Daily Health and Medicine News

Sciatica News and Treatment

Do You Have Suggestions For “Sciatica”?

By Lewis G. Maharam, MD, FACSM

Hi,

I am registered for the P.F. Chang’s Rock ‘n’ Roll Arizona Half Marathon on Jan. 16 and have had a very challenging bout of sciatica for months. After physical therapy, acupuncture, chiropractic and traditional medicine helps, I remain stifled in training with longer distance efforts at walk, run. I was not a true athlete to start and this is a real disappointment to me. Do you have any suggestions? Recommendations from your knowledge, expertise? I do not really want to pull out, but I am afraid that my performance will be impaired radically.

Thank you for your reply to this appeal.

Roseanne K.

Dear Roseanne:

Your letter was forwarded to me as Medical Director of all the Rock ‘n’ Roll Marathons. I’m sorry to hear of your issues.

I hear this same question all the time in my practice of sports medicine in NYC! Runners are the most sophisticated medical consumers I know, but they’re still getting — and buying — one of the big, bogus diagnoses of all time: “sciatica.” It’s bogus because it somehow makes you feel good without actually revealing a thing about what’s wrong. Sciatica is a symptom, not a diagnosis!

Why, then, do some physicians simply stick “sciatica” onto so many athletes like a diagnostic Post-it, give them a couple of generic exercises, and send them away? Because, frankly, a lot of back patients don’t get better. They return repeatedly with the same complaint, and the doctor eventually begins to wonder whether they even want to recover, overlooking the fact that it could be the treatment that’s not hitting the target. A more refined answer takes time and effort, whereas a “sciatica” diagnosis is an easy way of sending the patient away happy. (Plus, “sciatica” is a reimbursable diagnosis code.)

That tingling or painful sensation going down your leg could be caused by any number of things happening to any number of nerves way “upstream.” Degenerative disk disease, which we all get as we age, can let a vertebra settle onto a nerve and irritate or pinch it. A facet joint at the back of a vertebra can get out of alignment. A strained back muscle might go into spasm and painfully squeeze a nearby nerve or nerve sheathe. Even running with a leg-length discrepancy, the most common back pain culprit among my patients, can cause “sciatica”.

The list goes on and on, but fortunately these are not unfathomable mysteries. They can, and will, be found by someone determined to get to the bottom of a patient’s back pain because we now have the diagnostic tools to do that. And each cause has a specific treatment.

If “sciatica” is as far as you can get with your physician, consult someone else. You don’t want a Post-it — you want a probe. I’m sorry I can’t tell you that “you can run” without the real diagnosis. Please write back when you do get that real diagnosis, and let us know how things turned out. Good luck.

Enjoy the ride.

Dr. Lewis G. Maharam is the world’s premier running physician. He is medical director of Competitor Group’s Rock ‘n’ Roll Marathon series and The Leukemia & Lymphoma Society’s Team in Training program. He also serves as Chairman of the Board of Governors, International Marathon Medical Directors Association. Dr. Maharam’s column can be followed in Competitor Magazine and on his Facebook page: Running Doc

Any questions you may want answered by Dr. Maharam in future columns should be written in the comments below. Feel free to add your comments about your experience with the above situation as well. Dialogue is great and we look forward to expanding that in the comments section of this blog.

What to do about sciatica pain

Sciatica is an often-used term in the medical field and many of you reading this will have experienced that awful leg pain caused by a ‘pinched’ nerve in the lower back. Sciatica refers to the pain that radiates down the back of your leg along the path of the sciatic nerve. The sciatic nerve is the largest nerve in the body and originates from the spinal nerves of the lower five vertebrae in the spine.

As you go down each vertebrae of your spine from your neck to your tailbone, there are nerves that branch off the spinal cord and then exit your spine between each vertebrae. There are 31 matching pairs of spinal nerves supplying the left and right side of your body. Irritation of a spinal nerve at any level can have a number of consequences including: numbness, tingling, pins and needles, weakness and pain. When the nerves in the lower back area are irritated, sciatica is often the result.

Nerves are one of the most sensitive tissues in our body and they require a large amount of continuous blood flow to them to maintain health. All of our nerves added together account for only two per cent of our total body mass, however nerves use approximately 20 per cent of our blood flow, a full 10 times the amount you might expect. Because of this high demand for blood if there is any disruption of blood flow to the nerves as they exit the spine, the end result is very often pain.

Compression or inflammation of a spinal nerve is typically caused by either a bulging disc (disc herniation), or by compression from the deep spinal muscles. A disc rupture or herniation occurs when the tough, outer ring of the disc breaks open or cracks, allowing the inner fluid material to push outwards causing the disc to bulge. This bulging causes an inflammatory reaction that often leads to irritation of the nerve, resulting in pain. In the majority of the cases the disc bulge does not actually press on the nerve, however the resulting inflammation causes protective muscle tightening and joint stiffness to occur. Very often it is this resultant tightening of the muscles and spinal joints that prevents blood flow from ‘washing’ out the inflammation around the nerves. If this stiffness can be reversed, the body is in many cases able to heal itself and the sciatica pain goes away.

Although the pain from sciatica often comes on suddenly, the reality is that in most cases it is the result of years of accumulated micro-traumas to the spine. The stress and micro-traumas created by the constant motion of our spine and by poor postures, leads to ‘wear and tear’ on our discs, spinal joints and ligaments. Labour jobs and traumas such as motor vehicle accidents can also create early wearing down of the spine.

Treatment of sciatica focuses on improving the blood flow to the nerves by increasing the flexibility of the spine as well as releasing the deep muscle tension in the low back that often creates extra pressure on the exiting nerves. As soon as the mobility improves in the spine, the next step is often to strengthen the core muscles of the abdomen and lower back in order to prevent recurrence. Most cases of sciatica can be treated and do not require surgery. If you are suffering from sciatica type pain, consult your physiotherapist or medical doctor as it usually can be treated and shouldn’t be something you have to live with.

Check-up: Lumbar epidural steroid injections

With a recent diagnosis of sciatica, my GP referred me on to a specialist. She has recommendedan epidural steroid injection into my back. Can you explain what this is?

Sciatic pain is usually caused by irritation or compression of one or more spinal nerve roots in the lumbar spine. Although this can cause pain in the buttocks and down the leg, the problem is actually in the back.

For sciatic pain, an epidural steroid injection will be injected into the lumbar (lower back) area. A mixture of a dilute local anaesthetic and a long-acting steroid is injected into the epidural space that surrounds the spinal cord and nerve roots.

The aim of the treatment is to help reduce inflammation in that area.

What does the procedure involve?

Before the procedure, a small cannula will be placed in the back of your hand, through which a short-acting sedative will be given. This will make you feel relaxed. You may also be given oxygen during the procedure.

Lying, curled on your side, local anaesthetic will be used to numb the skin at the injection site and to numb the space between the lumbar vertebrae. An epidural needle is then passed through the skin into the epidural space with the aid of an X-ray image.

The anaesthetic and steroid mixture is injected slowly into the epidural space and you may feel a build-up of pressure in your back while this is done.

For a couple of hours after the injection, you will be positioned on your side, with the affected side down, to encourage the epidural medication solution to reach the affected area.

Most people can be discharged – with supervision – after a number of hours, or when all vital signs are stable.

What about side effects?

Soreness and bruising at the injection site, which typically settles after a few days, is common after epidural injection.

Less common side effects can include bleeding and haemorrhage into the epidural space or infection leading to an epidural abscess.

The spinal cord and nerves may be damaged by the needle, while puncture of the dural membrane can occur if the epidural needle is put in too far. Severe allergic reaction can develop due to the injection solution.

Epileptic seizures may occur and, in rare cases, numbness in the whole body can happen due to the local anaesthetic entering the spinal fluid.

Yeast Infection Treatment News

Doctors Claim Adam Lambert’s Yeast Infection Was Spread By Word Of Mouth

Word of Adam Lambert’s yeast infection has spread by word of mouth says Dr. Molrat F. Finnegan who examined the Ex-American Idol using a special bio-hazard suit and a 10-foot pole.

“Whenever the human mouth comes in contact with a bacteria like a Candida, it can spread like wildfire. In Mr. Lambert’s case it was a freakin’ hurricane!” Claims Finnegan.
Mexican pharmacy no prescription needed
The publicist for Lambert disclaims the diagnosis as Candida, and added that, ‘Dear Adam’ merely has a sore lip from licking toilet seats as a practical joke for friends…He was just joking around!

