MaryO

From http://story.news.yahoo.com/news?tm....oids_dc Inhaled Steroids May Not Reduce Women's Bone Mass NEW YORK (Reuters Health) - Postmenopausal women who use inhaled steroids to control their asthma may not be increasing their risk of osteoporosis and bone fracture over the long term, new study findings suggest. Inhaled steroids, which are among the safest and most effective treatments for persistent asthma, reduce inflammation in the airways. While steroids taken orally are known to reduce bone mass, it is unclear whether steroids taken through an inhaler, at currently recommended doses, have the same effect. The new study found that inhaled corticosteroids were not associated with a loss of bone density in the forearms of women who were long-term users. Dr. Solve Elmstahl, of Lund University in Malmo, Sweden, and colleagues measured bone density in the forearms of 106 postmenopausal women who had a history of using only inhaled steroids. They were compared with 674 women who had never been exposed to corticosteroids and 49 women with a history of using oral, injected and inhaled steroids. On average, study participants had used inhaled steroids for about 8 years, according to the report in the January issue of the Journal of Allergy and Clinical Immunology. The researchers found no difference in bone density between the inhaled-steroid group and the group with no steroid use. Women who had used oral steroids, as expected, had the lowest bone density measurements. "Moderate doses of inhaled corticosteroids seem to carry less risk than traditional oral corticosteroid therapy provided that the dose is kept at the lowest daily dose sufficient to maintain optimum control of the disease," the authors write. Nonetheless, Elmstahl's team notes that the number of women in the their study was small, and additional research will need to confirm or refute their findings. According to experts, women on steroid medications can help preserve their bone mass by engaging in weight-bearing exercise and getting enough calcium and vitamin D. SOURCE: Journal of Allergy and Clinical Immunology 2003;111:91-96.

HHS RELEASE--NEW INITIATIVE Date: January 22, 2003 For Release: Immediately Contact: HHS Press Office (202) 690-6343 Headline: HHS Budget Proposal To Include $100 Million Increase To Prevent Diabetes, Obesity And Asthma Across The Country New Initiative Would Support Community Efforts To Combat Growing Epidemics President Bush's fiscal year 2004 budget plan will include an increase of $100 million -- to $125 million -- for a new initiative to prevent diabetes, obesity and asthma through community initiatives to achieve healthier lifestyles for hundreds of thousands of Americans, HHS Secretary Tommy G. Thompson announced today. "To truly stem the epidemic of preventable diseases that threaten too many Americans, we need to move from a health care system that treats disease to one that avoids disease through wiser personal choices," Secretary Thompson said. "This new initiative will support community programs aimed at getting results and helping those at risk to avoid these diseases through proven prevention methods." Under the "Steps to a Healthier US" initiative, HHS would fund specific projects at the state and community level that would use proven medical and public health strategies to reduce the burden of diabetes, obesity and asthma among their populations. The initiative includes target goals for disease reduction. Projects under the initiative would include: State programs to motivate and support responsible health choices that would reduce the burden of preventable disease; Community initiatives to promote and enable healthful choices, especially those focused on youth and older Americans; Health care and insurance systems that put prevention first and reduce people's risk factors for chronic disease and reduce potential health care complications. Secretary Thompson has made disease prevention and health promotion a top priority for the department as part of a broader effort to reduce the burden of preventable medical conditions, both in terms of lives affected and health care costs. In June 2002, he joined President Bush to launch the White House's HealthierUS initiative. The incidence of diabetes and obesity among Americans are up sharply in the past decade, putting millions more Americans at higher risk for heart disease, stroke and other related medical conditions. Diabetes alone costs the nation nearly $100 billion each year in direct medical costs as well as indirect economic costs, including disability, missed work and premature death. Medical studies have shown that modest lifestyle changes -- such as getting more exercise and losing weight -- can reduce an individual's risks for developing these serious health conditions. "Not only do these preventable diseases take a terrible toll on the lives of individual Americans, but they also contribute to skyrocketing health care costs affecting our nation as a whole," Secretary Thompson said. "We must do more to encourage individual Americans to take personal responsibility for their health choices and to create a sense of social responsibility to ensure that policymakers support the kinds of programs that foster healthy activity and prevention." "Steps to a Healthier US" includes specific prevention goals for the fiscal year -- preventing diabetes for at least 75,000 Americans, preventing obesity for at least 100,000 Americans and preventing asthma-related hospitalizations for at least 50,000 Americans. HHS will rely on existing and expanded surveillance efforts to assess the new initiative's effectiveness at helping Americans to prevent disease and achieve good health. "It's disturbing to see that the number of Americans suffering from chronic diseases continues to go up each year," Secretary Thompson said. "The reason they are going up is very simple: We don't take care of ourselves. And by not taking care of ourselves, we are paying for it, both with our health and from our pocketbooks." The initiative represents an expansion of HHS' $25 million Healthy Communities initiative, which President Bush and Secretary Thompson proposed as part of the fiscal year 2003 budget request. This increase, included in the request for the Centers for Disease Control and Prevention (CDC), will be closely coordinated with existing diabetes, asthma, and obesity prevention programs at CDC. The expanded effort will involve five HHS agencies -- CDC, the Health Resources and Services Administration (HRSA), the Administration for Children and Families (ACF), the Administration on Aging (AoA) and the Agency for Healthcare Research and Quality (AHRQ).

