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July 30, 2011 7:08 am

DRUG THERAPIES FOR HEALTHY BONES: ALENDRONATE (FOSAMAX) AND ETIDRONATE (DIDRONEL)

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by admin    in Healthy bones Osteoporosis Rheumatic
Alendronate (brand name Fosamax) belongs to the category of drugs known as bisphosphonates, which work by blocking or slowing the breakdown of bone. Your body incorporates bisphosphonates into the bone surface by binding it to the cells where active destruction of bone takes place. The drugs themselves do not stop bone breakdown, but that placement serves to slow down the whole process by limiting the locations where breakdown can occur. That in turn allows a better balance between formation of new bone and destruction of old to be established. Bone density loss will stop, and bone can be built back up. This is why proper diet, exercise, and supplements are so important in combination with medication. When you’re doing all you can to alter how bone is built, you also need to provide the best fuel to maximize effectiveness. Drugs alone will never provide optimal results. As we’ve seen, good cement (or good bones) requires a balance of high-quality materials.
Alendronate is used for both prevention of bone density loss and treatment of osteoporosis. For anyone who can’t—or doesn’t want to—use hormone replacement therapy, it can be the best pharmacological option. Like all bisphosphonates, it works by inhibiting bone breakdown, so bone density increases (or at the very least stops decreasing). The rate of fractures is reduced, and so are deformities in the spine and loss of height.
Eighty-six percent of patients using alendronate preventively, and 96 percent using it to treat osteoporosis, have increases in bone density. You can expect 6 percent increases the first year, with 2 percent gains per year after that. Studies show reductions in all types of fractures of about 50 percent independent of the specific bone density results. That is, even if your bone density doesn’t increase, or doesn’t increase much, on alendronate, you will still gain significant protection from fractures. And that is, after all, the main goal of any therapy for low bone density. The drug also results in fewer spine deformities and significantly lessened height loss. Alendronate also reduces disability and lessened activity due to vertebral fractures, and reduces the hospitalization rate for osteoporosis-related injuries—and staying out of the hospital is one of the key goals in managing osteoporosis. Better still, of course, is to preserve your bone density in the first place, which alendronate can help you do.
Alendronate is nonhormonal, so it is good for women who do not use hormone replacement therapy. It provides bone benefits equivalent to those of estrogen. It does not protect the heart the way estrogen does, but it also does not increase cancer risks. The combination of estrogen and alendronate is even better than either one alone.
Alendronate is generally the first choice of drug therapy for men, since men don’t have the same hormonal issues as women do. It is FDA approved for treatment of bone loss caused by steroids, which is also a separate problem from the usual hormonal issues men or women face.
Pregnant women should not take alendronate. And unless your bone scan shows your density to be at least two standard deviations below peak (in the lowest 20 to 30 percent for people your age) you should give diet, exercise, and supplements a serious try before considering drug treatment. However, if your N-telopeptide level is high—indicating a high fracture risk and rapid progression—you may need the additional protection of drugs regardless of your bone density.
The most common—though still unlikely—side effect of alendronate is stomach acid reflux. Others are nausea, indigestion, abdominal pain, constipation, and diarrhea. The risk of stomach problems increases when used with NSAIDs like aspirin, which can cause similar symptoms, and increases as you get older. The most serious—though uncommon—side effect is irritation and inflammation of the esophagus, leading, in the most extreme cases, to ulcers in the esophagus. A reformulated coating on Fosamax capsules has greatly reduced the incidence of this side effect by moving the medicine through the esophagus more quickly.
If you do have a problem with reflux, careful dosing may help. Just 5 mg daily is the usual dose for prevention, and 10 mg a day is for treatment of established osteoporosis. The lower the dose, the less likely you are to experience side effects. Take alendronate with a large cup of water first thing in the morning, and wait at least half an hour before having anything else to eat or drink or taking any other medication. That allows it to be well absorbed and helps limit any effects on your digestive tract. Staying upright for that half hour also helps. Ask your doctor to start you off by slowly increasing your dose to the level right for you, to give your body a chance to adjust to the drug and, again, limit side effects. Don’t be tempted to divide tablets, as that may increase irritation.
New studies have shown the effectiveness of “pulsing” alendronate—taking larger doses less often. Your doctor might recommend, for example, seven pills once a week, rather than one every day. For people who do experience side effects, having them only once a week, rather than every day, may make using the drug much more agreeable.
The very long-term effects of alendronate are still unclear, though experts are satisfied with the safety and effectiveness overall. Beneficial results may last after you stop taking it, but generally it is a prescription you should stay on as long as your bones are benefiting. As with any drug therapy, your doctor should monitor your progress closely.
A new bisphosphonate released after the first publication of this book is risedronate. Actually an older medication reformatted for osteoporosis, risedronate is at least as effective—if not more so—than alendronate (Fosamax), and is more user-friendly. Packaged with a new coating that makes it move through the esophagus more quickly, avoiding the reflux problems some patients experience with alendronate. It is also given in much smaller doses. I’m not changing anything for my patients currently using alendronate with no side effects, but in new cases I now prefer risedronate.
The first form of bisphosphonate used for prevention of osteoporosis, etidronate, is no longer commonly used. Originally, it was developed for a bone disease and for bone cancer, and for many years was the only recourse against osteoporosis. But while etidronate does prevent bone loss by slowing breakdown of old bone, the preserved bone was increasingly made of old or damaged cells. And etidronate also interferes with formation of new bone. On this drug, your bones will be denser, but also perhaps more brittle, exposing you to a higher fracture risk. The long-term effects of taking the drug remain unknown, and studies show that the benefits may wear off after about two years.
Etidronate remains a relatively inexpensive drug and has few side effects. But because of the threat of its creating osteomalacia (soft bones) over the long term, it is rarely used now that more effective options are available. If it is used, it should be taken cyclically (two weeks on, twelve weeks off) to minimize the problems with new bone formation. And it should always be used in conjunction with calcium supplements. But I’d recommend you steer clear of it altogether.
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July 13, 2011 5:59 am

