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MountainQueen

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  1. An interesting article about testing hair for cortisol levels and heart attacks.....typically this experiment was done on men. Hair Gives a Heads-Up On Heart Attack Risk Stress may make you want to pull out your hair, but those tresses could be the key to measuring just how much stress you're under, according to a new study. The study found that the stress hormone cortisol can be measured in hair, providing the first long-term record of chronic stress that doesn't rely on a person's memories. High levels of cortisol in hair were associated with heart attacks, the researchers reported online today in the journal Stress. [stress and 9 other Destructive Human Behaviors] The findings could provide a new way to research chronic stress, according to the researchers. If the results can be replicated, the test may eventually be used in the doctor's office to identify people at high risk for cardiovascular disease. A record of stress The hair on your head is dead, but its follicle, or root, is alive. Substances like cortisol, which get released into the bloodstream when you're stressed, can seep into the follicle from the tiny blood vessels in the skin of the scalp. As the hair grows, traces of cortisol get trapped in the shaft, providing a way for researchers to measure the hormone over time. Because hair grows about 0.4 inches (1 centimeter) per month, most people have many months' worth of records of cortisol levels sitting on top of their heads. Previous measures of cortisol in blood or urine could record only a few hours' or days' worth of the hormone. "[Hair] tells me what happened to you in the last 10 months," study researcher Gideon Koren, a professor of pediatric medicine and toxicology at the University of Western Ontario, told LiveScience. "I can even see how things change monthly." Koren had previously used hair samples to measure drug toxicity in infants whose mothers used cocaine and heroine while pregnant. He learned that other colleagues were using similar methods to detect steroids in the systems of bodybuilders. If hair could accurately measure body-boosting steroids, he realized, it might also hold a record of other hormones, like cortisol. Previous research had found that the cortisol persists in the hair for at least six months, and in the case of several Peruvian mummies, up to 1,500 years. Hair and heart attacks To test the idea, Koren and his colleagues took hair samples from 120 men who checked into the cardiac unit of the Meir Medical Center in Israel. Half of the men were diagnosed with heart attacks, while the other half had other diagnoses like chest pain and infection. Only men were studied because heart attacks are more common in men, and because hormonal differences between men and women could skew the results. The researchers analyzed the cortisol levels in the 1.2 inches (3 cm) of hair closest to the scalp, representing about the last three months of the patients' lives. They found that cortisol levels were significantly higher in men who had heart attacks compared with men who had other illnesses. When the researchers split the men into quartiles based on their cortisol levels, they found that of the men with the lowest levels, 32 percent had heart attacks. In the men in the uppermost quartile of cortisol, that number jumped to 68 percent. The results held even after controlling for other heart-attack risk factors like cholesterol levels and body mass index (a measure of body fatness). "It's not the only one, of course, but cortisol is an important determinant of acute myocardial infarction," Koren said, using the technical term for heart attack. Testing the test The results will need to be replicated with larger numbers of patients before hair-cortisol testing goes mainstream, Koren warned. Other research has shown that cortisol levels in the hair do match cortisol levels in the blood, but Koren and his colleagues aren't yet sure if their results will apply to women. They also didn't test whether hair cortisol levels matched people's subjective feelings of stress. If the test works, however, it could be a noninvasive way to measure stress over time. That's important, Koren said, because people's long-term memories of stress aren't always reliable. "It could be another tool for us, if it's possible to do and not expensive," said Alicja Fishell, a psychiatrist at Women's College Hospital in Toronto. Fishell, who has collaborated with Koren before but was not involved in the current study, said the findings could one day prove useful to research in her area, reproductive health, because the effect of chronic stress on pregnant women and fetuses is not well-understood. "We need to have a good study that really correlates" the relationship between stress and later psychiatric problems in women at different reproductive stages of life, Fishell said. http://news.yahoo.com/s/livescience/hairgivesaheadsuponheartattackrisk;_ylt=AjLKG2wQ5Ll9Yz5NKm1kvGKs0NUE;_ylu=X3oDMTRmbm82a2VnBGFzc2V0A2xpdmVzY2llbmNlLzIwMTAwOTAzL2hhaXJnaXZlc2FoZWFkc3Vwb25oZWFydGF0dGFja3Jpc2sEY2NvZGUDbW9zdHBvcHVsYXIEY3BvcwM4BHBvcwM1BHB0A2hvbWVfY29rZQRzZWMDeW5faGVhZGxpbmVfbGlzdARzbGsDaGFpcmdpdmVzYWhl
  2. Thanks Zhen, that was a good article. I'm going to forward it to the "Cushing's Expert" at Mass General, that stood in front of me and said "Calories in have to be less than calories expended. It's as simple as that. Nothing else matters." Basically sending me home, after all sorts of testing highs to loose weight and exercise. I wasn't impresses at all, even though she thought I should have been impressed with her credentials and Mass General. Nope, not impressed at all. Despite 17 Ketosteroid levels four times "normal" and high 17-hydroxycortisteroids (17-OHC) she sent me home to diet and exercise. My UFCs were not consistently high. I was already living on less than 1200 calories and gaining weight. Obvious pituitary tumor on my MRI..... Needless to say. She was fired by me. MountainQueen
