Monthly Archives: November 2012

Fighting HIV and AIDS

The number of new AIDS cases declined in 2012, but that doesn’t mean it’s no longer a concern. There are still far too many people living with the disease, and far too many people infected with HIV who are seroconverting, or developing full-blown AIDS. Fortunately, research continues into treatments and cures, and efforts to eradicate the disease are ongoing.

For example, a drug called JQ1, normally used for certain types of cancer, is being investigated to determine what other effects it may have; one of these effects seems to be a reduction in viral load, the amount of the virus found in a patient’s body. Though there’s no magic bullet cure, JQ1 does make a tremendous difference. The researchers believe that while JQ1 does little to directly reduce viral load, it does make other HIV-fighting medications better able to locate the virus in order to destroy it.

Another study released recently indicates that HIV therapy started before the immune system has started to become damaged can prevent the infection from developing into AIDS, and can also protect the patient from infecting a partner. This result came from what was meant to be a ten-year study, but the results were so clear that the researchers chose to make their findings public early

Yesterday, U.S. Secretary of State Hillary Clinton announced what she referred to as a blueprint for entirely eliminating AIDS within a generation. She said that in the past four years, U.S. spending on anti-retroviral therapy for AIDS treatment has tripled. And there have been results, with significant decreases in rates of new infections during that time.

The announcement came shortly before World AIDS Day observances scheduled for December 1st. World AIDS Day was developed by the United Nations to bring continued attention to the condition and its effects, and continued work for a cure. Clinton specifically hopes to stop children from being born HIV positive, which occasionally happens to children born to mothers with the disease. The program will also address other issues that appear to make HIV transmission more common than it needs to be, and work to solve them.

Do You Need Back Surgery?

Back surgery is a frightening prospect to most people. Studies have found 66 percent of spine specialists surveyed believe that fear of possible treatments, including surgery, keeps people from seeking help for back pain. However, experts say not all patients who think they need surgery– or whose doctors have told them they need surgery– actually do. In fact, as many as nine in ten people with back pain can be treated successfully with less drastic interventions, such as medication, physical treatment, and exercise; some don’t even need treatment at all.

“It is heartbreaking to see that myths and an unnecessary fear of surgery are holding people back from getting even the most conservative help for their back pain,” said Dr. Joseph Cheng, associate professor of Neurological Surgery at Vanderbilt University Medical Center, in a statement.

Of course, the best treatment is not to have back pain in the first place. There’s no surefire way to avoid it entirely, but their are some steps you can take to reduce your risk. Being overweight can place a significant strain on your back. Regular exercise can help, as well as being beneficial in its own right. Smoking can cause back pain; one effect of nicotine is to restrict blood flow to the region, leading to painful pressure.

Posture also plays a role: standing with one foot a bit forward of the other and sitting with your knees higher than your hips ease pressure on your back. It’s best to sleep on your side; if you sleep on your back, keep your knees elevated. Lift with your knees by crouching down instead of bending over, and carry large, heavy objects as close to your body as possible.

One in eight people with back pain doesn’t see a specialist for more than three months, though doctors recommend seeing someone within six weeks. Only about one percent of cases require surgery, generally very specific ailments for which all other treatments have proven ineffective. The vast majority of the time, the pain can be treated with anti-inflammatory medications and painkillers, or chiropractic manipulation. If the pain goes away on its own, or with non-surgical treatment, surgery is not needed.

Make No Bones About Weight Loss Surgery

Bariatric surgery is widely touted as a drastic but effective method of weight loss. The surgery, which restructures the stomach to limit the amount of food a person can eat, has been successfully performed on thousands of obese patients in the last few decades. However, there are some side effects that are concerning doctors. One of the more worrying is a number of cases in which bariatric surgery seems to have resulted in bone loss.

Weight-loss surgery was first performed in 1954, and the first gastric bypass, the best-known type of bariatric surgery for weight loss, took place in 1966. Gastric bypass—initially using a technique called vertical banded gastroplasty to create a stomach pouch—was a safer procedure than the intestinal bypass that had been performed in the 1950s, which caused patients to become dangerously dehydrated. The modern procedure, called Roux-en-Y anastomosis, was developed more recently. It is one of the most common types of weight-loss surgery, and probably the one most people think of when they think of surgical weight loss.

