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Everything posted by MountainQueen

  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. 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
  7. 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."
  8. 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
  9. 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.
  10. 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.
  11. 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
  12. 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/
  13. 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."
  14. Articles like this tick me off! What a perfect time for this Dr. Jason Block to educate the public about Cushing's! Oh yeah, this guy's not an endocrinologist, he's a epidemiologist (in internal medicine)...... For the heavy, economic woes can mean weight gain. NEW YORK (Reuters Health) ? Being under stress -- including worrying about paying bills in today's economy -- may make overweight and obese people gain more weight, although stressed-out normal-weight individuals don't have this problem, new research in the American Journal of Epidemiology shows. "Where you start in terms of your weight seems to matter in how stress is associated with weight gain," Dr. Jason Block of Harvard Medical School in Boston, who conducted the research as a Robert Wood Johnson Foundation Health & Society Scholar at the Harvard School of Public Health, told Reuters Health. While psychosocial stress may increase people's risk of many health problems, from high blood pressure to cancer, less is known about how it might influence weight gain over time, Block and his team note in their report. To investigate, they looked at data on 1,355 men and women 25 to 74 years old in 1995 who were followed for nine years as part of the Midlife in the United States study. All had completed a telephone survey to assess their levels of psychosocial stress and identify psychiatric problems at the study's outset. The higher a person' body mass index (BMI) -- a measure of the ratio between height and weight -- at the beginning of the study, Block and his colleagues found, the more weight they gained in response to stress. And the effects varied by gender. While having trouble paying the bills and experiencing heavy job-related demands were linked to weight gain for men and women, lack of control over one's life and strained family relationships influenced weight gain in women, but not men. For men, having less autonomy on the job and less opportunity to use skills and learn new things also boosted the likelihood of gaining weight. Both men and women with generalized anxiety or depression who were heavy at the beginning of the study put on more weight over time than heavy people who weren't anxious or depressed. While his study didn't look at how stress might cause weight gain, Block noted, there are a couple of ways that make sense. Social subordination and stress up levels of the so-called stress hormone cortisol in people and animals, while high levels of the hormone also are associated with abdominal obesity. And eating causes the brain to release feel-good chemicals called endogenous opiates, he added, so certain people may rely on eating as a way to soothe themselves and release stress. "It appears to be a kind of comfort-eating thing as well as a cortisol thing." People should be aware that times of stress may be risky times for weight gain, the researcher said, especially if they are already heavy, and prepare themselves accordingly. "If you can prevent that weight gain it's a lot easier than having to deal with it after you've already gained the weight," Block noted. One main weapon against stress-induced weight gain, he added, is taking steps to cope with stress. "It's something that I talk to patients about all the time." He said he advises patients to do two things: make sure they have some time to themselves each day to meditate, exercise or even just have a break from family and work demands; and be sure to get enough sleep. "Sleep deprivation by itself has been linked to weight gain, and sleep deprivation is also related to higher levels of stress and higher levels of depression and anxiety," Block said. "Getting enough sleep can really help from multiple standpoints." Finally, he added, people with anxiety or depression should get help, and take medication if they need it. While some antidepressant and anti-anxiety medications can cause weight gain, Block pointed out, others don't have this side effect. "If weight is an issue for someone it's something they can discuss with their doctor to choose a medication that's less linked to weight gain than some of the others." SOURCE: American Journal of Epidemiology, July 15, 2009.