Isn't it a fantastic idea, Arlene? I think it's wonderful that Lynn and Sherri cooked up this idea and that Sherri is donating all this money to CUSH. Like Sue has said, "someday we'll move mountains" - or something similar Sorry, Sue, for misquoting you!

She'll get it at: CUSH Organization PO Box 24748 Lyndhurst, OH 44124 For more information: contact Cookie by email at CushieCookie@yahoo.com

Actually, the money goes to the CUSH treasurer, Cookie, but if Sherri sends it here, I'll see that Cookie gets it. I still need to order some.

Clinical Trials: CenterWatch Clinical Trials CenterWatch also provides educational materials on clinical trials for patients, care-givers and health consumers. To view a more detailed description of these resources, please visitwww.centerwatch.com/bookstore/pubs_cons_patientresources.htmlcolor>. 1) Phase 2 Study Assessing AMG 162 in the Treatment of Women with Low Bone Density. This study is being conducted in: Beverly Hills, CAcolor> Laguna Woods, CAcolor> Los Angeles, CAcolor> Palo Alto, CAcolor> Rancho Cucamonga, CAcolor> San Diego, CAcolor> San Francisco, CAcolor> 2) Have you been given a prescription for a cholesterol-lowering medication? This study is being conducted in: Various Cities, CAcolor> 3) Phase 2 Study Assessing AMG 162 in the Treatment of Women with Low Bone Density. This study is being conducted in: Lakewood, WAcolor> Duncansville, PAcolor> Wyomissing, PAcolor> 4) High Cholesterol. This study is being conducted in: Philadelphia, PAcolor> 5) Depression. This study is being conducted in: East Providence, RIcolor> 6) Phase 2 Study Assessing AMG 162 in the Treatment of Women with Low Bone Density. This study is being conducted in: Elmsford, NYcolor> 7) Have you been given a prescription for a cholesterol-lowering medication? This study is being conducted in: Various Cities, NYcolor> 8) Phase 2 Study Assessing AMG 162 in the Treatment of Women with Low Bone Density. This study is being conducted in: Cincinnati, OHcolor> 9) Luteinizing Hormone in Polysystic Ovary Syndrome: Impact of Obesity. This study is being conducted in: Boston, MAcolor> 10) Phase 2 Study Assessing AMG 162 in the Treatment of Women with Low Bone Density. This study is being conducted in: Bethesda, MDcolor> Kalamazoo, MIcolor> VERITAS MEDICINE CLINICAL TRIAL MATCHING SERVICE Through a collaboration with Veritas Medicine, you can also be actively matched to ongoing clinical trials. Veritas Medicine's Personalized Trial Matching service enables you to find clinical trials that match your specific medical and geographic search criteria. At this time, Veritas Medicine is actively matching patients to clinical trials in the following areas: Depression section: http://www.veritasmedicine.com/cw.cfm?cid=98280&cat_id=41color> Cholesterol Disorders section: http://www.veritasmedicine.com/cw.cfm?cid=98280&cat_id=174color> Osteoporosis section: http://www.veritasmedicine.com/cw.cfm?cid=98280&cat_id=201color> Additional Educational Resources: Informed Consent: A Guide to the Risks and Benefits of Volunteering for Clinical Trials A guidebook that helps patients, family members and advocates make more informed decisions before giving their consent to volunteer for a clinical trial and during their participation. For more information, visit: http://www.centerwatch.com/bookstore/pubs_cons_infconsent.htmlcolor> New Medical Therapies Reports A series of concise, easy-to-read reports filled with information on drugs in development and clinical trial activity for specific illnesses and medical conditions. For more information, visithttp://www.centerwatch.com/bookstore/pubs_cons_nmtform.htmlcolor> Volunteering for a Clinical Trial Brochure A handy and quick reference pamphlet for understanding the clinical trial process and what to expect as a clinical trial volunteer. For more information, visithttp://www.centerwatch.com/bookstore/pubs_cons_brochureform.htmlcolor>

