Tidbits

 

 

APclipart

Medical news items and events come to my attention that I would like to pass along to you in a brief form. I think of them as tidbits or snippets or what we used to call in newspaper journalism, shorts.

Shorts were typically off-the-AP-wire, human-interest articles that fit 2- to 3-inch holes on a news page. In the first newsroom I worked as a full-time employee, not as a student, I wrote my own stories, laid out my own pages, wrote my own headlines, and took my own photographs. I read a lot of 2- to 3-inch “filler” copy.

My tidbits, shorts, will not be fillers, but they will have human interest, related to the various topics in my book, to my medical research, and to me, and I will deliver them as the Associated Press and United Press International once did on their wires: in reverse chronological order, with the most recent first.

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SPECIAL : A NEW LITERARY VENTURE: WHAT I DID THIS SUMMER

9/25/17

Dear Readers:

I am pleased to announce publication in the United States this month of a book that honors the life, and preserves the voice, of a quiet and dutiful young woman who was murdered by the Nazis at the Auschwitz-Birkenau extermination camp: “JOHANNA HAMMEL: The Journey of a Jewish Woman from Konstanz via Gurs to Auschwitz-Birkenau, 1898-1942.”

Originally written by author Hans-Hermann Seiffert in German, “Johanna Hammel” movingly tells the story of its heroine’s forced deportation from her home in Konstanz, Germany; her imprisonment in southwestern France, where the French Vichy regime and its gendarmes assisted Hitler with his Jewish “cleansing” of Germany; and her eventual transport to Auschwitz through her own postcards and letters to her family, writings by her sister, friends and other witnesses, and archival documents.

I created the imprint, Improbable Memoirs, in order to publish this compelling book in our country, where, shockingly, some of our citizenry, who are fortunate to be governed by a Constitution that has no rival in the world for protecting individual freedoms,  openly espouse violent anti-Semitic and other Nazi views. (www.improbablememoirs.com)

Seiffert, who is not Jewish, is a member of “Stolpersteine for Konstanz—Against Intolerance and Forgetting Initiative,” which has been active since 2005. A Stolperstein is a brass-plated cobblestone memorial to a victim of Nazi Germany. “Johanna Hammel” is Seiffert’s fourth book Stolperstein—or, if you will, Stolperschrift, which is a written dedication—and the second one translated into English. Retired from a long management career, Seiffert, now 77, receives no monies for his writings. His work is its own reward.

Uta Allers of Baltimore translated the German edition of “Johanna Hammel” (pub. 2010) into English, and I edited her translation, enhancing the content so that it would be more accessible to an American audience. “Johanna Hammel” (112 pp., paperback, color illustrations) is a powerful Holocaust memoir, biography and history. When Johanna writes in her last postcard to her mother, who was spared transport to Auschwitz because of her age, that “even the bad times will come to an end,” her innocent optimism evokes heartfelt grief. You come to know, admire and mourn Johanna.

My dear friend Madeleine Weiss Fagan is Johanna Hammel’s great-niece. Madeleine and I have been friends for 45 years. She lives with her family in Columbia, Md. Although I had known that Madeleine’s Romanian father survived Nazi concentration camps and her German mother lived in the safe haven of Switzerland during the war, I never knew the story of Madeleine’s maternal grandparents and great-aunt until she brought “Johanna Hammel” to me, asking about its publication in the States. Madeleine’s late mother, Renée Weiss, an elegant woman whom I admired, gave Seiffert all of the correspondence that her grandmother and mother had received from her Aunt Johanna during that terrifying time.

Please click on www.improbablememoirs.com to learn more about “Johanna Hammel.” The book is for sale online for $15.95 plus $3.00 shipping. All book sales proceeds will go to Madeleine’s 91-year-old father, André Weiss, who financed the book’s publication. I am not taking any monies.

Madeleine and I are speaking now with the U.S. Holocaust Memorial Museum in Washington, D.C., about its hosting a book signing with author Hans Seiffert on Nov. 11, 2017. He is also expected to speak during Howard County, Md.’s Jewish Day of Global Learning on Nov. 12. I will post dates/times of all book events when they are finalized.

Thank you, Ann

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CLINICAL RISK FACTORS FOR INCREASED RISK OF LOW BONE MASS AND FRACTURES (See 5/10/17 blog for accompanying story)

5/10/17: According to the National Osteoporosis Foundation, a clinician should consider the following factors in seeking to identify an increased risk of low bone mass and fracture in a patient:

Life-style related factors:

  1. Alcohol (three or more drinks per day)

2. Aluminum ingestion (antacids)

3. Excessive vitamin A intake

4. Falling

5. High caffeine intake

6. High sodium (salt) intake

7. Immobilization

8. Inadequate physical activity

9. Low calcium intake (see blog)

10. Smoking

11. Thinness (body weight of less than 127 pounds)

12. Vitamin D deficiency

Other significant factors:

13. Prior fracture without major trauma

14. Clinical risks, including: 1) age 65 and over; 2) family history of osteoporosis or fractures; and 3) early menopause

15. Secondary osteoporosis

16. Height loss or kyphosis

17. Risk factors for falling (such as impaired balance or medication use)

18. Patient’s reliability, understanding, and willingness to accept intervention

(Adapted from the NOF’s “Clinician’s Guide to Prevention and Treatment of Osteoporosis,” 2014)

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FIVE HUMAN VIRUSES ADDED TO U.S. GOVERNMENT LIST OF KNOWN CARCINOGENS

2/1/17: The U.S. Dept. of Health and Human Services (HHS) updated its list of known cancer-causing substances last November by adding five human viruses and an industrial solvent. It also characterized a metallic element as “reasonably anticipated to be a human carcinogen.”

The seven new substances bring the total number of substances on HHS’s list of known, or reasonably anticipated to be, human carcinogens to 248. (See https://ntp.niehs.nih.gov/ntp/roc/content/listed_substances_508.pdf for the full list.)

In its “14th Report on Carcinogens,” prepared by the National Toxicology Program (NTP) and released three months ago, HHS designated the following viruses as known carcinogens:

1. Human immunodeficiency virus (HIV) type 1: Spread by unprotected sex and infected needles, the virus that causes AIDS increases the risk of non-Hodgkin and Hodgkin lymphomas, Kaposi sarcoma, and genital cancers.

2. Human T-cell lymphotropic virus type 1 (HTLV-1): A rare virus spread through unprotected sex, infected needles or syringes, and organ transplants, HTLV-1 can increase the risk of a rare blood cancer that infects specific white blood cells called CD4.

3. Epstein-Barr virus (EBV): Known for causing mononucleosis and transmitted primarily through saliva, EBV increases the risk of certain lymphomas and nasopharyngeal and stomach cancers.

4. Kaposi sarcoma-associated herpesvirus (KSHV): Often transmitted through saliva and also spread through sexual contact, blood, and organ transplants, KSHV has been linked to Kaposi sarcoma, a blood-vessel cancer, and two rare lymphomas.

5. Merkel cell polyomavirus (MCV): A common virus that lives on the skin, MCV can lead to the uncommon skin cancer, Merkel cell carcinoma.

