Our mission is to exceed the expectations of our patients by providing excellence in care and service. We are here to serve you. Dr. Mishock is one of only a few clinicians with doctorate level degrees in both physical therapy and chiropractic in the state of Pennsylvania.

Doctor Discovers Solution to Back Pain

Dr. Michael Ho announced a new solution to back pain and is giving 50% off to all readers of the Calgary Herald. “I guarantee it’ll help your back pain,” says Dr. Ho. Each household is limited to only 2 belts.

We have all suffered with some sort of pain and know how debilitating it can be.

Walter Rose never had pain until the day he awoke to crippling pain two years ago. “I woke up one morning and I couldn’t even get out of bed. My back seized up and I took a pain pill hoping the pain would disappear. It never did,” recalls the 50 year old fireman.

This story is very similar recounts 51 year old Peggy. “I had worked in the bank for over 20 years and my neck, back and shoulders are in pain everyday. Sitting all day has caused me to hunch over and I get terrible back pain.”

Both Walter and Peggy were sent from one specialist to another and yet the pain never went away. Finally both wound up at Dr. Michael Ho’s clinic in Toronto. To their surprise, Dr. Ho’s treatments were different and he also provided them with a treatment belt to use at home. After a few treatments, both patients couldn’t believe the results.

” My biggest regret is that I didn’t know of Dr. Ho sooner. I honestly don’t suffer with the pain anymore and I tell everyone about Dr. Ho and his belt. I must of bought 3 or 4 as gifts. This is the best purchase I have ever made,” exclaimed Peggy.

“Treatments can provide temporary relief, but the condition usually reoccurs. The reason is because the patient is lacking the home therapy treatments between visits and therefore the level of improvement may not be sufficient. Back pain treatments can cost thousands of dollars with no guarantees. This is why most people think they have to live with the pain. There needed to be another solution that people could afford and still be just as effective” says Dr. Michael Ho.

Dr. Michael Ho is a Canadian doctor that is internationally recognized for his expertise in treating pain.. His specialized technique and devices target the cause of the pain in order to effectively treat and provide long-term relief for his patients.

“In order to get immediate and long-term relief, you must understand the cause of the pain. Pain can be caused by muscle tension, stress and misalignments which can cause tense and tight muscles, putting excess strain on the joints and nerves causing a pinching effect that prevents proper circulation and oxygen to the muscles. When the muscles are deprived of oxygen, cramping, numbness, stiffness, swelling and pain can occur.”

“Canadian clinics have all the equipment and resources to help the patients, but the problem is that to effectively treat chronic pain, the treatments must be ‘ more frequent and for a longer period of time. ” This was very frustrating because I knew the patient couldn’t afford the time or money to come to the clinic everyday.

This is why Dr. Ho developed a home use back pain belt that allowed patients to treat themselves at home whenever they experienced any pain.

“After years of development, we were able to develop a Decompression Belt for back pain that is extremely effective in relieving pain, easy to use, they are affordable and you can use them at home.”

Dr. Ho has developed a clinical grade decompression belt that can be used in the comfort of your own home, allowing you to help relieve your back pain immediately at home – saving you the time, money and pain. Dr. Ho’s new Decompression Belt is endorsed by medical professionals and customers that have suffered with long-term, chronic back pain.

“Every patient with back pain should be wearing this belt because it gives you core strength and support in your spine, and a traction effect for great pain relief. The great thing is that patients with chronic back pain can wear this belt and get their life back. They can feel more confident, be more active, and do things that they love doing,” explains back specialist, Dr. Rice.

DR-HO’S Decompression Belt expands to allow traction, providing spinal support and pain relief for the lower back. Wrapped firmly around your waist, the Decompression Belt will provide pain relief in as little as 20 minutes, even if you have suffered with back pain for many years. By decompressing your disc, you relieve the pressure on the nerve, allowing better circulation & less pain in your back & legs.

“I have used many modalities to treat my patients, but nothing has been as effective as this decompression belt. I developed this belt for people suffering from herniated discs, pinched nerves, sciatica and back pain caused by aging and poor posture Whether you are working, walking or sitting, this belt can help protect, support and treat your back. Most importantly, you can be pain-free,” explains Dr. Ho.

Since making the Decompression Belt available to the public, we have sold out of inventory multiple times. “As a proud Canadian company, we saved a limited number of belts for readers of the Calgary Herald”. As an exclusive special, Dr. Ho has agreed to give the first 100 customers 50% off as well as include DR-HO’S Magic Instant Heat Therapy Pad absolutely free!

“The Decompression Belt will help eliminate your back pain fast, safe and without the use of drugs. You don’t have to live with your back pain any longer.”

Oh, my aching back! Does that back pain require rest or Rx?

Back pain is a common ailment, affecting more than 80 percent of adults at any given time. According to the American Academy of Family Physicians, most people experience back pain at some point in their lives — and 90 percent get better within a few weeks or respond well to non-surgical treatment, such as home care or physical therapy.

But how does a person know if their aching back requires medication and rest, or surgery?

Back pain doesn’t discriminate by age or fitness level, but most frequently strikes men and women between ages 30 and 50 due to the natural aging process, as well as sedentary lifestyles and lack of exercise — or too much exercise. Unfortunately, the risk of low back pain from disc disease or spinal degeneration increases with age.

Causes

Injury-related back pain is most often “acute” — meaning the pain usually goes away on its own, with rest. Back pain that lasts more than three months may be due to disease or aging, and is termed “chronic.”

Most low back pain follows some trauma to the back, but according to the National Institute on Neurological Disorders and Stroke, other causes include: degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, joint or disc irritation, or congenital spine abnormalities.

Obesity, smoking, stress, poor physical condition and certain sleeping positions are also causes of back pain.

The most common culprit, however, is muscle strain caused by lifting something too heavy or twisting the back in an unusual way.

A more severe consequence of lifting something heavy is the herniated disc. The disc is a cushion between two adjacent bones in the back. If the disc’s thick outer coating is damaged, its soft, spongy inner core can leak or bulge, causing nerve inflammation.

When damaged discs press on the nerve roots, then pain can radiate down the sciatic nerve (the large nerve that carries nerve fibers to the leg), and sciatica or leg pain can result.

Degenerative disc disease can cause pain due to normal age-related wear, but some people experience this pain more intensely than others. Other back issues develop from chronic conditions such as spinal stenosis, the narrowing of the spinal canal due to arthritis and bulging discs.

Treatment options

Most back pain can be resolved with non-surgical treatment. If these methods are unsuccessful, see your doctor for a medical evaluation. He or she may prescribe oral medications or physical therapy as a first step. If conservative methods do not relieve your pain, surgery may be a treatment option — especially if other symptoms suggest problems with a spinal nerve.

These symptoms include back pain that lasts longer than a few weeks, awakens you at night, or accompanies other symptoms such as muscle tightness and stiffness, severe leg pain (in the buttocks or radiating down the back of the leg), a tingling sensation in the leg, a change in bowel or bladder habits, or fever, chills and sweats.

A medical exam and imaging tests (X-ray, MRI, CT scan or ultrasound) can diagnose the source of back pain. If your back pain requires surgery, the good news is, most spine surgery techniques are now minimally invasive, involving a small incision, less scarring and shorter recovery time. Both orthopedic physicians and neurosurgeons perform spinal surgery.

Types of surgery

One surgical method, microdiscectomy, removes a small portion of bone or disc material through a tiny incision of the lower back without disturbing joints, ligaments and muscles in the lower spine.

Laser procedures are not covered by insurance and have very limited indications, so I probably would not promote this. Even more extensive decompression and fusion procedures can be done with minimally invasive procedures.

After minimally invasive back surgery, a patient may be able to get out of bed and walk on the same day or the day after surgery, and return quickly to walking, daily activities, and work as early as one to two weeks after the procedures, followed by physical therapy to regain strength.

Dr. Linda D’Andrea is a member of the medical staff at Pottstown Memorial Medical Center, Department of Surgery. She is a graduate of Temple University School of Medicine and completed a general surgery internship at the Medical College of Pennsylvania. She also completed a residency in orthopedics at Boston University Medical Center. Spinal fellowships were completed at Shriners Hospital for Children in Philadelphia and Temple University Hospital. D’Andrea is board certified by the American Board of Orthopaedic Surgery and is in practice with Brandywine Institute of Orthopaedics, 600 Creekside Drive, Pottstown.