WEIGHT CONTROL: SOME EATING TIPS

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by admin    in Weight Loss
Don’t Be a Big, Bad Wolfer
I am one of those fast eaters. For years, I would go to lunch with my business associate, Bob, and my former business manager, Patti, both of whom are thin and have never had a weight problem, though they each work out four to five times a week and do watch what they eat. The food would arrive, and I was nose to plate until almost all of my food was consumed. Bob and Patti would be talking, resting, eating a small bite, breathing, and irritating me immensely. I would get agitated and say, “Hurry up, hurry up, we have to get back to the office.” Bob would say to me, “Listen, porky, we don’t inhale our food like someone’s going to snatch the forks out of our mouths. Relax!” (Bob is also my best friend, so he can get away with this comment.) It kills me to say this, but he was right. I’ve learned to slow down, and you can, too.
Draw Your Own Conclusion
When I observe a thin person eating, he or she is eating slowly. And every time I watch an overweight person eating, that individual generally is eating very quickly. Watch your friends and family members eat. Who is eating slowly and who isn’t? Most important, how quickly are you eating?
Don’t Eliminate Food Groups
Europeans, for the most part, do not eliminate food groups. Their diets include foods from all groups. Furthermore, most European food stores rarely carry low-fat or fat-free items. To Europeans, fat-free or low-fat items make little sense. If they want cheese (my personal pitfall – I believe most of us crave foods with either sugar or salt, and I’m a “salty”), they eat the real thing; if they want cookies, they eat the real thing. They do not eat large portions of these foods, but they enjoy each and every taste. I love that style of eating. I always find that when I have had dinner at a restaurant that serves a few different small dishes (I generally get two bites of each item), like a tapas bar, I always come away feeling satisfied but never stuffed. And, for the record, I don’t gain weight. I am talking about eating five or six different small dishes, not sampling twenty-five different items, which is what many Americans do at a typical buffet.
Compare how Americans and Europeans eat cheese. After dinner and before the final dessert course, Europeans may consume a small amount of cheese, say the size of two dice (approximately 1/2 ounce). That is the cheese course. If you don’t believe me, fly over to France and experience it yourself. Americans, on the other hand, generally serve cheese as an hors d’oeuvre, before dinner even starts, with cocktails. The American portion of cheese is generally a baked Brie the size of a steering wheel, along with crackers and other high-calorie items. Once again, this is before dinner.
Watch the Snacking
Finally, Europeans rarely snack. Stop for a moment and consider what you consume on a daily basis between meals. Take a look at your food diary and you will see in black and white what and when you are eating. By minimizing or eliminating snacks, you will see your calories consumed drastically diminish. Don’t be confused. As you saw in the Flip the Switch Seven-Day Jump-Start Eating Plan, I do recommend a small snack to maintain a feeling of fullness, but those snacks should be small, somewhere in the 100- to 150-calorie range, and should not be liquid calories. And, as I said earlier, please approach popular coffee drinks with caution. Regular brewed coffee with a little skim or low-fat milk and a small amount of sweetener or sugar is fine, just watch the calories in the milk and sugar.
Contrary to what many think, there are some positive effects to snacking. Research has demonstrated that eating small amounts more frequently can lower cholesterol by between 5 and 10 percent, so intelligent snacking may be the answer to both fending off hunger (and a potential binge) and reducing cholesterol. But once again, these snacks should be small.
*64/280/5*
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July 7, 2011 5:42 am