Three other human viruses are already on the list of known carcinogens: hepatitis B, which causes chronic liver infections that increase the risk of liver cancer; hepatitis C, which, like hepatitis B, can cause liver inflammation leading to liver cancer; and human papillomaviruses (HPVs), which are spread through unprotected sexual activity and can increase the risk of cervical, vaginal, vulvar, penile, anal, mouth, and throat cancers.

The “Report on Carcinogens,” known as the RoC and created by Congress in 1978, identifies as known or likely carcinogens different types of environmental factors, such as chemicals; physical agents, such as X-rays and ultraviolet radiation; infectious agents, such as viruses; mixtures of chemicals; and exposure scenarios.

The new industrial solvent added to the list is the chemical trichloroethylene. It is used primarily to make hydrofluorocarbon chemicals and has been linked to an increased risk of kidney cancer.

Cobalt and cobalt compounds that release cobalt ions into the body are the new metallic element added to the list of substances that the NTP views as reasonably anticipated to be a human carcinogen. The cobalt listing does not include vitamin B-12, however, because cobalt in this nutrient/popular supplement does not release ions.

The first RoC was published in 1980. For a list of the substances that the NTP has reviewed, see https://ntp.niehs.nih.gov/pubhealth/roc/listings/index.html#C.

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“OUR PARENTS IN CRISIS” RECEIVES PINNACLE BOOK AWARD

12/23/16: It’s nice to end the year on a high note. “Our Parents in Crisis: Confronting Medical Errors, Ageist Doctors, and Other Healthcare Failings” has received a 2016 Pinnacle Book Achievement Award in the category of health from the National Assn. of Book Entrepreneurs.

I wish all of my readers and potential readers a peaceful, healthy, and crisis-free holiday season and a promising start to the new year.

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“OUR PARENTS IN CRISIS” WINS BEST BOOK AWARD OF 2016

11/20/16: I’m happy to report that my latest book, “Our Parents in Crisis: Confronting Medical Errors, Ageist Doctors, and Other Healthcare Failings,” has received a Best Book Award 2016 from USA Book News, winning in the Health: Aging/50+ category of its 13th annual contest. To learn more about the book contest and USA Book News, see http://www.bestbookawards.com/2016awardpressrelease.html and USABookNews.com.

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EMERGING INFECTIOUS DISEASES

11/18/16: I took away many fascinating tidbits from a talk last night by Dr. Anthony S. Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases, at the Smithsonian in Washington, among them:

Seventy-five percent of emerging pathogens are ZOONOTIC, meaning they originated in animals and “jumped species,” as Fauci said, to human beings. The one you undoubtedly know is HIV/AIDS, a virus that infected chimpanzees first. Others mentioned by Fauci included Ebola, Chikungunya, and Middle East Respiratory Syndrome (MERS), which is in the same family of viruses as SARS (Severe Acute Respiratory Syndrome). In each case, the VECTOR that transmitted the disease from an animal HOST to a human host was an infected mosquito.

Since 1981, when the human immunodeficiency virus (HIV) was discovered, 80 million people have been infected with it. Today, 36.7 million live with HIV. According to Fauci, the anti-viral drugs used to treat patients with HIV can extend their lives 50 years.

Among the 56 million deaths that occur worldwide each year, the celebrated NIH immunologist said, 15 percent are attributable to infectious diseases, or about 8.4 million.

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GENETIC TESTING FOR HEREDITARY CANCER (FOCUS ON BRCA GENES)

11/16/16: Genetic testing exists for more than 10,000 medical conditions, according to Georgetown University Professor Beth N. Peshkin, a genetic counselor who specializes in the 16 hereditary cancer/neoplastic syndromes that have been identified.

The best known among these syndromes, thanks to actress Angelina Jolie’s disclosure of her cancer risk and the preventive surgery she underwent, is hereditary breast and ovarian cancer (HBOC), which is primarily associated with mutations in the BRCA1 and BRCA2 genes.

(For more information about the 10,000+ conditions, see the website of the NIH Genetic Testing Registry: https://www.ncbi.nlm.nih.gov/gtr/. According to the site, 48,864 genetic tests now exist, involving 4241 genes.)

All of us, both men and women, have the BRCA1 and BRCA2 genes, which are on chromosome 17. They are among the 20,000 genes that we receive from our parents, one copy of each gene from each parent. The BRCA1 and BRCA2 genes, Professor Peshkin told my Georgetown Mini-Medical School class last night, are involved with cell growth, cell division, and cell repair. Normal BRCA genes work as tumor suppressors, helping to shut down cancer cells before they can cause harm.

It is only when a MUTATION of one of these genes occurs that the risk of HBOC and, to a lesser extent, other cancers, including prostate and pancreatic cancer and melanoma, increases. Contrary to popular understanding, it is the mutation, not the gene, which poses the risk of cancer. Eight hundred cancer-risk mutations have been identified in each BRCA gene, Peshkin said, and only one copy of the mutation is needed to create the risk. The mutation can be inherited from either parent, Mom or Dad, who may only be carriers and never have one of the hereditary cancers it causes.

Angelina Jolie’s 56-year-old mother died from ovarian cancer, as did a number of other members in her mother’s family. Jolie’s ancestry, thus, strongly suggested genetic testing. After learning that she tested positive for a BRCA1 mutation, the actress elected to have both of her breasts and her ovaries surgically removed as a prophylactic measure.

Jolie was 39 when she had a double mastectomy in 2013 and wrote about her decision in a Time magazine article covered as “The Angelina Effect.” After her double mastectomy, Peshkin said, genetic counselors like herself saw a two-fold increase in appointments. The awareness Jolie raised was inspiring and productive—life-saving for many who have a BRCA mutation.

I will return to the subject of hereditary cancer in a future blog. Peshkin also discussed two other inherited cancer syndromes that interest me: 1) Lynch syndrome (colon, endometrial, ovarian, gastric, pancreatic, and other cancers), associated with mutations of the MLH1 and MSH2 genes; and 2) Li-Fraumeni syndrome (breast and adrenocortical cancer, sarcoma, and multiple primary tumors), associated with the TP53 gene. Please check back later.

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CALCIUM SUPPLEMENTS MAY DAMAGE ARTERIES, HEART

10/19/16: Taking calcium supplements may raise the risk of plaque buildup in your arteries and damage to your heart, according to a report by researchers from Johns Hopkins Medicine and other academic institutions nationwide, published this month online in the “Journal of the American Heart Assn.” The research team also concluded that a diet high in calcium-rich foods may be beneficial for your heart. See http://jaha.ahajournals.org/content/5/10/e003815.full.

The JAHA report adds to growing medical concerns about the potential harms of calcium supplements. An estimated 43 percent of U.S. adult men and women take a supplement that contains calcium, according to the National Institutes of Health.

“When it comes to using vitamin and mineral supplements, particularly calcium supplements being taken for bone health, many Americans think that more is always better,” said lead researcher Erin Michos, M.D., M.H.S., of the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University School of Medicine.

“But our study adds to the body of evidence that excess calcium in the form of supplements may harm the heart and vascular system.”

The researchers analyzed data obtained from a federally funded 10-year national study of atherosclerosis among a large ethnically diverse population. They were motivated to look at the effects of calcium on the heart and vascular system because previous studies have shown that “ingested calcium supplements—particularly in older people—don’t make it to the skeleton or get completely excreted in urine, so they must be accumulating in the body’s soft tissues,” said John Anderson, Ph.D., professor emeritus of nutrition at the University of North Carolina at Chapel Hill and a co-author of the JAHA report.