Healthy Nutrition News: Restaurant Calorie Counts Often Inaccurate

Health Buzz: Restaurant Calorie Counts Often Inaccurate

Study: 1 in 5 Restaurant Calorie Counts Is False

Calorie counts posted in chain restaurants are often inaccurate, and one in every five meals packs at least 100 more calories than advertised on the menu, new research suggests. Boston scientists measured the calories in 269 items from nearly 50 fast-food and sit-down eateries, including McDonald’s, Burger King, Chipotle, Olive Garden, and Outback Steakhouse. They found that only 7 percent of the foods were within 10 calories of what the restaurants claimed, according to a study published Tuesday in the Journal of the American Medical Association. Seventeen foods had at least 273 more calories than stated on the menu. Restaurants were most likely to underestimate low-calorie fare like soups and salads, and overestimate the calories in less-healthy choices like pizza and chips and salsa. “The calories on your plate may be quite different from what you think you are getting, and the trouble is you can’t tell,” study author Susan Roberts, a senior scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, told USA Today. “I have a Ph.D. in nutrition, and I can’t tell if my dinner is 500 or 800 calories just by looking at the plate, and our study shows you can’t rely on the restaurants’ numbers for an individual meal.”
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10 Things That Can Sabotage Your Weight Loss

So you’ve got your plot to drop the extra pounds. It certainly seems sensible: You’re going to eat right, eat less, and exercise. After weeks of declining dessert and diligently hitting the treadmill, you step on the scale and…only 2 pounds gone? You conclude that something or someone must be sabotaging you.
Mexico medications
You might be right. While experts say weight loss can always be reduced to the simple “calories in, calories out” mantra—meaning if you eat fewer calories than you burn, you’ll lose weight—a host of oft-hidden saboteurs may be meddling with the balance. Here’s a smattering of them:

1. Treating healthy foods as low-calorie foods. “A lot of times they’re not consistent,” says Scott Kahan, codirector of the George Washington University Weight Management Program in Washington, D.C. So while whole grains, avocados, and nuts might be kind to your heart or cholesterol levels, dieters who binge on such foods can, before they know it, add hundreds of calories to the day’s total. Enjoy calorie-rich healthy foods, dietitians urge, but ration them out: a quarter of an avocado on a salad or a small handful of almonds for a snack.

2. Shunning shuteye. Some research has linked shorter sleep duration to a higher body mass index (a measure of body fat) and increased hunger and appetite. Additionally, if you’re tired, you might be prone to grab a sugar-laden treat for a midday boost, skip the gym, and have takeout for dinner to avoid cooking. It’s a vicious cycle. Aim for seven or eight hours a night. [Read more: 10 Things That Can Sabotage Your Weight Loss.]
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How to Stay on a Diet to Lose or Maintain Weight

A diet is only as good as your ability to stick to it. Research has found that most plans will help you lose weight, regardless of type—low-fat or low-carb, for example. What counts is whether you can stay on it long-term. And with restaurant meals, dinners with friends, and hot fudge sundaes to tempt you, adherence is an understandable challenge. Here are five tricks for making your diet stick:

1. Gather the troops. You need support, be it from a friend, a group like Overeaters Anonymous, or even an online community. Research suggests those who go it alone are most likely to fall off the wagon. That’s why some diet plans have a formal support component—Weight Watchers connects dieters via weekly meetings, while Jenny Craig members are assigned counselors for advice and encouragement. If you’re not comfortable talking about your weight face-to-face, log online. By signing up for the free program PeerTrainer, for example, dieters can interact and track each others’ weight-loss progress, pose questions, and swap diet and exercise tips. “It’s important to have people who will pick you up when times are tough and cheer you on when you have successes,” says registered dietitian Dawn Jackson Blatner, author of The Flexitarian Diet. Plus, she adds: “Healthy habits are contagious.”

How to eat your way to lower blood pressure

If you need to lower your blood pressure, consider swapping bread, crackers and cookies for foods like milk, yogurt, tofu and soy beverages.

According to a U.S. study published this week in Circulation: Journal of the American Heart Association, partly replacing refined carbohydrate with foods high in soy or milk protein may help prevent and treat high blood pressure.
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In the study, 352 adults with high-normal blood pressure or mild hypertension were assigned to take 40 grams of either soy protein, milk protein, or a refined carbohydrate supplement, every day for eight weeks.

The supplements had a similar sodium, potassium and calcium content and were taken twice daily in water or juice.

Compared with the carbohydrate supplement, using soy protein and milk protein significantly lowered systolic blood pressure. (Systolic blood pressure is the top number in a blood pressure reading and measures the pressure when the heart contracts.) Refined carbohydrate supplements did not change blood pressure.

The reduction in blood pressure was small on an individual level, but was considered important on a population level. It’s a decrease that could lead to 6 per cent fewer stroke-related deaths and a 4 per cent lower rate of heart-disease deaths.

Earlier studies have found that daily soy protein helps lower blood pressure. Soy protein’s blood pressure-lowering effect may be due to its phytochemical (isoflavone) and phosphorus content.

The well known DASH diet, rich in low-fat dairy products, has also been shown to guard against hypertension, presumably because of its calcium and potassium content – two minerals linked with healthy blood pressure. (DASH stands for Dietary Approaches to Stop Hypertension.)

The results of this week’s study demonstrated that milk protein also has a blood pressure-lowering effect. Milk protein contains enzymes and amino acids that have been shown to lower blood pressure.

One in five Canadians has high blood pressure, a condition that can cause heart attack, stroke, heart failure and kidney damage. High blood pressure is defined as 140/90 mm Hg or higher. If you have diabetes, 130/80 mm Hg is considered high.

An equal number of Canadians have pre-hypertension, a blood pressure reading between 130-139/85-89 mmHg. Unless lifestyle changes are made to bring blood pressure down, 60 per cent of people with pre-hypertension will develop high blood pressure in four years.

The following diet modifications can help you prevent hypertension, or lower your blood pressure if you already have it.

Limit refined carbs

A steady intake of white starches and sugary foods can cause salt retention and elevate blood pressure. Switch to 100-per-cent whole-grain foods such as whole-grain whole wheat bread and crackers, brown rice, whole-grain pasta, large flake or steel-cut oats, quinoa and unhulled barley.

Avoid sugary drinks; limit dessert to once or twice per week. Get used to adding less sugar or honey to coffee and tea and breakfast cereal.

Add milk or soy protein.

The DASH diet includes two to three low-fat dairy servings per day. One serving includes 1 cup skim or 1 per cent milk, 1 cup of 0.1 to 1 per cent milk-fat (MF) yogurt and 1.5 ounces of 7 per cent MF cheese.

To increase your intake of soy protein, use unflavoured or unsweetened soy beverages in place of, or in addition to, milk. Add firm tofu to stir-fries, toss soy beans into salads and snack on roasted soy nuts or edamame.

Increase fruit and vegetables

The DASH diet is also plentiful in fruit and vegetables: seven to 12 servings each day. These foods are excellent sources of potassium, a mineral that helps blood vessels relax and causes the kidneys to excrete more sodium. In fact, studies show that people with a low daily intake of the mineral are more likely to develop high blood pressure and suffer a stroke.

Adults need 4,700 milligrams of potassium each day. Excellent sources include bananas (1 medium = 422 milligrams), apricots (4 = 362 mg), prune juice (½ cup = 373 mg), cantaloupe (1 cup = 440 mg), spinach (½ cup cooked = 443 mg), Swiss chard (½ cup cooked = 508 mg) and sweet potato (1 small = 285 mg).

Eat legumes and nuts

Include beans and/or nuts in your diet four times per week. These foods are a good source of vegetable protein and they’re rich in magnesium, a mineral that promotes normal blood pressure.

Add chickpeas, kidney beans, black beans and lentils to salads, soups, pasta sauces, tacos and chilies. Snack on a small handful of unsalted, raw or dry roasted nuts.

Watch sodium

Excess sodium has been linked with elevated blood pressure in many studies. Canadians, aged nine to 50, require 1,500 milligrams of sodium each day. With age, our body becomes more sensitive to the blood pressure-rising effect of sodium and daily requirements drop to 1,300 milligrams for adults aged 50 to 70 and 1,200 milligrams for people over 70.

For most adults, the daily upper sodium limit is 2,300 milligrams. If you’re over 50 or have high blood pressure you should consume less.

Limit or avoid alcohol

If you drink, limit yourself to one to two drinks per day or a weekly maximum of 7 for women and 9 for men. Drinking more than two drinks per day increases blood pressure and escalates the long-term risk of developing hypertension.

Lose excess weight.

If you’re overweight and have hypertension, losing five kilograms will lower your blood pressure. In some cases, weight loss can reduce or eliminate the need for blood pressure medication. If you need to cut calories, replace refined grains and sweets with more fruit and vegetables.

Leslie Beck, a Toronto-based dietitian at the Medcan Clinic, is on CTV’s Canada AM every Wednesday.

More Supermarkets in Poor Neighborhoods Not Enough to Change Eating Habits

A study published in the Archives of Internal Medicine found that people on a tight budget don’t necessarily spend their money on healthier foods, even when they have easier access to them. The survey, which studied the eating habits of several thousand people in a number of cities in the U.S. for more than a decade, showed that making more fruits and vegetables available to poor families was not incentive enough to make them change their diets. Cheap snacks and fast food still remain the preferred choices.

Nutrition experts and policy makers have long argued that the scarcity of grocery outlets in low-income neighborhoods, a.k.a. “food deserts,” is one of the reasons why obesity and other lifestyle-related diseases are so widespread among the poor. That is why many, this writer included, have called on supermarket chains to set up shop in these deprived areas.

While the omnipresence of fast food places can explain a preference for burgers and fries, it comes as a surprise that easier access has done little to increase consumption of healthier food items.

“This raises the serious issue of how we get people to eat healthy,” said Barry Popkin, director of the Nutrition Transition Program at the University of North Carolina in Chapel Hill and lead author of the study.

Limiting the number of fast food joints and opening more grocery stores in these neighborhoods is obviously not enough. In 2008, the Los Angeles city council tried just that. It ordered a moratorium on new fast food restaurants and gave supermarkets incentives to expand their presence. “We had great success in building grocery stores, but selecting healthful foods from a store is up to the individual, said Jan Perry, Los Angeles councilwoman and one of the sponsors of the legislation.