  15. An interesting article. My mother, who went through nursing school in 1955 has been part of the Nurses' Health Study since it started back in the 1970s. Every year she answers a 100+ page questionaire and gives blood, or does a bone density test, or some other test. My Mom is now 74 years old. This study has been really productive for Women's health. It was the first study to look at just women. Prior to this study most studies were done on men and the results were just assumed to be the same for women.... http://www.channing.harvard.edu/nhs/ MountainQueen Hormones may tie caffeine to cancer risk Tue Jul 7, 6:14 pm ET NEW YORK (Reuters Health) ? Coffee and general caffeine intake may affect a woman's levels of estrogen and other sex hormones, a new study suggests -- offering a potential explanation for findings that link caffeine to certain cancers. Several studies have found connections between caffeine and breast and ovarian cancers, though the findings have not always been consistent. For instance, different analyses of the Nurses' Health Study (NHS) -- a large, long-running study of U.S. female nurses -- have linked higher caffeine intake to lower risks of breast and ovarian cancers in postmenopausal women, but to a higher risk of ovarian cancer before menopause. No one knows whether caffeine directly affects the risks of the cancers. But since estrogen and other sex hormones play a role in both diseases, it's possible that caffeine affects the risks of the cancers via hormonal influences, note investigators Dr. Joanne Kotsopoulos and colleagues at Harvard Medical School. The team looked at the relationship between coffee and caffeine intake and hormone levels among more than 1,200 women involved in the NHS. At various points during that study, the women had completed questionnaires on their diets and other lifestyle factors, and provided blood samples. Kotsopoulos and her colleagues used those stored samples to measure the women's levels of estrogen and other sex-related hormones. Overall, the researchers found, the more coffee and caffeine a premenopausal woman consumed, the lower her levels of estradiol, a form of estrogen, during the second half of the menstrual cycle. Meanwhile, higher caffeine intake was related to higher levels of another sex hormone, progesterone, the researchers report in the journal Cancer. The findings were somewhat different among postmenopausal women. For them, greater coffee and caffeine consumption was linked only to higher levels of sex hormone-binding globulin, or SHBG. Some studies have linked higher levels of SHGB -- which decreases the activity of estradiol and testosterone -- to a lower risk of breast cancer in postmenopausal women, Kotsopoulos and her colleagues note. Exactly what the current findings mean is far from clear, according to the researchers. In theory, lower estrogen levels in premenopausal women would help protect against ovarian cancer -- so the findings do not explain the earlier results linking higher caffeine intake to a higher risk of premenopausal ovarian cancer. Still, the researchers write, the results do suggest that caffeine influences sex hormone levels. They say that more studies are needed to see how those influences may affect hormone-related cancers. SOURCE: Cancer, June 15, 2009.
  16. Robin, Thank you for posting this story. I read it last night and I have thought about it ever since. Marie Richardson's story is haunting, not only because she wasn't diagnosed or treated correctly, but because I survived a rupture right next to my pituitary, and I thought for safety sake, we should all know the symptoms of a rupture: *sudden onset of a severe headache (described as the "worst headache of my life"), almost a thunderclap of a headache. *nausea and vomiting soon after the headache starts *stiff neck *transient loss of vision or consciousness *acute sensitivity to light, sound, smells *blood flows into the subarachnoid space (between the brain and the skull) it increases pressure on the brain making the person confused and lethargic. If you have these symptoms, get to a hospital, call 911! It is VERY rare that a pituitary tumor ruptures, but you should know the symptoms and you should discuss these symptoms with your loved ones in case you can't communicate, make sure they know to call 911. I hope I'm not scaring anyone, that is not my intent. My heart goes out to the Richardson Family. MountainQueen
  17. Big US study will test vitamin D, fish oil Jun 22, 2009 at 1:34 PM PDT Story Updated: Jun 22, 2009 at 1:34 PM PDT By Associated Press Two of the most popular and promising dietary supplements ? vitamin D and fish oil ? will be tested in a large, government-sponsored study to see whether either nutrient can lower a healthy person's risk of getting cancer, heart disease or having a stroke. It will be one of the first big nutrition studies ever to target a specific racial group ? blacks, who will comprise one quarter of the participants. People with dark skin are unable to make much vitamin D from sunlight, and researchers think this deficiency may help explain why blacks have higher rates of cancer, stroke and heart disease. "If something as simple as taking a vitamin D pill could help lower