“There is clearly something different in how the body uses and responds to supplements versus intake through diet that makes it riskier,” Anderson said.

Drs. Michos, Anderson, et al caution that their analysis only documents an association between calcium supplements and atherosclerosis and does not prove cause and effect.

ON A PERSONAL NOTE: I have osteopenia in my hips that a bone scan this summer revealed has worsened. Osteopenia is decreased bone density, but to a lesser extent/severity than osteoporosis, which my mother has in her spine. Mom has had a number of compression fractures of her vertebrae.

My gynecologist discussed bisphosphonates, such as Boniva® and Fosamax®, with me (no, thanks), prescribed a mega-dose of vitamin D2 every week, and recommended Life Extension Bone Restore with Vitamin K2. No calcium. I’ve been doing weight-bearing exercise regularly for 35 years.

According to Dr. Michos, more than half of all women over 60 take calcium supplements because they believe it will reduce their risk of osteoporosis. If you’re in that age group, what is your doctor telling you?

(Please link to my Facebook page for an update to my personal note: http://www.facebook.com/anngsjoerdsmaauthor/.)

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BEYOND THE COLONOSCOPY: SCREENING OPTIONS FOR COLORECTAL CANCER

9/16/16: The October 2016 issue of “Health After 50,” a newsletter published by Scientific American, contains a helpful article about colorectal-cancer screening that highlights the noninvasive tests available for those people who prefer not to have a colonoscopy. Although the colonoscopy is the gold standard for such cancer screening, the U.S. Preventive Services Task Force has endorsed several noninvasive options in order to encourage more people to be tested. To access the “Health After 50” article, click on: https://www.healthafter50.com/cancer/article/new-colorectal-screening-options

The USPSTF recommends colorectal-cancer screening for all people ages 50 to 75 who are at average risk and have no symptoms, according to “Health After 50.” Among the alternative tests described in its article is the computed tomography (CT) colonography, also known as a virtual colonoscopy, which entails inserting a small tube into a patient’s colon in order to infuse gas to distend the colon before the patient moves through a CT scanner. Like the colonoscopy, bowel prep is necessary for the virtual colonoscopy, but unlike the colonoscopy, the patient doesn’t have to be sedated, nor is a tube with a camera inserted through his/her anus and rectum to access the colon. The patient also is exposed to radiation. The USPSTF recommends that the virtual colonoscopy be given every five years, and the colonoscopy every 10 years.

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LECTURE SERIES TAKES NIH’S PULSE ON HOT TOPICS IN BIOMEDICAL RESEARCH

8/24/16: I’m excited. I’ve just enrolled in what promises to be a dynamite series of lectures sponsored by the Smithsonian Associates in collaboration with the National Institutes of Health. The five-session series, “The Pulse on Modern Medicine: Insights from NIH Experts,” will start Tues., Sept. 6, with a lecture by Dr. Eric Green, Director of the National Human Genome Research Institute. All lectures will be held at the copper-domed S. Dillon Ripley Center, located between the distinctive Smithsonian castle and the Freer Gallery of Art on the National Mall in Washington, D.C.

You need not be a scientist to take advantage of the star lineup of NIH pulse-takers. According to the Smithsonian Associates, each session will begin at 6:45 p.m. with “a 101-level introduction that offers fundamental information as background for the evening’s topic.” Refreshments will be served next, and the featured expert will speak from 7:45 p.m. to 8:45 p.m. In addition to Dr. Green, the speakers include:

Thurs., Oct. 13: Dr. William Gahl, Clinical Director, National Human Genome Research Institute, and Director, NIH Undiagnosed Diseases Program

Thurs., Nov. 17: Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases (The eminent Dr. Fauci has been much in the news lately discussing the Zika virus; last year, he was our national medical expert on Ebola. I can’t rave enough about Dr. Fauci, with whom I’ve had the pleasure of communicating.)

Thurs., Dec. 8: Dr. Julie Segre, Head, Microbial Genomics Section, and Chief, Translational and Functional Genomics Branch, National Human Genome research Institute

Tues., Jan. 24, 2017: Dr. Gary Gibbons, Director, National Heart, Lung, and Blood Institute

Among the hot topics to be discussed are precision medicine, personal health data, genomics, cancer, emerging infectious diseases, and undiagnosed and rare diseases.

Precision medicine is an approach to disease treatment and prevention that seeks to maximize effectiveness by taking into account individual patient variability in genes, environment, and lifestyle. It seems to be the future of medicine, and I am eager to learn more about it, as well as genomics.

You may purchase tickets for individual lectures or for the five-lecture series. The per-lecture cost is $30 for Smithsonian Associates members, $45 for non-members; the package price is $130 for members, $200 for non-members. For more info and tickets, see https://smithsonianassociates.org.

The Ripley Center, which houses the Smithsonian Associates, is located at 1100 Jefferson Drive, S.W. The closest metro stop is the Smithsonian (naturally); exit to the Mall.

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ATHEROSCLEROSIS IN OTHER ARTERIES

7/19/16: (This item continues an excerpt about atherosclerosis from my book, “Our Parents in Crisis: Confronting Medical Errors, Ageist Doctors, and Other Healthcare Failings,” that I started today on my Facebook page at www.facebook.com/anngsjoerdsmaauthor/. An autographed copy of the book is available in a Facebook special from the publisher for just $20, with free shipping, until July 22, 2016, at http://improbablebooks.com/purchasesfb.html.)

The Renal and Peripheral Arteries

The development and accumulation of fatty plaques in the renal arteries can reduce blood flow to the kidneys, increasing blood pressure and injuring tissue. Renal atherosclerosis can lead to progressive kidney dysfunction and failure.

Renal artery stenosis (RAS) is the narrowing of one or both of the arteries. Just like with CAD [coronary artery disease], RAS can be treated with lifestyle changes and medications. If this therapy proves insufficient, surgery may be done.

An atherosclerotic blockage in major arteries in the legs, arms, and/or pelvis leads to peripheral artery disease (PAD), aka peripheral vascular disease, a disorder suffered by about 30 percent of older Americans. PAD, which is characterized by severe pain, skin ulcerations, lameness (claudication), and numbness in the extremities, elevates the risk of blood clots. (Note that DVT [deep-vein thrombosis] describes a clotting problem in the veins, not the arteries.)

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The Carotid and Cerebral Arteries

Atherosclerosis also may affect the two big carotid arteries that carry blood to the brain, as well as arteries within the brain itself. If plaque-thickened walls obstruct cerebral arterial blood flow, an ischemic stroke may occur. The rupture of an aneurysm, or a ballooning out, of a cerebral arterial wall, causes a hemorrhagic (bleeding) stroke.

