Monthly Archives: June 2014

Reversing Type 1 Diabetes

insulin

Type 1 diabetes is a disease in which the pancreas does not produce enough of the hormone insulin to meet the needs of the body. Unlike type 2 diabetes, which develops when the body doesn’t respond to insulin properly as a result of excess abdominal fat, type 1 diabetes is an inherited autoimmune disease, in which the immune system treats the pancreas as a foreign body and attacks it.

As with most autoimmune diseases, type 1 diabetes has been on the rise in recent decades. It is normally diagnosed in children, and is a life-long condition. Symptoms include frequent urination and thirst, weight loss, extreme hunger, and fatigue. Type 1 diabetes used to be known as insulin-dependent diabetes, because patients had to carefully measure insulin levels, and inject themselves periodically. Modern medical technology has made it possible for people to use automatic insulin pumps to monitor their insulin levels and administer appropriate doses when it is necessary to do so.

Now a newer treatment may become available that could the condition entirely. Experiments with laboratory animals have found a way to protect the cells that produce insulin from the overactive immune system. The immune system doesn’t attack the protected cells, and so they are able to produce the needed insulin. The procedure has not yet been tried in humans, but the receptor involved works in similar ways in humans and mice, and so the researchers think the treatment might work in humans as well. They say it only works in the early stages of the disease, however.

Another suggested treatment involves using immune-suppressing drugs to stop the immune system from attacking the pancreas. After that, the immune system itself is rebooted, with new cells that are less hostile to the pancreas. The doctor who devised this approach is hoping that by rebooting the immune system the pancreatic cells can be kept safe. This treatment has been tested, in adults, and has proven successful for those patients. This is the first study to find a treatment that is effective even in patients who have had the disease for a long time. Ordinarily, the later type 1 diabetes is caught, the less well it responds to treatment.

Potential Treatments For ALS

gehrig

An estimated 30,000 Americans are affected by amyotrophic lateral sclerosis a neurodegenerative condition that causes the motor neuron cells in the spinal cord to gradually die off, keeping neural impulses from the brain from reaching the muscles. Muscle function slowly diminishes, making movement increasingly difficult. It is also known as Lou Gehrig's disease, after the New York Yankees player who was diagnosed with the condition in 1939, famously leading to his retirement from baseball, and who ultimately dies of the disease two years later. The condition typically begins with weakness in the arms and legs—the first symptom Gehrig noticed—and difficulty in breathing and swallowing. The muscles slowly begin to atrophy and eventually no longer work. In the end, the muscles needed for breathing no longer function.

The cause of ALS is unclear. Researchers believe it may be related to structures in the motor neurons called neurofilaments. In ALS, those neurofilaments are not constructed properly, so they malfunction. The task of the neurofilament is to transport molecules around motor neurons to enable the motor neurons to activate the muscles. The malfunctioning neurofilaments are unable to do this, so the molecules end up stuck, misplaced, or scattered. The researchers say the largest motor neurons, with the longest filaments, are in the legs, which is why the first signs of Lou Gehrig's disease are in the legs and feet.

There is no cure for ALS. Palliative care can make it possible for patients to live, and assistive technology allows them to prolong their independence, but nothing can be done to reverse or even stop the damage. However, there is some indication that an experimental drug for treating stroke patients may also disrupt a key mechanism of Lou Gehrig's disease. In experimental animals, this medication slowed down motor neuron death and delayed the progress of the disease.

Another possible treatment being investigated involves a copper compound that scientists hope will slow the condition and significantly improve the life expectancy of patients. Current treatments can extend lifespan by a handful of months at most. Since some of the damage ALS does has been traced to insufficient copper in the spinal cord, additional copper is thought to help. The compound allows the normally toxic metal to be administered safely; it is hoped this will prevent the damage from occurring, halting the disease.

Facts About Sunburn

sunburn

Sunburn means damage to your skin. The pain and discomfort is a sign that damage has occurred. The specific cause is a molecule in the skin called TRPV4, which is also associated with a common hereditary disease that affects the larynx. In the skin—in particular, the outermost epidermal layer of the skin—it responds to the UVB rays in sunlight by triggering a response the brings calcium to the surface of the skin. The calcium, in turn, comes with a chemical called endothelin, which causes pain and itching, but also draws more calcium—and more endothelin. But sunburn does more than suffuse your skin with calcium. Over time, the UV rays that cause sunburn can also lead to skin cancer.

Unfortunately the damage happens early. In fact, according to a recent study, skin cancer risk in middle age or beyond is 80 percent higher in people who had five or more sunburns between ages 15 and 20 —a large increase for what is already the most common form of cancer in the United States. Even study subjects with no family history of skin cancer were more prone to develop it themselves if they had multiple blistering sunburns as adolescents.