Just a reminder

FDA: Hormone Therapy Drug Labels to Change Wed Jan 8, 5:23 PM ET By Keith Mulvihill NEW YORK (Reuters Health) - The US Food and Drug Administration announced Wednesday that makers of estrogen-containing products that are used by women for menopause symptoms will be required to make label changes reflecting new safety concerns. In addition, women who do decide to take the drugs are being advised to take the lowest dose for the shortest possible time. The announcement comes six months after a US government-sponsored study, the Women's Health Initiative (WHI), was halted three years earlier than expected. The landmark study found that women taking a hormone replacement product had a slightly higher risk of heart disease, breast cancer, stroke and blood clots compared with women not taking the hormones. In that study, women were taking the drug Prempro, a combination of estrogen and progestin. Another arm of the WHI, in which women are taking an estrogen-only product called Premarin, is ongoing. Women who still have a uterus typically take estrogen combined with progestin, while those who have had a hysterectomy take estrogen alone. Shortly after the WHI was halted, Wyeth Pharmaceuticals made some labeling changes and the new labeling will affect the company's estrogen-containing products--Prempro, Premphase and Premarin. The FDA is also asking all other manufacturers of estrogen or estrogen/progestin products to make similar changes as well. "Today the FDA is taking action to provide new advice to women who use or are considering using estrogen or estrogen with progestin," said the FDA's Commissioner Dr. Mark B. McClellan. "Now a box warning about not using estrogens for cardiovascular protection and about the findings of the WHI has been added to these products," McClellan told attendees of a press conference. Although the FDA never approved the drugs for heart disease prevention, many doctors prescribed the drugs "off label" because there was preliminary evidence that the drugs might be helpful. Patient information that accompanies the products will be revised to reflect the new changes. "Different estrogens and progestins are believed to act similarly, and in the absence of data suggesting otherwise, women need to assume that the risk of other estrogens and progestins are similar," said McClellan. A labeling guidance policy will be published shortly for the manufacturers of these drugs, according to the FDA. Currently there are three FDA-approved indications for the use of Prempro, Premarin and Premphase. One is the treatment of hot flashes and night sweats, two common symptoms of menopause. "This indication and the FDA labeling has not changed," said McClellan. The two other indications have been revised, said McClellan. While the drugs are still recommended for moderate to severe vulvar and vaginal atrophy symptoms, "we now state the when prescribing for solely the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered," McClellan said. Although HRT drugs can still be prescribed to prevent the bone-thinning disease osteoporosis. the label will say they "should only be considered for women at significant risk for osteoporosis and nonestrogen treatments should be carefully considered," he said. There are now several different drugs on the market for patients at risk for osteoporosis, including a class of drugs called bisphosphonates. The FDA will continue to study whether low doses of the estrogen/progestin products are safer than higher doses, and compare the safety profiles of different types of products that contain the hormones. Above all, a woman who uses or is considering using estrogen-containing products should consult her doctor regarding the individual risks and benefits of the hormones, McClellan said. http://story.news.yahoo.com/news?tm....bels_dc

Cape Cod Candles: Lynn in Va Cushieinvirginia@msn.comcolor>) has an idea for a CUSH fundraiser. Her friend Sherri has been a Party-Lite Candle consultant for many years. The candles are all pure Cape Cod candles. The total cost is 15.00 per candle. This includes shipping/handling. The candle has many different scents/colors to choose from: Cinnamon Stick (Brown), Raspberry/Thyme (raspberry), Mulberry (Mulberry), Ocean Mist (Royal Blue), Bayberry (Sage), Lime/Cilantro (light sage), Honeydew (Mint), Pear / Basil (Yellow), Vanilla (Ivory). There is an optional lid and a platter to go underneath. Sherri has offered us her commission, $3.00 for each candle that is sold, to go to the CUSH Organization. For an order form, please email Cushieinvirginia@msn.comcolor> or download here in Excel format.color> Lynn is taking personal responsiblility for this. Many thanks to Lynn and Sherri!

Cape Cod Candles: Lynn in Va Cushieinvirginia@msn.comcolor>) has an idea for a CUSH fundraiser. Her friend Sherri has been a Party-Lite Candle consultant for many years. The candles are all pure Cape Cod candles. The total cost is 15.00 per candle. This includes shipping/handling. The candle has many different scents/colors to choose from: Cinnamon Stick (Brown), Raspberry/Thyme (raspberry), Mulberry (Mulberry), Ocean Mist (Royal Blue), Bayberry (Sage), Lime/Cilantro (light sage), Honeydew (Mint), Pear / Basil (Yellow), Vanilla (Ivory). There is an optional lid and a platter to go underneath. Sherri has offered us her commission, $3.00 for each candle that is sold, to go to the CUSH Organization. For an order form, please email Cushieinvirginia@msn.comcolor> or download here in Excel format.color> Lynn is taking personal responsiblility for this. Many thanks to Lynn and Sherri!

Just a reminder, if you're going to the Portland Meeting (or anywhere else, for that matter) that there are hats, t-shirts and lots of other Cushing's things available. See the whole line here: Cushing's Store. ?There will probably be some more bears and things for Valentine's day, too, like last year. Also, I'd made myself a personalized coffee mug for the last UVa convention. ?To see that, click here. ?Email me, if you're interested in something like this with your own name.

Hi again, Gus! I'm moving this to The "Main" Board (just click to access) where more people are likely to see this and answer. I don't think that very many people read this board. It's mostly for questions people have about how to make the best use of the boards, Welcome again, and best of luck to you!

I had needles and meds to carry around with me, too, way back in the dark ages of pit surgery! NIH gave me a supply, though, so I don't know about getting them from the pharmacy. Luckily, I never used any of them after I left NIH! I'm moving your post down to the Adrenal Surgery Board (just click to access), where others will be able to give you more info on this.