The issue of money, of course, comes first to mind. The healthiest foods are routinely the most expensive ones. Especially the costs for fresh fruits and vegetables have dramatically gone up in recent times. Obviously, it makes no sense to stock a lot of items people can’t afford. Perishable foods will always be pricier because of their shorter shelf life and extra expenses for refrigeration and labor.

“The cheapest calories come from fried foods, chips and sodas,” said Dr. Jonathan Fielding, director of the Los Angeles County Department of Public Health, who wrote a commentary for the study. What matters most for people with limited funds is to get the biggest bang for their buck. In terms of calories per dollar, fast food wins out every time.

Still, nutrition experts insist that improving the food environment is an important step to change people’s eating habits. “It can’t happen in a vacuum,” said Gwen Flynn, director of community health and education at the Community Health Council in Los Angeles. “What is needed is a comprehensive plan to change what people are eating, including community education and government and private subsidies for healthful foods.”

Programs like these actually exist already, although they are few and far in between. For instance, the U.S. Department of Agriculture (USDA) sponsors what it calls the Expanded Food and Nutrition Education Program (SNAP-ED), which provides free health- and nutrition education for food stamps recipients.

Educating the public is never an easy task, no matter what the subject is. Getting people to change their ingrained eating habits is probably one of the hardest things anyone can try. Predictably, there are plenty of voices decrying the involvement of government in such personal matters and their arguments are not always unjustified. However, most would agree that only informed choices are truly free choices. If people don’t know they have alternatives available to them, they will just keep doing what they’ve been doing before, whether it’s in their best interest or not.

Knock knock! You’ve got meal

Dubai: Thousands of well-heeled residents used to eating or ordering from fast-food outlets and restaurants are now turning to healthier nutrition services where dieticians and chefs work together to customise meals for them.

As buzzwords like calorie count and healthy eating at such ‘clinical and catering’ services catch on, refuelling on the run is no longer about making do with takeaways from fast-food outlets or quick-fix meals ordered from neighbourhood restaurants.

Right Bite, Lively, Health Factory – and now Balance Café – there are at least four such nutrition services that operate in Dubai alone, supplying up to five nutrition-packed meals a day that cover everything from breakfast, lunch and dinner, to AM and PM snacks.

At monthly charges that could go up to Dh3,000 per head, the meal plans don’t come cheap. But there are many takers as they are deemed healthy and hassle-free.

Sandra Gojkovic, Business Development Executive of Health Factory & Epicure Catering, said the 12,000 square foot kitchen in Al Quoz has served more than 4,000 customers over the past three years, with a current enrolment of “several hundred” individual and corporate clients.

The customer base is diverse and covers different nationalities, said Natalie Haddad, Founder of Right Bite, another large kitchen which works 24/7 in the same area. Without divulging the number of clients, she said they are catered to by over 100 staff, including 45 chefs, besides a fleet of 17 refrigerated vans that deliver meals to their doorstep from 5am to 10pm every day.

“Over 50 per cent of our clients are business executives who want to eat healthy or find it convenient to order from us. We also have entire families, students, pregnant women and people with health conditions like diabetes, blood pressure or heart problems,” said Haddad.

While catering establishments bring to mind assembly-line processes churning out food in quick succession to a large, undifferentiated pool of clients, these nutrition services claim their meals are highly personal with special care taken to keep them healthy.

“There can be no conveyor-belt style, one-solution-fits-all way to meaningful health,” said Sumit Kumar, Chef, Balance Café, whose meal plans are set to roll out.

Open boxes ready to be filled at a counter at Right Bite reveal the attention to detail. Every box of every dish carries a label that not only has information about the client, his/her age and location, but also specific remarks about his health condition and the ingredients that have to be added or omitted from the dish.

For example, many customers had opted for baked zatar fish, one of the dishes on the menu of the day when XPRESS visited the kitchen. But as the labels let on, each had a different specification: ‘allergic to garlic’, ‘no artichoke’, ‘not spicy’, ‘no bellpepper’, ‘no couscous, ‘add vegetable’, ‘add rice’ etc.

The menu, which changes every day, has a host of options that customers can choose from. Haddad pointed to a Saturday menu for lunch which includes at least five main dishes: chicken and whole wheat spaghetti with alfredo style sauce, riz bil lahem (rice with meat), baked tandoori fish with garlicky eggplant and potato, yakhnit bazilla (green peas and carrot stew with vermicelli rice) and chicken mortadella salad wrap (wholewheat tortilla stuffed with chicken mortadella, cucumber, lettuce, mushroom, carrot and cream cheese).

This comes with a side-dish like Spanish flat beans or vegetarian ratatouille salad, followed by a skinny dessert as an afternoon snack like apple tart, chocolate walnut bites or bagel chips with tomato salsa dip.

Sumptuous as the meals may sound, the calorie count is carefully factored. For example, at Health Factory, a package designed for a low metabolism client who needs to lose weight and stay in shape allows him 1,300 to 1,100Kcal per day. At Dh2,950 a month, it consists of three meals and two snacks throughout the day, all of which remain within the prescribed limit and help burn the excess fat in the body.

Chefs customise meals based on recommendations of dieticians with whom clients consult before choosing a meal plan. Regular follow-ups are also conducted to make necessary changes. (See Box: How It Works).

Dr Archana Ainapure, dietician at Health Factory, said, “Proper meal planning involves many considerations, such as meeting nutritional requirements, individual or family needs, economic factors, time and energy levels and availability of foods.”

At Balance Café, an Ayurvedic lifestyle consultant makes recommendations with the same aim of achieving the right balance between different foods required by the body. “A healthy individual who is moderately to highly active, needs to consume a meal that is based on 55 to 60 per cent carbohydrates, 20 to 25 per cent protein and the remaining 15-20 per cent fats,” said Kumar.

Healthy meal plans are also about regulating the right intake of salt, sugar or other micronutrients, said clinical dietician Hala Barghout at Lively. “Healthier meals contain less salt, less sugar and less saturated fats, besides other ingredients. That’s why they are called healthy. They deliver higher energy levels and boost the body’s immunity.”

Besides the food preparation, special care is also taken to ensure that they are delivered in refrigerated vans and insulated cooler bags to ensure that the food remains healthy. All hot items are put into microwave safe boxes which can be instantly heated and consumed. Fresh and full cooler bags are delivered on a daily basis, with empty cooler bags from the previous day being returned.

Customers vouch for the punctuality and benefits of the meal plans. “The food is delicious and since I have a hectic schedule with lots of meetings around town, logistics like timing of delivery and packaging are important to me,” noted Serge L., a customer of Health Factory, adding that the coordination with the dietician and the resulting calorie consumption plan had resulted in a weight loss of 19kg in five months.

A young couple based in Dubai said the whole-day meal plans from Right Bite made life simpler for them. “We don’t have to shop for our kitchen, cook or clean up. We love the variety of ready-to-eat foods we get at our doorstep, and we know they are healthy for us.”

Jessica, a 30-year-old sales executive who lives as a paying guest in Bur Dubai, said she switched to a healthy nutrition service last year after surviving on oily meals procured from a small-time restaurant for two years. “But I can afford only a lunch package. I wish they would bring down the costs,” she said, without naming the nutrition service.

How It Works

Customers must first have a consultation with a dietician to plan a perfect diet as per their need. They then get to choose from dishes on a menu that changes every day of every week. The information is then passed on to the chefs who customise meals accordingly. While the initial consultation in most services is free, there is a fee for the follow-ups which may result in changes needed along the way.

Take your pick

There are four major such services operating from Dubai with different monthly packages varying from around Dh1,000 to Dh3,780 per head:
Right Bite: Meal plans include full package (breakfast, morning snack, lunch, afternoon snack and dinner); AM package (breakfast, morning snack, lunch and afternoon snack); PM package (lunch, afternoon snack and dinner); Executive lunch package (lunch main entrée with a side-dish and afternoon snack) and One meal package (lunch or dinner main entrée with a side-dish) etc.
Lively: Full meal package (breakfast and morning drink, AM snack, lunch (appetiser and main meal), PM snack, and dinner (salad and main meal); Executive meal package or lunch package (appetiser, main dish, PM snack, fruit and bottle of water); Afternoon package (lunch, PM snack and dinner); Daylight package (breakfast, AM snack, appetiser with main dish (lunch) and PM snack etc.
Health Factory: Miracle (three meals and two snacks for those with low metabolism); Detox (28-day programme that helps rid you of toxins); Serenity (for busy folks, covers lunch and snacks); Titan (Meals rich in proteins and carbs for high metabolism, sports people); Baby Love (specially designed for pregnant women) etc.
Balance Café: Meal plans to be unveiled shortly.

Extension Office Introduces New Nutrition Specialist

This week Scotland County’s Missouri Extension Office welcomed Jennifer Mayfield as the new Regional Health and Nutrition Specialist. Mayfield will assist with dietary and health issues in Scotland and eight surrounding counties.

Mayfield has an impressive background in nutrition. She holds a Bachelor of Science in Nutrition and a Master of Arts in Family Systems from Southeast Missouri State University. She is also a Licensed Medical Nutrition Therapist in the state of Nebraska and plans on receiving a similar title in Missouri. For the past seven years, Mayfield worked in Nebraska, serving as a North American Missionary to the Santee Sioux Reservation and working as the tribe’s nutritionist, specializing in diabetic health. She also assisted with the Northern Ponca tribe’s dietary program.