Serious accusations popped up when Lambert was spotted wearing a surgical mask as he tried to shoo away a pack of cats that followed him into the popular night spot. Soon after, patrons began to complain of a foul odor and itching lips.

Treatment for recurrent yeast infection

How do you treat recurrent yeast infection? The patient has normal blood sugar and responds to fluconazole (Diflucan), butoconazole (Gynazole), or terconazole (Terazol), but the symptoms return. I would like a standard of care that addresses treatment using longer therapy and maintenance for prevention after symptoms are resolved.—NANCY J. YOUNG, MSN, Greensboro, N.C.

The CDC Web site lists treatment options for recurrent vulvovaginal candidiasis. A general vaginal culture should be done to confirm the diagnosis and determine whether an atypical yeast species is responsible. Ensuring that the right species is treated can help alleviate each clinical episode and prevent recurrences. Some experts recommend a longer duration of initial therapy or repeat treatments (e.g., seven to 14 days of topical therapy or three doses of fluconazole every third day rather than single-dose therapy) to ensure full remission. Maintenance regimens are only recommended once expanded therapy has failed. Maintenance regimens, also available on the CDC Web site, include weekly oral fluconazole for six months or topical clotrimazole once or twice per week. Beyond checking blood sugar, history-taking and relevant labs should also be used to rule out other immunosuppressive conditions like HIV. Also check that your patient is not using vaginal products or other agents that can cause or exacerbate candidiasis.—Lisa Stern, APRN (143-4)

Chemistry able to prevent oral yeast infection

While studying unique chemical signaling pathways among microorganisms in the human mouth, a team of OU researchers may have discovered something much greater: a better way of treating infectious diseases, which could help lessen the risk of creating new antibiotic-resistant superbugs.

Professor Robert Cichewicz of the Department of Chemistry and Biochemistry and his collaborator Professor Felicia Qi from OU Health Sciences Center’s College of Dentistry led a team of chemists and microbiologists who discovered that a certain microorganism, Streptococcus mutans, can inhibit the growth of the pathogenic yeast Candida albicans.

The inhibition of pathogenic substances is a relatively new concept. Over the years, the direct killing of pathogenic substances has led to resistant strains of bacteria, also known as superbugs.

“By inhibiting yeast this way, we can potentially inhibit the selection for resistant strains of yeast that could result in even more severe diseases,” Cichewicz said.

Traditional antibiotics could be reserved for more extreme cases.

Candida albicans exists in two stages: a relatively harmless yeast phase in which the microbe does not cause damage to the body and a pathogenic filamentous phase that has the capability of invading human tissue, Cichewicz said.

“We have discovered a molecule that inhibits a yeast cell’s morphological transformation into the latter — the filamentous phase,” Cichewicz said.

Thrush, a disease caused by human pathogenic yeast, occurs during this phase. It often appears as a white film that can be seen in the oral region, and it typically occurs in immunologically compromised individuals.

“Newborns, HIV patients, organ transplant recipients — these are all groups where thrush is likely to present itself,” Cichewicz said.

Postdoctoral fellows Matt Joyner and Trevor Ellis, graduate student Xiaoru Wang and research associate Jarrod King, all from chemistry and biochemistry, played critical roles discovering the molecule and chemically characterizing the new structure.

“Cichewicz and his team are leaders in this field,” Arthur Edison, professor of biochemistry and microbiology at the University of Florida said. “He has discovered entirely new approaches to studying the complex relationship between organisms. It’s difficult isolating and studying just one organism, but to be able to study two or more which are in entirely different kingdoms is amazing.”

This project was in collaboration with OU’s College of Dentistry.

“Dentistry will change as a field because of work like this,” Qi said. “Traditionally, we look at a problem of, say, teeth, and we come up with a mechanical solution – replacement of the teeth, etc. Now, with this work, we can attack the core issues that lead to poor dental health: the microorganisms themselves.”

The treatment is far from clinical trials, but interest is emerging quickly in this area of research.

“This could be an important tool for creating a fundamental shift in how we view the treatment of harmful microorganisms, and it has only been in the literature for a relatively short time,” Cichewicz said. “The National Institutes of Health and other medical research organizations are very interested in promoting research in areas such as this.”

Cancer News

Hormone Therapy Worsens Breast Cancer, Study Finds

Hormone treatment after menopause, already known to increase the risk of breast cancer, also makes it more likely that the cancer will be advanced and deadly, researchers are reporting.

The treatment studied was the most commonly prescribed hormone replacement pill, Prempro, which contains estrogens from horse urine and a synthetic relative of the hormone progesterone.

In recent years women have been urged to minimize hormone use, and the new findings lend that advice even more weight, according to the first author of an article published this week in The Journal of the American Medical Association.

Many doctors assume that women can safely take hormones for four or five years for menopause symptoms like hot flashes and night sweats, said Dr. Rowan T. Chlebowski, the first author and an oncologist who treats breast cancer patients at the Harbor-UCLA Medical Center in Torrance, Calif.

“I don’t think you can say that now,” he said. “I know some people have to take it because they can’t function, but the message now is that you really should try to stop after a year or two.”

Dr. Chlebowski said it was not known whether there is any length of time for which these hormones can be taken without increasing breast cancer risk.

The new information comes from the continuing follow-up of 12,788 women who were in the Women’s Health Initiative, a major federally financed study that compared women taking hormones with a group taking placebos. The study was halted in 2002, three years ahead of schedule, because researchers found that the hormones were causing small but significant increases in the risk of breast cancer, heart disease, strokes and blood clots in the lungs.

The 2002 study had a huge impact. Before it came out, there was a widespread belief that hormones would reduce women’s risk of heart disease and generally keep them youthful, sexy and healthy. For many doctors and patients, the study shattered that faith.

Six million American women had been taking hormones, but the number quickly fell by about half. The breast cancer rate also began to decrease soon after, and many researchers attribute the decrease to the drop in hormone use.

The new report increases the average follow-up time to 11 years from the original 5.6 years. It is the first report from the Women’s Health Initiative that includes death rates from breast cancer related to hormone use.

The researchers found small but significant increases in several harmful effects in women who took the hormones. As the study previously showed, women taking hormones are more likely to develop invasive breast cancer. Their rate of the disease was 0.42 percent per year, compared with 0.34 percent per year in the placebo group.

Among women with breast cancer, those who took hormones were more likely to have cancerous lymph nodes, a sign of more advanced disease — 23.7 percent, versus 16.2 percent in the placebo group.

More women who took hormones died from breast cancer — 0.03 percent per year, versus 0.01 percent per year in the placebo group. That translates to 2.6 deaths per 10,000 women per year among those taking hormones, twice as many as the 1.3 deaths per 10,000 in the placebo group.

Among women who had breast cancer, those who took hormones also had a higher death rate from other causes — 0.05 percent per year, versus 0.03 percent per year. In other words, there were 5.3 versus 3.4 deaths per 10,000 women per year — 1.9 extra deaths in hormone users.

It is not known for sure why the women taking hormones had more advanced tumors. But previous research has found that hormone treatment can cause delays in diagnosis by increasing breast density, making tumors harder to see on mammograms.

The more advanced state of the tumors in women taking hormones may help explain their increased death rate from breast cancer. Dr. Chlebowski said that in theory, the hormones may also help breast cancer and other cancers to grow and spread — which makes them more deadly — by stimulating the formation of blood vessels that feed tumors. He said that a report last year from the Women’s Health Initiative also found that although hormone treatment did not increase women’s rate of lung cancer, hormone use was linked to a higher death rate among women who had the cancer.

Another author of the new study, Dr. JoAnn E. Manson, a professor of medicine at Harvard Medical School and Brigham and Women’s Hospital, said women should not take the hormones at all unless they really need them, for moderate to severe symptoms like hot flashes and night sweats that disrupt sleep and really ruin their quality of life.

“It would be wonderful if there were effective options for women with moderate to severe hot flashes and night sweats that provided quality-of-life benefits without risks,” Dr. Manson said.

At the same time, she said, the new information should not necessarily alarm women who have taken the hormones, because the new report found only 1 to 2 additional breast cancer deaths per 10,000 women per year among those taking hormones.

Dr. Manson said it was the women who took hormones the longest who had the real increase in risk.

“The data suggest it is cumulative long-term use,” Dr. Manson said. “Women should avoid long-term use. I think that’s the bottom line.”

She said that women who want treatment should take the lowest possible dose that eases their symptoms.