these risks and eliminate these health disparities, that would be extraordinarily exciting," said Dr. JoAnn Manson. She and Dr. Julie Buring, of Harvard-affiliated Brigham and Women's Hospital in Boston, will co-lead the study. "But we should be cautious before jumping on the bandwagon to take mega-doses of these supplements," Manson warned. "We know from history that many of these nutrients that looked promising in observational studies didn't pan out." Vitamins C, E, folic acid, beta carotene, selenium and even menopause hormone pills once seemed to lower the risk of cancer or heart disease ? until they were tested in big studies that sometimes revealed risks instead of benefits. In October, the government stopped a big study of vitamin E and selenium pills for prostate cancer prevention after seeing no evidence of benefit and hints of harm. Vitamin D is one of the last major nutrients to be put to a rigorous test. For years, evidence has been building that many people are deficient in "the sunshine vitamin." It is tough to get enough from dietary sources like milk and oily fish. Cancer rates are higher in many northern regions where sunlight is weak in the winter, and some studies have found that people with lower blood levels of vitamin D are more likely to develop cancer. Fish oil, or omega-3 fatty acid, is widely recommended for heart health. However, studies of it so far have mostly involved people who already have heart problems or who eat a lot of fish, such as in Japan. Foods also increasingly are fortified with omega-3, so it is important to establish its safety and benefit. "Vitamin D and omega-3s have powerful anti-inflammatory effects that may be key factors in preventing many diseases. They may also work through other pathways that influence cancer and cardiovascular risk," Manson said. However, getting nutrients from a pill is different than getting them from foods, and correcting a deficiency is not the same as healthy people taking large doses from a supplement. The new study, which will start later this year, will enroll 20,000 people with no history of heart attacks, stroke or a major cancer ? women 65 or older and men 60 or older. They will be randomly assigned to take vitamin D, fish oil, both nutrients or dummy pills for five years. The daily dose of vitamin D will be about 2,000 international units of D-3, also known as cholecalciferol, the most active form. For fish oil, the daily dose will be about one gram ? five to 10 times what the average American gets. Participants' health will be monitored through questionnaires, medical records and in some cases, periodic in-person exams. "We're hoping to see a result during the trial, that we won't have to wait five years" to find out if supplements help, Manson said. Researchers also plan to study whether these nutrients help prevent memory loss, depression, diabetes, osteoporosis and other problems, Buring said. The $20 million study will be sponsored by the National Cancer Institute, with the National Heart, Lung and Blood Institute and other federal agencies. Pharmavite LLC of Northridge, Calif., is providing the vitamin D pills, and Ocean Nutrition Canada Ltd. of Dartmouth, Nova Scotia, is providing the omega-3 fish oil capsules. http://www.bakersfieldnow.com/news/health/48798747.html
  18. Patients Often Not Told About Abnormal Test Results Study finds communication breakdowns at least 7 percent of the time Posted June 22, 2009 By Alan Mozes HealthDay Reporter MONDAY, June 22 (HealthDay News) -- People who visit their primary care physician for routine blood tests or screenings are often not informed of the results, a new study finds. The failure of doctors and medical facilities to follow-up and give people test results is "relatively common," the researchers wrote, even when the results are abnormal and potentially troublesome, and affects one of every 14 tests. "If you're a patient, it's often assumed that no news is good news," acknowledged Dr. Lawrence P. Casalino, an associate professor and chief of the division of outcomes and effectiveness research in the public health department at Weill Cornell Medical College in New York City and the study's lead author. "But the bottom line is that is not always the case, and patients should not passively go along with that." Casalino and his colleagues report their findings in the June 22 issue of Archives of Internal Medicine. The researchers reviewed the medical records of 5,434 people aged 50 to 69 years old. They focused on those who, in the previous year, had abnormal results on one of 11 blood tests or one of three screening tests at primary care facilities in the Midwest and on the West Coast. They also combed through responses to 176 surveys completed by physicians designed to assess test result management procedures at each facility. The study found that in 135 cases -- of 1,889 abnormal test results -- either the person was not informed of the test results or the facility had not documented having communicated with the patient about the results. The upshot: more than a 7 percent failure rate in communicating abnormal test results. Furthermore, the researchers found that most of the primary care facilities involved in the study did not follow