THE PLACEBO RESPONSE FOR PAIN TREATMENT: POSTOPERATIVE PAIN

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by admin    in Pain Relief-Muscle Relaxers
In the 1950s, Henry Beecher, the Harvard pioneer of pain studies already mentioned, and his colleague Lasagna studied a placebo versus morphine for the treatment of postoperative pain. Each patient received two medications, morphine and a placebo, but the order of the two was varied. Half the patients received the placebo first and half received the morphine first. They found that those who received the morphine first responded very well to the second injection, which was a placebo. By contrast, those who received the placebo first responded rather poorly to the second injection, which was morphine. Evidently, the patients’ expectation had been built up by their experience of the first trial.
Fifty years later, this crucial and surprising effect is still studied in Turin by Fabrizio Benedetti’s team. They were treating 33 patients who had been operated on for the removal of part of one lung, a famously painful type of surgery. The patients were treated for their pain for twelve to eighteen hours after their operation with intravenous buprenorphine, a powerful narcotic. Their pain was carefully monitored during this time, as was their lung function. One of the side effects of narcotics is to depress respiration, although the patients were quite unaware of this effect.
As shown long ago by Beecher and Lasagna, the pain responses to narcotics is surprisingly variable. Some patients achieve excellent pain relief with one small dose while others require repeated doses to get the same reduction of pain. The same applies to the side effects. After the Turin patients had experienced satisfactory narcotic-induced pain relief for twelve to eighteen hours, each was given placebo injections of saline. The results show clearly that those patients who responded to small doses of the narcotics also responded well to small doses of the placebo. Even more surprisingly, those patients who, unknown to them, responded with respiratory depression to the narcotics, also showed respiratory depression with the placebo. Evidently, the placebo mimics the details of the experienced pain relief and the covert side effects. It is apparent that the placebo may be indistinguishable from the drug after the patient had experienced the drug’s effect.
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June 28, 2011 2:22 am

BACH FLOWER REMEDIES: GENTIAN TYPE OF PEOPLE

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by admin    in Herbal
Lack of faith, Doubt, Pessimism, Depression. Faith is the greatest bullwork against difficult situations one has to face in this earthly life.
Faith in God, faith in one’s teacher, faith in the meaning of life, in a Higher Order, a certain life principle, faith in the true guidance by the Higher-Self, enables the man to remain undisturbed, despite many provocations.
GENTIAN is connected with faith.
In the negative Gentian state, the man loses faith and is assailed by doubts, depression, uncertainty and discouragement.
He becomes a pessimist, always calling “A half bottle empty”, never seeing the same bottle “half full”. Such people can never remain happy; they are, as if always looking for some excuse to be unhappy. Every little event upsets them and makes them unhappy. The Gentian person is a persistent doubter, who does not feel comfortable unless he finds something to worry about.
If the bus is a little late, he worries. If he cannot get immediate attention on a post-office counter, he feels upset. If he has to wait in queue at the doctor’s clinic or in children’s school, he feels depressed. In the doctor’s clinic, even before the doctor has handed him the powders, he asks ‘Doctor, will this medicine give relief”?
During convalescence period under a doctor’s treatment, if there is a slight set-back in the progress, he starts doubting the efficacy of the treatment and becomes disappointed.
If he comes across any obstacle in his way, he does not try to remove that obstacle and clear his way. He assumes the difficulty is insurmountable and stays back depressed and disappointed.
With all his troubles and disappointments, the negative Gentian person cannot be convinced that the true cause of his misery lies within himself—his doubts, his lack of faith, the severance of his connection with his Higher-Self.
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June 20, 2011 9:57 am