Noting that many women are taking other hormone formulations in hope of avoiding Prempro’s risks, Dr. Manson said little was known about the drugs and more research was urgently needed.

“We really need to know what the health effects are,” she said.

She said more research was also needed to find out whether women who took hormones early in menopause had the same risks as women who started the drugs later.

An editorial accompanying the journal article said that the researchers had probably underestimated the increase in deaths from breast cancer due to hormone therapy, and that “with longer follow-up, the deleterious effect will appear larger,” even though the women are no longer taking the drugs.

The editorial writer, Dr. Peter B. Bach, a physician at Memorial Sloan-Kettering Cancer Center in New York, said that although the increase in cancer in the study might seem small, it becomes large when multiplied out over the population. He also questioned the advice being given to women, to consult their doctors about risks and benefits, and to take the lowest possible doses of the hormones for the shortest possible time. Like Dr. Chlebowski, he said there was no data to determine whether there is any safe interval.

“The fallback is that doctors and patients should be deciding this on a one-to-one basis, weighing risks and benefits,” Dr. Bach said in an interview. “How do you do that when you don’t know what the risks are? It’s a data vacuum. You can’t counsel your way through a clinical decision when you don’t have information.”

He added, “If you care about preventing this disease and keeping women from suffering and dying from it, then it’s hard to look at these drugs and not have serious concerns about them being used, even for what are intended to be relatively short periods of time.”

Stars Make Strides Against Breast Cancer

The Lincoln Stars hockey team and the American Cancer Society are pleased to announce that over $15,000 was raised for the “Making Strides Against Breast Cancer” campaign over the past weekend. The Stars wore specially-designed Breast Cancer-themed jerseys for their game against the Waterloo Blackhawks on Friday, October 15th at the Ice Box. The jerseys were sold in a live auction immediately following the conclusion of the game to benefit the American Cancer Society (ACS).

In addition, “Breast Cancer Awareness” t-shirts were sold at the game to raise additional funds. In total from the jersey auction and t-shirt sales, the Stars raised $15,150 for the American Cancer Society.

“We are so proud to partner with the American Cancer Society for the third season in the ‘Making Strides Against Breast Cancer’ campaign. Through the generosity of our fans, we’re able to raise funds in the fight against cancer and hopefully save lives,” said Jen Morand, Director of Corporate Sales and Marketing for the Lincoln Stars.

The event was sponsored by Art FX Screenprinting & Imaging, 92.9 The Eagle, Texas Roadhouse and FastFrame Lincoln.

Wyeth Wins Latest Trial Over Drugs’ Cancer Risk

A federal jury has sided with Wyeth Pharmaceuticals in the latest lawsuit that accused the drugmaker of not disclosing a link between its hormone replacement therapy and a higher risk of breast cancer.

A Little Rock jury deliberated briefly Tuesday before siding with Wyeth, which argued that it adequately warned doctors and patients of the risks associated with its Prempro and Premarin drugs.

Margaret Wilson and her husband, Billy Wilson, sued the drugmaker after she developed breast cancer after taking Prempro for 4½ years. The suit was one of thousands pending nationwide over the hormone replacement therapy.

Pfizer Inc. bought Wyeth for $68 billion in 2009.

Novak diagnosed with breast cancer

Actress Kim Novak has been diagnosed with breast cancer.

Novak, best known for her starring role in the 1958 classic Vertigo, is undergoing cancer treatment and is expected to make a full recovery, according to her manager, Sue Cameron.

“It was caught early by a routine yearly mammogram and is undergoing treatment,” Cameron told The Hollywood Reporter.

“All her doctors say she is in fantastic physical shape and should recover very well.”

Novak, 77, has also featured in notable films including Picnic, Pal Joey and Bell, Book and Candle.

She last appeared in Liebestraum in 1991, but her scenes were cut following a dispute with director Mike Figgis.

Astma Today

Acetaminophen no asthma trigger after all?

By Frederik Joelving

NEW YORK | Tue Oct 19, 2010 12:28am IST

(Reuters Health) – Doctors have been scratching their heads for years over the higher asthma risk in kids who use acetaminophen, a common painkiller known as Tylenol in the US.

Just last August, researchers studying toddlers in Ethiopia said it was “increasingly likely” that the drug had triggered much of the wheezing that troubled eight percent of those children. And another study hinted it might be fueling a large part of the worldwide increase in asthma (see Reuters Health story of Aug 13).

In a letter to the editor of the Journal of Allergy and Clinical Immunology, however, researchers from Germany say there is no cause for alarm.

Using long-term data for more than 3,000 children, they report that the link between asthma and acetaminophen only held when the medication was used to treat airway infections — not stomach flu or urinary tract infections.

“A lot of people associate (acetaminophen) with asthma,” said Dr. Eva Schnabel, of the German Research Center for Environmental Health in Neuherberg, who worked on the new analysis.

“Perhaps they should think it over and read the studies again,” she suggested.

Schnabel, who has no ties to drugmakers, said most earlier studies hadn’t followed children from the get-go and often relied on parents’ recall.

But parents whose kids have frequent airway infections might be more likely to remember using a painkiller to lower the fever. And it’s possible that the infections that led to acetaminophen use, and not the drug per se, could have caused asthma later on or revealed an underlying vulnerability to the disease.

“There have been several studies showing that viral infections are a risk factor for asthma,” Schnabel told Reuters Health.

The letter by Schnabel and her colleagues, which was reviewed by independent experts, is based on published data from kids followed closely up to age six.

Parents were asked to record all cases of fever in their child’s first year of life as well as airway, stomach and urinary tract infections. They also jotted down the medications they used in these cases.

Thirteen percent of the children developed asthma. Although use of acetaminophen — the most common painkiller by far — was more common in those who went on to have asthma, that difference was only found for airway infections.

“This analysis indicates that increased respiratory tract infection morbidity and not (acetaminophen) use during infancy is associated with the later development of asthma,” the researchers write.

“There is no argument anymore that (acetaminophen) shouldn’t be prescribed during infancy,” concludes Schnabel.

The researchers who suggested acetaminophen might trigger asthma could not be reached for comments.

SOURCE: link.reuters.com/xev38p Journal of Allergy and Clinical Immunology, online October 4, 2010.

Giving infants antibiotics triggers asthma?

Canadian medical researchers are conducting a 2.5-million-dollar study to answer whether giving antibiotics to infants in their first year of life triggers asthma and allergies that develop later on in childhood.

More than 50 percent of Canadian infants receive a prescription for antibiotics before they turn one year old, reports Discovery News .

The study aim is two-fold: first, to discern how intestinal bacteria inside newborns changes after taking antibiotics, and second, to study if those changes trigger medical conditions later.

The researchers are intrigued by microbiota. Considered to be ‘good’ intestinal bacteria, microbiota protect against harmful bacteria and help the body absorb nutrients.

Except no one is born with microbiota. It develops during the first year of life. Hence the age of the research subjects.

The study’s proof will be in the dirty diapers. Researchers will analyze the composition of microbiota from fecal samples at three months and again, at one year of age. DNA culled from the baby poop will identify bacteria in the microbiota.

School Bus Contractor Awarded by Asthma Group

Riteway Bus Service of Milwaukee, Wisc., was awarded the Wisconsin Asthma Coalition (WAC) 2010 WAC Taking Action for Asthma Award at a recent meeting.

The award was presented at the WAC meeting on Oct. 15 and highlighted the green efforts made by the school bus contractor. These environmentally friendly practices include idle reduction, fuel conservation programs, emission control technologies, newer, lower emission emitting buses and a plan to introduce hybrid school buses into the fleet sometime next year.

Riteway President Ronald Bast was on hand to accept the award, which was presented by WAC Chair Rhonda Yngsdal-Krenz. This is not a first for Riteway, as the company has received other accolades for its green efforts, including the 2010 Wisconsin Partners for Clean Air Award and the 2010 United Motorcoach Association Green Highway Award.

Headaches Treatment News

Ibuprofen May Help Relieve Acute Migraine Headaches

October 12, 2010 — Ibuprofen is an effective treatment for acute migraine headaches, providing pain relief in about half of patients, but complete relief in only a few, according to the results of a systematic review reported online October 6 in the Cochrane Database of Systematic Reviews.

“Migraine is a common, disabling condition and a burden for the individual, health services and society,” write Roy Rabbie, from the University of Oxford, United Kingdom, and colleagues from the Cochrane Pain, Palliative, and Supportive Care Group. “Many sufferers do not seek professional help, relying instead on over-the-counter analgesics. Co-therapy with an antiemetic should help to reduce symptoms commonly associated with migraine headaches.”