  3. An excellent article on Obesogens from Newsweek: http://www.newsweek.com/2009/09/10/born-to-be-big.html MountainQueen
  4. Some interesting concepts about "Obesogens". Worth the read! Why You Can't Lose Those Last 10 Pounds. On May 11, the White House announced it was targeting a new threat to America?s health and security. It wasn?t some rogue nation or terrorist organization, or a newfound disease or environmental threat. It was a class of chemicals that are making Americans fat. They?re called endocrine disrupting chemicals, or EDCs. And chances are you?re eating or drinking them right now. The White House Task Force on Childhood Obesity released a report called "Solving the Problem of Childhood Obesity Within a Generation." In the report they list endocrine-disrupting chemicals as a possible reason for increased obesity in the country and describe how scientists have coined a new term for these chemicals ? "obesogens" ? because they "may promote weight gain and obesity." What does this mean for you? It means that weight gain is not just about calories-in versus calories-out. No, America?s obesity crisis can?t entirely be blamed on too much fast food and too little exercise. We have to consider a third factor: the obesogens. They?re natural and synthetic compounds, and many of these chemicals work by mimicking estrogen ? the very hormone that doctors DON?T want women taking anymore (as a large clinical trial linked hormone therapy to increased risk of heart disease, breast cancer, stroke, blood clots and abnormal mammograms). Why traditional diets don?t work anymore Because high school biology was likely a while back, here?s a quick refresher: The endocrine system is made up of all the glands and cells that produce the hormones that regulate our bodies. Growth and development, sexual function, reproductive processes, mood, sleep, hunger, stress, metabolism and the way our bodies use food ? it?s all controlled by hormones. So whether you?re tall or short, lean or heavy ? that?s all determined in a big way by your endocrine system. But your endocrine system is a finely tuned instrument that can easily be thrown off-kilter. "Obesogens are thought to act by hijacking the regulatory systems that control body weight," says Frederick vom Saal, Ph.D., curators? professor of biological sciences at the University of Missouri. That?s why endocrine disruptors are so good at making us fat ? and that?s why diet advice doesn?t always work ? because even strictly following the smartest traditional advice won?t lower your obesogen exposure. See, an apple a day may have kept the doctor away 250 years ago when Benjamin Franklin included the phrase in his almanac. But if that apple comes loaded with obesity-promoting chemicals ? nine of the ten most commonly used pesticides are obesogens, and apples are one of the most pesticide-laden foods out there ? then Ben?s advice is way out of date. The obesogen effect is the reason why traditional diet advice ? choose chicken over beef, eat more fish, load up on fruits and vegetables ? may not work anymore. This is why we?re calling for a New American Diet. See, while digging up all of this research on obesogens we?ve discovered some good news: There?s no reason why all of our favorite foods ? from steak to burgers, from pasta to ice cream ? can?t be part of a reasonable weight-loss program. We just need to get rid of old thinking. We can reverse the obesogen effect if we simply adopt these four simple laws of leanness: Leanness Law No. 1: Know When to Go Organic The average American is exposed to 10 to 13 different pesticides through food, beverages and drinking water every day and nine of the ten most common pesticides are EDCs. But according to a recent study in the journal Environmental Health Perspectives, eating an organic diet for just five days can reduce circulating pesticide EDCs to non-detectable or near non-detectable levels. Of course, organic foods can be expensive. But not all organics are created equal?many foods have such low levels of pesticides that buying organic just isn?t worth it. The Environmental Working Group (EWG) calculated that you can reduce your pesticide exposure nearly 80 percent simply by choosing organic for the 12 fruits and vegetables shown in their tests to contain the highest levels of pesticides. They call them "The Dirty Dozen," and (starting with the worst) they are celery, peaches, strawberries, apples, blueberries (domestic), nectarines, sweet bell peppers, spinach, kale/collard greens, cherries, potatoes and grapes (imported). And you can feel good about buying the following 15 conventionally grown fruits and vegetables that the EWG dubbed "The Clean Fifteen," because they were shown to have little pesticide residue: onions, avocado, sweet corn (frozen), pineapples, mango, sweet peas (frozen), asparagus, kiwi fruit, cabbage, eggplant, cantaloupe (domestic), watermelon, grapefruit, sweet potatoes and honeydew melon. Leanness Law No. 2: Don?t Eat Plastic This ought to be a no-brainer. Indeed, you?re probably already thinking, Well, I don?t generally eat plastic. Ah, but you do. Chances are that you?re among the 93 percent of Americans with detectable levels of bisphenol-A (BPA) in their bodies, and that you?re also among the 75 percent of Americans with detectable levels of phthalates. Both are synthetic chemicals found in plastics that mimic estrogen ? essentially, artificial female hormones. And like pesticides, these plastic-based chemicals trick our bodies into storing fat and not building or retaining muscle. Decreasing your exposure to plastic-based obesogens will maximize your chances both of losing unwanted flab and of building lean muscle mass. Here?s how: 1) Never heat food in plastic containers or put plastic items in the dishwasher, which can damage them and increase leaching. BPA leaches from polycarbonate sports bottles 55 times faster when exposed to boiling liquids as opposed to cold ones, according to a study in the journal Toxicology Letters. 