The good news is that while early sunburn is a risk, avoiding sunburn even later in life can still provide some measure of protection. People who are especially prone to burning—people with fair skin, people who take certain medications, anyone who drinks while or immediately before going out in the sun—should be especially cautious. That means covering up as much as is possible when going out in the summer. It means wide-brimmed hats and UV-protecting sunglasses. It means staying in the shade, including the portable shade of a parasol for people with a particular tendency to burn.

It also means sunscreen. Experts say that sunscreen doesn't provide complete protection, but it does significantly improve matters. Sunscreen should have a sun protection factor of 30 or higher. A shot-glass-full is enough to cover most adults, though people showing more skin—or people with more skin to show—may need more. Some form of sunburn protection is important even on cloudy days, and even for people who aren't planning to simply soak up rays. It should be applied 15 minutes before going outside and reapplied every two hours. Even waterproof sunscreen could probably stand to be reapplied after it gets wet, especially after a dip in the pool.

Fellowship And Treatment For Migraine

migraine aura

For reasons scientists are not at all clear on, approximately 45 million Americans suffer migraines—though for many of them, the actual headaches are so infrequent, so mild, or so far from the usual migraine pattern that neither they nor their doctors even recognize that as what is occurring, rather than an ordinary, if perhaps unusually strong, headache. A tendency to suffer migraines, particularly with aura—light sensitivity coupled with a slight visual disturbance lasting a few minutes to an hour signaling the onset of a migraine headache—seems to have a strong genetic component, but heredity is not the whole story.

The headaches are largely random, but there are often broad patterns. Sufferers are particularly prone to migraines after triggers. These triggers vary from person to person, but the common ones include onions, nitrates in cured meat, the compound tyramine in some aged or preserved foods, alcohol, secondhand smoke, and MSG. Menstruation or pregnancy can also trigger migraine headaches in some people. Caffeine withdrawal can also bring them on. Stress is also frequently a trigger, with one study finding that people with migraine going through a period of stress had over four percent more headaches. Headaches often strike when the stress goes away.

Researchers are also working to learn more about other aspects of migraine. One tool is social media. Twitter and other social media services are invaluable tools for researchers of all stripes because they provide more or less anonymous self-reports of a wide variety of human experiences, including medical conditions, and migraines are no exception. It turns out migraine headache sufferers—seeking sympathy, looking for advice, or just self-documenting—frequently share their pain on Twitter. Researchers are using this vast amount of data to glean important information about where, when, and to whom migraines happen.

This information can help in developing treatments. Some existing treatments are truly off-the-wall. One company created a headband with an electrode placed so as to stimulate the nerves found behind the eyes. Powerful magnets run over the skull—called transcranial magnetic simulation—can also be effective. Medication is also helpful, though not always with the usual delivery method. A patch that administers medicine through the skin was recently introduced, and migraine is one indication for medical marijuana.

Taking Care Of Infants

baby with pacifier

Having a new baby is more stressful than new parents expect. This is particularly true for first-time parents, to whom the entire experience is new. Fortunately, newborns are resilient, certainly emotionally—nothing a new parent does in the first few weeks, or even months, is likely to have a permanent effect on the child’s psyche. Indeed, averaged out over years of parent-child interactions, one wrong step, or even a handful of wrong steps, is unlikely to do any lasting harm in the grand scheme of things.

Nonetheless, there are things new parents should know. For mothers who choose to breastfeed, there’s a learning curve—it’s not something a new mother will automatically be able to do correctly right out of the gate. That means that if the baby doesn’t feed correctly on the first try, it’s not a failure on the mother’s part. In any case, if breastfeeding proves impossible or impractical, it’s no big deal. While breastfeeding is by no means unhealthy, many of the claimed benefits are exaggerated, or have no real evidence backing them up.

New parents should also know about common health problems with newborns. Colds and coughs, even fever are normal. Vomiting—or spitting up—is pretty much inevitable. None of these are typically signs of a major health problem, and they usually go away after a few days. If they seem unusually serious or last for a long time, however, it’s a good idea to call the pediatrician. Even a parent who has a vague feeling of something not right can benefit from calling the doctor, if only for peace of mind. Pediatricians are used to first-time parents, and generally have a good sense of what’s simple worry and what is an actual problem.

In general, in fact, new parents who aren’t sure about something should ask—the obstetric nurses, doctors, friends, family. There is such a thing as too much advice, but risking that is worth the comfort a parent has knowing that they’re doing it right. Instinct is a good guide; it is vanishingly rare for something that feels right to be completely wrong, and doctors and nurses will usually be able to warn about these things. Cleanliness is something else that occupies the attention of new parents, but in fact, children can safely get dirty. The important thing to remember is that parenting has been done successfully for millions of years.