Hi, Gus! Welcome to the Cushing's Help and Support Boards. I'm moving this to the Doctors Hospitals Insurance and Disability Board (just click to access), so that others in your area might see this info if they need it, and so that others might offer opinions a bit easier

http://www.nytimes.com/2002....ion=top December 22, 2002 Chasing Youth, Many Gamble on Hormones By GINA KOLATA Dr. Ron Livesey was fat, tired and out of shape. At 49, he felt that his best years were behind him. So one day seven years ago, on his way to a medical meeting, he stopped at a doctor's office in Palm Springs, Calif., for his first hormone injections. Early the next morning, Dr. Livesey was at the meeting, sitting in a darkened auditorium watching slides of technical data. To his surprise, he found himself alert, taking everything in. He continued the hormone treatments. "People started commenting that I had so much more bounce and energy," he said. He lost 50 pounds ? thanks, he said, to diet changes and exercise made possible by the increased vigor. So Dr. Livesey, then an internist in New Hampshire, decided to go into business for himself. With a colleague, Dr. Joseph Raffaele, who went on a similar regimen, he founded Anti-Aging Medicine Associates, a clinic in Manhattan. They are part of a growing movement among doctors to offer a hormone replacement therapy that claims to restore the bodies and energy of youth. Until recently, most scientists considered anti-aging treatments to be little more than snake oil, provided by hucksters. Now, few doubt that growth hormone and testosterone can reshape aging bodies, potentially making them more youthful. But whether they counteract aging is unknown. And their long-term risks are ill defined. So medical experts ask whether it is right to regard aging as a disease, as fierce as a malignant cancer, to be fought with any and all means, tested or not. "How much are you willing to pay for a treatment that is not proven?" asked Dr. Huber Warner, an associate director at the National Institute on Aging. "How much risk are you willing to take?" But Dr. Ronald Klatz of Chicago, the founder and director of the American Academy of Anti-Aging Medicine, says patients cannot wait for long-term studies, which are not even in planning stages and would take years or decades to complete. "We'd have to wait," he said, "until the baby boomers are dead and in the ground and worms' meat." Clearly, many are not waiting. The academy, which began with 12 doctors in 1993, now has 8,000 physician members in the United States, Dr. Klatz said. The treatment is expensive: $1,000 a month for the panoply of drugs and dietary supplements, including human growth hormone and testosterone for men and women, estrogen and progesterone for women (the doctors say their "bioidentical" hormones are safe), melatonin, DHEA, vitamins and antioxidants. The unlikely hero of today's anti-aging movement was Dr. Daniel Rudman, an academic researcher at the Medical College of Wisconsin who asked if he could reverse the effects of aging by giving growth hormone to elderly men. Aging people, he noted, lose muscle and put on fat, their skin thins and their bones weaken. At the same time, growth hormone levels steadily decline. He observed that the effects of aging also appeared in young people who lacked growth hormone for medical reasons. So he gave growth hormone to 12 elderly men for six months, reporting that they gained muscle and lost fat. Nine men who served as controls had no such body changes. In his paper, published on July 5, 1990, in The New England Journal of Medicine, Dr. Rudman concluded with this sentence: "The effects of six months of growth hormone on lean body mass and adipose-tissue mass were equivalent in magnitude to the changes incurred during 10 to 20 years of aging." Dr. Klatz, of the Academy of Anti-Aging Medicine, called the paper "a thunderclap in the medical profession." "It was the first clinical paper in a mainstream U.S. medical journal to show that there were available interventions that could have a dramatic effect on the physiology of aging," he said. Human growth hormone has been approved by the Food and Drug Administration for use by people with medical deficiencies, and once a drug is on the market, doctors can legally prescribe it for any reason. "I was thrilled by the concept," said Dr. Maxine Papadakis of the University of California in San Francisco. But Dr. Papadakis said she worried about the sweeping conclusion about reversing aging. It was a small study, she said, and the men who took part knew who was taking growth hormone and who was not. Dr. Papadakis set out to test growth hormone in 52 healthy men from 70 to 85. She designed the study so that the men did not know if they were taking the drug or a dummy medication. Reporting in 1996, she found that growth hormone slightly increased muscle mass and decreased body fat but, paradoxically, did not make the men stronger. People had claimed it improved their mental clarity, but she found no such effects; if anything, those taking growth hormone did slightly worse on memory tests. They also suffered swollen legs and feet and achy joints, making them so uncomfortable that a quarter taking growth hormone had their doses reduced during the study. Dr. Papadakis said her results were ignored by growth hormone enthusiasts. "They can't let go of the hypothesis because they like it," she said. Others, like Dr. Warner, worry about animal studies. "I agree that mice and rats are not people, but mice that don't make growth hormone live longer," Dr. Warner said. "Mice that overproduce growth hormone live shorter lives. The same principle applies in fruit flies and little worms called nematodes. It may be irrelevant, but it makes us wonder." The next major paper was published on Nov. 13 in The Journal of the American Medical Association. In it, Dr. S. Mitchell Harman of the Kronos Longevity Research Institute in Phoenix and Dr. Marc Blackman of the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, reported that older men and women taking growth hormone lost fat and gained lean body mass without dieting or exercising. They did not formally assess the subjects' appearance. But Dr. Harman said, "you could see that some of these guys lost a significant amount of pot belly." On the other hand, many had the same side effects that afflicted Dr. Papadakis's subjects. Although they went away when the subjects stopped taking growth hormone, they gave the investigators pause. The American Academy of Anti-Aging Medicine said in a statement that the doses used in the study were far too high. Lower doses that reproduce the hormone levels of youth are safe and effective, the group said. But Dr. Papadakis said those were the levels her study reproduced. "Maybe we don't know the right dose," she said. "But then how can you be giving it to people? Get a grip." Dr. Livesey and Dr. Raffaele, at the Anti-Aging Medicine clinic in Manhattan, had expected most of their patients to be old people trying to gain enough strength to rise from a chair unassisted, or middle-aged people wanting to look young. Instead, they tend to be baby boomers, the doctors said, who are searching for something that other doctors did not provide. "By the time they come here, they've already gone to places to look better," Dr. Raffaele said. "They've had the Botox, the plastic surgery. The reason they're here is they want to have a good quality of life." Most keep their visits a secret, he said, adding: "They don't even want to tell their close friends. It's kind of like plastic surgery." They are like a 50-year-old woman living in New York who arrived at the doctors' anti-aging clinic last February. "I was feeling desperate," said the woman, who did not want to give her name because she is keeping the treatment secret from her friends. She was depressed, gaining weight, feeling old and fatigued. But, she said, when she began taking growth hormone, estrogen and progesterone, she noticed an immediate change in her mood and energy. It gave her the stamina and enthusiasm to start dieting and working out at a gym and she dropped 10 pounds. She said her libido returned, her hair grew, and even her bunions regressed so she could wear high heels again. Was it the drugs or the power of suggestion, the diet and exercise or the growth hormone that made the difference? Will she develop a serious disease as a result of taking the drugs or will she enter old age healthy and vigorous, younger than her years? It is impossible to know, researchers said, and that is why good studies are needed. "Our concern is that the evidence is mostly based on personal testimonials rather than good data," Dr. Warner said. "It's not hard to get people to believe something works, particularly if they are paying a lot of money for it." Dr. Alvin Matsumoto, a geriatrician at the Veterans Affairs Puget Sound Health Care System, sounded a similar note of caution. "For any particular patient, the trick is to determine who is the practitioner who has your best interests at heart. It is hard to distinguish that sometimes."