2) Avoid buying fatty foods like meats that are packaged in plastic wrap because EDCs are stored in fatty tissue. The plastic wrap used at the supermarket is mostly PVC, whereas the plastic wrap you buy to wrap things at home is increasingly made from polyethylene. 3) Cut down on canned goods by choosing tuna in a pouch over canned tuna. And get any canned and jarred foods from Eden Organic, one of the only companies that doesn?t have BPA in its cans. Leanness Law No. 3: Go Lean Always choose pasture-raised meats, which, studies show, have less fat than their confined, grain-fed counterparts and none of the weight-promoting hormones. Plus, grass-fed beef contains 60 percent more omega-3s, 200 percent more vitamin E and two to three times more conjugated linoleic acid (CLA, a near-magic nutrient that helps ward off heart disease, cancer and diabetes, and can help you lose weight, according to a study in the American Journal of Clinical Nutrition) than conventional beef. If you must choose a conventional cut of beef, choose lean cuts top sirloin, 95 percent lean ground beef, bottom round roast, eye round roast, top round roast or sirloin tip steak. Bison burgers and veggie burgers are also great substitutes when grass-fed beef isn?t available. And select sustainable lean fish with low toxic loads (meaning low levels of toxins like mercury and PCBs). A study in the journal Occupational and Environmental Medicine found that even though the pesticide DDT was banned in 1973, the chemical and its breakdown product DDE can still be found today in fatty fish. Bigger fish eat smaller fish, and so carry a much higher toxic load. Avoid ahi or bigeye tuna, tilefish, swordfish, shark, king mackerel, marlin and orange roughy ? and focus on smaller fish like anchovies, Atlantic herring and mackerel, and wild-caught Alaskan salmon. Choose farmed rainbow trout, farmed mussels, anchovies, scallops (bay, farmed), Pacific cod, Pacific Halibut, Tuna (canned light) and mahimahi. Also, when you cook the fish, broil, poach, grill, boil or bake instead of pan-frying ? this will allow contaminants from the fatty portions of fish to drain out. Leanness Law No. 4: Filter Your Water The best way to eliminate EDCs from your tap water is an activated carbon water filter. Available for faucets and pitchers, and as under-the-sink units, these filters remove most pesticides and industrial pollutants. Check the label to make sure the filter meets the NSF/American National Standards Institute?s standard 53, indicating that it treats water for both health and aesthetic concerns. Try The Brita Aqualux ($28, brita.com), Pur Horizontal faucet filter ($49, purwaterfilter.com) and Kenmore?s under-sink system ($60, kenmore.com). However, if you have perchlorate (a component of rocket fuel!) in your water (you can find out by asking your municipal water supplier for a copy of its most recent water-quality report) you?ll need a reverse osmosis filter. But for every five gallons of treated water they create per day, they discharge 40 to 90 gallons of wastewater, so make sure it?s necessary before purchasing one. http://shine.yahoo.com/event/loveyourbody/...pounds-1964849/
  5. I came across this article about the clinical use of Dex for CAH carriers. After reading this article I remembered that NO ONE asked me if I was pregnant before I took the Dex test. What would have happened if I had been? Very interesting article for CAH gene carriers: From Time Magazine on line: Medical Ethics: Prenatal Dexamethasone Use Questioned By CATHERINE ELTON Catherine Elton ? Mon Jun 21, 11:45 pm ET When Marisa Langford found out she was pregnant again, she called Dr. Maria New, a total stranger, before calling her own mother. New, a prominent pediatric endocrinologist and researcher at Mount Sinai Medical Center in New York City, is one of the world's foremost experts in congenital adrenal hyperplasia, or CAH, a group of inherited disorders of the adrenal gland. Langford and her husband learned they were silent carriers of the genetic variation that causes CAH when their son was diagnosed with the condition after birth. Their son - like the 1 in 16,000 babies born with CAH each year in the U.S. - faces a lifetime of taking powerful steroid medications to compensate for his faulty adrenal glands. When Langford contacted New about her second pregnancy, New, who was not Langford's regular doctor, called a local pediatric endocrinologist. That doctor prescribed Langford a commonly used medication for CAH. "Dr. New told me I had to start taking dexamethasone immediately," says Langford, 30, who lives in Tampa. "We felt very confident in someone of her stature and that what she was telling us was the right thing to do."(See the most common hospital mishaps.) The early prenatal use of dexamethasone, or dex, has been shown to prevent some of the symptoms of CAH in girls, namely ambiguous genitalia. Because the condition causes overproduction of male hormones in the womb, girls who are affected tend to have genitals that look more male than female, though internal sex organs are normal. (In boys, in contrast, the condition leads to early signs of puberty, such as deep voice, body hair and enlarged penis by age 2 or 3.) But while the prenatal treatment may address girls' physical symptoms, it does not prevent the underlying, medical condition, which in some severe cases can be life-threatening, nor does it preclude the need for medication throughout life. Langford says also that neither New nor her prescribing physician mentioned that prenatal dexamethasone treatment is an off-label use of the drug (an application for which it was not specifically approved by the government) or that the medical community is sharply divided over whether dexamethasone should be used during pregnancy at all. Is It Safe - or Even Necessary? To date, there has been just one controlled, prospective, long-term trial of prenatal dexamethasone for the prevention of ambiguous genitalia, conducted in Sweden. The results, published in 2007 in the Journal of Clinical Endocrinology & Metabolism - more than two decades after doctors began using the medication in pregnant patients - found some mild behavioral and cognitive deficits in children whose mothers had been treated. But the study, with just 26 participants, was too small to be definitive. "We just don't know what we are doing to these kids," says Dr. Walter Miller, the chief of endocrinology at University of California, San Francisco. "It's not sufficient to say, The baby was born and had all fingers and toes, so it's fine."