During her time in Nebraska, Mayfield wrote and received grants for the tribes that focused on using traditional tribal foods and methods of gardening to reduce obesity, diabetes, and other health concerns in the groups.

Mayfield’s objective for Scotland and the surrounding counties is to provide opportunities for nutritional education and training while working to meet the needs of community members.

“The main goal right now is to find out what the community wants and needs and to be as helpful as I can,” stated Mayfield.

She noted that community health issues could be anything from diabetes and heart disease risk to a lack of fresh fruits and vegetables or walking areas. Mayfield’s plan is to tackle those issues and also work with other area specialists to utilize resources that are already available to Scotland County residents such as the Healthy Lifestyles Initiative.

Dental Care News: Kool Smiles Expands Access in South Carolina

Kool Smiles Expands Access in South Carolina; New Greenville Location Marks Third South Carolina Office Opening In Six Months

Kool Smiles, a leading dental health provider for children and adults, announced the opening of a new office in the K-Mart Plaza by Mills Avenue in Greenville. The company’s second office in Greenville opened May 23, offering residents convenient new options for affordable dental care. The new location is the third new office opened in South Carolina during the last six months, with other new openings in North Charleston and Columbia.

The Centers for Disease Control and Prevention (CDC) reports that tooth decay currently affects more than 19 percent of U.S. children aged 2-19-more than any other chronic infectious disease. Untreated pain and infections may lead to developmental problems, such as eating, speaking, playing and learning.

Senator Joel Lourie of Columbia feels the new offices come at a great time for South Carolina residents. “We are pleased to have Kool Smiles in our communities and appreciate the valuable services they will provide to children and families. At a time when more and more people are struggling to meet their medical and dental expenses, it is encouraging to see an organization like Kool Smiles open their doors for service.”

Representative Bruce Bannister of Greenville shares Lourie’s enthusiasm. “The community is delighted Kool Smiles has opened a second facility in Greenville, SC,” Bannister says. “Nothing is more important to a child’s health than receiving quality preventative dental care.”

The newest location was opened in response to a strong need in the Greenville area. “This expansion reflects the depth of our commitment to this community,” explains Dr. Polly Buckey, DDS, MS, a board certified Pediatric Dentist who serves as spokesperson for Kool Smiles. “With these additional dentists, we’re positioned to better meet the needs of our patients for preventative and restorative care.”

The new Kool Smiles office, which accepts most types of insurance, boasts a sophisticated electronic medical records system. But what most patients will notice first is the cheerful, family-friendly decor. There’s an indoor playground where kids can relax before and after treatment, and a large observation window so parents can keep a close eye on their children.

“The upbeat atmosphere of our offices puts patients of all ages at ease,” explains Dr. Buckey. “Children especially are more relaxed, so they have a more positive experience and are more likely to return for recommended preventative care. It’s all part of our effort to transform the way people feel about and care for their teeth.”

“This expansion is further proof of the sea change we’re affecting in South Carolina dental care,” Dr. Buckey said. “Between 1999 and 2006, South Carolina’s number of licensed dentists enrolled in Medicaid nearly doubled, making it easier for children to find care. We’re thrilled to be part of this important advancement in accessible dentistry.”

Kool Smiles of Greenville Mills Avenue office at #3 K-Mart Plaza, approximately three miles from the other Greenville Kool Smiles at 3227 West Blue Ridge Drive, is within easy reach of most Greenville area residents. It’s just the latest of numerous locations Kool Smiles has opened in 2011, including new offices in North Charleston and Columbia, SC, Takoma Park, MD, New Orleans and Gretna, LA, San Angelo, TX, and Midwest City, OK.

To tour the new Greenville Mills Avenue Kool Smiles office or to book an appointment, please call (864) 438-0939. Those interested in employment opportunities may visit the Kool Smiles Jobs website.

About Kool Smiles

Kool Smiles is a leading dental health provider dedicated to expanding access to quality dental care for children and families in underserved communities. Kool Smiles dentists are proud to offer care to kids and adults with almost any insurance plan, including State Children’s Health Insurance Program (SCHIP), Medicaid and Tricare. Nationally, 97% of Kool Smiles patients plan to return and refer their friends and family. Kool Smiles also provides oral health education programs through partnerships with community schools and organizations.

The alarming state of oral health today is the foundation upon which Kool Smiles has built its mission and vision. Despite the United States’ status as the wealthiest country, the former U.S. Surgeon General concluded that oral care is the #1 unmet healthcare need for children. Over 50 percent of 5- to 9-year-old children have at least one cavity or filling, and that proportion increases to 78 percent among 17-year-olds. Oral health is essential to the general health and well-being of children and plays a critical role in their ability to succeed in school and acquire positive self-esteem.

Dental care pays dividends in overall health

While the economic crisis may have many necessities vying for scarce funds, skipping dental visits may be more costly in the long run. Difficult economic times often find people delaying or avoiding trips to the dentist, according to Deborah Locke, a licensed dental hygienist in New Jersey and New York with national board certification.

Downsized employees not only have lost medical benefits, but dental coverage, too, said Locke, who received her dental hygiene certificate from the University of Pennsylvania School of Dental Medicine in Philadelphia.

“People may not be aware of many subtle dental changes, because they don’t feel them or recognize them. This can result in delayed or skipped dental visits,” said Locke, a Marlboro resident who has been an active dental hygienist for 30 years. “It takes a trained dental professional to see small changes that if left untreated may develop into major costly dental problems or even medical diseases.”

The key to good dental health, she said, is education and knowledge.

“One of my key roles as a dental hygienist is to explain to patients the etiology of dental diseases and what individuals can do to prevent dental problems. These dental ‘issues’ if left unchecked could affect a person’s ability to eat properly, compromising one’s ability to maintain proper nutrition, which in turn may negatively impact one’s general health.

“Bleeding of the gums and inflammation [puffiness] in the gums is not a normal dental state,” said Locke, who has a Bachelor of Science degree in health education from New York University. “It is estimated that more than 90 percent of the population is afflicted with some level of gum disease, which is a slow, relatively painless process that, if left untreated, can result in bone degradation and eventual tooth loss.”

She said the dental office is the starting point for dental education.

“Ask questions about your mouth, the proper way to floss and brush, and what dental aids or rinses really work,” said Locke, who also earned a Master of Business Administration degree in health care administration from the Bernard M. Baruch College and Mount Sinai School of Medicine joint program in New York. “Education empowers you to take ownership of your dental and general health.”

Proper flossing and brushing of teeth, she said, are preventive actions that can be done at home. “We recommend brushing teeth with a soft toothbrush a minimum of twice a day, preferably after meals,” said Locke. “Daily flossing is critical to remove bacterial plaque between the teeth that, if not removed, forms calculus, or tartar, which can destroy the fibers that hold the teeth in place.”

Locke pointed out the benefits of daily flossing and the use of certain devices such as oral irrigators or water flossers. One of her patients who is in her 90s describes herself as an avid flosser. When Locke checked the woman’s teeth, she was very impressed. “Therewas no evidence of gum disease, no active infections, no mobility of the teeth. ‘What’s your secret?’ I asked her. She said that she flossed every day, even as a youngster before dental floss was readily available. She didn’t like the feeling of anything stuck to her teeth, so she used thread from her mother’s sewing kit,” Locke explained.

Locke states that good nutrition is key to good dental and overall health.

“Learn how to balance your intake of acidic and alkaline foods. Ingesting highacidic foods and drinks as well as improper tooth-brushing technique are the two main reasons for tooth sensitivity. Certain drinks like red wine, soda, and even ‘seemingly healthy’ fruit juice, can erode enamel, which is the outer layer of the tooth,” she said. “Moderate intake of these items and drinking more water, the wonder drink, are recommended.”

Achild’s primary or deciduous teeth, also called baby teeth, are very important, Locke said. “The deciduous teeth help the child speak and chew and are as important as the permanent adult teeth,” she said. “Check with your dentist or pediatric dentist to determine when you should bring your toddler in for his/her first dental visit.”

It may be recommended to start dental checkups when the deciduous teeth appear but not later thanwhen all the primary teeth have appeared, usually between 2½ to 3 years old, she said.

Locke, who is passionate about dental education, said that preventive care cannot be overestimated.

“If we, the dental professionals, educate, instruct and motivate our patients to take good care of their mouths, and to reduce the burden of infections, then we will be helping them to control their overall health as well,” she said, adding that poor dental health and hygiene cuts across socioeconomic lines.

Internet websites, such as the American Dental Association and the American Dental Hygiene Association, offer information on various dental topics. “Discuss these topics with your dental professional,” she said. “It’s another way to empower yourself.”

If lack of dental insurance or sudden loss of income prevents proper professional dental care, Locke suggests speaking with your dentist. “Honestly explain your financial situation and try to negotiate a financial plan,” she said. “Also, speak with friends and relatives about where they receive their dental care.

“Optimal dental health is a great investment,” she added.

For those with financial concerns, she suggested looking into low-cost dental clinics that are associated with hospitals or medical schools.