The goal of this review was to assess the effectiveness and tolerability of ibuprofen, given as monotherapy or together with an antiemetic, vs placebo and other active treatment for relief of acute migraine headaches in adults.

The investigators searched Cochrane CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Relief Database to identify studies published through April 22, 2010. Inclusion criteria were randomized, double-blind trials of self-administered ibuprofen vs placebo or active comparators to treat a migraine headache episode, with outcome data for at least 10 participants per treatment group.

Data were extracted, and methodological trial quality was reviewed independently by 2 investigators. Relative risk and number needed to treat (NNT) or harm vs placebo or other active drug were calculated from numbers of participants achieving each outcome.

The investigators identified 9 studies comparing ibuprofen with placebo or other active drugs, in which a total of 4373 participants were studied during a total of 5223 attacks. None of the identified studies used ibuprofen given together with a self-administered antiemetic. Single doses of medication were used to treat attacks in all identified studies.

Comparing ibuprofen 400 mg with placebo, NNTs were 7.2 for 2 hours pain-free (26% vs 12%), 3.2 for 2 hours of headache relief (57% vs 25%), and 4.0 for 24-hour sustained headache relief (45% vs 19%). Comparing ibuprofen 200 mg vs placebo, NNTs were 9.7 for 2 hours pain-free (20% vs 10%) and 6.3 for 2 hours of headache relief (52% vs. 37%).

The 400-mg dose of ibuprofen offered significantly better 2-hour headache relief than the 200-mg dose. Soluble formulations of ibuprofen 400 mg offered better 1-hour, but not 2-hour, headache relief than standard tablets.

For ibuprofen vs placebo, associated symptoms of nausea, vomiting, photophobia, phonophobia, and functional disability were reduced within 2 hours, and fewer participants used rescue medication. Adverse events were mostly mild and transient and occurred in similar numbers of participants across treatment groups. Two-hour headache relief, 24-hour headache relief, and use of rescue medication were similar for ibuprofen 400 mg vs rofecoxib 25 mg.

Limitations of this review include those inherent in the reviewed studies and that small numbers of events were used to calculate some results.

“Ibuprofen is an effective treatment for acute migraine headaches, providing pain relief in about half of sufferers, but complete relief from pain and associated symptoms for only a minority,” the review authors write. “NNTs for all efficacy outcomes were better with 400 mg than 200 mg in comparisons with placebo, and soluble formulations provided more rapid relief. Adverse events were mostly mild and transient, occurring at the same rate as with placebo.”

Oxford Pain Research Funds, UK, supported this study, along with Pain Research Funds, the National Health Service Cochrane Collaboration Programme Grant Scheme, and National Institute for Health Research Biomedical Research Centre Programme. Some of the study authors report various financial relationships with various pharmaceutical companies, charities, government, and industry sources.

Migraine goldmine for Botox maker

The landscape around the west coast of Ireland is breathtaking enough to wipe years off furrowed brows.

But it is not the rugged Irish scenery that has changed the face of the beauty industry. It is a pristine-looking glass-walled factory set in 12 hectares outside the picturesque town of Westport in County Mayo, which produces the entire world’s supply of Botox.

Kylie Minogue has admitted using it, as have Geri Halliwell, Courteney Cox and Jennifer Aniston, but it is no longer just celebrities looking to iron out the wrinkles in their foreheads.

Since it began production in 1990, the factory has pumped out more than 26m phials of the chemical otherwise known as Botulinum toxin a, generating $500m (£310m) a year for the pharmaceutical firm Allergan. In 2009, at the height of the recession, the company reported 8% earnings growth.

What makes investors “rather ecstatic”, says the chief executive, David Pyott, is that Allergan has grown from a company that relied on “purely reimbursed” business from hospitals and clinics to one that includes a booming cash business of private clients who use Botox and other medical aesthetic treatments under the Allergan umbrella, including dermal-fillers, breast implants and gastric bands. The wealthy always want to look beautiful.

“Even in the depths of the recession, the first half of 2009, the world market [for Botox] only declined 9%,” says Pyott. “In the recession what’s happened is men have spread out their treatments [from every three months to four months] and women have fewer things done.”

The Botulinum toxin, which is produced by the bacterium Clostridium botulinum, works by temporarily paralysing key muscles in the forehead. Pyott, 55, a Scot with a smooth-looking forehead, leads by example and uses it himself.

But it isn’t the beauty treatment that has the company so confident about future growth. It is all its other less sexy applications for Botox – 20 of them in total, including the recently approved application as a preventative medicine for chronic migraine – that opens up another potential goldmine.

There are an estimated 700,000 migraine sufferers in the UK alone reporting chronic head pain – dizziness, nausea and headaches can put someone out of action for up to two days at a time. The chronic form is defined as someone who has 15 headache days a month, of which at least eight are migraine.
Breakthrough

Analysts reckon that the migraine breakthrough could generate revenue of between $400m and $1bn by 2015 – almost double the company’s turnover.

Allergan employs 800 staff in Westport but the production of Botox is now so automated that it only requires the direct labour of 80 people. That’s about $625,000 revenue per employee.

“The Botox story is an amazing story and what’s really unusual is that the best may still be to come,” says Pyott, a Glasgow-born lawyer who has been chief executive since 1998.

“Right now our revenues are split 50:50 between cosmetic and therapeutic. But five years from now 70% of our sales may come from therapeutic, and that’s not because the use of Botox will decline.”

Pyott lists off some of the other Botox applications in the pipeline. “It always starts in a severe population,” he says referring to two future therapeutic applications: controlling weak bladders in multiple sclerosis sufferers and crash victims with spinal cord injuries. This is currently in clinical trials as is another weak bladder condition, affecting women over the age of 50.

Many of the discoveries of the use of Botox are by accident. It was discovered that it could erase wrinkles in 1987 after an eye specialist injecting patients to correct crossed eyes reported that a patient’s frown had disappeared.

Another cosmetic application, which was approved in 2008 by the US Food and Drug Administration, was born from an eye-drop product that Allergan makes. Patients reported that one side-effect was longer and fuller eyelashes. Back in the laboratory, Allergan came up with Latisse, which has now been approved in the US and is undergoing clinical trials in Europe.
Recession

For Ireland, which is in the throes of one of the worst recessions in the eurozone, the Botox story is important.

One of the reasons that Allergan set up shop in Westport 33 years ago was relocation aid and low corporation tax, which now stands at just 12.5%. Recently the European Union’s European commissioner for economic and financial affairs, Olli Rehn, suggested that this might have to be increased if Ireland was to reduce its gargantuan budget deficit.

But Pyott is unperturbed by the threat of rising taxes: “We have long assumed the rate would go up a couple of points,” he says. Having studied European Union law, he says that Brussels can huff and puff but “at the end of the day, it’s a matter of national sovereignty.”

He is also optimistic about the overall recovery of European markets comparison with those in the US. “Here and there, there are patches of gloom but here in our company we really see no big issues at all,” he says.

“We look at all the statistics very carefully and in fact, looking at the recovery of our markets, particularly those that are cash paid, there is no sign of the infamous ‘double dip’. In fact, I would say most European markets are recovering and growing more quickly than those in the United States.”
The history of Botox

Botox is 21 years old this year, but the bacterium, Clostridium botulinum, from which the product is derived, was discovered as far back as 1895.

By the 1950s scientists discovered the bacteria temporarily relaxed muscles, and so the story of Botox began. Its first medical application was in 1989 to fix crossed eyes and uncontrolled blinking.

The start of its use as a beauty treatment was accidental. An ophthalmologist in Canada treating a woman with crossed eyes noticed that it got rid of the patient’s frowns around the eye area. It was finally unleashed on the market in 2000 and has become a global phenomenon.

But that is only half the story. Botox is also used to alleviate 20 other more serious conditions including foot deformities in children with cerebral palsy; hyper-hydrosis (excessive under-arm sweating) and post-stroke spasticity (twisting of limbs and hands). It is undergoing clinical trials as a treatment for weak bladders in multiple sclerosis sufferers and car-crash victims.

Drug overuse causes headaches

Most people have headaches from time to time. But if you have a long-lasting headache, you may be experiencing a chronic daily headache. Also called “rebound headache,” it is a common disorder related to medication overuse, but it is also the most treatable cause of chronic headaches.