In this procedure, the intestine, which is normally the output for the whole stomach, is rerouted in a Y shape around most of the stomach and attached to a small pouch. Other surgeries involve a band, sometimes adjustable, around the stomach to limit its capacity. The adjustable band procedure is done laparoscopically, using miniaturized instruments through a small incision, and is one of the safest forms of bariatric surgery available.

Surgical techniques are usually reserved for significantly obese people—meaning a body mass index above 40—or people with a BMI higher than 35 and an obesity-related condition such as type 2 diabetes. In recent years procedures have started to be performed more often on teenagers as well as adults. Unfortunately, teenagers who have had the procedures, particularly Roux-en-Y, performed have shown reduced bone density. A similar though smaller effect has been seen with patients who had the surgery as adults.

Keeping your Nose Clean

More and more Americans are shunning medicine to deal with nasal congestion. Instead, they’re addressing the problem at the source. After all, if the problem is in your nose, it seems inefficient to fight it with something you put in your mouth. A popular alternative is to irrigate the nasal passages with saline. This procedure literally washes out the nose, clearing out the congestion and allowing the person doing it to breathe free again.

Nasal irrigation with a neti pot—from the Sanskrit word meaning “cleaning the nose”—has a long history in Ayurvedic yoga practice in India. It was initially done with handmade clay pots; today, most are metal, ceramic, glass or plastic, which are more sanitary and less cumbersome to use. The lamp-like shape, however, is almost unchanged over the centuries.

The practice began to take root in Western medicine in the 19th century. Scientific studies have shown that nasal irrigation using a neti pot, or with a pump or squeeze bottle, is an effective way of cleaning the nostrils, though some of the grander claims made for long-term or whole-body health effects are unsupported by the evidence.

Neti pots can be safely used with children as young as six, as well as adults. It’s considered a good treatment for allergies that cause congestion, for the common cold, for mild sinus infects, and for postnasal drip. Doctors warn, however, that people with acute sinus infections risk washing bacteria further into the body.

Nasal irrigation offers some advantages over medication. Medicines that treat the underlying illness often do little about the symptoms, particularly symptoms such as mucous build-up, in the nose and elsewhere, that are actually artifacts of the body’s efforts to fight infection. Medicines that are intended for decongestion can be difficult to obtain, and may have undesirable side effects such as drowsiness.

There are some safety concerns with irrigation as well, however. Mostly they revolve around an amoeba called Naegleria fowleri, which is found in untreated tap water and can, if it gets to the brain, cause the rare but fatal condition primary amoebic meningoencephalitis. However, most treated tap water is safe. If you want to try nasal irrigation at home but are unsure if your tap water has N. fowleri, boil the water before adding the salt. Just be sure to let it cool to below 80 degrees Fahrenheit before putting it in your nose.

Crohn’s and Bacteria

A study at a research facility in Montreal has nearly doubled the number of genetic regions known to be involved in inflammatory bowel diseases, including Crohn’s disease. Many of these regions—163 are now known—are also associated with autoimmune disease. Genetic regions are areas of DNA normally associated with specific organs or functions; most of the ones known for IBD are part of the system for fighting microbial infections.

This finding suggests that Crohn’s disease and ulcerative colitis, another inflammatory bowel disease, are related. It also lends support to the notion that Crohn’s is the result of an excessive immune response to bacteria. In fact, another study, in Australia, has found specific bacteria that are believed to trigger the condition. Called Proteobacteria, they are a normal component of what doctors all intestinal flora but were found in elevated levels in people with Crohn’s. The researchers had found earlier that specific strains of a Proteobacteria species called Campylobacter concisus had infected the intestinal cells of Crohn’s patients.

In Crohn’s disease, the small intestine or colon becomes inflamed, which is believed to be an immune reaction to harmless intestinal flora. This causes painful abdominal cramping, as well as other symptoms, such as bloody diarrhea. Crohn’s is often accompanied by poor appetite and weight loss. In addition to the discomfort, the disease can cause ulceration and other damage to the intestines which in many cases needs to be repaired with surgery.

Fortunately, while bacteria are involved in causing the disease, French researchers may have found a way to use bacteria to treat it. Crohn’s patients tend to be deficient in a protein called elafin. The researchers created genetically altered lactic acid bacteria, the sort that maker milk into cheese, which is safe for human consumption. The genetic modification made it so that the bacteria would create the elafin protein. When given to mice with IBD symptoms, the lactobacilli reduced inflammation. The treatment hasn’t been tested in humans, but the bacteria did reduce inflammation in biopsied tissue from Crohn’s patients, a sign that it may be effective for people.