Cosmetic Dentistry El Monte – Angel Dental Care

Los Angeles, California – 07/19/2011 Let your smile shine as brightly as the warm summer sun during this beautiful summer season Angel Dental Care wants to promote healthy teeth as well as meeting your cosmetic dentistry needs. There is nothing more important to us than insuring that you and your family are cared for with the utmost professionalism and state of the art techniques and procedures currently available. We treat all of our clients with honesty and integrity providing services at exceptional prices with impeccable customer service. Angel Dentistry is located in El Monte which is centrally located near Los Angeles.

At Angel Dentistry we offer full mouth reconstruction as well as tooth reconstruction. Many times a patient will need to see multiple specialists to perform a full mouth reconstruction, however at Angel Dentistry we will provide all of the services in our full service office. In the event that another specialist is needed we will help you through every step of the process providing superior customer care. Seeing multiple specialists can really become costly to the patient so seeing one dentist is not only more affordable, but you receive one on one treatment from our professionals. If you are looking for the best family dental care in Los Angeles look no further. We are here to answer any and all of your questions whether it be about a particular procedure or making a payment plan.

Angel Dental care is a full service dental office that is able to help patients with a comprehensive list of procedures. Weather you just need a checkup or a root canal we offer many procedures and unbeatable prices. We have you and your entire family in mind and provide services for adolescents and adults. Here at Angel Dental care we want to show you how to properly care for your teeth. We want to promote healthy gums and teeth as well as care for more severe dental issues that may arise. Whatever it is you need we will provide you with outstanding care.

Stop Smoking News: Anti-smoking supporter’s new proposal

Anti-smoking supporter’s new proposal

A campaigner whose plan to ban smoking outside public buildings and transport stops was rejected has taken a new tact – banning smoking in key city spots.

George Wood, chairman of Auckland Council’s community safety forum, put forward a proposal that would stop smokers congregating outside city buildings and near public transport areas.

The idea failed to gain majority support at the forum’s meeting on Thursday night because councillors said smoke-free areas in the city cannot be enforced unless money is spent on creating a new bylaw.

Wood refuses to let that decision extinguish his idea and now plans to push for smoking bans in downtown Auckland in plazas like Britomart, Aotea Square and Albert and Myers parks.

“The issue is not dead. Ok, we didn’t get it backed, but we’ll continue working on it and refining it,” he says.

He’s pushing for the support of Sandra Coney, chairman of the council’s parks, recreation and heritage forum as most Auckland parks have become smoke-free.

Wood also believes creating a stigma around smoking in public will be enough to prevent people from lighting up.

“Public pressure is strong enough for people to stop smoking in open areas. The stigma alone is enough to stop them from doing it,” he says.

Wood ruled out fining smokers as a means of enforcement, saying it would be “taking it a step too far”.

He wants smoking in public banned because it causes mess and it is “harmful to other people”.

“People step outside for a cigarette and they don’t seem to care about others and what harm they’re doing by passive smoking.”

Expectant mothers who quit smoking help baby

Stockholm – Expectant mothers who stop smoking around the time of getting pregnant can eliminate the heightened risk of low birthweight, premature birth and associated brain damage from tobacco, according to British research.

A team led by Professor Nick Macklon, from the Department of Obstetrics and Gynaecology, University of Southampton, UK, studied data from some 50,000 pregnancies registered at the Southampton University Medical Centre between 2002 to 2010.

It found that babies from women who stopped smoking either immediately before or shortly after conceiving had a significantly higher birthweight than those from mothers who had continued to smoke.

Macklon said that babies in this group had also reached the same gestational age and head circumference as those born to mothers who had never smoked. The study, he said, gave mothers-to-be hard evidence that stopping smoking no later than in the early phase of pregnancy was beneficial for their baby.

Macklon said that low birthweight was ‘the most common negative outcome’ of smoking during pregnancy. Pointing to long-term effects, too, he warned expectant mothers who continued to smoke because they believed that a smaller baby meant an easier birth.

‘Smoking during pregnancy is not just bad for the mother and baby,’ Macklon said, ‘but for the adult it will grow into.’

The findings were reported at the annual meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Stockholm.

Stop smoking and drinking

The RF Ministry of transport has developed a draft bill aiming to forbid drinking and smoking at stations, on trains, airplanes and ships.

The bill suggests forbidding selling beer and any other alcohol at railway stations and stops. Smoking is to be forbidden in city public transport, on commuter and long-distance trains, in airplanes in case the flight lasts less than three hours, at railway stations and stops.

Smoking on commuter trains, in places not designated for smoking at railway stations, stops and on local and long-distance trains, on board sea-going and inland vessels and airplanes in case the flight lasts less than three hours will be punished by either a warning or a fine of 2,000 rubles.

In Europe, it will cost you 2,000 euro to smoke at a railway station. But then, they have sockets for e-cigarettes everywhere.

Asthma Treatment: Gecko can’t cure Aids, asthma

Health department: Gecko can’t cure Aids, asthma

THE Department of Health (DOH) on Thursday expressed alarm over the persistent folkloric practice of using geckos or (locally called “tuko”) as cure for acquired immune deficiency syndrome (Aids) and asthma.

In a statement, Health Secretary Enrique T. Ona said geckos frenzy is now the department’s serious concern even as health officials do not recommend using lizards as cure to said ailments.

“The use of geckos as cure, which is unproven and have no scientific basis, could be dangerous because patients might not seek the proper treatment for their diseases like asthma, which could become more serious and later, require hospitalization and other more complications as well as more expensive treatment. Further, this is likely to aggravate their overall health and put them at greater risk,” Ona said.

For diseases like asthma, he said there are now very effective treatments available at affordable prices that can provide relief from this ailment.

“With regular treatment, asthmatic persons can successfully control the symptoms and live a comfortable and healthy life,” he said.

For patients infected with Human Immunodeficiency Virus (HIV), Ona said antiviral medications that can control the progress of the disease are now also available.

However, the DOH did not categorically admit that there is a cure to such deadly disease.

Melda (family name withheld), a single mother who resides in a hinterland barangay of Cagayan de Oro, said she finds hard to look for a job until she was contacted to secure live geckos weighing 300 grams for P10 million each.

Beside her house situated at a semi-forested area, Melda caged two geckos weighing 200 grams each feeding it with cockroaches, rice and monggo.

“If it can make me rich and live a decent life, why would I refuse to find geckos?” she said.

She claimed that a European national tapped a Manila man to contact her for the said “big business.”

Treatment, not medicine, helps asthma patients feel better

Inhaling albuterol helps asthmatic lungs work better, but patients who get it don’t feel much better than those treated with a placebo inhaler or phony acupuncture, according to a U.S. study.

The results, which appeared in the New England Journal of Medicine, demonstrate the importance of, literally, caring for patients and not just providing drugs, said co-author Ted Kaptchuk of Harvard Medical School.

The findings also demonstrate the impact of the so-called “placebo effect,” or the phenomenon seen in clinical trials when people given inactive, fake “treatments,” such as a sugar pill or saline, show improvements.

“My honest opinion is that a lot of medicine is the doctor-patient relationship,” Kaptchuk told Reuters Health.

“A lot of doctors don’t know that, they think it’s their drugs. Our study demonstrates that the interaction between the two is actually a very strong component of healthcare.”

All of the 39 patients, each of whom had mild-to-moderate asthma, thought the placebos were just as effective as the real therapy.

Those who got albuterol reported a 50 percent improvement in symptoms. The ones who got phony albuterol said they improved by 50 percent as well, while those getting sham acupuncture had a subjective improvement rate of 46 percent.

The only thing that didn’t work as well, according to the patients’ impressions, was no therapy at all, with the asthmatics sent home after waiting for several hours. In those cases, patients reported 21 percent improvement.

Only when the researchers measured the patients’ ability to force air from their lungs was the benefit of albuterol clear. The so-called FEV1 volume improved by 20 percent with the drug, nearly three times more than the 7 percent increase in patients getting the fake acupuncture, ersatz albuterol or no treatment.

Fake acupuncture turned out to be the most convincing treatment and was done doing needles that retract into the handle instead of going into the skin. In addition, the needles were “inserted” into the wrong acupuncture points, said Kaptchuk, who is trained in the discipline.

Eighty-five percent of the people who got it thought they were getting a real therapy, compared to 73 percent who received real albuterol and 66 percent who were getting placebo albuterol.

“Patients could not reliably detect the difference between this robust effect of the active drug and the effects of inhaled placebo and sham acupuncture,” the researchers wrote.

They also said the findings show that a patient’s self-report can be an unreliable indicator of actual improvement.

Kaptchuk said the test may help resolve the longstanding question of whether placebo treatments, because they seem to show a benefit, actually affect the physical illness.

“But changing subjective outcomes is very important for us,” he said.

Salt therapy lets asthma sufferers breathe easy

Lifestyle – Hay fever victim Judy Murphy chronicles arrival of halotherapy treatment in Galway

When you suffer from asthma and hay fever – an estimated 470,000 Irish people do – feeling under the weather is a regular occurrence.
In winter you are more likely to get chest infections. In summer, if you also suffer from hay fever, as people with asthma often do, you can face days of sniffling, sneezing and watery eyes.

And it’s not just people with asthma who get hayv fever – according to the Asthma Society about 15 percent of the population suffer from the condition.