basic protocol for test processing, and most did not have a defined policy on communicating test results to patients. Though the study found no difference in failure rates between facilities that relied exclusively on paper records and those that used only electronic filings, medical practices that used a hybrid of paper and electronic record-keeping had the highest failure rates. Practices that had in place better test result management procedures in general had lower failure rates, Casalino said. "Yet even in the best doctor's office it is possible -- and, actually, not uncommon -- for test results one way or another to get overlooked," he said. "A good relationship with your doctor is a valuable thing to have, but in this case it isn't enough," Casalino said. "You still need to be told whether your tests were normal or not. And if you don't get the result you're waiting for, you really should call the doctor's office and ask for it." Diane Pinakiewicz, president of the nonprofit National Patient Safety Foundation, said that the test results issue falls into the broader context of patient safety concerns in "an imperfect system with any number of opportunities for things to go wrong or fall through the cracks." Pinakiewicz said, "In the past -- 10 or 15 years ago -- if you didn't hear back about diagnostic test results, you probably simply assumed everything was OK. But the culture of medicine is changing," she added. "The patient of today is very different, and physicians and clinicians are also different. We know a lot more today about the safety importance of making sure physicians go through the entire continuum, from taking a sample to delivering results to patients. And physicians understand that transparency is important, and a patient's right to know is important." Nonetheless, Pinakiewicz said, proactive patient vigilance is key to keeping track of personal medical information after doctor visits. That's particularly important, she noted, when changing care settings, from an in-hospital stay to outpatient treatment, for instance. "Patients should not accept it when a physician or clinician says they will let you know if something is wrong," she said. "Patients should ask for their test results on a consistent basis, whether or not the results are of concern -- because, if you ask for them 100 percent of the time, there is no question you will always stay informed." http://health.usnews.com/articles/health/h...st-results.html
  19. Tests show many supplements have quality problems By MARILYNN MARCHIONE, AP Medical Writer Marilynn Marchione, Ap Medical Writer ? Tue Jun 9, 12:48 pm ET Lead in ginkgo pills. Arsenic in herbals. Bugs in a baby's colic and teething syrup. Toxic metals and parasites are part of nature, and all of these have been found in "natural" products and dietary supplements in recent years. Set aside the issue of whether vitamin and herbal supplements do any good. Are they safe? Is what's on the label really what's in the bottle? Tests by researchers and private labs suggest the answer sometimes is no. One quarter of supplements tested by an independent company over the last decade have had some sort of problem. Some contained contaminants. Others had contents that did not match label claims. Some had ingredients that exceeded safe limits. Some contained real drugs masquerading as natural supplements. "We buy it just as the consumer buys it" from stores, said Dr. Tod Cooperman, president of ConsumerLab.com. The company tests pills for makers that want its seal of approval, and publishes ratings for subscribers, much as Consumer Reports does with household goods. Other tests, reported in scientific journals, found prenatal vitamins lacking claimed amounts of iodine, and supplements short on ginseng and hoodia ? an African plant sparking the latest diet craze. "There's at least 10 times more hoodia sold in this country than made in the world, so people are not getting hoodia," said Dr. Mehmet Oz, a heart surgeon and frequent Oprah Winfrey guest who occasionally has touted the stuff. Industry groups say that quality problems are the exception rather than the rule. "I believe that the problem is narrow, that the well-established and reputable brands deserve their reputations," said Michael McGuffin, president of the American Herbal Products Association. Of course, prescription drugs have had problems, too. Dozens of deaths were linked last year to tainted heparin, a blood thinner produced in China, for example. However, pharmaceutical drugs must show evidence to the government of safety and effectiveness before they go on sale. Not so for dietary supplements. Fifteen years ago, Congress passed a law that treats supplements like food and allows them to go straight to market without federal Food and Drug Administration approval. The FDA can act only after consumers get sick or a safety issue comes to light. "We called it 'the body rule,'" said William Obermeyer, a chemist who left the FDA to found ConsumerLab.com with Cooperman. If a supplement was harmful, "we had to have so many adverse events before we could make a move on it. It was really like closing the barn door after all the animals left." The law said the FDA could write quality control