Roughly 83 percent of all strokes are ischemic; and 17 percent are hemorrhagic. According to Victor C. Urrutia, an assistant professor of neurology and director of the Johns Hopkins Hospital Stroke Center, 20 percent of ischemic strokes are caused by atherosclerotic cerebrovascular disease and 20 percent are caused by blood clots. (6)

Classic stroke symptoms include slurred speech, paralysis or numbness on one side of the face or body, blurred vision, mental confusion, a severe out-of-the-blue headache (the worst of your life, says Dr. Urrutia), dizziness, and a loss of balance. Within four minutes of being deprived of oxygen and nutrients, brain cells begin to die. (5)

The effects of a stroke vary from person to person and depend on its type, severity, and location. A stroke may impair a person’s movement and sensation, speech and language, vision, cognition (reasoning, memory), perception, emotional control, bowel and bladder control, and other vital body functions.

A transient ischemic attack(TIA), or so-called mini-stroke, produces symptoms similar to a stroke, but usually only lasts a few minutes and causes no permanent damage. A TIA may be a warning of an impending stroke, however, and should not be ignored.

According to Urrutia and Georgetown neurologist and stroke expert, Dr. Alexander W. Dromerick, giving tPA intravenously to a stroke sufferer within four and a half hours of the onset of symptoms substantially reduces the likelihood of his or her long-term disability or death. But note: The attending physician has to be certain from a brain scan that the patient’s stroke is ischemic, and not hemorrhagic, because tPA will aggravate cerebral bleeding. To be confident of access to, and the proper use of tPA, your Mom or Pop should go to a university-affiliated or other known stroke center. (7)

Stroke is the third leading cause of death in the United States.

Don’t second-guess stroke symptoms. Call 911 immediately.

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1.“Causes of Atherosclerosis,” Mayo Clinic at http://www.mayoclinic.com/health/arteriosclerosis-atherosclerosis/DS00525/DSECTION=causes.

2. “The Physiology and Pathology of Aging,” by David A. Sandmire, M.D., in Gerontology for the Health Care Professional, ed. Regula H. Robnett and Walter C. Chop (Sudbury, Mass.: Jones and Bartlett Publishers, 2nd ed., 2010), p. 83.

3. David L. Pearle, M.D., lecture on “Cardiology,” Georgetown University Mini-Medical School, March 20, 2012.

4. “What is Coronary Microvascular Disease?,” National Heart Lung and Blood Institute, at http/www.nhlbi.nih.gov/health/health-topics/topics/cmd.

5. Dr. Alexander W. Dromerick, “Under Pressure: Understanding How High Blood Pressure Affects Your Health,” presented by the Georgetown Center for Hypertension, Kidney & Vascular Research at the Georgetown University Medical Center, March 31, 2012.

6. Dr. Victor C. Urrutia, “Stroke Essentials,” presented in Johns Hopkins Medicine’s “A Woman’s Journey” conference, Baltimore, Md., Nov. 17, 2012. Of the remaining 60 percent, Dr. Urrutia says 30 percent of strokes are cryptogenic, meaning their cause is not known, and 25 percent are lacunar, meaning another defect is responsible. He has a 5-percent margin of error.

7. Ibid, and endnote 5, supra.

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ABOUT THOSE HPV VACCINE ADS: GUILT, GUILT, “MOM/DAD, DID YOU KNOW???”

7/4/16: I don’t usually comment on healthcare issues more relevant to adolescents and 20-somethings than to the over-50 crowd, but I can’t resist saying something about the “Mom/Dad, did you know?” human papillomavirus (HPV) vaccine commercials that are currently making the rounds on TV. The in-your-face message of guilt delivered by sweet-faced young adults (actors) who claim to have HPV cancers that could have been prevented compels a response.

But, before I comment, let me ask you: Do you think “guilting” parents works? Will parents, upon being implicitly blamed in these TV ads for their children developing cervical, throat, and other sexually transmitted HPV-caused cancers years later in adulthood, put pressure on reluctant pediatricians and other primary care physicians to administer the vaccine? Does guilt work better than a concerned public infomercial?

Despite the proven effectiveness of the HPV vaccine, which was introduced more than a decade ago, studies show  that the immunization rates are low: about 40 percent of girls and 20 percent of boys between the ages of 13 and 17. Studies also suggest that physicians, not parents, are largely responsible for the disappointing rates. Either the docs do not recommend the vaccine to parents and their young patients or they do so halfheartedly. See “HPV Sharply Reduced in Teenage Girls Following Vaccine, Study Says,” The New York Times, Feb. 22, 2016, at http://www.nytimes.com/2016/02/22/health/vaccine-has-sharply-reduced-hpv-in-teenage-girls-study-says.html.

Because the cancer-causing “high-risk” HPV types targeted by the vaccine are only transmitted sexually, physicians also must have a conversation that many prefer not to have. Too bad, I say. Be a professional, Dr. Avoidance. The subject is cancer prevention, not adolescent sexual activity.

The U.S. Centers for Disease Control and Prevention recommends routine vaccination for girls and boys ages 11 to 12 and vaccination for women ages 13 through 26 and men ages 13 through 21 who have not already been vaccinated. It advises men ages 22 through 26 to discuss vaccination with their physicians and decide what is best for them.

Rather than guilting parents, how about guilting doctors, who should know the facts about HPV, cancer, and the vaccine’s efficacy, and are duty-bound to discuss them with patients who need to know?

Actually, what interested me more about the TV commercial was not the guilt it hyped, but the bully behind the guilt. I searched in vain for a sponsor credit on the ad itself. Surely, the CDC wouldn’t use such a tactic. Would the National Cancer Institute or another government agency? It hardly seemed likely. A well-meaning non-profit, perhaps?

No. I was being naïve. The creator is Merck, the giant pharmaceutical company that manufactured the first HPV vaccine, Gardasil, which like the subsequent two (Gardasil-9 and Cervarix), is not a live-virus vaccine. It contains HPV proteins that help the body’s immune system produce antibodies against high-risk HPV types that can cause cancer, without causing an infection. (See http://www.hpv.com and http://www.gardasil.com/about-gardasil/faqs-about-gardasil/ for details.)

According to the National Cancer Institute, high-risk HPVs cause cervical cancer; anal cancer, which killed actress Farah Fawcett; oropharyngeal cancers (of the middle part of the throat, including the soft palate, the base of the tongue, and the tonsils), presumably one of which actor Michael Douglas had; and vaginal, vulvar, and penile cancers. In the United States, high-risk HPV types cause about 3 percent of all cancer cases among women, and 2 percent of all cancer cases among men.

Most high-risk HPV infections occur without symptoms, go away within one to two years, and do not cause cancer, the NCI says. To learn more about human papillomaviruses, the HPV vaccine, and HPV cancers, see:

“HPV and Cancer,” National Cancer Institute, at http://www.cancer.gov/about-cancer-causes-prevention/risk-infectious-agents/hpv-fact-sheet

“HPV Vaccine for Preteens and Teens,” Centers for Disease Control and Prevention,” at http://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html.

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COMPUTER-TECH PIONEERS CREATED EQUALITY IN OBLIVION

6/11/16: I came across a great quote in the June 2016 issue of “AARP Bulletin,” which I read in order to find great quotes and other pass-along tidbits. To wit:

“When we started Apple, Steve Jobs and I talked about how we wanted to make blind people as equal and capable as sighted people, and you’d have to say we succeeded when you look at all the people walking down the sidewalk looking down at something in their hands and totally oblivious to everything around them!” —STEVE WOZNIAK

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OBESITY IS A GLOBAL HEALTH THREAT

5/12/16: In a recent talk about global health, Dr.Bernhard Liese, professor and chairman of the Georgetown University Dept. of International Health, said that, worldwide, 39 percent of all adults 18 years old and over (more than 1.9 billion people) are overweight, and 13 percent of all such adults are obese.