It isn’t pleasant. And while the medication available to sufferers has improved hugely over the years, a lot of us who suffer wish there was a less ‘chemical’ way of clearing our respiratory systems.

Hence the growing phenomenon of halotherapy – otherwise known as salt therapy – in the Western world, with a recent addition in Galway being the Salt Spa in the city’s Radisson Hotel.

The idea of gargling salt water for sore throats or using saline nasal sprays to relieve congestion is pretty familiar, but halotherapy takes it to a new level.

My first experience of breathing salty air was during a visit to Warsaw Salt Mines a couple of years ago. Deep underground, the air was so clean you could actually feel it entering your system. The mines are a major tourist attraction in the region, both for their amazing underground cathedral and the reputed benefits their salt offers to people with respiratory disorders.

The idea that salt had health benefits was first highlighted by a Polish doctor, Felix Bochkovsky in 1843, when he was dealing with patients in salt mines in the Ukraine. His research indicated that the people working in salt mines didn’t suffer from colds and respiratory diseases despite working in harsh conditions and having poor nutrition.

Since then, the idea of using natural salt caves – speleotherapy – has spread and it has been used in Eastern Europe for generations. It is especially popular in Russia. In fact, it was in Russia, in 1987 that a system was developed using underground salt rock that had been shaped into blocks.

That technique allowed the atmosphere of the salt mines to be recreated above ground. It was further developed into halotherapy in which a saline diffuser releases salty air into a special room where the walls and floor are covered by layers of salt. The machine produces and maintains the required level of natural concentration of salt micro-particles to create similar conditions to those found in salt mines. These are small enough to penetrate deep into your lungs.
Ireland has only adopted salt therapy relatively recently, with the first cave being opened at Maynooth in early 2009 by Dr Tamas Bakonyi, a GP from Hungary involved in a practice in Leixlip.

The Radisson is one of two salt caves that opened in Galway this year and while it’s designed to offer relief from various ailments, it also comes with certain luxuries, including soft lights, music, a salt waterfall and – most impressively – stalactites hanging from the ceiling. And there’s a 15-minute ventilation period between each session to allow the room to be purified and germ free for each new group.

Ann McDonagh, the manager of the Radisson’s Spirit One Spa, explains that the salt spa was the brainchild of the hotel’s former manager, Stephen Kennedy, who first experienced these treatment rooms in Central Europe and decided to introduce the concept to Galway. But, while some of them are minimal in design, the Radisson went for more add ons.

Acne Treatment News: Acne Treatment Basics

Acne Treatment Basics

Acne is a common skin condition that causes pimples or zits on the face, chest, back, and other areas. An estimated 60 million people in the United States have acne at some time during their lives. Acne is most common in teenagers, but can be a problem for people of all ages.

The first rule of acne treatment is never to pop or pick at pimples or zits. No matter how clean the skin seems to be, popping a pimple allows bacteria and other germs to get inside the protective surface layer of the skin which in most cases will cause a red spot or bump that will last much longer than the original pimple would have. In general, acne treatments try to deal with one of three basic causes of acne: clogged pores, bacteria on the skin, and excess oil production by glands in the skin.

Open clogged pores
There are many products available that claim to open pores. It’s important to remember that if you have acne, your skin is sensitive and needs to be treated gently. Choose mild a mild cleanser that won’t dry out your skin. Some products contain fine granules that act as a mild scrub or a low concentration of salicylic acid that acts as a mild peeling agent to help open pores. Be sure to wash skin once or twice a day, especially after exercising and after wearing makeup to remove sweat and other substances that can clog the pores.

Control bacteria
Some cleansers that are available over-the-counter (OTC) contain antibacterial agents including benzoyl peroxide. Topical products that are applied to the skin include gels, creams, and lotions that may contain benzoyl peroxide, sulfur, resorcinol, salicylic acid, lactic acid, or other antibacterial agents. You may develop dry, flaky, or irritated skin after using these products. For some people, side effects go away after about a month of use. Others need to stop using the product to cancel the side effect. Also be aware that benzoyl peroxide is a bleach which can cause blotches on colored clothing, towels, carpeting, and other textiles.

Isotretinoin’s Link to IBD: Examining the Evidence

Although no link between isotretinoin therapy and inflammatory bowel disease has been proven, the absolute risk for these disorders in conjunction with treatment appears small.

“We would need to treat 2,977 patients with isotretinoin to observe 1 excess case of ulcerative colitis,” Dr. Catalin Mihai Popescu and her colleagues wrote in a research review (Arch. Dermatol. 2011;147:724-9).

Dr. Popescu, of Colentina Hospital, Bucharest, Romania, and her colleagues reviewed three case-controlled studies that examined the relationship between isotretinoin treatment for acne and the development of irritable bowel disease (IBD) or ulcerative colitis.

“Because the incidence of IBD is very low, randomized controlled trials or prospective cohort studies cannot be performed owing to issues of cost and sample size,” the authors wrote. “The most feasible, quickest, and cheapest approach that can provide the best evidence is a population-based case-control study.”

The studies examined included two led by Dr. S.D. Crockett of the University of North Carolina, Chapel Hill: a review of 12 case reports and 1 case series (Am. J. Gastroenterol. 2009;104:2387-93) and a population-based case-control study (Am. J. Gastroenterol. 2010;105:1986-93). The third study, led by Dr. C.N. Bernstein of the University of Manitoba IBD Clinical and Research Centre, Winnipeg, was also a population-based case-control study (Am. J. Gastroenterol. 2009;104:2274-78).

In their review of case reports, Dr. Crockett and colleagues found 15 cases of IBD among isotretinoin users in seven countries over a 23-year period. Based on this finding, the authors suggested that 59 cases of IBD could occur each year in conjunction with isotretinoin treatment.

In the population-based case control study, Dr. Crockett and colleagues used data from a large insurance claims database of 87 U.S. health plans. The authors found no significant isotretinoin association among patients with diagnostic claims for IBD, Crohn’s disease, or ulcerative colitis. When the researchers considered any exposure to the drug, they found that only the risk for ulcerative colitis was significant (odds ratio, 4.36). Higher doses, dose escalation, and longer duration of isotretinoin treatment increased the risk for ulcerative colitis significantly (up to OR 5.63).

Dr. Bernstein and colleagues’ case-control study found 1,960 cases of IBD diagnosed in a Manitoba health database during the period from 1995 to 2007. IBD and ulcerative colitis cases were matched with more than 19,419 controls. Patients with IBD were no more likely than matched controls to have used isotretinoin before diagnosis.

Dr. Popescu and her colleagues noted the quality of the studies was high, but their disparate findings make logical conclusions difficult. Dr. Popescu also suggested that antibiotics could be a possible link between acne treatment and IBD. Before taking isotretinoin, most patients with acne undergo protracted antibiotic treatment.

“A recent population-based case-control study showed that the hazard ratio for developing IBD for any exposure to a tetracycline antibiotic was 1.39,” they wrote. Other antibiotics used for acne treatment were associated with higher risks for Crohn’s disease: HR 2.25 for doxycycline and Crohn’s disease, and 1.61 for tetracycline/oxytetracycline.

“The risk of ulcerative colitis, but not Crohn’s disease, seems to be increased in patients taking isotretinoin,” the authors noted, “but further studies are needed to confirm or refute this finding. Although the absolute risk is very small … dermatologists and their patients should be aware of it, and, if persistent bowel symptoms develop, isotretinoin administration should be discontinued and patients should be referred to a gastroenterologist.”

However, they concluded, “this low absolute risk has to be weighed against the high risk of disfiguring scarring that may result from withholding isotretinoin treatment in patients with severe acne.”

Dr. Popescu reported receiving travel grants and honoraria from numerous pharmaceutical companies that manufacture acne and other dermatologic medications.

From acne treatment to menopause masks, Dr. Ava Shamban’s new book, Heal Your Skin, focuses on beautiful skin throughout life with ingredients that can already be found in your home!

The largest organ in the body, skin plays a huge role in self confidence and it is what most use to gauge the aging process. While genetics play a big part in determining the quality of your skin, there is no reason why you can’t make the effort to attain the most beautiful skin possible, especially with so many of the ingredients to do so already at home!

Recently, dermatologist and author Dr. Ava Shamban visited the set of The Doctors to discuss her new book, Heal Your Skin in which she talks about the importance of holistically treating the skin. Including fitness and nutrition tips, one of the things that Dr. Shamban stresses in her book is that beautiful and healthy skin does not have to cost a lot of money. Focusing on skin care that can be made at home from normal everyday kitchen items, Dr. Shamban shared 3 recipes to make at home for beautiful skin, regardless of life stage.

Acne Spot Treatment
Dr. Shamban calls adult acne “the perfect hormonal storm” and while there are expensive acne treatments available, she recommends making this spot treatment at home. Mixing together a teaspoon of nutmeg and a teaspoon of milk to create a paste, the nutmeg acts as an anti-inflammatory and the milk as an alpha hydroxy to spot treat acne. She recommends leaving the paste on the pimple for at least an hour or sleeping with it on overnight.

Pregnancy Scrub
During pregnancy, many skin issues may arise: more acne breakouts than usual and some women may experience melasma, also known as the pregnancy mask. This hyper-pigmentation occurs across the center of the face and while fractional laser resurfacing procedures may help, Dr. Shamban recommends this all-natural brown sugar scrub. Combine 2-3 tablespoons of brown sugar, half a cup of yogurt and whisk it together with egg whites for an all natural scrub for the face.