http://www.nytimes.com/2002....ion=top December 17, 2002 The Heavy Cost of Chronic Stress By ERICA GOODE In this season of bickering relatives and whining children, of overcrowded department stores and unwritten Christmas cards, it is instructive to consider the plight of the Pacific salmon. As the fish leap, flop and struggle upstream to spawn, their levels of cortisol, a potent stress hormone, surge, providing energy to fight the current. But the hormone also leads the salmon to stop eating. Their digestive tracts wither away. Their immune systems break down. And after laying their eggs, they die of exhaustion and infection, their bodies worn out by the journey. Salmon cannot help being stressed out. They are programmed to die, their systems propelled into overdrive by evolutionary design. Humans, on the other hand, are usually subject to stresses of their own making, the chronic, primarily psychological, pressures of modern life. Yet they also suffer consequences when the body's biological mechanisms for handling stress go awry. Prolonged or severe stress has been shown to weaken the immune system, strain the heart, damage memory cells in the brain and deposit fat at the waist rather than the hips and buttocks (a risk factor for heart disease, cancer and other illnesses), said Dr. Bruce S. McEwen, director of the neuroendocrinology laboratory at the Rockefeller University and the author of a new book, "The End of Stress as We Know It." Stress has been implicated in aging, depression, heart disease, rheumatoid arthritis and diabetes, among other illnesses. Researchers have known for many decades that physical stress takes a toll on the body. But only relatively recently have the profound effects of psychological stress on health been widely acknowledged. Two decades ago, many basic scientists scoffed at the notion that mental state could affect illness. The link between mind and body was considered murky territory, best left to psychiatrists. But in the last decade, researchers have convincingly demonstrated that psychological stress can increase vulnerability to disease and have begun to understand how that might occur. "If you would have said to me back in 1982 that stress could modulate how the immune system worked, I would have said, `Forget about it,' " said Dr. Ronald Glaser, an immunologist at Ohio State University. The more researchers have learned, the clearer it has become that stress may be a thread tying together many illnesses that were previously thought to be unrelated. "What used to be thought of as pathways that led pretty explicitly to one particular disease outcome can now be seen as leading to a whole lot of different outcomes," said Dr. Robert M. Sapolsky, a professor of neurology at Stanford. Central to this new understanding is a novel conception of stress, developed by Dr. McEwen, who has been studying the subject for more than three decades. According to his model, it is not stress per se that is harmful. Rather, the problems associated with stress result from a complicated interaction between the demands of the outside world and the body's capacity to manage potential threats. That capacity can be influenced by heredity and childhood experience; by diet, exercise and sleep patterns; by the presence or absence of close personal relationships; by income level and social status; and by the piling on of normal stresses to the point that they overload the system. In moderate amounts, the scientists argue, stress can be benign, even beneficial, and most people are equipped to deal with it. Preparing to give a speech, take a test or avoid a speeding car, the body undergoes an elaborate series of adjustments. Physiological processes essential in mobilizing a response ? the cardiovascular system, the immune system, the endocrine glands and brain regions involved in emotion and memory ? are recruited into action. Nonessential functions like reproduction and digestion are put off till later. Adrenaline, and later cortisol, both stress hormones secreted by the adrenal glands, flood the body. Heart rate and blood pressure rise, respiration quickens, oxygen flows to the muscles, and immune cells prepare to rush to the site of an injury. When the speech is delivered, the test taken or the car avoided, another complex set of adjustments calms things down, returning the body to normal. This process of "equilibrium through change" is called allostasis, and it is essential for survival. But it was developed, Dr. McEwen and Dr. Sapolsky point out, for the dangers humans might have encountered in a typical day on the savannah, the sudden appearance of a lion, for example, or a temporary shortage of antelope meat. Blaring car alarms, controlling bosses, two-career marriages, six-mile traffic jams and rude salesclerks were simply not part of the plan. When stress persists for too long or becomes too severe, Dr. McEwen said, the normally protective mechanisms become overburdened, a condition that he refers to as allostatic load. The finely tuned feedback system is disrupted, and over time it runs amok, causing damage. Work that Dr. McEwen and his colleagues have conducted with rats nicely illustrates this wear-and-tear effect. In the studies, the rats were placed in a small compartment, their movement restricted for six hours a day during their normal resting time. The first time the rats were restrained, Dr. McEwen said, their cortisol levels rose as their stress response moved into full gear. But after that, their cortisol production switched off earlier each day as they became accustomed to the restraint. That might have been the end of the story. But the researchers also found that at 21 days, the rats began to show the effects of chronic stress. They grew anxious and aggressive. Their immune systems became slower to fight off invaders. Nerve cells in the hippocampus, a brain region involved in memory, atrophied. The production of new hippocampal neurons stopped. Dr. Sheldon Cohen, a professor of psychology at Carnegie Mellon University, has found that people respond much the same way. Among volunteers inoculated with a cold virus, those who reported life stresses that continued for more than one month like unemployment or family problems were more likely to develop colds than those who reported stress lasting less than a month. The longer the stress persisted, the greater the risk of illness. Allostatic load is often made worse, Dr. McEwen said, by how people respond to stress, eating fatty foods, staying late at work, avoiding the treadmill or drinking to excess. "The fact is that we're now living in a world where our systems are not allowed a chance to rest, to go back to base line," he said. "They're being driven by excess calories, by inadequate sleep, by lack of exercise, by smoking, by isolation or frenzied competition." The Chemistry Shrinking Cells, Turned-Off Responses Doctors sometimes dismiss stress-related complaints as "all in the patient's head." In a sense, they are right. The brain, specifically the amygdala, detects the first signs of danger, as demonstrated in now-classic studies by Dr. Joseph LeDoux of New York University. Other brain areas evaluate the threat's importance, decide how to respond and remember when and where the danger occurred, increasing the chances of avoiding it next time. So it is not surprising that when the stress system is derailed, the brain is a target for damage. A decade of research has demonstrated that sustained stress and the resulting overproduction of cortisol can have chilling effects on the hippocampus, a horseshoe-shaped brain structure intimately involved in memory formation. Scientists say they believe that the hippocampus plays an active role in registering not only events, but also their context, an important task in the face of danger. In stressful situations, the hippocampus also helps turn off the stress response after the threat has subsided. But high levels of cortisol, studies have shown, can shrink nerve cells in the hippocampus and halt the creation of new hippocampal neurons. These changes are associated