Wind Turbines

Wind turbines are widely touted as a source of clean, sustainable energy, but they also generate no small amount of controversy. Most often, the arguments are over aesthetics—for all their benefits, wind farms aren’t much to look at—and over the amount of land the generators take up. However, since 2009, a number of people living near wind farms have reported concerning symptoms. In many cases, these people attribute the symptoms to an effect of the turbines, while experts attribute the condition to a phenomenon called the nocebo effect.

Deriving its name from the Latin word meaning “I shall harm,” the nocebo effect is a counterpart to the placebo effect. In both cases, something inert, such as a pill of cornstarch, that is followed or accompanied by an effect in a patient is believed to cause the effect, or treated as though it causes the effect. In the case of a nocebo response, this effect is a negative one. Wind turbine syndrome is viewed as an example of the nocebo effect.

Indeed, one expert, a public health professor in Sydney, Australia, says wind turbine syndrome bears the hallmarks of what is called a “communicated disease,” one that is “spread” by media coverage. The reported symptoms are vague and generic ones, such as nervousness, poor sleep, and chest tightness, that are both difficult to measure objectively and often found in purely psychosomatic conditions; the reported symptoms of of the sort that people expecting to experience them will often discover that they do.

The expert, Simon Chapman, says he has found a number of cases in which people who had been living near wind farms for years experienced symptoms within days, sometimes even hours, of learning about their green neighbors. He also notes that one of the leading advocates for people who claim to be suffering the condition is married to an outspoken opponent of wind energy.

However, most people who report symptoms that they believe are related to wind turbines are not deliberately lying. The nature of psychosomatic illness is that it is experienced as a real illness. While fear-mongering and hysteria may play a part in wind turbine syndrome, and there is no reliable medical evidence of a link between wind turbines and any symptoms, the feeling is nonetheless real.

Addison’s Disease

Around 9,000 Americans have a condition called Addison’s disease. In this illness, the adrenal glands, located on top of the kidneys, fail to produce enough cortisol, an anti-inflammatory hormone which is an important part of the body’s stress response. Cortisol is also used in the conversion of food into energy. Although Addison’s disease can be life-threatening, with proper care it’s not difficult to lead a normal life.

Addison’s disease manifests as either a primary or a secondary adrenal insufficiency, either a defect in adrenal gland functioning or in other parts of the body that affect the adrenal glands. In 70 percent of cases, Addison’s disease is an autoimmune response, in which the immune system mistakenly attacks the adrenal glands. Sometimes, conditions such as tuberculosis, HIV infection, and some types of cancer damage the adrenal glands.

Symptoms of Addison’s usually come up gradually. It starts with fatigue and weakness. Patients also have poor appetite and weight loss. Less common symptoms include nausea and vomiting, diarrhea, low blood sugar, and salt cravings. People who have other autoimmune conditions are particularly likely to have Addison’s disease. In addition, if you have unexplained darkening of your skin, talk to a doctor.

The disease is typically diagnosed with blood tests or imaging tests. There is no cure for Addison’s disease, but it can be treated with medications. Corticosteroids are sometimes prescribed, though they can also exacerbate the condition. It is generally recommended that patients get plenty of salt.

With proper treatment patients can generally live normal lives. Sometimes, however, a person will experience a flare-up called an addisonian crisis, with low blood pressure, low blood sugar and high potassium. This must be treated immediately with hydrocortisone and sugar.

Asthma and Esophageal Disease

Many people with asthma find they have another condition as well: frequent heartburn and accompanying symptoms known as gastroesophagal reflux disease. or GERD. Medical researchers have long doubted this was a coincidence, and now a Duke University team has found evidence of a connection between the conditions.

As many as 90 percent of asthma patients have some aspect of reflux as well. What the Duke researcher found is that certain aspects of GERD affect the immune system. In particular, even miniscule amounts of gastric fluid in the lungs can make the immune system particularly sensitive to the allergens that can trigger asthma.

Miniscule amounts of gastric fluid in the lungs—called microaspirations—is a common symptom of GERD. In GERD, the ring of muscles that normally prevents the stomach contents from going back into the esophagus doesn’t form a tight seal. When this happens, gastric fluid flows backwards, irritating the esophagus and leading to heartburn and sometimes nausea, as well as microaspirations.

