Monthly Archives: April 2014

Surgery For Weight Loss

Bariatic surgery is an often controversial procedure to help people lose weight. It is often derided as an "easy way out," but the fact is weight loss is difficult, the human body is deigned so that weight is much more easily gained than lost, and most diets usually don’t work for most people. If anything, patients who have weight loss surgery need to put more effort and thought into how and what they eat than dieters typically, do. The various kinds of bariatric surgery reduce stomach capacity in various ways, which make these restrictions easier, but also make them mandatory.

On of the most common types of weight loss surgery is called Roux-en-Y. The intestine is rerouted in a Y shape around most of the stomach and attached to a small pouch. This limits patients to the capacity of that pouch. Other types of surgery used miniaturized instruments inserted through a small incision to place an adjustable band around the stomach, making it smaller that way.

Regardless of the technique used, the health benefits are many. People with type 2 diabetes, for example, normally need insulin and medications the rest of their lives. However, obese people with type 2 diabetes—of which obesity is a major cause—show marked improvement, and in a study some were able to stop this maintenance treatment or diabetes entirely. Other studies found that obese people who underwent bariatric surgery successfully halved their heart attack risk. People on whom the weight loss operation had been performed had a 40 percent lower mortality rate and 50 percent fewer heart attacks than obese people who had not had surgery.

All this however, is not without a price. People who receive the surgery still need to follow a restrictive diet. In fact, it becomes more important, as failing to stick to the diet can result in not merely failing to lose weight, but in medical complications. Furthermore, the restrictive diet can mean nutritional deficiencies if people don’t carefully plan meals and take necessary supplements. There are also some signs that at least some procedures can make bones more brittle. While many patients find that the benefits more than compensate for the risks, it is still important for someone considering surgery for obesity to discuss both with a health care provider.

Looking At Pinkeye

The conjunctiva is a membrane on the inside of the eyelid. Most people would never even realize it was there but for itchiness, eye watering, and light sensitivity when it gets inflamed. Called conjunctivitis—or pinkeye, for the pinkish tinge that develops on the cornea—this inflammation may be caused by viruses, bacteria, or an allergic reaction. When it’s caused by viruses or bacterial infection, pinkeye is contagious, and bacterial conjunctivitis can actually damage the eye if left untreated. Bacterial conjunctivitis is also the most noticeable form, causing a greenish-yellow discharge that tends to glue the eye shut overnight.

Both the viral and bacterial types of conjunctivitis pass easily from person to person. That’s why it’s important for someone who has pinkeye to take steps to avoid spreading the condition. That means wiping down surfaces when possible and maintaining good hygiene techniques. Pinkeye is highly contagious for up to three weeks, so developing and maintaining habits is important. Someone with pinkeye should also avoid touching or rubbing their eyes, or at the very least, use hand sanitizer afterward. Something disposable, such as paper towels or cotton balls, should be used for compresses or applying topical treatments.

Compresses are the best way to deal with conjunctivitis—for viral or allergic conjunctivitis, the only way. Antibiotics can be given, topically or as drops, for the bacterial variety, but when a virus is responsible there’s usually nothing to do except wait it out, which takes about two or three weeks. To help alleviate some of the discomfort, wet a paper towel with cool but not cold water, wring it out and place it on the eyes. This should not be reused, even by the same person. Teabags can also be used as compresses, particularly green tea and chamomile. The teabags should be wettened but not dripping, and should be thrown away after.

When conjunctivitis is an allergic reaction, it isn’t contagious but it also isn’t going to go away as long as exposure to the allergen continues. Pinkeye can be a reaction to dust, dander, pollen, or any other sort of airborne particle. Allergy treatments such as antihistamines can help with this. Another option when it’s an allergic reaction is anti-inflammatory rugs such as decongestants or in severe cases, steroids. Avoiding the allergen, when possible, also helps.

The Uses Of Stem Cells

Modern genetic science is giving doctors and researchers an unprecedented ability to understand the human body, to repair it, and possibly even to improve it. Some of this is thanks to stem cells. The cells in the body are not all identical. As an embryo develops into a fetus, the embryonic stem cells start to specialize; by infancy, cells in each organ are specific to that organ. After a child is born, somatic stem cells are generated in bone marrow for use in repairing damaged tissue. Embryonic stem cells are pluripotent, meaning they have the potential to fit in as part of any organ, while adult stem cells are multipotent, meaning they can differentiate into many but not all cell types, depending on where they were derived from. Researchers are slowly learning to use these cells to improve treatments for people with serious illnesses.