with aging and memory problems. Some evidence also links a smaller hippocampus with post-traumatic stress disorder, depression and sexual abuse in childhood, though the meaning of this size difference is still being debated. Like other hormones, cortisol normally rises and falls with daily rhythms, its production higher in the morning and lower in the evening. Prolonged or severe stress appears to disrupt the cycle. Chronically stressed people sometimes have higher base line cortisol levels and produce too much or too little of it at the wrong times. One result, recent studies indicate, is that fat is deposited at the abdomen rather than the hips or the buttocks. One of cortisol's primary functions is to help mobilize energy in times of acute stress by releasing glucose into the blood. But when cortisol remains chronically elevated, it acts, along with high insulin levels, to send fat into storage at the waist. This makes sense if a famine looms. But it is bad news for anyone who wants to minimize the risk of heart disease, cancer and other illnesses. Studies have shown that excess cortisol secretion in animals increases visceral fat. And Dr. Elissa S. Epel at the University of California at San Francisco has found that even in slender women, stress, cortisol and belly fat seem to go together. The notion that being stressed makes people sick is a popular one, and most people subscribe to some version of it. Come down with the flu in the midst of a messy divorce or a frantic period at the office, and someone is bound to blame stress. But it was not until the 1980's and early 90's that scientists began to discover the mechanisms that might lie behind the mind and body link. Investigators uncovered nerves that connect the brain with the spleen and thymus, organs important in immune responses, and they established that nerve cells could affect the activity of infection-fighting white blood cells. Scientists also found that cytokines, proteins produced by immune cells, could influence brain processes. Among other things, the proteins appeared able to activate the second major phase of the stress response, the so-called hypothalamic-pituitary-adrenal, or H.P.A., axis. In this chemical sequence, the hypothalamus, situated in the forebrain, dispatches chemical signals to the pituitary, which in turn secretes the stress hormone ACTH, prompting the adrenal glands to produce cortisol. Much remains unknown about how the brain, the endocrine system and the immune system interact, and some of what is known is not well understood. For example, high levels of cortisol have long been known to shut off the production and action of cytokines, which initiate the immune response. At normal levels, cortisol can enhance immunity by increasing the production of inflammation-fighting cytokines. Yet in some cases, it seems, cortisol does not properly shut down the immune system under stress, allowing the continued production of cytokines that promote inflammation. These cytokines have been linked to heart disease, depression, stroke and other illnesses. Still, scientists can watch stress hammer away at the immune system in the laboratory. Dr. Glaser of Ohio State and his wife, Dr. Janice Kiecolt-Glaser, found that small wounds took an average of nine days longer to heal in women who cared for patients with Alzheimer's disease than in women who were not under similar stress. In another study, arguments between husbands and wives were accompanied by increases in stress hormones and immunological changes over a 24-hour period. Stress also seems to make people more likely to contract some infectious illnesses. Dr. Cohen of Carnegie Mellon has spent years inoculating intrepid volunteers with cold and influenza viruses, and his findings offer strong evidence that stressed people are more likely to become infected and had more severe symptoms after becoming ill. A direct link between stress and more serious diseases, however, has been more difficult to establish, Dr. Cohen said. Recent studies have provided increased support for the notion that stress contributes to heart disease, and researchers have tied psychological stress, directly or indirectly, to diabetes, rheumatoid arthritis, fibromyalgia, severe depression and other mental disorders. But the influence of chronic stress on other diseases like cancer remains controversial. All the same, Dr. Cohen said, "The evidence that stress puts people at risk for disease is a lot better than it was 10 years ago." The Risks From an Early Start, Lifelong Effects Why do some people seem more vulnerable to life's pressures than others? Personality and health habits play a role. And severe stress in early life appears to cast a long shadow. Dr. Michael Meaney of McGill University and his colleagues have found that rat pups intensively licked and groomed by their mothers were bolder and secreted lower levels of the stress hormone ACTH in stressful situations than rats lacking such attention ? an equanimity that lasted throughout their lives. (Cuddled pups, the researchers found in another study, were also smarter than their neglected peers.) In humans, physical and sexual abuse and other traumas in childhood have been associated with a more pronounced response to stress later in life. In one study, Dr. Charles Nemeroff, a psychiatrist at Emory University, and his colleagues found that women who were physically or sexually abused as children secreted more of two stress hormones in response to a mildly stressful situation than women who had not been abused. Yet perhaps the best indicator of how people are likely to be affected by stress is their position in the social hierarchy. In subordinate male monkeys, for example, the stress of being servile to their alpha counterparts causes damage in the hippocampus. And dominant monkeys who are repeatedly moved from social group to social group, forcing them to constantly re-establish their position, also exhibit severe stress and are more likely to develop atherosclerosis, according to studies by Dr. Jay Kaplan of Wake Forest University School of Medicine. Being low in the hierarchy also affects reproduction, presumably because evolution dictated that in times of stress, other factors were more pressing than procreation. In a recent study, Dr. Kaplan found that the constant low-level harassment by dominant female monkeys shut down reproductive function in subordinate females and built up fat deposits in their arteries. It would be nice to think that humans are less chained to their social rankings. But alas, researchers have found this not to be the case. A wealth of studies shows that the risk for many diseases increases with every step down the socioeconomic scale, even when factors like smoking and access to health care are taken into account. A real estate mogul living in a Park Avenue penthouse has a better health prognosis than the head of a small company in an upscale condo a few blocks away. And a renter in a one-bedroom apartment on the Upper West Side of Manhattan will be a tier or two lower still in health expectations. Even people's perceptions of their relative standings in society affect their disease risk. In one study, led by Dr. Nancy E. Adler, also at the University of California at San Francisco, women who placed themselves higher on the social ladder reported better physical health and had lower resting cortisol levels and less abdominal fat than women who placed themselves on lower rungs. No matter what one's circumstances, of course, some stress in life is inevitable. But illness is not, Dr. McEwen said. A variety of strategies can help reduce disease risk. Reaching for a gallon of ice cream to soothe the tension of a family argument is not one of them, however, nor is forgoing exercise in favor of curling up on the sofa for an eight-hour marathon of "Law and Order." The best ways to cope, Dr. McEwen said, turn out to be the time-honored ones: eat sensibly, get plenty of sleep, exercise regularly, stop at one martini and stay away from cigarettes. "It's a matter of making choices in your life," he said.