Alcohol seems to increase the risk of this occurring, but the evidence is not conclusive. It is widely recognized that obesity and pregnancy put pressure on the esophagus which may prevent the ring of muscles from properly closing. Smoking is also a risk factor for GERD, as are scleroderma and other connective tissue disorders. Some medications also increase the risk.

Medical treatment for GERD usually starts with antacids. These neutralize the stomach acid, but won’t heal the damage to the esophagus. The same is true of medications to reduce acid production. Medications called proton pump inhibitors do heal the damage, as well as stopping excess acid production. Pyrokinetc agents help strengthen the muscles to stop the condition from recurring.

There are also lifestyle treatments alongside or instead of a medical approach. Simply wearing loose clothing can help, as can maintaining a healthy weight. Some foods cause excess acid production; while the list varies, common culprits include fried foods, tomatoes, chocolate, mint, and caffeine. Eating smaller meals and not lying down for at least three hours afterward can help, as can elevating the head of the bed, such as with a wedge or cinder blocks. Finally, quitting smoking will help alleviate GERD and its symptoms.

Fitness and Diabetes

One of the easiest way to protect yourself from the effects of type 2 diabetes is by staying active. Type 2 diabetes comes on as a result of changes in the body; it’s not an inborn condition. Major risk factors include inactivity and eating too many sugary foods, but it turns out these are also factors influencing the severity of the disease. In fact, exercise has been called the most effective therapy for type 2 diabetes, burning the excess sugar insulin is no longer able to handle. Exercise can triple the efficacy of medication for diabetes.

Another thing that can help protect you from the ravages of diabetes is eating legumes, vegetables such as peas, beans, and lentils. In a recent study, a diet high in these foods was found to reduce levels of a protein known as glycated hemoglobin. High glycated hemoglobin levels are a diagnostic criterion for type 2 diabetes. Eating legumes was also found to reduce the risk of heart disease in people with diabetes. Fiber was less effective, but it was also found to have similar benefits.

One common symptom of diabetes is pain referred to as diabetic neuropathy. Now a medication may be available to help people with this condition. Called nabilone, it is currently given to chemotherapy patients to help with the nausea that often accompanies those treatments. It has cannabinoids, chemical compounds similar to those found in marijuana.

“This is a good option to help treat nerve pain due to diabetes, with very few side effects,” the lead researcher of the study, the University of Calgary’s Dr. Cory Toth, said in a statement. Dr. Toth found that, in addition to relieving pain, nabilone also helps patients sleep better.

An odd approach to diabetes prevention is vibration. Mouse experiments suggest that brief, daily whole-body vibration of people with conditions typically regarded as precursors to type 2 diabetes may help keep glucose levels under control. It was effective for normal mice as well as those who had the equivalent of a prediabetic condition, but it did not work on full-grown adult mice.

Holiday Health Tips

The holiday season is coming, starting with Thanksgiving on Thursday. The good news is that holiday time and holiday celebration are actually beneficial to your health. Good cheer and being with family provide a boost. The bad news is that stress peaks around holiday time as well. Here are some tips to help you through:

  • Take time out for yourself, to rest and recharge.
  • Get enough sleep. It’s an important part of both keeping your health and str‌ess management.
  • If you’re traveling for the holidays—or any other time—melatonin can help you adjust to time differences to avoid jet lag.
  • Use a dedicated step-stool rather than furniture to stand on when hanging decorations; it’s safer.
  • It’s always important not to drive drunk, but it’s particularly dangerous on icy roads or when snow reduces visibility.
  • Wash up. Washing your hands regularly helps you avoid the colds, flu, and similar ailments that are going around this time of year.
  • Try to eat healthy during the holidays, but recognize that celebrations and feasts are not the time to stick strictly to a weight-loss plan.
  • Don’t worry too much about watching your weight; the average person gains only a pound between Thanksgiving and the end of the year.
  • If you have diabetes, check your glucose at least once during holiday meals.
  • If you’re prone to heartburn or acid reflux, be careful with alcohol, caffeine (including chocolate), carbonation, and mint. Caffeine and alcohol can also make intestinal bowel problems flare up.
  • When you can, pick nutrient-rich foods and snacks such as nuts and fresh fruit and vegetables.

If you follow these tips, it will help you have a safe, healthy, and happy holiday season.