Regardless of the original headache syndrome, overuse of medication is found in approximately one third of patients who develop daily headaches. At general hospitals, 50 to 82 percent of patients suffering chronic daily headaches have experienced drug overuse.

Although the risk could vary depending on the kind of drugs used, any acute headache medication has a potential to lead to rebound headaches. Both prescription and over-the-counter medicines for headaches (such as aspirin and acetaminophen) can cause headaches if you take them too frequently. These medicines should not be consumed on more than two days per week.

Caffeine is an ingredient in some headache medicines. It may relieve your pain for a while but if caffeine or drinks containing it are taken every day, you might suffer headaches more frequently. Even when you stop consuming caffeine, reactive headaches can occur.

It is not clear why rebound headaches occur but scientists suspect that the regular use of medications changes the way in which certain pain pathways and receptors work in the brain. Rebound headaches are not an issue for people who take pain killers on a daily basis for the treatment of other conditions such as arthritis.

Severe rebound headaches occur every day, often waking you up in the early morning. The symptoms can be relieved with analgesics but return as the medication wears off. The location and severity of the headache may change each day. The patients may also have nausea, anxiety, irritability, depression or sleeping problems.

Arthritis News and Treatment

For the Treatment of Rheumatoid Arthritis, Surveyed European Rheumatologists Expect Well-Established TNF-Alpha Inhibitors to Lose Considerable Patient Share to Newer Agents in This Drug Class

Enbrel, Humira and Remicade Will Lose Patient Share Through 2013, According to a New Report from Decision Resources

BURLINGTON, Mass., Oct. 14 /PRNewswire/ — Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that, between 2010 and 2013, surveyed European rheumatologists expect well-established TNF-alpha inhibitors to lose considerable patient share to newer agents in this drug class, most notably Centocor Ortho Biotech/Merck/Mitsubishi Tanabe/Janssen’s Simponi and UCB/Otsuka’s Cimzia. The increased use of newer agents such as Simponi and Cimzia will most likely occur in newly diagnosed patients and/or in patients who do not respond to initial treatment with a biologic agent.

The new European Physician & Payer Forum report entitled Rheumatoid Arthritis in Europe: How Are Physicians and Payers Responding to an Expanding Arsenal of Biologic Agents? finds that the well-entrenched TNF-alpha inhibitors that stand to lose patient share include Amgen/Pfizer/Takeda’s Enbrel, Abbott/Eisai’s Humira and Centocor Ortho Biotech/Merck/Mitsubishi Tanabe’s Remicade. Surveyed European rheumatologists expect a particularly substantial decline by 2013 in the in-class patient share of Remicade — the only currently marketed intravenous (IV) TNF-alpha inhibitor.

“However, Remicade’s lost patient share among TNF-alpha inhibitors will not be fully replaced by uptake of Simponi IV,” said Decision Resources Analyst Martin Quinn. “Additionally, considerably more physicians from France, Germany, Spain and the United Kingdom expect to prescribe subcutaneous Simponi than expect to prescribe Simponi IV. This trend will be least pronounced in Italy, where rheumatologists report high patient share for Remicade.”

The report findings also suggest that the opportunity to gain patient share is set to increase for recently launched and emerging biologics with alternative mechanisms of action. These agents include Bristol-Myers Squibb’s Orencia, Roche/Chugai’s RoActemra and Genmab/GlaxoSmithKline’s Arzerra. Most notably, surveyed rheumatologists from France, Italy, and Spain predict that at least 40 percent of their patients treated with TNF-alpha inhibitors will receive a subsequent biologic with an alternative mechanism of action by the end of 2013.

The report also finds that patient cost-sharing for rheumatoid arthritis drugs does not pose a significant barrier to treatment for patients in France, Germany, Italy, Spain and the United Kingdom. For example, because patients with severe progressive rheumatoid arthritis in France make no out-of-pocket payments for biologics, private insurers — most of whom cover only out-of-pocket costs — do not play a central role in determining access to rheumatoid arthritis drugs.

The report is based on a survey of 250 rheumatologists from Germany (50), France (50), Italy (51), Spain (50) and the United Kingdom (50) and interviews with 16 European payers from Germany (3), France (3), Italy (4), Spain (3) and the United Kingdom (3).

Doctors, patients eagerly await new rheumatoid arthritis medicines

At first, Maria Perez couldn’t identify the severe pain that gripped her in her mid-30s, but she knew it wasn’t routine. She wondered if she had a hand sprain, considered surgery, and then discovered she had rheumatoid arthritis, a debilitating autoimmune disease that attacks a patient’s joints and vital organs.

“There were days when I could not even lift my leg. Like if I were to get out of bed and I were to put my foot on the floor, it would be the most incredible sharp pain up my leg,” said the 40-year-old New Jersey resident. “There were some days when I was just bedridden. I couldn’t be active at all.”

Perez got her life back when she began injecting Humira into her leg once every two weeks. Humira, a drug produced by North Chicago-based Abbott Laboratories, completely eliminated her pain, allowing her to take up new activities like kickboxing and walking her dog. But Perez said she would eagerly drop the injectable drug if she could find a pill that accomplished the same thing.

In several years, a new generation of drugs might give her that option and challenge Humira’s blockbuster status. Humira is in a class of genetically engineered pharmaceuticals known as “biologics,” which have changed the face of treatment for rheumatoid arthritis. Since the Food and Drug Administration approved it in 2002, Humira has been helping patients like Perez manage the disease and increase quality of life. In turn, the drug has evolved into a prominent cash cow for Abbott. This year alone, the drug is expected to rack up $6 billion in sales.

Now, researchers are looking to new remedies that could revolutionize treatment again. Oral drugs called JAK-inhibitors, aimed at blocking the parts of the immune system that perpetuate rheumatoid arthritis, are in the third phase of testing by Pfizer Inc. and Eli Lilly and Co. Rebecca Bader, a researcher with Syracuse University, said an oral medication will likely become the preferred medication for patients.

“If you can find something that’s administered easier, that’s a good thing for the customer,” said Bader. “I think anything that’s taken orally is better.”

Abbott spokeswoman DeAnna DuBose said the company also has an oral drug in preliminary development, but downplays the negative effects these new drugs might have on Humira. She noted that Humira is used by more than 500,000 patients worldwide for rheumatoid arthritis and other diseases and conditions, including Crohn’s, psoriasis and ankylosing spondylitis. The company also points out that Humira has undergone years of trials and patient use, and is well-positioned to remain a front-runner in rheumatoid arthritis treatment.

One percent of the U.S. population is affected by rheumatoid arthritis. Most people are diagnosed when they are middle-aged, according to researchers, but it also affects juveniles and the elderly. Several treatments exist for rheumatoid arthritis including painkillers, anti-inflammatory drugs and immune suppressants in addition to injectable biologics.

Dr. Nathan Wei of the Arthritis Treatment Center in Maryland, has been part of the research trials of the JAK-inhibitor drugs. He said the new drugs are as effective as the injectable ones on the market today. Wei said his biggest concerns are side effects, including decreased white blood cell count, elevated lipids levels, possible effects on kidney function and possibly elevated blood pressure. A Pfizer representative said the company’s drug has not yet been approved by the Food and Drug Administration and is still several years away from the market. Still, Wei has high hopes for these drugs.

I think they will change the landscape [of rheumatoid arthritis treatment], I do strongly believe that,” said Wei. “But in what way, it’s hard to say right now.”

If the drugs hit the market, they won’t become widely used immediately. For this reason, Sara Michelmore, a financial analyst at Cowan Financial Group, thinks companies like Abbott will not be seriously affected by the new drugs for a prolonged period.

“That’s several years away before there’s any significant impact,” Michelmore said. “They [doctors] are very unlikely to substitute a drug like Humira.”

Perez said she’s more than happy to take the injections as long as she must, but she is eager to simplify her life by switching to a pill. She hopes one day she’ll be able to plan airline flights without worrying about missing her scheduled doses and be able to carry her medication in her purse rather than storing it in a refrigerator.

Phobias & Mental Health News

Anxiety, Phobias and Kids: When to Seek Help

According to Dr. Paul Ballas, a child psychiatrist and the medical director at the Green Tree School for children with special needs in Germantown, Penn., anxiety, phobias and mood disorders are common problems for young children and adolescents.
Such anxieties often surface during the fall, when children return to school and experience changes in sleep patterns, stress levels and routines. Environmental factors such as high allergen levels have also been shown to be associated with higher rates of anxiety, Ballas said.