In fact, the potential benefits of this research are tremendous. These techniques could be a boon in pharmaceutical testing, for example, enabling researchers to observe the effects of medication on actual organs—not analogues or computer simulations—without risking test subjects’ heath. This will help drug makers in creating medications that are effective while still being safe. In addition, pluripotency means these cells can replace damaged, defective, or missing cells anywhere in the body. Many genetic conditions result in a part of an organ, even the brain not functioning properly, or even not being there at all. In neurodegenerative disease, neurons die off. With stem cells both of these problems can largely be solved.

Already, researchers are looking at ways to coax stem cells into forming transplantable organs, with properly differentiated cells, that are an exact match for patients. Normally transplant patients need to be careful to avoid rejections, in which the immune system recognizes the transplanted organ as a foreign body and tries to expel it. Stem cells can make transplant organs that are not foreign and will not be rejected.

In a recent advance, scientists were able to use cells from an adult to create pluripotent stem cells, rather than merely multipotent. This means that stem cells from embryos—which are controversial and hard to come by—may not be needed for pluripotency. Though the cells created in the study are not medically useful, the technique may prove to be.

Managing Your Stroke Risk

Stroke, an interruption in the flow of blood to the brain, affects more than three quarters of a million Americans each year. A person has a stroke, on average, every 40 seconds. It is the fourth most common cause of death in the country. It’s important to know the risk factors, both in order to better assess a person’s chances of having a stroke and, in some cases, to address bad habits that are making those chances higher than they need to be.

There are some risk factors for stroke that a person simply cannot control. The biggest one is age—every decade of life past 55 doubles someone’s risk. Family history of stroke is another one. Black people are more prone to stroke than people of other races, and women more so than men. There are also some other conditions, themselves due to a mix of controllable and uncontrollable factors, that raise stroke risk, such as diabetes and high blood pressure.

Another such condition is insomnia. The close to one-third of people who have trouble falling or staying asleep are 54 percent more prone to strokes than their well-rested peers. Insomnia was found to exacerbate the effects of diabetes on stroke risk, suggesting a link with the observed connection between insomnia and overeating. In addition, some activities, such as drinking alcohol and smoking, both raise stroke risk and often lead to insomnia. Researchers also suggest that lack of sleep raises blood pressure and causes mild inflammation, heightening vulnerability to stroke.

Marijuana also seems to show a link with stroke, as well as smaller stroke-like incidents called transient ischemic attacks. Though not as harmful as tobacco, marijuana is often smoked, and smoking anything can have deleterious effects on the cardiovascular system. In addition, marijuana is likewise associated with overeating, and also with being sedentary. The effect is most pronounced with heavy use.

People might not consider high stress a controllable risk factor, but it is, at least compared to gender. At any rate, relaxation techniques such as yoga can help lower the risk. A poor diet—high in salt and saturated fats—is something else that can be controlled. Even if saturated and trans fats can’t be cut out entirely, minimizing them in the diet can help. Quitting smoking makes a tremendous difference, particularly for women taking birth control pills. Finally, other illnesses that raise the risk do so less if properly treated.

Ending Meningitis Worldwide

The membrane sheath that protects and cushions the brain and spinal cord is called the meninges; when it becomes inflamed, that is the condition known as meningitis. Generally, this inflammation is due to an infection, which is usually viral though sometimes bacterial or fungal. Meningitis can also be a reaction to medication. The four are different conditions in terms of mechanism and treatment, but the effects and symptoms are similar. In all, meningitis from all causes strikes about 25,000 people annually.

Meningitis symptoms include fever, nausea and headache, loss of appetite, and seizures. Fever is a particularly important symptom to be aware of; when it is accompanied by confusion, vomiting, a severe headache, and a stiff neck, this indicates a need for immediate medical attention. In the absence of thee symptoms, a health care professional should still be consulted, though viral forms of meningitis do sometimes go away without intervention.

Meningitis can be prevented like any other infection. Good hygiene practices and washing hands appropriately—such as before handling food and after riding public transportation or coming in from outside—will prevent a great deal of infection. Cooking food thoroughly can help prevent the spread of infections that can lead to meningitis. Meningitis can also be prevented with vaccinations. The vaccine for the most common form, meningitis B, is almost 75 percent effective.

Another vaccine is effective against meningitis A, a form of the disease common in sub-Saharan Africa. "Effective" is an understatement—in places where vaccination programs operated, there were zero recorded cases of meningitis A in 2012, and a 94 percent reduction in overall meningitis cases. Recently, advances in vaccines have allowed the vaccine to reach remote areas where a program was not previously feasible. Vaccines have been developed that don’t need refrigeration, allowing more distant areas to be covered.