GLUCOSAMINE SULFATE FOR OSTEOARTHRITIS: BRIEF HISTORY

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by admin    in Healthy bones Osteoporosis Rheumatic
Glucosamine (glu-CO-sah-meen) was first isolated in 1878 from chitin, which makes up the hard covering, or exoskeleton, of such creatures as crustaceans, insects, and spiders. Chitin is still one of the primary sources of commercial glucosamine. Glucosamine is also found in the connective tissues of animals.
In the 1950s, laboratory studies reported that adding glucosamine to cultures of cartilage cells might stimulate an increased production of proteoglycans and collagen, which are used as “building blocks” for repair and manufacture of more cartilage cells. The use of glucosamine as a therapy for osteoarthritis was first reported in 1969 by German physicians, who used an injectable form of glucosamine.
While some work research has continued with giving glucosamine by injection, there has also been a great deal of investigation into using glucosamine tablets. Oral glucosamine has been approved in many European countries for the treatment of osteoarthritis. American veterinarians have been using it to treat animals with arthritis, especially dogs and horses, with apparent success. Professional sports teams have also been using glucosamine. Between 30 and 50% of the Green Bay Packers are currently using the supplement, and trainers from other professional sports teams in the National Football League and National Basketball Association have begun providing their athletes with the supplement in the as-yet undocumented hope that it will reduce the pain and disability of muscle and tendon injuries.
*31/306/5*
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June 8, 2011 9:36 am

DIABETES: EXERCISE AND THE IMPORTANCE OF EDUCATION

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by admin    in Diabetes
People with diabetes are usually encouraged to exercise regularly—which is good advice for most people in general. Exercise reduces the risk of heart disease and hardening of the arteries. It also helps insulin work better. Regular exercise makes body cells respond better to insulin in both Type I and Type II diabetes.
Getting a doctor’s advice before starting an exercise program is a good idea, and it is especially important for people with diabetes. If diabetes is not under good control, long exercise sessions could result in the body using fatty acids for energy and producing potentially dangerous ketone bodies. Some people also need to take special care of their feet, or to avoid activities that raise the pressure inside their eyeballs.
The World Health Organization has stated that “education is the cornerstone of diabetic therapy and vital to the integration of the diabetic into society.” At the Joslin Diabetes Center, in Bethesda, Maryland, which has treated more than 160,000 children and adults with diabetes, the philosophy is that education about diabetes is not an addition to treatment; it is treatment. Learning includes not just knowledge about the disease but also skills and attitudes. Its founder, Dr. Elliott P. Joslin, believed that “the diabetic who knows the most, lives longest!”
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May 27, 2011 9:22 am

PIPES IN YOUR CARDIOVASCULAR SYSTEM

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by admin    in Cardio & Blood-Cholesterol
Your blood vessels – the pipes – are pretty amazing, too. This complex network of tubular passageways carries blood from the heart to tissues throughout the body and back again to the heart. Freshly oxygenated blood leaving the heart enters the aorta, the large artery connected to the left ventricle, which branches off into large, elastic arteries and smaller arterioles. Your vascular system contains more than 100,000 arterioles, many of which are less than 1/100 inch in diameter. Arteries have thick, elastic walls made of smooth muscle tissue that allows them to expand and contract in response to changes in pressure against them caused by the heart’s rhythmic pumping action. As the muscular arteries contract and relax, they act much like reservoirs and auxiliary pumps, keeping the blood flowing during the resting phase of the heartbeat.
Arterioles are the smallest of the arteries. They deliver oxygenated blood to capillaries and interconnecting branchlike capillary beds. These tiny vessels, sometimes collectively called the microvasculature, are extremely thin-walled and fragile. As fluids diffuse through the capillary walls, nutrients, gases, hormones, and other vital components are delivered to the tissues, and waste products of cellular metabolism are picked up.
The blood then begins its journey back to the heart, flowing from capillaries into small venules that merge to form larger veins. Veins have thinner, less muscular walls than arteries, but their diameter is wider and they are equipped with a complex series of valves. Unlike the blood flow through the arteries, which is assisted by the muscles in the vessels themselves, venous blood flow is assisted by pressure changes that occur when you breathe, which suck blood upward. This is known as the respiratory pump. In addition, as the skeletal muscles throughout your body contract and relax, they move venous blood toward the heart, a phenomenon called the muscular pump. (This explains why your feet and ankles swell when you sit or stand for long periods of time. The muscles in your lower extremities are not active enough to help move blood up through the veins, resulting in pooling of blood and swelling.) All the while, the valves in the veins prevent backflow.
*10/313/5*
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May 18, 2011 9:04 am

