Monthly Archives: September 2012

Focus on Rabies

On this date in 1895, Louis Pasteur died in France. Pasteur was a French chemist who created a vaccine against rabies for people who have been exposed to the virus.

Even today, rabies kills 55,000 people each year. Almost every case of infection by the rabies virus in the world is due to dog bites, though pet dogs in the United States almost never transmit the disease. Most cases in the U.S. are traced to raccoons or bats, or foxes, skunks, or other wild animals. Only mammals get rabies, and it’s very rare in rabbits and small rodents. Animals that have become infected typically exhibit a change in behavior. Often, the animal will become more aggressive, even fearless—including in the face of humans or predators. Frothing at the mouth, the best known and most visible sign of the disease, is largely characteristic of the end stages, along with paralysis and strange sounds. Life expectancy for most animals is about a week.

The most common means of transmission is through bites—and nearly half the people bitten are under 15 years old. However, the virus that causes rabies can remain even in animals who have died of the disease. That’s why it’s important to avoid even touching dead animals if you don’t now for sure they didn’t have rabies. The disease can spread to humans if the animals blood or saliva comes in contact with an open wound or mucous membrane.

If an animal is acting strangely, report it to animal control whether it’s wild or it seems to be someone’s pet. In general, avoiding strange animals is part of protecting yourself from rabies. If you think you might have been exposed—if you’ve been bitten, or if you’ve handled a dead animal—it is urgent that you wash wounds thoroughly and seek immediate medical attention.

There is no confirmed treatment for rabies, so it is important to respond to exposure promptly. Rabies vaccine, or booster shots in people who have been previously vaccinated, must be administered right away. People who have not previously been vaccinated also receive the actual protein that is central to the immune response to rabies, directly in the wound.

An experimental treatment called the Milwaukee protocol is an alternative to vaccination, involving antiviral drugs and a medically induced coma. However, this treatment has only been successfully used in six patients since it was developed in 2004.

New Hope for Gliomas

Earlier this month, researchers at the University of Southern California announced an important discovery. The scientists found a simple way to make certain kinds of tumors much more vulnerable to radiation therapy, in turn making treatment easier and more effective.

Glioblastoma multiforme, a kind of glioma, is the most common type of brain tumor. Half of all patients diagnosed with glioma survive less than two years. GBM strikes in star-shaped cells called astrocytes, and the tumors are marked by rapid growth. It is the most invasive type of glioma, generally spreading to different parts of the brain and sometimes even to other parts of the body.

Unfortunately, when gliomas appear at multiple locations, the already low long-term survival rates plummet. In one study, patients with multisite tumors survived an average of just six months. Indeed, sometimes the prognosis is so brief that state-of-the-art treatments cannot be used because there’s simply no time. There’s some evidence that these multisite tumors are resistant to treatment; it seems that the mechanisms by which they invade multiple sites also protect the tumors from medical attack.

Treatment for glioma usually starts with surgery, to remove the major portion of the tumor. In some cases, surgery is either deemed unnecessary or regarded as too dangerous. Whether or not surgery is indicated, radiation treatments and chemotherapy are used to shrink and eliminate tumors. The drug temozolomide has been used for almost 15 years in conjunction with radiation to treat several kinds of cancer, including glioma, with some success and with fewer adverse effects than older therapies.

One thing that makes radiation therapy more effective, the UC researchers discovered, is a brief period of controlled fasting immediately before the radiation. Mice with brain tumors who were not fed up to 48 hours before therapeutic doses of radiation had more than double the survival rate of mice fed normally. Studies have not been undertaken in humans but the researchers have suggested that it may be helpful as a last-ditch effort to boost the effectiveness of treatment.

Migraines, Weight, and Behavior

There’s good news and bad news about migraines. The nearly 30 million people who suffer migraines regularly may find a silver lining in there being no link, according to a study, between the headache condition and weight gain, but children who suffer may have other problems throughout their lives.

Migraines are caused by abnormal brain activity and are typically precipitated by any of a handful of triggers. There vary from person to person, but common ones include caffeine withdrawal, disturbances in eating or sleeping, hormonal changes such as during menstruation, secondhand smoke, onions, nitrates, a compound in some aged or preserved foods called tyramine, and MSG. Other people may have additional triggers. Migraine sufferers frequently experience a visual disturbance called an aura before a full-fledged migraine comes on.