“This time of year is a very anxiety-producing time for many kids,” he said.
The first step in determining whether a child is suffering from a phobia or anxiety disorder is to identify whether the fear is rational. Ordinary anxiety takes place in the context of a situation, or stimulus, such as watching a scary movie or taking a test. On the other hand, phobias and anxiety disorders are characterized as fear without the stimulus, and can cause long-lasting psychological distress. Anxiety disorders often disrupt normal day-to-day function.
The main distinction between adults, adolescents and children is that adults and adolescents often recognize that the fear is irrational. An adult with a phobia of elevators may understand that riding an elevator is safe but still refuse to get on. A child with that same phobia may not understand that the fear is unreasonable or excessive and develop an excuse to not get on the elevator. Young children often confuse anxiety for physical pain and say they have a stomachache or headache to avoid situations that cause anxiety.
Ballas said that parents can help their kids through times of anxiety by first ensuring that their basic needs — adequate sleep, a healthy diet and physical activity — are met.
“You’d be amazed how much of a problem sleep deprivation is for young kids,” Ballas said. “If they get enough sleep, their anxiety might go away.”
In cases where treatment is needed to address the child’s anxiety, therapists may gradually sensitize children to the object of their fear in a controlled setting. An alternative tactic that is generally not recommended for children is known as “flooding,” which means confronting the person with the object of their fear at its worst. For example, if a child is afraid of riding the bus, he would be placed on the bus and forced to deal with it.
Cognitive behavioral therapy is a recognized short-term treatment in which a therapist identifies the cognitive distortions the child is experiencing and appeals to the child’s sense of reason as to why his fears do not make sense. This approach typically works well for children ages 5 and older, Ballas said.
Six categories of phobias common in children include:
Animal phobias: fear of insects, sharks, other animals.
Natural environment phobias: fear of storms, heights, water.
Blood, injections and injury phobias: fear of vaccinations, doctors’ offices.
Situational phobias: fear of flying, riding over bridges.
Social phobias: fear of social situations, public speaking, judgment or criticism from others.
Other phobias: any other specific phobia such as fear of choking or characters in costume.

Virtual Revulsion Therapy: Pixelated Pests Help Treat Cockroach Phobia

For people with katsaridaphobia, or the fear of cockroaches, the common pests are more than nuisances—they are the stuff of nightmares. When some phobics spot one of the skittering beasts they start sobbing uncontrollably, whereas others who have seen them in their homes seriously consider moving. Psychologists can treat such disruptive fears with exposure therapy, in which a therapist gradually presents the feared stimulus to the patient in increasingly intimate scenarios. Recently, some psychologists have successfully combined exposure therapy and virtual reality to treat fears of flying, heights and spiders, asking patients to interact with simulated environments that guarantee their safety.

Now, a team of psychologists has completed the first clinical trial testing the treatment of cockroach phobia with augmented reality—a younger cousin of virtual reality that layers digital animations over video or photos of a real-world environment. The new study, published in the September issue of Behavior Therapy, is the most recent and most significant step toward bringing augmented reality therapy out of the lab and into common clinical practice.

“I am thrilled with the research,” says Stéphane Bouchard, a psychologist at the University of Québec in Outaouais who has studied virtual reality therapy, but was not involved in the new study. “This study shows reliably the feasibility of augmented reality to treat specific phobias.”
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In the study psychologist Cristina Botella of the University of Jaume I in Spain and her colleagues treated six women diagnosed with cockroach phobia, according to criteria in the Diagnostic and Statistical Manual of Mental Disorders IV. The women wore an enclosed helmet comprising a camera and a monitor that allowed them to view their surrounding environment sprinkled with a few digital embellishments—incredibly realistic animated cockroaches, which the therapist could shrink, enlarge, multiply or vanish at will.

“With augmented reality you can modulate the exposure in ways you never could in real life,” says Soledad Quero, Botella’s colleague and a co-author of the paper. “It really shows the potential of new technologies to help people with psychological problems.”

Staring into the helmet viewer, the participants saw cockroaches scrabbling on the floor, encroaching on their personal belongings or crawling all over their fingers. The experimenters asked the phobics to keep the helmet on until their anxiety subsided by two or three subjective units of discomfort, as measured by a standard eight-point, self-reported Likert scale.

After treatment that lasted just under two hours on average all the participants demonstrated a significant reduction in their anxieties. They also reported a lessening of their condition’s severity and its ability to disrupt daily life, which the experimenters measured using similar standard scales. Most participants showed a reduction from a score of 7 or 8 to a score of 1 or 2. At a checkup 12 months later, most participants maintained these drops in angst. Directly after the therapy all the participants had been able to approach a jar containing a live cockroach, open it and place their hands inside for a few seconds. Before the procedure none could bring themselves to even touch the jar. During the checkup all but two participants successfully completed a repeat of the jar test, and three participants each killed cockroaches near their feet with a fly swatter.

“The most important finding is that the patients improve, but not only in reporting that they feel better—the changes affected what they could do in their real lives, too,” Quero says.

The trial’s small size makes it difficult to draw general conclusions about the efficacy of augmented reality therapy, but Bouchard says the results are robust enough to validate further larger studies—especially studies that specifically compare augmented reality therapy with alternative treatments, like virtual reality therapy and the most common technique, in vivo exposure, in which patients confront their fears in reality, whether it be living spiders or standing on the top floor of a skyscraper.

Successfully completed in vivo exposure therapy is usually quite effective, but nearly one quarter of patients drop out because of its intensity. In the new paper the researchers note—and Bouchard confirms—that augmented reality is not only more appealing for many patients, it should cost less than virtual reality therapy because the former involves simulating only the feared stimulus rather than an entire environment. Quero even envisions giving patients “augmented reality” homework to complete on mobile devices: Imagine, for example, using an iPhone or Droid to create the illusion of creeping cockroaches on the kitchen table.

So far, augmented reality therapy only exists in the lab, but Bouchard is encouraged by Botella’s study. “This is a pioneering application,” he says. “I can imagine we will see a diffusion of augmented reality into therapeutic settings just as we have seen with virtual reality.”

Physical illness may affect mental health

MUMBAI: As Sunday marked World Mental Health Day, doctors in the city cautioned Mumbaikars to watch out for those tell-tale signs triggered by minor illnesses. You may have wondered how a small bout of fever can cause extreme sadness, or why even the slightest noise can jar your nerves when you have a cold or a headache. Doctors have the answer-physical illness can lead to psychological problems in patients.

Doctors across specializations say that patients suffering from an illness, especially chronic, tend to develop not just minor mental problems like distress and anxiety, but also major ones like depression, phobias and even sexual dysfunction. About 14-20% of chronically ill patients have psychological problems, apart from minor distress and anxiety, say doctors.

Dr Ganesh Kumar, head of cardiology at L H Hiranandani Hospital, says that at least one in three patients is suffers from mental problems, including anxiety. “Patients suffering from a heart failure or an attack, especially younger ones, develop severe mental problems. First of all, the patients do not want to accept the fact that they are chronically ill. And when they do, they directly start fearing death,” he said. “Many young patients also start believing that having sex will stress out on their heart, which might lead to another attack. This causes sexual dysfunction and frustration in the patient as well as the spouse,” he added.

Dr Ashok Mahasur, chest physician with Hinduja Hospital, says that respiratory problems tend to make patients even more psychologically conscious. “Problems like chronic obstructive pulmonary disease, drug-resistant TB and lung fibrosis can are the ones which cause a lot of distress in the patient. As these are long-term problems, the patient’s thinking gets negative,” he said, adding that mental problems are rampant in 60-70% of patients suffering from respiratory illnesses. “Only around 20% of people-those who are not well educated or those who do not know much about the disease-have little anxiety,” Dr Mahasur added.

It is not just those suffering from cardio or respiratory problems who get worried, but also those with chronic kidney ailments. “Patients suffering from end-stage kidney disease who cannot find a donor, especially those who have to go for dialysis regularly, undergo great trauma. They cannot carry out their regular functions, feel unproductive and believe that they are a burden on the family. Most of the time, affordability of the treatment is also becomes a problem,” said Dr Bharat Shah, nephrologist, Lilavati Hospital.

Psychiatrist Dr Harish Shetty, however believes that depression in the chronically ill is generally misunderstood as anxiety. “If a person is suffering from diabetes and goes into depression, the family thinks it is because of erratic sugar levels. If symptoms of mental problems are taken care of along with the treatment for the physical illness, patients tend to recover sooner,” he said.