Cold has also been used to treat meningitis. Induced hypothermia has been used to prevent the inflammation in meningitis from doing permanent damage. Medical induction of hypothermia appeared to reduce pressure in the brains of trauma patients, and the thought was that the same effect would be observed in people with meningitis. However, in tests, this technique had a high mortality rate and the recommendation was that the treatment not be used.

Saving Lives With Vaccination

The job of the immune system is to protect the body from disease, but it can’t always do it alone. What it lacks in might, however, it can make up in memory: the immune system frequently remembers diseases that it has encountered and defeated, and if they come back, the immune system springs into action with the same tactics, so the person may never even notice. New illnesses, however, or familiar ones disguised as new, don’t cause this reaction.

That’s where vaccine comes in. A vaccine is a small amount of disease-causing microbe—not usually enough to make someone sick, but enough to give the immune system a taste of it and allow a defense to be mounted. This vaccination makes it possible for the immune system to defend against these illnesses from the first. According to the World Health Organization, vaccination prevents as many as three million deaths annually—but 20 percent of children are unvaccinated.

Many unvaccinated children are in the developing world, where doctors, equipment, and especially medications can be difficult to obtain, transport, store, and protect from ill-intentioned people. In all parts of the world, there are often pockets of resistance, parents who see the risks but none of the rewards of getting their child vaccinated. Though wrong, this position is understandable—the vaccination has no immediate beneficial effect and purports to protect against diseases the parent may well know only as names.

The consequences, however, can be quite real. According to experts, tens of thousands of children and adults each year get diseases they wouldn’t have if they had been vaccinated. Also, not everyone can be vaccinated—frail health, allergies, and other factors might make it impossible for a given person to be immunized. What’s more, some people who do get vaccinated get an ineffective one. Vaccines work best in large groups, so if everyone who can tolerate the vaccine gets it, these people will be safer.

Vaccines are most effective when administered on a specific timetable. Many are given in combination shots so that 14 diseases can be dealt with in fewer than 14 shots each round—though many require multiple rounds. After the initial dose is given to an infant, one or two boosters may be necessary over the next few years for maximum benefit. The schedule front-loads vaccinations so kids are protected as early as possible, and also so that the immune system will be particularly receptive to enhance the effectiveness.

Fighting Biting

Studies show that 60 percent of children and nearly half of teenagers bite their nails, and the habit doesn’t always disappear in adulthood. Nail biting in adults is recognized as a mental health issue, a manifestation of compulsive grooming like trichotillomania, compulsive air-pulling. Compulsive grooming is recognized as a form of obsessive-compulsive disorder. However, people seldom think of it in these terms; biting the nails is generally looked upon as a mere harmless habit. In fact, the apparent harmlessness makes it difficult to get a good idea of how many people do bite their nails—because people may not think about it and almost never seek treatment for it, the number of people with a nail-biting habit is almost certainly significantly underreported.

However, while it may seem harmless to bite ones nails, it isn’t. Sometimes this is obvious, such as when someone bites so much that their cuticles bleed. But there are more subtle dangers as well. Nail biting brings the fingers to the mouth. That much is obvious, but along with the fingers comes whatever they may have been touching recently—subway poles or bus straps, the roof of a gar, a toilet handle, raw meat, whatever it may be, and with that comes all manner of harmful things. In addition, the skin around the nails can break without necessarily causing bleeding, and even without blood, any of those microbes can cause an infections. When the nails are bitten down, they are unable to do their job of protecting the fingertip, so biting nails increases the risk of damage there.

Sometimes nail-biting, rather than obsessive-compulsive disorder, can be a sign of a different mental health problem, such as anxiety. In these cases, treating that will generally stop or significantly reduce nail-biting. Obsessive-compulsive disorder treatments might also, but there are more direct methods as well. Managing stress and avoiding boredom can work wonders. Chewing gum or doing something else to keep the mouth busy can also cut down on nail-biting. Sometimes, drastic measures might be needed. A substance called denatonium benzoate is the foulest-tasting substance known. Spreading it on the nails can be a powerful aversive therapy tool, stopping the nail biter long enough for the habit to be broken. This, and variations with less awful (though still bad) tastes, is the most common clinical remedy for biting the nails.