Treating Ovarian Cancer

inspirational plaque

Fewer than two percent of women get ovarian cancer. That’s the good news. The bad news is that there are almost no symptoms in the early stages, which is one reason 15,000 American women die of ovarian cancer every year. People most at risk for ovarian cancer are women with a family history of that or of breast cancer, women who have received hormone therapy or fertility treatments, smokers, women who have never been pregnant, women who use intrauterine devices, anyone who had menarche younger than 12 or menopause older than 52, and women with polycystic ovarian syndrome. Regardless of these risk factors, women between 50 and 60 are especially prone to develop the condition. It is recommended that anyone at risk for the silent disease get tested regularly.

Interestingly, though not being pregnant and using an intrauterine device for contraception increase the risk of ovarian cancer, suppressing ovulation might prevent it. Recent studies suggest that breastfeeding—which has a contraceptive effect because it triggers the release of certain hormones—and birth control pills reduce ovarian cancer risk in women with the BRCA gene mutations that would ordinarily make them particularly vulnerable. Surgical sterilization—a medical procedure in which the fallopian tubes are tied or severed, providing an essentially irreversible and permanent form of birth control—has a similar effect on ovarian cancer risk. The sterilization and breastfeeding connections are more firmly established than birth control pills, for which the evidence is more conflicting—past studies have shown oral contraception to raise cancer risk.

Other researchers have found a possible new treatment strategy to combat tumors. Ovarian cancer, like other cancers, is very resource-intensive, requiring bloodflow for oxygen and nutrients. There are drugs designed to block the blood vessels in the tumor and starve it, but often, patients develop a resistance to these drugs—the tumor figures out a way around it and sets up a new support system. Now scientists may have found the mechanism behind this regrowth: a protein that regulates a molecule that plays an essential part in blood vessel growth. Targeting that protein, in addition to the blood vessels already in the tumor, may make it possible to save the lives of more patients, and treat the cancer at more advanced stages.

Diabetes And Statins

statin

Life is full of trade-offs. One alarming one is that statins, drugs intended to lower unhealthy cholesterol levels and boost healthy cholesterol, thereby reducing the risk of heart disease, seem to raise the risk of type 2 diabetes. Obesity is associated with both high cholesterol and diabetes, but the drug itself seems to raise diabetes risk. In some studies, the risk of diabetes went up as much as 32 percent due to statin use, even as heart disease fell 44 percent. In part because of the obesity link, this side effect is a danger to the 13 million people expected to be on statins, some of the most widely prescribed medications in the world, during their lifetimes. Fortunately, researchers think they may have come up with a way to minimize this effect.

Statin drugs have come under fire recently for perceived over-prescription. Given the consistently high effectiveness of the drugs—lowering heart attack and stroke risk as much as 40 percent—and particularly given the side effects, there is some concern that people are being given statin prescriptions as a one-size-fits-all quick fix when they may be better served by some other approach. The side effects, though rare, can be dangerous or even fatal. In addition to type 2 diabetes, statin users can suffer memory loss, liver damage, and muscle weakness. In some cases, statins can lead to a potentially fatal condition of severe muscle pain, liver damage, and kidney failure called rhabdomyolysis. In light of these dangers, some experts are wary of prescribing these drugs to patients who do not have a high risk of heart disease. Patients who have not had a heart attack, or who do not already have high cholesterol, are unlikely to see enough benefit from statin drugs to offset these risks.

However, at least for diabetes, the risk may be easily manageable. The effect of statin drugs involves an immune response, which is how they achieve their cholesterol-lowering feats. However, another effect of this immune response is to target the pancreas and lower insulin levels, leading to elevated blood sugar. The immediate recommendation is a second drug, called glyburide, which protects the pancreas from this immune response, and helps maintain the production of the needed amount of insulin. The researchers say further investigation of the immune response is needed to find ways to prevent or counteract other side effects.

Growing Up With Sickle Cell

sickle

Doctors are increasingly able to control sickle-cell disease. The hereditary condition affects roughly 100,000 Americans, and can shorten life expectancy, though less so than in the past. People with sickle-cell disease have a genetic mutation that causes red blood cells to be rigid and misshaped, leading to excessive clotting. This means chest and joint pain and anemia, and greater risk of hypertension and stroke. The cells are also unusually fragile, with less than a quarter the life cycle of ordinary red blood cells, leaving people who have the disease unusually prone to infection. The rigidity and fragility are due to fibers that form in the cells of people who carry the mutation.

Advanced treatment techniques for sickle-cell disease are causing a good problem, that more and more children and adolescents with sickle-cell are becoming adults with sickle-cell, and are living with the condition as adults for longer. In studies, patients at the point of transition, who are becoming adults, lean more heavily on emergency rooms than pediatric patients do; researchers are looking into ways to get them the health care they need, without relying on emergency facilities that aren’t necessarily equipped to provide the kind of care these patients require.