rules for products sold in the U.S. It took the FDA 13 years to adopt these, and they are just now taking effect. But the rules do not say what tests companies must do to prove what is in their products, and some tests can be fooled by subbing other ingredients. The rules also set no limits on toxins such as lead; nor do they change the fundamental way these products are sold to the public. "It leaves the level of quality up to the manufacturer," Cooperman said. In a written statement, FDA spokeswoman Susan Cruzan said the new rules contain what is "needed to ensure quality," and that products that contain contaminants or whose labels do not honestly describe their contents, are considered adulterated and subject to further action by the agency. But she conceded that the agency is spread thin. "In that FDA has limited resources to analyze the composition of food products, including dietary supplements, it focuses these resources first on public health emergencies and products that may have caused injury or illness," she wrote. Millions of Americans take vitamin, herbal or other dietary supplements. Annual sales exceed $23 billion, and more than 40,000 products are on the market. Tens of thousands of supplement-related health problems are handled by U.S. poison control centers each year, according to a report in the New England Journal of Medicine in 2002. Until last year, supplement makers were not required to report problems to the FDA, and even now they must report only serious ones. The agency estimates that more than 50,000 safety problems a year are related to supplement use. The Institute of Medicine, an independent science panel that advises the government, studied the situation in 2005. "The committee is concerned about the quality of dietary supplements in the United States. Product reliability is low," says its report, which urged amending the 1994 law to tighten consumer protections. Trade associations say the FDA's new rules do that. "We are FDA-regulated products," though not in the same way as prescription or over-the-counter drugs, said Steven Mister, president of the Council for Responsible Nutrition. The FDA can ask law enforcement to act against any company selling an adulterated product, said McGuffin of the herbal products association. "You can go to jail, you can have your company seized," he said. "We represent companies that we consider the responsible center of the industry," who are working to comply with the new rules, he said. But his group only represents 250 of the 1,500 companies selling such products. And even though millions of people take supplements with no apparent ill effects, there have been many quality problems that a consumer might never realize because they don't always produce symptoms: _CONTAMINANTS ConsumerLab.com found lead in at least one brand each of zinc, black cohosh and ginkgo products tested in recent years. Lead can accumulate and cause many health problems, and the testing company wants a national limit of 0.5 micrograms per day ? a level that in California requires a warning on the label. A fungal toxin was found in four red yeast rice products in March 2008. And in 2007, federal officials warned about a liquid herbal supplement sold for colic and teething pain after finding cryptosporidium, a waterborne parasite that causes severe diarrhea. Ayurvedics ? popular herbals used in traditional medicines from India ? often contain hazardous metals, studies in medical journals report. In 2004, researchers tested 70 ayurvedic remedies in the Boston area and found that one in five had potentially harmful levels of lead, mercury or arsenic. Tests in Houston, Chicago, San Francisco and New York City turned up similar results. Metals naturally accumulate in certain herbs and come from the soil they are grown in. Many supplement ingredients come from Europe, India and China. "We don't know how much of the ingredients are imported ? whether they're coming from across town or across the world," Mister of the trade association conceded. But even manufacturers get duped, said Jana Hildreth of the Analytical Research Collective, a group of scientists advocating better supplement testing. "Companies started going to China and demanding lower prices," and unscrupulous suppliers sometimes spiked products with cheap ingredients that can trick lab tests, she said. An example: a buckwheat derivative, rutin, in place of pricier ginkgo. _POTENCY PROBLEMS In ConsumerLab.com testing last November, four out of seven supplements contained less ginkgo than claimed on their labels, and one failed to break apart properly to release its ingredients. Seven out of nine failed in tests in 2003, as did six out of 13 in 2005. "It is now believed that ginkgo is among the most adulterated herbs," the company reports. Tests by California scientists of two dozen ginseng supplements, reported in a nutrition journal in 2001, found that many differed from their labels. The concentrations of some ginseng compounds varied by up to 200-fold from product to product. In ConsumerLab.com tests, six out of nine chondroitin supplements failed testing in April 2007. One had only 8 percent of what it claimed to contain, and one "maximum strength" product had none. Vitamins