(See the top 10 medical breakthroughs of 2009.) In animal studies, dexamethasone has been shown to cause birth defects, but proponents of the treatment note that no human birth defects have ever been associated with the treatment, and that it is uncertain whether findings in lab animals translate to humans. Meanwhile, the possible benefits are clear: the treatment can spare young girls the potential psychosocial problems associated with having ambiguous genitalia as well as the ordeal of surgery to correct deformities later. "I see potential for benefits and I don't see evidence there's any negatives to this. There are lots of risks associated with surgery, and if this can prevent surgery, then it's a good thing," says Dr. Ingrid Holm, a pediatric endocrinologist at Children's Hospital in Boston. Research has also suggested that affected women who were treated with dex in the womb show more typical gender behavior than other women with CAH; the latter group tends to behave more tomboyishly and express little interest in having children. New told the Wall Street Journal in 2009 that the treatment further spares parents the "terrifying prospect" of not knowing whether their newborn is a boy or a girl. (Comment on this story.) It is these very benefits, however, that lead some researchers to question what, exactly, doctors are treating - and whether it needs to be treated at all. Miller believes that prenatal dex is being used to alleviate "parental anxiety," rather than the child's condition. Other doctors and researchers have criticized New for introducing gender behavior into the medical prognosis - in two recent presentations on CAH at medical conferences, New offered medical outcome data on prenatal dex alongside data on typical gender behavior. "Maybe this gives clinicians the idea that the treatment goal is normalizing behavior. To say you want a girl to be less masculine is not a reasonable goal of clinical care," says David E. Sandberg, a University of Michigan pediatric psychologist who treats and conducts research on children with CAH.(Read how postpartum depression can strike fathers.) Perhaps most controversially, prenatal dex must be given as soon as a woman learns she is pregnant, which is usually several weeks before genetic tests can determine if the fetus is in fact a female affected with CAH - the chance of which is 1 in 8 for parents who already have an affected child or know they are carriers of the genetic disorder. If the baby is healthy, treatment is stopped, but at that point, the fetus has been exposed to the steroid drug for weeks. There is no data on how many mothers receive prenatal dex, but according to the odds, 7 of 8 may be taking medication unnecessarily. Concerns over Patient Consent Some critics strongly oppose prenatal dex in large part because of the way it is presented to patients. Guidelines issued by pediatric endocrine societies in Europe and North America recommend that doctors obtain written informed consent from the patient as well as ethics-committee oversight for the treatment, but it is not known how many physicians adhere to these guidelines. Langford says she was not made aware of them. In addition, 2010 practice guidelines from the international Endocrine Society suggest that prenatal dex be administered as part of clinical research, which requires informed consent and ethics-committee oversight. However, prenatal dex is routinely given outside the research setting, as an off-label treatment. It is common - and perfectly legal - for doctors to use their own discretion when prescribing drugs off-label. Antiseizure drugs like topiramate are commonly prescribed to treat migraine headache pain, for example. The practice allows patients to receive valuable treatment for which the drug may not have been expressly approved and may never be - it takes money and drug-company interest, which are hard to come by, to conduct the large randomized controlled trials required for a new-use the Food and Drug Administration (FDA) approval of a drug that is already on the market. But as doctors share information about a drug's perceived off-label benefits and lack of harm, it gets even harder to take a step back and launch a formal randomized controlled trial - considered the gold standard in medical research - because patients demand the treatment, and doctors say it would be unethical to withhold it from them or from control groups in clinical trials. "It's a risky and dangerous way to innovate," says prominent University of Pennsylvania bioethicist Arthur Caplan. "There's no systematic collection of information. So, yes, things do get proven this way, and it is a way to innovate, but it also can come at a cost of unnecessary expense and, sometimes, bad side effects." It also enables doctors to do human research without gaining proper approval. All participants in human medical research are, by law, entitled to the protective oversight of an institutional review board (IRB), a committee that safeguards the interests of research volunteers and ensures they have been fully informed about the potential risks and benefits of an experimental treatment. If doctors are simply treating a patient with an off-label drug, they are not required to obtain written informed consent from patients. But if doctors give treatment with the intent to gain knowledge, they are technically doing research, which must receive IRB approval. Ethicists say physicians may sometimes treat patients off-label, then