Obesity News

Researchers piece together gene, obesity and fat distribution puzzle

EU-funded scientists have identified 18 new gene sites that impact overall obesity and 13 new sites associated with distribution of fat. The researchers from Europe, as well as Australia, Canada and the US, used a near 250,000-strong sample to investigate genetic links with human traits. The findings of the two studies, published in the journal Nature Genetics, shed light on why some people are more susceptible to obesity while others are not.

Part of the Genetic Investigation of Anthropometric Traits (GIANT) consortium, which comprises 400 experts from 280 research institutions worldwide, the scientists carried out a large-scale meta-analysis of genome-wide association studies (GWAS) providing insights on waist-hip ratio (WHR) and body mass index (BMI).

‘Different people have different susceptibilities to obesity,’ explains Dr Joel Hirschhorn from Children’s Hospital Boston and the Broad Institute in the US, one of the senior authors of the obesity paper who was involved in both studies. ‘Some don’t rigorously watch what they eat or how much they exercise and still resist gaining weight, while others constantly struggle to keep their weight from skyrocketing. Some of this variability is genetic, and our goal was to increase understanding of why different people have different inherited susceptibility to obesity.’

These studies succeeded in pinpointing genes that were never before suspected of influencing obesity. The results will help improve the categorisation and treatment of obesity in the future, according to Dr Hirschhorn.

The overall obesity study investigated the genetic determinants of BMI, which is determined by measuring a person’s weight in kilograms over height in metres squared. Data from 124,000 people from 46 studies uncovered 32 sites (of which 18 are new). The team found two novel variants, one of which is in the gene encoding for a receptor protein that responds to signals from the gut to influence insulin levels and metabolism, and another that is located near a gene known to encode proteins affecting appetite.

‘One of the most exciting parts of this work is that most of the BMI-associated variants identified are in or near genes that have never before been connected to obesity,’ comments Dr Elizabeth K. Speliotes from Massachusetts General Hospital and the Broad Institute, lead author of the BMI study and involved in both studies as well. ‘Through this work we are discovering that the underlying biological underpinnings of obesity are many, varied and largely uncharacterised.’

Their findings show that people with more than 38 BMI-increasing variants were about 15 to 20 pounds heavier than those who carried less than 22 such variants.

The second study investigated associations between gene sites and fat distribution. Evaluating the genetic determinants of WHR of 77,000 people in 32 studies, and checking against data of more than 113,500 individuals in 29 studies, the researchers found 14 gene regions associated with WHR, adding 13 new sites. It should be noted that seven of the identified genetic variations have stronger effects in females than in males, hinting that they trigger some of the differences in fat distribution between women and men.

‘By finding genes that have an important role in influencing fat distribution and the ways in which that differs between men and women, we hope to home in on the crucial underlying biological processes,’ says Dr Cecilia Lindgren of the Wellcome Trust Centre for Human Genetics at Oxford University in the UK, a senior researcher on the WHR study, who was involved in both papers.

The results in this study indicate that specific biological mechanisms play a role in regulating where the body stores fat. Genes that regulate cholesterol, triglyceride levels, and insulin and insulin resistance are associated with the regions impacting fat distribution.
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EU funding for the studies came from projects under Fifth and Sixth Framework Programmes (FP5 and FP6), specifically: EURO-BLCS (Biological, clinical and genetic markers of future risk of cardiovascular disease’), which was supported under the Quality of life and management of living resources budget line of FP5; as well as EUROSPAN (European special populations research network: quantifying and harnessing genetic variation for gene discovery’), MOLPAGE (‘Molecular phenotyping to accelerate genomic epidemiology’), PROCARDIS (‘A genome-wide mapping and functional genomics approach to elucidating precocious coronary artery disease’), and EURODIS (‘Functional genomics of pancreatic beta cells and of tissues involved in control of the endocrine pancreas for prevention and treatment of type 2 diabetes’), which between them received over EUR 25 million from the EU under the ‘Life sciences, genomics and biotechnology for health’ Thematic area of FP6. The studies were also backed by an EU Marie Curie Intra-European Fellowship grant.

European scientists that took part in the studies were from Austria, Croatia, Denmark, Estonia, Finland, Germany, Iceland, Italy, the Netherlands, Norway, Sweden, Switzerland and the UK.

Childhood obesity ad likens junk food to heroin

A controversial new ad which compares feeding children junk food to injecting them with heroin has restarted debate about the best way to tackle childhood obesity.

The Sydney-based agency which produced the ad says existing health advertising is not working to curb the problem.

It says it wanted to shock parents into action. But health experts say it has gone too far.

In the advertisement, a mother walks into a room carrying a brown paper bag. She sits down at a table next to her little boy who is colouring in.

She takes out some heroin and a syringe and ties a tourniquet around her son’s arm. The words on the screen say: “You wouldn’t inject your children with junk – so why are you feeding it to them?”

The producer of the Break the Habit ad and managing director of the Sydney-based agency The Precinct, Henry Motteram, says not resolving the signs of childhood obesity is “tantamount to child abuse”.

“We wanted the conversation to start. We wanted that conversation to be as big as possible and involving as many people as possible, hence why we decided to go down a shock tactic [path],” he said.

“Both obesity and drugs in general have a similar impact on people’s lives, both physically and psychologically in the long run.

“By no means are we saying that eating a hamburger is the same as taking a hit of drugs. The visual metaphor is about the long-term impact of this.”

The ad was posted on YouTube and attracted more than 500 comments. There was a diverse range of opinions from: “Thank you. Addiction is addiction, no matter what item or drug you put in there. Stop abusing your children!”

But others disagreed:

“Heroin will destroy your life and easily kill you. An occasional hamburger will not do either. They have nothing in common and this video is pure garbage,” said one commenter.

“That was bullshit. Somebody ought to slap the person who came up with that,” said another.

“If they want to do something about fat kids then the parents need to take the kids to a park or do something that involves running. Or maybe they should just get off their lazy arse and do something fun with their kids.”

‘Over the top’

Director of the Public Health Advocacy Institute, Professor Mike Daube, says childhood obesity is a massive problem in Australia, where 25 per cent of kids are now considered obese.

But he says the ad is over the top.

“This ad puts all the emphasis on kids. Then it puts all the blame on parents instead of people writing junk food [ads]. And then just for good measure it shows you how to inject heroin,” he said.

“So I’m not a fan of the ad. I admire anybody who has concerns about the obesity problem which is very real, but I don’t think this ad is the way to deal with it.”

It is a view shared by nutritionist Dr Rosemary Stanton.

“Heroin is dangerous, even in a small dose. And junk food isn’t dangerous in a small dose,” she said.

“But I do think that we need to make parents aware that it’s not safe to give their kids so much junk food [to eat]. And they currently aren’t aware of that.”

Dr Stanton says the first step to tackling childhood obesity is to get rid of junk food advertising.

“Sure it’s the parents who actually buy the junk food, but they buy it because the kids pester them to buy it,” she said.

“The kids pester them to buy it because they’ve seen the ads.

“So I think any society that is serious about doing anything about obesity in children and obesity in adults for that matter should look at stopping these highly persuasive, clever adults from encouraging kids to pester the parents.”

This afternoon, the Break the Habit advertisement was pulled from YouTube.

The agency says the parents of the young boy in the ad were concerned about all the media attention.

Study Says HFCS Does Not Cause Obesity

October 12, 2010

For years, high fructose corn syrup has been erroneously implicated as a prime suspect in the obesity epidemic. Inexact scientific reports and inaccurate media accounts have increased confusion about the sugar made from corn. New research proves otherwise.

A new study, presented on Saturday October 9, at the Obesity Society’s 28th Annual Scientific Meeting, further reinforces the facts about high fructose corn syrup. Results from the double-blind study revealed that fructose containing sweeteners (sugar, high fructose corn syrup) do not uniquely contribute to obesity when consumed as part of a healthy weight maintenance diet. The study also found that high fructose corn syrup no more contributes to caloric intake than table sugar (sucrose).

In the study, overweight or obese adults were placed on a 10-week eucaloric diet (an eucaloric diet provides your body with just the right number of calories necessary to maintain current body weight) which incorporated either high fructose corn syrup or sucrose-sweetened, low-fat milk. Participants’ consumption of low-fat milk accounted for between 10 to 20 percent of the daily allotted calories, representing typical levels of sweetener consumption. Study participants did not experience a change in body weight, percent of body fat, fat-mass, or percent of abdominal body fat. Additionally, there were no statistical differences between people given high fructose corn syrup and those given sucrose.