Hypercortisolemia is simply the overproduction of cortisol. Basically, what happens with people who have hypercortisolemia is that they have the inability to shut off the stress response so they are constantly responding to stress differently than other people. In addition to diseases like Cushing's, high stress responses can come from many different sources such as traumatic events, busy lifestyles, or physically, emotionally, or spiritually threatening situations. Stress responses are real, and are typically out of the control of the person experiencing them. For a more technical explaination read this

Physicians Offer Group Medical Appointments to Provide Quicker Access, Spend More Time With Patients Thursday December 12, 2:14 pm ET GARLAND, Texas, Dec. 12 /PRNewswire/ -- Want to have more time with your primary care physician? Try a group appointment. Two primary care physicians affiliated with Family Medical Center of North Garland, part of Baylor Health Care System, offer established patients a new medical appointment option to give the patients quicker access, more time with their physician and additional information obtained from interacting with others. Shared group medical appointments involve a group of up to 10 patients meeting together for a 90-minute appointment with the physician. Cliff Fullerton, M.D., and Kimberly McMillin, M.D., are the first physicians in North Texas to offer shared group medical appointments after learning about the concept at a meeting sponsored by the Institute of Health Care Improvement, Palo Alto, Calif. They began a pilot study in July. "Group appointments allow us to spend more time with our patients, discussing any concerns or questions they might have. From the patient perspective, our patients tell us that they enjoy the group setting because the other patients provide support as they share information among themselves about similar experiences," said Dr. Fullerton. "These group medical visits have gotten high ratings in our patient satisfaction surveys." At the beginning of the 90-minute group visit, a nurse or medical assistant takes each participant's vital signs. The physician then addresses each patient's individual needs, and a group co-leader, Harold Duncan, a licensed professional counselor, facilitates a discussion about common related social and emotional issues. Prior to the appointment, each patient and guest signs a confidentiality waiver. The group appointments occur every Thursday with Drs. McMillin and Fullerton alternating weeks. As deemed appropriate by the physician, some basic physical examination, such as evaluating an injured limb, breathing or heart rate, takes place during the session. At the end of the group appointment, the physician conducts any private exams or discussions as needed. Group appointments are scheduled at regular times, every other week. The appointments are most beneficial for patients who: -- have a chronic condition, such as arthritis, hypertension, asthma, diabetes or depression (MaryONote: Cushing's???) -- require routine follow-up appointments such as pregnancy -- want to get to know their physician better -- have a non-emergency need, but do need to talk to the doctor. "I feel like I am getting to know my patients better through these appointments, and the dynamic of the group setting brings shared knowledge and encouragement to the participants," said Dr. McMillin. Billing for a group medical appointment uses the physician office's standard billing process. The co-pay is the same as a regular office visit. Family Medical Center at North Garland is part of Baylor Health Care System. Both physicians are on the staff of Baylor Medical Center at Garland, which is a 220-bed community hospital offering comprehensive medical and surgical services ranging from 24-hour emergency care to cardiovascular surgery. The medical center serves residents of Garland, Rowlett, Sachse, Wylie and the surrounding region.