decide later to launch a follow-up study; or, they do follow-up research on patients who have been treated by other doctors. In the process, they have converted these patients into unwitting research volunteers. Some doctors game the system this way, Caplan says, to avoid battles with IRBs. Critics suspect that Mount Sinai's New, who has long championed prenatal dex and bills it as safe on her foundation website, has gamed the system. In a letter dated Feb. 2, 2010, a group of 36 bioethicists, including Alice Dreger, a professor of bioethics at Northwestern University, asked the FDA and the federal Office for Human Research Protections to investigate New's practices; the authors contend that the doctor has conducted follow-up studies on prenatal dex patients without receiving IRB approval for treatment trials. Dreger says she has also asked Weill Cornell Medical College, where New previously worked, and Mount Sinai Medical Center to investigate the matter. New, who declined to be interviewed for this article, does not administer the treatment in her current practice - according to Mount Sinai Medical Center, she has prescribed it only once since joining the hospital in 2004 - but ethical concerns remain, Dreger says, if the doctor consults with patients, resulting in their being prescribed dex elsewhere, then follows up with them for research purposes. At a medical conference in January, where New presented data from her research on prenatal dex, the doctor refused to answer a fellow researcher's questions regarding her process of informed consent. Clinical Trials vs. Legal Trials For Langford's part, she says she is grateful to New for her help, even though her daughter, now 4 and healthy, was found not to have CAH. But Jenny Westphal, 24, who took dexamethasone throughout her pregnancy at the recommendation of another doctor, says she feels misled. Like Langford she was not asked to give informed consent. Unlike Langford, however, her daughter, now 3, who has CAH, has also had serious and mysterious health problems since birth, including feeding disorders, that are not commonly associated with her adrenal-gland disorder. In April, Westphal, who lives in Wisconsin, started doing research online and discovered there was some controversy over the treatment. "I was outraged, frustrated and confused. Confused, because no one had ever warned me about this. I wasn't given the chance to decide for myself, based on the risks and benefits, if I wanted the treatment or not," she says. Westphal may never know whether her daughter's problems were caused by dexamethasone, though she will likely always believe they were. That is why so many similar situations, in which experimental drugs are prescribed off-label without informed consent rather than in clinical trials, wind up becoming case studies - not in scientific journals, but exactly where Westphal and her husband are considering taking theirs: to court. http://news.yahoo.com/s/time/20100622/hl_time/08599199645300
  6. Yup, but they're finally putting two plus two together (or should I say 3 + 1?).
  7. All sorts of VERY interesting info is coming out of this year's Endocrine Society's 2010 Meeting, http://www.endocrinetoday.com/default.aspx There's iteresting articles on guidelines for pituitary incidentalomas, Vitamin D, BPA, thyroid malfunction, Growth Hormone therapy, Endocrine Disruptors and PCOS, glucagon stimulating tests, etc, etc. More info than last year! Spend some time reading! MountainQueen
  8. Vitamin D Deficiency Linked to Diabetes, Metabolic Syndrome in Studies SATURDAY, June 19 (HealthDay News) -- A pair of new studies has uncovered evidence that low levels of vitamin D could lead to poor blood sugar control among diabetics and increase the risk of developing metabolic syndrome among seniors. Both findings are slated to be presented Saturday at the Endocrine Society's annual meeting in San Diego. In one study, researchers at the Johns Hopkins University School of Medicine in Baltimore reviewed the medical charts of 124 type 2 diabetes patients who sought specialty care at an endocrine outpatient facility between 2003 and 2008. More than 90 percent of the patients, who ranged in age from 36 to 89, had either vitamin D deficiency or insufficiency, the authors found, despite the fact that they all had had routine primary care visits before their specialty visit. Just about 6 percent of the patients were taking a vitamin D supplement at the time of their visit, the research team noted, and those who had lower vitamin D levels were also more likely to have higher average blood sugar levels. "This finding supports an active role of vitamin D in the development of type 2 diabetes," study co-author Dr. Esther Krug, an assistant professor of medicine, said in a news release from the Endocrine Society. "Since primary care providers diagnose and treat most patients with type 2 diabetes, screening and vitamin D supplementation as part of routine primary care may improve health outcomes of this highly prevalent condition," Krug added. A second study involving nearly 1,300 white Dutch men and women over the age of 65 found almost half were vitamin D-deficient, while 37 percent had metabolic syndrome. Metabolic syndrome is a grouping of health risk factors, including high blood pressure, abdominal obesity, abnormal cholesterol levels and high blood sugar. "Because the metabolic syndrome increases the risk of diabetes and cardiovascular disease, an adequate vitamin D level in the body might be important in the prevention of these diseases," study co-author Dr. Marelise Eekhoff, of VU University Medical Center in Amsterdam, said in the same news release. Regardless of gender, those with insufficient amounts of vitamin D in their blood were more likely to have the syndrome than those with sufficient amounts of vitamin D, Eekhoff and her colleagues found. "It is important," added Eekhoff, "to investigate the exact role of vitamin D in diabetes to find new and maybe easy ways to prevent it and cardiovascular disease."