Dr. Liese cited 2014 figures from the World Health Organization, which defines “overweight” as a body mass index (BMI) greater than or equal to 25, and “obese” as a BMI greater than or equal to 30. BMI is defined as a person’s weight in kilograms (2.2 kg. per pound) divided by the square of his height in meters.

According to the WHO, the number of obese people globally has more than doubled since 1980. Liese attributes the increase to a lifestyle shift from the consumption of local foods to a consumption of mass-produced, processed, convenient, and inexpensive foods; an increase in saturated fats, trans-fatty acids and salt in the foods we eat; higher-fat diets generally; and physical inactivity due to increasingly sedentary work and increasing urbanization. He shared some fast-food “factoids” about a chief supplier of mass-produced, processed, convenient, and inexpensive foods–McDonald’s–which has restaurants worldwide.

McDonald’s, Liese said:

–Opens five new restaurants every day

–Spends $1 billion on advertising every year

–Is the larger purchaser of beef worldwide

–Runs more playgrounds than any other private entity.

The “free” market can exact a high price.

 

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BOOK HONORED AS FINALIST IN NATIONAL INDIE BOOK CONTEST

5/9/16: “Our Parents in Crisis: Confronting Medical Errors, Ageist Doctors, and Other Healthcare Failings” was chosen as a finalist in the medical category of the 10th annual National Indie Excellence Awards. For a list of the winners and finalists, see http://www.indieexcellence.com.

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CALCULATE YOUR 10-YEAR RISK FOR HEART DISEASE

4/30/16: In a cardiology lecture that I attended April 26th, the professor emphasized a person’s 10-year risk of heart disease and its calculation. Dr. David Pearle of the Georgetown medical school said that he does a risk assessment for every patient he sees during an initial visit.

No doubt you are familiar with many of the cardiovascular (CV)-disease risk factors, both those that are non-modifiable (family history/genetics, sex, age) and those that you can modify by altering your lifestyle and/or habits. The latter include hypertension (systole, the period of heart contraction, is the important measurement); tobacco abuse; dyslipidemia (elevation of plasma cholesterol and triglycerides); diabetes mellitus (type 2)/insulin resistance; obesity; and physical inactivity. Pearle listed two other modifiable risks that are controversial and not uniformly accepted or interpreted by cardiologists: personality type and extreme stress.

Next to quitting smoking, exercise is the single most beneficial action you can take for your heart and overall health. It is the only “magic pill” we have.

It definitely helps to be female and to have favorable ethnicity. A higher percentage of African Americans develop high blood pressure than do Caucasians of Northern European ancestry, for example. Women develop cardiovascular disease as often as men do, but they generally develop it later in live, “gaining 10 years” of protection during their childbearing years, according to Dr. Pearle.

In 2013, the American College of Cardiology/American Heart Assn. published the risk calculation guidelines now in vogue. If you know your systolic blood pressure (the top number) and your total cholesterol and HDL levels, you can determine your 10-year risk by plugging them into the ACC/AHA calculator at:

http://tools.acc.org/ASCVD-Risk-Estimator/

You might compare the percentage you get with the Mayo Clinic’s more detailed CV risk calculation, which incorporates diet and level of physical activity, at:

http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-risk/itt-20084942.

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WANTED: PHYSICIANS WHO ARE SANE, DON’T WANT TO WORK HARD, AND ARE AFRAID OF THE LIGHT

4/21/16: In a Facebook post I published today, I shared some tidbits from a recent lecture by Dr. Jonathan E. Davis, professor and chairman of the Georgetown University Emergency Medicine Dept., about emergency medicine. His talk was part of the spring semester of Georgetown’s Mini-Medical School for the public.

Among the amusing graphics that Dr. Davis showed the class was one from a 2005 issue of The British Medical Journal purporting to show the personality characteristics of physicians according to various medical specialties. What kind of medical student, Davis posited, becomes an emergency medicine physician? One who is crazy and has a non-existent attention span, the BMJ’s“Physician, know thyself” chart shows, and Davis agreed. EM docs thrive on fast-changing action. Crazy medical students with “significant” attention spans become psychiatrists.

I looked up the source of this chart in the BMJ and discovered it was created by Dr. Boris Veysman, who was then a resident at Yale University School of Medicine. Veysman represented it as an algorithm to help graduating medical students decide which specialty to pursue. The student starts by deciding if he or she is crazy or sane and goes from there. Those who are sane, hard-working, and mean become . . . you guessed it, surgeons. Those who are sane, light-averse slackers are radiologists, of course.

Here’s Veysman’s full chart with explanation: http://www.bmj.com/content/331/7531/1529

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OPIOD ANALGESICS FOR CHRONIC PAIN

4/7/16: Here’s a link to an excellent review article in the March 31, 2016 New England Journal of Medicine about opioid diversion, into street uses, and opiod abuse, hot topics of late: http://www.nejm.org/doi/full/10.1056/NEJMra1507771. The authors are Nora D. Volkow, M.D., and A. Thomas McLellan, Ph.D. of the National Institute on Drug Abuse.

As one who effectively manages chronic back and leg pain with exercise, body and behavior awareness (too much sitting and long-distance driving are bad news), heat therapy, and occasional ibuprofen tablets, I refer you in particular to the authors’ table 5, which lists alternative treatments for pain.

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BOOK FOR SALE IN ELIZABETH CITY, NC

4/7/16: “Our Parents in Crisis: Confronting Medical Errors, Ageist Doctors, and Other Healthcare Failings” is now available for purchase at Page After Page Bookstore, 111 S. Water St., in Elizabeth City, NC; phone, (252) 335-7243. I will be doing a book event at Page After Page, which is across from the downtown waterfront, on Sat., May 14. Details will be posted here soon.

“Our Parents in Crisis” is rich with medical information about normal aging and alerts about healthcare pitfalls that will benefit readers of all generations. I promote it as “The truth about aging–not what you’ve been led to believe–and the facts about healthcare.” Protect your parents, protect yourself. And support your local independent bookstore, if you live in or near Elizabeth City. Thank you!

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FACEBOOK POSTS

4/2/16: Since I’ve become active on social media, I’ve learned that visitors to my sites prefer to get their medical news on my Facebook page, rather than my website, and most will not click a link on Facebook to my website to learn more about a topic. For that reason, I’ve started posting what I consider to be tidbits to my Facebook page. Recently, I addressed cancer immunotherapy and the incidence of “MRSA,” methicillin-resistant Staphylococcus aureus, in a South Florida hospital. I followed up my MRSA post with comments about why pharmaceutical companies do not develop new antibiotics. I also discussed a study pertaining to testosterone in older men. To transport to Facebook, click: http://www.facebook.com/anngsjoerdsmaauthor/.