and minerals had problems, too. A "high potency" iron supplement contained less than half the amount claimed. Of 23 top-selling vitamin C pills, one provided less than half the amount promised; the suggested dosages of some others were beyond recommended safe levels. Of 10 vitamin A supplements, one provided twice its stated amount, raising concern about toxic side effects. Last year, nearly 200 people were sickened by supplements containing up to 200 times the amount of selenium stated on the label. Symptoms included hair loss, discolored and painful fingernails, muscle cramps, joint pain, diarrhea and fatigue. _HIDDEN PRESCRIPTION DRUGS The FDA has repeatedly warned about herbal pills found to contain versions of Viagra and similar drugs to help men get an erection. These can pose a heart hazard, especially when taken with certain medications. In December, the FDA expanded warnings about dozens of brands of weight loss pills. Though the labels did not say so, some contained sibutramine, a controlled substance that poses heart risks; rimonabant, a drug not approved in the United States; a seizure medicine, and a diuretic. Red yeast rice, a traditional Chinese medicine, has compounds that may block cholesterol in a way similar to statin drugs. Some red yeast rice products have been found to contain lovastatin, the active ingredient in the drug Mevacor. Problems can occur at high doses or with other medicines. _OTHER RISKS Even "safe" supplements can be harmful. Beta-carotene takers still had increased rates of lung cancer six years after one study was stopped. These supplements "appear to increase rates of the disease, particularly among smokers," the National Cancer Institute warns. In another study, men taking vitamin E were slightly more likely to get prostate cancer, and those taking selenium were a little more likely to develop diabetes. The results could have been due to chance, but federal officials were taking no chances and stopped the study last October. Other studies suggest that high doses of vitamin C may help shield cancer cells from treatments designed to kill the cancer. "Antioxidants are not the magic bullets that the supplement industry would like consumers to believe," said David Schardt, a nutrition expert with the consumer advocacy group, the Center for Science in the Public Interest. "They're not even necessarily benign." Herbal sex pills containing the African tree bark extract yohimbe have landed men in hospitals with heart rhythm problems. This herb can cause high blood pressure, increased heart rate and other symptoms, the government warns. The most serious side effects occurred with diet pills containing ephedra ? heart problems, seizures and even deaths. The FDA banned it in 2004. The battle started in 1997, when the agency wanted strong warnings on labels, and it became a test case of FDA authority that went all the way to the U.S. Supreme Court, where the FDA ultimately prevailed. _DRUG INTERACTIONS Ginkgo, vitamin K, garlic, ginseng and other herbals can cause bleeding or clotting problems if taken with certain medications or before surgery. St. John's wort, promoted for depression, affects metabolism of more than half of all prescription drugs and can undermine birth control pills. Other supplements that can interfere with medicines include glucosamine, saw palmetto, soy and valerian. _OVERSTATED HEALTH CLAIMS Makers can say a supplement addresses a nutrient deficiency, supports health, or reduces the risk of developing a problem, but then must say the product "is not intended to diagnose, treat, cure, or prevent any disease." So consumers will see vague claims, such as "promotes healthy immune system function." The immune system has dozens of parts, and modifying one can be helpful or harmful, so "it's a quack concept," said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a Web site on medical scams. The Federal Trade Commission has stepped up actions against deceptive ads, said commission lawyer Rich Cleland. "It is a little like playing Whack-A-Mole," because each time one problem is resolved, more seem to pop up, he said. Last year, his agency reached a settlement against the makers of Airborne, a supplement aimed at people in crowded places such as airplanes, offices and schools. Company founders "made false claims that Airborne products are clinically proven to treat colds," and there is also no evidence the products can prevent colds, the FTC complaint says. Airborne's makers agreed to add $6.5 million to the $23.5 million they had already agreed to pay to settle a related private class-action lawsuit, bringing the total settlement fund to $30 million. Industry also has stepped up self-policing. The Council for Responsible Nutrition gave money to the Council of Better Business Bureaus so it could hire a lawyer to investigate some supplement sellers' sketchy claims. "There were cancer cures and 'blast off 29 pounds in 39 days' ? really the Wild West of advertising. It was totally out of control," said the BBB's advertising division director, Andrea Levine. The BBB council targets the worst claims in popular categories, such as diet, cold and flu, menopause, joint problems and sleep aids. "We can't do them all," but want to send a broad signal about what kinds of claims are over the line for each type of product, she said. http://news.yahoo.com/s/ap/us_med_unproven...edies_safety___ On the Net: FDA: http://www.fda.gov/consumer/updates/supplements080408.html Government supplement advice: http://tinyurl.com/alpr98 and http://tinyurl.com/kngv35