  9. Dealing with Patients Who 'Know More Than You Do' About Their Illness Leslie Kane, Other, 10:35AM Mar 4, 2010 A woman whose daughter had Glycogen-storage disease type 1 was in the ED because her daughter's blood glucose level had plunged to 20. The 40-ish ED physician wanted the daughter, who was vomiting but not displaying other severe symptoms of hypoglycemia, to drink cola soda as an emergency measure. The mother, who had previously experienced these episodes with her daughter and had read extensively about the disease in numerous medical journals, told the physician that he should start an IV immediately. The physician asked sarcastically, "Are you a doctor?" The mother, not a clinician, replied, "Yes! I'm a doctor for this specific person and this specific disease. You've had one lecture on this and I've had four years of experience." She felt that her years of educating herself about the disease and her first-hand experience with her daughter gave her more expertise with her daughter than the physician who had just come onto the case. The physician was taken aback, but started the IV. Consider the Source Some physicians appreciate and make use of a patient's or family member's knowledge. Others consider it an annoyance, especially if it's based on information from questionable or offbeat sources. "There are patients with uncommon diseases who, through first-hand experience as well as specialty-specific readings, do become as well as or better versed than their physician," says Gregory A. Hood, MD, internist with Drs. Borders and Associates, Lexington, KY, and president-elect of the Kentucky chapter of ACP. "In these cases, it does work to establish a partnership/alliance with the patient. "The good patients like this recognize that there are still consequences and unintended consequences of treatments and choices for which it is beneficial to have a physician's training and experience," he says. Hood's analogy: "There are expert mountain climbers who try to tackle professional grade challenges without a Sherpa, or without fully accounting for the Sherpa's advice and experience. Their biographies don't tend to work out too well. When the expert climber works together seamlessly with knowledgeable Sherpas then the best outcomes are realized." The trend is definitely for patients to be much more involved in their own care. For example, the Society for Participatory Medicine (www.participatorymedicine.org) encourages health care as an equal partnership between patients and health professionals and encourages and expects active involvement by all parties. And the growing popularity of patient advocacy organizations points up many patients' feeling that they need to take matters into their own hands. Such organizations typically promote 'partnerships,' but some relationships end up being adversarial. While most, if not all, doctors appreciate having an educated and motivated patient, not all visits with VIPS (Very Informed Patients) are positive. What's typically off-putting is the accompanying attitude. We all know that some people are likeable, diplomatic, charming, and others are--well, the opposite. Patients whose demeanor bespeaks respect and collaboration evoke different responses from those whose attitudes say, "Hey, why don't you know as much as I know? What am I paying you for?" As adults, we're supposed to have the self-awareness and maturity to not bristle when our knowledge, expertise, or self-image is questioned. Sometimes that's hard when you're also dealing with reimbursement woes, a backed-up waiting room, and other typical challenges of running a medical practice. Still, real or imagined assaults on our ego are constant throughout life, and self-reminders about keeping an equanimous attitude can sometimes save the moment. Practice Tip: You can help yourself by improving patient understanding of the difference between a useful medical source and a quack or non-authoritative source. One way is to provide a patient information print-out in your waiting room; an article on your practice website, or an item in your practice newsletter. Talk about these questions: What is a trusted medical source? What's the difference between a clinically-tested treatment and a treatment based only on one person's story? Some good sources for this information include: Http://www.cancer.gov/cancertopics/factshe...mation/internet http://nccam.nih.gov/health/webresources Do you prefer when patients do their own research and feel they are very knowledgeable about their treatment? Do you feel this helps you or causes more situations that take time to deal with? Let us know how you feel!!! http://boards.medscape.com/forums?128@717....e!comment=1