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SEPSIS: THE BODY’S LIFE-THREATENING RESPONSE TO INFECTION

3/21/16: In the span of 20 minutes last Thursday afternoon, I heard two people in different states use the dreaded word sepsis in a conversation: In the first instance, my cousin in Florida informed me that my critically ill uncle had been diagnosed by hospital ER doctors with sepsis, and in the second, a friend told me that an acquaintance had died the previous night after going into septic shock and suffering cardiac arrest in our local hospital’s emergency dept. I was gravely concerned about my uncle’s status and stunned by the death of a 63-year-old woman who, as best as I could determine, minimized symptoms of a kidney infection until it was too late.

Sepsis, according to the online U.S. Centers for Disease Control and Prevention, is “the body’s overwhelming and life-threatening response to infection,” which it furthers describes as a “complication” of infection. Also called septicemia, sepsis does not arise on its own. It occurs “when chemicals released into the blood stream to fight infection trigger inflammatory responses,” says the CDC. These responses, in turn, can trigger a “cascade of changes [blood clots, leaky vessels, low blood pressure] that can damage multiple organ systems, causing them to fail.” It is the body’s own immune system that causes this serious medical condition.

The source of my uncle’s sepsis is Clostridium difficile colitis, a bacterial infection in the gut that causes nasty bouts of diarrhea and a host of other symptoms (nausea, abdominal pain, fever, inflammation of the colon, etc.), depending on its severity. I extensively researched C.-diff when my father suffered an infection in a nursing home, and I consulted my own book last week to refresh my memory! These bacteria are in hospitals, nursing homes, the community, everywhere—including the human gastrointestinal tract. I will write soon about C.-diff in a blog post, but back to sepsis . . .

The way to treat sepsis, according to the National Institute of General Medical Sciences (NIGMS) at the NIH, is to try to “quell the infection, sustain the vital organs and prevent a drop in blood pressure.” “Quelling” is typically accomplished with broad-spectrum antibiotics that kill many types of bacteria until lab tests identify the specific infectious agent, such as C.-diff, and targeted antibiotics are administered.

Many physicians, says the online Mayo Clinic, “view sepsis as a three-stage syndrome”: sepsis, severe sepsis, and septic shock, each of which is recognizable by its symptoms. (See citation below.) Sepsis occurs “most often” in hospitalized patients whose immune systems are already compromised and who are exposed to an environment with infectious microbes. Patients in the intensive care unit are “especially vulnerable to developing infections” that can lead to sepsis, according to Mayo. Most common among them are pneumonia and abdominal, kidney, and bloodstream infections.

The earlier sepsis is treated–meaning the underlying infection is treated and cured–the better the prognosis. According to the NIGMS, more than a million people in the USA develop severe sepsis each year, of whom an estimated 28 to 50 percent die.

As of this writing, my beloved uncle, a cancer patient who recently underwent chemotherapy, is hanging on. Before this hospitalization, I had made plans to fly to Florida on Wednesday to visit him. I am optimistic that we will be talking soon.

For useful basic information about sepsis from the experts, I recommend:

The National Institute of General Medical Sciences’ sepsis fact sheet athttps://www.nigms.nih.gov/Education/Pages/factsheet_sepsis.aspx.

The U.S. Centers for Disease Control and Prevention, sepsis campaign, athttp://www.cdc.gov/sepsis/index.html.

The Mayo Clinic, “Sepsis,” athttp://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/dxc-20169787.

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FOCAL DYSTONIA: EMERSON NOT A ‘LUCKY MAN’

3/14/16: The late Keith Emerson of Emerson, Lake & Palmer is reported to have suffered from focal-hand dystonia, also known as musician’s dystonia or musician’s cramp, a neurological disorder that would have caused involuntary, uncontrollable muscle spasms in his hand(s), and possibly involuntary abnormal hand postures such as his fingers curling into his palms, whenever he played the keyboard. Emerson, 71, shot himself to death on March 10.

One to 2 percent of all professional musicians are estimated to have focal, task-specific dystonia. Pianists tend to develop symptoms in their fingers and hands, whereas brass and woodwind musicians experience involuntary contractions in the muscles of their faces and lips (called embouchure dystonia). When these body parts are at rest, the spasms, contractions, and contortions cease. They are associated with repetitive activity. Besides musicians, writers are susceptible to focal dystonia because of the stress placed on their hands when they hand-write or type. Writer’s cramp is for real. (I experience nerve tingling in my hands and arms and can only work at my computer for so long.)

To learn more about this disabling affliction, see:

“Dystonias Fact Sheet,” by the NIH’s National Institute of Neurological Disorders and Stroke at  http://www.ninds.nih.gov/disorders/dystonias/detail_dystonias.htm.

A summary by the United Kingdom’s Dystonia Society at http://www.dystonia.org.uk/index.php/about-dystonia/types-of-dystonia/focal-hand-dystonia/musicians-dystonia-musicians-cramp.

An overview by the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/dystonia/symptoms-causes/dxc-20163695.

I mourn every suicide, and while I do not know the personal hell that Keith Emerson was living, I do believe that, with insightful and compassionate help, most people can find their way out. I have hope.

**

[Sorry about the line spacing below. WordPress resists my editing! AS]

‘MUST READ,’ SAYS SMALL PRESS BOOKWATCH

3/11/16:  THIS BOOK REVIEW JUST IN:“’Our Parents in Crisis: Confronting Medical Errors, Ageist Doctors and Other Healthcare Failings’ is far more than a personal testimony; it is a wake-up call and a ‘must-read.’ The practical-minded advice for dealing with obstructive doctors and health care bureaucrats just might help you advocate for and protect your loved ones in their hour of greatest need. Highly recommended!”–“Small Press Bookwatch,” Midwest Book Review, March 2016, on The Health/Medicine Shelf.
The Midwest Book Review is based in Oregon, Wisconsin, and edited by James A. Cox.
**
AMYOTROPHIC LATERAL SCLEROSIS
3/4/16: The Johns Hopkins School of Medicine targets amyotrophic lateral sclerosis (ALS), the degenerative neurological disorder that most people know as Lou Gehrig’s disease, in its winter 2016 Hopkins Medicine journal (http://www.hopkinsmedicinemagazine.org). Johns Hopkins neurologists are cautiously optimistic that treatment advances for this incurable disease, which is known to be caused by a genetic mutation that erodes motor neurons in the brain, are on “the research horizon.”
As part of its initiative to further ALS research and develop therapies, including a possible cure, Johns Hopkins has launched a project known as Answer ALS, which will “build a gigantic new information repository with highly detailed data and images from 1,000 [ALS] patients at five top clinics around the country.” Dr. Jeffrey Rothstein, founder and director of Johns Hopkins’s ALS Clinic and Robert Packard Center for ALS Research, says Answer ALS may be “the most comprehensive project ever undertaken in any type of neurologic disease.” (See http://www.answerals.org.)

According to Hopkins Medicine, ALS typically affects people in their late 50s and early 60s. Sixty percent of all ALS sufferers are men; 90 percent are white. The prognosis is a devastating one, as patients experience progressive neuromuscular decline, with leg and arm muscles growing weaker to the point of total failure, and muscles needed for speech, swallowing, and breathing subsequently failing. Early in the onset of ALS, a patient may start tripping and dropping things frequently and feel extreme fatigue in his extremities. Most patients die within three to four years after onset, but 10 percent survive for 10 years, and 5 percent live 20 years.