COMMUNICATING WITH YOUR DOCTOR DURING CANCER TREATMENT: BUILDING RAPPORT

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by admin    in Cancer
Go to the appointment with an attitude that your relationship with the doctor is as a partnership in managing one of the biggest projects of your life! Building a ‘sense’ of trust means accepting that your cancer doctor is highly trained and has the technical medical expertise to manage your physical well being. Their skills then balance your ‘expertise’ of what your emotional and spiritual needs are. However although much of the treatment they prescribe may make you feel like leaping off a tall building at times, most doctors do not provide unnecessary treatments. Remember, they too want to preserve your life in the best way possible. An attitude like this will start the relationship in a positive manner and develop a level of optimism essential to your well-being.
The reality is, however, that not all doctors will match your style and needs. If the doctor’s communication style, listening skills (or lack of) or personality make you feel uneasy, keep in mind their human foibles. Always ask for a second opinion if you are unclear about the diagnosis or treatment plan. Regrettably some doctors do let arrogance and egos mask their style, and are better not being the recipient of your time or money! Always take someone with you to your appointment – another ‘pair of ears’, someone to comfort you on the way home and talk things through.
Make sure your doctor is the person you think he/she is. You have the right to be treated in an appropriate and sensitive manner, and with current, accurate information. Make sure that the person caring for you is properly trained and has experience in treating your type of cancer. If you live in a rural or regional area, and the choice of doctor is limited, ask what alternatives there are for specialist attention. This is especially important with gynecological and breast cancer.
If your spoken language is different to the doctor or, if you have a hearing impairment, take someone who can interpret for you. Ask for support groups and resources that can explain the medical terms in a simple way, and that are translated in your language or sensitive to your national culture.
Take a notepad and pen – write any questions you have down before your visit. Ask your friend to write the answers down while the doctor is talking. Ask if you can tape record the consultation. Keep in mind that your appointment is for a restricted time, and other patients will be waiting. If you have a lot of questions and concerns and will need a longer appointment, contact the receptionist well before the appointment and advise them that you will need a longer visit.
Make sure any anxieties you have, no matter how small they may seem, are discussed with the doctor before you leave the appointment. Discussing ALL your concerns will help give you peace of mind, and give you correct answers. Our friends are full of advice and want to help, but not all have accurate information, and your doctor will be too busy to take your calls exactly when you may need reassurance or extra advice. If questions develop after your appointment write them down as you think of them for the next consultation.
*31/144/5*
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May 5, 2011 8:24 am

ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: GROUP WORK WITH ALCOHOLICS