  20. An interesting article. Perhaps a precurser to genetic Cushing's tests. The symptoms discussed as "chronic diseases" sure sound like Cushing's symptoms to me! Experts identify genes linked to chronic diseases HONG KONG (Reuters) ? Researchers in South Korea have identified genes that are linked to key indicators such as blood pressure and bone density that have a bearing on chronic diseases such as hypertension and osteoporosis. In an article published in Nature Genetics, the scientists said they studied the DNA of nearly 9,000 people in South Korea and were able to identify genes that controlled indicators such as blood pressure, bone density, body mass index, waist-to-hip ratio, height and pulse rate. "We found some genes affecting systolic blood pressure, bone density etc," Hyung-Lae Kim of the National Institute of Health in Seoul, South Korea, told Reuters by telephone. These bodily measurements affect key chronic diseases including diabetes, hypertension, obesity and osteoporosis that are becoming massive problems in many countries. And knowing which genes are involved can potentially open the way for better prevention, management and control of these conditions in the future. Such genetic studies have been carried out in Caucasian populations, but less so among Asians. "The study also found new gene variants that either confer health risks specific to Asian ancestry or which show greater effects in combination with environmental factors prevalent in Asia," the researchers said in a statement. (Reporting by Tan Ee Lyn; Editing by Alex Richardson
  21. I hope your recovering well! I'm thinking of you! Let us know how you are when you can.


  22. Do you think any of these researchers ever hear of Cushing's? Hormones? Menopause? "Belly Fat Linked to Risk of Migraines Study Shows Excess Belly Fat May Increase Risk of Migraines for Men and Women Under 55 By Salynn Boyles WebMD Health NewsReviewed by Louise Chang, MDFeb. 13, 2009 -- Belly fat has been linked to increased risks for heart disease and diabetes. Now new research suggests it may also be linked to an increased risk for migraines, at least until middle age. Waist circumference was found to be a better predictor of migraine activity than general obesity in both men and women up until age 55. Earlier research has linked obesity with an increase in the frequency of migraines in people who already have them. But the new study is one of the few to suggest that obesity raises the overall risk for migraines. And it is the first to examine whether belly fat may play a specific role in migraines and severe frequent headaches. The findings will be presented in April at the annual meeting of the American Academy of Neurology (AAN) in Seattle. Belly Fat and Migraines Researchers from Philadelphia's Drexel University College of Medicine examined data collected from more than 22,000 participants in the ongoing National Health and Nutrition Examination Survey (NHANES). The survey included measurements of both abdominal obesity, measured by waist circumference, and overall obesity, as determined by body mass index (BMI). The data also include self-reported estimates of migraine and severe headache frequency. Women are three times as likely as men to suffer from migraines. Researcher B. Lee Peterlin, DO, tells WebMD that the findings may help researchers understand this gender difference. "This may be one piece of the puzzle," she says. "This does not suggest that if you lose your extra abdominal fat it will cure your migraines. But it may be a clue to help explain the sexual dimorphism in migraine." Even after controlling for overall obesity, excess belly fat was associated with a significant increase in migraine activity in both men and women between the ages of 20 and 55. "This is the age when migraine is most prevalent," she says. "Our findings suggest that both general obesity and abdominal obesity are associated with an increased prevalence of migraine in this age group." Women with extra belly fat were 30% more likely to experience migraines than women without excess belly fat, even after accounting for overall obesity, risk factors for heart disease, and demographic characteristics. The link between belly fat and migraines in men in this age group was not significant when accounting for these factors. Migraines in Women The findings suggest that belly fat is an important risk factor for migraine, but it may be more important in women than in men, Peterlin says. After age 55, carrying extra weight around the middle appeared to be associated with a slight decrease in migraine risk in women, but the reasons for this are not clear. "That was a surprise," Peterlin says. "It appears that there is an impact at every age, but it changes. In women under 55, belly fat is bad. But over 55, having belly fat may actually be mildly protective against migraine." Migraine researcher Stephen Silberstein, MD, tells