Migraines usually start in late teenage years or early adulthood, but are sometimes found in children, who may develop problems. In a study in Brazil published last week, children between five and 11 who were found to have migraine headaches also tended to exhibit behavioral problems and difficulties with proper socialization. These children were less likely than their peers to behave in ways considered age-appropriate, and tended to exhibit anxiety and depression.

A different report brings happier news. Migraines had been believed to cause weight gain in women, who make up about three-fourths of migraine sufferers. Using data from the massive Women’s Health Study, which tracks the same subjects over very long periods of time, researchers found that migraine sufferers had the same weight gain as women who were not prone to the headache.

Migraines can’t be cured, though they sometimes go away on their own. The headaches themselves may be treatable with over-the-counter painkillers, either general-use or intended specifically for migraines—those typically combine acetaminophen with aspirin and caffeine. Prescription medications called ergotamines and triptans, alone or in combination with caffeine, are effective specifically against migraines. People with frequent and chronic migraines are often prescribed beta blockers or antidepressants to reduce the frequency and severity of attacks.

Cushing Syndrome

The hormonal disorder called Cushing syndrome is any of a number of conditions in which the body is exposed to excessive amounts of the hormone cortisol. It most commonly occurs in people who are between 20 and 50 years old, especial women. The condition is a particular risk for people with type 2 diabetes and poorly controlled blood glucose.

Cortisol is a hormone that protects the body from inflammation. In addition to being produced by the body, it is often given, in the form of prednisone and other medications, to people with inflammatory illnesses. People who have an excess of cortisol—whether due to too much use of corticosteroid drugs or because the body produces too much—eventually get one of the conditions that falls under the umbrella of Cushing syndrome.

Cushing disorders often lead to obesity and neck fat, and can at the same time reduce muscle mass in the arms and legs. The skin thins and gets fragile, and muscles and bones are weak. There’s no one test for excessive cortisol, but several diagnostic procedures together will point to it, in conjunction with medical history and physical examinations. In some cases, X-rays of the pituitary glands will be taken to look for tumors, though not all cases of the condition are associated with tumors.

People with Cushing Syndrome tend to have high blood pressure, high blood glucose, irritability and fatigue. It can lead to decreased fertility and libido in men, and unwanted hair growth and menstrual irregularities in women. People with hypercortisolism tend to be unusually thirsty, and also to experience frequent urination.

Various types of Cushing syndrome are treated in different ways. Patients who are taking prednisone or other medications need to be tapered to the lowest therapeutic dose as quickly as practical. If the problem is overproduction of cortisol by the body, the cause can be addressed directly, such as a tumor that can simply be removed or treated with radiation.

In The Pink

With school in full swing, the threat of conjunctivitis, or pinkeye, is particularly strong. Although pinkeye doesn’t have a season, when kids are in close quarters they give it to each other—and to their parents.

Pinkeye refers to the pink tinge that develops on the cornea when the membrane on the inside of the eyelid—the conjunctiva—becomes inflamed, there are three kinds of pinkeye:

  • Viral conjunctivitis is very contagious, but usually clears up on its own, as well as being difficult to treat medically. It’s characterized by light sensitivity and itchy, watery eyes.
  • Bacterial conjunctivitis is transmitted by direct contact and should be treated with antibiotics, or there’s a risk of serious damage to the eye. This is the kind that causes the eyelids to be stuck shut, glued by a yellow or greenish-yellow discharge.
  • Allergic conjunctivitis is caused by dust, dander, and other irritants, and treated with allergy medication. As with the viral kind, allergic conjunctivitis is seen as watery eyes and light sensitivity.

Viral and bacterial conjunctivitis pass readily from person to person, so if someone has pinkeye, it’s important to wipe down surfaces around them when you can. One of the most effective ways to avoid catching pinkeye from someone (or, if it’s too late for that, spreading it to other people) is to wash your hands with soap and water when cooking and when you get home from somewhere. Hand sanitizer—used judiciously—can help as well.

If someone does have pinkeye, a cool compress—a washcloth wetted with cool but not cold water and wrung out—can help alleviate some of the discomfort. The washcloth shouldn’t be reused, even by the same person, without being laundered first. Teabags, particularly green tea and chamomile, can also be soothing if made slightly wet and put on the eye. If medical treatment is needed, these techniques will not replace it.