  10. An interesting follow up to previous article: Science News Share Blog Cite Print Email BookmarkType 2 Diabetes Gene Predisposes Children to Obesity, Study Finds ScienceDaily (Dec. 14, 2009) ? Pediatric researchers have found that a gene already implicated in the development of type 2 diabetes in adults also raises the risk of being overweight during childhood. The finding sheds light on the genetic origins of diabetes and may present an avenue for developing drugs to counteract the disease, which has been on the upswing in childhood and adolescence. "It has been a bit of a mystery to scientists how or even if these adult diabetes genes function during childhood," said study leader Struan F.A. Grant, Ph.D., a researcher and associate director of the Center for Applied Genomics of The Children's Hospital of Philadelphia. "This finding suggests that there may be genetic activity during childhood that lays the foundation for the later development of type 2 diabetes." Type 2 diabetes occurs either when the pancreas produces too little insulin, or when the body cannot efficiently use the insulin that is produced because the cells have become resistant. Formerly called adult-onset diabetes and still most common in adults, type 2 diabetes has been increasing sharply among children and teenagers. Grant and study co-leader Hakon Hakonarson, M.D., Ph.D., director of the Center for Applied Genomics at Children's Hospital, investigated 20 gene variants, known as single nucleotide polymorphisms (SNPs), previously reported to be associated with type 2 diabetes. The researchers drew on a cohort of nearly 7,200 Caucasian children, aged 2 to 18 years, in an ongoing genome-wide association study of childhood obesity at Children's Hospital. Dividing the cohort randomly in half allowed the team to follow their discovery study with a replication study. Researchers continue to unravel the complicated role of different diabetes-related genes in influencing body weight toward both lower and higher ends of the scale. The risk of developing type 2 diabetes in adulthood is often influenced by factors in the first year of life, including lower birth weight, as well as by higher body mass index (BMI) during childhood. Obesity is a well-known risk factor for type 2 diabetes. A previous study earlier this year by the same study team found that another type 2 diabetes gene, CDKAL1, affects fetal growth and increases the likelihood that a baby will be underweight at birth. The current study found that the gene HHEX-IDE does not affect birth weight, but makes it more likely that a child will become obese during childhood. The gene does not appear to predispose to obesity in adults, although by contributing to childhood obesity, it may set the stage for type 2 diabetes in adulthood. Grant cautioned that HHEX-IDE accounts for only a small proportion of the genetic contribution to the risk of type 2 diabetes, so many other gene variants remain to be discovered. However, he adds, HHEX-IDE may represent an important underpinning of the disease. "Previously we thought that this gene affects insulin production during adulthood, but we now see that it may play an early role in influencing insulin resistance through its impact on body size during childhood," said Grant. "One implication is that if we can develop medicines to target specific biological pathways in childhood, we may be able to prevent diabetes from developing later in life." The National Institutes of Health, the Cotswold Foundation and The Children's Hospital of Philadelphia supported this study.
  11. I wonder if Chromosone 16 has anything to do with Cushing's????? As Childhood or Adult Onset? Like CAH or adult-onset CAH? Worth a read. Study: Missing DNA can promote childhood obesity By MALCOLM RITTER, AP Science Writer Malcolm Ritter, Ap Science Writer ? Sun Dec 6, 2:24 pm ET NEW YORK ? Some children get severely obese because they lack particular chunks of DNA, which kicks their hunger into overdrive, researchers report. The British researchers checked the DNA of 300 children who'd become very fat, on the order of 220 pounds by age 10. They looked for deletions or extra copies of DNA segments. They found evidence that several rare deletions may promote obesity, including one kind they studied further and found in less than 1 percent of about 1,200 severely obese children. That deletion, on chromosome 16, apparently causes trouble because it removes a gene that the brain needs to respond to the appetite-controlling hormone leptin, said Dr. Sadaf Farooqi of Cambridge University. In her study, children with a chromosome 16 DNA deletion "have a very strong drive to eat," said Farooqi, who co-led the research. "They're very, very hungry, they always want to eat." The work, reported online Sunday by the journal Nature, has already produced a real-world payoff. Farooqi said four children with the chromosome 16 deletion had drawn the attention of British child welfare authorities, who blamed the parents for overfeeding them. "We were able to intervene" and get the parents of two children off the hook, and the other two cases are under discussion, she said. That's happened before when the scientists uncovered genetic causes for severe childhood obesity, she said. "It's a slightly unusual outcome of our research, but one we think is very important," she said. While scientists had previously discovered particular genes that promote obesity when damaged, the new work looked at larger chunks of DNA that can span several genes. The chromosome 16 deletion includes nine genes. Eric Ravussin, an obesity expert at the Pennington Biomedical Research Center in Baton Rouge, La., who wasn't involved in the study, said the work provides "a gold mine of information." That's because it identifies specific chromosome areas that scientists can explore to discover obesity-related genes, he said.