The only FDA-approved drug for ALS is riluzole, which can extend patients’ lives by five or six months, says Hopkins Medicine. Derived from research at Johns Hopkins, riluzole is 20 years old.

A distant female cousin of mine died from ALS when she was in her late 60s. According to the ALS Association, familial or inherited ALS accounts for 5 to 10 percent of all cases; and sporadic ALS, which can affect anyone, accounts for the other 90 to 95 percent.

To my knowledge, no one else in my family has ever had ALS. If one of my loved ones now presented with ALS symptoms, I’d encourage him to schedule an appointment at Johns Hopkins as soon as possible. ALS is a diagnosis that can be difficult to make, and its symptoms vary from patient to patient. Besides progressive muscle weakness, which also affects the lower back and, thus, suggests other problems, ALS symptoms include muscle stiffness, cramping, and twitching; slurred speech, drooling, coughing fits, and uncontrollable periods of laughing or crying. The common denominator is a lack of neuromuscular control.

Dr. Rothstein estimates that the incidence of ALS in the U.S. population is one-in-500. “At some point,” he says, “almost everyone will know a family member, a friend or, at the very least, a friend of a friend who is touched directly by this disease.”

My experience bears this out. Besides my cousin, I’ve known at least two others who have died of ALS, a former newspaper colleague (male) and the husband of a former colleague. The diagnosis no longer seems that unusual.

**

GEORGETOWN MINI-MEDICAL SCHOOL  

3/3/16: Georgetown University will open its spring 2016 Mini-Medical School (MMS) with the hot, cutting-edge topic of immunotherapy of cancer. I’ve already registered for the MMS eight-week session and can’t wait to attend Lombardi Comprehensive Cancer Center Director Louis Weiner’s March 29th class. (See my 2/10/16 tidbit, below.)

I’ve attended four previous sessions of Georgetown’s superb Mini-Medical School and thus qualify either as an MMS connoisseur or groupie. I love everything about this program—the university setting, the topics taken up on eight consecutive Tuesday evenings, the engaging professors who give the lectures, the renovated lecture hall in which they teach, even the food and beverages provided before each evening class. The MMS gives advocates and students of medicine like myself hard-to-obtain access to eminent experts, starting with basic-science topics and advancing to clinical-medicine specialties. The MMS schedule is designed to suggest the progression of courses through four years of medical school. Attendees graduate and receive a certificate at its conclusion.

This semester, the course, which runs from March 29-May 17, is light on the basic sciences, typically studied by medical students in their first two years. In addition to the cancer class, the MMS will cover gastroenterology, pharmacology, emergency medicine, cardiology, sexual health, global health, and diabetes. I have previously heard lectures on gastroenterology, pharmacology, cardiology, and diabetes, and can recommend all four. My chief interests are cancer, emergency medicine, and whatever more Professor David Pearle has to say about cardiology. I am willing to drive from North Carolina and deal with D.C. traffic just for these three classes. The others are icing on the cake–which, by the way, the MMS directors cut on graduation night.

As the Georgetown MMS’s popularity has increased, so has the registration fee, which is now $130 for the public. (Previous MMS students get a discount.) The fee may seem steep, but I consider it a bargain, as well as a donation to a community outreach program that I wish other medical schools would emulate. For registration information, see: https://som.georgetown.edu/prospectivestudents/specialprograms/minimed/register.

For more details on the course schedule, see: https://georgetown.app.box.com/s/mi8b2s73zxo9nwdfddvsxcdlysukzthq.

Please check my blog for selective reports on MMS classes.

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AT THE HOSPITAL

2/17/16: My good friend Jim tore up his left knee in a fall down some stairs last November and has been a shut-in condemned to wear a thigh-to-shin brace 24/7 since his surgery.

A gifted playwright, Jim has been out of his house only seven times in the past 3½ months and only for medical appointments. Thanks to his newly retired wife Mary, a dynamo who has been both his all-purpose caregiver and his editor/reader, Jim has thrived. No cabin fever for this pampered patient.

Still, Jim has a wicked sense of humor and loves conversation, so he is delighted when I hit the road for Baltimore and share a long afternoon with Mary and him. (I adore them both.) Like a stand-up comic, he kills me with observations, anecdotes, and one-liners. (He’s watched ALL of the debates.) This story was my favorite:

Carrying an imposing walking pole, Jim gets on a hospital elevator and nods at the man in the blue lab coat already on board. Jim’s left leg is encased in a metal brace that he calls The Tingler, for the Vincent Price horror flick by the same name. At nearly 6’ 2”, and sporting a long graying ponytail and heavy moustache, Jim cuts a towering, if dubious figure.

The elevator door starts to close, and an attractive young woman rushes through it. Nearly breathless, she holds an armful of books and a large cup of coffee. Her blonde hair is wet. A student, perhaps.

The slightly gray and balding doctor greets her: “You look like you’re ready for anything this morning.”

“Yes,” the woman nervously replies. “I’m just bright and beautiful.”

Without a beat, the doc responds: “I’m low key and humble.”

“I’m crippled and angry,” says Jim, in sequence.

Pause.

Pause. Twitter.

Pause. Shifting of position.

The door opens on Jim’s floor, and he steps out.

“I’m joking,” he says to his fellow passengers. “Y’all have a great day.”

They laugh.

Many is the time when I would have enjoyed meeting someone like Jim on a hospital elevator and exchanging a pas de deux of ironic truth, just to cut my tension.

Crippled and angry? I love it. Aren’t we all?

The doctor’s response was good, too, even if untrue. The young woman, Jim says, looked embarrassed.

**

TARGETED CANCER THERAPIES

2/10/16: Lately, I’ve been doing a lot of research about targeted cancer therapies, which are drugs or other substances that interfere with molecular targets involved in the growth and progression of cancer. Targeted therapies, which have been approved by the FDA in numerous types of cancer, are the focus of much anticancer drug development today.

Unlike standard chemotherapies, which kill cancerous cells, as well as rapidly dividing normal cells, targeted therapies typically block cancer-cell proliferation. They inhibit cell growth and, as such, are cytostatic, not cytotoxic. According to the National Cancer Institute (NCI), which I use as a primary source, targeted cancer therapies “are a cornerstone of precision medicine, a form of medicine that uses information about a person’s genes and proteins to prevent, diagnose, and treat disease.”

The NCI’s lay explanation of these therapies is the best I’ve come across online. You can access it at http://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet. At the end of this fact sheet, you’ll find a link to the NCI’s list of cancer clinical trials, which includes all NCI-funded trials as well as other studies throughout the USA and the world. Clinical trials for both FDA-approved and experimental targeted cancer therapies are ongoing.

The NCI was the first-ever institute of the National Institutes of Health in Bethesda, Md., which grew out of the U.S. Public Health Service and is now an agency of the U.S. Dept. of Health and Human Services. The NIH belongs to the people. Don’t hesitate to speak with your oncologist or suggest to a friend or relative that he/she speak to their oncologist about referral to the National Cancer Institute—contact names, phone numbers, and email addresses are provided online—if you believe you or a loved one might benefit from enrollment in a particular trial.