Alzheimer’s and Heart Disease

Alzheimer’s disease is not an inevitable part of aging. It is a medical condition, and medical professionals can help you take steps to prevent or manage it. There are lifestyle choices and changes that can reduce your chances of getting the condition or slow its progress if you do get it.

Alzheimer’s doesn’t strike all elderly people, but nearly all patients with the disease are over the age of 60. There’s a genetic component to Alzheimer’s risk, and most people who get it have or had at least one blood relative who also had the condition. Causes and risk factors are still being studied, but is seems to particularly strike women and long-term hypertension patients. Perhaps unsurprisingly, head trauma appears to also be related to incidence of Alzheimer’s.

Patients generally show increasingly clear signs of a gradual cognitive decline as the disease progresses. One of the best-known and most worrying symptoms is wandering; Alzheimer’s patients may, without warning, go off, possibly into danger. Wandering is generally the result of disorientation in an unfamiliar environment, or one that has become unfamiliar due to memory loss. In other instances, the person may be reliving the past, trying to carry out decades-old routines now obsolete, unwanted, or impossible.

There is currently no cure for Alzheimer’s, but some strategies can help reduce the odds of developing dementia. Keep your mind active; various studies have touted the benefits of crossword puzzles, Sudoku, and a host of other mental exercises. Physical activity and staying fit also seem to help. In particular, keeping your blood pressure under control can help lower your Alzheimer’s risk. Indeed, according to one recent study, blood pressure medication itself may help prevent Alzheimer’s.

Pharmaceuticals are not, of course, the only solution. Researchers are looking into preventing or controlling Alzheimer’s with lifestyle-based and other non-drug approaches. Quitting smoking, getting out and getting exercise, and generally heart-healthy activity all help protect you from the ravages of dementia.

Women and Heart Disease

Heart disease works in entirely different ways in women and in men. And it’s important to know what to look for, because not only is heart disease the number one killer of both women and men, it actually kills more women then men each year. More than one in three women who die every year die from heart disease.

Right now,more than 42 million women are walking around with heart disease, and most of them don’t know it, either because they don’t think it’s something women need to worry about or they’re not experiencing symptoms associated with heart disease in men. However, heart disease in women has a different set of symptoms. The symptom most people think of—chest pains—never even happens in half of all cases of heart disease in women. The signs to look for are fatigue, shortness of breath, indigestion or nausea, throat pain, and pain in the arms, particularly the left arm.

Little is known about heart disease in women, and few studies include women as subjects. However, there are some precautions that seem to help. Cigarette smoke, even secondhand, can raise your risk of heart disease, all the more so if you’re using hormonal birth control. Staying active and staying fit can help, as can a healthy diet; if you’re diabetic, it’s important that you keep it well-controlled. Another thing you should do is get your cholesterol levels and blood pressure checked regularly, and keep them under control.

High blood pressure can turn to heart disease quickly, but has no symptoms of its own. Excess salt can be bad for your blood pressure; indeed, sodium consumption may be the biggest single cause of hypertension. Eating right generally can help you maintain healthy blood pressure, particularly fruits and vegetables

If you think you may be having a heart attack, call 911 or your local emergency number immediately and tell them that you’re having symptoms of a heart attack. It’s important to get proper medical attention as soon as possible. Taking aspirin (but not other painkillers) will help, but it’s no substitute for proper care. Make sure to say you think you’re having a heart attack, and insist the emergency room personnel test for it; it may save your life.

Addiction and Recovery

More and more, people are recognizing what experts have been saying for years: drug dependency is an illness. That’s because it has become clear that treating it as an illness, rather than an indication of bad character or a simple failure of will, has the best outcomes in terms of helping addicts break away from addiction and lead healthy and productive lives. When addiction is treated as the sickness it is, a cure becomes possible.

Not all drug use is drug addiction. In fact, some common drugs, such as marijuana, do not lead to physical addiction, though a person can develop a habit. There are some signs you can look for that indicate if someone has a problem. Addiction is more than just an interest in the addictive substance; addicts refocus their lives around the object of addiction. Addicts tend to disregard responsibilities, relationships (including but not limited to intimate ones) and safety if those things stand between them and the high. Less subtle signs are mood swings, sudden changes in behavior, withdrawal from family members, losing interest in things like hobbies or even personal grooming, and changes in sleeping patterns.