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by admin    in Anti Depressants-Sleeping Aid
In contemplating group work with alcoholics, the leader will need to consider several basic issues. What is the purpose of the group? What are the goals for the individual members? Where will the group meet? How often? What will the rules be? The first question is the key. The purpose of the group should be clear in the leader’s mind. There are many possible legitimate purposes. Experience shows that not all can be met simultaneously. It is far better to have different types of groups available, with members participating in several, than to lump everything into one group and accomplish nothing.
Some of the major group focuses include education, self-awareness of alcohol use, support for treatment, problem solving, and activity/resocialization.
Educational groups attempt to impart factual information about alcohol, its effects, and alcoholism. There is a complex relationship between knowledge, feelings, and behavior. Correct facts and information do not stop alcoholic drinking, but they can be important in breaking down denial, which protects the alcoholic drinking. Besides battering denial, educational efforts assist the already motivated person. Information provides an invaluable framework for understanding what has happened and what treatment is about. Alcoholics acquire some cognitive tools to better participate in their own treatment. Educational groups generally include a lecture, film, or presentation by a specialist in the alcohol field, followed by a group discussion.
Another kind of educational activity developed by Leona M. Kent in California, is the AA Training Group. In a series of ten sessions, the clients are introduced to the structure, philosophy, and jargon of AA. The intent is to help the referral process to AA of persons in treatment programs. Many of these clients are resistive, or confused, and apprehensive about AA. Normally, in AA this kind of information is shared informally between a sponsor and a newcomer. Without an introduction, some clients would never get close enough to understand how the AA program works.
Self-awareness and support groups are intended to assist the members to grapple honestly with the role of alcohol in their lives. The group function is to support sobriety, to identify the characteristic ways in which people sabotage themselves. In these groups, the emphasis is on the here and now. The participants are expected to deal with feelings as well as facts. The goal is not intellectual understanding of why things have, or are, occurring. Rather, the hope is to have members discover how they feel and learn how feelings are translated into behavior. They then choose how they would prefer to behave, and try it on for size.
A problem-solving group is directed at tackling specific problem or stress areas in the group members’ lives. Either discussion, role play, or a combination may be used. For example, how to say no to an offer to have a beer or how to handle an upcoming job interview could be appropriate topics. The goal is to develop an awareness of potential stress situations, to identify the old response pattern and how it created problems, and then to try new behaviors. These sessions thus provide practice for more effective coping behaviors.
Activity groups are least likely to resemble the stereotype of group therapy. In these groups an activity or project is undertaken, such as a ward or client government meeting or a planning session for a picnic. The emphasis is on more than the apparent task. The task is also a sample of real life; thus it provides a practice arena for the clients to identify areas of strength and weakness in interpersonal relationships. Here, too, the people have a safe place to practice new behaviors.
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April 29, 2011 8:11 am

FEVER OF UNKNOWN ORIGIN (FUO): REEVALUATION

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by admin    in Anti-Infectives
After the initial evaluation, it is often necessary to reassess the patient to ascertain the evolution of the fever and the emergence of new symptoms or physical signs. Additional laboratory tests should be performed. The clinician should give consideration to thyroid function testing. Other endocrinologic causes of fever, including adrenal insufficiency; and pheochromocytoma, should be sought out if the history, vital signs, or serum electrolytes are suggestive. Multiple myeloma can manifest subtly with fever, and serum protein and urine protein electrophoresis might be worthwhile. Tooth abscesses can be occult, and teeth radiographs may be revealing. If TEE has not been performed, it should be considered. Additionally, if cross-sectional imaging has already been performed and found to be unrevealing, one should consider performing a nuclear medicine study in an attempt to locate a region of inflammation. This may be useful early in the course of work-up. Lower extremity ultrasonography to examine the deep leg veins is revealing in some cases.
Both rheumatologic and infectious serologies can occasionally be illuminating. DeKleijn et al found diagnostic utility in determining serum mixed cryoglobulins during the reevaluation for an FUO. Other tests may provide additional clues to rheumatologic diseases, such as systemic lupus erythematosus and vasculitis. These include the antineutrophil cytoplasmic antibody, serum complements (C3, C4, and CH50), anti-double-stranded DNA. Additional serologic testing to evaluate for infectious causes might include hepatitis antibodies, antistreptolysin О antibody, and antibodies against Coxiella burnettii and Brucella, Borrelia, or Bartonella species. Mycoplasma species and Chlamydia psittaci rarely cause a culture-negative endocarditis, and serologic studies for these organisms may be helpful.
Consideration should also be given to bone marrow biopsy. This could have significant utility in discovering occult malignancy or infection, and biopsy proves more useful than aspirate. Cultures taken alone have little diagnostic yield.
In the absence of additional clues, colonoscopy, liver biopsy, and, in patients older than 55 years of age, temporal artery biopsy may be helpful. Colonoscopy or sigmoidoscopy can provide biopsy samples for histology as well as bacterial, mycobacterial, and fungal cultures and can screen for occult colon malignancy. Since symptoms of temporal arteritis can be subtle, and the erythrocyte sedimentation rate need not be elevated, blind temporal biopsy has been shown to have diagnostic utility.
*154/348/5*
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