  12. If you get a chance, please watch the NOVA show on Public Broadcasting System (PBS) about epigenetics and the second genome. Very interesting when watched with endocrine/cushings in mind. Also stress markers and personality changes. http://www.pbs.org/wgbh/nova/genes/ I think you can also read the program trancript. I would love to hear what anyone else thinks. MountainQueen
  13. Vitual Pituitary Surgery! Practice Makes Perfect With Brain Surgery Simulator September 07, 2009 by Brendon Nafziger, Writer When David Clarke, MD, removed a benign tumor from a woman's brain last month, it was, in a way, the second time he had performed the surgery. Days earlier, the Halifax, Nova Scotia-based neurosurgeon had rehearsed the complex procedure on a state-of-the-art virtual-reality simulator, using a model created from the patient's own medical information. Dr. Clarke believes the operation was the first of its kind where a brain tumor surgery was practiced beforehand on a patient-specific simulator. Known as NeuroTouch, the computer simulator is being developed by a National Research Council of Canada team of engineers, computer programmers and neuroscientists. "We have flight simulators," says Ryan D'Arcy, PhD, a researcher at the NRC site in Halifax, and one of the "brains" behind the project, so he wanted to see "what would a simulator for neurosurgery be like." But Dr. D'Arcy believes this machine one-ups flight simulators. "This is effectively as though your pilot would simulate the exact flight you're about to take before you get on the airplane," Dr. D'Arcy says. "They would simulate the air conditions, what is the best route or whatever." To prepare simulations on NeuroTouch, surgeons feed MRI scans and other patient info into the computer, which then uses previously gathered data on tumor tissue types to create a three-dimensional model of the patient's condition -- all presented eerily realistic, high-resolution graphics. The surgeon controls the virtual operation using a feedback-giving device that mimics the look and feel of the continuous ultrasonic aspirator. (Aspirators are surgical tools that vibrate at a high-frequency, pulverizing cancerous tissue, which they then clear with suction.) "You can feel the vibration," says Dr. Clarke, "the tissue as it's being removed. It's like the actual thing." For now, NeuroTouch can model three of the most common types of brain cancers, according to Dr. Clarke, including primary brain tumors, pituitary tumors and meningiomas. The tumor removed from the Nova Scotian woman was a meningioma, a benign tumor that afflicts about two percent of the population. NeuroTouch will undergo trials at 5 sites across Canada, with 50 researchers from various disciplines involved in the project. Robert DiRaddo, PhD, of the NRC site in Montreal, and the Scientific Lead of NeuroTouch, is in talks with companies to commercialize the device, but he cannot divulge who is interested. "We would like to have an agreement in place within the next one to two years," he said in a statement. Dr. Clarke thinks the biggest impact of the simulator will be on the patients themselves. "How did my simulated surgery go?" was the first question his patient asked, he says, after he did a dress rehearsal on NeuroTouch. "It may be prophetic," he continues. "I think in the future, people and patients will want to know, how did it go? Were there problems encountered? Were you able to get around those problems? It obviously has implications for the risk of surgery, for consent of surgery. It represents [a change in] how the surgeons will interact with patients." http://www.dotmed.com/news/story/10121/
  14. An interesting article about the neurological effects of Lyme's Disease. 'Lyme Rage': Can Lyme Disease Affect Your Personality? Roaming Ticks Can Carry Disease Linked to Physical Problems, Mental Madness By ELISABETH LEAMY, JOSH GAYNOR and LEE FERRAN July 30, 2009 They're tiny insects that can cause big problems. A rise in the number of ticks this year has infectious disease experts focused on the best way to treat the Lyme disease that the little buggers can spread. Some believe the disease can rewire the brain when left untreated.Some 20,000 Americans are infected and treated every year, but countless others go undiagnosed. The illness has symptoms that include fever, fatigue and headaches, but if left untreated, Lyme disease can be more serious. While there are physical symptoms of the disease that can include severe headaches, severe joint pain and even numbness in the hands or feet, many experts believe Lyme disease can rewire the human brain and affect personality. "I'm convinced that Lyme in a chronic form can affect psychiatric issues, neurological issues and you can have neurological problems," New York epidemiologist Dr. Daniel Cameron said. Lyme disease patient Kelly Kulesz told "Good Morning America" she saw herself change overnight because of her infection. "They put me on stage fright medications," Kulesz said. "Doctors thought it was obsessive compulsive disorder, but it's just not." When Terry Jo Sedlacek went to trial for allegedly gunning down the Rev. Fred Winters in March, the defense cited his Lyme disease infection and it's contribution to what many call "lyme rage." But not all experts believe Lyme disease causes such " target="_blank">radical changes in personality. "The example I like to cite is if I have Lyme disease and I get run over by a truck, the Lyme disease didn't cause my broken leg," Halperin, said Dr. John Halperin, lead author on the new American Academy of Neurology Guideline on Lyme Disease Treatment. ABC News medical contributor Dr. Marie Savard, who had lyme disease, said that the possibility of personality changes should at least be taken into consideration. "It does affect the central nervous system. You can have behavior changes, personality changes," she said. "We have to listen and pay attention."
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