WebMD that the new research raises more questions than it answers. Silberstein is a spokesman for the American Academy of Neurology and a professor of neurology at Thomas Jefferson University in Philadelphia. "The large population-based studies indicate that obesity correlates with the frequency, but not the presence of migraines," he says. "This is the first time anyone has looked at abdominal girth and they found that it predicts the presence of migraines. This is an interesting observation, but these findings would definitely need to be duplicated." View Article Sources SOURCES: American Academy of Neurology 61st Annual Meeting, Seattle, April 25-May 2, 2009. B. Lee Peterlin, DO, Drexel University College of Medicine, Philadelphia. Stephen Silberstein, MD, professor of neurology, Thomas Jefferson University, Philadelphia; spokesman, American Academy of Neurology. ? 2009 WebMD, LLC. All rights reserved." http://www.webmd.com/migraines-headaches/n...sk-of-migraines
  23. Do you think any of these researchers ever hear of Cushing's? "Belly Fat Linked to Risk of Migraines Study Shows Excess Belly Fat May Increase Risk of Migraines for Men and Women Under 55 By Salynn Boyles WebMD Health NewsReviewed by Louise Chang, MDFeb. 13, 2009 -- Belly fat has been linked to increased risks for heart disease and diabetes. Now new research suggests it may also be linked to an increased risk for migraines, at least until middle age. Waist circumference was found to be a better predictor of migraine activity than general obesity in both men and women up until age 55. Earlier research has linked obesity with an increase in the frequency of migraines in people who already have them. But the new study is one of the few to suggest that obesity raises the overall risk for migraines. And it is the first to examine whether belly fat may play a specific role in migraines and severe frequent headaches. The findings will be presented in April at the annual meeting of the American Academy of Neurology (AAN) in Seattle. Belly Fat and Migraines Researchers from Philadelphia's Drexel University College of Medicine examined data collected from more than 22,000 participants in the ongoing National Health and Nutrition Examination Survey (NHANES). The survey included measurements of both abdominal obesity, measured by waist circumference, and overall obesity, as determined by body mass index (BMI). The data also include self-reported estimates of migraine and severe headache frequency. Women are three times as likely as men to suffer from migraines. Researcher B. Lee Peterlin, DO, tells WebMD that the findings may help researchers understand this gender difference. "This may be one piece of the puzzle," she says. "This does not suggest that if you lose your extra abdominal fat it will cure your migraines. But it may be a clue to help explain the sexual dimorphism in migraine." Even after controlling for overall obesity, excess belly fat was associated with a significant increase in migraine activity in both men and women between the ages of 20 and 55. "This is the age when migraine is most prevalent," she says. "Our findings suggest that both general obesity and abdominal obesity are associated with an increased prevalence of migraine in this age group." Women with extra belly fat were 30% more likely to experience migraines than women without excess belly fat, even after accounting for overall obesity, risk factors for heart disease, and demographic characteristics. The link between belly fat and migraines in men in this age group was not significant when accounting for these factors. Migraines in Women The findings suggest that belly fat is an important risk factor for migraine, but it may be more important in women than in men, Peterlin says. After age 55, carrying extra weight around the middle appeared to be associated with a slight decrease in migraine risk in women, but the reasons for this are not clear. "That was a surprise," Peterlin says. "It appears that there is an impact at every age, but it changes. In women under 55, belly fat is bad. But over 55, having belly fat may actually be mildly protective against migraine." Migraine researcher Stephen Silberstein, MD, tells WebMD that the new research raises more questions than it answers. Silberstein is a spokesman for the American Academy of Neurology and a professor of neurology at Thomas Jefferson University in Philadelphia. "The large population-based studies indicate that obesity correlates with the frequency, but not the presence of migraines," he says. "This is the first time anyone has looked at abdominal girth and they found that it predicts the presence of migraines. This is an interesting observation, but these findings would definitely need to be duplicated." View Article Sources SOURCES: American Academy of Neurology 61st Annual Meeting, Seattle, April 25-May 2, 2009. B. Lee Peterlin, DO, Drexel University College of Medicine, Philadelphia. Stephen Silberstein, MD, professor of neurology, Thomas Jefferson University, Philadelphia; spokesman, American Academy of Neurology. ? 2009 WebMD, LLC. All rights reserved." http://www.webmd.com/migraines-headaches/n...sk-of-migraines
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