These results are meaningful for the food and beverage industry because they provide further scientific evidence that products containing high fructose corn syrup do not promote weight gain more than products containing sugar.

Aromatherapy News

Relaxing Ritual of the Week: Aromatherapy Bath Meditation

When it comes to managing stress, it helps to have a variety of techniques to try. Some stress relief practices can help you to calm your physiology and reverse your stress response when it’s been triggered; others help you to manage and minimize the amount of stressors you have in your life. Some strategies take the form of ongoing habits that promote overall calmness and wellness. Trying something new each week can ensure that you’ll be able to hit stress from several different angles to effectively manage it more easily.

This week, I’d like to encourage you to try a strategy called Aromatherapy Bath Meditation. This one works really well as a nightly habit. It provides a way to unwind and relax, to get clean, and to practice meditation while you do it. (One of the many benefits of meditation is that it can help you feel less stressed overall, so this habit can help you with stressors you haven’t even experienced yet!) And if you use lavender as your scent, it can even help you sleep! This week, I challenge you to try this technique at least three times, and see how you like it.

Try The Aromatherapy Bath Meditation

You can also try last week’s relaxing ritual, the Chocolate Meditation. What are your favorite ways to relieve stress? Share in the comments (below), post on the About Stress Management Facebook Page, and pass it on with the ‘share’ button if you want to spread the stress relief.

Vermont Soap ~ Aromatherapy Air Care Fresheners

MIDDLEBURY, Vt.—Vermont Soap introduced an eco-conscious, all-natural line of Aromatherapy Air Fresheners. Scented with natural essential oils, these environmentally-conscious air fresheners offer health-conscious consumers an all-natural alternative to freshen the air. They can be sprayed directly in the air, on skin, fine linens and other fabrics and all water-safe surfaces. They can also be used to freshen personal spaces at home, school, work, in cars, dog beds or anywhere. These air fresheners contain pure essential oil aromas that won’t irritate the skin or nose. Aromatherapy Air Fresheners are free of artificial colors and fragrances, chemical preservatives, animal byproducts and are not tested on animals.

Aromatherapy Air Fresheners are offered in three scents to induce different moods: Country Lavender, Lemongrass Zen and Peppermint Magic. Lavender has a relaxing aroma, while lemongrass is uplifting and peppermint is clarifying and stimulating. Each freshener comes in an 8-oz. or 16-oz. re-usable spray bottle.

Massage Envy Launches Choices Program to Further Customize Massage Therapy

AromaTherapy and Deep Heat Relief Muscle Therapy Enhance Therapeutic Massage

SCOTTSDALE, Ariz., Sept. 30 /PRNewswire/ — Massage Envy, the nation’s largest massage therapy provider and the largest spa chain in America, began offering the new Choices program at its 633 locations this week. Choices provides four AromaTherapy options designed to relieve a variety of therapeutic needs including anxiety, headaches, emotional imbalance and insomnia. Deep Heat Relief Muscle Therapy is ideal for anyone who suffers from chronic pain or limited movement.

AromaTherapy options include:
Aches and Pains – specifically designed to promote circulation, this warming blend of clove, sweet birch, rosemary, and cypress helps aid tissue recovery after physical exertion.
Anxiety Release – known for their calming properties, lavender, chamomile, and vetiver are combined with uplifting aromas of citrus and clary sage.
Lavender Garden – English true lavender is used to both reduce pain and inflammation and act as a mild antidepressant and calming agent. Next, lavandin helps support the respiratory system, aids in natural detoxification, and promotes restful sleep.
Mint & Rosemary – this combination of mint oils and rosemary enlivens the mind and body. Peppermint is high in natural menthol, which aids in pain relief and cools the body while increasing circulation.

Asthma Treatment News

New Asthma Treatment Makes Breathing Easier

A new treatment called Bronchial Thermoplasty could help people with severe asthma breathe easier.

The process involved doctors putting a tiny catheter down breathing tubes to melt away the smooth muscle that can tighten during an asthma attack.

By increasing airflow, patients can respond better to inhalers and oral medications. Doctors warn that this in not a cure for asthma.

The treatment is only for people whose attacks are so severe, they make regular visits to the ER and use rescue inhalers constantly.

The procedure takes three outpatient treatments that last about 30 minutes each.

New Treatment Helps Asthmatics Breathe Easier

About 22 million Americans have asthma. Most are able to control it with medication, but about15-percent of asthma patients have cases so severe they require frequent trips to the hospital. Now there’s a new treatment to help those people breathe easier.

Tony Cook runs 6 to 7 miles a day. But until recently, his severe asthma made it too painful for him to work out for any length of time.

“It feels like a coil is just tightening around your lungs and you can’t get any relief whatsoever,” explained Cook.

In May, Tony underwent a new FDA approved treatment called bronchial thermoplasty. Doctors put a tiny catheter down his breathing tubes to melt away the smooth muscle that can tighten during an asthma attack. By increasing airflow, patients can respond better to inhalers and oral medications.

“We’re not curing asthma with this therapy. These patients will still have a diagnosis of asthma. What we’re hoping to do is bring them down a notch,” explained Dr. David Duhamel, Director of Pulmonary Procedures at Virginia Hospital.

Bronchial thermoplasty isn’t for people with mild or moderate asthma. It’s for people whose attacks are so severe that they make regular visits to the emergency room and need to use rescue inhalers constantly .

Bronchial thermoplasty takes three outpatient treatments that last about a half hour each.

“Right after the procedure I felt that coil loosen. To me, it was amazing,” said Cook.

Tony felt better immediately, but typically, the patients’ asthma gets worse the first few days after treatment then improves.

“I’m not coughing I’m not wheezing. It’s just the quality of life that I’ve always dreamed of having,” said Tony.

Because it’s so new, Tony’s procedure wasn’t covered by his insurance, but patients should check with their own carriers.

The FDA is requiring asthmatx, the company behind bronchial thermoplasty, to conduct a five-year study to determine the long-term effects of the treatment.

Inhaled steroids don’t help asthma flare-ups

(Reuters Health) – Doubling the dose of inhaled steroids doesn’t appear to dampen asthma attacks, despite the practice being recommended by many doctors, Canadian researchers said Thursday.

More than seven percent of adult Americans, and even more kids, have asthma, causing millions of visits to emergency rooms and doctors’ offices every year.

Until recently, national guidelines advised people to double the dose of inhaled steroids when they felt the telltale signs of an asthma flare-up coming on, such as chest tightness and coughing.

Those steroid medications, such as Pulmicort or Flovent, keep airway inflammation under control on a daily basis in asthmatics. So doctors had reasoned higher doses might work in emergencies.

“It is a reasonable thing to try,” said Dr. Andy Nish, an asthma expert at the Allergy and Asthma Care Center in Gainesville, Georgia, who was not involved in the new study, published by The Cochrane Collaboration.

“This article shows that sometimes we do things that seem reasonable and yet maybe aren’t as effective as we would like to think.”

The Canadian researchers pooled the best data available on outcomes with the higher doses, including five clinical trials that assigned 1,250 patients randomly to take either the standard dose of inhaled steroids or an increased dose.
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Overall, doubling or even quadrupling the amount of inhalant at the onset of a flare-up didn’t make patients any less likely to need rescue treatment with swallowed or injected steroids such as prednisone.

While effective, those stronger treatments may cause serious side effects like depression or bone thinning, so patients and doctors prefer to limit their use.

Except for 28 patients, all study participants were adults, so the findings may not apply to children.

“The most important strategy to reduce the rate and severity of flare-ups is to take daily preventive medications for asthma,” Dr. Francine M. Ducharme, who worked on the study, said in an e-mail to Reuters Health.

Ducharme, of the University of Montreal, said it was still common for doctors to recommend high-dose inhaled steroids to stave off attacks.

Instead, she said, patients should try rescue inhalers, which contain short-acting drugs such as albuterol that open up the airways. If that doesn’t work, swallowed or injected steroids may be necessary.

Nish said the best thing to do is try to prevent flare-ups. “Avoid cigarette smoke, stay indoors if it is a high-smog day, avoid exertion if it’s a cold or a hot day, and get your flu shot.”

And with the right medication, he said, many asthma attacks can be prevented.

“We can’t keep you from getting a cold, but hopefully we can keep that cold from causing significant exacerbations in your asthma,” he said.