If you think a loved one may have a substance abuse problem, there are things you can do to help. While treatment is most effective when it’s totally voluntary, there are success stories that start with the patient being pressured or even forced into a rehabilitation program. An intervention requires some planning beforehand—determining the extent of the problem, figuring out who will participate directly—but directly confronting an addict with the negative consequences of their behavior can prove to be precisely what is required to induce them to get help they need.

When someone is in recovery, it’s important to be supportive, particularly if you had (explicitly or otherwise) made maintaining the relationship contingent on their kicking their habit. That means, first and foremost, listening to what they say they need. You don’t have to listen uncritically, particularly to someone who has a history of being manipulative, but do listen. At any rate, be aware that there is no quick fix, and recovery is a process. In the long run, things can work out.

Making the Silent Killer Speak

It’s called the silent killer. There’s no simple test for it, and often no early symptoms, or symptoms that appear to be something else. And so ovarian cancer, operating in secret, kills 15,000 American women each year. New diagnostic techniques, however, are helping to bring this hidden illness into the light.

Recent research, in addition, is starting to help provide explanations for how the cancer works. The cancer cells are able to influence genes in the surrounding tissue to help create an environment that is comfortable for tumors. This may be part of the reason ovarian cancer is particularly prone to appear to go into remission for a while, only to come back, strong as ever, to wreak further havoc.

Exacerbating this is that the immune system, normally responsible for fighting cancers, may actually be helping ovarian cancer along. Cells called dendritic cells, which in a healthy immune system are an important part of the process by which the T cells, which attack invaders learn to recognize those invaders, appear to actively hide the tumor cells—while still functioning normally in all other ways. Scientists are not yet sure how or why these cells betray the body and assist the cancer.

Once ovarian cancer strikes, the symptoms are similar to quite a few other conditions. Symptoms include abdominal or pelvic pain, changes in bowel or bladder habits, bloating, loss of appetite, fatigue, and low back pain. While these symptoms are cause to see the doctor, particularly if you have a family history of ovarian or breast cancer or know you have a particular genetic vulnerability, the only real test is to examine the ovaries directly for tumors.

That may soon change, however. A new imaging technique combines three different tools to get an unprecedented look inside the body, which is giving diagnostic personnel the best chance yet of spotting precancerous conditions. The strengths of the various techniques—contrast of one, high resolution of another, deep-tissue capabilities of the third—combine into something greater than the sum of its parts.

Deadly but Treatable

The conditions collectively referred to as neglected tropical diseases affect billions of people worldwide, including half a billion children in the Global South; according to PLoS, some of these diseases are as easily found among Americans, particularly impoverished Americans, as in Nigeria. Philanthropic organizations are working to reduce the incidence of these conditions, which are usually exacerbated by poverty and poor infrastructure that hinders the delivery of heathcare in the developing world.

There is particular focus on the seven most common NTDs, which together account for over a billion cases:

  • Hookworm is contracted from walking barefoot on infested ground and affects 198 million people in sub-Saharan Africa. It is a leading cause of anemia in pregnant women and can lead to cognitive deficit in children.
  • Ascariasis, or roundworm, is a parasite found in contaminated water that affects 173 million people in sub-Saharan Africa. Globally, it is the most common parasitic worm in humans
  • Schistosomiasis is a worm infection acquired from freshwater snails with 166 million cases in sub-Saharan Africa. It has the highest mortality rate of the NTDs, though it is one of the easiest to treat.
  • Whipworm is a parasitic infection acquired from unwashed fruits and vegetables and contaminated soil that affects 162 million people in sub-Saharan Africa. Children are particularly prone to whipworm, and it can affect their growth if left uintreated.
  • Elephantiasis is a mosquito-borne parasite that affects 46 million people in sub-Saharan Africa. The selling associated with this illness can cause permanent disability.
  • Trachoma is a bacterial eye infection that affects 33 million people in sub-Saharan Africa and more than 84 million people worldwide. The world’s leading cause of preventable blindness, this disease thrives in impovrished rural areas with poor sanitation.
  • River blindness is a fly-borne parasitic worm disease that affects 18 million people in sub-Saharan Africa. It is the world’s fourth-leading cause of preventable blindness.

These conditions are common not because no treatment exists but because of the difficulty of getting the treatment—or any medical care—to the populations most vulnerable to it. The World Health Organization reports unprecedented efforts to fight these diseases, with $785 million spent on pursuing eradication, and millions more on treatment.