http://www.reuters.com/newsArt....1889596 Estrogen, UV Added to US Govt. List of Carcinogens Wed December 11, 2002 11:05 AM ET By Todd Zwillich WASHINGTON (Reuters Health) - A new US government report has for the first time identified estrogen-containing drugs and ultraviolet light as cancer-causing agents, federal agencies announced Wednesday. The report also lists wood dust, common in carpentry shops and saw mills, as a known cause of lung cancer. Fifteen other compounds, including industrial chemicals, dyes and one compound found in foods cooked at high temperatures, were also added to the list as probable human carcinogens. The report, published every 2 years by the National Toxicology Program, contains little new information about the agents it lists. Instead, it is a collection of known experimental data that the government uses to keep a running catalog of cancer-causing agents. Federal agencies and Congress use the list to guide regulations and legislation governing industrial and environmental health hazards. Wednesday's additions expanded the list to 228 compounds either "known" or "reasonably anticipated" to cause cancer in humans. It does not make conclusions about the magnitude of cancer risk posed by any of the compounds or what types of people may be most vulnerable. Steroidal estrogens were added to the list for the first time because of research data linking the compounds to an increased risk of cancer of the endometrium, or lining of the uterus. They have also been associated with a rise in breast cancer risk. Steroidal estrogens are used in hormone replacement therapy for menopausal women, and physicians are supposed to weigh the risk of cancer against the benefits of the drugs. Estrogen replacement therapy is also known to reduce the chances of ovarian cancer in women who take it. Broad-spectrum ultraviolet light, found in natural sunlight and in light used in tanning beds, was also classified as a known carcinogen because of a strong connection with cancers of the skin, lips and eyes, according to the report. The report also upgraded beryllium compounds, which are commonly used in ceramics shops, nuclear reactors and jewelry making, from a probable to a known carcinogen.

Thanks, Sue!

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Thanks, Cherri! Very interesting

Thanks for thie info, Paula - I knew that President Kennedy had Addison's from somewhere deep in my brain LOL but maybe publishing this information will get more people aware of this - and Cushing's!

FDA Issues Warning About Painkiller .c The Associated Press WASHINGTON (AP) - People who develop a rash upon taking a new painkiller called Bextra should immediately stop the drug because it has been linked to some rare but life-threatening skin diseases, federal health officials warned Friday. The Food and Drug Administration has about 20 reports of serious reactions - including the skin diseases Stevens-Johnson syndrome, toxic epidermal necrolysis and exfoliative dermatitis, as well as allergic reactions - among Bextra users since sales began in March. The FDA estimates about 800,000 to 1 million people had recently begun taking Bextra when the reactions were reported. The immune system-linked skin disorders are thought to be more likely during the first few weeks of a drug's use than after the body becomes accustomed to the medicine. Still, because those skin conditions are so rare, the FDA was surprised to see even that small cluster reported during Bextra's first year of sales. The conditions can be lifethreatening, and a few of the patients required hospitalization. Stopping Bextra at the first sign of a rash lowers the chance of suffering a severe reaction, said Dr. Lawrence Goldkind, FDA's deputy director for painkillers. In addition, the FDA warned that Bextra should not be used by anyone allergic to sulfa-containing drugs. Bextra maker Pharmacia Corp. wrote thousands of doctors this week alerting them to the warning. Bextra, known chemically as valdecoxib, treats arthritis and menstrual pain by reducing inflammation. It is a type of painkiller known as a cox-2 inhibitor. 11/15/02 13:46 EST Copyright 2002 The Associated Press.

Anyone interested in any of this stuff as Cushing's merchandise? Ski Cap Ceramic Ornament 8x10 Frame with an 4x6 photo insert Plush Bear wearing a t-shirt Holiday Stocking Woman's Thong :wow: Greeting Cards with envelopes 1 Page Wall Calendar Multi-page 12 month calendar Postcards