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OSTEOPOROSIS

2/4/16: I just read an excellent clinical overview of postmenopausal osteoporosis in the Jan. 21, 2016 issue of The New England Journal of Medicine (374 NEJM 254-62). The article is not available online to non-subscribers. A few highlights:

Low bone mineral density (BMD), particularly at the hip, is a strong risk factor for fractures. BMD is assessed by dual energy X-ray absorptiometry (DEXA) scans. The T score range for normal bone mass is +1 to -1; for low bone mass, -1 to -2.5 (osteopenia); and for osteoporosis, -2.5 or lower. (A T score compares your bone density to the average bone density of young healthy women. Men experience osteoporosis, too, typically after age 70, but the NEJM article looks only at women.)

According to epidemiologists Drs. Dennis M. Black and Clifford J. Rosen, drug treatment is “recommended in postmenopausal women who have a T score of -2.5 or less, a history of spine or hip fracture, or a Fracture Risk Assessment Tool (FRAX) score indicating increased fracture risk.”

Developed by the WHO, the FRAX allows you to calculate your 10-year risk of a hip or major osteoporotic fracture. Go to http://www.shef.ac.uk/FRAX/, click on the “Calculation Tool” link at the top, and find your continent (North America), country (USA), and race (Caucasian, Black, Hispanic, or Asian).

The authors report that bisphosphonates, a class of drugs that includes Boniva® and Fosamax® and is available now in generic form, and denosumab (Prolia®, Xgeva®) reduce the risk of hip, nonvertebral, and vertebral fractures, and teriparatide (Forteo®, Parathar®) reduces the risk of nonvertebral and vertebral fractures.

Although rare, osteonecrosis (bone death) of the jaw and atypical femur fractures have been reported with all of these drugs, along with less severe adverse effects. Overall, the authors say, a highly favorable benefit-to-risk ratio is associated with treatments for up to five years in women with osteoporosis. But they advise patients to take drug “holidays” after three or five years of therapy with some of the bisphosphonates.

They also recommend doing resistance and weight-bearing exercise to increase muscle mass and transiently increase BMD and avoiding smoking, which is associated with reduced BMD, and excess alcohol intake.

As for calcium and vitamin D intake, Black and Rosen describe the efficacy of both in the prevention of osteoporotic fractures as “controversial.” Vitamin D supplementation alone has not been shown to reduce the risk of fractures or to increase BMD. Calcium alone also has not produced positive findings. The authors advise postmenopausal women with osteoporosis to take 1000 to 1500 mg of calcium and 600 to 800 IU of vitamin D daily.

**

STROKES

1/26/16:  Yesterday I ran into a former newspaper colleague whom I hadn’t seen in longer than either of us could recall. I was saddened to learn that her husband had experienced two strokes in recent years, one ischemic, the other hemorrhagic. She also told me that he’d had surgery related to the brain aneurysm.

In my new book, I pass along some basic knowledge about strokes. This tidbit does the same.

Ischemic denotes a reduction in blood flow; hemorrhagic denotes bleeding. Roughly 83 percent of all strokes are ischemic, and 17 percent are hemorrhagic. According to my book source, Dr. Victor C. Urrutia, a neurologist and director of the Johns Hopkins Hospital Comprehensive Stroke Center, 20 percent of all ischemic strokes are caused by atherosclerotic cerebrovascular disease (arterial walls thickened by plaque buildup); and 20 percent are caused by blood clots. The rupture of an aneurysm, which is a balloon (outward) or sac, of a cerebral arterial wall, causes a hemorrhagic stroke, i.e., bleeding in the brain.

The effects of a stroke vary from person to person and depend on its type, severity, and location. Classic stroke symptoms include slurred speech, paralysis or numbness on one side of the face or body, blurred vision, mental confusion, a severe out-of-the-blue headache, dizziness, and a loss of balance. Within four minutes of being deprived of oxygen and nutrients (which arterial blood transports), brain cells begin to die.

You may have heard about a drug that, when given intravenously to a stroke victim within a few hours of the onset of symptoms, reduces the likelihood of long-term disability or death. This is tissue plasminogen activator or tPA, which I like to think of as a clot-buster. It catalyzes the dissolution of blood clots. tPA should not be used after a hemorrhagic stroke because it aggravates cerebral bleeding.

The best place for a person to be after suffering a stroke is in a university-affiliated or other recognized stroke center. Don’t second-guess symptoms. Call 911.

See the National Institute of Neurological Disorders and Stroke for an expert synopsis: http://www.ninds.nih.gov/disorders/stroke/knowstroke.htm.

**

LEWY BODY DEMENTIA

1/22/16: A neurologist at Florida Atlantic University College of Medicine has developed an easy-to-administer screening questionnaire for Lewy body dementias (LBD) that may help physicians who are not familiar with LBD direct patients to an accurate diagnosis sooner. (See my blog post of 11/23/15 for background.)

According to Scientific American’s “Health After 50” February 2016 newsletter, a diagnosis of LBD, which is a progressive neurological disorder with symptoms similar to both Parkinson’s disease and Alzheimer’s disease, typically takes as long as 18 months to make. Most LBD patients never see a neurologist who specializes in the disorder and thus risk taking potentially harmful drugs that are of no benefit to them. Delay also impedes therapy that may relieve their symptoms and enrollment in appropriate clinical trials.

Dr. James E. Galvin’s Lewy Body Composite Risk Score (LBCRS)© consists of 10 yes-no questions, four of which address motor symptoms (slow or rigid movement; tremors in extremities or head) and six of which cover non-motor symptoms (illogical thinking or incoherent, random thoughts; visual hallucinations). In his or her assessment, the clinician rates the presence or absence of physical signs and also elicits information about symptoms from the patient or a caregiver. The LBCRS is scored on a continuous scale that differentiates between non-Lewy body cases and probable Lewy body cases.

Dr. Galvin, M.D., M.P.H., published his research at http://www.ncbi.nlm.nih.gov/pubmed/26405688. You may obtain a PDF of the LBCRS by googling The Lewy Body Composite Risk Score. I think it’s well worth considering if you have a loved one who’s having fluctuating cognition and movement difficulties.

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THE LANCET CLINIC

1/20/16: An alternative to the Mayo Clinic’s website for research on diseases and disorders is The Lancet Clinic website at http://www.thelancet.com/clinical/diseases?utm_source=email&utm_medium=EM2_TL.com_users&utm_campaign=TheLancetClinic. Founded in 1823 by an English surgeon, The Lancet is one of the most prestigious peer-reviewed general medical journals in the world, as well as one of the oldest. Numerous medical-specialty journals now bear The Lancet name. The Lancet Clinic website eventually will provide overviews of 135 diseases, identified by their global burden. Descriptions of 45 diseases, including hypertension and Parkinson’s disease, are currently available online. Check it out.

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LOCAL PRESS

1/17/16: I recently met Outer Banks Sentinel reporter Neel Keeler at Bonnie’s Bagels in the Southern Shores Marketplace for an interview. Bonnie’s is a favorite among locals in my Outer Banks town for coffee, lunch, and lingering. Several neighbors happened by the cafe while Neel and I were talking, including 89-year-old Jack Sheehan (in photo with me), who gave my book a once-over. Here is the story that Neel filed:

http://www.obsentinel.com/news/southern-shores-author-takes-on-health-care-industry/article_a1688bd2-b3ca-11e5-a5c2-93fb5802ff10.html

 

 

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