Menopause Mask
In menopause, hormonal changes can be vast and this also affects the skin. Normal skin could one day feel oily and dry the next as hormones fluctuate. Bioidentical Hormone Replacement may help but Dr. Shamban suggests an at-home remedy, the Menopause Mask that might help with some of those skin issues. Combining 1 teaspoon of honey, a liquid form of acai berry, yogurt and corn starch to create a mask, Dr. Shamban says honey acts as an antiseptic and an anti-inflammatory agent while acai berry has powerful antioxidant qualities to help calm menopausal skin.

Dr. Shamban’s book Heal Your Skin covers skin care through several stages of life while looking at the importance of nutrition and fitness. She firmly believes that your skin is an accurate barometer of what you’re eating and how stressed out you are as well as how you treat your skin. Heal Your Skin not only provides at home tips on how to treat your skin issues, it is also full of tips on how to improve skin from the inside out.

Diabetes Treatment News: Drugmakers angle for advantage in treating diabetes

Drugmakers angle for advantage in treating diabetes

Obesity and longevity have helped make diabetes an epidemic in much of the world, and drugmakers are jockeying to make sure their medicines are used early and often.

Companies including Sanofi and Eli Lilly aim to introduce new classes of drugs that could further extend treatment options, and potentially their market share.

Once diagnosed, people with type 2 diabetes are commonly treated with generic drugs, followed by several different classes of branded pills, injected medicines and eventually insulin.

Some major pharmaceutical players are trying to gain an earlier foothold in that succession of treatment as the market for such drugs has grown dramatically, with global incidence of diabetes reaching nearly 350 million cases over the last 30 years.

At the American Diabetes Association meeting in San Diego this week, Boehringer Ingelheim Pharmaceuticals and Lilly promoted their new oral drug, Tradjenta, as a better option for a patient’s next line of defense after generics. Tradjenta, also known as linagliptin, is a member of a class of oral drugs known as DPP-4 inhibitors.

“Our focus is to be the first product to be added to metformin,” said John Smith, head of clinical development and medical affairs at Boehringer. Metformin is the generic pill initially prescribed for many diabetes patients.

That goal may be helped by the fact that another class of branded diabetes drugs may be falling out of favor. Since patients now live for decades with diabetes, the safety profile of treatments has become even more important. Drugmakers face increased scrutiny of cardiovascular and cancer risks.

“Patients with type 2 diabetes are living longer, so there is a higher incidence of other problems,” said Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York.

CONCERNS

Top-selling diabetes drug Actos, marketed by Takeda Pharmaceutical Co , is a high-profile example of the safety concerns. Recent data on the drug, with nearly $5 billion in annual sales, linked it to increased risk of bladder cancer if used for more than a year.

U.S. health officials added that information to the drug’s label, while France and Germany suspended Actos sales.

Actos is a thiazolidinedione — shortened to TZD or glitazone — designed to lower the body’s insulin resistance, the underlying problem for people with type 2 diabetes.

Earlier versions of glitazones caused serious liver damage for some people and were withdrawn from the market. Avandia, a member of the same class sold by GlaxoSmithKline , has been linked to heart risks.

For Actos, “it is too early to say” whether the preliminary findings have had an impact on sales, said Dr. Robert Spanheimer, Takeda’s vice president, medical and scientific affairs. He said full results from the Actos safety trial will be available in 2013.

ORAL DRUGS SEEN AS MOST CONVENIENT

Global sales of diabetes medicines totaled $35 billion last year and could rise to as much as $48 billion by 2015, according to research firm IMS Health, driven by increased prevalence and treatment, especially in countries such as China, India, Mexico and Brazil.

“There is a large amount of people who don’t know they have diabetes,” said Dr. Stuart Weinerman, chief of endocrinology at North Shore-Long Island Jewish Health System in New Hyde Park, New York. “There is an even larger group of people that have diabetes and don’t control it adequately.”

IMS also forecast growing use of oral diabetes medicines due to their convenience and efficacy.

“The aim is to preserve the option of oral therapy for as long as possible,” said Boehringer’s Smith.

Boehringer is also developing a member of a new class of drugs known as SGLT2 inhibitors, which are designed to block glucose from being absorbed into the bloodstream through the kidneys, allowing more sugar to be excreted with urine.

New data on another experimental SGLT2 inhibitor, dapafliglozin from Bristol-Myers Squibb and AstraZeneca , showed that it was effective in a two-year study. But more bladder and breast cancers were found in patients treated with the drug.

“The probability of these drugs causing cancer is very, very low … the duration of the trials was too short,” said Zonszein.

Lilly also featured information on Byetta, an injectable GLP-1 drug co-marketed with Amylin Pharmaceuticals , which is suing Lilly over its deal with Boehringer.

Amylin presented data at the conference showing no significant link between use of Byetta and heart rhythms, which is important since U.S. regulators have asked for a heart risk trial of the company’s once-weekly GLP-1 drug, Bydureon.

That data is expected soon and Amylin said it plans to refile for U.S. regulatory approval of Bydureon in the second half of this year.

Drugmakers are also working on improved versions of insulin, the blood-sugar controlling hormone that is missing in people with type 1 diabetes and can be needed by patients with the more common type 2 diabetes.

Novo Nordisk , the world’s biggest insulin producer, showed that its experimental long-acting insulin, degludec, lowered blood sugar levels with less risk of hypoglycemia, compared with Sanofi’s Lantus.

Degludec is formulated with spacer molecules to provide a more steady rate of absorption than current insulins, said Alan Moses, Novo Nordisk’s chief medical officer.

“It lines up like pearls on a string … the insulin just basically drops off one molecule at a time from the ends,” he explained.

Sanofi’s diabetes division head, Dennis Urbaniak, said the French drugmaker aims to hold its market share with Lantus.

“Lots of other folks are trying to change that position,” he said.

ADA: Intensive Tx No Better than Good Routine Diabetes Care

SAN DIEGO — Screening and early intensive management of type 2 diabetes may hold little benefit beyond usual care, perhaps because of more aggressive routine practice, researchers suggested.

Intense managment of glucose, lipids, and blood pressure for screen-detected cases in the randomized ADDITION trial modestly reduced cardiovascular events by 12% and raised overall survival by 9% over roughly five years, Simon J. Griffin, MD, of Addenbrooke’s Hospital at the University of Cambridge, England, and colleagues found.

But neither advantage reached statistical significance compared with the outcomes of routine primary care by Dutch, Danish, and British clinicians, the group reported here at the American Diabetes Association meeting and simultaneously online in The Lancet.

The first cardiovascular event incidence rate was 7.2% with intensive treatment versus 8.5% with usual care (HR 0.83, 95% confidence interval 0.65 to 1.05); all-cause mortality occurred in 6.2% and 6.7%, respectively (HR 0.91, 95% CI 0.69 to 1.21).

These results, reiterating those presented at the European Association for the Study of Diabetes meeting last fall, were again seen as an overall positive for early diabetes treatment regardless of intensity.

“Any form of early therapy seems to pay dividends when compared with either later detection or delayed diagnosis and intervention,” David Kendall, MD, the ADA’s chief scientific and medical officer, told MedPage Today.

The trial couldn’t be definitive about the clinical benefit of screen detection of diabetes in the context of current clinical practice, David Preiss, MRCP, and Naveed Sattar, PhD, both of the University of Glasgow, Scotland, cautioned in a commentary accompanying the Lancet paper.

“However, the substantial improvements in blood pressure and cholesterol observed in the routine care group suggest that early diagnosis and treatment of diabetes according to current guidelines is likely to be beneficial,” they wrote in the commentary.

The usual care group achieved an 11.7 mm Hg reduction in systolic blood pressure and 1.2 mmol/L lower LDL with treatment by standard European guidelines, reductions that were nearly as good as the 13.7 mm Hg and 1.3 mmol/L reductions with intensive management although reaching statistical significance for a difference.

European guidelines don’t recommend routine screening for diabetes, unlike ADA guidelines, which recommend screening every three years for all adults over age 45 or regardless of age for those overweight, obese, or with at least one risk factor.

But national guidelines in the three northern European countries involved got more aggressive on treatment for diabetes patients during the trial.

Thresholds for antihypertensive treatment dropped from a systolic blood pressure of 140 to 155 mm Hg in 2001 at baseline to 130 to 140 mm Hg at follow-up; cholesterol treatment thresholds fell from 5.0 to 6.0 mmol/L to 4.5 mmol/L.

Diabetes treatment goals changed to include 6.5% in the A1c target range in some countries, although remaining largely stable overall.

Those unexpected changes may have undermined the trial’s ability to detect significant benefits from intensive managment, Preiss and Sattar suggested.

By the end of the trial, “the treatment groups were similar in terms of allocated treatments (such as statins) and had similar prevalence of glycemia and cardiovascular risk factors, with the result that achieving the target of a 30% reduction in cardiovascular events with intensive therapy became unlikely,” they wrote in the Lancet.

ADDITION — the Anglo-Danish-Dutch study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care — included 3,057 patients (age 40 to 69) who screened positive for diabetes at primary care practices in Britain, the Netherlands, and Denmark.