Becoming Pregnant

As many as 15 percent of the thousands of couples who try to conceive every year face infertility. That means these couples have been trying to conceive for a year without success, or six months if the woman is over 35. Infertility is defined in terms of trying to conceive, rather than the underlying causes. The same medical or other conditions that are causing the problem may be present in couples who aren’t trying to conceive, or in men or women who are not in relationships in which procreation is normally expected. Causes of infertility are evenly split between men and women, both overall and specifically in about a third of infertile couples.

A recent study suggests that stress can be a major causal factor in difficulties couples may have getting pregnant. Women who high amounts of chemical indicators of stress had twice the odds of being infertile as women with lower stress levels, and were about a third less likely to become pregnant in each month of unprotected sex. This was the second study demonstrating a link between stress and difficulties conceiving. However, researchers say that other factors are far more prominent in both men and women. While reducing stress levels, particularly the woman’s, can help a couple conceive, other approaches are also likely to be needed.

Testosterone can affect fertility, including, perhaps surprisingly, in women. There is substantial clinical evidence that testosterone helps increase the number of eggs produced by women who are using in vitro fertilization to attempt to conceive. The understanding that testosterone plays a role in reproduction in women is not new, but the precise purpose it serves in that process is not fully understood. However, recent studies suggest testosterone might be used in the development of the structures that are responsible for releasing ova so they can be fertilized.

In vitro fertilization also can get a boost from attention to psychological and social factors. Neurotic patients and people who tend to withdraw in the face of conflict had worse outcomes in the study than better rounded would-be parents. However, people with good social support—people, including each other to lean on in tough times—not only had better outcomes but also despaired less when pregnancy did not occur.

Healthy Bones

In developing countries, one of the most common childhood ailments is a bone disease called rickets. Children with rickets generally are deficient in vitamin D or the minerals calcium or phosphorus. Rickets leads to an increased tendency to suffer fractures, dental problems, muscle weakness, bow legs, skeletal deformities, poor growth, a misshapen skull, or other problems.

Another bone disease, one more common among adults and in the developed world, is osteoporosis. The name of the disease provides a description—bone weakness. People with osteoporosis, too, are prone to bone fractures. One-third of all women over age 50 will have a fracture as a result of osteoporosis, and that fracture is likely to be her first indication that she’s losing bone mass.

Here are some tips on keeping bone fragility at bay:

  • Get enough calcium. Calcium is in milk, and grocery-store shelves are replete with calcium-enriched food products. Vitamin D, which is found in some foods and in sunlight, is also helpful.
  • Quit smoking and cut back on alcohol. Both of these things can hasten the loss of bone mass.
  • Talk to a doctor about the effects on bone density of important medications, such as corticosteroids.
  • Get exercise. Exercise helps strengthen bones and protect against diminishment

A bone density test should be a part of regular checkups for both women and men over about 50, or who are on corticosteroid medications. Early intervention can be important, as osteoporosis often has no symptoms at first.

Finding Prostate Cancer Early

According to the National Cancer Institute, nearly a quarter of a million people are expected to develop prostate cancer this year. Frequently, these cases can be successfully treated—if the disease is found in time. Unfortunately, the standard test is uncomfortable and potentially dangerous, and due to the nature of the condition, is done on a routine basis as part of a regular checkup for men over 50. As a result even though prostate cancer is one of the most common forms of cancer in men, 70 percent of biopsies for it come up negative.

The remaining 30 percent, however, are fortunate indeed, because early detection is the only way prostate cancer is tractable, and there are seldom any symptoms early on. One study looked at autopsies on men who had died in their 70s of natural causes and found that almost all of them—four out of five—had been living with untreated and in fact undiagnosed prostate cancer, even if that didn’t prove to be what ultimately killed them.

Because of the importance of early detection and of routine testing, urologists are looking for less invasive tests that are as accurate as the biopsies that are currently standard. These biopsies are performed if a blood test shows high levels of a compound called prostate specific antigen. However, at least half of patients with high PSA levels turn out not to have cancer at all, and in those who do, doctors frequently overestimate the size of the tumor, an error that affects the course of treatment. Now one researcher has proposed that using ultrasound scanners to detect unusual patterns of blood vessels can detect where tumors have established themselves, and to what extent. A quick, inexpensive, and non-invasive scan can thus replace the ordeal of biopsy, and the protracted analysis it requires.

Treatment for prostate cancer is not always necessary or even advisable if the tumor is small. In older patients especially, treating slow-growing prostate cancer may cause more problems than it solves and create more risk than it alleviates. When treatment is needed, hormone therapy shrinks the tumor by reducing the level of the testosterone it feeds on. Alternatively, radiation therapy can be used; a substance called reservatrol can be injected to make the tumor respond better to the radiation.