One reason the condition has become more treatable is a finding that bone marrow transplants—a surgical procedure that can be a treatment of last resort in severe or intractable cases—don’t require the donor and recipient to be an exact match. Donor marrow produces healthy red blood cells to replace the misshapen ones, but transplantation can be hard on the immune system. Treatments for milder cases are drugs, including an anti-depressant, that manage the symptoms and effects but don’t fix the cell production.

Newer research has found a way to get the patient’s own boy to produce more correctly-shaped red blood cells. In sickle-cell patients, the problem is in the adult cells. Fetal cells—those present at birth—are shaped normally. The genetic mutation affects only the adult cells. The chemical that regulates which type of cell is produced is a common one with a variety of functions in the body, but scientists may have found a way to target it only in red blood cells, leaving it alone elsewhere.

Food Safety

potato salad

Food poisoning is serious business. There are more than 250 different types of illness that are spread through undercooked or poorly stored food items. and they cause 48 million cases of food poisoning in the United States each year. Of those 250, the four most common are Campylobacter jejuni, the "cafeteria germ" Clostridium perfringens, Salmonella bacteria, and coliform bacteria of a type referred to as O157:H7. Other especially dangerous pathogens sometimes found in food are norovirus, the bacterium that causes listeriosis, and the parasite responsible for toxoplasmosis.

In most cases, regardless of the cause, symptoms of food poisoning follow roughly the same pattern. Most types generally involve nausea, vomiting, diarrhea, and abdominal cramps, and often fever. It doesn’t necessarily require medical attention except in severe cases, such as when there is visible blood, when there is a fever over 101.5° F, when the symptoms are accompanied by muscle weakness, when symptoms last longer than three days, or when the affected person is having trouble keeping liquids down or is showing signs of dehydration, such as dizziness or lightheadedness.

Unfortunately, while the overlap in symptoms, makes food poisoning easy to identify, it can make the specific kinds of food-borne illness difficult to distinguish. Knowing the source can help—different types of microbes are found in different types of foods—but the delayed onset can make even this difficult. Symptoms of a pathogen may hide for anywhere from 12 to 72 hours after the food is eaten, meaning patients, who tend to blame the most recent meal or the one before it, could be off by as much as three days. That’s why it’s important for people who have food poisoning to think back several days when trying to track down a source. If there is some indication of an outbreak, it may be possible to cross-reference the patient’s illness with other reports and pinpoint contaminated food products which may be responsible.

Even uncontaminated products, however, need to be prepared properly. Cooks who touch raw meat, especially poultry, should wash their hands before touching anything else, or wear gloves and dispose of them before touching anything else. Food should be cooked above 140°. and should not be between 40° and 140° for more than a few minutes.

Medical Marijuana

medical marijuana

One of the longest-cultivated medicinal plants is marijuana, or Cannabis sativa, which is also used recreationally. For a long time, marijuana was completely illegal in most places, but in recent years, more and more attention has been paid to the medical aspects of the drug, and of the active ingredient tetrahydrocannabinol, or THC. As a result, a growing number of states and countries have changed their laws to allow marijuana to be bought, sold, prepared, and used medicinally. The most common uses of marijuana as medicine have been for chronic pain, eye pressure due to glaucoma, and multiple sclerosis, but it is also used as an anti-nausea drug to counteract the effects of chemotherapy, and for a wide range of other conditions, including Huntington’s disease, sleep disorders, and schizophrenia.

The medical uses of marijuana were described in Egyptian medical papyri nearly 4,000 years ago. Physicians employed it as a pain reliever, an anti-inflammatory drug, and for hemorrhoids. The Chinese word for cannabis is derived from elements meaning "big numbness"; an ancient Chinese physician who mixed powdered cannabis into wine is believed to be the first to use cannabis as an anesthetic. In India it was used for insomnia, labor pain, and gastrointestinal problems.

In modern times, an Irish doctor working in Kolkatta, discovering cannabis being used there, introduced it to the West through his experiments, first giving it to European patients for pain and stomach cramps, later experimenting with it more formally for migraines, sleeplessness, and pains. Until 1937, around the time laws against marijuana began to be passed in the United States, over 2,000 patent medicines containing marijuana were sold by more than 280 manufacturers.

Marijuana is renowned for being very safe, but it is not wholly without side effects. The general consensus is that there is almost no addiction potential, though some studies have found evidence that daily use can lead to addiction. However, the recreational effects of marijuana occur with medical use as well, where they are classified as side effect. Dizziness can occur, for example. Marijuana has effects on blood sugar levels, something diabetics should be aware of, and it can increase bleeding risk and lower blood pressure. However, these can generally be managed with a little planning.