Patients randomized to intensive treatment received:
Antihypertensive treatment starting with an ACE inhibitor at a blood pressure of 120/80 mm Hg or higher, with directions to intensify treatment for blood pressures of 135/85 mm Hg or greater
Lipid-lowering medication at an LDL of 3.5 mmol/L (135 mg/dL) or higher with intensification for those at or above 4.5 mmol/L (174 mg/dL)
Diabetes medications targeting a hemoglobin A1c of 6.5% or less

At the mean 5.3 years of follow-up, all the individual components of the primary cardiovascular event outcome (cardiovascular death, MI, stroke, and revascularization) tended to favor intensive therapy numerically, although without statistical significance.

The researchers pointed to the apparent divergence of cardiovascular event rates beyond four years, suggesting that five years of follow-up may be insufficient if the benefits of more intensive therapy accrue over the long term as in the UKPDS study.

But Griffin’s group cautioned that they could not rule out chance findings.

The low event rates in both groups — half what had been expected — left the trial underpowered, potentially obscuring benefit from intensive therapy, the commentary noted.

Also, participating primary care practices may have been those more motivated to improve their quality of diabetes care, “such that the routine care delivered in the trial might not be representative of routine care elsewhere,” it added.

The quality of care in the routine primary practice group may just have been too good, the researchers agreed.

Diet, Metformin Cut Medical Cost for Prediabetes Patients

People with prediabetes can save thousands of dollars in medical costs by taking the diabetes drug metformin or making lifestyle changes, a new study shows.

Treatment with the inexpensive drug metformin, which lowers blood sugar levels, reduced costs by $1,700 over a decade, the researchers say. Intensive lifestyle changes, such as participating in tailored weight loss and exercise programs, saved $2,600 per person.

The study also showed that people who ate right and exercised had the highest scores on quality-of-life questionnaires that measure physical and mental functioning.

The cost savings are in line with other standard prevention strategies such as childhood immunizations and beta-blocker treatment in people who have had a heart attack, says William Herman, MD, professor of internal medicine at the University of Michigan, Ann Arbor.

The interventions should be offered to all people at high risk of developing diabetes, he tells WebMD. About 79 million Americans have prediabetes and are at high risk, according to the CDC.

Herman presented the study here at the annual meeting of the American Diabetes Association.

The cost-savings analysis comes from seven years of follow-up to the three-year study called he Diabetes Prevention Program (DPP). The study was halted early when both metformin and lifestyle changes far outperformed placebo.

The DPP showed that 10 years of treatment with metformin lowered the risk of developing diabetes by 18%, while lifestyle changes reduced the chance by 34%.

The economic analysis showed that lifestyle strategies were more expensive to implement, costing about $4,500 per person over 10 years. Metformin cost about $2,000 over a decade.

The increased cost of lifestyle programs was offset by the $2,600 savings in medical care, which included money spent on doctor and hospital visits as well as on drugs, Herman says.

When dollars spent were weighed against money saved, metformin saved $30 per person over 10 years and the lifestyle intervention cost $1,500.

While no price tag can be placed on improved physical and mental well-being, the researchers also weighed in the finding that lifestyle changes were associated with better quality-of-life scores than metformin, Herman says.

“Compared to doing nothing, the metformin intervention is cost-saving for diabetes prevention, and the intensive lifestyleintervention, though not saving dollars over 10 years, is extremely cost-effective,” he says.
New Approach for Diabetes Prevention

The new analysis “is important because as soon as DPP was published, people said, ‘This is great but we don’t have the resources,’” Herman says.

Only one in 10 common prevention strategies — prenatal care and flu shots, for example — actually saves money, he says.

The cost savings in the new study included lower costs for doctor and hospital visits as well as for drugs.

“I’m really stunned by these findings,” says James Meigs, MD, of Massachusetts General Hospital in Boston. “They could revolutionize the way we approach diabetes prevention.”

Most people prefer making exercise and dietary changes to taking a drug, says Meigs, who was not involved with the research.

In the study, the focus of the lifestyle intervention program was on losing and maintaining a 7% loss in body weight and 30 minutes a day of brisk walking, five times a week, or its equivalent, according to Herman.

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Cancer Prevention News: Confusion Over Breast Cancer Prevention, Detection

Confusion Over Breast Cancer Prevention, Detection

A new study that followed more than 133,000 women over 30 years found women who had regular mammogram screenings had a lower risk of dying from breast cancer. Specifically, researchers found, seven years of mammograms resulted in 30-percent fewer breast cancer deaths.

For patients, all the information out there on breast cancer can be confusing. But doctors in our area are sticking to their mammogram guidelines.

Doctor Lisa Tuszka, a breast health specialist, says starting annual mammograms at age 40 is what she recommends for early detection.

“Women who develop breast cancer in an earlier age — meaning younger than age 50 — tend to have more aggressive breast cancers and are diagnosed at a later stage.”

Tuszka says ten percent of women she’s seen in their 20s and 30s have breast cancer — a significant percentage she knows can’t be ignored.

From her doctoral program, she discovered even more alarming statistics.

“On a national average, about 20- to 30-percent of women have a family history of breast cancer. In this area, 45-percent of women have a family history of breast cancer,” Dr. Tuszka said.

That’s exactly why Bridget Bergstrom goes in for yearly mammograms. Her aunt died of breast cancer.

“She ended up with breast cancer, and I think if she would have gone in sooner, you know, would have been caught sooner, would have been a different story,” Bergstrom said.

But all the studies and recommendations out there can make it confusing for patients.

“At one time they were recommending that women start at the age of 50,” Kathy Jarek, RN, said.

Jarek, a breast health educator at St. Mary’s Hospital Medical Center, says she’s constantly answering questions about mammograms and self-exams.

“If women are confused or need clarification, I would suggest that they just talk their health care provider,” Jarek said.

Especially if they know they’re at risk, the specialists say, for some an annual check-up is the least they can do.

“Feeling of ease knowing that you’ve got it and you know that you’re good for another year,” Bergstrom said.

How to lower your risk of skin cancer this summer

You’ve heard it many times before: “Don’t forget to wear sunscreen!” But, is there an easier way to keep skin cancer prevention top of mind as summer starts to sizzle?

Dr. Michael Kaminer, member of the American Society for Dermatologic Surgery (ASDS), says, “Get your skin checked annually around the time of your birthday or a favorite holiday. With summer upon us, opt for July 4 or Labor Day to make sure you get an annual skin cancer screening.”

Many people might be surprised to learn that sun damage is cumulative, and sun exposure in your youth may lead to aging and skin cancer later on. To prevent sun damage, you should develop a routine of wearing and reapplying sunscreen.

“Overexposure to the sun, seen as sunburns, will set skin in a downward spiral,” notes Dr. Kaminer. “In fact, many of my patients can pinpoint the specific sunburn that damaged their skin. Protecting the skin from harmful UV rays is critical not just during the summer, but all year.”

So, what are some steps you can take on a daily basis to lower your risk of skin cancer this summer and beyond? Dr. Kaminer and the ASDS suggest the following:

Be sure to wear sunscreen: No matter what your skin type or how your body reacts to the sun, you should always wear sunscreen with a sun protective factor (SPF) of 30 or higher. Apply about one ounce (the size of a shot glass) of sunscreen to cover your entire body and reapply every two to three hours spent outdoors. Research shows that many people put on about half of the amount of sunscreen they need, so be sure to lather it on. Also, don’t forget your lips – use lip balm with an SPF of 30 or higher.

Take more than a break: Avoid sun exposure during peak hours of intensity from 10 a.m. to 4 p.m. If you must be outside, apply sunscreen 20 to 30 minutes before heading out and reapply throughout the day.

Wear sun protective clothing: Wearing a hat with a full, wide brim can help protect areas often exposed to the sun, such as the neck, ears, eyes, forehead, nose and scalp. Apply sunscreen under a T-shirt, or wear more protective clothing.

Protect your family: Teach children life-long skin protection habits at a young age, even if you think they aren’t listening. Set a good example by putting on sunscreen together.

In addition, Dr. Kaminer and the ASDS offer the following tips for long-term skin cancer detection and prevention:

Monitor your skin: If any unusual spots appear on your skin, get them checked out immediately. If something looks funny or different, see a dermatologic surgeon.

See the right doctor: When something doesn’t look right, schedule an appointment with a dermatologic surgeon, who can use a number of noninvasive tools to determine if the spot is cancerous. You can then work together to find the right treatment; many newer treatments are painless and do not cause scarring. To find a dermatologic surgeon, visit www.ASDS.net.

Get help from a friend: The best way to detect skin cancer, especially on hard-to-see places like the back, is to have your spouse, partner or a friend check your skin on a regular basis. Be sure to check your skin yourself too.

So, pack that sunscreen wherever you go and reapply. And be sure to schedule an appointment with your dermatologic surgeon this summer. Visit www.ASDS.net for more information on how to best detect and prevent skin cancer and to find a free skin cancer screening in your area.

About the ASDS
ASDS is the largest specialty organization exclusively representing dermatologic surgeons who have unique training and experience to treat the health, function and beauty of skin. Dermatologic surgeons are experts in skin cancer prevention, detection and treatment. As the incidence of skin cancer rises, dermatologic surgeons are committed to taking steps to minimize the life-threatening effects of this disease. ASDS members are pioneers in the field, having created and enhanced many of the advancements in dermatologic surgery to repair and improve the skin.